• 농촌의학ㆍ지역보건
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• 제18권2호
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• pp.105-119
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• 1993

The purpose of this study was to evaluate the program for the control of acute respiratory infections(ARI) in children in a Korean rural area(Yonchon county). Evaluating the program, we focused on the pattern of prescription and appropriateness of antibiotics prescribed by the health personnel who had participated in the ARI Control Program. It was implemented at the primary health care setting in rural area, such as district hospital, health subcenters, and health posts. During six-months programme monitoring period, medical records were reviewed and collected data were analysed by the pediatrician, research coordinator of this study. The baseline data were collected from medical records of the same period(six months) of one year before the implementation of the ARI programme. The study results were as follow : 1. Common cold was the most prevalent disease(78.7%. 594 cases) among the all ARI cases (755 cases). The less frequent cases were bronchitis(11.9%), acute pharyngitis(5.2%), and pneumonia(1.8%). 2. Significant reduction in the use of antibiotics was observed after the programme implementation. Ninety three(15.7%) of 594 common cold cases were received antibiotics compared with 282(35.2%) of 802 in the baseline period. In the cases of bronchitis and acute pharyngitis, the reduction rates were 15.1% and 23.2% respectively compared to the baseline period. 3. Mean duration of antibiotics prescription was 1.81-1.75 days, similar to the baseline data. 4. The appropriateness rate of antibiotics prescriptions were 84.3%(common cold), 35.6% (bronchitis) and 28.2%(acute pharyngitis). In the case of pneumonia, the antibiotics prescription was compatible to the criteria developed. 5. Pediatrician prescribed antibiotics more appropriately for all cases than general practitioners in health sub-center, and nurse practitioners in health posts. 6. Antibiotics therapy was shown to be of no effect in the treatment of the all ARI cases. At the 5 and 10 days check-up of common cold cases after visits, proportion of improved patients were 58.3% in the antibiotics-used group and 51.4% in the control group. In the other cases of ARI, the patterns of response were similar to common cold. None of the differences in outcome between the antibiotics-used and control group was statistically significant. This ARI programme may have substantial a substantial impact on antibiotics use at the public health institutions(district hospital, health subcenters, health posts) which are of major domain for primary health care in Korean rural areas.

• Child Health Nursing Research
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• 제20권2호
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• pp.87-95
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• 2014

목적 본 연구는 산욕초기 미숙아 어머니의 산후우울과 예측요인을 파악하기 위한 서술적 조사연구이다. 방법 연구대상자는 일 지역 두 곳의 신생아중환자실에 미숙아가 입원 중인 미숙아 어머니로 분만 후 2-3주이며, 배우자가 있는 기혼여성 101명을 대상으로 하였다. 자료수집기간은 2010년 6월부터 2011년 1월까지였다. 연구도구는 산후우울(Edinburgh Postnatal Depression Scale), 산전 우울, 주관적 아기 건강상태, 의료인 지지, 배우자 지지 측정도구를 사용하였다. 자료는 SPSS win 18.0 program을 이용하여 기술통계, ttest, ${\chi}^2$-test, multiple logistic regression으로 분석하였다. 결과 산욕초기 미숙아 어머니의 산후우울 발생률은 81.6%였으며, 산후우울 예측요인은 분만방법(OR, 5.57; 95% CI, 1.25-24.77), 주관적 아기 건강상태(OR, 0.34; 95% CI, 0.16-0.70) 및 의료인 지지(OR, 0.52; 95% CI, 0.28-0.97) 등으로 나타났다. 결론 대부분의 미숙아 어머니들은 산욕초기 산후우울을 나타내었기 때문에 조기 중재를 목적으로 한 스크리닝이 필요하다. 또한 산후우울은 제왕절개로 분만하였으며, 주관적으로 아기 건강상태가 불건강하다고 인식할수록 그리고 의료인 지지가 낮을수록 발생비율이 높게 나타났다. 따라서 의료인들은 미숙아 어머니들이 제왕절개로 분만한 경우 더욱 관심을 기울어야 하며, 주관적으로 자신의 아기를 부정적으로 인식하지 않도록 도와야 한다.

• 의료법학
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• 제23권3호
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• pp.47-87
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• 2022

코로나19 감염병 확산으로 인해 비대면진료가 일시적으로 허용되었고 지속 필요성에 대한 공감대가 커지고 있다. 그러나 현행 「의료법」은 의사와 의료인 간의 원격의료만 허용하고 있다. 비록 법률해석을 통해 의사와 환자 간의 비대면진료가 허용된다는 의견도 있지만 전체적인 법률체계를 고려할 때 허용되지 않는 것으로 보는 것이 타당하다. 그럼에도 불구하고 과학기술의 발달과 감염병 출현 시기의 단축 등을 종합적으로 고려할 때 앞으로 대면진료만을 고집하는 것은 바람직하지 않다. 따라서 안전하고 효과적인 비대면진료가 이뤄질 수 있는 방안을 고민하고 제도화하는 것이 전략적으로 필요하며, 또 중요하다. 이를 위해 앞으로 논의되어야 할 법률적 쟁점들을 미리 살펴보는 것이 이 글의 목적이다. 비대면진료를 구체적으로 규율하기 위해서는 우선 비대면진료의 범위와 대상 질환 그리고 시행 주체가 명확해야 한다. 또한 비대면진료가 시행되기 위해서는 구조적으로 시설과 장비 기준이 마련되어야 하고 기능적으로는 해당 시설과 장비를 통해 의사와 환자가 적극적으로 소통하고 정보를 실시간 교환할 수 있어야 하고 비대면진료 과정에서 발생하는 정보를 보호하기 위한 관리체계가 구체적으로 마련되어야 한다. 이처럼 비대면진료를 시행하기 위해 새롭게 정비되어야 할 내용뿐만 아니라 비대면진료를 통해 발생할 수 있는 책임의 문제와 비용의 문제도 구체적으로 정리될 필요가 있는 법적 쟁점이다.

• 사물인터넷융복합논문지
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• 제9권1호
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• pp.33-39
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• 2023

고령화 사회로 인한 만성질환자의 증가로 그들의 질병 예방과 관리가 시급하다. 이러한 문제를 해결하기 위한 생체인증 방법과 원격의료시스템들이 소개되고 있으나 의료정보와 개인인증의 보안성 문제를 해결하는데에는 어려움이 있다. 스마트 헬스케어는 대상자의 개인 의료정보를 포함하고 있으므로 무엇보다 개인정보의 보안이 중요한 분야이다. 따라서 본 논문에서는 프라이빗 블록체인 환경에서 손목 밴드 형태의 스마트 웨어러블 디바이스 ECG와 얼굴 개인인증을 활용한 원격의료시스템을 제안하고자 한다. 이 시스템에서는 다양한 의료인과 전 지역 만성질환자를 대상으로 하였으며, 데이터의 무결성과 투명성을 높일 수 있는 프라이빗 블록체인을, 위변조가 어렵고 개인식별성이 높은 ECG와 얼굴인증을 활용하여 보안성과 신뢰성이 높일 수 있는 시스템을 구성하였다. 이를 통해 재가 만성질환자의 질병 예방과 건강관리에 힘써 만성질환 관리의 효율성을 높이는데 기여하고자 한다.

• Korean Journal of Radiology
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• 제25권5호
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• pp.414-425
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• 2024

Objective: This study aims to explore the opinions on the insurance coverage of artificial intelligence (AI), as categorized based on the distinct value elements offered by AI, with a specific focus on patient-centered outcomes (PCOs). PCOs are distinguished from traditional clinical outcomes and focus on patient-reported experiences and values such as quality of life, functionality, well-being, physical or emotional status, and convenience. Materials and Methods: We classified the value elements provided by AI into four dimensions: clinical outcomes, economic aspects, organizational aspects, and non-clinical PCOs. The survey comprised three sections: 1) experiences with PCOs in evaluating AI, 2) opinions on the coverage of AI by the National Health Insurance of the Republic of Korea when AI demonstrated benefits across the four value elements, and 3) respondent characteristics. The opinions regarding AI insurance coverage were assessed dichotomously and semi-quantitatively: non-approval (0) vs. approval (on a 1-10 weight scale, with 10 indicating the strongest approval). The survey was conducted from July 4 to 26, 2023, using a web-based method. Responses to PCOs and other value elements were compared. Results: Among 200 respondents, 44 (22%) were patients/patient representatives, 64 (32%) were industry/developers, 60 (30%) were medical practitioners/doctors, and 32 (16%) were government health personnel. The level of experience with PCOs regarding AI was low, with only 7% (14/200) having direct experience and 10% (20/200) having any experience (either direct or indirect). The approval rate for insurance coverage for PCOs was 74% (148/200), significantly lower than the corresponding rates for other value elements (82.5%-93.5%; P ≤ 0.034). The approval strength was significantly lower for PCOs, with a mean weight ± standard deviation of 5.1 ± 3.5, compared to other value elements (P ≤ 0.036). Conclusion: There is currently limited demand for insurance coverage for AI that demonstrates benefits in terms of non-clinical PCOs.

• 치위생과학회지
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• 제18권6호
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• pp.349-356
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• 2018

일부 지역 치위생(학)과 3, 4학년 학생 196명을 대상으로 장애인의 전반적인 인식, 장애인 치과학에 대한 교육 여부, 장애인 환자 구강관리 역량 자가평가를 자기기입식 설문지를 이용하여 조사하였다. 그 결과, 대상자의 대부분이 장애인이나 장애인 환자에 대한 긍정적인 인식을 가지고 있었으며 84.7%는 장애인 전문 치과위생사 양성이 필요하고 76.5%는 졸업 후에 장애인 치과진료 관련 세미나에 참가할 의향이 있다고 하였다. 그러나, 전체 대상자의 각 장애인별 업무역량에 대한 자가평가는 보통 수준 미만으로 장애인 치과치료에 대한 업무역량이 충분하지 않다고 생각하고 있었다. 대상자의 71.4%는 교과 및 비교과 교육과정에서 장애인 치과진료를 경험하였으며 경험을 한 대상자가 장애인 환자에 대한 지식, 구강보건교육, 구강병 예방처치, 진료보조, 의사소통의 대부분 영역에서 본인의 역량을 유의한 수준으로 높게 평가하였다. 이론교육이 충분하였다고 응답한 군에서도 충분하지 않았다고 응답한 군에 비해 장애인 환자 관리 역량에 대해 유의하게 높은 수준으로 자가평가를 하였다. 이를 토대로 보았을 때 현재 교육과정상 치위생(학)과 학생들의 장애인 치과치료에 대한 업무역량은 부족한 것으로 보이나 장애인 환자의 구강건강 관리 및 치과진료 보조에 대해 긍정적이며 장애인 환자에 대한 경험과 이론 교육 등이 효과를 나타낸다고 판단된다. 따라서, 교육과정에 장애인 치과학이 포함될 수 있도록 제도적 뒷받침이 필요하고 충분한 이론교육과 실습교육을 병행하여 장애인 환자의 구강건강 향상에 이바지할 수 있는 인력을 양성하도록 해야 한다. 또한, 현장 임상실습 교육 시 장애인 환자를 경험할 수 있는 여건을 마련하고 장애인 전문 치과위생사 양성에 대한 심도 있는 논의도 이루어져야 할 것이다.

• 대한간호학회지
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• 제11권2호
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• pp.5-8
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• 1981

This study concerns itself with the development of a new model of comprehensive health service for rural communities of Korea. The study was conceived to resolve the problems of both underservice in rural communities and underutilization of valuable health manpower, namely the nurses, the disenchanted elite health personnel in Korea. On review of the current situation, the greatest deficiencies in the Korean health care system were found in the availability of primary care at the peripheries of md communities, in the dissemination of knowledge of disease prevention and health care, and in the induction of and guidance for active participation by the clientele in health maintenance at the personal, family and community level Abundant untapped health resources were identified that could be brough to bear upon the national effort to extend health services to every member of the Korean Population. Therefore, it was Postulated that the problem of underservice in rural communities of Korea can be structurcturally resolved by the effective mobilization and organization of untapped health resources, and that. a primary care Nursing Service System offers the best possibility for fulfillment of rural health service goals within the current health man-power situation. In order to identify appropriate strategies to combat the present difficulties in Korean rural health services and to utilize nurses and other health personnel in community-centered health programs, a search was made for examples of innovative service models throughout the world. An extensive literature survey and field visits to project sites both in Korea and in the United States were made. Experts in the field of world health, health service, planners, administrators, and medical and nursing practitioners in Korea, in the United States as well as visitors from other Asian countries were widely consulted. On the basis of information and inputs from these experts a new rural health service model has been constructed within the conceptual framework of community development, especially of the innovation diffusion Model. It is considered especially important that citizens in each community develop capacities for self-care with assistance and supports from available health professionals and participate in health service-related decisions that affect their own well-being. The proposed model is based upon the regionalization of health care planning utilizing a comprehensive Nursing Service System at the immediate delivery level The model features: (1) a health administration unit at each administrative level; (2) mechanisms for community participation; (3) a continuous source of primary health care at the local community level; (4) relative centralization of specialty care and provision of tertiary or super-specialty care only at major national metropolitan centers; and (5) a system for patient referral to the appropriate level of care. This model has been built around professional nurses as the key community health workers because their training is particularly suited and because large numbers of well-trained nurses are currently available and being trained. The special element in this model is a professional nurse-guided, self-care facilitating primary care Community Nursing Service System. This is supported by a Nursing Extension Service as a new training and support structure. (See attached diagrams). A broad spectrum of programs was proposed for the Community Nursing Service System. These were designed to establish a balance of activities between the clinic-centered individual care component and the field activity-centered educational and supportive component of health care services. Examples of possible program alternatives and proposed guidelines for health care in specific situations were presented, as well as the roles and functions of the key health personnel within the Community Nursing Service System. This Rural Health Service Model was proposed as a real alternative to the maldistributed, inequitable, uncoordinated solo-practice, physician-centered fee-for-service health care available to Koreans today.

• 농촌의학ㆍ지역보건
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• 제11권1호
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• pp.44-54
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• 1986

This study was aimed at investigating the health seeking behaviors of patients; For the purpose of analyzing the research theme we classified the study into two phase. First, the types of patients' health seeking behavior were categorized into a scheme according to what medical care resources were utilized in patients' coping process. Second, from patients' first visits to third visits to medical resources, we analyzed variations of factors which noted as crucial elements in constituting the patients' sickness career. To grasp the generalized characteristics from complicated empirical data, we limited the scope of our analysis to third stage of health seeking. A total of 121 persons who had beer suffering from chronic diseases more than 3 months was sampled among the residents of Banwol-Eup, the target Area of Korea University Health Project. The findings are as follows ; 1) In the course of visiting medical care resources, 34 different types of health seeking Behavior were found. From this result we inferred the idea that patients in Banwol-Eup had not any stable norms to cope with their pains. Clinics, hospital, pharmacy, Herb-doctors', folkways (self-treatment) were accessed by patients in orders. But more than half of patients who had utilized clinics or hospitals from their first to third visits, changed medical care resources to others, for example herb doctors or folkways, which had fundamentally different treatment models. Upon these two facts, the diversified types and capricious patterns in the health seeking behavior of Banwol patients, we observed a typical Shopping-Around phenomenon. 2) Factors which influenced patients' to their sickness career were changed along the courses of health seeking, from first to third visits as follows ; $\cdot$ Perceived seriousness of diseases were tended to decrease. $\cdot$ Professional medical personnel tended to be influencial in the patients' sickness career, (5.0%, 25.0% and 65.7%). The influence of the primary interaction groups such as parents, friends, neighbours, tended to decrease ; (90.9%, 71.2% and 30.0%). $\cdot$ The subjective reasons why to choose such a medical care resource were related to economic affordability and disease-itself as main motives. Credibility of health resources tended to increase 14.9%, 24.0% and 31.4 sequently. $\cdot$ Geographic accessibility factors did not change significantly. Most of patients had utilized health resources in Banwol and Anyang area. 3) Cultural inclination in the shopping-around phenomenon has shown difference among age groups. The age group' over 50 years' preferred traditional health resources to modern health resources. 4) Consistency of health seeking behavior on the shopping around phenomenon has shown difference according to the degrees of patients' economic affordability and those of psychological satisfaction toward modern health services. However, there were some restrictions in this thesis ; a) the study was limited to the 3rd health seeking career so it did not allow us to collect more informations after that, b) the study was not able to carry out causal analysis on patients health behavior determinated by explanatory model of health resources, and c) the study was not able to take into consideration of factors connected with social structural circumstances. Despite of restrictions described above, we are sure that this thesis would promote health providers' understanding toward patients' inclinations, through which they could provide efficient and accurate medical service.

• Journal of Hospice and Palliative Care
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• 제17권2호
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• pp.66-74
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• 2014

목적: 본 연구의 목적은 소생술 포기(Do Not Resuscitate, DNR)와 사전의료의향서(Advance Directives, AD)에 대한 환자 보호자와 의료인의 인식을 파악하고 비교하고자 함에 있다. 방법: 이 연구에서는 5개 종합 병원에 입원한 환자 보호자 145명과 이를 담당한 의료인 272명을 대상으로 2009년 9월 21일부터 15일간 조사를 실시하였다. 조사내용은 소생술 포기에 대한 인식 14문항, 연명 의료 중지 선택제에 대한 인식 3문항, 직업유무, 성별, 연령을 포함한 20문항으로 구성하였다. 결과: 소생술 포기와 사전의료의향서에 대한 필요성은 환자 보호자와 의료인에서 모두 높았으며, 특히 의료인이 환자 보호자보다 그 필요성을 더 많이 인식하였다(DNR ${\chi}^2=44.56$, P<0.001; AD ${\chi}^2=16.23$, P<0.001). 의료인은 소생술 포기에 대한 설명을 환자나 환자 보호자에게 제공해야 한다는 인식이 높았으나 환자 보호자의 경우 환자 보다 환자 보호자에게 제공해야 한다는 인식이 높았다. 소생술 포기와 사전의료의향서의 필요성에 대한 주 이유는 '회복 불가능한 환자의 고통 경감'으로 나타났다. 또 소생술 포기 결정 시기는 '말기질환 입원 즉시'가 가장 많았으며 의사결정은 '환자와 환자 가족이 상의하여 결정한다'는 의견이 가장 많았다. 소생술 포기에 대한 지침서의 필요성과 이로 인한 요구도 증가 역시 환자 보호자 보다 의료인이 높게 인식하였다(${\chi}^2=7.41$, P=0.0025). 결론: 이 연구 결과 한국 사회에서 소생술 포기와 사전의료의향서의 결정은 환자 보호자에 의존하는 경향이 높을 것으로 사료되며 따라서 환자와 환자 보호자가 이에 대한 객관적인 정보를 제공받아야 한다. DNR과 AD의 적용은 말기환자의 고통 경감이 주요한 이유로 나타나 호스피스와 연계한 후속 연구의 필요성이 나타났다. 의료인도 환자 보호자와의 인식 차이를 인지하고 DNR과 AD 결정을 위한 의사소통 시 이를 충분히 고려해야 한다.

• 대한소아치과학회지
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• 제39권2호
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• pp.206-225
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• 2012

General status of pediatric dentistry in Korea is to conduct vigorous academic activities and specialized medical care centering the Korean Association of Pediatric Dentistry (KAPD) that has about 1,000 pediatric dentists as members, pediatric dentistry departments of 11 Colleges of Dentistry, numbers of pediatric dentistry training institutions and private clinics specialized in children. From 1996, the accredited pediatric dentists were produced by the KAPD and from 2008, the state began to produce the accredited pediatric dentists. Since then, doctors with expertise in pediatric care had opened private clinics in addition to the university hospitals, it became the basis of a momentum to deepen the specialty of pediatric dentistry. The Dentistry community of Korea is going through rapid and profound changes recently, and the underlying reasons for such changes can be classified largely into a few categories: (1) Decreasing population and structural changes in population (2) Increase in numbers of dentists, (3) Changes in the pattern of dental diseases and (4) Changes in medical environment. In Korea, the children population in the age range of 0 ~ 14 years old had been decreased by 2 million in 2010 compared to that of 2000 due to reduction of birth rate. The current population of children in the age range of 0 ~ 4 years old in 2010 takes up 16.2% of the total population, but it is estimated that such percentage would decrease to 8.0% by 2050. Such percentage is largely behind the estimated mean global population of 19.6% by 2050. On the other hand, the number of dentists had been largely increased from 18,000 in 2000 to 25,000 in 2010. And it is estimated that the number will be increased to 41,000 by 2030. In addition, the specialized personnel of Pediatric dentistry had been shown as increased by 2.5 times during past 10 years. For the changes in the pattern of dental diseases, including dental caries, each df rate of 5 years old children and 12 years old children had been decreased by 21.9% and 16.7% respectively in 2010 compared to 2000. Each df Index also had been decreased by 2.5 teeth and 1.2 teeth respectively. The medical expenditure of Korea is less than that of OECD and more specifically, the expenditure from the National Health Plan is less than OECD but the expenditure covered by households is larger than OECD. These facts indicate that it is considered as requiring the coverage of the national health plan to be reinforced more in the future and as such reinforcement needs continuous promotion. In medical examination pattern of Pediatric dentistry, the preventive and corrective treatment were increased whereas the restorative treatment was decreased. It is considered that such change is caused from decrease of dental caries from activation of the prevention project at national level. For the restorative treatment, the restorations in use of dental amalgam, pre-existing gold crowning and endodontic treatment had been decreased in their proportion while the restorative treatment in use of composite resin had been increased. It is considered that such changes is caused by the change of demands from patients and family or guardians as they desired more aesthetic improvement along with socio-economic growth of Korean society. Due to such changes in dentistry, the pediatric dentistry in Korea also attempts to have changes in the patterns of medical examination as follows; It tends to implement early stage treatment through early diagnosis utilizing various diagnostic tools such as FOTI or QLF. The early stage dental caries so called white spot had been included in the subjects for dental care or management and in order to do so, the medical care guidelines essentially accompanied with remineralization treatment as well as minimally invasive treatment is being generalized gradually. Also, centering the Pediatric dentists, the importance of caries risk assessment is being recognized, in addition that the management of dental caries is being changed from surgical approach to internal medicinal approach. Recently, efforts began to emerge in order to increase the target patients to be managed by dentists and to expand the application scope of Pediatric dentistry along with through such changes. The interest and activities of Pediatric dentists which had been limited to the medical examination room so far, is now being expanded externally, as they put efforts for participating in the preventive policy making process of the community or the state, and to support the political theories. And also opinions are being collected into the direction that the future- oriented strategic political tasks shall be selected and researches as well as presentations on the theoretical rationale of such tasks at the association level.