• Sleep Medicine and Psychophysiology
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• v.17 no.2
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• pp.100-108
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• 2010

Objectives: "Internet-addiction" came into common use not only in clinical setting but also in everyday life. But, pathophysiology and diagnostic criteria of the internet addiction remain unknown. Because adolescents are in developing period, they might be vulnerable to the internet addiction, depression and sleep-related problem. The objectives of this study were to investigate the characteristics of internet addiction and its association with sleep pattern and depression in Korean adolescence. Methods: Subjects were 799 middle and high school students in Seoul, Korea. We administered a self-reported questionnaire including socio-demographic data, Korean versions of Young's Internet Addiction Scale (YIAS), Pittsburgh Sleep Quality Index (PS-QI), the Center for Epidemiologic Studies for Depression Scale (CES-D) and questions about internet using patterns. Data of 696 subjects were included in analysis. Chi-square tests were used to analyze proportional differences, and ANOVA with post-hoc tests were used to analyze differences among groups. Partial correlation analyses were performed to analyze the correlation of internet addiction with other variables (two-tailed, p<0.05). Results: Of the 696 participants (grade 2 of middle school; M2 135 vs. grade 1 of high school; H1 238 vs. grade 2 of high school; H2 323), 2.0% (n=14) were internet-addicted (IA), 27.7% (n=193) were over-using (OU) and 70.3% (n=489) were not-addicted (NA). The mean scores of YIAS, PSQI and CES-D scores were 35.24${\pm}$12.78, 5.53${\pm}$3.04 and 16.72${\pm}$8.69, respectively. In higher grade students, average total sleep time was shorter (M2 426.20${\pm}$67.68 min. vs. H1 380.47${\pm}$62.57 min. vs. H2 354.67${\pm}$73.37 min., F=51.909, p<0.001), and PSQI (4.69${\pm}$3.14 vs. 5.42${\pm}$3.15 vs. 5.97${\pm}$2.83, F=8.871, p<0.001) CES-D (13.53${\pm}$8.37 vs. 16.96${\pm}$8.24 vs. 17.87${\pm}$8.84, F=12.373, p<0.001) scores were higher than those of lower grade students. Comparing variables among IA, OU and NA groups, computer using time not for study (96.36${\pm}$63.31 min. vs. 134.92${\pm}$86.79 min. vs. 213.57${\pm}$136.87 min., F=34.287, p<0.001) and portable device using time not for study (84.22${\pm}$79.11 min. vs. 96.97${\pm}$91.89 min. vs. 152.31${\pm}$93.64 min., F= 5.400, p=0.005) were different among groups. PSQI (5.26${\pm}$2.97 vs. 6.08${\pm}$2.97 vs. 7.50${\pm}$4.41, F=8.218, p<0.001) and CES-D scores (15.40${\pm}$8.08 vs. 19.05${\pm}$8.42 vs. 30.43${\pm}$13.69, F=32.692, p<0.001) were also different among groups. YIAS score were correlated with computer using time not for study (r=0.356, p<0.001) and portable device using time not for study (r= 0.136, p<0.001). PSQI score (r=0.237, p<0.001) and CES-D score (r=0.332, p<0.001). YIAS score and PSQI score (r=0.131, p= 0.001), YIAS and CES-D score (r=0.265, p<0.001), PSQI score and CES-D score (r=0.357, p<0.001) were correlated each other. Conclusion: These results suggested that adolescents' internet-addiction was correlated with not only computer and portable device using time not for study but also depression and sleep-related problems. We should pay attention to depression and sleep-related problems, when evaluating internet-addiction in adolescents.

• Journal of Music and Human Behavior
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• v.4 no.2
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• pp.66-83
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• 2007

The purpose of this study is to learn both effects of the vocal psychotherapy on the self-consciousness and the variety of the self-consciousness on the vocal psychotherapy in return. The research for this study was performed to three subjects who were students of E university, Seoul, ten times for sixty minutes. The subjects were all volunteers for the advertisement on a music-therapy program searching for them on the web site of E university. The vocal psychotherapy program consists of four steps and each of them consists of two to four short terms again. Both before and after the experiment, examinations on self-consciousness were done to recognize the change of the subjects' self-consciousness which would be caused by the vocal psychotherapy activity. After every short term, the subjects were asked to write reports to closely analyze the change of self-consciousness according to the terms and the variety of the subjects. The effect of the vocal psychotherapy activity on the changes of scores in the self-consciousness examination is the first thing to point out on this study. There appeared some personal varieties on the total scores of the examination and scores of some sub-categories. Especially, there were different scores on the private self-consciousness, the public self-consciousness, and the social anxiety between before and after performing the vocal psychotherapy program. Subject A, who had got the best score of all on the scope of the private self-consciousness, showed the steepest decrease on the very scope. On the contrary, the subject showed decrease of scores of the public self-consciousness and the social anxiety in the relatively little rate. Subject B, who had got the highest score of the three on the public self-consciousness, showed the steepest decrease on that of all scopes and showed no difference on the social anxiety scope. In the case of the last one, subject C, who had relatively low scores on the private and public self-consciousness than the others, the private self-consciousness score increased but the public self-consciousness and the social anxiety scores decreased. The changes of the scores of each questions were examined in order to see possible other changes that had not been exposed on the changes of the total and sub-categories scores. As a result of that, of all twenty-eight questions, there were changes about one to two points. Subject A showed the difference with thirteen questions, subject B with sixteen and subject C with nineteen questions. The rate of change of subject C was relatively small but more questions changed and the change of score was wider than the others. Considering all those results, It can be possibly said that the vocal psychotherapy affects the changes of the scores of sub-categories in self-consciousness examination. The next thing to point out on this study is the change of recognition that was exposed on the subjects' report after every short term of the program. As a result of the close analyzing, according to the short terms and variety of self-consciousness, recognizing the way express subjects themselves by voice and recognizing their own voices appeared to be different. How much they cared about others and why they did so were also different. According to the self reports, subject A cared much about her inner thought and emotion and tended to concentrate herself as a social object. There appeared some positive emotional experiments such as emotional abundance and art curiosities on her reports but at the same time some negative emotions such as state-trait anxiety and neuroticism also appeared. Subject B, who showed high scores on the private and public self-consciousness like subject A, had a similar tendency that concentrates on herself as a social object but she showed more social anxiety than subject A. Subject C got relatively lower points in self-consciousness examination, tended to care about herself, and had less negative emotions such as state-trait anxiety than other subjects. Also, with terms going on, she showed changes in the way of caring about her own voice and others. This study has some unique significances in helping people who have problems caused by self-estimation activated with self-consciousness, using voices closely related to one's own self, performing the vocal skills discipline to solve the technical problems. Also, this study has a potentiality that the vocal psychotherapy activity can be effectively used as a way affects the mental health and developing personality.

• Sleep Medicine and Psychophysiology
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• v.17 no.1
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• pp.41-49
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• 2010

Unlike the case of adult obstructive sleep apnea syndrome (OSAS), there was no consistent finding on the changes of sleep architecture in childhood OSAS. Further understanding of the sleep electroencephalogram (EEG) should be needed. Non-linear analysis of EEG is particularly useful in giving us a new perspective and in understanding the brain system. The objective of the current study is to compare the sleep architecture and the scaling exponent (${\alpha}$) from detrended fluctuation analysis (DFA) on sleep EEG between OSAS and normal children. Fifteen normal children (8 boys/7 girls, 6.0${\pm}4.3$2.2 years old) and twelve OSAS children (10 boys/2 girls, 6.4${\pm}4.3$3.4 years old) were studied with polysomnography (PSG). Sleep-related variables and OSAS severity indices were obtained. Scaling exponent of DFA were calculated from the EEG channels (C3/A2, C4/A1, O1/A2, and O2/A1), and compared between normal and OSAS children. No difference in sleep architecture was found between OSAS and normal controls except stage 1 sleep (%) and REM sleep latency (min). Stage 1 sleep (%) was significantly higher and REM latency was longer in OSAS group (9.3${\pm}4.3$4.3%, 181.5${\pm}4.3$59.9 min) than in controls (5.6${\pm}4.3$2.8%, 133.5${\pm}4.3$42.0 min). Scaling exponent (${\alpha}$) showed that sleep EEG of OSAS children also followed the 'longrange temporal correlation' characteristics. Value of ${\alpha}$ increased as sleep stages increased from stage 1 to stage 4. Value of ${\alpha}$ from C3/A2, C4/A1, O1/A2, O2/A1 were significantly lower in OSAS than in control (1.36${\pm}4.3$0.05 vs. 1.41${\pm}4.3$0.04, 1.37${\pm}4.3$0.04 vs. 1.41${\pm}4.3$0.04, 1.37${\pm}4.3$0.05 vs. 1.41${\pm}4.3$0.05, and 1.36${\pm}4.3$0.07 vs. 1.41${\pm}4.3$0.05, p<0.05). Higher stage 1 sleep (%) in OSAS children was consistent finding with OSAS adults. Lower $'{\alpha}'$ in OSAS children suggests decrease of self-organized criticality or the decreased piling-up energy of brain system during sleep in OSAS children.

• Journal of Korean Society of Disaster and Security
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• v.6 no.1
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• pp.65-72
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• 2013

In this study, the early suicide prevention program was applied to the elementary school students and compared the prior & post effect of the program, and verified the status of psychology change like emotional status, or temptation to take a suicide, and presented the possibility as a suicide prevention program. The period of adolescence is the very unstable period in the process of growth being cognitively immature, emotionally impulsive period. It is the period emotionally unstable and unpredictable possible to select the method of suicide as an extreme method to escape the reality, or impulsive problem solving against small conflict or dispute situation. Many stress of the student such as recent nuclear family, expectation of parents to their children, education problem, socio-environmental elements, individual psychological factor lead students to the extreme activity of suicide in recent days. In this study, the scope of stress experienced in the elementary school as well as idea and degree of temptation regarding suicide by the suicide prevention program were identified, and through prevention program such as meditation training, breath training and through experience of anger control, emotion-expression, self overcome and establish positive self-identity and make understanding Self-control, Self-esteem & preciousness of life based on which the effect to suicide prevention was analyzed. The study was made targeting 51 students of 2 classes of 6th grade of elementary school of Goyang-si and processed 30 minutes every morning focused on through experience & activity of the principle & method of brain science. The data was collected for 20 times before starting morning class by using Suicide Probability Scale(herein SPS-A) designed to predict effectively suicide Probability, suicide risk prediction scale, surveyed by 7 areas such as Positive outlook, Within the family closeness, Impulsivity, Interpersonal hostility, Hopelessness, Hopelessness syndrome, suicide accident. Analytical methods and validation was used the Wilcoxon's signed rank test using SPSS Program. Though the process of program in short period, but there was a effective and positive results in the 7 areas in the average comparison. But in the t-test result, there was a different outcome. It indicated changes in the 3 questionnaires (No.7, No.14, No.19) out of 31 SPS-A questionnaires, and there was a no change to the rest item. It also indicated more changes of the students in the class A than class B. And in case of the class A students, psychological changes were verified in the areas of Hopelessness syndrome, suicide accident among 7 areas after the program was processed. Through this study, it could be verified that different results could be derived depending on the Student tendency, program professional(teacher in charge, processing lecturer). The suicide prevention program presented in this article can be a help in learning and suicide prevention with consistent systematization, activation through emotion and impulse control based on emotional stress relief and positive self-identity recovery, stabilization of brain waves, and let the short period program not to be died out but to be continued connecting from childhood to adolescence capable to make surrounding environment for spiritual, physical healthy growth for which this could be an effective program for suicide prevention of the social problem.

• Tuberculosis and Respiratory Diseases
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• v.44 no.2
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• pp.241-250
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• 1997

Objective : Although the prevalence of pulmonary tuberculosis has decreased progressively after the national control program for tuberculosis began, nowadays the number of MDRTB is increasing seriously. MDRTB tends to be poor responsive to current antituberculosis regimens. It is mainly due to poor compliance, high rate of side reaction of secondary drugs, and limitation in number of available drugs. The purpose of present study is to evaluate the clinical features of pulmonary tuberculosis patients admitted in one national tuberculosis hospital and to expose the problems pertaining to current remedies, to increase the treatment efficacy for pulmonary tuberculosis including MDRTB in the end. Method : Retrospective analysis of 336 pulmonary tuberculosis patients admitted in National Masan Tuberculosis Hospital was done. Contents of analysis were patients profile, the first diagnosed time and medical institutes, family history, residence, previous treatment history, chief complaints at the time of admission, lesion site on chest X -ray film, combined deseases, side reaction to antibuberculosis drugs, used drugs before admission and the results of drug sensitivity test. Results : The ratio between male and female was 4 : 1. Age showed relatively even distribution from 3rd to 6 th decades. 64.6% of the patients was diagnosed at public health center. Weight loss was the most common complaint at admission. Bilateral lesions on chest X-ray films were 59.8%. 130patients had combined desease, of which DM was the most common(37.7%). 95patients had family history, of which parents were the most common(41.7%). According to the time of first diagnosis, 31 patients were diagnosed before 1980, and after then the number of patients was increased by degrees. Residence overwhelmed in pusan and gyung-nam province. 258 patients got previous treatment history, of which 112 patients(43.4%) had more than 3 times and only 133 patients(51.6%)got regular medication. 97 patients used more than other 3 drugs in addition to INH, EMB, RFP and PZA before admission. 154 patients were informed with the results of drug sensitivity test. of which 77 patients had resistance to more than 5 drugs. Gastrointestinal problem was the most common in side reaction to drugs. Conclusion : In the case of weight loss of unknown cause, tuberculosis should be suspected. In first treatment, sufficient and satisfactory explanation for tuberculosis is necessary and treatment period should not be stict to 6 month-short term therapy. In retreatment, new drugs should not be added to used drugs even though drug sensitivity results show sensitivity to some of them. Proper time for surgical intervention should not be delayed.

• The Journal of Natural Sciences
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• v.7
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• pp.133-162
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• 1995

Paderborn's companies, Wameling and Cassau, produce the liturgical vestments, which have much traditional artistic merit. And Kevelaerer Fahnen + Paramenten GmbH, located in Kevelater which is a place of pilgrimage of the Virgin Mary, was known to Europe, Africa, America and the Scandinavia Peninsula as the "Hidden Company" of liturgical vesments maker up to now. Paderborn and Kevelaer were the place of the center of the religious world and the Catholic ceremony during a good few centries. The Catholic liturgical vestiments of these 3 companies use versatile design, color, shape and techniques. These have not only the symbolism of religion, but also can meet our's expectations of utilization of modern textile art, art clothing and wide-all division of design. These give the understanding of symbolic meanings and harmony according to liturgical vestments to the believers. And these have an influence on mental thinking and induction of religious belief to the non-believers as the recognition and concerns about the religious art. The liturgical vestments are clothes which churchmen put on at the all ceremonial function of a mass, a sacrament, performance and a parade according to rules of church. These show the represen-tation of "Holy God" in silence and distinguish between common people and churchmen. And these represent a status and dignity of churchmen and induce majesty and respect to churchmen. Common clothes of the beginning of the Greece and Rome was developed to Christian clothes with the tendency of religion. There were no special uniforms distinguished from commen people until the Christianity was recognized officially by the Roman Emperor Constantinus at A.D.313. The color of liturgical vestments was originally white and changed to special colors according to liturgical day and each time by the Pope Innocentius at 12th century. The color and symbolic meaning of the liturgical vestments of present day was originated by the Pope St. Pius(1566-1572). Wool and Linen was used as decorations and materials in the beginnings and the special materials like silk was used after 4th century and beautiful materials made of gold thread was used at 12th century. It is expected that there is no critical changes to the liturgical vestments of future. But the development of liturgical vestments will continues slowly by the command of conservative church and will change to simple and convenient formes according to the culture, the trend of the times and the fashion of clothes. The companies of liturgical vestments develop versatile design, embroidery technique and realization of creative design for distinction of the liturgical vestments of each company and artistic progress. The cooperation of companies, artists and church will make the bright future of these 3 companies. We expect that our country will be a famous producing center of the liturgical vestments through the research and development of companies, participation of artists in religeous arts and concerts of church.

• Trans-
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• v.3
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• pp.109-135
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• 2017

The purpose of this thesis is to analyze characteristics of everyday movement showed in performances of Steve Paxton. A work of art has been realized as a special object enjoyed by high class people as high culture for a long time. Therefore, a gap between everyday life and art has been greatly existed, and the emergence of everyday elements in a work of art means that public awareness involving social change is changed. The postmodernism as the period when a boundary between art and everyday life is uncertain was a postwar society after the Second World War and a social situation that rapidly changes into a capitalistic society. Changes in this time made scholars gain access academically concepts related to everyday life, and affected artists as the spirit of the times of pluralistic postmodernism refusing totality. At the same period of the time, modern dance also faced a turning point as post-modern dance. After the Second World War, modern dance started to be evaluated as it reaches the limit, and at this juncture, headed by dancers including the Judson Dance Theatre. Acting as a dancer in a dance company of Merce Cunningham, Steve Paxton, one of founders of the Judson Dance Theatre, had a critical mind of the conditions of dance company with the social structure and the process that movement is made. This thinking is showed in early performances as an at tempt to realize everyday motion it self in performances. His early activity represented by a walking motion attracted attention as a simple motion that excludes all artful elements of existing dance performances and is possible to conduct by a person who is not a dancer. Although starting the use of everyday movement is regarded as an open characteristic of post-modern dance, advanced researches on this were rare, so this study started. In addition, studies related to Steve Paxton are skewed towards Contact Improvisation that he rose as an active practician. As the use of ordinary movement before he focused on Contact Improvisation, this study examines other attempts including Contact Improvisation as attempts after the beginning of his performances. Therefore, the study analyzes Satisfyin' Lover, Contact at 10th & 2nd and Bound that are performances of Steve Paxton, and based on this, draws everyday characteristics. In addition, related books, academic essays, dance articles and reviews are consulted to consider a concept related to everyday life and understand dance historical movement of post-modern dance. Paxton attracted attention because of his activity starting at critical approach of movement of existing modern dance. As walking of performers who are not dancers, a walking motion showed in Satisfyin' Lover gave esthetic meaning to everyday movement. After that, he was affected by Eastern ideas, so developed Contact Improvisation making a motion through energy of the natural laws. In addition, he had everyday things on his performances, and used a method to deliver various images by using mundane movement and impromptu gestures originating from relaxed body. Everyday movement of his performances represents change in awareness of performances of the art of dancing that are traditionally maintained including change of dance genre of an area. His activity with unprecedented attempt and experimentation should be highly evaluated as efforts to overcome the limit of modern dance.

• Korean Journal of Heritage: History & Science
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• v.52 no.2
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• pp.196-219
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• 2019

According to the Samguk Yusa, the nine-story wooden pagoda at Hwangnyongsa Temple was built by a Baekje artisan named Abiji in 645. Until the temple was burnt down completely during the Mongol invasion of Korea in 1238, it was the greatest symbol of the spiritual culture of the Korean people at that time and played an important role in the development of Buddhist thought in the country for about 700 years. At present, the only remaining features of Hwangnyongsa Temple, which is now in ruins, are the pagoda's stylobate and several foundation stones. In the past, many researchers made diverse inferences concerning the restoration of the original structure and the overall architecture of the wooden pagoda at Hwangnyongsa Temple, based on written records and excavation data. However, this information, together with the remaining external structure of the pagoda site and the assumption that it was a simple wooden structure, actually suggest that it was a rectangular-shaped nine-story pagoda. It is assumed that such ideas were suggested at a time when there was a lack of relevant data and limited knowledge on the subject, as well as insufficient information about the technical lineage of the wooden pagoda at Hwangnyongsa Temple; therefore, these ideas should be revised in respect of the discovery of new data and an improved level of awareness about the structural features of large ancient Buddhist pagodas. This study focused on the necessity of raising awareness of the lineage and structure of the wooden pagoda at Hwangnyongsa Temple and gaining a broader understanding of the structural system of ancient Buddhist pagodas in East Asia. The study is based on a reanalysis of data about the site of the wooden pagoda obtained through research on the restoration of Hwangnyongsa Temple, which has been ongoing since 2005. It is estimated that the wooden pagoda underwent at least two large-scale repairs between the Unified Silla and Goryeo periods, during which the size of the stylobate and the floor plan were changed and, accordingly, the upper structure was modified to a significant degree. Judging by the features discovered during excavation and investigation, traces relating to the nine-story wooden pagoda built during the Three Kingdoms Period include the earth on which the stylobate was built and the central pillar's supporting stone, which had been reinstalled using the rammed earth technique, as well as other foundation stones and stylobate stone materials that most probably date back to the ninth century or earlier. It seems that the foundation stones and stylobate stone materials were new when the reliquaries were enshrined again in the pagoda after the Unified Silla period, so the first story and upper structure would have been of a markedly different size to those of the original wooden pagoda. In addition, during the Goryeo period, these foundation stones were rearranged, and the cover stone was newly installed; therefore, the pagoda would seem to have undergone significant changes in size and structure compared to previous periods. Consequently, the actual structure of the original wooden pagoda at Hwangnyongsa Temple should be understood in terms of the changes in large Buddhist pagodas built in East Asia at that time, and the technical lineage should start with the large Buddhist pagodas of the Baekje dynasty, which were influenced by the Northern dynasty of China. Furthermore, based on the archeological data obtained from the analysis of the images of the nine-story rock-carved pagoda depicted on the Rock-carved Buddhas in Tapgok Valley at Namsan Mountain in Gyeongju, and the gilt-bronze rail fragments excavated from the lecture hall at the site of Hwangnyongsa Temple, the wooden pagoda would appear to have originally been an octagonal nine-story pagoda with a dual structure, rather than a simple rectangular wooden structure.

• (The)Study of the Eastern Classic
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• no.63
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• pp.9-41
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• 2016

This paper focuses on 'clean(cheong: 淸)' kinds of style terminologies among various style terminologies appearing in Heo Gyun's Seongsushihwa("惺?詩話") and tries to analyze the distinctive points which 'clean(cheong: 淸)' kinds of style terminologies include. In Heo Gyun's Seongsushihwa, 11 of 'clean' kinds of style terminologies, such as "cheonggyeong(淸勁), cheonghryang(淸亮), cheongryeo(淸麗), cheongseom(淸贍), cheongso(淸?), cheongweol(淸越), cheongjang(淸壯), cheongjeol(淸絶), cheongjeol(淸切), cheongchang(淸?), cheongcho(淸楚)," were used. This paper focuses and analyzes 'cheonggyeong(淸勁)', 'cheongjeol(淸切)', 'cheongcho(淸楚)', and 'cheongweol(淸越)' that he suggested through applying to real literary pieces. The result of analysis indicates that 'clean' kinds of style terminologies 'cheonggyeong', 'cheongjeol', 'cheongcho', and 'cheongweol' share the same 1st character 'clean(淸)', yet have distinctive qualities by the 2nd characters. These 4 style terminologies all share 'cheong(淸)' image which means clear and clean, yet each one has the attribute of the 2nd character that indicates each one's individual characteristic. It is apparent that 'Cheonggyeong(淸勁)' reflects the 'gyeong(勁)' image meaning upright and solid and implies poems of poets' steadfast spirit within clear boundary; 'cheongjeol(淸切)' reflects the 'jeol(切)' image meaning either desperation and imminence or pitifulness and sorrow and implies poems of poets' urgent and pitiful emotions within clear and clean boundary; 'cheongcho(淸楚)' reflects the 'cho(楚)' image meaning either delicacy and fineness or slenderness and tenderness and implies poems of poets' beautiful but not luxurious, delicate and tender emotions within clear and clean boundary; and 'cheongweol(淸越)' reflects the image of 'weol(越)' meaning unworldliness and excellency and implies poems, within clear and clean boundary, of excellent appearance and mentality surpassing mundane world. Compared with the 1st character's attributes of the style terminologies which Heo Gyun used, the 2nd characters's attributes do not appear that vivid. Especially, in the case that the 2nd characters have similar meanings, it is not easy to clarify the categories. Indeed, in order to grasp clear and distinctive qualities of style terminologies, the kinds of them need to be initially categorized by the 1st characters, and then sorted by the 2nd characters. In this case, the contents which the 2nd characters of style terminologies indicate should be considered. It is because style terminologies explain both literary pieces' aesthetic qualities and writers' personalities, and because explanations about literary pieces' aesthetic qualities includes not only the conclusive poetic or semantic boundaries which literary pieces' created but also literary pieces' creation processes and expression techniques. Through the style terminologies with Heo Gyun used in Seongsushihwa, it can be aware that he evaluated poems focussing more on the conclusive semantic boundaries that poets' spirits and poems created than expression techniques or creation methods. The overall aspects Heo Gyun's such style criticism has will be checked out in more detail through further studies by examining more materials.

• The Korean Nurse
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• v.20 no.4 s.112
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• pp.27-38
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• 1981

오늘 저희에게 주어진 주제, 내일에 타당한 간호사업 및 간호교육의 향방을 어떻게 정하여야 하는가의 논의는 오늘날 간호계 주변에 일어나고 있는 변화의 실상을 이해하는 데서 비롯되어져야 한다고 생각하는 입장에서 먼저 세계적으로 건강관리사업이 당면한 딜레마가 어떠한 것이며 이러한 문제해결을 위해 어떠한 새로운 제안들이 나오고 있는가를 개관 하므로서 그 교육적 의미를 정의해 보고 장래 간호교육이 지향해야할 바를 생각해 보려 합니다. 오늘의 사회의 하나의 특징은 세계 모든 나라들이 각기 어떻게 전체 국민에게 고루 미칠 수 있는 건강관리체계를 이룩할 수 있느냐에 관심을 모으고 있는 사실이라고 봅니다. 부강한 나라에 있어서나 가장 빈궁한 나라에 있어서나 그 관심은 마찬가지로 나타나고 있읍니다. 보건진료 문제의 제기는 발달된 현대의학의 지식과 기술이 지닌 건강관리의 방대한 가능성과 건강 관리의 요구를 지닌 사람들에게 미치는 실질적인 혜택간에 점점 더 크게 벌어지는 격차에서 발생한다고 봅니다. David Rogers는 1960년대 초반까지 갖고 있던 의료지식의 축적과 민간인의 구매력 향상이 자동적으로 국민 건강의 향상을 초래할 것이라고 믿었던 순진한 꿈은 이루어지지 않았고 오히려 의료사업의 위기는 의료지식과 의료봉사간에 벌어지는 격차와 의료에 대한 막대한 투자와 그에서 얻는 건강의 혜택간의 격차에서 온다고 말하고 있읍니다. 균등 분배의 견지에서 보면 의료지식과 기술의 향상은 그 단위 투자에 대한 생산성을 낮춤으로서 오히려 장애적 요인으로 작용해온 것도 사실이고 의료의 발달에 따른 일반인의 기대 상승과 더불어 의료를 태성의 권리로 규명하는 의료보호사업의 확대로 야기되는 의료수요의 급증은 모두 기존 시설 자원에 압박을 초래하여 전래적 의료공급체제에 도전을 가해 왔으며 의료의 발달에 건 기대와는 달리 인류의 건강 문제 해결은 더욱 요원한 과제로 남게 되었읍니다. 현시점에서 세계인구의 건강문제는 기아, 영양실조, 안전한 식수 공급 및 위생적 생활환경조성의 문제에서부터 가장 정밀한 의료기술발달에 수반되는 의료사회문제에 이르는 다양한 문제를 지니고 있으며 주로 각개 국가의 경제 사회적 여건이 이 문제의 성격을 결정짓고 있다고 볼수 있읍니다. 그러나 건강 관리에 대한 요구는 영구히, 완전히 충족될 수 없는 요구에 속한다는 의미에서 경제 사회적 발달 수준에 상관없이 모든 국가가 공히 요구에 미치지 못하는 제한된 자원문제로 고심하고 있는 실정입니다. 또 하나의 공통된 관점은 각기 문제의 상황은 달라도 오늘날의 건강 문제는 주로 의료권 밖의 유전적 소인, 사회경제적, 정치문화적인 환경여건과 각기 선택하는 삶의 스타일에 깊이 관련되어 있다는 사실입니다. 따라서 오늘과 내일의 건강관리 문제는 의학적 견지에서 뿐 아니라 널리 경제, 사회, 정치, 문화적 관점에서 포괄적인 접근이 시도되어야 한다는 점과 의료의 고급화, 전문화, 일변도의 과정에서 소외되었던 기본건강관리체계 강화에 역점을 둔 다양하고 탄력성 있는 사업전개가 요구되고 있다는 점입니다. 다양한 건강관리요구에 적절히 대처할 수 있기 위한 그간 세계 각처에서 시도된 새로운 건강관리 접근과 그 제안을 살펴보면 대체로 4가지의 뚜렷한 성격들로 집약할 수 있을 것 같습니다. 그 첫째는 건강관리사업계획 및 그 수행에 있어 지역 사회의 적극적 참여를 유도하는 일, 둘째는 지역단위의 일차보건의료에서 부터 도심지 신예 종합병원, 시설 의료에 이르기까지 건강관리사업을 합리적으로 체계화하는 일. 셋째로 의료인력이용의 효율화 및 비의료인의 훈련과 협조 유발을 포함하는 효과적인 인력관리에 대한 제안과 넷째로 의료보험 및 각양 집단 의료유형을 포함하는 대체 의료재정 운영관리에 관련된 제안들을 들 수 있읍니다. 건강관리사업에 있어 지역사회 참여의 의의는 첫째로 사회 경제적인 제약이 모든 사람에게 가능한 최대한의 의료를 모두 고루 공급하기 어렵게 하고 있다는 점에서 제한된 정부재정과 지역사회가용자원을 보다 효율적으로 이용할 수 있게 하는 자조적이고 자율적인 지역사회건강관리체제의 구현에 있다고 볼 수 있으며 둘때로는 개인과 가족 및 지역민의 건강에 영향하는 많은 요인들은 실질적으로 의료권 외적 요인들로서 위생적인 생활양식, 식사습관, 의료시설이용 등 깊이 지역사회특성과 관련되어 국민보건의 실질적 향상을 위하여는 지역 주민의 자발적인 참여가 필수여건이 된다는 점 입니다. 지역 단위별 체계적인 의료사업의 전개는 제한된 의료자원의 보다 합리적이고 효율적인 이용을 가능하게 하며 요구가 있을때 언제나 가까운 거리에서 경제 사회적 제약을 받지 않고 이용할 수 있는 일차건강관리망을 통하여 건강에 관련된 정보를 얻으며 질병예방, 건강증진 및 기초적인 진료의 도움을 얻을 수 있고 의뢰에 대한 제2차, 제3차 진료에의 길은 건강관리사업의 질과 폭을 동시에 높고 넓게 해 줄 수 있는 길이 된다는 것입니다. 인력 관리에 관련된 두가지 기본 방향으로서는 첫째로 기존보건의료인력의 적정배치 유도이고 둘째는 기존인력의 역할확대, 조정 및 비의료인의 교육훈련과 부분적 업무대체를 들수 있으며 이러한 인력관리의 기본 방향은 부족되는 의료인력의 생산성을 높이고 주민들의 자조적 능력을 강화시킨다는 데에 두고 있음니다. 대체적 의료재정운영안은 대체로 의료공급과 재정관리를 이원화하여 주민의 경제능력이 의료수혜의 장애요소로 작용함을 막고 의료인의 경제적 동기에 의한 과잉치료처치에 의한 낭비를 줄임으로써 의료재정의 투자의 효과를 증대하는 데(cost-effectiveness) 그 기본방향을 두고 있다고 봅니다. 이러한 주변의료 사회적인 동향이 간호교육의 미래상에 끼치는 영향은 지대한 것이라 봅니다. 첫째로 장래 세계인구의 건강문제는 정치, 사회, 경제, 환경적인 의료권 밖의 요인들에 의해 더욱 크게 영향 받는다고 전제한다면 건강문제해결에 있어서도 전통적인 의료사업의 접근에서 더나아가 문제발생의 근원이 되는 생활개선이라는 차원에서 포괄적 접근을 생각하여야 하고 이를 위해선 정치, 경제, 사회전반에 걸친 깊이있는 이해과 주민의 생활환경에 직접 영향하는 교통수단, 통신망 mass media, 전력문제, 농업경영방법 및 조직적 사회활동 등 폭넓은 이해가 요구된다고 봅니다. 둘째로, 지역사회참여의 의의를 인정한다면 지역민의 자발적 참여를 효과적으로 유발시킬수 있고 의료집단과 각종 주민조직과 일반주민들 사이에서 협조적으로 일할수 있는 역량을 기르기위한 교육적 준비가 요구된다고 봅니다. 셋째로, 지역주민의 건강관리 자조능력 강화를 하나의 목표로 삼는다면 치료자에서 교육자로, 지도자에서 촉진자로, 제공자에서 지원자료의 역할의 변화 내지 다양화를 요구하게 될 것이므로 그에 대처할 수 있는 준비가 필요하다고 봅니다. 넷째로, 생각되어야 할 점은 지역중심건강관리사업을 지향하는 보건의료의 이념적 방향과 그에 상응하는 구체적 접근방법을 효율적으로 적용하기 위해서는 종횡으로 연결되는 의사소통체계의 정립과 민활한 정보교환이 이루어질 수 있어야 한다는 점에서 의사소통의 구심체로서 역할할 수 있는 역량을 함양해야 할 교육적 과제가 있다고 봅니다. 마지막으로 생각되어야 할 점은 지역중심으로 전개될 건강관리사업은 건강증진 및 질병예방적 측면과 질병진료 및 회복과 재활에 이르는 종합적이고 포괄적인 사업이어야 한다는 점에서 종래 공공 의료부문과 사설의료기관 사이에 나누어져 있던 예방의학과 치료의학의 통합 뿐 아니라 정부주축으로 이루어 지고 있는 지역사회개발사업 및 농촌지도사업과 종교 및 각종 민간인 집단이 벌이고있는 사업들과의 전체적인 통합적 접근이 이루어져야 한다고 생각하는 입장에서 종래 간호교육이 강조하지 않던 진료의 의무와 대외적 조직활동에 대한 보완적인 교육조치가 요구된다고 봅니다. 간호의 학문체계로서의 입장은 오랜 역사를 두고 논의의 대상이 되어왔으나 아직까지 뚜렷이 어떤 것이 간호 특유의 지식체계이며 건강문제에 관련하여 무엇이 간호특유의 결정영역이며 이 결정과 그 결과를 어떠한 방법으로 치료적 행위로 옮길 수 있는가에 대한 확실한 답을 얻지 못하고 있는 실정이라고 봅니다. 다만 근래에 제시된 여러 간호이론들 속에서 공통적으로 이야기되어지고 있는 개념들로선 우선 간호학문을 건강과 질병에 관련된 인간의 전인적이고 전체적인 상황을 다루는 학제적 과학으로서보는 입장이 있고 따라서 생물신체적인 면 외에 정신심리적, 사회경제적, 정치문화적 환경과의 상호작용 속에서 인간의 건강과 질병문제를 생각한다는 지향을 갖고 있다고 말할 수 있겠읍니다. 간호교육은 간호계 내적인 학문적, 이론적 체계화의 요구에 못지않게 대민봉사하는 전문직으로서의 사회적 책임을 감당해야하는 중요과제를 안고있어 변화하는 사회요구에 효과적으로 대처해 나가야 할 당면문제를 안고 있읍니다. 간효역할 확대, 보건진료원훈련 등 이러한 사회적 요구에 대응하려는 조치가 되겠읍니다. 이러한 시점에서 간호계가 분명히 짚고 넘어가야 할 사실은 이러한 움직임들이 종래의 의사들의 외업무공급을 연장 확대하는 입장에 서서 간호의 특수전문직 명목을 흐리게 할수있는 위험을 감수할 것인지 아니면 가능한 대체방안을 갖고 간호전문직의 독자적인 진로를 개척하면서 다각적인 도전을 받아들일 준비를 갖추든지 그 방향을 뚜렷이 해야할 일이라 생각합니다. 저로서는 이미 잘 훈련된 간호원들과 조산원들의 교육적, 경험적 배경을 기반으로 지역사회 최일선 건강관리요원으로 사회적 효능을 다 할수 있는 일차건강관리간호조직의 구현을 대체방안으로 제시하고 싶습니다. 간호원과 조산원들의 훈련된 역량과 건강관리체제의 구조적 변화를 효과적으로 조화시킨다면 대부분의 세계인구의 건강문제는 해결가능하다고 보는 입장입니다. 물론 정책과 의료와 행정적지원이 활성화되어지는 환경속에서만 그 기대하는 결과가 확대되리라는 점 부언하는 바입니다. 마지막으로 언급하고 싶은 점은 바로 오늘의 주제 ''교육의 동역자-선생과 학생''이라는 개념입니다. 특히 상회정의적 입장에서 보는 의료사업전개에 지역민 내지 의료소비자의 참여를 강조하는 현시점에 있어 교육자와 학생이 교육의 현장에서 서로 동역자로서 학습의 책임을 나누는 경험은 아주 시기적으로 적합하여 교육적으로 지대한 의미를 갖는 것이라고 생각합니다. 이에 수반되어져야 할 역할의 변화에 수용적인 자세를 갖고 적극 실제적용하려 노력하는 선생앞에서 자주적 결정을 행사해본 학생이야말로 건강관리대상자로 하여금 같은 결정권을 행사할수 있도록 촉구하여 주민의 자조적 역량을 기르고 의료사업의 민주화, 인간화를 이룩할 수 있는 길잡이가 될 수 있으리라 믿는 바입니다.