• Title/Summary/Keyword: 질병부담

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병원에서의 산업보건관리

  • Jeon, Gyeong-Ja
    • Korean Journal of Occupational Health Nursing
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    • v.2
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    • pp.40-51
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    • 1992
  • 본 연구는 병원에서의 산업보건관리 실태를 파악하기 위하여 전국에 있는 병원을 대상으로 1992년 12월 1일부터 1993년 1월 23일까지 설문조사를 설시하였다. 설문조사에 응당한 병원은 41개병원으로 회수율은 51.9%였다. 조사에 이용된 설문지는 산업안전보건법 내용을 기초로 하여 본 연구자가 작성한 것이며 안전보전에 관한 제반 규정, 안전보건관리체계, 근로자건강관리, 작업환경관리, 보건교육, 보건관련시설, 질병 및 상해에 대한 보상 등에 관한 45개문항으로 구성되어 있다. 분석결과는 다음과 같다. 첫째, 전체 병원 중 68.3%가 안전보건관리 규정이 있다고 답하였으며, 77.5%의 병원이 단체협약 중 근로자의 안전과 보건에 관한 조항을 포함시키고 있는 것으로 나타났다. 단체협약에 포함된 내용 중에는 정기건강진단(23.7%)과 질병 및 상해에 대한 보상(20.9%), 안전보건위원회의 구성(18.1%)등이 많았다. 둘째, 대상 병원중 66.7%가 안전보건관리책임자, 관리감독자, 안전담당자를 두고 있는 것으로 나타났고, 근로자수가 1,000명 이상인 병원은 83.3%가 이들 인력을 선임하고 있다. 그러나, 보건관리자와 안전관리자를 전담으로 두고 있는 경우는 한 곳도 없었으며 50%이내에서 겸직으로 선임하고 있었다. 또한, 안전보건위원회를 운영하고 있거나 노사협의회로 이를 대치하고 있는 병원은 54.2%로 절반 수준에 머물렀고, 그나마 정기적으로 운영을 하고 있다고 답한 병원은 3개 병원 밖에 되지 않았다. 세째, 근로자 건강관리를 위한 건강진단 실시 현황을 보면, 채용시검진 97.6%, 일반건강진단 100.0%, 특수 건강진단 24.4%가 실시하고 있었다. 건강진단에서 주로 실시하고 있는 항목은 흉부 X선검사, 시력, 혈압, 혈청GOT/GPT, 체중, 신장등이었다. 그러나, 병원에서 감염될 수 있는 기회가 높은 간염항원/항체검사의 실시율은 85.7%로 아직도 실시하지 않는 병원이 있음을 알 수 있다. 네째, 작업환경관리를 위하여 정기적으로 환경측정을 실시하는 병원은 21.6%였고 주로 측정하는 항목은 방사선이었다. 특히 소음, 조명, 분진에 대한 측정이 이루어지지 않음은 근로자뿐아니라 환자의 안위에도부정적인 영향을 미칠 수 있다. 다섯째, 안전한 작업과 근로자의 건강을 위하여 정기적인 보건교육을 설시하고 있는 병원은 불과 5.6%였다. 교육내용은 주로 안전에 관한 것이었다. 여섯째, 근로자의 일상적인 건강문제를 해결해주는 의무실을 독립적으로 마련하고 있는 병원은 한 곳도 없었고, 교대근무자나 당직자를 위한 수면시설은 44.7%, 작업 후에 사용할 수 있는 샤워시설은 35.1%의 병원이 마련하고 있었다. 일곱째, 근무중 다치거나 병에 걸렸을 때 치료비에 대한 부담은 대체로 병원이 하고 있으며 치료기간 중 근무는 병가나 휴직으로 처리되고 있다. 이는 병원이 산재보상보험법에 적용을 받지 않은 사업으로 분류되어 있는 현실에 기인된 것으로 보상과 관련된 부담을 병원이나 근로자 모두가 안게 되는 결과를 초래하게 되는 것이다. 이상에서 볼 때 병원근로자를 위한 산업보건관리는 주로 건강진단과 질병 및 상해에 대한 보상제도가 이루어지고 있는 실정이다. 그러므로 질병의 예방이나 악화방지 나아가 건강증진을 도모하기 위한 지속적인 노력을 기울이고 있는 병원은 전무한 상태임을 알 수 있다. 이러한 현실을 병원근로자를 위한 산업보건관리에 대한 인식이 전반적으로 부족함을 드러내는 것으로 이를 개선하기 위한 보다 적극적인 노력이 시급히 요청되고 있다.

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Congenital Heart Surgery with Fast Track Hospital Discharge (단기 퇴원 지침으로 시행한 선천성 심기형 수술)

  • 이정렬;정동섭
    • Journal of Chest Surgery
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    • v.34 no.1
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    • pp.41-44
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    • 2001
  • 배경: 최근 들어 최소 절개술의 도입의 장점으로 입원간의 단축이 거론되고 있다. 이에 본 연구에서는 최소 흉골 절개술(mini-sternotomy)하에 시행된 개심술 환자에 대하여 전향적으로 수술 후 문제가 없는 환아에 대하여 5일 이내에 퇴원을 시도하고 그 안전성, 경제성 등을 평가하였다. 대상 및 방법: 1998년 11월부터 1999년 7월까지 최소 흉골 절개술하에 개심술을 시행한 환자 중 5일 이내에 퇴원한 환자 29명과 1997년 1월부터 5월까지 전통적인 흉골 절개술로 개심술을 시행한 29명의 환아들을 각각 실험군(제1군)과 대조군(제2군)으로 하였다. 환자는 동일한 수술자로부터 수술을 받았고 질병군은 유사하였다. 결과: 제1군과 제2군의 수술 후 재원일수, 총 병원비, 합병증, 수술 후 소견 등에 차이가 있는지 비교하였다. 평균 수술 후 재원일수는 4.5$\pm$0.6일 및 9.1$\pm$2.4일이었다(p<0.05). 두 환자군에서 수술 후 합병증으로 인한 재입원은 없었고 수술 후 시행한 심초음파에서도 심장수술과 관련된 병변은 관찰되지 않았다. 제1군의 총 입원비의 평균은 7,333,184$\pm$113원이었고, 환자부담액은 3,464,383$\pm$80원이었다. 반면 제2군에서의 총 입원비의 평균은 7,486,136$\pm$140원, 환자부담액은 3,660,194$\pm$92원이었다(p>0.05). 결론: 본 연구를 통해 단기 퇴원 지침하에 환자를 치료함으로써 수술 후 재원일수를 단축시키는 시도가 합병증이나 잔존 병변을 남기지 않고 안정적으로 시행될 수 있다는 사실을 확인하였다. 하지만 경제적 이점은 통계적인 유의성을 찾을 수 없었다. 향후 환자군의 크기와 질병군의 난이도 등을 조절한 비교 평가가 필요하다고 생각된다.

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Hospital-Acquired Measles: A Systematic Review Using the Outbreak Reports and Intervention Studies of Nosocomial Infection (ORION) Statement

  • Erdenetuya Bolormaa;Cho Ryok Kang;Han Ho Kim;Young June Choe
    • Pediatric Infection and Vaccine
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    • v.31 no.1
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    • pp.64-74
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    • 2024
  • Purpose: Despite the recent increased number of nosocomial measles, the outbreak investigation reports are not usually standardized, thus posing unclear understanding of magnitude of its public health burden. We used the Outbreak Reports and Intervention Studies of Nosocomial Infection (ORION) statement, to compare nosocomial outbreaks and synthesize evidence to prevent hospital transmission of measles. Methods: A PubMed, Web of Science, Embase, Scopus, and Cochrane search in English, using the medical subject headings "measles," "nosocomial," "hospital," and "healthcare," was performed. We evaluated the quality of outbreak reports of nosocomial measles infection worldwide using the ORION statement findings and recommendations. Results: We reviewed 24 studies in accordance to the ORION statement. Measles transmission in healthcare settings is a significant burden on the morbidity, mortality, and economy of measles. The healthcare workers' booster vaccination guidelines should be monitored and enhanced during the post-elimination period of measles. The outcomes of infections must be explicit for outbreak reports. Conclusions: This study identified the epidemiological and clinical characteristics of nosocomial measles infections and provided strong evidence for infection control policies in hospitals.

Incidence and magnitude of out-of-pocket payment and factors influencing them in Industrial Accident Compensation Insurance (산재환자의 진료비 본인부담 발생 및 크기와 이에 영향을 미치는 요인)

  • Park, Bo-Hyun;Lee, Tae-Jin;Lim, Wha-Young
    • Health Policy and Management
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    • v.20 no.1
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    • pp.103-124
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    • 2010
  • Objectives: The out-of-pocket payment (OOP) of the Industrial Accident Compensation Insurance (IACI) in Korea was investigated empirically in terms of its incidence, magnitude and factors influencing them. Methods: The subjects were sampled with stratified, randomized methods among medical institutions of which the number of monthly IACI claims exceeded its median as of May 2008. Out of 204 institutions selected, 118 institutions (57.8%) responded to this survey. A total of 24,826 episodes(2,457 inpatient and 22,369 outpatient episodes) were included in this analysis. The incidence and magnitude of OOP of IACI were calculated by characteristics of institution as well as patient. Factors that affected the incidence and magnitude of OOP were investigated through multi-level analysis. Results: The overall incidence of OOP of IACI was 9.9% (25.6% for inpatient and 8.2% for outpatient) and the percentage of OOP among total expenditures was 8.3% on average (7.6% for inpatient and 26.8% for outpatient); 25.2% at traditional oriental medicine hospitals, 9.5% at general hospitals and 2.5% at the industrial-accident-designated medical institutions. The incidence of OOP of IACI was influenced by hospital size, ownership, longer duration of designation (over 5 years) and length of stay. On the other hand, its magnitude was influenced by medium-sized hospital, public hospital, location of large city and length of stay. Extra charges for upper grade room which accommodates less than 4 patients and treatment by specialists were the leading contributors to the magnitude of OOP of IACI. Conclusion: The incidence and magnitude OOP of IACI varied in institution type and were influenced by both institutional and patient's factors. In order to achieve the goal of Industrial Accident Compensation Insurance, appropriate level of compensation, that is, no incidence of OOP, for accident and disease of workers, it is necessary to take measures to reduce incidence and magnitude of OOP.

The Effects of the Revised Elderly Fixed Outpatient Copayment on the Health Utilization of the Elderly (노인외래정액제 개선이 고령층의 의료이용에 미친 영향)

  • Li-hyun Kim;Gyeong-Min Lee;Woo-Ri Lee;Ki-Bong Yoo
    • Health Policy and Management
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    • v.34 no.2
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    • pp.196-210
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    • 2024
  • Background: In January 2018, revised elderly fixed outpatient copayment for the elderly were implemented. When people ages 65 years and older receive outpatient treatment at clinic-level medical institutions (clinic, dental clinic, Korean medicine clinic), with medical expenses exceeding 15,000 won but not exceeding 25,000 won, their copayment rates have decreased differentially from 30%. This study aimed to examine the changes of health utilization of elderly after revised elderly fixed outpatient copayment. Methods: We used Korea health panel data from 2016 to 2018. The time period is divided into before and after the revised elderly fixed outpatient copayment. We conducted Poisson segmented regression to estimate the changes in outpatient utilization and inpatient utilization and conducted segmented regression to estimate the changes in medical expenses. Results: Immediately after the revised policy, the number of clinic and Korean medicine outpatient visits of medical expenses under 15,000 won decreased. But the number of clinic outpatient visits in the range of 15,000 to 20,000 won and Korean medicine clinic in the range of 20,000 to 25,000 won increased. Copayment in outpatient temporarily decreased. The inpatient admission rates and total medical expenses temporarily decreased but increased again. Conclusion: We confirmed the temporary increase in outpatient utilization in the medical expense segment with reduced copayment rates. And a temporary decrease in medical expenses followed by an increase again. To reduce the burden of medical expense among elderly in the long run, efforts to establish chronic disease management policies aimed at preventing disease occurrence and deterioration in advance need to continue.

Application of Hyperspectral Imaging System to Analyze Vascular Alteration for Preclinical Models (전임상 혈관분석을 위한 초분광 이미징 시스템의 활용)

  • Choe, Se-Woon;Woo, Young Woon
    • Journal of the Korea Society of Computer and Information
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    • v.20 no.4
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    • pp.69-76
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    • 2015
  • We present microscopy based hyperspectral imaging system that successively shows high spatial (micrometer) and temporal resolutions (milisecond), and acquired pseudocolor hemoglobin saturation map a result of various image processing techniques can provide additional information such as oxygen transport, abnormal vascularity and therapeutic effects besides structural and physiological measurements in various diseases. To increase understanding of vascular defects several optical methods of imaging for preclinical/clinical assessment have been developed so far. However, they have some limitations for outcoming resolution and user satisfaction level compared to its cost. A hyperspectral imaging system has shown a wide range of vascular characteristics associated with hypervascularity, aberrant angiogenesis or abnormal vascular remodeling in many diseases. This vascular characteristic is considered as a key component to diagnose and detect a type of disease as evidenced by them.

An Efficient Hospital Service Model of Hierarchical Property information classified Bioinformatics information of Patient (환자의 바이오인포매스틱 정보를 속성수에 따라 계층적으로 분류한 효율적인 의료서비스 모델)

  • Seo, In-Kyu;Lee, Sang Ho
    • Journal of Convergence Society for SMB
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    • v.5 no.4
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    • pp.17-23
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    • 2015
  • Due to the development of information and communication technology as health care service is popular variety utilizing bioinformatics patient information services are being provided to the patient. In particular, the healthcare utilizing bioinformatics information, and change in a variety of healthcare trends. However, healthcare services using bioinformatics information of the patient and the complexity of the disease, new diseases (SARS, AIDS, etc .) due to the emergence of increasing health care costs and health promotion services provided to patients may not be smooth. In this paper, we propose a model for low-cost health services and medical care of patients bioinformatics fast access to information. The proposed model can be so big a bioinformatics data formation by the patient's patient information anytime / anywhere providing medical services in the home or the nearest hospital for their own disease management. In particular, the proposed model of health care services is characterized improve work efficiency, reducing the burden on hospitals by passing a medical illness to easily analyze patient information.

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Adult-role Burdens and Socio-emotional Development of Children in Poverty (빈곤과 아동의 사회정서적 발달 간의 관계 : 성인역 부담의 역할을 중심으로)

  • Park, Hyun-Sun;Chung, Ick-Joong;Ku, In-Hoe
    • Korean Journal of Social Welfare
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    • v.58 no.2
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    • pp.303-330
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    • 2006
  • The purpose of this study was to investigate the relationships among poverty, family structure and functioning, burdens of adult roles and socio-emotional problems. It was especially focused on the relationship between the burden of adult roles and socioemotional problems among children in poverty. The Structural Equation model was employed for analyses. The Theoretical model was established based on previous researches related to poverty and adult roles (for example, parentification and parentified children). Data came from the first wave of 'Seoul Panel Study of Children; SPSC' and subjects consisted of 1,807 4th grade elementary school students and their parents who were located at K-Gu in Seoul. The survey was carried out from October 25th to November 20th in 2005. The Results of the Structural Equation model were congruent with the theoretical expectations. To find a more appropriate model, three kinds of structural models were hypothesized and analysed. In the most appropriate model which had a good model fit, poverty and family structure impacted on socio-emotional problems directly and indirectly. The relationship between poverty and socio-emotional problems was mediated by family functioning and burdens of adult roles. The same mediation process existed between family structure and socio-emotional problems also. In brief, children in poverty or those who have a single parent are more likely to have impaired family functioning, which is likely to cause higher burdens of adult roles. In turn, those who have higher burdens of adult roles are more likely to have socioemotional problems. In conclusion, various theoretical and practical implications for social work practice focusing on the burdens of adult roles or caretaker roles among children in poverty were discussed.

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Measuring the Burden of Hypertension using DALY in Korea (장애보정생존년수(DALY)를 활용한 우리 나라 고혈압의 질병부담 측정)

  • 윤석준;하범만;김창엽
    • Health Policy and Management
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    • v.11 no.3
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    • pp.89-101
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    • 2001
  • This study estimated the burden of disease due to hypertension in Korea in disability-adjusted life years(DALYs) using vital registration data and the National Health Examination Survey data. Firstly, we estimated the years life lost due to premature death (YLLs) of hypertension using the vital registration data. Secondly, to calculate the years lived with disability (YLDs), we estimated the average age at onset and disease duration using the National Health Examination Survey data. The disability weights for hypertension were estimated by person trade off method. Finally, the burden of hypertension was calculated in DALYs, which are the sum of YLLs and YLDs. The burden of hypertension for males was attributed mainly to YLD(97.9%). DALYs for females were also attributed mainly to YLD(96.7%). DALYS for males were 993,950 person-years and for females were 743,282 person-years. Results of this study provide a rational basis to plan a national health policy regarding the disease burden of hypertension in Korea. We will need accurate epidemiological study results and other study results of national burden of disease in Korea to get more accurate results of this burden of disease study.

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The burden of disease research of oral disorders and suggestions for improvement (구강 질병부담 연구와 개선 방안)

  • Chung, Ju Hyun;Jung, Hoi In
    • Journal of Korean Academy of Dental Administration
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    • v.9 no.1
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    • pp.1-6
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    • 2021
  • Measuring and quantifying the burden of disease (BoD) is crucial for healthcare policy-related decisions. For this purpose, summary measures of population health (SMPH) have been proposed to overcome the limitations of prevalence, incidence, and mortality. Oral health remains separated from the mainstream healthcare system, and the lack of reliable epidemiological data has been pointed out as the cause. In this study, we aimed to understand the flow of international and domestic BoD research related to oral disorders and the direction in which those studies should advance in the future. It is necessary to continuously revise the previously measured BoD of oral disorders and calculate the BoD by performing subdivisions, starting from the development of lay descriptions. Furthermore, developing elaborate BoD measurement methodologies that reflect the complexity of the oral cavity is essential.