• Title/Summary/Keyword: 질병 취약성

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우리나라의 모자보건사업 (여성과 어린이 건강문제와 증진방안)

  • Park Jeong-Han
    • 대한예방의학회:학술대회논문집
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    • 2002.07b
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    • pp.3-17
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    • 2002
  • 국민건강은 국가발전의 기본조건이다. 국민건강은 건강한 어린이의 출산에서 비롯되고, 건강한 어린이의 출산을 위하여 여성이 건강해야 한다 따라서 여성과 어린이 건강보호와 증진을 위한 모자보건사업은 국가보건사업 중 최우선 사업으로 추진되어야 한다. 우리나라의 모자보건사업은 1960대부터 보건소를 통하여 가족계획, 산전관리, 안전분만유도, 예방접종을 중심으로 하였다. 1980년대에 들어와 전국민의료보험의 실현과 국민생활수준의 향상 등으로 산전관리 수진율과 시설분만율이 급격히 증가하여 1990년대 후반에는 거의 100%에 도달하였고, 가족계획실천율도 1991년에 79.4%까지 증가하여 합계출산율이 1.6으로 감소하였고, 어린이 기본예방접종률도 90%이상이 되어 전염병 발생률이 현저히 감소하였다. 전통적인 모자보건사업 관련 지표들이 이렇게 향상되자 일선 보건요원에서부터 중앙정부의 정책결정권자에 이러기까지 모자보건사업에 대한 관심도가 떨어져 중앙부처의 모자보건업무 담당 부서도 축소되고, 모자보건 사업도 쇠퇴하였다. 그러나 어린이와 여성의 건강실태를 자세히 들여다보면 심각한 문제들이 대두되고 있다. 시설 분만율의 증가에 따라 제왕절개분만율이 40%대까지 급증하였고, 모유수유률은 10%대로 떨어졌다. 어린이의 체격은 커지고 있으나 체력은 떨어지고, 비만한 어린이가 급증하여 당뇨병과 같은 성인병 유병률이 어린이들에게 증가하고, 사고에 의한 어린이 사망과 장애가 늘고 있다. 또한 청소년들의 흡연율과 음주률이 증가하고, 성적 성숙이 빨라지고 사회의 개방풍조로 성(性)활동 연령이 낮아지고 성활동이 증가하여 혼전임신과 성폭력이 증가하고 있다. 여성들은 일찍 단산하고, 폐경 연령은 높아지고, 평균수명은 길어져 중년기와 장년기 그리고 노년기가 길어져 각종 만성질환에 이환될 기회가 늘어났다. 이러한 시기의 중요 건강문제들은 뇌혈관질환, 폐암, 유방암, 골다공증, 뇨실금 등과 같이 해결하기 어려운 것들이다. 이렇게 어린이와 여성들에게 새로운 건강문제들이 대두되고 있으나 이에 대한 대응정책이 없었고, 따라서 새로운 모자보건사업이 개발되지 않았으며 일선 보건요원의 훈련도 없었다. 그리고 이러한 건강실태를 파악하여 대책을 마련하고, 보건사업을 평가할 수 있는 보건정보체계가 없는 실정이다. 1990년대 중반에 소수의 학자들이 어린이와 여성건강문제의 심각성을 제기하고, 모자보건사업 활성화의 필요성을 주장하여 보건복지부가 '모자보건선도보건사업'이라는 이름으로 1999년부터 2001년까지 3년간 23개 보건소에서 시범사업을 시행하였다. 이 시범사업에서는 한정된 자원으로 여성과 어린이 보건문제를 효과적으로 해결하기 위해 새로운 보건사업의 개발과 효율적으로 수행하는 방법의 개발에 역점을 두어 많은 성과를 거두었다. 시범사업의 경험을 바탕으로 2002년에는 전국의 45개 보건소로 확대해나가고 있다. 모자보건선도보건사업에서는 임산부가 대상이었던 기존의 모자보건사업과는 달리 신생아, 영유아, 학동기 어린이, 청소년, 그리고 신혼부부에서부터 장년기 여성에 이르기까지 사업대상을 확대하고 생애주기에 따라 지역사회 건강문제해결을 목표로 한 보건사업을 수행하도록 하였다. 사업수행 과정에서 보건소는 지역내 대학과 협력체계를 구축하여 기술적 지원을 받고, 보건요원의 교육 훈련을 통해 사업기획 능력과 전문지식과 기술을 향상시켰고, 보건교육에 필요한 시설과 장비를 구입하였고, 민간의료기관과 연계하여 보건서비스의 질을 향상시켰다. 모자보건 선도보건소에서 제공하는 서비스는 취약계층 중심의 보건교육, 상담 및 지도, 고위험대상자 조기발견 및 민간기관 의뢰 및 주구관리, 질병 조기발견을 위한 검진 의뢰, 지역 보건통계 생산과 관리, 그리고 지역내 가용자원 안내 등이며, 저소득층에 대해서는 민간의료기관에 의뢰 또는 검진비용을 지원하였다. 이와 같이 지역사회 민간기관과 협력체계를 구축함에 따라 대상자를 지속적으로 관리할 수 있는 정보를 공유하게 되었고, 건강증진 및 질병예방, 치료, 사후관리를 포함한 지속적이고 포괄적인 서비스를 제공할 수 있게 되었다. 특히 고위험 및 건강의심 대상, 임부와 장년기 여성에 대해서는 건강검진서비스를 과감히 민간기관에 의뢰, 위탁하친 보건소는 상담자, 정보관리자로서의 역할로 전환할 수 있었다. 그러나 사업관리자의 양적 평가에 대한 고정관념과 질적 평가에 대한 인식부족, 기본 생정통계와 정보체계의 미비로 인한 부정확한 통계생산, 사업요원의 전문지식과 기술 부족, 그리고 인력부족 등이 문제점으로 대두되었다. 효율적인 사업확산과 조기 정착을 위해 중앙정부의 일관성 있는 정책과 재정적 지원이 필수적이며, 보건정보체계확립, 그리고 공공보건기관과 민간의료기관간의 공식적인 협력체계확립이 필요하다. 사업추진 모니터링 및 평가, 조정을 위하여 중앙에 '모자보건 선도사업 기술지원단'을 구성하여 운영하고, 프로그램 운영이 잘되는 보건소를 특성화 보건소로 지원 육성하고, 사업요원의 업무 적정화를 위한 보건소 조직과 기존 보건사업체계의 평가와 재편이 필요하다. 보건사업요원의 자질 향상을 위한 지속적인 교육 훈련 시스템과 보건통계생산 관리를 위한 정보체계의 구축이 요구된다. 모자보건사업관련 보건교육자료를 수집하고 개발하여 전국 보건소에 공급하는 중앙 보건교육자료 및 정보센터가 필요하다.

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Immunization Practices in Children with Renal Disease : A Survey of the Members of Korean Society of Pediatric Nephrology (신질환 소아의 예방접종 현황 : 대한소아신장학회 회원들의 접종 방식에 대한 조사)

  • Park Seong-Shik;Ahn Sung-Ryou;Lee Ju-Suk;Kim Su-Yung
    • Childhood Kidney Diseases
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    • v.6 no.2
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    • pp.198-208
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    • 2002
  • Purpose : There is no scientific basis for an immunization policy for children with renal disease who have increased risk of infection in Korea. As an initial step in approaching this problem, this survey of pediatric nephrologists was undertaken to determine the current recommendations of practicing pediatric nephrologists Methods : Questionnaires were sent to the members of Korean Society of Pediatric Nephrology via mail and E-mail. The questionnaire was designed to obtain information about the immunization practice of basic vaccination schedule for nephrotic syndrome, the side effects after vaccination and the immunization practice about recommended vaccines for children with renal disease. Results : Questionnaires were sent to 56 pediatric nephrologists. 35 replies were received (response rate: 62.5%). Almost of the respondents (82.8%) reported practicing at university hospital. All respondents reported modified vaccination schedule. 65.7% of the respondents immunized nephrotic children with live vaccines some time later after discontinuation of corticosteroids treatment and 57.1% of respondents immunized them with killed vaccines during medication of low doses of corticosteroids. Respondents experienced relapse of nephrotic syndrome after vaccination are nine, lack of vaccine efficacy are three and infection by organisms of live vaccines are two. 71.4% of respondents reported vaccinating children with renal disease for hepatitis B, pneumococcus and influenza during medication of low doses of corticosteroids. But There is few difference of the rates of respondents vaccinating them for Hemophilus influenzae type b between during medication of low doses of corticosteroids and after discontinuation of corticosteroids treatment (45.7% us 42.9%). Almost of respondents reported vaccinating renal failure children without immunosuppression for hepatitis B, pneumococcus, influenza and H. influenzae type b ($54.3{\sim}77.1%$). Conclusion : Pediatric nephrologists practiced modifying vaccination schedules for children with renal disease in Korea and there was variation according to the progression of disease and the doses of corticosteroids. It is necessary to establish the immunization guideline for children with renal disease through the prospective studies.

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Prediction of Quality of Life among the Elderly at Care Facilities for the Elderly according to Health States, Physical and Cognitive Functions, and Social Supports-Focused on D Metropolitan City (노인요양시설 노인의 건강상태, 신체적, 정신적 기능, 사회적 지지에 따른 삶의 질 예측요인-D 광역시를 중심으로-)

  • Kim, Jong-Im
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.16 no.7
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    • pp.4656-4667
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    • 2015
  • The purpose of this study was to investigate relations among the quality of life, health states, physical functions, cognitive functions, and social supports of the elderly at care facilities. The subjects include the elderly that were living in care facilities in some urban areas and aged 65 or older. The data of total 260 old people were used in analysis. Collected data were analyzed with descriptive statistics, t-test, ANOVA, Pearson correlation, and stepwise multiple regression. The elderly at care facilities, who were considered as physically and cognitive vulnerable, scored higher means on quality of life when they were satisfied with the length of stay and sleeping state, had higher subjective health states, had no tooth inconvenience and forgetfulness, suffered from a lower level of depression, had better cognitive functions, and received higher social supports. Quality of life had correlations with the sleeping state(r=-.20, p<.001), subjective health state(r=-.24, p<.001)s, depression(r=-.30, p<.001), and social supports(r=.30, p<.001). Social supports(${\beta}=.30$, p<.001), depression(${\beta}=-.25$, p<.001), subjective health states(${\beta}=-.22$, p<.001), length of stay(${\beta}=-.22$, p<.001), and sleeping state(${\beta}=-.12$, p=.025) turned out to predict the quality of life of the elderly at care facilities and have close relations with it. In short, the quality of life of the elderly is related to many different factors at care facilities. The findings indicate that nursing interventions and managements for quality of life require a mental and social approach or a whole person approach with a focus on the understanding of individual senior citizens rather than on physical activities and diseases.

Analysis of Medical Expenses Structure for Patients on Percutaneous Coronary Intervention by Medical Security Type (의료보장형태에 따른 관상동맥중재술 환자의 진료비 구조분석)

  • Son, Mi-Kyung;Lee, Sok-Goo
    • Journal of agricultural medicine and community health
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    • v.44 no.4
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    • pp.195-208
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    • 2019
  • Objectives: The purpose of this study was to analyze whether there are differences in medical expenses according to medical security type in the use of medical services with high disease burden such as coronary intervention. Methods: Chi-square test and covariance analysis(ANCOVA) were conducted to identify the differences in the characteristics and costs according to medical security type of 1,904 patients who underwent coronary intervention in a university hospital from 2011 to 2012. Hierarchical regression analysis was conducted to determine whether the cost affects medical expenses. Results: In the medical aid group, the proportion of women, those without a job, those without a spouse, and those who received hemodialysis was high, length of stay was high, patients using the emergency room and those who died was high. The medical aid patients were significantly higher in the non-benefit medical expenses, optional medical expenses, physician and admission, meals, medications and injections. National health insurance patients were significantly higher in procedure. The medical security type was found to be significant as a variable affecting the medical expenses. Conclusions: Provision of medical expenses should be managed in advance by providing prevention and education services for the vulnerable, and care services in the region should be provided to suppress the occurrence of medical expenses due to the increase in the number of days spent. In addition, it is necessary to support medical expenses to prevent unsatisfactory medical services from occurring for non-benefit and optional care.

Relationships between obesity, blood and urinary compositions, and dietary habits and depressed mood in Koreans at the age of 40, a life transition period (만 40세 생애전환기 건강진단 수검자의 우울기분과 영양 생활습관 및 건강특성과의 관련성)

  • Chu, Ji Eun;Lee, Ji Min;Cho, Han-Ik;Park, Yoon Jung
    • Journal of Nutrition and Health
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    • v.46 no.3
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    • pp.261-275
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    • 2013
  • This study was designed to investigate the relationships of depressed mood with obesity, blood and urinary compositions, and dietary habits in Koreans at the age of 40, a critical transition to the middle adulthood stage. A total of 27,684 people who have taken the Life Transition Period Health Examination at the Korea Association of Health Promotion in 2011 were divided into two groups; the depressed mood group (DG) and the non-depressed group (NG) according to results of the primary questionnaire for mental health. The results were analyzed using the health examination criteria of the National Health Insurance Corporation. Women and medicaid recipients showed higher incidence of depressed mood than men and health insurance subscribers. People with underweight in BMI or abdominal obesity showed correlation with depressed mood, while there was no significant relationship with metabolic syndrome. Regarding blood and urinary compositions, DG was related to a higher level of hemoglobin and lower levels of HDL-cholesterol and triglyceride, although the relationships diminished after adjustment for other confounder effects. According to dietary habits, more people in DG were categorized as a group for "Needs Much Improvement", and the odds ratio of the depressed mood showed a significant increase. Significant difference regarding the frequency of food items such as milk products, animal proteins, Kimchi, and fruits was observed between DG and NG. In addition, a higher portion of subjects in DG did not consume regular meals and various kinds of food. In conclusion, the depressed mood of 40 year-old adults was significantly related to underweight, higher waist measurement, and undesirable dietary habits. Results of our study can be applicable as a basic resource for development of effective nutrition counseling and education programs for improvement of mental health promotion during the critical transition to the middle adulthood stage.

Food Safety and Nutrition Education Program for Elderly and Assessment of Program Effectiveness Based on Health Belief Model (건강신념모델에 근거한 노인 대상 식품안전·영양교육 프로그램 효과 평가)

  • Choi, Jung-Hwa;Lee, Eun-Sil;Lee, Yoon-Jin;Lee, Hye-Sang;Chang, Hye-Ja;Lee, Kyung-Eun;Yi, Na-Young;Ahn, Yoon;Kwak, Tong-Kyung
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.45 no.9
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    • pp.1366-1374
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    • 2016
  • Most elderly have difficulties in managing food safety and nutrition by themselves. Various nutrition educations for the elderly have been developed, but food safety and nutrition education program and educational tools for the elderly are very limited. The aim of the study was to evaluate a food safety and nutrition education program based on the Health Belief Model (HBM) for the elderly. Education program was implemented for 220 seniors (137 educated group and 83 control group) aged over 65 years at senior welfare community centers. The intervention study was carried out on a weekly basis during each of 5 weeks, and each session lasted about 35 or 40 minutes. The effectiveness of the program was assessed with a questionnaire before and after education. Education program consisted of a 5 week program, and topics were 'Dietary changes for the elderly's healthy life', 'Prevention of food poisoning in everyday life', 'Safe food handling for my health', 'Healthy dietary life to prevent chronic disease', and 'Safety! nutrition! healthy dietary life'. Education program materials such as slides, handouts, videos, leaflet, and booklets were developed. As a result, there were score improvements in knowledge, dietary behaviors, and health belief after intervention in the intervention group, which were higher than those of the control group. In particular, there was a meaningful interrelation between dietary behavior and health belief (r=0.520, P<0.001). This finding suggests that changing beliefs is very important to make desirable dietary behavioral changes. For this reason, we can conclude HBM theory is an effective model to educate nutrition and food safety for the elderly. Furthermore, food safety and nutrition education programs are implemented and delivered continuously at various settings such as a health center or community welfare center, and those will contribute significantly to enhance perception and change their desirable dietary behaviors for the elderly.

Comparative analysis of food intake according to the family type of elderly women in Seoul area (서울 일부지역 여자 노인들의 가구유형에 따른 영양소 섭취실태 및 식사의 질 평가)

  • Lee, Yeon Joo;Kwon, Min Kyung;Baek, Hee Joon;Lee, Sang Sun
    • Journal of Nutrition and Health
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    • v.48 no.3
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    • pp.277-288
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    • 2015
  • Purpose: As the rate of senior citizens living alone increases in the current aging society, there is much concern regarding the health and nutritional intake of solitary senior citizens. Therefore, this study compared the nutritional intake of senior citizens according to their family type. Methods: In July and August of 2011, two senior citizen welfare centers in Seoul were visited to survey 267 elderly women. Excluding 54 subjects for which the data were incomplete, information from 213 subjects was analyzed. The subjects were divided into three family types, living alone (LA, n = 74), living with spouse (LS, n = 78), and living with children (LC, n = 61). Results: The mean age of the LA group was the highest, while the mean age of the LS group was the lowest (p < 0.001), and WHR of the LC group was the highest (p = 0.049). Income was the highest in the LS group (p < 0.001). Frequency of eating out was the lowest in the LA group (p = 0.031). By Duncan's multiple analysis, the amounts of energy intake, vegetable protein, fat, calcium, phosphorus, potassium, selenium, Vit D, Vit E, $Vit\;B_2$, niacin, $Vit\;B_6$, $Vit\;B_{12}$, and cholesterol were significantly higher in the LS group compared with the LA or LC group (p < 0.05). The intakes of calcium, Vit D, $Vit\;B_{12}$, and cholesterol were still significantly different among the three groups, even after adjustment for age and monthly income. The LA group ate less fruit and fish than the LS or LC group (p < 0.05). The LA group showed the lowest dietary diversity and the LS group showed the highest diversity (p = 0.014), however, the significance of dietary diversity score among the three groups disappeared after adjustment for age and monthly income. Conclusion: Elderly women living with spouse were receiving better nutrition than elderly women living alone or living with children. Therefore, solitary elderly women who do not live with their spouse or children should be offered greater opportunities to receive a balanced meal at a congregational kitchen or welfare center. To ensure their healthy diet, it is essential to provide continuous nutrition education with these groups in mind.

A Survey of Role Perception and Function Performance Related to Public Health Service among the Medical Staff in a National Hospital (일개 공공병원 종사자의 공공보건의료에 대한 인식과 기능수행에 대한 조사연구)

  • Cho, Young-Hye;Lee, Sang-Yeoup;Jeong, Dong-Wook;Choi, Eun-Jung;Kim, Yun-Jin;Lee, Jeong-Gyu;Go, Yu-Young;Lee, Yu-Hyone;Bae, Mi-Jin;Kim, Chang-Hoon
    • Journal of agricultural medicine and community health
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    • v.37 no.2
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    • pp.67-75
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    • 2012
  • Objectives: While there have recently been efforts to improve public health service at a governmental level, there is actually insufficient research on awareness of the roles related to public health service among hospital employees. This study examined role perception and function performance related to public health service among the medical staff in a national hospital. Methods: 15% were randomly sampled from each type of occupation among the medical staff in a national university hospital, a survey was conducted in 323 persons, and there were a total of 265 participants (80.2%): 103 doctors(38.9%), 98 nurses (37.0%), and 64 others (24.1%). Results: The hospital employees had insufficient awareness of their roles as public health service providers in terms of six required items for public health service: 1) services for supporting establishment, implementation, and assessment of public health service policies, 2) participation in the health service activities and support services by central or local governments, 3) technological support and educational services for private health service institutions, 4) health service for unprivileged brackets, 5) health service that requires association with other areas dealing with geriatric, disabled, and mentally-disordered people, and 6) health service for children and mothers. Conclusions: In general, since the hospital employees had insufficient awareness of their roles and responsibilities as public health service providers, it is necessary to secure manpower exclusively in charge of public health service and provide education about strategic public health service.

Effects of nutrition education on nutrition-related knowledge, dietary habits, and nutrient intakes of alcoholic patients (영양교육이 알코올중독자의 영양지식, 식습관 및 영양섭취상태에 미치는 효과)

  • Kim, An Na;Lim, Hyeon-Sook
    • Journal of Nutrition and Health
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    • v.47 no.4
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    • pp.277-286
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    • 2014
  • Purpose: The aim of this study was to examine the characteristics of nutrition-related knowledge, dietary habits, and nutrient intakes of alcoholic patients and how nutrition education affects these nutritional behaviors. Methods: Subjects included 37 adult male alcoholic patients who were hospitalized. The nutrition education program consisted of five lessons over a five-week period. An each 80-minute nutrition education program per week was implemented for the alcoholic patients over a five-week period. Both before and after the implementation of nutrition education, their nutrition-related knowledge and dietary habits were assessed and nutrient intakes were investigated. Results: The subjects showed drinking habits of considerably high frequency, a large quantity of alcohol consumption, and preference for soju (a liquor) over beer. They had proper weight, height, and BMI, and came from relatively poor socioeconomic backgrounds with a low-level of self-rated health status and a comparatively high rate of suffering from disease. Mean score of their nutrition-related knowledge and dietary habits was quite low. They consumed less energy, dietary fiber, vitamin C, thiamin, riboflavin, folic acid, Ca, and K, but more Na compared to each Dietary Reference Intake (DRI). After implementing the nutrition education, mean score of nutrition-related knowledge and dietary habits showed significant improvement. In addition, the meeting rate of each DRI of several nutrients was increased significantly, including energy, carbohydrate, dietary fiber, vitamins A, C, and $B_6$, thiamin, riboflavin, niacin, pyridoxine, folic acid, Ca, P, K, Fe, and Zn, while that of Na decreased. Conclusion: The findings of this study indicate that alcoholic patients had various nutritional problems, such as lack of nutrition-related knowledge, bad dietary habits, and insufficient nutrient intakes, however, these problems can be positively modified by implementation of a relatively short-term nutrition education program.

Oral Health and Occupational Status among Korean Adults (우리나라 성인의 직업 수준에 따른 구강건강불평등 현황)

  • Shin, Bo-Mi;Bae, Soo-Myoung;Yoo, Sang-Hee;Shin, Sun-Jung
    • Journal of dental hygiene science
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    • v.16 no.3
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    • pp.225-234
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    • 2016
  • The purpose of this study was to determine the oral health condition and behavioral status of Korean adults according to occupational status. The subjects were 7,676 adults, aged between 19 and 64 years, who completed both oral examination and questionnaire survey, among those who indicated that they were currently participating in economic activities, according to the data from the Fourth Korea National Health and Nutrition Examination Survey. Occupational class and employment status were selected as measures of occupational status. Complex-samples logistic regression models were used to assess the associations among oral health, behavioral, and occupational statuses. We found a significant occupational class-related difference in the oral health and behavioral statuses of both the men and women. In particular, the prevalence odds ratios of untreated dental caries in manual workers were 1.19 and 1.67 times higher than in non-manual workers, for men and women, respectively. As for oral health condition and behavioral status according to employment status, the health risk in temporary employment workers was higher than that in permanent employment workers. As for the prevalence odds ratios of the risk of dental caries, the highest values were observed for tooth brushing fewer than 3 times per day, not undergoing oral examinations, and chewing difficulty complaints. The risk of dental caries for agricultural, forestry, and fishing workers for both men and women was found to be the highest among other workers. Thus, strategies to promote workplace oral health in the microscopic and macroscopic perspectives should be developed to constantly monitor oral health problems, and to identify vulnerable social groups within occupational groups and the related factors that mediate oral health differences.