• 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.

• 한국산학기술학회논문지
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• 제15권9호
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• pp.5675-5682
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• 2014

구강질환은 단독 진행만이 아닌 혼합감염증으로 발생하므로 치아우식증 및 치주질환에 관여하는 원인 균주들의 명확한 분석이 필요하다. 이에, 본 연구는 치아우식증 및 치주질환의 원인균으로 잘 알려져 있는 세균을 검출하기 위해 타액을 채취하였다. 성인의 연령, 흡연 및 음주, 질병유무에 따른 구강세균분포 차이를 보고 구강세균의 위험요소를 확인하고자 한다. 본 연구 대상은 20대 이상 65세 미만 성인 120명을 대상으로 2014년 3월 15일 - 5월 10일까지 조사하였다. 타액 내 gDNA를 추출 후 PCR 방법을 이용하여 구강질환의 균 분포도를 확인하였다. 그 결과, S. mutans는 72명, P. intermedia 88명, S. mutans와 P. intermedia 균이 모두 검출된 성인은 54명, 구강세균이 검출되지 않은 성인은 14명으로 나타났다. 구강세균의 위험 요소 결과, 흡연자는 비흡연자에 비해 S. mutans 2.8배, P. intermedia 3.5배 더 높게 나타났다. 음주자는 비음주자에 비해 S. mutans 검출 위험도가 3.3배 더 높은 것으로 나타났으며, 전신질환자는 정상인에 비해 P. intermedia 검출된 위험도가 4.1배 더 높은 것으로 나타났다. 흡연, 음주, 전신질환은 구강 내 세균 검출위험도가 높은 인자임을 확인할 수 있었다. 또한 연령이 증가할수록 치주질환 세균이 더 많이 검출되었으며, 20대는 치아우식증과 치주질환이 공존하는 연령대인 만큼 구강세균의 분포가 더 두드러지게 나타남을 알 수 있었다. 구강세균이 검출된 성인은 치아우식증과 치주질환에 이환될 위험도가 그만큼 높다고 볼 수 있으므로, 구강환경을 청결히하고 정기적인 치과방문을 통해 구강질환을 예방해야 할 것이다.

• 가정∙방문간호학회지
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• 제3권
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• pp.53-66
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• 1996

Home Health Care is one part of the total health care system. It includes health care services that link the hospital to the community. While it is important for early discharge patients, home care is also important for people with chronic illnesses or handicapping conditions. In 1989 the Korean government passed a law that opened the way for formal development of home health care services beginning with education programs to certify nurses for home care, and then demonstration home care services. Part of the mandate of the demonstration projects was evaluation of home care services. This study was done in order to provide basic data that would contribute to the development of records that could be used for evaluation through a retrospective audit and to examine the care that had been given in Home Care at Wonju Christian Hospital over a twenty year period from 1974 to 1994. The purposes of the study were : to identify to characteristics of the clients who had received home care, to identify the reasons for client referrals, to identify the nursing problems of these clients, to identify the nursing care provided to these clients, and to identify differences in these areas over the twenty year period. The study was a descriptive study involving a retrospective audit of the client records. Demographic data on all clients were included : 4,171 clients from 2,564 families. Data on referrals, nursing diagnosis and nursing interventions were from even numbered records which had a patient problem list included in the record, 2,801 clients, Frequencies and ANOVA were used in the analysis. The results of the study showed that the majority of the clients were from Wonju city /county. There were more women than men related to the high number of postpartum clients(1,300). The high number of postparttum clients and newborns was also evident in the age distribution. An the number of maternal-child clients decreased over the 20 years, the mean age of the clients increased significantly. Other factors also contributed to this change ; as increasing number of clients with brain injuries or with cancer, and fewer children with burns, osteomyelitis and tuberculosis. There was a decrease in the mean number of visits and mean length of coverage, reflecting a movement towards a short term acute care model. The number of new clents dropped sharply after 1985. The reasons for this are : the development of other treatment alternatives for clients, the establishment of an active wellbaby clinic, many more options plus a decreasing number of new cases of Hansen's Disase, and insurance that allows people with burns to be kept in hospital until skin grafts are healed. Socioeconomic changes have resulted in an increase in the number of cases of cancer, stroke, head injuries following car accidents, and of diabetes. Of the 2,801 client records, 2,541(60.9%) contained a written referral but for 1,802 it contained only the medical diagnosis. The number of records with a referral requesting specific nursing care was 739(29.1%). Many family members who were identified as in need of nursing care had no written referral. Analysis of the patient problem list showed that 41.9% of the enteries were nursing diagnoses. Others incuded medical diagnosis, symptoms, and plans. The most frequently used diagnoses were alteration in nutrition, less than body requirements(115 entries), alteration in skin integrity(114), knowledge deficit(111), pain(78), self-care deficit(66), and alteration in pattern of urinary elimination(50). These are reflected in the NANDA categories for which the highest number of diagnosis was in the Exchanging pattern(446), followed by Moving(178), Feeling(136) and Knowing (115). Analysis of the frequency of interventions showed that exercise and teaching about exercise was the most frequent intervention, followed by teaching concering the need for follow-up care, checking vital signs, managing nutritional problems, managing catheters, giving emotional support, changing dressings, teaching about medication, teaching (subject not specified), teaching about diet, IM and IV medications or fluid, and skin care, in that order. Recommendations included: development of a record that would allow for efficient recording of frequently used nursing diagnoses and nursing interventions: expansion of the catchment area for Home Care at Wonju Christian Hospital ; expansion of the service to provide complication prevention, rehabilitation services, and support to increase the health maintenance /health promotion of the people being served as well as providing client dentered care ; and development of a clinical record that will allow efficient data collection from records, even though the recording is done by a variety of health care providers.

• Tuberculosis and Respiratory Diseases
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• 제60권3호
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• pp.277-284
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• 2006

연구배경: 폐결핵의 진단 및 치료지연은 결핵 환자의 사망률을 증가시키고, 결핵균 전파의 위험을 증가시킬 수 있다. 본 연구는 3차 민간의료기관에서 폐결핵 환자 치료지연의 요인을 분석하여, 결핵관리사업을 위한 기본적인 자료를 제공하고자 시행하였다. 방 법: 1999년 5월부터 10월까지 결핵균 도말 양성 혹은 배양 양성으로 새로이 진단된 폐결핵 환자 150명의 의무기록을 후향적으로 조사하였다. 지연치료군과 적절치료군으로 구분하여 환자 대조군 연구를 시행하여 치료지연의 요인을 분석하였고, 지연치료군 환자를 대상으로 전화 추적조사를 실시하여 치료적 중재를 실시하였다. 결 과: 대상 환자 150명 중 55명 (37%)이 지연치료군에 속하였다. 단변량 분석 결과 지연치료군의 의미있는 변수는 연령(61세 vs 40세; p <0.001), 항산균 도말 음성(85% vs 55%; p <0.001)과 1차 또는 2차 의료기관 미경유(56% vs 36%; p = 0.014)이었다. 다변량 분석 결과 고령 (p = 0.001), 항산균 도말 음성 (p = 0.001) 그리고 흉부사진상 하엽 침윤 소견 (p = 0.041)이 치료지연의 독립인자임을 확인하였다. 전화 추적조사 결과 치료를 받지 못한 22명의 환자 중 20명 (91%)이 병원에 다시 내원하기로 하였다. 결 론: 민간의료기관인 대학병원에서 폐결핵 치료 지연은 적지 않았다. 고령, 항산균 도말 음성, 하엽 침윤 소견이 치료지연의 위험요인이며, 체계적인 결핵 관리를 위한 조직 구성이 요구된다.

• 대한소아치과학회지
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• 제29권2호
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• pp.168-179
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• 2002

어린이의 치과 치료시 행동조절에 도움이 되고자 치료를 위해 내원한 어린이 환자 150명을 대상으로 치과의사의 의상에 대해 설문조사를 시행한 결과 다음과 같은 결론을 얻었다. 1. 가운과 일상복에 대한 선호도 조사에서는 성별(P<0.05), 연령(P<0.05), 거주지(P<0.05), 내원 횟수(P<0.05)에서 가운에 대한 선호도(65.3%)가 높았다. 2. 가운의 종류와 가운의 속의 복장에 대한 선호도는 긴 가운에 와이셔츠(30.7%), 양복형 가운에 와이셔츠(18.7%), 긴 가운에 폴로셔츠(17.3%) 순으로 나타났다. 3. 가운의 색에 대한 선호도는 흰색(34.7%), 분홍색(18.7%), 초록색(18.0%), 파랑색(15.3%), 노랑색(13.3%) 순으로 나타났다. 4. 가운의 무늬에 대한 선호도는 만화 캐릭터(49.3%), 병원로고(28.7%), 민무늬(14.7%) 순으로 나타났다. 5. 여자 치과의사의 일상복에 대한 선호도는 폴로셔츠(37.3%), 줄무늬셔츠(28.7%), 라운드티셔츠(18.7%), 개량한복(15.3%) 순으로 나타났다. 6. 남자 치과의사의 일상복에 대한 선호도순서는 무늬넥타이에 민무늬 와이셔츠(28.0%), 민무늬 넥타이에 와이셔츠와 넥타이 없이 무늬셔츠(21.3%), 넥타이 없이 민무늬 와이셔츠(14.7%)순으로 나타나났다. 7. 보호장비 착용에 대한 선호도 조사는 마스크와 글러브(28.7%), 장비 없음(26.7%), 마스크와 글러브와 보안경(22.7%), 마스크만 착용(22.0%) 순으로 나타났다. 본 연구의 결과에 비추어 볼 때, 어린이 환자의 치과 치료시, 심리적 안정감을 주기 위해서는 흰색의 획일적인 가운에서 벗어나 다양한 색채와 형태로 디자인된 치과의사의 복장이 어린이에게 친근감을 주어 행동조절에 도움이 될 것으로 사료된다.

• 대한중풍순환신경학회지
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• 제11권1호
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• pp.9-17
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• 2010

Objectives : This study was aimed to evaluate the current status of East-West integrated treatment in stroke and brain disease and to discuss further plans. Methods : The medical records of patients who visited the stroke and brain disease center at Kyung Hee University, East-West Neo Medical Center from May 2006 to August 2010 were evaluated. The general characteristics of patients who underwent integrated treatment, trend in the number of cross referrals were initially evaluated. Later major disorders, the reasons of referrals and the number of visits in outpatients were analyzed. Results : 1. 3496 patients were referred from the eastern medical hospital to the western medical hospital and 2440 patients from the western medical hospital to the eastern medical hospital. The number of patients reached a peak alter the opening of the hospital and has decreased from then on. Referrals of female patients were more than those of male patients and patients over 50 years old were the most. 2. Admitted patients with stroke of chronic stage were most commonly referred from the eastern medical hospital to the western medical hospital and cerebral infarction was most common from the western medical hospital to the eastern medical hospital. Among the outpatients cerebral infarction topped from east to west, and stroke of chronic stage from west to east. 3. 36.6% of the patients from east to west received integrated treatment more than 3 times and 28.6% from west to east. Headache was the second most common reason to be referred from west to east and 36.7% of patients didn't continue to have either of the treatment and 30.3% received eastern treatment only, Conclusions: According to this study, chronic stroke management was successfully performed in the outpatient clinic in the form of East-West integration treatment. Further research on other diseases such as headache is recommended.

• 한국학교보건학회지
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• 제13권2호
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• pp.295-317
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• 2000

This study was conducted to prevent oral disease of primary school, middle school, and high school students, providing basic data for the development of oral health education programs. Data were collected from 898 primary school, middle school, and high school students from March 2, 1999 to May 31, 1999. The results of this study are summarized as follows; 1) The subjects of this study were primary school students(32.6%), middle school students(33.0%), and high school students(34.4%). Boy students were slightly more prevalent than girl students. That is, primary school boys were 56.3%, middle school boys were 53.2%, and high school boys were 52.6%. 2) According to the self-judgement of oral health, primary school students were better than middle/high school students and boy students were better than girl students, 63.5% of primary school students and 57.8% of middle/high school students brushed their teeth once or twice a day. 3) 76.3% of middle/high school students and 63.5% of primary school students experienced dental caries. Girl students were higher than boy students in experiencing dental caries, 35.9% of primary school students and 27.6% of middle/high school students experienced periodontal disease. 4) 22.9% of primary school students and 7.9% of middle/high school students received oral examinations periodically. Girl students showed a higher rate than boy students in primary school, while boy students showed a higher rate than girl students in middle/high school. 5) Explaining to the reasons for reluctant visits to dental hospitals and clinics, 'no time to go' was highest(22.9% of primary school students; 27.4% of middle/high school students) and the rate of 'feeling scared' was second highest. Middle/high school students were more reluctant to visit dental hospitals and clinics than primary school students. In case of problematic symptoms in the mouth, the rate of 'feeling painful or cold in teeth when eating cold or hot foods' was highest, 71.3% of primary school students was concerned about oral health, while 68.6% of middle/high school students was concerned about it. 6) In gathering to the sources of information on oral health, the rate of medical institutions was highest(30.0%) in primary school students, while the rate of family members or persons around them was highest in middle/high school students. 7) 54.9% of primary school students received oral health education, while 13.1% of middle/high school students received it. Only 4.7% of middle school and high school girls received it. In relation to dental health education, the rate of 'possibility of prevention of oral caries or disease of the gum' was highest. 79.5% of primary school students and 80.3% of middle school students answered that they would attend oral health education. 8) 60.4% of primary school students and 60.2% of middle/high school students think the purpose of oral health is to prevent dental caries and disease of the gums. In preventing dental caries, 78.8% of primary school students and 71.8% of middle school students thought that periodical oral examination was effective, 88.4% of primary school students and 88.8% of middle/high school thought that brushing one's teeth was effective and 64.1% of primary school students and 50.7% of middle school students thought that the use of toothpaste containing fluoride was effective. In preventing periodontal disease, 91.1% of primary school students and 90.2% of middle/high school students thought that brushing one's teeth was effective, while 72.4% of primary school students and 70.3% of middle/high school students thought that teeth cleaning was effective. 9) 16.0% of middle school students and 12.7% of high school students thought that their oral health condition was healthy. According to individual experiences in dental treatment, the rate of experience of middle school students was higher than that of high school students, 12.7% of middle school students received oral examinations periodically, while only 3.3% of high school students did so. 10) In cases of 'having no problematic symptoms in the mouth' and 'concerns about oral health', the rate of middle school students was higher than that of high school students. In gathering obtaining information on oral health, the rate of obtaining it through broadcast media including TV, Radio, etc. was highest in middle school students, while the rate of obtaining it through family members or persons around them was highest in high school students. 11) 81.7% of middle school students have not received oral health education. In case of girl students, 97.3% have not received it in high school students. 85.6% of middle school students and 151.2% of high school students think that oral health education is necessary. 12) According to the knowledge level of oral health, the point of high school students($26.33{\pm}2.33$) was similar to the point of high school students($26.23{\pm}2.30$). It appeared that the point of primary school students was highest($26.35{\pm}2.50$) The more concerned about oral health the students were the higher the knowledge level of oral health was. In conclusion, the middle/high school students' knowledge level of oral health was lower than primary school students. The rate of middle/high School students' experience in oral health education was too low. Therefore, it is necessary to intensify oral health education for middle/high school students. Especially, the necessity of oral health education to girl students is strongly recommended. Developing an oral health education program for primary school, middle school, and high school students, related public authority and organizations, teachers; and dentists must actively make efforts together in order to maintain healthy teeth through having students prevent dental caries and periodontal disease.