• 대한예방한의학회지
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• 제23권3호
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• pp.109-119
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• 2019

Background : Germany is the first country in the world to introduce modern systems of public health insurance, and the country which most widely uses complementary alternative medicine(CAM) in Europe. In early 21^st century, a large evaluation studies were conducted to include acupuncture in health insurance payments, which were eventually decided. Objectives : This study is to investigate and analyze the process of public policy determination on insurance coverage for acupuncture in German health insurance system. Methods : We collected the data and information through the literature search and from the websites of German government departments and health insurance organizations. To obtain contextual information, German experts of health insurance and acupuncture clinical study were interviewed. Results : As use of acupuncture had been growing, German public health insurers wanted to evaluate the validity of acupuncture coverage and sponsored three evaluation projects for clinical effectiveness of acupuncture using randomized clinical trials, systematic reviews, and pragmatic trials from 2001 to 2005. For some pain condition, acupuncture was founded not to be effective than sham acupuncture, but more effective than standard care. The federal joint committee of health insurance decided to cover acupuncture for chronic pain of lumbar spine and chronic pain in at least one knee joint due to gonarthrosis. Conclusions : Considering the controversial subject matter in the process of acupuncture's health insurance coverage in Germany, expanding the benefits of Korean medicine in Korea needs to come up with ways to overcome the difficulties of placebo effect, standardization and lack of literature evidence.

• 한국산학기술학회논문지
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• 제18권8호
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• pp.64-71
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• 2017

본 연구에서는 재킷식 해상풍력터빈 지지구조물의 효과적인 건전성 모니터링을 위하여, 손상에 의한 구조물의 모드 특성 변화 및 군집신경망기법을 이용한 손상추정기법을 제안한다. 실용적 적용을 위하여 제한된 계측자료를 활용하고, 구조적으로 중요하며 손상이 발생될 확률이 큰 것으로 판단되는 중요부재를 대상으로 손상을 추정한다. 즉, 재킷식 지지구조물은 부재 개수가 많기 때문에, 모든 부재를 적절히 식별하기 위해서는 이에 상당하는 많은 수의 계측 데이터 채널 및 센서를 설치해야 한다. 이는 건전성 모니터링의 경제적 및 실용적인 측면에서 적절치 않다고 판단되며, 본 연구에서는 중요 구조부재에 대하여 제한된 계측자료를 활용하여 집중적으로 손상추정을 수행하기 위한 연구를 수행한다. 5 MW 해상풍력터빈에 적용될 수 있는 재킷식 해상풍력터빈 지지구조물을 모델링한 후, 수치 시뮬레이션을 수행하여 신경망의 훈련패턴을 생성한다. 이후, 군집신경망기법을 이용하여 중요부재에 대한 손상위치 및 손상정도를 20가지 손상경우에 대하여 추정한 결과, 모든 손상 경우에 대하여 성공적으로 손상을 판정할 수 있었으며, 군집신경망기법을 적용함으로써 추청결과의 정확성이 향상됨을 알 수 있었다. 또한 실험연구를 통하여 기법을 검증하였는데, 3가지 손상경우에 대하여 손상을 추정한 결과 합리적으로 손상을 추정할 수 있었다.

• 의료법학
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• 제21권1호
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• pp.153-185
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• 2020

불가항력 의료사고 보상사업의 근거 법률인 현행 「의료사고 피해구제 및 의료분쟁 조정 등에 관한 법률」 제46조제1항에서는, 보건의료인이 충분한 주의의무를 다하였음에도 불구하고 불가항력적으로 발생한 '분만에 따른 의료사고'를 사업의 대상으로 정하고 있다. 또한, 동법 시행령에서 보건의료기관개설자 중 분만실적이 있는 자가 보상재원의 30%를 부담하게 규정하고 있는바, 이에 대하여 헌법재판소에서는 2015헌가13 결정을 통해 의료분쟁조정법에서 위 사업의 분담금 납부의무자의 범위와 보상재원의 분담비율을 시행령에 위임하였다고 하여 헌법에 위반되지 않는다고 결정한 바 있다. 그러나 이는 의료진으로 하여금 의료과실이 없는 분만사고에 대하여 금전적으로 보상하게 하는 것으로 과실책임주의를 배제한 것인바, 이 제도의 본질이 사회보상적 성격을 갖는 사회보장제도의 일종이라면, 보건의료개설자의 비용분담 규정을 삭제하고 국가가 비용 전부를 부담하는 방법을 고려할 수 있을 것이다. 다만, 이와 더불어 의료사고 원인분석 및 재발방지 조치 등 의료기관의 노력을 강화하기 위한 제도적 장치를 함께 검토할 필요가 있다. 더불어, 의료분쟁조정법상 보건의료개설자가 부담하여야 할 보상재원의 분담비율의 상한을 정하는 것이 포괄위임금지원칙의 취지에 부합할 것이다. 한편, 의료사고 보상심의위원회의 분담금 지급기준과 관련하여, 시행령에서 보상의 기준이 되는 재태주수, 출생체중 등을 적시하고, 그 세부기준을 의료사고 보상심의위원회에서 정함이 타당하다. 마지막으로 불가항력 의료사고 보상사업에서 보상의 회색지대를 방지하기 위함은 물론, 의료'과실'이 규범적 판단임을 고려할 때 위 동법 제48조 제1항의 규정에서 '보건의료인의 과실이 인정되지 않는다는 취지의 감정서가 제출되고'의 요건은 삭제하는 것이 바람직하며, 반드시 의료중재원 조정·중재절차가 선행되어야 하는 현행의 규정을 개선할 필요가 있을 것이다.

• 한국치위생학회지
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• 제11권6호
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• pp.1017-1025
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• 2011

Objectives : Periodontal disease is a serious oral disease that frequently occurs among adults. The objective of this study is to provide necessary data for the development of an oral health care program that can effectively manage periodontal disease and subsequently maintain and enhance oral health. Methods : Data was collected from patients of a dental clinic in Daejeon, Korea from 1 July to 25 August 2009. A thesis submitted to the Committee of Graduate School of Public Health & Biotechnology Chungnam National University in partial fulfillment of the requirements for the degree of Master of Public Health conferred in February, 2010. Results : 68% of the patients were aware of periodontal disease, with older patients exhibiting better awareness. 48.0% replied that their periodontal health is good in general, with older patients inclined to say that their periodontal health was poor. 70.5% cited bad brushing habit or skipping the act of tooth brushing as the cause of periodontal disease, while 63.5% reported brushing their teeth an average of 3 times a day. 56.5% said that they brush their teeth correctly, and 63.5% told that they brush their teeth up and down, and left to right and 70.0% replied that they would attend an educational program for the prevention of periodontal disease, with older patients shown to more likely attend such a program. Conclusion : a program that can motivate people to become aware of the importance of oral health care should be developed and implemented. Such a program should include the dissemination of correct and accurate oral health care information and measures for educating people about the importance of prevention.

• Journal of Preventive Medicine and Public Health
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• 제39권4호
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• pp.293-301
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• 2006

The preventive medicine learning objectives, first developed in 1977 and subsequently supplemented, underwent necessary revision of the contents for the fourth time to create the fifth revision. However, the required educational contents of health promotion and disease prevention have been changed by the new trends of medical education such as PBL and integrated curriculum, the rapid change of the health and medical environment and the globalization of medicine. The Korean Society of Preventive Medicine formed a task force, led by the Undergraduate Education Committee in 2003, which surveyed all the medical colleges to describe the state of preventive medicine education in Korea, analyzed the changing education demand according to the change of health environment and quantitatively measured the validity and usefulness of each learning objective in the previous curriculum. Based on these data, some temporary objectives were formed and promulgated to all the medical schools. After multiple revisions, an almost completely new series of learning objectives for preventive medicine was created. The objectives comprised 4 classifications and 1 supplement: 1) health and disease, 2) epidemiology and its application, 3) environment and health, 4) patient-doctor-society, and supplementary clinical occupational health. The total number of learning objectives, contained within 13 sub-classifications, was 221 (including 35 of supplementary clinical occupational health). Future studies of the learning process and ongoing development of teaching materials according to the new learning objectives should be undertaken with persistence in order to ensure the progress of preventive medicine education.

• Safety and Health at Work
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• 제12권4호
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• pp.511-516
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• 2021

Background: Difficulties in walking and balance are risk factors for falling. This study aimed to predict dynamic balance based on demographic information and anthropometric dimensions in construction workers. Methods: This descriptive-analytical study was conducted on 114 construction workers in 2020. First, the construction workers were asked to complete the demographic questionnaire determined in order to be included in the study. Then anthropometric dimensions were measured. The dynamic balance of participants was also assessed using the Y Balance test kit. Dynamic balance prediction was performed based on demographic information and anthropometric dimensions using multiple linear regression with SPSS software version 25. Results: The highest average normalized reach distances of YBT were in the anterior direction and were 92.23 ± 12.43% and 92.28 ± 9.26% for right and left foot, respectively. Both maximal and average normalized composite reach in the YBT in each leg were negatively correlated with leg length and navicular drop and positively correlated with the ratio of sitting height to leg length. In addition, multiple linear regressions showed that age, navicular drop, leg length, and foot surface could predict 23% of the variance in YBT average normalized composite reach of the right leg, and age, navicular drop, and leg length could predict 21% of that in the left leg among construction workers. Conclusion: Approximately one-fifth of the variability in the normalized composite reach of dynamic balance reach among construction workers using method YBT can be predicted by variables age, navicular drop, leg length, and foot surface.

• 한국환경보건학회지
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• 제45권2호
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• pp.99-112
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• 2019

Objective: This study aims to analyze the characteristics of airborne radon and thoron level ($Bq/m^3$) generated from household products containing monazites, and estimate the effective doses (mSv/yr). Method: Radon & Thoron detector EQF3220 was used to monitor real-time airborne radon and thoron level ($Bq/m^3$), and their daughters ($Bq/m^3$) were recorded every two hours. Effective doses (mSv/yr) for radon and thoron were estimated according to models developed by International Commission on Radiological Protection (ICRP) and United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). Results: The average levels of radon and thoron were $87.8Bq/m^3$ (range; $20.8-156.3Bq/m^3$) and $1,347.5Bq/m^3$ (range; $4-5,839.7Bq/m^3$), respectively. The average equilibrium factors (F) were 0.23 and 0.007, respectively. The levels of radon progeny were far higher than that thoron. Latex mattress showed the highest F (0.38). The average effective doses were estimated to be ICRP (1.9 mSv/yr) and UNSCER (1.3 mSv/yr) for radon and UNSCEAR (1.6 mSv/yr) for thoron. Conclusions: Our results have far exceeded the allowable effective dose for general population (1 mSv/yr). The government's actions such as the ban of use of consumer products containing monazite and the establishment of surveillance system to evaluate health effects for the people affected should be taken as early as possible.

• Journal of Preventive Medicine and Public Health
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• 제55권3호
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• pp.226-233
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• 2022

Objectives: The aim of this study was to evaluate the subjective level of health-related quality of life of Korean healthcare workers using various quality-of-life instruments. Methods: This study included 992 participants, who were doctors and nurses. A survey was conducted between November 28 and December 4, 2019. Data from 954 participants divided into 3 groups (physicians, residents, and nurses) were analyzed. Four measurement tools (29 questions) were used in the survey to evaluate subjective health status and well-being. Results: In the Mayo Well-being Index, burnout during work (88.5%) and emotional difficulties caused by work (84.0%) were frequently cited by the respondents. Regarding questions on burnout and emotional difficulties, residents and nurses had the highest scores (91.0 and 89.6%, respectively). Emotional problems, such as anxiety, depression, and irritability, accounted for a high percentage (73.1%) of the total, while 82.2% of respondents reported that their work schedules interfered with their leisure and family time. There was no significant difference among the groups in subjective health status. However, 10.1% of the residents experienced very low quality of life, which was a higher proportion than that of physicians (2.7%) and nurses (5.2%). Conclusions: The level of well-being that Korean medical workers experienced in relation to work was lower than the results of the United States healthcare workers surveyed using the same tool. This study was unique in that it conducted a subjective quality-of-life survey on Korean healthcare workers.

• Clinical and Experimental Pediatrics
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• 제51권1호
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• pp.33-41
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• 2008

목 적 : 소아 청소년 건강관리에서 혈압 측정의 중요성이 점차 강조되고 있는 시점에서 한국의 소아 청소년들을 위한 정상 혈압 참고 치를 만들고자 하였다. 방 법 : 2005년에 새로운 신체성장 표준치를 만들기 위해 시행한 전국 소아 청소년들의 신체계측사업에 혈압 계측사업을 포함시켜 7-20세에 해당하는 소아 청소년 57,433명(남: 29,443명, 여: 27,990명)에서 신장, 체중 및 혈압 계측치를 얻었다. 혈압은 자동 진동혈압계인 Dinamap Procare 200(GE Inc., Milwaukee, Wi, USA)를 이용하여 측정하였고 앉은 자세에서 안정한 후 우측 팔에서 5분 간격으로 2번 측정하였다. 두 측정치의 평균치를 수축기 혈압과 이완기 혈압으로 기록하여 원 자료로 하였다. 체중이 +3SD 이상인 과체중아들 2,373명의 혈압은 제외하고 분석 하였다. 혈압 백분위수 표는 성별, 연령별, 신장 백분위수별로 만들어 졌으며 통계기법은 2004 Task Force in NHLBI (USA)이 사용한 통계기법을 원용한 고정 변형 LMS 방법을 사용하였다. 결 과 : 성별, 연령별(7-18세), 신장 백분위수별(5th, 10th, 25th, 50th, 75th, 90th, 95th) 혈압 참고치가 완성되었으며 신장 백분위수에 대한 자료는 질병관리본부 홈페이지인 http://www.cdc.go.kr/webcdc/에서 확인 할 수 있다. 고혈압의 기준치는 성별, 연령별, 신장대비에서 95 백분위수 이상으로 하고, 전고혈압 기준치는 90-95 백분위수 또는 수축기 및 이완기 혈압 130/80 mmHg 이상으로 정하였다. 결 론 : 이번에 마련된 우리나라 소아 청소년 정상 혈압 참고치는 처음이기 때문에 사용기준 및 고혈압의 기준은 앞으로 지속적인 논의와 연구가 필요할 것으로 생각된다. 또한 본 혈압 표는 자동 진동혈압계로 마련된 것이기 때문에 수동 수은 혈압계를 이용한 혈압 치를 평가하는 기준표로 사용하는 것은 주의해야 할 것이다.

• Safety and Health at Work
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• 제2권3호
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• pp.229-235
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• 2011

Objectives: In this study, we summarized the External Quality Assessment Scheme (EQAS) for the biological monitoring of occupational exposure to toxic chemicals which started in 1995 and continued until a $31^{st}$ round robin in the spring of 2010. The program was performed twice per year until 2009, and this was changed to once a year since 2010. The objective of the program is to ensure the reliability of the data related to biological monitoring from analytical laboratories. Methods: One hundred and eighteen laboratories participated in the $31^{st}$ round robin. The program offers 5 items for inorganic analysis: lead in blood, cadmium in blood, manganese in blood, cadmium in urine, and mercury in urine. It also offers 10 items for organic analysis, including hippuric acid, methylhippuric acid, mandelic acid, phenylglyoxylic acid, N-methylformamide, N-methylacetamide, trichloroacetic acid, total trichloro-compounds, trans,trans-muconic acid, and 2,5-hexanedione in urine. Target values were determined by statistical analysis using consensus values. All the data, such as chromatograms and calibration curves, were reviewed by the committee. Results: The proficiency rate was below 70% prior to the first round robin and improved to over 90% for common items, such as PbB and HA, while those for other items still remained in the range of 60-90% and need to be improved up to 90%. Conclusion: The EQAS has taken a primary role in improving the reliability of analytical data. A total quality assurance scheme is suggested, including the validation of technical documentation for the whole analytical procedure.