• 한국콘텐츠학회논문지
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• 제18권1호
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• pp.504-516
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• 2018

재정의 지속가능성 확보는 보편적 의료보장(UHC)을 달성하기 위해 필수적이며, 전 세계적으로 재정관리체계 구성요소 중 하나인 전략적 구매기능에 관심이 높아지고 있다. 본 연구에서는 전략적 구매의 개념과 기능을 고찰하고, 한국 건강보험제도에 있어서의 구매기능과 관련 기관을 Preker(2005)가 제시한 전략적 구매 모형에 근거하여 검토하였다. 이를 위하여 관련 문헌을 고찰하였다. 전략적 구매는 주어진 예산의 범위 내에서 국민이 필요로 하는 보건의료서비스를 제공하기 위한 전략적 활동으로 정의된다. 구매관리자는 정부 혹은 국민들을 대신하여 구매 활동을 수행하며, 정부, 구매자, 의료공급자의 관계는 주인-대리인 이론으로 설명될 수 있다. 우리나라에서의 '구매'는 '한정된 재정 내에서 국민이 필요로 하는 보건의료를 제공하기 위한 전략적 활동으로 급여 범위와 대상 설정, 상급종합병원 지정이나 정보 공개 등 양질의 의료서비스 공급자 선정 활동, 급여기준과 가격 설정, 진료비 지불방법의 설계와 운영, 심사와 평가, 모니터링 활동을 포함'하는 것으로 설명할 수 있다. 건강보험심사평가원과 국민건강보험공단이 정부의 위임을 받아 주된 구매활동을 수행하며, 의료기관평가인증원과 한국보건의료연구원 등이 일부 역할을 담당하고 있다.

• 대한간호학회지
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• 제26권3호
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• pp.576-590
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• 1996

Advanced countries such as the USA and Japan are eagerly seeking ways to improve health and welfare of the elderly. One of the services is home health care service using the telephone. Various types of services using the telephone have been developed, improved and are being utilized ranging from the basic consulting to emergency response systems in the area of health care for the elderly. A demonstration project was launched to study the feasibility of a consulting system and telemedicine for the elderly using the public phone system in Korea. For this project, a gathering site for the elderly was selected and those who visited this place were interviewed to find out what kinds of services they wanted and what kind of system they needed to provide the required services. Based on the users' requests and the surrounding environment, a telephone consulting facility was established at the Research Institute of Nursing Science at Seoul National University and consulting personnel was recruited, trained and posted at the center. An Application program for home health care nurses to use when they visited the patients at their homes was developed. This system operates on a notebook Computer and allows nurses to communicate with a doctor at a local hospital through a modem and telecommunication line. These systems were implemented for three months and problems which developed during operation of the systems were identified and progressively modified. Through system evaluation, it was found that a consulting system using phone service will be an invaluable system for the welfare of the elderly in the future. But in order to meet the elderly's need, more services than mere consultation are needed. That is, communication with physicians and hospitals are needed. Thus, when there is any need for physicians' attention, physicians or hospitals should be contacted directly. Similarly for telemedicine, when the home health care nurse visits elderly patients she can assess the patient's problem and provide nursing care, access a physician or hospital to refer her patient to or consult directly using the telecommunication the system. The above mentioned system is a basic form of futuristic telemedicine for the elderly and those who have chronic disease problems. This kind of system will be of great value when it is used on the national information super-highways in the future. In order to get to that stage, of course, this project needs great improvement in the technical, academic, and legal aspects.

• 한국환경보건학회지
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• 제41권4호
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• pp.241-248
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• 2015

Objectives: This study was conducted to provide scientific and effective information on phytoncides, which are associated with forest healing, and to activate recreational forests. Methods: The target sites were natural recreation forests, a forest park and an arboretum, and the control sites were three urban parks. The samples were collected at a volume of 6.0 L and a flow rate of 0.1 L/min for one hour using a low volume pump and the solid adsorbent sampling method. The phytoncide compounds adsorbed in the Tenax TA tube were analyzed by a automatic heat desorption unit and GC-MS. Results: By type of recreational forest, the annual concentrations of phytoncide (monoterpene) for the forest park showed the highest concentration with $1.450{\mu}g/m^3$, while those for the arboretum showed the lowest concentration at $0.892{\mu}g/m^3$, and thus the concentration of the forest park was approximately 1.6 times higher than the arboretum. The season showing the highest concentration of phytoncides was summer (June) and the forest park was the highest among the recreational forests. The concentrations of major components for phytoncide showed in descending order: ${\alpha}-pinene$, ${\beta}-pinene$, camphene, 3-carene and limonene. The seasonal concentration of ${\alpha}-pinene$, camphene and ${\beta}-pinene$ by type of recreational forest increased in April, which is characterized by low temperature and humidity, and the seasonal concentration of camphene decreased with higher humidity. The meteorological factors which had the high correlation with the concentration of total terpene were temperature and humidity. $CO_2$ and $O_2$ showed an inverse correlation. Conclusion: The major components of phytoncide were ${\alpha}-pinene$, ${\beta}-pinene$, camphene, 3-carene and limonene in descending order of concentration. Further and systematic study on the chemical nature of individual phytoncides, and on the effect of phytoncides on humans needs to be performed.

• Journal of Preventive Medicine and Public Health
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• 제42권6호
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• pp.416-423
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• 2009

Objectives : This study was performed to examine medical care utilization of psychiatric patients and to explore patients' characteristics associated with extended hospitalization. Methods : Data were extracted from information of Korean Health Insurance Review and Assessment Service. All data associated with admission and outpatient clinic visit were analysed by patient characteristics. We selected first psychiatric admission patients who diagnosed mental and behavioral disorders due to use of alcohol (main disease code: F10), schizophrenia and related disorders (F20-29) and mood disorders (F30~33) from January to June 2005. We analysed status of admission, mean length of stay, regular access to outpatient clinic and rates of extended hospitalization during 3 years. Bivariate and multivariate analyses were conducted to identify factors associated with extended hospitalization. Results : The number of psychiatric patients during the first six month of 2005 was 30,678. The mean length of stay was longest for schizophrenia and related disorders but shortest for mood disorders. Patients who experienced an extended hospitalization were 18.8% of total subjects. An extended hospitalization was more common in schizophrenia and related disorders than other diagnostic groups. The factors associated with the extended hospitalization were age, sex, diagnostic group, type of insurance and medical care utilization groups. Conclusions : The study indicates the problem of an extended hospitalization for psychiatric patients in Korea. It is suggested that variations in rates of extended hospitalization among medical care utilization group may need an active early intervention system in psychiatric treatment service. Particular attention needs to be devoted to planning and funding for reducing extended hospitalization.

• 치위생과학회지
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• 제5권1호
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• pp.13-17
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• 2005

성남시 지역주민의 구강건강을 증진시키기 위한 장기 지역사회구강보건 개발의 일환으로 학교구강보건사업에 필요한 구강보건 정보를 수집 정리할 목적으로 성남시 12세 아동의 구강건강실태를 조사한 후 분석 검토하여 다음과 같은 결론을 얻었다. 1. 성남시 12세 아동의 영구치우식경험자율은 74.7%, 영구치우식유병자율은 36.2%, 우식경 험영구치지수는 2.75개이었다. 2. 우식영구치율은 전체 28.4%이었는데 수정구의 우식영구치율이 36.8%로 분당구의 19.8% 에 비해 2배 가까운 수치를 보여 지역적 불균형 현상을 나타냈다. 3. 영구치가료필요자율은 1치면 충전을 필요로 하는 비율이 26.6%, 2치면 이상이 13.3%, 인조치관 수복필요가 1.8%, 치수치료 등이 5.3%, 발치필요가 2.2%로 나타났으며 치면열 구전색자율은 27.1%에 불과하였다. 4. 성남시는 12세 아동을 대상으로 한 학교구강보건사업 뿐만 아니라 아동의 구강건강상태 의 경우 구별로 불균형을 보이므로 우식발생이 높은 아동이나 우식발생위험이 높은 지역의 아동을 위한 조기검진치료사업 및 치면열구전색과 같은 우식예방사업을 적극 검토할 필요가 있었다.

• Journal of Preventive Medicine and Public Health
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• 제34권1호
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• pp.1-8
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• 2001

Objectives : To gather information about the factors which influence the interest and intention of admission into charging nursing hones for the elderly(CNH), as these homes represent an important method for resolving the problems related to the rapid population aging occurring in Korea. Methods : A face-to-face interview survey was carried out with 320(men 159, women 165) patients over 60 years old who were admitted at 2 university hospitals and 5 general hospitals in the Busan area between December 1998 and March 1999. Data were analyzed through t-test, ANOVA, correlation and multiple regression analysis. Results : The mean age and years of education of the study population was 67.0 and 7.7 years, and the types of chronic degenerative disease included musculoskeletal disorders(20.1%), cerebrovascular disease(17.1%), and diabetes(14.3%). The major forms of household living arrangement prior to admission were elderly alone(22.6%), and elderly couple(33.5%), while about half of them(55.5%) didn't want to live with their children id the future. Almost half were paying medication fees by themselves(46.6%). The level of actual intention of admission$(3.07{\pm}1.39)$ into a CNH was lower than that of interest$(3.22{\pm}1.33)$(p<0.01). Multiple analysis revealed that the intention of admission increased with decreasing number of future supportive persons$(\beta=-0.107)$, lower level of activity in daily life$(\beta=-0.447)$, and longer years of education$(\beta=-0.447)$ with 32.7% of $R^2$. As for the factors which determined the admission into a CNH, the fee and facilities were considered to be most important, and professional nursing and physician's care were the most desired services. In nomenclature, they preferred 'elderly hospital' or 'elderly health center' to CNH. Conclusions : Interest in CNH is increasing recently, but existing studies about patient experiences in CHN are still limited. This study may form a basis for future examinations of the needs and uses for CNH. Active financial support and public information are considered by the authors to be important factors for the induction of welfare services for the elderly, though CNH.

• 한국재난정보학회 논문집
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• 제19권4호
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• pp.859-868
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• 2023

연구목적: 해군에서 안전을 강화하기 위해 안전보건경영시스템 도입, 위험성 평가체계 개발 등의 노력을 기울이고 있으나 안전사고가 지속 발생하고 있어 안전관리체계에 대한 점검을 통해 발전방안을 제시하였다. 연구방법:해군 안전관리체계 진단을 위해 안전 환경의 변화, 문서체계, 안전보건경영시스템 운영 등을 검토하고 보완점을 찾아 개선방향을 도출하였다. 연구결과:해군의 안전 정책과 안전관리 방향을 제시할 수 있는 SMS 기준서와 이를 표준화된 방법으로 시행할 수 있는 지침을 제공하는 안전프로그램이 필요한 것을 확인하였다. 이 SMS에는 미 해군의 SMS, 국제표준 ISO 45001 규격과 우리 해군의 기존 안전관리체계를 포함한다. 결론: 해군의 안전관리체계는 안전정책과 기준을 명확하게 제시하고, 이를 시행할 수 있는 표준프로그램을 통해 안전업무의 공신력과 효용성을 갖추는 것이 필요한데 이를 위한 해군 SMS 개발이 필요하다.

• 대한장애인치과학회지
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• 제13권2호
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• pp.99-103
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• 2017

본 증례는 Pallister-Killian 증후군 및 뇌성마비, 외상성 뇌손상이 있는 환자의 보호자에게 구강위생 관리 교육 및 동기부여를 시행하기 위한 방법 중 QLF-D를 사용한 경우이다. 치과치료에 대한 접근성이나 협조도에 어려움이 있는 장애 아동에서 치아 우식의 조기탐지 및 회복에 대한 객관적인 진단 장비, 보호자 교육 및 동기부여에 대한 효과적인 시각적 교육 자료로서 QLF-D가 유용하게 사용될 수 있다. 더 나아가 구강 건강 증진을 통한 장애 아동의 삶을 질 개선을 기대할 수 있다.

• Journal of Preventive Medicine and Public Health
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• 제43권6호
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• pp.535-542
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• 2010

Objectives: Exposure assessment is a major challenge faced by studies that evaluate the association between pesticide exposure and adverse health outcomes. The objective of this study was to investigate the reliability of information that farmers self-report regarding their pesticide use. Methods: Twenty five items based upon existing questionnaires were designed to focus on pesticide exposure. In 2009, a selfadministrated survey was conducted on two occasions four weeks apart among 205 farmers residing in Gyeonggi and Gangwon provinces. For a reliability measure, we calculated the percentage agreement, the kappa statistics and the intraclass correlation coefficient (ICC) between the two reports according to the characteristics of the subjects. Results: Agreement for ever-never use of any pesticide was 96.4% (kappa 0.61). For both 'years used' and 'age at the first use' of overall pesticides, high agreement was obtained (ICC: 0.88 and, 0.78, respectively), whereas those of 'days used' and 'hours used' were relatively low (ICC: 0.42 and, 0.66, respectively). The kappa value for the use of personal protective equipment ranged from 0.46 to 0.59, and hygiene activities came out at 0.19 to 0.37. The agreement for individual pesticide use ranged widely and there was relatively low agreement due to the low response rates. The reliability scores did not significantly vary according to gender, age, the education level, the types of crop or the years of farming. Conclusions: Our results support that carefully designed, self-reported information on ever-never pesticide use among farmers is reliable. However, the reliability of data on individual pesticide exposure may be unstable due to low response rates and needs to be refined.

• 한국재난정보학회 논문집
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• 제1권1호
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• pp.3-26
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• 2005

In recent years, there is growing concern about the potential use of biological agents in war or acts of terrorism accompanied an increased realization that rapid preparedness and response are needed to prevent or treat the human damage that can be caused by these agents. The threat is indeed serious, and the potential for devastating numbers of casualties is high. The use of agents as weapons, even on a small scale, has the potential for huge social and economic disruption and massive diversion of regional and national resources to combat the threat, to treat primary disease, and to clean up environmental contamination. Biological weapons are one of weapons of mass destruction (or mass casualty weapons, to be precise. since they do not damage non-living entities) that are based on bacteria, viruses, rickettsia, fungi or toxins produced by these organisms. Biological weapons are known to be easy and cheap to produce and can be used to selectively target humans, animals, or plants. Theses agents can cause large numbers of casualties with minimal logistical requirements (in wide area). The spread of disease cannot be controlled until there is awareness of the signs of infection followed by identification of agents; and if the organism is easily spread from person to person, as in the case of smallpox, the number of casualties could run into the tens of thousands. Biological weapons could be used covertly, there can be a lot of different deployment scenarios. A lot of different agents could be used in biological weapons. And, there are a lot of different techniques to manufacture biological weapons. Terrorist acts that make use of Biological Agents differ in a number of ways from those involving chemicals. The distinction between terrorist and military use of Biological Weapon is increasingly problematic. The stealthy qualities of biological weapons further complicate the distinction between terrorism and war. In reality, all biological attacks are likely to require an integrated response involving both military and civilian communities. The basic considerations when public health agencies establish national defence plan against bioterrorism must be 1) arraying various laws and regulations to meet the realistic needs, 2)education for public health personnels and support of concerned academic society, 3)information collection and cooperative project with other countries, 4)Detection and surveillance(Early detection is essential for ensuring a prompt response to biological or chemical attack, including the provision of prophylactic medicines, chemical antidotes, or vaccines) and 5) Response(A comprehensive public health response to a biological or chemical terrorist event involves epidemiologic investigation, medical treatment and prophylaxis for affacted persons, and the initiation of disease prevention or environmental decontamination measures). The purpose of this paper is providing basic material of preparedness and response for biological terrorism in modern society.