• Journal of Preventive Medicine and Public Health
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• 제20권1호
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• pp.165-203
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• 1987

This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, $85{\sim}90%$ of the services provided by the health workers were other than FP/MCH, mainly for immunizations such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs.31%) and for more combined care (45% vs.23%). C) Organization factors (admistrative integrative issues) 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following ; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub·center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwive's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea); 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through family planning practice. 2) Goal consensus in FP/MCH shouBd be made among the health workers It administrators, especially to emphasize the need of care of 'wanted' child. But there is a long way to go to realize the 'real' integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (in) there should be a health sub·center director who can provide leadership training for managing the integrated program. There is a need for 'organizational support', if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the managment of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Worker, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.

• 대한간호학회지
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• 제33권2호
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• pp.256-264
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• 2003

Purpose: The purpose of this research was to find out tobacco control education taught graduate, baccalaureate and associate degree-nursing programs in Korea. Method: A valid and reliable questionnaire previously used to assess tobacco use in medical and nursing schools in the United States was translated and revalidated. Surveys were sent out to all the graduate, baccalaureate and associate nursing programs in Korea. All 6-tobacco curricula content areas recommended by the United States National Cancer Institute and the Agency for Health Care Policy and Research was included. Result: Majority of BSN (93.2%-75%) and AD (92.3%-64.1%) programs were teaching health hazards, cancer risk, health effects of tobacco, effects of ETS, contents of cigarette, withdrawal symptoms and high risk groups of smoking as a part of required courses. However, 87.5% (14/16) of graduate, 50.0% (22/44) in baccalaureate, 53.8% (21/39) in associate degree programs were not teaching about the 5 A's. Of those who reported teaching smoking cessation strategies, they were covered most frequently in Community Nursing (50%), Adult Health Nursing (43.8%) on the graduate level, and in Community Nursing (65.9%-BSN, 76.9%-AD) and Adult Health (54.5%-BSN, 74.4%-AD) on the undergraduate level. 31.1% (5/16) in Graduate, 18.2%(8/44) in BSN, 10.3% (4/39) in Associate Degree programs reported that there are no smoking students in their schools and rest of the schools reported either do not know or they have 1 to more than 21% of students smoking. Conclusion: The study results identifies the quantity and level of tobacco control content in three different nursing programs and will help in developing curricular guidelines in the future. Further survey needs to be done on nursing students' knowledge, attitude and belief on smoking and smoking cessation.

• 한국산학기술학회논문지
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• 제10권3호
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• pp.634-641
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• 2009

보건복지가족부 질병관리본부의 건강관리를 위한 지역 코호트사업으로 금산군 1개읍 9개면에 거주하는 만 40세이상부터 70세까지의 주민 중 본 연구에 참여의사를 밝힌 임의 추출된 총 2,007명(남: 868명, 여: 1,139명) 중 부부가 함께 조사된 297쌍(594명)을 대상으로 배우자의 고혈압 위험요인이 상대 배우자의 고혈압에 미치는 영향을 조사한 결과는 다음과 같다. 고혈압 위험요인은 아내가 대사증후군이 있는 경우(OR=2.879), 현재 음주자(OR=1.892)에서 높았다. 아내 고혈압에 대한 남편의 고혈압 위험요인은 연령(OR=1.037), 비만(OR=1.922), 대사증후군(OR=4.100), 중성지방(OR=1.793)에서 높았다. 결론적으로 농촌지역 부부들에서 함께 공유하는 공간과 시간에서 고혈압에 영향을 주는 요인은 연령, 체질량지수, 대사 증후군이 중요하므로 이에 대한 관리가 필요하다고 본다.

• 여성건강간호학회지
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• 제28권1호
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• pp.65-73
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• 2022

Purpose: This study investigated Korean healthcare providers' attitudes toward sexual and gender minority (SGM) persons and their knowledge and behavior concerning the collection of data on sexual orientation and gender identity (SO/GI). Methods: In this cross-sectional, descriptive study, 137 Korean healthcare providers were recruited through convenience sampling from internet communities for medical professionals. A structured questionnaire was created using Google Surveys. The Mann-Whitney U-test, Kruskal-Wallis test, and Spearman correlation analysis were performed. Results: The sample was mostly women (80.3%) and nurses (83.9%), who had overall negative attitudes toward SGM persons and low levels of knowledge and behavior with regard to the collection of patients' SO/GI data. Participants in their 20s, who were religious, and had clinical experiences in treating or providing nursing care for SGM persons had higher levels of knowledge about the collection of SO/GI data. The level of engagement in collecting SO/GI data was higher among women and in their 20s and 30s, unreligious participants, nurses, and those with less than 10 years of clinical experience. Positive attitudes toward SGM persons were associated with higher levels of knowledge, but lower levels of behavior, regarding the collection of SO/GI data. Conclusion: It is important to recognize the diversity of patients' SO/GI and to collect the corresponding information. To this end, it is necessary to develop and use a standardized SO/GI form. Healthcare providers should also receive education and training related to the health of SGM persons to resolve health problems that disproportionately affect SGM persons and related health disparities.

• 보건교육건강증진학회지
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• 제19권3호
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• pp.97-105
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• 2002

This study attempts to develop a program for obesity prevention and management for students in primary, middle, and high school and was carried based on the program development process as suggested by Ewles and Simnett. Data were collected from September 1st to September 30th, 2000. The study method is as follows: 1) Reviewing the present obesity control programs practiced in primary, middle, and high school (196 schools total) in metropolitan, medium-sized, and small cities, 2) Surveying obesity students'(682 students total) perception of the obesity management in their school. 3) Reviewing the annual plan for obesity in primary, middle, and high schools 4) Analyzing the educational data (CD, VIDEO) for obesity The results are as below: I. The media researched related to obesity were mainly CD and video, aimed primarily primary school students and are biased in nature. 2. The results of how to manage obesity in students: the difficulty of obesity education in the primary school, is the arousal of a sense of shame among obese students and the lack of various educational data are the most. In the middle and high schools, a lack of various educational data, and no time or lack of time were prevailing concerns. Paramount in managing obesity is weight control, as answered by majority of primary, middle, and high school students. The major problem of obesity management is the non-cooperation of children. 3. Asked whether the weight controlling aspect of health care class was helpful or not, 51.4% of primary school students, and 71.6% of middle and high school students answered not. The most popular educational method used in health care class is the computer, with a 56.4% approval rating. Most 43.5% of respondents answered that they wanted the content of obesity management program to focus on how to lose weight. Therefore, based on the results, the obesity management program is constructed to the steps of assessment, planning, implementation, and evaluation. Assessment includes administering surveys on health needs among students and their parents and physique tests. Planning includes the set-up of long term and short term educational goal and the establishment of an operation system. Implementation includes education, exercise, behavior modification, and health service programs. Evaluation includes step-by-step evaluations for obesity reduction. After this study is conducted, the following should be further researched: More practical and systematic obesity management programs should be developed for the evaluation results. In addition, it is important to develop an appropriate media for obesity management the primary, middle and high school students.

• 한국산학기술학회논문지
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• 제13권7호
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• pp.3094-3101
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• 2012

본 연구는 병원에서 제공하는 입원 서비스에 대한 입원환자 만족도를 분석하여 보다 나은 의료서비스를 제공하는데 활용하고, 의료서비스를 향상시켜 타 병원과의 경쟁에서 우위에 설 수 있도록 기초자료를 제공하고자 본 연구를 시도하였다. G시에 소재한 지방 상급종합병원의 입원환자를 대상으로 2011년 9월19일부터 9월 30일까지 설문조사를 실시하여 320부를 최종 분석한 결과, 첫째, 입원환자 서비스 만족도는 총 4점 만점에 평균 3.25점이였고, 둘째, 일반적 특성과 의료인서비스 만족도 결과는 진료과, 건강상태, 입원횟수에서, 병원 환경. 입 퇴원 절차 및 기타서비스 만족도에서는 연령, 진료과, 건강상태, 입원횟수에서 통계적으로 유의하였다. 셋째, 입원환자 서비스 만족도간의 상관관계에서는 통계적으로 유의미한 정(+)의 상관관계를 보였고, 넷째, 입원환자 만족도에 미치는 요인을 분석한 결과 의사서비스와 기타서비스가 통계적으로 유의미한 정(+)의 영향을 미치는 것으로 나타났다. 결론적으로 입원환자 만족도를 높이기 위해서는 환자와 접촉이 상대적으로 많은 진료과의 인력을 충분히 확보하고 입원기간 동안 환자가 만족 할 수 있는 다양한 프로그램 개발과 운영이 요구되며, 그에 따른 효과를 검증할 수 있는 후속 연구가 필요하다.

• 대한지역사회영양학회지
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• 제27권5호
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• pp.406-421
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• 2022

Objectives: The purpose of this study was to investigate the blood biochemical characteristics, comorbidities, dietary intake, and other risk factors leading to poor glycated hemoglobin (HbA1c) control in elderly Korean diabetes patients over 65 years of age. Methods: Data from the 4^th (2007-2009) and the 7^th (2016-2018) Korea National Health and Nutrition Examination Surveys (KNHANES) were used. Socio-demographic characteristics (age, gender, region, household income, education level, marital status, nutrition education, diabetes duration and diabetes treatment), lifestyle characteristics (drinking, smoking, regular walking, and subjective health perception), anthropometric characteristics (height, weight, and waist circumference), blood biochemical characteristics (HbA1c, high- density lipoprotein cholesterol, triglycerides, total cholesterol, blood urea nitrogen, and blood creatinine), co-morbidities (obesity, hypertension, hypercholesterolemia, hypertriglyceridemia, and anemia), energy and nutrients intake, food group intake, and HbA1c control-related risk factors were compared. Results: Compared to the 4^th survey, the 7^th survey showed an increase in diabetes prevalence among men, an increase in the prevalence of diabetes in the older patients, and an increase in the duration of diabetes. The energy ratio from carbohydrate consumption in the 7^th survey was lower than in the 4^th. Compared to the 4^th survey, thiamine and riboflavin intake had improved, and the intakes of vitamin A, vitamin C, and niacin had worsened in the 7^th. A comparison of food group intakes showed that there was a decrease in the consumption of whole grains, potatoes, and milk and an increase in the intake of beverages and alcoholic beverages. The risk factors for poor control of HbA1c were the duration of diabetes and co-morbid hypertriglyceridemia in the 4^th survey, whereas subjective health perception, obesity, and hypercholesterolemia as co-morbidities were found to be risk factors in the 7^th in addition to the risk factors highlighted in the 4^th survey. Conclusions: For the future management of elderly Korean diabetes patients, greater care is indicated for men over 75 years, and those with low levels of education. It is necessary to increase the intake of milk and vegetables, and reduce the intake of beverages and alcoholic beverages. In addition, it is necessary to reduce the incidence of obesity, hypercholesterolemia, and hypertriglyceridemia for proper control of blood sugar.

• 대한장애인치과학회지
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• 제9권2호
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• pp.85-90
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• 2013

The aim of this research is to compare the attitude toward the special needs of dental staffs between the special dental clinic (SDC) and the general dental clinic (GDC). Surveys were done on 21 dental staffs (7 dentists and 14 dental hygienists) of SDC and 47 dental staffs (10 dentists and 37 dental hygienists) of GDC. Attitudes were rated on a questionnaire with the five-point Likert scale. Mann-Whitney test was utilized for statistical analysis. In SDC, more female dentists and dental staffs who have relatives with disability were working. Dental staffs of SDC showed that the more experience they had, the more positive attitudes toward the communication with the patients with special needs (p<0.05). Dental staffs of SDC represented more active attitudes toward the oral health promotion, treatment, research and volunteering (p<0.05). In conclusion, dental staffs who have personal motivation were working in SDC and the experience of dental treatment to the patients with special needs influenced the dental staffs' attitudes toward them. In future, a research about the attitude toward the disabled with more exact scale should be followed.

• 보건교육건강증진학회지
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• 제23권5호
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• pp.47-73
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• 2006

Objectives: This study aims to identify gaps between knowledge regarding migration and the spread of HIV/AIDS, to improve understanding of migrants with HIV/AIDS and their human rights, and to make suggestions for Korean policy makers to reform laws and policies towards granting migrants with HIV/AIDS more human rights and access to treatment and care. Methods: This study is based on an extensive literature review, questionnaire surveys and in-depth interviews from randomly selected 8 countries from 5 different continents: Japan from Asia; Australia from Oceania; Finland, Germany, Ireland and United Kingdom(UK) from Europe; and Canada and United States of America(USA) in North America. Results: This study has found that Korea has a discriminating policy regarding HIV/AIDS and foreigners. Classifying HIV/AIDS into a legal communicable disease, it requires a presentation of HIV/AIDS test results from foreigners wanting a long-term stay before entering. In principle, foreigners with HIV/AIDS cannot either enter or stay in Korea. If they are known infected with HIV/AIDS by any reason, they became to face an immediate deportation regardless of their sojourn statuses and purposes. Conclusion: With the results, this study suggests three reasons why Korean government needs to change the current HIV/AIDS policy on foreigners: 1) HIV-related travel restrictions have no public health justification, 2) its strict HIV/AIDS policy on foreigners could result in restriction on the mobility and migration of its people by the other countries, inversely, and 3) it needs to meet international guidelines and to observe conventions that international organizations suggest to maintain its status as a member of the international society.

• 한국융합학회논문지
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• 제11권12호
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• pp.429-438
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• 2020

본 연구의 목적은 국제 교류 융합 활성화를 위하여 동남 아시아 간호대학을 대상으로 한국 간호에 대한 요구도를 조사하는 것이다. 본 연구에서는 태국, 베트남, 필리핀에 거주하는 교수와 학생들을 대상으로 Google Form을 활용하여 두 번에 나누어 설문 조사를 실시하였다. 첫 번째 설문조사에서는 간호교육의 큰 범주내에서 요구도 조사를 실시하고, 응급간호와, 감연관리에 관련된 주제가 가장 요구도가 높게 나타났다. 두 번째 설문조사에서는 첫 번째 설문조사결과에 근거하여 세부주제에 대한 요구도를 조사하기 위하여 실시하였고 결과 응급간호에서는 응급환자 중증도 분류가 우선순위가 가장 높은 주제에서 빈도가 제일 높게 나타났으며, 감염관리에서는 COVID-19과 같은 신종감염병에 대한 관리가 우선순위가 가장 높은 주제에서 빈도가 제일 높게 나타났다. 본 연구의 결과를 바탕으로 가장 빈도가 높은 순위에 따라 콘텐츠를 개발하여 국제교류프로그램에 활용할 것에 대하여 제안한다.