• 보건행정학회지
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• 제4권1호
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• pp.49-76
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• 1994

Small area variations in health care utilization have long been studied as an important issue related to boto cost containment and quality assurance. This study was conducted to investigate if variations in hospital services across small geographic areas in Korea existed. The claims data of the fiscal year 1992 obtained from the regional health insurance societies were used for the study. Main findings of the research can be summarized as follows : 1. Extremal Quotients(EQ) of hospital expenditure per capita and hospital days per capita varied among diagnosis types. The EQ ranged from 2.05(cataract) to 41.67(pneumonia) in hospital expenditure per capita and from 1.86(cataract) to 45.89(pneumonia) in hospital days per capita. The diagnosis groups which showed high variation were pneumonia, cephalo-pelvic disproportion, gastritis and duodenitis, fracture of rib, and acute bronchitis. Those which showed low variation were acute appendicitis and cataract. 2. The EQ level of admission rate was different in terms of diagnosis types, ranging from 2.57(catarct) to 44.45(pneumonia). The variations were high in medical disorders such as pneumonia, oephalo-pelvic disproportion, gastritis and duodenitis and acute bronchitis, while relatively low in surgical conditions such as acute appendicitis and cataract. 3. As an indicator of service intensity, the EQ of expenditure per admission ranged from 1.67(acute appendicitis) to 31.27(essential hypertension). The diagnoses which had high variation were essential hypertension, gastric ulcer, whereas those which had low variation were cephalopelvic disproportion and acute appendicitis. With regard to hospital days per admission, the EQ ranged from 1.55(acute appendicitis) to 28.13(gastric ulcer) by diagnosis types. The diagnosis groups with showed high variation were gastric ulcer, essential hypertension, and acute bronchitis, whereas those with low variation were cephalo-pelvic disproportion, intervertebral disc disorders, and acute appendicitis. Both the expenditure and hospital days per admission showed lewwer variations than the expenditure per capita, hospital days per capita and admission rate. 4. Comparing patterns of variation in utilization indices, diagnoses such as essential hypertension, gastric ulcer, fracture of rib showed higher variations in expenditure per admission than in admission rates, whereas diagnoses such as pneumonia, cephalo-pelvic disproportion and gastric ulcer showed higher variations in admission rate than expenditure per admission. These findings suggest that wide variations existed in several diagnoses groups across small areas in Korea. Further research should be performed to investigate factors related to small area variations including provider behavior.

• 의료법학
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• 제18권1호
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• pp.199-235
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• 2017

생명공학 연구자들의 중요한 이해 관심 중 하나는 연구를 목적으로, 현재 사용될 수 있거나 미래를 위해 보관될 수 있는 인체유래물을 다루는 것에 관한 논의이다. 본 논문은 인체유래물 연구에서 동의서 없는 폐기용 인체유래물의 재활용을 위한 정당성 모색을 목적으로 한다. 미래의료가 유전체 연구를 통해 예방 의료로 패러다임을 바꿀 것이라는 것은 널리 알려진 사실이다. 선진국들은 인간 유전체 연구를 위해 바이오 뱅크를 설립하여 연구자들을 지원해 오고 있으며, 한국 역시 마찬가지이다. 그런데 현재 한국의 인체유래물 연구자는 기증자의 동의서가 미비된 경우, 인체유래물을 보관할 수는 있으나 사용할 수는 없다. 뿐만 아니라, 인체유래물 연구 자원이 사용 기간이 한정 표시된 동의서로 인해 폐기되기도 한다. 그러나 필자들은 동의서 미비로 인해 현재 폐기되기만을 기다리는 바이오뱅크의 인체유래물이 매우 제한된 조건 하에서는 활용가능하며, 이러한 재활용에 정당한 근거가 있음을 주장한다. 이를 위해 바이오뱅크 및 인체유래물 활용과 관련된 법조문을 고찰하며 동의없는 인체유래물의 활용과 관련하여 제기될 수 있는 윤리적 문제에 대해 검토하고, 바이오뱅크의 폐기용 인체유래물의 재활용 근거를 모색한다.

• 한국방사선학회논문지
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• 제15권5호
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• pp.667-673
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• 2021

4차 산업혁명 시대에 진입하면서 방사선 의료 기술 개발의 혁신 및 고도화에 따라 방사선사의 업무 범위는 더욱더 확대될 것으로 판단된다. 본 연구에서는 의료장비 및 방사선사 인력 현황을 파악하여 4차 산업혁명시대 변화에 있어 방사선 의료기술분야 인재 양성 계획, 진로 및 취업 상담에 기초자료를 제공하고자 하였다. 보건의료 빅데이터를 이용하여 2020년부터 2분기 자료와 2021년 2분기 자료를 통해 분석하였다. 연구결과 2020년 대비 2021년 종별 의료장비 현황 비교 결과 C-Arm X-선 검사 장비가 6,638대로 5.83% 가장 높게 증가하였으며, 다음 순으로 MRI 검사 장비 1,811대 5.29%, 혈관조영 검사 장비 725대 5.22%, 일반 X-선 검사 장비 21,557대 3.99%, CT 검사 장비 2,136대 3.03%, 유방 검사 장비 3,425대 3.00% 증가하였다. 2020년 대비 2021년 전체 방사선사 인력 현황 비교 결과 29,038명으로 2.73% 증가하였다. 지역별 방사선사 인력 현황 비교 결과 경기 지역에서 5.96%로 가장 높게 증가하였으며, 다음순으로 강원 지역 5.66%, 충남지역 3.81% 증가하였다. 의료장비 및 방사선사 인력이 증가하는 상황에서 대학에서는 4차 산업혁명 시대의료 방사선 기술영역에서 적용할 수 있는 맞춤형 인공지능 및 빅데이터에 관한 이해 및 활용과 관련된 교과목 개발을 통한 전문적 지식과 실무역량을 갖춘 방사선사 양성이 필요하며, 협회 차원에서는 새로운 일자리 창출 및 취업 향상을 위한 적극적인 정책이 필요할 것으로 생각된다.

• Journal of Preventive Medicine and Public Health
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• 제7권1호
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• pp.211-222
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• 1974

The survey was carried out on 1,031 primary school children for about 1 month, from June 1, to June 30, 1974, for the purose of understanding indirectly scio-medical status of a remote rural area, reflecting health status of primary school children. The summarized results were as follows: 1) The average age of surveyed children according to school year by sex was older in girls than in boys. The entrance in school at suitable age was peaked as 80.9% in boys of 5th school year and 72.4% in girls of 3rd school year, and also sunk 68.8% in boys of 2nd school year and 58.7% in girls of 1st school year. 2) Prevalence rate according to W.H.O. diseases classification during last a month and a year. a) During last month: The diseases of respiratory system remarked the highest 101.1 in boys and 116.6 in girls. The next were diseases of digestive system (24.2 in boys and 32.1 in girls), The girls were higher than boys in prevalence rate. b) During last year: The diseases of diegestive system ranked the highest 133.0 in boys and next, the diseases of respiratory system (108.6 in boys). c) Present illness: Number of code III ranked the highest 129.2 and next XII(127.3) in boys but inverted in girls such as XII(144.9) and III(116.7) and also, Number of code XVII was prevalenced twice in boys than in girls. d) Chief complaints by sex: Abdominal pain ranked the highest 71.2 per 1,000 population and next headache (34.7) in boys but headache ranked the heighest 88.5 and next abdominal pain (63.3) in girls. e) Water drinking habit: Number of code IX was higher in habit of raw water drinker than in habit of boiled water drinker and healthy children were higher in boiled water habit group than in raw water habit group. The diseases of respiratory system were the highest 124.74 in girls and next, the diseases of digestive system (52.3 in girls). According to school year, healthy children were increased to higher grades. 3) Average sick day per total surveyed children and patient during last month and last year. a) Per surveyed 1,031 children was 0.28 days during last month and 0.98 days during last year. And also per patient was 1.78 days during last month and 3.22 days during last year. b) Average sick day was higher in girls than in boys during last month, but inverted during last year. 4) Average absented day per total surveyed children and patient during last month and last year. a) Per surveyed 1,031 children were 0.43 days during last month and 3.81 days during last year (omitted 1st school year). b) Per absented children were 2.0 days during last month and 7.10 days during last year. c) Per absented children were 8.16 days in boys and 3.17 days in girls. 5) Utilization of medical facilities: The drug-store was consulted 91.2% of the total utilized boys and girls. The strengthening of medical facilities and medical care activities in health subcenter is urgently required 6) Medical Expenses by period and sex: a) Average medical expenses per surveyed 1,031 children were 35.95 won, per patient were 298.04 won during last month. b) Average medical expenses per survey children (omitted 1st school year) were 80.56 won, per patient were 243.98 won and per treated patient were 318.87 won during last year. c) Medical expenses were higher in boys than in girls. 7) Rohrer index by sex, present illness and school year. a) Average Rohrer index was 129.8 in boys and 126.2 in girls. b) Average Rohrer index was increased for 1st school year to 2nd school year and thereafter falling down step by step by school year. c) Under 151-160 Rohrer index number of code III was the highest and above 151-160 Rohrer index of code XII was peaked.

• Journal of Preventive Medicine and Public Health
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• 제5권1호
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• pp.57-95
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• 1972

This study was conducted to assess the effectiveness of service by maternity aids concerning maternal and child health in improving simultaneously infant mortality, contraception and vital registration among expectant mothers in rural Korea, where there is less apportunity for maternal and child health care. It is unrealistic to expect to solve this problem in rural Korea through professional persons considering the situation of medical facilities and the socioeconomic condition of residents. So, we intended to adopt a system of services by maternity aids who were educated formally among indigenous women. After the women were trained in maternal and child health, contraception, and registration for a short period, they were assigned as a maternity aids to each village to help with various activities concerning maternal and child health, for example, registration of pregnant women, home visiting to check for complications, supplying of delivery kits, attendance at delivery, persuasion of contraception, and invitation for registration and so on. Mean-while, four researchers called on the maternity aids to collect materials concerning vital events, maternal child health, contraception and registration, and to give further instruction and supervision as the program proceeded. A. Changes of women's attitude by services of maternity aid. Now, we examined to what extent' such a service system to expectant mothers affected a change in attitude of women residing in the study area as compared to women of the control area. 1) In the birth and death places, there were no changes between last and present infants, in study or control area. 2) In regard to attendants at delivery, there were no changes except for a small percentage of attendance (8%) by maternity aid in study area. But, I expect that more maternity sids could be used as attendants at delivery if they would be trained further and if there was more explanation to the residents about such a service. 3) Considering the rate of utilization of sterilized delivery kit, I am sure that more than 90 percent would be used if the delivery kit were supplied in the proper time. There were significant differences in rates between the study and the control areas. 4) Taking into consideration the utilization rate of the clinic for prenatal care and well baby care, if suck facilities were installed, it would probably be well utilized. 5) In the contraception, the rate of approval was as high as 89 percent in study area as compared to 82 percent in the control area. 6) Considering the rate of pre-and post-partum acceptance on contraception were as much as 70 percent or more, if motivation to use contraception was given to them adequately, the government could reach the goals for family planning as planned. 7) In the vital registration, the rate of birth registration in the study area was some what improved compared to that of the control area, while the rate of death registration was not changed at all. Taking into account the fact that the rate of confirmation of vital events by maternity aids was remarkably high, if the registration system changed to a 'notification' system instead of formal registration ststem, it would be improved significantly compared to present system. B. Effect of the project Thus, with changes in the residents' attitude, was there a reduction in the infant death rate? 1) It is very difficult problem to compare the mortality of infants between last and present infants, because many women don't want to answer accurately about their dead children especially the infants that died within a few days after birth. In this study the data of present death comes from the maternity aides who followed up every pregnancy they had recorded to see what had happened. They seem to have very reliable information on what happened in first few weeks with follow up visitits to check out later changes. From these calculaton, when we compared the rate of infant death between last and present infant, there was remarkable reduction of death rate for present infant compare to that of last children, namely, the former was 30, while the latter 42. The figure is the lowest rate that I have ever heard. As the quality of data we could assess by comparing the causes of death. In the current death rate by communicable disease was much lower compare to the last child especially, tetanus cases and pneumonia. 2) Next, how many respondents used contraception after birth because of frequent contact with the maternity aid. In the registered cases, the respondents showed a tendency to practice contraception at an earlier age and with a small number of children. In a comparison of the rate of contraception between the study and the control area, the rate in the former was significantly higher than that of the latter. What is more, the proportion favoring smaller numbers of children and younger women rose in the study area as compared to the control area. 3) Regarding vital registration, though the rate of registration was gradually improved by efforts of maternity aid, it would be better to change the registration system. 4) In the crude birth rate, the rate in the study area was 22.2 while in the control area was 26.5. Natural increase rate showed 15.4 in the study area, while control area was 19.1. 5) In assessment of the efficiency of the maternity aids judging by the cost-effect viewpoint, the workers in the Medium area seemed to be more efficiency than those of other areas.

• 융합정보논문지
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• 제10권9호
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• pp.206-214
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• 2020

본 연구는 우리나라 종합병원을 대상으로 직·간접보조금이 수익성에 미치는 영향을 살펴보고자 하였다. 자료는 의료기관 회계정보공시시스템을 이용하여 2016년부터 2018년까지 270개 종합병원 회계정보를 수집하였다. 분석지표는 수익성으로 사업수익에 대한 순이익, 보조금지표는 사업수익에 대한 보조금(시설투자 목적의 국고보조금, 고유목적사업 관련 비용, 연구수익, 기부금수익) 비율을 사용하였다. 연구결과, 직접보조금인 국고보조금 비율은 공립기관이 57.30%로 매우 높았다. 간접보조금으로 세금감면 효과인 고유목적사업 관련 비용 비율은 사립대학교병원이 6.69%로 가장 높았으며, 결손 또는 운영보조 목적인 연구 수익 비율은 국립대학교병원이 2.8%로 가장 높았고 기부금수익 비율은 공립기관이 36.4%로 가장 높았다. 보조금이 수익성에 미치는 영향을 살펴본 결과, 국립대학교병원은 사업수익 대비 고유목적사업 관련 비용의 비율과 연구수익 비율이 낮을수록 사업수익 순이익율이 높았으며, 의료법인과 재단법인은 사업수익 대비 고유목적사업 관련 비용 비율이 높을수록 사업수익 순이익율이 높았다는 것을 알 수 있었다. 이러한 결과는 고유목적사업과 관련된 자금의 활용에 따라 수익성이 변동될 수 있다는 것을 의미한다.

• 대한예방한의학회지
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• 제24권2호
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• pp.71-82
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• 2020

Objectives : The purpose of this study is to evaluate clinical utilization by measuring compliance with the use of mobile health applications (AtopyPHR developed in a previous study) for patients with atopic dermatitis. Methods : Based on the AtopyPHR and the input period and frequency survey results for each symptom item, a scenario for measuring compliance was derived. The study period was 4 weeks. Participants installed AtopyPHR app and Telegram app on their smartphones, conducted user training on the app, and recorded symptoms using the app for 4 weeks. At the 2nd and 4th week visits, the AtopyPHR data recorded by the user can be viewed on the web page and used for medical decision. Compliance was analyzed by the date the symptoms were recorded. Results : There were 28 participants, all (100%) were compliant, and the compliance was 96.8. The patients were 1 to 18 years old, and the average age was 8.2±5.7 years, 10 males and 18 females. The actual date of participation in recording symptoms was 28.6±0.56 on average. Compared to Week 1, compliance decreased at Week 2, and Week 4 had the highest compliance. Daily check, daily emotion, stool/urine/sleep, and meal management showed high compliance, SCORAD and quality of life were higher than required to record. Conclusions : AtopyPHR was effective in compliance. The results of this study could be used to collect personal health data in daily life through the AtopyPHR, improving participant compliance. It is considered to be meaningful because it measured the compliance with the symptom record actually recorded using the mobile app rather than a questionnaire. This study may be useful not only for personal health care but also for medical decisions, as opinions are given by experts who treat atopic dermatitis.

• 한국학교ㆍ지역보건교육학회지
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• 제20권3호
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• pp.67-82
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• 2019

Objectives: The purpose of this study is to analyze how the different lifestyles between Koreans and Korean Americans have significant effects on their health. Despite being the same race, Koreans and Korean Americans have different health conditions and health attitudes due to the acquired environmental factors such as social-economic factors, lifestyle risk factors, healthcare systems, and medical utilization. It is crucial to examine how the different lifestyle habits between Koreans and Korean Americans lead to various health conditions for establishing an effective health promotion policy. Methods: In this study, a comparative analysis was conducted using the National Health and Nutrition Survey of Korea and CHIS data of the United States in 2005 and 2015 to provide valuable insights when establishing such a policy. Results: The specific research purpose is as follows: First, socioeconomic factors, such as (1)living habits risk factors, (2)health satisfaction levels, (3)disease outbreaks, and (4)medical uses, are analyzed to find the distinct characteristics among Koreans, Korean Americans, and Americans. Second, the three groups --Koreans, Korean Americans, and Americans-- were compared based on their exposure to disease-related lifestyle risk factors related to their body mass index and their general health condition. The research results are as follows: First, all three groups improved health conditions in 2015 better than in 2005. Koreans maintained relatively higher general health conditions compared to other groups: their prevalence rate of chronic diseases such as diabetes, high blood pressure, heart disease, and asthma was lower than that of U.S. residents. Second, in regards to health behavior factors, the lifetime smoking experience for Koreans and Americans both decreased in 2015 compared to 2005, while the lifetime smoking experience for Korean Americans increased slightly. The number of smokers for Koreans has greatly decreased over a decade while that of Americans has moderately increased. Third, according to the results of the multiple regression, the general health conditions, which is a dependent variable, suggests that the number of men who answered they are healthy is greater than that of women in Korea, compared to the United States. Conclusions: In conclusion, the acquired environmental factors had more significant impacts on health than the racial factors did. Compared to 2005, the health behaviors and health levels of Korean Americans in 2015 gradually became more similar to those of Americans.

• 산업융합연구
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• 제17권4호
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• pp.77-86
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• 2019

본 연구는 가정간호기반 호흡관리프로그램이 근위축성 측상경화증으로 가정에서 인공호흡기를 적용하고 있는 환자에게 미충족의료와 의료자원이용에 효과가 있는지를 확인하는 연구이다. 연구대상자는 실험군 19명, 대조군 21명으로 40명이다. Cox의 상호작용모델에 기반을 둔 가정간호기반 호흡관리프로그램은 인지적 동기로 교육, 전문간호, 사례관리, 내적 동기로 기도청결, 흉곽운동, 공기누적운동, 심리적 반응으로 명상과 적극적 경청이다. 이를 실험군은 12주 동안 제공하였고, 대조군은 통상적인 가정간호를 제공하였다. 중재관련변수는 사전, 사후 12주, 24주에 측정하였고, 의료자원이용은 24주에 측정하였다. 연구결과 호흡관리프로그램은 미충족의료정도에는 차이가 없었으나, 의료자원이용정도 중 입원횟수 감소에는 효과가 있었다. 이에 근위축성 측상경화증 환자 호흡관리프로그램은 호흡문제로 인한 의료기관 이용횟수를 감소시켜 환자의 호흡기능 향상에 기여할 수 있을 것이다.

• 한국산학기술학회논문지
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• 제18권8호
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• pp.162-170
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• 2017

본 연구는 중소병원 간호인력 현황과 관련 정책을 분석하고 인력 확보에 영향을 주는 요인을 파악하여 중소병원 간호인력 확보를 위한 정책을 입안하고 결정하는 데에 근거를 제시하고자 실시되었다. 보건복지부와 건강보험심사평가원 등에서 제시한 통계자료를 2차 분석한 후 그 결과를 다양한 내 외적 보건의료환경에 대한 이해를 기반으로 조명하였다. 연구결과 우리나라의 활동 간호사 수는 면허간호사 수의 50% 미만으로 그 수는 해마다 감소하고 있었으며, 이는 간호대학 정원증가의 비용 대비 성과의 효율성을 재고할 필요가 있음을 의미한다. 또한 간호관리료 차등제 실시로 인해 신규간호사는 물론 간호사 인력부족이 심각한 중소병원의 경력간호사들이 상급종합병원으로 이동하게 되는 결과를 야기하였으며, 결국 중소병원 간호인력 부족 현상을 더욱 악화시키는 원인이 되었다. 따라서 입원환자 간호관리료 차등제가 중소병원 간호인력 확보 정책으로 실효성이 있는지에 대한 재검토가 필요하며, 면허간호사에 대한 추적 관리 시스템을 통해 간호인력 수급의 불균형을 해소할 수 있어야 한다.