• Journal of Preventive Medicine and Public Health
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• 제29권4호
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• pp.721-732
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• 1996

생활수준과 교육수준이 매우 낮은 저개발국가에서의 임신분만 환경을 알아보고 건강관련 행위 실천(산전진찰, 시설분만, 제대기구소독)과 지식과 태도와의 관계를 알아보기 위하여 네팔 돌카 마을에서 지난 1년간(1994년 4월 13일$\sim$1995년 4월 12일)출산한 경험이 있는 산모를 대상으로 일반적 특성, 임신과 분만에 관련된 지식, 태도, 산전진찰률, 분만환경 등을 조사하였다. 이 지역의 임신과 분만에 관련된 지식수준은 낮은 편으로 대상자의 87.5%가 보건교육을 받은 경험이 없었다. 대상자의 29.6%는 임신시 흡연이 태아에 해가 없다고 하였으며, 42.8%는 임신시 음주와 약의 복용이 태아에 해가 없다고 답하였고, 17.1%가 제대절단시 소독하지 않은 기구를 사용해도 유해하지 않다고 응답하였는데, 교육을 받은 적이 없는 경우, 보건교육을 받은 경험이 없는 경우, 그리고 보건기관까지의 거리가 멀 수록 올바르지 못한 지식을 가지고 있었다. 응답자의 56.6%가 산전진찰이 필요없다는 태도를 보였고, 42.8%가 질출혈시 병원을 방문할 필요가 없다는 태도를 보였는데, 교육을 받은 적이 없는 경우, 보건 교육을 받은 경험이 없는 경우, 그리고 보건기관까지의 거리가 멀수록 바람직하지 못한 태도를 가지고 있었다. 또한 82.9%가 분만과정 자체가 불결한 것이라고 여기고 있었다. 한번이라도 산전진찰을 받은 경험이 있는 산전진찰 경험률은 28.3%였는데 교육을 받은 적이 없는 경우, 보건교육을 받은 경험이 없는 경우에 산전진찰 미경험률이 높았다. 시설분만율은 5.3%로 매우 저조하였고, 시설 외 분만인 경우 82.6%가 제대절단기구를 소독하지 않고 사용하고 있었는데 교육을 받은 적이 없는 경우, 보건교육을 받은 경험이 없는 경우, 그리고 보건기관까지의 거리가 멀수록 소독을 하지 않고 사용하고 있었다. 지식과 태도와의 관계에 있어서는 지식이 많은 군이 산전진찰의 필요성을 더 느끼며 질출혈시 병원방문의 필요성을 더 느끼고 있어, 임신과 분만에 관련하여 더 바람직한 태도를 가지고 있었다. 태도와 실천과의 관계에 있어서는 바람직한 태도를 가진 산모군이 산전진찰 경험률이 높았으며, 시설분만이 많아 실천율이 높았다. 다변량 분석에서도 지식이 태도에 양(陽)의 영향을 미치는 변수였으며, 태도는 실천에 영향을 미치는 유의한 양(陽)의 변수여서 실천을 위해서는 긍정적인 태도가 선행되어야 하고, 그러기 위하여는 먼저 올바른 지식을 가지고 있어야 함을 알 수 있었다. 이상의 연구결과로 볼 때, 저개발국가에서의 분만환경은 매우 열악한 편으로 모자의 건강수준 향상을 위해서는 예방적 기능으로서 보건교육 활동이 더욱 중요 성을 가지게 된다. 효율적 보건교육활동을 위해서는 보건교육을 보다 긴요하게 요하는 인구군이 어떤 계층이냐 하는 대상파악에 특별히 유념하여야 하는데 주로 교육수준이 낮고 생활이 어려운 인구층, 그리고 보건기관으로부터 멀리 떨어져 있는 사람들에게 중점적으로 교육을 시도하여야 하겠는데 이들 나라는 대부분의 국민이 교육수준이 낮고 생활수준이 낮은 편으로 보건교육시 단순한 지식의 전달에 그칠 것이 아니라 동기 유발을 가져와 행위변화를 할 수 있도록 보다 세밀한 연구노력이 필요하다. 또한 순회진료와 보건교육을 하는 의료캠프가 활성화되어야 하겠다. 향후 저개발국에 의료단을 파견하여 그 지 역의 보건문제 해결에 도움을 주기 위하여는 이와 같은 연구가 계속 진행되어 실천에 영향을 주는 요인들을 밝혀 지역보건의료 프로그램에 적극 활용해야 할 것으로 생각된다.

• Neonatal Medicine
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• 제15권2호
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• pp.151-159
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• 2008

목 적 : 최근 신생아 집중 치료술의 발달로 미숙아의 생존율이 증가하면서 이로 인한 미숙아의 합병증이 중요한 문제가 되고 있다. 백혈병양반응 (leukemoid reaction)은 골수 이외의 원인에 의해 절대호중구수 30,000/$mm^3$ 이상인 경우로 이에 대한 산전 위험 요소와 출생후 합병증과 예후에 관한 상관관계에 대해 잘 알려져 있지 않아 치료와 대책이 없는 상황이다. 이에 신생아 집중치료실에 입원한 미숙아를 대상으로 혈중 백혈구수를 분석하고 합병증과 예후를 대조군과 비교 분석하였다. 방 법 : 2005년 6월부터 2007년 7월까지 동국대학교 일산병원 신생아 집중 치료실에 입원한 재태 기간 37주미만의 미숙아 중 2,500 g 미만의 적정 체중아 252명을 후향적으로 의무기록을 통하여 조사하였다. 총혈구검사를 출생 직후 및 매일 또는 매주 시행하였고 절대호중구수가 30,000/$mm^3$ 이상인 경우를 백혈병양반응으로 정의하였다. 산전 위험 요소는 산모의 나이, 조기 양막 파수,융모양막염, C-반응 단백질 수치를 조사하였고 미숙아들의 합병증 및 예후는 재태 기간, 출생 체중, Apgar 점수, 신생아 호흡 곤란 증후군, 인공호흡기 사용일수, 기관지폐 형성 이상, 동맥관 개존, 뇌실 내 출혈, 괴사 장염, 미숙아 망막증, C-반응 단백질 수치, 산전 스테로이드 사용, 사망률을 후향적으로 조사하여 환자군과 대조군을 비교 분석하였다. 결 과 : 백혈병양반응을 보인 환자군은 총 8명(3.14%)이었다. 산전 관련인자로 산모의 연령과 조기 양막 파수와는 관련이 적었으나 융모양막염이 있는 경우(P=0.010)와 분만 전 산모의 높은 C-반응 단백질 수치(P<0.001)는 유의한 관련이 있었다. 환자군과 대조군을 통계적으로 비교하여 볼 때 환자군의 재태간(P=0.005)이 짧고 출생 체중(P=0.011)이 작았으며 1분 Apgar 점수(P=0.045)와 5분 Apgar 점수(P=0.014)가 낮았다. 환자군이 신생아 호흡 곤란 증후군(P=0.004)과 기관지폐 형성 이상(P< 0.001)과 관련이 컸으며 인공호흡기를 사용한 일수가 길었다(P<0.001). 체중이 비슷한 1,000 g 미만의 초극소 저체중 출생아에서 임상적 특징 및 합병증의 비교에서는 인공호흡기 사용일수(P=0.041)와 기관지폐 형성 이상의 발생률(P=0.006)이 백혈병양반응과 유의한 연관을 보였다. 환자군에서 출생 직후의 C-반응 단백질 수치가 유의하게 높았다(P<0.001). 환자군과 대조군의 특징과 합병증을 다변량분석을 실시하였을 때 기관지폐 형성 이상과 환자군의 C-반응 단백질 수치가 비교위험도가 각각 60.12, 4.57로 95%신뢰구간에서 유의한 값을 보였다. 전체 대상 환자군에서 동맥관 개존과 신생아 괴사 장염의 발생 비율이 높았으나 통계적으로 유의하지 않았다. 뇌실 내 출혈, 미숙아 망막증, 사망률, 산전 스테로이드 사용은 환자군과 대조군에서 차이는 없었다. 결 론 : 백혈병양반응은 산전 감염과 관련이 있고 이로 인해 백혈구수가 증가하여 과도한 염증반응이 출생후 기관지에 영향을 미쳐 기관지폐 형성 이상을 유발하는 것으로 생각된다. 출생 전 산모의 감염에 대한 산과적 치료와 출생 후 미숙아의 호흡기의 치료에 대한 연구가 필요할 것으로 생각된다.

• 대한간호학회지
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• 제4권3호
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• pp.81-91
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• 1974

The purpose of this study was to investigate the level of obstetric knowledge of pregnant women and postpartum mothers, and to contribute the data to community health teaching program as well as maternity nursing. 385 pregnant women and postpartum mothers visited at or admitted to Seoul Adventist Hospital were sampled. The results of the study were as follows. 1. 97.9% of the subjects were between the age of 21 to 35, most of them (82.9%) were housewives with high school education and with a middle class family background. 2. The first symptoms of pregnancy were amenorrhea (70.4%), nausea & vomiting (23.9%), change of skin color (1.6%). 3. 77.9% of the subjects did not know how to deal with morning sickness. 4. 52.9% did not know when the sex determination of the fetus-occurs. 5. Concerning the fetus position; 77.1% of them believed it lies head down. head up (12.0%). and not knowing (10.9%). 6. 73.2% recognized the need for a well balanced food during pregnancy. 7. As to the dangerous symptoms during pregnancy: vaginal bleeding was considered the 1st, edema, the and, continuous abdominal pain, the 3rd. 82% of them would confer with physician in case of vaginal bleeding. As to the type of activities restricted by pregnancy: hard exercise was considered first, travel the second, and coitus during 1st and last trimester of pregnancy the 3rd. 8. 82.4% of them visited antenatal clinic at the second or third month of amenorrhea and 88.5% realized the regular physical examination imperative. 9. The purpose of urine test was recognized correctly by 44.7%, blood test: 89.4%, B. P. and weight check ; 69.9%. 10. The need of breast care during pregnancy was recognized by 76.9% of the subject. 11. 75.8% realized that prenatal exercise was needed. The higher the education the better the understanding of the need for it before delivery. 12. The concept of postpartum period was understood correctly by 54.4%. 13. The state of uterus after delivery was understood correctly by 49.1% only. 14, Regarding the management of colostrums: 48.3% knew it was to feed infants, and it was to squeeze and discard 43.4%. 15. Dealing with postpartum exercise; 67.8% answered it was needed, 9.1% not needed, not heard about 23, 1%.

• 한국산학기술학회논문지
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• 제17권3호
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• pp.177-189
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• 2016

본 연구는 간호대학생에게 고충실도 시뮬레이터를 활용한 모성간호 시뮬레이션 교육을 적용하고, 그 효과를 평가하기 위한 단일군 전후설계 유사실험연구이다. 간호학과 4학년에 재학 중인 학생들에게 고충실도 환자 시뮬레이터를 활용하여 임부, 산부, 산욕부 간호에 대한 시뮬레이션 교육을 실시하였고, 교육기간은 2014년 11월 10일부터 3주간이었으며, 차시별 3시간씩 총 9시간에 걸쳐 진행되었다. 교육 전후 설문을 통해 자료수집을 실시하였고, 분석에 사용된 대상자 수는 83명이었다. 수집된 자료는 IBM SPSS Statistics 20.0 프로그램을 이용하여 실수와 백분율, 평균과 표준편차, paired t-test, independent t-test, Pearson's correlation coefficients를 분석하였다. 시뮬레이션 교육 후 시뮬레이션 효과성은 총점 26점 만점에 17.4이었으며, 시뮬레이션 교육 전과 후에 의사소통능력(t=4.58, p=<.001)과 모성간호 수행에 대한 자신감(t=9.70, p=<.001)은 유의하게 향상되었으나, 문제해결능력에는 차이가 없었다. 임상실습에 만족하는 경우에 시뮬레이션 교육 후 시뮬레이션 효과성(t=2.09, p=.040), 문제해결능력(t=3.13, p=.002), 의사소통능력(t=3.54, p=.001), 모성간호 수행에 대한 자신감(t=2.64, p=.010)이 유의하게 높은 것으로 나타났으며, 시뮬레이션 효과성은 문제해결능력(r=.494, p<.001), 의사소통능력(r=.361, p<.001) 및 모성간호에 대한 자신감(r=.497, p<.001)과 유의한 양의 상관관계가 있었다. 따라서 현 임상실습의 한계에 대한 대안이자, 학생들의 임상 간호에서 필요한 역량을 강화하기 위한 전략으로써 고충실도 시뮬레이터를 활용한 모성간호 시뮬레이션 교육이 적용될 수 있으며, 이 때 학습 과정 동안 학습자의 학습경험이 학습성과로 이어질 수 있도록 하기 위한 체계적인 시뮬레이션 교수학습 전략이 필요할 것이다.

• Journal of Preventive Medicine and Public Health
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• 제10권1호
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• pp.3-15
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• 1977

In order to find out health problems among inhabitants in slum areas in Kwanak-Ku, Seoul, a series of health survey was conducted upon 510 households by interview from March to December, 1976. The results obtained were as follows: 1. Employments of householders were unstable; Out of 508 householders, 164(32.3%) were unemployed and 184 (36.2%) were daily or temporary employees. 2. Average number of households per house was 2.0 and average area of residential room per person was $4.0m^2$. 3. 476(93.3%) out of 510 households were supplied with tap water and rest of them made use of ground water as a source of drinking water. 4. Only 279(18.3%) out of 1527 live births were delivered at medical facilities, 496(32.7%) were at home attended by doctors or midwives and 358(25.1%) took prenatal care. The above findings were worse in urban slum area than in other urban area of relatively high economic level, but were better than in rural area of less medical facilities. 5. Initiation of treatment were delayed until their illnesses were advanced in most of the households, 472(92.5%) out 510. In the early stage of the illness, 131(25.6%) of the house-holds sought physicians in their clinics or general hospitals and 250 (40.9%) visited chemists, to toy drugs at first hand. Frequency of visits to physician increased to 52.8% as the disease aggravated in later stages. 6. Cost of medical expenditure per household amounted to 815 won, and was paid to, in the order of chemists, physicians, chinese herb stores, chinese herb doctors. 7. Concerning the health knowledge of the inhabitants, 273(53.9%) out of 506 respondents were aware of the infectivity of pulmonary tuberculosis, and 68(13.4%) of them checked regularly their chest findings by X-ray at least once every two years. 8. As for the family planning, although 448(87.3%) out of 510 respondents were in favor of it, 215 (41.8%) of them were actually practicing contraception. 9. About 40.6% (125 respondents) of them obtained information and knowledge concerning contraception through personal contact with family planning workers. 10. Nutritional status of housewives was generally poor: 49(38.3%) out of 128 housewives were found to be anemic and average serum protein level was $7.5{\pm}0.82g/dl$.

• Clinical and Experimental Pediatrics
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• 제54권6호
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• pp.246-252
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• 2011

Purpose: The outcomes of small for gestational age (SGA) infants especially in extremely low birth weight infants (ELBWIs) are controversial. This study evaluated the mortality and morbidity of ELBWIs, focusing on whether or not they were also SGA. Methods: The medical records of 415 ELBWIs (birth weight<1,000 g), who were inborn and admitted to the Samsung Medical Center neonatal intensive care unit from January 2000 to December 2008, were reviewed retrospectively. Mortality and morbidities were compared by body size groups: very SGA (VSGA), birth weight ${\leq}$3rd percentile; SGA, 3rd to 10th percentile; and appropriate for gestational age (AGA) infants, >10th percentile for gestational age. For gestational subgroup analysis, groups were divided into infants with gestational age ${\leq}24^{+6}$ weeks (subgroup I), $25^{+0}$ to $26^{+6}$ weeks (subgroup II), and ${\geq}27^{+0}$ weeks (subgroup III) Results: Gestational age was $29^{+2}{\pm}2^{+6}$ weeks in the VSGA infants (n=49), $27^{+5}{\pm}2^{+2}$weeks in the SGA infants (n=45), and $25^{+4}{\pm}1^{+4}$ weeks in AGA infants (n=321). Birth weight was $692{\pm}186.6$ g, $768{\pm}132.9$ g, and $780{\pm}142.5$ g in the VSGA, SGA, and AGA groups, respectively. Cesarean section rate and maternal pregnancy-induced hypertension were more common in the VSGA and SGA than in AGA pregnancies. However, chorioamnionitis was more common in the AGA group. The mortalities of the lowest gestational group (subgroup I), and also of the lower gestational group (subgroup I+II) were significantly higher in the VSGA group than the SGA or AGA groups (P=0.020 and P=0.012, respectively). VSGA and SGA infants showed lower incidence in respiratory distress syndrome, ductal ligation, bronchopulmonary dysplasia, intraventricular hemorrhage than AGA group did. However, by multiple logistic regression analysis of each gestational subgroup, the differences were not significant. Conclusion: Of ELBWIs, extremely SGA in the lower gestational subgroups, had an impact on mortality, which may provide information useful for prenatal counseling.

• 디지털융복합연구
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• 제14권9호
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• pp.379-387
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• 2016

본 연구는 우리나라 출생아 전수(n=617,867)를 대상으로 산모 연령과 영아 사망과의 관련성을 파악하고자 시행하였다. 연구자료는 인구동태통계자료와 영아사망조사자료를 연계하여 사용하였고, 산모 연령에 따른 영아 사망 위험을 파악해 보기 위해 출생아의 성별과 다태 여부, 출생순위, 저체중아 여부, 선천성기형 여부를 보정한 다중 로지스틱 회귀분석을 시행하였다. 여러 혼란요인을 보정한 분석 결과, 25-29세 산모에 비해 20세 미만 산모(Odds ratio [OR], 5.29, 95% confidence interval [CI], 3.51-7.98)와 20-24세 산모(OR, 1.44, 95% CI, 1.23-1.69), 35-39세 산모(OR, 1.28, 95% CI, 1.11-1.46), 40세 이상 산모(OR, 1.94, 95% CI, 1.53-2.45)에서 영아 사망 오즈가 통계적으로 유의하게 높았다. 결론적으로, 이번 연구를 통해 35세 이상 고 연령 산모와 25세 미만의 저 연령 산모에서 영아 사망 위험이 높은 것을 확인할 수 있었고, 이들에서 영아 사망 위험이 높은 이유는 저체중아나 미숙아의 출산이 많기 때문으로 보인다. 산전관리 시 고령 산모의 경우 생물학적인 문제를 극복할 수 있는 관리정책이 만들어져야 할 것으로 보이고, 저 연령 산모의 경우 사회경제적인 부분과 사회적 편견 문제를 해결할 수 있는 관리정책이 만들어져야 할 것으로 보인다.

• 대한간호학회지
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• 제23권3호
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• pp.377-398
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• 1993

A survey of infant practices was conducted to provide information on which to base planned nursing interventions. The subjects were a convenience sample of 168 mothers visiting out - patients departments of five general hospitals and one public health center in Seoul for immunizations or treatment for common colds for their infants from two to 12 months of age. Data collection was carried out from July 8th to September 30th, 1991 using a questionnaire of 84 questions, 31 on the type of feeding, 22 on supplementary feeding and 21 on demographic infer mation. The results are summarized as follows : 1) The type of feeding was primarily artificial feed-ing (63.1%), followed by mixed feeding (22%) and breast feeding (14.9%) of the 59 mothers expecting during pregnancy to breast feed, 54. 2% changed artificial feeding and 30.5% went on to breast feed as they had expected. For mothers expecting to continue breast feeding over seven months. only one infant was being breast fed for over seven months. 2) For the 106 mothers using artificial feeding, 70. 8% hed attempted breast feeding, 64% of them for less than a month. Breast milk had been suppressed by for medication (38.7%) : 34.9% had used no specia] means. 3) The major reasons for replacing breast feeding with artificial feeding were the infants' demand for more milk (47.2% ) and insufficient supply of breast milk (49.3％). 4) Most mixed feeding was started at the age of one to three months (59.5%). Only 34.4% gave an artificial feeding after breast feeding : most (46%) alternated breast feeding with artificial feeding. On the whole, the motive for mixed feeding was the lack of breast milk (70.3%). 5) Many mothers (81.8%) were adding vitamin or mineral supplements to artificial milk and 51.5% were adding something to faciliate digestion. As for the method of sterilizing milk bottles and nipples, 56% had sterilized them together in boiling water from the beginning : 27% were just washing the bottles after boiling only once initially when measuring artificial milk powder, 31. 5% of the mothers over filled the measuring spoon rather than to the level. 6) The mother's occupation was related to her way of feeding. Mothers at home full time did more breast feeding than mothers employed outside the home. (x²=5.72, p=〈0.05). 7) Most mothers began supplementary food, from three to four months (48.8%) : 11.2% began later than seven months. Supplementary food was given between milk feedings by 67.2% of the mothers : 19.2% gave it before a milk feeding. Some mothers(26.4%) made their own supplementary food : 19.2% used ready - made supplementary food products for convenience. Recommendations for nursing interventions included : 1. Prenatal education about the advantages of breast feeding and breast care, and home visits after delivery for counselling related to breast feeding. Correct preparation of artificial feeding methods need to be taught in both pre & postnatal periods. In addition, specific education about supplementary feeding needed. 2. Further research is indicated about the Perceived lack of supply of breast milk and about the effectiveness of nursing interventions to Promote breast feeding.

• 대한간호학회지
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• 제4권2호
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• pp.121-130
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• 1974

This study was performed with, two groups of 369 pregnant women, which consisted of the first group of 186 pregnant women taking physical examinations for birth at the Korea clinic in Seoul during the months of November and December in 1972, and the second group of 183 pregnant women taking physical examinations for birth at the Kang Won Provincial Hospital for the 12 months from October, 1972 to September 1973, as the results of this study the following concussion was obtained. 1. Age distribution indicated that the group of 25 through 34 age among them fallen 76 percent. 2. The time of the first physical examination by the 76% pregnant women of the second group at Chun Chon was in the initial period of pregnancy, but the time of that by every 33% pregnant women of the first group in Seoul came to the initial, middle and late period of pregnancy, evenly. 3. The 65.6% of the second group had one or two times of physical examination and the 80% of the first group had one to eight times of physical examination. 4. The mean pregnancy times was 1.9 to the first group and 2.8 to the second group, showing high pregnancy rate in Seoul city- 5. The 57.3% of the first group and the 31.3% of the second group did one times of abortion. The 3.2% of the first group and the 10.7% of the second group did more then six times of abortion, this meant big difference between two groups. The 24.1% of the first group had four times of pregnancy and the 18.1% of the second group had three or four times of it. These percentages was the highest of all. 6. Death rate during the period of pregnancy was shown to be 3.2% to the first group and 9.7% to the second group, consequently indicating gre311y high death rate in local city. 7. Many of the first group have three children and some of the second group have seven children. 8. As to totemics of pregnancy, 23.7% of the first group, and 49.7% of the second group were shown to have totemics of pregnancy, consequently with greatly high totemics rate of pregnancy in local city. The 4.0% of the first group and 37.0% of the second group was short of hemoglobin, with remarkable difference between the two groups.

• 여성건강간호학회지
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• 제6권1호
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• pp.96-108
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• 2000

The purpose of this study was to provide the basic data for developing a program for effective education about GDM(Gestational Diabetes Mellitus) by investigating the knowledge and learning needs of pregnant women about GDM. The subjects were 192 pregnant women who visited obstetrical clinics for prenatal care. The data were collected from October, 1998 to December, 1999, using a 50-item questionnaire(knowledge ; 30 items, learning needs ; 20 items), and analyzed by SAS program for t-test, ANOVA, Ducan test, and Pearson correlation coefficients. The results were as follows. 1. The knowledge level about GDM 1) Pregnant women had very little knowledge(total means ; 15.1 of 30.0) about GDM. 2) Pregnant women more than 30 years old, pregnant women from Seoul, and pregnant women who had more than a bachelor's degree were more knowledgeable about GDM. 3) Pregnant women who didn't experience spontaneous abortions, pregnant women who had DM(Diabetes Mellitus) patients in their families, and pregnant women who received education about DM were more knowledgeable about GDM. 4) Pregnant women knew very well that GDM women have more maternal and fetal complications than normal pregnant women. Although they were knowledgeable about the importance and ways of controlling blood glucose level, they knew very little about the causes, symptoms, or management of hypoglycemia. 2. The learning needs about GDM 1) Pregnant women had high learning needs (total means ; 85.0 of 100.0) about GDM. 2) The learning needs of pregnant women who had more than a bachelor's degree and pregnant women who earned less than two million won in monthly income were higher than that of other groups. 3) Pregnant women had high learning needs about the health of their baby and themselves, but their learning needs related to weight control and exercise-things that play important roles in controlling blood glucose level-were relatively low. As a result of the above findings, a systemic and individualized program is required for pregnant women and GDM patients, In addition to that, further studies that investigate the effects of education and retention of learning obtained by education are required in the near future.