• Asian Pacific Journal of Cancer Prevention
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• 제14권7호
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• pp.4373-4377
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• 2013

Background: The majority of cervical cancers, the most prevalent cancer among Nepali women, are diagnosed in advanced stage leading to high mortality in Nepal. The present study explored factors associated with late diagnosis. Materials and Methods: A cross-sectional study was carried out in two specialized cancer hospitals of Nepal from August 12 to October 12, 2012. Randomly selected 110 cervical cancer patients were interviewed and their medical records were reviewed. Multivariate logistic regression analysis was performed to predict associations. Results: Mean age of patients was 52.7years (SD=10.6), 66% were illiterate and 77% were rural inhabitants. Medical shops (33.6%) and private hospitals (31%) were major first contact points of patients with health care providers (HCP). There was no cervical/per-speculum examination (78.2%) and symptoms misinterpretation (90%) of patients occurred in initial consultation with HCP. Four in every five cases (80.9%) of cervical cancer had late diagnosis. Literate women (adjusted OR=0.121, CI: 0.030-0.482) and women having abnormal vaginal bleeding as early symptom (adjusted OR=0.160, CI: 0.035-0.741) were less likely to suffer late diagnosis. Women who shared their symptoms late (adjusted OR=4.272, CI: 1.110-16.440) and did so with people other than their husband (adjusted OR=12.701, CI: 1.132-142.55) were more likely for late diagnosis. Conclusions: High level of illiteracy among women and their problematic health seeking behavior for gynecological symptoms are responsible for late diagnosis of cervical cancer in Nepal. In the absence of a routine screening program, prevention interventions should be focused on raising awareness of gynecological symptoms and improving health seeking behavior of women for such symptoms.

• 보건행정학회지
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• 제24권3호
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• pp.205-218
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• 2014

Background: Most studies on the national health insurance benefit expansion policy have focused on policy tools or decision-making process. Hence there was not enough understanding on how policies are actually implemented within the specific policy context in Korea which has a national mandatory health insurance system with a dominant proportion of private providers. The main objectives of this study is to understand the implementation process of the benefit coverage expansion policy. Unlike other implementation studies, we tried to examine both the process of implementation and decision making and how they interact with each other. Methods: Interviews were conducted with the ex-members of the Health Insurance Policy Review Committee. Medical doctors who implement the policy at the 'street-level' were also interviewed. To figure out major variables and the degree of their influences, the data were analyzed with Winter's Policy Implementation Model which integrates the decision making and implementation phases. Results: As predicted by the Winter model, problems in the decision making phase, such as conflicts among the members of committee, lack of applicable causal theories application of highly symbolic activities, and limited attention of citizen to the issue are key variables that cause the 'implementation failure.' In the implementation phase, hospitals' own financial interests and practitioners' dependence on the hospitals' guidance were barriers to meeting the policy goals of providing a better coverage for patients. Patients, the target group, tend to prefer physicians who prescribe more treatment and medicine. To note, 'fixers' who can link and fill the gap between the decision-makers and implementers were not present. Conclusion: For achieving the policy goal of providing a better and more coverage to patients, the critical roles of medical providers as street-level implementers should be noted. Also decision making process of benefit package expansion policy should incorporate its influence on the implementation phase.

• Restorative Dentistry and Endodontics
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• 제24권4호
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• pp.639-646
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• 1999

The dental care delivery system and the dental specialty system have a very close relationship each other. Compared to Korea. Western European countries with predominant public sector in dental service have recognized merely 2 or 3 dental specialties, while North American countries with predominant private sector, 8 or 9 ones. It is desirable to adopt the dental specialty system as soon as possible in Korea to encourage scientific development in various dental specialties and qualitative advance in dental service. We, however, have to establish equitable dental care delivery system which can use limited dental resources efficiently as follows. 1. clarifying the different roles in assignments between general dentists and specialists by the amendment of the related laws such as the Medical Act and establishing the organic patient-referral system. 2. adopting the dental specialty system and expanding personnel and equipments so that the dental college hospitals, especially dental divisions of general hospitals, night function as secondary care facilities with specialties. 3. determining the size of dental specialists according to the national needs for dental specialized service's, whose number is to be not more than 10% of the total dentists. 4. transferring the function of accredating dental specialists to the efficient, self-controlled professional organization such as the Korean Dental Association rather than putting it under the governmental control. 5. conducting a comprehensive review of specialty education and practice for re-recognition, and maintaining competence of specialists by re-accredating them periodically. I expect this article to contribute to further discussion about the dental specialty system in Korea in productive and practical way. I am sure that we can Establish this system in the near future when people in every walks of life-the academic circle, the press, the authority concerned, consumer groups and the Korean Dental Association-take part in the discussion with special concern.

• 한국병원경영학회지
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• 제23권4호
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• pp.40-52
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• 2018

The purpose of this study is to identify medical consumers' hospital selection factors in response to the rapidly changing environment of medical industry. For that purpose this study classified consumers' hospital selection factors into three categories such that human factors including expertise, reliability, empathy; system factor including, convenience, differentiation, efficiency; and facility factor including tangibility, accessibility, and location, based on the previous studies and the results of a preliminary survey of the patients of a small private hospital. The nine factors were further divided into 23 more specific attributes. Then, an online survey was conducted to measure the perceptions of the 23 attributes by the medical consumers over the age of 20. The analysis of the survey data using Kano model and Timko model indicated that 14 of the 23 attributes were classified as attractive factors, eight attributes were or classified as, one-dimensional factors, and one attribute, doctors' educational background, was classified as indifference factor. Of the 14 attractive factors, "unique and differentiated services related to medical treatment" and "distance from home to hospital" had the highest customer satisfaction coefficients. Of the eight one-dimensional factors, "kind treatment," "providing adequate explanations," "accuracy of diagnosis," and "cleanness of facilities" had the highest customer satisfaction coefficients as well as the highest dissatisfaction coefficients. The findings indicate that these six attributes are the most basic and most impactful attributes that hospitals must manage strategically to improve their service quality and attract more medical consumers to their hospitals.

• 대한치과기공학회지
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• 제20권1호
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• pp.61-89
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• 1998

Having taken as cause of dental technicians separation from their service a variety of individual idiosyncrasies, function-related factors, external environment factors, functional satisfaction, organizational commitment, and intention to remain, the present study conducted a mail questionnaire poll and interviews on those dental technicians who are mow in the service with private dental technical workshops and dental technical workshops in general hospitals and private dental clinics. The resultant findings from analysis of the repondent's general characteristics of cause of separation form service were revealed, as follows : 1) It was shown that the higher the academic career, the considerably higher cause of position commitment among causes of individual idio-syncrasies, reflecting a statistically significant result(P<0.05) 2) The less the number of working hours as viewed from the average number of working hours per day, the higher the positive emotion, reflecting a significant relation(P<0.01) 3) Causes from performing duties among function-related causes diclosed a statistically significant relation among marital status, career, monthly income, and positions(P<0.01) 4) Causes from wages showed a statistically significant relation in the average number of working hours per day(P<0.01), monthly income(P,0.05), and positions(P<0.05) 5) Causes from supervision exposed a significant relation in workplaces(P<0.01) 6) Causes from promotion represented a significant relation in positions(P<0.001) 7) Causes from opportunnities for taking a job as seen from external environment causes also disclosed a statistically significant relation in workplaces(P<0.05) 8) Reponsibility for family sustenace reflected a statistically significant relation in sex, age, marital status, career, monthly income, work fields, term of employment, positions, and experience of separation(P<0.001) 9) Functional satisfaction showed a statistically significant relation in marital status, career, monthly income, and the average number of hours a day(P<0.05) 10) Oraganizational commitment disclosed a statistically significant relation in work experience, monthly income, term of employment, positions(P<0.05) and the average number of working hours a day(P<0.001) 11) The intention to remain indicated a statistically significant relation in age, marital status, work experience, monthly income, positions(P<0.001) and term of employment. the average number of working hours a day(P<0.01), and in the performing work field(P<0.05)

• 한국직업건강간호학회지
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• 제23권4호
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• pp.254-261
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• 2014

Purpose: The purpose of this study was to investigate the degree of performance of TB control manpower in Korea and to identify the affecting factors associated with it. Methods: This study employed a quantitative observational with cross-sectional design and the subjects were consisted of 189 TB (Tuberculosis) control manpower who were working in both community health centers and private hospitals. Variables included in this study were demographic, social, work-related characteristics, aqhnd self-efficacy. A reliability of the instrument for the performance was Cronbach's ${\alpha}$=.91. Data were analyzed by t-test, ANOVA and multiple regression using SPSS (19th version). Results: The mean value of the degree of work-related performance of TB control manpower was $4.4{\pm}0.49$9 and it was higher than those of general nurses working in any other health care departments. The mean differences in the degree of work-related performance were in self-efficacy, workplace, the number of full charge manpower in TB, the number of participation in in-depth education, and the willingness to job maintenance. In multiple regression analysis, factors associated with TB control manpower' work-related performance were self-efficacy (${\beta}$=.164, p=.025), workplace (${\beta}$=-.186, p=.023), the number of participation in in-depth education(${\beta}$=.339, p<.002), and the willingness to job maintenance (${\beta}$=-.157, p=.036). Conclusion: Results of this study showed that work-related performances of manpower working in private hospital were higher than those of manpower in public health centers. So, it is necessary to enhance nation's active intervention to improve effectiveness and reduction of risk factors in TB policy.

• Nutrition Research and Practice
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• 제15권6호
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• pp.789-797
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• 2021

BACKGROUD/OBJECTIVES: Registered dietitian nutritionists (RDN) are providers of medical nutrition therapy (MNT) to address health and chronic disease. Traditionally, RDNs have provided care in healthcare facilities including hospitals and private care facilities. The purpose of this study was to determine how RDN individualized MNT in the home impacted nutrition, physical activity, and food security. SUBJECTS/METHODS: This is a secondary data analysis. The mean age of the participants (n = 1,007) was 51.6 years old with a mean body mass index (BMI) of 34.1 kg/m². Individualized MNT visits were delivered by an RDN in the home setting from January to December 2019. Participants were referred by healthcare professionals or self-referred. Participants had MNT benefits covered by their health insurance plan (43.3% Medicaid; 39.8% private insurance; 7.9% Medicare, 9% other). Health outcomes related to nutrition care were measured. Outcomes included self-reported consumption of nutrition factors and physical activity. Our secondary outcome focused on food security. The changes in weight, BMI, physical activity, and nutrition factors were analyzed by a linear regression model or linear mixed model, adjusting for age, sex, baseline value, and number of appointments. Food security was summarized in a 2 by 2 contingency table. RESULTS: Baseline values had significantly negative impacts for all changes and number of appointments was significant in the changes for weight and BMI. Increases in physical activity were significant for both female and male participants, 10.4 and 12.6 minutes per day, respectively, while the changes in weight and BMI were not. Regarding dietary factors, the consumption total servings per day of vegetables (0.13) and water (3.35) significantly increased, while the consumption of total servings of whole grain (-0.27), fruit (-0.32), dairy (-0.80) and fish (-0.81) significantly decreased. About 24% (of overall population) and 45% (of Medicaid population) reported improvements in food security. CONCLUSIONS: This study found that home visits were a useful setting for MNT delivered by RDNs. There is a strong need for individualized counseling to meet the participants' needs and personal goals.

• 한국융합학회논문지
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• 제9권9호
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• pp.105-115
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• 2018

본 연구는 지방의료원의 문제점을 진단하고 향후 개선 방안을 강구하기 위하여 지방 전북에 소재하는 G의료원과 N의료원을 연구 대상으로 선정하였다. 조직 및 인력 현황, 예산 및 경영 현황, 진료실적, 공공사업 추진실적, 고객만족도 조사를 중심으로 분석하였다. 그 결과, 재정상황은 인력 면에서 민간병원이나 국립대학병원에 비해 의사인력을 충분히 확보하지 못하였으며, 재정상황은 두 의료원경우 부채를 가지고 있으며, 의료급여환자수는 G의료원은 의료급여 환자 수가 매년 증가하고 있지만 N의료원의 경우 오히려 감소하고 있는 것으로 파악되었다. 환자만족도 조사결과는, G의료원의 경우 전국 평균점수에 근사하였고 N의료원은 전국 평균에 비해 약간 낮았다. 의료원의 발전과 운영효율화에 필수적인 정책은 공공병원 정체성 확립, 우수 의료인력 확충, 병원특성화 및 연계진료체계 구축이다. 또한 공공서비스에 대한 국비와 지방비의 안정적인 재정적 지원책 확보와 장례업, 임대업, 국책사업의 위임을 통한 안정적 수익사업의 구축이 중요하다.

• 한국경제지리학회지
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• 제1권2호
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• pp.71-84
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• 1998

의료서비스에 대한 수요와 공급은 지역의 자연환경과 함께 경제.사회 정치적 상황과 의료제도에 따라 차이가 있으므로 의료서비스시설의 입지문제는 그 수요와 공급의 공간작인 특성에 대한 연구가 선행되어야 한다. 본 연구에서는 기존 의료서비스시설의 공간적 분포패턴을 토대로 의료서비스 시설 입지의 지역적 차이를 분석하고, 우리나라 의료서비스시설의 입지적 특성과 의료서비스의 공간배열의 원리를 밝히는데 역점을 두었다. 특히 다른 서비스 시설의 입지문제와는 차별화 되는 입지결정 및 운영의 이원성과, 기능과 규모에 따라 입지원리가 다르게 작용하는 계층구조에 대한 분석을 시도하였다 이러한 연구는 의료서비스에 대한 지역 주민의 요구를 충족시킬 수 있는 의료기관의 적절한 공간적 배분계획모형 수립을 위한 기초 작업으로 지역 주민의 삶의 질 향상을 위한 의료서비스시설의 바람직한 의료서비스 시설 입지계획에 방향을 제시하는 기초가 될 수 있을 것이다.

• 대한영양사협회학술지
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• 제7권1호
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• pp.117-124
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• 2001

This study was conducted as a part of project developing the standards of the national board test for dietitian's licences. The purpose of this study was to define the job specification for dietitian's job description based on the knowledge, skill, attitude and related to the curriculum. The study team established the research team which composed of 11 person(7 professor in the university and 4 dietitians in hospitals, schools and private firms). The job description composed of 17 duties, 99 tasks and 576 task elements. For each element, the job specifications are written, which composed of introduction, process, required equipments, and required ability. Required ability included knowledge, skill and attitudes. The relations of the knowledge, skill and attitudes with the possible curriculum currently operated in the college or university were analyzed, also. Job specifications for 576 task elements are analyzed and framed.