• Journal of agricultural medicine and community health
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• v.1 no.1
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• pp.29-36
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• 1976

Introduction Recently, changes in the patterns and concepts of maternity care, in both developing and developed countries have been accelerating. An outstanding development in this field is the number of deliveries taking place in hospitals or maternity centers. In Korea, however, more than 90% of deliveries are carried out at home with the help of untrained relatives or even without helpers. It is estimated that less than 10% of deliveries are assisted by professional persons such as a physician or a midwife. Taking into account the shortage of professional person i11 rural Korea, it is difficult to expect widespread prenatal, postnatal, and delivery care by professional persons in the near future, It is unrealistic, therefore, to expect rapid development of MCH care by professional persons in rural Korea due to economic and sociological reasons. Given these conditions. it is reasonable that an educated village women could used as a "maternity aid", serving simple and technically easy roles in the MCH field, if we could give such a women incentive to do so. The midwife and physician are assigned difficult problems in the MCH field which could not be solved by the village worker. However, with the application of the village worker system, we could expect to improve maternal and child hoalth through the replacement of untrained relatives as birth attendants with educated and trained maternity aides. We hope that this system will be a way of improving MCH care, which is only one part of the general health services offered at the local health centre level. Problems of MCH in rural Korea The field of MCH is not only the weakest point in the medical field in our country hut it has also dropped behind other developing countries. Regarding the knowledge about pregnancy and delivery, a large proportion of our respondents reported having only a little knowledge, while 29% reported that they had "sufficient" knowledge. The average number of pregnancies among women residing in rural areas was 4.3 while the rate of women with 5 or more pregnancies among general women and women who terminated childbearing were 43 and 80% respectively. The rate of unwanted pregnancy among general women was 19.7%. The total rate for complications during pregnancy was 15.4%, toxemia being the major complication. The rate of pregnant women with chronic disease was 7%. Regarding the interval of pregnancy, the rates of pregnancy within 12 months and within 36 months after last delivery were 9 and 49% respectively. Induced abortion has been increasing in rural areas, being as high as 30-50% in some locations. The maternal death rate was shown 10 times higher than in developed countries (35/10,000 live births). Prenatal care Most women had no consultation with a physician during the prenatal period. Of those women who did have prenatal care, the majority (63%) received such care only 1 or 2 times throughout the entire period of pregnancy. Also, in 80% of these women the first visit Game after 4 months of gestation. Delivery conditions This field is lagging behind other public health problems in our country. Namely, more than 95% of the women deliveried their baby at home, and delivery attendance by a professional person occurred only 11% of the time. Attendance rate by laymen was 78% while those receiving no care at all was 16%. For instruments used to cut the umbilical corn, sterilized scissors were used by 19%, non-sterilized scissors by 63% and 16% used sickles. Regarding delivery sheets, the rate of use of clean sheets was only 10%, unclean sheets, vinyl and papers 72%, and without sheets, 18%. The main reason for not using a hospital as a place of delivery was that the women felt they did not need it as they had previously experience easy deliveries outside hospitals. Difficult delivery composed about 5% of the total. Child health The main food for infants (95%) was breast milk. Regarding weaning time, the rates within one year, up to one and half, two, three and more than three years were 28,43,60,81 and 91% respectively, and even after the next pregnancy still continued lactation. The vaccination of children is the only service for child health in rural Korea. As shown in the Table, the rates of all kinds of vaccination were very low and insufficient. Infant death rate was 42 per 1,000 live births. Most of the deaths were caused by preventable diseases. Death of infants within the neonatal period was 83% meaning that deaths from communicable diseases decreased remarkably after that time. Infant deaths which occurred without medical care was 52%. Methods of improvement in the MCH field 1. Through the activities of village health workers (VHW) to detect pregnant women by home visiting and. after registration. visiting once a month to observe any abnormalities in pregnant women. If they find warning signs of abnormalities. they refer them to the public health nurse or midwife. Sterilized delivery kits were distributed to the expected mother 2 weeks prior to expected date of delivery by the VHW. If a delivery was expected to be difficult, then the VHW took the mother to a physician or call a physician to help after birth, the VHW visits the mother and baby to confirm health and to recommend the baby be given proper vaccination. 2. Through the midwife or public health nurse (aid nurse) Examination of pregnant women who are referred by the VHW to confirm abnormalities and to treat them. If the midwife or aid nurse could not solve the problems, they refer the pregnant women to the OB-GY specialist. The midwife and PHN will attend in the cases of normal deliveries and they help in the birth. The PHN will conduct vaccination for all infants and children under 5, years old. 3. The Physician will help only in those cases referred to him by the PHN or VHW. However, the physician should examine all pregnant women at least three times during their pregnancy. First, the physician will identify the pregnancy and conduct general physical examination to confirm any chronic disease that might disturb the continuity of the pregnancy. Second, if the pregnant woman shows any abnormalities the physician must examine and treat. Third, at 9 or 10 months of gestation (after sitting of the baby) the physician should examine the position of the fetus and measure the pelvis to recommend institutional delivery of those who are expected to have a difficult delivery. And of course. the medical care of both the mother and the infants are responsible of the physician. Overall, large areas of the field of MCH would be served by the VHW, PHN, or midwife so the physician is needed only as a parttime worker.

• Journal of Korean Academy of Nursing
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• v.29 no.4
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• pp.963-976
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• 1999

This study was undertaken to investigate the general characteristics of students, which include the degree of satisfaction, motives of admission, the recognition of advantages and disadvantages, opinion of students on self-directed learning, and planning and anticipatory effects after graduation. Data was collected through a questionnaire survey over a period of four months, from May 1997 to August 1997. The subjects used for this study consisted of 322 RN students sampled from six RN-to-BSN programs in Korea using the census sampling method. Statistical methods employed for this study included discriptive statistics, M ANOVA, and F-test. The results of the study are as follows 1. The RN students' motives of admission to RN-to-BSN programs were ‘for personal advancement’, ‘to earn a BSN degree’, and ‘for professional development’ in this order. 2. The RN students' responses to the advantages of RN-to-BSN programs were ‘acquisition of new knowledge and a BSN degree’ and ‘to gain professional thinking and a broader view’, while as the disadvantages of RN-to-BSN programs were ‘geographical isolation of institutions’, ‘limitation of information’, and ‘underdeveloped school environments’ in this order. 3. The survey based on opinions toward self-directed learning showed that there was a need of detailed guidelines for self-directed learning. Most agreed that it was a very effective learning method for a RN student, and the self-directed learning method Increases motives for learning. 4. The students' anticipatory effect after graduation were ‘self-achievement’, ‘development of professional skills’, and ‘admission to post-graduate school or programs to study abroad’. 5. The students were very satisfied with the quality of faculty members, and satisfied with the quality of lectures and teaching. However, students were unsatisfied with rented lecture rooms, and very unsatisfied with self-directed learning methods. 6. School nurses showed higher statistical significances in the need for teaching material and anticipatory effect after graduation than other RN students working in hospitals and public health agencies. Also, school nurses, public health nurses, and industry nurses showed higher statistical significances in motives of admission than RN students working in hospitals. Further more, staff nurses, school nurses, and industry nurses showed higher levels of satisfaction toward a RN-to-BSN programs than nurses in higher positions, such as administrators or directors of nursing. 7 City residents were more satisfied with RN-to-BSN programs than rural residents. Otherwise, the rural residents had higher motives for admission, a bigger need for teaching materials, and recognition of the disadvantages of RN-to-BSN programs than city residents. Finally, RN students who earned below a monthly income of ￦1,000,000 showed higher motivation for admission than those who earned more than ￦1,000,000.

• Journal of Cadastre & Land InformatiX
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• v.54 no.1
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• pp.49-61
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• 2024

South Korea faces a declining population and rural areas vanishing due to urbanization. Infrastructure, especially medical facilities, may not be sustainable for a long-term. This may impact vulnerable groups like children, teens, and the elderly, worsened by an aging population and low birth rates. Gangwon-do, notably Chuncheon-si, suffers from rural depopulation and poor healthcare self-sufficiency. In this paper, using 2SFCA(Two-Step Floating Catchment Area), we analyze healthcare access in Chuncheon-si, identifying gaps and vulnerable areas. LISA analysis helps map medical vulnerability, considering patient demand and supply. The Gini coefficient assesses spatial inequality. We propose distributing healthcare services and personnel based on age and region. The aim is to identify locations for additional hospitals catering to the elders, Infants, Children, and Adolescents,considering spatial accessibility.

• Health Policy and Management
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• v.12 no.1
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• pp.21-53
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• 2002

The purpose of this study is to measure the resource use of the elderly in long-term care services and to examine the effects of patient and facility characteristics on their use of resources. The data were collected from 510 old people over sixty years of age, residing in five long-term care hospitals and two skilled nursing homes during the period between December 1, 2000 and February 28, 2001. For a full sample, when the first level of RUG(Resource Use Group)-III categories were employed as the proxy of patient severity, facility characteristics, such as location, size and ownership, have large effects on the resource use measured by service intensity, whereas patient characteristics such as severity have little or no effect. The resource use is significantly high if the facility: (1) is located in rural areas (gun): (2) has mare than 200 beds; (3) is a long-term care hospital; (4) is private; and (5) has a low percentage of medical aid patients. The analysis of the resource use in each RUG-III categories, for which ADL(Ability of Daily Living) were employed as the prosy of patient severity, shows a similar result. The loose relationship between the needs of residents and the resource use seems to be closely associated with the ineffective reimbursement system for providers. The current reimbursement system has no provision for quality improvement and reimburses facilities simply according to their types: fee-for-service for long-term care hospitals, and monthly-flat-rate or full-coverage-national-aid for skilled nursing facilities. It will be necessary to develop a more reasonable reimbursement system that takes patient's severity into account and gives incentives for long-term care providers to offer cost-effective services.

• The Journal of Internal Korean Medicine
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• v.37 no.1
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• pp.1-7
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• 2016

Objectives: This study aimed to investigate the sociodemographic factors of stroke patients.Methods: Patients were hospitalized at Korean medical hospitals with cerebral hemorrhage and infarction and then discharged between September 2013 and August 2014. We investigated the patients’ general character and risk factors, then the patients were classified according to the regions where they reside.Results: The results indicated that having hypertension and diabetes mellitus as an underlying disease was more common in stroke patients from the country. No other statistical significance was noted among the indexes of any other results.Conclusions: Based on these results, hypertension, and diabetes mellitus were more important risk factors in patients from the country than they were for city residents. Further large-scale studies are needed to generalize the findings of this study.

• Journal of Preventive Medicine and Public Health
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• v.25 no.4 s.40
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• pp.357-373
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• 1992

After medical insurance came into effect in Korea, health care system has undergone tremendous changes. Changing patterns of newly established clinics is one of them. To investigate changes and trends, a total of 10,184 clinics which were newly established from 1981 to 1990 were analysed. Data were obtained from the file of contracting medical facilities of the Federation of Medical Insurance Societies. The proportion of newly establishied clinics has increased gradually, so that they amount to 13% of the total medical facilities in Korea. Meanwhile, the number of newly established medium-size hospitals and general hospitals have decreased. The number of newly established clinics per 100,000 populations has increased in the all areas, but the rate of increase has decreased in the cities except in 6 major cities in 1990. The rate of increase in newly established clinics surpasses that of population increase. This study has identified the trend of young physicians' early driving into their solo medical practice than before. This indicates chance of the medical specialty training nowadays toughen due to the limited openings in residency programs. However, the sex ratio of physicians at newly established clinics has not changed. The decreasing tendency to open medical practice without beds and the increasing size of clinics are found in this study(The size has been measured in terms of medical manpower, of beds, and of medical equipment in this study). Two thirds of general practitioners have opened their clinics without beds, although such trend has been less in the case of specialists. All three indicators show increasing size, especially in the case of rural clinics. However, among them, the number of medical equipments has increased most significantly from 8.9 items in 1981 to 12.9 in 1990.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.7
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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.

• Journal of agricultural medicine and community health
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• v.25 no.2
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• pp.217-230
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• 2000

For the longest time, our government has played an inconsiderable role in the public health services of Korea, especially as it relates to their investment. Voices have cried out against increases in national health expenditure and for more establishment of public medical facilities. In light of this, the necessity and importance of public medical facilities have come into focus amidst the recent medical crisis. When public medical facilities filled in the gap created by the suspension or closure of private hospitals and clinics as a result of this national crisis and acted as a safety net, the demand for more establishment of such facilities increased. Although patient diagnosis and treatment are the first priority of public medical facilities, they must also deal with scopes that private medical facilities do not deal with, dislike, or have difficulty with. In this respect, the closure or privatization of public hospitals to reduce their number just because of their low profits or financial burdens that must be carried by the government is to ignore their innate importance and social role; therefore, we must do all we can to block such efforts and further empower these public health facilities according to demands of the time. The improvement of public health services can be realized by redefining its goals and roles, increasing government funding, strengthening of existing public health facilities and reorganizing the public health services system. Even if public health facilities were to increase their medical services and be reinforced, they cannot take on all the services related to public health services, Therefore, in a country like ours where public health services come second to private health services in the health care system, the health of citizens can be safeguarded only when private and public facilities cooperate and private medical facilities share the social responsibilities. Only the show of interest and effort by government, politicians, health professionals, professional organizations and public can initiate the improvement that is sought.

• International Journal of Fuzzy Logic and Intelligent Systems
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• v.14 no.4
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• pp.268-275
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• 2014

In future, hospitals are expected to automatically issue remote transcriptions. Many general hospitals are planning to encrypt their medical database to secure personal information as mandated by law. The electronic medical record system, picture archiving communication system, and the clinical data warehouse, amongst others, are the preferred targets for which stronger security is planned. In the near future, medical systems can be assumed to be automated and connected to remote locations, such as rural areas, and islands. Connecting patients who are in remote locations to medical complexes that are usually based in larger cities requires not only automatic processing, but also a certain amount of security in terms of medical data that is of a sensitive and critical nature. Unauthorized access to patients' transcription data could result in the data being modified, with possible lethal results. Hence, personal and sensitive data on telemedicine and medical information systems should be encrypted to protect patients from these risks. Login passwords, personal identification information, and biological information should similarly be protected in a systematic way. This paper proposes the use of electronic acupuncture with a built-in multi-pad, which has the advantage of being able to establish a patient's physical condition, while simultaneously treating the patient with acupuncture. This system implements a sensing pad, amplifier, a small signal drive circuit, and a digital signal processing system, while the use of a built-in fuzzy technique and a control algorithm have been proposed for performing analyses.

• Journal of Korean Academy of Nursing
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• v.9 no.2
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• pp.1-6
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• 1979

The topic I have chosen for presentation to you today is entitled, the theory of change in nursing practice or to put it into simpler words. How do new ideas in nursing get started - Where do they come from\ulcorner - How are these ideas spread through the social system of nurses\ulcorner - What makes some Directors of Nursing more ready to accept change than others\ulcorner What factors in-fluence than to introduce change\ulcorner The process of change has been the subject of considerable research in such diverse disciplines and fields as anthropology and rural sociology, marketing and, also, education, for many years. The studies are called“diffusion”studies, or sometimes“adoption”studies, or“adoption of innovation”studies. They deal specifically with the transmission of innovations to members of a social system, and are considered a subset of research in the general field of communication, Although a number of studies have been undertaken in medicine, and, in the past decade, numerous ones in education, there have been few studies on the process of change in nursing. Yet, nursing has undergone tremendous changes in the past 10 years - the nursing process has been introduced, there is the expanded role of the nurse which is rapidly becoming a regular mode of practice - and many, many more changes, We seem to be always running to try. to keep up with changes that have already taken place. Yet little is known about known about the process of change itself - how practitioners learn about new ideas and techniques, or about the factors which influence nurses to accept some changes and reject others. The purpose of the study I am about. to describe was to analyze the process of change as it functioned in regard to nursing innovations in a selected segment of Canadian hospitals, and to relate the analysis to general research and theory about information transmission and the acceptance of change. Three aspects of the process were investigated : 1. The flow of information about changes in nursing practice through a network of hospitals. 2. Factors influencing the adoption of changes in nursing practice. 3. Factors influencing delay in the adoption process, the rejection of changes, or their discontinuance following adoption.