개인형 이동장치의 안전 주요 문제점 및 개선방안 연구 (A Study on Major Safety Problems and Improvement Measures of Personal Mobility)
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- 한국재난정보학회 논문집
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- 제18권1호
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- pp.202-217
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- 2022
연구목적: 최근 개인형 이동장치(PM : Personal Mobility) 이용이 지속적으로 증가하면서 사고 또한 매년 폭발적으로 급증하고 있다. 이에 따라 PM 이용에 대한 안전 요구가 강화되고 있으나 여전히 안전한 환경을 위한 법/제도, 인프라, 관리체계 등은 부족한 실정이다. 따라서 본 연구에서는 PM 관련 선행연구 검토를 토대로 주요 문제점과 개선방안을 종합적으로 모색하고, 델파이조사를 통해 개선방안의 중요성에 따른 우선순위를 제시한다. 연구방법: 연구방법은 크게 문헌연구와 전문가 설문조사(델파이조사)로 구성된다. 기존의 선행연구와 개선사례(지방자치단체, 정부부처, 업체 등)를 검토하여 문제점, 개선사항을 도출하고 키워드를 기반으로 문제점/개선사항 분류표를 작성한다. 분류 내용을 토대로 전문가 설문조사를 실시하여 우선순위 개선방안을 도출한다. 연구결과: PM 관련 문제점은 인적요인과 관련하여 '교통법규 미준수, 지식 부족, 조작 미숙, 안전의식 부재'가, 물리적요인과 관련하여 '기기 특성, 도로-주행 가능 공간, 도로시설물, 주차시설'이, 관리적요인으로 '관리/감독, 제품관리, 이용자관리, 교육/훈련'이, 그 외 이 모든 요인들과 관련한 법률적요인을 '법률 부재/미흡, 혼선/중복, 실효성 저하' 측면으로 나눠볼 수 있었다. 이와 관련한 개선과제로 'PM 교육·홍보, 주차·반납, 도로개선, PM 등록·관리, 보험, 안전기준, 통행기준, PM 기기안전, PM 부대시설, 단속/관리, 전담조직, 서비스제공업체, 관리체계, 이와 관련한 법/제도 개선'의 14개 핵심 부문에 대해 42개 세부과제를 도출하였다. 세부 과제에 대한 중요도 평가결과 비용, 시간, 효과, 시급성, 실현가능성 평가항목에 대해 평균이 종합적으로 높은 과제는 '단속/계도활동 강화, 교육홍보/캠페인, 무단방치 PM관리, 통행규정 명확화'로 나타났다. 결론: PM 시장은 공유 서비스를 기반으로 점차 시장 규모가 커지고 있으며, 산업 활성화와 더불어 PM 이용의 안전환경이 보장되어야 한다. 이러한 측면에서 본 연구는 PM 관련 주요 문제점, 개선방안을 종합적인 관점에서 모색하고 우선적으로 필요한 개선대책의 순위를 알아본데 있어 그 의미가 있으며 향후 정책수립 자료의 기초가 될 수 있다는 점에서 그 가치가 있다. 향후에는 실질적인 정책 적용을 위해 개선 핵심 분야별로 심층적인 자료 보완이 필요할 것이다.
본 연구는 변화되고 있는 지역사회보건사업의 요구에 따른 연도별 보건소 간호사들의 역할 변화, 역할 수행에 따른 장애요인 및 간호업무 수행과 관련하여 인지하는 직무만족도를 파악하고자 1992년 3월 19일부터 4월 11일까지 경상남도 보건간호사 270명을 대상으로 설문조사한 결과는 다음과 같다. 보건간호사들이 수행한 최우선 보건사업은 1970년 이전에는 가족계획사업, 1970 - 1979년대에는 간호업무, 1980 - 1989년대에는 모자보건사업, 1990 - 1992년대에는 간호업무이었다. 가족계획사업 내용의 우선순위는 1970년 이전에는 자궁내장치 삽입 권장과 경구피임약 또는 콘돔 배부에 역점을 두었으며 그 이후로는 가족계획 홍보를 우선으로 했다. 모자보건사업 내용의 우선순위는 1970년 이전부터 임부등록에 많이 두었으며 그 다음으로 산전진찰과 예방접종에 치중한 것으로 나타났다. 결핵관리사업 내용의 수선순위를 보면 각 년대마다 신환자 발견 등록에 치중하였으며 그 다음으로 환자관리 및 투약 주사에 비중을 두었다. 간호업무 냉용의 우선순위를 보면 1970년대 이전에는 순회진료에 역점을 두었으며 그 다음으로 주사 및 투약에 치중하였다. 전염병관리 내용의 우선순위는 1970년 이전부터 1순위였으며 그 다음으로 투약 및 주사에 치중하였다. 1990-1992년대에는 상담 및 교육이 2순위로 나타났다. 노인보건사업 내용의 수선순위가 1979년대 이전부터 순회진료가 1순위였으며 그 다음으로 검진보조가 2순위로 나타났다. 사업별 업무수행시 장애요인을 보면 가족계획 사업에서는 주민의 이해부족이 28.8%, 예산부족이 13.6%, 보건행정체계 미비가 11.9%였으며, 결핵사업에서는 주민의 이해부족이 32.5%, 업무과다(인원부족)가 15.6%, 기술이나 지식의 부족이 13.0%였다. 업무과다(인원부족)와 시설 장비의 부족이 각각 15.6%, 주님의 이해부족이 13.0%였다. 직급별 보건간호사의 직무만족도에서 경력이나 능력에 비해 승진기회여부는 불만이다가 8,9급이 64.7%로 높았으며 전문직 발전의 기회는 없다가 6,7급이 67.7%, 8,9급이 64.0%로 높았다. 보건업무에 필요한 물품과 시설의 만족여부에서 하위급으로 내려갈수록 만족도는 낮았으며 보수의 만족도에서는 적당하다가 6,7급이 64.7%, 너무 작다가 8,9급이 53.0%로 높았다. 직급별 보건간호사의 직업 긍지 만족도에서 직급이 높을수록 직업적 긍지의 직무만족도는 높았다. 직급별 현 직급에 대한 만족도는 하위급으로 내려갈수록 만족하는 사람의 비율은 높아졌다. 보건간호사의 경력(년)별 직무만족도에서 보건간호사 경력이 많을수록 직급, 승진기회, 전문직 발전의 기회에 대한 직무만족도는 낮게 나타났다. 보건간호사의 경력(년)별 직업 긍지 만족도에서 보건간호사 경력이 많을수록 직업적 긍지의 직무만족도는 높게 나타났다. 대상자의 37.6%가 이직할 의사가 있다고 하였으며, 승진기회의 부족, 근무여건의 불만이 이직 이유였다. 하력과 경력은 직무만족도 사이에 유의한 상관관계가 없었으며 직급이 낮을수록 직무만족도는 낮아 유의한 관련성을 나타내었다. 1차 보건의료사업을 수행토록 하기 위해서는 보건간호사의 인식이나 주민들의 인식을 새롭게 하기 위한 홍보활동 및 교육이 더 주어져야 할 것이며 보건간호사의 승진기회 및 직급에 대란 불만도가 높기 때문에 보건간호사의 승진제도개선 및 직무영역확대가 고려되어야 할 것이다. 그래서 간호업무에 만족할 수 있는 제도개선에 대해 고려해야 할 것으로 생각된다.
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.
Today most developed countries provide modern medical care for most of the population. The rural area is the more neglected area in the medical and health field. In public health, the philosophy is that medical care for in maintenance of health is a basic right of man; it should not be discriminated against racial, environmental or financial situations. The deficiency of the medical care system, cultural bias, economic development, and ignorance of the residents about health care brought about the shortage of medical personnel and facilities on the rural areas. Moreover, medical students and physicians have been taught less about rural health care than about urban health care. Medical care, therefore, is insufficient in terms of health care personnel/and facilities in rural areas. Under such a situation, there is growing concern about the health problems among the rural population. The findings presented in this report are useful measures of the major health problems and even more important, as a guide to planning for improved medical care systems. It is hoped that findings from this study will be useful to those responsible for improving the delivery of health service for the rural population. Objectives: -to determine the health status of the residents in the rural areas. -to assess the rural population's needs in terms of health and medical care. -to make recommendations concerning improvement in the delivery of health and medical care for the rural population. Procedures: For the sampling design, the ideal would be to sample according to the proportion of the composition age-groups. As the health problems would be different by group, the sample was divided into 10 different age-groups. If the sample were allocated by proportion of composition of each age group, some age groups would be too small to estimate the health problem. The sample size of each age-group population was 100 people/age-groups. Personal interviews were conducted by specially trained medical students. The interviews dealt at length with current health status, medical care problems, utilization of medical services, medical cost paid for medical care and attitudes toward health. In addition, more information was gained from the public health field, including environmental sanitation, maternal and child health, family planning, tuberculosis control, and dental health. The sample Sample size was one fourth of total population: 1,438 The aged 10-14 years showed the largest number of 254 and the aged under one year was the smallest number of 81. Participation in examination Examination sessions usually were held in the morning every Tuesday, Wenesday, and Thursday for 3 hours at each session at the Namchun Health station. In general, the rate of participation in medical examination was low especially in ages between 10-19 years old. The highest rate of participation among are groups was the under one year age-group by 100 percent. The lowest use rate as low as 3% of those in the age-groups 10-19 years who are attending junior and senior high school in Taegu city so the time was not convenient for them to recieve examinations. Among the over 20 years old group, the rate of participation of female was higher than that of males. The results are as follows: A. Publie health problems Population: The number of pre-school age group who required child health was 724, among them infants numbered 96. Number of eligible women aged 15-44 years was 1,279, and women with husband who need maternal health numbered 700. The age-group of 65 years or older was 201 needed more health care and 65 of them had disabilities. (Table 2). Environmental sanitation: Seventy-nine percent of the residents relied upon well water as a primary source of dringking water. Ninety-three percent of the drinking water supply was rated as unfited quality for drinking. More than 90% of latrines were unhygienic, in structure design and sanitation (Table 15). Maternal and child health: Maternal health Average number of pregnancies of eligible women was 4 times. There was almost no pre- and post-natal care. Pregnancy wastage Still births was 33 per 1,000 live births. Spontaneous abortion was 156 per 1,000 live births. Induced abortion was 137 per 1,000 live births. Delivery condition More than 90 percent of deliveries were conducted at home. Attendants at last delivery were laymen by 76% and delivery without attendants was 14%. The rate of non-sterilized scissors as an instrument used to cut the umbilical cord was as high as 54% and of sickles was 14%. The rate of difficult delivery counted for 3%. Maternal death rate estimates about 35 per 10,000 live births. Child health Consultation rate for child health was almost non existant. In general, vaccination rate of children was low; vaccination rates for children aged 0-5 years with BCG and small pox were 34 and 28 percent respectively. The rate of vaccination with DPT and Polio were 23 and 25% respectively but the rate of the complete three injections were as low as 5 and 3% respectively. The number of dead children was 280 per 1,000 living children. Infants death rate was 45 per 1,000 live births (Table 16), Family planning: Approval rate of married women for family planning was as high as 86%. The rate of experiences of contraception in the past was 51%. The current rate of contraception was 37%. Willingness to use contraception in the future was as high as 86% (Table 17). Tuberculosis control: Number of registration patients at the health center currently was 25. The number indicates one eighth of estimate number of tuberculosis in the area. Number of discharged cases in the past accounted for 79 which showed 50% of active cases when discharged time. Rate of complete treatment among reasons of discharge in the past as low as 28%. There needs to be a follow up observation of the discharged cases (Table 18). Dental problems: More than 50% of the total population have at least one or more dental problems. (Table 19) B. Medical care problems Incidence rate: 1. In one month Incidence rate of medical care problems during one month was 19.6 percent. Among these health problems which required rest at home were 11.8 percent. The estimated number of patients in the total population is 1,206. The health problems reported most frequently in interviews during one month are: GI trouble, respiratory disease, neuralgia, skin disease, and communicable disease-in that order, The rate of health problems by age groups was highest in the 1-4 age group and in the 60 years or over age group, the lowest rate was the 10-14 year age group. In general, 0-29 year age group except the 1-4 year age group was low incidence rate. After 30 years old the rate of health problems increases gradually with aging. Eighty-three percent of health problems that occured during one month were solved by primary medical care procedures. Seventeen percent of health problems needed secondary care. Days rested at home because of illness during one month were 0.7 days per interviewee and 8days per patient and it accounts for 2,161 days for the total productive population in the area. (Table 20) 2. In a year The incidence rate of medical care problems during a year was 74.8%, among them health problems which required rest at home was 37 percent. Estimated number of patients in the total population during a year was 4,600. The health problems that occured most frequently among the interviewees during a year were: Cold (30%), GI trouble (18), respiratory disease (11), anemia (10), diarrhea (10), neuralgia (10), parasite disease (9), ENT (7), skin (7), headache (7), trauma (4), communicable disease (3), and circulatory disease (3) -in that order. The rate of health problems by age groups was highest in the infants group, thereafter the rate decreased gradually until the age 15-19 year age group which showed the lowest, and then the rate increased gradually with aging. Eighty-seven percent of health problems during a year were solved by primary medical care. Thirteen percent of them needed secondary medical care procedures. Days rested at home because of illness during a year were 16 days per interviewee and 44 days per patient and it accounted for 57,335 days lost among productive age group in the area (Table 21). Among those given medical examination, the conditions observed most frequently were respiratory disease, GI trouble, parasite disease, neuralgia, skin disease, trauma, tuberculosis, anemia, chronic obstructive lung disease, eye disorders-in that order (Table 22). The main health problems required secondary medical care are as fellows: (previous page). Utilization of medical care (treatment) The rate of treatment by various medical facilities for all health problems during one month was 73 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 52% while the rate of those who have health problems which did not required rest was 61 percent (Table 23). The rate of receiving of medical care for all health problems during a year was 67 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 82 percent while the rate of those who have health problems which did not required rest was as low as 53 percent (Table 24). Types of medical facilitied used were as follows: Hospital and clinics: 32-35% Herb clinics: 9-10% Drugstore: 53-58% Hospitalization Rate of hospitalization was 1.7% and the estimate number of hospitalizations among the total population during a year will be 107 persons (Table 25). Medical cost: Average medical cost per person during one month and a year were 171 and 2,800 won respectively. Average medical cost per patient during one month and a year were 1,109 and 3,740 won respectively. Average cost per household during a year was 15,800 won (Table 26, 27). Solution measures for health and medical care problems in rural area: A. Health problems which could be solved by paramedical workers such as nurses, midwives and aid nurses etc. are as follows: 1. Improvement of environmental sanitation 2. MCH except medical care problems 3. Family planning except surgical intervention 4. Tuberculosis control except diagnosis and prescription 5. Dental care except operational intervention 6. Health education for residents for improvement of utilization of medical facilities and early diagnosis etc. B. Medical care problems 1. Eighty-five percent of health problems could be solved by primary care procedures by general practitioners. 2. Fifteen percent of health problems need secondary medical procedures by a specialist. C. Medical cost Concidering the economic situation in rural area the amount of 2,062 won per residents during a year will be burdensome, so financial assistance is needed gorvernment to solve health and medical care problems for rural people.