• 제목/요약/키워드: Technical Services

검색결과 1,117건 처리시간 0.029초

가족계획(家族計劃) 및 모자보건사업(母子保健事業)의 효율적 통합방안(統合方案)에 관한 연구(硏究)(서산군(瑞山郡)) -기초조사보고(基礎調査報告)- (The Seosan County Family Planning/Maternal & Child Health Service Research Project, Korea -Project Design and Findings of the Baseline Survey-)

  • 방숙;조태호;이상주;한성현;임경주;안문영
    • Journal of Preventive Medicine and Public Health
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    • 제16권1호
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    • pp.163-192
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    • 1983
  • In order to facilitate the Korean government's efforts in integrating family planning and maternal & child health at the primary health care level (or township level), the Soon Chun Hyang College of Medicine, with the financial and technical assistance of WHO, has under-taken a service research project. The project has employed a quasi-experimental study design introducing interventions tat provide crucial factors lacking in the ongoing government programs such as midwives and qualified referral physicians. The study is being conducted in three locations, one control area and two study areas. Before introducing trained Nurse/Midewives into the study areas, a baseline prevalence survey was undertaken from 15 July 1981 to 10 August 1981 in selelcted townships of Seosan County. In this sample survey of bath the study and control areas, 2,484 eligible women (97% reponse rate) were interviewed to obtain benchmark data on basic evaluation indicators related to family planning and maternal and child health. The salients results were summarized as follows.: 1. CONTACT RATES WITH HEALTH WORKERS; During the year preceding the survey, 12% of women were visited by government health workers. The primary reason for such visits by health workers was family planning (45% of the visits). About 34% of the women visited the health centers during the year. The primary reason for visiting health centers was immunizations for their children (45% of the visits). 3. FAMILY PLANNING USE RATE; The baseline data showed little difference between women in the study area and the control area on contraceptive use. Approximately 59% were currently using some methods. However, among those current users, almost half were practicing less effective methods of birth control such as rhythm or withdrawal. Among other methods, the tubectomy was the most popular (16%), while use of the IUD, oral pill and condom together reached only 14%. 3. PRENATAL CARE RATE; About 75% of the women reported no prenatal care for their last births (the youngest child of each women), Additionally, among women received prenatal care, over half had only one visit. 4. ATTENDANCE AT DELIVERY; Most of the women surveyed (over 80%) were attended by a non-medical person during their last delivery. These figures are somewhat comparable to the national figure of 84% for remote areas. 5. POSTNATAL CARE; The proportion of women reporting postnatal care was only 4.5%, and postnatal care was not received by the majority of women surveyed. 6. CHILD HEALTH CARE: In contrast to the low rate of maternity care for women themselves, most women reported obtaining immunization care for their children. About 75% of the women obtained Polio and/or DPT, 58% BCG, and 44% Measles vaccine for their children. However, in terms of illness care, while 35% of the women stated that their youngest child had been sick during the month preceding the survey, only 28% of these women took their child to the clinic for treatment. 7. COMPLICATIONS OF PREGNANCY AND DELIVERY AND ABNORMALITIES IN THE NEWBORN; Among all last deliveries, 18% of the women had pregnancy complications and 9% of the women had complications during delivery About 5% of the women reported abnormality in their most recent newborn. 8. REPRODUCTION EFFICIENCY; PERINATAL MORTALITY AND INFANT MORTALITY Based on data from the pregnancy history in this survey, reproduction efficiency was estimated. Out of the 11,154 pregnancies reported by all women surveyed, foetal loss was 21% (almost 16% were induced abortions) and infant deaths before reaching one year old were 3.1%. The reproduction efficiency was, therefore, reduced to 76%. In terms of perinatal and infant mortality rates, the former was 40.2 per 1,000 total births and the latter was 39.3 per 1,000 live births. Both rates described J shaped relationships with age of mothers and parity, and they were also correlated with birth interval and mother's education. In summary, this baseline survey data indicated a need for (1) improving contraceptive practices with more effective methods to prevent unwanted pregnancies and (2) providing better services for maternal and child care to protect wanted pregancies. In the Korean rural setting. the author believes that the latter is more important as the value of each child has increased as a result of the family planning campaign for the past two decades. This calls for more effective integration of Family Planning and MCH programmes to meet the needs of the family in each stage of the child bearing and rearing period with deploying more qualified personnel than the current government program personnel.

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e헬스케어 비즈니스모델에 관한 연구: 비즈니스생태계 접근 중심으로 (A Study on e-Healthcare Business Model: Focusing on Business Ecosystem Approach)

  • 김영수;정재진
    • 벤처창업연구
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    • 제14권1호
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    • pp.167-185
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    • 2019
  • 대부분의 G20 국가에서 향후 수십 년 동안 의료 지출이 급격하게 성장할 것으로 예상하고 있듯이, 고연령 인구와 만성질환자의 증가로 인해 전 세계적으로 의료비 부담은 지속적으로 늘어나고 있으며 의료서비스의 지속적인 질 개선도 해결해야 할 과제로 대두되고 있다. 그러나 헬스케어와 IT 융합의 급변하는 기술 환경 하에서 이런 변화를 제대로 인식하지 못하고 적절한 대비를 하지 않는데서 그 문제가 더 커질 수 있다. 패러다임 변화와 의료 분야 문제 증대 상황에서 기술적, 제도적, 사업적 측면에서의 복합적인 대응이 절실히 필요하다. 핵심은 의료분야에 IT를 융합한 사업에 적합한 비즈니스모델의 도출이라 할 수 있다. 4차 산업혁명시대의 도래와 함께 사물인터넷 등의 신기술이 e헬스케어에 적용되면서 새로운 비즈니스모델의 필요성이 대두 되었다. 기존 인터넷 시대의 e헬스케어에서는 전통적인 조직 기반 (Firm-centric) 비즈니스모델이 되었으나 사물인터넷 시대에는 사물인터넷의 역동성 (Dynamics) 및 복잡성 (Complex)의 특성으로 인하여 단위 조직 (Firm-Centric)보다는 비즈니스생태계 (Business Ecosystem)기반의 접근이 필요하다. 본 논문에서는 사물인터넷 등 이머징 기술 (Emerging Technology)기반의 e헬스케어의 비즈니스생태계에 대한 연구 결과로 e헬스케어 비즈니스생태계의 3-레이어 (Layer) 구조에 기반한 생태계의 주요 발전 인자를 분석 제시한다. 3-레이어 비즈니스생태계는 (1) 인프라 스트럭처 레이어 (Infrastructure Layer), (2) 특성 레이어 (Characteristics Layer) 및 (3) 이해당사자 레이어 (Stakeholder Layer)로 정의하여 분석하였다. e헬스케어 비즈니스생태계의 주요 발전 인자측면에서는 (1) i헬스케어 개념의 도입, (2) 비즈니스생태계의 확장, (3) 비즈니스생태계 변화 프로세스 혁신, (4) 비즈니스생태계 리더쉽 혁신의 4가지 인자를 제안한다.

신뢰성 있는 전자기록관리기관 감사인증도구 개발에 관한 연구 (Development Process and Methods of Audit and Certification Toolkit for Trustworthy Digital Records Management Agency)

  • 이해영;김익한;임진희;심성보;조윤선;김효진;우현민
    • 기록학연구
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    • 제25호
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    • pp.3-46
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    • 2010
  • 전자기록관리는 수많은 사회적 기술적 요소가 상호작용하는 하나의 시스템이다. 신뢰받는 상태를 계속 유지하기 위해 전자기록관리기관은 감사와 인증의 정규적인 수행이 필요할 것이다. 이에 따라 개별 전자기록관리기관에서는 스스로의 신뢰도를 지속적으로 평가해보는 도구로 사용할 수 있고 스스로의 환경과 시스템을 자체 평가하여 부족한 부분도 파악할 수 있게 하는 도구의 필요성이 생겼다. 본 연구의 목적은 OAIS 참조모형(ISO 14721)과 영국 UKDA와 TNA의 자가진단보고서, TRAC 및 DRAMBORA 등 4개 표준과 국제모범사례를 분석하고, MoReq2와 현행 국내 법령 및 표준 등을 종합, 분석하여 자체인증도구를 개발하고자 하는 것이었다. 본 연구에서는 이 인증도구의 개발과정과 전체적인 틀을 기술함으로써, 타 기관에서도 기관의 특성에 따라 이러한 도구를 개발하고 자체적으로 활용할 수 있는 개발방법론을 제시하고자 하였다. 본 연구의 진행 결과, (기관) 운영관리, 분류체계 및 기준정보 관리, 입수, 등록 기술, 저장 보존, 처분, 서비스, 검색도구 제공, 시스템 관리, 접근통제 보안, 모니터링 감사증적 통계, 위험관리 등 총 12개 영역으로 진단영역이 확정되었다. 설정된 12개 영역 각각에 대해 각 영역별로 프로세스 맵 또는 기능차트 등을 만들고 업무기능을 분석한 후, 영역별 주요 업무기능 단위를 중심으로 구성된 54개의 '평가지표'가 도출되었다. 각 평가지표 별로 실제 자가진단을 시행할 수 있는 측정 가능하고 증빙이 가능하도록 작성한 208개의 '평가세부지표'를 도출하였다. 본 연구의 결과물로 생성된 이 지표는 전자기록관리기관의 감사인증도구로 사용될 수 있어, 기관 스스로 정기적으로 자가진단을 실행하는 데에 활용함으로써, 발견된 미비점을 보완하고 향후 기관의 발전 전략에 반영할 수 있다.

정보공개제도상의 정보부존재에 관한 고찰 중앙행정기관을 중심으로 (A study on non-existence information of the information disclosure system : focused on the central administrative agencies)

  • 김유승;최정민
    • 기록학연구
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    • 제46호
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    • pp.153-187
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    • 2015
  • 본 연구는 정보부존재 관련 실증연구가 거의 전무한 상황에서 정보부존재의 유형과 내용을 분석, 문제점을 도출하고 개선 방안을 제시하고자 하였다. 이를 위한 이론 연구로서 정보부존재의 정의와 판단기준을 살피고, 정보부존재의 법적, 통계적 연혁을 분석하였다. 또한 중앙행정기관의 정보부존재 현황과 문제점을 파악하기 위하여, 비공개 사유에서 정보부존재가 제외된 2012년부터 2014년까지 41개 중앙행정기관의 정보공개처리대장에 나타난 정보부존재 통지 내용을 분석하였다. 기관별 분석 결과, 3년간의 조사대상 기관 부존재처리 현황은 총 4421건으로 해마다 지속적인 증가 추이를 보이는 것으로 나타났다. 3년 동안 집계된 정보부존재 건수가 비공개 건수와 같거나 큰 기관이 조사대상 중 약 40%에 달해 비공개 사유에서의 정보부존재 제외가 다수 기관의 정보공개율과 비공개율에 큰 영향을 주었음을 반증하고 있었다. 정보부존재 사유의 유형 분석에서는 '공공기관이 청구된 정보를 생산, 접수하지 않는 경우'가 75% 이상을 차지하여 가장 많았고, 그 다음으로 '취합, 가공해야 하는 경우'와 '사유가 명시 되지 않은 경우'가 각각 7~10%를 차지하였다. 정보부존재 통지내용을 분석하여 도출한 운영상의 문제점으로는 1) 정보부존재에 사유에 대한 구체적 설명 미비, 2) 취합 및 가공의 범주 문제, 3) 이송처리의 문제, 4) 기록관리의 문제 등이었다. 이에 대해 본 연구는 정보부존재에 대한 관점과 기술적, 절차적 측면으로 개선 방안을 제시하였다. 구체적으로는 첫째, 정보부존재를 포함한 정보공개 문제가 기록관리 문제의 연장선상에서 이해되어야 한다는 점, 둘째, 앞선 이해를 바탕으로 정보공개 서비스 전반이 개선되어야 한다는 점, 셋째, 정보부존재 처리 절차가 개선되어야 한다는 점, 넷째, 정보부존재 처리 절차에 대한 구체적 지침이 마련되어야 할 것이다.

구급대원의 전문심장소생술 시뮬레이션훈련이 직무수행융합능력에 미치는 영향 (The effects of out of hospital ACLS simulation training on the paramedic's duty ability)

  • 박유나;조병준;김경용
    • 한국융합학회논문지
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    • 제10권4호
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    • pp.99-106
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    • 2019
  • 본 연구는 시뮬레이션을 기반으로 한 전문심장소생술 교육이 병원 전 단계에 구급대원이 환자에게 시행하는 전문심장소생술 직무수행에 미치는 영향을 분석하고 효과적인 전문심장소생술을 시행하기 위한 기초자료를 제공하는데 그 목적이 있다. 비동등성 대조군 전후 설계를 기초하였으며 연구대상은 K소방학교의 신규 임용된 구급대원 16명이 참여하였다. 평가 도구로 사용된 시뮬레이션 교육 프로그램과 평가지는 ACLS 시뮬레이션 전문가 6인(응급의학 전문의 2명, 전공교수 2명, 전문강사 2명)에게 사전 검토 및 의견을 받아 본 연구에 적합한 도구로 개발하였다. 교육은 이론 30분, 실습 150분으로 구성하여 4인 1조 1개팀으로 구성하였다. 강사가 5분간 시연을 한 후 개인별 실습 후 디브리핑(debriefing)을 통한 교정을 거친 후 개별, 팀별 교육을 실시하였다. 평가척도는 5점 리커트(Likert) 척도로 수행능력 평가 점수를 부여하였다. 자료분석은 Windows용 SPSS 22.0 프로그램을 사용하였으며, 대상자의 일반적 특성은 빈도분석을 하였으며, 실험군과 대조군의 동질성 검증은 t검정을 하였고 두 그룹의 집단의 차이 분석은 대응표본 t 검정(paired t-test)으로 분석하였다. 동질성 검사에 실험군과 대조군의 동질성을 확인 할 수 있었다. 전문심장소생술(ACLS) 수행기술 6가지에 대한 평가에서 시뮬레이션 교육을 받은 실험군이 교육을 받지않은 전통적 교육 방식의 대조군보다 모든 면에서 수행능력이 우수하였음을 증명하였다. 수행기술은 1. 심전도 2. 전문기기 3. 수액처치 4. 리더십과 팀워크 5. 의료지도 6. 이송중 평가 이상 6가지 이다. 일반적인 강의와 실습을 한 구급대원보다 시뮬레이션 교육을 받은 구급대원이 직무수행 능력이 향상된 것이 검증되었다 따라서 종합술기 과정에 있는 학생이나 임상에 종사하는 응급구조사에게 시뮬레이션 훈련과 교육이 확대 적용된다면 더 능숙하게 직무를 수행해 나갈 수 있을 것이며, 심정지 환자에게 제공되는 구급서비스가 향상될 것으로 기대한다.

이물 객체 탐지 성능 개선을 위한 딥러닝 네트워크 기반 저품질 영상 개선 기법 개발 (Development of deep learning network based low-quality image enhancement techniques for improving foreign object detection performance)

  • 엄기열;민병석
    • 인터넷정보학회논문지
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    • 제25권1호
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    • pp.99-107
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    • 2024
  • 경제성장과 산업 발전에 따라 반도체 제품부터 SMT 제품, 전기 배터리 제품에 이르기 까지 많은 전자통신 부품들의 제조과정에서 발생하는 철, 알루미늄, 플라스틱 등의 이물질로 인해 제품이 제대로 동작하지 않거나, 전기 배터리의 경우 화재를 발생하는 문제까지 심각한 문제로 이어질 가능성이 있다. 이러한 문제를 해결하기 위해 초음파나 X-ray를 이용한 비파괴 방법으로 제품 내부에 이물질이 있는지 판단하여 문제의 발생을 차단하고 있으나, X-ray 영상을 취득하여 이물질이 있는지 판정하는 데에도 여러 한계점이 존재한다. 특히. 크기가 작거나 밀도가 낮은 이물질들은 X-Ray장비로 촬영을 하여도 보이지 않는 문제점이 있고, 잡음 등으로 인해 이물들이 잘 안 보이는 경우가 있으며, 특히 높은 생산성을 가지기 위해서는 빠른 검사속도가 필요한데, 이 경우 X-ray 촬영시간이 짧아지게 되면 신호 대비 잡음비율(SNR)이 낮아지면서 이물 탐지 성능이 크게 저하되는 문제를 가진다. 따라서, 본 논문에서는 저화질로 인해 이물질을 탐지하기 어려운 한계를 극복하기 위한 5단계 방안을 제안한다. 첫번째로, Global 히스토그램 최적화를 통해 X-Ray영상의 대비를 향상시키고, 두 번째로 고주파 영역 신호의 구분력을 강화하기 위하여 Local contrast기법을 적용하며, 세 번째로 Edge 선명도 향상을 위해 Unsharp masking을 통해 경계선을 강화하여 객체가 잘 구분되도록 한다, 네 번째로, 잡음 제거 및 영상향상을 위해 Resdual Dense Block(RDB)의 초고해상화 방법을 제안하며, 마지막으로 Yolov5 알고리즘을 이용하여 이물질을 학습한 후 탐지한다. 본 연구에서 제안하는 방식을 이용하여 실험한 결과, 저밀도 영상 대비 정밀도 등의 평가기준에서 10%이상의 성능이 향상된다.

항공기(航空機) 사고조사제도(事故調査制度)에 관한 연구(硏究) (A Study on the System of Aircraft Investigation)

  • 김두환
    • 항공우주정책ㆍ법학회지
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    • 제9권
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    • pp.85-143
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    • 1997
  • The main purpose of the investigation of an accident caused by aircraft is to be prevented the sudden and casual accidents caused by wilful misconduct and fault from pilots, air traffic controllers, hijack, trouble of engine and machinery of aircraft, turbulence during the bad weather, collision between birds and aircraft, near miss flight by aircrafts etc. It is not the purpose of this activity to apportion blame or liability for offender of aircraft accidents. Accidents to aircraft, especially those involving the general public and their property, are a matter of great concern to the aviation community. The system of international regulation exists to improve safety and minimize, as far as possible, the risk of accidents but when they do occur there is a web of systems and procedures to investigate and respond to them. I would like to trace the general line of regulation from an international source in the Chicago Convention of 1944. Article 26 of the Convention lays down the basic principle for the investigation of the aircraft accident. Where there has been an accident to an aircraft of a contracting state which occurs in the territory of another contracting state and which involves death or serious injury or indicates serious technical defect in the aircraft or air navigation facilities, the state in which the accident occurs must institute an inquiry into the circumstances of the accident. That inquiry will be in accordance, in so far as its law permits, with the procedure which may be recommended from time to time by the International Civil Aviation Organization ICAO). There are very general provisions but they state two essential principles: first, in certain circumstances there must be an investigation, and second, who is to be responsible for undertaking that investigation. The latter is an important point to establish otherwise there could be at least two states claiming jurisdiction on the inquiry. The Chicago Convention also provides that the state where the aircraft is registered is to be given the opportunity to appoint observers to be present at the inquiry and the state holding the inquiry must communicate the report and findings in the matter to that other state. It is worth noting that the Chicago Convention (Article 25) also makes provision for assisting aircraft in distress. Each contracting state undertakes to provide such measures of assistance to aircraft in distress in its territory as it may find practicable and to permit (subject to control by its own authorities) the owner of the aircraft or authorities of the state in which the aircraft is registered, to provide such measures of assistance as may be necessitated by circumstances. Significantly, the undertaking can only be given by contracting state but the duty to provide assistance is not limited to aircraft registered in another contracting state, but presumably any aircraft in distress in the territory of the contracting state. Finally, the Convention envisages further regulations (normally to be produced under the auspices of ICAO). In this case the Convention provides that each contracting state, when undertaking a search for missing aircraft, will collaborate in co-ordinated measures which may be recommended from time to time pursuant to the Convention. Since 1944 further international regulations relating to safety and investigation of accidents have been made, both pursuant to Chicago Convention and, in particular, through the vehicle of the ICAO which has, for example, set up an accident and reporting system. By requiring the reporting of certain accidents and incidents it is building up an information service for the benefit of member states. However, Chicago Convention provides that each contracting state undertakes collaborate in securing the highest practicable degree of uniformity in regulations, standards, procedures and organization in relation to aircraft, personnel, airways and auxiliary services in all matters in which such uniformity will facilitate and improve air navigation. To this end, ICAO is to adopt and amend from time to time, as may be necessary, international standards and recommended practices and procedures dealing with, among other things, aircraft in distress and investigation of accidents. Standards and Recommended Practices for Aircraft Accident Injuries were first adopted by the ICAO Council on 11 April 1951 pursuant to Article 37 of the Chicago Convention on International Civil Aviation and were designated as Annex 13 to the Convention. The Standards Recommended Practices were based on Recommendations of the Accident Investigation Division at its first Session in February 1946 which were further developed at the Second Session of the Division in February 1947. The 2nd Edition (1966), 3rd Edition, (1973), 4th Edition (1976), 5th Edition (1979), 6th Edition (1981), 7th Edition (1988), 8th Edition (1992) of the Annex 13 (Aircraft Accident and Incident Investigation) of the Chicago Convention was amended eight times by the ICAO Council since 1966. Annex 13 sets out in detail the international standards and recommended practices to be adopted by contracting states in dealing with a serious accident to an aircraft of a contracting state occurring in the territory of another contracting state, known as the state of occurrence. It provides, principally, that the state in which the aircraft is registered is to be given the opportunity to appoint an accredited representative to be present at the inquiry conducted by the state in which the serious aircraft accident occurs. Article 26 of the Chicago Convention does not indicate what the accredited representative is to do but Annex 13 amplifies his rights and duties. In particular, the accredited representative participates in the inquiry by visiting the scene of the accident, examining the wreckage, questioning witnesses, having full access to all relevant evidence, receiving copies of all pertinent documents and making submissions in respect of the various elements of the inquiry. The main shortcomings of the present system for aircraft accident investigation are that some contracting sates are not applying Annex 13 within its express terms, although they are contracting states. Further, and much more important in practice, there are many countries which apply the letter of Annex 13 in such a way as to sterilise its spirit. This appears to be due to a number of causes often found in combination. Firstly, the requirements of the local law and of the local procedures are interpreted and applied so as preclude a more efficient investigation under Annex 13 in favour of a legalistic and sterile interpretation of its terms. Sometimes this results from a distrust of the motives of persons and bodies wishing to participate or from commercial or related to matters of liability and bodies. These may be political, commercial or related to matters of liability and insurance. Secondly, there is said to be a conscious desire to conduct the investigation in some contracting states in such a way as to absolve from any possibility of blame the authorities or nationals, whether manufacturers, operators or air traffic controllers, of the country in which the inquiry is held. The EEC has also had an input into accidents and investigations. In particular, a directive was issued in December 1980 encouraging the uniformity of standards within the EEC by means of joint co-operation of accident investigation. The sharing of and assisting with technical facilities and information was considered an important means of achieving these goals. It has since been proposed that a European accident investigation committee should be set up by the EEC (Council Directive 80/1266 of 1 December 1980). After I would like to introduce the summary of the legislation examples and system for aircraft accidents investigation of the United States, the United Kingdom, Canada, Germany, The Netherlands, Sweden, Swiss, New Zealand and Japan, and I am going to mention the present system, regulations and aviation act for the aircraft accident investigation in Korea. Furthermore I would like to point out the shortcomings of the present system and regulations and aviation act for the aircraft accident investigation and then I will suggest my personal opinion on the new and dramatic innovation on the system for aircraft accident investigation in Korea. I propose that it is necessary and desirable for us to make a new legislation or to revise the existing aviation act in order to establish the standing and independent Committee of Aircraft Accident Investigation under the Korean Government.

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보건진료원의 정규직화 전과 후의 보건진료원 활동 및 보건진료소 관리운영체계의 비교 분석 (Comparative Analysis of Community Health Practitioner's Activities and Primary Health Post Management Before and After Officialization of Community Health practitioner)

  • 윤석옥;정문숙
    • 농촌의학ㆍ지역보건
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    • 제19권2호
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    • pp.141-158
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    • 1994
  • 정부는 보건진료원으로 하여금 지역주민들에게 보다 더 의욕적으로 양질의 보건의료서비스를 제공하도록 하기 위하여 1992년 4월 1일부터 보건진료원을 별정직 공무원으로 정규직화 하였다. 본 연구는 보건진료원의 정규직화가 보건진료원의 업무활동과 보건진료소의 관리운영체계에 미친 영향을 분석하기 위해 경상남도와 경상북도의 보건진료소 중 집락추출법과 단순확률추출법으로 50개소를 뽑아 보건진료원을 대상으로 직접 면담조사하고 제반기록 및 보고서에서 필요한 자료를 발췌하였다. 조사기간은 1992년 1월 1일에서 3월 31일까지(정규직화 이전)와 1993년 1월 1일에서 3월 31일까지(정규직화 이후)였다. 보건진료원들의 96%가 정규직화를 원했는데 그 이유는 신분보장과 보수가 좋아지리라는 것이었다. 정규직화 후 보건진료원직을 자랑스럽게 생각한다는 사람이 24%에서 46%로 증가하였다. 신분보장에 대해서는 항상 불안하다는 사람이 30%에서 10%로 감소하였다. 정규직화 후 월평균 급여액은 802,600원에서 1,076,000원으로 34% 증가했으며 90%가 만족한다고 했다. 업무 내용별 자율성 인지정도는 업무계획, 업무수행, 진료소관리(재정)운영, 업무평가 영역에 대한 자율성 인지도가 정규직화 후에 증가되었다. 보건진료원의 활동내용 중 지역사회 자원파악, 지도작성상태, 지역사회조직 활용정도, 인구구조 파악정도와 가정건강기록부 작성은 정규직화 후에 특별한 변화는 없었다. 또한 집단보건교육, 개인보건교육, 학교보건교육의 실시도 정규직화 후에 변화가 없었다. 그러나 가정방문 실시현황은 1인당 월평균 13.6%회에서 정규직화 후에는 27.5%회로 늘었다. 모성보건 및 가족계획 사업 그리고 예방접종도 정규직화 후에 타기관에 의뢰하는 것이 더 늘었다. 통상질병관리 가운데 성인병관리는 3개월 동안 1개 진료소당 평균 고혈압환자는 12.7%명에서 11.6명으로, 암환자는 1.5명에서 1.2명으로, 당뇨병환자가 4.3명에서 3.4명으로 줄었다. 각종 기록부 비치상황은 장비대장, 약품관리 대장, 환자진료기록부는 100% 비치되었으나 기타 기록부는 그렇지 않았고 정규직화 후에도 변화는 없었다. 보건진료소가 보건소로부터 지원을 받는 내용은 약품 14.0%에서 30%로, 소모품 22.0%에서 52.0%로, 건물유지 및 보수가 54.0%에서 68% 로, 보건교육 자료가 34.0%에서 44.0%로 증가하였고, 장비는 58.0%에서 54.0%로 감소했다. 보건진료소의 월평균 수입은 진료수입이 약 22,000원 증가했고, 국비 또는 지방비 보조금이 4,800원에서 38,508%원으로 증가했으나 회비 및 기부금은 줄어 총수입은 약 50,000원 증가했다. 지출총액은 큰 변동이 없었다. 보건소로부터 3개월 동안 받은 지도감독 중 지시공문을 받은 진료소가 20%에서 38%로 늘었고, 방문지도는 79%에서 62%, 회의소집은 88%에서 74%로 감소하였다. 전화지도는 보건진료소당 평균 1.8회에서 2.1회로 늘었다(p<0.01). 면보건요원과의 협력관계가 있다고 한 보건진료원은 42%에서 36%로 감소하였다. 보건소장과의 관계가 좋다는 보건진료원이 46%에서 24%로 감소하였고, 보건행정계장과 관계가 좋다는 사림이 56%에서 36%로 감소하였다(p<0.05). 보건진료소 운영협의회 회장과의 관계가 좋다는 사람은 62%에서 38%로 감소되었고 보건진료소 운영협의회가 보건진료소에 별로 도움이 안된다와 전혀 도움이 되지 않는다는 사람이 정규직화 전과 후에 각각 92.0%, 82.0%였다. 운영협의회가 필요 없다는 사람은 정규직화 전에 4%에서 16%로 증가되었다(p<0.05). 보건진료원제도 발전을 위해 제안된 사항은 보건교육중심의 활동, 보건진료소운영의 자율성 보장 보건소에 경험이 풍부한 보건진료원을 두어 지도감독하게 할 것과 사용하는 약품의 종류를 늘려 줄 것 등이었다. 이상의 결과로 보하 정규직화 후 보건진료원의 역할, 기능 등의 업무활동의 변화는 거의 없었으나 신분보장과 봉급에 대한 만족도는 향상이 되었고 또한 자율성도 증가하였다. 보건소의 지원은 약간 늘었으며, 지도감독체제에서 지시 공문의 증가로 사무보고 업무가 많아지고, 근무 확인을 위한 전화감독은 늘었으나 업무치진을 위한 행정직 지도 또한 기술적 지도는 거의 없었다.

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인력수급 대책을 위한 치과기공사의 보건지소 진출에 관한 연구 - 2012년 틀니보험화 정책을 중심으로 - (The study on the entry of dental technicians in the public health center for a manpower supply and demand plane (Centering around a denture insurance policy in 2012))

  • 이종도;김정숙;박광식
    • 대한치과기공학회지
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    • 제32권4호
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    • pp.417-433
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    • 2010
  • Purpose: This study evaluated the manpower planning of dental technicians. Methods: Methods : Survey was conducted regarding subject's general characteristics, characteristics of dental technician's occupational view and working conditions, and reason to enter into branches of the public health enter. The survey sample consisted of 323 dental technicians (221 male/ 102 female). Survey was conducted for one month from August 1 to September 1 in 2010. Following results were obtained. Results: 1. Regarding general characteristics of the subjects, there was a slight male predilection with 68.4%. Subjects in their 40s occupied the highest proportion of 32.2%. Majority of subjects worked in the big cities (71.5%). Favored working places were dental laboratory (57.6%) and dental hospital or dental clinic (19.5%). Although no position is available in the public sector such as public health center or health care civil servant, 9.3% preferred working in the public health center. Public sector is more favored than 2-year technical colleges or dental supply and equipment companies. In respect to education, 57% of the subjects graduated college. 67.8% were married. Subjects who specialize in the porcelain or all-ceramic were 57.9%. With regard to current position, head of the dental laboratory was most common. 2. Following occupation characteristics were found. Economic reason took the highest proportion when deciding their occupation (39.9%) followed by gaining social experience (36.5%). Majority of the subjects (76.5%) wanted to work as dental technicians until their retirement. 71.5% pursuit to become a manager of the dental laboratory. 76.1% agreed on opening a dental technician position in the public health center. Regarding an authority to lead developing the dental technician position in the public sector, majority of the subject chose ministry of health and welfare (35.6%) and Korean dental technologist association (34.7%). Employment (average, 30%) and turnover rate (average, 36.5%) of dental technology college graduates ranged from 40% to 60%. Most important factors for the employment were practical experience (41.2%) and competency (34.4%). With regard to job satisfaction, so-so as 46.7% and satisfactory was 42.7% 3. In respect to the reason for opening a position in the public health center, 'It is needed to continue denture rogram for elderly patients' obtained the highest score (4.14 point). 'Institutional devices are required to open a position for dental technicians as a public healthcare provider' received high score (4.11 point). 4. Concerning the working conditions, 'professional knowledge is required' received the highest score (4.23) followed by 'too short maternity and parental leave' (4.21). 5. Relationship between general characteristics of the subjects and favor of working in the public health center was investigated. Significant differences were found according to the current and favored working area, favored occupation, education level, marital status, and specialty. Working in the public health center was favored by following subjects: working in mid- or small-sized cities (4.16 point, p<0.05); PhD degree-holder (4.59 point, p<0.01). 6. Among general characteristics of the subjects, significant difference of working conditions was found in the following factors: gender; working areas; favored working areas; favored working positions, and education level. Majority of subjects favored working in big cities and currently work in big cities although satisfaction was comparatively low (3.75 score). 7. Future plan to work in public health center was evaluated according to occupational characteristics. Subject's intention to work in the public healthcare center was significantly affected by opening of dental technician position, leading authority, average turnover rate, and factors affecting employment. Working in the public health care center was favored by the following subjects: Dental technicians who actively supported opening of the dental technician position (4.34 point, p<0.001); subjects who thought the Korean dental technologist association is responsible for the opening of positions in the public sector (4.26 point, p<0.001); and subjects who thought that attitude and character are important for the employment (p<0.001). 8. Concerning difference of working conditions according to the occupational characteristics, significant difference was demonstrated by factors such as a reason to choose to be a dental technician, work plan, pursuing position, responsible authority, average employment rate, and job satisfaction. High standard of working conditions was required in subjects who selected to be a dental technician for the leisure time after work (s.05 point, p<0.01), who planted to work until their marriage (4.25 point, p<0.001), and who pursuit to be a manager (3.98, p<0.05). 9. In respect to influence of general characteristics on the advancement to public health centers, the coefficient of determination (R2) was 0.068 and age affected the working condition with significant difference according to the pvalue. 10. Regarding influence of general characteristics on the advancement to public health centers, the coefficient of determination (R2) was 0.335 and work plan, opening of dental technician position in the public sector, and responsible authority had significant influence over the subject's intention to work in the public health center according to the p-value. 11. With regard to the influence of general characteristics on the advancement to public health centers, the coefficient of determination (R2) was 0.091 and reason to choose to be a dental technician, work plan, and responsible authority significantly affected subject's working conditions. Conclusion: Korean society is becoming a super-aged society according to several statistics. As aged population is rapidly increasing, national health insurance plans to cover denture for senior citizen over 75 years old from 2012. Therefore, dental technicians are urgently needed in the public health centers all over the nation. Many subjects in this study planed to work until their retirement and recognized dental technician's expertise. Ministry of health and welfare and Korean dental technologist association should co-operate each other to prepare foundation and institutional devices for dental technicians to advance into the public health center. This will improve oral health of the population. This study showed urgency of medical facilities and services which meets increasing number of aged population and welfare of the population.

"삼국사기(三國史記)"에 기록된 의약내용(醫藥內容) 분석 (Study on Medical Records In ${\ulcorner}$the Historical Records of the Three Kingdoms${\lrcorner}$)

  • 신순식;최환수
    • 제3의학
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    • 제2권1호
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    • pp.35-54
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    • 1997
  • We tried to observe the features of ancient medical practice by analysing the records related to medicine in the book, ${\ulcorner}$the Historical Records of the Three Kingdom${\lrcorner}$ of which content includes the features of medicine in mythology, plague, delivery of twins, drugs, medical system, shamanism, constitutional medicine, psychiatry, forensic medicine, deformity, a spa, medical phrase, health and welfare work, religion, death. physiological anatomy, Taoist medicine, acupuncture, the occult af of transformation and etc. Our initial concern was about where to draw line as of medical field and we defined medicine in more broad meaning. The book ${\ulcorner}$the Historical Records of the Three Kingdoms${\lrcorner}$ describes the world of mythology by way of medicine which is not clearly a conventional one. There appears records of birth of multiple offsprings 7 times in which cases are of triplets or more. Delivering multiple offsprings were rare phenomenon though such fertility was highly admired. This shows one aspect of ancient country having more population meant more power of the nation. Of those medical records conveyed in that book includes stories of childbirth such as giving birth to a son after praying, giving birth to Kim Yoo-shin after 20 months after mother's dream of conception, and a song longing for getting a laudable child. Plagues were prevalent throughout winter to spring season and one can observe various symptoms of plagues in the record. Of these epidemic diseases, cold type might have been more common than the heat one. Appearance of epidemic diseases frequently coincided with that of natural disasters that this suggests a linkage between plague and underlying doctrine on five elements' motion and six kinds of natural factors. There exists only a few names of diseases such as epidemic disease, wind disease, and syndrome characterized by dyspnea. Otherwise there appeared only afflictions that were not specified therefore it remains cluless to keep track of certain diseases of prevalence. Since this ${\ulcorner}$Historical Records of the Three Kingdoms'${\lrcorner}$ wasn't any sort of medical book, words and terms used were not technical kind and most were the ones used generally among lay people. Therefore any mechanisms of the diseases were hardly mentioned. Some of medicinal substances such as Calculus Bovis, Radix Ginseng, Gaboderma Luciderm, magnetitum were also in use in those days. 53 kinds of dietary supplies appears in the records and some of these might have been used as medicinal purpose. Records concerning dicipline of one's body includes activities such as hunting, archery, horseback riding etc. In Shilla dynasty there were positions such as professor of medicine, Naekongbong(內供奉), Kongbong's doctor(供奉醫師), Kongbong's diviner(供奉卜師). As an educational facility, medical school was built at the first year of King Hyoso's reign and it's curricula included various subjects as ${\ulcorner}$Shin Nong's Herbal classic${\lrcorner}$, ${\ulcorner}$Kabeul classic of acupuncture and moxbustion${\lrcorner}$, ${\ulcorner}$The Plain Questions of the Yellow Emperor's Classic of Internal Medicine${\lrcorner}$, ${\ulcorner}$Classic of Acupuncturer${\lrcorner}$, ${\ulcorner}$The Pulse Classic${\lrcorner}$, ${\ulcorner}$Classic of Channels and Acupuncture Points${\lrcorner}$ and ${\ulcorner}$Difficult Classic${\lrcorner}$. There were 2 medical professors who were in charge of education. To establish pharmacopoeia, 2 Shaji(舍知), 6 Sha(史), 2 Jongshaji(從舍知) were appointed. In Baekje dynasty, Department of Herb was maintained. Doing praying for the sake of health, doing phrenology also can be extended to medical arena. Those who survived over 100 years of age appear 3 times in the record, while 98 appears once. The earliest psychiatrist Nokjin differentiated symptoms to apply either therapies using acupuncture and drug or psychotherapy. There appears a case of rape, a case of burying alive with the dead, 8 cases of suicide that can characterize a prototype of forensic medicine. Deformity-related records include phrases as follow: 'there seems protrudent bone behind the head', 'a body which has two heads, two trunks, four arms.', 'a body equipped with two heads' In those times spa can be said to be used as a place for he리ing, convalescence, and relaxation seeing the records describing a person pretended illness and went to spa to enjoy with his friends. Priest doctors and millitary surgeons were in charge of the medical sevice in the period of the Three Kingdoms by the record written by Mookhoja(墨胡子) and Hoonkyeom(訓謙). Poor diet and regimen makes people more vulnerable to diseases. So there existed charity services for those poor people who couldn't live with one's own capacity such as single parents, orphans, the aged people no one to take care and those who are ill. The cause of affliction was frequently coined with human relation. There appeared the phenomenon of releasing prisoners and allowing people to become priests at the time of king's suffering. Besides, as a healing procedure, sutra-chanting was peformed. There appears 10 cases of death related records which varies from death by drowning, or by freezing, death from animals, death from war, death from wightloss and killing oneself at the moment of spouse's death and etc. There also exist certain records which suggest the knowledge of physiology and anatomy in those times. Since the taoist books such as ${\ulcorner}$Book of the Way and Its Power(老子道德經)${\lrcorner}$ were introduced in the period of Three Kingdoms, it can be considered that medicine was also influenced by taoism. Records of higher level of acupuncture, records which links the medicine and occult art of transformation existed. Although limited, we could figure out the medical state of ancient society.

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