• 농촌의학ㆍ지역보건
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• 제1권1호
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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.

• Tuberculosis and Respiratory Diseases
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• 제43권1호
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• pp.14-21
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• 1996

연구배경: 다제 내성 폐결핵 환자의 임상적 특성과 약제별 내성률, 치료에 영향을 미치는 인자, 이차 약제로 인한부작용, 치료내용 및 차료성적 등을 살펴 보고자 하였다. 대상: 약제 감수성 검사상 두가지 이상의 일차 약제에 동시 내성을 보이는 환자를 대상으로 후향성 연구를 시행하였다. 치료 결과의 판정은 정기적으로 6개월 이상 추적 관찰이 가능했던 환자만을 대상으로 치료후 호전을 1개월 이상의 간격으로 시행한 가래 검사상 3회 이상 음성이고 방사선 소견이 호전되거나 6개월 이상 변화가 없는 경우로, 치료 실패를 6개월간의 치료에도 균 음전화가 되지 않거나 방사선 소견상 악화를 보이는 경우로 정의하였다. 대상 환자들은 감수성 검사 결과에 따라 감수성 약제를 4제 이상 투여하여 치료받았다. 결과: 1) 총 71예와 환자를 대상으로 조사한 결과 35예(49%)에서 방사선상 공동을 관찰할 수 있었고 평균 4.1개의 약물에 내성을 지니고 있었는데 90%가 INH, RFP 동시 내성을 보였다. 2) 치료 결과의 판정이 가능하였던 55예중 35예(67%)의 환자가 치료후 호전을 보였으며 치료 실패는 18예(33%)이었다. 일차 내성 환자가 5예이었는데 치료 결과 판정이 가능하였던 4예는 모두 치료에 성공하였다. 3) 약제 부작용은 14예(20%)에서 나타났는데 간기능 악화가 6예로 가장 많았고 어지러움증 5예, 고요산 혈증을 동반한 관절통이 3예, 이명 3예 등의 순이었다. 이들 부작용의 절반 이상이 투약후 3개월 이내에 발생 하였다. 4) 약제 감수성 검사를 반복했을 때 INH, RFP의 경우 100% 가까운 일치율을 보였고 EMB, PZA 80% 정도 나머지 약물은 50% 미만이었다. 5) 5예의 환자가 수출을 받았고 이 중 1예는 항결핵 화학 요법의 보조적 치료로 수술을 했는데 균 음전화에 성공하였다. 결론: 다제 내성 폐결핵 환자에서도 규칙적인 약물 복용과 적절한 처방으로 약 2/3 정도에서 호전이 관찰되어 적극적인 항결핵 화학 요법을 시행해야 할 것으로 생각되지만 치료와 예후 판정에 도움이 되는 인자를 찾지는 못하였다.

• 한국인구학
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• 제12권2호
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• pp.1-21
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• 1989

For the analysis of mortality differentials by socioeconomic factors based on death registration data, we have considered four variables : place of residence, educational attainment, marital status and occupation. The age range adopted were 5 to 64 years of age for place of residence, and 25 to 64 years of age for the other factors. The mortality differentials by socioeconomic variables were clear and in the expected direction: mortality levels among urban residents, better educated groups, and non- agricultural workers were lower than among the other sub- groups. The average mortality level in rural areas is much higher than in urban areas : the rural mortality levels were at least double the urban levels at ages below 40 years, but became smaller after age 40, and no clear differentials by urban I rural residence increased until 1974~76 for the both sexes, but since the then differentials have declined slowley for both sexes. This changing pattern of mortality differentials by place of residence can be explained by historical socioeconomic development : the development generally started in urban areas, and rural areas followed : in the course of socioeconomic development the differences between the death rates in the two areas became smaller and finally the mortality levels in the two areas became nearly the same, as is found in the developed countries nowadays. The inverse relationships between mortality and educational level became stronger between the periods 1970~72 and 1984~86, but showed the same atterns of mortality differentials in both period : larger differences among the younger age groups, and for males, than among the older age groups, and for females. The increasing mortality differentials in the fourteen-year period between 1970~72 and 1984~86 were caused by inadequate living standards of the non- educated, whose proportion in the total population, however, dropped sharply during that period. Also, the much lower proportions of low - educated groups or of persons with no formal education among males than females helped to establish the clearly pronounced differentials. The mortality differentials by marital status in Korea showed the usual pattern : the mortality rates of the married in each age and sex group were clearly lower than those of others during the fourteen-year period between 1970~72 and 1984~86. In Korean society which remotes universal marriage, the never married recorded especially high death rates, presumably mainly because of ill - health, but also possibly because of the stigma attached to celibacy. However, the mortality differentials by marital status changed with the changes in the proportionate distribution by marital status during the period : the differences between the death rates of the married and never married groups became smaller, the proportion of the never married group increased : in contrast, the differences between mortalities of the married and widowed / divorced / separated groups widened, with the decrease in the proportion of the later group ; this tendency was perticularly marked for females. Occupational groups also showed clear mortality differences : among four occupational groups mortality of males was highest among agricultural workers and lowest among 'professional, admi-nistrative and clerical workers, However, when the death rates were standardized by educational level, the death rates by occupation in age group 45~64 years were nearly the same (excet for the mixed group consisting of unemployed, students, military servicemen and unknown). Therefore, the clear mortality dfferentials by occupation in Korea resulted mainly from the differences in educational level between different occupation groups. Since socioeconomic characteristics are related to each other, the net effect of each variable was examined. Each of the three variables - ducational level, marital status and urban / rural residence affected significantly Korean adult mortality when the effects of the other variables were controlled. Among the three variables educational level was the most important factor for the determination of the adult mortality level. When male's occupation was added to the above three variables, the effects of occupation on adult mortality were notably smaller after control for the effects of the other three variables while the net effects of these three variables were nearly the same irrespectively whether occupation was included or not. Thus, the differences in educational level (mainly), place of residence and marital status bring out the clear differences in observed mortality levels by occupation.

• Radiation Oncology Journal
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• 제17권2호
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• pp.172-178
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• 1999

목적 : 국내 방사선치료에 대한 전국현황의 통계를 1997년을 중심으로 한 병원 별 진료 장비, 인력 현황을 조사하고 그에 대한 연간 신환자수의 분포를 검토하여 그 결과를 선진국의 예와 비교함으로써 현재의 국내 방사선치료의 진료 수준을 분석하고자 하였다. 대상 및 방법 : 1998년에 치료방사선과가 있는 전국의 42개 병원을 대상으로 설문조사를 통해 자료를 수집하였다. 통계자료는 1997년 1월부터 12월까지 총 1년으로 하였고 통계처리는 마이크로소프트사의 Excel 프로그램을 이용하였다. 결과 : 1997년에 국내에서 42개의 병원이 71대의 외부 방사선치료장치, 100명의 치료방사선과 전문의, 26명의 의학 물리학자, 205명의 방사선사가 있었고 연간 19,773명의 신환을 치료하였다. 전국 42개 병원의 89$\%$,는 최소한 6 MeV 이상의 선형가속기를 보유하였고 95$\%$는 모의 조사장치를 소유한 반면 $5\%$는 모의 조사장치를 가지고 있지 않았다. 컴퓨터 치료계획을 할 수 있는 장비를 소유한 병원은 $91\%$였고, $83\%$는 정도관리 지침서를 가지고 있다고 응답하였다. 병원별 치료방사선과 의사가 단지 1명인 병원이 36%이었으며 의학 물리학자가 없는 곳이 38$\%$였다. 한 병원당년간 환자수 분포의 중앙값은 348명, 기계당 환자수의 중앙값은 263명, 방사선종양학과 전문의당 환자수의 중앙값은 171명, 방사선사당 환자수의 중앙값은 81명, 기계당 방사선사의 중앙값은 3명이다. 결론 : 국내의 치료방사선과를 보유한 병원의 수, 방사선치료를 받는 환자수 및 치료장비수는 일본 및 미국과 비교하여 인구비례로 계산해 볼때 매우 적은 편이다. 치료장비면에서는 선형가속기, 모의 조사장치, 컴퓨터 치료계획 시스템의 수준이 미국과 비교하여 크게 차이가 없었다. 의사, 방사선사에 대한 환자수의 부하(loading)는 미국과 비교하여 큰 차이는 없었다. 그러나 인력면에서 의학물리학자가 없는 병원의 수가 상당히 많은 관계로 이의 보완을 위해서 미국과 같은 part time 제도의 운영도 해 볼 수 있을 것이다.

• 한국어업기술학회:학술대회논문집
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• 한국어업기술학회 2000년도 춘계수산관련학회 공동학술대회발표요지집
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• pp.71-73
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• 2000

Campylobacter jejuni is most frequently identified cause of cause of acute diarrhoeal infections in developeed countries, exceeding rates of illness caused by both salmonella and shigilla(Skirrow, 1990 ; Lior 1994). Previous studies on campylobacter jejuni contamination of commercial broiler carcasses in u.s.(Stern, 1992). Most cases of the disease result from indirect transmission of Campylobactor from animals via milk, water and meat. In addition to Campylobactor jejuni. the closely relates species Campylobactor coli and Campylobactor lari have also been implicated as agents of gastroenteritis in humans. Campylobactor coli represented only approximately 3% of the Campylobactor isolates from patients with Campylobactor enteritis(Griffiths and Park, 1990) whereas Campylobactor coli is mainly isolated from pork(Lmmerding et al., 1988). Campylobactor jejuni has also been isolated from cases of bacteremia, appendicitis and, recently, has been associated with Guillai-Barre syndrome(Allos and Blaser, 1994; von Wulffen et al., 1994; Phillips, 1995). Studies in volunteers indicated that the infectious dose for Campylobactor jejuni is low(about 500 organisms)(Robinson, 1981). The methods traditionally used to detect Campylobactor ssp. in food require at least two days of incubation in an enrichment broth followed by plating and two days of incubation on complex culture media containing many antibiotics(Goossens and Butzler, 1992). Finnaly, several biochemical tests must be done to confirm the indentification at the species level. Therfore, sensitive and specific methods for the detection of small numbers of Campylobactor cells in food are needed. Polymerase chain reaction(PCR) assays targeting specific DNA sequences have been developed for the detection of Campylobactor(Giesendorf and Quint, 1995; Hemandex et al., 1995; Winter and Slavidk, 1995). In most cases, a short enrichment step is needed to enhance the sensitivity of the assay prior to detection by PCR as the number of bacteria in the food products is low in comparison with those found in dinical samples, and because the complex composition of food matrices can hinder the PCR and lower its sensitivity. However, these PCR systems are technically demanding to carry out and cumbersome when processing a large number of samples simutaneously. In this paper, an immunomagnetic method to concentrate Campylobactor cells present in food or clinical samples after an enrichment step is described. To detect specifically the thermophilic Campylobactor. a monoclonal antibody was adsorbed on the surface of the magnetic beads which react against a major porin of 45kDa present on the surface of the cells(Huyer et al., 1986). After this partial purification and concentration step, detection of bound cells was achieved using a simple, inexpensive microtitre plate-based hybridization system. We examined two alternative detection systems, one specific for thermophilic Campylobactor based on the detection of 23S rRNA using an immobilized DNA probe. The second system is less specific but more sensitive because of the high copy number of the rRNA present in bacterial cell($10^3-10^4$). By using specific immunomagnetic beads against thermophilic Campylobactor, it was possible to concentrate these cells from a heterogeneous media and obtain highly specific hybridization reactions with good sensitivity. There are several advantages in using microtitre plates instead of filter membranes or other matrices for hybridization techniques. Microtitre plates are much easier to handle than filter membranes during the adsorption, washing, hybridization and detection steps, and their use faciilitates the simultanuous analysis of multiple sample. Here we report on the use of a very simple detection procedure based on a monoclonal anti-RNA-DNA hybrid antibody(Fliss et al., 1999) for detection of the RNA-DNA hybrids formed in the wells.

• 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.

• 미술자료
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• 제98권
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• pp.226-241
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• 2020

러시아 상트페테르부르크의 에르미타주 박물관 3층 맨 우측에는, 세계 유수의 실크로드 미술 컬렉션을 상설전시하는 "중앙아시아실"이 자리 잡고 있다. 20세기 초 실크로드를 학술조사한 러시아의 코즐로프(Pyotr Kozlov), 베레조프스키(Mikhail Berezovsky), 올덴부르그(Sergey Oldenburg) 등에 의해 수집된 고고 미술품 들이다. 에르미타주 박물관 소장의 방대한 이들 유물은 그 대강을 파악할 수 있도록 지역별로 분류하여 공개중이며, 이제까지 독일과 프랑스, 영국, 네덜란드, 한국, 일본 등에서 개최된 특별전시를 통해 그 일부를 소개하기도 하였다. 그리고 러시아 실크로드 탐험대의 성과물을 종합적으로 공개한 대형 기획전시 이 2008년에 에르미타주 박물관에서 개최됨으로써, 러시아의 실크로드 관련 유물이 세상에 본격적으로 알려지게 되었다. 이번에 간행된 『아장구자예술품(俄藏龜玆藝術品)』(2018)은 중국의 상해고적출판사(上海古籍出版社)가 에르미타주 박물관과 공동으로, 당관 소장 실크로드 유물 가운데 쿠차 지역의 예술품만을 선정하여 출판한 도록이다. 이 도록의 편집과 논고 및 유물 해설은 에르미타주 박물관 동양부(Oriental Department)의 시니어 큐레이터 키라 사모슉(Dr. Kira Samosyuk)이 담당하였다. 키라 박사는 하라호토(Khara-Khoto)와 서역(西域) 미술 전문가로, 그 이름이 국제적으로 널리 알려져 있는 중앙아시아 불교미술 연구의 석학이다. 본서에는 에르미타주 박물관 소장의 쿠차 지역 출토 유물을 망라하여, 중앙아시아 불교미술에 있어서의 쿠차 지역의 특징을 입체적으로 파악할 수 있도록 하였을 뿐만 아니라, 러시아 탐험대가 남긴 현장사진과 스케치 등에 이르기까지 빠짐없이 소개함으로써, 수집 유물 이외의 귀중한 정보도 아울러 제공하고 있다. 키라 사모슉 박사는 본서의 게재 논문 「The Art of the Kuche Buddhist Temples」에서, 러시아의 실크로드 탐험의 개요를 소개하고, 주로 불교시대 쿠차의 역사 전개 과정과 쿠차에 전래된 불교의 양상 그리고 석굴의 벽화 묘사와 그 연대 문제를 논한 후, 벽화의 주제와 소상(塑像), 석굴사원이 예배의 장으로서 어떻게 운용되고 있었는지에 대해 상세하게 언급하고 있다. 키라 박사는 결론으로서, 쿠차 문화는 불교 전파의 역사 가운데 독립적인 위치를 점하고 있었을 뿐만 아니라, 중국이나 유목세계의 여러 민족과 관계를 맺고 있었으며, 간다라 미술, 헬레니즘, 고대 이란, 중국 문화와의 관련성 속에서 독자적인 성격을 구축하였음을 논하고 있다. 그리고 쿠차 지역에서 형성된 문화는 타림분지뿐만 아니라 돈황(敦煌)과 중원(中原) 지역의 석굴예술에도 지대한 영향을 미치고 있다는 점으로 문장을 마감하고 있다. 키라 박사의 논고 가운데 주목할 부분은 쿠차 지역 석굴의 조성(造成) 연대(年代)에 관한 것이다. 그녀는 이제까지 여러 학자들에 의해 제기된 벽화의 조성 연대에 관한 견해를 소개하며, 벽화의 인물이 착용하고 있는 갑주(甲冑)의 도상(圖像) 특징 등을 소그드 미술 등 주변 지역에서 출토된 관련 자료와 비교하여, 키질의 조성 연대를 기존의 학설보다 백여 년 이상 소급해야 함을 주장하며, 5세기 이전으로 추정하고 있다. 그러나 쿠차 지역 석굴의 조성 시기의 문제는 석굴의 형식 문제를 비롯하여 불화(佛畫)의 주제(主題)와 양식(樣式), 안료(顔料)의 문제, 복식(服飾)이나 두발(頭髮), 제 장식(裝飾) 요소 등을 학제적(學際的) 연구 방법으로 재조명하고, 그 과정에 나타나는 주변 문화권과의 관련성 등을 종합적으로 고찰한 위에 방사성탄소 연대 측정 등 과학적 방법을 보조 자료로 활용하는 수밖에 없다. 에르미타주 박물관에는 제2차세계대전 때 베를린에서 전리품으로 가져온 벽화편이 다수 소장되어 있다. 일반인에게는 물론 학계에서도 그 행방을 전혀 모르고 있었던 이들 벽화편이 최근에 보존처리를 마치고 일반에게 상설전시를 통해 소개되고 있다. 본서 출판의 경위를 서술한 서언(序言)에는 이번 간행이 에르미타주 박물관 소장 쿠차 예술품의 제1차 출판이라고 한 점으로 보아, 아마도 보존처리가 끝난 독일 컬렉션을 소개하는 도록의 편집도 예정되어 있는 듯하다. 아울러 투르판과 호탄 지역 문물을 소개하는 도록의 간행도 기대해본다. 현재 쿠차의 석굴사원에서 절취한 벽화편은 러시아와 독일, 한국 등 여러 국가에 분장되어 있다. 이번 도록 출판을 계기로 쿠차 현지의 키질 석굴을 비롯한 제 석굴사원의 잔존벽화를 중심으로, 세계 각지에 흩어져 있는 벽화를 함께 소개하여 이들 석굴사원 벽화의 원래 모습을 온전하게 소개하는 종합도록의 간행도 필요할 것으로 본다. 그리고 동서의 문화가 혼합되어 있고 쿠차 지역 특유의 지역적 특성이 반영된 석굴사원의 벽화류 등을 소개하는 도록에는, 각 유물에 대한 보다 상세한 해설이 요망된다. 그리고 미술사 이외에도 보존과학적 측면에서의 안료 분석 등 학제적 조사연구 성과도 포함될 수 있기를 기대해본다. 작금의 중국 서부 개발 정책에 따라, 신장 지역의 오아시스에 인구가 과밀 거주함으로써 유발되는 기후변화 등으로 석굴사원의 벽화는 현재 심각한 위기에 처해있다. 이러한 난관을 타개하기 위해서는, 중국의 문화계뿐만 아니라 문화재 보존수복(保存修復)의 첨단 기술을 보유하고 있는 여러 국가들이 실크로드 석굴벽화의 보존수복을 위해 공동 노력하고 아울러 관련 인적자원 양성 등을 위해 보존과학센터를 운영하는 등 모두의 중지를 모아야할 때다. 본서는 20세기 초 서구 열강에 의해 추진된 실크로드의 고대 유적 조사 결과 가운데, 러시아 조사대가 쿠차 지역의 석굴사원을 중심으로 거둔 성과를 종합적으로 소개하는 출판물이지만, 향후 에르미타주 박물관 소장의 독일 컬렉션 벽화까지 전부 소개될 경우, 쿠차의 불교미술과 실크로드 연구에 크게 공헌할 것임에 틀림없다. 이런 의미에서 본서는 이제까지 축적되어 온 쿠차 지역에 대한 고고미술 연구의 마지막 퍼즐 조각이자 실크로드 연구의 새로운 방향을 제시한 학적 의미를 지니고 있다. 본서는 에르미타주 박물관의 실크로드 미술 연구의 성과물이자 새로운 편집 체계로서 학적 편의를 제공하였다는 점에서 큰 의미를 부여할 수 있으며, 이 모든 것을 기획하고 실크로드 미술 연구에 새로운 경지를 개척한 키라 사모슉 박사에게 경의를 표하는 바이다.

• Journal of Preventive Medicine and Public Health
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• 제7권1호
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• pp.29-94
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• 1974

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.