• 보건행정학회지
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• 제14권4호
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• pp.48-74
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• 2004

Considering the existence of asymmetric information between doctor and patient, the doctor's reimbursement method has been considered as a desirable policy device of improving efficiency of patient's use of medical care in terms of its affecting doctor's practice pattern by determining doctor's practice revenue. By using the Community Tracking Study (CTS) physician data set, which includes not only various information on doctors practice arrangements and sources of practice revenue, but also vignettes of various clinical presentations, this paper investigates doctor's reaction to the financial incentive under the control of patient's specific medical situation. Under the econometric model for exploring the effect of doctor's reimbursement method on his/her practice patterns; referring patients, recommend doctor-visit or medical tests, the Hausman's specification test was used for checking out the possibility of the doctor's reimbursement method being endogeneized explanatory variable. In the case where the endogeneity problem of doctor's reimbursement method exists, the 2SLS method was used for correcting that problem, and the multiple regression method was used in the case where the problem is found to be nonexistent. Based on the empirical results, this paper finds that doctors do appear to respond to financial incentive. The empirical results show that the doctor's reimbursement method statistically significantly affects doctor's practice pattern and are coincident with the theoretical result proposed by previous researches, This results suggest, as doctor's practice revenues are mainly determined by prospective method, such as capitation, doctors would more refer their patients to specialists, and hesitate in recommending doctor-visit or medical exam.

• The Korean Journal of Pain
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• 제31권3호
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• pp.147-154
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• 2018

Fibromyalgia (FM) is a contested illness with ill-defined boundaries. There is no clearly defined cut-point that separates FM from non-FM. Diagnosis of FM has been faced with several challenges that occur, including patients' health care-seeking behavior, symptoms recognition, and FM labeling by physicians. This review focuses on important but less visible factors that have a profound influence on under- or over-diagnosis of FM. FM shows different phenotypes and disease expression in patients and even in one patient over time. Psychosocial and cultural factors seem to be a contemporary ferment in FM which play a major role in physician diagnosis even more than having severe symptom levels in FM patients. Although the FM criteria are the only current methods which can be used for classification of FM patients in surveys, research, and clinical settings, there are several key pieces missing in the fibromyalgia diagnostic puzzle, such as invalidation, psychosocial factors, and heterogeneous disease expression. Regarding the complex nature of FM, as well as the arbitrary and illusory constructs of the existing FM criteria, FM diagnosis frequently fails to provide a clinical diagnosis fit to reality. A physicians' judgment, obtained in real communicative environments with patients, beyond the existing constructional scores, seems the only reliable way for more valid diagnoses. It plays a pivotal role in the meaning and conceptualization of symptoms and psychosocial factors, making diagnoses and labeling of FM. It is better to see FM as a whole, not as a medical specialty or constructional scores.

• 대한간호학회지
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• 제24권3호
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• pp.432-447
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• 1994

Koreans are one of the fastest growing immigrant groups in America. Adjsting to life in foreign country produces a great deal of stress. Differences in culture, language, expectation and social behavior can lead to misunderstandings. The pregnancy and delivery event is one of maturational crisis in life cycle. The purpose of this research was to understand the structure of the lived experience of pregnant women and postpartum mothers who had immigrated to the United States. The research question was "What is the structure of the experience of pregnant women and postpartal mothers?" The sample consisted of 16 women registrated at the Obstetrics and Gynecology Department of one local clinic in Hawaii. The unstructured interviews were carried out from Jnuary 5, through January, 30, 1994. They were audio-recorded and analyzed using Van Kaam's method. There are different views on the causative factors of stress. Maladjustement to the immigrant life, spousal conflicts, anxiety related to bringing up the bay and conflicts between mother-in-law and daughter-in-law are considered to be related factors. The experiences of pregnant women over the period of the pregnancy can be varied and can include change of body image, emotional and physical change. The experiences of postpartum mothers over the postpartum period can be varied and can include postpartum depression emotional irritability, fear related to bringing up the baby and disappointment with husband. Positive experiences over the period of pregnancy and postpartum were the strengthen-ing beliefs. Sources of support were, first, spouse then mother and faith. Support was also received from the physician in charge and through self-control. The nurse, by providing empathetic support, should be a person with whom they can express their feelings and share their experiences.

• 보건교육건강증진학회지
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• 제13권1호
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• pp.1-27
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• 1996

Recently diseases related to personal health habit and lifestyle have become common in modern industrial society. These kinds of diseases can be prevented simply by changing one's lifestyle to be more healthy. As a result of realization our interest in general health has become stronger. The most basic environment for human-being in society is the home. Humans secure their livelihood, physically. mentally, and socially at home. Therefore health care at home is very important. In modern society the responsibility for this task is traditionally given to housewives. The purpose of this study was to measure the degree of the health knowledge, health concern, health behavior and family health care of the married women and to analyze its related factors. The subjects for this study. 1,100 married women who studied at social education institutes and who had children attending an elementary school or a kindergarten, were surveyed with questionnaires. The preliminary survey was carried out from Aug. 7, to Aug. 19, 1995. With complement of questions, the main survey was carried out from Sep. 11, to Sep. 30, 1995. The data was analysed by using the SAS program. The results were as follows. 1. General Characteristics (1) In the individual characteristics of the respondents, the married women aged 30-39 were 54.8%, the average age was 39.8 years old. 33.8% of respondents had 6-10 years of marriage period, and the average marriage period was 14.9 years. Most of them(96.5%) lived with their husband. Those who graduated from college and graduate school were 53.4%. And 68.3% of respondents had no job. (2) In the family characteristics, 69.3% of the married women had 3 or 4 family members and the average family size was 4.1 person. 60.0% of the respondents had 2 children. Most of the respondents(90.9%) had no married children. 84.8% of the respondents lived with their parents. Those who reported that the total family income was more than 2,500,000 won a month were 32.3%. When making the decisions, 68.5% of the married women discussed the family matter with their husband. (3) In the individual characteristics of the respondents, 51.5% answered they were in good health. 61.7% of the married women answered they obtained the health knowledge through mass media. 24.3% of the women answered they had patients in their family in these days. 67.5% of the respondents answered they could generally control their health by themselves. 2. The Health Knowledge, Concern and Behavior. (1) For the health knowledge, the average score was 11.8. The lowest percent of correct answer(27.8%) was in the item about the skin tests for tuberculosis. And the highest percent(97.%) was in the item about taking a rest. (2) For the health concern, the married women had the highest concern about washing hands. But they were indifferent to smoking. (3) For the health behavior, the highest score was in "changing socks and underwear everyday", and the lowest one was in "taking a regular dental examination". 3. The Family Health Care (1) For the family health care, the item of "using a drug with the order of doctor or pharmacist" had the highest grade(4.78), and "consulting with the family physician about the health problem" had the lowest grade(2.03). (2) Older women and the women with a longer period of marriage had the highest level of the family health care(p<0.001). The married women who had 3 children had the highest level of the family health care(p<0.001). Those who had 5 or 6 family member and higher income had the highest level had the high level of the family health care(p<0.01). Women in good health and those who had the health knowledge from health experts had a high level of the family health care. (3) For the correlation of the family health care and other variables, the health behavior showed the highest correlation with family heath care practice(r=0.74) and the second was health concern(r=0.43). The variables which could explain the family health care were health behavior, the health concern and married women's health status(r²=55.87). The most closely associated with family health care was health behavior(r²=54.93)

• 대한소아치과학회지
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• 제23권3호
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• pp.593-600
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• 1996

본 증례의 혈우병 및 자폐증 환아의 치료를 통해 다음과 같은 결론을 얻었다. 1. 혈우병 환자의 내원시 내과의사나 소아과의사 및 혈액학자에게 의뢰를하여 출혈찬도 및 부족인자 보충 퉁에 관한 자문을 얻어야 한다. 2. 매우심한중증의 혈우병 환자이거나 외과적 수술등으로 인해 많은 출혈이 예상될 경우에는 포괄적인 환자 관리를위해 입원 치료를 해주어야 한다. 3. 자폐중으로인한 행동조절이 어렵거나 그외 다른 요인에 의해 행동조절이 불가능한 혈우병 환자의 경우 입원치료가 필요하다. 4. 치과 시술을 행할때에는 최소의 관혈적인 치과치료 행하도록 노력해야 하며, 응급 상황을 대비해서 국소적인 지혈방법을 습득해야 한다. 5. 치과 시술시 환자의 동통 완화 및 소염작용을 위한 약물 처치시에도 주의를 요한다. Non-steroidal anti-inflammatory drugs는 혈소판응집을 방해하기 때문에 동통완화를 위해서는 aspirin 대신에 acetaminophen을 사용하며, 소염효과를 위해서는 steroid 계통의 약물을 사용하며 ibuprofen, indomethacin, phenylbutazone 등의 약제 사용은 금한다. 6. 혈우병 환자라고해서 두려워하거나 치과 치료의 질을 변경해서는 안된다.

• 의료법학
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• 제19권2호
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• pp.41-72
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• 2018

분업적 의료행위에 있어서 관여자들에 대한 의료과실을 인정함에 있어서는 그의 형사 책임을 제한하거나 또는 형사책임을 적절히 분배할 필요성이 있다. 본 논문은 분업적 의료행위에 있어서 의료인의 주의의무위반에 대한 판단기준과 이를 제한하는 규칙을 다루고 있다. 의료행위에 있어서 주의의무위반에 대한 판단기준으로 객관설이 타당함을 논증하였다. 주의의무를 판단함에 있어서 행위자 개인에게 최상의 주의의무 또는 완벽한 주의의무를 요구하는 것도 도덕적 요청으로는 의미가 있을지 모르지만, 법질서가 요구하는 수준은 사회적으로 상당한 수준 또는 '정상의' 주의의무라고 해석하는 것이 타당하다. 과실기준을 객관화함으로 개인이 책임을 지는 한계의 상한을 설정해줌으로써 개인에게 지나친 부담을 안겨주는 것을 방지하고 평등의 원칙에도 부합한다. 구체적 사례에 있어서 의료과실을 판단하는 경우에도 고려해야 할 표지를 설명하였다. 의료행위는 일반적 과실과는 다르게 전문성, 재량성과 같은 특수성, 정보의 편중성과 독점성이 있기 때문이다. 일반적 의학수준, 긴급성과 의료설비와 같은 의료환경과 조건, 의료행위의 전문성, 의료행위의 재량성에 대하여 검토하였다. 주의의무를 제한하는 규칙으로 허용된 위험의 이론과 신뢰의 원칙을 검토하였다. 수평적 분업관계에서는 신뢰의 원칙이 적용된다. 같은 병원 의사들이 각각 전문분야를 가지는 경우, 다른 병원 의사들 사이의 관계의 경우에는 원칙적으로 신뢰의 원칙이 적용된다. 그러나 예외적으로 신뢰의 원칙이 적용될 수 없는 경우도 존재한다. 수직적 분업관계에서는 신뢰의 원칙이 적용되지 않으며 상급자는 하급자를 신뢰할 수 없다. 이 경우 상급자는 하급자에 대한 위험감독의무로 전환된다. 관리의무는 임의적·간헐적 심사(stichprobenartige Überprüfungen)를 하는 것으로 충분하다고 생각한다.

• 산업진흥연구
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• 제5권3호
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• pp.89-96
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• 2020

본 연구는 아들러의 개인심리학을 연구하여 거기에서 도출된 상담이론을 토대로 상담과정과 상담기법을 연구하고자 하였다. 아들러의 상담과정의 진행은 첫째, 관계형성단계는 상담자와 내담자 상호 간의 합의된 목표를 향해 적극적인 파트너로서 일하는 평등하고 상호 협력적인 관계를 추구하는 단계이다. 둘째, 생활양식 탐색단계는 생활양식을 이해하고 생활양식이 삶의 과업에 어떠한 영향을 미치는지를 이해하는 것을 중요한 목표로 하는 단계이다. 셋째, 통찰단계는 통찰력을 가지는 단계이다. 넷째, 재정향(행동 전환)단계로 진행된다. 아들러의 상담기법은 일반적기법과 특수기법이 있는데, 일반적 기법으로는 즉시성, 충고하기, 격려하기, 역설적 의도, 시법보이기, 역할놀이 등이 있다. 특수기법으로는 초인종 누르기, 내담자의 수프에 침 뱉기, 마이더스 기법, 타인을 즐겁게 하기, 저질의 아이 피하기, 스스로 억제하기 등이 있다. 결론적으로 개인심리상담은 의학적 모델이 아니라 성장모델에 기초하며, 치료한다는 측면보다는 건강한 개인과 사회를 재교육하고 재조명하는 데 더 많은 관심을 가지고 있다. 그러므로 아동지도센터, 부모-아동상담, 부부상담, 가족상담, 집단상담과 치료, 아동과 청소년의 개인상담, 문화적 갈등, 정신건강 운동 등 다양한 영역에 적용된다.

• 대한임상검사과학회지
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• 제52권3호
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• pp.261-270
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• 2020

본 연구는 질 가산율 산출 및 적용기준을 검토하여 우수검사실 신임인증 및 전문인력영역에 있어 임상병리사를 추가 가능성을 알아보았다. 연구에 참여한 6개 기관은 1,000병상 이상의 대형병원 규모이며, 상근 진단검사의학과 전문의 평균 5명, 임상병리사는 평균 53명으로 전문의 1명당 10.6명으로 나타났다. 임상병리사의 행위분류별 소요시간에 대한 분석결과, 분석 중 행위는 낮아지고 있는 반면 검사실 운영, 정도관리 등의 강화로 포괄적 분석 전 행위의 비율이 높게 나타났다. 분석 중 행위는 생화학 검사수행 등의 비중이 높았고, 분석 후 행위는 결과분석 등이 대부분을 차지하였다. 이와 같이 검체검사 질 향상을 위해 많은 시간이 소요되며, 그에 맞는 인력이 요구된다. 결론적으로 검체검사 질 향상을 위해 임상병리사의 채용 역시 중요하며, 그에 따른 인원 규정이 필요하다 할 수 있다.

• 보건행정학회지
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• 제16권4호
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• pp.48-67
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• 2006

The aim of the study was to examine levels of satisfaction with health care in North Korea and to identify factors associated with it using a convenience sample of North Korean refugees in China. Data from the 2004 Survey of Health Seeking Behavior of North Korean Households conducted by the Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health were used. The study subjects were 273 North Korean refugees whose length of stay in China was less than 3 months. Factor analysis was used to extract factor dimensions from the 12 satisfaction items. Bivariate (t test and ANOVA) and multiple regression analyses were used in examining factors associated with satisfaction with health care use in North Korea Overall, satisfaction level was low ($2.36{\pm}0.36$, score range: 1-5). Of the three-factor dimensions, physician skills scored the highest $(2.93{\pm}0.36)$, followed by drug availability $(2.51{\pm}0.07)$ and general cleanliness $(1.66{\pm}0.55)$. In the multiple regression analysis, having a usual source of care was significantly associated with patient satisfaction. Respondents who identified primary care (section) doctors as their usual source of care tended to be less satisfied than those with the city or county hospital as their usual source of care. County residents tended to report a lower degree of satisfaction with general cleanliness than city residents. Among socioeconomic characteristics, the number of household assets positively predicted satisfaction with drug availability. North Korean residents appear to be dissatisfied with their medical care. It may reflect some inadequacies in the North's universal health care system to meet the healthcare needs of its people.

• 동아시아식생활학회지
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• 제15권5
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• pp.516-523
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• 2005

This study was performed to investigate dietary behaviors and consumption of health food in cancer patients. The subjects were 163 cancer patients recruited from the general hospital in Seoul, Korea. The data were obtained by the structured self administered questionnaire. The mean age of subjects was 51 years. Most of subjects didn't eat the visual fat of meat and chicken skin. The mealtime of the subjects was generally regular and most of subjects had breakfast. The subjects of this survey liked to eat foods with sweet taste but disliked to eat hot, salty and sour taste ones. The preference for fish, marine products and vegetables was high but that for instant foods and frying foods was very low. Most of subjects consumed the foods that is generally known as anticancer foods such as vegetables and fruits. On the other hand, most of subjects didn't intake butter, margarine, and frying foods that is known as risk factors of cancer. The majority of subjects$(84.7\%)$ consumed the health food The main reasons for taking health foods by subjects were to cure disease$(58.0\%)$, to prevent disease$(45.3\%)$, to supply nutrients$(39.3\%)$, to maintain the mental state$(12.7\%)$ and to recover fatigue$(10.7\%)$. Majority of subjects$(66.0\%)$ spent money more than 200,000 won/month to buy health foods. The purchasing channels of health foods by subjects were recommendation by family or friend$(64.0\%)$, by physician/pharmacist$(18.0\%)$ and by nutritionist or dietician(6.0), and advertisement through TV or radio$(12.0\%)$. The types of taking health foods of the subjects were vegetable extracted food$(60.0\%)$, mushrooms$(51.3\%)$, Lactobacillus food$(25.3\%)$, enzyme food$(22.6\%)$ calcium containing food$(20.0\%)$ and so on. The results of the current study show that although many cancer patients already practice healthy dietary behaviors, there is a substantial proportion who do not and most of cancer patients consume health foods.' Further intervention is needed to explore the effect of health foods in cancer patients