• Title/Summary/Keyword: quality of dental care service

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A Study on the analysis of activities of t?e 5.H.T. (5.H.T. in Pusan City) (부산지역 양호교사의 업무분석에 관한 연구)

  • Kim, Lee-Sun;Kim, Bok-Yong
    • Research in Community and Public Health Nursing
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    • v.1 no.1
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    • pp.465-502
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    • 1989
  • The purpose of this study was to find out the general characteristics of school health teachers, the status of school health resources and the degrees of self-confident performance for the 124 school health teachers in Pusan City. Data was collected by means of questionaires from Aug. 1986 to Mar. 1987. The data were analyzed by use of percentage, mean, standard deviation, t-test, ANOVA and Pearson-correlation coefficient. The results of this study were as follows: 1 . General Characteristics of School Health Teachers (SHT) 1) The average of age of the SHT was 32.8 years old and 39.5% of them were from 30 to 34 years old. 2) The average for school nursing experience of the SHT was 7.9 years and 37.9% of them were from 5 to 9 years. 3) The 45.2% of them have not the clinical experience. 4) The 74.2% of them were graduated from the 3 years college of nursing. 2. Status of school health resources and nursing activities. 1) The average of student number was 2497.3 and class number was 45.2. 2) The average of school health budget was 1039000 won and 27.7% of school health budget expended on examination cost. 3) Only 29.0% of all schools have organization for school health. 4) The 84.7% of all schools have health clinic separately and 69.1% of schools have less than $33m^2$ sized. 5) The average of clinic visitor number was 2111.8 for 1 year. 6) Major problem was on digestive system. And other problems were skin, respiratory, musculo-skeletal system and dental problem. 7) The number of literal message was 14.4 times for 1 year. 3. The degree of the school health teachers' self-confidence. The school health teachers' self-confidence was deviced into 6 and the maximum degree was 4. 1) Program planning & evaluation; 2.8 2) Clinic management; 2.9 3) Health education, 3.0 4) Management of school environment; 2.7 5) Health care services; 2.7 6) Operating of school health organization; 2.4 4. Significances to the degree of self-confidence on school health nursing activities. 1) There was significant difference between clinical management and Religion (t=2.15 p<.05) 2) There was significant difference between Operating of school health organization and level of school (F=3.588 p<.05) 3) Program planning & evaluation: expending time for clinical management (r=-0.184 p<.05) expending time for health care services (r=0.273 p<.01) 4) Clinical management: use of separate health clinic (r=0.151 p<.05) 5) Health education: use of separate health clinic (r=0.170 p<0.5) 6) Health care services: No. of student (r=-0.144 p<0.5) No. of class (r=-0.160 p<.05) 5. The degree of the school health teachers' self-discipline. The school health teachers' self-discipline was devided into 2 and the maximum degree was 2. 1) Program planning & evaluation:1.8 2) Clinic management: 1.9 3) Health education: 1.9 4) Management of school environment: 1.7 5) Health care services: 1.8 6) Operating of school health organization.: 1.3 6. Significances to the degree of self-discipline on school health nursing activities 1) Program planning & evaluation; Level of nursing education (F=4.309 p<.01) 2) Clinical management: Level of nursing education (F=3.587 p<.05) 3) Operating of school health organization: School health organization (t=-2.68 p<.01) 4) Health care services: School health organization (t=2,58 p<.05) 5) School health performance: School health organization (t=2.32 p<.05) 6) Program planning & evaluation: School health experience (r=0.239 p<.01) Expending time for program planning & evaluation (r=-0.172 p<.05) 7) Clinic management: School health experience (r=0.249 p<.01) Expending time for dinic management (r=0.181 p<.05) No. of student (r=-0.158 p<.05) Expending time of program planning & evaluation (r=-0.199 p<0.5) 8) Health education: School health experience (r=0.234 p<0.1) Expending time of program planning & evaluation (r=-0.193 p<.05) 9) Management of school environment: Age of school health teacher (r=0.142 p<.05) School health experience (r=0.255 p<.01) 10) Operating of school health organization: Medicine Purchase (r=-0.163 p<.05) 11) Health care services: School health experience (r=0.148 p<.05) Medicine purchase (r=-0.229 p<.01) 12) Total school health performance: School health experience (r=0.200 p<.05) Medicine purchase(r=-0.168 p<.05) Based on the above results, the suggestions are as follows: 1) As the SHT take charge of the reasonable number of student, the students will have benefit of the good health service in quality. 2) It is recommended to use the health clinic separately and to arrange adequate place for good school health service. 3) It is necessary that the SHT participate budget for school health. 4) It is required to enhance self-confidence on school health nursing activities through continuous educational programs.

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A Study Concerning Health Needs in Rural Korea (농촌(農村) 주민(住民)들의 의료필요도(醫療必要度)에 관(關)한 연구(硏究))

  • Lee, Sung-Kwan;Kim, Doo-Hie;Jung, Jong-Hak;Chunge, Keuk-Soo;Park, Sang-Bin;Choy, Chung-Hun;Heng, Sun-Ho;Rah, Jin-Hoon
    • Journal of Preventive Medicine and Public Health
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    • v.7 no.1
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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.

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Complication and Failure Analysis of Fixed Restorations (고정성 보철물과 연관된 합병증과 실패에 관한 조사)

  • Yun, Mi-Jung
    • Journal of Dental Rehabilitation and Applied Science
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    • v.27 no.2
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    • pp.149-159
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    • 2011
  • Restoring and replacing teeth with fixed prostheses commonly used in dental practice. Because of improper oral hygiene care and inaccurate laboratory procedure, complication of fixed prostheses was found in the mouth of patient. Although many efforts have been continually made to obtain the data of long term prognosis of fixed prostheses, it was difficult to do it. The purpose of this study was to evaluate the clinical status of fixed prostheses to improve the quality of dental care. In order to assess the clinical status of fixed prostheses, a total of 154 individuals (aged 22-82, 88 women and 66 men loaded with 578 unit of fixed prostheses, and 423 abutments) who visited the Department of Prosthodontics, Pusan National University Hospital, between January 2009 to December 2009 and removed old fixed prostheses were examined. The results of this study were as follows: 1. Length of service of fixed prostheses was $10.3{\pm}05.5$ years (mean), 10.0 years (median). 2. Location of fixed prostheses was found to have statistically significant influence on longevity of fixed prostheses (P<.05). The longevity of fixed prostheses was high in anterior-posterior combination region (mean:13.1, median:13.5) than anterior and posterior region. 3. Longevity of fixed prostheses made of metal was longest (mean:13.3, median:12.3). 4. Number of units in fixed prostheses was found to have no statistically significant influence on longevity of fixed prostheses (P>.05). 5. Condition of opposing dentition was found to have statistically significant influence on longevity of fixed prostheses (P>.05). The fixed prostheses lasted longest when opposed by complete denture (mean:17.1, median:19.7), removable partial denture, fixed prosthesis and natural dentition trailing behind (P<.05) 6. Periodontal disease (37.5%), dental caries (19.0%), defective margin (18.4%) were frequent complications. In 33.1% of the cases, abutment state after removing fixed prostheses was needed to be extracted.

Complication and Failure Analysis of Endodontically Treated Teeth Restored with Post and Cores (포스트로 수복한 근관 치료된 치아의 임상적 상태에 대한 평가)

  • Yun, Mi-Jung;Kim, Mu-Hyon;Jeong, Chang-Mo;Huh, Jung-Bo;Jeon, Yeong-Chan
    • Journal of Dental Rehabilitation and Applied Science
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    • v.28 no.4
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    • pp.359-370
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    • 2012
  • The endodontically treated tooth is generally restored with post and core, owing to the brittle and the loss of large amount of tooth structure. The purpose of this study was to evaluate the clinical status of fixed prostheses to improve the quality of dental care. In order to assess the clinical status of fixed prostheses, a total of 101 individuals (aged 30-89, 66 women and 35 men loaded with 125 fixed prostheses) who treated in the Department of Prosthodontics, Pusan National University Dental Hospital, between January 1990 to December 2005 were examined. The results of this study were as follows: 1. Length of service of fixed prostheses was $9.7{\pm}3.4$ years (mean), 11.1 years (median). 2. Age and sex of patient was found to have no statistically significant influence on longevity of fixed prostheses (P>.05). 3. Location of fixed prostheses was found to have statistically significant influence on longevity of fixed prostheses (P<.05). The longevity of fixed prostheses was low in anterio-posterior combination region (median:9.2 years). 4. Longevity of fixed prostheses made of base metal ceramic(median:12.0 years) and noble metal ceramic (median:11.3 years) is long (P<.05). 5. Number of units in fixed prostheses was found to have no statistically significant influence on longevity of fixed prostheses (P>.05). 6. Condition of opposing dentition was found to have no statistically significant influence on longevity of fixed prostheses (P>.05). 7. Dental caries, periapical disease, tooth fracture were frequent complications. In 51.9% of the cases, abutment state after removing fixed prostheses was needed to be extracted.

The Jurisdictional Precedent Analysis of Medical Dispute in Dental Field (치과임상영역에서 발생된 의료분쟁의 판례분석)

  • Kwon, Byung-Ki;Ahn, Hyoung-Joon;Kang, Jin-Kyu;Kim, Chong-Youl;Choi, Jong-Hoon
    • Journal of Oral Medicine and Pain
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    • v.31 no.4
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    • pp.283-296
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    • 2006
  • Along with the development of scientific technologies, health care has been growing remarkably, and as the social life quality improves with increasing interest in health, the demand for medical service is rapidly increasing. However, medical accident and medical dispute also are rapidly increasing due to various factors such as, increasing sense of people's right, lack of understanding in the nature of medical practice, over expectation on medical technique, commercialize medical supply system, moral degeneracy and unawareness of medical jurisprudence by doctors, widespread trend of mutual distrust, and lack of systematized device for solution of medical dispute. This study analysed 30 cases of civil suit in the year between 1994 to 2004, which were selected among the medical dispute cases in dental field with the judgement collected from organizations related to dentistry and department of oral medicine, Yonsei university dental hospital. The following results were drawn from the analyses: 1. The distribution of year showed rapid increase of medical dispute after the year 2000. 2. In the types of medical dispute, suit associated with tooth extraction took 36.7% of all. 3. As for the cause of medical dispute, uncomfortable feeling and dissatisfaction with the treatment showed 36.7%, death and permanent damage showed 16.7% each. 4. Winning the suit, compulsory mediation and recommendation for settlement took 60.0% of judgement result for the plaintiff. 5. For the type of medical organization in relation to medical dispute, 60.0% was found to be the private dental clinics, and 30.0% was university dental hospitals. 6. For the level of trial, dispute that progressed above 2 or 3 trials was of 30.0%. 7. For the amount of claim for damage, the claim amounting between 50 million to 100 million won was of 36.7%, and that of more than 100 million won was 13.3%, and in case of the judgement amount, the amount ranging from 10 million to 30 million won was of 40.0%, and that of more than 100 million won was of 6.7%. 8. For the number of dentist involved in the suit, 26.7% was of 2 or more dentists. 9. For the amount of time spent until the judgement, 46.7% took 11 to 20 months, and 36.7% took 21 to 30 months. 10. For medical malpractice, 46.7% was judged to be guilty, and 70% of the cases had undergone medical judgement or verification of the case by specialists during the process of the suit. 11. In the lost cases of doctors(18 cases), 72.2% was due to violence of carefulness in practice and 16.7% was due to missing of explanation to patient. Medical disputes occurring in the field of dentistry are usually of relatively less risky cases. Hence, the importance of explanation to patient is emphasized, and since the levels of patient satisfaction are subjective, improvement of the relationship between the patient and the dentist and recovery of autonomy within the group dentist are essential in addition to the reduction of technical malpractice. Moreover, management measure against the medical dispute should be set up through complement of the current doctors and hospitals medical malpractice insurance which is being conducted irrationally, and establishment of system in which education as well as consultation for medical disputes lead by the group of dental clinicians and academic scholars are accessible.