• Safety and Health at Work
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• 제2권2호
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• pp.87-96
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• 2011

In 1967, the problem of occupational lead exposure came to public attention in Korea. Since then, regular progress has been made in lowering workplace lead exposures, instituting new workplace controls, and implementing health examinations of exposed workers. Past serious lead poisoning episodes made it possible to introduce biological monitoring programs on a voluntary basis in high-lead-exposure facilities in Korea. Industry-specific occupational health services for lead workers in Korea during the last 22 years can be categorized into three phases. During the first phase (1988-1993), efforts were directed at increasing awareness among workers about the hazards of lead exposure, biological monitoring of blood zinc protoporphyrin began, and a respiratory protection program was introduced. During the second phase (1994-1997), a computerized health management system for lead workers was developed, blood-lead measurement was added to biologic monitoring, and engineering controls were introduced in the workplace to lower air-lead levels to comply with air-lead regulations. Finally, during the third phase (1998-present), a new biomarker, bone-lead measurement by X-ray fluorescence, was introduced. Bone-lead measurement proved to be useful for assessing body burden and to demonstrate past lead exposure in retired workers. Occupational health service practice for lead workers, including the industry-specific group occupational health system, has brought considerable success in the prevention of lead poisoning and in reducing the lead burden in Korean lead workers during the last several decades. The successful achievement of prevention of lead poisoning in Korea was a result of the combined efforts of lead workers, employers, relevant government agencies, and academic institutes.

• 임상간호연구
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• 제17권3호
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• pp.307-318
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• 2011

Purpose: This study was to identify topics for evidence-based clinical nursing practice guidelines in Korea. Methods: Data were collected from 330 staff nurses from 10 general hospitals and 53 nurses in charge of nursing education in 110 hospitals with over 500 beds. Using open questions, the nurses identified activities which could not be verified, which lacked consistency among nurses, clinical units and/or hospitals, which were not based on the up-to-date knowledge and which needed reform. The data were analysed by content analysis using a qualitative methodology. Results: Collected data consisted of 1882 clinical topics, which were classified into 50 topics, 207 mid-categories, and 456 sub-categories. The most frequent topics in order of frequency were medications, central line management, intravenous injections, urinary catheterization, perioperative nursing care, skin tests, pressure ulcer care, blood transfusions, laboratory examination-culture, respiratory care which were performed routinely in clinical setting by staff nurses. Conclusion: The research findings indicate the urgent need to develop evidence-based clinical nursing practice guidelines related to these research findings. Further research is needed to identify topics related to health promotion, and symptom/management of health problem.

• 보건행정학회지
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• 제31권4호
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• pp.508-517
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• 2021

Background: After the first case of coronavirus disease 2019 (COVID-19) in January 2020, Korea has experienced three waves in 2020. This study aimed to analyze changes in health care utilization according to the period of the 1st to 3rd waves of the COVID-19 pandemic. Methods: We analyzed 3,354,469,401 national health insurance claims from 59,104 medical facilities between 2017 and 2020. Observed-to-expected ratios (O:E ratio) with data from 2017 to 2019 as expected values and data from 2020 as observed values were obtained to analyze changes in medical utilization. T-test was used to test whether the difference of observed and expected values was statistically significant. Results: In 2020, the O:E ratio was 0.894, indicating a decrease in health care utilization overall during the pandemic. The O:E ratio of the 1st wave was 0.832, which was lower than those of the second (0.886) and third (0.873) waves. Health care utilization decreased relatively more among outpatient, women, children and adolescents, and health insurance patients. And health care utilization decreased more in small medical facilities and in Daegu and Gyeongbuk during the first wave. During the pandemic, the O:E ratios of respiratory diseases were 0.486-0.694, while chronic diseases and mental diseases were more than 1.0. Conclusion: Health care utilization decreased during the COVID-19 pandemic overall, and there were differences by COVID-19 waves, and by the characteristics of patients and medical facilities. It is necessary to understand the cause of changes in health care utilization in order to cope with the prolonged COVID-19 pandemic.

• 보건행정학회지
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• 제30권4호
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• pp.444-450
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• 2020

Background: In this study, we compared the incidents of humidifier disinfectants and incidents of mild hepatitis in Japan to highlight the differences in government response in the health care field in terms of "chain of responsibility". Methods: We examined whether the three mechanisms of action and the chain of responsibility hypothesis were applied to compare the cases of Korea and Japan. The incident of Japan occurred in 1987 in Misawa city, Aomori prefecture. In the 1990s, the safety of blood products increased dramatically. However, relief for infected victims was neglected. Green Cross did not notify the parties. In Korea, in the spring of 2011, a number of lung disease patients were accidentally admitted to a hospital in Seoul, and a female patient with respiratory failure symptoms expired. The Korea Centers for Disease Control and Prevention conducted animal tests and the Ministry of Health and Welfare issued an order for forced collection of humidifier disinfectants. Results: In the case of Japan, the Ministry of Health and Welfare had to take responsibility for follow-up measures such as the investigation of the cause, so it was tied to a "chain of responsibility". However, in the case of Korea, the Ministry of Health and Welfare was free from the chain. Conclusion: Through the comparison between the cases of Japan and Korea, we confirmed that whether or not a government organization chooses to conceal responsibility depends on its past behavior, which is whether it is free from the chain of responsibility or not. Therefore, it was reaffirmed that an organization (ministry or department) free from the chain of responsibility must exist within the government.

• 한국항행학회논문지
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• 제22권2호
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• pp.173-178
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• 2018

2015년 5월 첫 중동호흡기증후군 사례가 발생하여 환자 186명, 사망자 38명이 발생하고 16,693명을 격리하였다. 정부에서는 MERS 감염의 확산을 차단하기 위하여 확진 또는 의심환자와 접촉한 사람에 대한 모니터링을 시행하였다. 관리 담당자는 자가격리자에 대해 최대 잠복기인 14일 동안 1일 2회 감시를 실시하여 격리 준수 여부 등을 확인하였다. 그러나 격리대상자가 폭발적으로 증가하면서 관리 인력의 한계로 거주지 이탈자 발생 등의 문제가 발생하였다. 또한 관리자들은 하루에 두세번 전화로만 상태를 체크하다 보니 자가 격리 생활 수칙은 유명무실해졌으며 격리자들이 무단으로 외출할 경우 이를 통제하기란 사실상 불가능하다고 인정했다. 이에 본 논문에서는 자가격리장치 및 본인 인증 방법을 제안하고 검증하였다. 검증결과 본 논문에서 제안한 방법은 추후 자가격리장치 및 본인인증방법으로 사용되는데 전혀 문제가 없을 것으로 판단된다.

• 한국전자통신학회논문지
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• 제17권3호
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• pp.491-498
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• 2022

우리의 일상생활에서 양질의 수면은 행복 지수와 밀접한 관계가 있다. 사람들은 수면 장애를 만성 질환으로 인식하든 아니든 많은 어려움을 호소하고 있으며 일상생활에서 수면 중에 호흡 곤란을 경험하는 경우가 종종 발생한다. 수면 중에 호흡 관련 장애를 자동으로 인식하는 것은 매우 중요하나 현실적으로 매우 어렵다. 본 논문은 이러한 문제를 해결하기 위해 가정에서 건강관리를 위해 모바일 기반의 비접촉 수면 모니터링을 제안한다. 수면 중 호흡 신호는 스마트 폰의 소리 센서를 이용하여 호흡 신호를 수집하고, 신호의 특징을 추출, 호흡의 주파수, 진폭, 호흡의 주기, 호흡의 패턴을 분석한다. 모바일 건강이 모든 문제를 해결하지는 못하나 개인의 건강 상태의 조기 발견과 지속적인 관리를 목적으로 하고, 일반 가정의 침실에서 스마트 폰으로 추가 센서 없이 수면 중에 호흡과 같은 생리학적 데이터 모니터링의 가능성을 보여준다.

• Pediatric Infection and Vaccine
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• 제29권3호
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• pp.125-130
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• 2022

장기화된 코로나19의 유행으로 많은 임산부들이 분만에 임박하여 감염되는 사례들이 많아진 반면, 이런 상황에서 출생하는 신생아들을 처치 및 검사에 대한 국내 권고 사항은 코로나19 유행 초기에 만들어져 진료 현장에서 어려움이 많았다. 다행히 최근에 축적된 자료와 외국의 최신 지침을 반영한 국내 권고 사항이 개정 발표되어 이를 소개하게 되었다. 대표적인 변화로는 코로나19 확진 산모에게 출생한 신생아의 처치 및 검사가 반드시 음압 격리 시설 내에서 이루어질 필요 없이 적절한 보호장구를 착용한 상태에서 신생아실에서 이루어질 수 있도록 하였다. 또한 코로나19 검사도 생후 48-72시간에 1회 시행할 것을 권고하였으며, 모자 동실을 할 경우에는 증상 없는 건강한 신생아라면 검사 없이 경과 관찰할 수 있도록 하였다. 입원이 필요한 경우에는 기존 권고 사항과 같이 생후 24시간, 48시간 째에 각각 두 번 검사를 시행하도록 하였다. 개정된 권고 사항이 코로나19 확진 산모와 신생아의 진료에 유연성을 주면서 감염의 확산을 최소화할 수 있으리라 기대한다.

• 보건행정학회지
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• 제2권2호
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• pp.131-151
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• 1992

The contents of prescription service were comparatively analysed between health centers(HC) and private clinics(PC). Medical chart review was done for 330 otu-patients diagnosed with upper respiratory tract infection(UR) of 120 adults and 90 children, and gastritis or duodenitis of 120 adults. Emphasis on comparison was the prime cost of medication which used in prescription service. The results were as follows; 1. The prime costs fro the medication per visit of HC group were significantly higher than PC group in all three diseases, and the out of pocket payments of patients per visit were significantly lower in the HC group than PC group. 2. The reason for high prime costs of medication per visit of HC in adult case of URI were due to the idverse use of medication and long prescription period per visit. And high medication costs in children cases of URI in HC group were due to the longer prescription day. In cases of gastritis, the prime cost of medication was also higher because of longer prescription period and the higher prime cost of medication. The proportions of medications for injection in the HC and PC groups showed similar features. 3. In depth analysis of the prescription services showed the differences of the contents of medication. In adults cases of URI, the averaged cost of oral medication was significantly lower in HC group, but that of medication for injection was higher in HC group. In children cases of URI, the averaged cost of oral medication and medication for injection was lower in HC group than in PC group. But in the cases of gastritis it was was higher in HC group than in PC group. The prescription periods were longer in HC group than in PC group in all three diseases. As a conclusion prime medication cost and quality of prescription services of HC group were higher than PC group. In terms of health care the cost containment and quality assurance in physician visit for common disease, public sector utilization is good option for those perspectives. But it should not be generalized unless future study about structure and outcome research for quality assurance.

• 중환자간호학회지
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• 제16권2호
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• pp.1-14
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• 2023

Purpose : Sleep disturbances in patients in the intensive care unit (ICU) are related to health problems after discharge. Therefore, active prevention and management are required. Hence, identification of the factors that affect sleep in patients who are critically ill is necessary. Methods : The PubMed, Cochrane Library, CINAHL, EMBASE, and Web of Science databases were searched. Selection criteria were observational and experimental studies that assessed sleep as an outcome, included adult patients admitted to the ICU, and published between November 2015 and April 2022. Results : A total of 21,136 articles were identified through search engines and manual searches, and 42 articles were selected. From these, 22 influencing factors and 11 interventions were identified. Individual factors included disease severity, age, pain, delirium, comorbidities, alcohol consumption, sex, sleep disturbance before hospitalization, chronic obstructive pulmonary disease (COPD), cardiovascular disease, and high diastolic blood pressure (DBP), low hemoglobin (Hb), and low respiratory rate (RR). Environmental factors included light level, noise level, and temperature. Furthermore, treatment-related factors included use of sedatives, melatonin administration, sleep management guidelines, ventilator application, nursing treatment, and length of ICU stay. Regarding sleep interventions, massage, eye mask and earplugs, quiet time and multicomponent protocols, aromatherapy, acupressure, sounds of the sea, adaptive intervention, circulation lighting, and single occupation in a room were identified. Conclusion : Based on these results, we propose the development and application of various interventions to improve sleep quality in patients who are critically ill.

• Tuberculosis and Respiratory Diseases
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• 제64권2호
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• pp.109-124
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• 2008

연구배경: COPD는 전세계적으로 유병률, 이환율 및 사망률이 급격히 증가하는 질환으로 환자의 삶의 질을 호전 시키고 사회, 경제적인 질병부담을 줄이기 위해 경증 COPD 환자를 조기에 진단하여 적절히 치료하는데 일차진료의사의 역할이 중요하다. 근거중심을 바탕으로 개발된 GOLD와 같은 COPD 진료지침은 이 목적을 위해 유용하나 우리나라의 진료실태가 반영되지 않은 문제점이 있다. 근거중심을 바탕으로 우리나라 진료실정이 반영된 진료지침을 개발하기 위해 우리나라 일차진료의사들의 진료 실태를 조사하여 보고한다. 방법: 진료실태는 웹을 기반으로 COPD의 진단, 치료, 위험인자, 교육, 진료지침에 대한 25개의 설문을 포함 제작하였고 총 217명의 일차진료의사가 설문조사에 동의하고 참여하였다. 참여자의 의사경력은 평균 17.7년이며 76.5%가 내과를 전공하였고 지역적으로는 63.6%가 서울, 경기지역에서 진료를 하고 있었다. 결과: 비교적 높은 비율(61.8%)로 폐기능검사기를 보유하고 있지만 실제 진료 시 활용도는 낮은(35.8%) 편임을 알 수 있었다. 안정 시, 급성악화 시 COPD의 치료에서 경구제제의 처방빈도가 흡입제제에 비해서 모두 높았다. COPD의 주요 위험인자인 흡연에 대해서는 흡연여부 확인율, 금연권유율 등이 90% 이상으로 높았으나 금연을 위한 처방에서 금연 성공률이 높은 니코친대체제와 부프로피온의 병용 처방률이 4.3%로 낮았다. COPD 진료지침에 대한 인지도는 56.7%였고 그대로 따르는 경우는 7.3%로 국내 진료실태를 반영한 진료지침의 개발이 요구되며 진료지침의 보급과 확산을 위해서는 진료지침책자를 포함한 인쇄자료의 보급이 효과적임을 알 수 있었다. 결론: 우리나라 일차진료의사들의 COPD 진료실태는 진단에서 폐기능검사의 보유율에 비해 사용률이 낮고 치료에서 흡입제에 비해 경구제제의 처방을 선호하는 경향을 보였다. GOLD 진료지침에 대한 인지도는 높으나 그대로 따르는 일차진료의사는 적으므로 이번 진료실태조사 결과를 바탕으로 근거중심이지만 국내실정을 반영한 COPD 진료지침의 개발 및 보급이 필요하리라 생각된다.