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국민건강보험 발전방향 (Future Direction of National Health Insurance)

  • 박은철
    • 보건행정학회지
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    • 제27권4호
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    • pp.273-275
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    • 2017
  • It has been forty years since the implementation of National Health Insurance (NHI) in South Korea. Following the 1977 legislature mandating medical insurance for employees and dependents in firms with more than 500 employees, South Korea expanded its health insurance to urban residents in 1989. Resultantly, total expenses of the National Health Insurance Service (NHIS) have greatly increased from 4.5 billion won in 1977 to 50.89 trillion won in 2016. With multiple insurers merging into the NHI system in 2000, a single-payer healthcare system emerged, along with separation policy of prescribing and dispensing. Following such reform, an emerging financial crisis required injections from the National Health Promotion Fund. Forty years following the introduction of the NHI system, both praise and criticism have been drawn. In just 12 years, the NHI achieved the fastest health population coverage in the world. Current medical expenditure is not high relative to the rest of the Organization for Economic Cooperation and Development. The quality of acute care in Korea is one of the best in the world. There is no sign of delayed diagnosis and/or treatment for most diseases. However, the NHI has been under-insured, requiring high-levels of out-of-pocket money from patients and often causing catastrophic medical expenses. Furthermore, the current environmental circumstances of the NHI are threatening its sustainability. Low birth rate decline, as well as slow economic growth, will make sustainment of the current healthcare system difficult in the near future. An aging population will increase the amount of medical expenditure required, especially with the baby-boomer generation of those born between 1955 and 1965. Meanwhile, there is always the problem of unification for the Korean Peninsula, and what role the health insurance system will have to play when it occurs. In the presidential election, health insurance is a main issue; however, there is greater focus on expansion and expenditure than revenue. Many aspects of Korea's NHI system (1977) were modeled after the German (1883) and Japanese (1922) systems. Such systems were created during an era where infections disease control was most urgent and thus, in the current non-communicable disease (NCD) era, must be redesigned. The Korean system, which is already forty years old, must be redesigned completely. Although health insurance benefit expansion is necessary, financial measures, as well as moral hazard control measures, must also be considered. Ultimately, there are three aspects that we must consider when attempting redesign of the system. First, the health security system must be reformed. NHI and Medical Aid must be amalgamated into one system for increased effectiveness and efficiency of the system. Within the single insurer system of the NHI must be an internal market for maximum efficiency. The NHIS must be separated into regions so that regional organizers have greater responsibility over their actions. Although insurance must continue to be imposed nationally, risk-adjustment must be distributed regionally and assessed by different regional systems. Second, as a solution for the decreasing flow of insurance revenue, low premium level must be increased to an appropriate level. Likewise, the national reserve fund (No. 36, National Health Insurance Act) must be enlarged for re-unification preparation. Third, there must be revolutionary reform of benefit package. The current system built a focus on communicable diseases which is inappropriate in this NCD era. Medical benefits must not be one-time events but provide chronic disease management. Chronic care models, accountable care organization, patient-centered medical homes, and other systems that introduce various benefit packages for beneficiaries must be implemented. The reimbursement system of medical costs should be introduced to various systems for different types of care, as is the case with part C (Medicare Advantage Program) of America's Medicare system that substitutes part A and part B. Pay for performance must be expanded so that there is not only improvement in quality of care but also medical costs. Moreover, beneficiaries of the NHI system must be aware of the amount of their expenditure through a deductible payment system so that spending can be profiled and monitored. The Moon Jae-in Government has announced its plans to expand the NHI system; however, it is important that a discussion forum is created so that more accurate analysis of the NHI, its environments, and current status of health care system, can take place for reforming NHI.

호텔 뷔페음식(飮食)에 관한 실태조사(實態調査) -제(第) 1보(報).뷔페식당(食堂) 이용자(利用者)의 식행동(食行動)에 관(關)한 설문조사(設問調査)- (The Present State and Problems of Hotel Buffet Styled Restaurant -I. A Survey of Customer's Dining out Behaviours of Hotel Buffet Styled Restaurant-)

  • 모수미;최경숙;김창임;이수경;정상진;최선혜
    • 한국식생활문화학회지
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    • 제6권2호
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    • pp.175-184
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    • 1991
  • 본 연구에서는 부페식당 이용자의 식생활 태도를 알아보기 위해 설문조사를 실시하였는데 결과는 다음과 같다. 1) 조사대상자의 일반환경 조사대상자의 연령은 6세부터 70세까지로 20대, 30대, 40대가 주를 이루었고, 여자가 65.1%로 여성들이 많이 찾는 조사대상 부페식당의 특색을 보였다. 직업은 가정주부가 27.2%, 사무직이 19.3%, 전문직이 17.3%였고, 학생이 30.3%였다. 2) 평소 부페음식에 대한 견해에 관한 조사 평소 부페식당 이용이 '한 주에 $1{\sim}2$회'가 1.6%, '한 달에 $1{\sim}2$회'가 13.7%, '서너달에 $1{\sim}2$회'가 43.9%, '일년에 $1{\sim}2$회'가 36.9%, '처음'이 2.7%였다. 대상자들은 부페음식에 대해 음식의 가지수가 많고 마음대로 선택할 수 있고 음식의 모양, 진열 및 정갈함, 많이 먹을 수 있는 점 등에 대해서는 좋다고 생각하는 반면, 음식을 가지러 왔다 갔다 하는 점, 가격 등에 대해서는 부정적인 반응을 보였다. 3) 부페식당에서의 식사행동 부페식당에 온 이유는 '가족파티'가 31.3%였고, 동행인은 평균 $9.3{\pm}4.3$명이며 주로 가족 및 친척, 직장 동료였다. 식사에 소요된 시간은 1시간 32분${\pm}$26분이었고, 음식을 가져온 첫수는 평균 $3.7{\pm}1.2$회였으며, 최고 10회가 있었다. 만복감 후 식사첫수는 평균 $1.2{\pm}0.8$회였다. 부페식사시 가장 먼저 먹은 음식은 스프 23.9%, 샐러드 23.9%였는데, 여자는 스프, 샐러드의 비율이 높은 반면, 남자는 육류, 어패류의 비율이 높았으며, 음식 선택시 기준은 '내가 좋아하는 음식'이 70.7%로 가장 높게 나타나 부페식당 이용자들이 바람직한 식사순서 및 음식선택에 대한 인식이 낮음을 알 수 있었다. 부페식당에서 가장 좋아하는 음식의 국적은 54.4%가 한국음식으로 나타났다. 부페식사에서 '약간' 또는 ‘대단히 과식했다'고 응답한 경우가 64.0%로 많은 대상자들이 과식하는 것으로 나타났는데 이로 인한 건강 및 영양문제에 대한 교육이 필요하고 운영면에서는 이러한 일종의 음식의 낭비를 줄일 수 있는 방안에 대한 연구가 필요하다고 사료되었다. 5) 향후 부페식당의 발전방향에 대한 의견 부페식당의 발전방향에 대해 '가지수를 줄여서라도 가격을 짜게 하자'는 의견이 82.9%로 대부분 조사 대상자들이 현재 부페가격에 대해 부정적인 반응을 보였다. '한국음식을 더 많이 해서 전통음식과 친밀한 장소로 발전시키자', '계절식품을 이용하고 비슷한 종류의 음식은 빼서 가격을 낮추자', '연령에 따라서, 또, 성인에서는 성별에 따라 가격 차이를 두자'는 의견 등이 있었다.

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핵의학 검사 시행하는 환자에 의한 병원 종사자 피폭선량 평가 (Evaluation of Radiation Exposure to Medical Staff except Nuclear Medicine Department)

  • 임정진;김하균;김종필;조성욱;김진의
    • 핵의학기술
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    • 제20권2호
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    • pp.32-35
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    • 2016
  • 최근 핵의학 영상검사의 증가로 인하여 핵의학 검사를 시행하는 방사선 작업 종사자의 피폭도 증가하게 되었다. 더불어 핵의학 영상검사와 같은 날에 여러 가지 검사를 시행하는 환자도 증가하여 병원 종사자도 불가항력적인 방사선 피폭에 노출되고 있는 것이 현실이다. 하지만 핵의학 검사를 진행하는 과정에서 검사를 받는 환자 또는 검사를 시행하는 방사선 작업 종사자의 피폭에 대한 연구와 논문은 많이 발표되고 있으나 핵의학 검사를 시행하는 환자로 인하여 핵의학 검사에 관여하지 않는 병원 종사자가 받는 방사선 피폭에 대한 논문과 연구는 부족한 것이 사실이다. 이에 핵의학 검사로 인한 핵의학과 이외의 병원 작업 종사자가 받게 될 피폭선량에 대하여 알아보고자 한다. 2015년 7월부터 10월까지 서울대병원 핵의학과에 방사성의약품을 투여한 환자 250명(Bone scan 100명, Myocardial SPECT 100명, PET/CT 50명)을 대상으로 방사성의약품을 투여 직후와 핵의학 검사가 완전히 종료된 후의 방사선량률을 50cm 거리에서 측정하였다. 측정장비는 검교정이 완료된 Victoreen (FLUKE Inc., USA)과 Inspector(S.E. International, USA)를 사용하였다. 핵의학과 검사를 시행하는 환자로부터 발생하는 방사선량률을 측정한 결과, Bone scan은 방사성의약품 투여 직후에 $0.0278{\pm}0.0036mSv/h$, 검사 종료 후(투여 후 평균 3시간 52분 경과)에 $0.0060{\pm}0.0023mSv/h$, Myocardial SPECT는 투여 직후에 $0.0245{\pm}0.0027mSv/h$, 검사 종료 후(투여 후 평균 2시간 09분 경과)에 $0.0123{\pm}0.0041mSv/h$, PET/CT는 투여 직후는 이동이 없기 때문에 측정하지 않았고 검사 종료 후(투여 후 평균 68분 경과)에 $0.0439{\pm}0.0087mSv/h$로 측정되었다. 이와 같은 결과로 병원종사자가 핵의학 검사를 시행하는 환자와의 체류 시간이 5분간일 때 투여된 방사성의약품으로 인해 받는 방사선 피폭량은 Bone scan은 방사성의약품 투여 직후가 0.0023 mSv이고 검사가 종료된 후는 0.00049 mSv, Myocardial SPECT는 투여 직후가 0.002 mSv이고 검사가 종료된 후는 0.001 mSv, PET/CT는 검사가 종료된 후에 0.001 mSv정도임을 알 수 있었다. 연구 결과 핵의학검사를 시행하는 환자에 의한 병원 종사자의 방사선피폭은 원자력법에서 정한 선량한도와 비교하여 아주 미미하다고 볼 수 있었다. 하지만 방사선방호의 대원칙인 ALALA (As Low As Reasonably Achievable)에 의거하여 불필요한 방사성피폭은 가능한 줄이고자 하는 노력이 필요할 것이다. 이에 병원의 의료정보시스템을 개선하여 핵의학 검사 시행 여부 및 검사 진행사항을 확인 할 수 있게 하여 병원 종사사가 그 사실을 사전에 인지 가능하게 된다면 방사선 보호 장구를 착용하여 불필요한 방사선 피폭의 최소화 할 수 있을 것으로 사료된다.

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신안군(新安郡) 낙도(落島)에서 발생(發生)한 괴질(怪疾)의 원인(原因)에 관한 역학적(疫學的) 조사(調査)(I) (Epidemiologic Investigation for the Etiology of an Epidemic Ocurred among Animals and Humans in an Isolated Island, Korea(I))

  • 김정순;허용;윤형렬;이원영
    • Journal of Preventive Medicine and Public Health
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    • 제22권2호
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    • pp.290-301
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    • 1989
  • This is preliminary report on anthrax epidemic occurred in an island with about 100 residents. Since 1982 there had been sudden deaths among all kinds of domestic animals including cattle, dogs, ducks, chicken and goat but only a few among cats in an isolated island about three hours distance away by ferry boat from Mokpo city. From 1986 through 1988 nine human deaths and four patients occurred, which made the government intervene for investigation on June 25 1988. The epidemiological investigation consisted of interview survey and medical examination, medical record analysis, laboratory work to isolate the pathogens under the direction of hypothesis derived from the study and further confirmation of the pathogens by international institute. The summarized results are as followings: 1. According to the interview survey there were many deaths among domestic animals usually in cold and dry season such as January through March and September through November; 36 heads of cattle leaving one head, more than 40 hogs(all), hundreds of chicken leaving few alive, goats that had taken home from mountain and two or three cats out of around 40 had sudden deaths from 1982 till 1985, when the residents stopped to purchase and take them into the island anymore. Also there were eleven persons who had experienced the similar syndrome complex to those of admitted and expired patients and four of them revealed typical chest X-ray findings; from one of these four patients(Rho) B. anthracis is isolated. 2. Medical record on patients who had been admitted, showed common characteristics of the disease course. On admission they had either gastrointestinal or upper respiratory infection symptoms which invariably progressed to septicemic nature with pulmonary interstitial infiltration and mediastinal widening/bulging, and then to deadly acute respiratory distress syndrome. At the end stage chest X-ray revealed multiple bullous emphysema. One of another characteristics was oral ulceration with bleeding occurred in about 50% of the patients. Laboratory test results in common were leukocytosis with left shift and abnormal liver and kidney functions, particularly at the later stage of the illness. 3. Epidemiological characteristics was striking in that both mortality and incidence rates were high: the mortality rate was 8.7% average, male being three times higher than females but there was no distictive clustering by age group. The incidence rate for both sexes was 28.2% and there was no sex difference although a tendency of higher incidence among older ages was noticed. The highest mortality and incidence were observed in Won village where the first death of animal occurred and with the highest frequency among three villages of the island. 4. Among twelve bacilli species isolated from various specimens, two strains, one from patient and the other from soil where the recently died cow is hurried, were confirmed as B. anthracis by Pasteur Institute and CDC of USA(strain from soil). CDC reported that the strain did not produce capsule in bicarbonate media but reacted with the bacteriophage and one of five sera taken from the patients. Mode of transmission as well as incubation period of the agent has not been established yet, which needs further investigation in relation to the antigenic structure of the variant when it is confirmed.

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국가원수 경호적 측면에서의 EMP(Electro Magnetic Pulse) 방호 시스템에 대한 고찰 (Aspect of the chief of state guard EMP (Electro Magnetic Pulse) protection system for the consideration)

  • 정주섭
    • 시큐리티연구
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    • 제41호
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    • pp.37-66
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    • 2014
  • 최근 전자공학의 급격한 발달로 컴퓨터와 전자 통신 기술에 의존도가 높아지고 있으며 각 부분이 상호 연계되어 모든 전자 장비를 무용지물로 만드는 EMP에 의한 직접적 또는 간접적인 피해가 발생하고 있다. 대한민국과 긴박한 대치 상황에 놓여 있는 북한은 상당한 수준의 EMP 관련 기술을 가지고 있으며, EMP 무기를 이미 보유했거나 수년 내 EMP 무기의 개발을 완료할 것으로 전망하고 있다. 북한은 장거리 미사일발사 직후에 여러 차례 핵실험을 실시하였으며 노골적인 핵 협박 공세가 강화되었음을 보았을 때, 고고도 핵실험을 언제라도 할 수 있는 능력을 보유하였다고 보아야 하며, 이는 EMP 무기의 실전적인 공격능력이 갖추어 졌다는 것을 의미한다고 할 것이다. 이러한 시점에서 피해상황을 예측하여 대한민국의 안보현실에 부합되는 EMP 방호시스템의 구축은 무엇보다도 필요한 과제이다. 그 피해의 규모는 예측 불가하지만 크게 군사적 피해와 사회 경제적 피해 그리고 인명피해상황으로 구분해 보았을 때 통신 시스템 및 위성장비의 마비를 시작으로 군사안보시스템과 수송, 금융, 국가비상체계 등 여러 부문으로 피해가 나타난다. 일반적으로 EMP는 직접적인 인명피해는 없다고 보고되지만 의료기기에 의존하는 사람들에게는 치명적인 피해가 나타날 수 있다. 또한, 국가전력체계 마비로 인한 전력공급중단이 가져다주는 피해만 생각 할 것이 아니라 주 전력발전 중 원자력발전소 의존도가 높은 국내는 블랙아웃현상발생 시 심각한 원전사고로 이어질 수 있는 발전소 내부의 문제점도 예측해 보아야 한다. 우선 특별 전문 위원회를 구성하여 EMP 방호시설 및 장비에 대한 수요조사를 실시하고, 그에 맞는 소요예산을 구성하여 엄격한 기준 아래 시공업체를 선별하여야 한다. 그 후 EMP 방호성능검증을 위한 기관을 만들어 성능을 검증 한 후 유지 보수 안전 및 설계 시공회사 보안 관리를 하는 조직적이고 체계적인 과정을 거쳐 경호시설물이나 경호통신장비 기동장비 등에 대한 완벽한 EMP 방호시스템을 갖추어 놓아야 할 것이다.

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동병하치 확산을 위한 전략적 방향과 이행방안 (Strategic Direction and Road Map of Expanding Prevention of Winter Disease in the Summer)

  • 송호섭
    • Journal of Acupuncture Research
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    • 제27권3호
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    • pp.147-157
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    • 2010
  • Objectives : The purpose of this study was to propose appropriate strategic directions and road maps for successful achievement of programs preventing winter disease in the summer. Methods : Details on programs preventing winter disease in the summer such as clear concept, theoretical basis, current status, intervention or available prescriptions and indication/contraindication/caution were prepared through the related journal review, upon which an observational study was devised and done for simulation to find out even a trivial problem and to guarantee the safety beforehand. The experimental group was divided into 5 groups by the size of pill and the way ginger is treated; 1cm pill with ginger group, 3cm pill group without ginger, 3cm pill group dipped into ginger, 3cm pill group applying ginger to acupoints and 3cm pill group with ginger Results 1. program preventing winter disease in the summer was defined as representative winter diseases such as common cold, influenza, chronic asthma, chronic bronchitis, allergic rhinitis, emphysema, chronic gastritis and rheumatoid arthritis, and preventive care in the summer, reinforcing deficient yang qi of five viscera by using exuberant yang qi from summer heat. 2. It was based upon historically established theories which is 'nourishing yang qi in the spring and summer', 'long summer, namely rainy spell in the summer overwhelms the winter, because of earth winning water according to the five phases theory' and 'To replenish yang qi is major principle to treat winter diseases, which can be most appropriately and timely applied to the patient with deficient yang qi of five viscera inherently, especially in the three dog days of the summer, because of exuberant exterior yang qi and deficient interior yang qi in the five viscera'. 3. In the adjacent China and Taiwan, acupoint applying method in the three dog days named 'San Fu Tie' have been stirring a boom throughout the nation, in which Xiaochuan Gao was used as a basic prescription and it mainly was applied at bilateral $BL_{13}$, $_{15}$ and $_{17}$ for about 4 hours. As far as domestic current status, the necessity of adopting the above method prior to Herbal formula was also recognised, because not a few koreans have apprehension for the safety of it including medicinal herbs and are reluctant to take it any more due to negative advertisement of narrow minded doctors' association. 4. Indication of acupoint applying method in the three dog days included most of winter diseases such as common cold, influenza, chronic asthma, chronic bronchitis, allergic rhinitis, emphysema, chronic gastritis. contraindication was pregnant woman and the weak such as infants and the old. More attention was paid to grasp firmly the normal reaction following the treatment for preventing side effect and teasing blister. recommendation was also given to abstain from food inducing phlegm and dampness such as meat, shrimp and crab as well as cold drinks and foods 5. In the simulation observational study based upon the above findings following review the related articles, no blister was shown on the acupoints icluding bilateral $BL_{13}$, $_{15}$ and $_{17}$ in every experimental group during 24hr observation following the acupoint applying treatment with pills made by modified and devised prescription. At 4 hr, the effectiveness of it reached a peak showing redness and mild tenderness and there is little difference between groups 3cm pills groups regardless of the way ginger was treated. abdominal distention and growling was found in all the volunteers during the treatment at CV 8. Strategic directions and road maps : Through successful fulfillment of the program preventing winter disease in the summer, Korean traditional medicine should be integrated into mainstream national health care services. Cultural access was thought to be as important as Scientific EBM approach. First of all, To evoke potential cultural homogeneity from campaigns and press advertisement was needed for promoting public awareness about preventing winter disease in the summer by enhancing immunity via acupoint applying treatment in the three dog days, and then indigenous name as Sambokcheop, protocol, Clinical Research Form for data collection of it should be developed and prepared. Once the first step was taken this summer, through a thorough data collection and scrutinized scientific evaluation, drawbacks should be compensted for and the efficacy and safety should be substantiated.

광복이후 한국 공공도서관사 연구 -일제하 공공도서관제도의 영향을 중심으로- (A Study of the History of Korean Public Library after the Korean Liberation Day - An Emphasis on the influence of public Libraries System under the Japanese Imperialism-)

  • 김포옥
    • 한국문헌정보학회지
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    • 제20권
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    • pp.65-125
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    • 1991
  • The study has tried to analize and appraise how did public library system under the Japanese imperialism affect the establishment and managemant of Korean public libraries. To achieve the purpose of the above-mentioned study, the contents of $\ulcorner$Japanese library statute$\lrcorner$ under Japanese imperialism and the current $\ulcorner$Korean library law$\lrcorner$ have been mutually compared, at the same time, the vestiage of Japanese imperialism in view of the establishment, personnel administration and reading systems have been concretely investigated, analyzed and compared. The conclusions obtained from the above are as followings. 1. In those days of the Korean Liberation, the situation of Korean public libraries was such as it under the Japanese rule and so, their names were only changed. However, as a part of its independent activities, the national library have once carried out the various programs such as the training of professional librarians, the establishment of the new classification schedule and the chief Librarian and deputy Librarian from the professional librarians in the office regulations, and they were well worth being the good examples for today's Korean library circle. Though the Goverment of the Republic of Korea had been formally established, the situation of the library circle was very dull owing to the Korean war for a long time. In 1963, $\ulcorner$The Korean library law$\lrcorner$ was promulgated, but the establishment of public libraries did not give satisfactory results because of the institutional fragility. In the 1980's the importance of library was embossed from the viewpoint of life-long education and the number of libraries was increased. However, there were still the remaining vestiges of Japanese library system in the practical library services. 2. After the Korean Liberation, the influnces of public library system under the Japanese imperialism showed in the office regulation of national library and the Korea library Law were also in the legal mechanism. In particular, the regulations of $\ulcorner$The staff-member of public library$\lrcorner$ and $\ulcorner$Admission fee of public library$\lrcorner$ including the chief librarian have referred to the library system under the Japanese imperialism since the liberation day to date. 3. At that time of the Korean Liberation, the U.S.Military Government Office had decided that the public library administration should be attached to the administration of local and internal affairs in accordance with the Japanese administative system. As a result, the public libraries had been forced to be indirectly affected by public library system under the Japanese imperialism for twenty years since the Liberation. 4. Since the Liberation, the personnel adminstration of public library has been so far on the steps of model under the Japanese imperialism. As the result of the field survey, the position standards of local chief librarians, non-professional character, the extra post system and the preponderant appointment of non-professional offices have analyzed by the influence of Public library system under the Japanese imperialism. Therefore, the Government authorities-concerned must readjust the standards of qualification and the divided duties corresponding to the position of public library staff members and to stipulate expressly in the revised library law. In addition, the regulation of the admission fee should be also actively detected for the free adminssion of library users. 5. Since the Liberation Day, the reading methods of public library have been so far similar to reading method under the Japaness imperialism. For example, the admission fee levied, the complicated procedures of using books including entrance and exit of a library, no-admission system, the limited lending books, the deposit system of outdoor lending books and the surety liable jointly and severally are originally caused by bureaucracy of under the Japanese imperialism. Therefore, the public libraries should make an offer space and opportunities which can enjoy freedom to the gull in future. The procedures and standards of library users will be simplified, if possible. As the above-mentioned, the actual conditions of Korean public libraries have been examined and analyzed. As the result of it, there are still the remaining vestiges of public library system under the Japanese imperialism in the establishment and management of the nation-wide public libraries. Such the remnants are an obstacle to the democratic development of public libraries and so, the authorities-concerned should take the proper-measures as soon as possible.

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일부(一部) 지역사회(地域社會) 주민(住民)의 의료(醫療) 행태(行態)에 관(關)한 연구(硏究) - 반월읍(半月邑) 주민(住民)의 Shopping-around 현상(現象)을 중심(中心)으로 - (A Study on Health Seeking Behavior - Focused on Shopping-Around Phenomenon in Banwol-Eup Residents)

  • 최영택;이은일;김효중
    • 농촌의학ㆍ지역보건
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    • 제11권1호
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    • pp.44-54
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    • 1986
  • This study was aimed at investigating the health seeking behaviors of patients; For the purpose of analyzing the research theme we classified the study into two phase. First, the types of patients' health seeking behavior were categorized into a scheme according to what medical care resources were utilized in patients' coping process. Second, from patients' first visits to third visits to medical resources, we analyzed variations of factors which noted as crucial elements in constituting the patients' sickness career. To grasp the generalized characteristics from complicated empirical data, we limited the scope of our analysis to third stage of health seeking. A total of 121 persons who had beer suffering from chronic diseases more than 3 months was sampled among the residents of Banwol-Eup, the target Area of Korea University Health Project. The findings are as follows ; 1) In the course of visiting medical care resources, 34 different types of health seeking Behavior were found. From this result we inferred the idea that patients in Banwol-Eup had not any stable norms to cope with their pains. Clinics, hospital, pharmacy, Herb-doctors', folkways (self-treatment) were accessed by patients in orders. But more than half of patients who had utilized clinics or hospitals from their first to third visits, changed medical care resources to others, for example herb doctors or folkways, which had fundamentally different treatment models. Upon these two facts, the diversified types and capricious patterns in the health seeking behavior of Banwol patients, we observed a typical Shopping-Around phenomenon. 2) Factors which influenced patients' to their sickness career were changed along the courses of health seeking, from first to third visits as follows ; $\cdot$ Perceived seriousness of diseases were tended to decrease. $\cdot$ Professional medical personnel tended to be influencial in the patients' sickness career, (5.0%, 25.0% and 65.7%). The influence of the primary interaction groups such as parents, friends, neighbours, tended to decrease ; (90.9%, 71.2% and 30.0%). $\cdot$ The subjective reasons why to choose such a medical care resource were related to economic affordability and disease-itself as main motives. Credibility of health resources tended to increase 14.9%, 24.0% and 31.4 sequently. $\cdot$ Geographic accessibility factors did not change significantly. Most of patients had utilized health resources in Banwol and Anyang area. 3) Cultural inclination in the shopping-around phenomenon has shown difference among age groups. The age group' over 50 years' preferred traditional health resources to modern health resources. 4) Consistency of health seeking behavior on the shopping around phenomenon has shown difference according to the degrees of patients' economic affordability and those of psychological satisfaction toward modern health services. However, there were some restrictions in this thesis ; a) the study was limited to the 3rd health seeking career so it did not allow us to collect more informations after that, b) the study was not able to carry out causal analysis on patients health behavior determinated by explanatory model of health resources, and c) the study was not able to take into consideration of factors connected with social structural circumstances. Despite of restrictions described above, we are sure that this thesis would promote health providers' understanding toward patients' inclinations, through which they could provide efficient and accurate medical service.

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약제에 의한 가잠교미아의 할애효과에 대하여 (Selection of Chemicals for Separation of Copulated Moth of Silkworm, Bombyx mori L.)

  • 박광의;마영일;황석조
    • 한국잠사곤충학회지
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    • 제26권2호
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    • pp.11-15
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    • 1984
  • 잠종제조시 많은 잠종제조 노력을 성력화하기 위하여 누에 교미나방이의 할애제를 선발하고져 시중에서 쉽게 구할 수 있는 몇 가지 약제를 서로 잘 배합하여 이의 할애효과를 실험한 결과는 다음과 같다. 1. 약제 처리별 경시적 할애비율에 있어서 TCTFE 처리구는 10분만에 완전히 할애되었고 그 다음은 TCT FE+acetone (87.5 : 12.5 v/v) 배합구와 TCTFE+acetic acid (50 : 50v/v) 배합구가 약제 처리후 25분에 완전히 할애되었다. 그 외 acetic acid 원액처리는 1시간 40분 후에 완전히 할애되었다. 2. 약제 처리별 산란 조사에 있어서는 TCTPE+acetone (87.5 : 12.5 v/v) 구가 아구별 평균 산란수 및 아구별 평균 수정란수를 보아도 약제 처리중에서 가장 성적이 좋았고 무처리구인 대조구에 비해서는 유의성이 인정되지 않았다. 그러나 TCTFE와 acetic acid 단일처리구는 대조구에 비해 산란수 및 수정란수 모두 대조구보다 적었으며 불산란아도 acetic acid구는 39아로서 가장 많아 acetic acid 단일처리시는 약해로 인하여 산란태율이 저하되는 것으로 사료된다. 3. 약제 처리에 의한 다음 세대에 어떠한 영향을 주는가를 알고자 약제 처리를 한 후 산란한 다음 세대잠란을 사육한 결과 전처리구가 경과일수 21일 23시간으로 대조구와 같았으며 화용비율, 수견양, 단견중, 견층중 및 견층비율 등의 실용형질은 대조구와 같은 수준으로 유의성이 인정되지 않았다. 이상을 종합하여 보면 처리구중 TCTFE구는 누에 교미나방이의 할애제로서 효과는 인정되나 누에의 생이와 관련하여 볼 때 단용처리보다는 TCTFE와 acetone 등 적당한 다른 유기용제를 선발하여 이들을 적당량배합하므로서 할애효과를 더 높힐 수 있다고 생각된다25%, 45.5%, 8%, 2.7%, 5% 및 29.3%를 배출하고 있었다. 4. 배출된 충체는 모두 암놈이 었다. 충체의 길이는 일자별로 20일에서 40일째까지 일정한 양상으로 발육하고 있었고, 각 일자별, 증례별로 충체 길이는 정규분포 형식으로 분포하고 있었다. 이상의 소견에서 요충 암놈의 인체내 발육기간은 40일 이상이고 감염후 16일째까지의 어린 충체는"메벤다졸"이 나 "피란텔"에 대해서 정도의 차이는 있으나 치료에 저항한다고 결론을 내릴 수 있었다. 양 바이러스 감염잠에서는 2개로 분리되었다. 8. 체액단백질의 전기영동상은 FV 및 DNV감염잠 공히 건전잠의 것과 유사하나, 바이러스 접종 8일 후에는 양적인 감소를 나타내어 건전잠의 약 40%에 지나지 않았다. 9. FV 감염중장조직을 pyronin-methyl green 2종 염색을 하여 광학현미경으로 관찰한 결과, 바이러스 접종 8일 후의 중장원동세포내에서 A형 및 B형 봉입체가 형성되었음을 확인하였다. 10. FV감염 중장조직세포의 전자현미경 관찰에서는 바이러스 접종 5일 후에 배상세포의 'cytoplasmic wall'이 비대해지고 그 내부에 virus-specific vesicle이 형성되었으며, 바이러스 접종 8일 후에는 virus-specific vesicle, 바이러스 입자, linear structure, tubular structure 및 전자밀도가 높은 matrix 등의 바이러스 감염에 대한 특이적인 구조물이 배상세포의 세포질에서 관찰되었으며, microvilli내에서 바이러스 입자의 존재도 확정되었다. 특히 virus-specific vesicle 주위에서는 전자밀도가 높은 구형의 바이러스 입자 유사체가 관찰되었는데, 이것은 virus-specific vesicle 주위에서 바이러스 조립이 일어나는 것을 추정된다

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서울시 고등학생의 안전교육 실태 및 요구도 조사 (Needs Accessment of Safety Education of High School Students in Seoul)

  • 김민아;이명선
    • 보건교육건강증진학회지
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    • 제18권3호
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    • pp.133-162
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    • 2001
  • Unexpected accidents in school has been gradually increased every year, and student's mistaken was the first reason of the accident. To preventing the students from Unexpected accidents in school, safety education is more important than having strong facilities to have much more strong protecting forces for the accidents. Therefore, systematic education of safety is needed most of all, and especially, strengthening safety education in school is needed. Hereby, this study is aimed at investigating and analysing the actual condition and demand of safety education. It also conducted a survey with the target of 1,255 students in the second grade of high school in Seoul from April 20 to May 19, and the result of this study is as follows. 1. In the general features of the subject of the survey, boy students and girl students occupied 50.8% and 49.2% each, and boys' high school (34.3%), girls' high school(32.2%) and co-ed(33.5%) participated in balance. In the location, north from Han river occupied 54.6%, south were 45.2%. 2. According to the status of experiencing an accident, boys were more experienced then girls(p〈0.05). From the section, home accident(56.8%) occupied most followed by school accident, traffic accident, sports accident and poisoning. The accident happening most often in detailed category is sports accident such as basket ball, foot ball and dodge ball. The actual condition of the subject's using a school health facility shows that boys students use it more often than girl students(p〈0.01) 3. In attitude toward safety, the subject showed lower interest in safety issues than other social issues. But attitude in seriality of safety problems were high. Also, they responded ‘individual citizen’(63.1%) as the one who should make efforts for safety. Regarding knowledge of preventing safety accidents in attitude toward individual safety, 42.2% answered ‘they know a little’ and 32.6% of respondents say ‘they do not know’. To a question of the degree of the subject's following safety rules, 36.4% were answered ‘keeping’ and the group using a school health facility shows more ‘keeping’ the others(p〈0.05). 4. To a question of asking if they have experienced safety education, 51.2% answered ‘yes’. Teachers who mainly take care of safety education are answered as training teacher(48.7%). As for education time, training class(51.3%) is said to have safety education most followed by health-related event and PE(Physical Education). Frequency of education shows once or twice a session (62.8%) most often, but in case of co-ed school, 5-7times a session or more(20.1%) are being practiced. Looking at education time, 1-2 hour(s)(22.1%) or for a short time(22.1%) during class are being practiced. As an education method, instruction(43.8%) and video education(32.5%) are being practiced, and when it comes to education evaluation method, ‘not practiced’(70.0%) answered. To the question if they are satisfied with school safety education, they answered more ‘no(43.1%)’ than ‘yes(6.7%)’, and the reason is that safety education class is just for formality's sake, and the fact they already know is being repeated. The contents of safety education is composed of school safety, home safety, and first aid. 5. It is turned out that 56.5% of the total boy students and 61.1% of the total girl students recognize the necessity of safety education. To the question if safety education is needed in an elementary and middle education course, 46.4% of the subject answer answered' it's necessary'. The most reason for their answers are ‘safety education is directly related to life’. 6. Regarding the requested time of safety education is ‘one hour a week’ by 55.9%. For safety education, safety education teachers(38.7%) are answered to be the most proper. As a request for safety education, video education is answered to be the most appropriate(30.6%), followed by practical skills, lecture and discussion(p〈0.05). Demand of educational evaluation, practical skills, interview and observation are answered to be needed. To the question if they want to participate in the way of demanded safety education, 41.9% of respondents answer ‘have a mind to participate in’ (41.9%). To benefits followed by completing safety education, 72.0% of respondents answer ‘agree’, and 24.7% ‘do not agree’, which means lout 4 disagrees with completing safety education. 7. Looking at demand of safety education according to the features of the subject, ‘our position for the person who has handicapped’ was answer to the most.

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