保健診療員 訓練生의 諸特性 및 敎育實態 分析

황나미(Na-Mi, Hwang),김정태(Chung-Tai, Kim) 한국농촌의학 지역보건학회 1982 농촌의학·지역보건 Vol.7 No.1

농촌지역(農村地域) 분만(分娩)서어비스권(圈) 구명(究明)에 관한 연구(硏究) 충남(忠南) 서천군(舒川郡)을 중심으로

황나미 ( Na Mi Hwang ) 한국보건사회연구원 1985 保健社會硏究 Vol.5 No.1

Health Institutes for Delivery Service should be allocated so that the labor generates urgent and emergent, so as, the clients shoud have the easiest and quickest access to delivery service. This study was carried out to identify delivery service areas in Seo Cheon in order to help development of maternal and child health program in rural on the basis of delivery service demand. The data was collected by medical record from all Health Institutes, which served delivery care, and personal interview by means of home visiting in the cases of home delivery in Seo Cheon. The total number of birth for six months from 84, 1.1 -6.30 was 452, and 439 of them was the delivery women resided in survery area, Seo Cheon. In consideration of various factors influencing spatial accessibility, survery area was established in 14 districts as m=A, B, C,…………..N, Health Institutes as n = MCH center, Local clinic, Midwife`s clinic and CHP post. Heath Institutes preference of delivery women in each district are called "Relevance Index" and are mathematically defined as follows. The major findings are as follows: 1. The rate of delivery attendant by qualified personnels was 59.0 percentage 2. The number of district which identified maximum Relevance Index Value for MCH center was seven. 3. The number of district which identified "0" percentage, (Relevance Index Value) for CHP post was two of six districts.

가정간호의 발전방향

황나미,Hwang, Na-Mi 한국가톨릭의료협회 2001 한국가톨릭병원협회지 Vol.31 No.-

보건의료분야의 남북 교류 및 협력 실태와 향후 정책방향

황나미(Na Mi Hwang) 한국사회정책학회 2005 한국사회정책 Vol.12 No.1

North Korea has experienced a rapid decline in health care standards due to an acute shortage in health resources. Since the mid l990s, malnutrition, particularly among infants and young children, and tuberculosis and malaria have been reported as major health problems in North Korea. The objectives of this study are to identify laws and regulations between South and North Koreas and analyze the status of humanitarian assistance and find ways for developing cooperation between South and North Koreas in the health sector. The data used in this study are humanitarian assistance of government and non-governmental organizations for North Korea from 1997 to July 2005 and law and regulations related to inter-korean exchanges and cooperations. `The law on Inter-Korean Exchanges and Cooperations` of the South Korea was enacted to legally support humanitarian assistance for North Korea in 1990. Nevertheless, it was shown that due to a lack of coordination between NGOs, there arose several problems such as duplicated support to the North Korean health care sector. The findings suggest that South Korea`s health infrastructure should be focused on promoting participation of health experts, establishment of roles and responsibilities, and networking and inter-agency collaboration, and that the government will have to establish guidelines and strengthen its support for relevant agencies as well as for health and medical experts, with a view to developing effective communication channels between the two Koreas. Effective efforts should be made to meet these problems. Such efforts might include promotion of cooperation which both Koreas can benefit from, as well as provision of supports from a humanitarian standpoint.

D.D.S.T.에 의한 우리나라 농촌(農村) 영유아(?幼兒) 발육평가(發育平價)

황나미 ( Na-mi Hwang ) 한국보건사회연구원 1987 保健社會硏究 Vol.7 No.2

Theoretical Background and Purpose of Study In 1967 Frankenburg and Dodds introduced a new developmental screening test for infants and preschoolers between the ages of 2 weeks and 6.4 years as a clinical simple tool. The major purpose of this new screening instruments was to detect the development in four functional sectors of development; gross motor, fine motor, language and personal-social. A delay in any one of the four subtest sectors was indicated when the child was not to pass an item which more than 90 percent of children his chronological age were able to do. This study was conducted to obtain the data in rural children of Korea and compare this with the developmental norms of DDST and so if the DDST was available in Korea. Subjects consisted of 609 children who were bom on from July 1,1984 to December 31, 1985 ranging in age from 6 months to 24 months, residing in the townships. Each subject was assessed on the DDST by a trained examiner. Results The performance of 609 children on the DDST was as follows. 1) normal performance (no developmental delay): No. of 435 children 2) questionable (meaning that he had a delay in one subtest item or failed to pass at least one item in each sector) : No. of 124 children 3) serious delay (two or more delays on items in any one sector) : No. of 50 children 2. The chi-square analysis of the distribution of the sample between the characteristics of pregnancy and DDSP`s result is not significant. 3. But for father`s educational level, the chi-square value is 15, 65, which is significant at less than 0.05. 4. Serious delayed and questionable children on the DDSTs result must be made pediatric and neurologic follow-up studies, to determine exactly how many false positives and false negatives might actually exist over an extended period of time.

악성신생물(惡性新生物)(암(癌))의 리환(罹患) 및 사망(死亡)에 관한 고찰(考察)

황나미 ( Na Mi Hwang ),공세권 ( Sae Kwon Kong ) 한국보건사회연구원 1983 保健社會硏究 Vol.3 No.1

The social modernization and health development have influenced the mortality decline and change of mortality pattern. In developed countries the two main causes of death are the diseases of circulatory system and neoplasms which occupied two-third of ali deaths. In Korea, recent studies on mortality and cause of death shown more than 50 percent were due to aforementioned two causes of death. Therefore, further decline of mortality in the future can not be expected without solution of these two major causes of deaths. Throughout the world, the malignant neoplasms has been known as one of the incurable diseases and without a discovery of a new treatment, it will be difficult to lower mortality of the disease. The purpose of this study is to review the increase of death rate due to the neoplasms, epidemiological pattern of the causes unknown and incurable diseases. Medical treatment records of medically insured group and death registration records by physicians have been utilized for this study. Major findings are as follows. 1. Among the medically insured group, about two-third of the patients were treated for the diseases of the respiratory and digestive system and 13 percent of all death is due to the above two diseases. Among treated patients, only 0.6 percent was neoplasms, however, the dead of the disease occupied 14 percent of all deaths. It is obvious that the respiratory d and digestive system diseases are not fatal while neoplasm is fatal in many cases. 2. Among the neoplastic patients, 19.8 percent suffered from malignant neoplasm of digestive organs and peritoneum and 43.8 percent from benign neoplasms. In the cause of death, however, 63.2 percent from malignant and 0.2 percent benign. 3. In general, many of the patient with middle aged and over were treated for malignant neoplasms and died of it. Particulary, the largest number of patient occured from 55-64 years aged group and deaths from 45-64 years aged group. 4. In the basic classification of specific diseases, the majority of the patients were stomach, cancer and the next was lung cancer, the same trends has appeared in the causes of death. The men suffered from the cancer more than the women: Liver cancer was three times higher in men than women and men died of the cancer two times more than women. 5. Among maliganant neoplasms majority of the patients suffered from stomach, respiratory and lung cancer. Middle aged men were treated for and died of the neoplasm twice or three times higher than women.

가임기 여성의 출산에 영향을 미치는 생식건강 요인 연구

황나미 ( Na-mi Hwang ) 한국보건사회연구원 2007 保健社會硏究 Vol.27 No.2

본 연구는 우리사회의 출산진행 실태와 출산에 영향을 미치는 생식건강 요인을 분석하여, 출산수준을 제고할 수 있는 방안을 모색하는 데 그 목적이 있다. 「2005년 전국 결혼 및 출산 동향조사」자료를 활용하여 출산을 종결한 20~44세 유배우 가임여성의 최종 출생아수에 영향을 미치는 요인을 분석한 결과, 첫째아 출산전에 자연유산이나 인공임신중절을 경험한 여성은 최종출생아수가 통계적으로 유의하게 적은 것으로 나타나 원치않는 임신에 대한 사전 예방의 중요성과 인공임신중절의 위험성에 대한 교육의 강화가 요구된다. 가임기에 자녀사망을 경험한 여성은 최종출생 아수에 통계적으로 음의 관계를 나타내어 저출산 요인이 되고 있는 바, 연간 3,000~4,000여명에 이르는 14세 이하의 아동사망 규모를 주목할 때, 이들 모성이 신체적·정서적으로 안정된 상태에서 출산을 재시도 할 수 있도록 사회적 지지체계와 임신 및 출산 지원체계 구축이 요구된다. 35세 미만의 젊은 연령계층에서는 35세 이상의 연령계층과 동일하게 남아출산을 위해 출산을 지속함으로써 결국 최종출생아수가 많아지는 현상이 나타나 남아 선호현상이 여전히 지속되고 있었다. 한편, 불임진단 부부의 36.9%는 치료를 중단하거나 치료받지 못한 것으로 나타났다. 치료비 부담, 치료 과정에서의 신체적·정신적 고통, 고령 등이 주된 사유이었다. 이상과 같은 생식건강 문제를 최소화하고 차세대 인구의 질을 향상시키기 위해서는 청소년을 포함한 가임기 남녀가 신체적·정신적·사회적으로 건강한 성을 유지할 수 있도록 학교 및 산업장 등과 연계한 지역거점`생식건강센터`의 개설 및 운영이 필요하다. 또한, 2005년`근로기준법`에 유산·사산 유급휴가에 대한 제도적 장치가 마련된 바 있으나 유산 및 사산 발생건에 비해 활용이 저조한 것으로 나타나 임의 규정으로 인한 사용상의 어려움을 해소할 수 있도록 의무화할 수 있는 조항으로의 개선이 요구된다. Many factors contributes to the dramatic decline in fertility in Korea. The objective of this study is to explore the relationship between fertility and such determinant factors of reproductive health as induced abortion, spontaneous abortion, stillbirth, and infertility. Instead of indicator representing fertility level the number of living children of the married women who decided to terminate pregnancy served as dependent variable. The source of data was the National Survey data of Marriage and Fertility Transition conducted by Korea Institute for Health and Social Affairs in 2005. To analysis the effect of reproductive health indicators on the number of living children per woman, this study employed multiple regression analysis as a statistical technique. The result of analysis indicates that experiences of induced abortion or spontaneous abortion before first delivery have a negative relation with the number of living children. The experience of children`s death at the less than 35 years old women also has a strong negative relation with the number of living children and these women did not try to having a baby in the childbearing ages. While, having a son of women in age group 2034 has a strong positive relation with the number of living children. Gender is a major determinant of fertility decision making. This result shows most young married women have still son preference in society. One the other hand, infertility interferes with conception and delivery. This study shows that 7.5% of married couples experienced primary or secondary infertility. 36.9% of the infertile couples turned out not to receive appropriate modern medical treatment because of lack of medical fee or highly physical and emotional burden caused by treatment process. Based on this findings it is recommended that `Reproductive Health Counselling Center` is operated to improve of reproductive health for young men as well as women. These results could serve as information to develop the education and counselling programs of reproductive health for adolescent and the strategies for increasing fertility for married women.

종합병원의 제왕절개분만 관련요인 분석

황나미 ( Na-mi Hwang ) 한국보건사회연구원 1994 保健社會硏究 Vol.14 No.1

산모나 태아에게 심각한 위험이 미칠때 시행되는 제왕절개분만은 임산부사망률과 주산기사망률 감소에 기여한 것은 사실이나 최근 계속적인 증가를 보이고 있는 경향에 대해서는 양질의료의 추구와 국민의료비 억제측면에서 간과할 수 없는 문제이다. 이에 적정수준의 분만서비스를 제공할 수 있는 공급기반을 모색하고, 더 나아가서는 의료서비스 적정화를 위한 전략개발의 기반을 구축하기 위하여 적응증에 관한 임상적 고찰과 더불어 전국 종합병원을 대상으로 제 특성별 제왕절개분만 관련요인을 분석하였다. 연구결과, 평균 제왕절개분만율은 32.8%이며, 제왕절개분만율에 영향을 미치는 종합병원 특성을 소재지역, 분만건수, 설립주체로 나타나, 종합병원이 적정한 분만서비스를 제공하도록 하기 위해서는 의료인에게 자발적으로 질식분만을 권장하도록 유도하는 방안과 현행 의료보험 분만수가의 수정 및 보완이 그 대응방안으로 제시되었다. One of the most important issues facing health services is the rapidly increasing rate of cesarean section delivery. The Korean cesarean section rate has increased from 9.6 % in 1986 to approximately 28% in 1993 according to healthinsurance claim bills which have been submitted to National Federation of Medical Insurance. The charges for cesarean section are as much as four times those for vaginal births. The purpose of this study was to estimate the cesarean section rate by characteristics of General Hospital and analyze influencing factors at General Hospital on cesarean section rate for the adequate delivery services. The data was obtained from 1992 birth statistics of each General Hospital. Study population included all General Hospitals in Korea with a delivery service, 217 General Hospitals. The results are as follws : - Out of all deliveries of 275, 076, hospitalspecific cesarean section rates varied 0.01 % to 91.7 % and the mean of cesarean section rate of General Hospital was 32.8 %. - Several characteristics of General Hospital are stongly associated with cesarean section rate, such as location that is geographical region, ownership and deliveries per year. Cesarean section rate was negatively associated with deliveries per year and lower deliveries per year appear to have a higher cesarean section rate. General Hospitals established by private foundations or proprietary appear to have a higher cesarean section rate than public or teaching hospitals. It is concluded that the increase of cesarean section rate has been influenced by the health insurance system. It implies that high cesarean section rate is related to the financial incentives of cesarean section in comparison with vaginal delivery. I suggest a combined strategy may be necessary to lower the unjustifiably high cesarean section rate. One, doctors should obtain the second opinion and the other is minimizing financial incentives of cesarean section.

여성건강 관점에서의 공공 모자보건사업 현황과 발전방향

황나미(Na Mi Hwang) 대한여성건강학회 2007 여성건강 Vol.8 No.2

The social status of Korean women is still low despite the socio-economic development of Korea. The purpose of this paper is to find out maternal and child health(MCH) programs in public sectors, particularly as they are relate to women and suggest the future directions and development of strategies for women's health promotion in Korea. It has been a tremendous effort to improve of maternal health at both the government and private levels. It can be found maternal and child health policies and programmes related to women's health in Korea over the past four decades have focused mainly on population control or family planning and pregnant and postpartum mother's health to improve infant's health status not considered the broader picture of women's health. Few health policy decisions focusing on women. We should understand that the health of women is influenced not only by biomedical factors but also by socio-cultural factors. Despite of improving women's health thanks to socioeconomic development, no specific objectives on women's health have been set. Major strategies to improve of women's physical, psycho social health status are as follows. The Ten-Year(to the year 2020) Women's Health Development Plan need to be established by the governmental level, just not only involving the Ministry of Health and Social Affairs but also every Ministry related to women's welfare beyond MCH perspectives. Effective national policy formulation for women's health promotion requires the Law. The government should begin identifying the existing Laws related women's health and health statistics classified by gender, thereafter revise the relevant laws in order to develop better health promotion programs and intersectoral collaboration among themselves.

지역사회에서의 가정간호 접근성 제고 방안 - '서울시간호사회' 가정간호사업 분석을 토대로 -

황나미,박성애,김윤옥,문영임,박정숙,유호신,이계숙,Hwang, Na-Mi,Park, Sung-Ae,Kim, Yun-Ok,Moon, Young-Im,Park, Jeong-Sook,Ryu, Ho-Sihn,Rhee, Kae-Sook 한국가정간호학회 2003 가정간호학회지 Vol.10 No.1

Recently, there has been an increasing need for long-term care and comprehensive health care services in community settings. The Ministry of Health and Welfare introduced the Hospital-Based Home Nursing Care Program in 2000. Before this initiative, there was a Home Nursing Demonstration Center, affiliated with the Seoul Nurse Association, had offered home nursing services with the financial support from the local government. since 1993, the Center's nursing staff has been engaged in a general hospital in an effort to provide home nursing care services within Korea's health care system. The purpose of this study was to analyze and identify characteristics of community-based home nursing care supplied by a community-based home nursing team engaged in a general hospital. Also. visit nursing care services provided by public health centers were evaluated in terms of accessibility and supply versus demand, to enhance the accessibility of low-income patients living in Seoul to home nursing care services. Data were collected from home nursing insurance reimbursement claims submitted by the community-based home nursing care team from March 1 to October 30 in 2001 and a questionnaire survey on home-visit nursing services of 25 public health centers in Seoul. The subjects consisted of 197 patients and 12 public health centers. The result were as follows. First, medical institution's community-based home nursing care program was better in technical quality than health-center-based home-visit nursing care. In addition. the pattern of the subject patients was similar to that of hospital-based home nursing care program. Second, there was a high demand for community-based home nursing care while only a small number of home-visiting nurses served at public health centers in Seoul. As a result, many patients could not receive adequate care. Finally, we suggest that community-based home nursing care program should be introduced in the national health system to meet the at-home care needs of severely ill low-income patients. Furthermore, to better utilize home nursing and visit-nursing care resources and offer continued care for patients in community settings, an efficient referral network should be built among related institutions. This would require improvement of reimbursement system and amendment of the law related to health insurance system and community-based home nursing care services.