임산부의 분만방법 결정과정과 만족도

전혜리,박정한,박순우,허창규,황순구,Jun, Hae-Ri,Park, Jung-Han,Park, Soon-Woo,Huh, Chang-Kyu,Hwang, Soon-Gu 대한예방의학회 1998 예방의학회지 Vol.31 No.4

This study was conducted to assess the attitude of pregnant women toward delivery method, understanding of the reason for determining her own delivery method, participation in decision-making process and satisfaction with delivery method after labor. Study subjects were 693 pregnant women who had visited obstetric clinic for prenatal care in the last month of pregnancy in one general hospital and one obstetrics-gynecology specialty hospital in Taegu city from February 1 to March 31 in 1998. A questionnaire was administered before and after labor and a telephone interview was done one month after labor. Proportion of women who had health education and/or counselling about delivery method during prenatal care was 24.0% and this proportion was higher for women who had previous c-section(35.5%) than others. Women thought vaginal delivery is better than c-section for both maternal and baby's health regardless of previous delivery method. About 90% of primipara and multiparous women who had previous vaginal delivery wanted vaginal delivery for the index birth, while 85.6% of multiparous women who had previous c-section wanted repeat c-section. Reasons for choosing c-section in pregnant women who preferred vaginal delivery before labor were recommendation of doctors(81.9%), recommendation of husband (0.8%), agreement between doctor and pregnant woman(4.7%), and mother's demand (12.6%). Reasons for choosing vaginal delivery were mother's demand(30.6%) and no indication for c-section(67.2%). Reasons for choosing c-section in pregnant women who preferred c-section before labor were recommendation of doctors(76.2%), mother's demand(20.0%), recommendation of husband(1.3%), and agreement between doctor and pregnant woman(2.5%). Of the pregnant women who had c-section, by doctor's recommendation, the proportion of women who had heard detailed explanation about reason for c-section by doctor was 55.1%. Mother's statement about the reason for c-section was consistent with the medical record in 75.9% . However, over 5% points disparities were shown between mother's statement and medical record in cases of the repeat c-section and mother's demand. In primipara and multiparous women who had previous vaginal delivery, the delivery method for index birth had statistically significant association with the preference of delivery method before labor(p<0.05). All of the women who had previous c-section had delivered the index baby by c-section. Among mothers who had delivered the index baby vaginally, 84.9% of them were satisfied with their delivery method immediately after labor and 85.1% at 1 month after labor. However, mothers who had c-section stated that they are satisfied with c-section in 44.6% immediately after labor and 42.0% at 1 month after labor. Preferred delivery method for the next birth had statistically significant association with delivery method for the index birth both immediately after labor and in 1 month after labor. The proportion of mothers who prefer vaginal delivery for the next birth increased with the degree of satisfaction with the vaginal delivery for the index birth but the proportion of mothers who prefer c-section for the next birth was high and they did not change significantly with the degree of satisfaction with the c-section for the index birth. These results suggest that the current high technology-based, physician-centered prenatal and partritional cares need to be reoriented to the basic preventive and promotive technology-based, and mother-fetus-centered care. It is also suggested that active involvement of pregnant woman in decision-making process for the delivery method will increase the rate of vaginal birth after c-section and decrease c-section rate and improve the degree of maternal satisfaction after delivery. 본 연구는 임산부들의 분만전 분만방법에 대한 태도, 자신의 분만방법에 대한 이해 및 개입 정도, 분만후 분만방법에 대한 만족도 등을 평가하기 위하여 대구시내 1개 대학병원과 1개 산부인과 전문병원에서 산전진찰을 목적으로 내원한 임신 36주 이상의 임부 693명을 대상으로 분만전, 분만직후, 분만 1개월 후 3차례에 걸쳐 설문조사를 시행하였다. 임신기간 중 분만방법에 대한 교육이나 상담을 받은 임부는 24.0%였으며, 교육이나 상담을 받은 임부의 비율은 이전에 제왕절개분만을 한 임부에서 유의하게 높았다(p<0.05). 초산부, 자연분만을 했던 경산부, 제왕절개분만을 했던 경산부 모두 자연분만이 엄마나 아기의 건강에 더 좋다고 대답하였으나, 제왕절개분만을 했던 임부들 중 9.2%는 제왕절개분만이 아기의 건강에 더 좋다고 생각하였다. 분만전 선호하는 분만방법은 초산부와 자연분만을 했던 경산부는 90% 이상이 자연분만을 원했으나, 제왕절개분만을 했던 경산부는 85.6%가 제왕절개분만을 선호하였다. 분만전 자연분만을 선호하였던 임부들이 제왕절개 분만을 결정하게 된 이유는 의사의 권유가 81.9%, 남편의 권유가 0.8%, 충분히 상담후 결정한 경우가 4.7%, 산모가 원하여 12.6%였으며, 자연분만을 결정하게 된 이유는 대부분이 제왕절개분만을 할 특별한 사유가 없었거나(67.2%) 산모가 원한 것(30.6%)으로 나타났다. 제왕절개분만을 원했던 임부들의 제왕절개분만을 결정하게 된 이유는 의사의 권유가 76.2%, 산모가 원한 경우 20.0%, 남편의 권유가 1.3%, 의사와 충분히 상담후 결정한 경우는 2.5%였다. 의사의 권유로 제왕절개분만한 산모가 수술 이유에 대해 충분히 설명을 들은 경우는 55.1%였다. 제왕절개분만을 한 산모들의 수술 이유에 대한 의무기록과 산모 대답간의 일치율은 75.9%였으며, 반복 제왕절개분만일 경우와 산모가 원한 경우에 5% point 이상 응답을 차이가 났다. 초산부와 자연분만을 했던 경산부의 산전에 선호한 분만방법은 실제 분만방법과 유의한 관련성을 보였고(p<0.05), 제왕절개분만을 했던 경산부들은 선호도에 관계없이 100% 제왕절개분만을 하였다. 분만후 분만 방법별 자신의 분만방법에 만족하는 비율은 자연분만한 산모는 분만직후 84.9%, 분만 1개월 후 85.1%였으나 제왕절개분만을 한 산모는 분만직후 44.7%, 분만 1개월 후 42.0%로 나타냈다(p<0.05). 분만후 분만방법에 대한 선호도는 분만직후, 분만 1개월 후 모두 분만방법과 유의한 관계를 보였고, 각 시기별 분만방법에 대한 만족도와는 자연분만을 한 산모들은 자신의 분만방법에 만족할수록 자연분만을 선호하였지만, 제왕절개분만을 한 산모들은 만족 정도와 관계없이 제왕절개분만에 대한 선호도가 높았다. 이러한 결과는 그동안의 의사 중심의 전문적인 기술위주의 산전관리와 분만관리에서 기본적인 예방 및 건강증진 위주의 임부와 태아 중심 관리로의 방향 전환이 필요하며, 임부의 임신과 분만에 관한 적극적인 교육 및 상담이 필요하며, 분만방법 결정과정에 임부가 적극적으로 참여함으로써 제왕절개 분만율을 낮추고 제왕절개술후의 자연분만을 유도할 수 있을 뿐만 아니라 분만후 분만방법에 대한 만족도도 향상시킬 수 있음을 시사한다.

의과대학생의 의학교육 및 의료에 대한 의식 조사

박정한(Jung Han Park),김경환(Kyung Hwan Kim),전혜리(Hae Ri Jun),이주영(Ju Young Lee) 한국의학교육학회 1999 Korean journal of medical education Vol.11 No.2

1983년에 전국 규모의 의대생들에 대한 의식 및 가치관 조사를 실시한 이래 그동안 의대 수와 학생정원이 약 2배 증가하였고 사회․경제적 여건도 많이 변하였으므로 의대생들의 의식과 가치관이 어떻게 변하였는지 알아보기 위하여 이 조사를 다시 실시하였다. 1997년 11월 당시 전국의 40개 의대가운데 의학과 4학년까지 재학생이 있는 32개 대학의 의학과 재학생 전원을 모집단으로 하여 각 학년별 학생명부의 출석번호를 이용하여 10명에 1명씩 계통표본추출을 하고, 각 학년의 출석번호 끝번을 추가한 표본을 대상으로 설문조사를 하였다. 설문지는 1983년에 사용한 것을 근간으로 하여 최근 의료환경 변화에 대한 내용과 의대생들의 의학 및 직업관 형성에 관련된 문항을 추가하여 개발하였다. 조사는1997년 12월에서 1998년 1월 사이에 각 대학마다 사전에 위촉된 1명의 조사담당 교수가 조사대상자들에게 설문지를 배부하여 기입하게 하였다. 총 재학생 11,987명중에 설문 조사대상으로 뽑힌 1,386명가운데 1,233명 (89.0%)이 응답하였는데 응답자중 학년 미상 11명과 응답이 부실한 1명을 제외한 1,221명을 최종 분석대상으로 하였다. 몇 가지 특성을 중심으로 모집단과 조사표본을 비교해 본결과 표본의 대표성에는 별 문제가 없었다. 조사내용을 3부분으로 나누어 보고하였는데 1부에서는 조사방법과 조사대상자의 특성 및 응답자들의 의학교육에 대한 태도와 의학에 대한 본인의 적성에 관해 기술하였다. 응답자중 남자가 75.7 %를 차지하였다. 고졸 즉시 의대에 입학한 학생의 비율은 서울지역이 45.8 %, 서울 이외지역은 53.4 %이었다. 본인의 정치적 성향이 보수적이라는 사람이 서울지역은 43.9 %, 서울 이외 지역은 33.0 %로 지방 학생들이 진보적이라는 응답률이 더 높았다. 종교를 가진 사람이 57.2 %이었는데, 기독교가 31.0 %, 가톨릭 15.2 %, 불교 9.5 % 순이었다. 아버지의 교육수준이 대학 또는 그 이상인 사람이 59.8 %로 일반 국민의 교육수준보다 높았다. 아버지의 직업분포도 전문직 21.2%, 회사원 17.2%,공무원 13.1 %, 관리직 11.8 %, 의료인 8.7%로 화이트칼라가 지배적이었다. 의대진학 결정과정에 영향을 미친 사람이 있었다는 사람이 53.7 %이었는데, 이들중 부모가 62.1%를 차지하였다. 의대진학을 권유한 이유중 사회․경제적 측면이 33.5%로 가장 높은 비율을 차지하였다. 의학공부의 재미있는 측면은 생명현상을 배우는것 (47.2 %)과 인간을 배울 수 있다 (44.3%)는 것이었고, 재미없는 측면은 암기식 공부라는 것(39.7%)과 공부 분량이 너무 많다 (34.1%)는 것이었다. 만약 고교 3학년에 되돌아가 다시 대학을 선택할 경우 여전히 의대를 선택하겠다는 사람은 50.3 %이었으나, 지금 전과가 가능하다면 전과하겠다는 사람은 6.0 %에 불과하였다. 의학 공부에 자신의 적성이 맞다는 사람은 64.9%이었고, 이 비율은 학년이 올라갈수록 증가하였다. 장차 자기 아들을 의대에 보내겠다는 사람은 남학생중 36.6%, 여학생중 26.7%였고, 딸을 의대에 보내겠다는 사람은 각각 33.6%, 27.7%이었다. Since the first survey done in 1983, this is the second national sample survey of medical students about their perception and evaluation on medical study, career plan, and medical care system. One out of every 10 students plus one in each class were systematically sampled from each grade year of 32 medical schools in Korea that had students from freshman to senior in November 1997. A questionnaire was developed by adding items related with recent changes in medical care environment and with viewpoint on medicine and physician as an occupation to the questionnaire used in 1983. The questionnaire was administered at each school under the supervision of designated collaborator of the same school in December 1997 through January 1998. A total of 1,386 students were sampled from a total of 11,987 medical students and 1,233 students(89.0%) filled out the questionnaire. Twelve students were excluded from the analysis because of incomplete response and the final analysis was done for 1,221 students. A few demographic characteristics of the sample were compared with those of the study population to check the representativeness of the sample and found no skew. The contents of the study were divided into three parts and the first part describes the study methods, demographic and other characteristics of the sample, students viewpoint on medical education, and students aptitude for medicine Male students accounted for 75.7% of the sample. The proportion of students who entered medical school right after graduating from a high school was 45.8% in Seoul and 53.4% in other than Seoul area. The students who classified their own political inclination conservative were 43.9% in Seoul and 33.0% in other than Seoul and the percentage of students with progressive inclination was higher in out of Seoul than Seoul area. The proportion of students who have a religion was 57.2%; Christian 31.0%, Catholic 15.2%, and Buddhist 9.5%. The educational level of fathers of students was far higher than the level of general population, e.g. 59.8% had college or higher education. Occupation of fathers was mainly white-collar worker; professional worker 21.2%, company employee 17.2%, government official 13.1%, manager 11.8%, and medical professional 8.7%. In the decision-making process to enter the medical school, 53.7% of the students were influenced by someone else and 62.1% of them were parents. Socio-economic factor was the most common reason for recommending medical school and it accounted 33.5% of the reasons. Medical students enjoy learning life phenomenon(47.2%) and human being(44.3%) in medical study but most disturbing factors are memory work(39.7%) and too much to study(34.1%). If students were given another chance to choose a college as a senior student in high school, 50.3% of them said that they would choose medical school. Only 6% of students have intention to change their major subject of study if they are allowed to change now. The proportion of students who consider their scholastic aptitude is compatible with medical study was 64.9% and such proportion increased with grade. The percentage of students who are going to recommend medical school to their own son in the future was 36.6% for male and 26.7% for female students and to their own daughter 33.6% and 27.7%, respectively.

출생 및 영아사망 신고체계 및 전산정보체계 개발

박정한 ( Jung Han Park ),박순우 ( Soon Woo Park ),전혜리 ( Hae Ri Jun ),이영숙 ( Young Sook Lee ),이정애 ( Jung Ae Rhee ),조현 ( Hyun Cho ),정영해 ( Young Hae Chung ) 한국보건행정학회 1998 보건행정학회지 Vol.8 No.2

알루미늄 주방용기 제조공장에서 발생한 열사병 1례

전혜리,오동호,최정윤,박순우,조유리 大韓産業醫學會 1999 대한직업환경의학회지 Vol.11 No.2

An 18-year-old man suffered heat stroke after continuous working for 26 hours on his first day in an aluminium utensil plant in August 1998. His job was to put a pressed aluminium utensil on the conveyer before the process of spray painting. The ranges of temperature and relative humidity measured at the local weather-station during the patient's working period were 23.6-30.2℃, 49-87% respectively. On arrival the patient was comatose and suffered generalized seizure three times. His rectal temperature was 41.2℃, blood pressure was 90/60 mmHg, pulse was 148 beats/minute and respiratory rate was 28 times/minute. The serum level of AST was 421 IU/L, ALT was 205 IU/L, LDH was 1.160 IU/L, myoglobin was higher than 500 ng/mL, CK was higher than 2,000 IU/L. He recovered consciousness 7th day of admission and discharged after 2 months but cerebellar dysarthria was remained. The patient felt himself several prodromal symptoms of heat stroke and he showed awkward behavior considered to be drowsiness, but the patient and his co-workers neglected them. This case report shows that heat stroke can be occurred tin a condition that ambient temperature, humidity, and working load are not extreme. A thorough health education and management concerned with guidelines on salt and water intake, detection of early symptoms of heat-related illness, prompt body cooling and rapid transportation to a hospital is necessary.