일차보건사업(一次保健事業)을 위한 정보(情報)시스템 개발(開發)

문현상 ( Hyun Sang Moon ) 한국보건사회연구원 1981 保健社會硏究 Vol.1 No.1

I. Introduction Following the Alma-Ata declaration on Health for All by year 2000, many developing countries have formulated policies for action to launch Primary Health Care program. Primary health crae is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. It forms an integral part both of the country`s health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of con-tact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.<sup>1)</sup> Health is an essential element of socio-economic development policy in Korea. According to our constitution, it has stressed the importance of expanding the ac-cessibility of health care services. However, the organization of health care delivery is noticeably underdeveloped in Korea.<sup>2)</sup> The current health care system is far from being an integrated system in which needs and allocation of resources are closely coordinated. The bulk of health services are supplied through the mechanism of the free market. The expansion of the health care delivery capacity in the pst has relied almost entirely on increasing hospital beds in the private sector. In order to strengthen the public medical services, the Ministry Plans to renovate facilities and equipment in city and provincial hospitals and health centers and sub-centers which play a central role in providing primary care.<sup>3)</sup> The importance of health information system, in order to plan, implement, control and evaluate primary health program is nowadays accepted by all. Effort have been made in many countries to improve and adapt the existing health information to the needs. II. Community Health Information System Relevant community health information comes from two parts, population and health services. The element derived from these two parts lead to the knowledge of ex-isting situation, desired situation, needed interventions, performed activities. However, information system itself does not provide solutions for community health problem but it assist in their adequate selection of strategies. Community health information system is useful for 1) monitoring individual and family care, 2) identifying and understanding the health problems of community, 3) planning and operating the necessary services, and 4) evaluating services and impact. Development and implementation of primary health care activities must be preceded by a careful diagnosis of the problems and assessment of what is needed and what is fasible at the community level. Through the development of information system, it is necessary to know about the real and perceived health care needs. Health information system is needed for a clear formulation of development policies and strategies. To take into account the contribution of other sectors to attain the goals and to determine clear objectives within the context of primary health care policies, relevant information col-lection system should be developed. It is essential to improve managing and operating of primary health care activities through periodical observation on selected activities and comparision of expected and observed values. Therefore, in order to design the primary health care component of any health care delivery system, at least four groups of activities have to be carried out: 1) determination of areas of responsibility of each community health worker, 2) local programming of activities, 3) registration, processing and reporting of activities per-formed, and 4) supervision, monitoring and control. Since supervision, monitoring and control function is feasible through the existence of an information system, the meaning assigned to each one of them is following: supervision is an activity of inservice training aimed at maintaining or improving the pre-established standards on selected actions. It is a teaching activity with direct and personal relationship between trainer and trainee, in which with a higher degree of knowledge reorient the actions of each member of health worker. Monitoring is a process of periodical observation of selected activities, in which ex-pected and observed values are compared in order to assure a smooth evolution of the project. If discrepancies of practical value are detected between programmed and per-formed activities, then it is necessary to identify the responsible causes in order to better orient the managerial decision making process of the program. Control action is an activity performed by a decision-maker aimed at modifying the course of certain operations of the system or the magnitude and/or type of its inputs. Its objective is to assure that the observed values be equivalent to the programmed ones. III. Factors Included in Information System Development Appropriate organization for selecting, recording, reporting, processing, and using the information for the health and related services are the most important element in the design of primary health care information system. Mechanisms to coordinate the areas of planning, programming, management and other services should be established. Permanent enquiries by the community health workers and regular activities of health services, stimulation and motivation, contacts between health workers and health services at higher echelon are relevant factors for the improvement of the mechanisms of information system. Another aspect of information system is process of accessing needs and deciding about content of information system. To be an effective information system the follow-ing problems should be reflected into the information system. 1) Basis for decision about information content - objectives, targets, milestones, activities ... 2) Dialogue between users and producers in order to determine the appropriateness on the feasibility in the procedure of accomplishing the content of the information system. 3) Data collected should be relevant. 4) Information collected at the local level should reflect the important tasks and ac-tivities undertaken or that level. 5) Information on the activities of other organizations at community level. In primary health care, as it exists in many countries, it has been necessary to train lay persons to serve as providers of care. These persons are practically trained in disease recognition and care procedures. Nevertheless, they lack training in the systematic health and medical sciences and their range of competence in medical and health semantics is limited and the range of problems they treat is also limited. For the use of such persons, it may be desirable to develop and abridged or condensed version of a large classification, coding scheme for the development of a good functional health information system. In primary health care information system. there are six principal sources of inform-tion: 1) Records - resulting from the community health worker`s enquiries - resulting from the activities of health personnel and local health team and established according to their functions. 2) Home-based records (e.g. family sheets). 3) Reports on work formed. 4) Surveys (for community purposes). 5) Registers for primary health care activities. and 6) Ad-hoc reporting of emergency problems For the processing and use of information, particularly the following topics should be considered: 1) To promote effective use of information bv health workers and community at the local level. 2) Use of records as a basis for the delivery of health services. 3) Processing of information to be used by next higher echelon of monitoring and super-vision and information to be forwarded to higher echelons according to needs. 4) Analytical review - health status, health servides delivered, main health problems detected, types and quantities of resources supplied and needed, work performed, manpower requirements. 5) Presentation of information in forms which are usable by decision, and 6) Decisions for the solution of the problems that can be dealt with locally. Increasing effort has been devoted to management of record system. A first step in planning a record system is to document answers to the following questions. 1) Who are the users: For example, primary health worker (PHW). PHW supervisor. 2) What types of decisions need to be made and with what frequency? For example, the PHW shold decide each time a child is seen whether growth and development are satisfactory. PHW supervisor may need to know on monthly basis if children are be-ing followed as scheduled. 3) What data elements must be entered to produce the information? For example, weight, weight-age standard, visits programmed, visits accomplished. 4) What is the sources of the data and how are they to be collected? Finally, feed-back is one of the most important element in the development of infor-mation system. Feed-back should reflect real progress and impact on problems in achieving local primary health care goals and its should be provided with adequate con-tent in an appropriate form at proper time and level of decision.

人口推計

文顯相(Hyun Sang Moon) 인구문제연구소 1972 人口問題論集 Vol.- No.15

Urbanization and Changing Family Structure in Korea

Hyun-Sang Moon(文顯相),Yong-Chan Byun(卞鎔燦) 한국인구학회 1992 한국인구학 Vol.15 No.1

「봉가르츠」모형(模型)에 의한 우리나라 출산력(出産力) 매개변수(媒介變數)의 효과(效果) 추정(推定)

문현상 ( Hyun Sang Moon ) 한국보건사회연구원 1985 保健社會硏究 Vol.5 No.2

In Bongaarts model the four principal intermediate variables are considered inhibitors of fertility; delayed marriage, the use of contraception and induced abortion and postpartum infecun-dability. As a population moves through the transition from natural to controlled fertility, there is an increase in deliberate marital fertility control. This control is exerted primarily through a rise in contraceptive use, and practice of induced abortion. Accompanying the transition in the deliberate control of marital fertility are transitions in the other principal intermediate variables-marriage and postpartum infecundability. As a consequence of these trends in the intermediate variables, important changes take place in the levels of natural marital fertility, marital fertility and overall fertility. In this paper the fertility effects of the four most important intermediate variables are examined by using Fertility and Femily Planning Survey in Korea. The indexes Cm, Cc, Ca and Ci are calculated. It was concluded that variations in fertility between Korea and the population in phase IV, which have completed most or all of the fertility transition due to variations in marriage, induced abortion and postpartum infecundability. In Korea, index of marriage was high due to high proportion of women married. However, index of induced abortion and postpartum was low due to high prevalence rate of induced abortion and longer duration of postpartum infecundability.

Lung Care의 Nodule Enhance View를 이용한 폐결절 발견의 유용성

문현상(Hyun Sang Moon),차이열(Yi Yeol Cha),윤동삼(Dong Sam Youn),오정환(Jung Hwan Oh) 대한CT영상기술학회 2006 대한CT영상기술학회지 Vol.8 No.1

Purpose With the incidence of lung cancer increasing the usage of low-dose CT in early detection of the disease is also in the increase. Here we attempted to estimate has Nodule Enhance View could contribute in detection of pulmonary nodules in low-dose CT. Materials and Methods The object of this study were exammees taking low-dose CT in health check at our hospital from July 1st to july 31st in 2005. The examineeswere consisted of 47 male and 14 female. The total number was 60 and the average age was 47. We carried out only non-contrast scan and 64 MDCT(Somatom Sensation 64, Siemens) was used to get spiral scans under the condition of 30 effective mAs. After getting 1mm and 5mm thickness images at the same time, 5mm thickness images were transmitted to PACS and 1mm images were transmitted to mini server. In addition, 1mm thickness images were processed by Nodule Enhance View of Lung Care(Syngo Siemens). The final analysis of Lung Care was comparedwith interpretation of staffs in radiologist to measure the accuracy of Nodule Enhance View of Lung Care. Results After processing 1mm thickness images of 60 examinees by nodule enhance view, 14 examinees seemed to have nodule. This result was compared with the analysis of staffs in radiologist. Assuming that the interpretation of staff in radiologist had 100% accuracy, 23 examinees were in normal condition and the rest 37 got symptoms according to the medical opinion. Among them 12 examinees had nodule and the difference between Nodule Enhance View and staffs interpretation was only 2. Nodule detection points of the 2 examinees were different from that of normal exammees. Accuracy of Nodule Enhance View was 85.7% and the error limit of the results were 0.3%. Conclusion Sharing the result of Lung Care with staffs in radiologist, it is expected to have a great advantage to point out nodule and could be a useful method to check and determine lung cancer in advance. But detection of vessel as nodule could be a problem of Lung Care system to find a proper way to overcome.

우리나라 노인산업(老人産業)의 발전방향(發展方向)

문현상 ( Hyun-sang Moon ) 한국보건사회연구원 1996 保健社會硏究 Vol.16 No.1

21세기 老人問題는 지금과는 다른 보다 근본적인 變化가 예상된다. 急速한 人口의 高齡化가 진행될 것이며 女性就業과 家族構造 및 기능 변화로 가족에 의한 노인부양기능은 점점 弱化될 것이다. 그리고 미래의 老人層은 현재의 老人層과는 달리 교육수준, 경제력, 라이프 스타일에 많은 차이가 있을 것이다. 이러한 사회환경 변화는 우리나라 傳統의 家族에 의한 老人扶養을 대신할 새로운 노인복지산업을 요구하게 될 것이다. 그러나 아직 우리나라 노인복지 현실은 이러한 변화에 대응한 장기적 대책 마련이 미흡하다. 이 연구는 미래 老人福祉에 있어 하나의 방향으로 대두될 노인산업을 다루고 있다. 老人産業의 발전을 위한 기본방향으로는 첫째, 노인산업은 營利的 側面과 社會福祉的 側面을 고려하여 상호보완하는 조화가 필요하며 둘째, 우리 文化와 情緖에 맞는 老人産業으로 발전되어야 한다는 것이다. 셋째로는 민간기업에서 다양한 유료 노인복지서비스를 공급할 수 있도록 정부는 세제혜택과 규제완화 등 活性化 措置가 있어야 한다. 노인복지시설 투자를 활성화하기 위하여 관련 법규와 제도의 개선이 필요하며 이에는 세제 지원, 택지 공급, 금융 지원 등이 포함된다. 在家서비스에서는 營利性보다는 福祉次元의 公益性이 보다 중시되는 분야인 만큼 정부와 민간이 共同 參與하는 형태로 정부는 財政支援을, 運營은 民間이 맡아 하는 것이 바람직하다. 노인의료는 사회적으로 노인의료비 증가, 노인의료 시설 부족, 노인을 둔 가정에서의 의료비 부담 과중이 문제이며 이를 위하여 民間資本에 의한 老人療養施設의 확충, 醫療保險 酬價의 개선, 老人 介護保險의 도입 등이 요청된다. It is anticipated that Korea`s aging problem in the 21st century will greatly differ in nature in comparison with the current situation. Population aging will be rapid, and the enlargement of women`s participation in the labor force will create new problems for the support of the elderly within the family. However the elderly in the future will have more education and purchasing power due to the increase of incomes. Furthermore, they are going to enjoy a higher quality of life than before. This changing environment demands a new support system for elderly, namely, the development of the silver industry. The purpose of this study is to formulate development strategies for the silver industry in Korea. As a basic direction it emphasizes first the harmony of public welfare policies and the silver market, which will maximize profits and, secondly, it recommends maintaining the compatibility of traditional culture with the new industry. Lastly, a government incentive policy to induce private investment in the field of housing, nursing homes, and a health care and financial system for elderly is needed.

韓國의 死亡率 趨勢(國文抄)

權豪淵(Kwon, Ho-Youn),文顯相(Moon, Hyun-Sang) 인구문제연구소 1969 人口問題論集 Vol.- No.9