우리나라 가정방문간호의 현황과 향후 과제

박은옥,Park, Eunok 한국농촌의학지역보건학회 2019 농촌의학·지역보건 Vol.44 No.1

본 연구에서는 우리나라 보건소 방문건강관리사업과 노인장기요양보험의 방문간호, 의료기관의 가정간호사업 등 가정방문간호사업 현황을 살펴보고, 향후 발전과정을 모색하고자 수행되었다. 본 연구를 위하여 각 가정방문간호사업의 관련 법령, 통계자료, 지침과 안내서, 연구논문과 학술대회 자료집 등을 검색하여 관련 문헌을 고찰하였다. 연구결과 보건소 방문건강관리사업은 지역보건법에 근거하여 주로 취약계층을 대상으로 간호사에게 의해 비용부담 없이 제공되고 있으며, 2017년 12월을 기준으로 1,261,208명 등록 관리되는 것으로 나타났다. 보건소 방문건강관리사업 등록 대상자는 흡연율, 걷기 실천율, 혈압조절율, 혈당조절률 등이 향상되는 것으로 나타나, 건강행위와 질병관리 측면에서 긍정적인 효과가 있고, 비용-편익이 있다고 보고되었다. 노인장기요양보험에서의 방문간호는 노인장기요양보험법에 근거하여 간호사 또는 간호조무사에 의해 재가장기요양기관에서 방문간호를 제공하고 있으며, 시간당 정해진 수가에 따라 비용을 받고 있는데, 2017년에 전체 요양급여비의 0.2%만이 방문간호로 이용하는 것으로 나타났다. 재가장기요양보험 방문간호 이용자는 비이용자에 비해 의료비도 더 적게 쓰고, 입원일도 적다고 보고되었다. 의료기관 가정간호는 의료법에 근거하여 2명 이상의 가정간호사(가정전문간호사)를 고용한 의료기관에서 의사의 처방 하에 가정간호서비스를 제공하는데, 2017년 460명의 가정간호사가 가정간호서비스를 제공하고, 전체 의료비의 0.038%가 가정간호비용으로 지불된 것으로 나타났다. 우리나라 가정방문간호 유형은 관련법이나 인력, 사업 대상이 다르지만, 서비스 이용자의 건강관리에 효과가 있고, 비용-편익이 상당히 높은 것으로 나타났다. 우리나라 가정방문간호를 발전과 활성화를 위해 세 개 유형의 가정방문간호 서비스가 통합적으로 제공될 수 있는 방안을 모색하고, 근로 조건의 개선, 가정방문간호서비스 제공인력기준이나 방문간호수가 체계의 개선과 같은 법령의 개정 등을 고려할 필요가 있다고 본다. Objectives: We searched and reviewed the literature including the laws or acts, statistics, guidelines, papers and conference proceedings related to home visit nursing care in South Korea. Method: We searched and reviewed the literature including the laws or acts, statistics, guidelines, papers and conference proceedings related to home visit nursing care in Korea. Results: There are three types of home care nursing in Korea. Public health center provides home visit nursing to vulnerable population by registered nurses for free, based on community health act in public health center. As of 2017, 1,261,208 people were enrolled in the visiting health program of public health center. Health behavior and disease management has been improved and showed having cost-benefit effect among the enrolled people in visiting health program. Visiting nursing care in long-term care services is provided by registered nurses or nurse aid, based on long-term care act. The cost is paid as the unit price according to service time. 1,095,764 older people used long-term care services in 2017, only 0.2% of total cost used for home visiting nursing. Even though the number of user of home visiting nursing, it was reported that users spent less medical cost and hospitalized shorter. Hospital-based home care nursing is provided to patients and their families under the prescription of a doctor by family nurse specialists who are employed by medical institute based on medical law. Four hundred sixty family nurse specialists worked for hospital-based home care nursing and hospital-based home care services accounted for 0.038% of total medical expenses in 2017. Conclusion: Even though home visit nursing care services are different in aspect of legal basis, personnel, running institutes, and cost basis, home visit nursing care showed cost-benefit effect and good health outcomes. In order to advance home visit nursing care, the integrated home visiting care, improvement of working condition, and revision of legal basis should be considered.

한국(韓國) 농어촌(農漁村) 개발(開發)에 대(對) 한 소고(小考) -특(特)히 주택개량(住宅改良)을 중심(中心)으로-

최익한,Choe, Ik-Han 한국농촌의학지역보건학회 1977 농촌의학·지역보건 Vol.15 No.1

일부 농촌지역 고혈압자의 사망에 미치는 요인 -12년 추적 연구-

김기순,박종,Kim, Ki-Soon,Park, Jong 한국농촌의학지역보건학회 1993 농촌의학·지역보건 Vol.18 No.1

In order to find the factors associated with the death of hypertensives, 12 year follow-up study for 267 hypertensives whose average blood pressure were 140/90 mmHg or above during their first health screening in 1979-1980 at YongJin Township, Wanju Country, North Cholla Province by the Community Health Team of Chonju Presbyterian Medical Center. The study results are as follows : 1. Initial general characteristics of hypertensives were studied. The age distribution of studied hypertensives showed 27.3% in 40-49 years, 25.8% in 50-59 years, 29.6% in 60-69 years and 17.2% In 70 + years old group. Marital status showed that 82.8% of hypertensives had their wife or husband. 74. 5% were employed on agriculture. 56.5% of hypertensives were illiterate. 2. Among the hypertensives, 91.6% of male and 22.8% of female reported that they were smokers. 82.6% of hypertensives had body mass index lower than 25 Kg/$m^2$. 46.8% of average systolic blood pressure were 160mmHg or above and 54.3% of average diastolic blood pressure were 95mmHg or above. 3. Twenty percent of hypertensives reported that they were treating hypertension at the beginning of follow up, while 68.5% reported that they were not treated. 28.1% reported that they were treating hypertension within 6 months before last follow-up. but 69.3% reported that they were not treated for hypertension within Ii months before last follow up. So 50.6% were classified as never treated group and 41.2% as treated group. 4. Average blood pressure for initial 3 years were calculated. The change of average systolic blood pressure was observed as $161.3{\pm}19.4mmHg$ at the first year, $145.6{\pm}28.0mmHg$ at the second year and $141.4{\pm}37.2mmHg$ at the third year. Average diastolic blood pressure were changed from $96.2{\pm}14.4mmHg$ at the first year to $90.6{\pm}18.6mmHg$ at the second year and $86.4{\pm}22.9mmHg$ at the third year. 5. By the follow-up of hypertensives, 54 hypertensives (46.2%) among 117 male hypertensives and 50 hypertensives (33.3%) among 150 female hypertensives died for 12 years. 42.6% of male death and 52.0% of female death were caused by cerebrovascular diseases. 6. Through univariate statistical test about the association between general characteristics or cardiovascular risk factors of hypertensives and mortality for 12 years, age variable among male and among female age, marital status, occupation. educational level. systolic blood pressure and treatment status were shown as significant variable to influence upon the mortality. 7. By multiple logistic regression analysis, among male age and systolic blood pressure were selected as significant variable to be associated with the total mortality for 12 years. Among female age, systolic blood pressure and treatment status were selected as statistically significant variable to be associated with the total mortality for 12 years.

국민학교(國民學校) 및 집단주거시설(集團住居施設) 아동(兒童)의 요충감염현황(蟯蟲感染現況)

김종성,이준상,주경환,임한종,Kim, Jong-Seong,Lee, Joon-Sang,Joo, Kyoung-Hwan,Rim, Han-Jong 한국농촌의학지역보건학회 1988 농촌의학·지역보건 Vol.13 No.1

본 조사에서는 서로 다른 주거환경에서 생활하는 집단군에 대해 셀로판테이프항문주위도말법으로 요충감염현황에 대하여 조사한 결과 다음과 같은 결론을 얻었다. 1) 국민학교 및 집단시설거주아동 2,966명을 조사하여 484명이 요충란 양성자로 나타나 16.3%의 양성률을 보였다. 2) 지역별 조사에서 대도시지역의 경우 총 1,144명을 조사하여 79명이 양성자로 나타나 6.9%의 양성률을 보였고, 농촌지역에서는 총 1,268명을 조사하여 193명이 양성자로 나타나 15.2%의 양성률을 보여 대도시지역보다 농촌지역에서 터 높은 감염양상을 보였다. 3) 남, 여별 조사에서는 남자, 1,528명을 조사하여 240명이 양성자로 나타나 15.7%의 양성률을 보였으며, 여자의 경우 1,438명을 조사하여 244명이 양성자로 나타나 16.9%의 양성률을 보여 남, 여별 감염률은 큰 차이를 타나내지 않았다. 4) 국민학교 아동의 학년별 조사성적을 보면 대도시지역 국민학교 아동의 경우 저학년에서 고학년으로 올라갈수록 감염률이 저하되었으나 농촌지역 국민학교 아동의 경우 감염률에 있어서 학년별로 현저한 차이를 나타내지 않았다. 5) 주거환경별 조사에서는 국민학교 아동 2,412명을 조사하여 272명이 양성자로 나타나 11.3%의 양성률을 보였고, 고아원(영아원, 육아원) 아동 416명을 조사하여 136명을 조사하여 76명이 양성자로 나타나 55.1%의 높은 양성률을 보여 국민학교보다 집단거주시설 아동에서 더 높은 감염양상을 보였다. An epidemiological study was undertaken to evaluate the prevalence of E. vermicularis infestation among children in primary schools and orphanages. A total of 2,966 children in primary schools and orphanages was examined for F. vermicularis by means of cellotape anal swab technique. The purpose of the present studies is to determine the prevalence of enterobiasis among children and to make a comparison with the rate of infestation by survey areas. The result could be summarized as follows : 1) The egg positive rate of cellotape anal swab method was 16.3% out of 2,966 children. 2) The egg positive rate of urban area was 6.9% out of 1,144 children and the egg positive rate of rural area was significantly higher than that of urban area. 3) The egg positive rate of boys and girls were 15.7% out of 1,528 children and 16.9% out of 1,438 children. 4) The egg positive rate of primary schools, orphanages and mental retardation child group was 11.3% (out of 2,412), 32.7% (out of 416) and 55.1% (out of 138) respectively. There was noted a tendency of decrease in prevalence by increase of the age.

농촌 지역 남성들의 혈청 gamma-glutamyl transferase 활성도와 관련된 행태적 요인에 관한 연구

조병만,Cho, Byung-Mann 한국농촌의학지역보건학회 1998 농촌의학·지역보건 Vol.23 No.2

혈청 GGT는 임상적으로 널리 이용되고 있음에도 불구하고 정상 인구 집단에서의 행태적 관련 인자에 대해서는 잘 알려져 있지 않다. 본 연구에서는 경상남도 내의 농촌 지역인 울산시 울주군 두동면에서 1997년에 실시한 주민 건강 검진에 참여하였던 40세 이상의 남성 248명을 대상으로 혈청 GGT 활성도와 관련된 행태적 요인을 조사하였으며 다중 회귀 분석과 공분산 분석을 이용하여 혼란 변수의 영향을 통제하였다. 신체 비만지수(kg/$m^2$)와 알코올 섭취량(ml/day)이 증가함에 따른 혈청 GGT 활성도의 차이는 연령과 요인 상호간의 영향을 보정하였을 때 통계학적으로 유의하였다(p=0.051 및 p<0.001). 비음주자에서 신체 비만지수가 25 이상인 경우는 25 미만인 경우에 비해 혈청 GGT의 활성도가 통계학적요로 유의하게 상승하였으나(p=0.007), 음주자에서는 유의한 차이를 볼 수 없었다(p=0.892). 알코올 섭취는 신체 비만지수가 25미만인 경우와 25 이상인 경우 모두에서 혈청 GGT의 활성도 상승과 유의한 연관성을 보였다(p<0.001 및 p=0.002). 이상과 같은 소견은 농촌 지역 남성들에서 혈청 GGT의 활성도와 가장 밀접하게 관련된 요인이 음주, 그리고 비음주자에서의 비만임을 암시한다. Although serum gamma-glutamyl transferase(GGT) has been widely used as a marker of alcoholic hepatic dysfunction, little is known as to behavioral correlates in the normal population. To examine the association between serum GGT activity and some behavioral factors in male rural population, data un health examination in a rural population (248 males aged 40 years and older) was analyzed Multiple linear regression and analysis of convariance were used to control the effect of confounding factors. Adjusted average differences in the level of serum GGT according to body mass index(BMI: $kg/m^2$) and alcohol intake(ml/day) were statistically significant(p=0.051 0<0.001 respectively). Serum GGT activity for BMII$\geq$25 was significantly higher than for BMI<25 in non-drinkers(p=0.007), but not significantly different in drinkers(p=0.892). Alcohol intake was significantly associated with elevated serum GGT activity for both BMI$\geq$25 and BMI<25(p<0.001, p=0.002 respectively). These findings suggest that alcohol drinking, obesity in non-drinkers are important factors associated with serum GGT in male rural population.

농촌진료서 D의원의 운영성과 (1979~1981)

최경훈,안희도,김세환,김명호,Choe, Gyeong-Hun,An, Hui-Do,Kim, Se-Hwan,Kim, Myeong-Ho 한국농촌의학지역보건학회 1984 농촌의학·지역보건 Vol.9 No.1

수정-IPA를 통한 푸드카빙교육 효용성의 품질속성 분류에 관한 연구

이성주(Lee, Sung-Ju),임현철(Lim, Hyun-Cheo),김상미(Kim, Sang-Mi) 한국외식경영학회 2022 외식경영연구 Vol.25 No.2

본 연구는 푸드카빙 교육을 받은 수강생들이 지각하는 푸드카빙 효용성은 어떠한지 살펴보고, 어떠한 효용성들이 있고, 효용성의 품질 속성은 어떠한지 살펴보고자 하였다. 이러한 연구목적을 규명하기 위하여 푸드카빙 교육을 받은 경험이 있는 수강생을 모집단으로 설정하였고, 설문조사는 2020년 7월 20일부터 8월 20일까지 한 달간 진행되었다. 설문지는 총 500부를 배부하였고, 435부가 회수되었고, 불성실한 설문지 38부를 제외하고 397부가 최종 분석에 사용되었다. 분석결과, 중요 실행 요소로는 푸드카빙 교육은 지루하지 않고, 남녀노소 할 수 있고, 잡생각이 사라지고, 자존감이 높아지고, 자신의 가치가 높아지고, 마음이 편해지고, 우울함이 사라지는 등의 수업 자체에서 오는 만족감의 속성들이 포함되었다. 매력적 요소에는 푸드카빙 기술이 수익으로 연결되고, 강좌를 개설하고, 적은 금액으로 공방을 오픈하는 등의 수익 측면과 관련된 항목들이 포함되었다. 아울러, 기본적 요소에는 집중할 수 있고, 기분이 좋아지고, 자격증을 취득하고, 전문가가 될 수 있다는 측면의 항목들이 포함되었다. 이는 대체로 푸드카빙을 처음 배우는 수강생들이 기본적으로 가지는 목적들이 포함되었다. This study aims to examine the food carving utility perceived by students who received food carving education, the types of the utility, and its quality attributes. To investigate this research purpose, students who had received food carving education were set as a population, and the survey was conducted for one month from July 20 through August 20, 2020. 500 copies of the questionnaire were distributed in total, and 435 copies were collected. 397 copies were used in the final analysis, excluding 38 unreliable copies. As a result of the analysis, important execution factors included the attributes of satisfaction with the class itself, e.g., Food carving education was not boring; it could be done by men and women of all ages; it made cockeyed ideas disappear; it promoted their self-esteem; it enhanced their value; it comforted their hearts; and it made their depression disappear. Attractive elements included revenue-related items, such as food carving skills connected to profits; they could open lectures; and they could open a workshop with little money. Along with this, the basic elements included the following: They could concentrate; they could feel better; they could get a certificate; and they could become an expert. They usually included the purposes the students who would learn food carving for the first time had basically.

한국(韓國) 일부(一部) 농촌주민(農村住民)에 대(對)한 혈액학적(血液學的) 고찰(考察) -혈압치(血壓値)와 적혈구용적치관계(赤血球容積値關係)를 중심(中心)으로-

남택승,강득용,Nam, Taik-Sung,Kang, Duk-Yong 한국농촌의학지역보건학회 1977 농촌의학·지역보건 Vol.15 No.1

A study on blood pressure and hematocrit values of 1,559 people in 19 Korean rural areas was carried out in 1974 and the results were analyzed statistically. Obtained as follows: 1. The blood pressure according to sex and age groups (from the twenties to the seventies) was as follows: 1) The blood pressure of male by age group il) In the twenties, M (mean) was 125. 85/74, 15mm/Hg, a (standard deviation) was 15.9/10.2, and ill (standard error) was 1.55/0.99. (2) In the thirties, ${\delta}$ was 123.93/77.19 mm/Hg, a was 14.4/10.8, and m was 1.24/0.93. (3) In the forties, M was 128.44/81.15 mm/Hg, a was 23.9/14.7, and m was 2.16/1.33. (4) In the fifties, M was 128.48/181.24 mm/Hg, a was 24.7/13.9, and m was 2.05/1.16. (5) In the sixties, M was 135.80/81.70 mm/Hg, a was 27.4/18.8, and ${\delta}$ was 2.74/1.88. (6) In the seventies, M was 146.84/83. 16mm/Hg, ${\delta}$ was 24.5/10.0, and m was 5.62/2.30. 2) The blood pressure of female by age group (1) In the twenties, M was 117.89/73.33 mm/Hg, ${\delta}$ was 15.7/12.1, and m was 1.42/1.09. (2) In the thirties, M was 118.04/75.71 mm/Hg, ${\delta}$ was 16.9/13.0, and m was 1.13/0.87. (3) In the forties, M was 120.92/78.17 mm/Hg, ${\delta}$ was 20.9/12.9, and m was 1.42/0.87. (4) In the fifties, M was 122.14/79.55 mm/Hg, ${\delta}$ was 24.2/15.9, and m was 1.63/1.07. (5) In the sixties, M was 131.57/84.29 mm/Hg, ${\delta}$ was 28.4/16.9, and m was 2.58/1.53. (6) In the seven ties, M was 139.62/86, 54 mm/Hg, ${\delta}$ was 22.4/15.7, and m was 4.38/3.09. And the range of systolic blood pressure in male was 70~230 mm/Hg and in female was 80-230 mm/Hg. The range of distolic blood pressure in male was 50~160 mm/Hg and in female was 40~140 mm/Hg. 2. The hematocrit value according to sex and age groups was as follows: 1) The hematocrit values of male by age group (1) In the twenties, M was 42.72%, ${\delta}$ was 3.05, and m was 0.30. (2) In the thirties, M was 41.77%, ${\delta}$ was 3.29, and m was 0.28. (3) In the forties, M was 41.39, ${\delta}$ was 3.86, and m was 0.35. (4) In the fifties, M was 40.12%, ${\delta}$ was 3.65, and m was 0.30. (5) In the sixties, M was 39.88%, ${\delta}$ was 3.81. and m was 0.38. (6) In the seventies, M was 38.47%, ${\delta}$ was 2.27, and m was 0.52. 2) The hematocrit values of female by age group (1) In the twenties, M was 35.40%, ${\delta}$ was 3.37, and m was 0.30. (2) In the thirties, M was 35.50%, ${\delta}$ was 3. 35, and m was 0.22. (3) In the forties, M was 35.75%, ${\delta}$ was 3. 18, and m was 0.22. (4) In the fifties, M was 35.84%, ${\delta}$ was 3.30, and m was 0.22. (5) In the sixties, M was 35.70%, ${\delta}$ was 3.35, and m was 0.30. (6) In the seventies, M was 35.08%, ${\delta}$ was 3.08, and m was 0.60. The range of hematocrit values in male was 23~50% and in female was 18~50% (un associated with age groups). 3. In comparison with the blood pressure and the value of hematocrit of study groups showed that the blood pressure raised higher but the value of hematocrit got lowered on the contrary as the groups are getting older. 4. Total number of patients with hypertension was 165(10.6%) which were consisted with 71 male (11.3%) and 94 female (10.1%). But only two cases of the male patient and one case of the female patient were associated with protein uria. 5. The incidence of anemia by hematocrit values was as follows: 1) The incidence of male anemia patients based on$\leqq$41% ($\leqq$39%). (1) In the twenties, incidence was 43.90% (16.98%). (2) In the thirties, 41.48% (25.93%). (3) In the forties, 42.62% (25.41%). (4) In the fifties, 62.76% (40.69%). (5) In the sixties, 70% (38%). (6) In the seventies, 84.21% (73.68%). 2) The incidence of female anemia patients bailed on $\leqq$3

신 공중보건과 국가공중보건체계

배상수,Bae, Sang Soo 한국농촌의학지역보건학회 2012 농촌의학·지역보건 Vol.39 No.4

The New Public Health(NPH) is a comprehensive approach to protecting and promoting the health status of each individual member and society as a whole. NHP is not so much a philosophy to broaden the understanding of public health as it is an action plan to address current public health system. This paper's objectives include increasing public and professional awareness of the significant changes in the national public health systems of developed countries and contributing to more effective delivery of public health services in Korea. This paper reviews articles and documents concerning NPH and the public health system, and outlines of the achievements in developed countries since NPH movement began. These include the change in the definition and function of public health, expansion of public health networks, strengthening of public health policy, reorientation of public health delivery systems, promotion of workforce capacity, and the implementation of evidence-based management. To overcome the challenges facing the public health system of Korea, we must prioritize the value of population-based approach, expand the notion of a public health system to encompass all sectors that can influence health, promote a "Health in All Policies" approach, focus on an evidence-based health policy and program, develop core competencies for public health workers, and establish performance standards for public health organizations based on the core functions of public health.

예방보건행동(豫防保健行動) 및 치료보건행동(治療保健行動)과 사회경제적(社會經濟的)인 배경(背景)과의 관계(關係)

진신미,김명호,김영기,박종구,조우현,경영후,Jin, Sin-Mi,Kim, Myeong-Ho,Kim, Yeong-Gi,Park, Jong-Gu,Jo, U-Hyeon,Gyeong, Yeong-Hu 한국농촌의학지역보건학회 1979 농촌의학·지역보건 Vol.4 No.1