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일부 종합병원에 내원한 자궁내장치 피시술자에 관한 사회의학적 비교연구
김응익,고경실 한국보건통계학회 1986 보건정보통계학회지 Vol.11 No.1
A socio-medical study was performed to assess contraceptive effectiveness in the subjects 201 first users which were observed from May 1984 to August 1985. 91 clients who inserted Lippes loop were included to Non-active group and the other 110 clients, 52 users wearing TCu220c, 30 using MLCU250 and 28 with Gravigard were included to Active group. In the view point of continuous probability, dis-continuous probability and side effects which were occurred after they inserted IUD, it was compared with the effectiveness of Non-active group and that of Active group. The results are as follows; 1. General characteristics of both Non-active group and Active group such as age distribution, educational level, pregnancy frequency, living child, living son and induced abortion respectively were classfied. But there was no significant difference between these two groups (P>0.05) 2. According to the observation as of the and of August 1985 the number of continuous users of Active group appeared by far more than Non-active group with significant difference. As a result, there was a great of correlation between the types of IUD and continuous users of IUD (P<0.01, Odds Ratio=2.7). 3. The continuous Probability of the two groups was much greater in Active group than in Non-active group when was observed at the end of 3, 6, 9, 12 month (P<0.01). 4. The reasons for dis-continuous users were removal either by medical or non-medical reason, unexpected pregnancy and expulsion. But the greatest of the reason for discontinuous users showed the removal owing to medical reason not only Non-active group but Active group. 5. The medical reasons were bleeding, PID, pain, leucorrhea, tail in uterus and perforation. Bleeding was the first rank as 38.8% in Non-active group and 36.6% in Active group. But the next was PID (27.3%) in Non-active group and pain (27.3%) in Active group. 6. The users experienced side effects were 67% in Non-active group and 35% in Active group respectively (P<0.05, Odds Ratio=3.70). 7. Analysing the side effect, spotting, bleeding, low abdomen, leucorrhea, PID, perforation and tial in uterus were observed. PID was the first in Non-active group. (37.6%) and bleeding was the first in Active group (20.3%). Observing the time of incidence of side effect, 57.3% (53 cases) of total side effects in Non-active group and 61.1% (39cases)in Active group occurred in the period of between one month and three months. Though incidence rate of side effect of Active group was higher than that of Non-active group during this period (3 months), but after this period Non-active group was higher than Active group. There was correlation occurrence of side effect with risk pregnancy group in Non-active group (P<0.05, Odds Ratio=10.3). And there was correlation occurrence of side effect with risk age group (P<0.05, Odds Ratio=2.07).
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유선미,임민경,고경실,맹승희 대한보건협회 1998 대한보건연구 Vol.24 No.1
산업안전보건법에 근거하여 시행되는 근로자 일반건강진단은 근로자에게 정기적인 건강진단을 실시하여 근로자의 건강을 유지·증진시키기 위한 2차 예방사업이다. 본 연구에서는 일반건강진단의 효과를 평가하기 위하여 검진의 표적 질환 및 검사항목 선정, 검진실시 과정, 검진결과 및 사후관리 체계에 대하여 표적 질환 및 검사항목 선정에 대한 평가에 주목하여 검토하였다. 1996년 충남 소재 반도체 생산업체 생산직 근로자 581명을 대상으로 근로자 일반건강진단과 개인별 종합검진을 시행하고 건강진단 결과와 의무기록상의 의사의 진단을 조사하여 다음과 같은 결과를 얻었다. 1. 일반건강진단의 표적질환군 중에서 한국인의 10대 사인, 공무원 및 사립학교 교직원 의료보험상병자료에서 유병률이 높은 질환에 속하는 것은 호흡기 결핵, 간장질환, 당뇨, 고혈압 등이었다. 2. 일반건강진단은 개인별 종합겁진에 비해 검사 항목이 더 적고, 검진에 소요되는 시간이 길고, 의사의 개별적인 상담을 받을 기회가 적었다. 집단을 대상으로 시행하는 일반건강진단의 사후관리는 2차 검진 결과를 통보하고 난 뒤에는 개인에게 일임하고 있었다. 3. 일반건강진단 결과 유소견자(C)와 일반 질환자(D2) 중에는 소화기 질환이 가장 많았고, 순환기, 호흡기, 비뇨생식기 질환, 호흡기 결핵 순이었으며, 고혈압과 호흡기 결핵을 제외하면 구체적인 진단을 얻을 수 없었다. 개인별 중합검진의 경우 일반검진을 이용해서 얻지 못하면서 임상적으로 중요한 진단으로 십이지장궤양, 위궤양, 위암, 간경변, 폐암, 협심증, 요로감염, 신장암 등이 있었다. 일반건강진단과 종합검진에서 진단이 일치한 경우는 전체의 53.9%였고, kappa index는 0.249(p=0.000)였다. 일반건강진단 결과 가장 많았던 소화기 질환은 개인별 종합검진에서는 지방간, 정상, 간염 건강보균자, 간기능 이상, 알코올성 간염 등으로 구체적인 진단을 받았다 4. 1차 검진 이상자(절차구분 R)에게 시행한 2차 검진은 고지혈증의 경우 검사 이상을 보이는 경우가 많았으나, 간장 질환, 비뇨생식기 질환의 경우는 최종 진단을 결정하는데 크게 기여하지 않았다. 효과적인 일반건강진단을 통해 근로자의 건강증진을 도모하기 위하여 검진의 목표, 표적질환, 검사항목, 검진실시 과정, 결과 추구 관리에 대한 체계적인 연구가 필요하다. Workers' periodic health examination is secondary level preventive service which aims health promotion at work site. This study concerns the target diseases, clinical tests, the result, and the follow-up strategies to explore the effect of periodic health examination. 581 workers in semiconductor-manufacturing factory were selected for this study in 1996. We analysed the result of examination and diagnosis by doctors in hospital medical records. The result is as follows, 1. Target diseases of workers' periodic health examination which belong to 10th common causes of death in Korea and rank as common diseases in medical insurance prevalence were respiratory tuberculosis, liver diseases, diabetes mellitus, and hypertension. 2. The most common findings which showed abnormal result was disease of digestive system, followed by diseases of circulatory, respiratory, urogenital system and respiratory tuberculosis. But the diagnosis by periodic health examination was not concrete except hypertension and tuberculosis, and didn't cover important diagnoses such as peptic ulcer disease, gastric cancer, liver cirrhosis, angina pectoris, urinary tract infection and kidney cancer. 3. Most results of confirmatory health examination to make an valid diagnosis about hyperlipidemia revealed abnormal results. But confirmatory health examination about liver disease, urogenital disease seemed to contribute to confirmative diagnosis. In conclusion, we described some problems of target diseases, test items, confirmatory tests in worker's periodic health examination. So we'd like lo suggest more extensive reconsideration about adequate target diseases, test items, and confirmatory health examination and cost-benefit analysis to improve the efficacy of workers' periodic health examination.
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