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

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.

도시(都市)와 농촌지역(農村地域)의 영유아 예방접종률(豫防接種率) 비교조사(比較調査)

박정한,김정남,우극현,Park, Jung-Han,Kim, Jung-Nam,Woo, Kuck-Hyeun 대한예방의학회 1985 예방의학회지 Vol.18 No.1

도시와 농촌지역의 영 유아 예방접종 실태를 비교조사하기 위하여 1984년 3월 한달동안 대구시 중주 남산 1동과 경산군내 5개면에 보건진료원이 배치되어 있는 지역내 생후 $6{\sim}23$개월의 영 유아 514명을 대상으로 그들 어머니와의 설문지를 통한 면담조사를 실시하였다. 기본 접종율은 BCG의 경우 도시 98.0%, 농촌 95.8%였으며 이들 가운데 각각 91.4%, 88.1%가 생후 1개월 이내에 접종하였다. DPT 3회접종율은 도시 83.2%, 농촌 87.5%였고 소아마비 3회접종율도 도시 80.8%, 농촌 87.9%로 도시보다 농촌이 오히려 높았으며 단 한번도 접종하지 않은 경우는 드물었다. 홍역은 도시가 64.4%, 농촌은 55.3%로 도시가 농촌보다 더 높았으며 볼거리 및 풍진 예방접종율은 도시 50.4%, 농촌 36.0%였다. 그러나 홍역과 볼거리 및 풍진 접종이 완료되어야 하는 15개월 이후의 연령군에서 도시지역은 홍역이 85.3%, 볼거리 및 풍진은 77.6%, 그리고 농촌지역은 홍역이 73.7%, 볼거리와 풍진은 67.4%의 접종율을 보여, 도시지역의 홍역 및 볼거리 풍진 접종율이 농촌지역보다 통계적으로 유의하게 높았다(p<0.05). 이처럼 영 유아 기본 예방접종율이 전반적으로 향상된 것과 농촌지역의 BCG, DPT, 소아마비의 접종율이 도시지역과 비슷하거나 오히려 높은 것과 농촌지역 어머니들이 몰라서 예방접종을 실시하지 않은 경우가 도시보다 적은 것 등은 일반적인 국민 생활수준의 향상과 정부에서 모자보건사업을 중점적으로 실시해온 결과라고 생각된다. 그러나 아직도 모든 기본 접종을 적기에 실시하지 않는 경우가 많고 농촌지역에서는 볼거리와 풍진의 접종율이 다른 정종에 비해 특별히 부진하므로 예방접종 사업은 이러한 점을 보강하는 방향으로 추진되어야 하겠다. To assess the childhood immunization level of urban and rural areas, 250 mothers of $6{\sim}23$ months old children residing in Namsan 1 Dong, Taegu, and 264 mothers of the same age children residing in five areas of Kyungsan Gun where community health practitioners are assigned were interviewed in March, 1984. Immunization rate for BCG was 98.0% in urban area and 95.8% in rural area. Among children who had BCG vaccination 91.4% of them were immunized within 1 month after birth in urban area and 88.1% in rural area. The percentage of children who received three doses of DPT vaccine was 83.2% in urban, and 87.5% in rural area ana that for the polio vaccine was 80.8% in urban and 87.9% in rural area. Only a few children have never been immunized with either BCG or DPT or polio vaccine. Overall immunization rate for measles was 64.4% in urban area while it was 55.3% in rural area and that for mumps and rubella was 50.4% in urban area as compared with 36.0% in rural area. However, among children of 15 months old and above the percentage of measles vaccination was 85.3% in urban area and 73.7% in rural area. Mumps and rubella vaccination rate was 77.6% in urban area and 62.4% in rural area. These differences in measles, mumps and rubella vaccination rates between urban and rural areas were statistically significant (p<0.05). Such findings as improved immunization level, no significant differences in BCG, DPT and polio vaccination rate between urban and rural areas, and fewer mothers in rural area have not vaccinated their children than mothers in urban area because of their ignorance may be attributed to the general improvement of living standard and implementation of the maternal and child health services of the government. Nevertheless many of the mothers in rural as well as urban area have not immunized their children on time and measles, mumps and rubella vaccination rates are substantially lower than other childhood immunizations. Future immunization activity should be geared to reinforcing these areas.

예방의학의 새로운 도약을 위하여

박병주 대한예방의학회 2006 예방의학회지 Vol.39 No.1

신종 인플루엔자 대유행에 대한 우리나라의 대응방안

이덕형,박기동,Lee, Duk-Hyoung,Park, Ki-Dong 대한예방의학회 2005 예방의학회지 Vol.38 No.4

Influenza A viruses periodicall y cause worldwide epidemics, or pandemics, with high rates of illness and death. A pandemic can occur at any time, with the potential to cause serious illness, death and social and economic disruption throughout the world. Historic evidence suggests that pandemics occurred three to four times per century. In the last century there were three influenza pandemics. The circumstances still exist for a new influenza virus with pandemic potential to emerge an d spread. The unpredictability of the timing of the next pandemic is underlined by the occurrence of several large outbreaks of highly pathogenic avian influenza since the early 1980s. In 1999, the World Health Organization published the Influenza pandemic plan. The role of WHO and guidelines for national and regional planning. And in 2005, WHO revised the global influenza preparedness plan for new national measures before and during pandemics. This document outlines briefly the Korean Centers for Disease Control's plan for responding to an influenza pandemic. According to the new pandemic phases of WHO, we set up the 4 national levels of preparedness and made guidelines for preventing and control the epidemics in each phase. And also we described the future plans to antiviral stockpiles and pandemic vaccine development.

담배 가격인상이 흡연률과 흡연귀속사망에 미칠 영향에 대한 연구 -대도시 일부 사무직 근로자를 대상으로-

강종원,김정순,Kang, Jonw-Won,Kim, Joung-Soon 대한예방의학회 1997 예방의학회지 Vol.30 No.4

This study was performed to estimate the quantity of the effects of tobacco price raise on the smoking rate, and the smoking attributable deaths in Korea. The data were collected by questionnaire survey from 538 male of male workers. The questionnaire contained items on age, sex, living place, status of education, smoking history, the intention to quit smoking when the tobacco price be raised. The questionnaire, were distributed to the offices of enterprises, hospitals, research centers, and public agencies and then collected. Data were analyzed by using the age specific smoking rate, relative risks of eight major smoking related diseases, vital statistics, and the population attributable risk of deaths of smoking males. On the other hand, the impact of the tobacco price raise on the population attributable risk of death due to smoking in Korea was estimated by applying the presumed smoking rate after the price raise. The results obtained were as follows: 1. The smoking rate of male white color workers in large cities was 59.5%. 2. The proportion of male smokers who has the intention to quit smoking when the tobacco price be raised was 61.5%. 3. The proportion of male smokers who has the intention to quit smoking if the price of tobacco be raised was proportional to the degree of increasing tobacco price. It is estimated that if the tobacco price were raised more than four times as now, the presumed smoking rate goes down as low as 26.7%. If the tobacco price be raised 20% each year, presumed smoking rate is 46.2%. 4. The number of attributable male death of smoking estimated by using 8 major smoking related diseases(lung cancer, laryngeal cancer, esophageal cancer, stomach cancer, pancreatic cancer, cerebrovascular disease, ischemic heart disease, chronic obstructive pulmonary disease) was 25,863 death each year. That is 20.1% of total age over 20 male deaths. 5. f the tobacco price were raised more than four times as now and all smokers who has intention to quit smoking quits smoking, 12,336 lives, or 47.7% of smoking related deaths could be saved. 6. IF the actual practice rate of quitting smoking among male smokers with intention to stop smoking when the price of tobacco be raised is 10%, 25%, or 50%, then the expected decrease of death numbers when the tobacco price were raised more than four times as now can be 1,112, 3,483, 5,796 respectively.

지역사회 정신보건관련 센터 근무자와 병원 근무자들의 자살에 대한 인식 및 태도

김성남,이강숙,이선영,유재희,홍아름,Kim, Soung-Nam,Lee, Kang-Sook,Lee, Seon-Young,Yu, Jae-Hee,Hong, A-Rum 대한예방의학회 2009 예방의학회지 Vol.42 No.3

Objectives : The purpose of this study was to evaluate community mental health professionals and hospital workers attitude and awareness towards suicide. Methods : This study investigated 264 community mental health professionals and 228 hospital workers. SOQs (Suicidal Opinion Questionnaires) were used from July 2007 to September 2007. After a factor analysis for the attitude towards suicide, the items on ethics, mental illness, religion, risk, and motivation were included in the subsequent analysis. Results : There were significant differences in the attitude towards suicide according to religion, age, educational background, the marriage status, the economic position, and different professional licenses. Hospital workers' view was different from the community workers'. The hospital workers judged that suicide was due to mental illness, and suicide was high for the people in a special environment and who lacked motivation, which caused them to fall in a dangerous situation. For the lower educational group, they thought that suicide was attributable to mental illness. The awareness for suicide was significantly higher in the group with a postgraduate education, unmarried people, mental health professionals and the persons who had concern and experience with suicide. The factors that had an influence on the awareness of suicide were the items of mental illness, religion, risk and motivational factors. Conclusions : This study suggested that the factors to increase the awareness and attitude for suicide were the experience of increased education and case management of suicide. Therefore, education dealing with suicide and reinforcement of crisis management programs should be developed.

부산시내 남자 초.중.고등학생의 척추측만증 유병률 측정을 위한 단면조사

김복용,박정한,김풍택,Kim, Bok-Yong,Park, Jung-Han,Kim, Poong-Taek 대한예방의학회 1988 예방의학회지 Vol.21 No.2

남자 초 중 고등학생의 척추측만증 유병률을 알아 보고자 1988년 5월 부산 시내 남자 2개 국민학교 4학년 463명, 1개 중학교 1학년 543명, 1개 고등학교 1학년 387명 총 1,393명을 대상으로 국민학생에게는 시진으로, 중 고등학생에게는 시진과 폐결핵 집단검진을 위해 실시한 흉부X-선 간접촬영을 이용하여 조사하였다. 이상소견으로 나타난 학생의 체중, 신장, 평소 가방을 메고 다니는 방향을 조사하였다. 만곡의 크기는 Cobb's 방법을 이용하였다. 사진과 흉부X-선 간접촬영 어느 한쪽이라도 척추에 이상소견으로 판정된 학생은 국민학생 15명(3.2%), 중학생 174명(32.0%), 그리고 고등학생 92명(23.8%)이었다. 그러나 시진과 흉부X-선 간접촬영 모두 이상소견으로 일치되는 경우는 중학생 2.2%, 고등학생 2.6%이었으며 Cobb's 각이 $5^{\circ}$ 이상인 척추측만증은 중학생 1.1%, 고등학생 2.3%였다. 두가지 조사방법에 모두 이상소견을 보인 학생들의 가방메는 방향과 척추만곡의 방향은 통계적으로 유의한 상관관계를 보였다(p<0.05). 두가지 조사방법중 어느 한가지에 이상소견을 보인 281명의 평균체중과 신장은 같은 나이의 우리나라 표준체중과 신장에 비해 국민학생의 경우 체중은 거의 같았으나 신장은 표준신장보다 약간 작았다. 중학생은 표준치보다 체중은 1.4kg, 신장은 4.3cm 작았고 고등학생의 평균 체중과 신장은 모두 표준치보다 약간 더 높았다. 본 조사성적으로 미루어 보아 고등학교 상급학년에는 척추측만증 유병률이 더 높을 것이며 여학생들에게는 남자보다 더 흔하므로 척추측만증은 간과할 수 없는 학교보건문제로 생각된다. 또한 척추측만증 예방을 위해 가방의 무게를 줄이고, 학교에서 바른 자세를 갖도록 교육하고, 주기적으로 체조를 시키도록 하는 것이 좋을 것으로 생각된다. A cross-sectional survey was conducted to determine the prevalence rate of scoliosis in elementary, middle and high school boys in May 1988. The study population included 1,393 male students in Pusan ; 463 students of 4th grade in two elementary schools, 543 students of 1st grade in one middle school and 387 students of 1st grade in one high school. The students of elementary school were screened with inspection by two physicians at the same time and the students of middle and high schools were screened with both inspection by the same physicians and 70mm chest X-ray. Positive students in any one of the two screening tests were measured for height and body weight and asked for the shoulder side on which he carries the school bag. The angle of curvature on X-ray film was measured by Cobb's method. The number of positive students in any one of the two screening tests were 15(3.2%) in elementary schools, 174(32.0%) in middle school and 92(23.8%) in high school. However, positive rates in both tests were only 2.2% for the middle school students and 2.6% for the high school students and among these students 1.1% out of total middle school students and 2.3% of high school students had a curvature equal to or greater than $5^{\circ}$ of Cobb's angle on 70mm chest X-ray film. There was a statistically significant association between the direction of spinal curve and the shoulder side on which one carries school bag among positive students in both screening 1.sts (p<0.05) Mean height and body weight of 281 positive students in any one of two screening tests were compared with the Korean standard for the same age. Mean weight of elementary school students was nearly the same as the standard weight but the height was slightly shorter than the standard. However, both mean height and weight of the middle school students were lower than the standard while those of the high school students were higher. The prevalence rate of scoliosis for the 2nd and 3rd grades of high school is presumed to be higher than that of the 1st grade of high school and the rate for girls will be even higher than the rate for boys of the same age. Thus, scoliosis seems to be an important school health problem. To prevent scoliosis, it is recommeded to reduce the weight of school bag, educate the students to keep a right posture and exercise periodically.

심혈관계 질환 위험요인으로서의 중금속 - 납과 수은에 대한 분석 -

김대선,유승도,차정훈,안승철,이은희,Kim, Dae-Seon,Yu, Seung-Do,Cha, Jung-Hoon,Ahn, Seung-Chul,Lee, Eun-Hee 대한예방의학회 2005 예방의학회지 Vol.38 No.4

Objectives : We wanted to investigate the relationship between heavy metal, especially lead and mercury, to the blood pressure and cholesterol level in children. Methods : This study was undertaken in three primary schools and the study subjects were a total of 274 children. The lead in the blood and the urine mercury were analyzed by performing atomic absorption spectroscopy. Results : All of participants' blood lead levels and urine mercury concentrations were below the suggested level of concern according to the criteria of the CDC and ATSDR. We found no significant correlation between lead, mercury and the blood pressure. The blood lead level did not show any relationship with the blood pressure and cholesterol. However, the urine mercury levels were associated with the serum cholesterol. Conclusion : Our study suggests that mercury can induce an increase of cholesterol as a risk factor of myocardial infraction and coronary/cardiovascular disease.

VDT 취급 여성 사무직 근로자들의 견관절 기능장애에 대한 운동요법의 효과

최순석,정귀원,엄상화,정수진,이종태,전진호,이채언,배기택,Choi, Soon-Seok,Jeong, Kui-Won,Urm, Sang-Hwa,Jeong, Soo-Jin,Lee, Jong-Tae,Chun, Jin-Ho,Lee, Chae-Un,Pae, Ki-Taek 대한예방의학회 1998 예방의학회지 Vol.31 No.2

Visual display terminal(VDT) is popular in majority of office in modern countries. Musculoskeletal pain due to repetitive work with VDT is a serious industrial accident at present. In recent studies, shoulder pain in VDT users is the most common problem in Korea. The purpose of this study was to evaluate and compare the effect of excercises on shoulder dysfunction in VDT-related female office workers. Of the 119 patients with shoulder dysfunction, 32 patients entered into the study. 16 patients(Group I) were not prescribed excercises, other 16 patients (Group II) performed throughout the specific shoulder excercises such as pendular excercises(for-ward, backward and circumduction) and sidelying external rotation excercises with weights. After 3 months of excercises, the two groups were compared in term of the pain rating scale, disability questionnaire score and range of motion score. The results were summarized as follows ; 1. The pain rating scale in Group I before and after 3 months were not differenced significantly(p value=0.784) and in Group II, the scale before and after excercises were differenced significantly(p value=0.0005). 2. The disability questionnaire scores in Group I before and after 3 months were not differenced significantly(p value=0.437) and in Group II, the scores before and after excercises were differenced significantly(p value=0.0002). 3. The ROM scores of the affected shoulder in Group I before and after 3 months were not differenced significantly(p value=0.876) and in Group II, the scores before and after excercises were differenced significantly(p value=0.0017). In conclusion, that the specific shoulder excercises on shoulder dysfunction in VDT-related female office workers are encouraged.

경상남도 일부 농촌지역의 간흡충 감염에 대한 역학적 연구

주영희,오진경,공현주,손운목,김윤규,김정일,정갑열,신해림,Ju, Young-Hee,Oh, Jin-Kyoung,Kong, Hyun-Joo,Sohn, Woon-Mok,Kim, Yoon-Gyu,Kim, Jung-Il,Jung, Kap-Yeol,Shin, Hai-Rim 대한예방의학회 2005 예방의학회지 Vol.38 No.4

Objectives : To investigate the prevalence of Clonorchis Sinensis infestation and to determine the associated risk factors among a population in a part of the rural area of Gyeongsangnam-do, Korea, which is an area known to have a high mortality from liver cancer and a high infection of C. sinensis. Methods : The study populat ion consisted of those people who have lived in rural areas and who were over 40 years old. This study was performed in 5 areas during the period from 1999 to 200 3. Informed consents were obtained from the 2,381 study participants, and these people were interviewed about their life style habits with using the structured questionnaire that was administered by trained staff members. The subjects underwent blood sampling and their stool specimens were examined by using the Formalin-ether sedimentation technique. Results : Among the study subjects (N=2,381), the positivity for C. sinensis in the stool was 34.4% (95% CI=36.3-42.5); it was 39.4% (95% CI=36.3-42.5) in the males and 30.9% (95% CI=28.5-33.3) in the females . The positivity for C. sinensis was associated with current alcohol drinking (odds ratio=1.8, 95% CI: 1.5-2.1) and raw fish consumption (odds ratio 1.2, 95% CI: 0.9-1.6). Conclusion : The present study confirmed the high prevalence of C. sinensis in the study subjects. It is necessary to establish consistent medical management and education programs for the treatment and prevention of C. sinensis infestation in the rural inhabitants of Korea.