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          • 21C 국제보건의 동향과 전망 : 건강증진과 WHO

            문옥륜 서울대학교 보건대학원 2001 서울大學校 保健環境硏究所論叢 Vol.11 No.1

            The World Health Assembly of 2000 has made a resolution of the importance and urgency of prevention and control of noncommunicable disease(WHA 53.17) and framework convention on tobacco control(WHA 53.16), and of 2001 on transparency in tobacco control process(WHA 54.18). The executive Board will make diet, physical activity and health as the main resolution of the 2002 World Health Assembly. The trends have reminded us of the resolution of health promotion(WH 51.12) in 1998 and active ageing(WHA 52.7) in 1999. These tell us that the 21st century will be the era of health promotion and noncommunicable disease. This paper was presented at the Health & Medical Affairs Seminar for International Cooperation and Development Strategy organized by the Ministry of Health & Welfare, 27-28 December 2001 in Yangpung, Kyunggido. This paper has discussed main global issues related to health of the mankind in the 21st century: ageing, non-communicable disease, environmental pollution, occupational health, HIV/AIDS, smoking, obesity, and the rise of travelling. The paper has emphasized and importance of managing common behavioral risk factors such as tobacco, diet, alcohol, physical activity, and socio-economic, cultural & environmental factors. These are the main risk factors of cardio-vascular disease, cancer and chronic respiratory disease and diabetes mellitus. Avoiding the emergency of common main risk factors is the most basic strategy to be implemented. This should be involved in a comprehensive prevention strategy, which is cost-effective. To be cost-effective, a community-based intervention is a necessity.

          • 우리 나라 5대 사망원인의 사망구조에 관한 연구

            한소현,이시백 서울대학교 보건대학원 2001 서울大學校 保健環境硏究所論叢 Vol.11 No.1

            The purpose of present study is to investigate differential death rates of 5 leading causes of death. In this, therefore, analysis is made of age and regional differences in mortality rates by causes of death. The data for the present study were derived from the official mortality statistics of Korea from 1980 through 1999. The present study demonstrates that there are significant variation in mortality rates of 5 leading causes of death by region, sex, age and year observed. Death rates caused by circulatory disease and neoplasm are continuously increasing and high, while mortality by digestive system stay almost same level and relatively low. The geographical differences in mortality of 5 leading causes of death from neoplasm and circulatory system were higher in Jeonam and Kyungbuk and lower in city areas.

          • 대규모 원단 도매 시장에서의 포름알데히드 노출에 관한 연구

            최상준,백남원,김지현,이미선,황정희,정현희,이은희,최연기,양윤정,이태범,이경민,공정옥,이영미 서울대학교 보건대학원 2001 서울大學校 保健環境硏究所論叢 Vol.11 No.1

            This study was conducted to assessment airborne formaldehyde concentration at dry-goods stores, 'G' market and additionally at the reconstructed lecture room in the university during November, 2001. 'NIOSH 2016' method, with 2,4-DNPH treated silica gel sampler and HPLC, was used for sampling and analysis of formaldehyde concentration. Because every merchant rejects to participate in study, volunteers, pretend to customer, were involved to monitor personal exposure level. The results are summarized as follows ; 1. The geometric mean(GM) and geometric standard deviation(GSD) of TWA concentrations from 'G' market were 0.037 ppm and 2.17 respectively. 2. The TWA concentrations of the personal samples from 'G' market ranged from 0.009 to 0.065 ppm and those of the area samples from '' market ranged from 0.06 to 0.071 ppm. 3. The TWA concentrations of the area samples from reconstructed lecture room ranged from 0.022 to 0.094 ppm. The TWA concentration from latest reconstructed lecture room was higher than that of older reconstructed lecture room. 4. All of samples except one were exceeding NIOSH TWA criteria, 0.016 ppm.

          • SERVQUAL 척도를 활용한 입원환자 서비스의 질 구성차원에 관한 연구

            박재산,우영국 서울대학교 보건대학원 2001 서울大學校 保健環境硏究所論叢 Vol.11 No.1

            The objective of this study is to analyze the dimension of inpatient care service quality using SERVQUAL scale. The SERVQUAL scale is based on the gap theory, that is, the difference of patients' expectations and the actually received medical care service in hospital. On the basis of this theory, we measured the inpatients' perceived service quality and patient satisfaction. Data was gathered from a self-administered questionnaire at a 980 bed university hospital in Inchon City. These questionnaire measuring the service quality were distributed to 250 inpatients. A total of 166 questionnaires were finally analyzed. The response rate was 66.4%. Factor analysis was performed on 42 items and reliability and validity of these items was evaluated. And we analyzed the effect of service quality dimension on overall patient satisfaction through the multiple regression analysis. The major results of this study are as follows. First, The dimension of inpatient service quality was categorized into 7 dimensions, that is, personal caring, communication, access, physical environment, facilities and equipment, cleanliness, appropriateness and health status. Second, the reliability and validity of inpatient service quality items was satisfied. Finally, the effect of 7 dimensions on overall satisfaction was statistically significant (p<0.05).

          • OECD 주요국의 약제비 증가 억제방안 고찰

            장선미,박정영,김성옥 서울대학교 보건대학원 2001 서울大學校 保健環境硏究所論叢 Vol.11 No.1

            During last 30 years, most developed countries have been experienced rapid increase of pharmaceutical expenditures. In 1996, pharmaceutical expenditures represent 0.7-2.2% (Mean 1.2%) of GDP and 8-29% (Mean 15.4%) of National Health Expenditures in OECD countries. Thus most developed countries have developed and implemented various type of drug policies to contain expansion of pharmaceutical expenditures, because the pharmaceutical expenditures may be increased with growth of old population and become budgetary burden of NHS of NHI States. In this study, we introduced and reviewed various type of pharmaceutical policy of OECD countries to contain the pharmaceutical expenditure as follows. They are grouped as three different strategies by targets; physician, patient and health industry. First, we reviewed strategy to control physicians' prescribing behavior. These are 1. Budgeting constraints of prescribing (DRG, Pharmaceutical fixed budget), 2. Direct limitations of volume and expenditure, and 3. Guidelines for physicians, Benchmarking and feedback. Second, we reviewed strategy to control patient. These are 1. Co-payments and 2. Reference pricing. Third, we reviewed strategy to control Health Industry, These are 1. Price control (pricing), Reference pricing system, 2. Profit control, 3. Listing and delisting from reimbursement and 4. Fostering the use of generic drugs. The strategies to control physicians' prescribing may be effective if economic incentive or disincentive as well as information (lists or guidelines) is given to physicians. The strategies to control patients' should be accompanied with advance preparations such as considerations including health effect, equity, and quality (bio-equivalence). The impacts and considerations of these strategies which are implemented in OECD countries give us valuable lessons in developing policies to reduce pharmaceutical expenditure of Korea.

          • 한국인의 호기중 일산화질소(NO)의 농도

            하태규,이선화,김상섭,백도명 서울대학교 보건대학원 2001 서울大學校 保健環境硏究所論叢 Vol.11 No.1

            Nitric oxide has been found to be increased with the exacerbation of inflammatory state such as asthma or irritable bowel syndrome, and it has been suggested as a marker of inflammation. As yet no measurement of exhaled NO has been made for Koreans, and this was to describe the pattern of exhaled NO among general population. Exhaled NO was measured by chemiluminescence NO analyser (Ecophysic CLD 77 AM sp) with NO free gas. Subjects were instructed to blow slowly to the analyser at the rate of 100 ml/s. In total 493 subjects had participated with the age range of under 10 to over 70 year old. The average exhaled NO concentration was 7.86 ppb. The level was significantly higher for males than females, and when stratified by 10-year age group the level was highest for teens and lowest for 30's. FEVI/FVC was significantly associated with exhaled NO, and as FEVI/FVC got smaller the NO concentration got higher. The results of this study shows that exhaled NO is a convenient and reproducible measurement, and it is significantly associated with airway narrowing or possibly airway inflammation. Further study of potential factors of NO production and excretion is required.

          • 우리나라 유아들의 시력이상 현황과 그 원인

            이은희,이경민,이미선,엄기두,공정옥,민경복,백도명,박강원 서울대학교 보건대학원 2001 서울大學校 保健環境硏究所論叢 Vol.11 No.1

            Visual acuity impairment among children can lead to learning and behavioral disabilities. This study was carried out to describe the prevalence and risk factors of visual acuity impairment in Korean preschool children. Subject of this study was aged 4-6 children (n=2179) attending nursery and day-care centers of one district of Seoul City. The children were examined with Standard Visual Chart with diagrams familiar to children. If the visual acuity was equal to or less than 0.6, then it was described as impaired visual acuity. Age and sex were examined as for their associations with impaired visual acuity together with indicators of physical developments such as height, weight, and hemoglobin concentration. Based on the multiple logistic regression using SAS v 8.02, age and low birth weight were significant risk factors for impaired visual acuity, while other factors including parent's smoking history, housing environment, breast feeding history or diet habit were not. The results of this study indicate the importance of fetal environment/experiences in preventing impaired visual acuity. Possible role of incubators for low birth weight babies should also be considered.

          • 보험재정위기의 극복 : 전략과 처방 Strategies and Prescriptions

            문옥륜 서울대학교 보건대학원 2001 서울大學校 保健環境硏究所論叢 Vol.11 No.1

            As of March 16, 2001, the President of the National Health Insurance Corporation, Mr. T.Y. Park, announced that the Corporation will be faced with a bankruptcy by July this year. It was a shock to all of us. During the last two months, many have approached to causes of the matter from various different perspectives. This paper has tried to identify the root and to give directions of overcoming the financial crisis. The crisis was derived from an imbalance between excessive expenditure and insufficient income. However, even long before the implementation of the SDP (Separation of Dispensing and Prescribing) Policy, the crisis was forecast by the three well-known studies; Samsung, SNU Medical College and the Corporation. Nevertheless, it was impossible to raise the insurance premium or to cut the expenditure, mainly because of impending the National Health Insurance Integration (NHII). A kind of collective selfishness or group self-interest worked out. Furthermore, the SDP Policy set the insurance on five with excessive raise of the fee schedules. Further studies are called for to investigate the cause of successive financial deficits during five years before the implementation of the SDP policy. This is to separate the impact of IMF crisis from that of the NHII policy. Can it be possible to invent a single levying formula for the national health insurance? What will happen to integrate the national health insurance with the two levying formulae remained as it is? These are some of important questions remained without any answer. This study has tried to give a light on the difficult situation by citing the World Health Report 2000 of its performance evaluation. The current health insurance system is characterized by its mounting cost push and high level cost sharing and low fee schedules policy. This study has urged as a long-term health policy that Korea needs and introduction of the gate keeping system with emphasis on primary care, together with a change of payment method towards the contract system of payment. Coupled with these measures, a need is to explore all the possible means of financing including private health insurance carefully. As the short-term policy measures were widely developed, there is no need to repeat various income increasing and cost containment measures.

          • 병원에 재무구조이론의 적용방안 고찰

            최만규 서울대학교 보건대학원 2001 서울大學校 保健環境硏究所論叢 Vol.11 No.1

            The management condition of hospital is having been changed rapidly. The Korean hospitals to be grown up at supplier's market in old days without severe tackles now face the swirling torrents of reform which have it stay at windless area no more. Now that the 21st century are marching into a typhoon of endless competition, hospitals should keep up the optimal financial structure by strategic acquirement of capital for the purpose of accomplishing the role of a safeguard which exits and develops at the community to preserve the healthy life of its inhabitants. This study focuses on the logical base and validity of appliance of financial structure theory to hospitals following the explanation of their relationship with firms as the result of research to uncover their peculiarity in financing capital after the reference to financial structure theory to be made and developed to accomplish the optimal financial structure which can be divide into static tradeoff theory and pecking order theory. According to static trade-off theory optimal financial structure can be explained as the trade-off between costs and benefits by the use of debt. All the Korean hospitals including no-for-profit of for-prof-it private hospitals and public hospitals could have an advantage of tax shield if they use the debt of which the interest will be counted as an cost. Therefore static trade-off theory can be an appropriate device to account for the decision process of money supply. According to the pecking order theory capital will be acquired in the order of retained earnings→debt→equity, naturally stressing on the potentiality of profit and growth which are strong points to be applied to Korean hospitals.

          • 노인 장기입원환자와 보호자의 우울, 불안 정도에 따른 간호요구도에 관한 연구

            이선자,채은희,장숙랑 서울대학교 보건대학원 2001 서울大學校 保健環境硏究所論叢 Vol.11 No.1

            Objective: The purpose of this study is to investigate the Nursing need, Information need, physical need and Emotional need to Anxiety and Depression of the Elderly inpatient at the hospital. Methods: The author had interviews with 90 elderly patients and 181 care-givers from April to July in 2001 year using questionnaire. Statistical analysis of this study used the tool of frequency rates, ANOVA, Pearson correlation and multiple regression using SPSS 10.0 for windows. Results: Total nursing need and physical need of the care-givers are affected by their anxiety but in the patient did not show the difference of each nursing needs to their anxiety. Physical need showed the significancy to the patients depression, Especially these also showed the significancy to the economic states. ADL of the patient show very significant correlation in anxiety & depression, but cognitive function showed very significant correlation in depression. IADL also significant correlation in the male patients. Total nursing need, information need, physical need, and emotional need showed correlation with ADL, IADL, cognitive function respectively expect the relation of Information need and cognitive function. According to multiple regression, in all patients, total nursing need showed significancy in IADL, but among the male care-givers showed significancy in ADL, female showed significancy in the anxiety. Conclusion: This study emphasizes the assessment of the mental health status before assessing the nursing needs for the elderly patients. Among the elderly patients, if the assessment of the anxiety, and depression are made, nursing need, and care plan can be provided appropriately for the patients. Therefore mental health, and physical health status of the patients will be increased and protected.

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