Origins and Evolution of Social Medicine and Contemporary Social Medicine in Korea

한달선,배상수,김동현,최용준,Han, Dal Sun,Bae, Sang-Soo,Kim, Dong-Hyun,Choi, Yong-jun The Korean Society for Preventive Medicine 2017 예방의학회지 Vol.50 No.3

유럽의 많은 의과대학들은 사회의학을 교과목으로 개설하고 있으며, 미국에서는 일부 의과대학들이 사회의학을 department의 명칭에 사용하고 있다. 그러나 한국에서는 사회의학의 도입이 제대로 진행되지 못했다. 이는 한국 의학에 지대한 영향을 미친 미국 의학계가 한동안 그 용어와 원리를 수용하지 않았었기 때문일 것이다. 이러한 상황 인식을 바탕으로 1) 사회의학의 기원과 진화에 관하여 기술하고, 이어서 2) 한국 사회의학의 실상에 대하여 간략히 논의할 것이다. 사회의학은 1848년 프랑스와 독일에서 창시되어, 국제적으로 다양한 발전 과정을 거쳤다. 사회적, 경제적 여건이 건강, 질병 및 의료서비스에 미치는 영향이 심대하며, 따라서 그에 대한 과학적 연구가 필요하다는 것이 사회의학의 핵심적 개념에 속한다. 한국에서는 사회의학이 거의 사용되지 않는 용어지만, 그 내용은 의과대학 예방의학 교과과정에 도입된 상태이다. 그러나 이러한 내용적 수용은 사회의학에 대한 논의와 이해에 근거해서 이루어진 것이 아니므로 그 의의와 가치의 전달에 한계가 있다. 따라서 예방의학과 사회의학의 연계관계를 분명히 밝히고, 체계화하는 노력이 필요하다. 구체적으로는 의과대학 예방의학 과목의 명칭을 많은 나라에서처럼 예방사회의학으로 변경하고, 명칭에 부합하도록 내용을 조정 보완하는 방안을 검토할 필요가 있다. Social medicine is recognized as one of medical specialties in many countries. However, social medicine has never been formally introduced to Korea, presumably because the term and its principles were not accepted for some years in the past in American medicine, which has strongly influenced Korean medicine. This paper describes the origins and evolution of social medicine and briefly discusses contemporary social medicine in Korea. Social medicine was initiated in France and Germany in 1848. Since then, it has expanded globally and developed in diverse ways. Included in core principles of social medicine is that social and economic conditions have important effects on health and disease, and that these relationships must be subjected to scientific investigation. The term 'social medicine' is rarely used in Korea, but many of its subject matters are incorporated into preventive medicine which, besides prevention, deals with population health that is inescapably social. However, the Korean preventive medicine directs little attention to the basic concepts and principles of social medicine, upon which systematic development of social medicine can be based. Thus, it is necessary to supplement the social medicine contents of preventive medicine through formalizing the linkages between the two fields. One way of doing so would be to change the title of 'preventive medicine' course in medical colleges to 'preventive and social medicine,' as in many other countries, and to adjust the course contents accordingly.

A Case Note on the Medical Negligence of Traditional Chinese Herbal Medicine in the UK

Lee, Hai Woong Society of Preventive Korean Medicine 2014 대한예방한의학회지 Vol.18 No.3

Objective : Traditional medicine (TM) has been playing its role in national healthcare system and it is taken as complementary and alternative medicine (CAM) from the viewpoint of modern Western medicine. In the UK, not a few practitioners of Traditional Chinese Medicine (TCM) are working as CAM practitioners using herbal medicine and acupuncture therapy. Cases of dispute in the TCM practice are not rare these days because patients who take TCM service are increasing by year. Method : In the UK, dispute cases of the Traditional Medicine of East Asia can be found these days, however, it is hard to find a reported court case. A medical dispute case of TCM will be analysed to see the legal management and the resolving principle in the alternative medicine practice with some cases of Korean Medicine (KM) being discussed. Results : The usual pattern of clinical negligence can be discussed from the points of a duty of care, breach of that duty by negligence, and the harm to the patient from that breach of duty. The judge followed this procedure In this case to discuss the claims. The department of health proposed to introduce regulation to provide the reasonable quality in TCM practice, and the governmental system would be essential to regulate both the TCM practice and practitioners. Conclusion : The dispute case of traditional Chinese herbal medicine (TCHM) practice is important for the clinical negligence in TCHM practice. Judging the negligence of a TCHM practitioner involves the conventional negligence principle in tort law, and the TCHM practitioners are required to keep up with the up-to-date information on the related medical specialty. The reasoning is almost the same as that shown in the court case of Korea. The TCHM practice in the UK needs to be under the regulation by the government. The standard of care we expect of a TCHM practitioner is a further matter to discuss from the healthcare and social viewpoints.

Use and perception of Smoking Cessation in Traditional Medicine: A Survey of Korean Medical Practitioners

Lee, Ju Ah,Jang, Soobin,Park, Sunju Society of Preventive Korean Medicine 2018 대한예방한의학회지 Vol.22 No.2

Objectives : This survey assessed Korean medical doctors' (KMDs') use and perception of smoking cessation therapies in traditional Korean medicine (TKM) and their drawbacks. Methods : A total of 14,485 KMDs affiliated with the Association of Korean Medicine were sent surveys via email. They were asked the use and perception of smoking cessation therapies in TKM and their drawbacks: Present use of Korean medicine treatment for smoking cessation, ideal treatment for smoking withdrawal symptoms, advantages and disadvantages of smoking cessation treatments in Korean medicine were asked with closed-ended questionnaire. Results : Two hundred fifty-three KMDs (1.75%) responded to the questionnaire. According to the results of the study, more than half of KMDs (51.4%) answered that they have practiced smoking cessation therapy. The most frequently used treatments for smoking cessation were ear acupuncture (EA) (74.6%) and acupuncture (15.4%), and the most of TKM doctors said that they were the most effective treatments. The advantages of smoking cessation treatment in TKM were the fewer adverse events (53.4%), availability to stimulate acupoints continuously in everyday life (48.2%), and the possibility of controlling withdrawal symptoms. Disadvantages included the long treatment duration and the necessity of frequent visits to the doctor. The greatest disadvantage was the lack of sufficient evidence for the effectiveness of TKM smoking cessation protocols. Conclusions : Despite of the low response rate, the survey results show that the main treatment modalities for smoking cessation are acupuncture, and this was also estimated effective for stop smoking. However, to improve smoking cessation rate, the more various smoking cessation treatments should be developed.

Patients' and General Practitioners' Views About Preventive Care in Family Medicine in Switzerland: A Cross-sectional Study

Cohidon, Christine,Imhof, Fabienne,Bovy, Laure,Birrer, Priska,Cornuz, Jacques,Senn, Nicolas The Korean Society for Preventive Medicine 2019 예방의학회지 Vol.52 No.5

Objectives: The aim of this study was to describe general practitioners (GPs)' opinions and practices of preventive care and patients' opinions, attitudes, and behaviors towards prevention. Methods: The data stemmed from a cross-sectional national survey on prevention conducted in Switzerland from 2015 to 2016. In total, 170 randomly drawn GPs and 1154 of their patients participated. The GPs answered an online questionnaire and the patients answered a questionnaire administrated by fieldworkers present at their practices. Results: Both patients and GPs agreed that delivering preventive care is the dedicated role of a GP. It appeared that beyond classical topics of prevention such as cardiovascular risk factors, other prevention areas (e.g., cannabis consumption, immunization, occupational risks) were scarcely covered by GPs and reported as little-known by patients. In addition, GPs seemed to use a selective approach to prevention, responding to the clinical context, rather than a systematic approach to health promotion. The results also highlight possibilities to improve prevention in family medicine through options such as more supportive tools and public advertising, more time and more delegated tasks and, finally, a more recognized role. Conclusions: Despite an unfavorable context of prevention within the healthcare system, preventive care in family medicine is reasonably good in Switzerland. However, some limitations appear regarding the topics and the circumstances of preventive care delivery. A global effort is needed to implement necessary changes, and the responsibility should be broadened to other stakeholders.

An Edutainment Game Prototype for Sasang Constitutional Food Therapy

Yea, Sang-Jun,Zhao, Dapeng,Ryu, Il-Han,Yang, Changsop,Kim, Chul,Gweon, Gahgene Society of Preventive Korean Medicine 2015 대한예방한의학회지 Vol.19 No.2

Objective : Recently many kinds of food therapies have sprung up to prevent or manage disease and to promote health. Seeing Korean history, the Korean medical doctors have been applying food therapy based on the thought that the dietary sources were as important as the medicine. Therefore, in this study, we designed a mobile edutainment game prototype with the goal of providing education about healthy food knowledge for users who belongs to different constitutional types. Materials and Method : We adopted the Sasang Constitutional Medicine as the medical background knowledge for our edutainment game design. Based on the user study, we developed the process of edutainment system which is composed of 'My game', 'My constitution', and 'My food'. Among the whole process, we developed a prototype for the core module - the 'My game' part. This prototype used a jumping game for mobile devices that is composed of training, level 1 and level 2 stages. Results : From the target user evaluation, it was proved that 1) in terms of the learning effect of healthy diet, the edutainment game we developed has a significant advantage over the conventional learning media. 2) after playing the edutainment game, the good and bad food identification accuracy based on picture and text format were increased by 44% and 42% respectively, and 3) target users perceived enjoyment while using this prototype, as well as showed positive intention to use this game as edutainment tool in the future. Conclusion : We designed and developed mobile edutainment game prototype to educate healthy food knowledge based on Sasang Constitutional Medicine. Through user evaluation, we proved that our prototype enhanced healthy food knowledge and that user accepted the prototype as a beneficial edutainment tool.

Concurrent use of Korean Medicine and Western Medicine: findings from the 2008 National Survey

Hyun, Min Kyung Society of Preventive Korean Medicine 2017 대한예방한의학회지 Vol.21 No.1

Objectives : The concurrent use of Korean Medicine (KM) and Western Medicine (WM) for the management of disease are increasing. In this study, the factors determining the choice of concurrent use of KM and WM was investigated based on national survey data for the public. Methods : Survey data from 1239 people with experience treating diseases with KM were utilized for this study. The national survey data were gathered using e-mail and face-to-face interviews between December 2007 and January 2008. Results : Among people who had been treated with KM, 819 (66%) used both KM and WM to the treat same disease. Multivariable analysis revealed that concurrent users of KM and WM were significantly associated with age 40-69 (OR=1.43, 95% CI=1.12-1.82), university education or higher (OR=1.34; 95% CI=1.05-1.71), enhanced health status (OR = 0.47, 95% CI=0.35-0.62) and unsatisfied with WM (OR = 1.71, 95% CI=1.02-2.87). The respondents that reported KM was more effective than WM among concurrent users of KM and WM were significantly associated with being an office worker (OR=1.78, 95% CI=1.25-2.53), age 40-69 (OR = 0.62, 95% CI=0.44-0.86), unsatisfied with WM (OR=2.61, 95% CI=1.51-4.50) and overall satisfied with KM (OR=8.38, 95% CI=5.65-12.44) Conclusions : This study showed that two-thirds of KM user were concurrent user of KM and WM, and some influential factors determined the choice of a concurrent use of KM and WM. Therefore, Korean Medicine Doctors should consider the possibility of concurrent use, need to know the information on the benefits and risks of concurrent use.

Cross-sectional Study for Blood Metal Concentration in Patients with Herbal Medicine Intake

Park, Yeong-Chul,Lee, Sun-Dong Society of Preventive Korean Medicine 2009 대한예방한의학회지 Vol.13 No.1

Evidences from various countries suggest that toxic heavy metals in herbal medicine may constitute a serious health problem. In order to evaluate whether the toxic heavy metals caused by herbal medicine intake, blood samples collected from 222 patients taking herbal medicine were analyzed. In average levels of analyzed metals, $0.4{\sim}33.9%$ of total samples for 8 metals such as Cd, Co, Cu, Hg, Mn, Ni, Pb and Zn except Cr and Fe exceeded the upper limit for WHO reference value. In analysis of regression coefficients indicating the levels of metals increased or decreased after taking herbal medicine for one month, however, there were different aspects by intake types for herbal medicine. For example, the metals increased by taking decoction in blood samples were as follows; Cd and Pb whether Mn, Ni and Pb as increased metals were identified in the group taking pill and decoction(combined intake group). The odds ratio showing values higher than 1 indicating that people who take herbal medicine would have possibility higher for metal accumulation in blood than that from people who do not take herbal medicine. The metals showing the odds ratio higher than 1 were Hg and Ni in decoction group, and Cd and Hg in combined intake group. However, eight of the total, 10 metals showed the odds ratios lower than 1 by taking herbal medicine. Thus, this may explain the possible role of herbal medicine as a chelator for heavy metals in body.

Comparative Study on the Effects of Herbal Medicine and Western Medicine on the Liver Function Based on Cross-Sectional Design

Park, Hae-Mo Society of Preventive Korean Medicine 2010 대한예방한의학회지 Vol.14 No.1

Objective : The purpose of this study is to examine safety of herbal medicine on liver function and compare with western medicine. Method : 303 subjects of skin disease(vitiligo and psoriasis) were chosen at a local oriental medical clinic, and tested with a spot liver function test from Sept 1, 2006 to Dec 31, 2006. Subjects were grouped into untreated, herbal medicine, western medicine, and combination group by treatment record. Total bilirubin, AST, ALT and LDH was compared in each group, odds ratio and regression coefficient was calculated. Results : Subjects comprised of 116 individuals receiving western medication(38.28%), 54 receiving herbal medication(17.82%), 107 receiving combined forms of medication(35.31%), and 26 individuals without any types of medication(8.58%). With the mean age of 37.0 yr. 204 were male(67.3%), 99 were female(32.7%). Comparing variables of liver functions, there was no significant difference between the control and experiment groups. After adjusting potential confounders, monthly $\beta$(SE) of multiple regression -0.009~0.000 for the herbal group, -0.005~0.000 for the western group, and -0.001~0.001 for the combination group. No significant difference between the groups. OR of T-bilirubin were 1.02, 1.05, and 1.04. AST were 0.92, 0.94, and 0.98. ALT were 0.85, 0.99, and 0.97. LDH were 0.96, 1.06, 1.00 for the herbal, western, and combination group, respectively. Conclusion : Comparing with western medication, herbal medication did not cause special ill-effect on the liver function based on liver function tests.

Association Between Parity and Low Bone Density Among Postmenopausal Korean Women

Seo, Eunsun,Lee, Yongrong,Kim, Hyeon Chang The Korean Society for Preventive Medicine 2021 Journal of Preventive Medicine and Public Health Vol.54 No.4

Objectives: Low bone density (LBD) in the postmenopausal period has long been a pervasive public health concern; however, the association between parity and LBD has yet to be fully elucidated. Thus, we investigated the association between parity and LBD in postmenopausal Korean women. Methods: This study used baseline data from 1287 Korean postmenopausal women aged 40 years or older enrolled in the Cardiovascular and Metabolic Diseases Etiology Research Center community-based cohort study conducted in Korea from 2013 to 2017. The main exposure was parity (nullipara, 1, 2, 3+). The main outcome was LBD, including osteopenia and osteoporosis, based on bone mineral density measured using quantitative computed tomography of the lumbar spine (L1-2). Results: The mean age of participants was 57.1 years, and the median parity was 2. Of the 1287 participants, 594 (46.2%) had osteopenia and 147 (11.4%) had osteoporosis. No significant difference in the prevalence of LBD was found between nullipara and parous women, whereas higher parity was associated with a higher risk of LBD among parous women; the adjusted odds ratio (95% confidence interval) for the presence of LBD was 1.40 (0.97 to 2.02) for a parity of 2 and 1.95 (1.23 to 3.09) for a parity of 3 relative to a parity of 1. Conclusions: Women who have given birth multiple times may be at greater risk of bone loss after menopause; therefore, they should be a major target population for osteoporosis prevention.

Trends in Gender-based Health Inequality in a Transitional Society: A Historical Analysis of South Korea

Chun, Hee-Ran,Cho, Sung-Il,Khang, Young-Ho,Kang, Min-Ah,Kim, Il-Ho The Korean Society for Preventive Medicine 2012 Journal of Preventive Medicine and Public Health Vol.45 No.2

Objectives: This study examined the trends in gender disparity in the self-rated health of people aged 25 to 64 in South Korea, a rapidly changing society, with specific attention to socio-structural inequality. Methods: Representative sample data were obtained from six successive, nationwide Social Statistics Surveys of the Korean National Statistical Office performed during 1992 to 2010. Results: The results showed a convergent trend in poor self-rated health between genders since 1992, with a sharper decline in gender disparity observed in younger adults (aged 25 to 44) than in older adults (aged 45 to 64). The diminishing gender gap seemed to be attributable to an increase in women;s educational attainment levels and to their higher status in the labor market. Conclusions: The study indicated the importance of equitable social opportunities for both genders for understanding the historical trends in the gender gap in the self-reported health data from South Korea.