지역 간 병상수급 불균형이 가용성 미충족 의료에 미치는 영향 : 다수준분석과 패널분석을 이용하여

이민정,신영전 비판과 대안을 위한 사회복지학회/ 건강정책학회 2023 비판사회정책 Vol.- No.80

목적: 병상수급 불균형이 가용성 미충족 의료에 미치는 영향을 파악함으로써 적절한 병상 배분을 위한 정책제안의 기초자료를 제공하고자 한다. 방법: 만 18세 이상 성인과 70개 중진료권을 대상으로 병상수급의 불균형과 연도별 변화, 가용성 미충족 의료의 성, 연령, 지역별 격차와 추이를 파악하였다. 병상수급 불균형이 가용성 미충족 의료에 미치 는 영향을 확인하기 위해 다수준 분석과 7년간 지역 통계를 이용한 패널 분석을 하였다. 결과: 가용병상은 필요 병상보다 약 1.2배 많았으며, 지난 7년간 필요 병상과 가용병상 이 모두 증가하였다. 병상공급 과잉지역은 감소하나 부족 지역은 증가하는 양상이다. 시 간이 지남에 따라 가용성 미충족 의료는 감소했지만, 지역 간 상대격차는 커졌다. 다수 준 분석결과, 중년에는 개인, 가구, 지역 요인을 통제했음에도 병상공급이 부족하거나 (OR=1.27) 과잉(OR=1.22)인 지역이 적정한 지역에 비해 가용성 미충족 의료를 경험할 가능성이 유의하게 높았다. 패널 분석에서는 병상수급이 적절한 지역에 비해 부족(β =0.119, p=0.019)이거나 과잉(β=0.106, p=0.012)인 지역에서 가용성 미충족 의료율이 유의하게 증가하였다. 결론: 병상 부족이나 과잉과 같은 수급 불균형이 가용성 미충족 의료 증가의 결정요인임을 확인하였다. 이를 바탕으로 병상수급계획 수립의 주체인 정부 는 병상 수요에 따라 적절한 공급 수준을 진단하고 의료자원의 균형적 배분을 보장하여 지역 간 미충족 의료의 격차를 줄여야 한다. Purpose: The purpose of this study was to identify the current status of the supply-demand imbalance of hospital beds and the impact of bed availability on unmet medical needs, thereby providing a basis for policy recommendations for appropriate bed allocation. Methods: The imbalance and yearly changes in bed supply and demand, and gender, age, and regional disparities and trends in unmet medical needs were identified for adults aged 18 years and older and 70 medical service regions. To determine the impact of regional imbalances in bed supply and demand on unmet medical needs, we conducted a multilevel analysis and a panel analysis using 7 years of regional statistics. Results: The number of available beds was approximately 1.2 times greater than the number of needed beds, and both the number of needed and available beds increased quantitatively over the past seven years. The number of oversupplied regions is decreasing, but the number of undersupplied regions is increasing. While unmet medical needs have decreased over time, relative disparities between regions have increased. In multilevel analyses, in middle age, people in regions with insufficient (OR=1.27) or excess (OR=1.22) bed capacity were significantly more likely to experience unmet medical needs than those with adequate capacity, even after controlling for individual, household, and regional factors. In panel analysis, the rate of unmet medical needs was significantly increased in areas with either a shortage (β=0.119, p=0.019) or surplus (β=0.106, p=0.012) compared to areas with an adequate supply of hospital beds. Conclusion: We found that supply and demand imbalances, such as bed shortages or surpluses, are determinants of increased unmet medical needs. Based on this, the government, which is the main body of bed supply planning, should diagnose the appropriate supply level according to the demand for beds and ensure a balanced allocation of medical resources to reduce the disparity of unmet medical needs between regions.

천연 해조장 생태계 서비스 및 편익지표에 관한 탐색적 연구

강석규 ( Seok-kyu Kang ) 한국수산경영학회 2016 수산경영론집 Vol.47 No.3

The purpose of this study is to explore the ecosystem service and benefit indicators of natural seaweed beds. Ecosystems of natural seaweed beds provide a wide range of services and benefits to human society including provisioning services, regulating services, supporting services, and cultural services. Indicators for each of the ecosystem services are chosen by marine plants ecologists and as follows. Ecosystem indicators of natural seaweed beds for provisioning services are well-being food(amount of seaweed harvested/amount of fish landed, fish biomass, area of natural seaweed beds, the number of species, contribution to the second production), raw materials(amount of biomass by breed, amount of aquaculture feed), genetic resources(amount of genetic material extracted, amount of genetic material contained by age and habitat), and medicinal resources(amount of medicinal material extracted). Ecosystem indicators of natural seaweed beds for regulating services are air purification(amount of fine dust/NOx or SO2 captured), climate regulation(amount of CO2 sequestered), waste treatment(amount of N, P stored, biochemical degradation capacity COD), and costal erosion prevention(length and change of natural coast line, amount of sediment prevented). Ecosystem indicators of natural seaweed beds for supporting services are lifecycle and maintenance(primary production, contribution to the second production) and gene pool protection(amount of compositional factors in ecosystem, introduced species). Ecosystem indicators of natural seaweed beds for cultural services are recreation and tourism(the number of visits of an area) and information for cognitive development(amount of time spent in education, research and individual learning about ecosystem of natural seaweed beds).

편백나무를 활용한 웰니스 케어 캡슐형 침대 디자인 개발

임승택 한국가구학회 2018 한국가구학회지 Vol.29 No.3

This study is developed about Bed Design of Capsule-type, which is made from Cypress tree for modern people who suffer mental stress and insomnia to provide the optimal sleep environment. The purpose of this study is to contribute to pleasant sleep environment for modern people and the domestic furniture industry in terms of developing a bed of capsule-type allowing for mass production fusion and compositeness with multi-sensitive stimulation control technology such as visual angle, touch, auditory, olfactory sense and so on resulted from Cypress tree. The development method is searched from concept and structure of the bed through literary survey. Three new types of capsule beds will also be presented after investigating and analyzing domestic and international cases of capsule hotels and capsule beds. The result of analyzing 40 examples, bed of capsule-type is showed with mostly features that have a box-type for, material of fiber glass, white color, fusion and composite functions such as visual, the sense of touch, auditory, olfaction and so on, single-standing type of layout, closed door type. The form of design of cypress tree capsule beds in reference to this study is box shaped, made out of cypress tree, and has the natural color of cypress tree. Furthermore, the main functions include helping deep sleep from fusion and compositeness for instance LED therapy lighting system, a sound vibration bed unit, emotional stability video with an acoustic system, aroma and an oxygen generator. The layout of the bed is single-standing type for usability and the door type is closed for deep sleep. Convenient producing and assembling are caused by Ergonomic design focused on users, and it emphasizes the material properties having cypress tree contained phytoncide. The encapsulated bed prototype of new form suggests 3 types, which are single sliding type, double-storied casement, and round type. Two types from among these are intended for the general public, and the round type can be used by children and elderly people.

병원의 간호사이직률과 병원의 구조적 특성

조혜경(Jo, Hye-Kyung),이태용(Lee, Tae-Yong),김철웅(Kim, Chul-Woung) 한국산학기술학회 2015 한국산학기술학회논문지 Vol.16 No.1

본 연구는 병원에 근무하는 간호사의 이직률과 병원의 구조적 특성 간 관련성을 확인하기 위하여 시행하였다. 자료는 한국보건산업진흥원에서 매년 조사하는 병원경영분석자료를 이용하였으며, 2008년에 전국에서 자기기입식으로 입력한 병원은 247개였다. 2008년 우리나라 간호사의 평균 이직률은 32.0%(공공병원 15.5%; 사립병원 35.3%)였으며, 민간병원, 300병상 이하 병원, 비도시 지역병원, 간호사평균급여가 2,000만원 미만인 병원, 100병상 당 간호사 수가 20명 미만 인 병원에서 높았다. 실제 이직률에 영향을 미치는 요인은 경영주체(공공 또는 사립), 병원 규모, 병원 소재지, 간호사의 평균 임금, 100병상당 간호사 수였다. 각 병원의 이직률과 총 병상 수(r=-0.322), 간호사 평균급여(r=-0.186), 100병상 당 간호사 수(r=-0.390)는 상관관계가 있었으나, 이직률에 설명력이 있는 변수는 경영주체의 공공성 여부, 총 병상 수, 100병상 당 간호사 수였다(R2=.257). 결론적으로 병원간호사의 이직률은 민간병원 근무자가, 총 병상수가 적을수록, 100병상 당 간호사 수가 적을수록 높았다. 간호이직 관련요인을 명확히 하기 위하여 개인요인, 사회요인과 병원요인을 동시에 분석하는 추가연구가 필요하다. The aim of this study was to find out the relationship between hospital structural factors and nurses' turnover rate. Nurse turnover rate and the hospital's characteristics was using Statistics for Hospital Management Data of Korean Health Industry Development Institute. The data were reported 247 hospitals in 2008 all over the country. The turnover rate among nurses was 32.0% in Korea as of 2008; those factors actually affecting the rate included whether the hospital was managed publicly or privately, the hospital size, region, the average salary for nurses, and the number of nurses per 100 beds. While each hospital had the turnover rate correlated with the total number of beds (r=-.322), the average salary for nurses(r=-.186) and the number of nurses per 100 beds (r=-.390), variables explaining the turnover rate were whether the hospital was managed publicly or privately, the number of beds, and the number of nurses per 100 beds (R2=.257). In conclusion, nurses working in a privately-managed hospital and hospitals which had a smaller number of beds and which had a smaller number of nurses per 100 beds showed a higher turnover rate. Further study is required to elucidate the factors of the nurses' turnover.

수여부와 블록 이식골의 동시 피질골 천공과 수여부 피질골 천공의 비교

장인걸(In-Geol Chang),이동걸(Dong-Geol Lee),신창훈(Chang-Hoon Shin),홍종락(Jongrak Hong) 대한구강악안면외과학회 2009 대한구강악안면외과학회지 Vol.35 No.6

Purpose: The aim of this study is to compare volume and revascularization of autogenous block bone grafts in simultaneously cortical perforation of recipient beds and grafts, and only cortical perforation of recipient beds. Materials and methods: Two block bone in 8mm diameter was harvested in both skull using trephine bur on 20 New Zealand white rabbits. Harvested block bone was grafted on both inferior border of mandible. On the left side(experimental side), cortical bone of recipient beds and graft were perforated, and on the right side(control side), the only recipient bed was perforated. The rabbits had been sacrificed and infused the India ink for the observation of revascularization at 20 day and 40 day after surgery. The specimens were processed for H-E staining and quantitative analysis(independent t-test, p<0.01) was made under an optical microscope. In additional, specimens were processed for the observation of revascularization. Results: After 20 days, more bone volume was observed in experimental group, but no significant difference between two groups(p=0.106). There were significantly more bone volume in the experimental group at 40 days after surgery(p<0.01). After 20 days, more discrete vascular sprouts were observed in experimental side, but no difference at 40 days after surgery. Conclusion: We conclude that the cortical perforation of both the recipient beds and grafts improve revascularization at early stage and overall graft persistence.

Observation of typhoon-induced seagrass die-off using remote sensing

Kim, Keunyong,Choi, Jong-Kuk,Ryu, Joo-Hyung,Jeong, Hae Jin,Lee, Kitack,Park, Myung Gil,Kim, Kwang Young Academic Press in association with the Estuarine a 2015 Estuarine, coastal and shelf science Vol.154 No.-

<P><B>Abstract</B></P> <P>Satellite remote sensing has been used as an effective tool to monitor and manage seagrass beds, but this tool is not appropriate to use in highly turbid waters along the coast of Korea. In this study, satellite data were used to identify the method for detecting seagrass beds in turbid bay waters and describing temporal changes over the past 24?years. Moreover, we found the cause of seagrass die-off phenomenon by observing the long-term satellite images and evaluating the impact of the typhoon on seagrass beds. All seagrass spectra from different sensors (Landsat TM/ETM+, Aster, Spot-4, and Kompsat-2) have low reflectance in green and high in NIR regions, whereas unvegetated seawater has the opposite spectrum features. A training area in the green band and Mahalanobis Distance Classification algorithm was adopted for classification and mapping of seagrass beds. The error matrix using the <I>in situ</I> reference data for Kompsat-2 image classification was 72.9% accurate. The average area of seagrass beds was 4.6?km<SUP>2</SUP> from May 1990 to January 2012, and it was consistently >4.0?km<SUP>2</SUP>. A die-off of seagrass beds was observed in September 2012 after Typhoon Bolaven, Tembin, and Sanba consecutively passed the study site. When Typhoon Sanba passed the study site, it had sustained maximum wind speed (147.6?km?h<SUP>−1</SUP>) during low tide, unlike the other typhoons. We found that the water column buffer did not have any effect on resistance of seagrass bed to disturbance, which led to greater damage. Additionally, the three sequential typhoons that passed through during the short time probably produced a cumulative effect. These results allow an understanding of past changes, and reveal the sudden and influential changes in seagrass distribution. As seagrass removal might have negative effect on other associated communities, comprehensive monitoring is required to ensure that disturbed seagrass habitats is recovered naturally.</P>

병원의 경영성과 지표에 따른 영향요인 분석

권광현(Kwang-hyon Kwon),김동영(Dong-Young Kim),조덕영(Duk-Young Cho) 한국산업경제학회 2017 산업경제연구 Vol.30 No.1

본 연구는 병원의 경영성과 영향요인 변수와 의료수익률 변수가 병상 기준과 총자본 지표 기준에 따라 병원구분별, 지역별로 차이가 있는지 그리고 경영성과에 어떠한 영향을 미치는지를 분석하였으며, 분석결과는 다음과 같이 요약할 수 있다. 첫째, 차이분석 결과, 의료수익률 변수의 경우 병상 기준과 총자본 기준 모두에서 종합병원이 병원보다 높고, 병원이 요양병원보다 높았으며, 수도권 지역이 광역시 및 지방지역 보다 높은 것을 알 수 있었고, 나머지 변수의 경우 어떤 기준을 사용하는가에 따라 결과가 다르게 나타나고 있다는 것을 확인할 수 있었다. 둘째, 병원구분별 회귀분석의 경우, 인건비율 변수의 경우 병상 기준과 총자본 기준 모두에서 종합병원과 병원이 일관되게 병원의 경영성과에 긍정적인 영향을 미치는 것으로 나타났고, 복리후생비율 변수와 교육훈련비율 변수는 요양병원에서만, 의약품비율 및 재료비율 변수는 병원의 경우에서만, 광고선전비율 변수는 종합병원에서만 병상 기준과 총자본 기준에서 일관되게 병원의 경영성과에 긍정적인 영향을 미치는 것을 알 수 있었다. 셋째, 지역구분별 회귀분석의 경우, 인건비율 변수의 경우 병상 기준과 총자본 기준 모두 수도권 지역과 광역시 지역이 일관되게 병원의 경영성과에 긍정적인 영향을 미치는 것으로 나타났고, 교육 훈련비율 변수는 지방 지역에서만, 의약품비율 변수는 광역시 지역과 지방 지역에서, 광고선전비율 변수는 수도권 지역에서만 병상 기준과 총자본 기준에서 일관 되게 병원의 경영성과에 긍정적인 영향을 미치는 것으로 제시되었다. The study analyzed whether management performance impact factors and medical profitability variables have differences between hospital classification and regional classification, based on the criteria of hospital beds and total capital. and we analyzed how impact on management performance has been affected. First, through gap analysis, hospital beds-base and total capital-base, in the case of medical profit rate variable, we realized that general hospitals are higher than the hospitals, and hospitals are higher than the convalescent hospitals. and we recognized that centre area is higher than metropolitan area and rural area. Second, in the case of the regression analysis in hospital classification, labor rate variable had consistently a positive impact on hospital performance in both general hospitals and hospitals on hospital beds-base and total capital-base. and we analyzed that fringe benefit rate variable and training expense rate variable had a positive impact on hospital’s management performance only in convalescent hospitals and that advertising campaign rate variable had a positive impact on hospital’s management performance only in general hospitals and that medicinal rate and material rate variable had a positive impact on hospital’s management performance only in hospitals. and we analyzed that fringe benefit rate variable and training expense rate variable had a positive impact on hospital’s management performance only in convalescent hospitals and that advertising campaign rate variable had a positive impact on hospital’s management performance only in general hospitals and that medicinal rate and material rate variable had a positive impact on hospital’s management performance only in hospitals. Third, in the case of the regression analysis in regional classification, labor rate variable had consistently a positive impact on hospital performance in both centre area and metropolitan area on hospital beds-base and total capital-base. and we analyzed that training expense rate variable had a positive impact on hospital’s management performance only in rural areas and that medicine expense rate variable had a positive impact on hospital’s management performance only in metropolitan area and rural area, and that advertising campaign rate variable had a positive impact on hospital’s management performance only in centre area on hospital beds-base and total capital-base.

Comparative trophic structures of macrobenthic food web in two macrotidal wetlands with and without a dike on the temperate coast of Korea as revealed by stable isotopes

Park, Hyun Je,Kang, Hee Yoon,Park, Tae Hee,Kang, Chang-Keun Elsevier 2017 Marine environmental research Vol.131 No.-

<P><B>Abstract</B></P> <P>This study characterized trophic structures of the macrobenthic food webs in two contrasting estuarine wetlands, with and without a dike, on the southern coast of Korea, based on the δ<SUP>13</SUP>C and δ<SUP>15</SUP>N values of dominant macrobenthic consumers. The pelagic algal biomasses were similar in the upper <I>Phragmites australis</I>-covered and lower bare intertidal habitats partitioned by the dike, but the microphytobenthos (MPB) biomasses were extremely low in the <I>Phragmites</I> bed. The consumer δ<SUP>13</SUP>C values were more negative and their isotopic niche width was much narrower in the upper than in the lower habitat at the diked site. These dissimilar spatial patterns between sites suggest a simplified food-web structure, which reflects the reduced availability of MPB in the upper habitat in the dike-impacted site. Overall, our findings suggest that restriction of the tides by dike construction induces local changes in basal resource availability and faunal composition, leading to macrobenthic community trophic reorganization.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Tidal-wetland trophic structures in the presence/absence of the dike are compared. </LI> <LI> Microphytobenthos availability was low in the <I>Phragmites</I> bed at the diked site. </LI> <LI> Consumer δ<SUP>13</SUP>C values were more negative in the <I>Phragmites</I> bed than in the bare bed. </LI> <LI> Isotopic niches indicated a modified food-web structure in the diked marsh bed. </LI> <LI> Restriction of the tides by dike induces marsh-bed food-web trophic reorganization. </LI> </UL> </P>

CFD study of hydrodynamics behavior of a vibrating fluidized bed using kinetic-frictional stress model of granular flow

Seyyed Hossein Hosseini,Mahmood Reza Rahimi,Nader Azizi,Goodarz Ahmadi 한국화학공학회 2013 Korean Journal of Chemical Engineering Vol.30 No.3

The hydrodynamics of a vertically vibrating fluidized bed was studied using an Eulerian-Eulerian twofluid model (TFM) incorporating the kinetic theory of granular flow and including the frictional stress effects. Influences of frictional stresses, vibration amplitudes and frequency on behavior of the particles were studied. In the case with vertical vibration, the numerical results showed three regions of solid concentration along the bed height: a low particle concentration region near the bottom of the bed, a high concentration region in the middle of the bed, and a transition region at top of the bed. The accuracy of results was found to be closely related to the inclusion of the frictional stresses. Ability of the two-fluid model for predicting the hydrodynamics of vibrating fluidized beds was discussed and confirmed.

HEAT TRANSFER CHARACTERISTICS OF THREE PHASE FLUIDIZED BEDS

KANG, YONG,SUH, IL SOON,KIM, S. D. 충남대학교 공업교육연구소 1986 論文集 Vol.8 No.3

Heat transfer characteristics of two(liquid-gas, liquid-solid)and three(liquid-gas-solid)phase fluidized beds have been studied in a 15.2cm-ID column fitted with an axially mounted cylindrical heater. Effects of gas velocity (0-12 cm/s), liquid velocity (0-16 cm/s), particle size (1.7-8.0 mm) and liquid viscosity (0.001-0.039 Pa·s)on heat transfer coefficient were determined. The heat transfer coefficient increased with fluid velocities and particle size and it decreased with liquid viscosity in two and three phase fluidized beds. The bed porosity at which the maximum heat transfer occurred decreased with particle size but increased with liquid viscosity. The coefficient were correlated in terms of experimental variables. Modified Nusselt number from the present and previous studies has been correlated with modified Prandtl and Reynolds numbers.