공중보건학 (제4판):Public Health > Laboratory Medicine

세계보건기구(WHO)에서 건강은 인류 모두가 누려야 할 기본적인 권리로 규정하고 있으며, 우리나라 헌법에서도 모든 국민은 건강에 관하여 보호를 받는다고 명시하고 있다. 국민의 건강은 무엇보다도 국가나 지역사회의 공중보건수준에 의해 결정되기 때문에 공중보건학은 장차 국가면허를 취득해 보건의료분야에 종사하면서 국민의 건강유지 및 증진 업무를 맡게 될 보건의료인력의 경우 매우 중요한 의미를 갖는다. 따라서 공중보건학은 보건의료 분야의 전문인력을 양성하는 대학에서 뿐만 아니라, 우리의 일상생활에서 쉽게 접할 수 있는 각종 사회실무분야의 자격증취득시험, 보건직 공무원 임용 및 승진시험 등에서도 기본 소양이 되는 매우 중요한 교과목으로 자리 잡고 있다.
본 교재는 대학의 보건관련학과에서 국가면허시험을 준비하는 학생들을 주 대상으로 하였으나, 개인적으로 공부하는 수험생들에게도 도움이 될 수 있도록 교재 내용의 대부분을 강의노트 형식으로 간략하고 체계적으로 정리하였다. 또한 각 단원별로 충분한 연습문제를 준비해 교과내용에 대한 이해 여부를 확인할 수 있도록 하였다. 교재내용은 국시 출제기준에 근거하여 제1편 공중보건학 개념, 제2편 환경보건, 제3편 역학 및 질병관리, 제4편 보건관리 등으로 구성하였으며, 각 편은 다시 세부적인 장으로 나누어져 있다. 제1편에서는 건강과 공중보건학에 관한 개괄적인 내용을 다루고 있으며, 제2편에서는 환경위생, 환경보전, 식품위생, 산업보건 등 4개의 장으로 이루어져 있다. 특히, 환경보전 분야에서는 오늘날 전 지구적인 관심의 대상이 되고 있으며 전 인류의 공동대처를 필요로 하는 산성비(acid rain), 오존층 파괴(ozonedepletion) 및 지구온난화(global warming) 문제에 대하여 최근의 자료를 토대로 비교적 자세하게 기술하였다. 향후 이러한 광역 대기오염현상은 공중보건학적인 측면에서 지역사회구성원을 비롯하여 전 인류의 건강과 일상생활에 보다 심각한 영향을 초래하게 될 것이다. 제3편에서는 역학에 대한 개괄적인 내용과 함께 전염병관리, 기생충질환관리, 만성질환관리 등 4개의 장으로 나누어 기술하였으며, 제4편은 보건행정, 사회보장 그리고 각종 보건사업에 대한 내용으로 나누어 정리하였다. 교재의 내용은 최근의 가장 보편타당한 건강관련지식을 수록할 수 있도록 보건 및 환경관련법규의 개정에 맞추어 내용을 전면 수정 및 보완하였으며, 최근의 보건통계자료를 인용하여 건강문제를 보다 정확하게 이해할 수 있도록 하였다.
본문의 내용 중 난해하거나 주요 학술용어에 대해서는 영어와 한자를 괄호 안에 기입하였으며, 다소 난해한 용어나 내용에 대해서는 그 이해를 도울 수 있도록 부가적인 정보를 첨가하였다. 그러나 강의 일정에 따라 한정되어진 짧은 시간에 원고 집필이 이루어지다보니 미처 참고문헌과 인터넷 자료의 경우 그 출처가 일부 명확하게 제시되지 못한 점을 밝히며, 아직 여러 가지로 미흡한 점들이 많지만 향후 각 분야의 선후배님들을 모시고 다시 지속적인 첨삭이 이루어질 수 있었으면 한다.
마지막으로 본 교재를 집필할 수 있도록 도움을 주신 교수님들과 주위 분들께 삼가 감사인사를 드리며, 특히 출판이 가능하도록 배려해 주신 고려의학 최병진 사장님과 본서가 출간되기까지 여러 가지로 도움을 주신 관계직원 선생님들께도 깊은 감사를 드린다.

제11편 공중보건학 개념
I. 건강과 질병 ················································· 4
1. 건강의 정의 ·············································· 4
2. 질병의 정의 ·············································· 5
II. 공중보건학의 개념 ······································ 9
1. 공중보건학의 정의 ···································· 9
2. 공중보건학의 특성 ·································· 10
3. 공중보건학의 관련학문 ··························· 11
4. 보건의료의 개념 및 발전 ························ 12
III. 공중보건수준의 평가 ································ 17
1. 공중보건수준의 평가지표 ························ 17
2. 보건수준 평가의 3대 지표 ······················ 17
3. 국내 보건수준의 추이 ····························· 18
IV. 우리나라 공중보건의 과제와 전망 ········· 20
1. 사망양상의 변화 ····································· 20
2. 우리나라 공중보건의 과제 ······················ 21
3. 우리나라 보건의료의 전망 ······················ 22
4. 당면과제에 대한 해결방안 ······················ 22
V. 공중보건학의 발달사 ································ 23
1. 고대기(기원전∼서기 500년) ··················· 23
2. 중세기(500∼1500, 암흑기) ····················· 23
3. 여명기(1500∼1850, 요람기) ··················· 23
4. 확립기(1850∼1900) ································ 24
5. 발전기(1900년 이후) ······························· 25
VI. 건강증진 ··················································· 25
1. 개념 ························································ 25
2. 대두배경 및 발전과정 ····························· 26
3. WHO 오타와헌장의 5대 활동요소 ·········· 27
4. WHO 건강증진의 원칙 ··························· 28
제1장 환경위생 ··············································· 36
I. 환경위생의 개념 ········································ 36
1. 정의 ························································ 36
2. 환경위생의 발전 ····································· 36
3. 환경위생사업 ·········································· 37
II. 기후와 일광 ··············································· 37
1. 기후 ························································ 37
2. 일광 ························································ 38
III. 온열환경 ···················································· 41
1. 기온 ························································ 42
2. 기습 ························································ 43
3. 기류 ························································ 47
4. 복사열 ···················································· 47
5. 온열요소의 종합작용 ······························· 49
6. 체온조절 ················································· 53
IV. 공기 ·························································· 54
1. 공기의 성분과 오염 ································ 54
2. 공기의 성분과 건강 ································ 56
3. 기압과 건강장애 ····································· 58
4. 실내공기오염과 군집독 ··························· 58
V. 상수 ··························································· 62
1. 물의 중요성과 보건문제 ························· 62
2. 먹는물의 수질기준 ·································· 65
3. 먹는물의 수질검사 ·································· 73
4. 상수의 처리 ············································ 74
5. 일반정수법 ·············································· 75
6. 특수정수법 ·············································· 81
7. 수영장 및 공공욕장 ································ 83
VI. 하수 ·························································· 84
1. 하수와 보건 ············································ 84
2. 하수도 ···················································· 84
3. 하수처리 ··············································· 85
4. 하수의 오염도 측정 ································ 90
VII. 폐기물 및 분뇨처리 ································ 92
1. 폐기물 처리 ············································ 92
2. 분뇨 처리 ············································· 102
VIII. 의복 및 주택보건 ································· 103
1. 의복과 의복위생 ··································· 103
2. 주택 보건 ············································· 106
XI. 구충, 구서 ·············································· 110
1. 위생해충의 정의와 종류 ························ 110
2. 해충에 의한 보건위생상의 피해 ············ 110
3. 위생해충의 구제 ··································· 111
4. 주요 위생해충의 생태와 피해 ··············· 111
5. 위생해충의 병인론 ································ 116
6. 쥐의 특성과 구서법 ······························ 117
X. 소독 ························································· 118
1. 소독과 멸균 ·········································· 118
2. 소독방법 ··············································· 119
3. 물리적 소독법 ······································· 119
4. 화학적 소독법 ······································· 122
제2장 환경보전 ············································· 126
I. 환경오염과 보전 ······································· 126
1. 환경오염 ··············································· 126
2. 환경보전노력 ········································· 127
II. 대기오염 ··················································· 132
1. 대기오염의 개념 ··································· 132
2. 대기오염기준 ········································· 135
3. 대기오염과 기상 ··································· 141
4. 대기오염사건 ········································· 144
5. 대기오염 현상과 영향 ··························· 146
6. 자동차 대기오염 ··································· 153
7. 광역대기오염 ········································· 158
8. 엘리뇨와 라니냐 현상 ··························· 182
9. 대기오염방지대책 ·································· 183
III. 수질오염 ·················································· 183
1. 수질오염의 개념 ··································· 183
2. 수질오염원 ············································ 185
3. 주요 수질오염물질과 그 영향 ··············· 187
4. 수질오염지표 ········································· 189
5. 수질기준 ··············································· 196
6. 수질오염의 영향과 사례 ························ 200
7. 생물학적 농축과 독성도 평가 ··············· 202
8. 수질오염방지대책 ·································· 204
IV. 소음 및 진동 ·········································· 205
1. 소음·진동의 개념 ································ 205
2. 소음·진동의 척도 ································ 208
3. 소음·진동의 영향 ································ 211
4. 소음·진동기준 ····································· 215
5. 소음 및 진동의 대책 ···························· 217
V. 악취 ························································· 218
1. 악취의 정의 ·········································· 218
2. 악취방지법의 주요내용 ························· 218
3. 악취의 발생원 ······································· 219
4. 악취의 측정 ·········································· 219
5. 악취의 영향 ·········································· 219
6. 악취의 배출허용기준 ····························· 220
제3장 산업보건 ············································· 223
I. 산업보건의 개념 ······································· 223
1. 산업보건의 정의 ··································· 223
2. 산업보건의 중요성 ································ 224
3. 산업보건의 목적 ··································· 224
4. 산업보건의 발전과정 ····························· 224
5. 산업보건사업의 내용 ····························· 229
II. 산업장의 작업환경 및 보건관리 ············ 229
1. 산업장의 입지조건과 구비시설 ·············· 229
2. 작업환경의 측정과 관리 ························ 230
3. 근로자의 건강관리와 건강진단 ·············· 231
4. 산업보건교육과 건강증진사업 ················ 232
5. 근로자의 영양관리 ································ 233
6. 작업관리 ··············································· 235
7. 산업피로 관리 ······································· 237
III. 산업재해와 재해지표 ······························ 238
1. 재해의 개념 ·········································· 238
2. 산업재해지표 ········································· 240
3. 재해방지대책 ········································· 245
VI. 직업병의 관리 ········································ 246
1. 직업병의 개요 ······································· 246
2. 물리적 환경에 기인하는 직업병 ············ 246
3. 작업장의 분진에 의한 질병 ·················· 255
4. 공업중독 ··············································· 256
5. 신체에 과도한 부담을 주는 작업으로
인한 질병 ············································· 261
6. 직업병 예방 및 근로자의 보건관리대책
···························································· 264
제4장 식품위생 ············································· 266
I. 식품위생의 개념 ······································· 266
1. 식품위생의 정의 ··································· 266
2. 식품위생관리 ········································· 266
II. 식품에 의한 건강장해 ····························· 267
1. 식품관련전염병 ····································· 267
2. 인수공통전염병 ····································· 268
3. 식중독 ··················································· 270
4. 식품관련 기생충 질병 ··························· 270
III. 식중독 ····················································· 272
1. 세균성 식중독 ·········································272
2. 화학적 식중독 ······································· 275
3. 자연독에 의한 식중독 ··························· 277
4. 곰팡이독 식중독 ··································· 278
IV. 식품의 변질과 보존 ······························· 279
1. 식품변질의 개념 ··································· 279
2. 식품의 보존방법 ··································· 280
V. 식품의 위생관리 ····································· 281
1. 식품위생행정 강화 ································ 281
2. 식품위생행정의 과학화 ························· 281
3. 식중독 발생신고 ··································· 282
4. 식중독 예보지수 ··································· 282
제33편 역학 및 질병관리
제1장 역학 ····················································· 287
I. 역학의 개념 ·············································· 287
1. 역학의 정의 ·········································· 287
2. 의학과 역학의 비교 ······························ 288
3. 역학의 역할 ·········································· 288
4. 역학조사의 고전 사례 ··························· 289
II. 질병발생의 역학적 개념 ························· 290
1. 삼각형 모형설 ······································· 290
2. 수레바퀴 모형설 ··································· 291
3. 거미줄(원인망) 모형설 ·························· 291
III. 역학적 연구방법 ····································· 292
1. 역학조사의 개념 ··································· 292
2. 기술역학 ··············································· 293
3. 분석역학 ··············································· 294
4. 실험역학 ··············································· 299
5. 이론역학 ··············································· 300
IV. 질병발생의 빈도 및 위험도 측정과
역학조사의 오차방지 ····························· 303
1. 비, 비율, 율 ········································· 303
2. 유병률과 발생률 ··································· 303
3. 질병발생의 위험도 측정 ························ 304
4. 역학조사의 오차방지 ····························· 305
V. 역학적 연구의 평가 ································ 306
1. 바람직한 역학적 진단 검사법의 기준 ··· 306
2. 타당도 평가 ·········································· 306
3. 신뢰도 평가 ·········································· 307
제2장 전염병의 관리 ··································· 308
I. 전염병의 개념 ·········································· 308
1. 용어 정의 ············································· 308
2. 새로운 전염병의 유행 사례 ·················· 309
3. 전염병 발생설의 변천 ··························· 310
4. 전염병의 유행 ······································· 311
5. 전염병 발생의 시계열적 변화 ··············· 312
II. 전염병의 생성과정 ·································· 313
1. 전염병 생성의 6단계 구성요소 ············· 313
2. 병원체 ··················································· 314
3. 병원소 ··················································· 316
4. 병원소로부터 병원체의 탈출 ················· 318
5. 전파 유형 ············································· 319
6. 새로운 숙주에 침입 ······························ 321
7. 감수성 숙주의 감염 ······························ 322
III. 전염병 유행의 역학조사 ························ 326
1. 전염병 감시체계 ··································· 326
2. 전염병 유행의 역학조사 목적과 중요성
···························································· 326
3. 유행조사의 순서 ··································· 327
4. 전염병 유행의 유형 ······························ 327
5. 전염병 유행에 따른 역학현상 ··············· 328
IV. 전염병의 일반적인 관리 ························ 329
1. 전파예방 ··············································· 330
2. 숙주의 면역증강 ··································· 335
V. 급성전염병의 관리 ·································· 337
1. 소화기계 전염병 ··································· 337
2. 호흡기계 전염병 ··································· 341
3. 절지동물 매개전염병 ····························· 346
4. 동물매개전염병 ····································· 351
VI. 만성전염병의 관리 ································· 354
1. 결핵 ······················································ 354
2. 한센병 ··················································· 357
3. 성병 ······················································ 358
4. 후천성면역결핍증 ·································· 360
5. 트라코마 ··············································· 363
6. 간염 ······················································ 363
제3장 기생충질환의 관리 ···························· 365
I. 선충류 ······················································· 367
1. 회충증 ··················································· 367
2. 구충증 ··················································· 368
3. 요충증 ··················································· 368
4. 편충중 ··················································· 369
5. 말레이사상충증 ····································· 369
6. 동양모양선충증 ····································· 370
7. 선모충증 ··············································· 370
8. 아니사키스증 ········································· 371
II. 흡충류 ······················································ 372
1. 간흡충증 ··············································· 372
2. 폐흡충증 ··············································· 373
3. 요꼬가와흡충증 ····································· 374
III. 조충류 ····················································· 374
1. 무구조충증 ············································ 374
2. 유구조충증 ············································ 374
3. 광절열두조충 ········································· 375
IV. 원충류 ····················································· 375
1. 이질아메바증 ········································· 375
2. 질트리코모나스증 ·································· 376
제4장 만성질환의 관리 ································ 377
I. 만성질환의 개념 ······································· 377
1. 만성질환과 생활습관병 ························· 377
2. 발생 현황 ············································· 379
II. 만성질환의 종류 ······································ 380
1. 악성신생물(암) ······································ 380
2. 순환기계질환 ········································· 384
3. 당뇨병 ··················································· 390
III. 만성질환의 예방대책 ······························ 391
ix
제44편 보건관리
제1장 보건행정 ············································· 398
I. 보건행정의 개념 ······································· 398
1. 보건행정의 정의 ··································· 398
2. 보건행정의 범위 ··································· 398
3. 보건행정의 특성 ··································· 399
4. 보건행정의 체계 ··································· 399
II. 보건행정의 원리 ······································ 400
1. 보건문제의 해결과정 ····························· 400
2. 보건행정의 기술적 원칙 ························ 401
3. 보건행정의 행정적 원칙 ························ 402
III. 우리나라의 보건행정사 ·························· 406
1. 삼국시대(935년 이전) ··························· 406
2. 고려시대(936∼1392) ····························· 406
3. 조선시대(1392∼1910) ··························· 406
4. 한일합병시대(1910∼1945) ···················· 408
5. 8.15 해방 이후 미군정(1945∼1948)
···························································· 409
6. 대한민국 정부수립 이후(1948년 이후)
···························································· 409
IV. 우리나라의 보건행정 ····························· 410
1. 중앙보건행정 ········································· 410
2. 지방보건행정 ········································· 412
V. 보건소 ······················································ 414
1. 국외 보건소 제도의 발전 ······················ 414
2. 우리나라 보건소 제도의 변천 ··············· 414
3. 우리나라 보건소 제도 ··························· 414
VI. 국제보건관련기구 ··································· 415
1. 국제공중보건사무국 ······························· 415
2. 국제연합부흥행정처 ······························· 415
3. 범미보건기구 ········································· 416
4. 세계보건기구 ········································· 417
5. 유엔환경계획 ········································· 418
6. 국제연합아동긴급기금 ··························· 418
제2장 사회보장 ············································· 419
I. 사회보장의 개념 ······································· 419
1. 사회보장의 정의 ··································· 419
2. 사회보장의 기능 ··································· 419
3. 사회보장제도의 발달 ····························· 419
II. 사회보장제도의 구성 및 체계 ················ 420
1. 사회보험 ··············································· 421
2. 공공부조 ··············································· 422
3. 사회복지서비스 ····································· 422
III. 건강보험제도 ··········································· 423
1. 건강보험제도의 개념 ····························· 423
2. 국민건강보험제도의 발전과정 ················ 426
3. 국민건강보험제도의 주요내용 ················ 428
4. 요양급여비용의 본인일부부담금제도 ······ 431
5. 요양급여비용 지급방법 및 수가체계 ····· 432
6. 우리나라의 의료공급체계 ······················ 435
7. 노인장기요양보험제도 ··························· 435
IV. 의료급여제도 ·········································· 438
1. 수급권자의 유형 ··································· 438
2. 의료급여 수급권자의 자격관리 ·············· 438
3. 의료급여의 운영 및 진료체계 ············· 439
4. 의료급여의 내용 및 본인부담 ··············· 440
V. 산재보험제도 ··········································· 441
1. 개요 ······················································ 441
2. 산재보험의 특징 ··································· 442
3. 산재보험의 운영체계 ····························· 442
4. 산재보험급여의 종류 ····························· 443
5. 업무상 재해의 인정기준 ························ 443
VI. 연금보험제도 ·········································· 444
1. 국민연금제도의 개념 ····························· 444
2. 국민연금제도의 필요성 ························· 445
3. 국민연금제도의 연혁 ····························· 445
4. 가입대상과 급여종류 ····························· 445
5. 운영조직과 사업체계 ····························· 446
x
제3장 보건사업 ············································· 447
I. 모자보건 ··················································· 447
1. 모자보건의 개념 ··································· 447
2. 모자보건지표 ········································· 450
3. 모성보건 ··············································· 452
4. 영·유아보건 ········································ 456
II. 인구 및 가족계획 ···································· 460
1. 인구의 개념 ·········································· 460
2. 인구론의 발전 ······································· 461
3. 인구의 구성 ·········································· 462
4. 인구성장 ··············································· 464
5. 인구조사 ··············································· 468
6. 인구현황 ··············································· 470
7. 인구문제 및 대책 ·································· 473
8. 생명표 ··················································· 475
9. 가족계획 ··············································· 476
III. 보건교육 및 학교보건 ···························· 487
1. 보건교육의 개념 ··································· 487
2. 보건교육의 방법 ··································· 488
3. 보건교육의 대상 및 습득과정 ··············· 490
4. 보건교육의 계획과 평가 ························ 491
5. 학교보건 ··············································· 493
IV. 보건영양 ················································· 500
1. 보건영양의 개념 ··································· 500
2. 영양소의 3대 작용 ································ 500
3. 영양소의 종류와 기능 ··························· 501
4. 열량 대사 ············································· 507
5. 영양상태 판정을 위한 신체 계측치 및
비만판정 ··············································· 508
6. 식생활과 영양권장량 ····························· 513
V. 노인 및 정신보건 ··································· 515
1. 노인보건 ··············································· 515
2. 정신보건 ··············································· 520
VI. 사고와 중독 ············································ 525
1. 사고 ······················································ 525
2. 농약중독 ··············································· 525
3. 알코올 중독 ·········································· 527
4. 니코틴 중독 ·········································· 537
5. 약물중독과 남용 ··································· 540
6. 마약 중독 ············································· 542
7. 사이버중독 ············································ 552
VII. 보건통계 ················································ 555
1. 보건통계의 개념 ··································· 555
2. 모집단 및 표본 ····································· 556
3. 통계자료의 처리 ··································· 558
4. 보건지표 ··············································· 562
연습문제 ··················································· 569
참고문헌 ··················································· 638

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