• Title/Summary/Keyword: $V_{S30}$

Search Result 2,080, Processing Time 0.034 seconds

The Identification of the High-Risk Pregnacy, Usign a Simplified Antepartum Risk-Scoring System (단순화된 산전위험득점체계를 이용한 고위험 임부의 확인)

  • Jo, Jeong-Ho
    • The Korean Nurse
    • /
    • v.30 no.3
    • /
    • pp.49-65
    • /
    • 1991
  • This study was carried out to assess the problems with the pregnant women, and check out the risk-factors in the high-risk pregnancies, using a simplified antepartum risk-scoring system, which was revised from Edwards' scoring system to be suitable for Korean situaition. This instrument was included 4 categories, demographic, obstetric, medical and miscellaneous factors. This survey was based on the 1300 pregnant women who were admitted, $x^2$-test, F-test, Pearsons correation, using statistical package SAS in NAS computer system, KIST. The results of the study were as follows; 1. 1313 infants were deliveried of these 560 infants(42.7%) were born to mothers with risk-scores > 7, and 753 infants(57.3%) were born to mothers risk-scores <7. 2. Maternal age" parity, education level, of the demographic factors were significant relation statistically to identify the high risk pregnancies($X^2$=20.88, 42.87, 15.60 P < 0.01). 3. C-section, post term, incompetent cervix, uterine anomaly, polyhydramnios, congenital anomaly, sensitized RH negative, abortion, preeclampsia, excessive size infant, premature, low birth weight infanl, abnormal presentation, perinatal loss, multiple pregnancy, of the obstetric factors were significant relation statistically to identify the high risk-pregnancies. ($X^2$ = 175.96, 87.5, 16.28, 21.78, 9.46, 8. 10, 6.75, 22.9, 64.84, 6.93, 361.43, 185.55, 78.65, 45.52, P < 0.01). 4. Abnormal nutrition, anemia, UTI, other medicalcondition(pulmonary disease, severe influenza), heart disease, V.D., of the miscellaneous and medical factors, were significant relation statistically to identify the high risk-pregnancies. 5. Premature, low birth weight infant, contracted pelvis, abnormal presentation, of the risk factors were significantly related with Apgar score at 1 '||'&'||' 5 minute after birth and neonatal body weight. 6. Apgar score at 1 '||'&'||' 5 minute after, birth and neonatal body weight were significantly negative correlated with risk-score. 7. There were statistically significant difference between risk-score and Apgar score at 1 '||'&'||' 5 minute after birth, 3 group(0-3, 4-6, above 7), and neonatal body weight, 2 group(below 2.5kg, the other group) (F=104.65, 96.61, 284.92, P<0.01). 8. Apgar score at 1 '||'&'||' 5 minute after birth(below 7), and neonatal body weight(below 2.5kg), were significant relation statistically with risk score.($x^2$=65.99, 60.88, 177.07, P<0.01) were 60.8 %, 60% . 9. Correct classifications of morbid infants(l '||'&'||' 5 minute Apgar score < 7) were 77.8%, 83.8% and that of nonmorbid infants(l '||'&'||' 5 minute Apgar score > 7) were 60.8%, 60%. 10. There were statistically significant difference between dislribution of maternal risk-score among the morbid infants(l '||'&'||' 5 minute Apgar score < 7) and non morbid infants(l '||'&'||' 5 minute Apgar score> 7) ($x^2$=64.8, 58.8, P < 0.001). 11. There were statistically significant difference between distribution of morbid infants(l '||'&'||' 5 minute Apgar score < 7) and fetal death. 12. The predictivity for classifying high.risk cases was 12 % and for classifying low-risk cases was 98.3 % in 5 minute Apgar score. Suggestions for further studies are as follows; 1. Contineous prospective studies, using this newly revised scoring system are strongly recommended in the stetric service. 2. Besides risk facto~s used in this study, assessmenl of risks by factors in another scoring system and paralled studies related to perinatal outcome are strongly recommended.

  • PDF

Neural pathway innervating ductus Deferens of rats by pseudorabies virus and WGA-HRP (흰쥐에서 WGA-HRP와 pseudorabies virus를 이용한 정관의 신경로에 대한 연구)

  • Lee, Chang-Hyun;Chung, Ok-Bong;Ko, Byung-Moon;Lee, Bong-Hee;Kim, Soo-Myung;Kim, In-Shik;Yang, Hong-Hyun
    • Korean Journal of Veterinary Research
    • /
    • v.43 no.1
    • /
    • pp.11-24
    • /
    • 2003
  • This experimental studies was to investigate the location of PNS and CNS labeled neurons following injection of 2% WGA-HRP and pseudorabies virus (PRY), Bartha strain, into the ductus deferens of rats. After survival times 4-5 days following injection of 2% WGA-HRP and PRV, the rats were perfused, and their brain, spinal cord, sympathetic ganglia and spinal ganglia were frozen sectioned ($30{\mu}m$). These sections were stained by HRP histochemical and PRY inummohistochemical staining methods, and observed with light microscope. The results were as follows ; 1. The location of sympathetic ganglia projecting to the ductus deferens were observed in pelvic ganglion, inferior mesenteric ganglion and L1-6 lwnbar sympathetic ganglia. 2. The location of spinal ganglia projecting to the ductus deferens were observed in T13-L6 spinal ganglia. 3. The PRY labeled neurons projecting to the ductus deferens were observed in lateral spinal nucleus, lamina I, II and X of cervical segments. In thoracic segments, PRY labeled neurons were observed in dorsomedial part of lamina I, II and III, and dorsolateral part of lamina IV and V. Densely labeled neurons were observed in intermediolateral nucleus. In first lumbar segment, labeled neurons were observed in intermediolateral nucleus and dorsal commisural nucleus. In sixth lumbar segment and sacral segments, dense labeled neurons were observed in sacral parasympathetic nuc., lamina IX and X. 4. In the medulla oblongata, PRV labeled neurons projecting to the ductus deferens were observed in the trigeminal spinal nuc., A1 noradrenalin cells/C1 adrenalin cells/caudoventrolateral reticular nuc., rostroventrolateral reticular nuc., area postrema, nuc. tractus solitarius, raphe obscurus nuc., raphe pallidus nuc., raphe magnus nuc., parapyramidal nuc., lateral reticular nuc., gigantocellular reticular nuc.. 5. In the pons, PRV labeled neurons projecting to the ductus deferens were ohserved in parabrachial nuc., Kolliker-Fuse nuc., locus cooruleus, subcooruleus nuc. and AS noradrenalin cells. 6. In midbrain, PRV labeled neurons projecting to the ductus deferens were observed in periaqueductal gray substance, substantia nigra and dorsal raphe nuc.. 7. In the diencephalon, PRV labeled neurons projecting to the ductus deferens were observed in paraventricular hypahalamic nuc., lateral hypothalamic nuc., retrochiasmatic nuc. and ventromedial hypothalamic nuc.. 8. In cerebrum, PRV labeled neurons projecting to the ductus deferens were observed in area 1 of parietal cortex. These results suggest that WGA-HRP labeled neurons of the spinal cord projecting to the rat ductus deferens might be the first-order neurons related to the viscero-somatic sensory and sympathetic postganglionic neurons, and PRV labeled neurons of the brain and spinal cord may be the second and third-order neurons response to the movement of smooth muscles in ductus deferens. These PRV labeled neurons may be central autonomic center related to the integration and modulation of reflex control linked to the sensory and motor system monitaing the internal environment. These observations provide evidence for previously unknown projections from ductus deferens to spinal cord and brain which may be play an important neuroanatornical basic evidence in the regulation of ductus deferens function.

Effects of Solvent Extraction by Immersion on the Quality and Storage Stability of Rice (용매침지(溶媒浸漬)에 의한 탈지(脫脂)처리가 쌀의 품질(品質) 및 저장성(貯臧性)에 미치는 영향)

  • Cheigh, Hong-Sik;Kwon, Tai-Wan
    • Korean Journal of Food Science and Technology
    • /
    • v.4 no.4
    • /
    • pp.271-275
    • /
    • 1972
  • Effects of solvent extraction by immersion on the quality and storage stability of Korean rice were studied. Proportions of lipid extracted from whole grain of rice by immersing into two volumes(v/wt) of hexane and ethanol for 72 hours at room temperature were 0.41% and 0.38% respectively. Small changes of water content and hardness of rice were observed by solvent treatment. Cooking characteristics; that is, water-uptake ratio. extended volume, total solid, and starch-iodine blue test of rice was markedly changed by ethanol treatment, while little changes were observed by hexane treatment. No considerable differences in moisture sorption isotherm of rice were observed by both solvent treatments. Changes in TBA number and stale flavor appearance of rice treated with or without solvent immersion during storage at $60^{\circ}C$ showed that rice treated with hexane had best storage stability compared to ethanol treatment, while ethanol treatment of rice had better storage stability than no treatment. Similar results were noted in changes of the flavor score of cooked rice samples which were freeze dried.

  • PDF

Plankton Community Response to Physico-Chemical Forcing in the Ulleung Basin, East Sea during Summer 2008 (2008년 하계 울릉분지에서 관측된 물리·화학적 외압에 대한 플랑크톤 군집의 반응)

  • Rho, Tae-Keun;Kim, Yun-Bae;Park, Jeong-In;Lee, Yong-Woo;Im, Dong-Hoon;Kang, Dong-Jin;Lee, Tong-Sup;Yoon, Seung-Tae;Kim, Tae-Hoon;Kwak, Jung-Hyun;Park, Hyun-Je;Jeong, Man-Ki;Chang, Kyung-Il;Kang, Chang-Keun;Suh, Hae-Lip;Park, Myung-Won
    • Ocean and Polar Research
    • /
    • v.32 no.3
    • /
    • pp.269-289
    • /
    • 2010
  • In Summer 2008, a multidisciplinary survey was conducted onboard R/V Haeyang 2000 to understand plankton response to the three distinct physico-chemical settings that developed in the Ulleung Basin of the East Sea. Baseline settings of hydrographic conditions included the presence of the thin (<20 m) Tsushima Surface Water (TSW) on top of the Tsushima Middle Water (TMW). It extends from the Korea Strait to $37^{\circ}N$ along the $130^{\circ}E$ and then turns offshore and encompasses the relatively saline (T>$26^{\circ}C$, S>33.7) Ulleung Warm Eddy surface water centered at $36.5^{\circ}N$ and $131^{\circ}E$. A relatively colder and saline water mass appeared off the southeastern coast of Korea. It was accompanied by higher nutrient and chlorophyll-a concentrations, suggesting a coastal upwelling. Most of the offshore surface waters support low phytoplankton biomass (0.3 mg chl-a $m^{-3}$). A much denser phytoplankton biomass (1-2.3 mg $m^{-3}$) accumulated at the subsurface layer between 20-50 m depth. The subsurface chlorophyll-a maximum (SCM) layer was closely related to the nutricline, suggesting an active growth of phytoplankton at depth. The SCM developed at shallow depth (20-30 m) near the coast and deepened offshore (50-60 m). A fucoxanthin/zeaxanthin ratio was high in coastal waters while it was low in offshore waters, which indicated that diatoms dominate coastal waters while cyanobacteria dominate offshore waters. The community structure and biomass of phytoplanktonare closely related to nitrogen availability. Zooplankton biomass was higher in the coastal region than in the offshore region while species richness showed an opposite trend. Zooplankton community structure retained a coastal/offshore contrast. These suggest that summer hydrography is a stable structure, lasting long enough to allow a hydrography-specific plankton community to evolve.

Study on the osteoporosis knowledge, concern about osteoporosis factors, and health behavior to prevent osteoporosis of women in Jeonbuk area (전북지역 성인여성의 골다공증 지식, 골다공증관련 요인에 대한 관심 및 예방적 건강행동에 관한 연구)

  • Lee, Hyun Ju;Rho, Jeong Ok
    • Journal of Nutrition and Health
    • /
    • v.51 no.6
    • /
    • pp.526-537
    • /
    • 2018
  • Purpose: The purpose of the study was to identify women's osteoporosis knowledge, concerns about osteoporosis factors, and health behavior as well as to examine the relationship between these variables. Methods: The participants were 394 women in the Jeonbuk area. The data were analyzed using a t-test, ANOVA, Duncan test, and hierarchical regression analysis with SPSS v. 24.0. Results: The score for osteoporosis knowledge was 6.21 points out of a possible 12, the score for concern about osteoporosis factors was 26.50 points out of a possible 40. The score for the health behavior was 57.26 points out of a possible 85. The knowledge showed significant differences according age (p < 0.01), income (p < 0.05), education level (p < 0.01), drinking milk in childhood (p < 0.05), health interest (p < 0.05), and osteoporosis information (p < 0.01). The concern showed significant differences according to age (p < 0.001), income (p < 0.05), health interest (p < 0.001), osteoporosis information (p < 0.001), family history of osteoporosis (p < 0.05), and calcium medications (p < 0.001). The health behavior showed significant differences according to age (p < 0.001), income (p < 0.01), drinking milk in childhood (p < 0.05), health interest (p < 0.001), osteoporosis information (p < 0.01), and calcium medications (p < 0.01). Regression analysis showed that the concern about osteoporosis factors was the most influential variable on health behavior, followed by health interest of the subjects, age, and the osteoporosis knowledge. Conclusion: Therefore, it is necessary to consider educational programs on increasing interest in osteoporosis according to the age and health for improving the health behavior to prevent osteoporosis.

A study on the weight control behavior according to cluster types of the motivation to use social media among university students in the Jeonbuk area (전북지역 대학생의 소셜미디어 이용동기 유형에 따른 체중조절 행태 연구)

  • Jiyoon Lee;Sung Suk Chung;Jeong Ok Rho
    • Journal of Nutrition and Health
    • /
    • v.56 no.2
    • /
    • pp.203-216
    • /
    • 2023
  • Purpose: This study examines the weight control behavior depending on university students' motives of using social media. Methods: The participants were 447 university students in the Jeonbuk area. Collected data were analyzed using factor analysis, cluster analysis, analysis of variance, and χ2 tests with SPSS v. 26.0. Considering the motives of using social media, we investigated the usage of social media, dietary behavior related to social media, and weight control behavior. Results: Using the K-clustering method, the motives to use social media were categorized into three clusters: cluster 1 was the interest-centered group, cluster 2 was the multipurpose information-seeking group, and cluster 3 was the relationship-centered group. Among the various social media sites, YouTube (86.8%), Instagram (76.1%), and Facebook (61.1%) were the most visited by the subjects. The dietary behavior related to social media in cluster 2 was significantly higher than clusters 1 and 3 (p < 0.001). Clusters 1 and 2 showed a significantly higher dissatisfaction with one's weight (p < 0.05) and consequent interest in weight control than cluster 3 (p < 0.001). Cluster 2 used weight control-related information from social media significantly more than other clusters (p < 0.05). Weight control experiences in cluster 1 and 2 were significantly higher than in cluster 3 (p < 0.001). Conclusion: Differences in dietary behavior related to social media and weight control behavior were observed between cluster types of motivation to use social media. Based on the usage motives of university students and their behaviors, we propose that educational programs should be conducted for weight control using social media.

The Study on the Debris Slope Landform in the Southern Taebaek Mountains (태백산맥 남부산지의 암설사면지형)

  • Jeon, Young-Gweon
    • Journal of the Korean Geographical Society
    • /
    • v.28 no.2
    • /
    • pp.77-98
    • /
    • 1993
  • The intent of this study is to analyze the characteristics of distribution, patter, and deposits of the exposed debris slope landform by aerial photography interpretation, measure-ment on the topographical maps and field surveys in the southern part Taebaek mountains. It also aims to research the arrangement types of mountain slope and the landform development of debris slopes in this area. In conclusion, main observations can be summed up as follows. 1. The distribution characteristics 1)From the viewpoint of bedrocks, the distribution density of talus is high in case of the bedrock with high density of joints, sheeting structures and hard rocks, but that of the block stream is high in case of intrusive rocks with the talus line. 2)From the viewpoint of bedrocks, the distribution density of talus is high in case of the bedrock with high density of joints, sheeting structures and hard rocks, but that of the block stream is high in case of inrtusive rocks with the talus line. 2) From the viewpoint of distribution altitude, talus is mainly distributed in the 301~500 meters part above the sea level, while the block stream is distributed in the 101~300 meters part. 3) From the viewpoint of slope oriention, the distribution density of talus on the slope facing the south(S, SE, SW) is a little higher than that of talus on the slope facing the north(N, NE, NW). 2. The Pattern Characteristics 1) The tongue-shaped type among the four types is the most in number. 2) The average length of talus slope is 99 meters, especially that of talus composed of hornfels or granodiorite is longer. Foth the former is easy to make free face; the latter is easdy to produce round stones. The average length of block stream slope is 145 meters, the longest of all is one km(granodiorite). 3) The gradient of talus slope is 20~45${^\circ}$, most of them 26-30${^\croc}$; but talus composed of intrusive rocks is gentle. 4) The slope pattern of talus shows concave slope, which means readjustment of constituent debris. Some of the block stream slope patterns show concave slope at the upper slope and the lower slope, but convex slope at the middle slope; others have uneven slope. 3. The deposit characteristics 1) The average length of constituent debris is 48~172 centimeters in diameter, the sorting of debris is not bad without matrix. That of block stream is longer than that of talus; this difference of debris average diameter is funda-mentally caused by joint space of bedrocks. 2) The shape of constituent debris in talus is mainly angular, but that of the debris composed of intrusive rocks is sub-angular. The shape of constituent debris in block stream is mainly sub-roundl. 3) IN case dof talus, debris diameter is generally increasing with downward slope, but some of them are disordered and the debris diameter of the sides are larger than that of the middle part on a landform surface. In block stream, debris diameter variation is perpendicularly disordered, and the debris diameter of the middle part is generally larger than that of the sides on a landform surface. 4)The long axis orientation of debris is a not bad at the lower part of the slope in talus (only 2 of 6 talus). In block stream(2 of 3), one is good in sorting; another is not bad. The researcher thinks that the latter was caused by the collapse of constituent debris. 5) Most debris were weathered and some are secondly weathered in situ, but talus composed of fresh debris is developing. 4. The landform development of debris slopes and the arrangement types of the mountain slope 1) The formation and development period of talus is divided into two periods. The first period is formation period of talus9the last glacial period), the second period is adjustment period(postglacial age). And that of block stream is divided into three periods: the first period is production period of blocks(tertiary, interglacial period), the second formation period of block stream(the last glacial period), and the third adjustment period of block stream(postglacialage). 2) The arrangement types of mountain slope are divided into six types in this research area, which are as follows. Type I; high level convex slope-free face-talus-block stream-alluvial surface Type II: high level convex slope-free face-talus-alluvial surface Type III: free face-talus-block stream-all-uvial surface Type IV: free face-talus-alluval surface Type V: talus-alluval surface Type VI: block stream-alluvial surface Particularly, type IV id\s basic type of all; others are modified ones.

  • PDF

Effect of Exercise on Antioxidant Enzyme Activities of Skeletal Muscle and Liver in STZ-diabetic Rats (STZ-당뇨쥐에서 운동부하가 골격근 및 간의 항산화효소 활성도에 미치는 영향)

  • Seok, Kwang-Ho;Lee, Suck-Kang
    • Journal of Yeungnam Medical Science
    • /
    • v.17 no.1
    • /
    • pp.21-30
    • /
    • 2000
  • Background: The purpose of the present study was to investigate the effect of exercise on the activities of antioxidant enzymes, super oxide dismutase(SOD), glutathione peroxidase(GPX) and catalase(CAT) of skeletal muscle(gastrocnemius) and liver in streptozotocin(STZ) induced diabetic rats. The malondialdehyde(MDA) concentration was also measured as an index of lipid poroxidation of tho tissues by exercise-induced oxidative stresses in diabetic rats. Material and Methods: Male Sprague-Dawley rats were randomly divided into control and STZ-induced diabetic rats. The STZ in citrate buffer solution was injected twice at S days intervals intraperitoneally(50, 70 mg/kg respectively). On the 28th day after the first STZ injection, the diabetic animals were randomly divided into pre- and post-exercise groups, The exercise was introduced to the rats of post-exercise group by treadmill running until exhaution with moderate intensity ($V_{O2max}$: 50-70%) of exercise. The duration of average running time was 2 hours and 19 minutes. Results: The blood glucose concentration was increased(p<0.001) and plasma insulin concentration was decreased(p<0.001) in the diabetic rats. The glycogen concentration in the muscle and liver was decreased by exhaustive exercise in the diabetic rats(p<0.001), In the skeletal muscle, the activities of GPX was increased(p<0.05) and the activities of SOD and CAT were not changed in the diabetic rats compare to those of the control rats. The activities of GPX was not changed by exercise but the activities of SOD(p<0.01) and CAT(p<0.01) were decreased by exercise in the diabetic rats, The concentration of MDA was not changed by exercise in diabetic rats, and the values of pre-exercise and post-exercise diabetic rats were not different from the value those of control rats, In the liver, the activities of SOD was decreased(p<0.01), and the activities of GPX and CAT were not changed in diabetic rats compared to the values of control rats, The activities of SOD, GPX and CAT were not changed by exercise in diabetic rats but the activity of SOD seemed to decrease slightly, The MDA concentration was increased in the diabetic rats compared to the values of control rats(p<0.001), but there was no change of MDA concentration by exercise in diabetic rats, Conclusions: In summary, exhaustive physical exercise did not seem to impose oxidative stress on the skeletal muscle because of due to oxygen free radicals, regardless of the decrease in SOD and CAT in the diabetic rats, In liver tissue, the tissue damage by oxidative stress was observed in diabetic rats but the additional tissue damage by exhaustive physical exercise was not observed.

  • PDF

Investigation on Korean Local Maize Lines V. Variabilities of Plant Characters of Multi-eared and Tillered Lines(MET) (재래종 옥수수 수집종에 대한 특성조사 제5보 다수다벽 재래종 옥수수계통의 특성변이)

  • Choe, B.H.;Park, J.S.;Kim, Y.R.;Park, K.Y.
    • KOREAN JOURNAL OF CROP SCIENCE
    • /
    • v.26 no.1
    • /
    • pp.56-68
    • /
    • 1981
  • A maize line was selected in 1979 among 1000 Korean local maize lines collected in 1977. The selected maize line was characterized by having three to four tillers and eight to 10 ears on each individual plant. The line was assumed to have a great potential as a silage crop. The investigation was conducted as one of the serial studies on the Korean maize collected lines to provide basic information on the genetic variabilities of the multi-eared and tillered (MET) line and on other agronomic characters, prior to use the line as material for future breeding works for silage crop. The MET line and Suwon #19, single cross hybrid, as check variety were planted on May 1, 15 and 30, in three different levels of plant populations. The results obtained were summarized as follows: 1. The genetic variabilities of multi-ear and tillering habits were greater than environmental variabilities. 2. Total dry leaf weight of individual plant of MET line was also significantly higher than that of Suwon #19. 3. The mean number of tillers and ears bearing on the individual plant of MET line varied greatly with plant densities. The number of tillers and ears was on the average 2.9 and 7.0, respectively, when planted in 60cm. by 60cm. 4. The total dry matter and dried stem weight of the individual plant on MET line were comparable to those of Suwon #19. 5. The kernel weight from the individual plant of MET line was 5 to 40% less than that of Suwon #19, depending upon the plant densities. 6. The Kernel to stover ratio was higher for Suwon #19 than for the MET line. (41% to 35%). 7. The MET line had shown first tiller two weeks after planted on May 1. The second and third tillers appeared three to five days after the appearance of the first tiller. 8. The MET line was very specific in tillering habits. All the tillers were borne on the first few nodes of main stem below the soil surface. 9. The tillering habits of MET line were vigorous in the early part of the growing season, but less vigorous in the later part of the growing season. The number of efficient tillers bearing useable ears, was around two to three, when planted in 60cm. by 60cm. 10. The difference of plant height between main stem and first few tillers was around 10cm. 11. The ear size of MET line was around one-third of the major corn belt hybrids. The shape of ear of MET line was conical, with different diameter. 12. The kernel of the MET line was flinty with small soft starch patches on the endosperm part. 13. The 100 kernel weight was around 15gr., which is about one half of the major high yielding hybrids. 14. The ear height of MET line was comparatively higher than that of Suwon #19. 15. Significantly high and positive phenotypic correlation coefficients were obtained among major plant characters. 16. The growth rate of MET line was slower than that of Suwon #19. 17. MET line and Suwon #19 were both heavily infected with black streaked mosaic virus.

  • PDF

An Intervention Study on Integration of Family Planning and Maternal/Infant Care Services in Rural Korea (가족계획과 모자보건 통합을 위한 조산원의 투입효과 분석 -서산지역의 개입연구 평가보고-)

  • Bang, Sook;Han, Seung-Hyun;Lee, Chung-Ja;Ahn, Moon-Young;Lee, In-Sook;Kim, Eun-Shil;Kim, Chong-Ho
    • Journal of Preventive Medicine and Public Health
    • /
    • v.20 no.1 s.21
    • /
    • pp.165-203
    • /
    • 1987
  • This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, $85{\sim}90%$ of the services provided by the health workers were other than FP/MCH, mainly for immunizations such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs.31%) and for more combined care (45% vs.23%). C) Organization factors (admistrative integrative issues) 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following ; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub·center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwive's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea); 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through family planning practice. 2) Goal consensus in FP/MCH shouBd be made among the health workers It administrators, especially to emphasize the need of care of 'wanted' child. But there is a long way to go to realize the 'real' integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (in) there should be a health sub·center director who can provide leadership training for managing the integrated program. There is a need for 'organizational support', if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the managment of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Worker, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.

  • PDF