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An Analysis of Determinants of Health Knowledge, Attitude and Practice of Housewives in Korea (한국부인의 보건지식, 태도 및 실천에 영향을 미치는 제요인분석)

  • 남철현
    • Korean Journal of Health Education and Promotion
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    • v.2 no.1
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    • pp.3-50
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    • 1984
  • The levels of health knowledge, attitude and practice of housewives considerably effect to the health of households, communities and the nation. This study was designed to grasp the levels of health knowledge, attitude and practice of houswives and analyse the various factors effecting to health in order to provide health education services as well as materials for effective formulation and implementation of health policy to improve the health of the nation. This study has been conducted through interviews by trained surveyers for 4,281 housewives selected from 4,500 households throughout the country for 40 days during July 11-August 20, 1983. The results of survey were analysed by stepwise multiple regression and path analysis are summarized as follows; 1. Based on the measurement instrument applied to this study, the levels of health knowledge, attitude and practice of housewives were extremely low with 54.5 points out of 100 points in full. Higher level with 72 points and above was approximately 21 percent and lower level with 39 points and below was approx. 24 percent. The middle level was approx. 55 percent. In order to implement health programs successively, health education should be more strengthened and to improve the level of health knowledge, attitude and practice (KAP) of the nation, political consideration as a part of spiritual reformation must be concentrated on health. 2. The level of health knowledge indicated the highest points with 57.3 the level of attitude was the second with 55.0 points and the practice level was the lowest with 50.0 point. Therefore, planning and implementation of health education program must be based on the persuasion and motivation that health knowledge turn into practice. 3. Housewives who had higher level of health knowledge, showed their practice level was relatively lower and those who had middle or low level of it practice level was the reverse. 4. Correlations among health knowledge, attitude and practice (KAP) were generally higher and statistically significant at 0.1 percent level. Correlation between total health KAP level and health knowledge was the highest with r=.8092. 5. Health KAP levels showed significant differences according to the age, number of children, marital status, self-assessed health status and concern on health of the housewives interviewed (p<0.001) 6. Health KAP levels also showed significant differences according to the education level, economic status, employment before marriage and grown-up area of the housewives interviewed. (p<0.001) 7. Heath KAP levels showed significant differences according to health insurance benificiary and the existence of patients in the family. (p<0.001). 8. Health KAP levels showed significant differences according to distance to government organizations, schools, distance to health facilities, telephone possession rate, television possession rate, newspaper reading rate and activities of Ban meeting and Women's club. (p<0.001) 9. Health KAP levels showed significant differences according to electric mass communication media such as television, radio and village broadcasting etc. and printed media such as newspaper, magazine and booklets etc., IEC variables such as individual consultation and husband-wife communication, however, there was no significance with group training. 10. Health KAP of the housewives showed close correlation with personal characteristics variables, i.e., education level (r=.5302), age (r=-.3694) grown-up area (r=.3357) and employment before marriage. In general, correlation of health knowledge level was higher than the levels of attitude or practice. In case of health concern and health insurance, correlation of practice level was higher than health knowledge level. 11. Health KAP levels showed higher correlation with community environmental characteristics, Ban meeting and activity of Women's club, however, no correlation with New-village movement. 12. Among IEC variables, husband-wife communication showed the highest correlation with health KAP levels and printed media, electric mas communication media and health consultation in order. Therefore, encouragement of husband-wife communication and development of training program for men should be included in health education program. 13. Mass media such as electric mass com. and printed media were effective for knowledge transmission and husband-wife communication and individual consultation were effective for health practice. Group training was significant for knowledge transmission, however, but not significant for attitude formation or turning to health practice. To improve health KAP levels, health knowledge should be transmitted via mass media and health consultation with health professionals and field health workers should be strengthened. 14. Correlation of health KAP levels showed that knowledge level was generally higher than that of practice and recognized that knowledge was not linked with attitude or practice. 15. The twenty-five variables effecting health KAP levels of housewives had 41 per cent explanation variances among which education level had great contribution (β=.2309) and electric mass com. media (β=.1778), husband-wife communication (β=.1482), printed media, grown-up area, and distance to government organizations in order. Variances explained (R²) of health KAP were 31%, 15%, and 30% respectively. 16. Principal variables contributed to health KAP were education level (β=.12320, β=.1465), electric mass comm. media (β=.1762, β=.1839), printed media, (β=.1383, β=.1420) husband-wife communication (β=.1004, β=.1067), grown-up area and distance to government organizations, in order. Since education level contributes greatly to health KAP of the housewives, health education including curriculum development in primary, middle and high schools must be emphasized and health science must be selected as one of the basic liberal arts subject in universities. 17. Variences explained of IEC variables to health KAP were 19% in total, 14% in knowledge, 9% in attitude, and 10% in health practice. Contributions of IEC variables to health KAP levels were printed media (β=.3882), electric mass comm media (β=.3165), husb-band wife com. (β=.2095,) and consultation on health (β=.0841) in order, however, group training showed negative effect (β=-.0402). National fund must be invested for the development of Health Program through mass media such as TV and radio etc. and for printed materials such as newspaper, magazines, phamplet etc. needed for transmission of health knowledge. 18. Variables contributed to health KAP levels through IEC variables with indirect effects were education level (Ind E=0.0410), health concern (Ind E=.0161), newspaper reading rate (Ind E=.0137), TV possession rate and activity of Ban meeting in order, however, health facility showed negative effect (Ind E=-.0232) and other variables showed direct effect but not indirect effect. 19. Among the variables effecting health KAP level, education level showed the highest in total effect (TE=.2693) then IEC (TE=.1972), grown-up city (TE=.1237), newspaper reading rate (TE=.1020), distance to government organization (TE=.095) in order. 20. Variables indicating indirect effects to health KAP levels were; at knowledge level with R²=30%, education level (Ind E=.0344), newspaper reading rate (Ind E=.0112), TV possession rate (Ind E=.0689), activity of Ban meeting (Ind E=.0079) in order and at attitude level with R²=13%, education level (Ind E=. 0338), activity of Ban meeting (Ind E=.0079), and at practice level with R²=29%. education level (Ind E=.0268), health facility (Ind E=.0830) and concern on health (Ind E=.0105). 21. Total effect to health KAP levels and IEC by variable characteristics, personal characteristics variables indicated larger than community characteristics variables. 22. Multiple Correlation Coefficient (MCC) expressed by the Personal Characteristic Variable was .5049 and explained approximately 25% of variances. MCC expressed by total Community environment variable was .4283 and explained approx. 18% of variances. MCC expressed by IEC Variables was .4380 and explained approx. 19% of variances. The most important variable effected to health KAP levels was personal characteristic and then IEC variable, Community Environment variable in order. When the IEC effected with personal characteristic or community characteristic, the MCC or the variances were relatively higher than effecting alone. Therefore it was identified that the IEC was one of the important intermediate variable.

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Countermeasure and Outbreak Mechanism of Cochlodinium polykrikoides red tide 1. Environmental characteristics on outbreak and disappearanceof C. polykrikoides bloom (Cochlodinium polykrikoides 적조 발생기작과 대책 1. Cochlodinium polykrikoides 적조 발생과 소멸의 환경특성)

  • Park, Young-Tae;Kim, Young-Sug;Kim, Kui-Young;Park, Jong-Soo;Go, Woo-Jin;Jo, Yeong-Jo;Park, Seong-Yoon;Lee, Young-Sik
    • The Sea:JOURNAL OF THE KOREAN SOCIETY OF OCEANOGRAPHY
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    • v.6 no.4
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    • pp.259-264
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    • 2001
  • Typhoon and neap tide on Cochlodinium polykrikoides bloom and water temperature on disappearance of C. polykrikoides bloom were investigated to elucidate the outbreak mechanism of C. polykrikoides blooms at Naro and Namhae coastal area in South Sea of Korea. The first observation of C. polykrikoides blooms were observed when thermocline was disappeared by typhoon, tide, etc. The first blooms of C. polykrikoides were observed on neap tide or before one day from neap tide in 1996-1998 and 2000. However, thermocline was disappeared by typhoon in 1994 and 1999, the first blooms were observed early 12-30 day than 1996-1998 and 2000. The main reason of disappearance of C. polykrikoides blooms after typhoon on 1997-2000 seems to be other environmental change by typhoon rather than low water temperature. In the future, the first C. polykrikoides bloom will be appear around the first neap tide of latter part of August with breaking down of thermocline, but if the thermocline be collapsed by typhoon in July, the C. polykrikoides bloom will be appear at beginning of August. The outbreak of C. polykrikoides blooms will be explain as follows: The vegetative cells, which was germinated by environmental change or already exist in surface water at low level, input to the surface water, and then nutrients and trace metals which were suppled from out side of C. polykrikoides bloom area inflow to surface. The vegetative cells are growth by the nutrients and trace metals at suitable environmental conditions e.g. water temperature, salinity, and sufficient light.

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Prevalence and Risk Factors of Gallstones in Adult Health Screening Population (건강한 성인의 담석 유병률과 위험인자)

  • Lee, Mi-Hwa;Kwon, Duck-Moon;Cho, Pyong-Kon
    • Journal of radiological science and technology
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    • v.37 no.4
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    • pp.287-294
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    • 2014
  • Gallstone is the most common disease of the biliary system. Korean has experienced an increase in the percentage of cholesterol gallstones. The major risk factors associated with cholesterol gallstones are age, gender as well as obesity. This study was designed to determine the prevalence of gallstones in the last three years and evaluate the associated risk factors in the population who underwent health screening. The study population consisted of 2,484 males and 2,212 females who visited the health promotion center in Dalseogu, Daegu in Korea from January 2011 to December 2013. Each participant in the study had their biliary system gallbladder examined using ultrasonography. Classified as underweight, normal weight or overweight using the population of obese according to the body mass index, and classified according to mood diagnosis of diabetes presented by the American Diabetes Association. Fasting blood glucose and number of liver function, the divided the control group by referring to the normal liver function values used herein. The geological map, I was classified as NCEP APT III. A showed of total 148 people were found to have gallstones. The prevalence of sex among 148 patients (3.15%) 84 men (1.79%) and 64 women 1.36%) which shows significantly there is little difference. 1.84% 40 years and below, 3.38% 40's showed age prevalence was 4.66% in 50's and above. In addition, Total-cholesterol was at the most in 52 people, LDL-cholesterol in 398 people, Triglyceride in 36 people, HDL-cholesterol in 19 people. The abnormal group, was created from the total-cholesterol categories from a physical examination of a subject that has been found to be gallstones in the gallbladder. A result of conducting the univariate analysis shows the prevalence of gallstones, a correlation that is meaningful. The logistic regression analysis of multiple ages was chosen to show risk factors age independent cholelithiasis. In spite of the conclusion, gallstones are not displayed in relation to the metabolic syndrome but in order to clarify this, not only the subject of a health examination is needed but, a further study of the general public when possible.

Effect of Thyroxie and Propylthiouracil on the Responses of Plasma Corticosterone and Brain Norepinephrine to Swim-Stress (수영(水泳)-스트레스에 의한 혈장 Corticosterone 함량 및 뇌(腦) Catecholamine대사(代謝)의 변동(變動)에 미치는 Thyroxine 및 Propylthiouracil의 영향)

  • Shin, Kyung-Ho;Hong, Ki-Nam;Kim, Hyung-Gun;Chun, Boe-Gwun
    • The Korean Journal of Pharmacology
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    • v.25 no.1
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    • pp.13-21
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    • 1989
  • The circadian rhythm of spontaneous motor activity was not significantly altered by $T_4$(4mg/kg, i.p. inj. once a day for 5 days: $T_4$) and PTU (fed ad lib in 0.01% drinking water for 5 weeks: PTU). The plasma thyroxine level was markedly increased by $T_4$ but reduced by PTU, and the plasma thyrotropin level was markedly increased by PTU but moderately increased by $T_4$. Clonidine slightly increased the plasma CS level, but the clonidine effect was significantly enhanced by $T_4-pretreatment$. The brain NE and MHPG contents were little affected by $T_4$ but the NE content was significantly decreased by PTU. The SS-induced increase of plasma CS level was moderately decreased by PTU but increased by $T_4$. However, clonidine significantly inhibited the SS-induced increase, and the inhibitory effect of clonidine was not significantly affected by PTU and $T_4$, respectively. The brain MHPG content and MHPG/NE ratio were significantly decreased by clonidine but increased by SS. The clonidine- and SS-induced changes of brain MHPG content and MHPG/NE ratio were not altered by $T_4$. PTU did not affect the SS-induced increase of brain NE turnover but significantly attenuated the clonidine-induced decrease. The SS-induced increases of brain MHPG content and MHPG/NE rtatio were markedly inhibited by clonidine, and the inhibitory effect of clonidine was not affected by $T_4$ and PTU, respectively. These results suggest that the responses to swim-stress is not signigicantly affected by the alteration of thyroid function and that the hypothalamo-adenohypophysis-adrenocortical stimulation in response to swim-stress seems to be mediated via hypothalamic noradrenergic activation, and the stress response may be inhibited by the agonistic activity of clonidine on the presynaptic ${\alpha}_2-adrenoceptor$.

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Chemoprevention of Helicobacter pylori-associated Gastric Carcinogenesis in a Mouse Model; Is It Possible?

  • Hahm, Ki-Baik;Song, Young-Joon;Oh, Tae-Young;Lee, Jeong-Sang;Surh, Young-Joon;Kim, Young-Bae;Yoo, Byung-Moo;Kim, Jin-Hong;Ha, Sang-Uk;Nahm, Ki-Taik;Kim, Myung-Wook;Kim, Dae-Yong;Cho, Sung-Won
    • BMB Reports
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    • v.36 no.1
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    • pp.82-94
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    • 2003
  • Although debates still exist whether Helicobacter pylori infection is really class I carcinogen or not, H. pylori has been known to provoke precancerous lesions like gastric adenoma and chronic atrophic gastritis with intestinal metaplasia as well as gastric cancer. Chronic persistent, uncontrolled gastric inflammations are possible basis for ensuing gastric carcinogenesis and H. pylori infection increased COX-2 expressions, which might be the one of the mechanisms leading to gastric cancer. To know the implication of long-term treatment of antiinflammatory drugs, rebamipide or nimesulide, on H. pylori-associated gastric carcinogenesis, we infected C57BL/6 mice with H. pylori, especially after MNU administration to promote carcinogenesis and the effects of the long-term administration of rebamipide or nimesulide were evaluated. C57BL/6 mice were sacrificed 50 weeks after H. pylori infection. Colonization rates of H. pylori, degree of gastric inflammation and other pathological changes including atrophic gastritis and metaplasia, serum levels and mRNA transcripts of various mouse cytokines and chemokines, and NF-${\kappa}B$ binding activities, and finally the presence of gastric adenocarcinoma were compared between H. pylori infected group (HP), and H. pylori infected group administered with long-term rebamipide containing pellet diets (HPR) or nimesulide mixed pellets (HPN). Gastric mucosal expressions of ICAM-1, HCAM, MMP, and transcriptional regulations of NF-${\kappa}B$ binding were all significantly decreased in HPR group than in HP group. Multi-probe RNase protection assay showed the significantly decreased mRNA levels of apoptosis related genes and various cytokines genes like IFN-$\gamma$, RANTES, TNF-$\alpha$, TNFR p75, IL-$1{\beta}$ in HPR group. In the experiment designed to provoke gastric cancer through MNU treatment with H. pylori infection, the incidence of gastric carcinoma was not changed between HP and HPR group, but significantly decreased in HPN group, suggesting the chemoprevention of H. pylori-associated gastric carcinogenesis by COX-2 inhibition. Long-term administration of antiinflammatory drugs should be considered in the treatment of H. pylori since they showed the molecular and biologic advantages with possible chemopreventive effect against H. pylori-associated gastric carcinogenesis. If the final concrete proof showing the causal relationship between H. pylori infection and gastric carcinogenesis could be obtained, that will shed new light on chemoprevention of gastric cancer, that is, that gastric/cancer could be prevented through either the eradication of H. pylori or lessening the inflammation provoked by H. pylori infection in high risk group.

Effect of Dietary Fish Oil on Lipid Peroxidation in Rats Liver and Brain During Postnatal Development (어유섭취가 출생후 발달과정의 흰 쥐의 간과 뇌조직의 지질과산화와 그 관련기능에 미치는 영향)

  • 박명희
    • Journal of Nutrition and Health
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    • v.20 no.2
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    • pp.111-121
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    • 1987
  • Lipie peroxide formation, antiperoxidative s system and body adaptability for handling lipid p peroxide were examined in the first and second g generations of rats fed fish oil. Mackerel oil(MO) was used and four other dietary oils and fat, i.e. soybean oil(SO), perilla oil(PO), rapeseed oil(RO) and beef tallow(BT) were also employed to compare the effect of fish oil. Synthetic diets containing these five dietary fats at the level of 1O%(w/w), were given to the correspond­m ing groups of male and female rats weighing about 70 grams. After 34 days of feeding, male a and female rats were mated and their offsprings were raised throughout suckling (17, 26 days) and weanling (39 days) periods. Liver lipid pero­x xide level was highest in MO group of both first (mother rats after lactation) and second genera­t tions of 17 and 26 days old, but not of 39 days old. During suckling period, liver lipid peroxide level was well matched to total unsaturation of dietary fat. Brain lipid peroxide levels were not different among five groups. Liver $alpha$-tocopherol a and reduced glutathione (GSH) levels were lowest in MO fed first generation. In second generation, $alpha$-tocopherol level was also low in MO group, although the effect was less pronoun­c ced, but GSH level was not different from other groups. Oxidized glutathione (GSSG) level did not consistently vary by change in dietary fat. Glutathione peroxidase activity increased as young rats grew up to 39 days. Superoxide d dismutase activity change was insignificant by a age, but was shown as lowest in MO group. At the age of 26 and 39 days, liver glutatione peroxidase activity was increased as was level of lipid peroxide, suggesting that this is the one of the mechanisms responsible for body adapta­b bility for protection against the accumulation of lipid peroxide.

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The Effect of Hyperthermia Combined with Radiation on Crypts of the Mouse Jejunum (마우스공장 소낭선의 방사선 효과에 온열요법의 병용이 미치는 영향에 관한 실험적 연구)

  • Bae, Hoon-Sik;Park, Charn-Il;Kim, Jung-Jin
    • Radiation Oncology Journal
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    • v.5 no.1
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    • pp.13-21
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    • 1987
  • The effect of local hyperthermia of 41 to $43^{\circ}C$ for 30 minutes on radiosensitivity of normal tissue was studied utilizing jejunal crypt microcolony assay. Hyperthermia of this range enhanced the radiation effect and the effect was mainly additive without significant effect on the slopes of cell survival curves. At the isoeffect level of 20 microcolony formation, the thermal enhancement ratio was 1.02, 1.10 and 1.39 for $41^{\circ},\;42^{\circ}\;and\;43^{\circ}C$, respectively. The distribution of microcolony formation along the circumference of jejunum was not uniform, having more colonies around the mesenteric border, and this suggests the effect of uneven cooling by blood circulation.

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The Effect of Forest Production on National Income (임업생산(林業生産)이 국민소득(國民所得)에 미치는 영향(影響))

  • Lee, Sung Yoon
    • Journal of Korean Society of Forest Science
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    • v.9 no.1
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    • pp.61-74
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    • 1969
  • Forest area in Korea ocupies as much as 68 percent of the total land area, but forest production figure in the statistics is rather trifling: that is about 2 percent of Gross National Production (G.N.P.), on the average. In view of the primary industrial sector, its production only weighs no more than 5 percent of this whole sector. Forest production written above refers only to direct forest income of the whole forest income. For the primary forest products they are in many cases used as raw materials for other interrelated industries. The added value there-from, which arises from round about production Process, in other word, indirect income is of most singnificance. Nevertheless, until nowadays forest production has been merely refered to timber production i, e, direct production but indirect income has never been looked upon. In this regard, calculated indirect forest income by means of input ratio method. The material used were Leontiefls tables of two 1963 and 1966 fiscal years, surveyed and analysed by The Bank of Korea. Indirect forest income calculated were 42,688,200,000 won in 1963 and 74,789,800,000 won in 1966 compared direct forest income of 14,361,000,000 won in 1963 and 17,709,000,000 won in 1966. So far as indirect forest income is considered total forest production indices composed of direct and indirect forest income amount to 8.23% in 1963 and 10.12% in 1966 of Gross National Production. Invisuable forest income which originates from, what we cal, indirect benefit of forestry such as land conservation, flood and drought control, soil run off control, scenic beauty and many others is naturall, not included in the calculation. As already mentioned, primary forest products are, for the most part, utilized as raw materials for other industries, therefore indirect forest income is rather appreciable than direct forest income, contributing for the growth and development of other connected industries. In these points of view, forestry must not be evaluated trifling in deciding industrial importances.

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The Study on the Influence of Selection Characteristics of Franchise System, business possibility, Communication, Moral Hazard on Franchisee's Perceived Risk, and Recontracting Intention in the Food Service Franchise Industry (외식 프랜차이저의 사업성, 커뮤니케이션, 모럴해저드가 프랜차이지의 위험지각과 재계약의도에 미치는 영향)

  • Yu, Jong-Pil;Lee, In-Ho
    • Journal of Distribution Research
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    • v.16 no.1
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    • pp.1-27
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    • 2011
  • I. Introduction: This study is to examine the structural relationships among exogenous variable (preliminary and post-support, franchisee's perceived business possibility, communication, moral hazard), the mediated variables(satisfaction, perceived risk, trust) and dependent variable(recontracting intention) in the food service franchise industry context. More specifically, this study has considered some realistic characteristics factors influencing satisfaction, perceived risk and trust between franchisors and franchisees and their further recontracting intention from the perspective of a practical approach. In this study, 437 data has been collected and used for the SPSS and AMOS analysis. The data were analyzed with structural equation modeling. Since the result of the overall model analysis demonstrated a good fit, we could further analyze our data. II. Research Model: This study is to examine the structural relationships among preliminary and post-support by franchisor, franchisee's perceived business possibility, and communication, moral hazard, has on effect on franchisee's satisfaction, perceived risk, trust and recontracting intention in the food service franchise industry context. Hypotheses are as following (Stern & EL-Ansary 1988; Oliver, 1997;Kee & Knox, 1970; Moorman, Deshpande & Zaltman, 1993; Perron, 1998; Zaheer, McEvily, Perrone, 1998). III. Result and Implication: We examined franchisee who have food service stores for samples of this study. The data were analyzed with structural equation modeling using path analysis. The result of the overall model analysis appeared as following: ${\chi}^2$ = 61.578 (d.f.=9, p<0.01), CFI =.990, GFI =.973, AGFI =.863, RMR =.019, RMSEA= .116, NFI = .988, TLI = .959. The findings can be summarized as follows: First, preliminary and post support of franchisor, perceived business possibility and communication positively influence to franchisee's satisfaction. Second, moral hazard of franchisor has negatively influence to franchisee's satisfaction and positively influence to perceived risk. Third, franchisee's satisfaction and trust has positively influence to recontracting intention. Fourth, franchisee's perceived risk has negatively influence to trust and recontracting intention. We can concluded that franchisor's preliminary and post support of franchisor, perceived business possibility and communication may be considered as the important factors influence to franchisee's satisfaction. Moral hazard has become a focused issue in franchise industry. Finally, the managerial implication has been stated as followings: First, in the process of building a systematic industry support franchise system and developing a creative business model, franchisee's stable profitability should be considered as the first important factor. The franchisee's trust to franchise may become a dominant factor that influence the business expansion of franchisor. Second, franchisor should communication with their franchisees and deal with the realistic difficulties faced by them with an effort. Third, the franchisor should achieve a synergy effect by utilizing the win-win strategy. The moral hazard strategy that achieving the profit through franchisee's damage will not be inadvisable to franchisor. Then the long-term oriented development and profitability can be maintained. To do so, the franchise industry may break away from the traditional business structure to improve management transparency and competitiveness on investment and organizational changing management. The conflict between franchisor and franchisee also can be reduced and big success can be achieved in the franchise industry.

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Types of Perception toward End-of-Life Medical Decision-making of Clinical Nurses: Q-Methodological Approach (말기환자의 의료적 의사결정에 관한 임상간호사의 인식: Q 방법론적 접근)

  • Jo, Kae-Hwa;Kim, Yeon-Ja;Sohn, Ki-Cheul
    • Journal of Hospice and Palliative Care
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    • v.15 no.1
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    • pp.18-29
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    • 2012
  • Purpose: We analyzed how clinical nurses in Korea perceive terminally ill patients' medical decision-making. Methods: The Q-methodology which analyzes the subjectivity of each item was used. We selected 34 Q-statements among those provided by each of 37 subjects and grouped them into a shape of normal distribution using a 9 point scale. The collected data were analyzed using a QUANL PC program. Results: Four types of perception toward medical decision-making were identified. Type I focuses on patient participation, and Type II emphasizes the role of health professionals. Type III is characterized by an open-minded culture toward death, and Type IV values the role of family members. Conclusion: The results of this study indicate the need for development of a multi-disciplinary curriculum medical decision-making and death for medical and nursing students.