• 제목/요약/키워드: Birth order

검색결과 589건 처리시간 0.028초

비만증환자(肥滿症患者)의 생활행태(生活行態) 및 체질(體質)에 관(關)한 조사보고(調査報告) (The survey on life patterns and constitution in obese patients)

  • 권영달;송용선
    • 대한한의학회지
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    • 제16권2호
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    • pp.79-99
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    • 1995
  • The survey was done on 30 cases of obese patients who were treated by fasting therapy in the Dept. of Oriental Rehabilitation Medicine, oriental medical hospital in Won Kwang University from May 1995 to August 1995. The results are as follows: 1. The ratio of females to males was 1:14. The distribution was 20th decades (63%), 30th decade(13%), 10th decade(6.7%), and 40th decade(6.7%). 2. In the age of obese-prevalence, the middle to high school years was the highest number as 12 persons(40%). The 20th decade(23.3%) and 30th decade(13.3%) were the second and third highest frequency of subjects. 3. In the obesity index, 150% of ideal weight was the highest percentage with persons(40%). 120-129%(30%), 130-139%(23.3%) and 140-149%(6.7%) were in order of frequency. 4. In the family histories of obese patients, it was found that hypertension had a high incidence of 8 persons. Other evidences of family histories were DM (7), cancer (3) and CVD (2). In hereditary tendency of obese parents, it was known that hereditary tendency of obese mothers was high at 14 persons, that of obese fathers was 5 persons, and that of obese parents was 2 persons. 5. In identifying the cause of obesity, it was found that changes of diet patterns was high at 24 persons(80%). Pregnancy, birth and diseases were in order of cause. 6. The review of consumption showed that obese patients ate the same amount as non-obese persons in the case of 21 patients(70%), 8 patients(26.7%) ate more than non-obese persons and 1 person(3.3%) ate less than persons of the same ages. 7. Obese patients consumption of daily snacks was 10 persons(33%). 17 person(57%) of the obese patients ate midnight snacks every 3-4 days. 11 persons(37%) of the obese patients ate out every 3 - 4 days. 8. For the purpose of weight reduction, 15 patients(50%) used exercise. Fasting therapy(36.7%) and food restriction(33.3%) were the second and third methods used by obese patients. 9. In the relation of constitution medicine usage with obese patients, TAE-EUM-IN was 14 persons(46.7%), SO-EUM-IN was 11 persons(36.7%), and SO-YANG-IN was 5 persons(l6.7%).

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왕불유행, 목통, 통초가 산후 생쥐의 유즙분비량과 유즙분비 관련 인자에 미치는 영향 (Effect of Melandrii Herba, Akebia Quinata Decaisne, and Tetrapanax Papyriferus on Milk Secretion and Lactation Related Factors in Postpartum Mice)

  • 이가위;이은희;이창현;김홍준
    • 대한한방부인과학회지
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    • 제31권2호
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    • pp.1-17
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    • 2018
  • Objectives: The purpose of this study is to investigate the effect of Melandrii Herba (MH), Akebia Quinata Decaisne (AQ), and Tetrapanax Papyriferus (TP) on milk secretion and aquaporin (AQP) expression in lactating mice. Methods: For the experiment, the mice were divided into three groups, which were orally administered MH (2,720 mg/kg), TP (400 mg/kg) and AQ (2,800 mg/kg) extracts respectively for 3 weeks from Day 1 after the birth, compared with the control group (C group), which was administered distilled water. A group consisted of six infantile mice per postpartum mouse. For comparison with the C group, non-pregnant SKH-1 mice were used as the virgin group. Results: 1. When it comes to the immunohistochemical staining for prolactin receptors in the mammary glands, the AQ and MH groups showed a strong immune response to the secretory epithelial cells constituting the mammary alveoli, while the TP group represented a weaker immune response. 2. In the immunohistochemical staining for AQP in the mammary glands, AQP1 showed a strong immune response in the walls of capillaries and venules around the mammary alveoli, and AQP3 in the epithelial cells constituting the mammary alveoli, and AQP5 in some tissues between the mammary alveoli. AQP1 was expressed in the order of TP group>AQ group=C group>MH group, and AQP3 was MH group and AQ group>TP group=C group, and AQP5 was MH group>C group>AQ group and TP group. 3. In the Western blot, AQP1 was expressed in the order of TP group>AQ group>C group>MH group, and AQP3 was MH group>AQ group>C group>TP roup, and AQP5 was MH group>TP Group>C group>AQ group. All of AQP1, 3, 5 expression were significantly higher in the C group than in the Virgin group. Conclusions: The administration of Akebia Quinata Decaisne, Tetrapanax Papyriferus and Melandrii Herba have the effect of improving prolactin levels in postpartum mice and increasing the expression of prolactin receptor and AQPs in the mammary glands, suggesting that lactation might be enhanced by the development of the mammary glands.

초등학교 저학년 아동들의 안전사고 발생 실태 및 관련요인 분석 (A Study on the Occurrences and Causes of Accidents in Lower Grade Elementary School Children)

  • 김소선;이은숙
    • 대한간호학회지
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    • 제29권1호
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    • pp.117-126
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    • 1999
  • Accidents involving children are an important cause of death and disability. They also have enomorous financial implications. In order to prevent childhood accidents, research and education for safety should be strengthened. The purpose of this study was to determine how often young children have accidents and what factors affect the accident rate. The sample consisted of 771 children who were in the second, third and forth grades of two elementary schools located in Kyung-gi Province. One school had students from middle class families living in apartment complexes and the other, students from lower income families mainly living in single houses. The questionnaires included items on the occurance of accidents and the parents' attitudes regarding accidents during the academic year from March 1997 to February 1998. The Questionnaires were distributed to conventiently selected students to be compeleted by their parents and collected during the period of May 28, to June 6, 1998. The data were analyzed using SAS PC statistical package. The results of the study are as follows ; 1. Of 771 student subjects, 393 had 887 accidental injuries during the study period. 2. The month, the day and the time with the highest accident rate were May, Sunday, and between 1 and 4 p. m. each. 3. In the analysis of the location where the injury took place, the most frequent place was on around their homes followed by school and, then, inside the home 4. Most of the accidents were caused by carelessness on the part of the children and the most frequent type of injury was an abrasion. 5. Children most injured their legs 6. They were treated at home most often and usually emergency treatment was performed by family members with, disinfection being the main type of first aid. Cost of the treatment ranged from 8,000 to 20,000 won in most cases. 7. House type and parents' education level were statistically significant in chi-square analysis. 8. Parents educate their children about traffic safety most frequently followed by fire safety and, then, prevention of violence. 9. Parents think that prevention of violence should be the most important part of injury prevention education both at school and home. 10. To identify factors related to accident occurrence, multiple logistic regression was performed and the main factors were birth order and house type.

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未婚 남성의 가족의식에 관한 고찰 (Study on family Consciousness of unmarried Man)

  • 고정자
    • 가정과삶의질연구
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    • 제1권2호
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    • pp.89-106
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    • 1983
  • After accepting the modernized western culture, we, the Koreans, had traditionally patriarchal valuation on the family life, which has been changed into modernize on in these days. Under these circumstances, we examined into family consciousness of workmen, office workers and student of universities in Pusan with questioning papers by inquiring their general views of family, marriage, family planning , and inheritance. The results obtained can be summarized as follows. 1. General views of family 1)Most of them prefer nuclear family to gross one in structure of family. In decision of family's affairs, the lower educated persons want an unilateral relationship, which means unconditional obdience to their parent's opinion. they are more concerned about the profit of the family than that of individual. on the other hand, they want 2-generations nuclear family system. 2) Concerning children's future affairs, they want compromising method. 2. Views of Marriage 1) Date with the other sex motivated their desire to improve social adaptation and social association. 17-19 year old students regard date as a preparatory stage of marriage. They consider it most desirable date to enjoy free conversation each other. They hope their date partners are high educated. 2) The conditions of mate selection are in order character, health, vitality in living, appearance and education. The less educated placed an emphasis on vitality in living. 3) They are not much interested in marital harmony. If parents are against their marriage an account of bad marital harmony, they will take into consideration about it. 4) They wish to keep purity before marriage, as possible. They want engagement period of 6 months. Any agreeable reasons shall compel them to break off their appointment. 5) they consider it ideal for mate's age to be 26-30 years old, and also think it affirmative to follow their parent's agreement in marriage. It is considerable that they put off their marriage only because they have lots of work to do before marriage. 6)Marriage declaration is to be made on the wedding day. It still exists that they don't want to marry when they are inth same surname and family tree. But it is clear that they don't regard it as the reason of breaking off the betrothal. 3. Family Planning 1) They are willing to agree to the campaign "just two is enough". They want a son and a daughter. Even though they have two daughters, they won's bear child to get son. 2) the lower educated persons are ignorant of the method of birth control. 4. Inheritance 1)Most of them say householder inheritance is to be kept up continuously. It is reasonable that anyone who can afford to perform religious service should bear it responsibility. 2)They don't want the difference in inheritance as the conscious to the conscious of the equality of the sexes spread widely into our society, but it is worthy of notice that some of them still don't mind unequal treatment. 3) When they have no child, the property inheritances are in order his wife and his parents. According to above mentions, we conclude like this: Their consciousness of marital harmony, marriage, family planning and inheritance shows definitely passive rationism in the transitional stage which is mixed with western individualism and traditional feudalism. On account of being lack of steady fast self-conscience, they can not make their positive reaction on anything. Finally, we should make every possible efforts to have our firm self-conscience through the re-education.

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상호매체성의 이론과 그 적용 - 피터 그리너웨이의 <프로스페로의 서재>를 중심으로 (A Theory of Intermediality and its Application in Peter Greenaway's )

  • 박기현
    • 비교문화연구
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    • 제19권
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    • pp.39-77
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    • 2010
  • The cinema of Peter Greenaway has consistently engaged questions of the relationship between the arts and particularly the relations of image and writing to cinema. When different types of images are correlated and merged with each other on the borders of painting, photography, film, video and computer animation, the interrelationships of the distinct elements cause a shift in the notion of the whole image. This analysis proposes to articulate the complex relationship between the 'interartial' dimension and the 'intermedial' dimension in Peter Greenaway's film, (1991). If the interartiality is interested in the interaction between various arts, including the transition from one to another, the intermediality articulates the same type of relationship between two or more media. The interactional relationship is the same on both sides; on the contrary, the relationship between art and media does not show the same symmetry. All art is based on one or more media - the media is a condition existence of art - but no art can't be reduced to the status of media. This suggests that if the interartiality always involves the intermediality, this proposal may not be reversed. First, we analyse a self-conscious investigation into digital art and technology. Prosospero's Books can be read as a daring visual essay that self-consciously investigates the technical and philosophical functions of letters, books, images, animated paintings, digital arts, and the other magical illusions, which have been modern or will be post-modern media to represent the world. Greenaway uses both conventional film techniques and the resources of high-definition television to layer image upon image, superimposing a second or third frame within his frame. Greenaway uses the frame-within-frame as the cinematic equivalent of Shakespeare's paly-within-play : it offer him the possibility to analyse the work of art/artist/spectator relationship. Secondly, we analyse the relationship between the written word, oral word and the books. Like the written word, the oral word changes into a visual image: The linguistic richness and nuances of Shakeaspeare's characters turn into the powerful and authoritative, but monotone, voices of Gielgud-Prospero, who speaks the Shakespearean lines aloud, shaping the characters so powerfully through his worlds that they are conjured before us. Specially each book is placed over the frame of the play's action, only partially covering the image, so that it gives virtually every frame at least two space-time orientations. Thirdly, we try to show how Peter Greenaway uses pictorial references in order to illustrate the context of the Renaissance as well as pictorial techniques and language in order to question the nature of artistic representation. For exemple, The storm is visualised through reference to Botticelli's : the storm of papers swirling around the library is constructed to look like a facsimili copy of Michelangelo's Laurentiana Library in Florence. Greenaway's modern mannerism consists in imposing his own aesthetic vision and his questioning of art beyond the play's meta-theatricality: in other words, Shakespeare''s text has been adapted without being betrayed.

노인장기요양보험제도의 문제점 및 개선방안에 관한 고찰 (A Study on the Problems and Improvement of Long-Term Care Insurance for the Elderly)

  • 안명선;박주현
    • 한국콘텐츠학회논문지
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    • 제19권8호
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    • pp.525-534
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    • 2019
  • 우리나라는 경제발전과 보건의료의 발달로 인한 평균수명의 연장과 저출산 등으로 세계에서 가장 급속도로 인구구조의 고령화 문제에 직면하고 있다. 정부는 이러한 사회적 구조 및 노인문제를 해결하기 위하여 장기요양대상 노인의 삶의 질 향상과 가족부양 부담의 완화 등을 목적으로 노인장기요양보험법을 제정 시행 중에 있다. 하지만, 노인장기요양보험제도의 시행결과, 시설의 민영화와 난립으로 서비스의 공적 책임과 시설의 질 제고에 대한 요청이 확산되고 있다. 이 밖에, 저임금 요양인력의 양산, 질 개선에 관한 과제, 재원조달 방식에 관한 문제, 등의 대비가 다각도로 필요하다. 이에 노인장기요양보험제도가 장기 지속적으로 유지 발전하기 위해서는 시대적인 사회환경의 변화에 따라 법 제도적 측면의 개선방안의 모색과 더불어 노인복지서비스가 신체적 건강뿐만 아니라 노후 생활의 안정을 위한 정신적 심리적 조치를 강구하는 방안을 검토한다.

초등학교 아동의 개인위생에 대한 조사 (A Study on Personal hygiene of Primary School Students)

  • 김재삼;남철현;강희양
    • 한국학교보건학회지
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    • 제9권1호
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    • pp.109-123
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    • 1996
  • The study was designed to gain necessary basic data, in order to grasp the actual condition on personal hygiene of primary school students and to help school health education and child health education data development of parents of students, the survery was carried out through this reporter's interview for mothers who have primary school pupil in KyungBug area during the period of a month from 14 the April to 30 the April 1994. The results of this study can be summarized as follows. 1. As for general characteristics, the percent of answer mothers with 30~34 years 44.9%, and the percent of answer mothers with 35~39 years was 37.6%, 14.6% of answer mother was 40 years and over. The most house types was apartment house, that is 64.8% and independence house was 18.9%, 13.7% of answer mothers was multivalent house residents. As for level of school career, the percent of high school was 64.2% and the percent of university was 20.5%, 10.1% of answer mothers was finishment of middle school. As for religion a lack of religion was 38.4% and a Buddhist was 36.8%, a christian was 13.4%, 10.4% of answer mothers was a catholic. As for jobs, the percent of office was 33.9%, specialist and expert skiller was 17.3%, self-management was 16.0%, fishing and agrarian villiages was 11.6%, public service personnel and shool personnel was 9.1%. As for the number of sons and daughters, the percent of two was 70.5%, the percent of one was 16.0%, and the percent of male students was 54.1%. As for level of economic life middle level was 59.9%. 2. The percentage of washing hand after school hours was 66.8% and not washing hand after school hours was 33.2%. In washing hand after school hours family of independence house, mothers that have schoolcareer of university, female students, three and over of sons and daughters was high individually (p<0.05). 3. As for paring one's nails, once a ten days was 52.9% once a five days was 22.5% once a fifteen days was 19.0%, once a twenty and over was 5.6%. 4. 54.7% of primary school students of answer mother's take a bath once a few days and 31.6% take a bath once a week, 10.1% take a bath once a tendays. 5. The percentage of changing of underwear once a day was 60.9%, once a few days was 37.1%, once a week was 2.0%, as for changing of underwear, sons and daughters that has mothers with 29 years and downward, one number of sons and daughters, females students was high individually (p<0.01). 6. The percentage of haircut once a 20~30 days was 59.9%, once a 31~40 days was 17.9%, once a 40 days and over was 16.6%. As for the percentage of haircut once a 20~30 days apartment house residents, male students was high (p<0.01). 7. The percentage of experience in taking nutrition was 79.8% and the percentage of experience in taking restorative was 72.3%. As for taking nutrition, apartment house residents, one number of sons and daughters, male students was high individually (p<0.01). As for taking restorative apartment house residents, on number of sons and daughters, male students was high individually (p<0.05). 8. The percentage of habit of unbalanced diet was 44.0%, sons and daughters that have mother with 40 years and over apartment house residents, male students, one number of sons and daughters was high indivdually (p<0.05). 9. As for hygiene condition of sons and daughters, the percentage of good state of health was 65.2%, middle state of health was 3.5% bad state of health was 11.4%. In good state of health sons and daughters that have mothers with 29 years and downward, multivalent house residents, three numbers of sons and daughters, female students, high birth was high individually. 10. As for fattness of sons and daughters, existence was 18.2%. No existence was 81.8%. in existence sons and daughters who have mothers with 40 years and downward, independence house resident, special job and expert skill job, three and over number of sons and daughters, female students, low birth was high individually. 11. As for use aspect of medical facilities of sons and daughters, hospital doctors was 53.1%, drugstore was 42.3%, chinese medicine hospitals or health organization was 4.6%. In usage of drugstore, sons and daughters of mothers with 29 years, 40 years and over was 55.6%, 61.4% individully, inusage of hospital doctors 30~34 years, 34~39 tears was 64.5%, 49.1% individully (p<0.01), apartment house residents, one or two numbers of sons and daughters, male students was high individually. In the percentage of using drugstore, school career of middle school and downward, in occupation, three and over numbers of sons and daughters, low birth was high individually (p<0.05). According to the results mentioned above. An actual condition and a related matters on personal hygiene of primary school students must be used as the basis data of a health education program and a health data of a health education program and a health data related, a teaching materials development and must be helped to the health life education of parents of students and childs.

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

  • 방숙;한성현;이정자;안문영;이인숙;김은실;김종호
    • Journal of Preventive Medicine and Public Health
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    • 제20권1호
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    • pp.165-203
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    • 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.

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임신초기 모체의 엽산영양상태와 동 영향인자 (Maternal Folate Status and Its Influencing Factors in Early Pregnancy)

  • 이정아;이종임;임현숙
    • 한국식품영양과학회지
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    • 제33권2호
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    • pp.331-338
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    • 2004
  • 임신초기 모체의 엽산영양은 태아의 신경관 손상을 예방하는 측면에서는 물론이고 엽산 필요량이 증가하는 임신후기를 대비한다는 점에서도 중요하다. 그러므로 본 연구에서는 임신초기에 있는 151명의 임신부들을 대상으로, 이들이 식사를 통해 얼마의 엽산을 섭취하는지를 조사하고, 혈청과 적혈구의 엽산 농도와 혈장 호모시스테인 농도를 분석하여 엽산영양상태를 평가하고, 이들의 엽산영양상태에 영향을 미치는 인자들이 무엇인지 분석하고자 하였다. 본 연구대상자의 조사당시 임신기간은 9.1$\pm$2.3주이었으며, 초산부가 46%이었고 나머지는 경산부이었다. 에너지 및 엽산 섭취량은 각각 1559$\pm$589 ㎉/day 및 230.8$\pm$145.2 $\mu$g/day로 각 권장량의 72.5%및 46.2%로 낮았다 혈청과 적혈구의 엽산 농도는 각각 5.5$\pm$1.9 ng/mL 및 266.6$\pm$75.0 ng/mL으로, 연구 대상자의 7.8%가 혈청 엽산 수준이 3 ng/mL미만인 결핍상태에 해당하였고 60.3%는 경계역(3∼5.9 ng/mL)에 속하였으며, 적혈구 엽산 농도가 l57 ng/mL미만인 결핍상태에는 4.3%가 해 당하였다. 그러나 혈청 호모시스테인 농도는 정상범위이었다. 따라서 본 연구대상자의 엽산영양상태는 비교적 양호하다고 판정되었다. 혈청 엽산 농도에 영향을 끼칠 수 있는 유의한 인자는 건강상태점 수(+), 혈장 호모시스테인 농도(-), 연령 (-), 임신기간(-) 및 엽산 섭취량(+) 순으로 그 영향력이 높았고, 적혈구 엽산 농도의 영향인자는 교육수준(-), 혈장 호모시스테인 농도(-), 지난번 출산 영아의 출생시 신장(+),연령(-)및 에너지 섭취량(+)이었고, 혈장 호모시스테인 농도의 영향인자는 지난번 출산 영아의 출생시 신장(-), 경제수준(+),혈청 엽산 농도(-)와 임신전 체중(+)이었다. 이러한 결과는, 혈장이나 적혈구의 엽산 농도나 혈장 호모시스테인 농도를 분석하지 않고도, 임신초기에 있는 모체의 엽산영양상태를 개략적으로 판정하는데 있어 주관적으로 평가한 불량한 건강상태, 높은 교육수준 또는 경제수준, 지난번 출산에서 작은 체위의 영아를 출산한 경력, 고연령 또는 엽산이나 에너지섭취량 부족을 위험 인자로 활용할 수 있음을 시사한다. 아울러 임신기간이 진행되었을수록 엽산영양상태가 저하되었을 가능성이 있음도 나타내준다. 앞으로 임신초기 임신부의 엽산영양상태를 어떤 위험인자를 몇 가지나 가졌느냐에 따라 평가하는 연구결과가 나와야 이들 위험 인자의 실용성 을 확인할 수 있을 것이다. 그러나 우선 이들 위험 인자를 많이 지닌 임신부라면 임신초기부터 엽산 섭취량을 늘리거나 엽산보충제 섭취를 일찍 시작하는 등의 방법으로 엽산영양상태를 양호하게 유지하도록 하는 것이 바람직할 것이다.

선택적 함구증 아동의 임상특성 및 치료경과 (CLINICAL CHARACTERISTICS AND TREATMENT COURSES OF THE CHILDREN WITH SELECTIVE MUTISM)

  • 정선주;홍강의
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • 제6권1호
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    • pp.74-89
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    • 1995
  • 본 연구는 DSM-IV에 의해 선택적 함구증으로 진단된 23명의 아동들을 대상으로 임상적인 특성(인구학적 특성, 임상경과, 발달력, 성격특성, 가족력, 지능지수, 학업성취도), 치료방법 및 기간, 치료경과등을 조사하여 다음과 같은 결과를 얻었다. 1) 대상군의 남녀 비율은 1 : 4.8로 여아에서 높았으며 발병시 평균연령을 3세 4개월, 치료시작의 평균연령은 7세 7개월이었다. 2) 주산기의 문제를 가지고 있었던 아동은 22%였으며 언어발달이 지연되었던 아동은 26%였다. 3세 이전에 주 양육자와의 분리경험이 있던 아동은 26%, 3세 이전에 외상이나 심리적 충격을 입었던 아동은 26%였다. 유뇨증의 병력은 30%에서, 유분증의 병력은 4%에서 있었다. 3) 어머니의 공생적인(symbiotic relationship) 관계에 있는 아동은 61%였고 가정내에서 아버지보다 어머니의 영향력이 우세한 경우는 65%였다. 부모중 정신병리나 알콜/약물중독의 문제를 가지고 있는 경우는 39%였다. 과거력상 신체적인 학대를 받았던 아동은 26%였다. 4) 환아들의 성격특성중 가장 많은 것은 수줍음(100%)이었고 그 다음으로는 불안해 한다(83%), 고집이 세다(83%), 아기 같고 의존적이다(65%), 화를 잘 낸다(52%), 조종하려고 한다(39%) 순으로 많았다. 5) 지능검사를 실시한 16명 아동의 평균 지능지수는 88.3이었고 이중 정신지체의 기준은 IQ 69 이하의 아동이 7명, 70 이상인 아동아 9명이었다. 6) 치료방법중 놀이치료를 받은 아동이 65%로 가장 많았으며 약물치료를 받은 아동은 21%, 행동치료를 받은 아동은 8%, 한 가지 이상의 방법을 복합하여 치료받은 아동은 12%였다. 7) 치료종료시 최우수 평가를 받은 아동은 8.6% 였고 우수의 평가를 받은 아동은 30.4% 양호의 평가를 받은 아동은 52%, 불량의 평가를 받은 아동은 8.7%였다. 추적도사의 최우수의 평가를 받은 아동은 21.7%였고 우수는 13%, 양호는 21.7%, 불량은 34.8% 였다. 치료성과는 유의미한 상관관계를 보이는 변수는 지능지수로 나타났다. 8) 대상군을 공생형 함구증(symbiotic mutism), 언어공포성 함구증(speech phobic mutism), 반응성 함구증(reactive mutism), 수동-공격성 함구증(passive aggressive mutism)으로 분류하였을때 각각 65%, 8.6%, 12%, 30%였다. 지능지수에 따라 정신지체로 분류된 7명과 정상지능군에 속하는 9명을 비교적 언어발달 및 성격특성, 가족역동, 치료성과 등에서 차이가 있음을 알 수 있었다.

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