• 수면정신생리
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• 제3권2호
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• pp.32-42
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• 1996

연구배경 : 상기도 저항증후군 (UARS)으로 진단 받은 환자 및 이들의 수면다원검사 소견을 정상인 및 수면 무호흡증(OSA) 환자의 그것과 비교 연구함으로서 UARS의 이해에 도움을 얻고자하였다. 방법 : 임상적인 면담, 신체검사 및 식도내 음압 (Pes)의 측정을 포함하는 수면다원검사를 통하여 UARS로 진단받은 20 명의 환자와 OSA로 진단 받은 30명의 환자를 대상으로 하였고, Williams 등 (10)의 자료를 정상비교치로 이용하였다. 결과 : UARS는 OSA 보다 젊고 비만도가 낮은 환자특성을 보이고 수면다원검사시 OSA의 진단기준이 되는 RDI와 $SaO_2$가 정상에 가까운 특정을 보임을 알 수 있다. 기타 수면지표들은 정상범위에 속하거나 이상소견이 있더라도 OSA 환자의 그것보다는 경미하여 UARS가 OSA보다는 가벼운 상태의 장애임을 시사한다. 그러나 UARS 환자들의 ESS의 점수는 병적인 수준으로 낮 동안의 졸림기로 일상생활에 많은 장애를 받고 있음을 시사한다. 결론 : 본 연구결과는 UARS 환자의 특성 및 이들의 특정 적인 수면다원검사 소견을 보여줬다고 생각하며 지금까지 발표되고있는 UARS에 대한연구결과들을 지지한다. 즉 UARS는 임상적, 실험실적으로 OSA와는 다른특징이 있는 수면관련 호흡장애의 아형이다. 따라서 임상적으로 수면관련 호흡장애가 의심되는 환자의 나이가 젊고 BMI가 정상이고, 일반수면다원검사에서 RDI와 $SaO_2$ 등이 수면관련 호흡장애 진단기준에 미흡하더라도 수면중 코를 고는 등의 상기도 저항(upper airway resistance)을 시사하는 증상이 있고, 뇌파상 이유없이 자주 반복되는 전기 생리적인 각성이 있다면 UARS를 의심하여야한다. UARS 환자들이 호소하는 낮 동안의 졸림기는 OSA 환자들의 그것과 비슷하여 일상생활에 많은 고통을 주고 반복적인 흉곽내 압력의 지나친 상승은 심혈관계에 해로운 영향을 미치는 바 UARS에 대한관심이 필요하다.

• 한국축산식품학회:학술대회논문집
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• 한국축산식품학회 1998년도 정기총회 및 제21차 춘계학술발표회
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• pp.37-54
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• 1998

건국대학교본 연구는 쑥의 추출물을 이용해 생체내에서 에탄올의 분해효능, 간기능 및 Cd 독성 저하작용에 미치는 효과를 알아보기 위하여 실시하였다. 본 실험에서 에탄올 분해효능은 Rat 1kg 당 25% 에탄을 5g을 경구투여한 후 쑥추출물의 카테킨 농도를 측정하여 이를 기준으로 일일 사료섭취량의 2% 원료수준으로 각각 미정맥주사를 하였다. 에탄올만 경구투여한 대조군과 에탄올을 경구투여한 후 쑥추출물을 미정맥주사한 실험군은 시간별(0, 1, 2, 3시간)로 미정맥에서 혈액을 채취해 3000rpm에서 10분간 원심분리하여 혈장을 분리시킨 후 GC(Gas Chromatography)로 혈중 에탄올 농도를 측정하였다. 또한 같은 방법으로 시간만 달리해 (0시간, 5시간) 혈장을 취해 GOT, GPT의 활성치를 측정하여 간손상정도를 측정하였다. 간기능에 미치는 효과는 간실질세포를 기본배지에 배양한 대조군과 쑥추출물을 배지의 1% 및 2% 원료수준으로 기본배지에 첨가하여 간실질세포를 배양한 실험군으로 나누어 36시간 배양한 후 현미경으로 형태를 관찰하고 생존 세포수와 GOT, GPT의 활성치를 함께 측정하였다. Cd 독성 저하작용은 4주령의 Sprague-Dawley 수컷 흰쥐를 구입하여 대조군(CON,0.85% saline 10ml/kg B.W.)과 Cd단독 투여군(CD, 0.4mg $CdCl_2/kg$ B.W.), Cd과 쑥추출물을 복강내 투여한 군(IP, 쑥 추출물은 일일사료섭취량의 1% 수준) 그리고 쑥추출물을 구강내 투여한 군(PO, 쑥 추출물은 일일사료섭취량의 1%수준)으로 분류하여 4주간 사육하였다. 사육 후 각종 장기 및 혈액을 채취하여 장기에서의 GSH 농도, GSH-Px 및 GR의 활성과 혈장 GOT, GPT 활성을 측정하였고 더불어 각 조직에서 Cd축적량을 조사하였다. 실험결과를 요약하면 다음과 같다. (1) 쑥추출물의 카테킨의 함량을 Iwasa와 Torri의 방법을 변형하여 측정한 결과 네 가지의 추출물중에서 카테킨의 함량은 쑥의 열수추출물이 $8{\sim}10mg/100g$으로 가장 많았으며 쑥의 에탄올 추출물은 $3{\sim}4mg/100g$인 것으로 나타났다. (2) 쑥 추출물을 HPLC를 이용해 주요 카테킨의 성분을 비교한 결과 쑥의 열수추출물 및 에탄올추출물은 (-)-Epigallocatechin (EGC)의 함량이 가장 높았다. (3) 시간에 따른 혈중 에탄올 농도를 GC로 측정한 결과 각각 에탄올을 투여한지 1시간 후의 에탄올 농도에서는 CON-E의 경우가 가장 높은 것으로 나타났고 MDW-E, MOH-E군은 CON-E에 비해 유의하게(p<0.05) 감소하는 것을 알 수 있었다. (4) 간실질세포 배양 36시간 후 배지를 걷어내고 밑면에 모인 세포를 모아 현미경으로 수를 측정하여 평균을 낸 결과는 2% MDW-L가 가장 많았으며 2% MOH-L을 제외하고는 CON-L의 세포수가 가장 적었다. 또한 배양 후 취한 세포내의 GOT, GPT의 활성치는 실험군간의 유의한 차이는 없었다. (6) 간 조직중의 GSH 함량수준은 쑥추출물 투여군들(IP, PO)이 CD군에 비해 유의적으로 증가(p<0.05)하여 대조군과 같은 정상수준으로 되었다. (7) 간 신장에서의 GSH-Px 활성은 저농도의 Cd에 의해서는 영향을 받지 않은 것으로 나타났다. (8) 혈장 GOT활성은 IP군이 대조군에 비해 증가하였으나 CD군에 비해 유의적으로 감소(p<0.05)하였다. 이상의 결과에서 쑥추출물이 체내에서 에탄올 분해를 촉진시키고 간기능을 개선시킴은 물론 GSH농도의 정상회복과 GR의 증가 및 혈장에서의 GOT활성의 감소 등으로 보아 Cd의 간독성도 감소시키는 작용이 있는 것으로 사료되었다.

• 한국직업건강간호학회지
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• 제13권1호
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• pp.5-18
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• 2004

This study aims to investigate the use state of the health service computerization system in the occupational nursing field and the occupational nursers' satisfaction level, and provide basic data to promote the development of the health service computerization system for the nursing field. For this study, a questionnaire was provided to 118 occupational nurses who belong to Busan and Gyeongnam branches of KAOHN(Korean Association of Occupational Health Nurses) for 2 months (from Dec. 1, 2002 to Jan. 31, 2003). A tool of Choi Yong-Heui(2000) was used to investigate the satisfaction level of using the health service computerization system. The collected materials were analyzed in real number and percentage, average and standard deviation, t-test and ANOVA by using the SPSS WIN 10.0 program. This study is summarized as follows: 1. The average age was $31.99{\pm}5.58$ old in this study. The married were 54.2%. Participants who graduated from a junior college was 76.9%. The average service period was $4.48{\pm}4.68$ years. In service types, 79.7% of participants served in a health care center. The average service period was $3.22{\pm}2.89$ years. The service place which had 1000 workers or more was 35.6%. 2. Only 20.3% of participants in this study had a computer use education. 3. The field who participants used mostly was communication/internet, $3.29{\pm}.85$ hours in average. 4. 97.1% of occupational fields had computers and peripheral devices: 71.4% in pentium computer, 42.8% in the hard disk capacity of 20-29GB, 60.0% in 15 inch monitors, 86.2% in printers, 18.1% in digital cameras, 12.4% in LAN, and 9.5% in scanners. 80.1% of the occupational fields which were objects of study could use communication. 5. The occupational fields which did not introduced the health service computerization system were 62.8%. The main cause was attributable to entrepreneurs' insufficient recognition 66.6%. 51.5% of the entrepreneurs did not have an introduction plan. 37.2% of participating companies had the health service computerization system. 56.4% of them introduced it since the year 2000. 81.6% of the introduction motivation aimed to the efficiency of health service. The most issue upon introduction was insufficient understanding of a person in charge - 25.6%. The in-house development of the system covered 56.4%. 61.5% of the participants accepted their demands from the first stage of development. The direct effect of computerization showed the increase of 25.9% in the quickness and continuity of service treatment, and 25.9% in the serviceability of statistical treatment. 6. 22.0% of the participants had a computerization system use education. 69.2% of them had a in-house education. An educational method by nurses who used the computerization system was 76.9%. 92.3% of the education was helpful for practical duties. 7. An analysis of the computer use by health service fields showed that the medicine management in a health management field was 15.9%. the work environment measuring management in a work environment filed was 32.9%. the employment. general and special examination management in a heal th management field was 61.1 %. the various reports management in an administrative field was 64%. the health education data preparation management in an educational field was 58.0%. and the medicine and expendables management in an equipment management field was 51.6%. An analysis of the computerization system use showed that the various statistical data manage in a health management field was 13.0%. the work environment measuring management in a health management field was 34.8%. the personal disease management in a health management field was 51.9%. the heal education data preparation management in an educational field was 54.5%. and the equipment management of health care centers in an equipment management field was 52.6%. 8. 31.6% of the participants wanted that health service computerization system would include the generals of health services. 42.4% of the participants thought that first of all. the aggressive interest and investment of employers were required to build the health service computerization system. 9. The participants' satisfaction level on the computerization system use was $3.51{\pm}.57$ points. An analysis by each factor showed $3.62{\pm}.68$ points in a service change factor. $3.15{\pm}.63$ points in a computer program use factor, and $3.45{\pm}.71$ points in a continuous computerization use factor. 10. An analysis of the computerization system use by general characteristics of participants showed that the married (p = .022) had the satisfaction level higher than the unmarried. 11. The satisfaction level of the computerization system use by participants' computer use ability tended to be higher in proportion to the increase of computer use abilities in spreadsheet (F=2.606. p=.048). presentation (F=3.62. p=.012) and communication/internet(F=2.885. p=.0321. Based on the study results mentioned above. I will suggest as follows : The nationwide enlargement and repetition study is required for occupational nurses who serve in occupational nursing fields. The computerization system in a health service field is inferior comparing with other fields. The computerization system standard by business types and characteristics should be prepared through employers's aggressive participation and national support. Therefore various statistical data which occurs in occupational fields will be managed systematically and efficiently. A regular and systematic computer education plan for occupational nurses in charge of health services in the filed is urgently required to efficiently manage and improve the health of on-site workers.

• 지능정보연구
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• 제20권1호
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• pp.177-193
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• 2014

개인정보 분야에서의 다양한 정보 보안 이슈가 발생함에 따라 해당 분야의 전문가를 확인하기 위한 프레임워크는 매우 중요한 영역이 되었다. 전문가 탐색과정은 주로 연구 업적 등을 통한 주관적인 평가가 일반적이지만 보다 객관적인 방식을 통한 선정이 매우 중요하다. 소셜 네트워크 분석기법의 응용이 다양한 영역에서 활용됨에 따라 본 연구는 개인정보보호분야의 전문가를 확인하고 해당 전문가들의 연구실적을 판단하기 위한 분석 프레임워크를 제시하고자 하였다. 본 연구는 연구 목적에 따라 개인정보보호 연구영역의 연구성과 자료를 바탕으로 소셜 네트워크 분석을 실시하고 핵심연구자의 성과를 분석하였다. 수집된 데이터는 연구의 공저자, 발행기관, 소속기관 등의 네트워크 구성에 활용되어 핵심전문가 집단을 관리하기 위한 프레임워크를 제시하였다. 본 연구는 NDSL에서 최근 5년 동안 발표된 논문들을 중심으로 자료를 수집하였다. 연구자들이 학술 정보를 교환하는 정기 간행물인 학술지를 바탕으로 연구 네트워크를 형성하는 네트워크 자료를 수집함으로써 연구활동에 대한 정보를 분석할 수 있었다. 일반적으로 연구자들은 연구 결과를 논문으로 발표하고, 발표된 논문들이 다수의 관련 분야 전문가들에게 공유된다는 점에서 학술연구지는 연구자들의 지식관련 의사소통 공간이며 지식의 구조화에 핵심적인 역할을 수행한다. 그에 따라 본 연구의 연구 대상 분야로 설정한 개인정보보호 분야의 연구 구조를 이해하기 위해 국내에서 발표된 관련 분야의 논문들을 연구 대상으로 자료가 수집되었다. 특히 자료의 선별 기준은 국내 최대의 데이터베이스를 보유하고 있는 NDSL에서 개인정보보호 관련 키워드를 보유한 논문 데이터를 수집 및 정제하여 분석 자료로 사용하였다. 2005년부터 2013년까지 약 2,000개의 연구결과 중 주제 관련성, 공저자 추출 등을 수집하였다. 데이터 수집 이후 연구 분석을 위한 데이터 처리를 통하여 통해 총 784개의 논문을 선정하고 분석대상으로 확정하였다. 분석 결과, 개인정보보호 연구영역의 전문가 집단을 이용한 연구논문 성과에 대한 분석은 핵심 연구자들을 추출해내고 전문가 집단을 관리하는 데 도움을 제공할 수 있다. 특히 소속집단 및 연구논문 발행기관을 분석함으로써 개인정보보호 연구영역에서 확인되지 않았던 연구자들의 연구 논문 게재의 공저자 네트워크가 매우 밀접함을 확인할 수 있다. 또한 연구논문의 발행기관 및 소속집단의 특성을 추출함으로써 개인정보보호 영역의 전문가 평가지표로서 소셜 네트워크 지표들의 활용가능성을 확인하였다.

• 마케팅과학연구
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• 제19권2호
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• pp.68-79
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• 2009

The interplay between hedonic and utilitarian attributes has assumed special significance in recent years; it has been proposed that consumption offerings should be viewed as experiences that stimulate both cognitions and feelings rather than as mere products or services. This research builds on previous work on hedonic versus utilitarian benefits, regulatory focus theory, customer satisfaction to address two question: (1) Is the shopping goal at the point of purchase different from the shopping value? and (2) Is the customer loyalty after the use different from the shopping value and shopping goal? We surveyed 345 peoples those who have bought the electronic-goods within 6 months. This research dealt with the shopping value which is consisted of 2 types, hedonic and utilitarian. Those who pursue the hedonic shopping value may prefer the pleasure of purchasing experience to the product itself. They tend to prefer atmosphere, arousal of the shopping experience. Consistent with previous research, we use the term "hedonic" to refer to their aesthetic, experiential and enjoyment-related value. On the contrary, Those who pursue the utilitarian shopping value may prefer the reasonable buying. It may be more functional. Consistent with previous research, we use the term "utilitarian" to refer to the functional, instrumental, and practical value of consumption offerings. Holbrook(1999) notes that consumer value is an experience that results from the consumption of such benefits. In the context of cell phones for example, the phone's battery life and sound volume are utilitarian benefits, whereas aesthetic appeal from its shape and color are hedonic benefits. Likewise, in the case of a car, fuel economics and safety are utilitarian benefits whereas the sunroof and the luxurious interior are hedonic benefits. The shopping goals are consisted of the promotion focus goal and the prevention focus goal, based on the self-regulatory focus theory. The promotion focus is characterized into focusing ideal self because they are oriented to wishes and vision. The promotion focused individuals are tend to be more risk taking. They are more sensitive to hope and achievement. On the contrary, the prevention focused individuals are characterized into focusing the responsibilities because they are oriented to safety. The prevention focused individuals are tend to be more risk avoiding. We wanted to test the relation among the shopping value, shopping goal and customer loyalty. Customers show the positive or negative feelings comparing with the expectation level which customers have at the point of the purchase. If the result were bigger than the expectation, customers may feel positive feeling such as delight or satisfaction and they would want to share their feelings with other people. And they want to buy those products again in the future time. There is converging evidence that the types of goals consumers expect to be fulfilled by the utilitarian dimension of a product are different from those they seek from the hedonic dimension (Chernev 2004). Specifically, whereas consumers expect the fulfillment of product prevention goals on the utilitarian dimension, they expect the fulfillment of promotion goals on the hedonic dimension (Chernev 2004; Chitturi, Raghunathan, and Majahan 2007; Higgins 1997, 2001) According to the regulatory focus theory, prevention goals are those that ought to be met. Fulfillment of prevention goals in the context of product consumption eliminates or significantly reduces the probability of a painful experience, thus making consumers experience emotions that result from fulfillment of prevention goals such as confidence and securities. On the contrary, fulfillment of promotion goals are those that a person aspires to meet, such as "looking cool" or "being sophisticated." Fulfillment of promotion goals in the context of product consumption significantly increases the probability of a pleasurable experience, thus enabling consumers to experience emotions that result from the fulfillment of promotion goals. The proposed conceptual framework captures that the relationships among hedonic versus utilitarian shopping values and promotion versus prevention shopping goals respectively. An analysis of the consequence of the fulfillment and frustration of utilitarian and hedonic value is theoretically worthwhile. It is also substantively relevant because it helps predict post-consumption behavior such as the promotion versus prevention shopping goals orientation. Because our primary goal is to understand how the post consumption feelings influence the variable customer loyalty: word of mouth (Jacoby and Chestnut 1978). This research result is that the utilitarian shopping value gives the positive influence to both of the promotion and prevention goal. However the influence to the prevention goal is stronger. On the contrary, hedonic shopping value gives influence to the promotion focus goal only. Additionally, both of the promotion and prevention goal show the positive relation with customer loyalty. However, the positive relation with promotion goal and customer loyalty is much stronger. The promotion focus goal gives the influence to the customer loyalty. On the contrary, the prevention focus goal relates at the low level of relation with customer loyalty than that of the promotion goal. It could be explained that it is apt to get framed the compliment of people into 'gain-non gain' situation. As the result, for those who have the promotion focus are motivated to deliver their own feeling to other people eagerly. Conversely the prevention focused individual are more sensitive to the 'loss-non loss' situation. The research result is consistent with pre-existent researches. There is a conceptual parallel between necessities-needs-utilitarian benefits and luxuries-wants-hedonic benefits (Chernev 2004; Chitturi, Raghunathan and Majaha 2007; Higginns 1997; Kivetz and Simonson 2002b). In addition, Maslow's hierarchy of needs and the precedence principle contends luxuries-wants-hedonic benefits higher than necessities-needs-utilitarian benefits. Chitturi, Raghunathan and Majaha (2007) show that consumers are focused more on the utilitarian benefits than on the hedonic benefits of a product until their minimum expectation of fulfilling prevention goals are met. Furthermore, a utilitarian benefit is a promise of a certain level of functionality by the manufacturer or the retailer. When the promise is not fulfilled, customers blame the retailer and/or the manufacturer. When negative feelings are attributable to an entity, customers feel angry. However in the case of hedonic benefit, the customer, not the manufacturer, determines at the time of purchase whether the product is stylish and attractive. Under such circumstances, customers are more likely to blame themselves than the manufacturer if their friends do not find the product stylish and attractive. Therefore, not meeting minimum utilitarian expectations of functionality generates a much more intense negative feelings, such as anger than a less intense feeling such as disappointment or dissatisfactions. The additional multi group analysis of this research shows the same result. Those who are unsatisfactory customers who have the prevention focused goal shows higher relation with WOM, comparing with satisfactory customers. The research findings in this article could have significant implication for the personal selling fields to increase the effectiveness and the efficiency of the sales such that they can develop the sales presentation strategy for the customers. For those who are the hedonic customers may be apt to show more interest to the promotion goal. Therefore it may work to strengthen the design, style or new technology of the products to the hedonic customers. On the contrary for the utilitarian customers, it may work to strengthen the price competitiveness. On the basis of the result from our studies, we demonstrated a correspondence among hedonic versus utilitarian and promotion versus prevention goal, WOM. Similarly, we also found evidence of the moderator effects of satisfaction after use, between the prevention goal and WOM. Even though the prevention goal has the low level of relation to WOM, those who are not satisfied show higher relation to WOM. The relation between the prevention goal and WOM is significantly different according to the satisfaction versus unsatisfaction. In addition, improving the promotion emotions of cheerfulness and excitement and the prevention emotion of confidence and security will further improve customer loyalty. A related potential further research could be to examine whether hedonic versus utilitarian, promotion versus prevention goals improve customer loyalty for services as well. Under the budget and time constraints, designers and managers are often compelling to choose among various attributes. If there is no budget or time constraints, perhaps the best solution is to maximize both hedonic and utilitarian dimension of benefits. However, they have to make trad-off process between various attributes. For the designers and managers have to keep in mind that without hedonic benefit satisfaction of the product it may hard to lead the customers to the customer loyalty.

• 대한한의학회지
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• 제15권2호
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• pp.9-27
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• 1994

연구(硏究)의 목적(目的) 및 배경(背景) : 본 연구는 노령인구의 증가와 더불어 심각한 사회문제화 되고 있는 노인병의 실태를 파악하기 위한 노인건강검진 사업의 일환으로 전주우석대부속한방병원 및 부설우석의원에서 국내최초의 한양방동시종합검진을 실시한 바 있어서, 이를 토대로 노인질환의 분포와 건강실태를 파악하고 한양방동시종합검진의 효율성을 검토해 보기 위함이다. 연구(硏究) 방법(方法) : 연구대상은 전라북도 김제군에 거주하는 60세 이상의 노인 641명을 대상으로 전주우석대부속한방병원 및 부설우석의원에서 1994.6.24부터 1994.7.13까지 실시한 한양방동시종합검진(1차 검진) 결과를 대상으로 하였다. 양방의 1차검진은 X-ray 검사, 혈액검사, 소변검사, 혈압, 시력, 청력 등의 측정으로 행해졌고, 한방검진은 한방의 사진법(四診法)(望,聞,問,切(망,문,문,절))과 현증력(現症歷), 주소증(主訴證), 과거력(過去歷), 가족력(家族歷), 사회력(社會歷) 등을 살피는 문진표(問診表)와 사상체질(四象體質) 테스트법을 이용하여 행해졌다. 결과(結果) 및 결론(結論) : 본 연구의 결과 및 결론은 다음과 같다. 1) 한양방종합판정상 검진 대상자 641명중 운동기계질환자 75.8%, 소화기계질환자 43.4%, 순환기계질환자 41.5%, 호흡기계질환자 22.3%, 안이비인후과질환자 8.1%, 내분비계질환자 5.6%, 비뇨생식기계질환자 5.3%의 순으로 질병을 앓고 있는 것으로 나타났다. 2) 병명에 따른 질환의 빈도를 살펴보면, 요통, 위염 및 소화성궤양, 슬통, 심장병, 고혈압, 만성기관지염, 기관지천식, 빈혈증, 당뇨병, 폐결핵, 시력장애, 중풍 등의 순으로 나타났다. 3) 연령별 질환의 빈도를 살펴보면, 60-75세, 76-85세, 86세 이상으로 구분할 때 대부분의 질환이 60-75세에 다발하는 경향을 보이고, 오히려 연령이 높아질수록 질병이환율이 감소하는 경향을 보이는 반면, 안이비인후과질환만이 점진적 증가를 보여 대조를 이루었다. 4) 가족력과 질환과의 상관관계를 살펴보면, 중풍환자의 25.0%가 중풍의 가족력을, 고혈압환자의 11.6%가 고혈압의 가족력을 가지고 있는 것으로 나타나 가족력과의 상관관계가 매우 높게 나타남을 알 수 있었고, 그밖에 결핵은 5.6%, 당뇨병은 2.6%가 가족력을 가지고 있는 것으로 나타났다. 5) 음주와 질환과의 상관관계를 살펴보면, 호흡기질환의 36.4%, 고혈압의 34.7%, 심장병의 33.3%, 소화기질환의 28.4%가 음주를 하는 것으로 나타났으나 음주의 정도는 조사되지 않아 음주와 질환과의 필연적 관계는 알 수 없었다. 6) 흡연과 질환과의 상관관계를 살펴보면, 호흡기질환의 44.1%, 심장병의 38.0%, 고혈압의 29.8%가 흡연을 하는 것으로 나타났으나 흡연의 정도는 조사되지 않아 흡연과 질환의 필연적 관계는 알 수 없었다. 7) 사상체질의 분포는 태음인(太陰人) 44.6%, 소양인(少陽人) 30.7%, 소음인(少陰人) 24.7%, 태양인(太陽人) 0.0%의 순으로 나타났고, 체질별 질환빈도는 모든 체질에서 운동기계 질환과 소화기계 질환의 이환율을 높았는데, 태음인에서는 순환기계질환(50.0%), 호흡기계질환 (23.1%)이 타체질에 비해 높게 나타났고, 소양인에서는 운동기계질환(77.7%), 난청등 안이비인후과 질환(12.2%)이 타체질에 비하여 높게 나타났고, 소음인에 있어서는 소화기계 질환(65.8%)이 타체질에 비해 높게 나타났다. 8) 양방의 1차검진상 이상소견자의 빈도와 한양방종합판정에 의한 질환의 빈도 사이에는 상당한 차이가 있는 것으로 나타났는데, 이는 노인질환의 특성상 건강검진에 한방의 참여가 필요한 이유가 되는 내용이라 사료된다. 이상에서 살펴본 바, 이번에 실시한 국내최초(國內最初)의 한양방동시종합검진(韓洋方同時綜合檢診)은 양방위주의 건강검진보다 노인의 질환과 건강실태를 파악하는데 있어서 훨씬 효율적(效率的)이었다고 사료되는 바이나, 처음 실시한 만큼 미진한 면이 많았다. 앞으로 한방이 공중보건사업에 효율적으로 차여하기 위해서는 많은 문제점을 개선하여 한양방동시종합검진의 모델과 한방보건사업의 프로젝트가 제시되어야 할 것으로 사료된다.

• 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.