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Intensive Culture of the Pacific White Shrimp Litopenaeus vannamei, under Limited Water Exchange - II. Indoor Post-Nursery Culture of Juvenile Shrimp - (사육수 비교환 방식에 의한 흰다리새우의 고밀도 사육 - II. 흰다리새우의 실내 중간양성 -)

  • Jang, In-Kwon;Kim, Jong-Sheek;Seo, Hyung-Chul;Cho, Kook-Jin
    • Journal of Aquaculture
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    • v.22 no.1
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    • pp.42-50
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    • 2009
  • Shrimp farming which is entirely conducted in outdoor ponds in the west coast of Korea has been suffered from mass mortality due to viral epizootics. Intensive indoor shrimp culture under limited water exchange can solve these problems of outdoor ponds including viral transmission from environment, pollution due to discharge of rearing water, low productivity and limited culture period. In this study, juvenile L. vannamei (B.W. 0.08-0.09 g) was stocked with $3,000-5,455/m^3$ in density in four raceway tanks (two $12.9\;m^2$, two $18\;m^2$ tanks) and cultured for 42 days with 2.7-3.4% of daily water exchange. Results from four tanks showed FCR of 0.79-1.29, survival of 38.2-48.0%, and yields of $2.49-4.22\;kg/m^3$ which is consistent with 12-20 and 8-14 times higher than those of commercial shrimp hatchery and outdoor pond in Korea, respectively. Concentrations of total ammonia nitrogen in all four tanks were 1.11-1.42 ppm in mean level and did not exceed 6.0 ppm (0.096 ppm of $NH_3$) which is still acceptable levels for shrimp growth. During the culture trial, concentration of $NO_2$-N rapidly increased from stocking, resulting in mean concentration of 18.45-22.07 ppm. It also exceeded 10 ppm over four weeks and maintained at 35-45 ppm for four days in all tanks, accounting for low survival of shrimp due to long-term exposure to high concentration of $NO_2$-N. Nevertheless, the results with survival rate over 38% from raceways which experienced the extreme $NO_2$-N levels suggests that under "biofloc system" white shrimp can acclimate to high $NO_2$-N concentration to some degree.

The Prognostic Indicies of Pneumocystis Carinii Pneumonia in Immunocompromised Patients other than Acquired Immune Deficiency Syndrome (비 AIDS 면역 결핍 환자들에서 발생한 주폐포자충 폐렴의 예후인자)

  • Park, Wann;Kim, Yoo-Kyum;Lee, Jin-Seong;Ahn, Jong-Jun;Hong, Sang-Bum;Shim, Tae-Sun;Lim, Chae-Man;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Koh, Youn-Suck
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.4
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    • pp.805-812
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    • 1998
  • Background: Among the variety of opportunistic infections, pneumonia comprises the major morbidity in immunocompromised patients. Pneumocystis carnii pneumonia (PCP) and cytomegalovirus (CMV) pneumonia are common infectious illness of immunocompromised hosts. Although there are many reports regarding to the co-infection of PCP and CMV diagnosed by bronchoalveolar lavage (BAL) fluid examination, the effects of CMV co-infection on the outcome of PCP is still controversial. The purpose of this investigation is to evaluate the effects of CMV detected by BAL fluid examination on the clinical course of PCP in the immunocompromised patients other than human immunodeficiency virus infection. Method: Ten patients with PCP were enrolled and retrospective analysis of their medical records were done. HIV infected persons were excluded. The PCP was diagnosed by BAL fluid examination with Calcofluor-White staining. CMV was detected in BAL fluid by Shell-vial culture system. Chest radiographic findings were reviewed. We used Fisher's exact test and Mann-Whitney U test for statistical analysis of data. Results: The underlying disorders of patients were idiopathic pulmonary fibrosis (n=1), renal transplantation (n=4), necrotizing vasculitis (n=l), systemic lupus erythematosus (n=1), brain tumor (n=1), chronic myelogenous leukemia (n=1), unidentified (n=1). There were no difference in clinical course, APACHE III score, arterial blood gas analysis, white blood cell count, lymphocyte count, serum albumin concentration, chest radiographic findings and mortality between patients with PCP alone (n=4) and those with CMV co-infection (n=6). Univariate analysis regarding to the factors that associated with mortality of PCP were revealed that the application of mechanical ventilation (p=0.028), the level of APACHE III score (p=0.018) and serum albumin concentration (p=0.048) were related to the mortality of patients with PCP. Conclusion: The clinical course of PCP patients co-infected by CMV were not different from PCP only patients. Instead, accompanied respiratory failure, high APACHE III score and poor nutritional status were associated with poor outcome of PCP.

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Factors Affecting the Property of $CaCO_3$Precipitated from $CaCl_2-Na_2CO_3-H_2O$ System ($CaCl_2-Na_2CO_3-H_2O$ 반응계에서 침강성탄산칼슘의 성상에 영향을 주는 인자에 관하여)

  • Song, Young-Jun;Park, Charn-Hoon;Cho, Dong-Sung
    • Resources Recycling
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    • v.5 no.4
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    • pp.32-41
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    • 1996
  • The objective of this study was to investigate the facton affecting the property of CaCO, farmed from CaClz-Na,CO,-HiOsystem. The effcct of the concentmtlon of reaclants, impurity, the pH of reaction, the addition of sccd crystal, and injectingvelocity af reaclant solution an thc yield oI CaCO; polymorphs. parlide size and whiteness of CaCO, were investigated. Thcmqor resulls are ;o fallows; I The optimum concentratinn of reildilnts for forming vaterlte and aragonite is the range of 0.1-1.0 mol/l, when the yicld of vittcrite and araga~nles howed 7542% and XU-90%. respedively. 2. Among thc composition of impunticscontained h limestone, Fe' decrease the wh~tcness nf CaCO;. md Mg" increase the yield of aragonite. 3. The pHrange of vaterite and aragonite are formed with high yield is 8-11, and Calcite is famed in pH 6-8 with big particle size of 1over and in pH 11-13 with small particle size of I under. 4. The yicld of calcite and aragonite was increased by addingthc seed cryst.al nf itself.d cryst.al nf itself.

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Anti-inflammatory effects of Ishige sinicola ethanol extract in LPS-induced RAW 264.7 cell and mouse model (LPS로 유도된 RAW 264.7 Cell과 마우스 모델에 대한 넓패(Ishige sinicola) 에탄올 추출물의 항염증 효과)

  • Kim, Ji-Hye;Kim, Min-Ji;Kim, Koth-Bong-Woo-Ri;Park, Sun-Hee;Cho, Kwang-Su;Kim, Go-Eun;XU, Xiaotong;Lee, Da-Hye;Park, Ga-Ryeong;Ahn, Dong-Hyun
    • Food Science and Preservation
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    • v.24 no.8
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    • pp.1149-1157
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    • 2017
  • Inflammation is the first response of the immune system to infection or irritation in our body. The use of medicinal plants has been widely applied as an alternative source for drug development. One of marine natural resources, the anti-inflammatory effect of Ishige sinicola ethanol extract (ISEE), was evaluated by using LPS-induced RAW 264.7 cell and mice model. As a result, the production of nitric oxide (NO) and pro-inflammatory cytokines (IL-6, IL-$1{\beta}$, TNF-${\alpha}$) were inhibited with increasing concentration of ISEE without any cytotoxicity. Furthermore, ISEE suppressed the expression of not only inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), nuclear factor-kappa B (NF-${\kappa}B$) p65, and mitogen-activated protein kinases (MAPKs), including extracellular signal-regulated kinase (ERK) 1/2, p38, and c-Jun N-terminal kinase (JNK) in a dose-dependent manner. In mice ear edema test, the formation of edema was reduced at the highest dosage of ISEE and the reduction of the number of infiltrated mast cells was observed in histological analysis. These results indicate that ISEE has a potent anti-inflammatory activity and can be used as a pharmaceutical material for many kinds of inflammatory disease.

Application and Effectiveness of a Preceptorship for the Improvement of Clinical Education (임상실습 교육개선을 위한 일 실습지도자 활용모델 (preceptorship model)의 적용 및 효과에 관한 연구 -암센타, 재활센타, 중환자실 실습을 중심으로-)

  • 이원희;김소선;한신희;이소연;김기연
    • Journal of Korean Academy of Nursing
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    • v.25 no.3
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    • pp.581-596
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    • 1995
  • Clinical practice in nursing education provides an opportunity for students, through the process of ap-plying theoretical knowledge to practice, and to learn nursing skills as well as being socialized into nursing and as such decrease the reality shock of actual nursing practice. Because of a shortage of nursing faculty, the job of achieving the objectives of the clinical practice had been turned over to the head nurses. This resulted in many problems, such as, unclear location of responsibilities and inadequate feedback from head nurses. Therefore this study was done to introduce and evaluate the use of preceptors as a way to minimize the above problems, and to maximize the achievement of the clinical practice objectives. Using an adaptation of Zerbe's (1991) three-tiered team model, clinical practice was done using a preceptor, a head nurse and a clinical instructor, each with different and well defined roles. The subjects of this study were 67 senior students of the College of Nursing of Y University in Seoul whose clinical practice in adult nursing was carried out between May 1, 1994 and December 8, 1994. There were 22 preceptors who had at least two years of clinical experience and who were recommended by their head nurses. They were given additional education on the philosophy and objectives of the College of Nursing, on communication skills, on the theory and practice of education, and on nursing diagnosis and education evaluation. The role of the preceptor was to work one-to-one with students in their practice. The role of the head nurse was to supervise and evaluate the preceptors. The role of the clinical instructor was to provide the education program for the preceptors, to provide ad-vice and suggestions to the preceptors and to maintain lines of communication with the college. With each of these roles in place, it was thought that the effectiveness and efficiency of the clinical practice could be increased significantly. To evaluate the effectiveness of the preceptorship, the three - tiered model, Lowery's Teacher Evaluation Opinion Form translated and adapted to Korea was used to measure student statisfaction. The Clinical Practice Compentency Evaluation Tool developed by Lee et ai was also used to measure student competencies. The results of this study are as follows 1. The satisfaction with clinical practice was higher with the introduction of the perceptors than it was before they were used. (t=-5.96, p=<.005) 2. The clinical practice competencies were higher with the introduction of the preceptors than it was before they were used(t=-5.l3, p<.005) 3. In order to analyze areas not measured by the quantitative tools additional analysis of the open questions was done. The results of this analysis showed that : 1) The students felt positive about their sense of security, confidence, handling of responsbility, and being systematic. They also felt positive about improvements in knowledge, opportunities for direct care, and socialization. 2) The students felt negative about the technical part of their role, lack of knowledge by the preceptor, unprofessional attitudes on the part of the preceptor, difficulty in the role of the professional nurse(student). 3) The preceptors felt positive about their responsibility, motivation, and relationship with the college. 4) The preceptors felt negative about their bur-den. Introduction of the preceptorship model will lead to change and improvement in the negative factors discussed above, solve problems in the present clinical education system, increase continuity in the education of the students, help with socialization of the students and motivation of the preceptors to up-grade their education and increase their confidence. These objectives must be obtained to further the development of professional nursing, and thus, making the preceptorship a reality is our job for the future.

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Consolidation Behavior of Soft Ground by Prefabricated Vertical Drains (페이퍼드레인 공법에 의한 연약지반의 압밀거동)

  • Lee, Dal Won;Kang, Yea Mook;Kim, Seong Wan;Chee, In Taeg
    • Korean Journal of Agricultural Science
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    • v.24 no.2
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    • pp.145-155
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    • 1997
  • The large scaled field test by prefabricated vertical drains was performed to evaluate the superiority of vertical discharge capacity for drain materials through compare and analyze the time-settlement behavior with drain spacing and the compression index and consolidation coefficient obtained by laboratory experiments and field monitoring system. 1. The relation of measurement settlement($S_m$) versus design settlement($S_t$) and measurement consolidation ratio($U_m$) versus design consolidation ratio($U_t$) were shown $S_m=(1.0{\sim}1.1)S_t$, $U_m=(1.13{\sim}1.17)U_t$ at 1.0m drain spacing and $S_m=(0.7{\sim}0.8)S_t$, $U_m=(0.92{\sim}0.99)U_t$ at l.5m drain spacing, respectively. 2. The relation of field compressing index($C_{cfield}$) and virgin compression index($V_{cclab.}$) was shown $C_{cfield}=(1.0{\sim}1.2)V_{cclab.}$, But it was nearly same value when considered the error with determination method of virgin compression index and prediction method of total settlement. 3. Field consolidation coefficient was larger than laboratory consolidation coefficient, and the consolidation coefficient ratio($C_h/C_v$) were $C_h=(2.4{\sim}3.0)C_v$. $C_h=(3.5{\sim}4.3)C_v$ at 1.0m and 1.5m drain spacing and increased with increasing of drain spacing. 4. The evaluation of vertical discharge capacity with drain spacing from the results of the consolidation coefficient ratio showed largely superior in case the Mebra drain and Amer drain than other drain materials at 1.0m and 1.5m drain spacing, while the values showed nearly same value in case same drain spacing.

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Studies on Requirements of Optimum Dietary Essential Fatty Acids in Juvenile Eel, Anguilla japonica (치어기 뱀장어의 사료내 필수지방산 요구량에 관한 연구)

  • 배준영;한경민;박건준;배승철
    • Journal of Aquaculture
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    • v.17 no.4
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    • pp.275-281
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    • 2004
  • The present study was conducted to evaluate dietary requirements for essential fatty acids (EFAs) such as linoleic acid (LA, l8:2n-6), -lenolenic acid (LNA, 18:3n-3), or docosahexaenoic acid (DHA, 22:6n-3), eicosapentaenoic acid (EPA, 20:5n-3) and arachidonic acid (ARA, 20:4n-6) in juvenile eel Anguilla japonica cultured in a recirculating system for 16 weeks. The experimental diets contained 50% crude protein, 10% crude lipid and 3800 kcal/kg energy.Brown fish meal and blood meal were used as the main protein sources, while coconut oil, com oil and linseed oil were used as the lipid source to yield target fatty acids ratios. At the end of the trial, the effects of essential fatty acids supplementation on weight gain (WG), specific growth rate (SGR), feeding efficiency (FE), proximate composition andwhole body fatty acids contents were examined. WG, SGR, and FEof eels fed diet D2, D3, was significantly higher (P<0.05) than those of fish fed the other diets. Whole body HUFA concentration of eels fed D 1 was significantly lower (P<0.05) than those fed the other diets. HUFA/SFA (saturated fatty acids) ratio of whole body in eels fed diets D2, D3 and D6 were significantly higher than that of eels fed diet D1 (P<0.05).DHA/EPA ratio of whole body in eels fed diet D7was significantly higher than those fed the other diets; and eels fed diet D5 showed the lowest DHA/EPA ratio among all the dietary treatments (P<0.05).Based on the experimental results, we concluded that LNA (n-3) and LA (n-6) were necessary for optimum growth of juvenile eel, and the dietary requirement of LNA and LA were 0.35∼0.5% and 0.5∼0.65%, respectively.

A Three-year Study on the Leaf and Soil Nitrogen Contents Influenced by Irrigation Frequency, Clipping Return or Removal and Nitrogen Rate in a Creeping Bentgrass Fairway (크리핑 벤트그라스 훼어웨이에서 관수회수.예지물과 질소시비수준이 엽조직 및 토양 질소함유량에 미치는 효과)

  • 김경남;로버트쉬어만
    • Asian Journal of Turfgrass Science
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    • v.11 no.2
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    • pp.105-115
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    • 1997
  • Responses of 'Penncross' creeping bentgrass turf to various fairway cultural practices are not well-established or supported by research results. This study was initiated to evaluate the effects of irrigation frequency, clipping return or removal, and nitrogen rate on leaf and soil nitrogen con-tent in the 'Penncross' creeping bentgrass (Agrostis palustris Huds.) turf. A 'Penncross' creeping bentgrass turf was established in 1988 on a Sharpsburg silty-clay loam (Typic Argiudoll). The experiment was conducted from 1989 to 1991 under nontraffic conditions. A split-split-plot experimental design was used. Daily or biweekly irrigation, clipping return or removal, and 5, 15, or 25 g N $m-^2$ $yr-^1$ were the main-, sub-, and sub-sub-plot treatments, respectively. Treatments were replicated 3 times in a randomized complete block design. The turf was mowed 4 times weekly at a l3 mm height of cut. Leaf tissue nitrogen content was analyzed twice in 1989 and three times in both 1990 and 1991. Leaf samples were collected from turfgrass plants in the treatment plots, dried immediately at 70˚C for 48 hours, and evaluated for total-N content, using the Kjeldahl method. Concurrently, six soil cores (18mm diam. by 200 mm depth) were collected, air dried, and analyzed for total-N content. Nitrogen analysis on the soil and leaf samples were made in the Soil and Plant Analyical Laboratory, at the University of Nebraska, Lincoln, USA. Data were analyzed as a split-split-plot with analysis of variance (ANOVA), using the General Linear Model procedures of the Statistical Analysis System. The nitrogen content of the leaf tissue is variable in creeping bentgrass fairway turf with clip-ping recycles, nitrogen application rate and time after establishment. Leaf tissue nitrogen content increased with clipping return and nitrogen rate. Plots treated with clipping return had 8% and 5% more nitrogen content in the leaf tissue in 1989 and 1990, respectively, as compared to plots treated with clipping removal. Plots applied with high-N level (25g N $m-^2$ $yr-^1$)had 10%, 17%, and 13% more nitrogen content in leaf tissue in 1989, 1990, and 1991, respectively, when compared with plots applied with low-N level (5g N $m-^2$ $yr-^1$). Overall observations during the study indicated that leaf tissue nitrogen content increased at any nitrogen rate with time after establishment. At the low-N level treatment (5g N $m-^2$ $yr-^1$ ), plots sampled in 1991 had 15% more leaf nitrogen content, as compared to plots sampled in 1989. Similar responses were also found from the high-N level treatment (25g N $m-^2$ $yr-^1$ ).Plots analyzed in 1991 were 18% higher than that of plots analyzed in 1989. No significant treatment effects were observed for soil nitrogen content over the first 3 years after establishment. Strategic management application is necessary for the golf course turf, depending on whether clippings return or not. Different approaches should be addressed to turf fertilization program from a standpoint of clipping recycles. It is recommended that regular analysis of the soil and leaf tissue of golf course turf must be made and fertilization program should be developed through the interpretation of its analytic data result. In golf courses where clippings are recycled, the fertilization program need to be adjusted, being 20% to 30% less nitrogen input over the clipping-removed areas. Key words: Agrostis palustris Huds., 'Penncross' creeping bentgrass fairway, Irrigation frequency, Clipping return, Nitrogen rate, Leaf nitrogen content, Soil nitrogen content.

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Activation of Pro-Apoptotic Multidomain Bcl-2 Family Member Bak and Mitochondria-Dependent Caspase Cascade are Involved in p-Coumaric Acid-Induced Apoptosis in Human Jurkat T Cells (p-Coumaric acid에 의해 유도되는 인체 Jurkat T 세포의 에폽토시스 기전)

  • Lee, Je-Won;Kim, Young-Ho
    • Journal of Life Science
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    • v.21 no.12
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    • pp.1678-1688
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    • 2011
  • The apoptogenic effect of p-coumaric acid, a phenolic acid found in various edible plants, on human acute leukemia Jurkat T cells was investigated. Exposure of Jurkat T cells to p-coumaric acid (50-$150{\mu}M$) caused cytotoxicity and TdT-mediated dUTP nick-end labeling (TUNEL)-positive apoptotic DNA fragmentation along with Bak activation, ${\Delta}{\psi}m$ loss, activation of caspase-9, -3, -7, and -8, and PARP degradation in a dose-dependent manner. However,these apoptotic events were completely abrogated in Jurkat T cells overexpressing Bcl-2.Under these conditions, necrosis was not accompanied. Pretreatment of the cells with the pan-caspase inhibitor (z-VAD-fmk) could prevent p-coumaric acid-induced sub-$G_1$ peak representing apoptotic cells, whereas it failed to block ${\Delta}{\psi}m$ loss, indicating that the activation of caspase cascade was prerequisite for p-coumaric acid-induced apoptosis as a downstream event of ${\Delta}{\psi}m$ loss. FADD- and caspase-8-positive wild-type Jurkat T cell clone A3, FADD-deficient Jurkat T cell clone I2.1, and caspase-8-deficient Jurkat T cell clone I9.2 exhibited similar susceptibilities to the cytotoxicity of p-coumaric acid, excluding an involvement of Fas/FasL system in triggering the apoptosis. The apoptogenic activity of p-coumaric acid is more potent in malignant Jurkat T cells than in normal human peripheral T cells. Together, these results demonstrated that p-coumaric acid-induced apoptogenic activity in Jurkat T cellswas mediated by Bak activation, ${\Delta}{\psi}m$ loss, and subsequent activation of multiple caspases such as caspase-9, -3, -7, and-8, and PARP degradation, which could be regulated by anti-apoptotic protein Bcl-2.

The Study on the Family Functionality and Spousal Relationship of Middle-aged Women to Develop Health Promoting Program (중년여성의 건강증진 프로그램 개발을 위한 기초연구 -가족기능과 부부관계를 중심으로-)

  • Yang, Kyung-Hee;Kim, Young-Hee
    • Research in Community and Public Health Nursing
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    • v.12 no.3
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    • pp.680-695
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    • 2001
  • The purpose of this study was to provide basic data for developing nursing intervention for middle-aged women. This study identified health status, family functionality and spousal relationship and analyzed relationship between individual characteristics and family functionality/ spousal relationship. The subjects, of this study were 1.723 women from 45 to 55 years of age, who lived in J city. Data were analyzed using percentages, means, t-tests, ANOVA and Pearson's correlation coefficients with the SPSS statistical program. The results of the study were as follow: 1. The rate of women who perceived themselves to be healthy was 36.6%, those who did not was 30.8%. The most frequent health problem was a disease of the skeletal system (13.2%). 2. The mean score of family functionality was $3.25{\pm}.60$, with cohesion score of $3.58{\pm}.66$ and adaptability score of $2.99{\pm}.63$. 3. The mean score of total spousal relationship was $3.22{\pm}.42$; the relationship with in-laws was 3.78; sexual relationship, 3.74; life style, 3.44; and recreational activity. 3.39. 4. The women who experienced menopause perceived themselves to be unhealthier than those who did not. 5. Healthy women had a high score at total spousal relationship. personality of spouse. life style, recreational activity, and children's influence. 6. The women from 40 to 50 years of age. and women who graduated from middle or high school and had medium economic status showed a high score in family functionality. There was no correlation between family functionality and experience of the menopause. 7. Lower aged women were not good in personality of spouse (p<.05), sexual relationship (p<.05), and relationship with relatives (p<.05), Inexperienced women's menopause was influenced by their children (p<.05), Women who graduated from middle or high school (p<.001) and had medium economic status (p<.05) showed a high score in spousal relationship. 8. The higher the family functionality score. the higher spousal relationship. score (p<.001): love and communication (p<.001), personality of husband (p<.05), and religion (p<.001). relationship with relatives (p<.05), but the lower the score of recreational activity (p<.05), and share of role (p<.001) in the spousal relationship. 9. In the family functionality, the higher the cohesion score. the higher was the adaptability score (p<.001). l) The higher the cohesion score, the higher were love and communication, personality of husband. life style. sexual relationship. and children's influence, but the lower were share of role in spousal relationship(p<.001). 2) The higher the adaptability score, the higher were love and communication, religion, but the lower were the personality of husband, life style. sexual relationship, recreational activity, relationship with relatives, share of role(p<.001), and children's influence in spousal relationship (p<.05). 10. Variables within the spousal relationship have relationships with other variables. 1) The higher the love and communication score. the higher personality of husband religion, life style, communication. relationship with relatives, and children s influence (p<.001). 2) The higher personality of husband life style sexual relationship. recreational activity, relationship with relatives, share of role, and children's influence (p<.001). 3) The higher the religion score, the lower the recreational activity score (p<.05). 4) The higher the life style, the higher were the sexual relationship, recreational activity. relationship with relatives. share of role, and children's influence (p<.001). 5) The higher the sexual relationship score. the higher were recreational activity. relationship with relatives, share of role. and children's influence (p<.001). 6) The higher the recreational activity, the relationship with relatives, share of role. and children's influence (p<.001). 7) The higher the relationship with relatives, the higher were the share of role. the higher children's influence (p<.001). In conclusion. the spousal relationship was not good in unhealthy women, and the family functionality was related with the age of women and educational level. Also the spousal relationship was related with the age of women, personality of husband, sexual relationship. relationship with relatives by marriage and influence of sons and daughters. Menopause was related with spousal relationship, not related with family functionality. And the family functionality not related with perceived health status. but was correlated with spousal relationship. Therefore, the health management program for middle-aged woman should take place before menopause and must be based on promoting the family functionality and spousal relationship as well as physical health.

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