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The Effect of Pleural Thickening on the Impairment of Pulmonary Function in Asbestos Exposed Workers (석면취급 근로자에서 늑막비후가 폐기능에 미치는 영향)

  • Kim, Jee-Won;Ahn, Hyeong-Sook;Kim, Kyung-Ah;Lim, Young;Yun, Im-Goung
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.6
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    • pp.923-933
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    • 1995
  • Background: Pleural abnormality is the the most common respiratory change caused by asbestos dust inhalation and also develop other asbestos related disease after cessation of asbestos exposure. So we conducted epidemiologic study to investigate if the pleural abnormality is associated with pulmonary function change and what factors are influenced on pulmonary function impairment. Methods: Two hundred and twenty two asbestos workers from 9 industries using asbestos in Korea were selected to measure the concentration of sectional asbestos fiber. Ouestionnaire, chest X-ray, PFT were also performed. All the data were analyzed by student t-test and chi-square test using SAS. Regressional analysis was performed to evaluate important factors, for example smoking, exposure concentration, period and the existence of pleural thickening, affecting to the change of pulmonary function. Results: 1) All nine industries except two, airborn asbestos fiber concentration was less than an average permissible concentration. PFT was performed on 222 workers and the percentage of male was 88.3%, their mean age was $41{\pm}9$ years old, and the duration of asbestos exposure was $10.6{\pm}7.8$ yrs. 2) The chest X-ray showed normal(89.19%), pulmonary Tb(inactive)(2.7%), pleral thickening (7.66%), suspected reticulonodular shadow(0.9%). 3) The mean values of height, smoking status, concentration of asbestos fiberwere not different between the subjects with pleural thickening and others, but age, cumulative pack-years, the duration of asbestos exposure were higher in subjects with pleural thickening. 4) All the PFT indices were lower in the subjects with pleural thickening than in the subjects without pleural thickening. 5) Simple regression analysis showed there was a significant correlation between $FEF_{75}$ which is sensitive in small airway obstruction and cumulative smoking pack-years, the duration of asbestos exposure and the concentration of asbestos fiber. 6) Multiple regression analysis showed all the pulmonary function indices were decreased as the increase of cumulative smoking pack-years and especially in the indices those are sensitive in small airway obstruction. Pleural thickening was associated with reduction in FVC, $FEV_1$, PEFR and $FEF_{25}$. Conclusion: The more concentration of asbestos fiber and the more duration of asbestos exposure, the greater reduction in $FEF_{50}$, $FEF_{75}$. Therefore PFT was important in the evaluation of early detection for small airway obstruction. Furthermore pleural thickening without asbesto-related parenchymal lung disease is associated with reduction in pulmonary function.

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Culture Conditions of Aspergillus oryzae in Dried Food-Waste and the Effects of Feeding the AO Ferments on Nutrients Availability in Chickens (건조한 남은 음식물을 이용한 Aspergillus oryzae균주 배양조건과 그 배양물 급여가 닭의 영양소 이용률에 미치는 영향)

  • Hwangbo J.;Hong E. C.;Lee B. S.;Bae H. D.;Kim W.;Nho W. G.;Kim J. H.;Kim I. H.
    • Korean Journal of Poultry Science
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    • v.32 no.4
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    • pp.291-300
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    • 2005
  • Two experiments were carried out to assess the appropriate incubation conditions namely; duration, moisture content and the ideal microbial inoculant for fermented dried food waste(EW) offered to broilers. The nutrient utilization of birds fed the FW diets at varying dietary inclusion rates was also compared with a control diet. In Experiment 1, different moisture contents(MC) of 30, 40, 50 and $60\%$ respectively were predetermined to establish the ideal duration of incubation and the microbial inoculant. A 1mL Aspergillus oryzae(AO) $(1.33\times10^5\;CFU/mL)$ was used as the seed inoculant in FW. This results indicated that the ideal MC for incubation was $40\~50\%$ while the normal incubation time was > 72 hours. Consequently, AO seeds at 0.25, 0.50, 0.75 and 1.00mL were inoculated in FW to determine its effect on AO count. The comparative AO count of FW incubated for 12 and 96 hours, respectively showed no significant differences among varying inoculant dosage rates. The FW inoculated with lower AO seeds at 0.10, 0.05 and 0.01mL were likewise incubated for 72 and 96 hours, respectively and no changes in AO count was detected(p<0.05). The above findings indicated that the incubation requirements for FW should be $%40\~50\%$ for 72 hours with an AO seed incoulant dosage rate of 0.10mL. Consequently, in Experiment II, after determining the appropriate processing condition for the FW, 20 five-week old male Hubbard strain were used in a digestibility experiment. The birds were divided into 4 groups with 5 pens(1 bird per pen). The dietary treatments were; Treatment 1 : Control(Basal diet), Treatment 2 : $60\%$ Basal+4$40\%$ FW, Treatment 3 : $60\%$ $Basal+20\%\;FW+20\%$ AFW(Aspergillus oryzae inoculate dried food-waste diet) and Treatment 4: $60\%$ Basal+$40\%$ Am. Digestibility of treatment 2 was lowed on common nutrients and amino acids compared with control(p<0.05) and on crude fat and phosphorus compared with AFW treatments(T3, T4)(plt;0.05). Digestibility of treatment 3 and 4 increased on crude fiber and crude ash compared treatment 2 (p<0.05). Digestibility of control was high on agrinine, leucine, and phenylalnine of essential amino acids compared with treatment 3 and 4(p<0.05), and diestibility of treatment 3 and 4 was improved on arginine, lysine, and threonine of essential amino acids. Finally, despite comparable nutrient utilization among treatments, birds fed the dietary treatment containing AO tended to superior nutrient digestion to those fed the $60\%$ Basa1+$40\%$ FW.

Effect of Physical Training on Electrocardiographic Amplitudes and the QRS Vector (체력단련(體力鍛練)이 심전도파고(心電圖波高)와 QRS벡타에 미치는 효과(效果))

  • Yu, Wan-Sik;Hwang, Soo-Kwan;Kim, Hyeong-Jin;Choo, Young-Eun
    • The Korean Journal of Physiology
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    • v.18 no.1
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    • pp.51-65
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    • 1984
  • In an effort to elucidate the effect of physical training on the electrocardiographic amplitudes, QRS vector, axis and QRS vector amplitude, electrocardiograms were recorded before and 1, 5 and 10 minutes after 3 minute rebounder exercise in 23 healthy male students aged between 18 and 21 years in two groups of athletes and non-athletes. ECG amplitudes were measured from lead I, $V_1$ and $V_5$ and axis and amplitudes of QRS vectors were measured from lead I and III in frontal plane, from lead $V_2$ and lead $V_6$ in horizontal plane. The results obtained are summarized as follows. ECG amplitudes: The R wave amplitude was $23.38{\pm}1.14\;mm$ in athletes which was higher than $17.91{\pm}2.00\;mm$ in non-athletes. After exercise, the difference in two groups remained significant throughout the recovery period. The S wave amplitude was increased significantly, and the T wave amplitude was decreased in both groups after exercise. The P wave amplitude was increased in both groups after exercise, and it was lower in athletes than in non-athletes. The PQ segment amplitude was zero in athletes but negative in non-athletes than in the resting state. The J point amplitude was positive in resting state and was negative after exercise in both groups. J+0.08 sec point amplitude was also lowered after exercise, and it was higher in athletes than in non-athletes. Therefore the whole ST segment was proved to be decreased after exercise. The summated amplitude of R in $V_5$ plus S in $V_1$ was $38.74{\pm}2.71\;mm$ in athletes which was higher than $32.82{\pm}2.90\;mm$ in non-athletes. After exercise, it was also significantly higher in athletes than in non-athletes. Axis of QRS vector: In frontal plane, axis of QRS vector was $62.7{\pm}7.36^{\circ}$ in athletes, it showed no significant difference between the two groups. In horizontal plane, axis of QRS vector was $-23.5{\pm}7.2^{\circ}$ in athletes which was significantly higher than $-38.8{\pm}8.2^{\circ}$ in non-athletes. After exercise, it was significantly higher than the resting state in both groups. Amplitude of QRS vector : In frontal plane, amplitude of QRS vector was $13.86{\pm}1.44\;mm$ in athletes which was significantly higher than $9.62{\pm}0.97\;mm$ in non-athletes. After exercise, it was also significantly higher in athletes than in non-athletes. In horizontal plane, amplitude of QRS vector was $19.82{\pm}2.10\;mm$ in athletes which was significantly higher than $16.90{\pm}1.39\;mm$ in non-athletes. After exercise, it was also significantly higher in athletes than in non-athletes. From the above, these results indicate that R wave amplitude in athletes was significantly higher than in non-athletes before and after exercise, and that the summated amplitude of R in $V_5$ plus S in $V_1$ in athletes was also $38.74{\pm}2.71\;mm$ suggesting a left ventricular hypertrophy We should note that the PQ segment and ST segment amplitude were higher in athletes than in non-athletes, and they were decreased with exercise in both groups. In particular, the fact that amplitudes of QRS vector in frontal plane or in horizontal plane were significantly greater in athletes than in non-athletes may be an index in evaluating athletes.

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The Effect of Interferon-γ on Bleomycin Induced Pulmonary Fibrosis in the Rat (Interferon-γ 투여가 쥐에서의 Bleomycin 유도 폐 섬유화에 미치는 영향)

  • Yoon, Hyoung Kyu;Kim, Yong Hyun;Kwon, Soon Seog;Kim, Young Kyoon;Kim, Kwan Hyung;Moon, Hwa Sik;Park, Sung Hak;Song, Jeong Sup
    • Tuberculosis and Respiratory Diseases
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    • v.56 no.1
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    • pp.51-66
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    • 2004
  • Objectives : The matrix metalloproteinases (MMPs) that participate in the extracellular matrix metabolism play a important role in the progression of pulmonary fibrosis. The effects of the MMPs are regulated by several factors including Th-1 cytokines, $interferon-{\gamma}$ ($IFN-{\gamma}$). Up to now, $IFN-{\gamma}$ is known to inhibit pulmonary fibrosis, but little is known regarding the exact effect of $IFN-{\gamma}$ on the regulation of the MMPs. This study investigated the effects of $interferon-{\gamma}$ on the pulmonary fibrosis and the expression of the lung MMP-2,-9, TIMP-1,-2, and Th-2 cytokines in aa rat model of bleomycin induced pulmonary fibrosis. Materials and methods : Male, specific pathogen-free Sprague-Dawley rats were subjected to an intratracheal bleomycin instillation. The rats were randomized to a saline control, a bleomycin treated, and a bleomycin+$IFN-{\gamma}$ treated group. The bleomycin+$IFN-{\gamma}$ treated group was subjected to an intramuscular injection of $IFN-{\gamma}$ for 14 days. At 3, 7, 14, and 28 days after the bleomycin instillation, the rats were sacrificed and the lungs were harvested. In order to evaluate the effects of the $IFN-{\gamma}$ on lung fibrosis and inflammation, the lung hydroxyproline content, inflammation and fibrosis score were measured. Western blotting, zymography and reverse zymography were performed at 3, 7, 14, 28 days after bleomycin instillation in order to evaluate the MMP-2,-9, and TIMP-1,-2 expression level. ELISA was performed to determine the IL-4 and IL-13 level in a lung homogenate. Results : 1. 7 days after bleomycin instillation, inflammatory changes were more severe in the bleomycin+$IFN-{\gamma}$ group than the bleomycin group (bleomycin group : bleomycin+$IFN-{\gamma}$ group=$2.08{\pm}0.15:2.74{\pm}0.29$, P<0.05), but 28 days after bleomycin instillation, lung fibrosis was significantly reduced as a result of the $IFN-{\gamma}$ treatment (bleomycin group : bleomycin+$IFN-{\gamma}$ group=$3.94{\pm}0.43:2.64{\pm}0.13$, P<0.05). 2. 28 days after bleomycin instillation, the lung hydroxyproline content was significantly reduced as a result of $IFN-{\gamma}$ treatment (bleomycin group : bleomycin+$IFN-{\gamma}$ group=$294.04{\pm}31.73{\mu}g/g:194.92{\pm}15.51{\mu}g/g$, P<0.05). 3. Western blotting showed that the MMP-2 level was increased as a result of the bleomycin instillation and highest in the 14 days after bleomycin instillation. 4. In zymography, the active forms of MMP-2 were significantly increased as a result of the $IFN-{\gamma}$ treatment 3 days after the bleomycin instillation, bleomycin+$IFN-{\gamma}$ group (bleomycin group : bleomycin+$IFN-{\gamma}$ group=$209.63{\pm}7.60%:407.66{\pm}85.34%$, P<0.05), but 14 days after the bleomycin instillation, the active forms of MMP-2 were significantly reduced as a result of the $IFN-{\gamma}$ treatment (bleomycin group : bleomycin+$IFN-{\gamma}$ group=$159.36{\pm}20.93%:97.23{\pm}12.50%$, P<0.05). 5. The IL-4 levels were lower in the bleomycin and bleomycin+$IFN-{\gamma}$ groups but this was not significant, and the IL-13 levels showed no difference between the experiment groups. Conclusion : The author found that lung inflammation was increased in the early period but the pulmonary fibrosis was inhibited in the late stage as a result of $IFN-{\gamma}$. The inhibition of pulmonary fibrosis by $IFN-{\gamma}$ appeared to be associated with the inhibition of MMP-2 activation by $IFN-{\gamma}$. Further studies on the mechanism of the regulation of MMP-2 activation and the effects of MMP-2 activation on pulmonary fibrosis is warranted in the future.

Studies on the Propagation of the Freshwater Prawn, Macrobrachium nipponense (De Haan) Reared in the Laboratory 2. Life History and Seedling Production (담수산 새우, Macrobrachium nipponense (De Haan)의 증${\cdot}$양식에 관한 생물학적 기초연구 2. 생활사 및 종묘생산에 관한 연구)

  • KWON Chin-Soo;LEE Bok-Kyu
    • Journal of Aquaculture
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    • v.5 no.1
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    • pp.29-67
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    • 1992
  • Life cycle and seed production of the freshwater prawn, Macrobrachium nipponense, were studied and the results are as follows : 1. Larval development : Embryos hatched out as zoea larvae of 2.06 mm in mean body length. The larvae passed through 9 zoea stages in $15{\~}20$ days and then metamorphosed into postlarvae measuring 5.68 mm in mean body length. Each zoea stage can be identified based on the shapes of the first and second antennae, exo- and endopodites of the first and second pereiopods, telson and maxillae. 2. Environmental requirements of zoea larvae : Zoea larvae grew healthy when fed with Artemia nauplii. Metamorphosing rate was $65{\~}72{\%}$ at $26{\~}28\%$ and $7.85{\~}8.28\%_{\circ}Cl.$. The relationship between the zoeal period (Y in days) and water temperature (X in $^{\circ}C$) is expressed as Y=46.0900-0.9673X. Zoeas showed best survival in a water temperature range of $26{\~}32^{\circ}C$ (optimum temperature $28^{\circ}C$), at which the metamorphosing rate into postlarvae was $54{\~}72\%$ The zoeas survived more successfully in chlorinity range of $4.12{\~}14.08{\%_{\circ}}Cl.$, (optimum chlorinity $7.6{\~}11.6\;{\%_{\circ}}Cl.$.), at which the metamorphosing rate was $42{\~}76{\%}$. The whole zoeal stages tended to be longer in proportion as the chlorinity deviated from the optimum range and particularly toward high chlorinity. Zoeas at all stages could not tolerate in the freshwater. 3. Environmental requirements of postlarvae and juveniles : Postlarvae showed normal growth at water temperatures between $24{\~}32^{\circ}C$ (optimun temperature $26{\~}28^{\circ}$. The survival rate up to the juvenile stage was $41{\~}63{\%}$. Water temperatures below $24^{\circ}C$ and above $32^{\circ}$ resulted in lower growth, and postlarvae scarcely grew at below $17^{\circ}C$. Cannibalism tended to occur more frequently under optimum range of temperatures. The range of chlorinity for normal growth of postlarvae and juveniles was from 0.00 (freshwater) to $11.24{\%_{\circ}}Cl.$, at which the survival rate was $32{\~}35\%$. The postlarvae grew more successfully in low chlorinities, and the best growth was found at $0.00\~2.21{\%_{\circ}}Cl.$. The postlarvae and juveniles showed better growth in freshwater but did not survive in normal sea water. 4. Feeding effect of diet on zoea Ilarvae : Zoea larvae were successfully survived and metamorposed into postlarvae when fed commercial artificial plankton, rotifers, and Artemia nauplii in the aquaria. However, the zoea larvae that were fed Artemia nauplii and reared in Chlorella mixed green water showed better results. The rate of metamorphosis was $68\~{\%}75$. The larvae fed cow live powder, egg powder, and Chlorella alone did not survive. 5. Diets of postlarvae, juveniles and adults : Artemia nauplii and/or copepods were good food for postlarvae. Juveniles and adults were successfully fed fish or shellfish flesh, annelids, corn grain, pelleted feed along with viscera of domestic animals or fruits. 6. Growth of postlarvae, juveniles and adults : Under favorable conditions, postlarvae molted every five or six days and attained to the juvenile stage within two months and they reached 1.78 cm in body length and 0.17 g in body weight. The juveniles grew to 3.52 cm in body length and 1.07 g in body weight in about four months. Their sexes became determinable based on the appearance of male's rudimental processes (a secondary sex character) on the endopodites of second pereiopods of males. The males commonly reached sexual maturity in seven months after attaining the postlarvae stage and they grew to 5.65 cm in body length and 3.41 g in body weight. Whereas the females attained sexual maturity within six to seven months, when they measured 4.93 cm in body length and 2.43 g in body weight. Nine or ten months after hatching, the males grew $6.62{\~}7.14$ cm in body length and $6.68{\~}8.36$ g in body weight, while females became $5.58{\~}6.08$ cm and $4.04{\~}5.54$ g. 7. Stocking density : The maximum stocking density in aquaria for successful survival and growth was $60{\~}100$ individuals/$\ell$ for zoeas in 30-days rearing (survival rate to postlarvae, $73{\~}80{\%}$) ; $100{\~}300$ individuals/$m^2$ for postlarvae of 0.57 cm in body length (survival rate for 120 days, $78{\~}85{\%}$) ; $40{\~}60$ individuals/$m^2$ for juveniles of 2.72 cm in body length (survival rate for 120 days, $63{\~}90{\%}$) : $20{\~}40$ individuals/$m^2$ for young prawns of 5.2 cm in body length (survival rate for 120 days, $62\~90{\%}$) ; and $10\~30$ individuals/$m^2$ for adults of 6.1 cm in body length (survival rate for 60 days, $73\~100{\%}$). The stocking density of juveniles, youngs and adults could be increased up to twice by providing shelters.

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The Clinical Characteristics of Lung Cancer in Patients with Idiopathic Pulmonary Fibrosis (특발성 폐섬유화증에 동반된 폐암 환자의 임상적 특정)

  • Park, Joo-Hun;Lee, Jin-Seong;Song, Koun-Sik;Shim, Tae-Sun;Lim, Chae-Man;Koh, Youn-Suck;Lee, Sang-Do;Kim, Woo-Sung;Kim, Won-Dong;Kim, Dong-Soon
    • Tuberculosis and Respiratory Diseases
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    • v.46 no.5
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    • pp.674-684
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    • 1999
  • Background : It has been generally known that the incidence of lung cancer is higher in the patients with idopathic pumonary fibrosis (IPF) than those in general population. The reported incidence was variable from 4.8 to 43.2%. There were controversies on the most frequent cell type (squamous cell carcinoma vs. adenocarcinoma) and no study was done about the real concordance of cancer and the fibrotic lesion. And the pulmonary fibrosis may influence not only the development of cancer but also the treatment and prognosis of the cancer, but there was no report on that point. Method : Total 63 patients ($66.8{\pm}7.8$ year, M : F=61 : 2) were diagnosed as IPF combined with lung cancer (IFF-CA) at Asan Medical Center. A retrospective analysis was done about the risk factors of the lung cancer, pulmonary function test, the site of cancer(especially the relationship of the cancer with the fibrotic lesion), the histologic types, and the stage of cancer. The histologic types were compared with those of 2,660 patients with lung cancer who were diagnosed at the same institute for the same period. The effect of IPF on the treatment of the cancer was evaluated with the survival time after the detection of lung cancer. Results : The lung cancer was found in 63(22.9%) out of 281 patients with IPF. But in most of them(45 patients), lung cancer was detected at the same time with IPF and only in 18 patients, the cancer was diagnosed during the follow-up($25.2{\pm}17.7$ months) of IPF. So in our study, 6.7% of patients with IPF developed lung cancer during the course of the disease. The age ($66.8{\pm}7.84$ vs. $63.4{\pm}11.1$ years), percentage of smoker (88.9 vs. 67.2%), and the male gender (96.8 vs. 67.6%) were significantly higher in IPF-CA compared with lone IPF (p<0.05). The odds ratio of smoking was 4.7 compared with non smoking IPF controls. The lung cancer was located more frequently in the upper lobe and 55.5% was in the periphery of lung. The cancer was developed in the fibrotic lesion in 23 patients (35.9%), and in the majority of the patients, the cancer was separated from the fibrosis. The cell type of the lung cancer in IPF-CA was squamous cell carcinoma 34.9%, adenocarcinoma 30.2%, small cell carcinoma 19.0%, large cell undifferenciated carcinoma 6.3%, and others 9.5%. No significant difference in the distribution of histologic type of the lung cancer was found between IPF-CA and lone lung cancer. There was no significant difference in demographic features, cell types, location and the stage of the cancer between the group with concurrent IPF-CA and the group with cancer diagnosed during the follow up of IPF. There was a tendency (but statistically not significant : p=0.081) of higher incidence of adenocarcinoma among the cancers developed in the fibrotic area(43.5%) (F-CA) than in the cancers in non-fibrotic area (22.5%) (NF-CA). The prognosis of the patients with F-CA was poor (median survival : 4 months) compared with the patients with NF-CA (7 months, p=0.013), partly because the prevalence of severe IPF (the extent of fibrosis in HRCT 50%) was higher in F-CA group. Conclusion : These data suggest that the lung cancer in the patients with IPF has similar features to the ordinary lung cancer.

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Problems in the Korean National Family Planning Program (한국가족계획사업(韓國家族計劃事業)의 문제점(問題點))

  • Hong, Jong-Kwan
    • Clinical and Experimental Reproductive Medicine
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    • v.2 no.2
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    • pp.27-36
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    • 1975
  • The success of the family planning program in Korea is reflected in the decrease in the growth rate from 3.0% in 1962 to 2.0% in 1971, and in the decrease in the fertility rate from 43/1,000 in 1960 to 29/1,000 in 1970. However, it would be erroneous to attribute these reductions entirely to the family planning program. Other socio-economic factors, such as the increasing age at marriage and the increasing use of induced abortions, definitely had an impact on the lowered growth and fertility rate. Despite the relative success of the program to data in meeting its goals, there is no room for complacency. Meeting the goal of a further reduction in the population growth rate to 1.3% by 1981 is a much more difficult task than any one faced in the past. Not only must fertility be lowered further, but the size of the target population itself will expand tremendously in the late seventies; due to the post-war baby boom of the 1950's reaching reproductive ages. Furthermore, it is doubtful that the age at marriage will continue to rise as in the past or that the incidence of induced abortion will continue to increase. Consequently, future reductions in fertility will be more dependent on the performance of the national family planning program, with less assistance from these non-program factors. This paper will describe various approaches to help to the solution of these current problems. 1. PRACTICE RATE IN FAMILY PLANNING In 1973, the attitude (approval) and knowledge rates were quite high; 94% and 98% respectively. But a large gap exists between that and the actual practice rate, which is only 3695. Two factors must be considered in attempting to close the KAP-gap. The first is to change social norms, which still favor a larger family, increasing the practice rate cannot be done very quickly. The second point to consider is that the family planning program has not yet reached all the eligible women. A 1973 study determineded that a large portion, 3096 in fact, of all eligible women do not want more children, but are not practicing family planning. Thus, future efforts to help close the KAP-gap must focus attention and services on this important large group of potential acceptors. 2. CONTINUATION RATES Dissatisfaction with the loop and pill has resulted in high discontinuation rates. For example, a 1973 survey revealed that within the first six months initial loop acceptance. nearly 50% were dropouts, and that within the first four months of inital pill acceptance. nearly 50% were dropouts. These discontinuation rates have risen over the past few years. The high rate of discontinuance obviously decreases the contraceptive effectiveness. and has resulted in many unwanted births which is directly related to the increase of induced abortions. In the future, the family planning program must emphasize the improved quality of initial and follow-up services. rather than more quantity, in order to insure higher continuation rates and thus more effective contraceptive protection. 3. INDUCED ABORTION As noted earlier. the use of induced abortions has been increase yearly. For example, in 1960, the average number of abortions was 0.6 abortions per women in the 15-44 age range. By 1970. that had increased to 2 abortions per women. In 1966. 13% of all women between 15-44 had experienced at least one abortion. By 1971, that figure jumped to 28%. In 1973 alone, the total number of abortions was 400,000. Besides the ever incre.sing number of induced abortions, another change has that those who use abortions have shifted since 1965 to include- not. only the middle class, but also rural and low-income women. In the future. in response to the demand for abortion services among rural and low-income w~men, the government must provide and support abortion services for these women as a part of the national family planning program. 4. TARGET SYSTIi:M Since 1962, the nationwide target system has been used to set a target for each method, and the target number of acceptors is then apportioned out to various sub-areas according to the number of eligible couples in each area. Because these targets are set without consideration for demographic factors, particular tastes, prejudices, and previous patterns of acceptance in the area, a high discontinuation rate for all methods and a high wastage rate for the oral pill and condom results. In the future. to alleviate these problems of the methodbased target system. an alternative. such as the weighted-credit system, should be adopted on a nation wide basis. In this system. each contraceptive method is. assigned a specific number of points based upon the couple-years of protection (CYP) provided by the method. and no specific targets for each method are given. 5. INCREASE OF STERILIZA.TION TARGET Two special projects. the hospital-based family planning program and the armed forces program, has greatly contributed to the increasing acceptance in female and male sterilization respectively. From January-September 1974, 28,773 sterilizations were performed. During the same time in 1975, 46,894 were performed; a 63% increase. If this trend continues, by the end of 1975. approximately 70,000 sterilizations will have been performed. Sterilization is a much better method than both the loop and pill, in terms of more effective contraceptive protection and the almost zero dropout rate. In the future, the. family planning program should continue to stress the special programs which make more sterilizations possible. In particular, it should seek to add the laparoscope techniques to facilitate female sterilization acceptance rates. 6. INCREASE NUMBER OF PRIVATE ACCEPTORS Among the current family planning users, approximately 1/3 are in the private sector and thus do not- require government subsidy. The number of private acceptors increases with increasing urbanization and economic growth. To speed this process, the government initiated the special hospital based family planning program which is utilized mostly by the private sector. However, in the future, to further hasten the increase of private acceptors, the government should encourage doctors in private practice to provide family planning services, and provide the contraceptive supplies. This way, those do utilize the private medical system will also be able to receive family planning services and pay for it. Another means of increasing the number of private acceptors, IS to greatly expand the commercial outlets for pills and condoms beyond the existing service points of drugstores, hospitals, and health centers. 7. IE&C PROGRAM The current preferred family size is nearly twice as high as needed to achieve a stable poplation. Also, a strong boy preference hinders a small family size as nearly all couples fuel they must have at least one or more sons. The IE&C program must, in the future, strive to emphasize the values of the small family and equality of the sexes. A second problem for the IE&C program to work. with in the: future is the large group of people who approves family planning, want no more children, but do not practice. The IE&C program must work to motivate these people to accept family planning And finally, for those who already practice, an IE&C program in the future must stress continuation of use. The IE&C campaign, to insure highest effectiveness, should be based on a detailed factor analysis of contraceptive discontinuance. In conclusion, Korea faces a serious unfavorable sociodemographic situation- in the future unless the population growth rate can be curtailed. And in the future, the decrease in fertility will depend solely on the family planning program, as the effect of other socio-economic factors has already been maximumally felt. A second serious factor to consider is the increasing number of eligible women due to the 1950's baby boom. Thus, to meet these challenges, the program target must be increased and the program must improve the effectiveness of its current activities and develop new programs.

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