• 제목/요약/키워드: Technical Summary

검색결과 78건 처리시간 0.029초

자성 미세입자에의 항체 고정화 방법이 면역결합반응에 미치는 영향 (Effect of Antibody Immobilization Method to Magnetic Micro Beads on its Immunobinding Characteristics)

  • 최효진;황상연;장대호;조형민;강정혜;성기훈;주재범;이은규
    • Korean Chemical Engineering Research
    • /
    • 제44권1호
    • /
    • pp.65-72
    • /
    • 2006
  • 자력을 이용한 분리기술의 장점을 이용하여 여러 가지 불순물들이 섞여 있는 현탁 용액으로부터 자성입자를 이용하여 목적 단백질만을 얻어낼 수 있는 기술의 가능성에 대하여 알아보고자 하였다. 자성입자를 이용하는 경우에는 (1) 자성입자 표면에 리간드 고정화, (2) ligand(리간드)와 목적 물질과의 특이적 결합, (3) 자력을 이용한 자성입자의 분리, (4) 목적 물질의 탈착 그리고 (5) 자성입자의 재사용 순서로 진행되어 여러 단계의 공정을 단순화시킬 수 있다. 이러한 자성입자를 이용한 방법은 효율성, 단순성, 까다롭지 않은 조건, 자동화의 용이성, 비용의 저렴함으로 인해 관심이 증대되고 있다. 본 연구에서는 표면이 카르복실기로 처리된 자성입자에 IgG 항체를 고정화시킨 후 IgG를 목적 단백질로 하여 이를 분리해내고자 하였다. 이를 위하여 자성입자 표면에 다른 물질과의 비특이적 결합이 일어나지 않을 조건에 대하여 확인해 보았으며, IgG 항체를 배향성 고정화시켜 자성입자가 목적 단백질과 보다 효과적으로 결합하여 목적 단백질인 IgG만을 선택적으로 분리해 낼 수 있는지에 대하여 알아보았다. 높은 pH를 사용할 경우 비특이적 흡착을 줄일 수 있었으며, IgG 항체 고정화된 자성입자를 사용할 경우 목적 단백질인 IgG와 선택적으로 반응함을 알 수 있었다. IgG 항체의 고정화에서 Fc지역 C-terminus에 인접해 있는 탄수화물 부분을 이용하여 배향성을 준 경우, IgG 항체 내의 아민기와 고정화시키는 비배향성 고정화 방법보다 항원과의 결합능력이 약 2배 높았다.

단계적 야생동식물 선량평가 코드 K-BIOTA의 특성 및 적용 (Characteristics of the Graded Wildlife Dose Assessment Code K-BIOTA and Its Application)

  • 금동권;전인;임광묵;최용호;김병호
    • Journal of Radiation Protection and Research
    • /
    • 제40권4호
    • /
    • pp.252-260
    • /
    • 2015
  • 본 논문은 ICRP103 환경방호를 대비하여 국내에서 개발된 야생동식물 선량평가 코드 K-BIOTA의 기술적 배경 및 적용 사례를 기술한다. K-BIOTA는 스크리닝(screening) 선량평가(Level 1&2)와 부지 특성적 상세평가(Level 3)의 3단계의 단계적 평가방법을 적용한다. 스크리닝 단계평가는 상세평가의 필요성 여부를 판단하기 위한 예비적 평가 단계로 개별적인 생물종보다는 동식물을 그룹별로 구분하여 평가한다. Level 1 평가는 스크리닝 목적의 참조준위로부터 유도된 최대환경매체농도 값과 실제 환경매체농도 값의 비교로부터 위험도 지표(risk quotient)를 계산한다. Level 1 평가 결과 위험도 지표가 1보다 작으면 생태계의 건전성이 유지된다는 결론과 함께 평가를 종료하고, 1 보다 크면 동식물 그룹별로 평균적인 전이계수나 평형분배계수 값을 적용하여 조금 더 실제적인 Level 2 평가를 수행한다. 따라서 Level 2 평가가 Level 1 평가보다 덜 보수적이다. Level 2평가에서 위험도지표가 1 보다 작으면 생태계의 건전성이 유지된다는 결론을 내리고 평가를 종료하고, 1보다 크면 Level 3 평가를 수행한다, Level 3 평가는 부지 특성적 데이터를 고려하는 상세평가단계로, 동식물 그룹별 평가 대신 부지 대표적 동식물에 대한 개별적 선량평가를 수행하며, 대표적 동식물의 종류 및 크기, 거주인자, 전이계수, 평형분배계수에 대한 부지 특성적인 값을 사용한다. 또한 Level 3 평가 단계에서는 전이계수, 평형분배계수, 환경매체농도 (토양농도 또는 물의 농도)에 대한 개별 동식물의 피폭 선량률에 대한 불확실도 분석을 선택적으로 수행할 수 있다. 적용 가능한 확률밀도함수는 정규분포, 로그정규분포, 균일분포, 지수분포의 4가지이다. 국제원자력기구의 EMRAS II (Environmental Modeling for Radiation Safety) 모델 시나리오 비교 공동연구에 참가하여 K-BIOTA의 적용성을 검증하였다. 그 결과로 K-BIOTA는 다양한 오염 환경에서 거주하는 야생동식물의 방사선 영향을 평가하는데 유용함이 입증되었다.

가족계획(家族計劃) 및 모자보건사업(母子保健事業)의 효율적 통합방안(統合方案)에 관한 연구(硏究)(서산군(瑞山郡)) -기초조사보고(基礎調査報告)- (The Seosan County Family Planning/Maternal & Child Health Service Research Project, Korea -Project Design and Findings of the Baseline Survey-)

  • 방숙;조태호;이상주;한성현;임경주;안문영
    • Journal of Preventive Medicine and Public Health
    • /
    • 제16권1호
    • /
    • pp.163-192
    • /
    • 1983
  • In order to facilitate the Korean government's efforts in integrating family planning and maternal & child health at the primary health care level (or township level), the Soon Chun Hyang College of Medicine, with the financial and technical assistance of WHO, has under-taken a service research project. The project has employed a quasi-experimental study design introducing interventions tat provide crucial factors lacking in the ongoing government programs such as midwives and qualified referral physicians. The study is being conducted in three locations, one control area and two study areas. Before introducing trained Nurse/Midewives into the study areas, a baseline prevalence survey was undertaken from 15 July 1981 to 10 August 1981 in selelcted townships of Seosan County. In this sample survey of bath the study and control areas, 2,484 eligible women (97% reponse rate) were interviewed to obtain benchmark data on basic evaluation indicators related to family planning and maternal and child health. The salients results were summarized as follows.: 1. CONTACT RATES WITH HEALTH WORKERS; During the year preceding the survey, 12% of women were visited by government health workers. The primary reason for such visits by health workers was family planning (45% of the visits). About 34% of the women visited the health centers during the year. The primary reason for visiting health centers was immunizations for their children (45% of the visits). 3. FAMILY PLANNING USE RATE; The baseline data showed little difference between women in the study area and the control area on contraceptive use. Approximately 59% were currently using some methods. However, among those current users, almost half were practicing less effective methods of birth control such as rhythm or withdrawal. Among other methods, the tubectomy was the most popular (16%), while use of the IUD, oral pill and condom together reached only 14%. 3. PRENATAL CARE RATE; About 75% of the women reported no prenatal care for their last births (the youngest child of each women), Additionally, among women received prenatal care, over half had only one visit. 4. ATTENDANCE AT DELIVERY; Most of the women surveyed (over 80%) were attended by a non-medical person during their last delivery. These figures are somewhat comparable to the national figure of 84% for remote areas. 5. POSTNATAL CARE; The proportion of women reporting postnatal care was only 4.5%, and postnatal care was not received by the majority of women surveyed. 6. CHILD HEALTH CARE: In contrast to the low rate of maternity care for women themselves, most women reported obtaining immunization care for their children. About 75% of the women obtained Polio and/or DPT, 58% BCG, and 44% Measles vaccine for their children. However, in terms of illness care, while 35% of the women stated that their youngest child had been sick during the month preceding the survey, only 28% of these women took their child to the clinic for treatment. 7. COMPLICATIONS OF PREGNANCY AND DELIVERY AND ABNORMALITIES IN THE NEWBORN; Among all last deliveries, 18% of the women had pregnancy complications and 9% of the women had complications during delivery About 5% of the women reported abnormality in their most recent newborn. 8. REPRODUCTION EFFICIENCY; PERINATAL MORTALITY AND INFANT MORTALITY Based on data from the pregnancy history in this survey, reproduction efficiency was estimated. Out of the 11,154 pregnancies reported by all women surveyed, foetal loss was 21% (almost 16% were induced abortions) and infant deaths before reaching one year old were 3.1%. The reproduction efficiency was, therefore, reduced to 76%. In terms of perinatal and infant mortality rates, the former was 40.2 per 1,000 total births and the latter was 39.3 per 1,000 live births. Both rates described J shaped relationships with age of mothers and parity, and they were also correlated with birth interval and mother's education. In summary, this baseline survey data indicated a need for (1) improving contraceptive practices with more effective methods to prevent unwanted pregnancies and (2) providing better services for maternal and child care to protect wanted pregancies. In the Korean rural setting. the author believes that the latter is more important as the value of each child has increased as a result of the family planning campaign for the past two decades. This calls for more effective integration of Family Planning and MCH programmes to meet the needs of the family in each stage of the child bearing and rearing period with deploying more qualified personnel than the current government program personnel.

  • PDF

디지털 아카이브즈의 문제점과 방향 - 문화원형 콘텐츠를 중심으로 - (Digital Archives of Cultural Archetype Contents: Its Problems and Direction)

  • 함한희;박순철
    • 한국비블리아학회지
    • /
    • 제17권2호
    • /
    • pp.23-42
    • /
    • 2006
  • 본고는 문화원형콘텐츠를 유통시키고 있는 문화콘텐츠닷컴의 디지털아카이브 시스템에 주목해서 문제점을 분석하고 대안을 제시하는 것이 목적이다. 문화원형콘텐츠는 전통문화와 컴퓨터기술을 접목시켜 개척한 새로운 분야이다. 정부에서는 이 산업을 육성해서 한국문화의 세계화와 국가 경쟁력을 강화시킬 의도를 가지고 있다. 우리나라의 역사와 전통 풍물 생활 전승 예술 지리지 등 다양한 분야의 문화원형을 디지털 콘텐츠화하여 문화산업에 필요한 창작소재로 제공하는 것이 그 핵심내용이다. 아울러 디지털 콘텐츠 유통체계 정립과 저작권 관리를 통해서 공공부문 문화콘텐츠의 산업적 활용도를 제고하려는 의도도 포함된다. 본고에서 다루는 대상자료는 현재 문화콘텐츠닷컴에서 유통, 관리되고 있는 문화원형콘텐츠들이다. 이 성과물들은 2002년부터 2005년까지 개발되어서 문화콘텐츠닷컴 DB에 구축되어 있다. 이 자료들을 통해서 현재의 디지털아카이브 시스템의 문제점을 분석하였고, 현재의 시스템이 안고 있는 한계점을 요약하면 다음과 같다. 첫째는 각 자료에서 사용하는 주요 용어의 선택에 따라 유사한 자료들이 서로 다른 주제로 분류되면서 다른 항목에 속하게 되는 것이다. 둘째는, 따라서 서로 다른 항목 간에 교차검색이 이루어지지 않는 한계점이 있다. 현재의 제 문제를 해결할 수 있는 방법으로 본고에서는 온톨로지 기능을 포함한 데이터마이닝시스템을 이용해서 풍부한 지식정보표현과 활용이 가능한 디지털아카이브 시스템을 제안하고 있다. 데이터마이닝은 다섯 가지의 방법으로 가능하다. 의미검색 문서요약 문서클러스터링 문서분류 그리고 주제추적이다. 최근에 빠르게 개발되고 있는 디지털 신기술도 인문학과 긴밀하게 연결되지 않으면, 그 활용도가 제한적이라는 점을 본고를 통해서 지적하였다. 창작소재로서의 문화원형콘텐츠의 활용도를 크게 향상시킬 수 있는 길은 바로 신지식관리를 위한 통학적(uni-discipline) 접근이라는 점을 일깨우고자 한다.

항공기(航空機) 사고조사제도(事故調査制度)에 관한 연구(硏究) (A Study on the System of Aircraft Investigation)

  • 김두환
    • 항공우주정책ㆍ법학회지
    • /
    • 제9권
    • /
    • pp.85-143
    • /
    • 1997
  • The main purpose of the investigation of an accident caused by aircraft is to be prevented the sudden and casual accidents caused by wilful misconduct and fault from pilots, air traffic controllers, hijack, trouble of engine and machinery of aircraft, turbulence during the bad weather, collision between birds and aircraft, near miss flight by aircrafts etc. It is not the purpose of this activity to apportion blame or liability for offender of aircraft accidents. Accidents to aircraft, especially those involving the general public and their property, are a matter of great concern to the aviation community. The system of international regulation exists to improve safety and minimize, as far as possible, the risk of accidents but when they do occur there is a web of systems and procedures to investigate and respond to them. I would like to trace the general line of regulation from an international source in the Chicago Convention of 1944. Article 26 of the Convention lays down the basic principle for the investigation of the aircraft accident. Where there has been an accident to an aircraft of a contracting state which occurs in the territory of another contracting state and which involves death or serious injury or indicates serious technical defect in the aircraft or air navigation facilities, the state in which the accident occurs must institute an inquiry into the circumstances of the accident. That inquiry will be in accordance, in so far as its law permits, with the procedure which may be recommended from time to time by the International Civil Aviation Organization ICAO). There are very general provisions but they state two essential principles: first, in certain circumstances there must be an investigation, and second, who is to be responsible for undertaking that investigation. The latter is an important point to establish otherwise there could be at least two states claiming jurisdiction on the inquiry. The Chicago Convention also provides that the state where the aircraft is registered is to be given the opportunity to appoint observers to be present at the inquiry and the state holding the inquiry must communicate the report and findings in the matter to that other state. It is worth noting that the Chicago Convention (Article 25) also makes provision for assisting aircraft in distress. Each contracting state undertakes to provide such measures of assistance to aircraft in distress in its territory as it may find practicable and to permit (subject to control by its own authorities) the owner of the aircraft or authorities of the state in which the aircraft is registered, to provide such measures of assistance as may be necessitated by circumstances. Significantly, the undertaking can only be given by contracting state but the duty to provide assistance is not limited to aircraft registered in another contracting state, but presumably any aircraft in distress in the territory of the contracting state. Finally, the Convention envisages further regulations (normally to be produced under the auspices of ICAO). In this case the Convention provides that each contracting state, when undertaking a search for missing aircraft, will collaborate in co-ordinated measures which may be recommended from time to time pursuant to the Convention. Since 1944 further international regulations relating to safety and investigation of accidents have been made, both pursuant to Chicago Convention and, in particular, through the vehicle of the ICAO which has, for example, set up an accident and reporting system. By requiring the reporting of certain accidents and incidents it is building up an information service for the benefit of member states. However, Chicago Convention provides that each contracting state undertakes collaborate in securing the highest practicable degree of uniformity in regulations, standards, procedures and organization in relation to aircraft, personnel, airways and auxiliary services in all matters in which such uniformity will facilitate and improve air navigation. To this end, ICAO is to adopt and amend from time to time, as may be necessary, international standards and recommended practices and procedures dealing with, among other things, aircraft in distress and investigation of accidents. Standards and Recommended Practices for Aircraft Accident Injuries were first adopted by the ICAO Council on 11 April 1951 pursuant to Article 37 of the Chicago Convention on International Civil Aviation and were designated as Annex 13 to the Convention. The Standards Recommended Practices were based on Recommendations of the Accident Investigation Division at its first Session in February 1946 which were further developed at the Second Session of the Division in February 1947. The 2nd Edition (1966), 3rd Edition, (1973), 4th Edition (1976), 5th Edition (1979), 6th Edition (1981), 7th Edition (1988), 8th Edition (1992) of the Annex 13 (Aircraft Accident and Incident Investigation) of the Chicago Convention was amended eight times by the ICAO Council since 1966. Annex 13 sets out in detail the international standards and recommended practices to be adopted by contracting states in dealing with a serious accident to an aircraft of a contracting state occurring in the territory of another contracting state, known as the state of occurrence. It provides, principally, that the state in which the aircraft is registered is to be given the opportunity to appoint an accredited representative to be present at the inquiry conducted by the state in which the serious aircraft accident occurs. Article 26 of the Chicago Convention does not indicate what the accredited representative is to do but Annex 13 amplifies his rights and duties. In particular, the accredited representative participates in the inquiry by visiting the scene of the accident, examining the wreckage, questioning witnesses, having full access to all relevant evidence, receiving copies of all pertinent documents and making submissions in respect of the various elements of the inquiry. The main shortcomings of the present system for aircraft accident investigation are that some contracting sates are not applying Annex 13 within its express terms, although they are contracting states. Further, and much more important in practice, there are many countries which apply the letter of Annex 13 in such a way as to sterilise its spirit. This appears to be due to a number of causes often found in combination. Firstly, the requirements of the local law and of the local procedures are interpreted and applied so as preclude a more efficient investigation under Annex 13 in favour of a legalistic and sterile interpretation of its terms. Sometimes this results from a distrust of the motives of persons and bodies wishing to participate or from commercial or related to matters of liability and bodies. These may be political, commercial or related to matters of liability and insurance. Secondly, there is said to be a conscious desire to conduct the investigation in some contracting states in such a way as to absolve from any possibility of blame the authorities or nationals, whether manufacturers, operators or air traffic controllers, of the country in which the inquiry is held. The EEC has also had an input into accidents and investigations. In particular, a directive was issued in December 1980 encouraging the uniformity of standards within the EEC by means of joint co-operation of accident investigation. The sharing of and assisting with technical facilities and information was considered an important means of achieving these goals. It has since been proposed that a European accident investigation committee should be set up by the EEC (Council Directive 80/1266 of 1 December 1980). After I would like to introduce the summary of the legislation examples and system for aircraft accidents investigation of the United States, the United Kingdom, Canada, Germany, The Netherlands, Sweden, Swiss, New Zealand and Japan, and I am going to mention the present system, regulations and aviation act for the aircraft accident investigation in Korea. Furthermore I would like to point out the shortcomings of the present system and regulations and aviation act for the aircraft accident investigation and then I will suggest my personal opinion on the new and dramatic innovation on the system for aircraft accident investigation in Korea. I propose that it is necessary and desirable for us to make a new legislation or to revise the existing aviation act in order to establish the standing and independent Committee of Aircraft Accident Investigation under the Korean Government.

  • PDF

우리나라 재래공업 산지의 사회적 분업 - 담양죽제품과 여주 도자기 산지를 사례로 - (Social division of labor in the traditional industry district - foursed on Damyang bamboo ware industry of Damyang and Yeoju pottery industry of Yeoju, South Korea)

  • 박양춘;이철우;박순호
    • 대한지리학회지
    • /
    • 제30권3호
    • /
    • pp.269-295
    • /
    • 1995
  • 본 연구에서는 담양 죽제품과 여주 도자기 산지를 사례로 재래공업 존립의 중요한 요소인 산지내 사회적 분업의 실태, 특성 그리고 의의를 밝히고자 하였다. 산지내 사회적 분 업은 주로 원자재조달과 제품생산, 제품생산과 제품판매간에 이루어지고 있으며, 생산공정상 의 사회적 분업 및 제품생산 부문과 그 관련시설, 기계제작 부문간의 사회전 분업은 부분적 으로 이루어지고 있다. 그 성격에 있어서는 담양 죽제품산지는 산지완결형의 그리고 여주 도자기 산지는 미산지완결형의 특성이 강하다. 그리고 사회적 분업체계를 구성하는 기업들 은 독자성을 가진 수평적 분업체계를 유지하고 있으나 수요변화에 적극적으로 대응하기 위 한 신제품의 개발과 판로개척을 선도할 수 있는 기업이 밭달하지 못하고 있다. 산지존립에 있어서의 사회적 분업의 의의로는 생산공정의 세분화와 업종분화를 통해서 노동력 부족을 극복함과 동시에 생산비를 절감할 수 있고 소자본의 신규참여를 용이하게 하고 경기변동에 따른 위험부담을 분산하며 다방면에 걸친 축적된 노-하우를 활용한 업종과 제품의 전환을 통하여 제품의 다양화와 제품수명주기가 연장된다는 점을 들 수 있다.

  • PDF

특성화고 진학 및 졸업 후 진로에 대한 중학생, 학부모, 산업체 인사 담당자의 인식 비교 연구 (A Comparative Study on Awareness of Middle School Students, School Parents, and Human Resources Directors in Industrial Institutions about Admission into Specialized High Schools and Career after Graduating from Specialized High Schools)

  • 이병욱;안재영;이찬주;이상현
    • 대한공업교육학회지
    • /
    • 제38권2호
    • /
    • pp.48-67
    • /
    • 2013
  • 본 연구는 특성화고 교육의 주요 수요자가 될 중학생, 학부모, 산업체 인사 담당자의 특성화고 진학 및 졸업 후 진로에 대한 인식을 조사하여 특성화고의 운영 방향에 관한 시사점을 제안하고자 한다. 이를 위해 충남 아산시의 중학교 3학년생과 학부모 및 산업체 인사를 대상으로 조사 연구를 실시하였다. 본 연구의 결과를 요약하면 다음과 같다. 첫째, 중학생과 학부모는 대체로 특성화고 마이스터고 등 직업 교육 기관보다는 일반고 진학을 희망하였고 고교 선택 요인으로 중학생은 학업 성적을, 학부모는 적성 소질을 가장 고려하였다. 둘째, 중학생 학부모 산업체 인사는 특성화고의 목적을 학생의 소질 적성 향상 및 취업으로 인식하였고, 특성화고의 긍정적인 이미지는 소질 적성을 일찍 살림, 취업이 잘됨, 졸업 후 자립이 빠름, 우수한 기술 습득 등으로, 부정적인 이미지는 사회적 편견 및 차별, 성적이 좋지 않은 학생의 진학, 승진 임금 등에 대한 불이익, 대학 진학에 불리 등으로 인식하였다. 또한 특성화고 교육이 전공분야 기초 실무 능력 향상, 직업 기초 능력 함양, 창의 인재 육성, 바른 인성 및 태도 함양에 대해 효과가 있는 것으로 인식하였다. 셋째, 다수의 중학생과 학부모가 아산시에 특성화고 설립 시 특성화고 진학 의사를 나타냈고 진학 이유는 적성 소질을 일찍 살림, 우수한 기술 습득, 조기 취업 희망 등, 미진학 이유는 적성 소질에 맞지 않음, 특성화고에 대한 인식 부족, 대학 진학에 불리, 사회적 편견 및 차별 등이었다. 또한 특성화고 졸업 후 취업과 대학 진학을 비슷하게 희망하였고 취업 이유는 대체로 사회 진출을 빨리하여 성공하고 싶거나 대학을 졸업해도 취업하기 어렵기 때문에, 진학 이유는 대체로 전공에 대한 심화교육과 학력에 따른 사회적 차별 때문이었다. 중학생 학부모 산업체 인사가 인식하는 채용 기준으로 직무 수행 능력이 가장 큰 비중을 차지하였다. 중학생과 학부모는 공업 계열 학과, 가정 가사 및 상업 관련 학과를 주로 희망하고 있으며 학과 선택을 위해 적성 소질, 미래 유망, 취업에 유리함 등을 고려하였다. 산업체 인사의 특성화고 학생의 채용 이유는 학생을 산업체의 인재로 성장, 학생이 직무 수행 능력을 갖춤, 고졸 수준의 인력이 필요함 등이었고, 인력이 필요하거나 학생이 직무 수행 능력을 갖추면 채용할 수 있다는 일부 응답이 있었다. 이상의 결과에 따른 특성화고 운영 방향에 대한 제언은 다음과 같다. 특성화고는 학생과 학부모의 다양한 요구에 부합도록 학과 및 교육과정을 다양화하고 진로 지도에 입각한 특성화고 입학 시스템을 구축하며 일 기반 현장 학습을 구축하여 학생의 직무 수행 능력을 향상시켜야 한다. 정부는 특성화고 학생의 실질적인 경력 발달이 가능하도록 선취업 후진학 정책을 정비하고 취업률 등 정량적 평가보다는 특성화고 교육의 내실화를 위한 방향으로 관련 정책을 추진하며, 특성화고 관련 기능 인력이 제대로 평가 및 대우받을 수 있는 각 부처의 협력적 지원이 요구된다.

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

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

  • PDF