• 식물분류학회지
• /
• 제45권1호
• /
• pp.96-107
• /
• 2015

본 연구는 제주도에 분포하는 수생 및 습생 식물의 식물상을 규명하고, 습지환경의 식물종다양성을 보존하기 위한 기초자료를 확보하고자 수행하였다. 야외 조사는 제주도 전 지역을 대상으로 2010년 5월부터 2014년 9월에 걸쳐 이루어졌다. 본 식물상 연구를 통해 확인된 습지식물은 총 52과 98속 181종 6변종 2품종 189분류군이었다. 이 중 총 38과 60속 96종 3변종 99분류군이 수생식물로, 23과 45속 85종 3변종 2품종 90분류군이 습생식물로 나타났다. 또한 사초과 식물인 Eleocharis${\times}$yezoensis H. Hara를 한국미기록식물로 보고하였다. 조사된 식물 중 환경부지정보호야생식물은 순채, 전주물꼬리풀 등 5분류군이 분포하는 것으로 조사되었다. 멸종위기종은 위급종이 제주고사리삼 1분류군, 위기종이 물까치수염 등 5분류군, 취약종이 대구돌나물 등 7분류군으로 나타났다. 식물구계학적 특정식물로는 V등급이 10분류군, IV등급이 7분류군, III등급이 15분류군, II등급이 5분류군, I등급이 7분류군으로 총 44분류군이 확인되었다. 귀화식물은 총 8과 9속 9종 1변종 10분류군으로 나타났다. 제주도의 습지는 식물종다양성이 매우 높고, 희귀식물 및 식물지리학적으로 중요한 식물 등이 다수 분포하여 식물학적 가치가 매우 높은 것으로 판단된다. 따라서 습지 및 종의 보존을 위한 구체적인 보호 및 관리 체계의 수립이 요구된다.

• 식물병연구
• /
• 제7권3호
• /
• pp.155-163
• /
• 2001

기주반응 실험을 통하여 무병징 또는 엷은 병징을 발현하는 satRNA 보유 Paf-CMV 및 Rs2-CMV를 고추 CMV병의 방제를 위한 약독바이러스로 공시하여 교차방어효과를 검정하였다. 공시한 satRNA-CMV는 모두 agar gel diffusion test에서 강독계로 공시한 Mf-CMV의 항원과 융합하는 침강선을 나타내 subgroup I의 혈청 형으로 판단되었다. 이들 약독계 satRNA-CMV의 물리적성질은 내희석성이 $10^{-4}$으로, 강독계 Mf-CMV나 satRNA를 보유하고 있는 Ap-CMV보다 낮게 나타났으나, 내열성 및 내보존성 은 차이를 보이지 않았다. 공시한 satRNA의 염기서열을 결정한 결과, Rs2-satRNA는 335염기, Ap-satRNA 347염기, Paf-satNA 386염기로 구성되어 있었다. 이들 염기서열을 이미 보고된 Y-CMV의 satRNA와 비교한 결과, 양 말단 영역 특히 5'말단으로부터 80염기 및 3'말단으로부터 174염기는 안정된 conserved sequence를 나타냈다. 그러나 중간영역의 염기서열에서는 .많은 변이를 나타냈고, 특히 병징과 관련된 domain으로 보고된 영역에서 Paf-satRNA의 염기서열은 다른 계통의 satRNA에 비하여 많은 차이를 보였다. 각 satRNA의 cDNA로부터 전사시킨 transcript RNA를 Mf-CMV의 게놈RNA와 혼합하여 고추에 접종한 결과, 본래의 각 satRNA-CMV를 접종하였을 때와 마찬가지로 Paf-satRNA 및 Rs2-satRNA의 transcript 와 혼합한 Mf-CMV에 감염된 고추의 병징이 약하게 발현되었다. 선발된 약독CMV의 강독계 바이러스에 대한 교차방어효과를 검정하기 위하여 Paf-CMV 및 Rs2-CMV를 접종한 고추와 담배에 강독 Mf-CMV를 challenge한 후 교차방어 지속효과를 검정한 결과, Paf-CMV를 접종한 고추와 담배는 모두 Mf-CMV를 challenge 접종한 3주후까지 병징이 발현되지 않았으나, Rs2-CMV를 접종한 식물은 challenge 2주 후에 약 반수의 개체에서 강독계 병징이 발현되었다. 또한 challenge바이러스의 농도별 교차방어효과에서도 Paf-CMV를 접종한 고추에 정제한 Mf-CMV를 0.2 mg/ml 이하의 농도로 challenge한 경우, 접종 30일이 되었을 때까지 병징이 발현되지 않았으나, Rs2-CMV에서는 일부의 개체에서 병징이 발현되어 강독계에 대한 교차방어의 효과가 일정하게 나타나지 않았다. 한편 고추의 유묘에 약독CMV를 접종한 다음, 포장에 재배하면서 바이러스병징이 발현되는 개체를 조사한 결과, 약독 CMV접종 30-60일 후에 Paf-CMV 접종구에서 1.8-6.4%, Rs2-CMV 접종구에서 8.2-18.3%그리고 무접종구에서 2.7-47.2%의 바이러스병징이 발현됨으로서 Paf-CMV의 강독계 CMV의 감염에 대한 교차방어효과가 안정되고 높게 나타났다..

• Pediatric Infection and Vaccine
• /
• 제10권2호
• /
• pp.215-222
• /
• 2003

목 적 : 3개월 이하의 영아가 열이 있는 경우에 세균성 질환의 가능성이 크고 단순한 바이러스에 의한 질환과 감별이 어려워 여러 가지 검사 및 입원 치료를 하게 되는데, 고위험군과 저위험군을 분류하여 불필요한 검사와 치료를 줄이기 위한 연구들이 진행되었으나 통일된 방법은 없었다. 따라서 저자들은 열이 있는 3개월 이하의 영아들을 대상으로 심각한 질환과의 관련성 및 치료 방향을 살펴보려고 본 연구를 시행하였다. 방 법 : 2001년 1월부터 2002년 12월까지 전주 예수병원에 발열(항문 체온 ${\geq}38.0^{\circ}C$)을 주소로 내원한 3개월 이하의 영아들을 대상으로 내원 당시 검사기록을 기준으로 고위험군과 저위험군을 분류하고 이에 따른 심각한 세균성 질환과의 관련성을 조사하였다. 결 과 : 1) 총 378명의 환아 중 고위험군 216명(57.1%), 저위험군 162명(42.9%)이었고, 고위험군으로 분류된 항목 중에서는 말초 혈액 검사 이상이 100명(26.2%), 소변 검사이상이 99명(26.3%), 뇌척수액 검사 이상이 75명(22.3%)이었다. 2) 심각한 세균성 질환이 105명(27.8%), 심각한 질환이 172명(45.5%) 발생하였다. 이중 요로 감염이 98명(25.2%), 패혈증 10명(2.6%), 세균성 수막염 2명(0.6%), 무균성 수막염 77명(22.8%)이었다. 3) 고위험군 중 76명(35.2%)이 심각한 세균성 질환이었고 저위험군 중 29명(17.9%)이 심각한 세균성 질환이었다. 따라서 위험 예측기준의 민감도는 72.4%, 특이도는 48.7%, 음성 예측치는 82.1%, 양성 예측치는 35.2%이었다. 결 론 : 3개월 이하의 발열이 있는 영아를 고위험군과 저위험군으로 분류하는 것은 심각한 세균성 질환을 예측하는 데 많은 도움이 되나, 본 병원에서는 저위험군에서도 상당수의 심각한 세균성 질환이 발생하였다. 따라서 저위험군이라 하여 외래에서 추적 관찰만 하는 것은 신중하게 결정해야 할 것으로 사료된다.

• 한국의학물리학회지:의학물리
• /
• 제17권3호
• /
• pp.131-135
• /
• 2006

본 연구의 목적은 2차원적 이온전리함 배열의 특성을 분석하고 세기변조방사선치료 선량분포 확인의 유용성을 평가하기 위함이다. 본 실험에 사용된 2차원적 이온전리함 배열(MatriXX, Scanditronix-Wellhofer, IBA, Germany)은 $24{\times}24cm^2$ 범위에 1,024개의 평판형 전리함(용적: $0.08cm^3$, 직경: 4.5 mm, 높이: 5 mm, 배열간격: 7.62 mm)이 일정한 간격으로 배열되어있다. MatriXX의 특성분석을 위해 선량 직선성, 선량률 의존도, 출력 계수, 단기 선릉재현성을 분석하였으며, 선량분포 확인의 신뢰도를 평가하기 위해 Varian사의 동적쐐기와 세기변조 방사선치료의 선량분포를 분석하였다. 선량 직선성의 범위는 $1{\sim}800$cGy이었으며, 1% 미만의 오차율을 보였다. 선량률 의존성(범위 $100{\sim}600MU/min$)은 300 Mu/min을 기준으로 했을 때 모든 선량률 범위에서 0.4% 미만의 선량변화를 보였다. 또한, 물팬톰에서 0.1 cc 지두형 전리함으로 측정한 출력계수와 폴리스틸렌 팬톰에서 MatriXX로 측정한 출력계수를 비교하였다. 이 실험의 결과, $3{\times}3{\sim}24{\times}24cm^2$ 범위에서 0.5% 미만의 일치를 나타내었다. 단기 출력재현성 확인을 위하여 15분 간격으로 6회 측정한 결과, 0.5% 내의 차이를 보였다. 동적쐐기와 세기변조 방사선 조사면의 일치성 실험에서도 치료계획장치의 계산값과 필름측정값이 비교적 잘 일치함을 알 수 있었다. 본 연구를 통해 MatriXX의 물리적인 특성을 분석하였으며 세기변조방사선치료의 품질관리를 위한 유용성을 확인하였다.

• 한국습지학회지
• /
• 제25권2호
• /
• pp.145-158
• /
• 2023

인공습지(CW)는 도시 폐수처리를 위한 효과적인 기술로, 물리-화학적 및 생물학적 자연처리과정을 통해 오염 물질이 제거된다. 본 연구는 서지학적 분석 방법을 통하여 인공습지의 현재까지의 연구 진행 상황과 향후 연구 동향을 조사하였다. 인공습지를 통한 페수 처리 성능 평가 분석을 위하여 최근 출판된 논문(오픈 액세스 학술지 포함) 100편을 기반으로 종합적 분석 및 검토를 수행하였다. 분석 결과, 스페인, 중국, 이탈리아, 미국이 논문 출판수가 두드러지는 것으로 나타났다. 논문에서 가장 많이 사용된 핵심용어는 수질(n=19), 식물 정화(n=13), 강우유출수(n=11), 인(n=11) 순으로 나타났으며, 수질개선과 영양염류 제거에 대한 인공습지의 효율성 관련 연구가 폭넓게 연구되고 있는 것으로 분석되었다. 검토된 다양한 유형의 인공습지 중 Hybrid 형태의 인공습지가 TSS(95.67%) 및BOD(88.67%)으로 오염물질 저감효율이 가장 높은 것으로 나타났으며, VSSF, HSSF는 TSS 제거(83.25% 및 78.83%)에 가장 효과적인 것으로 조사되었다. VSSF 습지는 가장 높은 COD 제거 효율(71.82%)을 보였다. 일반적으로 인공습지에서 물리적 처리(예: 침전, 여과, 흡착)와 생물학적 메커니즘(예: 생분해)은 TSS, BOD, COD 제거 효율에 영향을 미치기 때문이다. Hybrid 형태의 인공습지는 호기성 및 혐기성 조건, 다양한 식생 유형, 다양한 매체 구성 등의 다양한 인자와 여러 처리 과정을 통해 미생물 활성도 증가 및 질소 처리를 통해 TN(60.78%)의 높은 저감효과를 보였다. FWS 형태의 인공습지는 퇴적물에 결합된 인을 침전 및 식물의 흡수를 통해 높은TP 제거효율(54.50%)로 나타났습니다. 일반적으로 인공습지에는 식물 정화 능력이 뛰어난 Phragmites, Cyperus, Iris 및 Typha 이 적용되고 있다. 본 연구는 향후 도시 지역에서 발생되는 폐수 처리를 위한 지속 가능한 대안으로 제시 가능할 것으로 사료된다.

• 한국심리학회지:학교
• /
• 제16권3호
• /
• pp.433-451
• /
• 2019

이 연구는 한국의 초등학교 내에서 발생하는 문제행동을 측정할 수 있는 신뢰롭고 타당한 척도를 개발하여 평가 및 개입을 위한 기초자료를 제공하기 위해 실시하였다. 문헌 개관과 초등교사 면담, 미국에서의 훈육실 의뢰 조건, 국내 학교들의 벌점체계, 그린마일리지, 정서행동특성검사 등을 참고하여 초등학생 문제행동선별척도: 교사용(Classroom Problem Behavior Scale-Elementary School) 문항 군집을 구성하였다. 국내 초등학교 교사 및 교과교사 총 6명에게 내용타당도 검증 후 수업 내 문제행동, 수업 외 문제행동에 대해 각각 4개, 3개의 요인을 상정하고, 이를 측정하는 63개의 예비문항을 제작하였다. 1차 검증에서 예비문항에 대하여 154명의 아동 자료를 수집하여 가장 적합하다고 판단되는 최종 23문항을 선정하였다. 2차 검증에서 교사가 평정한 초등학생 209명의 자료를 활용하여 신뢰도와 타당도를 검증하였다. 분석 결과, 이 척도는 수업 내 문제행동으로 수업 준비 행동, 수업 방해 행동, 공격 행동, 위축 행동의 4요인에 14문항, 수업 외 문제행동으로 규칙 위반 행동, 공격 행동, 위축 행동의 3요인에 9문항, 총 23문항으로 구성하는 것이 가장 타당한 것으로 나타났다. 검사-재검사 신뢰도는 대부분의 소척도에서 .80이상의 상관계수를 보이고 있어 시간적 안정성도 가지고 있는 것으로 나타났고, 각 하위요인별 내적 합치도 역시 .76~.94로 전반적으로 양호하였다. 수렴타당도를 확인하기 위해 '아동·청소년 행동평가척도 교사용'(Teacher's Report Form, TRF)과 교사용 교실 적응 관찰 점검표(Teacher Observation of Classroom Adaptation-Checklist, TOCA-C)와의 상관분석에서 중간수준 이상의 상관이 나타났고 외현화와 공격행동, 내재화와 위축 등 유사한 개념에서 더 높은 상관을 보였다. 확인적 요인분석을 위해 실시한 구조방정식모형 검증에서도 양호한 적합도를 확인하였다. 마지막으로 문항의 구성과 검증 과정에서의 시사점 및 제한점을 논의하였다.

• 현장농수산연구지
• /
• 제17권1호
• /
• pp.57-71
• /
• 2015

본 연구에서는 산업분야에서 다양하게 이용되고 있는 연동펌프를 농축양액 주입장치로 사용한 관비장치를 개발하고 성능시험을 실시하였으며, 얻어진 결과는 다음과 같다. 튜브 내경별, 회전수별, 롤러수별 유량특성 시험결과 펌프 회전속도가 빨라짐에 따라 유량은 직선적으로 증가하였으며, 튜브 내경이 커질수록 기울기도 커졌으며, 롤러수가 3개일 때가 4개일 때의 유량 보다 더 많은 것으로 나타났다. 또한 튜브재질에 있어서는 복원력이 우수한 재질의 노프렌 튜브에서 유량이 많은 것으로 나타났다. 관비장치의 농축양액 주입위치에 따른 혼삽성능 실험결과 안정화 시간은 농축양액을 공급펌프의 흡입 측에 주입한 경우에는 17초, 공급펌프의 토출 측에 주입한 경우에는 16초 이었으며, EC는 안정화 구간에서 각각 1.42±0.05, 1.39±0.02 dS/m로 나타나 주입위치에 따른 영향은 크지 않은 것으로 판단된다. 측정 센서 설치위치에 따른 안정화시간은 주관에 삽입 설치한 경우에는 17초, 여수관에 설치한 경우에는 27초로 나타나 센서는 주관에 삽입 설치하는 것이 바람직한 것으로 판단된다. EC는 안정화 구간에서 각각 1.43±0.05, 1.45±0.07dS/m의 근소한 차이를 보였다. 시작기의 제어성능 실험결과 제어정밀도가 ±0.05dS/m로 나타나 제어성능이 우수한 것으로 나타났다. 농가 현장시험결과 개발한 관비장치에 의해 재배한 오이가 정상적인 생육을 하는 것으로 나타나 개발한 시험용 장치의 실용화가 이루어진다면 관비재배 농가에서 활용할 수 있을 것으로 판단된다.

• 한국지역지리학회지
• /
• 제6권2호
• /
• pp.1-19
• /
• 2000

본 연구는 중부지역의 중심지로 발전하고 있는 대전광역시를 대상으로 노령화 지구의 공간적 분포 패턴을 분석하고자 하였다. 그 결과 노령화 지구는 대전광역시 CBD지역과 CBD인접지역, 그리고 주변지역간에 뚜렷한 차이를 나타내고 있으며, 그 분포에 있어서도 양극화 현상이 뚜렷함을 확인하였다. 그리고 인구감소지구는 노령화지구와 대체로 중복되어 있고, 비노령인구의 전출에 의하여 노령인구비율이 높아지고 있으며, 인구증가지구는 노령화 지구와 전혀 중복되어 나타나지 않고, 비노령인구의 전입에 의해 노령인구비율이 낮아지고 있다. 인구이동에 의한 노령인구의 증가여부를 확인하기 위하여 각 그룹별로 연령 코호트 분석방법을 이용하여 노령화 지구의 출현요인을 분석한 결과, 인구노령화의 진행 은 인구의 사회적 증감률 변화와 매우 밀접하게 관련되어 있고, 특히 비노령인구의 전출에 의해 노령인구비율이 높아지고 있음을 확인할 수 있었다. CBD지역과 CBD인접지역을 포함한 중심시가지에서는 결혼, 새로운 주택취득에 의한 세대분리 등의 전출, 즉, 비노령인구의 전출이 인구노령화를 촉진하는 주요인이 되고 있고, 반면 주변지역에서는 비노령인구의 지구의로의 전출뿐 아니라 새롭게 노령인구로 편입되어져 가는 연령층 인구와 사망률의 저하에 따른 평균수명의 연장으로 인한 노령인구의 절대적 증대가 인구노령화를 촉진하는 요인으로 작용하고 있다.

• Journal of Preventive Medicine and Public Health
• /
• 제7권1호
• /
• pp.1-28
• /
• 1974

The writers have conducted the investigation to assess the nutritional status of young rural Korean children aged from 0 to 4 years old in August 1971. The survey areas were Kaejong-myon. Daeya-myon, Okku-gun, Jeonra-bukdo, Korea. These survey areas were typical agricultural plain areas. The total numbers of children examined were 2,706 comprising 1,394 male and 1,312 female. The weight, height, and chest circumference of children were measured and means and standard deviations. were calculated for each measurement. In addition, the nutritional status of each child was classified by the four levels of malnutrition and the Gomez classification, The examination of red blood cell count, haematocrit value, and intestinal parasite infection were carried out at the same time. In general, recent work tend to suggest that environmental influences, especially nutrition, are of great importance than genetic background or other biological factors for physical growth and development. Certainly the physical dimensions of the body are much influenced by nutrition, particularly in the rapidly growing period of early childhood. Selected body measurements can therefore give valuable information concerning protein-calory malnutrition. Growth can also be affected by bacterial, viral, and parasitic infection. For the field workers in a developing country, therefore, nutritional anthropometry appears to be of greatest value in the assessment of growth failure and undernutrition, principally from lack of protein and calories. In order to compare and evaluate the data obtained, the optimal data of growth from the off-spring of the true well-fed, medically and socially protected are needed. So-called 'Standards' that have been compiled for preschool children in Korea, however, are based on measurement of children from middle or lower socio-economic groups, who are, in fact, usually undernourished from six months of age onwards and continuously exposed to a succession of infective and parasitic diseases. So that, the Harvard Standards which is one of the international reference standards was used as the reference standards in this study. Findings of the survey were as follows: A. Anthropometric data: 1) Comparing the mean values for body weight obtained with the Korean standard weight of the same age, the rural Korean children were slightly haevier than the Korean standard values in both sexes. Comparing with the Japanese children values, the rural Korean children were slightly haevier in male and in the infant period of female but lighter in female of the period of 1 to 4 years old than Japanese children. 2) Comparing the mean values for height obtained with the Korean standard height of the same age, the rural Korean children were taller than the Korean standard values except the second half of infatn period in both sexes. Comparing with the Japanese children, the rural Korean children were slightly smaller than Japanese children except the first half of infant peroid in both sexes. 3) Mear values of chest circumference of rural Korean children obtained were less than the Korean standard values of the same ages in both sexes. B. Prevalence of Protein-Calory Malnutrition: Children examined were devided into two groups, i. e., infant(up to the first birthday) and toddler (1 to 4 fears old). 1) Percentages of four levels of malnutrition: a) When the nutrtional status of each child was classified (1) by body weight value, the percentages for male and female of children attained standard growth were 52.8%(infant 83.3%, toddler 44.4%) and 39.7% (infant 74.5%. toddler 30.5%), the first level of malnutrition were 31.9%(infant 13.7%, toddler 36.9%) and 31.7%(infant 15.3%, toddler 36,0%), the second level of malnutrition were 12.3%(infant 1.7%, toddler 15.3%) and 23.3% (infant 7.7%, fodder 27.5%), the third level of malnutrition were 2.7%(infant 0.7%, toddler 3.2%) and 4.6%(infant 1.8%, toddler 5.3%) the fourth level of malnutrition were 0.3% (infant 0.7%, toddler 0.2%) and 0.7% (0.7% for infant and toddler) respectively. (2) by height value, the percentages for male and female of children attained standard growth were 80.3% (infant 97.3%, toddler 75.6%) and 75.1% (infant 96.4%, toddler 69.5), the first level of malnutrition were 17.9% (infant 2.0%, toddler 22.3%) and 23.6% (infants 3.6%, toddler 28.8%), the second level of malnutrition were 1.2% (infant 0.3%, toddler 1.5%) and 1.1% (infant 0%, toddler 1.4%), the third level of malnutrition were 0.4%(infant 0.3%, toddler 0.5%) and 0.2%(infant 0%, toddler 0.3%), the fourth level of malnutrition were 0.1%(infant 0%, toddler 0.1%) and 0% respectively. (3) by body weight in relation to height, the percentages for male and female of children attained standard growth were 87.9% (infant 77.6%, toddler 87.9%) and 78.2% (infant 77.4%, toddler 78.2%), the first level of malnutrition were 12.2% (infant 18.4%, toddler 10.6%) and 18.2% (infant 17.9%, toddler 18.3%), the second level of malnutrition were 1.9%(infant 3.3%, toddler 1.5%) and 3.0%(infant 3.3%, toddler 2.9%), the third level of malnutrition were 0.1%(infant 0%. toddler 0.1%) and 0.5% (infant 0%, toddler 0.6%), the fourth level of malnutrition were 0.1%(infant 0.7%, toddler 0%) and 0.3% (infant 1.5%, toddler 0%) respectively. b) When the nutritional status of each child according to the mother's age at perturition, i. e., young aged mother (up to 30 years old), middle aged mother (31 to 40 years old) and old aged mother (41 years or above) was classified (1) by body weight, among infants and toddlers, at each year of age, with increasing the mother's age, there was an increase in percentage of subjects underweight. This tendency of increasing percentage of underweight was more significant in the infant period than the toddler period. (2) by height value, no significant differences between each mother's age group were found. c) When the nutritional status of each child according to the birth rank, i. e., lower birth rank (first to third) and higher birth rank (fourth or above) was classified (1) by weight value, children of higher birth rank were slightly more often underweight than those of lower birth rank, but not significant. (2) by height value, no differences were found between children of lower and higher birth rank. 2) Gomez Classification: When the nutritional status of each child was classified a) by body weight value, the percentages for male and female of children. attained standard growth were 53.1% (infant 82.6%, toddler 44.9%) and 39.2% (infant 73.4%, toddler 30.1%), the first degree of malnutrition were 39.4% (infant 14.7%, toddler 46.2%) and 47.1% (infant 21.9%, toddler 53.8%), the second degree of malnutrition were 7.3%(infant 2.3%, toddler 8.6%) and 12.9% (infant 4.0%, toddler 15.2%). and the third degree of malnutrition were 0.2%. (infant 0.3%, toddler 0.2%) and 0.8% (infant 0.7%, toddler 0.9%) respectively. b) by height value, the percentages for male and female of children attained standard growth were 80.8% (infant 97.0%, toddler 76.3%) and 73.8%(infant 95.6%, toddler 68.0%), the first degree of malnutrition were 18.5% (infant 2.7%, toddler 22.9%) and 24.6% (infant 4.4%, toddler 30.0%), the second degree of malnutrition were 0.6%(infant 0.3%, toddler 0.7%) and 0.5% (infant 0.1%, toddler 0.7%), and the third degree of malnutrition were 0.1%(infant 0%, toddler 0.1%) and 1.1% (infant 0%, toddler 1.3%) respectively. C. Results of clinical laboratory examination: 1) Red blood cells: The ranges of mean red blood cell counts for male and female were $3,538,000/mm^3\;to\;4,403,000/mm^3\;and\;3,576,000/mm^3\;to\;4,483,000/mm^3$ respectively. The lowest red cell counts were seen at the age of 0-3 months for male and 1-2 months for female. 2) Haematocrit value : The ranges of haematocrit value of male and female were 35.1% to 38.8% and 34.7% to 38.8% respectively. The lowest haematocrit values were seen at the age of 2-3 months for male and 1-2, months for female. 3) The prevalence rates of intestinal parasites for male and female children with Ascaris lumbricoides were 34.1% (infant 18.8%, toddler 38.1%) and 36.0%(infant 18.4%, toddler 40.7%), with Trichocephalus trichiuris were 6.8% (infant 2.9%, toddler 7.9%) and 9.0% (infant 3.0%, toddler 10.6%), with Hookworm were 0.3% (infant 0.5%, toddler 0.2%) and 0.3% (infant 0.5%, toddler 0.3%), with Clonorchis sinensis were 0.4%(infant 0%, toddler 0.5%) and 0.1%(infant 0%, toddler 0.1%) respectively.

• 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.