• 보건교육건강증진학회지
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• 제12권2호
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• pp.109-119
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• 1995

As the population of elderly in Korea is increasing rapidly since the 1990's and will more rapidly in the 21st Century, the demand of their health care would be a great burden to health care expenditure. Then it would be necessary to contemplate the functional status and life satisfaction for elderly to make them live more independently. The objectives of this study were find out the functional status in life and life satisfaction for the elderly aged 65 or over who had resided in urban area of two Gus in Pusan and rural area of two Myuns in Haman Gun in Kyeognam Province, and to provide basic data for planning systematic health care programme. The study period was two weeks from February 6 to February 18, 1995 and the subjects were 274 elderly of which 143 were urban residents, 131 were rural residents, and the study method was by structured questionnaire. The data were analyzed with SAS/PC/sup +/ programme using Chi-square test, t-test, ANOVA, Pearson's correlation coefficients, and multiple regression analysis. The results were as follows; 1. To see the pattern of living together, those living with partners were the most common, 39.1% ; 37.8% of urban elderly lived with married sons, 32.2% of them lived with partners, but 46.6% of rural elderly lived with partners, 16.8% of them lived with married sons, which showed difference between residence(p<0.005). 2. Elderly who had jobs were 64.1% in rural residents, and 7.7% in urban residents, which showed significant difference(p<0.05). 3. The score of cognitive function of total subjects was 24.7, that of urban elderly was 23.8, and that of rural elderly was 25.7, then it was higher in rural ones and low for old-elders and those who had no jobs. 4. The score of PADL was 26.8 for urban elderly, 30.1 for rural elderly, and that of IADL was 22.2 for urban elderly, 25.6 for rural elderly, which showed higher activities of daily living for rural elderly than urban elderly(p<0.001). 5. The score of domestic performance was 21.9 for urban elderly, and 30.5 for rural elderly, which showed higher score for rural elderly(p<0.001). 6. The score of life satisfaction was 20.7 for urban elderly, 29.8 for rural elderly, then it was higher for rural elderly(p<0.01). 7. As a result of ANOVA for functional status in living by general characteristics; the score of cognitive function differed by age, job; that of PADL differed by age, job, education, and the pattern of living together, that of IADL differed by age, job, and the pattern of living together. The score of domestic role performance differed by age, job, marital status, and the pattern of living together. 8. ANOVA for life satisfaction showed that the score of life satisfaction differed by job(p<0.001) and the pattern of living together(p<0.01). 9. The correlations between functional status in living and life satisfaction showed that the higher the score of cognitive function was(r=0.39), the higher the score of activities of daily living was(r=0.50), and the higher the score of domestic role performance was(r=0.41), the higher the score of life satisfaction. 10. Stepwise multiple regression analysis for life satisfaction pointed out that residence was responsible for 39.9% of the variance. cognitive function was for 5.3%, and domestic role performance was for 1.2%.

• Architectural research
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• 제8권1호
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• pp.1-7
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• 2006

Various housing measures are needed for the rapidly aging society of Korea. In particular, the welfare policy for the elderly has changed towards the community care. Taking this fact into consideration, it is necessary to have the establishment of a system that offers the elderly appropriate welfare services at their appropriate residence (ageing in place) for the effectiveness of the community care. In this aspect, there are a number of implications to Korea to study merits and demerits of the Health Facilities for the Aged (HFA) in Japan. The society of Japan has been rapidly aging since 1970, and Korea is to face the same situation. As for the data of this study, a total of 2,393 facilities (as of November 1999) mentioned in the annual report of the Japanese Ministry of Health, Labor and Welfare were classified based on types of their establishment: (1) free-standing structures (603 facilities); (2) annexes to hospitals (981 facilities); (3) annexes to welfare facilities (511 facilities); and (4) annexes to clinics (298 facilities). Next, 239 facilities were selected through taking a sample of 10 percent from each type of the HFA mentioned above. This was done through the random sampling method with the computer program of MS EXCEL. The Implications of the results of analyses are as follows. First, most of the health facilities were planned with the scale that was larger than the scale of standard special nursing homes in terms of the total floor area. Precise equations that were to obtain precise results of the scale of the HFA and the appropriate number of residents were obtained through the method of the regression analysis. Korea and Japan have similarities in terms of culture, society and family relations; however, the two countries also have differences in terms of the application of laws on the establishment of houses, hospitals, and welfare facilities. As for planning the scale of the HFA, the realities of Korea should be considered. Second, as for the functional aspect of the HFA with a condition of returning home, the place before and after the HFA showed the pattern of 'from a residential place to a residential place' and 'from a hospital to a hospital.' This reveals a close correlation with the types of the HFAs and operational ways of the facilities. Its cause is considered to be the aspect of the operation and management of the HFA rather than the aspect of its function of providing services in association with medical and health facilities. Therefore, when intermediate welfare facilities are considered in Korea, it is strongly advised to consider the problem of annexes to other facilities and efficiency of sharing of the facilities in terms of its operation and management.

• 가정과삶의질연구
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• 제2권1호
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• pp.131-150
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• 1984

The purpose of this study is to explore the family as an interaction system, concentrating on the mutual influences between communication and family development; (1) how Communication patterns affect family relationships, and (2) how relationships among family members affect communication. In order to do this Galvin, Brommel used the following frame work; family is a system in which communication regulates cohesion and adaptability by a flow of message patterns through a defined network of evolving interdependent relationships. A family system consists of members, the relationships among them, the family attributes, the members attributes and an environment in which family functions. Within the framework of common cultural communication patterns, each family has the capacity to develop its own communication code based on the experiences of individual members and the collective family experience. Most of us develop our communication skills within the family context learning both the general cultural language and the specific familial communication code. Communication may be viewed as a symbolic, transactional process as the process of creating and sharing meanings. To say that communication is a process implies a continuous interaction of an indefinite large numbers of variables with a concomitant,. continuous change in the values taken by these variables. Finally the process implies change, Family functions include the primary functions of cohesion and adaptability, and supporting functions of family images, themes, boundaries, and biosocial issues. The primary functions reveal concepts integrated family interaction and supporting function, along with those of cohesion and adaptability, give shape to family life. the characteristics of developed relationships of richness, uniqueness efficiency, substitutability, pacing , openness spontaneity, and evaluation are reflected in the verbal and nonverbal behaviors with which family members negotiated a set of common meanings and develop thier own unique message system. The message system is the major element of communication process and influences both the form and the content of thier relationship and in create and share meanings. Family systems need to provide order and predictability for thier members, specifically focusing on communication rules and the networks by which messages are transmitted. Most rules emerge as a result of multiful interactions. There are basic rules and rules about rules, or metarules. Perceiving the rules of family system is very difficult because often family members don't think about the basic rules, much less the metarules. Breaking the rule may result in the creation of a new set because the system may recalibrate itself to accept more variety of behavior. Families develop communication networks to deal with the general issue. Family adaptability may be seen through the degree of flexibility in forming and reforming networks and networks become a vital part of the decision- making process and relate to the power dynamics operating within the family. Networks also play an integral part in maintaining the roles and rules operating with the family system. Thus networks and rules have mutual influence. The family -of -origin issues influence all aspects of family communication and account for many of the communication patterns, rules and networks and the role of the family -of-origin influences as a primary force for communication on behavior of newly forming systems. Each family system develops its own communication meanings. There is not one right way to communicate within a family but may be indefinitly large change of family life and communication behavior. Study on functional family communication helps to gain a better understanding of dynamics of family communication and ability of a new insight into the family.

• 한국가정과학회지
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• 제7권3호
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• pp.15-33
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• 2004

A precise understanding of the human form in static pose serves as the basis of designing clothing. When the human body is in motion, however, even an article of clothing designed to fit the human form in static pose can pull and change, thus restricting the body. In order to increase the fit of the clothing, which may be termed the second skin, its form and measurements therefore must be determined in correlation not only with the formal characteristics of the human body, in static pose but also with its functional characteristics in motion, as caused by the movements of the human body. In this study, the motion factor was selected as the primary basis for designing slacks with good fit in both static and moving states. By indentifying the areas in which lower limb movement cause significant changes in body surface lines, we suggest several application methods for designing slacks. Using unmarried female university students aged 18 - 24 as subjects, a total of 32 body surface categories (15 body surface lines and 17 body surface segment lines) were measured in one static and 9 movement poses. In particular, expansion and contraction levels and rates were measured and used in the analysis. The analysis first involved the calculation of the average measurement per body part in body surface line in static pose as well as of the average expansion and contraction levels and rates in 9 lower limb movements. Two-way MANOVA and multiple comparison analysis (Tukey) were conducted on movements and individual somatotypes regarding measurement per body part and expansion and contraction rates. Body parts whose measurements of body surface lines differed significantly in body surface line in static pose versus in movement were then identified. The results of this study are as follows. First, changes in body surface lines caused by lower limb movements were significant in all body surface lines of the lower trunk, both horizontal and vertical, with the exception of abdomen girth, midway thigh girth, ankle girth, hip length, and posterior knee girth. Second, significantly expanded 10 body surface lines in moving pose were detected and illustrated in table 4. These body parts should be studied in designing or pattern designing, especially for close-fitting pants, in using stretch fabric, and in sensory evaluation of good fit during movement.

• 대한간호학회지
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• 제21권1호
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• pp.89-116
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• 1991

The purpose of this study was to describe mother -infant interacting behavior patterns related to newborn infant feeding and to explore the mother's cultural belief about their infant. The data collection was conducted by observation and interview. Twenty-five mothers and their newborn infants who were normally delivered and were also planned to breast feed were comprised as the subjects of this study. All subjects were interviewed and observed individuaily at 1 to 5 days after the delivery at the hospital, mid -wife's clinic, Maternal Child Health Center and their home throughout the country from remote area to big city, The observation data were recorded with symbolic letter on a recording sheet newly developed as a result of preliminary study. The interview data were taperecorded and then recorded in narrative form. Mother - infant interaction behaviors in early feeding period were analyzed based on 19 analytic sub-categories and their composing elements. Unit of analysis were mother, infant and mother -infant dyad. 8 analytic categories draw from the data. Each were preparation, instrument, interaction inducing, evaluation referred to mother's behavior, preparation, instrument, interaction inducing referred to infant's behavior and synchronic behaviors referred to mother - infant dyad. Frequencies of behavior items based on the categories were converted to percent. The result showed that in mother's preparation behavior, the breast condition of Korean mother can be an affecting factor for mother - infant interaction during feeding, and vocalization behavior was observed most frequently in interaction inducing behavior while the least frequent behavior observed was contacting. Subcultural characteristics of mother - infant interaction behaviors were analyzed for their relationships between groups of mothers who have lived in remote area vs urban area, and who were multipara vs primipara. Using a chi -square test, there were statistically significant relationships in the activity of psychological readiness in preparation behavior and the movement of extremities for the position of instrumental behavior in both groups. However, interaction inducing behaviors were not related with statistical significance in any set of groups. Accomplishment of marriage, bonding and emotional mediation of family members were the categories related to mother's cultural belief about the infant in aspect of functional values. Infant at birth is considered little more than a biological organism without social capabilities. Although the newborn infant is still be attached to his mother, he makes his mother extend her territoriality. The mother's interacting behavior toward her infant based on those beliefs appeared task oriented, separative behavioral series. On the other hand, it was seen that infant reacted independently to his mother's behavior by the in-nate perceptual abilities. Those independent behavioral series of mother and infant on the feeding situation were synchronized at any moment. Nurses are In a unique position to teach mothers about their infant's capabilities and help reducing some of uncertainty about infant's behaviors. Study results indicated that the informations infant's social capabilities and breast feeding should be given to the mothers. The results of this study have several implications for nursing. First, the study results will be used as fundamental resources for the development of the assessment tool about the early mother - infant interaction. Second, the results could be a relevant information in the fied. I of maternal child nursing education as real and useful data. Third, the behavioral patterns of early mother - infant interaction which were classified based on the qualitative analysis could be used for nursing theory development as very fundamental data.

• 한국수산과학회지
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• 제54권6호
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• pp.880-889
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• 2021

The home meal replacement (HMR) market has attracted significant attention due to COVID-19 pandemic and products that utilize the combination of different processed ingredients are now being developed. In this study, Broughton's ribbed ark Scapharca broughtonii was soaked in seasoned soy sauce with the incorporation of mustard leaf Brassica juncea (M-BRA), which is known to have a unique texture as well as excellent functional properties such as antioxidation, to develop a regional specialty product. The optimal conditions for manufacturing M-BRA from the seasoned soy sauce (the sauce to be added [X₁] and the soaking time [X₂]), were examined using response surface methodology (RSM) to analyze the significance of the salinity (Y₁), amino-N content (Y₂), and overall acceptance (Y₃). The coefficient of determination (R²) between X₁-X₂ and Y₁-Y₃ were close to 1, thereby confirming the suitability of the RSM model. The optimal conditions were seasoned soy sauce addition of 140% and soaking time of 156 min. The M-BRA manufactured under these conditions exhibited superior overall acceptance compared to seasoned commercial soy sauce, which was used as a control. We expect that the market for M-BRA manufactured by combining marine and agricultural materials will expand owing to superior overall acceptance compared with commercial products.

• 디자인학연구
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• 제18권3호
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• pp.85-94
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• 2005

최근 대부분의 제품 디자이너들이 3차원 CAD 시스템을 필수적인 디자인 도구로서 활용하고 있고 이를 기반으로 많은 신제품들이 동시공학적 프로세스로 개발되고 있다. 그런데 초심 디자이너들이 3차원 CAD시스템을 사용하며 겪는 어려움 중 하나는 스크린을 통해 모델링한 오브젝트의 실체적 느낌을 정확히 판단하기 어렵다는 것이다. 이러한 '실체성 결여'의 문제는 3차원 CAD시스템에서의 모델링 작업이 가상공간 안에서만 이루어지기 때문에 촉각적 상호작용이 부재하고 현실공간에 대한 맥락정보가 결여되어 있는 것이 그 원인이라고 착 수 있다. 문제해결을 위해 본 연구에서는 증강현실기술을 활용하여 3차원 CAD 모델링 오브젝트를 현실공간에 정합시킴으로서 제품디자인에서 상호작용적인 정량구조 시뮬레이션의 가능성을 탐색하고자 하였다. 본 연구는 우선 증강현실 기반 정량구조 시뮬레이션 시스템을 구축하고 그 속에서 인간이 가상 오브젝트의 크기를 얼마나 정확하게 인지하고 조정할 수 있는지 실험하였다. 실험 결과 상대오차 1.3%이내(상대표준편차 5.3%이내)로서 상당히 정확하고 정밀한 크기 인지와 조정이 가능한 것으로 나타났다. 실험조건에 따라서는 주변참조물이 풍부한 경우 오브젝트에 대한 크기인지가 용이하고 HDM보다는 LCD 패널을 사용할 경우 더욱 정확한 크기 조정이 가능한 것으로 나타났다. 연구를 통해 제안한 증강현실 기반 정량구조 시뮬레이션시스템의 응용가능성을 탐색하기 위해 홈 서비스 로봇의 외관에 대해 사용자의 선호경향을 파악하는데 적용해 보았다. 아직 홈 서비스 로봇에 대한 전형적 이미지가 미비해서인지 외관특성에 대한 실험참가자의 선호경향에는 큰 편차가 보였고 군집분석을 통해 몇 그룹으로 세분화할 수 있었다. 그러나 팔이라는 조형요소의 유무에 따라 민감한 반응을 보인 점과 인체와 같이 신장과 팔길이 사이에 강한 상관성이 존재하는 것은 흥미로운 발견이었다. 프로세스를 제안하고자 한다.0 이용과 복제제한에 관한 주기(terms governing use and reproduction notes), 541 직접적 출처주기(immediate source of acquisition note), 545 행정연혁/개인이력주기(biographical or historical note), 581 출판주기(publication note), 850 소장처(holding institution) 데이터필드의 식별기호를 재구성, 추가하였다.근방법과 컨조인트 분석)의 조화를 이룰 수 있는 이론적 기초가 될 수 있다. 즉, 제품디자인의 결정요인 분석결과는 QFD의 접근방법에, 제품 디자인 파급효과 분석결과는 컨조인트 분석에 각각 보완적 기여를 할 수 있다. 이와 동시에, 실증적 분석결과는 Ettlie(1997)의 디자인 통합(DI) 이론에 대한 실증적 기반을 제공할 수 있다. 마지막으로, 성공적인 디자인 경영(DM)을 위해서는 최고 경영자의 지원뿐만 아니라 부처 간 의사소통의 장애요인을 제거하고 CFT(cross-functional team)를 운영함으로써 동시적 엔지니어링(CE) 및 제품 및 공정 디자인의 개발이 제품 개발의 속도를 가속화하고 디자인 품질을 높이며 시장 성공을 보증할 수 있도록 해야 한다.임과 채팅은 긍정적인 상호관련을 가진 것으로 나타난 반면 전자메일 서비스 이용은 성적 만족과 부정적인 상호관련을 가진 것으로 분석되었다. 이는 대학생들이 지루하게 느끼거나 외로움을 느낄 때 전자메일을 주로 이용하지만 성적 만족을 위해 전자메일을 이용하지 않고 있다는 사실을 보여주는 것이다. (3) 인터넷 이용 이후 다른 미디어와 면대면 커뮤니케이션과의 관계 인터넷을 이용한 후 응답자들의 전통적인 미디어(텔레비전, 라디오, 신문, 잡지, 편지, 전화) 이용이 감소되었으며 친구, 가족, 이성친구와의 면대면 커뮤니케이션 역시 감소된

• 동의생리병리학회지
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• 제21권1호
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• pp.219-225
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• 2007

동의보감에 의하면 음식과 의 ${\cdot}$ 약은 그 근원이 같다고 보고 있으며 현대 영양학에서 다루는 열량과 5대 영양소의 개념 이외에 모든 식물(食物)을 기미론(氣味論)적 방법으로 그 성질과 효능을 규명하여 약이적 특징을 중요시하였다. 또한 최근에는 식품이 갖는 주요 기능 중 생리조절 기능이나 항상성 유지에 관여하는 기능 등에 대한 연구가 진행되면서 이러한 기능을 갖는 식품은 건강증진, 질병의 예방이나 노화억제 등 인간의 건강을 증진하는데 중요한 역할을 한다고 판단하여 이런 성분들을 많이 함유하고 있는 식물자원에 관한 연구가 활발하며 우리 나라에도 한약재를 포함한 생약을 이용한 연구가 진행되고 있다. 본 연구는 현대 식이병이 있을 때 일반 음식의 형태로 섭취하여 질병 치료에 도움을 주고 건강을 증진시킬 수 있는 한방식사요법인 약선식에 관한 연구로서 약선의 효과를 과학적이고 객관적인 수준에서 평가해보고자 계획, 수행하였다. 이에 본 연구자들은 한약자원을 이용하여 생체의 고지혈 상태를 포함한 관상심장계 질환을 예방할 수 있는 약선차를 고안하였다. 이에 따른 연구의 일환으로 한약재를 군신좌사론(君臣佐使論)에 준하여 혼합하여 차를 고안하였고 일반 영양성분 및 안전성을 평가하였다. 분석한 결과를 토대로 본 연구에서 고안한 약선차의 식품영양학적 접근을 시도하여 활용가능성을 타진하였다. 본 연구의 조성물을 활용하여 차 형태뿐 아니라 다양한 약선식으로의 활용도 가능하리라 판단되며 이 결과는 한약자원의 식품으로서의 활용방안 및 과학화의 기초자료가 될 수 있을 것이고 또한 전 세계적으로 관심이 큰 기능성 식품의 연구 및 시장동향에 동양의 medicinal herb를 이용한 기능성 식품의 소개에 기초자료가 될 수 있으리라 사료된다.며, 종속영양 원생동물 생물량의 80% 이상을 차지하였다. Protoperidinium spp.에 의해 우점하는 종속영양 유각와편모류는 첫 번째 대증식기에 가장 우점하였으며, Gyrodinium spp.로 구성된 종속영양 무각와편모류는 두 번째 대증식기에 가장 우점 하였다. 그외 Noctiluca scintilla는 첫 번째 대증식기에 식물플랑크톤 소멸에 중요한 역할을 하는 것으로 나타났다. 결과적으로 식물플랑크톤의 대증식기 동안에 종속영양 원생동물 군집은 식물플랑크톤의 생물량 및 군집구 조의 변화에 빠르게 반응하였으며, 이와 같은 결과는 두 군집 사이에 잠재적인 피식-포식자의 관계가 있음을 암시한다. 따라서 조사기간 동안 종속영양 원생동물은 식물플랑크톤 대증식의 소멸과 관련된 중요한 섭식자로서, 식물플랑크톤 군집을 조절하는데 중요한 역할을 하였을 것으로 사료된다.<0.05) 질소 소화율에서는 S1구가 처리구중에서 가장 높은 결과를 보였다(p<0.05). 분변 내 휘발성 지방산 발생량에서는 분을 1일간 발효 후 측정한 결과 S1구와 S2구가 CON구와 비교하여 유의적으로 높게 나타났다(p<0.05). 결론적으로, 비육돈 사료 내 3.32%의 호맥 사일리지의 혼합급여는 혈액 내 코티졸 함량, 도체육의 명도와 황색도, 지방산 조성 및 영양소 소화율에 영향을 미치는 것으로 사료되나 이에 대한 보다 많은 연구가 필요할 것으로 판단된다.니티와 공원과의 관계로 공원 설계와 관리에 있어서 영국에서는 커뮤니티가 직접 고객(client)으로서 역할을 하고 있었다. 한국에서도 계획 및 설계 과정에 주민을 참여시키는 경우가 있으나 의견청취 정도에 머물고 있고, 몇몇 시민단체를 중심으로 시민들이 직접 공원 관리에 참여하는 경우도 있으나 운동(movement)차원에 머물고

• 한국의류학회지
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• 제17권4호
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• pp.622-637
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• 1993

The Purposes of this study were to investigate the significant correlation among the length changes of body surface total lines and between the length changes of body surface total lines and those of component body surface segment lines, and to reveal anticipated relation among body surface length changes by the lower limb movement including all movement direction of hip joint, knee joint & ankle joint for the more functional clothing making & designing. 10 Crosswise & 5 lengthwise body surface total lines and 48 crosswise & 39 lengthwise body surface segment lines of 26 female college students aged from 18 to 24 years were measured directly on the body surface and analyzed by ANOYA & Multiple Comparison Test(Tukey), and the length changes of them were calculated as the difference of the mean length at Fl movement from the mean length at each movement and were analyzed by PEARSON CORRELATION. The results were as following : 1. Correlation among the length changes of body surface total lines (1) Correlation among the length changes of body surface total lines significantly changed by the movement ; 1) The more GA5 expanded, the more GA6 & GA7 each expanded, and the more GA18 expanded, the more GA1 & GA3 each expanded. 2) The more GA15 expanded, the less GA14 each contracted. 3) The more GA7 expanded, the larger GA17 contracted. 4) The more GA1 & GA18 expanded, the larger GA16 contracted, and the larger GM contracted, the less GA16 contracted. (2) Only GA7 and GA17(at F4) showed high (over r=0.7) correlation coefficient, But others' correlation coefficients were r=0.4~0.7. (3) Correlation coefficients among & between girth items and length items 1) Correlation coefficients among girth items were shown + ; between GA3 and GA4, GA5, GA8, between GA5 and GA6, GA7, GA9 each, between GA1 and GA6 and between GA4 and GA7. 2) Correlation coefficients among length items were shown + or - ; shown + between GA14 and GA15 and between GA17 and GA16 ; but Shown - Between GAlS and GA16. 3) Correlation coefficients between girth items and length items were mainly shown - : shown-between GA1 and GA16, GA17, between, GA4 and GA16, between GA6, GA7 each and GA17, between GA8 and GA18 ; but shown + between GA1, GA3 each and GA18 and between GA8 and GA14 were shown +. 2. Correlation between the length changes of body surface total lines and those of component body surface segment lines. (1) All correlation coefficients were + except A147 of GA14. (2) Correlation coefficient over r=0.7 was shown ; between GA3 and CB3, A35 each, between GA5 and A054, between GA6 and A63, between GA7 and A72, A74 each, between GA8 and A83, A84 each, between GA15 and A153, between GA16 and Al64, Al65 each, between GA18 and A189 : but was not shown between GA4, GA17 and it's component body surface segment lines each. (3) Characteristics of correlation between the length changes of body surface total lines and those of body surface segment lines ; 1) If significant correlation of body surface total lines were expansion parts, it's component body surface segment lines was also expansion segment and the otherwise were the same. But exception was shown between expansion line GA3 and A031 (at F4), between GA18 and AlS9 (at F6) and between GA14 and A147, so to speak GA3 & lines and GA14 was contraction total line oppositely A147 was expansion. 2) The more GA3, GAlS expanded, the less A031, A189 contracted. 3) The more GA14 contracted, the more A147 expanded. 4) All correlation except the above 2), 3), the more total lines (GA1, GA3, GA5, GA15, GA16, GA18) expanded, the more segment lines (A15, CB1, A31, A34, CB3, A52, A54, A153, A169, A181) expanded, or the larger total lines (GA14, GA16, GA17) contracted, the larger segment lines (A141, A142, A161, A164, A165, A172) contracted.

• Journal of Preventive Medicine and Public Health
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• 제20권1호
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• pp.165-203
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• 1987

This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, $85{\sim}90%$ of the services provided by the health workers were other than FP/MCH, mainly for immunizations such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs.31%) and for more combined care (45% vs.23%). C) Organization factors (admistrative integrative issues) 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following ; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub·center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwive's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea); 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through family planning practice. 2) Goal consensus in FP/MCH shouBd be made among the health workers It administrators, especially to emphasize the need of care of 'wanted' child. But there is a long way to go to realize the 'real' integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (in) there should be a health sub·center director who can provide leadership training for managing the integrated program. There is a need for 'organizational support', if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the managment of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Worker, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.