• Title/Summary/Keyword: Formal Methods

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Associations of Social Participation and Trust with Suicidal Ideation and Attempt in Communities with High Mortality (사망률이 높은 지역사회에서 사회적 참여와 신뢰의 자살 생각 및 시도와 연관성)

  • Ha, Mi-Oak;Kim, Jang-Rak;Jeong, Baekgeun;Kang, Yune-Sik;Park, Ki-Soo
    • Journal of agricultural medicine and community health
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    • v.38 no.2
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    • pp.116-129
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    • 2013
  • Objectives: This study was performed to identify the associations of social capital with suicidal thoughts and attempts in Korean communities with poor health. Methods: We used the data from community health interviews conducted at 40 administrative sections (dong, eup, or myeon) with high mortality from August to October in 2010, 2011, and 2012 as part of the Health Plus Happiness Plus Projects in Gyeongsangnam-do Province. The 8,800 study subjects composed of 220 adults systematically sampled from each administrative section were asked if they had thought about suicide or had attempted suicide within 1 year. The social participation was measured with 'participation in formal and/or informal group' and trust using responses to three questions about trust of others. Results: The prevalence of suicidal ideation and attempt within 1 year were 10.4% and 0.8%, respectively. The logistic regression analysis revealed that those who participated in only informal groups, or had highest trust level reported less suicidal ideation, or attempt after adjusting for socio-demographic factors (sex, age, marital status, occupation, and food affordability), self-rated health, and health behaviors (smoking, alcohol drinking, and exercise). Conclusions: This study suggested social capital such as social participation and trust was associated with less suicide ideation and attempt. More studies are warranted for the association of social capital with suicidal behavior.

A Study on the Artistic Techniques of the Chinese Early Cartoons -Focusing on Lian Huan Hua(連環畵) and - (중국 초기 만화 예술기법 연구 - 연환화 작품 <산향거변>과 <백모녀>를 중심으로-)

  • Lurenjing, Lurenjing
    • Cartoon and Animation Studies
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    • s.39
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    • pp.451-472
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    • 2015
  • Lian Huan Hua(連環畵) has occurred in the history of China Cartoon was initially developed as a unique literary style of Chinese painting and narrative combined. Also Lian Huan Hua are also tend to form once the fusion 1920s was also a very creative fashion cartoon style. This is also referred to as chain cartoon. In 1950-1960, China 's Lian Huan Hua also mature a 'golden age' legal group reaches to indicate the unique formal features developed independently. This work is a dramatic expression of Lian Huan Hua narrative, shows a more realistic representation techniques and art forms such as portraiture is a very big breakthrough was achieved artistic maturity of the work increased significantly. by He You Zhi(賀友直) and by Hau San Chuan(華三川) is a masterpiece of artistry and maturity in the period leading side. Chapter 2 looked at the origin and development of Chinese Lian Huan Hua, it was seen by the fact that China achieved new progress in Lian Huan Hua upset every time the combination of content and form, In addition, the work of 1950-1960 in the development process of China's Lian Huan Hua confirmed the fact that they won the biggest achievement in artistry and maturity surface. Therefore, Chapter 3 how 'golden age' masterpiece of and the dramatic narrative of expression by analyzing a specific angle in the multifaceted image of the , realistic portraiture, such as the acquisition of Chinese concrete artistry Lian Huan Hua I want to show. Analysis of the figures depicting nature, landscape screens. consisted of highlights and background and techniques of utilization, production methods. The purpose of this research work is to identify two conditions of great Lian Huan Hua through analysis of concrete work and painting techniques such as framing and directing the Lian Huan Hua's artistic achievements is to investigate the influence of China in the early comics. These two works are focused on a realistic view of life and put out was to create a more effective representation of information it attempts to pass a new production techniques and will have the significance. Also completed was a new style absorbed throughout the aesthetic advantages are compelling own personality writers of Eastern and Western paintings are remarkable in that its performance. But the difference in the two works represent all types and painting techniques has a the mood of common China's lives.

A study on factors affecting high school students of school violence - Focusing on personality factors - (고등학생의 학교폭력에 영향을 미치는 요인에 관한 연구 : 인성요인을 중심으로)

  • Lee, Jung-Duk;Chang, Jeong-Hyeon
    • Korean Security Journal
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    • no.42
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    • pp.393-422
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    • 2015
  • The school is committed to the role of public education for the effective development of student academic achievement and intellectual ability. It is also a space to expand the range of care and understanding for others with as a member of the academic community as well. However, the reality of our country schooling has been pointed out that if a lot about the lack of character education related to the attitude of life care for others and feel a sense of responsibility. An individual is not necessarily emotional intelligence There are side out, as well as grow into adults, schools are obliged to teach a variety of methods associated with it. Nevertheless, education is not of the country beyond the formal excessive administrative work or other activities due to the process of character education to neglect, including the work of teachers. Therefore, students brought the expansion of the act that should not, and eventually lead to serious social issues that directly harm others, such as school violence. Therefore, students brought the expansion of the act that should not, and eventually lead to serious social issues that directly harm others, such as school violence. This study is based on an act of juvenile delinquency and criminology education was to refine the concept of toughness and validate the relationship between school violence through empirical research. Accordingly, from July 1, 2013 September 31, 2013 to 277 high schools across the country are attending the third year of the schools available for non-response and analysis of the students who participated in the admission and simulated typical presentation of K University in Gyeonggi-do not judge students in the final analysis, except for the data and data from a total of 1045 patients were utilized. As a result, many schools have experienced violence, male student work can be applied to a lot of rock school violence was experienced. Also, a lot of experience can be applied to a healthy student rock school violence, anger-control and empathy, this is considered a low student showed consciousness experienced school violence exerted.

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Chardin's Genre Paintings of Child Education: The Enlightenment Views on Children of the French Bourgeois Class in the 18th Century (샤르댕의 아동 교육 장르화 - 18세기 프랑스 부르주아의 계몽주의적 아동관)

  • Ko, Yu-Kyoung
    • The Journal of Art Theory & Practice
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    • no.8
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    • pp.33-58
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    • 2009
  • This paper examines four genre paintings on the subject of child education by Jean-Baptiste-Sim${\'{e}}$on Chardin(1699-1779). The Governess, The Diligent Mother, Saying Grace, and The Morning Toilette garnered critical attention after they were exhibited in the Salon from 1739 to 1741. After the exhibition, the paintings were made into prints and frequently sold to members of the bourgeois class in Paris. The iconographical details of Chardin's genre paintings have, thus far, been compared to Dutch genre pictures of the seventeenth century. Further, most studies conducted on Chardin's paintings focus on formal analysis rather than the historical and social contexts. Through attempting social-contextual readings of Chardin's educational series, this paper argues that the significance of Chardin's painting series of child education lies in his representation of the ideal French bourgeois family and the standard of early childhood education in the eighteenth-century French Enlightenment period. In each of the four child education paintings, Chardin depicted a mother with children in a domestic space. Even though this theme derives from traditional Dutch genre paintings in the seventeenth century, the visual motifs, the pictorial atmosphere and the painting techniques of Chardin all project the social culture of eighteenth century France. Each painting in the child education series exemplifies respectively the attire of a French gentlemen, the social view on womanhood and the education of girls, newly established table manners, and the dressing up culture in a 'toilette' in eighteenth century France. Distinct from other educational scenes in previous genre paintings, Chardin accentuated the naive and innocent characteristics of a child and exemplified the mother's warmth toward that child in her tender facial expressions and gesturing. These kinds of expressions illustrate the newly structured standard of education in the French Enlightenment period. Whereas medieval people viewed children as immature and useless, people in the eighteenth century began to recognize children for their more positive features. They compared children to a blank piece of paper (tabula rasa), which signified children's innocence, and suggested that children possess neither good nor bad virtues. This positive perspective on children slowly transformed the pedagogical methods. Teaching manuals instructed governesses and mothers to respect each child's personality rather than be strict and harsh to them. Children were also allotted more playtimes, which explains the display of various toys in the backgrounds of Chardin's series of four paintings. Concurrently, the interior, where this exemplary education was executed, alludes to the virtue of the bourgeois's moderate and thrifty daily life in eighteenth century France. While other contemporary painters preferred to depict the extravagant living space of a French bourgeoisie, Chardin portrayed a rather modest and cozy home interior. In contrast to the highly decorated living space of aristocrats, he presented the realistic, humble domestic space of a bourgeois, filled with modern household objects. In addition, the mother is exceptionally clad in working clothes instead of fashionable dresses of the moment. Fit to take care of household affairs and children, the mother represents the ideal virtues of a bourgeois family. It can be concluded that the four genre paintings of child education by Chardin articulate the new standards of juvenile education in eighteenth century France as well as the highly recognized social virtues between French bourgeois families. Thus, Chardin's series of child education would have functioned as a demonstration of the ideal living standards of the bourgeois class and their emphasis on early childhood education in the French Enlightenment period.

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A Study on Transfer Process Model for long-term preservation of Electronic Records (전자기록의 장기보존을 위한 이관절차모형에 관한 연구)

  • Cheon, kwon-ju
    • The Korean Journal of Archival Studies
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    • no.16
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    • pp.39-96
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    • 2007
  • Traditionally, the concept of transfer is that physical records such as paper documents, videos, photos are made a delivery to Archives or Records centers on the basis of transfer guidelines. But, with the automation of records management environment and spreading new records creation and management applications, we can create records and manage them in the cyberspace. In these reasons, the existing transfer system is that we move filed records to Archives or Records centers by paper boxes, needs to be changed. Under the needing conditions of a new transfer paradigm, the fact that the revision of Records Act that include some provisions about electronic records management and transfer, is desirable and proper. Nevertheless, the electronic transfer provisions are too conceptional to apply records management practice, so we have to develop detailed methods and processes. In this context, this paper suggest that a electronic records transfer process model on the basis of international standard and foreign countries' cases. Doing transfer records is one of the records management courses to use valuable records in the future. So, both producer and archive have to transfer records itself and context information to long-term preservation repository according to the transfer guidelines. In the long run, transfer comes to be the conclusion that records are moved to archive by a formal transfer process with taking a proper records protection steps. To accomplish these purposes, I analyzed the 'OAIS Reference Model' and 'Producer-Archive Interface Methodology Abstract Standard-CCSDS Blue Book' which is made by CCSDS(Consultative committee for Space Data Systems). but from both the words of 'Reference Model' and 'Standard', we can understand that these standard are not suitable for applying business practice directly. To solve this problem, I also analyzed foreign countries' transfer cases. Through the analysis of theory and case, I suggest that an Electronic Records Transfer Process Model which is consist of five sub-process that are 'Ingest prepare ${\rightarrow}$ Ingest ${\rightarrow}$ Validation ${\rightarrow}$ Preservation ${\rightarrow}$ Archival storage' and each sub-process also have some transfer elements. Especially, to confirm the new process model's feasibility, after classifying two types - one is from Public Records center to Public Archive, the other is from Civil Records center to Public or Civil Archive - of Korean Transfer, I made the new Transfer Model applied to the two types of transfer cases.

Dokdo of Korea, A Chance for Peace and Co-Prosperity A Study Using Perspectives of Public Diplomacy and Negotiation Strategies (Memorial Lesson from fisherman, An Yong-bok as a Supreme Negotiator) (한국의 독도, 평화와 상생의 기회: 공공외교 및 협상 관점의 연구 (탁월한 소시민 협상가, 어부 안용복을 기리며))

  • Mi-ae Hwang
    • Journal of Public Diplomacy
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    • v.2 no.2
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    • pp.27-52
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    • 2022
  • Objectives: The neighboring countries of South Korea and Japan in Northeast Asia have interacted in both positive and negative ways, at times as close partners and other times adversaries, throughout their long and thorny history of extensive dynamics. The controversial dispute over Dokdo is one of the most critical issues evoking harsh tensions and arguments asserting wholly opposite claims. Dokdo is a small island between two coastal states, but significant in terms of territorial, botanical, and marine resources, and thus ownership of the island has become a point of conflict accompanied by a troubled history. But why has Dokdo been a source of conflicts and how should the controversial Dokdo issue be addressed in a way that fosters positive influence and co-prosperity? Methods: This study provides comprehensive and critical insights from a wealth of previous research and strategic suggestions for the Korean government. It utilizes the three perspectives of historical documents and political context, international regulations and legal frames, and public diplomacy. Furthermore, it applies these resources to negotiation theories and strategies to propose reasonable solutions. Results: This study suggests that it is important for Korea and Japan to try to build mutual trust through more active communication and interaction in order to understand each other before attempting to create a formal resolution via negotiation. In addition to these efforts, Korea needs to be ready for the inevitable need to take decisive action in terms of negotiation, using analytic and efficient strategies. The study proposes three solutions: 1) Strong Action Strategy, 2) International Legal Strategy, and 3) Public Diplomacy Strategy. Conclusions: From the perspective of public diplomacy, the Dokdo issue needs to be converted from a symbol of conflicts between Korea and Japan into a symbol of peace and co-prosperity. In addition to promoting a positive relationship between the two states, it can also contribute to the security environment of the Northeast Asian region and global peace.

A Study on Oriental Medical Diagnosis of Musculoskeletal Disorders using Moire Image (Moire 영상을 이용한 근골격계 질환의 한의학적 진단에 관한 연구)

  • Lee Eun-Kyoung;Yu Seung-Hyun;Lee Su-Kyung;Kang Sung-Ho;Han Jong-Min;Chong Myong-Soo;Chun Eun-Joo;Song Yung-Sun;Lee Ki-Nam
    • Journal of Society of Preventive Korean Medicine
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    • v.4 no.2
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    • pp.72-92
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    • 2000
  • This research has conducted studies on an Oriental medicine-based method of diagnosing of occupational musculoskeletal system diseases. This researcher has searched through existing relevant medical literature. Also, this researcher has worked on a moire topography using moire topography. In this course, this researcher has reached the following conclusion in relation to the possibility of using a moire topography as a diagnosing device of musculoskeletal system diseases under Oriental medicine . 1 The Western medicine outlines its criteria of screening occupational musculoskeletal system diseases as follows A. The occupational musculoskeletal diseases must clearly include one or more of the subjective symptoms characterized by pain, hypoesthesia dysaesthesia, anaesthesia. etc . B, There should be clinically admitted objective observations and diagnosis outlining that the disease concerned shows symptoms such as tenderness, induration. and edema that can appear with occupational musculoskeletal system diseases. dyscinesia should be admitted with the disease concerned, or there should be observations and diagnosis outlining that abnormality exists in electric muscular or nervous diagnosis and examination . C. It should be admitted that prior to the occurrence of symptoms or observations and diagnosis on musculoskeletal system-related diseases, a patient has been engaged in works with conditions requiring improper work posture or work movement. That is, this is an approach whereby they see abnormality in the musculoskeletal system come from material and structural defect, and adjust and control abnormality in the musculoskeletal system and secreta . 2. The Oriental medicines sees that a patient develops the pain of occupational musculoskeletal diseases as he cannot properly activate the flow of his life force and blood thus not only causing formation of lumps in the body and blocking the flow of life force and blood in some parts of the body. Hence, The Oriental medicine focuses on resolving the cause of weakening the flow of life force and blood, instead of taking material approach of correcting structural abnormality Furthermore , Oriental medicine sees that when muscle tension builds up, this presses blood vessels and nerves passing by, triggering circulation dyscrasia and neurological reaction and thus leading to lesion. Thus, instead of taking skeletal or neurophysiological approach. it seeks to fundamentally resolve the cause of the flow of the life force and blood in muscles not being activated. As a result Oriental medicine attributes the main cause of musculoskeletal system diseases to muscle tension and its build-up that stem from an individual's long formed chronicle habit and work environment. This approach considers not only the social structure aspect including companies owners and work environment that the existing methods have looked at, but also individual workers' responsibility and their environmental factors. Hence, this is a step forward method. 3 The diagnosis of musculoskeletal diseases under Oriental medicine is characterized by the fact that an Oriental medicine doctor uses not only photos taken by himself, but also various detection devices to gather information and pass comprehensive judgment on it. Thus, it is the core of diagnosis under Oriental medicine to develop diagnosing devices matching the characteristics of information to be induced and to interpret information so induced from the views of Oriental medicine. Diagnosis using diagnosing devices values the whole state of a patient and formal abnormality alike, and the whole balance and muscular state of a patient serves as the basis of diagnosis. Hence, this method, instead of depending on the information gathered from devices under Western medicine, requires devices that provide information on the whole state of a patient in addition to the local abnormality information that X-ray. CT, etc., can offer. This method sees muscle as the central part of the abnormality in the musculoskeletal system and thus requires diagnosing devices enabling the muscular state. 4. The diagnosing device using moire topography under Oriental medicine has advantages below and can be used for diagnosing musculoskeletal system diseases with industrial workers . First, the device can Provide information on the body in an unbalanced state. and thus identify the imbalance and difference of height in the left and right stature that a patient can not notice at normal times. Second, the device shows the twisting of muscles or induration regions in a contour map. This is not possible with existing shooting machines such as X-ray, CT, etc., thus differentiating itself from existing machines. Third, this device makes it possible for Oriental medicine to take its unique approach to the abnormality in the musculoskeletal system. Oriental medicine sees the state and imbalance state in muscles as major factors in determining the lesion of musculoskeletal system, and the device makes it possible to shoot the state of muscles in detail. In this respect, the device is significant. Fourth, the device has an advantage as non-aggression diagnosing device.

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A Study on medical Qigong mentioned in ${\ll}$Samilshingo${\gg}$ (三一神誥) (${\ll}$삼일신고(三一神誥)${\gg}$에 나타난 의료기공(醫療氣功)에 관(關)한 연구(硏究))

  • Ban, Chang-Yul
    • Journal of Korean Medical Ki-Gong Academy
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    • v.7 no.2
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    • pp.40-94
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    • 2004
  • Recently, meditation, Zen meditation and Qigong became popular in western. For that reason, Value of Korea traditional methods for health promotion have been evaluated but theoretical evidence about that is insufficient. ${\ll}$The Yellow Emperor's Inner Classic${\gg}$ (黃帝內經). So, I reviewed history of Korea Qigong according to period, in order to produce theoretical evidence of Korea medical Qigong and investigated ${\ulcorner}$Han${\lrcorner}$ thought (${\ulcorner}$${\lrcorner}$ 思想) as theoretical evidence of Korea Qigong. I have obtained following results by comparing meaning of god, a view of human body and practice method of the ${\ll}$Samilshingo${\gg}$ (三一神誥) with ${\ll}$The Yellow Emperor's Inner Classic${\gg}$ (黃帝內經). Sinsundo(神仙道) of native to race became active during the period of the Three Kingdoms but more disappeared due to under the influence of Taoism. So only has been remained in existence since the period of the unity silla. There could accept positively the foreign ideas belonging to Confucianism, Buddhism and Taoism have been brought since the period of the Three Kingdoms because ${\ll}$Samilshingo${\gg}$ (三一神誥), one of three the scriptures as the origin of ${\ulcorner}$Han${\lrcorner}$ thought(${\ulcorner}$${\lrcorner}$ 思想) included the original form of three religion belonging to Confucianism, Buddhism, Taoism. Three common results as theoretical evidence of Qigong were found out by comparing ${\ll}$Samilshingo${\gg}$ (三一神誥) with ${\ll}$The Yellow Emperor's Inner Classic${\gg}$ (黃帝內經). First, in meaning of god, there is not only different from the gods of heaven and the gods of human but also keep understanding with each other and there was common feature of logical structure that function of god was divided into three. Second, In a view of human body, there were in common with ${\ll}$Samilshingo${\gg}$ (三一神誥) as theory of only as energy(氣一元論), theory of bisection as truth false(眞妄二分論), theory of trisection as spirit(性) destiny(命) nature(精) and mind(心) energy(氣) body(身)(性 命 精, 心 氣 身의 三分論) and ${\ll}$The Yellow Emperor's Inner Classic${\gg}$ (黃帝內經) as theory of only as energy(氣一元論), theory of bisection as shape and god(形神二分論), theory of trisection as nature(精) energy(氣) god(神) or shape(形) energy(氣) god(神)(精 氣 神, 形 氣 神의 三分論) according to formal part. Also, spirit(性) destiny(命) nature(精) as truths of three(三眞) were understand as nature(精) energy(氣) god(神) as treasure of three(三寶) by part of reason and mind(心) energy(氣) body(身) as false of three(三妄) were understand as nature(精) energy(氣) god(神) as treasure of three(三寶) by part of function. Third, In practice method, pause of thinking(止感) modulation of breath(調息). prohibition of sensibility(禁觸) mentioned in ${\ll}$Samilshingo${\gg}$ (三一神誥) as practice method each were understand regulation of an etiological cause as an internal cause, an external cause and not internal and external cause in oriental medicine. Namely, pause of thinking(止感) was understand as regulation method of emotion, mind and nature. modulation of breath(調息) was not only as modulation of energy from the inner parts of the body but also that from the internal and external parts of the body, prohibition of sensibility(禁觸) was understand as regulation method of ear, eye, mouth, and nose and posture, life style. These results suggest that ${\ll}$Samilshingo${\gg}$ (三一神誥) is worth meaning of Korea medical Qigong because meaning of god, a view of human body, practice method of mentioned in ${\ll}$Samilshingo${\gg}$ (三一神誥) is common with that of ${\ll}$The Yellow Emperor's Inner Classic${\gg}$ (黃帝內經) as theoretical evidence of Qigong.

Comparisons of Unicortical and Bicortical Lateral Mass Screws in the Cervical Spine : Safety vs Strength (경추부의 후관절 나사못 고정술에서 단피질삽입법과 양피질 삽입법 간의 특성에 관한 비교)

  • Park, Choon-Keun;Hwang, Jang-Hoe;Ji, Chul;Lee, Jae Un;Sung, Jae Hoon;Choi, Seung-Jin;Lee, Sang-Won;Seybold, Eric;Park, Sung-Chan;Cho, Kyung-Suok;Park, Chun-Kun;Kang, Joon-Ki
    • Journal of Korean Neurosurgical Society
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    • v.30 no.10
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    • pp.1210-1219
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    • 2001
  • Introduction : The purpose of this study was to analyze the safety, pullout strength and radiographic characteristics of unicortical and bicortical screws of cervical facet within cadaveric specimens and evaluate the influence of level of training on the positioning of these screws. Methods : Twenty-one cadavers, mean 78.9 years of age, underwent bilateral placement of 3.5mm AO lateral mass screw from C3-C6(n=168) using a slight variation of the Magerl technique. Intraoperative imaging was not used. The right side(unicortical) utilized only 14mm screws(effective length of 11mm) while on the left side to determine the length of the screw after the ventral cortex had been drilled. Three spine surgeons(attending, fellow, chief resident) with varying levels of spine training performed the procedure on seven cadavers each. All spines were harvested and lateral radiographs were taken. Individual cervical vertebrae were carefully dissected and then axial radiographs were taken. The screws were evaluated clinically and radiographically for their safety. Screws were graded clinically for their safety with respect to the spinal cord, facet joint, nerve root and vertebral artery. The grades consisted of the following categories : "satisfactory", "at risk" and "direct injury". Each screw was also graded according to its zone placement. Screw position was quantified by measuring a sagittal angle from the lateral radiograph and an axial angle from the axial radiograph. Pull-out force was determined for all screws using a material testing machine. Results : Dissection revealed that fifteen screws on the left side actually had only unicortical and not bicortical purchase as intended. The majority of screws(92.8%) were satisfactory in terms of safety. There were no injuries to the spinal cord. On the right side(unicortical), 98.9% of the screws were "satisfactory" and on the left side(bicortical) 68.1% were "satisfactory". There was a 5.8% incidence of direct arterial injury and a 17.4% incidence of direct nerve root injury with the bicortical screws. There were no "direct injuries" with the unicortical screws for the nerve root or vertebral artery. The unicortical screws had a 21.4% incidence of direct injury of the facet joint, while the bicortical screws had a 21.7% incidence. The majority of "direct injury" of bicortical screws were placed by the surgeon with the least experience. The performance of the resident surgeon was significantly different from the attending or fellow(p<0.05) in terms of safety of the nerve root and vertebral artery. The attending's performance was significantly better than the resident or fellow(p<0.05) in terms of safety of the facet joint. There was no relationship between the safety of a screw and its zone placement. The axial deviation angle measured $23.5{\pm}6.6$ degrees and $19.8{\pm}7.9$ degrees for the unicortical and bicortical screws, respectively. The resident surgeon had a significantly lower angle than the attending or fellow(p<0.05). The sagittal angle measured $66.3{\pm}7.0$ degrees and $62.3{\pm}7.9$ degrees for the unicortical and bicortical screws, respectively. The attending had a significantly lower sagittal angle than the fellow or resident(p<0.05). Thirty-three screws that entered the facet joint were tested for pull-out strength but excluded from the data because they were not lateral mass screws per-se and had deviated substantially from the intended final trajectory. The mean pull-out force for all screws was $542.9{\pm}296.6N$. There was no statistically significant difference between the pull-out force for unicortical($519.9{\pm}286.9N$) and bicortical($565.2{\pm}306N$) screws. There was no significant difference in pull-out strengths with respect to zone placement. Conclusion : It is our belief that the risk associated with bicortical purchase mandates formal spine training if it is to be done safely and accurately. Unicortical screws are safer regardless of level of training. It is apparent that 14mm lateral mass screws placed in a supero-lateral trajectory in the adult cervical spine provide an equivalent strength with a much lower risk of injury than the longer bicortical screws placed in a similar orientation.

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

  • Bang, Sook;Han, Seung-Hyun;Lee, Chung-Ja;Ahn, Moon-Young;Lee, In-Sook;Kim, Eun-Shil;Kim, Chong-Ho
    • Journal of Preventive Medicine and Public Health
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    • v.20 no.1 s.21
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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.

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