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A DESCRIPTIVE STUDY ON THE CONTRIBUTING FACTORS OF EARLY CHILDHOOD CARIES OF 5 YEARS CHILDREN IN KANGNUNG CITY (강릉시 5세 아동의 "조기 유아기 우식증" 관련 추정요인의 기술 역학적 연구)

  • Park, Jin-A;Ma, Deuk-Sang;Park, Deok-Young;Park, Ho-Won;Lee, Gwang-Su
    • Journal of the korean academy of Pediatric Dentistry
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    • v.29 no.2
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    • pp.226-236
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    • 2002
  • The purpose of this study was to get descriptive statistics of the contributing factors for early childhood caries and to predict the relationship of dietary, behavior factors and health status factors of the mother and child at pregnancy and after birth. 411 first caregivers of 5-year-old children in 12 kindergartens in Kangnung city were selected by stratified random cluster sampling. They were asked to fill out questionnaires and 364 of them responded. The obtained results were as follow: 1. Over the three-Fourth of children used nursing bottle or had breast feeding habit beyond the age of 1 year. 2. 8.7% of respondents didn't recognize the necessity of the preventive measures immediate after eruption of primary tooth, and only 35.1% replied that they had begun tooth cleaning. 3. Over 90% of children brush the teeth more than once per day. But over half (614%) of them brush their teeth without parents instruction. Sixty percent of children eat between the meals as often as 1-3 time(s) a day and the remainder at any times. 4. The first time of dental visit was for most children (87%) at over 3 years, recommending the earlier dental visit. Notwithstanding the rate of routine dental visit experience was relatively high(40.2%), implicating positive parents' attitude about oral health at Kangnung area. 5. The relationships between oral health state of the parents and the variables such as the timing of the first tooth cleaning, the frequency of brushing, the time of first dental visit, and the reason of first dental visit were not statistically significant. Together, there was no statistically significant difference between rural and urban area, private and public kindergarten, and boy and girl($x^2-test$, p>.05 or Fisher's exact test, p>.05).

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A Review of Responses of Nursing Students Following Clinical Maternity Nursing Practice (모성 간호 실습 후 분만과정에 대한 간호학생의 심리적 반응 고찰 -모성 간호 실습, 실습에 대한 간호학생의 심리적 반응-)

  • Cho, Cheong-Ho
    • 모자간호학회지
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    • v.4 no.1
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    • pp.41-51
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    • 1994
  • The purposes of this study were to identify responses of nursing students following clinical maternity nursing practice, to develop data of further effective clinical maternity nursing practice, to understand nursing students perceive the natural maturation process toward pregnancy delivery and puerperal process, to help the nursing students achieve personality growth and development through clinical maternity nursing practice. The subjects were 35 senior nursing students from the Department of Nursing Science of Chung-Ang University. The data were collected from the 1st semester (Feb.22$\sim$June 9) to the 2nd semester(Aug.23$\sim$Nov.10), 1993 through self-reporting using an open ended questionnaire about perception and feelings regarding the normal delivery process. The data analysis used descriptive method. Results of the study were as follows : 1. Following clinical practice in maternity nursing, the responses of the nursing students were collected included both positive and negative aspects. The positive responses were classified in to four categories and each category included subgroups. One group, labelled as $\ulcorner$The birth of noble life$\lrcorner$ had a subgroup, (I felt the mystery and wonder of life), another group, $\ulcorner$After delivery, comfort and satisfaction$\lrcorner$ with the subgroup (I can bear to see the comfort and relief beyond pain) (C/S is better than vaginal delivery) (Very easy), the 3rd group, $\ulcorner$ I realized family friendship and support$\lrcorner$ with subgroup (Honorable, Magnificient) (I thank my parents ) (It's good to looking at my husband's support), and the 4th group, $\ulcorner$The birth of a healthy baby$\lrcorner$, with its subgroup, (baby looks pretty and healthy). 2. The negative responses were classified in eight categories and each category included subgroups. One group labelled as $\ulcorner$Fear$\lrcorner$, had subgroups of (Terrible, Horrible) (Shock) (Dread), another group, $\ulcorner$Tension$\lrcorner$, and its subgroup, (I became tense about stories heard before clinical practice), the 3rd group, $\ulcorner$surprise$\lrcorner$ and its subgroup (I was surprised at the delivery process), the 4th group, $\ulcorner$Power lessness$\lrcorner$ and its subgroup, (I watched the labor pain impatiently), the 5th group $\ulcorner$Apathy$\lrcorner$ ; and its subgroup, (I didn't feel the empathy for the labor pain of the pregnant women), the 6th group, $\ulcorner$Disgust$\lrcorner$ and its subgroup, (Disgust, Embarrassed), the 7th group, $\ulcorner$Inevitable destiny$\lrcorner$ and its subgroups (necessity of self-sacrifice and difficulty) (I accepted it as a women's destiny) (I can't do it), the last group, $\ulcorner$There seems to be trouble$\lrcorner$ and its subgroup, (It seems to have been a little too hard for mother and baby). Suggestions for further studies are as follows : 1. Nursing students should receive intensive education about $\ulcorner$The birth of noble life$\lrcorner$ $\ulcorner$After delivery, comfort and satisfaction$\lrcorner$ $\ulcorner$I realized family friendship and support$\lrcorner$ $\ulcorner$The birth of a healthy baby$\lrcorner$, so that a more positive attitude can be developed before clinical maternity nursing. 2. Nursing students should be given an orientation which is reality based and related clinical maternity nursing (using for A.V. Materials), so that they will not feel they tension, of the negative categories. 3. Nursing students should be received articles on Pain Relief Method, so that they will be prepared activie and positive in the clinical practice, and therefore they will not feel the powerlessness, of the negative categories. 4. F/U for responses of nursing students should be checked following clinical maternity nursing to evaluate the effects of the instruction.

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A Study on the Propensity to Purchase Babies' Cosmetics (베이비화장품의 구매행태에 관한 연구 - 대구, 경북 지역을 중심으로 -)

  • Lee Kyung-Hwa;Kim Ju-Duck
    • Journal of the Society of Cosmetic Scientists of Korea
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    • v.31 no.2 s.51
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    • pp.169-177
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    • 2005
  • The propensity to purchase babies' cosmetics is investigated and analysed for this research. The synopsis of this research paper is as follows. The first, the $68\%$ of all respondents do not how a manufacturer or brand name in the reality of variously emerging domestic and import cosmetics for babies. The second, in case of a child haying a fair, sensitive skin or atopy (atopic dermatitis), the respondents are careful in choosing babies cosmetics but in case of a child having a normal skin the older a child grows from a stage of a new-born, a baby and an infant to a primary-school child, the older its mother is, the more respondents use adults' cosmetics in common rather than use cosmetics only for babies. $7.6\%$ of respondents do not use babies' cosmetirs at ail. Especially, in using bathing goods such as a shampoo or a body cleanser, they frequently use adults' cosmetics in common. The third, the qualify is taken into the utmost consideration in purchasing babies' cosmetics. The Quality of imports is trusted and preferred better than that of domestic goods. The cost of purchasing babies cosmetics is less than 10,000 Won. consumers recognize that the price or cosmetics is rather high. The last, the improvement or babies cosmetics is 'the safety of goods', answered by $56.5\%$ of respondents. The respondents are generally not satisfied with babies' cosmetics. So, a baby's skin is threatened by a newly-built house syndrome, the increase of atopic dermatitis, etc., caused by an environmental pollutions, a change of diet and a change of residential life. Under these actual conditions, babies' cosmetics which can protect a delicate and sensitive skin of a baby should be developed immediately. Consumers should have a correct choice with precise recognition and information on a baby's skin and cosmetics and continually use the efficacious and excellent babies' cosmetics to prevent a baby from a skin irritation, and need to show a keen interest in a healthy skin of a baby.

Epidermal Structure and Stomatal Types in Some Species of Korean Crassulaceae (한국산 돌나물과(Crassulaceae) 수종의 표피구조와 기공유형)

  • Jeong, Woo-Gyu;Sung, Min-Wung
    • Journal of Plant Biology
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    • v.28 no.2
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    • pp.105-118
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    • 1985
  • This study was carried out to investigate the epidermal structure and types of stomata on the upper and lower surfaces of the leaves in six species and one variety belonging to Korean Crassulaceae. The shape of epidermal cells was polygonal, isodiametric, or elongated. The cell wall was thick, sinuous or deeply sinuous. The subsidiary cell wall was thin or mostly arched. The cytolith-containing cells were found in Orostachys japonicus. The distribution of stomata was more on the upper surface than on the lower surface in the leaves of O. japonicus and Sedum sarmentosum. The stomata in the other species were less on the upper surface than on the lower surface, and stomatal size was different in each species. The great majority of stomatal types was the helico-eumesogenous type. This type was subdivided into two, parahelico-eumesogenous type and diahelico-eumesogenous type by us on the basis of the angle of division of guard mother cell and the long axis of the last-formed subsidiary cells. Sometimes allelo-eumesogenous type as well as aniso-eumesogenous type was found. The tetra-eumesogenous type with four mesogenous subsidiary cells was rarely observed. It was observed that the varieties of aniso-eumesogenous type with one to three subsidiary cells and one helix of subsidiary cells were developed by the secondary division of subsidiary cells of aniso-eumesogenous stoma. The compound shape of helico-eumesogenous stomata was found. Five new kinds of stomatal types were observed as follows; the helico-tetra-eumesogenous type, the coallelohelico-eumesogenous type, the cohelico-allelo-eumesogenous type, the duplotetra-eumesogenous type, and the aniso-euperigenous type. These types were reported here in the vascular plants for the first time.

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Chronic pain control in patients with rheumatoid arthritis (만성통증 환자의 통증 조절)

  • Eun, Young
    • Journal of muscle and joint health
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    • v.2 no.1
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    • pp.17-40
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    • 1995
  • Rheumatoid arthritis is the one of the chronic diseases, one of its major symptoms is a chronic pain. Despite developing medical treatment and surgical techniques, it is suggested that to control the pain is the goal of the treatment. But pain is an inner experience and even those closest to the patient cannot truly observe its progress or share in its suffering. The National Academy of Sciences Institute of Medicine's report on Pain and Disability concluded that there is no objective measure of pain-(exactly) no pain thermometer-nor can there ever be one, because the experience of pain is inseparable from personal perception and social influence such as culture. To explore chronic pain experience is to understand the process and property of the patient's perception of pain through the response to pain, the coping with pain, and the adaptation to pain. Therefore a qualitative study was conducted in order to gain an understanding of pain experience of patients with RA in korea. I used naturalistic inquiry as a research methodology, which had 5 axioms, the first is that realities are multiple, constructed, and holistic, the second is that knower and known are interactive, inseparable, the third is only time and context bound working hypotheses(idiographic statements) are possible, the forth is all entities are in a state of mutual simultaneous shaping, so that it is impossible to distinguish causes from effects and the last is that inquiry is value-bound. Purposive sampling was conducted as a sampling. 20 subjects who experienced pain over 10 years, lived in middle-sized city and big city in Korea, and 17 women and 3 men. The subject's age was from 32 to 62 (average 48.8), all were married, living with their spouse and children, except two-one divorced and the other widow before they became ill. I collected data using In depth structured interview. I had interviews two or three times with each subject, and the interviews were conducted at each subject's home. Each interview lasted about two hours an average. A recording was taken with the consent of the subject. I used inductive data analysis-such as unitizing and categorizing. unitizing is a process of coding, whereby raw data are systematically transformed and aggregated into units. Categorizing is a process wherby previously unitized data are organized into categories that provide descriptive or inferential information about the context or setting from which the units were derived. This process is used constant comparative method. The pain controlling process is composed of behavior of pain control. The behaviors of pain control are rearranging of ADL, hiddening role conflict, balancing treatment, and changing social relation. Rearranging of ADL includes diet management, sleep management, and the adjustment of daily life activities. The subjects try to rearrange their daily activities by modified style of motions, rearranging time span & range of activities, using auxillary facilities, and getting help in order to keep on the pace of daily life. Hiddening role conflict means to reduce conflicts between sick role and their role as a family member. In this process, the subjects use two modes, one is to control the pain complaints, and the other is to internalize the value which is to stay home is good for caring her children and being a good mother. To control pain complaints is done by 'enduring', 'understanding' the other family members, or making them undersood in order to reduce pain. Balancing treatment is composed of two aspects. One is to keep the pain within the endurable level, the other is to keep in touch with medical personnel in order to get the information of treatment and emotional support. Changing social relation is made by information seeking and sharing, formation of mutual support relation, and finally simplification of social relationships. The subjects simplify their social relationships by refraining from relations with someone who makes them physically and psychologically strained. In particular the subjects are apt to avoid contact with in-laws, and the change of relation to in-laws results in lessening the family boundary. In the course of this process, they confront the crisis of family confict result in family dissolution. This crisis is related to the threat of self-existence. Findings from this study contribute to understanding the chronic pain experience. To advance this study, we should compare this result with other cases in different cultural contexts. I think to interpret these results, korean cultural background should be considered. Especially the different family concept, more broader family members and kinship network, and the traditional medical knowledge influences patients' behavior.

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Down syndrome in women aged more than 35 Years positive detection rates (산전선별검사를 통한 35세이상 산모 다운증후군 양성률 비교 평가)

  • Oh, Taek Min;Kim, Ga-Yeon;Lee, Young ki
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.22 no.6
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    • pp.314-320
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    • 2021
  • With the increasing age of motherhood in recent years, attributed to late marriages due to social or environmental factors, the Down's syndrome screening test using biochemical markers has become essential for pregnant women. The process of diagnosing Down's syndrome pregnancy in the high-risk group subjects involves chromosomal analysis, which is performed on samples obtained through invasive procedures such as chorionic biopsy or amniotic fluid. Thus, to reduce unnecessary invasive tests and lower the risk to mother and fetus, it is important to identify a screening test with low risk and high Down's syndrome detection rate. Recently, as the average age of mothers has increased, numerous inspection agencies have classified high-risk mothers as women over the age of 35 years. This study evaluated a total of 36,436 pregnant women aged between 17 to 46 years, and who requested prenatal screening at an inspection agency in Yongin in 2018. Test (13,690 people) Four tests were conducted by applying the time-resolved fluoroimmunoassay method using the direct sandwich and indirect sandwich technology, and the immunoassay method using the sandwich method. We aimed to confirm the difference in positivity rate with increasing age of the subjects. We believe that in future, data obtained from this study will be very useful for the prevention and treatment of Down's syndrome risk at varied inspection institutions, and for prospective mothers.

Adolescent's Risk Behavior and the Quality of Life: the Role of Protective Factors on Risk Behavior (청소년의 위험행동과 삶의 질: 위험행동에 대한 보호요인의 역할)

  • Sang-Chul Han
    • Korean Journal of Culture and Social Issue
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    • v.12 no.5_spc
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    • pp.99-116
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    • 2006
  • This paper discuss adolescent's a quality of life related with risk behavior. The purpose of this study investigate to influence on risk behavior(runaway, smoking, sexual behavior) of the protective factors that moderate adolescent's problem behavior(delinquency). The assumption of this study that the protective factors counterbalance the negative influence of risk factors and finally, diminish a the problem behavior including a delinquent. A total of 1,020 students of a vocational high schook and a 216 adolescents of a special groups(the public institution that consisted with a delinquent young man) completed the questionnaires(risk behavior, 5 protective factors) of compiled by this researcher. The protective factors have selected based on the various prior studies analyzed with adolescent's risk behavior a family functioning, a father(a mother) each and child communication, a self efficacy, and a social support. Statistics appled for the data analysis are Chisqure analysis, two-way ANOVA, and Standard Discrimination analysis. The results of this study are as follows. First, the special group is higher than the general group in the rate of runaway, smoking, and sexual deviant behavior. Second, the protective factors are not action in the special group have experienced delinquency, but are only action in the general group consisted with the students of a vocational high schools. This means that the protective factors discriminating the participation of the risk behaviors, and blocking out the intervention of a problem behavior in the general adolescents. Although each protective factor influence to different according to each risk behavior, a role of a parent-child communication, a family functioning, and self-efficacy high orderly. Finally, discussed based on the previous studies that the protective factors moderate the negative influence of risk factors, offset the connection between a risk behavior and a. problem behavior, and improve and a resilience and the quality of life of the adolescents.

CLINICAL STUDY OF THE ABUSE IN PSYCHIATRICALLY HOSPITALIZED CHILDREN AND ADOLESCENTS (소아청소년 정신과병동 입원아동의 학대에 대한 임상 연구)

  • Lee, Soo-Kyung;Hong, Kang-E
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.10 no.2
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    • pp.145-157
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    • 1999
  • This study was performed by the children and adolescents who were abused or neglected physically, emotionally that were selected in child & adolescents psychiatric ward. We investigated the number of these case in admitted children & adolescents, and also observed characteristics of symptoms, developmental history, characteristics of abuse style, characteristics of abusers, family dynamics and psychopathology. We hypothesized that all kinds of abuse will influnced to emotional, behavioral problems, developmental courses on victims, interactive effects on family dynamics and psychopathology. That subjects were 22 persons of victims who be determined by clinical observation and clinical note. The results of the study were as follows:1) Demographic characteristics of victims:ratio of sex was 1:6.3(male:female), mean age was $11.1{\pm}2.5$. According to birth order, lst was 12(54.5%), 2nd was 5(23%), 3rd was 2(9%) and only child was 3(13.5%). 2) Characteristics of family:According to socioeconomic status, middle to high class was 3(13.5%), middle one was 9(41.% ), middle to low one was 9(41%), low one was 1(0.5%). according to number of family, under the 3 person was 3(13.5%), 4-5 was 17(77.5%), 6-7 was 2(9%). according to marital status of parents, divorce or seperation were 5(23%), remarriage 2(9%), severe marital discord was 19(86.5%). In father, antisocial behavior was 7(32%), alcohol dependence was 10(45.5%). In mother, alcohol abuse was 5(23%), depression was 17(77.3%), history of psychiatric management was 6(27%). 3) Characteristics of abuse:Physical abuse was 18(81.8%), physical and emotional abuse and neglect were 4(18.2%). according to onset of abuse, before 3 years was 15(54.5%), 3-6 years was 5(27.5%), schooler was 1(15%). Only father offender was 2(19%), only mother offender was 8(35.4%), both offender was 8(35.4%), accompaning with spouse abuse was 7(27%), and accompaning with other sibling abuse was 4(18.2%). 4) General characteristics and developmental history of victims:Unwanted baby was 12(54.5%), developmental delay before abuse was9(41%), comorbid developmental disorder was 15(68%). there were 6(27.5%) who didn‘t show definite sign of developmental delay before abuse. 5) Main diagnosis and comorbid diagnosis:According to main diagnosis, conduct disorder 6(27.3%), borderline child 5(23%), depression4(18%), attention deficit hyperactivity disorder(ADHD) 4(18%), pervasive developmental disorder not otherwise specified 2(9%), selective mutism 1(5%). According to comorbid diagnosis, ADHD, borderline intelligence, mental retardation, learning disorder, developmental language disorder, oppositional defiant disorder, chronic tic disorder, functional enuresis and encoporesis, anxiety disorder, dissociative disorder, personality disorder due to medical condition. 5) Course of treatment:A mean duration of admission was $2.4{\pm}1.5$ months. 11(15%) showed improvement of symtoms, however 11(50%) was not changed of symtoms.

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A Survey on Child Battering among Elementary School Children and Related Factors in Urban and Rural Areas (도시 및 농어촌 아동의 가정내 구타발생률 및 관련요인 조사)

  • Jeon, Kae-Soon;Park, Jung-Han
    • Journal of Preventive Medicine and Public Health
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    • v.24 no.2 s.34
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    • pp.232-242
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    • 1991
  • To determine the incidence rate of child battering and related factors, a questionnaire survey was Conducted on 1,255 children in 4th and 5th grades of two elementary schools (one in the upper economic class area with 519 students and the other in the lower economic class area with 504 students) in Taegu and two schools in rural areas of Kyungpook province (120 and 112 students, respectively) from 1st May to 10th May 1990. Total number of children who were battered during one-month period (1-30 April 1990) prior to the survey was 918 (73.1%). Among the battered children 87 (6.9%) were severely battered (twice or more in a month by kicking or more severe method) and 831 children (66.2%) were moderately battered (all other battering than severe battering). The percentage of battered children and degree of battering were not significantly different between two schools in Taegu and between urban and rural areas. Common reasons for battering were disobediance (61.9%), making troubles (34.9%), and poor school performance (33.3%). However, 16.1% of severely battered children responded that the perpetrators battered them to wreak their anger and 5.7% of them did not know the reason why they were battered. A majority of the battered children (65%) regretted their fault after being battered but 20.7% of the severely battered children wanted to run away and 9.2% of them had an urge to commit suicide. While most of the physical injuries due to battering were minor as bruise (52.7%) but some of them were severe, e.g., bone fracture (2.5%), skin laceration (1.5%), and loss of consciousness. (0.2%). The common psycho-behavioral complaints of the severely battered children were unwillingness to study (31%), unwillingness to live (17.2%), and reluctance to go home (13.8%). The incidence rate of severe battering was significantly higher (p=0.018) among the children living in a quarter attached to a store (14.0%) than the children living in an apartment (6.6%) and individual house (6.2%). The incidence rate of severe battering was higher among children living in a rental house (8.4%) than children living in their own house 6.3%) (p=0.005). The children of father only working (5.1%) and mother only working (4.5%) had a lower incidence rate of severe battering than the children of both parents working (9.1%) and both parents unemployed (20.7%) (p=0.006). More children were battered when there was a sick family member (80.8%) compared with the children without a sick family member (71.4%) (p=0.001). The incidence rates of severe and moderate battering increased as the frequency of quarreling between mother and father increased (P=0.000). The percentage of unbattered children was higher among children whose father's occupation was professional (39.4%) than that of the total study subjects (26.9%) (p<0.001).

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The Application of Customer Relationship Management for the Effective Prenatal Care (효과적인 산전관리를 위한 고객관계관리(CRM)의 도입)

  • Shin, Sook;Paik, Soo-Kyung;Kang, Sung-Hong;Kim, Yu-Mi
    • Korea Journal of Hospital Management
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    • v.10 no.1
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    • pp.93-114
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    • 2005
  • The prenatal care is the preventive medical service to help the pregnant mother deliver the healthy baby. It's regular examines give some chances to check-up the healthy conditions. This thesis concentrates on the CRM system to support an effective prenatal care system and prove the effectiveness of it. As CRM is the adapted management related to the customer's own information, it is important to develop the CRM model classified by the patients characteristics. A general hospital in Busan operated the CRM system to carry out the effective prenatal care and there is an analysis to ensure the effectiveness of CRM system for the pregnant women in our maternity ward. The results can be summarized as follows: 1) According to the comparisons with the CRM system, we can conclude the system is desirable. (1) Maternal Age : In the age distribution, the prenatal visit frequency, triple marker freqency, oral GTT and targeted ultrasonography in the experimental group in 30 to 34 years old is higher on the whole. For over 35 years old group, the higher frequency comes out in the oral GTT and targeted ultrasonography and for 25 to 29 years old group the different figure shows just in the targeted ultrasonography. (2) Area of residence: There is a clear difference in all the items in Busan and near area but no sign of difference in prenatal visits and oral GTT in other residencial area. Especially in the targeted ultrasonography the higher figure shows in the experimental group located in the both areas. The targeted ultrasonography is known as the specific examination which should be examined by the specialists, on the contrary the other examinations can be operated in the small clinic. So the public information and seminars related with ultrasonography increases the check-up frequency. The clinic requests some ultrasonographical examinations to the specialists in general hospital. (3) Parity: The clear difference shows that the CRM system causes the prenatal visit frequency to become higher in experimental group. The figure is 9.7 times and 8.6 times each. This is opposite that the past study said multiparity reduced the average prenatal visits. But the result of CRM is considered as the method to help the multiparity understand the importance of the prenatal care. (4) Obstetrical history: In the experimental group of the spontaneous delivery group, the figure is higher in the prenatal visit frequency, triple marker, oral GTT and targeted ultrasonography but the Caesarean section delivery group has higher figure in targeted ultrasonography. (5) In the first check-up, the rate of targeted ultrasonography in under 16 week pregnancy, in the 16 week pregnancy to 32 week pregnancy and the over 32 week pregnancy in the experimental group is upper than the compared one. For the oral GTT, there is a difference in under 16 week pregnancy but no difference in prenatal visits and triple marker. 2) The analysis of characteristics of prenatal care through the decision tree resulted in the fact that the most important variable is the residential area. After the delivery frequency is following, the obstetrical history and maternal age are in order. It is the same result in the triple marker and oral GTT. Consequently it is the same order of important variables in CRM system. The effectiveness of CRM system is proved in this study. The CRM system is a marketing method to control and lead the customers through the segmentation of customer data. It increases the new customer aquisition, maintenance of loyal customers, augmentation of customers value, activation of potential customers and creation of life time customers. So eventually it can enlarge the customers value. The medical institution should make efforts to establish the data base enforced by the customer's information on the underlying ordinary data system to carry out the CRM system effectively. In addition, it should develop the a variety of marketing strategy in order to set up one to one marketing satisfying the needs of individual patients.

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