Assessment of nutritional status of patients with chronic obstructive pulmonary disease (만성 폐쇄성 폐질환 환자의 영양상태 평가)
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- Tuberculosis and Respiratory Diseases
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- v.44 no.1
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- pp.93-103
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- 1997
Background : Malnutrition is a common finding in patients with chronic obstructive pulmonary disease, especially in the emphysema group. Although the mechanism of malnutrition is not confirmed, it is believed to be a relative deficiency caused by hypermetabolism due to increased energy requirements of the respiratory muscles, rather than a dietary deficiency. Malnutrition in chronic obstructive pulmonary disease is not a merely coincidental finding. It is known that the nutritional status correlates with physiologic parameters including pulmonary function, muscular power, and exercise performance, and is one of the important and independent prognostic factors of the disease. Methods : Patients with chronic obstructive pulmonary disease Yongdong Severance Hospital from May, 1995 to March, 1996 and age-matched healthy control group were studied. Survey of nutritional intake, anthropometric measurements and biochemical tests were done to assess nutritional status. Relationship between nutritional status and FEV1 (forced expiratory volume at one second), which was a significant functional parameter, was assessed. Results : 1) The patient group was consisted of 25 males with mean age of 66.1years and FEV1 of
Just before the Korean War, the total number of the North Korean troops was 198,380, while that of the ROK(Republic of Korea) army troops 105,752. That is, the total number of the ROK army troops at that time was 53.3% of the total number of the North Korean army. As of December 2008, the total number of the North Korean troops is estimated to be 1,190,000, while that of the ROK troops is 655,000, so the ROK army maintains 55.04% of the total number of the North Korean troops. If the ROK army continues to reduce its troops according to [Military Reform Plan 2020], the total number of its troops will be 517,000 m 2020. If North Korea maintains the current status(l,190,000 troops), the number of the ROK troops will be 43.4% of the North Korean army. In terms of units, just before the Korean War, the number of the ROK army divisions and regiments was 80% and 44.8% of North Korean army. As of December 2008, North Korea maintains 86 divisions and 69 regiments. Compared to the North Korean army, the ROK army maintains 46 Divisions (53.4% of North Korean army) and 15 regiments (21.3% of North Korean army). If the ROK army continue to reduce the military units according to [Military Reform Plan 2020], the number of ROK army divisions will be 28(13 Active Division, 4 Mobilization Divisions and 11 Local Reserve Divisions), while that of the North Korean army will be 86 in 2020. In that case, the number of divisions of the ROK army will be 32.5% of North Korean army. During the Korean war, North Korea suddenly invaded the Republic of Korea and occupied its capital 3 days after the war began. At that time, the ROK army maintained 80% of army divisions, compared to the North Korean army. The lesson to be learned from this is that, if the ROK army is forced to disperse its divisions because of the simultaneous invasion of North Korea and attack of guerrillas in home front areas, the Republic of Korea can be in a serious military danger, even though it maintains 80% of military divisions of North Korea. If the ROK army promotes the plans in [Military Reform Plan 2020], the number of military units of the ROK army will be 32.5% of that of the North Korean army. This ratio is 2.4 times lower than that of the time when the Korean war began, and in this case, 90% of total military power should be placed in the DMZ area. If 90% of military power is placed in the DMZ area, few troops will be left for the defense of home front. In addition, if the ROK army continues to reduce the troops, it can allow North Korea to have asymmetrical superiority in military force and it will eventually exert negative influence on the stability and peace of the Korean peninsular. On the other hand, it should be reminded that, during the Korean War, the Republic of Korea was attacked by North Korea, though it kept 53.3% of troops, compared to North Korea. It should also be reminded that, as of 2008, the ROK army is defending its territory with the troops 55.04% of North Korea. Moreover, the national defense is assisted by 25,120 troops of the US Forces in Korea. In case the total number of the ROK troops falls below 43.4% of the North Korean army, it may cause social unrest about the national security and may lead North Korea's misjudgement. Besides, according to Lanchester strategy, the party with weaker military power (60% compared to the party with stronger military power) has the 4.1% of winning possibility. Therefore, if we consider the fact that the total number of the ROK army troops is 55.04% of that of the North Korean army, the winning possibility of the ROK army is not higher than 4.1%. If the total number of ROK troops is reduced to 43.4% of that of North Korea, the winning possibility will be lower and the military operations will be in critically difficult situation. [Military Reform Plan 2020] rums at the reduction of troops and units of the ground forces under the policy of 'select few'. However, the problem is that the financial support to achieve this goal is not secured. Therefore, the promotion of [Military Reform Plan 2020] may cause the weakening of military defence power in 2020. Some advanced countries such as Japan, UK, Germany, and France have promoted the policy of 'select few'. However, what is to be noted is that the national security situation of those countries is much different from that of Korea. With the collapse of the Soviet Unions and European communist countries, the military threat of those European advanced countries has almost disappeared. In addition, the threats those advanced countries are facing are not wars in national level, but terrorism in international level. To cope with the threats like terrorism, large scaled army trops would not be necessary. So those advanced European countries can promote the policy of 'select few'. In line with this, those European countries put their focuses on the development of military sections that deal with non-military operations and protection from unspecified enemies. That is, those countries are promoting the policy of 'select few', because they found that the policy is suitable for their national security environment. Moreover, since they are pursuing common interest under the European Union(EU) and they can form an allied force under NATO, it is natural that they are pursing the 'select few' policy. At present, NATO maintains the larger number of troops(2,446,000) than Russia(l,027,000) to prepare for the potential threat of Russia. The situation of japan is also much different from that of Korea. As a country composed of islands, its prime military focus is put on the maritime defense. Accordingly, the development of ground force is given secondary focus. The japanese government promotes the policy to develop technology-concentrated small size navy and air-forces, instead of maintaining large-scaled ground force. In addition, because of the 'Peace Constitution' that was enacted just after the end of World War II, japan cannot maintain troops more than 240,000. With the limited number of troops (240,000), japan has no choice but to promote the policy of 'select few'. However, the situation of Korea is much different from the situations of those countries. The Republic of Korea is facing the threat of the North Korean Army that aims at keeping a large-scale military force. In addition, the countries surrounding Korea are also super powers containing strong military forces. Therefore, to cope with the actual threat of present and unspecified threat of future, the importance of maintaining a carefully calculated large-scale military force cannot be denied. Furthermore, when considering the fact that Korea is in a peninsular, the Republic of Korea must take it into consideration the tradition of continental countries' to maintain large-scale military powers. Since the Korean War, the ROK army has developed the technology-force combined military system, maintaining proper number of troops and units and pursuing 'select few' policy at the same time. This has been promoted with the consideration of military situation in the Koran peninsular and the cooperation of ROK-US combined forces. This kind of unique military system that cannot be found in other countries can be said to be an insightful one for the preparation for the actual threat of North Korea and the conflicts between continental countries and maritime countries. In addition, this kind of technology-force combined military system has enabled us to keep peace in Korea. Therefore, it would be desirable to maintain this technology-force combined military system until the reunification of the Korean peninsular. Furthermore, it is to be pointed out that blindly following the 'select few' policy of advanced countries is not a good option, because it is ignoring the military strategic situation of the Korean peninsular. If the Republic of Korea pursues the reduction of troops and units radically without consideration of the threat of North Korea and surrounding countries, it could be a significant strategic mistake. In addition, the ROK army should keep an eye on the fact the European advanced countries and Japan that are not facing direct military threats are spending more defense expenditures than Korea. If the ROK army reduces military power without proper alternatives, it would exert a negative effect on the stable economic development of Korea and peaceful reunification of the Korean peninsular. Therefore, the desirable option would be to focus on the development of quality of forces, maintaining proper size and number of troops and units under the technology-force combined military system. The tableau above shows that the advanced countries like the UK, Germany, Italy, and Austria spend more defense expenditure per person than the Republic of Korea, although they do not face actual military threats, and that they keep achieving better economic progress than the countries that spend less defense expenditure. Therefore, it would be necessary to adopt the merits of the defense systems of those advanced countries. As we have examined, it would be desirable to maintain the current size and number of troops and units, to promote 'select few' policy with increased defense expenditure, and to strengthen the technology-force combined military system. On the basis of firm national security, the Republic of Korea can develop efficient policies for reunification and prosperity, and jump into the status of advanced countries. Therefore, the plans to reduce troops and units in [Military Reform Plan 2020] should be reexamined. If it is difficult for the ROK army to maintain its size of 655,000 troops because of low birth rate, the plans to establish the prompt mobilization force or to adopt drafting system should be considered for the maintenance of proper number of troops and units. From now on, the Republic of Korean government should develop plans to keep peace as well as to prepare unexpected changes in the Korean peninsular. For the achievement of these missions, some options can be considered. The first one is to maintain the same size of military troops and units as North Korea. The second one is to maintain the same level of military power as North Korea in terms of military force index. The third one is to maintain the same level of military power as North Korea, with the combination of the prompt mobilization force and the troops in active service under the system of technology-force combined military system. At present, it would be not possible for the ROK army to maintain such a large-size military force as North Korea (1,190,000 troops and 86 units). So it would be rational to maintain almost the same level of military force as North Korea with the combination of the troops on the active list and the prompt mobilization forces. In other words, with the combination of the troops in active service (60%) and the prompt mobilization force (40%), the ROK army should develop the strategies to harmonize technology and forces. The Korean government should also be prepared for the strategic flexibility of USFK, the possibility of American policy change about the location of foreign army, radical unexpected changes in North Korea, the emergence of potential threat, surrounding countries' demand for Korean force for the maintenance of regional stability, and demand for international cooperation against terrorism. For this, it is necessary to develop new approaches toward the proper number and size of troops and units. For instance, to prepare for radical unexpected political or military changes in North Korea, the Republic of Korea should have plans to protect a large number of refugees, to control arms and people, to maintain social security, and to keep orders in North Korea. From the experiences of other countries, it is estimated that 115,000 to 230,000 troops, plus ten thousands of police are required to stabilize the North Korean society, in the case radical unexpected military or political change happens in North Korea. In addition, if the Republic of Korea should perform the release of hostages, control of mass destruction weapons, and suppress the internal wars in North Korea, it should send 460,000 troops to North Korea. Moreover, if the Republic of Korea wants to stop the attack of North Korea and flow of refugees in DMZ area, at least 600,000 troops would be required. In sum, even if the ROK army maintains 600,000 troops, it may need additional 460,000 troops to prepare for unexpected radical changes in North Korea. For this, it is necessary to establish the prompt mobilization force whose size and number are almost the same as the troops in active service. In case the ROK army keeps 650,000 troops, the proper number of the prompt mobilization force would be 460,000 to 500,000.
As the population, buying power, and intensity of self-expression of the elderly generation increase, its importance as a market segment is also growing. Therefore, the mass marketing strategy for the elderly generation must be changed to a micro-marketing strategy based on the results of sub-segmentation that suitably captures the characteristics of this generation. Furthermore, as a customer access strategy is decided by sub-segmentation, proper segmentation is one of the key success factors for micro-marketing. Segments or sub-segments are different from sectors, because segmentation or sub-segmentation for micro-marketing is based on the homogeneity of customer needs. Theoretically, complete segmentation would reveal a single voice. However, it is impossible to achieve complete segmentation because of economic factors, factors that affect effectiveness, etc. To obtain a single voice from a segment, we sometimes need to divide it into many individual cases. In such a case, there would be a many segments to deal with. On the other hand, to maximize market access performance, fewer segments are preferred. In this paper, we use the term "sub-segmentation" instead of "segmentation," because we divide a specific segment into more detailed segments. To sub-segment the elderly generation, this paper takes their lifestyles and life stages into consideration. In order to reflect these aspects, various surveys and several rounds of expert interviews and focused group interviews (FGIs) were performed. Using the results of these qualitative surveys, we can define six sub-segments of the elderly generation. This paper uses five rules to divide the elderly generation. The five rules are (1) mutually exclusive and collectively exhaustive (MECE) sub-segmentation, (2) important life stages, (3) notable lifestyles, (4) minimum number of and easy classifiable sub-segments, and (5) significant difference in voices among the sub-segments. The most critical point for dividing the elderly market is whether children are married. The other points are source of income, gender, and occupation. In this paper, the elderly market is divided into six sub-segments. As mentioned, the number of sub-segments is a very key point for a successful marketing approach. Too many sub-segments would lead to narrow substantiality or lack of actionability. On the other hand, too few sub-segments would have no effects. Therefore, the creation of the optimum number of sub-segments is a critical problem faced by marketers. This paper presents a method of evaluating the fitness of sub-segments that was deduced from the preceding surveys. The presented method uses the degree of homogeneity (DoH) to measure the adequacy of sub-segments. This measure uses quantitative survey questions to calculate adequacy. The ratio of significantly homogeneous questions to the total numbers of survey questions indicates the DoH. A significantly homogeneous question is defined as a question in which one case is selected significantly more often than others. To show whether a case is selected significantly more often than others, we use a hypothesis test. In this case, the null hypothesis (H0) would be that there is no significant difference between the selection of one case and that of the others. Thus, the total number of significantly homogeneous questions is the total number of cases in which the null hypothesis is rejected. To calculate the DoH, we conducted a quantitative survey (total sample size was 400, 60 questions, 4~5 cases for each question). The sample size of the first sub-segment-has no unmarried offspring and earns a living independently-is 113. The sample size of the second sub-segment-has no unmarried offspring and is economically supported by its offspring-is 57. The sample size of the third sub-segment-has unmarried offspring and is employed and male-is 70. The sample size of the fourth sub-segment-has unmarried offspring and is not employed and male-is 45. The sample size of the fifth sub-segment-has unmarried offspring and is female and employed (either the female herself or her husband)-is 63. The sample size of the last sub-segment-has unmarried offspring and is female and not employed (not even the husband)-is 52. Statistically, the sample size of each sub-segment is sufficiently large. Therefore, we use the z-test for testing hypotheses. When the significance level is 0.05, the DoHs of the six sub-segments are 1.00, 0.95, 0.95, 0.87, 0.93, and 1.00, respectively. When the significance level is 0.01, the DoHs of the six sub-segments are 0.95, 0.87, 0.85, 0.80, 0.88, and 0.87, respectively. These results show that the first sub-segment is the most homogeneous category, while the fourth has more variety in terms of its needs. If the sample size is sufficiently large, more segmentation would be better in a given sub-segment. However, as the fourth sub-segment is smaller than the others, more detailed segmentation is not proceeded. A very critical point for a successful micro-marketing strategy is measuring the fit of a sub-segment. However, until now, there have been no robust rules for measuring fit. This paper presents a method of evaluating the fit of sub-segments. This method will be very helpful for deciding the adequacy of sub-segmentation. However, it has some limitations that prevent it from being robust. These limitations include the following: (1) the method is restricted to only quantitative questions; (2) the type of questions that must be involved in calculation pose difficulties; (3) DoH values depend on content formation. Despite these limitations, this paper has presented a useful method for conducting adequate sub-segmentation. We believe that the present method can be applied widely in many areas. Furthermore, the results of the sub-segmentation of the elderly generation can serve as a reference for mature marketing.