• 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.

• 대한예방의학회:학술대회논문집
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• 1999.10a
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• pp.44-44
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• 1999

• 대한예방의학회:학술대회논문집
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• 2002.10a
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• pp.368-368
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• 2002

• Korean Journal of Occupational Health Nursing
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• v.24 no.1
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• pp.39-47
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• 2015

Purpose: This study is performed to help manage the metabolic syndrome in work place by identifying the effect on metabolic syndrome with subjects of Korean adult workers. Methods: Using part of data of "The Fourth Korean National Health and Nutrition Examination survey 2nd year (2008)" which center for disease control is investigating. The general characteristics include age, educational level, occupation and marital status as factors affecting the metabolic syndrome of workers in this study. Results: Work-related factors are the working environment in which they are working while they are pressed for time due to work status and overload. If the work status of worker is unpaid family member, the risk is increased by more than twice compared to paid workers. The risk for metabolic syndrome in work environment to work while fighting the clock is decreased compared to the work environment without time pressure. Conclusion: In order to manage the metabolic syndrome of workers, health promotion program to change management of both working condition and working environment can contribute to prevent the metabolic syndrome and ultimately prevent the cerebrocardiovascular diseases.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.25 no.2
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• pp.194-201
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• 2015

Objectives: The purpose of this study is to assess the exposure level to dust and airborne microorganisms among employed workers in a clothing shopping center. Materials and Methods: On-site investigation of a clothing shopping center was performed between October and November 2012. The hazardous substances measured in this study are particulate matter(Total dust, respirable dust) and airborne microorganisms (Total airborne bacteria, total airborne fungi). Results: The highest geometric mean levels of particulate matter(total dust, respirable dust) for personal sampling were $1.735(SD:0.883)mg/m^3$ for total dust and $0.0711(SD:0.008)mg/m^3$ for respirable dust, respectively. Those for area sampling were $0.625(SD:0.091)mg/m^3$ for total dust and $0.0718(SD:0.012)mg/m^3$ for respirable dust, respectively. The highest geometric averaged concentrations of airborne microorganisms(Total airborne bacteria, total airborne fungi) were detected at $1,181(SD:105)cfu/m^3$ for total airborne bacteria and $683(SD:114)cfu/m^3$ for total airborne fungi, respectively. Concentrations of particulate matters and airborne microorganism in clothes shopping center did not correlate significantly with environmental factors such as temperature or relative humidity. Conclusions: Exposure levelshave not been established for service workers. Thus, health risk assessment for this group is very difficult. Health guidelines for service workers should be established as soon as possible.

• Korean Journal of Occupational Health Nursing
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• v.33 no.1
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• pp.1-11
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• 2024

Purpose: This study aimed to analyze the factors influencing the well-being of middle-aged non-shift female workers using health-determinant models. Methods: This study analyzed data from the fifth Korean Working Conditions Survey (KWCS), involving 5,449 participants. A hierarchical multiple regression analysis was employed to examine the relationships between various factors and well-being. Results: The analysis identified key factors affecting well-being in middle-aged female non-shift workers, including supervisor support, presenteeism, satisfaction with the working environment, autonomy in working hours, support from coworkers, workplace discrimination, occupation, work-life balance, sleep problems, workplace size, weekly work hours, and sickness absence. This study confirms that the well-being of middle-aged non-shift female workers is influenced by factors at the individual, social, and community levels as well as by conditions related to love. Conclusion: To enhance the well-being of middle-aged female non-shift workers, it is essential to reinforce positive factors such as support from coworkers and superiors. Additionally, addressing and mitigating negatively influencing factors such as workplace discrimination and sleep problems is crucial in promoting well-being. By implementing measures to improve these aspects, organizations and policymakers can contribute to a healthier and more supportive work environment for middle-aged, non-shift female workers.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.23 no.2
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• pp.65-74
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• 2013

Objectives: This study attempted to develop a method to measure ultra-trace lead concentrations in plasma using Inductively Coupled Plasma Mass Spectrometry(ICP-MS) and to test whether plasma lead can be used as a biomarker for the biological monitoring of exposure to lead. Methods: Lead concentrations in 160 plasma samples of field workers and 42 plasma samples from the control group were measured by ICP-MS. Blood zinc protophorphyrin(ZPP) concentrations and urinary ${\delta}$-aminolevulinic acid${\delta}-ALA$) were measured for correlation analysis with plasma lead. Results: The mean lead level in the plasma of the workers exposed to lead at work were 786.1 ng/L. Plasma lead levels were not correlated with blood ZPP or urinary ${\delta}-ALA$ concentrations. Otherwise, plasma lead levels showed a good correlation coefficient of 0.400 with blood lead levels, and their correlation coefficient had a better value of 0.552 for the non-smoking and drinking group. In the general population group which was not exposed to lead in the workplace and was considered the control group, the mean concentration of plasma lead was 123.1 ng/L. The plasma lead levels for the general population group showed a good correlation coefficient of 0.520 with blood ZPP and urinary ${\delta}-ALA$ concentrations.

• Journal of Preventive Medicine and Public Health
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• v.31 no.3 s.62
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• pp.404-413
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• 1998

This study was conducted in order to clarify the factors affecting the number of utilization to health center for the shipyard workers who have been work in exposed environment to solvent. At first the tendencies of the number of utilization to health conte. in accordance with cumulative exposure(CE), lifetime weighted average exposure(LWAE), one's place of duty, work contents, states of using safety apparatus, the degree of the knowledge on handling solvents, exposure year. 1). The increase in the cumulative exposure(CE) war significantly higher in the number of utilization to health center. The group with longer exposure year showed significantly higher number of utilization to health center(p<0.01). Considering the work contents such as power blasting, spray, mixing and touch-up, the group of touch-up showed higher number of utilization to health center and this difference was statistically significant(p<0.001). Those who were not using the safety apparatus, showed higher number of utilization to health center, which was statistically significant(p<0.05). The degree of the knowledge on handling the solvent had no relation with using health center. 2) The results conducted from this study by multiple regression analysis in clarifying the factors affecting the number of utilization to health center, CE, exposure year and using safety apparatus was significant factor in utilization of health center.

• Korean Journal of Occupational Health Nursing
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• v.23 no.1
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• pp.47-54
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• 2014

Purpose: This study was to investigate the effects of U-Health program on metabolic syndrome of workers. Methods: This study was conducted with a pretest-posttest control group study for 6 month from May to October 2010. Subjects in the experimental group participated in the U-Health program (n=315), whereas the control group did not (n=157). Results: In the U-Health group, statistically significant reductions in BMI(body mass index), waist circumference, cholesterol, and triglyceride were observed. The results of this study showed that 6 months of U-Health program influenced on the metabolic syndrome of workers in a positive way. Conclusion: It is, therefore, suggested to actively utilize the U-Health program to manage the workers' health.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.23 no.3
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• pp.315-322
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• 2013

Objectives: This study was conducted in order to prepare fundamental data and assess the short-term effects of applying cerebrovascular disease prevention programs by the Ministry of Employment and Labor and the Korea Occupational Safety and Health Agency (KOSHA) in Korea. Methods: The number of study subjects was 2,676 workers (58.5%) who were able to evaluate the level of incidence risk at pre- and post-applications of the program, among the 4,576 total workers who were enrolled in the cerebrovascular disease prevention program during 2011. The guidelines for this prevention program were adopted from KOSHA GUIDE H-1-2010. To determine the program' effectiveness, the workers'risks for cerebrovascular disease were assessed pre- and post-application of the program. Results: The blood pressure level was significantly reduced by 4.09 mmHg for the mean systolic blood pressures and 5.47 mmHg for diastolic blood pressures, respectively. The mean level of total cholesterol and BMI were also reduced significantly by 2.07 g/dl and 0.1 $0.1kg/m^2$. The rate of smoking was decreased by 4.0% and the percentage of workers engaging in regular exercise was increased by 29.8%. The level of overall cerebrovascular disease risk was reduced among 1,451 (70.7%) of 2,052 workers at low risk and above. The level of cerebrovascular disease risk was lower in the improved group for health behavior than the unimproved group (odds ratio =1.7, p < 0.001). Conclusions: The author considers that the application of the cerebrovascular disease prevention program by the Korea Occupational Safety and Health Agency reduced cerebrovascular diseases risks among workers who were enrolled in the cerebrovascular disease prevention program and it must be accompanied by an improvement in health behavior for prevention of cerebrovascular disease.