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Lipopolysaccharide-induced Synthesis of IL-1beta, IL-6, TNF-alpha and TGF-beta by Peripheral Blood Mononuclear Cells (내독소에 의한 말초혈액 단핵구의 IL-1beta, IL-6, TNF-alpha와 TGF-beta 생성에 관한 연구)

  • Jung, Sung-Hwan;Park, Choon-Sik;Kim, Mi-Ho;Kim, Eun-Young;Chang, Hun-Soo;Ki, Shin-Young;Uh, Soo-Taek;Moon, Seung-Hyuk;Kim, Yang-Hoon;Lee, Hi-Bal
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.4
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    • pp.846-860
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    • 1998
  • Background: Endotoxin (LPS : lipopolysaccharide), a potent activator of immune system, can induce acute and chronic inflammation through the production of cytokines by a variety of cells, such as monocytes, endothelial cells, lymphocytes, eosinophils, neutrophils and fibroblasts. LPS stimulate the mononucelar cells by two different pathway, the CD14 dependent and independent way, of which the former has been well documented, but not the latter. LPS binds to the LPS-binding protein (LBP), in serum, to make the LPS-LBP complex which interacts with CD14 molecules on the mononuclear cell surface in peripheral blood or is transported to the tissues. In case of high concentration of LPS, LPS can stimulate directly the macrophages without LBP. We investigated to detect the generation of proinflammatory cytokines such as interleukin 1 (IL-1), IL-6 and TNF-$\alpha$ and fibrogenic cytokine, TGF-$\beta$, by peripheral blood mononuclear cells (PBMC) after LPS stimulation under serum-free conditions, which lacks LBPs. Methods : PBMC were obtained by centrifugation on Ficoll Hypaque solution of peripheral venous bloods from healthy normal subjects, then stimulated in the presence of LPS (0.1 ${\mu}g/mL$ to 100 ${\mu}g/mL$ ). The activities of IL-1, IL-6, TNF, and TGF-$\beta$ were measured by bioassaies using cytokines - dependent proliferating or inhibiting cell lines. The cellular sources producing the cytokines was investigated by immunohistochemical stains and in situ hybridization. Results : PBMC started to produce IL-6, TNF-$\alpha$ and TGF-$\beta$ in 1 hr, 4 hrs and 8hrs, respectively, after LPS stimulation. The production of IL-6, TNF-$\alpha$ and TGF-$\beta$ continuously increased 96 hrs after stimulation of LPS. The amount of production was 19.8 ng/ml of IL-6 by $10^5$ PBMC, 4.1 ng/mL of TNF by $10^6$ PBMC and 34.4 pg/mL of TGF-$\beta$ by $2{\times}10^6$ PBMC. The immunoreactivity to IL-6, TNF-$\alpha$ and TGF-$\beta$ were detected on monocytes in LPS-stimulated PBMC. Some of lymphocytes showed positive immunoreactivity to TGF-$\beta$. Double immunohistochemical stain showed that IL-1$\beta$, IL-6, TNF-$\alpha$ expression was not associated with CD14 postivity on monocytes. IL-1$\beta$, IL-6, TNF-$\alpha$ and TGF-$\beta$mRNA expression were same as observed in immunoreactivity for each cytokines. Conclusion: When monocytes are stimulated with LPS under serum-free conditions, IL-6 and TNF-$\alpha$ are secreted in early stage of inflammation. In contrast, the secretion of TGF-$\beta$ arise in the late stages and that is maintained after 96 hrs. The main cells releasing IL-1$\beta$, IL-6, TNF-$\alpha$ and TGF-$\beta$ are monocytes, but also lymphocytes can secret TGF-$\beta$.

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The Respiratory and Hemodynamic Effects of Prone Position According to the Level of PEEP in a Dog Acute Lung Injury Model (잡종견 급성폐손상 모델에서 Prone position 시행시 PEEP 수준에 따른 호흡 및 혈류역학적 효과)

  • Lim, Chae-Man;Chin, Jae-Yong;Koh, Youn-Suck;Shim, Tae-Sun;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.1
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    • pp.140-152
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    • 1998
  • Background: Prone position improves oxygenation in patients with ARDS probably by reducing shunt Reduction of shunt in prone position is thought to be effected by lowering of the critical opening pressure (COP) of the dorsal lung because the pleural pressure becomes less positive in prone position compared to supine position. It can then be assumed that prone position would bring about greater improvement in oxygenation when PEEP applied in supine position is just beneath COP than when PEEP is above COP. Hemodynamically, prone position is expected to attenuate the lifting of cardiac fossa induced by PEEP. Based on these backgrounds, we investigated whether the effect of prone position on oxygenation differs in magnitude according to the level of PEEP applied in supine position, and whether impaired cardiac output in supine position by PEEP can be restored in prone position. Methods: In seven mongrel dogs, $PaO_2/F_1O_2$(P/F) was measured in supine position and at prone position 30 min. Cardiac output (CO), stroke volume (SV), pulse rate (PR), and pulmonary artery occlusion pressure (PAOP) were measured in supine position, at prone position 5 min, and at prone position 30 min. After ARDS was established with warmed saline lavage(P/F ratio $134{\pm}72$ mm Hg), inflection point was measured by constant flow method($6.6{\pm}1.4cm$ $H_2O$), and the above variables were measured in supine and prone positions under the application of Low PEEP($5.0{\pm}1.2cm$ $H_2O$), and Optimal PEEP($9.0{\pm}1.2cm$ $H_2O$)(2 cm $H_2O$ below and above the inflection point, respectively) consecutively. Results : P/F ratio in supine position was $195{\pm}112$ mm Hg at Low PEEP and $466{\pm}63$ mm Hg at Optimal PEEP(p=0.003). Net increase of P/F ratio at prone position 30 min, however, was far greater at Low PEEP($205{\pm}90$ mm Hg) than at Optimal PEEP($33{\pm}33$ mm Hg)(p=0.009). Compared to CO in supine position at Optimal PEEP($2.4{\pm}0.5$ L/min), CO in prone improved to $3.4{\pm}0.6$ L/min at prone position 5 min (p=0.0180) and $3.6{\pm}0.7$ L/min at prone position 30 min (p=0.0180). Improvement in CO was attributable to the increase in SV: $14{\pm}2$ ml in supine position, $20{\pm}2$ ml at prone position 5 min (p=0.0180), and $21{\pm}2$ ml at prone position 30 min (p=0.0180), but not to change in PR or PAOP. When the dogs were turned to supine position again, MAP ($92{\pm}23$ mm Hg, p=0.009), CO ($2.4{\pm}0.5$ L/min, p=0.0277) and SV ($14{\pm}1$ ml, p=0.0277) were all decreased compared to prone position 30 min. Conclusion: Prone position in a dog with saline-lavaged acute lung injury appeared to augment the effect of relatively low PEEP on oxygenation, and also attenuate the adverse hemodynamic effect of relatively high PEEP. These findings suggest that a PEEP lower than Optimal PEEP can be adopted in prone position to achieve the goal of alveolar recruitment in ARDS avoiding the hemodynamic complications of a higher PEEP at the same time.

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Analysis of p53 and Retinoblasoma(Rb) Gene Polymorphisms in Relation to Lung Cancer in Koreans (한국인 폐암 환자에 대한 p53 및 Rb유전자의 다형성 분석)

  • Lee, Kyung-Sang;Sohn, Jang-Won;Yang, Suck-Chul;Yoon, Ho-Joo;Shin, Dong-Ho;Park, Sung-Soo;Lee, Jung-Hee;Lee, Chun-Geun;Cho, Youl-Hee
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.3
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    • pp.534-546
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    • 1997
  • Background : The p53 and retinoblastoma(Rb) tumor suppressor genes are associated with the pathogenesis of several types of human cancer. Substantial proportion of the primary lung cancers or cell lines have been reported to have the p53 and/or the Rb gene mutations. But, so far there is no report on the analysis of the Rb gene polymorphism as one of the genetic susceptibility marker. This study was undertaken to establish the gene frequencies of the polymorphic genotypes of the p53 and Rb genes in Koreans to evaluate the possible involvement of these genotypes as a risk factor of lung cancer. Methods : In this study 145 controls without previous and present tumor history and 128 lung cancer patients were subjected to analysis. The two intragenic polymorphisms of the p53 gene(exon 4/ AccII, intron 6/MspI) and one intron 17/XbaI polymorphism of the Rb gene were analysed by the method of polymersae chain reaction- restriction fragment length polymorphisms(PCR-RFLPs). The genotype of the intron 3/16 bp repeat polymorphism of p53 was determined by PCR and direct gel electrophoresis. Results : There were no significant differences in the genotype distributions of the p53 gene between lung cancer patients and controls. But heterozygotes(Arg/Pro) of the exon 4/AccII polymorphisms were slightly over-represented than controls, especially in the Kreyberg type I cancer, which was known to be associated with smoking. The intron 3/16 bp duplication and the intron 6/MspI polymorphisms were in complete linkage disequilibrium. About 95% of the individuals were homozygotes of the common alleles both in the 16 duplication and MspI polymorphisms, and no differences were deteced in the genotype distributions between lung cancer patients and controls. Overall genotype distributions of the Rb gene polymorphisms between lung cancer patients and controls were not significantly different However, the genotype distributions in the Kreyberg type I cancer were significantly different from those of controls(p = 0.0297) or adenocarcinomas(p = 0.0008). It was noticeable that 73.4% of the patients with adenocarcinomas were heterozygotes(r1/r2) whereas 39.2% of the Kreyberg type I cancer were heterozygous at this polymorphisms. In the lung cancer patients, significant differences were also noted between the high dose smokers and low dose smokers including non-smokers(p = 0.0258). The relative risk to Kreyberg type I cancer was significantly reduced in the individuals with the genotype of r1/r2(odds ratio = 0.46, 95% C.I. = 0.25-0.86, p = 0.0124). The combined genotype distribution of the exon 4 AccII of the p53 and the intron 17 Rb gene polymorphisms in Kreyberg type I cancers were significantly different from dose of controls or adenocarcinomas. The highest odds ratio were observed in the individuals with the genotypes of Arg/Pro and r2/r2(odds ratio = 1.97,95% C.I. = 0.84-4.59) and lowest one was in the patients with Arg/Arg, r1/r2 genotype(odds ratio = 0.54, 95% C.I. = 0.25-1.14). Conclusion : The p53 and the Rb gene polymorphisms modulate the risk of smoking induced lung cancer development in Koeans. However, the exact mechanism of risk modulation by these polymorphism remains to be determined. For more discrete clarification of associations between specific genotypes and lung cancer risk, the evaluations of these polymorphisms in other ethnics and more number of patients will be needed.

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Physiological and Ecological Studies on the Low Temperature Damages of Rice (Oryza sativia L.) (수도의 저온장해에 관한 생리 생태학적 연구)

  • 오윤진
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.26 no.1
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    • pp.1-31
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    • 1981
  • Experiments were conducted to investigate rice varietal response to low water and air temperatures at different growth stages from 1975 to 1980 in a phytotron in Suweon and in a cold water nursery in Chooncheon. Germination ability, seedling growth, sterility of laspikelets, panicle exertion, discoloration of leaves, and delay of heading of recently developed indica/japonica cross(I/J), japonica, and indica varieties at low air temperature or cold water were compared to those at normal temperature or natural conditions. The results are summarized as follows: 1. Practically acceptable germination rate of 70% was obtained in 10 days after initiation of germination test at 15\circ_C for japonica varieties, but 15 days for IxJ varieties. Varietal differences in germination ability at suboptimal temperature was greatest at 16\circ_C for 6 days. 2. Cold injury of rice seedlings was most severe at the 3.0-and 3.5-leaf stage and it was reduced as growth stage advanced. A significant positive correlation was observed between cold injury at 3-leaf stage and 6-leaf stage. 3. At day/night temperatures of 15/10\circ_C seedlings of both japonica and I/J varieties were dead in 42 days. At 20/15\circ_C japonica varieties produced tillers actively, but tillering of I/J varieties was retarded a little. At 25/15\circ_C, both japonica and I/J varieties produced tillers most actively. Increase in plant height was proportional to the increase in all varieties. 4. In I/J varieties the number of differentiated panicle rachis branches and spikelets was reduced at a day-night temperature of 20-15\circ_C compared to 25-20 or 30-25\circ_C, but not in japonica varieties although panicle exertion was retarded at 20-15\circ_C. The number of spikelets was not correlated with the number of primary rachis branches, but positively correlated with that of secondary rachis branches. 5. Heading of rice varieties treated with 15\circ_C air temperature at meiotic stage was delayed compared to that at tillering stage by 1-3 days and heading was delayed as duration of low temperature treatment increased. 6. At cold water treatment of 17\circ_C from tillering to heading stage, heading of japonica, I/J, and cold tolerant indica varieties was delayed 2-6, 3-9, and 4-5 days, respectively, Growth stage sensitive to delay of heading delay at water treatment were tillering stage, meiotic stage, and booting tage in that order, delay of heading was greater in indica corssed japonica(Suweon 264), japonica(Suweon 235), and cold tolerant indica(Lengkwang) varieties in that order. Delay of heading due to cold water treatment was positively correlated with culm length reduction and spikelet sterility. 7. Elongation of culms and exertion of panicles of rice varieties treated with low air temperature 17\circ_C. Culm length reduction rate of tall varieties was lower than that of short statured varieties at low temperature. Panicle exertion was most severaly retarded with low temperature treatment at heading stage. Generally, retardation of panicle exertion of 1/1 varieties was more severe than that of japonica varieties at low temperature. There was a positive correlation between panicle exertion and culm length at low temperature. 8. The number of panicles was increased with cold water treatment at tillering stage, but reduced at meiotic stage. As time of cold water treatment was conducted at earlier growth stage, culm length was shorter and panicle exertion poorer. 9. Sterility of all rice varieties was negligible at 17\circ_C for three days but 30.3-85.2% of strility was observed for nine-day treatment at 17\circ_C. Among the tested varieties, sterility of Suweon 264 and Milyang 42 was highest and that of Suweon 290 and Suweon 287 was lowest. The most sensitive growth stage to low temperature induced sterility was from 15 to 5 days before heading. There was positive correlation between sterility of rice plants treated with low temperature at meiotic and heading stage. 10. Percentage of spikelet sterility was greatest at cold water treatment at meiotic stage (auricle distance -15~-10cm) and it was higher in 1/1 (Suweon 264, Joseng tongil), japonica (Nongbaek, Towada), and cold tolerance indica(Lengkwang) varieties in the order. Level of cold water and position of young-ear affected on the sterility of varieties at meiotic stage; percentage of spikelet sterility of variety, Lengkwang, of which young-ear was located above the cold water level was high, but that of short statured variety, Suweon 264, of which young-ear was located in the cold water was lower. 11. Percentage of ripened grains was not reducted at 15\circ_C air temperature for three days at full heading stage in all varieties. However, at six-day low temperature treatment Suweon 287, Suweon 264 showed percentage of ripended grains lower than 60%, but at nine-day low temperature treatment all varieties showed percentage of ripened grains lower than 60%. Low temperature treatment of 17\circ_C from 10 days after heading for 20 days did not affect on the ripening of all varieties. 12. Uptake of nitrogen, phosphorous, potassium, calcium, and magnesium in whole plants was higher at average air temperature of 25\circ_C, but concentration of the elements was lower compared to those at 19\circ_C. However, both total uptake and concentration of manganese were higher at 19\circ_C compared to 25\circ_C. 13. Higher application of nitrogen, phosphorus, silicate, and compost increased yield of rice due to increased number of panicles and spike let fertility in cold water irrigated paddy.

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Management and Use of Oral History Archives on Forced Mobilization -Centering on oral history archives collected by the Truth Commission on Forced Mobilization under the Japanese Imperialism Republic of Korea- (강제동원 구술자료의 관리와 활용 -일제강점하강제동원피해진상규명위원회 소장 구술자료를 중심으로-)

  • Kwon, Mi-Hyun
    • The Korean Journal of Archival Studies
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    • no.16
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    • pp.303-339
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    • 2007
  • "The damage incurred from forced mobilization under the Japanese Imperialism" means the life, physical, and property damage suffered by those who were forced to lead a life as soldiers, civilians attached to the military, laborers, and comfort women forcibly mobilized by the Japanese Imperialists during the period between the Manchurian Incident and the Pacific War. Up to the present time, every effort to restore the history on such a compulsory mobilization-borne damage has been made by the damaged parties, bereaved families, civil organizations, and academic circles concerned; as a result, on March 5, 2004, Disclosure act of Forced Mobilization under the Japanese Imperialism[part of it was partially revised on May 17, 2007]was officially established and proclaimed. On the basis of this law, the Truth Commission on Forced Mobilization under the Japanese Imperialism Republic of Korea[Compulsory Mobilization Commission hence after] was launched under the jurisdiction of the Prime Minister on November 10, 2004. Since February 1, 2005, this organ has begun its work with the aim of looking into the real aspects of damage incurred from compulsory mobilization under the Japanese Imperialism, by which making the historical truth open to the world. The major business of this organ is to receive the damage report and investigation of the reported damage[examination of the alleged victims and bereaved families, and decision-making], receipt of the application for the fact-finding & fact finding; fact finding and matters impossible to make judgment; correction of a family register subsequent to the damage judgement; collection & analysis of data concerning compulsory mobilization at home and from abroad and writing up of a report; exhumation of the remains, remains saving, their repatriation, and building project for historical records hall and museum & memorial place, etc. The Truth Commission on Compulsory Mobilization has dug out and collected a variety of records to meet the examination of the damage and fact finding business. As is often the case with other history of damage, the records which had already been made open to the public or have been newly dug out usually have their limits to ascertaining of the diverse historical context involved in compulsory mobilization in their quantity or quality. Of course, there may happen a case where the interested parties' story can fill the vacancy of records or has its foundational value more than its related record itself. The Truth Commission on Compulsory mobilization generated a variety of oral history records through oral interviews with the alleged damage-suffered survivors and puts those data to use for examination business, attempting to make use of those data for public use while managing those on a systematic method. The Truth Commission on compulsory mobilization-possessed oral history archives were generated based on a drastic planning from the beginning of their generation, and induced digital medium-based production of those data while bearing the conveniences of their management and usage in mind from the stage of production. In addition, in order to surpass the limits of the oral history archives produced in the process of the investigating process, this organ conducted several special training sessions for the interviewees and let the interviewees leave their real context in time of their oral testimony in an interview journal. The Truth Commission on compulsory mobilization isn't equipped with an extra records management system for the management of the collected archives. The digital archives are generated through the management system of the real aspects of damage and electronic approval system, and they plays a role in registering and searching the produced, collected, and contributed records. The oral history archives are registered at the digital archive and preserved together with real records. The collected oral history archives are technically classified at the same time of their registration and given a proper number for registration, classification, and keeping. The Truth Commission on compulsory mobilization has continued its publication of oral history archives collection for the positive use of them and is also planning on producing an image-based matters. The oral history archives collected by this organ are produced, managed and used in as positive a way as possible surpassing the limits produced in the process of investigation business and budgetary deficits as well as the absence of records management system, etc. as the form of time-limit structure. The accumulated oral history archives, if a historical records hall and museum should be built as regulated in Disclosure act of forced mobilization, would be more systematically managed and used for the public users.

A Study Concerning Health Needs in Rural Korea (농촌(農村) 주민(住民)들의 의료필요도(醫療必要度)에 관(關)한 연구(硏究))

  • Lee, Sung-Kwan;Kim, Doo-Hie;Jung, Jong-Hak;Chunge, Keuk-Soo;Park, Sang-Bin;Choy, Chung-Hun;Heng, Sun-Ho;Rah, Jin-Hoon
    • Journal of Preventive Medicine and Public Health
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    • v.7 no.1
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    • pp.29-94
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    • 1974
  • Today most developed countries provide modern medical care for most of the population. The rural area is the more neglected area in the medical and health field. In public health, the philosophy is that medical care for in maintenance of health is a basic right of man; it should not be discriminated against racial, environmental or financial situations. The deficiency of the medical care system, cultural bias, economic development, and ignorance of the residents about health care brought about the shortage of medical personnel and facilities on the rural areas. Moreover, medical students and physicians have been taught less about rural health care than about urban health care. Medical care, therefore, is insufficient in terms of health care personnel/and facilities in rural areas. Under such a situation, there is growing concern about the health problems among the rural population. The findings presented in this report are useful measures of the major health problems and even more important, as a guide to planning for improved medical care systems. It is hoped that findings from this study will be useful to those responsible for improving the delivery of health service for the rural population. Objectives: -to determine the health status of the residents in the rural areas. -to assess the rural population's needs in terms of health and medical care. -to make recommendations concerning improvement in the delivery of health and medical care for the rural population. Procedures: For the sampling design, the ideal would be to sample according to the proportion of the composition age-groups. As the health problems would be different by group, the sample was divided into 10 different age-groups. If the sample were allocated by proportion of composition of each age group, some age groups would be too small to estimate the health problem. The sample size of each age-group population was 100 people/age-groups. Personal interviews were conducted by specially trained medical students. The interviews dealt at length with current health status, medical care problems, utilization of medical services, medical cost paid for medical care and attitudes toward health. In addition, more information was gained from the public health field, including environmental sanitation, maternal and child health, family planning, tuberculosis control, and dental health. The sample Sample size was one fourth of total population: 1,438 The aged 10-14 years showed the largest number of 254 and the aged under one year was the smallest number of 81. Participation in examination Examination sessions usually were held in the morning every Tuesday, Wenesday, and Thursday for 3 hours at each session at the Namchun Health station. In general, the rate of participation in medical examination was low especially in ages between 10-19 years old. The highest rate of participation among are groups was the under one year age-group by 100 percent. The lowest use rate as low as 3% of those in the age-groups 10-19 years who are attending junior and senior high school in Taegu city so the time was not convenient for them to recieve examinations. Among the over 20 years old group, the rate of participation of female was higher than that of males. The results are as follows: A. Publie health problems Population: The number of pre-school age group who required child health was 724, among them infants numbered 96. Number of eligible women aged 15-44 years was 1,279, and women with husband who need maternal health numbered 700. The age-group of 65 years or older was 201 needed more health care and 65 of them had disabilities. (Table 2). Environmental sanitation: Seventy-nine percent of the residents relied upon well water as a primary source of dringking water. Ninety-three percent of the drinking water supply was rated as unfited quality for drinking. More than 90% of latrines were unhygienic, in structure design and sanitation (Table 15). Maternal and child health: Maternal health Average number of pregnancies of eligible women was 4 times. There was almost no pre- and post-natal care. Pregnancy wastage Still births was 33 per 1,000 live births. Spontaneous abortion was 156 per 1,000 live births. Induced abortion was 137 per 1,000 live births. Delivery condition More than 90 percent of deliveries were conducted at home. Attendants at last delivery were laymen by 76% and delivery without attendants was 14%. The rate of non-sterilized scissors as an instrument used to cut the umbilical cord was as high as 54% and of sickles was 14%. The rate of difficult delivery counted for 3%. Maternal death rate estimates about 35 per 10,000 live births. Child health Consultation rate for child health was almost non existant. In general, vaccination rate of children was low; vaccination rates for children aged 0-5 years with BCG and small pox were 34 and 28 percent respectively. The rate of vaccination with DPT and Polio were 23 and 25% respectively but the rate of the complete three injections were as low as 5 and 3% respectively. The number of dead children was 280 per 1,000 living children. Infants death rate was 45 per 1,000 live births (Table 16), Family planning: Approval rate of married women for family planning was as high as 86%. The rate of experiences of contraception in the past was 51%. The current rate of contraception was 37%. Willingness to use contraception in the future was as high as 86% (Table 17). Tuberculosis control: Number of registration patients at the health center currently was 25. The number indicates one eighth of estimate number of tuberculosis in the area. Number of discharged cases in the past accounted for 79 which showed 50% of active cases when discharged time. Rate of complete treatment among reasons of discharge in the past as low as 28%. There needs to be a follow up observation of the discharged cases (Table 18). Dental problems: More than 50% of the total population have at least one or more dental problems. (Table 19) B. Medical care problems Incidence rate: 1. In one month Incidence rate of medical care problems during one month was 19.6 percent. Among these health problems which required rest at home were 11.8 percent. The estimated number of patients in the total population is 1,206. The health problems reported most frequently in interviews during one month are: GI trouble, respiratory disease, neuralgia, skin disease, and communicable disease-in that order, The rate of health problems by age groups was highest in the 1-4 age group and in the 60 years or over age group, the lowest rate was the 10-14 year age group. In general, 0-29 year age group except the 1-4 year age group was low incidence rate. After 30 years old the rate of health problems increases gradually with aging. Eighty-three percent of health problems that occured during one month were solved by primary medical care procedures. Seventeen percent of health problems needed secondary care. Days rested at home because of illness during one month were 0.7 days per interviewee and 8days per patient and it accounts for 2,161 days for the total productive population in the area. (Table 20) 2. In a year The incidence rate of medical care problems during a year was 74.8%, among them health problems which required rest at home was 37 percent. Estimated number of patients in the total population during a year was 4,600. The health problems that occured most frequently among the interviewees during a year were: Cold (30%), GI trouble (18), respiratory disease (11), anemia (10), diarrhea (10), neuralgia (10), parasite disease (9), ENT (7), skin (7), headache (7), trauma (4), communicable disease (3), and circulatory disease (3) -in that order. The rate of health problems by age groups was highest in the infants group, thereafter the rate decreased gradually until the age 15-19 year age group which showed the lowest, and then the rate increased gradually with aging. Eighty-seven percent of health problems during a year were solved by primary medical care. Thirteen percent of them needed secondary medical care procedures. Days rested at home because of illness during a year were 16 days per interviewee and 44 days per patient and it accounted for 57,335 days lost among productive age group in the area (Table 21). Among those given medical examination, the conditions observed most frequently were respiratory disease, GI trouble, parasite disease, neuralgia, skin disease, trauma, tuberculosis, anemia, chronic obstructive lung disease, eye disorders-in that order (Table 22). The main health problems required secondary medical care are as fellows: (previous page). Utilization of medical care (treatment) The rate of treatment by various medical facilities for all health problems during one month was 73 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 52% while the rate of those who have health problems which did not required rest was 61 percent (Table 23). The rate of receiving of medical care for all health problems during a year was 67 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 82 percent while the rate of those who have health problems which did not required rest was as low as 53 percent (Table 24). Types of medical facilitied used were as follows: Hospital and clinics: 32-35% Herb clinics: 9-10% Drugstore: 53-58% Hospitalization Rate of hospitalization was 1.7% and the estimate number of hospitalizations among the total population during a year will be 107 persons (Table 25). Medical cost: Average medical cost per person during one month and a year were 171 and 2,800 won respectively. Average medical cost per patient during one month and a year were 1,109 and 3,740 won respectively. Average cost per household during a year was 15,800 won (Table 26, 27). Solution measures for health and medical care problems in rural area: A. Health problems which could be solved by paramedical workers such as nurses, midwives and aid nurses etc. are as follows: 1. Improvement of environmental sanitation 2. MCH except medical care problems 3. Family planning except surgical intervention 4. Tuberculosis control except diagnosis and prescription 5. Dental care except operational intervention 6. Health education for residents for improvement of utilization of medical facilities and early diagnosis etc. B. Medical care problems 1. Eighty-five percent of health problems could be solved by primary care procedures by general practitioners. 2. Fifteen percent of health problems need secondary medical procedures by a specialist. C. Medical cost Concidering the economic situation in rural area the amount of 2,062 won per residents during a year will be burdensome, so financial assistance is needed gorvernment to solve health and medical care problems for rural people.

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Effect of Low Temperature Treatment of Seed Bulb and Planting Date on Plant Growth and Yield in Garlic (마늘의 파종기별(播種期別) 저온처리(低溫處理)의 차이(差異)가 생육(生育) 및 수량(收量)에 미치는 영향(影響))

  • Shin, Seong Lyon;Lee, Woo Sung
    • Current Research on Agriculture and Life Sciences
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    • v.6
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    • pp.49-69
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    • 1988
  • In order to develop a cropping system that can produce garlic in the period of short supply from March to April, effects of low temperature treatment of seed bulbs and planting dates, starting date of low temperature treatment, days of low temperature treatment on plant growth, maturity and yield were studied in Southern strain, 'Namhae' and in Northern strain, 'Euiseong' of garlic (Allium sativum). The results obtained were as follows. In Sorthern strain, sprouting was significantly enhanced by low temperature treatment only in Sep. 14, and Sep. 29 plantings. Days to sprout were least in 30 days of low temperature treatment of Sep. 14 planting and in 45 days treatment of Sep. 29 planting. When considering on the beginning date of low temperature treatment, a marked difference was observed between treatments started before July 31 and after Aug. 15. Sprouting was most enhanced in 45 days low temperature treatment of Aug. 15 and Aug. 30 plantings. In Northern strain, sprouting was en hanced by low temperature treatment in planting from Sep. 29 to Nov. 13 and low temperature treatment for 60 days was most effective. Effect of low temperature treatment on early plant growth was observed in Sep. 14 and Sep. 29 plantings, but the effect on plant growth at intermediate stage or thereafter was observed in up to Oct. 29 plantings. Optimun days for low temperature treatment on growth enhancement was 45 and 60 days in Southern strain and 60 days in Northern strain in each planting dates. In Southern strain, the longer the low temperature treatment and the later the planting date the less the number of leaves developed. In Northern strain, normal leaves were not developed in plantings from Sep. 14 to Nov. 13. In Southern strain, clove differentiation and bulbing were earlist in 45 and 60 days treatment of Sep. 14, Sep. 29, and Oct. 14 planting initiated on July 31 and Aug. 15. In Northern strain, clove differentiation and bulbing were earlist in 60 days treatment of Oct. 14 planting initiated on Aug. 15 and Aug. 30. In treatment initiated later than above, longer the low temperature treatment the earlier the clove differentiation and bulbing in both Southern and Northern strains. The earlier the initiation date and the longer of low temperature treatment, the earlier bolting in southern strain. In Northern strain, bolting was most enhanced in 45 and 60 days of low temperature treatment initiated on Aug. 15 and Aug. 30. The longer the low temperature treatment in plantings thereafter, the earlier the bolting. The earlier the planting date garlic bulbs. Harvest date was earliest in 45 and 60 days low temperature treatment started from July 31 to Aug. 30 in Southern strain, and it was in 60 and 90 days low temperature treatment initiated from July 31 to Aug. 30 in Northern strain. Bulb weight was heaviest in 45 days low temperature treatment of Oct. 14 planting and next was in 45 days treatment of Sep. 29 planting in Southern strain. In Northern strain, bulb weight was heaviest in 60 days treatment of Oct. 14 planting and next was in 45 days treatment of Oct. 14 planting. When considered in the aspect of the beginning date of low temperature treatment, bulb weight was heaviest in 45 days treatment started on Aug. 30 in Southern strain and in 60 days treatment started on Aug. 15 in Northern strain. A high negative correlation between days to harvest and plant height on January 12, and a high positive correlation between days to harvest and days clove differentiation were observed. This indicates that enhanced plant growth and clove differentiation induced by low temperature treatment advanced the harvest date. A high negative correlation between bulb weight and days to clove differentiation, days to harvest suggests that the enhanced clove differentiation result and in heavier bulb weight. From the above results, it suggested that early crop of garlic can be harvested by planting at the period of Sep. 29 to Oct. 14 after 45 days of low temperature treatment of seed bulbs of Southern strain. Then harvest date can be shortened by 30 days compared to control and garlic can be harvested in early April.

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Experimental Studies on the Antitumor Effects of Jinryungtang Gagambang Extract (진령탕가감방의 항종양효과(抗腫瘍效果)에 관(關)한 실험적(實驗的) 연구(硏究))

  • Jeong, Jun-Tak;Moon, Goo;Moon, Suk-Jae
    • THE JOURNAL OF KOREAN ORIENTAL ONCOLOGY
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    • v.4 no.1
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    • pp.37-53
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    • 1998
  • The sprig of Jinryungtang Gagambang has been used for curing as a traditional medicine without any experimental evidence to support the rational basis for their clinical use. This experiment was carried out to evaluate the possible therapeutic or antitumoral effects of Jinryungtang Gagambang extract against cancer, and to study some mechanisms responsible for its effect. The cytotoxic and antitumor effects were evaluated on human cell liens (A549, hep3B, Caki-1, Sarcoma 180) after exposure to Jinryungtang Gagambang extract using in ILS, colony forming efficency and SRB assay which were regarded as a valuable method for cytotoxic and antitumor effects of unknown compound on tumor cell lines. The results obtained in this studies were as follows. 1. As a result of exposure to Jinryungtang Gagambang extract, the proliferation of A549, hep3B, Caki-1, good correlations were shown from the results of SRB assay and those of clogenetic assay. 2. The oral administration of Jinryungtang Gagambang extract showed significant effects of increase of MST(mean survival time) and ILS(increased life span) depending on the increasing concentration. 3. Against squamous cell carcinoma induced by MCA, Jinryungtang Gagambang decreased not only the frequency of tumor production but also the number and weight of tumors per tumor bearing mice(TBM). Jinryungtang Gagambang also significantly suppressed the development of 3LL cell-implanted tumors by frequency and their size, and some developed tumors were regressed by the continuous treatment of Jinryungtang Gagambang extract into TBM. 4. Jinryungtang Gagambang extract also increased NK cell activities. According to the above results, it could be suggested that Jinryungtang Gagambang extract has prominent antiutmor effect.

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The Influence of Store Environment on Service Brand Personality and Repurchase Intention (점포의 물리적 환경이 서비스 브랜드 개성과 재구매의도에 미치는 영향)

  • Kim, Hyoung-Gil;Kim, Jung-Hee;Kim, Youn-Jeong
    • Journal of Global Scholars of Marketing Science
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    • v.17 no.4
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    • pp.141-173
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    • 2007
  • The study examines how the environmental factors of store influence service brand personality and repurchase intention in the service environment. The service industry has been experiencing the intensified competition with the industry's continuous growth and the influence from rapid technological advancement. Under the circumstances, it has become ever more important for the brand competitiveness to be distinctively recognized against competition. A brand needs to be distinguished and differentiated from competing companies because they are all engaged in the similar environment of the service industry. The differentiation of brand achievement has become increasingly important to highlight certain brand functions to include emotional, self-expressive, and symbolic functions since the importance of such functions has been further emphasized in promoting consumption activities. That is the recent role of brand personality that has been emphasized in the service industry. In other words, customers now freely and actively express their personalities or egos in consumption activities, taking an important role in construction of a brand asset. Hence, the study suggests that it is necessary to disperse the recognition and acknowledgement that the maintenance of the existing customers contributes more to boost repurchase intention when it is compared to the efforts to create new customers, particularly in the service industry. Meanwhile, the store itself can offer a unique environment that may influence the consumer's purchase decision. Consumers interact with store environments in the process of,virtually, all household purchase they make (Sarel 1981). Thus, store environments may encourage customers to purchase. The roles that store environments play are to provide informational cues to customers about the store and goods and communicate messages to stimulate consumers' emotions. The store environments differentiate the store from competing stores and build a unique service brand personality. However, the existing studies related to brand in the service industry mostly concentrated on the relationship between the quality of service and customer satisfaction, and they are mostly generalized while the connective studies focused on brand personality. Such approaches show limitations and are insufficient to investigate on the relationship between store environment and brand personality in the service industry. Accordingly, the study intends to identify the level of contribution to the establishment of brand personality made by the store's physical environments that influence on the specific brand characteristics depending on the type of service. The study also intends to identify what kind of relationships with brand personality exists with brand personality while being influenced by store environments. In addition, the study intends to make meaningful suggestions to better direct marketing efforts by identifying whether a brand personality makes a positive influence to induce an intention for repurchase. For this study, the service industry is classified into four categories based on to the characteristics of service: experimental-emotional service, emotional -credible service, credible-functional service, and functional-experimental service. The type of business with the most frequent customer contact is determined for each service type and the enterprise with the highest brand value in each service sector based on the report made by the Korea Management Association. They are designated as the representative of each category. The selected representatives are a fast-food store (experimental-emotional service), a cinema house (emotional-credible service), a bank (credible-functional service), and discount store (functional-experimental service). The survey was conducted for the four selected brands to represent each service category among consumers who are experienced users of the designated stores in Seoul Metropolitan City and Gyeonggi province via written questionnaires in order to verify the suggested assumptions in the study. In particular, the survey adopted 15 scales, which represent each characteristic factor, among the 42 unique characteristics developed by Jennifer Aaker(1997) to assess the brand personality of each service brand. SPSS for Windows Release 12.0 and LISREL were used in the analysis of data verification. The methodology of the structural equation model was used for the study and the pivotal findings are as follows. 1) The environmental factors ware classified as design factors, ambient factors, and social factors. Therefore, the validity of measurement scale of Baker et al. (1994) was proved. 2) The service brand personalities were subdivided as sincerity, excitement, competence, sophistication, and ruggedness, which makes the use of the brand personality scales by Jennifer Aaker(1997) appropriate in the service industry as well. 3) One-way ANOVA analysis on the scales of store environment and service brand personality showed that there exist statistically significant differences in each service category. For example, the social factors were highest in discount stores, while the ambient factors and design factors were highest in fast-food stores. The discount stores were highest in the sincerity and excitement, while the highest point for banks was in the competence and ruggedness, and the highest point for fast-food stores was in the sophistication, The consumers will make a different respond to the physical environment of stores and service brand personality that are inherent to the corresponding service interface. Hence, the customers will make a different decision-making when dealing with different service categories. In this aspect, the relationships of variables in the proposed hypothesis appear to work in a different way depending on the exposed service category. 4) The store environment factors influenced on service brand personalities differently by category of service. The factors of store's physical environment are transferred to a brand and were verified to strengthen service brand personalities. In particular, the level of influence on the service brand personality by physical environment differs depending on service category or dimension, which indicates that there is a need to apply a different style of management to a different service category or dimension. It signifies that there needs to be a brand strategy established in order to positively influence the relationship with consumers by utilizing an appropriate brand personality factor depending on different characteristics by service category or dimension. 5) The service brand personalities influenced on the repurchase intention. Especially, the largest influence was made in the sophistication dimension of service brand personality scale; the unique and characteristically appropriate arrangement of physical environment will make customers stay in the service environment for a long time and will lead to give a positive influence on the repurchase intention. 6) The store environment factors influenced on the repurchase intention. Particularly, the largest influence was made on the social factors of store environment. The most intriguing finding is that the service factor among all other environment factors gives the biggest influence to the repurchase intention in most of all service types except fast-food stores. Such result indicates that the customers pay attention to how much the employees try to provide a quality service when they make an evaluation on the service brand. At the same time, it also indicates that the personal factor is directly transmitted to the construction of brand personality. The employees' attitude and behavior are the determinants to establish a service brand personality in the process of enhancing service interface. Hence, there should be a reinforced search for a method to efficiently manage the service staff who has a direct contact with customers in order to make an affirmative improvement of the customers' brand evaluation at the service interface. The findings suggest several managerial implications. 1) Results from the empirical study indicated that store environment factors have a strong positive impact on a service brand personality. To increase customers' repurchase intention of a service brand, the management is required to effectively manage store environment factors and create a friendly brand personality based on the corresponding service environment. 2) Mangers and researchers must understand and recognize that the store environment elements are important marketing tools, and that brand personality influences on consumers' repurchase intention. Based on such result of the study, a service brand could be utilized as an efficient measure to achieve a differentiation by enforcing the elements that are most influential among all other store environments for each service category. Therefore, brand personality established involving various store environments will further reinforce the relationship with customers through the elevated brand identification of which utilization to induce repurchase decision can be used as an entry barrier. 3) The study identified the store environment as a component of service brand personality for the store's effective communication with consumers. For this, all communication channels should be maintained with consistency and an integrated marketing communication should be executed to efficiently approach to a larger number of customers. Mangers and researchers must find strategies for aligning decisions about store environment elements with the retailers' marketing and store personality objectives. All ambient, design, and social factors need to be orchestrated so that consumers can take an appropriate store personality. In this study, the induced results from the previous studies were extended to the service industry so as to identify the customers' decision making process that leads to repurchase intention and a result similar to those of the previous studies. The findings suggested several theoretical and managerial implications. However, the situation that only one service brand served as the subject of analysis for each service category, and the situation that correlations among store environment elements were not identified, as well as the problem of representation in selection of samples should be considered and supplemented in the future when further studies are conducted. In addition, various antecedents and consequences of brand personality must be looked at in the aspect of the service environment for further research.

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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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