• Title/Summary/Keyword: managing-by-results

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Association between Risk of Obstructive Sleep Apnea and Subjective Health and Health-Related Quality of Life of the Korean Middle-Aged and Elderly Population (한국 중고령층의 폐쇄성 수면무호흡증 위험과 주관적 건강 및 건강 관련 삶의 질 간의 연관성)

  • Nu-Ri Jun;Min-Soo Kim;Jeong-Min Yang;Jae-Hyun Kim
    • Health Policy and Management
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    • v.34 no.2
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    • pp.141-155
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    • 2024
  • Background: This study aimed to identified the relationship between the risk of obstructive sleep apnea, subjective health, and health-related quality of life among the middle-aged and elderly population in Korea. Methods: Adults aged 40 or older were extracted from the total 22,559 respondents to the 2019-2020 Korea National Health and Nutrition Examination Survey VIII, and secondary analysis was conducted on a total of 6,659 middle-aged and elderly people with no missing values. Logistic regression analysis and multiple regression analysis were conducted to examine the relationship between obstructive sleep apnea risk factors and subjective health as well as quality of life. Results: The subjective health status decline in the high-risk group compared to the non-risk group for obstructive sleep apnea was statistically significantly higher, with an odds ratio of 1.84 (p<0.001). The health-related quality of life was also statistically significantly lower by 0.02 points (β, -0.02; p<0.001). As a result of subgroup analysis on specific variables, the association between the risk of obstructive sleep apnea and subjective health and health-related quality of life was statistically significant depending on gender, sleep time, presence of depression, household income, and number of household members. Based on the obstructive sleep apnea risk group, women had a higher correlation with low subjective health and lower health-related quality of life scores than men. Sleeping time of more than 8 hours or less than 6 hours was more associated with low subjective health and lower health-related quality of life score than sleeping time of 6-8 hours. Patients with depression were more likely to have low subjective health than those without depression. The lower the household income level and the smaller the number of household members, the higher the association with low subjective health and the lower the health-related quality of life score. Conclusion: It is essential to recognize that the risk of obstructive sleep apnea not only directly affects sleep disorders but also impacts individuals' subjective health and quality of life. Consequently, social support and education should be provided to raise awareness of this issue. Particularly, programs for preventing and managing obstructive sleep apnea should target vulnerable groups such as women, individuals in single-person households, low household income, and those with depression, aiming to improve their subjective health and quality of life.

The Characteristics of Retention and Evapotranspiration in the Extensive Greening Module of Sloped and Flat Rooftops (저토심 경사지붕과 평지붕 녹화모듈의 저류 및 증발산 특성)

  • Ryu, Nam-Hyong;Lee, Chun-Seok
    • Journal of the Korean Institute of Landscape Architecture
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    • v.41 no.6
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    • pp.107-116
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    • 2013
  • This study was undertaken to investigate the characteristics of retention and evapotranspiration in the extensive greening module of sloped and flat rooftops for stormwater management and urban heat island mitigation. A series of 100mm depth's weighing lysimeters planted with Sedum kamtschaticum. were constructed on a 50% slope facing four orientations(north, east, south and west) and a flat rooftop. Thereafter the retention and evapotranspiration from the greening module and the surface temperature of nongreening and greening rooftop were recorded beginning in September 2012 for a period of 1 year. The characteristics of retention and evapotranspiration in the greening module were as follows. The water storage of the sloped and flat greening modules increased to 8.7~28.4mm and 10.6~31.8mm after rainfall except in the winter season, in which it decreased to 3.3mm and 3.9mm in the longer dry period. The maximum stormwater retention of the sloped and flat greening modules was 22.2mm and 23.1mm except in the winter season. Fitted stormwater retention function was [Stormwater Retention Ratio(%)=-18.42 ln(Precipitation)+107.9, $R^2$=0.80] for sloped greening modules, and that was [Stormwater Retention Ratio(%)=-22.64 ln(X)+130.8, $R^2$=0.81] for flat greening modules. The daily evapotranspiration(mm/day) from the greening modules after rainfall decreased rapidly with a power function type in summer, and with a log function type in spring and autumn. The daily evapotranspiration(mm/day) from the greening modules after rainfall was greater in summer > spring > autumn > winter by season. This may be due to the differences in water storage, solar radiation and air temperature. The daily evapotranspiration from the greening modules decreased rapidly from 2~7mm/day to less than 1mm/day for 3~5 days after rainfall, and that decreased slowly after 3~5 days. This indicates that Sedum kamtschaticum used water rapidly when it was available and conserved water when it was not. The albedo of the concrete rooftop and greening rooftop was 0.151 and 0.137 in summer, and 0.165 and 0.165 in winter respectively. The albedo of the concrete rooftop and greening rooftop was similar. The effect of the daily mean and highest surface temperature decrease by greening during the summer season showed $1.6{\sim}13.8^{\circ}C$(mean $9.7^{\circ}C$) and $6.2{\sim}17.6^{\circ}C$(mean $11.2^{\circ}C$). The difference of the daily mean and highest surface temperature between the greening rooftop and concrete rooftop during the winter season were small, measuring $-2.4{\sim}1.3^{\circ}C$(mean $-0.4^{\circ}C$) and $-4.2{\sim}2.6^{\circ}C$(mean $0.0^{\circ}C$). The difference in the highest daily surface temperature between the greening rooftop and concrete rooftop during the summer season increased with an evapotranspiration rate increase by a linear function type. The fitted function of the highest daily surface temperature decrease was [Temperature Decrease($^{\circ}C$)=$1.4361{\times}$(Evapotranspiration rate(mm/day))+8.83, $R^2$=0.59]. The decrease of the surface temperature by greening in the longer dry period was due to sun protection by the sedum canopy. The results of this study indicate that the extensive rooftop greening will assist in managing stormwater runoff and urban heat island through retention and evapotranspiration. Sedum kamtschaticum would be the ideal plant for a non-irrigated extensive green roof. The shading effects of Sedum kamtschaticum would be important as well as the evapotranspiration effects of that for the long-term mitigation effects of an urban heat island.

Factors Related to Waiting and Staying Time for Patient Care in Emergency Care Center (응급의료센터 내원환자 진료시 소요시간과 관련된 요인)

  • Han, Nam Sook;Park, Jae Yong;Lee, Sam Beom;Do, Byung Soo;Kim, Seok Beom
    • Quality Improvement in Health Care
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    • v.7 no.2
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    • pp.138-155
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    • 2000
  • Background: Factors related to waiting and staying time for patient care in emergency care center (ECC) were examined during 1 month from Apr. 1 to Apr. 30, 1997 at an ECC of Yeungnam university hospital in Taegu metropolitan city, to obtain the baseline data on the strategy of effective management of emergency patients. Method: The study subjects consisted of the 1,742 patients who visited at ECC and the data were obtained from the medical records of ECC and direct surveys. Results: The mean interval between ECC admission time and initial care time by each ECC duty residents was 83.1 minutes for male patients and 84.9 minutes for female patients, and mean ECC staying time (time interval between admission and final disposition from ECC) was 718.0 minutes in men and 670.5 minutes in women. As the results, the mean staying time in ECC was higher in older age, and especially the both of initial care time and staying time were highest in patients of medical aid, and shortest in patients of worker's accident compensation insurance. The on admission or not, previously endotracheal-intubation state of patient. The ECC staying ti initial care time was much more delayed in patients of not having previous medical records and the ECC staying time was higher in referred patients from out-patient department, in transferred patients from the other hospitals and patients having previous records, and in patients partly used the order-communicating system. The factors associated with the initial care time were the numbers of ECC patients and the existence of any true emergent patients, being cardiopulmonary resuscitation (CPR) statusme was much more longer in patients of drug intoxication, in CPR patients, in medical department patients, in transfused patients and in patients related to 3 or more departments. And according to the numbers of duty internships, the ECC staying time for four internships was more longer than for five internships and after admission ordering was done, also-more longer in status being of no available beds. As above mentioned results, the factors for the ECC staying time were thought to be statistically significant (P<0.01) according to the patient's age and the laboratory orders and the X-ray films checked. And also the factor for the ECC staying time were thought to be statistically significant (P<0.01) according to the status being of no available beds, the laboratory orders and/or the special laboratory orders, the X-ray films checked, final disposing department, transferred to other hospital or not, home medication or not, admission or not, the grades of beds, the year grades of residents, the causes of ECC visit, the being CPR status on admission or not, the surgical operation or not, being known personells in our hospital. Conclution: Authors concluded that the relieving method of long-staying time in ECC was being establishing the legally proved apparatus which could differentiate the true emergency or non-emergency patients, and that the methods of shortening ECC staying time were doing definitely necessary laboratory orders and managing beds more flexibly to admit for ECC patients and finally this methods were thought to be a method of unloading for ECC personnels and improving the quality of care in emergency patients.

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A Study on Effects of Application of Nursing Process by Nursing Profess notes.(School of nursing) (간호기록지를 통해서 본 간호과정 적용효과에 관한 연구(간호전문대학을 중심으로))

  • 최상순;조희숙;백승남
    • Journal of Korean Academy of Nursing
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    • v.11 no.2
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    • pp.55-68
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    • 1981
  • The prime object of the study is to evaluate how much all the students of the Nursing Schools throughout the nation are in comprehension toward the application of nursing process to clinical experience as means of systematic solution of nursing problems. An effort has been made to find out the actual state whether they are in practice of clinical experience in accordance with application of nursing process, over the period of four weeks managing from December 1st to 28th, 1980 and centering on 36 nursing schools, and meanwhile and evaluation, employing the assessment tool used by Bertuccietal, has been made on the nursing process notes recorded by 200 senions out of 21 nursing schools where application of nursing process to clinical experience being in practice. The assessment tool is composed of 5 different criteria in view of patient nursing and authors made an attempt to find out the result of clinical experience on application students in accordance with 5 different scoring criteria and further evaluating all the findings thereof. The findings were disposed of accordance with practice duration and criteria of the specific sudents subject to this finding as to verify the scoring difference in significance and of which the results are as follows: 1) as of now, in 21 (58.2%) out of 36 nursing Schools nursing process in being appliced in clinical experience. 2) Schools that started the application of nursing process to clinical experience amount to - for more than 4 yrs -6 (28.6%) - for 2 to 3 yrs-11s(52.4%) - for 1 yr -4 (19.0%) 3) As for the response upon application of nursing process. To clinical etperience, the largest voice (61.9%) heard was that it is rather difficult beyond the lecturing thereof, to practically apply it outs patients and the second voice (19.1%) turned out to be that it is hard to put in practice owing to uninformed nurses of the process serving in the clinical field. 4) The response. Of the processors assigned to instruction as to the most difficult problem in criteria of nursing process, the largest voice (38.2%) centered on the problem assessment while the second voice (17.7%) on the indirect nursing activity and the objective data respectively and considered to be the easiest was the indirect nursing activity (11.7%). 5) In order for a satisfactory. application of nursing process to clinical experience hence-forth, it has been pointed out that sufficient number of nurses should be supplemented in clinical field (44.1%) and at the same time supplementory education (35.3%) centered around professors be necessary. 6) Of the criteria that record result of nursing process, a significant difference in comprehension of subjective and objective data has been revealed according to the degree of the practice duration of application to clinical experience. For instance, while although poor it may seen, only 74.9% in subjective data and 71.1% in objective data represent the student group in practice for more than 4 years and only 56.3% in subjective data and 66.8% in objective data represent the student group in practice for 2 to 3 years but they still surpass in comprehension over the student group in practice for 1 year attaning only 19.6% in subjective data and 16.8% in objective data (P < 0.005). 7) As for problem assessment, the student group who started application of nursing process for 4 years stand for 37,7% the group for 2 to 3 years started for 25.3% and the group for 1 year started for 5.4%, revealing no significant difference according to duration (P < 0.5) and as poor as to indicate only 22.8% on an overage is in comprehension. 8) On direct and indirect nursing activity, the student group of for more than 4 years in appling nursing process (representing 49.5% in direct nursing activity, 21.4% in indirect nursing activity). Know more about it than the student group of for 2 to 3 years (representing 36.3% in direct nursing activity, 20.8% in indirect nursing activity) but revealed no significant difference. (P < 0.5) 9) The student group applying nursing process for more than 4 years subjective data (74.9%) comprehend were more than objective data (71.1%) but shown no significant difference (P < 0.5). 10) However, the student group applying nursing process for 2 to 3 years comprehend objective data (66.8%) well ever subjective data (55.5%) indicating that 40.9% in average is in comprehension, thereby revealing a significant difference (P < 0.005). 11) On the other hand, the student group applying nursing process to clinical experience for 1 year had revealed themselves as poorly as to comprehend only 11.7% are an average of it, revealing no significant difference (P < 0.5). In consequence of the fore going, I the conductor of the present study, hereby suggest the following points: 1) Application of nursing process to clinical experience be practiced in all the Nursing Schools all over the nation at the earliest possible date in order that scientific nursing be prevailed (as of now only 58.0%), 2) In teaching nursing process, it is desirable to teach specific method of applying to practical clinical situations. 3) In order to meet the end of satisfactory application of nursing process to clinical experience, sufgecient nursing man power be sysplemented in clinical field and at the save time supplementary education by professors is necessary. 4) Sinces the students whose application duration of nursing process to clinical experience is longer comprehend more about it, it is reguired that the schools not yet in practice of the application be promptlyurged to follow. 5) Of the criteria recording nursing process, since it is comparatively hard to comprehend“assessment”and“Direct and indirect nursing activity”, a concentrated instruction is desirable. 6) The students whose duration of application of nursing process to clinical experience falls short of 1 years be put in a concentrated guidance program on individual criterion.

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A Study on the Relationship between Musculoskeletal Symptoms and Health Promoting Life Style among Some Workers (일부 직업인들의 근골격계 자각증상과 강증진생활양식간의 연관성에 관한 연구)

  • Kang Hong-Gu;Lee Eun-Kyoung;Jun Sun-Young;Kim Sang-Deok;Jeoung Jae-Yeal;Lee Yong-Gil;Jahng Doo-Sub;Song Yung-Sun;Lee Ki-Nam
    • Journal of Society of Preventive Korean Medicine
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    • v.5 no.2
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    • pp.40-68
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    • 2001
  • In this study, grade of subjective symptom appealed by laborer of Jeollabuk-do was evaluated using questionary regarding factor made effect on musculoskeletal disease and in addition, studied relationship with health promotion life style of them. Based on the result, relationship of general characteristics of musculoskeletal subjective symptom and life-style of the subjects was concluded as below. 1. General characteristics of study subjects were as following. Ratio of male was higher as 57.7% of male and 42.2% female and age distribution was 5.1% of 20s, 34.99% of 30s, 36.3% of 40s and 23.7% of 50s and therefore, $30{\sim}40$ aged groups showed highest ratio. Most subjects (74.9%) was married status and in case of education level, high-school graduate and dropout (23.3%) and over-college graduate (46.8%) showed highest distribution. $1{\sim}2$ Mil. KRW (29.5%) and $2{\sim}2.99$ Mil. KRW (21.2%) is the main income distribution and however there was high ratio of non-reply (29.0%). In case of employment period, $10{\sim}14$ years (15.3%) and over 15 years (29.6%) showed highest ratio and there were many non-reply (39.4%) and in addition, 67.6% replied as own house and 14.3% as lease on deposit base in question of residence type. 2. Subjects showed high ratio of subjective symptom appeal of 62.79% and many cases (50.23%) appealed 1 or 2 symptoms. Symptom by body region was 29.8% (waist), 27% (shoulder), 21.2% (knee), 15.5% (neck), 9.5% (ankle), 8.1% (wrist) and 5.0% (elbow) in order. In case of relationship with general characteristics, female comparing with male, non-residence of own house, subjects with lower education level and employment period of $10{\sim}14$ years showed higher appeal rate and kind of symptoms than others. Therefore, it was concluded that rate of musculoskeletal symptom appeal have close relationship with gender, level of living, education level, age and employment period. 3. In case of severe pain of upper body except waist and ankle, it was appealed in both or right side and it means that upper body pain is originated from right side and right region pain is transited to both region pain. In addition, there was 39.41% of non-reply to existence of right-left region pain and therefore, it was evaluated that, in may cases, there was no awareness of their own symptom condition even on subjective symptom. 4. Degree of pain was, as pain over middle level, evaluated as 2.79 on full mark of 4.0 and in order of waist (2.97), ankle (2.83), knee (2.82), wrist (2.82), neck (2.79), shoulder (2.70) and elbow (2.62). In addition, 71.97% appealed $2{\sim}3$ cases for the latest 1 week. Owing to subjective symptom, 54.95% drop into hospital or pharmacy, 10.32% made temporary retirement or absence, 7.99% transferred into more comfortable duty and $39.4{\sim}54%$ experienced one or more managing mentioned above. 5. Fulfillment of health promotion life style of subjects was evaluated on full mark of 4.0 and total score was 2.63. Average mark of each area was personal relationship (3.05), self-realization (2.92), stress management (2.63), health control (2.48), physical exercise (2.19) and nutrition management (2.19) and personal relationship was highest and physical exercise and nutrition management were lowest. As general characteristics influencing health promotion life style, gender, residence style and employment period showed significant difference. Male showed higher mark than female and showed higher mark in order of own house, others, lease on deposit base, monthly rent. Subjects with longer employment period showed higher mark with significant difference. 6. Accounting of factor influencing each area of health promotion life style, self-realization showed significance in marriage status, income, residence style and education level and health control in age, residence style and employment period. Physical exercise showed significant difference in gender, age, residence style and employment period and nutrition in gender, age, residence style and employment period. Stress management showed significant difference in residence style and employment period and however not in personal relationship. 7. Health promotion life style relating with existence and kind of pain showed significant difference in all area except personal relationship area. In absence of pain, there was statistically significant high score in all area even in total health promotion life style and all area. Accounting of kind of pain, cases of $1{\sim}2$ kinds of pain and $5{\sim}6$ kinds of pain showed relatively high score and it was lower than mark of subject stated absence of pain. 8. Subjects appeal symptom were classified by symptom region and difference of total and each areas were evaluated. General area (p=0.002), self-realization (p=0.012), health management (p=0.023), physical exercise (p=0.028), nutrition management (p=0.028) and stress control (p=0.001) showed statistically significant difference and not in personal relationship area. Especially, elbow, shoulder and neck area marked high and group appealed pain of knee, arm and elbow, foot and ankle marked low. Based on those results, subjective symptom should be accounted seriously in diagnosis of occupational musculoskeletal disease of laborer and among subjective symptom, general characteristics of gender, age, condition of living, education level and employment period make effect. Generally subject appeal symptom marked lower than subject without symptom appeal and it means that life management of subject appealing musculoskeletal pain make important role in management and treatment of occupational musculoskeletal disease.

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A Study to Decrease Exposure Dose for the Radiotechnologist in PET/CT (PET/CT 검사에서 방사선 종사자 피폭선량 저감에 대한 방안 연구)

  • Cho, Seok-Won;Park, Hoon-Hee;Kim, Jung-Yul;Ban, Yung-Kak;Lim, Han-Sang;Oh, Ki-Beak;Kim, Jae-Sam;Lee, Chang-Ho
    • The Korean Journal of Nuclear Medicine Technology
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    • v.14 no.2
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    • pp.159-165
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    • 2010
  • Purpose: Positron emission tomography scan has been growing diagnostic equipment in the development of medical imaging system. Compare to $^{99m}Tc$ emitting 140 keV, Positron emission radionuclide emits 511 keV gamma rays. Because of this high energy, it needs to reduce radioactive emitting from patients for radiotechnologist. We searched the external dose rates by changing distance from patients and measure the external dose rates when we used shielder investigate change external dose rates. In this study, the external dose distribution were analyzed in order to help managing radiation protection of radiotechnologists. Materials and Methods: Ten patients were searched (mean age: $47.7{\pm}6.6$, mean height: $165.5{\pm}3.8$ cm and mean weight: $65.9{\pm}1.4$ kg). Radiation were measured on the location of head, chest, abdomen, knees and toes at the distance of 10, 50, 100, 150 and 200 cm. Then, all the procedure was given with a portable radiation shielding on the location of head, chest and abdomen at the distance of 100, 150 and 200 cm and transmittance was calculated. Results: In 10 cm, head (105.40 ${\mu}Sv/h$) was the highest and foot (15.85 ${\mu}Sv/h$) was the lowest. In 200 cm, head, chest and abdomen showed similar. On head, the measured dose rates were 9.56 ${\mu}Sv/h$, 5.23 ${\mu}Sv/h$, and 3.40 ${\mu}Sv/h$ in 100, 150 and 200 cm respectively. When using shielder, it shows 2.24 ${\mu}Sv/h$, 1.67 ${\mu}Sv/h$, and 1.27 ${\mu}Sv/h$ in 100, 150 and 200 cm on head. On chest, the measured dose rates were 8.54 ${\mu}Sv/h$, 4.90 ${\mu}Sv/h$, 3.44 ${\mu}Sv/h$ in 100, 150 and 200 cm, respectively. When using shielder, it shows 2.27 ${\mu}Sv/h$, 1.34 ${\mu}Sv/h$, and 1.13 ${\mu}Sv/h$ in 100, 150 and 200 cm on chest. On abdomen, the measured dose rates were 9.83 ${\mu}Sv/h$, 5.15 ${\mu}Sv/h$ and 3.18 ${\mu}Sv/h$ in 100, 150 and 200cm respectively. When using shielder, it shows 2.60 ${\mu}Sv/h$, 1.75 ${\mu}Sv/h$ and 1.23 ${\mu}Sv/h$ in 100, 150 and 200 cm on abdomen. Transmittance was increased as the distance was expanded. Conclusion: As the distance was further, the radiation dose were reduced. When using shielder, the dose were reduced as one-forth of without shielder. The Radio technologists are exposed of radioactivity and there were limitations on reducing the distance with Therefore, the proper shielding will be able to decrease radiation dose to the radiotechnologists.

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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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Studies on Dairy Farming Status, Reproductive Efficiencies and Disorders in New Zealand (I) A Survey on Dairy Farming Status and Milk Yield in Palmerston North Area (뉴질랜드 (Palmerston North) 의 낙농 현황과 번식 및 번식장해에 관한 연구(I) Palmerston North 지역의 낙농 현황과 우유 생산량에 관한 조사 연구)

  • 김중계;맥도날드
    • Korean Journal of Animal Reproduction
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    • v.24 no.1
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    • pp.1-18
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    • 2000
  • Eighty dairy farms in Palmers ton North area in New Zealand were surveyed on 1) general characteristics (10 Questions), 2) milk yield and feed supplementary (7 questions), 3) reproductive efficiencies (12 questions) and 4) reproductive disorders (12 questions) by mail questions from February to July, 1998. Among those 4 items from 38 dairy farms (47.5%), especially in items 1) and 2), overall dairy farming situation, supplementary feeding and milk yields were surveyed and analyzed for Korean dairy farmers (especially in Cheju island) to have better understanding or higher economical gains. The results were as follows. 1. In dairy experience, 21 (45%) among 38 dairy farms surveyed were answered that farming less than 15 years, 15~19 year, 20~25 years and over 26 years experience were 3 (7.9%), 7 (18.4%), 6 (15.8%) and 5 (13.2%) which generally showed longer experience compare to Korean dairy farming situation. In survey of labour input and business goal of dairy farming, self-managing farms, sharemilkers, unpaid family manpowering farms, manager running farms, farms with hired worker, farms with part time helper and other type was 21 (55.3%), 10 (26.3%), 2 (3.5%), 3 (5.3%), 18 (31.6%), 2 (3.5%), and 1 (1.8%), respectively. 2. Analyzing pasture and tillable land, pasture according to feeding scale (200, 300 and 400 heads) were 56, 90 and 165.3 ha, and tillable lands were 51, 78 and 165 ha which showed some differences among feeding scale. In recording methods in 38 farms replied, 36 (95%) dairy handbook and 23 (70%) dual methods taking farms were higher than that of 10 (26.3%) computer and 15(39.5%) well-recorder methods. 3. Dairy waste processing facilities in environmental field were almost perfect except of metropolitan area, and so no problem was developed in its control so far. Hence, 26 farm (68.4%) of pond system was higher rather than those in 8 (21.2%) of using as organic manure after storing feces of dairy cattle, 1(2.6%) bunker system and 3 (7.9%) other type farms. 4. In milking facilities, 33 farms (86.9%) of Harringbone types were higher than those in 3 (7.9%) of Walkthrough types, 1 (2.6%) of Rotary system and other types. Although the construction facilities was not enough, this system show the world-leveled dairy country to attempted to elevate economic gains using the advantage of climatic condition. 5. In milking day and yearly yield per head, average 275 milking days and 87 drying days were longer than that of 228 average milking days in New Zealand. Annual total milk yield per head and milk solid (ms) was 3,990 kg and approximately 319 kg. Dairy milk solid (ms) per head, milk yield, fat percentage was 1.2 kg, 15.5 kg and average 4.83% which was much higher than in other country, and milk protein was average 3.75%. 6. In coclusion, Palmerstone North has been a center of dairy farming in New Zealand for the last 21 years. Their dairy farming history is 6~9 year longer than ours and the average number of milking cows per farm is 355, which is much greater than that (35) of Korea. They do not have dairy barn, but only milking parlors. Cows are taken care of by family 0.5 persons), are on a planned calving schedule in spring (93%) and milked for 240~280 days a year, avoiding winter. Cows are dried according to milk yield and body condition score. This management system is quite different from that of Korean dairy farms. Cows are not fed concentrates, relying entirely on pasture forages and the average milk yield per cow is 3,500 kg, which is about 1/2 milk yield of Korean dairy farms. They were bred to produce high fat milk with an average of 4.5%. Their milk production cost is the lowest in the world and the country's economy relies heavily on milk production. We Korean farmers may try to increase farming size, decreasing labor and management costs.

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