• Title/Summary/Keyword: norm function

Search Result 310, Processing Time 0.028 seconds

Clinical Study of Heart Rate Variability on Patients with Idiopathic Parkinson's Disease according to Clinical Scale(Hoehn-Yahr stage, UPDRS) (특발성 파킨슨병 환자의 임상척도에 따른 심박변이도의 변화에 대한 연구)

  • Park, Sang-min;Lee, Sang-hoon;Jung, Ji-cheol;Kim, Kun-hyung;Park, Hi-joon;Lim, Sabina;Chang, Dae-il;Lee, Yun-ho
    • Journal of Acupuncture Research
    • /
    • v.22 no.3
    • /
    • pp.137-144
    • /
    • 2005
  • Objective : This study was designed to assess the heart rate variablitv of patients with Parkinson's disease according to Hoehn-Yahr stage. Methods : Subjects were voluntarily recruited by newspapers and internet. All the subjects are confirmed as idiopathic parkinson's disease by a neurologist. The patients were grouped by Hoehn-Yahr(H-Y) stage. Heart rate variability was measured for 5 minutes after 5 minutes' bed rest. Subjects were comprised of 3 groups which were H-Y stage I (n=14), H-Y stage H(n=9), H-Y stage III(n=7). We compared the heart rate variability of each groups by one-way ANOVA test. We also studied the relationship between UPDRS score and Heat rate variability components (SDNN, RMS-SD and TP) by pearson correlation analysis and simple linear regressin analysis Results: Age, duration was matched among groups. SDNN, RMS-SD, TP were significantly decreased as H-Y stage increased(p<0.05). Especially there was significant difference between H-Y stage I and III group(p<0.05). But other components(Heart rate, LF, HF, LF/HF ratio) were not showed significant difference. SDNN, RMS-SD and TP were significantly decreased as UPDRS scores increase(p<0.05). Conclusion : This study suggests that the function of the autonomic nervous system decreases as Parkinson`s disease progresses.

  • PDF

On the Bibliographies of Chinese Historical Books - Classifying and cataloguing system of six historical bibliographies - (중국의 사지서목에 대하여 -육사예문$\cdot$경적지의 분류 및 편목체재 비교를 중심으로-)

  • Kang Soon-Ae
    • Journal of the Korean Society for Library and Information Science
    • /
    • v.24
    • /
    • pp.289-332
    • /
    • 1993
  • In china, six bibliographies of offical historical books are evaluated at the most important things among the systematically-editing bibliographies. These bibliographies would be usful to study the orign of classical sciences and their development, bibliographic research of Chinese classics, bibliographic judgement on genuine books, titles, authors, volumes. They could be refered to research into graving, correcting, and existence of ancient books. therefore, these bibliographies would be applied to estimation the phase of scientific and cultural development. The study of these bibliographies has been not yet made in Korea. This thesis lays its importance on the background of their appearance, their classification norms, organizing system of their catalogue, and comparison between their difference. 1. Editing and compiling of Chilyak (칠약) by Liu Chin (유흠) and official histories played an important role of entering an apperance of historical book's bibliographies. Chilyak has been lost. However, its classification and compiling system of classical books would be traced by Hansoyemunji(한서예문지) of which basic system is similar to Chilyak. It classified books according to their scientific characteristic. If a few books didn't have their own categories, they were combined by the circles parallel to the books' characteristic. With the books classified under the same scientific characteristic, they were again divided into the scientific schools or structures. It also arranged the same kinds of books according to the chronology. The some books wi th duplicate subjects were classified multiplely by their duplicate subject. 2. Ssu-ma Chon's (사마천) The Historical Records (Saki, 사기) and Pan Ku's (반고) The History of the Former Han Dynasty (Hanso, 한서) has also took effects on appearance of historical books' bibliographies. Covering overall history, Saki was structured by the five parts: The basic annals(본기), the chronological tables (표), the documents (서), the hereditary houses (세가), biographies (열전). The basic annals dealt with kings and courts' affairs according to the chronology. The chronological tables was the records of the annals. The documents described overall the social and cultural systems. The hereditary houses recorded courts' meritorious officials and public figures. The biographies showed exemplars of seventy peoples selected by their social status. Pan Ku(반구)'s The History of the Former Han Dynasty(한서) deserved to be called the prototype for the offical histories after Saki's (사기; The Historical Records) apperance. Although it modelled on Saki, it had set up its own cataloguing system. It was organized by four parts; the basic annals (본기), the chronological tables (표), treatises(지), biographies (열전). The documents in the Hanso(한서) was converted into treatises(지). The hereditary houses and biographies were merged. For the first time, the treatise with The Yemunji could operate function for historical bibliographies. 3. There were six historical bibliographies: Hansoyemunji(한서예문지), Susokyongjeokji (수서경적지), Kudangsokyongjeokji(구당서경적지), Shindangsoyemunji (신당서예문지), Songsayemunji (송사예문지), Myongsayemunji (명사예문지). 1) Modelling on Liu Chin's Chilyak except Chipryak(집략), Hansoyemunji divided the characteristic of the books and documents into six parts: Yukrye(육예), Cheja(제자), Shibu(시부), Pyongsoh(병서), Susul(수술), Pangki(방기). Under six parts, there were thirty eight orders in Hansoyemunji. To its own classification, Hansoyemunji applied the Chilyak's theory of classification that the books or documents were managed according to characteristic of sciences, the difference of schools, the organization of sentences. However the overlapped subjects were deleted and unified into one. The books included into an unsuitable subject were corrected and converted into another. The Hansoyemunji consisted of main preface (Taesoh 대서), minor preface (Sosoh 소서) , the general preface (Chongso 총서). It also recorded the introduction of books and documents, the origin of sciences, the outline of subjects, and the establishment of orders. The books classified by the subject had title, author, and volumes. They were rearranged by titles and the chronological publication year. Sometimes author was the first access point to catalogue the books. If it was necessary for the books to take footnotes, detail notes were formed. The Volume number written consecutively to order and subject could clarify the quantity of books. 2) Refering to Classfication System by Seven Norms (칠분법) and Classification System by Four Norms(사분법), Susokyongjeokji(수서경적지) had accomplished the classification by four norms. In fact, its classification largely imitated Wanhyosoh(완효서)'s Chilrok(칠록), Susokyongjeokji's system of classification consisted of four parts-Kyung(경), Sa(사), Cha(자), Chip(칩). The four parts were divided into 40 orders. Its appendix was again divided into two parts, Buddihism and Taiosm. Under the two parts there were fifteen orders. Totally Susokyongjeokji was made of six parts and fifty five orders. In comparison with Hansoyemunji(한서예문지), it clearly showed the conception of Kyung, Sa, Cha, Chip. Especially it deserved to be paid attention that Hansoyemunji laied history off Chunchu(춘추) and removed history to Sabu(사부). However Chabu(사부) put many contrary subjects such as Cheja(제자), Kiye(기예), Sulsu(술수), Sosol(소설) into the same boundary, which committed errors insufficient theoretical basis. Anothor demerit of Susokyongjeokji was that it dealt with Taiosm scriptures and Buddism scriptures at the appendix because they were considered as quasi-religion. Its compilation of bibliographical facts consisted of main preface(Taesoh 대서), minor preface(Sosoh 소서), general preface (Chongsoh 총서), postscript (Husoh 후서). Its bibliological facts mainly focused on the titles. Its recorded authors' birth date and their position. It wrote the lost and existence of books consecutive to total number of books, which revealed total of the lost books in Su Dynasty. 3) Modelling on the basis of Kokumsorok(고분서록) and Naewaekyongrok(내외경록), Kudangsokyongjeokji(구당서경적지) had four parts and fourty five orders. It was estimated as the important role of establishing basic frame of classification by four norms in classification theory's history. However it had also its own limit. Editing and compling orders of Kudangsokyongjeokji had been not progressively changed. Its orders imitated by and large Susokyongjeokji. In Its system of organizing catalogue, with its minor preface and general preface deleting, Kudangsokyongjeokji by titles after orders sometimes broke out confusion because of unclear boundaries between orders. 4) Shindangsoyemunji(신당서예문지), adding 28,469 books to Kudangsokyongjeokji, recorded 82,384 books which were divided by four parts and fourty four orders. In comparison with Kudangkyongjeokj, Sindangsoyemunji corrected unclear order's norm. It merged the analogical norms four orders (for instance, Kohun 고훈 and Sohakryu 소학류) and seperated the different norms four orders (for example, Hyokyong 효경 and Noneuhryu 논어류, Chamwi 참위 and Kyonghaeryu 경해류, Pyonryon 편년 and Wisaryu 위사류). Recording kings' behaviors and speeches (Kikochuryu 기거주류) in the historical parts induced the concept of specfication category. For the first time, part of Chipbu (집부) set up the order of classification norm for historical and literatural books and documents (Munsaryu 문사류). Its editing and compiling had been more simplified than Kudangsokyongjeokji. Introduction was written at first part of bibliographies. Appendants except bibliographic items such subject, author, title, volume number, total were omitted. 5) Songsayemunji(송사예문지) were edited in the basis of combining Puksong(북송) and Namsong(남송), depending on Sabukuksayemunji(사부국사예문지). Generally Songsayemunji had lost a lot of bibliographical facts of many books. They were duplicated and wrongly classified books because it committed an error of the incorrectly annalistic editing. Particularly Namsong showed more open these defaults. Songsayemunji didin't include the books published since the king Youngchong(영종). Its system of classification was more better controlled. Chamwiryu(참위류) in the part of Kyongbu(경부) was omitted. In the part of history(Sabu 사부), recordings of kings' behaviors and speeches more merged in the annals. Historical abstract documents (Sachoryu 사초류) were seperately arranged. In the part of Chabu(자부), Myongdangkyongmaekryu(명당경맥류) and Euisulryu(의술류) were combined. Ohangryu(오행류) were laied off Shikuryu(시구류). In the part of Chipbu(집부), historical and literatural books (Munsaryu 문사류) were independentely arranged. There were the renamed orders; from Wisa(위사) to Paesa(패사), Chapsa (잡사) to Pyolsa(열사), Chapchonki(잡전기) to Chonki(전기), Ryusoh(류서) to Ryusa(류서). Introduction had only main preface. The books of each subject catalogued by title, the volume number, and author and arranged mainly by authors. Annotations were written consecutively after title and the volume number. In the afternote the number of not-treated books were revealed. Difference from Singdangsohyemunji(신당서예문지) were that the concept and boundary of orders became more clearer. It also wrote the number of books consecutive to main subject. 6) Modelling on Chonkyongdangsomok (경당서목), Myongsayemunji(명사예문지) was compiled in the basis of books and documents published in the Ming Danasty. In classification system, Myongsayemunji partly merged and the seperated some orders for it. It also deleted and renamed some of orders. In case of necessity, combining of orders' norm was occured particulary in the part of Sabu(사부) and Chabu(자부). Therefore these merging of orders norm didn't offer sufficient theretical background. For example, such demerits were seen in the case that historical books edited by annals were combined with offical historical ones which were differently compiled and edited from the former. In the part of Chabu(자부), it broke out another confusion that Pubga(법가), Meongga(명가), Mukga(묵가), Chonghweongka's(종횡가) thoughts were classified in the Chapka(잡가). Scriptures of Taiosim and Buddhism were seperated from each other. There were some deleted books such as Mokrokryu(목록류), Paesaryu(패사류) in the part of history (Sabu 사부) and Chosaryu(초사류) in the part of Chipbu(집부). The some in the each orders had been renamed. Imitating compiling system of Songsayemunji(송사예문지), with reffering to its differ-ence, Myongsayemunji(명사예문지) wrote the review and the change of the books by author. The number of not-treated books didn't appear at the total. It also deleted the total following main subject.

  • PDF

Level Set based Topological Shape Optimization of Phononic Crystals (음향결정 구조의 레벨셋 기반 위상 및 형상 최적설계)

  • Kim, Min-Geun;Hashimoto, Hiroshi;Abe, Kazuhisa;Cho, Seonho
    • Journal of the Computational Structural Engineering Institute of Korea
    • /
    • v.25 no.6
    • /
    • pp.549-558
    • /
    • 2012
  • A topology optimization method for phononic crystals is developed for the design of sound barriers, using the level set approach. Given a frequency and an incident wave to the phononic crystals, an optimal shape of periodic inclusions is found by minimizing the norm of transmittance. In a sound field including scattering bodies, an acoustic wave can be refracted on the obstacle boundaries, which enables to control acoustic performance by taking the shape of inclusions as the design variables. In this research, we consider a layered structure which is composed of inclusions arranged periodically in horizontal direction while finite inclusions are distributed in vertical direction. Due to the periodicity of inclusions, a unit cell can be considered to analyze the wave propagation together with proper boundary conditions which are imposed on the left and right edges of the unit cell using the Bloch theorem. The boundary conditions for the lower and the upper boundaries of unit cell are described by impedance matrices, which represent the transmission of waves between the layered structure and the semi-infinite external media. A level set method is employed to describe the topology and the shape of inclusions. In the level set method, the initial domain is kept fixed and its boundary is represented by an implicit moving boundary embedded in the level set function, which facilitates to handle complicated topological shape changes. Through several numerical examples, the applicability of the proposed method is demonstrated.

Impacts Analysis of the operation of DVR(Driving Video Recorder) on Driver's Behavior Change and Reduction of Traffic Accident (교통사고 영상기록장치(DVR : Driving Video Recorder)의 설치가 운전자의 운전태도 변화와 교통사고 저감에 미치는 효과 분석)

  • Jang, Seok-Yong;Jeong, Heon-Yeong;Baek, Sang-Geun;Go, Sang-Seon
    • Journal of Korean Society of Transportation
    • /
    • v.27 no.3
    • /
    • pp.119-130
    • /
    • 2009
  • The aim of this study is to analyze the effects of DVR(Driving Video Recorder) operation on decreasing the number of traffic accidents, the cost of traffic accident claim, and the behavioral change in drivers' driving. The data for this research are obtained from taxi drivers in Busan. For this, Structural Equation Model and two-way ANOVA are employed for empirical analysis. Overall results of this study show that the number of traffic accidents of 4 taxi corporations in Busan has decreased by average 32.7 percent after using DVRs. In addition, as to the cost of taxi accident claims, it is expected that the DVR operation has a considerable effect on economic benefits of taxi corporations. Moreover, this study could make clear the difference in behaviors between DVR users and non-users, and discriminate the positive and negative impacts of the DVR operation on the drivers' driving behavior. The study quantitatively examined the indirect impact of 'attitude', 'subject norm' and 'behavioral control' factors on planned 'behavior', and the direct impact of 'behavioral control' factor on the planned 'behavior'. This study suggests that they should add the video recoding function of DVRs when operation recorder(blackbox for the car) is obligatorily set up on cars for business by traffic security law.

A Study on the Method of Health Promotion in Korean Medicine: Correlation between Night-shift Work and Yin-deficiency (건강증진을 위한 한의학적 방법론 연구 -야간근로와 음허증의 상관관계를 중심으로-)

  • Lee Sang Jae;Park Jong Bae;Lee Sun Dong;Kim Kwang Ho
    • Journal of Physiology & Pathology in Korean Medicine
    • /
    • v.18 no.2
    • /
    • pp.344-348
    • /
    • 2004
  • This study regarded irregular life styles such as nigh-shifts as contrary to the norm advised in the rules of Yang-saeng to analyze the problems brought about in relation to the concept of 'Yin-deficiency syndrome'. Yin-deficiency survey was given to sales workers on a big shopping mall in Seoul to compare the measurements of daytime workers to those of nigh-shift workers. The measurement of complaining symptoms related to Yin-deficiency of daytime workers and night-shift workers were compared, In comparison of the daytime workers and the night-shift workers, night-shift workers showed higher measurements than the daytime workers in the item of irritable fever on the five Hearts, flushing of the zygomatic region in the afternoon, tidal fever, dizziness, insomnia, yellow and scanty urination, and constipation. Especially tidal fever, insomnia, and constipation showed statistically significant difference. The total of ten items consisting of Yin-deficiency-related symptoms showed statistically significant high score in night-shift workers than the daytime workers. 'Factors for deficiency-type Heat' consisting of irritable fever on the five Hearts, flushing of the zygomatic region in the afternoon, tidal fever, and dried mouth and throat showed statistically significant high score in night-shift workers than the daytime workers. 'Accompanying factors' consisting of night sweats, emaciation, dizziness, insomnia, yellowish and scanty urination, and constipation also showed statistically and significantly high score in night-shift workers than the daytime workers. From the above results that night-shift workers show high degree of Yin-deficiency than daytime workers, and those overworking irregularly also show high degree of Yin-deficiency than those who work for adequate amount of time regularly implies that sitting up at night for work and sleeping at daytime, excessive work, and irregular life styles all function as high-risk factor for Yin-deficiency.

System and Prospects of Social Welfare Law (사회복지법의 규범체계와 과제)

  • Cheon, Kwang-Seok
    • Journal of Legislation Research
    • /
    • no.41
    • /
    • pp.7-42
    • /
    • 2011
  • The social welfare law concerning the children, the elderly and the disabled has been sufficiently in the center of the discussion in the academic as well as practical arena. One can find however rarely academic proposals about the way of understanding, spheres affiliated with this legal system, and systematic characteristics. So these problems stay now vague. This article aims to approach to these points of issue. First, it tries to reveal the physical, psychological and psychic characteristics of these group of people. These situation are not to be effectively protected by norms and measures provided by other instruments of social security, i.e. social insurances and social assistances. Second, based upon these functional limits inherent to these instruments of social security the own system of the social welfare law is explored in this article. The discussing points are as follows; 1. the concept of social welfare law, 2. as core principles; realization of the personality and freedom based upon self-determination right, universalism and equality. 3. rearrangements of the legal provisions to bring harmony with the legal purpose and function of social welfare law. Finally, it is pointed that the evaluation of the relevant legislation is essential, since in this area the difference between the norm purpose and the reality could be immense.

Seeking for the Determinants of Entrepreneurship from National Level Data (국가 특성이 창업활동에 미치는 영향 실증 분석)

  • Kim, Hyung Jun;Min, Tae Ki;Wang, Jingbu;Schuler, Diana;Oh, Keun Yeob
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
    • /
    • v.15 no.6
    • /
    • pp.55-65
    • /
    • 2020
  • The purpose of this study is to empirically analyze the factors that affect start-up activities at the national level. Unlike most existing research about entrepreneurship at the individual level, this empirical analysis makes use of the total early-stage entrepreneurial activity(TEA) index at national level. This was developed by the Global Entrepreneur Monitor (GEM) as the measure for the degree of entrepreneurship of the countries. Based on the previous studies, not only national income level and unemployment rate, but also other factors including the cultural characteristics of the countries were included in our regression model. Using GEM's panel data, we found that the effectiveness of the factors depends on the stage of economic development. In particular, we found 'U-shape' relationship between the level of per capita income and entrepreneurship activity by the panel regression analysis using quadratic function. This analysis result can explicitly confirm what the existing literature have explained descriptively. Furthermore, the governmental support programs are shown to have significantly positive effects on the entrepreneurship or start-up activities in the factor-driven and efficiency-driven economies. On the contrary, those programs were not very helpful in the innovative economies. Lastly, this research suggests that the 'education and training' and the 'entrepreneurial culture' be the supportive norm for new business regardless of the economic development level.

A Study on the Elements of Interior Design in Victorian Style (빅토리안 스타일 주택 실내 디자인에 관한 연구)

  • Kim, Jung-Keun
    • Archives of design research
    • /
    • v.18 no.4 s.62
    • /
    • pp.25-34
    • /
    • 2005
  • The purpose of the present study is to investigate the characteristics of the current Victorian-style interior by reviewing the basic Victorian-style house in the past. this research was analyzed various prior studies and literatures, and found the following results: First, the Victorian-style house and interior space showed various historical trends and adopted every style from Gothic to rococo, and sometimes more than one style influenced a single place. Its formality was applied depending on the function and standard of each room. Second, the interior had many decorative things with free, irregular or other patterns, influenced by Romanticism and Naturalism. The several environmental factors such as air pollution and hygienic matter were also related with its trend. the dramatic changes in the kitchen and sanitary facilities were appeared based on the technical development, and affluent design styles were also used. All these reflected the characteristics of the Victorian age. In conclusion, the characteristics of Victorian-style were influenced by many factors including: (a) the trend of Romanticism and Naturalism, (b) consideration of family convenience based on the technical development, (c) the Socio-Environmental factors like air pollution and the social norm, and (d) reflection of the individual value in accordance with frequent contacts with foreign cultures. In this respect, it is necessary to reevaluate the Victorian-style after paying due regard to such factors.

  • PDF

The Application of Operations Research to Librarianship : Some Research Directions (운영연구(OR)의 도서관응용 -그 몇가지 잠재적응용분야에 대하여-)

  • Choi Sung Jin
    • Journal of the Korean Society for Library and Information Science
    • /
    • v.4
    • /
    • pp.43-71
    • /
    • 1975
  • Operations research has developed rapidly since its origins in World War II. Practitioners of O. R. have contributed to almost every aspect of government and business. More recently, a number of operations researchers have turned their attention to library and information systems, and the author believes that significant research has resulted. It is the purpose of this essay to introduce the library audience to some of these accomplishments, to present some of the author's hypotheses on the subject of library management to which he belives O. R. has great potential, and to suggest some future research directions. Some problem areas in librianship where O. R. may play a part have been discussed and are summarized below. (1) Library location. It is usually necessary to make balance between accessibility and cost In location problems. Many mathematical methods are available for identifying the optimal locations once the balance between these two criteria has been decided. The major difficulties lie in relating cost to size and in taking future change into account when discriminating possible solutions. (2) Planning new facilities. Standard approaches to using mathematical models for simple investment decisions are well established. If the problem is one of choosing the most economical way of achieving a certain objective, one may compare th althenatives by using one of the discounted cash flow techniques. In other situations it may be necessary to use of cost-benefit approach. (3) Allocating library resources. In order to allocate the resources to best advantage the librarian needs to know how the effectiveness of the services he offers depends on the way he puts his resources. The O. R. approach to the problems is to construct a model representing effectiveness as a mathematical function of levels of different inputs(e.g., numbers of people in different jobs, acquisitions of different types, physical resources). (4) Long term planning. Resource allocation problems are generally concerned with up to one and a half years ahead. The longer term certainly offers both greater freedom of action and greater uncertainty. Thus it is difficult to generalize about long term planning problems. In other fields, however, O. R. has made a significant contribution to long range planning and it is likely to have one to make in librarianship as well. (5) Public relations. It is generally accepted that actual and potential users are too ignorant both of the range of library services provided and of how to make use of them. How should services be brought to the attention of potential users? The answer seems to lie in obtaining empirical evidence by controlled experiments in which a group of libraries participated. (6) Acquisition policy. In comparing alternative policies for acquisition of materials one needs to know the implications of each service which depends on the stock. Second is the relative importance to be ascribed to each service for each class of user. By reducing the level of the first, formal models will allow the librarian to concentrate his attention upon the value judgements which will be necessary for the second. (7) Loan policy. The approach to choosing between loan policies is much the same as the previous approach. (8) Manpower planning. For large library systems one should consider constructing models which will permit the skills necessary in the future with predictions of the skills that will be available, so as to allow informed decisions. (9) Management information system for libraries. A great deal of data can be available in libraries as a by-product of all recording activities. It is particularly tempting when procedures are computerized to make summary statistics available as a management information system. The values of information to particular decisions that may have to be taken future is best assessed in terms of a model of the relevant problem. (10) Management gaming. One of the most common uses of a management game is as a means of developing staff's to take decisions. The value of such exercises depends upon the validity of the computerized model. If the model were sufficiently simple to take the form of a mathematical equation, decision-makers would probably able to learn adequately from a graph. More complex situations require simulation models. (11) Diagnostics tools. Libraries are sufficiently complex systems that it would be useful to have available simple means of telling whether performance could be regarded as satisfactory which, if it could not, would also provide pointers to what was wrong. (12) Data banks. It would appear to be worth considering establishing a bank for certain types of data. It certain items on questionnaires were to take a standard form, a greater pool of data would de available for various analysis. (13) Effectiveness measures. The meaning of a library performance measure is not readily interpreted. Each measure must itself be assessed in relation to the corresponding measures for earlier periods of time and a standard measure that may be a corresponding measure in another library, the 'norm', the 'best practice', or user expectations.

  • PDF

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
    • /
    • v.20 no.1 s.21
    • /
    • pp.165-203
    • /
    • 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.

  • PDF