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TREATMENT OF ECHOLALIA IN CHILDREN WITH AUTISM (자폐아동의 반향어 치료)

  • Chung, Bo-In
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.9 no.1
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    • pp.47-53
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    • 1998
  • The purpose of this study was to investigate the possibility of providing familiar tasks as a treatment option to decrease echolalia. Two comparisons were made:One was to compare ‘conversation condition’ and ‘task performance condition.’ and the other was to compare ‘task performance alone condition’ and ‘task performance along with contingency of reinforcement condition.’ Two echolalic children aged 12 and 13 years participated in the experiment and A-B-A-B-BC-B-BC design was used, in which A was conversation only, B was task performance, and C was task performance along with contingency of reinforcement. In the A condition, the therapist asked easy and short questions to the child;in the B condition the child was given familiar tasks with short instruction, and in BC condition, each child was reinforced for his performance on given tasks, in which immediate echolalia was controlled through his hands being held down for 5 seconds. Delayed echolalia was recorded without any intervention being given. Each child was put into each of the 7 treatment conditions. With a 15 minutes session, each child went through 5 to 6 sessions per day for 2 weeks. The mean echolalia(immediate) rates across the 7 treatment conditions were:For child 1, A(99%)-B(65%)-A(95%)-B(10%)-BC(7%)-B(6%)- BC(7%) and for child 2, A(67%)-B(62%)-A(63%)-B(35%)-BC(8%)-B(4%)-BC(0%). As to the generalization of the treatment effect of immediate echolalia to the untreated delayed echolalia, there was shown a drastic reduction of delayed echolalia in child 2:A(35%)-B(57%)-A(56%)-B(40%)-BC(8%)-B(5%)-BC(9%). Child l’s delayed echolalia was negligible(mean=3%) pre-and post treatments. In conclusion, the results of this study clearly show that providing a task performance setting with familiar tasks can certainly be helpful for minimizing echolalic response, and along with the use of the contingency of reinforcement technique it can further not only correct echolalic behavior to a negligible degree but also help the echolalic child generalize its treatment effect to the child’ overall language improvement.

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Efficacy of Mitral Valve Surgery in Moderate Ischemic Mitral Regurgitation (MR) (중등도의 허혈성 승모판막 폐쇄부전증 환자에서 승모판막 수술의 유용성)

  • Jung Sung Ho;Lee Jae Won;Choi Jun Young
    • Journal of Chest Surgery
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    • v.38 no.5 s.250
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    • pp.357-365
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    • 2005
  • Background: Patients with mitral regurgitation (MR) in the setting of coronary artery disease have a dismal long-term prognosis whether treated medically or surgically. Moreover, the optimal management of moderate ischemic MR at the time of coronary artery bypass grafting (CABG) remains the subjects of controversy. Thus, the present retrospective study was undertaken to determine whether mitral valve surgery for moderate ischemic MR at the time of CABG would be preferable to CABG alone in terms of clinical outcome. Material and Method: Between January 1997 and December 2003, 34 patients with moderate (Gr 3/4) ischemic MR underwent CABG alone (Group I, n=23) or CABG plus mitral valve surgery (Group II, n=11). Operative mortality, long-term survival and echocardiographic parameters were used to evaluate the efficacy of mitral valve surgery in patients with moderate ischemic MR. The mean follow-up durations of each group were $69.3\pm4.3$ months and $53.1\pm4.9$ months respectively. Result: There was no hospital mortality in both groups. There was one case of late mortality in Group I. The mean number of bypass graft was similar ($3.8\pm1.2\;vs\;3.7\pm1.3$ respectively). Cardiopulmonary bypass time was longer in group II (p=0.014). In group II, all of the patients received mitral annuloplasty using ring. On immediate postoperative echo-cardiogram, mitral regurgitation was reduced more in group II (p=0.002). Echocardiogram performed at last follow-up state showed no difference except the grade of MR between the two groups. Actuarial survival of both groups at 5 years was similar ($95.5\%\;vs\;100\%$, p=0.48). Conclusion: This study shows that in selected patients with moderate ischemic MR, CABG without mitral valve surgery might be sufficient. However, patients with low EF and NYHA functional class pre-operatively had tendency of significant residual MR, so mitral valve surgery should be necessary in these patients, and moreover, MR severity and left ventricle volume decreased more in mitral valve surgery group. Therefore, more large-scale studies are necessary to determine these effects on the ventricular function and long-term survival.

Performance of Drip Irrigation System in Banana Cultuivation - Data Envelopment Analysis Approach

  • Kumar, K. Nirmal Ravi;Kumar, M. Suresh
    • Agribusiness and Information Management
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    • v.8 no.1
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    • pp.17-26
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    • 2016
  • India is largest producer of banana in the world producing 29.72 million tonnes from an area of 0.803 million ha with a productivity of 35.7 MT ha-1 and accounted for 15.48 and 27.01 per cent of the world's area and production respectively (www.nhb.gov.in). In India, Tamil Nadu leads other states both in terms of area and production followed by Maharashtra, Gujarat and Andhra Pradesh. In Rayalaseema region of Andhra Pradesh, Kurnool district had special reputation in the cultivation of banana in an area of 5765 hectares with an annual production of 2.01 lakh tonnes in the year 2012-13 and hence, it was purposively chosen for the study. On $23^{rd}$ November 2003, the Government of Andhra Pradesh has commenced a comprehensive project called 'Andhra Pradesh Micro Irrigation Project (APMIP)', first of its kind in the world so as to promote water use efficiency. APMIP is offering 100 per cent of subsidy in case of SC, ST and 90 per cent in case of other categories of farmers up to 5.0 acres of land. In case of acreage between 5-10 acres, 70 per cent subsidy and acreage above 10, 50 per cent of subsidy is given to the farmer beneficiaries. The sampling frame consists of Kurnool district, two mandals, four villages and 180 sample farmers comprising of 60 farmers each from Marginal (<1ha), Small (1-2ha) and Other (>2ha) categories. A well structured pre-tested schedule was employed to collect the requisite information pertaining to the performance of drip irrigation among the sample farmers and Data Envelopment Analysis (DEA) model was employed to analyze the performance of drip irrigation in banana farms. The performance of drip irrigation was assessed based on the parameters like: Land Development Works (LDW), Fertigation costs (FC), Volume of water supplied (VWS), Annual maintenance costs of drip irrigation (AMC), Economic Status of the farmer (ES), Crop Productivity (CP) etc. The first four parameters are considered as inputs and last two as outputs for DEA modelling purposes. The findings revealed that, the number of farms operating at CRS are more in number in other farms (46.66%) followed by marginal (45%) and small farms (28.33%). Similarly, regarding the number of farmers operating at VRS, the other farms are again more in number with 61.66 per cent followed by marginal (53.33%) and small farms (35%). With reference to scale efficiency, marginal farms dominate the scenario with 57 per cent followed by others (55%) and small farms (50%). At pooled level, 26.11 per cent of the farms are being operated at CRS with an average technical efficiency score of 0.6138 i.e., 47 out of 180 farms. Nearly 40 per cent of the farmers at pooled level are being operated at VRS with an average technical efficiency score of 0.7241. As regards to scale efficiency, nearly 52 per cent of the farmers (94 out of 180 farmers) at pooled level, either performed at the optimum scale or were close to the optimum scale (farms having scale efficiency values equal to or more than 0.90). Majority of the farms (39.44%) are operating at IRS and only 29 per cent of the farmers are operating at DRS. This signifies that, more resources should be provided to these farms operating at IRS and the same should be decreased towards the farms operating at DRS. Nearly 32 per cent of the farms are operating at CRS indicating efficient utilization of resources. Log linear regression model was used to analyze the major determinants of input use efficiency in banana farms. The input variables considered under DEA model were again considered as influential factors for the CRS obtained for the three categories of farmers. Volume of water supplied ($X_1$) and fertigation cost ($X_2$) are the major determinants of banana farms across all the farmer categories and even at pooled level. In view of their positive influence on the CRS, it is essential to strengthen modern irrigation infrastructure like drip irrigation and offer more fertilizer subsidies to the farmer to enhance the crop production on cost-effective basis in Kurnool district of Andhra Pradesh, India. This study further suggests that, the present era of Information Technology will help the irrigation management in the context of generating new techniques, extension, adoption and information. It will also guide the farmers in irrigation scheduling and quantifying the irrigation water requirements in accordance with the water availability in a particular season. So, it is high time for the Government of India to pay adequate attention towards the applications of 'Information and Communication Technology (ICT) and its applications in irrigation water management' for facilitating the deployment of Decision Supports Systems (DSSs) at various levels of planning and management of water resources in the country.

THE CHANGE OF CANAL CONFIGURATION AFTER INSTRUMENTATION BY SEVERAL NICKEL-TITANIUM FILES IN THE SIMULATED CANAL WITH ABRUPT CURVATURE (수종의 엔진구동형 니켈-타이타늄 파일에 의한 급한 만곡의 근관 성형시 근관형태 변화에 대한 비교연구)

  • Lim, Jung-Jang;Kim, Dong-Jun;Hwang, Yun-Chan;Hwang, In-Nam;Oh, Won-Mann
    • Restorative Dentistry and Endodontics
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    • v.30 no.4
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    • pp.303-311
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    • 2005
  • The purpose of this study was to evaluate which type of Ni-Ti files are able to maintain canal configuration better in the simulated canal with abrupt curvature near it's apex. Ninety six simulated root canals were made in epoxy resin and $\sharp$15 finger spreader was used as root canal templates. The simulated root canals were made with radius of curvature of 1.5mm, 3.0mm, 4.0mm, 6.0mm respectively and the angle of curvature of all simulated canals were adjusted to 90 degree. The simulated canals were instrumented by ProFile, ProTaper, Hero 642, and $K^3$ at a 300 rpm using crown-down pressureless technique. Pre-instrumented and post-instrumented images were taken by digital camera and were superimposed with Adobe Photos hop 6.0 program. Images were compared by image analysis program. The changes of canal width at the inner and outer side of the canal curvature. canal transportation were measured at 9 measuring point with 1 mm interval. Statistical analysis among the types of Ni-Ti files was performed using Kruskal-Wallis test and Mann-Whitney U-test. The result was that ProFile maintain original canal configuration better than other engine driven Ni-Ti files in the canals above 3.0mm radius of curvature, and in the 1.5mm radius of curvature, most of Ni-Ti flies were deformed or separated during instrumentation.

Pulmonary Arterial Growth Pattern after Shunt Operation in Patients of Pulmonary Atresia with Ventricular Septal Defect Associated with Juxtaductal Stenosis (Juxtaductal stenosis가 동반된 PA/VSD환자에서 체폐단락술 부위에 따른 폐동맥 크기의 변화)

  • 이교준;박영환;최재영;조범구
    • Journal of Chest Surgery
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    • v.31 no.9
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    • pp.861-866
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    • 1998
  • Background: Pulmonary atresia (PA) with ventricular septal defect has various morphology of pulmonary arteries and pulmonary blood flow sources, so pulmonary arterial hypoplasia and arborization abnormality make this anomaly difficult to manage surgically. In cases associated with juxtaductal stenosis, we evaluated the change of the pulmonary arterial and juxtaductal stenotic site after shunt operations, and would like to find useful information in surgical planning and methodology of these patients. Material and Method: Among 59 cases diagnosed as PA with ventricular septal defect associated with juxtaductal stenosis, 29 cases who had cardiac catheterization before and after shunt operation were selected from July, 1991 to July, 1996. In 10 cases of right shunt operation(Group I) and 19 cases of left shunt operation (Group II), the diameters of the descending aorta, both pulmonary arteries, and the juxtaductal stenosis site were measured before and after the shunt operation. Result: In both Group I and II, the pre- and postoperative ratio of diameters of the ipsilateral pulmonary artery to the descending aorta was from 0.78${\pm}$0.31 units to 1.01${\pm}$0.26 units and from 0.67${\pm}$0.18 units to 0.84${\pm}$0.27 units respectively, showing a signigicant increase. The contralateral pulmonary artery index was increased from 0.92${\pm}$0.28 units to 1.05${\pm}$0.15 units and from 0.94${\pm}$0.27 units to 1.08${\pm}$0.37 units respectively, but could not be confirmed statistically. In both groups, the change of juxtaductal stenosis showed an aggravating tendency but of no statistical significance from 0.43${\pm}$0.27 units to 0.39${\pm}$0.25 units and from 0.32${\pm}$0.10 units to 0.30${\pm}$0.16 units respectively, and we experienced 2 total obstruction in Group II. Because the increased pulmonary blood flow by shunt operation has a favorable effect to the pulmonary arterial growth, the shunt operation is a recommended treatment in patients with hypoplastic pulmonary arteries. But in PA with ventricular septal defects, the change of juxtaductal stenosis is very important. In conclusion, the growth of ipsilateral (shunt site) pulmonary artery was promoted by shunt operation, but there is a tendency for the juxtaductal stenosis to be aggravated. And we experienced 2 total obstruction in Group II. Conclusion: Thus, in cases operated with shunt method, much careful postoperative follow up study including angiographic evaluation is needed, and after the shunt operation on the side of pulmonary artery associated with juxtaductal stenosis, early precise planning for total correction is recommended.

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Estimation of the CY Area Required for Each Container Handling System in Mokpo New Port (목표 신항만의 터미널 운영시스템에 따른 CY 소요면적 산정에 관한 연구)

  • Keum, J.S.
    • Journal of Korean Port Research
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    • v.12 no.1
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    • pp.35-46
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    • 1998
  • The CY can be said to function in various respect as a buffer zone between the maritime and overland inflow-outflow of container. The amount of storage area needed requires a very critical appraisal at pre-operational stage. A container terminal should be designed to handle and store containers in the most efficient and economic way possible. In order to achieve this aim it is necessary to figure out or forecast numbers and types of containers to be handled, CY area required, and internal handling systems to be adopted. This paper aims to calculate the CY area required for each container handling system in Mokpo New Port. The CY area required are directly dependent on the equipment being used and the storage demand. And also the CY area required depends on the dwell time. Furthermore, containers need to be segregated by destination, weight, class, FCL(full container load), LCL(less than container load), direction of travel, and sometimes by type and often by shipping line or service. Thus the full use of a storage area is not always possible as major unbalances and fluctuations in these flow occuring all the time. The calculating CY area must therefore be taken into account in terms of these operational factors. For solving such problem, all these factors have been applied to estimation of CY area in Mokpo New Port. The CY area required in Mokpo New Port was summarized in the conclusion section.

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The Impact of the Internet Channel Introduction Depending on the Ownership of the Internet Channel (도입주체에 따른 인터넷경로의 도입효과)

  • Yoo, Weon-Sang
    • Journal of Global Scholars of Marketing Science
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    • v.19 no.1
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    • pp.37-46
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    • 2009
  • The Census Bureau of the Department of Commerce announced in May 2008 that U.S. retail e-commerce sales for 2006 reached $ 107 billion, up from $ 87 billion in 2005 - an increase of 22 percent. From 2001 to 2006, retail e-sales increased at an average annual growth rate of 25.4 percent. The explosive growth of E-Commerce has caused profound changes in marketing channel relationships and structures in many industries. Despite the great potential implications for both academicians and practitioners, there still exists a great deal of uncertainty about the impact of the Internet channel introduction on distribution channel management. The purpose of this study is to investigate how the ownership of the new Internet channel affects the existing channel members and consumers. To explore the above research questions, this study conducts well-controlled mathematical experiments to isolate the impact of the Internet channel by comparing before and after the Internet channel entry. The model consists of a monopolist manufacturer selling its product through a channel system including one independent physical store before the entry of an Internet store. The addition of the Internet store to this channel system results in a mixed channel comprised of two different types of channels. The new Internet store can be launched by the independent physical store such as Bestbuy. In this case, the physical retailer coordinates the two types of stores to maximize the joint profits from the two stores. The Internet store also can be introduced by an independent Internet retailer such as Amazon. In this case, a retail level competition occurs between the two types of stores. Although the manufacturer sells only one product, consumers view each product-outlet pair as a unique offering. Thus, the introduction of the Internet channel provides two product offerings for consumers. The channel structures analyzed in this study are illustrated in Fig.1. It is assumed that the manufacturer plays as a Stackelberg leader maximizing its own profits with the foresight of the independent retailer's optimal responses as typically assumed in previous analytical channel studies. As a Stackelberg follower, the independent physical retailer or independent Internet retailer maximizes its own profits, conditional on the manufacturer's wholesale price. The price competition between two the independent retailers is assumed to be a Bertrand Nash game. For simplicity, the marginal cost is set at zero, as typically assumed in this type of study. In order to explore the research questions above, this study develops a game theoretic model that possesses the following three key characteristics. First, the model explicitly captures the fact that an Internet channel and a physical store exist in two independent dimensions (one in physical space and the other in cyber space). This enables this model to demonstrate that the effect of adding an Internet store is different from that of adding another physical store. Second, the model reflects the fact that consumers are heterogeneous in their preferences for using a physical store and for using an Internet channel. Third, the model captures the vertical strategic interactions between an upstream manufacturer and a downstream retailer, making it possible to analyze the channel structure issues discussed in this paper. Although numerous previous models capture this vertical dimension of marketing channels, none simultaneously incorporates the three characteristics reflected in this model. The analysis results are summarized in Table 1. When the new Internet channel is introduced by the existing physical retailer and the retailer coordinates both types of stores to maximize the joint profits from the both stores, retail prices increase due to a combination of the coordination of the retail prices and the wider market coverage. The quantity sold does not significantly increase despite the wider market coverage, because the excessively high retail prices alleviate the market coverage effect to a degree. Interestingly, the coordinated total retail profits are lower than the combined retail profits of two competing independent retailers. This implies that when a physical retailer opens an Internet channel, the retailers could be better off managing the two channels separately rather than coordinating them, unless they have the foresight of the manufacturer's pricing behavior. It is also found that the introduction of an Internet channel affects the power balance of the channel. The retail competition is strong when an independent Internet store joins a channel with an independent physical retailer. This implies that each retailer in this structure has weak channel power. Due to intense retail competition, the manufacturer uses its channel power to increase its wholesale price to extract more profits from the total channel profit. However, the retailers cannot increase retail prices accordingly because of the intense retail level competition, leading to lower channel power. In this case, consumer welfare increases due to the wider market coverage and lower retail prices caused by the retail competition. The model employed for this study is not designed to capture all the characteristics of the Internet channel. The theoretical model in this study can also be applied for any stores that are not geographically constrained such as TV home shopping or catalog sales via mail. The reasons the model in this study is names as "Internet" are as follows: first, the most representative example of the stores that are not geographically constrained is the Internet. Second, catalog sales usually determine the target markets using the pre-specified mailing lists. In this aspect, the model used in this study is closer to the Internet than catalog sales. However, it would be a desirable future research direction to mathematically and theoretically distinguish the core differences among the stores that are not geographically constrained. The model is simplified by a set of assumptions to obtain mathematical traceability. First, this study assumes the price is the only strategic tool for competition. In the real world, however, various marketing variables can be used for competition. Therefore, a more realistic model can be designed if a model incorporates other various marketing variables such as service levels or operation costs. Second, this study assumes the market with one monopoly manufacturer. Therefore, the results from this study should be carefully interpreted considering this limitation. Future research could extend this limitation by introducing manufacturer level competition. Finally, some of the results are drawn from the assumption that the monopoly manufacturer is the Stackelberg leader. Although this is a standard assumption among game theoretic studies of this kind, we could gain deeper understanding and generalize our findings beyond this assumption if the model is analyzed by different game rules.

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The Effect of Structured Information on the Sleep Amount of Patients Undergoing Open Heart Surgery (계획된 간호 정보가 수면량에 미치는 영향에 관한 연구 -개심술 환자를 중심으로-)

  • 이소우
    • Journal of Korean Academy of Nursing
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    • v.12 no.2
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    • pp.1-26
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    • 1982
  • The main purpose of this study was to test the effect of the structured information on the sleep amount of the patients undergoing open heart surgery. This study has specifically addressed to the Following two basic research questions: (1) Would the structed in formation influence in the reduction of sleep disturbance related to anxiety and Physical stress before and after the operation? and (2) that would be the effects of the structured information on the level of preoperative state anxiety, the hormonal change, and the degree of behavioral change in the patients undergoing an open heart surgery? A Quasi-experimental research was designed to answer these questions with one experimental group and one control group. Subjects in both groups were matched as closely as possible to avoid the effect of the differences inherent to the group characteristics, Baseline data were also. collected on both groups for 7 days prior to the experiment and found that subjects in both groups had comparable sleep patterns, trait anxiety, hormonal levels and behavioral level. A structured information as an experimental input was given to the subjects in the experimental group only. Data were collected and compared between the experimental group and the control group on the sleep amount of the consecutive pre and post operative days, on preoperative state anxiety level, and on hormonal and behavioral changes. To test the effectiveness of the structured information, two main hypotheses and three sub-hypotheses were formulated as follows; Main hypothesis 1: Experimental group which received structured information will have more sleep amount than control group without structured information in the night before the open heart surgery. Main hypothesis 2: Experimental group with structured information will have more sleep, amount than control group without structured information during the week following the open heart surgery Sub-hypothesis 1: Experimental group with structured information will be lower in the level of State anxiety than control group without structured information in the night before the open heart surgery. Sub-hypothesis 2 : Experimental group with structured information will have lower hormonal level than control group without stuctured information on the 5th day after the open heart surgery Sub-hypothesis 3: Experimental group with structured information will be lower in the behavioral change level than control group without structured information during the week after the open heart surgery. The research was conducted in a national university hospital in Seoul, Korea. The 53 Subjects who participated in the study were systematically divided into experimental group and control group which was decided by random sampling method. Among 53 subjects, 26 were placed in the experimental group and 27 in the control group. Instruments; (1) Structed information: Structured information as an independent variable was constructed by the researcher on the basis of Roy's adaptation model consisting of physiologic needs, self-concept, role function and interdependence needs as related to the sleep and of operational procedures. (2) Sleep amount measure: Sleep amount as main dependent variable was measured by trained nurses through observation on the basis of the established criteria, such as closed or open eyes, regular or irregular respiration, body movement, posture, responses to the light and question, facial expressions and self report after sleep. (3) State anxiety measure: State Anxiety as a sub-dependent variable was measured by Spi-elberger's STAI Anxiety scale, (4) Hormornal change measure: Hormone as a sub-dependent variable was measured by the cortisol level in plasma. (5) Behavior change measure: Behavior as a sub-dependent variable was measured by the Behavior and Mood Rating Scale by Wyatt. The data were collected over a period of four months, from June to October 1981, after the pretest period of two months. For the analysis of the data and test for the hypotheses, the t-test with mean differences and analysis of covariance was used. The result of the test for instruments show as follows: (1) STAI measurement for trait and state anxiety as analyzed by Cronbachs alpha coefficient analysis for item analysis and reliability showed the reliability level at r= .90 r= .91 respectively. (2) Behavior and Mood Rating Scale measurement was analyzed by means of Principal Component Analysis technique. Seven factors retained were anger, anxiety, hyperactivity, depression, bizarre behavior, suspicious behavior and emotional withdrawal. Cumulative percentage of each factor was 71.3%. The result of the test for hypotheses show as follows; (1) Main hypothesis, was not supported. The experimental group has 282 minutes of sleep as compared to the 255 minutes of sleep by the control group. Thus the sleep amount was higher in experimental group than in control group, however, the difference was not statistically significant at .05 level. (2) Main hypothesis 2 was not supported. The mean sleep amount of the experimental group and control group were 297 minutes and 278 minutes respectively Therefore, the experimental group had more sleep amount as compared to the control group, however, the difference was not statistically significant at .05 level. Thus, the main hypothesis 2 was not supported. (3) Sub-hypothesis 1 was not supported. The mean state anxiety of the experimental group and control group were 42.3, 43.9 in scores. Thus, the experimental group had slightly lower state anxiety level than control group, howe-ver, the difference was not statistically significant at .05 level. (4) Sub-hypothesis 2 was not supported. . The mean hormonal level of the experimental group and control group were 338 ㎍ and 440 ㎍ respectively. Thus, the experimental group showed decreased hormonal level than the control group, however, the difference was not statistically significant at .05 level. (5) Sub-hypothesis 3 was supported. The mean behavioral level of the experimental group and control group were 29.60 and 32.00 respectively in score. Thus, the experimental group showed lower behavioral change level than the control group. The difference was statistically significant at .05 level. In summary, the structured information did not influence the sleep amount, state anxiety or hormonal level of the subjects undergoing an open heart surgery at a statistically significant level, however, it showed a definite trends in their relationships, not least to mention its significant effect shown on behavioral change level. It can further be speculated that a great degree of individual differences in the variables such as sleep amount, state anxiety and fluctuation in hormonal level may partly be responsible for the statistical insensitivity to the experimentation.

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Effect of Planned Nursing Intervention on the Stress, the Maternal Role Strain, and the Maternal Role Performance of Mothers of Premature Infants (계획된 간호 중재가 미숙아 어머니의 스트레스, 모성 역할 긴장과 역할 수행에 미치는 영향)

  • Joung Kyoun -Hwa
    • Child Health Nursing Research
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    • v.5 no.1
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    • pp.70-83
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    • 1999
  • The birth of a premature infant is distressing for its parents. The parents of a premature infant experience stress according to the infant's physical appearance and behavior, the environment of the neonatal intensive care unit (NICU) , and the alteration in the parental role. Especially, a mother of a premature infant feels distressed even after the discharge of the infant : therefore, she has difficulties in maternal role performance. The main purpose of this study is to identify the effects of the planned infant care information program in order to lower the stress level for mothers of premature infants caused by the birth and hospitalization in NICU of premature infants, to reduce the maternal role strain, and to promote the maternal role performance after the infants' discharge. This study employed two methods of research at the same time : quasi -experimental non-equivalent pre and post test to compare : non-equivalent post test to compare. The total number of subjects was 19 who were assigned to the research program : 12 mothers of premature infants at the NICU at the Ch university hospital and 7 at the NICU at the Y general hospital located in Chounju city. The data were collected for 79 days from August 18 to November 5, 1998. The questionnaire method was applied for the data collection, and the measures used in this study were Parental Stressor Scale : NICU(Miles, 1993), the Maternal Role Strain Measures ( Hobbs, 1968 ; Steffensmeier, 1982) , and Self Confidence Scale (Pharis, 1978). Research procedure is as follows : after preliminary examination, the experimental subjects, the mothers of premature infants at the Nl CU at Ch university hospital were provided with slide films and information developed by the researcher based on existing documents and data. It took two 60-minute sessions a week for two weeks, and the mothers' stress level was measured using the same instrument twice one week and two week after the infants' hospitalization. The stress level of the contrast subjects, the mothers at Y general hospital was measured during the same period. The experimental subjects were provided with booklets on matters that require attention after the infants' discharge and on developmental project, and they were educated to play the maternal role in person for 2-3 hours a week : breast-feeding, burping a baby, and changing diapers. One week after the infants' discharge, the maternal role strain and the maternal role performance were examined in two groups of the subjects. The analysis of collected data was done using descriptive statistics including real numbers, percentages, averages, and standard deviations. Mann-Whitney test ; x² test ; Repeated Measures Analysis of Variance ; ANCOVA Spearman's rho correlation coefficients. The results on this study were as follows. (1) The examination of the same quality showed that there were no differences in the general and obstetrical characters between the two groups. However, in terms of the characters of premature infants. just right after their birth, the infants at the contrast group weighed more than those at the experimental group(U=16.5, p=.02), and the former was in mother's womb longer than the latter(U=15.5, p=.02). (2) The stress level of the mothers provided with the plannned nursing intervention program became lower as time passed compared to the others'(F=16.61, p=.00) Even when the influence of weight at birth and the length of gestation was removed among the premature infants' characters, the mothers' stress levels made a statistical difference 2 weeks after the infants' hospitalization depending on treatment (F=8.00, p=.01) (3) The maternal role strain of the mothers provided with the planned nursing intervention program was lower than the others'(U=2.0, p=.00). Even when the influence of weight at birth and the length of gestation was removed among the premature infants' characters, the maternal role strain levels made a statistical difference 2 weeks after the infants' hospitalization, depending on treatment(F=14.72, p=.00). (4) The maternal role performance level of the mothers provided with the planned nursing program was higher than the others'(U=.0, p=.00). Even when the influence of weight at birth and the length of gestation was removed among the premature infants' characters, the mothers' stress levels made a statistical difference 2 weeks after the infants' hospitalization, depending on treatment(F=8.00, p=.01). (5) The correlation between a mother's stress level 2 weeks after her infant's hospitalization, the maternal role strain and the maternal role performance were compared : the stress and the maternal role strain were statistically irrelevant to each other(r=.33, p=.12) : the stress was found to be in inverse proportion to the maternal role performance(r=-.53, p=.02). The maternal role strain was in inverse proportion to the maternal role performance as well(r=-.50, p=.00). In conclusion, for the mothers provided with the planned nursing intervention program, their stress level was getting lower as time passed during the infants' hospitalization, their maternal role strain reduced when they took care of their infants after their discharge, and their maternal role performance level was high compared to the other mothers. Besides, the lower the stress level of mothers of premature infants was during the infants' hospitalization, the higher the maternal role performance after their discharge was. The lower maternal role strain was, the higher the maternal role performance was as well. These results of the study suggested that the nursing intervention program for the mothers of premature infants developed by the researcher would be effectively applied to nursing practice, and it would be a foundation for the development of this kind of program.

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The Effect of Pulmonary Rehabilitation in Patients with Chronic Lung Disease (만성 폐질환 환자에서의 호흡재활치료의 효과)

  • Choe, Kang Hyeon;Park, Young Joo;Cho, Won Kyung;Lim, Chae Man;Lee, Sang Do;Koh, Youn Suck;Kim, Woo Sung;Kim, Dong Soon;Kim, Won Dong
    • Tuberculosis and Respiratory Diseases
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    • v.43 no.5
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    • pp.736-745
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    • 1996
  • Background : It is known that pulmonary rehabilitation improves dyspnea and exercise tolerance in patient with chronic lung disease, although it does not improve pulmonary function. But there is a controversy whether this improvement after pulmonary rehabilitation is due to increased aerobic exercise capacity. We performed this study to evaluate the effect of pulmonary rehabilitation for 6 weeks on the pulmonary function, gas exchange, exercise tolerance and aerobic exercise capacity in patients with chronic lung disease. Methods : Pulmonary rehabilitations including education, muscle strengthening exercise and symptom-Umited aerobic exercise for six weeks, were performed in fourteen patients with chronic lung disease (COPD 11, bronchiectasis 1, IPF 1, sarcoidosis 1 ; mean age $57{\pm}4$ years; male 12, female 2). Pre- and post-rehabilitaion pulmonary function and exercise capacity were compared. Results: 1) Before the rehabilitation, FVC, $FEV_1$ and $FEF_{25-75%}$ of the patients were $71.5{\pm}6.4%$. $40.6{\pm}3.4%$ and $19.3{\pm}3.8%$ of predicted value respectively. TLC, FRC and RV were $130.3{\pm}9.3%$, $157.3{\pm}13.2%$ and $211.1{\pm}23.9%$ predicted respectively. Diffusing capacity and MVV were $59.1{\pm}1.1%$ and $48.6{\pm}6.2%$. These pulmonary functions did not change after pulmonary rehabilitation. 2) In the incremental exercise test using bicycle ergometer, maximum work rale ($57.7{\pm}4.9$) watts vs. $64.8{\pm}6.0$ watts, P=0.036), maximum oxygen consumption ($0.81{\pm}0.07$ L/min vs. $0.96{\mu}0.08$ L/min, P=0.009) and anaerobic threshold ($0.60{\pm}0.06$ L/min vs. $0.76{\mu}0.06$ L/min, P=0.009) were significantly increased after pulmonary rehabilitation. There was no improvement in gas exchange after rehabilitation. 3) Exercise endurances of upper ($4.5{\pm}0.7$ joule vs. $14.8{\pm}2.4$ joule, P<0.001) and lower extremity ($25.4{\pm}5.7$ joule vs. $42.6{\pm}7.7$ joule, P<0.001), and 6 minute walking distance ($392{\pm}35$ meter vs. $459{\pm}33$ meter, P<0.001) were significantly increased after rehabilitation. Maximum inspiratory pressure was also increased after rehabilitation ($68.5{\pm}5.4$ $CmH_2O$ VS. $80.4{\pm}6.4$ $CmH_2O$, P<0.001). Conclusion: The pulmonary rehabilitation for 6 weeks can improve exercise performance in patients with chronic lung disease.

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