• Journal of Hospice and Palliative Care
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• 제16권4호
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• pp.205-215
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• 2013

말기암환자들은 암의 진행으로 인한 여러 가지 육체적, 정신적 증상들로 고통 받고 있으며, 통증뿐만 아니라 피로감, 쇠약감, 식욕부진, 오심 구토, 호흡곤란 등은 말기암환자의 삶의 질 감소에 큰 영향을 미친다. 피로감은 여러 기전 및 원인에 의하여 발생하는데, 치료 가능한 원인으로는 약물부작용, 빈혈, 심한 통증, 수면장애, 우울증 또는 불안감, 영양부족, 내과적 동반질환 등이다. 피로감의 주 기전으로는 사이토카인의 조절이상 및 시상하부-뇌하수체-부신축의 기능부전, serotonin의 조절이상 생체리듬의 파괴, ATP에서의 변화 등이다. 치료는 치료 가능한 원인을 제거하고 환자의 에너지를 보존할 수 있게 하는 방향으로 활동을 계획하고, 교육해야 하며, 약물 치료로는 corticosteroid와 psychostimulants를 사용할 수 있다. 식욕부진과 악액질도 여러 가지 치료 가능한 원인이 있을 수 있는데, 구내염, 구강 캔디다증, 구강 herpes, 구강건조, 변비, 통증과 호흡곤란같이 조절이 안 되는 증상, 섬망, 오심 구토, 우울증, 위장관 운동기능 장애, 역류성 식도염, 내분비 장애가 포함 된다. 식욕부전의 기전은 음식섭취를 조절하는 뇌의 생리적 기전의 이상과 관련, serotonin 분비 증가, IL-$1{\alpha}$, IL-1, IL-6, IL-8 TNF-${\alpha}$와 관련이 있다. 악액질의 기전은 에너지와 기질(substrate metabolism)에서의 변화, 종양에서 생산된 지질분해요소와 단백질 분해요소, 호르몬 이상, 암세포로부터 세포성장에 필요한 영양분을 빼앗기는 것, 에너지 섭취의 감소 등이다. 치료는 정신과 상담 및 환자와 가족의 교육인데, 교육할 때는 환자와 그 가족에게 식욕부진과 악액질이 암으로 인한 임종과정 중 일어나는 자연적인 현상이라는 것을 알리며, 다른 행동으로 환자를 돌보는 방법 등을 교육한다. 약물치료로는 megestrol acetate와 dronabinol, steroid를 사용할 수 있다. 오심 구토의 원인 중 치료가 가능할 수도 있는 것으로는 약물, 요독증, 감염, 불안증, 변비, 상부위장관 폐쇄, 고칼슘혈증, 저나트륨증이 있고, 치료는 metoclopramide, haloperidol, olanzapine 또는 ondansetron 등을 사용해 볼 수 있다. 말기 암에서 호흡곤란의 증상은 폐의 특별한 병변이 없이도 환자가 호소할 수 있는데, 이 경우 opioids가 효과적이다. 말기 암환자에서 환자의 증상을 경감시켜주기 위한 완화치료는 매우 중요하며, 환자의 증상을 잘 평가하고 적절한 치료 및 관리를 해 줌으로써 환자의 삶의 질을 향상시킬 수 있다. 따라서 이들 환자의 증상 호소에 더욱 관심을 갖고 적극적으로 치료하고 관리하여야 할 것이다.

• 한국콘텐츠학회논문지
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• 제16권5호
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• pp.488-496
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• 2016

본 연구는 중학생들의 학교급식에 대한 만족도와 식품 기호도를 조사하여 학교급식의 질을 향상시키기 위한 기초 자료를 제공하고자, 도시 지역 중학교 1, 2학년 292명(남학생 : 152명, 여학생 : 140명)을 대상으로 설문조사 하였다. 조사 대상자는 중학교 1학년 134명, 2학년 158명 이었다. 식사준비자는 어머니가 271명(92.8%), 할머니 17명(5.8%), 아버지 4명(1.4%), 기타 17명(5.8%)이었다. 음식을 선택할 때 제일 먼저 생각하는 것은 '맛이 있는 것'(82.9%), '몸에 이로운 것'(6.5%), '영양가 높은 것'(4.5%), '색 또는 냄새가 좋은 것'(3.1%), 기타(3.1%)의 순으로 나타났다. 급식 만족도를 5점 척도로 조사하였고, 맛에 대한 만족도는 밥($3.99{\pm}0.74$), 반찬($3.99{\pm}0.65$), 국($3.61{\pm}0.86$), 김치($3.54{\pm}1.12$) 순이었고, 양에 대한 만족도는 밥($3.88{\pm}0.83$), 국($3.87{\pm}0.79$), 김치($3.80{\pm}0.89$), 반찬($3.71{\pm}0.93$) 순이었고, 종류에 대한 만족도는 반찬($4.09{\pm}0.67$), 밥($4.01{\pm}0.77$), 국($4.01{\pm}0.64$), 김치($3.84{\pm}0.86$)의 순이었다. 식품 기호도 조사 결과, 면류의 기호도가 5점 만점에 $4.32{\pm}0.72$로 가장 높고, 전과 부침류, 볶음류, 튀김류, 일품요리, 국과 탕류, 구이류, 밥류, 김치류, 조림류, 나물류 순이었다. 본 연구 결과, 학생들이 기피하는 식품에 대한 이유를 조사하여 대체 방안을 연구하고 특히 기호도가 낮은 채소류, 어패류에 대한 다양한 조리법을 개발하며, 건강한 식습관을 위한 영양교육이 요구되어진다.

• 한국과학교육학회지
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• 제35권1호
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• pp.159-167
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• 2015

RI-Biomics 기술 분야는 차세대 국가 신 성장 동력 핵심기술 중의 하나로써 전 세계적으로 비약적인 발전을 하고 있는 첨단방사선융합 분야이다. 이에 각 선진국들은 RI-Biomics 분야의 세계 경제시장에서 앞서 나가기 위하여 집중적인 지원과 부단한 노력을 기울이고 있다. 이러한 RI-Biomics 분야를 국내에서 주도하기 위해서는 세계수준에 맞는 고도의 기술력과 전문지식을 지닌 우수한 인력들의 확보가 필요하지만, 국내에서는 보유한 기술력에 비해 수행할 수 있는 전문인력들이 부족한 실정이다. 따라서 본 연구에서는 검증된 RI-Biomics 인력양성 모델을 활용하여 전문가 인터뷰와 전국 학생대상 설문조사를 반영한 최적화된 교육프로그램을 설계 및 개발함으로써 RI-Biomics 전문인력양성을 위한 기반을 구축하고자 하였다. 본 교육프로그램은 RI-Biomics 분야를 크게 4개의 분야로 구분하여 구성하였으며, 각 과정별 교육을 통하여 RI-Biomics 분야의 전반적인 과정을 이해하는데 주안점을 두고 개발되었다. 교육프로그램의 유용성 및 타당성을 검증하기 위하여 실제 유관학과 대학생 8명을 대상으로 시범운영을 실시하였으며, 한국방사선진흥협회(서울)와 한국원자력연구원 첨단방사선 연구소 RI-Biomics 센터(정읍)에서 총 3주간 진행 되었다. 세부 교육과정은 RI-Biomics 분야의 기본교육인 방사성동위원소 취급 및 안전교육 1주, 전문기술 교육인 RI-Biomics 응용기술 2주로 구성되었다. 3주간의 교육결과를 평가하기 위하여 실습일지와 개별보고서를 작성하였으며, 설문조사를 통하여 교육 만족도 및 건의사항을 수렴하였다. 본 교육프로그램 운영결과, 모든 학생들이 교육과정에 대한 높은 만족도와 지속적인 참여의사를 나타냈다. 또한 시범교육 운영 간 우수인력 발굴 및 지속적인 교육프로그램 운영을 위한 심화과정의 필요성이 제기되었다. 본 연구를 통해 제시된 교육프로그램과 운영방안은 향후 RI-Biomics 분야의 대학 교과과정 개발을 위한 기초자료로 활용될 것이며, RI-Biomics 기술 전문인력들의 양성과 국내 RI-Biomics 분야의 발전에 기여할 것이다.

• 기술혁신연구
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• 제30권2호
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• pp.29-58
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• 2022

벤처기업은 경쟁력 강화를 위한 내부 역량 구축에는 자원과 인력이 부족하기 때문에 공동연구, 네트워킹 등 외부와의 협력이 중요한 역할을 하고 있다. 이에 본 논문에서는 벤처기업의 산학협력 경험이 조직학습역량과 혁신성과에 미치는 영향에 대하여 살펴보고자 하였다. 지속적으로 확대되고 있는 정부 R&D 투자가 벤처기업과 대학의 협력을 촉진함으로써 조직학습역량을 강화하고 혁신성과를 창출하는 메커니즘을 실증 분석하였으며 연구결과는 다음과 같다. 첫째, 벤처기업의 산학협력 경험은 조직학습역량을 강화시키는 것으로 나타났다. 벤처기업은 대학과의 협력 및 자원 활용을 통해 내부 역량 강화에 중요한 역할을 하고 있음을 실증분석 한 것이다. 둘째, 벤처기업의 조직학습역량은 혁신성과에 유의한 영향을 미쳤다. 조직학습역량이 높은 조직은 새로운 아이디어를 발굴하고 공유하는 문화를 가지게 됨으로써 기업의 혁신성과 창출에도 긍정적인 역할을 하는 것으로 나타났다. 마지막으로 벤처기업 창업자의 배태조직(incubator organization)에 따른 산학협력과 조직학습역량을 분석한 결과 중소(벤처)기업 및 개인 경험 기반의 창업 그룹이 대학과의 협력을 통해 조직학습역량과 혁신성과 창출에 긍정적인 영향을 미치는 것으로 나타났다. 중소(벤처)기업과 개인기반의 창업자는 대기업, 대학 및 연구소 창업자에 비해 상대적으로 더 높은 기술역량을 보유한 대학과 협력함으로써 기업의 조직학습역량 강화에 도움을 받은 것으로 볼 수 있다. 본 연구를 통해 정부는 벤처기업의 R&D 성과를 극대화하기 위해 대학과 협력 유도하는 정책이 필요할 것이다. 물론 벤처기업과 대학에 나눠주기식 지원이 혁신성과를 저해하고 있다는 비판도 존재하지만 정부 투자는 기술 축적, 고급인력 양성, 혁신 네트워크 강화 등 무형자원 확충에 중요한 역할을 한다. 그렇기에 정부는 벤처기업의 성장을 위한 투자 전략성 강화를 위해 정부의 권한을 적절하게 활용해야 할 것이다.

• 한국항만경제학회지
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• 제23권3호
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• pp.165-184
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• 2007

본 연구에서는 한 EU FTA 협상에서 중요이슈가 되고 있는 지적 재산권으로서의 지리적 표시제에 대한 의의 및 보호체계를 검토 연구했다. 지리적 표시는 상품의 품질 등이 지리적 특성과 연계된 지리적 명칭을 지적재산권으로 보호해주는 제도이다. 19C 후반부터 이에 대한 보호노력이 여러형태로 계속되어 오다가 드디어 WTO TRIPS 협정 상에 지적 재산권 보호대상으로 규정되었고, 이에 따라 지리적표시는 양자 규범 복수규범 내지 임의 규범에서 다자 규범 의무 규범으로 발전 된 것이다. 지리적 표시는 이같이 다자규범으로 자리 잡은 후에도 특히 EU를 주도로 하여 DDA 협상에서 계속 확대 개선을 위한 논의가 활발히 이루어지고 있다. 지리적표시보호에 대한 각국의 체계 및 형태는 유사하나 크게는 EU형과 미국형이 있다. 특히 EU는 지리적 표시가 품질정책 및 공동농업정책의 근간이 되어있고 현재 남부 공업국가의 품목들이 대부분을 점하고 있는 5,000여개의 지리적 표시가 주류 및 가공식품을 중심으로 등록되어 있으며 이에 따라 지리적표시의 국제적 보호규범체계의 정립 및 확대에서 항상 주도적 입장을 유지하고 있다. 우리나라는 1997년 7월부터 농수산 품질관리법에 의한 등록제를 마련했고 2004 7월에는 상표법에 의한 지리적표시 단체장 등록제도를 도입 운영하고 있으며 이에 기초하여 40여개의 품목들이 지리적 표시품목으로 등록되어있다. 한국과 EU 간의 지리적 표시에 관련한 협상에서는 EU 측의 적극적 상호인정 요구가 추진이 예상되고 이에 따라 우리의 대응이나 전략여하가 문제된다. 물론 EU는 그 보호가 발전되어 있고 보호등록이 많으며 그것이 농업정책의 개혁과 고품질 농산물의 화대 정책의 근간을 이루고 있다는 점에서 적극적 상호인정이 쉽지 않다. 그러나 여기서 우리는 장기적 구도로 본다면 지리적 표시 보호의 상호 인정을 회피나 무조건적 거부보다는 긍정적 단계적 측면에서 조심스럽게 접근하되 국제적 규범과 조화하면서도 후속적 관리와 대응에 철저한 이른바 전략적 수용과 대비를 고려할 수 있을 것이다. 특히 우리의 지리적표시제는 우리 농산물만의 특성에 따른 품질 향상과 경쟁력 강화 및 고 부가치 전략 구축에 결정적이고도 중요한 요인이 될 수 있다는 강점도 있다는 점이다. 정부와 농업인의 지혜를 모아 지리적 표시로 등록된 40여개 품목에 대한 지속적 품질개선은 물론 타 농산물 및 식품의 지속적 표시확대 그리고 특성화에로의 개발전략 등으로 EU시장에 과감히 진출할 경우 유럽시장에의 우리의 접근성 창출성이 크게 증폭 될 것이다.

• 한국터널지하공간학회 논문집
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• 제23권6호
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• pp.469-484
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• 2021

터널 설계 시 지반조사를 통한 암반분류 결과는 공사기간 및 공사비 산출, 그리고 터널안정성 평가에 지대한 영향을 미친다. 국내에서 지금까지 완공된 3,526개소의 터널들의 설계 및 시공을 통해 관련 기술들은 지속적으로 발전되어 왔지만, 터널 설계 시 암질 및 암반등급을 보다 정확하게 평가하기 위한 방법에 대한 연구는 미미하여 평가자의 경험 및 주관에 따라 결과의 차이가 큰 경우가 적지 않다. 따라서 본 연구에서는 암석샘플에 대한 주관적 평가를 통한 기존의 인력에 의한 암반분류 대신, 최근 지반분야에서도 그 활용도가 급증하고 있는 머신러닝 알고리즘을 이용하여 시추조사에서 획득한 다양한 암석 및 암반정보를 분석하여 보다 신뢰성있는 RMR에 의한 암반분류 모델을 제시하고자 하였다. 국내 13개 터널을 대상으로 11개의 학습 인자(심도, 암종, RQD, 전기비저항, 일축압축강도, 탄성파 P파속도 및 S파 속도, 영률, 단위중량, 포아송비, RMR)를 선정하여 337개의 학습 데이터셋과 60개의 시험 데이터셋을 확보하였으며, 모델의 예측성능을 향상시키기 위해 6개의 머신러닝 알고리즘(DT, SVM, ANN, PCA & ANN, RF, XGBoost)과 각 알고리즘별 다양한 초매개변수(hyperparameter)를 적용하였다. 학습된 모델의 예측성능을 비교한 결과, DT 모델을 제외한 5개의 머신러닝 모델에서 시험데이터에 대한 RMR 평균절대오차 값이 8 미만으로 수렴되었으며, SVM 모델에서 가장 우수한 예측성능을 나타내었다. 본 연구를 통해 암반분류 예측에 대한 머신러닝 기법의 적용 가능성을 확인하였으며, 향후 다양한 데이터를 지속적으로 확보하여 예측모델의 성능을 향상시킨다면 보다 신뢰성 있는 암반 분류에 활용될 수 있을 것으로 기대된다.

• 한국심리학회지 : 문화 및 사회문제
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• 제12권5호_spc
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• pp.45-79
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• 2006

필자와 공동연구자들(2002)이 선행연구에서 개발한 주관안녕척도를 사용하여 한국문화에서 주관안녕에 영향을 미치는 변인들을 알아낸 연구 결과들을 개관하고, 국내외 연구들과 비교하여 시사점을 논의하고, 장래 연구할 과제들도 제안하였다. 먼저 주관안녕에 영향을 미치는 선행요인들로 ① 개인차와 인구통계 변인들, ② 개인과정 요인들, ③ 대인과정 요인들 및 ④ 한국문화의 요인으로 사회규범에 따른 행동을 다룬 연구 결과들을 개관했다. 또한 노인을 대상으로 주관안녕이 동시점에서 신체건강의 예측에 기여하는 수준과 아울러 1년 이상이 경과한 시점에서 종단적으로 신체건강이나 생사에 어떤 영향을 미치는지도 알아냈다. 본 논문은 한국문화에서 필자와 공동연구자들이 수행한 실증연구의 결과들과 연결시켜서 주관안녕을 연구하는데 따르는 이론, 방법 및 과제들을 구체적으로 논의함으로써 장차 문화비교 연구와 아울러 국내 연구에 시사점들을 제시한데 의의가 있다.

• Journal of the Korean Wood Science and Technology
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• 제2권4호
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• pp.4-14
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• 1974

The total forest land area in Korea accounts for some 67 percent of the nation's land total. Its productivity, however, is very low. Consequently, forest production accounts for only about 2 percent of the gross national product and a minor proportion of no more than about 5 percent versus primary industry. In this case, however, only the direct income from forestry is taken into account, making no reference to the forestry output induced by other industrial sectors. The value added Or the induced forestry output in manufacturing the primary wood products into higher quality products, makes a larger contribution to the economy than direct contribution. So, this author has tried to analyze the structure of forestry and compute the repercussion effect and the induced output of primary forest products when utilized by other industries for their raw materials, Hsing the input-output table and attached tables for 1963 and 1966 issued by the Bank of Korea. 1. Analysis of forestry structure A. Changes in total output Durng the nine-year period, 1961-1969, the real gross national product in Korea increased 2.1 times, while that of primary industries went up about 1. 4 times. Forestry which was valued at 9,380 million won in 1961, was picked up about 2. 1 times to 20, 120 million won in 1969. The rate of the forestry income in the GNP, accordingly, was no more than 1.5 percent both in 1961 and 1962, whereas its rate in primary industries increased 3.5 to 5.4 percent. Such increase in forestry income is attributable to increased forest production and rise in timber prices. The rate of forestry income, nonetheless, was on the decrease on a gradual basis. B. Changes in input coefficient The input coefficient which indicates the inputs of the forest products into other sectors were up in general in 1966 over 1963. It is noted that the input coefficient indicating the amount of forest products supplied to such industries closely related with forestry as lumber and plywood, and wood products and furniture, showed a downward trend for the period 1963-1966. On the other hand, the forest input into other sectors was generally on the increase. Meanwhile, the input coefficient representing the yolume of the forest products supplied to the forestry sector itself showed an upward tendency, which meant more and more decrease in input from other sectors. Generally speaking, in direct proportion to the higher input coefficient in any industrial sector, the reinput coefficient which denotes the use of its products by the same sector becomes higher and higher. C. Changes in ratio of intermediate input The intermediate input ratio showing the dependency on raw materials went up to 15.43 percent m 1966 from 11. 37 percent in 1963. The dependency of forestry on raw materials was no more than 15.43 percent, accounting for a high 83.57 percent of value added. If the intermediate input ratio increases in any given sector, the input coefficient which represents the fe-use of its products by the same sector becomes large. D. Changes in the ratio of intermediate demand The ratio of the intermediate demand represents the characteristics of the intermediary production in each industry, the intermediate demand ratio in forestry which accunted for 69.7 percent in 1963 went up to 75.2 percent in 1966. In other words, forestry is a remarkable industry in that there is characteristics of the intermediary production. E. Changes in import coefficient The import coefficient which denotes the relation between the production activities and imports, recorded at 4.4 percent in 1963, decreased to 2.4 percent in 1966. The ratio of import to total output is not so high. F. Changes in market composition of imported goods One of the major imported goods in the forestry sector is lumber. The import value increased by 60 percent to 667 million won in 1966 from 407 million won in 1963. The sales of imported forest products to two major outlets-lumber and plywood, and wood products and furniture-increased to 343 million won and 31 million won in 1966 from 240million won and 30 million won in 1963 respectively. On the other hand, imported goods valued at 66 million won were sold to the paper products sector in 1963; however, no supply to this sector was recorded in 1963. Besides these major markets, primary industries such as the fishery, coal and agriculture sectors purchase materials from forestry. 2. Analysis of repercussion effect on production The repercussion effect of final demand in any given sector upon the expansion of the production of other sectors was analyzed, using the inverse matrix coefficient tables attached to the the I.O. Table. A. Changes in intra-sector transaction value of inverse matrix coefficient. The intra-sector transaction value of an inverse matrix coefficient represents the extent of an induced increase in the production of self-support products of the same sector, when it is generated directly and indirectly by one unit of final demand in any given sector. The intra-sector transaction value of the forestry sector rose from 1.04 in 1963 to 1, 11 in 1966. It may well be said, therefore, that forestry induces much more self-supporting products in the production of one unit of final demand for forest products. B. Changes in column total of inverse matrix coefficient It should be noted that the column total indicates the degree of effect of the output of the corresponding and related sectors generated by one unit of final demand in each sector. No changes in the column total of the forestry sector were recorded between the 1963 and 1966 figures, both being the same 1. 19. C. Changes in difference between column total and intra-sector transaction amount. The difference between the column total and intra-sector transaction amount by sector reveals the extent of effect of output of related industrial sector induced indirectly by one unit of final demand in corresponding sector. This change in forestry dropped remarkable to 0.08 in 1966 from 0.15 in 1963. Accordingly, the effect of inducement of indirect output of other forestry-related sectors has decreased; this is a really natural phenomenon, as compared with an increasing input coefficient generated by the re-use of forest products by the forestry sector. 3. Induced output of forestry A. Forest products, wood in particular, are supplied to other industries as their raw materials, increasng their value added. In this connection the primary dependency rate on forestry for 1963 and 1966 was compared, i. e., an increase or decrease in each sector, from 7.71 percent in 1963 to 11.91 percent in 1966 in agriculture, 10.32 to 6.11 in fishery, 16.24 to 19.90 in mining, 0.76 to 0.70 in the manufacturing sector and 2.79 to 4.77 percent in the construction sector. Generally speaking, on the average the dependency on forestry during the period 1963-1966 increased from 5.92 percent to 8.03 percent. Accordingly, it may easily be known that the primary forestry output induced by primary and secondary industries increased from 16, 109 million won in 1963 to 48, 842 million won in 1966. B. The forest products are supplied to other industries as their raw materials. The products are processed further into higher quality products. thus indirectly increasing the value of the forest products. The ratio of the increased value added or the secondary dependency on forestry for 1963 and 1966 showed an increase or decrease, from 5.98 percent to 7.87 percent in agriculture, 9.06 to 5.74 in fishery, 13.56 to 15.81 in mining, 0.68 to 0.61 in the manufacturing sector and 2.71 to 4.54 in the construction sector. The average ratio in this connection increased from 4.69 percent to 5.60 percent. In the meantime, the secondary forestry output induced by primary and secondary industries rose from 12,779 million Wall in 1963 to 34,084 million won in 1966. C. The dependency of tertiary industries on forestry showed very minor ratios of 0.46 percent and 0.04 percent in 1963 and 1966 respectively. The forestry output induced by tertiary industry also decreased from 685 million won to 123 million won during the same period. D. Generally speaking, the ratio of dependency on forestry increased from 17.68 percent in 1963 to 24.28 percent in 1966 in primary industries, from 4.69 percent to 5.70 percent in secondary industries, while, as mentioned above, the ratio in the case of tertiary industry decreased from 0.46 to 0.04 percent during the period 1963-66. The mining industry reveals the heaviest rate of dependency on forestry with 29.80 percent in 1963 and 35.71 percent in 1966. As it result, the direct forestry income, valued at 8,172 million won in 1963, shot up to 22,724 million won in 1966. Its composition ratio lo the national income rose from 1.9 percent in 1963 to 2.3 per cent in 1966. If the induced outcome is taken into account, the total forestry production which was estimated at 37,744 million won in 1963 picked up to 105,773 million won in 1966, about 4.5 times its direct income. It is further noted that the ratio of the gross forestry product to the gross national product. rose significantly from 8.8 percent in 1963 to 10.7 percent in 1966. E. In computing the above mentioned ratio not taken into consideration were such intangible, indirect effects as the drought and flood prevention, check of soil run-off, watershed and land conservation, improvement of the people's recreational and emotional living, and maintenance and increase in the national health and sanitation. F. In conclusion, I would like to emphasize that the forestry sector exercices an important effect upon the national economy and that the effect of induced forestry output is greater than its direct income.

• Journal of Preventive Medicine and Public Health
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• 제20권1호
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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.

• 농촌의학ㆍ지역보건
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• 제1권1호
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• pp.5-9
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• 1976

The categories of national health problems may be mainly divided into health promotion, problems of diseases, and population-economic problems which are indirectly related to health. Of them, the problems of diseases will be exclusively dealt with this speech. Rurality and Disease Problems There are many differences between rural and urban areas. In general, indicators of rurality are small size of towns, dispersion of the population, remoteness from urban centers, inadequacy of public transportation, poor communication, inadequate sanitation, poor housing, poverty, little education lack of health personnels and facilities, and in-accessibility to health services. The influence of such conditions creates, directly or indirectly, many problems of diseases in the rural areas. Those art the occurrence of preventable diseases, deterioration and prolongation of illness due to loss of chance to get early treatment, decreased or prolonged labour force loss, unnecessary death, doubling of medical cost, and economic loss. Some Considerations of Innovative Approach The followings art some considerations of innovative approaches to the problems of diseases in the rural Korea. 1. It would be essential goal of the innovative approaches that the damage and economic loss due to diseases will be maintained to minimum level by minimizing the absolute amount of the diseases, and by moderating the fee for medical cares. The goal of the minimization of the disease amount may be achieved by preventive services and early treatment, and the goal of moderating the medical fee may be achieved by lowering the prime cost and by adjusting the medical fees to reasonable level. 2. Community health service or community medicine will be adopted as a innovative means to disease problems. In this case, a community is defined as an unit area where supply and utilization of primary service activities can be accomplished within a day. The essential nature o the community health service should be such activities as health promotion, preventive measures, medical care, and rehabilitation performing efficiently through the organized efforts of the residents in a community. Each service activity should cover all members of the residents in a community in its plan and performance. The cooperation of the community peoples in one of the essential elements for success of the service program, The motivations of their cooperative mood may be activated through several ways: when the participation of the residents in service program of especially the direct participation of organized cooperation of the area leaders art achieved through a means of health education: when the residents get actual experience of having received the benefit of good quality services; and when the health personnels being armed with an idealism that they art working in the areas to help health problems of the residents, maintain good human relationships with them. For the success of a community health service program, a personnel who is in charge of leadership and has an able, a sincere and a steady characters seems to be required in a community. The government should lead and support the community health service programs of the nation under the basis of results appeared in the demonstrative programs so as to be carried out the programs efficiently. Moss of the health problems may be treated properly in the community levels through suitable community health service programs but there might be some problems which art beyond their abilities to be dealt with. To solve such problems each community health service program should be under the referral systems which are connected with health centers, hospitals, and so forth. 3. An approach should be intensively groped to have a physician in each community. The shortage of physicians in rural areas is world-wide problem and so is the Korean situation. In the past the government has initiated a system of area-limited physician, coercion, and a small scale of scholarship program with unsatisfactory results. But there might be ways of achieving the goal by intervice, broadened, and continuous approaches. There will be several ways of approach to motivate the physicians to be settled in a rural community. They are, for examples, to expos the students to the community health service programs during training, to be run community health service programs by every health or medical schools and other main medical facilities, communication activities and advertisement, desire of community peoples to invite a physician, scholarship program, payment of satisfactory level, fulfilment of military obligation in case of a future draft, economic growth and development of rural communities, sufficiency of health and medical facilities, provision of proper medical care system, coercion, and so forth. And, hopefully, more useful reference data on the motivations may be available when a survey be conducted to the physicians who are presently engaging in the rural community levels. 4. In communities where the availability of a physician is difficult, a trial to use physician extenders, under certain conditions, may be considered. The reason is that it would be beneficial for the health of the residents to give them the remedies of primary medical care through the extenders rather than to leave their medical problems out of management. The followings are the conditions to be considered when the physician extenders are used: their positions will be prescribed as a temporary one instead of permanent one so as to allow easy replacement of the position with a physician applicant; the extender will be under periodic direction and supervision of a physician, and also referral channel will be provided: legal constraints will be placed upon the extenders primary care practice, and the physician extenders will used only under the public medical care system. 5. For the balanced health care delivery, a greater investment to the rural areas is needed to compensate weak points of a rurality. The characteristics of a rurality has been already mentioned. The objective of balanced service for rural communities to level up that of urban areas will be hard to achieve without greater efforts and supports. For example, rural communities need mobile powers more than urban areas, communication network is extremely necessary at health delivery facilities in rural areas as well as the need of urban areas, health and medical facilities in rural areas should be provided more substantially than those of urban areas to minimize, in a sense, the amount of patient consultation and request of laboratory specimens through referral system of which procedures are more troublesome in rural areas, and more intensive control measures against communicable diseases are needed in rural areas where greater numbers of cases are occurred under the poor sanitary conditions.