Research Fields and Priority Setting for Health Sciences in Korea

This study was conducted to identify the important research fields and areas for solving current and future health care problems in Korea and to develop priorities in selected research fields and areas. Delphi technique was used to collect expert's opinion. Questionnaire surveys were carried out three rounds, and 29 panel members were invited. From second questionnaire survey, we proposed the median value of score and respondent's score in each item. Prevalence, seriousness and manageability were the main criteria to select the research fields and areas and in priority setting. In health fields, 20 research fields were selected and population, family planning, and environmental pollution were the most important research fields among them. In each research field, several research areas were selected. Because our study had 85 research areas, the priority of research areas was selected in each research fields.

An Overview of Family Planning in Korea (1961-l978)

In recent decades it has been proved that the success or failure of family planning program in developing countries has tremendous impact on the improvement of health, welfare, as well as the general socio-economic development. Therefore it is worth giving a review of family planning in Korea during the last two decades. We are happy to credit the voluntary leaders, particular1y from the public health sector of universities, who played a key pioneering role in the initiation of the organized effort and for the continued leadership in the development of the national program. The organization of 17,000 village level family planning mothers' clubs in 1968 is one of the most outstanding innovative achievements. Despite such long standing problems as very poor morale of the family planning workers, poor national health care network, and stubborn preference for boys, Korea has been fairly successful in achieving the demographic objectives by reducing the total fertility rate from 6.0 in 1960 to 2.7 in 1968, and by increasing the rate of family planning practice from 9% in 1964 to 49% in 1978.

Family Planning Program in Korea

No abstract available.

A Study of Hospital Utilization by and the Cost of Care to Patients in a Private University Hospital in Seoul, Republic of Korea, 1955-1974

In an attempt to understand the changing pattern of hospital care utilization and costs, a study was made of the medical and administrative records of 7,798 patients, who were discharged from a private, university teaching hospital in the years 1955, 1960, 1965, 1970 and 1974. An analysis of the ages of the patients who utilized the hospital, revealed little change over the study in the age distribution of female patients, but did show increases in the percentages of male patients who were under 5 and over 60 years of age. The overall average length of stay in hospital decreased continuously, from 17.1 days in 1955 to 10.4 days in 1974, and the average length of stay of those who were discharged within 90 days of admission decreased from 14.4 days in 1955 to 8.9 days in 1974. Patients who received surgical treatment remained in hospital for three to four days longer than did those who received non-surgical treatment. Obstetrical cases remained in hospital for 6.9 days in 1955, and 4.8 days in 1974. A large majority of the patients (87 - 96%) were discharged within one month of admission, and virtually all (97.5 - 99.4%) within three months. In respect to the place of residence of the patients, the data revealed that 80% were from Seoul Two-thirds of the patients from Seoul resided in districts immediately surrounding the hospital, showing that despite increasingly effective transportation facilities, hospital utilization continued to be localized to people living in areas near the institution. The study revealed little change in disease patterns over the years: the percentage of obstetrical admissions remained highest with infectious and parasitic diseases, gastrointestinal diseases, injuries, neoplasms and respiratory diseases ranking in descending order. The status of patients at time of discharge showed improvement: the recovery rate increased, and the proportion of patients who died decreased. Total hospital expenses increase 4.4 times and expenses per patient day increased 6.2 times, both results having been determined through the use of constant market prices. It is considered that the latter increase resulted primarily from intensification of medical care and shortening of the hospitalization period. Among the various components of hospital care costs, room (hotel-type) and treatment expenses remained at approximately 40%of the total, while expenses for drugs and injections were approximately 20% in each of the five years of the study. Study of the relative increase of hospital costs by component of care revealed that the highest. increases over the twenty-year period was in the cost of laboratory services, followed by drugs and injections. It would seem that these high increases resulted from rapid technological developments in diagnostic and therapeutic procedures.

Persistent Chemicals in Birds and Herbs in Korea

Measurements were made of the residual level of chlorinated hydrocarbon compound and mercury compound in the tissues of wild birds and herbs in Korea from November 1974 to August 1975. Aldrin was detected in all of the wild birds analyzed. The residue levels of aldrin varied from 0.353ppm to 16.115ppm. Among the tissues analyzed, the feathers contained the highest concentration of aldrin, but chloridane could not be detected in wild birds. The pesticides detected in wild birds were (alpha+beta)-BHC gamma-BHC, delta-BHC, heptachlor, aldrin, TDE and DDT. Dieldrin was detected only in the stomach of eastern dunlin caught at the Nakdong River basin. Residue levels of mercury were measured in all wild birds analyzed. Among tissues analyzed for mercury compound concentration, here also the feathers showed the highest level. The feathers of the eastern dunlin showed a high content of mercury compound which was 76.665 ppm at the highest level. Herbs used as material for oriental remedies were contaminated by chlorinated hydrocarbons which were (alpha+beta)-BHC, gamma-BHC, dieldrin, DDT, heptachlor, TDE, aldrin and epoxide. The insect materials from Cicadae testa, Bombycis corpus, and Scolopendia were much more contaminated by pesticides than plant materials. Herbs cultivated in arable areas were also found to be more contaminated by pesticides than wild ones. Herbs, on the whole, contained lower levels of chlorinated hydrocarbons than wild birds. The incidence of pesticide residues in natural products and in wild birds, however, should be considered as a global environmental pollution problem. The present investigation could contribute as a baseline study for the monitoring of pesticide pollution, its application and dispersal, and the hazard limit for food and human health.

The Health Post Project: An Approach to Improve Health Care Delivery at the Grass-Roots in Rural Korea

The Health Post Project in Gang Wha Gun is part of the Yonsei University Medical College's Community Health Teaching Project. Two townships, Son Won Myun and Nae Ga Myun, with a total population of 14,000 are being guided through a planned change process in order to raise health consciousness in the community based education of medical and other health manpower through demonstration of relevant community health principles and provision of entry points for applied teaching. The key to community access is provided through village based Family Health Workers (FHW) who, according to carefully designed selection procedures, functions, service package, training and implementation plan now serve as semi-independent village health representatives. The FHW is supervised by the government employed township health workers who in turn received re-orientation as multi-purpose workers. Their functions were re-designed according to project needs. Thus the government health services in the target area have been extended to the household level through FHW activities in MCH, TB care and Family Planning. The Health Post Project provides a statistically controlled environment with a base line survey and constantly incoming data. It also provides communication channels for reciprocal understanding of the health issues and problems between traditional villagers and city educated faculty and students. Moreover, the Health Post Project provides motivation for the communities to solve their health problems with existing resources to the highest degree possible. Finally, the development of grass-root level services in cooperation with the communities has potential for long term benefits. These include relevant training of health manpower regarding principles and practice of rural community health. It also includes the study and development of health manpower and service packages, streamlining of administrative and evaluation procedures, and information urgently needed for health planning.

Use of Mother's Class in Promoting IUD Acceptance and Its Effectiveness

This paper is a result of experimental studies on family planning in Koyang county, a rural setting of Korea. The Koyang experience has shown that the acceptance of IUD is heavily dependent on two factors: the distance from the village to the IUD service clinic and the extent of side reactions: and unfavorable rumors about its use in the community. While the problem of distance was solved by sending out mobile teams or by establishing new clinics in the villages, the problem of side reaction and unfavorable rumors still remained. This study was set up to see whether the organization of mothers' classes could be a means to promote the acceptance and retention of IUDs. The mothers' class was organized in each village (hamlet), and the membership was opened to every women in the village. It was hypothesized that the mothers, class with the proper educational materials will work as an adequate educational program to offset rumors and to make a favorable social climate for accepting and retaining the IUD. The field experiment was conducted according to the "before-after" design with a control group. It was found that the educational program in the mothers' class was effective in promoting the acceptance and retention of contraceptive practice, particularly the IUD.

Family Planning Programs During Last One Decade in Korea

No abstract available.

Family Planning and Maternal and Child Health

No abstract available.

A Basic Health Survey of the Yonsei Community Health Service Area, Seoul / 예방의학회지

INTRODECTION: In order to improve medical education through the introduction of a concept of comprehensive health care of a community, an area surrounding the University Campus was chosen for the Community Health Service Project. It has been on operation for last 4 years with its major emphasis on family planning services, and maternal and child health care. The major objectives of this survey at the area are to obtain: 1) The demographic data, 2) The health need and trend of medical care. 3) The attitude and practice in maternity care to be used for further improvement of the planning and the services of the project. Population and Survey Method: Out of three Dongs of the Community Health Service Area, only two Dongs namely Changchun and Yonhee were selected for the survey. Total number of households and population in the area studied was 3.683 and 21,857 respectively. An interview was performed with questionnaire schedule which was recorded by interviewers. This includes the degree of utilization of health services provided by the Community Health Service Program such as family planning, prenatal care during their last pregnancy, delivery history and complications of the delivery as well as the incidence of illnesses in general. Prior to the interview, all interviewers were trained for interviewing technique for two days. The survey was carried out during the period from October December 1967. RESUTLS: 1) Demographic Data : 41.3% of the population studied were children under age 15 and only 3.5% were over 60 years of age. Crude birth rate and crude death rate of this area studied during the period of November 1966-October 1967 were 20.5 and 7.7 respectively. Infant mortality rate during the same period was 35.9. 50.4% of the 2,832 households fell into the category of middle class, 39.8% to the lower class and 9.5% to the upper class in economic condition. 19.8% of 2,832 householders had no formal education, 22.7% primary school, and 57.5% middle or higher school education. 2) Health Status and Utilization of the Community Health Service: Those who suffered from many illnesses during the month of October, 1967 were 690(4.6% of 14,891 persons). Classification of these patients into the type of disease shown respiratory diseases 27.4%, gastrointestinal diseases 18.1%, tuberculosis 10.9%, skin and genitourethral diseases 4.5% and gynecologic patients 4.5%. Only 55.9% of the patients received medical care at hospital or doctor's clinic. But among TB and gynecologic patients, 70.7% and 72.4% were treated at medical facilities. 10.6% of 2,832 householders interviewed has ever utilized the Community Health Service Program provided by the Yonsei Medical School. Classifying these clients into the type of service, 35.9% utilized the wellbaby clinic, 31.0% the family planning clinic, 14.7% the home delivery care, and the rest utilized other services such as the premarital guidance clinic and the sanitary inspection service. 3) Maternity Care: 23.6% of 2,151 deliveries were done at medical facilities such as hospital, private clinic, while 76.4% were done at home. Acceptance rate of prenatal care was 32.6% as whole, but 49.6 of 774 women who had the prenatal care service had their deliveries at medical facility. 45.1% of total deliveries were attended by medical and or paramedical personnel. 75.8% of the deliveries of those received prenatal care were attended by medical and or paramedical personnel while only 27.8% of the deliveries of those who did not have prenatal care attended by medical and or paramedical personnel. 49.8% of deliveries of the upper class, 29.8% of the middle class and 9.9% of the lower class were attended by medical and or paramedical personnel. 6.2, 3.3% and 24.8% of mothers reported about their experience of edema, coma and fever during the period of trimester of pregnancy and puerperium. 4) Family Planning: The rate of practice of family planning was 27.9%. 31.7% of them were by IUD, 20.9% by oral pill, 15.2% by sterilization and the rest by traditional methods. Those women who had 3 to 4 children had highest(30.2%). Practice rate among the various methods of family planning, oral pill was the most popular method to whom had 2 or less children. In relation between the practicing rate of family planning and living standard, the upper, middle and lower class practiced 37.5, 29.4 and 19.9% respectively.

Improving Access to the IUD: Experiments in Koyang

The experimental study has been conducted in six townships of Koyang County, Kyonggi Province to identify more efficient methods of carrying the Intra-Uterine Device (IUD) into rural areas since May 1965, covering in all 76,810 inhabitants with 10,073 eligible women in 13,947 households. IUD acceptance rates are improved remarkably in two townships with activities of the mobile service and stationary clinic, impling that the IUD program could be intensified if IUD services are extended to the village either by mobile service or stationary services. The most of the eligible women wanting IUD in the future preferred to have IUD insertion by female physician on the before survey, but the results of the study shows no difference in IUD insertions by female and male physicians. Reasons to choose a clinic for IUD insertion are most likely to be accessibility or availability and reliability of the service with a little shyness problem. It indicates that the sex of physician inserter is not important in Korea. IUD termination rates are least for postpartum, and are trivially different between those inserted within ten days after onset of menstruation and those inserted later. IUD termination rates in terms of the qualification of inserter show that Ob-Gyn specialist is with the lowest termination rates, but it is interesting that nurse working alone with the postpartum cases did best of all and suggested that nurses can potentially insert IUD's as efficiently as do physicians if the proper training is given to them.

Study on a Method to Improve Vital Statistics and Family Planning Simultaneous1y among Maternity Cases

To demonstrate and assess the possibility of improving simultaneously vital statistics and family planning in urban and rural Korea, a action-cum-research project was conducted for a period of one year, from May 1966 to April 1967, over the area covering Kimchun city and a part of surrounding Kumnung Gun, Kyongsangpuk-do province, Korea. As the method of study, a sterilized simple delivery kit was distributed to the expectant mothers in the experimental areas, and its effects on the reporting of vital events such as births and deaths and the acceptance of family planning were compared with the same in the control areas without such an action program. A single delivery kit contained one vinyl sheet for covering and one for lying on, one cotton sheet, a pair of scissors, one foot of thread, two pieces of gauze, a piece of soap, a weight scale and one doubled envelope. From the study, the system of distributing simple hygiene delivery kits to all expectant mothers in an area is an effective method of obtaining accurate statistics of births. It is also effective in the reduction of infant mortality, which, in turn, promotes acceptance of family planning in rural Korea.

The National Family Planning Program as a Strategic Platform for the Improvement of Maternal and Child Health in Kore

The health conditions under which the mothers and children of Korea live are not adequate. We realize that the needs in the field of MCH a re enormous, but that it is unrealistic and unwise to use the entire health budget of 4.9 million dollars to build maternity and pediatric hospitals. There must be an extensive program to reduce the number of births as well as the number of deaths if the living standrds in Korea are to improve. The success of Korea's health program is closely related to the general economic development. Without a reduction in the number of births it seems impossible that a successful economic development program can be planned, or executed. In the first five years of the program the group successfully reached by the family planning program was largely the receptive, motivated women in the older child bearing age group. A strategic platform for the success of the next five year plan would be to concentrate on the younger less motivated mothers; to educate them to better family spacing and child care. Inclusion of family planning in a comprehensive, total maternal and child care program seems a rational and effective approach. Therefore a successful national family planning program would seem to be a sound basic platform on which to base maternal and child health work as well as the economic development program in Korea. We need not repeat here the merits of family planning in Korea. A1ready the national program has accomplished much towards improving the health of Korea's mothers and children. It is hoped that in the coming decade the family planning program will go beyond the immediate aim of curbing the explosive population growth and adopt as its long-term objective promotion of total maternal and chi1d health. This objective can only be achieved by good organization, careful planning, competent staff and an adequate budget. A comprehensive maternal and child health program should include better care of children, responsible parenthood, marriage guidance, maternity care, and sterility correction all leading to better mental and physical health.

A Survey of Fertility and Attitude Toward Family Planning in Rural Korea

This is a first report on an interview study of fertility and attitude toward family planning among a systematic random sample of about 1,000 couples in Korean rural area. More specifically, the authors analyzed the replies to the five important questions in fertility control; (1) the level of fertility, (2) the ideal family size, (3) the family planning limitation factors, (4) the prevalence of conception control and (5) the attitude towards the use of contraceptives. It was found that the level of reproductive performance has remained high with the total fertility rate of 7 or more, while their ideal family size revealed at the interview was 3 to 5. Such an excess fertility has not been well controlled by delaying of the age of marriage and/or by spacing birth, but the most prominent factors in limiting the family size has been the high mortality of children especially in infancy. As the infant mortality rate is declining, the family limitation is now practiced by the increasing rate of induced abortion. The practice of modern contraceptive method was low in prevalence, and if they were in use a high proportion were known to have begun the practice only after having their desired number of children(3 to 5). Family planning information was widespread and general1y accepted by the informed population. Also the majority of the respondents desired to learn (60%) and to practice (55%) the family planning. However, they were unable to practice it mainly due to the lack of detailed knowledge and instructions. This points out the need for proper education for developing the active family planning program in Korean rural area.

A Comprehensive Study of the Health Needs and of Health Care in Seoul

No abstract available.