가나의 국가개발계획과 대외원조 우선순위의 일치성 고찰: 미국과 중국 비교분석

학위논문(석사) -- 서울대학교대학원 : 국제대학원 국제학과(국제협력전공), 2023. 8. 김태균.This research examines the extent to which U.S. and Chinese foreign aid align with Ghana's national development plan and the practices employed by the donors to bridge gaps in aid alignment, drawing valuable lessons for future aid practices. The research methodology involves analyzing government official documents, policy papers, key informant interviews, and aid data from the U.S., China, and Ghana. The study finds that both the U.S. and China have made efforts to align their aid priorities with Ghana's national development plan, although some deviations exist. The U.S. has prioritized sectors such as agriculture, health, and education, closely aligning with Ghana's development priorities in these areas. China has shown a strategic interest in infrastructure and information and communication technology (ICT), which aligns with Ghana's focus on infrastructure development. Despite slight non-alignment in certain sectors, the overall alignment between the aid priorities of the U.S. and China and Ghana's national development plan is noteworthy. Ghana's diverse aid sources have mitigated the impact of these deviations, and the volume of non-alignment aid is relatively small, ensuring aid effectiveness. To bridge gaps in aid alignment, the U.S. employs a collaborative approach by working closely with the Ghanaian government to ensure their Country Development Cooperation Strategies align with Ghanas national development plan. China, despite its own strategic interests, makes efforts to align aid with Ghana's development priorities by utilizing both top-down and bottom-up aid decision making processes and Corporate Social Responsibility (CSR) programs. These strategies and practices enhance alignment and demonstrate the commitment of both donors to Ghana's development.본 연구는 미국과 중국의 대외원조가 가나의 국가개발계획에 일치하는 정도와 원조불일치 격차를 해소하기 위해 공여국들이 사용하는 전략을 조사하여 향후 원조 실행에 대한 교훈을 도출한다. 연구방법론에는 미국, 중국, 가나의 정부 공문서, 정책 문서, 핵심정보원 인터뷰, 원조 데이터 등을 분석한 것이 포함된다. 이 연구는 약간의 원조 편차에도 불구하고, 미국과 중국 모두 대외원조 우선순위를 가나의 국가개발계획에 맞추기 위해 노력했다는 것을 발견했다. 미국은 농업, 보건, 교육과 같은 분야에 우선순위를 두었으며, 이 분야들은 모두 가나의 개발 우선순위와 밀접하게 일치한다. 중국은 인프라와 정보통신기술(ICT)에 전략적인 관심을 보여왔으며, 이는 가나의 인프라 개선 계획과 일치한다. 특정 분야에서 약간의 원조일치 편차가 있음에도 불구하고, 미국과 중국의 대외원조 우선순위와 가나의 국가개발계획 사이의 전반적인 일치는 주목할 만하다. 가나의 대외원조 다각화는 이러한 편차의 영향을 완화시켰고, 원조불일치 양은 상대적으로 적어 원조효과를 보장하였다. 미국은 원조불일치의 격차를 해소하기 위해 가나 정부와 긴밀히 협력하여 원조 우선순위가 국가개발계획과 일치하도록 보장할 수 있게 협력적인 접근 방식을 채택하고 있다. 중국은 자국의 전략적 이익에도 불구하고 탑다운 및 바텀업 원조 의사결정 프로세스와 기업의 사회적 책임 (CSR) 프로그램을 모두 활용하여 원조를 가나의 개발계획과 맞추기 위해 노력했다. 이러한 전략과 실행은 원조일치를 강화하고 가나의 발전에 대한 두 공여국의 노력을 보여준다.Abstract Table of Contents List of Figures List of Tables I. Introduction 1 II. Literature Review 4 1. Aid Effectiveness 4 2. Donor-Recipient Relations 6 3. Foreign Aid and Ghanas Development 7 III. Research Design 10 1. Motivation 10 2. Case Selection 11 3. Research Questions and Hypotheses 12 4. Analytical Framework 13 5. Research Methodology 14 IV. U.S. Aid Priorities in Ghana 17 1. Historical Overview of the U.S. Engagement with Ghana 17 2. U.S. ODA Characteristics 18 3. U.S. ODA Priorities 20 V. Chinas Aid Priorities in Ghana 26 1. Historical Overview of Chinas Engagement with Ghana 26 2. Chinas Foreign Aid Characteristics 28 3. Chinas Foreign Aid Priorities 30 VI. Ghanas National Development Priorities 35 1. Ghanas Transition to Lower-Middle Income Country and the Vision for Beyond Aid 35 2. National Development Programme Priorities 37 3. The Way Forward: Ghanas Long-Term Development Plan 42 VII. Donors Aid Alignment with Ghanas National Development Priorities and Alignment Strategies 45 1. Alignment analysis 45 2. Ghanas Strategies for Aid Received 52 3. Donors' Strategies for Alignment 55 VIII. Conclusion 58 Bibliography 66 국문초록 71석

야간 근무자의 수면 장애에 대한 비약물적 중재의 효과: 체계적 문헌고찰 및 메타분석

학위논문(박사)--서울대학교 대학원 :간호대학 간호학과,2019. 8. 최스미.야간 근무자는 일주기 불균형으로 인하여 일반 낮 근무자에 비해 수면 장애가 심한 것으로 보고되었으며, 이는 심혈관 질환, 비만, 암, 우울증 및 비만과 같은 신체적, 정신적 건강 문제와 연관성이 있는 것으로 알려져 있다. 2007년 국제 암 연구 기관 (International Agency for Cancer)이 야간 근무를 포함하는 교대 근무가 발암 가능성이 있는 것으로 분류 한 이후, 많은 연구자들은 야간 근무자들을 대상으로 비약물적 수면 중재 효과를 조사하기 위한 임상 실험을 실시했다. 여러 비약물적 수면 중재 효과를 평가한 연구는 많음에도 불구하고 이러한 중재를 종합적으로 검토하고 효과의 크기를 분석한 연구가 부족한 실정이다. 따라서 본 연구는 체계적 문헌고찰 및 메타분석을 통해 그 동안 축적된 야간 근무자를 대상으로 수면 장애를 해결하기 위한 비약물적 중재를 실시한 연구를 평가, 종합, 분석하여 과학적인 근거를 제시하고자 시도되었다. 본 연구의 설계, 수행, 보고의 전 단계는 중재연구에서의 메타분석 가이드라인인 PRISMA를 적용하여 확인하는 과정을 거쳤으며, 계획 단계에서 연구의 주요 질문 및 선택 기준은 PICOTS-SD를 기반으로 선정하였다. PICOTS-SD의 각 구성 요소를 나타내는 주요 개념어는 중심 주제어와 자연어를 사용하여 MEDLINE, EMBASE, CINAHL, PsychINFO 검색엔진, 수면 관련 국제 저널 및 회색 문헌을 검색하였다. 본 연구에서 문헌의 질과 잠재적 비뚤림 평가는 Cochrane Risk of Bias 도구를 활용하여 시행하였다. 선택배제 기분에 따라 총 28편의 문헌이 추출되었으며, 그 중 20 편의 문헌이 메타분석에 포함되었다. 랜덤효과모형을 이용하여 전반적인 수면 장애에 대한 비약물적 중재의 효과 크기, 수면 장애 종류에 따른 비약물적 중재의 효과 크기, 비약물적 중재 방법에 따른 효과 크기 및 직업 종류에 따른 효과 크기를 산출하였다. 메타분석 결과, 야간 근무자의 수면 장애에 대한 비약물적 중재의 효과 크기는 Hedges g -1.43 (95%CI: -2.34, -0.53)로 통계적으로 유의한 것으로 나타났다. 수면 장애 종류별로 분석한 결과, 근무 중 졸림 (Hedges g= -2.83, 95% CI: -4.55, -1.10), 수면의 양 (Hedges g= 0.76, 95% CI: 0.15, 1.37), 수면의 질 shift (Hedges g= -0.57, 95% CI: -0.81, -0.34)로 통계적으로 유의한 효과 크기를 나타냈다. 비약물적 중재 방법 중 빛 요법 (Hedges g= -1.62, 95% CI: -2.81, -0.43)은 통계적으로 유의한 효과 크기를 나타냈으나, 근무 중 낮잠과 행동 중재 프로그램은 통계적으로 유의한 효과를 나타내지 않았다. 직업 종류에 따른 분석 결과, 의료계에 종사하는 야근 근무자와 산업 및 제조업에 종사하는 야간 근무자에게서 비약물적 중재는 유의한 효과를 나타냈다. 본 연구의 결과는 야간 근무자의 수면 장애 완화에 비약물적 중재가 유의한 효과가 있음을 시사한다. 또한, 수면 장애 완화 효과는 의료계, 산업 및 제조업에 종사하는 야간 근무자에게 빛 요법을 적용했을 때 가장 큰 것으로 보인다. 본 연구 결과는 야간 근로자의 수면 장애 예방 및 완화에 다양한 비약물적 중재가 효과적임을 확인함으로써, 실무에서 야간 근로자를 위한 중재를 선택하고 실행하는 데 객관적은 증거를 제공할 수 있을 것이다.Sleep disturbances are notorious among night workers and remain as a popular target of research. Various adverse physiological and psychological problems in night workers are associated with sleep disturbances caused by chronic exposure to circadian misalignment. In 2007, the International Agency for Research on Cancer classified shift work including night work as a probable human carcinogen. Since then, researchers have conducted trials to investigate effects of various interventions in mitigating sleep problems. Although many have evaluated different sleep-mediating methods, there is a lack of study that summarizes currently existing interventions applicable to night workers and provides a pooled effect size of the interventions. Therefore, the primary objective of this systematic review and meta-analysis was to critically review and synthesize exiting literature on the impact of non-pharmacological interventions implemented among night workers in mitigating and decreasing sleep disturbances. A systematic review was performed following the PRISMA reporting guideline. The leading study question and the selection criteria were developed using PICOTS-SD framework. MeSH terms, EMTREE terms, CINAHL headings and keywords representing each component of PICOTS-SD were selected to conduct a rigorous literature search using MEDLINE, EMBASE, CINAHL Plus with Full Text, PsycINFO databases, internationally renowned journals and grey literature. Cochrane Risk of Bias tool was used to evaluate study quality and to identify potential risk of biases. Of the 3,093 retrieved articles, 28 met our inclusion and exclusion criteria. Of these, 20 were included in the meta-analysis. We identified 6 non-pharmacological interventional methods: controlled light exposure, short-wavelength light protection, strategic naps, shift schedule modification, behavioral training and aromatherapy. Overall, non-pharmacological interventions had a significantly therapeutic effect on sleep disturbances in night workers compared to the control group who did not receive any treatment (Hedges g= -1.43, 95% CI: -2.34, -0.53). The interventions showed significant effects on reducing sleepiness on-shift (Hedges g= -2.83, 95% CI: -4.55, -1.10), increasing sleep length off-shift (Hedges g= 0.76, 95% CI: 0.15, 1.37) and sleep quality off-shift (Hedges g= -0.57, 95% CI: -0.81, -0.34) with medium to large effect sizes. Subgroup analysis based on the intervention types showed controlled light exposure to have a significant effect on reducing sleep disturbances (Hedges g= -1.62, 95% CI: -2.81, -0.43). However, the effects of strategic naps and behavioral training were not significant. Non-pharmacological interventions showed a significant effect in night workers engaged in healthcare industries (Hedges g= -1.28; 95% CI -2.48 to -0.07) and industrial or manufacturing industries (Hedges g= -2.74; 95% CI -4.65 to -0.83). The findings of the current study suggest non-pharmacological interventions to be favorable in mitigating sleep disturbances in night workers, with greatest impact apparent for sleepiness on-shift. The effect seems to be greatest when using the controlled light exposure intervention on night workers engaged in healthcare, industrial and manufacturing occupations. Our findings provide an objective and supporting evidence to incorporate various non-pharmacological interventions in improving sleep health among night workers. We also suggest further research to identify potential modifying factors and to establish optimal combination of strategies best suitable for real-world night work setting.ABSTRACT i CHAPTER I. INTRODUCTION 1 1. Background 1 2. Purpose 5 3. Terminology 6 CHAPTER II. LITERATURE REVIEW 9 1. Night work and sleep physiology 9 2. Night work and health 10 3. Night work adaptation 12 CHAPTER III. CONCEPTUAL FRAMEWORK 14 CHAPTER IV. METHODOLOGY 15 1. Study design 15 2. Study question and selection criteria 15 3. Search sources and strategy 20 4. Study selection 22 5. Data extraction 23 6. Assessment of risk of bias 24 7. Statistical analysis 25 8. Ethical consideration 30 CHAPTER V. RESULTS 31 1. Study selection 31 2. General description of included studies 33 3. Non-pharmacological interventions 34 4. Risk of bias within the included studies 47 5. Quantitative synthesis results 49 CHAPTER VI. DISCUSSION 70 1. Effect of non-pharmacological interventions on sleep disturbances 71 2. Effect of controlled light exposure on sleep disturbances 72 3. Effect of strategic naps on sleep disturbances 73 4. Effect of behavioral training on sleep disturbances 75 5. Effect of non-pharmacological on occupation types 77 6. Limitations 78 7. Significance of research 79 CHAPTER VII. CONCLUSIONS & RECOMMENDATIONS 81 REFERENCES 82 APPENDIXES 109 국문 초록 209Docto

Lifestyle patterns, dietary intakes and body compositions of Korean female nursing students and their relations to bone mineral density

학위논문 (석사)-- 서울대학교 대학원 : 간호학과, 2014. 2. 최스미.Osteoporosis is one of the leading global health problems with no definitive cure available. It is usually diagnosed when one has fracture due to dramatically decreased bone mineral density (BMD). Peak bone mass (PBM) is established during ones late-20s. Once PBM is reached, the BMD slowly deteriorates over lifetime period. Therefore, an effort to maximize PBM should be established for osteoporosis prevention. It has been reported that lifestyle patterns, dietary intakes and body compositions have effects on BMD formation. Therefore, this study aims to describe Korean female nursing students current BMD, lifestyle patterns, dietary intakes, body compositions and their relations to BMD. A total of 160 female students attending to a nursing school at a college in Seoul, Korea were evaluated. Data collection took place from June 10th to October 25th of 2013. An ultrasonometer was used to determine BMD, one-on-one interview, survey, 24-hour recall and food diary methods were used to determine general characteristics, past and current lifestyle patterns and dietary intakes. An InBody 720 machine was used to analyze body compositions. Data were analyzed using Windows SPSS 20.0 program. The results are as of the followings: The average BMD (t-score) of the students was 0.37 (±1.26), and among these students 128 (80%) was in the normal range and 32 (20%) were in the below the normal range. Currently, 59 students (36.9%) were involved in regular exercise, and they spend about 1.25 (±1.58) times per week on exercising and spent 11.6 (±9.17) hours per week on outdoor activities. When students were divided into a high frequency group (>5h/wk) and a low frequency group (≤5h/wk) according to their past and current exercise hours, the number of students in the high frequency group were as of the followings: elementary school (71, 44.4%), middle school (43, 26.9%), high school (22, 13.8%) and current (24, 15%). Students were divided into 3 groups according to the analysis of their food diaries: adequate, deficient and excessive. A total of 137 (85.6%) students had excessive sodium intakes and 86 (53.8%) had excessive cholesterol intakes. However, 109 (68.1%) had adequate fiber intake and 81 (50.6%) had adequate vitamin C intakes. Vitamin D deficiency was noted in 104 (65%) students, and calcium deficiency was noted in 84 (52.5%) students. As for the body composition, the average BMI of the students, an indicative of their nutritional status, was 21.3kg/m2 (±1.97). The students were divided into 3 groups according to their BMIs: normal (115, 71.8%), underweight (11, 6.9%) and overweight (34, 21.3%). When the students were divided into normal BMD and below the normal BMD groups, variables that showed significant findings are as of the followings. Among lifestyle patterns, weekly exercise frequency (p=.05) and daily caffeine consumption (p=.07) showed significant differences between the groups. Also, weekly exercise hours during elementary school (p=.07), milk consumption during high school (p=.05) and current days (p=.02), and current breakfast consumption (p=.07) showed significant BMD differences. Only vitamin B5 (p=.07) and copper (p=.03) were significant among nutrients analyzed from the dietary intakes. As for the body compositions, BMI (p=.06) and height (p=.03) showed significant differences. This study showed that despite the fact that exercise frequency and caffeine consumption have effects on BMD, a large number of Korean female nursing students were not engaged in regular exercise and were consuming about 2 cups of caffeine daily. Although past and current milk intakes have a positive effect on BMD, our subjects showed a decreasing trend in milk consumption as they progressed from childhood into the adulthood. More than half of the subjects had excessive intakes of sodium and cholesterol that are known to have negative effects on general health. Also, more than half of the subjects had deficiency in vitamin D and calcium intakes. Therefore, in order to strengthen Korean female college students BMD, there is a need for comprehensive interventional programs that reinforces regular exercise, reduces caffeine, sodium and cholesterol intakes, and increases milk, breakfast, vitamin D and calcium intakes.I. Introduction 1 1.Research purpose 4 2.Terminology 5 II. Literature review 8 1.The importance of BMD in young females 8 2. Lifestyle patterns, dietary intakes, nutritional status and body compositions that influence the BMD of female college students 9 III. Method 12 1. Design 12 2. Subject 12 3. Measurement 15 4. Data collection 19 5. Data analysis 22 IV. Results 24 V. Discussion 39 VI. Conclusion 48 VII. References 50 VIII. Appendix 1. 57 IX. Appendix 2. 68 X. 국문초록 70Maste