The tuberculosis is the infectious disease. Generally, the active tuberculosis patient can infect the 10 persons for one year within the daily activities like casual conversation and singing together. The infectivity of tuberculosis can continue for a life time, and infected persons can remain at risk for developing active tuberculosis. To control this contagious disease, along with the active tuberculosis patients, non-infectious but non-compliant patients who can be infectious if their immune systems become impaired have to be managed. To control the non-complaint patients, medical treatment order should be combined with the public order. Because tuberculosis is the risk of community health, the human rights like liberty and freedom of movement can be restricted for public welfare under the article 37(2) of constitution. Even when such restriction is imposed, no essential aspect of the freedom or right shall be violated. The degree of restriction on the rights of citizens is different what methods are chosen to non-complaint patients. For example, under the directly observed therapy program, the patients and medical staffs make an appointment and meet to confirm the drug intakes according to the schedule, which is the medical treatment combined with the mildest public order. If the patients break the appointments or have the history of disobedient, the involuntary detention can obtain the legitimate cause. The Tuberculosis Prevention Act has the two step programs on this involuntary detention, The admission order (Article 15) is issued when the patients are infectious. The quarantine order (Artle 15-2) is issued when the patients are infectious and non-complaint. The legal criteria for involuntary detention are discussed and published through the international conventions and covenants. For example, World Health Organization had made guidance on human rights and involuntary detention for tuberculosis control. The restrictions should be carried out in accordance with the our law and in the legitimate objective of public interest. And the restriction should be based on scientific evidence and not imposed in an unreasonable or discriminatory manner. We define and adopt these international criteria under our constitution and legal system. Least restrictive alternative principle, proportionality principle and the individual evaluation methods are explained through the reviews of United States court decisions. Habeas Corpus Act is reviewed and adopted as the procedural due process to protect the patient rights as a citizen. Along with that, what conditions and facilities which are needed to performed quarantine order are discussed.
Cho Su-Jin;Kim, Hyun-Jin;Lee Jeong-Won;Lee Seung-Joo
Childhood Kidney Diseases
/
v.9
no.1
/
pp.46-55
/
2005
Purpose : Recurrent urinary tract Infection(UTI) in primary vesicoureteral reflux(VUR) may lead to serious renal scarring, a major cause of childhood hypertension and end-stage renal disease. To prevent recurrent UTI, low-dose long--term antibiotic prophylaxis has been recommended. However, recurrent UTI still develops during antibiotic prophylaxis, the efficacy of which is now being disputed. The emergence of resistant bacteria has also raised concerns. To evaluate the effect of antibiotic prophylaxis, we investigated recurrent UTI during prophylactic antibiotic use in children with primary VUR Materials : The incidence and risk factors of recurrent UTI were retrospectively evaluated in ninety-one children with primary VUR on trimethoprim- sulfamethoxazole(TMP/SMX) prophylafis during the year following their index febri]e UTI. Results : Recurrent UTI occurred in 31.9%(29/91) children and comprised 0.32 episodes/patient year. Febrile UTI was 0.26 episode/patient year and afebrile UTI was 0.07 episodes/patient year. The recurrent rate of UTI in male patients with phimosis was 37.2%(19/51), which was significantly higher than in males without phimosis 0%(0/5)(P=0.025). In the logistic regression analysis for recurrent UTI, renal scar was the significant risk factor for recurrent UTI [RR 3.8(95% CI 1.0-14.1) P=0.04]. For other well-known risk factors such as sex, age, degree of VUR, APN, and voiding dysfunction, the differences were not significant. Conclusion : TMP/SMX prophylaxis did not prevent recurrent UTI in children with primary VUR. Phimosis and renal scars were the risk factors for recurrent UTI but the grade of primary VUR was not. In VUR without phlmosis and renal scar, a randomized controlled study without antibiotic prophylaxis is required. (J Korean Soc Pediatr Nephrol 2005;9:46-55)
Purpose : Renal abscess is very rare in children and its diagnosis is difficult because symptoms are often nonspecific. In previous studies, on]y 15% to 25% of patients were reported to be diagnosed at the time of admission. Early diagnosis and treatment are important be cause mortality rate correlates positively with the time of diagnosis. The purpose of this study is to clarify the clinical features of children with renal abscess and to investigate the possible indicators of this disease for early diagnosis and Proper treatment. Methods : Twelve children diagnosed with renal abscess from Jan. 1996 to Jul. 2004 were included. The age of patients ranged from S months to 15 years. We retrospectively analyzed the demographics of patients, their symptoms, predisposing factors, diagnostic methods and causative organisms and the treatment modalities. Results : Fever was the most common manifestation, Five children(42%) had vesicoureteral reflux. Renal ultrasonography and computerized tornography were the most frequently used imaging tools to detect renal abscess. Gram negative bacteria were isolated in 7 patients and Staphylococcus aureus grew in 2 patients. All patients received intravenous antibiotics and 4 patients underwent aspiration or drainage of renal abscess. The average admission duration was 30 days. Conclusion : Renal abscess should be included in the differential diagnosis of prolonged fever in children, especially when flank pain is combined. For early diagnosis and a better prognosis, patients should be promptly investigated with ultrasonography or computerized tomography.
Purpose: Diabetic nephropathy is the most common cause of end stage renal disease and the incidence is progressively increasing. The aim of this study was to investigate the differences of $^{99m}Tc$-DMSA renal uptake among diabetic patients with normoalbuminuria, microalbuminuria and overt proteinuria, and then to determine the clinical usefulness of $^{99m}Tc$-DMSA in predicting early diabetic nephropathy Materials and Methods: $^{99m}Tc$-DMSA scan was performed and a total renal uptake of $^{99m}Tc$-DMSA was measured in 145 diabetic patients. Patients were divided into 3 groups according to the amount of 24 hour urinary albumin excretion as Group I (normoalbuminuria, 74 cases), Group II (microalbuminuria, 39 cases), and Group III (overt proteinuria, 32 cases). The differences of $^{99m}Tc$-DMSA renal uptake among the 3 groups and the correlation between the renal uptake of $^{99m}Tc$-DMSA and other clinical parameters were analyzed. Results: The total renal uptake of $^{99m}Tc$-DMSA of Group II ($40.8{\pm}11.0%$) was significantly lower than that of Group I ($54.4{\pm}6.3%$, p<0.001). The uptake of Group III ($27.7{\pm}12.0%$) was significantly lower than those of both Group I and Group II (p<0.001). $^{99m}Tc$-DMSA total renal uptakes correlated negatively with serum creatinine level (r=-0.629, p<0.001) and positively correlated with creatinine clearance rate (r=0.102, p<0.001). Conclusion: $^{99m}Tc$-DMSA total renal uptake of diabetic patients with microalbuminuria was significantly decreased compared with that of patients of normoalbuminuria. Therefore, $^{99m}Tc$-DMSA scan can be used as a diagnostic study for early detection of the diabetic nephropathy.
Purpose: It is widely recognized that good quality control (QC) program is essential for adequate imaging diagnosis using gamma camera. The purpose of this study is to survey the current status of QC of gamma cameras in Republic of Korea for implementing appropriate nationwide quality control guidelines and programs. Methods: A collection of data is done for personnel, equipment and appropriateness of each nuclear medicine imaging laboratory's quality control practice. This survey is done by collection of formatted questionnaire by mails, emails or interviews. We also reviewed the current recommendations concerning quality assurance by international societies. Results: This survey revealed that practice of quality control is irregular and not satisfactory. The irregularity of the QC practice seems due partly to the lack of trained personnel, equipment, budget, time and hand-on guidelines. Conclusion: The implementation of QC program may cause additional burden to the hospitals, patients and nuclear medicine laboratories. However, the benefit of a good QC program is obvious that the hospitals can provide good quality nuclear medicine imaging studies to the patients. It is important to use least cumbersome QC protocol, to educate the nuclear medicine and hospital administrative personnel concerning QC, and to establish national QC guidelines to help each individual nuclear medicine laboratory.
This study assessed hazards at the harvest stage of strawberry farms which may cause risk to humans. A total of 216 samples were collected from 6 strawberry farms (soil culture farms: A, B, C; nutriculture farms: D, E, F) located in Western Gyeongnam. The collected samples were subjected for sanitary indicator bacteria (aerobic plate count, coliforms and Escherichia coli), major foodborne pathogens (E. coli O157:H7, Listeria monocytogenes, Salmonella spp., Staphylococcus aureus and Bacillus cereus), and fungi. The levels of APC and coliform in the soil culture farms were 1.0-6.9 and 0.4-4.6 log CFU/g (leaf, mL, hand or 100 $cm^2$), respectively. The samples obtained from the nutriculture farms were contaminated with the levels of 0.8-4.9, and 0.2-2.6 log CFU/g (leaf, mL, hand or 100 $cm^2$) of APC and coliform. However, E. coli was not detected in any samples. In major foodborne pathogens, S. aureus was detected at the level of ${\leq}$3.3 log CFU/hand in workers' hand samples and B. cereus was detected at the levels of 0.4-4.1 log CFU/g (hand or 100 $cm^2$) in soil, plants and workers' hygiene. L. monocytogenes, E. coli O157:H7 and Salmonella spp. were not detected. Fungi were detected at the levels of 1.0-5.2 and 0.2-4.4 log CFU/g (leaf, mL, hand or 100 $cm^2$) in soil culture and nutriculture farms, respectively.
Purpose: Population using complementary and alternative medicine (CAM) and the cost or it are increasing all over the world. In this study, we investigated the utilization state of CAM in the elderly people during the last 6 months of life. Methods: We found 4,210 persons in Seoul, older than 65 years who received a funeral subsidy from health insurance after death during the latter half of the year, 2001. We stratified them by age and gender and selected 301 persons and surveyed them by questionnaire. Results: 247 persons (83.1%) used at least one of CAM during their last 6 months of life. Diet and Nutrition remedy showed the highest utilatization rate (65.5%), and drug therapies also were much used (29.9%). Utilization rate was higher in female (60%) and according to the cause of death, the highest in a geriatric disease groups, and the lowest in the cancer group. Whole satisfaction to CAM was high with average 4.25 points out of total 6, and adverse effects were almost free with average 5.55 points out of total 6. Satisfaction was the highest in Diet and Nutrition remedy but the lowest in Manipulative and Body-Based methods. Adverse-effect score was best in Manipulative and Body-Based methods. According to age and the causative disease of death, there were significant differences in satisfaction and adverse effect levels. Conclusion: Majority of old people used at least one of CAM during their last 6months of life. Whole satisfaction and adverse-effect level were very excellent.
This study was conducted on greenhouses whose side heights had been raised after the columns of 1-2W basic type greenhouses had been cut and welding with the same-sized pipes. When the wind load or snow load affects restructured pipe greenhouse like this, those parts will be structurally unsafe. To examine this, the bending strength of welded columns were measured through four stages and compared with the pipes in their original condition. Results are as follows. In the case of a bending test on welded joints about steel pipes used for greenhouses, satisfactory results couldn't be drawn because sections of both ends and the loading parts couldn't endure loads and sank regardless of loading methods. Partial problems could be solved by inserting inside pipe(steel bar) at the sections and the loading parts, but it was necessary to devise more satisfactory bending test methods. The strength of welded joints wasn't much different compared with original conditions and demonstrated only slight differences according to the sample production conditions. However, significant incompleteness in the welding process was expected to cause a decisive loss in strength. On the assumption that there were no problems in the welding process or with regard to the inclination of sub materials for columns after connection, it was deemed reasonable to assume that the strength of welded pipes was about 84~90% of the strength of the pipes in their original condition. Considering mid- and long-term strength decline following the onset of rust at joints or welding sections, structural changes in the main sub materials that are used for greenhouses at farmhouses have to be avoided to ensure structural safety, unless these changes are inevitable.
Salmonella spp. are one of major pathogens for zoonosis in worldwide, and can replicate within host cells and generally cause enterocolitis and foodborne poisoning which represents a considerable public health burden. The present study was designated to investigate the safty for host cells, antibacterial effects of Saururus chinensis Baill water extract (SCWE) on pure culture and infection with Salmonella enterica serovar Typhimurium (S. typhimurium) in murine derived macrophage RAW 264.7 cells. The different treatment of SCWE concentration (1, 10 or $100{\mu}g/ml$) did not show any cytotoxic effect to RAW 264.7 cells for 24 h incubation. In determination of antibacterial activity of SCWE against S. typhimurium, bacterial viability was markedly decreased compared to SCWE-untreated control. In RAW 264.7 cells, SCWE significantly induced morphological change (p<0.05). In infection assay of S. typhimurium in RAW 264.7 cells pretreated with $100{\mu}g/ml$ of SCWE, which are non-cytotoxic concentration, bacterial uptake ability of macrophage was increased corresponding with morphological change, whereas bacterial survival rates within macrophage was markedly reduced comparing to that of SCWE-untreated control. Furthermore, nitric oxide (NO) production in SCWE-treated cells was slightly decreased until 24 h post infection. Taken together, these findings demonstrated that SCWE have the antibacterial activity for S. typhimurium and the protective effects against S. typhimurium infection through activating murine macrophage independent on NO, suggesting that SCWE were beneficial on the disease caused by intracellularly replicating pathogens as a safe alternatives of conventional chemotherapies.
This article intends to look for the desirable form of Confucian familism in the era of the 4th Industrial Revolution. First of all, the concept of the fourth industrial revolution is a very vague concept. Therefore, it would be more meaningful to analyze the situation of the family in present Korean society and to find an alternative to it in Confucian familism. But the problem is that it is very burdensome to bring out the Confucian familism idea again. Since Confucian Confucianism was criticized in 1915 during the New Cultural Movement, many people have criticized Confucian familism as patriarchal and authoritarian, and thus an anti-democratic value that seriously damaged the equality of men and women. Therefore, the discussion starts with looking at the justification of such an evaluation. I wanted to see if their evaluation of Confucian familism is legitimate or an unjustified evaluation resulting from misunderstanding, and if it is an inappropriate evaluation, where they are based. In addition, I examined whether the cause of such an evaluation was attributed to the subject who made the evaluation, or because the spectrum of significance contained in the Confucian familism thought formed over 2500 years was too wide. I sought to reassess criticism of the existing Confucian familism by looking for answers to these questions. Through such a reevaluation, I has found that the wrong criticism of Confucian familism was because we saw the Confucian scholarship and the Confucian scholarship without distinguishing the ideological Confucianism from the Qin(秦) Dynasty. In the end, I tried to show that Confucian familism can function as an alternative to resolve family problems that are occurring in today's Korean society through the illuminating work of the ideas of Confucian familism.
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