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A Study in an Effective Programs for Emergency Care Delivery System (응급의료 전달체계의 충실 방안)

  • Kwon Sook Hee
    • Journal of Korean Public Health Nursing
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    • v.9 no.1
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    • pp.83-102
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    • 1995
  • As the society is being industrialized, the fast-paced economic development that has caused substantial increase in cerebrovascular and coronary artery diseases and the industrial development and increased use of means of transportation have resulted in the rapid rise of incidents in external injuries as well. So the pubic has become acutely aware of the need for fast and effective emergency care delivery system. The goal of emergency care delivery system is to meet the emergency care needs of patients. The emergency care delivery system is seeking to efficiently satisfy the care needs of people. Therefore the purpose of this study is designed to develop an effective programs for emergency care delivery system in Korea. The following specific objectives were investigated. This emergency care delivery system must have the necessary man power, for transfering the patients, communication net work, and emergency care facilities. 1) Man power Emergency care requires n0t only specialized traning in the emergency treatment but also knowledge and experience i11 other related area, so emergency care personnel traning program should be designed in order to adapt to the specific need of emergency patients. It will be necessary to ensure professional personnel who aquires the sufficient traning and experience for emergency care and to look for legal basis. We have to develop re-educational programs for emergency nurse specialist. They should be received speciality of emergency nursing care so that they will work actively and positively in emergency part. Emergency medical doctor and nurse specialist should be given an education which is related in emergency and critical care. Emergency care personnel will continue to provide both acute and continuing care as partner with other medical team. 2) Transfering the patients. Successful management of pre-hospital care requires adequate traning for the emergency medical technician. Traning program should be required to participate in a actual first aids activites in order to have apportunities to acquire practical skills as well as theoretical knowledge. The system of emergency medical technician should be remarkablly successful with first responder firefighters. Establishing this system must add necessary ambulances operating at any given time. It will be necessary to standardize the ambulance size and equipment. Ambulance should be arranged with each and every fire station. 3) Communication net work. The head office of emergency commumication network should be arranged with the head office of fire station in community. It is proposed that Hot-line system for emergency care should be introduce. High controlled ambulance and thirtial emergency center should simultaneously equip critical-line in order to communication with each other. Ordinary ambulance and secondary emergency facility should also simultaneously equip emergency-line in order to communication with each other. 4) Emergency care facilities. Primary emergency care facilities should be covered with the ambulatory emergency patients-minor illness and injuires. Secondary emergency care facilities should be covered with the emergency admission patients. Third emergency care center should be covered with the critical patients who need special treatments and operation. Secondary and third emergency care facilities should employ emergency medical doctor and emergency nurse specialist to treat in-patients with severe and acute illness and multiple injuires. It should be fashioned for a system of emergency facilities that meets emergency patients needs. Provide incentives for increased number of emergency care facilities with traning in personal/clinical emergency care. 5) Finance It is recommended to put the finance of a emergency care on a firm basis. The emergency care delivery system should be managed by the government or accreditted organizations. In order to facilitate this relevant program the fund is needed for more efficient and effective emergency researchs, service, programs, and policy. 6) Gaining understanding and co-operation of pubic It is also important to undertake pubic education to improve understanding of first aids and C. P. R of individuals, communities and business. It is proposed that teachers and health officers be certified in C. P. R. The C. P. R education can be powerful influence save lives. Lastly appropriate emergency care information must be provided to the pubic for assisting them in choosing emergency care.

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A Study on status of school health and analysis of factors affecting school nursing activities in the secondary school in Seoul (서울지역 국민학교(國民學校) 양호교사의 학교간호업무(學校看護業務) 수행정도(遂行程度)에 관(關)한 연구(硏究))

  • Kim, Eun Hee
    • Journal of the Korean Society of School Health
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    • v.1 no.2
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    • pp.50-65
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    • 1988
  • This study was conducted in order to grasp the condition of about the school nurse's service and to offer the basic materials of improving the school health service. The objects were comprised of 98 volunteered school nurses who take service in the elementary school. The material of this study was the questionaire suited to the purpose of this research which has been made through studying references and this questionaire has been corrected and revised three times. All the questionaire written by school-nurses. The results are as follows; 1. General features of the objects of study Average age was 35.9 and average career was 9.2 years. Except working as school-nurse, the past career was that average clinical-field was 3.4 years and health service was 4 months. Their educational level was as high as 72.4% of the objects were graduated from above 3 years college and 89.8% were married. 76.5% have religions and 94.8% were working at with national and public schools. 99.0% were doing only nursing service. 2. The conditions of the school health resources. The ratio of school-nurse to students was one to 2630. School-nurse to classes, one to 49.3, and school-nurse to teachers, one to 54. For total amount of a year budget of school health, from three hundred thousands to fifty nine hundred thousands won was most common. Expenses for purchasing medicine were used most. 58.2% of school-nurses hasn't known a year budget. There was an organization for school health in 74.2% of schools. 42.9% of nursing rooms were in the center of school and 88.8% were on first floor. Nursing room were used alone without being used by another purpose and the room size of 71.6% was below 10 pyong. 3. The conditions of school health service Average users of nursing room were 413 a month. The most of them had digestive trouble. Sending letters to home was 15.9 times a year. The most contents of letters was about health education. Object spent much time managing nursing room. 4. The degree of school health service When 2 points was given to "perform" and 1 point was to "not perform" the total average was 1.75, health education 1.89, environmental management 1.86, plan of project and evaluation 1.83, management of nursing room 1.82, health management 1.78, run of school health organization 1.32. 5. Correlation between the school health services and variables (1) The part of project plan and evaluation of school health service has relationship to existence or none-existence of school health organization (P<0.01), past health service career (P<0.05), number of classes (P<0.01), number of students (P<0.01), sending letters to home about health education (P<0.01) and number of users (P<0.05). (2) The part of nursing room management has relationship to ages (P<0.05) past clinical career (P<0.05), number of classes (P<0.05), number of students (P<0.05) and sending letters to home about health education (P<0.01). (3) The part of health education has relationship to existence or none-existence of school health organization (P<0.05), past clinical career (P<0.05), the ratio of health management to school nurse's all work (P<0.05) and the ratio of health education to school nurse's all work (P<0.01). (4) The part of environmental management to ages (P<0.01), career as a school-nurse (P<0.01), salary step(P<0.01), sending letters to home about health education (P<0.01), sending all letters to home (P<0.001), the ratio of health management to school nurse's all work (P<0.05), the ratio of health education to school nurse's all work (P<0.05) and area of school-nurse's room to be used. (5) The part of school health organization management to number of classes (P<0.05). (6) The part of health management to number of classes (P<0.05), sending letters to home about health education (P<0.001), sending all of letters to home (P<0.01) and the ratio of health management to school nurse's all work (P<0.05). (7) The part of school health service to ages (P<0.05), past clinical career (P<0.05), past health career (P<0.01), number of classes (P<0.05), number of student (P<0.05), sending letters to home about health education (P<0.05), sending all letters to home (P<0.05), the ratio of health management to school nurse's all work (P<0.05), the ratio of health education to school nurse's all work (P<0.01) and area of school - nurse's room to be used (P<0.05). ## Suggestion for further studies are as follows. 1. School-nurse should exert herself to advance a quality to take care of school population's health. 2. It is necessary that systematic support required to keep school population's health. 3. Home, school and community should make efforts cooperatively and the proper roles of students, teachers, health team members and parents must be achieved.

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Study on Characteristics of Chemical Properties and Microbial Flora of Organic Farming Soil in Korea (유기농 토양의 화학적 특성 및 미생물상 연구)

  • Park, Kwang-Lai;Suga, Yuko;Hong, Seung-Gil;Lee, Chorong;Ahn, Minsil;Kim, Seok-Cheol;Hashimoto, Tomoyoshi
    • Journal of the Korea Organic Resources Recycling Association
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    • v.24 no.4
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    • pp.77-83
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    • 2016
  • The objectives of this study was to investigate the difference between organic-farming and conventional-farming soils relatives to soil chemical properties and microbial flora. Fifteen soil sampling sites were chosen from the certified organic upland farm, considered with its location, crop and application of organic compost types. Soil chemical properties were analyzed by standard methods established by National Institute of Agricultural Sciences, Rural Development Administration. For the soil chemical properties, the values of pH were ranged from 4.5 to 7.3. The values of electrical conductivity (EC) in the sampling sites were below 2 dS/m of convention cultivation soil. For analyzing the microbial flora, the bacillus(16S rDNA) and cladothricosis(18S rDNA) were analyzed by using PCR-DGGE (Denaturing Gradient Gel Electrophoresis) in the soil of 15 sampling sites. Cluster analysis of biodiversity index was performed by using pattern of DGGE. DGGE patterns and clustering analysis of bacterial DNA from soil extracts revealed that the bacterial community was differentiated between less than 5 years and more than 5 years depending on the cultivation history. But there was no consistent tendency between cultivation history and regional trend in the case of molds. Therefore, it would be very effective to analyze bacterial clusters of organically cultivated soils in long - term cultivated soil for more than 5 years.

Differential Relations of Depression, Anxiety and Sleep Disturbances by Gender in Young Adolescents (청소년에서 우울 및 불안 증상과 수면 곤란의 성별에 따른 차별적 관련성)

  • Kim, Eun-Jin;Kang, Su-Gyeong;Moon, Myeong-Sung;Lim, Se-Won;Oh, Kang-Seob
    • Korean Journal of Psychosomatic Medicine
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    • v.18 no.2
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    • pp.62-71
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    • 2010
  • Objectives : The aim of the study was to investigate the prevalence by gender and to evaluate associations of depression, anxiety and sleep disturbances in a large sample of adolescents from the general population. Methods : 1422 subjects, aged 14 years students were recruited in the seven middle-school of the local community. The self-report questionnaire(Children's Depression Inventory : CDI, Beck Anxiety Inventory : BAI and Pittsburgh Sleep Quality Index : PSQI) was used for screening depression, anxiety and sleep disturbances in adolescent. CDI, BAI, and PSQI score was categorized into the following quartiles : $\leq$21, 22-25, 26-28, and $\geq$29 ; $\leq$21, 22-26, 27-31, and $\geq$32 ; $\geq$5, <5. The cut-off score is that CDI is 22, BAI is 22 and PSQI is 5. The result was analyzed using the independent t-test, the chi-square test and logistic regression analyses. Results : The mean CDI score($12.52{\pm}8.32$ vs. $10.39{\pm}7.52$ ; p=0.003), BAI($7.77{\pm}7.93$ vs. $9.84{\pm}9.04$ ; p<0.001) and PSQI($4.57{\pm}2.67$ vs. $3.64{\pm}2.30$ ; p=0.013) of girls were significantly higher than for boys. But, boys in the fourth quartile of CDI(CDI$\geq$29) and BAI(BAI$\geq$32) were at significantly elevated risk for sleep disturbances more than for girls after adjustment for sex, history of psychiatric treatment(CDI odd ratio, 14.66 ; 95% CI, 4.17-51.53, BAI odd ratio, 32.99 ; 95% CI, 4.26-255.39). Conclusion : The results suggest that high CDI, BAI score appears to increase the risk for developing sleep disturbances in boys more than girls.

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A Study on the Nurse's Response for the Clinical Application of Nursing Diagnosis (간호진단 임상적용을 위한 교육프로그램의 효과 및 간호사의 반응조사 연구)

  • Chun, C.Y.;Lim, Y.S.;Kim, Y.S.;Park, J.W.;Cho, K.S.
    • The Korean Nurse
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    • v.29 no.1
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    • pp.59-71
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    • 1990
  • Although the usefulness and importance of clinical application of nursing diagnosis are well recognized by the academic circle, it is not yet generally practiced. In order to provide data for establishing a policy for clinical nursing diagnosis; a study was made at a seminar, sponsored by the Department of nursing, Severance Hospital, with participation of 190 nurses from 33 hospitals. The objective of the study was to find out; 1) if the nurses agree with the academic community in recognizing the benefits and problems of clinical application of nursing diagnosis; 2) how the nurses evaluate their ability to carry out nursing diagnosis; and 3) if educational programs would help enhance ability of nursing diagnosis among nurses. The summary of findings by the study is as follows; 1. While all nurses responded positively on the question of benefits improving science and quality of nursing, thus elevating credibility and position of nurses, some expressed concern on the practicality of the system in setting up nursing objectiveness, confirming the nursing problems and utilizing patient information. For the 20 questions and the scale of 1~5, the lowest average score was 3.223 and the highest 4.066. 2. The study attempted to find out the opinion of the nurses on the problems that 'would make difficult to adopt the nursing diagnosis in clinics. The result of the study indicates the nurses believe the major problems are the fact that the subject of nursing diagnosis are not well defined and that the form sheets do not match with the ones that are currently being used. However, comparing it with the result of the previous study on the same question (inadequate manpower and insufficienf time allocated for the job were two major problems pointed out then.), it can be said that the opinion of the nurses studied this time was much more positive and it suggests that they believe the system can be adopted without increasing manpower and only by giving additional training and by adjusting the format of nursing record sheets. It suggests that the future for adopting a clinical nursing diagnosis is very bright. 3. As the most urgent problem to be solved for adopting clinical nursing diagnosis, 38. 5% responded that it was "education of nurses, "and 34.2% responded that it was "staffing adequate number of nurses". 4. For the 10 questions asked for self-evaluation of ability to adopt the system, with the scale of 1~5, average score was lower than 3. This indicate that they evaluate their ability to adopt the system is low. 5. The results of study taken before and after the educational programs for clinical nursing diagnosis were compared with overall score in order to determine if such program would cause changes in the response to the effect of clinical application of nursing diagnosis, and it was found that there was statistically significant changes suggesting that the education contributed to positive change in the response. 6. The results of study taken before and after the educational programs for clinical nursing diagnosis were compared with overall score in order to determine how the proble~ ms for adopting nursing system would be effected by such educational programs, and it was found that those problems be not soived with a short course of training. 7. The results of study taken before and after the educational programs for clinical nursing diagnosis were compared with overall score in order to determine if such programs would bring changes in the self-evaluation of nurses on the ability of nursing diagno sis, and it was found that program improve score of self-evaluation their ability of the nursing diagnosis. As seen in the above reports, it was found that the nu'rses are very positive about the clinical nursing diagnosis, that educational program for the clinical nursing diagnosis helps nurses for positively changing their attitude for ,the nursing diagnosis, for their self-confidence on their ability to perform nursing diagnosis. With improved know-how and self"confictence of nurses gained through educational and .training programs, the future of clinical application of nursing diagnosis is very bright.diagnosis is very bright.

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Optimal Spatial Scale for Land Use Change Modelling : A Case Study in a Savanna Landscape in Northern Ghana (지표피복변화 연구에서 최적의 공간스케일의 문제 : 가나 북부지역의 사바나 지역을 사례로)

  • Nick van de Giesen;Paul L. G. Vlek;Park Soo Jin
    • Journal of the Korean Geographical Society
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    • v.40 no.2 s.107
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    • pp.221-241
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    • 2005
  • Land Use and Land Cover Changes (LUCC) occur over a wide range of space and time scales, and involve complex natural, socio-economic, and institutional processes. Therefore, modelling and predicting LUCC demands an understanding of how various measured properties behave when considered at different scales. Understanding spatial and temporal variability of driving forces and constraints on LUCC is central to understanding the scaling issues. This paper aims to 1) assess the heterogeneity of land cover change processes over the landscape in northern Ghana, where intensification of agricultural activities has been the dominant land cover change process during the past 15 years, 2) characterise dominant land cover change mechanisms for various spatial scales, and 3) identify the optimal spatial scale for LUCC modelling in a savanna landscape. A multivariate statistical method was first applied to identify land cover change intensity (LCCI), using four time-sequenced NDVI images derived from LANDSAT scenes. Three proxy land use change predictors: distance from roads, distance from surface water bodies, and a terrain characterisation index, were regressed against the LCCI using a multi-scale hierarchical adaptive model to identify scale dependency and spatial heterogeneity of LUCC processes. High spatial associations between the LCCI and land use change predictors were mostly limited to moving windows smaller than 10$\times$10km. With increasing window size, LUCC processes within the window tend to be too diverse to establish clear trends, because changes in one part of the window are compensated elsewhere. This results in a reduced correlation between LCCI and land use change predictors at a coarser spatial extent. The spatial coverage of 5-l0km is incidentally equivalent to a village or community area in the study region. In order to reduce spatial variability of land use change processes for regional or national level LUCC modelling, we suggest that the village level is the optimal spatial investigation unit in this savanna landscape.

A Study of Estimation of Forest Ecosystem Carbon Storage in Gyeryongsan National Park, Korea (계룡산 국립공원 산림생태계의 탄소축적량 산정에 관한 연구)

  • Jang, Ji-Hye;Yi, Joon-Seok;Jeong, Ji-Sun;Song, Tae-Young;Lee, Kyengjae;Suh, Sang-Uk;Lee, Jaeseok
    • Korean Journal of Ecology and Environment
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    • v.47 no.4
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    • pp.319-327
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    • 2014
  • Understanding and quantifying of carbon storage in ecosystem is very important factor for predicting change of global carbon cycle under the global climate change. We estimated total ecosystem carbon in Gyeryongsan National Park with naturally well preserved ecosystem in Korea. Vegetation of Gyeryongsan National Park was classified with mainly four communities with Quercus mongolica (1,743.5 ha, 38.0%), Quercus variabilis (1,174.0 ha, 25.6%), Quercus serrata (971.9 ha, 21.2%), Pinus densiflora (695.2 ha, 15.2%). Biomass and soil carbons were calculated from biomass allometric equations based on the DBH and carbon contents of soil and litter collected in quadrat in each community. The tree biomass carbon was in Quercus variabilis ($130.1tCha^{-1}$), Pinus densiflora ($111.1tCha^{-1}$), Quercus mongolica ($76.2tCha^{-1}$), Quercus serrata ($39.0tCha^{-1}$). Soil carbon storage was in Quercus mongolica ($159.7tCha^{-1}$), Quercus serrata ($121.0tCha^{-1}$), Pinus densiflora ($110.5tCha^{-1}$), Quercus variabilis ($90.8tCha^{-1}$). Ecosystem carbon storage was Pinus densiflora ($239.9tCha^{-1}$), Quercus mongolica ($235.9tCha^{-1}$), Quercus variabilis ($226.0tCha^{-1}$), Quercus serrata ($165.9tCha^{-1}$), total amount was $867.7tCha^{-1}$. The area of each vegetation carbon storage was Quercus mongolica ($411,200tCha^{-1}$), Quercus variabilis ($265,300tCha^{-1}$), Pinus densiflora ($166,800tCha^{-1}$), Quercus serrata ($161,200tCha^{-1}$) and the total ecosystem carbon amount estimated $1,045,400tCha^{-1}$ at Gyeryongsan National Park. Theses results indicate that different in naturally well preserved ecosystem.

Alexithymia in Major Depressive Disorder and Subclinical Depression (주요 우울장애와 준임상적 우울증에서의 감정표현불능증)

  • Kim, Seog-Ju;Yu, Seung-Hee;Kim, Seong-Youn;Kim, Dong-Wook;Cho, In-Hee;Cho, Seong-Jin
    • Korean Journal of Psychosomatic Medicine
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    • v.15 no.2
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    • pp.100-106
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    • 2007
  • Objectives : The objective of the present study was to investigate alexithymia in major depressive disorder(MDD) and subclinical depression(SCD). Methods : Three hundred eighty-six community-dwelling adults(238 females and 148 males, age 19-79; mean age $43.0{\pm}13.9$) were recruited. Structured clinical Interview for DSM-IV(SCID) was conducted for the diagnosis of MDD or other Axis I psychiatric disorders. The Center for Epidemiological Studies for Depression Scale(CES-D) and the Totonto Alexithymia Scale(TAS) were administered to assess depressive symptom and alexithymia, respectively. Among subjects without MDD, those who had minor depressive disorder on the SCID or high scores(i.e. over 16) on the CES-D were defined as subjects with SCD. TAS total score and factor I, II, III scores of TAS in MDD, SCD, and non-depressive controls were compared. Results : Among 386 subjects, 38 subjects(9.8%) were diagnosed as MDD by DSM-IV criteria, while 57 subjects(14.8%) were classified into SCD group. There were significant differences between 3 groups(MDD, SCD and non-depressive controls) in total score($F_{2,383}=14.0$, p<0.01), factor I(difficulty in identifying feeling)($F_{2,383}=23.4$, p<0.01) and factor II(difficulty in describing feeling)($F_{2,383}=7.8$, p<0.01), but not factor III(external oriented thinking)($F_{2,383}=1.8$, p=0.16) of TAS. In post-hoc analysis, both MDD subjects and SCD subjects had higher scores in TAS total, factor I and factor II, compared to non-depressive controls(all p<0.01). In contrast, there were no significant differences between MDD subjects and SCD subjects in any TAS factor. Conclusion : In this study, both MDD subjects and SCD subjects were more alexithymic than non-depressive control subjects. These findings suggest that SCD, as well as MDD, is also related to alexithymia.

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Occurrence Characteristics of Weed Flora in Arable Fields of Korea (우리나라 농경지에 발생하는 잡초 현황)

  • Lee, In-Yong;Oh, Young-Ju;Park, Jung-Soo;Hong, Sun-Hee;Choi, Jun-Keun;Heo, Su-Jeoung;Kim, Eun Jeong;Lee, Chae-Young;Park, Kee Woong;Cho, Seng-Hyun;Kwon, Oh-Do;Im, Il-Bin;Kim, Sang-Kuk;Seong, Deok-Gyeong;Chung, Young-Jae;Kim, Chang-Seog;Lee, Jeongran;Seo, Hyun-A;Jang, Hyung-Mok;Kim, Jin-Won
    • Weed & Turfgrass Science
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    • v.6 no.2
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    • pp.86-108
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    • 2017
  • The nationwide weed survey was conducted in arable land, paddy field, upland, orchard and pasture, over whole country of Korea during 3 years from 2013 to 2015. Also, these survey were conducted in order to determine a change of weed community and to identify a major dominant weed species, and problem weeds. Weeds of arable land were composed of 619 species belonging to 81 families. Weeds occurred in paddy field were 90 species belonging to 28 families, upland weeds were 375 species of 50 families, orchard weeds were 492 species of 63 families and pasture weeds 275 species of 52 families. Among total 81 families, the Asteraceae (15.5%) was the biggest family, followed by Poaceae (13.1%), Fabaceae (5.5%), Cyperaceae (5.2%), Polygonaceae (6.3%), respectively. And these weed species were composed of annual weeds of 209 species (33.8%), winter annual of 102 species (16.4%) and perennial weeds of 308 species (49.8%). Exotic weeds naturalized in Korea were investigated as 166 species. Weed flora in Korean cultivation area have been increased as much as 13 families and 186 species for 10 years compared to 2000~2004 weed survey result of 68 families and 433 species. The increment could be resulted from the change of weed population such as increase of the herbicide-resistant and the difference of investigation method.

Time Series Analysis on Outcomes of Tuberculosis Control and Prevention Program between Small Areas in Korea - with Patient Registry Data of 234 City.County.District Public Health Centers - (소규모 지역간 결핵관리사업 성과에 대한 시계열분석 - 전국 234개 시.군.구 보건소의 환자등록자료를 중심으로 -)

  • Kim, Chun-Bae;Choe, Heon;Shin, Kye-Chul;Park, Jong-Ku;Ham, Soo-Keun;Kim, Eun-Mi
    • Tuberculosis and Respiratory Diseases
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    • v.48 no.6
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    • pp.837-852
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    • 2000
  • Backgrounds : Today, tuberculosis cannot only be cured medically, but also controlled by public health. Despite the overall worldwide decline in tuberculosis, the disease continues to be a significant problem among developing countries and in the slums of large cities in some industrialized countries. Particularly, this communicable disease has come into the public health spotlight because of its resurgence in the 1990's. our country has been operating the Korean National Tuberculosis Control Program since 1962, focusing around public health centers. Therefore, this study aims to compare the effectiveness of tuberculosis control activities, one of the major public health activities in Korea, by producing indexes, such as the yearly registration rate per 100,000 population and treatment compliance of tuberculosis on in small areas (communities). Methods : This work was accomplished by constructing a time-series analytic model using data from "1980~2000: the Yearly Statistical Report" with patient registry data of 234 City. County. District public health centers and by identifying the factors influencing the tuberculosis indexes. Results : The trends of pulmonary tuberculosis positive point prevalence and pulmonary tuberculosis negative point prevalence on X-ray screening have declined steadily, beginning in 1981 and continuing to 1998 by region (city, county, district). Although the tuberculosis mortality rate steadily shows a declining trend by year and region, but Korea still ranks first among 29 OECD countries in 1998, with a tuberculosis mortality rate of 7.1 per 100,000 persons, according to the time-series analysis for fatal diseases. Conclusion : The results of the study will form the fundamental basis of future regional health care planning and the Korean Tuberculosis Surveillance System on 2000. Since the implementation of local autonomy through the Local Health Act of 1995, it has now become vita1 for each city, county, district public health centers to determine its own priorities for relevant health care management, including budget allocation and program goals.

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