• Title/Summary/Keyword: Quality Education

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Exploratory Study of Person Centered Care Practice in Korean Long-term Care Facilities using DCM(Dementia Care Mapping) as a tool (DCM(Dementia Care Mapping)을 활용한 한국 요양시설에서의 사람중심케어 실천의 탐색적 연구)

  • Kim, Dongseon
    • 한국노년학
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    • v.41 no.2
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    • pp.197-215
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    • 2021
  • This study aims to evaluate Person Centered Care practice and characteristics of care services in Korean long-term care facilities using Dementia Care Mapping as a tool. DCM, systematic observational evaluation tool for measuring dementia patients' QOL, was transformed into self-report rating scale. The process of transforming DCM into a scale of 34 items involves operationalization of DCM concepts and it's adaptation into Korean long-term care practices. Review by research team of Bradford university was added to maintain DCM concept and meaning in this scale. The scale with Cronbach alpha of .88 was surveyed on 343 care workers. Survey result shows PCC value practiced by them is 3.77(of 5 likert scale) and values on each categories of PCC reveal the characteristics of care in Korean facilities; attachment(4.02), comfort(3.95), inclusion(3.89), identity(3.67) and occupation(3.41). Dementia care in Korean facilities focuses on recipients'safety, comfort but lacks individualistic care and the meaningful and fulfilling occupation for patients. Looking at the organizational and individual factors influencing DCM values, the small facilities showed higher PCC values and there are no significant difference in PCC values between public and private facilities. Managers and care workers with career of 1~2 years showed higher PCC values compared to other career ranks and lengthes. This study suggests care practice should be centered on personhood of patients in long-term care facilities, for which introduction of unit care and education of PCC for service providers including support personnel are needed. DCM and Korean DCM scale developed in this study are suggested for the PCC-based assessment on care quality.

The Impact of Community on Family Relations Satisfaction : Focusing on the Family Happiness Composite Index in Korea (지역사회가 가족관계만족에 미치는 영향 : 한국 가족행복종합지수를 중심으로)

  • Oh, Youngeun;Choo, Joohee;ko, kawangyee
    • 지역과문화
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    • v.7 no.2
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    • pp.173-202
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    • 2020
  • This study aims to enhance the family-friendliness of the region by examining the relationship between family relations and the community environment, and objectively comparing the local environment surrounding the family. To this end, we reviewed the areas of socio-cultural and economic sectors that affect the family relationship satisfaction, and in particular, analyzed the trend of changes in regional index by utilizing the Korean Family Happiness Composite Index (KFHCI) developed as a community indicators. This index utilizes community indicators published in the National Statistical Portal's "e-Region indicators," and these variables are related to family relationship satisfaction. Therefore, this study compared the seven areas of the Family Happiness Composite Index (Population Family, Health Culture, Education, Income Consumption, Employment Labor, Housing Transportation, Environment and Social Integration) by region, and examined the trends for 10 years. According to the study, the average score of KFHCI's entire region was rising from 2008 to 2018. Overall, the community environment that affects family relationship satisfaction is also improving. The regions belonging to the upper level were Jeonnam, Gangwon, Chungnam, Jeonbuk, and Gyeongbuk. Areas belonging to the lower level are Seoul, Busan, Daegu, Incheon, and Gwangju. In almost sectors, the lower-level regions did not have sufficient physical infrastructure compared to population density and over-density, and improved little by little, but not enough to reflect the needs of local people and improve the quality of life. In the future, we should develop more regular and complementary indicators to develop customized policies for each region that can improve the quality of family relationships. It will also be necessary to study the impact of each index field when a socioeconomic crisis occurs due to social disasters, and try to change indicators

Physical Characterization of Domestic Aggregate (국내 골재의 물리적 특성 분석)

  • Junyoung Ko;Eungyu Park;Junghae Choi;Jong-Tae Kim
    • The Journal of Engineering Geology
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    • v.33 no.1
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    • pp.169-187
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    • 2023
  • Aggregates from 84 cities and counties in Korea were tested for quality to allow analysis of the physical characteristics of aggregates from river, land, and forest environments. River and land aggregates were analyzed for 18 test items, and forest aggregates for 12 test items. They were classified according to watershed and geology, respectively. The observed physical characteristics of the river aggregates by basin were as follows: aggregates from the Geum River basin passed through 2.5, 1.2, 0.6, 0.3, 0.15, and 0.08 mm sieves; clay lumps constituted the Nakdong River basin material; aggregates from the Seomjin River basin passed through 10, 5, and 2.5 mm sieves; those from the Youngsang River basin passed through 1.2, 0.6, 0.3, 0.15, and 0.08 mm sieves; and aggregates from the Han River basin passed through 10, 5, 2.5, 1.2, 0.6, 0.3, and 0.08 mm sieves, Stability; Standard errors were analyzed for the average amount passing through 10, 0.6, and 0.08 mm silver sieves, and performance rate showed different distribution patterns from other physical characteristics. Analysis of variance found that 16 of the 18 items, excluding the absorption rate and the performance rate, had statistically significant differences in their averages by region. Considering land aggregates by basin, those from the Nakdong River basin excluding the Geum River basin had clay lumps, those from the Seomjin River basin had 10 and 5 mm sieve passage, aggregates from the Youngsang River basin had 0.08 mm sieve passage, and those from the Han River basin had 10, 0.6, and 0.08 mm sieve passage. The standard error of the mean of the quantity showed a different distribution pattern from the other physical characteristics. Analysis of variance found a statistically significant difference in the average of all 18 items by region. Analyzing forest aggregates by geology showed distributions of porosity patterns different from those of other physical characteristics in metamorphic rocks (but not igneous rocks), and distributions of wear rate and porosity were different from those of sedimentary rocks. There were statistically significant differences in the average volume mass, water absorption rate, wear rate, and Sc/Rc items by lipid.

Improving the nutrition quotient and dietary self-efficacy through personalized goal setting and smartphone-based nutrition counseling among adults in their 20s and 30s (개인별 목표 설정과 스마트폰 기반 영양상담을 통한 20-30대 성인의 영양지수 및 식이 자아효능감 향상)

  • Dahyeon Kim;Dawon Park;Young-Hee Han;Taisun Hyun
    • Journal of Nutrition and Health
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    • v.56 no.4
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    • pp.419-438
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    • 2023
  • Purpose: This study examines the effectiveness of personalized goal setting and smartphone-based nutrition counseling among adults in their 20s and 30s. Methods: Nutrition counseling was conducted for a total of 30 adults through a 1:1 chat room of a mobile instant messenger, once a week for 8 weeks. The first week of counseling included a preliminary online questionnaire survey and a dietary intake survey. Based on the results of the preliminary survey, 2 dietary goals were set in the second week and the participants were asked to record their achievements on a daily checklist. From the third week onwards, counselors sent feedback messages based on the checklist and provided information on dietary guidelines in a card news format every week. Post-counseling questionnaires and dietary intake surveys were conducted in the seventh week. Changes in dietary habits during the counseling were reviewed in the eighth week, followed by a questionnaire survey on the evaluation of the counseling process. Results: The nutrition quotient (NQ) scores and self-efficacy scores were significantly higher after nutrition counseling. The NQ scores of consumption frequencies of fruits, milk and dairy products, nuts, fast food, Ramyeon, sweet and greasy baked products, sugarsweetened beverages, the number of vegetable dishes at meals, and breakfast frequency were significantly higher after nutrition counseling. The intake of protein, vitamin A, thiamin, riboflavin, folate, calcium, and iron, and the index of nutritional quality of vitamin A, riboflavin, folate, calcium, and iron were higher after nutrition education. The participants were satisfied with the nutrition counseling program and the provided nutrition information. Conclusion: Personalized goal setting and smartphone-based nutrition counseling were found to be effective in improving the quality of diet and self-efficacy in young adults. Similar results were obtained in both the underweight/normal weight and the overweight/obese groups.

Bone Density and Related Factors of Vegetarian and Non-vegetarian University Students in Seoul Area (서울지역 채식.비채식 대학생의 골밀도에 미치는 영향요인에 관한 연구)

  • Chung, Nam-Yong;Choi, Soon-Nam
    • Journal of the Korean Society of Food Culture
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    • v.21 no.1
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    • pp.86-98
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    • 2006
  • This study was conducted to investigate factors affecting bone density of food and nutrition vegetarian and non-vegetarian university students in Seoul area. Data for food habits, dietary and health-related behaviors were obtained by self administered questionnaires. BQI(bone quality index) of the subjects was measured by an Quantitative Ultrasound (QUS). The results are summarized as follows: The average height, weight, BMI and osteopenia percentage of the vegetarian and non-vegetarian male and female student were 172.61cm, 62.42kg, 20.98 and 24.2%; 175.38cm, 72.52kg, 23.71 and 16.7%; 160.47cm, 55.76kg, 21.66 and 55.9%; 161.77cm, 56.34kg, 21.53 and 37.6%, respectively. The BQI of the subjects were 101.73 and 107.43 in male student group, and 84.15, 89.64 in female student group, respectively. The BQI, Z-score value of bone density was significantly different in female group. Weight and BMI were positively related with BQI in male and female group. BQI was positively affected by nutrition supplement and negatively affected by seafood in vegetarian male student group. In vegetarian female student group, amount of meal was positively related with BQI and meal regularity was negatively related BQI. The result of this study revealed that the desirable food habits, dietary behaviors and health-related lifestyles may have a beneficial effect on bone density. They should have practically and systematically organized nutritional education on optimum body weight, good eating habits, weight bearing exercise and intakes of good quality nutrient for higher bone density level.

Survey of Current Status of the Patients with Home Ventilator in Seoul and Kyunggi Province (가정용 인공호흡기를 사용하는 서울 및 경기 지역 환자의 실태)

  • Ahn, Jong-Joon;Lee, Ki-Man;Shim, Tae-Sun;Lim, Chae-Man;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Koh, Youn-Suck
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.5
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    • pp.624-632
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    • 2000
  • Background : Home ventilation can decrease hospital-acquired infection, increase physical activity, improve nutritional status, enhance quality of life, and reduce medical costs. The number of patient using home ventilators has been increasing, particularly in Europe and United States. Although the number of patients with home ventilation has been increasing in Korea, the current status of these patients is not well known. This study was undertaken to obtain basic information upon these patients in addition to evaluating any problems related to patients' home care in our country. Methods : A register of 92 patients with home ventilators in Seoul and Kyunggi Province were obtained from commercial ventilator supply companies. The patients were contacted by phone and 29 of them accepted our visit. Information concerning education about home care before discharge, equipment cost, and problems related to home care were documented. The mode and preset variables of the home ventilator were checked; tidal volume (TV), peak airway pressure, and oxygen saturation were measured. Results : There were 26 males (90%) and their mean age was 48.0 (${\pm}20.1$) years. The underlying diseases were : 21 neuromuscular disorders, 2 spinal cord injuries, 6 chronic lung diseases. Among the caregivers, spouses (n=14) predominated. Education for home care before discharge was performed primarily by intensive care unit nurses and the education for ventilator management by commercial companies. Twenty-five of the 29 patients had tracheostomies. Volume targeted type (VTT ; n=20, 69%) was more frequently used than the pressure targeted type (PTT). Twenty-three of the 29 patients purchased a ventilator privately, which cost 7,450,000 (${\pm}$3,290,000) won for a PTT, and 14,280.000 (${\pm}$3,130,000) won for a VTT. Total cost for the equipment was 11,430,000 (${\pm}$634,000) won. The average cost required for home care per month was 1,120,000 (${\pm}$1,360, 000) won. Conclusion : The commonest underlying disease of the patients was neuromuscular disease. The VTT ventilator was primarily used with tracheostomy. Patients and their families considered the financial difficulties associated with purchasing and maintaining equipment for home care an urgent problem. Some patients were aided by a visiting nurse, however most patients were neglected and left without professional medical supervision.

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Trends of Study and Classification of Reference on Occupational Health Management in Korea after Liberation (해방 이후 우리나라 산업보건관리에 관한 문헌분류 및 연구동향)

  • Ha, Eun-Hee;Park, Hye-Sook;Kim, Young-Bok;Song, Hyun-Jong
    • Journal of Preventive Medicine and Public Health
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    • v.28 no.4 s.51
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    • pp.809-844
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    • 1995
  • The purposes of this study are to define the scope of occupational health management and to classify occupational management by review of related journals from 1945 to 1994 in Korea. The steps of this study were as follows: (1) Search of secondary reference; (2) Collection and review of primary reference; (3) Survey; and (4) Analysis and discussion. The results were as follows ; 1. Most of the respondents majored in occupational health(71.6%), and were working in university (68.3%), males and over the age 40. Seventy percent of the respondents agreed with the idea that classification of occupational health management is necessary, and 10% disagreed. 2. After integration of the idea of respondents, we reclassified the scope of occupational health management. It was defined 3 parts, that is , occupational health system, occupational health service and others (such as assessment, epidemiology, cost-effectiveness analysis and so on). 3. The number of journals on occupational health management was 510. It was sightly increased from 1986 and abruptly increased after 1991. The kinds of journals related to occupational health management were The Korean Journal of Occupational Medicine(18.2%), Several Kinds of Medical Colloge Journal(17.0%), The Korean Journal Occupational Health(15.1%), The Korean Journal of Preventive Medicine(15.1%) and others(34.6%). As for the contents, the number of journals on occupational health management systems was 33(6.5%) and occupational health services 477(93.5%). Of the journals on occupational health management systems, the number of journals on the occupational health resource system was 15(45.5%), occupational finance system 8(24.2%), occupational health management system 6(18.2%), occupational organization 3(9.1%) and occupational health delivery system 1 (3.0%). Of the journals on occupational health services, the number of journals on disease management was 269(57.2%), health management 116(24.7%), working environmental management 85(18.1%). As for the subjects, the number of journals on general workers was 185(71.1%), followed by women worker, white coiler workers and so on. 4. Respondents made occupational health service(such as health management, working environmental management and health education) the first priority of occupational health management. Tied for the second are quality analysis(such as education, training and job contents of occupational health manager) and occupational health systems(such as the recommendation of systems of occupational and general disease and occupational health organization). 5. Thirty seven respondents suggested 48 ideas about the future research of occupational health management. The results were as follows: (1) Study of occupational health service 40.5%; (2) Study of organization system 27.1%; (3) Study of occupational health system (e.g. information network) 8.3%; (4) Study of working condition 6.2%; and (5) Study of occupational health service analysis 4.2%.

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A study on the gratification of the patient in the Dental Hospital (치과병원 내원환자의 만족도 조사분석)

  • Kim, Min-Young;Lee, Keun-Woo;Moon, Hong-Suk;Chung, Moon-Kyu
    • The Journal of Korean Academy of Prosthodontics
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    • v.46 no.1
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    • pp.65-82
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    • 2008
  • Statement of problem : Today's market economy has been changed more and more to consumer concerned. It is owing to not only consumers ' rising standard of living and education, but also purchasers' easy accessibilities to products through various mass media. The consumer centered market system, where customer can choose items with diverse alternatives to satisfy their self esteem, is also applied to the field of medical business, and accelerated by an increasing income level of shoppers and introducing the whole nations' medical insurance system. Today, the medical industry has become competitive due to increasing number of medical institutions and medical personnel, and this offers wide choices to consumers in the medical market place. At this point of time, it is essential to survey on the primary factor of gratification for the patient in the Dental clinic, as well as on the problems and suggestions in medical service. Purpose : The analysis in this study shows essential factors and expected influential elements in satisfaction of the patient in the Dental Hopsital, and strategic suggestions for the provider of dental service, which can be of benefit to the prospective customer as well as can make improvement in the quality of dental treatment service. Material and method : This study had been researched by collecting and analyzing the organized questionnaires, which were filled in directly from 784 patients, who visit Dental Hospital, Yonsei University in Seoul, from January 23rd to April 15th. Result : It can be summarized like the followings. 1. The social and demographical peculiarities of respondents are as follows. Samples of gender and marital status are adequately extracted, but data on occupation and treatment are are under a bias toward students, undergraduates and graduate students, and orthodontics. 2. 74% of patients who answer the questionnaire were highly satisfied with the service of dental clinic in the section of overall satisfaction. 3. The survey result about specific service of dental treatment, within sections of independent variables, is like the followings; Patients are highly gratified with service system, kindness, explanation, explanation on expected waiting hours, reservation system, emergency measures, expert treatment, existence of knowledge of dentistry, size of hospital, disinfection, equipment and parking, but lowly satisfied with expense of treatment, preparatory hours for treatment, waiting hours, treatment hours and the period of subscription. 4. The correlation analysis showed that there is no significant linear relationship between the independent variables. 5. The probit regression analysis showed that 8 out of 34 independent variables explained the dependent variables at the level of 0.01. 6. It shows that 8 independent variables, which can affect customers 'satisfaction, are clearing up of inconvenience, service system, kindness, explanation, treatment hours per attendance, reservation system, existence of knowledge of dentistry, and contentment of equipment in the hospital. Conclusion : The consumer's satisfaction totally relies on subjective evaluations of customers. Providing appropriate service, which can meet the criteria for the customer who demands various wares, pursues luxury goods, and expects high quality of medical service, is essential to fulfill patients' satisfaction. Many medical institutions do their best to satisfy their customer, touch their consumer, and offer patience centered services, and it is also applied to the field of dentistry. Establishing brand new strategic managements and elevating the quality of dental service based on this survey are required to improve the satisfaction of patience in the Dental Hospital.

A survey on the nutrient intake and food consumption of the students at the dormitories, College of Agriculture, Seoul National University (서울대학교(大學校) 농과대학(農科大學) 남녀(男女) 기숙사생(寄宿舍生)의 영양섭취(營養攝取) 조사(調査))

  • Mo, Su-Mi;Han, In-Kyu;Kim, Ze-Uook;Lee, Chun-Yung;Kim, Ho-Sik
    • Applied Biological Chemistry
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    • v.7
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    • pp.92-104
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    • 1966
  • For the purpose of the better dietary management and to empahsize of importance in nutrition education for 552 students at the dormitories, College of Agriculture, Seoul National University, the dietary survey was conducted for each consecutive seven days, from March 7th to 13th at the boy's dormitory, from March 14th to 20th at the girl's dormitory, respectively. In comparison the average caloric and nutrient intake per caput per day at the both, girl's and boy's dormitory with the recommended dietary allowances for age of 25, the intake of calories and all nutrients except riboflavin were over the allowances for the boy, while the caloric intake by the girl was considerablly below the allowance. But it is meant that only 150 calories was actually deficient in comparison with the figure of the average energy consumption determined for the girls at the dormitory of the Sook-myung Woman's University, whose pattern of living was quite similar to those of the girls at this college. Except iron and ascorbic acid, all other nutrients were deficient for the girls. The calories in the form of protein of a diet taken by the boy was 12.9% and that by the girl was 12.8%. Protein quality of the diet taken by boy scored 70 while that by the girl scored 79. NDp Cal% of the diet taken by the boy was 7 and that by the girl was figured out to be 8. Therefore, calculated reference protein taken by the boy was 55.8 grams and that by the girl was 36.9%. Though it is generally recommended that at least 1/3 of the protein should come from animal sources, it was apparent by this survey that providing 1/5 of the protein from animal sources with remaining part of high quality vegetable protein foods in the adequate mixed diet would give satisfactory results for both girl and boy students. This was clearly demonstrated by the recommended reference protein and NDp Cal% met. Significant difference between boys and girls in the average consumption of seasonings was found. In consumption per day of seasonings, boy used 1.5 grams of red pepper powder which means they used 15 times more of red pepper than girls did. Kochujang was used 13 grams by boy-students which was as high as 21 times of that of the girl. Total salt intake by the boy was 34 grams while the girl consummed 23 grams. It is obviously recognized that boys prefer more peppery and salty flavor than girls do. To reduce the amount of protein consummed and to improve the quality of protein food, increase of riboflavin rich food and increase of fat intake in place of grain intake are recommendable to the boy. For the girl's diet, consumption of grains, particularly more intake of barley mal· be recommendable to meet the B group of vitamins allowances as well as the caloric allowance. The use of more servings of yellow green vegetables is needed to the girl.

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Innovative approaches to the health problems of rural Korea (한국농촌보건(韓國農村保健)의 문제점(問題點)과 개선방안(改善方案))

  • Loh, In-Kyu
    • Journal of agricultural medicine and community health
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    • v.1 no.1
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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.

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