• Journal of Korean Public Health Nursing
• /
• v.13 no.1
• /
• pp.97-113
• /
• 1999

To investigate the actual condition of the adult-smoking in Chinan County. I used self-reporting questionnaires among 923 residents living in nine districts selected at random among the sites of eleven eup-myons from December 28. 1998 to January 6. 1999. collected data and analyized using SPSS. The smoking rate of adults in Chinan County was $36.9\%$. There was a significant difference in smoking rate according to the age. gender, education and job among general characteristics. The smoking rate in group of above 40s was about $40\%$ and that of the male took $55.5\%$ which was higher than that of female and the smoking rate of the people having high-school education was the highest$(46.2\%)$. With regard to the career. the smoking rate of the farmers ranked first$(46.1\%)$. Therefore anti-smoking business for smokers should be focused on above 40 years old, males. people having high school education and farmers. As the result of the survey of smoking habits of 340 people who smoke currently, the average smoking begining age was 21.8 and $81.5\%$ among them was between 16-25 years old. $4.4\%$ was under 15. during around the elementary school. Most motives to smoke were as followed; curiosity or taste$(33.6\%)$, relief of stress $(31.2\%)$, peer presure$(26.5\%)$ And considering the amount of the cigarette which is smoked per day, the case which is less than a pack of cigarettes was highest as $75.5\%$ and the people who smoke over one pack of cigarettes took $24.5\%$. As for the kind of tobacco which is smoked, how to smoke and the desire for the smoking, most case was toxin was moderate$(47.8\%)$ or mild$(46.9\%)$. shallowly$(49.0\%)$ or deeply$(46.3\%)$ and under stress$(33.4\%)$. after meals$(27.8\%)$, during drink$(15.7\%)$ and so on. The highest point marked among the factors of smoking motives was 'the reduce of negative emotion' $(3.27\pm1.00)$. followed by 'uncomfortable habits' $(2.87\pm1.02)$, 'addiction' $(2.84\pm1.06)$. 'habit' $(2.74\pm1.12)$. 'pleasure' $(2.70\pm1.04)$. 'stimulus' $(2.59\pm.90)$, 'sensation-exercise satisfaction' $(2.42\pm.97)$. Smokers smoke to reduce the negative emotions when angry in most common case. depressed. anxious. uncomfortable. lone. ashamed or embarrased. and intend to solve the certain problem. etc. Other motives are uncomfortable habit. addiction. habit. pleasure and the pursuit of stimulus. The level of nicotine dependence of adults m Chinan County was 10.57 which amount to 'high' wholly. As the resulf of the level of nicotine dependence score. the people who are low in the level of nicotine was $33.5\%$. the people who are high was $48.2\%$. very high was $18.4\%$. The approach for anti-smoking for smokers should be conducted differently according to the level of the nicotine. For the people who are in low level of nicotin dependence the prohibition of the smoking should be guided through the approach to foster strong will. for those who are in 'high' by acquiring proper method for the prohibition of smoking. and for those who are 'very high' the anti-smoking should be induced by providing proper program because of the possibility of the suffer from abstinence syndrome. The difference of the level of nicotine with the general characteristics of the objects had not statistically significant difference. The difference of the level of nicotine dependence accompanied by smoking habit had statistically significant difference according to the amount of smoke, the kind of tobacos. smoke inhale habit. In other words, the group of heavy smokers had higher level of the nicotine dependence than that of the light smokers relatively and the group which smoke strong taboaco has higher level of nicotine than that of which smoke mild or moderate. And the group of smokers who smoke deeply has higher level of nicotine than that who smoke shallowly or nonswallow. Aa a result of the analysis of the correlation between smoking motive factors and the level of nicotine, there was the indication that people who smoke for the decrease of the negative emotion. habit, pleasure. stimulus. sensation-exercise satisfaction had high level of the nicotine dependence. As the result of the anti-smoking will of smokers. $65.0\%$ of them had prohibition of smoking will. $29.3\%$ had no will to quit smoke. The most important reason for anti-smoking was health. $67.9\%$ had experience to try to quit smoke and the biggest reason to fail to quit smoking was the lack of the will power to keep anti-smoking. $52.8\%$ of them were advised to stop smoking from their spouses or children. only $2.8\%$ were by medical. The people who have the opinion to need anti-smoking education were $69.6\%$. Therefore when the business for the hygine of the mouth for adult is set. it should be centered on the people who have intention of prohibition of the smoking and help to quit smoking by way of other affirmative counter-program not smoking under stress.

• Korean Journal of Community Nutrition
• /
• v.8 no.6
• /
• pp.889-900
• /
• 2003

This study was carried out to obtain information regarding eating habits, including health related behavior and health food consumption patterns. The subjects of this study were 149 men and 152 women residing in the Ulsan area. We obtained results by means of a questionnaire and an interview, and these were analyzed using the SPSS package program. The results of this study are summarized as follows The average age of the men was 47.6 $\pm$ 7.3 years and of the women was 47.3 $\pm$ 7.6 years old. The average height and weight of the men were 169.4 $\pm$ 5.5 cm and 67.7 $\pm$ 8.2 kg, respectively. Those of the women were 157.6 $\pm$ 5.0 cm and 58.2 $\pm$ 7.5 kg, respectively. The BMI values of all the subjects ranged from 20.0 to 25.0, all within the normal levels. In the case of dietary patterns, 24.3% of the total population always skipped a meal. In particular, 15.9% of the total population skipped breakfast. No time to eat, no appetite, having no taste, and having poor health were themain reasons for skipping meals. With regard to health care, there was a significant difference between the men and the women with respect to smoking and drinking (p<0.001). Of the total population, 40.5% hardly exercised (less than once a week), 26.2% exercised occasionally, 13.6% frequently exercised, and 19.6% exercised almost every day. A total of 60.7% responded that they were not interested in their health. The mean eating habit score of the subjects was 65.6 $\pm$ 9.9. The women had a higher eating habit score than the men (64.0 $\pm$ 9.6 for the men and 67.2 $\pm$ 9.9 for the women). Except for one group above 60 years, the older group had a higher eating habit score than the younger one. The group having a higher income and a more specialized career had a higher eating habit score than the one having a lower income and a less specialized career. There was also a marital difference. The group of single subjects showed a lower eating habit score than the married group. The group having a higher eating habit score drank, smoked and went out for meals less, and exercised more than the group having lower scores. They also were more concerned about their health. In the older group, there were more diabetic and hypertensive individuals. The subjects who had a higher BMI index were more likely to be patients with hypertension, especially in the men's group. Those who had a higher BMI index and hypertension simultaneously took a variety of medicines and foods for promoting health. Those who worried a lot about their health and had health problems tended to take special foods for their health. Patients usually took tonics. Special foods for health included Chinese medicines, tonic foods, vitamin or mineral supplements and manufactured health food supplements. Preferences for them depended on the sex and age of the subject. In the case of tonic foods, the men liked them more than the women. Foods other than tonic foods were favorites with the women. This study may provide basic information on the eating habits and health related behaviors of middle-aged people. However, further studies are needed to improve the eating habits and to change the nutritional attitudes, so that people can make better choices of health foods.

• Research in Community and Public Health Nursing
• /
• v.15 no.4
• /
• pp.587-599
• /
• 2004

Purpose: The purpose of this study is to compare abdomen-fat rate, life style and social-support between normal weight women and obese women. Method: 304 women objectives from their 30 to 59 years of age were selected living in Je-chon city, Chung-Buck province and their height and weight were measured from April 1st to June 30th, 2003. Data were classified into low-weight group ($18.5kg/m^2$), normal-weight group ($18.5{\sim}22.9kg/m^2$), over weight group ($23{\sim}24.9kg/m^2$), and obese group ($25kg/m^2$) following the Korean Conference of Obesity, 2001. in which 119 people in the normal weight group and 91 people in the obese group, i.e. total 210 people were analyzed in sequence. Using SPSS Win 10.1 Program, frequency and percentile, and by ANOVA, $X^2-test$ and t-test were treated. Results: The average age of obese women was 46.68 distributing 40.7% of forties and 39.6% of fifties while normal-weight women were average 41.73-year old distributing 53.8% of forties and 34.5% of thirties, which revealed aged in obese women. The body fat rate of obese women averaged $37.52{\pm}4.17%$, in which 98.9% of obese women and 21.0% of normal weight women with a more than 30% of body-fat rate resulted in a higher body-fat rate in obese women. The waists of obese women averaged $88.37{\pm}8.22cm$, in which more than 85cm showed in obese women of 68.2% and normal weight women of 7.6% indicating a higher waist-fat rate in obese women. The abdomen-fat rate of more than 0.85 of waist vs hip-fat showed 74.7% in obese women and 58.4% in normal weight women, indicating a higher abdomen-fat rate in obese women. Obese women and normal weight women showed significant differences in education level, number of children, religion, menstrual status, and mother's weight. Especially, obese women ate hotter or saltier food than normal weight women preferring meat. However, no significant differences appeared in marital status, social economic status. occupation. eating habits. smoking. drinking and physical exercise. Social support levels showed a lower rate in obese women than in normal weight women, indicating a statistically significant difference (p<.05). Observing areas of social support, obese women showed lower rates in attachment/intimacy, social integrity, opportunity of foster and confidence in value except help and instruction, which indicated a statistically significant difference (p<.05). Social support for obese women showed significant differences in age, education level, social hierarchy, religion and menstrual status. Obese women were more negative than normal weight women in health recognition, indicating a statistically significant difference (p<.01). Normal weight women showed higher health recognition when provided high social support and significantly low (p<.01) health recognition when provided low social support. However, there was no significant difference in health recognition in obese women whether high or low social support was given. The health recognition of obese women showed significant differences in age, education level, social hierarchy, number of children, menstrual status, physical exercise, eating habits, eating taste and preference of food. Conclusion: Obese women showed elder than normal-weight women, higher body-fat rate and abdomen-fat rate, lower social support, and a tendency to more negative health recognition. Therefore, providing weight-control programs for the treatment of obesity and prevention of recurrence for obese women to prevent progressing to adult disease and promote a healthy life, we suggest that better eating habits and the encouragement of regular physical exercise should be included, as well as total approachment on change of health recognition and social support would be needed.

• Journal of Korean Public Health Nursing
• /
• v.19 no.1
• /
• pp.74-94
• /
• 2005

The purpose of this study was to compare the effect of education between CAI(Computer Assisted Instruction) and lectures for smoking cessation among male students who attended vocational high schools. Conducted from February 24th to April 26th, 2003, the study design was quasi-experimental with nonequivalent control group pretest-posttest design. The study subjects were 60 male students in K vocational high school in Daegu city, who were present smokers and had more than 7.0 ppm concentration level of carbon monoxide. Thirty students were randomly chosen as the experimental group which applied CAI education method for smoking cessation. The other 30 students served as the control group which received lecture education method of 40 minutes on four consecutive days. CAI education for smoking cessation was composed of ready-made individual learning contents, counseling by using cyber-communication, writing a letter to stop smoking, and writing a written agreement for smoking cessation. Lecture education for smoking cessation was composed of a ready-prepared lecture for the group, writing a letter to stop smoking, and writing a written agreement for smoking cessation. To measure smoking related knowledge, Jeong Ree Roh(1996)'s smoking related knowledge scale$(Cronbach's\;{\alpha}=0.84)$ was modified and used by the researcher. To measure smoking related attitude, Jeong Ree Roh(1996)'s smoking related attitude scale$(Cronbach's\;{\alpha}=0.91)$ was modified and used by the researcher. Smoking related knowledge scale's Cronbach's $\alpha$ was 0.83 in the pilot study and 0.93 in this study. Smoking related attitude scale's Cronbach's a was 0.80 in the pilot study and 0.98 in this study. To determine the smoking amount, the number of cigarettes smoked per day was checked. The concentration level of CO in the exhaled breath was measured (Micro CO Cat. No. MCO2, UK). Data was analyzed by $x^2-test$, t-test, repeated measures ANOVA. simple main effects, and time contrast test with SPSS/Win 11.0 program. The results of this study were as follows: 1. The first hypothesis. that 'Smoking-related knowledge score in the experimental group by using CAI education for smoking cessation will be higher than that in the control group by using lecture education for smoking cessation', was not supported. 2. The second hypothesis, that 'Smoking-related attitude in the experimental group by using CAI education for smoking cessation will be higher than that in the control group by using lecture education for smoking cessation'. was supported(F=6490.79. p=0.000). 3. The third hypothesis. that 'Smoking amount in the experimental group by using CAI education for smoking cessation will be less than that in the control group by using lecture education for smoking cessation'. was supported. 1) The third-1st sub-hypothesis. that 'The number of cigarettes smoked per day in the experimental group by using CAI education for smoking cessation will be less than that in the control group by using lecture education for smoking cessation'. was supported(F=134.19. p=0.000). 2) The third-2nd sub-hypothesis. that 'The concentration level of CO by ppm per one exhaled breath in the experimental group by using CAI education for smoking cessation will be lower than that in the control group by using lecture education for smoking cessation"' was supported(F=268.55. p=0.000). From the above results. CAI education can be an effective intervention to improve smoking-related knowledge and attitude. and to reduce the number of cigarettes smoked per day and the concentration level of CO by ppm per one exhaled breath. Lecture education can be effective to improve smoking-related knowledge. In the future, when CAI education and lecture education for smoking cessation are applied on the school nursing field. the students can gain a comprehensive understanding of smoking cessation, changes in smoking-related knowledge. smoking-related attitude and reducing smoking amount. Furthermore, CAI education for smoking cessation could be developed as an individual self initiative program and could give a guideline to apply CAI education for smoking cessation in other field.

• Journal of Korean Public Health Nursing
• /
• v.8 no.2
• /
• pp.1-34
• /
• 1994

This study has been done in order to analyze the relationship between climacteric symptoms and the stress of life events. For the purpose of this study. objectives set up were as followings. : 1. Climacteric symptoms complained by middle aged women are studied. 2. The stress of life events experienced by middle aged women is studied. 3. The relationship between climacteric symptoms and the stress of life events is studied. 4. The relationship between climacteric symptoms and general characteristics is studied. and the relationship between the stress of life events and general characteristics is also studied. The sample size of this study was 462 cases. The subjects were middle-aged women. who were from 40 to 60 years old and resided in Seoul. Data were collected by using questionnaires which consisted of 122 questions from Jan. 1 to Feb. 7 in 1992. The questionnaires include questions about general characteristics. climacteric symptoms and life events. The measurement scales for this study were adopted from the climacteric symptoms scale developed by Chi. Sung-Ai and the measurement scale of stress related to life events devised by Lee. Pyoung Sook. The analysis of data collected was done by using SPSS-pc package. Firstly. general characteristics were analyzed by using descriptive statistical methods. Secondly. climacteric symptoms were analyzed by using descriptive statistical methods. the analysis of variance and correlation analysis. Thirdly. the stress of life events was studied by using descriptive statistical methods. the analysis of variance. and tests of independence. The results of this study are as followings. 1. General characteristics of the respondents are as followings: The average age is 49. 13. and the age group from 46 to 50 has $30.5\%$ in the respondents. Christianity is the major religion $(42.6\%)$. and the respondents with a high school diploma are $(43.1\%)$ of the respondents. $60\%$ of all respondents are housewives. and $90.5\%$ are married. The average number of children is 2.71. and the average number of family is 4.24 Monthly income of $39.1\%$ of the respondents is from l,010,000 Won to 2,000,000 Won. The premenopausal group is $4.9\%$. and $45.5\%$ of all respondents are satisfied with marrital life. $43.3\%$ of all feel happy. and $13.9\%$ feel economic frustration. $27.9\%$ of respondents are satisfied with sexual life. and $45\%$ of all report that the amount of recreational activities are more needed. 2. The average score of climacteric symptoms is 1. 8461 (The maximum score is 5.0). The symptoms complained frequently are nervousness. muscle-ache. fatigue. headache and knee-ache. Climacteric symptoms are significantly different in menopausal states. age groups. the number of children, marrital satisfaction. the feeling of life. self-reported health states and sexual satisfaction. 3. The life events occurred frequently were 'discord with husband', 'children's important exams', 'separation from husband related to works' and 'vacation'. When life events are analyzed by factors. the most frequently mentioned factor is 'marrital life'. The stress of life events is significantly different in a few general characteristics (age. the number of children, the number of family, monthly income, menopausal status, the feeling of life. self-reported health states, economic satisfaction). 4. The score of climacteric symptoms complained is significantly different according to the stress of life events (p<0.051, Especially, the difference is the widest in psychological symptoms according to the factor of 'couple. marrital life' among stressful life events. In Summary, climacteric symptoms complained by middle-aged women are related to the amount of the stress of life events. Whether life events are positive of negative is not important. Yet. climacteric symptoms and stressful life events are deeply related to general characteristics. so we can not insist strongly that one be directly related to the other.

• Journal of the Korean Society of Food Science and Nutrition
• /
• v.38 no.11
• /
• pp.1551-1558
• /
• 2009

The management of skeletal health in the twenties is the number one priority for preventing fracture or osteoporosis occurrence in later life cycle. Therefore, the factors influencing bone mineral density were examined by anthropometric measurements, food intakes, bone mineral density and biochemical nutritional indexes in blood among college students. Among the students who received health examinations from May to December, 2007, 532 male and 507 female students who agreed to participate in the study were selected. Nutritional intakes were estimated with 3-day 24-hour recall method. Bone mineral density was measured by ultrasonic attenuation passing through right calcaneus bone and expressed as broadband ultrasound attenuation and t-score was calculated by WHO criteria. Red blood cell count, hemoglobin, hematocrit values were measured by whole blood analysis, and alkaline phosphatase, serum calcium and serum iron were used as indexes for biochemical nutritional status. Data analysis was conducted using SPSS 14.0 program, and protecting and risk factors on bone health status were analyzed by logistic regression analysis between normal bone health group (t-score$\underline{\geq}$ -1.0) and osteopenia group (t-score<-1.0). The results showed that more people belong to the normal bone health group probably because this study was conducted among those with their peak bone density. Biochemical nutritional status and nutrition intakes of both groups for normal and osteopenia did not show statistically significant difference except MCHC, animal protein and animal iron intakes in female. According to the results of logistic regression analyses, dietary intakes of animal protein, animal iron and zinc showed protecting effects against osteopenia. Therefore, dietary nutritional intakes of micronutrients, especially iron and zinc are important for bone health of young people.

• Journal of the Korean Home Economics Association
• /
• v.46 no.8
• /
• pp.97-107
• /
• 2008

This study was conducted in order to identify the relationship between psychological factors, such as depression and self-esteem, and nutritional status, such as nutritional risk index and nutrient intake, among the elderly in Chunnam Province. The participants were 119 elderly individuals over the age of 65 years who visited the Senior Welfare Center in Chunnam province between January 29 and February 2, 2007. This study was conducted using a structured questionnaire that included, the Center for Epidemiologic Studies Depression Scale (CES-D), General Self Efficacy Scale (GSES), Nutritional Screening Initiative Checklist (NSI checklist), questions pertaining to the general characteristics of the participants and an estimation of nutrient intake using the 24-hour recall method. Data were analyzed by the SPSS program. Analysis of the participant's CES-D scores revealed that 43.7% of the subjects were normal and 56.3% had more than mild depression. The mean GSES score was 45.9 for the entire group of subjects (51.9 for men, 43.6 for women). The mean nutritional risk index value was 4.30 (5.03 for men, 4.01 for women). Analysis of the participant's scores on the NSI checklist revealed that 69.7% of the subjects were normal and 30.3% exhibited a moderate nutritional risk. The CES-D was positively correlated with the NSI checklist (p < 0.05) but negatively correlated with nutrient intake. However, the GSES was negatively correlated with the NSI checklist (p < 0.05), but positively correlated with nutrient intake (P < 0.01 for protein, calcium, phosphorus, zinc etc.). The results of this study indicate that it is necessary to manage psychological factors, including depression and self-esteem, in the elderly in order to decrease their nutritional risk and increase their nutrient intake.

• Journal of dental hygiene science
• /
• v.6 no.1
• /
• pp.23-28
• /
• 2006

This study was conducted to investigate the oral health related quality of life in elders concerning to residence at urban and rural. The subjects were 215 old persons who were over the 60 years old, living at Sahagu in Busan(113persons) and Geojer Si in Kyungnam (102persons). The data for this study were collected by direct interviewing method from May 30 th to June 30 th and September 12 th, 2005. Cushing & Sheiham's Sociodental Scale which measures oral health related quality of life was used for this study. The data were analysed by a computerized program named statistical package for social science including frequency, percentage, t-test. The results of this study were summarized as follows; 1. Mean score of the oral health related quality of life in elders is $2.42{\pm}1.03$ 2. There was a significant difference in oral health related quality of life in elders between the age 60 ~ 70 years group and the over than 71 years group(P < 0.01). 3. There was a significant difference in oral health related quality of life in elders between the urban and rural group(P < 0.05). Above findings suggest that further study about proper program for geriatric oral health evaluation is necessary in improving the oral health related quality of life in elders.

• Journal of dental hygiene science
• /
• v.10 no.6
• /
• pp.431-438
• /
• 2010

This study was designed to identify the relationship between emotional labor and reaction factor(job satisfaction, fatigue), buffer factor(social support) among dental hygienist. The number of respondents was 50 who work in dental clinic and period of investigation was march 2010 through April 2010. A structured questionnaire was employed to evaluate the level of participants' sociodemographics, job-related factors, health-related behaviors, emotional labor and self-perceived fatigue, job satisfaction, social support. While the mean values of emotional labor were higher than thosewho work in hospital and lower than those who work in service employees. These results suggest that emotional labor was related to an increase in fatigue and strong correlation between involuntary emotional expression, self-perceived fatigue, job satisfaction, social support in dental hygienist. Multiple regression analysis has found that social support and no. of personnel were main factors that influence to the level of emotional labor in dental hygienist. The results of this study suggest that emotional labor was a determinant predictor of self perceived fatigue. Thus, a management program for emotional labor is strongly recommended for promotion of quality of life in dental hygienist and to improve dental service and competitiveness.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
• /
• v.7 no.1
• /
• pp.29-50
• /
• 2001

This research have been made to define how the IADL (Instrumental Activity of Daily Living) performance and the subjective health index of the Aged are affected by their residential circumstance, gender and age, and how deeply these two factors are related and interact. For the period of June 1 to July 31, 2000, we had conducted a questionnaire and direct interview with 693 persons over age sixty-five (65) in Daejon and in other adjacent area, grouping into three different residential types The Aged living at home, The Aged living at welfare facilities and The Aged living alone, and studied on how the IADL performance and the subjective health index of the Aged are influenced and interact as per their characteristics, daily activity and mentality. We had analyzed all the data obtained through this research by the method of : - analysis of frequency as per specific factors by SPSS 1O.0/PC+, - $x^2$ test, - t-test, - ANOVA, - multiple regression analysis by factors. The research concludes followings : a. It appears that the three (3) factors such as gender, age and residential circumstance of the Aged deeply affect the IADL performance and subjective health index of the Aged. (p<0.01) b. With regard to IADL performance of the Aged by the gender, it was analyzed that the female-Aged gains 23.8 point on average, which shows the performance of the female-Aged is less independent. (p<0.01). In addition, it was also found that the IADL performance is becoming less and less independent following their age increasing. In analyzing IADL performance by the residential type, it appears that the Aged living at welfare facilities gains the lowest 21.5 points and is least independent. It was also found that the Aged living at welfare facilities need some assistances from others for their performing IADL. (20-24 point) (p<0.001) c. With regard to the subjective health index of the all-Aged participated in this research, the analysis indicates 8.8 point and this is considered as a point of general standard (7-10 point). In analyzing this index by the gender, the female-Aged gains only 8.6 point which explains a lot of female-Aged consider they are not really healthy. (p<0.001) In analyzing this index by the residential type, the Aged living at welfare facilities and the Aged living alone gain the comparatively lower point, - respectively 8.4 point for the Aged living at welfare facilities and 8.8 point for the Aged living alone. The Aged living at these two residential types express they are obviously in a bad situation of health. (p<0.001) d. With regard to the factors affecting the IADL performance and the subjective health index of the Aged, it was analyzed that the IADL performance can largely be affected by the factors such as depression, frequency of going-out and age rising, and that the subject health index can also deeply be affected by depression, pain and by how much they are satisfied with their current living conditions. e. It was analyzed that the interacting between the IADL performance and the subjective health index is not that strong but even weak. As a result, we were able to conclude that the IADL performance is less independent in case of the female-Aged, the Aged living at welfare facilities, and following the age rising. As for the subjective health state the Aged themselves are aware of, we concluded that the female-Aged, the Aged living at welfare facilities and the Aged living alone, are more critical about their health. From this research, we were able to realize that, when the OMT (Orthopedic Manual Therapy) needed, the physical therapists are really required to have a correct and cautious understanding of the situation in which the aged persons are, and take care of them with more concerns and more improved treatment.