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A Survey on the Status of Health Examination among Farmers in a Rural Area (일부 농촌지역 농업종사자들의 건강진단 수검 실태)

  • Park, Soon-Woo
    • Journal of agricultural medicine and community health
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    • v.22 no.1
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    • pp.1-18
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    • 1997
  • This study was carried out to reveal the status of health examination among farmers and to attract more attention to the health care system for farmers. Ten pre-trained medical students interviewed the rural residents 18 years of age and older in eight villages which were randomly selected from a county near Taegu city in Korea, in August 1996. Finally 751 persons were interviewed of whom the percentages of male and female were 41.8%, 58.2% respectively. Among the subjects, 361(48.3%) were fully engaged in farming, 184(24.4%) were partly engaged, and the remaining 206(27.3%) were not engaged in farming at all. The overall prevalence of farmer's disease was 23.0% and there was no significant difference between the group of fully engaged in farming(23.3%) and the group of not-fully engaged(22.9%). But the prevalence of farmer's disease in female subjects(27.8%) was significantly higher than that in male(16.2%)(p<0.01). Among the 288 farmer engaged in spraying pesticide, 113(39.2%) had experienced one or more pesticide related symptoms during last one year, but only 18(15.9%) of them had visited medical facilities due to their symptoms. The experience of receiving education about pesticide was significantly correlated with the degree of wearing protectors during pesticide spraying(p<0.001). Among the 736 persons excluding non-respondents, 281(38.2%) received health examination during last one year ; 176(62.6%) of them received free health examination, and 105(37.4%) received charged one. Among the 533 persons 40 years age and older, only 124(23.3%) had received the 'health examination for the elderly' during last one year, which is provided for the 40 years age and older by Korea medical insurance corporation and medical insurance societies. Most of all beneficiaries of self-employed medical insurance thought the imposed contributions as very expensive(77.4%) or moderately expensive(13.2%). The great majority of farmers are exposed to various health risk factors including pesticide, high temperature, overwork etc. comparable to industrial workers. But farmers are excluded from the regular yearly worker's health examination because of not belonging to a company despite they pay relatively more medical insurance contributions compared with the industrial workers and the urban self-employed medical insureds. It is necessary to develop special health management program for farmers such as the special health examination for the industrial workers exposed harmful agents.

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Health Management and Services of School-Nurse in Special Schools (특수학교의 보건관리)

  • Lee, Kyung Hee;Park, Jae Yong
    • Journal of the Korean Society of School Health
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    • v.4 no.2
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    • pp.176-192
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    • 1991
  • School nurses, in service of 102 special schools in Korea, were urveyed by mail questionnaires from February to March, 1991 and 77 of hem responded. Collected data were analyzed to establish the direction of health management in special school and to provide basic reference data for improving the quality of the management of school-nurses' services. The major findings are as follows: Out of special schools surveyed, 67.5% is private school and 83.2% is located in city. The average number of classes, students, and educational personnels per special school is 17.2, 194, and 28 respectively. The average age of school-nurses surveyed is 32.7. The proportion of graduates from the junior college and upward was 97.4%, the proportion of the married was 71.4%. Out of respondents, 71.4% has religion : 79.2% has past career in the fields of clinics or public health: 62.3% accompanishes independent services: 77.9% belongs to primary school. About 69% of nursing room in special schools surveyed is located at the first floor. Out of special school surveyed, 90.9% has no organization for school health programms: Only 18.2% entrusted everyone of school doctor, school dentist, and school pharmacists with school health. 46.8% of respondents didn't know about the annual budget for school health programmes. The average annual expenditure for school health programme per special school was 317,000F26. won and the purchase cost for medical supplies accounted for the larger part of them. The monthly average number of students utilizing school nursing room was 71 per school, annual utilization times of school nursing room was 4.4 per student and utilization due to injury was prevalent by 26.6% and there is some differences in using the school nursing room according to disabled area. Rate of referral to medical facilities was 1.4%. The leading reason of referral to medical facilities was high fever among those who have visual handicaps, fracture among those who have emotional disturbance, injury by trauma among others. Nine hundred fifty six students of students in special school surveyed have sufferd from epilepsy and prevalence rate of epilepsy was 6.4%. Only 22.6% of respondents replied that they had physical examination more than 2 times per year. Out of respnodents, 98.7% answered that they had health education and 67.1% of them ansered that they educated in a classroom, 98.7% of respondents emphasized need of sex education. Respondents put the most emphasis on the personal hygiene when they performed health education and they used broadcasting education in the area of visual handicaps, OHP or VTR in hearing handicaps, home correspondence or OHP VTR in other area importantly. About 47% of repondents answered that health education was the most difficult and they emphasized that definite guide on health management was requested. Respondents had self-confidence and high perfomance rate in most of school-nurses' services completely, but so they was not in area of evaluation of school health programmes, an examination of physical strength, evaluation of health education, management of school purification area, suture of wounds. In consideration of above findings, we may conclude that special education for school-nurse in special schools as well as improvement of definite guiding principles are requested to establish direction for health management in special schools and to improve the degree of quality for school-nurses' sevices in special schools.

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Training, Working State and Ways of Improving Work of Sex Education Counselors in Health Centers (대구·경북지역 보건소 성교육 담당자의 훈련 및 업무현황과 개선방안)

  • Yeom, Seok-Hun;Kim, Chang-Yoon;Lee, Kyeong-Soo
    • Journal of agricultural medicine and community health
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    • v.27 no.2
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    • pp.159-175
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    • 2002
  • This present study was conducted to reduce problems by analyzing training and work of sex education counselors and to come up with ways of improving sex education counseling. A survey was performed in 57 subjects at health centers who finished training on sex education counseling in Taegu Metropolitan City and cities, kuns, and gus of Kyongsangbuk Province from December, 1999 to February, 2000 on general characteristics, items relating to the work of sex education, and ways of improving work. The results are as follows. Out of the sex education counselors, there were 55 females, taking 99% out of the total counselors, and the average age of these counselors was 42 years. There were 26 nurses, and their government grade was level 7 in 36 and level 6 in 14. The members who had finished sex education counseling at each public health center was 2.1 counselors at an average. Among those had finished sex education training, 30 was not in sex counseling. When analyzed the answers given by 27 sex counselors who were counseling at the time and the results are as follows. As for the amount of work, 15 answered to have too much work and 1 little; as for having pride on being a sex education counselor, 18 answered to felt pride and 7 so-so; as for materials for sex education and counseling, 25 answered to use videos, 23 books, 10 pictures, 8 beam projectors, and 7 slides. All of the subjects answered to have other responsibilities besides sex education and counseling, and the satisfaction felt on having other responsibilities was 6 satisfied, 12 average, and 2 dissatisfied. The proportion of work load in sex education counselors was other work besides sex education 76.2%, sex education at schools 7.6%. collecting sex education materials 5.7%, counseling of adolescents 4.9%. development of sex education materials 3.5%, and administrative work related to sex education 3.1%. The biggest problem of their work was over-load in 9 respondents, lack of sex education materials in 8, lack of training in 6, and shortage of professionals in 2. As for the answer on the ways of improving matters related to work of sex education counselors, the most frequent answer was that the organizations responsible for sex education needs to be more professional and systematic, followed by dividing the work load so that they could concentrate on developing education materials and sex education and counseling. Thus, the results of the present study indicated that in order to utilize human resources efficiently, the speciality of counselors needs to be considered when making personnel transfers among health centers, and continued activity as a sex education counselor needs to promoted by reducing other overloading tasks. And systematic re-training of the counselors needs to be done, and education manuals that are diverse and realistic to applicable to the children, who are to be the subjects of sex education, need to be developed and distributed.

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Performance State and Improvement Countermeasure of Primary Health Care Posts (보건진료소(保健診療所)와 업무실태(業務實態)와 개선방안(改善方案))

  • Park, Young-Hee;Kam, Sin;Han, Chang-Hyun;Cha, Byung-Jun;Kim, Tae-Woong;Gie, Jung-Aie;Kim, Byong-Guk
    • Journal of agricultural medicine and community health
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    • v.25 no.2
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    • pp.353-377
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    • 2000
  • This study was performed to investigate the performance state and improvement countermeasure of Primary Health care Posts(PHPs). The operation reports of PHPs(1996 330 PHPs, 1999 313 PHPs) located in Kyongsangbuk-Do and data collected by self-administered questionnaire survey of 280 community health practitioners(CHPs) were analyzed. The major results were as follows: Population per PHP in 1999 decreased in number compared with 1996. But population of the aged increased in number. The performance status of PHP in 1999 increased compared with 1996. A hundred forty one community health practitioners(50.4%) replied that the fiscal standing of PHP was good. Only 1.4% replied that the fiscal standing of PHP was difficult. For the degree of satisfaction in affairs, overall of community health practitioners felt proud. The degree of cooperation between PHP and public health institutions was high and the degree of cooperation of between PHP and private medical institutions was high. The degree of cooperation between PHP and Health Center was significantly different by age of CHP, the service period of CHP, and CHP's service period at present PHP. Over seventy percent of CHPs replied that they had cooperative relationship with operation council, village health workers, community organization. CHPs who drew up the paper on PHP's health activity plan were 96.4 % and only 11.4% of CHPs participated drawing up the report on the second community health plan. CHPs who grasped the blood pressure and smoking status of residents over 70% were 88.2%, 63.9% respectively and the grasp rate of blood pressure fur residents were significantly different according to age and educational level of CHP. CHPs received job education in addition continuous job education arid participated on research program in last 3 years were 27.5%, respectively. CHPs performed the return health program for residents in last 3years were 65.4%. Over 95% of CHPs replied that PHPs might be necessary and 53.9% of CHPs replied that the role of PHPs should be increased. CHPS indicated that major reasons of FHPs lockout were lack of understanding for PHP and administrative convenience, CHPs were officials in special government service governors intention of self-governing body. CHPs suggested number of population in health need such as the aged and patients with chronic disease, opinion of residents, population size, traffic situation and network in order as evaluation criteria for PHP and suggested results of health performance, degree of relationship with residents, results of medical examination anti treatment, ability for administration and affairs in order as evaluation criteria for CHP. CHPs replied that the important countermeasures for PHPs under standard were affairs improvement of PHPs and shifting of location to health weakness area in city. Over 50% of CHPs indicated that the most important thing for improvement of PHPs was affairs adjustment of CLIP. And CHPs suggested that health programs carried out in priority at PHP were management of diabetes mellitus and hypertention. home visiting health care, health care for the aged. The Affairs of BLIP should be adjusted to satisfy community health need and health programs such as management of diabetes mellitus and hypertention, home visiting health care, health care for the aged should be activated in order that PHPs become organization reflecting value system of primary health care.

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Effectiveness of Smoking Prevention Program based on Social Influence Model in the Middle School Students (흡연예방교육에 의한 청소년들의 흡연에 대한 지식 및 태도변화와 흡연량의 감소 효과)

  • Roh, Won-Hwan;Kang, Pock-Soo;Kim, Sok-Beom;Lee, Kyeong-Soo
    • Journal of agricultural medicine and community health
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    • v.26 no.1
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    • pp.37-56
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    • 2001
  • This study was conducted to analyze the degree of changes in knowledge and attitude toward smoking and to examine the factors affecting knowledge and attitude for smoking after providing a smoking prevention program based on social influence model for a year to middle school students. Study population consists of 665 subjects of middle school students(aged 14 years) in Gumi city in Kyeongsangbukdo Province. Among them three-hundred sixty-seven students(intervention group) were educated to a smoking prevention program for 1 year from April 1999 to April 2000. School-based four-class program to prevent smoking was developed. The program provides instruction about short and long-term negative physiologic and social consequences of smoking and also discussed the health hazards of smoking, social pressure to smoke, peer norms regarding tobacco use, and refusal skill. A 45-item self-administered structured questionnaire was designed to evaluate the change of knowledge, attitude, smoking rate and the amount of smoking. The instrument was comprised of 11 knowledge items, thirteen attitude item and demographic items. Each scales were created by summing responses to each items within each scales and high scores on the knowledge, attitude, and smoking behavioral intention scales indicated positive responses. Based on the changes before and after the implementation of smoking prevention program between intervention and control group, the change of scores on knowledge were significantly different between the control group and the intervention group(p<0.05) and the change of scores on the attitude toward smoking was significantly different between intervention and control group. The change of smoking rate were not showing a significant difference between two groups but the amount of smoking were significantly reduced in intervention group than control group. In multiple regression analysis on changes of knowledge about smoking, the variables of smoking prevention program education, previous knowledge on smoking and students' school performance were selected the significant variables. In multiple regression to analysis of the factors influencing changes in attitude toward smoking, the variables of smoking prevention program education, previous knowledge on smoking were shown to be significant. The smoking prevention program was effective on change of knowledge and attitude of middle school students. In considering that the policy should be needed to extent of implementation of school-based health education curricula based on social influence model and it would contribute to reduce smoking of students.

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Application of LCA on Lettuce Cropping System by Bottom-up Methodology in Protected Cultivation (시설상추 농가를 대상으로 하는 bottom-up 방식 LCA 방법론의 농업적 적용)

  • Ryu, Jong-Hee;Kim, Kye-Hoon;Kim, Gun-Yeob;So, Kyu-Ho;Kang, Kee-Kyung
    • Korean Journal of Soil Science and Fertilizer
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    • v.44 no.6
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    • pp.1195-1206
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    • 2011
  • This study was conducted to apply LCA (Life cycle assessment) methodology to lettuce (Lactuca sativa L.) production systems in Namyang-ju as a case study. Five lettuce growing farms with three different farming systems (two farms with organic farming system, one farm with a system without agricultural chemicals and two farms with conventional farming system) were selected at Namyangju city of Gyeonggi-province in Korea. The input data for LCA were collected by interviewing with the farmers. The system boundary was set at a cropping season without heating and cooling system for reducing uncertainties in data collection and calculation. Sensitivity analysis was carried out to find out the effect of type and amount of fertilizer and energy use on GHG (Greenhouse Gas) emission. The results of establishing GTG (Gate-to-Gate) inventory revealed that the quantity of fertilizer and energy input had the largest value in producing 1 kg lettuce, the amount of pesticide input the smallest. The amount of electricity input was the largest in all farms except farm 1 which purchased seedlings from outside. The quantity of direct field emission of $CO_2$, $CH_4$ and $N_2O$ from farm 1 to farm 5 were 6.79E-03 (farm 1), 8.10E-03 (farm 2), 1.82E-02 (farm 3), 7.51E-02 (farm 4) and 1.61E-02 (farm 5) kg $kg^{-1}$ lettuce, respectively. According to the result of LCI analysis focused on GHG, it was observed that $CO_2$ emission was 2.92E-01 (farm 1), 3.76E-01 (farm 2), 4.11E-01 (farm 3), 9.40E-01 (farm 4) and $5.37E-01kg\;CO_2\;kg^{-1}\;lettuce$ (farm 5), respectively. Carbon dioxide contribute to the most GHG emission. Carbon dioxide was mainly emitted in the process of energy production, which occupied 67~91% of $CO_2$ emission from every production process from 5 farms. Due to higher proportion of $CO_2$ emission from production of compound fertilizer in conventional crop system, conventional crop system had lower proportion of $CO_2$ emission from energy production than organic crop system did. With increasing inorganic fertilizer input, the process of lettuce cultivation covered higher proportion in $N_2O$ emission. Therefore, farms 1 and 2 covered 87% of total $N_2O$ emission; and farm 3 covered 64%. The carbon footprints from farm 1 to farm 5 were 3.40E-01 (farm 1), 4.31E-01 (farm 2), 5.32E-01 (farm 3), 1.08E+00 (farm 4) and 6.14E-01 (farm 5) kg $CO_2$-eq. $kg^{-1}$ lettuce, respectively. Results of sensitivity analysis revealed the soybean meal was the most sensitive among 4 types of fertilizer. The value of compound fertilizer was the least sensitive among every fertilizer imput. Electricity showed the largest sensitivity on $CO_2$ emission. However, the value of $N_2O$ variation was almost zero.

A Survey on Consumption Behaviors of the Fast-Foods in University Students (대학생의 패스트푸드 소비행태에 관한 연구)

  • Cho, Kyu-Seok;Im, Byoung-Soon;Kim, Seok-Eun;Kim, Gye-Woong
    • Korean Journal of Human Ecology
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    • v.14 no.2
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    • pp.313-319
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    • 2005
  • This survey was conducted in order to obtain the basic data for desirable consumption habits through investigation and analysis of university students' fast food consumption behaviors. Questionnaires were collected from a total of 374 male and female students living in big or small and medium-sized cities in August, 2004. The contents surveyed were utilization and expenses of fast foods, choice of fast foods, relationship between fast foods and a diet, and characteristics of fast food restaurants. The results obtained are summarized as follows: 1. The ratio of the surveyees varied according to gender, residence, and the size of a city they're living in. For example, males took up 48.66% of the surveyees, while females did 51.34%. The ratio of residents in apartments and stand-alone houses was 54.81% and 45.19% each. 47.33% of the respondents were living in big cities, while 52.67% of them in small and medium-sized cities. 2. 70.1% of the surveyees responded that they are with friends when having fast foods. There was a highly significant difference between male and female in the type of eating companions (p<0.001). The average number of days that they eat fast foods was 1 to 2 times a week, which accounted for 63.7% of the respondents. However, in the case of eating foods, there was no significant differences between two sexes. 3. 64.2% of the surveyees paid more than 20,000 won to buy fast foods for a week, which showed no significant differences between genders. They tend to split a bill, rather than one person pays all. There was a highly significant difference between genders in paying method (p<0.001). 4. 52.1 % of the respondents chose a menu themselves. Their most favored food was chickens (26.5%), which showed a statistically significant difference between genders (p<0.001). 46.8% of them preferred coke as a drink, which had no significant difference between genders. 42.2% of the surveyees had fast foods between lunch and dinner, which also had no significant difference between genders. The most important factor in choosing a menu was its taste (62.8%), which indicated a significant difference between males and females (p<0.05). 5. The preference to fast foods was due to the influence of western culture (36.4%) and eating-out habits (29.1%), which was significantly different between genders (p<0.05). Those who eat fast foods answered they have normal weight and normal body type (49.5%). 24.3% of them were relatively fat with significant difference between genders (p<0.05). 63.4% of the surveyees thought themselves not picky with foods, and there was a significant difference between genders (p<0.05). 78.3% of them mostly preferred franchise restaurants because they are convenient and cheap.

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Choline and Betaine Concentrations in Breast Milk of Korean Lactating Women and the Choline and Betaine Intakes of Their Infants (한국 수유부 유즙의 콜린과 베타인 농도 및 영아의 콜린과 베타인 섭취량)

  • Jeong, Han-Ok;Suh, Yoon-Suk;Chung, Young-Jin
    • Journal of Nutrition and Health
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    • v.43 no.6
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    • pp.588-596
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    • 2010
  • Most nutrients taken by pregnant women are secreted into their breast milk. Food contains choline together with betaine, and in human body choline is oxidized to betaine which transfer methyl group. The aim of the study was to estimate the concentrations of choline and betaine in breast milk of Korean lactating women and the choline and betaine intakes of their infants. Total choline, free choline and betaine concentrations in breast milk of some lactating women living in Daejon Metropolitan city were analyzed every month by using HPLC-MS and enzymatic method during the first five months. Total choline concentrations of breast milks were 157.64 mg/L (1.52 mmol/L), 157.83 mg/L (1.52 mmol/L), 165.99 mg/L (1.60 mmol/L), 153.67 mg/L (1.48 mmol/L), 145.05 mg/L (1.39 mmol/L) by month after delivery for five months. The concentrations of total choline and free choline in breast milks were not significantly changed for the five months while the betaine concentrations gradually decreased. Daily intake of total choline of the infants appears to be adequate for the infant's requirement according to the US DRI; 124.6 mg/d, 120.9 mg/d, 126.5 mg/d 104.1 mg/d from 2nd to 5th month after birth. Free choline and betaine intakes of the infants were not significantly changed during the four months except showing decrease in betaine intake per kg body weight. Choline intakes of the infants more correlated with choline concentrations of the breast milks (r = 0.982, p = 0.000) than intake amount of the breast milk (r = 0.414, p = 0.028). These results suggest that the choline intake of Korean breast-fed infants appears to be adequate and the intake could be affected by the choline concentration of the breast milk.

Evaluation of Cryptosporidiurn Disinfection by Ozone and Ultraviolet Irradiation Using Viability and Infectivity Assays (크립토스포리디움의 활성/감염성 판별법을 이용한 오존 및 자외선 소독능 평가)

  • Park Sang-Jung;Cho Min;Yoon Je-Yong;Jun Yong-Sung;Rim Yeon-Taek;Jin Ing-Nyol;Chung Hyen-Mi
    • Journal of Life Science
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    • v.16 no.3 s.76
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    • pp.534-539
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    • 2006
  • In the ozone disinfection unit process of a piston type batch reactor with continuous ozone analysis using a flow injection analysis (FIA) system, the CT values for 1 log inactivation of Cryptosporidium parvum by viability assays of DAPI/PI and excystation were $1.8{\sim}2.2\;mg/L{\cdot}min$ at $25^{\circ}C$ and $9.1mg/L{\cdot}min$ at $5^{\circ}C$, respectively. At the low temperature, ozone requirement rises $4{\sim}5$ times higher in order to achieve the same level of disinfection at room temperature. In a 40 L scale pilot plant with continuous flow and constant 5 minutes retention time, disinfection effects were evaluated using excystation, DAPI/PI, and cell infection method at the same time. About 0.2 log inactivation of Cryptosporidium by DAPI/PI and excystation assay, and 1.2 log inactivation by cell infectivity assay were estimated, respectively, at the CT value of about $8mg/L{\cdot}min$. The difference between DAPI/PI and excystation assay was not significant in evaluating CT values of Cryptosporidium by ozone in both experiment of the piston and the pilot reactors. However, there was significant difference between viability assay based on the intact cell wall structure and function and infectivity assay based on the developing oocysts to sporozoites and merozoites in the pilot study. The stage of development should be more sensitive to ozone oxidation than cell wall intactness of oocysts. The difference of CT values estimated by viability assay between two studies may partly come from underestimation of the residual ozone concentration due to the manual monitoring in the pilot study, or the difference of the reactor scale (50 mL vs 40 L) and types (batch vs continuous). Adequate If value to disinfect 1 and 2 log scale of Cryptosporidium in UV irradiation process was 25 $mWs/cm^2$ and 50 $mWs/cm^2$, respectively, at $25^{\circ}C$ by DAPI/PI. At $5^{\circ}C$, 40 $mWs/cm^2$ was required for disinfecting 1 log Cryptosporidium, and 80 $mWs/cm^2$ for disinfecting 2 log Cryptosporidium. It was thought that about 60% increase of If value requirement to compensate for the $20^{\circ}C$ decrease in temperature was due to the low voltage low output lamp letting weaker UV rays occur at lower temperatures.

Referral Patterns and Needs for Specialist Care among Patient Referred from Health Center (보건소의 진료의뢰 양상과 의뢰환자들의 전문과목 요구도)

  • Hwang, Tae-Yoon;Kim, Chang-Yoon;Kang, Pock-Soo
    • Journal of Preventive Medicine and Public Health
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    • v.29 no.1 s.52
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    • pp.133-143
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    • 1996
  • This study was conducted to assess the referral patterns to specialist from general practitioners in health center and perceived needs of referred patients for specialist care in health center. The study subjects were 249 patients who visited to health centers and were referred to other medical facilities. The data were obtained from questionnaire survey which was conducted in Kyongju-City Health Center, Seongju-Gun Health Center and Koryong-Gun Health Center in Kyongsangbuk-Do, from June 10 to October 17, 1995. The total referral rate was 2.7%. The proportion of patients who wished to be referred to medical specialists was 85.9%, and the proportion of patients referred by general practitioners in health centers was 14.1%. Among the patients who wished to be referred to medical specialists, 45.9% visited directly to health centers, 34.6% visited health centers via local clinics and 19.5% visited health centers to get referral permission only. The reasons for getting referral permission in health centers were easy geographical accessibility(34.6%), easy to get referral permission in health centers(27.1%), and very difficult to get referral permission in local clinics(16.4%). Among the diseases of referred patients, diseases of the musculoskeletal system and connective tissue were most prevalent on a whole, but diseases of nervous system and sensory organs were comparatively high among the patients who wished to be referred to medical specialists and infectious and parasitic diseases were comparatively high among the patients referred by general practitioners in health centers. The most favorable medical facility was general hospital including university hospital in both groups of patients who wished to be referred to medical specialist and the patient referred by general practitioners in health centers. Regarding the needs for specialist care in health center, 75.2% of patients who wished to be referred to medical specialists and 74.3% of patients referred by general practitioners in health center wanted the specialist care. The most frequently requested specialty is internal medicine(47.1%), and then orthopedics and general surgery. Based on above results, this study revealed that the majority of patients referred from health center wished to be referred to medical specialists at their own will, so, referral system at health center level should be changed. And if specialist care in health center be provided, the medical care by internist could be provided first, and then that of orthopedics and general surgery could be provided. These kinds of medical cares could be covered by local clinicians as a part-time job on a voluntary basis.

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