우리나라 기생충병관리의 현황(現況)과 효율적방안에 관(關)한 연구(硏究) (The Present Status and a Proposal of the Prospective Measures for Parasitic Diseases Control in Korea)
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- Journal of Preventive Medicine and Public Health
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- 제3권1호
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- pp.1-16
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- 1970
우리나라에서 공중보건상(公衆保健上) 중요(重要)한 연충류감염에 대(對)하여 1969년(年) 현재(現在) 실시(實施)한 관리(管理) 현황(現況)을 조사(調査)하였으며, 그 결과(結果)를 보면 1966년(年)부터 1969년(年)까지의 학생기생충검사 및 회충구충 사업(事業)에 있어서 그 간(間) 회충감염률의 저하(低下)를 별(別)로 가져오지 못하였음이 나타났으며 따라서 앞으로 본(本) 사업(事業)의 개선(改善) 또는 보다 적극적인 사업(事業)의 추진(推進)이 요망(要望)된다. 보건사회부(保健社會部)에서 지정(指定)한 지역(地域)에서
As a part of the epidemiological studies of clonorchiasis, this study was conducted to evaluate the current endemicity and the natural transition of the Clonorchis infection in Gimhae Gun and delta area a high endemic area in Korea in recent years, prior to the introduction of praziquantel which will eventually influence the status of the prevalence. The data obtained in this study in 1983 were evaluated for natural transition of the infection in comparison with those obtained 16 years ago in 1967 by the author(Kim, 1974). The areas of investigation, villages and schools surveyed, methods and techniques used in this study were the same as in 1967, except for the contents of the questionnaire for raw freshwater fish consumption by the local inhabitants. 1) The prevalence rate of clonorchiasis in the general population of the villages was 48.1% on the average out of a total of 484 persons examined. The average of those of the riverside-delta area was 65.2% and 43.0% in the inland area. Among the schoolchildren, the prevalence rate was 8.2% on the average out of a total of 1,423 examined. By area, the prevalence rate was 10.8% in the riverside delta area and 2.8% in the inland area. By sex, difference in the prevalence was seen only in the inhabitants of the inland area showing 52.4% in the male and 33.5% in the female. 2) In the natural transition of the infection, the prevalence rate among the inhabitants has decreased from 68.8% in 1967 to 48.1% in 1983, and in the schoolchildren from 56.4% in 1967 to 8.2% in 1983. The reduction rate was higher in the riverside-delta area than in the inland area. 3) In the prevalence rate by age, 11.9% was first seen in the 5-9 age group and the rate gradually increased up to 75.0% in the 50-59 age group. By sex, the rate was higher in the male than in the female in the 20-29 age group and over. 4) In the natural transition of the prevalence rate by age, the reduction rate of the infection during the past 16 years was greater in the younger age groups up to the 40-49 age group and reached the same level in the age group 50-59. Reduction was seen again in the age group over 60s. By sex, the reduction rate was greater in the female than in the male in the 20-29 age group and over. By area, the reduction rate was greater in the riverside delta area than in the inland area, particularly in the young age groups. 5) In the intensity of the infection among the cases, the mean egg out-put per mg feces per infected cases(EPmg) in the inhabitants was 6.3. EPmg of those of the river-side-delta area was 15.4 and that of the in-land was 2.8. On the other hand, in the schoolchildren, EPmg was 3.2, and no difference was seen between the two areas, the river-side-delta area and the inland area. 6) In the transition of the intensity of the infection by area, EPmg among the inhabitants inexplically increased from 7.8 in 1967 to 15.4 in 1983. This was probably caused by uneven specimen collection in the process of sampling the population. EPmg of the inhabitants in the inland area and those of the schoolchildren of both riverside delta and inland areas showed a similar decrease in the past 16 years. 7) The intensity of the infection by age showed a relatively low level in the 20-29 age group and below, and EPmg 5.1-9.5 was seen in the 30-39 age group and over. Sex, Epmg was 5.8 in the male and 4.7 the female. By in 8) In the transition of the intensity of the infection, EPmg decreased from 6.2 in 1967 to 5.4 in 1983. By age, in contrast to the figures of 1967 in which EPmg gradually increased with some fluctuation from 1.1 in the 0-4 age group to peak 10.5 in the 50-59 age group, in 1983 lower intensity of the infection was seen in the age group from 10-14 to 20-29 with the EPmg range of 0.6-2.7. 9) In the distribution of the clonorchiasis cases by the range of EPmg value, 43.2% of the cases were in 0.1 0.9 and 34.6% in 1.0-4.9. As a whole by cumulative percent, 44.6% of them were under 0.9 as light infection and 86.1% of them under 9.9 up to moderate infection. By sex, no difference was seen in Epmg. 10) In the transition of the distribution by the range of Epmg, the cases were distributed up to the range 80.0-99.9 in 1967 and to 60.0-79.9 in 1983. By cumulative percent, in the range of 0.1-0.9 and less, light infection, 34.3% of them were distributed in 1967 and 44.6% in 1983 with about 10% increase. In the range of 5.0-9.9 and less, up to moderate infection, 83.2% in 1967 and 86.1% in 1983 of the cases were seen, respectively. 11) The practice of raw freshwater fish consumption among the inhabitants seems to have decreased in recent years. Those who admitted to raw freshwater fish consumption in the last two years among the infected inhabitants were 59.3%, although 86.8% of them professed to have experience with raw freshwater fish consumption. 31.7% of those who have had experience of the raw freshwater fish consumption denied any further consumption in recent years. From an interview of 543 school-children, 24.1% of them admitted to an experience of raw freshwater fish consumption. However, those who have practised in the past two years comprized 17.9%. Those who denied raw freshwater fish consumption in recent years among those who had such experience were 26.0% out of 131 interviewed. The rate of raw freshwater fish consumption in both inhabitants and schoolchildren were higher in the male than in the female. On the contrary, the rate of those who did not practise in recent years among those who had experience of raw freshwater fish consumption was higher in the female than in the male. 12) The major reason for the reduction of raw freshwater fish consumption among the local inhabitants was the risk of the fluke infection. However, it has become apparent that such change of taste has resulted from water pollution impact which has affected throughout the areas of the freshwater systems in this locality since last several years. 13) In animal survey, Clonorchis infection was seen in 14.8% of 88 dogs examined and 3.7% of 27 house rats examined. It was noted that populations of dogs and cats have increased in the villages surveyed. Although the prevalence rate was lower in the present survey than those of 1967, the significance of the animals as the reservoir host has not changed. 14) Prevalence rate of Clonorchis infection by cercariae in the first intermediate host, Parafossarulus manchouricus, was 0.6% out of 517 snails examined. The infection rate was lower in comparison with 2.3% out of 2,124 examined in 1967. Moreover, sharp decreases in number and distribution of the intermediate host snails in many watershed areas of the huge freshwater systems in this locality seemed to reduce transmission of Clonorchis in connection with the intermediate host stage of its life cycle. 15) Clonorchis infection in the second intermediate fish hosts was relatively low. The mean number of Clonorchis metacercaria per fish in Pseudorasbora parva was 517 in 1983, whereas it was 1943 in 1968 through 1969. Environmental water pollution has also caused the decreased fish population density in these areas, and this has also apparently affected to the practice of raw freshwater fish consumption among the local inhabitants. 16) In conclusion, endemicity of Clonorchis infection in Gimhae Gum and delta area of the Nagdong River has sharply decreased during the past 16 years. The major cause of the regressive transition of the infection was the water pollution of the land water systems of this locality. The pollution has upset the ecosystems comprizing of the intermediate hosts of Clonorchis in many areas, and also affected to a significant extent to the discontinuance of the local inhabitants for raw freshwater fish consumption.
Out of a total of 58 species of helminthic and protozoan parasitic infections in Korea, so far 38 species were reported as intestinal parasites of man. Quite a few species of the intestinal parasitic infections have long been prevalent throughout the country and this has been a significant public health problem. In this paper, current status and transition of the intestinal parasitic infections in the past years were presented. Chronological reviewing of data show background and prospects of change in the prevalence of infections. In the national prevalence survey on parasitic infections conducted once every five years since 1971, stool examinations were done by both cellophane thick smear and brine flotation techniques. Every egg positive case of Ascaris lumbricoides and Clonorchis sinensis was further examined by Stoll's dilution egg counting technique. In 1981, perianal swab using adhesive cellulose tape was added for Enterobius infection. For protozoan cyst examination conducted by province and city in '81, fecal specimens were fixed in SAF solution and examined by the formalin-ether concentration technique. High prevalence of parasitic infection in ana before the 1960s can be easily understood from the data given by the Ministry of Health and Social Affairs in 1967. From a parasite control point of view, the 1960s was the preparatory period particularly for control of soil-transmitted helminthiasis. Several organizations which have contributed to parasite control were founded in this period and the prevention law of parasitic infections was passed in '66. In the '70s, overall prevalence rates of the common intestinal parasitic infections, which were highly prevalent in the past were turned into reduction phase for the first time. The '80s can be said to be an active control period of parasitic infections. Intestinal helminths According to the reports of the national prevalence survey on parasitic infections, the prevalence of helminthic infections was 84.3%(number of person examined:24,887) in '71, 63.2%(27,178) in '76, and 41.1%(35,018) in '81. By area, the prevalence rate in '81 was 35.1%(20,569) in urban areas and 49.6%(14,447) in rural areas. Intestinal nematodes Ascaris lumbricoides The prevalence of Ascaris infection has decreased significantly in recent years. Among students, the prevalence was 55.4%, in '69 and decreased to 4.7% in '83. In the national prevalence surveys, the prevalence decreased to 13.0% in '81 from 54.9% in '71. By area, the prevalence decreased to 8.5% in '81 from 46.4% in '71 in urban area and 19.4% in '81 from 59.6% in '71 in rural area. By age, the prevalence has become in recent years relatively even in all age groups, although higher prevalence used to be seen in young age groups of around 10 years old, particulary in the highly prevalent rural areas. By sex, the prevalence was higher in the female than in the male. Unfertilized egg positive rates among the ascariasis cases increased gradually up to 55.4% on the average in '81. The intensity of the infection was also significantly decreased. Trichuris trichiura Trichuris infection had also decreased to 23.4% in '81 from 65.4% in '71. By area, the decreasing tendency of the prevalence became faster in urban areas than in the rural areas. The prevalence in urban and rural areas in '71 was 69.7%, and 63.1% respectively and decreased to 19.5% and 29.0% respectively in '81. By age, the prevalence reached a peak at the 10-14 age group and showed relatively even distribution throughout all age groups. By sex, the prevalence was close in young age groups, but in the 30s or over age group, especially in rural area, the prevalence was significantly higher in the female than in the male. The prevalence has much fluctuated depending in the area. The prevalence in rural areas surveyed in the '80s shows a range between 20.9% and 73.7% by locality. It is anticipated that the prevalence of Trichuris infection will drop more rapidly, when mass treatment is conducted. Hookworms Hookworm infection by mostly Ancylostoma duodenale and a few by Necator americanus has decreased to a negligible levels in recent years. In the national prevalence surveys, the prevalence was 10.7% in '71, 2.2% in '76, and 0.5% in '81. The prevalence was higher in rural areas than in urban areas. Wide application of multi-specific anthelminthics in the ascariasis control programmes conducted in the past decade appear to have been effective against hookworm infection. Trichostrongylus orientalis As in the case with hookworm infection, the prevalence of Trichostrongylus infection has reached a negligible levels. In the national prevalence surveys, the prevalence was 7.7% in '71, 1.0% in '76 and 0.2% in '81. Enterobius vermicularis In the national prevalence survey in '81, the egg positive rate was 12.0%. Higher prevalence is expected when examined repeatedly. The prevalence rate was 10.3% in urban area and 14.6% in rural area. In recent surveys conducted in rural areas among schoolchildren, the prevalence was 32.4% in Gimhae Gun in '82 and 64.1% in Yeongyang Gun in '83. By age, the egg positive rate was higher in young age groups of around 10 and sharply decreased in age groups of around 20 and then somewhat increased again in middle age groups. By sex, the prevalence was higher in the female than in the male. Strongyloides stercoralis Strongyloides stercoralis infection has rarely been found in Korea. Three cases were reported in 1914. And 0.1-0.5% were found infected out of 2,642 persons examined at the prisoner-of-war camp on Geojedo in 1956. One case was reported in '54 and '82, respectively. Anisakis spp. No systematic survey has been conducted for anisakiasis In Korea. So far, only several cases have been found 1 case in Seoul in '71, 5 cases in Busan in '81 and 1 case in Busan in '84. Intestinal trematodes Metagonimus yokogawai In the national prevalence survey conducted in 1981, the egg positive rate was 1.24% on the average. High endemic areas are located in the southwestern part of Korea. The prevalence in Hadong Gun was 29.1% on the average in '79. In a survey conducted in 76, the prevalence was 44.0% in Gwangyang, 55.0% in Gogseung and 29.0% in Gurye. The infection is closely correlated with raw sweetfish consumption in these areas. Other intestinal trematodes A human case of Heterophyes heterophyes was reported in 1914. Several species were reported in the '80s : 17 cases of Fibricola seoulensis, 9 cases of Pygidiopsis summa, 8 cases of Heterophyes heterophyes nocens, 1case of Heterophyopsis continua, 2 cases of Stellantchasmus falcatus, 1 case of Stictodora sp., 1 case of Echinostoma hortense, and 4 cases of Echinochasmus japonicus. As the intermediate hosts, snakes and frogs play a role for F.seoulensis and fish for the rest of the species. Intestinal cestodes Taenia saginata and T. solium Egg positive rates in the national prevalence survey were 0.7% in '76 and 1.1% in '81. The prevalence in '81 was 0.6% in urban area and 1.8% in rural area. The proglottid positive rate in Jeju Do was 19.2% on the average. On Udo, Jeju Do in 1983, the egg positive rate among the inhabitants was 2.9%. Hymenolepis nana In the national prevalence survey, egg positive rates were 0.6% in '76 and 0.4% in '81. No difference was seen in the prevalence by area and sex. Hymenolepis diminuta Infected cases were reported : 3 in '64 and I in '66. Egg positive rate in '81 was 0.01% in the national prevalence survey. Diphylobothrium latum So far, about 30 cases have been reported. The cases have been reported more frequently in recent surveys. Mesocestoides sp. A case was reported from a hospitalized patient in Seoul in '67. Spirometra erinacei Two cases were reported in '84 following reidentification of the adult worms collected in '74. Intestinal protozoa Out of a total of 23 species of human protozoan infections in Korea, 13 species were reported as intestinal protozoa : Entamoeba histolytica, E coli, Endolimax nana, Iodamoeba b
목 적: 전국 병원의 방사선종양학과에서 식도암으로 방사선 치료를 받은 환자들을 각 병원으로부터 입력 받아 세부 항목별로 분석하여 식도암 환자들의 구성과 특징을 파악하여 범국가적인 자료로 활용하는 한편 치료방침을 분석하여 향후 적절한 치료를 위한 가이드라인으로 삼고자 하였다. 대상 및 방법: 전국 병원의 방사선종양학과에서 1998년과 1999년의 2년간에 걸쳐 식도암으로 확진된 246명을 대상으로 하였다. 연간 400명 미만의 방사선치료 신환자 발생병원들을 A군, 400명 이상 900명 미만의 병원들을 B군, 그리고 900명 이상 신환자가 발생하는 병원을 C군으로 분류하여 최종적으로 A군에서 12병원, B군에서 8개 병원, 그리고 C군에서 3개의 병원이 연구에 참여하였다. 이미 개발된 Web-based Korean PCS system을 통해 각 병원으로부터 직접 자료를 입력 받아 이를 세부 항목별로 분석하였고 통계적 처리는 SPSS version 12.0.1을 사용하고 범주형 자료는 Chi-squared test를 사용하였고 연속변수는 ANOVA, Kruskal-Wallis test를 적용하였다. 결 과: 입력된 환자들의 성별 분포는 남자 224명(91.1%), 여자 22명(8.9%)이었고 연령별 중앙값은 62세 전후였다. 진단 및 병기결정을 위한 검사로는 식도 촬영술(228명, 92.7%), 식도내시경(226명, 91.9%) 및 흉부 식도 CT 스캔(238명, 96.7%)을 주로 시행하였다. 편평상피암이 대종을 이루어 237명(96.3%)의 환자에서 관찰되었고 중흉부식도(mid-thoracic esophagus)에서 발생한 식도암이 가장 많았다(110명, 44.7%). 임상 병기는 III기가 과반수 이상을 차지하였다(135명, 54.9%). 방사선 치료만 받은 경우는 57명(23.2%), 방사선 치료와 수술을 병용한 경우는 전체의 15%인 37명, 항암약물 치료와 방사선 치료를 병용한 경우는 123명(50%)이었다. 수술과 방사선 치료를 병행한 경우 전례에서 수술을 먼저 시행한 후 방사선 치료를 하였다. 항암치료를 방사선치료와 병행한 경우 반수 이상에서(70명, 56.9%) 동시항암방사선 치료를 시행하였고 31명(25.2%)에서 항암치료 후 방사선치료를 또는 항암요법 단독치료 후 동시항암방사선치료를(13명, 10.6%) 시행하였다. 방사선 치료는 6 MV (116명, 47.2%)와 10 MV (87명, 35.4%)의 X-ray가 대종을 이루었다. 방사선 치료 시 조사야는 longitudinal margin의 경우 중앙값은 7.0 cm이었지만 각 군별로 현저한 차이가 있었다(A군; 5.5 cm, B군; 8.0 cm, C군; 14.0 cm). 계획용 CT를 사용하지 않고 고식적인 AP/PA 조사야를 사용하여 치료한 경우가 대부분이었는데(206명, 83.7%) 이 때 방사선 조사량의 중앙값은 3,600 cGy이었다. 이후 추가 방사선 치료 시 계획용 CT를 사용하지 않고 2-oblique fields 사용하여 치료한 경우가 87명(35.4%)이었는데 방사선 조사량의 중앙값은 1,800 cGy이었다. 전 환자에서 1일 1회 180 cGy로 치료하였다. 전 환자에서 조사된 총 방사선량의 중앙값은 5,580 cGy이었다. 수술 후 방사선 치료를 시행한 경우 중앙값은 5,040 cGy이었고 수술을 받지 않은 환자 중앙값은 5,940 cGy이었다. 근접조사 방사선 치료는 총 34명(13.8%)에서 시행되었고, 전 환자에서 high dose rate Iridium-192를 사용하였다. 조사범위는 종양에서 longitudinal margin의 중앙값은 1 cm, prescribed isodose curve에서 axial length의 평균값은 8.25 cm, 폭은 2 cm, 그리고 전후 폭의 중앙값도 2 cm이었다. Fraction size의 중앙값은 300 cGy이었는데 B군의 경우는 500 cGy이었다. 총 분할 횟수는
1980-'90년대에 쌀의 자급생산이 지속되고 생활수준 향상에 따른 양질미 수요가 점증되면서 자포니카 다수성 품종의 미질 개선에 힘을 크게 기울이게 되었고 식미향상을 위한 육종연구 와 효율적 평가 기술개발 연구에 박차를 가하게 되어 쌀의 이화학적 특성과 식미 및 밥 물리성간 상관과 식미의 객관적 평가방법 개발, 양식미 쌀 및 가공적성 특수미 개발 등 그 동안 많은 연구성과를 올리게 되었다. 1990년대에 밥맛이 매우 좋은 고품질 자포니카 품종과 대립, 심백미, 향미, 유색미 등 가공용 특수미 품종을 개발 보급하였고 식미와 용도에 대하여 식미검정계, 신속점도측정계 및 texture 분석계 등을 이용하여 검토하였다. 최근에는 아밀로스 함량이 9%로 찹쌀과 맵쌀의 중간 성질을 가진 중간찰 품종인 '백진주벼'와 배유가 보얀 멥쌀인 '설갱 벼'를 비롯하여 라이신 함량이 높은 '영안벼' 육성하여 쌀의 가공 이용성과 기능성을 한층 높혀 놓았다. 식미와 여러 가지 미질 특성간 관련성에 관한 연구 결과를 요약해 보면 다음과 같다. 쌀의 상온흡수율 및 최대흡수율은 K/Mg율 및 알칼리 붕괴도와 유의한 부의 상관성을 나타내었으며 가열흡수율이 높은 품종일수록 밥의 용적팽창률이 컸다. 수분함량이 낮은 경질인 쌀일수록 침지 20분 후의 상온흡수율과 최대흡수율이 더 높은 경향이었으며 이러한 흡수 특성은 쌀 단백질 함량이나 아밀로스 함량 및 식미와는 유의한 상관성이 없었다 취반 적정가수량은 품종에 따라 마른 쌀 무게의 1.45-l.61배의 변이를 나타내었고 평균은 1.52배였으며 알맞게 취사된 밥의 부피는 평균 쌀 부피의 2.63배가되었다. 쌀 형태, 알칼리붕괴도, 호응집성, 아밀로스 및 단백질 함량은 거의 비슷하지만 식미에 차이가 있는 자포니카 품종들을 사용하여 식미와 관련된 쌀의 이화학적 특성을 검토한 결과, 밥의 윤기와 식미 총평은 생산 연도에 따라 호화점도 특성 중 최고점도, 최저점도 및 응집점도와 밀접한 관계를 나타내었다. 밥맛이 가장 좋은 일품 벼는 쌀의 외층에 아밀로스 함량 분포가 낮고 쌀을 열탕에 담근 20분간 우러난 용출액의 요드 정색도가 낮고 증가정도도 완만하였다. 일품 벼는 밥맛이 떨어지는 동해 벼에 비해 밥알 횡단면의 주사형 전자현미경 사진에서 밥알 외층의 호화전분의 그 물망이 매우 치밀하고 속층의 전분립의 호화정도가 양호하였다. 식미총평은 식미관련 이화학적 특성과의 관계를 이용한 중회귀식에 의해 매우 높은 결정계수로 추정이 가능하였다. 밥노화의 품종간 차이는 α-amylase-iodine 법으로 비교할 수 있었는데 노화정도가 적었던 품종은 일품벼, 추청벼, 사사니시끼, 진부벼 및 고시히까리였다. 통일형 품종인 태백벼와 자포니카 품종 중 섬진벼가 비교적 밥노화가 빨랐다 일반적으로 밥맛이 좋은 품종이 밥의 노화정도가 느렸으며 찬밥의 탄력성이 큰 경향이었다. 또한 밥노화가 느렸던 품종은 최저점도가 높았고 최종점도가 낮았다 찬밥의 탄력성은 쌀의 마그네슘함량과 밥의 용적팽창률과 밀접한 관계를 나타내었다. 식은밥의 더운밥 대비 경도 변화율은 취반용출액의 고형물량과 취반용적 팽창률과 부의 상관을 나타내었다. 식미관련 주요 이화학적 특성은 밥의 노화와도 직접 간접으로 상관이 있는 것으로 평가되었다. 쌀의 여러 가지 식품 가공적성과 관련된 형태 및 이화학적 특성은 가공식품 종류에 따라 매우 다르다. 쌀 튀김성은 호응집성이 연질이거나 아밀로스 함량이 낮을수록 양호하며 지질함량이나 단백질 함량이 높으면 좋지 않은 경향이다. 심복백정도가 심할수록 튀김현미 정립률이 떨어지며 현미 강도가 높을수록 튀김률은 높은 경향이었다 쌀국수는 밀가루와 50% 혼합시에 쌀의 칼륨 및 마그네슘 함량이 높은 품종일수록 제면 총평이 낮은 경향이었고 제면이 양호한 것이 국수물의 용출고형 물량이 적은 경향이었다. 쌀빵 가공적성은 품종에 따라서 현미와 백미간에 현저한 차이를 나타내는 것이 있는데 현미에서 반죽의 부피 증가율이 큰 쌀일수록 푹신한 감이 있는 쌀방 제조가 가능하였으며 백미에서 단백질 함량이 높은 품종일수록 쌀빵이 더욱 촉촉한 느낌이 있는 경향이었다. 아밀로스 함량이 높고 호응집성이 경질인 쌀일수록 쌀빵의 탄력성이 더 높은 경향이었다. 쌀의 발효 및 양조적성은 심복백이 심한 쌀이나 새로운 돌연변이인 뽀얀 멥쌀이 홍국균이나 홍국균의 균사활착 밀도가 높고 당화 효소 역가도 높은 경향이었으며 쌀알이 대립이면서 단백질 함량이 낮은 쪽이 양조에 유리한 것으로 알려져 있다. 찰벼 품종도 여러 가지 이화학적 특성과 전분구조 특성의 차이에 따라 9개의 품종군으로 나누어 볼 수 있을 만큼 품종적 변이가 크며 이들 이화학적 및 구조적 특성간에 상호 밀접한 연관성을 나타내었으며 유과·인절미·식혜ㆍ미숫가루 등에 상당한 가공적성의 차이를 보였다. WTO 체제 출범이후 생산비와 가격 면에서 경쟁력이 약한 우리 쌀이 살아남기 위해서는 품질의 고급화와 쌀 가공식품의 다양화 및 고기능성 개발을 추구할 수밖에 없다. 따라서 이와 같은 노력은 벼 품종개발만으로 소기의 성과를 올리기 어렵고 쌀 식품의 고급화 및 다양화를 위한 여러 분야의 긴밀한 연구협력이 수반되지 않으면 안 된다.
The success of the family planning program in Korea is reflected in the decrease in the growth rate from 3.0% in 1962 to 2.0% in 1971, and in the decrease in the fertility rate from 43/1,000 in 1960 to 29/1,000 in 1970. However, it would be erroneous to attribute these reductions entirely to the family planning program. Other socio-economic factors, such as the increasing age at marriage and the increasing use of induced abortions, definitely had an impact on the lowered growth and fertility rate. Despite the relative success of the program to data in meeting its goals, there is no room for complacency. Meeting the goal of a further reduction in the population growth rate to 1.3% by 1981 is a much more difficult task than any one faced in the past. Not only must fertility be lowered further, but the size of the target population itself will expand tremendously in the late seventies; due to the post-war baby boom of the 1950's reaching reproductive ages. Furthermore, it is doubtful that the age at marriage will continue to rise as in the past or that the incidence of induced abortion will continue to increase. Consequently, future reductions in fertility will be more dependent on the performance of the national family planning program, with less assistance from these non-program factors. This paper will describe various approaches to help to the solution of these current problems. 1. PRACTICE RATE IN FAMILY PLANNING In 1973, the attitude (approval) and knowledge rates were quite high; 94% and 98% respectively. But a large gap exists between that and the actual practice rate, which is only 3695. Two factors must be considered in attempting to close the KAP-gap. The first is to change social norms, which still favor a larger family, increasing the practice rate cannot be done very quickly. The second point to consider is that the family planning program has not yet reached all the eligible women. A 1973 study determineded that a large portion, 3096 in fact, of all eligible women do not want more children, but are not practicing family planning. Thus, future efforts to help close the KAP-gap must focus attention and services on this important large group of potential acceptors. 2. CONTINUATION RATES Dissatisfaction with the loop and pill has resulted in high discontinuation rates. For example, a 1973 survey revealed that within the first six months initial loop acceptance. nearly 50% were dropouts, and that within the first four months of inital pill acceptance. nearly 50% were dropouts. These discontinuation rates have risen over the past few years. The high rate of discontinuance obviously decreases the contraceptive effectiveness. and has resulted in many unwanted births which is directly related to the increase of induced abortions. In the future, the family planning program must emphasize the improved quality of initial and follow-up services. rather than more quantity, in order to insure higher continuation rates and thus more effective contraceptive protection. 3. INDUCED ABORTION As noted earlier. the use of induced abortions has been increase yearly. For example, in 1960, the average number of abortions was 0.6 abortions per women in the 15-44 age range. By 1970. that had increased to 2 abortions per women. In 1966. 13% of all women between 15-44 had experienced at least one abortion. By 1971, that figure jumped to 28%. In 1973 alone, the total number of abortions was 400,000. Besides the ever incre.sing number of induced abortions, another change has that those who use abortions have shifted since 1965 to include- not. only the middle class, but also rural and low-income women. In the future. in response to the demand for abortion services among rural and low-income w~men, the government must provide and support abortion services for these women as a part of the national family planning program. 4. TARGET SYSTIi:M Since 1962, the nationwide target system has been used to set a target for each method, and the target number of acceptors is then apportioned out to various sub-areas according to the number of eligible couples in each area. Because these targets are set without consideration for demographic factors, particular tastes, prejudices, and previous patterns of acceptance in the area, a high discontinuation rate for all methods and a high wastage rate for the oral pill and condom results. In the future. to alleviate these problems of the methodbased target system. an alternative. such as the weighted-credit system, should be adopted on a nation wide basis. In this system. each contraceptive method is. assigned a specific number of points based upon the couple-years of protection (CYP) provided by the method. and no specific targets for each method are given. 5. INCREASE OF STERILIZA.TION TARGET Two special projects. the hospital-based family planning program and the armed forces program, has greatly contributed to the increasing acceptance in female and male sterilization respectively. From January-September 1974, 28,773 sterilizations were performed. During the same time in 1975, 46,894 were performed; a 63% increase. If this trend continues, by the end of 1975. approximately 70,000 sterilizations will have been performed. Sterilization is a much better method than both the loop and pill, in terms of more effective contraceptive protection and the almost zero dropout rate. In the future, the. family planning program should continue to stress the special programs which make more sterilizations possible. In particular, it should seek to add the laparoscope techniques to facilitate female sterilization acceptance rates. 6. INCREASE NUMBER OF PRIVATE ACCEPTORS Among the current family planning users, approximately 1/3 are in the private sector and thus do not- require government subsidy. The number of private acceptors increases with increasing urbanization and economic growth. To speed this process, the government initiated the special hospital based family planning program which is utilized mostly by the private sector. However, in the future, to further hasten the increase of private acceptors, the government should encourage doctors in private practice to provide family planning services, and provide the contraceptive supplies. This way, those do utilize the private medical system will also be able to receive family planning services and pay for it. Another means of increasing the number of private acceptors, IS to greatly expand the commercial outlets for pills and condoms beyond the existing service points of drugstores, hospitals, and health centers. 7. IE&C PROGRAM The current preferred family size is nearly twice as high as needed to achieve a stable poplation. Also, a strong boy preference hinders a small family size as nearly all couples fuel they must have at least one or more sons. The IE&C program must, in the future, strive to emphasize the values of the small family and equality of the sexes. A second problem for the IE&C program to work. with in the: future is the large group of people who approves family planning, want no more children, but do not practice. The IE&C program must work to motivate these people to accept family planning And finally, for those who already practice, an IE&C program in the future must stress continuation of use. The IE&C campaign, to insure highest effectiveness, should be based on a detailed factor analysis of contraceptive discontinuance. In conclusion, Korea faces a serious unfavorable sociodemographic situation- in the future unless the population growth rate can be curtailed. And in the future, the decrease in fertility will depend solely on the family planning program, as the effect of other socio-economic factors has already been maximumally felt. A second serious factor to consider is the increasing number of eligible women due to the 1950's baby boom. Thus, to meet these challenges, the program target must be increased and the program must improve the effectiveness of its current activities and develop new programs.
CTA ester bonds in TG molecules were not attacked by pancreatic lipase and lipases produced by microbes such as Candida cylindracea, Chromobacterium viscosum, Geotricum candidium, Pseudomonas fluorescens, Rhizophus delemar, R. arrhizus and Mucor miehei. An aliquot of total TG of all the seed oils and each TG fraction of the oils collected from HPLC runs were deuterated prior to partial hydrolysis with Grignard reagent, because CTA molecule was destroyed with treatment of Grignard reagent. Deuterated TG (dTG) was hydrolyzed partially to a mixture of deuterated diacylglycerols (dDG), which were subsequently reacted with (S)-(+)-1-(1-naphthyl)ethyl isocyanate to derivatize into dDG-NEUs. Purified dDG-NEUs were resolved into 1, 3-, 1, 2- and 2, 3-dDG-NEU on silica columns in tandem of HPLC using a solvent of 0.4% propan-1-o1 (containing 2% water)-hexane. An aliquot of each dDG-NEU fraction was hydrolyzed and (fatty acid-PFB ester). These derivatives showed a diagnostic carboxylate ion,
소셜 네트워크는 사용자들의 공통된 관심사, 경험, 그리고 일상 생활들을 함께 공유하기 위해 소셜 네트워크 상 사람들을 서로 연결시켜주는 거대한 커뮤니케이션 플랫폼이다. 소셜 네트워크상의 사용자들은 포스팅, 댓글, 인스턴스 메시지, 게임, 소셜 이벤트 외에도 다양한 애플리케이션을 통해 다른 사용자들과 소통하고 개인 정보 관리하는데 많은 시간을 소비한다. 소셜 네트워크 상의 풍부한 사용자 정보는 추천시스템이 추천 성능을 향상시키기 위해 필요한 큰 잠재력이 되었다. 대부분의 사용자들은 어떤 상품을 구매하기 전 가까운 관계이거나 같은 성향을 가진 사람들의 의견을 반영하여 의사 결정을 하게 된다. 그러므로 소셜 네트워크에서의 사용자 관계는 추천시스템을 위한 사용자 선호도 예측을 효율적으로 높이는데 중요한 요소라 할 수 있다. 일부 연구자들은 소셜 네트워크에서의 사용자와 다른 사용자들 사이의 상호작용 즉, 소셜 관계(social relationship)와 같은 소셜 데이터가 추천시스템에서 추천의 질에 어떠한 영향을 미치는가를 연구하고 있다. 추천시스템은 아마존, 이베이, Last.fm과 같은 큰 규모의 전자상거래 사이트 또한 채택하여 사용되는 시스템으로, 추천시스템을 위한 방법으로는 협업적 여과 방법과 내용 기반 여과 방법이 있다. 협업적 여과 방법은 사용자들의 선호도 학습에 의해 사용자가 아직 평가하지 않은 아이템 중 선호할 수 있는 아이템을 정확하게 제안하기 위한 추천시스템 방법 중 하나이다. 협업적 여과는 사용자들의 데이터에 초점을 맞춘 방법으로 유사한 배경과 선호도를 가지는 사용자들로부터 정보를 수집하여 사용자들의 선호도 예측을 자동으로 발생시킨다. 특히 협업적 여과는 근접한 이웃 사용자들에 의해서 목적 사용자가 선호할 수 있는 아이템을 제시하는 것으로 유사한 이웃 사용자를 찾는 것이 중요하다. 좋은 이웃 사용자 발견은 사용자와 아이템을 고려하는 방법이 일반적이다. 각 사용자는 아이템 즉, 영화, 상품, 책 등에 자신의 선호도를 나타내기 위하여 평가 값을 입력하고, 시스템은 이를 바탕으로 사용자-평가 행렬을 구축한다. 이 사용자-평가 행렬은 목적 사용자와 유사하게 아이템을 평가한 사용자 그룹을 찾기 위한 것으로, 목적 사용자가 아직 평가하지 않은 아이템에 대하여 사용자-평가 매트릭스를 통해 그 평가 값을 예측한다. 현재 이 협업적 여과 방법은 전자상거래와 정보 검색에서 적용되어 개인화 시스템에 효율적으로 사용되고 있다. 하지만 초기 사용자 문제, 데이터 희박성 문제와 확장성 그리고 예측 정확도 향상 등 해결해야 할 과제가 여전히 남아 있다. 이러한 문제들을 해소하기 위해 많은 연구자들은 하이브리드, 신뢰기반, 소셜 네트워크 기반 협업적 여과와 같은 다양한 방법을 제안하였다. 본 논문에서는 전통적인 협업적 여과 방식의 예측 정확도와 추천 성능을 향상시키기 위해 소셜 네트워크에 존재하는 소셜 관계를 이용한 협업적 여과 시스템을 제안한다. 소셜 관계는 소셜 네트워크 서비스 중 하나인 페이스북 사용자들이 남긴 포스팅과 사용자의 소셜 네트워크 친구와 의견 교류 중 남긴 코멘트와 같은 사용자 행동을 기반으로 정의된다. 소셜 관계를 구축하기 위해 소셜 네트워크 사용자의 포스팅과 댓글을 추출하고, 추출된 텍스트에 불용어 및 특수 기호 제거와 스테밍 등 전처리를 수행하였다. 특징 벡터는 TF-IDF를 이용하여 전처리된 텍스트에 나타난 각 단어에 대한 특징 점수를 계산함으로써 구축된다. 본 논문에서 이웃 사용자를 결정하기 위해 사용되는 사용자 간 유사도는 특징 벡터를 이용한 사용자 행동 유사도와 사용자의 영화 평가를 기반으로 한 전통적 방법의 유사도를 결합하여 계산된다. 제안하는 시스템은 목표 사용자와 제안한 방법을 통해 결정된 이웃 사용자 집단을 기반으로 목표 사용자가 평가하지 않은 아이템에 대한 선호도를 예측하고 Top-N 아이템을 선별하여 사용자에게 아이템을 추천하게 된다. 본 논문에서 제안하는 방법을 확인하고 평가하기 위하여 IMDB에서 제공하는 영화 정보 기반으로 영화 평가 시스템을 구축하였다. 예측 정확도를 평가하기 위해 MAE 값을 이용하여 제안하는 알고리즘이 얼마나 정확한 추천을 수행하는지에 대한 예측 정확도를 측정하였다. 그리고 정확도, 재현율 및 F1값 등을 활용하여 시스템의 성능을 평가하였으며, 시스템의 추천 품질은 커버리지를 이용하여 평가되었다. 실험 결과로부터 본 논문에서 제안한 시스템이 보다 더 정확하고 좋은 성능으로 사용자에게 아이템을 추천하는 것을 볼 수 있었다. 특히 소셜 네트워크에서 사용자 행동을 기반으로 한 소셜 관계를 이용함으로써 추천 정확도를 6% 향상시킴을 보였다. 또한 벤치마크 알고리즘과의 성능비교 실험을 통해 7% 향상된 추천 성능의 결과를 보여준다. 그러므로 사용자의 행동으로부터 관찰된 소셜 관계를 CF방법과 결합한 제안한 방법이 정확한 추천시스템을 위해 유용하며, 추천시스템의 성능과 품질을 향상시킬 수 있음을 알 수 있다.
현재 경복궁에 대한 연구는 건축사 문헌사 미술사를 중심으로 이루어지고 있는데, 이와 같은 연구는 현전(現傳)하는 건물과 기록에만 의존할 수밖에 없음으로 궁궐 전체를 연구하는 데는 한계가 있다. 그러나 현재까지도 양호한 상태로 잔존해 있는 경복궁 건물지 유구, 특히'적심(積心)'은 이러한 연구의 공백을 채워줄 수 있는 중요한 고고(考古)학 자료라 할 수 있겠다. 본고에서는 이러한 경복궁의 '적심'에 대하여 분석하여, 형태 규모 재료 축조방식에 따라 그 형식을 분류하고, 이것이 건물 기초로써 상부 건물과 어떤 관계를 가지는지 알아보기 위하여 궁궐 건물 유형별 사용된 적심을 검토하고, 시기별 변천양상을 살펴보았다. 그 결과, 경복궁 건물지 적심은 총 21가지 형식으로 구분되는데, 각 건물 유형에 따라 건물의 기초 즉 적심도 달리 축조되며, 시기별로도 적심의 축조방식 및 재료 등이 변화하여, 특정 시기에 유행하는 적심의 형식이 있음을 확인할 수 있었다. 경복궁 적심은 평면 형태에 따라 원형(I), 말각방형(II), 세장방형(III), 방형(IV), 통적심(V)으로 분류할 수 있으며, 다시 축조방식과 사용된 재료에 따라 21가지 형식으로 세분된다. 특히 조선전기 14~16세기에는 원형 잡석 적심(I-1), 말각방형 장대석(II-1), 말각방형 잡석+와전(II-2a) 세 가지 형식의 적심만 축조되다가, 조선후기 19세기에 들어 21가지 분류한 모든 적심이 다양하게 축조된다. 19세기 고종연간 내에서도 연대별로 각기 다른 형식의 적심을 사용하고 있는데, 특히 재료에서 두드러진 차이점이 확인된다. 경복궁을 재건한 고종 2년(1865)~고종 5년(1868)에 축조된 적심 10가지 형식 중 무려 7가지가 와전편을 섞어 넣은 형식인 반면, 고종 10년(1873)과 고종 13년(1876) 혹은 고종 25년(1888)에는 축조된 5가지 형식 중 3가지가 강회를 섞어 넣은 사질토를 사용한 형식으로 대조를 이룬다. 궁궐 건물은 '주인의 신분과 용도'에 따라 건물의 서열이 정해지고, 건물의 이름 뒤에 가장 중요하고 격이 높은 순서대로 전(殿), 당(堂), 합(閤), 각(閣), 재(齋), 헌(軒), 누(樓), 정(亭) 등의 명칭이 붙어 그 유형이 구분되며, 그 격에 맞추어 건축물이 축조된다. 이 건물 유형별 사용된 적심을 검토한 결과, 건물의 유형(전(殿), 당(堂), 합(閤), 각(閣), 재(齋), 헌(軒), 누(樓), 정(亭))에 따라 그 기초, 즉 적심도 달리 축조되는 것을 확인할 수 있었다. 현 자료의 한계 상'전', '당', '각', '방'등 일부 건물 유형만 확인되었는데, '전'과 '각'의 경우 장대석으로 축조한 방형 적심(IV)이, '당'과 '방'의 경우 기와와 잡석을 사용하여 축조한 말각방형 적심(II)이 많이 사용되었으며, 기타 건물명을 알 수 없는 경우는 대부분 조선전기 선대(先代) 건물지의 적심임으로, 조선전기에 원형 잡석 적심(I-1)이 많이 축조된 것을 알 수 있었다. 이를 통해 주인의 신분이 높고 격이 높은 건물일수록 건축물도 격이 높듯이, 그 기초부, 즉 적심 또한 가장 견고하고 좋은 재료를 사용하여 축조한 것으로 추정해 볼 수 있다. 또한 '당'과 '방'은 같은 말각방형 적심이 사용되었지만, '당'은 잡석과 와전편을 주재료로 사용한 II-2a(잡석+와전편 말각방형 적심)형식이, '방'은 II-2a형식의 상면에 15~20cm 가량 와전편을 깐 II-2b(와전편+(잡석+와전편 말각방형적심)) 형식이 많아 차이가 있었다. 이러한 건물 유형별 적심은 시기별로 축조되는 형식에 변화가 있는 것으로 확인되었다. '전'과 '각'의 경우 모두 14~15세기 조선전기에는 I-1형식(원형 잡석)의 적심을 축조하다가, 19세기 조선후기에는 다양한 형식의 적심이 축조되는데, 그 중에서도 특히 방형 적심(IV)이 많이 축조되었음을 알 수 있었다. '당'의 경우 조선후기의 변천양상만을 확인할 수 있었는데, 고종 4년(1867) 축조된 적심은 잡석과 와전편을 섞어 넣은 형식의 적심이 많이 축조되고, 이후 고종 13년(1876) 혹은 고종 25년(1888)에는 다른 건물 유형에서 확인되지 않는 강회사질토 및 탄축 적심이라는 독자적인 형식이 사용되었다. 본 연구를 통해 조선전기에 비해 후기에 적심의 다양한 축조방식과 재료가 개발되었음을 알 수 있었으며, 이는 당시 궁궐건물 기초 축조 기술 수준의 변화가 있었음을 대변해 준다. 또한 건물 유형별로 사용되는 적심의 형식이 다른 것이 확인되어, 건물의 기초를 축조할 때 미리 계산된 건축 공법을 적용하였음을 알 수 있었다.
Much has teed changed in the field of hospital administration in the It wake of the rapid development of sciences, techniques ana systematic hospital management. However, we still have a long way to go in organization, in the quality of hospital employees and hospital equipment and facilities, and in financial support in order to achieve proper hospital management. The above factors greatly effect the ability of hospitals to fulfill their obligation in patient care and nursing services. The purpose of this study is to determine the optimal methods of standardization and quality nursing so as to improve present nursing services through investigations and analyses of various problems concerning nursing administration. This study has been undertaken during the six month period from October 1971 to March 1972. The 41 comprehensive hospitals have been selected iron amongst the 139 in the whole country. These have been categorized according-to the specific purposes of their establishment, such as 7 university hospitals, 18 national or public hospitals, 12 religious hospitals and 4 enterprise ones. The following conclusions have been acquired thus far from information obtained through interviews with nursing directors who are in charge of the nursing administration in each hospital, and further investigations concerning the purposes of establishment, the organization, personnel arrangements, working conditions, practices of service, and budgets of the nursing service department. 1. The nursing administration along with its activities in this country has been uncritical1y adopted from that of the developed countries. It is necessary for us to re-establish a new medical and nursing system which is adequate for our social environments through continuous study and research. 2. The survey shows that the 7 university hospitals were chiefly concerned with education, medical care and research; the 18 national or public hospitals with medical care, public health and charity work; the 2 religious hospitals with medical care, charity and missionary works; and the 4 enterprise hospitals with public health, medical care and charity works. In general, the main purposes of the hospitals were those of charity organizations in the pursuit of medical care, education and public benefits. 3. The survey shows that in general hospital facilities rate 64 per cent and medical care 60 per-cent against a 100 per cent optimum basis in accordance with the medical treatment law and approved criteria for training hospitals. In these respects, university hospitals have achieved the highest standards, followed by religious ones, enterprise ones, and national or public ones in that order. 4. The ages of nursing directors range from 30 to 50. The level of education achieved by most of the directors is that of graduation from a nursing technical high school and a three year nursing junior college; a very few have graduated from college or have taken graduate courses. 5. As for the career tenure of nurses in the hospitals: one-third of the nurses, or 38 per cent, have worked less than one year; those in the category of one year to two represent 24 pet cent. This means that a total of 62 per cent of the career nurses have been practicing their profession for less than two years. Career nurses with over 5 years experience number only 16 per cent: therefore the efficiency of nursing services has been rated very low. 6. As for the standard of education of the nurses: 62 per cent of them have taken a three year course of nursing in junior colleges, and 22 per cent in nursing technical high schools. College graduate nurses come up to only 15 per cent; and those with graduate course only 0.4 per cent. This indicates that most of the nurses are front nursing technical high schools and three year nursing junior colleges. Accordingly, it is advisable that nursing services be divided according to their functions, such as professional, technical nurses and nurse's aides. 7. The survey also shows that the purpose of nursing service administration in the hospitals has been regulated in writing in 74 per cent of the hospitals and not regulated in writing in 26 per cent of the hospitals. The general purposes of nursing are as follows: patient care, assistance in medical care and education. The main purpose of these nursing services is to establish proper operational and personnel management which focus on in-service education. 8. The nursing service departments belong to the medical departments in almost 60 per cent of the hospitals. Even though the nursing service department is formally separated, about 24 per cent of the hospitals regard it as a functional unit in the medical department. Only 5 per cent of the hospitals keep the department as a separate one. To the contrary, approximately 12 per cent of the hospitals have not established a nursing service department at all but surbodinate it to the other department. In this respect, it is required that a new hospital organization be made to acknowledge the independent function of the nursing department. In 76 per cent of the hospitals they have advisory committees under the nursing department, such as a dormitory self·regulating committee, an in-service education committee and a nursing procedure and policy committee. 9. Personnel arrangement and working conditions of nurses 1) The ratio of nurses to patients is as follows: In university hospitals, 1 to 2.9 for hospitalized patients and 1 to 4.0 for out-patients; in religious hospitals, 1 to 2.3 for hospitalized patients and 1 to 5.4 for out-patients. Grouped together this indicates that one nurse covers 2.2 hospitalized patients and 4.3 out-patients on a daily basis. The current medical treatment law stipulates that one nurse should care for 2.5 hospitalized patients or 30.0 out-patients. Therefore the statistics indicate that nursing services are being peformed with an insufficient number of nurses to cover out-patients. The current law concerns the minimum number of nurses and disregards the required number of nurses for operation rooms, recovery rooms, delivery rooms, new-born baby rooms, central supply rooms and emergency rooms. Accordingly, tile medical treatment law has been requested to be amended. 2) The ratio of doctors to nurses: In university hospitals, the ratio is 1 to 1.1; in national of public hospitals, 1 to 0.8; in religious hospitals 1 to 0.5; and in private hospitals 1 to 0.7. The average ratio is 1 to 0.8; generally the ideal ratio is 3 to 1. Since the number of doctors working in hospitals has been recently increasing, the nursing services have consequently teen overloaded, sacrificing the services to the patients. 3) The ratio of nurses to clerical staff is 1 to 0.4. However, the ideal ratio is 5 to 1, that is, 1 to 0.2. This means that clerical personnel far outnumber the nursing staff. 4) The ratio of nurses to nurse's-aides; The average 2.5 to 1 indicates that most of the nursing service are delegated to nurse's-aides owing to the shortage of registered nurses. This is the main cause of the deterioration in the quality of nursing services. It is a real problem in the guest for better nursing services that certain hospitals employ a disproportionate number of nurse's-aides in order to meet financial requirements. 5) As for the working conditions, most of hospitals employ a three-shift day with 8 hours of duty each. However, certain hospitals still use two shifts a day. 6) As for the working environment, most of the hospitals lack welfare and hygienic facilities. 7) The salary basis is the highest in the private university hospitals, with enterprise hospitals next and religious hospitals and national or public ones lowest. 8) Method of employment is made through paper screening, and further that the appointment of nurses is conditional upon the favorable opinion of the nursing directors. 9) The unemployment ratio for one year in 1971 averaged 29 per cent. The reasons for unemployment indicate that the highest is because of marriage up to 40 per cent, and next is because of overseas employment. This high unemployment ratio further causes the deterioration of efficiency in nursing services and supplementary activities. The hospital authorities concerned should take this matter into a jeep consideration in order to reduce unemployment. 10) The importance of in-service education is well recognized and established. 1% has been noted that on the-job nurses. training has been most active, with nursing directors taking charge of the orientation programs of newly employed nurses. However, it is most necessary that a comprehensive study be made of instructors, contents and methods of education with a separate section for in-service education. 10. Nursing services'activities 1) Division of services and job descriptions are urgently required. 81 per rent of the hospitals keep written regulations of services in accordance with nursing service manuals. 19 per cent of the hospitals do not keep written regulations. Most of hospitals delegate to the nursing directors or certain supervisors the power of stipulating service regulations. In 21 per cent of the total hospitals they have policy committees, standardization committees and advisory committees to proceed with the stipulation of regulations. 2) Approximately 81 per cent of the hospitals have service channels in which directors, supervisors, head nurses and staff nurses perform their appropriate services according to the service plans and make up the service reports. In approximately 19 per cent of the hospitals the staff perform their nursing services without utilizing the above channels. 3) In the performance of nursing services, a ward manual is considered the most important one to be utilized in about 32 percent of hospitals. 25 per cent of hospitals indicate they use a kardex; 17 per cent use ward-rounding, and others take advantage of work sheets or coordination with other departments through conferences. 4) In about 78 per cent of hospitals they have records which indicate the status of personnel, and in 22 per cent they have not. 5) It has been advised that morale among nurses may be increased, ensuring more efficient services, by their being able to exchange opinions and views with each other. 6) The satisfactory performance of nursing services rely on the following factors to the degree indicated: approximately 32 per cent to the systematic nursing activities and services; 27 per cent to the head nurses ability for nursing diagnosis; 22 per cent to an effective supervisory system; 16 per cent to the hospital facilities and proper supply, and 3 per cent to effective in·service education. This means that nurses, supervisors, head nurses and directors play the most important roles in the performance of nursing services. 11. About 87 per cent of the hospitals do not have separate budgets for their nursing departments, and only 13 per cent of the hospitals have separate budgets. It is recommended that the planning and execution of the nursing administration be delegated to the pertinent administrators in order to bring about improved proved performances and activities in nursing services.