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A Study of Home Care Needs of Patients at Discharge and Effects of Home Care -Centered on Patients Discharged from a Rural General Hospilal- (퇴원환자의 가정간호요구와 가정간호사업의 효과 분석 - 일 종합병원을 중심으로)

  • Choi, Yun Soon;Kim, Dai Hyun;Storey, Margaret;Kim, Cho Ja;Kang, Kyu Sook
    • The Korean Nurse
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    • v.31 no.4
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    • pp.77-99
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    • 1992
  • The study was carried out at W. hospital, an affiliated hospital of Y university, involved a total of 163 patients who were discharged from the hospital between May 1990 und March 199J. Data collection was twice, just prior to discharge and a minimum of three months post discharge. Thirty patients who lived within a hour travel time of the hospital received home care during the three months post discharge. Nursing diagnoses and nursing interventions For these patients were analyzed in this study. The results of the study are summarized as follows : 1. Discharge needs for the subjects of the study were analyzed using Gordon's eleven Functional categories and it was found that 48.3% of the total sample had identified nursing needs. Of these, the needs most frequently identified were in the categories of sexuality, 79.3 %, health perception, 68.2 % self concept, 62.5 %, and sleep and rest 62.5 %. Looking ut j he nursing diagnosis that were made for the 30 patients receiving home care, the following diagnoses were the most frequently given; alteration in sexual pattern 79.3%, alterations in health maintenance, 72.6%, alteration in comfort, 68.0%, depression, 64.0%, noncompliance with diet therapy, 6.3.7%, alteration in self concept, 55.6%, and alteration in sleep pattern, 53%. 2. In looking at the effects of home nursing care as demonstrated by changes in the functional categories over the three month period, it was Found that of the 11 functional categories, the need level for health perception, nutrition, activity and self concept decreased slightly over the three month period. On the average sleep patterns improved, but restfulness was slightly less and bowel elimination patterns improved but satisfaction with urinary elimination was slightly less. On the other hand, role enactment, sexuality, stress management and spirituality decreased slightly. The only results that were statistically significant at the 0.05 level were improvement. in digestion and decrease in pain. No statistically significant changes were found in ability related to ADL, the total ADL Score at discharge was $19.78{\pm}8.234, and after 3 months $19.01{\pm}8.12$. Considering that a majority of the patients were over 60 years of age and that many had brain or spinal cord injuries, the fact that their ADL ability did nor deteriorate after discharge can be interpreted as related to a positive impact by the home health care nurses. Similarly there was a slight be not statistically significant decrease in the quality of life scores between the two lest times(l47.83 at discharge and 113.02 at the three month period). Again, when the chronic nature of thee problems facing these patients is considered this maintenance of quality of life can be interpreted as a positive impact by the home health care nurses. 3. One of the home care nursing activities was diagnosis. For this activity it was found that for nine functional health categories(sexuality and spirituality excepted) there were 20 nursing diagnoses. The most frequent were noncompliance, alteration in skin integrity both actual and potential, and impaired physical mobility in that order. 4. Delivery of home health care by the home health nurses included the following nursing activities; assessment, patient education, demonstration of care activities, counselling, direct care to the patient and referrals. Direct care included changing dressings, bladder irrigations, changing Foley catheters, measurement of residual urine, perineal care, position change, back care, oral hygiene, exercise and massage of motion exercises, cleansing enemas, tracheostomy suctioning and tracheostomy care, care of dentures, applications of heat and other similar nursing activities. In conclusion almost 50% of (he sample indicated a need for continued nursing care at the time of discharge and for the patients in the sample who received home care there was a slight decrease in nursing needs but while the patients had chronic and debilitation problems there was ill decrease in ADL abilities or in quality of life. Further study needs Lo be done La increase the reliability and validity of the tool that was used to measure home health care needs. It is also recommended that study by done using a randomized sampling with a control group to compare patients who receive home care with those who do not.

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A Clinical Study for Promoting Quality Nusing Care in a University Hospital (질적 간호제공을 위한 간호단위 시범 운영 효과에 관한 임상적 연구)

  • Lee, A.J.;Kim, S.H.;Seong, Y.H.;Yoo, S.A.;Kwon, I.G.;Jeong, Y.I.;Nam, H.K.;Kwon, E.J.
    • The Korean Nurse
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    • v.32 no.5
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    • pp.66-77
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    • 1994
  • The purpose of this study was to develop a new nursing unit which can meet changing health care needs, enhance patients' satisfaction and nurses' job satisfaction, and finally guarantee quality nursing care with present manpower. For this, one medical unit was selected as a unit for quality care. And one medical unit which is similar in staffing and patients' characteristics was selected as a control unit. To assess present problems and identify the remedies to the problems a hospital-wide survey and a workshop were performed. According to the survey results, educational programs and improvement of the facilities and equipment supply system, managereal support for interdepartmental cooperation and intensification of bed-side nursing care were adopted as main principles for operating model unit, This model unit was operated for 3 months from Sep. 1, 1992 to Nov. 30, 1992. To evaluate the effectiveness of the model unit, derect/indirect nursing care hours, patients' satisfaction to nursing care, nurses' job satisfaction, and quality care index were measured. Direct/indirect nursing care hours were compared with that of the control unit, and patients' and nurses' satisfaction and quality care index were measured before and after operating model unit and compared with each other. The results of the study were as follows; 1. In the model unit mean direct nursing care hours per cach shift was 146.88 minutes and indirect nursing care hours was 354.72 minutes. The ratio of the direct nursing care hour to indirect nursing hour was 29.6 ; 70.4 and that of the control unit was 26.9 : 73.1. Direct nursing care hour in model unit was longer than that of the control unit. But, the difference was not significant. In subcategories of direct nursing care, the time spent in mobility and exercise, conservation of body temperature, hygiene, and communication and health education were longer than that of the con" trol unit. 2. Indirect nursing care hour in model unit was shorter than that of the control unit. But, the difference was not significant. In subcategories of indirect nursing care, the time spent in drug management and ward arrangement was shorter than that of the control unit. 3. Patients' satisfaction to nursing care was increased significantly after operating the model unit (T=-3.48, P=-0.002) and satisfaction to subcategories of physical comfort measure, psychological cate, and unit management components were significantly higher than before. 4. In the model unit, nurses' total job satisfaction was increased significantly after operating the model unit(Z=2.1004, P=.0357) and satisfaction to subcategory of satisfaction to administration was significantly higher than before (Z=-2.0732, P=.0382). 5. After operating the model unit, quality care index was increased from 89 to 93. With this results, it can be summarized that all the measures tried for quality care, such as educational programs, managereal support for interdepartmental cooperation, and improvement of the equipment and facility provision resulted in partial increase in direct nursing care hours, nurses satisfaction to their job and patients' satisfaction to nursing care. In can be postulated that managereal support and motivation without proper staff supplementation is not enough for increasing direct nursing care hours. And for the enhancement of the level in clinical nursing, and staff supplement must be considered sincerely and the measures for reducing indirect nursing care hours, such as computerization of nursing care activities, improvement of facilities and equipment and facilities supply system, must be instituted in addition.

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Influence of Supplemental Dietary Yeast Culture on the Noxious Gas Emission in Broiler Houses and Performance of Broiler Chicks (효모배양물 첨가 사료가 계사내 유해가스 발생 및 육계의 생산성에 미치는 영향)

  • Park, J. H.;Ryu, M. S.;Kim, S. H.;Na, C. S.;Kim, J. S.;Ryu, K. S.
    • Journal of Animal Science and Technology
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    • v.45 no.1
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    • pp.41-48
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    • 2003
  • Two experiments were conducted to investigate the effect of dietary supplementation of yeast culture on the performance of broiler chicks and noxious gas emission in broiler houses. Two hundred forty and three hundred and twenty, one day old Cobb male broiler chicks in Expt 1 and Expt 2, respectively were alloted to four treatment levels of yeast culture (0, 0.1, 0.2, 0.4%). To each treatment, 60 birds were assigned in Expt 1 and 5 replicates of 16 birds each were assigned in Expt 2. Basal diets contained 21.5% and 19.0% CP, and 3,100kcal/kg ME for the starting and finishing periods, respectively. Ammonia and $CO_2$ gas emission were detected twice a day for seven days during the five week period of Expt 1. Weight gain, feed intake and feed efficiency were measured for five weeks in Expt 2. Intestinal microbes, blood cholesterol and ND antibody titer were examined at the end of Expt 2. In Expt 1, the concentration of $NH_3$ in the house of birds fed yeast culture tended to be lower than the control. It was significantly lower in the 0.4% yeast culture treatment than the control (P<0.05). $CO_2$ concentration was significantly lower in all yeast culture treatments regardless of its dietary supplemental level than the control (P<0.05). different from others. Feed efficiency (feed/gain), however, was significantly improved in all yeast culture treatments relative to that of the control for starting period (P<0.05) and that of 0.2% yeast culture treatment was significantly lower than those of the control and 0.4% for the overall period. Total number of E. coli in the ileum of birds fed yeast culture at 0.1 and 0.2% was significantly lower than those of the control and 0.4% in the ileum. The CFU of Lactobacillus spp. of birds fed yeast culture at 0.1% was higher in the cecum compared to other treatments (P<0.05). Total cholesterol level of chicks fed 0.1% yeast culture seemed to be lower compared to that of other treatments, whereas LDL-cholesterol level was significantly lower than those of the control and 0.4% treatment. ND antibody titer tended to be higher in the yeast culture treatments than the control, but was not significantly different. The results of these experiments indicated that 0.2% yeast culture may have a potential to reduce the noxious gas emission in broiler houses and maximize the performance of broiler chicks.

In Vitro Development and Survival Following Cryopreservation of Bovine Embryos according to Ovary Transport Temperature (난소 수송 온도에 따른 소 체외 수정란의 발육 및 동결-융해 후의 생존성)

  • Cho S.R.;Choi S.H.;Kim H.J.;Choe C.Y.;Jin H.J.;Son D.S.
    • Journal of Embryo Transfer
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    • v.21 no.2
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    • pp.163-168
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    • 2006
  • The present study was carried out to investigate in vitro development and post-thawed survivability of bovine embryos according to different ovary transport temperatures. Bovine ovaries were collected at a local slaughterhouse and were transported at 4 different temperature categories to laboratory: $7{\sim}10^{\circ}C\;(T1),\;11{\sim}17^{\circ}C\;(T2),\;18{\sim}25^{\circ}C\;(T3)$ and above $26^{\circ}C$ (control group). The cumulus-oocyte-complexes aspirated from ovaries were in vitro matured, fertilized and cultured. The rates of maturation (to metaphase II), cleavage and development to blastocysts were compared among treatment groups. Furthermore, frozen-thawed blastocysts were in vitro cultured to compare the survivability among groups. The maturation rates in the T1, T2 and T3 groups ($60.0{\sim}68.2%$) were significantly lower than that in the control group (81.8%, p<0.05). The cleavage rates in the T1 and T2 groups (52.6 and 54.5%) were significantly lower than that in the control group (83.6%, p<0.05). However, there was no difference in the development rate to blastocysts among all groups ($27.9{\sim}33.0%$, p>0.05). The survivability of frozen-thawed embryos was significantly lower in the T1 group (46.2%) than those in the T2, T3 and control groups ($68.8{\sim}7.13%$, p<0.05). In conclusion, the results suggest that ovary transport temperature at $26^{\circ}C$ may be optimal for the better in vitro development and the survival of frozen-thawed embryos produced in vitro Furthermore, exposure of ovary to temperature below $10^{\circ}C$ during transport may significantly decrease both in vitro development and survivability of frozen-thawed blastocysts.

The Comparative Study on Health Promoting Behaviors by Shift Pattern of Duties of Women Workers in workplace (산업장 여성근로자의 근무형태에 따른 건강증진행위 비교)

  • Jang, Hee Jung;Park, Kyung Min
    • Korean Journal of Occupational Health Nursing
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    • v.8 no.1
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    • pp.22-41
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    • 1999
  • This study intended to analyze the health promoting behaviors, compare their factors according to the shift pattern of duties of women workers who were working in the industrial workplace and present basic data in planning systematic and effective programs of health promotion for three-shift system and day-duty. Using Quota Sampling, 219 women workers were selected as subjects from 5 workshops which had 50 settled workers up to 300 and 10 factories which had more than 300 located in Taegu and Kyung-Book Province. Data were collected by means of questionnaire from September 12 to September 30, 1998. As the instruments of the study were used Health Promotion Lifestyle Profile(HPLP) which was adapted and adjusted by Seo, Y. O. for health promoting behavior, the one developed by Moon, J. S. (1990) for health-belief, the one developed by Sherer et al.(1982) and then adapted by Oh, H. S. for self-efficacy, and the one developed by Park, J. W. (1985) for social support. The analysis of data were performed with Cronbach's ${\chi}^2$-test, t-test, ANCOVA, Kendal tau, Pearson correlation, Stepwise Multiple Regression test using SPSS program. The results of the study are as follows : 1. There was a significant difference in age(${\chi}^2=32.46$, p=0.000), career (${\chi}^2=18.47$, p=0.000), working day(t=-3.18, p=0.000) by the shift pattern of duties in terms of socio-demographic characteristics. 2. There was a statistically significant difference between the two groups on the health promoting behaviors (t=2,52, p=0.012). The score of three-shift group on health promoting behaviors was 2.27, showing that it was lower by .13 than that of day-duty group(2.40). 3. ANCOVA involving age, career and working day as covariables, which had revealed significant difference before, showed that health promoting behaviors by the shift patterns of duties was significantly different(F=4.88, p=0.028). 4. In consideration of variables that have an influence on health promoting behavior by the shift pattern of duties, social support occupied 19.4% of health promoting behavior in the three-shift group and 22.5% including the sense of self-efficacy. In the day-duty group, social support occupied 34.4% of health promoting behavior. 5. The score of three-shift group(2.94) was significantly lower than that of day-duty group(3.12) in the perceived benefit of health-belief(t= -3.29, p=0.001), while the score of three-shift group (2.48) was significantly higher than that of day-duty group(2.24) in the perceived barrier (t=4.22, p=0.000). In the sense of self-efficacy(t=-4.20, p=0.000), the score of three-shift group(3.24) was significantly lower than that of day-duty group(3.53) while in social support(t=-4.56, p=0.000) the one of three-shift group(2.64) was significantly lower than that of day-duty group(2.88). The suggestions are as follows on the basis of the results of this study : 1. It is required to develop health promoting program that takes the shift pattern of duties of women workers into consideration. In addition, there are special demands on developing nursing strategies for health promoting behavior of three-shift workers. 2. It is required to develop specific strategies for social support which is the most significant factor to the health promoting behavior for women workers. 3. It is necessary to develop some programs for improving the sense of self-efficacy, social support, and health-belief of three-shift workers. To achieve these tasks, industrial nurses should play an active role and improve the ability of self-health care of women workers.

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Catalytic Wet Oxidation of Azo Dye Reactive Black 5 (아조염료 Reactive Black 5 폐수의 촉매습식산화)

  • Suh, Il-Soon;Yoo, Shin-Suk;Ko, Mi-So;Jeong, Samuel;Jung, Cheol-Goo;Hong, Jeong-Ah;Yoon, Wang-Lai
    • Korean Chemical Engineering Research
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    • v.48 no.2
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    • pp.259-267
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    • 2010
  • The catalytic wet oxidations of the wastewater containing azo dye Reactive Black 5(RB5) with heterogeneous catalyst of CuO have been carried out to investigate the effects of temperature($190{\sim}230^{\circ}C$) and catalyst concentration(0.00~0.20 g/l) on the removals of colour and total organic carbon TOC. The wastewater colour was measured with spectrophotometer, and the oxidation rate was estimated with TOC. About 90% of colour was removed during 120 min in thermal degradation of the RB5 wastewater at $230^{\circ}C$, while TOC was not removed at all. As increasing reaction temperature and catalyst concentration, the removal rates of colour and TOC increased in the catalytic wet oxidations of RB5 wastewater. The effects of catalyst were already considerable even at 0.01 g CuO/l, while the removal rates of colour and TOC increased negligibly with increasing the catalyst concentration above 0.05 g CuO/l. The initial destruction rates of the wastewater colour have shown the first-order kinetics with respect to the wastewater colour. TOC changes during catalytic wet oxidations have been well described with the global model, in which the easily degradable TOC was distinguished from non-degradable TOC of the wastewater. The impacts of reaction temperature on the destruction rate of the wastewater colour and TOC could be described with Arrhenius relationship. Activation energies of the colour removal reaction in thermal degradation, wet oxidation, and catalytic wet oxidation(0.20 g CuO/l) of the RB5 wastewater were 108.4, 78.3 and 74.1 kJ/mol, respectively. The selectivity of wastewater TOC into the non-degradable intermediates relative to the end products in the catalytic wet oxidations of RB5 wastewater was higher compared to that in phenol wet oxidations.

Dust Spatial Distribution and Emission of Tunnel Ventilated Windowless Broiler Building (터널환기 무창육계사의 분진크기별 분포와 배출농도에 관한 연구)

  • Choi, H.C.;Yeon, G.Y.;Spmg, J.I.;Kang, H.S.;Kwon, D.J.;Yoo, Y.H.;Yang, C.B.;Chun, S.S.;Kim, Y.K.
    • Journal of Animal Environmental Science
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    • v.12 no.3
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    • pp.115-122
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    • 2006
  • This study investigated the spatial distribution of dust originating from tunnel-ventilated windowless broiler building measuring 12 m wide, 61 m long, with a side wall height of 3 m and a capacity of 16,982 birds. Dust concentrations in terms of total suspended particles (TSP), and particulate matter of sizes $10\;{\mu}m$(PM10), $2.5\;{\mu}m$(PM2.5), and $1\;{\mu}m(PM1)$ were measured at 30 minutes interval by using GRIMM Aerosol Monitor (GRIMM AEROSOL). The spatial distribution of dust showed the lower dust concentration in the inlet than in the outlet of the tunnel ventilation, and dust concentration decreasing as the dust size decreased, as follows: $317.9\;{\mu}g/m^3$ TSP; $74.7{\mu}m/m^3$ PM10; $9.7\;{\mu}g/m^3$ PM2.5; and $6.2\;{\mu}g/m^3$ PM1 in the inlet; and $2,678.5\;{\mu}g/m^3$ TSP; $555.5\;{\mu}g/m^3$ PM10; $33.3\;{\mu}g/m^3$ PM2.5; and $10.2\;{\mu}g/m^3$ PM1 in the outlet. The dust concentration emitted from the tunnel ventilated fan was $446.6\;{\mu}g/m^3$ TSP; $129.1\;{\mu}g/m^3$ PM10; $15.8\;{\mu}g/m^3$ PM2.5; and $6.1\;{\mu}g/m^3$ PM1 in the 3 meters from the fan and $25.1\;{\mu}g/m^3$ TSP; $8.8\;{\mu}g/m^3$ PM10; $5.6\;{\mu}g/m^3$ PM2.5; and $4.9\;{\mu}g/m^3$ PM1 in the 50 meters from the fan.

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Quantity and Characteristics of Manure Produced by Holstein Heifer at Different Seasons (홀스타인 육성우의 계절별 분뇨 배설량 및 특성에 관한 연구)

  • Choi, D.Y.;Kwag, J.H.;Park, C.H.;Jeong, K.H.;Kim, T.I.;Kim, J.H.;Yoo, Y.H.;Yang, C.B.;Hong, H.L.
    • Journal of Animal Environmental Science
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    • v.12 no.3
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    • pp.123-132
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    • 2006
  • This study was conducted to determine the volume of Holstein heifers manure excreted and its characteristics. The average dry matter intake of heifers was 6.7 kg/head/day. The intake rate was lowest in spring among four seasons. The average dry matter intake rate during spring, summer, fall, and winter was 4.6, 8.3, 7.1, and 6.8 kg/head/day, respectively. The average water intake of heifers was $19.3{\ell}/head/day$. The wale. consumption was highest value ($21.8{\ell}/head/day$) in summer and lowest values ($18.3{\ell}/head/day$) in spring and winter. Values were found not to be statiscally different for the four seasons. The average manure production of heifers (average live weight was 363.1 kg) was 20.3 kg/head/day and it was 5.6% of live animal weight. The manure production during spring, summer, fall, and winter was 13.7, 23.5, 25.0, and 20.2 kg/head/day, respectively. Production during spring was lower than the other seasons (p<0.05). A higher correlation between live weight and manure production ($R^2=0.7816$) and between live weight and feed intake ($R^2=0.7296$) was observed for heifers. Correlations between manure production and water intake and between manure production and feed intake were found to be relatively low for heifers. The moisture content of feces was 83.5% and that of urine 94.6%. The pH of feces and urine were in the ranges of 7.4 and 7.5, respectively. The $BOD_5$, COD, SS, T-N, T-P concentrations of the heifer feces were 18,048, 50,114, 119,833, 2,519, and $427mg/{\ell}$, respectively. Heifer urine showed lower levels of $BOD_5(5,434mg/{\ell})$, COD$(6,550mg/{\ell})$, SS$(825mg/{\ell})$, T-N$(3,616mg/{\ell})$, and $T-P(28mg/{\ell})$ than feces. The fertilizer nutrient concentrations of heifer feces was 0.25% N, 0.1% $P_2O_5$ and 0.14% $K_2O$. Urine was found to contain 0.36% N, 0.006% of $P_2O_5$ and 0.31% $K_2O$.

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A Study on Differences of Opinions on Home Health Care Program among Physicians, Nurses, Non-medical personnel, and Patients. (가정간호 사업에 대한 의사, 간호사, 진료관련부서 직원 및 환자의 인식 비교)

  • Kim, Y.S.;Lim, Y.S.;Chun, C.Y.;Lee, J.J.;Park, J.W.
    • The Korean Nurse
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    • v.29 no.2
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    • pp.48-65
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    • 1990
  • The government has adopted a policy to introduce Home Health Care Program, and has established a three stage plan to implement it. The three stage plan is : First, to amend Article 54 (Nurses for Different Types of Services) of the Regulations for Implementing the Law of Medical Services; Second, to tryout the new system through pilot projects established in public hospitals and clinics; and third, to implement at all hospitals and equivalent medical institutions. In accordance with the plan, the Regulation has been amend and it was promulgated on January 9,1990, thus establishing a legal ground for implementing the policy. Subsequently, however, the Medical Association raised its objection to the policy, causing a delay in moving into the second stage of the plan. Under these circumstances, a study was conducted by collecting and evaluating the opinions of physicians, nurses, non-medical personnel and patients on the need and expected result from the home health care for the purpose of help facilitating the implementation of the new system. As a result of this study, it was revealed that: 1. Except the physicians, absolute majority of all other three groups - nurses, non-medical personnel and patients -gave positive answers to all 11 items related to the need for establishing a program for Home Health Care. Among the physicians, the opinions on the need for the new services were different depending on their field of specialty, and those who have been treating long term patients were more positive in supporting the new system. 2. The respondents in all four groups held very positive view for the effectiveness and the expected result of the program. The composite total of scores for all of 17 items, however, re-veals that the physicians were least positive for the- effectiveness of the new system. The people in all four groups held high expectation on the system on the ground that: it will help continued medical care after the discharge from hospitals; that it will alleviate physical and economic burden of patient's family; that it will offer nursing services at home for the patients who are suffering from chronic disease, for those early discharge from hospital, or those who are without family members to look after the patients at home. 3. Opinions were different between patients( who will receive services) and nurses (who will provide services) on the types of services home visiting nurses should offer. The patients wanted "education on how to take care patients at home", "making arrangement to be admitted into hospital when need arises", "IV injection", "checking blood pressure", and "administering medications." On the other hand, nurses believed that they can offer all 16 types of services except "Controlling pain of patients", 4. For the question of "what types of patients are suitable for Home Health Care Program; " the physicians, the nurses and non-medical personnel all gave high score on the cases of "patients of chronic disease", "patients of old age", "terminal cases", and the "patients who require long-term stay in hospital". 5. On the question of who should control Home Health Care Program, only physicians proposed that it should be done through hospitals, while remaining three groups recommended that it should be done through public institutions such as public health center. 6. On the question of home health care fee, the respondents in all four groups believed that the most desireable way is to charge a fixed amount of visiting fee plus treatment service fee and cost of material. 7. In the case when the Home Health Care Program is to be operated through hospitals, it is recommended that a new section be created in the out-patient department for an exclusive handling of the services, instead of assigning it to an existing section. 8. For the qualification of the nurses for-home visiting, the majority of respondents recommended that they should be "registered nurses who have had clinical experiences and who have attended training courses for home health care". 9. On the question of if the program should be implemented; 74.0% of physicians, 87.5% of non-medical personnel, and 93.0% of nurses surveyed expressed positive support. 10. Among the respondents, 74.5% of -physicians, 81.3% of non-medical personnel and 90.9% of nurses said that they would refer patients' to home health care. 11. To the question addressed to patients if they would take advantage of home health care; 82.7% said they would if the fee is applicable to the Health Insurance, and 86.9% said they would follow advises of physicians in case they were decided for early discharge from hospitals. 12. While 93.5% of nurses surveyed had heard about the Home Health Care Program, only 38.6% of physicians surveyed, 50.9% of non-medical personnel, and 35.7% of patients surveyed had heard about the program. In view of above findings, the following measures are deemed prerequisite for an effective implementation of Home Health Care Program. 1. The fee for home health care to be included in the public health insurance. 2. Clearly define the types and scope of services to be offered in the Home Health Care Program. 3. Develop special programs for training nurses who will be assigned to the Home Health Care Program. 4. Train those nurses by consigning them at hospitals and educational institutions. 5. Government conducts publicity campaign toward the public and the hospitals so that the hospitals support the program and patients take advantage of them. 6. Systematic and effective publicity and educational programs for home heath care must be developed and exercises for the people of medical professions in hospitals as well as patients and their families. 7. Establish and operate pilot projects for home health care, to evaluate and refine their programs.

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Epidemiological Studies of Clonorchiasis. - I. Current Status and Natural Transition of the Endemicity of Clonorchis sinensis in Gimhae Gun and Delta, a High Endemic area in Korea (간흡충증(肝吸虫症)의 역학(疫學) - I. 고도유행지(高度流行地) 김해지방(金海地方)에 있어서의 간흡충감염(肝吸虫感染)의 현황(現況)과 자연추이(自然推移))

  • Kim, D.C.;Lee, O.Y.;Lee, J.S.;Ahn, J.S.;Chang, Y.M;Son, S.C.;Moon, I.S.
    • Journal of agricultural medicine and community health
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    • v.8 no.1
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    • pp.44-65
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    • 1983
  • 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.

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