The Public Health Welfare Conception of the Beveridge Report and Its Realization via the NHS (베버리지 보고서의 의료보장 구상과 NHS를 통한 구현)
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- The Korean Society of Law and Medicine
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- v.24 no.3
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- pp.59-104
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- 2023
This essay attempts to analyze the public health welfare conception within the text of the Beveridge Report and its realization via the NHS in Great Britain. Once referring to the influence of the Report to create the foundations of the 20th-century welfare system, the quest to scrutinize the original intentions of the Report and its succession to the NHS is certainly intriguing. Furthermore, when regarding the significance of public health policy for a modern state, the effort to engage in Beveridge's conception and its realization is more than timely. In light of such a premise, this paper indulges in its study by the following methods. First, the historical background of the Report - namely, the role of the spirit of the age and the experience of the Emergency Medical Service are to be analyzed to identify the origins of the welfare policies proposed by Beveridge. Furthermore, the public health welfare conception of the Report conceived from its time is reflected upon by engaging on the goal towards social welfare and public health scheme. Lastly, the aims of the NHS and its management, treatment classification, and rehabilitation program are reviewed for comparative analysis with the Report to survey the realization of Beveridge's design. In this process, this paper not only takes into account the original text of the Report - but also other essential works of law and public policy, including the NHS Constitution for England and the National Health Service Act of 1946. The intentions of this study are not bound by merely coinciding with the Report, but resonate significance via reflecting upon the Beveridgian legacy on the modern welfare state from the current perspective. The structured analysis to research the aims and policies of the Report and to compare them to the reality of the NHS may provide an opportunity to confirm the realization of Beveridge's scheme in British society. In addition, this essay is part of an academic endeavor to critically assess the past and the present of the welfare institution in the public health sector. As such, it is hopeful that the essay sheds light on further studies concerning the constructive remedies of the Korean welfare system as well.
The utilization of generative AI in the medical field is also being rapidly researched. Access to vast data sets reduces the time and energy spent in selecting information. However, as the effort put into content creation decreases, there is a greater likelihood of associated issues arising. For example, with generative AI, users must discern the accuracy of results themselves, as these AIs learn from data within a set period and generate outcomes. While the answers may appear plausible, their sources are often unclear, making it challenging to determine their veracity. Additionally, the possibility of presenting results from a biased or distorted perspective cannot be discounted at present on ethical grounds. Despite these concerns, the field of generative AI is continually advancing, with an increasing number of users leveraging it in various sectors, including biomedical and life sciences. This raises important legal considerations regarding who bears responsibility and to what extent for any damages caused by these high-performance AI algorithms. A general overview of issues with generative AI includes those discussed above, but another perspective arises from its fundamental nature as a large-scale language model ('LLM') AI. There is a civil law concern regarding "the memorization of training data within artificial neural networks and its subsequent reproduction". Medical data, by nature, often reflects personal characteristics of patients, potentially leading to issues such as the regeneration of personal information. The extensive application of generative AI in scenarios beyond traditional AI brings forth the possibility of legal challenges that cannot be ignored. Upon examining the technical characteristics of generative AI and focusing on legal issues, especially concerning the protection of personal information, it's evident that current laws regarding personal information protection, particularly in the context of health and medical data utilization, are inadequate. These laws provide processes for anonymizing and de-identification, specific personal information but fall short when generative AI is applied as software in medical devices. To address the functionalities of generative AI in clinical software, a reevaluation and adjustment of existing laws for the protection of personal information are imperative.
Background: The shortage of dental hygienists as assistant is a great concern to dental clinics, while dental hygienists are rather pursuing the role of oral hygiene control and preventive treatments which is the main role for dental hygienists in the United States. The dental hygienist and dental assistant system in the United States can be a reference in these discussions. Methods: Educational requirements for licensure and work areas for dental hygienists and dental assistants were investigated through the information provided by the American Dental Association (ADA), American Dental Hygienists Association, National Board Dental Hygiene Examination (NBDHE), Dental Assistants Association of America (ADAA), and Dental Assistants National Board (DANB). Results: In the United States, each state has different systems, but in general, dental hygienists obtain licenses after completing 2~3 years of associate degree programs in dental hygiene after obtaining basic learning skills, and mainly perform tasks related to patient screening procedures, oral hygiene management and preventive care. Dental assistants can take the license test after completing a training course of 9~11 months to obtain a dental assistant certification. Additional expanded work typically requires passing state qualification tests, completing a training program, obtaining a degree, or gaining clinical experience for a certain period of time, depending on the state Conclusion: The scope of work of dental hygienists designated by the Medical Engineer Act and the Enforcement Decree in Korea includes both the work of dental hygienists and dental assistants in the United States, and if a dental assistant system like the United States is introduced to address the current shortage of dental assistants, institutional supplementation such as adjustment of the scope of work and expansion of the role of dental hygienists in oral hygiene management and prevention work is needed and in-depth discussion is necessary.
Recently concerns have been raised due to the unbalanced supply of crops: the price of crops has been unstable and at one point the price went up so high that the word Agflation(agriculture+ inflation) was coined. Korea, in particular, is a small-sized country and needs to secure the stable supply of crops by investing in the produce importation at a national level. Investment in foreign produce importation is becoming more important as a measure for sufficient supply of crops, limited supply of domestic crops, weakened farming conditions worldwide, as well as recent changes in the use of crops due to the development of bio-fuels, influence of carbon emission on crops, the price increase in crops, and influx of foreign hot money. However, there are many problems with investing in foreign produce importation: lack of support from the government; lack of farming information and technology; difficulty in securing the capital; no immediate pay-off from the investment and insufficient management. Although foreign produce is originally more price-competitive than domestic produce, it loses its competiveness in the process of importation (due to high tariffs) and poor distribution system, which makes it difficult to sell in Korea. Therefore, investment in foreign produce importation is being questioned for feasibility; to make it possible, foreign produce must maintain the price-competitiveness. Especially, harvest of agricultural products depends on natural and geographical conditions of each country and those products have indigenous properties, so distribution system according to import and export of agricultural products should be treated more carefully than that of other industries. Distribution costs are differentiated into each item and include cost of sorting and wrapping, cost of wrapping materials, cost of domestic transport, cost of international transport and cost of clearing customs for import and export. So transporting and storing agricultural products generates considerable costs compared with other products. Also, due to upgrade of dietary life, needs for stability, taste and visible quality toward food including agricultural products are being raised and wrong way of storage causes decomposition of food and loss of freshness, making the storage more difficult than that in room temperature, so storage and transport in distribution of agricultural products needs specialty. In addition, because lack of specialty in distribution and circulation such as storage and wrapping does not solve limit factors in distance, the distribution and circulation has been limited to a form of import and export within short-distant region. Therefore, need for distribution out-sourcing which can satisfy specialty in managing distribution and circulation and it is needed to establish more effective distribution system. However, existing distribution system of agricultural products is exposed to various problems including problems in distribution channel, making distribution and strategy for distribution and those problems are as follows. First, in case of investment in overseas agricultural industry, stable supply of the products is difficult because areas of production are dispersed widely and influenced by outer factors due to including overseas distribution channels. Also, at the aspect of quality, standardization of products is difficult, distribution system is quite complicated and unreasonable due to long distribution channels according to international trade and financial and institutional support is not enough. Especially, there are quite a lot of ineffective factors including multi level distribution process, dramatic gap between production cost and customer's cost, lack of physical distribution facilities and difficulties in storage and transport due to lack of wrapping containers. Besides, because import and export of agricultural products has been manages under the company's own distribution according to transaction contract between manufacturers and exporting company, efficiency is low due to excessive investment in fixed costs and lack of specialty in dealing with agricultural products causes fall of value of products, showing the limit to lose price-competitiveness. Especially, because lack of specialty in distribution and circulation such as storage and wrapping does not solve limit factors in distance, the distribution and circulation has been limited to a form of import and export within short-distant region. Therefore, need for distribution out-sourcing which can satisfy specialty in managing distribution and circulation and it is needed to establish more effective distribution system. Second, among tangible and intangible services which promote the efficiency of the whole distribution, a function building distribution environment which includes distribution information, system for standard and inspection, distribution finance, system for diversification of risks, education and training, distribution administration and tax system is wanted. In general, such a function building distribution environment is difficult to be changed and supplement innovatively because its effect compared with investment does not appear immediately despite of its necessity. Especially, in case of distribution of agricultural products, as a function of collecting and distributing is performed individually through various channels, the importance of distribution information and standardization is getting more focus due to the problem of repetition of work and lack of specialty. Also, efficient management of distribution is quite difficult due to lack of professionals in distribution, so support to professional education is needed. Third, though effort to keep self-sufficiency ratio of staple food, rice is regarded as important at the government level, level of dependency on overseas of others crops is high. Therefore, plan for stable securing food resources aside from staple food is also necessary. Especially, governmental organizations of agricultural products distribution in Korea are production-centered and have unreasonable structure whose function at the aspect of distribution and consumption is quite insufficient. And development of new distribution channels which can deal with changes in distribution environment and they do not achieve actual results of strategy for distribution due to non-positive strategy for price distribution. That is, it implies the possibility that base for supply will become vulnerable because it does not mediate appropriate interests on total distribution channels such as manufacturers, wholesale dealers and vendors by emphasizing consumer protection excessively in the distribution of agricultural products. Therefore, this study examined fundamental concept and actual situation for our investment to overseas agriculture, drew necessities, considerations, problems, etc. of overseas agricultural investment and suggested improvements at the level of distribution for price competitiveness of agricultural products cultivated in overseas under five aspects; government's indirect support, distribution's modernization and distribution information function's strengthening, government's political support for distribution facility, transportation route, load and unloading works' improvement, price competitiveness' securing, professional manpower's cultivation by education and training, etc. Here are some suggestions for foreign produce importation. First, the government should conduct a survey on the current distribution channels and analyze the situation to establish a measure for long-term development plans. By providing each agricultural area with a guideline for planning appropriate production of crops, the government can help farmers be ready for importation, and prevent them from producing same crops all at the same time. Government can sign an MOU with the foreign government and promote the importation so that the development of agricultural resources can be stable and steady. Second, the government can establish a strategy for an effective distribution system by providing farmers and agriculture-related workers with the distribution information such as price, production, demand, market structure and location, feature of each crop, and etc. In order for such distribution system to become feasible, the government needs to reconstruct the current distribution system, designate a public organization for providing distribution information and set the criteria for level of produce quality, trade units, and package units. Third, the government should provide financial support and a policy to seek an efficient distribution channel for foreign produce to be delivered fresh: the government should expand distribution facilities (for selecting, packaging, storing, and processing) and transportation vehicles while modernizing old facilities. There should be another policy to improve the efficiency of unloading, and to lower the cost of distribution. Fourth, it is necessary to enact a new law covering exceptional cases for importing produce in order to maintain the price competitiveness; currently the high tariffs is keeping the imported produce from being distributed domestically. However, the new adjustment should be made carefully within the WTO regulations since it can create a problem from giving preferential tariffs. The government can also simplify the distribution channels in order to reduce the cost in the distribution process. Fifth, the government should educate distributors to raise the efficiency and to modernize the distribution system. It is necessary to develop human resources by educating people regarding the foreign agricultural environment, the produce quality, management skills, and by introducing some successful cases in advanced countries.
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
This study is to empirically examine the primary dimensions of visual merchandising (VMD) of internet shopping mall, namely store design, merchandise, and merchandising cues, to be a attractive virtual store to the shoppers. The authors reviewed the literature related to the major components of VMD from the perspective of the AIDA model, which has been mainly applied to the offline store settings. The major purposes of the study are as follows; first, tries to derive the variables related with the components of visual merchandising through reviewing the existing literatures, establish the hypotheses, and test it empirically. Second, examines the relationships between the components of VMD and the attitude toward the VMD, however, putting more emphasis on finding out the component structure of the VMD. VMD needs to be examined with the perspective that an online shopping mall is a virtual self-service or clerkless store, which could reduce the number of employees, help the shoppers search, evaluate and purchase for themselves, and to be explored in terms of the in-store persuasion processes of customers. This study reviewed the literatures related to store design, merchandise, and merchandising cues which might be relevant to the store, product, and promotion respectively. VMD is a total communication tool, and AIDA model could explain the in-store consumer behavior of online shopping. Store design has to do with triggering a consumer attention to the online mall, merchandise with a product related interest, and merchandising cues with promotions such as recommendation and links that induce the desire to pruchase. These three steps might be seen as the processes for purchase actions. The theoretical rationale for the relationship between VMD and AIDA could be found in Tyagi(2005) that the three steps of consumer-oriented merchandising are a store, a product assortment, and placement, in Omar(1999) that three types of interior display are a architectural design display, commodity display, and point-of-sales(POS) display, and in Davies and Ward(2005) that the retail store interior image is related to an atmosphere, merchandise, and in-store promotion. Lee et al(2000) suggested as the web merchandising components a merchandising cues, a shopping metaphor which is an assistant tool for search, a store design, a layout(web design), and a product assortment. The store design which includes differentiation, simplicity and navigation is supposed to be related to the attention to the virtual store. Second, the merchandise dimensions comprising product assortments, visual information and product reputation have to do with the interest in the product offerings. Finally, the merchandising cues that refer to merchandiser(MD)'s recommendation of products and providing the hyperlinks to relevant goods for the shopper is concerned with attempt to induce the desire to purchase. The questionnaire survey was carried out to collect the data about the consumers who would shop at internet shopping malls frequently. To select the subject malls, the mall ranking data announced by a mall rating agency was used to differentiate the most popular and least popular five mall each. The subjects was instructed to answer the questions after navigating the designated mall for five minutes. The 300 questionnaire was distributed to the consumers, 166 samples were used in the final analysis. The empirical testing focused on identifying and confirming the dimensionality of VMD and its subdimensions using a structural equation modeling method. The confirmatory factor analysis for the endogeneous and exogeneous variables was carried out in four parts. The second-order factor analysis was done for a store design, a merchandise, and a merchandising cues, and first-order confirmatory factor analysis for the attitude toward the VMD. The model test results shows that the chi-square value of structural equation is 144.39(d.f 49), significant at 0.01 level which means the proposed model was rejected. But, judging from the ratio of chi-square value vs. degree of freedom, the ratio was 2.94 which smaller than an acceptable level of 3.0, RMR is 0.087 which is higher than a generally acceptable level of 0.08. GFI and AGFI is turned out to be 0.90 and 0.84 respectively. Both NFI and NNFI is 0.94, and CFI 0.95. The major test results are as follows; first, the second-order factor analysis and structural equational modeling reveals that the differentiation, simplicity and ease of identifying current status of the transaction are confirmed to be subdimensions of store design and to be a significant predictors of the dependent variable. This result implies that when designing an online shopping mall, it is necessary to differentiate visually from other malls to improve the effectiveness of the communications of store design. That is, the differentiated store design raise the contrast stimulus to sensory organs to promote the memory of the store and to have a favorable attitude toward the VMD of a store. The results that navigation which means the easiness of identifying current status of shopping affects the attitude to VMD could be interpreted that the navigating processes via the hyperlinks which is characteristics of an internet shopping is a complex and cognitive process and shoppers are likely to lack the sense of overall structure of the store. Consequently, shoppers are likely to be alost amid shopping not knowing where to go. The orientation tool enhance the accessibility of information to raise the perceptive power about the store environment.(Titus & Everett 1995) Second, the primary dimension of merchandise and its subdimensions was confirmed to be unidimensional respectively, have a construct validity, and nomological validity which the VMD dimensions supposed to have a positive correlation with the dependent variable. The subdimensions of product assortment, brand fame and information provision proved to have a positive effect on the attitude toward the VMD. It could be interpreted that the more plentiful the product and brand assortment of the mall is, the more likely the shoppers to favor it. Brand fame and information provision as well affect the VMD attitude, which means that the more famous the brand, the more likely the shoppers would trust and feel familiar with the mall, and the plentifully and visually presented information could have the shopper have a favorable attitude toward the store VMD. Third, it turned out to be that merchandising cue of product recommendation and hyperlinks affect the VMD attitude. This could be interpreted that recommended products could reduce the uncertainty related with the purchase decision, and the hyperlinks to relevant products would help the shopper save the cognitive effort exerted into the information search and gathering, which could lead to a favorable attitude to the VMD. This study tried to sheds some new light on the VMD of online store by reviewing the variables mentioned to be relevant with offline VMD in the existing literatures, and tried to link the VMD components from the perspective of AIDA model. The effect size of the VMD dimensions on the attitude was in the order of the merchandise, the store design and the merchandising cues.It is said that an internet has an unlimited place for display, however, the virtual store is not unlimited since the consumer has a limited amount of cognitive ability to process the external information and internal memory. Particularly, the shoppers are likely to face some difficulties in decision making on account of too many alternative and information overloads. Therefore, the internet shopping mall manager should take into consideration the cost of information search on the part of the consumer, to establish the optimal product placements and search routes. An efficient store composition would be possible by reducing the psychological burdens and cognitive efforts exerted to information search and alternatives evaluation. The store image is in most part determined by the product category and its brand it deals in. The results of this study support this proposition that the merchandise is most important to the VMD attitude than other components, the manager is required to take a strategic approach to VMD. The internet users are getting more accustomed and more knowledgeable about the internet media and more likely to accept the internet as a shopping channel as the period of time during which they use the internet to shop become longer. The web merchandiser should be aware that the product introduction using a moving pictures and a bulletin board become more important in order to present the interactive product information visually and communicate with customers more actively, therefore leading to making the quantity and quality of product information more rich.
1. Production and consumption of chemical fertilizers in Korea could be divided into five different phases of total imports, setting up fertilizer plants, self-sufficiency in production, net export, and diversification in compound fertilizers. Currently the nation has production capacity of 800 thousand M/T of nitrogen, 400 thousand M/T of phosphate (
Purpose : Pelvis and lumbar spine radiography, among various types of diagnostic radiography, include gonads of the human body and give patients high radiation dose. Nevertheless, diagnostic reference levels for patient radiation dose in pelvis and lumbar spine radiography has not yet been established in Korea. Therefore, the radiation dose that patients receive from pelvis and lumbar radiography is measured and the diagnostic reference level on patient radiation dose for the optimization of radiation protection of patients in pelvis and lumbar spine radiography was established. Methods : The conditions and diagnostic imaging information acquired during the time of the postero-anterior view of the pelvis and the postero-anterior and lateral view of the lumbar spine at 125 medical institutions throughout Korea are collected for analysis and the entrance surface dose received by patients is measured using a glass dosimeter. The diagnostic reference levels for patient radiation dose in pelvis and lumbar spine radiography to be recommended to the medical institutes is arranged by establishing the dose from the patient radiation dose that corresponds to the 3rd quartile values as the appropriate diagnostic reference level for patient radiation dose. Results : According to the results of the assessment of diagnostic imaging information acquired from pelvis and lumbar spine radiography and the measurement of patient entrance surface dose taken at the 125 medical institutes throughout Korea, the tube voltage ranged between 60~97 kVp, with the average use being 75 kVp, and the tube current ranged between 8~123 mAs, with the average use being 30 mAs. In the posteroanterior and lateral views of lumbar spine radiography, the tube voltage of each view ranged between 65~100 kVp (average use: 78 kVp) and 70~109 kVp (average use: 87 kVp), respectively, and the tube current of each view ranged between 10~100 mAs(average use: 35 mAs) and between 8.9~300 mAs(average use: 64 mAs), respectively. The measurements of entrance surface dose that patients receive during the pelvis and lumbar spine radiography show the following results: in the posteroanterior view of pelvis radiography, the minimum value is 0.59 mGy, the maximum value is 12.69 mGy and the average value is 2.88 mGy with the 1st quartile value being 1.91 mGy, the median being 0.59 mGy, and the 3rd quartile value being 3.43 mGy. Also, in the posteroanterior view of lumbar spine radiography, the minimum value is 0.64 mGy, the maximum value is 23.84 mGy, and the average value is 3.68 mGy with the 1st quartile value being 2.41 mGy, the median being 3.40 mGy, and the 3rd quartile value being 4.08 mGy. In the lateral view of lumbar spine radiography, the minimum value is 1.90 mGy, the maximum value is 45.42 mGy, and the average value is 10.08 mGy with the 1st quartile value being 6.03 mGy, the median being 9.09 mGy and the 3rd quartile value being 12.65 mGy. Conclusions : The diagnostic reference levels for patient radiation dose to be recommended to the medical institutes in Korea is 3.42 mGy for the posteroanterior view of pelvis radiography, 4.08 mGy for the posteroanterior view of lumbar spine radiography, and 12.65 mGy for the lateral view of lumbar spine radiography. Such values are all lower than the values recommended by 6 international organizations including World Health Organization, where the recommended values are 10 mGy for the posteroanterior view of pelvis radiography, 10 mGy for the posteroanterior view of lumbar spine radiography and 30 mGy for the lateral view of lumbar spine radiography.
Today most developed countries provide modern medical care for most of the population. The rural area is the more neglected area in the medical and health field. In public health, the philosophy is that medical care for in maintenance of health is a basic right of man; it should not be discriminated against racial, environmental or financial situations. The deficiency of the medical care system, cultural bias, economic development, and ignorance of the residents about health care brought about the shortage of medical personnel and facilities on the rural areas. Moreover, medical students and physicians have been taught less about rural health care than about urban health care. Medical care, therefore, is insufficient in terms of health care personnel/and facilities in rural areas. Under such a situation, there is growing concern about the health problems among the rural population. The findings presented in this report are useful measures of the major health problems and even more important, as a guide to planning for improved medical care systems. It is hoped that findings from this study will be useful to those responsible for improving the delivery of health service for the rural population. Objectives: -to determine the health status of the residents in the rural areas. -to assess the rural population's needs in terms of health and medical care. -to make recommendations concerning improvement in the delivery of health and medical care for the rural population. Procedures: For the sampling design, the ideal would be to sample according to the proportion of the composition age-groups. As the health problems would be different by group, the sample was divided into 10 different age-groups. If the sample were allocated by proportion of composition of each age group, some age groups would be too small to estimate the health problem. The sample size of each age-group population was 100 people/age-groups. Personal interviews were conducted by specially trained medical students. The interviews dealt at length with current health status, medical care problems, utilization of medical services, medical cost paid for medical care and attitudes toward health. In addition, more information was gained from the public health field, including environmental sanitation, maternal and child health, family planning, tuberculosis control, and dental health. The sample Sample size was one fourth of total population: 1,438 The aged 10-14 years showed the largest number of 254 and the aged under one year was the smallest number of 81. Participation in examination Examination sessions usually were held in the morning every Tuesday, Wenesday, and Thursday for 3 hours at each session at the Namchun Health station. In general, the rate of participation in medical examination was low especially in ages between 10-19 years old. The highest rate of participation among are groups was the under one year age-group by 100 percent. The lowest use rate as low as 3% of those in the age-groups 10-19 years who are attending junior and senior high school in Taegu city so the time was not convenient for them to recieve examinations. Among the over 20 years old group, the rate of participation of female was higher than that of males. The results are as follows: A. Publie health problems Population: The number of pre-school age group who required child health was 724, among them infants numbered 96. Number of eligible women aged 15-44 years was 1,279, and women with husband who need maternal health numbered 700. The age-group of 65 years or older was 201 needed more health care and 65 of them had disabilities. (Table 2). Environmental sanitation: Seventy-nine percent of the residents relied upon well water as a primary source of dringking water. Ninety-three percent of the drinking water supply was rated as unfited quality for drinking. More than 90% of latrines were unhygienic, in structure design and sanitation (Table 15). Maternal and child health: Maternal health Average number of pregnancies of eligible women was 4 times. There was almost no pre- and post-natal care. Pregnancy wastage Still births was 33 per 1,000 live births. Spontaneous abortion was 156 per 1,000 live births. Induced abortion was 137 per 1,000 live births. Delivery condition More than 90 percent of deliveries were conducted at home. Attendants at last delivery were laymen by 76% and delivery without attendants was 14%. The rate of non-sterilized scissors as an instrument used to cut the umbilical cord was as high as 54% and of sickles was 14%. The rate of difficult delivery counted for 3%. Maternal death rate estimates about 35 per 10,000 live births. Child health Consultation rate for child health was almost non existant. In general, vaccination rate of children was low; vaccination rates for children aged 0-5 years with BCG and small pox were 34 and 28 percent respectively. The rate of vaccination with DPT and Polio were 23 and 25% respectively but the rate of the complete three injections were as low as 5 and 3% respectively. The number of dead children was 280 per 1,000 living children. Infants death rate was 45 per 1,000 live births (Table 16), Family planning: Approval rate of married women for family planning was as high as 86%. The rate of experiences of contraception in the past was 51%. The current rate of contraception was 37%. Willingness to use contraception in the future was as high as 86% (Table 17). Tuberculosis control: Number of registration patients at the health center currently was 25. The number indicates one eighth of estimate number of tuberculosis in the area. Number of discharged cases in the past accounted for 79 which showed 50% of active cases when discharged time. Rate of complete treatment among reasons of discharge in the past as low as 28%. There needs to be a follow up observation of the discharged cases (Table 18). Dental problems: More than 50% of the total population have at least one or more dental problems. (Table 19) B. Medical care problems Incidence rate: 1. In one month Incidence rate of medical care problems during one month was 19.6 percent. Among these health problems which required rest at home were 11.8 percent. The estimated number of patients in the total population is 1,206. The health problems reported most frequently in interviews during one month are: GI trouble, respiratory disease, neuralgia, skin disease, and communicable disease-in that order, The rate of health problems by age groups was highest in the 1-4 age group and in the 60 years or over age group, the lowest rate was the 10-14 year age group. In general, 0-29 year age group except the 1-4 year age group was low incidence rate. After 30 years old the rate of health problems increases gradually with aging. Eighty-three percent of health problems that occured during one month were solved by primary medical care procedures. Seventeen percent of health problems needed secondary care. Days rested at home because of illness during one month were 0.7 days per interviewee and 8days per patient and it accounts for 2,161 days for the total productive population in the area. (Table 20) 2. In a year The incidence rate of medical care problems during a year was 74.8%, among them health problems which required rest at home was 37 percent. Estimated number of patients in the total population during a year was 4,600. The health problems that occured most frequently among the interviewees during a year were: Cold (30%), GI trouble (18), respiratory disease (11), anemia (10), diarrhea (10), neuralgia (10), parasite disease (9), ENT (7), skin (7), headache (7), trauma (4), communicable disease (3), and circulatory disease (3) -in that order. The rate of health problems by age groups was highest in the infants group, thereafter the rate decreased gradually until the age 15-19 year age group which showed the lowest, and then the rate increased gradually with aging. Eighty-seven percent of health problems during a year were solved by primary medical care. Thirteen percent of them needed secondary medical care procedures. Days rested at home because of illness during a year were 16 days per interviewee and 44 days per patient and it accounted for 57,335 days lost among productive age group in the area (Table 21). Among those given medical examination, the conditions observed most frequently were respiratory disease, GI trouble, parasite disease, neuralgia, skin disease, trauma, tuberculosis, anemia, chronic obstructive lung disease, eye disorders-in that order (Table 22). The main health problems required secondary medical care are as fellows: (previous page). Utilization of medical care (treatment) The rate of treatment by various medical facilities for all health problems during one month was 73 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 52% while the rate of those who have health problems which did not required rest was 61 percent (Table 23). The rate of receiving of medical care for all health problems during a year was 67 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 82 percent while the rate of those who have health problems which did not required rest was as low as 53 percent (Table 24). Types of medical facilitied used were as follows: Hospital and clinics: 32-35% Herb clinics: 9-10% Drugstore: 53-58% Hospitalization Rate of hospitalization was 1.7% and the estimate number of hospitalizations among the total population during a year will be 107 persons (Table 25). Medical cost: Average medical cost per person during one month and a year were 171 and 2,800 won respectively. Average medical cost per patient during one month and a year were 1,109 and 3,740 won respectively. Average cost per household during a year was 15,800 won (Table 26, 27). Solution measures for health and medical care problems in rural area: A. Health problems which could be solved by paramedical workers such as nurses, midwives and aid nurses etc. are as follows: 1. Improvement of environmental sanitation 2. MCH except medical care problems 3. Family planning except surgical intervention 4. Tuberculosis control except diagnosis and prescription 5. Dental care except operational intervention 6. Health education for residents for improvement of utilization of medical facilities and early diagnosis etc. B. Medical care problems 1. Eighty-five percent of health problems could be solved by primary care procedures by general practitioners. 2. Fifteen percent of health problems need secondary medical procedures by a specialist. C. Medical cost Concidering the economic situation in rural area the amount of 2,062 won per residents during a year will be burdensome, so financial assistance is needed gorvernment to solve health and medical care problems for rural people.