• Title/Summary/Keyword: food hygiene

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Anti-Oxidative Effects of Cymbopoton Citratus Ethanol Extract through the Induction of HO-1 Expression in RAW 264.7 Cells (RAW264.7 세포에서 Cymbopogon Citratus 에탄올 추출물의 HO-1 유도를 통한 항산화 효과)

  • Chung-Mu Park;Hyun-Seo Yoon
    • Journal of The Korean Society of Integrative Medicine
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    • v.11 no.4
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    • pp.73-82
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    • 2023
  • Purpose : Cymbopogon citratus, also known as lemongrass, has widely spread around the world and its essential oil is usually applied in food, perfume, and other industrial purposes. In addition, C. citratus has also been used for the treatment of inflammation, digestive disorders, and diabetes in traditional medicine. In this study, the antioxidative activity of C. citratus ethanol extract (CCEE) was analyzed in RAW 264.7 cells through the induction of one of phase II enzymes, heme oxygenase (HO)-1 by nuclear factor-erythroid 2 p45-related factor (Nrf)2, mitogen-activated protein kinase (MAPK), and phosphoinositide 3-kinase (PI3K)/Akt. Methods : The antioxidative activity of CCEE against oxidative stress and its underlying molecular mechanisms were analyzed by the cell viability assay, intracellular reactive oxygen species (ROS) formation assay, and Western blot analysis in RAW 264.7 cells. Results : The results exhibited that CCEE potently attenuated tert-butyl hydroperoxide (t-BHP) induced intracellular ROS levels in a dose-dependent manner without any cytotoxicity. CCEE treatment significantly induced the expression of HO-1 which is known for its antioxidative capacity. In addition, CCEE treatment significantly upregulated the expression of Nrf2, a corresponding transcription factor for the regulation of antioxidative enzymes, which was in accordance with the HO-1 overexpression. MAPK and PI3K/Akt were also evaluated for their important roles in the regulation of cellular redox homeostasis against oxidative damage. As a result, the potent HO-1 expression was mediated by not extracellular regulated kinase (ERK), c-Jun NH2 terminal kinase (JNK), p38, but phosphoinositide 3-kinase (PI3K) phosphorylation. To confirm the antioxidative activity of CCEE-induced HO-1 expression, oxidative damage was initiated by t-BHP and attenuated by CCEE treatment, which was identified by HO-1 selective inhibitor and inducer. Conclusion : Consequently, CCEE potently induced the HO-1-mediated antioxidative potential through the modulation of Nrf2 and PI3K/Akt signaling pathways in RAW 264.7 cells. These results suggest that CCEE could be a promising strategy for the mitigation against cellular oxidative damage.

A Study on the Perception of Medical Radiation Exposure and Irradiated Foods among College Students in Nursing and Health-related and Health-unrelated Majors (간호보건계열과 비보건계열 대학생들의 의료용 방사선피폭과 방사선조사식품의 인식에 관한 연구)

  • Young-Nam PARK;Jae-Ki RYU
    • Korean Journal of Clinical Laboratory Science
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    • v.56 no.3
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    • pp.265-272
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    • 2024
  • This study aimed to investigate the knowledge and awareness of medical radiation and irradiated foods among nursing college students and those pursuing health-related and health-unrelated majors and to provide basic data for developing and promoting appropriate educational programs on the use of radiation. The knowledge of medical radiation was the highest among those over 30 years of age (3.0 points), and members of the Department of Clinical Laboratory Science (3.0 points). The awareness of the risk of medical radiation was the highest among female (3.34 points), among members of the Department of Nursing and Health Science (3.40 points), and among third-year students (3.41 points). The awareness of the benefits of medical radiation was the highest in male (3.90 points). The awareness of irradiated foods and its safety was low in all departments. The need for education regarding irradiated foods and the willingness to provide information on such foods were high. In conclusion, it is thought that specific promotional activities and educational programs are needed to improve the accuracy of knowledge regarding medical radiation among college students and increase their awareness on the safety of irradiated foods.

Research about influence on the teeth health by the smoking - research intended for students of dental technology in Daegu - (흡연이 치아건강에 미치는 영향에 관한 연구 - 대구지역 치기공과 학생을 중심으로 -)

  • Kim, Jeong-Sook;Jung, Hyo-Kyung;Lee, Jong-Do
    • Journal of Technologic Dentistry
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    • v.31 no.3
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    • pp.35-45
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    • 2009
  • This survey study was conducted on dental technician school students in April 2008 to investigate the effects of smoking on oral health. 110 male and 39 female students were surveyed and cross analysis was performed to examine the relationship between oral health status and smoking-related and oral health maintenance characteristics of smoking and non-smoking group. T-test and one-way ANAVA was used to analyze the average difference verification of two independent samples(smoking group and non-smoking group) and followings are the results. In general characteristics, 74 male students(74.7%) and 25 female(25.3%) students smoked and the percentage of male students were higher in smoking group. Regarding class grade, 2nd-year students(37 students, 37.4%) and 1st-year students(18 students, 36.0%) took the highest percentage of smoking and non-smoking group, respectively. Concerning the experience of drinking, smoking group consumed more alcoholic beverages(94 students, 94.9%) With respect to the frequency of between-meal consumption, respondents who eat between-meal once or twice smoked more. Respecting preferences of sweet food, respondents who enjoyed sweet food smoked more. Concerning smoking characteristics, many of smoking group had been smoked fo a long time(two to five years) and it was worrisome. About the amounts of smoking, 50 respondents(52.6%) of smoking group smoked 20 cigarettes a day with the highest proportion. With regard to the awareness of harmfulness, 70 respondents(70.7%) considered smoking as very harmful and showed that smoking group were aware of its harmfulness but it was habitualized. Respecting smokers in family members, father was more common as smokers(58 respondents, 58.6%) in family and showed that the influence of father. Main reasons of poor periodontal health were alchoholic consumption, smoking, and oral parafunctional habit(57 respondents, 56.7%) in smoking group and neglect of oral hygiene(21 respondents, 42.0%) in non-smoking group. With regard to the scaling, 80 respondents of smoking group(80.8%) didn't received scaling and showed that more oral health education was required. Regarding the periodontal status, non-smoking group was $1.26{\pm}0.44$, respondents who received scaling was $1.43{\pm}0.50$, respondents who regularly floss was $1.50{\pm}0.52$, respondents who brush more than three times a day was $1.38{\pm}0.49$ and had better periodontal health. Bleeding during tooth brushing was more frequent in smoking group ($1.51{\pm}0.70$). Regarding mouth order, non-smoking group was $2.34{\pm}0.62$, after scaling was $2.02{\pm}0.76$, patients who regularly floss was $1.50{\pm}0.52$, patients who brush more than three times a day was $1.81{\pm}0.87$. Concerning the experience of dental caries treatment, smoking group was $1.20{\pm}0.40$, patients who do not floss was $1.30{\pm}0.46$, patients who brush once a day was $1.29{\pm}0.45$. With regard to dental prosthesis, non-smoking group was $3.78{\pm}1.62$, patients who received scaling was $1.43{\pm}0.50$, patients who regularly floss was $1.40{\pm}0.51$, patients who brush more than three times a day was $1.24{\pm}0.43$. From these results, oral health education and smoking has correlation and more oral health education needs to be carried out to educate students with non-health related majors about harmfulness of smoking on oral health. Also more study are required.

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Effect of Pre-preparation with Vinegar against Microorganisms on Vegetables in Foodservice Operations (단체급식에서 채소류 전처리를 위한 식초 소독의 미생물적 효과)

  • 김소희;정수열
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.32 no.2
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    • pp.230-237
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    • 2003
  • For hygenic evaluation, microbiological tests of seasoned raw vegetal)les from five high school foodservice operations were conducted. The antimicrobiological effect of pre-preparation with vinegar against microorganisms on vegetables in foodservice operations was also investigated. Total plate counts of leek gukgalli, broad bellflower saengchae and vegetable salad ranged from 10$^4$ CFU/g to 10$^{6}$ CFU/g. Coliform levels of those ranged from 10$^2$CFU/g to 10$^4$ CFU/g. Leek washed three times was pre-prepared at different concentration (0.05%,0.1%,0.5%,1% and 2%) and temperature ( 1$0^{\circ}C$ 2$0^{\circ}C$ and 4$0^{\circ}C$) for 5, 10 and 30 minutes. The higher the concentration and temperature of vinegar were, the more the antimicrobiological activity increased. The sanitizing activity of vinegar increased with treatment time. Considering the quality of vegetable and the expense, when the levels of total plate counts and coliform of vegetable were 10$^{6}$ and 10$^3$ CFU/g, pre-preparation with 0.5% of vinegar at 2$0^{\circ}C$ for 10 minutes was best. The population of total plate count and coliform on row and leek washed three times increased during storage for 72 hours. However, The levels of microorganism on leek samples pre-prepared with 0.5% and 1% vinegar decreased during storage. After the treatment of vinegar at 1$0^{\circ}C$ for 10 minutes, Staphylocucus aureus, Escherichia coli O157, Shigella sonnei, Salmonella entritidis, Listeria monolytogenes were not detected.

Dietitians′ Perception on Usage of Cook/chill Vegetables in Institution Foodservice (단체급식 소에서의 냉장조리 채소의 이용에 대한 영양사의 인식조사)

  • 류은순;이동선
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.30 no.6
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    • pp.1293-1300
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    • 2001
  • We surveyed dietitians'perception on usage of cook/chill vegetables, The questionnaires were distributed to 245 dietitians working in elementary schools and other institutions in Busan area. According to the survey, 75.9% of the dietitians perceived that minimally processed ready -to-use vegetal)toes would be helpful for the institutional foodservice They answered that problems of vegetable usage in the foodservice mainly come from long preparation time (45.4%), a large quantity of leftover (13.1%), and a high ratio of disuse (16.0%). Degree of preparedness from raw vegetables was highest for garlic, and was in tile order of platicodcm, onions, carrots, Potatoes, Korean cabbage and radish.40.9% of the dietitians answered that it was necessary Ic develop cook/chill vegetables in their institute restaurants. The high career group ( >6 yrs.) was, however, significantly (p<0.05) negative against the use of cooHchill vegetables. The dietitians were expecting that developing cook/chill vegetables would save cooking time and processes (4.43/5.00), and reduce waste (4.53/5.00) greatly. They also estimated that focal hygiene and quality would be improved, and labor cast be reduced moderately. On the other hand, they thought that the cost of flood would not be reduced.

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Hazard Analysis for the Cultivation Stage of Strawberry Farms for Securing Preliminary Data to Establish the Good Agricultural Practices (농산물우수관리제도 확립의 기초자료 확보를 위한 딸기농장 재배단계의 위해요소 분석)

  • Lee, Chi-Yeop;Lee, Won-Gyeong;Song, Jeong-Eon;Kim, Kyeong-Yeol;Shim, Won-Bo;Yoon, Yo-Han;Kim, Yun-Shik;Chung, Duck-Hwa
    • Journal of agriculture & life science
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    • v.46 no.3
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    • pp.97-108
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    • 2012
  • Physical, chemical and biological hazards of strawberry farms at the cultivation stage were analyzed to establish the GAP(Good Agricultural Practice) system. Samples were collected from the plants, cultivation environments(water, soil and air), and personal hygiene (hand, glove, and clothes) of three strawberry farms(A, B, and C) and were tested to analyze physical, chemical (heavy metals and pesticide residues), and biological(sanitary indications and foodborne pathogens) hazards. Physical hazards such as insects and pieces of metal and glass were found in the strawberry farms and can be potential bow for strawberry products. Heavy metal and pesticide residue as chemical hazards were detected at levels lower than the regulation limit. In case of biological hazards, total bacteria and coliform were detected at the levels of 1.6~7.3 and 1.3~5.6 log CFU/g, leaf, mL, hand or $100cm^2$. However, Escherichia coli was not detected in all samples. Bacillus cereus and Staphylococuus aureus were detected at levels of ${\leq}$ 1.1~6.1 log CFU and 4.7~5.4 log CFU/g, mL, hand or $100cm^2$, whereas Listeria monocytogenes, E. coli O157 and Salmonella spp. were not detected in all samples. This study demonstrates that various harzards were in strawberry farms at the growing stage. Therefore proper management such as GAP is needed to prevent the occurrence of food poisoning associated with the hazards revealed in this study.

A Study on the Present Condition and Reform Plan of School Health in a Rural Area (한 농촌지역 학교보건의 현황과 개선방안에 관한 연구)

  • Shin, Young-Jeon;Noh, Hak-Jae;Choi, Boyul;Park, Hung-Bae;Kim, Hyun-Joo
    • Journal of the Korean Society of School Health
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    • v.9 no.1
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    • pp.55-67
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    • 1996
  • This research has incorporated a postal survey from the principals, nurse-charging teachers and nurse-teachers of the fiftyfive elementary, middle and high school in Yang-pyeong county area where its supplementary rate of nurse-teachers is less than adequate. It is to analyse the current status of the school health service in the area and to come out with a plan to improve the school health program through the participations of the health related experts of the local community. The survey was done in the two months of period of April to May of 1994. The result of the survey follows. The student population in the Yang-pyeong county area is 13,998 and the school employee population is 904 which counts for about 19.2% of the whole population of the area. However, the supplementary rate of nurse-teachers is only 10.8% (4 in 55 schools) which is very low in terms of relativity. School health committee only exist in 17% of the whole number of schools in the area and 50 of school health committee answered that their activity do not meet the adequate level. Only 54. 3% of the whole school numbers has included the school health finance in their financial plans and the amount set for the school health finance is about 500,000 wons (100,000-1,600,000 wons). 64.9% of the schools in the Yang-pyeong county area have the permanent nursing room established in the school. But, often than the equipment for a simple physical examinations, their supply of the health related equipments are less than adequate. Particitations of school doctor in the school health service is at only 67.6% which pretty much include only the physical examinations. Nurse-charging teachers consider their utmost important role is to teach health education but, they answered that they spent most of their times and efforts on physical examinations & immunizations. The average number of students visition to the nursing room is 2.5 persons and complains for basic discomfort as headache, concussion, stomachache and indigestion problems and usual pills used are the analgesics and digestives. Physical examination is done in the most schools every year but, 51.4% of nurse-charging teachers answered the physical examination does not really help. About the emergency treatment ability, 75.7% reports that both manpower & equipment are short. The school food services are present in only 8 schools (21.6%) but, 89.2% of nurse-charging teachers answer that there is a definite need of the food service. The survey says that the utmost important environmental health and safety factors are the traffic accidents followed by improper heat system, lighting, the stools and desks that do not consider the student physical status The overall evaluation of school health program reports that there are adequate physical examination, immunization, environmental hygiene, and management of safety but, on the other hand, health education, health councelling & management of nursing room are not managed properly. The principals of the survey pool report shortage of public agency support, lack of understanding of school health, shortage of nursing equipments and school health finance as the barrier factors of school health. The nurse-charging teachers report on the same questions as their less than qualitifying expertise, extraload of work upon the nursing affairs, shortage of nursing equipments & school health finance. The head masters & nurse-charging teachers answered that they are desperate for the meetings of nurse-charging teachers, construction of school health councelling system & training education in order to improve school health and if these are available, they will actively participate in them. After the careful analysis of the survey result, it is apparent that through the relations of the manpowers, establishment of community-oriented school health is definitely in need in rural area where there is low supplementary rate of nurse-teachers and poor school health environment.

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Cohort Observation of Blood Lead Concentration of Storage Battery Workers (축전지공장 근로자들의 혈중 연농도에 대한 코호트 관찰)

  • Kim, Chang-Yoon;Kim, Jung-Man;Han, Gu-Wung;Park, Jung-Han
    • Journal of Preventive Medicine and Public Health
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    • v.23 no.3 s.31
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    • pp.324-337
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    • 1990
  • To assess the effectiveness of the interventions in working environment and personal hygiene for the occupational exposure to the lead, 156 workers (116 exposed subjects and 40 controls) of a newly established battery factory were examined for their blood lead concentration (Pb-B) in every 3 months up to 18 months. Air lead concentration (Pb-A) of the workplaces was also checked for 3 times in 6 months interval from August 1987. Environmental intervention included the local exhaust ventilation and vacuum cleaning of the floor. Intervention of the personal hygiene included the daily change of clothes, compulsory shower after work and hand washing before meal, prohibition of cigarette smoking and food consumption at the work site and wearing mask. Mean Pb-B of the controls was $21.97{\pm}3.36{\mu}g/dl$ at the preemployment examination and slightly increased to $22.75{\pm}3.38{\mu}g/dl$ after 6 months. Mean Pb-B of the workers who were employed before the factory was in operation (Group A) was $20.49{\pm}3.84{\mu}g/dl$ on employment and it was increased to $23.90{\pm}5.30{\mu}g/dl$ after 3 months (p<0.01). Pb-B was increased to $28.84{\pm}5.76{\mu}g/dl$ 6 months after the employment which was 1 month after the initiation of intervention program. It did not increase thereafter and ranged between $26.83{\mu}g/dl\;and\;28.28{\mu}g/dl$ in the subsequent 4 tests. Mean Pb-B of the workers who were employed after the factory had been in operation but before the intervention program was initiated (Group B) was $16.58{\pm}4/53{\mu}g/dl$ before the exposure and it was increased to $28.82{\pm}5.66{\mu}g/dl$(P<0.01) in 3 months later (1 month after the intervention). The values of subsequent 4 tests remained between 26.46 and $28.54{\mu}g/dl$. Mean Pb-B of the workers who were employed after intervention program had been started (Group C) was $19.45{\pm}3.44{\mu}g/dl$ at the preemployment examination and gradually increased to $22.70{\pm}4.55{\mu}g/dl$ after 3 months(P<0.01), $23.68{\pm}4.18{\mu}g/dl$ after 6 months, and $24.42{\pm}3.60{\mu}g/dl$ after 9 months. Work stations were classified into 4 parts according to Pb-A. The Pb-A of part I, the highest areas, were $0.365mg/m^3$, and after the intervention the levels were decreased to $0.216mg/m^3\;and\;0.208mg/m^3$ in follow-up tests. The Pb-A of part II was decreased from $0.232mg/m^3\;to\;0.148mg/m^3,\;and\;0.120mg/m^3$ after the intervention. Pb-A of part III and W was tested only after intervention and the Pb-A of part III were $0.124mg/m^3$ in Jannuary 1988 and $0.081mg/m^3$ in August 1988. The Pb-A of part IV not stationed at one place but moving around, was $0.110mg/m^3$ in August 1988. There was no consistent relationship between Pb-B and Pb-A. Pb-B of the group A and B workers in the part of the highest Pb-A were lower than those of the workers in the parts of lower Pb-A. Pb-B of the workers in the part of the lowest Pb-A incerased more rapidly. Pb-B of group C workers was the highest in part I and the lowest in part IV. These findings suggest that Pb-B is more valid method than Pb-A for monitoring the health of lead workers and intervention in personal hygiene is more effective than environmental intervention.

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A cohort study on blood zinc protoporphyrin concentration of workers in storage battery factory (축전지 공장 근로자들의 혈중 Zinc Protoporphyrin에 대한 코호트 연구)

  • Jeon, Man-Joong;Lee, Joong-Jeong;SaKong, Joon;Kim, Chang-Yoon;Kim, Jung-Man;Chung, Jong-Hak
    • Journal of Preventive Medicine and Public Health
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    • v.31 no.1 s.60
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    • pp.112-126
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    • 1998
  • To investigate the effectiveness of the interventions in working environment and personal hygiene for the occupational exposure to the lead, the blood zinc protoporphyrin (ZPP) concentrations of 131 workers (100 exposed subjects and 31 controls) of a newly established battery factory were analyzed. They were measured in every 3 months up to 18 months. Ai. lead concentration (Pb-A) of the workplaces was also checked for 3 times in 6 months interval from August 1987. Environmental intervention included the local exhaust ventilation and vacuum cleaning of the floor. Intervention of the personal hygiene included the daily change of clothes, compulsory shower after work and hand washing before meal, prohibition of cigarette smoking and food consumption at the work site and wearing mask. Mean blood ZPP concentration of the controls was $16.45{\pm}4.83{\mu}g/d\ell$ at the preemployment examination and slightly increased to $17.77{\pm}5.59{\mu}g/d\ell$ after 6 months. Mean blood ZPP concentration of the exposed subjects who were employed before the factory was in operation (Group A) was $17.36{\pm}5.20{\mu}g/d\ell$ on employment and it was increased to $23.00{\pm}13.06{\mu}g/d\ell$ after 3 months. The blood ZPP concentration was increased to $27.25{\pm}6.40{\mu}g/d\ell$ on 6 months (p<0.01) after the employment which was 1 month after the initiation of intervention program. It did not increase thereafter and ranged between $25.48{\mu}g/d\ell$ and $26.61{\mu}g/d\ell$ in the subsequent 4 results. Mean blood ZPP concentration of the exposed subjects who were employed after the factory had been in operation but before the intervention program was initiated (Group B) was $14.34{\pm}6.10{\mu}g/d\ell$ on employment and it was increased to $28.97{\pm}7.14{\mu}g/d\ell$ (p<0.01) in 3 months later(1 month after the intervention). The values of subsequent 4 tests were maintained between $26.96{\mu}g/d\ell$and $27.96{\mu}g/d\ell$. Mean blood ZPP concentration of the exposed subjects who were employed after intervention program had been started (Group C) was$21.34{\pm}5.25{\mu}g/d\ell$ on employment and it was gradually increased to $23.37{\pm}3.86{\mu}g/d\ell$ (p<0.01) after 3 months, $23.93{\pm}3.64{\mu}g/d\ell$ after 6 months, $25.50{\pm}3.01{\mu}g/d\ell$ after 9 months, and $25.50{\pm}3.10{\mu}g/d\ell$ after 12 months. Workplaces were classified into 4 parts according to Pb-A. The Pb-A of part I, the highest areas, were $0.365mg/m^3$, and after the intervention the levels were decreased to $0.216mg/m^3$ and$0.208mg/m^3$ in follow-up test. The Pb-A of part II which was resulted in lowe. value than part I was decreased from $0.232mg/m^3$ to $0.148mg/m^3$, and $0.120mg/m^3$ after the intervention. The Pb-A of part III was tested after the intervention and resulted in $0.124mg/m^3$ in January 1988 and $0.181mg/m^3$ in August 1988. The Pb-A of part IV was also tested after the intervention and resulted in $0.110mg/m^3$ in August 1988. There was no consistent relationship between Pb-A and blood ZPP concentration. The blood ZPP concentration of the group A and B workers in the part of the highest Pb-A were lower than those of the workers in the parts of lower Pb-A. The blood ZPP concentration of the workers in the part of the lowest Pb-A increased more rapidly. The blood ZPP concentration of the group C workers was the highest in part III. These findings suggest that the intervention in personal hygiene is more effective than environmental intervention, and it should be carried out from the first day of employment and to both the exposed subjects, blue color workers and the controls, white color workers.

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Job importance, job performance, and job satisfaction in dietitians at geriatric hospitals or elderly healthcare facilities in Jeju (제주지역 요양 (병)원 영양사의 직무중요도, 직무수행도 및 직무만족도 분석)

  • Kang, Hye-Sook;Lee, Yunkyoung;Chae, In-Sook
    • Journal of Nutrition and Health
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    • v.49 no.3
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    • pp.189-200
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    • 2016
  • Purpose: This study analyzed job importance, job performance, and job satisfaction in 38 dietitians working at geriatric hospitals and elderly healthcare facilities in Jeju surveyed from September 15-24, 2014 with the aim of providing basic data for improving the quality of meals and nutrition management for elderly patients. Methods: Data were analyzed using descriptive analysis, ${\chi}^2$-test, t-test, ANOVA, and Pearson's correlation coefficients using the SPSS Win program (version 12.0). Results: Regarding job importance, the average score was 4.29 (out of 5), indicating that hygiene and safety management scored the highest at 4.77 (out of 5), and nutrition management scored the lowest at3.86. In terms of job performance of subjects, the average score was 2.87 (out of 5), indicating that cooking operation management scored the highest at 4.42 (out of 5). Regarding the Importance-Performance Analysis (IPA) of job importance and job performance, hygiene and safety management and cooking operation management scored high for importance and performance (B quadrant) menu management, human resource management, and nutrition management scored low for importance and performance (C quadrant) and purchasing management and financial management were included inD quadrant and A quadrant, respectively. For the level of job satisfaction of subjects, the average score was 3.37 (out of 5), indicating that relationships with colleagues scored the highest at 3.72, and improving professionalism scored the lowest at 2.95. Additionally, job importance and performance of subjects were positively correlated withjob satisfaction (r = 0.395, r = 0.386, both p < 0.05). Conclusion: In conclusion, scores for job importance and job performance of nutrition management were low, and job satisfaction of improving professionalism scored low. Therefore, continuous training and education programs of nutrition management should be provided to improve professionalism of dietitians at geriatric hospitals and elderly healthcare facilities.