• 제목/요약/키워드: less developed countries

검색결과 230건 처리시간 0.034초

다제 내성 폐결핵 환자의 임상상 및 치료에 대한 고찰 (Clinical Features and Management of Multidrug-Resistant Tuberculosis)

  • 이재철;이승준;김계수;유철규;정희순;김영환;한성구;심영수
    • Tuberculosis and Respiratory Diseases
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    • 제43권1호
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    • pp.14-21
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    • 1996
  • 연구배경: 다제 내성 폐결핵 환자의 임상적 특성과 약제별 내성률, 치료에 영향을 미치는 인자, 이차 약제로 인한부작용, 치료내용 및 차료성적 등을 살펴 보고자 하였다. 대상: 약제 감수성 검사상 두가지 이상의 일차 약제에 동시 내성을 보이는 환자를 대상으로 후향성 연구를 시행하였다. 치료 결과의 판정은 정기적으로 6개월 이상 추적 관찰이 가능했던 환자만을 대상으로 치료후 호전을 1개월 이상의 간격으로 시행한 가래 검사상 3회 이상 음성이고 방사선 소견이 호전되거나 6개월 이상 변화가 없는 경우로, 치료 실패를 6개월간의 치료에도 균 음전화가 되지 않거나 방사선 소견상 악화를 보이는 경우로 정의하였다. 대상 환자들은 감수성 검사 결과에 따라 감수성 약제를 4제 이상 투여하여 치료받았다. 결과: 1) 총 71예와 환자를 대상으로 조사한 결과 35예(49%)에서 방사선상 공동을 관찰할 수 있었고 평균 4.1개의 약물에 내성을 지니고 있었는데 90%가 INH, RFP 동시 내성을 보였다. 2) 치료 결과의 판정이 가능하였던 55예중 35예(67%)의 환자가 치료후 호전을 보였으며 치료 실패는 18예(33%)이었다. 일차 내성 환자가 5예이었는데 치료 결과 판정이 가능하였던 4예는 모두 치료에 성공하였다. 3) 약제 부작용은 14예(20%)에서 나타났는데 간기능 악화가 6예로 가장 많았고 어지러움증 5예, 고요산 혈증을 동반한 관절통이 3예, 이명 3예 등의 순이었다. 이들 부작용의 절반 이상이 투약후 3개월 이내에 발생 하였다. 4) 약제 감수성 검사를 반복했을 때 INH, RFP의 경우 100% 가까운 일치율을 보였고 EMB, PZA 80% 정도 나머지 약물은 50% 미만이었다. 5) 5예의 환자가 수출을 받았고 이 중 1예는 항결핵 화학 요법의 보조적 치료로 수술을 했는데 균 음전화에 성공하였다. 결론: 다제 내성 폐결핵 환자에서도 규칙적인 약물 복용과 적절한 처방으로 약 2/3 정도에서 호전이 관찰되어 적극적인 항결핵 화학 요법을 시행해야 할 것으로 생각되지만 치료와 예후 판정에 도움이 되는 인자를 찾지는 못하였다.

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천안지역 소아 백일해 감염의 유병률과 임상적 고찰 (Prevalence and Clinical Characteristics of Pertussis in Children, Cheonan, Korea)

  • 이건송;손재성;정은희;홍기배;이미정;유지숙;장영표;박우성;김재경;임인수;노의정
    • Pediatric Infection and Vaccine
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    • 제16권2호
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    • pp.175-182
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    • 2009
  • 목 적: 최근 10년 동안 여러 나라에서 백일해의 발생률이 증가하고 있으며, 특히 사춘기 및 성인 연령에서 발생률이 증가하고 있음을 보고하였다. 본 연구는 천안 지역에서 백일해의 유병률과 임상양상을 알아보고 우리나라 백일해에 대한 역학 조사에 도움이 되고자 하였다. 방 법: 2008년 3월에서 2009년 9월까지 단국대학교병원 소아청소년과에 호흡기 증상으로 입원치료를 하였거나 외래 진료를 받고 호흡기 감염균 다중 PCR 검사를 시행한 118명의 환아를 대상으로 하였다. 검체는 환아의 비인두액을 무균의 카테터를 이용하여 채취하였고 이를 다중 PCR 검사를 시행하여 B. pertussis 균주의 밴드유무를 판독하고 DNA sequencing을 시행하였다. 결 과: 118명의 환아 중 10명(8%)에서 B. pertussis 양성을 보였고, 2009년 7-9월에 6명이 발생하였다. 10명 중 9명 이 3개월 미만의 영아였으며, 7명은 DTaP 예방접종을 시행하지 않은 환아였다. 진단 전 기침의 평균 기간은 10.9${\pm}$5.2일이였다. 임상양상은 발작적 기침이 10명(100%)에서 있었으며 기침 후 구토증상이 8명(80%), 기침 시 입술 주위 청색증을 보인 환아가 7명(70%) 이였다. 발열은 1명에서만 관찰되었다. 전형적인 기침 양상인 whooping은 4명(40%)에서 관찰되었다. 평균 백혈구 수는 20,068${\pm}{\pm}10,135/mm^3$ (9,280-38,320/$mm^3$) 이었고, 평균 림프구는 67.1${\pm}{\pm}$21.7% (13.3-82.5%)였다. 폐렴, 무기폐, 기종격동의 합병증과 함께 호흡곤란이 있었던 1명의 환아는 치료 중 84,400/$mm^3$의 백혈구 상승이 있었다. DTaP를 접종하지 않은 7명의 환아 중 6명에서 합병증이 발생했으며 백신 접종의 유무와 합병증 발생과는 통계적으로 유의한 연관성이 있었다(P =0.033). 결 론: 중부지역에서 백일해의 발생이 2009년 7-9월에 집중되어 있었다. 향후 소아청소년과 혹은 전국적인 감시체계 등을 통하여 국내에서의 백일해 역학의 변화에 대한 연구가 필요할 것으로 보인다.

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국내 기계등급구조재의 등급구분체계 및 기준설계값 결정방법 연구 (Determination of Grades and Design Strengths of Machine Graded Lumber in Korea)

  • 홍정표;이전제;박문재;여환명;방성준;김철기;오정권
    • Journal of the Korean Wood Science and Technology
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    • 제43권4호
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    • pp.446-455
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    • 2015
  • 국내외 기계등급제재목(구조재 및 층재)의 등급기준 및 설계강도 산출방법을 비교 분석하고 국내 제재산업 실정을 고려한 평균 탄성계수(modulus of elasticity, 이하 MOE) 기준방법 적용을 제안하였다. 먼저 올바른 기계등급제재목 기준 정착을 위해 기계등급구조재와 기계등급층재의 공통점과 차이점을 설명하였다. 최소 고정 MOE 기준 등급을 사용하는 국내 기준은 등급구분에는 편리하나 휨강도(modulus of rupture, 이하 MOR) 예측과 자원이용도 측면에서는 효율성이 낮은 것으로 파악되었다. 해외에서 사용되는 평균 MOE 기준 방법은 초기 컴퓨터 기반 작동을 요구하나 MOR-MOE 직선회귀에 근거한 합리적인 MOR 예측과 품질관리 측면에서 효율성이 높은 것으로 분석되었다. 무엇보다도 현 국내 기계등급구조재 등급체계는 수종별 강도 특성을 반영하지 못하고 있다는 것이 가장 큰 문제점으로 분석되었으며 이러한 결과를 기반으로 MOR-MOE 직선회귀분석에 근거한 기계등급제재목 등급기준 및 기준설계값 산출방법 적용을 제안하였다. 이를 통하여 궁극적으로 부가가치가 높은 국산 기계등급구조재 생산 활성화를 이루고, 기계 등급구조재의 층재 전용 가능에 따른 구조용 집성재 가격경쟁력 제고 효과를 얻을 수 있다고 사료되었다.

배수공 각 작업 단계별 물발자국 영향평가 (Impact Evaluation of Water Footprint on Stages of Drainage Works)

  • 천디;김준수;바타갈래 위누리;김병수
    • 대한토목학회논문집
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    • 제40권2호
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    • pp.225-231
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    • 2020
  • 지구상 물의 총량 중 사람이 사용할 수 있는 담수는 지하수, 빙설 등을 제외하면 0.01 % 이하이기 때문에 물 관리 대응 필요성이 커지고 있다. 주요 국가들은 수자원을 보호하고 효율적으로 활용하기 위해서 자원의 채취단계에서 운영단계에 투입되는 물의 양을 정량적으로 추정할 수 있는 물 발자국 연구를 주로 농업 중심으로 진행하고 있다. 우리나라도 최근 물 부족에 대응하기 위하여 여러 정책을 진행 중에 있으며 건설산업에서도 정책개발은 물론 이를 뒷받침할 수 있는 기초연구의 필요성이 강조되고 있다. 본 연구는 도로의 배수공을 대상으로 공종에 투입되는 자원의 물 소모량을 산정하기 위하여 원료채취단계, 운반단계, 제작단계까지 분석 및 DB를 구축하였다. 물 사용량을 추정방법은 Water Footprint Manual과 환경성적표지 인증안내서에서 제시한 방법을 활용하였으며, 각 공정에 투입된 자재의 물소모계수, 취수원 수역에 따른 물 특성화 인자, 간접수 및 직접수를 고려한 물 발자국을 산정 후 배수공 주요 공법별 원단위 물 사용량을 산정하였다. 물발자국 산정 결과 배수공 자재 중 브라운 아스팔트, 철근, 레미콘이 전체 97 %를 차지하였다. 배수공법별은 암거공, 측구공, 암거날개벽, 철근콘크리트 개거가 전체 92.2 %를 차지하였다. 배수공 전체 단계별 산정된 물 소모량과 물발자국은 원료 채취단계, 운반단계, 제작단계 순으로 나타났다. 본 연구에서 산정된 배수공 전체 자재나 배수공법별의 물발자국은 농업 분야와 건설업 분야 기초 자료로써 활용될 수 있다. 분석의 신뢰도를 높이기 위해서는 추후 국외의 데이터베이스를 더 찾아서 지속적인 검토 및 연구가 필요할 것으로 판단된다.

Detection of Campylobacter jejuni in food and poultry visors using immunomagnetic separation and microtitre hybridization

  • Simard, Ronald-E.
    • 한국어업기술학회:학술대회논문집
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    • 한국어업기술학회 2000년도 춘계수산관련학회 공동학술대회발표요지집
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    • pp.71-73
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    • 2000
  • Campylobacter jejuni is most frequently identified cause of cause of acute diarrhoeal infections in developeed countries, exceeding rates of illness caused by both salmonella and shigilla(Skirrow, 1990 ; Lior 1994). Previous studies on campylobacter jejuni contamination of commercial broiler carcasses in u.s.(Stern, 1992). Most cases of the disease result from indirect transmission of Campylobactor from animals via milk, water and meat. In addition to Campylobactor jejuni. the closely relates species Campylobactor coli and Campylobactor lari have also been implicated as agents of gastroenteritis in humans. Campylobactor coli represented only approximately 3% of the Campylobactor isolates from patients with Campylobactor enteritis(Griffiths and Park, 1990) whereas Campylobactor coli is mainly isolated from pork(Lmmerding et al., 1988). Campylobactor jejuni has also been isolated from cases of bacteremia, appendicitis and, recently, has been associated with Guillai-Barre syndrome(Allos and Blaser, 1994; von Wulffen et al., 1994; Phillips, 1995). Studies in volunteers indicated that the infectious dose for Campylobactor jejuni is low(about 500 organisms)(Robinson, 1981). The methods traditionally used to detect Campylobactor ssp. in food require at least two days of incubation in an enrichment broth followed by plating and two days of incubation on complex culture media containing many antibiotics(Goossens and Butzler, 1992). Finnaly, several biochemical tests must be done to confirm the indentification at the species level. Therfore, sensitive and specific methods for the detection of small numbers of Campylobactor cells in food are needed. Polymerase chain reaction(PCR) assays targeting specific DNA sequences have been developed for the detection of Campylobactor(Giesendorf and Quint, 1995; Hemandex et al., 1995; Winter and Slavidk, 1995). In most cases, a short enrichment step is needed to enhance the sensitivity of the assay prior to detection by PCR as the number of bacteria in the food products is low in comparison with those found in dinical samples, and because the complex composition of food matrices can hinder the PCR and lower its sensitivity. However, these PCR systems are technically demanding to carry out and cumbersome when processing a large number of samples simutaneously. In this paper, an immunomagnetic method to concentrate Campylobactor cells present in food or clinical samples after an enrichment step is described. To detect specifically the thermophilic Campylobactor. a monoclonal antibody was adsorbed on the surface of the magnetic beads which react against a major porin of 45kDa present on the surface of the cells(Huyer et al., 1986). After this partial purification and concentration step, detection of bound cells was achieved using a simple, inexpensive microtitre plate-based hybridization system. We examined two alternative detection systems, one specific for thermophilic Campylobactor based on the detection of 23S rRNA using an immobilized DNA probe. The second system is less specific but more sensitive because of the high copy number of the rRNA present in bacterial cell($10^3-10^4$). By using specific immunomagnetic beads against thermophilic Campylobactor, it was possible to concentrate these cells from a heterogeneous media and obtain highly specific hybridization reactions with good sensitivity. There are several advantages in using microtitre plates instead of filter membranes or other matrices for hybridization techniques. Microtitre plates are much easier to handle than filter membranes during the adsorption, washing, hybridization and detection steps, and their use faciilitates the simultanuous analysis of multiple sample. Here we report on the use of a very simple detection procedure based on a monoclonal anti-RNA-DNA hybrid antibody(Fliss et al., 1999) for detection of the RNA-DNA hybrids formed in the wells.

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The Trend of Cigarette Design and Tobacco Flavor System Development

  • Wu, Jimmy Z.
    • 한국연초학회지
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    • 제24권1호
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    • pp.67-73
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    • 2002
  • In light of addressing consumer health concern, coping with anti-tobacco movement, and promoting new product, tobacco industry is actively pursuing to make a new generation of cigarettes with low tar and nicotine deliveries, and less harmful substances. Low tar and low nicotine cigarettes increases their market shares dramatically world wide, especially in KT&G, multinational tobacco companies, EU countries, even in China regulated by CNTC to set up yearly target to lower tar and nicotine deliveries. On the other hand, to design a new cigarette with reduced harmful substances begins to gain speed. The "modified Hoffmann list" publishes thirty plus substances in tobacco leaf and main smoke stream, which is the prime suspect causing health problems. Various ways and means are developed to reduce such components including new tobacco breeds, new curing method, tobacco leaf treatment before processing, selected filtration system, innovated casing system to reduce free radicals, as well as some non conventional cigarette products. In TSRC held this year, the main topic is related to reduce tobacco specific nitrosamines in tobacco leaf. The new generation of cigarette is in the horizon. It still needs a lot help to produce commercial products with satisfied taste and aroma characters. The flavor industry is not regulated by many governments demanding which ingredients might or might not be for tobacco use. However, most of the cigarette companies self impose a list of ingredients to guide flavor suppliers to design flavors. Unfortunately, the number of ingredients in those lists is getting shorter every year. It is understandable that the health is not the only reason. Some cigarette companies are playing safe to protect the company from potential lawsuit, while others are just copying from their competitors. Moreover, it is obvious that it needs more assistance from casings and flavors to design new generation of cigarettes with missing certain flavor components in tobacco leaf and main smoke stream. These flavor components are either non-existed or at lower level at new form of cured tobacco leaf or filtered in the main smoke stream along with reduced harmful substances. The use of carbon filters and other selected filtration system poses another tough task for flavor system design. Specific flavor components are missing from the smoke analysis data, which brings a notion of "carbon taste" and "dryness" of mouth feel. It is ever more demanded by cigarette industry to flavor suppliers to produce flavors as body enhancer, tobacco notes, salivating agents, harshness reducer, and various of aromatic notes provided they are safe to use. Another trend is that water based flavor or flavor with reduced ethanol as solvent is gaining popularity. It is preferred by some cigarette companies that the flavor is compounded with all natural ingredients or all ingredients should he GMO free. The new generation of cigarettes demands many ways of new thinking process. It is also vital for tobacco industry. It reflects the real needs for the consumers that the cigarette product should be safe to use as well as bearing the taste and aroma characters smokers always enjoyed. An effective tobacco flavor system is definitely a part of the equation. The global trend of tobacco industry is like trends of any other industries lead by consumer needs, benefited with new technology availability, affected by the global economy, and subjected for various rules and regulations. Anti-tobacco organizations and media exceptionally scrutinize cigarette, as a legal commercial product. Cigarette is probably the most studied commercial product for its composition, structure, deliveries, effects, as well as its new developmental trend. Therefore, any new trend of cigarette development would be within these boundaries. This paper is trying to point out what it would be like for tobacco industry in the next few yews and what concerns the tobacco industry. It focuses mostly on the efforts to produce safer cigarettes. It is such a vital task for the tobacco industry and its affiliate industries such as cigarette papers, filters, flavors, and other materials. The facts and knowledge presented in this paper might be well known for the public. Some of the comments and predictions are very much personal opinion for a further discussion.

우리나라의 환경오염 현황과 그 대책 (Environmental Pollution in Korea and Its Control)

  • 윤명조
    • 대한기관식도과학회:학술대회논문집
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    • 대한기관식도과학회 1972년도 춘계종합 학술대회 초록집
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    • pp.5-6
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    • 1972
  • 1960년이래 우리나라 산업은 현저하게 발달하였으며 이에 따르는 부수적인 현상이라고 할 수 있는 교통기관의 발달과 도시인구의 비대도 병행하였다. 그리나 이미 선진국가에서 겪었던 경험과 같이 기계문명의 발달과 함께 자연 환경의 파괴라는 문제에 봉착하게 되었다. 대기오염과 도시소음은 호흡기 질환, 이비인후과 질환, 안질환, 그리고 도시민에 주는 불안감과 피로촉진 적인 요인이 되고 있음은 이미 밝혀졌으며 또한 활발하게 이에 관련되는 연구들이 진행되고 있다. 때문에 인류의 사회복지 향상을 위한 노적의 결과가 우리들의 건강을 위협하는 이율배반적인 현상을 초래하게끔 강요하였다는 모순을 볼 수 있다. 대기오염을 유발시키는 원인은 연료의 연소에 기인되므로 연료사용량의 증가는 대기오염도를 심하게 하여 주는 원인이 된다. 대기 오염물질의 발생원은 연료를 많이 사용하는 곳으로 일반적으로 교통기관, 산업장, 화력발전소 및 난방, 취사 등으로 구분한다. 따라서 연료 사용량과 연소방법을 기초로 하여 연간 대기로 배출하는 오염물질을 추정할 수 있다. 1960년에서 1969년 즉 10년간의 우리나라 연료사용량을 기초로 하여 향후 1980년까지의 대기오염물질의 연간 배출량 추세를 보면 1970년도에 연간 약 80만톤의 오염물질을 전국의 대기속으로 배출하였으며 향후 뚜렷한 대책을 강구치 않는 한 1975년도에는 약 3배로 증가할 것이며 10년 후인 1980년에는 약 6배로 증가된 462만들을 배출할 것으로 추산할 수 있다. 미국의 경우 1968년도의 연간 오염물질 배출량을 보면 2억 1천 4백만 톤을 배출하였으며 1966년도보다 약 70%증가하였다. 그러나 우리나라의 경우를 보면 같은 연도의 증가율은 2.3배로서 3년간의 배출 증가는 미국보다 훨씬 높은 추세를 나타내고 있었다 국토 단위면적(km$^{7}$ )으로 볼 때 우리나라의 1975년도에는 약 24톤을 배출하였으며 미국의 1968년도와 비슷한 배출량이라 할 수 있다. 1975년도에 서울에서 배출되는 오염물질의 양은 연간 36.4만 톤이며 하루에 약 1,000톤을 배출할 것으로 산출된다. 이 사실을 오염원 별로 보면 연간 배출되는 총량의 약 40%는 자동차의 배기에 의하여 오염되고 있으며 산업장은 약 30%를 차지할 것으로 추정된다. 한편 1970년도에 전국에서 배출된 양의 22.8%가 서울에서 집중적으로 배출되었음은 심각한 문제이며 이와 같은 현상을 보존키 위한 대책의 필요성을 암시하여 주고 있다. 서울시에서 배출되고 있는 유해가스 중 자극성이 있는 가스로써 비인후계 질환을 일으키는 유독가스 유황산화물, 질소산화물, 탄화수소는 전 배출량의 절반 이상을 차지하고 있다 특히 유황산화물의 배출원인은 유황분의 농도가 높은 방카C유를 도시에서 많이 사용하고 있기 때문에 라고 생각된다. 실제로 서울시의 대기중에 배출되는 연간 총량의 95%는 벙커 C유라고 지적한 바 있다. 전술한 바와 같이 서울시에서 배출되는 오염물질의 40%는 자동차의 배기에 의하여 오염되고 있으므로 자동차의 문제만 해결한다면 대기오염물질의 40%에 해당되는 연간 배출량인 15만톤(1975년도)은 제거가 가능하며 또한 벙커 C유를 다른 연료로 대치한다면 약 10만톤 유황산화물을 제거할 수 있다 즉 1975년도의 연간 총 배출량 36.4만 톤 중 약 70%에 해당되는 25만톤은 해결할 수 있다는 결론을 얻을 수 있으며 여러 실험결과를 종합하면 최소 약 50%의 배출물을 제거할 소 있는 것으로 믿는다. 도시소음의 발생원은 교통소음, 산업소음, 건설소음 및 일반소음 등으로 구분될 수 있으며 연간 시민들에 의하여 60%가 소음으로 인한 피해에 대한 호소였음을 볼 때 가장 큰 비중을 차지한다고 할 수 있다. 도시소음은 자연의 정숙을 파괴하는 가장 큰 원인이라 할 수 있지만 한편 너무나 큰 비중을 차지하는 공공성을 띄우고 있거나 또는 취재대상이 명확히 구분되지 않는 경우가 많다는 것이 특징이다. 따라서 건설소음은 현재 세계적으로 행정적 규제를 강력히 시행 못하고 있으며 다만 공정에 사용되는 기계류를 기계공학적인 면에서 개선하고 있는 실정이며 교통기관의 경우는 운행노선의 조절(교통량분산) 항로조절, 역사이전 등의 소극적인 방법을 취하고 있으며 일반소음은 경범죄 및 선거법으로 단속하고 있는 실정이다. 도시소음의 가장 큰 비중을 차지하는 소음원은 교통소음이라 할 수 있으며 서울시의 주간도로 주변의 소음도는 평규 75㏈이며 최고 소음도는 85㏈이다. 특히 경적음은 100㏈ 전후로서 도로주변 소음으로서 가장 문제가 된다. 자동차의 운전상태에 따라 소음발생도는 달라서 대형 차량의 경우 발차시의 가장 크며 소형자동차는 속도에 비례하여 크다. 노후차량일수록 소음도는 커서 그 원인은 정비 불량으로 발생되는 차체소음이라 할 수 있다. 따라서 대책면에서 볼 때 정비강화, 교차로와 주차장의 감소 그리고 운행 장애물 제거등에 주력을 두어야 하며 독일의 소음방지 법령중 Hessen 경찰명령(제11조)에 의하면 라인에 경고하는 그의 목적에 자동차 경적을 사용하였을 때에는 200마르크 이상 500마르크 이하의 벌금을 과료하고 있으며 우리나라의 경우는 거의 없다고 할 수 있다. 서울시는 급진적으로 비대하여져 과거 교외에 있던 역이 현재 13개소가 주택지의 가운데 있게 되었으며 기차소음으로 인한 생활환경의 파괴는 크다. 실제로 신촌역의 경우 철로에서 200m 지점에서 소음을 측정한 결과 듸젤기관차에서는 68㏈에서 79㏈였으며 석탄기관차는 68㏈에서 98㏈였다. 공해방지법의 소음평가 방법(NRN)으로 소음분석 및 평가하면 최소 200m 지점에서는 모두 공해방지법에 저촉을 받고 있으며 특히 경적음과 석탄기관차의 주행은 NRN 60을 초과하였으며 이 수치는 ISO의 평가내용에 의하면 주민들의 지역사회 활동에 강력하게 장해를 준다는 결론을 얻을 수 있다. 기차소음의 대책면에서 볼 때 경적을 경종으로 대치하며 또한 주행속도를 조절한다면 많은 도움이 될것으로 추측된다. 일본의 경우 연속철(long rail)의 채용, 탄성체, 결장치의 사용 침목과 철로의 연결지점에 진동흡수재료사용 그리고 필요한 지점에 1~1.5m 높이의 방음벽설치등으로 많은 효과를 얻었다고 한다.

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국유림경영(國有林經營)의 합리화(合理化)에 관(關)한 연구(硏究) (A Study on Rationalization of National Forest Management in Korea)

  • 최규련
    • 한국산림과학회지
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    • 제20권1호
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    • pp.1-44
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    • 1973
  • 국유림경영(國有林經營)은 어느 나라를 막론(莫論)하고 그 사명(使命)과 경영목적(經營目的)으로 봐서 중요시(重要視)되고 있다. 한국(韓國)의 국유림(國有林)도 또한 한국경제(韓國經濟)의 비약적(飛躍的)인 발전(發展)에 따라 목림수요(木林需要)의 계속적(繼續的)인 증가(增加)로 국가적(國家的)인 사명(使命)과 산업경제적(產業經濟的)으로 더욱 중요(重要)한 위치(位置)에 놓이게 되었다. 그러나 지금(只今)까지 한국임정(韓國林政)의 주요목표(主要目標)가 산림자원(山林資源)의 보존(保存)과 국토보전기능(國土保全機能)의 회복(回復)에만 급급(汲汲)한 나머지 임업(林業)의 경제생산성(經濟生產性)을 높이는 산업정책적의의(產業政策的意義)가 적었음을 우리는 부인(否認)할 수 없다. 그리하여 한국(韓國)의 임업(林業)도 한국경제구조중(韓國經濟構造中)의 일환(一環)으로서 산업적(產業的)으로 발전(發展)시킬 필요(必要)에 직면(直面)하게 되어 국유림(國有林)도 합리적(合理的)인 산림시업(山林施業)에 기초(基礎)를 둔 산림생산력(山林生產力)의 증강(增强)이 절실(切實)하게 되었고, 그렇게 하므로써 결과적(結果的)으로 우수(優秀)한 산림(山林)이 조성(造成)되어 자연(自然), 산림(山林)의 국토보전기능(國土保全機能) 기타(其他)의 공익적기능(公益的機能)도 발휘(發揮)될 수 있을 것으로 본다. 한국(韓國)의 국유림(國有林)은 1908년(年) 임적계출시(林籍屆出時)의 역사적(歷史的) 소산(所產)으로서 그 후(後) 국토보존(國土保存)과 산림경영(山林經營) 학술연구(學術硏究) 기타(其他) 공익상(公益上) 국유(國有)로 보존(保存)할 필요(必要)가 있는 요존림(要存林)과 이에 속(屬)하지 않는 부요존림(不要存林)으로 구분(區分)하고 요존국유림중(要存國有林中) 국가(國家)가 직접(直接) 임업경영(林業經營)을 목적(目的)으로 하는 산림(山林)은 3개영림서(個營林署)에서 관리(管理)하고 있으며 기타(其他)는 각시도(各市道) 및 타부처소관(他部處所管)으로 되어있는데 국유림(國有林)은 1971년말현재(年末現在) 전국산림면적(全國山林面積)의 19.5%(1,297,708 ha)를 점(占)하고 있으나 임목축적(林木蓄積)은 전국산림총축적량(全國山林總蓄積量)의 50.1%($35,406,079m^3$)를 점(占)하고 연간(年間) 국내용재생산량(國內用材生產量)의 23.6%($205,959m^3$)를 생산(生產)하고 있는 사실(事實)은 한국임업(韓國林業)에 있어 국유림(國有林)이 점(占)하고 있는 지위(地位)가 중요시(重要視)되고 있는 이유(理由)이다. 따라서 국유림경영(國有林經營)의 성패(成敗)는 한국임업(韓國林業)의 성쇠(盛衰)를 좌우(左右)한다고 단언(斷言)할 수도 있을 것이다. 산림(山林)이 가진 모든 기능(機能)이 가 중요(重要)하지만 특(特)히 목재생산(木材生產)은 한국(韓國)과 같이 매년(每年) 막대(莫大)한 외재도입(外材導入)(1971년도(年度)는 $3,756,000m^3$ 도입(導入)에 160,995,000불(弗) 지출(支出))을 필요(必要)로 하는 임업실정(林業實情)임에 비춰 더욱 중요시(重要視)되고 이에 대처(對處)하기 위(爲)한 산림생산력(山林生產力)의 증강(增强)은 시급(時急)한 과제(課題)인 것이다. 그러나 임업생산(林業生產)은 장기생산(長期生產)이기 때문에 경제발전(經濟發展)에 따른 급격(急激)한 목재수요(木材需要)의 증가(增加)에 직시(直時) 대처(對處)하기 어려우므로 장기적(長期的)인 전망(展望)밑에 자금(資金)과 기술(技術)을 효과적(効果的)으로 투입(投入)하고 국유림경영(國有林經營)을 합리화(合理化)하고 능률화(能率化)하여 생산력증강(生產力增强)을 기(期)하여야 할 것이다. 한국(韓國)의 국유림사업(國有林事業)에는 기술적(技術的) 재정적(財政的)인 애로(隘路)와 인건비(人件費)의 증대(增大) 노임(勞賃)의 상승(上昇) 행정제경비(行政諸經費)의 증가등(增加等) 많은 난관(難關)이 가로놓여있다 하겠으나 앞으로의 국유림(國有林)의 발전여부(發展與否)는 사회(社會) 경제(經濟)의 발전(發展)에 적응(適應)한 기술(技術)과 경영방식(經營方式)을 채용(採用)할 수 있느냐 없느냐에 달려있다고 본다. 이러한 관점(觀點)에서 본조사연구(本調査硏究)에서는 한국(韓國)의 국유림경영(國有林經營)의 실태(實態)를 파악분석(把握分析)하고 불합리(不合理)한 문제점(問題點)들을 찾아서 정책적(政策的) 기술적(技術的) 재정적면(財政的面)에서 개선(改善)할 수 있도록 하는데에 본연구(本硏究)의 목적(目的)이 있다. 본논문작성(本論文作成)에 있어 국유림(國有林)의 각종통계(各種統計)는 산림청(山林廳)이 1971년말현재(年末現在) 산림기본통계(山林基本統計) 및 1973년도(年度) 산림사업실적통계(山林事業實績統計)에 의거(依據)하였고 기타(其他)는 현지영림서(現地營林署)에서 얻은 자료(資料)를 인용(引用)하였다. 논자(論者)는 본연구결과(本硏究結果) 다음과 같은 국유림개선방안(國有林改善方案)을 제시(提示)코저 한다. 1) 국유림조직기구(國有林組織機構)에 있어 영림서(營林署)의 증설(增設)로 집약적(集約的)안 국유림경영(國有林經營)을 도모(圖謀)하고 경영계획계(經營計劃係)를 과기구(課機構)로 강화(强化)한다. 2) 보호직원(保護職員)의 증원(增員)으로 1인당책임구역면적(人當責任區域面積)을 1,000~2,000ha 정도(程度)로 축소(縮小)시킨다. 3) 국유림경영(國有林經營) 일선책임자(一線責任者)인 영림서장(營林署長)의 빈번(頻繁)한 인사이동(人事異動)으로 일관성(一貫性)있는 경영계획실행(經營計劃實行)에 차질(蹉跌)을 가져오지 않도록 한다. 4) 경영계획업무(經營計劃業務)에 있어 부실(不實)한 계획(計劃)이 되지 않도록 충분(充分)한 예산(豫算)과 인원(人員)을 배정(配定)하여 기초적(基礎的)인 조사(調査)를 면밀(綿密)히 한다. 5) 1영림서(營林署) 1사업구원칙(事業區原則)을 현실(現實)시키고 1사업구면적(事業區面積)은 평균(平均) 2만(萬) ha 이하(以下)로 한다. 6) 장기차입금(長期借入金)으로 조속(早速)히 미립목지(未立木地)를 입목지화(立木地化)하고 활엽수림(濶葉樹林)의 수종갱신(樹種更新)과 활엽수림(濶葉樹林)의 이용방도(利用方途)를 개발(開發)한다. 7) 조림(造林) 및 양묘사업(養苗事業)의 기계화(機械化) 약제화(藥劑化) 방안(方案)을 강구(講究)하고 실천(實踐)하므로써 노동력(勞動力) 부족(不足)에 대비(對備)한다. 8) 보호사업(保護事業)에 있어 산화피해율(山火被害率)이 외국(外國)에 비(比)하여 막대(莫大) 하므로 제도변(制度面)이나 장비면(裝備面)에서 개선(改善)되어야 하고 방화선(防火線)의 설치(設置) 및 유지(維持)에 필요(必要)한 최소한도(最小限度)의 예산(豫算)을 확보(確保)한다. 9) 제품생산사업(製品生產事業)을 강화(强化)하고 생산(生產) 가공(加工) 유통(流通)을 계열화(系列化)하여 지원민(地元民)에게 경제적혜택(經濟的惠澤)을 준다. 10) 임도망(林道網)의 시설정비(施設整備)와 치산사업(治山事業)은 국유림자체(國有林自體)의 개발(開發)을 위(爲)해서나 지방개발(地方開發)을 위(爲)해서 필요(必要)하므로 일반회계(一般會計)의 부담(負擔)으로 추진(推進)한다. 11) 임업(林業)의 기계화(機械化)는 목재수요(木材需要)의 증대(增大)와 노력부족(勞力不足)에 따라 필연적(必然的)이므로 가계도입(機械導入) 및 국산화(國產化), 사용자(使用者)의 양성(養成) 및 기계관리(機械管理)에 만전(萬全)을 기(期)한다. 12) 노무사정(勞務事情)은 악화(惡化)할 것이 예견(豫見)되므로 임업노동자(林業勞動者)의 확보(確保) 및 복리후생대책(福利厚生對策)을 수립(樹立)한다. 13) 경제변동(經濟變動)에 따른 수지악화시(收支惡化時)에도 일정규모(一定規模)의 지출(支出)을 보장(保障)하기 위(爲)하여 잉여금(剩餘金)의 일부(一部)은 기금(基金)으로 확보(確保)하고 나머지는 확대조림(擴大造林) 임도사업등(林道事業等) 선행투자사업(先行投資事業)에 사용(使用)한다.

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병원 간호행정 개선을 위한 연구 (A Study for Improvement of Nursing Service Administration)

  • 박정호
    • 대한간호학회지
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    • 제3권1호
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    • pp.13-40
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    • 1972
  • Much has teed changed in the field of hospital administration in the It wake of the rapid development of sciences, techniques ana systematic hospital management. However, we still have a long way to go in organization, in the quality of hospital employees and hospital equipment and facilities, and in financial support in order to achieve proper hospital management. The above factors greatly effect the ability of hospitals to fulfill their obligation in patient care and nursing services. The purpose of this study is to determine the optimal methods of standardization and quality nursing so as to improve present nursing services through investigations and analyses of various problems concerning nursing administration. This study has been undertaken during the six month period from October 1971 to March 1972. The 41 comprehensive hospitals have been selected iron amongst the 139 in the whole country. These have been categorized according-to the specific purposes of their establishment, such as 7 university hospitals, 18 national or public hospitals, 12 religious hospitals and 4 enterprise ones. The following conclusions have been acquired thus far from information obtained through interviews with nursing directors who are in charge of the nursing administration in each hospital, and further investigations concerning the purposes of establishment, the organization, personnel arrangements, working conditions, practices of service, and budgets of the nursing service department. 1. The nursing administration along with its activities in this country has been uncritical1y adopted from that of the developed countries. It is necessary for us to re-establish a new medical and nursing system which is adequate for our social environments through continuous study and research. 2. The survey shows that the 7 university hospitals were chiefly concerned with education, medical care and research; the 18 national or public hospitals with medical care, public health and charity work; the 2 religious hospitals with medical care, charity and missionary works; and the 4 enterprise hospitals with public health, medical care and charity works. In general, the main purposes of the hospitals were those of charity organizations in the pursuit of medical care, education and public benefits. 3. The survey shows that in general hospital facilities rate 64 per cent and medical care 60 per-cent against a 100 per cent optimum basis in accordance with the medical treatment law and approved criteria for training hospitals. In these respects, university hospitals have achieved the highest standards, followed by religious ones, enterprise ones, and national or public ones in that order. 4. The ages of nursing directors range from 30 to 50. The level of education achieved by most of the directors is that of graduation from a nursing technical high school and a three year nursing junior college; a very few have graduated from college or have taken graduate courses. 5. As for the career tenure of nurses in the hospitals: one-third of the nurses, or 38 per cent, have worked less than one year; those in the category of one year to two represent 24 pet cent. This means that a total of 62 per cent of the career nurses have been practicing their profession for less than two years. Career nurses with over 5 years experience number only 16 per cent: therefore the efficiency of nursing services has been rated very low. 6. As for the standard of education of the nurses: 62 per cent of them have taken a three year course of nursing in junior colleges, and 22 per cent in nursing technical high schools. College graduate nurses come up to only 15 per cent; and those with graduate course only 0.4 per cent. This indicates that most of the nurses are front nursing technical high schools and three year nursing junior colleges. Accordingly, it is advisable that nursing services be divided according to their functions, such as professional, technical nurses and nurse's aides. 7. The survey also shows that the purpose of nursing service administration in the hospitals has been regulated in writing in 74 per cent of the hospitals and not regulated in writing in 26 per cent of the hospitals. The general purposes of nursing are as follows: patient care, assistance in medical care and education. The main purpose of these nursing services is to establish proper operational and personnel management which focus on in-service education. 8. The nursing service departments belong to the medical departments in almost 60 per cent of the hospitals. Even though the nursing service department is formally separated, about 24 per cent of the hospitals regard it as a functional unit in the medical department. Only 5 per cent of the hospitals keep the department as a separate one. To the contrary, approximately 12 per cent of the hospitals have not established a nursing service department at all but surbodinate it to the other department. In this respect, it is required that a new hospital organization be made to acknowledge the independent function of the nursing department. In 76 per cent of the hospitals they have advisory committees under the nursing department, such as a dormitory self·regulating committee, an in-service education committee and a nursing procedure and policy committee. 9. Personnel arrangement and working conditions of nurses 1) The ratio of nurses to patients is as follows: In university hospitals, 1 to 2.9 for hospitalized patients and 1 to 4.0 for out-patients; in religious hospitals, 1 to 2.3 for hospitalized patients and 1 to 5.4 for out-patients. Grouped together this indicates that one nurse covers 2.2 hospitalized patients and 4.3 out-patients on a daily basis. The current medical treatment law stipulates that one nurse should care for 2.5 hospitalized patients or 30.0 out-patients. Therefore the statistics indicate that nursing services are being peformed with an insufficient number of nurses to cover out-patients. The current law concerns the minimum number of nurses and disregards the required number of nurses for operation rooms, recovery rooms, delivery rooms, new-born baby rooms, central supply rooms and emergency rooms. Accordingly, tile medical treatment law has been requested to be amended. 2) The ratio of doctors to nurses: In university hospitals, the ratio is 1 to 1.1; in national of public hospitals, 1 to 0.8; in religious hospitals 1 to 0.5; and in private hospitals 1 to 0.7. The average ratio is 1 to 0.8; generally the ideal ratio is 3 to 1. Since the number of doctors working in hospitals has been recently increasing, the nursing services have consequently teen overloaded, sacrificing the services to the patients. 3) The ratio of nurses to clerical staff is 1 to 0.4. However, the ideal ratio is 5 to 1, that is, 1 to 0.2. This means that clerical personnel far outnumber the nursing staff. 4) The ratio of nurses to nurse's-aides; The average 2.5 to 1 indicates that most of the nursing service are delegated to nurse's-aides owing to the shortage of registered nurses. This is the main cause of the deterioration in the quality of nursing services. It is a real problem in the guest for better nursing services that certain hospitals employ a disproportionate number of nurse's-aides in order to meet financial requirements. 5) As for the working conditions, most of hospitals employ a three-shift day with 8 hours of duty each. However, certain hospitals still use two shifts a day. 6) As for the working environment, most of the hospitals lack welfare and hygienic facilities. 7) The salary basis is the highest in the private university hospitals, with enterprise hospitals next and religious hospitals and national or public ones lowest. 8) Method of employment is made through paper screening, and further that the appointment of nurses is conditional upon the favorable opinion of the nursing directors. 9) The unemployment ratio for one year in 1971 averaged 29 per cent. The reasons for unemployment indicate that the highest is because of marriage up to 40 per cent, and next is because of overseas employment. This high unemployment ratio further causes the deterioration of efficiency in nursing services and supplementary activities. The hospital authorities concerned should take this matter into a jeep consideration in order to reduce unemployment. 10) The importance of in-service education is well recognized and established. 1% has been noted that on the-job nurses. training has been most active, with nursing directors taking charge of the orientation programs of newly employed nurses. However, it is most necessary that a comprehensive study be made of instructors, contents and methods of education with a separate section for in-service education. 10. Nursing services'activities 1) Division of services and job descriptions are urgently required. 81 per rent of the hospitals keep written regulations of services in accordance with nursing service manuals. 19 per cent of the hospitals do not keep written regulations. Most of hospitals delegate to the nursing directors or certain supervisors the power of stipulating service regulations. In 21 per cent of the total hospitals they have policy committees, standardization committees and advisory committees to proceed with the stipulation of regulations. 2) Approximately 81 per cent of the hospitals have service channels in which directors, supervisors, head nurses and staff nurses perform their appropriate services according to the service plans and make up the service reports. In approximately 19 per cent of the hospitals the staff perform their nursing services without utilizing the above channels. 3) In the performance of nursing services, a ward manual is considered the most important one to be utilized in about 32 percent of hospitals. 25 per cent of hospitals indicate they use a kardex; 17 per cent use ward-rounding, and others take advantage of work sheets or coordination with other departments through conferences. 4) In about 78 per cent of hospitals they have records which indicate the status of personnel, and in 22 per cent they have not. 5) It has been advised that morale among nurses may be increased, ensuring more efficient services, by their being able to exchange opinions and views with each other. 6) The satisfactory performance of nursing services rely on the following factors to the degree indicated: approximately 32 per cent to the systematic nursing activities and services; 27 per cent to the head nurses ability for nursing diagnosis; 22 per cent to an effective supervisory system; 16 per cent to the hospital facilities and proper supply, and 3 per cent to effective in·service education. This means that nurses, supervisors, head nurses and directors play the most important roles in the performance of nursing services. 11. About 87 per cent of the hospitals do not have separate budgets for their nursing departments, and only 13 per cent of the hospitals have separate budgets. It is recommended that the planning and execution of the nursing administration be delegated to the pertinent administrators in order to bring about improved proved performances and activities in nursing services.

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농촌(農村) 주민(住民)들의 의료필요도(醫療必要度)에 관(關)한 연구(硏究) (A Study Concerning Health Needs in Rural Korea)

  • 이성관;김두희;정종학;정극수;박상빈;최정헌;홍순호;라진훈
    • Journal of Preventive Medicine and Public Health
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    • 제7권1호
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    • pp.29-94
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    • 1974
  • 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.

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