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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
> Journal Vol & Issue
Journal of agricultural medicine and community health
Journal Basic Information
Journal DOI :
Korean Association of Agricultural Medicine and Community Health
Editor in Chief :
Volume & Issues
Volume 16, Issue 2 - Dec 1991
Volume 16, Issue 1 - Jun 1991
Selecting the target year
Policy Measures for Improving Health Care Services in Rural Areas
Moon, O.R. ; Lee, L.S. ; Park, J.Y. ; Ko, D.H. ; Lee, K.H. ;
Journal of agricultural medicine and community health, volume 16, issue 2, 1991, Pages 97~119
Korea has made a rapid economic development since the last three decades. This has helped Korea narrow the gap in health service differences in resource availability and in quality of care. However urban and rural differentials are still remarkable. This study has maintained that health status of rural residents is inferior to that of urban dwellers. Therefore, this study was carried out to develop policy measures for improving health services in rural areas. In order to achieve the objective of this study the authors collaborated closely and made field visits, interviews and conducted an extensive literature review regarding rural health services. The following policy options are recommended as a summary ; First, the quality of rural health personnel is a single most important factor influencing the level of rural health services. An innovative program for public health doctors to the internship and/or residency training program such as specialty board program of family medicine. Second, dissatisfaction regarding employment of public health doctors is problematic. More rational employment and deployment programs are needed to meet their personal desire. One way to do this is to make it wide open and competitive. Third this study shows how to increase physician productivity in the rural public health sector. Incentive system needs to be elaborated for the career development of rural health workers. University linked job opportunity as clinical professor is an example. Fourth, without straightening the function of health centers and subcenters, the future of rural health services is doomed to failure. Straightening primary health care is one way to enrich the program of public health facilities and reactivating the operation of health center/hospital is another. A close linkage of public facilities with private hospitals is a minimum requirement for the operation of health delivery system within a health district. Fifth, some measures are urgently required to enhance hospital services in medically underserved areas. Financial subsidy, tax exemption, long-term public loans and higher priority of health manpower deployment are some of them. Sixth, new health programs should be in tiated to meet changing needs of peoples in rural areas. Home health care program, hospice program, nursing home, residential program for the elderly are recommended.
A Study of Cardiovascular Disease(Hypertension) for Ulleung-Gun Inhabitants
Han, Kyung-Yog ; Lee, Jei-Cheul ; Lee, Moo-Sang ;
Journal of agricultural medicine and community health, volume 16, issue 2, 1991, Pages 120~124
From the medical examination held on 1988, an interested fact was observed that the cardiovascular disease related examination results of the Ulleung-Gun inhabitants were more marked than those of other areas. An intended search for hypertension with related tests was executed from September
, 1989 to September
, 1989 on 344 Ulleung-Gun inhabitant and the results were as follows. 1) Among the 344 subjects, males were 94 and female, 250. The reason of showing lower number of males than the number of females was due to the fishing work season of showing lower medical examination period was overlapped. 2) 58% of the subjects are the age of over 50 years old. 3) The suspected cases were 68 among 344, and the suspected rate was 19.7%. 4) Abnormality rates of related tests were as follows : suspected ECG 10.1%, hypertension 9.0%. high triglyceride value 5.8%, and high total cholesterol value 4.6%. 5) Table 5 shows that the higher of ages, the higher of ages, the higher of the suspected rates of all 4 related and results. especially the abnormality of hypertension and EOG was marked. 6) Table 6 shows that the incidence of hypertension was higher from the subjects having family history than those who had no family history, from those taking foods salty than those taking foods unsalty, from those taking diet of meat than those taking vegetable diets. 22 cases among 31 had abnormal ECG results and/or high triglyceride values. But there were 5 subjects who had no hypertension related factor.
Analysis of Utilization and Expenses of Medical Care Services in a Designated Rural Areas
Kim, Jin-Soon ;
Journal of agricultural medicine and community health, volume 16, issue 2, 1991, Pages 125~133
The medical insurance system has been adopted in rural areas in 1988. Since then, the utilization of medical care services has increased rapidly in rural areas. According to the various study on medical care utilization, the people in rural areas used more curative care services than urban areas. The purpose of this study was to analyze the utilization and expenses of medical care services in designated rural areas : Choonseong Gun, Kangwon Province ; and Soonchang Gun, Cheonbuk province in Korea. Medical care utilization of medical care beneficiaries showed slightly increase, while there was a decrease of 18% and more for the medicaid. Regarding selection of medical care institutions, medical care beneficiaries used more hospitals and clinics than health center networks, but the health center networks was used more by the medicaid. However, the hospitalized Soonchang health center was able to provide more curative care to the people than the other two health centers. More than 50% of the patients treated by hospitalized health center were residents of the place in which health center was located.
Quantitative Analysis of Amino Acids of Paragonimus Westermani Treated with Praziquantel in Vivo and in Vitro
Tak, Byung-Yun ; Chung, Myung-Sook ; Joo, Kyoung-Hwan ; Rim, Han-Jong ;
Journal of agricultural medicine and community health, volume 16, issue 2, 1991, Pages 134~140
The amino acid constituents of Paragonimus westermani were very imperfectively known. Lee(1964) detected 9 amino acids in the tissue hydrolysates of P. westermani, and 13 amino acids were detected from the cyst content and body fluid constituents of P. ohirai, But, the quantity of amino acids in P. westermani is still unknown. In the present investigation 18 amino acids, the fundamental constituents of proteins, were quantitatively studied by high performance liquid chromatography. The results obtained were as follows : A total of 18 amino acids were recovered in protein hydrolysates of P. westermani obtained from cat. ; They were cystein, aspartic acid, glutamic acid, serine. glycine, histidine. arginine, threonine, alanine, proline, tyrosine, valine, methionine, isoleucine, leucine, phenylalanine, tryptophan and lysin. Among them, glutamic acid was the most abundant form and tryptophan, cystein, methionine, and histidine constitute minor portion of hydrolysates. Compared to the normal P. westermani, the volume of hydrolysates obtained from the praziquantel(PZQ) treated worm-0.lug PZQ/ml saline for 6 hours incubation, and
2days in vivo treatment was generally increased except tryptophan. A total of 17 free amino acids were identified and the volume was 174.18 umol/1 gm wet weight P. westermaini. Among them, glycine and alanine constitute 28% of total volume. No significant differences were observed in the material obtained from worm treated with PZQ. However, slight increase of serine, arginine and the slight diminution of glutamic acid and proline was observed.
Quantitative Analysis of Cystic Fluid Components in Cysticercus cellulosae
Moon, Joon ; Chung, Myung-Sook ; Joo, Kyoung-Hwan ; Rim, Han-Jong ;
Journal of agricultural medicine and community health, volume 16, issue 2, 1991, Pages 141~153
Free amino acid(FAA), free fatty acid(FFA), and amino acid obtained by hydrolysis of protein components of cystic fluid(CF) of Cysticercus cellulosae in pig and man were analyzed. FFA was analyzed by gas chromatography using Varian model 2700, and flame ionization detector with 6 feet
1/4inch glass column. Flow rate of
was 30 ml/min,
was 30 ml/min, air was 350 ml/min respectively and chart speed was 1 cm/min. Amino acid was analyzed by high performance liquid chromatography using Waters model 441, and fluorescence detector at 338nm/425nm with column of amino acid analyzer. Buffer A of mobile phase was pH 3.05 and pH of buffer B was 9.6 respectively. The results obtained were as follows : Seven FFAs containing 12~18 carbons were detected : Saturated fatty acids were lauric acid (
), myristic acid(
), palmitic acid(
), Stearic acid(
). Unsaturated fatty acids were oleic acid(
), linoleic acid(
), and one unidentified fatty acid was detected. Generally much more quantity of FFA was determined in CF obtained from pig than that from man. FFA of the largest quantity was palmitic acid; 0.078 mg/ml. Eighteen FAAs were detected and the largest quantity was alanine. Ouantity of alanine was 386 ug/ml in CF from pig 108 ug/ml in CF from man respectively. while histidine in CF from pig was 273 ug/ml, that from man was only 4.3 ug/ml. Eighteen amino acids were identified by hydrolysis of protein in CF from man. But, histidine was not identified in CF from pig. Amino from pig and ug/ml from man.
Electron Microscopic Study on the Effect of Albendazole Against Paragonimus Westermani
Hwang, Eui-Jung ; Kim, Soo-Jin ; Joo, Kyoung-Hwan ; Rim, Han-Jong ;
Journal of agricultural medicine and community health, volume 16, issue 2, 1991, Pages 154~164
Albendazole is a broad spectrum anthelmintics with high activity against intestinal nematodes as well as tremtodes and cestodes infections. But so far wormicidal effect of albendazole against Paragonimus westermani is uncertain. The present study undertaken to observe the morphological changes of Paragonimus westermani which was obtained from experimentally infected with metacercariae isolated from Cambaroides similis and 9 of them were given albendazole 2 doses of 25mg/kg daily for the 2 days and 4 days from the day of 20 weeks after infection. The Paragonimus werms were collected from the lung of the cats which were autopsied at 24 hours after treatment. The fine structures of the collected worms were studied by means of scanning and transmission electron microscopy. The findings of the observations were compared with those of untreated worms. The results are as follows : 1) In the scanning electron microscopic(SEM) observations, the worms obtained from 2 days treated group showed many blebs which were formed on the surface of damaged tegument in between two suckers. Protrusion of oral sucker typically observed and surrounding tegumental ridges were damaged. 2) The worms obtained from 4 days treated group showed marked contraction revealing half size of normal worms. 3) The transmission electronmicroscopic(TEM) observations indicated that large blebs of irregular shapes were formed by the destruction of tegumental ridge of tegumental syncytium and also showed degeneration of mitochondriae. 4) Destruction of tegumental syncytium formation of blebs were usually observed in the ventral side of the worms. 5) Differentiation of tegumental layer and basement layer muscular layer and parenchymal layer around two suckers of worms obtained at 4 days treated group was difficult. 6) Many host cells invaded and destroyed the degenerated tegument by the occurrence of blebs or the exposed muscular layer of the worm after exfoliation of the tegument.
Two Cases of Cerebral Cysticercosis Treated with Albendazole
Joo, Kyoung-Hwan ; Rim, Han-Jong ;
Journal of agricultural medicine and community health, volume 16, issue 2, 1991, Pages 165~171
Two patients with confirmed cerebral cysticercosis were treated with Albendazole(Zentel
) at a daily dose of 1.200mg t.i.d. for 14 consecutive days and evaluated for tolerance and therapeutic effects. First case was 29 year old male, who had experience of 4 times of grand mal seizures during 1 year period before administration in Korea University Hospital. His chief complaints were seizure and moderate degree headache. He also had 4 subcutaneous nodules on the thorax, right and left upper arms. Among them one nodule was biopsied and confirmed microscopically as Cysticercus cellulosae hominis. Computed tomography of the brain showed four round low density lesions in right postero-frontal area, sylvian area, intra-occipital area and left parietal area. Second case was 48 year old male, who also had experience of seizures at 3 years, 5 months and 3 months before administration. In this case, no subcutaneous nodules and no headaches were noted. Brain CT showed four round low density lesions in right postero-parietal area and temporo-parietal area, and left temporo-parietal and parietal area. Serum antibody against cystic fluid antigen was detected by ELISA in both cases. The efficacy of the treatment of cerebral cysticercosis was assessed by the frequency of convulsions after treatment for 22 months follow-up. by the disappearance of the densities in cystic lesions at brain CT for 6 months follow-up, and disappearance of subcutaneous nodules, headache and so on. As the results, all low density lesions in both cases were disappeared in films of brain CT, and 4 nodules in first case were also disappeared. No more seizure and complain of headache occurred during the last 22 months after treatment in both cases. Post-treatment complete blood count and liver function test revealed no remarkable change compared to pre-treatment test. In the nations of Latin America, the physicians do not initially recommended the simultaneous administrations of steroids, reserving them only for patients whom the adverse reactions such as severe headache and/or seizures are occurred. According to them, in most patients these symptoms are controlled with aspirin and symptomatic drugs. But our experience using praziquantel is different, and most cerebral cysticercosis patients who takes PZQ had complaint of severe headache and sometimes seizure. So we simultaneously used dexamethasone as 6mg q.i.d. for 14 consecutive days and 6 days tapering thereafter in both cases for prevention of reactions produced by the host in response to the deaths of the parasites. As the conclusion, albendazole is effective in patients who presented cerebral cysticercosis and albendazole may help in the control of cysticercosis.
Shin, Sang-Won ; Park, Seung-Chull ;
Journal of agricultural medicine and community health, volume 16, issue 2, 1991, Pages 172~176
Lyme disease, or Lyme borreliosis. is an infection caused by spirohete Borrellia burgdorferi. This disease was recognized in Lyme, Conneticut U.S.A. in 1975. The onset of the disease is usually heralded by the appearance of a pathognomic skin lesion, known as erythema chronicum migrans, and accompanied by flue like or meningitis like symptoms. Unless treatment is initiated early, the disease usually disseminated, often resulting carduac, neurologic, or joint manifestations. All stages of the disease are usually curable by appropriate antibiotic therapy, and can prevent severe late cardiac, neurologic, and joint complications. Lyme disease is typically defined by clinical evidence supported by serologic test. The diagnosis require serologic confirmantion of erythema chronicum migrans, occurring in patient in nonendemic countries. Determination of antibody titer against B. burgdorferi by enzyme linked immunosorbent assay(ELISA) currently the most practical diagnostic test. Currently Lyme disease occurs in U.S.A. Europe, and Australia. It has recently recognized in China, Japan, and Soviet Union also. In United States, Lyme disease is most common vector borne infection. There is no reported case of patients with this disease in Korea. But the vector of this disease, -Ixodes ticks- had been identified in Korea. And Korea is geographically closely related to China and Japan where Lyme disease is already reported. We expect first case of Lyme disease could he reported in near future. We review the clinical manifestations and diagnostic method of Lyme disease.
Reforming the Rural Health Insurance Programs in Korea
Moon, Ok-Ryun ;
Journal of agricultural medicine and community health, volume 16, issue 2, 1991, Pages 179~194
Despite its universal coverage of health insurance, the rural health insurance program(RHIP) stands at the crossroads in Korea. The RHIP has weaknesses in stability of financing, problems of inequities in the provision of health services and has suffered from high cost of running the program. The author has analyzed these problems from the perspective of health insurance policy and presented several options for improvement. First of all, this study urged the importance of a firm Governmental commitment of RHIP with the 50% subsidization of contributions as the Government had promised, instead of the current 40%. This can be justified from the 20% subsidization by the Government for the contributions of private school teachers and their dependents, who belong to richer segments of the population. Second, various cost containment measures ought to be sought curbing the rising demand for medical through strengthening health education and increasing individual responsibility, and tightening the claim review process. Third, this study requires the Government to run a demonstration project on the introduction of case payment system for primary health care. Fourth introducing an income-related cost sharing scheme is another possibility. Reforming the cost sharing formula for large medical expenditures is recommendable for a beginning. This measure can take the form of tax credit for medical expenditures of the poor. Fifth, the degree of financial adjustment among health insurance plans should be levelled up for enhancing stability of RHIP and social solidarity. Sixth, health policy should be redirected toward development of rural health resources and higher priority should be put on relieving difficulties in access to care. Seventh. the insurance plan owned-hospital needs to be developed or provision of health services in the medically underserved areas, and the need of such facilities is particularly acute for geriatric care, rehabilitation and renal dialysis, etc. Eighth, more generous insurance benefits are required of the elderly who are suffering the most : elimination of the maximum 180 days of benefit period and provision of glasses and artificial dentures, etc. Ninth. the economies of scale principle is working for the operating expenses of regional self-employed insurance plan. Thus, measures should be instituted to pursue an optimum size of health insurance plans. Lastly, excessive dependence on exclusion items is an evil so that some radical remedies are urgently required to cut them.
Jeong, Myeong-Chae ;
Journal of agricultural medicine and community health, volume 16, issue 2, 1991, Pages 195~207