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폐쇄성 수면무호흡증후군의 진단에 있어 턱 압박술의 유용성 (Usefulness of the Chin Press Maneuver in Assessing the Severity of Obstructive Sleep Apnea Syndrome)

  • 김무진
    • 수면정신생리
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    • 제8권1호
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    • pp.22-29
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    • 2001
  • 목 적 : 폐쇄성 수면무호흡증의 진단에 있어 야간 수면다원검사가 중요함에도 비용이나 시간의 문제로 임상의들이나 환자들이 이 검사의 시행을 주저하는 측면이 있다. 만약 진찰로 어느 정도 수면호흡장애의 정도를 가늠할 수 있다면 수면다원검사를 포함하는 다음 단계 진단과정 선택이나 경과의 관찰에 중요한 길잡이가 될 수 있을 것이며 환자들을 이해시키는 일도 좀 더 쉬워 질 것이다. 이에 저자는 Simmons등이 처음 제안한 턱 압박술을 이용해 체계화한 새로운 호흡장애지수(이하 CPS)를 고안하고 진찰시 이것을 측정하여 야간 수면다원검사로 나타나는 여러 호흡장애 변수들과의 상관관계를 분석함으로써 이 지수의 타당도를 검토하고자 하였다. 방 법 : 임상적으로 폐쇄성 수면무호흡증(이하 OSA)이 의심되어 수면다원검사실에 의뢰된 환자들 중 검사 결과 폐쇄성 수면호흡장애로 최종 진단된 43명을 연구 대상으로 하였다. 이 중 상기도 저항증후군(이하 UARS)이 15명, OSA가 28명이었다. CPS(범위 $0{\sim}6$)범주와 진단 범주간의 카이제곱 검정을 실시하여 상관성을 검토한 뒤 이 지수와 수면무호흡지수(이하 AHI), 수면 시간당 산소포화도 저하 건수(이하 SaO2 dips) 등의 기존 수면무호흡 관련 변수와 상관분석을 시행하였다. 결 과 : 연구 대상의 평균연령은 $45.95{\pm12.47$세(범위 $14{\sim}76$세)였고 BMI의 평균은 $25.98{\pm}3.61$(범위 19.65${\sim}$37.64)였다. OSA군과 UARS군 사이에 나이, 성별, BMI에 유의한 차이는 없었다. 두 진단군 사이에 호흡장애지표와 ESS에서는 유의한 차이가 있었으나(p<0.05) 수면 변수에는 차이가 없었다. 전체 대상의 CPS 구간 중앙값 평균은 4.14(범위 $1{\sim}6$)이었다. 진단범주와 CPS범주간의 카이제곱 검정 결과 진단에 따라 CPS의 차이가 있었다(Likelihood Ratio $X^2$ test ; $X^2=17.41$, df=5, p=0.004). 결합도 Somers'd는 0.65로 나와($0.65{\pm}0.12$, t=4.83, p=0.000) CPS가 OSA군에서 뚜렷이 높아지는 양상을 보이고 있다. Spearman 상관관계분석에서 CPS가 AHI(r=0.77), SaO2 dips(r=0.83)와 좋은 정 상관관계를 보여주었다(p<0.001). 그 외에 90%이하 산소포화도 누적시간 백분율(r=0.76), Epworth 졸음척도치(r=0.57), 일 단계 수면의량(r=0.55)과도 강하거나 뚜렷한 정 상관관계를 보였으며 (p<0.05), 동맥혈 최저 산소포화도(r=-0.69)하고는 뚜렷한 역 상관관계를 보였다(p<0.05). 그러나 동맥혈 산소포화도 저하 건의 평균 지속시간과는 상관관계가 약했다. CPS와 AHI에 대한 회귀 분석 결과 턱 압박시 약간 호흡장애를 느끼는 수준(CPS가 3) 이상의 경우 수면다원검사를 시행하면 AHI가 5이하로 나올 확율은 약 3분의 1이하로 나왔다. 결 론 : CPS가 AHI, SaO2 dips 등 기존의 수면 무호흡 지수들과 뚜렷한 정 상관관계를 보여 턱 압박술은 수면무호흡증의 진단시 그 정도를 예측하는데 있어 유용하다.

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키워드 자동 생성에 대한 새로운 접근법: 역 벡터공간모델을 이용한 키워드 할당 방법 (A New Approach to Automatic Keyword Generation Using Inverse Vector Space Model)

  • 조원진;노상규;윤지영;박진수
    • Asia pacific journal of information systems
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    • 제21권1호
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    • pp.103-122
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    • 2011
  • Recently, numerous documents have been made available electronically. Internet search engines and digital libraries commonly return query results containing hundreds or even thousands of documents. In this situation, it is virtually impossible for users to examine complete documents to determine whether they might be useful for them. For this reason, some on-line documents are accompanied by a list of keywords specified by the authors in an effort to guide the users by facilitating the filtering process. In this way, a set of keywords is often considered a condensed version of the whole document and therefore plays an important role for document retrieval, Web page retrieval, document clustering, summarization, text mining, and so on. Since many academic journals ask the authors to provide a list of five or six keywords on the first page of an article, keywords are most familiar in the context of journal articles. However, many other types of documents could not benefit from the use of keywords, including Web pages, email messages, news reports, magazine articles, and business papers. Although the potential benefit is large, the implementation itself is the obstacle; manually assigning keywords to all documents is a daunting task, or even impractical in that it is extremely tedious and time-consuming requiring a certain level of domain knowledge. Therefore, it is highly desirable to automate the keyword generation process. There are mainly two approaches to achieving this aim: keyword assignment approach and keyword extraction approach. Both approaches use machine learning methods and require, for training purposes, a set of documents with keywords already attached. In the former approach, there is a given set of vocabulary, and the aim is to match them to the texts. In other words, the keywords assignment approach seeks to select the words from a controlled vocabulary that best describes a document. Although this approach is domain dependent and is not easy to transfer and expand, it can generate implicit keywords that do not appear in a document. On the other hand, in the latter approach, the aim is to extract keywords with respect to their relevance in the text without prior vocabulary. In this approach, automatic keyword generation is treated as a classification task, and keywords are commonly extracted based on supervised learning techniques. Thus, keyword extraction algorithms classify candidate keywords in a document into positive or negative examples. Several systems such as Extractor and Kea were developed using keyword extraction approach. Most indicative words in a document are selected as keywords for that document and as a result, keywords extraction is limited to terms that appear in the document. Therefore, keywords extraction cannot generate implicit keywords that are not included in a document. According to the experiment results of Turney, about 64% to 90% of keywords assigned by the authors can be found in the full text of an article. Inversely, it also means that 10% to 36% of the keywords assigned by the authors do not appear in the article, which cannot be generated through keyword extraction algorithms. Our preliminary experiment result also shows that 37% of keywords assigned by the authors are not included in the full text. This is the reason why we have decided to adopt the keyword assignment approach. In this paper, we propose a new approach for automatic keyword assignment namely IVSM(Inverse Vector Space Model). The model is based on a vector space model. which is a conventional information retrieval model that represents documents and queries by vectors in a multidimensional space. IVSM generates an appropriate keyword set for a specific document by measuring the distance between the document and the keyword sets. The keyword assignment process of IVSM is as follows: (1) calculating the vector length of each keyword set based on each keyword weight; (2) preprocessing and parsing a target document that does not have keywords; (3) calculating the vector length of the target document based on the term frequency; (4) measuring the cosine similarity between each keyword set and the target document; and (5) generating keywords that have high similarity scores. Two keyword generation systems were implemented applying IVSM: IVSM system for Web-based community service and stand-alone IVSM system. Firstly, the IVSM system is implemented in a community service for sharing knowledge and opinions on current trends such as fashion, movies, social problems, and health information. The stand-alone IVSM system is dedicated to generating keywords for academic papers, and, indeed, it has been tested through a number of academic papers including those published by the Korean Association of Shipping and Logistics, the Korea Research Academy of Distribution Information, the Korea Logistics Society, the Korea Logistics Research Association, and the Korea Port Economic Association. We measured the performance of IVSM by the number of matches between the IVSM-generated keywords and the author-assigned keywords. According to our experiment, the precisions of IVSM applied to Web-based community service and academic journals were 0.75 and 0.71, respectively. The performance of both systems is much better than that of baseline systems that generate keywords based on simple probability. Also, IVSM shows comparable performance to Extractor that is a representative system of keyword extraction approach developed by Turney. As electronic documents increase, we expect that IVSM proposed in this paper can be applied to many electronic documents in Web-based community and digital library.

양성자치료기 가속기 시설에서의 작업종사자의 방사선 피폭 연구 (A Study of Radiation Exposure in Proton Therapy Facility)

  • 이상훈;신동호;윤명근;신정욱;라정은;곽정원;박성용;신경환;이두현;안성환;김대용;조관호;이세병
    • 한국의학물리학회지:의학물리
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    • 제20권1호
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    • pp.37-42
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    • 2009
  • 국립암센터에 설치된 양성자 치료기는 양성자 가속기의 운영을 통해 많은 양의 이차방사선을 방출하게 되는데, 이는 양성자 빔이 가속 중에 주위의 물질과 반응을 하여 이차 입자를 발생하고 방사성 동위원소도 생성하기 때문이다. 생성된 방사성 동위원소에 의한 방사선량은 시간에 따라 감쇠되지만 양성자 치료기의 운영 및 유지보수를 위해 수시로 가속기 작업종사자들이 시설내부로 접근해야 하며 이로 인해 이차방사선에 의한 피폭 문제가 발생될 수 있다. 본 논문에서는 양성자 가속기(Cyclotron)를 포함한 양성자 치료기의 운영을 위해 필요한 작업종사자들의 작업환경을 평가하고, 적절한 수준의 방사선 방호대책을 수립하기 위해 양성자 치료기 운영 중 가장 높은 수준의 방사선이 발생되는 양성자 가속기(Cyclotron) 및 주변 지역에서의 가속기 가동에 따른 방사선 발생 정도를 측정하였고 그 지속시간을 분석하였다. 이를 위해 양성자 빔의 손실이 가장 큰 가속기 주변과 에너지 선택 시스템(Energy Selection System, ESS)지역의 탄소(graphite, $^{12}C$) 재질로 구성된 에너지 감쇠장치(degrader)에서의 방사선 변화를 추적하고, 가속기에서 생산된 230 MeV의 고정된 에너지 빔이 에너지 감쇠장치(degrader)를 거쳐 ESS를 통해 전송된 빔의 효율을 산출하고 빔의 전송 구간에서의 상대적인 방사화 정도를 분석하였다. 이러한 분석 자료를 토대로 작업종사자들의 작업간 피폭 수준을 계산하고 연간 피폭 정도를 측정하였다. 작업 중 가속기 시설내의 선량은 수십 ${\mu}Sv/h$로 다른 방사선 치료기에 비해 상대적으로 높은 수준이지만 작업시간을 고려한 연간 총 피폭 선량은 작업자에 따라 1~3 mSv/year 정도로, 연간 피폭 한계 선량보다 충분히 낮은 수준으로 운영이 가능하였다.

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지상파 DMB를 이용한 클립캐스트 서비스 설계 및 구현 (Design and Implementation of Clipcast Service via Terrestrial DMB)

  • 조석현;서종수
    • 방송공학회논문지
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    • 제16권1호
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    • pp.23-32
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    • 2011
  • 본 논문에서는 지상파 DMB를 이용하여 동영상, mp3, 텍스트, 정지영상 등 파일의 일부분인 클립을 전송하고 단말기에서 수신하는 클립캐스트 서비스를 위한 시스템 설계를 제안하고 구현하였다. 지상파 DMB 클립캐스트를 위해서는 데이터 채널의 별도 할당이 필요하며 이를 위해서는 기존 대역의 재조정이 필요하다. 클립캐스트는 지상파 DMB 시청이 적은 심야시간 (03:00~04:00)에 콘텐츠를 전송하며 비디오 서비스의 비트율을 352 Kbps로 낮추고 TPEG 서비스 대역을 이용하면 320 Kbps의 비트율로 클립캐스트 전송이 가능하다. 또한 단말기의 DMB 프로그램 구동을 위해 SMS(Short Message Service) 구동 방식과 EPG(Electronic Program Guide) 구동방식을 제안하였다. 클립캐스트 서비스는 멀티미디어 객체를 전송하는 MOT 프로토콜을 이용하며 파일의 안정적인 전송을 위하여 카루젤 형태로 2번 반복하여 전송한다. 이럴 경우 1시간 동안 전송 가능한 데이터 용량은 72 Mbyte로서, 500 Kbps급의 동영상을 시청할 경우 약 20분 정도의 동영상 서비스가 가능하다. 지상파 DMB 데이터 채널로 전송되는 클립을 표출할 때에는 CMS(Content Management Server)와 통신하여 각 클립의 길이에 대한 정보를 전달받은 후, 에러 없이 전송된 파일에 대해서만 표출해 준다. 각 콘텐츠는 사용자에게 미리보기 형식으로 제공이 가능하고 해당 콘텐츠 전체를 이용하기 위해서는 해당 콘텐츠에 할당된 URL로 접속하여 과금 과정을 거친 후 콘텐츠 다운로드가 가능하게 된다. 본 논문에서는 클립캐스트 서비스를 위한 지상파 DMB 시스템 설계를 제안하고 이를 구현함으로써 MediaFLO, DVB-H 등 타 모바일 방송에서 서비스하고 있는 파일 다운로드 서비스의 구현이 가능하게 되었다. 클립캐스트 서비스를 위한 단말기의 구동으로 타 모바일 방송에서는 EPG 구동 방식만 구현한데 비해 본 시스템에서는 EPG 보다 수신 신뢰성이 높은 SMS를 이용한 구동 방식을 제안함으로써 보다 안정된 서비스 제공이 가능하게 되었다. 이에 따라 클립캐스트 서비스에서 SMS와 EPG를 같이 이용하여 단말기를 구동시키는 하이브리드 구동 방식도 가능하게 되었다.

근무형태 및 피폭선량에 따른 PET/CT실의 운영 효율성 평가 (Operation Efficiency Estimation of PET/CT Center by Work Form and Exposure Dose)

  • 권오진;정서희;백승찬;김경호
    • 핵의학기술
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    • 제13권1호
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    • pp.93-97
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    • 2009
  • 2006년~2008년 2사분기까지의 2.5년간의 환자 건수는 14,674건이었으며, $^{18}F$-FDG 평균 주사량은 461.5 MBq 였다. 2.5년간 순환근무는 3회 이루어졌고, 10명의 방사선사 중 PET과 Gamma 영역별 1인을 제외한 8명의 순환근무가 시행되었다. 추가로 2008년 3인의 신입인력이 야간에 투입되어 이에 대한 평가도 이루어졌다. 방사선사의 근무연한은 15년 이상이 2인, 10~15년이 3인, 5~10년이 1인, 5년 미만이 3인이었다. 이들의 개인별 피폭선량은 먼저 PET실에 근무를 하고 있을 때가 Gamma 영역에 근무하고 있을 때 보다 더 높게 나왔다. 가장 큰 원인으로는 일일 처리 건수 면에서 PET과 Gamma영역의 차이가 거의 없는 상태에서 $^{99m}Tc$보다는 상대적으로 에너지가 높은 $^{18}F$-FDG를 사용하는데 있다고 본다. 특히 개인별 피폭선량도 근무연한에 따른 분기별 평가에서 서로 다르게 나타났다. 또한 순환근무 초기 1개월째보다는 업무의 연속성을 익힌 3개월째에 더 낮은 피폭선량을 보여 주고 있다. 이는 PET 실의 근무연한이 길수록 업무의 숙달도가 증가하여 개인별 피폭선량은 감소하는 것으로 보인다. 예약실에 근무하는 간호사의 피폭선량은 $^{18}F$-FDG 주사 후 짧은 시간에 환자와의 접촉이 이루어지고 있어 그리 큰 문제점을 보이지는 않았다. 그러나 임신 가능성이 있는 간호사일 경우는 이를 재고해 보아야할 필요가 있다. 순환 근무를 통한 장시간 PET/CT실을 벗어난 상황이 될 경우 대부분의 근무자가 초기 1개월에서 업무의 연속성 결여 및 개인별 피폭선량 증가라는 위험성을 내포하였다. PET/CT 환자의 증가에 따른 PET/CT실 전체의 과도한 피폭을 분산하기 위한 순환 근무제의 도입이 또 다른 문제점을 갖고 있음을 알 수 있다.5,6) 이를 해결하기 위해서는 근무자의 업무재교육과 순환 및 고정 근무제의 적절한 병행을 시행할 필요가 있다고 본다. 또한 고정 근무자는 순환 근무 인력들의 이런 문제점을 해결하기 위해 업무영역에서 표준화된 업무지침서 등을 만들어야 한다.

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한국 청소년의 식사의 질 평가에 적절한 식품군의 조성 -Kant의 최소량에 기초하여- (Composition of Food Groups Appropriate for Evaluation of Diet Quality of Korean Adolescents -Based on Kant's Minimum Amount-)

  • 엄지숙;박민영;정영진
    • Journal of Nutrition and Health
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    • 제39권6호
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    • pp.560-571
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    • 2006
  • The purpose of this study was to determine composition of food groups appropriate for the evaluation of the quality of total diet or food guide, using the data from the 1998 National Health and Nutrition Survey. Twenty-four-hour-dietary recalls of total 1,110 Korean adolescents aged 13 - 19 years (male 543, female 567) were analyzed for food group consumed (Dietary Diversity Score, DDS), intake patterns of food group, mean index of nutritional quality (mINQ) and nutrient adequacy ratio (NAR). Considering Korean food pattern different from the Americans, this study is to check if Korean 5 food groups with both of oil & sugar group and vegetable & fruit group, and a minimum amount of 30 g in grain group and 15 g in meat group modified from Kant's minimum amount, 15 g in grain and 30 g in meat, could also be appropriate for the diet evaluation of Korean adolescents. Combination of food group and minimum food intake per each food group used in the first trial were categorized into 6 kinds of types: 1) American 5 food groups with Kant's minimum amount as control or 2) American 5 food groups with modified Kant's minimum amount 3) Korean 5 food groups excluded by sugar with the modified amount 4) Korean 5 food groups with modified amount 5) American food groups added oil group with the modified amount 6) American food groups added oil & sugar group with the modified amount. In case of oil group or oil and sugar group, 5 g was quoted for the minimum amount. Correlation between DDS and indices of other diet quality in each type of food group composition were analyzed and the best food group composition was traced by comparing the correlation coefficients of DDS and mINQ or MARs at ${\alpha}\;<\;0.01$. There was no meaningful difference in weight length index of the subjects of eating or not-eating oil or oil & sugar, while the values of mINQ showed higher in the subjects eating oil but no difference in the subjects eating oil & sugar, compared to the group not-eating, respectively. In comparison of type 1 and type 2, correlation between DDS and indices of other diet quality showed higher in type 1 using Kant's amount. And comparing the type of a combined group of fruit & vegetable (type 3 and 4) and the type of separated group of fruit and vegetable (type 5 and 6). six groups of separated vegetable and fruit showed the higher correlation of DDSs and indices of diet quality. In case of being classified into six groups with oil, DDS showed correlation of r = 0.293 with INQ. While, being classified into six groups with oil & sugar instead of oil only, DDS showed correlation of r = 0.249 with INQ. Accordingly the type 5 with oil is regarded as the better food group type than the type 6 with oil & sugar. Since better result was shown in the composition of six groups with Kant's minimum amount, the comparative analysis on both of type1 with oil and oil & sugar was finally performed. Then oil added type 1 showed higher correlation of DDS and indices of diet quality. These result indicated that it would be more appropriate to use six food groups with separate vegetable and fruit including oil group (oil-added type 1) rather than oil & sugar group for evaluation of dietary quality of Korean adolescents using DDS.

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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