• 제목/요약/키워드: skin and structure

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한국표준질병사인분류중 한방내과영역의 분류체계 개선 및 진단명 구성에 관한 연구 (The Research about the Classification System Improvement and Cord Development of Korean Classification of Disease on Oriental Internal Medicine)

  • 이원철
    • 대한한방내과학회지
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    • 제31권1호
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    • pp.1-10
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    • 2010
  • Objectives : It is necessary that the international classification of diseases (ICD) be examined in order to comprise the third revision of the Korean Classification of Disease on Oriental Medicine (KCD-OM) and disease classification in the oriental internal medicine field. It is essential that the selection, classification and definition of disease and pattern names of oriental concepts in internal medicine be clear. Since 2008, the fifth revision of the Korean Classification of Disease (KCD-5) has been used in Korea. It was required to use the reference classification from the Oriental medicine area based on the ICD-10. Methods : In this review, the necessity for, meaning of and content of the third revision are briefly described. The ICD system was reviewed and KCD-OM was reconstructed. How diagnosis in the oriental internal medicine area had changed is discussed. Review and Results : In 1973, the disease classification of oriental medicine was established the basis on the contents of Dongeuibogam. It was irrespective of the ICD. As to the classification system in the Oriental internal medicine field, systemic disease was comprised of wind, cold, warm, wet, dryness, heat, spirit, ki, blood, phlegm and retained fluid, consumptive disease, etc. Diseases of internal medicine comprised a system according to the five viscera and the six internal organs and followed the classification system of Dongeuibogam. The first and second revisions were of the classification system based on the curriculum in 1979 and 1995. In 1979, in the first revision, geriatric disease and idiopathic types of disease were deleted, and skin disease was included among surgery diseases. This classification was expanded to 792 small classification items and 1,535 detailed classification items to the dozen disease classes. In 1995, in the second revision, it was adjusted to 644 small classes and 1,784 detailed classification items in the dozen disease classes. KCD-OM3 did KCD from this basis. It added and comprised the oriental medical doctor's concept names of diseases considering the special conditions in Korea. KCD-OM3 examined the KCD-OMsecond revised edition (1994). It improved the duplex classification, improper classifications, etc. It is difficult for us to separate the disease names and pattern names in oriental medicine. We added to the U code and made one classification system. By considering the special conditions in Korea, 169 codes (83 disease name codes, 86 pattern name codes) became the pre-existence classification and links among 306 U codes of KCD-OM3. 137 codes were newly added in the third revision. U code added 3 domains. These are composed of the disease name (U20-U33, 97 codes), the disease pattern name (U50-U79, 191 codes) and the constitution pattern name of each disease (U95-U98, 18 codes). Conclusion : The introduction of KCD-OM3 conforms to the diagnostic system by which oriental medical doctors examine classes used with the basic structure of the reference classification of WHO and raises the clinical study and academic activity of the Korean oriental medicine and makes the production of all kinds of nation statistical indices possible. The introduction of KCD-OM3 promotes the diagnostic system by which doctors of Oriental medicine examine classes using the association with KCD-5. It will raise the smoothness and efficiency of oriental medical treatment payments in the health insurance, automobile insurance, industrial accident compensation insurance, etc. In addition, internationally, the eleventh revision work of the ICD has been initiated. It needs to consider incorporating into the International Classification of Diseases some of every country's traditional medicine.

중환자실 간호사의 기초간호과학 지식의 필요성 분석 (A Study of Content Analysis on ICU(Intensive Care Unit) Nurses' Knowledge of Basic Nursing Sciences)

  • 변영순;최명애;김희승;박미정;서화숙;이경숙;최스미;홍해숙
    • Journal of Korean Biological Nursing Science
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    • 제4권1호
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    • pp.41-49
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    • 2002
  • The purpose of this study was to identify the knowledge contents of basic nursing sciences needed by nurses in the practices of the intensive care unit(ICU). To attain the goal of this study, the nurses working at 10 hospitals in the areas of Seoul and Kangwon Province were randomly selected. They were primarily interviewed, and the open question was secondarily put to them through the questionnaire. In the process of the 1st interview, the interviewees were asked of the question, "What is the knowledge of basic sciences such as anatomy, pathology, physiology. microbiology, pharmacology and the like thought to be lacking when you communicate with doctors in the ICU and when you carry out your nursing practices in it?" The contents of the interview were tape-recorded. The period of data collection ranged from May 1, 2001 to Sept 30. The interviews were conducted with total of 20 nurses. The open-end questionnaire was secondarily mailed to nurses. 113 questionnaires were returned. 100 questionnaires except 13 ones thought to be poorly completed in content were used for data analysis. Three coders classified data obtained from the interview and the questionnaire research into 5 detailed items relating to such as anatomical physiology, pathology, pharmacology. microbiology and basics of nursing. The three coders had experiences in nursing education of 18 years, 8 years and 6 years, respectively, and of them one coder was professor in basic nursing sciences. Data were statistically treated using frequency analysis and percentage by the SAS program. As a result, the following findings were obtained : It was found that the contents that ICU nurses responded were most needed in the field of Human structure and function were water and electrolytic balance(38%), blood and circulatory system(20%), changer in the patient's skin(12%), the arrangement of the human body(10%) and the endocrine system(10%), nervous system(6%), and assessment of the state of the patient's consciousness(4%). It was found that the contents that ICU nurses responded were most needed in the field of pathology were found to be the process of the progress of the disease(32%), symptoms of the disease(27%), prognosis of the disease(22%), followed by the injury-healing process, clinical pathological examination, and examination by radiation. It was found that the contents that nurses responded were most needed in the field of pharmacology were the effect of drug(25%), the side effect of drug(22%), the relationship between diseases and drug(20%), the relationship between disease-causing bacteria and drug(20%) and chemotherapy(2%). It was found that the contents that ICU nurses responded were most needed in the field of microbiology were the relationship between diseases and disease-causing bacteria(45%), Kinds and characteristics of disease-causing bacteria(18%), infection control(16%), application of the aseptic technique(12%), isolation(9%) and the like. It was found that the basic knowledge that ICU nurses responded were needed were the identification of the patient's current state(36%), understanding of the therapeutic process(22%), the operating principle of medical equipment and instrument(20%), medical terminology(9%), equipment and instrument management(7%), calculation of the dose of injection(2%) and the like.

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전신 정위 고정장치 제작과 임상효과에 대한 연구 (The Clinical Effect and Construction of a Stereotactic Whole Body Immobilization Device)

  • 정진범;정원균;서태석;최경식;진호상;지영훈
    • 한국의학물리학회지:의학물리
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    • 제15권1호
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    • pp.30-38
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    • 2004
  • 목적: 방사선 치료 시 환자의 움직임을 최대한 고정시켜 줄 수 있으며 환자 자세에 대한 Setup 오차를 감소시키고 환자 전신에 산재한 병소를 위치화하고 좌표화할 수 있는 전신 정위 고정장치 제작과 제작한 고정장치에 대한 고정효과 및 재현성을 나타내는 환자 자세의 Setup 오차를 평가하였다. 대상 및 방법: 자체 제작한 고정장치는 크게 기본판(base plate)과 고정틀(Immobilizer), Vacuum cushion, 벨트로 이루어진다. 기본판은 50${\times}$130${\times}$1 ㎤ 베크라이트로 고정틀은 견고한 아세탈 재질을 사용하여 제작하였다. 초기의 Lax frame의 경우, side panel에 부착되어 있는 좌표계(coordinates)를 기본판 바닥에 radiopaque catheter wire를 사용하여 N 타입으로 새겨서 넣어 위치측정이 가능한 좌표계로 적용할 수 있도록 하였다. 제작된 고정장치에 대한 성능실험으로 방사선 투과율 측정 실험과 가상표적을 부착한 지원 환자를 대상으로 표적에 대한 위치측정실험이 수행되었다. 그리고 CCTV 카메라와 Digital Video Recorder (DVR)를 이용하여 획득된 환자 영상을 Matlab 프로그램으로 환자 자세에 대한 Setup 오차를 분석하였다. 결과: 전신 정위 고정장치는 CT 촬영과 방사선치료 시 사용 가능성에 중점을 두고 제작되었다. 이 고정장치의 구조는 갠트리의 회전각의 변화에 따라 충돌하지 않게 제작되었고 측면으로 경사지게 입사되는 빔의 투과율을 최대화할 수 있게 제작되었다. 고정틀의 고정효과를 높여주는 고정벨트는 입사된 빔의 방향에 방해되지 않게 제작되었다. 고정장치에 대한 방사선 투과율은 10과 21 MV의 에너지에서 95, 95%로 측정되었고 지원 환자에 부착한 가상 표적의 위치는 CT 촬영으로 파악할 수 있었다. Matlab 프로그램으로 분석한 setup 오차는 흉부의 측면과 중심부위에서 3.69$\pm$1.60, 2.14$\pm$0.78 mm이고 복부의 측면과 중심부위에서 7.11$\pm$2.10, 6.54$\pm$2.22 mm이며 여자 환자 경우, 가슴 측면의 Setup 오차는 6.33$\pm$1.55 mm으로 측정되었다. 결론: 전신 정위 고정장치의 제작과 실험을 통해 extra-cranial 암에 대한 방사선수술에서 매우 실용적이고 유용하게 사용될 것으로 사료되며 표적 위치 결정과 환자 고정 도구로서 사용될 것이다. 더 많은 환자 치료자세의 Setup 오차 측정이 수행되면 정확한 환자의 Setup 오차의 결과를 향상시킬 수 있을 것으로 기대된다.

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착유우의 톱밥발효우사 이용연구 제 1 보 : 낙농가의 톱밥발효우사 형태별 이용효과 비교 (Study on the Utilization of Sawdust Bedding Barn for Dairy Cows)

  • 권두중;권응기;기광석;이기종;한정대;정석찬;강승원;강상열;정형섭;장학주
    • 한국축산시설환경학회지
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    • 제1권1호
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    • pp.9-19
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    • 1995
  • This study was carried out to investigate the effect of sawdust bedding barn on manure handing, management labour and physiological aspect of dairy cows, and then to establish the criteria on the optimum utilization method of sawdust bedding barn. 46 tie stall barns and 49 sawdust bedding barns were surveyed to cmopare the milk productivity between two different barns, and also 5 tie stall barns, 15 sawdust bedding barns and 1 rice hull bedding barn were selected to study the utilization situation of sawdust barn in Kyung-Ki province area. The major results obtained were as follows; 1. The roof material of sawdust barn were consisted of 66% vinyl house, 23% PVC light and 11% slate and galvanum coated tin. Most of the floor structure was earth ground with the rate of the approximately 82%. 2. The average occupied area of sawdust bed per cow was 15.2 $m^2$, depth that 30 cm and the utilization period was 12 months. 3. Milk Yield was significantly higher at sawdust barn than at tie stall barn(P<0.01). Bacterial and somatic cell count in raw milk were less at the sawdust barn than in tie stall barn. However, there was not significance difference between two barns. 4. The labour hour needed to cow management in the sawdust barn was approximately 48% of that of tie stall barn. 5. The temperature and moisture content measured in sawdust bed were closely affected by seasonal ambient temperature. The skin and hair of cow were much cleaner at the PVC light roofed sawdust barn than any other roof materials. 6. The additives used for improving of fermentation did not show any effect on temperature and moisture content in sawdust bed. When the ambient temperature was $30.4^{\circ}C$, the surface temperature of measured 1 cm above the sawdust bed was $12.2^{\circ}C$ lower and the temperature of 100 cm above the sawdust bed was $2.4^{\circ}C lower under shading net facility than that of vinyl roofed one.7. The hoof length of miking cow was 7.95 cm in tie stall and 9.19 cm in sawdust barn with high significance (P<0.01). And disease occurence such as mastitis and foot-rot tended to decrease in the sawdust barn. 8. The number of total bacteria and coliform bacteria were less in the sawdust bed compared with earth ground resting area. And a parasite strongyloides papillosus was detected but without any infected cow. 9. The nitrate($NO_3N$) content in non-roofed earth ground resting area and earth ground under the sawdust bed was likely to pollute the ground water. 10. In economic point of view, rice hull bedding barn was the cheapest among different systems. And in the sawdust bedding barn PVC light + slate roofed barn was most desirable, and vinyl roofed one the least.

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계면활성제에 의해 유도되는 농약의 엽면 침투성 연구 현황 (Review of the study on the surfactant-induced foliar uptake of pesticide)

  • 유주현;조광연;김정한
    • 농약과학회지
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    • 제6권1호
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    • pp.16-24
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    • 2002
  • 농약의 식물 엽면 침투성에 관하여 보고한 국내외 논문을 조사하여 최근에 빈번하게 사용되고 있는 침투율 측정법과, 계면활성제에 의해서 유도되는 농약의 엽면 침투기작에 관한 연구 동향을 고찰하였다. 농약의 식물 엽면 침투성 연구에는 생물검정법, 식물 잎이나 cuticular membrane을 이용하는 방사능 추적 기술이 주로 이용되고 있다. 가장 최근에는 수용성 색소 Congo Red를 추적물질로 이용하는 새로운 침투율 측정법이 제안되었다. 농약의 엽면 침투에 있어서 최대의 장벽은 epicuticular wax와 cuticular wax를 포함하는 잎 표면의 왁스층이며, 일부 연구자들은 이를 limiting skin이라 부르기도 한다. 농약의 몰부피(molar volume), 수용해도 및 분배계수 등의 이화학적 성질은 식물 엽면 침투성에 영향을 미치지만 제한적인 상관관계를 나타낼 뿐이며, 일반화할 수 있는 어떠한 상관관계도 아직 발견되지 않았다. Polyoxyethylene을 친수기로 가지는 지방족 알콜 계면활성제들은 많은 농약에 대하여 좋은 침투성 증진제로 알려져 있다. 침투성 증진제로 사용되는 계면활성제가 농약의 엽면 침투성을 증진하는 데에는 계면활성, 가용화 능력, 흡습성 및 미셀생성임계농도 등 계면활성제 고유의 성질이 크게 관여하는 것 같지는 않다. 최근의 연구에서 침투성 증진 효과가 큰 계면활성제는 식물의 왁스층에 쉽게 흡수되어 가역적으로 왁스층의 유동성을 증가시키는 가소제 역할(plasticizing effect)을 한다는 것이 밝혀졌다. 계면활성제가 왁스층에 먼저 침투하면 wax층의 유동성이 증가하고, 이로 인하여 wax층 내에서 농약의 이동성과 분배계수가 달라짐으로써 농약의 엽면 침투 속도가 변화한다는 것이다. 그러나 계면활성제의 친유기 부분인 지방족 알콜의 탄소수와 친수기의 ethylene oxide 부가중합도가 농약의 침투성 증진에서 어떠한 역할을 하는지는 상세히 밝혀져 있지 않다. 다만 계면활성제 자체의 엽면 침투 속도가 농약의 침투속도와 깊은 관련이 있을 것으로 추정되고 있다.

DICOM 파일을 사용한 Geant4 시뮬레이션과 Gafchromic EBT2 필름에 의한 인체 내 흡수선량 비교 연구 (Comparative Studies on Absorbed Dose by Geant4-based Simulation Using DICOM File and Gafchromic EBT2 Film)

  • 모은희;이상호;안성환;김종일
    • 한국의학물리학회지:의학물리
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    • 제24권1호
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    • pp.48-53
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    • 2013
  • 몬테카를로 방식은 지금까지 인체 내 흡수선량을 계산하는 가장 정확한 방법으로 알려져 왔고. 이러한 계산 방법을 이용하기 위한 인체 내부의 장기 묘사는 인체 모형 팬텀이 주로 사용되어 왔다. 그러나 최근 Geant4 코드를 사용한 몬테카를로 계산에서는 CT의 DICOM 파일에서 인체의 여러 장기에 대한 자료를 직접 추출하고 시뮬레이션에 필요한 geometry로 변환하여 사용하려는 다양한 노력이 시도되고 있다. 이와 같은 기능은 실제 인체의 해부학적 구조를 그대로 재현하면서 인체 내부의 흡수선량을 정확히 계산 할 수 있도록 한다. 따라서 본 연구에서는 DICOM 파일을 연동한 Geant4을 이용하여 인체 내 흡수선량을 계산하였고, 이를 Gafchromic EBT2 필름을 이용한 측정 선량과 비교함으로써 그 유용성을 확인하고자 하였다. 본 연구에서 시뮬레이션을 이용하여 계산한 선량과 EBT2 필름을 이용한 선속 중심축에서의 측정선량을 비교한 결과 피부표면에서부터 최대선량 깊이까지 선량이 급격하게 변화하는 build up 영역을 제외하고는 오차(difference) 범위가 평균 3.75% 임을 알 수 있었다. 또한 선량의 계산 값을 각 CT slice 별로 출력되도록 하였고, 또 각 slice에서도 복셀 하나하나의 선량 값이 출력되도록 하여 측정하고자 하는 장기별, 기관별 흡수선량을 쉽게 확인 할 수 있도록 하였다. 이처럼 인체 모형 팬텀이 아닌 실제 인체의 image data인 CT DICOM 파일을 이용한 선량계산을 각 slice, voxel 별로 선량 값을 출력하는 방식은 다양한 부위의 정확한 선량계산을 가능하게 하므로 향후 방사선 치료계획 시스템의 선량 계산에 유용할 것이라 생각한다. 또한 현재 사용 중인 여러 에너지 영역에도 적용이 가능하므로 인체 내 방사선의 흡수선량 확인을 위해 유용하게 활용되어질 수 있을 것으로 생각된다.

제주도 난대림에서 노루 뿔의 성장과정에 의한 어린나무 박피에 관한 연구 (Peeling Damage of Sapling caused by the Developing Process of Roe Deer Antlers in Warm-temperate Forests of Jeju Island)

  • 김은미;박영규;권진오;김지은;강창완;이치봉
    • 한국농림기상학회지
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    • 제14권4호
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    • pp.254-259
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    • 2012
  • 산림에서 나무껍질이 벗겨지는 피해는 노루를 비롯한 사슴과에 속하는 포유류에 의해 발생하며 먹이 부족이 주요 원인이다. 그러나 제주도에서는 뿔이 녹각으로 되는 과정에서 벨벳을 벗겨내는 행동에 의해 나무껍질이 벗겨지는 피해가 발생하여 이들을 살펴보았다. 국립산림과학원 한남시험림내의 해발 400m에서 500m 사이에 위치한 6km구간의 임도 주변 5m지역을 대상으로 2011년 9월 9일부터 10월 4일까지 맑은날을 택하여 본조사를 실시하였다. 노루가 뿔로 긁은 피해목은 총 25종, 267본이었으며 낙엽활엽수가 18종 134본, 상록활엽수가 5종 71본, 나머지 2종 62본은 침엽수였다. 뿔 긁기로 가장 선호하는 수종은 굴거리나무(Daphniphyllum macropodum), 삼나무(Cryptomeria japonica), 비목(Lindera erythrocarpa), 누리장나무(Clerodendrum trichotomum), 산초나무(Zanthoxylum schinifolium) 순이었다. 피해목은 주로 3~4년생의 어린나무이며 평균 수고는 $120.7{\pm}42.4cm$이었고, 지상 5cm 높이에서의 직경은 $1.5{\pm}0.5cm$, 피해 시작점(최저점)은 지상에서부터 평균 $22.1{\pm}10.1cm$ 지점이었고, 피해길이는 평균 $27.5{\pm}10.6cm$이었다. 나무껍질이 벗겨지면 이차적으로 균류의 침입을 받게 되며 이로 인해 어린나무의 외형이 변하거나 죽게 되어 난대림의 향후 종 구성에 영향을 야기할 수 있다. 기후변화에 따른 제주도 산림의 식생변화가 예견되는 시점에서 노루의 뿔에 의한 피해는 난대림의 자연 갱신은 물론 조림과 묘목생산 그리고 지속적인 산림경영에 영향을 미칠 것으로 판단된다.

동양배 '신고'와 '사과배' 과실의 저장 중 세포벽 특성의 변화 비교 (Comparison of Changes in Cell Wall Characteristics during Storage in 'Niitaka' and 'Pingguoli' Pear Fruits)

  • 김진국;박일룡;천종필;카타오카이쿠오;황용수
    • 농업과학연구
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    • 제36권1호
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    • pp.1-10
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    • 2009
  • 동양배 '신고'와 '사과배'의 저장기간 중 서로 다른 생리적 특성과 세포벽 특성 변화를 비교 검토하여 과실생리 및 저장기술의 기초자료로 얻고자 본 실험을 실시하였다. 저장 기간 중 '신고'의 품질변화는 중량감소가 큰 반면, '사과배'에서는 급격한 호흡급등현상과 에틸렌 생합성이 많았으며, 전분감소가 컸다. 수용성 펙틴함량은 '신고'가 '사과배'보다 높았으며 CDTA-가용성 펙틴은 두 품종간의 차이가 크지 않았다. $Na_2CO_3$-가용성 펙틴은 '사과배'가 '신고'보다 높았으며 수용성 펙틴과는 달리 저장 기간이 길어질수록 증가하였다. 4% 및 24% KOH 가용성 펙틴은 저장기간에 따른 변화 폭이 크지 않았다. 수용성 펙틴의 분획 결과,'신고'와 '사과배' 저장 중 거대 분자의 구조 변화에서 많은 차이를 보였고, '신고'와 '사과배' 모두 저장 기간이 길어질수록 펙틴의 가수분해 및 측쇄 사슬의 당 분해가 관찰되었다. $Na_2CO_3$-가용성 펙틴의 경우 당 분포는 저장 기간에 관계없이 일정하였지만 펙틴은 분자량 변화가 컸다. 4% 및 24% KOH 가용성 펙틴의 분획 결과 두 품종에 있어 헤미셀룰로스의 구조 변화가 서로 달라, '사과배'의 경우는 4% KOH 가용성 추출물의 분획에서 세포벽을 구성하고 있는 당들의 가수분해가 컸으며 '신고' 보다 '사과배'에서 노화 과정 중 헤미셀룰로스의 변화가 더 심하였다.

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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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