• Korean Journal of Psychosomatic Medicine
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• v.12 no.2
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• pp.165-173
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• 2004

Objectives: Diabetes mellitus is a heterogeneous, chronic, progressive disease characterized by hyperglycemia and abnormality in protein, carbohydrate, fat metabolism. Recent studies have reorted two times prevalence of depression in individuals with diabetes compared to individuals without diabetics. This study was designed to investigate glycemic controls, anxiety, alexithymia, stress responses between depressed diabetic patients and non-depressed diabetic patients. Methods The subjects were 60 diabetic patients(mean age : $50.3{\pm}9.7$ years, 31 men and 29 women) who were confirmed to have diabetes depending on the laboratory findings as welt as clinical symptoms at the St. Vincent Hospital Diabetes Clinic, from Mar. 2004 to Sep. 2004. Laboratory test including, blood chemistry. glycated hemoglobin, urinalysis for proteinuria and Korean version of Beck Depression Inventory(BDI), State and Trait Anxiety Inventory(STAI), Toronto Alexithymia Scale(TAS) and Stress Response Inventory(SRI) were used for assessment. Based on BDI scores, all diabetics were divided into 13 depressed-diabetics group(above 20 point) and 47 non-depressed group(below 20 point). We compared demographic data. glycemic controls, STAI, TAS and SRI scores between two groups by independent t-test. Results : 1) Depressed diabetic groups were 13(mean age : $55.4{\pm}7.2$ years, 7 men and 6 women) and non depressed groups were 47(mean age $48.9{\pm}9.8$ years, 24 men and 23 women). In depressed diabetics, compared with non-depressed group, manifested aged(p=0.031), but other demographic data showed no difference between two groups. 2) No significant differences were noted in FBS, PP2h, Hb A1C, total cholesterol, HDL-cholesterol, SGOT/SGPT, BUN levels between depressed and non-depressed groups. But, blood creatine levels of depressed group were significantly increased than non-depressed group(p=0.026). 3) No significant differences were found in the score of STAI, STAI-S, STAI-T, TAS between depressed and non-depressed groups. 4) The SRI scores of depressed groups were significantly higher than non-depressed groups$(59.7{\pm}24.9\;vs.\;31.5{\pm}22.0)(p=0.000)$. Conclusion : The above results suggest that depressed diabetic patients are have more stress responses and higher blood creatine levels. However, there were no differences in laboratory data related to glycemic controls, and anxiety. alexithymia levels between two groups. We suggest that physicians should consider integrated approaches for psychiatric problems in the management of diabetes.

• The Journal of Korean Society for Radiation Therapy
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• v.23 no.1
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• pp.21-29
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• 2011

Purpose: The purpose of this master's thesis is to utilize basic data in order to improve the quality of life of cancer patients who received radiation therapy after analysing related factors that influence patient's quality of life and obtaining information about physical, mental problems of patients. Materials and Methods: By using a structured questionnaire about various characteristics and forms of support, I carried out a survey targeting 107 patients that experienced radiation therapy at a university hospital in the Daejeon metropolitan area from July 15 to August 15, 2010 and analysed the factors influencing quality of life. Results: In case of pain due to disease, 65.15 and painless 81.87 showed a high grade quality of life. As body weight decreases, the quality of life become lower. When the grade of quality of life according to economic characteristics was compared, all items except treatment period showed a difference (P=0.000). When the score of social support, family support, medical support and self-esteem was low, the mark of quality of life showed respectively 61.71, 68.77, 71.31, and 69.39 on the basis of 128 points. When the score of support form was high, the mark of quality of life showed 90.47, 83.29, 90.40, and 90.36 (P<0.05). When analyzing the correlation between social support, family support, medical support and self-esteem and the degree of quality of life, social support was 0.768, family support 0.596, medical support 0.434, self-esteem 0.516. They indicated the correlation of meaningful quantity statistically (P<0.01). The factors that improved the quality of life were married state, having a job and painless status. As monthly income increases, the quality of life was also much improved (P<0.05). Among the factors related to quality of life, social support and medical support and higher self-esteem scores of the quality of life score increased 0.979 point, 0.508 points and 1.667 point, respectively. Conclusion: In conclusion, the quality of life of cancer patients that received radiation treatment is related to social support, medical support and self esteem. Self-esteem is an important factor that influenced quality of life, so if government offers works that doesn't affect patient's health, they are a useful method that maximize self-esteem and lessen their financial burden at the same time. Along with these policies, the developments of the attention of medical and the program for cancer patient's family are needed for the purpose of improving quality of life of cancer patients. Lastly, medical team, patients and family have to cooperate in harmony to overcome difficulties of cancer patients.

• Journal of agricultural medicine and community health
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• v.26 no.1
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• pp.19-35
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• 2001

This study was conducted to investigate the internal changes and the countermeasure for performance improvement by Separation of Prescribing and Dispensing Practice (SPDP) in Health Center. Data were collected from two sources: Performance report before and after SPDP of 25 Health Centers in Kyongsangbuk-do and 6 Health Centers in Daegu-City and self-administerd questionnaire survey of 221 officials at health center. The results of this study were summarized as follows: Twenty-four health centers(77.4%) of 31 health centers took convenience measures for medical treatment of citizens and convenience measures were getting map of pharmacy, improvement of health center interior, introduction of order communication system in order. After the SPDP in health centers, 19.4% of health centers increased doctors and 25.8% decreased pharmacists. 58.1% of health centers showed that number of medical treatments were decreased. 96.4%, 80.6% 80.6% 96.7% of health centers showed that number of prescriptions, total medical treatment expenses, amounts paid by the insureds and the expenses to purchase drugs, respectively, were decreased. More than fifty percent(54.2%) of health centers responded that the relative importance of health works increased compared to medical treatments after the SPDP, and number of patients decreased compared to those in before the SPDP. And there was a drastic reduction in number of prescriptions, total medical treatment expenses, amounts paid by insureds, the expenses to purchase drugs after the SPDP. Above fifty percent(57.6%) of officers at health center responded that the function of medical treatment should be reduced after the SPDP. Fields requested improvement in health centers were 'development of heath works contents'(62.4%), 'rearrangement of health center personnel'(51.6%), 'priority setting for health works'(48.4%), 'restructuring the organization'(36.2%), 'quality impro­vement for medical services'(32.1%), 'replaning the budgets'(23.1%) in order. And to better the image of health centers, health center officers replied that 'health information management'(60.7%), 'public relations for health center'(15.8%), 'kindness of health center officers'(15.3%) were necessary in order. Health center officers suggested that 'vaccination program', 'health promotion', 'maternal and children health', 'communicable disease management', 'community health planning' were relatively important works, in order, performed by health center after SPDP. In the future, medical services in health centers should be cut down with a momentum of the SPDP so that health centers might reestablish their functions and roles as public health organizations, but quality of medical services must be improved. Also health centers should pay attention to residents for improving health through 'vaccination program', 'health promotion', 'mother-children health', 'acute and chronic communicable disease management', 'community health planning', 'oral health', 'chronic degenerative disease management', etc. And there should be a differentiation of relative importance between health promotion services and medical treatment services by character of areas(metropolitan, city, county).

• Journal of agricultural medicine and community health
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• v.27 no.2
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• pp.75-86
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• 2002

This study was conducted to investigate the changes in patients and medical services before and after the Separation of Prescription and Dispensing in Health Center. For the purpose of this study, prescription data of 5,890 prescribed patients in March 2000(before the Separation of Prescription and Dispensing) and 3,496 prescribed patients in March 2001(after the Separation) in 4 Health Centers located in Gyeongsangbuk-do and Gyeongsangnam-do were collected. For investigation of the change of character of prescribed patients and the disease, sex, age, chief diagnosis, the hind of medical insurance, days of visit, days of prescription were investigated by using National Health Insurance claim data. And for investigation of change of prescription, prescribed drugs per each claim, the use rate of antibiotics, injection, and high-price antiphlogistic drug were investigated for acute respiratory disease and musculoskeletal disease. The major results were as follows: For the changes of prescribed patients of each disease, patients with acute respiratory disease were decreased by 49.7% after the Separation of Prescription and Dispensing than before the Separation of Prescription and Dispensing and patients with hypertension(18.1%), patients with musculoskeletal disease(70.5%), patients with diabetes(8.5%), patients with digestive organ disease(71.2%), patients with chronic respiratory disease(76.4%) were decreased. But patients with urethritis were increased by 66.7%. The mean Health Center visited days of prescribed patients decreased significantly after the Separation of Prescription and Dispensing than before in both male and female(p<0.01) and in health insurance patients(p<0.01). For the each of the disease, hypertension, diabetes, musculoskeletal disease decreased. The mean prescribed days increased after the Separation of Prescription and Dispensing than before(p<0.01). According to the kine of disease, the mean prescribed days increased after the Separation of Prescription and Dispensing than before in all the diseases except the urethritis(p<0.01). For acute respiratory diseases, number of prescribed drugs per each claim decreased significantly after the Separation of Prescription and Dispensing(4.7 drugs) than before(4.9 drugs) and the prescription rate of injection decreased significantly from 63.8% to 7.70%, and the prescription rate of antibiotics decreased significantly from 337% to 19.1%(p<0.01). For musculoskeletal diseases before and after Separation of Prescription and Dispensing, number of prescribed drugs per each claim decreased significantly from 3.7 to 3.2 and the prescription rate of injection decreased significantly from 64.9% to 1.7%, and the prescription rate of high-price antiphlogistic drugs increased significantly from 29.1% to 397%(p<0.01). In consideration of above findings, the mean visited days decreased and on the contrary, the mean prescribed days per each prescription increased after Separation of Prescription and Dispensing than before in health centers. For the prescription pattern of physicians, number of prescribed drugs and the prescription rates of injection and antibiotics per each claim decreased, but the prescription rate of high-price antiphlogistic drugs increased after Separation of Prescription and Dispensing.

• Journal of Chest Surgery
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• v.37 no.10
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• pp.845-855
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• 2004

Background: No general consensus has been available regarding the necessity of postoperative radiation therapy (PORT) and its optimal techniques in the patients with chest wall invasion (pT3cw) and node negative (N0) non-small cell lung cancer (NSCLC). We did retrospective analyses on the pT3cwN0 NSCLC patients who received PORT because of presumed inadequate resection margin on surgical findings. And we compared them with the pT3cwN0 NSCLC patients who did not received PORT during the same period. Material and Method: From Aug. of 1994 till June of 2002, 22 pT3cwN0 NSCLC patients received PORT-PORT (＋) group- and 16 pT3cwN0 NSCLC patients had no PORT-PORT (-) group. The radiation target volume for PORT (＋) group was confined to the tumor bed plus the immediate adjacent tissue only, and no regional lymphatics were included. The prognostic factors for all patients were analyzed and survival rates, failure patterns were compared with two groups. Result: Age, tumor size, depth of chest wall invasion, postoperative mobidities were greater in PORT (-) group than PORT (＋) group. In PORT (-) group, four patients who were consulted for PORT did not receive the PORT because of self refusal (3 patients) and delay in the wound repair (1 patient). For all patients, overall survival (OS), disease-free survival (DFS), loco-regional recurrence-free survival (LRFS), and distant metastases-free survival (DMFS) rates at 5 years were 35.3%, 30.3%, 80.9%, 36.3%. In univariate and multivariate analysis, only PORT significantly affect the survival. The 5 year as rates were 43.3% in the PORT (＋) group and 25.0% in PORT (-) group (p=0.03). DFS, LRFS, DMFS rates were 36.9%, 84.9%, 43.1 % in PORT (＋) group and 18.8%, 79.4%, 21.9% in PORT(-) group respectively. Three patients in PORT (-) group died of intercurrent disease without the evidence of recurrence. Few suffered from acute and late radiation side effects, all of which were RTOG grade 2 or lower. Conclusion: The strategy of adding PORT to surgery to improve the probability not only of local control but also of survival could be justified, considering that local control was the most important component in the successful treatment of pT3cw NSCLC patients, especially when the resection margin was not adequate. Authors were successful in the marked reduction of the incidence as well as the severity of the acute and late side effects of PORT, without taking too high risk of the regional failures by eliminating the regional lymphatics from the radiation target volume.

• Journal of the Korean Society of Food Science and Nutrition
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• v.34 no.6
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• pp.840-849
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• 2005

In order to investigate the relationship between intake conditions of health food and health-related factors by residence and sex in Tong-Young area, a survey was carried out from 1,303 adults. Health foods were classified 3 groups including vitamin and mineral supplements, toner foods and manufactured health food supplements. Health-related factors were stress, fatigue, smoking and drinking. The $29.5\%$ of the subjects had taken some health food for health. Especially the male took more toner foods habitually than the female did. In take of vitamin and mineral supplements by residence, there was a significant difference $(p\leq0.01)$ as follows. The subjects in island $(20.0\%)$ who took vitamin/mineral supplements were about two times as compared with the subjects in Dong $(10.8\%)$, or Eub-Myeon $(10.0\%)$. The subjects taking supplementary food replied over fair $(82.8\%)$, the subjects taking toner food replied over fair (90.3$\%$) scored higher than who replied bad or very bad in self-perceived health status. Therefore, the better the subjects felt self-perceived health status, the more they took health foods for health themselves. In self-perceived stress status, the subjects who replied a little $(50.0\%,\;45.3\%)$ or little $(19.9\%,\;26.4\%)$, took vitamin and mineral supplements or manufactured health foods a lot. In toner food there was a significant correlation $(p\leq0.05)$ as follows. The less the subjects felt stress, the more they took dietry supplement. No smoker $(12.9\%)$intake rate of vitamin and mineral supplements was higher than smoker $(8.8\%)$. Smokers $(6.5\%)$ intake rate of toner food was higher than no smoker $(4.0\%)$. It was not significant the relationship between intake condition of health food and drinking. The main motivation for taking health food were by self-decision and invitation of friends or neighbors.

• Journal of Hospice and Palliative Care
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• v.6 no.1
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• pp.22-33
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• 2003

Purpose : The purpose of this study was to evaluate the present status of patients' satisfaction and the reasons for any satisfaction or dissatisfaction in cancer pain management Methods : A cross-sectional survey was used to obtain the feedback about pain management. The results of the survey were collected from 59 in- or out-patient who had cancer treatment at two of the teaching hospitals in Seoul from July, 2002 to November, 2002. The data was obtained by a structured questionnaire based on the American Cancer Society Patient Outcome Questionnaire(APS-POQ) and other previous research. The clinical information for all patients were compiled by reviewing their medical records. Resuts : 1) The subjects' mean score of the worst pain was 6.77, the average pain score was 3.80, and the pain score after management was 2.93 for the past 24 hours. The mean score of total pain interference was $25.03{\pm}12.82$. Many of the subjects had false beliefs about pain such as 'the experience of pain is a sign that the illness has gotten worse', 'pain medicine should be 'saved' in case the pain gets worse' and 'people get addicted to pain medicine easily'. 2) 66.1% of the subjects were properly medicated with analgesics. 33.9% of the subjects reported use of various methods in controlling pain other than the prescribed medication. Only 33.9% of the subjects had a chance to be educated about pain management by doctors or nurses. 3) The mean score of patients' satisfaction with pain management was $4.19{\pm}1.14$. 72.9% of the subjects answered 'satisfied' with pain management. The reasons for dissatisfaction were 'the pain was not relieved even after the pain management', 'I was not quickly and promptly treated when I complained of pain', 'doctors and nurses didn't pay much attention to my complaints of pain.', and 'there was no appropriate information given on the methods of administration, effect duration and side effects of pain medicine.' The reasons for satisfaction were: 'the pain was relieved after the pain management.', 'doctors and nurses quickly and promptly controlled my pain.', 'doctors and nurses paid enough attention to my complaints of pain.' and 'trust in my physician'. 4) In pain severity or pain interference, no significant difference was found between the satisfied group and dissatisfied group. On the belief 'good patients avoid talking about pain', a significant difference was found between the satisfied group and dissatisfied group. Conclusions : The patients' satisfaction with cancer pain management has increased over the years but still about 30% of patients reported to be 'not satisfied' for various reasons. The results of this study suggest that patients' education should be done to improve satisfaction in the pain management program.

• Journal of Food Hygiene and Safety
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• v.37 no.6
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• pp.373-384
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• 2022

Fluoxastrobin a fungicide developed from Strobilurus species mushroom extracts, can be used as an effective pesticide to control fungal diseases. In this study, we optimized the extraction and purification of fluoxastrobin according to its physical and chemical properties using the QuEChERS method and developed an LC-MS/MS-based analysis method. For extraction, we used acetonitrile as the extraction solvent, along with MgSO₄ and PSA. The limit of quantitation of fluoxastrobin was 0.01 mg/kg. We used 0.01, 0.1, and 0.5 mg/kg of five representative agricultural products and treated them with fluoxastrobin. The coefficients of determination (R²) of fluoxastrobin and fluoxastrobin Z isomer were > 0.998. The average recovery rates of fluoxastrobin (n=5) and fluoxastrobin Z isomer were 75.5-100.3% and 75.0-103.9%, respectively. The relative standard deviations (RSDs) were < 5.5% and < 4.3% for fluoxastrobin and fluoxastrobin Z isomer, respectively. We also performed an interlaboratory validation at Gwangju Regional Food and Drug Administration and compared the recovery rates and RSDs obtained for fluoxastrobin and fluoxastrobin Z isomer at the external lab with our results to validate our analysis method. In the external lab, the average recovery rates and RSDs of fluoxastrobin and fluoxastrobin Z isomer at each concentration were 79.5-100.5% and 78.8-104.7% and < 18.1% and < 10.2%, respectively. In all treatment groups, the concentrations were less than those described by the 'Codex Alimentarius Commission' and the 'Standard procedure for preparing test methods for food, etc.'. Therefore, fluoxastrobin is safe for use as a pesticide.

• Journal of Wetlands Research
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• v.18 no.4
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• pp.474-480
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• 2016

In this study, formation background of biodiversity and its changes in the process of geologic history, and effects of climate change on biodiversity and human were discussed and the alternatives to reduce the effects of climate change were suggested. Biodiversity is 'the variety of life' and refers collectively to variation at all levels of biological organization. That is, biodiversity encompasses the genes, species and ecosystems and their interactions. It provides the basis for ecosystems and the services on which all people fundamentally depend. Nevertheless, today, biodiversity is increasingly threatened, usually as the result of human activity. Diverse organisms on earth, which are estimated as 10 to 30 million species, are the result of adaptation and evolution to various environments through long history of four billion years since the birth of life. Countlessly many organisms composing biodiversity have specific characteristics, respectively and are interrelated with each other through diverse relationship. Environment of the earth, on which we live, has also created for long years through extensive relationship and interaction of those organisms. We mankind also live through interrelationship with the other organisms as an organism. The man cannot lives without the other organisms around him. Even though so, human beings accelerate mean extinction rate about 1,000 times compared with that of the past for recent several years. We have to conserve biodiversity for plentiful life of our future generation and are responsible for sustainable use of biodiversity. Korea has achieved faster economic growth than any other countries in the world. On the other hand, Korea had hold originally rich biodiversity as it is not only a peninsula country stretched lengthily from north to south but also three sides are surrounded by sea. But they disappeared increasingly in the process of fast economic growth. Korean people have created specific Korean culture by coexistence with nature through a long history of agriculture, forestry, and fishery. But in recent years, the relationship between Korean and nature became far in the processes of introduction of western culture and development of science and technology and specific natural feature born from harmonious combination between nature and culture disappears more and more. Population of Korea is expected to be reduced as contrasted with world population growing continuously. At this time, we need to restore biodiversity damaged in the processes of rapid population growth and economic development in concert with recovery of natural ecosystem due to population decrease. There were grand extinction events of five times since the birth of life on the earth. Modern extinction is very rapid and human activity is major causal factor. In these respects, it is distinguished from the past one. Climate change is real. Biodiversity is very vulnerable to climate change. If organisms did not find a survival method such as 'adaptation through evolution', 'movement to the other place where they can exist', and so on in the changed environment, they would extinct. In this respect, if climate change is continued, biodiversity should be damaged greatly. Furthermore, climate change would also influence on human life and socio-economic environment through change of biodiversity. Therefore, we need to grasp the effects that climate change influences on biodiversity more actively and further to prepare the alternatives to reduce the damage. Change of phenology, change of distribution range including vegetation shift, disharmony of interaction among organisms, reduction of reproduction and growth rates due to odd food chain, degradation of coral reef, and so on are emerged as the effects of climate change on biodiversity. Expansion of infectious disease, reduction of food production, change of cultivation range of crops, change of fishing ground and time, and so on appear as the effects on human. To solve climate change problem, first of all, we need to mitigate climate change by reducing discharge of warming gases. But even though we now stop discharge of warming gases, climate change is expected to be continued for the time being. In this respect, preparing adaptive strategy of climate change can be more realistic. Continuous monitoring to observe the effects of climate change on biodiversity and establishment of monitoring system have to be preceded over all others. Insurance of diverse ecological spaces where biodiversity can establish, assisted migration, and establishment of horizontal network from south to north and vertical one from lowland to upland ecological networks could be recommended as the alternatives to aid adaptation of biodiversity to the changing climate.

• Journal of the Korean association of regional geographers
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• v.3 no.2
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• pp.163-193
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• 1997

Medical services are a fundamental and essential service in all urban areas. The location and accessibility of medical service facilities and institutions are critical to the diagnosis, control and prevention of illness and disease. The purpose of this paper is to present the results of a study on the location of medical facilities in Kwangju and the utilization of these facilities by the inhabitants. The following information is a summary of the findings: (1) Korea, like many countries, is now witnessing an increase in the age of its population as a result of higher living standards and better medical services. Korea is also experiencing a rapid increase in health care costs. To ensure easy access to medical consultation, diagnosis and treatment by individuals, the hierarchical efficient location of medical facilities, low medical costs, equalized medical services, preventive medical care is important. (2) In Korea, the quality of medical services has improved significantly as evident by the increased number of medical facilities and medical personnel. However, there is still a need for not only quantitative improvements but also for a more equitable distribution of and location of medical services. (3) There are 503 medical facilities in Kwangju each with a need to service 2,556 people. This is below the national average of 1,498 inhabitants per facility. The higher locational quotient and satisfactory population per medical facility showed at the civic center. On the other hand, problem regions such as the traditional residential area in Buk-Gu, Moo-deung mountain area and the outer areas of west Kwangju still maintain rural characteristics. (4) In the study area there are 86 general medicine clinics which provide basic medical services. i. e. one clinic per every 14,949 residents. As a basic service, its higher locational quotient showed in the residential area. The lower population concentration per clinic was found in the civic center and in the former town center, Songjeong-dong. In recently build residential areas and in the civic center, the lack of general medicine clinics is not a serious medical services issue because of the surplus of medical specialists in Korea. People are inclined to seek a consultation with a specialist in specific fields rather than consult a general practitioner. As a result of this phenomenon, there are 81 internal medicine facilities. Of these, 32.1% provide services to people who are not referred by a primary care physician but who self-diagnose then choose a medical facility specializing in what they believe to be their health problem. Areas in the city, called dongs, without any internal facilities make up 50% of the total 101 dongs. (5) There are 78 surgical facilities within the area, and there is little difference at the locational appearance from internal medicine facilities. There are also 71 pediatric health clinics for people under 15 years of age in this area, represents one clinic per 5,063 people. On the quantitative aspect, this is a positive situation. Accessibility is the most important facility choice factor, so it should be evenly located in proportion to demander distribution. However, 61% of 102 dongs have no pediatric clinics because of the uneven location. (6) There are 43 obstetrical and gynecological clinics in Kwangju, and the number of residents being served per clinic is 15,063. These services need to be given regularly so it should increase the numbers. There are 37 ENT clinics in the study area with the lower concentration in Dong-gu (32.4%) making no locational differences by dong. There are 23 dermatology clinics with the largest concentration in Dong-Gu. There are 17 ophthalmic clinics concentrated in the residential area because of the primary function of this type of specialization. (7) The use of general medicine clinics, internal medicine clinics, pediatric clinics, ENT clinics by the inhabitants indicate a trend toward primary or routine medical services. Obstetrics and gynecology clinics are used on a regular basis. In choosing a general medicine clinic, internal medicine clinic, pediatric clinic, and a ENT clinic, accessibility is the key factor while choice of a general hospital, surgery clinic, or an obstetrics and gynecology clinic, thes faith and trust in the medical practitioner is the priority consideration. (8) I considered the efficient use of medical facilities in the aspect of locational and management and suggest the following: First, primary care facilities should be evenly distributed in every area. In Kwangju, the number of medical facilities is the lowest among the six largest cities in Korea. Moreover, they are concentrated in Dong-gu and in newly developed areas. The desired number of medical facilities should be within 30 minutes of each person's home. For regional development there is a need to develop a plan to balance, for example, taxes and funds supporting personnel, equipment and facilities. Secondly, medical services should be co-ordinated to ensure consistent, appropriate, quality services. Primary medical facilities should take charge of out-patient activities, and every effort should be made to standardize and equalize equipment and facility resources and to ensure ongoing development and training in the primary services field. A few specialty medical facilities and general hospitals should establish a priority service for incurable and terminally ill patients. (9) The management scheme for the inhabitants' efficient use of medical service is as follows: The first task is to efficiently manage medical facilities and related services. Higher quality of medical services can be accomplished within the rapidly changing medical environment. A network of social, administrative and medical organizations within an area should be established to promote information gathering and sharing strategies to better assist the community. Statistics and trends on the rate or occurrence of diseases, births, deaths, medical and environment conditions of the poor or estranged people should be maintained and monitored. The second task is to increase resources in the area of disease prevention and health promotion. Currently the focus is on the treatment and care of individuals with illness or disease. A strong emphasis should also be placed on promoting prevention of illness and injury within the community through not only public health offices but also via medical service facilities. Home medical care should be established and medical testing centers should be located as an ordinary service level. Also, reduced medical costs for the physically handicapped, cardiac patients, and mentally ill or handicapped patients should be considered.