• 제목/요약/키워드: Ob & Gy Disease

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CaPSPI(Diagnostic System for Climacteric and Postmenopausal Syndrome Pattern Identification) 업그레이드를 위한 검진용 치료용 진단 결과 분석에 대한 통계 연구 (A Statistical Study on the Result Analysis of CaPSPI, a Diagnostic System for Climacteric and Postmenopausal Syndrome Pattern Identification)

  • 김태희;이인선;김종원;전수형;지규용;강창완
    • 대한한방부인과학회지
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    • 제35권3호
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    • pp.105-121
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    • 2022
  • Objectives: It is a statistical analysis study to examine the results of CaPSPI (Diagnostic System for Climacteric and Postmenopausal Syndrome Pattern Identification), developed for objective defecation of climacteric and postmenopausal syndrome. Methods: Total 341 people's questionnaire responses were statistically analyzed. 275 people involved in developing CaPSPI 2018 (E) and 146 people involved in 2019-2020 study of research1,3). Results: The frequency of diagnosis for examination was the highest at liver depression, 93.8% for 320 times, the lowest at heartheat, 62.8% for 214 times. The frequency of treatment for examination was the highest at liver depression, 54.3% for 185 times, and the lowest at dual deficiency of heart-spleen, 16.7% for 57 times. The diagnosis ratio was the lowest at dual deficiency of heart-spleen, 19.72%, and the highest at liver depression, 57.81%. As a result of comparing these diagnoses with the Kupperman's index, all showed significant differences. As a result of comparing these disease elements, all showed significant differences. The correlation between diagnosis and dialectic elements was found to have similar results with the korean medical pathology, and in 7 dialectics except for heartheat, the treatment version was more severe or progressing to perjury than for examination. Conclusions: The CaPSPI shows the characteristics of korean medicine well, and it is needed to utilize the high correlative disease elements to upgrade the system.

체계적 문헌고찰과 델파이 기법을 활용한 갱년기장애 변증(辨證)진단 도구 개발을 위한 기초 연구 (Development of a Guideline for the Application of a Diagnostic Tool for Menopausal Syndromes Based on the Use of Systemic Review and Delphi Method)

  • 이인선;김동일;유정은;강창완
    • 대한한방부인과학회지
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    • 제30권4호
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    • pp.175-202
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    • 2017
  • Objectives: This study was conducted towards developing a screening tool for syndrome differentiation in the diagnosis of menopause in menopausal and perimenopausal women. Methods: We conducted a literature review of studies on menopausal diagnosis based on syndrome differentiation, and examined well-founded differentiated syndromes and their respective clinical symptoms. Based on the findings, we created a questionnaire through consultations with Oriental medicine experts in physiology, pathology, and diagnostics. Finally, the research team conducted an expert Delphi study on differentiated syndromes and the associated clinical symptoms. Results: Seven differentiated syndromes were selected, including Liver Depression (肝鬱), Kidney Yin Deficiency (腎陰虛), Kidney Yang Deficiency (腎陽虛), Liver and Kidney Yin Deficiency (肝腎陰虛), Kidney Yin and Yang Deficiency (腎陰陽兩虛), Heart-Kidney Noninteraction (心腎不交), and Dual Deficiency of Heart and Spleen (心脾兩虛); 4 disease locations, including liver (肝), heart (心), spleen (脾), and kidney (腎); and 3 disease natures, including Yin Deficiency (陰虛), Qi Stagnation (氣滯), and Blood Deficiency (血虛). In addition, we added 3 supplemental disease natures, including Yang Deficiency (陽虛), Qi Deficiency (氣虛), and Heat (火熱), in consideration of syndrome differentiation categories that may possibly be added in a follow-up clinical questionnaire. Conclusions: This resulted in a total of 7 differentiated syndromes, 4 disease locations, and 6 disease natures. We translated the clinical symptoms of these 17 categories into Korean Hangeul. After consulting with 5 Oriental medicine experts and a psychology expert, we produced a questionnaire for use in diagnosing menopause based on syndrome differentiation. The calculation of scores for the syndrome differentiation screening tool will be confirmed through clinical research based on the results of a review of existing literature.

난소낭종에 대한 한의 임상 연구의 종설 (A Review of Ovarian Cyst Management in Oriental Medicine)

  • 김동일
    • 대한한방부인과학회지
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    • 제20권4호
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    • pp.175-190
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    • 2007
  • Purpose: Ovarian cysts are fluid-filled sacs or pockets within or on the surface of an ovary. Most cysts present little or no discomfort and are noncancerous and harmless. So non-surgical treatments with herbal medicine or acupuncture and moxa therapy are important and suitable in this pathology. But there are few RCT articles about ovarian cyst in Korean Medicine(KM) clinical and research field. Methods: To review treatment method and other research tendency about ovarian cyst in journals related with KM and Traditional Chinese Medicine(TCM) through web-searching. Searching was done through web site #http://omis.ksucc.ac.kr# and pub-med(http://www.ncbi.nlm.nih.gov/sites/entrez) with key words #ovarian cyst#, #TCM#, #herb#, #CAM#, and #acupuncture#. Results: Seven articles were searched in journals related with KM, then six of them were simple case report and the other one was about diagnosis for ovarian cyst and another gynecologic disease such as uterine myoma and infertility through the iris diagnosis. And two articles were searched in journals related with TCM, then one of them was simple case report but the other is RCT article. Conclusion: KM and TCM therapies have some beneficial effect to resolve cyst, but objective power as a evidence is weak in the viewpoint of EBM. So continuous clinical trials such as RCT and multi center trials are needed.

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한의학 관련 학회지의 월경통 관련 논문에 대한 종설 (A Review of Dysmenorrhea Related Articles in Literature of Oriental Medicine)

  • 김동일
    • 대한한방부인과학회지
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    • 제21권1호
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    • pp.134-149
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    • 2008
  • Purpose: Dysmenorrhea is a common gynecologic condition among reproductive-age women. It consisted with menstrual clamps and other symptoms such as nausea. vomiting, diarrhea, and fatigue. Pain control for this disease mainly through NASIDs. but recently CAM therapies, acupuncture and others for painful menstruation are widely used in western countries. But RCT articles about dysmenorrhea in Korea, are not enough to lead such global research trends. The purpose of this study is to review treatment method and other research tendency about dysmenorrhea in Korean Medicine(KM) related dominant journals. Methods: Searching was done through web site and directly searched dysmenorrhea related articles in journals of Korean medicine Gynecology, published during 1996-2007. Results: Twenty five articles were searched in KM related journals, then two of them were simple case report and ten were paper of clinical trials. But there no RCT or control group-designed study. All of them present positive effect on dysmenorrhea but drop out rates were relatively high. Conclusion: KM therapies including acupuncture and herbal medicine have some beneficial effect to resolve menstrual cramps, but KM therapy related Korean articles don't have strong objective power as a evidence in the viewpoint of EBM. So continuous clinical trials such as RCT and multi center trials are needed.

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알코올성 간질환 변증 설문, DSOM, SF-36을 이용한 알코올성 간질환 환자의 금주 효과 연구 (Effect of Stopping Drinking, Using Alcoholic Liver Disease Questionnaire, DSOM and SF-36)

  • 이재왕;홍상훈;박상은;손호영;김도경;이승연;이수영;김보경;강창완;이인선
    • 대한한방내과학회지
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    • 제31권2호
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    • pp.356-364
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    • 2010
  • Objectives : This study was done to evaluate the effect of stopping drinking, using alcoholic liver disease questionnaire, Diagnosis System of Oriental Medicine (DSOM) and Health Related Quality of Life (HRQOL). Methods : 49 men who satisfied the requirement participated in this trial. They stopped drinking for 6 weeks. They were analyzed using DSOM, alcoholic liver disease questionnaire and SF-36. The data were classified by age (<47,$\geq$48) and alcoholic intake per day (<100g,$\geq$100g). For HRQOL, the SF-36v2 Health Survey was used and Quality Metric Health Outcomes Scoring Software 2.0 (QualityMetric, Lincoln, RI, USA) was applied for the analysis. Results : The alcoholic liver disease questionnaire had a partial correlation with DSOM. Generally stopping drinking decreased Heat (熱). Especially in the group drinking over 100g per day, the correlation was high. In the group over 48 years old, spleen (脾) was improved comparatively. In the group with low HRQOL (PCS<31.43, MCS<23.33) deficiency (虛) was improved. Conclusions : We found that stopping drinking can improve pathogenic factors of alcoholic liver disease and the alcoholic liver disease questionnaire be a useful diagnostic method on alcoholic liver disease by comparison with DSOM.

골다공증 진단방법에 관한 기초연구 (Preliminary Study of a Diagnostic Tool for Osteoporosis)

  • 양경희;박금숙;이정란;정헌영
    • 동의생리병리학회지
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    • 제23권5호
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    • pp.933-937
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    • 2009
  • The purpose of this study is to develop a diagnostic screening tool for the early detection of osteoporosis in persons with a predisposition for this condition and to facilitate effective management of the disease. Data are collected using questionnaires. The subjects are 120 women in a small city OB-GY clinic in South Korea, who are 6 months or more post menopausal and who have been examined for BMD. Two items in general syndrome of kidney vacuity(Shin Hur) : hears noises like streaming water or the sound of shrill chirrups of a cicada (OR=3.34, p<0.1), feels twinges in the back and knee(OR=4.10, p<0.05), one item in kidney yin vacuity: feels thirst and gets sore throat(OR=8.5, p<0.01) were proven as statistically significant risk factors in the identification of osteoporosis (Odds Ratio). The predictability score was 86.36%, and ROC curve was 0.84. This study attempted to identify risk factors in female osteoporosis so as to develop a screening tool for the purposes of early diagnosis, the effective management of osteoporosis patients and to modify the progress of their disease. Further studies are needed to elaborate this tool's ability to identify contributing factors in osteoporosis as defined by diagnostic evidence predicted by Oriental Medicine Theory.

알코올성 간염의 변증설문 개발에 관한 연구 (Study to Develop the Pattern Identification Questionnaire for Alcoholic Hepatitis)

  • 김정은;박상은;이재왕;손호영;이병권;신철경;이수영;김원일;홍상훈;김보경;지규용;강창완;이인선
    • 동의생리병리학회지
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    • 제23권5호
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    • pp.958-963
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    • 2009
  • I Alcoholic hepatitis is a serious liver disease that may lead to cirrhosis and carcinoma, and the short-term mortality rate is fairly high in severe patients. This study was conducted to develop the instrument of pattern identification for alcoholic hepatitis. We made the pattern identification questionnaire and symptoms indicator through reviewing traditional oriental medical literatures and got advices from the advisor committee with Delphi technique. The advisor committee on this study was organized by 10 professors of internal medicine of oriental medical colleges nationwide. The questionnaire was composed of questions about 6 pattern identification - dampness, heat, liver, spleen, cold and dryness. We gave importance to each symptoms of 6 pattern identification which had been scored on a 5-point scale. We surveyed two groups: 36 male alcoholic hepatitis patients whose Alcohol Use Disorder Identification Test(AUDIT) scores were over 12 and who drank alcohol over 40 g per day were allocated to the hepatitis group. Forty three men who did not drink alcohol were allocated to the normal group. Alcoholic hepatitis had relativities to dampness, heat among cause of disease and liver, spleen among viscera. There were statistical significances between the hepatitis group and the normal group in dampness, heat, liver questionnaire. As a result of this study we suggest that the questionnaire would be effective instruments of pattern identification for alcoholic hepatitis.

한방진단설문지 DSOM (r) S.1.1의 Upgrade를 위한 신뢰도 연구 (Reliability Study for Upgrade of Diagnosis System of Oriental Medicine DSOM(r) S.1.1)

  • 이인선;김종원;지규용;이용태;김규곤
    • 동의생리병리학회지
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    • 제26권1호
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    • pp.88-97
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    • 2012
  • DSOM(Diagnosis System of Oriental Medicine), questionnaire for oriental medical(medicine) diagnosis is an online survey system containing 152 questions for female, 149 questions for male that asking the basic symtoms of 16 pathogenic factors(病機). The result of DSOM denotes reliability according to the level of major symptoms of each pathogenic factor. Standard level of reliability is equal to all 16 pathogenic factor basically except phlegm(痰). In case of phlegm(痰) we give different weight depending on whether the factor includes gray color under the orbit(痰飮氣) or not. To examine reliability of DSOM, statistical analysis has been done to the data of felmale 10101, male 1564 except for bad responses and stored between 1st April 2000 to 3rd June 2011. Based on the study, the conclusions were as follows. Reliability of DSOM. For female, all pathogenic factors showed over 85% confidence level except for phlegm 82.6%. For male, all pathogenic factors showed more than 90% confidence level except two factors, phlegm(痰) indicates 87.% and damp(濕) indicates 89.8%. HH rates among pathogenic factors were more than 50 points. For female, HH rates of other 14 pathogenic factors were all over 80% except for heat(熱) 78.2% and insufficiency of Yang(陽虛) 75.3%. For male HH rates of all pathogenic factors were more than 80% except HH rates of heat 78.2% and damp 77.8%. Research based on a degree of satisfaction of reliability derived from pathogenic factors with scores of HH results in for all 16 pathogenic factors showed over 85% of relatively high level of satisfaction for both sexes whose reliability standard come under 5~4 points. Comparing appearance frequency of pathogenic factors for both sexes. Male only displays higer than female in heat(熱). Whereas female were higher than male for other 15 pathogenic factors and the difference was biggest in heart(心) and least in insufficiency of Yin(陰虛). Comparing appearance frequency order of pathogenic factors for both sexes. Female outdistanced male in blood stasis(血瘀) coldness(寒) blood-deficiency(血虛) phlegm(痰), while male outdistance female in heat(熱) insufficiency of Yin(陰虛) deficiency of qi(氣虛). Male had lower average of each pathogenic factors than female except heat(熱) as well as deficiency of qi(氣虛).

우리나라 농촌(農村)의 모자보건(母子保健)의 문제점(問題點)과 개선방안(改善方案) (Problems in the field of maternal and child health care and its improvement in rural Korea)

  • 이성관
    • 농촌의학ㆍ지역보건
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    • 제1권1호
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    • pp.29-36
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    • 1976
  • Introduction Recently, changes in the patterns and concepts of maternity care, in both developing and developed countries have been accelerating. An outstanding development in this field is the number of deliveries taking place in hospitals or maternity centers. In Korea, however, more than 90% of deliveries are carried out at home with the help of untrained relatives or even without helpers. It is estimated that less than 10% of deliveries are assisted by professional persons such as a physician or a midwife. Taking into account the shortage of professional person i11 rural Korea, it is difficult to expect widespread prenatal, postnatal, and delivery care by professional persons in the near future, It is unrealistic, therefore, to expect rapid development of MCH care by professional persons in rural Korea due to economic and sociological reasons. Given these conditions. it is reasonable that an educated village women could used as a "maternity aid", serving simple and technically easy roles in the MCH field, if we could give such a women incentive to do so. The midwife and physician are assigned difficult problems in the MCH field which could not be solved by the village worker. However, with the application of the village worker system, we could expect to improve maternal and child hoalth through the replacement of untrained relatives as birth attendants with educated and trained maternity aides. We hope that this system will be a way of improving MCH care, which is only one part of the general health services offered at the local health centre level. Problems of MCH in rural Korea The field of MCH is not only the weakest point in the medical field in our country hut it has also dropped behind other developing countries. Regarding the knowledge about pregnancy and delivery, a large proportion of our respondents reported having only a little knowledge, while 29% reported that they had "sufficient" knowledge. The average number of pregnancies among women residing in rural areas was 4.3 while the rate of women with 5 or more pregnancies among general women and women who terminated childbearing were 43 and 80% respectively. The rate of unwanted pregnancy among general women was 19.7%. The total rate for complications during pregnancy was 15.4%, toxemia being the major complication. The rate of pregnant women with chronic disease was 7%. Regarding the interval of pregnancy, the rates of pregnancy within 12 months and within 36 months after last delivery were 9 and 49% respectively. Induced abortion has been increasing in rural areas, being as high as 30-50% in some locations. The maternal death rate was shown 10 times higher than in developed countries (35/10,000 live births). Prenatal care Most women had no consultation with a physician during the prenatal period. Of those women who did have prenatal care, the majority (63%) received such care only 1 or 2 times throughout the entire period of pregnancy. Also, in 80% of these women the first visit Game after 4 months of gestation. Delivery conditions This field is lagging behind other public health problems in our country. Namely, more than 95% of the women deliveried their baby at home, and delivery attendance by a professional person occurred only 11% of the time. Attendance rate by laymen was 78% while those receiving no care at all was 16%. For instruments used to cut the umbilical corn, sterilized scissors were used by 19%, non-sterilized scissors by 63% and 16% used sickles. Regarding delivery sheets, the rate of use of clean sheets was only 10%, unclean sheets, vinyl and papers 72%, and without sheets, 18%. The main reason for not using a hospital as a place of delivery was that the women felt they did not need it as they had previously experience easy deliveries outside hospitals. Difficult delivery composed about 5% of the total. Child health The main food for infants (95%) was breast milk. Regarding weaning time, the rates within one year, up to one and half, two, three and more than three years were 28,43,60,81 and 91% respectively, and even after the next pregnancy still continued lactation. The vaccination of children is the only service for child health in rural Korea. As shown in the Table, the rates of all kinds of vaccination were very low and insufficient. Infant death rate was 42 per 1,000 live births. Most of the deaths were caused by preventable diseases. Death of infants within the neonatal period was 83% meaning that deaths from communicable diseases decreased remarkably after that time. Infant deaths which occurred without medical care was 52%. Methods of improvement in the MCH field 1. Through the activities of village health workers (VHW) to detect pregnant women by home visiting and. after registration. visiting once a month to observe any abnormalities in pregnant women. If they find warning signs of abnormalities. they refer them to the public health nurse or midwife. Sterilized delivery kits were distributed to the expected mother 2 weeks prior to expected date of delivery by the VHW. If a delivery was expected to be difficult, then the VHW took the mother to a physician or call a physician to help after birth, the VHW visits the mother and baby to confirm health and to recommend the baby be given proper vaccination. 2. Through the midwife or public health nurse (aid nurse) Examination of pregnant women who are referred by the VHW to confirm abnormalities and to treat them. If the midwife or aid nurse could not solve the problems, they refer the pregnant women to the OB-GY specialist. The midwife and PHN will attend in the cases of normal deliveries and they help in the birth. The PHN will conduct vaccination for all infants and children under 5, years old. 3. The Physician will help only in those cases referred to him by the PHN or VHW. However, the physician should examine all pregnant women at least three times during their pregnancy. First, the physician will identify the pregnancy and conduct general physical examination to confirm any chronic disease that might disturb the continuity of the pregnancy. Second, if the pregnant woman shows any abnormalities the physician must examine and treat. Third, at 9 or 10 months of gestation (after sitting of the baby) the physician should examine the position of the fetus and measure the pelvis to recommend institutional delivery of those who are expected to have a difficult delivery. And of course. the medical care of both the mother and the infants are responsible of the physician. Overall, large areas of the field of MCH would be served by the VHW, PHN, or midwife so the physician is needed only as a parttime worker.

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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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