• Tuberculosis and Respiratory Diseases
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• 제42권4호
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• pp.535-547
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• 1995

연구배경: 균혈증은 중환자실에서 흔히 발생하는 문제로 일반 병실에서 보다 그 빈도가 더 높고 중환자의 사망률을 높이는 원인이 되며, 중환자실의 종류에 따라 감염의 선행요인, 원발부위, 원인 균주, 예후에 차이가 있다는 보고가 있다. 이에 저자 등은 본원의 내과계와 외과계 중환자들에서 발생한 균혈증의 임상적, 세균학적 양상과 예후 등에 있어서, 양 중환자 군 간에 차이가 있는지 알아보고자 본 연구를 시행하였다. 방법: 1990년 2월부터 1993년 12월까지 균혈증이 증명되었던 내과계 중환자 189예와 외과계 중환자 67예를 대상으로 병록을 후향적으로 검토하여 임상적, 세균학적 특징과 예후를 비교하였다. 결과: 1) 균혈증이 확인된 내과계 중환자는 전체 내과계 중환자에 비해 평균 연령이 높았으나, 외과계 중환자에서는 균혈증이 있었던 환자와 전체 외과계 중환자 간의 평균 연령의 차이는 없었다. 균혈증이 확인된 중환자는 전체 중환자에 비해 중환자실내 평균 재실 일수가 길었으며, 균혈증은 전체 평균 재실 기간을 초과한 상태에서 발생하였다. 2) 중환자의 균혈증 발생률은 내과계(7.9%)가 외과계(2.4%)보다 많았으나, 균혈증 환자의 평균 연령, 남녀비, 중환자실 재실 기간은 양 군 간에 차이가 없었다. 3) 외과계 균혈증 중환자는 내과계에 비해 균혈증 전 전신적 항생제나 부신피질 호르몬 사용, 감염과 연관된 경피적 장치, 침습적 조직이 선행되었던 경우가 많았다(전신적 항생제 사용: 내과계 45%, 외과계 63%, p<0.05; 부신피질 호르몬 사용: 내과계 14%, 외과계 36%, p<0.01; 기계장치: 내과계 19%, 외과계 39%, p<0.01; 침습적 조작: 내과계 19%, 외과계 61%, p<0.01). 4) 균혈증 획득 장소의 분포는 내과계의 경우 원외 균혈증 빈도(42%)가 외과계에 비해 상대적으로 높았고, 외과계는 중환자실내 획득 균혈증 빈도(78%)가 높았다(p<0.01). 5) 양 중환자실에서 균혈증의 원인 균주, 원발병소는 차이가 없었으며, 중환자실내 획득 균혈증의 경우 균혈증 발생 병일에도 차이가 없었다. 6) 균혈증의 원인 균주나 원발병소에 따른 예후의 차이는 없었다. 7) 균혈증 중환자의 사망률은 내과계(72.5%)가 외과(40.3%)보다 높았으며, 균혈증이 없었던 환자의 사망률에 비해 양 중환자군 모두 균혈증을 동반한 경우 사망률이 높았다(p<0.05). 결론: 균혈증을 가진 중환지는 일반 중환자에 비해 사망률이 더 높았으며, 평균 재실 기간을 초과한 상태에서 감염에 이환되고, 이는 다시 중환자실 재실 기간을 연장시키는 것으로 사료되었다. 내과 및 외과계 중환자에 따른 비교에서 내과계 균혈증 증환자는 선행 요인에 있어 간질환과 급성 호흡부전이 많았고 지역사회 획득 균혈증이 많았으며 사망율이 더 높았던 반면, 외과계 균혈증 중환자는 선행 요인으로 외상, 항생제나 면역억제제 시용 및 침습적 조작의 빈도가 많았으며 중환자질내 획득 균혈증의 빈도가 높았으나 사망률은 내과계보다 낮았다 양 균혈증군에서 균혈증의 원발 병소, 원인 균주 및 이에 따른 사망률에는 유의한 차이가 없었다.

• 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.