中等症 및 重症 肺結核患者에 對한 社會醫學的調査

劉公珠(Kong-ju, Yu) 서울대학교 보건환경연구소 1967 보건학논집 Vol.4 No.1

中等症 및 重症 肺結核患者에 對한 社會醫學的調査

劉公珠 서울大學校 保建大學院 1967 公衆保健雜誌 Vol.4 No.1

A study was conducted with 228 cases of the moderately and far advanced pulmonary tuberculosis patients to know the reasons why they had not been found and treated by medical or public health services during the early or minimal stage. The author analysed several socio-medical factors or situations which might have something to do with the progress or advances of the disease for 2 months from Sept. 1 to Oct. 31, 1966. at Tbc. Clinic, Wonju Union Christian Hospital, Kang Won Do. Out of the samples of 228 cases pulm. tbc patients, 42.5% were mod. advanced and 57.5%, far advanced. 52.9% of all the patients were AFB positive with sputum examinations. The results obtained were as follows: (1) Of all the patients analysed, 67.5% were male and 32.5%, female. The age group of 30-39 years showed the largest number with 32.5% of the total patients and the older as well as the younger they were, the fewer the number of patients in those age group. (2) 42.1% of the patients were living at small cities, the remaining 57.9%, rural areas. (3) The living status were divided into 4 classes, high, middle, low and very low. 43% of the cases belong to the low class in terms of living status and it was the largest number among the above 4 clases. Next were the middle class, occupying 39.5% of all. Only 2.5%, the smallest, belong to the high class. (4) Their educational backgrounds were varied. 38.7% of the patients had primary school education and they were the largest group. The next one was the non-school-educated, occupying 30% of all the cases. Only 2.2%, the smallest group, were the college-educated. (5) 42.2% of the patients analysed had no occupation, occupying the largest percentage of all. 29.9% of all were farmers, the most common occupation in our patients. The next one was laborers, with 10.5%. (6) Several socio-medical backgrounds before finding their disease, tbc. a) 20.3% of all the patients (1st group) had no subjective symptoms indicating pulm. tbc before finding their disease and so had no previous treatments. The largest group of all, 46.8% (2nd group) had some symtoms making suspicious of pulm. tbc but not have medical helps because of several reasons. The remaining 32.9% of all the patients (3rd group) had susupected symptoms and been treated for similar diseases as pulm. tbc prior to coming to the clinic. b) Of the 2nd group mentioned above who had symptoms but no treatment, the largest part, 54%, had not been treated by any medical services because of lack of financial resources, i.e., no money to consult with a physician, or poverty. Next common reason was the ignorance of the importance of their symptoms, i.e., they paid little attention to their symptoms which consisted of 33.6% of the 2nd group of the patients. 10.3% of this group were living in the remote rural areas in which it was difficult to find the means of the travel i.e., the means of transportation were not easily available. c) Of the smilar diseases diagnosed and treated before recognizing their pulm. tuberculosis among the 3rd group of the patients, pleurisy was the most common entity the patients had suffered from, that occupied 48.0%. Next one, bronchitis occupied 14.7% of the 3rd group and 10.6% of the patients said they were diagnosed and treated for pneumonia just prior to being diagnosed as tbc. Past history of paragonimiasis and lung abscess made up 5.3% of the patients, respectively. (7) Several socio-medical situations when they found their disease, tbc. for the first time; a) Concerning the motives of finding their disease, tbc, 57.9% of all the patients, the largest percentage, were found at hospital by chance (most of them at Wonju Union Christian Hospital) when they visited the hospital for other complaints(without suspecting tbc.). The next group, 29.0% of all, consulted a physician at a clinic or hospital to confirm their suspected symptoms as pulm. tbc. Another 8.3% of the patients visited a health center with suspected pulmonary symptoms to rule out pulm. tbc. The remaining 5.7% of the patients were found by mass checking of chest x-ray. b) The degree of advance of their pulm. tbc when they were found for the first time were studied. 57.0% of all the patients were far-advanced and 28.0% were moderately advanced, and the remaining 15.0% only were found at minimal stage. c) 65.2% of all the patients were AFB positive with sputum examanation when they had been diagnosed as having tbc. (8) Several sodio-medical situations after finding their disease, tbc. a) Duration of the disease; The largest number was shown with the patient who had been suffering from pulm. tbc. for 1-2 yrs. since finding their disease (34.0%), which is followed by the group who had been suffered for less than I yr. (25.9%), 11.9% of the patients, for 2-3 yrs. and the remaining 28.2% for 3yrs. or more. b) Duration of regular & continuous anti-tbc. therapy; 28.9% of the patients had been taking regular anti-tbc. therapy for less than 6 months. 25.0% of all had been on sepcific anti-tbc. treatment for 6-12 months. 21.1%. for 1-2 yrs. The remaining 11.47%, for 3 yrs. or more. c) Since discovery of their disease, 57.9% of all had been taking anti-tbc. therapy at tbc. clinic. Wonju Union Christian Hospital continuously. Prior to coming to WUCH tbc. clinic for treatment, 13.6% of all the patients had received advices for the treatment of their diseases at drug stores. The drug store appeared to be the most common place the patients consulted prior to coming to the tbc. clinic. 11.8% of the patients had visited a health center for treatment before they come to WUCH tbc. clinic. 11.4% had visted another clinic or hospital. The remaining 5.3% took treatment according to the advice of herb medical clinic. d) After begining anti-tbc. therapy at WUCH tbc. clinic, ony 50.8% of the patients.(1st group) had taken regular and continuous therapy at the tbc. clinic. And the remaining 49.2% of the patients (2nd group) had discontinued their regular treatment from time to time due to several reasons. e) Among the reasons the 2nd group of the patients could not continue their regular therapy, lack of financial means (poverty) was the main cause, consisting of 66.1% of the 2nd group. 24.1% of the 2nd group discontinued their anti-tbc. therapy because of poor response to the drugs, e.i., they had become doubtful to the effect of the drugs on their disease. And the remaining 9.8% could not visit the clinic regularly due to the remote distances from their homes or travel inconviniences (or traffic difficulties). f) Of the 35 patients who had chances to perform sensitivity test of AFB against the 3 main anti-tbc. drugs, 31.4%, the largest number, showed resistance against INH & SM concomitantly. 22.8% showed resistance aginst INH, PAS & SM., 11.5%, against INH & PAS. Only 11.5% showed susceptibility against 3 main anti-tbc. drugs(i.e.,INH,PAS & SM). (9) Several observations about the patient's families; a) The size of the patient's families were studied; 21.0% of the patients, the largest group, had six members of the family including the patient himself. 19.3% had four members and 14.6%, five. The average size of their families was 5.6 in number of family members. b) The number of the family using the same room with the patient was surveyed; 25.8% of the patients lived in a room alone, (not with his other members of the family). Another 21.9% of all the pationts lived with three other members of the family in the same room, 20.3% used a room with other two members of the family, and the 12.8% with one. The average number of the members of the family using the same room with the patients was 3.1 (The number did not include the patinent himself). c) The familes of the only 23.6% of the patients had checked chest X-ray to rule out the infectious disease from the contacts and among them 55.6% of the above patients (23.6% of all) had been found as having new pulm. tbc. patients in their families.