A Study On Impact Of Goods And Service Tax On Small Traders With Reference Mysuru District, Karnataka

The study investigates the impact of Goods and Services Taxes on small businesses. Tax policies have such a big impact on the economy in terms of both efficiencies and equity. For Indian government small traders and medium traders are one of the pillars. Here small traders can fill the registration through online itself. In VAT the tax payment where differed from state to state in some states we have earn 10 lakhs we should pay VAT but for some states if its 5 lakhs itself we need to pay VAT. So it leads to confusion and its not much effective. So compare to that in GST we have one nation one tax. So that small and medium traders can go anywhere and can expand there revenue and business anywhere in India. This study is based on both primary data and secondary data. For collecting of primary data from sample respondents used structured questionnaire. Statistical tools like Garrett ranking method and chi-squre test, ANOVA are used for analysis of data

Accuracy of transcutaneous bilirubin measurement in full-term newborns at 3400 meters above sea level / Precisión de la bilirrubinometría transcutánea en recién nacidos a término a 3400 metros sobre el nivel del mar

Abstract Background: Neonatal jaundice is a frequent benign condition in newborns. However, a rapid diagnosis must be established for its most appropriate treatment. The objective of this study was to measure the correlation between total serum bilirubin (TSB) and transcutaneous bilirubin (in forehead and sternum) in full-term newborns at 3400 m above sea level. Methods: We conducted a prospective and cross-sectional study in full-term newborns with clinical jaundice from the Hospital Regional in Cusco-Peru. General characteristics and measurement of TSB, transcutaneous forehead bilirubin (TcBF), and transcutaneous bilirubin in the sternum (TcBS) were explored. Correlation, sensitivity, and specificity were calculated. Receiver operating characteristic (ROC) curves were constructed using the SPSS statistical package, version 22.0. Results: A total of 123 newborns were evaluated. The mean bilirubin values were 13.7 ± 3.5 for TcBF, 14.1 ± 3.1 for TcBS, and 13.8 ± 3.9 for TSB. In addition, Pearson correlation coefficients between TSB/TcBF and TSB/TcBS were 0.90 and 0.91, respectively (p < 0.001). For the percentile 95 cut-off point, a sensitivity of 93% and 100% and a specificity of 89% and 80% were obtained for TcBF and TcBS, respectively, with an area under the curve of 0.813 for TcBF and 0.815 for TcBS (p < 0.001) Conclusions: Measurement of transcutaneous bilirubin is a fast and painless method that can be considered a reliable tool for screening and monitoring neonatal jaundice, but not for a definitive diagnosis to decide the use of phototherapy in full-term newborns at 3400 m above sea level.

Resumen Introducción: La ictericia neonatal es una condición benigna y frecuente en los recién nacidos, en quienes es preciso hacer un diagnóstico rápido para el tratamiento más adecuado. El objetivo de este estudio fue determinar la correlación entre la bilirrubina sérica total (BST) y la bilirrubina transcutánea (frente y esternón) en recién nacidos a término a 3400 metros sobre el nivel del mar. Método: Estudio prospectivo y transversal en recién nacidos con ictericia clínica en el Hospital Regional de la Ciudad de Cusco, Perú. Se exploraron las características generales y se midieron la BST, la bilirrubina transcutánea en la frente (BTcF) y la bilirrubina transcutánea en el esternón (BTcE). Se calcularon la correlación, la sensibilidad y la especificidad, y se elaboraron las curvas de características operativas del receptor (ROC) con el paquete estadístico SPSS 22.0. Resultados: Se evaluaron 123 recién nacidos. El promedio de la BST fue de 13.8 ± 3.9, el de la BTcF fue de 13.7 ± 3.5 y el de la BTcE fue de 14.1 ± 3.1. La correlación entre BST/BTcF y BST/BTcE fue de 0.90 y 0.91, respectivamente (p < 0.001). Para el punto de corte del percentil 95 según el nomograma Bhutani se obtuvo una sensibilidad del 93% y el 100%, y una especificidad del 89% y el 80%, para la BTcF y la BTcE, respectivamente, con un área bajo la curva ROC de 0.813 para la BTcF y de 0.815 para la BTcE (p < 0.001). Conclusiones: La medición de la bilirrubina transcutánea es un método rápido e indoloro, y podría ser considerado confiable para el despistaje y el seguimiento de la ictericia neonatal, mas no para un diagnóstico definitivo con el fin de decidir el uso de fototerapia en recién nacidos a término a 3400 metros sobre el nivel del mar.

On-line Searches for Terms Related to Hand Hygiene During the COVID-19 Pandemic Worldwide

ABSTRACT Objective: To analyze the difference in the on-line searches for terms related to hand hygiene during the COVID-19 pandemic in developed and middle-income countries. Material and Methods: The cross-sectional study analyzed the digital data through the Google Trends website to obtain the variation of the relative search volume (RSV) through the terms "alcohol gel" and "handwashing." According to socio-economic development, the countries were divided into two groups: countries from different continents and hemispheres, with more than 15 million inhabitants, with more than 50% of the population with access to the Internet network and over 1,000 confirmed cases of infected with COVID-19. The paired t-test was applied to compare the means. The significance value adopted was p<0.010. Results: The searches related to the term "hand washing" were more significant when compared to the term "alcohol gel," and the term "alcohol gel" presented a higher average volume of research in developed countries (p<0.010). The developed countries had a higher average relative volume of research than middle-income countries (p<0.010). Developed countries sought more for the term "alcohol gel," and the term "hand washing" showed no difference in the volume of research about the country's socio-economic aspect. Conclusion: Developed countries have a higher volume of search for hand hygiene terms. The middle-income countries must create proposals for raising awareness outside the on-line environment so that this information reaches the entire population during the pandemic.

Research progress on the influencing factors for vaccine hesitancy / 预防医学

@#Vaccine hesitation refers to the refusal or delay of vaccination when vaccination services are available and is one of the top ten threats to global health. Vaccine hesitation varies in different countries，and its influencing factors are very complex.However，domestic research on this phenomenon is still in its infancy.This article reviews the phenomenon of vaccine hesitation，the occurrence and influencing factors of vaccine hesitation in some developed countries since the 21st century，to provide the basis for taking effective measures for the phenomenon of vaccine hesitation in China.

Patient delays and system delays in breast cancer treatment in developed and developing countries / O atraso de paciente e atraso de sistema no tratamento do câncer de mama nos países desenvolvidos e em desenvolvimento

AbstractDelays in treating breast cancer have been associated with a more advanced stage of the disease and a decrease in patient survival rates. The scope of this integrative review was to analyze the main causal factors and types of patient and system delays. The underlying causal factors of delays were compared among studies conducted in developing and developed countries. Of the 53 studies selected, 24 were carried out in developing countries and 29 in developed countries, respectively. Non-attribution of symptoms to cancer, fear of the disease and treatment and low educational level were the most frequent causes of patient delay. Less comprehensive health insurance coverage, older/younger age and false negative diagnosis tests were the three most common causal factors of system delay. The effects of factors such as age were not decisive per se and depended mainly on the social and cultural context. Some factors caused both patient delay and system delay. Studies conducted in developing countries identified more causal factors of patient delay and had a stronger focus on patient delay or the combination of both. Studies conducted in developed countries had a stronger focus on aspects of system delay during treatment and guidance of breast cancer patients in the health care system.

ResumoO atraso no tratamento de câncer de mama foi associado com o aumento do palco da doença e a diminuição da sobrevida do paciente. O objetivo desta revisão integrativa foi a analise dos principais fatores causais e dos tipos de atraso. Sendo estes comparados entre estudos de países em desenvolvimento e desenvolvidos. Dos 53 estudos selecionados, 24 eram de países em desenvolvimento e 29 de países desenvolvidos, respectivamente. A não atribuição dos sintomas ao câncer, o medo e a menor escolaridade foram as causas mais citadas do atraso de paciente ao tratamento. Seguro menos abrangente, idade e testes diagnósticos falsos negativos foram às causas mais comuns identificadas do atraso do sistema. O efeito de vários fatores como o fator idade, dependeu principalmente do contexto social e cultural. Alguns fatores causaram tanto atraso relacionado ao paciente quanto ao sistema. Os estudos dos países em desenvolvimento identificaram mais fatores causais do atraso relacionado ao paciente, focando mais forte neste referido fator ou na combinação com o de sistema. Enquanto estudos de países desenvolvidos enfocaram com maior frequência aspectos do atraso de sistema durante o tratamento e a orientação de pacientes no sistema de saúde.

Relación entre determinantes socioeconómicos, cobertura en salud y caries dental en veinte países / Relationship between Socioeconomic Determinants, Health Coverage, and Dental Caries in Twenty Countries / Relaqáo entre determinantes socioeconómicos, cobertura em saúde e a cárie dentária em vinte países

Objetivo: establecer la relación entre determinantes estructurales socioeconómicos, cobertura del sistema de salud y caries dental en veinte países. Métodos: análisis ecológico mixto de datos secundarios de veinte países. Los criterios de inclusión fueron países que presentaran tres valores de COP (cariados, obturados, perdidos) de las últimas cuatro décadas. Las variables independientes fueron: gasto total en salud, gasto sanitario público, índice de pobreza, tasa de alfabetización de adultos, tasa de mortalidad materna, tasa de mortalidad en menores de cinco años y esperanza de vida al nacer. Resultados: la caries dental muestra un valor estable (COP 2,4) desde 1990, con tendencia a disminuir en países más desarrollados y aumentar en los menos desarrollados. Conclusión: los países se clasificaron en tres grupos: universalistas (con mejores los indicadores), dualista y excluyentes (con peores condiciones socioeconómicas). En los países dualistas y excluyentes no se encontró asociación entre prevalencia de caries y factores determinantes socioeconómicos.

Objective: establishing the relationship between structural socioeconomic determinants, coverage of the health system, and dental caries in twenty countries. Methods: ecologic mixed analysis of secondary data of twenty countries. The inclusion criteria were countries that showed three COP values (decayed, filled, lost) during the last four decades. The independent variables were: total expenses on health; public sanitation expenses; poverty index; literacy rate in adults; maternal mortality rate; mortality rate in children younger than 5 and life expectancy at birth. Results: Dental caries shows stable scores (COP 2.4) from 1990, with a tendency toward lower scores in more developed countries and toward higher scores in less developed ones. Conclusion: the countries were classified in three groups: universalist (best indicators), dualist, and excluding (worse socioeconomic conditions). Dualist and excluding countries did now show any association between the prevalence of caries and socioeconomic determinant factors.

Objetivo: estabelecer a relação entre determinantes estruturais socioeconómicas, cobertura do sistema de saúde e cárie dentária em vinte países. Métodos: análise ecológico misto de dados secundários de vinte países. Os critérios de inclusao foram países que apresentaram tres valores de COP (cariados, obturados, perdidos) nas últimas quatro décadas. As variáveis independentes foram: despesa total em saúde, despesa sanitária pública, índice de pobreza, taxa de alfabeti-zação de adultos, taxa de mortalidade materna, taxa de mortalidade em menores de cinco anos e expectativa de vida quando nascer. Resultados: a cárie dentária mostra um valor estável (COP 2,4) desde 1990, com tendencia a diminuir em países mais desenvolvidos e aumentar nos menos desenvolvidos. Conclusão: os países classificaram-se em tres grupos: universalistas (com melhores indicadores), dualista e excludentes (com piores condicoes socioeconómicas). Nos países dualistas e excludentes nao foi encontrada associação entre prevalencia de cárie e fatores determinantes socioeconómicos.

Percutaneous Needle Biopsy-An Assertive Tool In The Diagnosis of Bone Tumors in Under Developed Countries.

Our study on 106 cases of bone tumors aims at correlating the clinical, radiological and cytological findings of benign and malignant tumors of bone and evaluating the usefulness of percutaneous biopsy as a diagnostic tool in underdeveloped countries. Giant cell lesions were the most common benign tumor, 42 cases (84%) and giant cell tumor was the most common giant cell lesion in our study, 27 (64.3%). Round cell tumor appeared to be the most common malignant tumor of bone, 20 cases (35.7%). Osteosarcoma represented 15 cases (14.2%) of all bone tumors and 26.8% of all malignant bone tumors in our study. Final histopathological diagnosis was available only in 54 cases. Out of which 53 cases showed concordance with previous cytological diagnosis. Only a single case of chondrosarcoma was misdiagnosed as chondroma on FNAC (false negative). The sensitivity and specificity of FNAC was 96.0% and 100% respectively while positive predictive value and negative predictive values were 100% and 96.7% respectively. The diagnostic accuracy in our study was 98.1%.

Healthcare inequalities: The United States vs India

The relationship between healthcare services and inequalities is more likely when a group that shares a salient identity faces severe inequalities of various kinds. Such inequalities may be catalyzed by economic, social, political or concern cultural status. The objectives of this review are to identify the issues and challenges involve in healthcare inequalities, to compare factors contributes to healthcare inequalities and to purpose suggestions and recommendations for improvement based on issues and challenges between United States and India. Comparing annual year healthcare report, documentation of healthcare institutional, Ministry of Health‘s report and circular, official institutional website, scientific healthcare journals, articles and reports published in 1994 until 2011 regarding healthcare inequalities between United States and India. Health inequalities in the healthcare system contributed by the different in socioeconomic status and accessibility to the healthcare facility due to high cost of treatment has been common risk ‘Catastrophic’ factors to the inequalities in both countries. Health financing system and resource allocation that benefit only the upper class social spectrum of the population. Disparities occur due to the imbalance in distribution of wealth, discrimination and change in the world economy. Adapting healthcare system that provides care to all classes of people need improvement as no healthcare system is perfect. This matter must be tackle urgently as it’s a matter of national concern.

La industria farmacéutica y la sostenibilidad de los sistemas de salud en países desarrollados y América Latina / The pharmaceutical industry and the sustainability of healthcare systems in developed countries and in Latin America

La crisis económica y su impacto en las finanzas públicas en la mayoría de los países desarrollados, están originando políticas de contención del gasto en los servicios de salud. Las leyes actuales del medicamento exigen calidad, seguridad y eficacia de estos productos. Algunos países incluyen criterios de eficiencia para los nuevos medicamentos que desean ser incluidos en la financiación pública. El consumo apropiado de genéricos y "medicamentos biosimilares" es muy importante para mantener el equilibrio financiero de los servicios de salud. El problema en América Latina es que no todos los productos multifuentes son bioequivalentes y no todos los países tienen los recursos necesarios para realizar los estudios de bioequivalencia in vivo. La Agencia Europea del Medicamento en 2005 aprobó la directriz sobre "medicamentos biosimilares" y después se han autorizado trece de ellos para su comercialización. El referenciamiento de este modelo por otros países seria importante. La influencia de la industria farmacéutica sobre las áreas políticas y administrativas es necesario controlarla. Las compañías farmacéuticas afirman que actúan con responsabilidad social corporativa, por ello, se debería garantizar el cumplimiento de la misma con la sociedad.

The global economic crisis and its impact on public finances in most developed countries are giving rise to cost-containment policies in healthcare systems. Prevailing legislation on medication requires the safety, quality, and efficacy of these products. A few countries include efficiency criteria, primarily for new medication that they wish to include in public financing. The appropriate use of generic and "biosimilar medication" is very important for maintaining the financial equilibrium of the Health Services. The problem in Latin America is that not all multisource products are bioequivalent and not all countries have the resources to conduct bioequivalence studies in vivo. The European Medicines Agency in 2005 adopted guidelines on "biosimilar medicines" and thirteen of them were subsequently approved for general release. Benchmarking of this model by other countries would be important. The influence of the pharmaceutical industry on political and administrative areas is enormous and control is necessary. The pharmaceutical companies claim that they act with corporate social responsibility, therefore, they must ensure this responsibility toward society.

Abandono del tratamiento: una causa de muerte evitable en el niño con cáncer / Treatment abandonment: cause of preventable death in children with cancer

Objetivos: El presente texto muestra el análisis de una cohorte de niños con cáncer para determinar el riesgo de recaída o muerte en los pacientes que abandonan el tratamiento, y explora los determinantes del abandono. Métodos: Estudio de cohorte retrospectivo. Se incluyeron a 303 pacientes menores de 23 años, entre enero de 1998 y diciembre de 2000. La información fue obtenida de la historia clínica y entrevista telefónica con familiares de los pacientes. Se utilizó estadística descriptiva para las frecuencias de variables categóricas. Se realizaron tablas de contingencia y se calculo la prueba Χ2 o el test exacto de Fisher para determinar la asociación de las variables con el abandono, en los casos que no cumplían los supuestos de la Χ2 Se estimaron las Hazard Ratio de falla al tratamiento usando un modelo de regresión de Cox. El análisis de supervivencia se realizó mediante el método de Kaplan-Meier. Resultados: El 17,87% abandonó el tratamiento. La probabilidad de recaer o morir por la enfermedad se asoció al abandono de tratamiento (P=0,001). El análisis bivariado mostró que el riesgo de recaída y el abandono fueron las únicas variables asociadas al desarrollo del evento. Los HR ajustados para el abandono y el riesgo de recaída fueron 3,90 (IC 95%; 2,27-6,77) y 2,24 (IC 95%; 1,29-3,88), respectivamente. El resto de variables no mostraron resultados significativos. Conclusiones: El porcentaje de abandono de tratamiento, del 17,87%, es alto, comparado con el de países desarrollados, y muestra una fuerza de asociación elevada para recaer o morir.

Objective: A cohort of children with cancer was analyzed to determine the risks of relapse or death in patients who abandoned treatment, as well as to explore causes for abandonment. Methods: A retrospective cohort study was carried out with 303 patients, under age 23, from January 1998 to December 2000. Data were obtained from medical records and a telephone survey. Descriptive statistics were used to determine frequencies of category variables; contingency tables and calculation of the test, or the Exact Fisher Test, determined the association of variables with abandonment, in cases which did not fulfill Chi2 suppositions. Hazard ratio (HR) of treatment failure was calculated with the Cox regression model and survival analysis with the Kaplan-Meier method. Results: A total of 17.87% patients abandoned treatment. Relapse and mortality were associated with treatment failure (P=0.001). Bivariate analysis revealed that the risks of relapse and abandonment were the only variables associated with development of event. Adjusted HR for abandonment and relapse risk was 3.90 (CI 95%; 2.27-6.77) and 2.24 (CI 95%; 1.29-3.88), respectively. The remaining variable showed no significant results. Conclusions: Treatment abandonment at 17.87% is high compared to developed countries, and reveals an accentuated tendency to be associated with relapse and death.

Stroke epidemiology: a review of population-based studies / 国际脑血管病杂志

Since 2007, a number of published population-based studies have shown that stroke epidemiology has changed. There are some differences in morbidity, mortality, risk factors and clinical prognosis of stroke between the high-income countries and the less developed countries.

Socioeconomic inequities in the health and nutrition of children in low/middle income countries / Iniqüidades sociais na saúde e nutrição de crianças em países de renda baixa e média

OBJECTIVE: To describe the effects of social inequities on the health and nutrition of children in low and middle income countries. METHODS: We reviewed existing data on socioeconomic disparities within-countries relative to the use of services, nutritional status, morbidity, and mortality. A conceptual framework including five major hierarchical categories affecting inequities was adopted: socioeconomic context and position, differential exposure, differential vulnerability, differential health outcomes, and differential consequences. The search of the PubMed database since 1990 identified 244 articles related to the theme. Results were also analyzed from almost 100 recent national surveys, including Demographic Health Surveys and the UNICEF Multiple Indicator Cluster Surveys. RESULTS: Children from poor families are more likely, relative to those from better-off families, to be exposed to pathogenic agents; once they are exposed, they are more likely to become ill because of their lower resistance and lower coverage with preventive interventions. Once they become ill, they are less likely to have access to health services and the quality of these services is likely to be lower, with less access to life-saving treatments. As a consequence, children from poor family have higher mortality rates and are more likely to be undernourished. CONCLUSIONS: Except for child obesity and inadequate breastfeeding practices, all the other adverse conditions analyzed were more prevalent in children from less well-off families. Careful documentation of the multiple levels of determination of socioeconomic inequities in child health is essential for understanding the nature of this problem and for establishing interventions that can reduce these differences.

OBJETIVO: Descrever o efeito das iniqüidades sociais sobre a nutrição e saúde de crianças de países de renda baixa e média. MÉTODOS: Foram revisadas informações disponíveis sobre disparidades socioeconômicas intra-países, relativas a uso de serviços de saúde, estado nutricional, morbidade e mortalidade. Adotou-se um modelo conceitual com cinco categorias hierárquicas na produção de iniqüidades: contexto e posição socioeconômica, diferenças na exposição, na vulnerabilidade, nos desfechos de saúde e nas conseqüências. Em pesquisa realizada na base PubMed, no período de 1990-2007 foram encontrados 244 artigos relacionados ao tema. Foram também analisados os resultados de cerca de 100 inquéritos de âmbito nacional recentes, incluindo Pesquisas Nacionais de Demografia e Saúde e Inquéritos por Conglomerados de Múltiplos Indicadores, do Fundo das Nações Unidas para a Infância. RESULTADOS: Crianças de famílias pobres, em comparação com aquelas de famílias mais ricas, são mais suscetíveis à exposição a agentes patogênicos; uma vez expostas, têm um risco aumentado de adoecer, devido à sua menor resistência e menor cobertura de medidas preventivas. Uma vez que se tornam doentes, têm menor acesso a serviços de saúde, a qualidade dos serviços que logram utilizar tende a ser inferior, com menor acesso a tratamentos médicos que garantam sua sobrevivência. Como conseqüência, crianças de famílias mais pobres apresentam maiores taxas de mortalidade e maior risco de serem subnutridas. CONCLUSÕES: Exceto obesidade infantil e práticas inadequadas de aleitamento materno, todas as outras condições adversas analisadas tiveram maior prevalência entre as crianças de famílias menos favorecidas. A documentação cuidadosa dos múltiplos níveis de determinantes das iniqüidades socioeconômicas em saúde infantil é essencial para o entendimento da natureza do problema, e para o estabelecimento de intervenções que possam reduzir estas diferenças.

Exporting "failure": why research from rich countries may not benefit the developing world / Exportando "fracasso": porquê a pesquisa de países desenvolvidos pode não beneficiar os países em desenvolvimento

The '10/90 gap' was first highlighted by the Global Forum for Health Research. It refers to the finding that 90 percent of worldwide medical research expenditure is targeted at problems affecting only 10 percent of the world's population. Applying research results from the rich world to the problems of the poor may be a tempting, potentially easy and convenient solution for this gap. This paper had the objective of presenting arguments that such an approach runs the risk of exporting failure. Health interventions that are shown to be effective in the specific context of a Western industrialized setting will not necessarily work in the developing world.

O "gap 10/90" foi inicialmente apontada pelo Global Forum for Health Research. Refere-se ao achado de que 90 por cento dos gastos mundiais em pesquisa médica é voltada a problemas que afetam apenas 10 por cento da população mundial. Resultados de pesquisa aplicáveis provenientes dos países ricos aos problemas dos pobres poderiam ser uma solução tentadora, conveniente e potencialmente fácil para solução desse gap. O artigo teve por objetivo apresentar argumentos de que tal abordagem acarretaria o risco de exportar fracassos. Intervenções em saúde que se mostram efetivas no contexto específico de um país ocidental industrializado necessariamente não funcionará em um país em desenvolvimento.

Analyze to Medical Situation of CAM in Developed Countries / 国际中医中药杂志

This article reviewed development and current situation of Complementary and Alternative Medicine(CAM) in developed countries such as european countries, Japan, South Korea, Australia and the United States of recent years. The items included in this study were the situation of medical treatment, construction of medical institutions and associations, medical cost and the insurance. The article also made a suggestion on the development of TCM in China in order to ensure her leading role in the field of traditional medicine in the world.

Review of Foreign Medical Education Management / 中华医学教育探索杂志

The state of scale management,structure of hierarchy,professional institutions,educational system and degree,situation of academy and cost of medical education in developed countries was summarized in this article respectively to provide reference for our medical education reform.

Assessment of primary care level in Korea and comparison with the developed countries

BACKGROUND: Due to the limited medical resources, effectiveness, efficiency, and equity has become the main issue of health care system reform in the developed countries, which has lead to the focusing on strengthening of primary care. The study was performed to assess the primary care level and health indicators in Korea utilizing objective criteria used in other developed countries, so as to evaluate its current status compared to the developed countries. METHODS: Starfield's primary care scoring criteria of the system and practice characteristics was used to evaluate the primary care level in Korea and 13 members of the OECD countries. According to the primary care score, the countries were grouped in to 3 groups(highest, middle, lowest) and were compared the health indicators, health care expenditure, and satisfaction with health care system. RESULTS: Korea ranked the lowest in both primary care level and health indicators. The amount of health care expenditure and satisfaction with health care system were also low. Health indicators were worst in the lowest primary score group. But unexpectedly, middle group had better health indicators than highest group in most items. CONCLUSION: Primary care level in Korea is very low compared to the developed countries. Middle primary care level countries having better health indicators may be due to the overemphasis of efficiency and equal distribution in highest level countries leading to low quality service. Korea should consider modelling the middle group countries in the course of establishing primary care system with equal balancing in quantity and quality.

Historical Development of Ethical Research in Psycho-Counseling and Psycho-therapy in Developed Countries / 中国医学伦理学

According to the overview of historical development of ethical research in psycho-counseling and psycho-therapy in developed countries,this paper aims to summarize the research experience and outcome,in order to promote related Chinese ethical research based on China's realistic situation.