JP5231835B2 - Health guidance support system - Google Patents

Description

  The present invention relates to loss (increased expenditure of a person, decrease in income, quality of life: Quality of life) in a communication network in which a medical information system or a medical device and a patient balance management apparatus are connected. QOL)), and a health guidance support system used when providing an appropriate health guidance guide to health leaders.

  In recent years, in health examinations, information such as exceeding a warning value or being close to a warning value is obtained for each inspection item, and health guidance based on the information is performed.

Moreover, there are many known examples of the disease incidence calculation means as follows.
JP 2003-47614 A JP-A-2005-265 JP 2006-53628 A JP 2006-259809 A

  By the way, if there is a disease such as diabetes or hypertension that causes a long-term treatment or a decrease in QOL once affected, there is a disease that can be cured by a short-term treatment such as a gastric ulcer.

  However, the conventional techniques described above have the following problems.

  Regardless of the loss and loss rate when suffering from a certain disease, we paid attention only to whether the test item value was close to or exceeded the threshold, and provided health guidance based on it.

  There are known examples of means for determining the incidence of disease, but the loss and loss rate when suffering from the disease, and further, a prevention plan has not been provided to the examinee.

  When calculating the loss rate and creating a prevention plan in a health checkup, if the person being examined is not a healthy person, there is a possibility of a number of diseases. It was not right.

  Therefore, the present invention has been made in view of the above circumstances, and its purpose is to be able to calculate the loss and loss rate due to the disease and present the prevention plan and the degree of loss reduction to the examinee. It is possible to calculate the probability of onset and the expected loss for multiple possible diseases, and graphically display them to indicate the diseases that the health instructor should pay attention to. It is to provide a health guidance support system that can be used.

That is, the present invention according to claim 1 is a medical information system or a medical device, a patient balance management device for managing the balance of the examinee, and a health management system that compensates for the medical expenses at least for the illness of the examinee. A health guidance support system comprising a communication network, the health management system comprising: disease statistical data storage means having disease statistical data; medical examination data storage means having medical examination data; The patient balance data storage means for storing the balance of patients having at least money, life, and behavior history, and the incidence calculation means for calculating the incidence of disease based on the disease statistical data from the medical examination data; and loss Shitsusan detecting means for calculating whether the examinee is how much loss the suffering the patient to the disease occurs, the incidence of the disease, Daewoo when the disease has affected awake Hand stage you calculate an expected value of the loss from the loss, characterized by comprising: a hand stage you post a calculated expected value to the testee in means for calculating the expected value.

Further, the present invention according to claim 5 is a medical information system or medical device, a patient balance management device for managing the balance of the examinee, and health management that supplements the medical expenses at least for the illness of the examinee. In a health guidance support system in which the system is connected by a communication network, at least one of the medical information system and the medical device has disease statistical data storage means having disease statistical data, and medical examination data Medical checkup data storage means, and the medical checkup balance management device has checkup balance data storage means for storing the balance of the patient having at least the money, life, and behavior history of the checkup, The health management system includes an onset rate calculating means for calculating an onset rate of a disease based on the disease statistical data from the medical examination data, and when the examinee suffers from a disease, Calculating a loss Shitsusan detecting means, and the incidence of the disease, and hand stage you calculate the expected value from the loss that may appear when the disease has affected happening, the expected value for calculating whether the degree of losses hand stage post expectation value calculated by means of the examinees, and having a.

  According to the present invention, it is possible to calculate a loss / loss rate due to a disease, to present a prevention plan and a degree of loss reduction to a patient, and to develop a plurality of possible diseases Providing a health guidance support system that calculates the probability and expected loss value and graphically displays them to present the disease that health leaders should pay attention to and provide optimal health guidance to the examinee it can.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings.

(First embodiment)
FIG. 1 is a block diagram showing a configuration of a health guidance support system according to the first embodiment of the present invention.

  In FIG. 1, the health guidance support system 1 is configured by a communication network (network connection) between a medical information system or medical equipment, a patient management apparatus, and a health insurance association.

  In the health guidance support system 1, a hospital or clinic (hospital / clinic) 10, a company, a public office or school (company / government / school) 20, a health insurance association 30, and a terminal 60 for examinees are connected via a network. It has been configured.

  The hospital or clinic 10 has a medical information system or medical equipment (medical information system / medical equipment) 11. The medical information system or medical device 11 is, for example, a medical examination system having a medical examination data / test data of a medical examinee, a clinic system, a disease statistical data storage device having disease data, and a specimen device having specimen data. It is.

  The company, the government office or the school 20 has a examinee balance management device 21, and is a device for managing various balances of the examinee, for example. This examiner's balance management device 21 is constituted by, for example, a person-employment management device having health promotion allowances such as the number of leave days of the examinee, school attendance / working status, medical expenses, exercise, etc., and food expenses / salary income.

  The recipient terminal 60 is a terminal for presenting information to the examinee. This terminal is configured by a display device 61, for example.

  The health insurance association 30 is a health management system for compensating for medical expenses for diseases of the examinee and his family. The health insurance association 30 includes a medical checkup or medical data registration system (health checkup / medical data registration system) 31 as a storage means, a medical account balance data registration system (personnel data registration system) 32 as a storage means, And a health guidance support medical device 40. In this embodiment, the disease statistics data 101 and the medical examination data 102 acquired from the medical information system or the medical device 11 are registered in the medical examination or medical data registration system 31, and the patient balance data 103 is registered in the patient balance data. It is registered in the system 32.

  The medical guidance support medical device 40 includes a disease statistics data acquisition unit 41, a medical examination data acquisition unit 42, a patient balance data acquisition unit 43, a loss calculation unit 44, an onset rate calculation unit 45, and a loss rate calculation. Unit 46 and loss rate presentation unit 47.

  The disease statistics data acquisition unit 41 is means for acquiring the disease statistics data 101 registered in the medical examination or medical data registration system 31 in the health guidance support medical device 40. Similarly, the medical examination data acquisition unit 42 is means for acquiring the medical examination data 102 registered in the medical examination or medical data registration system 31 in the health guidance support medical device 40. Further, the examiner balance data acquisition unit 43 is means for registering the examiner balance data 103 registered in the examiner balance data registration system 32.

  The loss calculation unit 44 is a means for calculating a loss that is expected when the examinee suffers from a certain disease. The onset rate calculating unit 45 is a means for calculating the onset rate of the disease based on 101 from the medical examination data 102 to the disease statistical data.

  The loss rate calculation unit 46 is a means for calculating a loss rate from the onset rate of the disease and the loss that can occur when it occurs. The loss rate presenting unit 47 is means for presenting the loss rate to the examinee, and transmits and receives the request and the result of the request to the examinee terminal 60.

  Next, the processing operation of the health guidance support system 1 in this embodiment will be described with reference to the flowchart of FIG.

  First, in steps S1 and S2, the examination request is registered by the medical examination or medical data registration system 31 and the examiner balance data registration system 32. This is because the disease statistics data 101 and the concentric data 102 are registered by the medical information system or the medical device 11 of the hospital or clinic 10, and the patient balance data is stored by the patient balance management device 21 of the company, the public office or the school 20. be registered. Here, a correlation coefficient between a disease and a test value is registered as the disease statistical data 101, and a medical examination / test data (blood glucose level, γ-GTP, etc.) is registered as the medical examination data. .

  Next, in step S <b> 3, the disease statistical data 101 and the medical examination data 102 are acquired by the onset rate calculating unit 45 by the disease statistical data acquiring unit 41 and the medical examination data acquiring unit 42 in the health guidance support medical device 40. . Then, the onset rate for each disease is calculated by the onset rate calculating unit 45. As a calculation method, a known method described in the aforementioned patent document is used.

  Further, in step S 4, the disease statistics data 101, the medical examination data 102 and the patient balance data 103 are transferred to the loss calculation section 44 by the disease statistical data acquisition section 41, the medical examination data acquisition section 42 and the medical examiner balance data acquisition section 43. To be acquired. The loss calculation unit 44 calculates a loss expected when suffering from a certain disease. For example, when there is a possibility of suffering from diabetes or the like, a 5-year survival rate is extracted from the disease statistical data 101 based on the medical examination data 102 to calculate how much the survival rate can be lost. Further, the treatment cost when suffering from diabetes is calculated from statistics such as an electronic medical record in the disease statistical data 101. Further, the decrease in income due to the absence of work is calculated by the salary / vacation management device of the patient balance data 103 from the number of days of hospitalization obtained from the electronic medical record or the like in the disease statistics data 101. In this way, the loss is calculated.

  Next, in step S5, the loss rate calculation unit 46 calculates the loss rate from the incidence rate of the disease calculated in step S3 and the loss expected when suffering from the disease calculated in step S4. That is, the expected value of loss is calculated.

  In step S <b> 6, the loss rate is presented to the examinee from the loss rate presentation unit 47 via the display device 61 in the examinee terminal 60.

For example, FIG. 3 is a graph showing the probability of occurrence and the expected loss value for a disease A, B, and C of a patient. In this case, it is assumed that the onset occurs when the bar graphs D ₁ , D ₂ , D ₃ representing the occurrence probabilities exceed a threshold indicated by a broken line. And the loss expected value at the time of onset is represented by the line graph. This shows that the loss increases even when the probability of occurrence is low.

  FIG. 4 shows the incidence and loss for each treatment plan for diseases A, B, C,..., And all diseases, where (a) shows no countermeasures and (b) shows diet and exercise for each treatment plan. (C) is the table | surface which showed each example of the case where (c) is based on the predetermined treatment plan A, (d) is the case where the treatment plan A and the said life improvement are performed.

  Here, all diseases represent diseases when all diseases A, B, C,... Are considered. However, all the diseases A, B, C,... Are not added to obtain the values of all diseases. This is due to the following reason.

  That is, the risk rate may increase because the disease incidence and the 5-year mortality rate are often correlated with each other. This is calculated in the onset rate calculation unit 45 in consideration of the correlation.

  In addition, if a plurality of affected areas are treated together in one treatment, the amount of money may be lower than that of individual treatment. Or conversely, the degree of treatment difficulty increases, and it is conceivable that a plurality of affected areas are collected more than the individual treatment.

  Furthermore, since exercise is often a fixed amount with a membership system, it does not simply mean A + B + C.

  Next, creation of a chart representing the loss and treatment plan based on this table will be described.

  FIG. 5 is a level conversion table for creating a chart of loss and treatment plan based on the disease table of FIG. For each item in the table of FIG. 4, probability [%], amount [yen], and failure level (total value) are assigned to risk levels. In other words, the incidence rate, 5-year mortality rate is converted into probability, and the patient-paid treatment cost, insurance-paid treatment cost, income lost by the person based on the 5-year survival rate, exercise cost, total treatment cost, total loss amount Is expressed in monetary amounts. Here, although the danger level is expressed in 11 levels from 0 to 10, it is not particularly limited to this, and any level of evaluation may be used as long as it is easily recognized by the examinee.

  FIG. 6 is a chart of loss and treatment plan based on the disease table of FIG. The loss and treatment plan chart in FIG. 6 is for disease A only.

  In FIG. 6, 9 items for the disease A in FIG. 4 are represented by 11 risk levels (refer to the conversion table in FIG. 5), the center is “0”, and the level is increased step by step toward the outside. . In addition, the treatment plan in FIG. 4 (a) without countermeasures is indicated by a broken line, the life improvement in FIG. 4 (b) is indicated by a one-dot chain line, and the treatment plan A in FIG. 4 (c) is indicated by a two-dot chain line. FIG. 4D shows the treatment plan and improvement of life with a solid line.

  In the loss and treatment plan chart, the exercise cost is relatively lower than other loss amounts such as the treatment cost, and therefore is shown as relatively level 0.

  According to this chart, it is possible to easily recognize which item is high in risk and how much the loss is. In addition, since each item is displayed for each treatment plan, it is possible to recognize which treatment plan is more effective.

  Then, when the display of “failure level” on the chart of FIG. 6 is clicked by an operation of a graphical user interface (GUI) or the like, a detailed failure level graph shown in FIG. 7 is displayed. In this example, six levels of 0-5 are shown for each of the six levels of "hand numbness", "paralysis", "blindness", "anemia", "vomiting", and "fatigue". The higher the number, the more serious it becomes.

  As shown in the table of FIG. 8A, the six stages of failure levels are defined using a Brunstrom stage or the like in which the failure degree is divided into stages. For example, the state of numbness of the hand is expressed in six stages from “various knobs / extensions possible” to “no movement (relaxing paralysis)”, with “all movements possible” being 0.

  The failure level data of each examinee is shown as a table in FIG. This indicates the expected failure level of the examinee (the higher the value, the more serious) based on the failure level definition in the table of FIG. FIG. 7 is a chart of failure levels created from the table of FIG.

  FIG. 9 is another chart of loss and treatment plan based on the disease table of FIG. The loss and treatment plan chart in FIG. 9 is for all diseases including the disease A, disease B, disease C,... In FIG.

  In FIG. 9, 9 items for disease A in FIG. 4 are represented by 11 risk levels (see the conversion table in FIG. 5), with the center being “0” and increasing outward by 1 level. . In addition, the treatment plan in FIG. 4 (a) without countermeasures is indicated by a broken line, the life improvement in FIG. 4 (b) is indicated by a one-dot chain line, and the treatment plan A in FIG. 4 (c) is indicated by a two-dot chain line. FIG. 4D shows the treatment plan and improvement of life with a solid line. The way of viewing the chart is the same as in FIG.

  Thus, by calculating the onset probability, the expected loss value, and the like for a plurality of predicted diseases, and graphically displaying them with the chart, it is possible to present the diseases to which the health leader should pay attention. Then, when the health instructor presents the disease, loss / risk caused by the disease can be reduced.

  Also, for both, you can visualize how much you will benefit from the loss.

  Next, a modification of this embodiment will be described.

  FIG. 10 is a block diagram showing a configuration of a health guidance support system according to a modification of the first embodiment of the present invention.

  In FIG. 10, this health guidance support system 1a is constituted by a network connection of a medical information system or medical equipment and a patient management apparatus.

  In this health guidance support system 1a, only the configuration is partially different, and other basic configurations and processing operations are the same as those of the health guidance support system 1 of the first embodiment described above. Therefore, the corresponding parts are denoted by the same reference numerals and the description thereof is omitted.

  The health guidance support system 1a has a configuration in which a hospital or clinic (hospital / clinic) 10a, a company, a public office or school (company / government / school) 20a, and a health insurance association 30a are connected via a network. Yes.

  The hospital or clinic 10a has a medical information system or medical equipment (medical information system / medical equipment) 11a. In this modification, the medical information system or medical device 11a has a database for registering the disease statistical data 101 and the medical examination data 102.

  Further, the company, the public office or the school 20a has a patient balance management device 21a. The examiner balance management device 21 a has a database for registering the examiner balance data 103.

  The health insurance association 30a includes a disease statistic data acquisition unit 41, a medical examination data acquisition unit 42, a patient balance data acquisition unit 43, a loss calculation unit 44, an onset rate calculation unit 45, a loss rate calculation unit 46, and a loss rate presentation unit 47. , And a health guidance support medical device 40 a having a terminal 60 for a patient including a display device 61.

  Thus, the database for registering various data does not necessarily exist in the health insurance association. Further, as in this modification, the terminal for the examinee may be in the health insurance association.

(Second Embodiment)
Next, a second embodiment of the present invention will be described.

  In the second embodiment, the basic configuration and processing operations of the health support guidance system are the same as those of the health guidance support system according to the first embodiment shown in FIGS. Since the configuration and the processing operation are the same, the same parts are denoted by the same reference numerals, illustration and description thereof are omitted, and only different parts will be described.

  FIG. 11 is a block diagram showing a health guidance support medical device in a health insurance association constituting the health guidance support system according to the second embodiment of the present invention.

  In FIG. 11, this health guidance support medical device 40 b includes a disease statistics data acquisition unit 41, a medical examination data acquisition unit 42, a patient balance data acquisition unit 43, a loss calculation unit 44, an onset rate calculation unit 45, a loss rate. The calculation unit 46, the prevention plan creation unit 51, and the prevention plan presentation unit 52 are configured.

  The preventive plan creation unit 51 is a means for creating a preventive plan based on the above-described loss rates of a plurality of diseases. In the creation of this prevention plan, a plan is created so as to minimize not only a single disease but also a predicted loss rate of a plurality of diseases. The preventive plan presenting unit 52 is means for presenting the preventive plan created by the preventive plan creating unit 51 via the display device 61 in the examinee terminal 60.

  In the prevention plan creation unit 51, the incidence, loss, and loss rate when the prevention plan is implemented are based on the past treatment execution results in the disease statistical data 101, the medical examination data 102, and the patient balance data 103 described above. Is calculated.

  For example, when suffering from a plurality of diseases such as metabolic syndrome, a plurality of life improvement and treatment methods can be considered. In such a case, the examinee can compare information for determining which treatment method to select. For example, when no countermeasure is taken, the table shown in FIG. 4A and the broken line chart in FIG. 6 are assumed. When the life improvement is performed, the table in FIG. 4B and the one-dot chain line chart in FIG. 6, and when the treatment plan A is performed, the table in FIG. 4C and the two-dot chain line chart in FIG. The case where treatment plan A and life improvement are performed together is shown in the table of FIG. 4D and the solid line chart of FIG.

  In the present embodiment, a prevention plan creation unit 51 creates a prevention plan based on the above-described past treatment execution results for each treatment plan. As a result, the prevention plan is displayed on the display device 61 via the prevention plan presentation unit 52. The examinee selects as appropriate from the preventive plans displayed on the display device 61.

  As described above, according to the second embodiment, since the prevention plan based on the treatment plan is created, the examinee can select the prevention plan according to the situation at that time. Depending on the prevention plan, it is possible to create and present not only a single disease but also a prevention plan for minimizing the predicted loss rate of a plurality of diseases.

(Third embodiment)
Next, a third embodiment of the present invention will be described.

  In the third embodiment, the basic configuration and processing operation of the health support guidance system are the same as those of the health guidance support system according to the first embodiment shown in FIGS. Since the configuration and the processing operation are the same, the same parts are denoted by the same reference numerals, illustration and description thereof are omitted, and only different parts will be described.

  FIG. 12 is a block diagram showing a health guidance support medical device in a health insurance association constituting a health guidance support system according to the third embodiment of the present invention.

  In FIG. 12, this medical guidance support medical device 40c includes a disease statistics data acquisition unit 41, a medical examination data acquisition unit 42, a medical examinee balance data acquisition unit 43, a loss calculation unit 44, an onset rate calculation unit 45, a loss rate. Calculation unit 46, prevention plan creation unit 51, prevention plan presentation unit 52, onset rate or loss rate totaling unit (onset rate / loss rate totaling unit) 55, onset rate or loss rate presenting unit (onset rate / loss rate presenting unit) 56 and an insurer display device 57.

  The onset rate / loss rate totalization unit 55 is a means for performing totalization to achieve reduction targets for diseases imposed on the insurer by the government or the like, for example, patients with metabolic syndrome and their reserves. In the onset rate / loss rate totaling unit 55, the expected value of how much the reduction expectation of the disease and the countermeasure cost will be calculated is totaled. Then, the totaling result is displayed on the insurer display device 57 via the onset rate / loss rate presentation unit 56. The insurer looks at the numerical values displayed on the insurer display device 57 and determines whether or not the target can be achieved.

  Thus, according to the third embodiment, it is possible to easily know the current situation with respect to the disease reduction target imposed on the insurer.

  Although the embodiments of the present invention have been described above, the present invention can be variously modified without departing from the gist of the present invention other than the above-described embodiments.

  Further, the above-described embodiments include inventions at various stages, and various inventions can be extracted by appropriately combining a plurality of disclosed constituent elements. For example, even if some constituent requirements are deleted from all the constituent requirements shown in the embodiment, the problem described in the column of the problem to be solved by the invention can be solved, and the effect described in the column of the effect of the invention Can be extracted as an invention.

It is the block diagram which showed the structure of the health guidance support system which concerns on the 1st Embodiment of this invention. It is a flowchart for demonstrating the processing operation of the health guidance support system 1 in the 1st Embodiment of this invention. It is the graph which showed the generation | occurrence | production probability with respect to the disease A, B, and C of a certain patient, and an estimated loss value. Expresses the incidence and loss of each treatment plan for diseases A, B, C, ... and all diseases, where (a) is no measure for each treatment plan, (b) is a lifestyle improvement through diet and exercise When performed, (c) is a table showing an example when a predetermined treatment plan A is used, and (d) is a table showing respective examples when the treatment plan A and the life improvement are performed. 5 is a level conversion table for creating a chart of loss and treatment plan based on the disease table of FIG. 5 is a chart of loss and treatment plan based on the disease table of FIG. It is a graph showing a detailed failure level. (A) is a table in which the degree of failure is staged, and (b) is a table showing an example of the failure level for each failure item. 5 is another chart of loss and treatment plan based on the disease table of FIG. It is the block diagram which showed the structure of the health guidance support system which concerns on the modification of the 1st Embodiment of this invention. It is the block diagram which showed the health guidance support medical device in the health insurance association which comprises the health guidance support system which concerns on the 2nd Embodiment of this invention. It is the block diagram which showed the health guidance support medical device in the health insurance association which comprises the health guidance support system which concerns on the 3rd Embodiment of this invention.

Explanation of symbols

  DESCRIPTION OF SYMBOLS 1, 1a ... Health guidance support system, 10 ... Hospital or clinic (hospital / clinic), 11, 11a ... Medical information system or medical device (medical information system / medical device), 20 ... Company, public office or school (company)・ Public authorities / schools), 21, 21a ... Medical checker balance management device, 30 ... Health insurance association 30, 31 ... Medical checkup or medical data registration system (health checkup / medical data registration system), 32 ... Medical checkup balance data registration system (Personnel data registration system), 40, 40a, 40b, 40c ... health guidance support medical device, 41 ... disease statistics data acquisition unit, 42 ... medical examination data acquisition unit, 43 ... patient balance data acquisition unit, 44 ... loss Calculation unit, 45 ... incidence rate calculation unit, 46 ... loss rate calculation unit, 47 ... loss rate presentation unit, 51 ... prevention plan creation unit, 52 ... prevention plan presentation unit, 55 ... incidence rate Is a loss rate totaling unit (onset rate / loss rate totaling unit), 56 ... onset rate or loss rate presenting unit (onset rate / loss rate presenting unit), 57 ... display device for insurers, 60 ... terminal for examinees, 61 Display device 101 Disease statistics data 102 Medical check data 103 Patient balance data

Claims (5)

A health system comprising a medical information system or medical device, a medical account balance management device for managing the medical balance of the medical examinee, and a health management system that at least compensates the medical expenses for the medical condition of the medical examinee through a communication network. In the guidance support system,
The health management system includes:
Disease statistical data storage means having disease statistical data;
Medical examination data storage means having medical examination data;
A patient balance data storage means for storing a balance of a patient having a history of at least money, life, and behavior of the examinee;
An onset rate calculating means for calculating an onset rate of a disease based on the disease statistical data from the medical examination data;
And loss Shitsusan detecting means for calculating the loss or how much to the testee occurs when the examinee is suffering from a disease,
And incidence of the disease, and hand stage calculate an expected value of the loss from the loss that may appear when the disease has affected awake,
Hand stage post expectation value calculated by means for calculating the expected value to the testee,
A health guidance support system characterized by comprising: Health guidance support system according to claim 1, characterized by further comprising display means for displaying the expected value posted in means for posting the expected value. The health management system includes:
Based on the expected value calculated by the means for calculating the expected value , the incidence of the disease, and the loss that can occur when the disease occurs and suffers, how much the incidence, loss, and expected value are reduced Preventive plan creation means to create what you can do,
A preventive plan presenting means for presenting the preventive plan created by the preventive plan creating means to the examinee;
The health guidance support system according to claim 1, further comprising: The health management system includes:
The incidence of the disease in the plurality of examinees, and hand stage you aggregate expected value,
The incidence, the incidence rate was aggregated at the means to aggregate the expected value, and hand stage that be presented to the insurer the expected value,
The health guidance support system according to any one of claims 1 to 3, further comprising: A health system comprising a medical information system or medical device, a medical account balance management device for managing the medical balance of the medical examinee, and a health management system that at least compensates the medical expenses for the medical condition of the medical examinee through a communication network. In the guidance support system,
At least one of the medical information system and the medical device is
Disease statistical data storage means having disease statistical data;
Medical examination data storage means having medical examination data;
Have
The patient balance management device is:
A patient balance data storage means for storing a balance of a patient having a history of at least money, life, and behavior of the examinee;
Have
The health management system includes:
An onset rate calculating means for calculating an onset rate of a disease based on the disease statistical data from the medical examination data;
And loss Shitsusan detecting means for calculating the loss or how much to the testee occurs when the examinee is suffering from a disease,
And incidence of the disease, and hand stage calculate the expected value from the loss that may appear when the disease has affected awake,
Hand stage post expectation value calculated by means for calculating the expected value to the testee,
A health guidance support system characterized by having

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