Journal of Preventive Medicine and Public Health

Ok Ryun Moon

37 Articles

Certificate Education for Geriatric Physician: Satisfaction and Feasibility.: Sung Chun Lee, Hwa Joon Kim, Hyung Joon Park, Jong Lull Yun, Chang Yup Kim, Ok Ryun Moon, Soong Nang Jang; J Prev Med Public Health. 2008;41(1):10-16.; DOI: https://doi.org/10.3961/jpmph.2008.41.1.10

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OBJECTIVES
Korea faces a number of challenges to meet demands in the area of geriatric professional medicine in a country with a rapidly ageing population. We evaluated the satisfaction and feasibility of the current education certification for geriatric physicians. METHODS: Geriatric physicians who were deemed qualified by the Korean Geriatrics Society during the period of 2001 to 2005 (n=2,200) were asked to complete structured questionnaires sent to them by mail about their satisfaction of and need for certificates of education, as well as their opinions on their geriatric specialty training. A total of 419 physicians responded. Descriptive analysis and hierarchical regression were performed to rate the respondents.satisfaction, the characteristics of the need for clarity and utility in education certification, and the characteristics of their patients. RESULTS: Although most respondents were satisfied with their education certification, those who had more elderly patients, aged 65 or older, and those who had more cognitively impaired patients, rated their education as significantly lower than did other physicians. Both groups expressed the need for more the comprehensive care and assessment concerning of their education. Multiple regression analysis indicated that satisfaction with geriatric physician qualification was associated with a physician's age, specialty, and percentage of elderly patients. CONCLSIONS: This study suggests that the current system of education certification is limited in terms of feasibility and physician satisfaction.

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Is socioeconomic disparity in disability improving among Korean elders?
Soong-Nang Jang, Sung-il Cho, Ichiro Kawachi
Social Science & Medicine.2010; 71(2): 282. CrossRef

Disparities in Participation in Health Examination by Socio-economic Position among Adult Seoul Residents.: Eun Jeong Chun, Soong Nang Jang, Sung Il Cho, Youngtae Cho, Ok Ryun Moon; J Prev Med Public Health. 2007;40(5):345-350.; DOI: https://doi.org/10.3961/jpmph.2007.40.5.345

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OBJECTIVES
To determine the disparity in the rate people undergo health examinations according to socioeconomic position (SEP) and the changes in this disparity with time. METHODS: Seoul citizens}health profile data from 1997 to 2005 were analyzed. The study subjects were 40 years old and over, and the total number of subjects was 6,601 in 1997, 8,994 in 2001, and 8,819 in 2005. Those aged 60 years and over were eliminated from the analysis of subjects}occupation. We used education, family income and occupation as indicators of SEP. The age-standardized health examination attendance rate for each year was calculated according to the education, family income and occupation. The odds ratios (ORs) from multiple logistic regressions were adjusted for age. RESULTS: The disparity in the rate of attendance according to the SEP decreased from 1997 to 2005 but still existed. Even though the disparities among the subgroups according to education, family income and occupation were not that high, the disparity between the group with the highest SEP and the other groups was considerable. CONCLUSIONS: Our findings suggest that unequal access to health examination services according to socioeconomic position still exists. This disparity has decreased recently but the disparity according to level of education was the greatest.

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Socioeconomic differences in the perception of inequalities in healthcare utilization and health in South Korea
Nayeon Kim, Hye-won Yun, Juwon Park, Fatima Nari, Hee Jin Wang, Jae Kwan Jun, Kui Son Choi, Mina Suh
Preventive Medicine Reports.2023; 36: 102445. CrossRef
Association between oral examination and out-of-pocket expenditures on dental care
Choi Jee-Hye, Kim Nam-Hee
Journal of Korean Academy of Oral Health.2022; 46(1): 11. CrossRef
Longitudinal Pure‐Tone Threshold Changes in the Same Subjects: Analysis of Factors Affecting Hearing
Hantai Kim, Jung‐Jun Lee, Yeorae Moon, Hun Yi Park
The Laryngoscope.2019; 129(2): 470. CrossRef
Impact factors of revisit intention in health examinations and moderator effects of kindness of staff : Focusing on participants of Korea Association of Health Promotion, Gangwon Branch
Sung Ok Jang, Deuk Jung, Min Jeong Kang, Jong Seok Lee
Korean Journal of Health Education and Promotion.2018; 35(2): 113. CrossRef
Participation inequality in the National General Health Examination based on enterprise size
Young Joong Kang, Jong Heun Park, Huisu Eom, Bohwa Choi, Seyoung Lee, Ji-Won Lee, Jun-Pyo Myong
Annals of Occupational and Environmental Medicine.2017;[Epub] CrossRef
Perception about Age at the Start and End of Periodic Health Examinations: a Survey-based Study on University Hospital in Korea
Sujeong Shin, Yun-Mi Song, Hyeonyoung Ko, Yoon-Ho Choi, Woo Yong Lee, Son Mi Chung, Sunyoung Park, Insub Kim, Jinyoung Shin
Korean Journal of Health Promotion.2017; 17(3): 161. CrossRef
Determinants of the Use and Type of Comprehensive Medical Examination Services
Kwan-Sik Moon, Yang-Kyun Kim, Hye-Jung Chang
The Korean Journal of Health Service Management.2016; 10(2): 83. CrossRef
A Study on the Determinants of Rescreening for Using the Private Health Screening Program
Il-Su Park, Yoo-Mi Kim, Sung-Hong Kang
Journal of Digital Convergence.2015; 13(1): 383. CrossRef
What Factors Cause a Complete Examination of Infant Health Checkup?
Seungjin Kang, Woojin Chung, Heejin Kim, Sunmi Lee
Health Policy and Management.2014; 24(3): 261. CrossRef
Changes in the Clinicopathological Characteristics and Outcomes of Thyroid Cancer in Korea over the Past Four Decades
Bo Youn Cho, Hoon Sung Choi, Young Joo Park, Jung Ah Lim, Hwa Young Ahn, Eun Kyung Lee, Kyung Won Kim, Ka Hee Yi, June-Key Chung, Yeo-Kyu Youn, Nam Han Cho, Do Joon Park, Chang-Soon Koh
Thyroid.2013; 23(7): 797. CrossRef
The Relationship between Socioeconomic Status and Gastric Cancer Screening in the Population of a Metropolitan Area
Hyun-Suk Oh, Sun A Kim, Sun-Seog Kweon, Jung-Ae Rhee, So-Yeon Ryu, Min-Ho Shin
Journal of agricultural medicine and community health.2013; 38(3): 174. CrossRef
Regional Factors Associated with Participation in the National Health Screening Program: A Multilevel Analysis Using National Data
Hyung-Kook Yang, Dong-Wook Shin, Seung-Sik Hwang, Juwhan Oh, Be-Long Cho
Journal of Korean Medical Science.2013; 28(3): 348. CrossRef
Socioeconomic disparity in cervical cancer screening among Korean women: 1998–2010
Minjee Lee, Eun-Cheol Park, Hoo-Sun Chang, Jeoung A Kwon, Ki Bong Yoo, Tae Hyun Kim
BMC Public Health.2013;[Epub] CrossRef
The Relationship between Trust in Healthcare System and Health Examination Participation
Baek-Geun Jeong, In-Kyoung Hwang, Hae-Sook Sohn, Kwang-Wook Koh, Tae-Ho Yoon, Jeong-Hun Lim
Journal of agricultural medicine and community health.2010; 35(4): 395. CrossRef
The Determinants of the Use of Opportunistic Screening Programs in Korea
Sungwook Kang, Chang Hoon You, Young Dae Kwon
Journal of Preventive Medicine and Public Health.2009; 42(3): 177. CrossRef
Relationship between Perceived Neighborhood Characteristics and Vigorous Physical Activity among Adult Seoul Residents
Chung Gun Lee, Youngtae Cho
Journal of Preventive Medicine and Public Health.2009; 42(4): 215. CrossRef

Continuity of Care of Patient with Diabetes and Its Affecting Factors in Korea.: Chai Hyun Yoon, Sin Jae Lee, Sooyoung Choo, Ok Ryun Moon, Jae Hyun Park; J Prev Med Public Health. 2007;40(1):51-58.; DOI: https://doi.org/10.3961/jpmph.2007.40.1.51

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OBJECTIVES
The objectives of this study were to estimate the continuity of care for all Koreans with diabetes and to identify factors affecting the continuity of care. METHODS: We obtained National Health Insurance claims data for patients with diabetes who visited health-care providers during the year 2004. A total of 1,498,327 patients were included as study subjects. Most Frequent Provider Continuity (MFPC) and Modified, Modified Continuity Index (MMCI) were used as indexes of continuity of care. A multiple linear regression analysis was used to identify factors affecting continuity of care. RESULTS: The average continuity of care in the entire population of 1,498,327 patients was 0.89+/-0.17 as calculated by MFPC and 0.92+/-0.16 by MMCI. In a multiple linear regression analysis, both MFPC and MMCI were lower for females than males, disabled than non-disabled, Medicaid beneficiaries than health insurance beneficiaries, patients with low monthly insurance contributions, patients in rural residential areas, and patients whose most frequently visited provider is the hospital. CONCLUSIONS: The continuity of care for patients with diabetes is high in Korea. However, women, the disabled and people of low socio-economic status have relatively low continuity of care. Therefore, our first priority is to promote a diabetes management program for these patients.

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Analysis of Continuity of Care and Its Related Factors in Diabetic Patients: A Cross-Sectional Study
Ji Yeh Shin, Ha Jin Kim, BeLong Cho, Yun Jun Yang, Jae Moon Yun
Korean Journal of Family Medicine.2022; 43(4): 246. CrossRef
The Role of Continuity of Care in the Management of Chronic Disease
Seung-Won Oh
Korean Journal of Family Medicine.2022; 43(4): 207. CrossRef
Trends in life expectancy among medical aid beneficiaries and National Health Insurance beneficiaries in Korea between 2004 and 2017
Jinwook Bahk, Hee-Yeon Kang, Young-Ho Khang
BMC Public Health.2019;[Epub] CrossRef
The effects of continuity of care on hospital utilization in patients with knee osteoarthritis: analysis of Nationwide insurance data
Boyoung Jung, Kyoung Hee Cho, Dong Hyun Lee, Soyoon Kim
BMC Health Services Research.2018;[Epub] CrossRef
Association between supplementary private health insurance and visits to physician offices versus hospital outpatient departments among adults with diabetes in the universal public insurance system
Chang Hoon You, Ji Heon Choi, Sungwook Kang, Eun-Hwan Oh, Young Dae Kwon, Iratxe Puebla
PLOS ONE.2018; 13(4): e0192205. CrossRef
The effect of continuity of care on the incidence of end-stage renal disease in patients with newly detected type 2 diabetic nephropathy: a retrospective cohort study
Yun Jung Jang, Yoon Soo Choy, Chung Mo Nam, Ki Tae Moon, Eun-Cheol Park
BMC Nephrology.2018;[Epub] CrossRef
Use of Western Medicine and Traditional Korean Medicine for Joint Disorders: A Retrospective Comparative Analysis Based on Korean Nationwide Insurance Data
Boyoung Jung, Sukjin Bae, Soyoon Kim
Evidence-Based Complementary and Alternative Medicine.2017; 2017: 1. CrossRef
Effects of the Continuity of Care on Hospital Utilization : Convergence A Propensity Score Matching Analysis
Lee-Su Ahn
Journal of Digital Convergence.2015; 13(9): 323. CrossRef
The Quality of Medical Care Provided to Homeless Diabetes Patients in a General Hospital in Seoul, and the Prevalence of Diabetes Comorbidities
Sun Hee Beom, Moo Kyung Oh, Chul Woo Ahn
Korean Journal of Medicine.2014; 86(5): 585. CrossRef
Continuity of ambulatory care and health outcomes in adult patients with type 2 diabetes in Korea
Jae-Seok Hong, Hee-Chung Kang
Health Policy.2013; 109(2): 158. CrossRef
The Comparison of Health Status and Health Behavior among Hypertension Group, DM Group, and Hypertension DM Group for the Aged Provided with Customized Home Care Service by Visiting Nurses
Hee Kyoung Hyoung, Hyo-Soon Jang
Journal of Korean Academy of Community Health Nursing.2011; 22(1): 11. CrossRef
Educational disparities in quality of diabetes care in a universal health insurance system: evidence from the 2005 Korea National Health and Nutrition Examination Survey
Y. K. Do, K. N. Eggleston
International Journal for Quality in Health Care.2011; 23(4): 397. CrossRef
Group Classification on Management Behavior of Diabetic Mellitus
Sung-Hong Kang, Soon-Ho Choi
Journal of the Korea Academia-Industrial cooperation Society.2011; 12(2): 765. CrossRef
Continuity of Care for Elderly Patients with Diabetes Mellitus, Hypertension, Asthma, and Chronic Obstructive Pulmonary Disease in Korea
Jae Seok Hong, Hee Chung Kang, Jaiyong Kim
Journal of Korean Medical Science.2010; 25(9): 1259. CrossRef

Educational Differences in Health Care Utilization in the Last Year of Life among South Korean Cancer Patients.: Soo Young Choo, Sang Yi Lee, Chul Woung Kim, Su Young Kim, Tae Ho Yoon, Hai Rim Shin, Ok Ryun Moon; J Prev Med Public Health. 2007;40(1):36-44.; DOI: https://doi.org/10.3961/jpmph.2007.40.1.36

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OBJECTIVES
There have been few studies examining the differences in health care utilization across social classes during the last year of life. Therefore, in this study we analyzed the quantitative and qualitative differences in health care utilization among cancer patients across educational classes in their last year of life, and derived from it implications for policy. METHODS: To evaluate health care utilization by cancer patients in the last year of life, Death certificate data from 2004 were merged with National Health Insurance data (n=60,088). In order to use educational level as a social class index, we selected the individuals aged 40 and over as study subjects (n=57,484). We analyzed the differences in the medical expenditures, admission days, and rates of admission experience across educational classes descriptively. Multiple regression analysis was conducted to evaluate the association between medical expenditures and independent variables such as sex, age, education class, site of death and type of cancer. RESULTS: The upper educational class spent much more on medical expenditures in the last one year of life, particularly during the last month of life, than the lower educational class did. The ratio of monthly medical expenditures per capita between the college class and no education class was 2.5 in the last 6-12 months of life, but the ratio was 1.6 in the last 1 month. Also, the lower the educational class, the higher the proportion of medical expenditures during the last one month of life, compared to total medical expenditures in the last one year of life. The college educational class had a much higher rate of admission experiences in tertiary hospitals within Seoul than the other education classes did. CONCLUSIONS: This study shows that the lower educational classes had qualitative and quantitative disadvantages in utilizing health care services for cancer in the last year of life.

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Cross-national differences in wealth inequality in health services and caregiving used near the end of life
Jennifer A. Ailshire, Cristian A. Herrera, Eunyoung Choi, Margarita Osuna, Elina Suzuki
eClinicalMedicine.2023; 58: 101911. CrossRef
Socioeconomic differences in the perception of inequalities in healthcare utilization and health in South Korea
Nayeon Kim, Hye-won Yun, Juwon Park, Fatima Nari, Hee Jin Wang, Jae Kwan Jun, Kui Son Choi, Mina Suh
Preventive Medicine Reports.2023; 36: 102445. CrossRef
Cross-National Differences in Wealth Inequality in Health Services and Caregiving Used Near the End of Life
Jennifer A. Ailshire, Cristian A. Herrera, Eunyoung Choi, Margarita Osuna, Elina M. Suzuki
SSRN Electronic Journal .2022;[Epub] CrossRef
Socioeconomic position and use of healthcare in the last year of life: A systematic review and meta-analysis
Joanna M. Davies, Katherine E. Sleeman, Javiera Leniz, Rebecca Wilson, Irene J. Higginson, Julia Verne, Matthew Maddocks, Fliss E. M. Murtagh, Holly Gwen Prigerson
PLOS Medicine.2019; 16(4): e1002782. CrossRef
Joint Symposium of Korean Cancer Association & UICC-ARO—Cross-boundary cancer studies: cancer and Universal Health Coverage (UHC) in Asia
Eun-Cheol Park, Norie Kawahara, Shinjiro Nozaki, Hasbullah Thabrany, Shunya Yoshimi, Sohee Park, Duk Hyoung Lee, Hideyuki Akaza, Jae Kyung Roh
Japanese Journal of Clinical Oncology.2017; 47(9): 889. CrossRef
Medical Costs and Healthcare Utilization among Cancer Decedents in the Last Year of Life in 2009
Inuk Hwang, Dong Wook Shin, Kyoung Hee Kang, Hyung Kook Yang, So Young Kim, Jong-Hyock Park
Cancer Research and Treatment.2016; 48(1): 365. CrossRef
Barriers to Cancer Care, Perceived Social Support, and Patient Navigation Services for Korean Breast Cancer Patients
Jung-won Lim
Social Work in Health Care.2015; 54(1): 47. CrossRef
Equity in health care: current situation in South Korea
Hong-Jun Cho
Journal of the Korean Medical Association.2013; 56(3): 184. CrossRef
Inequalities in Medical Care Utilization by South Korean Cancer Patients According to Income: A Retrospective Cohort Study
Tae Ho Yoon, Sang-Yi Lee, Chul-Woung Kim, Su Young Kim, Baek-Geun Jeong, Hyeung-Keun Park
International Journal of Health Services.2011; 41(1): 51. CrossRef
Factors Influencing Utilization of Medical Care Among Osteoarthritis Patients in Korea: Using 2005 Korean National Health and Nutrition Survey Data
Min Young Kim, Jong Ku Park, Sang Baek Koh, Chun-Bae Kim
Journal of Preventive Medicine and Public Health.2010; 43(6): 513. CrossRef

Relationship of Socioeconomic Factors with Medical Utilization for Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia in a South Korean Community.: Han Hae Kim, Kyoung Ae Kong, Hun Jae Lee, Hana Yoon, Bo Eun Lee, Ok Ryun Moon, Hyesook Park; J Prev Med Public Health. 2006;39(2):141-148.

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Abstract PDF: OBJECTIVES
We wanted to evaluate the medical underutilization for benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) among Korean elderly men and we wanted to determine their associated factors. METHODS: This study was conducted on 239 men with LUTS and 116 men with BPH who were compatible with the diagnostic criteria from a total of 641 participants. These participants were over 50 years old and they were randomly chosen in a community-based study for estimating the prevalence of BPH. Using a self-reported questionnaire, we surveyed the sociodemographics, health status, quality of life, lower urinary tract symptoms, medical utilization and reasons for not seeking treatment. RESULTS: Only 27.6% of the men with LUTS and 31.0% of the men with BPH reported having visited a doctor for urinary symptoms. The reasons for not visiting a doctor were, in order of responses from the group with LUTS: 'considered the symptoms as a part of the normal ageing process', 'not enough time to visit a doctor', 'financial difficulty' and 'the symptoms were not severe or bothersome'. Regarding BPH, the responses were the same as those of the group with LUTS however, 'financial difficulty' placed second. Among the men with experience of visiting a doctor for urinary symptoms, 33.3% of those with LUTS and 28.1% of those with BPH were not treated. The most common reason in both groups was 'the symptoms were not severe to be treated'. On a multiple logistic regression analysis, the larger size household (odds ratio (OR) 3.03, 95% confidence interval (CI)=1.40-6.54) and an unsatisfactory quality of life related with urinary symptoms (OR 2.98, 95% CI=1.23-7.21) were associated with medical utilization in the group of LUTS. For BPH, the current employment status was related with the medical utilization (OR 2.80, 95% CI=1.10-7.11), in addition to the larger size household (OR 3.24, 95% CI=1.14-9.21). CONCLUSIONS: Many men with urinary symptoms do not visit a doctor. This medical underutilization for people with LUTS and BPH may be associated with economic status in Korea.; Summary

The Relationship between Regional Material Deprivation and the Standardized Mortality Ratio of the Community Residents Aged 15-64 in Korea.: Baek Geun Jeong, Kap Yeol Jung, Joon Youn Kim, Ok Ryun Moon, Yong Hwan Lee, Young Seoub Hong, Tae Ho Yoon; J Prev Med Public Health. 2006;39(1):46-52.

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Abstract PDF: OBJECTIVES
This study was performed to investigate the relationship between regional material deprivation and the standardized mortality ratios(SMRs) of community residents aged 15-64 in Korea. METHODS: SMRs were investigated using the registered death data from 1995 to 2000 that was obtained from the Korean National Statistics Office with the denominators being drawn from the 1995 to 2000 census. Material deprivation was measured using the Townsend score that was calculated from the 1995 to 2000 census. The relationship between the regional material deprivation and the SMRs of the community residents aged 15-64 was investigated by using ANOVA, Spearman's rank correlation analysis and Pearson's correlation analysis. The trends in mortality inequality were investigated using the concentration index. RESULTS: On the ANOVA, the SMRs of the men and women residents in the least deprived areas were the smallest and those in the most deprived areas were the largest. Spearman's rank correlation analysis, Pearson's correlation analysis and the concentration index revealed that significant positive relationships exist between the regional material deprivation and the SMRs of the community residents aged 15-64. CONCLUSIONS: This study suggests that there are mortality inequalities among the communities in Korea and part of this difference is due to the material deprivation of the community. Strategies aimed at reducing mortality inequalities among the communities will be needed to address economic inequalities. Further studies are needed to explore the mechanisms of how the regional deprivation influences on health and how the other factors of the community influence on the health of the community residents.; Summary

A Study on Characteristics of Core Projects Described in 3rd Community Health Plans.: Dong Moon Kim, Weon Young Lee, Chang Yup Kim, Ok Ryun Moon; J Prev Med Public Health. 2004;37(1):88-98.

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Abstract PDF: OBJECTIVE
The 3rd community health plan let health centers select and promote core projects considering budget and manpower. This study analyzed the content and selection processes of core projects, using the nationwide 3rd community health plans, to give relevant information on health center policies. METHODS: Classification criteria for content analysis of core projects were established and verified through a literature review and by specialist discussions. Fifty plans were selected by stratified proportional random sampling for regional characteristics. And coding criteria standardized through coding repetition and discussion, by 2 persons (k> 0.7). Using stratified proportional random sampling for 16 cities and provinces, regional characteristics, 117 plans were selected, and the contents of the core project selection processes and program contents analyzed. RESULTS: The survey was used by 59.8 % of samples as a core project decision-making method. The participants included 98.6, 81.4, 40 and 38.6% of the health staffs, residents, medical institutions, and administrators, respectively. Discussion was used by 15.4% of samples. The participants were health staffs by 100% as a great. The ranking of the frequencies of the selected core projects were, in order; chronic disease control, health promotion, elderly health, maternal-child health, and oral health at 16.4, 14.8, 14.3, 12.7 and 11.9%, respectively. Analyses on the chronic disease control and elderly health contents showed the diversity of object disease, high rates of visitors on patient detection programs, high rates of unclear target populations, and the provision of medical exams and treatments as the main services, with high variations in business per-formance. The national health budgets for health centers in 2003 were about 910 and 240 million won for chronic disease control and elderly health, respectively, which were less than for the other five priority core projects. CONCLUSION: The chronic disease control and elderly health at the health centers were not standardized for object disease, patient detection program, target population, service provision, and national support budget was insufficient. Thus it is necessary to develop standard guidelines, and increase financial support, for chronic disease control and elderly health.; Summary

Socioeconomic Costs of Obesity for Korean Adults.: Baek Geun Jeong, Ok Ryun Moon, Nam Soon Kim, Jae Heon Kang, Tae Ho Yoon, Sang Yi Lee, Sin Jae Lee; Korean J Prev Med. 2002;35(1):1-12.

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Abstract PDF: OBJECTIVE
To estimate the socioeconomic costs of obesity in Korea, 1998. METHODS: The 1998 National Health and Nutrition Examination Survey (1998 NHNES) data was used and 10,880 persons who had taken health examinations were selected for study. Essential hypertension, NIDDM (non insulin-dependent diabetes mellitus), dyslipidemia, osteoarthritis, coronary heart disease, stroke were included as obesity related disease. The data of direct costs of obesity was obtained from the National Federation of Medical Insurance. The category of indirect costs was the loss of productivity caused by premature death and admission, time costs, traffic costs, nursing fees due to obesity. Multiple logistic regression model was developed to estimate prevalence odds ratio by obesity class adjusted demographic and socio-ecnomic factors and calculate PAF (Population Attributable Fraction) of obesity on obesity related disease. And we finally calculated the socioeconomic costs of obesity in relation to BMI with PAF. RESULTS: The direct costs of obesity were 2,126 billion~965 billion Won in considering out of pocket payment to uninsured services, and the indirect costs of obesity were 2,099 billion~1,086 billion Won. Consequently, in considering out of pocket payment to uninsured services, the socioeconomic costs of obesity were 4,225 billion~2,050 billion Won, which corresponded to about 0.094% ~0.046% of GDP and 1.88%~0.91 of total health care costs in Korea. CONCLUSIONS: Obesity represents a major health problem with significant economic implications for the society. This results are conservative estimates as far as all obesity related disease and all health care and indirect costs were not included due to missing information. Further studies are needed to caculate socioeconomic costs of obesity more exactly.; Summary

Increasing Prevalence of Obesity Related Disease for Koreans Associated with Overweight and Obesity.: Nam Soon Kim, Ok Ryun Moon, Jae Heon Kang, Sang Yi Lee, Baek Geun Jeong, Sin Jae Lee, Tae Ho Yoon, Kyung Hwa Hwang; Korean J Prev Med. 2001;34(4):309-315.

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Abstract PDF: OBJECTIVE
To develop a better understanding of the relationship between weight status and the prevalence of obesity related diseases in the Korean population. METHODS: The 1998 Korean National Health and Nutrition Survey was used and 10,880 persons who had previously taken health examinations were selected for study. The Korean Society for the Study of Obesity's classification of weight status was used. Hypertension, diabetes mellitus, dyslipidemia, osteoarthritis, chronic heart disease, stroke were included as obesity related disease. A logistic regression model was developed to estimate the prevalence odds ratio by obesity class adjusted for demographic and socio-economic factors and we converted the odds ratio to a prevalence ratio using the base line prevalence of disease to aid in the interpretation of the ratios. RESULTS: The prevalence of obesity was 26.3% based on the KSSO classification (BMI> or =25). A graded increase in the prevalence ratio was observed with increasing severity of overweight and obesity for all health outcomes with the exception of chronic heart disease in men and stroke in both men and women. With normal weight individuals as the reference, for men who were younger than 50 years, the prevalence ratios were highest for hypertension BMI<23-25: 1.70(95% CI=1.41-2.05), 25 or =30: 4.83(95% CI=3.78-5.84). The prevalence ratios for dyslipidemia were as high as hypertension, but were lower than hypertension for diabetes mellitus and osteoarthritis. Prevalence ratios generally were greater in younger adults. The prevalence of having 2 or more obesity related diseases increased with weight status category, except in people who were older than 50 years. CONCLUSIONS: Based on results, obesity is an increasingly important health problem in Korea and the disease burden increases according to weight status. For Korean adults, the strongest relationship was seen between weight status and hypertension and dyslipidemia. In older people the impact of excess weight and obesity is stronger than that seen in younger people. Increased efforts in the study of obesity and prevention and treatment of obesity and obesity related disease are required.; Summary

Development and Evaluation of the Reliability and Validity of the VSSS-82 Korean Version for Measuring Satisfaction with Community-based Mental Health Services in Psychiatric Patients.: Weon Seob Yoo, Young Jeon Shin, Ok Ryun Moon, Jung Hyun Nam; Korean J Prev Med. 2001;34(3):211-218.

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Abstract PDF: OBJECTIVES
To develop a Korean version of VSSS-82 for measuring the multi-dimensional satisfaction with community-based mental health services in psychiatric patients and to investigate both the reliability and validity of the Korean version. METHODS: The VSSS-82 English version was translated and back-translated with some modification. Data from 68 psychosis patients using community-based mental health services in three Community Mental Health Centers (CMHCs) was collected through a personal interview survey regarding the satisfaction and suitability of service. Variability of satisfaction and internal consistency, discriminant validity, and concurrent validity of the VSSS-82 Korean version were evaluated. RESULTS: A higher number of dissatisfied subjects and significant pairwise differences for the dimensions were found. The Crohnbach's alpha coefficient, a measure of internal consistency, ranged from 0.56 (overall satisfaction) to 0.90 (skills and behavior) and significant differences in satisfaction was found in patients by the self-rated suitability of service. CONCLUSIONS: The VSSS-82 Korean version is a reliable and valid instrument for measuring multi-dimensional satisfaction with community-based mental health service.; Summary

Change of Medical Utilization Claims in Self-employees before and after the Economic Crisis in Korea.: Sin Jae Lee, Ok Ryun Moon, Won Ki Jhang, Soon Ae Choi, Sang Yi Lee, Nam Soon Kim, Baek Geun Jeong; Korean J Prev Med. 2001;34(1):28-34.

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Abstract PDF: OBJECTIVES
To investigate the changing pattern of medical utilization claims following the economic crisis in Korea. METHODS: The original data consisted of the claims of the 'Medical insurance program of self-employees' between 1997 and 1998. The data was selected by medical treatment day ranging between 1 January and 30 June. Medical utilizations were calculated each year by the frequency of claims, visit days for outpatients, length of stay for inpatients, total days of medication, and the sum of expenses. RESULTS: The length of stay as an inpatient in 1998 was decreased 4.7 percent in comparison to 1997. However, inpatient expenses in 1998 increased 10.8 percent as compared to 1997. Inpatient hospital claims in 1998 increased 6.2 percent over 1997, although general hospital inpatient claims in 1998 decreased 3.3 percent in comparison to 1997. The outpatient claim frequency decreased 7.3 in 1998 percent as compared to 1997. Outpatient visit days of in 1998 were decreased 8.5 percent in comparison to that recorded in 1997. Outpatient claim frequencies of 'gu region' in 1998 decreased 10.5 percent comparison to that in 1997, but 'city and gun region' decreased less than 'gu region'. CONCLUSIONS: Medical utilization in 1998 deceased in relation to 1997. Medical utilization by outpatients decreased more than that of inpatients. Medical utilization by 'gu regio n' decreased more than the other regions.; Summary

Differences in Health Behaviors among the Social Strata in Korea.: Tae Ho Yoon, Ok Ryun Moon, Sang Yi Lee, Baek Geun Jeong, Sin Jae Lee, Nam Sun Kim, Won Ki Jhang; Korean J Prev Med. 2000;33(4):469-476.

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Abstract PDF: OBJECTIVES
To analyze differences in health behaviors among the social strata in Korea by using the 1995 National Health and Health Behavior Survey Data. METHODS: Study participants numbered 2,352 men and 1,016 women aged between 15-64 years old, with housewives, students and non-waged family workers excluded. Health behaviors in this study were defined according to the recommendations of the Alameda 7 study. The measure of health behaviors was based on the Health Practices Index(HPI; 0-5 range, with the exclusion of snacking between meals and regularly eating breakfast) developed by the Alameda County research. The significance of the relationship between social strata and HPI was assessed by considering the adjusted means from the multi-variate model. RESULTS: For men, incidence rates of never having smoked, no/moderate use of alcohol, regular exercise, and regular 7-8 hours sleep per night were higher in the upper social strata. Meanwhile, for women, incidence rates of never having smoked, no/moderate use of alcohol, appropriate weight, regular exercise, and regular 7-8 hours sleep per night were higher in the upper strata. HPI varied significantly among social strata in both sexes (p<0.001), a result which held true when adjusted for age, education, income, social insurance type, marital status and region. CONCLUSIONS: Health behaviors assessed by Health Practices Index(HPI) varied significantly among social strata for both sexes. Therefore, the existing gap in health behaviors among social strata can be corrected more effectively by target oriented health promotional activities.; Summary

The State of the Art of Preventive Medicine in North Korea With Reference to the Content Analysis of a Medical Textbook.: Sang Gu Yi, Ok Ryun Moon, Sin Jae Lee, Jung chul Kim, Wen Yong, Piao Song Lin; Korean J Prev Med. 2000;33(3):373-382.

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Abstract PDF: OBJECTIVES
The most frequently cited health related slogan in North Korea is that socialistic medicine is preventive medicine. It implies that North Korea puts preventive medicine at the operational center of its national health care system. This study aimed at examining and comparing preventive medicine practices in North Korea with those of South Korea. METHODS: Efforts have been made to obtain a textbook for analysis its contents. Many people have iassisted in the study by joining the interview. Some of these people are as follows: a former professor of PyongYang Medical School, NK physicians living in South Korea, WHO staffs, diplomatic officials, etc. The major items of analysis consisted of industrial medicine and hygiene, nutrition, school health, epidemiology, health statistics and heath policy & management. RESULTS: Public health philosophy is finely rooted and well integrated in the operation of the North Korean national health care system, particularly in the area of industrial medicine and hygiene. Preventive medicine with a strong health surveillance system spanning a number of broad social organizations is a major tool to improve the health of the people in North Korea. The emphasis on preventive medicine has a close relationship with the 'Juche Philosophy' and the shortage of pharmaceuticals and medical equipment. To cope with the shortage problem, North Korean health workers are encouraged to grow medicinal herbs. We have found that they put little effort into teaching newly emerging diseases, such as AIDS, VDT syndrome, hazards of EMF, and agricultural chemical poisonings. Of the subjects of the preventive medicine text, 78.9% coincide with those of South Korean industrial health manuals and 34.2% with South Korean epidemiology texts. However, an absolute difference was found to exist between the heath policies and management systems. CONCLUSION: In North Korea, the concept of preventive medicine functions as the basic philosophic strategy of the national health care system. It differs greatly from the South Korean system in both practice and educational content. Its contribution to society is simply incomparable to that of South Korea. More communication and further study is called for in order to improve the preventive medicine practices in the future.; Summary

A Study on the Family Burden of the Mentally Ill in a Rural Area.: Weon Young Lee, Young Jeon Shin, Jung Hoe Kim, Chung Hyun Nam, Ok Ryun Moon; Korean J Prev Med. 1999;32(3):400-414.

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Abstract PDF: OBJECTIVES
This is a descriptive study which was carried out to identify characteristics of the chronic mentally ill and their families in a rural area and the influencing factors on family burden. METHODS: Data was collected for seven months beginning April 1, 1998 by questionnaire from chronic mentally ill patients and their families in two towns and seven townships of the rural areas of Kyonggi Province. In additional to the mental diagnosis of the mentally ill patients, family burden was measured by interviewing the other family members using the questionnaire developed by Pai & Kapur (1981). Of those interviewed, 103 patients were selected for final analysis. RESULTS: Of 103 mentally ill patients, 36.1% of the subjects were not under treatment. In particular, of 29 patients with schizophrenia, 48.3% of the subjects had stopped taking medication and 6.9% of the subjects had never been treated. According to the results of a specialized examination by a psychologist, 81% of patients were in need of hospitalization. Most primary caregivers were parents. Of the 101 primary caregivers in the study, 39.6% were over 65 years old. In case of death of the primary caregiver, 50.5% of these 101 mentally ill patients would not have anyone to care for them. Of the various kinds of family burden, primary caregivers most often reported psychological stress. Overall, the families of dementia and schizophrenia patients complained of the most family burden. Through univariative analysis, the variables of sex, education and current treatment type of the patients, the relationship with the patient and marital status of the primary caregiver and the number of people living together in the household showed significant correlation with the family burden of schizophrenia patients. Univariative analysis also showed that there were a number of variables which were correlated to the family burden in mentally retarded patients. Concerning the need for mental health services, the most common requests were for entitlement to disability benefits and housing programs. CONCLUSIONS: Community mental health services in rural areas must be developed, planned and executed in consideration of the local situation. In particular, the development of various family support programs is needed in order to mitigate emotional, mental and economic burdens and carry out a positive role to care for and rehabilitate patients.; Summary

A Comparative Study on Enhancing the Function of the Heath Center in a urban area.: Weon Young Lee, Young Jeon Shin, Young Jun Kwon, Bo Youl Choi, Ok Ryun Moon, Hye Jeong Jeon; Korean J Prev Med. 1998;31(4):857-874.

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PDF: Summary

A Study on Service Characteristics of Directors of Health Centers in Korea.: Jae Won Yoo, Ok Ryun Moon, Sang Yi Lee, Chul Woung Kim, Sang Gu Yi; Korean J Prev Med. 1998;31(4):786-800.

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Abstract PDF: This study has attempted to show general characteristics of health centre directors who have served the post of directorship during the last 40 years. Of 3,000 such health centre directors, information on about 2,500 directors was collected. While average length of service for health center directors has increased, that of vacancy period has decreased. Rural areas have a shorter average length of service than the urban area. Rural areas have twice longer length of vacancy period per health center. Kangwon-do has the longest average length of vacancy period since 1980(2.79 months/year), and Daejeon has the shortest length of vacancy period(0.21 months/year). Chung-buk has no physician directors. The civil servant's rank for the directorship has promoted from the fifth level to the fourth level since 1990. A comparison between the physician director and non-physician director was made as follows : First, the proportion of physician directors had maintained rather high before 1980s ; 62.5% in 1963, 78.3% in 1970, 70.4% in 1980. It decreased to 44.1% in 1990 and 47.6% in 1997. Instead, non-physician directors has abruptly increased since 1980s(12.4% in 1980, 55.4% in 1990 and 50.8% in 1997). Second, physician directors mainly locate in the urban area(58.0% in 1997), but non-physician directors mainly in the rural area(67.2% in 1997). Third, since 1980, the average length of service for physician directors and for non-physician directors has become similar. Fourth, the mean age of physician directors is 45.1 years, and that of non-physician directors 55.7 years. The latter is 10 years older than the former.; Summary

A Study on Estimation of Caring Demand for Extended Care Facilities by Activities of Daily Living.: Chul Woung Kim, Ok Ryun Moon, Sang Yi Lee, Jae Won Yoo, Sang Gu Yi; Korean J Prev Med. 1998;31(3):564-578.

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Abstract PDF: Most extended care facilities have admitted both the healthy and unhealthy elderly, among which members' average caring demand vary. The Aged Welfare Law, however, currently provides no reasonable basis on the staffing policy for extended care facilities. It just reflects the admitted number of the elderly rather than differences in members' average caring demand among facilities. This study is designed to estimate the need for caring staff on the basis of the correlation between the individual health status measured by various tools including Activities of Daily Living and caring demand by actual service time for each one. The sample included all of the admitted elderly(187 persons) in 4 extended care facilities, two in Seoul and the other two in KangWon-Do over the survey period October 5 through October 20, 1996. The survey process consisted of 3 stages. (1) The current staffing information was collected through self-completed written questionnaires left for head official in each facility. (2) Six graduate students at School of Public Health interviewed all residents to collect information on their health status and sociodemographics. The response rate for the interview was relatively high(85%). (3) Information on direct and indirect caring time consumed for each residents came from self-completed written questionnaires given to nurses and helpers in each target facilities. Analysis of the data was made using Pearson's correlation and multiple regression technique through SAS program. Based on this procedure, the following was found. 1. No facility meet the staffing standard in the Aged Welfare Law completely. 2. It is actual service time that is most correlated with ADL(Activities of daily living). 3. When all of the elderly are divided by four groups based on the level of ADL, the mean values of needed caring time in each group are 15, 21, 36 and 88 minutes respectively. 4. There is no significant difference among facilities in distribution of elderly person by group. 5. No facility meets the estimated number of nurses and helpers which reflects health status of the admitted elderly. Therefore, it is required that severity of the admitted elderly be considered in establishing staffing standard for extended care facility.; Summary

The Possibility of Regional Health Insurance Data in Blueprinting the Local Community Health Plan.: Sang Yi Lee, Chul Woung Kim, Ok Ryun Moon; Korean J Prev Med. 1997;30(4):870-883.

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Abstract PDF: The health center has to play an important role in promoting community health and satisfying a variety of community health needs and demands in the decentralized Korea. The nearly enacted Community Health Act compels every health center to make its own health plans which intend to deal with local health problems and plan its future health care. This obligation is obviously a big burden to most health centers. They do not have experiences in and abilities of making local health care plans. In order to establish a systematic community health plan, health centers have to concentrate their efforts on enhancing the ability of making health care plan through gathering and analysing the local health informations. However, it is very difficult in reality. This is simply because it will take long time to accomplish these activities. It seems natural that various professionals and researchers participate in carrying out the process of making community health plan in the initial stage. No standardized methodology and analysing framework exist even in the health professional society. Nonetheless, it is common to introduce survey research methodologies in analysing consumer's health care utilization and cost, and in identifying factors influencing health behaviors. Many researchers and professionals have applied social survey methodologies in obtaining information on providers and health policy makers as well. The authors have found that few studies have ever utilized local health data stored at the self-employed medical insurance society as the data source of planning activities. The purpose of this study is to illustrate the usefulness of the data stored at the Sung-Dong Gu Self-employed Medical Insurance Society in establishing the community health plan. The major contents of this study are as follows ; 1. Frequency of utilization by age, area, sex, type of medical care institutions, and some major diseases 2. Medical treatment by type of medical care institutions, by classification of 21 diseases, by frequency of three-character categories 3. Medical treatment of major neoplasm and some chronic diseases by age, sex, and area. The conclusion of this study is that it is of great potentiality to find out the local health problems and to use them in blueprinting the community health plan through comparing the frequency of medical utilization analyzed by a variety of variables with NHI health data or the health data from survey research.; Summary

A study on a hospital services evaluation method b physician survey.: Won Gi Jhang, Ok Ryun Moon; Korean J Prev Med. 1996;29(4):815-830.

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Abstract PDF: A physician survey was done by mailing for the purpose of performing hospital services evaluation and ranking. A slightly over one thousand samples were drawn from the list of professional societies, and 324 physicians(about 32 percent) replied. This study has focused on developing easy and simple method to evaluate hospital services, and providing patients with useful information. Hospital service structure and process were evaluated without outcome evaluation, because it is difficult to obtain reliable data regarding health services outcome indicators. Clinical specialty was targeted to evaluate, and three specialties were chosen, that is obstetrics & gynecology, cardiology, and proctology. Among 16 structural indicators, four indicators were finally chosen in each specialty by respondent specialists. And then using these indicators, structural score was calculated for study hospitals. For process evaluation, physicians were requested to nominate five most famous hospitals. The nomination score and structural score were summed up to produce final score and hospital ranking. This method is very easy to conduct rather than other hospital services evaluation methods prevailing in Korea. And it is more useful for patients to choose hospitals, according to his/her own purpose, because it gives high ranking hospitals with specific clinical specialty.; Summary

Job Satisfaction and Commitment of General Hospital Employees.: Dong Woon Han, Seung Sub Eom, Ok Ryun Moon; Korean J Prev Med. 1995;28(3):588-608.

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Abstract PDF: This study was intended to enhance the level of hospital personnel management through analysing job satisfaction of hospital employees in terms of structural, personal and environmental variables. The sample of this study consist of a total of 790 persons including doctors, residents, interns, pharmacists, nurses, medical engineers, office workers and manual workers who have worked for general hospitals with 200 beds, 300 beds and 800 beds respectively. The Likert's 5 scales were used for the measurement of satisfaction. The results can be summarized as follows: 1. Structural variables. The level of satisfaction on the job itself was generally low 2.8 in Likert`s 5 scales, with the order of role ambiguity(3.87), routinization(2.6), work overload (2.45) and autonomy(2 37). Hospital employees are aware of their responsibility and they regarded their work as heavy one. The compensatory satisfaction degree was 2.5 which was also low: There were in the order stability(3.l), distributive justice(2.57), pay(2.3) and promotion(l.9). Usually hospital employees showed high degree of stability, while, their satisfaction on promotion possibility is quite low due to specially differentiated structures of hospitals. The degree of satisfaction on the internal conditions of organizational culture was relatively higher as 2.92: They were co-worker's support(3.69), supervisory support(3.15), role conflict(2.64) and welfare(2.17) in order. The satisfaction on welfare as an economic condition was the lowest. 2. Personal Variables. The level of satisfaction on personal variables was 3.27 which seemed to be quite high: contribution to the hospital(3.38), attitude on job performance(3.28) and pride as a member of the, hospital(3.07). They seem to believe that their work has been helpful to the performance of hospitals. 3. Environmental Variables. The degree of satisfaction on these variables was 3.07 the average which was derived from environmental factors such as family-role conflict and community support related to hospital employees' environment. The order of satisfaction for each variable is community support(3.2) and family-role conflict(2.94). They turned out to be fairly satisfied with their job in community and yet, they wanted more spare time to spend with their family.; Summary

A Comparative Study on Evaluation Methods of Permanent Impairment in Korea.: Chang Ok Rhee, Jung Keun Choi, Mi A Son, Ok Ryun Moon; Korean J Prev Med. 1994;27(3):627-651.

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Abstract PDF: In this study, literature review was done to examine and compare the current status and problems of different evaluation approaches toward permanent impairment in Korea. Alternatives and improvements in the current approaches in Korea were suggested. Series of cases were also examined to compare different approaches applied to the real cases, using 105 cases from a hospital data and another 207 cases from insurance company data. The main findings of the literature review are as follows; 1. The current evaluation methods of permanent impairment in Korea are grouped into two categories, grading and rating. Grading of impairments are expressly specified in 17 various statutes. 2. In Grading methods, the rigid system of 14 different grades has been adopted uniformally for the convenience of administration, which may not be, appropriate or valid from medical and scientifical aspect. 3. The advantage of McBride method is assessment of occupational disability rate. However the classified compensable occupations are only 280 and limited to manufacturing industries in 1960s' of U.S.A., which is not appropriate to current Korean circumstances. Especially, the job list does not include managerial officers or mental workers. 4. AMA Guides is the scientific and reasonable method for the assessment of physical impairment rate. However compensation and reparation of impairment case is difficult because this method cannot assess the disability rate according to occupation, age, etc. The results of cases comparative study are as follows: 5. The physical impairment could be compared in 167 out of total 312 cases and for the cases of complex impairment, McBride method underestimate physical impairment rate compared with AMA method. 6. When disability rate was assessed, occupation was considered the compensation of only 85 cases, and age was used in only 21 cases. This was because occupation and age compensation in McBride method are unreasonable. 7. The most ideal alternative is to assess physical impairment according to AMA method and then to develop a compensation method appropriate for the circumstances of Korea society.; Summary

Cost-Benefit Analysis on Rubella Vaccination Policy.: Young Jeon Shin, Bo Youl Choi, Hung Bae Park, Ok Ryun Moon, Bae Joong Yoon; Korean J Prev Med. 1994;27(2):337-365.

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Abstract PDF: Rubella is a viral disease with mild constitutional symptoms and generalized rashes ln childhood, it is an inconsequential illness, but when it occurs during early pregnant period, there are significant risks of heart defects, cataract, mental retardation to the fetus. The series of congenital defects induced by rubella is called 'congenital rubella syndrome'. Many research have been performed to find out more effective prevention program on rubella. The objectives of this study are, first, to calculate the incidence rate of acute rubella infection and congenital rubella syndrome in korea, second, to evaluate economic efficiency of several rubella vaccination policies and to offer data for the most reasonable decision on vaccination policy. Study populations are 663,312 children of one year-old in 1992. The author has performed cost-benefit analyses according to the three vaccination policies-U.S.A.'s. U.K's and Sweden's. In this study, the author got the incidence rate of acute rubella infection using the catalytic model. In the meantime, the author used 50 per 100,000 live births as the incidence rate of congenital rubella syndrome. The discount rate used in this study was 5 percent per annum. The sensitivity analyses were done with different discount rates (4%, 7%) and different incidence rate of congenital rubella syndrome (10,100 per 100,000 live births): The study results are as follows: 1. Without vaccination, lifetime expenditures per patient for acute rubella infection amount to 14,822 won and the total expenditures to about 3.1 billion won. Meanwhile, lifetime expenditures per patient for congenital rubella syndrome amount to about 91 million won and the total expenditures to about 16.3 billion won without vaccination. 2. The cost of vaccination for a child of one year old was 2,322 won and the total cost for the one year old children was about 1.5 billion won(American style). The cost for vaccination of female children at fifteen was about 339 million won (British style). And the cost of vaccination at one for both sex and female children at fifteen was about 1.9billion won (Swedish style). 3. The benefit to cost ratios of vaccination or female children at fifteen that is the british mode of rubella vaccination, was 60.0 at the level of 80 % population coverage and 48.6 at 100% coverage. It shows much higher benefit to cost ratio than those of the other two vaccination policies. 4. Both net benefits of vaccination at one (American style) and that of vaccinations at one and fifteen (Swedish style) range from about 17.0 billion to 17.8 billion won, those were larger than that of vaccinations of female children at fifteen(British style, about 16.0 billion). 5. In marginal cost-benefit analysis of only additional program or revaccination, the benefit to cost ratios were 3.6(80% coverage rate) or 0.6 (100% coverage rate). It implies that additional program was less efficient or inefficient 6. In sensitively analysis with different discount rates (4% or 7%) and different incidence rates of congenital rubella syndrome (l0 or 100 per 100,000 live births), the benefit to cost ratios has fluctuated in wide range. However, all the ratios of vaccination of female children at fifteen were higher than those of the others. Even under the most conservative assumption, the benefit to cost ratios of all the rubella vaccination policies were higher than 3.3. In conclusion all the rubella vaccination policies found to be cost-effective and particularly the vaccination of female children at fifteen was strongly recommended.; Summary

Industry of Employment and Spontaneous Abortion of Female Workers.: Joung Soon Park, Myung Chae Na, Do Myung Paek, Ok Ryun Moon; Korean J Prev Med. 1994;27(2):242-257.

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Abstract PDF: In Korea, female workforce has reached more than 40% of total working population but the effects of work on spontaneous abortion are yet to be examined. This study was conducted to investigate the occupational effects on spontaneous abortion. Medical insurance claim data were used to examine the effects of the employment status and industry of employment on spontaneous abortion The study population was composed of females, aged 15~44, who were the beneficiary of medical insurance in the month of June, 1993. The working females covered by medical insurance for industrial workers, hand the highest age-adjusted Spontaneous Abortion rate(SAB rate=claim frequency of spontaneous abortion/claim frequency of complication of pregnancy, childbirth and the puerperium), 6.65% whereas female dependants of medical insurance for industrial workers had the lowest age-adjusted SAB rate, 4.54%. Among industrial workers, the workers in manufacturing industry had the highest age-adjusted Spontaneous Abortion ratio(SAB ratio=claim frequency of spontaneous abortion/claim frequency of completely normal delivery), 43.2/100 whereas those in financing and service industry had age-adjusted SAB ratio, 16.2/100 and 20.5/100, respectively. The results of the study suggest the adverse effect of manufacturing industry on reproduction. Work environment such as chemical exposures, overwork, awkward posture, and job stress should be further studied for their effects on reproductive functions of female.; Summary

A study on the practice variations according to physician characteristics.: Eun Kyeong Jeong, Ok Ryun Moon, Chang Yup Kim; Korean J Prev Med. 1993;26(4):614-627.

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Abstract PDF: It is well known that a physician's personal characteristic affects his practice pattern. Furthermore, a physician's specialty has powerful influences on his practice pattern. However, despite the fact specialization has received the most attention for its influence on physician's service behavior, few studies have been conducted on the variations of contents and volume of physician's services. This study has intended to identify factors influencing the practice variations according to various physician characteristics. There are some other evidences that medical care providers are different in using of health services and resources in Korea. Four physician characteristics were selected for the analysis, two demographical factors, age and sex, and two practice factors, place of practice and medical specialty. Also, three indicators of service amount(total amount of insurance claim bill, number of visits per case, number of prescriptions per case) were selected. From the pool of insurance claims for ambulatory care received by the Korean National Federation of Medical Insurance(NFMI), 84,898 cases were randomly sampled. In the meantime using physician database of NFMI, 613 general practitioners(GP), 107 regular family physicians(FP), 483 'grandfather' family physicians(GFP), and 1,157 specialist practitioners(SP) were randomly sampled. Their different practice contents were compared concerning the specialty, age groups, sex, and practice sites(urban-rural). Specialist physicians tend to provide more costly care than do generalists. General practitioners and family physicians usually make fewer following visits and prescriptions. Age is also the important factor in determining the amount of services, which is highest at the physician's age group of 40's. Female doctors and urban practitioners use much more resources than their counterparts respectively. Research findings suggest that physician's characteristics particularly the specialty can affect practice patterns and resource utilizations. Other characteristics such as age and sex are not controllable but physician's specialty is relatively easily controllable during the entire phases of policy implementation. This is all the more true in the individual's initial decision of his specialty. Specialization therefore should receive policymaker's attention for its potential influence on medical care utilization and health care expenditure.; Summary

Geographic variations in tonsillectomy and adnoidectomy (T & A) and appendectomy in Korea.: Hong Ki Lee, Ok Ryun Moon, Key Hyo Lee; Korean J Prev Med. 1993;26(3):430-441.

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Abstract PDF: The objectives of this study are two-fold : to identify geographic variations in the rate of tonsillectomy and adenoidectomy(T and A) and appendectomy and analyze the socioeconomic variables and health resources which affect geographic variation in the rate. The nationwide three month's cases of the two surgical procedures in 1991 are obtained from the record of the National Federation of Medical Insurance. The analysis shows two to ten-fold variations in the regional rates for the performance of two common procedures such as T and A and appendectomy. T and A shows a bigger regional variations than appendectomy. As a result of multiple regression, the factor of bed supply has been found significant for the dependent variable of the rate of T and A. The findings of large variations in the rate of surgical procedures throughout the country would have important implications for allocating scarce resources and managing quality of care. Further analysis is needed for the elaboration of the above implications.; Summary

A study on diagnostic criteria of noise-induced hearing loss among workers in an iron foundry.: Ji Yong Kim, Hyun Sul Lim, Hae Kwan Cheong, Ok Ryun Moon; Korean J Prev Med. 1993;26(3):371-386.

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Abstract PDF: This study was carried out to evaluate diagnostic criteria of noise-induced hearing loss (NIHL) among workers in an iron foundry. Of 1,093 workers under the observation of noise-specific health examination, 184 workers were selected by way of first and second screening audiometric examination. A questionnaire survey, otological examinations, Rinne test and audiometric test were performed and the results were as follows; The degree of hearing impairment in the left ear was more severe than in the right ear(p<0.05). The difference between hearing threshold of the first and the second hearing test at 1,000 Hz was about 5 dB with a narrow range of deviations while the difference at 4,000 Hz was about -7dB with a wide range. Of the total study workers, 84.8% were tested within 15 hours away from noise exposure, and the rest after 16 hours. This study has identified that mean hearing loss at 4,000 Hz showed a significant statistical difference among the two study groups while mean hearing loss by 4-divided classification did not. The same phenomena were observed between the group with and without tinnitus and between the group with and without difficulty in hearing(p<0.05). Among 184 workers, 10 workers(5.4%) diagnosed as NIHL by old diagnostic criteria in contrast to 150 workers diagnosed as NIHL by the new diagnostic criteria. There was a significant difference between the two groups in the average hearing loss at 4,000 Hz and 4-divided classification(p<0.01), but there were no significant difference in age, the duration of employment, blood pressure and the duration wearing the personal hearing protector(p>0.05). If we apply Early Loss Index(ELI) method, some workers in younger age group diagnosed as NIHL by the new diagnostic criteria were fallen into within the normal range. In the mean time older age group show reverse results in contrast to the above finding. It is too early to confirm the value of the usage of the new diagnostic criteria in hearing examination. Further study is called for to verify the value of this criteria.; Summary

Changes and Trends in the Newly Established Clinics in Korea.: Byung Soon Choi, Ok Ryun Moon; Korean J Prev Med. 1992;25(4):357-373.

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Abstract PDF: After medical insurance came into effect in Korea, health care system has undergone tremendous changes. Changing patterns of newly established clinics is one of them. To investigate changes and trends, a total of 10,184 clinics which were newly established from 1981 to 1990 were analysed. Data were obtained from the file of contracting medical facilities of the Federation of Medical Insurance Societies. The proportion of newly establishied clinics has increased gradually, so that they amount to 13% of the total medical facilities in Korea. Meanwhile, the number of newly established medium-size hospitals and general hospitals have decreased. The number of newly established clinics per 100, 000 populations has increased in the all areas, but the rate of increase has decreased in the cities except in 6 major cities in 1990. The rate of increase in newly established clinics surpasses that of population increase. This study has identified the trend of young physicians' early driving into their solo medical practice than before. This indicates chance of the medical specialty training nowadays toughen due to the limited openings in residency programs. However, the sex ratio of physicians at newly established clinics has not changed. The decreasing tendency to open medical practice without beds and the increasing size of clinics are found in this study(The size has been measured in terms of medical manpower, of beds, and of medical equipment in this study). Two thirds of general practitioners have opened their clinics without beds, although such trend has been less in the case of specialists. All three indicators show increasing size, especially in the case of rural clinics. However, among them, the number of medical equipments has increased most significantly from 8.9 items in 1981 to 12.9 in 1990.; Summary

A Study on the Status of Seeking Intervention among the Workers with Health Problems Identified by the Workers' Periodic Health Examination.: Hee Kwan Cheong, Joung Soon Kim, Ok Ryun Moon, Hyun Sul Lim; Korean J Prev Med. 1992;25(4):343-356.

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Abstract PDF: Authors studied the workers' knowledge about the health problems detected through the previous workers' periodic health examination, content of follow-up management and actions taken for their health problem detected on previous health examination. From June to September 1992, workers' periodic health examination was performed on workers employed in 10 companies located in 2 middle-sized Korean cities. A questionnaire survey was done for 150 workers who reported to have D2 result of either hypertension or liver disorder at the previous workers' periodic health examination done in 1991. The results are as follows; 1. Of 160 workers who had D2 result of either hypertension or liver disorder in previous examination one year before, only 85 workers(51.3%, 43 workers with hypertension, 38 workers with live disorder) responded that they have such disorders. The other 65 workers responded to questionnaire were all those with C results. Respondents' knowledge about their diagnoses was relatively precise (95.2% in hypertension group, 94.6% in liver disorder group) but knowledge about classification of diseases was poor. 2. The main efforts to solve the health problem was self management (26 spells, 55.3%), visiting clinic or hospital (6 spells, 12.8%), use of herb medicine (2 spells, 4.3%) and use of drug store (2 spells, 4.3%) in hypertension group. In liver disorder group, 30 spells (71.4%) relied on self management, 6 spells (14.3%) on hospital or clinic and 9 spells (21.4%) had no effort to improve the health problem. Content of self management was low salt diet, quit smoking, regular exercise and quit alcohol drinking in order. Avoidance of salt in diet was high in hypertension group and quitting alcohol drinking was high in liver disorder group. In those with self management, 80.7% of hypertension group and 83.3% of liver disorder group continued previous effort. Those, however, who utilized clinic or hospital, only 16.7% and 50.0% were still visiting hospital or clinic. 3. Fifty seven percent of hypertension group and 64.3% of liver disorder group was presently smoking, 8.5% and 11.9% reduced smoking and 21.3% and 14.3% stopped smoking. Forty nine percent of hypertension group and 28.6% of liver disorder group was presently drinking. Reduced alcohol intake was reported in 29.8% and 40.5%, 12.8% and 23.8% stopped alcohol drinking. Sixty six percent of hypertension group and 73.8% of liver disorder group did no regular exercise, but 12.8% and 11.9% of each group increased their physical exercise for last one year. Forty three percent of hypertension group and 38.1% of liver disorder group was overweight (defined by bodymass index greater or equal than 25). Reduced body weight was reported in 17.2% and 16.7% of each group. Reduced dietary salt intake was high in hypertension group (51.5%). The study results suggest that follow-up management after workers' periodic health examination is not satisfactory. In order to improve this situation, adequate information on the result of the workers' periodic health examination should be distributed to each worker group with health education and counselling.; Summary

Minimum Optimal Scale of the Self-Employed Health insurance Programs in Korea.: Gang Won Park, Jung Un Lee, Hae Kyung Kim, Ok Ryun Moon; Korean J Prev Med. 1992;25(4):333-342.

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Abstract PDF: The purpose of this study is to estimate the minimum optimal scale(MOS) of the self-employed health insurance associations. Considering the high proportion of operating expenses, the author have selected 254 regional health insurance associations from the 1990 Finance Report of the self-employed health insurance programs. both a quadratic function and a hyperbolic function were chosen for the analysis. The dependent variables are the average maintenance cost per insured person and per household, and the independent variables are the number of insured members and of household. The minimum optimal scale was obtained from the differentiation of the quadratic function. Major findings are summarized as follows: 1. The M.O.S. was calculated as 166,174 members (27,442 households) for the rural self-employed health insurance associations and 258,462 members (75,446 households) for the urban. Providing that both the rural and urban health insurance associations would e integrated, the M.O.S. be found to become 231,687 members (68,101 households) 2. Compared with the optimal minimum scale, the magnitude of the current health insurance association found to be much smaller, less than half of the optimal scale. 3. In order to reduce the operating cost, it is necessary to enlarge the operational scale of self-employed health insurance associations.; Summary

Regional Variations in the Cesarean Section Rate and It's Determinants in Korea.: Hye Kyung Kim, Jeon Un Lee, Kang Won Park, Ok Ryun Moon; Korean J Prev Med. 1992;25(3):312-329.

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Abstract PDF: The purpose of this study is to estimate cesarean section rate in Korea and analyze the socioeconomic variables and health resources which affect regional variation in the rate. Samples were drawn from the record of vaginal and cesarean section deliveries based upon insurance claim bills which have been submitted to the National Federation of Medical Insurance for the first three months, January through March, 1991. The results are obtained as follows: It was found that, cesarean section rate was increasing rapidly up to 23.1% in 1991. Cesarean section per 10 thousand insured people was 4.8 and the number of cesarean section per 10 thousand insured eligible(15-49 years old) female was 7.6. The fee for normal delivery was 109,489 won and that for cesarean section was 390,024 won. The average days of hospitalization in normal delivery was 2.3 days, and those in cesarean section was 7.6 days. On the average cesarean section has a longer of stay as much as by 4.3 days and cost 3.6 times more than normal deliveries. Cesarean section rates vary among medical facilities: 19.8% at clinics 37.6% in small-scale hospitals, and 29.1% in general hospitals. The regional variation of cesarean section rates was also fairly prominent. The South Cheju Gun has the highest rate of cesarean section, 56.2%. Meanwhile no cesarean section cases has been reported in Sunchang Gun during the period of this study. The variation is noted among provinces. The rate for Cheju province has been 3.4 times higher than that for Chunnam. The number of cesarean section per 10 thousand insured people vary greatly among regions, too. This study has found that there exists significant regional variations among various geographic units in terms of average length of stay, average cost, number of obsretricians and number of beds. Multiple regression analysis was done to identify factors explaining the regional variance of various cesarean section rates: In the urban areas, no significant explaining variables were noted except the number of beds for the dependent variable of cesarean section cases per 10 thousand insured eligible females. The smaller the number of bed, the more cases of cesarean section was noted for an urban area. The is mostly because the rate of cesarean section is higher in medium-size hospitals than in large general hospitals. In the rural areas, the factor of education has been found significant for all three dependent variables. The higher the educational level, the rate of cesarean section is most likely to rise. An income variable measured by the amount of monthly insurance contribution has been identified a powerful predictor in explaining the variance of cesarean section rates. The same has been noted for the number of obstetricians. Similar findings are observed for the country as a whole. The income level has been found as the most powerful explaining factor in the regional variance of cesarean section rates. In general the rate is higher in the urban areas, and lower in the area with more small hospitals. As this is the initial attempt to identify the factors relevant to the regional difference in the rates of cesarean section, more elaborated study is urgently required.; Summary

An analysis of the physician productivity in general hospitals.: Jung Un Lee, Ki Hyo Lee, Ok Ryun Moon; Korean J Prev Med. 1991;24(3):400-413.

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Abstract PDF: The purpose of this paper is to identify factors affecting the optimum mix of required inputs and other relevant factors which account for the variation in physician's productivity in general hospitals, and to find out their implications for the efficient health planning and management. An extended version of Cobb-Douglas production function and cross sectional data of one day patient census from all general hospitals in Korea in 1988 were used in the analysis. Main results of the analysis and their implications could be summarized as follows ; (1) The production function for physician's inpatient service shows the evidence of economies of scale, but the production function for physician's outpatient and adjusted-patient service, which combines both out- and inpatient service, shows that of dis-economies of scale. (2) The physician's role for production for all service is smaller than auxiliary personnel's, which imply that more intensive utilization of nurses, nursing aides and other auxiliary personnel is desirable for improving general hospital productivity. (3) In case of physician's inpatient and adjusted-patient service, nurses is recommended for the efficient operation of general hospitals. (4) The factor of hospital beds plays the leading role among required inputs in the production for physician's in- and adjusted-patient service. (5) The physician's productivity of general hospitals in rural area is lower than that in urban area. And the productivity of teaching hospitals is lower than that of the other hospitals. Further analysis was made in physician production function based upon the size of hospitals, namely those hospitals below 250 beds and those above. Explained variances by the factor of hospital beds was significantly increased in the case of those hospitals above 250. A more detailed and thorough investigation is needed for verifying factors influencing physician's productivity in general hospitals in Korea.; Summary

Study on the workers' participation in industries.: Jae Wook Choi, Ok Ryun Moon; Korean J Prev Med. 1991;24(3):339-355.

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Abstract PDF: The concept of workers' participation in occupational health was introduced to Korea recently in relation to primary health care in occupational health. But there is confusion and debate about workers' participation concept. The purpose of this study was to review the concepts of workers' participation and to conduct evaluation the workers' participation status in occupational health and safety. 394 workers and 54 employers (5.6%) in north area of Kyunggi-Do, were selected and interviewed with a questionnaire by a trained interviewer from August to September 1990. In general, the concept of workers' participation is based on industrial democratization and Declaration of Human Rights which had been powerful ideologies in labor movement. Contrary to workers' participation, community participation is rooted in the Health Rights. So, it is necessary to consider concept of workers' participation to improve participation. The results of survey were as follows: 1. Most of companies (71.75) carried out occupational health education to workers in study area. 2. The Occupational Safety and Health Committee (OSHC) were set up in 24.1% among the study companies, and 72.7% of workers among respondents thought that OSHC was helpful to workers health. 3. The workers signed his name to personal health report in 43.1% and the rate of participation in occupational environment examination was 54.9%. 4. The workers prefer the OSHC (39.3%), owner (35.1%) and union (25.8%) as a occupation health organization, but owners prefer OSHC (54.5%), manager (43.2%) and union (2.3%). 5. Among the factors of the general characteristics, the existence of labor union was a major determinant of workers' attitude and level of workers' participation. As we have seen, most levels of workers' participation are low in occupational health. The variable of existence of labor union among the factors was a major determinant of workers attitude and level of workers' participation. Therefore, in order to promote workers health, it is necessary to ponder long deeply on occupational health care system under the viewpoint of workers' participation.; Summary

A literature review on the health status of Korean workers under the Japanese colonialism.: Chang Yeop Kim, Ok Ryun Moon; Korean J Prev Med. 1991;24(1):45-56.

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Abstract PDF: The history of occupational health in Korea has covered the era of the Republic of Korea after the Liberation from Japanese colonialism. But the number of Korean workers exceeded about 2 millions at the times of liberation in 1945, so that it is expected that many occupational health problems inflicted Korean workers under the Japanese colonialism. The authors reviewed medical literatures, administrative documents, and other available data which were published under the colonial state, and collected things which had reference to the health status of Korean workers. The results were as follows; 1. Nutritional status of Korean workers was supposed to be inferior to of general population, some students, and poor inhabitants in a remote moutain villages. 2. It was supposed that the constitution of Korean workers was near lower limit of average build of contemporary Koreans. 3. The accidents rate in mines was significantly high but decreasing year after year, and the most importance cause of accidents was the fall of roof in the mine. The medical facilities and equipments for miners were supposed to be not sufficient in the mines and workshops. 4. Some occupational disease including silicosis, noise-induced hearing impairment, and decompression disease were known. But, overall incidence or prevalence of these diseases could not be identified. 5. On the whole, the fatalities of acute infectious diseases of Korean workers were higher than those of Japanese inhabitants in Korea and Korean inhabitants. The prevalence of pulmonary tuberculosis of Korean workers was increasing with every passing year. 6. The medical personnels and facilities were so deficient that most Korean workers were out of adequate medical use. We discussed only a part of the health status of Korean workers under the Japanese colonialism, so it would be necessary to have a better grasp of details of occupational health policy and health status in the era of afflicting.; Summary

Medical Technology of North Korea: with Special Reference to the Content Analysis of Medical Textbooks.: Seok Goo Lee, Hyeong Ryeol Yoon, Gi Hyo Lee, Ok Ryun Moon; Korean J Prev Med. 1990;23(4):416-427.

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Abstract PDF: Unfortunately, we have poor knowledge of medical technology in North Korea. This study has thus attempted to identify the level and status of medical technology development through analyzing the contents of medical textbooks currently in use. This study has assumed that three factors are influencing the level and status of medical technology in a society ; the level of socio-economic development in general, the level of scientific technology revolution and health policy. Forty textbooks are collected for this purpose. The main findings are summarized as follows: 1) North Korea has strengths in that (1) its herb drugs, which are in a broad use, are cheaper, more safe and more attainable than bio-equivalent chemical ones, and (2) the development of its medical technology was carried out with emphasis on the practical and basic health needs. 2) North Korea has weaknesses in that (1) its medical diagnostic method largely depends on manual procedures, (2) the R & D investment in the development of chemical drugs, especially antibiotics, is very small, (3) the amount of medical equipments is in a absolute shortage, and (4) the medical technology is destitute of specialty, caused mainly by the overemphasis on Juche-Uihak or herb medicine. 3) Medical technology has two faces, positive and negative so that it cannot be successfully evaluated by one. It eventually acts a positive function for public health through developments of drug, equipment and new medical treatment method. But it is also true that it has negative effects such as the dehumanization of high cost medical technology, cost hike due to over-investments in expensive equipments, and the absence of wholistic care from overspecialization. 4) We have to consider economic status and the social needs of medical care in order to evaluate the medical technology of a society. It is also the ease with North Korea. A whole picture of the North Korean medical technology could be understood only if further comprehensive studies of medical technology are to be carried out for North Korea.; Summary

Exploring H.M.O. Feasibility in the Korean Health Care Delivery Settings.: Ok Ryun Moon; Korean J Prev Med. 1977;10(1):62-70.

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Abstract PDF: No abstract available.; Summary

A Study on the Administrative Enhancement for Health Center Activities.: Ok Ryun Moon; Korean J Prev Med. 1970;3(1):97-110.

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Abstract PDF: No abstract available.; Summary

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