Journal of Preventive Medicine and Public Health

Volume 25(1); March 1992

Original Articles

Psychiatric symptoms of workers exposed to organic solvents.: Seoung Hoon Lee, Nung Ki Yoon, Jong Young Lee, Suk Kwon Suh; Korean J Prev Med. 1992;25(1):1-12.

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Abstract PDF: To assess the pattern of psychiatric symptoms and to evaluate the relationship between exposure related variables(duration of work and urinary hippuric acid concenturation) and psychiatric symptoms in organic solvent exposed workers, case control study of forty-two solvent exposed workers and ninety-six non-exposed workers was conducted. The general health questionnaire 28(GHQ28) was administered to evaluate psychiatric symptoms and urinary hippuric acid concenturations was measured to estimate the present status of solvent exposure in exposed group and to estimate normal level in non-exposed group. The meand concenturation of urinary hippuric acid was significantly higher in exposed group (2.953g/creatinine g) than non-exposed group (0.395g/creatinine g) (P<0.01). The total positive rates of symptoms were significantly higher in exposed group(28.2%) than non-exposed group(17.5%) (P<0.05). The positive rates of symptoms for four sub-scales of GHQ 28 in exposed group were in the order of somatic symptoms, anxiety, social dysfunction, depression and in the order of social dysfunction, anxiety, depression, somatic symptoms in non-exposed group.The positive rates of symptoms for somatic symptoms and anxiety were significantly higher in exposed group than non-exposed group (P<0.05) and the proportion of workers with six or more positive symptoms(dysthymic states) in exposed group were significantly higher than non-exposed group (P<0.01). After the effect of age, sex, level of income, level of education, and duration of work were controlled, the total score of GHQ28 was still significantly different between exposed and non-exposed group(P<0.01). In multiple logistic regression analysis on the dysthymic state, the odds ratio of level of income was statistically significant in both group. The odds ratios of exposure related variables such as duration of work and hippuric acid concenturations were not statistically significant but there was a tendency that exposure related variables had an effect on dysthymic state in exposed group.In future, comtinuous evaluation of psychiatric symptoms on organic solvent exposed workers and studies to detect the factors that affect on psychiatric symptoms are required.; Summary

Interaction of Sodium Selenite on Neurotoxicity Induced by Methylmercuric Chloride.: J S Park, H M Lee, Y Chung, D C Shin, J H Roh, Y H Moon; Korean J Prev Med. 1992;25(1):13-25.

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Abstract PDF: This study was conducted to investigate the mechanism of protective effect by sodium selenite in Methylmercuric chloride neurotoxicity, increasing intracellular Ca2+ concentration of the neuron. Methylmercuric chloride of 3 mg/kg of body weight was administered simultaneously with sodium selenite of 5 mg/kg and pretreatment of sodium selenite via intraperitoneal injection to rats. Also, effect of methylmercuric chloride(25 micrometer, 50 micrometer, 100 micrometer) and sodirum selenite(200 micrometer) on free intrasynaptosomal Ca2+ concentration were studied using the fluorescent Ca2+ indicator fura2 in vitro. After the treatment, at 6, 24, and 48 hours later, mercury in the cerebral cortex, liver and kidney tissues, succinic dehydrogenase activities, adenosin-5'-triphosphate concentration, acetylcholinesterase activities, and intracellular Ca2+ concentration in the cerebral cortex were determined in vivo. Cerebral synaptosomes of rats were incubated with methylmercuric chloride and sodium selenite in Hepes buffer for 10 minutes and free intrasynaptosomal Ca2+ concentration were measured with fura2 in vitro.The results were summarized as follows; 1. The combined administration of CH3HgCl and Na2SeO3 and pretreatment of Na2SeO3 according to time significantly more increased in the cerebral cortex and decreased in the liver, kidney mercury concentrations compared to the administration of CH3HgCl only. 2. The combined administration of CH3HgCl and Na2SeO3 and pretreatment of Na2SeO3 increased more succinic dehydrogense and acetylcholinesterase activities compared to the administration of CH3HgCl only. Particularly pretreatment of Na2SeO3 significantly more compared to the administration of CH3HgCl only. The concentration of adenosine-5'-triphosphate in Na2SeO3 treatment groups revealed a favourable effect compared to the administration of CH3HgCl only. 3. Intracellular Ca2+ concentration in administration of CH3HgCl only was increased significantly more than control group in all test hours but was increased significantly more at 48 hous only after treatment in combined administration of CH3HgCl and Na2SeO3 and pretreatment of Na2SeO3 according to time interval more decreased significantly intracellular Ca2+ concentration compared to the administration of CH3HgCl only. 4. Free intrasynaptosomal Ca2+ concentration in the combined administration of CH3HgCl and Na2SeO3 was decreased (24%-40%) significantly more than the administration of CH3HgCl only. From the above results, the specific dosage of Na2SeO3 decreased increment of intracellular Ca2+ concentration induced by administration of CH3HgCl. These findings suggest the protective mechanism of Na2SeO3 on the neurotoxicity of CH3HgCl.; Summary

Carpal Tunnel Syndrome among Packing Workers in A Rayon Manufacturing Factory.: Won Jin Lee, Eun Il Lee, Chul Whan Cha; Korean J Prev Med. 1992;25(1):26-33.

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Abstract PDF: The carpal tunnel syndromes is one of the most common peripheral nerve entrapment syndromes. The typical symptoms are pain, numbness and paresthesia in the median nerve territory of the hand. Recently, it is widely recognized that occupational factor is regarded as the important cause of the carpal tunnel syndrome. Clinical study is performed in the 42 female workers who is repetitively working at packing department in a rayon manufacturing factory from November 1991 till March 1992. The study included a questionnaire, physical examinations, and the neurophysiological test. The summary of the results obtained was as follows: 1. Among 42 packing workers, 9 workers(21.4%) were diagnosed as carpal tunnel syndrome by electromyography. The affected side was bilateral in 4 workers(9.5%), right in 4 workers(9.5%), and left in one worker(2.4%). 2. Among 42 subjects, 28 workers(66.7%) complained the clinical symptoms related to carpal tunnel syndrome, 11 workers(26.2%) showed positive Phalen sign, and 7 workers(16.7%) showed positive Tinel sign. 3. Researchers regard electromyographic finding as the gold standard for diagnosis of carpal tunnel syndrome. The sensitivity and specificity of the clinical symptoms to diagnose the carpal tunnel syndrome were 0.89, 0.39 respectively. If the carpal tunnel syndrome is diagnosed by the combination of the positive findings of the symptoms and the physical examinations, either Tinel of Phalen sign, the sensitivity and specificity were 0.67 and 0.76 respectively. Considering above results, though this small number of worker is not adequate for epidemiologic conclusions, carpal tunnel syndrome seems to be an important occupational disorder among packing workers in a rayon manufacturing factory.; Summary

A Study on The Effect of Hyperoxia on EKG Findings of Rabbits.: Soo Jin Lee, Jae Cheol Song, Hung Bae Park; Korean J Prev Med. 1992;25(1):34-43.

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Abstract PDF: To investigate the effect of hyperoxia on EKG findings and to evaluate the applicability of EKG as noninvasive monitoring index of oxygen toxicity, 38 rabbits were continuously exposed to 6 different conditions-3 hyperbaric oxygenations (HBO-2.5, 3.5 and 5ATA, 100% O2), normobaric oxygenation (NBO, 100% O2), hyperbaric aeration (HBA-5ATA, 21% O2) and normobaric aeration (NBA, 21% O2)-for 120 minutes and their EKG and time to dyspnea and convulsion were recorded. Dyspnea and death were observed in exposure conditions of HBO-3.5 and HBO-5 (Positive rate of dyspnea; 10%, 100%, death; 10%, 25%, respectively) only, and convulsion in 4 oxygenation groups (NBO; 20%, HBO-2.5; 20%, HBO-3.5; 20%, HBO-5; 88%). Abnormal EKG findings included arrhythmia and ST-T changes and the incidences was increasing with doses(partial pressure of oxygen). In addition to EKG change, findings observed during exosure were dyspnea and convulsion in the order of appearence and when non specific ST-T change was accepted as positive (abnormal) finding, the frequency of abnormal EKG was statistically significant(p<0.01), but when it was excluded from positive results, the frequency of EKG change was not significant(p>0.05). These results suggest that the effect of hyperoxia on heart is myocardial ischemia and arrhythmia, that oxygenation more than 3.5ATA causes myocardial damage in 120 minutes exposure, and that EKG is valuable as monitoring index of oxygen toxicity.; Summary

The Effect of Alcohol on the Blood Lipid Level of Korean Adult Men.: Chung Yill Park, Yun Chul Hong, Seung Han Lee; Korean J Prev Med. 1992;25(1):44-52.

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Abstract PDF: This study was conducted to evaluate the relations between alcohol intake and blood lipid level in a group of 1,138 Korean adult men, ages 20 to 69 years. Total number of each of a variety of drinks in the previous two weeks was obtained by questionnaire and converted into grams of alcohol consumed in a week. The levels of blood lipid such as Cholesterol, HDL-Cholesterol, Triglyceride and LDL-Cholesterol were examined by enzyme method. We also observed the effects of various variables such as age, body mass index, smoking, exercise and blood pressure on blood lipid level. The results obtained were as follows; 1. Average weekly alcohol intake was 129.0+/-167.4 gm and that of 30-39 age group was the highest as 149.3+/-170.4gm. 2. Levels of Cholesterol, Triglyceride and LDL-Cholesterol tended to increase with increasing age, but level of HDL-Cholesterol showed no significant relationship with age. 3. The positive linear regressions of alcohol intake on HDL-Cholesterol and Triglyceride were noted statistically significant. 4. Multiple regression analysis demonstrated that the effect of alcohol on HDL-Cholesterol and Triglyceride was statistically significant and the contribution rates were 5.0% and 0.8%, respectively. And, in the case of HDL-Cholesterol, the alcohol intake was the most significant independent variable.; Summary

A Study on the Criteria for Selection of Medical Care Facilities.: Woo Hyun Cho, Han Joong Kim, Sun Hee Lee; Korean J Prev Med. 1992;25(1):53-63.

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Abstract PDF: There are increasing interest and need for information on health care consumer with the significance of hospital marketing and strategic planning being increasingly emphasized. This study was conducted to investigate the criteria for selection of medical facilities according to the characteristics of health care consumer by the types of medical services on a sample of 1,500 population aged 20 years and above. Major findings are as follows; 1. When considering the criteria for selection of medical facilities into two factors, namely, quality or convenience factors, convenience factor was the major contributor for outpatient and dental services whereas it was quality factor for inpatient services. 2. Females and those residing in large cities selected medical facilities based on convenience factor in the outpatient services. In the case of inpatient service, persons who considered their present health status to be good and whose ages were 50 years old and above choose medical facilities based on quality factor. 3. Persons who considered medical facilities to be profit-making tended to choose medical facilities based on convenience factor for outpatient services. There were no differences in the cases of inpatient and dental services. 4. There was no significant difference on the criteria for selection of medical facilities according to the decision maker for selection or trust on medical facilities. On the use of health service information, selection of medical facilities was based on qPality factor for those who made more use of the information in the cases of outpatient and dental services. 5. Analysis using the logistic regression model on the criteria for the selection of medical facilities with the characteristics of health care consumer as independent variables was performed. The selection of medical facilities was significantly related with residential area, sex, and use of information on medical facilities for outpatient services and with age, average monthly income, and perception of health status for inpatient services. For dental services significant association with residential area and use of information on medical facilities was seen. The results of this study, despite some limitations, can be used as baseline data for marketing and strategic planning of hospital management.; Summary

Factors affecting the price-reduction rates among the insurance medicines.: Hyoung Joong Kim, Woo Hyun Cho, Han Joong Kim, Byung Yool Cheon; Korean J Prev Med. 1992;25(1):64-72.

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Abstract PDF: To provide the information necessary for the insurance medicine management plan, price discount rates among the insurance medicines were studied. A total of 2,107 items of insurance medicine of which prices were discounted via government inspections of real transactional process of insurance medicine were analysed. The conclusions are as follows; 1. Among the variables relevant to the characteristics of manufacturers, price discount rates of insurance medicines were statistically significant with production rankings of manufacturers, incorporation year, existence of investments by foreign corporation, existence of a research institute, and enrollment in the exchange. And among the variables relevant to the properties of medicines, the number of enrolled items which have the same components, classification, the date of new enrollment, the sales of items, and the number of raw materials in the items were statistically significant. 2. Stepwide multiple regression was done to identify the factors which affect the price discount rates of insurance medicines. The number of enrolled items which have the same components, production rankings of manufactures, classification number (medicines for function of tissue cells), incorporation year (1940-1949), existence of investments by foreign corporations, classification number (anti-germ medicines), number of raw materials in the items, the sales of items, and medicines whose major objective is not treatment were significant variables and the R2-value for these variables was 21.2%. Considering all of the above results, for management of insurance medicines, it seems important that the real transactional prices of insurance medicines should be identified systematically, focusing on the properties which affect the price discount rates of insurance medicines.; Summary

Impact of increasing the level of copayments on the number of physician visits.: Ki Hong Chun, Hang Jung Kim; Korean J Prev Med. 1992;25(1):73-87.

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Abstract PDF: The level of copayment increased in order to stabilize the financial condition of the health insurance on 1986. An important question regarding the policy was whether the increase in the level of copayments reduced the utilization of medical services in the poor selectively. In spite of the importance of the research question, no study has been reported. This study was designed to find out changes in nuniU rs of physician visits, to explain charac teristics influencing the difference of utilization before and after the program. Finally the interaction effect between the program and the level of income was examined for the abover question. A total of 10,421 persons from eight institutions was selected as the study sample. Research findings are as follows. 1. The number of physician visits decreased by ten percent as a result of increasing the level of copayment. 2. The decrease was remarkable in some groups such as children, rural area and large family. 3. The most important factor which explained the difference was the number of physician visits before the introduction of the new program.. The more numbers of physian visits during the last year were, the more numbers of physian visits decreased after the program. 4. The interaction term between the program and the level of income was statistically significant in the multiple regression model which explained physician visits and its coefficient was negative. It means that an increase in copayment did not reduced the number of physician visits in the poor, selectively. 5. It can be concluded that imposing adequate copayment reduces the use of medical services as well as medical costs without serious damage in access especially for the poor pule.; Summary

A Comparative Study on the Pattern of Outpatient Department Utilization at a Tertiary Level Hospital before and after Implementation of the Patient Referral System.: Kyeong Soo Lee, Chang Yoon Kim, Pock Soo Kang; Korean J Prev Med. 1992;25(1):88-100.

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Abstract PDF: This study was conducted to assess the effects of implementation of the patient referral system started July 1st, 1989. A comparison on the pattern of outpatient services of the Departments of Internal Medicine, General Surgery, and Pediatrics at the Yeungnam University Hospital was conducted for each one year period before and after implementation of the patient referral system. The pre-implementation period was from July 1. 1988 to June 30, 1989 and the post-implementation period was from July 1. 1989 to June 30, 1990. The information used for this study was obtained from official forms, prepared by the Yeungnam University Hospital, and submitted to the Korean Medical Insurance Cooperatives. After implementation of the patient referral system, the number of outpatient cases in the Department of Internal Medicine decreased 36.1% from 9,669 cases to 6,181 cases a year. Cases in the Department of General Surgery decreased 23.7% from 1,864 cases to 1,422 cases a year. The number of cases in the Department of General Surgery decreased 23.7% from 1,864 cases to 1,422 cases a year. The number of cases in the Department of Pediatrics decreased 36.9% from 3,372 cases to 2,128 cases a year. After implementation of the patient referral system, the average age of cases in the Departments of Internal Medicine and General Surgery was 52.5 and 49.7 years old, respcetively. This was a significant increase in comparison with the pre-implementation period. After implementation of patient referral system, the proportion of new outpatients in the Department of Internal Medicine decreased form 24.1% to 14.6%, the Department of General Surgery from 36.0% to 23.4%, and the Department of Pediatrics from 15.5% to 8.3%. The number of visits per case decreased significantly in the Department of Internal Medicine(from 1.74 to 1.61), but there was no significant change in the Department of General Surgery and Pediatrics. The length of treatment per case increased significantly in all three departments (form 16.1 days to 19.3 days in the Department of Internal Medicine, from 12.0 days to 15.2 days in the Department General Surgery, and 8.9 days to 11.2 days in the Department of Pediatrics). The number of clinical tests per case increased significantly in the Department of Internal Medicine (from 22. to 2.5), in the Department of Pediatrics(from 0.8 to 1.1) and increased in the Department of General Surgery(from 6.4 to 6.6). The average medical cost per case decreased form 43,900 Won to 42,500 Won in the Department of Internal Medicine, while the cost increased from 75,900 Won to 78,500 Won in the Department of General Surgery and from 12,700 Won to 13,500 Won in the Department of Pediatrics. In case-mix, the chronic degenerative disease(i. e. hypertension, diabetes mellitus, angina pectoris, malignant neoplasm, and pulmonary tuberculosis) ranked higher and acute infectious diseases and simple cases(i. e. gastritis and duodenitis, haemorrhoids, anal fissure, carbuncle, acute URI, and bronchitis) ranked lower after implementation of the patient referral system compared to before implementation.; Summary

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