Journal of Preventive Medicine and Public Health

Volume 27(2); June 1994

Original Articles

Perspective on Population Characteristics and Health Problems of Koreans in 21st Century.: Joung Soon Kim; Korean J Prev Med. 1994;27(2):175-185.

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Abstract PDF: In order to anticipate disease pattern and health problems of Koreans in the 1st part of 21st century(by the year 2020), transition of population characteristics, mortality and morbidity data during the last 30 years Koreans have experienced were reviewed. On the actual basis of epidemiolgic transition process that has undergone during last 30 years since 1960 along with socioeconomic development and successful implementation of selective national health policies(family planning, medical insurance and etc.), following changes can be expected in the 21st century in Korea, under the assumption that the current rate of progress is maintained. The population of South Korea alone will be doubled the population of 1960 by the year 2013;aged population older than 65 years will be increased from 3.3% in 1960 to 11.4% in 2020 with increased average age of the population from 23.6 year in 1970 to 39.2 year in 2020;urban population from 28% in 1960 to 83% in 2005. GNP/capita has increased tremendously from U.S. $120 in 1970 to $6,749 in 1992, and the government estimated it would be $19,350 in 2010 and $29,460 in 2020. Growth and developmental indices of children, educational achievement and social status of women also showed a remarkable improvement and anticipated to make further progress. Leading causes of mortality and morbidity have shown a striking change during the last 30 years, from infectious diseases to chronic degenerative diseases and man-made injuries. Occurrence of communicable diseases may become minimal although viral hepatitis, venereal diseases including AIDS, and well adapted herpes virus infections will maintain their endemic level. Newly evolving infectious agents, however, should be carefully monitored because of rapidly changing environments and human behaviors. Tuberculosis may increase up to the epidemic level when AIDS prevails. Ischemic heart diseases may increase steadily with increasing occurrence of hypertension and diabetes mellitus whereas cerebrovascular diseases may be decreased slowly. Musculaskeletal diseases which contribute a lot to the disability of aged people may be a major health problems due to increased aged population. Mental diseases, particularly that caused by alcohol and drug abuse, and senile dementia may become a prominent health problem. On the other hand injuries caused by traffic and industrial accidents that have shown most striking increase till now may be decreased considerably by intensive intervention. The health policies in the 21st century will be oriented to the health promotion for good quality life rather than life-savings.; Summary

The Korean Health Care Delivery System Early in the 21st Century.: Dal Sun Han; Korean J Prev Med. 1994;27(2):186-193.

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Abstract PDF: This paper is an attempt to identify major challenges to be faced by the Korean health care delivery system for about 30 year in the future and to deliberate over possible policy responses to them. It is not intended to make a precise prediction of the future profile of the system, but the focus is given to understanding what we have to do from now on in order to develop health care in Korea toward a desirable direction. Although the discussion has been made in a rather fragmented manner, it would hopefully provide stepping stones for a systematic study of the Korean health care system from a long range perspective.; Summary

The Korean Environmental Problems Early in the 21st Century.: Y Chung; Korean J Prev Med. 1994;27(2):194-199.

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Abstract PDF: No abstract available.; Summary

The Effect of Coffee Consumption on Serum Total Cholesterol Level in Healthy Middle-Aged Men.: Myung Hee Shin, Dong Hyun Kim, Jong Myun Bae, Hyung Ki Lee, Moo Song Lee, Joon Yang Noh, Yoon Ok Ahn; Korean J Prev Med. 1994;27(2):200-216.

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Abstract PDF: In present study, the authors investigated the possible effect of coffee consumption on serum cholesterol level in 1017 men between the ages of 40 and 59 years, who were randomly selected from the members of Seoul Cohort Study. Serum total cholesterol data was collected with other serologic indices(e.g. systolic blood pressure, diastolic blood pressure, hight, weight, etc.)through the program of biennial health check-up offered by Korean Medical Insurance Corporation(KMIC). The amount of coffee consumption was assessed by a self-administered questionnaire through mailing. Other confounding factors, such as age, body mass index, cigarette smoking, alcohol consumption, physical activity, and other dietary intake pattern were also determined by the questionnaire. The differences in means of serum total cholesterol in compared to non consumers were -0.4+/-3.56mg/dl for those drinking less than 1 cup a day, -0.6+/-3.60mg/dl for those drinking 1 cup a day, and 7.1+/-3.41mg/dl for those drinking more than 2 cups a day. Since smoking interacted the relationship between coffee consumption and serum total cholesterol, we re-analyzed those relationship in smokers and non-smokers separately. Other atherogenic behaviors were well correlated with total cholesterol, so we adjusted the mean values of serum total cholesterol through multivariate model selection with age(r=0.12), total cigarette index(cigarette-years; r=0.10), Quetelet's index(kg/m2, r=0.16), daily calory expenditure(kcal/day, r=0.06), weekly meat and poultry consumption(g/week, r=0.05), weekly fish consumption(g/week, r=0.08), other caffeinated beverage intake(cups/week), and the amount of sugar and prim added to the coffee. Among those variables only age, Quetelet's index, fish consumption, and total cigarette index(in smokers)were remained in the models. After adjustment, the corresponding differences of total cholesterol in smokers were changed to 0.4+/-5.24mg/dl, -0.5+/-4.97mg/dl, and 8.9+/-4.78mg/dl, which were significantly different among themselves(P=0.011). In non-smokers, however, the differences were not statistically significant(P=0.76). Adjusted mean values of systolic blood pressure and diastolic blood pressure were also determined to evaluate the direct effect of coffee to cardiovascular system, but their means were not significantly different by coffee consumption(p=0.18 for SBP, P=0.48 for DBP). Assuming instant coffee on the most popular type of coffee in Korea, the association observed in our study between coffee and serum total cholesterol, especially in smokers , is very interesting finding for the connection between coffee and serum total cholesterol, because only 'boiled coffee' tend to show significant lipid raising effect rather than to other types of coffee, like filtered or espresso, in most of the western countries. We concluded that people who drink coffee more than 2 cups a day have significantly higher serum total cholesterol level than those who never drink coffee, especially in smokers.; Summary

A Case-Control Study of Primary Liver Cancer and Liver Disease History.: Dong Hyun Kim, Byung Joo Park, Keun Young Yoo, Yoon Ok Ahn, Hyo Suk Lee, Chung Yong Kim, Sang Il Lee, Moo Song Lee, Hyung Sik Ahn, Heon Kim, Tae Soo Park; Korean J Prev Med. 1994;27(2):217-225.

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Abstract PDF: The relationship between past liver disease history and the risk of primary liver cancer was analyzed in a hospital-based case-control study conducted in Seoul on 165 patients with histologically or serologically confirmed hepatocellular carcinoma and individually age-and sex-matched 165 controls in hospital for ophthalmologic, ontologic, or nasopharyngeal problems. Significant association were observed for liver diseases occurring 5 or more years before liver cancer diagnosis[OR, 4.9;97% confidence interval(CI), 1.6~14.0) and family history of liver disease(OR, 9.0;95% CI, 2.1~38.8). These associations were mot appreciably modified by allowance for major identified potential confounding factors, From these results, it is possible to speculate that liver cell injuries caused by Considering the significant effect of family history of liver diseases on PLCA risk after adjusting past liver disease history, there might be genetic susceptibility in the carcinogenic mechanism of liver cancer. Further investigations are needed to clarify the effect of family history of liver disease on PLCA risk.; Summary

Correlation between Dietary Sodium and Electrocardiographic Left Ventricular Hypertrophy Among Hypertensives.: Daniel W Jones; Korean J Prev Med. 1994;27(2):226-229.

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Abstract PDF: In hypertensives, electrocardiographic left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular disease Animal and human studies suggest an association between left ventricular mass and dietary sodium (Na) intake. This study electrocardiographic LVH (S in VI + R in V5 > or = 3.5 mV). Blood pressure (BP), body in 40 otherwise healthy Korean patients with untreated essential hypertension on the standard Korean diet Among these variables, only Na excretion (mmol/day) was significantly different between those with and without LVH[LVH+:357+/-50, LVH-:268+/-25(p=0.04]. Thus, dietary sodium intake may be predictive of electrocardiographic LVH.; Summary

A Survey on the Prevalence of Musculoskeletal Symptom accord ing to Work Task.: Hae Ju Oh, Duk Hee Lee, In Guen Park, She Han Jang; Korean J Prev Med. 1994;27(2):230-241.

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Abstract PDF: Though people occupationally exposed to machineries and automation in the industrialized society desire work involving decreased strength, due to the continuous and repetitive activities, a new industrial stress is present. Studies on prevalence of musculoskeletal disease and their related risk factors have evolved. In this study in relation to work tasks, we investigated the differences in musculoskeletal symptoms occurring in each body region. The results of the survey were as follows. 1. When comparing age, level of education, work duration, job satisfaction and leisure time activities according to work risk, age in control group was 32.83+/-5.5, in comparison to the other 2 groups was smaller(p<0.05), and level of education in control group was higher(p<0.05) Work duration in the cutting department as 8.04+/-4.99 years longer than the other 2 groups(p<0.05), but there was no difference in the job satisfaction and leisure time activities. 2. The mean of symptom scores of each work task was 1.54 in the cutting department, 1.57 in the press department and 1.59 in the control group, and there was no significant difference in the 3 groups. The mean of symptom scores for upper extremities in the control group was low but mo statistically significant difference was shown. 3. When comparing the mean of symptom score according to work task in the each body region, in the shoulder region, the symptom score in the press department which desired strength was higher than the other 2 groups but no significant difference was shown. In the wrist region the cutting department scored 1.01 and in comparison to the other 2 groups was significantly increased(p<0.05). 4. The results of the univariate regression analysis on the major individual risk factors associated with musculoskeletal symptom relating work showed that previous symptom complaints in the same body region was significant risk factor(p<0.001) in the whole body, Besides wrist, hip, and knee, psychological problem was shown to be a significant factor(p<0.05). And the body regions which work task was significant risk factor were wrist and neck region(p<0.05). 5. The results of the multiple regression analysis involving significant factors of each body region from the unfavorite regression analysis showed that previous symptom shoulder, elbow and lumbar region(p<0.001) and psychological problem in the shoulder, elbow and lumbar region(p<0.05) were significant factors, and work task was significant factor in the wrist(p<0.05).; 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 Survey on Physical Complaints Related with Farmers' Syndrome of Vinylhouse and Non-vinylhouse Farmers.: Ju Young Lee, Jung Han Park, Doohie Kim; Korean J Prev Med. 1994;27(2):258-273.

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Abstract PDF: To compare the physical complaints of vinylhouse farmers with those of non-vinylhouse farmers, a personal interviews on 250 and 142 vinylhouse farmers were conducted in Sungjoo county in Kyungpook province selected by a random sampling from July 5 to July 10, 1993. Blood pressure of the subjects was also measured. Vinylhouse farmers had a higher average age, larger family size, shorter experience of farming, more working hours per day and working days per year and higher annual income than non-vinylhouse farmers. The frequency of preticide spray of the vinylhouse farmer was 3.4times on the average in June 1993 as compared with 2.0 times of non-vinylhouse farmers, and 16.7 times for the vinylhouse farmers during the last one year while it was 8.3 times for the non-vinylhouse farmers in the same period. While 39.6% of vinylhouse farmers experienced pesticide intoxication symptoms such as headache, nausea, vomiting, dizziness, itching, and skin irritation, etc. during the month of June, 25.4% of non-vinylhouse farmers experienced such symptoms. The most frequent symptoms among eight symptoms that constitute the farmers' syndrome were lumbago, numbness of hand or foot shoulder pain and dizziness regardless of sex and type of farming. Prevalence of the farmers' syndrome in male and female among vinylhouse farmers were 22.1%, 43.4%, respectively, and the prevalence in non-vinylhouse farmers was 23.2% for male and 50.7%for female. There was no statistically significant difference in the prevalence of farmers' syndrome between vinylhouse and non-vinylhouse farmers. However, The prevalence on female was about 2 times higher than that of male When the effects of other factors were adjusted by multiple logistic regression for farmers' syndrome, the prevalence in female was 3.0 times higher than that of male. The prevalence of farmers' syndrome was increased as the age of farmers increased on both vinylhouse and non-vinylhouse farmers, and adjusted odds ratio of farmers' syndrome increased by 3% as the age increased by 1 year Adjusted odds ratio of Farmers' syndrome in farmers who experienced pesticide intoxication during the month of June was 3.7times higher than that of farmers who did not have such experience. While the prevalence of hypertension in male and female non-vinylhouse farmers were 22.4%, 13.7%, respectively, the prevalence in vinylhouse farmers were 13.5% for male and 12.0% for female. However, there was no association between farmers' syndrome and hypertension. It was found in this study that the vinylhouse farmers are at a high risk of pesticide intoxication, which is associated with the common physical complaints. To reduce such risk it is necessary to develop farming methods which do not require the pesticide of may use less pesticide, a safer method of pesticide spraying, and the protective equipments which can be worn at a high temperature and have a better protective effect. Also education of farmers for the correct methods of ventilation after pesticide spraying in the vinylhouse and wearing the protective equipments may be considered as a supportive method. Since inappropriate posture at work and intensive labor may cause farmers' syndrome, it is recommended to develop farming tools which reduce physical burden and take a rest and exercise periodically during work. It is necessary to strengthen the hypertension management program of the Kyungpook province, because the prevalence of hypertension was as high as about 15%.; Summary

Respiratory Health of Foundry Workers Exposed to Binding Resin.: Jung Keun Choi, Chang Ok Rhee, Do Myung Paek, Byung Soon Choi, Yong Chul Shin, Ho Keun Chung; Korean J Prev Med. 1994;27(2):274-285.

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Abstract PDF: The effects of resin on the respiratory health have been investigated in 309 workers from four iron and steel foundries and the results compared with those from 122 workers who were not significantly exposed to resin gas and silica dust at the same industries. Phenol-formaldehyde resin was used in the core making and molding processes and workers were exposed to their decomposition products as well as to silica dist containing particulates The subjects were grouped according to formaldehyde, dust and other gas exposures, and smoking habits were considered also in the analysis. Standardized respiratory symptom questionnaire was administered by trained interviewers. Chest radiograph, pulmonary function tests, and methacholine challenge tests were done. Environmental measurements at the breathing zone were carried out to determine levels of formaldehyde, respirable dust and total dust. Foundry workers had a higher prevalence of symptoms of chronic bronchitis with chronic phlegm and chronic cough when exposed to dust. Exposure to gas was significantly associated with lowered FEV1 and obstructive pulmonary function changes. Exposure to formaldehyde and phenol gas was associated with wheezing symptom among workers, but FEV1 changes after methacholine challenge were not significantly different among different exposure groups. When asthma was defined as the presence of bronchial hyperreactivity with more than 20% decrease in FEV1 after methacholine challenge, 17 workers out of 222 tested had asthma. Fewer asthmatic workers were found among groups exposed to for maldehyde, gas and dust, which indicates a healthy worker effects in a cross-sectional study. The concentration of formaldehyde gas ranged from 0.24 to 0.43 ppm among studied foundries. The authors conclude that fornaldehyde and phenol gas from combust resin is probably the cause of asthmatic symptoms and also a selection force of those with higher bronchial reactivity away from exposures.; Summary

A Follow-up Study on the Personal Noise Exposed Dose and Hearing Loss.: Won Sool Kim, Young Seoub Hong, Yang Seak Kim, Sang Ju Lee, Kyung Il Park, Kap Yull Jung, Joon Youn Kim; Korean J Prev Med. 1994;27(2):286-298.

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Abstract PDF: For the purpose of presenting the basic data for the establishment of control measures on the long-term noise exposed workers, this study was carried or on the relationship between personal noise exposed dose and hearing loss on the 67 male workers whose hearing threshold had exceeded 40dB in 4,000Hz, from 1990 to 1992. Conclusively, the level of hearing loss was significantly related to personal noise exposed dose which was measured by the personal noise dosemeter was more efficient rather than the noise level of workplace for the evaluating the long-term change of hearing acuity. And although in the case of not-diagnosed as noise induced hearing loss, it was suspected that the active control programs such as improvement of noisy environment or early transfer to proper workplace were needed on the workers who exposed with over 90dB in personal noise exposed dose.; Summary

Sociomedical Survey on the Occupational Low Back Injuries of the Some Workers in Pusan Area.: Jong Ook Park, Don Kyoun Kim, Su Ill Lee, Byung Mann Cho, Bong Soo Cho, Yeung Wook Kim; Korean J Prev Med. 1994;27(2):299-312.

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Abstract PDF: This survey was performed to obtain the basic information for the prevention and management of occupational low back injury(LBI). The subjects of this survey were 952 workers(male, 892;female, 60) who had taken occupational LBI in some industries of Pusan area from January 1 to December 31, 1991. Observation period was 2.6 years from the beginning to the end of medical treatment. The obtained results were summarized as follows; 1. The proportion of LBI workers was 15.9% of the workers who had taken any occupational injuries and 0.32% of all workers in this surveyed area. 2. 8.0% of the workers had taken LBI on the 1st day of employment and 55.2% of the workers were within one year, 91.4% of the workers were within 10 years according to cumulative frequency distribution. 3. Handling of heavy objects was the most common cause of LBI(32.0%) and fall down(26.9%) and slip down(16.3%) were the next in order. 4. The most common causes of both lumbar sprain and HNP were handling of heavy objects and that of lumbar fracture was fall down. 5. The mean duration for medical treatment of LBI workers was 143 days. 6. The total direct compensation cost for LBI workers was 6,736 million Won and the proportion of medical, resting, disability compensation costs were 25.0%, 37.0%, 38.0% respectively. 7. The percentages of retreated workers and disabled workers were 11.9%(113 persons) and 22.9%(218 persons) of total LBI workers respectively.; Summary

Cross-sectional Study on Respiratory Symptoms due to Air Pollution Using a Questionnaire.: Ho Jang Kwon, Soo Hun Cho, Sun Min Kim, Mi Na Ha, Sang Hwan Han; Korean J Prev Med. 1994;27(2):313-325.

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Abstract PDF: A cross-sectional study was conducted in an effort to investigate the effect of air pollution on respiratory symptoms. Two groups of female aged more than 20 living in the unpolluted rural area of Taebul(n=159) and urban area of Taegu(n=140)were selected. The ATS-DAD-78 questionnaire was translated into Korean and administered with minor modification. The proportion of smoker was less than 1% in both area. Exposure to smoking and higher educational level were more frequent in Taegu. Age-adjusted prevalence rates of 'chronic cough', 'chronic sputum', 'wheezing', and 'dyspnea' were higher in Taegu than in Taebul. In particular, the prevalence rate of 'chronic sputum' in Taegu was found to be higher, which was statistically significant. Exposure to smoking and education level were not concerned with all respiratory symptom prevalence rates. In conclusion, this study indicates that an urban factor is related to the rates of respiratory symptoms in Korea.; Summary

Health Risk of Organic Pollutants in the Suspended Particulates in a Traffic Area of Seoul.: Dong Chun Shin, Yong Chung, Jong Man Kim, Seong Eun Park, Yong Wook Lim; Korean J Prev Med. 1994;27(2):326-336.

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Abstract PDF: Due to rapid industrialization and economic development since 1970's, Seoul has become known as one of the most heavily polluted cities in the world. This is especially because of its air pollution. This study was conducted to characterize the cancer risk from organic pollutants in the suspended particulates of Seoul. Extractable organic matter(EOM)and PAHs in Shinchon, a major traffic area, were measured monthly in two periods of Aug. 1987-Sep. 1988, and Sep. 1990-Aug. 1991. While the differences both of EOM and benzo(a)pyrene concentrations between these two periods were not significant(P>0.05), the differences between heating and non-heating seasons were significant(P<0.01). The estimated mean concentrations of EOM and benzo(a)pyrene in fine particles in non-heating season were 3.98 microgram/m3 and 0.51ng/m3 respectively, and in heating season were 6.75 microgram/m3 and 2.96 ng/m3 respectively, in these two periods combined. The calculated risk from EOM was compared with that from benzo(a)pyrene and also these values were compared with the level of acceptable risk.; 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

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