Journal of Preventive Medicine and Public Health

Original Articles

The Outcomes of an e-Wellness Program for Lupus Patients in Thailand: A Participatory Action Research Approach: Nop T. Ratanasiripong, Steven Cahill, Christine Crane, Paul Ratanasiripong; J Prev Med Public Health. 2023;56(2):154-163. Published online March 9, 2023; DOI: https://doi.org/10.3961/jpmph.22.491

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Objectives
Systemic lupus erythematosus (SLE) or lupus patients usually experience various physical and psychological challenges. Since the coronavirus disease 2019 pandemic, these challenges have become even harsher. Using the participatory action research approach, this study evaluated how an e-wellness program (eWP) impacted SLE-related knowledge and health behaviors, mental health, and quality of life among lupus patients in Thailand.
Methods
A 1-group, pretest-posttest design study was conducted among a purposive sample of lupus patients who were members of Thai SLE Foundation. The 2 main intervention components were: (1) online social support, and (2) lifestyle and stress management workshops. Sixty-eight participants completed all the study requirements, including the Physical and Psychosocial Health Assessment questionnaire.
Results
After being in the eWP for 3 months, participants’ mean score for SLE-related knowledge increased significantly (t=5.3, p<0.001). The increase in sleep hours was statistically significant (Z=-3.1, p<0.01), with the percentage of participants who slept less than 7 hours decreasing from 52.9% to 29.0%. The percentage of participants reporting sun exposure decreased from 17.7% to 8.8%. The participants also reported significantly lower stress (t(66)=-4.4, p<0.001) and anxiety (t(67)=-2.9, p=0.005). The post-eWP quality of life scores for the pain, planning, intimate relationship, burden to others, emotional health, and fatigue domains also improved significantly (p<0.05).
Conclusions
The overall outcomes showed promising results of improved self-care knowledge, health behaviors, mental health status, and quality of life. It is recommended that the SLE Foundation continues to use the eWP model to help the lupus patient community.

Summary

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Positive psychological capital, post-traumatic growth, social support, and quality of life in patients with systemic lupus erythematosus: A cross-sectional study
Lyu Meng, Cui-Rong Gao, Hui-Cai Wang, Raxida Yasin, Rui-Jie Huang, Yu-Xin Zhao, Xiao-Hui Ma, Yuan-Yuan Wen
Lupus.2024; 33(5): 470. CrossRef

Intervention to Improve Menstrual Health Among Adolescent Girls Based on the Theory of Planned Behavior in Iran: A Cluster-randomized Controlled Trial: Fatemeh Darabi, Mehdi Yaseri; J Prev Med Public Health. 2022;55(6):595-603. Published online November 30, 2022; DOI: https://doi.org/10.3961/jpmph.22.365

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Abstract PDF: Objectives
Poor menstrual health may lead to school absenteeism and adverse health outcomes for adolescents. The purpose of this study was to determine the effect of pubertal and menstrual health education on health and preventive behaviors among Iranian secondary school girls.
Methods
A quasi-experimental study was conducted to evaluate the effectiveness of a health intervention program. A total of 578 students (including intervention and control participants) in 12 schools in Tehran Province, Iran were included by multistage random sampling. The program comprised seven 2-hour educational sessions. After confirming the reliability and validity of a researcher-made questionnaire, that questionnaire was used to collect the required data, and the groups were followed up with after 6 months.
Results
After the educational intervention, the mean scores of menstrual health-related knowledge and constructs of the theory of planned behavior were significantly higher in the intervention group than in the control group (p<0.001 for all dimensions).
Conclusions
The results of this study emphasize the effectiveness of menstrual health interventions in schools. These findings should also encourage health policy-makers to take committed action to improve performance in schools.; Summary

Brief Report

Analysis of a Targeted Intervention Programme on the Risk Behaviours of Injecting Drug Users in India: Evidence From the National Integrated Biological and Behavioural Surveillance Survey: Damodar Sahu, Varsha Ranjan, Nalini Chandra, Saritha Nair, Anil Kumar, Elangovan Arumugam, Mendu Vishnu Vardhana Rao; J Prev Med Public Health. 2022;55(4):407-413. Published online July 19, 2022; DOI: https://doi.org/10.3961/jpmph.22.150

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Objectives
This study provides insights on the impact of a targeted intervention (TI) programme on behaviour change among injecting drug users (IDUs) in India.
Methods
This paper examined the data from the Integrated Biological and Behavioural Surveillance 2014-2015 for IDUs in India. Logistic regression was performed to understand the factors (TI programme services) that affected injecting risk behaviours by adjusting for covariates. Propensity score matching was conducted to understand the impact of the TI programme on using new needles/syringes and sharing needles/syringes in the most recent injecting episode by accounting for the covariates that predicted receiving the intervention.
Results
Participants who received new needles and syringes from peer educators or outreach workers were 1.3 times (adjusted odds ratio, 1.29; 95% confidence interval [CI], 1.09 to 1.53) more likely to use new needles/syringes during most recent injecting episode than participants who did not receive needles/syringes. The matched-samples estimate (i.e., average treatment effect on treated) of using new needles in the most recent injecting episode showed a 2.8% (95% CI, 0.0 to 5.6) increase in the use of new needles and a 6.5% (95% CI, -9.7 to -3.3) decrease in needle sharing in the most recent injecting episode in participants who received new needles/syringes. There was a 2.2% (95% CI, -3.8 to -0.6) decrease in needle sharing in the most recent injecting episode among participants who were referred to other services (integrated counselling and testing centre, detox centres, etc.).
Conclusions
The TI programme proved to be effective for behaviour change among IDUs, as substantiated by the use of new needles/syringes and sharing of needles/syringes.

Summary

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Effectiveness of targeted intervention program under the national AIDS control program among Hijra and transgender population: Evidence from Integrated Biological and Behavioral Surveillance, 2014-15
Nishakar Thakur, Sanjay Rai, Shashi Kant, Arvind Pandey, Damodar Sahu, Puneet Misra, Partha Haldar, Shreya Jha, Pradeep Kumar, Chinmoyee Das
International Journal of STD & AIDS.2024; 35(5): 337. CrossRef

Original Articles

The Busan Regional CardioCerebroVascular Center Project’s Experience Over a Decade in the Treatment of ST-segment Elevation Myocardial Infarction: Kyunghee Lim, Hyeyeon Moon, Jong Sung Park, Young-Rak Cho, Kyungil Park, Tae-Ho Park, Moo-Hyun Kim, Young-Dae Kim; J Prev Med Public Health. 2022;55(4):351-359. Published online June 24, 2022; DOI: https://doi.org/10.3961/jpmph.22.071

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Abstract Summary PDF Supplementary Material

Objectives
The Regional CardioCerebroVascular Center (RCCVC) project was initiated to improve clinical outcomes for patients with acute myocardial infarction or stroke in non-capital areas of Korea. The purpose of this study was to evaluate the outcomes and issues identified by the Busan RCCVC project in the treatment of ST-segment elevation myocardial infarction (STEMI).
Methods
Among the patients who were registered in the Korean Registry of Acute Myocardial Infarction for the RCCVC project between 2007 and 2019, those who underwent percutaneous coronary intervention (PCI) for STEMI at the Busan RCCVC were selected, and their medical data were compared with a historical cohort.
Results
In total, 1161 patients were selected for the analysis. Ten years after the implementation of the Busan RCCVC project, the median door-to-balloon time was reduced from 86 (interquartile range [IQR], 64-116) to 54 (IQR, 44-61) minutes, and the median symptom-to-balloon time was reduced from 256 (IQR, 180-407) to 189 (IQR, 118-305) minutes (p<0.001). Inversely, the false-positive PCI team activation rate increased from 0.6% to 21.4% (p<0.001). However, the 1-year cardiovascular death and major adverse cardiac event rates did not change. Even after 10 years, approximately 75% of the patients had a symptom-to-balloon time over 120 minutes, and approximately 50% of the patients underwent inter-hospital transfer for primary PCI.
Conclusions
A decade after the implementation of the Busan RCCVC project, although time parameters for early reperfusion therapy for STEMI improved, at the cost of an increased false-positive PCI team activation rate, survival outcomes were unchanged.

Summary

Korean summary
이번 연구에서는 부산권역심뇌혈관질환센터사업 시작 후 10여년간의 ST분절상습심근경색 환자 치료성적의 변화를 살펴보았다. 사업 시작 후 관상동맥중재시술팀의 위양성소집률이 크게 증가한 대신 ST분절상승심근경색 환자의 조기재관류 치료의 시간지표는 의미 있게 개선되었다. 그러나 생존지표는 사업 시작 전과 비교해 차이가 없었는데 중재시술이 불가능한 병원을 경우하는 사례가 많아 골든타임 이내에 조기 재관류치료를 받은 환자의 비율이 전체 환자의 1/4에 불과한 것이 그 원인으로 보인다.

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Relevance Index Regional Variation by Each Disease and Its Essential Medical Field: A Retrospective Data Analysis From 2016-2020 in Korea
Young-Eun Kim, Jeehee Pyo, Haneul Lee, HyeRan Jeong, Young-Kwon Park, Jeong-Wook Seo, Minsu Ock, Seok-Jun Yoon
Journal of Korean Medical Science.2023;[Epub] CrossRef

Associations Between Preschool Education Experiences and Adulthood Self-rated Health: Jeehye Lee, Jinwook Bahk, Young-Ho Khang; J Prev Med Public Health. 2017;50(4):228-239. Published online May 10, 2017; DOI: https://doi.org/10.3961/jpmph.16.110

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Abstract PDF Supplementary Material

Objectives
This study aimed to examine the association between preschool education experiences and adulthood self-rated health using representative data from a national population-based survey. Methods: Data from the Korean Labor and Income Panel Study in 2006 and 2012 were used. A total of 2391 men and women 21-41 years of age were analyzed. Log-binomial regression analyses were conducted to examine the associations between preschool education experience and self-rated health in adulthood. Parental socioeconomic position (SEP) indicators were considered as confounders of the association between preschool education experience and adulthood subjective health, while current SEP indicators were analyzed as mediators. Age-adjusted prevalence ratios (PRs) and the associated 95% confidence intervals (CIs) were estimated. Results: Compared with men without any experience of preschool education, those with both kindergarten and other preschool education experiences showed a lower prevalence of self-rated poor health (PR, 0.65; 95% CI, 0.47 to 0.89). In women, however, such an association was not evident. The relationship of preschool education experiences with self-rated poor health in adulthood among men was confounded by parental SEP indicators and was also mediated by current SEP indicators. After adjustment for parental and current SEP indicators, the magnitude of the associations between preschool education experiences and adulthood subjective health was attenuated in men. Conclusions: Preschool education experience was associated with adulthood self-rated health in men. However, this association was explained by parental and current SEP indicators. Further investigations employing a larger sample size and objective health outcomes are warranted in the future.

Summary

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Self-rated health and its determinants in patients with hypertension in Isfahan in 2019
Asieh Mansouri, Alireza Khosravi Farsani, Noushin Mohammadifard, Fatemeh Nouri, Mahnaz Jozan, Ghazaal Alavi Tabatabaei, Rezvan Salehidoost, Hamed Rafiee
BMC Public Health.2024;[Epub] CrossRef

The Prevalence of Cardiovascular Disease Risk Factors and the Framingham Risk Score in Patients Undergoing Percutaneous Intervention Over the Last 17 Years by Gender: Time-trend Analysis From the Mayo Clinic PCI Registry: Moo-Sik Lee, Andreas J. Flammer, Hyun-Soo Kim, Jee-Young Hong, Jing Li, Ryan J. Lennon, Amir Lerman; J Prev Med Public Health. 2014;47(4):216-229. Published online July 31, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.4.216

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Abstract PDF

Objectives
This study aims to investigate trends of cardiovascular disease (CVD) risk factor profiles over 17 years in percutaneous coronary intervention (PCI) patients at the Mayo Clinic. Methods: We performed a time-trend analysis within the Mayo Clinic PCI Registry from 1994 to 2010. Results were the incidence and prevalence of CVD risk factors as estimate by the Framingham risk score. Results: Between 1994 and 2010, 25 519 patients underwent a PCI. During the time assessed, the mean age at PCI became older, but the gender distribution did not change. A significant trend towards higher body mass index and more prevalent hypercholesterolemia, hypertension, and diabetes was found over time. The prevalence of current smokers remained unchanged. The prevalence of ever-smokers decreased among males, but increased among females. However, overall CVD risk according to the Framingham risk score (FRS) and 10-year CVD risk significantly decreased. The use of most of medications elevated from 1994 to 2010, except for β-blockers and angiotensin converting enzyme inhibitors decreased after 2007 and 2006 in both baseline and discharge, respectively. Conclusions: Most of the major risk factors improved and the FRS and 10-year CVD risk declined in this population of PCI patients. However, obesity, history of hypercholesterolemia, hypertension, diabetes, and medication use increased substantially. Improvements to blood pressure and lipid profile management because of medication use may have influenced the positive trends.

Summary

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Can conventional cardiovascular risk prediction models be improved by nuclear magnetic resonance (NMR) metabolomic signatures?
Remya Sudevan
European Journal of Preventive Cardiology.2023; 30(3): 241. CrossRef
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Arthur Shiyovich, Tal Ovdat, Robert Klempfner, Roy Beigel, Majdi Halabi, Avinoam Shiran, Keren Skalsky, Avital Porter, Katia Orvin, Ran Kornowski, Alon Eisen
Journal of Cardiology.2022; 79(4): 515. CrossRef
Heterogeneity of Treatment Effects for Intensive Blood Pressure Therapy by Individual Components of FRS: An Unsupervised Data-Driven Subgroup Analysis in SPRINT and ACCORD
Yaqian Wu, Jianling Bai, Mingzhi Zhang, Fang Shao, Honggang Yi, Dongfang You, Yang Zhao
Frontiers in Cardiovascular Medicine.2022;[Epub] CrossRef
Radial artery access is under‐utilized in women undergoing PCI despite potential benefits: Mayo Clinic PCI Registry
Rebecca C. Chester, Syeda A. Mina, Bradley Lewis, Nan Zhang, Richard Butterfield, Eric H. Yang
Catheterization and Cardiovascular Interventions.2020; 95(4): 675. CrossRef
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Arthur Shiyovich, Nir Shlomo, Tal Cohen, Zaza Iakobishvili, Ran Kornowski, Alon Eisen
International Journal of Cardiology.2020; 304: 8. CrossRef
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Jocelyn J. Drinkwater, Timothy M. E. Davis, Valentina Hellbusch, Angus W. Turner, David G. Bruce, Wendy A. Davis
Cardiovascular Diabetology.2020;[Epub] CrossRef
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Ygal Plakht, Abeer Abu Eid, Harel Gilutz, Arthur Shiyovich
Angiology.2019; 70(6): 530. CrossRef
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AlJohara M. AlQuaiz, Amna Rehana Siddiqui, Ambreen Kazi, Mohammad Ali Batais, Ali M. Al-Hazmi
BMC Cardiovascular Disorders.2019;[Epub] CrossRef
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Marta Regina Cezar-Vaz, Clarice Alves Bonow, Marlise Capa Verde Almeida de Mello, Daiani Modernel Xavier, Jordana Cezar Vaz, Maria Denise Schimith
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SeyedHossein Rabani, Mahsa Sardarinia, Samaneh Akbarpour, Fereidoun Azizi, Davood Khalili, Farzad Hadaegh, Katriina Aalto-Setala
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Ayman J. Hammoudeh, Imad A. Alhaddad, Yousef Khader, Ramzi Tabbalat, Eyas Al-Mousa, Akram Saleh, Mohamad Jarrah, Assem Nammas, Mahmoud Izraiq
Journal of the Saudi Heart Association.2017; 29(3): 195. CrossRef
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Shikhar Agarwal, Karan Sud, Badal Thakkar, Venu Menon, Wael A. Jaber, Samir R. Kapadia
The American Journal of Cardiology.2017; 119(10): 1532. CrossRef
Cardiovascular manifestations of renovascular hypertension in diabetic mice
Sonu Kashyap, Sean Engel, Mazen Osman, Yousif Al-Saiegh, Asarn Wongjarupong, Joseph P. Grande
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English Abstracts

Crisis Intervention for Workers in Severely Stressful Situations After Massive Layoffs and Labor Disputes.: Jong Min Woo, Jeong Ho Chae, Soo Chan Choi; J Prev Med Public Health. 2010;43(3):265-273.; DOI: https://doi.org/10.3961/jpmph.2010.43.3.265

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OBJECTIVES
Due to the economic crisis and globalization, many workers have been suffering from severe occupational stress due to job insecurity and struggles related to downsizing and restructuring. This study aims to assess the stress levels among workers involved in fierce labor disputes and massive layoffs and to evaluate their specific needs and satisfaction with counseling services set up to help workers cope with severely stressful situations? METHODS: The authors provided crisis intervention to workers in traumatic situations to compare the differential level of stress responses and needs among the workers remaining employed in a large auto factory, those laid off by it, and those laid off by other companies in the same region (Pyeongtaek, Gyeonggi Province). We measured stress levels using the worker's stress response inventory (WSRI) and heart rate variability (HRV), and assessed workers' satisfaction with the counseling services. RESULTS: 502 workers participated in the program. Fifty-seven percent of them consulted with occupational problems. The mean WSRI score of the workers remaining employed in the automobile factory was higher than that of the unemployed (employed: 39.8+/-19.9, unemployed: 29.3+/-18.8). Ninety-five percent of workers responded that they were satisfied or very satisfied with the counseling services. CONCLUSIONS: This study suggests the urgent need for the establishment of a national crisis intervention program dedicated to supporting workers in severely stressful situations.

Summary

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Can We Blame the Climate of an Organization for the Stress Experienced by Employees?
Sanjeev P. Sahni, Vaijayanthee Kumar
Jindal Journal of Business Research.2012; 1(2): 181. CrossRef

A Comparative Study on Comorbidity Measurements with Lookback Period using Health Insurance Database: Focused on Patients Who Underwent Percutaneous Coronary Intervention.: Kyoung Hoon Kim, Lee Su Ahn; J Prev Med Public Health. 2009;42(4):267-273.; DOI: https://doi.org/10.3961/jpmph.2009.42.4.267

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OBJECTIVES
To compare the performance of three comorbidity measurements (Charlson comorbidity index, Elixhauser's comorbidity and comorbidity selection) with the effect of different comorbidity lookback periods when predicting in-hospital mortality for patients who underwent percutaneous coronary intervention. METHODS: This was a retrospective study on patients aged 40 years and older who underwent percutaneous coronary intervention. To distinguish comorbidity from complications, the records of diagnosis were drawn from the National Health Insurance Database excluding diagnosis that admitted to the hospital. C-statistic values were used as measures for in comparing the predictability of comorbidity measures with lookback period, and a bootstrapping procedure with 1,000 replications was done to determine approximate 95% confidence interval. RESULTS: Of the 61,815 patients included in this study, the mean age was 63.3 years (standard deviation: +/-10.2) and 64.8% of the population was male. Among them, 1,598 (2.6%) had died in hospital. While the predictive ability of the Elixhauser s comorbidity and comorbidity selection was better than that of the Charlson comorbidity index, there was no significant difference among the three comorbidity measurements. Although the prevalence of comorbidity increased in 3 years of lookback periods, there was no significant improvement compared to 1 year of a lookback period. CONCLUSIONS: In a health outcome study for patients who underwent percutaneous coronary intervention using National Health Insurance Database, the Charlson comorbidity index was easy to apply without significant difference in predictability compared to the other methods. The one year of observation period was adequate to adjust the comorbidity. Further work to select adequate comorbidity measurements and lookback periods on other diseases and procedures are needed.

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Adjusting for Confounders in Outcome Studies Using the Korea National Health Insurance Claim Database: A Review of Methods and Applications
Seung Jin Han, Kyoung Hoon Kim
Journal of Preventive Medicine and Public Health.2024; 57(1): 1. CrossRef
High‐Intensity Statin Reduces the Risk of Mortality Among Chronic Liver Disease Patients With Atherosclerotic Cardiovascular Disease: A Population‐Based Cohort Study
Sungho Bea, In‐Sun Oh, Ju Hwan Kim, Dong Hyun Sinn, Yoosoo Chang, Seungho Ryu, Ju‐Young Shin
Journal of the American Heart Association.2023;[Epub] CrossRef
Impact of comorbidity assessment methods to predict non-cancer mortality risk in cancer patients: a retrospective observational study using the National Health Insurance Service claims-based data in Korea
Sanghee Lee, Yoon Jung Chang, Hyunsoon Cho
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Jill Hardin, Jenna M. Reps
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Use of hospitalisation history (lookback) to determine prevalence of chronic diseases: impact on modelling of risk factors for haemorrhage in pregnancy
Jian Sheng Chen, Christine L Roberts, Judy M Simpson, Jane B Ford
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Korean Journal of Health Policy and Administration.2010; 20(1): 87. CrossRef
Comparative Study on Three Algorithms of the ICD-10 Charlson Comorbidity Index with Myocardial Infarction Patients
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Impact of an Early Hospital Arrival on Treatment Outcomes in Acute Ischemic Stroke Patients.: Young Dae Kwon, Sung Sang Yoon, Hyejung Chang; J Prev Med Public Health. 2007;40(2):130-136.; DOI: https://doi.org/10.3961/jpmph.2007.40.2.130

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OBJECTIVES
Recent educational efforts have concentrated on patient's early hospital arrival after symptom onset. The purpose of this study was to evaluate the time interval between symptom onset and hospital arrival and to investigate its relation with clinical outcomes for patients with acute ischemic stroke. METHODS: A prospective registry of patients with signs or symptoms of acute ischemic stroke, admitted to the OO Medical Center through emergency room, was established from September 2003 to December 2004. The interval betwee symptom onset and hospital arrival was recorded for each eligible patient and analyzed together with clinical characteristics, medication type, severity of neurologic deficits, and functional outcomes. RESULTS: Based on the data of 256 patients, the median interval between symptom onset and hospital arrival was 13 hours, and 22% of patients were admitted to the hospital within 3 hours after symptom onset. Patients of not-mild initial severity and functional status showed significant differences between arrival hours of 0-3 and later than 3 in terms of their functional outcomes on discharge. Logistic regression models also showed that arrival within 3 hours was a significant factor influencing functional outcome (OR=5.6; 95% CI=2.1, 15.0), in addition to patient's initial severity, old age, cardioembolism subtype, and referral to another hospital. CONCLUSIONS: The time interval between symptom onset and hospital arrival significantly influenced treatment outcome for patients with acute ischemic stroke, even after controlling for other significant clinical characteristics. The findings provided initiatives for early hospital arrival of patients and improvement of emergency medical system.

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Hyong-Hu Park, Mun-Joo Cho, In-Chul Im, Jin-Soo Lee
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Original Articles

A cohort study on blood zinc protoporphyrin concentration of workers in storage battery factory.: Man Joong Jeon, Joong Jeong Lee, Joon Sakong, Chang Yoon Kim, Jung Man Kim, Jong Hak Chung; Korean J Prev Med. 1998;31(1):112-126.

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Abstract PDF: To investigate the effectiveness of the interventions in working environment and personal hygiene for the occupational exposure to the lead, the blood zinc protoporphyrin(ZPP) concentrations of 131 workers ( 100 exposed subjects and 31 controls ) of a newly established battery factory were analyzed. They were measured in every 3 months up to 18 months. Air lead concentration (Pb-A) of the workplaces was also checked for 3 times in 6 months interval from August 1987. Environmental intervention included the local exhaust ventilation and vacuum cleaning of the floor. Intervention of the personal hygiene included the daily change of clothes, compulsory shower after work and hand washing before meal, prohibition of cigarette smoking and food consumption at the work site and wearing mask. Mean blood ZPP concentration of the controls was 16.45+/-4.83 microgram/dashliter at the preemployment examination and slightly increased to 17.77+/-5.59 microgram/dashliter after 6 months. Mean blood ZPP concentration of the exposed subjects who were employed before the factory was in operation (Group A) was 17.36+/-5.20 microgram/dashliter on employment and it was increased to 23.00+/-13.06 microgram/dashliter after 3 months. The blood ZPP concentration was increased to 27.25+/-6.40 microgram/dashliter on 6 months (p<0.01) after the employment which was 1 month after the initiation of intervention program. It did not increase thereafter and ranged between 25.48 microgram/dashliter and 26.61 microgram/dashliter in the subsequent 4 results. Mean blood ZPP concentration of the exposed subjects who were employed after the factory had been in operation but before the intervention program was initiated (Group B) was 14.34+/-6.10 microgram/dashliter on employment and it was increased to 28.97+/-7.14 microgram/dashliter (p<0.01) in 3 months later(1 month after the intervention). The values of subsequent 4 tests were maintained between 26.96 microgram/dashliter and 27.96 microgram/dashliter. Mean blood ZPP concentration of the exposed subjects who were employed after intervention program had been started (Group C) was 21.34+/-5.25 microgram/dashliter on employment and it was gradually increased to 23.37+/-3.86 microgram/dashliter (p<0.01) after 3 months, 23.93+/-3.64 microgram/dashliter after 6 months, 25.50+/-3.01 microgram/dashliter (p<0.01) after 9 months, and 25.50+/-3.10 microgram/dashliter after 12 months. Workplaces were classified into 4 parts according to Pb-A. The Pb-A of part I, the highest areas, were 0.365 microgram/m4, and after the intervention the levels were decreased to 0.216 microgram/m4 and 0.208 microgram/m4 in follow-up test. The Pb-A of part II which was resulted in lower value than part I was decreased from 0.232 microgram/m4 to 0.148 microgram/m4, and 0.120 microgram/m4 after the intervention. The Pb-A of part III was tested after the intervention and resulted in 0.124 microgram/m4 in January 1988 and 0.081 microgram/m4 in August 1988. The Pb-A of part IV was also tested after the intervention and resulted in 0.110 microgram/m4 in August 1988. There was no consistent relationship between Pb-A and blood ZPP concentration. The blood ZPP concentration of the group A and B workers in the part of the highest Pb-A were lower than those of the workers in the parts of lower Pb-A. The blood ZPP concentration of the workers in the part of the lowest Pb-A increased more rapidly. The blood ZPP concentration of the group C workers was the highest in part III. These findings suggest that the intervention in personal hygiene is more effective than environmental intervention, and it should be carried out from the first day of employment and to both the exposed subjects, blue color workers and the controls, white color workers.; Summary

Impacts of Implementation of Patient Referral System in terms of Medical Expenditures and Medical Utilization.: Sang Hyuk Jung, Han Joong Kim; Korean J Prev Med. 1995;28(1):207-224.

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Abstract PDF: A new medical delivery system which regulated outpatient department(OPD) use from tertiary care hospitals was adopted in 1989. Under the new system, patients using tertiary care hospital OPD without referral slip from clinics or hospital could not get any insuranced benefit for the services received from the tertiary care hospital. This study was conducted to evaluate the Patient Referral System(PRS) with respect to health care expenditures and utilization. Two data sets were used in this study. One was monthly data set(from January 1986 to December 1992)from the Annual Report of Korea Medical Insurance Corporation(KMIC). The other was monthly joint data set composed of personal data of which 10% were selected randomly with their utilization data of KMIC from January 1988 to December 1992. The data were analyzed by time-series intervention model of SAS-ETS. The results of this study were as follows: 1. There was no statistically significant changes in per capita expenditures following PRS. 2. Utilization episodes per capita was increased statistically significantly after implementation of PRS. The use of clinics and hospitals increased significantly, whereas in tertiary care hospitals the use decreased significantly immediately after implementation of PRS and increased afterwards. 3. Follow-up visits per episode were decreased statistically significantly after implementation of PRS. The decrease of follow-up visits per episode were remarkable in clinics and hospitals, whereas in tertiary care hospitals it was increased significantly after implementation of PRS. 4. There was no statistically significant changes in prescribing days per episode following PRS. Futhermore, clinics and hospitals showed a statistically significant decrease in prescribing days per episode, whereas in tertiary care hospital it shower statistically significant increase after implementation of PRS. 5. Except high income class, the use of tertiary care hospitals showed statistically significant decrease after implementation of PRS. The degree of decrease in the use of tertiary card hospitals was inversely proportional to income. These results suggest that the PRS policy was not efficient because per capita expenditures did not decrease, and was not effective because utilization episodes per capita, follow-up visits per episode, and prescribing days per episode were not predictable and failed to show proper utilization. It was somewhat positive that utilization episodes per capita were decreased temporarily in tertiary card hospitals. And PRS policy was not appropriate because utilization episodes per capita was different among income groups. In conclusion, the PRS should be revised for initial goal attainment of cost containment and proper health care utilization.; Summary

Twelve-year Study on Body Mass Index Changes of Obese Adolescents.: Yun Ju Kang, Il Suh, Chang Ho Hong, Jong Ku Park; Korean J Prev Med. 1994;27(4):665-676.

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Abstract PDF: The purpose of this study is to observe the longitudinal changes in BMI (Body Mass Index) of obese and non-obese 3rd. grade high school students in Seoul for 12 years and to see the trends of overt weight gain in obese adolescents. The results are as follows; 1. The average annual increasing rates of body mass indices in male students were 1.14kg/m2 in obese group and 0.59 in non-obese group. In female students, the average annual increasing rates of body mass indices were 0.93kg/m2 in obese group and 0.53kg/m2 in non-obese group. 2. The change rate of BMI for 12 years was significantly higher in obese group than non-obese group. 3. Puberty had less influence on the change rate of BMI in obese group compared to non-obese group. 4. In obese group, 71.8% of the variance in BMI at 17 can be predicted by BMI at 16 years in male students. In female students 44.4% can be predicted by BMI at age 16. 5. Among the 17-year-old obese students, 58.8% of the males and 56.2% of females were found not to have been obese at 7 years of age. 6. Among the 17-year-old obese students, those who were obese at 7 years of age were found to have higher BMI at later ages than those who were in the non-obese group. Obese adolescents were more likely to be obese in their childhood than non-obese group. There was no optimal age for the significant weight gain and the increasing rate of BMI was constantly higher in obese group than in non-obese group. Due to the fact that child obesity in early age contributes to obesity in adolescence, close observation is advised on the other hand, a large proportion of obese adolescents can be preventable by early interventions, because about 50% of obese adolescents were not obese in early elementary school age.; Summary

Impacts of the Implementation of the DRG Based Prospective Payment System on the Medicare Expenditures.: Han Joong Kim, Chung Mo Nam; Korean J Prev Med. 1994;27(1):107-116.

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Abstract PDF: The united states adopted DRG based prospective payment system (PPS) in order to control the inflation of health care costs. No study used statistical test while many studies reported the cost containing effect of the PPS. To study impacts of the PPS on the Medicare expenditure, this study set the following three hypotheses: (l) The PPS decelerated the increase in the hospital expenditure (part A), (2) the PPS accelerated the increase in the expenditure of outpatients and physicians (part B), (3) the increase in total expenditure was decelerated inspite of the spill over (substitution) effect because saving in the part A expenditure were greater than losses in the part B expenditure. The dependent variables are per capita hospital expenditure, per capita part B expenditure, and per capita total expenditure for the Medicare beneficiaries. An intervention analysis, which added intervention effect to the time series variation on the Box-Jenkins model, was used. The observations included 120 months from 1978 to 1987. The results are as follows: (l) The annual increase in the per capita part A expenditure was $5.11 after the implementation of DRG where as that before the PPS had been $11.1. The effect of the reduction ($5.99) was statistically significant (t=-3.9). (2) The spill over (substitution) effect existed because the annual increase in the per capita part B expenditure was accelerated by $l.73 (t=l.91) after the implementation of the PPS. (3) The increase in the total Medicine expenditure per capita was reduced by $4.26(t=-2.19) because the spill over effect was less than cost savings in the Part A expenditure.; Summary

Cohort Observafion of Blood Lead Concentration of Storage Battery Workers.: Chang Yoon Kim, Jung Man Kim, Gu Wung Han, Jung Han Park; Korean J Prev Med. 1990;23(3):324-337.

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Abstract PDF: To assess the effectiveness of the interventions in working environment and personal hygiene for the occupational exposure to the lead, 156 workers (116 exposed subjects and 40 controls) of a newly established battery factory were examined for their blood lead concentration (Pb-B) in every 3 months up to 18 months. Air lean concentration (Pb-A) of the workplaces was also checked for 3 times in 6 months interval from August 1987. Environmental intervention included the local exhaust ventilation and vacuum cleaning of the floor. Intervention of the personal hygiene included the daily change of clothes, compulsory shower after work and hand washing before meal, prohibition of cigarette smoking and food consumption at the work site and wearing mask. Mean Pb-B of the controls was 21.97 +/- 33.6 microgram/dl at the preemployment examination and slightly increased to 22.75 +/- 3.38 microgram/dl after 6 months. Mean Pb-B of the workers who were employed before the factory was in operation (Group A) was 20.49 +/- 3.84 microgram/dl on employment and it was increased to 23.90 +/- 5.30 microgram/dl after 3 months <(P<0.01). Pb-B was increased to 28.84 +/- 5.76 microgram/dl 6 months after the employment which was 1 month after the initiation of intervention program. It did not increase thereafter and ranged between 26.83 microgram/dl and 28.28 microgram/dl in the subsequent 4 tests. Mean Pb-B of the workers who were employed after the factory had been operation but before the intervention program was initiated (Group B) was 16.58 +/- 4.53 microgram/dl before the exposure and it was increased to 28.82 +/- 5.66 microgram/dl (P<0.01) in 3 months later (1 month after the intervention). The values of subsequent 4 tests remained between 26.46 and 28.54 microgram/dl. Mean Pb-B of the workers who were employed after intervention program had been started (Group C) was 19.45 +/- 3.44 microgram/dl at the preemployment examination and gradually increased to 22.70 +/- 4.55 microgram/dl after 3 months (P<0.01), 23.68 +/- 4.18 microgram/dl after 6 months, and 24.42 +/- 3.60 microgram/dl after 9 months. Work stations were classified into 4 parts according to Pb-A. The Pb-A of part I, the highest areas, were 0.365 mg/m3, and after intervention the levels were decreased to 0.216 mg/m3 and 0.208 mg/m3 in follow-up tests. The Pb-A of part II was decreased from 0.232 mg/m3 to 0.148 mg/m3, and 0.120 mg/m3 after the invention. Pb-A of part III and IV was tested only after intervention and the Pb-A of part III were 0.124 mg/m3 in January 1988 and 0.081 mg/m3 in August 1988. The Pb-A of part IV, not stationed at one place but moving around, was 0.110 mg/m3 in August 1988. There was no consistent relationship between Pb-B and Pb-A. Pb-B of the group A and B workers in the part of the highest Pb-A were lower than those of the workers in the parts of lower Pb-A. Pb-B of the workers in the part of the lowest Pb-A increased more rapidly. Pb-B of group C workers was the highest in part I and the lowest in part IV. These findings suggest that Pb-B is more valid method than Pb-A for monitoring the health of lead workers and intervention in personal hygiene is more effective than environmental intervention.; Summary

Impact of District Medical Insurance Plan on Number of Hospital Patients: Using Box-Jenkins Time Series Analysis.: Yong Jun Kim, Ki Hong Chun; Korean J Prev Med. 1989;22(2):189-196.

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Abstract PDF: In January 1988, district medical insurance plan was executed on a national scale in Korea. We conducted an evaluation of the impact of execution of district medical insurance plan on number of hospital patients: number of outpatients; and occupancy rate. This study was carried out by Box-Jenkins time series analysis. We tested the statistical significance with intervention component added to ARIMA model. Results of our time series analysis showed that district medical insurance plan had a significant effect on the number of outpatients and occupancy rate. Due to this plan the number of outpatients had increased by 925 patients every month which is equivalent to 8.3 percents of average monthly insurance outpatients in 1987, and occupancy rate had also increased by 0.12 which is equivalent to 16 percents of that in 1987.; Summary

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