Journal of Preventive Medicine and Public Health

Original Articles

Short-term Effects of Ambient Air Pollution on Emergency Department Visits for Asthma: An Assessment of Effect Modification by Prior Allergic Disease History: Juhwan Noh, Jungwoo Sohn, Jaelim Cho, Seong-Kyung Cho, Yoon Jung Choi, Changsoo Kim, Dong Chun Shin; J Prev Med Public Health. 2016;49(5):329-341. Published online September 8, 2016; DOI: https://doi.org/10.3961/jpmph.16.038

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Objectives
The goal of this study was to investigate the short-term effect of ambient air pollution on emergency department (ED) visits in Seoul for asthma according to patients’ prior history of allergic diseases.
Methods
Data on ED visits from 2005 to 2009 were obtained from the Health Insurance Review and Assessment Service. To evaluate the risk of ED visits for asthma related to ambient air pollutants (carbon monoxide [CO], nitrogen dioxide [NO2], ozone [O3], sulfur dioxide [SO2], and particulate matter with an aerodynamic diameter <10 μm [PM10]), a generalized additive model with a Poisson distribution was used; a single-lag model and a cumulative-effect model (average concentration over the previous 1-7 days) were also explored. The percent increase and 95% confidence interval (CI) were calculated for each interquartile range (IQR) increment in the concentration of each air pollutant. Subgroup analyses were done by age, gender, the presence of allergic disease, and season.
Results
A total of 33 751 asthma attack cases were observed during the study period. The strongest association was a 9.6% increase (95% CI, 6.9% to 12.3%) in the risk of ED visits for asthma per IQR increase in O3 concentration. IQR changes in NO2 and PM10 concentrations were also significantly associated with ED visits in the cumulative lag 7 model. Among patients with a prior history of allergic rhinitis or atopic dermatitis, the risk of ED visits for asthma per IQR increase in PM10 concentration was higher (3.9%; 95% CI, 1.2% to 6.7%) than in patients with no such history.
Conclusions
Ambient air pollutants were positively associated with ED visits for asthma, especially among subjects with a prior history of allergic rhinitis or atopic dermatitis.

Summary

Citations

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Gary Adamkiewicz, Jahred Liddie, Jonathan M. Gaffin
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ATMOSPHERIC POLLUTANTS AND PREVALENCE OF ASTHMA AMONG CHILDREN: A REVIEW
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The Nonlinear Association Between Internet Using Time for Non-Educational Purposes and Adolescent Health: Jong Yeon Kim; J Prev Med Public Health. 2012;45(1):37-46. Published online January 31, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.1.37

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Abstract PDF

Objectives

This study was performed to consider the association between Internet using time for non-educational purposes and adolescent health, and to examine how health status differs between Internet users and non-users.

Methods

We analyzed 2009 data from the Korea Adolescent Risk Behavior Web-Based Survey, conducted on a nationally representative sample of students in grades 7 to 12. A total of 75 066 adolescents were categorized into four groups according to their Internet using time excluding using for educational purposes: non-Internet users (NIUs), occasional Internet users (OIUs) (<1 h/d), moderate Internet users (MIUs) (≥1 and <2 h/d), and heavy Internet users (HIUs) (≥2 h/d). Health factors included eight health risk behavior indices, four mental health indices and six physical health indices.

Results

The distribution of Internet use was as follows: NIUs 17.4%, OIUs 68.1%, MIUs 12.7%, and HIUs 1.7%. In multivariate analysis, using OIUs as a reference, U- or J-shaped associations were observed for five health risk behavior indices (current smoking, current drinking, drug abuse, sexual intercourse, sedentary behavior on weekdays) and four mental health indices (stressed, depressed, suicidal ideation, attempted suicide) in both genders. After removing confounding effects, including age, region, school type, subjective school record, subjective economic status, presence of parents, living with family, and sedentary behavior, these associations were still observed.

Conclusions

Health professionals should consider both Internet non-users (for non-educational purposes) and heavy users to be high-risk groups in terms of health status. Also, more well-designed studies are needed to clarify what factors are working in these nonlinear associations.

Summary

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Research Support, Non-U.S. Gov't

Assessment of Di (2-ethylhexyl) Phthalate Exposure by Urinary Metabolites as a Function of Sampling Time.: Moon Seo Park, Yun Jung Yang, Yeon Pyo Hong, Sang Yon Kim, Yong Pil Lee; J Prev Med Public Health. 2010;43(4):301-308.; DOI: https://doi.org/10.3961/jpmph.2010.43.4.301

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Abstract PDF

OBJECTIVES
In most DEHP exposure assessment studies, single spot urine sample was used. It could not compare the exposure level among studies. Therefore, we are going to represent the necessity of selection of proper sampling time of spot urine for assessing the environmental DEHP exposure, and the association urinary DEHP metabolites with steroid hormones. METHODS: We collected urine and plasma from 25 men. The urine sampling times were at the end of the shift (post-shift) and the next morning before the beginning of the shift (pre-shift). Three metabolites of DEHP {mono(2-ethylhexyl) phthalate [MEHP], mono-(2-ethyl-5-hydroxyhexyl)phthalate [MEHHP], and mono(2-ethyl-5-oxohexyl)phthalate [MEOHP]} in urine were analyzed by HPLC/MS/MS. Plasma luteinzing hormone, follicle stimulating hormone, testosterone, and 17beta-estradiol were measured at pre-shift using a ELISA kit. A log-transformed creatinine-adjusted urinary MEHP, MEHHP, and MEOHP concentration were compared between the post- and pre-shift. The Pearson's correlation was calculated to assess the relationships between log-transformed urinary MEHP concentrations in pre-shift urine and hormone levels. RESULTS: The three urinary metabolite concentrations at post-shift were significantly higher than the concentrations in the pre-shift (p<0.0001). The plasma hormones were not significantly correlated with log-transformed creatinine - adjusted DEHP metabolites. CONCLUSIONS: To assess the environmental DEHP exposure, it is necessary to select the urine sampling time according to the study object. There were no correlation between the concentration of urinary DEHP metabolites and serum hormone levels.

Summary

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English Abstract

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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Abstract PDF

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.

Summary

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Original Articles

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

A study on Performing Time of Neurobehavioral Test in Workers exposed to Organic Solvents.: Kang Won Park, In Geun Park, Jin Ha Kim, Kang Woo Bae, Duk Hee Lee, Yong Hawn Lee; Korean J Prev Med. 1997;30(1):171-180.

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Abstract PDF: This study was performed to see whether neurobehavioral tests was affected by the exposure-free time in the workers chronically exposed to organic solvents. Thirty-four female workers were participated and four items among neurobehavioral core test battery of World Health Organization, including digit span, Santa Ana Dexterity, digit symbol, Benton Visual Retention, were administered to the workers. Test was conducted three times-preshift on Monday, preshift on Weekday and during shift on Weekday-per person and the interval of tests was 2 weeks. Digit span forward, Santa Ana Dexterity, digit symbol, and Benton Visual Retention showed significant decrements by performing time, especially during shift on Weekday versus preshift on Monday and preshift on Weekday. In addition, the score at preshift on Weekday was significantly lower than preshift on Monday, in preferred Santa Ana Dexterity and digit symbol. Generally, those who were exposed to high concentration, over 50 years and under 6 years of education showed marked decrease of score at during shift. So, it would be desirable that neurobehavioral test is conducted at preshift on Monday and items related to short term memory could be considerable to be done at preshift on Weekday.; Summary

Physical Fitness, Leisure Time Physical Activity, and Serum Lipid Levels in Middle-Aged Male Workers .: Jang Rak Kim, Bock Dong Nam, Ju Ho Kim, Song Kwan Lee, Joong Kap Moon, Jang Ho Lee, Dae Yong Hong; Korean J Prev Med. 1996;29(2):173-186.

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Abstract PDF: This is a cross-sectional study to evaluate the relationships between physical fitness, leisure time physical activity, and serum lipid levels in middle-aged male workers. Physical fitness was measured by a step test score, and leisure time physical activity was self-reported on a questionnaire. Serum total cholesterol was negatively related to physical fitness(r=-0.27), and positively to obesity index(r=0.27). But leisure time physical activity was related to total cholesterol negatively(r.-0.20) only in subjects whose total cholesterol levels were above 170mg/dl. High density lipoprotein(HDL) cholesterol was positively related to physical faintness(r=0.15), negatively to obesity index(r=-0.22), and positively to weekly alcohol consumption(r=0.14). Total cholesterol/HDL cholesterol ratio was related to physical fitness(r=-0.23), obesity index(r=0.32), total cigarette index (r=0.13), weekly alcohol consumption(r=-0.13), and vegetable preference(r=0.13) physical fitness was also related to leisure time physical activity(r=0.19) and obesity index(r=-0.18). In multiple linear regression models, physical fitness(beta= -0.23) and obesity index(beta=0.18) were significantly associated with total cholesterol, obesity index(beta=-0.25) with HDL cholesterol, and obesity index(beta=0.30), physical fitness(beta= -0.16) and vegetable preference (beta=0.14) with total cholesterol HDL cholesterol ratio. In conclusion, as physical fitness has a stronger relationship with serum lipid levels than leisure time physical activity, and the association between physical fitness and leisure time physical activity is modest, physical fitness should be added as an important variable in addition to activity in future epidemiologic studies.; Summary

Trend and Prediction of Urban Family Expenditure for Health Care.: Jae Yong Park, Si Hyun Nam; Korean J Prev Med. 1995;28(2):347-363.

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Abstract PDF: The increase of health care expenditures is an important problem in the almost countries. Also, suppression of the health care expenditures is an important problem in the health field of Korea since the national health insurance for total people in 1989. Thus, it is very important to grasp the change of the health care expenditures of family and proportions of the health care expenditures to total expenditures of family, because they are the basis of national health care expenditures in Korea. While the health care expenditures of urban family were increased during 1980-1993 by 12.8% annually, the total expenditures of urban family were increased by 14.8% annually. consequently, the proportions of health care expenditures to total expenditures were decreased from 5.98% to 4.76%. The proportions of health care expenditure for 3 years to come were predicted to 4.75% in 1994, 4.67% in 1995, and 4.63% in 1996 by the time-series ana]ysis. That is, it was predicted that they would be decreasing slowly. The product elasticity of health care expenditure was less than 1 in the multiple regression analysis, so the health care is normal good rather than superior good. Therefore, it seems that the household economy is able to bear the expense pursuing the improvement of quality of health care by actualizing the medical insurance fee.; Summary

A Comparison of Laparoscopic Cholecystectomy with Open Cholecystectomy in a Korean Hospital.: Eun Mee Lee, Seung Hum Yu, Myong Sei Sohn, Suk Il Kim; Korean J Prev Med. 1995;28(2):325-333.

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Abstract PDF: Laparoscopic cholecystectomy was introduced into Korea in 1990 and has been rapidly replacing open cholecystectomy when the indications were met. In this study a medical utilization and technology was assessed on the selected hospitalized patients with cholelithiasis who underwent open or laparoscopic cholecystectomy from April 1, 1991 to March 31, 1994. The results are as follows. Despite the low reimbursement rate by the health insurance, the number of laparoscopic cases have been steadily increased. The post-operative days before health insurance coverage were significantly shortened from 8.4 days to 4.6 days. The preoperative days before health insurance coverage were significantly shorted from 8.4 days to 4.0 days. The total length-of-stays in the hospital were also significantly shortened from 15.2 days to 10.7 and 9.8 days in laparoscopic cholecystectomy. The laparoscopic cholecystectomy showed low expenses in all aspects expect the average hospital charges per day. For the hospital to have cost containment, it is more effective if length-of-stay is shorter because of high daily inpatient hospital charge. The laparoscopic cholecystectomy also showed shortened anesthesia time and operation time compared with open cholecystectomy that were statistically significant. The mean anesthesia and operation time for open cholecystectomy were 113.2 and 90.2 minutes but those of laparoscopic cholecystectomy were 105.7 and 68.6 minutes. According to this study the laparoscopic cholecystectomy has reduced the medical expenditure and we recommend this procedure over open cholecystectomy. The further discussion on the different morbidity rate between two types of procedure is essential in providing quality medical care, and to educate specialist.; 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

Leisure time physical activity and its relationship to coronary risk factors in male workers.: Yun Kyeong Rho, Mi Hae Yeh, Sung Kook Lee, Byung Yeol Chun; Korean J Prev Med. 1993;26(3):332-346.

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Abstract PDF: This study was attempted to observe leisure time physical activity pattern and its relationship to coronary risk factors(BMI, systolic blood pressure, diastolic blood pressure, serum total cholesterol, triglycerides, fasting blood sugar). Subjects participated in this study were 277 adult male workers of an industry in Kyungpook province, Korea. Energy expenditure were measured using modified Physical Activity History questionnaire of CARDIA study by interviewing. Serum total cholesterol, triglycerides and blood sugar level were tested with 5 ml fasting blood and height, weight and blood pressure were measured. Data on smoking and drinking habits and others were obtained. Geometric mean of leisure time physical energy expenditure were estimated as 212.80 kcal per week for study subjects and only 22.4% of them expended 2,000 kcal or more per week in leisure time physical activity. Taking walks or hikes and jogging or running were more frequent leisure time physical activities in study subjects. Statistically significant mean differences in total weekly leisure time physical activity for all coronary risk factors were not found among three groups. Because energy expenditure of leisure time was generally low in this subjects and most of them were healthy men, we did not found that leisure time physical activity was significantly associated with coronary risk factors.; 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

A Relationship of Care Time with Functional Status and Patients Characteristics among Patients in Long-term Care Hospitals.: Jee Jeon Yi, Sang Wook Yi, Jeong In Kim, Seung Hm Yu, Hyeong Sik Yoo; J Prev Med Public Health. 2004;37(3):282-291.

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Abstract PDF: OBJECTIVES
The aim of this study was to investigate the functional status variables related to the care time of health professionals for patients in long-term care facilities. METHODS: The functional stati of 1001 patients in 8 longterm care hospitals were examined by the Resident Assessment Instrument for Long-term Care Facility Version 2.0. The care time of health professionals for patients was calculated using data from a self-reported task survey by nurses, auxiliary nurses, private aides, doctors, physiotherapists and social workers. RESULTS: The average care time per diem was 240.6 minutes. The care time by doctors, nurses and private aides were 11.0, 71.0 and 139.5 minutes, respectively. The lower the function of activities of daily living (ADL) and the greater the symptoms of extensive services, special care and clinical complexity, the more care time was served. On the contrary, the greater the symptoms of nursing rehabilitation, depression, cognitive disorder, behavior problem and psychiatry/mood disorder, the less care time was served. Age and gender were not significantly related to the care time. CONCLUSIONS: Developing a case mix classification system for elderly long term care patients may be helpful for both of patients and health care providers. The ADL, extensive services, special care and clinical complexity of variables should be considered in the development of a case mix system for the long term care of patients in Korea.; Summary

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