Journal of Preventive Medicine and Public Health

Volume 27(1); March 1994

Original Articles

Association of Stress Level with Smoking Amounts among University Students.: Jong Myon Bae, Yoon Ok Ahn, Byung Joo Park; Korean J Prev Med. 1994;27(1):1-10.

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Abstract PDF: The aim of this study was to assess the degree of association between individual stress and the amount of smoking among male senior students of a medical college. The questionnaire survey was conducted twice for collecting the data on stress level in terms of BEPSl score, smoking amounts, alcohol intake, and residence type in 1992 and 1993. Among the 223 responders, 39.9% were smokers. In the smokers, the association between stress level and smoking amount was significant after controlling for alcohol intake and residence type (P < 0.l). Especially in the group of living without family, the association was more significant (p=0.06). Therefore, it is recommendable that the stress management program is called upon for the student smokers to reduce smoking amount.; Summary

HgCl2 Dysregulates the Immune Response of Balb/c Mice.: No Suk Kim, Dai Ha Koh, Chong Suh Kim, Jung Sang Lee, Nam Song Kim, Hwang Ho Lee; Korean J Prev Med. 1994;27(1):11-24.

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Abstract PDF: The studies reported here were undertaken to investigate the effects of mercury chloride on immune system of Balb/c mouse employing a flexible tier of in vitro and in vivo assays. Mercury chloride inhibited the proliferative responses of spleen cells to lipopolysaccharide, pokeweed mitogen, and phytohemagglutinin as a dose-dependent manner. This inhibitory effect was observed not only when HgCl2 was added 2nd or 3rd day of 3 days culture period but also when spleen cells was pretreated with HgC12 for 2 hours. Mercury chloride, however, potentiated the production of IgM and IgG from spleen cells. During the HgCl2 administration by drinking for 3 weeks, the weight gain of mice was significantly blunted than that of control group mice, while no overt signs related to mercury toxicity were noted in any mice of experimental group. There was no change in thymus and spleen weights, and in histological findings of kidney, bone marrow of femur, thymus, spleen, and politeful lymph node after 3 weeks of mercury exposure. However, HgC12 induced a significant increase of total serum IgM, IgG including IgG1, IgG2a and IgG2b, and IgE in Balb/c mice. Treatment in vivo with anti-IL-4 monoclonal antibody significantly abrogated the HgCl2-induced increase in total serum IgG1 and IgE. Whereas HgCl2 potentiated total serum IgM and IgG, there was, there was no difference in total serum hemagglutinin to SRBC(Sheep Red Blood cell) between experimental and control group mice when these mice were immunized with SRBC. All these findings observed in Balb/c mice suggest that mercury perturbates well-orchestrated regulation of immune responses before developing histopathological changes in lymphoid tissues.; Summary

Relationship between Violent Criminal Behavior and Imbalance of Scalp Hair Minerals in Man.: Doo Hie Kim, Bon Ki Jang, Duk Hee Lee, Sung Chul Hong, Byung Hie Kim; Korean J Prev Med. 1994;27(1):25-43.

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Abstract PDF: To estimate the factors to the inclination of the criminal violence, the content of trace minerals and toxic metals in the scalp hair were measured during the period from May 1992 to october 1992. One hundred eleven violent and 89 nonviolent criminal inmates of Taegu correctional Institute were selected. The inmates of violent criminals were imprisoned by murder, robber, rape, injury and violent acts. Those of nonviolent criminals were swindle, larceny, and adultery and had no history of institutional violence. The contents of two toxic metals(cadmium, lead) and five trace minerals(Cu, Fe, Zn, Mg, Na) were determined by an atomic absorption spectrophotometer(lL. 551). The contents of cadmium and lead in hair of violent criminals were significantly higher as 0.56+/-0.14ppm, 11.53+/-3.32ppm, respectively, than 0.42+/-0.20ppm, 9.63+/-4.31ppm of nonviolent group (P<0.01). But the level of copper was significantly lower than nonviolent group (P<0.05). The factors that had a significant correlation with the inclination of violence in multiple logistic regression analysis were cadmium (odds ratio=98.09), unmarried (odds ratio=0.39), many times of criminal history (odds ratio=l.57) and residence of rural area (odds ratio=0.44). The results suggest that the sub-toxic contents of cadmium and lead in the hair may be of potential effect on behavior, and the mineral analysis may be an important adjunctive diagnostic procedure. Further studies into this problem are necessary.; Summary

Mercury Contents of Scalp Hair by Consumption Pattern of Fishes, Shellfishes and its Products.: Won Shik Lee, Doo Hie Kim; Korean J Prev Med. 1994;27(1):44-58.

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Abstract PDF: This study was conducted to examine the levels of total and organic mercury in the scalp hair of the elementary school children and adults, and their relalionship with the consumption pattern of fishes and shellfishes. The scalp hair samples were collected from the occipital part of 115 children and 131 adults in costal, urban and rural areas of kyungpook province from June to August 1991. The mercury content was analysed by the atomic absorption spectrophotometer (model IL. 555)with atomic vapor accessory (model IL. 440). The total and organic mercury contents of hair were significantly higher (P<0.01) among the children who prefer fish and/or shellfish (7.728ppm, 6.610ppm), and canned fish and/or fish pastes (6.969 ppm, 5.885ppm) than those who prefer meat(4.822ppm, 3.905ppm) and vegetables(3.974ppm, 3.224 ppm). The children who prefer to eat the canned fish without cooking showed a higher mercury content than the children who prefer to eat it as stew or mixed with vegetables (P<0.01l). There was a dose-response relationship between the intake frequency of canned fish, raw fish and cooked fish and the content of total and organic mercury of hair; the children who eat fish almost everyday showed 2 times higher than those who eat rarely (P<0.0l). The mercury content in the hair of the children who eat raw fish was significantly higher than that of the children who eat boiled or broiled fish (P<0.01). The total and organic mercury contents of adult scalp hair increased with age up to the forties and slightly decreased in the fifties. The mercury contents of those who were engaged in the fishery and raw fish restaurant were 2 times higher than those of the farmers. The mercury content of the persons who were favorite dishes of fish and shellfish were most high, and who prefer raw fish were 2 times higher than those of the persons who prefer vegetables and broiled fish. The contents of total and organic mercury in adult scalp hair showed also a increasing tendency with the intake frequency of raw and cooked fish.; Summary

A Study on Experiments the Environmental Conditions and the Adaptation of the Human Body in the Vinyl House.: Bu Ja Shim; Korean J Prev Med. 1994;27(1):59-73.

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Abstract PDF: The purpose of this study is to experiments the environmental conditions and the adaption of the human body in the vinyl house. The study was done in spring and winter and experimental clothes were used working clothes in the vinyl house. The results are as follows. 1. Environmental conditions; In the spring season, the indoor air temperature was 27.4+/-3.7 degrees C and the outdoor air temperature was 14.4+/-2.7 degrees C. In the winter season, the indoor air temperature was 18.3+/-4.8 degrees C and the outdoor air temperature was 7.6+/-2.5 degrees C on the average. 2. Skin Temperature; In the spring season, the mean skin temperatures indoor and outdoor were 33.81+/-0.7 degrees C and 31.57+/-0.8 degrees C respectively, a difference of 2.24 degrees C. In the winter season, they were 31.95+/-1.93 degrees C and 29.86+/-0.55 degrees C respectively, a difference of 2.09 degrees C. 3. Clothing climate; In the spring season, the temperature and humidity in the inner layer of clothing were 34.77+/-0.80 degrees C and 70.75+/-1.65% and indoor, 31.9+/-0.52 degrees C and 51.9+/-3.70% outdoor respectively. In the winter season, those were 32.52+/-1.04 degrees C and 64.65+/-3.68% indoor, 30.27+/-0.96 degrees C and 45.07+/-2.68% outdoor respectively. 4. Physiological Factors; Body temperature increased slightly and the pulse rate also rises, but blood pressure decreased a little with the rise of environmental temperature both in the spring and winter seasons. 5. Psychological Factors; Thermal sensation in the spring season was expressed as "slightly larm" or "warm" indoor and as "neutral" in the open air, while in the winter it was expressed as "neutral" or "slightly warm" outdoor the house and as "cold" in the open air. Comfort sensation was characterized as "uncomfortable" or "slightly uncomfortable" indoor both in the spring and winter seasons, but in the open air it was characterized as "comfortable" in the spring and as "slightly uncomfortable" in the winter.; Summary

Sleeping Patterns and Gastrointestinal Disorders According to the Shift Works in Female Textile Workers.: Ki Ha Yoo; Korean J Prev Med. 1994;27(1):74-83.

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Abstract PDF: To investigate the sleeping patterns and gastrointestinal disorders of shift workers, the auther studied 434 female workers who worked at textile industry ill Taejon city from september 1 ,1992 to september 31 ,1992. Shift pattern were divided into 3 categories; 3 shift (shifts per 8 hours), 2 shift (day and night shift) and day work. The results obtained were as follows: 1. The average sleeping hours when adjusted for the education level of the total study subjects was 6.1 hours. That of 3 shift workers was 6.1 hours, 2 shift workers was 6.0hours, but that of day workers was 6.5 hours. There were no significant difference among the shift workers. 2. For the 3 shift workers, the average physiologic adjusted duration in day shirt(2.2 days) was shorter than that or night shift(2.7 days) and there were significant difference among the rotating shift works (P<0.001). The sleeping problems in day shift was less than those of night shift (P<0.001). 3. 44.9% of 3 shift workers, 39.3% of 2 shift workers and 33.1% of day workers complained gastrointestinal symptoms when adjusted for the age, education level, job tenure, work post. And the rates of gastrointestinal symptoms complained increase with job tenures (P<0.001). 4. The most frequent gastrointestinal diseases were gastitis and gastric ulcer with 14.2 %, Irritable bowel syndrome with 3.1%, duodenitis and duodenal ulcer with 2.1% and combined gastrointestinal disease with 2.1%. Age, eating habit, amount of coffee per day, job tenure, work post and shift pattern showed no significant difference with the gastrointestinal diseases when adjusted for the age. According to the above results, the auther suggested that the shift pattern and job tenure can affect to the sleeping problem and gastrointestinal symptoms.; Summary

Effects of Hyperoxia on 8-Hydroxydeoxyguanosine Formation in Carbon Monoxide Exposed Rats.: Heon Kim, Soo Hun Cho, Myung Hee Chung; Korean J Prev Med. 1994;27(1):84-106.

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Abstract PDF: Hyperbaric oxygen(HBO) therapy for carbon monoxide(CO) poisoning eventually inducing the hypoxia-reoxygenation condition, may produce oxygen free radicals, which forms 8-hydroxydeoxyguanosine(8-OH-dG) by attacking C-8 position of deoxy-guanosine (dG) in DNA. Effects of oxygen partial pressure or duration of HBO therapy with or without CO poisoning on the tissue 8-OH-dG formation were investigated. Male Sprague-Dawley rats were grouped and exposed to air(control group), 4000ppm of CO for 10 to 30 minutes(CO only group), air for 30 minutes after 30 minute exposure to 4000ppm of CO(CO-air exposure group), HBO after 30 minute exposure to 4000ppm of CO(CO-HBO group), or HBO therapy for 10-120 minutes (HBO only group). The 8-OH-dG concentrations in the brain and the lung tissues were measured with high performance liquid chromatography and electrochemical detector (ECD). Average concentrations of the 8-OH-dG of each group were statistically compared. In the brain tissues, 8-OH-dG concentrations of the CO only group, the CO-air exposure group, and the CO-HBO group did not significantly differ from those of the control group. Similar insignificance was also found between the CO-HBO group and the HBO only groups. No appreciable dose-response relationship was observed between the 8-OH-dG concentration and the oxygen partial pressure or the duration of HBO. However, the 8-OH-dG concentrations of the 30 minute CO only group were higher than those of the CO-air exposure group (p-value<0.05). In the lung tissues, there were no significant differences between the 8-OH-dG concentrations of the control group and those of the CO only group, the CO-air exposure group, and the CO-HBO group. However, mean 8-OH-dG concentration of the CO-air exposure group was significantly higher than that of the CO only group under the same CO exposure condition(p-value<0.05). With the duration of CO exposure, the 8-OH-dG concentrations of the lung tissues decreased significantly (p-value<0.05). The concentrations of 8-OH-dG in the lung tissues proportionally increased with the duration of HBO, but no such relation was observed with the oxygen partial pressure. These results suggest that the brain may be more resistant to oxygen free radicals as compared with the lungs, and that oxygen toxicity following HBO may be affected by factors other than oxygen free radicals.; 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

Effects of Regional Medical Insurance on Utilization of Medical Care in Urban Population.: Seok Beom Kim, Pock Soo Kang; Korean J Prev Med. 1994;27(1):117-134.

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Abstract PDF: The effects of regional medical insurance on utilization of medical care in urban population was examined in this study. The data was collected in a 2-year follow-up household survey conducted at Taegu city before and after implementation of the regional medical insurance. The study population was divided into 2 groups. Cohort I was the uninsured in 1989 and cohort II was the insured in 1989. After the coverage of medical insurance, physician visit rate per 1,000 population, use-disability ratio and use-restricted activity ratio in cohort I were increased compared to cohort II in both of acute and chronically ill people. The use-disability ratio and use-restricted activity ratio of the insured poor were lower than those of the insured nonpoor in both of cohort I and cohort II. The major reasons for pharmacy use were accessibility and affordability before the coverage of medical insurance in cohort I, however, after the coverage of medical insurance, the important reason was accessibility rather than affordabifity. In logistic regression analysis of physician visit, the significant independent variables were acute illness episode(+), chronic illness episode(+) and income(+) in both of cohort I and cohort II. In cohort I, after the coverage of medical insurance, more people replied that the medical cost of hospital and clinic was reasonable. The people who covered by the regional medical insurance were more dissatisfied with the imposed premium than those who covered by other types of medical insurance in both of cohort I and cohort II. More people in cohort II than cohort I were dissatisfied with the services from hospitals and clinics after implementation of the regional medical insurance. In conclusion. after the coverage of medical insurance, the gap between the poor and the nonpoor still exists in terms of medical care utilization.; Summary

An Analysis of Determinants of Elderly Medical Costs Inflation Using Deterministic Model.: Seung Hum Yu, Myong Sei Sohn, Eun Cheol Park; Korean J Prev Med. 1994;27(1):135-144.

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Abstract PDF: The purpose of this study compares determinants of eldery medical cost inflation with those of other age groups by analysing aggregated data with a deterministic model. The deterministic model of per capita medical cost inflation consists of increases in price, intensity of services, and medical utilization. We used a time series data (1985-1991) from National Medical Insurance and analyzed by age groups. In total population, the average increase rates of inpatient and outpatient medical costs were respectively 9.5% and 8.8% during 6 years and the major cause of inflation was the increase in service intensity in both of inpatient and outpatient cases. But in the population of 65 years old and over, the average increase rates of inpatient and outpatient medical costs were respectively 13.8% and 14.8% and the major cause of inflation was the increase in per-capita medical utilization in both of inpatient and outpatient cases. Also, the increase in service intensity of 65 years old and over was the highest of other age groups. This pattern was similar during study periods. we concluded that the level of medical cost inflation and the determinants in elderly was the highest-especially in per capita medical utilization, therefore, the inflation of medical costs in elderly will be higher than other age groups for the further in Korea.; Summary

Knowledge and AttitudeA;of the Workers and the Health Personnel on the Health Management in Kyung-In Area.: Seong Sil Chang, Se Hoon Lee; Korean J Prev Med. 1994;27(1):145-158.

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Abstract PDF: This study was performed to investigate the knowledge and attitude of workers in small scale industries on health management, and to provide the basic data for more effective service by the group occupational health service system. The knowledge and attitude of 247 workers and 46 health personnel in the industries scattered around Incheon were investigated from December 1992 to February 1993. The results were summarized as follows; 1. There were significant differences between the workers and the health personnel by age, sex, marriage status, job-position and education level. 2. The recognition level of the workers to contract work related disease was significantly higher than that of health personnel, and recognition level of the workers on environmental hazards and on the utility of measuring hazards were lower than that of health personnel. 3. The recognition level on the content of the group occupational health service system was significantly different between workers and health personnel, 72.6% of the responses from the workers answered that they did not know what the group occupational health service system was, but 82.2% of the responses from the health personnel answered that they knew well what it was. And 79.0% of all respondents thought it was necessary for worker's health. 4. seventy three percent of the respondents from the workers indicated that they had never taken health education. However, 93.0% of all respondents answered positively for the need of health education to promote their health. 5. current health service system was judged to be insufficient for the demand of workers for better health. Most of the respondents prefered a formal but flexible health service system and they wanted the periodic health examination to be followed up. It was revealed that despite of poor knowledge, the demand of workers for health service was higher than the current supply. Therefore, this study suggests that educating both health personnel and workers to obtain correct knowledge on the hazards to work environment and health management is needed for effective occupational health service.; Summary

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