Journal of Preventive Medicine and Public Health

Volume 39(1); January 2006

English Abstracts

New Era for the Journal of Preventive Medicne and Public Health.: Byung Joo Park; J Prev Med Public Health. 2006;39(1):1-1.

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Abstract PDF: No abstract available.; Summary

Preventive Medicine in Times of a Rapid Epidemiologic Transition in Korea.: Jung Han Park; J Prev Med Public Health. 2006;39(1):2-6.

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Abstract PDF: Ever since the foundation of the Korean Society for Preventive Medicine in 1947, members of the Society had made a remarkable contribution to the public health development and national health promotion. They had played key roles in establishing national health system, improving environmental hygiene, controlling infectious and chronic diseases, promoting family planning, improving industrial and environmental health, and developing health service management. However, the Society had less actively responded to the changes in health service needs of the population that were caused by a rapid epidemiologic transition in last a few decades. Early detection and treatment of chronic diseases including cancer and cardiovascular diseases and risk reduction by the life style modification are major approaches to the contemporary national health problems and they are the core contents of preventive medicine. The author proposed to develop the clinical preventive medicine specialist who will have additional training in clinical medicine for health screening and life style modification to the current preventive medicine training program and thus will be able to provide comprehensive preventive medical services. Another area that the Society may take the initiative is training preventive medicine specialist in the disaster, including bioterrorism, preparedness and management. The Society should be more active in proposing health policy and health service program and also participate collectively in a large scale health research project of the government. These approaches may not only contribute more effectively to the national health promotion but also improve the identity of the Society.; Summary

Future of Preventive Medicine Education in Korea: Hopes and Challenges.: Kwang Ho Meng; J Prev Med Public Health. 2006;39(1):7-12.

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Abstract PDF: Throughout the century, based on the precedent set by Flexner in the United States, almost every subsequent report on the reform of medical education has pointed out the need for more prevention-oriented teaching in the curriculum. This has been particularly so in countries like Korea where the basic public health services have been so important for the improvement of health of the people. And, in fact, preventive medicine and public health have contributed a great deal to the prevention of communicable diseases and prolongation of life expectancy. Recently, however, along with the educational reform that emphasizing the interdisciplinary teaching, integration of basic science and clinical education, and centralization of responsibility for the medical education curriculum, concerns are being voiced by preventive medicine educators. These concerns are primarily centered around the fear that the implementation of interdisciplinary, centrally administered courses would result in a weakening of content and teaching expertise as well as a loss of departmental power and control. This paper foresees that preventive medicine and public health will be more important in Korea in the future and proposes that preventive medicine educators will have to step forward and turn the challenges of curricula restructuring into opportunities to expand the role of preventive medicine in the curricula of their institutions.; Summary

Does a Higher Coronary Artery Bypass Graft Surgery Volume Always have a Low In-hospital Mortality Rate in Korea?.: Kwang Soo Lee, Sang Il Lee; J Prev Med Public Health. 2006;39(1):13-20.

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Abstract PDF: OBJECTIVES
To propose a risk-adjustment model with using insurance claims data and to analyze whether or not the outcomes of non-emergent and isolated coronary artery bypass graft surgery (CABG) differed between the low- and high-volume hospitals for the patients who are at different levels of surgical risk. METHODS: This is a cross-sectional study that used the 2002 data of the national health insurance claims. The study data set included the patient level data as well as all the ICD-10 diagnosis and procedure codes that were recorded in the claims. The patient's biological, admission and comorbidity information were used in the risk-adjustment model. The risk factors were adjusted with the logistic regression model. The subjects were classified into five groups based on the predicted surgical risk: minimal (<0.5%), low (0.5% to 2%), moderate (2% to 5%), high (5% to 20%), and severe (=20%). The differences between the low- and high-volume hospitals were assessed in each of the five risk groups. RESULTS: The final risk-adjustment model consisted of ten risk factors and these factors were found to have statistically significant effects on patient mortality. The C-statistic (0.83) and Hosmer-Lemeshow test (x2=6.92, p=0.55) showed that the model's performance was good. A total of 30 low-volume hospitals (971patients) and 4 high-volume hospitals (1,087patients) were identified. Significantdifferences for the in-hospital mortality were found between the low- and high-volume hospitals for the high (21.6% vs. 7.2%, p=0.00) and severe (44.4% vs. 11.8%, p=0.00) risk patient groups. CONCLUSIONS: Good model performance showed that insurance claims data can be used for comparing hospital mortality after adjusting for the patients' risk. Negative correlation was existed between surgery volume and in-hospital mortality. However, only patients in high and severe risk groups had such a relationship.; Summary

Socioeconomic Costs of Alcohol Drinking in Korea.: Woo Jin Chung, Hyun Jun Chun, Sun Mi Lee; J Prev Med Public Health. 2006;39(1):21-29.

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Abstract PDF: OBJECTIVES
We wanted to estimate the annual socioeconomic costs of alcohol drinking in Korea. METHODS: The costs were classified as direct costs, indirect costs and the other costs. The direct costs consisted of direct medical costs, indirect medical costs and subsidiary medical costs. Particularly, the medical costs and population attributable fraction for disease were considered to reflect the calculation of the direct medical costs. The indirect costs were computed by the extent to which the loss of productivity and loss of the workforce might have occurred due to changes in mortality and morbidity according to alcohol drinking. The other costs consisted of property loss, administration costs and costs of alcoholic beverage. RESULTS: The annual costs, which seemed to be attributable to alcohol drinking, were estimated to be 149,352 hundred million won (2.86% of GDP). In case of the latter, the amount includes 9,091 hundred million won for direct costs (6.09%), 62,845 hundred million won for the reduction and loss of productivity (42.08%), 44,691 hundred million won for loss of the workforce (29.92%), and the other costs (21.91%). CONCLUSIONS: Our study confirms that compared with the cases of Japan (1.9% of GNP) and the other advanced countries (1.00-1.42% of GDP), alcohol drinking incurs substantial socioeconomic costs to the Korean society. Therefore, this study provides strong support for government interventions to control alcohol drinking in Korea.; Summary

A Multilevel Study on the Relationship between the Residential Distribution of High Class (Power Elites) and Smoking in Seoul.: Chang Seok Kim, Sung Cheol Yun, Hye Ryun Kim, Young Ho Khang; J Prev Med Public Health. 2006;39(1):30-38.

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Abstract PDF: OBJECTIVES
We examined whether the neighborhood socioeconomic position predicts the smoking rates after adjusting for individual socioeconomic position indicators. METHODS: Data were obtained from the 2001 Seoul Health Indicators Survey. The neighborhood socioeconomic position was the residential distribution of the high class (power elites), as measured by the location quotients (LQ) for each administrative dong (district). A high LQ denotes a high neighborhood socioeconomic status. The individual socioeconomic position included education, occupation and income. Age-adjusted smoking rates according to the LQ level were computed with the direct method. The total number of subjects in this study (26,022 men and 28,007 women) was the reference. A multilevel logistic regression analysis was conducted with the individuals at the first level and the neighborhoods at the second level to estimate the odds ratios of smoking with 95% confidence intervals. RESULTS: For men, the age-adjusted smoking rates increased with a decrease in the LQ. For women, the relationship between the age-adjusted smoking rate and the LQ was not clear. The odds of smoking for both genders were greater among those subjects with lower incomes and lower education. The manual occupational class had greater odds of smoking than the non-manual class for the males, while the odds ratio of smoking among females with a manual occupation tended to be lower than those females with a non-manual occupation. For the males, the LQ levels independently predicted smoking after adjustment for individual income. However, this relation between the LQ and smoking in males was explained by full adjustment for the individual socioeconomic position indicators (education, occupation and income). CONCLUSIONS: A low level of neighborhood socioeconom-ic position was associated with higher smoking rates among the men residing in Seoul. This association between the neighborhood socioeconomic position and smoking in men was explained by the individual socioeconomic position. Anti-smoking efforts to reduce geographical inequality in smoking should be directed at reducing the smoking rates between the individuals with different socioeconomic backgrounds in the metropolitan city of Seoul, South Korea.; Summary

Estimating the Burden of Psychiatric Disorder in Korea.: Jae Hyun Park, Seok Jun Yoon, Hee Young Lee, Hee Sook Cho, Jin Yong Lee, Sang Jun Eun, Jong Hyock Park, Yoon Kim, Yong Ik Kim, Young Soo Shin; J Prev Med Public Health. 2006;39(1):39-45.

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Abstract PDF: OBJECTIVES
This study estimated the burden of disease especially caused by psychiatric disorders in Korea by using DALY, a composite indicator that was recently developed by the Global Burden of Disease study group. METHODS: First, 11 of the major psychiatric disorders in Korea were selected based on the ICD-10. Second, the burden of disease due to premature death was estimated by using YLLs (years of life lost due to premature death). Third, for the calculation of the YLD (years lived with disability), the following parameters were estimated in the formula: the incidence rate, the prevalence rate and the disability weight of each psychiatric disorder. Last, we estimated the DALY of the psychiatric disorders by adding the YLLs and YLDs. RESULTS: The burden of psychiatric disorder per 100,000 people was attributed mainly to unipolar major depression (1,278 person-years), schizophrenia (638 person-years) and alcohol use disorder (287 person-years). For males, schizophrenia (596 person-years) and alcohol use disorder (491 person-years) caused the highest burden. For females, unipolar major depression (1,749 person-years) and schizophrenia (680 person-years) cause the highest burden. As analyzed by gender and age group, alcohol use disorder causes a higher burden than schizophrenia in men aged 40 years and older. For females, unipolar major depression causes the highest burden in all age groups. CONCLUSIONS: We found that each of the psychiatric disorders that cause the highest burden is different according to gender and age group. This study's results can provide a rational basis to plan a national health policy regarding the burden of disease caused by psychiatric disorders.; Summary

The Relationship between Regional Material Deprivation and the Standardized Mortality Ratio of the Community Residents Aged 15-64 in Korea.: Baek Geun Jeong, Kap Yeol Jung, Joon Youn Kim, Ok Ryun Moon, Yong Hwan Lee, Young Seoub Hong, Tae Ho Yoon; J Prev Med Public Health. 2006;39(1):46-52.

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Abstract PDF: OBJECTIVES
This study was performed to investigate the relationship between regional material deprivation and the standardized mortality ratios(SMRs) of community residents aged 15-64 in Korea. METHODS: SMRs were investigated using the registered death data from 1995 to 2000 that was obtained from the Korean National Statistics Office with the denominators being drawn from the 1995 to 2000 census. Material deprivation was measured using the Townsend score that was calculated from the 1995 to 2000 census. The relationship between the regional material deprivation and the SMRs of the community residents aged 15-64 was investigated by using ANOVA, Spearman's rank correlation analysis and Pearson's correlation analysis. The trends in mortality inequality were investigated using the concentration index. RESULTS: On the ANOVA, the SMRs of the men and women residents in the least deprived areas were the smallest and those in the most deprived areas were the largest. Spearman's rank correlation analysis, Pearson's correlation analysis and the concentration index revealed that significant positive relationships exist between the regional material deprivation and the SMRs of the community residents aged 15-64. CONCLUSIONS: This study suggests that there are mortality inequalities among the communities in Korea and part of this difference is due to the material deprivation of the community. Strategies aimed at reducing mortality inequalities among the communities will be needed to address economic inequalities. Further studies are needed to explore the mechanisms of how the regional deprivation influences on health and how the other factors of the community influence on the health of the community residents.; Summary

Human Multi-route Exposure Assessment of Lead and Cadmium for Korean Volunteers.: Eunha Oh, Eun Il Lee, Hosub Lim, Jae Yeon Jang; J Prev Med Public Health. 2006;39(1):53-58.

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Abstract PDF: OBJECTIVES
We wanted to evaluate the main route of exposure to lead and cadmium for the general population in Korea by using multi-route and multi-media exposure assessment METHODS: Samples of air at the homes, samples of the food and water and peripheral blood samples were collected from thirty volunteers living in Seoul (the metropolitan area), Yong-in (the suburban area) and Ansan (the industrial area) in 2001. Graphite furnace atomic absorption spectrometric methods were used for the determination of the Pb and Cd levels in the air, food, water and blood samples. RESULTS: The average intake of lead through the air, drinking water and food were 5.06 microgram/day (26.3%), 0.002 microgram/day (0.1%), and 16.4 microgram/day (73.6%), respectively. The average intake of cadmium through the air, drinking water and food were 0.082 microgram/day (0.9%), 0.001 microgram/day (0.007%), and 12.61 microgram/day (99.0%), respectively. The blood lead level was statistically higher in the male subjects than in the female subjects (3.39 and 2.22 microgram/dl, respectively), and only gender was a significant variable on the multiple regression analysis for blood lead. CONCLUSIONS: This study showed that the intake of lead and cadmium through food was the major route of exposure. A policy to reduce the pollutants according to the exposure routes should be established. However, more studies will be needed to support these data for the general population.; Summary

Health Behavior Factors Affecting Waist Circumference as an Indicator of Abdominal Obesity.: Kyung Won Paek, Yoon Mi Hong; J Prev Med Public Health. 2006;39(1):59-66.

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Abstract PDF: OBJECTIVES
This study was performed to identify the socioeconomic factors, the psychosocial factors and the heath behavior factors that have an influence on abdominal obesity, as measured by using the waist circumference. METHODS: Data was obtained from individuals aged above 20 years who had their waist circumference measured on the Korean National Health and Nutrition Examination Survey 2001, which was a cross-sectional health survey. RESULTS: Regression analysis of the factors that affect abdominal obesity showed that the education level, income, smoking, duration of smoking, drinking consumption, frequency of exercises and sleeping were the associated factors for abdominal obesity. For men, the duration of smoking, education level, income and drinking consumption were the associated factors for abdominal obesity. For woman, the education level, income, duration of smoking, drinking consumption and frequency of exercise were the associated factors for abdominal obesity. CONCLUSIONS: Abdominal obesity is a risk factor for morbidity and mortality, and it is associated with chronic diseases, including cardiovascular disease and diabetes. Based on the findings, it is essential to modify heath behaviors for preventing abdominal obesity, which is a condition associated with the incidence of chronic disease.; Summary

Related Factors for the Initiation of Smoking in High School Students Based on the Transtheoretical Model.: Jee Young Hong, Moo Sik Lee, Baeg Ju Na, Keon Yeop Kim; J Prev Med Public Health. 2006;39(1):67-73.

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Abstract PDF: OBJECTIVE
This study was conducted to investigate the relationship between the intention of smoking and its related factors in high school students. METHODS: Our study subjects were 1,203 high school students who resided in one city and in one county region. We conducted a self-administered questionnaire survey from June 7 to June 19, 2004. Both the decisional balance and temptation inventory showed high reliability estimates. We provided good fit for the 12-item decisional balance inventory and the 10-item temptation inventory by using a confirmatory factor analysis. We also used multiple logistic regression analysis to identify the major contributing factors for the intention to start smoking. RESULTS: On the univariate analysis, the subjects who were female, the 2nd and 3rd grade students,the students in vocational high school, the ex-drinkers or current drinkers, and ex-smokers were found to be significantly more distributed in the groups with intention to start smoking. Except for the concept of the cons, the group with intention to start smoking showed significantly higher standardized T scores for the 7 concepts of decisional balance and temptations. On the multiple logistic regression analysis, the females, the 2nd and 3rd grade students, the students in vocational high school, the experience of cigarette smoking and low T score of the cons were significantly related to the intention to start smoking. CONCLUSIONS: The intention to start smoking in high school students was affected by various factors such as gender, the school grade and the experience of smoking. Therefore, further research should be conducted for providing the essential data for developing a brief instrument for selecting the groups with intention of starting smoking among adolescents.; Summary

Factors Affecting Breastfeeding Rate and Duration.: Won Ju Hwang, Woo Jin Chung, Dae Ryong Kang, Moon Hee Suh; J Prev Med Public Health. 2006;39(1):74-80.

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Abstract PDF: OBJECTIVES
The purpose of this study is to examine the factors affecting the rate and duration of breastfeeding. METHODS: We analyzed the data from the year 2000 Korea National Fertility Survey that was collected through direct interviews. In particular, the mothers who delivered their last child and the child was under 1 year of age from January 1998 to June 2000 (N=1,066) were analyzed via a logistic model to assess the factors affecting the breastfeeding rate. Among the study subjects, those who had initiated breastfeeding (N=740) were analyzed through Cox's proportional hazard model to evaluate the factors affecting the duration of breastfeeding. RESULTS: The multivariate logistic model showed that the delivery type and the baby's birth-weight have a statistically significant influence on the breastfeeding rate. Women who delivered their babies through Cesarean section were less likely than others to breastfeed. In contrast, the women whose babies weighed 2.5Kg or more were more likely than others to breastfeed. The results obtained from the survival analysis are as follows: the higher the mother's education level, the shorter is the breastfeeding duration. The mother's work status played a significant role in the early termination of breastfeeding. Women aged 35 or older showed a longer breastfeeding duration than the younger age groups, whereas the maternal age was not a significant factor in affecting whether or not a mother would breastfeed. CONCLUSIONS: Reducing the cases of operative delivery (Cesarean section) and low weight births, enlightening young and highly educated women on breastfeeding and improving the environment for breastfeeding on the job are important strategies to encourage women to breastfeed.; Summary

Relationship between the Exposure to Ozone in Seoul and the Childhood Asthma-related Hospital Admissions according to the Socioeconomic Status.: Ji Young Son, Ho Kim, Jong Tae Lee, Sun Young Kim; J Prev Med Public Health. 2006;39(1):81-86.

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Abstract PDF: BACKGROUND
A number of studies have reported associations between the ambient air pollution concentrations and various health outcomes. Especially, ozone is well known for primary risk factor of asthma attacks. The results of a recent study indicate that the size of the effect on health outcomes due to air pollution varied according to several conditions, including age, gender, race and the socioeconomic status. Therefore, this study was conducted to examine the associations of ozone with the childhood asthma hospitalizations as stratified by the socioeconomic status (SES) at the community level in Seoul, Korea, 2002. METHODS: SES at aggregated levels was measured on the basis of average regional health-insurance rate per citizen in the area. We applied the generalized additive model to analyze the effect of ozone on asthma after controlling for the potential confounding variables that were capable of influencing the results. RESULTS: Our analysis showed that the number of children who were hospitalized for asthma increased as the SES of the residence area decreased. The estimated relative risks of hospitalization for asthma, as stratified by the SES of the community level, were 1.12 (95% confidence interval 1.00-1.25) in districts with the highest SES levels, 1.24 (95% CI=1.08-1.43) within the moderate SES levels, and 1.32 (95% CI=1.11-1.58) in the districts with the lowest SES levels. CONCLUSIONS: Our analysis showed that exposure to air pollution did not equally affect the health status of individuals. This suggests that not only the biological-sensitivity markers, but also the SES of the subjects should be considered as potentially confounding factors.; Summary

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