Journal of Preventive Medicine and Public Health

Volume 22(2); June 1989

Original Articles

An Analysis of the Factors Affection Anemia in the Female Industrial Workers.: Myeong Ho Park, Yong Joon Kim; Korean J Prev Med. 1989;22(2):181-188.

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Abstract PDF: In this study an attempt was made to determine the factors affecting anemia in female industrial workers. The population was identified through the records of screening examinations given by Kosin Medical Center to the industrial workers in Sasang Industrial Complex during the period from March 1987 to October 1988. One hundred twenty eight cases were selected from the records screening examination of 155 anemic patients. A case-control study was carried out using matched 128 anemic cases and 128 non-anemic workers who were selected by simple random sampling. Age was matched, and their occupational history, general characteristics, physical characteristics and health status were analyzed. The results were; 1. In the anemic group, educational level was lower, and the frequencies of irregular menstruation and poor appetite were higher than in the control group but these differences were statistically not significant. 2. The percentage of working with organic solvents, working hours and years of service (total years exposed to organic solvents) were significantly higher in the anemic group than those in the control group. 3. A career exposed to organic solvents was more influential factor affecting anemia in the female industrial workers rather than menstruation amount of other factors, and it was statistically significant.; 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

Manager's Attitude about Health Management of Workers in Coal Mine Industry.: Kyung Yong Rhee, Jeon Pyo Hong; Korean J Prev Med. 1989;22(2):197-207.

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Abstract PDF: This study was planned to investigate employer's attitude about health management of workers in coal mine industry. The sample size was 38.3%(178 coal mine industries) of total 463 coal mine industries. The mailing survey was used to collecting data of coal mine industry and manager of coal mine industry. Distribution of attitude about health management of workers in coal mine industry, specifically necessity and availability of some items of health management and some apparatus of working environment, was skewed to positive attitude. While recognition of susceptability of coal workers' pneumoconiosis was low, that of seriousness of incidence of coal workers' pneumoconiosis was high.; Summary

An Experimental Study on the Protective Effects of Ginseng Extract to Oxygen Toxicity.: Jae Young Park, Sang Il Lee, Dork Ro Yun; Korean J Prev Med. 1989;22(2):208-214.

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Abstract PDF: The protective effects of Panax Ginseng extract to oxygen toxicity of mice were studied under 5 ATA hyperbaric oxygen atmosphere. The findings observed are as follows: 1) Administration of Ginseng water extract manifested the prolonging survival time of mice to oxygen toxicity by hyperbaric oxygen atmosphere. After 18 hours of single Ginseng water extract administration and three days, seven days of consecutive Ginseng water extract administration showed the protective effect against oxygen toxicity. 2) Three days and seven days of consecutive Ginseng water extract administration showed the more efficient protective effect than single Ginseng Water extract administration. 3) Seven days of consecutive Ginseng water extract administration did not showed the more efficient protective effect than three days of consecutive Ginseng water extract administration.; Summary

Hair Heavy Metal Contents in Mentally Retarded Children II: In Association with Cadmium and Zinc.: Soon Woo Park, Jong Young Lee, Doohie Kim; Korean J Prev Med. 1989;22(2):215-222.

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Abstract PDF: The relationship between cadmium level and mental retardation was investigated. The 297 subjects with mental retardation were drawn from two schools providing special educational services, one, consisted of children living in an orphan home, another, children with parents. The 117 control subjects were drawn from whom had got average or above average academic achievement in a general elementary school. Hair sample was taken from the nape of the neck and the cadmium and zinc analysis were carried out on an atomic absorption spectrophotometer (IL 551). Children in the retarded group had significantly higher cadmium levels compared with control but not in zinc levels. There was no relationship between metal concentrations and age except control male group, which showed significant positive linear relationship in zinc, and there was no difference between sex in both metal except the male orphan group in cadmium. In the orphan group, there was relationship between severity of retardation and cadmium concentration in both sex but not in retarded children with parents. No difference in cadmium levels between the group with Down's syndrome, one of causes of mental retardation and the control group suggested the cadmium as a possible cause of mental retardation. In the case of accompanying autism, zinc level was significantly lower than that of other accompanying disease. Although not establishing an etiologic relationship, findings of this study suggest that there are some influences of cadmium on mental retardation, and call for a continuing study.; Summary

Study of the Amount and Share of Drug Cost in the Total Medical Fee under Medical Insurance Scheme.: Chu Won Lee, Oh Surk Hahn; Korean J Prev Med. 1989;22(2):223-235.

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Abstract PDF: To grasp the idea about how drugs are used under Medical Insurance Scheme, the amount and share of drug cost in the total medical fee have been reviewed and analyzed for different types of patients(in-patient out-patient), medical institutions and frequently seen diseases and following findings were revealed. In 1986, drug cost took 32.78% of total medical fee for in-patients and 32.98% for out-patients averaged over 30% share as a whole. When drug cost per case in 1980 be indexed to 100, it has shown steady growth to become 200 for in-patients and about 150 for out-patients in 1986. The contribution of drug cost to the total medical fee is, regardless of patient type-in-patients and out-patients, the highest in University hospitals and followed by General hospitals, Hospitals and Clinics in descending order. That for the most frequent 10 diseases came out the highest, 79% with the essential benign hypertension of out-patients in the General hospitals, 61% for the gastric ulcer of out-patients in Hospitals and 33% for the female genital disease of out-patient in Clinics. The drug cost of oral formula was contributed the most, 7.93% by cardiovascular agents followed by hepatic detoxicants(5.47%) and out-patients(4.93%), and that of injectable formula was contributed the most by antibiotics(24.17%), followed by protein amino-acid preparations(6.19%). The order of drug usage by specially for the in-patients was the highest with internal medicine followed by general surgery and E.N.T, and that for the out-patients was in the order of Internal medicine, neuropsychology and Ob/Gy. This study revealed that the drug dependency was characteristically different to specialty. In view of the fact that drug cost on average exceeds over 30% of total medical fee, proper drug administration appears to be vitally important for the financial standing of the Medical Insurance Scheme. As a consequence, drug usage guidelines including antibiotics usage shall be established first of all and the voluntary participation for the regulation of drug usage and propagation of the guidelines to medical institutions are strongly coerced.; Summary

An Evaluation of a Patient Referral System using Intervention Analysis.: Woo Hyun Cho, Hae Jong Lee, Myongsei Sohn, Chung Mo Nam, Seung Hum Yu; Korean J Prev Med. 1989;22(2):236-241.

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Abstract PDF: The purpose of this study was to introduce the methodology of intervention analysis with time series data and to investigate the influence of the patient referral system on medical care utilization in Kangwha county. The data were obtained at the Kangwha Medical Insurance Society and we analysed the material based on the outpatient care fee. The results were as follows: 1. The average outpatient care utilization in the hospital decreased by 41.7% due to the patient referral system. 2. The utilization of the health institution increased by 278.8 persons per month due to the patient referral system. 3. The patient referral system did not influence the total outpatient care utilization. The methodology of intervention analysis, which detected the effect of intervention, will be helpful to the study of public health area.; Summary

Comparison and Analysis of the Results of Preventive Medicine Sutdy in a Medical College.: Seung Hum Yu, Jaehoon Roh, Sang Hyuk Jung, Chung Mo Nam; Korean J Prev Med. 1989;22(2):242-247.

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Abstract PDF: The purpose of this study was to find a better evaluation method by comparison and analysis of the subdivision-score for preventive medicine with other subjects and total score. Among the 475 students who were second grade in 1983, 1984 and 1985, we analyzed the scores for all subjects at Yonsei University College of Medicine obtained by 443 students, with the exception of 32 students who had a temporary absence from school, failed or had been expelled. And we analyzed the score for preventive medicine of 162 students who were second grade in 1987 and 179 students who were second grade in 1988. Statistical analysis of the above was done using the correlation analysis, chi-square test and discriminating index. The results were as follows: 1. The correlations of the subdivision of preventive medicine in 1984, 1987 and 1988 were statistical significantly high(r=0.36-0.56). 2. The grades obtained for preventive medicine and for other subjects except pediatrics (clerkship) were not independent. 3. The discriminating indices that determined whether or not a pertinent evaluation was made were 0.42 in 1983, 0.52 in 1984 and 0.54 n 1985. These results were classified as excellent. These results suggest that the score of a subject is determined not by the characteristics of the subject, but by the amount of personal study.; Summary

Cost-benefit Analysis of Health Screening Test for the Insured.: Seung Hum Yu, Myongsei Sohn, Woo Hyung Cho, Eun Cheol Park, Young Doo Lee, Kyu Sik Lee, Ki Hong Chun; Korean J Prev Med. 1989;22(2):248-258.

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Abstract PDF: As a result of cost-benefit analysis by making a macroscopic approach to the health screening projects conducted 4 times since 1980 for the insured people of the Korea Medical Insurance Corporation, the following conclusions were reached. 1. The direct costs put into the health screening project, and the time costs which were paid by examines or calculated in terms of social costs have been estimated. The results is that the lowest estimation was 10,337 million won and the highest 15,141 million won when a minimum of 1.5 hours of time spent and a maximum 4 hours were applied. 2. In terms of the psychiatric benefits, the lowest estimation was 5,341 million won while the highest was 5,585 million won. 3. In terms of the benefits for each kind of diseases, the lowest estimation of 37,188 million won and highest estimation of 74,383 million won have been calculated for the liver diseases. And for the cardiovascular diseases, the minimum estimation was 14,475 million won while the maximum was 20,532 million won. In case of pulmonary tuberculosis, with external effect benefits being included, the estimation ranged from the minimum of 1,649 million won to the maximum of 1,832 million won. And the estimation of benefits for diabetes mellitus and renal diseases ranged from 89 million won to 92 million won and from 4,567 million won respectively. 4. In comparing costs and benefits, as a results of comparing each highest and lowest estimation, a range of minimum 46,708 million won and maximum 98,071 million won of benefits has been gained.; Summary

A Study of the Factors Causing Delayed Reimbursement of Medical Insurance Benefit.: Myongsei Sohn, Ki Hong Chun, Young Doo Lee; Korean J Prev Med. 1989;22(2):259-267.

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Abstract PDF: The objective of this study was to analyze the influence of the hospital and insurer in causing delayed reimbursement of medical insurance benefits. We analyzed major variables at three different sized hospitals to examine the effect of the hospital and insurer using the two-way ANOVA method. The results were as follows: 1. The time interval between claim by hospitals and payment of the benefit was statistically different according to hospital in both admission and outpatient care. 2. The time needed by the insurer for investigating the claimers was statistically different according to hospital and insurer in both admission and outpatient care. There was interaction between the hospital and insurer factors in outpatient care. 3. Although there was interaction between the hospital and insurer factors in admission care, the time interval between claim and payment was statistically different. In outpatient care, the payment interval between claim and payment was also statistically different according to the hospital and insurer.; Summary

The Bacteriological Survey of the Main Streams in Kyong-Ju City: on Samonellae.: Ik Han Che; Korean J Prev Med. 1989;22(2):268-275.

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Abstract PDF: The studies on the standard plate count, most probable number(MPN) and isolation of the Enterobacteriaceae, especially Salmonella species from stream waters of Kyong-Ju city were carried out from June to July, 1988. The relationship between water temperature, weather and standard plate count were observed. The locations where all of the MPN was higher than 1,600 were Mun-chon bridge, Wol-song bridge, Go-hun bridge and the area adjoining the Hyong-san river. The higher the water temperature, the more the viable counts without rain. Bacteriological survey of the Salmonella species was performed with the total 80 specimens isolated from 16 areas which are the main streams in Kyong-Ju city. The author identified 5 strains(2.36%) of Salmonella typhi, 5 strains(2.3%) of Salmonella paratyphi, 2 strains(1.42%) of Salmonella paratyphi B, 63 strains(29.72%) of other Salmonella groups by biochemical tests and serotyping tests with slide agglutination.; Summary

Impact of Changes in Maternal Age and Parity Distribution on Low Birth Weight Incidence Rate.: Young Ae Kim, Jung Han Park; Korean J Prev Med. 1989;22(2):276-282.

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Abstract PDF: The objective of this study was to examine the impact of changes in maternal age and parity distribution on birth weight. The study population included 7,786 single live births in 1987 delivered at 9 medical facilities in Pusan. Data were obtained from the delivery record. The proportion of infants born to the mothers of 25-29 years increased from 56.4% in 1977 to 65.1% in 1987 and the proportion to the mothers of 30-34 years increased from 18.8% in 1977 to 21.6% in 1987. In the same period, the proportions of 1st and 2nd birth order were increased from 56.9% and 28.8% to 59.9% and 36.8%, respectively. The proportion of infants born to the age group of < or = 24 and 35 < or = years were decreased in 1987. The proportion of births of the third or higher birth order was decreased from 14.2% in 1977 to 3.3% in 1987. Low birth weight (<2500gm) incidence rate was 5.3% in 1977 and it was decreased to 4.0% in 1987. It was estimated that changes in maternal age-parity distribution accounted for 10.7% of the decreased in low birth weight incidence rate. Rest of the change (89.3%) was attributed to the reduction of age-parity specific low birth weight incidence rate. Application of the direct adjustment method was considered to be an adequate tool for evaluating the impact of family planning on neonatal health.; Summary

Occurrence of Pediatric Diseases in Relation to the Environment, Seasons and Atmospheric Phenomena(weather).: Duk Jin Yun, Kyung Sook Park, Han Kee Hwang, Chi Ok Ahn, Do Kwang Yun, Yung Jo Kwon, Dong Chul Park, Yong Hwang Yun, Chung Mo Nam; Korean J Prev Med. 1989;22(2):283-289.

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Abstract PDF: This study was conducted to investigate the association of the occurrence of pediatric disease with environmental, seasonal and atmospheric factors. The data were collected at 5 pediatric clinics in Seoul and the Department of Pediatrics of Yongin Severance Hospital from May 1986 to April 1987. The results were as follows: 1. Vacation periods had a great influence upon the occurrence of pediatric diseases. 2. The majority of pediatric diseases occurred mainly in spring and autumn, not in summer and winter. 3. The higher the average relative humidity was, the less diseases occurred; and the higher the maximum change of daily temperature, the more diseases occurred. 4. In summer, the pattern of diseases varied along with the environmental factors(eg., toilet).; Summary

Epidemiologic Investigation for the Etiology of an Epidemic Ocurred among Animals and Humans in an Isolated Island, Korea (I).: J S Kim, Y Heo, H Y Yoon, W Y Lee; Korean J Prev Med. 1989;22(2):290-301.

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Abstract PDF: This is preliminary report on anthrax epidemic occurred in an island with about 100 residents. Since 1982 there had been sudden deaths among all kinds of domestic animals including cattle, dogs, ducks, chicken and goat but only a few among cats in an isolated island about three hours distance away by ferry boat from Mokpo city. From 1986 through 1988 nine human deaths and four patients occurred, which made the government intervene for investigation on June 25 1988. The epidemiological investigation consisted of interview survey and medical examination, medical record analysis, laboratory work to isolate the pathogens under the direction of hypothesis derived from the study and further confirmation of the pathogens by international institute. The summarized results are as followings: 1. According to the interview survey there were many deaths among domestic animals usually in cold and dry season such as January through March and September through November; 36 heads of cattle leaving one head, more than 40 hogs(all), hundreds of chicken leaving few alive, goats that had taken home from mountain and two or three cats out of around 40 had sudden deaths from 1982 till 1985, when the residents stopped to purchase and take them into the island anymore. Also there were eleven persons who had experienced the similar syndrome complex to those of admitted and expired patients and four of them revealed typical chest X-ray findings; from one to these four patients(Rho) B. anthracis is isolated. 2. Medical record on patients who had been admitted, showed common characteristics of the disease course. On admission they had either gastrointestinal or upper respiratory infection symptoms which invariably progressed to septicemic nature with pulmonary interstitial infiltration and mediastinal widening/bulging, and then to deadly acute respiratory distress syndrome. At the end stage chest X-ray revealed multiple bullous emphysema. One of another characteristics was oral ulceration with bleeding occurred in about 50% of the patients. Laboratory test results in common were leukocytosis with left shift and abnormal liver and kidney functions, particularly at the later stage of the illness. 3. Epidemiological characteristics was striking in that both mortality and incidence rates were high; the mortality rate was 8.7% average, male being three times higher than females but there was no distinctive clustering by age group. The incidence rate for both sexes was 28.2% and there was no sex difference although a tendency of higher incidence among older ages was noticed. The highest mortality and incidence were observed in Won village where the first death of animal occurred and with the highest frequency among three village of the island. 4. Among twelve bacilli species isolated from various specimens, two strains, one from patient and the other from soil where the recently died cow is buried, were confirmed as B. anthracis by Pasteur Institute and CDC of USA(strain from soil). CDC reported that the strain did not produce capsule in bicarbonate media but reacted with the bacteriophage and one of five sera taken from the patients. Mode of transmission as well as incubation period of the agent has not been established yet, which needs further investigation in relation to the antigenic structure of the variant when it is confirmed.; Summary

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