Journal of Preventive Medicine and Public Health

Volume 22(3); September 1989

Original Articles

The Change of Children's Blood Pressure and Factors Affecting the Level of Blood Pressure In Children.: Il Suh, Il Soon Kim, Chung Mo Nam, Soon Young Lee, Hee Chul Oh, Chun Bae Kim, Eun Cheol Park; Korean J Prev Med. 1989;22(3):303-312.

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Abstract PDF: To show the distribution and change of blood pressure according to age and find factors affecting the level of blood pressure in primary school children, a follow-up study was conducted from 1986 to 1989 on 401 first grade children attending primary school in Kangwha county in 1986 and their parents. The blood pressure of the children was significantly increased according to age. The average annual increase was 1.8mmHg in systolic blood pressure and 2.5mmHg in diastolic blood pressure. The level of blood pressure did not show any significant difference in both sexes. Among children who were at or above the 80th percentile of blood pressure in the first grade, 35 and 30% of them have remained at the same level of systolic and diastolic blood pressure respectively in the fourth grade. But we could not find any significance in the tracking of blood pressure of children who were at or above the 90th percentile of blood pressure in the first grade. Weight and pulse rate were shown to significant factors affecting systolic blood pressure in children of both sexes and mother's blood pressure and skinfolds thickness were also affected systolic blood pressure in girls. The variables significantly affecting diastolic blood pressure were arm circumference and pulse rate for boys and height and pulse rate for girls.; Summary

Human Health Factors and Traffic Accidents among Taxi Drivers in the Seoul Area.: Ihm Soon Kim, Kyung Jong Lee, Jaehoon Roh, Young Hahn Moon; Korean J Prev Med. 1989;22(3):313-322.

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Abstract PDF: The present status of the traffic accident rate in Korea shows that it is the highest in the world with a continuously increasing trend. Human factors account for 90% of the causes of traffic accidents. Therefore, the purpose of this study was to determine some human factors related to traffic accidents by studying the relationship between health status and traffic accidents. To accomplish this purpose, all taxi companies located in the Seoul area were divided in three groups according to the number of taxi possessed, then some companies in each group were randomly selected for study, and a total of 222 drivers in those selected companies were questioned and examined from April 15 to April 22, 1989. Seventy drivers among 222 had experienced a traffic accident. A chi-square test was performed on the data, then, factor analysis and discriminant analysis were executed with the following results: 1. The drivers complaining of gastroenteric symptoms numbered 110(49.5%), which was the major symptom among all drivers complaining of poor health. 2. In the primary analysis, variables related to traffic accidents were divided into general, occupational, and health characteristics. Drivers having no traffic accident experience and drivers having that experience were subjected to question about age, educational level, residential status, monthly average income, working hours and days, degree of satisfaction with their profession and homelife, degree of worry about health. degree of fatigue, medication, drunken driving, and illness, but there were no statistical significances. 3. In the factor analysis, the 8 health variables which causes traffic accidents were classified into 3 common factors which were perceived health factor, sleeping and drunken driving, and visual acuity and smoking factor. Perceived health was the factor which contributed most to explaining accidents. 4. In the discriminant analysis, a correct prediction rate of 68.0% was obtained in the factors of all the characteristics. 5. Degree of satisfaction with their homelife and educational and economic factor in the general characteristics, degree of satisfaction with their profession in the occupational characteristics, and sleeping and drunken driving in the health characteristics were selected as statistically significant factors to discriminant the traffic accident. 6. Among the factors of the general, occupational, and health characteristics, degree of satisfaction with their homelife, driving experience, family factor, perceived factor were selected as the statistically significant factors.; Summary

Gas diffusion effect on Nifedipine in coal workers pneumoconiosis by radio-opacity size.: Yong Hee Cheon; Korean J Prev Med. 1989;22(3):323-327.

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Abstract PDF: Carbon monoxide diffusing capacity(DLco) was evaluated before and after nifedipine administration in coal workers' pneumoconiosis by the size of radioopacity. Nifedipine was administered to 18 men and 17 men of small round opacity group and large opacity group respectively. Placebo was administered to 19 men and 15 men of small and large opacity group respectively. In large opacity group DLco was increased after nifedipine administration. But, it was not significant statistically(0.05 < p < 0.01). In other groups, there were no significance difference between and after medication.; Summary

Chest Radiological Changes after Cessation and Decrease of Exposure to Welding Fume in Shipyard Welders.: H S Sohn, J T Lee, H R Shin, C U Lee, K T Pae, H J Park, Y W Kim; Korean J Prev Med. 1989;22(3):328-336.

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Abstract PDF: 27 shipyard welders were diagnosed as pneumoconiosis and suspected pneumoconiosis(1976 - 1988) by chest radiographs and were observed over three years. 27 welders were divided into three groups by the state of exposure to welding fume i.e. cessation, decrease or continuity of exposure. And we observed the changing pattern of the chest radiographs of 27 welders with the passage of time. The results were as follows; 1. Group I (ceased exposure to welding fume) were 10 cases: suspected pneumoconiosis, 7 cases: pneumoconiosis). Chest radiographs of all cases were improved. The shape and size of small opacities was improved in 6 cases(85.7%) and did not changed in 1 case(14.3%) out of 7 pneumoconiosis welders. 2. Group II (decreased exposure to welding fume) were 5 cases(2 cases: suspected pneumoconiosis, 3 cases: pneumoconiosis). Chest radiographs were progressed in 2 cases(40%), did not changed in 1 case(20%), were improved in 2 cases(40%) out of 5 cases. The shaped and size of small opacities was progressed in 1 case(33.3%) and was improved in 2 cases(66.7%) out of 3 pneumoconiosis welders. 3. Group III (continued exposure to welding fume) were 12 cases(1 case: suspected pneumoconiosis, 11 cases: pneumoconiosis). Chest radiographs were progressed in 9 cases(75%), did not changed in 3 cases(25%) out of 12 cases. The shape and size opacities was progressed in 1 case(9.1%) and did not changed in 10 cases(90.9%) out of 11 pneumoconiosis welders. 4. The average duration for development into suspected pneumoconiosis was 6.6 years and for progression of each one category after that was 2.2 years(p<0.01). The radiological appearance of pneumoconiosis had disappeared or decreased after cessation of exposure to the welding fume. So that, early detection and control e.g., change of department of pneumoconiosis of welders by screening program will be important for medical surveillance of welders.; Summary

A Survey on the Changes in Industrial Noisy Environment and Hearing loss of Workers.: Yong Hwan Lee; Korean J Prev Med. 1989;22(3):337-354.

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Abstract PDF: In order to evaluate the noisy environment and hearing loss of workers served in noisy working environment, the author investigated 212 manufacturing industries located in Ulsan Industrial District that could be observed for 3 successive years from 1986 to 1988. The obtained results were as follows: 1. There was increased tendency in the number of workers served in noisy working environment and that of examined of hearing loss for three years. 2. In the noise level of working environment, the number of industries less than 89dB(A) was increased every year, while more than 90dB(A) was in decreasing tendency. 3. Mean hearing loss by frequency was the most prominent in 4,000Hz, the level of hearing loss was in increasing tendency yearly, and that of left eat was higher than right ear in almost all type of industry. 4. In 1986, the level of hearing loss by type of industry was highest in manufacture of electronic and electronic, and followed by paper and plywood, and metal products in right ear; that was in the order of manufacture of electric and electronic, metal products and textile products in left ear. In 1987, that was in the order of manufacture of metal products, machinery and others in right ear, and metal products, machinery and food stuff in left ear in 1988, manufacture of others, food stuff and machinery in both ear. 5. In hearing loss by service duration, right ear of 5-9 years group was higher than that of less than 5 years in 1987, whereas in 1988, the longer in service duration, the higher in the level of hearing loss in both ear. 6. In 1986, 1987 and 1988, the prevalence rate of noise-induced hearing loss were showed increasing tendency as 0.4%, 0.8% and 1.5%, respectively, and manufacture of textile products was highest(1.0%) in 1986, machinery(1.2%) in 1987 and others(2.8%) in 1988. 7. The proportion of grade E in early loss index were 76.1%(1986), 78.2%(1987) and 80.5%(1988) in left ear, 75.9%(1986), 76.4%(1987) and 75.9%(1988) in right ear.; Summary

A Study on the Physical and Mental Health Factors affecting Industrial Accidents.: Myung Sun Lee, Jaehoon Roh, Young Hahn Moon; Korean J Prev Med. 1989;22(3):355-367.

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Abstract PDF: This study examined the physical and mental health factors affecting the industrial accidents of 142 injured and 1,212 uninjured workers in the shipbuilding industry from 1986 to 1988. The results acquired from the Todai Health Index (THI) and from analysis of the health examination were as follows: 1. Among the personal characteristics of the workers, the educational level of injured workers was significantly lower than that of the uninjured workers. 2. Among the physical characteristics, vision and R hrer Index of the injured workers were lower than those of the uninjured workers, and the difference was statistically significant. On the other hand, the differences in height, weight, hearing function, hematocrit, blood pressure, urine test, and X-ray findings were not statistically significant between the injured and uninjured workers. 3. The score of the THI questionnaire on the physical and mental health of the injured workers was higher than that of the uninjured workers, and the difference was statistically significant. 4. Form the THI score, the industrial workers had complained more about mental health than physical health and there was a statistically significant relation with the industrial accidents. 5. The relative risk expressed in terms of the odds ratio was 2.9 for poorer vision, 2.7 for a lower educational level, 2.2 for a higher THI score and 1.6 for overdrinking. 6. Educational level, vision, and the THI score were selected as significant factors influencing industrial accidents based on a log-linear model. According to the results of this model by logistic analysis, the odds ratio of industrial accidents was 1.8 for a lower educational level, 1.7 for poorer vision, and 1.6 for a higher THI score. 7. By event history analysis with the dependent variable as the duration of work at the time of the industrial accident, educational level, age, R hrer Index and THI score were the statistically significant variables selected, and the hazard rate of industrial accident occurrence was 0.24 for a lower educational level, 0.92 for age, 0.99 for a lower R hrer Index and 2.72 for a higher THI score. As we have seen, educational level and THI score were the most significant factors affecting the hazard rate of industrial accidents. Vision, R hrer Index, age, and drinking behavior were also statistically significant variables influencing industrial accidents. Therefore, in order to prevent industrial accidents, it is necessary to establish a health management plan for industry which can objectively evaluate not only the physical but also the mental health of the workers. If we use this type of study as a prospective study design, we can determine the relative risk of physical and mental health factors on industrial accidents. Furthermore, it is expected that this type of study will provide workers at high risk with more precise basic data for a health management plan for industrial accident prevention.; Summary

Hair Heavy Metal Contents in Mentally Retarded Children III: In Association with Mercury.: Ki Hwan Han, Bong Ki Jang, Soon Woo Park, Doohie Kim; Korean J Prev Med. 1989;22(3):368-379.

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Abstract PDF: The relationship between mercury level of hair 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 regular elementary school. Hair sample were taken from the nape of the neck and the mercury analysis was carried out on an atomic absorption spectrophotometer(IL 551). There was no relationship between mercury contents and age, and there was a statistically significant difference in mercury contents between male and female in the mentally retarded children living with parents. Children in the retarded group had significantly higher mercury contents compared with control group except the female group with parents. Also, the mercury levels in the retarded group living in an orphan home were significantly higher than that of the retarded group with parents. The concomitant diseases were Down's syndrome, epilepsy, cerebral palsy and autism. There were statistically significant differences in hair mercury levels in the cases of accompanying Down's syndrome and cerebral palsy in male and Down's syndrome and autism in female compared with the control group of the same sex. The most accompanying handicap was speech disturbance(40.7%) and the others were crippled, emotional disturbance etc. The percentages of double handicap were 66.7% among 6 persons exceeding 6ppm of their hair mercury contents, 10.4% among 3~6 ppm and 15.7% among the group of 3ppm or less. The findings of this study suggest that the more opportunities of exposure to mercury in mentally retarded children may have occurred, so it can not be excluded the possibility of mercury as a contributing factor to mental retardation. Therefore, the causal relationship between mercury levels and mental retardation should be established through the examinations about their living environments, dietary pattern, eating habit etc.; Summary

Cost analysis of hypertension screening program.: Eun Cheol Park, Seung Hum Yu; Korean J Prev Med. 1989;22(3):380-388.

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Abstract PDF: To evaluate the costs the hypertension screening program of the Korea Medical Insurance Corporation, the records of the screening examinations were used. The sample size was 49,983 of the 906,554 people insured by the Corporation and was obtained by two-stage stratification random sampling. The alternatives for efficiency of the screening program, which were divided into three categories: modification of the screening test package, application of other hypertension diagnostic criteria, and selective approach of tested groups by age, were evaluated according to the cost per patient detected. The results of this study were as follows: In the hypertension screening system, the cost per patient detected was Won 30,833. The most nonsensitive test for hypertension detection was ophthalmoscopy, which was examine during the second stage of screening. If the ophthalmoscope examination was excluded, only one person was not detected, which was 0.2% of detected persons, and the cost per patient detected decreased to Won 28,098. The most efficient modification of the screening test package was measurement of blood pressure through the first and second stages of screening. The cost per patient detected by this modification was Won 24,408. The application of other diagnostic criteria, which were more restricted criteria, increased the cost per patient detected by 3.7%-6.7%. The cost per patient detected were Won 170,582 for persons less than 39 years old, Won 20,032 for persons 40 to 59 years old, and Won 8,675 for persons 60 years old and over. In conclusion, the best alternative suggested with respect to efficiency and practical application excluded the ophthalmoscope examination of second stage screening and restricted the target population to persons greater than 40 years old. The application of this alternative decreased 54.9% of the screening costs and the cost per patient detected was Won 15,222. This study was limited in that measurement of effectiveness was not of the ultimate goal of screening, which is decreasing morbidity and mortality, but was of disease detection as the short-term objective.; Summary

Child Rearing Practice of Working Mothers in a Poor Area of Pusan.: Yeon Ja Hwang, Jung Han Park; Korean J Prev Med. 1989;22(3):389-397.

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Abstract PDF: To identify the problems in child rearing practice of employed mothers in urban poor area, all of 201 women with children under 6 years old living in Yun San 3 Dong, a poor area of Pusan city, were interviewed with a questionnaire by a trained interviewer from 10th April to 10th May 1989. Among 201 women, 51 women were employed and 150 women were unemployed. Of the employed mothers 78.5% got their jobs because of economical need and 31.4% of them worker for 60-69 hours per week. Their average monthly income was 100,000-190,000 Won in 33.4% and 200,000-290,000 Won in 25.4%. Breast milk was fed in 66.0% of the children of unemployed mothers while 49.0 of the children of the employed mothers were breast-fed (p<0.05). The most common reason for not breast feeding was shortage of breast milk among unemployed mothers (58.9%) but that of the employed mothers was their job(63.6%). The basic immunization for children was completed in 70.5% of children of employed mothers as compared with 82.0% of the children of the unemployed mothers were completely immunized (p<0.1). Accident experience rate of children among the employed mothers was 23.5% and that of the children of the unemployed mothers was 17.3%. The most common cause of accident in children of the unemployed mothers was carelessness while they were playing(34.6%) but in children of the employed mothers it was traffic accident(25.0%) and falling(25.0%). Most of the traffic accidents took place while the children's brother or sister of age under 14 years were baby sitting. When the accident took place 73.1% of the unemployed mothers were just at home, but 58.3% of the employed mothers were out of home for work. In case of the employed mothers, 58.7% of their children were looked after by an adult mainly grandparents, 15,7% by the children's brothers and sisters under 14 years old, and 3.9% of the children were left alone. A majority of the unemployed mothers wanted to get a job if someone could take care of their children. To facilitate the women employment and for the safety and health of the children, good nurseries for working mothers need to be established at a cost they can afford.; Summary

Economic Benefits of Implementing National Health Insurance by Measurement of Changes in the Consumer's Surplus.: Han Joong Kim, Hae Jong Lee; Korean J Prev Med. 1989;22(3):398-405.

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Abstract PDF: A change in the consumer's surplus was measured in order to evaluate the social benefit to be derived from expanding health insurance to the entire population. The most refined and correct way to measure a project's net benefit to society is to determine a change in the consumer's surplus. Benefits from introducing the health insurance program to the uninsured people can be classified into two elements. The first is the pricing-down effect(E1) which results from applying the insurance price system, which is lower than the actual price, to the uninsured patients. The second effect(E2) is a decrease in actual payment because an insured patient pays only a portion of the total medical bill(copayment). We collected medical price information from the data banks of 93 hospitals, and obtained information of medical utilization by referring to the results of other research and from data published by the Korean Medical Insurance Societies. The total net benefit was estimated as won214 billion, comprising the first effect(E1) of won57 billion and the second effect(E2) of won157 billion. The price elasticity of physician visits is less than that of hospital admissions; however, benefits from the increase in physician visits are greater than those from hospital admissions because there are considerably more of physician visits than hospital admissions. The sensitivity analysis also shows the conclusion that expansion of the health insurance program to the entire population would result in a positive net benefit. Therefore, we conclude that the National Health Insurance Program is socially desirable.; Summary

A Study on Food Intake of a Rural Community Housewives with the Related Factors and Nutrition Education-Index.: Ji Yong Kang, Ja Hyung Wie, Jeong Sun Park, Eun Hee Ha, Jeong Ok Kwak; Korean J Prev Med. 1989;22(3):406-421.

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Abstract PDF: This study is aimed at developing a nutritional task of a community as public health activities of Su-Dong Myun, Demonstration Project area of Ewha Womans University. The content of this study is the points of nutritional diagnosis for the residents nutritional evaluation, the analysis of the related factors and the educational material with Nutrition Education-Index. Two hundreds housewives were examined during the period of Jan. 30 in 1989. 1. In terms of the housewives' age, those aged 30 to 39 were 32.5% which was the highest and educational level, graduation of primary school was 31.5% which was the highest. The housewives who had no job were 60.6% and those who participated in community activities were 56.5%. 2. In terms of the points of nutritional diagnosis, 50 to 74 points were 51.5% which was the highest and total average was 65.1 +/- 15.0. 3. As for the points of nutritional knowledge, the average was 54.9 points, attitude was 77.4 points and eating practice was 70.8 points. 4. The number of clinical symptoms of nutritional deficiency was 16.1 ones per person. 5. As for the relation which nutritional knowledge, attitude, eating practice exert on one another, nutritional knowledge had negative correlation with eating practice(-0.04) and attitude has some correlation with eating practice(0.17). 6. The variable having to do with the points of nutritional diagnosis showed the highest correlation coefficient(0.55) as the points of nutritional knowledge. 7. As for the variable having to do with the number of the symptoms of nutrition deficiency, the higher points of knowledge(-0.05) is, the higher the total average points of nutritional diagnosis(-0.09) is, negative correlation was appeared. 8. The result in which the variant having to do with the number of clinical symptoms of nutritional deficiency was analyzed by multiple regression analysis showed that the lack of time for preparing meals in non agricultural households made the greatest contribution (9% explained) and the households having vegetable garden made the second greatest contribution (3% explained).; Summary

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