Journal of Preventive Medicine and Public Health

Volume 23(3); September 1990

Original Articles

Comparison of Control Methods for Estimation Bias in Unmatched Analysis of Matched Data.: Keun Young Yoo; Korean J Prev Med. 1990;23(3):247-254.

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Abstract PDF: No abstract available.; Summary

Blood Lead Concentration of Taxi Drivers in Taegu, Korea.: Kun Sakong, Pock Soo Kang, Jong Hak Chung; Korean J Prev Med. 1990;23(3):255-261.

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Abstract PDF: Taxi drivers are exposed to vehicular exhaust aerosols which are a major source of atmospheric lead pollution in Korea where lead additives are incorporated in petrol. To investigate the blood lead concentration, their correlation factors and influences on taxi drivers, samples were collected from 90 taxi drivers who were living in the Taegu City, during August, 1989. Blood lead concentration was estimated by the atomic absoption spectrophotometer (IL.551) equipped with flameless furnace atomizer (IL.665). The results were analyzed statistically and compared with control group were 26.34 +/- 6.53 microgram/dl and 20.77 +/- 4.80 microgram/dl respectively (p<0.01). No significant correlation was observed between the blood lead concentration of taxi drivers and driver career (r=0.093). There were no difference of statistical significance in the blood lead concentration of smokers and nonsmokers.; Summary

A Study on the Early Diagnosis of Pneumoconiosis.: Young Lim, Im Goung Yun; Korean J Prev Med. 1990;23(3):262-273.

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Abstract PDF: In order to assess the method which is more sensitive one to detect the early change of lung tissue by the inhaled dust, we have performed the various medical examinations such as chest radiography, pulmonary function test, high resolution chest CT, bronchoalveolar lavage and lung biopsy used bronchoscope and ultrathin bronchoscopy examination to 48 persons. The control group were 8 persons who did not exposed to dust, 40 cases of the experimental group have professionally exposed to the mineral dust. The results were as follows ; 1. The total number of cells in bronchoalveolar lavage was significantly increased in all of the pneumoconiosis group classified by chest and high resolution chest CT. 2. The composition rate of macrophage to the total number of cells in bronchoalveolar lavage fluid was significantly decreased in all of the pneumoconiosis group compared with the control group. 3. The composition rate of neutophils and lymphocytes to the total number of cells in bronchoalveolar lavage fluid was significantly increased in all of the pneumoconiosis group compared with the control group. 4. The forced expiratory volume in one second (FEV1.0), maximal mid-expiratory flow (MMF), and maximal voluntary ventilation (MVV) were significantly increased only in the group of the progressed pneumoconiosis relatively. 5. We observed submocosal edema, anthracotic pigmentation and granuloma formation in transbronchial lung biopsy of the suspected pneumoconiosis (category 0/1) case which is thought to the early change of coal workers' pneumoconiosis.; Summary

A study on the status of working environment control and health management of workers in a manufacturing industries.: Jung O Ham, Kyu Yoon Hwang, Kyu Dong Ahn, Byung Kook Lee, Tack Sung Nam; Korean J Prev Med. 1990;23(3):275-284.

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Abstract PDF: To obtain the useful information for the status of working environment and health management of workers in manufacturing industries, comparision of results on the status of working environmental and health management of workers for 32 manufacturing industries in Chunam area from 1988 to 1989 was carried out. The results were as follows: 1. The rate of over-PEL(Permissible Exposure Limit) to for hazardous factors decreased significantly 23.5% in 1988, 18.3% in 1989 (p<0.05) and, the highest rate of over-PEL was the stone and sand handling industry, the highest rate of over-PEL was the dusty worplace as 38.5% in 1988, 35.2% in 1989. 2. The rate of workers exposed to hazardous factors in 1988 and in 1989 was 22.4% respectively, the rate of workers checked up special health examination was 40.1% in 1988, 75.3% in 1989. In stone and sand handling an dmedicochemical industries, none of workers exposed to hazardous factors was subjected to special health examination in 1988, but 75% of workers exposed to hazardous factors had checked up in 1989. 3. The 6 industries appointed as part-time factory physician among 17 industries which were supposed to have factory physician according to the Safety and Healthy Act of Korea, 6 out of 24 industries only appointed industrial hygienist, furthermore 4 out of 6 hygienists had another duty in addition to occupational hygiene itself.; Summary

A Study on the Regional Self-sufficiency for In-patient Care Services.: Dal Sun Han, Soon Ho Kwon; Korean J Prev Med. 1990;23(3):285-295.

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Abstract PDF: The utilization of medical care services has been partly regionalized with the implementation of referral requirement by the government since July 1, 1989 when the health insurance coverage was extended to all the people. For the purpose of regionalization, the whole country has been primarily divided into tertiary care regions, and each of them again into secondary care regions. This study investigates the self-sufficiency for in-patient care services of secondary care regions focusing on why it varies among the regions. In doing so, analysis is performed to examine a model which embodies three sets of hypotheses as follows: 1) The regional self-sufficiency for medical care services would be subject to direct influences of regional characteristics, amount of available services and structural properties of regional medical care system ; 2) The regional characteristics would have indirect effects on the self-sufficiency which are mediated by medical care services ; and 3) The amount of available services would indirectly affect the self-sufficiency by influencing the structure of regional medical care system. The results of analysis were generally consistent with the model. The findings have some practical implications. The regional self-sufficiency for medical care services partly depends upon basic properties of each region which cannot be changed in a short period of time. Thus the self-sufficiency for medical care services can be improved by health policy measure. In some of the regions the self-sufficiency for in-patient care services was much higher or lower than can be predicted from the bed-population ratio. Indication is that the allocation of health resources should be made considering a variety of factors bearing upon the supply of and demand for health care ; not on the basis of just a single criterion like the availability. The self-sufficiency of a certain region is related to not only its own characteristics but also the characteristics of neighboring regions. Therefore, attention should be also directed to the inter-regional relationships in health care when the needs for investment of health resources in a region are assessed. However, it should be noted that this study used the data collected before the referral requirement was imposed. A replication of this analysis using recent data would provide an evaluation of the impact on the self-sufficiency of the referral requirement as well as a confirmation of the findings of this study.; Summary

Relationship of Hair Copper and Mercury Contents to Personality in Chronic Schizophrenia.: Doohie Kim, Young Woo Kang, Soon Woo Park, Kuen Hoo Lee, Young Sook Lee; Korean J Prev Med. 1990;23(3):296-308.

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Abstract PDF: The relationship between copper and mercury contents in the scalp hair and chronic schizaphrenia was investigated. The samples of scalp hair were collected from 80 male chronic schizophrenic patients at the age from 20 to 20, who were hospitalized in the National Psychiatric Hospital in Seoul. As the napes and the Minnesota Multiple Personality Inventory (MMPI) was performed also. The copper and mercury contents were determined by an atomic absorption spectrophotometer. Significantly higher T-score of MMPI was seen in patients group for Hypochondriasis Scale (Hs), Depression Scale (D), Psychopathic Deviate Scale (Pd), Paranoia Scale (Pa), Psychasthenia Scale (Pt), Schizophrenia Scale (Sc) subscales than control group, and the frequency distribution by T-score was also significantly different between the patient and the control group for above scales. The content of copper in the hair of patient group was significantly higher than control group. In the case of mercury, the mean value of patient group was significantly higher than control group. Between the value of copper and mercury, statistically significant negative correlation (r=-0.25) was found. When grouped by the T-score of MMPI, there was no difference of copper contents between T-score subgroup at all MMPI scale. But the mercury contents showed significant difference between T-score subgroup at Pt, Sc scale. When compared between the group of above 70 T-score and the group of less than 70, the mercury contents of Pa, Pt, Sc scale of above 70 T-score group were significantly higher than the group of less than 70. In other scales, the mercury content of the above 70 group were higher than the group of less than 70 except Mf scale, although there were no statistically significances. In D, Pa, Sc scales, as the T-score of MMPI increased, the contents of mercury also increased. When divided into the patient group and the control group, the copper contents of the patient groups were significantly lower than the control group at each T-score scale in most MMPI scales. In the case of mercury, the value of patient group were significantly lower than the control group in the less than 44 scale of D, in the 60~69 scale of Pd, in the 45~59 scale of Mf, in the 60~69 scale of Ma, in the less than 44 of Si. These results suggest that the effects of the deficiency of copper or high intake of mercury on schizophrenia and personality may be of possible value. Thus further studies are necessary to determine whether schizophrenia and personality formation would be attributed to copper deficiency or mercury intake.; Summary

Effect of Zinc Administration on the Autistic Children.: Kyeong Dong Chung, Doohie Kim; Korean J Prev Med. 1990;23(3):309-315.

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Abstract PDF: The purpose of this study was to evaluate the effect of zinc administration on the autistic children. the subject diagnosed as infantile autism were 24 male and 10 female children of a special school in Taegu city. Control group were selected from 1 : 2 ratio matched with cases on sex and age. The results were as follows. In female autistic group, the mean content of zinc in hair was significantly lower than control group, but in male the result was inverse at all age group. The content of zinc in hair showed significant correlation with age in male autistic group and control group. Zinc content of hair, age and sex accounted for 37.2% of the variance of autistic score and the most significant variable was zinc content. Autistic group were divided into two group. Group I which zinc content of hair below 150 ppm were administrated with multi-vitamin contained 10mg of zinc, Group II which zinc content of hair above 150 ppm were administrated with placebo. Total administration period was eight weeks. In zinc administration group, there was a decreasing tendency of autistic score as the zinc content of hair was increased but the relationship was not statistically significant.; Summary

Determinants Influencing the Utilization of the Rural Health Sub-centers.: Jong Doo Kang; Korean J Prev Med. 1990;23(3):316-323.

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Abstract PDF: To analyze of determinants infuencing the utilization of the rural health sub-centers (HSCs), 116 of 144 HSCs in Kyoung Gi Do, were selected for this study. The self-administered questionnaire covering the environment and the characteristics of doctors working in the HSCs was sent to HSCs by mail. 105 questionnaires were returned of which 88 were completed and use in the study. The dependant variable was the total number of medical care visits to the HSCs from January 1, 1990 to March 31, 1990. Data was analyzed by multiple regression analysis. The results were as follows: First, the more time required to set from the HSCs to nearest hospital or clinic, the higher the utilization of the HSCs. Second, the more geographically accessible the HSCs was, the more utilization the HSCs. Third, the older of the HSCs doctors were, the more utilization of the HSCs. Fourth, the higher frequency of bus service from the HSCs to town, the more utilization of the HSCs. Fifth, the more time required from the HSCs to town, the more utilization of the HSCs. Therefore, the determinants influencing the utilization of the rural HSCs in Kyong-Gi Do, are mostly geographical accessibility of medical care.; Summary

Cohort Observafion of Blood Lead Concentration of Storage Battery Workers.: Chang Yoon Kim, Jung Man Kim, Gu Wung Han, Jung Han Park; Korean J Prev Med. 1990;23(3):324-337.

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Abstract PDF: To assess the effectiveness of the interventions in working environment and personal hygiene for the occupational exposure to the lead, 156 workers (116 exposed subjects and 40 controls) of a newly established battery factory were examined for their blood lead concentration (Pb-B) in every 3 months up to 18 months. Air lean concentration (Pb-A) of the workplaces was also checked for 3 times in 6 months interval from August 1987. Environmental intervention included the local exhaust ventilation and vacuum cleaning of the floor. Intervention of the personal hygiene included the daily change of clothes, compulsory shower after work and hand washing before meal, prohibition of cigarette smoking and food consumption at the work site and wearing mask. Mean Pb-B of the controls was 21.97 +/- 33.6 microgram/dl at the preemployment examination and slightly increased to 22.75 +/- 3.38 microgram/dl after 6 months. Mean Pb-B of the workers who were employed before the factory was in operation (Group A) was 20.49 +/- 3.84 microgram/dl on employment and it was increased to 23.90 +/- 5.30 microgram/dl after 3 months <(P<0.01). Pb-B was increased to 28.84 +/- 5.76 microgram/dl 6 months after the employment which was 1 month after the initiation of intervention program. It did not increase thereafter and ranged between 26.83 microgram/dl and 28.28 microgram/dl in the subsequent 4 tests. Mean Pb-B of the workers who were employed after the factory had been operation but before the intervention program was initiated (Group B) was 16.58 +/- 4.53 microgram/dl before the exposure and it was increased to 28.82 +/- 5.66 microgram/dl (P<0.01) in 3 months later (1 month after the intervention). The values of subsequent 4 tests remained between 26.46 and 28.54 microgram/dl. Mean Pb-B of the workers who were employed after intervention program had been started (Group C) was 19.45 +/- 3.44 microgram/dl at the preemployment examination and gradually increased to 22.70 +/- 4.55 microgram/dl after 3 months (P<0.01), 23.68 +/- 4.18 microgram/dl after 6 months, and 24.42 +/- 3.60 microgram/dl after 9 months. Work stations were classified into 4 parts according to Pb-A. The Pb-A of part I, the highest areas, were 0.365 mg/m3, and after intervention the levels were decreased to 0.216 mg/m3 and 0.208 mg/m3 in follow-up tests. The Pb-A of part II was decreased from 0.232 mg/m3 to 0.148 mg/m3, and 0.120 mg/m3 after the invention. Pb-A of part III and IV was tested only after intervention and the Pb-A of part III were 0.124 mg/m3 in January 1988 and 0.081 mg/m3 in August 1988. The Pb-A of part IV, not stationed at one place but moving around, was 0.110 mg/m3 in August 1988. There was no consistent relationship between Pb-B and Pb-A. Pb-B of the group A and B workers in the part of the highest Pb-A were lower than those of the workers in the parts of lower Pb-A. Pb-B of the workers in the part of the lowest Pb-A increased more rapidly. Pb-B of group C workers was the highest in part I and the lowest in part IV. These findings suggest that Pb-B is more valid method than Pb-A for monitoring the health of lead workers and intervention in personal hygiene is more effective than environmental intervention.; Summary

Health characteristics and symptom of workers in reactive dye industries.: Kyung Jong Lee, Young Hahn Moon, Jaehoon Roh, Hae Sim Park, Chein Soo Hong; Korean J Prev Med. 1990;23(3):338-344.

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Abstract PDF: This study investigated the symptoms, medical and occupational history of 424 workers of 5 reactive dye Industries in the Inchon area in Korea. The study was performed on March 6 and July 19, 1989. The tests applied to the subjects were: serum total IgE, skin prick test with 7 inhalatory antigens, pulmonary function test, chest X-ray, methacholine test, and bronchoprovocation test. The workers were classified according to these tests into 4 groups (healthy, realitively healthy, need careful medical observation, and occupational asthma), and were compared in terms of the group characteristics and the symptom prevalence. The prevalence of occupational asthma of workers in reactive dye was 5.9%. Significant differences were observed among the 4 groups. The groups were significantly different in the variables of sex and duration of smoking among their general characteristics ; asthma, bronchitis, and other respiratory diseases with respect to their past medical history. This study suggests that we should pay special attention to the workers exposed to the risk of occupational asthma.; Summary

The study for recent changes of disease-mix in health insurance data.: Seung Hum Yu, Sang Hyuk Jung; Korean J Prev Med. 1990;23(3):345-357.

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Abstract PDF: Accumulated data on medical care utilization among the insured in Korea Medical Insurance Corporation can explain the health status of the population. The purpose of this study was to analyze a change of the disease-mix and utilization pattern by controlling the size of the population enrollment. Major findings of the study are as follows: 1. The changes of inpatient disease-mix a. Utilization rate was 139.2% in 1988 against 1980. b. Disease groups higher than the average utilization rate included neoplasms, endocrine, nutritional and metabolic diseases and immunity disorders, mental disorders etc. Meanwhile, disease groups seen less often were infections and parasistic diseases, diseases of bloodforming, diseases of the digestive system etc. c. Utilization rate was up 106.3% in 1988 compared to 1985, and diseases above that average level were ill-defined intestinal infections, chronic liver disease and cirrhosis, diabetes mellitus, essential hypertension, etc. d. The disease-mix by institution in 1988 compared to 1985 shows that chronic disorders rank high in general hospitals whereas opthalmologic, obstetric, and orthopedic diseases rank high in private clinics. 2. The changes of outpatient disease-mix a. Utilization rate was up 175.2% in 1988 compared to 1980. b. Disease groups higher than the average utilization rate included neoplasms, endocrine, nutritional and metabolic diseases and immunity disorders, mental disorders etc. And disease groups seen less often were infections and parasistic diseases, diseases of the respiratory system, diseases of the genitourinary system. etc. c. Utilization rate was up 104.0% in 1988 compared to 1985, and diseases above that average level were gastric ulcer, diseases of hard tissues of teeth, etc. And diseases seen below that average level were acute nasopharyngitis (common cold), acute upper respiratory infections of multiple or unspecified sites, etc. It was concluded that medical care utilization level was increased, and that, from 1980 to 1988, disease-mix shifted to the chronic disorders. Chronic disorders accounted for more medical care utilization in general hospitals.; Summary

Sister Chromatid Exchanges in Lymphocytes of Some Workers Exposed to Hexavalent Chromium.: Dong Hoon Shin, Nung Ki Yoon, Suk Kwan Suh, Min Hae Yeh; Korean J Prev Med. 1990;23(3):358-368.

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Abstract PDF: To investigate the possibility of utilizing of sister chromatid exchange(SCE) analysis in lymphocytes as an indicator which could evaluate the effects of mutagenicity after in vivo exposure to hexavalent chromium, this study was conducted using some of chromium plating workers occupationally exposed to hexavalent chromium, chromium trioxide (CrO3) in Taegu city. The study population was 12 Cr platers with perforation of nasal septum, 12 Cr platers without perforation of nasal septum and 20 controls. The SCE in peripheral blood lymphocytes of the subjects was analyzed and blood chromium concentration was estimated using the atomic absorption spectrophotometer (IL 551) equipped with furnace atomizer (IL 755). The mean SCE frequencies for Cr platers with and without perforation of nasal septum were statistically higher than those for control. The difference in SCE frequencies by age, smoking habits were not statistically significant both in Cr platers and controls. There was no difference in SCE frequencies by career of Cr platers workers. In Cr platers, the correlation between the mean SCE frequencies and chromium concentration in blood was not statistically significant. Using the transformation y=(sum SCE)1/2+(sum SCE+1)1/2, when the data was studied by multiple regression, it appeared that the influence of the occupation was the most important. Age, smoking, occupation and CrB(blood chromium concentration) together explain only 32.3% of interpersonal variation on SCE. The results in this study suggest that a genetic risk due to occupationally exposure to hexavalent chromium is clearly inferable and thus, SCE analysis in human lymphocytes may be used indicator of biological toxic effects of chromium. Further, populatio analysis studies are required before SCE frequency can be used as a mutagenic indicator in human population.; Summary

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