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JPMPH : Journal of Preventive Medicine and Public Health

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Volume 24(4); December 1991
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Original Articles
Seroprevalence of antibody to the hepatitis C virus in methamphetamine abusers.
Jin Kyoo Kim, Ji Ho Lee, Byung Mann Cho, Soo Il Lee
Korean J Prev Med. 1991;24(4):465-472.
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AbstractAbstract PDF
This study was designed to estimate the prevalence of hepatitis C virus(HCV) infection in drug abusers. The subjects were 141 inpatients who had been admitted to a general hospital with the symptoms and signs of methamphetamine intoxication. Seroprevalence of antibody to the hepatitis C virus(anti-HCV) was 60.3%,(85/141) and it was higher in the group with increased frequency and duration of drug abuse, but such a relationship was not found in the seroprevalence of hepatitis B surface antigen(HBsAg). These findings suggested the possibility of high prevalence of HCV infection in methamphetamine abusers, and the importance of repetitive percutaneous injection in the transmission of HCV infection.
Summary
Economic analysis of order communication system for hospitals.
Young Moon Chae, Hae Jong Lee, Chang Rae Park
Korean J Prev Med. 1991;24(4):473-484.
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  • 24 Download
AbstractAbstract PDF
Hospitals have been very susceptable to changes in external environment. Accordingly, they have been experiencing great financial difficulty due to low insurance rates and increasing competition. As a remedy, hospitals have attempted to use computer in a strategic manner. Such system is called strategic information system (SIS) , and order communication system (OCS) is an example of SIS in hospital setting. While OCS has known to be effective in reducing waiting time for outpatients, many hospitals are reluctant to introduce this system mainly because there are no real data or methods for justifying the cost of the system. Cost-benefit analysis has been traditionally used for such purpose, but this method deals with limited portion of benefits and therefore not very useful for analyzing the economic feasibility of SIS. In this paper, information economics tools which expand cost with value was used to analyze the economic feasibility of OCS. To assist the analysis, financial simulation model was developed using simulation package, called IFPS (Interactive Financial Planning System).
Summary
An Evaluative Analysis of the Referral System for Insurance Patients.
Dalsun Han, Byungyik Kim, Youngjo Lee, Sangsoo Bae, Soonho Kwon
Korean J Prev Med. 1991;24(4):485-495.
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AbstractAbstract PDF
This study examined the effects of referral requirements for insurance patients which have been enforced since July 1, 1989 when medical insurance coverage was extended to the whole population except beneficiaries of medical assistance program. The requirements are mainly aimed at discourag - ing the use of to Vii; ry care hospitals by imposing restrictions on the patient's choice of a medical service facility. The expectation is that such change in the pattern of medical care utilization would produce several desirable effects including increased efficiency in patient care and balanced development of various types of medical service facilities. In this study, these effects were assessed by the change in the number of out-patient visits and bed-days per illness episode and the share of each type of facility in the volume of services and the amount of expenditures after the implementation of the new referral system. The data for analysis were obtained from the claims to the insurance for government and school employees. The sample was drawn from the claims for the patients treated during the first six months of 1989, prior to the enforcement of referral requirements, and those of the patients treated during the first six months of 1990, after the enforcement. The 1989 sample included 299,824 claims (3.6% of total) and the 1990 sample included 332,131(3.7% of total). The data were processed to make the unit of analysis an illness episode instead of an insurance claim. The facilities and types of care utilized for a given illness episode are defined to make up the pathway of medical care uti lization. This pathway was conceived of as a Markov Chain process for further analysis. The conclusion emerged from the analysis is that the enforcement of referral requirements resulted in less use of tertiary care hospitals, and thereby decreased the volume of services and the amount of insurance expenses per illness episode. However, there are a few points that have to be taken into account in relation to the conclusion. The new referral system is likely to increase the use of medical services not covered by insurance, so that its impact on national health expenditures would be different from. that on insurance expenditures. The extension of insurance coverage must have inereased patient load for all types of medical service organizations, and this increase may be partly responsible for producing the effects attributed to the new referral system. For example, excessive patient load for tertiary care hospitals may lead to the transfer of their patients to other types of facilities. Another point is that the data for this study correspond to very early phase of the new system. But both patients and medical care providers would adapt themselves to the new system to avoid or overcome its disadvantages for them, so as that its effects could change over time. Therefore, it is still necessary to closely monitor the impact of the referral requirements.
Summary
Long term noise exposure of steel mill workers, hearing loss and blood pressure.
Myung Wha Ha, Doohie Kim
Korean J Prev Med. 1991;24(4):496-506.
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AbstractAbstract PDF
A cross-sectional study was conducted to investigate the effect of long term noise exposure on blood pressure among steel mill workers. The workers participated in periodic medical examinations performed from August 27 to September 6 in 1990. Examined were 1,034 workers with high-level noise exposure(average 91.8+/-5.2 dB{AA)), and 390 workers with low-level noise exposure(average 75.2+/-4.6 dB(A)). No significant difference was found in systolic or diastolic blood pressure between the two exposure groups. Prevalence of hypertension (> or = 160 mmHg systolic or > or = 100 mmHg diastolic) was higher in a younger age group (< or = 40 years old) of high-level noise exposure than of low-level noise exposure. However, the difference was not statistically significant. Furthermore, in younger ages, prevalence of. hypertension appeared to be higher in the hearing loss group (> or = 25dB at 1000 Hz or > or = 40 dB at 4000 Hz in at least one ear) than in the normal hearing group. From multiple regression analysis, hearing loss, body mass index, age, alcohol and family history of hypertension were proven to be predictors of diastolic blood pressure (p<0.02). When regression was performed for each age group, hearing loss was a strong predictor of diastolic pressure in the younger age group (p<0.01).
Summary
Carboxyhemoglobin Dissociation Pattern by Age in the Rat.
Sun Min Kim, Heon Kim, Soo Hum Cho
Korean J Prev Med. 1991;24(4):507-515.
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AbstractAbstract PDF
One, two, six and ten week old Sprague-Dawley rats were exposed to carbon monoxide at 3,700 ppm for 30 minutes, and carboxyhemoglobin was measured immediateley, 5, 30, 60, 90, 120 minutes after the exposure. In each time after the exposure, the means of the carboxyhemoglobin levels were "compared among the week age groups. The regression analysis was done using the natural logarithm. of the carboxyhemoglobin concentration as a dependent variable and the time after the exposure. as an independent vaiable. From the regression equation, the half lives of the carboxyhemoglobin were calculated. The one week old rats showed significantly higher carboxyhemoglobin level than other week age rats in the entire time after the exposure. The corrected carboxyhemoglobin concentration calculated by subtracting the normal carboxyhemoglobin level from the me cured carboxyhemoglobin at each age group, showed no uniform differences.
Summary
The Relationship of Low-Level Blood Lead to Plasma Renin Activity and Blood Pressure.
Soon Woo Park, Doo Hie Kim
Korean J Prev Med. 1991;24(4):516-530.
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AbstractAbstract PDF
A case-control study was conducted to investigate the effect of low-level blood lead on the blood pressure. The plasma renin activity (PRA) was measured also to investigate one of the possible mechanisms by which lead may play a role to influence on the blood pressure. Seventy-two hypertensive and sixty-nine control study subjects were selected from the workers who had no history of job-related lead exposure, in Ulsan city and it's vicinity, Korea. In addition to measuring blood lead levels and PRA, body mass index(BMI), hematocrit, serum sodium, potassium, creatinine, ionized calcium, and cholesterol were measured. Also, the habits of smoking, alcohol drinking and family history of hypertension were checked. The blood lead level of the hypertensive group was 19.8+/-5.5 microgram/dl, which was significantly higher than that of the control group, 12.5+/-4.7 microgram/dl (p<0.01). On multiple logistic regression analysis, the odds ratio of blood lead level on the occurrence of high blood pressure was 1.38, also statistically significant (p<0.01). There was no significant differences between the hypertensive and the control group in the PRA or In(PRA), but there was a marginally significant linear relationship between blood lead and PRA in the hypertensive group (p<0.1). In conclusion, blood lead level which has been known to be within normal limits may be one of the possible risk factors of hypertension and PRA alteration by lead may act as one of the mechanisms.
Summary
Adequacy of Medical Manpower and Medical Fee for Newborn Nursery Care.
Jung Han Park, Soo Yong Kim, Sin Kam
Korean J Prev Med. 1991;24(4):531-548.
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AbstractAbstract PDF
To assess the adequacy of medical manpower and medical fee for the newborn nursery care, the author visited 20 out of 24 hospitals with the pediatric training program in Youngnam area between July 29 and August 14, 1991. Total number of newborn, both normal and sick, admission and discharge in 1--30 June 1991 was obtained from the logbook of nursery. Head nurse and staff pediatrician of the nursery were interviewed to get the current staffing for the nursery and their subjective opinion on the adequacy of nursery manpower and the difficulties in recruiting manpower. Average medical fee charged for the maternity and normal newborn nursery care was obtained from the division of self-audit of medical insurance claim of each hospital. Average minimum requirement of nursing care time for one normal newborn per day was 179.5 (+/-58.6) minutes; 2023(+/-50.7) minutes for the university hospitals and 164.2(+/-60.5) minutes for the general hospitals. The ratio of minimum requirement of nursing care time and available nursing time was 1.42 on the average. Taking the additional requirement of nursing care for the sick newborns into consideration, the ratio was 2.06. The numbers of R. N. and A. N. in the nurserys of study hospitals were 31%, and 17%, respectively, of the nursing manpower for the nursery recommended by the American Academy of Pediatrics. These findings indicate that the nursing manpower in newborn nursery is in severe shortage. Ninety percent of the head nurses and 85% of the staff pediatrician stated that the newborn nursery is short of R.N. and 75% of them said that the nurse's aide is also short. Major reason for not recruiting R.N. was the financial constraint of hospital. For the recruitment of nurse's aide, short supply was the second most important reason next to the financial constraint. However, limit of quarter in T.O. was the major reason for the national university hospitals. Average total medical fee for the maternity and newborn nursery cares of a normal vaginal delivery who stayed two nights and three days at hospital was 219,430Won. Out of the total medical fee, 20,323Won(9.3%) was for the newborn nursery care. In case of C-section delivery six nights and seven days, who stayed otal medical fee was 732,578Won and out of the total fee 76,937Won (12.0%) was for the newborn care. Cost for a newborn care per day by cost accounting was 16,141Won for the tertiary care hospitals and 14,576Won for the all other hopitals. The ratio of cost and the fee schedule of the medical insurance for a newborn care per day was 5.0 for the tertiary care hospitals and 4.9 for the all other hospitals. Considering the current wage level of the medical personnel, capital investment for the hospital facilities and equipments, and the cost for hospital maintenance, it is hard to expect adequate quality care in the newborn nursery under the current medical insurance fee schedule.
Summary

JPMPH : Journal of Preventive Medicine and Public Health