Journal of Preventive Medicine and Public Health

Volume 29(1); March 1996

Original Articles

A Study on the Health Risk Agents in the Workplace of a General Hospital.: Yang Ok Kim, Ki Soon Kim, Jong Park, So Yeon Ryu, Hee Yeon Yang; Korean J Prev Med. 1996;29(1):1-14.

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Abstract PDF: To evaluate the health risk of the workplace environment of a general hospital toward the hospital workers, a questionnaire survey on the perception of risk at the workplace environment and environmental measurements at 27 locations with 240 workers in the hospital were made from October 25th, 1993 to October 30th, 1994. The results were as follows; 1. By the environmental measurements, 86 workers(36%) were found to be exposed to poor or harmful degree of general illumination, 193 workers(80%) were exposed to poor or harmful local illumination, 34 workers(14%) were exposed to poor or harmful degree of thermal condition and l80 workers(75%) were exposed to poor or harmful noise level, but nobody was exposed to poor or harmful dust and toluene concentration. Also nobody was exposed to poor or harmful level of radiation or anticancer/antibiotic agents. 2. The subjective perceptions on the environmental conditions felt by the workers were different from the objective findings by the environmental measurements. The workers underscored the poor illumination state and overscored the dust concentrations. Also workers oversensitized about the thermal condition, the noise level, the radiation level, the toluene concentration and anticancer/antibiotic agents. 3. The sources of noise were the dialogue(179 workers) and the office instruments(131workers). The sources of dust came from the clothes(108 workers) and the building materials(79 workers). 4. The questionnaire survey showed that the 28 workers were exposed to poor or harmful level of the antibiotics, 10 workers to alkali or acid and 6 workers to drug dust in the pharmacy but the above findings could not be proved by the environmental measurements.; Summary

Lead Concentrations of Pigeon's Tissue as Indicator of Lead pollution in Air and Soil.: Yung Woo Byun, Tae Yoon Hwang, Jung Jeung Lee, Chang Yoon Kim, Jong Hak Chung; Korean J Prev Med. 1996;29(1):15-26.

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Abstract PDF: It has been studied that a variety of fauna and flora are sensitive biological indicators which reflect the severity of regional pollution of heavy metals, but in the center of part of Taegu city the controversial issue of lead poisoning attributable to the atmosphere which contains an increased concentrations of lead has been raised recently, it is usually hard to find suitable plants or animal in the areas with heavy traffic. Pigeons are ubiquitous in and around Taegu city area, inhabiting even the most densely populated areas with heavy traffic with its small body size, high metabolic turnover, and rather limited mobility, a pigeon, as a biological indicator is expected. This study was conducted to monitor lead pollution in the Taegu and kyongju city in Korea. We measured the lead content of the various tissue of three groups of feral pigeon(Columbia livia) and soil and atmospheric lead concentration. First group was obtained io heavy traffic area in Taegu City, the second group was obtained a park in Taegu city and the third group was obtained light traffic area in kyongju city. The air and soil lead concentration of heavy traffic area in Taegu city was 0.11 microgram/m2, 4.96 microgram/g, that of park in Taegu city was 0.05 microgram/m3, 2.65 microgram/g and that of light traffic area in kyonngju city was 0.03 microgram/m3, 0.01 microgram/g. The lead content of lung, blood, kidney, femur and liver of feral pigeons in heavy traffic area in Taegu city was significantly higher than pigeons obtained in a park in Taegu city and low traffic density area in Kyonfju city(p<0.01). But stomach lead content of three group did not reflect a significant difference. In this study positive correlation was found between atmospheric lead concentrations and the concentration of lead in the pigeon's lung(r=0.5040, p<0.001), blood(r=0.3322, p<0.01), kidney(r=0.4824, p<0.001), femur(r=0.7214, p<0.001) and liverer (r=0.4836, p<0.01). we can also found positive correlation between soil lead concentrations and the concentration of lead in the pigeon's femur(r=0.4850, p<0.001), kidney(r=0.4850, p<0.001) and liver(r=0.4386, p<0.01). In the pigeon`s tissue there were significant correlations between concentration of lead in the blood and kidney(r=0.4818, p<0.001), femur(r= 0.6157, p<0.001) and liver(r=0.3889, p<0.001). In conclusion, at the heavy traffic area in Taegu city, lead concentrations found in the atmosphere and soil are reflected in the lead concentrations of different tissue of urban pigeons. It is suggested that the tissue of pigeons can be good biological indicators of environmental lead pollution.; Summary

Scientific rationale and applicability of dose-reponse models for environmental carcinogens.: Dongchun Shin, Yong Chung, Jongman Kim, Seongim G Lee, Mansik Hwang; Korean J Prev Med. 1996;29(1):27-42.

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Abstract PDF: This study described methods to predict human health risk associated with exposure to environmental carciongens using animal bioassay data. Also, biological assumption for various dose-response models were reviewed. To illustrate the process of risk estimate using relevant dose-response models such as Log-normal, Mantel-Bryan, Weibull and Multistage model, we used four animal carcinogenesis bioassy data of chloroform and chloroform concentrations of tap water measured in large cities of korea from 1987 to 1995. As a result, in the case of using average concentration in exposure data and 95 % upper boud unit risk of Multistage model, excess cancer risk(RISK I) was about 1.9 x 10-6, in the case of using probability distribution of cumulative exposure data and unit risks, those risks(RISK II) which were simulated by Monte-Carlo analysis were about 2.4 x 10(-6) and 7.9 x 10(-5) at 50 and 95 percentile, respectively. Therefore risk estimated by Monte-Carlo analysis using probability distribution of input variables may be more conservative.; Summary

Nephropathy in Chronic Lead Poisoning.: Byoung Gwon Kim, Sung Ryul Kim, Young Seoub Hong, Seo Hee Rha, Jung Man Kim, Kap Yull Jung, Joon Youn Kim; Korean J Prev Med. 1996;29(1):43-50.

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Abstract PDF: We experienced a case of nephropathy in chronic lead poisoning. The patient was 43-year-old male who has been working in secondary lead smelting plant for ]4 years. On admission, blood pressure was 160/90 mmHg and the others were non-specific. In past history, he received chelating agent administration for lead poisoning irregularly and medicated for gout, and the blood lead concentration was 180.0 microgram/dl on 2 months before admission. Smoking habit has been 1 pack per day for 15 years and drinking habit has been 1 bottle of Soju per day but less now. In liver function test, AT/ALT were 27/28 IU/l and gamma-GT was 456 IU/l. In blood test, Hb:11. 5 g/dl , Hct: 34.0% and basophilic stipplings were found in peripheral blood smear. Chest PA was normal and abdominal ultrasonographic finding was non-specific except fatty liver. In the test of lead exposure indices, pbB: 83.0 microgram/dl, pbU: 28.3 microgram/l, and blood ZPP was 300.0 microgram/dl. And in renal function test, BUN: 31.4 mg/dl, blood creatinine: 2.7mg/dl, blood uric acid: 9.1 mg/dl, urinary albumin: 100.0 mg/g creatinine, urinary a alpha 1-microglobulin: 120.5 mg/g creatinine, urinary beta2-mioroglobulin: 183.8 microgram/g creatinine, and 24 hours urinary creatinine clearance was 31.9 ml/min. The ultasonoguided renal biopsy showed the global sclerosis of glomerulus, moderate atrophy and loss of tubule, and interstitial fibrosis in light microscopy. There were diffuse losses of brush border of proximal tubule in electronmicroscopy.; Summary

A study on the trend in the length of hospital stay in Korea.: Woo Hyun Cho, Ki Hong Chung, Im Ok Kang; Korean J Prev Med. 1996;29(1):51-66.

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Abstract PDF: The purpose of this study was to examine the trends of length of hospital stay (LOS), which is most likely to be a major attribute to hospital performance From 1984 to 1994, an average LOS of each hospital was analyzed by factors such as medical departments, bed size, occupancy rate, region and ownership. This study was analyzed changing rate of LOS during 11 years. This rate was calculated by simple regression, which was used only with hospital without missing data during 11 years. This study findings are as follows. 1. The results indicated that the average LOS was steadily increased until 1990 but it was slightly decreased after 1990. 2. This trend could be found in all hospital scale and all group of occupancy rate. Specifically this trends of LOS were found in internal medicine, corporate owned hospitals, and hospitals in major city. But LOS of individual owned hospital was continuously increased until 1994. 3. Means of changing rates of LOS were calculated from 1984 to 1994. If we divided it into two parts, before 1990 and after 1990, most changing rates of LOS before 1990 except individual owned hospital were found positive sign. The changing rates after 1990 were negative sign but small hospital(lesser then 200 bed), individual owned hospital, national & public hospital and hospital in small urban have little change of LOS after 1990. Finally from this results we thought that most hospitals in korea began to be concerned with LOS. Nevertheless LOS of several hospital such as small hospital or individual owned hospital was increased. And this trend may be caused by a few patients, low occupancy rate, or low profit. This trend of LOS is different from that of other countries. Perhaps this phenomenon is resulted from the reimbursement method. Because of fee for service reimbursement system in korea the hospitals didn't need to shorten LOS in order to save the cost and increase the profit. Therefore reform of hospital cost reimbursement method will be reduced to reduce hospital cost in korea. we thought that the korean health authority should consider the reimbursement method by unit of bundle of services, for example DRG and prepayment in the united states. This study presents some limitations such as on insight of severity of disease, case-mix measurement of hospital, and other clinical characteristics that can possibly affect LOS, However, this study reports an important trend in LOS from 1984 to 1994.; Summary

Drug Sensitivity and Relapsed Period of Relapsed Pulmonary Tuberculous Patients registered in Some Public Health Offices, in Seoul.: Hye Sook Park, Eun Hee Ha, Cha Hyung Wie, Ji Yong Kang; Korean J Prev Med. 1996;29(1):67-78.

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Abstract PDF: The purpose of this study was examine the general characteristics of relapsed pulmonary tuberculous patients (i.e. age, sex, weight, occupation, previous forms of treatment, drug sensitivity, and the frequency of relapse) in order to improve future treatments of tuberculosis as well as to perpetuate health education. The data was obtained from the medical records of 186 relapsed pulmonary tuberculosis patients who were registered for treatment at various public health officers in Seoul during the year of 1994. The major findings obtained from the study were as follows; l) The male to female ratio of relapsed pulmonary tuberculous patients was about 7:3, more specifically 23.7% of the men and 30.9% of the women were between 20 and 29 years of age. 2) Comparing initial less aggravated states to relapsed states, patients with minimal x-ray findings later proved moderately advanced X-ray findings. Furthermore, patients with negative sputum AEB findings later proved positive sputum AFB findings. 3) of the l86 patients studied, 91.9% suffered, relapse and 8.1% suffered 2 or more relapses. Of the patients who suffered at least 1 relapse, 54.8% received short-term treatment, 26.9% received long-term treatment, and 18.3% received treatment of an unknown during their initial tuberculosis treatment periods. 4) Fifty five point four percent of the patients had no reaction to the drug treatment(not available), 25.9% of the patients had sensitive reaction to the drug treatment, 18.7% of the patients had resistant reaction to the drug treatment. Drug resistance was higher in patients to exhibited positive X-ray findings as well as in patients that exhibited positive sputum findings furthermore, patients receiving treatment of an unknown nature(35.5%) exhibited higher drug resistance than those receiving short-term treatment(13.6%) and long-term treatment(l7.0%). 5) Of the 160 patients who suffered relapses, 8.8% suffered a relapse within 1 year after treatment and 91.2% suffered a relapse at least 1 year after treatment. Furthermore, our study showed that women, under 30, who received short-term treatment and encounterd complications during their primary treatment suffered relapses faster than any other groups studied. In addition, minimal X-ray findings and sputum AFB findings were not correlated to the time relapse occurred. Therefore, the greater efforts are needed to prevent relapsed pulmonary tuberculosis.; Summary

Factors Influencing Compliance with Anti-Tuberculosis Therapy.: Cheon Tae Kim, Kyeong Soo Lee, Pock Soo Kang; Korean J Prev Med. 1996;29(1):79-90.

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Abstract PDF: The purpose of the study was to determine factors influencing compliance with anti-tuberculosis therapy. The study subjects were 104 tuberculosis patients who have received the initial treatment in 3 health centers of Kyongju-city, Dalseong-Gun in Teagu and Kumi-city. Data were collected between september and october 1995. The patients were classified into the improved group and the non-improved group according to outcomes of 3 month treatment with short-term therapeutic regimen. To find factors influencing compliance with anti-tuberculosis therapy, multiple logistic regression was made. There was no significant differences between the improved group and the non-improved group in sex, age, education level, occupation, family pattern, and habitual change regarding smoking and drinking. The level of knowledge about anti-tuberculosis therapy in the improved group was significantly higher than the non-improved group(p<0.01). Multiple logistic regression analysis revealed that family support for not forgetting medication(p<0.05) was a predictor of improvement and knowledge about anti-tuberculosis therapy (p=0.054), regularity of medication(p=0.062), and consultation to family, doctor and nurse(p=0.075)were marginal predictors of improvement. Treatment must be given to every patient confirmed as having tuberculosis and must be given free of charge to the patients. The requirements for adequate chemotherapy are prescribed in the correct dosage and taken regularly by the patient for a sufficient period to prevent relapse of the disease after cure. It is suggested that education to the patients should be reinforced and connectedness between patients and tuberculosis control workers and family should be solidated.; Summary

The Risk Factors of Industrial Low Back Pain among Shipyard Workers.: Yun Chul Hong, Eun Hee Ha, Hye Sook Park; Korean J Prev Med. 1996;29(1):91-102.

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Abstract PDF: Low back pain patients an controls of shipyard workers were surveyed between June 1995 and september 1995 to identify risk factors of industrial low back pain. The patients were 17 male workers who had got medical treatment for over 3 days because of industrial back pain controls were 51 male workers who had not have musculoskeletal disorder for one year before the survey. By univariate analysis, the workers who did overtime work 4 times or more for the last 2 weeks showed odds ratio of 3.67 on low back pain with the workers who did less overtime work. Carrying heavy materials was also associated with the low back pain and the odds ratio increased with the increase of carrying weight. work space and work posture were not associated with the low back pain significantly. The welder had higher odds ratio than the other workers on low back pain. The duration of employment and job satisfaction did not affect the risk of low back pain. Multiple logistic regression analysis showed that frequency of overtime work for the last 2 weeks and carrying heavy materials among the risk factors were associated significantly with the low back pain. We found that important risk factors of low back pain of shipyard workers are work intensity factors such as overtime work and carrying heavy weight.; Summary

Bronchial Hyperresponsiveness in Workers Exposed to Isocyanates.: Kyeong Sook Choi, Kyoo Sang Kim, Byung Soon Choi, Jung Keun Choi, Se Hui Lee, Young Hahn Moon; Korean J Prev Med. 1996;29(1):103-112.

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Abstract PDF: We studied the association of nonspecific bronchial hyperresponsiveness with general characteristics, exposure concentration, respiratory symptoms, chest x-ray findings, past histories and pulmonary function. We determined bronchial hyperresponsiveness by methacholine challenge test. And we conducted a respiratory symptom questionnaire and performed spirometry on 111 workers occupationally exposed to isocyanates in various industries. About 21.6% of subjects had bronchial hyperresponsiveness. No significant differences were observed between the hyperresponsive and non-responsive group with respect to age, sex, employment period, height, and smoking histories cough and breathlessness were significantly associated with the bronchial hyperresponsiveness. The hyperresponsive group had more experience of bronchitis and asthma in the past than the non-responsive group. The lower FEV1 and FEV1 % were closely related with bronchial hyperresponsiveness. Bronchial hyperrespoosiveness seems to be associated with some of respiratory symptoms, past histories and pulmonary function parameters in workers exposed to isocyanates.; Summary

A Survey on Health Behavior of Male Workers in Steel Industry.: Eun Hee Ha, Hyun Sul Lim, Cha Hyung Wie, Jung Ok Kwak; Korean J Prev Med. 1996;29(1):113-132.

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Abstract PDF: This study was carried out to evaluate the relations among workers' general characteristics, work-related behaviors and health related behaviors in a steel industry with 1,134 workers in Pohang. The results were as follows; 1. The mean age of workers was 50 years old and working duration was 15 years and over. Most of them were married(94 5%) and had studied beyond high school (53.0%). They performed three shift work and most of them(63.0%) had experienced industrial accidents. The frequency of noise and dust exposure was defined by a minimum of 6 hours per day, and workers complained about noise exposure(62.9%) and dust(55.6%). There were current smokers(67.7%), current drinkers(74.3%) and current exercising workers(32.3%) in the industry. The number of cigarette consumption in current drinkers was significantly high (13.6 +/- 8.4 pieces/day) and the alcohol consumption in current smokers was significantly high(l04.5 +/- 113.5 g/wk). And the number of cigarette consumption of exercisers was significantly low and the alcohol consumption of exercisers was higher than non-exercisers. 3. The ratio of current smokers on frequent noise in exposed workers versus non-exposed workers was not significantly high but the current drinkers in frequent noise and dust exposed workers was significantly higher than non--exposed. 4. The normal levels of SGOT workers in non-smokers were significantly higher than in current smokers, and the abnormal levels of LFT(SGOT, SGPT, gamma-GTP workers in nondrinkers were significantly high. The normal levels of SBP and DBP workers in current smokers were not significantly high but were significantly high in non-drinkers. 5. The ratio of current smokers in workers unsatisfied with their job and working condition was higher than non-smokers, but the ratio of current drinkers in workers satisfied with their job and working condition were higher. 6. The significant factors for SGOT and gamma-GTP were age, the drinking amount and BMI. But the only significant factor for r-GTP was BMI. The significant factors for DBP were age, the alcohol consumption and BMI And the significant factors for SBP were age, BMI.; Summary

Referral Patterns and Needs for Specialist Care among Patient Referred from Health Center.: Tae Yoon Hwang, Chang Yoon Kim, Pock Soo Kang; Korean J Prev Med. 1996;29(1):133-143.

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Abstract PDF: This study was conducted to assess the referral patterns to specialist from general practitioners in health center and perceived needs of referred patients for specialist care in health center. The study subjects were 249 patients who visited to health centers and were referred to other medical facilities. The data were obtained from questionnaire survey which was conducted in Kyongjuu-city Health center, Seongju-Gun Health center and Koryong-Gun Health center in Kyongsangbuk-Do, from June 10 to october 17, 1995. The total referral rate was 2.7%. The proportion of patients who wished to be referred to medical specialists was 85.9%, and the proportion of patients referred by general practitioners in health centers was 14.1%. Among the patients who wished to be referred to medical specialists, 45.9% visited directly to health centers, 34.6% visited health centers via local clinics and 19.5% visited health centers to get referral permission only. The reasons for getting referral permission in health centers were easy geographical accessibility(34.6 %), easy to get referral permission in health centers(27.l%), and very difficult to get referral permission in local clinics(l6.4%). Among the diseases of referred patients, diseases of the musculoskeletal system and connective tissue were most prevalent on a whole, but diseases of nervous system and sensory organs were comparatively high among the patients who wished to be referred to medical specialists and infectious and parasitic diseases were comparatively high among the patients referred by general practitioners in health centers. The most favorable medical facility was general hospital including university hospital in both groups of patients who wished to be referred to medical specialist and the patient referred by general practitioners in health centers. Regarding the needs for specialist care in health center, 75.2% patients who wished to be referred to medical specialists and 74.3% of patients referred by general practitioners in health center wanted the specialist care. The most frequently requested speciality is internal medicine(47.1%), and then orthopedics and general surgery. Based on above results, this study revealed that the majority of patients referred from health center wished to be referred to medical specialists at their own will, so, referral system at health center level should be changed. And if specialist care in health center be provided, the medical care by internist could be provided first, and then that of orthopedics and general surgery could be provided. These kinds of medical cares could be covered by local clinicians as a part-time job on a voluntary basis.; Summary

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