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Volume 31(3); August 1998
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Original Articles
Reliability and Validity of the Korean Version of ISAAC Questionnaire.
Seong Woo Choi, Yeong Su Ju, Dae Sung Kim, Jae Yong Kim, Ho Jang Kwon, Dae Hee Kang, Sang Il Lee, Soo Hun Cho
Korean J Prev Med. 1998;31(3):361-371.
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AbstractAbstract PDF
Recent increases of asthma and allergies in childhood made the need for a standardized approach to international and regional comparisons of their prevalence and severity. To address these issues, "International Study of Asthma and Allergies in Childhood (ISAAC)" is currently underway. In Korea, "Nationwide Study of Asthma and Allergies in Korean Children" began in 1995 according to ISAAC protocol. ISAAC written and video questionnaires were used in this survey, but their reliability and validity were not evaluated properly yet. In this study, our aim was to evaluate the reliability and validity of two kinds of questionnaires and their usefulness in international and regional comparisons. The test and retest of two questionnaires were completed by male(n=110) and female(n=111) middle school students with two and three weeks interval each. Kappa(or weighted kappa) were calculated from each questions and validity coefficients were estimated from those statistics. In Korean version of written questionnaire, the questions for allergic rhinitis, atopic dermatitis, allergic conjunctivitis, and food allergy proved to have high kappa values(or weighted kappa values) and validity coefficients and they can be used in further studies without any correction. But some questions about asthma(especially nocturnal cough, wheezing in exercise, and severe asthma) and drug allergy need to be revised for better understanding to study subjects. Video questionnaire has the same degree of reliability and validity when compared to written questionnaire and this is the unexpected result. Accordingly, it also need to be revised to overcome the racial and cultural differences of the study subjects. In conclusion, the Korean version of written and video questionnaires may be considered to be useful methods in international and regional comparisons of asthma and allergic diseases in childhood after correction of some questions.
Summary
Characteristics of Traffic Accident for the Primary School Students and Its Affecting Factors.
Am Park, Yeon Kyung Lee, Jeong Yun Kim, Tae Yong Lee, Sok Goo Lee, Young Chae Cho, Dong Bae Lee
Korean J Prev Med. 1998;31(3):372-383.
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AbstractAbstract PDF
For the purpose to analysis the characteristics of traffic accidents(TA) and investigate the relationship between traffic accidents and children attention problem rating scale(CAP) and, family environment scale(FES), this questionnaire survey was conducted to the 16 primary school students in Taejon from July 14 to August 26, 1997. The number of study subjects who had an experience of traffic accidents from July 1, 1996 to June 30, 1997 were 195, and the number of control subjects were 512. The main results were as follows; 1. The traffic accident rates was 0.9% as a whole, but those were 1.4% in boys, 0.7% in girls, 1.3% in low (1st-3rd) grade, and 0.8% in high (4th-6th) grade. 2. The rates of traffic accidents were high in spring, friday, afternoon and a driveway around home. TA occurred during walking with friends most frequently. 3. In CAP the score of inattention was lower in TA group than control group, and hyperactivity was higher in TA group but they didn't showed significantly different. In FES, cohesion score was higher in TA group than control group, but Conflict score and Expressiveness score were in control group, but they didn't showed significantly different. 4. In CAP the odds ratio of inattention score for TA group was 0.84, but that of hyperactivity score was 1.15. In FES, the odds ratio of cohesion score was 1.06, but that of expression score and conflict score was 0.94 and 0.96, respectively. In conclusion, the relationships between TA and CAP, TA and FES in this study were not clear to explain personal characteristics and environmental conditions.
Summary
The effect of sodium and potassium intake on blood pressure change in Korean adolescents.
Il Suh, Chung Mo Nam, Kang Hee Lee, Sun Ha Jee, Suk Il Kim, Gyu Sang Kim, Chun Bae Kim
Korean J Prev Med. 1998;31(3):384-394.
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AbstractAbstract PDF
In order to investigate the effect of the urinary excretion of sodium and potassium on the change on blood pressure over 3 years, 668 adolescents aged 13 years living in Kangwha area were investigated in a longitudinal follow-up study. Two measurements were taken on each blood pressure (diastolic, systolic) and the average of the two readings was used in the analysis. Sodium and potassium intake were estimated by the determination of those electrolytes in 24hr urine. The mixed model regression analysis was used to identify the effect of urinary sodium and potassium on the change of blood pressure after controlling for BMI of each age. On simple bivariate analysis no relationship was found between urinary sodium excretion and systolic or diastolic blood pressure among both male and female, however, a significant positive association between urinary potassium excretion and systolic blood pressure among male. The results of mixed regression analysis showed that the body mass index (BMI) were more influential that urinary electrolytes among this study subjects. It suggested that risk factors observed from the adults, may not be identical with that of the growing aged population. After control of the BMI and age, significant association between sodium and diastolic BP among male, and association between potassium and systolic BP among female, were found. In summary, the results indicate that growth has been more influential than dietary factor on blood pressure for growing aged population.
Summary
The Incidence Rate of Coronary Heart Disease in City Area.
Byung Yeol Chun, Kwon Bae Kim, Kee Sik Kim, Young Jo Kim, Yoon Nyun Kim, Chang Yoon Kim, Wee Hyun Park, Dong Gu Shin, Bong Sub Shin, Jong Joo Lee, Choong Won Lee, Sung Gug Chang, Jae Eun Jun, Yong Keun Cho, Shung Chuil Chae, Gi Yong Choi, Young Ae Ha, Young Sook Lee
Korean J Prev Med. 1998;31(3):395-403.
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AbstractAbstract PDF
To estimate the incidence rate of coronary heart disease in Korea, of all residents of the Taegu city aged 25 or above, those who had an acute MI or fatal coronary event between 1 July 1996 and 30 June 1997 were registered. Seven hundreds and eight patients were registered during the study period(685 were identified at hospital and 23 were autopsy cases). Age-standardized annual incidence rate of men in city area was 93 per 100,000(95% CI; 61-142) and 33(95% CI; 16-67) in women(100 in men and 20 in women aged 35-64). The incidence was rapidly increased after age 40 in men, however, in women after age 60. Twenty-eight-days case fatality rate was 45% in men and 47% in women. However, in the age group of 45-59 case fatality rate in women was two times higher than that in men. In conclusion, crude annual incidence rate of CHD in city area was 73 per 100,000 in men and 33 in women. The age-standardized annual incidence of CHD in men(93 per 100,000) was 3.2 times higher than that in women (33 per 100,000) in Korea.
Summary
The relationship between the utilization of health center and exposed amount to solvent by using cumulative exposure index.
Ju Won Park, Soon Young Lee, Jae Yeon Jang, Kyung Jong Lee, Ho Grun Jeong
Korean J Prev Med. 1998;31(3):404-413.
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AbstractAbstract PDF
This study was conducted in order to clarify the factors affecting the number of utilization to health center for the shipyard workers who have been work in exposed environment to solvent. At first the tendencies of the number of utilization to health center in accordance with cumulative exposure(CE), lifetime weighted average exposure(LWAE), one's place of duty, work contents, states of using safety apparatus, the degree of the knowledge on handling solvents, exposure year. 1) The increase in the cumulative exposure(CE) was significantly higher in the number of utilization to health center. The group with longer exposure year showed significantly higher number of utilization to health center(p<0.01). Considering the work contents such as power blasting, spray, mixing and touch-up, the group of touch-up showed higher number of utilization to health center and this difference was statistically significant(p<0.001). Those who were not using the safety apparatus, showed higher number of utilization to health center, which was statistically significant(p<0.05). The degree of the knowledge on handling the solvent had no relation with using health center. 2) The results conducted from this study by multiple regression analysis in clarifying the factors affecting the number of utilization to health center, CE, exposure year and using safety apparatus was significant factor in utilization of health center.
Summary
A Case of Metal Fume Fever Associated with Copper Fume in a Welder.
Hyun Sul Lim, hae Kwan Cheong
Korean J Prev Med. 1998;31(3):414-423.
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AbstractAbstract PDF
Metal fume fever has been known as an occupational disease is induced by intense inhalation of fresh metal fume with a particle size smaller than 0.5 nm to 1 nm. The fumes originate from heating metals beyond their boiling point, as happens, for example, in welding operations. Oxidation usually accompanies this process. In most cases, this syndrome is due to exposure to zinc oxide fumes; however, other metals like copper, magnesium, cadmium, manganese, and antimony are also reported to produce such reactions. Authors report a case of metal fume fever suspected to be associated with copper fume inhalation. The patient was a 42-year-old male and was a smoker. He conducted inert gas tungsten arc welding on copper-coated materials without safety precautions such as a protective mask and adequate ventilation. Immediately after work, he felt metallic taste in his mouth. A few hours after welding, he developed headache, chilling sensation, and chest discomfort. He also complained of myalgia, arthralgia, feverish sensation, thirst, and general weakness. Symptoms worsened after repeated copper welding on the next day and subsided gradually following two weeks. Laboratory examination showed a transient increase of neutrophil count, eosinophilia, elevated erythrocyte sedimentation rate, and positive C-reactive proteinemia. Blood and urine copper level was also increased compared to his wife. Before this episode, he experienced above complaints several times after welding with copper materials but welding of other metals did not produce any symptoms. It was suggested that copper fume would have induced metal fume fever in this case. Further investigations are needed to clarify their pathogenic mechanisms.
Summary
A Study on Urinary Cadmium Concentration and Renal Indices of Inhabitant in an Abandoned Mine Area.
Jung Duck Park, Chan Byung Park, Byung Sun Choi, Eun Yong Kang, Yeon Pye Hong, Im Won Chang, Byung Yeol Chun, Min Hae Yeh
Korean J Prev Med. 1998;31(3):424-439.
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AbstractAbstract PDF
Urinary cadmium is used as a sensitive indicator for internal Cd dose, and increased excretion of N-acetyl-beta-D-glucosaminidase(NAG), beta(2)microglobulin(MG) and total protein are useful indices for renal dysfunction by chronic exposure to Cd. The target group was 184 inhabitant(82 men and 102 women) in an abandoned mine area known as exposure to low level Cd. The control group was took 160 individuals(64 men and 96 women) in Cd not-exposed area. Urinary Cd concentration was significantly higher in the target group than the control. The geometric mean of urinary Cd for male was 2.56ng/l, 2.80ng/g creatinine and 2.50ng/S.G. in the target group and 1.19ng/l, 1.36ng/g creatinine and 1.17ng/S.G. in the control. For female 2.69ng/l, 3.94ng/g creatinine and 2.63ng/S.G. in the target group and 1.27ng/l, 1.97ng/g creatinine and 1.25ng/S.G. in the control, respectively. In addition, urinary Cd of the target group had affected by the period of residence and dietary habit for the rice and the vegetables from the target area. These findings suggest the chronic exposure to Cd of the target population. Mean excretion of urinary NAG, beta(2)MG and total protein were not significant between two groups. In the target group, urinary NAG activity and total protein were significantly correlated with urinary Cd, but beta(2)MG was not related. Urinary excretion of NAG, beta(2)MG and total protein were significantly increased in 10 than in <2 of urinary Cd level. In 2~10 group of urinary Cd level, the excretion of NAG significantly increased while not showed for beta(2)MG. In present study, urinary excretion of NAG was relatively sensitive than beta(2)MG in chronic exposure population to low level Cd.
Summary
Correlation of Fit Factors for Respirators and Anthropometric Dimension.
Don Hee Han
Korean J Prev Med. 1998;31(3):440-448.
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AbstractAbstract PDF
In many developed countries, for example, USA, respirator fit testing is required before entering specific work environment to ensure that the respirator worn satisfies a minimum of fit and that the user knows when the respirator fits properly. Unfortunately because we have not fit test regulation in Korea, a lot of workers wearing respirators may be potentially exposed to hazards. This study was conducted to evaluate the fitting performance for respirators and correlation fit factors with facial dimensions of wearers. 110 subjects (70 males, 40 females) were fit tested for three quarter masks, i.e., two domestic-made Mask Z, and Y and one foreign-made Mask T using PortaCount 8020. A facial dimension survey of the same subjects was conducted to develop a facial dimension grids for correlation fit factors with facial dimension parameters. A facial dimension grid was developed on the basis of face length and lip length for quarter masks. The results obtained were as follows: 1. Fit factors of Mask T were much higher than those of Masks Z, and Y. 2. Males were fitted more properly than females. 3. Male in box "f" of grid would be adequately fitted Mask Y and male in box "b", "e", "f", "h" of grid would be sufficiently fitted Mask T. Female in box "h" of grid may have a good fitting performance for both Mask Y, and T. But subjects in all boxes of grid would be inadequately fitted Mask Z.
Summary
Lipid Peroxidation and Antioxidants in Workers Exposed to Lead.
Won Jin Lee, Cheon Hyun Hwang, Cheong Sik Kim, Soung Hoon Chang, Yang Ho Kim, Hae Joon Kim
Korean J Prev Med. 1998;31(3):449-459.
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AbstractAbstract PDF
This study was started to find out if plasma malondialdehyde(MDA), alpha-tocopherol and erythrocyte superoxide dismutase(SOD) activity could be markers of biological activity resulting from exposed to lead in workers. Blood samples were randomly obtained from lead -exposed workers(n=29), CO2 welders(n=60) and office workers(n=60). We used whole blood to analyse blood lead with atomic absorption spectrophotometer. Superoxide dismutase activity in erythrocyte was measured with spetrophotometer. MDA and alpha-tocopherol in plasma were measured with high performance liquid chromatography. Lead-exposed workers was significantly high in blood lead concentration(29.37 ng/dl) compared with welders(6.42 ng/dl) and office workers(5.01 ng/dl). The level of plasma MDA was significantly higher in the lead-exposed workers(1.87 nmol/g cholesterol) than the welders(1.41 nmol/g cholesterol) and office workers(1.41 nmol/g cholesterol). Erythrocyte SOD activity in lead-exposed workers(56.80 U/g Hb) was significantly increased than those of welders(37.63 U/g Hb) and office workers(20.47 U/g Hb). The plasma alpha-tocopherol level of lead-exposed workers(4.93 ng/g cholesterol) was statistically different from welders(4.25 ng/g cholesterol) and office workers(4.28 ng/g cholesterol). Neither age nor smoking was related to SOD or MDA level. Blood lead was significantly correlated with erythrocyte SOD activity(r=0.405), plasma MDA(r=0.296) and alpha-tocopherol(r=0.207). Plasma MDA was also significantly correlated with SOD (r=0.217). In multiple regression analysis, the change of MDA and SOD activity level related to the blood lead concentration. These results suggested that the increase of plasma MDA and erythrocyte SOD activity in lead-exposed workers had a close relationship with the oxidative stress induced by lead.
Summary
A study on appropriateness of price of medical care service in health insurance.
Ki Hong Chun, Kui Son Choi, Im Ok Kang
Korean J Prev Med. 1998;31(3):460-470.
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AbstractAbstract PDF
By expanding health insurance, customers will carry a smaller burden of medical costs. As a result, the number of visits to a physician increase and this result in the improvement of medical accessibility. But medical care utilization may be changed not only by insurance status but also by socio-demographic factor, economic status and other factors. The question thus remains, at which level of accessibility and what price of medical care service in health insurance will the customer and the medical care service be satisfied. The price of medical care service is comprised of the customer's out-of-pocket money and the costs not covered by health insurance. If the price of medical care services in health insurance are appropriate, medical care utilization should not differ because of the difference in income status or the acuteness of illness. But If the price is not adequate, low income groups will receive relatively low medical care utilization, particularly in the case of chronic disease. The purpose of this study is to evaluate the differences in medical care utilization among the various income groups and those with varying acuteness of illness. The major hypotheses to test in this study are : (I) whether there are differences in medical care utilization among different income groups exist, (II) whether differences in medical care utilization among different income groups exist with the hospital type. (III) whether differences in medical care utilization among different income groups exist with the acuteness of illness and with age. The data was collected from the JongRo District Health Insurance Society in Seoul. A total of 118,336 persons were selected as the final sample for this study. The major findings of this study were as follows ; 1. The volume of ambulatory utilization among users was statistically significant by income level. 2. Among different income groups, the volume of ambulatory utilization was statistically significant by the acuteness of illness. 3. Higher income groups with chronic diseases had a greater volume of ambulatory utilization than other groups.
Summary
Estimation of Disease Code Accuracy of National Medical Insurance Data and the Related Factors.
Euichul Shin, Yong Mun Park, Yong Gyu Park, Byung Sung Kim, Ki Dong Park, Kwang Ho Meng
Korean J Prev Med. 1998;31(3):471-480.
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AbstractAbstract PDF
This study was undertaken in order to estimate the accuracy of disease code of the Korean National Medical Insurance Data and disease the characteristics related to the accuracy. To accomplish these objectives, 2,431 cases coded as notifiable acute communicable diseases (NACD) were randomly selected from 1994 National Medical Insurance data file and family medicine specialists reviewed the medical records to confirm the diagnostic accuracy and investigate the related factors. Major findings obtained from this study are as follows: 1. The accuracy rate of disease code of NACD in National Medical Insurance data was very low, 10.1% (95% C.I.: 8.8-11.4). 2. The reasons of inaccuracy in disease code were 1) claiming process related administrative error by physician and non-physician personnel in medical institutions (47.0%), 2) input error of claims data by key punchers of National Medical Insurer (31.3%) and 3) diagnostic error by physicians (21.7%). 3. Characteristics significantly related with lowering the accuracy of disease code were location and level of the medical institutions in multiple logistic regression analysis. Medical institutions in Seoul showed lower accuracy than those in Kyonngi, and so did general hospitals, hospitals and clinics than tertiary hospitals. Physician related characteristics significantly lowering disease code accuracy of insurance data were sex, age group and specialty. Male physicians showed significantly lower accuracy than female physicians; thirties and forties age group also showed significantly lower accuracy than twenties, and so did general physicians and other specialists than internal medicine/pediatric specialists. This study strongly suggests that a series of policies like 1) establishment of peer review organization of National Medical Insurance data, 2) prompt nation-wide expansion of computerized claiming network of National Medical Insurance and 3) establishment and distribution of objective diagnostic criteria to physicians are necessary to set up a national disease surveillance system utilizing National Medical Insurance claims data.
Summary
Treatment Process and Outcomes of Brain Injuried ER Patients.
Hye Ryeon Hong, Ki Nam Jin, Dong Woo Lee, Jae Su Kim
Korean J Prev Med. 1998;31(3):481-489.
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AbstractAbstract PDF
Injuries and infectious diseases have been the most important public health problems since the beginning of human life. Injuries result in death of about 30,000 people each year in South Korea. In terms of years of life lost, injuries are considerably more costly than either heart disease or cancer. In terms of cost - both the direct costs of care and the indirect costs to individuals, families, and societies of a diminished life - injuries are among the most expensive of all social problems. The main purposes of this study are (1) to describe the outcomes as well as treatment process of brain injured patients and (2) to identify the factors impacting on length of stay during hospitalization and hospital fees. The research method used in this study was to review the medical records of five hundreds brain injured cases using systemic random sampling. The multiple logistic regression was administered to identify the factors impacting on the outcomes. The results are as follow: (1) the consultation rate was found to be 72.9% while referral rate was 11.2%; (2) nearly 30% of the respondents were hospitalized over 30 days; (3) multiple logistic regression analyses revealed that the determinants influencing LOS were number of consultations, number of lab tests, and surgery; (4) the determinants of hospital fee were severity of brain injury, gender of patients, number of consultations, number of lab tests, and surgery.
Summary
Predicting hospital bankruptcy in Korea.
M S Lee, Y J Seo
Korean J Prev Med. 1998;31(3):490-502.
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AbstractAbstract PDF
This study purports to find the predictor of hospital bankruptcy in Korea and to examine the predictive power of the discriminant function model of hospital bankruptcy. Data on 17 financial and 4 non-financial indicators of 31 bankrupt and 31 profitable hospitals of 1, 2, and 3 years before bankruptcy were obtained from the hospital performance databank of Korea Institute of Health Services Management. Significant variables were identified through mean comparison of each indicator between bankrupt and profitable hospitals, and the discriminant function model of hospital bankruptcy was developed. The major findings are as follows : 1. As for profitability indicators, net worth to total assets, operating profit to total capital, operating profit ratio to gross revenues, normal profit to total assets, normal profit to gross revenues, net profit to total assets were significantly different in mean comparison test in 1, 2, and 3 years before hospital bankruptcy. With regard to liquidity indicators, current ratio and quick ratio were signifiant in 1 year before bankruptcy. For activity indicators, patients receivable turnover was significant in 2 and 3 years before bankruptcy and added value per adjusted inpatient days was significant in 3 years before bankruptcy. 2. The discriminant function in 1, 2, and 3 years before bankruptcy were; Z=-0.0166Xquick ratio - 0.1356Xnormal profit to total assets - 1.545 x total assets turnarounds in 1 year before bankruptcy, Z=-0.0119Xquick ratio - 0.1433Xoperating profit to total assets - 0.0227Xvalue added to total assets in 2 years before bankruptcy, and Z=-0.3533Xnet profit to total assets - 0.1336Xpatients receivables turnrounds - 0.04301Xadded value per adjusted patient + 0.00119Xaverage daily inpatient census in 3 years before bankruptcy.3. The discriminant function's discriminant power in 1, 2, and 3 years before bankruptcy was 77.42, 79.03, 82.25% respectively.
Summary
Quality of Life(QOL), Life Satisfaction, and Its Determinents of the Physically Disabled in Taegu City .
Youg Sook Lee, Keon Yeop Kim, Ki Soo Park, Jae Hee Son, Jong Young Lee
Korean J Prev Med. 1998;31(3):503-515.
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AbstractAbstract PDF
In order to investigate the factors influencing QOL and life satisfaction of the physically disabled, the author interviewed, by using structuralized questionnaire, 440 individuals among the physically disabled who were participated in Health Examination from April to July, 1997. The questionnaire consisted of the general characteristics(sex, age, marital status, family number, etc), the Reintegration to Normal Living Index(RNLI) to assess QOL, and the single item of five-likert scale to evaluate life satisfaction. The means of RNLI were 16.2+/-4.8 in total score, 12.2+/-3.4 in daily functioning and 4.0+/-2.1 in perception of self. The respondents were less reintegrated toward social activities and relationships than impairments or disabilities. While the satisfied group was 47.3%, the dissatisfied group was 52.7%. As the results of multiple regression and logistic regression analysis, the significant predictors of QOL were age, education, job, grade of disability and subjective health status. The life satisfaction were related to economic status, job and subjective health status. To improve QOL and life satisfaction of the physically disabled, it is important that we improve their basic socioeconomic status by getting a job through rehabilitation education and induce them to have positive self-assessment by extending the opportunity of social participation.
Summary
The Difference in Attitude toward Medical Care between Patients and Physicians.
Myung Geun Kang, Jong Ku Park, Han Joong Kim, Myong Sei Sohn, Dal Rae Kim
Korean J Prev Med. 1998;31(3):516-539.
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AbstractAbstract PDF
The objective of this study is to identify the difference in attitude toward medical care between patients who visited a university hospital or an oriental medical hospital of oriental medical college, and physicians who engaged in the same hospitals. The subjects of this study were 397 cases who agreed to respond the prepared questionnaire, including 288 patients(146 university hospital utilizers and 142 utilizers for an oriental medical hospital) and 109 physicians(76 physicians and 33 oriental medical doctors). The attitude toward medical care was measured by the structured questionnaire developed for this study, which had high validity and reliability according to factor analysis, item discriminant validity, and Cronbach's alpha coefficients. On the criteria of mean value of care and cure score, the attitude toward medical care was classified into 4 groups encompassing a group with dependent attitude on medical care, a group with skeptical attitude toward it, a group with cure-oriented attitude, and a group with care- preferred attitude. The results of chi-square test, discriminant analysis, and logistic regression analysis were as follows; patients who visited a university hospital, patients who visited an oriental hospital, physicians, and oriental medical doctors included in the group with dependent attitude, the group with cure-oriented attitude, the group with skeptical attitude, and the group with care-preferred attitude, retrospectively. Among the subdomains of care and cure domains, which classified in reference to the result of factor analysis on pilot study, those that patients ranked more importantly than physicians were 'the importance of medical equipment for diagnosis and treatment', 'authority of physician, 'aggressiveness of treatment', 'information giving', 'personal interest' in the case of western medicine. In the case of oriental medicine, those were 'the importance of equipment for diagnosis and treatment', 'aggressiveness of treatment', 'amenities and accessibility', 'coordination of medical staff'. Both physicans and patients put the subdomain, 'physicians' medical knowledge and skillfulness' on the highest rank. The differences in ranking the important attributes of medical care between patients and physicians were apparent in the area of an 'importance of medical equipment for diagnosis and treatment' and so on. It meant that patient had over-expectation on medical care and suggested that the policy on demand side such as the development and dissemination of an evidence-based recommendation protocol for health care consumers might be important in Korea. In addition, regarding the attitude of physicians, during the medical education and training it may be necessary to emphasize the aspect of 'care' of medical care rather than 'cure'. In planning on heath care delivery system, it should be considered that there is a difference in the attitude toward medical care between western medicine and oriental medicine as well as between health care providers and consumers. We expect that more valid measurement tool be developed in this area, which may be major limitation of this study and that this kind of research be expanded into the non-academic settings.
Summary

JPMPH : Journal of Preventive Medicine and Public Health