Journal of Preventive Medicine and Public Health

Special Article

Burden of Disease in Japan: Using National and Subnational Data to Inform Local Health Policy: Stuart Gilmour, Yi Liao, Ver Bilano, Kenji Shibuya; J Prev Med Public Health. 2014;47(3):136-143. Published online May 30, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.3.136

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The Global Burden of Disease (GBD) study has been instrumental in guiding global health policy development since the early 1990s. The GBD 2010 project provided rich information about the key causes of mortality, disability-adjusted life years, and their associated risk factors in Japan and provided a unique opportunity to incorporate these data into health planning. As part of the latest update of this project, GBD 2013, the Japanese GBD collaborators plan to update and refine the available burden of disease data by incorporating sub-national estimates of the burden of disease at the prefectural level. These estimates will provide health planners and policy makers at both the national and prefectural level with new, more refined tools to adapt local public health initiatives to meet the health needs of local populations. Moreover, they will enable the Japanese health system to better respond to the unique challenges in their rapidly aging population and as a complex combination of non-communicable disease risk factors begin to dominate the policy agenda. Regional collaborations will enable nations to learn from the experiences of other nations that may be at different stages of the epidemiological transition and have different exposure profiles and associated health effects. Such analyses and improvements in the data collection systems will further improve the health of the Japanese, maintain Japan's excellent record of health equity, and provide a better understanding of the direction of health policy in the region.

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Original Articles

Community Based Study for Stress and It's Related Factors.: Gyung Jae Oh, Jeong Mi Lee, Sang Sun Kil, Keun Sang Kwon; Korean J Prev Med. 2003;36(2):125-130.

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Abstract PDF: OBJECTIVES
This study evaluated the stress of community residents using the General Health Questionnaire, GHQ-60, as an instrument of stress measurement. METHODS: The study included 2100 residents, aged 20 and over, living in three areas, a large city, a medium sized city and a rural area, between June and September 2001. A questionnaire interviewing method was used to collect data. The data were analyzed using a t-test, ANOVA, Pearson's correlation coefficients and multiple regression analysis. RESULTS: In this study, the degree of stress, as measured by the GHQ-60, was shown to be significantly higher in the following categories: females, people over 60 years old, people engaged in the primary industries and labor work, low incomes, the divorced and the bereaved, people who received no more than an elementary education, people who suffer from chronic diseases and non-exercisers. A factor analysis suggested that there were three factors of social dysfunction factors; psychosomatic symptom, and depression and anxiety. The social dysfunction factors was statistically significant for the groups described above. The factor of psychosomatic symptoms was statistically significant in the rural residents, and in the groups described above. The depression and anxiety factor was statistically significant in the large city residents, people aged between 20-29 years, students, unmarried persons, university graduates and those having suffered from chronic diseases. From the multiple linear regression analyses, chronic disease, exercise, gender and income, proved to be significant stress related factors. CONCLUSIONS: This study suggests that special attention should be given to the management of the chronic invalided, non-exercisers, females and small income earners, in order to maintain and promote the psychological health of residents in a community.; Summary

Dimensions of Consumer Ratings of a Hospital Outpatient Service Quality.: Ki Tae Moon, Seung Hum Yu, Woo Hyun Cho, Dong Kee Kim, Yunwhan Lee; Korean J Prev Med. 2000;33(4):495-504.

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Abstract PDF: OBJECTIVES
To examine various dimensions of consumer ratings of health care service with factor analysis and to find which factors influence the overall quality of health care service. METHODS: A cross-sectional study was conducted on outpatients of a general hospital located in Sungnam City. A self-administered questionnaire was used to assess the consumer? ratings of health care service received. The response rate was 92.8% with a total of 537 persons completing the questionnaire. Factor analysis was performed on 34 items evaluating the quality of health care service. Items were grouped into 5 dimensions as a result of factor analysis and the reliability and validity of influence on patient service assessment were evaluated for each dimension. RESULTS: The 5 dimensions were as follows ; 1) physician services, 2) non-physician services, 3) process 4) facilities, and 5) cleanliness. A positive correlation with the quality of health care service was found for the dimensions of non-physician services and process, while no significant correlation was found for the dimensions of physician services, facilities, and cleanliness. CONCLUSIONS: The result of this study may provide basic information for the development of future self-administered questionnaires of consumer ratings and for the evaluation of quality improvement activities in hospital outpatient settings.; Summary

A study on the attitude affecting the preventive behavior for hearing conservation.: Kyung Yong Rhee, Kwan Hyung Yi; Korean J Prev Med. 1996;29(2):371-384.

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Abstract PDF: The purpose of this study is to investigate attitude factor related to hearing conservation and to find attitude affecting the preventive behavior for hearing conservation. The research method used in this study was self-administered questionnaire samples of the study were composed of 353 workers exposed noise selected randomly in 10 ship-building manufacturing companies. Authors extracted following 9 factors related hearing conservation from 26 attitude propositions prepared from previous study results and health belief model; (l) general perceived susceptibility, (2) relative perceived susceptibility compared with colleagues, (3) concern to the personal protective devices, (4) perceived severity and concern to the hearing capacity, (5) concern to the hearing and noise assessment, (6) concern to the control noise and hearing conservation, (7) group pressure and reason of wearing protective devices, (8) apathy of hearing loss from noise, (9) knowledge about hearing conservation Attitude factors affecting the preventive health behavior were general perceived susceptibility, concern to the noise control and hearing conservation, and concern to the personal protective devices in the case of wearing personal protective devices. But in the case of avoiding noise exposure as preventive health behavior, perceived severity and concern to the hearing capacity was a significant attitude factor with knowledge about hearing conservation.; Summary

Reliability and Validity of PWI (Psychosocial Wellbeing Index).: Chae Yong Lee, Jong Young Lee; Korean J Prev Med. 1996;29(2):255-264.

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Abstract PDF: To study reliability and validity of PWl, this newly developed self-administered questionnaire which measures stress, was given to medial students. All respondent(133) were followed 4 weeks later and 92 were retested. Cronbach's a coefficient of data was 0.93. Test-retest reliability measured by pearson's correlation coefficient was 0.72(p<0.01l). Exploratory factor analysis(EFA) performed by principal axis factor method without iteration and by varimax rotation explored 13 principal components(eigenvalues > l). After exploring 4 factor structure according to previous study results, factor 1 showed good agreement but other factors did not. Confirmatory factor analysis(CFA) showed poor fit of 4 factor model to data. In the further study, it may be considered to model that has unidimensional factor structure.; Summary

Community screening for stress by using General Health Questionnaire.: Soo Sung Oh, Kwang Seub Lee, Seok Joon Sohn, Jin Su Choi, Jung Ae Rhee; Korean J Prev Med. 1995;28(1):123-140.

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Abstract PDF: This study investigated the stress of community residents in Kwang-Ju and Chonnam areas by using the General Health Questionnaire(GHQ-60) as a instrument of stress measurement. The number of subject were 445 residents who lived in three areas (large city, middle city, and rural area) and they were individually interviewed in March, 1994. The result of study showed that the degrees of stress measured by GHQ-60 were statistically significant in the residents' area, age. sex variables: (a) the residents in middle city among three area had the highest level of stress: (b) the resident who were more than 60 in age had the highest level of stress: (c) the female resident had more stress than male residents: (d) particularly, the residents who were more than 60 years old in the middle city had the highest level of stress. Further, the results of factor analysis showed that there were three factors of social dysfunction, depression and anxiety, and psychosomatic symptom. The social dysfunction factor was statistically significant in both age and resident area variables. The depression and anxiety factor was statistically significant in the residents' area, age. sex variables. The psychosomatic symptom factor was statistically significant in both age and sex variables. The study suggested that they should give a special attention to solve the old people's stress because stress was closely related to residents age.; Summary

Measurement of Ambulatory Patients' Satisfaction and Its Influencing Factors in a Tertiary Hospital.: Sang Il Lee; Korean J Prev Med. 1994;27(2):366-376.

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Abstract PDF: Patients' evaluation of hospital care is one of the most important aspects of quality assessment. Survey allows patients to judge subjectively the events that occur during their hospital visit if performed properly. This study describes the result of a research effort to develop outpatient questionnaire that has sufficient validity and reliability to be used to measure patients' perception of satisfaction in Korea and to investigate influencing factors on patients' satisfaction. Self-administered questionnaire was developed for outpatient and the survey was conducted covering 827 outpatients in a tertiary hospital. It was confirmed by factor analysis that patients evaluate several components of ambulatory care distinctly ;hospital environment, administration and ancillary services, and medical care. We found strong evidence of construct validity and internal consistency for the above three dimensions of hospital process. On the contrary, reliability of overall outcome measures was low. It suggests that three items concerning overall outcome measures have some different meanings in patients' perception. Using logistic regression analysis it was found that previous health status, cost evaluation, and improvement in health status have significant influences on the level of patients' overall satisfaction and that patient's sex, experience of previous visit, expectation for improvement, cost evaluation, and improvement in health status are strongly related with intention to recommend hospital. In spite of some limitations the results of this study can be used helpfully as baseline informations for developing self-administered questionnaire and for exploring the influencing factors on patients' satisfaction. Further comprehensive research efforts should be made on the measurement of ambulatory patients' satisfaction and its related factors in current Korean situation.; Summary

A study on the factors afecting the subjective symptoms of VDT syndrome.: Jai Dong Moon, Min Chul Lee, Byong Woo Kim; Korean J Prev Med. 1991;24(3):373-389.

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Abstract PDF: In order to develop the measuring tool of VDT syndrome and investigate the variables affecting the development of VDT syndrome, a questionnaire study accompanied with the evaluation of working environment was performed with 138 VDT users from six public organs in Kwangju area. The result were summarized as follows: 1. As a result of analysis with data collected by newly developed questionnaire, VDT syndrome included five factors named as eye-related component, psychological component, general body component, musculoskeletal component, and skin-related component and the estimates of the internal consistency of five factors were 0.877, 0.820, 0.796, 0.791, 0.593 respectively. 2. Variables affecting the level of eye-related symptoms were the type of main job using VDT, the total time of VDT operation per day, and the use of external filter on CRT. 3. The level of eye-related symptoms in the group using external filter was higher significantly than that in the group not using filter. 4. The past history of severe illness affected the level of psychological symptoms significantly. 5. Variables affecting the level of general body symptoms were job satisfaction and income satisfaction. 6. Variables affecting the level of musculoskeletal symptoms were the type of main job using VDT, whether majored in EDPS, the level of typewriting, job satisfaction, and the total time of VDT, operation per day. 7. Age and the use of external filter were significantly related to the level of skin-related symptoms. 7. Age and the use of external filter were significantly related to the level of skin-related symptoms.; Summary

A Study on the Regional Function of Health Care by the Disease Pattern of the Inpatients.: Huyn Rim Choi, Sang Il Lee, Young Soo Shin, Yong Ik Kim; Korean J Prev Med. 1988;21(2):390-403.

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Abstract PDF: The objectives of the study were to provide the basic informations needed in the development of balanced medical services throughout the nation. As the national health care system was expanding rapidly along with the economic growth, quantitative re-evaluation of the system is of great need. For that reason, characteristics of the admitted patients were analyzed for the case-mix and patients' flow within and through regions. Materials were 421,530 cases of inpatients, who were reported through Medical Insurance Corporation(KMIC) for insurance claim, during the period of March 1, 1985 through February 28, 1987. Korean Diagnosis Related Groups(K-DRGs) classification system was adopted for the study of case-mix and 189 cities and countries were classified into 5 district groups by factor analysis results of K-DRGs. The major findings of this study were as follows ; 1) Factor analysis of case-mix, employing K-DRG system, revealed 5 distinct functional district groups. Group A(18 district) was prominent for tertiary medical care. In group B(36 districts), rather simple procedures were prevalent. Group C(26 districts) was distinctive for the medical care of well organized internal medicine practices with qualified clinical laboratories. Group D(17 districts) was characterized by relatively high balanced medical care. Group E (92 districts) was with very low level of medical care. 2) Analysis of the case-flow through the districts showed 3 types of flow patterns ; inflow, outflow, and balanced types. Inflow type of case-flow was found in Group A, C and D while Group B and E showed outflow type. Inflow was most prominent in Group A and Group E was of typical outflow type. Group B was consistently the outflow type except for Major Diagnostic Category XX regardless of the disease treaders, but Group C and D were inflow or outflow types according to the disease tracers.; Summary

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