Journal of Preventive Medicine and Public Health

Original Articles

Therapeutic Compliance and Its Related Factors of Patients with Hypertension in Rural Area.: Sang Won Lee, Sin Kam, Byung Yeol Chun, Min Hae Yeh, Yun Sik Kang, Keon Yeop Kim, Young Sook Lee, Ki Soo Park, Jae Hee Son, Hee Sook Oh, Moon Young Ahn, Pu Dol Lim; Korean J Prev Med. 2000;33(2):215-225.

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Abstract PDF: OBJECTIVE
The purpose of this study was to examine the therapeutic compliance and its related factors in the rural hypertensives. METHOD: A questionnaire survey and blood pressure measurement were performed to 3,876 residents of a rural area, and 660 hypertensives were selected as subjects of study. The study employed a hypothetical model which was composed of constructs from the health belief model and KAP model. The analysis techniques employed included contingency table analysis and structural equation modeling. RESULT: The proportion of those who were compliant to the treatment of hypertension was 44.2% of subjects. As the result of structural equation modeling, when patients had more favorable attitude toward treatment, higher perceived benefit, or lower perceived barriers to treatment, the therapeutic compliance was significantly higher(T>2.0). When patients had more knowledge about hypertension, or higher perceived severity of hypertension, the attitude toward the treatment of hypertension was more favorable significantly(T>2.0). And when patients had the support for treatment from family or neighbor, the attitude toward treatment was more favorable(T>2.0). When patients had experience of health education, they had more knowledge, higher perceived susceptibility of complication, perceived severity for hypertension, and perceived benefit of treatment, compare to patients without health education(T>2.0). CONCLUSION: In consideration of above findings, in order to improve the therapeutic compliance in the rural hypertensives, it would be necessary to change attitude, perception, knowledge about hypertension and its treatment, by various methods such as effective health education and programs for maintaining the supportive environment for hypertension treatment.; Summary

A Study on the Family Burden of the Mentally Ill in a Rural Area.: Weon Young Lee, Young Jeon Shin, Jung Hoe Kim, Chung Hyun Nam, Ok Ryun Moon; Korean J Prev Med. 1999;32(3):400-414.

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Abstract PDF: OBJECTIVES
This is a descriptive study which was carried out to identify characteristics of the chronic mentally ill and their families in a rural area and the influencing factors on family burden. METHODS: Data was collected for seven months beginning April 1, 1998 by questionnaire from chronic mentally ill patients and their families in two towns and seven townships of the rural areas of Kyonggi Province. In additional to the mental diagnosis of the mentally ill patients, family burden was measured by interviewing the other family members using the questionnaire developed by Pai & Kapur (1981). Of those interviewed, 103 patients were selected for final analysis. RESULTS: Of 103 mentally ill patients, 36.1% of the subjects were not under treatment. In particular, of 29 patients with schizophrenia, 48.3% of the subjects had stopped taking medication and 6.9% of the subjects had never been treated. According to the results of a specialized examination by a psychologist, 81% of patients were in need of hospitalization. Most primary caregivers were parents. Of the 101 primary caregivers in the study, 39.6% were over 65 years old. In case of death of the primary caregiver, 50.5% of these 101 mentally ill patients would not have anyone to care for them. Of the various kinds of family burden, primary caregivers most often reported psychological stress. Overall, the families of dementia and schizophrenia patients complained of the most family burden. Through univariative analysis, the variables of sex, education and current treatment type of the patients, the relationship with the patient and marital status of the primary caregiver and the number of people living together in the household showed significant correlation with the family burden of schizophrenia patients. Univariative analysis also showed that there were a number of variables which were correlated to the family burden in mentally retarded patients. Concerning the need for mental health services, the most common requests were for entitlement to disability benefits and housing programs. CONCLUSIONS: Community mental health services in rural areas must be developed, planned and executed in consideration of the local situation. In particular, the development of various family support programs is needed in order to mitigate emotional, mental and economic burdens and carry out a positive role to care for and rehabilitate patients.; Summary

Association between Cognitive Impairment and ADL of the Elderly in Rural Area.: Sang Kyu Kim, Seok Beom Kim, Pock Soo Kang; Korean J Prev Med. 1999;32(1):65-71.

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Abstract PDF: OBJECTIVES
The purpose of this investigation was to study the correlation between cognitive impairment and activities of daily living(ADL) in the elderly of rural area. METHODS: The study population consisted of 210 elderly people aged 65 years and older, living in a district of Kyongju City. The cognitive impairment was measured with the Korean version of mini-mental state examination(MMSE-K) and newly constructed the Korean version of mini-mental state examination (K-MMSE). Bristol activities of daily living scale developed specifically to be used with people with dementia was used to measure ADL. RESULTS: The mean scores of both MMSE-K and K-MMSE were significantly different by sex groups and by age groups, respectively(p<0.05). The mean scores of ADL were significantly different by age groups(p<0.01) not by sex groups. Among the 4 components of ADL(instrumental activities of daily living(IADL), self care, orientation, and mobility), the mean score of the orientation was significantly higher in men(p<0.01); and IADL, orientation and mobility components were significantly different by age groups(p<0.01). ADL correlated well with MMSE-K (r=0.54) and K-MMSE(r=0.52) and showed higher correlation in female (r=0.73, 0.71) than male(r=0.27, 0.29). IADL and orientation showed significant correlation with MMSE-K(r=0.52, 0.62) and K-MMSE(r=0.50, 0.63), respectively(p<0.01). CONCLUSIONS: In developing and establishing a care model for people with dementia in the community, both cognitive impairment and the activities of daily living(ADL) need to be considered.; Summary

Health related practices and morbidity among adult in rural area.: Jue bok Song, Boo Ouk Rhee, Hai Rim Shin, Kap Yeol Jung, Joon Youn Kim; Korean J Prev Med. 1997;30(2):342-355.

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Abstract PDF: This research was carried out to determine the performance rate of health related practices, to measure the agreement between morbidity by doctor's diagnosis and morbidity by 'subject' self-reported and the degree of association between health related practices and morbidity rate by doctor's diagnosis, to identify their effects on morbidity among rural area populations. The data were gathered by volunteer residents(over the age of 20) of Haman Myeon, Haman Gun, Kyeongsangnam Do in Korea, from June 10, 1993 to June 12, 1993 (369 male and 516 female). Face to face interview, lab, chest P-A, EKG and physical examination were completed. Descriptive statistics, agreement analysis and multiple logistic regression procedures were employed for analyses. The results of the study were summarized as follows : 1) Age adjusted morbidity rates by doctor's diagnosis and self-reported were 38.5% (male:37.3%, female:36.5%), 26.4% (male:33.3%, female:27.5%), respectively. Kappa coefficient between morbidity by doctor's diagnosis and morbidity by self-reported was 0.21 (male:0.21, female:0.22). 2) The frequency of disease by doctor's diagnosis was as follows: hypertension (15.3%), gastritis (9.6%), diabetes mellitus (8.5%), liver disease (8.1%), and degenerative arthritis (6.2%) in the study population. 3) Order of health practice performance rate was as follows: Males- normal body weight (62.1%), non-heavy alcohol consumption (57.5%), 7-8 hours of sleeping (50.1%), non-smoking (21.7%), and exercise (19.8%). Females- non-heavy alcohol consumption (97.3%), non-smoking (84.7%), normal body weight (57.8%), 7-8 hours of sleeping (45.0%), and exercise (9.9%). 4) There was no significant relationship between health related practice and morbidity except exercise among health related practices. 5) Health related practice index which was recategorized by high, medium, and low had effects on the probability of developing morbidity.; Summary

The Study of Body Fat Percent Measured by Bioelectric Impedance Analyzer in a Rural Adult Population.: Baeg Ju Na, Yo Sub Park, Byung Hwan Sun, Hae Sung Nam, Jun Ho Shin, Seok Joon Sohn, Jin Su Choi; Korean J Prev Med. 1997;30(1):31-44.

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Abstract PDF: Obesity usually is defined as the presence of and abnormally amount of adipose tissue. In many epidemiologic study, obesity as a health risk factor has been estimated by Body Mass Index(BMI) in general. This study was conducted to review of body fat percent measured by Bioelectric impedance analyzer as a estimator of obesity in a rural adult population. The study subjects were 421 men and 664 women who reside in the area on the Juam lake. They were sampled by multistage cluster sampling. Their mean age was 59 years old. Body fat percent increased with age, but BMI decreased with age in this study. Body fat percent was more larger at female and elder on the same BMI. The correlation coefficient between with body fat percent and body mass index was low (r=0.4737). Body fat percent was explained by not only BMI but also sex and age (r(2)=0.63). The result suggested that it is inadequate for BMI only to estimate obesity about elderly person who reside in the rural community. The relation of body fat percent and body mass index of this study agreed with the preceding knowledges and studies in general.; Summary

Physician Utilization and its Determinants in Rural and Urban Slun Areas.: Jin Hee Lee, Kee Ho Ko, Yong Sik Kim, Jung Ae Rhee; Korean J Prev Med. 1988;21(2):404-418.

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Abstract PDF: The household survey was performed in a urban slum and a rural Chonnam areas to measure the level of illness and medical care utilization and to find the determinants of physician utilization. The data revealed that age-adjusted prevalence rates of acute and chronic diseases were much the same in both areas ranged between 10.0 to 11.3%. But medical care utilization was more frequent in urban slum than in rural area. The facility of the first medical contact was also different. Some personal and disease related variables including disease severity and activity restricted day were significantly, but somewhat differently by area, associated with physician utilization pattern. When applying Anderson model, the medical need factors explained 42.2 and 40.4% of physician utilization in urban slum and in rural areas respectively, while the enabling factors explained 18.0 and 12.2% and the predisposing factors explained 17.1 and 8.9% correspondingly.; Summary

Birth Registration Rate and Accuracy of Reported Birth Date in Rural Area.: Jung Han Park, Chang Yik Lee, Jang Rak Kim, Jung Hup Song, Min Hae Yeh, Seong Eok Cho; Korean J Prev Med. 1988;21(1):70-81.

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Abstract PDF: To measure the birth registration rate and the validity of birth registration data in rural area, all of the 4,014 married women under 49 years of age who had not been sterilized in Gunwee county of Kyungpook province were followed by Myun health workers for 2 years from April 1, 1985 to March 31, 1987 and 766 births were detected. All of the birth registration records of Myun offices were reviewed on September 30, 1987 and 944 births which occurred within the above mentioned period were found. Actual birth date obtained by follow-up study were compared with the birth date on registration card. Among 766 births detected by follow-up study, 576 births(75.2%) which were reported within 6 months after birth were ascertained on the official registration records and 96 births(12.5%) were not found on the records although mother stated that the birth was registered. The registration rate within legal due date was 61.3% among 576 births detected by follow-up study and also ascertained on the official records. The registration rate within legal due date was lower in mothers under 20 years of age and above 35 years and in mothers who had only primary education. It was decreased as the birth order increased. The registration rate was higher in births occurred from October to March than births occurred from April to September. All of the births of 7 neonatal deaths were not reported. The registered birth date was consistent with the actual birth date in 78.0%. Birth date on record was earlier than the actual birth date in 6.8% and later in 15.3%. The consistency rate was lower in mothers above 35 years of age(54.5%), and in infants of 4th birth order and above(56.3%). The rate was increased as the maternal education level increased. The rate of boys was higher than that of girls. A higher percentage(17.4%) of infants born in March was registered with earlier date than the actual birth date and most of these registered birth dates were lunar calendar date. This might be related with the age for entering the primary school. The study findings revealed that the birth registration rate within legal due date and accuracy of report have been increased in recent years, but the infant mortality rate derived from the birth registration seems to be very inaccurate. It is suggested to let the medical personnel who delivered the baby report the birth by mail directly to the current address of parent while infants delivered at home without professional attendant may comply with the present registration system.; Summary

A Follow-up Study of Fertility and Pregnancy Wastage of Women in Rural Area.: Jung Han Park, Sin Hyang Kim, Byung Yeol Chun, Gui Yeon Kim, Min Hae Yeh, Seong Eok Cho, Jae Yeon Cho; Korean J Prev Med. 1988;21(1):21-30.

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Abstract PDF: To measure the fertility rate and pregnancy wastage of women in rural area, 3,780 married women under 50 years old who were not sterilized either woman or husband in Gunwee county were followed up for 2 years. Seventeen Myun health workers visited these women periodically to check the status of their family planning practice and menstruation. Pregnant women were interviewed for their past obstetric history and followed up to the time of delivery. Family planning was practiced in 51.6% of the 6,826 women-years observed during the period from April 1, 1985 to March 31, 1987. Pregnancy, abortion and delivery covered 7.6% of the observed women years and family planning was not practiced in 36.5% of the women-years. When sterilized women at the beginning of the study were included, the family planning practice rate was 72.1% which was slightly higher than the national family planning practice rate. However, 28% of the women of 30-39 years old had not practiced family planning although they had 2-3 children and they used more such less effective methods as safe-period method and condom than the women of 20-29 years old. Overall pregnancy rate was 14.3 per 100 woman-years. Women of 25-29 years old had the highest pregnancy rate of 27.4 per 100 woman-years. Pregnancy wastage including spontaneous and induced abortions and still births was 22.0% of all pregnancies and it increased with the age of women; 15.8% in women less than 30 years old and 43.7% in women of 30 years and over. Women who terminated the pregnancy with induced abortion had more pregnancies, more previous induced and spontaneous abortions and shorter pregnancy interval than those women who terminated with live birth. Pregnant women terminated with a live birth had received 4.2 prenatal cares on the average. Eighty-five percent of deliveries occurred at a medical facility and 15% at home which was substantially lower home delivery rate than the other rural area of Korea. This may be due to the effects of the demonstration project for the primary health care in 1970s in Gunwee county. These findings suggest that family planning service in rural area should be strengthened by promoting the use of more effective contraceptive method among women over 30 years of age.; Summary

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