Journal of Preventive Medicine and Public Health

Original Articles

Cancer Patients’ Utilization of Tertiary Hospitals in Seoul Before and After the Benefit Expansion Policy: Sanghyun Cho, Youngs Chang, Yoon Kim; J Prev Med Public Health. 2019;52(1):41-50. Published online January 4, 2019; DOI: https://doi.org/10.3961/jpmph.18.166

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Abstract Summary PDF Supplementary Material

Objectives
The aim of this study was to investigate cancer patients’ utilization of tertiary hospitals in Seoul before and after the benefit expansion policy implemented in 2013.
Methods
This was a before-and-after study using claims data of the Korean National Health Insurance Service from 2011 to 2016. The unit of analysis was inpatient episodes, and inpatient episodes involving a malignant neoplasm (International Classification of Diseases, Tenth Revision codes: C00-C97) were included in this study. The total sample (n=5 565 076) was divided into incident cases and prevalent cases according to medical use due to cancer in prior years. The tertiary hospitals in Seoul were divided into two groups (the five largest hospitals and the other tertiary hospitals in Seoul).
Results
The proportions of the incident and prevalent episodes occurring in tertiary hospitals in Seoul were 34.9% and 37.2%, respectively, of which more than 70% occurred in the five largest hospitals in Seoul. Utilization of tertiary hospitals in Seoul was higher for inpatient episodes involving cancer surgery, patients with a higher income, patients living in areas close to Seoul, and patients living in areas without a metropolitan city. The utilization of the five largest hospitals increased by 2 percentage points after the policy went into effect.
Conclusions
The utilization of tertiary hospitals in Seoul was concentrated among the five largest hospitals. Future research is necessary to identify the consequences of this utilization pattern.

Summary

Korean summary
2014년부터 2016년까지 암 발생자 입원의 34.9%가 서울 소재 상급종합병원에서 이루어졌으며, 그중 73.9%가 5대 상급종합병원에서 이루어졌다. 4대 중증질환 보장성 강화 정책 후에 암환자의 서울 소재 상급종합병원 이용은 6.1%(2% 포인트) 증가하였으며, 5대 상급종합병원 이용률은 증가(정책 전: 23.6%, 정책 후: 25.8%), 그 외 서울 소재 상급종합병원 이용률은 감소하였다(정책 전: 9.3%, 정책 후: 9.1%).

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Evaluation of Geographic Indices Describing Health Care Utilization: Agnus M. Kim, Jong Heon Park, Sungchan Kang, Yoon Kim; J Prev Med Public Health. 2017;50(1):29-37. Published online December 19, 2016; DOI: https://doi.org/10.3961/jpmph.16.099

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Abstract PDF

Objectives
The accurate measurement of geographic patterns of health care utilization is a prerequisite for the study of geographic variations in health care utilization. While several measures have been developed to measure how accurately geographic units reflect the health care utilization patterns of residents, they have been only applied to hospitalization and need further evaluation. This study aimed to evaluate geographic indices describing health care utilization.
Methods
We measured the utilization rate and four health care utilization indices (localization index, outflow index, inflow index, and net patient flow) for eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee replacement surgery, caesarean sections, hysterectomy, computed tomography scans, and magnetic resonance imaging scans) according to three levels of geographic units in Korea. Data were obtained from the National Health Insurance database in Korea. We evaluated the associations among the health care utilization indices and the utilization rates.
Results
In higher-level geographic units, the localization index tended to be high, while the inflow index and outflow index were lower. The indices showed different patterns depending on the procedure. A strong negative correlation between the localization index and the outflow index was observed for all procedures. Net patient flow showed a moderate positive correlation with the localization index and the inflow index.
Conclusions
Health care utilization indices can be used as a proxy to describe the utilization pattern of a procedure in a geographic unit.

Summary

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Timothy A. Reistetter, Julianna M. Dean, Allen M. Haas, John D. Prochaska, Daniel C. Jupiter, Karl Eschbach, Yong-Fang Kuo
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The Effect of Geographic Units of Analysis on Measuring Geographic Variation in Medical Services Utilization: Agnus M. Kim, Jong Heon Park, Sungchan Kang, Kyosang Hwang, Taesik Lee, Yoon Kim; J Prev Med Public Health. 2016;49(4):230-239. Published online July 14, 2016; DOI: https://doi.org/10.3961/jpmph.16.034

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Abstract PDF Supplementary Material

Objectives
We aimed to evaluate the effect of geographic units of analysis on measuring geographic variation in medical services utilization. For this purpose, we compared geographic variations in the rates of eight major procedures in administrative units (districts) and new areal units organized based on the actual health care use of the population in Korea.
Methods
To compare geographic variation in geographic units of analysis, we calculated the age–sex standardized rates of eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee-replacement surgery, caesarean section, hysterectomy, computed tomography scan, and magnetic resonance imaging scan) from the National Health Insurance database in Korea for the 2013 period. Using the coefficient of variation, the extremal quotient, and the systematic component of variation, we measured geographic variation for these eight procedures in districts and new areal units.
Results
Compared with districts, new areal units showed a reduction in geographic variation. Extremal quotients and inter-decile ratios for the eight procedures were lower in new areal units. While the coefficient of variation was lower for most procedures in new areal units, the pattern of change of the systematic component of variation between districts and new areal units differed among procedures.
Conclusions
Geographic variation in medical service utilization could vary according to the geographic unit of analysis. To determine how geographic characteristics such as population size and number of geographic units affect geographic variation, further studies are needed.

Summary

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Agnus M. Kim, Jong Heon Park, Seongcheol Cho, Sungchan Kang, Tae Ho Yoon, Yoon Kim
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The Impact of an Emergency Fee Increase on the Composition of Patients Visiting Emergency Departments: Hyemin Jung, Young Kyung Do, Yoon Kim, Junsoo Ro; J Prev Med Public Health. 2014;47(6):309-316. Published online November 24, 2014; DOI: https://doi.org/10.3961/jpmph.14.044

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Abstract PDF: Objectives
This study aimed to test our hypothesis that a raise in the emergency fee implemented on March 1, 2013 has increased the proportion of patients with emergent symptoms by discouraging non-urgent emergency department visits.
Methods
We conducted an analysis of 728 736 patients registered in the National Emergency Department Information System who visited level 1 and level 2 emergency medical institutes in the two-month time period from February 1, 2013, one month before the raise in the emergency fee, to March 31, 2013, one month after the raise. A difference-in-difference method was used to estimate the net effects of a raise in the emergency fee on the probability that an emergency visit is for urgent conditions.
Results
The percentage of emergency department visits in urgent or equivalent patients increased by 2.4% points, from 74.2% before to 76.6% after the policy implementation. In a group of patients transferred using public transport or ambulance, who were assumed to be least conscious of cost, the change in the proportion of urgent patients was not statistically significant. On the other hand, the probability that a group of patients directly presenting to the emergency department by private transport, assumed to be most conscious of cost, showed a 2.4% point increase in urgent conditions (p<0.001). This trend appeared to be consistent across the level 1 and level 2 emergency medical institutes.
Conclusions
A raise in the emergency fee implemented on March 1, 2013 increased the proportion of urgent patients in the total emergency visits by reducing emergency department visits by non-urgent patients.; Summary

Variations in the Hospital Standardized Mortality Ratios in Korea: Eun-Jung Lee, Soo-Hee Hwang, Jung-A Lee, Yoon Kim; J Prev Med Public Health. 2014;47(4):206-215. Published online July 31, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.4.206

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113 Download
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Abstract PDF

Objectives
The hospital standardized mortality ratio (HSMR) has been widely used because it allows for robust risk adjustment using administrative data and is important for improving the quality of patient care.
Methods
All inpatients discharged from hospitals with more than 700 beds (66 hospitals) in 2008 were eligible for inclusion. Using the claims data, 29 most responsible diagnosis (MRDx), accounting for 80% of all inpatient deaths among these hospitals, were identified, and inpatients with those MRDx were selected. The final study population included 703 571 inpatients including 27 718 (3.9% of all inpatients) in-hospital deaths. Using logistic regression, risk-adjusted models for predicting in-hospital mortality were created for each MRDx. The HSMR of individual hospitals was calculated for each MRDx using the model coefficients. The models included age, gender, income level, urgency of admission, diagnosis codes, disease-specific risk factors, and comorbidities. The Elixhauser comorbidity index was used to adjust for comorbidities.
Results
For 26 out of 29 MRDx, the c-statistics of these mortality prediction models were higher than 0.8 indicating excellent discriminative power. The HSMR greatly varied across hospitals and disease groups. The academic status of the hospital was the only factor significantly associated with the HSMR.
Conclusions
We found a large variation in HSMR among hospitals; therefore, efforts to reduce these variations including continuous monitoring and regular disclosure of the HSMR are required.

Summary

Citations

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Development and Application of New Risk-Adjustment Models to Improve the Current Model for Hospital Standardized Mortality Ratio in South Korea
Hyeki Park, Ji-Sook Choi, Min Sun Shin, Soomin Kim, Hyekyoung Kim, Nahyeong Im, Soon Joo Park, Donggyo Shin, Youngmi Song, Yunjung Cho, Hyunmi Joo, Hyeryeon Hong, Yong-Hwa Hwang, Choon-Seon Park
Yonsei Medical Journal.2025; 66(3): 179. CrossRef
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A New Disability-related Health Care Needs Assessment Tool for Persons With Brain Disorders: Yoon Kim, Sang June Eun, Wan Ho Kim, Bum-Suk Lee, Ja-Ho Leigh, Jung-Eun Kim, Jin Yong Lee; J Prev Med Public Health. 2013;46(5):282-290. Published online September 30, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.5.282

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Abstract PDF

Objectives

This study aimed to develop a health needs assessment (HNA) tool for persons with brain disorders and to assess the unmet needs of persons with brain disorders using the developed tool.

Methods

The authors used consensus methods to develop a HNA tool. Using a randomized stratified systematic sampling method adjusted for sex, age, and districts, 57 registered persons (27 severe and 30 mild cases) with brain disorders dwelling in Seoul, South Korea were chosen and medical specialists investigated all of the subjects with the developed tools.

Results

The HNA tool for brain disorders we developed included four categories: 1) medical interventions and operations, 2) assistive devices, 3) rehabilitation therapy, and 4) regular follow-up. This study also found that 71.9% of the subjects did not receive appropriate medical care, which implies that the severity of their disability is likely to be exacerbated and permanent, and the loss irrecoverable.

Conclusions

Our results showed that the HNA tool for persons with brain disorders based on unmet needs defined by physicians can be a useful method for evaluating the appropriateness and necessity of medical services offered to the disabled, and it can serve as the norm for providing health care services for disabled persons. Further studies should be undertaken to increase validity and reliability of the tool. Fundamental research investigating the factors generating or affecting the unmet needs is necessary; its results could serve as basis for developing policies to eliminate or alleviate these factors.

Summary

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Age-Stratified Risk of Severe COVID-19 for People With Disabilities in Korea: Nationwide Study Considering Disability Type
Boyeong Ryu, Hoyeon Jang, Jaiyong Kim, Sung-il Cho, Seong-Sun Kim
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Improving the Performance of Risk-adjusted Mortality Modeling for Colorectal Cancer Surgery by Combining Claims Data and Clinical Data: Won Mo Jang, Jae-Hyun Park, Jong-Hyock Park, Jae Hwan Oh, Yoon Kim; J Prev Med Public Health. 2013;46(2):74-81. Published online March 28, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.2.74

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Abstract PDF

Objectives

The objective of this study was to evaluate the performance of risk-adjusted mortality models for colorectal cancer surgery.

Methods

We investigated patients (n=652) who had undergone colorectal cancer surgery (colectomy, colectomy of the rectum and sigmoid colon, total colectomy, total proctectomy) at five teaching hospitals during 2008. Mortality was defined as 30-day or in-hospital surgical mortality. Risk-adjusted mortality models were constructed using claims data (basic model) with the addition of TNM staging (TNM model), physiological data (physiological model), surgical data (surgical model), or all clinical data (composite model). Multiple logistic regression analysis was performed to develop the risk-adjustment models. To compare the performance of the models, both c-statistics using Hanley-McNeil pair-wise testing and the ratio of the observed to the expected mortality within quartiles of mortality risk were evaluated to assess the abilities of discrimination and calibration.

Results

The physiological model (c=0.92), surgical model (c=0.92), and composite model (c=0.93) displayed a similar improvement in discrimination, whereas the TNM model (c=0.87) displayed little improvement over the basic model (c=0.86). The discriminatory power of the models did not differ by the Hanley-McNeil test (p>0.05). Within each quartile of mortality, the composite and surgical models displayed an expected mortality ratio close to 1.

Conclusions

The addition of clinical data to claims data efficiently enhances the performance of the risk-adjusted postoperative mortality models in colorectal cancer surgery. We recommended that the performance of models should be evaluated through both discrimination and calibration.

Summary

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Jon Helgeland, Doris Tove Kristoffersen, Katrine Damgaard Skyrud, Anja Schou Lindman, Alanna M Chamberlain
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The Relationship Between the Social Network of Community-living Elders and Their Health-related Quality of Life in Korean Province: Jun Tae Lim, Jong-Heon Park, Jin-Seok Lee, Juhwan Oh, Yoon Kim; J Prev Med Public Health. 2013;46(1):28-38. Published online January 31, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.1.28

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Abstract PDF

Objectives

This study aimed to collect information that will help enhance the social networks and improve the quality of life among elderly people by observing the relationship between their social network and health-related quality of life (HRQoL) and by analyzing social network factors affecting HRQoL.

Methods

This study was based on the 2008 Community Health Survey in Yeoncheon County. Three hundred elders were included in the study population. We compared the revised Lubben Social Network Scale (LSNS-R) score and Euro quality of life-5 dimensions health status index by demographic characteristics and chronic disease prevalence. We analyzed the data using multiple regression and tobit regression by setting the HRQoL as the dependent variable and social network and other characteristics as the independent variables. We analyzed social network factors by using factor analysis.

Results

The LSNS-R score differed significantly according to age and existence of a spouse. According to the results from the hierarchical multiple regression analysis, the LSNS-R explained 0.10 of the variance and LSNS-R friends factor explained 0.10 of the variance. The tobit regression indicated that the contribution of the LSNS-R family size factor to the regression coefficient of the independent variable that affected the HRQoL was B_T=2.96, that of the LSNS-R family frequency factor was B_T=3.60, and that of LSNS-R friends factor was B_T=5.41.

Conclusions

Social networks among elderly people had a significant effect on HRQoL and their networks of friends had a relatively higher effect than those of family members.

Summary

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Differences in Obesity Rates Between People With and Without Disabilities and the Association of Disability and Obesity: A Nationwide Population Study in South Korea: Moo-Kyung Oh, Hyeongap Jang, Yong-Ik Kim, Belong Jo, Yoon Kim, Jong-Heon Park, Jin-Seok Lee; J Prev Med Public Health. 2012;45(4):211-218. Published online July 31, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.4.211

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Abstract PDF

Objectives

The objective of this study was to identify the differences in obesity rates among people with and without disabilities, and evaluate the relationship between obesity rates and the existence of disabilities or characteristics of disabilities.

Methods

Mass screening data from 2008 from the National Disability Registry and National Health Insurance (NHI) are used. For analysis, we classified physical disability into three subtypes: upper limb disability, lower limb disability, and spinal cord injury. For a control group, we extracted people without disabilities by each subtype. To adjust for the participation rate in the NHI mass screening, we calculated and adopted the weight stratified by sex, age, and grade of disability. Differences in obesity rates between people with and without disabilities were examined by a chi-squared test. In addition, the effect of the existence of disabilities and grade of disabilities on obesity was examined by multiple logistic regression analysis.

Results

People with disabilities were found to have a higher obesity rate than those without disabilities. The obesity rates were 35.2% and 35.0% (people with disabilities vs. without disabilities) in the upper limb disability, 44.5% and 34.8% in the lower limb disability, 43.4% and 34.6% in the spinal cord injury. The odds for existence of physical disability and grade of disability are higher than the non-disabilities.

Conclusions

These results show that people with physical disability have a higher vulnerability to obesity.

Summary

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Research Support, Non-U.S. Gov't

Effect of Repeated Public Releases on Cesarean Section Rates.: Won Mo Jang, Sang Jun Eun, Chae Eun Lee, Yoon Kim; J Prev Med Public Health. 2011;44(1):2-8.; DOI: https://doi.org/10.3961/jpmph.2011.44.1.2

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Abstract PDF

OBJECTIVES
Public release of and feedback (here after public release) on institutional (clinics and hospitals) cesarean section rates has had the effect of reducing cesarean section rates. However, compared to the isolated intervention, there was scant evidence of the effect of repeated public releases (RPR) on cesarean section rates. The objectives of this study were to evaluate the effect of RPR for reducing cesarean section rates. METHODS: From January 2003 to July 2007, the nationwide monthly institutional cesarean section rates data (1 951 303 deliveries at 1194 institutions) were analyzed. We used autoregressive integrated moving average (ARIMA) time-series intervention models to assess the effect of the RPR on cesarean section rates and ordinal logistic regression model to determine the characteristics of the change in cesarean section rates. RESULTS: Among four RPR, we found that only the first one (August 29, 2005) decreased the cesarean section rate (by 0.81 percent) and continued to have an impact period through the last observation in May 2007. Baseline cesarean section rates (OR, 4.7; 95% CI, 3.1 to 7.1) and annual number of deliveries (OR, 2.8; 95% CI, 1.6 to 4.7) of institutions in the upper third of each category at before first intervention had a significant contribution to the decrease of cesarean section rates. CONCLUSIONS: We could not found the evidence that RPR has had the significant effect of reducing cesarean section rates. Institutions with upper baseline cesarean section rates and annual number of deliveries were more responsive to RPR.

Summary

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Utilization of Acid Suppressants After Withdrawal of Ranitidine in Korea: An Interrupted Time Series Analysis
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Changes in cesarean section rate before and after the end of the Korean Value Incentive Program
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Khic-Houy Prang, Roxanne Maritz, Hana Sabanovic, David Dunt, Margaret Kelaher, Lamberto Manzoli
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International Journal for Quality in Health Care.2021;[Epub] CrossRef
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English Abstracts

The Change in Readmission Rate, Length of Stay and Hospital Charge after Performance Reporting of Hip Hemiarthroplasty.: Won Mo Jang, Sang Jun Eun, Pilyoung Sagong, Chae Eun Lee, Moo Kyung Oh, Juhwan Oh, Yoon Kim; J Prev Med Public Health. 2010;43(6):523-534.; DOI: https://doi.org/10.3961/jpmph.2010.43.6.523

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OBJECTIVES
We assessed impact of performance reporting information about the readmission rate, length of stay and cost of hip hemiarthroplasty. METHODS: The data are from a nationwide claims database, National Quality Improvement Project database, of Health Insurance Review & Assessment Service in Korea. From January 2006 to April 2008, we received information of length of stay, readmission within 30 days, cost of 22 851 hip hemiarthroplasty episodes. Each episodes has retained the diagnoses of comorbidities and demographics. We used time-series analysis to assess the shifting of patients selections, between high volume(over 16 operations in a year) and low volume institutions, after performance reporting (december 2007). The changes of quality (readmission, length of stay) and cost were evaluated by multilevel analysis with adjustment of patient's factors and institutional factors after performance reporting. RESULTS: As compared with the before performance reporting, the proportion of patients who choose the high volume institution, increased 3.45% and the trends continued 4 months at marginal significance (p=0.059). After performance reporting, national average readmission rate, length of stay were decreased by 0.49 OR (95% CI=0.25-0.95) and 10% (beta=-0.102 p<0.01) and cost was not changed (beta=-0.01, p<0.27). The high volume institutions were more decreased than low volume in length of stay. CONCLUSIONS: After performance reporting, readmission rate, length of stay were decreased and the patient selections were marginal shifted from low volume institutions to high volume institutions.

Summary

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The factors influencing variation by local areas in antibiotics prescription rate according to the public reporting
Yu-Jin Chun, Chang-Yup Kim
Health Policy and Management.2012; 22(3): 427. CrossRef

Patterns of Unintentional Domestic Injuries in Korea.: Eun Jung Lee, Jin Seok Lee, Yoon Kim, Kunhee Park, Sang Jun Eun, Soo Kyung Suh, Yong Ik Kim; J Prev Med Public Health. 2010;43(1):84-92.; DOI: https://doi.org/10.3961/jpmph.2010.43.1.84

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OBJECTIVES
To investigate the patterns of unintentional home injuries in Korea. METHODS: The study population was 12,382,088 people who utilized National Health Insurance services due to injuries (main diagnosis codes S00 to T28) during 2006. Stratified samples(n=459,501) were randomly selected by sex, age group and severity of injury. A questionnaire was developed based on the International Classification of External Causes of Injury and 18,000 cases surveyed by telephone were analyzed after being projected into population proportionately according to the response rates of their strata. Domestic injury cases were finally included. RESULTS: Domestic injuries (n=3,804) comprised 21.1% of total daily life injuries during 2006. Women were vulnerable to home injuries, with the elderly and those of lower income (medical-aid users) tending to suffer more severe injuries. Injury occurred most often due to a slipping fall (33.9%), overexertion (15.3%), falling (9.5%) and stumbling (9.4%), with severe injury most often resulting from slipping falls, falls and stumbles. Increasing age correlated with domestic injury-related disability. CONCLUSIONS: The present findings provide basic information for development of home injury prevention strategies, with focus on the elderly.

Summary

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Ji‐Young Son, Jaehyung Lim, Dong‐Hun Han
Dental Traumatology.2024; 40(5): 537. CrossRef
The meaning and principles of damage control surgery
Gil Jae Lee
Journal of the Korean Medical Association.2024; 67(12): 732. CrossRef
Relationships between trauma death, disability, and geographic factors: a systematic review
Bona Hwang, Taewook Jeong, Jiyeon Jo
Clinical and Experimental Emergency Medicine.2023; 10(4): 426. CrossRef
The Relationship between Injury and Socioeconomic Status in Reference to the Fourth Korean National Health and Nutrition Examination Survey
Sung-Kyung Kim, Hyocher Kim, Kyungsuk Lee, Hee-Tae Kang, Sung-Soo Oh, Sang Baek Ko
Annals of Occupational and Environmental Medicine.2014;[Epub] CrossRef
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Sung-Kyung Kim, Ji-Min Son, Jae-Young So, Hyocher Kim, Kyungsuk Lee, Sung-Soo Oh, Sang Ko
Annals of Occupational and Environmental Medicine.2013; 25(1): 29. CrossRef
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Medical Care Utilization Status and Associated Factors with Extended Hospitalization of Psychiatric Patients in Korea.: Soo Kyung Suh, Yoon Kim, Jong Ik Park, Myung Soo Lee, Hong Suk Jang, Sun Young Lee, Jin Seok Lee; J Prev Med Public Health. 2009;42(6):416-423.; DOI: https://doi.org/10.3961/jpmph.2009.42.6.416

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OBJECTIVES
This study was performed to examine medical care utilization of psychiatric patients and to explore patients' characteristics associated with extended hospitalization. METHODS: Data were extracted from information of Korean Health Insurance Review and Assessment Service. All data associated with admission and outpatient clinic visit were analysed by patient characteristics. We selected first psychiatric admission patients who diagnosed mental and behavioral disorders due to use of alcohol (main disease code: F10), schizophrenia and related disorders (F20-29) and mood disorders (F30~33) from January to June 2005. We analysed status of admission, mean length of stay, regular access to outpatient clinic and rates of extended hospitalization during 3 years. Bivariate and multivariate analyses were conducted to identify factors associated with extended hospitalization. RESULTS: The number of psychiatric patients during the first six month of 2005 was 30,678. The mean length of stay was longest for schizophrenia and related disorders but shortest for mood disorders. Patients who experienced an extended hospitalization were 18.8% of total subjects. An extended hospitalization was more common in schizophrenia and related disorders than other diagnostic groups. The factors associated with the extended hospitalization were age, sex, diagnostic group, type of insurance and medical care utilization groups. CONCLUSIONS: The study indicates the problem of an extended hospitalization for psychiatric patients in Korea. It is suggested that variations in rates of extended hospitalization among medical care utilization group may need an active early intervention system in psychiatric treatment service. Particular attention needs to be devoted to planning and funding for reducing extended hospitalization.

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Evaluation Studieses

The Socioeconomic Cost of Injuries in South Korea.: Kunhee Park, Jin Seok Lee, Yoon Kim, Yong Ik Kim, Jaiyong Kim; J Prev Med Public Health. 2009;42(1):5-11.; DOI: https://doi.org/10.3961/jpmph.2009.42.1.5

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Abstract PDF

OBJECTIVES
This study was conducted to estimate the socioeconomic cost of injuries in South Korea. METHODS: We matched claims data from national health insurance, automobile insurance and industrial accident compensation insurance (IACI), and mortality data obtained from the national statistical office from 2001 to 2003 by patients' unique identifier. Socioeconomic cost included both direct cost and indirect cost: the direct cost was injury-related medical expenditure and the indirect cost included loss of productivity due to healthcare utilization and premature death. RESULTS: The socioeconomic cost of injuries in Korea was approximately 1.9% of the GDP from 2001 to 2003. That is, 12.1 trillion KRW (Korean Won) in 2001, 12.3 trillion KRW in 2002, and 13.7 trillion KRW in 2003. In 2003, direct medical costs were 24.6% (3.4 trillion KRW), the costs for loss of productivity by healthcare utilization were 13.0% (1.8 trillion KRW), and the costs for loss of productivity by premature death were 62.4% (8.6 trillion KRW). CONCLUSIONS: In this study, the socioeconomic cost of injuries in Korea between 2001 and 2003 was estimated by using not only health insurance claims data, but also automobile insurance, IACI claims and mortality data. We conclude that social efforts are required to reduce the socioeconomic cost of injuries in Korea, which represented approximately 1.9% of the GDP for the time period specified.

Summary

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Association between the Pattern of Prophylactic Antibiotic Use and Surgical Site Infection Rate for Major Surgeries in Korea.: Pilyong Sakong, Jin Seok Lee, Eun Jung Lee, Kwang Pil Ko, Cheol Hwan Kim, Yoon Kim, Yong Ik Kim; J Prev Med Public Health. 2009;42(1):12-20.; DOI: https://doi.org/10.3961/jpmph.2009.42.1.12

6,817 View
98 Download
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Abstract PDF

OBJECTIVES
The purpose of this study was to analyze the association between the pattern of prophylactic antibiotic use (PAU) and the surgical site infection (SSI) rate for major surgeries in Korea. METHODS: We retrospectively reviewed the medical records of patients who underwent cardiac, colon and gastric surgery, hysterectomies and hip/knee replacements at 20 hospitals, and inclusive of over 500 beds. We randomly sampled 60 cases per surgery type for patients discharged between September and November, 2006. A total fo 2,924 cases were included in our analysis. Cox's proportional hazard analysis was conducted to evaluate the association between the pattern of PAU and SSI rate. RESULTS: The proportion of patients who received their first prophylactic antibiotics (PA) 1 hour before incision was 65.5%, who received inappropriate PAs was 80.8%, and the proportion of patients whose PA was discontinued within 24 hours of surgery was 0.5%. The average duration of PAU after surgery was 9 days. The relative risk (RR) of SSI in patients who received their first PA more than 1 hour before incision was significantly higher than for those who received it within 1 hour prior to incision (RR=8.20, 95% CI=4.81-13.99). Inappropriate PA selection increased SSI rate, albeit with marginal significance (RR=1.97, 95% CI=0.96-4.03). Also, prolonged PAU following surgery had no effect on SSI rate. CONCLUSIONS: These results suggest that the pattern of PAU in the surgeries examined was not appropriate. Errors in the timing of PAU and of PA selection increase SSI rate. SSI rate remained unaltered following prolonged PAU after surgery.

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The effect of first- and third-generation prophylactic antibiotics on hospitalization and medical expenditures for cardiac surgery
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Han Deok Kwak, Dong Jin Choi, Si Uk Woo, Jin Kim, Jun Won Um, Seon Hahn Kim
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English Abstracts

Factors Affecting Social Distance toward Mental Illness: A Nationwide Telephone Survey in Korea.: Sangjun Moon, Jin Seok Lee, Sue Kyung Park, Sun Young Lee, Yoon Kim, Yong Ik Kim, Youngsoo Shin; J Prev Med Public Health. 2008;41(6):419-426.; DOI: https://doi.org/10.3961/jpmph.2008.41.6.419

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OBJECTIVE
The purpose of this study was to investigate impact of knowledge, familiarity, and prejudice about mental illness as well as demographic factors on the social distance from mentally ill people, which is a proxy measure of discrimination. METHOD: To assess the impact of knowledge and familiarity, prejudice about mental illness and demographic factors on the social distance from mental illness, we conducted a telephone survey in South Korea with the responders being nationally representative people who were 18 years old or over (n=1040). Independent samples T-tests, one way ANOVA and linear regression analysis were performed to analyze the results of the survey. RESULT: The social distance from mental illness decreased as the knowledge and familiarity increased, but the social distance was increased as prejudice was increased. Prejudice had a greater impact on social distance than familiarity and knowledge. Females showed greater social distance than did males. A higher education level had a negative effect on social distance. CONCLUSION: To reduce the social distance from mentally ill people, efforts to increase the familiarity about mental illness as well as efforts to educate people about mental illness are important.

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Claire Nee, Clare Witt
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Factors Affecting Public Prejudice and Social Distance on Mental Illness: Analysis of Contextual Effect by Multi-level Analysis
Hyeongap Jang, Jun-Tae Lim, Juhwan Oh, Seon-Young Lee, Yong-Ik Kim, Jin-Seok Lee
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The Incidence and Patterns of Unintentional Injuries in Daily Life in Korea: A Nationwide Study.: Kunhee Park, Sang Jun Eun, Eun Jung Lee, Chae Eun Lee, Doo Yong Park, Kyounghun Han, Yoon Kim, Jin Seok Lee; J Prev Med Public Health. 2008;41(4):265-271.; DOI: https://doi.org/10.3961/jpmph.2008.41.4.265

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OBJECTIVES
This study was conducted to estimate the cumulative incidence rate (CIR) of unintentional injuries in Korean daily life and to describe the pattern of unintentional injuries. METHODS: The study population was the people who used the National Health Insurance because of injuries (ICD code: S00~T98) during 2006. The stratified sample according to gender, age and the severity of injury (NISS, New Injury Severity Score) was randomly selected. The questions on the questionnaire were developed as a reference for an international classification tool (ICECI, International Classification of External Causes of Injury). The questions included the locations of injury, the mechanisms of injury and the results of injury. Moreover, we used age, gender, region and income variables for analysis. RESULTS: The CIR of unintentional injuries that occurred in daily life for 1 year per 100,000 persons was 17,606, and the CIR of severe injuries was 286. Many injuries were occurred at home (29.6%), public places (19.0%), school (13.7%) and near home (12.0%). The major mechanisms of injuries were slipping (48.8%), contact (14.0%), physical over-exertion (13.8%), and fall (6.6%). Infants and old aged people were vulnerable to injuries, and those who lived rural area and who were in a low income level were vulnerable too. CONCLUSIONS: We signified the risk groups and risk settings of unintentional injuries in Korean daily life. These results could contribute to establishing strategies for injury prevention and implementing these strategies.

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Min Kyoung Kim, Nam Soo Park, So Hyeong Kim
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Association between Falls and Nutritional Status of Community-Dwelling Elderly People in Korea
Ah-Ra Jo, Mi-Jeong Park, Byung-Gue Lee, Young-Gyun Seo, Hong-Ji Song, Yu-Jin Paek, Kyung-Hee Park, Hye-Mi Noh
Korean Journal of Family Medicine.2020; 41(2): 111. CrossRef
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Factors Affecting Comsumer's Usage of Health Information on the Internet.: Jong Hyock Park, Jin Seok Lee, Hyejung Jang, Yoon Kim; J Prev Med Public Health. 2008;41(4):241-248.; DOI: https://doi.org/10.3961/jpmph.2008.41.4.241

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OBJECTIVES
The purpose of the study was to identify a gap between consumer characteristics and utilization of health information on the Internet. METHODS: A telephone survey of nationally representative samples was conducted using structured questionnaires, and 1,000 of the 1,189 responses obtained were included in our analysis. The following variables were included in the analysis as potential predictors of health information use on the Internet: predisposing factors such as gender, age, and education status; enabling factors such as region and monthly household income; consumer need for health information; and attitude to health. Multiple logistic regression analysis was used to evaluate the association between utilization rate and the potential predictors. RESULTS: Thirty-nine percent of consumers had obtained health information on the Internet over a one-year period. The utilization rates were higher for consumers who were young, educated, worked in the office setting, had higher incomes, wanted health information, and were able to use the Internet. The utilization rate was 5.35 times higher in the younger group (20-30 years) than in the elderly group (95% CI=2.21-12.97); 2.21 times higher for office workers than for manual workers (95% CI=1.16-4.20); 3.61 times higher for college graduates than for middle school graduates and below (95% CI=1.07-11.59); 1.99 times higher for people with monthly household incomes over 3,000,000 won than for those with monthly household incomes below 1,500,000 won (95% CI=1.01-3.92). CONCLUSIONS: There needs to be a paradigm shift, with consideration of not only Internet accessibility in the digital age, but also consumer ability and attitudes toward utilization of health information.

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Tae Hee Lee, Seong-Eun Kim, Kyung Sik Park, Jeong Eun Shin, Seon-Young Park, Han Seung Ryu, Jung-Wook Kim, Yoo Jin Lee, Young Sin Cho, Suyeon Park
The Korean Journal of Gastroenterology.2018; 72(6): 295. CrossRef
Social network analysis on consumers' seeking behavior of health information via the Internet and mobile phones
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Reference Interval of Serum Thyroid Hormones in Healthy Korean Adults.: Yoon Young Jang, Chang Yoon Kim, Tae Yoon Hwang, Kyung Dong Kim, Chae Hoon Lee; J Prev Med Public Health. 2008;41(2):128-134.; DOI: https://doi.org/10.3961/jpmph.2008.41.2.128

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OBJECTIVES
This study was conducted to determine the reference interval of serum thyroid hormones (TSH, FT(3), FT(4)) in healthy Korean adults. METHODS: Health examination data from 1,591 healthy Korean adults who visited an university hospital were analyzed. Patients with specific health conditions capable of altering laboratory results were excluded from the study. Serum thyroid hormones were measured using IMMULITE 2000 (DPC, USA, 2002). Subjects were 18-65 years old; 911 were male, and 690 were female. RESULTS: The arithmetic means of TSH, FT(3), and FT(4) values for male subjects were 1.28+/-1.84 micronIU/ml, 3.23+/-0.57 pg/ml, and 1.42+/-0.22 ng/dl, respectively. In female subjects, the arithmetic means of TSH, FT3, and FT4 values were 1.49+/-2.08 micronIU/ml, 3.08+/-0.54 pg/ml, and 1.29 +/-0.24 ng/dl, respectively. The arithmetic mean FT(4) value for males decreased with age (p<0.01). The arithmetic mean FT(3) value for females increased with age (p<0.01). The arithmetic mean thyroid hormone values of all study subjects differed significantly based on season. The arithmetic mean of male FT(4) decreased with increasing BMI (p<0.01). The arithmetic mean of female FT(3) increased with increasing BMI (p<0.01). The reference intervals recommended by the IMMULITE 2000 manufacturer are 0.40-4.00 micronIU/ml for TSH, 1.80-4.20 pg/ml for FT(3), and 0.80-1.90 ng/dl for FT(4) (same values for both genders). CONCLUSIONS: There was a significant difference in the interval of thyroid hormones between males and females, but the reference interval of IMMULITE 2000 was not established by gender. There is a need to reestablish the reference interval for thyroid hormones in Korean healthy adults.

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Hyun-Kyung Chung
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Physician Factors Associated with the Blood Pressure Control among Hypertensive Patients.: So Young Kim, In Sook Cho, Jae Ho Lee, Ji Hyun Kim, Eun Jung Lee, Jong Hyock Park, Jin Seok Lee, Yoon Kim; J Prev Med Public Health. 2007;40(6):487-494.; DOI: https://doi.org/10.3961/jpmph.2007.40.6.487

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OBJECTIVES
Little is known about the physician-related factors that are associated with the management of hypertension. The purpose of this study was to determine the physician-related factors associated with blood pressure control in hypertensive patients. METHODS: We surveyed 154 physicians at 117 public health (subhealth) centers in Gyeonggi-do. Forty-one physicians completed the survey (response rates: 26.6%) and 31 physicians were finally included as the study subjects. Using the information obtained from the selfreported survey, we measured the physician-related factors associated with hypertension control, including their perception of hypertension, prescription patterns (combination prescription rates, specific antihypertensives prescription rates among patients with diabetes mellitus), and sociodemographic factors. We then collected data on blood pressure and medication use in patients seen by these physicians from the health center's information system. We compared the physicians' perceived hypertension control rates with the actual rates, and then evaluated the rate of high overestimation (overestimation by more than 25% of the median degree of hypertension control rate overestimation) among the physicians. The physicians' antihypertensive prescription patterns were also evaluated. Multiple logistic regression analysis was used to evaluate the independent association between hypertension control and physicianrelated factors. RESULTS: The physicians tended to overestimate the proportion of their patients with controlled blood pressure (79.5% perceived vs. 57.8% actual). The percentage of physicians with high overestimation was 35.5% (11 physicians). The physicians with lower control rates were more likely to highly overestimate their patients' control rates. Physicians with below-median actual control rates tended to prescribe fewer combination treatments for patients with uncontrolled blood pressure and angiotensinconverting enzyme inhibitors or fewer angiotensin receptor blockers for patients with diabetes mellitus. The rate of high overestimation by physicians was 1.31 times higher in patients with uncontrolled blood pressure than in patients with other conditions (OR=1.31, 95% CI: 1.17-1.48). CONCLUSIONS: Physicians have a tendency to overestimate the rates of hypertension control in their patients. Because physicians have a direct role in treatment outcomes, physicians' overestimation about hypertension management contributes to inadequate blood pressure control. Thus, interventions for improving physician' awareness regarding the management of patients with hypertension are needed.

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Original Articles

Relationships of Smoking, Stress and Social Support of High School Students.: Eun Hyun Lee, Chun Ki Hong, Mi Sook Song, Soon Young Lee, Jee Yoon Kim; Korean J Prev Med. 2003;36(2):131-136.

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Abstract PDF: OBJECTIVES
The purpose of the present study was to explore a possible interaction effect of stress and social support on the smoking status and identify smoking related factors of high school students. METHODS: A cross-sectional design was used for this study. A total of 1, 251 high school students from Gyeonggi-do were selected using stratified-proportional random cluster sampling methods. The participants completed a set of questionnaires to measure their smoking status, stress, social support and sociodemographic information. The obtained data were analyzed using descriptive statistics, x2-tests and hierarchical logistic regressions. RESULTS: The interaction effect of stress and social support on smoking status was not supported. However, stress, sex, types of school, parent's smoking and friends' smoking were significantly predicted the smoking status of the high school students. CONCLUSIONS: In relation to the prevention of adolescents' smoking, it is recommended to decrease the stress levels of students, to make adolescents' parents cease smoking, and to educate adolescents on how to refuse the temptation to smoke or pressure from their smoking friend.; Summary

Association between BMI and Mortality: Kangwha cohort study.: Soo Jin Yoon, Sang Wook Yi, Soh Yoon Kim, Heechoul Ohrr, Yun Hee Park, Soon Young Lee, Tae Yong Sohn; Korean J Prev Med. 2000;33(4):459-468.

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Abstract PDF: OBJECTIVES
To investigate the association between BMI and Mortality. METHODS: This study was based on the analysis and assembly of the 'Kangwha Cohort Study', previously conducted by the Department of Preventive Medicine, Yonsei University. A total of 2,696 males and 3,595 females were followed for almost ten years and ten months from March 1985 to January 1996, a total of whom 2,420 died during this period. The Cox's proportional hazards regression model was used to analyze this data. RESULTS: We found a U-shaped relationship between BMI and mortality among the aged men in the Kangwha cohort. The hazard ratio of dying was adjusted for age, marital status, occupation, self cognitive health level, chronic disease, smoking, and alcohol frequency, then sorted by body mass index into the following groups; less than 18.5, 18.5 to less than 21.0, 21.0 to less than 23.5, 23.5 to less than 26.0 and greater than or equal to 26. The corresponding ratios for men were 1.81(1.50-2.19, 95%CI), 1.31(1.14-1.51, 95%CI), 1.0(referent), 1.05(0.87-1.26, 95%CI) and 1.39(1.09-1.76, 95%CI), respectively. And for women, 1.46(1.19-1.78), 1.12(0.95-1.31, 95%CI), 1.0(referent), 1.00(0.84-1.20, 95%CI) and 1.09(0.89-1.34, 95%CI), respectively. CONCLUSIONS: The risk of death among aged men in Kangwha increased in the under and overweight groups. The relationship between BMI and mortality has been well studied in Western populations, but little is known about the association between BMI and mortality in our country. So, on the basis of this study, it is apparent that more studies of the relationship between BMI and mortality will be needed for future work.; Summary

Validation of the International Classification of Diseases 10th Edition Based Injury Severity Score(ICISS).: Yoon Kim, Ku Young Jung, Chang Yup Kim, Yong Ik Kim, Youngsoo Shin; Korean J Prev Med. 1999;32(4):538-545.

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Abstract PDF: OBJECTIVE
To compare the predictive power of International Classification of Diseases 10th Edition(ICD-10) based International Classification of Diseases based Injury Severity Score(ICISS) with Trauma and Injury Severity Score(TRISS) and International Classification of Diseases 9th Edition Clinical Modification(ICD-9CM) based ICISS in the injury severity measure. METHODS: ICD-10 version of Survival Risk Ratios(SRRs) was derived from 47,750 trauma patients from 35 Emergency Centers for 1 year. The predictive power of TRISS, the ICD-9CM based ICISS and ICD-10 based ICISS were compared in a group of 367 severely injured patients admitted to two university hospitals. The predictive power was compared by using the measures of discrimination(disparity, sensitivity, specificity, misclassification rates, and ROC curve analysis) and calibration(Hosmer-Lemeshow goodness-of-fit statistics), all calculated by logistic regression procedure. RESULTS: ICD-10 based ICISS showed a lower performance than TRISS and ICD-9CM based ICISS. When age and Revised Trauma Score(RTS) were incorporated into the survival probability model, however, ICD-10 based ICISS full model showed a similar predictive power compared with TRISS and ICD-9CM based ICISS full model. ICD-10 based ICISS had some disadvantages in predicting outcomes among patients with intracranial injuries. However, such weakness was largely compensated by incorporating age and RTS in the model. CONCLUSIONS: The ICISS methodology can be extended to ICD-10 horizon as a standard injury severity measure in the place of TRISS, especially when age and RTS were incorporated in the model. In patients with intracranial injuries, the predictive power of ICD-10 based ICISS was relatively low because of differences in the classifying system between ICD-10 and ICD-9CM.; Summary

Cancer Incidence in Kangwha County(1986 - 1992).: Soh Yoon Kim, Heechoul Ohrr, Hyung Gon Kang, Suk Il Kim, Sang Wook Yi; Korean J Prev Med. 1999;32(4):482-490.

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Abstract PDF: OBJECTIVES
This paper presents the information on the incidence of cancer from the population-based cancer resistry in Kangwha County. Material and METHODS: This investigation is based on Kangwha cancer registry. The data included cases of cancer diagnosed from 1986 through 1992. The diagnosis of cancer was confirmed by a team of physicians and nurses with the medical records kept in the clinics and hospitals based on the diagnostic criteria recommended by WHO. Home visitings were also made to cancer patients confirmed in every 6 months for the follow up and for the collection of relevant information directly from the patients. RESULTS: A total of 992 cancer cases were registered during 1986 - 1992. The age-adjusted cancer incidence rate of all site is 201.7 in men and 110.7 in women. The most common cancer is the stomach cancer in both sexes. The age-adjusted incidence rate of the stomach cancer is 65.9 in men and 25.0 in women per 100,000 population. The lung cancer(33.8) and liver cancer(27.7) are next common cancers in men. The cervical cancer(21.8) and lung cancer(8.4) are next in women. CONCLUSION: The most common cancer is the stomach cancer in both sexes. The annual age-adjusted incidence rate of the stomach cancer is 65.9 in men and 25.0 in women per 100,000 population.; Summary

Development of Korean Neurobehavioral Test Battery - Assessment of the Validity of Traditional and Computerized Neurobehavioral Tests.: Jong Hak Chung, Chang Yoon Kim, Joon Sa Kong, Man Joong Jeon, Park Chin Hong; Korean J Prev Med. 1998;31(4):692-707.

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Abstract PDF: Aim. A neurobehavioral test for workers exposed to organic solvents in the workplace can be affected by many factors : age, education, motivation, ethnicity, etc. To apply more suitable neurobehavioral test for Korean workers, we evaluated the validity of several items of computerized and traditional neurobehavioral tests. Methods. We have applied eleven tests : four items of computerized neurobehavioral test(Swedish Performance Evaluation System) including Addition, Symbol-Digit, Digit Span, and Finger tapping speed, and seven items of traditional neurobehavioral test consisting of Addition, Digit-Symbol , Digit Span, Benton visual retention test, Pursuit aiming, Pegboard, and Tapping. These tests were performed on 96 workers exposed to solvents, and 100 reference workers. The concurrent and construct validities were evaluated by group difference, correlation with age, educational level, hippuric acid level, neurotoxic symptom, current exposure level, multitrait-multimethod matrix, factor analysis, and discriminant analysis. Results. Statistically significant differences were observed between the workers exposed to solvents and referents in computerized Symbol-Digit, Finger tapping speed, traditional Digit-Symbol and Pegboard. The computerized Symbol-Digit, traditional Digit-Symbol, Addition, Benton visual retention test, and Pegboard were found to be related to the age. The performance of computerized Symbol-Digit, Addition, and traditional Digit-Symbol were found to be related to the educational level significantly. The computerized Symbol-Digit, Finger tapping speed, and traditional Digit-Symbol were found to be related to hippuric acid, and neurotoxic symptom. The discriminability of Finger tapping speed, and Pegboard was better than the other tests. In discriminant analysis, the model with two variables, the computerized Symbol-Digit and Pegboard, classified almost 70 percent of the workers correctly. Conclusions. These results suggest that the computerized Symbol-Digit, Finger tapping speed, and Pegboard are more satisfactory for our purpose, and the Addition, Tapping, Benton visual retention test, and Pursuit aiming are less valid than other items. These may allow the reasonable selection of core neurobehavioral tests for workers exposed to solvents in Korea.; 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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Abstract 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

A cohort study on blood zinc protoporphyrin concentration of workers in storage battery factory.: Man Joong Jeon, Joong Jeong Lee, Joon Sakong, Chang Yoon Kim, Jung Man Kim, Jong Hak Chung; Korean J Prev Med. 1998;31(1):112-126.

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Abstract PDF: To investigate the effectiveness of the interventions in working environment and personal hygiene for the occupational exposure to the lead, the blood zinc protoporphyrin(ZPP) concentrations of 131 workers ( 100 exposed subjects and 31 controls ) of a newly established battery factory were analyzed. They were measured in every 3 months up to 18 months. Air lead concentration (Pb-A) of the workplaces was also checked for 3 times in 6 months interval from August 1987. Environmental intervention included the local exhaust ventilation and vacuum cleaning of the floor. Intervention of the personal hygiene included the daily change of clothes, compulsory shower after work and hand washing before meal, prohibition of cigarette smoking and food consumption at the work site and wearing mask. Mean blood ZPP concentration of the controls was 16.45+/-4.83 microgram/dashliter at the preemployment examination and slightly increased to 17.77+/-5.59 microgram/dashliter after 6 months. Mean blood ZPP concentration of the exposed subjects who were employed before the factory was in operation (Group A) was 17.36+/-5.20 microgram/dashliter on employment and it was increased to 23.00+/-13.06 microgram/dashliter after 3 months. The blood ZPP concentration was increased to 27.25+/-6.40 microgram/dashliter on 6 months (p<0.01) after the employment which was 1 month after the initiation of intervention program. It did not increase thereafter and ranged between 25.48 microgram/dashliter and 26.61 microgram/dashliter in the subsequent 4 results. Mean blood ZPP concentration of the exposed subjects who were employed after the factory had been in operation but before the intervention program was initiated (Group B) was 14.34+/-6.10 microgram/dashliter on employment and it was increased to 28.97+/-7.14 microgram/dashliter (p<0.01) in 3 months later(1 month after the intervention). The values of subsequent 4 tests were maintained between 26.96 microgram/dashliter and 27.96 microgram/dashliter. Mean blood ZPP concentration of the exposed subjects who were employed after intervention program had been started (Group C) was 21.34+/-5.25 microgram/dashliter on employment and it was gradually increased to 23.37+/-3.86 microgram/dashliter (p<0.01) after 3 months, 23.93+/-3.64 microgram/dashliter after 6 months, 25.50+/-3.01 microgram/dashliter (p<0.01) after 9 months, and 25.50+/-3.10 microgram/dashliter after 12 months. Workplaces were classified into 4 parts according to Pb-A. The Pb-A of part I, the highest areas, were 0.365 microgram/m4, and after the intervention the levels were decreased to 0.216 microgram/m4 and 0.208 microgram/m4 in follow-up test. The Pb-A of part II which was resulted in lower value than part I was decreased from 0.232 microgram/m4 to 0.148 microgram/m4, and 0.120 microgram/m4 after the intervention. The Pb-A of part III was tested after the intervention and resulted in 0.124 microgram/m4 in January 1988 and 0.081 microgram/m4 in August 1988. The Pb-A of part IV was also tested after the intervention and resulted in 0.110 microgram/m4 in August 1988. There was no consistent relationship between Pb-A and blood ZPP concentration. The blood ZPP concentration of the group A and B workers in the part of the highest Pb-A were lower than those of the workers in the parts of lower Pb-A. The blood ZPP concentration of the workers in the part of the lowest Pb-A increased more rapidly. The blood ZPP concentration of the group C workers was the highest in part III. These findings suggest that the intervention in personal hygiene is more effective than environmental intervention, and it should be carried out from the first day of employment and to both the exposed subjects, blue color workers and the controls, white color workers.; Summary

Performance Evaluation of Emergency Medical Center.: Chul Hwan Kang, Yoon Kim, Pyung Soo Lee, Young Dae Kwon, Chang Yup Kim, Young Soo Shin; Korean J Prev Med. 1997;30(4):884-892.

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Abstract PDF: Currently, there are 100 community emergency centers which expect to provide professional emergency care like Level 1 trauma centers in U.S.A. To evaluate Performance of emergency center, most studies have been widely adopted death rate based methods such as Trauma and Injury Severity Score(TRISS) and A Severity Characterization of Trauma(ASCOT). However, these methods are only applicable in situation where registration process of trauma patients is well established. Therefore, an alternative method should be applied to evaluate performance of emergency centers in Korea which does not have well-developed registration scheme. This study aims to develop new performance measures which are applicable to Korea and evaluate performance of 35 community emergency centers through new measures. The new measures are included that 'W-statistic' ; death rate calculated on the basis of International Classification based Injury Severity Score(ICISS), and 'the degree of severity' ; rate of severe trauma patients of each emergency medical centers. The study results can be summarized as follows. First, about 34% of sample emergency centers show they provide proper care in terms of their function. Second, tertiary hospitals, university hospitals, and hospitals located in Seoul show higher severity degree of patients and lower severity-adjusted death rate.; Summary

Serum HBsAg and Anti-HBs Positive Rate among a City Health Center Visitors.: Mal Sook Shin, Tae Yoon Hwang, Chang Yoon Kim; Korean J Prev Med. 1997;30(3):508-517.

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Abstract PDF: Hepatitis B virus(HBV) infection is one of the major health problems in Korea and HBsAg positive rate was known to be about 5~15% in general population. This study was conducted to identify the positive rates of serum HBsAg and anti-HBs among community population regared as having high HBV vaccination rate than in previous decade, using EIA(Enzyme immunoassay) method, in Seo-Gu, Taegu, Korea. The study subjects were 1,160 who visited Seo-Gu Health Center for check-up serologic markers of hepatitis B. The data were obtained from the serologic test for hepatitis markers and questionnaire survey was conducted to obtain the general characteristics, vaccination history, past history of hepatitis and other liver disease , and exposure history to risk factors of hepatitis of the study subjects. The positive rates of HBsAg and anti-HBs were 5.2% and 62.4% respectively. The positive rates of HBsAg for male and female were 6.6% and 4.3% respectively. The age was divided into two groups as group I(less than 15 years old), group II(more than 16years old) according to the hypothesis that these two groups might be different in HBV vaccination rate. HBV vaccination rates for group I and II were 83.1% and 52.3%. The positive rates of HBsAg for group I and II were 2.6% and 6.5%. The positive rates of HBsAg for the vaccinated people of the group I and II were 2.2% and 3.5%, the positive rates of anti-HBs for the vaccinated people of the group I and II were 70.1% and 71.1% respectively. The most significant factor in positive rate of HBsAg was 'hepatitis carrier in family'. Multiple logistic regression analysis revealed that 'hepatitis history' and 'hepatitis carrier in family' were significant variables for positivity of HBsAg, and 'hepatitis B vaccination' was only a significant variable for positivity of anti-HBs.; 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

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

Relationship of Body Fat Percent with Serum Lipid Level and Blood Pressure in Adults.: Seock Whan Lee, Tae Yoon Hwang, Chang Yoon Kim; Korean J Prev Med. 1995;28(4):783-794.

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Abstract PDF: This study was conducted to clarify the relationship of body fat percent with serum lipid level and blood pressure in adults. The study subjects were 472 men and l89 women who visited Multiphasic Health screening center of Yeungnam university Hospital in Taegu from May 20 to September 30, 1994. The relationship of serum lipid and blood pressure with BMl, Katsura index, atherogenic index, which calculated from the health screening data and body fat percent measured by impedance fat meter(model SIF-819) were analyzed. Three groups were classified as Group I(men: body fat percent > or= 20, women: body fat percent > or= 25, Group II (men: 15 < or = body fat percent <20, women: 20 < or = body fat percent<25, Group III(men: body fat percent <15. women: body fat percent<20) In this study, Group I accounted for 3.2%in men, 3.7%in women. Weight was significantly different among three groups in both sexes(p<0.01) and height was not significantly different among three groups. In men, serum total cholesterol, triglyceride, high density lipoprotein, low density lipoprotein. atherogenic index were significantly different(p<0.01). In women, serum total cholesterol and low density lipoprotein were significantly different(p<0.05 but there was no differences in triglyceride and high density lipoprotein among three groups. BMl and Katsura index were significantly different among three groups in both sexes(p<0.01). In men, body fat percent was positively correlated with weight, BMl, Katsura index, total cholesterol, triglyceride, low density lipoprotein, atherogenic index and systolic and diastolic blood pressures, and negatively correlated with high density lipoprotein. In women, body fat percent was positively correlated with age, height, weight, BMl, Katsura index, total cholesterol, triglyceride, low density lipoprotein and atherogenic index, and negatively correlated with high density lipoprotein. But there was no significant correlation between body fat percent and blood pressure in women. In multiple regression analysis for total cholesterol, fat percent, age and BMl were significant independent variables in men(p<0.05, R2=0.1286), and body fat percent and age in women(p<0.05, R2=0.3399). In case of LDL/HDL ratio, only BMl was a significant independent variable in men(p<0.01, R2=0.0954), and body fat percent, age and BMl in women(p<0.05, R2=0.3164). In multiple regression analysis, age, low density lipoprotein and total cholesterol were significant independent variables on systolic blood pressure in men(p<0.05, R2=0.1297), age and total cholesterol in women(p<0.055, R2=0.1705). On diastolic blood pressure, only age was a significantly independent variable in men(p<0.01, R2=0.0972) and women(p<0.01, R2=0..1218). From the result of this study, it could concluded that body fat percent was significantly associated with other obesity indices and serum lipid, but had no significant association with blood pressure. To establish the relationship of body fat percent with blood pressure, further study which consider other variables that may have an effect on blood pressure should be performed.; Summary

Lead Level in Blood, Scalp Hair and Toenail of Elementary Schoolchildren.: Jae Uk Kim, Jung Jeung Lee, Chang Yoon Kim, Jong Hak Chung; Korean J Prev Med. 1995;28(1):73-84.

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Abstract PDF: This study was conducted to measure the lead level in the blood, scalp hair and toenail of the elementary schoolchildren and assess the relationship among those samples. Lead concentration of the blood, scalp hair and toenail was measured for l00(male 50, female 50) fourth grade elementary schoolchildren in Taegu city. The mean lead level in the blood, scalp hair and toenail was 6.00+/-2.44 microgram/dl, 6.28+/-3.54 microgram/dl 6. 68 and 7.33+/-3.18 microgram/g. The mean lead level in the blood of schoolboys was 6.43+/-2.77 microgram/dl and that of schoolgirls was 5.59+/-2.01 microgram/dl. The mean lead level in the scalp hair of schoolboys was 7.66+/-2.97 microgram/dl and that of schoolgirls was 6.88+/-3.54 microgram/g. The mean lead level in the toenail of schoolboys was 8.19+/-3.5 microgram/g and that of schoolgirls was 6.47+/-2.52 microgram/g and their difference was statistically significant. In schoolboys, the correlation coefficient between the lead level in the blood and scalp hair was 0.4909, and the data were fitted best by the regression equation Y=0.5255X+4.2810, where Y and X are scalp hair and blood concentration. In schoolgirls the correlation coefficient between the lead level in the blood and scalp hair was 0.3778, and the data were fitted best by the regression equation Y=0.6655X+2.9632, where Y and X are scalp hair and blood concentration. In schoolboys. the correlation coefficient between the lead level in the blood and in the toenail was 0.5533, and the data were fitted best by the regression equation Y=0.7076X+3.6472, where Y and X are toenail and blood concentration. In schoolgirls the correlation coefficient between the lead level in the blood and in the toenail was 0.2738, and the data were fitted best by the regression equation Y=0.3431X+4.5570 where Y and X are toenail and blood concentration. In schoolboys, the correlation coefficient between the lead level in the scalp hair and in the toenail, in the schoolboys was 0.4148, and the data were fitted best by the regression equation Y=0.4956X+4.3986, where Y and X are toenail and scalp hair concentration. In schoolgirls the correlation coefficient between the lead level in the scalp hair and in the toenail 0.1159, and the data were fitted best by the regression equation Y=0.0825X+5.9214 here Y and X are toenail and scalp hair concentration. Correlation among lead concentration in the blood, scalp hair and toenail of schoolchildren were statistically significant except between scalp hair and toenail in schoolgirls. These finding suggest that blood, scalp hair and toenail can be used substitutive samples between each others.; Summary

The epidemiology of delays in a teaching hospital.: Yoon Kim, Kun Sei Lee, Chang Yup Kim, Yong Ik Kim, Young Soo Shin, Sang Il Lee; Korean J Prev Med. 1993;26(4):650-660.

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Abstract PDF: This study aims to describe the causes of medically unnecessary hospital stay at a teaching tertiary hospital, using modified version of Delay Tool in which the causes of delay are divided into six major categories ; delay related to test scheduling, test results, surgery, medical staff, patient/family, and administration. For the analysis of hospital stay, 6,479 inpatient-days were reviewed in two medical and four surgical departments for one month. Initially inappropriate hospital stays were identified using Appropriateness Evaluation Protocol(AEP), and causes of delay listed in Delay Tool were assigned to each of them. In both medical and surgical services, the most important cause of delay was related to medical staffs, ranging from 3.6% to 51.6% of total inpatient days. Next important category was delay related to test scheduling in medical services(4.7~9.2%), and delay related to surgery in surgical services(7.3~15.0%). Among subcategories of delay related to medical staffs, delay due to conservative care was the most important cause of inappropriate hospital stay(2.9~46.4%). Each clinical departments had different distribution among delay categories, which could not be fully justified by their clinical characteristics. The Delay Tool would be helpful in exploring factors related to the inefficient use of hospital beds. As a measurement tool of inappropriate hospital stay, however, the Delay Tool should be refined in the definitions of categories and its contents.; Summary

An analysis an dassessment of diagnostic and therapeutic process in some freqent admissions and operations.: Chang Yup Kim, Yoon Kim, Young Dae Kwon, Yong Ik Kim, Young Soo Shin; Korean J Prev Med. 1993;26(3):400-411.

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Abstract PDF: The aim of this study is to analyze the variations among hospitals and hospital groups in resource use and procedures of diagnostic and therapeutic process, such as laboratory tests, radiologic examinations, tissue diagnosis, timing of surgery after admission, the time required for operation. The study was performed for five procedures including cesarean section(C/S), appendectomy, cholecystectomy, cataract extraction, and pediatric pneumonia. The 2,316 subjects were selected from medical insurance claims list, and from this list 413 cases were sampled for medical record review. The patterns of resource utilization and process of treatment were described according to hospitals and characteristics of hospital groups. The major results were as follows: 1. The numbers of laboratory and radiologic tests showed significant difference among hospitals and hospital groups. In case of hospital groups, we could find tendencies of more tests with increasing hospital bed size. 2. In general, the proportion of operative cases evaluated by tissue diagnosis postoperatively among all operations ranged from 28.3% to 1005. The proportion varied among hospital groups, of which general hospital A group(more than 15 specially) showed the highest proportion. 3. Post-admission delay until operation and the time required for operative procedure were not invariable among hospitals and hospital groups. The duration of operation in tertiary hospitals was slightly shorter than general hospitals, with varying statistical significance. We could find that probably there were differences of quality among hospitals in some components of procedures, which suggested that the implementation of quality assurance activities would be mandatory. In this study, we simply described the patterns of resource utilization and some features of clinical process, with institution of the need for advanced studies with in-depth analyses for each component of diagnosis and treatment procedures.; Summary

A Comparative Study on the Pattern of Outpatient Department Utilization at a Tertiary Level Hospital before and after Implementation of the Patient Referral System.: Kyeong Soo Lee, Chang Yoon Kim, Pock Soo Kang; Korean J Prev Med. 1992;25(1):88-100.

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Abstract PDF: This study was conducted to assess the effects of implementation of the patient referral system started July 1st, 1989. A comparison on the pattern of outpatient services of the Departments of Internal Medicine, General Surgery, and Pediatrics at the Yeungnam University Hospital was conducted for each one year period before and after implementation of the patient referral system. The pre-implementation period was from July 1. 1988 to June 30, 1989 and the post-implementation period was from July 1. 1989 to June 30, 1990. The information used for this study was obtained from official forms, prepared by the Yeungnam University Hospital, and submitted to the Korean Medical Insurance Cooperatives. After implementation of the patient referral system, the number of outpatient cases in the Department of Internal Medicine decreased 36.1% from 9,669 cases to 6,181 cases a year. Cases in the Department of General Surgery decreased 23.7% from 1,864 cases to 1,422 cases a year. The number of cases in the Department of General Surgery decreased 23.7% from 1,864 cases to 1,422 cases a year. The number of cases in the Department of Pediatrics decreased 36.9% from 3,372 cases to 2,128 cases a year. After implementation of the patient referral system, the average age of cases in the Departments of Internal Medicine and General Surgery was 52.5 and 49.7 years old, respcetively. This was a significant increase in comparison with the pre-implementation period. After implementation of patient referral system, the proportion of new outpatients in the Department of Internal Medicine decreased form 24.1% to 14.6%, the Department of General Surgery from 36.0% to 23.4%, and the Department of Pediatrics from 15.5% to 8.3%. The number of visits per case decreased significantly in the Department of Internal Medicine(from 1.74 to 1.61), but there was no significant change in the Department of General Surgery and Pediatrics. The length of treatment per case increased significantly in all three departments (form 16.1 days to 19.3 days in the Department of Internal Medicine, from 12.0 days to 15.2 days in the Department General Surgery, and 8.9 days to 11.2 days in the Department of Pediatrics). The number of clinical tests per case increased significantly in the Department of Internal Medicine (from 22. to 2.5), in the Department of Pediatrics(from 0.8 to 1.1) and increased in the Department of General Surgery(from 6.4 to 6.6). The average medical cost per case decreased form 43,900 Won to 42,500 Won in the Department of Internal Medicine, while the cost increased from 75,900 Won to 78,500 Won in the Department of General Surgery and from 12,700 Won to 13,500 Won in the Department of Pediatrics. In case-mix, the chronic degenerative disease(i. e. hypertension, diabetes mellitus, angina pectoris, malignant neoplasm, and pulmonary tuberculosis) ranked higher and acute infectious diseases and simple cases(i. e. gastritis and duodenitis, haemorrhoids, anal fissure, carbuncle, acute URI, and bronchitis) ranked lower after implementation of the patient referral system compared to before implementation.; Summary

Cohort Observafion of Blood Lead Concentration of Storage Battery Workers.: Chang Yoon Kim, Jung Man Kim, Gu Wung Han, Jung Han Park; Korean J Prev Med. 1990;23(3):324-337.

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Abstract PDF: To assess the effectiveness of the interventions in working environment and personal hygiene for the occupational exposure to the lead, 156 workers (116 exposed subjects and 40 controls) of a newly established battery factory were examined for their blood lead concentration (Pb-B) in every 3 months up to 18 months. Air lean concentration (Pb-A) of the workplaces was also checked for 3 times in 6 months interval from August 1987. Environmental intervention included the local exhaust ventilation and vacuum cleaning of the floor. Intervention of the personal hygiene included the daily change of clothes, compulsory shower after work and hand washing before meal, prohibition of cigarette smoking and food consumption at the work site and wearing mask. Mean Pb-B of the controls was 21.97 +/- 33.6 microgram/dl at the preemployment examination and slightly increased to 22.75 +/- 3.38 microgram/dl after 6 months. Mean Pb-B of the workers who were employed before the factory was in operation (Group A) was 20.49 +/- 3.84 microgram/dl on employment and it was increased to 23.90 +/- 5.30 microgram/dl after 3 months <(P<0.01). Pb-B was increased to 28.84 +/- 5.76 microgram/dl 6 months after the employment which was 1 month after the initiation of intervention program. It did not increase thereafter and ranged between 26.83 microgram/dl and 28.28 microgram/dl in the subsequent 4 tests. Mean Pb-B of the workers who were employed after the factory had been operation but before the intervention program was initiated (Group B) was 16.58 +/- 4.53 microgram/dl before the exposure and it was increased to 28.82 +/- 5.66 microgram/dl (P<0.01) in 3 months later (1 month after the intervention). The values of subsequent 4 tests remained between 26.46 and 28.54 microgram/dl. Mean Pb-B of the workers who were employed after intervention program had been started (Group C) was 19.45 +/- 3.44 microgram/dl at the preemployment examination and gradually increased to 22.70 +/- 4.55 microgram/dl after 3 months (P<0.01), 23.68 +/- 4.18 microgram/dl after 6 months, and 24.42 +/- 3.60 microgram/dl after 9 months. Work stations were classified into 4 parts according to Pb-A. The Pb-A of part I, the highest areas, were 0.365 mg/m3, and after intervention the levels were decreased to 0.216 mg/m3 and 0.208 mg/m3 in follow-up tests. The Pb-A of part II was decreased from 0.232 mg/m3 to 0.148 mg/m3, and 0.120 mg/m3 after the invention. Pb-A of part III and IV was tested only after intervention and the Pb-A of part III were 0.124 mg/m3 in January 1988 and 0.081 mg/m3 in August 1988. The Pb-A of part IV, not stationed at one place but moving around, was 0.110 mg/m3 in August 1988. There was no consistent relationship between Pb-B and Pb-A. Pb-B of the group A and B workers in the part of the highest Pb-A were lower than those of the workers in the parts of lower Pb-A. Pb-B of the workers in the part of the lowest Pb-A increased more rapidly. Pb-B of group C workers was the highest in part I and the lowest in part IV. These findings suggest that Pb-B is more valid method than Pb-A for monitoring the health of lead workers and intervention in personal hygiene is more effective than environmental intervention.; Summary

English Abstract

Factors Affecting National Health Insurance Mass Screening Participation in the Disabled.: Jong Hyock Park, Jin Seok Lee, Jin Yong Lee, Ji Young Hong, So Young Kim, Seong Ok Kim, Byong Hee Cho, Yong Ik Kim, Youngsoo Shin, Yoon Kim; J Prev Med Public Health. 2006;39(6):511-519.

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Abstract PDF: OBJECTIVES
As the disabled have higher prevalence rates and earlier onsets of chronic diseases than the nondisabled, their participation in mass screening is important for the early detection and intervention of chronic diseases. Nevertheless, in Korea, the disabled have lower participation rates in mass screening services than the nondisabled. The purpose of the study was to find determinants for the participation in the National Health Insurance (NHI) mass screening program among the disabled. METHODS: In this study, the NHI mass screening data of 423,076 disabled people, which were identified using the National Disability Registry (2003), were analyzed. Of the factors affecting the participation rates in mass screenings, the following variables were included for the analysis: socioeconomic stati, such as sex, age, category of health insurance program, region and income; disability characteristics, such as disability type, and severity. A multiple logistic regression analysis was used to evaluate the association between the participation rates, disability characteristics variables and demographic variables. RESULTS: The participation rate in mass screening of the disabled was 41.3%, but was lower in females, an age of more than 70 years, self-employed and for those with an average monthly insurance premium over 133,500 Won and in metropolitan regions. The participation rate was 1.31 times lower in females than males (95% CI=1.29-1.33); 3.50 times lower in the elderly (more than 70 years) than the younger (95% CI=3.33-3.67); 1.43 times lower in those who live in metropolitan areas (95% CI=1.40-1.46); 2.59 times lower for those in a health insurance program for the self-employed than for employees (95% CI=2.56-2.63); 1.19 times lower for the higher income (more than 133,500) than the lower income group (4,400-22,000) for the average monthly insurance premium (95% CI=1.15-1.23); 2.04 times lower for those with brain palsy and stroke disabilities than with auditory impairments (95% CI= 1.97-2.11) and 3.27 times for those with severe compared to mild disabilities (95% CI=3.15-3.40). CONCLUSIONS: The disabled with high severity, and locomotive and communication disabilities have lower participation rates in mass screening services in Korea.; Summary

Comparative Study

Differences in Medical Care Utilization Rates of the Disabled and the Non-disabled with Ambulatory Care Sensitive Conditions.: Sang Jun Eun, Jee Young Hong, Jin Yong Lee, Jin Seok Lee, Yoon Kim, Yong Ik Kim, Youngsoo Shin; J Prev Med Public Health. 2006;39(5):411-418.

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Abstract PDF: OBJECTIVES
The purpose of this study was to determine whether the disabled have worse access to primary care than the non-disabled. METHODS: We used the National Disability Registry data and the National Health Insurance data for the calendar year 2003, and we analyzed 807,380 disabled persons who had been registered until December 2001 and we also analyzed 1,614,760 non-disabled persons for nine ambulatory care sensitive conditions (ACSCs). The rates of physician visits and hospitalizations for the patients with ACSCs were compared between the disabled and the nondisabled. Multiple logistic regression analysis was used to evaluate the association between medical care utilization and disability and to assess the association between hospitalization and the number of physician visits while controlling for potential confounders. RESULTS: The numbers of physician visits per 100 patients were 0.78~0.97 times lower for the disabled than that for the non-disabled with five of nine ACSCs. The numbers of hospitalizations per 100 patients were 1.16~1.77 times higher for the disabled than that for the non-disabled with all the ACSCs. While the ORs of a physician visit for the disabled were significantly lower than that for the non-disabled with all the ACSCs (OR: 0.44~0.70), and the ORs of hospitalization for the disabled were significantly higher (OR: 1.16~1.89). The lower physician visit group (number of physician visits < or =1) was more likely to be hospitalized than the higher physician visit group (number of physician visits > or =2) (OR: 1.69~19.77). The effect of the physician visit rate on hospitalization was larger than the effect of disability on hospitalization. CONCLUSIONS: The results suggest that the disabled were more likely to be hospitalized for ACSCs due to their lower access to primary care.; Summary

English Abstracts

Effects of the Personal Stereo System on Hearing in Adolescents.: Jong Seo Park, Sean Hee Oh, Pock Soo Kang, Chang Yoon Kim, Kyeong Soo Lee, Tae Yoon Hwang, Joon Sakong; J Prev Med Public Health. 2006;39(2):159-164.

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Abstract PDF: OBJECTIVES
This study was conducted to evaluate the effects of the personal stereo system on the hearing in adolescents. METHODS: A total of 68 adolescents(age: 13-18 years) who visited the ENT Department at a University Hospital in Daegu were personally interviewed. The questionnaires were about general characteristics of the subjects, the time of personal stereo system use(year, hour) and place. Cumulative exposure to the personal stereo system was calculated by the product of the total years and the daily hours of their use. Pure tone audiometry was performed and the hearing threshold was measured at 500, 1000, 2000, 4000 and 8000 Hz. RESULTS: The average time of using a personal stereo system a day was about 3 hours and 75% of the subjects used a personal stereo system for 2-5 years. The elevation of threshold was more prominent in the subjects who used personal stereo systems for 4 years and more compared with those subjects who used them for 3 years and under. The elevation of hearing threshold was also more prominent in the subjects who used personal stereo systems for 4 hours and more a day compared with those subjects who used personal stereo systems for 3 hours and under a day. The elevation of hearing threshold was more prominent in the subjects who used personal stereo systems for 13 hour..years and more compared to the subjects who used them 12 hour..years and under. CONCLUSIONS: These results suggest that the elevation of hearing threshold can happen to adolescents who used personal stereo systems for a long time. In order to prevent hearing loss, we need to teach adolescents appropriate usage of the personal stereo system and hearing tests should be included in the periodic school-based physical examination for the adolescents.; Summary

Reformation of Residency Trainingship for the Future of Preventive Medicine in Korea.: Chang Yoon Kim; J Prev Med Public Health. 2006;39(2):110-114.

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Abstract PDF: From the start of the residency trainingship in 1963, the residency training programs have been contributed much on the establishment and development of preventive medicine in Korea. But these programs are now have several problems to update the changes in health service needs of the population that were caused by a rapid epidemiologic transition from the acute infectious diseases to chronic diseases in last a few decades. Strengthening in medical practice, not just in knowledge is urgently required. Must have more concentrate on preventive service for the individual, as in clinical preventive medicine. Training residents by the systematic and well scheduled programs, not just 'teacher's assistant' in the academic facilities. Trying the change in the system of Specilty of Preventive Medicine to the well established several subspecialty, so more specific competency can be gained through the training. These approach and reformation may not only contribute for the better future of the preventive medicine, but also improve in disease prevention and health promotion, which required by the society in Korea.; Summary

Estimating the Burden of Psychiatric Disorder in Korea.: Jae Hyun Park, Seok Jun Yoon, Hee Young Lee, Hee Sook Cho, Jin Yong Lee, Sang Jun Eun, Jong Hyock Park, Yoon Kim, Yong Ik Kim, Young Soo Shin; J Prev Med Public Health. 2006;39(1):39-45.

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Abstract PDF: OBJECTIVES
This study estimated the burden of disease especially caused by psychiatric disorders in Korea by using DALY, a composite indicator that was recently developed by the Global Burden of Disease study group. METHODS: First, 11 of the major psychiatric disorders in Korea were selected based on the ICD-10. Second, the burden of disease due to premature death was estimated by using YLLs (years of life lost due to premature death). Third, for the calculation of the YLD (years lived with disability), the following parameters were estimated in the formula: the incidence rate, the prevalence rate and the disability weight of each psychiatric disorder. Last, we estimated the DALY of the psychiatric disorders by adding the YLLs and YLDs. RESULTS: The burden of psychiatric disorder per 100,000 people was attributed mainly to unipolar major depression (1,278 person-years), schizophrenia (638 person-years) and alcohol use disorder (287 person-years). For males, schizophrenia (596 person-years) and alcohol use disorder (491 person-years) caused the highest burden. For females, unipolar major depression (1,749 person-years) and schizophrenia (680 person-years) cause the highest burden. As analyzed by gender and age group, alcohol use disorder causes a higher burden than schizophrenia in men aged 40 years and older. For females, unipolar major depression causes the highest burden in all age groups. CONCLUSIONS: We found that each of the psychiatric disorders that cause the highest burden is different according to gender and age group. This study's results can provide a rational basis to plan a national health policy regarding the burden of disease caused by psychiatric disorders.; Summary

Medical Expenses by Site of Cancer and Survival Time among Cancer Patients in the Last One Year of Life.: Jee Jeon Yi, Won Kon Yoo, So Yoon Kim, Kwang Ki Kim, Sang Wook Yi; J Prev Med Public Health. 2005;38(1):9-15.

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Abstract PDF: OBJECTIVES
To analyze medical expenses by cancer site and survival time among cancer patients in their last year of life. METHOD: The study subjects were 45, 394 people that had died of cancers in 2002, were registered by the Korea Central Cancer Registry and received National Health Insurance benefit in the last year (360 days) of life. Personal identification data, general characteristics, dates of death and cancer incidence, and site of cancer were collected from the National Statistical Office and the Korea Central Cancer Registry, and merged with the data of the individual medical expenses of the Health Insurance Review Agency. RESULTS: Average monthly cost curves were U-shaped with high costs near the time of diagnosis and death, and lower costs in between. Medical expenses in the last year of life were around 30.3, 16.7, 13.0, and 12.1 million won among leukemia, lymphoma, ovarian cancer, and breast cancer patients, respectively. Digestive organ cancers including stomach, esophagus, liver, pancreas, and colorectal cancers had relatively low medical expenses. Medical expenses in the last year of life were inverse U-shaped with high expenses near one year of survival. Average monthly cost in the 12 months before death among the patients who had survived 10~15 years were more than two-fold greater than the cost before diagnosis among those who had survived for less than one year. CONCLUSIONS: Leukemia was the most expensive cancer. It is possible that once diagnosed as cancer, medical expenses do not return to the level before diagnosis. Further research will be needed to understand the magnitude and change of the medical expenses among cancer patients with long term follow up data.; Summary

Original Article

Assessing the Factors Influencing Patient Satisfaction after Receiving Laser in situ Keratomileusis (LASIK) .: Woohyun Cho, Hye Young Kang, Ji Yoon Kim, Yoon Chung, Jongho Lee, Jemyung Lee; J Prev Med Public Health. 2004;37(2):111-119.

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Abstract PDF: PURPOSE
To identify those factors influencing the post-operative satisfaction in myopia patients receiving laser in situ keratomileusis (LASIK) METHODS: This study included 288 consecutive patients who received LASIK between July and December 2001 from two eye clinics located in Seoul and Pusan. Factors that were considered to influence post-operative satisfaction included pre-operative baseline characteristics, pre-operative expectation for treatment outcomes, and treatment outcomes. Before undergoing LASIK, study subjects were asked to rate the degree of their expectation for the improvement of visual functions and symptoms after LASIK on a 5-point Likert-type scale: where 1 referred to 'somewhat worse, ' 2 to 'no change, ' 3 to 'somewhat improved, ' 4 to 'improved, ' and 5 to 'very improved.' Self-administered questionnaire was used to evaluate baseline visual functions and symptoms on a 5-point scale before LASIK. At 6 months after LASIK, the evaluation was repeated to measure treatment outcomes in terms of the difference in the score before and after LASIK. Post-operative satisfaction was also measured at 6 months on a 5-point scale. Multiple regression analysis was performed to examine the independent relationship between influencing factors and postoperative satisfaction. RESULTS: A total of 171 patients (59.4%) participated in the 6-month follow-up investigation. The average expectation scores for the improvement in visual functions and symptoms were 3.8 and 3.4, respectively. The average score for the 7 questions assessing satisfaction was 4.0. The results of the regression analysis showed that the post-operative satisfaction increased with improvement in the visual function (beta=0.16, p< 0.05) and symptoms (beta=0.25, p< 0.05), the degree of preoperative refractive error (beta=0.26-0.67, p< 0.05) and in male patients (beta=0.31, p< 0.1). The pre-operative expectation was not a statistically significant factor in explaining postoperative satisfaction in the regression model. CONCLUSION: The finding from this study was that patients with very severe myopia tended to be more satisfied with the treatment than those with mild myopia, which implies that LASIK can be more beneficial to those suffering from a severe visual condition. Patient satisfaction was also significantly affected by the treatment outcomes experienced after LASIK. This suggests that improving the clinical outcome is the most fundamental requirement for the improvement of patient satisfaction.; Summary

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