Journal of Preventive Medicine and Public Health

Original Articles

Beyond Medical Bills: High Prevalence of Financial Toxicity and Diverse Management Strategies Among Vietnamese Patients With Cancer: Binh Thang Tran, Thanh Gia Nguyen, Dinh Duong Le, Minh Tu Nguyen, Nhan P. T. Nguyen, Minh Hanh Nguyen, The Due Ong; J Prev Med Public Health. 2024;57(4):407-419. Published online June 24, 2024; DOI: https://doi.org/10.3961/jpmph.24.090

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Abstract Summary PDF Supplementary Material: Objectives
This study was conducted to measure financial toxicity (FT) among patients with cancer in Vietnam using the COmprehensive Score for financial Toxicity (COST) and to describe the cost management strategies employed by these patients.
Methods
This comprehensive cross-sectional study enrolled 634 patients from 2 specialized oncology hospitals in Vietnam. Using COST cut-off scores, FT was classified as none/mild (≥26), moderate (14-25), or severe (≤13). Cost management strategies, or coping mechanisms, were classified into 4 groups: lifestyle changes, financial resource strategies, treatment modifications, and support seeking.
Results
The prevalence of FT was 91.8%, with 51.7% of participants demonstrating severe and 40.1% exhibiting moderate FT. Severe FT was significantly associated with female, low education level, unstable employment, low household economic status, and advanced cancer stage. The most common coping strategies were as follows: among lifestyle changes, reducing spending on basic items and leisure activities (78.7%) and cutting back on essential household expenses (66.4%); among financial resource strategies, borrowing money from relatives or friends (49.1%) and withdrawing funds from retirement or savings accounts (34.1%); within treatment modifications, switching treatment facilities or doctors due to cost concerns (9.3%); and within support seeking, obtaining help from welfare or community organizations (18.8%). All strategies were significantly more likely to be used by patients with severe FT.
Conclusions
FT was highly prevalent among patients with cancer. Most patients relied on lifestyle adjustments and coping strategies, underscoring the need for improved financial support systems to alleviate the economic burden associated with cancer care.; Summary

Key Message
- This first large-scale analysis looks into the financial toxicity faced by patients with cancer in Vietnam, as an example of low- and middle-income countries.
- Financial toxicity was remarkably high prevalent and strongly associated with patient- level factors.
- Patients experiencing financial toxicity tend to use various cost-coping strategies.
- These findings underscore the need for routine screening for financial toxicity risk and interventions.

Prevalence and Determinants of Catastrophic Healthcare Expenditures in Iran From 2013 to 2019: Abdoreza mousavi, Farhad lotfi, Samira Alipour, Aliakbar Fazaeli, Mohsen Bayati; J Prev Med Public Health. 2024;57(1):65-72. Published online November 25, 2023; DOI: https://doi.org/10.3961/jpmph.23.291

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Objectives
Protecting people against financial hardship caused by illness stands as a fundamental obligation within healthcare systems and constitutes a pivotal component in achieving universal health coverage. The objective of this study was to analyze the prevalence and determinants of catastrophic health expenditures (CHE) in Iran, over the period of 2013 to 2019.
Methods
Data were obtained from 7 annual national surveys conducted between 2013 and 2019 on the income and expenditures of Iranian households. The prevalence of CHE was determined using a threshold of 40% of household capacity to pay for healthcare. A binary logistic regression model was used to identify the determinants influencing CHE.
Results
The prevalence of CHE increased from 3.60% in 2013 to 3.95% in 2019. In all the years analyzed, the extent of CHE occurrence among rural populations exceeded that of urban populations. Living in an urban area, having a higher wealth index, possessing health insurance coverage, and having employed family members, an employed household head, and a literate household head are all associated with a reduced likelihood of CHE (p<0.05). Conversely, the use of dental, outpatient, and inpatient care, and the presence of elderly members in the household, are associated with an increased probability of facing CHE (p<0.05).
Conclusions
Throughout the study period, CHE consistently exceeded the 1% threshold designated in the national development plan. Continuous monitoring of CHE and its determinants at both household and health system levels is essential for the implementation of effective strategies aimed at enhancing financial protection.

Summary

Key Message
• The aim of this study was to analyze the prevalence and determinants of catastrophic health expenditures (CHE) in Iran. • Catastrophic health expenditures (CHE) are used for monitoring financial protection within health systems. • The World Health Organization defines CHE as out-of-pocket payments for healthcare that exceed 40% of a household’s capacity to pay. • In Iran, the prevalence of CHE increased from 3.60% in 2013 to 3.95% in 2019. • Continuous monitoring of CHE and its determinants is essential for implementing effective strategies aimed at enhancing financial protection.

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An analysis of financial protection and financing incidence of out-of-pocket health expenditures in Kazakhstan from 2018 to 2021
Askhat Shaltynov, Yulia Semenova, Madina Abenova, Assel Baibussinova, Ulzhan Jamedinova, Ayan Myssayev
Scientific Reports.2024;[Epub] CrossRef

Changes in Adolescent Health Behavior and the Exacerbation of Economic Hardship During the COVID-19 Pandemic: A Cross-sectional Study From the Korea Youth Risk Behavior Survey: Chaeeun Kim, Haeun Lee, Kyunghee Jung-Choi, Hyesook Park; J Prev Med Public Health. 2024;57(1):18-27. Published online November 11, 2023; DOI: https://doi.org/10.3961/jpmph.23.306

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Abstract Summary PDF Supplementary Material

Objectives
This study investigated the association between exacerbated economic hardship during the coronavirus disease 2019 (COVID-19) pandemic and changes in the health behaviors of Korean adolescents.
Methods
We analyzed data from the 2021 Korea Youth Risk Behavior Survey and included 44 908 students (22 823 boys and 22 085 girls) as study subjects. The dependent variables included changes in health behaviors (breakfast habits, physical activity, and alcohol use) that occurred during the COVID-19 pandemic. The aggravation of economic hardship by COVID-19 and the subjective economic status of the family were used as exposure variables. Multiple logistic regression analysis was utilized to calculate the prevalence odds ratios (PORs).
Results
Severe exacerbation of a family’s economic hardship due to COVID-19 was negatively associated with the health behaviors of adolescents, including increased breakfast skipping (POR, 1.85; 95% confidence interval [CI], 1.55 to 2.21 for boys and POR, 1.56; 95% CI, 1.27 to 1.92 for girls) and decreased physical activity (POR, 1.37; 95% CI, 1.19 to 1.57 for boys and POR, 1.38; 95% CI, 1.19 to 1.60 for girls). These negative changes in health behaviors were further amplified when combined with a low subjective family economic status.
Conclusions
The experience of worsening household hardship can lead to negative changes in health behavior among adolescents. It is crucial to implement measures that address the economic challenges that arise from stressful events such as COVID-19 and to strive to improve the lifestyles of adolescents under such circumstances.

Summary

Korean summary
이 연구는 코로나바이러스감염증-19 (COVID-19) 대유행 기간 악화된 가구의 경제적 상황과 청소년의 건강 행태 변화의 관련성을 청소년건강행태조사를 이용하여 분석하였다. 가구의 경제적 상황이 COVID-19로 인해 심각하게 악화된 경우, 청소년 건강 행태의 부정적인 변화와 연관성이 관찰되었다. 가구의 경제적 상황이 악화되는 경험은 청소년들의 건강 행태에 부정적인 변화를 초래할 수 있다. COVID-19와 같은 사회적 사건으로 인해 발생하는 경제적 어려움에 대응하는 조치를 마련하고, 이러한 상황에서 청소년들의 건강 행태를 개선하기 위한 개입이 필요하다.

Key Message
This study investigated the association between exacerbated economic hardship during the coronavirus disease 2019 (COVID-19) pandemic and changes in the health behaviors of Korean adolescents using the 2021 Korea Youth Risk Behavior Survey. Severe exacerbation of a family’s economic hardship due to COVID-19 was negatively associated with the health behaviors of adolescents. The experience of worsening household hardship can lead to negative changes in health behavior among adolescents. It is crucial to implement measures that address the economic challenges that arise from stressful events such as COVID-19 and to strive to improve the lifestyles of adolescents under such circumstances.

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Family Dynamics, Socioeconomic Hardships, and Health Risk Behaviours of Bulgarian Adolescents during the COVID-19 Pandemic
Elitsa Dimitrova, Anna Alexandrova-Karamanova
Children.2024; 11(8): 1016. CrossRef

Measuring Out-of-pocket Payment, Catastrophic Health Expenditure and the Related Socioeconomic Inequality in Peru: A Comparison Between 2008 and 2017: Akram Hernández-Vásquez, Carlos Rojas-Roque, Rodrigo Vargas-Fernández, Diego Rosselli; J Prev Med Public Health. 2020;53(4):266-274. Published online June 10, 2020; DOI: https://doi.org/10.3961/jpmph.20.035

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Abstract PDF Supplementary Material

Objectives
Describe out-of-pocket payment (OOP) and the proportion of Peruvian households with catastrophic health expenditure (CHE) and evaluate changes in socioeconomic inequalities in CHE between 2008 and 2017.
Methods
We used data from the 2008 and 2017 National Household Surveys on Living and Poverty Conditions (ENAHO in Spanish), which are based on probabilistic stratified, multistage and independent sampling of areas. OOP was converted into constant dollars of 2017. A household with CHE was assumed when the proportion between OOP and payment capacity was ≥0.40. OOP was described by median and interquartile range while CHE was described by weighted proportions and 95% confidence intervals (CIs). To estimate the socioeconomic inequality in CHE we computed the Erreygers concentration index.
Results
The median OOP reduced from 205.8 US dollars to 158.7 US dollars between 2008 and 2017. The proportion of CHE decreased from 4.9% (95% CI, 4.5 to 5.2) in 2008 to 3.7% (95% CI, 3.4 to 4.0) in 2017. Comparison of socioeconomic inequality of CHE showed no differences between 2008 and 2017, except for rural households in which CHE was less concentrated in richer households (p<0.05) and in households located on the rest of the coast, showing an increase in the concentration of CHE in richer households (p<0.05).
Conclusions
Although OOP and CHE reduced between 2008 and 2017, there is still socioeconomic inequality in the burden of CHE across different subpopulations. To reverse this situation, access to health resources and health services should be promoted and guaranteed to all populations.

Summary

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Kasim Allel, Miguel M Cabada, Collen Lau, Deborah Mills, Richard C Franklin, Yan Zhu, Luis Furuya-Kanamori
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Informal payments in health facilities in Peru in 2018: Analysis of a cross-sectional survey
Laura Espinoza-Pajuelo, Patricia Mallma, Hannah Hogan Leslie, Patricia Jannet García, Sarthak Gaurav
PLOS Global Public Health.2024; 4(1): e0001837. CrossRef
An Examination of Inter-State Variation in Utilization of Healthcare Services, Associated Financial Burden and Inequality: Evidence from Nationally Representative Survey in India
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Prevalence and Determinants of Catastrophic Healthcare Expenditures in Iran From 2013 to 2019
Abdoreza mousavi, Farhad lotfi, Samira Alipour, Aliakbar Fazaeli, Mohsen Bayati
Journal of Preventive Medicine and Public Health.2024; 57(1): 65. CrossRef
Consumer Financial Protection Versus Catastrophic Healthcare Expenditure in Zambia
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Effects of Iranian Economic Reforms on Equity in Social and Healthcare Financing: A Segmented Regression Analysis: Hamed Zandian, Amirhossein Takian, Arash Rashidian, Mohsen Bayati, Telma Zahirian Moghadam, Satar Rezaei, Alireza Olyaeemanesh; J Prev Med Public Health. 2018;51(2):83-91. Published online February 6, 2018; DOI: https://doi.org/10.3961/jpmph.17.050

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Abstract PDF

Objectives
One of the main objectives of the Targeted Subsidies Law (TSL) in Iran was to improve equity in healthcare financing. This study aimed at measuring the effects of the TSL, which was implemented in Iran in 2010, on equity in healthcare financing. Methods: Segmented regression analysis was applied to assess the effects of TSL implementation on the Gini and Kakwani indices of outcome variables in Iranian households. Data for the years 1977-2014 were retrieved from formal databases. Changes in the levels and trends of the outcome variables before and after TSL implementation were assessed using Stata version 13. Results: In the 33 years before the implementation of the TSL, the Gini index decreased from 0.401 to 0.381. The Gini index and its intercept significantly decreased to 0.362 (p<0.001) 5 years after the implementation of the TSL. There was no statistically significant change in the gross domestic product or inflation rate after TSL implementation. The Kakwani index significantly increased from -0.020 to 0.007 (p<0.001) before the implementation of the TSL, while we observed no statistically significant change (p=0.81) in the Kakwani index after TSL implementation. Conclusions: The TSL reform, which was introduced as part of an economic development plan in Iran in 2010, led to a significant reduction in households’ income inequality. However, the TSL did not significantly affect equity in healthcare financing. Hence, while measuring the long-term impact of TSL is paramount, healthcare decision-makers need to consider the efficacy of the TSL in order to develop plans for achieving the desired equity in healthcare financing.

Summary

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Prevalence and Determinants of Catastrophic Healthcare Expenditures in Iran From 2013 to 2019
Abdoreza mousavi, Farhad lotfi, Samira Alipour, Aliakbar Fazaeli, Mohsen Bayati
Journal of Preventive Medicine and Public Health.2024; 57(1): 65. CrossRef
Decomposition of Socioeconomic Inequality in Cardiovascular Disease Prevalence in the Adult Population: A Cohort-based Cross-sectional Study in Northwest Iran
Farhad Pourfarzi, Telma Zahirian Moghadam, Hamed Zandian
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Farhad Pourfarzi, Satar Rezaei, Reza Malekzadeh, Arash Etemadi, Telma Zahirian Moghadam, Hamed Zandian
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Has the Copayment Ceiling Improved Financial Protection in the Korean National Health Insurance System? Evidence From the 2009 Policy Change: Tae-Jin Lee, Chelim Cheong; J Prev Med Public Health. 2017;50(6):393-400. Published online November 9, 2017; DOI: https://doi.org/10.3961/jpmph.17.151

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Abstract PDF

Objectives
To relieve the financial burden faced by households, the Korean National Health Insurance (NHI) system introduced a “copayment ceiling,” which evolved into a differential ceiling in 2009, with the copayment ceiling depending on patients’ income. This study aimed to examine the effect of the differential copayment ceiling on financial protection and healthcare utilization, particularly focusing on whether its effects varied across different income groups.
Methods
This study obtained data from the Korea Health Panel. The number of households included in the analysis was 6555 in 2008, 5859 in 2009, 5539 in 2010, and 5372 in 2011. To assess the effects of the differential copayment ceiling on utilization, out-of-pocket (OOP) payments, and catastrophic payments, various random-effects models were applied. Utilization was measured as treatment days, while catastrophic payments were defined as OOP payments exceeding 10% of household income. Among the right-hand side variables were the interaction terms of the new policy with income levels, as well as a set of household characteristics.
Results
The differential copayment ceiling contributed to increased utilization regardless of income levels both in all patients and in cancer patients. However, the new policy did not seem to reduce significantly the incidence of catastrophic payments among cancer patients, and even increased the incidence among all patients.
Conclusions
The limited effect of the differential ceiling can be attributed to a high proportion of direct payments for services not covered by the NHI, as well as the relatively small number of households benefiting from the differential ceilings; these considerations warrant a better policy design.

Summary

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Distribution and Determinants of Out-of-pocket Healthcare Expenditures in Bangladesh: Rashidul Alam Mahumud, Abdur Razzaque Sarker, Marufa Sultana, Ziaul Islam, Jahangir Khan, Alec Morton; J Prev Med Public Health. 2017;50(2):91-99. Published online February 7, 2017; DOI: https://doi.org/10.3961/jpmph.16.089

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Abstract PDF

Objectives
As in many low-income and middle-income countries, out-of-pocket (OOP) payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh.
Methods
A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method.
Results
The mean total OOP healthcare expenditures was US dollar (USD) 27.66; while, the cost of medicines (USD 16.98) was the highest cost driver (61% of total OOP healthcare expenditure). In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures.
Conclusions
The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes.

Summary

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The Impact of the Financial Crisis on Lifestyle Health Determinants Among Older Adults Living in the Mediterranean Region: The Multinational MEDIS Study (2005-2015): Alexandra Foscolou, Stefanos Tyrovolas, George Soulis, Anargiros Mariolis, Suzanne Piscopo, Giuseppe Valacchi, Foteini Anastasiou, Christos Lionis, Akis Zeimbekis, Josep-Antoni Tur, Vassiliki Bountziouka, Dimitra Tyrovola, Efthimios Gotsis, George Metallinos, Antonia-Leda Matalas, Evangelos Polychronopoulos, Labros Sidossis, Demosthenes B. Panagiotakos; J Prev Med Public Health. 2017;50(1):1-9. Published online December 19, 2016; DOI: https://doi.org/10.3961/jpmph.16.101

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Abstract PDF

Objectives
By the end of the 2000s, the economic situation in many European countries started to deteriorate, generating financial uncertainty, social insecurity and worse health status. The aim of the present study was to investigate how the recent financial crisis has affected the lifestyle health determinants and behaviours of older adults living in the Mediterranean islands.
Methods
From 2005 to 2015, a population-based, multi-stage convenience sampling method was used to voluntarily enrol 2749 older adults (50% men) from 20 Mediterranean islands and the rural area of the Mani peninsula. Lifestyle status was evaluated as the cumulative score of four components (range, 0 to 6), that is, smoking habits, diet quality (MedDietScore), depression status (Geriatric Depression Scale) and physical activity.
Results
Older Mediterranean people enrolled in the study from 2009 onwards showed social isolation and increased smoking, were more prone to depressive symptoms, and adopted less healthy dietary habits, as compared to their counterparts participating earlier in the study (p<0.05), irrespective of age, gender, several clinical characteristics, or socioeconomic status of the participants (an almost 50% adjusted increase in the lifestyle score from before 2009 to after 2009, p<0.001).
Conclusions
A shift towards less healthy behaviours was noticeable after the economic crisis had commenced. Public health interventions should focus on older adults, particularly of lower socioeconomic levels, in order to effectively reduce the burden of cardiometabolic disease at the population level.

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Special Articles

The Role of Major Donors in Health Aid to the Democratic People's Republic of Korea: Haewon Lee, Deborah Y. Ahn, Soyoung Choi, Youngchan Kim, Hyunju Choi, Sang Min Park; J Prev Med Public Health. 2013;46(3):118-126. Published online May 31, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.3.118

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Abstract PDF

We investigated the major trends in health aid financing in the Democratic People's Republic of Korea (DPRK) by identifying the primary donor organizations and examining several data sources to track overall health aid trends. We collected gross disbursements from bilateral donor countries and international organizations toward the DPRK according to specific health sectors by using the Organization for Economic Cooperation and Development creditor reporting system database and the United Nations Office for the Coordination of Humanitarian Affairs financial tracking service database. We analyzed sources of health aid to the DPRK from the Republic of Korea (ROK) using the official records from the ROK's Ministry of Unification. We identified the ROK, United Nations Children's Fund (UNICEF), World Health Organization (WHO), United Nations Population Fund (UNFPA), and The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) as the major donor entities not only according to their level of health aid expenditures but also their growing roles within the health sector of the DPRK. We found that health aid from the ROK is comprised of funding from the Inter-Korean Cooperation Fund, private organizations, local governments, and South Korean branches of international organizations such as WHO and UNICEF. We also distinguished medical equipment aid from developmental aid to show that the majority of health aid from the ROK was developmental aid. This study highlights the valuable role of the ROK in the flow of health aid to the DPRK, especially in light of the DPRK's precarious international status. Although global health aid from many international organizations has decreased, organizations such as GFATM and UNFPA continue to maintain their focus on reproductive health and infectious diseases.

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Molecular Typing in Public Health Laboratories: From an Academic Indulgence to an Infection Control Imperative: Franz Allerberger; J Prev Med Public Health. 2012;45(1):1-7. Published online January 31, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.1.1

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Using three Austrian case studies, the variegated applications of molecular typing in today's public health laboratories are discussed to help illustrate preventive management strategies relying on DNA subtyping. DNA macrorestriction analysis by pulsed field gel electrophoresis has become the gold standard for subtyping of food borne pathogens like listeria, salmonella, campylobacter and Bacillus cereus. Using a Salmonella Mbandaka outbreak from the year 2010 as example, it is shown how the comparison of patterns from human isolates, food isolates, animal isolates and feed isolates can allow to identify and confirm a source of disease. An epidemiological connection between the simultaneous occurrence of tuberculosis in cattle and deer with cases of human tuberculosis due to Mycobacterium caprae in 2010 was excluded using mycobacterial interspersed repetitive units variable-number tandem repeats subtyping. Also in 2010, multilocus sequence typing with nonselective housekeeping genes, the so-called sequence based typing protocol, was used to elucidate connections between an environmental source (a hospital drinking water system) and a case of legionellosis. During the last decades, molecular typing has evolved to become a routine tool in the daily work of public health laboratories. The challenge is now no longer to simply type microorganisms, but to type them in a way that allows for data exchange between public health laboratories all over the world.

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Original Articles

Predicting hospital bankruptcy in Korea.: M S Lee, Y J Seo; Korean J Prev Med. 1998;31(3):490-502.

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Abstract PDF: This study purports to find the predictor of hospital bankruptcy in Korea and to examine the predictive power of the discriminant function model of hospital bankruptcy. Data on 17 financial and 4 non-financial indicators of 31 bankrupt and 31 profitable hospitals of 1, 2, and 3 years before bankruptcy were obtained from the hospital performance databank of Korea Institute of Health Services Management. Significant variables were identified through mean comparison of each indicator between bankrupt and profitable hospitals, and the discriminant function model of hospital bankruptcy was developed. The major findings are as follows : 1. As for profitability indicators, net worth to total assets, operating profit to total capital, operating profit ratio to gross revenues, normal profit to total assets, normal profit to gross revenues, net profit to total assets were significantly different in mean comparison test in 1, 2, and 3 years before hospital bankruptcy. With regard to liquidity indicators, current ratio and quick ratio were signifiant in 1 year before bankruptcy. For activity indicators, patients receivable turnover was significant in 2 and 3 years before bankruptcy and added value per adjusted inpatient days was significant in 3 years before bankruptcy. 2. The discriminant function in 1, 2, and 3 years before bankruptcy were; Z=-0.0166Xquick ratio - 0.1356Xnormal profit to total assets - 1.545 x total assets turnarounds in 1 year before bankruptcy, Z=-0.0119Xquick ratio - 0.1433Xoperating profit to total assets - 0.0227Xvalue added to total assets in 2 years before bankruptcy, and Z=-0.3533Xnet profit to total assets - 0.1336Xpatients receivables turnrounds - 0.04301Xadded value per adjusted patient + 0.00119Xaverage daily inpatient census in 3 years before bankruptcy.3. The discriminant function's discriminant power in 1, 2, and 3 years before bankruptcy was 77.42, 79.03, 82.25% respectively.; Summary

Electrocardiographic findings of a Community People by Computerized Device for Analysis.: Esun Koo, Jae Young Kim, Hae Joon Kim; Korean J Prev Med. 1998;31(2):183-198.

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Abstract PDF: In order to determine the prevalence rate and find out the sexual difference of abnormal electrocardiographic findings manifested by computerized EKG, which is equipped with auto-analyzing function, a total of 2,083 electrocardiograms that were taken from population over 20 years-old from October 1996 to February, 1997 were studied according to their age, gender and blood pressure. l. Using the electrocardiography, with auto-analyzing function, 33 kinds of abnormal findings were manifested. The prevalence rate of abnormal findings was 52.8% in male and 43.7% in female. Among them, the most common finding was sinus bradycardia found in 17.6% of male and 15.4% of female. Left ventricular hypertrophy by voltage criteria, minimal voltage of left ventricular hypertrophy, left axis deviation and atrial fibrillation were more common in male than in female statistically. Both of nospecific T wave and ST segment abnormality were more common in female than in male statistically. 2. Thirty-three kinds of abnormal findings were manifested. They revealed one abnormal finding alone or combined with some other ones making 128 kinds of abnormal findings. The most common abnormal finding that manifested alone was right axis deviation (100%), then myocardial ischemia (95.7%) the next. The most common abnormal finding that complexed with other abnormal findings were left anterior fascicular block(percentage of single manifestation; 26.2%) and nonspecific T wave abnormality(percentage of single manifestation; 32.9%). Also, combination of sinus bradycardia and minimal voltage of left ventricular hypertrophy, and combination of sinus bradycardia and left ventricular hypertrophy were included in 25th sequences of abnormal findings. 3. The prevalence rate of abnormal electrocardiographic findings were higher in older group, hypertensive group, and the group of higher systolic or diastolic pressure in both sexes. 4. Abnormal findings that commonly manifested with sinus bradycardia were voltage criteria or minimal voltage of left ventricular hypertrophy(38.6%): sinus arrhythmia(10.5%); nonspecific T wave or ST segment abnormality(18.4%) and first degree AV block(7.2%) in descending order. 5. The most common site which manifested myocardial ischemia was posterior and inferior wall with equal percentage of 23.4%. And then anterior wall(19.l%), and antero-lateral wall and septum with equal percentage of 10.6% was noted in descending order.; Summary

Combined Effect of Vibration Intensity, Grip Temperature, Noise and Pushing Power on Grip Forces and Skin Temperatures of Fingers.: Kyungsim Koh, B Griefahn, M Fritz, P Brode; Korean J Prev Med. 1994;27(4):763-776.

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Abstract PDF: Recent studies reveal that grip forces during the hand-arm vibration are most significant for the genesis of vibration-induced white finger syndrome. Therefore, exerted grip forces and skin temperatures or fingers were regarded as dependent variables in experiments and the effects of grip temperature, noise, pushing force, vibration and the combined effect of vibration and pushing force were studied. The objectives or the present study were, first, to varify and compare the changes of grip force affected by grip temperature, noise, pushing force, vibration and the combined effect of vibration and pushing force and, second, to observe the reaction of finger skin temperature affected by above factors. Forty-six healthy male students(25.07+/-2.85) participated in five systematically permuted trials, which endured 4 minutes each other. Experiments were executed in a special chamber with an air temperature of 21 C. In each experiments, the subjects were exposed to five experiment types: (l) grip force of 25 N only, (2) pushing force of 50 N, (3) acceleration of vibration 7.1m/sec2(z-direction), (4) pink noise or 95 dB(A) and (5) combination of pushing force 50 N and acceleration of vibration 7.1m/sec2. A repeated-measures analysis of variance(ANOVA) was performed on the grip force to test whether it was affected by noise, pushing force, vibration and pushing force. The present results show that vibration was significantly related to the increase of grip force, but the other factors, such as pushing force, noise and grip temperature had no significant influence on the increase of grip force and that the reaction of finger skin temperature were significantly affected by the skin temperature at start of experiment and grip temperature, not grip force and other experimental conditions. Therefore, we suggest that the management for decreasing the grip force is meaningful to prevent the occurrence of Hand-arm vibration syndrome (HAVS).; Summary

Induction Of Metallothionein And Toxicity In Acute Cadmium Intoxicated Rat.: Kyung Joon Min, Jung Duck Park, Yeon Pyo Hong, Im Won Chang; Korean J Prev Med. 1993;26(2):231-250.

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Abstract PDF: Thirty five male Sprague-Dawley rats were treated with cadmium chloride solution ranging from 0.2 to 3.2mg CdCl2/kg by intravenous single injection. At 48 hours after administration of cadmium, total cadmium, MT bound cadmium and histopathologic finding in liver, kidney, lung, heart, testis, metallothionein in liver, kidney and total cadmium in blood were examined. Tissue cadmium concentration was highest in liver, followed by in kidney, heart, lung and testis. Cadmium bound to metallothionein(MT-Cd) and ratio of MT-Cd to total cadmium were increased in liver and kidney dependently of cadmium exposure dose, but not significantly changed in other organs. On histopathologic finding, the most susceptible organ was heart in considering cadmium exposed dose, but testis in considering cadmium concentration. Blood cadmium concentration was increased with dose-dependent pattern, and significantly correlated with tissue cadmium concentration, so that we may estimate tissue cadmium concentration by measurement of blood cadmium concentration. Metallothionein in liver and kidney was increased with dose-dependent pattern, higher in liver than in kidney, and was significantly correlated with tissue cadmium concentration. However, metallothionein induction efficiency of tissue cadmium(microgram MT/microgram Cd) was greater in liver than in kidney, and reverse to tissue concentration or exposed dose of cadmium.; Summary

Contents of Lead, Cadmium and Zinc in Bone, Muscle and Fin of Carassius carassius from Middle Stream of Nakdong River, Korea.: Doohie Kim, Yong Gu Kim, Bong Ki Jang; Korean J Prev Med. 1988;21(2):307-319.

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Abstract PDF: In order to determine the contents of lead, cadmium and zinc, the tissues of the crussian carp, Carassius carassius, collected from the middle streams of the Nakdong river were examined. During the dry season from 8 to 15, March, 1987, six loci were selected to sample the fish and river water; five of them were the midstreams of the Nakdong river i.e., the vicinities of the Andong dam, the Nakdong bridge, the Waegwan bridge, Gangjung and Gaepori, the other one was the Kumho river around the Paldal bridge(see Fig.1). The microanalyses of lead and cadmium contents were undertaken by the atomic absorption spectrophotometer(Model IL-551) connected with CTF-IL 655, while that of zinc by the flame method with IL-551 only. The contents of lead and cadmium in water sampled from Gaepori distant from about 30km downward from the junction with the Kumho river were about 1.5 times higher than those from Gangjung distant about 0.5km upward from the junction, and the content of zinc from Gaepori was slightly higher than that from Gangjung. However, the contents of lead and cadmium in water sampled from Gaepori were three fifth of those from the vicinity of Paldal bridge far about 2km upperward from the junction. In the other words, the contents of lead and cadmium in the samples from the vicinity of the Paldal bridge were about 2.5 to 3 times higher than those from the Gangjung and 5 times higher than those from the Andong dam. The contents of the heavy metals in the tissues of Carassius carassius were relatively consistent to those of the aquatic environments were the fish were collected, with higher contents in the tissues of the crussian carp collected from the vicinity of Gaepori and the Paldal bridge which were so much polluted than in those from other loci in upper stream from the junction. And the contents of lead and cadmium in tissues were positively correlated with the age of the fish, however, that zinc was not. The contents of lead in bone of crussian carp from the vicinity of the Paldal bridge in the group of 0-1 year old fish were similar to those of 4-5 years old fish from Gaepori, and higher than those of 3-4 years old fish collected from the upper stream of the junction. It is likely that fishing from Gaepori and the paldal bridge is not recommended, and all the industrial producers have to pay intensive attention to the water pollution due to the sewage disposal.; Summary

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