Journal of Preventive Medicine and Public Health

Volume 22(4); December 1989

Original Article

Past, Present and Future of Preventive Medicine in Korea.: S H Yu; Korean J Prev Med. 1989;22(4):423-453.

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Abstract PDF: No abstract available.; Summary

Case Report

Mass paraquat poisoning in a small island community: case report.: Sung Woo Lee, Tae Wha Chung, Kang Won Choi, Jung Ki Lim, Duk Hyoung Lee; Korean J Prev Med. 1989;22(4):454-465.

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Abstract PDF: In a small island community with a population of less than 100 residents, nine persons died and five experienced severe illness during the period from November 1986 to May 1988. Their initial symptoms were sore throat and fever. Renal failure and hepatitis developed which one week after the onset. Oral mucosal ulcer developed in some cases. After one week, progressive respiratory failure and dyspnea developed evidently and severe respiratory distress and hypoxia preceded those fatal cases. Chest X-ray findings revealed bilateral diffuse multiple cystic lesion with occasional multiple large emphysematous bullae. Based on these features paraquat poisoning was diagnosed and route of poisoning was investigated. In three sources of drinking water, trace amount of paraquat was detected in November 1988, six months after the incidence of recent fatal case. In November 1988, soybean sauces and soybean pastes from 12 households were found contaminated with high concentration of paraquat, the cause of this mass poisoning has been suggested.; Summary

Original Articles

Lessons Learned from the Recent Past: A Personal Perspective on U.S. AIDS Policy.: Caitlin C Ryan; Korean J Prev Med. 1989;22(4):466-473.

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Abstract PDF: No abstract available.; Summary

A Study on the Effect of Improvement in Work Environment and of Segregation in a Fluorescent Lamp Manufacturing Factory.: Soung Hoon Chang, Kwang Jong Kim; Korean J Prev Med. 1989;22(4):474-479.

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Abstract PDF: This research was conducted to evaluate the effect of improvement in work environment and of segregation in a fluorescent lamp manufacturing factory. Among the total of 80 workers, 8 workers whose mercury concentration in urine reached a hazardous level (200-299 microgram/l) were moved to mercury free workplace. The follow-up examination for their mercury concentration in urine was done three times; on May 3, 1988, September 1, 1988 and April 3, 1989. The results were as follows: 1. Mercury concentration in the air was reduced from 0.140 to 0.107 mg/m3 in 4 months, and to 0.087 mg/m3 in one year after environmental improvement in workplace. However the level still exceeded the Threshold Limit Value. 2. The geometric mean of urinary mercury concentration among 80 workers was 173.0 microgram/l (5.1~458.6 microgram/l). The distribution of workers according to urinary mercury concentration showed that 9 workers (11.2%) were above the mercury poisoning level (300 microgram/l), 24 workers (30.0%) were 200-299 microgram/l, 35 workers (43.8%) were 50-199 microgram/l, and 12 workers (15.0%) were below 50 microgram/l. 3. Among the 24 workers whose urinary mercury concentration was 200-299 microgram/l, 8 were able to be followed up. Their mean urinary mercury concentration before segregation was 244.9 microgram/l, but decreased to 151.4 microgram/l in four months, 128.8 microgram/l in six months, and 46.8 microgram/l in one year after segregation.; Summary

A Study on Relationship between Exposure to Toluene and Excretion of Hippuric Acid in Urine with Male Sovent Workers.: Sung Soo Lee, Kyu Dong Ahn, Byong Kook Lee, Taik Sung Nam; Korean J Prev Med. 1989;22(4):480-485.

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Abstract PDF: The objective of this study was to examine the correlation between personal exposure of toluene at workplace and the concentration of hippuric acid in urine of male solvent workers. The study groups are 60 toluene exposed workers who worked at video tape factory and printing factory. The results are as follows: 1. The coefficient of correlation between toluene concentration of personal exposure and concentration of urinary hippuric acid was 0.649 (regression equation Y=0.015X+0.936, Y=urinary hippuric acid concentration, X=Toluene concentration of personal exposure). 2. Urinary hippuric acid concentration of workers with TLV 100 ppm of toluene was calculated 2.44 g/L by the regression equation (Y=0.015X+0.936).; Summary

Concentrations of lead, iron and zinc in blood of coal workers' pneumoconiosis patients.: Ho Chun Choi, Ho Keun Chung, Hae Jeong Kim; Korean J Prev Med. 1989;22(4):486-494.

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Abstract PDF: Lead, iron, and zinc concentrations in whole blood were determined by atomic absorption spectrophotometry, using a simple one-step dilution procedure, which were measured in 3 groups, 98 officers unexposed to dust or to metal, 58 coal miners without pneumoconiosis, and 113 coal workers' pneumoconiosis (CWP) patients. The results were as follows; 1. The precisions (C. V.%) of lead, iron, and zinc in blood were 12.65+/-6.95%, 1.47+/-1.25% and 6.35+/-3.34%, respectively. 2. Lead and zinc in blood showed the log-normal distribution unlike iron in blood which showed normal distribution. 3. Lead, iron, and zinc concentrations in blood of 3 groups were follows. There was significant difference of concentration far zinc in blood by groups statistically. 4. The difference of lead, iron, and zinc concentrations in blood was not significant (p>0.05) by profusion on chest radiographs.; Summary

A study on the concentration and health risk of trihalomethanes in drinking water.: Yong Chung, Dong Chun Shin, Bo Young Lee, Sung Han Yu, Sang Hyuk Chung; Korean J Prev Med. 1989;22(4):495-505.

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Abstract PDF: This study was conducted as a nationwide survey in Korea to determine the THM (trihalomethane) concentration levels in the drinking water of 14 selected cities. The survey was undertaken in one city (Kwangju) during September and October of 1988 and 14 cities in January through February of 1988. The results were as follows: 1. The KMnO4 consumption was 10.6 mg/l - 11.6 mg/l in Pusan and Ulsan, exceeding the drinking water standard of 10 mg/l. Pusan, Inchon, Kwangju, Ulsan, Mokpo and Junju areas also exceeded the ammonia nitrate standard of 0.5 mg/l, Other tap waters surveyed were detected below the drinking water standards. 2. The THM concentrations of tap water measured in January and February of 1989 were detected in the range 1.20 microgram/l - 150.8 microgram/l. 3. In the comparative study of the THM concentration of tap water measured in the Kwangju area during September and October of 1988, the average THM concentration of 145.63 +/- 70.72 microgram/l showed a sifford increase compared to that of 23.8 +/- 8.31 microgram/l surveyed in January and February 1989. 4. The proportion of the four THM compounds found in tap water was bromoform, 47%; chloroform, 30%; chlordibromomethane, 13%; and dichlorobromomethane, 10%. 5. Since the results indicate that the concentration of bromoform was 2 - 10 times higher than that of chloroform measured in the seaside district of Pusan, Ulsan and Cheju Island, it is reasonable to assume that the raw water was somehow influenced by seawater. 6. The average lifetime cancer rate of the population exposed to chloroform measured in the surveyed areas was 17 cancer incidences per 1 million population. From the above results, the existence of THM in the distribution systems seems to be inevitable, since chlorine disinfection is performed in water treatment plants in our country. There seems to be a trend of increasing. THM concentrations due to the contamination of raw water. In order to establish any form of regulations, health risk assessment is an imminent subject.; Summary

Comparison of Subjective Symptoms of Fatigue and Salivary pH among Teachers between Special School and Elementary.: Soon Ja Lee, Doohie Kim; Korean J Prev Med. 1989;22(4):506-517.

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Abstract PDF: Two hundred and fifty teachers of special school (for the disabled) and 414 elementary school teachers were selected for the targets in order to compare their degrees of fatigue symptoms and to find what kind of relationship is between subjective symptoms of fatigue and pH is the saliva. It was 30 minutes before their closing hours on April 21th, 1989 that their physical, mental and neuro-sensory symptoms and salivary pH were examined. The test results are summarized as follows: It is observed that an interrelation between subjective fatigue and pH in their saliva shows a significant relationship between physical and neuro-sensory symptoms in a sense of statistics. The rate of subjective fatigue complained by the special teachers is higher than that by the elementary teachers. In the case of salivary pH, the special teachers' is as a whole lower than the elementary teachers'. The complain rates in each item, checked of special teachers are generally higher than those of the elementary teachers. It is in the mental symptom related item that there are many sub-items which show significant difference. According to the average of salivary pH based on the degrees of complained symptoms shown in the pH related items, the salivary pH of the group with complained symptoms is lower than that of the group without complained symptoms. In the rate of complaints, by sex, both sexes of the special teachers show high ones but salivary pH is low. The complain rate of mental symptoms shown by female group from the special teacher is significantly higher(p<0.05). By age, the group in their thirties from the special teachers show the higher complain rate of mental symptoms (29.3%) and the lower salivary pH (p<0.05) than that (15.1%) of the elementary teachers belonging to the same age category. However, the special teachers in their forties show the lower complain rate of physical symptoms that of the elementary teachers (p<0.05). From the viewpoint of their working years, the special teachers below 14 years and elementary teachers above 15 years in their career show high complain rates. Among those who belong to the category of 10-14 working years, the special teachers show the higher complain rate of mental symptoms than that of their counterparts. In the case of the salivary pH, the special teachers of all working-year categories show the higher pH than that of the elementary teachers. But there is not significantly difference. From the viewpoint of sleeping hours in the previous night of the questionnaire surveyed, among those who slept for over 7 hours, the special teachers show the higher complain rate of mental symptoms with significant difference, but the lower salivary pH than that of their counterparts. From the viewpoint of their marital status, existence of disease history, the special teachers show the higher complain rate of subjective fatigue, but the lower salivary pH than that of the elementary teachers respectively. According to the above results, the special teachers generally show the higher complain rate of subjective fatigue, the lower salivary pH, and the higher complain rate of mental symptoms. To prevent the possible accumulation of mental fatigue of the special teachers, ways and means to make use of leisure time, recreational facilities are necessarily provided. Since the degree of fatigue and salivary pH have a correlation to some extent, it is necessary that further continuous studies on the correlation between the degrees of fatigue and salivary pH should be pursued.; Summary

Hair Heavy Metal Contents in Mentally Retarded Children IV: In Association with Copper.: Doohie Kim, Sang Soong Nam, Soon Woo Park; Korean J Prev Med. 1989;22(4):518-527.

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Abstract PDF: The relationship between copper content in scalp hair and mental retardation was investigated. Samples of scalp hair were collected from 297 mentally retarded children who were students in one of two schools providing special educational services, one, consisted of children living in an orphan home, the other, children living with parents. For comparison, 117 scalp hair samples were collected from the children who had got average or above average academic achievement in a regular elementary school. Hair samples were taken from the nape of the neck and the copper content was determined by an atomic absorption spectrophotometer (IL 551). There was no statistically significant difference in scalp copper levels across different age groups except female orphan group, but no trend or correlation between copper contents and age was found. The hair copper contents of the group accompanied by Down's syndrome and unknown group were significantly lower than that of control group in both sex, and in the case of accompanied by epilepsy or autism, lower than control group in male. Although the results of this study show no evidence that mental retardation has owed to copper deficiency, the possibility of copper deficiency in their fetal or infant age could not be ruled out. Thus further study is needed to determine whether mental retardation could be attributed to copper deficiency. through the examinations about their living environments, dietary pattern, eating habit and the impact of copper deficiency on brain development.; Summary

The Economic Losses of Smoking.: Jong Ku Park, Kyu Sik Lee; Korean J Prev Med. 1989;22(4):528-541.

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Abstract PDF: The purpose of this study was to identify and measure the economic costs and benefits due to smoking in Korea. Cigarette smoking is a major cause of morbidity and mortality. In addition to the health risks of smoking, there are important economic consequences. A complete assessment of the economics of smoking requires evaluation of various health, economic, and intangible parameters, including benefits as well as costs of both the production and consumption of tobacco. In this article we focus on costs resulting from the health effects of smoking (expenditures for medical care and the value of productive output lost to morbidity, and premature mortality among smokers), since economic benefits from tobacco industry is offset by expenditures for purchasing tobacco. Two distinct methodologies will be applied to measure the economic costs of smoking cigarette, the human capital and willingness-to-pay approaches. This article used the former method. In 1985, total economic losses due to smoking was estimated as 505.7 billion won, which was composed of morbidity losses 64.9 billion won, mortality losses 429.1 billion won and indirect costs 11.7 billion won.; Summary

An Analysis of Determinants of Medical Cost Inflation using both Deterministic and Stochastic Models.: Han Joong Kim, Ki Hong Chun; Korean J Prev Med. 1989;22(4):542-554.

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Abstract PDF: The skyrocketing inflation of medical costs has become a major health problem among most developed countries. Korea, which recently covered the entire population with National Health Insurance, is facing the same problem. The proportion of health expenditure to GNP has increased from 3% to 4.8% during the last decade. This was remarkable, if we consider the rapid economic growth during that time. A few policy analysts began to raise cost containment as an agenda, after recognizing the importance of medical cost inflation. In order to prepare an appropriate alternative for the agenda, it is necessary to find out reasons for the cost inflation. Then, we should focus on the reasons which are controllable, and those whose control are socially desirable. This study is designed to articulate the theory of medical cost inflation through literature reviews, to find out reasons for cost inflation, by analyzing aggregated data with a deterministic model. Finally to identify determinants of changes in both medical demand and service intensity which are major reasons for cost inflation. The reasons for cost inflation are classified into cost push inflation and demand pull inflation. The former consists of increases in price and intensity of services, while the latter is made of consumer derived demand and supplier induced demand. We used a time series (1983-1987), and cross sectional (over regions) data of health insurance. The deterministic model reveals, that an increase in service intensity is a major cause of inflation in the case of inpatient care, while, more utilization, is a primary attribute in the case of physician visits. Multiple regression analysis shows that an increase in hospital beds is a leading explanatory variable for the increase in hospital care. It also reveals, that an introduction of a deductible clause, an increase in hospital beds and degree of urbanization, are statistically significant variables explaining physician visits. The results are consistent with the existing theory. The magnitude of service intensity is influenced by the level of co-payment, the proportion of old age and an increase in co-payment. In short, an increase in co-payment the utilization, but it induced more intensities or services. We can conclude that the strict fee regulation or increase in the level of co-payment can not be an effective measure for cost containment under the fee for service system. Because the provider can react against the regulation by inducing more services.; Summary

Comparative Analysis of Delivery Management in Various Medical Facilities.: Jung Han Park, Young Sook You, Jang Rak Kim; Korean J Prev Med. 1989;22(4):555-577.

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Abstract PDF: This study was conducted to compare the delivery management including laboratory tests, medication and surgical procedures for the delivery in various medical facilities. Two university hospitals, two general hospitals, three hospitals, two private obstetric clinics, and two midwifery clinics in a large city were selected as they permitted the investigators to abstract the required data from the medical and accounting records. The total number of deliveries occurred at these 11 facilities between 15 January and 15 February, 1989 was 789 among which 606(76.8%) were vaginal deliveries and 183(23.3%) were C-sections. For the normal vaginal deliveries, CBC, Hb/Hct level, blood typing, VDRL, hepatitis B antigen and antibody, and urinalysis were routinely done except the private clinics and midwifery clinics which did not test for hepatitis B and Hb/Hct level at all. In one university hospital ultrasonography was performed in 71.4% of the mothers and in one general hospital liver function test was done in 76.7% of the mothers. For the C-section, chest X-ray, bleeding / clotting time and liver function test were routinely done in addition to the routine tests for the normal vaginal deliveries. Episiotomy was performed in 97.2% of the vaginal deliveries. The type and duration of fluid infused and antibiotics administered showed a wide variation among the medical facilities. In one university hospital antibiotics was not administered after C-section at all while in the general hospitals and hospitals one or two antibiotics were administered for one week on the average. In one private clinic one pint of whole blood was transfused routinely. A wide variation was observed among the medical facilities in the use of vitamin, hemostatics, oxytocics, antipyreptics, analgesics, anti-inflammatory agents, sedatives, digestives, stool softeners, antihistamines, and diuretics. Mean hospital day for the norma vaginal deliveries of primipara was 2.6 days with little variation except one hospital with 3.5 days. Mean hospital day for the C-section of primipara was 7.5 days and that of multipara was 7.6 days and it ranged between 6.5 days and 9.4 days. Average hospital fee for a normal vaginal delivery without the medical insurance coverage was 182,100 Won for the primipara and 167,300 Won for the multipara. In case of the primipara covered by the medical insurance a mother paid 82,400 Won and a multiparous mother paid 75,600 Won. Average hospital fee for a C-section without the medical insurance was 946,500 Won for the primipara and 753,800 Won for the multipara. In case of the primipara covered by the medical insurance a mother paid 256,200 Won and a multiparous mother paid 253,700 Won. Average hospital fee for a normal vaginal delivery in the university hospitals showed a remarkable difference, 268,000 Won vs 350,000 Won, as well as for the C-section. A wide variation in the laboratory tests performed for a normal vaginal delivery and a C-section as well as in the medication and hospital days brought about a big difference in the hospital fee and some hospitals were practicing the case payment system. Thus, standardization of the medical care to a certain level is warranted for the provision of adequate medical care for delivery.; Summary

A Study on the Insurance Contribution and Health Care Utilization of the Regional Medical Insurance Scheme.: Sang Il Lee, Hyun Rim Choi, Hyeong Sik Ahn, Yong Ik Kim, Young Soo Shin; Korean J Prev Med. 1989;22(4):578-590.

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Abstract PDF: This study was conducted to assess the equity in the regional insurance scheme through analysis of the computerized data from one regional insurance society and National Federation of Medical Insurance. We analysed the insurance contribution and benefit by the classes based on total and income-related contribution per household. The major findings of this study are as follows: 1. The average proportion of income-related contribution among the total was 39.2% and the upper classes show higher proportion of the income-related contribution. 2. The upper classes show higher health care utilization rate than the lower classes. It suggests that the lower classes have relatively large unmet medical needs. 3. The analysis through the Lorenz curve reveals that there exists transference of contributions from the upper to lower classes. But the cumulative percentage of insurance benefit is smaller than that of the number of the insured. It implies that regional medical insurance scheme in Korea has still some inequity in the context of social security principles.; Summary

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