Journal of Preventive Medicine and Public Health

Volume 26(4); December 1993

Original Articles

Lifestyle.: Hee Choul Ohrr; Korean J Prev Med. 1993;26(4):469-479.

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Abstract PDF: This article reviewed the historic and epidemiologic reasons for the emergence of health promotion with a special focus on lifestyle. Health effects of tobacco, alcohol, physical exercise, and nutrition were briefly presented by reviewing recent researches. Social environments supposed to limit the application of health promotion strategies are also mentioned.; Summary

Determinants Of Health: Environmental Factors.: Hyun Sul Lim; Korean J Prev Med. 1993;26(4):480-507.

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Abstract PDF: Environmental pollution is common problem of the present world that is intimately related to the future survival of human beings. The problems of environmental pollution originate from the pursuit of benefit by enterprises, insufficient countermeasure of government and ignorant life style of the people. Health hazards due to environmental pollution have characteristics of irreversibility, difficulty in measurement and ineffectiveness of personal prevention. Objects of this article are to review the various aspects of environmental pollution, to outline the present status of environmental pollution and strategy to control environmental pollution in Korea. In the first part of this article, causes of environmental pollution are presented. International relationships, world-wide status of environmental pollution and health hazards due to environmental pollution are briefly reviewed. In the second part, present status of air, water, soil and ocean pollution in Korea is presented. Pollution by radioactive materials, noise, vibrations, odor, wastes and chemicals is reviewed. Climate changes related to environmental poisoning, problems of workplace environment, pesticide and defoliants are also reviewed. Finally, control measures for environmental pollution including the role of government are reviewed.; Summary

Health-Related Behaviors: Theoretical Models And Research Findings.: Sang Soo Bae; Korean J Prev Med. 1993;26(4):508-533.

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Abstract PDF: A wide range of health professionals have interest in changing the health behavior of individuals. To intervene effectively and to make informed judgements about how to measure the success of such interventions, health professionals must have an deep understanding of health behavior. This paper provides and overview of the thories of health-related behaviors and the strength and weakness of each, how the theories relate to others, and how they can be used in practice. The theories reviewed include Suchmann's stages of illness experience, Health belief model, Attribution theory, Fishbein's theory of reasoned action, Multiattribute utility models, Consumer information processing, and Andersen's models. Finally, this paper introduces the reader to interesting research findings in our country.; Summary

The Role of Preventive Medicine in Korea.: Y S Shin; Korean J Prev Med. 1993;26(4):534-540.

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Abstract PDF: No abstract available.; Summary

Epidemiological characteristics of HIV infected homosexuals in Korea(1992).: Young Keol Cho, Yung Oh Shin, Young Bong Kim; Korean J Prev Med. 1993;26(4):541-550.

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Abstract PDF: In order to investigate psychological and behavioral characteristics homosexuals and to present evidence that homosexuals are in danger of HIV infection in Korea, this study was done by self-administered questionnaire and then direct interview with the 28(35%) HIV infected homosexual/bisexuals of 79 HIV infected persons reported in 1992. Homosexuals without heterosexual activity were 9 and the others were bisexuals. Sixty-five percent of respondents had a guilty conscience for their homosexual activity. Twenty(71%) were in twenties and 5(18%) in thirties. Twelve(43%) were detected via health card checking by health office, 21% by blood donation, 18% by hospital visit, and 7% by partner notification. Motivations for homosexual activity were curiosity(36%), temptation or recommendation(14%) and compulsion(11%). Eighteen(72%) never used condom on anal sex. Nine of 26 respondents had experience for anal sex with foreigners. Fourteen(54%) of 26 respondents had history for sexually transmitted diseases. Fightly percent did not have sexual contact after HIV infection and the others usually used condom. It was confirmed that over 57% of the respondents were infected within 1 year before HIV diagnosis and over 82% within 2 years. These data suggest that HIV infection among homosexual group is rapidly spreading.; Summary

An experimental study on the effect of maltol against oxygen toxicity.: Sung Joo Hwang, Soo Hon Cho, Dork Ro Yon; Korean J Prev Med. 1993;26(4):551-564.

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Abstract PDF: Since the widespread application of hyperbaric oxygenation in clinical medicine, the problems of oxygen toxicity have been attracting a deep interest from the researchers on hyperbaric medicine as a practical issue. Among extensive research trials, the study on the protective agents oxygen toxicity occupied one of the most challenging field. As the mechanisms of oxygen toxicity, the role of the oxygen free radicals produced by peroxidation process are strongly accepted by the leading researchers on oxygen toxicity, the probable protective effects of antioxidant against oxygen toxicity are sustaining a sufficient rational. Maltol(2-methyl-3-hydroxy-gamma-pyrone) which is known to be a component of Korean red ginseng has been reporting to have an antioxidant action. But, further study is needed to provide definite evidence for this compound to be an antioxidant, since the action was based on the results which were obtained under in vitro experiment. In this study, the author attempted to evaluate the effect of maltol as protective agent against oxygen toxicity through the observation of death rate, convulsion rate, time to convulsion and microscopic pathological changes in some organs of experimental rats exposed to various conditions. The findings observed are as follows: 1) The death rate, convulsion rate, time to convulsion, lung/weight ratio and microscopic pathological finding of lung were identified as reliable objective and quantitative indices for oxygen toxicity. 2) Maltol showed excellent protective effect against pulmonary oxygen toxicity as an antioxidant.; Summary

A study on the change of urinary catecholamine sexcretion due to noise stress.: Hyung Suk Kim, Joon Bae Chun, Ulf Lundberg; Korean J Prev Med. 1993;26(4):565-573.

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Abstract PDF: Noise is not only affecting the ear and the auditory cortex locally, but its influence is widely spread throughout the brain structures, e. g., the reticular formation, the brain stem nuclei or the subcortical forebrain area. Hence, any of the organism's activities can be hindered or stimulated by noise. High noise is a stressor and the catecholamine level can be used both as a stress marker and as an indicator of modified sympathetic nervous system activity. Several recent studies have found that the urinary excretion of catecholamines is increased due to high noise intensity, especially unexpectedly high and long lasting noise. The present study was conducted in order to examine the effects of noise stress on urinary excretion of catecholamines in rats and humans. Rats were exposed to 90 dB noises for 10, 30, and 60 minutes, 3 and 12 hours. 24 hour urinary samples were collected and the catecholamines were extracted by alumina and analyzed by HPLC-ECD. Catecholamine levels increased with time of exposure up to 60 minutes: norepinephrine concentration at 60 min of noise=1.038 ng/ml, epinephrine=0.636 ng/ml. Urine catecholamines of blue collar workers exposed to 90 dB of noise at the workplace were collected between 2 and 4 p.m. and compared to that of white collar workers exposed to 70 dB. Mean norepinephrine level of the blue collar workers was 0.89 ng/ml(+/-0.25), epinephrine 0.24 ng/ml(+/-0.09), and that of the white collar workers 0.48 ng/ml(+/-0.12), epinephrine 0.19 ng/ml(+/-0.05). It was concluded that noise acts as a stressor and increases the catecholamine levels in both rats and humans.; Summary

A Study On The Factors Of Absenteeism Among The Manufacturing Workers.: Dong Bae Lee, Tae Yong Lee, Young Chae Cho, Young Soo Lee, Jang Kyun Oh, Am Park; Korean J Prev Med. 1993;26(4):574-586.

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Abstract PDF: This study was to examine the actual conditions and contributing factors of absenteeism in manufacturing workers. Subjects were 1,184 workers employed in Taejon city and the observation period for absenteeism was 3 months (June to August), 1992. We obtained the following results. 1. Percentage of the absentees among the studied subjects were 21.1% in gross absence and 6.9% in sickness absence. Gross absence rate of subjects was 1.2% and sickness absence rate was 0.5%. 2. In the group of absentees, mean days of absence was 2.8 days and those of sickness was 4.4 days. Mean days of sickness absence due to injury was higher than that of illness, but the total days of sickness absence was high in extremity injuries, trunk injury, general fatigue, head injury, musculoskeletal problem in that order. 3. Variables contributing to the absence were job classification, education level, working hours per day, exposure of noxious factor, worker classification. 4. In the group of absentees, variables influencing the gross absence rate were working atmosphere, body mass index, working environment, working hours per day but those of the sickness absence were working hours per day, education level and working atmosphere.; Summary

A study on occupational hydrofluoric acid burns in a hydrofluoric acid manufacturing factory.: Hyun Sul Lim, Hae Kwan Cheong, Ji Young Kim; Korean J Prev Med. 1993;26(4):587-598.

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Abstract PDF: Hydrofluoric acid is one of the strongest irritating, corrosive and poisonous inorganic chemicals. Hydrofluoric acid burns are occurring with ever-increasing frequency due to the wide use of this acid in industries. Hydrofluoric acid burns are characterized by severe progressive tissue destruction and excruciating pain due to the unique properties of the freely dissolvable fluoride ion. The authors reviewed medical records of 32 cases(36 spells) of hydrofluoric acid burns which occurred in a hydrofluoric acid manufacturing factory from Sep. 1, 1990 to June 30, 1993. The results are as follows; 1. Eleven measurements of air concentrations of hydrofluoric acid by detection tube method from 1990 to 1992 were all below TLV(Department of Labor, R. O. K). 2. There were 19 cases(22 spells) of hydrofluoric acid burns which occurred during the study period among regular employees. The overall incidence density of hydrofluoric acid was 17.8 cases(20.6 spells) per 100 person-year. Incidence density was 19.0 cases(22.0 spells) per 100 person-year among male workers and there were no female cases. Incidence density was 32.9 cases(38.3 spells) per 100 person-year among production workers and 1.9 cases(1.9 spells) per 100 person-years among management workers with the difference being statistically significant(P<0.01). 3. Of 32 cases(36 spells) of hydrofluoric acid burns among workers who were regularly employed or temporarily employed, 26 spells(81.2%) were between age 20 to 39. In 15 spells(41.7%) burns occurred between 12 : 00 and 17 : 59 with 16 spells(44.3%) having arrived at hospital within 2 hours after the accident. 4. Of 36 spells, the main cause of hydrofluoric acid burns were by splashes(8 spells, 22.2 %). The most frequent site of burns were fingers and pain was the most frequent symptom. Thirty spells(83.3%) of the hydrofluoric acid burns were treated with local injection of antidote(calcium gluconate). Complete recovery without scarring were observed in most of the cases(34 out of 36 cases, 94.4%). The study results suggest that to prevent hydrofluoric acid burns, environmental control and the wearing of hydrofluoric acid resistant protective clothes and gloves are important. It is also stressed that establishment of an emergency management and a transfer system for hydrofluoric acid burn victims is necessary.; Summary

Prenatal care utilization pattern and its determinants in rural Korea.: Jang Rak Kim, Jung Han Park, Jae Kyong Lee, Sang Hong Seo, Joon Yong Bang; Korean J Prev Med. 1993;26(4):599-613.

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Abstract PDF: To study the pattern of prenatal care utilization and its determinants in rural Korea, 976 mothers(65.5%) out of 1,489 living mothers in Chinyang, Sachon and Hapchon Counties in Kyongsangnam Province who had delivered a baby between July 1, 1990 and June 30, 1991 were interviewed by the Myon health workers from January 3 through February 15, 1992. The Andersen's behavioral model for health service utilization was applied to develop the frames for analysis. The dependent variable was a number of prenatal care visits. And the independent variables included in the model were the variables pertaining to the predisposing, enabling, medical need and other components. The proportion of mother who had ever received the prenatal care service for the index pregnancy was 97.3%. However, the proportion of mothers who had made more than 10 visits was only 20.6%, which indicated that majority of mothers had paid far less visits than recommended 10~12 visits for each normal pregnancy. The low utilization of prenatal care services(none or less than 4 visits) was related to mother's low educational level, the high birth order, beneficiary of the medical aid, the absence of clinic in the community, no diagnosed disease of mother during pregnancy, and mothers engaged in farming. Inequity of access seemed to exist because social structure variables and the variables of enabling component were important predictors. And there seemed to be high mutability in equalizing the distribution of prenatal care services because the variables of enabling component such as type of medical security and whether there was a clinic or not in the community were substantially important.; Summary

A study on the practice variations according to physician characteristics.: Eun Kyeong Jeong, Ok Ryun Moon, Chang Yup Kim; Korean J Prev Med. 1993;26(4):614-627.

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Abstract PDF: It is well known that a physician's personal characteristic affects his practice pattern. Furthermore, a physician's specialty has powerful influences on his practice pattern. However, despite the fact specialization has received the most attention for its influence on physician's service behavior, few studies have been conducted on the variations of contents and volume of physician's services. This study has intended to identify factors influencing the practice variations according to various physician characteristics. There are some other evidences that medical care providers are different in using of health services and resources in Korea. Four physician characteristics were selected for the analysis, two demographical factors, age and sex, and two practice factors, place of practice and medical specialty. Also, three indicators of service amount(total amount of insurance claim bill, number of visits per case, number of prescriptions per case) were selected. From the pool of insurance claims for ambulatory care received by the Korean National Federation of Medical Insurance(NFMI), 84,898 cases were randomly sampled. In the meantime using physician database of NFMI, 613 general practitioners(GP), 107 regular family physicians(FP), 483 'grandfather' family physicians(GFP), and 1,157 specialist practitioners(SP) were randomly sampled. Their different practice contents were compared concerning the specialty, age groups, sex, and practice sites(urban-rural). Specialist physicians tend to provide more costly care than do generalists. General practitioners and family physicians usually make fewer following visits and prescriptions. Age is also the important factor in determining the amount of services, which is highest at the physician's age group of 40's. Female doctors and urban practitioners use much more resources than their counterparts respectively. Research findings suggest that physician's characteristics particularly the specialty can affect practice patterns and resource utilizations. Other characteristics such as age and sex are not controllable but physician's specialty is relatively easily controllable during the entire phases of policy implementation. This is all the more true in the individual's initial decision of his specialty. Specialization therefore should receive policymaker's attention for its potential influence on medical care utilization and health care expenditure.; Summary

Factors related to poor school performance of elementary school children.: Jung Han Park, Gui Yeon Kim, Kyu Sook Her, Ju Young Lee, Doo Hie Kim; Korean J Prev Med. 1993;26(4):628-649.

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Abstract PDF: This study was conducted to investigate the factors related to the poor school performance of the elementary school children. Two schools in Taegu, one in the affluent area and the other in the poor area, were selected and a total of 175 children whose school performance was within low 10 percentile(poor performers) and 97 children whose school performance were within high 5 percentile(good performers) in each class of 2nd, 4th and 6th grades were tested for the physical health, behavioral problem and family background. Each child had gone through a battery of tests including visual and hearing acuity, anthropometry(body weight, height, head circumference), intelligence(Kodae Stanford-Binet test), test anxiety(TAI-K), neurologic examination by a developmental pediatrician and heavy metal content(Pb, Cd, Zn) in hair by atomic absorption spectrophotometry. A questionnaire was administered to the mothers for prenatal and perinatal courses of the child, family environment, child's developmental history, and child's behavioral and learning problems. Another questionnaire was administered to the teachers of the children for the child's family background, arithmatic and language abilities and behavioral problem. The poor school performance had a significant correlation with male gender, high birth order, broken home, low educational and occupational levels of parents, visual problem, high test anxiety score, attention deficit hyperactivity disorder(ADHD), poor physical growth(weight, height, head circumference) and low I.Q. score. The factors that had a significant correlation with the poor school performance in multiple logistic regression analysis were child's birth order(odds ratio=2.06), male gender(odds ratio=5.91), broken home(odds ratio=9.29), test anxiety score(odds ratio=1.07), ADHD(odds ratio=9.67), I.Q. score(odds ratio=0.85) and height less than Korean standard mean-1 S. D.(odds ratio=11.12). The heavy metal contents in hair did not show any significant correlation with poor school performance. However the lead and cadmium contents were high in males than in females. The lead content was negatively correlated with child's grade(p<0.05) and zinc was positively correlated with grade(p<0.05). Among the factors that showed a significant correlation with the poor school performance, high birth order, short stature and ADHD may be modified by a good family planning, good feeding practice for infant and child, and early detection and treatment of ADHD. Also, teacher and parents should restrain themselves from inducing excessive test anxiety by forcing the child to study and over-expecting beyond the child's intellectual capability.; 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

Geographical distribution of physician manpower by specialty and care level.: Seung Hum Yu, Sang Hyuk Jung, Byung Yool Cheon, Tae Yong Shn, Hyohn Joo Oh; Korean J Prev Med. 1993;26(4):661-671.

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Abstract PDF: In order to compare the geographical distribution of physician by level of medical care and specialty, a log linear model was applied to the annual registration data of the Korean Medical Association as of the end of December, 1991 which was supplemented from related institutions and adjusted with relevant sources. Those physicians in primary and secondary care institutions were not statistically significantly unevenly distributed by province-level catchment area. There were some differences in physician distribution among big cities, medium and small-sized cities, and counties; however, those physicians for primary care level were equitably distributed between cities and counties. Specialties for secondary care physicians were less evenly distributed in county areas than in city areas, and generalists are distributed more evenly in cities and counties than in big cities. There is a certain limitation due to underregistration in the annual physician registration to the Korean Medical Association; however, the geographical distribution of physicians has been improved quantitatively. It is strongly suggested that specialties and the level of medical care should be considered for further physician manpower studies.; Summary

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