Journal of Preventive Medicine and Public Health

Volume 14(1); October 1981

Original Articles

Changes in Hospital and Clinic Care Patterns Under the Medical Insurance System.: Il Suh; Korean J Prev Med. 1981;14(1):3-12.

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Abstract PDF: To identify the changes in profession care patterns after the introduction of medical insurance in korea, professional care in hospitals and clinics of two succeeding years were compared. The hospital and clinics selected for this study were those which located in Seoul city. Hospital were classified into 3 categories: university hospital, general hospital and hospital. The diseases selected for this study were acute appendicitis and normal delivery. They were selected because their disease courses are considered to be fairly stable. The variables used for this study were length of stay, total hospital costs, costs of each components of cares. The information used for this study was obtain form the official forms requested by the medical facilities to the Korea Medical Insurance Corporation. The two periods studies were 3 months of each year form March 1st to May 3st in 1979 and 1980. The total number of normal deliverly studied was 289 in 1979, 301 in 1980 respectively and acute appendicitis was 92 and 111 respectively. In order to compare the quantity of medical care between 2 study periods the insurance price scores of 1979 were converted to prices of 1980. For statistical test of difference between 2 periods T-test and Welch's test were used. The result of the study were briefly summarized in below. 1. No significant difference was observed in the average length of stay of both disease between two study periods in all types of hospitals. 2. No significant difference was observed in the average total hospital costs of both disease in all types of hospital, but in the private clinic costs was rather decreased significantly in 1980. 3. More cost decrease were seen than cost increase in 1980 in all types of facilities. More cost changes by items were seen in acute appendicitis than in normal deliverly between two study periods. The total hospital costs can be divided into 2 portions: charges for drug and material and for physician. In normal delivery, costs for physician's charges was significantly decreased in almost all the hospitals and costs for drug and material were not changed significantly in all the hospitals in 1980. In the university hospitals, however, the costs for drug and material were increased significantly 1980. The cost decrease for physician's charge were mainly due to the decrease in the costs of laboratory test, treatment and physical therapy. The increase in the costs for the drug and material in the university hospital was mainly due to the increase in the costs for drug for oral administration and injection. 4. The proportion of components of medical care in the hospital has not been changed significantly, however, the cost for injection in normal deliverly was characteristically increased in 1980 in all hospitals studied. In general in the proportion of the costs for drug and material was tended to increase and the costs for physician was tended to decrease in 1980. The increase in the costs for drug and material were considered to be due to increase in the cost for drugs for oral administration and injection. The decrease in the costs for physician were due to decrease in the costs of laboratory test, treatment and physical therapy. Above mention changes in hospital and clinic care patterns are considered to be mostly influenced by the review criteria set by the K.L.C. for the assessment of the fee request made by clinics and hospitals.; Summary

A Research on Crippled Schoolchildren in Chungnam Area.: Jang Won Kwon; Korean J Prev Med. 1981;14(1):13-22.

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Abstract PDF: A study was conducted to provide comprehensive information in epidemiological state of crippled schoolchildren in Chungnam area from November 23, 1979 to 19, 1980. In this study, two step survey was conducted upon whole primary, middle and high school, and subsequent selected 537 case in total 3,063 crippled children. The results obtained are as follows; 1. The prevalence rate of orthopedic defect children was 3.7 per 1,000 and dominant male as 6 : 4. 2. It was relatively high the school grade and prevalence rate more increased. Prevalence rate was highest in high school as 4.7 per 1,000, middle in middle school as 4.4 per 1,000 and lowest in primary school as 3.1 per 1,000. 3. The most predominant group was 15-19 age as 52.9 percent. 4. The most common job of their parent was agriculture as 52.9 percent and next job sales and service. Economic state of Cripple's parent have revealed no particular difference. 5. In a family, the most common incidence rate was first children in both sex and decreased by ordered sibling. 6. Poliomyelitis was the most common cause as 71.5 percent and next cerebral palsy 11.9 percent. 7. The most common affected sited was lower extremity (Right: 42.3%, Left: 35.5%) and next upper extremity. Right was more dominant as 55:45. 8. Intelligence was decreased in cerebral palsy predominantly than other cause of defect, including poliomyelitis. 9. For the treatment of their condition at onset of illness, crippled children was utilized private clinic and herb medicine, but was changed tendency of treatment as acupuncture and moxibustion after diagnosis of cause defect.; Summary

Passive Smoking in Poorly Ventilated Room Space.: Jung Ae Rhee; Korean J Prev Med. 1981;14(1):23-31.

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Abstract PDF: This study was conducted to investigation the effects of passive inhalation of cigarette smoke and the correlation between change of flicker value and active or passive smoking in poorly ventilated room. Forty five male student were tested by divided into four experimental groups composed of active and passive smokers and three control groups. Each four experimental groups were exposed to smoke for Two hours in enclosed room. Vital capacities, flicker values, blood carboxy-hemoglobin levels and carbon monoxide concentration in room air were estimated before, during and after the exposure, and amounts of smoking or smoke exposure during two hours were also noted. The results obtained were as follows; 1. Concentration of carbon monxide in air and increase of blood carboxy-hemoglobin level(% COHb) were positively correlated with smoking amount. 2. Increase of blood carboxy-hemoglobin in passive smokers, in average, were about seventy six percent of that in smokers, as 2.2% vs. 2.9%. 3. Comparison with published data showed that Peterson's equation gave most similar result to this study in estimation of increase of blood carboxy-hemoglobin level. 4. During the exposure, flicker values fell steadily in both experimental groups and control groups as time passed. Flicker value were, however, elevated again in experimental groups after exposure, despite the fact that values still fell in control groups. 5. Blood carboxy-hemoglobin and flicker value were negatively correlated and this correlationship was stronger in passive smoker than in active smoker. 6. Multiple regression equation between flicker value and exposure time and blood carboxy-hemoglobin level was expressed as: Flicker value=41.6-0.2COHb%-0.9Hour, 7. In general, it is suggested that biological criteria would be more preferable than chemical criteria in establishment of statutory limitation of smoking in enclosed spaces.; Summary

Opinions of Medical Practitioners in Local Area about Rural Medical Care Practices.: Jin Su Choi; Korean J Prev Med. 1981;14(1):33-38.

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Abstract PDF: During 2 months from December 1979 to January 1980, Medical practitioners in chonnam province were grouped into Si (city), Eup(town) and Myun (rural area) groups according to the locations of their clinic. 40 practitioners were randomly selected in each group and were asked their opinions about rural medical care in general. Total of 88 practitioners replied to the question as 73.3 percent of response rate in average. The most frequently mentioned advantages of rural practice were ease of clinic opening in Si-and Myun-group respondents and good social relationship in Eup-group respondents. The most frequently mentioned disadvantages were medical isolation in Si-group respondents and resident's ignorance in medicine in Eup-and Myun-group respondents. In all groups, most respondents though that rural medicine care should be delivered by and controled by physician. Suggestions made by Eup-and Myun-group respondents for improving rural medical care by structural change focused on the regional medical insurance system, while Si-group respondents noted district hospital or hospital linkage as most preferable system.; Summary

AN Analysis of Cause of Death from the Reported Death Certification.: Dongwoo Lee; Korean J Prev Med. 1981;14(1):39-42.

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Abstract PDF: Recent changes in the cause of death among the Korean population seem to be systematic and significant. Data on cause of death from the medically certified death certificates provide at least four types of evidence: a sudden increase in recent years in the numbers of death due to cerebrovascular disease or circulatory diseases including rheumatic fever and chronic heart disease and althersclerosis; increasing steadily in the numbers of death due to malignant neoplasm of various sites, and death due to accident; decreasing steadily in the numbers of death due to communicable diseases or parasite diseases; and a large number of deaths with unspecified symptoms and ill-defined conditions. The lack of complete registration of the occurred or the incomplete description on the cause of death reported suggests that statistical information of cause if death form the medically certified death records is meaning in interpreting changing patterns.; Summary

Measles Infections and Measles Vaccinations Rates for the Past 10 Years in Kang Wha: A Cohort Observation.: Yong Ho Lee; Korean J Prev Med. 1981;14(1):43-51.

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Abstract PDF: The objective of the study is to measure the changes in measles infection and measles vaccination rates for the past 10 years in a rural area, Kang Wha. The study population were the entire children who were born between 1971 and 1980 in three townships (Sunwon, Naegae, Buleun) in Kangwha Country. Two interview surveys were carried out during the 10 years of period, one in 1977 and the other in 1981. The data were collected by Family Health Workers through interview with structured questionnaires. The diagnosis of measles was mainly based on histories, symptoms and sign of the disease. If a mother had reported measles history of her child, a public physician reviewed and decided the final diagnosis of the reported case. A retrospective cohort observation was done in order to see the trends of measles infections and measles vaccinations. The major findings were as follows; 1. The 5 year prevalence rate of measles vaccinations was 51.3% between 1971 and 1975 and 71.9% between 1976 and 1980 respectively. The difference between two periods was statistically significant (P<0.05). The secular trend of measles vaccinations showed increasing tendency from 1971 to 1978 and since then kept maintained. 2. In the birth cohort analysis of measles vaccinations, the vaccination rate, in general, were higher in the later cohort groups than that of earlier cohort groups. 3. The 5-year experience rates for measles infections were 24.3% between 1971 and 1975 and 17.2% between 1976 and 1980 respectively. This difference was statistically significant(p<0.05). The secular trend of experience rates for measles infections showed decreasing tendency from 1971 to 1980 except an outbreak in 1976. 4. The birth cohort analysis of experience rates for measles infections showed that the rate was higher in the later cohort groups than that of the earlier cohort groups. This decreasing tendency was prominent between 1973-1974 and 1976-1977. 5. The distribution of age specific incidence rates for measles inflections showed unimodal curve with the peak at the age of 12 to 18 months. This finding were same in both two surveys. 6. Seasonal variations of the measles inflections showed two peaks, one major peak in March through May and the another minor peak in September through December. 7. The 5-year reduction rate for measles inflections among those vaccinated was 90.4% between 1971 and 1975 and 88% and between 1976 and 1980.; Summary

Hospital Services Utilization by Insured and Non-insured Patients for Cesarean Section in a University Hospital.: Seung Hum Yu, Woo Hyun Cho, Dai Kyu Oh; Korean J Prev Med. 1981;14(1):53-58.

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Abstract PDF: In order to discover difference that may exist in quantity of medical care services, length of stay and hospital changes between insured and non-insured patients, records for primary Cesarean section patients discharged between July 1978 and June 1980 from a university hospital were examined. In addition, Cesarean section rates among the total deliveries for a two-year period between the groups were studied. The results showed that volume of services was greater and length of stay was longer among the insured, however, charges were higher among the non-insured. Cesarean section rates were statistically significantly different between insured and non-insured patients for every age group except the group of 35 or more.; Summary

A Result on the Physical Checkup of Public Officals and Schools.: Nung Ki Yoon; Korean J Prev Med. 1981;14(1):59-64.

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Abstract PDF: Korean Medical Insurance Cooperation executed the physical checkup intended for all the members of public officials, school personnel in private schools, and the insured as a national-wide event in 1980. This is the result of a part of Taegu district and its contiguous country this hospital took change of. Physical checkup method was divided into the first health examination and the second health examination. The second health examination was executed for those who needed reexamination according to the result of the first health examination. After that, we passed judgment on the result finally. The total number of the first health examination was 10,779 ; 4,606 in public officials, 2,327 in police constables, 3,976 in school personnel in private schools. The classification of physical checkup is as follows; A group: normal groups. B group: those who do not require immediate medical care but require preventive measure or who are doubtful of disease or who had undetermined diagnosis (attention) C group: those who require immediate medical care but who are able to be on duty (simple recuperation). D group: those who require immediate medical treatment and recuperation (suggestion from office and recuperation). Total B group to the in the first health examination was 4.73%, that of total C,D groups 2.21%. That of total C,D groups to the total in the first health examination by occupation was 2.30% in public officials, 2.19% in police constables, 2.04% in school personnel. Consequently there was no different among occupations. Total C,D groups of hypertension to the total in the first health examination was 1.68% and hypertension was 76.05% to all disease. These rates mentioned to above were higher than any other rate in disease. Subsequently, being low, the rate of diabetes was 15.54%. From the view point of age, the higher rate appeared in men and women over 35 years old of B group and over 45% years old of C,D groups in three occupation in comparison with other ages and the older men were, the higher men who took a disease were.; Summary

A Study on Sickness and the Status of Medical Care in a Rural Area.: Jeong Sun Park; Korean J Prev Med. 1981;14(1):65-74.

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Abstract PDF: This survey was made to determine the overall health situation on (1) the status of sickness; (2) the medical care utilization; (3) the medical cost in Mi-Kum Myun, Nam Yang Ju Gun, Kyung_Gi Do. The survey with questionnaire was carried out with 2,840 peoples in 560 households from August 9th to 16th, 1979. The findings from the survey were as follows; 1. Annul morbidity rate of the prolonged ill cases was 97.2 per 1,000 population (male 94.7, female 99.6). The highest age specific morbidity rate was 274.5 of the 45-to 64-year group and the lowest was 21.9 of the 5-to 14-year group. 2. Annul morbidity rate of the new patients was 777.5 per 1,000 population(male 644.5, female 909.5). 3. The chief complaints distribution of the prolonged ill cases was: local pain 36.6%, indigestion 22.4%, and coughing 7.3%, respectively. In terms of age and sex distribution, a large number of female of the 45-to 64-year group complained of local pain or general pain a large number of both sexes of the 25-to 44-year group complained of indigestion. 4. The major diseases of the new patients which classified with International Classification of Disease (I.C.D) were disease of the respiratory system, disease of the digestive system, and disease of the musculo-skeletal system and connective tissue for male, disease of the respiratory system, disease of the digestive system, and accident, poisoning, violence for female. 5. Total ill days of the 92 new patients were 536 days and average ill days per were 6+/-38.3 days. 6. The rate of receiving treatment in the prolonged ill case was 82.2%(medical facilities 46.4%, drug stores 27.5%, herb medicine 8.3%). 7. The rate of receiving treatment by first choice of the new patients was 88.0% (drug stores 57.%, medicine facilities 28.2%, and herb medicine 2.2%), and the rate of receiving treatment by second choice was 30.9% of first treatment cases (medicine facilities 44.0%, drug store 44.0% and herb medicine 12.0%). 8. Annul hospitalization rate per 1,000 population was (male 12.0, female 11.9). 9. The locations of medical facilities utilized by out-patients were: in the prolonged ill cases Seoul or other places 66.4%, Nam Yang Ju Gun 33.6%, in cases of the new patients Seoul or other places 35.1% and Nam Yang Ju Gun 64.9% respectively. 10. The satisfaction rate of the new patients by mode of receiving treatment was: in cases of primary utilization by first choice herb medicine 100.0%, medical facilities 88.5%, and drug stores 69.8%, in cases of secondary utilization medical facilities 100.0%, herb medicine 100.0%, and drug stores 72.7% respectively. 11. The medical cost per utilized facilities was as follows; in average medical fee per case out-patient 8,947 won, in-patient 266,000 won, drug stores 1,532 won, and herb medicine 15,607 won, in average medical fee per day out-patient 4,829 won, in patient 14,178 won, drug stores 891 won, and herb medicine 4,906 won respectively. 12. The sources of the hospital changes paid out were: there own expense 50.0%, debt 35.3%, and security of medical care 14.7% respectively.; Summary

Prevalence of the Vibration Syndrome among Rock-drilers in the Anthracite Mining Area.: Jae Hoon Roh; Korean J Prev Med. 1981;14(1):75-80.

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Abstract PDF: Due to rapid industrialization and economic development, the occupational diseases have appeared as one of the social problems in Korea. Up until now little has been known about the prevalence rate, predisposing factor and symptomatology the occupational disease due to localized vibration in Korea. The researcher intends to investigate the prevalence rate and affecting factors of the occupational disease due to localized vibration among rock-drillers in the anthracite mines. A total of 135 rock-drillers were interviewed and examined from May 15th to 31th, 1980. The results were revealed as follows; 1. The prevalence rate of the vibration syndrome among rock-drillers was 12.6%. 2. The latent period of the vibration syndrome was 6.8% years. 3. The prevalence rate of the vibration syndrome was not significantly different between smokers and non-smokers. 4. With the increase of total vibration exposure time, the prevalence rate of the vibration syndrome increased also. 5. The average vibration sensation threshold was high (6.4dB) in stage 1 of the vibration syndrome and low (-0.6dB) in stage 0. 6. The average pain sensation threshold was high (4.4g) in stage 1 of the vibration syndrome and low (2.5g) in stage 0.; Summary

An Epidemiological Study on the Industrial Injures of Textile Workers in Daegu Area.: Pock Soo Kang; Korean J Prev Med. 1981;14(1):81-88.

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Abstract PDF: The present study was conducted to investigate the status of industrial injuries through a prospective study for a year from August 1980 to July 1981. The subjects were 15 textile industries which were selected by random sampling in Daegu. The results obtained are as follows: Annal over-all incidence rate of industrial injuries was 3.3 percent and the rate showed 6.7 percent in male and 2 percent in female. The rate showed decreasing tendency with larger scale of industries. By the age group, 15-19 age group was the highest as 49.3 percent. Age specific incidence rate of industrial injuries revealed highest as 4.7 precent among the group the group of 30 years old and over. By the years of service, 57.1 percent of the total cases belonged to the group less than 1 year and the rate revealed increasing tendency with shorter period of service. The highest frequency in industrial injuries was observed at the point of 3 hours after the beginning of the work in a day as 18.1 percent. Frequency of industrial injuries showed highest as 27.7 percent in winter time and showed 14 percent and 11.8% percent in January and August, respectively. By the cause of injuries, machinery accident showed the highest as 39.2 percent and followed by the accidents due to striking against object as 17.8 percent, fall of ground as 16.3% percent and hand tool as 7.2% percent. Frequency of injured parts of body was highest as 43.9 percent in fingers. The frequency was much higher in upper extremities (66.9%) than in lower extremities (17.6%). By the kind of injuries, laceration wound was highest as 35.7% percent and the next was superficial injury and contusion as 35.1 percent. By the duration of treatment, most of the cases was belonged to the group less than 1 month as 79.1 percent and the duration showed prolonging tendency with larger scale of industries.; Summary

A Study on industrial Accidents of Workers in Jeonbug Areas.: In Dam Hwang, Young Soo Park, Suk Kwon Suh; Korean J Prev Med. 1981;14(1):89-96.

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Abstract PDF: Of 2,740 industries in Jeonbug area which are covered by industrial insurance policy, 462 facilities which the accidents related to industry occurred during the year of 1979 were studied, and the results are summarized as follows; 1. The accidents related to industry occurred in 462 industries of the total 2,740 industrial facilities in Jeonbug area as of 1979. 2. The incidence rate accident per 1,000 workers was 34.3(49.2 in male workers and 12.8% in female workers), the frequency rate of the total industries in Jeonbug area was 13.36, and severity rate was 1.3. 3. The frequency rates and severity rates by type of industry in study area were quit different to compare with those of national rates. 4. The incidence rate of construction industry was 223.6 per 1,000 workers, and that of transportation-communication industries were 78.6. 5. The proportion of industrial accidents of 20-24 age group was 22.1 percent of the total accidents, and the proportions decreased according to age increase. 6. The incidence rate in the industry having less than 49 workers was 20.6 per 1,000 workers, that of industry with 50-99% workers was 26.7, that of industry with100-199 was 51.9, that of industry with 200-499 was 80.2 and that of with more than 500 workers was 40.7. 7. The accidents which occurred in the workers with experience of less than one year was 69.4 percent of the total accidents, otherwise, the longer the workers have worked the less accident they have. 8.The most accidents occurred in the shift between 10 to12 o'clock, and 16 to 18 hour. 9. The primary causes of the industrial accidents were found to be collisions, machinery, falling objects and falls. 10. The site of injury by type of industry were quit different, and the major site of injury was finger. 11. The laceration and open injuries of the accidents related to industry were 37.2 percent of the total ceases, and fractures or dislocations were 28.5 percent, and contusions were 6.5% percent. 12. Death rate of industrial accident was 5.0 per 1,000 workers, and those of industry were 47.6 in transportation, 42.8 in construction industry, 24.4 in mine industry, and 2.0 in manufacturing industry.; Summary

A Study on the Status of Working Environment of Some Rubber and Chemical Products Manufacturing Industries in Busan.: J Y Kim, C U Lee, K T Pea, J H Kim, J O Kim, D K Kim, Y W Kim; Korean J Prev Med. 1981;14(1):97-110.

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Abstract PDF: This study was conducted in order to investigate the status of harmful working environment on twelve rubber and ten chemical products manufacturing industries in Busan area over a period of five months from June 1 to October 31, 1980. The summarized results were as follows; 1. The highest and lowest mean values of harmful environmental elements in workroom of rubber products manufacturing industries were noted in twisting (98.7dB) and coating department (77.3dB) to noise, molding (6.43mg/m3) and forming (1.33mg/m3) to dust, bonding (toluene 463.7ppm, xylene 83.3ppm and benzene 6.7ppm, respectively) to organic solvents respectively. Also in chemical products manufacturing, they were noted in grinding (95.1dB) and shining department (76.8dB) to noise, packing (4.30mg/m3) and staining (3.20mg/m3) to dust, shining (393.3ppm and 375.0ppm, respectively) and varnishing(125.5ppm and 121.7ppm, respectively) to toluene and xylene, and scattering (51.8ppm) and mixing (23.9ppm) to benzene, respectively. 2. The mean values of harmful elements in workroom of rubber products manufacturing were 86.3dB to noise, 4.16mg/m3 to dust, 258.2ppm to toluene, 230.3ppm to xylene, and 54.0ppm to benzene, respectively. Also in chemical products manufacturing, they were 85.2dB to noise, 3.69mg/m3 to dust, 227.9ppm to toluene, 213.2 ppm to xylene, and 36.3ppm to benzene, respectively. 3. Number of workers exposed to harmful working environment, over TLV, of a total 10,195 workers in rubber manufacturing were 1,002(9.8%) to noise, 212(2.1%) to dust, 1,581(15.5%) to tolune, 1,509(14.8%) to xylene, and 1,524(15.0%) to benzene, respectively. Number of workers exposed to harmful working environment, over TLV, of a 1,913 workers in chemical products manufacturing were 112(5.9%) to noise, 132(6.9%) to each organic solvent, respectively. 4. The values of noise and dust of rubber and chemical products manufacturing in 1980 were lower then those in 1977, but the value of organic solvent in 1980 was with that in 1977.; Summary

Cadmium and Lead Concentrations in Blood if Solderers among Autoworkers.: Bae Joung Yun; Korean J Prev Med. 1981;14(1):111-116.

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Abstract PDF: Econmic development of Korea brought rapid progress and expansion of her industries. Accordingly, number of workers who have been exposed to hazardous metal are increasing. For better understanding the significance of on the job human metal pollution, a total of 22 solderers among autoworkers and 28 controls among medical students was purposively selected as samples of the study. From their blood, concentrations cadmium and lead were measured with atomic absorption spectrophotometer, and to compare with statistical indices of controls those of solderers were summarized as follows. 1. Each frequency distribution of cadmium and lead concentration in blood of solderers was more positively skewed showing non-Gaussian distribution. 2. Interindividual variation of lead concentration on blood of solderers was markedly revealed. 3. Each mean of cadmium and lead concentration in blood of solderers was higher than that of controls(Cd;p<0.01, Pb;p<0.01). 4. Relative ratio of cadmium concentration in blood of solderers to that of controls was 1.36 by arithmetic mean and 1.39 geometric mean. Relative ratio of cadmium concentration in blood of solderers to that of controls was 1.53 by arithmetic 1.30 by geometric mean. 5. It was shown that concentration of lead id slightly correlation with that of cadmium both in solderers and controls(solderers;P<0.1, control;P<0.1).; Summary

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