Journal of Preventive Medicine and Public Health

Volume 15(1); October 1982

Original Articles

Saemaul Education for ImprovingRural Health in Korea.: Sook Bang; Korean J Prev Med. 1982;15(1):5-16.

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Abstract PDF: The Saemaul Undong has brought great improvements tothe life-style environment of rural communities, but it has not been able to focuson a health program. In order to improve rural health, develop human resources, and utilise the nation's manpower, the Saemaul Undong should focus on a community health project. Mobilizing the manpower for such a project can be done by providing. opportunities for youth and young adults, especially village women, to betrained as primary health caretakers. This project can be achieved through the joint support of the Ministry of Horne Affairs, the Ministry of health and Social Affairs, and other Ministries. It will take decision and courage by government officials to implement, such a grand plan, but it is a very crucial task to promote primary health care throughout the whole nation. This calls for top leader's concern & will to adovocate and support a "Saemaul Movement for health", giving health asfirst priority to the Saemaul Undong as afresh political drive of the fifth Republic of Korea Government.; Summary

Physician's Responsibilities in Medical Dispute.: Joon Sang Lee, Baik Hi Choi; Korean J Prev Med. 1982;15(1):17-32.

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Abstract PDF: A physician assumes toward his patient the obligation to use such reasonable care and skill as is commonly possessed and exercised by physicians in the same general lime of practice in the same or similar localities and to use his best judgment at the times. Medical disputes between physicians and patients are ever more increased in these days as human body happens to cause a variety of changes in body unlike the function of machine. Such increased trends of medical disputes became a problem in common across the word under the influence of affluent living standard, high consciousness of life value and right by today's people. The aim of this dissertation is oriented to forming a physician's responsibilities in medical-care accidents arising between physicians and patients. A general physician, for example, has not been negligent merely because a specialist might have treated the patient with greater skill and knowledge. However, the fact that a physician may have acted to the best of his ability will not avoid legal problems for damages resulting from substandard treatment, that is the degree of care and skill which is to be expected of the ordinary practitioner in his field of practice. The duty of a physician who is, or holds himself out to be, a specialist is greater in the field of his specialty than one who is a general physician. A patient's consent to routine medical procedures is implied from the fact that patient comes to the physician with a medical problem and voluntarily submits to the procedures. For the more serious medical procedures and for major operations, however, it is preferable for the physician to have the patient's consent in writing, to facilitate proof of the consent in the event of a dispute or litigation. Suppose that mistakes on the part of physicians are likely to be blamed in all cases of malpractice. Then it will create a sort of shrinkage in activities of medical treatment. There should be some limitation on excessive application of "The thing speaks for itself" on mistakes by physicians and availablity of cause and effect. It is a matter of complicity as well as a matter of importance to draw a definite boundary on responsibilities of physician. A series of further research on this particular aspect is strongly urged.; Summary

A Study on the Effects of BCG Vaccination against Tuberculosis.: Pock Soo Kang, Sung Kwan Lee; Korean J Prev Med. 1982;15(1):33-46.

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Abstract PDF: In Korea BCG vaccination has been employed as the main control measure for tuberculosis since 1962. Recently, the protective efficacy of BCG against tuberculosis has been controversial worldwide. A case-control study was conducted to evaluate the efficacy of BCG in Korea which has a high prevalence of tuberculosis (2.5%). The study subjects were children under the age of 14 years who were hospitalized and diagnosed as tuberculosis in three general hospitals in Taegu City during last 6 years (1975~1980). Among 416 hospitalized tuberculous patients, 314 cases were confirmed as to the presence or absence of the BCG scar. A control group was selected from the same hospital patients of the same period as the cases. The control group was other than tuberculous patients whose distribution of age, sex and residence were the same as the cases. The results obtained are as follows: For all forms of tuberculosis, the relative risk and the protective efficacy of BCG were 3.5 and 71.8%. The efficacy was higher among female than among male (78.6% vs. 65.8%). The efficacy was higher among the one year and above than among less than 1 year of age. For tuberculous meningitis, the relative risk and the protective efficacy of BCG were 3.9 and 74.3%. The efficacy was statistically significantly higher among female than among male (p<0.05). The relative risk and the protective efficacyt of BCG for uberculous meningitis combined with miliary tuberculosis and combined with pulmonary tuberculosis represented 6.9, 85.6%, and 7.4, 86.5%, respectively. On the other hand, the relative risk and the protective efficacy of BCG for miliary tuberculosis were 2.1 and 51.6%, and for pulmonary tuberculosis, 2.3 and 54.7%, respectively. From these results, it appears that BCG vaccination is an efficient preventive measure in Korea where tubercuuosis is prevalent. Thus the routine BCG vaccination should be continued.; Summary

A Comparative Study on Responses to Korean Version Questionaires on Respiratory Symptoms.: Yoon Ok Ahn, Byung Joo Park, E Hyock Kwon; Korean J Prev Med. 1982;15(1):47-56.

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Abstract PDF: Korean versions of British Medical Research Council (MRC), Cornell 1V, Mgdical Index(CMI), and American Thoracic Society 78 (ATS-DLD-78) respiratory questionaires were compared with each other, and were tested the stability, in terms of test-retest reliability, of each questions by self-administration of those to 156 medical students. The results obtained and conclusions drawn are as follow: 1. The degree of agreements between responses to the comparable questions of CMI vs MRC, and of CMI vs ATS-DLD-78 were not satisfactory. There were, however, 71~100 per cent of agreement between responses to the questions on Cough, Wheezing, Phlegm, Breathlessness, and Chest illness of ATS-DLD-78 vs MRC questionaire. And the ATS-DLD-78 tended to yield greater number of positive responses than MRC (See Table 4). 2. All of the coefficient of stability of each questions in 3 questionaires were statistically significant, ranged 77~100 per cent, except that of the question on episode' of cough and phlegm in ATS-DLD-78 questionaire (See Table 5-1). The question is composed of two collateral conditions, "lasting for 3 weeks or more" and "each year". 3. It can be insisted that the Section-B questions of CMI is not proper for use in epidemiologic survey on respiratory illness. And rather than MRC, the ATS-DLD-78 questionaire deserves to prefer to be used in epidemiologic studies on respiratory illness. 4. In question-wording, especially, of inquiring past experience, it is possible to Iessen the reliability of the question that including collateral conditions such as 'the duration lasted of symptoms', and moreover, of which words are not common usage. For example, for Korean '10-days' or 'half a month' is more familiar time unit rather than 'week'.; Summary

A Study on Development of Questionaire for Use in Epidmiologic Survey on Respiratory Illness in Korea.: Yoon Ok Ahn, Keun Youl Kim, E Hyock Kwon; Korean J Prev Med. 1982;15(1):57-74.

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Abstract PDF: Questionaires on symptoms of respiratory disease have been used in Korea to elicit the probable health effects of air pollution in epidemiologic studies. The objectives of such studies often include comparing prevalence of symptoms of respiratory system between different population groups or between the same population groups at different times. Unfortunately, little attention has been paid to standardization of those questionaires, whether those are Korean versions or not. Furthermore, no attempt to develop Korean questionaire on respirator symptoms and relevant information has been made. Followed by 'a comparative study on responses to Korean version questionaires (English origin) of CMI, MRC, and ATS-DLD-78' two types of questionaires on respiratory symptoms and relevant information for Korean adult, which are short form (SUN=81-AS) and long forms (optional questions are added to the short one, SUN-81-AL), have been designed suitable to Korean background by authors (see Annex). The self-administered and closed-question questionaire were tested their validity and reliability by administration to 180 normal adults(medical and nursing students) and 60 clinical patients of Seoul National University Hospital, with spirometric exam. The results obtained and conclusions drawn are as follow: 1. It took less than 10 minutes to complete the questionaire SNU-81-AS and SNU-81-AT. 2. The test-retest reliability of each questions in AS and AL were observed as 92.7% and 92.1%, respectively. And all of the level of agreement are statistically significant with kappa statistic. 3. In addition to higher prevalence rate of symptoms in patients group compared with normal group, the correlations between FEV 1.0/FVC predictive value(%) and number of symptoms were statistically significant in patients group (See Fig. 1 and Table 7). 4. The answer rate to optional questions in AL form among those who are not to do was about 10%, while the no-answer rate among who are to do was about 15% in Normal (medical and nursing students) group. 5. From the viewpoints of validity and reliability, the new Korean questionaire (SNU-81-AS and AL) developed by authors are to be recommendable to use in epidemiologic studies on respiratory illness in Korea. The self-administration, however, of opthional questions in AL form may not assure the quality of data gathered.; Summary

Mercury Contents in Normal Blood of Koreans.: Yong Sun Kim, Kyeu Chull Chung; Korean J Prev Med. 1982;15(1):75-82.

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Abstract PDF: Normal range of mercury contents in blood and its relationship with urinary mercury excretion were studies with 68 healthy male adults living in Seoul city, who had no obvious evidence of either occupational exposure to mercury or therapeutic use of mercurial agents. Mercury analysis was made by means of dithizone colorimetric method with coefficient of variation of 10.9% in an average ranging from 5.1% to 18.0%. 1. Mercury contents in normal human blood were both normally and log-normally distributed, and better fitted to the latter. 2. Geometric mean and standard deviation of the mercury contents were 24.0%(log(-1) 1.38)+/-1.66 microgram/100 ml (log(-1) 0.22 microgram/100 ml) ranging from 7.2 to 79.7 microgram/100 ml with 95% confidence interval. 3. Mercury contents in normal human blood differed from person to person (p<0.01), and the variability of the measurements was negligible (p>0.05). 4. Mercury in the blood was contained much higher in erythrocytes than I!in plasma (p<0.01), showing the geometric means of 21.0+/-1.25 microgram/100 ml in red blood cells and 14.3+/-1.62 microgram/100 ml in plasma, respectively. 5. Mercury contents in normal human blood had a relationship of power function with mercury excretion in urine corrected with a gram of creatinine excretion per liter of urine (p<0.10).; Summary

Dental Erosion in two Factories using Acids.: Yong Hee Cheon, Ho Kwun Kwon, Young Hahn Moon, Jae Hoon Roh; Korean J Prev Med. 1982;15(1):83-88.

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Abstract PDF: Acid erosion of teeth was studied in two factories. The A was the textile factory possessing dyeing process using acids. The B was the metal product manufactof,ing factory possessing electroplating process. The control group was selected at the same factory not exposed to acids. The results were summarized as below. 1. The pH of saliva was the range of 6.6+/-6.8 in both factories. 2. The prevalence rate of erosion of teeth was higher in case group at ,the B. It was statistically significant. 3. The rate of erosion of incisor were the range of 12%16% (case group), 7%21,0,o (control group) at the A and 10%-20%(case group), 2%-5%(control group) at the B. 4. The rate of erosion of degree 3 which is necessary for conforming, owing to occupational induction, were 8.9% (incisor: A) and 6.8/0,o(incisor: B).; Summary

A Study on Antibody Producing by Intoxication of Cadmium Chloride or Lead Acetate in Rat.: Yong Chung, Sung Kun Jung, Sook Pyo Kwon; Korean J Prev Med. 1982;15(1):89-94.

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Abstract PDF: Among the environmental pollutants, cadmium and lead compounds may impair human health. These compounds may inhibit the biological metabolic function of bum.an body and may furthermore cause the disease directly or indirectly. This study was undertaken to investigate the effects of the immune response by intoxication of cadmium chloride and chloride acetate. Cadmium chloride (8.8 mg/kg, in saline 10 ml) and lead acetate (15 mg/kg, in saline 10 ml) were administered by lntraperitoneal injection. After 3 weeks, the rats were intoxicated with the above chemicals and immunized with sheep RBC. After 4 weeks, the immune response of rat spleen cells was measured by the Jerne's technique. The results were obtained as follows; 1. There was no change in leukocyte counts by the intoxication of cadmium chloride or lead acetate. 2. Cadmium chloride or lead acetate reduced hemoglobin contents for most intoxicated and immunized groups. 3. Hematocrits were decreased by the intoxication of cadmium chloride or lead acetate significantly. 4. It was determined that total protein, A/G (Albumin/Globulin), alpha-, beta- and gamma-globulins in rat serum were not changed. 5. Intoxication by cadmium chloride or lead acetate reduced the number of hemolytic plaque to the sheep RBC in rat spleen cells. Therefore, antibody producing of rat spleen cells was suppressed by the intoxication of cadmium chloride and lead acetate.; Summary

A Study on Distribution of Heavy Metals in Normal Korean Tissues.: Seong Gil Jang, Byung Yul Moon, Kyou Chull Chung; Korean J Prev Med. 1982;15(1):95-110.

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Abstract PDF: For the purpose of investigation to identify the quantities of heavy metals contained in the tissues of the Korean people, a series of analyses was conducted with atomic absorption spectrophotometry to measure the amount of lead, cadmium and copper distributed in various tissues, such as brain, liver, kidney, heart, lung, spleen, large intestine, hair, muscle, fat, stomach, costal cartilage, blood and urine, obtained from 30 cadaverous bodies who were believed not exposed to the said heavy metals during their life time either occupationally or therapeutically. 1. Lead content: Inter-individual difference was noted in lead contents in each tissue, vis., the average content of lead in hair was the highest with 14.90+/-9.74 ppm. The next was in costal cartilage that contained 5.06+/-3.86 ppm. The average contents of lead in liver, kidney and muscle were the lowest in value, showing 1.11+/-0.92 ppm, 0.73+/-0.48 ppm and 0.06+/-0.06 ppm, respectively. The lead contents in tissues of children under the age of 10 were significantly lower than those of adults, and the higher values were shown in finales than in females in general. The lead contents in most of the tissues such as hair, costal cartilage, kidney, lung, fat, stomach, large intestine, heart, muscle and urine were well correlated with age. 2. Cadmium content: The average content of cadmium in kidney appeared to be the highest, of ether tissues showing 20.7+/-29.82 ppm, and liver came nest with the value of 1.17+/-0.99 ppm. It was estimated that 83.9% of the total cadmium absorbed into the body was stored in kidney, 4.7% in liver, and the remaining 11.4% was distributed in the rest of the tissues. Cadmium contents in tissues showed difference between both sexes showing higher values in the females than in the males, which was quite contrary to the lead content. Cadmium contents in tissues steadily increased in amount with age, showing a significant correlation with age in all tissues. 3. Copper content: The average content of copper in hair was the highest with 10.36+/-2.21 ppm, and liver came next with 6.31+/-1.24 ppm. The copper that was absorbed into the body w4s distributed in each tissue: 29.9.% in hair, 18.2% in liver, 5~11% in brain, heart and kidney, and 3.0~3.5% in stomach, blood, and lung. The copper contents in tissues of children under the age of 10 showed significantly higher values in liver, kidney, heart and large intestine than those of the adults. The copper contents in brain, costal cartilage and fat were well correlated with age showing the highest correlation coefficient of 0.870 (p<0.01) in brain tissue. There was no difference in copper contents in tissues between both sexes, and the values were, in general, lower than those for Japanese.; Summary

Lead Determinaiton in 25 microliter Whole Blood Sample by Atomic Absorption Spectrophotometer with Furnace Atomizer.: Hyung Suk Kim, Yang Won Park, Do Suh Koo; Korean J Prev Med. 1982;15(1):111-114.

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Abstract PDF: To determine Pb level in blood, we usually used to pull out about 5ml blood from venous vessel and this sample was digested with acids to decompose organic matter and then determined the Pb contents by Atomic Absorption Spectrophotometer with flame. But recent trend in quan titating Pb in small amount of sample is very much recommended in clinical chemistry specially pediatrics, and industrial hygiene and occupational health area. Authors tried to determine Pb contents in small amount blood of 25 microliter by using capillary tube method and got the possibility of determination of ng amount of Pb in 25yl whole blood sample without any pretreatment of sample.; Summary

Estimation of Number of Dantists Required for the Systematic School Dental Programmes.: Ho Kwun Kwon; Korean J Prev Med. 1982;15(1):115-124.

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Abstract PDF: The systematic school dental health programmes have been recognized as one of the most effective national dental health measures. This study was conducted to estimate the number of dentists required for the systematic school dental programmes in Korea applying the methodology recommended by WHO. Information necessary for the study was obtained by a mass oral examination to the 1241 primary and middle school students in Kang Wha area. First and 6th grade students from primary school and 3rd year students from middle school were specifically selected for the examination. The results are summarized below: 1) For the Type I program recommended by WHO, 1.8 dentists per 10,000 primary school children were estimated to be necessary. For the Type II program 2.5 dentists, Type III program 2.0 dentists, Type IV program 3.6 dentists per 10,000 primary school children were estimated to be necessary. In order to extend the systematic school dental programmes to the middle students, 2.0 dentists for the Type I program and 2.4 dentists for the Type II program 2.2 dentists for the Type III program, 3.6 dentists for the Type IV program per 10,000 students were estimated to be necessary. 2) If we assume that prophylaxis are done by hygienist, for the Type I program 1.3 dentists and 0.5 hygienist, for the Type II program 1.8 dentists and 0.7 hygienist, for the Type III program 1.3 dentists and 0.7 hygienist, for the Type III program 2.2 dentists and 1.4 hygienists per 10,000 primary school students were estimated to be necessary. In order to extend this program to the middle school, 1.4 dentists and 0.6 hygienist for the Type I program, 1.6 dentists and 0.8 hygienist for the Type II program, 1.4 dentists and 0.8 hygienist for the Type III program, 2.2 dentists and 1.4 hygienist for the Type IV program per 10.000 students were estimated to be necessary.; Summary

The Influence of Subjective Complaints to the Course of Treatment in Pulmonary Tuberculosis Patients.: Sang Soo Kim; Korean J Prev Med. 1982;15(1):125-130.

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Abstract PDF: In order to investigate the relation of subjective complaints to objective course of treatment in pulmonary tuberculosis, one hundred and seventy four cases registered at the University Health Center in Chonnam University were divided into two groups, complaint group and non-complaint group. By analysing the record at the University Health Center during these seven years from 1973 to 1979, following results were obtained: 1. In complaint group who had subjective symtoms, thirty eightcases(77.6%) among forty nine cases were detected at clinic visit. In non-complaint group who had not any symtoms, one hundred and twenty one cases (96.8%) among one hundred and twenty five cases were detected at compulsive physical examination. 2. Comparisons of complaint group with non-complaint group were not statistically significant in many aspects, but significantly higher cases were discharged at the University Health Center to receive other medical service in complaint group than in non-complaint group. (6.1% vs 0.8, respectively). On the contrary, non-complaint group refused medication more than two times compared with complaint group in the course of treatment (29.9% vs 12.2%, respectively). 3. In the average time lag from initial diagnosis to initial treatment, comparisons between complaint vs non-complaint group were significant (7.8 vs 28.3 days, respectively). 4. Subiective symptoms were thought to create motivation to receivetherapy, and infuence of motivation to therapy was strong at initial stage but it become weaker as time passed.; Summary

Effects of Oral D-Penicillamine in Treatment of Industrial Lead Poisoning.: Soon Duck Kim; Korean J Prev Med. 1982;15(1):131-138.

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Abstract PDF: For the purpose of the curative effects of oral D-penicillamine in lead Ip0soning,D-penicillamine was orally administered to 7 lead poisoned workers which were employed in glaze product industry dealing with the lead oxide (Pb3O4). The doses of D-penicillamine was 1, 200mg per day which was administered by oral 7days schedules, taking for 5 days and stopping for the following 2days, repeatedly during 3 months period-(All the poisoned workers started working again in that industry after I month treatment, and were treated by oral D-penicillamine for 2 months still being exposed to contaminated environment. In order to evaluate the curative effects of D-penicillamine, IOgm of whole blood and 24 hours urine were collected every 14 days during the curative period for laboratory analysis(hemoglobin, blood lead. urine c-aminolevulinic acid, urine coproporphyrin, and urine lead levels) with the observation of the clinical symptoms. The results were as follows; 1. Oral D-penicillamine effected good curative results as that hemoglobin, blood lead, urine caminolevulinic acid, and urine coproporphyrin levels were decreased belpiv the critical level within 1 month treatment. 2. After re-exposure, oral D-penicillamine effected to some extent as that urine lead level was decreased 'below the critical level after 3 months treatment with disappgarence of the clinical symptoms after 2 months treatment. However, the curative effects of orral D-penicillamine in the lead exposure state is questionable since increasement of blood lead' level and remarkable decreasement of urine lead level after 3 months treatment can be observed.; Summary

A Study on Retreatment Patients of Pulmonary Tuberculosis Who had Registered at a City Health Center.: Yong Ja Kim; Korean J Prev Med. 1982;15(1):139-144.

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Abstract PDF: A study was carried out in 81 retreatment patients with sputum positive pulmonary tuberculosis who had previously been treated with first-line drugs for more than one year at Health Center. The Fallowing results were obtained; 1. Of the total 81 case of retreatment patients, male patients occupied 63(77.8%) and 18(22.20%a) were female. Age group of 30-,-49 years was 54.3% of total cases. 2. By extent of disease, moderate advanced cases were 53.1% and far advanced cases were 35.8%. 3. Of 81 patients admitted to the study, 65(80.3%) completed 1 year treatment 16(19.7%) patients discharged prematurely before 1 year. 4 patients terminated their treatment during 9-11 months after registration. 4. Completment rate of chemotherapy was highest (90%) at age of under'. 30 years. 5. Intractable patients with persistant positive sputum test for A.F.B. even after 12 months of retreatment were occupied 9(13.8%) of total retreatment cases.; Summary

Carboxyhemoblobin Dissociation at the Various Partial Pressures of Oxygen.: Byung Joo Park; Korean J Prev Med. 1982;15(1):145-152.

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Abstract PDF: No abstract available.; Summary

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