Journal of Preventive Medicine and Public Health

Volume 26(3); September 1993

Original Articles

Mean fasting blood glucose level and an estimated prevalence of diabetes mellitus among a representative adult Korean population.: Jung Soon Kim, Young Joon Kim, Sun Ill Park, Young Pyo Hong; Korean J Prev Med. 1993;26(3):311-320.

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Abstract PDF: This study was carried out along with the 1990 6th National Tuberculosis Prevalence Survey in order to estimated the prevalence rate of diabetes mellitus among a representative adult Korean population. Fasting blood glucose was measured by diastix(Ames) using glucometer II for seventy seven percent of the population(30 years old or above) residing in 190 enumeration districts randomly sampled from 146,944 general ED. The prevalence of diabetes mellitus of the population was estimated by projecting the ratio of > or = 200 mg/dl PP2 of fasting blood sugar level below 120 by sex to the study population. Fasting blood glucose and 2hr. postprandial blood glucose were measured on about 3000 subsampled individuals, and diabetes mellitus was defined by the WHO criteria-FBG > or = 120 mg/dl or PP2 > or = 200 mg/dl when FBG is below 120 mg/dl. The results obtained are as follows: 1. Estimated prevalence(age adjusted) of diabetes mellitus was 4.6% for male 8.1% for female. The age adjusted mean FBG was 93.9+/-26.2mg/dl for male and 102.9+/-31.5mg/dl for female. 2. The prevalence increased as age advanced with peak in 60~69 years old age group for both sexes. 3. The mean FBG and estimated prevalence rate of diabetes mellitus varied considerably among the populations of fifteen cities and provinces ; it varied from 87.0+/-17.7 to 104.6+/-34.5mg/dl and 1.2% to 8.9% for males, and from 93.3+/-25.3 to 116.7+/-38.6 mg/dl and 3.4% to 20.8% for females. 4. The mean FBG and prevalence rates were higher among the rural population than those residing in metropolitan areas. 5. The proportion of the people previously treated among the diabetics was estimated to be a little less than one fifth. 6. Factors strongly associated with FBG were age, sex, family history of D. M., BMI, area and educational level among eleven variables.; Summary

The epidemiologic study of farmers' syndrome in Chonnam province.: Gang Moon, Jin Su Choi, Seok Joon Sohn, Byong Woo Kim; Korean J Prev Med. 1993;26(3):321-331.

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Abstract PDF: This survey was conducted to investigate Farmers' Syndrome and its related factors in Chonnam province. 5,920(men 6,148, women 6,722) persons in urban area and 12,870(men 6148, women 6,722) persons in rural area were selected in stratified cluster sampling manner, and interviewed individually with structured questionnaire in April, 1992. The results were summarized as follows: 1. In rural area of Chonnam province, the prevalence of Farmers' syndrome positive was 283 per 1,000 persons(203 in male, 355 in female). In urban area of Chonnam province, control area, the prevalence of Farmers' syndrome positive was 113(72 in male, 145 in female). The prevalence of Farmers' syndrome positive in rural area was 2.5 times higher that of urban area, and the prevalence in female was 1.7 times higher than that of male. The prevalence in total respondents was 256. 2. In rural area of Chonnam province, the age standardized prevalence of Farmers' syndrome positive was 209 per 1,000 persons(140 in male, 267 in female). In urban area of Chonnam province, control area, the age standardized prevalence of Farmers' syndrome positive was 122(79 in male, 158 in female). The age standardized prevalence in total respondents was 194. 3. The associated factors with Farmers' syndrome in univariate analysis were having illness during recent 15 days ,age, sex, occupation, area, monthly income, education, medical security status, family size and duration of farming. 4. When applying multiple logistic regression for Farmers' syndrome, the significant variables were having illness during recent 15 days, area, sex, age, education, medical security status, family size and duration of farming.; Summary

Leisure time physical activity and its relationship to coronary risk factors in male workers.: Yun Kyeong Rho, Mi Hae Yeh, Sung Kook Lee, Byung Yeol Chun; Korean J Prev Med. 1993;26(3):332-346.

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Abstract PDF: This study was attempted to observe leisure time physical activity pattern and its relationship to coronary risk factors(BMI, systolic blood pressure, diastolic blood pressure, serum total cholesterol, triglycerides, fasting blood sugar). Subjects participated in this study were 277 adult male workers of an industry in Kyungpook province, Korea. Energy expenditure were measured using modified Physical Activity History questionnaire of CARDIA study by interviewing. Serum total cholesterol, triglycerides and blood sugar level were tested with 5 ml fasting blood and height, weight and blood pressure were measured. Data on smoking and drinking habits and others were obtained. Geometric mean of leisure time physical energy expenditure were estimated as 212.80 kcal per week for study subjects and only 22.4% of them expended 2,000 kcal or more per week in leisure time physical activity. Taking walks or hikes and jogging or running were more frequent leisure time physical activities in study subjects. Statistically significant mean differences in total weekly leisure time physical activity for all coronary risk factors were not found among three groups. Because energy expenditure of leisure time was generally low in this subjects and most of them were healthy men, we did not found that leisure time physical activity was significantly associated with coronary risk factors.; Summary

The blood pressure level and sexual maturity in the children at puberty.: Kyoo Sang Kim, Soon Young Lee, Ill Suh, Chung Mo Nam, Sun Hwa Jee; Korean J Prev Med. 1993;26(3):347-358.

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Abstract PDF: The purpose of this study is to analyze the relationship between the blood pressure level and their sexual maturity and physical growth in the children at puberty. For this purpose, we estimated the blood pressure, physical growth and sexual maturity of the boys of 335 and girls of 373 who are in the middle schools which are located in Kang-wha County, KyungKi-Do. Both systolic and diastolic pressure were measured twice. Such physical growth as height, body weight, skin fold thickness, waist circumference, hip circumference and arm circumference were measured. The sexual maturity was estimated according to the classification of Tanner's 5-phase-sexual-maturity; in boys, their pubic hair development phase; in girls, their pubic hair and breast development phase and the menstrual experience. In the phase of the pubic hair development, the boy's sexual maturity was distributed into this; the 1 st 56.4%, the 2nd 29.3%, the 3rd 9.9%, the 4th 4.1% and the 5th 0.3%. While the girls sexual maturity was distributed into this : the 1 st 20.5%, the 2nd 34.9%, the 3rd 30.6% the 4th 12.6% and the 5th 1.3% in the phase of the pubic hair development, and the 1 st 0.8%, the 2nd 13.7%, the 3rd 36.2%, the 4th 18.8% and the 5th 30.5% in the phase of the breast development. This indicated that the girls sexual maturity was higher than those of the boys. The girls menstrual experience rate accounted to the 58.2%. In order to see the relationship between the children's sexual maturity and blood pressure level, we regress blood pressure level on physical growth(i.e., height, BMI) and sexual maturity. Sexual maturity in treats as dummy variables. As the result of this analysis, the boys' sexual maturity has nothing to do with the blood pressure either systolic or diastolic. But the girl's systolic pressure was statistically significant; the 9% of the physical growth, the 5% of the pubic hair development and the 4% of the breast development in sexual maturity was explained. In the girls' diastolic pressure, only their pubic hair development was statistically significant; the 7% of the physical growth and the 7% of the pubic hair development in the diastolic was explained and the 5% of the physical growth in the diastolic Korotokoff phase was explained, especially, the girls experienced menstruation, their systolic and diastolic pressure were significantly high(P<0.01). Conclusively, in the first grade children attending middle schools who are in the early process of the sexual development, the sexual maturity was not related to blood pressure level, on the other hand, the blood pressure level of the girls who are more sexual development than those of the boys' have something to do with sexual maturity and physical growth.; Summary

Smoking ststus and its related factors in male students of middle and high schools in Kwangju.: Yun Ji Lee, Jung Ae Lee; Korean J Prev Med. 1993;26(3):359-370.

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Abstract PDF: To identify the smoking status and its related factors in middle and high school boys in Kwangju a study was performed from 15th to 30th of June 1992. Population were selected by two-stage random sampling method and total 3,959 students replied to the self-administered questionnaire survey(1,574 in middle school, 1,664 in academic high school, 712 in business high school). The results were as follows; 1. The proportion of current smokers was 1.5% in middle schools and 20.1% in high schools. And the smoking rates increased with school grade years(p<0.01). 2. For the motivation of smoking, curiosity was the most frequent factor and the next was temptation by friends. 3. The most common situation on the first experience of smoking was that middle school boys smoked a cigarette which was found in a house, through curiosity, with friends, at home. High school boys smoked a cigarette taken from friends, through curiosity, with friend, on the road or at home. 4. The proportion of smokers who smoke a cigarette regularly was 34.8% among smokers in middle school and 70.2% among smokers in high school. The most proportion of duration of smoking was less than 1 month among middle school boys (20.8%) and more than 2 years among high school boys(43.9%). The first smoking experience was in elementary school among middle school boys and the third grade of middle school in high school students. Most current smokers(73.9% in middle school boys, 65.3% in high school boys) wanted to quit smoking. 5. Smokers had significant association with intimate friend's smoking, mother's and brother's smoking, inharmonious friendships, dissatisfied with home and school life, lower school grades, generous attitude to other smokers, lack of knowledge to passive smoking and no contact to mass media(TV)(p<0.01).; Summary

A study on diagnostic criteria of noise-induced hearing loss among workers in an iron foundry.: Ji Yong Kim, Hyun Sul Lim, Hae Kwan Cheong, Ok Ryun Moon; Korean J Prev Med. 1993;26(3):371-386.

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Abstract PDF: This study was carried out to evaluate diagnostic criteria of noise-induced hearing loss (NIHL) among workers in an iron foundry. Of 1,093 workers under the observation of noise-specific health examination, 184 workers were selected by way of first and second screening audiometric examination. A questionnaire survey, otological examinations, Rinne test and audiometric test were performed and the results were as follows; The degree of hearing impairment in the left ear was more severe than in the right ear(p<0.05). The difference between hearing threshold of the first and the second hearing test at 1,000 Hz was about 5 dB with a narrow range of deviations while the difference at 4,000 Hz was about -7dB with a wide range. Of the total study workers, 84.8% were tested within 15 hours away from noise exposure, and the rest after 16 hours. This study has identified that mean hearing loss at 4,000 Hz showed a significant statistical difference among the two study groups while mean hearing loss by 4-divided classification did not. The same phenomena were observed between the group with and without tinnitus and between the group with and without difficulty in hearing(p<0.05). Among 184 workers, 10 workers(5.4%) diagnosed as NIHL by old diagnostic criteria in contrast to 150 workers diagnosed as NIHL by the new diagnostic criteria. There was a significant difference between the two groups in the average hearing loss at 4,000 Hz and 4-divided classification(p<0.01), but there were no significant difference in age, the duration of employment, blood pressure and the duration wearing the personal hearing protector(p>0.05). If we apply Early Loss Index(ELI) method, some workers in younger age group diagnosed as NIHL by the new diagnostic criteria were fallen into within the normal range. In the mean time older age group show reverse results in contrast to the above finding. It is too early to confirm the value of the usage of the new diagnostic criteria in hearing examination. Further study is called for to verify the value of this criteria.; Summary

10-year analysis of blood lipid profile and other risk factors among aircrew members in Korea.: In Ho Kwak, Yong Ho Lee; Korean J Prev Med. 1993;26(3):387-399.

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Abstract PDF: This study was conducted to analyzed blood lipid profile and other risk factors among crew members who are currently active and had more than 10 years of experience as crew members. Data was analyzed using medical record files in an airline medical department. The results are as follows. 1. The total number of crew members studied was 392. Among age groups, those below age 40 consisted of 26(6.9% of the total), those in age 41~50 were 135(34.4%) and those over age 51 were 230(58.7%). 263 were former air force pilots consisting 66.9%. Those who had captain status numbered 211 comprising 53.7% of the total. The type of aircraft most of the crew members involved were large size aircraft which totaled 268(68.2%). With respect to the number of working years as crew members, 488(48.9%) comprised the largest group with 11~15 years. 2. The rate of smoking among crew members has shown gradual decrease with 50.3% smoking in 1983 to 33.6% in 1993. Among 41~50 age group the rate has shown a decrease from 20.9% to 13.3%. In those group over age 51 it decreased from 25.5% to 16.6%. But group below age 40 were within the range of 3.6~3.8% with no significant change in the rate of smoking. 3. Body Mass Index in age group over 51 was slightly higher than other age groups. On the whole, BMI over 25 was not found. 4. The total cholesterol levels of those below age 40 were 196.9+/-38.5 mg/dl, 216.2+/-39.2 mg/dl in ages 41~50, and 225.1+/-42.5 mg/dl in age group over 51. No significant difference was found among age groups. 5. HDL-cholesterol levels of over age 50 were higher than other age group and ranged from 40~55 mg/dl. 6. LDL-cholesterol levels of those over 51 were 126.7+/-37.7 mg/dl higher than other age groups. But there were no significant changes in all age during 10 years of follow up. 7. Cardiac index of age group below age 40 was 3.8, 4.3 in age group 41~50 and 4.5 in those over age 51 group. No significant changes among groups were found during the follow up period. 8. Triglyceride levels of age group below age 40 was 142.2+/-70.1, 167.3+/-77.5 in age group of 41~50 and 173.6+/-89.7 in age group over 50 showing that triglyceride levels increased with age. No significant changes in pattern were noted.; Summary

An analysis an dassessment of diagnostic and therapeutic process in some freqent admissions and operations.: Chang Yup Kim, Yoon Kim, Young Dae Kwon, Yong Ik Kim, Young Soo Shin; Korean J Prev Med. 1993;26(3):400-411.

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Abstract PDF: The aim of this study is to analyze the variations among hospitals and hospital groups in resource use and procedures of diagnostic and therapeutic process, such as laboratory tests, radiologic examinations, tissue diagnosis, timing of surgery after admission, the time required for operation. The study was performed for five procedures including cesarean section(C/S), appendectomy, cholecystectomy, cataract extraction, and pediatric pneumonia. The 2,316 subjects were selected from medical insurance claims list, and from this list 413 cases were sampled for medical record review. The patterns of resource utilization and process of treatment were described according to hospitals and characteristics of hospital groups. The major results were as follows: 1. The numbers of laboratory and radiologic tests showed significant difference among hospitals and hospital groups. In case of hospital groups, we could find tendencies of more tests with increasing hospital bed size. 2. In general, the proportion of operative cases evaluated by tissue diagnosis postoperatively among all operations ranged from 28.3% to 1005. The proportion varied among hospital groups, of which general hospital A group(more than 15 specially) showed the highest proportion. 3. Post-admission delay until operation and the time required for operative procedure were not invariable among hospitals and hospital groups. The duration of operation in tertiary hospitals was slightly shorter than general hospitals, with varying statistical significance. We could find that probably there were differences of quality among hospitals in some components of procedures, which suggested that the implementation of quality assurance activities would be mandatory. In this study, we simply described the patterns of resource utilization and some features of clinical process, with institution of the need for advanced studies with in-depth analyses for each component of diagnosis and treatment procedures.; Summary

A study on the depression and cognitive impairment in the rural elderly.: Jung Ae Rhee, Hyang Gyun Jung; Korean J Prev Med. 1993;26(3):412-429.

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Abstract PDF: For the purpose of promotion of mental health in the rural elderly, the author surveyed 558 elderlies aged 60 years or more, and assessed the prevalence rates of depression and cognitive impairment by using self-rating depression scale of Zung(SDS) and the Korean version of mini-mental state examination(MMSEK). Also the association between depression or cognitive function and socio-environmental factors were investigated. The major findings were as follows; 1. The prevalence rates of severe depression and cognitive impairment were 20.9% and 14.9% in all the elderly of both sexes, respectively. 2. The rates of depression and cognitive impairment increased with increasing age in both sex groups. The mean scores of SDS increased and the mean scores of MMSEK decreased significantly among them(P<0.01). 3. Those being female, widows or widowers, and those having low levels of physical activity, showed significantly high the mean scores of depression and had significantly low the mean scores of cognitive impairment(P<0.01). 4. The depression scores relating to decreased libido, confusion, psychomotor retardation, hopelessness and indecisiveness were relatively high in both sexes. 5. All the items of mini-mental state examination were significantly correlated with depression. 6. In stepwise multiple regression analysis on depression, MMSEK, level of physical activity, chronic disease, marital status and family income were selected as highly correlated variables, and the R2-value for these variables was 33.7%. 7. In stepwise multiple regression analysis on cognitive function, level of physical activity, age, depression, sex and marital status were selected as highly correlated variables, and the R2-value for these variables was 62.6%. The depression and cognitive impairment of the elderly were positively correlated with nearly all sociodemographic variables.; Summary

Geographic variations in tonsillectomy and adnoidectomy (T & A) and appendectomy in Korea.: Hong Ki Lee, Ok Ryun Moon, Key Hyo Lee; Korean J Prev Med. 1993;26(3):430-441.

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Abstract PDF: The objectives of this study are two-fold : to identify geographic variations in the rate of tonsillectomy and adenoidectomy(T and A) and appendectomy and analyze the socioeconomic variables and health resources which affect geographic variation in the rate. The nationwide three month's cases of the two surgical procedures in 1991 are obtained from the record of the National Federation of Medical Insurance. The analysis shows two to ten-fold variations in the regional rates for the performance of two common procedures such as T and A and appendectomy. T and A shows a bigger regional variations than appendectomy. As a result of multiple regression, the factor of bed supply has been found significant for the dependent variable of the rate of T and A. The findings of large variations in the rate of surgical procedures throughout the country would have important implications for allocating scarce resources and managing quality of care. Further analysis is needed for the elaboration of the above implications.; Summary

A study on the determinants of hospital profitability.: Ki Hong Chun, Woo Hyun Cho; Korean J Prev Med. 1993;26(3):442-456.

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Abstract PDF: Financial stability is the foremost prerequisite for the continuous growth and development of hospitals. The present study aimed at developing a deterministic model using the factors which affect the hospitals profitability and at discovering which factor affected the hospital profitability. The study conducted questionnaire surveys on all general hospitals, with the exception of special hospitals, with over eighty hospital beds. Of the 274 subject hospitals, 136 of them, consituting 49.6% of the whole, were used in the study. The results are as follow. 1. In the deterministic model, outpatient revenue was affected more by the number of physician visits than by outpatient service intensity. Inpatient revenue was found to be affected more by the number of discharged patients than by inpatient service intensity. However, the increase rate of the service intensity not only contributed in stepping up the operating margin by 4~8% in outpatient and 3~6% in inpatient, but it was statistically significant. 2. Among the factors which determined the operating cost within the deterministic model, the number of patients had a greater impact on the operating cost than the resource consumption per patient. 3. The resource consumption per patient were proved to have the greatest effect on the profitability within the probabilistic model. The management cost per adjusted patient, in particular, was proven to have a statistically significant effect on the profitability in all hospitals.; Summary

A study on the repeat tests for diagnosis at a tertiary hospital in Taegu city.: Jae Yong Park, Gui Young Kim; Korean J Prev Med. 1993;26(3):457-468.

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Abstract PDF: This study was conducted to investigate the repeat test rate for diagnosis at a tertiary hospital for the outpatients who were referred themselves to the hospital by the clinics and other medical facilities. The study population consisted of 498 patients who visited outpatient department of internal medicine, general surgery, orthopedic surgery and neurosurgery in the hospital between March 16 and April 11, 1992. This study was surveyed by the questionnaire about the tests for diagnosis at first level medical facilities, and then, was investigated by the medical record about the tests for diagnosis at a tertiary hospital. The proportion of test among the patients who utilized the first level medical facilities was 20.9% for the X-ray test, 10.6% for the urinalysis, 9.0% for the electrocardiogram, 3.4% for the computer tomogram and 6.4% for the ultrasonogram. At the tertiary hospital, the X-ray test was 45.2%, the liver function test was 24.7%, the urinalysis was 19.1%, and the electrocardiogram was 15.7%. The proportion of patients who possessed results of test for diagnosis at the first level medical facilities was 76.5% for the computer tomogram, and 31.3% for the ultrasonogram. As the repeat test rate between the first level medical facilities and the tertiary hospital, the thyroid function test was the first rank as 71.4%, the second rank was the routine CBC as 67.9%, and the third rank was the X-ray test as 64.4%. But among the patients that brought the result for tests at the first level medical facilities, the repeat test rate was as follow ; the routine CBC was 75.0%, the liver function test was 72.7%, and the computer tomogram was 15.4%.; Summary

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