Journal of Preventive Medicine and Public Health

Volume 28(3); September 1995

Original Articles

Differences of Screening Test Results of Health Examination between Clerks and Laborers.: Jong Won Park, Dong Hoon Shin, Mi Young Lee, Suk Kwon Suh; Korean J Prev Med. 1995;28(3):543-550.

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Abstract PDF: The authors conducted a cross-sectional study to evaluate the differences of screening test results between clerks and laborers in an occupational health center in Taegu, 1992. A total of 10,207 workers was included in the study of these, male were 5,597 and female 3,610. Constitutional variables included were items of health examination and some confounding variables(sex, age, body weight and work duration). All analyses were conducted separately for each sex through the use of multiple logistic regression analysis on occupation, controlling for age, work duration, and body weight. laborers showed abnormal hearing test more often than clerks in both sexes. The blood pressure that showed statistical significance in univariate analysis in both sexes lost its significance after controlling covariates. Liver function and urine protein had statistically significant differences between two occupational groups in males and visual correction did in females. The results suggest that there are differences clerks and laborers in some of screening tests and analytic studies are needed to identify the causes of the differences.; Summary

A Study on Safety Accidents Occurred for 5 Years at a Welding Material Manufacturing Factory.: Hyun Sul Lim; Korean J Prev Med. 1995;28(3):551-562.

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Abstract PDF: To assess the status of safety accidents, authors reviewed and analysed the records of safety accidents of a welding material manufacturing factory at pohang city from January 1989 to December 1993. The results are; 1. The total incidence of safety accidents was 295 spells for five years. 2. Average age of workers with accident was 35.7 years. Average duration of employment was 6.2 years and the duration of employment increased as the year increased. 3. There was no statistical significance on season, month, weekday and time by year in the incidence of safety accidents. The most frequent part of body injured was upper and the most frequent type of injury was abrasion. 4. Mean admission rate of safety accidents was 12.6% and the ratio of treated spells as occupational injury was 7.8%. 5. The most frequent cause of injury was worker's mistake and the most frequent action for the prevention of further accidents was safety education. 6. The incidence rate of safety accidents on 1993 was 116.2 spells per l,000 persons. Above results suggest that to prevent safety accidents, safety education should be done continuously, the environmental and human factors were controlled and more exact reporting system of safety accidents was needed.; Summary

The Degree and Related Factors of the Depression and Burnout among Private Practice Physicians.: Jun Ho Shin, Gun Su Kim, Yo Sub Park, Bek Ju Na, Seok Joon Sohn, Byong Woo Kim; Korean J Prev Med. 1995;28(3):563-575.

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Abstract PDF: In order to investigate the prevalence and the factors related to the depression and burnout among private practice physicians, a SDS(self-rating depression scale) and MBl(Maslach burnout inventory) -based questionnaire study was performed on 344 private practice physicians in Kwangju and chonnam area. The results were summarized as follows. 1. Mean SDS score was 38.3 in total subjects and the prevalence rate of depression was 48.8%. As for the frequency order of the items of the SDS, decreased libido, diurnal variation and hopelessness were relatively high, and suicidal rumination, constipation and agitation were noted low. 2. Noticeable factors related with depression were smoking, coffee use, sleeping time and satisfaction with income. 3. As a result a factor analysis with the MBl data, five factors named as emotional exhaustion, depersonalization, personal accomplishment, involvement and self-interest were extracted. Statistical analysis of the data demonstrated that 48.8% of the physician sample reported high scores on emotional exhaustion, and 45.3% scored high on depersonalization. Personal accomplishment scores remained high with 45.3% reporting high personal accomplishment. 4. Variables related to the burnout were age, sleeping time, family size religion, medical speciality. duration of practice setting, visiting patient number, closing day per month and job satisfaction. 5. In the relationship with depression, burnout was closely related to depression. Above results showed that the high percentage of private practice physicians experiencing depression and burnout suggests the need for further research to establish trends, to identify causal factors, and to develop avenues to reduce stress.; Summary

Study on activities of some occupational health nurses in Kyungnam area.: Young Sook Kim, Hae Sook Shon, Jeong Hak Kang, Chang Hee Lee, Chae Un Lee; Korean J Prev Med. 1995;28(3):576-587.

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Abstract PDF: Authors purposed to observe activities of occupational health nurses and it's related factors, and to suggest the way that induct better occupational health nurses' activities with questionnaire to 87 occupational health nurses who individually work as health manager in the plant. The questionnaire included type of plant and number of workers, general characteristics, work conditions, activities, etc. Major findings are as follows. 1. 82.8% of occupational health nurses were third decade 93.1% graduated junior college or college. And 82.8% were not married. 2. General work conditions: 40.2% were belonged to safety-health section, 98.85% were mere clerks. 60.9% worked less than weekly 44 hours, and an annual salary of 50.6% was between 10million and 14 million won. 3. work condition related to health manager work: there was separated health care room in 94. 3%, working period as health manager(occupational health nurse) was less than 5 years in 70.1%, 49.4% had the out-of-health manager work. In 87.4%, occupational physician was appointed, only 6.9% of them were full time, 52.9% of them worked little in the plants The problems related to workers' health were discussed with industrial nurses in 88.5%. 4. Attitude for their work: 88.5% were thought that their work is important for workers' health care, 57.5% satisfied to work as health manager. In 51.7%, motive to being industrial nurse were the appropriate aptitude. 5. Activities: General medical care in 100 % were carried out, in 97 7% works related to general health examination, in l00% works related to special health examination were carried. But works related to use of protective apparatus were carried out in 20.8%. 6. Factors related to level of activities: In cases who solved the health related problems by themselves, the level of activities was significantly higher than in others. In cases there w ere full time occupational physician, the level of activities was significantly lower. 7. Occupational health nurse's needs: 100% wanted regular education, 89.7% wanted the qualifying examination. As the results, author suggests that the right of self-control is given to occupational health nurses and the work of occupational physician is clearly defined for the induction of the better activities of occupational health nurses.; Summary

Job Satisfaction and Commitment of General Hospital Employees.: Dong Woon Han, Seung Sub Eom, Ok Ryun Moon; Korean J Prev Med. 1995;28(3):588-608.

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Abstract PDF: This study was intended to enhance the level of hospital personnel management through analysing job satisfaction of hospital employees in terms of structural, personal and environmental variables. The sample of this study consist of a total of 790 persons including doctors, residents, interns, pharmacists, nurses, medical engineers, office workers and manual workers who have worked for general hospitals with 200 beds, 300 beds and 800 beds respectively. The Likert's 5 scales were used for the measurement of satisfaction. The results can be summarized as follows: 1. Structural variables. The level of satisfaction on the job itself was generally low 2.8 in Likert`s 5 scales, with the order of role ambiguity(3.87), routinization(2.6), work overload (2.45) and autonomy(2 37). Hospital employees are aware of their responsibility and they regarded their work as heavy one. The compensatory satisfaction degree was 2.5 which was also low: There were in the order stability(3.l), distributive justice(2.57), pay(2.3) and promotion(l.9). Usually hospital employees showed high degree of stability, while, their satisfaction on promotion possibility is quite low due to specially differentiated structures of hospitals. The degree of satisfaction on the internal conditions of organizational culture was relatively higher as 2.92: They were co-worker's support(3.69), supervisory support(3.15), role conflict(2.64) and welfare(2.17) in order. The satisfaction on welfare as an economic condition was the lowest. 2. Personal Variables. The level of satisfaction on personal variables was 3.27 which seemed to be quite high: contribution to the hospital(3.38), attitude on job performance(3.28) and pride as a member of the, hospital(3.07). They seem to believe that their work has been helpful to the performance of hospitals. 3. Environmental Variables. The degree of satisfaction on these variables was 3.07 the average which was derived from environmental factors such as family-role conflict and community support related to hospital employees' environment. The order of satisfaction for each variable is community support(3.2) and family-role conflict(2.94). They turned out to be fairly satisfied with their job in community and yet, they wanted more spare time to spend with their family.; Summary

A Case-control Study on Risk Factors of Osteoporosis in Some Korean Outpatient Women of One General Hospital of Seoul.: Sun Ok Woo, Sangsoo Bae, Dong Hyun Kim; Korean J Prev Med. 1995;28(3):609-622.

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Abstract PDF: Until now there are few available epidemiologic data of osteoporosis in Korea, and the severity of osteoporosis-related health problem has not been widely recognized yet. But the numbers of the old people are increasing in Korea, and in 2000, the proportion of people over 65 will be up to about 6.8% of total population. Therefore, osteoporosis, one of the most common metabolic bone disease among the old people, will be one of the most important public health problem. on this background this study was performed to find out risk factors of the development of osteoporosis in Korean women through case-control approach. The subject of this study were selected among the women one general hospital in seoul and were checked bone density from sep. 1988 to sep. 1993. Those who were diagnosed to have hypertension, diabetes mellitus, thyroid disease, breast disease, or liver disease, which are thought to influence bone density, were excluded. Also excluded those who are age-unknown. Finally the subjects were 2,139 women aged between 18 and 79. We operatively defined patient group as those whose bone density is below 1.03 g/cm2, 90% of average bone density of women of 4th decade who visited the same hospital. And we defined control group as whose bone density is above 1.15g/cm2. we randomly selected 201 women from the patient group and 202 from the control. As independent variables we chose age, menarche age, menopause age, menopause type, the number of siblings, the number of pregnancies, body mass index, taking oral pill or not, feeding type, and educational state. Multiple logistic regression analysis was done to see the influence of these variables on the risk of osteoporosis. Results are as follows; 1. menopausal status was statistically significant risk factor to all women irrespective of her age, while obesity and later menopause age were food to be statistically significant protective factors. 2. The more siblings and pregnancies, the greater the risk of osteoporosis, but these factors were not statistically significant. This result is not consistent with other studies. Further studies are strongly needed.; Summary

Comparison of work measures for some physician services in Obstetrics & Gynecology.: Yeong Joo Hur, Myong Sei Sohn, Eun Cgeol Park, Hyung Gon Kang, Han Joong Kim; Korean J Prev Med. 1995;28(3):623-639.

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Abstract PDF: We have never seen any method to cope basically with complicated situation and problems around medical reimbursement rates here in Korea since 1977 witnessed by the beginning of medical insurance. By the way researchers concerned are beginning to propose some kinds of innovative and detailed ideas to government these days. They are Diagnosis-related group(DRG)and Resource-based relative value scale(RBRVS). In the light of this situation it is so encouraging that our government can come up with that and move. In case of RBRVS research we have already been reaching even to the level of reviewing and revising methodology for its further development after naive pilot study on internal medicine and general surgery last year. However there might be something different conditions between USA and Korea to apply the same Dr. Hsiao's method and it must be vital to check so called 'total work approach' compared with 'intra-service work approach' before expanding to the whole medical fields. According to the 'Intra-service approach', the physician's work is supposed to be divided into three sub-works by the name of intraservice work, pre, and post service work. These sub-works, again should be merged together to be the pre-postwork subset through some statistical methods of the estimation process applied by Dr. Hsiao's methodology in RBRVS development later on. But in this paper that estimation process was not taken because we could have real values for all of those surveyed items related to just one specialty, OB & GY. Instead, we used some statistical comparison procedures relevant to demographic characteristics, reliability & validity and correlation analysis with American RVU(Relative value unit) between the total work and merged total work from intraservice work approach. The unit of analysis was individual physicians of OB & GY and 300 physicians were selected for each approach through statistical sampling method based on national population of OB & GY physicians in korea. And also with the thankful help of Advisory committee under Korean Association of OB & GY, questionnaires were made and mailed to the subjects, two times. As a result there were not any statistically significant differences in demographic characteristics between the two approaches except for the variable 'Response time for the questionnaire', but in other sections of comparisons, response rate, representative values, reliability & validity test, correlation analysis with American RVU, all showed 'Total approach' was not only more rational and statistically meaningful than ,'Intra-service approach' but also had considerable merits. But we are not absolutely sure about this paper's robustness. Because of some limitations, we'd rather like to suggest further researches should be followed. In that sense the first thing would be a research for the influence of doctor's haracteristics, especially 'frequency' on the rating of work and the way to define total work more clearly.; Summary

A methodological study on simplifying claims review system in medical insurance.: Suk Il Kim, Hyung Gon Kang, Han Joong Kim, Young Moon Chae, Myongsei Sohn, Myung Keun Lee; Korean J Prev Med. 1995;28(3):640-650.

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Abstract PDF: After the introduction of National Medical Insurance in 1989, the medical demand has rapidly increased. The impact of increased medical demand was followed by an increase in the number of claims in need of review. We studied a new, fair method for reducing the number of claims reviewed. we analysed 90,583 outpatient claims submitted between september and october; claims were made for services given August of 1994. We finally suggested a screening system for claims review using a statistical method of discriminant analysis of the medical costs. The results were as follows. 1. In the cut-off group, age, days of medication, number of hospital or clinic visits, and total change were significantly high The cut-off rates according to the hospital-type and existence of accompanied disease were significantly different. 2. According to ICD, the cut-off rate was highest in peripheral enthesopathies and allied syndromes(20.76%), lowest in acute sinusitis(0.93%). The mean charges were significantly different according to ICD and existence of cut-off. 3. we build discriminant functions by ICD with such discriminant variables as patient age, sex, existence of accompanied disease, number of hospital or clinic visits, and 9 detailed hospital or clinic charges included in claim. 4. we applied the discriminant function for screening those claims that were expected to be cut-off. The sensitivities comprised from 40% to 70%, and specificities from 70% to 95% by ICD. Acute rhinitis had highest sensitivity(100.00%)and other local infections of skin and subcutaneous tissue had highest specificity(98.45%). The excepted number of cut-off was 17,762(19.61%). The total sensitivity was 49.62%, the total specificity was 82.57% and the error rate was 19.66%. We lacked economic analysis such as cost-benefit analysis. But, if the few method of screening claims using discriminant analysis were applied, the number of claims in need of review will reduce considerably.; Summary

The effects of age adjustment on the diagnosis of noise induced hearing loss.: Jong Uk Won, Yeon Soon Ahn, Jae Hoon Roh; Korean J Prev Med. 1995;28(3):651-662.

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Abstract PDF: In Korea there is no specific method of age adjustment in noise induced hearing loss(NIHL). we attempted the age adjustment to understand the effects of age on the diagnosis of NIHL. We used the International Standard Organization 1999 as an age adjustment method. We used the 1,617 otologically normal person's hearing data from a health examination center, and 206 workers diagnosed as NIHL. we concluded as follows; 1. The ISO 7029 function used for age specific hearing loss is not suited to Korean people. 2. The mean of age specific hearing loss is 11.0 6.2dB, and the older of age, the more decrease on hearing loss, especially in 4000Hz. 3. The difference of NIHL between before age adjustment and after age adjustment in the 3rd decade is 5.4dB, in the 4th decade is 6.7dB, in the 5th decade is 8.5dB, in the 6th decade is 10.4dB, and in the 7th decade is 12.9dB. The older, the more is the difference. 4. After age adjustment, the number of workers diagnosed as NIHL decreases to 60% of unadjusted.; Summary

An Analysis of Health Examination Outcome in the Special Health Examination Institute.: Yeon Soon Ahn, Sang Hyuk Jung, Dong Chun Shin, Jong Uk Won, Jae Hoon Roh; Korean J Prev Med. 1995;28(3):663-677.

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Abstract PDF: Special health examination institute has done periodic health examination for workers who have worked in the hazardous workplace. However, assessment on outcome in special health examination institute about detection ability of occupational disease has not been. In this circumstances, we studied on the differences of health examination outcome among special health examination institutes and identified related factors which affected outcome of special health examination in the special health examination institutes. The summary of the results were as follows. 1. 50 special health examination institutes were examined in this study. Among them, university institutes were 13 cases(26.0%), hospitals were 20 cases(40.0%), a corporation aggregates were 9 cases(18.0%) and an auxiliary organs of company were 8 cases(16.0%). There were 29(58.0%) institutes with a preventive medicine specialist, but 21 institutes(42.0%) were not. 2. Total workers examined in 50 institutes were 606,948 and workers diagnosed as occupational disease(D1) were 3,156. The rate of occupational disease was 6 workers per 1,000 examined workers. Workers needed for close observation(C) were 95,809 and the rate of workers needed for close observation was 141 per 1,000 examined workers. 3. The rate of occupational disease of university institutes was highest(11.3 per l,000 examined workers) and followed by hospitals(6.0 per 1,000 examined workers), a corporation aggregates(4.2 per 1,000 examined workers), and an auxiliary organs of company(l.2 per 1,000 examined workers.). The difference of the rate of occupational disease between university institutes and an auxiliary organs of company was statistically moderate significant(p<.1).The rate of occupational disease in special health examination institutes with establishment duration was more than 10 years was statistically higher than institutes with establishment duration was less than 10 years(p<0.l). 4. The results of multiple regression, R2 was 0.3394(adjusted R2 was 0.2109), F-value was 2, fi41ft(p<0.5), and statistically significant variables were establishment duration(p<0.1), number of examined workers per one doctor(p<.l), and auxiliary organs of company(p<0.l), which dependent variable was the rate of occupational disease and independent variables were number of examined workers per one doctor, classification of institute, the rate of working environment exceeding TLV, duration of institute establishment, presence of a preventive medicine specialist.; Summary

Olfactory Dysfunction in Chromium Exposed Workers.: Yeong Jin Yu, Sang Hwa Ohm, Jong Tae Lee, Byung Chul Yu, Kui Oak Jung, Kyu Il Cho, Ki Tack Pai; Korean J Prev Med. 1995;28(3):678-689.

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Abstract PDF: Chromium is one of the representative toxic substance by occupational exposure which damage the mucosa of respiratory tract including nasal septal perforation. The aim of this study is to evaluate the effect of chromium exposure on olfactory function and to obtain the fundamental information about chromium exposure. The authors performed olfactory function test, laboratory tests and questionnaire interview on the subject of three groups, that is, two exposed groups and one nonexposed group from May 1 to June 30, 1994. Exposed group 1 was 15 male workers without nasal septal perforation, exposed group 2 was 15 male workers with nasal septal perforation among 103 workers in 22 chromium plating factories, and nonexposed group was 15 male medical students. The gathered informations were histories of chromium exposure, habits of smoking and alcohol drinking, the concentrations of chromium in serum and urine, and asparate aminotransferase(AST), alanine aminotransferase(ALT), gamma-gluutamyl transferase,etc. Olfactory function was checked by T and T olfectometer using phenyl ethyl alcohol(material A), methyl cyclopentenolone(material B), iso-valeric acid(material C), gamma-undecalactone(material D), skatole(material E) and the results were expressed by detection threshold(DT) and recognition threshold(RT). There was a significant difference between exposed groups and nonexposed group in A, B, C, D, E substances by DT and in A, B, C, D substances by RT(p<0.01) The degree of olfactory dysfunction was highest in the exposed group 2 and lowest in the nonexposed group in all five substance by Dt and it was same in A B, D substance RT and the difference of RT and DT. As summary, olfactory dysfunction by chromium exposure was recognized and the degree of olfactory dysfunction was higher in the exposed group with nasal septal perforation. Therefore, it would be helpful to apply olfactory function test for the early detection of olfactory dysfunction, and this test would be considered as the basic tool within workers' compensation system.; Summary

Normal Predicted Values of Pulmonary Function of the Primary School Children in Rural Area and Sensitive Index of Respiratory Symptoms.: Byung Sun Choi, Jung Duck Park, Yeon Pyo Hong, Im Won Chang; Korean J Prev Med. 1995;28(3):690-705.

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Abstract PDF: Pulmonary function tests were conducted on 815 healthy primary school children (390 males and 425 female) in rural area using Collins Survey Spirometer (warren E. collins, Inc, U. S. A.) with X-Y Recorder. Respiratory symptoms(cough, sputum, sore throat, chest pain, chest tightness, dyspnea, coryza) were surveyed by the interviews. Multiple regression analysis and regression diagnostics were done for prediction equations of FVC, FEV1, PEFR and FEF25-75% . FVC, FEV1, PEFR and FEF25-75% values in 3 groups of children classified by the number of symptom were compared each other through standard variable value. FVC, FEV1, PEFR and FEF25-75% showed highly significant correlation with age, height and weight. Prediction equations for FVC, FEV1, PEER, FEF25-75% are functions of height only in both male and female children aged between 6 and 12 years old. PEFR showed a significant difference related with the number of symptom in female. These results suggest that the PEFR is sensitive PFT parameter in this study.; Summary

An analysis of liver function test of preemployment screening for office workers.: Yeon Gyo Shin, Yong Jin Lee, Jae Eog Ahn, Kuck Hyeun Woo, Joo Ja Kim, Byung Kook Lee; Korean J Prev Med. 1995;28(3):706-714.

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Abstract PDF: This is to analyze and compare the distribution of the liver function test and its abnormal rates of the preemployment screening for office workers in asymptomatic young age groups between female and male. Liver function test(SGPT and SGOT) of 8,184 young adults(2,633 in female and 5,551 in male) were examined during the period from Jan.1,1994 to Dec. 31, 1994. The results were as follows; 1. Mean level of SGPT was 9.l+/-7.6(IU/L) in female, 21.0+/-27.9(IU/L) in male, and that of SGOT was 15.1+/-6.0(IU/L) in female, 20.5+/-26.5(IU/L) in male. There were significant differences(p<0.01) between female and male in both SPT and SGOT. And also there was significant increasing trend(p<0.05) by age groups in male for SGPT, decreasing trend(p<0.01) in female for SGOT. 2. In the abnormal rates of liver function test by the level of cut-off value, there were significant differences up to twice between the lowest and the highest cut-off value in both female(0.4% vs 0.7%) and male(6.5% vs 12.4%) 3. Abnormal rate of SGPT was 0.4% in female and 6.3% in male, and that of SGOT was 0.2% in female and 1.2% in male with significant differences between female and male in both tests.; Summary

Psychometric Charateristics of Occupational Low Back Pain Patients.: Mi Na Ha, Soo Hun Cho, Ho Jang Kweon, Sang Hwan Han, Young Soo Joo, Nam Jong Pack; Korean J Prev Med. 1995;28(3):715-725.

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Abstract PDF: This study was done for identifying the factors which affect psychologic symptoms of low back(LBP) patients. The study subjects were 43 work-related low back pain patients, 28 work-related non-low back pain patients and 47 general low back injury patients. The study material is SCL 90-R for checking psychologic symptoms and questionnaire for obtaining general information about the subjects. The data were analyzed by model of analysis of covariance adjusted by several variables such as gender, age, education and marital status and then compared the least square means of symptom score between groups. To identify the factors that affect psychologic symptom, duration of suspension, return to work and interaction factor of these two variables were analyzed by multivariate model and we calculated partial correlation coefficient of these variables. As a result, work-related LBP patients showed higher score of symptoms in somatization, depression and psychosis than work-related non-LBP and non-work-related LBP. Duration of suspension and return to work were significant explanatory variables for psychologic symptom score of work-related LBP. Then, we may conclude that the treatment and rehabilitation programe for work-related LBP should cover the strategy of early return to work.; Summary

Atmospheric Concentration of Heavy Metals of Pusan Area.: In Hyeok Song, Gyu Il Cho, Deog Hwan Moon, Chang Hee Lee, Jung Hak Kang, Jong Gab Kim, Yong Soo Han, Chae Un Lee; Korean J Prev Med. 1995;28(3):726-733.

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Abstract PDF: This study was carried out to assess the present level of atmospheric metals. Five metals-lead, cadmium, chromium, manganese, vanadium-were checked on the industrial(Sasang) and residental area(Daeshindong) in the city of Pusan sampling period was the year of 1986, 1990, and 1994, and the sampling time was 2 days of each site. As the result of comparison with the atmospheric standard of ASHRAE(1980) the average concentrations of lead was above the standard, the average concentrations of chromium was around the standard, and the average concentrations of cadmium and vanadium was below the standard. The average concentrations of manganese was above the standard of industrial environment. And the average concentrations of five metals was higher in the industrial area than the residental area The average concentrations of lead cadmium and chromium showed the increase tendency by the year, and the average concentrations of vanadium showed no change, and the average concentrations of manganese showed the decrease tendency. As a result of correlation analysis, lead and cadmium(r=0.31), vanadium and manganese(r=0.24), vanadium and chromium(r=0.19) showed significance.; Summary

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