Journal of Preventive Medicine and Public Health

Volume 30(2); June 1997

Original Articles

Reliability and Validity on Measurement Instrument for Health Status Assessment in Occupational Workers.: Sang Baek Koh, Sei Jin Chang, Myung Guen Kang, Bong Suk Cha, Jong Ku Park; Korean J Prev Med. 1997;30(2):251-266.

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Abstract PDF: In order to test scaling assumption, and to assess the validity, reliability, and acceptability of the Short Form 36(SF-36) health survey questionnaire, we conducted a survey. Samples were 296 workers who had been employed in small sized companies. All scale passed for item internal consistency(100% sucess rate) and item discriminant validity(100% success rate). Reliability coefficients were ranged from a low of 0.51 to a high of 0.85. For 87.5% of the total workers, inconsistent responses were not observed. Only 3.0% of the total workers failed two or more checks. Factor analysis was performed using principal axis factor method and quartimax rotation. In this survey, the SF-36 retained available psychometric properties even when used in a generally healthy worker group. But further study with some consideration to develope health status measurement is expected ; first, the definition of health status should be rationalized. Second, the measurement of outcome is an important consideration in evaluations of quality of care. But ambiguities hinder understanding of this important topic. Third, internal consistency should be interpreted with caution as an indication reliability because it ignores potentially important sources of variation that can occur over time.; Summary

The Incidence of Hepatitis B in Military Service ad the Effect of Asymptomatic HBsAg Carriers on the Incidence.: Rock Kwon Kim, Il Suh, Hung Mo Nam, Kwang Hyub Han; Korean J Prev Med. 1997;30(2):267-278.

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Abstract PDF: The purpose of this study was to investigate the incidence rate of hepatitis B in the military service and to examine the effect of the asymptomatic HBsAg carriers on the incidence of hepatitis B. The subject were 223,270 men who were conscripted to the Korean Army from 1991 to 1994 year. According to the conscripted year, four conscription cohort were constructed. At the screening examination for military service no test for hepatitis B were performed in 1991 and 1992. In 1993, a screening test for hepatitis B were performed and those who were confirmed as HBsAg positive or > or = SGPT 100IU were excluded from conscription. In 1994, the criteria for conscription was changed and those who were HBsAg positive were not excluded from conscription. Only those who were > or =SGPT 100IU were excluded. The main results were as follows ; 1. The positive rate of HBsAg is 5.5% in the conscripted men. 2. The incidence rates of the hepatitis B in 1991 and 1992 conscription cohort were 9.96 and 8.10 per ten thousand per son - year, respectively. The incidence rate of the hepatitis B was 1.34 per ten thousand per son - year in 1993 conscription cohort which was confirmed as HBsAg negative at the screening test, and 7.41 per ten thousand per son - year in 1994 conscription cohort which included the HBsAg positive. 3. The incidence rate of hepatitis B was 99.98 per ten thousand per son- year in HBsAg positive group and 2.25 per ten thousand per son - year in HBsAg negative group. The incidence rate of the group with high SGPT and HBsAg positive was 255 times higher than that of normal population. 4. The incidence of hepatitis B in HBsAg negative group did not increase even though the probability of personal contact with HBsAg positive had been increased. From the above result s, the men who have high SGPT with HBsAg positive should be excluded from military service, and it can not be said that asymptomatic HBsAg carrier s influence on the hepatitis B incidence among the HBsAg negative through personal contact.; Summary

A Seroepidemiologic Study on Rubella Antibody in Pregnant Women in Kyonggi Do.: Moran Ki, Boyoul Choi, Young Jeon Shin, Hung Bae Park, Bae Joong Youn, Joong Surk Hahn; Korean J Prev Med. 1997;30(2):279-292.

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Abstract PDF: The vaccinations of susceptible children and postpubertal females are the major means to prevent congenital rubella syndrome(CRS). Another means for reducing the CRS is therapeutic abortion or fetal monitoring for women who are infected in the first four months of pregnancy. We couldnt estimate the incidence of CRS in Korea, because there was no surveillance system for rubella and CRS. Nationwide vaccination program for 15months infant had been started early 1980s. So, most women at childbearing age during study period were not received rubella vaccination. We set forth CRS management system for pregnant women in two rural county of Kyonggi province, Korea. In this system, the presence of rubella IgG and IgM antibodies for early pregnant women were examined with MEIA(Microparticle Enzyme Immunoassay) method by IMx automated analyzer Abbott. The infected pregnant women followed up in order to confirm their children CRS. This study was carried out from Mar.1993 to Jun.1994, and pregnant women examined were 874 persons. The results were summarized as follows. The overall positive rate of rubella IgG antibody was 94.5%(826/874). The positive rate was significantly increase as the age increased, and reached 100% in pregnant women who were over 35 years old. This results suggest that a meaningful number of women are infected during childbearing years. The geometric mean titer of IgG of sero-positive subjects was significantly declined as the age increased. On the question about history of URI symptoms and rash in pregnancy, 20.7% of respondents checked on URI symptoms with rash, 13.5% only URI symptoms without rash, and 65.8% no symptoms. However there was no demonstrable association between the rubella like infection history in pregnancy and the rubella IgG and IgM antibody status. Rubella infection rate in pregnant women was 0.9%(95% CI 0.4-1.8%). Two of these 8 infected pregnancies were terminated by therapeutic abortion. One of them was not followed. Five babies had no gross anomalies at birth. In Dec.1996, three of five babies were normal appeared infants. Two of them were not followed. Throughout this study results, we confirmed the need of CRS management system for pregnant women, in Korea.; Summary

A SMR study of Korean public servants.: Hyun Kyung Kim, Yong Chul Kim, Do Myung Paek; Korean J Prev Med. 1997;30(2):293-307.

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Abstract PDF: In Korea, sudden deaths of middle-aged and older male workers who are the responsible persons at home as well as workplace, have aroused social concern. Besides, U.N. has reported recently that mortality of Korea male in 40-50's was one of the highest among newly developed countries in 1992. Not much is, however, known about the nature of the work contributing to the mortality of different groups of workers. Therefore, this study was done to examine mortality of public servants, comprising about 5% of all the employed in Korea, according to their job titles and grades. The datas of 1753 official deaths, comprised 323 (only disease-oriented deaths) applicants of survivors' compensation, were used to examine age-adjusted Standardized Mortality Ratios(SMRs) according to their job titles, grades, tenures and cause of deaths. Controlling age and sex difference was conducted using 26,950,481 general population, 95,340 general deaths and 864,560 working public servants. All the groups were aged 20-64, who were being observed January - December in 1993, at the same time. Results and discussions are as follows. 1. SMRs standardized by general population was significantly low (SMR 44.9 CI 42.8-52.7) for all job titlses. Of public servants, 90.0% was graduated from high school, although 17.5% in general population. The distinction of social status such a education may produce a strong healthy worker effect. Besides, SMRs for different tenure groups showed a steady increase as tenure increases. This suggests that the magnitude of healthy-worker effect may be greater with increasing tenures. 2. SMRs standardized by own public servants was significantly elevated for workmen(SMR 121.0, CI 110.2-132.6) in solitue. When SMRs for different grade of workmen was examined, 9th(SMR 124.2, CI 104.4-146.7) and 10th(SMR 137.9 CI 120.8-156.8)grade, lower grade in workmen, showed significantly elevated SMRs. Of workmen, 57.0% were graduated from high school and 50.1% in 9th grade, as well. These mean that low economic states made up social class, education may increase mortality rate. 3. Of SMRs according to all causes of death, only policemen on 'cause of death related hypertensive disease'(SMR 282.5, CI 121.6-556.7) was significantly high except for 'cause of death related other signs, symptoms and ill-defined conditions'. 4. When SMRs on cause of death related hypertensive disease for different grade of policemen was examined, senior policemen(SMR 241.9), in charge of the front service, showed elevated SMR, in spite of statistical no significance. Especially, the working hour of senior policemen is quite long and also the work schedule is even more irregular for policemen. The results of this study showed that mortality for different jobs differed, and it differed also for different grades in the same job. This difference in mortality may reflect the difference in the nature of job contents, and further studies are warranted to elucidate which job characteristics are responsible.; Summary

Changes in blood pressure and determinants of blood pressure level and change in Korean adolescents.: Il Suh, Chung Mo Nam, Sun Ha Jee, Suk Il Kim, Young Ok Kim, Sung Soon Kim, Won Heum Shim, Chun Bae Kim, Kang Hee Lee, Jong Won Ha, Hyung Gon Kang, Kyung Won Oh; Korean J Prev Med. 1997;30(2):308-326.

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Abstract PDF: Many studies have led to the notion that essential hypertension in adults is the result of a process that starts early in life: investigation of blood pressure(BP) in children and adolescents can therefore contribute to knowledge of the etiology of the condition. a A unique longitudinal study on BP in Korea, known as Kangwha Children's Blood Pressure(KCBP) Study was initiated in 1986 to investigate changes in BP in children. This study is a part of the KCBP study. The purposes of this study are to show changes in BP and to determine factors affecting to BP level and change in Korean adolescents during age period 12 to 16 years. A total of 710 students(335 males, 375 females) who were in the first grade at junior high school(12 years old) in 1992 in Kangwha County, Korea have been followed to measure BP and related factors(anthropometric, serologic and dietary factors) annually up to 1996. A total of 562 students(242 males, 320 females) completed all five annual examinations. The main results are as follows: 1. For males, mean systolic diastolic BP at age 12 and 16 years old were 108.7 mmHg & 118.1 mmHg(systolic), and 69.5 mmHg & 73.4 mmHg(diastolic), respectively. BP level was the highest when students were at 15 years old. For females, mean systolic and diastolic BP at age 12 and 16 years were 114.4 mmHg & 113.5 mmHg(systolic) and 75.2 mmHg & 72.1 mmHg(diastolic), respectively. BP level reached the highest point when they were 13-14 years old. 2. Anthropometric variables(height, weight and body mass index etc) increased consitantly during the study period for males. However, the rate of increase was decreased for females after age 15 years. Serum total cholesterol decreased and triglyceride increased according to age for males, but they did not show any significant trend for females. Total fat intake increased at age 16 years compared with that at age 14 years. Composition of carbohydrate, protein and fat among total energy intake was 65:15:20 at age 14 and 16 years. 3. Most of anthropometric measures, especially, height, body mass index(BMI) and triceps skinfold thickness, showed a significant correlation with BP level in both sexes. When BMI was adjusted, serum total cholesterol showed a significant negative correlation with systolic BP at age 12 years in males, but at age 14 years the direction of correlation changed to positive. In females serum total cholesterol was negatively correlated with diastolic BP at age 15 and 16 years. Triglyceride and creatine showed positive correlation with systolic and diastolic BP in males, but they did not show any correlation in females. There was no consistent findings between nutrient intake and BP level. However, protein intake correlated positively with diastolic BP level in males. 4. Blood pressure change was positively associated with changes in BMI and serum total cholesterol in both sexes. Change in creatine was associated with BP change positively in males and negatively in females. Students whose sodium intake was high showed higher systolic and diastolic BP in males, and students whose total fat intake was high maintained lower level of BP in females. The major determinants on BP change was BMI in both sexes.; Summary

Correlation between Obesity Indices and Cardiovascular Risk Factors and Usefullness of Abdominal Obesity Indices.: Hunyoung Ha, Bo Youl Choi, Hung Bae Park; Korean J Prev Med. 1997;30(2):327-341.

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Abstract PDF: It is a well known fact that obesity is an important cause of cardiovascular disease, emphasized by many studies. Recently, cardiovascular diseaase has been found to correlate not only to the extent of obesity, but also the fat distribution of the individual; especially, focusing on obesity of the abdomen. Unfortunately, the proposed indices for abdominal obesity are numerous, and the results vary according to the index chosen. Three-hundred and twelve bus drivers in November, 1995, were chosen as subjects of this study. The author chose to measure serum lipid levels, fasting blood sugar levels and blood pressure, that are thought to be important risk factors of cardiovascular diseases. Obesity indices were calculated using anthropometric measurements. We were able to evaluate the significance of obesity indices by examining correlations between these indices and the risk factors of cardiovascular disease. The results obtained were as follows: 1. The abdominal obesity indices and risk factors of cardiovascular disease, the levels of total cholesterol in the serum, fasting blood sugar levels, and diastolic blood pressure, increased significantly according to age. 2. There was a significant difference in the abdominal obesity indices according to drinking and smoking habits controlled for age. Among the risk factors of cardiovascular disease, triglyceride and diastolic pressures had significant differences according to the presence or absence of a drinking history controlled for age. 3. Although all obesity indices showed significant correlations, the weakest correlation was between BMI and abdominal diameter index and the strongest correlation was between sagittal diameter and sagittal diameter matched for height. 4. There was a negative correlation between HDL-cholesterol and obesity indices. The weakest correlation was between fasting blood sugar levels and both SD and SDH showed correlations with the risk factors. 5. There was a significant correlation between SD and total cholesterol in the serum and fasting blood sugars controlled for age, drinking, and BMI. 6. After categorizing the subjects into 2 separate age groups at the 40 year mark, in the less than 40 year old age group, controlled for drinking and BMI, the results of comparitive studies have shown correlations between total cholesterol serum levels and waist-hip ratio, conicity-index, and SD. There were correlations between fasting blood sugar levels and SD, ADI, and SDH. There were no correlations between obesity indices and both total cholesterol serum levels and fasting blood sugar levels in the greater than 40 year old age group. There were significant correlations between abdominal obesity indices and total serum cholesterol or fasting blood sugar levels in the less than 40 year old age group, but no correlations in the age group over 40. These correlated factors between abdominal obesity and cardiovascular disease are assumed to exist in Korea as well. Furthermore, in this study a high correlation was found between SD, SDH and the risk factors of cardiovascular disease. Even when controlled for age, drinking, smoking, and BMI, the correlations between risk factors of cardiovascular disease and these indices exist. Therefore, the obesity indices, SD and SDH may prove to be important prognostic indicators or risk factors of cardiovascular disease; Summary

Health related practices and morbidity among adult in rural area.: Jue bok Song, Boo Ouk Rhee, Hai Rim Shin, Kap Yeol Jung, Joon Youn Kim; Korean J Prev Med. 1997;30(2):342-355.

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Abstract PDF: This research was carried out to determine the performance rate of health related practices, to measure the agreement between morbidity by doctor's diagnosis and morbidity by 'subject' self-reported and the degree of association between health related practices and morbidity rate by doctor's diagnosis, to identify their effects on morbidity among rural area populations. The data were gathered by volunteer residents(over the age of 20) of Haman Myeon, Haman Gun, Kyeongsangnam Do in Korea, from June 10, 1993 to June 12, 1993 (369 male and 516 female). Face to face interview, lab, chest P-A, EKG and physical examination were completed. Descriptive statistics, agreement analysis and multiple logistic regression procedures were employed for analyses. The results of the study were summarized as follows : 1) Age adjusted morbidity rates by doctor's diagnosis and self-reported were 38.5% (male:37.3%, female:36.5%), 26.4% (male:33.3%, female:27.5%), respectively. Kappa coefficient between morbidity by doctor's diagnosis and morbidity by self-reported was 0.21 (male:0.21, female:0.22). 2) The frequency of disease by doctor's diagnosis was as follows: hypertension (15.3%), gastritis (9.6%), diabetes mellitus (8.5%), liver disease (8.1%), and degenerative arthritis (6.2%) in the study population. 3) Order of health practice performance rate was as follows: Males- normal body weight (62.1%), non-heavy alcohol consumption (57.5%), 7-8 hours of sleeping (50.1%), non-smoking (21.7%), and exercise (19.8%). Females- non-heavy alcohol consumption (97.3%), non-smoking (84.7%), normal body weight (57.8%), 7-8 hours of sleeping (45.0%), and exercise (9.9%). 4) There was no significant relationship between health related practice and morbidity except exercise among health related practices. 5) Health related practice index which was recategorized by high, medium, and low had effects on the probability of developing morbidity.; Summary

The effects of aircraft noise on the hearing loss, blood pressure and response to psychological stress.: Sang Hwan Han, Soo Hun Cho, Kyungshim Koh, Ho Jang Kwon, Mina Ha, Yeong Su Ju, Myung Hee Shin; Korean J Prev Med. 1997;30(2):356-368.

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Abstract PDF: In effort to determine whether aircraft noise can have health effects such as hearing loss, hypertension and psychological stress, a total of 111 male professors and administrative officers working a college near a military airport in Korea(exposed group) and a total of 168 males and 112 females matched by age groups(control groups) were analyzed. Personal noise exposure and indoor and outdoor sound level of jet aircraft noise were measured at the exposed area. And pure tone, air conduction test and measurement of blood pressure were given to the exposed(males) and matched control groups(males and females). BEPSI(Brief Encounter Psychological Instrument) and psychological response to aircraft noise were examined for the exposed group. The noise dosimetry results revealed time-weighted averages(TWAs) that ranged from 61 to 68 dBA. However the levels encountered during taking off jet airplanes reached 126 dBA for two half minutes time period. The audiometric test showed that mean values of HTL(hearing threshold level) in exposed group at every frequency(500, 1,000, 2,000, 4,000, and 8,000 Hz were much lower than them of male and female control groups. And in old age groups, interaction of age and noise was observed at 8,000 Hz in both ears(p< 0.05). Conclusively, aircraft noise does not appear to induce hearing loss directly, but may decreased hearing threshold level by interaction of aging process and noise exposure. However, difference of mean values of exposed and control groups on blood pressure was not significantly. In psychological test, annoyance was the most severe psychological response to noise in exposed group, but mean value of BEPSI was not correlated with job duration in exposed group; Summary

Effects of Mercury Chloride on Nitric Oxide Syntheses in Mouse Peritoneal Macrophage and EMT-6 Cell.: Keun Sang Kwon, Dai Ha Koh, No Suk Ki, Jung Ho Youm; Korean J Prev Med. 1997;30(2):369-380.

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Abstract PDF: The effects of treatment with mercury chloride on the nitrite and nitrate syntheses were observed in peritoneal macrophages from Balb/c mice and EMT-6 cells in vitro. The cells were cultured in Dulbecco's modified Eagle's medium(DMEM) with cytokines. Amounts of nitrite and nitrate in the culture media after 24 and 36 hours of culture were about 2-fold, and 3-fold of those measured after 12 hours respectively. There were very close associations between the amounts of nitrite and nitrate measured in the culture media according to culture time. The survival rate of peritoneal macrophages was significantly decreased by mercury chloride added into the media in dose-dependent manner, however the survivals of EMT-6 cells were not influenced by mercury chloride concentration in media. Nitrite and nitrate syntheses were dose-dependently decreased by mercury chloride added in culture media. ATP synthesis also decreased in EMT-6 cells by mercury chloride. These results reported here suggest that the disorder of cell mediated immunity by mercurials could be related to the inhibition of nitric oxide synthesis which seems to be caused by the inhibition of ATP synthesis.; Summary

Contact dermatitis among male workers exposed to metalworking fluids.: Youngwoo Jin, Jun Young Lee, Euna Kim, Seung Hyun Park, Changho Chai, Yonghyu Choi, Kyoo Sang Kim; Korean J Prev Med. 1997;30(2):381-391.

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Abstract PDF: In an epidemiological study of metal workers exposed to metalworking fluids(MWF), the prevalence time of evoultion, seasonal occurrence and clinical type of contact dermatitis were investigated. Composinal analyses of MWF with HPLC, dermatological examination and two consecutive questionnaire surveys were conducted. Study population was divided into two groups ; workers contact to cutting oil and workers contact to rust preventive oil. In the analysis of MWF, aliphatic hydrocarbons, having 12-20 carbons, was most common composition(49.04%) of cutting oil otherwise, major contents (90.99%) of the rust preventives oil were aliphatic hydrocarbons composed of 6-9 carbons. The frequency (point prevalence) of contact dermatitis(CD) was 7(12.7 per 100 subjects) in the dermatological examination of 55 workers. As the result of second survey for contact dermatitis, cumulative prevalence of oil working full-time and recent 1 year prevalence in two groups were 28.0, 16.7 and 15.1, 12.5 per 100 subjects. There were no difference in the prevalence of CD by oil, age, oil contact duration. Summer is the most common evolution season in workers exposed to cuttiogs, but not in workers exposed to rust preventive oil. Major clinical type of CD was erythematous papules in both groups. It presents the importance of preventive measures that 51.1% suffer from contact dermatitis had medical care at their own expense, and 47.1% of them felt serious about their contact dermatitis. From the fact that 68.6% think cotton gloves protective apparatus, we emphasize the need for health education.; Summary

Comparisons on the worker's health status and working environment between small and large industries in Kyeungin industrial complex.: Jonguk Won, Jaesuk Song, Jaehoon Roh; Korean J Prev Med. 1997;30(2):392-401.

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Abstract PDF: Generally working environment and worker's health status of small scale industries(SSI) which employ less than 50 workers are known to be poorer than those of large scale industries(LSI) which employ more than 500 workers. However, according to the analysis of occupational injuries in Korea, prevalence rate of occupational injuries of SSI was 3.1 times as high as LSI. But there was no difference in prevalence rate of occupational disease and workers with suspected occupational disease(D1) between SSI and LSI. To confirm these two different facts, we surveyed working environment and worker's health status of SSI and LSI in Kyeungin industrial complex. Workers in SSI were 10,878 and workers in LSI were 8,291 and number of hazardous agents in SSI were 3,554 and those of LSI were 1,916. We found following results. First, proportion of male workers and workers who were less than 30 years old and more than 50 years old was higher in SSI compared to LSI. Second, worker in SSI had more liver disease, viral hepatitis, and pneumoconiosis than in LSI, and there were more worker with suspected occupational disease, general disease, and worker needed close observation in SSI. But these effects had not statistical significance under the condition controlled by age and sex with logistic regression. Third, the numbers measured for specific chemicals, organic solvents, and heavy metals in SSI was more than in LSI. However there was on difference in the excess rate of each hazardous agent between SSI and LSI. As the above results workers' health status in SSI was poorer than in LSI, but these results were mainly due to the population structure difference. Although there were some limitation of this study and problems of sensitivity and validity for periodic health examination and working environment evaluation method, the concept that working environment and worker's health status in SSI should be reviewed. In future the study that will reveal the real weak point of SSI should be performed.; Summary

Determinants of Patient Satisfaction : Allergic Rhinitis Patients Treated with Laser Therapy.: Kinam Jin, Woo Kyung Chung, Seung Yon Jang; Korean J Prev Med. 1997;30(2):402-412.

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Abstract PDF: The purpose of this study is to examine the factors influencing the allergic rhinitis patients' satisfaction with laser surgery. The data were collected by telephone interviews with 211 patients who visited E university hospital. The statistical methods used for the analysis were factor analysis, reliability test, and hierarchical multiple regression. We find that satisfaction level is a function of not only the surgery outcome but also the socio-psychological experience during treatment. With the improvement in nasal allergic condition, patients were more likely to be satisfied with medical services. And patients who had positive experience with physicians and facilities reported higher satisfaction level. While the surgery outcome explained 68% of the variation of satisfaction level, socio-psychological experience explained 23% of it. This result clearly shows that physicians need to pay attention to the socio-psychological aspect as well as the technical aspect of medical services.; Summary

A Study of Hospital Choice on the basis of Consumption Values Theory.: Sun Hee Lee; Korean J Prev Med. 1997;30(2):413-427.

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Abstract PDF: This research is based on the Consumption Values theory proposed by Sheth(1991). The purpose of this research is finding the factors related to the process of hospital choice. The expectation of six hospital outpatients 600 was analyzed by six consumption values categories: functional values, social values, emotional value, rarity value, situational values, health related values. The main results of this research is as following; 1. In the result of factor analysis 22 consumption value factors which affect the hospital preference were extracted; kindness/clearness, service speed, comfortabness of space, technical competence in functional values, high income/active social life, low income/blue calar, unmarried/man, middle aged/big family, woman/married, introvert in social values, high-class, comfortableness, reliability in emotional value, newness, classiness in rarity value, social relationship, close to residence, social reputation in situational values, priority on health, health behavior, active sense of value on health in health related values. 2. The difference of consumption values among hospital types were analyzed. The critical factors in reference for corporate hospitals newly established were kindness/ clearness, service speed, convenience, classiness, comfortableness, and newness. University hospitals were preferred by the factors of reliability, and social reputation. In general hospital, convenience and close to residence were critical factor. 3. In logistic regression, age, marital status, education level and income as sociodemographic variables were significaltly related to general hospital choice. Also service speed and close to residence were positively and high income/active social life and high class value were negatively related to general hospital choice. On university hospital choice, age and marital status, education show posive relationship whereas income showing negative relationship. Kindness/clearness, service speed, comfortableness of space, unmarried/man, comfortable feeling, newness and close to residence showed negative relationship with university hospital selection whereas technical competence, reliability in emotional value, classiness in rarity value, social relationship in functional values showed positive relationship. Lastly kindness/clearness, comfortableness of space, high income/active social life, unmarried/man, high-class, comfortableness and newness were positively related to corporate hospitals newly established choice in contast to negative relationship in reliability in emotional value and classiness. In summary, we found that hospital user also choose to hospital in base of various consumption value. Further studis to investigate the hospital consumer behavior will be needed.; Summary

Completeness Estimation of the Korean Medical Insurance Data in Childhood Asthma.: M N Ha, H J Kwon, D H Kang, S H Cho, K Y Yoo, Y S Joo, J H Sung, J W Kang, D S Kim, S I Lee; Korean J Prev Med. 1997;30(2):428-436.

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Abstract PDF: OBJECTIVES
: The purpose of this paper is to estimate the completeness of the Korean Medical Insurance Data in childhood asthma. METHODS : Capture-recapture method was used to estimate the prevalence of childhood asthma and case ascertainment rate(completeness) of Korean Medical Insurance Data using two source model, 'Korean Medical Insurance Committee Data (KMICD)' and 'Nationwide Study of Asthma and Allergies in Korean Children'. The asthma cases were restricted to those who were born from 1981 to 1989 and were identified by their Resident Register Number. Asthma cases in Korean Medical Insurance Data were defined as cases coded by ICD-9 493 and ICD-10 J45. In 'Nationwide Study of Asthma and Allergies in Korean Children', asthma cases were defined as the children who had been diagnosed asthma and had experienced symptoms of asthma during the past 12 months. The defined cases in two data sources were matched by 13 digits Resident Register Number. The numbers of matched patients in two data sources were 245 of 32,825 eligible total subjects. Chapman and Wittes' nearly unbiased estimation was used for capture-recapture analysis of two data sources. RESULTS : Observed prevalence rate of childhood asthma was 5.3% and estimated prevalence rate by capture-recapture analysis was 11.6%. The highest prevalence rate was observed in 6-7 age group and the older the rate decreased. The completeness (the proportion of cases ascertained by KMICD to the total observed cases by two data sources) was 20.6%, and ranged from 10.8% to 28.8% by area. CONCLUSIONS : Invalid diagnosis of cases might overestimate the prevalence of childhood asthma and might underestimate the completeness of Korean Medical Insurance Committee Data in this study; Summary

Trend of Medical Care Utilization and Medical Expenditure of the Elderly Cohort.: Kyeong Soo Lee, Pock Soo Kang; Korean J Prev Med. 1997;30(2):437-461.

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Abstract PDF: Because of a significant improvement in the economic situation and development of scientific techniques in Korea during the last 30 years, the life expectancy of the Korean people has lengthened considerably and as a result, the number of the elderly has markedly increased. Such an increase of the number of aged population brought about many social, economic, and medical problems which were never seriously considered before. This study was conducted to assess the trend of medical care utilization and medical expenditure of the elderly. The data of each patient in the study were taken from computer database maintained for administrative purpose by the Korea Medical Insurance Corporation. The study population was 132,670 who were 60 years old or more and registered in Korean Medical Insurance Corporation from 1989 to 1993. The study subjects were predominantly female(56.3%) and 10,000-20,000 Won premium group(50.6%). The following are summaries of findings : The total increase of the number of inpatient cases was 40.5% from 1989 through 1993. The average annual increase was 3.7% in inpatient medical expenditures per case, 4.4% in inpatient medical expenditures per day and 0.08% in length of stay per case from 1989 through 1993. Cataract was the most prevalent disease of 10 leading frequent diseases in all ages from 1989 through 1993. The case mix in 1993 compared to 1989 revealed that cataract and ischemic cerebral disease were increased whereas essential hypertension and pulmonary tuberculosis were decreased. The average annual increase of medical expenditures was 3.8% in general hospitals, 6.3% in hospitals and 2.4% in clinics. From 1989 through 1993, medical expenditures used by high-cost patients accounted for about 14% to 20% of all expenditures for inpatient care, while they represented less than 2.5% of the elderly population. Time series analysis revealed that total medical expenditures and doctor's fee for inpatient will be progressively increased whereas drug expenditures for inpatient will be decreased. And there will be no change in length of stay. Based on the above results, the factors increasing medical cost and utilization should be identified and the method of cost containment for the elderly health care should be developed systematically.; Summary

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