Journal of Preventive Medicine and Public Health

Volume 31(4); November 1998

Original Articles

Comparison of Histopathologic Stages of Asymptomatic and Symptomatic Cervical Neoplasm Patients.: Hyeon Woo Yim, Won Chul Lee, In Young Hwang, Yong Il Kwon, Jong Sup Park, Hoon Kyp Kim; Korean J Prev Med. 1998;31(4):583-591.

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Abstract PDF: Screening is for the early detection and treatment of diseases in prior to development of symptoms, so that more favourable prognosis could be obtained. To evaluate efficiency of screening test for cervical neoplasms, we compared the histopathologic stages of asymptomatic cervical neoplasm patients diagnosed by screening test, with those of symptomatic patients confirmed by pathology. Total 1,120 cases of cervical neoplasm patient, diagnosed at Kang-nam St. Mary's hospital from Jan. 1990 to Dec. 1996, were reviewed by chart, and classified as asymptomatic and symptomatic group based on the presence of subjective symptoms on their hospital visit. Their histopathologic stages were analysed. The results were as follows, 1. From the total of 1,120 patient, asymptomatic group comprised 264 cases (25.5%). Asymptomatic proportion increased 15.3% in 1991 to 34.7% in 1996. 2. Mean age for the occurrence of cervical neoplasm was 44.3 +/- 10.4 years for the asymptomatic group, and 49.3+/-13.2 years for the symptomatic group, showing statistically significant differences(p=0.001). 3. Among the study subjects, 465 cases(45.0%) had CIS(carcinoma in situ), and 569 cases(55.0%) had invasive cancers. 4. Percentage of cervical neoplasm patient diagnosed at asymptomatic stages were 45.8% in twenties, 32.0% in thirties, 27.7 % in forties, 21.7% in fifties, 18.7% in sixties and 1.8% in above seventies, showing statistically significant differences according to age group(p=0.001). 5. In thirties, 87.2% of the asymptomatic patients were diagnosed as CIS and 45.0% of symptomatic patient were diagnosed as CIS. With increment of ages, CIS proportion were markedly decreased. 6. 76.9% of asymptomatic patients were diagnosed as CIS, and 34.0 % of symptomatic patients were diagnosed as CIS, suggesting screening test at asymptomatic stage can increase CIS proportion. 7. CIS proportion of asymptomatic patient was highest in thirties(40.4%) and 2nd highest in forties(34.0%). Screening test for cervical neoplasm should be actively carried out from the thirties.; Summary

Incidence of Female Breast Cancer in a Defined Area in Korea.: Keun Young Yoo, Sue Kyung Park, Joo Hon Sung, Dong Young Noh, Kuk Jin Choe; Korean J Prev Med. 1998;31(4):592-603.

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Abstract PDF: This study was conducted to estimate incidence rate of female breast cancer in a defined area of Chungchongbuk-do in Korea. The presumptive breast cancer cases were selected from two different sources, i.e., medical utilization database of the National Health Insurance Corporation and the database from the National Cancer Registry. Medical students visited each hospital where the presumptive cases had been treated as a breast cancer patient, and made a dictation of medical record of each patient based on the claims stored in the Insurance Corporation from January to December 1995. The diagnoses in the claims included one of the following diagnostic codes; ICD-9 174-175(malignant neoplasms of the breast), 233(carcinoma in situ of the breast and genito-urinary system)or ICD-10 C50(malignant neoplasms of the breast), D05(carcinoma in situ of the breast and genito-urinary system). Each case has been confirmed as having a breast cancer by a breast surgeon through a medical record review. Age-standardized incidence rate of female breast cancer to the Korean population was estimated to be 10.5(95%confidence interval : 8.1-12.9)per 100,000 persons in 1995. Age-standardized rate to the world population was 9.8 per 100,000 persons, and the truncated rate for ages 35-64 was 27.2 per 100,000 persons. Validity of these estimates is discussing in comparison with previous methods of incidence estimation in Korea.; Summary

A Cohort Study of Physical Activity and All Cause Mortality in Middle-aged Men in Seoul.: Dae Sung Kim, Hye Won Koo, Dong Hyon Kim, Jong Myon Bae, Myung Hee Shin, Moo Song Lee, Chung Min Lee, Yoon Ok Ahn; Korean J Prev Med. 1998;31(4):604-615.

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Abstract PDF: Although previous studies revealed the association of physical activity with mortality rate, it is unclear whether there is a linear trend between physical activity and mortality rate. In this study, the association of physical activity with the risk of all-cause mortality was analysed using Cox's proportional hazard model for a cohort of 14,204 healthy Korean men aged 40-59 years followed up for 4 years(Jan. 1993 - Dec. 1996). Physical activity and other life style were surveyed by a postal questionnaire in December 1992. Total of 14,204 subjects were grouped into quartiles by physical activity. Using death certificate data, 123 deaths were identified. The second most active quartile had a lowest mortality rate with relative risk of 0.44(95% C.I.: 0.23-0.84) compared with most sedentary quartile, showing a J-shape pattern of physical activity-mortality curve. By examining the difference in proportion of cause of the death between most active quartile and the other quartiles, there was no significant difference of proportional mortality from cardiovascular deaths, cerebrovascular deaths or deaths from trauma. The covariates were stratified into two group between which the trend of RR was compared to test the effect modification. There was no remarkable effect modification by alcohol intake, smoking, body mass index, calorie consumption, percent fat consumption. In conclusion, moderate activity was found to have more protective effect on all-cause mortality than vigorous activity and that the J-shape pattern of physical activity-mortality curve was not due to the difference of mortality pattern or effect modification by alcohol intake, smoking, body mass index, calorie consumption and percent fat consumption.; Summary

Chromosome Aberrations and Sister Chromatid Exchanges of Hospital Workers Exposed to Radiation.: Ae Ri Cha, Mi Sun Kim, In Kyung Hwang, Su Ill Lee, Byung Mann Cho, Don Kyoun Kim; Korean J Prev Med. 1998;31(4):616-627.

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Abstract PDF: In order to evaluate the cytogenetic hazard among hospital workers potentially exposed to low dose of radiation, the analysis of chromosome aberrations(CA) and sister chromatid exchanges(SCE) in lymphocytes were performed in 79 hospital workers and 79 non-exposed workers. The mean frequency of chromosomal exchange and deletion(respectively, 0.20X10-2/cell and 0.39X10(-2)/cell) in the exposed group were significantly higher than those(0.07X10(-2)/cell and 0.23X10-2/cell) in control group. The frequency of sister chromatid exchanges was 5.04/cell in the control vs. 6.57/cell in the exposed group. There were also significant differences in the mean frequencies of CA and SCE adjusted for age, sex, smoking, drinking between two groups. There were no evidence of significant increase of CA and SCE according to the department or duration of employment. But the frequency of cells having chromosome aberration was significantly higher in the exposed group than in the control group related to duration of employment. There was no dose-effect relationship between the cumulative doses and the frequency of CA and SCE. But in the case of last 1 yr cumulative dose, there were evidence of significant dose-dependant increase of chromosome type CA and percentage of cells with aberration. The result suggest that there is cytogenetic hazard in risk group like hospital workers handling low dose radiation. And the analysis CA and SCE are useful biological indicators for the exposure of low dose level of radiation.; Summary

Study on the Exposure Levels of Organic Solvents and Subjective Symptoms of Dry-cleaning Workers.: Soo Young Kim, Jeong Yun Kim, Yeon Kyeng Lee, Sok Goo Lee, Young Soo Lee, Young Chae Cho, Tae Young Lee, Dong Bae Lee; Korean J Prev Med. 1998;31(4):628-643.

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Abstract PDF: To investigate the exposure levels of organic solvents and subjective symptoms of dry-cleaning workers, 77 male and 52 female dry-cleaning workers who had been worked in a small city of Chungnam province, and a large city, Taejon were selected for the study group. Air concentrations of organic solvents in the working environment were analyzed, and subjective symptoms of dry-cleaning workers were surveyed, from July to August 1996. The results obtained were as follows: 1. The concentrations of organic solvents in the working environment were within permissible TLV-TWA limits. 2. For the 13 symptom clusters, the most frequently complained symptom clusters were fatigue as 71.3%, and followed by depression and urinary disturbances as 53.5% and 51.9%. Other symptom clusters complained were below 50%. 3. Positive response rates of subjective symptoms were significantly higher in worker groups such as lived in a large city, female, higher education level, more frequently alcohol drinking, higher concentration of organic solvent in working environment, work in alone. 4. Workers who had used solvent B showed 2.3 point higher scores of subjective symptoms than those of solvent A. Of the subjective symptoms scores, amnesia and nervousness were higher in solvent B user group than solvent B user group. 5. As a result of factor analysis, 3 factors such as depression, urinary disturbance and neurologic disturbance were selected. 6. As a result of the logistic regression analysis, sex, the number of fellow workers, working time, region, job tenure, smoking, alcohol drinking, ventilating system, concentration of organic solvent in working environment and place of residence were selected for the related variables For the conclusion, even though the concentrations of organic solvents in the working environments of dry-cleaning workers were within permissible limit of TLV-TWA, many dry-cleaning workers complained symptoms, such as fatigue, depression, urinary disturbances and so on. And the factors affecting to the symptoms of dry-cleaning workers were the number of fellow workers, work hours, region, job tenure, smoking and alcohol drinking.; Summary

A study on manganese health hazards among experienced welders.: Gyu Hoi Kim, Hyun Sul Lim, Sun Hee Yu; Korean J Prev Med. 1998;31(4):644-665.

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Abstract PDF: This study was conducted to evaluate the health hazards and to develop early diagnostic methods of the manganism in experienced welders and to know the meaning of signal intensities on the brain Magnetic Resonance images. It was carried out from December 1996 to February 1997 with 277 male welders, the duration of welding was at least 5 years or more. The study was consisted of a questionnaire, physical examination and measurements of blood and urine manganese concentrations. Brain Magnetic Resonance imaging was done on 19 study subjects by random sampling. As the duration of welding increases, the positive rates of clinical symptoms, neurological examinations and blood manganese concentrations were also increased. However, physical examinations and urine manganese concentrations were not statistically significant with the duration of welding. Authors couldn't observe any Parkinsonism-like diseases. There were statistically significant correlations between duration of welding and blood manganese concentrations(r=0.16, p<0.01). There were not statistically significant correlations between duration of welding and urine manganese concentrations(r=0.06). There were statistically significant correlations between blood and urine manganese concentrations(r=0.34, p<0.01). By viewing brain Magnetic Resonance images, 13 welders(68.4 %) among 19 welders were found to have signal intensities. The positive rates of clinical symptoms, physical examinations, neurological examinations and blood and urine manganese concentrations were not statistically different between those with signal intensities and those without signal intensities. We would like to suggest that some non-specific clinical symptoms and neurological signs are correlated with the duration of welding but any Parkinsonism-like diseases had not been observed with these welders. Next we suggest that the high signal intensities on T1WI of brain Magnetic Resonance images are not the sign of manganese intoxication but the sign of manganese deposition.; Summary

A study on heavy metal concentration of cosmetics on the market.: Hun Lee, Yoo Jung Yoo, Myoung Hee Park, Jung Ho Kim, Yong Hee Lee, Chan Seok Moon, Yong Shik Hwang, Deog Hwan Moon; Korean J Prev Med. 1998;31(4):666-679.

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Abstract PDF: This study aims at providing the fundamental data on the field of cosmetics by comparing heavy metal concentration in terms of domestic / foreign products, items, companies and colors. This study has determined the concentration of chromium, lead, mangagnese, nickel, copper and vanadium in cosmetics such as moisturizer, concealer, foundation (Ivory-yellow), compact powder (Ivory-yellow), lip color (Red, brown), eye shadow (Red, brwon and dark green) and eye liner (Black) manufactured by five domestic cosmetic companies and five foreign cosmetic companies on the market. The samples have been collected in cosmetic stores in Pusan from Dec. lst 1996 to Jan. 3lst 1997. The results are as follows : 1. The heavy metal concentration in cosmetics was 2.42ng/g for chromium, 0.82ng/g for lead, 4.49ng/g for manganese, 1.69ng/g for nickel, 0.53ng/g for copper, and 0.51ng/g for vanadium, respectively. 2. Lead and vanadium concentration were significantly higher in domestic cosmetics than foreign cosmetics(p<0.05). 3. The mean(GM) concentrations of heavy metal were different significantly (p<0.01) when classified with cosmetic items. The highest means shown at eye shadow in Cr (14.96ng/g), Cu (1.32ng/g), V (1.28ng/g), and Ni (8.30ng/g), compact powder in Pb(2.50ng/g), eye liner in Mn(90.62ng/g). 4. The mean(GM) concentrations of heavy metal were different significantly (p<0.01) among colored cosmetics. The highest mean concentration of Cr, Ni, Cu and V were dark green- colored cosmetics, that of Mn was black-colored cosmetics, and that of Pb was ivory yellow-colored cosmetics.; Summary

Species Differences in Effect of Ethanol to Urinary Metabolites Excretion of Trichloroethylene in Mice and Rats.: Eun Yong Kang, Jung Duck Park, Yeon Pye Hong, Im Won Chang; Korean J Prev Med. 1998;31(4):680-691.

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Abstract PDF: This study was conducted to examine the species differences in the urinary excretion of trichloroethanol(TCE-OH) and trichloroacetic acid(TCA) of trichloroethylene(TCE) metabolites and the effect of ethanol on these metabolites in mice and rats. TCE administered to Male Sprague Dawley rats and ICR mice as a single oral dose(100, 200, 500, 1,000 or 2,000 mg/kg body weight) and ethanol(3.0 g/kg body weight) was taken orally 12 hours before TCE administration. The metabolites in urine were measured 0, 12, 24, 36 and 48 hours after TCE administration. The results of metabolite excretion were as follows; Total trichlorocompounds(TTC) in urine increased with TCE dose in mice while increased only below dose of 1,000 mg/kg TCE in rats. The net excretion of TCE metabolites was significantly greater in mice than rats, although the proportion of TCE-OH to TCA was not different between mice and rats. These findings indicate that mice were internally exposed to significantly higher concentration of TCE metabolites than rats and this trend appeared to be more prominent with the increase of TCE dose. Ethanol increased significantly TCE-OH in urine of rats while the increase of TCE-OH induced by ethanol was not significant in mice, and didn't increase TCA of urine in both of rats and mice. This result suggests that the effect of ethanol on TCE metabolism may be due to the increase of TCE-OH.; Summary

Development of Korean Neurobehavioral Test Battery - Assessment of the Validity of Traditional and Computerized Neurobehavioral Tests.: Jong Hak Chung, Chang Yoon Kim, Joon Sa Kong, Man Joong Jeon, Park Chin Hong; Korean J Prev Med. 1998;31(4):692-707.

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Abstract PDF: Aim. A neurobehavioral test for workers exposed to organic solvents in the workplace can be affected by many factors : age, education, motivation, ethnicity, etc. To apply more suitable neurobehavioral test for Korean workers, we evaluated the validity of several items of computerized and traditional neurobehavioral tests. Methods. We have applied eleven tests : four items of computerized neurobehavioral test(Swedish Performance Evaluation System) including Addition, Symbol-Digit, Digit Span, and Finger tapping speed, and seven items of traditional neurobehavioral test consisting of Addition, Digit-Symbol , Digit Span, Benton visual retention test, Pursuit aiming, Pegboard, and Tapping. These tests were performed on 96 workers exposed to solvents, and 100 reference workers. The concurrent and construct validities were evaluated by group difference, correlation with age, educational level, hippuric acid level, neurotoxic symptom, current exposure level, multitrait-multimethod matrix, factor analysis, and discriminant analysis. Results. Statistically significant differences were observed between the workers exposed to solvents and referents in computerized Symbol-Digit, Finger tapping speed, traditional Digit-Symbol and Pegboard. The computerized Symbol-Digit, traditional Digit-Symbol, Addition, Benton visual retention test, and Pegboard were found to be related to the age. The performance of computerized Symbol-Digit, Addition, and traditional Digit-Symbol were found to be related to the educational level significantly. The computerized Symbol-Digit, Finger tapping speed, and traditional Digit-Symbol were found to be related to hippuric acid, and neurotoxic symptom. The discriminability of Finger tapping speed, and Pegboard was better than the other tests. In discriminant analysis, the model with two variables, the computerized Symbol-Digit and Pegboard, classified almost 70 percent of the workers correctly. Conclusions. These results suggest that the computerized Symbol-Digit, Finger tapping speed, and Pegboard are more satisfactory for our purpose, and the Addition, Tapping, Benton visual retention test, and Pursuit aiming are less valid than other items. These may allow the reasonable selection of core neurobehavioral tests for workers exposed to solvents in Korea.; Summary

The effect of smoking and drinking habit on the health status of lead workers.: Choong Koo Lee, Yong Bae Kim, Gap Soo Lee, Kyu Yoon Hwang, Hwa Sung Kim, Sung Soo Lee, Kyu Dong Ahn, Byung Kook Lee; Korean J Prev Med. 1998;31(4):708-718.

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Abstract PDF: To investigate the effect of smoking and drinking habit on the health status in lead using industries, 2,785 male workers in lead using industries (7 storage battery industries, 7 secondary smelting and related industries, and 4 primary metal and other manufacturing industries) were selected for this study. This study was carried out as a part of periodic health examination. Selected study variables were zinc protoporphyrin in whole blood (ZPP), SGOT and SGPT for laboratory test. Questionnaire for lead related symptoms and smoking and drinking habit was provided to all the workers and filled up by themselves and reconfirmed by physician. The results obtained were as follows; 1. The overall smoking and drinking rate of study population were 69.8% and 73.6%, respectively. While the smoking and drinking rate of storage battery workers were 68.8% and 72.3%, those of secondary smelting industries and other industries were 66.0% and 66.4% and 74.6 and 80.3% respectively. 2. While the mean values of blood ZPP of lead exposed workers were significantly higher than other group, those of SGOT of storage battery workers were significant higher than other worker. But there were no differences of mean values of other variables. 3. Smoking habit did not affect on the mean value of blood ZPP of workers in special health examination group, but there were significant differences of blood ZPP and SGOT between drinker and non-drinker. 4. Symptom prevalence of lead exposure were higher in drinking and smoking group than non-drinking and non-smoking group. 5. In multiple regression analysis of the total lead related symptoms, blood ZPP, SGOT, and SGPT as dependent variable, respectively, and age, work duration, blood ZPP, pack year and amount of alcohol drinking as independent variables, work duration, pack year, amount of alcohol drinking, age contributed to total symptoms; and age, work duration, pack year contributed to blood ZPP; and age, amount of alcohol drinking, work duration contributed to SGOT; and pack year contributed to SGPT.; Summary

The Association between Job Characteristics, Psychosocial Distress and Homocysteine.: Bong Suk Cha, Sang Baek Koh, Sei Jin Chang; Korean J Prev Med. 1998;31(4):719-727.

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Abstract PDF: This study was carried out to assess the relationship between jobstrain, psychosocial distress and homocysteine. The study design was cross-sectional, and included 152 industrial workers in middle sized city. A self-adminstered questionnaire measured general characteristic, job strain and psychosocial distress. Blood was drawn into EDTA tube, and total plasma homocysteine was measured by HPLC. Homocysteine in the high job demand group was significantly higher than that in the low job demand. Cholesterol in the high job control group was significantly higher than that in the low job control. Homocysteine was significantly higher in the high job strain group than that in the other group. Folate and vitamin B12 showed a significantly negative correlation with homocysteine. Multiple regression analysis was used to determine whether the psychosocial distress and other variable contributed to explaining the homocysteine. Stress correlates with the homocysteine.; Summary

Relationship of Level of Stress, Life Style, Subjective Symptoms and Clinical Diagnosis in Clients taken Multiphasic Screening Program.: Jun Han Park, Jin Ho Chun, Jang Mi Kang, Byung Chul Son, Dae Hwan Kim, Chang Hee Lee, Kui Won Jeong, Sang Hwa Urm; Korean J Prev Med. 1998;31(4):728-739.

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Abstract PDF: To improve wellness and quality of life by recognizing the health effects of stress, the author estimated the relationships between stress, subjective symptoms and clinical diagnosis through a questionnaire and a battery of specified laboratory tests - electrocardiography, blood pressure, cholesterol, aspartate aminotransferase(AST), alanine aminotransferase(ALT), gamma glutamyl transferase(gamma-GTP), fasting blood sugar, gastro-endoscopy or UGI, abdominal sonography, etc. The data was gathered from 337 clients who were undergoing multiphasic screening program at a University Hospital from January to March 1998. The mean age of subjects was 46.5+/-11.2 years and the mean of body mass index was 24.0+/-3.7kg/m2. The mean level of stress was 18.5+/-6.0 expressed as the score out of 40. By general characteristics and life style among male, mean level of stress was significantly higher in case of lower socioeconomic status, habitual drug use, longer daily working time(>10 hours), no regular exercise, drinkers, irregular meal, skipping breakfast(p<0.05). In case of female, that was significantly higher in case of lower education, lower socioeconomic status, longer daily working time(>10 hours), no regular exercise, drinkers, smokers, irregular meal, skipping breakfast(p<0.05). Significant correlations were observed between stress and subjective symptoms in all kinds of organ system(p<0.01). Correlation coefficients of stress among male were relatively high with neuro-psychiatric symptom(gamma=0.476) and cardio-vascular symptom(gamma=0.361) in order, and correlation coefficients of stress among female was highest with neuro-psychiatric symptom(gamma=0.371). The prevalence of the diagnosis through the battery of laboratory tests was high in upper gastrointestinal disorders and hypercholesterolemia in order in both sex group. Among male the mean score of stress was significantly high in ulcerative peptic disorder of upper gastrointestine and hepatopathy in order (p<0.05) . Among female that was significantly high in diabetes mellitus. In summary, it is likely that there are associations between stress, subjective symptoms and clinical diagnosis. To promote wellness and quality of life through, therefore, it would be of value that periodic stress evaluation program and stress management including appropriate control of smoking and drinking, regular exercise and meal.; Summary

The Knowledge and Practice of the Breast Self-examination in Women who got health check up.: Soo Jin Jeong, Soon Seok Choi, Jun Han Park, Sang Hwa Urm, Kui Won Jeong, Chae Un Lee, Ki Taek Pae; Korean J Prev Med. 1998;31(4):740-750.

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Abstract PDF: The methods for the early diagnoses of breast cancer are mammography, physical examination, breast self-examination(BSE). This study was conducted to investigate the knowledge and practice of BSE by structured questionnaire which included questions on general characteristics, performance of mammography, physical examination of breast, knowledge and practice of BSE. The subjects in this study were 412 females between 20 and 69 years old who visit to the Health Care Center of College of medicine of Inje University from December 1997 to February 1998. The results were as follows: 1. Women who have gotten the regular mammography are 8.19% of these subjects and women who have gotten the regular physical examination by doctors are 4.19% of these subjects. 2. Regarding BSE, 77.4% of these subjects said that they knew BSE and 3.88% of these subjects said that they practiced BSE regularly. It was that women who knew BSE were more younger, better-educated and higher economic status(p=0.001) and lived a normal life with her husband(p=0.033). And women who practiced BSE regularly were more younger, and married(p=0.001). 3. The most common barrier to doing BSE is 'Do not see the needs/Worry unnecessarily', and the most common reasons for doing BSE is 'Early detection'. 4. The overall frequency and percentage distribution of recommended BSE step in Korea is lower than U.S.A.; Summary

Decision-making process and satisfaction of pregnant women for delivery method.: Hae Ri Jun, Jung Han Park, Soon Woo Park, Chang Kyu Huh, Soon Gu Hwang; Korean J Prev Med. 1998;31(4):751-769.

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Abstract PDF: This study was conducted to assess the attitude of pregnant women toward delivery method, understanding of the reason for determining her own delivery method, participation in decision-making process and satisfaction with delivery method after labor. Study subjects were 693 pregnant women who had visited obstetric clinic for prenatal care in the last month of pregnancy in one general hospital and one obstetrics-gynecology specialty hospital in Taegu city from February 1 to March 31 in 1998. A questionnaire was administered before and after labor and a telephone interview was done one month after labor. Proportion of women who had health education and/or counselling about delivery method during prenatal care was 24.0% and this proportion was higher for women who had previous c-section(35.5%) than others. Women thought vaginal delivery is better than c-section for both maternal and baby's health regardless of previous delivery method. About 90% of primipara and multiparous women who had previous vaginal delivery wanted vaginal delivery for the index birth, while 85.6% of multiparous women who had previous c-section wanted repeat c-section. Reasons for choosing c-section in pregnant women who preferred vaginal delivery before labor were recommendation of doctors(81.9%), recommendation of husband(0.8%), agreement between doctor and pregnant woman(4.7%), and mother's demand(12.6%). Reasons for choosing vaginal delivery were mother's demand(30.6%) and no indication for c-section(67.2%). Reasons for choosing c-section in pregnant women who preferred c-section before labor were recommendation of doctors(76.2%), mother's demand(20.0%), recommendation of husband(1.3%), and agreement between doctor and pregnant woman(2.5%). Of the pregnant women who had c-section, by doctor's recommendation, the proportion of women who had heard detailed explanation about reason for c-section by doctor was 55.1%. Mother's statement about the reason for c-section was consistent with the medical record in 75.9%. However, over 5% points disparities were shown between mother's statement and medical record in cases of the repeat c-section and mother's demand. In primipara and multiparous women who had previous vaginal delivery, the delivery method for index birth had statistically significant association with the preference of delivery method before labor(p<0.05). All of the women who had previous c-section had delivered the index baby by c-section. Among mothers who had delivered the index baby vaginally, 84.9% of them were satisfied with their delivery method immediately after labor and 85.1% at 1 month after labor. However, mothers who had c-section stated that they are satisfied with c-section in 44.6% immediately after labor and 42.0% at 1 month after labor. Preferred delivery method for the next birth had statistically significant association with delivery method for the index birth both immediately after labor and in 1 month after labor. The proportion of mothers who prefer vaginal delivery for the next birth increased with the degree of satisfaction with the vaginal delivery for the index birth but the proportion of mothers who prefer c-section for the next birth was high and they did not change significantly with the degree of satisfaction with the c-section for the index birth. These results suggest that the current high technology-based, physician-centered prenatal and partritional cares need to be reoriented to the basic preventive and promotive technology-based, and mother-fetus-centered care. It is also suggested that active involvement of pregnant woman in decision-making process for the delivery method will increase the rate of vaginal birth after c-section and decrease c-section rate and improve the degree of maternal satisfaction after delivery.; Summary

Analysis of influencing factors on self-employed physician's income.: Woong Sub Park, Han Joong Kim, Myong Sei Sohn, Eun Cheol Park; Korean J Prev Med. 1998;31(4):770-785.

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Abstract PDF: This study describes the relation of physician's income and price of medical service and social welfare through microeconomic view, reviews the literature of influencing factor on physician's income, and it describes general distribution of physician's income, and analyzes influencing factor of physician's income. A total of 844 persons responded to the mail survey, through stratified sampling by 23 branches of medical society in Korean RBRVS study. The design of the study is cross sectional study, and the unit of analysis is a physician. To examine the change of average income per month, multiple regression was used to test the change according to physician's characteristics, demographic characteristics, scale of clinic(or hospital), average intensity of ordinary work, and specialty. The major findings of this study are as follows; 1. As for self-employed physicians, the difference of average income per month among specialties was 4,850,000won, but the difference was 6,020,000won under the control of control variables, and average income per month was significantly higher for physicians who had sick-beds than physicians who had no sick-beds. 2. The number of average out-patients per month and number of nurses and nursing aides significantly positively associated, but the number of physician significantly negatively associated with average income per month. In conclusion, the number of out-patient and number of nurses and nursing aides is the major influencing factor, and the difference of average income per month among specialties existed in self-employed physicians. So this study suggests basic hypothesis that the price of medical service and supply of physician by specialties are not pertinent. Being a cross-sectional study, this study can not suggest causal explanations. In the future, further study is needed for causal explanations.; Summary

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