Journal of Preventive Medicine and Public Health

Volume 33(4); December 2000

Original Articles

The Cancer-preventive Potential of Panax ginseng: A Review of Human and Experimental Evidence.: Hai Rim Shin, Joon Youn Kim, Duk Hee Lee, Taik Koo Yun, Gareth Morgan, Harri Vainio; Korean J Prev Med. 2000;33(4):383-392.

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Abstract PDF: OBJECTIVE
We have reviewed the potential cancer preventive and other relevant properties of Panax ginseng C. A. Meyer, which has been traditionally used as a natural tonic in oriental countries. DATA IDENTIFICATION AND STUDY SELECTION: Publications on Panax ginseng and its relation to cancer were obtained from the Medline database (1983-2000) and by checking reference lists to find earlier reports. The reports cover experimental models and human studies on cancer-preventive activity, carcinogenicity and other beneficial or adverse effects. In addition, possible mechanisms of chemoprevention by ginseng were also considered. RESULTS: Published results from a cohort and two case-control studies in Korea suggest that the intake of ginseng may reduce the risk of several types of cancer. When ginseng was tested in animal models, a reduction in cancer incidence and multiplicity at various sites was noted. Panax ginseng and its chemical constituents have been tested for their inhibiting effect on putative carcinogenesis mechanisms (e.g., cell proliferation and apoptosis, immunosurveillance, angiogenesis); in most experiments inhibitory effects were found. CONCLUSION: While Panax ginseng C. A. Meyer has shown cancer preventive effects both in experimental models and in epidemiological studies, the evidence is currently not conclusive as to its cancer-preventive activity in humans. The available evidence warrants further research into the possible role of ginseng in the prevention of human cancer and carcinogenesis.; Summary

Impacts of DRG Payment System on Behavior of Medical Insurance Claimants.: Beom Man Ha, Gilwon Kang, Hyoung Keun Park, Chang Yup Kim, Yong Ik Kim; Korean J Prev Med. 2000;33(4):393-401.

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Abstract PDF: OBJECTIVES
To evaluate the impacts of the DRG payment system on the behavior of medical insurance claimants. Specifically, we evaluated the case-mix index, the numbers of diagnosis and procedure codes utilized, and the corresponding rate of diagnosis codes before, during and after implementation of the DRG payment system. METHODS: In order to evaluate the case-mix index, the number of diagnosis and procedure codes utilized, we used medical insurance claim data from all medical facilities that participated in the DRG-based Prospective Payment Demonstration Program. This medical insurance claim data consisted of both pre-demonstration program data (fee-for-service, from November, 1998 to January, 1999) and post-demonstration program data (DRG-based Prospective Payment, from February, 1999 to April, 1999). And in order to evaluate the corresponding rate of diagnosis codes utilized, we reviewed 820 medical records from 20 medical institutes that were selected by random sampling methods. RESULTS: The case-mix index rate decreased after the DRG-based Prospective Payment Demonstration Program was introduced. The average numbers of different claim diagnosis codes used decreased (new DRGs from 2.22 to 1.24, and previous DRGs from 1.69 to 1.21), as did the average number of claim procedure codes used (new DRGs from 3.02 to 2.16, and previous DRGs from 2.97 to 2.43). With respect to the time of participation in the program, the change in number of claim procedure codes was significant, but the change in number of claim diagnosis codes was not. The corresponding rate of claim diagnosis codes increased (from 57.9% to 82.6%), as did the exclusion rate of claim diagnosis codes (from 16.5% to 25.1%). CONCLUSIONS: After the implementation of the DRG payment system, the corresponding rate of insurance claim codes and the corresponding exclusion rate of claim diagnosis codes both increased, because the inducement system for entering the codes for claim review was changed.; Summary

Seasonal Variation of Pre-term Births in Korea.: Duk Hee Lee, Sang Hyeok Ma, Hai Rim Shin; Korean J Prev Med. 2000;33(4):402-408.

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Abstract PDF: OBJECTIVES
To investigate possible seasonal patterns of pre-term birth in Korea. METHODS: A total number of 2,669,357 single live births reported to the National Statistical Office from 1995 to 1998 were analyzed. Composite monthly cohorts of ongoing pregnancies were constructed for each month of the year and the probability of pre-term birth was estimated. RESULTS: Increases in the probability of a pre-term birth occurred during winter for the birth of first child and during summer for the birth of second or later child. This seasonal variation was similar among groups divided by sex, residency, age of mother, and education of mother. CONCLUSIONS: These findings suggests that some environmental factors related to season may partially explain the incidence of premature births.; Summary

Estimating the Disability Weight of Major Cancers in Korea Using Delphi Method.: Seok Jun Yoon, Young Dae Kwon, Byoung Yik Kim; Korean J Prev Med. 2000;33(4):409-414.

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Abstract PDF: OBJECTIVES
To estimate the weighting for the disability caused by major cancers in Korea using the Delphi method. METHODS: We selected 19 panelists to estimate the disability weighting of major cancers in Korea by using the Delphi method. To select the relevant kinds of cancers, we used National Death Certificate Data produced by the National Statistical Office in 1996. Then the stability of each delphi round was calculated by using the coefficient of variance. RESULTS: The disability weight of major cancers for males was pancreas cancer(0.36), liver cancer(0.35), esophageal cancer(0.30), stomach cancer(0.27), lung cancer(0.26), and colorectal cancer(0.30). The disability weight of major cancers for females was pancreas cancer(0.36), liver cancer(0.34), esophageal cancer(0.29), stomach cancer(0.28), lung cancer(0.26), and colorectal cancer(0.28). CONCLUSION: The results of this study will provide baseline data useful for the measurement of the burden of disease caused by cancers in Korea.; Summary

Factors Related to Self-Perceived Health of Young Adults.: Kee Ho Park, Woohyun Cho, Il Suh, Jong Ku Park; Korean J Prev Med. 2000;33(4):415-425.

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Abstract PDF: OBJECTIVES
To determine which factors are related to young adults perception of their health. Two research questions were asked. Which aspects of health does self-perceived health as a index of general health reflect? Why do two individuals with the same level of general health have different health perceptions? METHODS: The sampling frame comprised college or graduate school students, aged 20 to 29, who were members of A, one of the 4 biggest internet communication services. The questionnaires were sent to study samples(n= 1,000) and answered by E-mail. Response rate was 37.0%. RESULTS: Firstly, physical health ranked highest and self-perceived health ranked lowest. Secondly, health, anxiety, depression, and self-perceived health showed significant differences between the sexes, with women showing a higher health status in these categories except for self-perceived health. Thirdly, the two factors significantly related to self-perceived health were physical health and self-esteem, as determined by multivariate analysis. CONCLUSIONS: The factors significantly related to self-perceived health were physical health and self-esteem. Further studies of the health characteristics of young adults are needed.; Summary

Structural Modeling of Quality, Satisfaction, Value and Purchase Intention in Health Care Service.: Kui Son Choi, Woo Hyun Cho, Sunhee Lee, Jung Mo Nam; Korean J Prev Med. 2000;33(4):426-435.

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Abstract PDF: OBJECTIVES
To determine the relationships among quality, satisfaction, value and purchase intention in health care service. METHODS: The data were gathered from out-patients who had used hospital services. They were asked to assess service quality, satisfaction, service value, and purchase intention. A total of 557 usable questionnaires were gathered. The data were analyzed using SAS version 6.12. The analytic methods employed in the study were confirmatory analysis and covariance structural analysis. RESULTS: Service quality exhibited a significant and positive relationship with satisfaction, service value, and purchase intention. Furthermore, satisfaction had a significant and positive relationship with purchase intention. And finally, service value had a significant and positive relationship with both satisfaction and purchase intention. Based on these findings, it is evident that satisfaction was a mediator between service quality and purchase intention. Also service value played a mediating role between service quality and satisfaction. CONCLUSIONS: These results suggest that service quality is an antecedent of satisfaction and service value, and exerts a stronger influence on purchase intentions than satisfaction and service value do. Thus, managers may need to emphasize service quality in health care.; Summary

Factors Affecting Users' Satisfaction with Order Communicating System.: Jin Seok Lee, Chang Yup Kim, Bum Man Ha, Gilwon Kang, Byoung Yik Kim, Yong Ik Kim; Korean J Prev Med. 2000;33(4):436-448.

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Abstract PDF: OBJECTIVES
To identify the factors affecting users' satisfaction with the Order Communicating System(OCS) and to highlight the factors important for the successful establishment of OCS. METHODS: A Users Satisfaction survey was sent to 4,513 people, consisting of 1,503 doctors, 2,379 nurses, 255 pharmacists and 370 administrative workers in 16 hospitals which had introduced OCS. The response rate was 63.9%. Measurement of users' satisfaction was performed with the instrument which was used in Doll's study. Some aspects of Doll's instrument were adjusted according to the aims of this study. The classifying sections of this survey included age, job and status classification, computer experience , OCS education, duration of daily OCS use, type of order entering, number of personnel in the Hospital Information System's department, cost of OCS, problem frequency, proportion of work managed by hand, OCS type, and Hospital establishment type. RESULTS: There was a positive correlation between satisfaction level and managerial status throughout all job classifications. Irrespective of the importance of OCS education as a factor relating to users' satisfaction, the additional work load caused by OCS lowered users' satisfaction. Different factors affected users' satisfaction according to job and status classification. The composition of factors affecting the pharmacist and administrative worker satisfaction levels was simpler than that of the doctor and nurse levels. There were no statistically significant differences between the actual computer experience duration of daily OCS use and users' satisfaction with OCS. CONCLUSIONS: There was an understandable relationship between users' attitude to OCS and factors affecting users' satisfaction. The results of this study could be used as a basis for the successful expansion of the operation of OCS. But more detailed studies on users' satisfaction and further improvements of methodologies are required for the successful establishment of OCS.; Summary

Size of Prostatitis Symptoms Using Prostatitis Symptom Index(PSI): The Effect of Prostatitis Symptoms on Quality of Life.: Seok Soo Byun, Daehee Kang, Keun Young Yoo, Sue Kyung Park, Cheol Kwak, Moon Ki Jo, Hyeon Hoe Kim, Chongwook Lee; Korean J Prev Med. 2000;33(4):449-458.

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Abstract PDF: OBJECTIVES
To determine the prevalence of prostatitis symptoms in the general population by questionnaire survey and to measure the effect of prostatitis symptoms on quality of life(QOL). MATERIALS AND METHODS: A cross sectional community-based epidemiologic study was performed on 2,034 men, living in the Seoul metropolitan area using stepwise random sampling. Out of 2,034 interviewees, 1,356 men who were older than 40 and provided sufficient information were selected for this study. The questionnaires were completed by well trained interviewers. Contents of the questionnaires included demographic data, the Prostatitis Symptom Index(PSI), the International Prostate Symptom Score(IPSS), a general health questionnaire section and a sexual health questionnaire section. The PSI was composed of a sum of the scores from three questions about dysuria, penile pain and perineal pain and it ranged 0 to 12. Incidence of prostatitis symptoms was defined by a score of 4 or more and the reference group was defined as consisting of those with a score of 3 or less. The rate of incidence of prostatitis symptoms was assessed according to age and the difference of QOL between the prostatitis symptoms group and the reference group. RESULTS: The overall positive rate of prostatitis symptoms measured by the PSI, in men older than 40, living in the Seoul metropolitan area, was 4.5%(61/1,356), adjusted to 4.8% by the relative proportion of this age group in the general population of the Seoul metropolitan area as compared to Korea and the World. The proportion of the group with prostatitis symptoms assessed by the PSI did not increase with age although the proportion of participants with moderate to severe lower urinary tract symptoms (LUTS) did increase with age. The group with prostatitis symptoms suffered from a much greater incidence of LUTS compared to the reference group (p<0.05). The QOL scores of the IPSS, and the general health and sexual health status of the group with prostatitis symptoms, were worse than those of the reference group.(p<0.05). CONCLUSIONS: The positive rate of prostatitis symptoms in men older than 40, living in the Seoul metropolitan area, was 4.8% and it didn't increase with age. The general QOL of the group with prostatitis symptoms was much worse than that of the reference group.; Summary

Association between BMI and Mortality: Kangwha cohort study.: Soo Jin Yoon, Sang Wook Yi, Soh Yoon Kim, Heechoul Ohrr, Yun Hee Park, Soon Young Lee, Tae Yong Sohn; Korean J Prev Med. 2000;33(4):459-468.

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To investigate the association between BMI and Mortality. METHODS: This study was based on the analysis and assembly of the 'Kangwha Cohort Study', previously conducted by the Department of Preventive Medicine, Yonsei University. A total of 2,696 males and 3,595 females were followed for almost ten years and ten months from March 1985 to January 1996, a total of whom 2,420 died during this period. The Cox's proportional hazards regression model was used to analyze this data. RESULTS: We found a U-shaped relationship between BMI and mortality among the aged men in the Kangwha cohort. The hazard ratio of dying was adjusted for age, marital status, occupation, self cognitive health level, chronic disease, smoking, and alcohol frequency, then sorted by body mass index into the following groups; less than 18.5, 18.5 to less than 21.0, 21.0 to less than 23.5, 23.5 to less than 26.0 and greater than or equal to 26. The corresponding ratios for men were 1.81(1.50-2.19, 95%CI), 1.31(1.14-1.51, 95%CI), 1.0(referent), 1.05(0.87-1.26, 95%CI) and 1.39(1.09-1.76, 95%CI), respectively. And for women, 1.46(1.19-1.78), 1.12(0.95-1.31, 95%CI), 1.0(referent), 1.00(0.84-1.20, 95%CI) and 1.09(0.89-1.34, 95%CI), respectively. CONCLUSIONS: The risk of death among aged men in Kangwha increased in the under and overweight groups. The relationship between BMI and mortality has been well studied in Western populations, but little is known about the association between BMI and mortality in our country. So, on the basis of this study, it is apparent that more studies of the relationship between BMI and mortality will be needed for future work.; Summary

Differences in Health Behaviors among the Social Strata in Korea.: Tae Ho Yoon, Ok Ryun Moon, Sang Yi Lee, Baek Geun Jeong, Sin Jae Lee, Nam Sun Kim, Won Ki Jhang; Korean J Prev Med. 2000;33(4):469-476.

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Abstract PDF: OBJECTIVES
To analyze differences in health behaviors among the social strata in Korea by using the 1995 National Health and Health Behavior Survey Data. METHODS: Study participants numbered 2,352 men and 1,016 women aged between 15-64 years old, with housewives, students and non-waged family workers excluded. Health behaviors in this study were defined according to the recommendations of the Alameda 7 study. The measure of health behaviors was based on the Health Practices Index(HPI; 0-5 range, with the exclusion of snacking between meals and regularly eating breakfast) developed by the Alameda County research. The significance of the relationship between social strata and HPI was assessed by considering the adjusted means from the multi-variate model. RESULTS: For men, incidence rates of never having smoked, no/moderate use of alcohol, regular exercise, and regular 7-8 hours sleep per night were higher in the upper social strata. Meanwhile, for women, incidence rates of never having smoked, no/moderate use of alcohol, appropriate weight, regular exercise, and regular 7-8 hours sleep per night were higher in the upper strata. HPI varied significantly among social strata in both sexes (p<0.001), a result which held true when adjusted for age, education, income, social insurance type, marital status and region. CONCLUSIONS: Health behaviors assessed by Health Practices Index(HPI) varied significantly among social strata for both sexes. Therefore, the existing gap in health behaviors among social strata can be corrected more effectively by target oriented health promotional activities.; Summary

Asbestos and Non-Asbestos Fiber Content in Lungs of Autopsied Subjects in Pohang with no Known History of Occupational Asbestos Exposure.: Hyun Sul Lim, Ji Yong Kim, Dong Hoon Kim, Kiyoshi Sakai, Naomi Hisanaga; Korean J Prev Med. 2000;33(4):477-483.

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To obtain reference values for the pulmonary asbestos and non-asbestos fiber contents of residents in Korea and to compare them with similar results from Japan. METHODS: The autopsied lung specimens from 22 deceased people (20 males and 2 females) in Pohang, without any known occupational history of asbestos exposure, were analyzed for incidence of asbestos and non-asbestos fibers by transmission electron microscopy with energy dispersive X-ray analysis after using low temperature ashing procedures. RESULTS: Chrysotile fiber (46.2%) was the major fiber type found in the lungs of the subjects. The asbestos fiber concentrations found in males and females were 0.09x106 fibers/(g of dry lungs) and 0.30x106 fibers/(g of dry lungs), respectively, showing a geometric mean concentration 0.09x106 fibers/(g of dry lung tissue), due to the predominance of males in the sample. The non-asbestos fiber contents in males and females were 4.61x106 fibers/(g of dry lungs) and 17.79x106 fibers/(g of dry lungs), respectively, with a geometric mean concentration 5.21x106 fibers/(g of dry lung tissue). CONCLUSIONS: Residents in Pohang had significantly lower levels of both asbestos and non-asbestos fibers than urban residents in Korea. Furthermore, Koreans had significantly lower levels of both asbestos and non-asbestos fibers than Japanese.; Summary

Cost-benefit Analysis of Mandatory Prescription in Korea.: Young Keon Jee, Han Joong Kim, Eun Cheol Park, Hye Young Kang; Korean J Prev Med. 2000;33(4):484-494.

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Abstract PDF: OBJECTIVE
To evaluate the relative benefits and the costs associated with the introduction of the new pharmaceutical provision called 'Mandatory Prescription Syste m' which separates the role of physicians from that of pharmacists with respect to the prescription and dispensation of from the perspective of consumers (i.e., patients). METHODS: The costs of the system were measured by considering both direct and indirect costs. Direct costs included additional payments for ambulatory care and dispensing fees that occurred under the new system. Indirect costs consisted of transportation expenses and costs related to time spent for physician consultation, waiting for the prescriptions to be filled, and extra traveling. Benefits identified in this study were the reduction of drug misuse and overuse, and the overall decrease in drug consumption among the Korean population. Sensitivity analysis was performed for the inclusion of benefits for outpatients of hospitals, price elasticity, and increased fees for established patients. RESULTS: The net benefit was estimated to be about minus 1,862 billion won and the benefit-cost ratio was 0.478. This indicates that the costs of 'Mandatory Prescription' outweigh its benefits, relative to the previous system. The sensitivity analysis results for all the variables considered in this study consistently showed the benefit-cost ratio to be less than 1. CONCLUSION: The results of this study suggest that implementing Mandatory Prescription System in Korea might be inefficient from the consumer's perspective. The results of this study do not coincide with the results of previous studies, presumably because of the differences in study design and in which items of costs and benefits were considered.; Summary

Dimensions of Consumer Ratings of a Hospital Outpatient Service Quality.: Ki Tae Moon, Seung Hum Yu, Woo Hyun Cho, Dong Kee Kim, Yunwhan Lee; Korean J Prev Med. 2000;33(4):495-504.

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Abstract PDF: OBJECTIVES
To examine various dimensions of consumer ratings of health care service with factor analysis and to find which factors influence the overall quality of health care service. METHODS: A cross-sectional study was conducted on outpatients of a general hospital located in Sungnam City. A self-administered questionnaire was used to assess the consumer? ratings of health care service received. The response rate was 92.8% with a total of 537 persons completing the questionnaire. Factor analysis was performed on 34 items evaluating the quality of health care service. Items were grouped into 5 dimensions as a result of factor analysis and the reliability and validity of influence on patient service assessment were evaluated for each dimension. RESULTS: The 5 dimensions were as follows ; 1) physician services, 2) non-physician services, 3) process 4) facilities, and 5) cleanliness. A positive correlation with the quality of health care service was found for the dimensions of non-physician services and process, while no significant correlation was found for the dimensions of physician services, facilities, and cleanliness. CONCLUSIONS: The result of this study may provide basic information for the development of future self-administered questionnaires of consumer ratings and for the evaluation of quality improvement activities in hospital outpatient settings.; Summary

Analysis of Pap Smear Results over Twenty Year Period, 1979-1998.: Ji Won Han, Jin Ho Chun, Dae Hoon Jeong, Ki Tae Kim, Hye Kyoung Yoon; Korean J Prev Med. 2000;33(4):505-512.

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To estimate the significance of the Pap smear as a screening tool for cervical cancer. METHODS: A total of 79,840 Pap smear results performed at Pusan Paik Hospital over the 20 year period from 1979 to 1998 were collected and analyzed. RESULTS: The number of Pap smear cases increased markedly during this period, and the results as a whole were classified as consisting of 96.4% normal and benign cytology, 2.2% pre-cancerous cytology, and 1.4% cervical cancer. The relative frequency of cervical cancer decreased from 1.6% in 1979 to 0.7% in 1998. About 64% of the Pap smears were distributed within the age range of 30 to 49 years, and the rate of cervical cancer increased with age, age of marriage and experience of childbirth (p<0.01). The overall agreement of Pap smear results with histologic diagnosis by one histologic degree was 92.7%(1,128/1,217) with 73 overestimated cases and 16 underestimated cases of Pap smear compared to histologic diagnosis. CONCLUSION: This result implies that the Pap smear is an excellent screening tool for cervical cancer with respect to both its scale and validity. Periodic and active Pap smear testing would be helpful for the secondary prevention of cervical cancer.; Summary

The Prevalence, Awareness, Treatment, and Control of Hypertension, and Related Factors in Rural Korea.: Yong Chan Ha, Hyun Ju Chun, Hae Kyoung Hwang, Byung Sung Kim, Jang Rak Kim; Korean J Prev Med. 2000;33(4):513-520.

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Abstract PDF: OBJECTIVES
To estimate the prevalence of hypertension, rates of awareness, treatment modalities, and control of hypertension, and also to identify factors in rural Korea that are related to these aspects of hypertension. METHODS: A cross-sectional survey, including blood pressure(BP) measurements and interviews, investigating the variables in the health belief model was performed from August to November, 1999 on 1,426 (79.4%) study subjects out of 1,797 registered residents over 30 years old in Ibansong-Myun, Chinju City. A second survey was performed from January to March, 2000 on 376 (80.0%) subjects out of 470 hypertensive (or suspected hypertensive) subjects found in the first survey. Two BP readings were taken in each survey using a standard mercury sphygmomanometer. Hypertension was defined as either a BP reading < 140/90 mmHg in both surveys, or as subjects on oral hypertensive medication. RESULTS: Estimated hypertension prevalence was 24.9% for men, and 30.4% for women. Rates of hypertension awareness, treatment (the regular use of oral hypertensives), and control (reduction of BP to <140/90 mmHg) were 52.5%, 34.4%, and 12.9%, respectively. The factors related to lower hypertension awareness in the logistic regression analysis were male gender, farming occupation, and higher perceived barrier to medical treatment (those for whom visiting health professionals is a burden). CONCLUSIONS: To improve the low awareness, treatment, and control of hypertension, a more active and out-reaching hypertension control program, including routine BP measurements for every visitor to primary care facilities, is needed in rural Korea.; Summary

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