Journal of Preventive Medicine and Public Health

Original Articles

Evaluation of the Public Health Emergency Response to the COVID-19 Pandemic in Daegu, Korea During the First Half of 2020: Hwajin Lee, Keon-Yeop Kim, Jong-Yeon Kim, Sin Kam, Kyeong Soo Lee, Jung Jeung Lee, Nam Soo Hong, Tae-Yoon Hwang; J Prev Med Public Health. 2022;55(4):360-370. Published online June 22, 2022; DOI: https://doi.org/10.3961/jpmph.22.068

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Objectives
This study evaluated the response in Daegu, Korea to the first wave of the coronavirus disease 2019 (COVID-19) pandemic according to a public health emergency response model.
Methods
After an examination of the official data reported by the city of Daegu and the Korea Centers for Disease Control and Prevention, as well as a literature review and advisory meetings, we chose a response model. Daegu’s responses were organized into 4 phases and evaluated by applying the response model.
Results
In phase 1, efforts were made to block further transmission of the virus through preemptive testing of a religious group. In phase 2, efforts were concentrated on responding to mass infections in high-risk facilities. Phase 3 involved a transition from a high-intensity social distancing campaign to a citizen participation–based quarantine system. The evaluation using the response model revealed insufficient systematic preparation for a medical surge. In addition, an incorporated health-related management system and protection measures for responders were absent. Nevertheless, the city encouraged the participation of private hospitals and developed a severity classification system. Citizens also played active roles in the pandemic response by practicing social distancing.
Conclusions
This study employed the response model to evaluate the early response in Daegu to the COVID-19 pandemic and revealed areas in need of improvement or maintenance. Based on the study results, creation of a systematic model is necessary to prepare for and respond to future public health emergencies like the COVID-19 pandemic.

Summary

Korean summary
이 연구는 공중보건 위기대응 모형을 적용하여 코로나19 1차 유행에 대한 대구시의 대응을 평가하였습니다. 모형의 세부적 요소인 15개 역량에 따른 평가 결과, 대구의 대응에서 개선 또는 유지해야 할 영역들이 확인되었습니다. 이 결과를 바탕으로, 한국형 공중보건 위기대응 모형을 체계적으로 구축해야 할 것입니다.

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Factors influencing psychological concerns about COVID-19 in South Korea: direct and indirect damage during the early stages of pandemic
Min-sung Kim, Sung-il Cho
BMC Public Health.2024;[Epub] CrossRef
Estimation of the Effectiveness of a Tighter, Reinforced Quarantine for the Coronavirus Disease 2019 (COVID-19) Outbreak: Analysis of the Third Wave in South Korea
Marn Joon Park, Ji Ho Choi, Jae Hoon Cho
Journal of Personalized Medicine.2023; 13(3): 402. CrossRef

Association Between Atrial Fibrillation and the Risk of Dementia in the Korean Elderly: A 10-Year Nationwide Cohort Study: Min-Ah Nah, Kyeong Soo Lee, Tae-Yoon Hwang; J Prev Med Public Health. 2020;53(1):56-63. Published online January 3, 2020; DOI: https://doi.org/10.3961/jpmph.19.117

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Objectives
The objective of this study was to determine the effect of atrial fibrillation (AF) on the risk of dementia in the Korean elderly.
Methods
A 10-year retrospective cohort study was conducted using the National Health Insurance Service-Senior Cohort database. We excluded those who were under 65 years of age as of January 2006 (n=46 113), those who were diagnosed with dementia between 2002 and 2005 (n=9086), and those with a history of stroke prior to AF diagnosis (n=8392). We used a Cox proportional hazards model with a time-varying covariate to determine whether AF is associated with the risk of dementia after adjusting for potential confounders.
Results
In univariable Cox regression, the hazard ratio (HR) of dementia according to AF status was 1.28 (95% confidence interval [CI], 1.23 to 1.33). After adjusting for potential confounders, AF was found to increase the risk of dementia (HR, 1.12; 95% CI, 1.07 to 1.17), Alzheimer dementia (HR, 1.12; 95% CI, 1.07 to 1.17), and vascular dementia (HR, 1.10; 95% CI, 1.03 to 1.18). In patients diagnosed with AF, the incidence of dementia was lower (HR, 0.50; 95% CI, 0.47 to 0.52) in patients who were treated with oral anticoagulants.
Conclusions
Investigating the potential risk factors of dementia in an aged society is important. We found a slightly higher risk of dementia in those with AF than in those without AF, and we therefore concluded that AF is a potential risk factor for dementia.

Summary

Korean summary
본 연구에서는 국민건강보험공단 노인표본코호트 자료를 사용하여 심방세동의 유무가 치매의 발생위험과 연관되어 있는지 분석하였다. 잠재적인 교란변수들을 통제하여 분석한 결과 심방세동은 치매(HR 1.12, 95% CI 1.07 to 1.17), 알츠하이머 치매(HR 1.12, 95% CI 1.07 to 1.17), 혈관성 치매(HR 1.10, 95% CI 1.03 to 1.18) 발생과 연관되어 있는 것으로 나타났다. 한 편, 심방세동 환자에서의 항응고제 복용은 치매 발생위험(HR 0.50, 95% CI 0.47 to 0.52)을 감소시키는 것으로 나타났다.

Citations

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Effects of risk factors on the development and mortality of early- and late-onset dementia: an 11-year longitudinal nationwide population-based cohort study in South Korea
Min Young Chun, Wonjeong Chae, Sang Won Seo, Hyemin Jang, Jihwan Yun, Duk L. Na, Dongwoo Kang, Jungkuk Lee, Dustin B. Hammers, Liana G. Apostolova, Sung-In Jang, Hee Jin Kim
Alzheimer's Research & Therapy.2024;[Epub] CrossRef
Progressive Memory Decline in a Patient With Atrial Septal Defect: Case Report and Literature Review
Yaw Amo Wiafe, Gordon Manu Amponsah, George Asafu Adjaye Frimpong, Isaac Kofi Owusu
Clinical Medicine Insights: Case Reports.2023; 16: 117954762311767. CrossRef
FIBRILAÇÃO ATRIAL E DEMÊNCIA VASCULAR: UMA REVISÃO INTEGRATIVA DA LITERATURA
Caroline Melo de Sousa, Milena Nunes Alves Sousa, Fabrício Kleber de Lucena Carvalho
Revista Contemporânea.2022; 2(3): 739. CrossRef
A systematic review and meta‐analysis to determine the effect of oral anticoagulants on incidence of dementia in patients with atrial fibrillation
Mingjie Lin, Wenqiang Han, Jingquan Zhong, Lin Wu
International Journal of Clinical Practice.2021;[Epub] CrossRef
Risk of dementia in patients with atrial fibrillation: Short versus long follow‐up. A systematic review and meta‐analysis
Marco Zuin, Loris Roncon, Angelina Passaro, Cristina Bosi, Carlo Cervellati, Giovanni Zuliani
International Journal of Geriatric Psychiatry.2021; 36(10): 1488. CrossRef
Clinical Utility of the Pathogenesis-Related Proteins in Alzheimer’s Disease
Bin Zhou, Masanori Fukushima
International Journal of Molecular Sciences.2020; 21(22): 8661. CrossRef

A Survival Analysis of Gastric or Colorectal Cancer Patients Treated With Surgery: Comparison of Capital and a Non-capital City: Nam-Soo Hong, Kyeong Soo Lee, Sin Kam, Gyu Seog Choi, Oh Kyoung Kwon, Dong Hee Ryu, Sang Won Kim; J Prev Med Public Health. 2017;50(5):283-293. Published online July 3, 2017; DOI: https://doi.org/10.3961/jpmph.17.043

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Objectives
The objective of the present study was to compare prognosis of patients with gastric or colorectal cancer according to places where they received surgeries. Methods: The cancer patients underwent surgeries in sampled hospitals located in Daegu were matched 1:1 to the patients who visited sampled hospitals in Seoul using propensity score method. After the occurrences of death were examined, Kaplan-Meier method was used for survival analysis and the log-rank test was performed to compare the survival curves. Results: A total of six out of 291 gastric cancer patients who had surgeries in Daegu died (2.1%) and ten deaths (3.4%) occurred from patients went Seoul hospitals. Out of 84 gastric cancer patients who had chemotherapy after surgeries in Daegu, 13 (15.5%) patients died while 18 (21.4%) deaths occurred among patients underwent surgeries in Seoul. Six deaths (6.9%) out of 87 colorectal cancer patients who had surgeries in Daegu were reported. Five patients (5.7%) died among the patients underwent surgeries in Seoul. Among the colorectal cancer patients with chemotherapy after surgeries, 13 patients (12.4%) who visited hospitals in Daegu and 14 (13.3%) patients who used medical centers in Seoul died. There were no significant differences according to places where patients used medical services. Conclusions: The result of this study is expected to be used as basic data for policy making to resolve centralization problem of cancer patients and to help patients to make rational choices in selection of medical centers.

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Domestic medical travel from non-Seoul regions to Seoul for initial breast cancer treatment: a nationwide cohort study
Jae Ho Jeong, Jinhong Jung, Hee Jeong Kim, Jong Won Lee, Beom-Seok Ko, Byung Ho Son, Kyung Hae Jung, Il Yong Chung
Annals of Surgical Treatment and Research.2023; 104(2): 71. CrossRef
MCR1 and KPC2 Co-producing Klebsiella pneumoniae Bacteremia: First Case in Korea
Ji Young Park, Sang Taek Heo, Ki Tae Kwon, Do Young Song, Kwang Jun Lee, Ji Ae Choi
Infection & Chemotherapy.2019; 51(4): 399. CrossRef
The Effect of Residential Area and Hospital Bed Size on the Use of Hospital in Other Regions for Cancer Inpatients
Sung-Soo Kim
Journal of Health Informatics and Statistics.2018; 43(1): 18. CrossRef

English Abstracts

Apolipoprotein E Polymorphism and Cognitive Function Change of the Elderly in a Rural Area, Korea.: Sang Kyu Kim, Tae Yoon Hwang, Kyeong Soo Lee, Pock Soo Kang, Hee Soon Cho, Young Kyung Bae; J Prev Med Public Health. 2009;42(4):261-266.; DOI: https://doi.org/10.3961/jpmph.2009.42.4.261

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OBJECTIVES
The aim of this study is to examine the cognitive function change related to aging, the incidence of cognitive impairment, and the association between apolipoprotein E polymorphism and cognitive impairment through a follow-up of the elderly with normal cognitive ability at baseline. METHODS: Two hundred and fifteen subjects aged 65 and over were surveyed in February, 1998 (baseline survey), and their cognitive function was assessed again in 2003 (1st follow-up) and the once again in 2006 (2nd follow-up). Ninety one subjects completed all surveys up through the 2nd follow-up and their cognitive function scores using MMSE-K (Korean Version of the Mini-Mental State Examination) and the distribution of apolipoprotein E allele were analyzed. RESULTS: The cognitive function scores decreased with aging and the difference between baseline and the 2nd follow-up scores of the study increased with the age group. The incidence rate of cognitive impairment through an 8-year follow-up was 38.5% and higher in older age groups. Age was the only significant factor for incidence of cognitive impairment, but there was no significant association between apolipoprotein E genotype and incidence of cognitive impairment. CONCLUSIONS: The cognition of the elderly decreased with aging and the association of apolipoprotein E genotype with incidence of cognitive impairment was not significant in this study. To confirm the association between apolipoprotein E polymorphism and incidence of cognitive impairment further studies will be needed.

Summary

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ApoE Type 4 Allele Affects Cognitive Function of Aged Population in Tianjin City, China
Shoudan Sun, Jingming Fu, Jun Chen, Wei Pang, Ruomei Hu, Haiqiang Li, Long Tan, Yugang Jiang
American Journal of Alzheimer's Disease & Other Dementiasr.2015; 30(5): 503. CrossRef

Change of Cognitive Function and Associated Factors among the Rural Elderly: A 5-Year Follow-up Study.: Sang Kyu Kim, Pock Soo Kang, Tae Yoon Hwang, Joon Sakong, Kyeong Soo Lee; J Prev Med Public Health. 2007;40(2):162-168.; DOI: https://doi.org/10.3961/jpmph.2007.40.2.162

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Abstract PDF

OBJECTIVES
This prospective population-based cohort study was conducted to evaluate the risk factors of cognitive impairment and the degree of cognitive function change through a 5-year follow-up. METHODS: The baseline and follow-up surveys were conducted in 1998 and 2003, respectively. Among 176 subjects who had normal cognitive function in the baseline study, 136 were followed up for 5 years. The cognitive function was investigated using the Korean version of the Mini-Mental State Examination (MMSE-K). The collected data were analyzed using SPSS and Stata. RESULTS: Of the 136 subjects analyzed, 25 (18.4%) were cognitively impaired. Old age and low social support in the baseline survey were risk factors for cognitive impairment after 5 years. In the generalized estimating equation for 128 subjects except severe cognitive impairment about the contributing factors of cognitive function change, the interval of 5 years decreased MMSE-K score by 1.02 and the cognitive function was adversely affected with increasing age, decreasing education and decreasing social support. CONCLUSIONS: Although the study population was small, it was considered that the study results can be used to develop a community-based prevention system for cognitive impairment.

Summary

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Status of Physical and Mental Function and, Its Related Factors Among the Elderly People Using from Long-Term Care Insurance Service
Nam-Kyou Bae, Young-Soo Song, Eun-Sook Shin, Young-Chae Cho
Journal of the Korea Academia-Industrial cooperation Society.2012; 13(12): 5976. CrossRef
Toxicities and functional consequences of systemic chemotherapy in elderly Korean patients with cancer: A prospective cohort study using Comprehensive Geriatric Assessment
Dong-Yeop Shin, Jeong-Ok Lee, Yu Jung Kim, Myung-Sook Park, Keun-Wook Lee, Kwang-Il Kim, Soo-Mee Bang, Jong Seok Lee, Cheol-Ho Kim, Jee Hyun Kim
Journal of Geriatric Oncology.2012; 3(4): 359. CrossRef
Apolipoprotein E Polymorphism and Cognitive Function Change of the Elderly in a Rural Area, Korea
Sang-Kyu Kim, Tae-Yoon Hwang, Kyeong-Soo Lee, Pock-Soo Kang, Hee-Soon Cho, Young-Kyung Bae
Journal of Preventive Medicine and Public Health.2009; 42(4): 261. CrossRef

Original Articles

Prevalence and Related Factors of Knee Osteoarthritis in Rural Woman.: Sung Ho Yun, Pock Soo Kang, Seok Beom Kim, Kyeong Soo Lee; Korean J Prev Med. 2001;34(4):331-336.

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Abstract PDF: OBJECTIVES
To assess the prevalence of knee osteoarthritis through proper diagnosis in a rural community and to elucidate the relevant factors of this health problem in order to develop educational methods for the prevention of female knee osteoarthritis as well to provide basic data for prospective research. METHODS: Over a period of three months starting from August, 2000, 432 women over the age of 40 and living in a rural area were selected by a multistage cluster sampling method in order to investigate the prevalence of knee osteoarthritis and the related factors. The study utilized interviews and radiological examination. The criteria of knee osteoarthritis used was the American College of Rheumatology classification criteria for osteoarthritis of the knee(1995). RESULTS: The adjusted prevalence of knee osteoarthritis among the subjects was 55.0%, and multiple logistic regression analysis showed that the odds ratio(OR) of knee osteoarthritis among subjects 50-59 years of age and subjects older than 60 years of age as compared to subjects 40-49 years of age were 2.43(95% CI: 1.30-4.70) and 4.40(95% CI: 2.47-7.83), respectively. The OR of knee osteoarthritis among factory workers or farmers as compared to others was 1.79(95% CI: 1.03-3.12). The OR of knee osteoarthritis among subjects who had a family history and subjects who had knee injury or surgical history against those subjects had neither were 2.56(95% CI: 1.42-4.63) and 4.70(95% CI:1.45-15.19), respectively. The OR of knee osteoarthritis among smokers against non smokers was 0.47(95% CI: 0.22-0.97). CONCLUSIONS: Related factors of knee osteoarthritis included age, occupation, family history, smoking, knee injury and history of surgery. In order to prevent knee osteoarthritis in high risked rural woman, education concerning self-care methods and safety guideline must be provided at the work place by the public and private health sectors. Additionally, these women should be continually encouraged to exercise, including jogging and swimming regularly.; Summary

The Patient Recognition, Acceptability and Evaluation of Feasibility for Day Surgery.: Young Ah Kang, Young Ran Beak, Kyeong Soo Lee, Seok Beom Kim, Pock Soo Kang; Korean J Prev Med. 2000;33(3):334-342.

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Abstract PDF: OBJECTIVES
This study was conducted in order to investigate the degree of recognition, acceptability, and attitude towards day surgery of patients who were hospitalized with diseases that were candidates for day surgery; in order to analyze the average length of stay for treatment of the ailments; and to analyze the percentage of patients who could be discharged on the same day after the surgery using the post-anesthesia discharge scoring system. METHODS: Data was collected between February 1 and March 31, 1999 from 353 patients who received surgery for cataract, adenoid hypertrophy, inguinal hernia, strabismus, ptosis, cholelithiasis, hemorrhoid, or anal fistula, at a general hospital in Daegu city. The patients were interviewed and surveyed by a post-anesthesia discharge scoring system(PADS) in order to collect data on patient condition such as vital signs, activity and mental status, pain, nausea and vomiting, surgical bleeding, intake and output after the surgery. RESULTS: Among the 353 patients, 52.7% were awar of the day surgery and 52.1% were interested in day surgery. Of the respondents, 43.1% said 'my ailment was not serious and the surgery was simple' and 30.4% said 'according to my condition rest at home was desirable' as the reasons for wanting day surgery Alternatively, 56.5% of those declining day surgery said the 'uncertainty of staying home' was the reason. The greatest concern in discharging within 24 hours after surgery was a post-op emergency situation. On the other hand, the shortened hospitalization was the largest advantage of day surgery with 39.1% responding this way, followed by the savings in hospitalization costs (25.8%) and emotional stability (13.7%). The majority of those surveyed (47.6%) believed that discharge should be determined within 1-2 days after the surgery. The average hospital stay was 3.1 days for dischargeable ailments. Pain (45.6%), nausea and vomiting (10.5%), and headache (7.9%) were the common symptoms following surgery. The percentage of patients who were able to be discharged within 24 hours after surgery revealed 95.2% were dischargeable after approximately 3 hours, 99.2% dischargeable after 12 hours, and 100% dischargeable atter 24 hours. CONCLUSIONS: According to the PADS score, the cataract extract and strabismus correction patients were eligible for day surgery and the further evaluation concerning the reason for delayed recovery of the other diseases is needed.; Summary

Community-based Helicobacter pylori Screening and its Effects on Eradication in Patients with Dyspepsia.: Seong Ho Kim, Dae Yong Hong, Pock Soo Kang, Seok Beom Kim, Kyeong Soo Lee, Sang Kyu Kim, Jeong Ill Suh, Mee Kyung Kim; Korean J Prev Med. 2000;33(3):285-298.

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Abstract PDF: CONCLUSIONS: To investigate the positive rate of Helicobacter pylori in patients with dyspepsia; medical compliance and related factors; the eradication rate a year after screening and related factors; the relationship between the eradication of Helicobacter pylori and the improvement of symptoms; and the estimated cost of three alternative approaches to treat Helicobacter pylori in the community. METHODS: A total of 510 subjects with dyspeptic symptoms were selected and given the serological test in March 1998. The subjects were all adults over 30 years of age residing in Kyongju city. RESULTS: Of the 510 selected subjects, 375 (73.5%) subjects proved positive for Helicobacter pylori on serological testing. Of these 304 (81.1%) who consented to an endoscopic examination, underwent a Campylobacter-like organism (CLO) test. Of these 304 subjects, 204 (67.1%), who had positive CLO test results, were given the triple therapy - tripotassium dicitrato bismuthate, amoxicillin, and metronidazole. To determine the eradication rate of Helicobacter pylori, 181 (88.7%) out of the 204 subjects who were given the triple therapy completed a follow-up urea breath test one year later. Of these, the Helicobacter pylori of 87(48.1%) subjects was eradicated. Among the 122 subjects who were medication compliant, the Helicobacter pylori eradication rate was 57.4% (70 subjects), while the eradication rates was only 28.8% (17subjects) in the non-compliant group. The Helicobacter pylori eradication was significantly related to compliance (p<0.01), but not to other characteristics and habits. The symptom improvement rate tended to be higher 62.1%), in the Helicobacter pylori eradicated group than in the non-eradicated group (59.6%). CONCLUSIONS: When the advantages and disadvantages of each alternative treatment were considered in the light of cost, antibiotic tolerance and the number of patients to be treated, alternative II was favorable in terms of cost. Alternative III was favorable in terms of the number of patients to be treated, antibiotic tolerance and early detection of gastric cancer. Further long-term research analyzing the cost-benefit and cost-effectiveness of each treatment will be needed as supporting material in creating new policies.; 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

Factors Influencing Compliance with Anti-Tuberculosis Therapy.: Cheon Tae Kim, Kyeong Soo Lee, Pock Soo Kang; Korean J Prev Med. 1996;29(1):79-90.

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Abstract PDF: The purpose of the study was to determine factors influencing compliance with anti-tuberculosis therapy. The study subjects were 104 tuberculosis patients who have received the initial treatment in 3 health centers of Kyongju-city, Dalseong-Gun in Teagu and Kumi-city. Data were collected between september and october 1995. The patients were classified into the improved group and the non-improved group according to outcomes of 3 month treatment with short-term therapeutic regimen. To find factors influencing compliance with anti-tuberculosis therapy, multiple logistic regression was made. There was no significant differences between the improved group and the non-improved group in sex, age, education level, occupation, family pattern, and habitual change regarding smoking and drinking. The level of knowledge about anti-tuberculosis therapy in the improved group was significantly higher than the non-improved group(p<0.01). Multiple logistic regression analysis revealed that family support for not forgetting medication(p<0.05) was a predictor of improvement and knowledge about anti-tuberculosis therapy (p=0.054), regularity of medication(p=0.062), and consultation to family, doctor and nurse(p=0.075)were marginal predictors of improvement. Treatment must be given to every patient confirmed as having tuberculosis and must be given free of charge to the patients. The requirements for adequate chemotherapy are prescribed in the correct dosage and taken regularly by the patient for a sufficient period to prevent relapse of the disease after cure. It is suggested that education to the patients should be reinforced and connectedness between patients and tuberculosis control workers and family should be solidated.; Summary

A Comparative Study on the Pattern of Outpatient Department Utilization at a Tertiary Level Hospital before and after Implementation of the Patient Referral System.: Kyeong Soo Lee, Chang Yoon Kim, Pock Soo Kang; Korean J Prev Med. 1992;25(1):88-100.

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Abstract PDF: This study was conducted to assess the effects of implementation of the patient referral system started July 1st, 1989. A comparison on the pattern of outpatient services of the Departments of Internal Medicine, General Surgery, and Pediatrics at the Yeungnam University Hospital was conducted for each one year period before and after implementation of the patient referral system. The pre-implementation period was from July 1. 1988 to June 30, 1989 and the post-implementation period was from July 1. 1989 to June 30, 1990. The information used for this study was obtained from official forms, prepared by the Yeungnam University Hospital, and submitted to the Korean Medical Insurance Cooperatives. After implementation of the patient referral system, the number of outpatient cases in the Department of Internal Medicine decreased 36.1% from 9,669 cases to 6,181 cases a year. Cases in the Department of General Surgery decreased 23.7% from 1,864 cases to 1,422 cases a year. The number of cases in the Department of General Surgery decreased 23.7% from 1,864 cases to 1,422 cases a year. The number of cases in the Department of Pediatrics decreased 36.9% from 3,372 cases to 2,128 cases a year. After implementation of the patient referral system, the average age of cases in the Departments of Internal Medicine and General Surgery was 52.5 and 49.7 years old, respcetively. This was a significant increase in comparison with the pre-implementation period. After implementation of patient referral system, the proportion of new outpatients in the Department of Internal Medicine decreased form 24.1% to 14.6%, the Department of General Surgery from 36.0% to 23.4%, and the Department of Pediatrics from 15.5% to 8.3%. The number of visits per case decreased significantly in the Department of Internal Medicine(from 1.74 to 1.61), but there was no significant change in the Department of General Surgery and Pediatrics. The length of treatment per case increased significantly in all three departments (form 16.1 days to 19.3 days in the Department of Internal Medicine, from 12.0 days to 15.2 days in the Department General Surgery, and 8.9 days to 11.2 days in the Department of Pediatrics). The number of clinical tests per case increased significantly in the Department of Internal Medicine (from 22. to 2.5), in the Department of Pediatrics(from 0.8 to 1.1) and increased in the Department of General Surgery(from 6.4 to 6.6). The average medical cost per case decreased form 43,900 Won to 42,500 Won in the Department of Internal Medicine, while the cost increased from 75,900 Won to 78,500 Won in the Department of General Surgery and from 12,700 Won to 13,500 Won in the Department of Pediatrics. In case-mix, the chronic degenerative disease(i. e. hypertension, diabetes mellitus, angina pectoris, malignant neoplasm, and pulmonary tuberculosis) ranked higher and acute infectious diseases and simple cases(i. e. gastritis and duodenitis, haemorrhoids, anal fissure, carbuncle, acute URI, and bronchitis) ranked lower after implementation of the patient referral system compared to before implementation.; Summary

English Abstract

Effects of the Personal Stereo System on Hearing in Adolescents.: Jong Seo Park, Sean Hee Oh, Pock Soo Kang, Chang Yoon Kim, Kyeong Soo Lee, Tae Yoon Hwang, Joon Sakong; J Prev Med Public Health. 2006;39(2):159-164.

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Abstract PDF: OBJECTIVES
This study was conducted to evaluate the effects of the personal stereo system on the hearing in adolescents. METHODS: A total of 68 adolescents(age: 13-18 years) who visited the ENT Department at a University Hospital in Daegu were personally interviewed. The questionnaires were about general characteristics of the subjects, the time of personal stereo system use(year, hour) and place. Cumulative exposure to the personal stereo system was calculated by the product of the total years and the daily hours of their use. Pure tone audiometry was performed and the hearing threshold was measured at 500, 1000, 2000, 4000 and 8000 Hz. RESULTS: The average time of using a personal stereo system a day was about 3 hours and 75% of the subjects used a personal stereo system for 2-5 years. The elevation of threshold was more prominent in the subjects who used personal stereo systems for 4 years and more compared with those subjects who used them for 3 years and under. The elevation of hearing threshold was also more prominent in the subjects who used personal stereo systems for 4 hours and more a day compared with those subjects who used personal stereo systems for 3 hours and under a day. The elevation of hearing threshold was more prominent in the subjects who used personal stereo systems for 13 hour..years and more compared to the subjects who used them 12 hour..years and under. CONCLUSIONS: These results suggest that the elevation of hearing threshold can happen to adolescents who used personal stereo systems for a long time. In order to prevent hearing loss, we need to teach adolescents appropriate usage of the personal stereo system and hearing tests should be included in the periodic school-based physical examination for the adolescents.; Summary

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