Journal of Preventive Medicine and Public Health

Original Articles

Medical Care Expenditure in Suicides From Non-illness-related Causes: Jungwoo Sohn, Jaelim Cho, Ki Tae Moon, Mina Suh, Kyoung Hwa Ha, Changsoo Kim, Dong Chun Shin, Sang Hyuk Jung; J Prev Med Public Health. 2014;47(6):327-335. Published online November 4, 2014; DOI: https://doi.org/10.3961/jpmph.14.038

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Objectives
Several epidemiological studies on medical care utilization prior to suicide have considered the motivation of suicide, but focused on the influence of physical illnesses. Medical care expenditure in suicide completers with non-illness-related causes has not been investigated.
Methods
Suicides motivated by non-illness-related factors were identified using the investigator’s note from the National Police Agency, which was then linked to the Health Insurance Review and Assessment data. We investigated the medical care expenditures of cases one year prior to committing suicide and conducted a case-control study using conditional logistic regression analysis after adjusting for age, gender, area of residence, and socioeconomic status.
Results
Among the 4515 suicides motivated by non-illness-related causes, medical care expenditures increased in only the last 3 months prior to suicide in the adolescent group. In the younger group, the proportion of total medical expenditure for external injuries was higher than that in the older groups. Conditional logistic regression analysis showed significant associations with being a suicide completer and having a rural residence, low socioeconomic status, and high medical care expenditure. After stratification into the four age groups, a significant positive association with medical care expenditures and being a suicide completer was found in the adolescent and young adult groups, but no significant results were found in the elderly groups for both men and women.
Conclusions
Younger adults who committed suicide motivated by non-illness-related causes had a higher proportion of external injuries and more medical care expenditures than their controls did. This reinforces the notion that suicide prevention strategies for young people with suicidal risk factors are needed.

Summary

Citations

Citations to this article as recorded by

Socioeconomic factors associated with suicidal behaviors in South Korea: systematic review on the current state of evidence
Nicolas Raschke, Amir Mohsenpour, Leona Aschentrup, Florian Fischer, Kamil J. Wrona
BMC Public Health.2022;[Epub] CrossRef
Impact of intergenerational support and medical expenditures on depression: Evidence from rural older adults in China
Congrong Li, Qing Han, Jinrong Hu, Zeyu Han, Hongjuan Yang
Frontiers in Public Health.2022;[Epub] CrossRef

Medical Care Utilization During 1 Year Prior to Death in Suicides Motivated by Physical Illnesses: Jaelim Cho, Won Joon Lee, Ki Tae Moon, Mina Suh, Jungwoo Sohn, Kyoung Hwa Ha, Changsoo Kim, Dong Chun Shin, Sang Hyuk Jung; J Prev Med Public Health. 2013;46(3):147-154. Published online May 31, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.3.147

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Abstract PDF

Objectives

Many epidemiological studies have suggested that a variety of medical illnesses are associated with suicide. Investigating the time-varying pattern of medical care utilization prior to death in suicides motivated by physical illnesses would be helpful for developing suicide prevention programs for patients with physical illnesses.

Methods

Suicides motivated by physical illnesses were identified by the investigator's note from the National Police Agency, which was linked to the data from the Health Insurance Review and Assessment. We investigated the time-varying patterns of medical care utilization during 1 year prior to suicide using repeated-measures data analysis after adjustment for age, gender, area of residence, and socioeconomic status.

Results

Among 1994 suicides for physical illness, 1893 (94.9%) suicides contacted any medical care services and 445 (22.3%) suicides contacted mental health care during 1 year prior to suicide. The number of medical care visits and individual medical expenditures increased as the date of suicide approached (p<0.001). The number of medical care visits for psychiatric disorders prior to suicide significantly increased only in 40- to 64-year-old men (p=0.002), women <40 years old (p=0.011) and women 40 to 64 years old (p=0.021) after adjustment for residence, socioeconomic status, and morbidity.

Conclusions

Most of the suicides motivated by physical illnesses contacted medical care during 1 year prior to suicide, but many of them did not undergo psychiatric evaluation. This underscores the need for programs to provide psychosocial support to patients with physical illnesses.

Summary

Citations

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Late-life suicide in an aging world
Diego De Leo
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Risk factors for suicidal behavior in older adults
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Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery).2022; (1): 18. CrossRef
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Quinn D. Kellerman, Narineh Hartoonian, Megan L. Beier, Steven L. Leipertz, Charles Maynard, Trisha A. Hostetter, Jodie K. Haselkorn, Aaron P. Turner
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Regina Praetorius, December Maxwell, Komal Alam
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Adaptation of evidence‐based suicide prevention strategies during and after the COVID‐19 pandemic
Danuta Wasserman, Miriam Iosue, Anika Wuestefeld, Vladimir Carli
World Psychiatry.2020; 19(3): 294. CrossRef
Contact with primary and mental health care prior to suicide: A systematic review of the literature from 2000 to 2017
Kim Stene-Larsen, Anne Reneflot
Scandinavian Journal of Public Health.2019; 47(1): 9. CrossRef
Use of prescription medication prior to suicide in Norway
Anne Reneflot, Silje L. Kaspersen, Lars Johan Hauge, Jorid Kalseth
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Use of primary healthcare services prior to suicide in Norway: a descriptive comparison of immigrants and the majority population
Carine Øien-Ødegaard, Anne Reneflot, Lars Johan Hauge
BMC Health Services Research.2019;[Epub] CrossRef
Clinical epidemiology of long-term suicide risk in a nationwide population-based cohort study in South Korea
Hyewon Lee, Woojae Myung, Chunsoo Lee, Junbae Choi, Ho Kim, Bernard J. Carroll, Doh Kwan Kim
Journal of Psychiatric Research.2018; 100: 47. CrossRef
Areas of uncertainties and unmet needs in bipolar disorders: clinical and research perspectives
Michael Bauer, Ole A Andreassen, John R Geddes, Lars Vedel Kessing, Ute Lewitzka, Thomas G Schulze, Eduard Vieta
The Lancet Psychiatry.2018; 5(11): 930. CrossRef
A study of people who attempted suicide referred to the emergency ward of Ali Ibn Abi Taleb hospital, Rafsanjan, Iran (2016)
Alireza Taherifard, Hassan Ahmadinia, Reza Vazirinejad, Zahra Javadi, Seyed Zia Tabatabaei, Mohsen Rezaeian
Journal of Occupational Health and Epidemiology.2018; 7(4): 201. CrossRef
Towards Actualizing the Value Potential of Korea Health Insurance Review and Assessment (HIRA) Data as a Resource for Health Research: Strengths, Limitations, Applications, and Strategies for Optimal Use of HIRA Data
Jee-Ae Kim, Seokjun Yoon, Log-Young Kim, Dong-Sook Kim
Journal of Korean Medical Science.2017; 32(5): 718. CrossRef
Effectiveness of Nursing Preventive Interventions in Suicide re- Attempts
B Ghanbari, SK Malakouti, M Nojomi, K Alavi, SH Khaleghparast, A Sohrabzadeh
Iran Journal of Nursing.2016; 29(99): 34. CrossRef

English Abstract

Effect of Sociodemographic Factors, Cancer, Psychiatric Disorder on Suicide: Gender and Age-specific Patterns.: Jae Young Park, Ki Tae Moon, Yoo Mi Chae, Sang Hyuk Jung; J Prev Med Public Health. 2008;41(1):51-60.; DOI: https://doi.org/10.3961/jpmph.2008.41.1.51

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Abstract PDF

OBJECTIVES
We examined the effect of sociodemographic factors, cancer, and psychiatric disorders on suicide by gender and age-specific patterns in South Korea. METHODS: The study is a case-control study. Claim data was obtained from the national health insurance database and national death registration database. The number of people who committed suicide was 11,523, which was matched with a control group consisting of ten times as many people at 115,230 selected from the national health insurance and medical aids beneficiaries. The medical utilization of the case group was one year before death and that of the control group was from July 1,2003 to June 30, 2004. Four variables-address, economic status, presence of a psychiatric disease, and cancer-were used in multiple logistic regression analyses. RESULTS: Living in cities or in rural areas showed a greater risk for suicide than living in a metropolitan city. Low economic status, the presence of a psychiatric disorder, and cancer were also statistically meaningful risk factors for suicide. The three major psychiatric diseases, schizophrenia, alcohol abuse, and bipolar disorder, were meaningful in all age groups, but the scale of the odds ratio differed by the age group. Only the psychiatric disorder variable was meaningful in the adolescent group, whereas a psychiatric disorder and economic status were meaningful for the young adult group, and all variables were meaningful for the middle-aged group. A psychiatric disorder and cancer were meaningful in the elderly group, economic status was meaningful for male subjects, and address was meaningful for female subjects. CONCLSIONS: Factors such as living in city or rural areas, low economic status, the presence of a psychiatric disorder, and cancer were statistically meaningful risk factors in suicide. These factors also differed by age group. Therefore, policymakers should establish policies for suicide prevention that are relevant for each age group.

Summary

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Landscape of Elderly Suicide in South Korea: Its Trend According to Age, Gender, and Educational Attainment
J. W. Kim, H. Y. Jung, D. Y. Won, Y. S. Shin, J. H. Noh, T. I. Kang
OMEGA - Journal of Death and Dying.2020; 82(2): 214. CrossRef
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Original Articles

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

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

Impacts of Implementation of Patient Referral System in terms of Medical Expenditures and Medical Utilization.: Sang Hyuk Jung, Han Joong Kim; Korean J Prev Med. 1995;28(1):207-224.

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Abstract PDF: A new medical delivery system which regulated outpatient department(OPD) use from tertiary care hospitals was adopted in 1989. Under the new system, patients using tertiary care hospital OPD without referral slip from clinics or hospital could not get any insuranced benefit for the services received from the tertiary care hospital. This study was conducted to evaluate the Patient Referral System(PRS) with respect to health care expenditures and utilization. Two data sets were used in this study. One was monthly data set(from January 1986 to December 1992)from the Annual Report of Korea Medical Insurance Corporation(KMIC). The other was monthly joint data set composed of personal data of which 10% were selected randomly with their utilization data of KMIC from January 1988 to December 1992. The data were analyzed by time-series intervention model of SAS-ETS. The results of this study were as follows: 1. There was no statistically significant changes in per capita expenditures following PRS. 2. Utilization episodes per capita was increased statistically significantly after implementation of PRS. The use of clinics and hospitals increased significantly, whereas in tertiary care hospitals the use decreased significantly immediately after implementation of PRS and increased afterwards. 3. Follow-up visits per episode were decreased statistically significantly after implementation of PRS. The decrease of follow-up visits per episode were remarkable in clinics and hospitals, whereas in tertiary care hospitals it was increased significantly after implementation of PRS. 4. There was no statistically significant changes in prescribing days per episode following PRS. Futhermore, clinics and hospitals showed a statistically significant decrease in prescribing days per episode, whereas in tertiary care hospital it shower statistically significant increase after implementation of PRS. 5. Except high income class, the use of tertiary care hospitals showed statistically significant decrease after implementation of PRS. The degree of decrease in the use of tertiary card hospitals was inversely proportional to income. These results suggest that the PRS policy was not efficient because per capita expenditures did not decrease, and was not effective because utilization episodes per capita, follow-up visits per episode, and prescribing days per episode were not predictable and failed to show proper utilization. It was somewhat positive that utilization episodes per capita were decreased temporarily in tertiary card hospitals. And PRS policy was not appropriate because utilization episodes per capita was different among income groups. In conclusion, the PRS should be revised for initial goal attainment of cost containment and proper health care utilization.; Summary

Geographical distribution of physician manpower by specialty and care level.: Seung Hum Yu, Sang Hyuk Jung, Byung Yool Cheon, Tae Yong Shn, Hyohn Joo Oh; Korean J Prev Med. 1993;26(4):661-671.

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Abstract PDF: In order to compare the geographical distribution of physician by level of medical care and specialty, a log linear model was applied to the annual registration data of the Korean Medical Association as of the end of December, 1991 which was supplemented from related institutions and adjusted with relevant sources. Those physicians in primary and secondary care institutions were not statistically significantly unevenly distributed by province-level catchment area. There were some differences in physician distribution among big cities, medium and small-sized cities, and counties; however, those physicians for primary care level were equitably distributed between cities and counties. Specialties for secondary care physicians were less evenly distributed in county areas than in city areas, and generalists are distributed more evenly in cities and counties than in big cities. There is a certain limitation due to underregistration in the annual physician registration to the Korean Medical Association; however, the geographical distribution of physicians has been improved quantitatively. It is strongly suggested that specialties and the level of medical care should be considered for further physician manpower studies.; Summary

The Projection of Medical Care Expenditure in View of Population Age Change.: Seung Hum Yu, Sang Hyuk Jung, Jeung Mo Nam, Hyohn Joo Oh; Korean J Prev Med. 1992;25(3):303-311.

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Abstract PDF: It is very important to estimate the future medical care expenditure, because medical care expenditure escalation is a big problem not only in the health industry but also in the Korean economy today. This study was designed to project the medical care expenditure in view of population age change. The data of this study were the population projection data based on National Census Data (1990) of the National Statistical Office and the Statistical Reports of the Korea Medical Insurance Corporation. The future medical care expenditure was eatimated by the regression model and the optional simulation model. The significant results are as follows; 1. The future medical care expenditure will be 3,963 billion Won in the year 2000, 4,483 billion Won in 2010, and 4,826 billion Won in 2020, based on the 1990 market price considering only the population age change. 2. The proportion of the total medical care expenditure in the elderly over 65 will be 10. 4% in 2000, 13.5% in 2010, and 16.9% in 2020. 3. The future medical care expenditure will be 4,306 billion Won in the year 2000, 5,1101 billion Won in 2010, and 5, 699 billion Won in 2020 based on the 1990 market price considering the age structure change and the change of the case-cost estimated by the regression model. 4. When we consider the age-structure change and inflation compared with the preceding year, the future medical care expenditurein 2020 will be 21 trillion Won based on a 5% inflation rate, 42 trillion Won based on a 7.5% inflation rate, and 84 trillion Won based on a 10% inflation rate. Consideration of the aged (65 years old and over)will be essential to understand the acute increase of medical care expenditure due to changes in age structure of the population. Therefore, alternative policies and programs for the caring of the aged should be further studied.; Summary

The study for recent changes of disease-mix in health insurance data.: Seung Hum Yu, Sang Hyuk Jung; Korean J Prev Med. 1990;23(3):345-357.

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Abstract PDF: Accumulated data on medical care utilization among the insured in Korea Medical Insurance Corporation can explain the health status of the population. The purpose of this study was to analyze a change of the disease-mix and utilization pattern by controlling the size of the population enrollment. Major findings of the study are as follows: 1. The changes of inpatient disease-mix a. Utilization rate was 139.2% in 1988 against 1980. b. Disease groups higher than the average utilization rate included neoplasms, endocrine, nutritional and metabolic diseases and immunity disorders, mental disorders etc. Meanwhile, disease groups seen less often were infections and parasistic diseases, diseases of bloodforming, diseases of the digestive system etc. c. Utilization rate was up 106.3% in 1988 compared to 1985, and diseases above that average level were ill-defined intestinal infections, chronic liver disease and cirrhosis, diabetes mellitus, essential hypertension, etc. d. The disease-mix by institution in 1988 compared to 1985 shows that chronic disorders rank high in general hospitals whereas opthalmologic, obstetric, and orthopedic diseases rank high in private clinics. 2. The changes of outpatient disease-mix a. Utilization rate was up 175.2% in 1988 compared to 1980. b. Disease groups higher than the average utilization rate included neoplasms, endocrine, nutritional and metabolic diseases and immunity disorders, mental disorders etc. And disease groups seen less often were infections and parasistic diseases, diseases of the respiratory system, diseases of the genitourinary system. etc. c. Utilization rate was up 104.0% in 1988 compared to 1985, and diseases above that average level were gastric ulcer, diseases of hard tissues of teeth, etc. And diseases seen below that average level were acute nasopharyngitis (common cold), acute upper respiratory infections of multiple or unspecified sites, etc. It was concluded that medical care utilization level was increased, and that, from 1980 to 1988, disease-mix shifted to the chronic disorders. Chronic disorders accounted for more medical care utilization in general hospitals.; Summary

Analysis of charges per case by hospital characteristics: In regard to acute appendicitis and NSVD.: Sang Hyuk Jung, Seung Hum Yu, Han Joong Kim; Korean J Prev Med. 1990;23(2):216-223.

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Abstract PDF: To identify the factors influencing the charges per case of acute appendicitis and normal spontaneous vaginal delivery (NSVD), the personal data-base files and hospital-characteristics-reporting data files of Korea Medical Insurance Corporation were analyzed. One hundred and twenty-nine institutions were selected. The results of this study were as follows: 1. The differences of charges per case with respect to hospital ownership, location, and equipment levels were statistically significant. 2. The results of multiple regression analysis revealed that bed capacity was the most significant variable in both diseases. 3. Ownership was significant variable in acute appendicitis. In NSVD, ownership and hospital equipment level were statistically significant. In conclusion, bed capacity was statistically the most significant variable in the analysis of charges per case. And we thought that the results of this study would influence the policy of the hospital bed supply.; Summary

Survival Analysis of Hospitalized Mesothelioma Patients.: Chun Bae Kim, Sang Hyuk Jung, Kyung Jong Lee, Jong Doo Kang; Korean J Prev Med. 1990;23(1):77-86.

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Abstract PDF: Between 1977 and 1987, 20 patients with mesothelioma were treated at Severance Hospital. Data was gathered from medical charts at the time of hospitalization of mesothelioma patients and from a follow-up questionnaire by mail or telephone. The results acquired were as follows: 1. Among the 20 patients, 11 men and 9 women with mesothelioma were identified. The mean age at hospitalization was 47 years and 11 mesothelioma patients were known or presumed to be dead during the different observation periods. 2. Only one mesothelioma patient had a definite history of occupational asbestos exposure. 3. The sites of orgin of mesothelioma were the pleura(13), peritoneum(2), pericardium(2), mediastinum(2), and pelvis(1). Common symptoms included dyspnea, chest pain, abdominal distension, etc. 4. Pathologically, mesotheliomas were divided into 14 malignant types and 6 benign types ; and histologically, 8 fibrous mesotheliomas and 3 epithelial mesotheliomas were shown. 5. There was a statistically significant difference in survival rate according to pathologic type and smoking status. In the groups with malignant mesothelioma, 50% survival time from first symptoms was 18 months and that from diagnosis was 11 months. Also, 75% survival time from diagnosis was 6 months in the smoking groups and 19 months in the non-smoking groups.; Summary

Comparison and Analysis of the Results of Preventive Medicine Sutdy in a Medical College.: Seung Hum Yu, Jaehoon Roh, Sang Hyuk Jung, Chung Mo Nam; Korean J Prev Med. 1989;22(2):242-247.

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Abstract PDF: The purpose of this study was to find a better evaluation method by comparison and analysis of the subdivision-score for preventive medicine with other subjects and total score. Among the 475 students who were second grade in 1983, 1984 and 1985, we analyzed the scores for all subjects at Yonsei University College of Medicine obtained by 443 students, with the exception of 32 students who had a temporary absence from school, failed or had been expelled. And we analyzed the score for preventive medicine of 162 students who were second grade in 1987 and 179 students who were second grade in 1988. Statistical analysis of the above was done using the correlation analysis, chi-square test and discriminating index. The results were as follows: 1. The correlations of the subdivision of preventive medicine in 1984, 1987 and 1988 were statistical significantly high(r=0.36-0.56). 2. The grades obtained for preventive medicine and for other subjects except pediatrics (clerkship) were not independent. 3. The discriminating indices that determined whether or not a pertinent evaluation was made were 0.42 in 1983, 0.52 in 1984 and 0.54 n 1985. These results were classified as excellent. These results suggest that the score of a subject is determined not by the characteristics of the subject, but by the amount of personal study.; Summary

Periodic Health Examination.: Seung Hum Yu, Jae Hoon Roh, Hae Jong Lee, Sang Hyuk Jung; Korean J Prev Med. 1989;22(1):45-50.

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Abstract PDF: The purpose of this study was to select the manageable diseases which are prevalent in Korea for periodic health examinations and to evaluate the sensitivity and specificity of periodic health examination in detecting these diseases. The data was derived from reimbursement data of the Korea Medical Insurance Corporation over a two year period (April 15, 1986 to April 14, 1988) and interviews with Yonsei Medical School professors. This study demonstrated that: 1. The manageable diseases which were selected for periodic health examinations are pulmonary tuberculosis, viral hepatitis, diabetes mellitus, syphilis groups, essential hypertension, renal disease groups, and iron deficiency anemia. 2. The sensitivity of the health screening for each disease was as follows: pulmonary tuberculosis 51.5%, viral hepatitis 60.3%, diabetes mellitus 64.7%, syphilis groups 63.3%, essential hypertension 49.9%, renal disease groups 44.0%, and iron deficiency anemia 80.9%. We conclude that peiodic health esaminations should focus on the manageable diseases that we have defined. The number of items in periodic health screening tests and hospital quality control should be increased for the diseases with a demonstrated low sensitivity.; Summary

English Abstract

A Study on Scheduling Periodic Examinations for the Early Detection of Breast Cancer in Korea.: Seong Hwa Jeong, Dae Ryong Kang, Nam Wook Hur, Jinheum Kim, Soon Young Lee, Sang Hyuk Jung, Chung Mo Nam; J Prev Med Public Health. 2006;39(4):346-352.

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Abstract PDF: OBJECTIVES
The purposes of this study were to propose a screening schedule for the early detection of breast cancer among Korean women, as based on the statistical model, and to compare the efficacy of the proposed screening schedule with the current recommendations. METHODS: The development of the screening schedule for breast cancer closely followed the work of Lee and Zelen (1998). We calculated the age-specific breast cancer incidence rate from the Korea Central Cancer Registry (2003), and then we estimated the scheduling of periodic examinations for the early detection of breast cancer, using mammography, and based on the threshold method. The efficacy of the derived screening schedule was evaluated by the schedule sensitivity. RESULTS: For estimating the screening schedule threshold method, we set the threshold value as the probability of being in the preclinical stage at age 35, the sensitivity of mammography as 0.9 and the mean sojourn time in the preclinical stage as 4 years. This method generated 14 examinations within the age interval [40, 69] of 40.0, 41.3, 42.7, 44.1, 45.4, 46.7, 48.0, 49.3, 51.0, 53.2, 55.3, 57.1, 59.0 and 63.6 years, and the schedule sensitivity was 75.4%. The proposed screening schedule detected 85.2% (74.5/87.4) of the cases that could have been detected by annual screening, but it required only about 48.7% (14.0/30.0) of the total number of examinations. We also examined the threshold screening schedules for a range of sensitivities of mammography and the mean sojourn time in the preclinical stage. CONCLUSIONS: The proposed screening schedule for breast cancer with using the threshold method will be helpful to provide guidelines for a public health program for choosing an effective screening schedule for breast cancer among Korean women.; Summary

Original Article

A Longitudinal Study of the Relationship Between Health Behavior Risk Factors and Dependence in Activities of Daily Living.: Sang Hyuk Jung, Truls Oslash stbye, Kyoung Ok Park; J Prev Med Public Health. 2006;39(3):221-228.

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Abstract PDF: OBJECTIVES
The purpose of this study was to shed further light on the effect of modifiable health behavior risk factors on dependence in activities of daily living, defined in a multidimensional fashion. METHODS: The study participants were 10,278 middle aged Americans in a longitudinal health study, the Health and Retirement Survey (HRS). A multi-stage probability sampling design incorporating the effect of population sizes (Metropolitan and non-metropolitan), ethnicity (the non-Hispanic White, the Hispanic, and the Black), and age (age 51-61) was utilized. Basic Activities of Daily Living (ADL) were measured using five activities necessary for survival (impairment in dressing, eating, bathing, sleeping, and moving across indoor spaces). Explanatory variables were four health behavior risk factors included smoking, exercise, Body Mass Index (BMI), and alcohol consumption. RESULTS: Most participants at baseline were ADL independent (1992). 97.8% of participants were independent in all ADL's at baseline and 78.2% were married. Approximately 27.5% were current smokers at baseline, and the subjects reported moderate or heavy exercise were 74.8%. All demographic characteristics and behavioral risk factors were significantly associated with the ADL status at Wave 4 except alcohol consumption. Risk behaviors such as current smoking, sedentary life style and high BMI at Wave 1 were associated with ADL status deterioration; however, moderate alcohol consumption tended to be more related to better ADL status than abstaining at Wave 4. ADL status at Wave 1 was the strongest factor and the next was exercise and smoking affecting ADL status at Wave 4. People who were in ADL dependent at Wave 1 were 15.17 times more likely to be ADL dependent at Wave 4 than people who were in ADL independent at Wave 1. Concerning smoking cigarettes, people who kept only light exercise or sedentary life style at Wave 1 were 1.70 times more likely to be died at Wave 4 than the people who did not smoke at Wave 1. CONCLUSIONS: All demographics and health behaviors at wave 1 had consistently similar OR trends for ADL status to each other except alcohol consumption. Smoking and exercise in health behaviors, and age and gender in demographics at Wave 1 were significant factors associated with ADL group separation at Wave 4.; Summary

English Abstract

Analysis of Behavioral Stage in Pap Testing by Using Transtheoretical Model.: Hye Jean Lee, Sun Hee Lee, Sang Hyuk Jung, Hai Rim Shin, Dae Kyu Oh; J Prev Med Public Health. 2005;38(1):82-92.

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Abstract PDF: OBJECTIVE
To evaluate the relationships among sociodemographic characteristics, health behaviors, levels of pros and cons and stages of change in Pap testing for uterine cervical cancer. METHODS: A questionnaire survey was performed on 560 randomly sampled people who were assigned to participate in a Pap testing program by the 'National Cancer Screening Project in 2003' between 25 September and 10 October in Gyeonggi, Korea. Data about the behaviors and intentions of Pap testing, sociodemographic characteristics, health behaviors, and levels of acknowledged benefit (pros) and barrier (cons) for Pap testing was collected. The stages of change were grouped according to behaviors and intentions of Pap testing as passive, active, and relapse. RESULTS: Logistic analysis between the passive and active groups showed that city dwellers, 'high' and 'middle' groups in terms of the individual's health belief, those who had undergone a health examination within the past 2 years, and those who had undergone hormone replacement therapy had a higher odds ratios to be in the active group. As the 'benefit' scores increased and the 'Unnecessity' scores decreased, the probabilities to be in the active group increased. According to the logistic analysis results between the active and relapse groups, those who were 60 years or older, members of the National Heath Insurance, and those who had not undergone a health examination within the past 2 years had a higher odds ratio to be in the relapse group. The 'Benefit' scores were not significant in this relationship. The probabilities of being in the relapse group increased as the 'Unnecessity' and 'Shamefulness' scores increased. CONCLUSIONS: In conclusion, health planners should inform women in the passive group of the benefits and necessity of Pap testing. It would be better to reduce the barriers to the active group of undergoing Pap smear. This study might be a useful guide for future planning of Pap testing program.; Summary

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