Journal of Preventive Medicine and Public Health

Original Articles

Healthcare Systems and COVID-19 Mortality in Selected OECD Countries: A Panel Quantile Regression Analysis: Jalil Safaei, Andisheh Saliminezhad; J Prev Med Public Health. 2023;56(6):515-522. Published online October 15, 2023; DOI: https://doi.org/10.3961/jpmph.23.162

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Abstract Summary PDF: Objectives
The pandemic caused by coronavirus disease 2019 (COVID-19) has exerted an unprecedented impact on the health of populations worldwide. However, the adverse health consequences of the pandemic in terms of infection and mortality rates have varied across countries. In this study, we investigate whether COVID-19 mortality rates across a group of developed nations are associated with characteristics of their healthcare systems, beyond the differential policy responses in those countries.
Methods
To achieve the study objective, we distinguished healthcare systems based on the extent of healthcare decommodification. Using available daily data from 2020, 2021, and 2022, we applied quantile regression with non-additive fixed effects to estimate mortality rates across quantiles. Our analysis began prior to vaccine development (in 2020) and continued after the vaccines were introduced (throughout 2021 and part of 2022).
Results
The findings indicate that higher testing rates, coupled with more stringent containment and public health measures, had a significant negative impact on the death rate in both pre-vaccination and post-vaccination models. The data from the post-vaccination model demonstrate that higher vaccination rates were associated with significant decreases in fatalities. Additionally, our research indicates that countries with healthcare systems characterized by high and medium levels of decommodification experienced lower mortality rates than those with healthcare systems involving low decommodification.
Conclusions
The results of this study indicate that stronger public health infrastructure and more inclusive social protections have mitigated the severity of the pandemic’s adverse health impacts, more so than emergency containment measures and social restrictions.; Summary

Key Message
This study investigates whether COVID-19 mortality rates across a group of developed nations are associated with characteristics of their healthcare systems, beyond the differential policy responses in those countries. To this aim, a quantile regression with non-additive fixed effects is applied to estimate mortality rates across quantiles. The results of this study indicate that stronger public health infrastructure and more inclusive social protections have mitigated the severity of the pandemic’s adverse health impacts, more so than emergency containment measures and social restrictions.

Factors Related to Regional Variation in the High-risk Drinking Rate in Korea: Using Quantile Regression: Eun Su Kim, Hae-Sung Nam; J Prev Med Public Health. 2021;54(2):145-152. Published online March 16, 2021; DOI: https://doi.org/10.3961/jpmph.20.507

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Abstract Summary PDF Supplementary Material

Objectives
This study aimed to identify regional differences in the high-risk drinking rate among yearly alcohol users in Korea and to identify relevant regional factors for each quintile using quantile regression.
Methods
Data from 227 counties surveyed by the 2017 Korean Community Health Survey (KCHS) were analyzed. The analysis dataset included secondary data extracted from the Korean Statistical Information Service and data from the KCHS. To identify regional factors related to the high-risk drinking rate among yearly alcohol users, quantile regression was conducted by dividing the data into 10%, 30%, 50%, 70%, and 90% quantiles, and multiple linear regression was also performed.
Results
The current smoking rate, perceived stress rate, crude divorce rate, and financial independence rate, as well as one’s social network, were related to the high-risk drinking rate among yearly alcohol users. The quantile regression revealed that the perceived stress rate was related to all quantiles except for the 90% quantile, and the financial independence rate was related to the 50% to 90% quantiles. The crude divorce rate was related to the high-risk drinking rate among yearly alcohol users in all quantiles.
Conclusions
The findings of this study suggest that local health programs for high-risk drinking are needed in areas with high local stress and high crude divorce rates.

Summary

Korean summary
본 연구는 quantile regression을 이용하여 high risk drinking 의 지역간 변이 요인을 파악하였습니다. 연구결과, high risk drinking rate 의 지역간 변이가 크고, quanile별로 관련요인을 다르다는 것을 파악하였습니다. 본 연구의 결과는 높은 지역의 스트레스와 조이혼율의 관리와 함께 지역 고위험음주율의 건강프로그램이 필요하다는 것을 암시한다.

Citations

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Prevalence and Related Factors of Depression Before and During the COVID-19 Pandemic: Findings From the Korea National Health and Nutrition Examination Survey
Eung-Joon Lee, Seung Jae Kim
Journal of Korean Medical Science.2023;[Epub] CrossRef
Data resource profile: the Korean Community Health Status Indicators (K-CHSI) database
Hye-Eun Lee, Yeon-gyeong Kim, Jin-Young Jeong, Dong-Hyun Kim
Epidemiology and Health.2023; 45: e2023016. CrossRef
Prevalence, awareness, and treatment of depression among community-dwelling stroke survivors in Korea
Eung-Joon Lee, Oh Deog Kwon, Seung Jae Kim
Scientific Reports.2022;[Epub] CrossRef

Effects of Iranian Economic Reforms on Equity in Social and Healthcare Financing: A Segmented Regression Analysis: Hamed Zandian, Amirhossein Takian, Arash Rashidian, Mohsen Bayati, Telma Zahirian Moghadam, Satar Rezaei, Alireza Olyaeemanesh; J Prev Med Public Health. 2018;51(2):83-91. Published online February 6, 2018; DOI: https://doi.org/10.3961/jpmph.17.050

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Abstract PDF

Objectives
One of the main objectives of the Targeted Subsidies Law (TSL) in Iran was to improve equity in healthcare financing. This study aimed at measuring the effects of the TSL, which was implemented in Iran in 2010, on equity in healthcare financing. Methods: Segmented regression analysis was applied to assess the effects of TSL implementation on the Gini and Kakwani indices of outcome variables in Iranian households. Data for the years 1977-2014 were retrieved from formal databases. Changes in the levels and trends of the outcome variables before and after TSL implementation were assessed using Stata version 13. Results: In the 33 years before the implementation of the TSL, the Gini index decreased from 0.401 to 0.381. The Gini index and its intercept significantly decreased to 0.362 (p<0.001) 5 years after the implementation of the TSL. There was no statistically significant change in the gross domestic product or inflation rate after TSL implementation. The Kakwani index significantly increased from -0.020 to 0.007 (p<0.001) before the implementation of the TSL, while we observed no statistically significant change (p=0.81) in the Kakwani index after TSL implementation. Conclusions: The TSL reform, which was introduced as part of an economic development plan in Iran in 2010, led to a significant reduction in households’ income inequality. However, the TSL did not significantly affect equity in healthcare financing. Hence, while measuring the long-term impact of TSL is paramount, healthcare decision-makers need to consider the efficacy of the TSL in order to develop plans for achieving the desired equity in healthcare financing.

Summary

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Mohammad Hossein Mehrolhassani, Vahid Yazdi-Feyzabadi, Marzieh Lashkari
Cost Effectiveness and Resource Allocation.2020;[Epub] CrossRef
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Telma Zahirian Moghadam, Pouran Raeissi, Mehdi Jafari-Sirizi
International Journal of Human Rights in Healthcare.2019; 12(2): 124. CrossRef
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Rasoul Tabari-Khomeiran, Sajad Delavari, Satar Rezaei, Enayatollah Homaie Rad, Mostafa Shahmoradi
International Journal of Human Rights in Healthcare.2019; 12(3): 208. CrossRef
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Shahram Habibzadeh, Hamed Zandian, Hasan Edalatkhah, Mohammad Mehrtak
International Journal of Human Rights in Healthcare.2019; 12(2): 138. CrossRef
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English Abstract

Factors Influencing Utilization of Medical Care Among Osteoarthritis Patients in Korea: Using 2005 Korean National Health and Nutrition Survey Data.: Min Young Kim, Jong Ku Park, Sang Baek Koh, Chun Bae Kim; J Prev Med Public Health. 2010;43(6):513-522.; DOI: https://doi.org/10.3961/jpmph.2010.43.6.513

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OBJECTIVES
The purpose of this study was to define the association between the medical utilization of osteoarthritis patient and its related factors. METHODS: We used the 2005 Korean National Health and Nutrition Survey data and we enrolled 2833 participants who were forty or older and who were diagnosed as having osteoarthritis by a doctor within 1 year and who had suffered from osteoarthritis for more than 3 months. The Andersen behavioral model was used as the analytic framework, and the variables were categorized into predisposing, enabling, and need factors. To determine the influence of each variable on the medical utilization of osteoarthritis patient, we applied hierarchical logistic regression analysis with two stages: the first stage included the predisposing and enabling factors and the second stage included the need factors. RESULTS: On the hierarchical logistic analysis, the variables of personal income, the type of medical security, the duration of arthritis related symptoms within 1 month, the subjective health status and the duration of osteoarthritis showed a statistically significant difference between whether the medical utilization in men patients. And the variables of age, limitation activity due to osteoarthritis, arthritis related symptoms within 1 month, and the subjective health status had a statistically significant difference between whether the medical utilization in women patients. CONCLUSIONS: The patients who tend to receive less care are those suffer less from symptoms of osteoarthritis, those who are within the initial phase, or those with a low-level severity of osteoarthritis. It is necessary to encourage patients to receive the treatment in the initial phase.

Summary

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Associations Between Fat Mass, Lean Mass, and Knee Osteoarthritis: The Fifth Korean National Health and Nutrition Examination Survey (KNHANES V)
Seong Rae Kim, Kyung-Hyun Choi, Go-Un Jung, Doosup Shin, Kyuwoong Kim, Sang Min Park
Calcified Tissue International.2016; 99(6): 598. CrossRef
Convergence analysis of determinants affecting on geographic variations in the prevalence of arthritis in Korean women using data mining
Yoo-Mi Kim, Sung-Hong Kang
Journal of Digital Convergence.2015; 13(5): 277. CrossRef
The relative importance of perceived doctor’s attitude on the decision to consult for symptomatic osteoarthritis: a choice-based conjoint analysis study
Domenica Coxon, Martin Frisher, Clare Jinks, Kelvin Jordan, Zoe Paskins, George Peat
BMJ Open.2015; 5(10): e009625. CrossRef
Complementary and alternative medicine use of women with breast cancer: Self-help CAM attracts other women than guided CAM therapies
Deborah N.N. Lo-Fo-Wong, Adelita V. Ranchor, Hanneke C.J.M. de Haes, Mirjam A.G. Sprangers, Inge Henselmans
Patient Education and Counseling.2012; 89(3): 529. CrossRef

Research Support, Non-U.S. Gov't

Reliability and Data Integration of Duplicated Test Results Using Two Bioelectrical Impedence Analysis Machines in the Korean Genome and Epidemiology Study.: Boyoung Park, Jae Jeong Yang, Ji Hyun Yang, Jimin Kim, Lisa Y Cho, Daehee Kang, Chol Shin, Young Seoub Hong, Bo Youl Choi, Sung Soo Kim, Man Suck Park, Sue K Park; J Prev Med Public Health. 2010;43(6):479-485.; DOI: https://doi.org/10.3961/jpmph.2010.43.6.479

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Abstract PDF

OBJECTIVES
The Korean Genome and Epidemiology Study (KoGES), a multicenter-based multi-cohort study, has collected information on body composition using two different bioelectrical impedence analysis (BIA) machines. The aim of the study was to evaluate the possibility of whether the test values measured from different BIA machines can be integrated through statistical adjustment algorithm under excellent inter-rater reliability. METHODS: We selected two centers to measure inter-rater reliability of the two BIA machines. We set up the two machines side by side and measured subjects' body compositions between October 2007 and December 2007. Duplicated test values of 848 subjects were collected. Pearson and intra-class correlation coefficients for inter-rater reliability were estimated using results from the two machines. To detect the feasibility for data integration, we constructed statistical compensation models using linear regression models with residual analysis and R-square values. RESULTS: All correlation coefficients indicated excellent reliability except mineral mass. However, models using only duplicated body composition values for data integration were not feasible due to relatively low R2 values of 0.8 for mineral mass and target weight. To integrate body composition data, models adjusted for four empirical variables that were age, sex, weight and height were most ideal (all R2>0.9). CONCLUSIONS: The test values measured with the two BIA machines in the KoGES have excellent reliability for the nine body composition values. Based on reliability, values can be integrated through algorithmic statistical adjustment using regression equations that includes age, sex, weight, and height.

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Nutritional Consequences and Management After Gastrectomy
Jae-Moon Bae
Hanyang Medical Reviews.2011; 31(4): 254. CrossRef

English Abstract

Association Between Prophylactic Antibiotic Use and Surgical Site Infection Based on Quality Assessment Data in Korea.: Kyoung Hoon Kim, Choon Seon Park, Jin Hee Chang, Nam Soon Kim, Jin Seo Lee, Bo Ram Choi, Byung Ran Lee, Kyoo Duck Lee, Sun Min Kim, Seon A Yeom; J Prev Med Public Health. 2010;43(3):235-244.; DOI: https://doi.org/10.3961/jpmph.2010.43.3.235

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OBJECTIVES
To examine the prophylactic antibiotic use in reducing surgical site infection. METHODS: This was a retrospective study for patients aged 18 years and older who underwent gastrectomy, cholecystectomy, colectomy, cesarean section and hysterectomy. The data source was quality assessment data of the Health Insurance Review & Assessment Service gathered from medical records of 302 national hospitals. Prophylactic antibiotic use was defined as: timely antibiotic administration or inappropriate antibiotic selection. We performed hierarchical logistic regression to examine the association between prophylactic antibiotic use and surgical site infection with adjustment for covariates. RESULTS: The study population consisted of 16 348 patients (1588 gastrectomies, 2327 cholecystectomies, 1,384 colectomies, 3977 hysterectomies and 7072 cesarean sections) and surgical site infection was identified in 351 (2.1%) patients. The rates of timely antibiotic administration and inappropriate antibiotic selection varied according to procedures. Cholecystectomy patients who received timely prophylactic antibiotic had a significantly reduced risk of surgical site infection compared with those who did not receive a timely prophylactic antibiotics (OR 0.64, 95% CI=0.50-0.83), but no significant reduction was observed for other procedures. When inappropriate prophylactic antibiotics were given, the risk of surgical site infection significantly increased: 8.26-fold (95% CI=4.34-15.7) for gastrectomy, 4.73-fold (95% CI=2.09-10.7) for colectomy, 2.34-fold (95% CI=1.14-4.80) for cesarean section, 4.03-fold (95% CI=1.93-8.42) for hysterectomy. CONCLUSIONS: This study examines the association among timely antibiotic administration, inappropriate antibiotic selection and surgical site infection. Patients who received timely and appropriate antibiotics had a decreased risk of surgical site infection. Efforts to improve the timing of antibiotic administration and use of appropriate antibiotic are needed to lower the risk of surgical site infection.

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Sung-Jin Bae, Inah Kim, Jaechul Song, Euy-Suk Chung
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Seung Ju Kim, Kyu-Tae Han, Sun Jung Kim, Eun-Cheol Park
International Journal for Quality in Health Care.2017; 29(2): 222. CrossRef
Comparing the Postoperative Complications, Hospitalization Days and Treatment Expenses Depending on the Administration of Postoperative Prophylactic Antibiotics to Hysterectomy
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Shi‐Peng Gong, Hong‐Xia Guo, Hong‐Zhen Zhou, Li Chen, Yan‐Hong Yu
Journal of Obstetrics and Gynaecology Research.2012; 38(3): 509. CrossRef
Overview of Antibiotic Use in Korea
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Infection & Chemotherapy.2012; 44(4): 250. CrossRef
The effect of surgical site infection on the length of stay and health care costs
Jin-Hee Chang, Kyoung-Hoon Kim, Soon-Man Kwon, Seon-A Yeom, Choon-Seon Park
Korean Journal of Health Policy and Administration.2011; 21(1): 44. CrossRef
Risk factors for surgical site infection in children at the teaching hospital Gabriel Touré, Bamako
A. Togo, Y. Coulibaly, B.T. Dembélé, B. Togo, M. Keita, L. Kanté, A. Traoré, I. Diakité, H. Ouologuem, G. Diallo
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The Feasibility of Short Term Prophylactic Antibiotics in Gastric Cancer Surgery
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Original Articles

Using Tobit Regression Analysis to Further Understand the Association of Youth Alcohol Problems with Depression and Parental Factors among Korean Adolescent Females.: Jorge Delva, Andrew Grogan Kaylor, Emily Steinhoff, Dong Eok Shin, Kristine Siefert; J Prev Med Public Health. 2007;40(2):145-149.; DOI: https://doi.org/10.3961/jpmph.2007.40.2.145

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OBJECTIVES
This study characterized the extent to which youth depressive symptoms, parental alcohol problems, and parental drinking account for differences in alcoholrelated problems among a large sample of adolescent females. METHODS: The stratified sample consists of 2077 adolescent females from twelve female-only high schools located in a large metropolitan city in the Republic of Korea. Students completed a questionnaire about alcohol use nd alcohol problems, their parents' alcohol problems, and a number of risk and protective factors. Data were analyzed using tobit regression analyses to better characterize the associations among variables. RESULTS: Almost two-thirds of students who consume alcohol had experienced at least one to two alcohol-related problems in their lives and 54.6% reported at least one current symptom of depression, with nearly one-third reporting two depressive symptoms. Two-thirds of the students indicated that at least one parent had an alcoholrelated problem, and that approximately 29% had experie nced several problems. Results of tobit regression analyses indicate that youth alcohol-related problems are positively associated with depressive symptoms (p<0.01) and parent drinking problems (p<0.05). Parental drinking is no longer significant when the variable parental attention is added to the model. Decomposition of the tobit parameters shows that for every unit of increase in depressive symptoms and in parent drinking problems, the probability of a youth experiencing alcohol problems increases by 6% and 1%, respectively. For every unit of increase in parental attention, the probability of youth experiencing drinking problems decreases by 5%. CONCLUSIONS: This study presents evidence that alcoholrelated problems and depressive symptoms are highly prevalent among adolescent females. Although a comprehensive public health approach is needed to address drinking and mental health problems, different interventions are needed to target factors associated with initiation of alcohol problems and those associated with increased alcohol problems among those who already began experiencing such problems.

Summary

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Donna Cross, Therese Shaw, Melanie Epstein, Natasha Pearce, Amy Barnes, Sharyn Burns, Stacey Waters, Leanne Lester, Kevin Runions
European Journal of Education.2018; 53(4): 495. CrossRef
Parenting and Youth Psychosocial Well- Being in South Korea using Fixed-Effects Models
Yoonsun Han, Andrew Grogan-Kaylor
Journal of Family Issues.2013; 34(5): 689. CrossRef
Alcohol and tobacco use among South Korean adolescents: An ecological review of the literature
Jun Sung Hong, Na Youn Lee, Andrew Grogan-Kaylor, Hui Huang
Children and Youth Services Review.2011; 33(7): 1120. CrossRef
Tobit Model for Outcome Variable Is Limited by Censoring in Nursing Research
Kuan-Chia Lin, Su-Fen Cheng
Nursing Research.2011; 60(5): 354. CrossRef
The Relationship of Weight‐Related Attitudes With Suicidal Behaviors in Korean Adolescents
Jun‐Su Kim, Kayoung Lee
Obesity.2010; 18(11): 2145. CrossRef
The Difficulty of Maintaining Positive Intervention Effects: A Look at Disruptive Behavior, Deviant Peer Relations, and Social Skills During the Middle School Years
John E. Lochman, Karen L. Bierman, John D. Coie, Kenneth A. Dodge, Mark T. Greenberg, Robert J. McMahon, Ellen E. Pinderhughes
The Journal of Early Adolescence.2010; 30(4): 593. CrossRef
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Community Based Study for Stress and It's Related Factors.: Gyung Jae Oh, Jeong Mi Lee, Sang Sun Kil, Keun Sang Kwon; Korean J Prev Med. 2003;36(2):125-130.

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Abstract PDF: OBJECTIVES
This study evaluated the stress of community residents using the General Health Questionnaire, GHQ-60, as an instrument of stress measurement. METHODS: The study included 2100 residents, aged 20 and over, living in three areas, a large city, a medium sized city and a rural area, between June and September 2001. A questionnaire interviewing method was used to collect data. The data were analyzed using a t-test, ANOVA, Pearson's correlation coefficients and multiple regression analysis. RESULTS: In this study, the degree of stress, as measured by the GHQ-60, was shown to be significantly higher in the following categories: females, people over 60 years old, people engaged in the primary industries and labor work, low incomes, the divorced and the bereaved, people who received no more than an elementary education, people who suffer from chronic diseases and non-exercisers. A factor analysis suggested that there were three factors of social dysfunction factors; psychosomatic symptom, and depression and anxiety. The social dysfunction factors was statistically significant for the groups described above. The factor of psychosomatic symptoms was statistically significant in the rural residents, and in the groups described above. The depression and anxiety factor was statistically significant in the large city residents, people aged between 20-29 years, students, unmarried persons, university graduates and those having suffered from chronic diseases. From the multiple linear regression analyses, chronic disease, exercise, gender and income, proved to be significant stress related factors. CONCLUSIONS: This study suggests that special attention should be given to the management of the chronic invalided, non-exercisers, females and small income earners, in order to maintain and promote the psychological health of residents in a community.; Summary

Prediction of HIV and AIDS Incidence Using a Back-calculation Model in Korea.: Ju Young Lee, Jin Soo Hwang, Un Yeong Goh, Mee Kyung Kee, Jee Yun Kim; Korean J Prev Med. 2002;35(1):65-71.

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Abstract PDF: OBJECTIVE
To estimate the status of HIV infection and AIDS incidence using a back-calculation model in Korea. METHODS: Back-calculation is a method for estimating the past infection rate using AIDS incidence data. The method has been useful for obtaining short-term projections of AIDS incidence and estimating previous HIV prevalence. If the density of the incubation periods is known, together with the AIDS incidence, we can estimate historical HIV infections and forecast AIDS incidence in any time period up to time t. In this paper, we estimated the number of HIV infections and AIDS incidence according to the distribution of various incubation periods RESULTS: The cumulative numbers of HIV infection from 1991 to 1996 were 708~1,426 in Weibull distribution and 918~1,980 in Gamma distribution. The projected AIDS incidence in 1997 was 16~25 in Weibull distribution and 13~26 in Gamma distribution. CONCLUSIONS: The estimated cumulative HIV infections from 1991 to 1996 were 1.4~4.0 times more than notified cumulative HIV infections. Additionally, the projected AIDS incidence in 1997 was less than the notified AIDS cases. The reason for this underestimation derives from the very low level of HIV prevalence in Korea. Further research is required for the distribution of the incubation period of HIV infection in Korea, particularly for the effects of combination treatments.; Summary

Case Report

Short-term Effect of Air Pollution on Respiratory Disease in Seoul : A Case-Crossover Study.: Young Ju Lee, Jong Tae Lee, Young Su Ju, Dong Chun Shin, Hyoung June Im, Soo Hun Cho; Korean J Prev Med. 2001;34(3):253-261.

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Abstract PDF: OBJECTIVES
To evaluate the hypothesis that air pollution could increase emergency room visits for respiratory diseases, and if so, to quantify the strength of association between those. METHODS: We compiled daily records of hospital emergency room visits for respiratory diseases in Seoul, from November 1. 1995 to October 31. 1996, by using medical utilization data of unscheduled visits. In addition, air quality and weather data for the same period was collected. And a case-crossover design was applied by adopting conditional logistic regression analysis to determine the relationship between air pollutants and emergency room visits for respiratory diseases. In particular, the control periods were chosen by a bidirectional paired matching technique 7, 14, and 21days before and after the case periods. RESULTS: Only ozone was associated with the increased number of emergency room visits for respiratory diseases. The relative risk according to a 30ppb increase of ozone concentration (24hr mean, lagged 1day) was 1.91 (95% confidence interval = 1.78-2.05). CONCLUSION: There was a statistically significant association between the ambient ozone and daily emergency room visits for respiratory diseases.; Summary

Original Articles

A Cohort Study on Risk Factors for Chronic Liver Disease: Analytic Strategies Excluding Potentially Incident Subjects.: Moo Song Lee, Dae Sung Kim, Dong Hyun Kim, Jong Myun Bae, Myung Hee Shin, Yoon Ok Ahn; Korean J Prev Med. 1999;32(4):452-458.

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Abstract PDF: OBJECTIVES
The authors conducted the study to evaluate bias when potentially diseased subjects were included in cohort members while analyzing risk factors of chronic liver diseases. METHODS: Total of 14,529 subjects were followed up for the incidence of liver diseases from January 1993 to June 1997. We have used databases of insurance company with medical records, cancer registry, and death certificate data to identify 102 incident cases. The cohort members were classified into potentially diseased group(n=2,217) when they were HBsAg positive, serum GPT levels higher than 40 units, or had or has liver diseases in baseline surveys. Cox' model were used for potentially diseased group, other members, and total subjects, respectively. RESULTS: The risk factors profiles were similar for total and potentially diseased subjects: HBsAg positivity, history of acute liver disease, and recent quittance of smoking or drinking increased the risk, while intake of pork and coffee decreased it. For the potentially diseased, obesity showed marginally significant protective effect. Analysis of subjects excluding the potentially diseased showed distinct profiles: obesity increased the risk, while quitting smoking or drinking had no association. For these intake of raw liver or processed fish or soybean paste stew increased risk; HBsAg positivity, higher levels of liver enzymes and history of acute liver diseases increased the risk. CONCLUSIONS: The results suggested the potential bias in risk ratio estimates when potentially diseased subjects were included in cohort study on chronic liver diseases, especially for lifestyles possibly modified after disease onset. The analytic strategy excluding potentially diseased subjects was considered appropriate for identifying risk factors for chronic liver diseases.; Summary

A study on the attitude affecting the preventive behavior for hearing conservation.: Kyung Yong Rhee, Kwan Hyung Yi; Korean J Prev Med. 1996;29(2):371-384.

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Abstract PDF: The purpose of this study is to investigate attitude factor related to hearing conservation and to find attitude affecting the preventive behavior for hearing conservation. The research method used in this study was self-administered questionnaire samples of the study were composed of 353 workers exposed noise selected randomly in 10 ship-building manufacturing companies. Authors extracted following 9 factors related hearing conservation from 26 attitude propositions prepared from previous study results and health belief model; (l) general perceived susceptibility, (2) relative perceived susceptibility compared with colleagues, (3) concern to the personal protective devices, (4) perceived severity and concern to the hearing capacity, (5) concern to the hearing and noise assessment, (6) concern to the control noise and hearing conservation, (7) group pressure and reason of wearing protective devices, (8) apathy of hearing loss from noise, (9) knowledge about hearing conservation Attitude factors affecting the preventive health behavior were general perceived susceptibility, concern to the noise control and hearing conservation, and concern to the personal protective devices in the case of wearing personal protective devices. But in the case of avoiding noise exposure as preventive health behavior, perceived severity and concern to the hearing capacity was a significant attitude factor with knowledge about hearing conservation.; Summary

A Study on the Incidence of Diabetes and Its Risk Factors in the Impaired Glucose Tolerence.: Joo Hee Park, Yeon Gyo Shin, Joo Ja Kim, Taik Sung Nam, Byung Kook Lee; Korean J Prev Med. 1994;27(3):425-437.

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Abstract PDF: This is to study the incidence of Diabetes and its risk factors in the impaired glucose tolerance group. 1084 subjects who had been examined 3 times for regular check-up in one human dock center under the university hospital were studied between 1986~1993. The results are as follows; Prevalence rate of diabetes was 3.56%, and that of impaired glucose tolerance was 30.90% as of initial examination. The rate of diabetes was increasing with the age where 1.2% at age group 30~39, 3.21% at age group 40~49, 5.84% at age group 50~59, 14.28% at age group 60 and over. And also the rate of impaired glucose tolerance was increasing with the age where 21.29% at age group 30~39, 31.42% at age group 40~49, 38.91% at age group 50~59, 33.33% at age group 60 and over. Of the examinees who were initially examined, total incidence rate of diabetes who developed to obvious diabetes at the 3rd follow-up examination from the initially impaired glucose tolerance group was 4.63% and it was 11.3 times higher than from the normal group (0.41%). After controlling for the effects of both age and obesity, the risk of subsequent diabetes for subjects with impaired glucose tolerance remained significantly higher than for normal subjects (Relative Risk, 10.48). Test for trends for developing to diabetes by the increasing level of fasting blood sugar and 1 hr blood sugar at the initial examination were statistically significant in either normal and impaired glucose tolerance group. To determine the risk factor for developing to diabetes, logistic regression test was applied. Only fasting blood sugar and 1 hr blood sugar were predictors for developing diabetes from the impaired glucose tolerance group at initial examination.; Summary

An analysis of contributing factors to financial status of regional health insurance.: Jong Kook Moon, Myeong Ho Park, Yong Joon Kim; Korean J Prev Med. 1991;24(2):211-220.

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Abstract PDF: Finances of health insurance can be explained by factors determining benefit expense and premium collection. This study was conducted to analyze factors contributing to the financial status of rural health insurance. Nationwide 134 health insurance associations except the six pilot project counties were analyzed and obtained the followings. 1. In univariate analysis, statistically significant variables that explain 1) outpatient benefit expenditures include public health center utilization, proportion of pregnant women, premium and collection rate of premium 2) inpatient benefit expenditures include public health center utilization, proportion of old age, proportion of pregnant women, premium and collection rate of premium 3) profits include public health center utilization, proportion of old age, proportion of pregnant women and collection rate of premium. 2. In multiple regression analysis, statistically significant determinants in 1) outpatient benefit include premium and public health utilization 2) inpatient benefit include premium 3) profit include public health center utilization, premium and collection rate of premium.; Summary

Change in Medical Care Utilization over Time in Early Years of Insurance Coverage.: Byoung Yik Kim, Youngjo Lee, Dal Sun Han; Korean J Prev Med. 1990;23(2):185-193.

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Abstract PDF: The purpose of this study is to observe the pattern of change in medical care utilization over time in early years of insurance coverage. The source of data is the benefit records file of a voluntary medical insurance society for covering the four-year period, from 1982 to 1985. The measure of medical care utilization used in this study is the age-sex standardized percentage of the enrollee who have visited a physician over total analytical population during a three-month period. For six cohorts by the year of enrollment (1979-1984), the relationship between the utilization and duration of insurance coverage was examined controlling for the calender year and season. In the analysis, logistic multiple regression and residual analysis were employed. It was observed that medical care utilization rapidly increased during the early stage of insurance coverage, and after then increased at a slower rate over time to become almost stable in about twenty months.; Summary

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