OBJECTIVES: This 3-year longitudinal study was conducted to evaluate the influence of self-rating health perception on health care utilization and all cause-death risk. METHODS: The hypothesis was tested using a community-based samples, among which subjects 3,414 were interviewed in 1995. Self-rating health perception was assessed by single-item question. Three components of health care utilization amount(number of visits, number of medications, yearly health care expenses) per year were measured using medical insurance data during 3-year follow-up period among subjects in district health care insurance. There were 123 deaths from all causes among 3,085 subjects interviewed. RESULTS: The results showed that those who had poor health perception revealed more increases in the amount of health care utilization than good health perception group (p<0.05). After adjusting for age and sex, the poor health perception group had higher death risk over 3 years than good health perception group(hazard ratio=1.88). but, after adjusting health care utility, supplementary, was not significant. CONCLUSION: These results suggest that self-rating health percep-tion was associated with difference in health care utilization and all cause-death risk.
Delivery of Health Care* ; Follow-Up Studies ; Insurance ; Longitudinal Studies

OBJECTIVE: This paper examines the possible toxicity to immune system in farmers chronically exposed to pesticides. METHODS: We compared 43 male farmers exposed to pesticides with 29 male residents who had neither past nor current pesticides exposure. The selected variables for studying immunotoxicity were WBC, CD3, CD4, CD8, CD19, CD56, IgG, IgA, IgM, and IL-2. As part of the baseline questionnaires for the immunotoxicity, subjects were asked about kinds of farming, pesticides exposure and medical history. RESULTS: None of the variables for studying immunotoxicity showed statistically significant difference between the two groups. Although the results were not statistically significant, CD4 and the CD4/CD8 ratio decreased and CD8 increased. These effects showed a dose response change with exposure level. In the exposed group, the values of CD3, CD4, CD4/CD8 and CD19 decreased and those of the CD8 and CD56 increased compared to the non-exposed group. Also there was higher prevalence of self-reported disease in the exposed group compared to the non-exposed group. CONCLUSIONS: Although statistically significant differences in indices of immunotoxicity in farmers exposed to pesticides were not shown, the results suggest that pesticides may decrease immune function. More advanced test methods for immunotoxicity need to be developed and tested in larger population to detect immunotoxic effects of pesticides.
Humans ; Immune System ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Interleukin-2 ; Male ; Pesticides* ; Prevalence ; Surveys and Questionnaires

OBJECTIVES: In Korea, pharmacists can dispense medicines without doctor's prescription. This causes the high proportion of pharmaceutical expenditures. The study shows the prescribing behaviors of practicing pharmacists with the simulated patient of arthritis. We select the arthritis as a subject of simulation, because the arthritis is one of the major health problems and the abuse of cortico-steroids is usual in treatment of arthritis patients. METHODS: Twenty drug stores among the 320 drug stores in a district, Seoul, Korea were randomly selected. One of the researchers visited the drug stores and received the medicines from the pharmacists after explaining standardized scenario of arthritis. The simulated patient recorded the practice behaviors of pharmacists. RESULTS: The mean number of prescribed drugs are four and half. Among the twenty pharmacists, the nineteen prescribed non-steroidal anti-inflammatory drugs and the seven(35%) prescribed the cortico-steroids. The antacids were prescribed by the fourteen(70%) pharmacists. The five(25%) pharmacists only recommended the simulated patients to visit the medical doctors, and the three(15%) performed physical examination to the simulated patients. The three pharmacists(15%) asked the past history of the drug adverse effects and no pharmacist explained the adverse effects of prescribed medicines. CONCLUSIONS: The research shows that the cortico-steroids are frequently prescribed and the pharmacists commonly do not give the explanations of the prescribed medicines to the arthritis patients.
Antacids ; Arthritis* ; Health Expenditures ; Humans ; Korea ; Patient Simulation ; Pharmacists* ; Physical Examination ; Prescriptions* ; Seoul

OBJECTIVES: Most descriptive studies of cancer have focused either on cancer incidence or mortality. Cancer prevalence has rarely been estimated. Cancer prevalence data can be used as a measure of the economic and social burden of cancer and are also useful for health care planning. This study attempts to estimate cancer prevalence in Kangwha county. METHODS: This investigation is based on data of Kangwha cancer registry. The data include all cases of cancer diagnosed from 1983 through 1992. We define "prevalent cases" as cancer patients who is alive as of January 1, 1993. For each five-year age group, the number of "known prevalent cases" is added to the number of "estimated prevalent cases". Prevalence is calculated by dividing these sums by the populations of Kangwha County on December 31, 1992(derived from Kangwha Statistics Annual). RESULTS: Crude prevalence of cancer among males and females are 536.7 and 601.1 per 100,000 respectively. Gastric cancer is the most common malignant neoplasm(213.2 per 100,000, crude prevalence) among males. It is followed by lung cancer(45.1 per 100,000), liver cancer(32.8 per 100,000), rectal cancer(25.4 per 100,000) and colon cancer(25.4 per 100,000). Cervical cancer is the most common cancer(201.9 per 100,000, crude prevalence) and is followed by gastric cancer(91.5 per 100,000), thyroid cancer(64.8 per 100,000), breast cancer(57.2 per 100,000) and rectal cancer(32.7 per 100,000) among females. CONCLUSIONS: We tried to estimate cancer prevalence based on the Kangwha cancer registry for the first time in Korea. The estimation of cancer prevalence based on a population-based cancer registry will be more correct and useful as the data accumulate. We will make another estimation in the near future.
Breast ; Colon ; Delivery of Health Care ; Female ; Humans ; Incidence ; Korea ; Liver ; Lung ; Male ; Mortality ; Prevalence* ; Stomach Neoplasms ; Thyroid Gland ; Uterine Cervical Neoplasms

OBJECTIVES: The aim of this study is to identify major factors associated with physical functioning among the Korean elderly. METHODS: Data come from a survey of a nationally representative sample of 2,058 older people aged 60 years or older living in the community. A hierarchical functioning scale was constructed, using upper and lower body mobility, IADLs, and ADLs. Socioeconomic characteristics, chronic conditions, measures of health status, health service use, and social support were analyzed to explore their influence on functioning. Polytomous logistic regression analysis was conducted to identify major contributing factors to different levels of functioning. RESULTS: Persons of older age, female, with chronic diseases (heart disease, stroke, fracture/dislocation) were consistently more likely to show a higher degree of functional limitation. There were variations, however, among other factors; e.g., those with arthritis were more likely to be only mildly impaired, but not moderately or severely impaired. CONCLUSIONS: Older Korean adults living in the community with impaired functioning constitute persons with diverse characteristics. Policy and program activities need to address specific needs of older people in different functioning states.
Activities of Daily Living ; Adult* ; Aged ; Arthritis ; Chronic Disease ; Female ; Health Services ; Humans ; Logistic Models ; Stroke

OBJECTIVES: Since 1991, nationwide massive neonatal screen-ing program for phenylketonuria (PKU) and congenital hypothyroidism have been performed in Korea. As in many other countries, efficiency of this program has not been definitely concluded. For the purpose of evaluation of this program, from the perspective of efficiency, a cost-benefit analysis was carried out. METHODS: Costs of the detection and the treatment program were compared with the projected benefit(avoided costs) that results from the prevention of the mental retardation associated with the disorders due to PKU and hypothyroidism. Costs and benefits were discounted at an annual rate of 5 %, and duration of life-long labor was assumed to be 30 years. Cost and benefit were estimated based on the detection rates of one case of PKU per 5,572 and one case of congenital hypothyroidism per 32,554 babies screened during 1991-1997. RESULTS: The benefit-cost ratio was 0.418. The sensitivity analysis for the discount rates and labor durations showed that most cost-benefit ratios were lower than one(1.0) except when discount rate was changed to 3% and detection rate to two- or threefold and/or labor duration to 40 years. CONCLUSIONS: The result of this study suggested that present program of mass screening for PKU and congenital hypothyroidism could not be justified in terms of efficiency. It doesn't coincide with the results of previous studies in major developed countries, presumably because of difference in detection rates and welfare cost for the disabled.
Congenital Hypothyroidism ; Cost-Benefit Analysis* ; Developed Countries ; Hypothyroidism ; Infant, Newborn ; Intellectual Disability ; Korea* ; Mass Screening* ; Metabolism, Inborn Errors* ; Neonatal Screening ; Phenylketonurias

OBJECTIVES: In Korea, as in most countries, there will be a sharp increase in the number of dementia patients in the near future. However basic data on dementia prevalence, which is important in defining epidemiologic characteristics and in implementing preventive strategy, are limited. This study was conducted to estimate the prevalence rate of dementia in the urban elderly aged 65 or older in Kwangmyung, Korea. METHODS: A two phase design was used for case finding and case identification. In phase I, a representative sample aged 65 or older was selected and interviewed by door-to-door survey with a Korean version of the Mini-Mental State Examination (K-MMSE). In phase II, Of the 946 subjects interviewed in phase I, 356 elderly were randomly selected disproportionately according to K-MMSE score. Of these elderly, 223 (61.5%) underwent standardized clinical evaluations, including psychiatric interview, neurological examination, and neuropsychological assessment. Dementia was diagnosed by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. The diagnosis of Alzheimer's disease (AD) was made by National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association(NINCDS-ADRDA) criteria and vascular dementia (VD) by DSM-IV. RESULTS: The overall weighted prevalence rate of all dementia among Kwangmyung residents aged 65 or older was 12.8%(age-adjusted rate: 13.0%, 95% Confidence Interval[CI]: 10.6-15.3%). Women had much higher prevalence rate than men even when age was controlled(15.9%[95% CI 12.6-19.2%] vs 7.5%[95% CI 4.6-10.4%]). The rates of dementia were 5.2%, 12.2%, 17.0%, and 34.3% for the age groups of 65-69, 70-74, 75-79 and 80 and over, respectively. The rate of AD appeared to be slightly higher than that of VD(5.2% vs 4.8%), though not statistically significant. Most of the cases(69%) were mild dementia according to CDR(<1) in these subjects. CONCLUSIONS: These results showed that the prevalence rate of dementia among urban elderly in Korea appears to be higher than those of other Asian countries.
Aged* ; Alzheimer Disease ; Asian Continental Ancestry Group ; Communication Disorders ; Cross-Sectional Studies ; Dementia* ; Dementia, Vascular ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Female ; Humans ; Korea* ; Male ; Neurologic Examination ; Prevalence*

OBJECTIVES: This study was conducted to evaluate factors related to the intention of participation in a worksite smoking cessation program. METHODS: To explain the health behavior of participating intention in a worksite smoking cessation program, the health belief model(HBM) was used as study model, and 144 self-administered questionnaires were completed by electronic company workers. Variables of the health belief model were composed of perceived susceptibility to smokinginduced disease, perceived severity of smoking-induced disease, economical gain as perceived benefit of smoking cessation, and nicotine dependency as perceived barrier of smoking cessation. Variables of sociodemographics, smoking status, knowledge about adverse health effects of smoking, and cues to smoking cessation were used as modifying factors. RESULTS: Perceived severity(POR=1.99, 95%CI: 1.03-3.83), perceived benefit(POR=2.11, 95%CI: 1.07-4.17), and perceived barrier(POR=0.29, 95%CI: 0.11-0.76) were significant variables to the intention of participation in a worksite smoking cessation program in the logistic regression analysis. The perceived severity was significantly affected by knowledge about adverse health effects of smoking(POR=2.17, 95%CI: 1.23-3.84). The perceived barrier was significantly affected by education level(POR=3.66, 95%CI: 1.17-11.44), age to first cigarette (POR=0.32, 95%CI: 0.10-0.98), pack-years(POR=5.47, 95%CI: 2.37-12.61). To the perceived benefit, the model was not fitted. CONCLUSIONS: Our results found that counterplans improving the knowledge about adverse health effects of smoking, preventing early smoking, and decreasing smoking amount should be considered for an effective smoking ban policy.
Cues ; Education ; Health Behavior ; Intention* ; Logistic Models ; Nicotine ; Surveys and Questionnaires ; Smoke* ; Smoking Cessation* ; Smoking* ; Tobacco Products ; Workplace*

OBJECTIVES: This study describes the risk factors affecting the unexpected readmission of 261 patients who were discharged from a university hospital in Seoul. METHODS: This case-control study reviewed medical records of inpatients who had been discharged from a hospital between 1 August 1995 and 31 October 1995 after the treatment for general diseases. The cases were 68 patients who were readmitted unexpectedly within 28 days of discharge from an index stay, and the controls were 193 patients who were discharged without readmission during the study period. RESULTS: Logistic regression analysis results were as follows; Patients who had no operation during their hospital stay were more likely to be readmitted unexpectedly than patients who had operation. Patients who had 1 or 2 parts of their body being involved in treatment were more likely to be readmitted unexpectedly than patients who hand more than 3 parts of their body being involved in treatment. Patients who had complications after surgery were more likely to be readmitted unexpectedly than patients who had no complications. Insufficient discharge planning caused unexpected readmissions. CONCLUSIONS: Discharge planning education should be extended to health care providers. And the assessment of discharge planning should be evaluated. Readmission is often necessary for the treatment of related problems originating from initial hospitalization, which causes cost problems. Unexpected readmission is preventable and the models for readmission can serve as a valuable clinical tool for high risk patients.
Case-Control Studies* ; Education ; Hand ; Health Personnel ; Hospitalization ; Humans ; Inpatients ; Length of Stay ; Logistic Models ; Medical Records ; Patient Discharge ; Risk Factors ; Seoul

OBJECTIVES: This study was performed to determine the relationships among Health concern, health practice and health status of the disabled. METHODS: A self-administered questionnaire survey was carried out for 1,662 disabled persons in Taegu city from April to July, 1997. RESULTS: Health concern had a significant and positive relationship with health practice(p<0.05) and health practice also had a significant and positive relationship with self-rated health status(p<0.05) in men and women. To determine the structural model of the Health concern, health practice, health status and sociodemographic variables, the covariance structural analysis was used. In men, age, economic status, medical security type, educational level and type of disability had significant direct effects on Health concern(T>2.0). Educational level and type of disability had significant direct effects on health practice(T>2.0). And Economic status, medical security type and job status had significant direct effects on health status(T>2.0). In women, economic status and educational level had significant direct effects on Health concern(T>2.0). However there was no variable which had a significant direct effect on health practice. Job status had a significant direct effect on health status(T>2.0). In men and women, health practice was significantly increased with increasing Health concern and the more health practice, the higher health status(T>2.0). CONCLUSIONS: It is recommended that the institutional approach which improve the economic status of the disabled with understanding their behavior and attitude should be established to increase health status, in addition, the health policy for encouraging the disabled, such as health education, consulting and health promotion program, should be done.
Daegu ; Disabled Persons ; Female ; Health Education ; Health Policy ; Health Promotion ; Humans ; Male ; Models, Structural ; Surveys and Questionnaires