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.
Aged ; Censuses ; Population Forecast ; Health Expenditures* ; Humans ; Inflation, Economic ; Insurance ; Korea

No abstract available.
Cytomegalovirus Infections* ; Cytomegalovirus*

To determine the effect of percutaneous transluminal coronary angioplasty on the left ventricular diastolic filling in patients with coronary artery disease, diastolic filling was serially examined before, early(within 2 days) and late(5~15 days) after PTCA using pulsed Doppler echocardiography in 14 patients(12 unstable angina; 2 stable angina). The Control group was consisted of 20 normal persons with similar age and sex distribution. The left anterior descending artery was dilated in 10 patients, the right coronary artery in 3 patients, and the circumflex artery in 1 patient. Peak velocity of early diastolic rapid inflow(E), peak velocity of late diastolic inflow (A), A/E ratio, and deceleration time of E wave were measured by pulsed Doppler echocar diography. 1) LVangiogram was performed in 10 patients, and showed normal wall motion in 7 cases and regional hypokinesia in 3 cases. Delta area decreasing rate was 59+/-10%, and LVEDP was 11+/-4 mmHg. 2) A/E ratio was greater in patient group(1.00+/-0.28) than in normal control (0.64+/-0.10) (p<0.05). There was no significant difference in A and E values between two groups. 3) A/E ratio decreased significantly from 1.00+/-0.28(pre-PTCA) to 0.85+/-0.24 (late post-PTCA) (p<0.01), but there was no significant change at early post-PTCA(0.94+/-0.32). Deceleration time also decreased significantly from 213+/-56 msec(pre-PTCA) to 177+/-34 msec (late post-PTCA) (p<0.05), but there was no significant change at early post-PTCA (199+/-34 msec). In conclusion, there was impairment of left ventricular diastolic filling in patients with coronary artery disease which gradually improved after PTCA, and this result probably is related to post-ischemic "stunned" myocardium.
Angina, Unstable ; Angioplasty, Balloon, Coronary ; Arteries ; Coronary Artery Disease* ; Coronary Vessels* ; Deceleration ; Echocardiography, Doppler, Pulsed* ; Humans ; Hypokinesia ; Myocardium ; Sex Distribution

In order to analyze academic achievement of medical students and its related factors, a total of 2,371 students who entered the premedical course of O university from 1987 were reviewed based on cohor t of their admission year. Those who did not promoted to medical college from premedical course in two years were 15% and those who did not graduate medical school in four years were 21%. The percentage of female students and outside Seoul residents has been growing. The percentage that students parents' occupation is medical profession has been decreasing. Those who failed during premedical course have higher conditional probability to fail during the medical studies. The results suggest that medical educators pay more attention to those who failed during the premedical course. Also the criteria whether students are failed or promoted to next grade is reasonable should be studied in depth.
Cohort Studies* ; Female ; Humans ; Occupations ; Schools, Medical ; Seoul ; Students, Medical*

BACKGROUND: Progression of coronary artery disease(CAD) is highly unpredictable, and follows a nonlinear course. In previous reports, progression was related to acute myocardial infarction and cardiac death. The present study was designed to assess the characteristics of progression of CAD and to ditermine the predictors for progression. METHODS: The present study included 41 patients(age 55+/-9 years ; male/female=36/5) with CAD who underwent coronary angiography at least twice(interval : mean 26 months), and patients who underwent coronary angioplasty of coronary bypass surgery before the 2nd angiograms were excluded from analysis. The coronary arterial bed was divided into 15 segments according to American Heart Association(AHA) committee report. We measured both % stenosis and minimal diameter of the lesions, and divided the lesions into four Ambrose's morphological categories. Progression was considered to be present if one of the following changes had occurred : increase in % stenosis of lesions by> or =20%, decrease in minimal diameter by> or =0.5mm, or any new occlusion. For the purpose of detecting predictors we investigated clinical history(smoking, hypertension, obesity, and DM), angiographic findings(numbers of diseased vessels and lesions), and biochemical study (total cholesterol, LDL, HDL, triglyceride, uric acid, and albumin). RESULTS: Altogether, 32 patients(78%) showed progression, and regression was present in 11 patients(27%). Six patients had both progressed lesions and regressed lesions. Progression occurred most frequently in segments with stenosis of 1% to 25% at initial arteriogram. Progression occured in increasing order in proximal right coronary artery, mid-LAD, and proximal LAD. There was no significant differences in progression among four Ambrose's morphologic categories. 59(10%) of the analyzable 589 segments had progressed, 19 them upto occlusion, and 7 segments became infarct related artery. In 5(71%) of 7 cases of new myocardial infarction it occurred in segments with< or =75% stenosis at initial arteriogram. The analysis selected two independent predictors for progression: uric acid and numbers of lesions> or =20% stenosis. CONCLUSION: The present study suggests that progression of CAD occurred most frequently in minimally stenotic lesions and that about two thirds of acute myocardial infarction occurred from insignificantly stenotic lesion. Uric acid level and numbers of lesions> or =20% stenosis were selelcted as the independent predictors of coronary disease progression.
Angioplasty ; Arteries ; Cholesterol, LDL ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Death ; Heart ; Humans ; Hypertension ; Myocardial Infarction ; Obesity ; Research Report ; Triglycerides ; Uric Acid

BACKGROUND: Reperfusion of ischemic myocardium has been postulated to result in a specific oxygen radical mediated tissue injury. Iron may liberate during ischemia and we hypothesized that administration of the iron chelator, deferoxamine during ischemia would result in improved recovery after postischemic reperfusion. PURPOSE: To test whether iron-catalyzed processes contribute to myocardial necrosis during ischemia and reperfusion, deferoxamine was administered to block iron catalyzed hydroxyl radical formation in rabbits. METHODS: Eleven rabbits were divided into two groups: control group (n=5) and deferoxamine pretreatment group (n=6). the left circumflex coronay artery was ligated for 30 minutes and reperfused for 180 minutes. Area at risk (AR) was measured by non-stained area with ethylene blue injection into left atrium after left circumflex coronary artery ligation. Infarct size was measured by weighing after tripheyltetrazolium chloride staining. Heart rate was measured using electrocardiographic recording and systemic blood pressure was monitored by pressure transducer connected to the catheter in the left ventricle. RESULTS: 1. There was no significant difference of heart rate and blood pressure in deferoxamine pretreatment group compared with control group. 2. There was significant decrease of serum iron concentration after continuous infusion of deferoxamine compared with serum iron concentration before ligation of coronary artery (P<0.05). 3. There was no significant difference of area at risk between control and deferoxamine pretreatment group. 4. Area at necrosis to area at risk was significantly reduced in deferoxamine pretreatment group compared with control group (P<0.05) The results suggest that deferoxamine infusion prior to coronary artery occlusion has a significant benefit in reducing infarct size in this model.
Arteries ; Blood Pressure ; Catheters ; Coronary Vessels ; Deferoxamine* ; Electrocardiography ; Heart Atria ; Heart Rate ; Heart Ventricles ; Hydroxyl Radical ; Iron ; Ischemia ; Ligation ; Myocardial Infarction* ; Myocardium ; Necrosis ; Oxygen ; Rabbits ; Reperfusion ; Transducers, Pressure

PURPOSE: Calcium-activated potassium channels(KCa) may be involved in the transient outward current of the first phase of cardiac action potential. But it is still not clear whether cardiac myocytes express any Kca. We try to identify here the types of Kc, expressed in rat caridac myocytes. METHODS: We isolated total heart RNA from 50 rats(Spague-Dawley) and performed reverse transcription-polymerase chain reaction(RT-PCR) using specifically designed synthetic oligonucleotide primer sets. From the pure culture of cardiac myocyte, Kc, gene expression was detected by Southern blot analysis. RESULTS: RT-PCR revealed expressions of BKca(large-conductance Kca, rSlo) and S&,(small-conductance Kca, rSK1). We prepared cardiac myocytes pure culture(>9596 pure myocyte) using pure culture technique. RT-PCR and Southern blot analysis of rat cardiac myocyte showed only rSK1-specific band, but no rSlo-specific was detected. CONCLUSION: The expressions of more than one type of Kca are detected from rat heart. A sub-type of SKcrSK1, was expressed in cardiac myocyte, while the main subunit of BKca(rSlo) was found in cells other than myocytes, most likely in the smooth muscle of cardiac blood vessels.
Action Potentials ; Animals ; Blood Vessels ; Blotting, Southern ; Culture Techniques ; Gene Expression ; Heart ; Muscle Cells ; Muscle, Smooth ; Myocytes, Cardiac* ; Potassium ; Potassium Channels, Calcium-Activated* ; Rats* ; RNA

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.
Humans ; Pediatrics ; Preventive Medicine*

The purpose of this study was to introduce the methodology of intervention analysis with time series data and to investigate the influence of the patient referral system on medical care utilization in Kangwha county. The data were obtained at the Kangwha Medical Insurance Society and we analysed the material based on the outpatient care fee. The results were as follows: 1. The average outpatient care utilization in the hospital decreased by 41.7% due to the patient referral system. 2. The utilization of the health institution increased by 278.8 persons per month due to the patient referral system. 3. The patient referral system did not influence the total outpatient care utilization. The methodology of intervention analysis, which detected the effect of intervention, will be helpful to the study of public health area.
Ambulatory Care ; Fees and Charges ; Humans ; Insurance ; Public Health ; Referral and Consultation*

A 39-year-old hairdresser developed sodium bromate poisoning after drinking a cup of hair neutralizer in a suicide attempt. This is the first case of visual loss afteringestion of sodium bromate. Only few cases are as a cause of acute renal failure reported in medical literature. She presented 1 day later with anuria, required hemodialysis. Sensorineural hearing loss, often a characteristic finding, was developed.
Acute Kidney Injury* ; Adult ; Anuria ; Deafness* ; Drinking ; Hair ; Hearing Loss, Sensorineural ; Humans ; Poisoning* ; Renal Dialysis ; Sodium* ; Suicide