Effects of Venlafaxine ER on Blood Pressure during the Acute Treatment of Major Depressive Patients / 대한정신약물학회지

OBJECTIVE: Venlafaxine is an antidepressant with a dual action of blocking reuptake of both serotonin and norepinephrine at therapeutic dose like some tricyclic antidepressants. However it may share the relative safety of SSRIs in overdosage and cardiotoxicity. One common concern for 1st line use of venlafaxine is the risk of hypertension. There have been some controversies about this adverse effect. In present study, we evaluate the effects of venlafaxine on blood pressure in therapeutic dose in acute treatment of major depressive patients. METHODS: The sample consisted of 65 major depressive patients who taken venlafaxine and 65 patients taken paroxetine, respectively. Blood pressure and other variables were evaluated in these subjects at baseline, 1 week, and 4 week of acute phase therapy, and mean blood pressure was compared each other by analysis of covariates. The incidence of sustained elevation of blood pressure during the study period was evaluated and stratified by age, sex, past history of hypertension, obesity, and dose of medication. These data were compared in two groups by chi square test and Fisher's Exact Test. RESULTS: At 1 week point, there were no significant differences between the two groups in mean blood pressure and other variables when controlling the baseline data. But at 4 week point, there was significant difference in mean diastolic pressure change between the two groups (venlafaxine group, -0.20+/- 6.98 mmHg;paroxetine group, 0.82+/-6.75 mmHg, p=0.020). When stratified by obesity (BMI>25), there was also significant difference in mean systolic and diastolic pressure change between the two groups at 4 week point (p=0.002;p=0.026). When comparing the incidence rate of sustained elevation of blood pressure during the study periods, only in venlafaxine group, three subjects developed elevation of blood pressure. When stratified the venlafaxine group with various factors, the incidence rate in the subjects who used high dose of venlafaxine (225 mg/day) was significantly different with those who used lower dose (below 225 mg/day). CONCLUSION: Our findings suggest that the use of venlafaxine can be associated with sustained elevation of blood pressure though used in therapeutic dose, but it can be detected with close monitoring and managed by reducing dose or hold the drug. In the future, to find out the risk factor of sustained elevation of blood pressure associated with venlafaxine use, large scaled and well controlled trials are needed.

Expression of the Matrix Metalloproteinase-2/9 and Tissue Inhibitor of Metalloproteinase-2 Proteins with Heterozygosity of p53 Gene in Thyroid Tumors / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mutations or overexpression of the p53 gene is believed to play an important role in the progression of various human malignant tumors. The type IV collagenase (matrix metalloproteinase: MMP) initiates the degradation of the extracellular matrix and consequently may play a role in the process of tumor invasion and metastasis. Although MMPs are known to be expressed in a variety of tissues and molecular studies in malignant tumor have shown the high frequency of loss of heterozygosity (LOH) in some specific regions, the study on the MMPs expression along with LOH on p53 gene related to clinicopathological parameters in thyroid tumors is very rare. MATERIALS AND METHOD: In this study, we examined the MMP-2, MMP-9 and tissue inhibitor of metalloproteinase (TIMP) -2 expression in association with p53 gene LOH using immunohistochemical method and molecular polymorphic analysis in 100 cases of thyroid tumors (50 papillary carcinomas, 10 follicular carcinomas, 20 follicular adenomas, 20 nodular hyperplasias). LOH was examined at four p53 gene related microsatellite loci including TP53, D17S796, D17S5, D17S513. RESULTS: By immunohistochemistry, MMP-2 expression was detected in 37 (74%) papillary carcinomas, 4 (40%) follicular carcinomas, 5 (25%) follicular adenomas and 2 (10%) nodular hyperplasia cases. MMP-9 expression was detected in 35 (70%) papillary carcinomas, 4 (40%) follicular carcinomas, 4 (20%) follicular adenomas and 2 (10%) nodular hyperplasia cases. TIMP-2 expression was detected in 32 (64%) papillary carcinomas, 4 (40%) follicular carcinomas, 4 (20%) follicular adenomas and 1 (5%) nodular hyperplasia cases. By PCR-polymorphism study, p53 LOH was detected in 31 (62%) papillary carcinomas, 8 (80%) follicular carcinomas, 6 (30%) follicular adenomas and 0 (0%) nodular hyperplasia cases. The differences in MMP-2, MMP-9 and TIMP-2 expression rates and p53 LOH between malignant and benign tumors were statistically significant. Also, MMP-2, MMP-9, TIMP-2 expression and p53 LOH correlated well with higher tumor histologic grade. Also statistically significant correlation was found between p53 LOH and lymph node metastasis. The MMP-2 expression showed increased tendency of lymphatic emboli formation and lymph node metastasis, but there was not statistically significant. MMP-2 expression was well correlated with MMP-9 expression and p53 LOH, but there is no remarkable correlation of expression of MMP-2 and MMP-9 comparable to TIMP-2 expression. CONCLUSION: We concluded that the expression of MMP-2, MMP-9 and TIMP-2 with p53 LOH may contribute to the malignant transformation and poorly differentiated grade in thyroid tumors. Also, MMP-2 expression may be regulated by p53 gene.

Treatment of Two Cases of Retropharyngeal Hematomas / 대한이비인후과학회지

Retropharyngeal hematoma is a rare lesion developed after trauma. The development of retropharyngeal hematoma following minor trauma is a rare occurrence. Because this lesion has the possibility of compressing the potential airways, the rapid assessment and treatment are needed. This article discusses two cases of hematoma formation in the retropharyngeal space in an elderly drunken man after a seemingly minor injury. Management is consisted of tracheostomy, endotracheal intubation, and aspiration of hematoma. And retropharyngeal hematoma is associated with cervical extension or flexion injuries, anticoagulation therapy, great vessel trauma, and foreign body ingestion, etc.

A prospective study of Helicobacter pylori reinfection rate and related factors in Gyeongju-si residents / 대한내과학회지

BACKGROUND: High prevalence of Helicobacter pylori (H. pylori) in developing countries may result in high reinfection rate after eradication therapy, but there were few studies on H. pylori reinfection, especially in community population. The aim of this study was to investigate the one -year reinfection rate of H. pylori after successful eradication therapy and the factors related to the reinfection of H. pylori in community population. METHODS: 86 persons who had been confirmed as H. pylori-negative by 13C-urea breath test were included. They were ones of 181 persons treated by eradication regimen one year ago because of H. pylori-positive in serologic H. pylori antibody test and rapid urease test. The reinfection rate of H. pylori and the factors related to the reinfection of H. pylori were investigated after one-year follow-up. The subjects were confirmed as H. pylori reinfection by repetitive 13C-urea breath test and asked to answer the questionnaire regarding demographic characteristics, dyspepsia symptoms, health-related behaviors and family history. RESULTS: The one-year reinfection rate was 18.6% in this study. The one-year reinfection rate of the subjects who aged above 50 years was 23.4% (p < 0.05). The symptom score (total 5) was positively related to H. pylori reinfection (p < 0.05). In multivariate logistic regression analysis, the subjective symptom score was the significant factor in predicting H. pylori positivity by 13C-urea breath test (OR=4.5, p < 0.05). CONCLUSION: During 1 year period after successful H. pylori eradication, the reinfection rate of H. pylori was 18.6%. The subjective symptom score survey by questionnaire may be useful predictor of H. pylori reinfection in community setting.

Analysis of a Functional Serotonin Transporter Gene Polymorphism of Normal Controls and Patients with Schizophrenia in Korean Population / 신경정신의학

OBJECTIVE: Serotonin is a neurotransmitter which might play an important role in the pathophysiology of schizophrenia. As atypical antipsychotics, which antagonize serotonin receptors, exert effects on negative symptoms of schizophrenia, perturbation of serotonin system has been thought as a good indicator to probe the pathogenesis of schizophrenia. Serotonin transporter is crucial for regulating serotonergic neurotransmission and has a deletion/insertion polymorphism of the gene's transcriptional initiation site. This study was designed to examine the association of schizophrenia and polymorphism of serotonin transporter gene (5-HTTLPR). METHODS: Genomic DNA analysis with polymerase chain reaction (PCR) was used for genetic typing of polymorphism of 5-HTTLPR. It was carried out among a total of 111 patients with schizophrenia and 208 normal controls. The significances of genetic association of the polymorphisms with the disease and with clinical variables were estimated by chi-square test and analysis of variances. RESULTS: The results were as follows: 1) There were no significant differences in allelic or genotype frequencies between the group of patients with schizophrenia and controls. 2) There were no significant differences in positive syndrome scale score of positive and negative syndrome scale (PANSS), duration of illness and number of admission according to 5-HTTLPR genotypes. 3) There was a difference in age at onset according to 5-HTTLPR genotypes. 4) There was a significant difference in negative syndrome scale score and general psychopathology score of PANSS according to 5-HTTLPR genotypes. CONCLUSION: These results suggest that polymorphism of serotonin transporter gene might be related to the pathophysiology of schizophrenia.

Prevalence and Related Factors of Knee Osteoarthritis in Rural Woman / 예방의학회지

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

A Case of Hemangioendothelioma on the Nasal Septum / 대한이비인후과학회지

Hemangioendothelioma(HE) is a rare intermediate-grade malignant vascular neoplasm first described in 1982 by Weiss and Enzinger as a specific entity. The HE is differentiated by both in its characteristic behavior and histologic appearance into benign (hemangioma) and malignant tumor (angiosarcoma). The tumor rarely occurs in the nose and paranasal cavity. At least four distinct entities are recognized within HE: epitheloid HE, spindle cell HE, kaposiform HE, malignant endovascular papillary angioendothelioma. However, it is difficult to classify a small remaining group of vascular neoplasms that show a considerable overlap in their histologic appearance. The composite and polymorphous HE are therefore classified separately. Surgical excision is the treatment of choice. Generally, the prognosis is good. The authors recently experienced a case of HE on the nasal septum which was treated by excision. We report this case with the review of literature.

The Patient Recognition, Acceptability and Evaluation of Feasibility for Day Surgery / 예방의학회지

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

Community-based Helicobacter pylori Screening and its Effects on Eradication in Patients with Dyspepsia / 예방의학회지

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

Association between Cognitive Impairment and ADL of the Elderly in Rural Area / 예방의학회지

OBJECTIVES: The purpose of this investigation was to study the correlation between cognitive impairment and activities of daily living(ADL) in the elderly of rural area. METHODS: The study population consisted of 210 elderly people aged 65 years and older, living in a district of Kyongju City. The cognitive impairment was measured with the Korean version of mini-mental state examination(MMSE-K) and newly constructed the Korean version of mini-mental state examination (K-MMSE). Bristol activities of daily living scale developed specifically to be used with people with dementia was used to measure ADL. RESULTS: The mean scores of both MMSE-K and K-MMSE were significantly different by sex groups and by age groups, respectively(p<0.05). The mean scores of ADL were significantly different by age groups(p<0.01) not by sex groups. Among the 4 components of ADL(instrumental activities of daily living(IADL), self care, orientation, and mobility), the mean score of the orientation was significantly higher in men(p<0.01); and IADL, orientation and mobility components were significantly different by age groups(p<0.01). ADL correlated well with MMSE-K (r=0.54) and K-MMSE(r=0.52) and showed higher correlation in female (r=0.73, 0.71) than male(r=0.27, 0.29). IADL and orientation showed significant correlation with MMSE-K(r=0.52, 0.62) and K-MMSE(r=0.50, 0.63), respectively(p<0.01). CONCLUSIONS: In developing and establishing a care model for people with dementia in the community, both cognitive impairment and the activities of daily living(ADL) need to be considered.

The Association of Pap Smear, Health Screening Testsand Health Promotion Activities / 대한산부인과학회잡지

A survey with self-administered questionnaire method to examine the association of Pap Smear health screening tests and health promotion activities for 500 women who visited OPD of Obstetrics and Gynecology. The compliance of pap smear of the rich, married, house wife and self employed women was higher than others. Women who received Pap smears were significantly more likely to receive breast examiniations, mammograms, gastrofibroscopy and regular blood pressure check-up. The Pap smear was associated with health promotion activities such as own private physician, no cooling beverage intake, milk intake and heptitis B vaccination. In conclusion, health care providers may use the Pap smear as a marker of whether a woman has received screening for several other medical problems. Thus, the Pap smear can be considered a "sentinel" test for health screening in women.

Knowledge and Attitude about AIDS among Teachers in Taegu City / 영남의대학술지

The AIDS is a serious health problem worldwide today and also in Korea. Increasing knowledge and modification of behavior by health education is an important goal of human immunodeficiency virus(HIV) prevention strategies. And school health education is an important part of health education. This study was conducted to evaluate the knowledge and attitude about AIDS in teachers and professors in Taegu City and to provide the basic data for school health education. A self-administered questionnaire was given to 1,124 teachers and professors from April to June 1992. Indeed, the majority of the teachers and professors have a lot of knowledges about AIDS, but many of them also have misconceptions. The level of knowledge about AIDS was positively associated with attitude toward infected students. The sources of knowledge about AIDS were mainly TV, newspapers and magazines, but a few of the subjects obtained their knowledge from health education programs. This study suggest., that the reinforcement of health education for the teachers, professors and students be needed to provide the accurate knowledge on AIDS and adequate knowledge sources and materials for school health education on AIDS should be developed.

Demand of Work-site Health Promotion Program for Employees / 대한산업의학회지

This study was conducted to identify the demand of work-site health promotion program of employees. A self-administered questionnaire method was uses to collect data from 492 employees from 40 work-sites in Taegu City and Kyungpook Provincial area. The work-site health screening programs conducted for several years were placed low value by employees. The out-door exercise was the most popular heath promotion activity implemented at work-site as a whole. The employees expressed that periodic health check-up, the health counseling, indoor exercise would be implemented as a health promotion program in the future. The male employees regarded that the periodic health check-up program should be established preferentially at work-site. However, the female employees gave priority to fitness program. The health related behavioral patterns slightly influenced the preference of health promotion program. The health screening program for employees should be improved and the health education of nutrition and diet for female employees should be implemented.

Demand of Work-site Health Promotion Program for Employees / 대한산업의학회지

This study was conducted to identify the demand of work-site health promotion program of employees. A self-administered questionnaire method was uses to collect data from 492 employees from 40 work-sites in Taegu City and Kyungpook Provincial area. The work-site health screening programs conducted for several years were placed low value by employees. The out-door exercise was the most popular heath promotion activity implemented at work-site as a whole. The employees expressed that periodic health check-up, the health counseling, indoor exercise would be implemented as a health promotion program in the future. The male employees regarded that the periodic health check-up program should be established preferentially at work-site. However, the female employees gave priority to fitness program. The health related behavioral patterns slightly influenced the preference of health promotion program. The health screening program for employees should be improved and the health education of nutrition and diet for female employees should be implemented.

Premedical Students' Motivations for a Career as a Physician / 한국의학교육

The motivation and timing of the decision to be a physician were examined for premedical students of three universities in Taegu. The primary motivation for seeking a career in medicine was the spirit of service to mankind, but the economic reward was also important value. A number of students could not make a decision to enter a medical school just before admission test. There was a correlation between the motivation, timing and autonomy of decision to be a physician with the academic satisfaction of premedical students. The students who motivated by a spirit of service, made a decision earlier or got a autonomy in decision-making to enter a medical performed a better premedical preparation.

Effects of Regional Medical Insurance on Utilization of Medical Care in Urban Population / 예방의학회지

The effects of regional medical insurance on utilization of medical care in urban population was examined in this study. The data was collected in a 2-year follow-up household survey conducted at Taegu city before and after implementation of the regional medical insurance. The study population was divided into 2 groups. Cohort I was the uninsured in 1989 and cohort II was the insured in 1989. After the coverage of medical insurance, physician visit rate per 1,000 population, use-disability ratio and use-restricted activity ratio in cohort I were increased compared to cohort II in both of acute and chronically ill people. The use-disability ratio and use-restricted activity ratio of the insured poor were lower than those of the insured nonpoor in both of cohort I and cohort II. The major reasons for pharmacy use were accessibility and affordability before the coverage of medical insurance in cohort I, however, after the coverage of medical insurance, the important reason was accessibility rather than affordabifity. In logistic regression analysis of physician visit, the significant independent variables were acute illness episode(+), chronic illness episode(+) and income(+) in both of cohort I and cohort II. In cohort I, after the coverage of medical insurance, more people replied that the medical cost of hospital and clinic was reasonable. The people who covered by the regional medical insurance were more dissatisfied with the imposed premium than those who covered by other types of medical insurance in both of cohort I and cohort II. More people in cohort II than cohort I were dissatisfied with the services from hospitals and clinics after implementation of the regional medical insurance. In conclusion. after the coverage of medical insurance, the gap between the poor and the nonpoor still exists in terms of medical care utilization.

Morbidity pattern of residents in urban poor area by health screening / 영남의대학술지

The purpose of this study was to assess the morbidity pattern of urban residents in the poor area by health screening for the community diagnosis. The items of health screening were history taking and physical examination by medical doctor and hearing test, check blood pressure, test for hematocrit, liver function (sGOT, sGPT), urine sugar and protein, and chest X-ray. The examinee in health screening were 437 persons and they occupied 16.9% of total residents in the poor area. Male examinee were 129 persons (9.9% of total residents) and female examinee were 308 persons (23.9% of total residents). Age group of above sixty years old, 42.0% of total residents in the poor area were participated, but only 5.9% were participated in age group of 10 to 19 years old. Among the 437 examinee, 191 persons (43.7%) had one or more abnormal findings in health screening. In male 38.7% had abnormal findings, and somewhat lower than that of female (45.8%). Age group of above sixty years had most high rate of abnormal findings (69.8%), in contrast to age group of 10 to 19 years old (10.9%). Diseases of the digestive system was the most common and which occupies 23.7% of total abnormal findings. And diseases of the circulatory system occupied 19.7%. Low hematocrit (14.6% of total participants of 437 persons) occupies the most common abnormal findings for screening test (hematocrit, blood pressure, hearing test, sGOT/sGPT, urine protein and urine sugar, chest X-ray) and high blood pressure (10.1%) occupied second, third; hearing impairment (5.5%), fourth; abnormal liver function (4.1%), fifth; sugar in urine (2.3%), sixth; protein in urine (1.4%) and lastly abnormal chest X-ray (0.9%). The positive rate of abnormal findings in health screening was very high compared with morbidity rate by health interview. It is supposed that some portion of this high rate is by selection bias in examinee in health screening specially high participating rate in older age, and the other portion is due to the low socioeconomic status and bad environment of the residents of the poor area. These findings will be good information for the research and development of health care system in the urban poor area.

Morbidity pattern and medical care utilization behavior of residents in urban poor area / 영남의대학술지

The purpose of the study was to assess the morbidity pattern and the medical care utilization behavior of urban residents in the poor area. The study population included 2,591 family members of 677 households in the poor area of Daemyong 8 Dong, Nam-Gu, Taegu and 2,686 family members of 688 households, near the poor area in the same Dong, were interviewed as a control group. On this study the household interview method was applied. Well-trained interviewers visited every household in the designated area and individually interviewed heads of households or housewives for general information, morbidity condition, and medical care utilization with a structured questionnaire. Individuals were interviewed from 1 to 30 December 1988. The major results were summarized as follow: The proportion of the people below 5 years of age was 4.2% of the total study population and 5.5% were above 65 years of age in the poor area. This was slightly higher than in the control area. The average monthly income of a household in the poor area was 403,000 won versus 529,000 won in the control area. Fifty-eight percent of the residents in the poor area and sixty-one percent in the control area were medical security beneficiaries, but the proportion of medical aid beneficiaries was 7.8% in the poor area and 4.6% in the control area. The 15-day period morbidity rate of acute illnesses was 57.1 per 1,000 in the poor area and 24.2 per 1,000 in the control area. Respiratory disease is the most common acute illness in both areas. The most frequently utilized medical facility was the pharmacy among the patients with acute illnesses in the poor area. Among them 58.1% visited pharmacy initially while 38.4% of the patients in the control area visited a clinic. Among persons with illnesses during the 15 days, 8.8% in the poor area and 4.6% in the control area did not seek any medical facility. Mean duration of utilization of medical facilities was 3.5 days in the poor area and 3.3 days in the control area. Initially of the medical facilities in Daemyong 8 Dong, The pharmacy in the poor area and the clinic in the control area were most commonly utilized. The most common reason for visiting the hospital was 'regular customers' in the poor area and 'geographical accessibility' in the control area. The one year period morbidity rate of chronic illness in the poor area was 83.0 per 1,000 population and 28.0 per 1,000 in the control area. Disease of nervous system was the most common chronic illness in the poor area while cardiovascular disease in male and gastrointestinal disease in female were most prevalent in the control area. The most frequently utilized medical facility was the pharmacy among the patients with chronic illnesses in the poor area. Among them 24.2% visited the pharmacy initially while 34.7% of the patients in the control area visited the out-patient department of the hospital within a 15-day period. Among the patients with chronic illnesses 34.9% in the poor area and 16.0% in the control area did not seek any medical facility. Mean duration of utilization of medical facilities was 9.2 days in the poor area and 9.9 days in the control area within a 15-day period. Initially of the medical facilities in Daemyong 8 Dong, the pharmacy in the poor area and the hospital in the control area were most commonly utilized. The most common reason for visiting the hospital, clinic, health center or pharmacy in the poor area was 'geographical accessibility' while the reason for visiting herb clinic was 'good result' and 'reputation' in both areas.

Comparison of medical care utilization patterns between beneficiaries of medical aid and medical insurance / 영남의대학술지

A household survey was conducted to compare the patterns of morbidity and medical care utilization between medical aid beneficiaries and medical insurance beneficiaries. The study population included 285 medical aid beneficiaries that were completely surveyed and 386 medical insurance beneficiaries selected by simple random sampling from a Dong (Township) in Taegu. Well-trained surveyors mainly interviewed housewives with a structured questionnaire. The morbidity rates of acute illness during the 15-day period, were 63 per 1,000 medical aid beneficiaries and 62 per 1,000 medical insurance beneficiaries. The rates for chronic illness were 123 per 1,000 medical beneficiaries and 73 per 1,000 medical insurance beneficiaries. The most common type of acute illness in medical aid and medical insurance beneficiaries was respiratory disease in medical aid beneficiaries, musculoskeletal disease was most common, but in medical insurance beneficiaries, gastrointestinal disease was most common. The mean duration of acute illness of medical aid beneficiaries was 3.8 days and that of medical insurance beneficiaries was 6.8 days. During the one year period, mean duration of medical aid beneficiaries chronic illnesses was 11.5 months which was almost twice as long compared to medical insurance beneficiaries. Pharmacy was most preferable facility among the acute illness patient in medical aid beneficiaries, but acute cases of medical insurance beneficiaries visited the clinic most commonly. Chronic cases of both groups visited the clinic most frequently. There were some findings suggesting that much unmet need existed among the medical aid beneficiaries. In acute cases, the average number of days of medical aid users utilized medical facilities was less than medical insurance users. On the other hand, the length of medical care utilization of chronic cases was reversed. Geographical accessibility was the most important factors in utilization of medical facilities. Almost half of the study population answered the questions about source of funds on medical security correctly. Most respondents considered that the objective of medical security was affordability. The chief complaint on hospital utilization was the complicated administrative procedures. These findings suggest that there were some problems in the medical aid system, especially in the referral system.

A study on the accidents of the residents in a rural area / 영남의대학술지

To determine the incidence rate of accidents and its associated factors, a prospective survey was carried out in a rural area of a total of 1,360 residents for 1 year from January 1 to December 31, 1988 in Shin-am Ri, Jungdong Myun, Sangju Kun, Kyeongpook Province. Data for accidents were collected by the community health practitioner who is working at Primary Health Post in Shin-am Ri. A total number of accident cases was 85 among 1,360 persons during one year study period, and annual incidence rate was 62.5 per 1,000 persons. The highest incidence rate of accident was observed in the age group of 30-39 was 179.8. The incidence rate of accident in male was 86.5 which was about 2 times that in female. In male, the highest incidence rate was seen in 30-39 age group and in female, 60-69 age group. The highest incidence rate of accident was observed in spring (29.4%) and summer (29.4%), and the lowest in fall (17.7%). The highest incidence rate of accident was observed in Friday (24.5%) by day of week, and between 9 a.m. to 12 a.m. by time zone. The most frequent use of medical facilities was Primary Health Post (51.8%) and the next was clinic (38.8%). Mean duration of treatment was 9.8 days. The accident occurred in the room and kitchen (23.5%), in the yard and barn (23.5%), on the road (22.4%), and in the rice field and dry field (20.0%). The causes of accident were motor vehicle accident (20.0%), piercing or cutting (20.0%), collision or fighting (12.9%), and poisoning (11.8%) in order of frequency. The most common type of injury was open wound which was 43.5%. The most common tool of accident was farm machine which was 23.5%. The most common injured part of body was extremity 55.3%.