The Accuracy of ICD codes for Cerebrovascular Diseases in Medical Insurance Claims / 예방의학회지

OBJECTIVES: We attempted to assess the accuracy of ICD codes for cerebrovascular diseases in medical insurance claims (ICMIC) and to investigate the reasons for error. This study was designed as a preliminary study to establish a nationwide surveillance system. METHODS: A total of 626 patients with medical insurance claims who indicated a diagnosis of cerebrovascular diseases during the period from 1993 to 1997 was selected from the Korea Medical Insurance Corporation cohort (KMIC cohort: 115,600 persons). The KMIC cohort was 10% of those insured who had taken health examinations in 1990 and 1992 consecutively. The registered medical record administrators were trained in the survey technique and gathered data from March to May 1999. The definition of cerebrovascular diseases in this study included cases which met one of two criteria (Minnesota, WHO) or 'definite stroke' in CT/MRI finding. We questioned the medical record administrators to explain the error if the final diagnoses were not coded as stroke. RESULTS: The accuracy rate of the ICMIC was 83.0% (425 cases). Medical records were not available for 8.2% (51 cases) due to the closing of hospitals, the absence of a computer system or omission of medical record, etc. Sixty-three cases (10.0%) were classified as impossible to interpret due to insufficient records in 'major clinical symptoms' or 'neurological deficits'. The most common reason was 'to meet review criteria of medical insurance benefits (52.9%)'. The department where errors in the ICMIC occurred most frequently was the department for medical insurance claims in the hospital. CONCLUSION: The accuracy rate of the ICMIC was 83.0%.

Hepatic Effect of Simultaneous Exposure to Nickel and Cadmium in Rats / 대한산업의학회지

OBJECTIVES: This research was intended to verify hepatic effect of simutaneously combined exposure of nickel chloride and cadmium chloride with IPRL(Isolated Perfused Rat Liver) method. METHODS: AST(aspartate aminotransferase), ALT(alanine aminotransferase), LDH(lactate dehydrogenase) and perfusion flow rate were used as the indicator of hepatotoxicity and oxygen consumption rate were used as the indicator of viability. 300(+/-50) g weighted rats were allocated randomly to each group (control group, 50 microM 200 microM separately exposure group of NiC1, and CdC1, simultaneously combined exposure group of NiC1 and CdC1) by 5, totally 35. Buffer which got out of liver was sampled and then biochemical indicator of hepatotoxicity was measured. In order to verify difference among groups, two way repeated ANOVA was used. With comparing mean summation of separate exposure group with mean of simultaneous exposure group, possibility that combined effect could be synergistic effect was verified. RESULTS: AST, ALT, LDH increased in both of separate exposure group and simultaneous exposure group. Perfusion flow rate and oxygen consumption rate decreased but statistically significant difference among groups was not found, In each exposure group, AST, ALT, LDH, oxygen consumption rate of simultaneous exposure group increased more than sum of separate exposure group after any sampling time. CONCLUSIONS: It was found that simultaneous combined effect could be synergistic effect through the biochemical indicator of hepatotoxicity.

The Epidemiological Characteristics of a Shigellosis Outbreak (1998) in Wonju City, Kangwon-Do / 한국역학회지

From September 8-28 1998, 55 cases of shigellosis, characterized by watery diarrhea, high fever, abdominal cramps and headache were reported at K elementary school in Wonju City. The isolated serotype was Shigella sonnei (group D). We collected bacteriologic specimens from high-risk populations, disinfected epidemic areas, and monitored all the medical facilities in Wonju City. Through these efforts, we found 168 cases of shigellosis, and of these, 117 were culture-confirmed and 51 were diagnosed by symptoms. The incidence rate per 10,000 population in Wonju City was 1.00 in males and 1.19 in females. The secondary attack rate was 13.6%. The mode of transmission at K elementary school was most often caused by the common epidemic source of single exposure. The source of infection was believed to be the foods distributed on September 7. However, epidemiologic evidence suggested that the sources of infection were scattered over many places within the city. The reasons included: i) shigellosis is an endemic disease in Korea; ii) there were shigellosis-like patients at J primary school in Wonju City in late August; and iii) there was a shigellosis outbreak at Chongil Myun, Hoeng Seong Gun, which was located near Wonju City, in early August.