Health Indicators Related to Disease, Death, and Reproduction / 예방의학회지

One of the primary goals of epidemiology is to quantify various aspects of a population’s health, illness, and death status and the determinants (or risk factors) thereof by calculating health indicators that measure the magnitudes of various conditions. There has been some confusion regarding health indicators, with discrepancies in usage among organizations such as the World Health Organization the, Centers for Disease Control and Prevention (CDC), and the CDC of other countries, and the usage of the relevant terminology may vary across papers. Therefore, in this review, we would like to propose appropriate terminological definitions for health indicators based on the most commonly used meanings and/or the terms used by official agencies, in order to bring clarity to this area of confusion. We have used appropriate examples to make each health indicator easy for the reader to understand. We have included practical exercises for some health indicators to help readers understand the underlying concepts.

Health Indicators Related to Disease, Death, and Reproduction / 예방의학회지

One of the primary goals of epidemiology is to quantify various aspects of a population’s health, illness, and death status and the determinants (or risk factors) thereof by calculating health indicators that measure the magnitudes of various conditions. There has been some confusion regarding health indicators, with discrepancies in usage among organizations such as the World Health Organization the, Centers for Disease Control and Prevention (CDC), and the CDC of other countries, and the usage of the relevant terminology may vary across papers. Therefore, in this review, we would like to propose appropriate terminological definitions for health indicators based on the most commonly used meanings and/or the terms used by official agencies, in order to bring clarity to this area of confusion. We have used appropriate examples to make each health indicator easy for the reader to understand. We have included practical exercises for some health indicators to help readers understand the underlying concepts.

Changes in the Distribution of Maternal Age and Parity and Increasing Trends in the Low Birth Weight Rate in Korea Between 1995 and 2005 / 예방의학회지

OBJECTIVES: This study measured the impact of shifts in maternal age and parity on the increase in the low birth weight (LBW) rate in Korea. METHODS: We obtained raw data for all 6 397 945 live births registered at the Korea National Statistical Office between 1995 and 2005. We calculated the proportion of increment in the LBW rate due to changes in the distribution of maternal age and parity (AP-dis) and the proportion due to changes in the age- and parity-specific LBW rate (AP-spe). RESULTS: The LBW rate increased from 3.02% in 1995 to 4.28% in 2005. The multiple birth rate increased from 1.32% to 2.19% during the same period. Of the 1.26% points increment in the LBW rate, 0.64% points occurred among singleton births and 0.62% points occurred among multiple births. Changes in the AP-dis accounted for 50% of the increase in the LBW rate among singleton births, but did not contribute to the increase in the LBW rate among multiple births. The remainder of the total increment in the LBW rate was explained by the increase in the AP-spe. CONCLUSIONS: This study demonstrated that shifts in maternal age and parity among singleton births and increased multiple births were important contributors to the increment in the LBW rate. This study also revealed that the increase in the AP-spe was an equally important contributor as the shifts in maternal age and parity to the increment in the LBW rate among singleton births and was a major contributor among multiple births.

The Relationship between Developmental Quotient in Children with Delayed Language Development and Later Intellectual Quotient / 소아과

PURPOSE: The objective of this study was to test the predictive validity of developmental test for later intellectual development in young children with delayed language development. METHODS: The study subjects were 66 children who had presented delayed language development and had an initial developmental test and a follow-up intelligence test. The mean age at initial test was 34.2 months(17-48 months), and the mean age at the follow-up test was 55.0 months(40-79.5 months). RESULTS: According to CAT DQ(Cognitive Adaptive Test Developmental Quotient), 66 children were divided into 4 groups: group I(CAT DQ = or85). There was a moderate correlation between CAT DQ and later total IQ in group I(r=0.58) and II(r= 0.50), but a low correlation in group III(r=0.19) and IV(r=-0.16). IQs in follow-up tests of all children in group I and II were lower than 70, except two children whose IQs were 75 and 78. IQs of children in group III were lower than 85 except for three children whose IQs were 89, 89, and 90, respectively. CONCLUSION: The findings of this study suggest that if DQ is lower than 70, the child is highly probable to be mentally subnormal in later years. Although the correlation between CAT DQ and later total IQ is low in children with DQs over 70, if a DQ is between 70 and 84, the child is very likely to have learning disability in later years.

Annual Visit Days, Prescription Days and Medical Expenses of Hypertensive Patients / 예방의학회지

OBJECTIVES: To evaluate the annual visit days, the annual prescription days and the medical costs of hypertensive patients. METHODS: The medical insurance records of 40,267 incident patients with the diagnostic code of hypertension from September 1998 through August 1999 in Daegu city were reviewed. RESUJLTS: The proportion of the most proper medical care pattern group (Group VIII) who visited for 6-15 days with 240 prescription days or more a year was only 6.2%. The proper care group (Group IX) who visited for more than 16 days with 240 prescription days or more a year was 9.3%. The overall proper care group (Group VIII+IX) was therefore 15.5%. The proportion of the insufficient care group (Group I,IV) in both the number of visiting days and prescription days was 57.4%. The mean prescription day of the most proper group (Group VIII) was 29 days; the mean annual medical expenses, 453,587won; the mean annual amount paid by patients, 218,013won; and mean medical expenses per prescription day, 1,483won. The proportion of the overall proper care group (Group VIII+IX) was significantly higher in adults aged 50-59, those who were enrolled in industrial workers health insurance as well as government employees and private school teachers health insurance, and those who made a higher contribution per month (p<0.01). According to the type of medical facilities, the proportion of the most proper medical care pattern group was highest in the general hospitals (9.3%) but the overall proper care group was higher in the public health centers (22.1%) and private clinics (17.1%). CONCLUSIONS: The management system of hypertension should be reinforced urgently. Therefore, it is necessary to develop guidelines including the number of visiting days per year and prescription days per visit day, and make the system provide medical facilities to more properly care for hypertensive patients.

Annual Visit Days, Prescription Days and Medical Expenses of Hypertensive Patients / 예방의학회지

OBJECTIVES: To evaluate the annual visit days, the annual prescription days and the medical costs of hypertensive patients. METHODS: The medical insurance records of 40,267 incident patients with the diagnostic code of hypertension from September 1998 through August 1999 in Daegu city were reviewed. RESUJLTS: The proportion of the most proper medical care pattern group (Group VIII) who visited for 6-15 days with 240 prescription days or more a year was only 6.2%. The proper care group (Group IX) who visited for more than 16 days with 240 prescription days or more a year was 9.3%. The overall proper care group (Group VIII+IX) was therefore 15.5%. The proportion of the insufficient care group (Group I,IV) in both the number of visiting days and prescription days was 57.4%. The mean prescription day of the most proper group (Group VIII) was 29 days; the mean annual medical expenses, 453,587won; the mean annual amount paid by patients, 218,013won; and mean medical expenses per prescription day, 1,483won. The proportion of the overall proper care group (Group VIII+IX) was significantly higher in adults aged 50-59, those who were enrolled in industrial workers health insurance as well as government employees and private school teachers health insurance, and those who made a higher contribution per month (p<0.01). According to the type of medical facilities, the proportion of the most proper medical care pattern group was highest in the general hospitals (9.3%) but the overall proper care group was higher in the public health centers (22.1%) and private clinics (17.1%). CONCLUSIONS: The management system of hypertension should be reinforced urgently. Therefore, it is necessary to develop guidelines including the number of visiting days per year and prescription days per visit day, and make the system provide medical facilities to more properly care for hypertensive patients.

The Principle and Practice of PBL / 한국의학교육

No abstract available.

Epidemiologic Study for the Association between Phenol Contaminated Drinking Water and Poor Pregnancy Outcomes in Taegu City / 한국역학회지

From 14 to 17 March 1991 the Nakdong River which is a major source of drinking water for Taegu was contaminated with phenol that was spilled out of a factory in Gumi industrial park. Many people who drank the contaminated water complained of various symptoms and were apprehensive of possible adverse effect to the fetus. This study was conducted to examine the effect of drinking water contaminated with phenol on pregnancy outcome in Taegu. All of livebirths and stillbriths delivered in the 5 General Hospitals in Taegu during 1 year from 1 April 1991 were included for this study. For this duration, total number of babies delivered in the 5 General Hospitals was 21,196. Among them, 77.7%(16,468) were delivered from women living in Taegu and it accounted for 47.5% of 34,688 livbirths registered in Taegu during the same period. The babies born to the women living in Taegu were divided into phenol-exposed and unexposed groups. Exposed group was the residents of the area where contaminated water was supplied and they accounted for 81.4% of the women included for this study. Unexposed group was the residents of the area where drinking water was not contaminated with phenol and they accounted for 18.6% of the study subjects. Data were abstracted from the hospital records. All the rates were adjusted for the maternal age and parity by direct method. The abortion rates for the exposed group was 1.7 per 1,000 abortions and livebirths and 1.6 for the unexposed group. The stillbirth rate for the exposed group was 10.5 per 1,000 livebirths and stillbirths 20 weeks of gestation and 9.5 for unexposed group. The early neonatal death rate(within the 1st week after birth) for the exposed group was 7.8 per 1,000 livebirths and 5.4 for the unexposed group. The perinatal death rate for the exposed group was higher as 14.1 per 1,000 livebirths and stillbirths 28 weeks of gestation than 10.8 for the unexposed group. The proportions of intrauterine growth retardation(IUGR) were 2.7% for the exposed group and 3.3% for the unexposed group. Congenital anomaly incidence rates per 1,000 livebirths was 7.4 for the exposed group and 8.4 for the unexposed group. The low birthweight incidence rate for the exposed group was 6.6% and 6.5% for the unexposed group. These differences between two groups were not statistically significant. The premature birth rate(< 37 completed gestational week) was 6.0% for the exposed group and 4.8% for the unexposed group and the difference was statistically significant(p<0.05). Monthly variation of these indices did not show any clue that suggested concurrent change with the phenol contamination of the drinking water. There were no sufficient evidence that could support the hypothesis of adverse effects of phenol contaminated water on pregnancy outcome, such as abortion, stillbirth, premature birth, IUGR, congenital anomalies and early neonatal death.

Views of Korean Medical Students on the Medical Education and Medical Care

No abstract available.

Survey on Behavioral Science Education in Korean Medical Schools and Development of a Standard Syllabus / 한국의학교육

OBJECTIVES: To survey the behavioral science education in Korean medical schools and to develop a standard syllabus for behavioral science course. SUBJECTS: Professors who are in charge of behavioral science course in 32 medical schools in 1996. METHODS: To develop a standard syllabus of behavioral science course for medical school Delphi technique was used. A questionnaire was mailed to each professor who was in charge of the behavioral science course in 32 medical schools to ask about the course objectives and contents and educational method in January 1996 and 27 questionnaires were completed and returned. The course objectives and syllabi of 27 medical schools were listed and mailed to the same professors to check his/her opinion on the necessity of each item for the behavioral science course. Twenty-three questionnaires were returned and analyzed. The opinion of 23 respondents on each objective and syllabus were listed again and mailed back to the respondents and asked to check if he/she agree with the other respondents' opinion. Nineteen questionnaires were collected. From this results a standard syllabus was developed. RESULTS: We recommend that educational objectives of behavioral science course for medical students include understanding of human behavior in biologic, psychologic and sociocultural contexts, understanding of the relationship between body and mind (stress and diseases), acquiring techniques for establishing doctor-patient relationship, and acquiring knowledge and skill for holistic approach to patient care. Recommendable syllabi for behavioral science course are medicine and behavioral science (basic principles of human behavior), body and mind, growth and development, family and health, medical care and society and culture, illness behavior, physician's identity, doctor-patient relationship, communication (clinical interview), and psychologic aspects of human behavior. We recommend that the behavioral science course be offered in the first and second grades of medical students, be integrated into the medical curriculum to link better with clinical courses. Duration of course needs to be expanded from 25.2 hours on the average at present to at least 48 hours. To improve the effectiveness of behavioral science education, it is necessary to develop various teaching methods such as small group discussion, panel discussion, case study, role play and clinical practicum. It is recommended that behavioral science be taught by a team consisted of behavioral scientists and physicians with behavioral science background including psychiatrists instead of by psychiatrist alone.

A National Sample Survey of Medical Students about Their Perception and Evaluation on Medical Study, Career Plan, and Medical Care System: Part 1. Survey Methods and Characteristics of Sample / 한국의학교육

Since the first survey done in 1983, this is the second national sample survey of medical students about their perception and evaluation on medical study, career plan, and medical care system. One out of every 10 students plus one in each class were systematically sampled from each grade year of 32 medical schools in Korea that had students from freshman to senior in November 1997. A questionnaire was developed by adding items related with recent changes in medical care environment and with viewpoint on medicine and physician as an occupation to the questionnaire used in 1983. The questionnaire was administered at each school under the supervision of designated collaborator of the same school in December 1997 through January 1998. A total of 1,386 students were sampled from a total of 11,987 medical students and 1,233 students(89.0%) filled out the questionnaire. Twelve students were excluded from the analysis because of incomplete response and the final analysis was done for 1,221 students. A few demographic characteristics of the sample were compared with those of the study population to check the representativeness of the sample and found no skew. The contents of the study were divided into three parts and the first part describes the study methods, demographic and other characteristics of the sample, students' viewpoint on medical education, and students' aptitude for medicine Male students accounted for 75.7% of the sample. The proportion of students who entered medical school right after graduating from a high school was 45.8% in Seoul and 53.4% in other than Seoul area. The students who classified their own political inclination conservative were 43.9% in Seoul and 33.0% in other than Seoul and the percentage of students with progressive inclination was higher in out of Seoul than Seoul area. The proportion of students who have a religion was 57.2%; Christian 31.0%, Catholic 15.2%, and Buddhist 9.5%. The educational level of fathers of students was far higher than the level of general population, e.g. 59.8% had college or higher education. Occupation of fathers was mainly white-collar worker; professional worker 21.2%, company employee 17.2%, government official 13.1%, manager 11.8%, and medical professional 8.7%. In the decision-making process to enter the medical school, 53.7% of the students were influenced by someone else and 62.1% of them were parents. Socio-economic factor was the most common reason for recommending medical school and it accounted 33.5% of the reasons. Medical students enjoy learning life phenomenon(47.2%) and human being(44.3%) in medical study but most disturbing factors are memory work(39.7%) and too much to study(34.1%). If students were given another chance to choose a college as a senior student in high school, 50.3% of them said that they would choose medical school. Only 6% of students have intention to change their major subject of study if they are allowed to change now. The proportion of students who consider their scholastic aptitude is compatible with medical study was 64.9% and such proportion increased with grade. The percentage of students who are going to recommend medical school to their own son in the future was 36.6% for male and 26.7% for female students and to their own daughter 33.6% and 27.7%, respectively.

A National Sample Survey of Medical Students about Their Perception and Evaluation on Medical Study, Career Plan, and Medical Care System: Part 2. Career Plan after Graduating from Medical School / 한국의학교육

A national sample survey of medical students about their perception and evaluation on medical study, career plan, and medical care system was conducted in December 1997 through January 1998. About 10% of all the medical students in 32 medical schools that had students from freshman to senior in November 1997 were systematically sampled for a questionnaire survey. Out of 1,386 students, 1,233(89.0%) had responded and 12 of them were excluded from the analysis because of incomplete response. This report is the second part of the study regarding career plan of students after graduating from medical school. Criteria of medical students for choosing specialty of medicine are professional reward and personal interest. Among the respondents, 92.2% plan to choose clinical medicine, 2.5% basic medical sciences, and 4.8% special areas of medicine such as health administration, medical engineering, forensic medicine, medical education, and health economics. If it is guaranteed that they will be a professor after training, 8.8% of them want to study special areas of medicine, and 7.3% basic medical sciences. The students who had admitted to a medical school after obtaining bachelor's degree were more prone to choose clinical medicine than other students. The most common reason for not choosing basic medical sciences was lower income than clinician. Among the students who want to be a clinician, 92.2% want to be a specialist and the preferred specialties were internal medicine 36.0%, orthopedics 9.0%, general surgery 7.7%, psychiatry 7.5%, and pediatrics 5.7%. Comparing with the findings of 1983 study, the proportions of students who want to major internal medicine and minor subjects were markedly increased and that of general surgery increased slightly while that of pediatrics was decreased. The places of work that the students prefer in the future were university hospital 43.2% (10% point increase from the finding in 1983), general hospital 37.1% and private practice 9.4% (10% point decrease from the finding in 1983). It was noticeable that some of the students want to be a medical missionary and health administrator. The students prefer their university hospital most for post-graduate training and the reason is only because it is their alma mater. One can anticipate from these findings that it will be very difficult to get basic medical scientists and primary physicians in the future.

A National Sample Survey of Medical Students about Their Perception and Evaluation on Medical Study, Career Plan, and Medical Care System: Part 3. Student's View on Merits and Demerits of Being Physician, Patients and Diseases, Medical Practice, and Medic / 한국의학교육

A national sample survey of medical students about their perception and evaluation on medical study, career plan, and medical care system was conducted in December 1997 through January 1998. About 10% of all the medical students in 32 medical schools that had students from freshman to senior in November 1997 were systematically sampled for a questionnaire survey. Out of 1,386 students, 1,233(89.0%) had responded and 12 of them were excluded from the analysis because of incomplete response. This report is the third part of the study regarding students' view on merits and demerits of being physician, patients and diseases, medical practice, and medical care system. Respondents indicated that the merits of being a physician are humanitarian nature of work(30.0%) and autonomy of work(28.0%) and the demerits are too busy to enjoy peronal life(56.5%) and too much stress from work(41.2%). Social status of physicians was assessed by the students in four dimensions, i.e. social prestige, social influence, power, and income. Students were found to think that the current social status of physicians is lower than it should be ideally in all of four dimensions. Ninety percent of student agreed that physician is a noble occupation that deals with human life but only two-thirds of students agreed that physician is economically secured and socially well recognized occupation. Students regarded the medical insurance system as instigating increase of general hospital and withering of private clinics and hindering medical development by reducing investment capacity. Major problems in medical care system indicated by the students are irrational medical insurance system, concentration of physicians in large cities, and irrational health care delivery system. Medical students regarded the role of nurses as not merely assisting physicians(40.7%) but have to participate more actively in patient care(49.8%). Regarding medical study's effect on views of patients and diseases, 60.4% of them indicated that they became to view patients more as entities of diseases and this was a significant increase from 28.9% in 1983 study. For criteria of death, 73.5% agreed with brain-death. Regarding organ transplantation, 79.2% agreed to encourage it but only 46.9% agreed to encourage artificial fertilization in vitro. In case of accidental death, 73.5% agreed to donate their organs for transplantation. To a statement related with medical malpractice reading "Physicians should be treated generously for their mistakes in medical practice so long as the mistakes are not due to negligence", 71.6% of the students agreed to the statement. To another statement reading "Physicians should be thoroughly investigated and duly penalized for mistakes made by them in their medical practice", only 31.8% agreed to it. These findings suggested that medical students are well aware of the problems in the health care system and social status of physicians. Changes were noticed in the sense of responsibility for medical malpractice and physician's attitude toward patients since 1983 study.

A National Sample Survey of Medical Students about Their Perception and Evaluation on Medical Study, Career Plan, and Medical Care System: Part 3. Student's View on Merits and Demerits of Being Physician, Patients and Diseases, Medical Practice, and Medic / 한국의학교육

A national sample survey of medical students about their perception and evaluation on medical study, career plan, and medical care system was conducted in December 1997 through January 1998. About 10% of all the medical students in 32 medical schools that had students from freshman to senior in November 1997 were systematically sampled for a questionnaire survey. Out of 1,386 students, 1,233(89.0%) had responded and 12 of them were excluded from the analysis because of incomplete response. This report is the third part of the study regarding students' view on merits and demerits of being physician, patients and diseases, medical practice, and medical care system. Respondents indicated that the merits of being a physician are humanitarian nature of work(30.0%) and autonomy of work(28.0%) and the demerits are too busy to enjoy peronal life(56.5%) and too much stress from work(41.2%). Social status of physicians was assessed by the students in four dimensions, i.e. social prestige, social influence, power, and income. Students were found to think that the current social status of physicians is lower than it should be ideally in all of four dimensions. Ninety percent of student agreed that physician is a noble occupation that deals with human life but only two-thirds of students agreed that physician is economically secured and socially well recognized occupation. Students regarded the medical insurance system as instigating increase of general hospital and withering of private clinics and hindering medical development by reducing investment capacity. Major problems in medical care system indicated by the students are irrational medical insurance system, concentration of physicians in large cities, and irrational health care delivery system. Medical students regarded the role of nurses as not merely assisting physicians(40.7%) but have to participate more actively in patient care(49.8%). Regarding medical study's effect on views of patients and diseases, 60.4% of them indicated that they became to view patients more as entities of diseases and this was a significant increase from 28.9% in 1983 study. For criteria of death, 73.5% agreed with brain-death. Regarding organ transplantation, 79.2% agreed to encourage it but only 46.9% agreed to encourage artificial fertilization in vitro. In case of accidental death, 73.5% agreed to donate their organs for transplantation. To a statement related with medical malpractice reading "Physicians should be treated generously for their mistakes in medical practice so long as the mistakes are not due to negligence", 71.6% of the students agreed to the statement. To another statement reading "Physicians should be thoroughly investigated and duly penalized for mistakes made by them in their medical practice", only 31.8% agreed to it. These findings suggested that medical students are well aware of the problems in the health care system and social status of physicians. Changes were noticed in the sense of responsibility for medical malpractice and physician's attitude toward patients since 1983 study.

Decision-making process and satisfaction of pregnant women for delivery method / 예방의학회지

This study was conducted to assess the attitude of pregnant women toward delivery method, understanding of the reason for determining her own delivery method, participation in decision-making process and satisfaction with delivery method after labor. Study subjects were 693 pregnant women who had visited obstetric clinic for prenatal care in the last month of pregnancy in one general hospital and one obstetrics-gynecology specialty hospital in Taegu city from February 1 to March 31 in 1998. A questionnaire was administered before and after labor and a telephone interview was done one month after labor. Proportion of women who had health education and/or counselling about delivery method during prenatal care was 24.0% and this proportion was higher for women who had previous c-section(35.5%) than others. Women thought vaginal delivery is better than c-section for both maternal and baby's health regardless of previous delivery method. About 90% of primipara and multiparous women who had previous vaginal delivery wanted vaginal delivery for the index birth, while 85.6% of multiparous women who had previous c-section wanted repeat c-section. Reasons for choosing c-section in pregnant women who preferred vaginal delivery before labor were recommendation of doctors(81.9%), recommendation of husband(0.8%), agreement between doctor and pregnant woman(4.7%), and mother's demand(12.6%). Reasons for choosing vaginal delivery were mother's demand(30.6%) and no indication for c-section(67.2%). Reasons for choosing c-section in pregnant women who preferred c-section before labor were recommendation of doctors(76.2%), mother's demand(20.0%), recommendation of husband(1.3%), and agreement between doctor and pregnant woman(2.5%). Of the pregnant women who had c-section, by doctor's recommendation, the proportion of women who had heard detailed explanation about reason for c-section by doctor was 55.1%. Mother's statement about the reason for c-section was consistent with the medical record in 75.9%. However, over 5% points disparities were shown between mother's statement and medical record in cases of the repeat c-section and mother's demand. In primipara and multiparous women who had previous vaginal delivery, the delivery method for index birth had statistically significant association with the preference of delivery method before labor(p<0.05). All of the women who had previous c-section had delivered the index baby by c-section. Among mothers who had delivered the index baby vaginally, 84.9% of them were satisfied with their delivery method immediately after labor and 85.1% at 1 month after labor. However, mothers who had c-section stated that they are satisfied with c-section in 44.6% immediately after labor and 42.0% at 1 month after labor. Preferred delivery method for the next birth had statistically significant association with delivery method for the index birth both immediately after labor and in 1 month after labor. The proportion of mothers who prefer vaginal delivery for the next birth increased with the degree of satisfaction with the vaginal delivery for the index birth but the proportion of mothers who prefer c-section for the next birth was high and they did not change significantly with the degree of satisfaction with the c-section for the index birth. These results suggest that the current high technology-based, physician-centered prenatal and partritional cares need to be reoriented to the basic preventive and promotive technology-based, and mother-fetus-centered care. It is also suggested that active involvement of pregnant woman in decision-making process for the delivery method will increase the rate of vaginal birth after c-section and decrease c-section rate and improve the degree of maternal satisfaction after delivery.

Establishment of a New Medical School and Recruitment

No abstract available.

Analysis of Educational Goals and Objectives of Korean Medical Schools / 한국의학교육

The contents of educational goals and objectives of 32 Korean medical schools, that were listed in the Korean Medical Education Directory for 1994-1995, were analysed to help developing new educationa l goals and objectives. Regarding the professions in which the graduates of medical schools can be engaged, all of the 32 school were aiming at the medical doctor. 34.4% at the medical scientist, 28.1% at the medical educator, and 15.6% at the health administrator. Only 37.5% of the medical schools stated that their educational objective is training the primary physician and 50% of the schools did not specify the level of their graduates as a physician. The proportion of schools which stated that the medical student should learn in three domains of educational objectives, i.e. medical knowledge,clinical skills and attitude were 18.8% and 56.3% of the schools descirbed learning just in two domains of medical knowledge and skills which may reflect underating the importance of attitude. The proportions of knowledge and skills which may reflect underating the importance of attitude. The proportions of schools that stated aquiring the ability of holistic management of patients and self-learning/life long study in their educational objectives were 28.1% and 62.5%, respectively. The proportion of schools that emphasized on the medical ethics and morality was 93.8% and on cultivating human nature was 71.9%. These reflect that a high quality of ethics and morality was 93.8% and on cultivating human nature was 71.9%. These reflect that a high quality of ethics and human nature is required to the medical doctor. The universal and ultimate goal of human society and universities, such as democratic educational ideology, Korean educational ideology, prosperity of human society, promotion of human welfare, and improvement of public health, were included in the educational goals in 43.8% of the schools. As the primary goal of medical schools is the producing primary physicians, it is suggested to include the affective domain(attitude), cultivation of the capacity of self-learning and ability of holistic management of patients in the educational objectives of medical shools.

An Epidemiologic Investigation of Typhoid Fever Outbreak in 0hchun Middle and High Schools Located in Young-il Gun Kyungpook Province / 한국역학회지

An epidemiologic investigation was conducted to identify the source of infection and the mode of transmission of typhoid fever outbreak occurred in Ohchun middle and high schools located in Young il Gun, Kyungpook Province from May 21 to Jun 4, 1994. Four out of 13 hospitalized students in three general hospitals in Pohang City were culture positive typhoid fever (Salmonella typhi Group D). Review of the in and outpatient logbooks of the three general hospitals in Pohang City, county health center and local clinics in the vicinity of the Ohchun middle and high schools suggested that the outbreak was confined to the schools. Drinking water source of the schools was two underground water pumps that had no treatment facilities; one in northern end and the other in southern end of the main school building. However, the southern water pump was closed on April 28, 1994 because a recent test for the water revealed E-coli suggesting a possible fecal contamination. Two hundred twenty students stated that they had experienced symptoms related to typhoid fever since April l, 1994 in a self administered questionaire survey of all of the 2, 226 students. Personal interviews with these 220 students were performed to confirm the clinical history together with a rectal swab culture for typhoid fever and Widal test. A total of 39 patients were detected; 15 confirmed cases (culture-positive) and 24 suspected cases (symptom positive with equal to or greater than 1:160 titer of Salmonella O-antibody or 1:320 titer of H-antibody titer in Widal test). The epidemic curve showed a unimodal curve with a peak on the second week(17 May, 1994) and tailed down to the 5th week (22 28 May, 1994). The overall incidence rate of typhoid fever was 1.8 per 100 students; 1.5 (1.6 for male, 1.5 for female) in the middle school and 2. 4 (6. 2 for male, 0. 4 for female) in the high school. When contrasted with the students who did not drink water at all in the school, the relative risks of incidence rate of typhoid fever for the students who drank the underground water of the school, both underground water and water brought from home, or water brought from home only were 55.5, 19.0, and 3.0 respectively. Three classes which had especially high incidence rates of typhoid fever were located in the southern part of the main school building, where the contaminated underground water pump is located. These findings suggested that the source of infection was the contaminated underground water of the school. Both of the two underground water pumps were closed permanently and the public running water was supplied to the schools.

A Case-Control Study of Risk Factors for Hemorrhagic Fever with Renal Syndrome in Korean Soldiers / 한국역학회지

A case-control study was conducted to identify the specific risk fatctors for hemorrhagic fever with renal syndrome(HFRS) in Korean soldiers. The case group consisted of 196 confirmed HFRS patients who were admitted to the Capital Armed Forces General Hospital between I November 1989 and 15 January 1992 and were 25 years old or younger. The control group consisted of 258 non-HFRS patients who were admitted to the same hospital and meeting following conditions; onset of symptom was within five days before or after the onset date of case, had regular military activities up to the onset of symptom, and no noticeable signs for the diagnosis. Most of the cases and controls came from the units located in Kyonggi province (61.7% of cases, 75.9% of controls) and Kangwon province (31.6% of cases, 15.5% of controls). The distribution of places where the cases and controls had moved into during 60 days period prior to admission was similar to that of the base units. Among 196 cases, 89.3% occurred in October through December and 46.9% in November. Significant risk factor was the field living condition. The odds ratio (OR) for sleeping in a tent vs not sleeping in a tent during 60 days period prior to admission was 1.55 (95% CI=1.07-2.25) and that for sleeping on the bare ground or in a vehicle was 3. 63 (95% CI=1.48-8.86). Other statistically significant risk factors were advanced tac tical training (OR=1.51, 95% CI=1.02-2.24), drinking surface water (OR=1.83, 95% CI=1.21-2.77), exposure to indoor dust (OR=1.58, 95% CI=1.05-2. 37), fixing trench (OR=1.63, 95% CI=1.12-2.37) and having seen Apodemus in the outdoors (OR=4. 61, 95% CI=2.12-10.02). Most of these risk factors were related with camping (field living condition) and thus the interaction between each risk factor and camping was examined by cross tabulation. None of the ORs for five risk factors was statistically significant for the cases who had no camping. However all of the ORs for the cases who had camping were increased and statistically significant ;2.27 for advanced tactical training, 2.64 for drinking surface water, 2.14 for exposure to indoor dust, 2.91 for fixing trench, and 7.58 for having seen Apodemus in outdoors. It was revealed in this study that the highest risk factor for HFRS is camping in the area where the Apodemus inhabits.

A Survey on Physical Complaints Related with Farmers' Syndrome of Vinylhouse and Non-vinylhouse Farmers / 예방의학회지

To compare the physical complaints of vinylhouse farmers with those of non-vinylhouse farmers, a personal interviews on 250 and 142 vinylhouse farmers were conducted in Sungjoo county in Kyungpook province selected by a random sampling from July 5 to July 10, 1993. Blood pressure of the subjects was also measured. Vinylhouse farmers had a higher average age, larger family size, shorter experience of farming, more working hours per day and working days per year and higher annual income than non-vinylhouse farmers. The frequency of preticide spray of the vinylhouse farmer was 3.4times on the average in June 1993 as compared with 2.0 times of non-vinylhouse farmers, and 16.7 times for the vinylhouse farmers during the last one year while it was 8.3 times for the non-vinylhouse farmers in the same period. While 39.6% of vinylhouse farmers experienced pesticide intoxication symptoms such as headache, nausea, vomiting, dizziness, itching, and skin irritation, etc. during the month of June, 25.4% of non-vinylhouse farmers experienced such symptoms. The most frequent symptoms among eight symptoms that constitute the farmers' syndrome were lumbago, numbness of hand or foot shoulder pain and dizziness regardless of sex and type of farming. Prevalence of the farmers' syndrome in male and female among vinylhouse farmers were 22.1%, 43.4%, respectively, and the prevalence in non-vinylhouse farmers was 23.2% for male and 50.7%for female. There was no statistically significant difference in the prevalence of farmers' syndrome between vinylhouse and non-vinylhouse farmers. However, The prevalence on female was about 2 times higher than that of male When the effects of other factors were adjusted by multiple logistic regression for farmers' syndrome, the prevalence in female was 3.0 times higher than that of male. The prevalence of farmers' syndrome was increased as the age of farmers increased on both vinylhouse and non-vinylhouse farmers, and adjusted odds ratio of farmers' syndrome increased by 3% as the age increased by 1 year Adjusted odds ratio of Farmers' syndrome in farmers who experienced pesticide intoxication during the month of June was 3.7times higher than that of farmers who did not have such experience. While the prevalence of hypertension in male and female non-vinylhouse farmers were 22.4%, 13.7%, respectively, the prevalence in vinylhouse farmers were 13.5% for male and 12.0% for female. However, there was no association between farmers' syndrome and hypertension. It was found in this study that the vinylhouse farmers are at a high risk of pesticide intoxication, which is associated with the common physical complaints. To reduce such risk it is necessary to develop farming methods which do not require the pesticide of may use less pesticide, a safer method of pesticide spraying, and the protective equipments which can be worn at a high temperature and have a better protective effect. Also education of farmers for the correct methods of ventilation after pesticide spraying in the vinylhouse and wearing the protective equipments may be considered as a supportive method. Since inappropriate posture at work and intensive labor may cause farmers' syndrome, it is recommended to develop farming tools which reduce physical burden and take a rest and exercise periodically during work. It is necessary to strengthen the hypertension management program of the Kyungpook province, because the prevalence of hypertension was as high as about 15%.