A questionnaire survey wds conducted to assess the experience of the needle stick injury in 144 seniors of a medical school during the previous 10 months. One hundred and five of them (73%) had responded. About sixty-nine percent (72 cases) of the respondents had suffered at least one u and there had been 129 injuries in total. Seventy-eight (56.6%) of the injuries took place at the time of the venipuncture. The emergency and operating room incurred 76.7% and 23.3% of the injury, respectively. Injuries with bleeding account for 50.4%. None of the respondents was systematically educated about the prevention of injury. This survey shows that the needle-stick Injury is a great risk for the medical students' health, and that educational effort for its prevention is warranted.

The survey methods for confirming the epidemicity and identifying the possible causes of the cancer epidemic can be different from those for infectious diseases. The procedure for confirming whether the outbreak is epidemic or not is quite different. Household survey for identifying cancer cases and residents actually living at the area should be done. Hospital survey for medical record review should be performed to identify all cancer cases among the residents of the outbreak area and confirmig the final diagnoses of the cancer cases. Comparing the level of cancer incidence or mortality with other areas can be done by using Poisson distribution, or calculating SIR (Standard Incidence Ratio) from cumulative incidence rates. Case-control study can be conducted to identify the etiologic, factors of the cancer epidemic and to establish strategy for preventing further recurrence of the outbreak.

This is to study the incidence of Diabetes and its risk factors in the impaired glucose tolerence group. 1084 subjects who had been examined 3 times for regular check-up in one human dock center under the university hospital were studied between $1986{\sim}1993$. The results are as follows; Prevalence rate of diabetes was 3.56%, and that of impaired glucose tolerence was 30.90% as of initial examination. The rate of diabetes was increasing with the age where 1.2% at age group $30{\sim}39$, 3.21% at age group $40{\sim}49$, 5.84% at age group $50{\sim}59$, 14.28% at age group 60 and over. And also the rate of impaired glucose tolerance was increasing with the age where 21.29% at age group $30{\sim}39$, 31.42% at age group $40{\sim}49$, 38.91% at age group $50{\sim}59$, 33.33% at age group 60 and over Of the examinees who were initially examined, total incidence rate of diabetes who developed to obvious diabetes at the 3rd follow-up examination from the initially impaired glucose tolerence group was 4.63% and it was 11.3 times higher than from the normal group (0.41%). After controlling for the effects of both age and obesity, the risk of subsequent diabetes for subjects with impaired glucose tolerance remained significantly higher than for normal subjects (Relative Risk, 10.48). Test for trends for developing to diabetes by the increasing level of fasting blood sugar and 1hr blood sugar at the initial examination were statistically significant in either normal and impaired glucose tolerence group. To determine the risk factor for developing to diabetes, logistic regression test was applied. Only fasting blood sugar and 1hr blood sugar were predictors for developing diabetes from the impaired glucose tolerence group at initial examination.

The objective of this study was to evaluate outcome for the patients of the intensive care unit, using APACHE III prognostic system. We prospectively collected the information of 429 patients in intensive care units at 2 tertiary care hospitals and 4 secondary care hospitals in PUSAN who had been admitted from December 1, 1993 to February 28, 1994. The results were as follows. 1. APACHE III scores were various from 0 to 173. But the distribution of the scores were similar between tertiary care hospitals and secondary care hospitals. 2. The mortality rate significantly increased as APACHE III score rised (p<0.001). Within the interval of same score, generally, the mortality of operative patients was higher in secondary care hospitals but in the case of nonoperative patients higher in tertiary care hospitals. 3. When the tertiary care hospitals compared with secondary for ratio of the predicted mortality rate to the actual mortality rate, there was little difference. 4. When we compared the 6 hospitals, one hospital had significantly better results and another hospital was significantly inferior (p<0.05).

Despite the public health importance of injury and poisoning in terms of its high mortality and incidence, epidemiologic information to be utilized are scarce in Korea. This study was carried out in 1990 on a representative sample population (about 55,000 persons) along with the 6th National Tuberculosis Prevalence Survey in order to estimate the magnitude of injury and poisoning occurrence and to identify its epidemiologic characteristics which can be aided for establishing preventive strategy. Pre-tested and structured Questionnaire was used by trained interviewer to collect data including general information of the person, various information on the injury and poisoning during the past one year such as time and place of its occurrence, its nature and external causes, type of medical institute attended, duration of treatment and outcome of the accident occured. In analysis of the data collected incidence rates per 1000 persons by sex, age group and its nature as well as external causes, and relative frequencies were calculated. The result obtained are as followings; 1. The incidence rate per 1000 was 30 for both sexes, 39 for male and 22 for female, male being 1.8 times more frequent than female. Age adjusted incidences were not much different from the crude rates. Age group specific rate curve showed bimodal shape in both sexes, small peaks in preschool children and higher peaks in older ages. The incidence rate per 1000 people by area was highest in Jeon-bug province (57/1000) and the lowest in Daegu city(11/1000). 2. The place where the injuries occured were road in 46%, within the boundary of house in 25%, and working place in 12% The injuries and poisoning had occured more frequently during the months from March to August of the year than other months. 3. The relatively frequent injuries by its nature were contusion with intact skin surface (19%), fracture of upper limb (13%), open wound of head, neck and trunk (12%) and fracture of lower limb (11%) among males; contusion with intact skin surface (28%), sprains and strains of joints and adjacent muscle (14%), fracture of upper limb (10%) and fracture of lower limb (9%) among females. Higher incidence rate among males than females were fracture of skull (4.5 times), open wound and fractures of limbs ($2{\sim}3$ times). Age specific rate of injuries and poisoning by its nature showed increasing pattern by age in fractures of upper and lower limbs and sprains & strains of joints whereas the age group of 30's showed highest incidence in open wounds of upper limb. Fractures of radius and ulna in upper limb, fractures of tibia & fibula and ankle in lower limb were most frequent among fractures of upper and lower limbs. The frequent injuries among sprains and strains of joints and adjacent muscles were that of ankle, foot and back, and among open wound were that of head and fingers. 4. Relative frequency of injuries and poisoning by external causes showed following order : other accidents (25%), accidental falls (23%), motor vehicle accident (22%) and other road vehicle accident (14%) among males and accidental falls (37%), motor vehicle accident (24%) and other accident (18%) among females. The external causes revealing higher incidences among males than females, were other road vehicle accident (4.8 times), vehicle accident not elsewhere classifiable (4.4 times), accidental poisoning (4.4 times), accidents due to natural and environmental factors (2.8 times), and sucide & self-inflicted injuries (2.8 times). Age specific incidence by external causes for frequent injuries showed that incidence of other accident steadily increased from 10's till age 50's; motor vehicle traffic accident increased from age 20's and dropped after age 60's; on the other hand accidental fall increased strikingly by age. The most frequent external causes among motor vehicle traffic accidents was motor vehicle traffic accident involving collision with pedstrain (69%), pedal cycle accident (30%) and other road vehicle accident (71%) among other road vehicle accidents; falls on same level from slipping, tripping or standing (44%) and other falls from one level to another among accidental falls; accidents caused by machinary (32%) for male and striking against or struck accidentally by objects or person for female among other accidents. 5. Seventy nine percent of the injuries and poisonings were treated in general hospital or hospital/clinic. The duration of treatment ranged from a few days to 123 weeks; the majority(52%) took under 2 weeks, 36% for $3{\sim}8$ weeks and 4% over 21 weeks. 6. The accident resulted in full recovery of normal healthy state in 62%, residual functional defects in 21% and on process of treatment in 16%.

This study was carried out to evaluate the relations between sociodemographic, work-related factors and health related behaviors in a group of 1,042 workers in Taejeon and Chungnam area. The results were as followings: The older workers took more irregularly meals, more cigarette and more alcohol than the younger. Men had more appropriate sleeping time, more regular exercise than women, but more frequent alcohol consumption and cigarette smoking. The married had more regular sleeping habit than the unmarried. The group of married were smoking more and obese. In view of monthly income which represent the socioeconomic state of workers, the group of more than 1 million won had more frequent alcohol ingestion, more heavier body weight than another group of less than 1 million won. Workers having their work hours exceed 9 hours had inappropriate sleep duration, and shift workers took more irregularly meals. The group having poor self-rated health status showed more regular diet, exercise and overweight. Workers recently experienced chronic illness were more overweight and lesser smokers. Above results showed that the health related behaviors were related to the sociodemographic characteristics and occupation-related characteristics. The study for relationship between variant factors affecting health behavior and disease or mortality is need and it should be emphasized that the publicity and education of health related behavior for industrial workers is necessary.

In order to provide necessary information for better health of workers through understanding the actual status of the industries adopting shift systems. The data were gathered from a stratified random sample of 347 (0.5%) firms selected out of about 70,000 manufacturing industries throughout the nation in 1993. Stratification during sampling was by industrial group and number of workers. The major findings obtained from 288 firms surveyed completely were as follows : 1. About 20.2% of the 288 firms were adopting shift systems and shirtworkers accounted for about 25.1% of the total work force in 288 firms. 2. The bigger number of workers was, the higher the adopting rate of shift system was. 3. The rate of having welfare facilities such as dining room, commuting bus, washing facilities, and health care room etc. was higher in the industries adopting shift systems. 4. The major industrial groups adopting shift systems were the rubber a: plastic goods manufacturing industry (54.1 per 100 firms) and the textile manufacturing industry (44.8 per 100 firms). However, the proportion of shiftworkers was higher in the textile manufacturing industry (70.5 per 100 firms) and the electronics industry (57.9 per 100 frms). 5. The most predominant work schedule was the weekly rotating, semi-continuos 2-crew 2-shift system (47.5%). 6. In the industries adopting shift systems, shiftworkers had an adjusted average of 0.29 spells per 100 workers ($0.14{\sim}0.45$ in 95% C.I.) compared to 0.23 spells per 100 nonshift dayworkers ($0.15{\sim}0.31$ in 95% C.I.) for 1 month. 7. Also, in the industries adopting shift systems, the adjusted average annuel turn-over rate of shiftworkers was 13.07 per 100 workers ($12.03{\sim}14.12$ in 95% C.I.) compared to 10.18 per 100 nonshift dayworkers ($9.53{\sim}10.82$ in 95% C.I.).

A cross-sectional study was performed to evaluate the effects of chronic low-dose solvent on neurobehavioral performance of 118 male car painters. A control group of 113 workers matched for age was selected from different sections of the factory. The mean age and the mean duration of employment were 33 years and 6.7 years in both groups. Mean years of education were 11.4 years in car painters and 11.8 years in controls. Each worker completed a medical and occupational questionnaire and four tests of Swedish performance evaluation system. These included simple reaction time, symbol digit, digit span and finger tapping speed. Althougth the mean duration of employment was 6.7 years, comparison of mean performance showed a significantly poorer performance on simple reaction time (p<0.05), symbol digit(p<0.01) and digit span(p<0.05) in car painters. In univariate analysis, age and educational level contributed to poorer performance on symbol digit and digit span. Smoking appeared to slow finger tapping speed in car painters. Performance of four tests of car painters exposed to high level of solvent was poorer than that of car painters exposed to low level. In multiple regression models, controlling for age, alcohol, smoking and shift work, solvent exposure was found to be associated with performance of simple reaction time, symbol digit and digit span and exposure to high level of solvent was related to poorer performance of symbol digit and digit span.

For the purpose of preparing the fundamental data on air pollution in underground shopping center and also contributing to the health improvement of residents, the authors measured the level of $SO_2,\;NO_2,\;TSP,\;CO,\;CO_2$ and also some related factors as air temperature, air movement, relative humidity and mean radiation temperature at inside and outside of underground shopping center in Pusan from January to February and from July to August 1994. The results were as follows : 1. The mean concentration of CO within the underground shopping center was $3.1{\pm}1.3ppm$ in winter and $2.1{\pm}0.9ppm$ in summer. There was a negative correlation (p<0.01) between inner CO concentration and temperature in summer and no correlation between inner CO concentration and outer CO concentration in underground shopping center 2. The mean concentration of COE within the underground shopping center was $876{\pm}353ppm$ in winter and $757{\pm}125ppm$ in summer. There was a negative correlation (p<0.01) between inner $CO_2$ concentration and air movement in summer and positive correlation (p<0.05) between inner $CO_2$ concentration and outer $CO_2$ concentration in underground shopping center. 3. The mean concentration of $SO_2$ within a underground shopping center was $0.036{\pm}0.019ppm$ in winter and $0.040{\pm}0.013ppm$ in summer. There was a positive correlation(p<0.01) between inner $SO_2$ concentration and temperature in summer and positive correlation between inner $SO_2$ concentration and outer $SO_2$ concentration in summer and winter in underground shopping center. 4. The mean concentration of $NO_2$ within a underground shopping center was $0.052{\pm}0.038ppm$ in winter and $0.042{\pm}0.016ppm$ in summer. There was a no correlation between inner $SO_2$ concentration and thermal factors in summer and winter and low correlation between inner $SO_2$ concentration and outer $SO_2$ concentration in underground shopping center 5. The mean concentration of TSP within a underground shopping center was $430{\pm}214{\mu}g/m^3$ in winter, $366{\pm}73{\mu}g/m^3$ in summer, and very in excess of the atmospheric environmental quality standards of Korea ($150{\mu}g/m3{\downarrow}$). There was low correlation between inner TSP concentration and temperature in summer and high correlation between inner TSP concentration and outer TSP concentration in underground shopping center.

For the purpose of providing the basic data for health management of workers who are exposed to chromium and for improving the quality of working environment, the authors evaluated blood and urinary level of chromium, the occupational history. AST, ALT, Hb, Hct, nasal specular examinaton on 287 workers who have been dealed chromium compounds in 56 manufacturing Industries of five types, that is, 38 metal plating services(plating),4 manufacture of other fabricated metal products (fabricated metal product), 5 manufacturing of dyestuff(dyestuff), 6 dressing and dyeing of leather(leather), 3 others(manufacture of pottery and ceramic househod wares, motor vehicles, electronic valves and tubes and other electronic components) and also measured the level of chromium in air from February to October 1993. The results were as follows ; 1. The utilized type of chromium compounds was the hexavalent state in plating fabricated metal product dyestuff, leather and the trivalent state in .other, and atmosperic chromium concentration as geometric mean was $0.0138mg/m^3(0.001{\sim}0.068mg/m^3)$ in plating, $0.0115mg/m^3(0.006{\sim}0.015mg/m^3)$ in fabricated matal product, $0.068mg/m^3(0.002{\sim}0.019mg/m^3)$ in dyestuff, $0.0083mg/m^3(0.002{\sim}0.028mg/m^3)$ in leather $0.0039mg/m^3(0.003{\sim}0.005mg/m^3)$ in other by the type of industry and it exceeded TLV-TWA ($0.05mg/m^3$) in five (13.6%) of plating services. 2. The geometric mean of chromium in blood was $1.54{\mu}g/dl(0.10{\sim}3.62{\mu}g/dl)$ in Plantng, $0.94{\mu}g/dl(0.27{\sim}2.82{\mu}g/dl)$ in fabricated metal product, $0.51{\mu}g/dl(0.10{\sim}3.25{\mu}g/dl)$ in dyestuff, $0.87{\mu}g/dl(0.15{\sim}8.00{\mu}g/dl)$ in leather, $0.55{\mu}g/dl(0.20{\sim}2.28{\mu}g/dl)$ in other by the type of industry(p<0.001). 3. The geometric mean of chromium in urine was $14.47{\mu}g/l(6.90{\sim}28.00{\mu}g/l)$ in planting, $4.63{\mu}g/l(0.24{\sim}43.00{\mu}g/l)$ in fabricated metal product, $5.93{\mu}g/l(1.00{\sim}33.00{\mu}g/l)$ in dyestuff, $11.09{\mu}g/l(0.80{\sim}48.00{\mu}g/l)$ in leather, $12.41{\mu}g/l(10.10{\sim}41.00{\mu}g/l)$ in other by the type of industry(p<0.001). 4. As the result of nasal specular examination, twenty four cases (8.4%) of nasal septal perforation among 287 total subjects was observed, and there were 17 (9.7%) cases in plating, 4 csaes (14.3%) in dressing and dyeing of leather. In the comparison of chromium concentration in blood and urine between the perforated group and non-perforated group, the perforated group showed a significantly higher value as $1.883{\pm}3.055{\mu}g/dl\;and\;0.793{\pm}0.815{\mu}g/dl$(P<0.001), $21.31{\pm}34.610{\mu}g/L\;and\;9.304{\pm}11.079{\mu}g/L$ (P<0.001). 5. The mean concentration of chromium in blood, urine and the mean level of AST, ALT, Hb and Hct in exposure group were higher than those of control group(p<0.001).

In a TV component manufacturing factory, 102 male workers aged $20{\sim}39$ years old were participated in testing for physical fitness. At the same time, worker's periodic health examination was done. Test battery for physical fitness include grip strength, trunk flexion, standing long jump, side step, single leg balance with eye close, push ups and Harvard step test. As a result of testing for physical fitness, synthetically, there is no difference between manufacturing workers and officers. By bioelectrical impedance test, it means a declining tendency to all 7 factors in the obese workers, and so, it is important for obese workers not only to promote physical fitness but also to promote health. Excluding grip strength and single leg balance with eye close, 5 fitness factors are negatively associated with degree of diastolic Blood pressure, but it is statistically not significant. And levels of sGOT & sGPT have no association with physical fitness factors.

In order to identify the necessary information of biochemical Indices for renal effect of lead for the early detection in medical surveillance of lead worker, the reference values of urinary N-acetyl-$\beta$-D-glucosaminidase (NAG) activities were studied with 205 office workers in one industrial complex area who were not exposed to lead occupationally. While study variables selected for lead exposure were blood lead (PbB), blood zinc protoporphyrin(ZPP) and $\delta$-aminolevulinic acid (DALA) in urine, those for renal effect were urinary N-acetyl-$\beta$-D-glucosaminidase (NAG), blood urea nitrogen (BUN), serum creatinine(Cr), serum uric acid (Ua), and urinary total protein(U-TP). The results obtained were as follows: 1. The mean values of blood lead, ZPP and DALA in all subjects were $14.39{\pm}4.02{\mu}g/dl,\;21.61{\pm}8.00{\mu}g/dl,\;and\;2.73{\pm}0.90mg/l$ respectively. 2. The mean value of urinary NAG activities in all subjects was $3.51{\pm}2.01U/l$. The mean value of urinary NAG activities, which calculated from NAG activities divided by urinary creatinine concentration (CNAG), was $5.42{\pm}5.53U/g$ creatinine and log-arithmic normal distributed. 3. The reference value of urinary NAG activity was 12.06 U/g creatinine(95% CU=10.57-14.76 U/g creatinine). 4. Logarithmic CNAG(r=0.781 p<0.0l), U-TP(r=0.670 p<0.01) and ZPP(r=0.172 p<0.05) showed statistically significant correlation with CNAG.

This study was conducted to examine the effect of chronic low dose organic solvent exposures in the industries towards then neurobehavioral functions of workers. Subjective symptoms on neurobehavioral function as well as a visual reaction time test (Flicker test) were administered to 94 exposed and 162 unexposed workers in a oil refinery and some other auto-repair shops. The results obtained were as follows : 1. Symptom complaints were higher and Flicker test values were lower in exposed workers than in unexposed workers. 2. Flicker valus were Inversely correlated with urinary Hippuric acid concentration in exposed workers(r=-0.26, p<0.05). 3. Flicker valus were inversely co..elated with Subjective symptom score(r=-0.15, p<0.05). Low Flicker value were also related with some subjetive symptoms such as 'Dimmed vision', 'Nightmare', 'Weakness on extrimity' in workers as a whole. While symptoms of 'Dimmed vision ', 'Nightmare' only observed among exposed workers.

The genetically determined ability to metabolize debrisoquine (DBR) is related to risk of lung cancer and DBR hydroxylation exhibits wide inter-individual variation. In this study, 100 korean adults were tested for their ability to metabolize DBR. The DBR metabolic phenotype were determined by metabolic ratio (MR, DBR / 4-HDBR) which is the percent dose excreted as unchanged DBR divided by the percent dose excreted as 4-hydroxyebrisoquine(4-HDBR) in a aliquot of an eight hour urine sample, after 10mg DBR test dose administration. Analysis was performed on a capillary gas chromatograph fitted with electron capture detector. The results were as follows; 1 Geometric mean of DBR MR was 0.32 in male,0.27 in female,0.30 in total and the distribution of log (MR) was seemed to follow normal distribution. 2. Metabolic ratio of DBR was higher in non-smoker and non-drinker than in smoker and drinker without any statistically significant difference. 3. None of personal factors was significantly related to DBR MR except age. 4. The DBR metabolic phenotype was extensive metabolizer(EM) 93, intermediate metabolizer(IM) 7 by traditional method and EM 98, IM 3 by Caporaso's method. The poor metabolizer (PM) phenotype was not found by either method. 5. Maximal expected PM phenotype was 0.36% by traditional method and 0.04% by Caporaso's method.

To investigate the effect of carbon disulfide on blood pressure, the BP measurements in the periodic health examination results and the medical records of factory clinic were reviewed. The study subjects were composed of 1336 male and 544 female workers, who were categorized into three groups by the exposure status-highly exposed, moderately exposed and non-exposed group. The results of the study were as follows; 1. The age-adjusted mean systolic and diastolic BP of male workers were 122.35 mmHg/79.11 mmHg in highly exposed, 121.57mmHg/79.05mmHg in moderately exposed and 122.67mmHg/82.27mmHg in non-exposed group. For female workers, BPs were 115.13mmHg/74.49mmHg in moderately exposed and 113.48mmHg/74.30mmHg in non-exposed group. 2. In multiple regression analysis of maximum BP against Age and tenure, the slope coefficients of age and tenure on the systolic BP were 0.379, 0.667 respectively and those on the diastolic BP were 0.331, 0.405 respectively in highly exposed male workers. Tenure was a significant variable in this study. For female workers, however the slope coefficients of tenure on BP were significant only for systolic BP of moderately-exposed group. 3. In multiple regression analysis of Bp against age, cumulative exposure index (CEI), cholesterol, all the variables showed significant slope coefficients in male, but age and CEI on systolic BP were significant for female workers (p<0.05). 4. In the multiple analysis of the amount of Bp change and the velocity of Bp change among male workers, the slope coefficients of tenure tended to increase as exposure level increased. Among female workers, the slope coefficients of tenure were significant on the amount of Bp change and the velocity of Bp change in moderately exposed group.

This study was conducted to evaluate the relationships between the environmental exposure and biological monitoring among workers exposed to metallic mercury We interviewed each workers to get the medical history including previous hazardous occupational history. We measured the respiration rate and tidal volume of each worker in order to calculate the 8-hour inhaled mercury of workers. And we wafted to evaluate the effect of exposure duration to mercury concentrations in blood and urine as biologic exposure indices of metallic mercury. The regression and correlation analysis were done to the relationships of 8-hour inhaled mercury and mercury in blood and urine. The results were as follows; 1. The subjects were 35 fluorescent lamp manufacturing workers. The mean age of subjects was .24.8 years old, and the mean work careers of workers was 1.19 years. 89% of the total was consisted man. 2. The correlation coefficients between 8-hour inhaled mercury and mercury in blood and urine were higher than that of only considered air mercury concentration. 3. The correlation coefficients of 8-hour inhaled mercury and mercury in blood and urine were above 0.9 in workers who had exposed to mercury more than 1 year 4. The R-square value and -value of regression analysis between the 8-hour inhaled mercury and mercury in blood and urine was also higher in workers who had exposed to mercury over 1 year than in workers who had less than 1 year working experience. The important results of this study were that relationships between the 8hr-inhaled mercury and mercury in blood and urine was very high than that with air mercury concentration only. And the results were very apparent when considering workers 1 year or more. Therefore we concluded that the work career and respiratory volume of each individuals should be considered in evaluation the, results of biological monitoring of workers exposed to metallic mercury.

This study was conducted to investigate whether variations in hospital services utilization across small geographic areas in Korea existed, and if so, what factors are responsible for the variation. The claims data of the fiscal year 1992 obtained from the regional health insurance societies were used for the study. Main findings of the research can be summarized as follows: 1 Extremal Quotients (EQ) of hospital expenditure per capita and hospital days per capita were 2.69 and 2.73, and Coefficient of Variation (CV) were 0.14, both, respectively. The EQ and the CV of admission rate were also 2.71, 0.15. The EQ and the CV of expenditure per admission were 1.73, 0.10 and those of hospital days per admission were 1.29, 0.06. All these statistics were statistically significant and this result provides strong evidence for the existence of small area variations. 2. Comparing patterns of variation among areas, the area which showed higher utilization amounts is Chansungp'o. Koje area, whereas the areas which showed lower utilization amounts are Yongju, Changhung, Miryang, Mokp'o, Koch'ang area. 3. Multivariate analytic methods were used to examine factors related to the variation across areas. In terms of the health resource availability variables, beds per capita or physicians per capita were positively associated with all utilization indices. As for the health service market structure variables, the proportion of health care institutions operating for less than f years was positively related to the expenditure per capita, hospital days per capita and expenditure per admission. In addition the proportion of the private health care institutions also had a negative relationship with total utilization amount and admission rate and the proportion of physicians under age 40 was negatively associated with expenditure per capita and expenditure per admission. With regard to the socio-demographic characteristics, proportion of medicaid population was positively related to hospital days per capita, and percentage of paved road was positively related to hospital days per admission. As a conclusion, wide variations existed across small areas in Korea and supply factors were found to be important in explaining the variation.

In this study, literature review was done to examine and compare the current status and problems of different evaluation approaches toward permanent impairment in Korea. Alternatives and improvements in the current approaches in Korea were suggested. Series of cases were also examined to compare different approaches applied to the real cases, using 105 cases from a hospital data and another 207 cases from a insurance company data. The main findings of the literature review are as follows; 1. The current evaluation methods of permanent impairment in Korea are grouped into two categories, grading and rating. Gradings of impairments are expressly specified in 17 various statutes. 2. In Grading methods, the rigid system of 74 different grades has been adopted uniformally for the convenience of administration, which may not be, appropriate or valid from medical and scientifical aspect. 3. The adventage of McBride method is assessment of occupational disability rate. However the classified compensable occupations are only 280 and limited to manufacturing industries in 1960s'of U.S.A., which is not appropriate to current Korean circumstances. Especially, the job list does not include managerial officers or mental workers. 4. AMA Guides is the scientific and reasonable method for the assessment of physical impairment rate. However compensation and reparation of impairment case is difficult because this method cannot assess the disability rate according to occupation, age, etc. The results of cases comparative study are as follows: 5. The physical Impairment could be compared in 167 out of total 312 cases, and for the cases of complex impairment, McBride method underestimate physical impairment rate compared with AM A method. 6. When disability late was assessed, occupation was considered the compensation of only 85 cases, and age was used in only 21 cases. This was because occupation and age compensation in McBride method are unreasonable. 7. The most Ideal alternative is to assess physical impairment according to AMA method and then to develop a compensation method appropriate for the circumstances of Korea society.