Yong Ik Kim

Risk factors for the development of NIDDM in Yonchon County, Korea

OBJECTIVE To determine the risk factors for the development of NIDDM in Yonchon County of Korea. RESEARCH DESIGN AND METHODS We studied 1,193 Korean nondiabetic subjects at baseline who participated in a 2-year follow-up study on diabetes in Yonchon County. A 75-g oral glucose tolerance test was performed 2 years after the baseline examination. Age, sex, and anthropometric and metabolic characteristics at baseline were analyzed simultaneously as potential predictors of conversion to NIDDM. We also designed a nested case-control study to determine the role of hyperinsulinemia and/or hyperproinsulinemia in the conversion to NIDDM in patients with newly developed diabetes and control subjects matched for age, sex, BMI, and waist-to-hip-ratio. RESULTS At 2 years, 67 subjects developed diabetes, as defined by World Health Organization criteria. The age-adjusted incidence was significantly higher in men (6.4%) than in women (3.0%), and the incidence increased as age increased in both sexes. Multiple logistic regression analysis revealed age, male sex, and fasting and 2-h glucose levels to be significant risk factors for the development of NIDDM, whereas waist-to-hip ratio and BMI were not. In a nested case-control study, baseline proinsulin but not insulin levels were significantly higher in subjects who progressed to NIDDM than in those who did not. CONCLUSIONS In the Korean population, β-cell dysfunction, as measured by high proinsulin levels, seems to be associated with subsequent development of NIDDM, whereas regional and general obesity and fasting insulin levels, which may be a surrogate for insulin resistance, were not.

Factors Affecting Public Prejudice and Social Distance on Mental Illness: Analysis of Contextual Effect by Multi-level Analysis

Objectives While there have been many quantitative studies on the publics attitude towards mental illnesses, it is hard to find quantitative study which focused on the contextual effect on the publics attitude. The purpose of this study was to identify factors that affect the publics beliefs and attitudes including contextual effects. Methods We analyzed survey on the publics beliefs and attitudes towards mental illness in Korea with multi-level analysis. We analyzed the publics beliefs and attitudes in terms of prejudice as an intermediate outcome and social distance as a final outcome. Then, we focused on the associations of factors, which were individual and regional socio-economic factors, familiarity, and knowledge based on the comparison of the intermediate and final outcomes. Results Prejudice was not explained by regional variables but was only correlated with individual factors. Prejudice increased with age and decreased by high education level. However, social distance controlling for prejudice increased in females, in people with a high education level, and in regions with a high education level and a high proportion of the old. Therefore, social distance without controlling for prejudice increased in females, in the elderly, in highly educated people, and in regions with a high education and aged community. Conclusions The result of the multi-level analysis for the regional variables suggests that social distance for mental illness are not only determined by individual factors but also influenced by the surroundings so that it could be tackled sufficiently with appropriate considering of the relevant regional context with individual characteristics.

Current Status of Subspecialists Training Programs and Factors Affecting Subspecialists' Job Selection after Training

Purpose:This study was designed to identify current status of the subspecialist training programs and related factors affecting subspecialist’s job selection. Methods: The study subject were 5,569 subspecialist trainees in 61 hospitals between 1989 and 1999. Among them, 1,260 subjects were selected to identify employment status after training. Also we analysed factors affecting career selection for 863 subspecialist on which basic information was available. Results: About 26.6% of all subspecialist trainees trained in 1999 was for subspecialist in internal medicine, the largest majority, and 89.3% was in metropolitan areas. Also 91.1% were trained in teaching hospitals. Among subspecialist completed training, 79.5% selected career to work at general or teaching hospitals as of 1999, but 13.5% practised at clinics. The factors affecting career selection after training were gender, ownership of medical school, and specialty. Conclusion: The fact that not a few subspecialist work at primary care clinics means there are unreasonable human resource allocation and planning, with probable poor quality of primary care. Therefore, it is necessary to have a human resource plan at the national level for appropriate number of subspecialist, based on each specialty, in particular. Any structural factors affecting destination of subspecialist trainees, such as gender and graduated medical school, etc, should be dealt with in the long run.