Journal of Preventive Medicine and Public Health

Volume 31(1); March 1998

Original Articles

PCR and RFLP-based CYP2D6(B) and CYP2D6(T) Genotyping for Korean Lung Cancer Cases and Controls.: Jin Ho Chun, Chang Hee Lee, Sang Hwa Urm, Byung Chul Son, Jun Han Park, Kui Oak Jung, Chang Hak Sohn, Hye Kyoung Yoon, Choon Hee Son, Hyung In Kim, Jin Seok Kim; Korean J Prev Med. 1998;31(1):1-14.

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Abstract PDF: The genetically determined CYP2D6 activity is considered to be associated with cancer susceptibility with inter-individual variation. Genetic polymorphism of CYP2D6(B) and CYP2D6(T) was determined by the two polymerase chain reaction(PCR) and BstN1 and EcoN1 restriction fragment length polymorphisms(RFLP) for 67 lung cancer cases and 95 healthy volunteer controls. The cases were composed of 26 squamous cell carcinoma, 14 small cell carcinoma, 10 adenocarcinoma, 3 large cell undifferentiated carcinoma, and 14 not histologically diagnosed. The results were gained from the 142 subjects (57 cases and 85 controls) who observed successfully in two PCR and BstN1/EcoN1 RFLP. Only one and no mutant allele of the CYP2D6(B) and CYP2D6(T) gene was detected, that is, the frequency of mutant allele was very low; 0.7%(1/142) and 0%(0/142), respectively. Detected mutant allele of the CYP2D6(B) was heterozygous type(WM). The odds ratios for lung cancer susceptibility with CYP2D6(B) and CYP2D6(T) genotype were not calculated. These results are similar to the previous understanding that the mutant allele is very rare in Orientals compared to Caucasians, therefore, it considered that CYP2D6(B) and CYP2D6(T) genotypes have maybe no association with lung cancer susceptibility in Koreans. This is the basic data of CYP2D6(B) and CYP2D6(T) genotypes for Koreans. It would be hepful for further study to determine lung cancer susceptibility of Koreans with the data about CYP1A1, CYP2E1, GSTM1 from future study.; Summary

A Case-control Study for Assessment of Risk Factors of Breast Cancer by the p53 Mutation .: Heon Kim, Se Hyun Ahn, Moo Song Lee; Korean J Prev Med. 1998;31(1):15-26.

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Abstract PDF: p53 is the most frequently mutated gene in female breast cancer tissues and the prognosis of breast cancer could be changed by mutation of the gene. This study was performed to examine risk factors for breast cancer subtypes classified by p53 mutation and to investigate the roles of p53 gene mutation in carcinogenesis of breast cancer. The study subjects were 81 breast cancer patients and 121 controls who were matched to cases 1:1 or 1:2 by age, residence, education level and menopausal status. All the subjects were interviewed by a well-trained nurse with standardized questionnaire on reproductive factors, and were asked to fill the self-administrative food frequency and 24 hour recall questionnaires. p53 gene mutation in the cancer tissue was screened using polymerase chain reaction (PCR)-single strand conformational polymorphism (SSCP) method. Mutation type was identified by direct sequencing of the exon of which mobility shift was observed in SSCP analysis. Mutations were detected in p53 gene of 25 breast cancer tissues. By direct sequencing, base substitutions were found in 20 cancer tissues (10 transition and 10 transversion), and frame shift mutations in 5 (4 insertions and 1 deletion). For the whole cases and controls, risk of breast cancer incidence decreased when the parity increased, and increased when intake amount of total calory, fat, or protein increased. Fat and protein were statistically significant risk factors for breast cancer with p53 mutation. For breast cancer without p53 mutation, protein intake was the only significant dietary factor. These results suggests that causes of p53 positive breast cancer would be different from those of p53 negative cancer, and that dietary factors or related hormonal factors induce mutation of p53, which may be the first step of breast cancer development or a promoter following some unidentified genetic mutations.; Summary

A Meta-analysis on the Risk Factors of Cerebrovascular Disorders in Koreans.: Jong Ku Park, Myung Keun Kang, Chun Bae Kim, Ki Soon Kim, Sun Ha Jee; Korean J Prev Med. 1998;31(1):27-48.

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Abstract PDF: This study was conducted to integrate the results of studies which evaluated or identified the risk factors of CVD(cerebrovascular disorders) for Koreans. We retrieved the literature published in Korean by manual search and the English literature by Medline database to identify studies on the relationship between reported risk factors and CVD conducted for the Korean from 1980 to August, 1997. Hypertension and total serum cholestrol were selected as subjects of quantitative meta-analysis as risk factors of CVD in Koreans. The overall effect sizes of the risk of CVD due to hypertension and total serum cholesterol were calculated by common odds ratio(OR) and average standardized mean difference, retrospectively. Before the integration of each effect sizes into common effect sizes, the heterogeneity tests were conducted. Also, sensitivity tests were conducted for the estimated common effect sizes. Regarding hypertension and CVD, a total of 9 epidemiologic studies were identified with a total of 2,271 cases of CVD. The overall OR of hypertension associated CVD was 4.10(95% confidence interval[CI] 3.56 to 4.71). The OR of hypertension associated with hemorrhagic CVD and ischemic CVD were 6.56(95% CI : 4.92 to 8.80) and 3.28(95% CI : 2.77 to 3.90), retrospectively. The OR of hypertension in relation to hemorrhagic CVD was significantly higher than that of hypertension in relation to overall CVD or ischemic CVD. Regarding serum total cholesterol and ischemic CVD, total 9 epidemiologic studies were identified with a total of 843 cases of ischemic CVD. Average mean difference as an effect size was 0.76, which was judged an important value according to Cohen's criteria. Our data suggested that hypertension was an important risk factor of overall CVD and its subtypes, and that the total serum cholesterol was associated with ischemic CVD in Koreans. For the lack of reliable prospective studies, however, we concluded that further research designed longitudinally would be required in this area.; Summary

Reliability and validity study of a life style questionnaire for elderly people.: Byiung Joo Park, Dae Sung Kim, Hye Won Koo, Jong Myon Bae; Korean J Prev Med. 1998;31(1):49-58.

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Abstract PDF: The study was done to determine the reliability and validity of a life style questionnaire for the elderly. The questionnaires were sent to 16,524 elderly people who were beneficiaries of Korean Medical Insurance Corporation in Pusan. Among the completed 9,139 questionnaires, 200 were randomly sampled and retested. Finally, 110 duplicates were collected. Weighted kappa-value and Pearson correlation coefficients were estimated to measure the reliability. Validity coefficient was estimated by using reliability coefficient. In self-self responses, reliability coefficients of the most of items were over 0.6 except some physical activity related item. Relatively high reliability was observed in smoking, alcohol related items and anthropometric items. In self-proxy responses, most of the physical activity related items were found to be less reliable than self-self responses. Smoking and alcohol related items were consistently reliable. Male showed higher validity in food related item than female. On the other hand, some of the physical activity related items and smoking and alcohol related items were less valid in male than female. With regard to bias of proxy respondents, offsprings tended to underestimate the frequency of 'house cleaning' and 'kitchen work' and overestimate the height of them. In conclusion, the life style questionnaire was found to be reliable in the most of items. But, some items related with physical activity were found to be somewhat less reliable. Sexual difference on the validity was identified in some items. With regard to bias of proxy respondents, offsprings tended to have bias in part of items of housework and anthropometry.; Summary

Association of Hypertension with Cluster of Obesity, Abnormal glucose and Dyslipidemia in Korean Urban Population.: Kang Sook Lee, Jung A Kim, Jung Il Park; Korean J Prev Med. 1998;31(1):59-71.

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Abstract PDF: To examine the association of hypertension with cluster of obesity, abnormal glucose and dyslipidemia in Korean urban population, we conducted this cross-sectional study among 3027 men and 2127 women age 20-85 years who visited a prevention center between May 1991 and June 1995 for a multiphasic health check at St. Mary's Hospital, Seoul. By the self-administered questionnaire, the informations of educational attainments, monthly income, alcohol consumption, cigarette smoking, and physical excercise level were obtained. Height, weight, and blood pressure were measured by a trained nurse. The fasting blood sugar(FBS), total cholesterol, high density lipoprotein (HDL) cholesterol and triglyceride were tested by enzyme method. Low density lipoprotein (LDL) cholesterol was calculated by 'total cholesterol - HDL cholesterol - triglyceride/5'. For testing the differences of cardiovascular risk factors between hypertension and normotension group, t-test and x2 test were performed and for the age adjusted odds ratios of hypertension in persons with obesity, abnormal glucose, and dyslipidemia compared with normal, logistic regression was performed by using SAS pakage programme. The results obtained were as follows: 1. Age, weight, body mass index, blood glucose, total cholesterol, low density lipoprotein, triglyceride of hypertension group in men and women were significantly higher than normotension group, but height and high density lipoprotein of hypertension group only in women significantly lower than normotension group. The frequency of obesity (body mass index > or =25 kg/m2), abnormal glucose (> or = 120 mg/dl), hypercholesterolemia (> or =240 mg/dl), lower HDL cholesterol (<45 mg/dl in women only), higher LDL cholesterol (> or =160mg/dl), and hypertriglyceridemia (> or =250 mg/dl) in hypertension group of men and women were significantly higher than normotension group. 2. Systolic and diastolic blood pressure were negatively correlated with hight, but positively with age, weight, BMI, total cholesterol, LDL cholesterol, and triglyceride in men and women. And BMI was positively correlated with fasting blood sugar, total cholesterol, LDL cholesterol and triglyceride but negatively with HDL cholesterol. 3. The odds ratios of hypertension were as follows in men and women : among persons who were obese compared with those nonobese, 2.53 (95% Confedence Intervals [C.I.] 2.08-3.07) and 2.22 (95%C.I. 1.71-2.87); among persons who were abnormal glucose compared with those normoglycemic, 1.43 (95%C.I 1.13-1.82) and 2.01 (95%C.I 1.36-2.94); and among persons who were dyslipidemia (hypercholesterolemia or lower HDL cholesterol or higher LDL cholesterol or hypertriglyceridemia) compared with those normal lipid, 1.59 (95%C.I 1.30-1.95) and 1.51 (95%C.I 1.16-1.96). After combined more than one risk factor, the odds ratios were increased. Among persons with cluster of obesity, abnormal glucose, and dyslipidemia, the odds ratio of hypertension was 2.25 (95%C.I 1.47-3.37) in men and 3.02 (95%C.I 1.71-5.30) in women. In conclusion, it was suggested that hypertension was associated with cluster of obesity, abnormal glucose, dyslipidemia in this Korean urban population.; Summary

Characteristics of health lifestyle patterns by the quantification method.: Soon Young Lee, Seon Woo Kim; Korean J Prev Med. 1998;31(1):72-81.

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Abstract PDF: The purpose of this study was to investigate the relation between health behavior patterns and demographic, socio-economic characteristics, health status, health information in Korea. The quantification method through canonical correlation analysis was conducted to the data from Korea National Health Survey in 1995, which consisted of 5,805 persons. The health lifestyle patterns were quantified as good diet lifestyle, passive lifestyle to the negative direction and drinker lifestyle, smoker lifestyle, hedonic lifestyle and fitness lifestyle to the positive direction. The covariate were related to health lifestyle patterns in the order of sex, age, marital status, occupation, health information, economic status, level of physical labour, health status. Characteristics of male, age below 50, married, blue colored worker, no health information, low in economic status, heavy level of physical labour, and poor in health status were positively related to drinker lifestyle, smoker lifestyle, hedonic lifestyle, fitness lifestyle sequentially.; Summary

Air particulate matters and daily mortality in Ulsan, Korea.: Jong Tae Lee, Seong Im Lee, Dongchun Shin, Yong Chung; Korean J Prev Med. 1998;31(1):82-90.

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Abstract PDF: A large number of studies have indicated associations between particulate air pollution and daily mortality. Daily measurements of total suspended particulates (TSP) by high volume air sampler were matched to daily death counts supplied by the National Statistics Office, Korea. All deaths, except deaths from accidents, occurred at Ulsan from 1 January 1991 to 31 December 1994 were considered in the poisson regression analysis. The multiple regression models were used to investigate a main effects of air particulate pollution controlling for SO2 levels, air temperature, relative humidity, seasonal variation, and calendar year. The results indicated that the effects of TSP, SO2, temperature, and relative humidity were not significantly associated with all cause mortality. It could, however, be emphasized that the size of the parameter estimate of TSP was very similar to that of previous studies. An increase in particulates of 100microgram/m4 was associated with a 3% increase in mortality. This relationship was observed at TSP levels well below the current National Ambient Air Quality Standard of 150microgram/m4 in Korea as well.; Summary

Prediction of the risk of skin cancer caused by UVB radiation exposure using a method of meta-analysis.: D C Shin, J T Lee, J Y Yang; Korean J Prev Med. 1998;31(1):91-103.

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Abstract PDF: Under experimental conditions, UVB radiation, a type of ultra violet radiation, has shown to relate with the occurrence of skin erythema (sun-burn) in human and skin cancer in experimental animal. Cumulative exposure to UVB is also believed to be at least partly responsible for the "aging" process of the skin in human. It has also been observed to have an effect of altering DNA (deoxyribonucleic acid). UVB radiation is both an initiator and a promotor of non-melanoma skin cancer. Meta-analysis is a new discipline that critically reviews and statistically combines the results of previous researches. A recent review of meta-analysis in the field of public health emphasized its growing importance. Using a meta-analysis in this study, we explored more reliable dose-response relationships between UVB radiation and skin cancer incidence. We estimated skin cancer incidence using measured UVB radiation dose at a local area of Seoul (Shin chon-dong). The studies showing the dose-response relationships between UVB radiation and non-melanoma skin cancer incidence were searched and selected for a meta-analysis. The data for 7 reported epidemiological studies of three counties (USA, England, Australia) were pooled to estimated the risk. We estimated rate of incidence change of skin cancer using pooled data by meta-analysis method, and exponential and power models. Using either model, the regression coefficients for UVB did not differ significantly by gender and age. In each analysis of variance, non-melanoma skin cancer incidence after removing the gender and age and UVB effects was significant (p>0.01). The coefficients for UVB dose were estimated 2.07x10-6 by the exponential model and 2.49 by the power model. At a local area of Seoul (Shin chon-dong), BAF value were estimated 1.90 and 2.51 by the exponential and power model, respectively. The estimated BAF value were increased statistical power than that of primary studies that using a meta-analysis method.; Summary

A Study on the Size of Dust in Workplaces of a Shipyard.: Choong Ryeol Lee, Cheol In Ryu; Korean J Prev Med. 1998;31(1):104-111.

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Abstract PDF: To obtain the basic information that can be used as a factor for explaining the diversity of welders' pneumoconiosis, the authors measured the concentrations of dust according to the size of dust in 71 workplaces of a shipyard where welders' pneumoconiosis have occurred. The concentrations of dust according to the size of dust showed no difference between workplaces regardless of kinds of work.; Summary

A cohort study on blood zinc protoporphyrin concentration of workers in storage battery factory.: Man Joong Jeon, Joong Jeong Lee, Joon Sakong, Chang Yoon Kim, Jung Man Kim, Jong Hak Chung; Korean J Prev Med. 1998;31(1):112-126.

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Abstract PDF: To investigate the effectiveness of the interventions in working environment and personal hygiene for the occupational exposure to the lead, the blood zinc protoporphyrin(ZPP) concentrations of 131 workers ( 100 exposed subjects and 31 controls ) of a newly established battery factory were analyzed. They were measured in every 3 months up to 18 months. Air lead concentration (Pb-A) of the workplaces was also checked for 3 times in 6 months interval from August 1987. Environmental intervention included the local exhaust ventilation and vacuum cleaning of the floor. Intervention of the personal hygiene included the daily change of clothes, compulsory shower after work and hand washing before meal, prohibition of cigarette smoking and food consumption at the work site and wearing mask. Mean blood ZPP concentration of the controls was 16.45+/-4.83 microgram/dashliter at the preemployment examination and slightly increased to 17.77+/-5.59 microgram/dashliter after 6 months. Mean blood ZPP concentration of the exposed subjects who were employed before the factory was in operation (Group A) was 17.36+/-5.20 microgram/dashliter on employment and it was increased to 23.00+/-13.06 microgram/dashliter after 3 months. The blood ZPP concentration was increased to 27.25+/-6.40 microgram/dashliter on 6 months (p<0.01) after the employment which was 1 month after the initiation of intervention program. It did not increase thereafter and ranged between 25.48 microgram/dashliter and 26.61 microgram/dashliter in the subsequent 4 results. Mean blood ZPP concentration of the exposed subjects who were employed after the factory had been in operation but before the intervention program was initiated (Group B) was 14.34+/-6.10 microgram/dashliter on employment and it was increased to 28.97+/-7.14 microgram/dashliter (p<0.01) in 3 months later(1 month after the intervention). The values of subsequent 4 tests were maintained between 26.96 microgram/dashliter and 27.96 microgram/dashliter. Mean blood ZPP concentration of the exposed subjects who were employed after intervention program had been started (Group C) was 21.34+/-5.25 microgram/dashliter on employment and it was gradually increased to 23.37+/-3.86 microgram/dashliter (p<0.01) after 3 months, 23.93+/-3.64 microgram/dashliter after 6 months, 25.50+/-3.01 microgram/dashliter (p<0.01) after 9 months, and 25.50+/-3.10 microgram/dashliter after 12 months. Workplaces were classified into 4 parts according to Pb-A. The Pb-A of part I, the highest areas, were 0.365 microgram/m4, and after the intervention the levels were decreased to 0.216 microgram/m4 and 0.208 microgram/m4 in follow-up test. The Pb-A of part II which was resulted in lower value than part I was decreased from 0.232 microgram/m4 to 0.148 microgram/m4, and 0.120 microgram/m4 after the intervention. The Pb-A of part III was tested after the intervention and resulted in 0.124 microgram/m4 in January 1988 and 0.081 microgram/m4 in August 1988. The Pb-A of part IV was also tested after the intervention and resulted in 0.110 microgram/m4 in August 1988. There was no consistent relationship between Pb-A and blood ZPP concentration. The blood ZPP concentration of the group A and B workers in the part of the highest Pb-A were lower than those of the workers in the parts of lower Pb-A. The blood ZPP concentration of the workers in the part of the lowest Pb-A increased more rapidly. The blood ZPP concentration of the group C workers was the highest in part III. These findings suggest that the intervention in personal hygiene is more effective than environmental intervention, and it should be carried out from the first day of employment and to both the exposed subjects, blue color workers and the controls, white color workers.; Summary

A Survey on the Prevalence of Musculoskeletal Symptoms and Related Factors among Korea Seamen.: Jaeho Kim, Jongyoung Lee; Korean J Prev Med. 1998;31(1):127-138.

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Abstract PDF: The purpose of this study is provide a basic data for the prevention and management of musculoskeletal symptoms in Korea seamen. 569 seamen's questionnaire had been acquired at Korea Marine Training and Research Institute from February 24 to March 31 in 1997. The results of this study were as follows; Prevalence in musculoskeletal symptom within recent 12 months was 68.5%. It was 76.3% in seamen who had graduated from colleges or universities and 56.0% in seamen who had graduated from elementary school(p<0.01). The more working hours(p<0.01), services on the vessel(p<0.01), and the less job atisfaction(p<0.05), the higher prevalence of musculoskeletal symptoms were. The distribution of musculoskeletal symptoms by the part of the body was turned out as Back ; 43.6%, knee ; 23.9%, shoulder ; 19.3%. The officers had more frequency of symptom around the neck than the ratings(p<0.01) and the seamen who work at the engine room were more frequent in elbow than those at deck department(p<0.05). In the duration of pain, 55.4% were less than one week, 20.6% less than 30 days, and 24.0% 30 days and more. the cause of symptom was turned out as 34.5% by excessive hard work and 30.1% was unknown. For the treatment of the musculoskeletal symptoms, 40.3% with symptomes did not have any medical treatment, 27.6% was self-treated and 22.7% was treated at hospital. This study shows that musculoskeletal disorders are seamen's important health problem and they can not properly take medical service due to the out of home for a long period as characteristics of occupation.; Summary

Diving patterns and diving related disease of diving fishermen in Korea.: Joon Sakong; Korean J Prev Med. 1998;31(1):139-156.

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Abstract PDF: Diving related disease including decompression sickness is an important occupational health problem and diving fishermen remain a fairly hazardous occupation in Korea. To prevent diving related disease, we investigate diving patterns, incidence of diving related diseases, and contributing factors of 433 diving fishermen of three coast interviewing and mailing questionnaire in 1996. Mean age of divers was 39.7 years, ranged from 24 to 58 years, 92.8% of these were male, and 58.4% of divers were high school graduates. Mean duration of work as a diver was 12.9 years, ranged from 2 to 40 years. It was found that 70.4% of divers were using hookah system, 22.2% of helmet, and only 2.5% SCUBA. About half of them have learned diving skills from other divers. The peak season of diving was from April to June and mean working days were 20.3 days per month during the peak season. On the average, the divers dived 5-6 times, ranged from 1 to 10 times a day with 51.1 minutes of diving time, ranged from 20 to 120 minutes, at 30 m or 40 m in depth, and 35.5 minute of interval on surface. Most divers ascended slowly making decompression stop, yet the decompression profile used was not based on any scientific knowledge except for their own experiences. It appeared that each diving system had slightly different diving patterns. There were 282(65.0%) divers that suffered from DCS in 1995 and 31.2% of divers were given recompression therapy at a medical facility since they worked as diving fishermen. Skin and musculoskeletal complaints were common symptoms of DCS and 39% of divers experienced a voiding difficulty. In univariate analysis, females have an increased frequency of DCS(93% vs 66% for males). Old age, long duration of work, helmet diving, diving time, diving depth, repetitive diving, and blow up were all contributing factors to DCS. It was found that most diving patterns exceed no decompression limit and did not use the standard decompression table. This suggests that most of divers are at high risk of developing diving related disease with prolonged dives and lengthy repetitive diving in deep depth. Considering the diving patterns and economic aspect of professional diving, the incidence of DCS among diving fishermen in Korea will not decrease in the near future. These findings suggest that periodic health surveillance for divers, and education of health and safety are important for reducing the risk of diving related disease in the population of diving fishermen.; Summary

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