Journal of Preventive Medicine and Public Health

Volume 33(3); September 2000

Original Articles

Seroprevalence and Risk Factors of Toxoplasma gondii Infection in High School Students in Cheju Province .: Seong Chul Hong, Hyun Jong Yang, Jong Myon Bae, Hyun Sik Choi, Hwan Sik Hwang, Hoon Kyu Oh, Dong Hyun Yun; Korean J Prev Med. 2000;33(3):271-279.

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Abstract PDF: OBJECTIVES
To assess the seroprevalence and risk factors of toxoplasmosis in high school students in Cheju Province, Korea. METHODS: A total of 4,570 high school students from 18 schools in Cheju Province were investigated for Toxoplasma gondii antibodies(IgG) by enzyme linked immunosorbent assay (ELISA). Risk factors for toxoplasmosis, such as place of residence, type of house, contact with cats and other pets, and rare meat consumption, were examined by questionnaire. RESULTS: The overall antibody positive rate was 5.5% and ranged from 2.6 to 11.5% by school. There was no significant difference between males and females. Statistical analyses of the questionnaire data indicated that the risk factors for seropositivity were: (1) birth place (Cheju/others), (2) place of residence (rural/urban), (3) dietary habits (vegetarian/non vegetarian), (4) eating rare meat, (5) exposure to pets and (6) hepatitis B. CONCLUSION: We confirmed that the prevalence of the anti-Toxoplasma gondii antibody in a population of high school students in Cheju Province was to the previously reported prevalence.; Summary

A Survey of the Prevalence of Rubella Antibodies in Teachers of Child Bearing Age on Cheju Island .: Jong Myon Bae, Hyun Jong Yang, Seong Chul Hong; Korean J Prev Med. 2000;33(3):280-284.

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Abstract PDF: BACKGROUND
Congenital rubella syndrome (CRS) can be controlled by vaccination. Because rubella is typically a childhood disease, occurring predominantly in the 5 to 14 year age group, female school teachers may be a high-risk population for CRS. CONCLUSIONS: To determine the prevalence rate of rubella antibodies in school teachers of child bearing age. METHODS: The study population consisted of primary, middle and high school teachers of child bearing age. The subjects were aged 35 years and younger, and consented to immunoglobulin (Ig) level testing using the ELISA method. RESULTS: The positive rate of IgG was 77.9% in the study subjects (n=314). Sixty-three teachers (21.4%) were susceptible to rubella infection. Thirty-seven teachers (11.8%) had a history of rubella vaccination. Among the female teachers with no vaccination history, the proportion of negative IgM and IgG was 21.7%, and the proportion of positive IgM was 2.9%. Seventy-nine percent of the study subjects did not know that they should not become pregnant for three months after receiving the rubella vaccine. CONCLUSION: School teachers of child bearing age should be considered a high risk group for CRS, and should be vaccinated if they are found to be seronegative.; Summary

Community-based Helicobacter pylori Screening and its Effects on Eradication in Patients with Dyspepsia.: Seong Ho Kim, Dae Yong Hong, Pock Soo Kang, Seok Beom Kim, Kyeong Soo Lee, Sang Kyu Kim, Jeong Ill Suh, Mee Kyung Kim; Korean J Prev Med. 2000;33(3):285-298.

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Abstract PDF: CONCLUSIONS: To investigate the positive rate of Helicobacter pylori in patients with dyspepsia; medical compliance and related factors; the eradication rate a year after screening and related factors; the relationship between the eradication of Helicobacter pylori and the improvement of symptoms; and the estimated cost of three alternative approaches to treat Helicobacter pylori in the community. METHODS: A total of 510 subjects with dyspeptic symptoms were selected and given the serological test in March 1998. The subjects were all adults over 30 years of age residing in Kyongju city. RESULTS: Of the 510 selected subjects, 375 (73.5%) subjects proved positive for Helicobacter pylori on serological testing. Of these 304 (81.1%) who consented to an endoscopic examination, underwent a Campylobacter-like organism (CLO) test. Of these 304 subjects, 204 (67.1%), who had positive CLO test results, were given the triple therapy - tripotassium dicitrato bismuthate, amoxicillin, and metronidazole. To determine the eradication rate of Helicobacter pylori, 181 (88.7%) out of the 204 subjects who were given the triple therapy completed a follow-up urea breath test one year later. Of these, the Helicobacter pylori of 87(48.1%) subjects was eradicated. Among the 122 subjects who were medication compliant, the Helicobacter pylori eradication rate was 57.4% (70 subjects), while the eradication rates was only 28.8% (17subjects) in the non-compliant group. The Helicobacter pylori eradication was significantly related to compliance (p<0.01), but not to other characteristics and habits. The symptom improvement rate tended to be higher 62.1%), in the Helicobacter pylori eradicated group than in the non-eradicated group (59.6%). CONCLUSIONS: When the advantages and disadvantages of each alternative treatment were considered in the light of cost, antibiotic tolerance and the number of patients to be treated, alternative II was favorable in terms of cost. Alternative III was favorable in terms of the number of patients to be treated, antibiotic tolerance and early detection of gastric cancer. Further long-term research analyzing the cost-benefit and cost-effectiveness of each treatment will be needed as supporting material in creating new policies.; Summary

Understanding the Occurrence of Lung Cancer in Foundry Workers through Health Insurance Data .: Yeon Soon Ahn, Jae Seok Song, Seong Kyu Kang, Ho Keun Chung; Korean J Prev Med. 2000;33(3):299-305.

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Abstract PDF: CONCLUSIONS: To investigate the difference in the occurrence of lung cancer between foundry workers and non-foundry workers by comparing the number of workers diagnosed with lung cancer through health insurance data. METHODS: The study population was comprised of 28,884 workers who had undergone at least one general or special medical examination between January 1995 and December 1997 at the occupational health center. All of the subjects had health insurance during this period. We combined the medical examination data with the health insurance data to compare the number of foundry workers diagnosed with lung cancer and the number of non-foundry workers diagnosed with lung cancer. RESULTS: Seven workers were diagnosed with lung cancer among the 1,591 foundry workers, compared to twelve workers among the 27,293 non-foundry workers (odds ratio: 10.04, 95% confidence interval: 3.95-25.55). The seven foundry workers diagnosed with lung cancer were all exposed to dust, and six out these seven workers were engaged in finishing or shake-out processes. CONCLUSIONS: Although the information for this study was obtained from health insurance data, which has limitations such as accuracy and completeness, the number of foundry workers diagnosed with lung cancer was significantly higher than that of non-foundry workers. Therefore, a well-designed cohort study should be followed to confirm the higher lung cancer rates in foundry workers.; Summary

Urinary 1-Hydroxypyrene and 2-Naphthol as a Biological Exposure Markers of Total Suspended Particulate in the General Population .: Jong Won Kang, Soo Hun Cho, Heon Kim, Daehee Kang, Chul Ho Lee; Korean J Prev Med. 2000;33(3):306-312.

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Abstract PDF: BACKGROUND
Polycyclic aromatic hydrocarbons (PAH) are well known environmental pollutants. The measurement of PAH in ambient air is not commonly used, because it is quite difficult to perform and is unreliable. Using biomarkers of PAH can be an alternative approach to this problem. The PAH in ambient air is absorbed in particulate matter. Total suspended particulate(TSP) or particulate matter of less than 10 micrometer in diameter (PM10) can be easily measured. Therefore, TSP or PM10 can be used as a surrogate measurements of ambient air PAH. CONCLUSIONS: We investigated whether the urinary concentration of two biomarkers of PAH, 1-hydroxypyrene (1-OHP) and 2-naphthol, could reflect the total suspended particulate in the general population. METHODS: In order to exclude the effects of occupational exposure and smoking, first grade middle school students were included in this study. Four middle schools within a one kilometer boundary of ambient air monitoring stations were selected. Total suspended particulate was regarded as the marker of airborne PAH. Diet and smoking data were collected by self administered questionnaires, and spot urine samples were collected. Urinary 1-OHP and 2-naphthol were analyzed by high performance liquid chromatography. RESULTS: The correlation between urinary 1-OHP, 2-naphthol and passive smoking was not statistically significant. The correlation between urinary 1-OHP and TSP indices was not statistically significant. The correlations between urinary 2-naphthol and TSP of two lag days, one lag day, and zero lag days were statistically significant. The statistical significance of two lag days was the strongest (p=0.001), one lag day was the next (p=0.0275), and zero lag days was the weakest (p=0.0349). CONCLUSION: Our results imply that the urinary concentration of 2-naphthol can be applied as a PAH exposure marker for the general population with low PAH exposure.; Summary

Evaluation of the Completeness of Case Reporting during the 1998 Cheju-do Mumps Epidemic, Using Capture-recapture Methods .: Myoung Hee Kim, Jin Kyoung Park, Mo Ran Ki, Young Joo Hur, Bo Youl Choi, Joung Soon Kim; Korean J Prev Med. 2000;33(3):313-322.

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Abstract PDF: OBJECTIVES
To estimate mumps incidence during the study period and to evaluate the completeness of case reporting. METHODS: Capture-recapture methods, originally developed for counting wildlife animals, were used. The data sources were 1) the National Notifiable Communicable Disease Reporting System (NNCDRS; 848 cases), 2) the School Health Reporting System, temporarily administered by the Division of Education (SHRS; 1,026 cases), and 3) a survey of students (785 cases). We estimated the number of unobserved mumps cases by matching the three data sources and fitting loglinear models to the data. We then determined the estimated total number of mumps cases by adding this to the number of observed cases. Completeness was defined as the proportion of observed cases from each source to the total of estimated cases. RESULTS: The total number of observed cases was 1,844 and the total number of estimated cases was 1,935 (95% CI: 1,878-2,070). The overall completeness was 43.8% of the NNCDRS, 53.0% of the SHRS, and 40.6% of the survey. However, completeness varied by area and age. CONCLUSION: Although the completeness of NNCDRS data appeared higher than in the past, it is difficult to generalize this result. In Korea, it is possible to estimate the size of health hazards relatively cheaply and quickly, by applying capture-recapture methods to various data using a multiple data collection system.; Summary

Hepatitis B Virus DNA Mutation, Pattern of Major Histocompatibility Class-I among Familial Clustered HBV Carriers in Relation to Disease Progression .: Seung Pil Jung, Hyo Suk Lee, Chung Yong Kim, Yoon Ok Ahn; Korean J Prev Med. 2000;33(3):323-333.

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Abstract PDF: OBJECTIVES
Chronic HBsAg carriers are the principal source of infection for other susceptible people, and are themselves at high risk of developing serious liver diseases. In Korea, it has been estimated that 65-75% of the HBsAg positives remained as persistent carriers. Additionally, familial clustering of HBV infection has frequently been observed among carriers. Some would become progressive, chronic hepatitis patients, and others would not. The aim of this study was to evaluate the association between various factors, such as the duration of infection, type of virus, mutation of precore/core region in HBV, major histocompatibility class-I, and developing chronic liver diseases among familial HBV carriers. METHODS: Chronic carrier status was identified by repeated serological tests for HBsAg at intervals of six months or more. A familial chronic carrier was defined when the disease was observed in a family member over two generations. Two families were recruited, among which a total of 20 chronic HBsAg carriers(11 carriers in No.1, and 9 in No.2 family) were identified. Data on the general characteristics and liver disease status were collected. Identification of the HBV-DNA was successful only for 13 subjects among the 20 carriers. Analysis of viral DNA in terms of subtype, pre-core and core region mutations was carried out. The type of major histocompatibility class-I for the 13 subjects was also analysed. RESULTS & CONCLUSIONS: Seven of 10 chronic HBV carriers of the 1st generation and one of 10 of the 2nd generation were clinical patients with chronic hepatitis, the others, three of the 1st and nine of the 2nd generation, were asymptomatic carriers. This data indicates that the duration of HBV carriage is one of the major factors for disease severity. The subtype of HBsAg analysed using HBV-DNA identified in 13 carriers were adr, and the pattern of precore nonsense mutation in HBV-DNA was identical among family members, which means that the same virus strains were transmitted between the family members. The association between the precore or core mutations in HBV-DNA and the disease severity was not observed. While it was suggested that a specific type of MHC class-I may be related to disease progression.; Summary

The Patient Recognition, Acceptability and Evaluation of Feasibility for Day Surgery.: Young Ah Kang, Young Ran Beak, Kyeong Soo Lee, Seok Beom Kim, Pock Soo Kang; Korean J Prev Med. 2000;33(3):334-342.

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Abstract PDF: OBJECTIVES
This study was conducted in order to investigate the degree of recognition, acceptability, and attitude towards day surgery of patients who were hospitalized with diseases that were candidates for day surgery; in order to analyze the average length of stay for treatment of the ailments; and to analyze the percentage of patients who could be discharged on the same day after the surgery using the post-anesthesia discharge scoring system. METHODS: Data was collected between February 1 and March 31, 1999 from 353 patients who received surgery for cataract, adenoid hypertrophy, inguinal hernia, strabismus, ptosis, cholelithiasis, hemorrhoid, or anal fistula, at a general hospital in Daegu city. The patients were interviewed and surveyed by a post-anesthesia discharge scoring system(PADS) in order to collect data on patient condition such as vital signs, activity and mental status, pain, nausea and vomiting, surgical bleeding, intake and output after the surgery. RESULTS: Among the 353 patients, 52.7% were awar of the day surgery and 52.1% were interested in day surgery. Of the respondents, 43.1% said 'my ailment was not serious and the surgery was simple' and 30.4% said 'according to my condition rest at home was desirable' as the reasons for wanting day surgery Alternatively, 56.5% of those declining day surgery said the 'uncertainty of staying home' was the reason. The greatest concern in discharging within 24 hours after surgery was a post-op emergency situation. On the other hand, the shortened hospitalization was the largest advantage of day surgery with 39.1% responding this way, followed by the savings in hospitalization costs (25.8%) and emotional stability (13.7%). The majority of those surveyed (47.6%) believed that discharge should be determined within 1-2 days after the surgery. The average hospital stay was 3.1 days for dischargeable ailments. Pain (45.6%), nausea and vomiting (10.5%), and headache (7.9%) were the common symptoms following surgery. The percentage of patients who were able to be discharged within 24 hours after surgery revealed 95.2% were dischargeable after approximately 3 hours, 99.2% dischargeable after 12 hours, and 100% dischargeable atter 24 hours. CONCLUSIONS: According to the PADS score, the cataract extract and strabismus correction patients were eligible for day surgery and the further evaluation concerning the reason for delayed recovery of the other diseases is needed.; Summary

A Meta-analysis on the Association between Chronic Noise Exposure and Blood Pressure.: Chun Bae Kim, Sang Baek Koh, Jai Young Kim, Bong Suk Cha, Hong Ryul Choi, Jong Tae Lee, Chung Mo Nam, Sang Yun Lee, Seung jun Wang, Keeho Park, Dae Youl Kim; Korean J Prev Med. 2000;33(3):343-348.

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Abstract PDF: OBJECTIVES
This study was conducted to integrate the results of studies assessing the association between chronic noise exposure and blood pressure. METHODS: Using a MEDLINE search with noise exposure, blood pressure and hypertension as key words, we retrieved articles from the literature that were published from 1980 to December 1999. The criteria for quality evaluation were as follows: 1) the study subjects must have been workers employed at a high noise level area 2) The paper should use average and cumulative noise exposure as method for exposure evaluation. 3) Blood pressure in each article should be reported in a continuous scale Among the 77 retrieved articles, six studies were selected for quantitative meta-analysis. Before the integration of the regression coefficients for the association between blood pressure and noise level, homogeneity tests were conducted. RESULTS: All studies were a cross-sectional design and the study subjects were industrial workers. Five papers used a time-weighted average for noise exposure and only one paper calculated the cumulative noise exposure level. The measurement of blood pressure in the majority of studies were accomplished in a resting state, and used an average of two or more readings. The homogeneity of studies was rejected in a fixed effect model, so we used the results in a random effect model. The results of the quantitative meta-analysis, the weighted regression coefficient of noise associated with systolic blood pressure and diastolic blood pressure were 0.05 (95% confidence interval [CI]: -0.03, 0.13) and 0.06 (95% CI: -0.01, 0.13), respectively. CONCLUSIONS: Our results suggested that chronic exposure to industrial noise does not cause elevated blood pressure.; Summary

Short-term Glycemic Control and the Related Factors in Association with Compliance in Diabetic Patients.: Gui Young Kim, Jae Yong Park, Bo Wan Kim; Korean J Prev Med. 2000;33(3):349-363.

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Abstract PDF: OBJECTIVES
Generally, it seemed that the therapeutic result in diabetic patients was changed by compliance. This study was conducted on the basis of assumption that the therapeutic result in diabetic patients could control according to compliance. This study was conducted to analyze the related factors in association with compliance to drug, diet and exercise therapy. METHODS: 224 diabetic patients in Kyungpook National University Hospital were selected through the interviews and HbA1c values from 1 Jan. to 28 Feb. 1997. The drug compliance was tested by regularity of drug administration, the diet compliance was tested by restriction of food, exactly allocation, balance of nutrient, measuring food and the exercise compliance was tested by regularity of exercise per day. We assessed compliance by percentage, X2-test and generalized logit regression model(method:enter). RESULTS: The significant variable was the satisfaction to medical personnels in drug, the knowledge to disease in diet, the participation of the diabetic education in exercise therapy and the satisfaction to medical personnels in HbA1c. Using the generalized logit model(method : enter) in compliance change, the significant variables were the satisfaction to medical personnels and the complication in drug; the significant variables were the age at the first diagnosis, the family history, the concern of health, the knowledge of disease, the self-exertion for therapy and the complication in diet; the only significant variable was the gender in exercise therapy. CONCLUSIONS: The degree of glycemic control in diabetic patients was influenced by compliance. In order to improve patient's compliance, we must foster the knowledge on the diseases, lead participation for diabetic education. Because the satisfaction to medical personnels was the important variables, we must build up good relationship between doctors and patients.; Summary

Cancer Screening Rate and Related Factors in Rural Area.: Kun Sei Lee, Soung Hoon Chang, Won Jin Lee; Korean J Prev Med. 2000;33(3):364-372.

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Abstract PDF: OBJECTIVES
Cancer is the second most frequent cause of death in Korea. Cancer screening tests can save lives through early detection. Enhancing the cancer screening rate is an important strategy for reducing cancer mortality. The purpose of our study was to evaluate the screening rate and related factors in a rural area. The study investigated relationships between sociodemographic characteristics, several preventive behaviors, and the experience of several cancer screening behaviors. MATERIALS AND METHODS: The study population was recruited voluntarily from the three rural areas(Myen) in Chungju city. The participants completed structured questionnaire from July 21, 1998 to July 26, 1998. RESULTS: The proportions of the study population who had previously received stomach, liver, breast, or cervix cancer screening tests were 24.5%, 18.5%, 27.0%, 59.2% respectively. The 1-year screening rates of stomach, liver, breast, and cervix cancer were 7.4%, 6.8%, 8.6%, 15.6% respectively. In multivariate logistic analysis, some sociodemographic variables, preventive behaviors, or psychological variables were significantly associated with several cancer screening tests. Those who had previously received a stomach cancer screening test were significantly associated with the presence of chronic disease, physician? recommendation, use of alcohol family history of cancer, or previous liver cancer screening test. Those who had previously received a liver cancer screening test were associated with education level, physician? recommendation and previous stomach cancer screening test. Those who had received a cervix cancer screening test were significantly associated with education level, presence of a transportation vehicle, physician? recommendation use of alcohol and previous breast cancer screening test. And those who had received a previous breast cancer screening test were significantly associated with age, marital status, and earlier cervix cancer screening test. CONCLUSION: Based on the results of this study a strategy to promote cancer screening and health objectives at the district level can be made.; Summary

The State of the Art of Preventive Medicine in North Korea With Reference to the Content Analysis of a Medical Textbook.: Sang Gu Yi, Ok Ryun Moon, Sin Jae Lee, Jung chul Kim, Wen Yong, Piao Song Lin; Korean J Prev Med. 2000;33(3):373-382.

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Abstract PDF: OBJECTIVES
The most frequently cited health related slogan in North Korea is that socialistic medicine is preventive medicine. It implies that North Korea puts preventive medicine at the operational center of its national health care system. This study aimed at examining and comparing preventive medicine practices in North Korea with those of South Korea. METHODS: Efforts have been made to obtain a textbook for analysis its contents. Many people have iassisted in the study by joining the interview. Some of these people are as follows: a former professor of PyongYang Medical School, NK physicians living in South Korea, WHO staffs, diplomatic officials, etc. The major items of analysis consisted of industrial medicine and hygiene, nutrition, school health, epidemiology, health statistics and heath policy & management. RESULTS: Public health philosophy is finely rooted and well integrated in the operation of the North Korean national health care system, particularly in the area of industrial medicine and hygiene. Preventive medicine with a strong health surveillance system spanning a number of broad social organizations is a major tool to improve the health of the people in North Korea. The emphasis on preventive medicine has a close relationship with the 'Juche Philosophy' and the shortage of pharmaceuticals and medical equipment. To cope with the shortage problem, North Korean health workers are encouraged to grow medicinal herbs. We have found that they put little effort into teaching newly emerging diseases, such as AIDS, VDT syndrome, hazards of EMF, and agricultural chemical poisonings. Of the subjects of the preventive medicine text, 78.9% coincide with those of South Korean industrial health manuals and 34.2% with South Korean epidemiology texts. However, an absolute difference was found to exist between the heath policies and management systems. CONCLUSION: In North Korea, the concept of preventive medicine functions as the basic philosophic strategy of the national health care system. It differs greatly from the South Korean system in both practice and educational content. Its contribution to society is simply incomparable to that of South Korea. More communication and further study is called for in order to improve the preventive medicine practices in the future.; Summary

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