Journal of Preventive Medicine and Public Health

Volume 29(3); September 1996

Original Articles

Distribution af active physicians and their working areas after 10 years of graduation.: Seung Hum Yu, Tae Yong Sohn, Hyohn Joo Oh; Korean J Prev Med. 1996;29(3):429-438.

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Abstract PDF: The geographical distribution of active physicians who graduated from medical schools before 1985 were studied. Those who had emigrated, hold non-medical jobs, are in the military service, or work as public health physicians and resident staff were excluded from the study. A total of 27,728 physicians were analyzed. Our studies have shown a relationship between the location of the medical schools from the which the physicians have graduated and the geographical regions in which they practice. A statistically significant number of physicians are working near the medical colleges from which they have graduated. That is, those who had graduated from medical schools located in the southern area of the country are presently working in the same region. This relationship was shown to be especially significant for older physicians and female doctors, who work around the area of the medical colleges from which they graduated.; Summary

The Relationship between Change in Obesity Indices and Change in Serum Lipids in Adult Male Workers.: Young Ae Ha, Byung Yeol Chun, Sin Kam, Sung Kook Lee, Min Hae Yeh; Korean J Prev Med. 1996;29(3):439-450.

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Abstract PDF: This study was conducted to evaluate the relationship between change in obesity indices and change in serum lipids in adult male workers. Two-hundred-eight adult male workers of an industry in Taegu city were followed-up from 1991 to 1995. Height, weight, circumferences of hip and waist, blood pressure were measured and serum lipids were analysed. Data on life style were obtained using self-administered questionnaires. Mean differences of anthropometric measurements between 1991 and 1995 were as follows; 1.63kg in weight, 3.61cm in waist circumferences, 4.23cm in hip circumferences, 0.52kg/m2 in BMI and -0.021 in WHR. Those of lipids were as follows; 15.09mg/dl in total cholesterol, 20.43mg/dl in triglyceride, 9.40mg/dl in HDL-cholesterol, 2.87 in MI-index(p<0.01) and 350mg/dl in LDL-cholesterol. The changed value of BMI and Katsura index were strongly correlated with that of total cholesterol(r=0.174, p<0.05), the changed value of BMI correlated with that of triglyceride(r=0.374, p<0.01) and the changed value of weight correlated with that of MI index(r=-0.173, p<0.05). The changed value of WHR was significantly correlated with that of total cholesterol(r=0.162, p<0.05), however, was not significantly correlated with HDL-cholesterol, LDL-cholesterol, triglyceride and MI index. The changed value of weight, BMI and Katsura index were correlated with that of triglyceride(r=0.262, p<0.01; r=0.267, p<0.01; r=0.258, p<0.01) and the changed value of MI index(r=-0.143, p<0.05; r=-0.158; r=-0.144, p<0.01), adjusting the pattern of change in life style. The changed values of HDL-cholesterol and MI index between 1991 and 1995 in low WHR group were significantly higher than those in high WHR group(p<0.05, p<0.01), adjusting the baseline value of them. Similar pattern was observed when considering Katsura index. When stratifying by BMI value of 1991, in low BMI group, the changed value of HDL-cholesterol and MI index showed the same pattern as above, however the of triglyceride was statistically higher in obese group than in non obese group(p<0.05). In conclusion BMI might be a better indicator to predict serum lipids change than other obesity indices.; Summary

Drug Abuse Status and Its Determinants of Male High School Students in Taegu.: Jung Rak Nam, Sin Kam, Jae Yong Park, Chang Hyun Han, Young Ae Ha; Korean J Prev Med. 1996;29(3):451-470.

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Abstract PDF: To identify the drug abuse status and its determinant factors in high school boys in Taegu, the study was performed from April to May, 1995. Study population were selected by cluster sampling method and total 5,665 students replied to the self-administered questionnaire survey(2,207 in academic high school, 3,458 in business high school). The major findings were as follows; The proportion of drinking, smoking experience was 55.0%, 45.8%, respectively, and the proportion of current drinker, current smoker was 27.2%, 27.5%. The drinking, smoking experience rate of second grade students was higher than first grade and it was higher in business high school boys. The proportion of a stimulant, a hallucinogen, hemp leaf cigarets experience was 3.2%, 1.6%, 0.1%, respectively. Drug abuse had significant association with home environment(lower economic status, frequent move, death of father or mother, apart from family), parents environment(parents' indifference, parents' drinking and smoking, etc.), school life(lower school grades, intimate friend's drug abuse, etc.), generous attitude to drug abuse, higher level of stress. Students who replied that the law prohibited immature person(students) from drinking and smoking showed lower drug abuse rate. In multiple logistic regression analysis, second grade students, business high school students, parents' indifference, lower school grades, intimate friend's drug abuse, no recognition of the fact that the law prohibits high school students from drinking and smoking, generous attitude to drug abuse, higher level of stress were significantly related with alcohol abuse and smoking. Other drugs abuse were related with above factors. On consideration of above findings, to prevent students from drug abuse, we have to try together in house, school, and society.; Summary

The Diagnostic Role of HRCT in Simple Pneumoconiosis.: Kyoung Ah Kim, Ji Hong Kim, Hwang Sin Chang, Hyeong Sook Ahn, Young Lim, Im Goung Yun; Korean J Prev Med. 1996;29(3):471-482.

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Abstract PDF: Early recognition of coalescence in pneumoconiotic lesions is important because such coalescence is associated with the respiratory symptoms and deterioration of lung function. This complicated form of pneumoconiosis also has worse prognosis than does simple pneumoconiosis. High resolution computerized tomography(HRCT) provides significant additional information on the stage of the pneumoconiosis because it easily detects coalescence of nodules and emphysema that may not be apparent on the simple radiograph. The Purpose of this study is to clarify the role of HRCT in detection of large opacity and the relationship of change between the coalescence of nodules or emphysema and lung function in dust exposed workers. 1. There was good correlation between the HRCT grade of pneumoconiosis and ILO category of profusion. 5(9.09%) in 55 study population had confluent nodule extending over two or more cuts on HRCT. HRCT could identify the pneumoconiotic nodules which was not found by simple radiography in 6 workers with category 0/0. 2. No significant difference was observed coalescence of nodules and emphysema by dust type. 3. There was no significant difference in pulmonary function according to ILO and HRCT classification. 4. HRCT could detect the significant reduction in FEV1, FEV1/FVC, PEER, FEF25, FEF50, and FEF75 and remarkable increase in RV and TLC in study persons with emphysema compared with non-emphysema group. 5. Emphysema was found more often in nodules-coalescence group than small opacity group by HRCT. We found that HRCT could easily detect areas of coalescence and complicated emphysema compared to plain chest X-ray. Also our data suggest that it is primarily the degree of emphysema rather than the degree of pneumoconiosis that determines the level of pulmonary function.; Summary

The Estimation of Prevalence of Diabetes Mellitus in a Rural Adult Population.: Sue Kyung Park, Joung Soon Kim; Korean J Prev Med. 1996;29(3):483-494.

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Abstract PDF: The objectives of this study are to estimate the prevalence of diabetes mellitus(DM) and to identify risk factors associated with fasting blood sugar in a rural adult population. We carried out a cross-sectional study on the residents over 30-year old. Among the 1077 eligible subjects, 725 persons responded to the study; the study consisted of interview on family and past history of DM, anthropometry, blood pressure, and blood sugar level in each subjects. Only 707 subjects of 725 participants had fasting blood sugar(FBS) examined and the rest, 18 subjects were had casual blood sugar examined due to failure of fasting over 8-hour. When subjects had FBS >or= 140mg/dl, 2 hours postprandial blood sugar level was checked after 75g oral glucose loading. The prevalence of DM was 8.9%, and age standardized prevalence rate adjusted to Korean population of 1995 was 5.8%. Mean and SD of fasting blood sugar in men was 99.8 +/- 22.6, and in women was 111.5 +/- 29.9. Mean levels of fasting blood sugar were significantly higher in women than in man and as their ages advanced the prevalencies in creased in both sexes. PP2 blood sugar levels were significantly higher in elder age and in persons with higher FBS levels than others. The risk factors associated with FBS were past history of diabetes, sex, socioeconomic status and waist-to-hip circumference ratio; the risk of diabetes was increased in female, people with past DM history, central obesity and low socioeconomic state. The low socioeconomic status associated with DM in this study, which is different from other study results, should be pursued in further studies.; Summary

NO2- and ATP synthesis in the EMT-6 cell stimulated by mercury chloride.: Gyung Jae Oh, Dai Ha Koh, Jung Ho Youm; Korean J Prev Med. 1996;29(3):495-506.

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Abstract PDF: Effect of Mercury chloride on the synthesis of NO2- and ATP were observed in EMT-6 cells which were culture with cytokines(IL-1alpha and IFN-gamma) and various concentrations of mercury chloride from 0.05 to 0.08 M. Viability of EMT-6 cells were observed above 90% in almost groups. There were not significant differences in the viability between mercury supplemented groups and control group. It suggests viability of EMT-6 cells were not influenced by these concentrations of mercury chloride. Results of the synthesis of nitrite showed significant time and group effect. There is a significant interaction effect between concentration of mercury chloride and culture time. The effect of various concentration of mercury chloride is not the same for all levels of culture time. There were significant differences in the synthesis of nitrite between mercury chloride supplemented groups and control group, and the synthesis of nitrite in EMT-6 cell by the supplement of mercury chloride was significantly decreased in a dose-dependent manner. Results of the synthesis of ATP showed a significant group effect, and the time main effect and the Group x Time interaction were also significant. There were significant differences in the synthesis of ATP between mercury chloride supplemented groups and control group, and the synthesis of ATP in EMT-6 cell by the supplement of mercury chloride was significantly decreased in a dose-dependent manner. These results suggest that the disorder of cell mediated immunity by mercury chloride could be related to the inhibition of nitric oxide synthesis which will be caused by the decreased synthesis of ATP.; Summary

Carpal Tunnel Syndrome among workers in a condom industry.: Joong Koo Kang, Do Myung Paek, Young Jung Lee, Hyeo Il Ma, Mi A Song, Hong Ki Lee, Jung Keun Choi; Korean J Prev Med. 1996;29(3):507-520.

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Abstract PDF: The objectives of this study are to investigate the prevalence of occupation related carpal tunnel syndrome(CTS) among workers in a condom industry; to analyse the sensitivity and specificity of clinical signs or symptoms such as hand diagram, Tinel's sign and Phalen's sign in carpal tunnel syndrome; and to test vibration threshold test using audiometry as a technically easy and noninvasive method in the diagnosis of carpal tunnel syndrome in stead of nerve conduction velocity(NCV). The study group was divided into exposed group(39 cases)and non-exposed group(48 cases) based on whether or not excessive use of wrist movements exist. 1. There are statistically significant differences in symptoms and signs of carpal tunnel syndrome such as hand diagram, Tinel's sign and Phalen's sign between exposed and non-exposed group(p<0.05). 2. Six cases(9 hands) were confirmed as carpal tunnel syndrome by NCV. Five cases(7 hands) belonged to exposed group, 1 case(2 hands) to nonexposed group. As there are significant differences in prevalence of carpal tunnel syndrome between two groups(p<0.05), excessive use of wrist in occupation is a risk factor of carpal tunnel syndrome. 3. When we use NCV as a gold standard in the diagnosis of carpal tunnel syndrome, sensitivity and specificity of hand diagram, Tinel's sign and Phalen's sign is as followed; hand diagram; sensitivity 88.9%, specificity 84.2%. Tinel's sign; sensitivity 55.6%, specificity 72.8%. Phalen's sign; sensitivity 14.3%, specificity 88.4%. Among above clinical signs and symptoms, hand diagram is the best clinical screening test. 4. The differences of vibration threshold between median and ulnar nerve at the same time are useful in the diagnosis of carpal tunnel syndrome but the time change of vibration threshold of median nerve over time are not sensitive enough. It is concluded that vibration threshold between median and ulnar nerve at the same time can be used as a supplementary or alternative criterion to indicate that the nerve dysfunction is located in the carpal tunnel.; Summary

A Computerized Scoring Method of The Hahn Double 15 Hue Test.: Wan Seoup Park, Jong Young Lee; Korean J Prev Med. 1996;29(3):521-528.

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Abstract PDF: The Hahn double 15 hue test is used for social and vacational aptitude test to separate strongly and mildly affected subjects among the colour vision defective persons, detected using colour vision test. However, the assessment of colour vision defect type and severity is based on the hue confusions which are represented diagrammatically on Hahn double 15 hue score sheet, this qualitative assessment of the test results have not provide a numerical score suitable for mathematical analysis. This paper presented a new proposal for quantitatively scoring the Hahn double 15 hue test based on those hue confusions made by the subject. With this program large numbers of double 15 hue test results can be processed easily and rapidly, and program helps to compare the severity of specific type colour vision defect and monitor acquired colour vision defect which has various disease process, continuously.; Summary

The Assessment of Acquired Dyschromatopsia among Organic-Solvents Exposed Workers.: Mi Jung Kang, Su Hee Kang, Suk Kwon Suh, Dong Hoon Shin, Jong Young Lee; Korean J Prev Med. 1996;29(3):529-538.

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Abstract PDF: We investigated the occurrence of color vision loss in 70 organic solvent mixtures exposed workers and in 47 controls. Color Vision was assessed with a color arrangement test designed to identify the defective color sense, the Han Double 15-Hue Test. The results of the test were no significant difference between exposed workers and controls in the proportion of subjects who committed one or two errors. Quantitative analysis, using color confusion index(CCI), showed no signifiant difference between exposed workers and controls. A significant linear correlation was present between age and CCI in both exposed workers(CCi=0.0056age + 0.94; r=0.23; p<0.05) and controls(CCI=0.0066age + 0.86; r=0.33; p<0.05). Qualitative analysis of the patterns on the hue circle showed that the prevalence of acquired dyschromatopsia was 21% in both and no significant difference. Multiple regression analyses showed that age was significantly related to color vision loss. These results did not provide evidence of a relationship between organic solvents exposure and incidence of color vision loss. In field studies for monitor the people at risk of the acquired color vision loss involving low-dose organic solvents exposed workers, both quantitative and qualitative information should be considered.; Summary

Application of HHIE-S(Hearing Handicap Inventory for the Elderly-Screening version) to screening test of noise-induced hearing loss.: Mi Young Lee, Suk Kwon Suh, Choong Won Lee; Korean J Prev Med. 1996;29(3):539-554.

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Abstract PDF: The study conducted from May to September in 1994 to investigate applicability of the Hearing Handicap Inventory for the Elderly-Screening version(HHIE-S) in parallel with the puretone audiometer to the initial screening test of noise-induced hearing loss(NIHL) in some noise-exposed workers. Subjects were selected by systemic sampling that took every fifth person from 6,700 workers taking the annual occupational health examination by the department of Health Maintenance of Dongsan Hospital Keimyung University in Taegu. The authors administered the pure-tone audiometric test and self-reported questionnaire of HHIE-S including items of sociodemographic and job-related variables concurrently. The final subjects analysed were 1,019(488 males and 531 females) excluding fourteen persons who had many missing values in their questionnaires. The reliability coefficients of HHIE-S scale by Cronbach's alpha were 0.84. In the univariate analysis of hearing handicap measured by the HHIE-S, work duration, military service and the hearing threshold loss at 1kHz and 4kHz was the only selected variable explaining the hearing handicap in males and hearing threshold loss at 1kHz and 4kHz, age, and work duration were selected in females. In ROC curves for HHIE-S scores against NIHL as gold standard which was defined by the follow-up audiogram as more than 30dB of the average of 0.5/1/2kHz and 50dB at 4kHz, the optimal cutoff for the parallel HHIE-S appeared to be 8. The results suggest that HHIE-S appeared to have some reliability and validity in this data and might be used in screening NIHL in parallel with pure-tone audiometer in noise-exposed workers.; Summary

Nationwide incidence estimation of colorectal cancer by subsite of origin in Korea.: B J Park, M S Lee, Y O Ahn, D S Heo, D H Kim, H Kim, H S Yew, T S Park; Korean J Prev Med. 1996;29(3):555-564.

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Abstract PDF: Nationwide incidence survey was conducted to estimate the annual incidence rates of colorectal cancer among Koreans between Jan 1, 1988 and Dec 31, 1989. The population of the incidence survey was the beneficiaries of Korea Medical Insurance Corporation(KMIC), Which were about 4,500,000 persons. The medical records of patients with diagnosis of either ICD-9 153(colon cancer), 154(rectal caner), 197(secondary malignat neoplasm of digestive and respiratory system), or 211(benign neoplasm of digestive system) were abstracted for the period with the standard format. The diagnosis was confirmed by one oncologist through the review of these abstracts. The numerator of the rate was finally defined as the incident colorectal cancer cases diagnosed between July 1, 1988 and June 30, 1989. The crude annual incidence of colorectal cancer for men was 13.1 per 100,000 and 10.6 for women, which was still low when compared with those of Japan and China during the same period. Age-adjusted sex ratio was 1.2 for fight-sided colon cancer and 1.9 for left-sided colon cancer. The excess of right colon cancer among postmenopausal women was remarkable, so further analytical approach would be needed to investigate which factors are related with this phenomenon.; Summary

The Relationship between Work Posture and Cervical Spine Abnormality among Cervicobrachial Disorder Workers in a Microwave-oven Assembling Factory.: Jong Park, Chul Gab Lee, Young Sook Kim; Korean J Prev Med. 1996;29(3):565-578.

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Abstract PDF: This study conducted to evaluate the association of work posture with cervical spine abnormality toward 106 microwave-oven assemblers. A self-administered questionnaire was used to obtain a general characteristics and a work history of workers. The posture of neck and shoulder joint of workers were measured with video tape recording and the simple X-ray of cervical spine was checked-up to observe the X-ray abnormality including degenerative change, curvature abnormality, disc space narrowing or disc canal narrowing. The result were as follows. 1. The prevalence of degenerative change among cervicobrachial disorder workers was 44.3%(47 persons), curvature abnormality was 43.4%(46 persons), disc space narrowing was 21.7%(23 persons), and disc canal narrowing was 21.7%(23 persons). 2. The prevalence of degenerative change at cervical spine was increased with the degree of neck flexion(flexed versus neutral; odds ratio (OR)=2.7), the total work posture of neck(mild or severe awkward versus neutral; OR=1.2, 3.4). 3. The prevalence of degenerative change at cervical spine was increased with the degree of the right shoulder flexion, the heaviness of the materials carried by the right hand and the degree of awkwardness at the total work posture of right shoulder(p<0.05). 4. There was no evidence of association between curvature abnormality, disc space narrowing, disc canal narrowing and work posture. In conclusion the awkward work posture was related with degenerative change of cervical spine among microwave oven assembling workers and the further study in these field must be made to prove the association objectively.; Summary

Knowledge, Attitude and Practice according to Types of Occupational Health Management.: Sung Hee Kim, Hae Ryeun Shin, Sang Woo Kim, Kuck Hyeun Woo, Wan Seoup Park, Jae Yong Park; Korean J Prev Med. 1996;29(3):579-596.

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Abstract PDF: The first purpose of this study was to compare the mean Knowledge, Attitude & Practice(KAP) scores concerning major occupational Health between two types of occupational health management in small & medium-scale textile factories. Sample number was 1,138 workers. In small & medium factories with 300 workers or less, they have two alternatives for occupational health management; Individual Health Management or Vicarious Health Management. The second purpose was to determine if there was a relationship between duration of Vicarious health management and mean kap scores for 694 workers from the Vicarious Health Management group. We used self-administered questionnaires for measuring KAP. The results of this study were; 1. There was significant difference concerning all socioeconomic & occupational variables(gender, age education level, marital status, Blue/White collar, working duration of present factory, working duration of total factories) except for shift. 2. There was no significant difference of mean scores of Knowledge and attitude between the Individual Health Management Group and the Vicarious Health Management. But, the mean score of Practice was significantly different. 3. According to multiple regression analysis, the mean score of Knowledge significantly increased with age, education level, working duration of all factories increased. The mean score of Attitude significantly increased with age, education level and married. The mean score of Practice significantly increased with age, education level, working duration of all factories, married and men. 4. In conclusion, The type of Health management did not significantly affect the mean KAP scores concerning major occupational Health problems. 5. But, the Duration of Vicarious Health management significantly increased the mean KAP scores.; Summary

Repair of Chromate induced DNA-Protein Crosslinks in Rat Lymphocyte.: Hun Jae Lee, Kwan Hee Lee, Yun Chul Hong; Korean J Prev Med. 1996;29(3):597-608.

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Abstract PDF: Genotoxic agents can induce various DNA lesions. DNA-Protein Crosslinks(DPCs) were known as the important DNA lesions which could impair gene expression because DPCs had a high probability of resisting repair and persisting through cell cycle. This repair resistance of DPCs could have biological significance but had not been evaluated clearly yet. Most of the studies that have evaluated the repair of DPCs only compared the extent of DPCs repair with other DNA lesions. We injected K2CrO4, a genotoxic agent, into Sprague-Dawley rats intraperitoneally(5mg/kg) and isolated blood lymphocytes 12 hours later. These lymphocytes were cultured in the mitogen added growth media and mitogen free media separately. The degree of the repair of DPCs was monitored for 4 days by the K-SDS assay. 4 day later, the amount of DPCs decreased by 4.6% in the mitogen added media but in creased by 10.9% in the mitogen free media. These results showed that DPCs induced by K2CrO4 were not repaired easily and the DPCs were biologically significant DNA lesions. We thought the decrease of DPCs in the mitogen added media was not due to the repair of DPCs, but from the increase of normal cell proliferation. Therefore, it is very important to consider the proliferation of normal cells when estimating the repair of DPCs.; Summary

The Assessment of Stress between White and Blue Collar Workers by using Psychosocial Well-being Index.: Seong Ouk Hur, Seong Sil Chang, Jung Wan Koo, Chung Yill Park; Korean J Prev Med. 1996;29(3):609-616.

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Abstract PDF: This study was conducted to evaluate the degree of stress state and the risk factors related to in 967 white collar workers and 275 blue collar workers buy using Psycosocial Well-being Index. The results obtained were as follows: 1. In the white collar workers and blue collar workers, young age, low education and low income groups had high scores of stress, while in white collar workers, female had high scores of stress but in blue collar workers male had high scores of stress. 2. According to psychosocial well-being index, mild stress state were 73.9% and 53.1%, high risk stress state were 8.9% and 44.4%, and healthy state were 17.2 and 2.6% in white collar and blue collar workers respectively. 3. The total stress score was highly associated with the factors of depression, social performance and self-confidence, general well-being and vitality, and sleeping disturbance and anxiety in order. 4. In reliability test of stress factors, Cronbach's coefficients of depression, social performance and self-confidence, general well-being and vitality, and sleeping disturbance and anxiety were 0.89, 0.81, 0.79, and 0.74 respectively. In conclusion, it suggested that age, sex, marital status, income, education, sleeping time, smoking and exercise habit were associated with stress score, all of above factors should considered to occupational health.; Summary

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