Journal of Preventive Medicine and Public Health

Volume 31(2); June 1998

Original Articles

A Study on Major Health Components of National Health Examination Survey in Korea.: Soon Young Lee, Hae Kyung Kim, Ju Won Park, Seung Soo Shim; Korean J Prev Med. 1998;31(2):167-182.

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Abstract PDF: The purpose of this study was to identify the major health components and measurements to be conducted in National Health Examination Survey(KNHES). The prevalence and severity of disease, acceptability of population and the possibility, of standardization of measurement were considered as guideline for selecting the components. On the base of magnitude and severity of disease, chronic liver disease, hepatic cancer, gastric ulcer, stomach cancer, essential hypertension, cerebrovascular disease, ischemic heart disease, pulmonary tuberculosis, lung cancer, DM, breast cancer, cervical cancer, arthritis and intervertebral disc disorder were selected as the preliminary target diseases. Questionnaire survey for 648 persons in 'K' city and medical specialists in five clinical societies were conducted for evaluating the acceptability of general population for the measurements and the possibility of standardization for the procedures. In conclusion, the major target diseases were chronic liver disease, hypertension and DM and the total cholesterol, high density lipoprotein, triglyceride, total protein, albumin, hemoglobulin, hematocrit, platlet count, anti-HBs, HBsAg, height and weight were selected for basic physical components.; Summary

Electrocardiographic findings of a Community People by Computerized Device for Analysis.: Esun Koo, Jae Young Kim, Hae Joon Kim; Korean J Prev Med. 1998;31(2):183-198.

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Abstract PDF: In order to determine the prevalence rate and find out the sexual difference of abnormal electrocardiographic findings manifested by computerized EKG, which is equipped with auto-analyzing function, a total of 2,083 electrocardiograms that were taken from population over 20 years-old from October 1996 to February, 1997 were studied according to their age, gender and blood pressure. l. Using the electrocardiography, with auto-analyzing function, 33 kinds of abnormal findings were manifested. The prevalence rate of abnormal findings was 52.8% in male and 43.7% in female. Among them, the most common finding was sinus bradycardia found in 17.6% of male and 15.4% of female. Left ventricular hypertrophy by voltage criteria, minimal voltage of left ventricular hypertrophy, left axis deviation and atrial fibrillation were more common in male than in female statistically. Both of nospecific T wave and ST segment abnormality were more common in female than in male statistically. 2. Thirty-three kinds of abnormal findings were manifested. They revealed one abnormal finding alone or combined with some other ones making 128 kinds of abnormal findings. The most common abnormal finding that manifested alone was right axis deviation (100%), then myocardial ischemia (95.7%) the next. The most common abnormal finding that complexed with other abnormal findings were left anterior fascicular block(percentage of single manifestation; 26.2%) and nonspecific T wave abnormality(percentage of single manifestation; 32.9%). Also, combination of sinus bradycardia and minimal voltage of left ventricular hypertrophy, and combination of sinus bradycardia and left ventricular hypertrophy were included in 25th sequences of abnormal findings. 3. The prevalence rate of abnormal electrocardiographic findings were higher in older group, hypertensive group, and the group of higher systolic or diastolic pressure in both sexes. 4. Abnormal findings that commonly manifested with sinus bradycardia were voltage criteria or minimal voltage of left ventricular hypertrophy(38.6%): sinus arrhythmia(10.5%); nonspecific T wave or ST segment abnormality(18.4%) and first degree AV block(7.2%) in descending order. 5. The most common site which manifested myocardial ischemia was posterior and inferior wall with equal percentage of 23.4%. And then anterior wall(19.l%), and antero-lateral wall and septum with equal percentage of 10.6% was noted in descending order.; Summary

Factors influencing weight control behavior and intention of obese children and adolescents.: Yunju Kang, Myongsei Sohn, Kinam Jin, HanJoong Kim, Heechoul Ohr, Sungjae Shin; Korean J Prev Med. 1998;31(2):199-214.

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Abstract PDF: This study was undertaken to explain weight control behavior and intention of obese children and adolescents as measured by the elements of the health belief model. A total of 732 obese students from 28 schools in Seoul metropolitan area and their mothers were assessed with a self-administered questionnaire. The analyzed results are as follows; l. Among obese students, 45.3% of male students and 57.2% of female students, a significantly higher portion than male students, reported that they had tried to lose weight within the recent year. Exercise was the most frequently used method to lose weight followed by diet control, drug use, and specialized clinic visits, in descending order. 2. Male students were more likely to try to lose weight if they perceived a low threat level and their mother had a job, and female students were more likely to try to lose weight if they were younger in age, perceived a low threat level and had strong external motivating factors. 3. Female students showed a significantly higher level of intention to obesity control than male students, and the intention level of their mothers also showed the same trend. 4. In male students, the degree of weight dissatisfaction, weight control experience, the level of obesity related beliefs of students, the educational level of the mother and economic status of the family were significant predictors of intention to obesity control, and in females, age, the level of obesity related beliefs of students and intention of their mothers were significant. In the mothers of male students, obesity index of students, age of the mother and the level of obesity related beliefs of the mother were significant predictors of intention of the mother, and in the mothers of female students, obesity index of students, occupational status of the mother and obesity related beliefs of the mother were significant. 5. According to the path model of intention to obesity control, the degree of weight dissatisfaction had the most powerful effect in male students, and perceived net benefit level was the most important variable in female students. Since the weight control behavior and intention of obese students were more predictable by the degree of weight dissatisfaction than the obesity index, we can conclude that only the students dissatisfied with their weight are well motivated for obesity control. There can be a discrepancy between the mother and her child's beliefs and intention status(especially in male students), so the therapists should also assess the student's opinion as well as the mother's. In female students, the perceived net benefit level was the most important predictor of intention to obesity control, therefore the intervention program should pay particular attention to the positive benefits of weight control rather than negative aspects(threats) of obesity.; Summary

A Survey for Computerized Information System of Occupational Health Management at Worksite.: Heui Sug Jo, Eun Hee Ha, Yun Chul Hong, Chul Hwan Kim, Kyung Ja June, Hye Sook Park; Korean J Prev Med. 1998;31(2):215-227.

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Abstract PDF: In order to develop the computerized information system of occupational health management at worksite, we surveyed actual states of computer use at worksites. We used a self-administrative questionnaire to the members of Korean Association of Occupational Health Nursing(KAOHN) from July 4 to August 21 in 1997. Among the members of KAOHN, 147 members answered. The worksites where they, were employed were very diverse in aspect of jobs, locations, and size. Occupational health computerized system was used at 30(20.4%) worksites among 147 respondents. When they first introduced the computerized system the most difficult problem was the lack of support of manager. The programs that they have used mainly consist of drug management, health examination management, disease management, but the program of worksite environment management have been rarely used. Most users felt that the computerized system was effective, but there were problems in connection within programs. Many worksites have plans to take or expand the computerized information system within several years. It is necessary to develop the effective and integrated occupational health computerized system.; Summary

Effect of Therapeutic Exercises on Shoulder Dysfunction in VDT-related female Office Workers.: Soon Seok Choi, Kui Won Jeong, Sang Hwa Urm, Soo Jin Jeong, Jong Tae Lee, Jin Ho Chun, Chae Un Lee, Ki Taek Pae; Korean J Prev Med. 1998;31(2):228-239.

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Abstract PDF: Visual display terminal(VDT) is popular in majority of office in modern countries. Musculoskeletal pain due to repetitive work with VDT is a serious industrial accident at present. In recent studies, shoulder pain in VDT users is the most common problem in Korea. The purpose of this study was to evaluate and compare the effect of exercises on shoulder dysfunction in VDT-related female office workers. Of the l19 patients with shoulder dysfunction, 32 patients entered into the study. 16 patients(Group I) were not prescribed exercises, other 16 patients (Group II) performed throughout the specific shoulder exercises such as pendular exercises(forward, backward and circumduction) and sidelying external rotation exercises with weights. After 3 months of exercises, the two groups were compared in term of the pain rating scale, disability questionnaire score and range of motion score. The results were summarized as follows ; l. The pain rating scale in Group I before and after 3 months were not differenced significantly(p value=0.784) and in Group II, the scale before and after exercises were differenced significantly(p value=0.0005). 2. The disability, questionnaire scores in Group I before and after 3 months were not differenced significantly(p value=0.437) and in Group II, the scores before and after exercises were differenced significantly(p value=0.0002). 3. The ROM scores of the affected shoulder in Group I before and after 3 months were not differenced significantly(p value=0.876) and in Group II, the scores before and after exercises were differenced significantly(p value=0.0017). In conclusion, that the specific shoulder exercises on shoulder dysfunction in VDT-related female office workers are encouraged.; Summary

Blood Lead Levels of Children in Ulsan Industrial Area.: Cheol In Yoo, Ji Ho Lee, Choong Ryeol Lee, Sung Ryul Kim, Seon Ho Lee; Korean J Prev Med. 1998;31(2):240-248.

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Abstract PDF: We conducted this study, to obtain basic data of lead concentrations in children of Ulsan industrial area and to evaluate the difference in blood lead levels between industrial area and suburban area. The study subjects were composed of 348 school children residing in industrial area and 100 school children of suburban area. There is no difference in age and sex distribution of study participants between industrial and suburban area. The obtained results were as follows: l. The geometric means of blood lead levels of study participants were 4.90 ng/dl, which is lower than current acceptable value 10 ng/dl. 2. The children residing in industrial area had the higher blood lead levels(5.26 ng/dl) than suburban children(3.81 ng/dl) with statistical significance(P<0.001).; Summary

Evaluation of factors affecting sensory neural hearing loss.: Seong Chul Hong, Seong wook Bae, Jong Young Lee; Korean J Prev Med. 1998;31(2):249-264.

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Abstract PDF: Reports on a potential relationship between sensory neural hearing loss(SNHL) and cardiovascular or hematologic factor show that the results are controversial. A detailed analysis of risk factors in the development of SNHL was carried out in 3,050 non-noise exposed healthy worker. The mean hearing threshold of both ears at 500, 1000, 2000, 4000, 8000Hz was measured and the effect of age, possible cardiovascular risk factor and hematologic factor (blood viscosity and hemostatic factors) on SNHL were evaluated. First, each of these were associated with loss of hearing sensitivity when univariately and multivariatively analysed. In a multiple regression model, age, sex, body mass index, WBC and total cholesterol level were independently associated with the mean of hearing sensitivity decrease at 4000 and 8000Hz. Second, study subjects were divided into two group (normal vs SNHL) and we compare the possible risk between both groups, and analysed univariate and multivariative logistic model. In a multiple logistic regression model, age, sex, body mass index, WBC and total cholesterol level, total protein, platelet were independently associated with SNHL. Our results show that we have some reliable indices of susceptibility to SNHL using cardiovascular measures or biochemical factor, but future, more extensive studies are required.; Summary

The Influence of Smoking and Alcohol Intake on Copper, Zinc, and Nitric Oxide Concentration in Serum.: Yeon Pyo Hong, Byung Sun Choi, Jung Duci Park, Im Won Chang; Korean J Prev Med. 1998;31(2):265-274.

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Abstract PDF: To investigate the change of nitric oxide(No), copper, and zinc in serum on smoking and alcohol ingestion in young adults, this study was performed in a cross-sectional study in 127 healthy, men in Korea who had HBsAg(-), HCVAb(-), and no symptomatic liver, heart, gastrointestinal, chronic diseases, and inflammatory sign(lower than 10,000 white blood cell count in CBC). At the men's entry into the study, blood samples were drawn from each subject and immediately centrifuged for analysis of NO, copper, and zinc. Each man completed a questionnaire that provided information on smoking, alcohol intake and present and past medical history. NO was analyzed by HPLC(Green et al., 1982), copper and zinc by atomic absorption spectrophotometer with air-acetylene flame and total cholesterol(TC) by Spectrum EPX. smoking(number of cigarettes per day and pack-year) and alcohol intake was grouped tertile. Copper was adjusted for age and zinc and for age and TC. NO, copper, and zinc on smoking and alcohol ingestion were analyzed in general linear models, respectively. NO, copper and zinc in serum did not show statistical differences between non-smoking and high-smoking group and no-alcohol intake and high-alcohol intake group. This study, suggested that copper, zinc, and NO was not good biological marker for early effect by smoking and alcohol intake in young adults. However, selection bias should be Considered in evaluation of this result. A large prospective study, will be needed in advance on usefulness of copper, zinc, and NO as a marker for risk fictors and early change of atherosclerosis.; Summary

A case-control study on the effects of the genetic polymorphisms of N-acetyltransferase 2 and glutathione S-transferase mu and theta on the risk of bladder cancer.: Heon Kim, Wun Jae Kim, Hyung Lae Lee, Moo Song Lee, Cheol Hwan Kim, Ro Sa Kim, Hong Mei Nam; Korean J Prev Med. 1998;31(2):275-284.

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Abstract PDF: Activities of enzymes involved in the metabolism of various carcinogenic xenobiotics is one of the most important host factors for cancer occurrence. N-acetyltransferase (NAT) and glutathione S-transferases (GST) are enzymes which reduce the toxicity of activated carcinogenic metabolites. Slow N-acetylation and lack of GST mu (GSTM1) were reported as risk factors of bladder cancer. GST theta (GSTT1), which is another type of GST, was reported to be deleted at higher proportion among Koreans. Since cause of bladder cancer is not fully explained by single risk factor, many kinds of enzymes would be involved in the metabolism of carcinogens excreted in urine. This study was performed to investigate whether the polymorphisms of NAT2, GSTM1 and GSTT1 are risk factors of bladder cancer and to evaluate the effects of their interaction on bladder cancer development. Sixty-seven bladder cancer and 67 age- and sex-matched non-cancer patients hospitalized in Chungbuk National University Hospital from March to December 1996, are the subjects of this case-control study. Questionnaire interview was done and the genotypes of NAT2, GSTM1 and GSTT1 were identified using PCR methods with DNA extracted from venous blood. The effects of the polymorphism of NAT2 and GSTM1 and their interaction on bladder cancer were statistically tested after controlling the other risk factors. The frequencies of slow, intermediate, and rapid acetylators were 3.0%, 38.8%, and 58.2% for the cases, and 7.6%, 40.9%, and 51.5% for the controls, respectively. The risk of bladder cancer was not associated with the increase of NAT2 activity(x(2) trend=l.18, P-value>0.05). GSTM1 was deleted in 68.7% of the cases and 49.3% of the controls (x(2)=5.21, P-value<0.05), and the odds ratio (95% CI) was 2.23 (l.12 - 4.56). GSTT1 deletion, the rate of which were 26.9% for the bladder cancer patients and 43.3% for the controls, was a significant protective factor against bladder cancer. Smoking history, turned out to be insignificant as a risk factor of bladder cancer (OR=l.85, 95% CI: 0.85 - 4.03), and occupation could not be tested because of the extremely small number of occupational history related to the increase of bladder cancer. In multiple logistic analysis controlling the effects of other risk factors, GSTM1 deletion was the only significant risk factor for bladder cancer (OR: 2.56, 95% CI: l.22-5.36, P-value<0.05), but slow acetylation and GSTT1 deletion were not. These results suggest that GSTM1 deletion may, be a significant risk factor of bladder cancer. Since there have been much debates on causal relationship between slow acetylation and GSTT1 deletion, and bladder cancer, further studies are needed.; Summary

Effect of cigareet smoking on air-conduction hearing threshold level in adult men.: Jin Seok Kim, Min Hae Yeh, Byung Yeol Chun, Kuck Hyeun Woo, Yune Sik Kang, Keon Yeop Kim, Young Sook Lee; Korean J Prev Med. 1998;31(2):285-292.

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Abstract PDF: To investigate the effect of smoking on the hearing threshold, l,887 adult male workers who visited health care center during the period l January 1996 - 31 July 1997 were selected. Air-conduction hearing threshold level, diastolic blood pressure(DBP), total cholesterol, fasting blood sugar(FBS), hematocrit and obesity, were measured. The data on age, occupation, and smoking were collected. Air-conduction hearing threshold in smoker was significantly higher than non-smoker in categories of 250, 500, 1000 and 4000 Hz(p<0.05). Mean values of PTA-low, PTA-mid, and PTA-high in smoker were also significantly higher than non-smoker(p<0.05). In multiple regression analysis, smoking is likely to play a significant role after controlling age, occupation, DBP, FBS, total cholesterol, hematocrit, and obesity,(p<0.05). The hearing threshold was significantly increased with increasing age(p<0.05), the manufacturing worker may have higher hearing threshold(p<0.05). The higher hematocrit and the more obese, the higher hearing threshold(p<0.05). However, DBP, total cholesterol and FBS were not significantly related with hearing threshold level. In conclusion, smoking was significantly related with the hearing threshold level in adult men.; Summary

The comparison of health-related quality of life between the institutional elderly and the community living elderly.: Kyeong Soo Park, Yong Gil Seo, Hae Sung Nam, Seok Joon Sohn, Jung Ae Rhee; Korean J Prev Med. 1998;31(2):293-309.

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Abstract PDF: The purpose of this study is to compare the level of health-related quality of life and relating factor between institutional elderly and community living elderly. The subjects were 390 from Sanatorium or Nursing home and 467 from the community, in Kwangju. The results are followed : l) A comparison of ADL between two groups, institutional elderly and community living elderly, resulted in that community elderly were more significantly independent in the areas of bathing and transfer than institutional elderly. 2) A comparison of IADL between two groups resulted in that ; Community elderly, were more independent in the areas of using telephone and transportation, food preparation, house keeping, and doing laundry. Institutional elderly were more independent in the area of handling finances. 3) In the case of poor health-related quality of life, institutional elderly showed 2.4 times in the dimension of physical fitness, l.8 times in daily activity, 2 times in social activity, 2 times in pain, 26.7 times in social support, and 0.4 times in subjective quality of life higher than community elderly. There was no significant differences in the rest of dimensions. 4) In institutional elderly, the analysis of variables related to the health-related quality, of life resulted in that; The relating factors were sex, education, and chronic illness in the dimension of physical function. Direct contact with family or significant others in the dimension of social activity. Chronic illness in the dimension of pain and perceived health status. Direct or indirect contact with family or significant others over the phone or through letters in the dimension of social support. 5) The analysis of variables relatd to the health-related quality of life showed that community elderly has more relating variables in each area than institutional elderly. The relating factors were age, sex, and chronic illness in the dimension of physical function. Education and chronic illness in the dimension of emotional status. Age and chronic illness in the dimension of daily activity and social activity. Education and chronic illness in the dimension of pain and perceived health status. Sex, education, family size in the dimension of social support. Education and chronic illness in the dimension of subjective quality-of-life. Throughout general daily activity, community elderly showed more satisfactory results than institutional elderly, but in the subjective area of health-related quality of life, such as subjective quality of life, institutional elderly, group showed more positive results. And community elderly had more relating factors than institutional elderly. For the health care of the elderly that focused on quality, of life, new approaches considering the characteristics of both group, institutional and community, living elderly, are needed.; Summary

A Telephone Survey on the Opinions about Family Doctor.: Hong Gwan Seo, Jae Heon Kang, Cheol Hwan Kim, Seong Won Kim; Korean J Prev Med. 1998;31(2):310-322.

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Abstract PDF: In order to reinforce the role of primary care physician and to improve doctor-patient relationship, the Korean government tried to introduce 'Family Doctor Registration Program' into Seocho-Gu in Seoul, Ansung-Gun and Paju city in Kyunggi-Do in Oct. 1996. Community residents and doctors in those area did not show much interest in this project because of low incentives. We have done this study to see how much people know 'Family Doctor Registration Program' and what is people's real needs about 'Family Doctor Registration Program. We selected l,800 telephone numbers in Seoul, Chongju city, and Ansung-Gun by multi-stage stratified random sampling. Three trained survey personnels called them and got answers to the premade questionnaire until they completed the questionnaires of 200 persons in each community. The calling time was 7-9 p.m. from Monday to Friday, 3-9 p.m. on Saturday, and 9 a.m. to 9 p.m. on Sunday. We dropped out the persons who did not respond 3 times. The subjects consisted of 222 male and 367 female residents. Their ages ranged from 20 to 78: 24.8% in their 30s, 23.4% in their 20s, 22.5% in their 40s in male, and 35.2% in their 30s, 22.5% in their 40s, 18.5% in their 20s in female. 9.9% of male and 13.2% of female had their Family Doctors. The specialties of their Family, Doctors were internists in 56.2%, general surgeons in ll.0%. The persons who did not have their family, doctors were asked which doctors they would prefer if they had choices of family doctor. The results were internists in 50.3%, family physicians in 13.0%, pediatricians in 4.8%. Only 16.0% residents knew that government tried to introduce Family Doctor Registration Program. The 'Family Doctor Registration Program' was not well known to people. The results of our study showed that more effective incentives and public notifications are needed to activate this program.; Summary

Determinanats of Health Care Utilization of the Physically Disabled.: Keon Yeop Kim, Young Sook Lee, Ki Soo Park, Jae Hee Son, Sin Kam, Byung Yeol Chun, Jae Yong Park, Min Hae Yeh; Korean J Prev Med. 1998;31(2):323-334.

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Abstract PDF: To investigate determinants of health care utilization of the physically, disabled over 20 years old in age living in Taegu city, a self-administered questionnaire survey was carried out for 337 disabled persons with chronic illness from April to July, 1997. Health care utilization rate was 81.9%(69.l% for hospital or clinic and 12.8% for pharmacy). Marital status, job, health concern, and response to illness showed statistically, significant relationship with health care utilization(p<0.05). By, path analysis, job, economic status, medical security type and response to illness had a significant direct effect on health care utilization(p<0.05), however, health concern and regular source of care had an indirect effect. The reasons of no health utilization were due to economic problem(31.l%), no symptom(18.0%), inconvenience to seek care or no accompanying persons to be helped(14.8%), unseriousness of the severity of the illness(14.8%), too busy to be treated or no free time(8.2%), hopeless prognosis to be treated(6.6%) in order. In conclusion, it is recommended that the program for expanding medicaid, improving socioeconomic status by getting a job and health education to increase the health Concern toward physically disabled should be implemented to increase health care utilization rate.; Summary

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