Journal of Preventive Medicine and Public Health

Volume 35(2); May 2002

Original Articles

Bioinformatics and Genomic Medicine.: Ju Han Kim; Korean J Prev Med. 2002;35(2):83-91.

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Abstract PDF: Bioinformatics is a rapidly emerging field of biomedical research. A flood of large-scale genomic and postgenomic data means that many of the challenges in biomedical research are now challenges in computational sciences. Clinical informatics has long developed methodologies to improve biomedical research and clinical care by integrating experimental and clinical information systems. The informatics revolutions both in bioinformatics and clinical informatics will eventually change the current practice of medicine, including diagnostics, therapeutics, and prognostics.Postgenome informatics, powered by high throughput technologies and genomic-scale databases, is likely to transform our biomedical understanding forever much the same way that biochemistry did a generation ago. The paper describes how these technologies will impact biomedical research and clinical care, emphasizing recent advances in biochip-based functional genomics and proteomics. Basic data preprocessing with normalization, primary pattern analysis, and machine learning algorithms will be presented. Use of integrated biochip informatics technologies, text mining of factual and literature databases, and integrated management of biomolecular databases will be discussed. Each step will be given with real examples in the context of clinical relevance. Issues of linking molecular genotype and clinical phenotype information will be discussed.; Summary

Quantifying the Burden of Cardiovascular Disease Attributable to Total Suspended Particulate and Sulfur Dioxide Using Years Lived with Disability.: Seok Jun Yoon, Beom Man Ha, Jong Won Kang, Ho Jang Kwon; Korean J Prev Med. 2002;35(2):92-98.

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Abstract PDF: OBJECTIVE
To estimate the burden of cardiovascular disease attributable to the total suspended particulates (TSP) and sulfur dioxide (SO2) in Korea using the YLD (years lived with disability) measurement. METHODS: Congestive heart failure(CHF) and myocardial infarction (MI) were chosen as the main cardiovascular diseases whose causes are attributable to the TSP and SO2 levels. In order to calculate the YLD (years lived with a disability), the following parameters in the formula were estimated. : the incidence rate, the case fatality rate, The expected duration of a disability and the average age of onset were estimated. The expected duration of a disability and the average age of onset were calculated using the DISMOD method, as developed by the GBD researchers. The burden of cardiovascular disease due to TSP and SO2 was estimated using the number of years that the patient lived with a disability. RESULTS: The YLD of the CHF due to the TSP and SO2 was attributed to the TSP (94.4 person-year) and SO2 levels (35.0 person-year). The YLD of the MI due to the TSP and SO2 was attributed to the TSP (148.4 person-year) and SO2 levels(27.6 person-year). CONCLUSION: The YLD method employed in this study was appropriate for quantifying the burden of cardiovascular disease. Therefore, it would provide a rational basis for planning a national health policy regarding the disease burden of the risk factors in Korea.; Summary

Cost-Effectiveness Analysis of a Hyperlipidemia Mass Screening Program in Korea.: Yeon Soon Cha, Young Ho Khang, Moo Song Lee, Weechang Kang, Sung Hoon Jeon, Kee Lak Kim, Sang Il Lee; Korean J Prev Med. 2002;35(2):99-106.

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Abstract PDF: OBJECTIVE
Until now, there have been no evidence-based guidelines produced for the mass screening of hyperlipidemia cases in Korea. This study was done to find the most efficient strategy for a hyperlipidemia-screening program among Korean adults. METHOD: Seven alternative strategies for hyperlipidemia screening were formulated and compared in terms of cost-effectiveness. Cost and effectiveness were estimated from social perspectives and using a two-stage screening process (initial testing and additional testing for positives from the first test). A computerized database (based on persons who had visited a health promotion center in one teaching hospital for a routine health check-up) was used to determine the cost and the outcome of various strategies. Official data was used in calculating direct and indirect costs. Effectiveness was measured according to the number of persons who needed clinical intervention for hyperlipidemia. A stratified analysis, considering age group and sex, was then done. Sensitivity analyses, focusing on several uncertain parameters, were also done. RESULTS: Of the seven test alternatives available, the most cost-effective strategy was a screening program, which consisted of an initial test of total cholesterol,high-density lipoprotein cholesterol and triglyceride. There was some variation in the rank of the cost-effectiveness ratios for the seven alternatives dependent on age group or gender. CONCLUSIONS: Current hyperlipidemia screening practice, for National Health Insurance beneficiaries, tests only the total cholesterol level with a cut-off value of 260mg/dl as an initial screening test. It is not the best strategy for cost-effectiveness, and should be modified. Different screening strategies taking age group and sex into account should be developed and used for the efficient mass screening of hyperlipidemia cases among Korean adults.; Summary

The Effect of Strengthening Exercise Program on the Physical Activity, Activities of Daily Living, Social Behavior and Functional Performance of the Elderly in a Home for the Aged.: Hyun Sook Kim, Chee Kyung Chung, Kang Sook Lee; Korean J Prev Med. 2002;35(2):107-115.

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Abstract PDF: OBJECTIVES
To evaluate the effects of a strengthening exercise program on the physical activity, activities of daily living(ADL), social behavior and functional performance of the elderly in a home for the aged. METHODS : We administered a survey questionnaire that consisted of questions to establish general characteristics, health habits and status, physical activity, ADL, and social behavior. Additionally, a physical fitness and functional performance examination was performed on subjects who were 65 years old or older. Study subjects numbered 33 in the experimental group and 35 in the control group. For intervention, we used a strengthening exercise program of the upper and lower limbs for 12 weeks(5 times/week) using dumbbells and lead-packed weights. RESULTS: After the strengthening exercise program, the scores of physical activity and social behavior were significantly higher than the control group and the before exercise measurements. Moreover, the variables of functional performance were significantly higher than in the control group or the before exercise records. CONCLUSION: These results indicate that a strengthening exercise program can improve the score of physical activity, ADL and social behavior, as well as decrease the time(sec) of functional performance of the elderly in a home for the aged.; Summary

Health Promoting Lifestyle, Anxiety and Self-Esteem : Korean Immigrants in New York.: Hyo Jeong Song, Hee Chong Baek, Myung Ja Kim; Korean J Prev Med. 2002;35(2):116-122.

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Abstract PDF: OBJECTIVES
To examine the relationships among health promoting lifestyle, anxiety, and self-esteem for korean immigrants in New York. METHODS: The study included 425 adults aged 18 and over, who were chosen from Korean church and social organizations located in New York. The data were collected from April to July, 1996 using self-administered questionnaires. Data analyses were conducted using stepwise multiple regression, Pearson s correlation coefficients, t-test, and ANOVA. RESULTS: Health promoting lifestyle was significantly different by age, religion, occupation, and the length of residence. Those insured and those with no current medial diagnosis revealed significantly higher score in health promoting lifestyle than their counterparts. As for the level of anxiety, significant differences were found by educational level, marital status, occupation, income, and the length of residence. Self-esteem varied significantly by education, marital status, occupation, income, and the length of residence. Those with no current medical diagnosis and those insured experienced significantly higher level of self-esteem than their counterparts. Negative correlations were observed between health promoting lifestyle and anxiety. Perceived health status at present was positively correlated to perceived health status in the future. Health promoting lifestyle was significantly predicted by anxiety, age, and insurance. CONCLUSIONS: The above findings suggested that it is necessary to develop programs improving the perceived health status and lowering the level of anxiety. In this context, further researches on the relation between health promoting lifestyle and anxiety is required.; Summary

Cigarette Smoking, Alcohol and Cancer Mortality in Men: The Kangwha Cohort Study.: Sang Gyu Lee, Chung Mo Nam, Sang Wook Yi, Hee Chul Ohrr; Korean J Prev Med. 2002;35(2):123-128.

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Abstract PDF: OBJECTIVE
To examine the relationship between cigarette smoking, alcohol and cancer mortality in men in the Kangwha cohort after 12 years and 10 months of follow up. METHODS: The subjects consisted of 2,681 men in the Kangwha cohort aged over 55 in 1985. Number of deaths and the time to death from all cancers and other cause were measured and the data for the smoking and drinking habits were obtained from the baseline survey data in 1985. All subjects were categorized into four groups according to their smoking habits: non-smokers, ex-smokers, moderate-smokers (1-19 cigarettes per day), heavy-smokers (> or =20 cigarettes per day). In addition, they were also categorized according to their drinking habits: non-drinkers, light-drinkers (< or =1 drink per week), moderate-drinkers (<3 drinks per day), heavy-drinkers (> or =3 drinks per day). The cancer specific death rates were calculated according to their smoking and drinking status. The adjusted risk ratio for all cancer deaths according to their smoking and drinking status were estimated using the Cox's proportional hazard regression model. RESULTS: Using nonsmokers as the reference category, the adjusted risk ratio for all cancer deaths were 1.573(95% CI=1.003-2.468) for heavy-smokers. For lung cancer deaths, the adjusted risk ratios were 3.540(95% CI=1.251-10.018) for moderate-smoker and 4.114(95% CI=1.275-13.271) for heavy-smokers. Compared to non-drinkers, the adjusted risk ratio for stomach cancer was 2.204(95% CI=1.114-4.361) for light-drinkers. CONCLUSION: Smoking is the most significant risk factor for cancer deaths particularly lung cancer.; Summary

A Study on the Seropositivity of HBsAg among Biennial Health Examinees: A Nation-wide Multicenter Survey.: Dae Sung Kim, Young Sik Kim, Jae Yong Kim, Yoon Ok Ahn; Korean J Prev Med. 2002;35(2):129-135.

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Abstract PDF: OBJECTIVE
The primary objective of this study was to estimate the prevalence of HBsAg-positives in the late 1990's among Korean adults. In addition, we evaluated the association of age, a residential area, a vaccination rate, a family history of chronic liver diseases and a past history of acute liver disease with the seropositivity of HBsAg, and estimated the prevalence of chronic HBV infection by follow-up for 6 month or more. METHODS: A total of 10 areas, six metropolitan and four small cities, were selected. In each cities, one health screening center was selected for recruitment of study subjects. The study subjects were enrolled from a general health examination program that is provided by medical insurance companies. Questionnaires on various risk factors were administered to the study subjects. Sera was drawn and tested for HBsAg by radioimmunoassay. HBeAg and ALT were also tested for those of HBsAg positive. The HBsAg positives was retest for HBsAg 6 months later. RESULTS: Among the study subjects (n= 1816), the seroprevalence of HBsAg was 5.5% (95% CI= 4.5%-6.6%), 7.4% in men (95% CI= 5.8-9.4) and 3.6% in women (95% CI= 2.5-5.0). A past history of acute liver disease and a family history of chronic liver diseases was shown to be risk factors for HBsAg positivity. Among the 31 HBsAg-positives, negative seroconversion rate was estimated to be 3.2 %, Thus, prevalence of chronic HBV infection was estimated to be 5.3% (95% CI= 3.7-6.6). CONCLUSION: In this study, the HBsAg seroprevalence rate was lower than that of the other studies in 1980's, particularly in young adult and women. Considering the public health importance of liver cancer and chronic liver diseases, the further effort is needed to prevent and reduce the HBV infection.; Summary

An Approach to Survey Data with Nonresponse: Evaluation of KEPEC Data with BMI.: Jieun Baek, Weechang Kang, Youngjo Lee, Byung Joo Park; Korean J Prev Med. 2002;35(2):136-140.

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Abstract PDF: OBJECTIVES
A common problem with analyzing survey data involves incomplete data with either a nonresponse or missing data. The mail questionnaire survey conducted for collecting lifestyle variables on the members of the Korean Elderly Phamacoepidemiologic Cohort(KEPEC) in 1996 contains some nonresponse or missing data. The proper statistical method was applied to evaluate the missing pattern of a specific KEPEC data, which had no missing data in the independent variable and missing data in the response variable, BMI. METHODS: The number of study subjects was 8,689 elderly people. Initially, the BMI and significant variables that influenced the BMI were categorized. After fitting the log-linear model, the probabilities of the people on each category were estimated. The EM algorithm was implemented using a log-linear model to determine the missing mechanism causing the nonresponse. RESULTS: Age, smoking status, and a preference of spicy hot food were chosen as variables that influenced the BMI. As a result of fitting the nonignorable and ignorable nonresponse log-linear model considering these variables, the difference in the deviance in these two models was 0.0034(df=1). CONCLUSION: There is a lot of risk if an inference regarding the variables and large samples is made without considering the pattern of missing data. On the basis of these results, the missing data occurring in the BMI is the ignorable nonresponse. Therefore, when analyzing the BMI in KEPEC data, the inference can be made about the data without considering the missing data.; Summary

Incidence of Hypertension in a Cohort of an Adult Population.: Byung Yeol Chun, Sin Kam, Hee Sook Oh, Sang Won Lee, Kook Hyeun Woo, Moon Young Ahn; Korean J Prev Med. 2002;35(2):141-146.

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Abstract PDF: OBJECTIVES
This study was performed in order to assess the incidence of hypertension based on two-years follow-up of a rural hypertension-free cohort in Korea. METHODS: The study cohort comprised 2,580 subjects aged above 20 (1,107 men and 1,473 women) of Chung-Song County in Kyungpook Province judged to be hypertensive-free at the baseline examination in 1996. For each of two examinations in the two-year follow-up, those subjects free of hypertension were followed for the development of hypertension to the next examination one year (1997) and two years later (1998). The drop-out rate was 24.7% in men and 19.6% in women. Hypertension was defined as follows 1) above mild hypertension as a SBP above 140 mmHg or a DBP above 90 mmHg, 2) above moderate hypertension as a SBP above 160 mmHg or a DBP above 100 mmHg or when the participant reported having used antihypertensive medication after beginning this survey. RESULTS: The age-standardized incidence of above mild hypertension was 6 per 100 person years (PYS) in men and that of above moderate hypertension was 1.2. In women, the age-standardized rate for above mild hypertension was 5.7 and 1.5 for above mild and moderate hypertension, respectively. However, the rates of incidence as calculated by the risk method were 4.8% and 1.0% in men and 4.6%, 1.2% in women, respectively. In both genders, incidence was significantly associated with advancing age(p<0.01), In men, the incidences of above moderate hypertension by age group were 0.5 per 100 PYS aged 20-39, 0.7 aged 40-49, 1.7 aged 50-59, 3.6 aged 60-69, and 5.8 aged above 70(p<0.01). In women, those the incidence measured 0.6 per 100 PYS aged 20-39, 1.8 aged 40-49, 1.3 aged 50-59, 3.3 aged 60-69, and 5.6 aged above 70(p<0.01). After age 60, the incidence of hypertension increased rapidly. CONCLUSIONS: The incidence data of hypertension reported in this study may serve as a reference data for evaluating the impact of future public efforts in the primary prevention of hypertension in Korea.; Summary

A Case-Control Study on the Relationship between Obesity and Female Colorectal Cancer.: Aesun Shin, Hachung Yoon, Keun Young Yoo; Korean J Prev Med. 2002;35(2):147-152.

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Abstract PDF: OBJECTIVES
A hospital-based case-control study was conducted to evaluate the role of obesity in the development of colorectal cancer. METHODS: Three hundred and twenty four histologically confirmed female colorectal cancer cases and 26,998 non-cancer controls were selected from patients invited to the Aichi Cancer Center, Nagoya, Japan between 1989 and 1995. Information concerning demographic factors, medical history, family medical history, reproductive factors and dietary factors were obtained from self-administered questionnaires and medical records. The effects of weight and body mass index to colorectal cancer were examined using multiple logistic regression to control for other risk factors. RESULTS: There was no significant association between female colorectal cancer and obesity. Heavier weight adjusted for height or body mass index did not increase the risk of colorectal cancer. CONCLUSIONS: These results suggest that there is no associa-tion between colorectal cancer risk and obesity in women.; Summary

Accuracy of the Registered Cause of Death in a County and its Related Factors.: Eun Kyung Chung, Hee Young Shin, Jun Ho Shin, Hae Sung Nam, So Yeon Ryu, Jeong Soo Im, Jung Ae Rhee; Korean J Prev Med. 2002;35(2):153-159.

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Abstract PDF: OBJECTIVES
To evaluate the accuracy of the registered cause of death in a county and its related factors. METHODS: The data used in this study was based on 504 cases, in a county of Chonnam province, registered between January and December 1998. Study subjects consisted of 388 of the 504 cases, and their causes of death were established by an interview survey of the next of kin or neighbor and medical record surveys. We compared the registered cause of death with the confirmed cause of death, determined by surveys and medical records, and evaluated the factors associated with the accuracy of the registered cause of death. RESULTS: 62.6% of the deaths were concordant with 19 Chapters classification of cause of death. external causes of mortality, endocrine, nutritional and metabolic diseases, neoplasms and diseases of the circulatory system showed the good agreement between the registered cause of death and the confirmed cause of death. The factors relating to the accuracy of the registered cause of death were the doctors' diagnosis for the cause of death (adjusted Odds Ratio: 2.67, 95% Confidence Interval: 1.21-5.89) and the grade of the public officials in charge of the death registry (adjusted Odds Ratio: 0.30, 95% CI= 0.12-0.78). CONCLUSIONS: The accuracy of the registered cause of death was not high. It could be improved by using the doctors' diagnosis for death and improving the job specification for public officials who deal with death registration.; Summary

Comparison of Job Stressors between Managers and Employees in White-Collar Workers of an Electric Company.: Jin Kook Tak, Kang Sook Lee, Hyun Sook Hong; Korean J Prev Med. 2002;35(2):160-168.

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Abstract PDF: OBJECTIVES
This study was intended to investigate the differences of job stressors between managers and low level employees among white-collar workers. Another objective of this study was to examine whether the effects of job stressors on mental health differ between the two groups. METHODS: Data was obtained from 204 managers and 251 low level employees who were employed in white-collar jobs. Fourteen job stressors and seven job stress variables were measured. RESULTS: Among the 14 job stressors, role overload, job insecurity, and work-family conflict were higher job stressors for the manager group whereas role conflict, work-aptitude incongruity, participation in decision making, and promotion problems were higher job stressors for the low level of employees. There were no differences in job stress scores between the two groups. However, differences in the effects of job stressors on job stress were found between the two groups. For the manager group, job insecurity, work-aptitude incongruity, and work-family conflict significantly affected in explanation of job stress whereas for the low level employees, role underload, peer satisfaction, and environmental problems significantly explaining the job stress variables. CONCLUSIONS: There were significant differences in job stressors between managers and low level employees among white-collar workers. Additionally there were differences in the effects of job stressors on job stress between the two groups.; Summary

A Cross-Sectional Study on gamma-GTP and its Related Factors in Male Workers.: Keon Yeop Kim, Sin Kam, Jong Hyun Lee, Young Ae Ha, Kyung Eun Lee; Korean J Prev Med. 2002;35(2):169-174.

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Abstract PDF: OBJECTIVE
To investigate gamma-Glutamyltransferase (gamma-GTP) and its related factors in male industrial workers. METHOD: Five hundred and forty male workers without heart disease, diabetes mellitus, renal disease, hepatitis, and other liver diseases were surveyed in October 1998. Blood samples were collected to test for gamma-GTP, total-cholesterol and fasting blood glucose. A self-administered questionnaire survey on life style was also done. RESULTS: The total geometric mean value of gamma-GTP was 30.6 U/L. According to a univariate analysis: age, BMI(body mass index, kg/m2), alcohol consumption, current smoking, stress, diastolic blood pressure, and blood total cholesterol were significantly associated with gamma-GTP(p<0.05). From a multiple regression analysis: BMI, alcohol consumption, current smoking, diastolic blood pressure and total-cholesterol were significantly related to gamma-GTP(p<0.05). Coffee consumption was negatively related to gamma-GTP, but not significantly. CONCLUSION: We recommend that a change in health behavior (i.e. reducing alcohol intake, controlling BMI and not smoking) is necessary to decrease gamma-GTP in male workers.; Summary

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