Journal of Preventive Medicine and Public Health

Volume 35(4); November 2002

Original Articles

Effect of Glutathione on Lead Induced Modulation of NO Synthesis in RAW 264.7 Cell.: Sae Ron Shin, Gyung Jae Oh, Keun Sang Kwon, Wook Hee Yoon; Korean J Prev Med. 2002;35(4):269-274.

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To evaluate the effect of glutathione(GSH) on lead induced modulation of nitric oxide(NO) synthesis, and to examine how lead modulates NO production in macrophages. METHODS: This study was observed in a culture of RAW 264.7 cells, which originated from a tumor in a Balb/c mouse that was induced by the Abelson murine leukemia virus. The compounds investigated were lead chloride, N-acetyl-cystein(NAC), and Buthionine Sulfoximine(BSO). RESUJLTS: ATP synthesis in RAW 264.7 cells was unchanged by each lead concentration exposure in a dose dependent manner. The NO synthesis was decreased when exposed to lead(PbCl2) concentration 0.5 micro M. The presence of 300 micro M NAC, used as a pretreatment in the culture medium, caused the recovery of the lead induced decrease in NO synthesis, but in the presence of 300 micro M BSO as a pretreatment, there was no recoverey. Pretreatment with NAC and BSO had no affect on ATP synthesis at any of the lead concentrations used. CONCLUSIONS: These results indicated that GSH has a protective effect toward lead toxicity, and suggested that the inhibition of NO production in macrophage due to lead toxicity may be related to cofactors of iNOS (inducible nitric oxide synthase); Summary

DNA Damage in Lymphocytes after Hair Dyeing and Related Factors among Women Volunteers.: Jin A Cho, Eun Ha Oh, Dong Geun Sul, Eun Il Lee; Korean J Prev Med. 2002;35(4):275-281.

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To evaluate the DNA damage by hair dyeing in human lymphocytes. METHODS: Comet assays were carried out to evaluate the DNA damage in lymphocytes by hair dyeing. Twenty subjects were selected from women volunteers whose age ranged from 55 to 67 year old. All subjects had no smoking history. Blood samples were collected before and 6 hours after hair dyeing. DNA damage was evaluated by means of the tail moments, which were quantified by a KOMET 4.0 image analysis system. RESUJLTS: The tail moments before hair dyeing showed no significant differences among subjects except for the high frequency group. The mean values of the tail moments in subjects with low and high frequencies of hair dyeing were 1.39 and 1.77, respectively (p<0.05). The tail moments after hair dyeing increased significantly. The mean values of tail moments in subjects before and after hair dyeing were 1.45 and 1.79, respectively (p<0.01). However, the difference levels of DNA damage in lymphocytes before and after hair dyeing were found to be slightly lower in both the dietary supplement taking group and high frequency group. CONCLUSIONS: The high frequency group appears to have a higher level of DNA damage than the low frequency group before hair dyeing. DNA damage in lymphocytes was found to be significantly higher in the volunteers after hair dyeing. In this study, the related factors such as high frequency and taking dietary supplements appeard to reduce DNA damage in lymphocytes after hair dyeing.; Summary

Determination of Free 4-hydroxyproline with Dansylchloride by HPLC in Human Urine.: Keou Weon Lee, Kyung Jong Lee, Young Bong Cho; Korean J Prev Med. 2002;35(4):282-286.

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The level of 4-hydroxyproline (4-Hyp) in human urine was measured using high performance liquid chromatography (HPLC) with a fluorescence detector. This method is useful for medical examinations and investigating the radicals induced by physical, chemical, mental stresses. This method is superior to many published several methods in terms of its low cost and ability to analyze many samples. METHODS: The urine from workers in a tire manufacturing company (22 male pre- and post-shift workers) and 18 office-workers as controls were analyzed. Data concerning age, the cumulative drinking amount and the cumulative smoking amount was collected with a questionnaire. The optimum applied amount of dansyl-Cl, the optimum reaction temperature and time, the recoveries and the optimum pH of the eluent and buffer were determined. 4-Hyp from human urine was derivatized with dansyl-Cl (dimethylamino-naphthalene-1-sulfonyl chloride) after removing the alpha-amino acid by a treatment with phthalic dicarboxaldehyde (OPA) and cleaned with Bond Elut C18 column. The 4-Hyp derivatives were separated on a reversed phase column by gradient elution with a phosphate buffer (5 m mol, pH 8.0) and acetonitrile, and detected by fluorescence measurements at 340 nm (excitation) and 538 nm (emission). RESUJLTS: The detection limit for the urinary free 4-Hyp was 0.364 micro mol/l. The recovery rate of 4-Hyp was 99.7 %, and the effective pH of the phosphate buffer and borate buffer were 3.0 and 8.0, respectively. From statistical analysis, age, drinking and smoking did not affect the urinary free 4-Hyp in both the controls and workers. The range of urinary 4-Hyp in the controls, pre-shift, and post-shift workers were 0.33-16.44, N.D-49.06, and 0.32-56.27 micro mol/l. From the pared-sample t-test, the urinary 4-Hyp levels in post-shift workers (11.82+/-16.73 n mol/mg Cre) were 2-fold higher than in pre-shift workers (5.36+/-5.53 n mol/mg Cre) and controls (4.91+/-4.89 n mol/mg Cre). CONCLUSIONS: This method was developed with high sensitivity, accuracy, and precision. The present method was effectively applied to analyze the urinary free 4-Hyp in both controls and workers.; Summary

The Effect of Social Support on Chronic Stress and Immune System in Male Manufacturing Workers.: Sei Jin Chang, Sang Baek Koh, Jong Ku Park, Bong Suk Cha; Korean J Prev Med. 2002;35(4):287-294.

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To examine whether cumulative chronic stress influences the immune status, and to verify the effect of social support on the relationship between these two dimensions in male manufacturing workers. METHODS: A total of 39 workers were recruited for this study. A structured-questionnaire was used to assess general characteristics, job characteristics (work demand and decision latitude), psychosocial distress, and social support. The serum levels of CD4 and CD8 were measured as immune markers, and were collected between 8:00 and 10:00am in order to standardize the markers. Nonparametric statistics were used to estimate the differences between job characteristics and the immune markers. RESUJLTS: General characteristics, and health-related behaviors, were not associated with CD4, CD8 or CD4/CD8. No relationships were found between job characteristics and the mean levels of immune reactivity. These results were consistent, even after controlling for social support. Social support failed to modify the relationship toward work demand, decision latitude or psychosocial distress to CD4, CD8, and CD4/CD8. CONCLUSION: Cumulative chronic life stress might not influence the immune status, and the effects of social support on the immune function under chronic stress, may not play a crucial role in modifying the relationships. This implication supports that the effect of stress on the immune function may be determined by the characteristics of that stress. Further research should effectively considers the type, magnitude and timing of a stress event, and modifiable factors, such as personality traits, coping style, and hormone excretion levels, on the alteration of immune status.; Summary

Epidemiologic Investigation on an Outbreak of Cholera in Gyeongsangbuk-do, Korea, 2001.: Jun Ho Lee, Hyun Sul Lim, Kwan Lee, Jun Chul Kim, Sang Won Lee, Un Yeong Go, Byung Kuk Yang, Jong Koo Lee, Moon Sik Kim; Korean J Prev Med. 2002;35(4):295-304.

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This study was carried out to investigate the cause, magnitude and transmission route of the cholera outbreak in 2001. METHODS: The study population were those persons who ingested foods at the restaurant, were confirmed as cholera patients, had symptoms of diarrhea and served as workers at the restaurant. A questionnaire survey and microbiological examinations on the microbes isolated from rectal swabs were conducted. Of the cases, 316 food histories were surveyed by an analysis of the restaurant menu. RESUJLTS: There were 139 confirmed cases of cholera reported in Korea in 2001. Of these, 104 were related to the restaurant. By region, Gyeongsangbuk-do had the highest incidence with 91 cases. Of these 91 cases, 74 had ingested foods at the restaurant, 2 were employees and 3 were secondary infection cases within the families. The results of the odds ratio analysis of the 316 persons having ingested foods at the restaurant were as follows: sandwiches 5.07 (95% CI, 1.85-14.59), soybean curd 2.45 (95% CI, 1.09-5.56), noodles 2.34 (95% CI, 1.24-4.42), steamed squid 2.01 (95% CI, 1.17-3.47) and vinegared rice 1.82 (95% CI, 1.08-3.09). It was certain the restaurant in question was the cause of the 2001 outbreak. CONCLUSIONS: We suspected that more than one restaurant employee contaminated foods served at the restaurant. In addition, eating raw fishes purchased at the Pohang Fisheries infected the employees of the restaurant. There is a possibility that these raw fishes were themselves contaminated by cholera bacilli in the sea.; Summary

Reproductive History and Hip Fracture in the Elderly Women in Korea: A Cohort Study.: Seung Mi Lee, Yooni Kim, Koung Eun Youn, Byung Joo Park; Korean J Prev Med. 2002;35(4):305-312.

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The reproductive history of women has been suggested to have a possible influence on the risk of osteoporotic fractures. The purpose of this study was to assess the association between reproductive history and hip fractures in the elderly women. METHODS: The study subjects were drawn from women members of the Korean Elderly Pharmacoepidemiologic Cohort (KEPEC), aged 65 years or over, whose reproductive histories were available, and who were beneficiaries of the Korea Medical Insurance Corporation (KMIC) in 1993 and lived in Busan city, Korea. The information on reproductive histories, and possible confounders, were collected from mailed questionnaires. Potential hip fracture cases were collected from the claims data obtained between 1993 and 1998, with a hospital survey conducted to confirm the final diagnoses. Rate ratios and their 95% confidence intervals, were calculated using a Cox's proportional hazard model. RESUJLTS: Following up 5,219 women for 6 years, 51 cases were confirmed with hip fractures. When adjusted for age, weight and physical activity, the rate ratio of hip fractures in women who had given birth three or more times was 0.56 (95% CI: 0.25 - 1.25), compared with those who had given birth two or less times. When adjusted for age, number of births, weight and physical activity, the rate ratio in women who first gave birth when younger than 22 years was 0.60 (95% CI: 0.34 - 1.08) compared with those who had giving birth at 22 years or older. CONCLUSIONS: According to these findings, an early age when first giving birth might decrease the risk of hip fractures in elderly Korean women.; Summary

Community Based Cross-sectional Study on the Risk Factors of Dementia among the Elderly in a City.: Ihn Sook Jeong, Jung Soon Kim, Byung Chul Chun, Eu Soo Cho; Korean J Prev Med. 2002;35(4):313-321.

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To identify the risk factors of dementia among the elderly in a large city. METHODS: A cross-sectional study was conducted in July 2001, with potential participants selected by stratified two stage cluster sampling of the elderly population of Keumgog dong, Busan. A total of 452 elderly people aged 65 years and over, underwent a two phase diagnostic procedure. Mini-mental State Examination-Korean (MMSE-K) and Samsung Dementia Questionnaire were used for the 1st stage, and the Clinical Dementia Rating Scale (CDR), the Bartel ADL, and IADL Index, the Korean Geriatric Depression Scale (KGDS), the Modified Hatchinski Ischemic Scale (MHIS), and other laboratory tests were used for the 2nd stage. RESUJLTS: Of the 446 participants finally chosen, 45 were confirmed with dementia, and 363 as normal, with the rests not confirmed with dementia or as normal, were excluded from the analysis. According to the logistic regression analysis, the risk of dementia was significantly higher in; people aged 80 and above (OR=4.36, 95% CI=1.97-9.62), illiterate (OR=3.58, 95% CI=1.71-7.46), who had a history of strokes (OR=6.35, 95% CI=2.71-14.87), or who had a history of hyperlipidemia (OR=4.74, 95% CI=1.65-13.61), compared to their counterparts. CONCLUSIONS: These results suggest that efforts to prevent strokes and hyperlipidemia can significantly decrease the risk of dementia.; Summary

The Efficient Methods of Population-based Cancer Registration in Daegu City.: Dae Gu Jin, Sin Kam, Byung Yeol Chun, Soon Ki Ahn, Jong Yeon Kim; Korean J Prev Med. 2002;35(4):322-330.

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This study was conducted to automatically improve the completeness and validity of the Daegu Cancer Registry, using cross record linkage of many data sources, and to develop a computerized patient enrollment system for efficient communication among cancer researchers via the internet. METHOD: We analyzed 10,229 cancer patients who were reported in the National Cancer Registry, and from pathological reports, health insurance cancer claims lists, cancer patient records at hospital information centers and death certificates from the Korea National Statistical Office. RESULT: We confirmed 4,624 cancer patients and found 897 of new cases from a review of medical chart. The new cases were detected efficiently using cross record linkage. We developed a computerized patient enrollment system, based on a client-server model, for the input of cancer patients, and then developed a web-based reporting homepage and patient enrollment system for the internet. CONCLUSION: This system could manage cancer databases systematically, and could be given to other researchers as a basic database.; Summary

Study of Disability-Adjusted Life Expectancy(DALE) Using National Health Interview Survey in Korea.: Young Hoon Kwon, Jung Kyu Lee, Young Kyung Do, Seok Jun Yoon, Chang Yup Kim, Yong Ik Kim, Young Soo Shin; Korean J Prev Med. 2002;35(4):331-339.

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To measure DALE (Disability-Adjusted Life Expectancy) in Korea to find out how long Koreans live in a state of full heath. METHODS: DALE was calculated using the life table of 1999 and the disability prevalence from the National Health Interview Survey (NHIS), which was conducted with a sample of 13,523 households in 1998. The disability prevalence was measured using the annual prevalence of the long-term limitation of activities, which were divided into classes 1, 2, 3, 4, 5 and 6 according to the severity of the limitation. The disability weights were measured for each 6 class by conducting a survey of 16 healthcare professionals. The severity-adjusted disability prevalence was calculated by multiplying the disability prevalence of each class by the disability weights respectively. Healthy life years lost due to disability was calculated by multiplying the life expectancy by the severity-adjusted disability prevalence. Finally DALE was measured as the life expectancy minus healthy life years lost due to disability. RESUJLTS: DALE for 1999, which refers to the expectation of equivalent years of good health, were 72.5, 69.5 and 75.3 years, for total, for males and for females, respectively. The percentages for DALE out of the life expectancy were 95.8, 96.6 and 94.4% for total, for males and for females, respectively. CONCLUSIONS: DALE is a newly developed indicator, which could effectively show the healthy life expectancy of populations. A greater notice and use of DALE would be expected as life expectancies increase and the quality of life changes in Korea.; Summary

Annual Visit Days, Prescription Days and Medical Expenses of Hypertensive Patients.: Bu Dol Lim, Byung Yeol Chun, Sin Kam, Jeong Soo Im, Soon Woo Park, Jung Han Park; Korean J Prev Med. 2002;35(4):340-350.

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To evaluate the annual visit days, the annual prescription days and the medical costs of hypertensive patients. METHODS: The medical insurance records of 40,267 incident patients with the diagnostic code of hypertension from September 1998 through August 1999 in Daegu city were reviewed. RESUJLTS: The proportion of the most proper medical care pattern group (Group VIII) who visited for 6-15 days with 240 prescription days or more a year was only 6.2%. The proper care group (Group IX) who visited for more than 16 days with 240 prescription days or more a year was 9.3%. The overall proper care group (Group VIII+IX) was therefore 15.5%. The proportion of the insufficient care group (Group I,IV) in both the number of visiting days and prescription days was 57.4%. The mean prescription day of the most proper group (Group VIII) was 29 days; the mean annual medical expenses, 453,587won; the mean annual amount paid by patients, 218,013won; and mean medical expenses per prescription day, 1,483won. The proportion of the overall proper care group (Group VIII+IX) was significantly higher in adults aged 50-59, those who were enrolled in industrial workers health insurance as well as government employees and private school teachers health insurance, and those who made a higher contribution per month (p<0.01). According to the type of medical facilities, the proportion of the most proper medical care pattern group was highest in the general hospitals (9.3%) but the overall proper care group was higher in the public health centers (22.1%) and private clinics (17.1%). CONCLUSIONS: The management system of hypertension should be reinforced urgently. Therefore, it is necessary to develop guidelines including the number of visiting days per year and prescription days per visit day, and make the system provide medical facilities to more properly care for hypertensive patients.; Summary

Physical Activity and Hip Fracture in Elderly People: A Cohort Study in Korea.: Kyung Eun Youn, Seung Mi Lee, Yooni Kim, Byung Joo Park; Korean J Prev Med. 2002;35(4):351-358.

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To evaluate the relationship between physical activity and the risk of hip fracture in the elderly Korean people. METHODS: The study population was a Physical Activity Subcohort (n=8,908) extracted from the Korean Elderly Pharmacoepidemiological Cohort (KEPEC). Physical activity information was obtained from a mailed questionnaire surveys. The outcome data was collected from claims data gathered between Jan. 1993 and Dec. 1998. A hospital survey relating to potential cases was conducted to confirm the final diagnoses. The abstracted data was reviewed by a medical doctor before the final diagnoses were confirmed. A mailing questionnaire survey was performed to obtain information on potentially confounding variables, including alcohol intake, smoking habits, weight, height and postmenopausal duration. There were 79 confirmed cases hospitalized due to hip fractures between Jan. 1993 and Dec. 1998. Relative risk of physical activity scores on the hip fracture, and their 95% confidence intervals, were estimated by a Cox's proportional hazard model using SAS for Windows ver. 6.12. RESUJLTS: Compared to the reference group, the adjusted relative risk of hip fracture associated with the most physical active category; after controlling for age, weight and alcohol intake in the males, and for weight, alcohol intake and postmenopausal duration in the females, were 1.04 (95% CI=0.35-3.06) and 0.44 (95% CI=0.26-0.77), respectively. CONCLUSIONS: Physical activity may protect elderly women from hip fracture.; Summary

The Development of Physical Functioning Scale for Community-Dwelling Older Persons.: Yun Hwan Lee, Kyung Jong Lee, Geun Shik Han, Soo Jin Yoon, Yeon Kyung Lee, Chan Ho Kim, Jeong Lim Kim; Korean J Prev Med. 2002;35(4):359-374.

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To develop a physical functioning instrument for older adults living in the community. METHODS: A representative sample of 979 people aged 65 years or over were interviewed in-person. Of these, 199 people also completed a detailed in-hospital examination. The scale items were selected based on the frequency of endorsement, along with the item-total and inter-item correlations. The associations of the scale with their physical performance and clinical examination were analyzed to evaluate the criterion-related validity. Construct validity was assessed using factor analysis, and internal consistency through Cronbach's alpha and item-total correlations. Test-retest reliability was measured by agreement between the household survey and the repeat survey at the in-hospital examination. RESUJLTS: Initially, 23 items on the level of difficulty, ranging from no difficulty to an inability to complete a task, with the specific mobility and self-care tasks were included. Those with a high frequency of endorsement and a low inter-item or item-total correlations were excluded, resulting in a 10-item Physical Functioning (PF) scale. Equal weights were given to each item and a summated score was calculated. Significant associations were found between the PF scores and the physical performance, survey and clinical data. The scale revealed a 2-factor (mobility and self-care) structure. Cronbach's alpha was 0.92 and the item-total correlations were in the 0.63 to 0.78 range. Pearson's correlations for the test-retest ranged between 0.56 and 0.61. CONCLUSIONS: The newly developed Physical Functioning (PF) scale showed good psychometric properties in older people. Further work, however, is needed to improve its sensitivity to discriminate higher levels of functioning, in addition to assessing its predictive value in detecting changes in health.; Summary

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