Journal of Preventive Medicine and Public Health

Volume 37(2); May 2004

Editorials

A Discussion on the Public Acceptance for Private For-profit Hospitals.: Hae Jong Lee; J Prev Med Public Health. 2004;37(2):99-103.

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Abstract PDF: No abstract available.; Summary

The Problems on Approving For-profit Ownership of Medical Institutions.: Sin Kam; J Prev Med Public Health. 2004;37(2):104-110.

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Abstract PDF: No abstract available.; Summary

Original Articles

Assessing the Factors Influencing Patient Satisfaction after Receiving Laser in situ Keratomileusis (LASIK) .: Woohyun Cho, Hye Young Kang, Ji Yoon Kim, Yoon Chung, Jongho Lee, Jemyung Lee; J Prev Med Public Health. 2004;37(2):111-119.

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Abstract PDF: PURPOSE
To identify those factors influencing the post-operative satisfaction in myopia patients receiving laser in situ keratomileusis (LASIK) METHODS: This study included 288 consecutive patients who received LASIK between July and December 2001 from two eye clinics located in Seoul and Pusan. Factors that were considered to influence post-operative satisfaction included pre-operative baseline characteristics, pre-operative expectation for treatment outcomes, and treatment outcomes. Before undergoing LASIK, study subjects were asked to rate the degree of their expectation for the improvement of visual functions and symptoms after LASIK on a 5-point Likert-type scale: where 1 referred to 'somewhat worse, ' 2 to 'no change, ' 3 to 'somewhat improved, ' 4 to 'improved, ' and 5 to 'very improved.' Self-administered questionnaire was used to evaluate baseline visual functions and symptoms on a 5-point scale before LASIK. At 6 months after LASIK, the evaluation was repeated to measure treatment outcomes in terms of the difference in the score before and after LASIK. Post-operative satisfaction was also measured at 6 months on a 5-point scale. Multiple regression analysis was performed to examine the independent relationship between influencing factors and postoperative satisfaction. RESULTS: A total of 171 patients (59.4%) participated in the 6-month follow-up investigation. The average expectation scores for the improvement in visual functions and symptoms were 3.8 and 3.4, respectively. The average score for the 7 questions assessing satisfaction was 4.0. The results of the regression analysis showed that the post-operative satisfaction increased with improvement in the visual function (beta=0.16, p< 0.05) and symptoms (beta=0.25, p< 0.05), the degree of preoperative refractive error (beta=0.26-0.67, p< 0.05) and in male patients (beta=0.31, p< 0.1). The pre-operative expectation was not a statistically significant factor in explaining postoperative satisfaction in the regression model. CONCLUSION: The finding from this study was that patients with very severe myopia tended to be more satisfied with the treatment than those with mild myopia, which implies that LASIK can be more beneficial to those suffering from a severe visual condition. Patient satisfaction was also significantly affected by the treatment outcomes experienced after LASIK. This suggests that improving the clinical outcome is the most fundamental requirement for the improvement of patient satisfaction.; Summary

Association between Alcohol Drinking and Cardiovascular Disease Mortality and All-cause Mortality: Kangwha Cohort Study.: Sang Wook Yi, Sang Hyun Yoo, Jae Woong Sull, Heechoul Ohrr; J Prev Med Public Health. 2004;37(2):120-126.

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Abstract PDF: OBJECTIONS: This study sought to examine relationships between alcohol drinking and cardiovascular disease mortality and all-cause mortality. METHODS: From March 1985 through December 1999, 2, 696 males and 3, 595 females aged 55 or over as of 1985 were followed up for their mortality until 31 December 1999. We calculated the mortality risk ratios by level of alcohol consumption. Among the drinker, the level of alcohol consumption was calculated by the frequency of alcohol comsumption and the type of alcohol. Cox proportional hazard model was used to adjust for confounding factors. RESULTS: Among males, compared to abstainer, heavy drinker had significantly higher mortality in all cause (Risk ratio=1.35), cardiovascular disease (Risk ratio=1.52) and cerebrovascular disease (Risk ratio =1.66). Although not significant, moderate drinker had lower ischemic heart disease mortality (Risk ratio =0.38). Among females, there was no statistically significant association between alcohol comsumption and mortality. CONCLUSION: The results of this study suggest that alcohol drinking has harmful effect on all-cause mortality, cardiovascular disease mortality and cerebrovascular disease mortality among males, especially in heavy drinker among males. Minimal evidence on protective effect for cardiovascular disease mortality in low or moderate drinker is observed.; Summary

Agreement between Smoking Self-report and Urine Cotinine among Adolescents.: Ihn Sook Jeong, No Rai Park, Jinkyung Ham; J Prev Med Public Health. 2004;37(2):127-132.

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Abstract PDF: OBJECTIONS: Cotinine, the major metabolite of nicotine, is a useful marker of exposure to tobacco smoke and self-reporting of smoking status is thought not to be reliable. This study aimed to evaluate the agreement between the smoking self-report among adolescents and the urinary cotinine test. METHODS: The study subjects were 1226 middle and high school students in Hanam city, who were selected by stratified random sampling. The self-report about smoking behavior was compared with urine cotinine value measured with PBM AccuSignRfi Nicotine (Princeton BioMeditech Corporation, USA). The percentage agreement, kappa and 95% confidence interval (CI) were calculated. RESULTS: The overall percentage agreement was 88.6%, and those for boys, girls, middle school, general school and vocational school students were 87.3%, 90.1%, 93.7%, 85, 5%, 90.7%, and 78.4%, respectively. The overall kappa index was 0.46 (95% CI=0.39-0.54) for overall, and those for boys, girls, middle school, general school and vocational school students were 0.56 (95% CI=0.48-0.65), 0.20 (95% CI=0.07-0.32), 0.21 (95% CI=0.09-0.34), 0.55 (95% CI=0.47-0.64), 0.42 (95% CI=0.33-0.52), and 0.48 (95% CI=0.36-0.60), respectively. CONCLUSION: The percentage agreement was relatively high but the kappa values very low for girls, and middle school students. Though the prevalence bias can be influenced by these results, the selfreport was not a sufficient tool for the evaluation of adolescents' smoking status, especially in girls or middle school students.; Summary

Association of Drinking Patterns and Health Characteristics with Beverage Preference.: Jee Jeon Yi, Heechoul Ohrr, Sang Wook Yi, Woo Jin Chung; J Prev Med Public Health. 2004;37(2):133-140.

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Abstract PDF: PURPOSE
To investigate the association between the type of preferred alcoholic beverage and drinking pattern and health characteristics. METHODS: A Cross-sectional study was conducted from 22 April to 3 May in 2002. 301 females and 699 males aged 13 to 59 were personally interviewed. Data on sociodemographic characteristics, drinking pattern and health characteristics were collected. 735 drinkers who were 19 year-old or over were included in analysis. Beverage preference was classified 3 categories: Beer drinker, wine drinker (including wine, makguly, chungju and yakju) and soju drinker (including soju and spirits). RESULTS: Beer drinkers were likely to be females. Compared to wine or soju drinkers, beer drinkers were less frequently drank, and consumed less total alcohol per week and less alcohol per 1 drinking among both male and female. Controlling for various confounders, beer drinker had significantly less total alcohol consumption per week, and alcohol consumption per 1 drinking than wine and soju drinker. CONCLUSION: Beer drinking were associated with less smoking in males and healthy drinking pattern in both gender than soju drinking.; Summary

A Study on the Cost and Proportion of Complementary and Alternative Medicine in Total Healthcare Cost among Elderly in the Last 6 Months of Life.: Jee Jeon Yi, Heechoul Ohrr, Sang Wook Yi; J Prev Med Public Health. 2004;37(2):141-149.

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Abstract PDF: OBJECTIONS: To evaluate the cost and proportion of complementary and alternative medicines (CAM) in the total healthcare costs among the elderly in the last 6 months of life. METHODS: The care-giving families of 301 persons older than 65 years, who died between July 1st and December 31st of 2001, and were also registered in Self-Employed Health Insurance Programs in Seoul, were interviewed. RESULTS: The cost of CAM was 1.09 million Won, which as a proportion of the total healthcare cost was 38.1%. The elderly aged between 65 and 69 year-old, male, living with their spouse, Buddhist and having cancers had higher CAM costs in an ANOVA and simple regression analysis. After controlling of various factors, age was the only significant factor associated with the cost of CAM. The elderly above 80 years old, female, bereaved and Buddhist had higher proportional CAM costs, and the elderly having cancers or cardiovascular diseases had lower proportional CAM costs in an ANOVA and simple regression analysis. After adjusting for various factors, the elderly above 85 years old, female and Buddhist had higher proportional CAM costs, and the elderly having cancers had lower proportional CAM costs. CONCLUSION: The very old and Buddhist, and/or the ill with no clear diagnosis, may depend more on CAM. Further research will be needed on the meaning and impact of CAM and their costs to public health and the total healthcare system.; Summary

Nonsteroidal Anti-inflammatory Drugs Utilization Patterns among the Elderly with Osteoarthritis at Primary Ambulatory Care Units in Busan Metropolitan City, Korea.: Nam Kyong Choi, Yooni Kim, Seung Mi Lee, Byung Joo Park; J Prev Med Public Health. 2004;37(2):150-156.

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Abstract PDF: OBJECTIONS: To investigate the utilization patterns of non-steroidal anti-inflammatory drugs (NSAIDs) among the elderly with osteoarthritis (OA) undergoing primary ambulatory care in Busan metropolitan city, Korea. METHODS: OA patients, aged 65 years and over, were identified from the Korean National Health Insurance Review Agency drug prescription database. The subjects had at least one episode of claim for OA (ICD-10-CM: M15-M19) between August 1, 2000 and February 28, 2002. Trends in the determinations of NSAIDs utilization were identified using chi-squared tests for trend. RESULTS: There were 47, 711 osteoarthritic patients. The total number of visits by these patients was 177, 443, with a total frequency for NSAID prescriptions of 214, 952. Seventy-nine percent of the OA patients were female. NSAIDs were prescribed on 133, 284 visits (75.1%) and the proportion of prescriptions was significantly increased with age. Only the proportion of visit when NSAIDs were prescribed decreased, from 65.1 to 43.5%, during the study period (p< 0.001). However, the proportion of combined treatments with anti-ulcer drugs was increased. The use of NSAIDs injections was decreased. Of the individual NSAIDs, diclofenac (28.7% of total frequency of NSAID prescriptions), piroxicam (15.0%) and talniflumate (8.7%), were the most frequently prescribed. Among the NSAIDs prescribed OA visits, 45.7% used two or more NSAIDs. CONCLUSION: The total proportion of NSAIDs prescribed to the osteoarthritic patients was higher than in other studies. The decline in the use of NSAIDs during the study period, and the frequent selection of safer medications, such as combination therapy with anti-ulcer drug, may reflect the risk awareness of the use of NSAIDs.; Summary

Effects of Chromium (VI) Exposure on the Placental Function and Reproduction in Rats.: Heun Lee, Jin Ho Chun, Deog Hwan Moon, Chae Un Lee, Sung Goo Kang, Byung Chul Son, Dae Hwan Kim, Chang Hee Lee, Jung Won Kim, Chae Kwan Lee; J Prev Med Public Health. 2004;37(2):157-165.

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Abstract PDF: OBJECTIONS: This study aimed to investigate the toxic effects of chromium (VI) on the placental function and reproduction in rats. For the study, the placental prolactin-growth hormone (PRL-GH) gene expression, placental trophoblast cell differentiation and reproductive data were analyzed. METHODS: The pregnancies of F344 Fisher rats were checked by the presence of a copulatory plug or sperm in the vaginal smear, which was defined as day 0 of the pregnancy. Pregnant rats were divided into the three groups. The control group was given tap water (chromium level < 0.001 ppm) and the remaining groups were given 250 or 750 ppm of chromium (VI) [as potassium dichromate], from day 7 to 19 of the pregnancy. Rats were sacrificed at days 11 and 20 of pregnancy. The mRNA levels of PRL-GH and Pit-1a and b isotype genes were analyzed by Northern blot hybridization and reverse transcriptionpolymerase chain reaction (RT-PCR). The hormonal concentration was analyzed by radioimmunoassay, and the differentiation of placental trophoblast cells were observed by histochemical studies. Reproductive data, such as placental and fetal weights, pregnancy period, and litter size, were surveyed at day 20 of pregnancy and after birth. A statistical analysis was carried out using the SAS program (version 8.1). RESULTS: The mRNA levels of the prolactin-growth hormone (PRL-GH) family of genes were dose dependently reduced by chromium exposure. The mRNA levels of Pit-1a and b isotype genes that induce the expression of the PRL-GH family of genes were also reduced by chromium exposure. The PRL-GH hormonal concentration in the rat placenta, fetus and maternal blood were decreased by chromium exposure. In the middle stage of pregnancy (day 11), a high dose of chromium suppressed the differentiation of spongiotrophoblast cells that secret the PRLGH hormones. In the last stage of pregnancy (day 20), a high dose of chromium induced apoptosis of placental cells. Reproductive data, such as placental and fetal weights, litter size, were reduced, but the pregnancy period was extended in the group exposed to chromium compared with the controls. CONCLUSION: Chromium (VI) disrupts the ordered functions of the placenta, which leads to reproductive disorders in rats.; Summary

Factors Associated with Cervical Cancer Screening in Busan, Korea.: Kui Son Choi, Duk Hee Lee, Kap Yeol Jung, Jieun Son, Tae Won Jang, Yoon Kyu Kim, Hai Rim Shin; J Prev Med Public Health. 2004;37(2):166-173.

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Abstract PDF: OBJECTIONS: Cervical cancer is the second most frequent cancer among women in Busan. The Pap smear test could have a significant effect on detecting cervical cancer, and enhancing their rate of use is an important strategy for reducing the incidence and mortality of cervical cancer. This study aimed to evaluate the factors associated with the past use of the Pap smear test in Korean women. METHODS: A population-based survey was carried out in Busan between November 1999 and March 2000. 1, 673 participants were randomly selected from 2, 684 women in Busan, using a 2-stage cluster sampling method, and interviewed in their homes. Their socio-demographic characteristics, smoking, drinking, familial cancer history, Pap smear screening history, reproductive and menstrual factors, sexual habits and use of contraceptive methods data were collected by a trained interviewer using a questionnaire. The use of the screening test was defined by a self-report from the participants on how many times they had had a Pap smear test in their lifetime, and when they had received their latest examination. RESULTS: Of the 1, 673 respondents (62.3% response rate), 57.6% had had a Pap smear test during her life (mean number, 2.3). Among the health examination participants (1, 064), 961 (90.3%) reported having sexual experience and 70.9% of these had had a Pap smear test. In a multiple logistic regression analysis, statistically significant relationships were observed for age groups and the Pap smear test rate (odds ratio, OR for 35-44 years=2.45; OR for 45-54 years=3.41; OR for 55 years=2.60; reference, under 34 years). The married or cohabiting women were more likely to have used the Pap smear test than those separated or widowed (OR=1.73). Among the reproductive behavioral measures, the number of births (OR for 3 births=4.22; OR for 2 births=3.95; OR for 1 births=3.38; reference, 0 births) and husband's extra-marital affairs (OR=1.50) were associated with the rates of use of Pap smear tests. CONCLUSION: It appears that the most important contributing factors to cervical cancer screening were age, marital status and number of births. A positive association was also observed for the husband's extra-marital affairs. This study enabled us to systematically assess the relationship between Pap smear rates and risk factors for cervical cancer. It is hoped that this study will make a significant contribution to the accumulating scientific evidence on the identification of factors associated with cervical cancer screening in Korea.; Summary

Association of Dietary Factors with Cognitive Impairment in Older Women.: Jin Hee Kim, Yunhwan Lee, Geunshik Han; J Prev Med Public Health. 2004;37(2):174-181.

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Abstract PDF: OBJECTIVE
To examine the association between dietary factors and cognitive impairment in older Korean women living in the community. METHODS: Wave 2 data, from the Suwon Longitudinal Aging Study (SLAS), of 365 women aged 65 years or over, were used. The Korean version of the 30-point Mini-Mental State Examination (MMSE-K) was used to assess cognitive impairment (score< = or19). Dietary habits and frequencies of food group consumption were also examined. RESULTS: A total of 67 women (18.4%) were found to be cognitively impaired. In bivariate analyses, nondietary factors, such as age, marital status, education, income, self-rated health, depression, emotional support, social activity, exercise, and dietary factors, such as self-rated nutritional status, frequency of beans and bean products and milk and dairy products consumption were associated with cognitive impairment. In the multivariate analysis, a higher frequency ( > = or 1 vs. < 1 time/day) of beans and bean products (OR=0.48, 95% CI: 0.23-0.99) and milk and dairy products (OR=0.25, 95% CI: 0.10-0.61) consumption was inversely associated with cognitive impairment, after adjustment for non-dietary factors. CONCLUSION: These results suggest that dietary factors may play a significant role in cognitive impairment of older Korean women.; Summary

Circadian Disruptions of Heart Rate Variability among Weekly Consecutive-12-hour 2 Shift Workers in the Automobile Factory in Korea.: Mia Son, Juhon Sung, Myunggul Yum, Jung Ok Kong, Hye Un Lee, In A Kim, Jung Yeon Kim; J Prev Med Public Health. 2004;37(2):182-189.

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Abstract PDF: OBJECTIONS: The objective of this study is to compare the circadian patterns of heart rate variability assessed by 24-hour ambulatory electrocardiographic (ECG) recordings during day shift and night shift among the workers in the 5 days-concecutive- 12-hour shift in an automobile factory in Korea. METHODS: The study population consisted 300 workers, who were randomly selected among the 8700 total workers in one car factory. To analyse circadian variation, the 24-hour ECG recordings (Marquette) were measured during day shift (08: 00-20: 00 h) and night shift (20: 00-08: 00 h). Analysis was performed for all time and frequency domain measures of HRV. 233 workers completed taking 24-hour ECG recordings. RESULTS: This study shows that the 24 hourcircadian variation mainly follows work/sleep cycle rather than day/night cycle among shift workers. This study also shows that among the night shift, the circadian variation between work and sleep cycle decreased compared to the work/sleep cycle among day shift workers. All time and frequency domain parameters (except LF/HF ratio) show significantly different between work and sleep in the day shift and night shift. CONCLUSION: These changes in heart rate variability circadian rhythms reflect significant reductions in cardiac parasympathetic activity with the most marked reduction in normal vagal activity among the shift workers. Especially, it suggests the circadian rhytm has blunted among the night workers. The quantification of the circadian variation in HRV can be a surrogates of workers' potential health risk, as well as suggests possible mechanisms through which the shift works compromise workers' health.; Summary

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