Journal of Preventive Medicine and Public Health

Volume 39(2); March 2006

English Abstracts

Future of Scientific Research on Preventive Medicine in Korea.: Hyun Sul Lim; J Prev Med Public Health. 2006;39(2):105-109.

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Abstract PDF: The Korean Society of Preventive Medicine has undergone continuous development, after overcoming the difficult early years, in the 59 years since its establishment in 1947. It has repeatedly upgraded its quality and quantity of research with the first journal edition in 1968 and the continuous increase in publication numbers, scientific articles, joint research projects, intra-field exchanges and participation in various international scientific activities. In the future, we should gather a more extensive collection of opinions regarding the introduction of clinical preventive medicine specialists and prepare for the establishment of a training program for clinical specialists into a preventive medicine residency course. Moreover, we should raise interest in the importance of protecting individual information and maintaining medicine ethics. It's impossible to develop academic activities without cooperation. We need such cooperation with basic medical approaches across a wide range of fields. Furthermore, we should strengthen our cooperation with aspects of clinical and drug epidemiology in many fields including public health, statistics, and dietetics. Finally, we should raise the level of international cooperation with many countries, including North Korea, to prevent diseases and promote health. Preventive medicine is a science in which practice is as important as theory. We must aim to nurture preventive medicine specialists who practice in many areas of society with the goal of preventing diseases, promoting health, improving fertility, and securing healthy elderly life for individuals and the entire population. To this end, we will endeavor to promote both theoretical and practical components of academic development.; Summary

Reformation of Residency Trainingship for the Future of Preventive Medicine in Korea.: Chang Yoon Kim; J Prev Med Public Health. 2006;39(2):110-114.

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Abstract PDF: From the start of the residency trainingship in 1963, the residency training programs have been contributed much on the establishment and development of preventive medicine in Korea. But these programs are now have several problems to update the changes in health service needs of the population that were caused by a rapid epidemiologic transition from the acute infectious diseases to chronic diseases in last a few decades. Strengthening in medical practice, not just in knowledge is urgently required. Must have more concentrate on preventive service for the individual, as in clinical preventive medicine. Training residents by the systematic and well scheduled programs, not just 'teacher's assistant' in the academic facilities. Trying the change in the system of Specilty of Preventive Medicine to the well established several subspecialty, so more specific competency can be gained through the training. These approach and reformation may not only contribute for the better future of the preventive medicine, but also improve in disease prevention and health promotion, which required by the society in Korea.; Summary

Socioeconomic Mortality Inequality in Korea: Mortality Follow-up of the 1998 National Health and Nutrition Examination Survey(NHANES) Data.: Young Ho Khang, Hye Ryun Kim; J Prev Med Public Health. 2006;39(2):115-122.

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Abstract PDF: OBJECTIVES
This study was conducted to examine the relationships of the several socioeconomic position indicators with the mortality risk in a representative longitudinal study of South Korea. METHODS: The 1998 National Health and Nutrition Examination Survey was conducted on a cross-sectional probability sample of South Korean households, and it contained unique 13-digit personal identification numbers that were linked to the data on mortality from the National Statistical Office of Korea. Of 5,607 males and females, 264 died between 1999 and 2003. Cox's regression was used to estimate the relative risks (RR) and their 95% confidence intervals (CI) of mortality. RESULTS: Socioeconomic differences in mortality were observed after adjustments were made for gender and age. Compared with those people having college or higher education, those people without any formal education had a greater mortality risk (RR=2.21, 95% CI=1.12-4.40). The mortality risk among manual workers was significantly greater than that for the non-manual workers (RR=2.73, 95% CI=1.47-5.06). A non-standard employment status was also associated with an increase in mortality: temporary or daily workers had a greater mortality risk than did the full-time workers (RR=3.01, 95% CI=1.50-6.03). The mortality risk for the low occupational class was 3.06 times greater than that of the high and middle occupational classes (95% CI=1.75-5.36). In addition, graded mortality differences according to equivalized monthly household income were found. A reduction of monthly household income by 500 thousand Korean Won (about 400 US dollars) was related with a 20% excess risk of mortality. Self-reported poor living standards were also associated with an increased risk of mortality. Those without health insurance had a 3.63 times greater risk of mortality than the insured (95% CI=1.61-8.19). CONCLUSIONS: This study showed the socioeconomic differentials in mortality in a national longitudinal study of South Korea. The existence of socioeconomic mortality inequalities requires increased social discussion on social policies in Korean society. Furthermore, the mechanisms for the socioeconomic inequalities of mortality need to be explored in future studies.; Summary

Smoking and Colorectal Cancer Risk in the Korean Elderly.: Hwa Jung Kim, Seung Mi Lee, Nam Kyong Choi, Seon Ha Kim, Hong Ji Song, Yuong Kyun Cho, Byung Joo Park; J Prev Med Public Health. 2006;39(2):123-129.

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Abstract PDF: OBJECTIVES
The incidence of colorectal cancer increased greatly among the elderly in Korea, but the relationship between smoking and colon cancer remains controversial. Few studies have targeted Asian elderly people. We analyzed the smoking status, the amount smoked, and the smoking duration as risk factors of colorectal cancer to determine their association and causality. METHODS: The cohort members (n=14,103) consisted of 4,694 males and 9,409 females, and they were derived from the Korea Elderly Phamacepidemilogic Cohort (KEPEC), which was a population-based dynamic cohort. They were aged 65 years or more and they lived in Busan Metropolitan City between from 1993-1998; they were beneficiaries of the Korean Medical Insurance Corporation (KMIC). The baseline information was surveyed by a selfadministered mailed questionnaire; after 8.7 person-years of mean follow up period, 100 cases of colorectal cancer occurred. The adjusted relative ratio (aRR) of smoking status, the smoking amount and the smoking duration were calculated from the Cox's proportional hazard model with the never-smokers as a reference group and the Cox model controlled for age, gender, precancerous lesions of CRC, medication history of NSAIDs and antibiotics, the alcohol drinking status and BMI. RESULTS: Compared with the never smokers, the aRRs were 2.03 (95% CI=1.02-4.03) and 1.36 (95% CI=0.80-2.32) for the ex-smokers and current smokers, respectively. Statistical significant trends were not observed for the dose-relationship among the elderly, either for the mean daily amount smoked (p for trend=0.28) or for the total amount (p for trend=0.15). Still, the aRRs were 1.51 (95% CI=0.97-2.34) for the elderly who smoked less than 40 years and 2.35 (95% CI=1.16-4.74) for the elderly who had 40 years or more of smoking (p for trend=0.06). Smokers who started smoking before the age 20 had an increased aRR of 2.15 (95% CI=1.17-3.93) compared to the never smokers. CONCLUSIONS: After controlling for age, gender, precancerous lesion of CRC, medication history of NSAIDs and antibiotics, the alcohol drinking status and BMI, smoking increases the risk of colorectal cancer among elderly people. The age when starting smoking is also important.; Summary

Comparative Study

Effects of Oxidative DNA Damage and Genetic Polymorphism of the Glutathion Peroxidase 1 (GPX1) and 8-Oxoguanine Glycosylase 1 (hOGG1) on Lung Cancer.: Chul Ho Lee, Kye Young Lee, Kang Hyeon Choe, Yun Chul Hong, Sung Il Noh, Sang Yong Eom, Young Jun Ko, Yan Wei Zhang, Dong Hyuk Yim, Jong Won Kang, Heon Kim, Yong Dae Kim; J Prev Med Public Health. 2006;39(2):130-134.

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Abstract PDF: OBJECTIVES
Oxidative DNA damage is a known risk factor of lung cancer. The glutathione peroxidase (GPX) antioxidant enzyme that reduces hydrogen peroxide and lipid peroxides plays a significant role in protecting cells from the oxidative stress induced by reactive oxygen species. The aim of this case-control study was to investigate effects of oxidative stress and genetic polymorphisms of the GPX1 genes and the interaction between them in the carcinogenesis of lung cancer. METHODS: Two hundreds patients with lung cancer and 200 age- and sex-matched controls were enrolled in this study. Every subject was asked to complete a questionnaire concerning their smoking habits and their environmental exposure to PAHs. The genotypes of the GPX1 and 8-oxoguanine glycosylase 1 (hOGG1) genes were examined and the concentrations of urinary 1-hydroxypyrene (1-OHP), 2-naphthol and 8-hydroxydeoxyguanosine (8-OH-dG) were measured. RESULTS: Cigarette smoking was a significant risk factor for lung cancer. The levels of urinary 8-OH-dG were higher in the patients (p<0.001), whereas the urinary 1-OHP and 2-naphthol levels were higher in the controls. The GPX1 codon 198 polymorphism was associated with an increased risk of lung cancer. Individuals carrying the Pro/Leu or Leu/Leu genotype of GPX1 were at a higher risk for lung cancer (adjusted OR=2.29). In addition, these individuals were shown to have high urinary 8-OH-dG concentrations compared to the individuals with the GPX1 Pro/Pro genotype. On the other hand, the polymorphism of the hOGG1 gene did not affect the lung cancer risk and the oxidative DNA damage. CONCLUSIONS: These results lead to a conclusion that individuals with the GPX1 Pro/Leu or Leu/Leu genotype would be more susceptible to the lung cancer induced by oxidative stress than those individuals with the Pro/Pro genotype.; Summary

Research Support, Non-U.S. Gov't

Glutathione S-transferases (GSTM1, GSTT1 and GSTP1) and N-acetyltransferase 2 Polymorphisms and the Risk of Gastric Cancer.: Su Hyung Hong, Jung Wan Kim, Ho Gak Kim, In Kyu Park, Jun Wook Ryoo, Chang Hyeong Lee, Yoon Kyung Sohn, Jong Young Lee; J Prev Med Public Health. 2006;39(2):135-140.

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Abstract PDF: OBJECTIVES
Polymorphisms of genes from glutathione Stransferases (GSTs) and N-acetyltransferase 2 (NAT2) have been associated with increased susceptibility to various cancers. Previous results showed that East Asians such as Koreans, Japanese and Chinese have a much higher frequency of the GSTM1 and GSTT1 null genotypes and NAT2 rapid acetylator type. Therefore, we investigated the association between the polymorphic types of GSTs (GSTM1, GSTT1, GSTP1) and NAT2 and the incidence of gastric cancer which is one of the most prevalent cancers among the East Asians. METHODS: It was performed in a case-control study consisting of 238 healthy subjects and 108 cancer patients (54 distal and 54 proximal carcinomas). We also evaluated the association between GSTs and NAT2 and the risk factors for gastric cancer such as alcohol consumption, smoking, H. pylori infection, family history of gastric cancer, and tumor location. RESULTS: In our study, the percentage of cases whose hometown was rural was higher than those of controls (odds ratio (OR) =2.88; 95% CI=1.72-4.76), and the frequency of the lower socio-economic status increased significantly in patients (OR=2.53; 95% CI=1.59-4.02). There was no significant difference in the GST polymorphic types between the cases and controls. However, NAT2 rapid or intermediate acetylator types were frequently detected in the cases with family history of gastric cancer (OR=1.92; 95% CI=1.79-26.0). CONCLUSIONS: These results suggest that the hometown and socio-economic status are important environmental factors for gastric carcinogenesis, and NAT2 polymorphic types could be associated with familial gastric carcinoma.; Summary

English Abstract

Relationship of Socioeconomic Factors with Medical Utilization for Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia in a South Korean Community.: Han Hae Kim, Kyoung Ae Kong, Hun Jae Lee, Hana Yoon, Bo Eun Lee, Ok Ryun Moon, Hyesook Park; J Prev Med Public Health. 2006;39(2):141-148.

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Abstract PDF: OBJECTIVES
We wanted to evaluate the medical underutilization for benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) among Korean elderly men and we wanted to determine their associated factors. METHODS: This study was conducted on 239 men with LUTS and 116 men with BPH who were compatible with the diagnostic criteria from a total of 641 participants. These participants were over 50 years old and they were randomly chosen in a community-based study for estimating the prevalence of BPH. Using a self-reported questionnaire, we surveyed the sociodemographics, health status, quality of life, lower urinary tract symptoms, medical utilization and reasons for not seeking treatment. RESULTS: Only 27.6% of the men with LUTS and 31.0% of the men with BPH reported having visited a doctor for urinary symptoms. The reasons for not visiting a doctor were, in order of responses from the group with LUTS: 'considered the symptoms as a part of the normal ageing process', 'not enough time to visit a doctor', 'financial difficulty' and 'the symptoms were not severe or bothersome'. Regarding BPH, the responses were the same as those of the group with LUTS however, 'financial difficulty' placed second. Among the men with experience of visiting a doctor for urinary symptoms, 33.3% of those with LUTS and 28.1% of those with BPH were not treated. The most common reason in both groups was 'the symptoms were not severe to be treated'. On a multiple logistic regression analysis, the larger size household (odds ratio (OR) 3.03, 95% confidence interval (CI)=1.40-6.54) and an unsatisfactory quality of life related with urinary symptoms (OR 2.98, 95% CI=1.23-7.21) were associated with medical utilization in the group of LUTS. For BPH, the current employment status was related with the medical utilization (OR 2.80, 95% CI=1.10-7.11), in addition to the larger size household (OR 3.24, 95% CI=1.14-9.21). CONCLUSIONS: Many men with urinary symptoms do not visit a doctor. This medical underutilization for people with LUTS and BPH may be associated with economic status in Korea.; Summary

Comparative Study

Estimating the Cost Saving Due to the Effect of Kremezin in Delaying the Initiation of Dialysis Treatments among Patients with Chronic Renal Failure.: Hye Young Kang, Woohyun Cho, Sunmi Lee, Hyung Jong Kim, Ho Yong Lee, Tae Wook Woo; J Prev Med Public Health. 2006;39(2):149-158.

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Abstract PDF: OBJECTIVES
We wanted to evaluate the economic value of a pharmaceutical product, Kremezin, for treating patients with chronic renal failure (CRF) by estimating the amount of cost savings due to its effect for delaying the initiation of dialysis treatments. METHODS: We defined a conventional treatment for CRF accompanied by Kremezin therapy as 'the treatment group' and only conventional treatment as 'the alternative group.' The types of costs included were direct medical and nonmedical costs and costs of productivity loss. The information on the effect of Kremezin was obtained from the results of earlier clinical studies. Cost information was derived from the administrative data for 20 hemodialysis and 20 peritoneal dialysis patients from one tertiary care hospital, and also from the administrative data of 10 hemodialysis patients from one free-standing dialysis center. Per-capita cost savings resulting from Kremezin therapy were separately estimated for the cases with delay for the onset of hemodialysis and the cases with immediate performance of peritoneal dialysis. By computing the weighted average for the cases of hemodialysis and peritoneal dialysis, the expected per-capita cost savings of a patient with CRF was obtained. Using a discount rate of 5%, future cost savings were converted to the present value. RESULTS: The present value of cumulative cost savings per patient with CRF from the societal perspective would be 18,555,000~29,410,000 Won or 72,104,000~112,523,000 Won if Kremezin delays the initiation of dialysis by 1 or 4 years. CONCLUSIONS: The estimated amount of cost savings resulting from treating CRF patients with Kremezin confirms that its effect for delaying the onset of dialysis treatments has a considerable economic value.; Summary

English Abstract

Effects of the Personal Stereo System on Hearing in Adolescents.: Jong Seo Park, Sean Hee Oh, Pock Soo Kang, Chang Yoon Kim, Kyeong Soo Lee, Tae Yoon Hwang, Joon Sakong; J Prev Med Public Health. 2006;39(2):159-164.

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Abstract PDF: OBJECTIVES
This study was conducted to evaluate the effects of the personal stereo system on the hearing in adolescents. METHODS: A total of 68 adolescents(age: 13-18 years) who visited the ENT Department at a University Hospital in Daegu were personally interviewed. The questionnaires were about general characteristics of the subjects, the time of personal stereo system use(year, hour) and place. Cumulative exposure to the personal stereo system was calculated by the product of the total years and the daily hours of their use. Pure tone audiometry was performed and the hearing threshold was measured at 500, 1000, 2000, 4000 and 8000 Hz. RESULTS: The average time of using a personal stereo system a day was about 3 hours and 75% of the subjects used a personal stereo system for 2-5 years. The elevation of threshold was more prominent in the subjects who used personal stereo systems for 4 years and more compared with those subjects who used them for 3 years and under. The elevation of hearing threshold was also more prominent in the subjects who used personal stereo systems for 4 hours and more a day compared with those subjects who used personal stereo systems for 3 hours and under a day. The elevation of hearing threshold was more prominent in the subjects who used personal stereo systems for 13 hour..years and more compared to the subjects who used them 12 hour..years and under. CONCLUSIONS: These results suggest that the elevation of hearing threshold can happen to adolescents who used personal stereo systems for a long time. In order to prevent hearing loss, we need to teach adolescents appropriate usage of the personal stereo system and hearing tests should be included in the periodic school-based physical examination for the adolescents.; Summary

Evaluation Studies

Evaluation of Fourier Transform Near-infrared Spectrometer for Determination of Oxalate in Standard Urinary Solution.: Yeong Eun Kim, Su Hyung Hong, Jung Wan Kim, Jong Young Lee; J Prev Med Public Health. 2006;39(2):165-170.

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Abstract PDF: OBJECTIVES
The determination of oxalate in urine is required for the diagnosis and treatment of primary hyperoxaluria, idiopathic stone disease and various intestinal diseases. We examined the possibility of using Fourier transform near-infrared (FT-NIR) spectroscopy analysis to quantitate urinary oxalate. The practical advantages of this method include ease of the sample preparation and operation technique, the absence of sample pre-treatments, rapid determination and noninvasiveness. METHODS: The range of oxalate concentration in standard urine solutions was 0-221 mg/l. These 80 different samples were scanned in the region of 780-1,300 nm with a 0.5 nm data interval by a Spectrum One NTS FT-NIR spectrometer. PCR, PLSR and MLR regression models were used to calculate and evaluate the calibration equation. RESULTS: The PCR and PLSR calibration models were obtained from the spectral data and they are exactly same. The standard error of estimation (SEE) and the % variance were 10.34 mg/l and 97.86%, respectively. After full cross validation of this model, the standard error of estimation was 5.278 mg/l, which was much smaller than that of the pre-validation. Furthermore, the MCC (multiple correlation coefficient) was 0.998, which was compatible with the 0.923 or 0.999 obtained from the previous enzymatic methods. CONCLUSIONS: These results showed that FT-NIR spectroscopy can be used for rapid determination of the concentration of oxalate in human urine samples.; Summary

Research Support, Non-U.S. Gov't

Influencing Facotrs that Affect the Biological Monitoring of Workers Exposed to N,N-Dimethylformamide in Textile Coating Factories.: In Sung Chung, Jon Ghan Kim, Sang Kug Choi, Jong Youn Bae, Mi Young Lee; J Prev Med Public Health. 2006;39(2):171-176.

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Abstract PDF: OBJECTIVES
The objective of this study is to assess the factors influencing biological monitoring of textile coating factory workers exposed to N,N-dimethylformamide(DMF). METHODS: We studied 35 workers who were occupationally exposed to DMF from 9 textile coating factories. The study was carried out in two phases; summer and winter. While air concentration of DMF, temperature and humidity were assessed in order to monitor the atmospheric conditions, biological monitoring was done to determine the internal dose by analyzing the N-methylformamide(NMF) collected from urine at the beginning and end of the shift. Questionnaires and medical surveillance were also obtained during the two phases. RESULTS: Median air concentrations of DMF in winter and summer were 1.85 ppm and 2.78 ppm respectively. Also the difference between the urinary NMF concentration at the beginning and end of the shift (deltaNMF) was always significant in each season (P<0.001). The correlations between log DMF in air, log end-of-shift urinary NMF (r=0.555, P<0.001) and log deltaNMF (r=0.444, P<0.001) was statistically significant in summer. The temperature, humidity, a shift system and different styles of clothing worn were significantly different during the two phases. In a multivariate analysis, temperature and the concentration of DMF in the air were the main factors influencing biological monitoring of textile coating factory workers. CONCLUSIONS: Concerning more comprehensive prevention measures to reduce exposure for those workers occupationally exposed to DMF, dermal exposure conditions such as temperature and humidity together with the air concentration of DMF should be assessed and biological monitoring is necessary to reduce adverse health effects, especially during the summer.; Summary

English Abstract

Kangwha Study Association Analysis of the Essential Hypertension Susceptibility Genes in Adolescents: Kangwha Study.: Il Suh, Chung Mo Nam, Sung Joo Kim, Dong Jik Shin, Nam Wook Hur, Dae Ryong Kang; J Prev Med Public Health. 2006;39(2):177-183.

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Abstract PDF: OBJECTIVES
In this study we examined the association between the genetic markers ACE (A-240T, C-93T, I/D, A2350G), AGT (M235T), AT1R (A1166C), CYP11B2 (T-344C, V386A), REN (G2646A), ADRB2 (G46A, C79G, T-47C, T164I), GNB3 (C825T) and ADD1 (G460W) and the presence of essential hypertension in adolescents. METHODS: The Kangwha Study is an 18-year prospective study that is aimed at elucidating the determinants of the blood pressure level from childhood to early adulthood. For this study, we constructed a case-control dataset of size of 277 and 40 family trios data from the Kangwha Study. For this purpose, we perform a single locus-based case-control association study and a single locus-based TDT (transmission/disequilibrium test) study. RESULTS: In the case-control study, the single locus-based association study indicated that the ADD1 (G460W) (p=0.0403), AGT (M235T) (p=0.0002), and REN (G2646A) (p=0.0101) markers were significantly associated with the risk of hypertension. These results were not confirmed on the TDT study. This study showed that genetic polymorphisms of the ADD1, AGT and REN genes might be related to the hypertension in Korean adolescents. CONCLUSIONS: This study provided useful information on genetics markers related to blood pressure. Further study will be needed to confirm the effect of the alpha adducin gene, the angiotensinogen gene and the renin gene on essential hypertension.; Summary

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