| Jung Jin Cho | 36 Articles |
Background
Prediabetes is a metabolic state between normoglycemia and diabetes and is known to carry a higher risk of developing overt diabetes and cardiovascular disease (CVD). The relative and absolute risks of all-cause mortality, CVD, coronary heart disease, and stroke in prediabetes patients, as well as in diabetic patients, is higher than that in patients with normoglycemia. Carotid intima-media thickness (cIMT) is a method used to stratify CVD risk. In this study, we aimed to determine whether the neutrophil-to-lymphocyte ratio (NLR) correlates with cIMT in prediabetes patients. Methods From January 1, 2016, to February 20, 2021, 581 adults their 30s–70s who underwent carotid ultrasonography as part of a comprehensive medical examination at the Dongtan Sacred Heart Hospital were enrolled. Statistical analysis using SPSS presented t-test and chi-square test significance levels into a group with normal cIMT (nIMT; cIMT <1 mm) and a group with thick cIMT (tIMT; cIMT ≥1 mm). Binary logistic regression analysis was performed to confirm the correlation between NLR and cIMT. Results In prediabetic adults, age, hemoglobin A1c (HbA1c), systolic blood pressure, and NLR were significantly higher in the tIMT group than in the nIMT group. In the regression analysis, NLR, age, and HbA1c were significantly correlated with cIMT. Conclusion NLR was significantly higher in the tIMT group than in the nIMT group; therefore, NLR may be used to assess CVD risk in prediabetes patients. Citations Citations to this article as recorded by
Background
Depression is suggested to be associated with cardiovascular disease, including ischemic heart disease and cerebrovascular disease. This study investigated the impact of depression on cardiovascular disease in the elderly population in Korea. Methods This retrospective cohort study was performed using the Senior Cohort database released by the Korean National Health Insurance Services from January 1, 2008 to December 31, 2012, or January 1, 2009 to December 31, 2013. The study group constituted participants newly diagnosed with depression, but not cardiovascular disease. The control group constituted participants with no past history of depression or cardiovascular disease, and were not diagnosed with depression during the follow-up period. During the 5-year follow-up period, development of ischemic heart disease or cerebrovascular disease was assessed. Depression and cardiovascular disease were identified using the International Classification of Diseases, 10th revision, Clinical Modification codes. The data was analyzed using Cox proportional hazards model. Results The hazard ratio (HR) between depression and ischemic heart disease was 1.38 (95% confidence interval [CI], 1.23 to 1.55) and the HR between depression and cerebrovascular disease was 1.46 (95% CI, 1.32 to 1.62), after adjusting all confounding variables. Conclusion Independent of other cardiovascular risk factors, depression increased the risk of ischemic heart disease by 38% and cerebrovascular disease by 46% among older adults in Korea. Since depression may increase the risk of cardiovascular disease, future research should focus on the diagnosis and prevention of cardiovascular disease in people with depression. Citations Citations to this article as recorded by
Background
Korea’s rapidly aging population has experienced a sharp rise in the prevalence of dementia. Patients with Alzheimer’s disease (AD), which is estimated to be about three-quarters of all patients with dementia, tend to have higher mortality rates compared with patients without Alzheimer’s disease. In this study, a survival analysis of patients with AD was conducted in order to provide knowledge to those who provide medical care to these patients. Methods Data on individuals over 65 years old in 2004 were extracted from the Korean National Health Insurance Services’ Senior Cohort database (2002–2013). The subjects were 209,254 patients, including 2,695 who were first diagnosed with AD (the AD group) and 206,559 that had not been diagnosed with the disease (non-AD group). To investigate the independent effect of AD on survival, the Cox proportional-hazards model, hazard ratios (confidence interval of 95%), and the Kaplan-Meier method were used. Results Mean survival time in the AD group was 5.3±3.3 years, which was about 2.5 years shorter than that in the non-AD group (7.8±2.4 years). The mortality rate in the AD group (66.3%) was higher than that in the non-AD group (26.3%). The adjusted hazard ratio in the AD group was 2.5 and, therefore, it was found that the AD group had a 2.5-fold higher risk of death than the non-AD group. Conclusion Overall, AD has a large, independent impact on survival. Survival time was shorter, and the mortality rate and risk were generally higher in the AD group, compared with the non-AD group. Citations Citations to this article as recorded by
Given emerging evidence of the association between stress and disease, practitioners need a tool for measuring stress. Several instruments exist to measure perceived stress; however, none of them are applicable for population surveys because stress conceptualization can differ by population. The aim of this study was to develop and validate the Perceived Stress Inventory (PSI) and its short version for use in population surveys and clinical practice in Korea. From a pool of perceived stress items collected from three widely used instruments, 20 items were selected for the new measurement tool. Nine of these items were selected for the short version. We evaluated the validity of the items using exploratory factor analysis of the preliminary data. To evaluate the convergent validity of the PSI, 387 healthy people were recruited and stratified on the basis of age and sex. Confirmatory analyses and examination of structural stability were also carried out. To evaluate discriminatory validity, the PSI score of a group with depressive symptoms was compared with that of a healthy group. A similar comparison was also done for persons with anxious mood. Exploratory factor analysis supported a three-factor construct (tension, depression, and anger) for the PSI. Reliability values were satisfactory, ranging from 0.67 to 0.87. Convergent validity was confirmed through correlation with the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and State-Trait Anxiety Inventory. People with depressive or anxious mood had higher scores than the healthy group on the total PSI, all three dimensions, and the short version. The long and short versions of the PSI are valid and reliable tools for measuring perceived stress. These instruments offer benefits for stress research using population-based surveys. Citations Citations to this article as recorded by
Background
The purpose of this study is to evaluate the influence of job characteristics and occupational stress on health related behavior. Methods: Eight thousand five hundred twenty two workers (21-65 years of age) who recruited from a nationwide sample in Korea completed a self-administered questionnaire regarding socio-demographic factors, job characteristics, health-related behaviors such as alcohol consumption, current smoking status & exercise, and occupational stress assessed by Korean Occupational Stress Scale. Multivariate analyses were conducted to analyze the association of occupational stress and job characteristics with health behavior according to gender separately.Results: In male, the problem drinking was positively associated with older age, lower educational level, some industries such as 'transport,' 'wholesale and retail trade' industries, difficult physical environment, insufficient job control, inadequate social support, job insecurity, and organizational injustice. Current smoking was positively associated with younger age, lower educational level, single marital status, lower incomes,'transport' industry and high job demand. The rate of regular exercise was negatively associated with lower incomes, shift works, and the 'electricity, gas and water supply' industies, high job demand, insufficient job control, inadequate social support, job insecurity, and lack of reward. 'Financial institutions and insurance' industry. Conclusion: Occupational stress and certain industrial classification have impact on health related lifestyles in Korean male employees. Citations Citations to this article as recorded by
Increasing thyroid cancer incidence is due to the increased detection of small papillary cancers and may not interpreted as an increase in the true occurrence of disease. Further workup of thyroid incidentalomas—impalpable nodules detected fortuitously during a radiological investigation—may contribution of the increasing thyroid cancer. Screening asymptomatic adults or children for thyroid cancer using either neck palpation or ultrasonography is not recommended in the US Preventive Services Task Force and the Korean lifetime health maintenance program. Generally, only thyroid incidentalomas > 1 cm should be evaluated, since they have a greater potential to be clinically significant cancers and thyroid nodules < 1 cm that require evaluation because of suspicious US findings, associated lymphadenopathy, a history of head and neck irradiation, or a history of thyroid cancer in one or more first-degree relatives
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Korean Lifetime Health Maintenance Program (KLHMP) represents one of several efforts to take a more evidence-based approach to the development of recommendations on a wide range of preventive services. This paper summarizes the methods of the third KLHMP developed by Korean Academy of Family Medicine. The review process of KLHMP was mainly based on trans contextual guideline adaptation of United States preventive service Task force (USPSTF) recommendation. The method of review process was done according to categories of recommendation (adotion of USPSTF's recommendation, adatation of USPSTF's recommendation, development of new recommendation). If the recommendation done by USPSTF is up to date and acceptable in Korean context, it was translated and adopted. If the USPSTF recommendation was not up to date, nor applicable, the recommendation was drawn by adaptation process. If the condition has not been reviewed by USPSTF, the recommendation was drawn by de novo development process, forming key question, literature search (primary researchs, systematic reviews, guidelines), literature evaluation, evidence systhesis, considering of applicability and acceptability of evidence.
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Periodic Health Examination and Prevention Guidelines for Koreans were first proposed since 1988. Based on that guideline, clinical preventive services has been applied to clinic population in a few University Hospitals since 1991. In 1995, LHMP development committee in Korean Academy of Family Physician Society first published evidence based clinical practice guidelines and updated the guidelines in 2003. Lifetime Health Maintenance Program (LHMP) committee represents efforts to take a more updated evidence-based approach to the development of the third updated clinical practice guideline in 2009. We focused on approaches that can reliably assess the extent of updating required, a model of limited literature searches with modest expert involvement to reduce the cost and time.
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Background
As one of harm reduction strategies, tobacco manufacturers have begun to introduce lower-yield cigarettes. Lower-yield cigarettes, so called light cigarettes, have been perceived as less hazardous by some smokers. However, there have been very few studies concerning smoking lower yield products the lead to lower nicotine absorption. We evaluated the association between brand nicotine yield of cigarettes and actual nicotine intake by measuring urinary cotinine. Methods: Four hundred sixty four male smokers aged 18 or over who participated in health check-ups in a hospital from May to October 2007 fi lled out a self-administered smoking questionnaire. Urinary cotinine concentration was measured at the time of participation. The subjects were divided into three groups (ultralight [nicotine: 0.05 mg], light [0.1 mg], and regular [> 0.1 mg] group) according to the level of brand nicotine yield of cigarettes which they smoked. Results: The median urinary cotinine concentrations of ultralight (N = 62), light (N = 216), and regular (N = 186) groups were 735.5 ng/mL (interquartile range, 320 to 1,300 ng/mL), 956.0 ng/mL (429 to 1,491 ng/mL), and 1,067.5 ng/mL (615 to 1,613 ng/mL), respectively. There was a signifi cant difference in urinary cotinine between the regular and the other groups (P = 0.015). However, multiple logistic regression analysis to evaluate the risk of being in the highest quartile of urinary cotinine concentration (≥ 1,532 ng/mL) after adjusting for possible confounding variables showed that the odds ratios were 0.84 (95% CI, 0.52 to 1.37) in the light nicotine group and 0.82 (95% CI, 0.38 to1.72) in the ultralight nicotine group compared to the regular nicotine group. Conclusion: There was no significant difference in the risk of elevated urinary cotinine concentrations in male adult smokers according to brand nicotine yield of cigarettes groups.
Background: Depression increases the risk of cardiovascular risk factors in adults. However, the association between depression and cardiovascular risk factors was not well evaluated in South Korea. Our study was done to evaluate the association between depression and cardiovascular risk factors in workers. Methods: The study population was selected among adults working in several industries that had more than 50 employees. They had received their medical examinations at the Health Promotion Center of Hallym University Sacred Heart Hospital between March and November 2005. We estimated the odds ratio to determine whether depression (Korean Center for Epidemiologic Studies Depression Scale score ≥21) was associated with each cardiovascular risk factors (hypertension, diabetes mellitus, hypercholesterolemia, and obesity). Results: The prevalence of depression was 15.5%. Depression was significantly associated with hypertension (P＜0.001), obesity (P=0.03) and hypercholesterolemia (P=0.004). The adjusted odds ratio for hypertension and hypercholesterolemia were 1.41 (95% CI 1.04∼1.91) and 1.59 (95% CI 1.05∼2.40), respectively. The association between depression and obesity was eliminated after adjustment (1.25, 95% CI: 0.97∼1.61). Conclusion: Depression was significantly associated with hypertension and hypercholesterolemia in workers. Further long-term study on the association of depression with cardiovascular risk factors is necessary. (J Korean Acad Fam Med 2008;29:645-650)
Background: Childhood obesity is becoming more prevalent, associated with a variety of adverse consequences which leads to adulthood obesity. Although diagnosis is usually made by body mass index, there is neither a cutoff point for the percentage body fat nor abdominal circumference. The aim of this study was to identify each cutoff point for both measures. Methods: The measurement of height, weight, abdominal circumference and percentage body fat was performed through manual assessment and bioelectrical impedance analysis for 4,242 subjects aged 11 in Gunpo City, South Korea. The cutoff point for body fat percentage and abdominal circumference is set to maximize the sum of sensitivity and specificity for detecting obesity and overweight using the Receiver Operating Characteristics (ROC) curve. Results: The mean percentage body fat was 13.6±6.9% for boys and 19.4±5.3% for girls. The mean abdominal circumference of boys was 68.0±9.1 cm, and that of girls was 64.3±7.7 cm. The cutoff point of percentage body fat for obesity was 21.8% in boys and 24.5% in girls. The prevalence of obesity was 15.2%, 16.7% for males and females, respectively. The abdominal circumference cutoff for obesity was 76.9 cm in boys and 70.7cm in girls. Based on that, the prevalence of obesity was 19.7% for boys and 20.0% for girls, which was higher than what was identified by body mass index, as in the case of body fat percentage. Conclusion: The cutoffs of body fat percentage and abdominal circumference in one city of Gyeonggi Province were lower than those suggested in the previous studies. (J Korean Acad Fam Med 2008;29:492-498)
Background
: Serum Gamma-glutamyltransferase (GGT) has been used clinically as a marker for excessive alcohol consumption or liver diseases, but it was reported recently that GGT is associated with cardiovascular disease. This study was done to verify the association between GGT and the metabolic syndrome in Korean male workers. Methods : Total cholesterol, triglycerides, HDL cholesterol, body mass index (BMI), waist circumference, blood pressure, fasting glucose, uric acid, and GGT were measured and liver US was performed in 1,215 male workers who underwent annual health check up in a university health promotion center from May to October 2003. The association of GGT with the metabolic syndrome was assessed. Results : The mean age of subjects was 41.9±7.2 years and the mean BMI was 24.1±2.7 kg/m2. A raised GGT level (GGT＞75 IU/L) was seen in 172 of 1,136 (15.1%) and the prevalence of the metabolic syndrome was 9.9% (112/1,136). Individuals with the metabolic syndrome had a higher mean GGT concentration (53.4 IU/L) than individuals without the metabolic syndrome (34.4 IU/L; P＜0.001). The subjects with increased GGT showed more risk of metabolic syndrome than the subjects with normal GGT by multivariate analysis (OR=2.835). Subgroup analyses did not change the association between the GGT and the metabolic syndrome. Conclusion : This study showed that the serum GGT was associated with the metabolic syndrome and that increased GGT was another feature of the metabolic syndrome.
Background
: Density patterns on mammography have been related to the risk factors for breast cancer in the western countries. High mammographic density appears to confer a 4-fold risk of breast cancer. While the proportion of high-density mammography is higher in Korean women than in Caucasian women, the incidence of breast cancer in Korean women is considerably lower. Therefore, we examined if the mammographic breast density pattern correlates with the risk factors for breast cancer in Korean women. Methods : In a cross-sectional design, we recruited 1,758 pre- and post-menopause women without prior history of breast cancer and breast surgery who underwent screening mammogram and completed a self-administered questionnaire in 6 general hospitals. On the basis of ACR BI RADS breast composition, four density patterns were classified in caudocranial and mediolateral mammography by a designated radiologist in each hospital. Multiple linear logistic regression was used for statistical analyses. Results : Inter-rater reliability between the initial report and the report made by another blinded radiologist was high (Pearson's co-efficient=0.81). Overall, the age, body mass index, family history of breast cancer, and duration of hormone replacement therapy correlated with the mammographic density patterns. In pre-menopausal women, the high body mass index and parity (=2) were associated with low mammographic density. In post- menopausal women, older age, high body mass index, negative family history of breast cancer, and duration of hormone replacement therapy were associated with low mammographic density. Conclusion : Our data showed that the mammographic breast density patterns correlated with risk factors for breast cancer in Korean women. While the proportion of high-density mammography is higher in Korean women, the incidence of breast cancer is lower than in the western population. This maybe dependent on other unknown factors.
Background
: C-reactive protein is a substance that elevates when there is an abnormal metabolic reaction or inflammatory condition. Some researchers in Korea reported different results about the association between smoking and CRP. In this study, the relationship between CRP and various smoking characteristics among Korean men was investigated. Methods : Data were analyzed in healthy men, who had visited a health promotion center in a university hospital from September, 2003 to December, 2003. CRP was quantitatively analyzed by high sensitivity-CRP. Elevated CRP (≥2.2 mg/L) level in relation to various smoking characteristics were studied and multiple logistic regression analysis for elevated CRP (≥2.2 mg/L) level was conducted. Results : The number of current smokers was 893, past smokers 550, and non-smokers 413. The association between smoking status, daily smoking amount, duration of smoking (P=0.031, P=0.003, P=0.034) and elevated CRP level was shown by chi-square test. After multiple logistic regression analysis for risk factors, elevated CRP level was shwon to be associated with daily smoking amount in the current smokers, body fat percentage, WBC count and HDL-cholesterol. The odds ratios for elevated CRP level by smoking amount were 2.32 (95% confidence interval 1.11∼4.85) in those who smoked 10∼19 cigarettes per day, 3.54 (95% confidence interval 1.64∼7.63) in those who smoked more than 20 cigarettes per day compared to those who smoked less than 10 cigarettes per day. Conclusion : Among current smokers, elevated CRP level was associated with daily smoking amount in the current smokers, This is the first study to report the relationship between CRP level and smoking behaviors among Korean men.
Background
: Erectile dysfunction (ED) has been presented as a predictor of cardiovascular diseases. Earlier studies had revealed risk factors for erectile dysfunction, but the results are variable. We conducted this study to evaluate the association between various factors and ED. Methods : The subjects were 403 men, over 20 years old, who visited a university hospital health promotion center from February to May 2003. They responded to 'the Korean version of 5-item International Index of Erectile Function (IIEF-5)'. The subjects were divided into ED group and normal group according to 'IIEF-5' score. We studied the association between ED and sociodemographic factors, smoking, exercise, depression, diabetes, hypertension, dyslipidemia and analysed stress and job stress in a subgroup who responded to the questionnaires. Results : The mean age of subjects was 45.6±8.9 and 34.2% of the subjects had ED. The risk of ED increased 1.09 times per year (P＜0.01). Statistically significant association between ED and education level, income, occupation, smoking (P＜0.01), DM, and exercise (P＜0.05) was shown by univariate analysis, but not by multivariate analysis. By multivariate analysis, the risk of ED increased significantly in older age, lower educational group and severe depression (P＜0.01). Among 251 subjects who completed the Psychiatric Wellbeing Inventory- Short form, high risk of stress group wsa associated with high risk of ED by univariate analysis (P＜0.01) but this association did not exist in multivariate analysis. We could not find the association between ED and job stress. Conclusion : The prevalence of ED was 34.2% among the subjects over 20 year-old and the risk of ED increased significantly in older age, lower educational group, and in subjects who had moderate to severe depression.
Background
: One method for achieving medical practice to be more evident, especially in the field of primary care, is to encourage the use of clinical guidelines. If development of guidelines is difficult because of time and cost, an evidence based foreign guidelines can be selected and translated into Korean for application. Methods : A team was formed, consisting of 11 family physician experts on evidence based medicine and clinical practice guidelines. We selected six respiratory diseases requiring clinical guidelines because of variability in practice. We searched several clinical practice guideline databases and selected one guideline according to currency, scope of guideline, whether it was evidence based, and its feasibility in the field of primay care. We translated selected guideline's full-texts or summaries which were done by authorized organization into Korean. Results : The selected respiratory diseases were chronic obstructive pulmonary disease, asthma, pneumonia, sinusitis, rhinitis, and influenza. According to criterion, we selected GOLD (Global Initiative for Chronic Obstructive Lung Disease) for chronic obstructive lung disease, GINA (Global initiative for asthma) for asthma, CDC (Center for disease control) guideline for influenza, IDSA (Infectious Diseases Society of America) guideline for pneumonia, AAP (American Academy of Pediatrics) guideline for sinusitis, and JCAAI (Joint Council of Allergy, Asthma and Immunology) for rhinitis. Conclusion : We selected six common respiratory diseases and the most appropriate evidence based guidelines for those particular diseases.
Background
: The aim of this study was to investigate the health problems which women feel important and what they want to know from their doctors in the family practice clinics. Methods : The subjects were all female patients who visited the family practice clinics at the four hospitals in which some members of the Study Group for Women's Health in Korean Academy of Family Medicine worked from December 10 to 15, 2001. We surveyed by self-administered questionnaire on important health topic, health care services they woud like to receive, what they expected from their doctors, what topics they have difficulty in discussing with, the doctors preference of physician's gender. We analyzed the results by age groups; 19∼44, 45∼64, and 65 years old and over. Results : A total of 437 women answered the questionnaires, whose mean age was 49.4 year. Health topics that women felt important were osteoporosis, stress, cervical cancer, arthritis, and stroke, which varied with the age groups and recent health perception. The provision of health care services which they desired were in the order of treatment, prevention and health promotion, and diagnosis, which varied with the age groups and recent health perception. What they expected from their doctors were in the order of giving accurate diagnosis, explaining the treatment plan, and answering their questions. They had difficulty undergoing physical exam undressed, gynecological exam, and discussing on their sexual problems. Conclusion : Women who visited the family practice clinics felt differently on important health problems according to the age groups. Overall, they wanted to receive health services on the treatment, prevention and health promotion of osteoporosis, stress, cervical cancer, and arthritis.
Background
: Osteoporosis is an important health concern among the postmenopausal women. Therefore, it is necessary to find out acceptable screening tools for osteoporotic patients. The purpose of this study was to evaluate the Risk Index by OSTA as a screening test for osteoporosis. Methods : The study population was 322 naturally caused menopausal women in Korea. Their was of femoral neck and lumbar spine BMD measured by DEXA. Risk Index by OSTA, based on weight and age, was calculated and the sensitivity and specificity for osteoporosis and osteopenia were evaluated. To find out the proper cut-off point for osteoporosis and osteopenia among the postmenopausal women in Korea, we also compared the sensitivity and specificity of each Risk Index value. Results : The mean age and ages at menopause were 59.1(±6.2) and 50.7 (±2.7) years, respectively. The prevalence of osteoporosis was 9.6% with femoral neck BMD. For oeteoporosis, using a cut-off point of -1 yielded a sensitivity of 74.3% and a specificity of 52.2% with femoral neck BMD. Using a cut-off of -2 yielded a sensitivity of 87.3% and a specificity of 70.9%. The ROC curve showed an AUROC 0.88 for Risk Index in identifying osteoporosis. Conclusion : The Risk Index is an acceptable, simple and useful method in the diagnosis of osteoporosis with a Risk Index of -2 in Korean postmenopausal women.
Background
: Eosinophilia is associated with distinctive disease processes that include helminthic parasitic infections, allergic diseases and a diversity of disease of ill defined etiology. But the rate of persistent eosinophilia is not known in incidental eosinophilia without definite disease such as parasite of allergic disease. Methods : This study included 242 middle aged men who found eosinophilia incidentally in health check up at a general hospital and followed-up after 2 years. The man who didn't know eosinophilia and never treated nor worked up for eosinophilia included. We study the persistent rate of eosinophilia after a follow-up of 2 years. Results : In 78% of incidental eosinophilia, the number of eosinophilia was less than 1000/㎕. The rate of persistent eosinophilia which incidentally founded after a follow-up 2 years is 29.8%. Higher numbers of eosinophilia, hither rate of persistent eosinophilia. Eosinophil number less than 1000/㎕ showed 23.8% persistent eosinophilia, 1000-1499/㎕ 46.3%, 1500-1999/㎕ 57.1%, more than 2000/㎕ 80% persistent eosinophilia respectively(P<0.05). Conclusion : Incidental eosinophilia less than 1000/㎕ usually mormalized without intervention, so simple observation is recommended.
Background
: Death form coronary heart disease is increasing and this study is to evaluate the effect of longitudinal changes of lifestyle and biological parameters on the blood lipid levels, as the risk factor of the coronary heart disease. Methods : Total cholesterol and total cholesterol to HDL-cholesterol ratio (atherosclerogenic index) as an indicator for risk of coronary heart disease were examined longitudinally in sample(n=463) of middle-aged men by 2 years. The independent variables were body mass index, smoking, alcohol, exercise, diastolic blood pressure, uric acid. All data was drawn form questionnaire, blood chemistry, and review of chart. Results : ANOVA test according to categorized variables revealed that for total cholesterol, uric acid (P<0.01) and diastolic blood pressure (P<0.01), and for atherosclerogenic index, and body mass index (P<0.001) were significant. In correlation analysis, total cholesterol was associated with uric acid (r=0.20, P<0.001), diastolic blood pressure(r=0.15, P<0.001) and body mass index(r=0.30, P<0.05). and for atherosclerogenic index so was body mass index (r=0.18, P<0.001). In regression, uric acid(β=6.07, P<0.001), diastolic blood pressre(β=0.36, P<0.01) for total cholesterol, and body mass index(β=0.22, P<0.001) for atherosclerogenic index were significant. But changes in alcohol consumption, smoking, and exercise were not statistically significant. Conclusion : In order to reduce risks of coronary heart disease, the more aggressive medical intervention for the uric acid, DBP, and BMI, would be essential. This study was done without medical intervention. So, further study with intervention, adequate duration and intensity for parameters modification is required.
Background
: It has been reported that hypercholesterolemia is associated with coronary heart disease and that alcohol intake influence on the lipid metabolism. This study was conducted to evaluate the relations between alcohol intake and serum lipid level. Methods : We reviewed 906 subjects who had visited for routine checkup at family practice of Hanil hospital and then excluded 130 subjects with DM, renal disease, thyroid disease, hepatic disease or drug administration which might have influence on serum lipids. From the remaining 776 subjects, we obtained the amount and the frequency of alcohol drinking during the previous 2 weeks and the duration of alcohol intake, using a formed questionnaire. The alcohol dependence score was recorded by the National Alcoholism Screening Test. The serum lipids such as total cholesterol, triglyceride, and HDL-cholesterol were tested by enzyme method and obesity index was obtained by Broca’s methods. These data were analyzed by SAS/TC program. Results : The total number of subjects was 776. Of those, 67.7% (n=525) were male and 32.3%(n=25) females. The mean age of subjects was 50.5 years (range 15 to 77 years). The distribution according to the obesity index was as follows; underweight group 7.1%, normal-weight group 38.1%, over-weight group 31.6%, obesity group 23.2%. The number of the drinkers was 382(49.2%) in males and 7(0.9%) in females. The mean serum lipid level were compared and analyzed among the groups. The results were as follows; the total cholesterol and triglyceride levels were higher in males and the HDL-cholesterol levels was higher in females. The total cholesterol and triglyceride levels increased with age and obesity index, the HDL-cholesterol level decreased with obesity index. In the relationship between alcohol intake and serum lipid levels in males, The geometric mean of triglyceride level was higher among all the variables of alcohol intake, and the HDL-cholesterol level increased with the amount and the frequency of alcohol intake. The results of multiple regression analysis associated with age, obesity, index, the amount and the frequency of alcohol intake in males were as follows; the triglyceride level was positively associated with the amount of alcohol intake, and the HDL-cholesterol level was positively associated with the frequency of alcohol intake. Conclusion : The effects of age, sex and the obesity index on the serum lipid level are remarkable, and in males, alcohol intake increases triglyceride and HDL-cholesterol levels. Further study is needed to find out about whether alcohol intake have influences on coronary heart disease according to serum lipid levels.
Background
: Helicobacter pylori infection is thought to be an important factor the pathogenesis of gastric and duodenal ulcer. But in Korea, there are new studies on the prevalence of Helicobacter pylori infection in peptic ulcer patients and their relationship between the location of ulcers and Helicobacter pylori infection. The aim of this study was to investigate the prevalence of Helicobacter pylori infection of gastric and duodenal ulcer patients in Korea and the relationship between the location of ulcers and Helicobacter pylori infection. Methods : We studied 476 consecutive patients with duodenal ulcers or benign gastric ulcer which were diagnosed by gastrofiberscopy in Family Medicine of Hanil Hospital from January 1995 to December 1998l Helicobacter pylori infection was evaluated with rapid urease test(CLO test) in 72.7% patients. Results : The test rate of CLO test was not significantly different by sex, age and site of gastric ulcer lesions, but test rate in the gastric ulcer was significantly lower than in the duodenal ulcer. The prevalence of Helicobacter pylori infection diagnosed with CLO test was 90.1%. The prevalence of Helicobacter pylori infection was not significantly different between males and females. Also it was also not significantly different according to age. 90.8% of those with gastric ulcer patients and 88.9% of the duodenal ulcer had Helicobacter pylori infection, but the difference was not significant. significantly. 94.6% of gastric ulcers located in only one area had Helicobacter pylori infection, compared to 83.6% of gastric ulcers which was located in multiple areas. The prevalence of Helicobacter pylori infection was significantly lower in patients who had lesions located in multiple areas. Conclusion : We conclude that the majority of peptic ulcer patients in Korea have Helicobacter pylori infection. Gastric ulcer located in multiple areas had significantly lower prevalence of Helicobacter pylori infection, which may suggest that gastric ulcers in multiple areas have other etiologic factors.
Background
: Although family physicians are performing an increasing number of esophagogastoduodenoscopies(EGDs), there is little research conducted in Korea. Thus, the purpose of this research is to assess the ability of family physicians in performing EGD. Methods : All EGDs performed by family physicians in the department of family medicine of one general hospital from January 1995 to December 1996 were reviewed retrospectively through medical records. The including physicians a family physician and nine family residents, performed EGDs five times per week. Results : 4,468 EGDs were performed on 4,313 persons during the two years. No major complications were noted and all of the procedures were completely investigated to the second portion of the duodenum. Normal findings were 1,268 cases(28.4%) and abnormal findings were 3,200 cases(71.6%). Among the abnormal findings, gastritis was the most common finding(73.7%). The most common pathologic diagnosis was peptic ulcer 37.7%(177/470cases). Positive rate of CLO test was 89.4%. Family physicians, endoscopic diagnosis agreed with pathologic reports in 86.6%. The number of EGDs performed by each family physician ranged from 2 to 1,503 cases. Data of six physicians who performed more than 200 EGDs for their diagnostic were comparatively analyzed ability. Diagnosis of normal, gastritis or gastric ulcer was significantly different(P<0.05) according to each physicians but the diagnosis of duodenal ulcer was not statistically different(P<0.05). There was little difference among physicians in the biopsy rate. The agreement ratio between endoscopic diagnoses and pathologic reports among those physicians who performed more than 200 procedures were 79.7-93.3% and were not statistically different(P<0.05). Conclusion : This study is the first report of EGDs performed by family physician in Korea. Some family physicians performed more than 4,000 EGDs without major complications in primary care. These data confirm the ability of some family physicians to perform EGD. Biopsy analysis indicates the diagnostic accuracy is high. Further study on performance of EGD by family physicians and its standardization concerning description of endoscopic are needed.( J Korean Acad Fam Med 1999;20:1027-1039)
Background
: Recent increase in use of the periodic health screening is due to a concern for health. But study of patient's compliance with recommended periodic health screening has not yet been conducted. This study was accomplished to clarify which aspect to be considered in order to increase patient's compliance after health screening. Methods : This study was done from March 3 to May 15 in 1997 by Hanil health care center. Among 370 workers in a state-run corporation who received health screening two years ago, 170 men were advised to receive and additional laboratory test or treatment at the time. They were asked to fill out a questionnaire and were interviewed by doctors to evaluate their compliance. 162 of 170 patients(95.3%) were enrolled in the study, except 8 patients who did not answer the questionnaire. Results : The mean age of patients was 54 years. Most of them were technicians and managers, graduated from high school or higher, and had an annual income of at least 35,000,000. The disease of requiring an additional test or treatment were in the order of liver disease, hypertension, gastrointestinal disease, urologic disease and abnormal urinalysis. 68 patients(42%) were compliant and 94 patients(58%) were noncompliant. For reasons of noncompliance, 27 patients(28.7%) answered "because I had no symptoms", 20 patients(21.2%) answered "because I didn't think I needed the test or the treatment" and 12 patients(12.7%) answered "because I was busy". The factors influencing compliance were analyzed through chi-square or Fisher's exact test. Their compliance was highly related to the patients' insight into the necessity of the test, the existing disease, and the reporting method of the health screening results. It was not associated with the patients' feeling about their health status, the health behaviors such as smoking and drinking, occupational factors, distance from thire homes to the hospital, or the presence of a hospital near home for those who didn't live in Seoul. The independent effect of the factors influencing the compliance was evaluated by means of stratified analysis. The only independent factor associated with the compliance was the patients' insight. The compliance according to diseases was higher than average in hypertension, liver disease, diabetes mellitus and urologic disease, and lower than average in pulmonary disease, gastrointestinal disease, thyroid disease, cardiac disease, opthalmologic disease and abnormal urinalysis. Conclusion : The most influencing factor related to compliance was the patient's insight into the necessity of the further testing. We should consider a proper way to increase compliance on health screening. Direct counseling, if possible, is recommended following health screening and way to increase patient's compliance utilising mail report as another.
Background
: Increasing the need of appropriate prediction formulas of pulmonary function parameters in Korean adults, interest about which affect the pulmonary function para-meters are increasing. Therefore we examined the relationship between pulmonary function pa-rameters derived from the forced expiratory spirogram and age, height, weight, and smoking amount in Korean middle aged men. Methods : We analyzed the result of parameters derived from the forced expiratory spiro-gram in 1,954 men who enrolled in health examination of on corporation, from March 1995 to April 1996, who are aged from 45 to 59, and who have neither history of cardiopulmonary dis-ease nor lesions on chest X-ray. Pulmonary function was estimated by SPIROVIT SP-200(Switzerland). We evaluated the relationship between pulmonary function parameters and age, height, weight and smoking amount by multiple linear regression method. Results : Mean age, height and weight were similar among current-smoker, ex-smoker and non-smoker group. Results of the effect on height-adjusted pulmonary function parameters ac-cording to smoking status were that FVC, FEV₁ and FEV₁/FVC showed no difference among three groups, but FEF 25-75% showed significant decrease in smokers group. To adjust the effects of age, height and weight about pulmonary function, we analyzed the parameters by multiple linear regression method. Results showed that all pulmonary function parameters showed nega-tive correlations with smoking amounts. We evaluated the effect of age, height and weight on pulmonary function parameters by multiple linear regression method. FVC and FEV₁showed negative correlations with age, positive correlations with height and no significant correlations with weight. FEV₁/FVC showed negative correlation only with age, and FEF 25-75% showed signi-ficant negative correlation with age and positive correlation with weight, but no significant cor-relation with height. We compared the predicted value estimated for Korean with that for American. Predicted value from prediction formulas for Korean were higher than that for American. Conclusion : Smokers had significant decrease of FEF 25-75% compared with ex-smokers and non-smokers in Korean middle aged men. This indicates that smoking develops early changes on peripheral small airways. We have got predicton formulas for pulmonary function parameters in which FVC and FEV₁consisted of age and height and FEF 25-75% consisted of age and weight. Because prediction values estimated by Korean were higher than that by American, we must apply appropriate prediction formulas in Korean to Korean pulmonary function test.
Background
: It is well known that heavy alcohol consumption may result in various lesions on multiple organs and tissue, especially liver. This was conducted to evaluate the relations between the status of alcohol consumption and serum activity of hepatic enzymes such as AST, ALT, and √GTP that were usually used as a screening test. Methods : All subjects were 906 persons, who visited and questioned at the outpatient clinic of Department of Family Medicine in Hanil Hospital from June, 1995 to August, 1995 for the purpose of regular health screening. We analyzed 825 persons, excluding 56 persons with HBsAg(+), 7 persons with hepatic problems wthin 6 months and 18 persons with medication drugs that could change serum activity of hepatic enzyme of joints, muscles, cardiac problems. Amount of alcohol consumption during 2 weeks and alcohol consumption once, duration, frequency per month were obtained by questionnaire. Alcohol dependent score was conducted using NAST questionnaire that was developed to evaluated alcohol dependency in Korean. The levels of serum activity of hepatic enzyme such as AST, ALT, √GTP were examined by enzyme method. Thest data were analyzed using SAS/PC statistic program. Results : Total number of subjects was 825, of whom 559(67.8%) were male and 266(32.2%) were female, of whom 408(49.45%-male:36.52%, female:63.48%) were teetotalers and 417(50.55%-male:98.32%, Female:63.48%) were drinkers. Amount of alcohol consumtion during 2 weeks and alcohol consumtion once trended to increase with decresing age in male(P<0.01). The distribution of frequency f alcohol consumtion per month in drinkers was following 1 to 4 per month(37.9%), 5 to 9 per month(26.1%), 10 to 14 per month(14.8%), the above 20 per month(11.5%), 15 to 19 per month(9.5%). The distribution of duration of alcohol consumtion in drinker group was following the above 16 yrs(83.0%), 11 to 15 yrs(8.4%), 6 to 10 yrs(6.7%), the below 5 yrs(1.9%). The mean of alcohol dependent score was 0.88. Statistical analysis of variance showed that the difference found between the various alcohol consum-tion group(during 2 wks and once) and frequency were significant for the mean AST, ALT, √GTP and the various alcohol dependent score was significant for the mean AST, √GTP, The varios duration was significant for mean √GTP(P<0.01). Statistical χ² trends test showed that the difference found between the varient drinking groups was only significant for the percentage of abnormal √GTP(P<0.01). Multivariate Linear Logistics regression analysis demonstrated that the effect of amount of alcohol consumtion once and alcohol dependent score on AST, duration on ALT, amount of alcohol cosumtion during 2wks on √GTP were statistically significant in male. Counclusion: The serum activity of √GTP might have most effective value as a screening test for alcohol consumtion, then AST might have higher value than ALT.
Background
: Most health professionals agree that exercise has positive effect on physical well-being. In addition, they believe that exercise has benefit for improvement of psychologic stress, mood sate, social relationship and sleep disturbance. The purpose of this study is to evaluate the effect of regular exercise on complaining of somatic symptoms in healthy adults. Methods : 309 healthy adults were selected among the visitors at hanil health screening center from February 23 to June 23, 1995. The evaluation was done about the frequency of exercise and somatic symptoms via questionnaire which consisted of 21 symptoms chosen from a list of 35 symptoms of somatization disorder met by DSM-III-R criteria. The 3 categories for exercise were classified as regular, Intermittent and none exercise groups. Results : Women did lesser regular exercise and had more somatic symptoms than men. In general population, regular exercise group had significantly lesser somatic symptoms than none and intermittent exercise group, and general, cardiovascular, digestive and musculo-skeletal symptoms showed positive association with regular exercise. In men, regular exercise group was associated with lesser somatic symptoms and only cardiovascular symptoms showed positive association with regular exercise. But in women, the numbers of somatic symptoms were not significantly different among exercise groups. Conclusion : In the study of the effect of exercise regularity on somatic symptoms, the numbers of somatic symptom were fewer for the regular exercise group than none an intermittent exercise group in men. Therefore regular exercise helps reduce complaining of somatic symptoms.
Background
: Industrialization has taken its roll in creating a noisy environment that has resulted in various man-made diseases. Their most distinctive one is Noise-induced hearing loss(NIHL). Although developed NIHL has never treated, developing of NIHL could be prevented if with attention, sufficiently. Thus, its prevention can not be emphasized very much. One method of its prevention is screening test for high risk group of NIHL during priodic health examination. Our study was designed to find prevalence and characteristics of NIHL in men in their twenties with military duty-off and its related factors. Methods : The selected subjects were 103 males in their twenties with military duty-off taken periodic health examination of new officer candidates in a public enterprise at 8 july 1994 at hanil general Hospital. Data were gathered by questionnaire which is consist of past medical history related to hearing loss, noise exposure and its kinds. Screening Audiometer test was performed. Otoscopic examination and physical examination related to hearing disturbances were performed. Thereafter, audiogram(air-and bone- conduction) were performed if any abnormal finding was detected by screening audiometer test. Results : Among 103 male subjects, 11 subjects(10.7%) were considered to NIHL cases and were shown to have C-5 dip pattern. Their mean hearing loss at 4,000Hz and by 3-divided method were 45.9(dB), 10.0(dB) in Lt. ear and 36.8(db), 10.3(dB) in Rt. ear, respectively. Among 14 cases of other noise exposure group, only 1 case was considered NIHL case. Conclusion : Among 103 subjects, 11 subjects were shown to have C-5 dip pattern known as incipient appearance of NIHL or its advanced pattern. Thus, prevalence of NIHL was 10.7%. According to this results, we thought that some hearing conservation programs should be applied to this group. and we considered that, if their job should be performed in a noisy environment, screening test for hearing disturbance should be applied.
Background
: As interest of people about health focused on early detection of disease and health promotion, periodic examination is increased. Plasma glucose test and semiquanititative urine stick test have been used currently as a screening test of DM. We evaluated the significance of urine glucose test as a screening test for DM in mass screening through the detection rate and validity of the urine glucose test using semiquantitative urine stick stest. We also examined the proporton and age distribution of people with abnormal plsma glucose level. Methods : We inquired the level of fasting plasma glucose and urine glucose of 19,920 men who enrolled on the periodic health examination of one coporation. The level of urine glucose was measured by the urine stick using the oxidative enzymatic method. Results : The sex of 19,920 objects was only man with age ranging from 20's to 50's. Age distribution was not corresponding to the standard demographic distribution pattern. The number of people with positive urine stick test was 125, 1.45% of total objectives and increased with age, 0.78% in the group under 30 years old and 5.1% in the group more than 50 years old. Sensitivity of urine glucose test was 29.8% and increased with glucose level, 20% in the group of plasma glucose 140-170mg/dl, 43.6% in 180-199mg/dl and 58.0% in more than 200 mg/dl. Sensitivity also increased with age, 0.0% in the group under the 30-year-old, 14.9% in the group of 30's, 45.7% in 40's and 51.6% in 50's. Also false negative rate of urine glucose test was high, 70.2%. Conclusion : Urine glucose test with urine stick seems to be defective method in cost-benefit as a mass screening examination considering low sensitivity of 29.8%, low positive predictive rate of 68.8% and low prevalence of DM, although specificity is high. It may be selectively used in high risk group or in people with symptoms of DM. It seems to be proper to diognose DM with plasme glucose test when suspicious of DM, too.
Background
: TSH is of great use as screening test in health examination. Recently, new sensitive EIA has been developed. We calculated normal range of TSH and positive predictive value of TFT abnormality by this method. Also, this study was carried out for the purpose of presuming the prevalence of TFT abnormality in community screening test of our county. Methods : TSH levels were measured in 4,708 subjects that participated in periodic health examination at department of family medicine, Hanil hospital. The subjects with TSH abnormality were carried out test of T3 and T4. Results : There were 4,649 men and 59 women in study population. According to area, subjects were distributed to 1,935 in rural area, 1,651 in small and medium cities and 1,122 in large cities. The number of subjects with TSH abnormality was 123 (2.6%) and the number of subjects with TFT abnomality among male was 32(0.7%). There was no statistically difference by age and sex, there was revealed as statistically significant higher rate in small and medium cities by area. The TSH was revealed as left skewed distribution. The normal ragne of TSH was 0.34~3.28mIU/L after log transformation and positive predictive value was 26%. After supposing sensitivity was 100%, specificity was etimated as 98.1%. Conclusion : The prevalence of T3, T4 abnormality in Korea as similar as other countries was 0.7% and positive predictive value of T3, T4 abnormality by EIA methods was 26% that was low. Therefore it seems that there are restrictions in cost effectiveness as community screening test, although sensitivity and specificity were high.
Background
: In considerable portion of patients complaining upper gastrointestinal symptoms, the causes of the symptoms are not certain. This study was purposed to identify the factors related to the upper gastrointestinal symptoms. Methods : the subjects were selected among the people that visited outpatient department of family medicine for the purpose of health screening and were examined by gastrofiberoscopy or upper gastrointestine series. All subjects were surveyed to determine the existence of 8 upper gastrointestinal symptoms and 15 factors composed of social environment, life style, diet patterns. Results : The number of complaining symptoms was correlated significantly with sex, diet pattern, sleep pattern, exercise, and bowel habit. The bowel habit was correlated with 7 symptoms. Sleep pattern was correlated with 6 symptoms and diet pattern was correlated with 5 symptoms. The pepticulcer was correlated significantly with male, diet pattern, alcoho drinking, cigarette smoking. There was no significant correlation between peptic ulcer and number of complained sympotoms. Also there was no significant correlation between each symptom and peptic ulcer. Conclusion : Upper gastrointestinal symptoms were affected by sex, diet pattern, exercise, sleep pattern, and bowel habit rather than organic causes. and these factors should be considered in management of patients presenting with upper gastrointestinal symptoms.
Background
: Acute hepatitis B can often induce chronic liver diseases, which cause serious complications. Korea is an endemic area where HBsAg positive rate is reported to be 5~10% of whole population. Therefore hepatitis B vaccination is essential to prevent disease transmission and it is important to assess the factors that after vaccination. Methods : The study was carried out in 1,006 subjects among 2,870 adults that became candidates for hepatitis B vaccination. the subjects received a dose of Hepavax 1.0ml. The second and third doses were given one month and six months after the first dose. Al blood samples were tested for HBsAg and anti-HBs by EIA method. Chi-square test was performed for statistical analysis of the results by SPSS. Results : Four years after hepatitis B vaccination, the subjects that negative HBsAg and negative anti-HBs were 33% and that negative HBsAg and positive anti-HBs were 66.4% Anti-HBs positive rate was significantly associated with vaccination doses. In the 975 subjects who received and dose or more, there was no statistically significant relationship between anti-HBs positive rate and the subject's age or sex. Two years after vaccination, 779 subjects had anti-HBs and 18.6% of these subjects converted to negative anti-HBs status two years later. And this negative conversion did not show statistically significant correlation with vaccination doses, subject's age or sex. Conclusion : Four years after vaccination, anti-HBs positive rate was significantly associated with vaccination doses but it was not associated with the subject's age or sex. After 3 doses vaccination, the anti-HBs positive rate was 77.5% and 68.1% at 2 years and 4 years respectively. This negative conversion rate of 10.4% was not associated with vaccination doses and subject's sex or age. These facts don't support the necessity of booster vaccination after 5 years from initial vaccination.
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