Journal of Preventive Medicine and Public Health

Volume 32(3); September 1999

Original Articles

Laboratory-Acquired Infections with Hantavirus at a Research Unit of Medical School in Seoul, 1996.: Soo Hun Cho, Young Su Ju, Daehee Kang, Suhnggwon Kim, Ik Sang Kim, Sung Tae Hong; Korean J Prev Med. 1999;32(3):269-275.

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Abstract PDF: BACKGROUND
In April 6, 1996, a male researcher who has worked at a research unit at the Basic Research Building of Seoul National University(SNU) College of Medicine admitted to SNU Hospital due to persistent fever. He was diagnosed serologically as hemorrhagic fever with renal syndrome(HFRS). Another female researcher in the same unit was also diagnosed as HFRS at the same hospital several days later. Epidemic investigation of HFRS was conducted to determine the magnitude of the problems since these two cases were strongly suspected to have laboratory-acquired infections of HFRS. METHODS: All researchers and employees working at the Basic Research Building(BRB) of SNU College of Medicine as of April 1, 1996 were recruited for the study. Information on symptoms of HFRS and history of contact to experimental animals were collected by self-administered questionnaires and serological tests among study subjects were also conducted by indirect immunofluorescent antibody(IFA) to hantavirus. The experimental animals were also serologically tested for infection with hantavirus by IFA. RESULTS: Among 218 surveyed, six researchers and an animal caretaker had hantavirus antibodies above 1:20 in IFA titer. Five of seven sero-positive subjects had antibodies above 1:640 in IFA titer and had shown clinical symptoms compatible to HFRS during Jan. 1 to Apr. 20, 1996. The sero-positive persons had handled animals more frequently than sero-negative persons (OR, 19.68; 95% CI, 1.11 - 350.40) and handling animals at the animal quarter at School of Public Health(SPH) had shown consistently higher risk to get infected with hantavirus irrespective of types of animals handled (OR, 4.90 - 6.37). Sero-positivity of rats of the aniamal quarter at BRB was 30-60%, whereas 80% of rats at SPH tested were shown sero-positivity. CONCLUSION: There was a epidemic of HFRS in research units of a medical school during the period from Jan. through Apr. Further investigation is needed to determine the extent and the mode of transmission of the laboratory-acquired infection with hantavirus in other research facilities.; Summary

Structural Relationships among Health Concern, Health Practice and Health Status of the Disabled.: Ki Soo Park, Byung Yeol Chun, Sin Kam, Min Hae Yeh, Yun Sik Kang, Keon Yeop Kim, Jae Hee Son, Young Suk Lee; Korean J Prev Med. 1999;32(3):276-288.

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Abstract PDF: OBJECTIVES
This study was performed to determine the relationships among Health concern, health practice and health status of the disabled. METHODS: A self-administered questionnaire survey was carried out for 1,662 disabled persons in Taegu city from April to July, 1997. RESULTS: Health concern had a significant and positive relationship with health practice(p<0.05) and health practice also had a significant and positive relationship with self-rated health status(p<0.05) in men and women. To determine the structural model of the Health concern, health practice, health status and sociodemographic variables, the covariance structural analysis was used. In men, age, economic status, medical security type, educational level and type of disability had significant direct effects on Health concern(T>2.0). Educational level and type of disability had significant direct effects on health practice(T>2.0). And Economic status, medical security type and job status had significant direct effects on health status(T>2.0). In women, economic status and educational level had significant direct effects on Health concern(T>2.0). However there was no variable which had a significant direct effect on health practice. Job status had a significant direct effect on health status(T>2.0). In men and women, health practice was significantly increased with increasing Health concern and the more health practice, the higher health status(T>2.0). CONCLUSIONS: It is recommended that the institutional approach which improve the economic status of the disabled with understanding their behavior and attitude should be established to increase health status, in addition, the health policy for encouraging the disabled, such as health education, consulting and health promotion program, should be done.; Summary

A Case-control Study of Unexpected Readmission in a University Hospital.: Hyohn Joo Oh, Seung Hum Yu; Korean J Prev Med. 1999;32(3):289-296.

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Abstract PDF: OBJECTIVES
This study describes the risk factors affecting the unexpected readmission of 261 patients who were discharged from a university hospital in Seoul. METHODS: This case-control study reviewed medical records of inpatients who had been discharged from a hospital between 1 August 1995 and 31 October 1995 after the treatment for general diseases. The cases were 68 patients who were readmitted unexpectedly within 28 days of discharge from an index stay, and the controls were 193 patients who were discharged without readmission during the study period. RESULTS: Logistic regression analysis results were as follows; Patients who had no operation during their hospital stay were more likely to be readmitted unexpectedly than patients who had operation. Patients who had 1 or 2 parts of their body being involved in treatment were more likely to be readmitted unexpectedly than patients who hand more than 3 parts of their body being involved in treatment. Patients who had complications after surgery were more likely to be readmitted unexpectedly than patients who had no complications. Insufficient discharge planning caused unexpected readmissions. CONCLUSIONS: Discharge planning education should be extended to health care providers. And the assessment of discharge planning should be evaluated. Readmission is often necessary for the treatment of related problems originating from initial hospitalization, which causes cost problems. Unexpected readmission is preventable and the models for readmission can serve as a valuable clinical tool for high risk patients.; Summary

Factors Related to the Intention of Participation in a Worksite Smoking Cessation Program.: Jae Hee Son, Sung Ah Kim, Sin Kam, Min Hae Yeh, Ki Su Park, Hee Sook Oh; Korean J Prev Med. 1999;32(3):297-305.

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Abstract PDF: OBJECTIVES
This study was conducted to evaluate factors related to the intention of participation in a worksite smoking cessation program. METHODS: To explain the health behavior of participating intention in a worksite smoking cessation program, the health belief model(HBM) was used as study model, and 144 self-administered questionnaires were completed by electronic company workers. Variables of the health belief model were composed of perceived susceptibility to smokinginduced disease, perceived severity of smoking-induced disease, economical gain as perceived benefit of smoking cessation, and nicotine dependency as perceived barrier of smoking cessation. Variables of sociodemographics, smoking status, knowledge about adverse health effects of smoking, and cues to smoking cessation were used as modifying factors. RESULTS: Perceived severity(POR=1.99, 95%CI: 1.03-3.83), perceived benefit(POR=2.11, 95%CI: 1.07-4.17), and perceived barrier(POR=0.29, 95%CI: 0.11-0.76) were significant variables to the intention of participation in a worksite smoking cessation program in the logistic regression analysis. The perceived severity was significantly affected by knowledge about adverse health effects of smoking(POR=2.17, 95%CI: 1.23-3.84). The perceived barrier was significantly affected by education level(POR=3.66, 95%CI: 1.17-11.44), age to first cigarette (POR=0.32, 95%CI: 0.10-0.98), pack-years(POR=5.47, 95%CI: 2.37-12.61). To the perceived benefit, the model was not fitted. CONCLUSIONS: Our results found that counterplans improving the knowledge about adverse health effects of smoking, preventing early smoking, and decreasing smoking amount should be considered for an effective smoking ban policy.; Summary

Prevalence of Dementia in the Elderly of an Urban Community in Korea .: Dong Hyun Kim, Duk L Na, Byeon Gil Yeon, Yeonwook Kang, Kyung Bok Min, Soo Hyun Lee, Sang Suk Lee, Mi Ra Lee, Ok Jung Pyo, Chan Byung Park, Sunmean Kim, Sang Soo Bae; Korean J Prev Med. 1999;32(3):306-316.

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Abstract PDF: OBJECTIVES
In Korea, as in most countries, there will be a sharp increase in the number of dementia patients in the near future. However basic data on dementia prevalence, which is important in defining epidemiologic characteristics and in implementing preventive strategy, are limited. This study was conducted to estimate the prevalence rate of dementia in the urban elderly aged 65 or older in Kwangmyung, Korea. METHODS: A two phase design was used for case finding and case identification. In phase I, a representative sample aged 65 or older was selected and interviewed by door-to-door survey with a Korean version of the Mini-Mental State Examination (K-MMSE). In phase II, Of the 946 subjects interviewed in phase I, 356 elderly were randomly selected disproportionately according to K-MMSE score. Of these elderly, 223 (61.5%) underwent standardized clinical evaluations, including psychiatric interview, neurological examination, and neuropsychological assessment. Dementia was diagnosed by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. The diagnosis of Alzheimer's disease (AD) was made by National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association(NINCDS-ADRDA) criteria and vascular dementia (VD) by DSM-IV. RESULTS: The overall weighted prevalence rate of all dementia among Kwangmyung residents aged 65 or older was 12.8%(age-adjusted rate: 13.0%, 95% Confidence Interval[CI]: 10.6-15.3%). Women had much higher prevalence rate than men even when age was controlled(15.9%[95% CI 12.6-19.2%] vs 7.5%[95% CI 4.6-10.4%]). The rates of dementia were 5.2%, 12.2%, 17.0%, and 34.3% for the age groups of 65-69, 70-74, 75-79 and 80 and over, respectively. The rate of AD appeared to be slightly higher than that of VD(5.2% vs 4.8%), though not statistically significant. Most of the cases(69%) were mild dementia according to CDR(<1) in these subjects. CONCLUSIONS: These results showed that the prevalence rate of dementia among urban elderly in Korea appears to be higher than those of other Asian countries.; Summary

Cost-benefit Analysis of Massive Screening for Inborn Errors of Metabolism in Korea.: Chang Yup Kim, Sunmean Kim, Nami Hwang; Korean J Prev Med. 1999;32(3):317-324.

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Abstract PDF: OBJECTIVES
Since 1991, nationwide massive neonatal screen-ing program for phenylketonuria (PKU) and congenital hypothyroidism have been performed in Korea. As in many other countries, efficiency of this program has not been definitely concluded. For the purpose of evaluation of this program, from the perspective of efficiency, a cost-benefit analysis was carried out. METHODS: Costs of the detection and the treatment program were compared with the projected benefit(avoided costs) that results from the prevention of the mental retardation associated with the disorders due to PKU and hypothyroidism. Costs and benefits were discounted at an annual rate of 5 %, and duration of life-long labor was assumed to be 30 years. Cost and benefit were estimated based on the detection rates of one case of PKU per 5,572 and one case of congenital hypothyroidism per 32,554 babies screened during 1991-1997. RESULTS: The benefit-cost ratio was 0.418. The sensitivity analysis for the discount rates and labor durations showed that most cost-benefit ratios were lower than one(1.0) except when discount rate was changed to 3% and detection rate to two- or threefold and/or labor duration to 40 years. CONCLUSIONS: The result of this study suggested that present program of mass screening for PKU and congenital hypothyroidism could not be justified in terms of efficiency. It doesn't coincide with the results of previous studies in major developed countries, presumably because of difference in detection rates and welfare cost for the disabled.; Summary

Factors Associated with Physical Functioning among Community-Dwelling Older Adults.: Yunhwan Lee, Kwisook Choi; Korean J Prev Med. 1999;32(3):325-332.

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Abstract PDF: OBJECTIVES
The aim of this study is to identify major factors associated with physical functioning among the Korean elderly. METHODS: Data come from a survey of a nationally representative sample of 2,058 older people aged 60 years or older living in the community. A hierarchical functioning scale was constructed, using upper and lower body mobility, IADLs, and ADLs. Socioeconomic characteristics, chronic conditions, measures of health status, health service use, and social support were analyzed to explore their influence on functioning. Polytomous logistic regression analysis was conducted to identify major contributing factors to different levels of functioning. RESULTS: Persons of older age, female, with chronic diseases (heart disease, stroke, fracture/dislocation) were consistently more likely to show a higher degree of functional limitation. There were variations, however, among other factors; e.g., those with arthritis were more likely to be only mildly impaired, but not moderately or severely impaired. CONCLUSIONS: Older Korean adults living in the community with impaired functioning constitute persons with diverse characteristics. Policy and program activities need to address specific needs of older people in different functioning states.; Summary

The Prevalence of Cancer in Kangwha County.: Sang Wook Yi, Heechoul Ohrr, Kang Hee Lee, Suk Il Kim, Hyung Gon Kang, Sun Ha Jee; Korean J Prev Med. 1999;32(3):333-342.

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Abstract PDF: OBJECTIVES
Most descriptive studies of cancer have focused either on cancer incidence or mortality. Cancer prevalence has rarely been estimated. Cancer prevalence data can be used as a measure of the economic and social burden of cancer and are also useful for health care planning. This study attempts to estimate cancer prevalence in Kangwha county. METHODS: This investigation is based on data of Kangwha cancer registry. The data include all cases of cancer diagnosed from 1983 through 1992. We define "prevalent cases" as cancer patients who is alive as of January 1, 1993. For each five-year age group, the number of "known prevalent cases" is added to the number of "estimated prevalent cases". Prevalence is calculated by dividing these sums by the populations of Kangwha County on December 31, 1992(derived from Kangwha Statistics Annual). RESULTS: Crude prevalence of cancer among males and females are 536.7 and 601.1 per 100,000 respectively. Gastric cancer is the most common malignant neoplasm(213.2 per 100,000, crude prevalence) among males. It is followed by lung cancer(45.1 per 100,000), liver cancer(32.8 per 100,000), rectal cancer(25.4 per 100,000) and colon cancer(25.4 per 100,000). Cervical cancer is the most common cancer(201.9 per 100,000, crude prevalence) and is followed by gastric cancer(91.5 per 100,000), thyroid cancer(64.8 per 100,000), breast cancer(57.2 per 100,000) and rectal cancer(32.7 per 100,000) among females. CONCLUSIONS: We tried to estimate cancer prevalence based on the Kangwha cancer registry for the first time in Korea. The estimation of cancer prevalence based on a population-based cancer registry will be more correct and useful as the data accumulate. We will make another estimation in the near future.; Summary

The Study of Prescription Behaviors of Practicing Pharmacists with Simulated Patients of Arthritis.: Hong Jun Cho, Kwang Su Uh, Jin Wook Choi; Korean J Prev Med. 1999;32(3):343-346.

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Abstract PDF: OBJECTIVES
In Korea, pharmacists can dispense medicines without doctor's prescription. This causes the high proportion of pharmaceutical expenditures. The study shows the prescribing behaviors of practicing pharmacists with the simulated patient of arthritis. We select the arthritis as a subject of simulation, because the arthritis is one of the major health problems and the abuse of cortico-steroids is usual in treatment of arthritis patients. METHODS: Twenty drug stores among the 320 drug stores in a district, Seoul, Korea were randomly selected. One of the researchers visited the drug stores and received the medicines from the pharmacists after explaining standardized scenario of arthritis. The simulated patient recorded the practice behaviors of pharmacists. RESULTS: The mean number of prescribed drugs are four and half. Among the twenty pharmacists, the nineteen prescribed non-steroidal anti-inflammatory drugs and the seven(35%) prescribed the cortico-steroids. The antacids were prescribed by the fourteen(70%) pharmacists. The five(25%) pharmacists only recommended the simulated patients to visit the medical doctors, and the three(15%) performed physical examination to the simulated patients. The three pharmacists(15%) asked the past history of the drug adverse effects and no pharmacist explained the adverse effects of prescribed medicines. CONCLUSIONS: The research shows that the cortico-steroids are frequently prescribed and the pharmacists commonly do not give the explanations of the prescribed medicines to the arthritis patients.; Summary

Immunotoxicity among Farmers Exposed to Pesticides.: Wonjin Lee, Chae Sung Lim, Kun Sei Lee, Soung Hoon Chang; Korean J Prev Med. 1999;32(3):347-354.

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Abstract PDF: OBJECTIVE
This paper examines the possible toxicity to immune system in farmers chronically exposed to pesticides. METHODS: We compared 43 male farmers exposed to pesticides with 29 male residents who had neither past nor current pesticides exposure. The selected variables for studying immunotoxicity were WBC, CD3, CD4, CD8, CD19, CD56, IgG, IgA, IgM, and IL-2. As part of the baseline questionnaires for the immunotoxicity, subjects were asked about kinds of farming, pesticides exposure and medical history. RESULTS: None of the variables for studying immunotoxicity showed statistically significant difference between the two groups. Although the results were not statistically significant, CD4 and the CD4/CD8 ratio decreased and CD8 increased. These effects showed a dose response change with exposure level. In the exposed group, the values of CD3, CD4, CD4/CD8 and CD19 decreased and those of the CD8 and CD56 increased compared to the non-exposed group. Also there was higher prevalence of self-reported disease in the exposed group compared to the non-exposed group. CONCLUSIONS: Although statistically significant differences in indices of immunotoxicity in farmers exposed to pesticides were not shown, the results suggest that pesticides may decrease immune function. More advanced test methods for immunotoxicity need to be developed and tested in larger population to detect immunotoxic effects of pesticides.; Summary

Self-Rating Perceived Health: The Influence on Health Care Utilization and Death Risk.: Sun Seog Kweon, Sang Yong Kim, Jeong Soo Im, Seok Joon Sohn, Jin Su Choi; Korean J Prev Med. 1999;32(3):355-360.

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Abstract PDF: OBJECTIVES
This 3-year longitudinal study was conducted to evaluate the influence of self-rating health perception on health care utilization and all cause-death risk. METHODS: The hypothesis was tested using a community-based samples, among which subjects 3,414 were interviewed in 1995. Self-rating health perception was assessed by single-item question. Three components of health care utilization amount(number of visits, number of medications, yearly health care expenses) per year were measured using medical insurance data during 3-year follow-up period among subjects in district health care insurance. There were 123 deaths from all causes among 3,085 subjects interviewed. RESULTS: The results showed that those who had poor health perception revealed more increases in the amount of health care utilization than good health perception group (p<0.05). After adjusting for age and sex, the poor health perception group had higher death risk over 3 years than good health perception group(hazard ratio=1.88). but, after adjusting health care utility, supplementary, was not significant. CONCLUSION: These results suggest that self-rating health percep-tion was associated with difference in health care utilization and all cause-death risk.; Summary

Development of Work-related Musculoskeletal Disorder Questionnaire Using Receiver Operating Characteristic Analysis.: Jaiyong Kim, Ho Jang Kwon, Yeongsu Ju, Soo Hun Cho, Daehee Kang, Joohon Sung, Seong Woo Choi, Jae Wook Choi, Jae Young Kim, Don Gyu Kim; Korean J Prev Med. 1999;32(3):361-373.

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Abstract PDF: OBJECTIVES
Receive Operating Characteristic(ROC) curve with the area under the ROC curve(AUC) is one of the most popular indicator to evaluate the criterion validity of the measurement tool. This study was conducted to develop a standardized questionnaire to discriminate workers at high-risk of work-related musculoskeletal disorders using ROC analysis. METHODS: The diagnostic results determined by rehabilitation medicine specialists in 370 persons(89 shipyard CAD workers, 113 telephone directory assistant operators, 79 women with occupation, and 89 housewives) were compared with participant's own replies to 'the questionnair on the worker's subjective physical symptoms'(Kwon, 1996). The AUC's from four models with different methods in item selection and weighting were compared with each other. These 4 models were applied to 225 persons, working in an assembly line of motor vehicle, for the purpose of AUC reliability test. RESULTS: In a weighted model with 11 items, the AUC was 0.8155 in the primary study population, and 0.8026 in the secondary study population(p=0.3780). It was superior in the aspects of discriminability, reliability and convenience. A new questionnaire of musculoskeletal disorder could be constructed by this model. CONCLUSION: A more valid questionnaire with a small number of items and the quantitative weight scores useful for the relative comparisons are the main results of this study. While the absolute reference value applicable to the wide range of populations was not estimated, the basic intent of this study, developing a surveillance tool through quantitative validation of the measures, would serve for the systematic disease prevention activities.; Summary

The Relationship of Organizational Culture and Organizational Effectiveness at the General Hospital.: Heuisug Jo, Sunhee Lee, Woohyun Cho, Kihong Chun, Okryun Moon; Korean J Prev Med. 1999;32(3):374-382.

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Abstract PDF: OBJECTIVES
Organizational culture has been important in field of organizational behavior research for the past decade. Although there has been a growing interest in the organizational culture and organizational effectiveness, there is few research in health care field. This study was carried out to investigate the relationship of organizational culture and organizational effectiveness at general hospital. METHODS: Data was collected by self-administrated questionares. Organizational cultures were measured by using Likert scale. A general hospital in Kyunggi-Do was selected and survey was conducted to 675 workers. Data was analyzed with computer package, PC- SPSS. RESULTS: There were four types of organizational culture in this hospital : consensual culture, developmental culture, hierarchical culture, rational culture. Many workers recognized their culture as rational culture and developmental culture. This finding showed that the hospital had both human related and task related climate. There were some differences in recognition of sub-organizational culture by occupational group, but perceived organizational culture was in accordance with sub-organizational culture in general. Multiple regression analysis and multiple logistic regression analysis were conducted to find the relationship of organizational culture and organizational effectiveness. As a result, developmental culture showed a strong relationship with organizational commitment and job-satisfaction. CONCLUSIONS: These results showed that types of organizational culture were significantly related to organizational effectiveness and understanding the existing culture is essential to develope their organizational effectiveness.; Summary

What Factors Affect Mortality over the Age of 40?.: Jong Ku Park, Sang Baek Koh, Chun Bae Kim, Myung Guen Kang, Kee Ho Park, Seung Jun Wang, Sei Jin Chang, Soon Ae Sin; Korean J Prev Med. 1999;32(3):383-394.

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Abstract PDF: OBJECTIVES
This study was conducted to identify the factors influencing the mortality of Koreans over the age of 40 by a nested case-control study. METHODS: The cohort consisted of the beneficiaries of Korea Medical Insurance Corporation for Government Employees & Private School Teachers and Staff(KMIC) who received health examinations of KMIC in 1992 and 1993 retrospectively. At that time, they were more than 40 years old. The cases were 19,258 cohort members who had died until December 31, 1997. The controls were 19,258 cohort members who were alive until December 31, 1997. Controls were matched with age and sex distribution of the cases. The data used in this study were the funeral expenses requesting files, and the files of health examinations and health questionnaires gathered in 1992 and 1993. To assess the putative risk factors of death, student t-test, chi-square test, multiple logistic regression analysis were used. RESULTS: In multiple logistic regression analysis, independent risk factors of death were as follows; systolic blood pressure, diastolic blood pressure, blood glucose, AST, urine glucose, urine protein, alcohol drinking(frequency), cigarette smoking and perceived health status, intake of restoratives and blood transfusion showed positive associations with death; coffee consumption showed negative associations with death; and body mass index and serum total cholesterol showed J-shaped association with death. CONCLUSIONS: Regarding the direction of association, the result of analysis on the data restricted to '96-'97 was same as that of '93-'97. But in some variables such as obesity, serum cholesterol, the odds ratios of death in the data of '96-'97 were higer than those of '93-'94, which suggested that the data of '93-'94 was bearing effect-cause relationship. We concluded that it suggested further researches using long-term follow-up data to be needed in this area.; Summary

A Distribution of Waist-hip Ratio Associated with the Blood Pressure in Middle-aged Men.: Jong Myon Bae, Dae Sung Kim, Jaiyong Kim, Yoon Ok Ahn; Korean J Prev Med. 1999;32(3):395-399.

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Abstract PDF: BACKGROUND
Excess abdominal fat, expressed as an increased ratio of waist to hip circumferences (WHR), is independently associated with higher levels of blood pressure. Although a WHR greater than 1.0 in men has been shown to predict complications from obesity, the WHR has not been evaluated in all ethnic groups. METHODS: In order to ascertain the association between WHR and classification of blood pressure and to investigate the critical value of WHR as a predictive factor of hypertension in Korean middle-aged men, we compared the mean of WHRs according to the classification of blood pressure in Seoul Cohort participants. RESULTS: Through a survey of direct measurement of waist and hip girth, 452 subjects were recruited from the cohort. The mean of WHR was 0.88 and its standard deviation was 0.04. The mean of WHRs was higher in the systolic blood pressure group (above 140 mmHg), diastolic blood pressure group (above 90 mmHg), and hypertension group than in the systolic blood pressure group (below 140 mmHg), diastolic blood pressure group (below 90 mmHg), and normotensive group, respectively. And WHR of above 0.89 was associated with hypertension (z-value =6.66). CONCLUSIONS: It is necessary for Korean males with WHR greater than 0.89 to recommend the primary prevention and early detection of hypertension.; Summary

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