Journal of Preventive Medicine and Public Health

Volume 43(1); January 2010

Research Support, Non-U.S. Gov'ts

Relationship Between Serum Concentrations of Organochlorine Pesticides and Metabolic Syndrome Among Non-Diabetic Adults.: Sun Kyun Park, Hyo Kyung Son, Sung Kook Lee, Jung Ho Kang, Yoon Seok Chang, David R Jacobs, Duk Hee Lee; J Prev Med Public Health. 2010;43(1):1-8.; DOI: https://doi.org/10.3961/jpmph.2010.43.1.1

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OBJECTIVES
This study was performed to investigate if organochlorine pesticides (OCPs) were associated with metabolic syndrome and insulin resistance among non-diabetes. METHODS: Among subjects who participated in a community-based health survey, 50 non-diabetic subjects with metabolic syndrome and 50 normal controls were selected. Insulin resistance was measured by the homeostasis model assessment (HOMA-IR). Eight OCPs were selected. RESULTS: After adjusting for confounders except for body mass index (BMI), beta-hexachlorocyclohexane (beta-HCH) and heptachlor epoxide were positively associated with metabolic syndrome. Odds ratios across tertiles of beta-HCH and heptachlor epoxide were 1.0, 3.2 and 4.4, and 1.0, 4.0 and 6.0, respectively (p for trend = 0.01 and <0.01). After additional adjustment for body mass index (BMI), heptachlor epoxide still showed an increasing trend with adjusted odds ratios of 1.0, 4.1, and 4.6 (p for trend = 0.10). When the five components of metabolic syndrome (with the definition of high fasting glucose (> or =100 mg/dL)) were separately analyzed, all components were positively, but not significantly, associated with heptachlor epoxide. As the serum concentration of heptachlor epoxide increased, HOMA-IR increased significantly in subjects with metabolic syndrome even after adjusting for BMI (p value <0.05 and <0.01). CONCLUSIONS: Despite the small sample size, this study suggests that the background exposure to some OCPs may be associated with metabolic syndrome.

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The Validity and Reliability of a Screening Questionnaire for Parkinson's Disease in a Community.: Jong Hun Kim, Hae Kwan Cheong, Chong Sik Lee, Sung Eun Yi, Kun Woo Park; J Prev Med Public Health. 2010;43(1):9-17.; DOI: https://doi.org/10.3961/jpmph.2010.43.1.9

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OBJECTIVES
Parkinson's disease is one of the most common neurodegenerative diseases in the elderly population. In order to estimate the prevalence of Parkinson's disease in the community, the application of a good screening tool is essential. We evaluated the validity and reliability of a Parkinson's disease screening questionnaire and propose an alternative measure to improve its validity for use in community surveys. METHODS: We designed the study in a three-phase approach consisting of a screening questionnaire, neurologic examination, and confirmatory examination. A repeated survey was administered to patients with disease detected in the community and on 150 subjects. We examined internal consistency using Cronbach's alpha test, test-retest reliability using the kappa statistic, and validity using sensitivity, specificity, and ROC curves. Unadjusted odds ratios were utilized for the estimation of weights for each questionnaire item. RESULTS: The Cronbach's alpha of the questionnaire was 0.708. The kappa statistic for test-retest reliability was good to generally fair in most of the items. When newly proposed weighting scores were used, the optimum cut-off value was 7/8. When cut-off value was 5/6 for surveying prevalence in a community, the sensitivity was 0.98, and the specificity was 0.61, with simultaneous improvement in reliability. CONCLUSIONS: We recommend 5/6 as the ideal cut-off value for the survey of PD prevalence in community. This questionnaire designed for the Korean community could help future epidemiologic studies of PD.

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English Abstracts

Association Between Gamma-Glutamyltransferase and Hypertension Incidence in Rural Prehypertensive Adults.: Jun Hyun Hwang, Ji Yeon Shin, Byung yeol Chun, Duk Hee Lee, Keon Yeop Kim, Wee hyun Park, Shung chull Chae; J Prev Med Public Health. 2010;43(1):18-25.; DOI: https://doi.org/10.3961/jpmph.2010.43.1.18

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OBJECTIVES
Prehypertension is associated with a higher risk of developing hypertension compared with normotension. Yet, factors predicting the development of hypertension among prehypertensive people are ill-understood. This prospective cohort study was performed to examine if serum gamma-glutamyltrasferase (GGT) within a normal range can predict the future risk of hypertension among prehypertensive adults. METHODS: Study subjects were 293 prehypertensive persons >30-years-of-age who participated in a community-based health survey in 2003 and who were followed up in 2008. Sex-specific quartiles of baseline serum GGT were used to examine association with 5-year hypertension incidence. RESULTS: Baseline serum GGT within normal range predicted the risk of developing hypertension for 5 years only in prehypertensive women. Adjusted relative risks were 1.0, 3.7, 3.6, and 6.0 according to quartiles of baseline serum GGT (P for trend <0.01). This pattern was similarly observed in non-drinkers. However, serum GGT was not associated with incident hypertension in men. Different from serum GGT, baseline serum alanine aminotransferase, another well-known liver enzyme, did not predict the risk of incident hypertension in both genders. CONCLUSIONS: Even though baseline serum GGT within normal range strongly predicted the future risk of hypertension, it was observed only in women, Although underlying mechanisms of this association are currently unclear, serum GGT can be used to select a high risk group of hypertension in prehypertensive women.

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Gamma-glutamyltransferase and risk of hypertension
Setor K. Kunutsor, Tanefa A. Apekey, Bernard M.Y. Cheung
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Cun-Fei Liu, Yu-Ting Gu, Hai-Ya Wang, Ning-Yuan Fang, Antony Bayer
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Association between γ-glutamyltransferase and prehypertension
XUZHEN QIN, GUODONG TANG, LING QIU, TAO XU, XINQI CHENG, SHAOMEI HAN, GUANGJIN ZHU, YAJUN LIU
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Impact of Shared-Decision Making on Patient Satisfaction.: Won S Suh, Chae Kyung Lee; J Prev Med Public Health. 2010;43(1):26-34.; DOI: https://doi.org/10.3961/jpmph.2010.43.1.26

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OBJECTIVES
The purpose of this research is to analyze the impact of shared-decision making on patient satisfaction. The study is significant since it focuses on developing appropriate methodologies and analyzing data to identify patient preferences, with the goals of optimizing treatment selection, and substantiating the relationship between such preferences and their impact on outcomes. METHODS: A thorough literature review that developed the framework illustrating key dimensions of shared decision making was followed by a quantitative assessment and regression analysis of patient-perceived satisfaction, and the degree of shared-decision making. RESULTS: A positive association was evident between shared-decision making and patient satisfaction. The impact of shared decision making on patient satisfaction was greater than other variable including gender, education, and number of visits. CONCLUSIONS: Patients who participate in care-related decisions and who are given an explanation of their health problems are more likely to be satisfied with their care. It would benefit health care organizations to train their medical professionals in this communication method, and to include it in their practice guidelines.

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The Medical Use of the Disabled Among Overusers of Medical Aid in Korea.: Sun Mi Shin, Eui Sook Kim, Chang Ki Park, Hee Woo Lee; J Prev Med Public Health. 2010;43(1):35-41.; DOI: https://doi.org/10.3961/jpmph.2010.43.1.35

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OBJECTIVES
In Korea, the top 10% of Medical Aid recipients represent nearly 60% of total payment, with the costs for those disabled for over 365 days representing approximately 30% of total payment. The purpose of this study was to compare Medical Aid use of the disabled with non-disabled recipients, and to identify contributing factors to the total payment in the top 2% of recipients identified as Medical Aid overusers. METHODS: Subjects (n=2,211) selected were > or =18-years-of-age and received >1000 days of co-payment-free type I Medical Aid. Case managers (n=200) conducted interviews in December 2006, and collected data from Health Insurance Review & Assessment Service. Amounts over the 9 months from January September 2006 were analyzed descriptively and using Chi-square, ANCOVA, and robust multiple linear regression. RESULTS: Disabled individuals (mean age 61.3 years) composed 36.6% of subjects; 44.8% of the disabled were male. On a monthly basis per capita, the disabled group averaged 10.5 outpatient days, total payment of 523,000 Korean Won(won), inpatient payment of 359,000won, and outpatient payment of 183,000won. All values exceeded the monthly average for non-disabled individuals. Contributing factors were identified as male gender (82,000won), elementary school or lower educational level (64,000won), residence in a small city (82,000won), lack of family support (61,000won), kidney disability (673,000won), intellectual disability (151,000won), and multiple disabilities (119,000won). CONCLUSIONS: The identification of contributing factors to Medical Aid use by those defined as disabled supports the adoption of comprehensive alternative policies such as strengthening of education and consultation services, provision of alternative facilities, and promotion of self-care.

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Young Dae Kwon, Hyejung Chang, Youn Jung Choi, Sung Sang Yoon
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Multilevel Analysis of Health Care Service Utilization among Medical Aid Beneficiaries in Korea
Yang Heui Ahn, Ok Kyung Ham, Soo Hyun Kim, Chang Gi Park
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Factors Associated With the Overuse or Underuse of Health Care Services Among Medical Aid Beneficiaries in Korea
Yang Heui Ahn, Eui Sook Kim, Ok Kyung Ham, Soo Hyun Kim, Seung Sik Hwang, Sang Hee Chun, Na Yeon Gwon, Jin Yi Choi
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Comparative Study on Three Algorithms of the ICD-10 Charlson Comorbidity Index with Myocardial Infarction Patients.: Kyoung Hoon Kim; J Prev Med Public Health. 2010;43(1):42-49.; DOI: https://doi.org/10.3961/jpmph.2010.43.1.42

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Abstract PDF

OBJECTIVES
To compare the performance of three International Statistical Classification of Diseases, 10th Revision translations of the Charlson comorbidities when predicting in-hospital among patients with myocardial infarction (MI). METHODS: MI patients > or =20 years of age with the first admission during 2006 were identified(n=20,280). Charlson comorbidities were drawn from Heath Insurance Claims Data managed by Health Insurance Review and Assessment Service in Korea. Comparisions for various conditions included (a) three algorithms (Halfon, Sundararajan, and Quan algorithms), (b) lookback periods (1-, 3- and 5-years), (c) data range (admission data, admission and ambulatory data), and (d) diagnosis range (primary diagnosis and first secondary diagnoses, all diagnoses). The performance of each procedure was measured with the c-statistic derived from multiple logistic regression adjusted for age, sex, admission type and Charlson comorbidity index. A bootstrapping procedure was done to determine the approximate 95% confidence interval. RESULTS: Among the 20,280 patients, the mean age was 63.3 years, 67.8% were men and 7.1% died while hospitalized. The Quan and Sundararajan algorithms produced higher prevalences than the Halfon algorithm. The c-statistic of the Quan algorithm was slightly higher, but not significantly different, than that of other two algorithms under all conditions. There was no evidence that on longer lookback periods, additional data, and diagnoses improved the predictive ability. CONCLUSIONS: In health services study of MI patients using Health Insurance Claims Data, the present results suggest that the Quan Algorithm using a 1-year lookback involving primary diagnosis and the first secondary diagnosis is adequate in predicting in-hospital mortality.

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Socioeconomic Inequity in Self-Rated Health Status and Contribution of Health Behavioral Factors in Korea.: Minkyung Kim, Woojin Chung, Seungji Lim, Soojin Yoon, Jakyoung Lee, Eunkyung Kim, Lanju Ko; J Prev Med Public Health. 2010;43(1):50-61.; DOI: https://doi.org/10.3961/jpmph.2010.43.1.50

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Abstract PDF

OBJECTIVES
The study is investigated socioeconomic variations in self-rated health status and contribution of health behavioral factors in Korea. METHODS: A nationally representative sample (2,800 men and 3,230 women aged 20-64 years) from the 2005 Korea National Health and Nutrition Surveys was analyzed using logistic regression. RESULTS: Self-rated health was lower among lower socioeconomic groups compared with higher socioeconomic groups, with gender being irrelevant. This association was attenuated when health behavioral and socio-demographic factors were adjusted. When each health behavioral factor was considered separately, mediators such as smoking in men, and stress or exercise in women explained a large part of the decreased socioeconomic health inequalities. CONCLUSIONS: In Korea, subjective health inequalities arise from different socioeconomic status, but this difference is decreased by health behavioral factors. Therefore, socioeconomic inequity in self-rated health status can be corrected more effectively by promotional health behaviors.

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Factors Associated with Cancer Screening Intention in Eligible Persons for National Cancer Screening Program.: Rock Bum Kim, Ki Soo Park, Dae Yong Hong, Cheol Heon Lee, Jang Rak Kim; J Prev Med Public Health. 2010;43(1):62-72.; DOI: https://doi.org/10.3961/jpmph.2010.43.1.62

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Abstract PDF

OBJECTIVES
To identify factors associated with cancer screening intention using the Theory of Planned Behavior (TPB). METHODS: Among 55,920 eligible persons for National Cancer Screening Program (NCSP) in J city, 1,100 individuals were contacted. Of these, 797 were interviewed using a structured questionnaire. Thirty-six responses were excluded due to incomplete data. The remaining 761 completed questionnaires were analyzed to find factors associated with cancer screening intention. RESULTS: Cancer screening intention was significantly associated with behavioral attitude (p<0.01) and subjective norm (p<0.01), but not with perceived behavioral control (p=0.29) in the TPB model. These three constructs explained 29.7% of cancer screening intention in multiple linear regression analysis. External factors such as socio-demographic status, health and health behavior variables explained 8.9% of screening intention. Among them, household monthly income, past cancer screening experience, exercise and daily eating habit were significantly associated with screening intention. CONCLUSIONS: Cancer screening intention may be influenced by focusing attitude, subjective norm in TPB model and other external factors. However, further studies are warranted to identify factors influencing cancer screening intention and behavior.

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High Risk Groups in Health Behavior Defined by Clustering of Smoking, Alcohol, and Exercise Habits: National Heath and Nutrition Examination Survey.: Kiwon Kang, Joohon Sung, Chang yup Kim; J Prev Med Public Health. 2010;43(1):73-83.; DOI: https://doi.org/10.3961/jpmph.2010.43.1.73

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Abstract PDF

OBJECTIVES
We investigated the clustering of selected lifestyle factors (cigarette smoking, heavy alcohol consumption, lack of physical exercise) and identified the population characteristics associated with increasing lifestyle risks. METHODS: Data on lifestyle risk factors, sociodemographic characteristics, and history of chronic diseases were obtained from 7,694 individuals > or =20 years of age who participated in the 2005 Korea National Health and Nutrition Examination Survey (KNHANES). Clustering of lifestyle risks involved the observed prevalence of multiple risks and those expected from marginal exposure prevalence of the three selected risk factors. Prevalence odds ratio was adopted as a measurement of clustering. Multiple correspondence analysis, Kendall tau correlation, Man-Whitney analysis, and ordinal logistic regression analysis were conducted to identify variables increasing lifestyle risks. RESULTS: In both men and women, increased lifestyle risks were associated with clustering of: (1) cigarette smoking and excessive alcohol consumption, and (2) smoking, excessive alcohol consumption, and lack of physical exercise. Patterns of clustering for physical exercise were different from those for cigarette smoking and alcohol consumption. The increased unhealthy clustering was found among men 20-64 years of age with mild or moderate stress, and among women 35-49 years of age who were never-married, with mild stress, and increased body mass index (>30 kg/m2). CONCLUSIONS: Addressing a lack of physical exercise considering individual characteristics including gender, age, employment activity, and stress levels should be a focus of health promotion efforts.

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Patterns of Unintentional Domestic Injuries in Korea.: Eun Jung Lee, Jin Seok Lee, Yoon Kim, Kunhee Park, Sang Jun Eun, Soo Kyung Suh, Yong Ik Kim; J Prev Med Public Health. 2010;43(1):84-92.; DOI: https://doi.org/10.3961/jpmph.2010.43.1.84

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Abstract PDF

OBJECTIVES
To investigate the patterns of unintentional home injuries in Korea. METHODS: The study population was 12,382,088 people who utilized National Health Insurance services due to injuries (main diagnosis codes S00 to T28) during 2006. Stratified samples(n=459,501) were randomly selected by sex, age group and severity of injury. A questionnaire was developed based on the International Classification of External Causes of Injury and 18,000 cases surveyed by telephone were analyzed after being projected into population proportionately according to the response rates of their strata. Domestic injury cases were finally included. RESULTS: Domestic injuries (n=3,804) comprised 21.1% of total daily life injuries during 2006. Women were vulnerable to home injuries, with the elderly and those of lower income (medical-aid users) tending to suffer more severe injuries. Injury occurred most often due to a slipping fall (33.9%), overexertion (15.3%), falling (9.5%) and stumbling (9.4%), with severe injury most often resulting from slipping falls, falls and stumbles. Increasing age correlated with domestic injury-related disability. CONCLUSIONS: The present findings provide basic information for development of home injury prevention strategies, with focus on the elderly.

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Editorial

Bringing Up-to-Date Public Health Research to Your Doorstep.: Yunhwan Lee; J Prev Med Public Health. 2010;43(1):93-94.; DOI: https://doi.org/10.3961/jpmph.2010.43.1.93

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Abstract PDF: No abstract available.; Summary

Published Erratums

Corrigendum.: Nirinjini Naidoo, Kee Seng Chia; J Prev Med Public Health. 2010;43(1):95-95.; DOI: https://doi.org/10.3961/jpmph.2010.43.1.95

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Abstract PDF: The authors regret that they incorrectly cited the name of one of the authors and the contact number of the corresponding author in the original publication. The name of the first author should have read: Nasheen Naidoo. The correct contact number of the corresponding author, Kee Seng Chia, is (65)6516-4971.; Summary

Erratum.: Sue K Park, Ji Yeob Choi; J Prev Med Public Health. 2010;43(1):96-97.; DOI: https://doi.org/10.3961/jpmph.2010.43.1.96

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Abstract PDF: There was an error in the numbering of the references in page 375-376: Sue K. Park, Ji-Yeob Choi. Risk Assessment and Pharmacogenomics in Molecular and Genomic Epidemiology. J Prev Med Public Health 2009; 42(6): 371-6.; Summary

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