Journal of Preventive Medicine and Public Health

Volume 35(3); August 2002

Original Articles

Maternal Working Conditions on Adverse Pregnancy Outcomes: A Prospective Cohort Study.: Jung Jin Cho, Ji Yong Kim, Jin Joo Chung, Kyung Sim Ko; Korean J Prev Med. 2002;35(3):197-204.

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To evaluate the association between working conditions and adverse pregnancy outcomes in Korea. METHODS: We obtained data on health history, lifestyle, housework and working conditions, such as shift work, hours standing, working time, job demand, lifting at work and at home, between August and September 2000, from self-reported questionnaires. A group of 344, occupationally active, pregnant women from 51 industries were studied. Of the women studied, 328 women were further interviewed by telephone between November 2000 and September 2001. Result : Compared with daytime work, shift work increased the risk for preterm birth (an adjusted risk ratio of 2.74, 95% CI=1.02-2.62) and low birth weight (an adjusted risk ratio of 2.74, 95% CI=1.02-2.62). A significantly increased risk was found for prolonged standing, with an adjusted risk ratio of preterm births of 6.80 (95% CI=2.01-23.0). There were no significant differences in the incidence of spontaneous abortion between the occupational working conditions, with the exception of a previous history of spontaneous abortion. CONCLUSION: These findings suggest that maternal working conditions, such as shift work and prolonged standing, contribute significantly to preterm birth and low birth weight.; Summary

Cohort Study for the Effect of Chronic Noise Exposure on Blood Pressure among Male Workers.: Ji Ho Lee, Tae Joon Cha, Jang Rak Kim, Weechang Kang, Seung Rim Yaang, Choong Ryeol Lee, Cheol In Yoo; Korean J Prev Med. 2002;35(3):205-213.

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Whether exposure to chronic noise induces an increase in blood pressure, or the development of hypertension, has not been established. A cohort study was performed to identify the effects of chronic noise exposure on blood pressure. METHODS: 530 males working at a metal manufacturing factory in Busan, Korea were enrolled for the study. They were monitored for 9 consecutive years, from 1991 to 1999, with an annual health check-up. The subjects were divided into 4 groups, which were determines by noise level categories(NLC) according to noise intensity ; NLC-I: office workers, exposed to noise a level below 60dB(A); NLC-II: field technical supporters or supervisors, frequently exposed to workplace noise, wearing no hearing protection device; NLC-III: workers, exposed to workplace noise below 85 dB(A), wearing ear plugs or muffs; NLC-IV: workers, exposed to workplace noise over 85 dB(A), wearing both ear plugs and muffs. RESULTS: After controlling possible confoundens, such as baseline age, smoking, alcohol intake, exercise, family history of hypertension, systolic(SBP) or diastolic blood pressure(DBP) and changes in BMI (body mass index), the pooled mean for the systolic blood pressures, over the duration of the study period, were 3.8mmHg, 2.0mmHg and 1.7mmHg higher in NLC-IV, NLC-III NLC-II groups, respectively, than in the NLC-I group. There were no significant differences in the diastolic blood pressures between the groups. CONCLUSION: This study suggests that chronic noise exposure increases systolic blood pressure independently, among male workers.; Summary

Relationship of Serum Uric Acid to Cardiovascular Risk Factors in Korean Male Workers.: So Yeon Ryu, Jong Gab Oh, Chul Gab Lee, Ki Soon Kim; Korean J Prev Med. 2002;35(3):214-220.

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To investigate the relationship of serum uric acid to cardiovascular risk factors in Korean male workers. METHODS: We screened 522 male workers at an electrical manufacturing company by a periodic health examination and a questionnaire survey in 2000. We collected data relating to age, smoking status, alcohol drinking status, body mass index (BMI), blood pressure, serum lipid, fasting blood glucose and serum uric acid. The data were analyzed using a variety of methods, including ANOVA, Pearson's correlation, and multivariate regression analyses, to examine the association between uric acid and cardiovascular risk factors with a cross-sectional study design. RESULTS: The concentration of serum uric acid showed positive associations with BMI, total cholesterol, triglyceride, and LDL-cholesterol; it was also significantly correlated to systolic and diastolic blood pressures. Life-style characteristics, such as smoking and alcohol drinking showed no significant association. From the multivariate regression analyses, BMI, total cholesterol and fasting blood glucose levels were found to be independent positive predictors of uric acid; while age, blood pressure and smoking status give no independent contribution explaining the variability of serum uric acid levels. Conclusions : This study demonstrates that serum uric acid level have a significant association with cardiovascular risk factors, such as BMI, total cholesterol and blood glucose in some Korean male workers.; Summary

The Protective Effects of Garlic against Carbon tetrachloride-induced Hepatotoxicity.: Byung Sun Choi, Jong Moon Lee, Jung Duck Park, Yeon Pyo Hong; Korean J Prev Med. 2002;35(3):221-228.

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The purpose of this study was to find the protective effects of garlic on the halogenated hydrocarbon induced hepatotoxicities, and the possible protection mechanisms involved. METHODS: Male Sprague-Dawley rats received garlic (0.5 %) or regular diet, for 4 weeks. This was followed by a single dose of corn oil (the controls), carbon tetrachloride (400mg/kg body weight) and trichloroethylene (2,000mg/kg body weight) being administered to each diet group. Blood samples were collected 24 hours following the administration, and the serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities measured. The liver samples were studied for their cytochrome P450 and CYP2E1 contents, lipid peroxidation and histopathology. RESULTS: The results for the group receiving the 0.5 % garlic diet showed a slight decrease of CYP2E1 expression compared with the regular diet group. Carbon tetrachloride was significantly decreased the CYP2E1 contents in both the regular and garlic diet groups, but the trichloroethylene remained unchanged. Garlic did not decrease the lipid peroxidation of the liver in the control group, but attenuated the increase of lipid peroxidation caused by carbon tetrachloride. Garlic attenuated the increase of both the serum AST and ALT activities caused by carbon tetrachloride. The histopathological observations also showed that garlic attenuated centrilobular necrosis and vacuolar degenerative changes significantly in the carbon tetrachloride treated group. Conclusions : The results indicate that garlic attenuates the carbon tetrachloride-induced hepatotoxicity, through the prevention of the metabolic activation and lipid peroxidation.; Summary

Effects of Ethanol and Phenobarbital on Hemoglobin Adducts Formation in Rats Exposed to Direct Black 38.: Chi Nyon Kim, Se Hoon Lee, Jaehoon Roh; Korean J Prev Med. 2002;35(3):229-235.

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To evaluate the effects on the formation of benzidine-hemoglobin, and benzidine metabolite-hemoglobin adducts, caused by pretreatment with the known xenobiotic metabolism effectors, ethanol and phenobarbital, in rats administered Direct Black 38 dye. METHODS: The experimental rats were divided into three groups: a control group, an ethanol group and a phenobarbital group. Rats were pretreated with ethanol (1g/kg) or phenobarbital (80mg/kg) 24 hours prior to the oral administration of Direct Black 38 (0.5mmol/kg), with the control group being administered the same amount of distilled water. Blood samples were obtained from the vena cava of 5 rats from each group prior to, and at 30 min, 3 h, 6 h, 9 h, 12 h, 24 h, 48 h, 72 h, 96 h, and 144 h following the oral administration of Direct Black 38. Directly after sampling the blood was separated into hemoglobin and plasma, with the adducts being converted into aromatic amines by basic hydrolysis. Hydrolyzed benzidiene, monoacetylbenzidine and 4-aminobiphenyl were analyzed by reverse-phase liquid chromatography with an electrochemical detector. The quantitative amount of the metabolites was expressed by the hemoglobin binding index (HBI). RESULTS: In the ethanol group, benzidine-, monoacetylben-zidine-, and 4-aminobiphenyl-HBI were increased to a greater extent than those in the control group. These results were attributed to the ethanol inducing N-hydroxylation, which is related to the formation of the hemoglobin adduct. In the phenobarbital group, all the HBIs, with the exception of the benzidine-HBI, were increased to a greater extent than those of the control group. These results were attributed to the phenobarbital inducing N-hydroxylation related to the formation of the hemoglobin adduct. The N-acetylation ratio was only increased with the phenobarbital pretreatment due to the lower benzidine-HBI of the phenobarbital group compared to those of the control and ethanol groups. The N-acetylation ratios for all groups were higher than 1 for the duration of the experimental period. Although the azo reduction was unaffected by the ethanol, it was inhibited by the phenobarbital. The ratio of the benzidine-HBI in the phenobarbital group was lower than those of the ethanol the control groups for the entire experiment. CONCLUSION: Our results indicate that both ethanol and phenobarbital increase the formation of adducts by the induction of N-hydroxylation, but also induced N-acetylation. Phenobarbital decreased the formation of benzidine-HBI due to the decrease of the azo reduction. These results suggest that the effects of ethanol and phenobarbital need to be considered in the biochemical monitoring of Direct Black 38.; Summary

The Causality among the Internal Customer Satisfaction, the External Customer Satisfaction and the Customer Loyalty of Medical Service.: Sookyung Paik; Korean J Prev Med. 2002;35(3):236-244.

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To empirically investigate the relationship of internal and external customer satisfactions, service quality, and customer loyalty in medical services. METHODS: This essay proposes an integrated model to explain the causality of internal and external customer satisfactions, service quality, and customer loyalty. To this end, a structural model was developed, consisting of the following factors: internal and external customer satisfactions, service quality, and customer loyalty. The study included 214 sets of data, with 107 sets being collected for both out-patients and in-patients. The data were analyzed using AMOS 4.0. RESULTS: We found the greater the internal customer satisfaction, the greater the out-patient quality of service quality. Secondly, the greater the service quality, the greater the external customer satisfaction of both in- and out-patients. The service quality of doctors, compared to that of the nurses, had a greater effect on external customer satisfaction. Thirdly, the service quality of doctors and nurses affected both internal and external customer satisfactions, which ultimately affected the customer loyalty. Finally the greater the external customer satisfaction, the greater the customer loyalty. CONCLUSION: This study confirms the positive relationship among the internal and external customer satisfactions, service quality, and customer loyalty, which proves the doctors quality of service is the primary factor for external satisfaction, and customer loyalty relating to medical services.; Summary

H2 Receptor Antagonists and Gastric Cancer in the Elderly: A Nested Case-Control Study.: Yooni Kim, Dae Seog Heo, Seung Mi Lee, Kyoung Eun Youn, Hye Won Koo, Jong Myon Bae, Byoung Joo Park; Korean J Prev Med. 2002;35(3):245-254.

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To test if the intake of H2 receptor antagonists (H2-RAs) increases the risk of gastric cancer in the elderly. METHODS: The source population for this study was drawn from the responders to a questionnaire survey administered to the Korea Elderly Pharmacoepidemiological Cohort (KEPEC), who were beneficiaries of the Korean Medical Insurance Corporation, were at least 65 years old, and residing in Busan in 1993. The information on H2-RAs exposure was obtained from a drug prescription database compiled between Jan. 1993 and Dec. 1994. The cases consisted of 76 gastric cancer patients, as confirmed from the KMIC claims data, the National Cancer Registry and the Busan Cancer Registry. The follow-up period was from Jan. 1993 to Dec. 1998. Cancer free controls were randomly selected by 1:4 individual matching, which took in to consideration the year of birth and gender. Information on confounders was collected by a mail questionnaire survey. The odds ratios, and their 95% confidence intervals, were calculated using a conditional logistic regression model. RESULTS: After adjusting for a history of gastric ulcer symptoms, medication history, and body mass index, the adjusted OR (aOR) was 4.6 (95% CI=1.72-12.49). The odds ratio of long term use (more than 7 days) was 2.3 (95% CI=1.07-4.82). The odds ratio of short term use was 4.6 (95% CI=1.26-16.50). The odds ratio of parenteral use was 4.4 (95% CI=1.16-17.05) and combination use between the oral and parenteral routes (aOR, 16.8; 95% CI=1.21-233.24) had the high risk of gastric cancer. The aOR of cimetidine was 1.7 (95% CI=1.04-2.95). The aOR of ranitidine was 2.0 (95% CI=1.21-3.40). The aOR of famotidine was 1.7 (95% CI=0.98-2.80). CONCLUSION: The intake of H2-RAs might increase the risk of gastric cancer through achlorhydria in the elderly.; Summary

Serum Total Cholesterol Levels and Related Factors in a Rural Adult Population.: Soon Ki Ahn, Byung Yeol Chun, Sin Kam, Dae Gu Jin, Jong Yeon Kim; Korean J Prev Med. 2002;35(3):255-262.

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To investigate the total cholesterol levels and related factors in a rural adult population. METHODS: 3,207 adults( 1,272 men and 1,935 women) were examined in 1997. Their heights, weights, and fasting serum total cholesterol levels were measured, and their body mass indices were calculated. A questionnaire interviewing method was used to collect risk factor data. RESULTS: The mean value of total cholesterol were 190.5 mg/dl, and 198.8 mg/dl, and the age-adjusted prevalence rates for hypercholesterolemia (above 240 mg/dl) were 13.7% and 10.2%, in men and women, respectively. From simple analyses, age, educational level, coffee intake, amount of meat and food intake, waist circumference, waist-hip circumference ratio(WHR), and body mass index(BMI) were significant risk factors in men (p<0.05) relating to serum total cholesterol levels. In women, age, educational level, hypertension history, diabetes history, herbal drug history, amount of food intake, alcohol consumption, waist circumference, WHR, BMI, and menopausal status were significant risk factors (p<0.05). In multiple linear regression analyses, waist circumference (p<0.01), BMI (p<0.01), and coffee intake (p<0.05) proved to be significant risk factors in men. Whereas, menopausal status (p<0.01), BMI (p<0.01), herbal drug history (p<0.01), amount of food intake (p<0.05), waist circumference (p<0.05), and alcohol consumption (p<0.05) were significant risk factors in women. Conclusions : The significant risk factors, for both men and women, relating to the serum total cholesterol were waist circumference and BMI. Thus, for the reduction of serum total cholesterol level, it is recommended that health education for the control of obesity should be implemented.; Summary

Estimation of Joint Risks for Developing Uterine Cervix Cancer in Korea.: Hachung Yoon, Aesun Shin, Sue Kyung Park, Myung Jin Jang, Keun Young Yoo; Korean J Prev Med. 2002;35(3):263-268.

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This study was aiming at estimating the joint effects of various risk factors associated with uterine cervix cancer in Korea. METHODS: Data obtained from a case-control study were analyzed with a multiplicative model. RESULTS: After adjustment for age and husband's educational attainments, the family history of cervical cancer (OR=2.1, 95% CI=1.2-3.9), unstable marital status due to separation, by death or divorce, etc. (OR=2.8, 95% CI=1.7-4.6), and a large number of deliveries (> or = 3 vs. nulliparous OR=6.5, 95% CI=1.4-29.9) increased the risk of uterine cervix cancer. Conversely, first sexual intercourse at an older age (> or = 25 years vs. <19 years OR=0.4, 95% CI=0.2-0.6) and husband's circumcision (OR=0.7, 95% CI=0.5-1.0) decreased the risk. In the multiplicative model, the highest joint risk (OR=39.2, 95% CI 5.9-258.9) was observed in women with a family history of uterine cervical cancer, an unstable marital status, where the ex-husband was not circumcised, with 3 or more delivery experiences, and having her first sexual intercourse when younger than 19 years of age. However, women without a family history of uterine cervix cancer, married to a circumcised husband, having had her first sexual intercourse at 25 years or older, and nulliparous, showed the lowest joint effect (OR=0.3, 95% CI=0.1-0.5). CONCLUSION: As carcinogenesis is a complex action involving various factors, we consider a joint effects approach to be appropriate in an epidemiological study on risk factors for uterine cervix neoplasms.cervix neoplasm.; Summary

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