Journal of Preventive Medicine and Public Health

Volume 38(3); August 2005

English Abstracts

Epidemiology and Social Epidemiology.: Yun Mi Song; J Prev Med Public Health. 2005;38(3):237-240.

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Abstract PDF: Social epidemiology is a sub-discipline of epidemiology explicitly investigating social determinants of population distributions of health, disease, and well-being. Persistent pattern of social inequalities in health in spite of the broad improvement in the physical environment over the last centuries necessitated the development of this field as an approach to understand disease etiology that incorporates social experiences as more direct determinant of health. Social epidemiology incorporates theories, measurement tools, and techniques from a wide variety of other social sciences. A population perspective, the social context of behavior, contextual multilevel analysis, a developmental and life-course perspective, and general susceptibility to disease are the most important guiding concepts in social epidemiology.; Summary

What is the Origin of Inequalities in Work and Health?.: Mi A Son; J Prev Med Public Health. 2005;38(3):241-251.

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Abstract PDF: There has been an enormous increasing trend of widening gap of social inequalities since economic crisis at the end of 1997 in Korea. Since then, Korean society has deteriorated in economic and social conditions; the unemployment rate, temporary or casual workers and absolute poverty have increased. This paper presents the origin of inequalities in work and health in Korea. The origin of inequalities in work begins with the relationship between the capitalist and labourers in the capitalist mode of production. The conception and execution are dissolved in the work process in the capitalist mode of production. Thus, captitalists become control over ther labour process from workers. An alienation of the work process from the workers. The distribution of work is the majour source if inequalities in many countries as well as Korea. This paper presents the increasing tendency of unhealthy states such as mortality, early death, morbidity, physical work load, workplace injury amongst the under-privileged: ordinary workers, unemployed people, casual workers and socially deprived people in Korea.; Summary

Health Policy and Social Epidemiology.: Young Jeon Shin; J Prev Med Public Health. 2005;38(3):252-258.

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Abstract PDF: Major approaches of Social epidemiology; 1) holistic, ecological approach, 2) population based approach, 3) development and life-course approach, 4) contextual multi-level approach, have stressed the importance of not only social context of health and illness, but also the population based strategy in the health interventions. Ultimately, it provides the conceptual guidelines and methodological tools to lead toward the healthy public policies; integrated efforts to improve condition which people live: secure, safe, adequate, and sustainable livelihoods, lifestyles, and environments, including housing, education, nutrition, information exchange, child care, transportation, and necessary community and personal social and health services.; Summary

Neighborhood Characteristics and Individual Health under Korean Context.: Sung Won Jung, Young Tae Cho; J Prev Med Public Health. 2005;38(3):259-266.

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Abstract PDF: Recently much attention has been paid to the effect of neighborhood characteristics on the health of individuals, independent of individual demographic and/or socioeconomic characteristics. Although many empirical studies of a kind, mostly based on Western society, have appeared on various international journals, few studies have shown empirical evidence of neighborhood characteristics as an independent and significant risk factor of ill health in Korea. This paper discusses possible reasons that neighborhood seems to be neither significant nor substantial regarding its impact on the health of Koreans. Addressing the uniqueness of Korean society regarding the concept of neighborhood, attributes of neighborhoods, and methodological challenges, authors suggest that more sophisticated conceptual and methodological approach, specific to Korean society, should enable to reveal the effect of neighborhood characteristics on individual health in Korea.; Summary

Lifecourse Approaches to Socioeconomic Health Inequalities.: Young Ho Khang; J Prev Med Public Health. 2005;38(3):267-275.

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Abstract PDF: Evidence on the relation of socioeconomic position (SEP) with health and illness is mounting in South Korea. Several unlinked studies and individually linked studies (longitudinal study) showed a graded inverse relationship between SEP and mortality among South Korean males and females. Based on the mortality relative ratios by occupational class reported in the published papers of South Korea and western countries, the magnitude of the socioeconomic inequality in mortality in South Korea seems to be similar to or even greater than that in western industrialized countries. A potential contribution of health related selection, health behaviors and psychosocial factors to explain this socioeconomic inequality in mortality was discussed. It was suggested that early life exposure measures would demonstrate a greater ability to explain socioeconomic inequalities in all-cause mortality than the above pathway variables in South Korea. This is based on the cause-specific structure of mortality among the South Korean population who have a relatively greater proportion of stomach cancer, hemorrhagic stroke, liver cancer and liver disease, and tuberculosis, which share early life exposures as important elements of their etiology, than western countries. However, the relative contribution of early and later life socioeconomic conditions in producing socioeconomic inequality in health may differ according to the outcome, thus remains to be investigated.; Summary

Validation Studies

Comparing the Performance of Three Severity Scoring Systems for ICU Patients: APACHE III, SAPS II, MPM II.: Eun Kyung Kim, Young Dae Kwon, Jeong Hae Hwang; J Prev Med Public Health. 2005;38(3):276-282.

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Abstract PDF: OBJECTIVE
To evaluate the predictive validity of three scoring systems; the acute physiology and chronic health evaluation (APACHE) III, simplified acute physiology score (SAPS) II, and mortality probability model (MPM) II systems in critically ill patients. METHODS: A concurrent and retrospective study conducted by collecting data on consecutive patients admitted to the intensive care unit (ICU) including surgical, medical and coronary care unit between January 1, 2004, and March 31, 2004. Data were collected on 348 patients consecutively admitted to the ICU (aged 16 years or older, no transfer, ICU stay at least 8 hours). Three models were analyzed using logistic regression. Discrimination was assessed using receiver operating characteristic (ROC) curves, sensitivity, specificity, and correct classification rate. Calibration was assessed using the Lemeshow-Hosmer goodness of fit H-statistic. RESULTS: For the APACHE III, SAPS II and MPM II systems, the area under the receiver operating characterist ic (ROC) curves were 0.981, 0.978, and 0.941 respectively. With a predicted risk of 0.5, the sensitivities for the APACHE III, SAPS II, and MPM II systems were 81.1, 79.2 and 71.7%, the specificities 98.3, 98.6, and 98.3%, and the correct classification rates 95.7, 95.7, and 94.3%, respectively. The SAPS II and APACHE III systems showed good calibrations (chi-squared H=2.5838 p=0.9577 for SAPS II, and chi-squared H=4.3761 p=0.8217 for APACHE III). CONCLUSIONS: The APACHE III and SAPS II systems have excellent powers of mortality prediction, and calibration, and can be useful tools for the quality assessment of intensive care units (ICUs).; Summary

Comparative Study

The Impact of High Apparent Temperature on the Increase of Summertime Disease-related Mortality in Seoul: 1991-2000.: Gwang yong Choi, Jong nam Choi, Ho Jang Kwon; J Prev Med Public Health. 2005;38(3):283-290.

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Abstract PDF: OBJECTIVE
The aim of this paper was to examine the relationship between the summertime (June to August) heat index, which quantifies the bioclimatic apparent temperature in sultry weather, and the daily disease-related mortality in Seoul for the period from 1991 to 2000. METHODS: The daily maximum (or minimum) summertime heat indices, which show synergetic apparent temperatures, were calculated from the six hourly temperatures and real time humidity data for Seoul from 1991 to 2000. The disease-related daily mortality was extracted with respect to types of disease, age and sex, etc. and compared with the time series of the daily heat indices. RESULTS: The summertime mortality in 1994 exceeded the normal by 626 persons. Specifically, blood circulation-related and cancer-related mortalities increased in 1994 by 29.7% (224 persons) and 15.4% (107 persons), respectively, compared with those in 1993. Elderly persons, those above 65 years, were shown to be highly susceptible to strong heat waves, whereas the other age and sex-based groups showed no significant difference in mortality. In particular, a heat wave episode on the 22nd of July 2004 (> 45 degree C daily heat index) resulted in double the normal number of mortalities after a lag time of 3 days. Specifically, blood circulation-related mortalities, such as cerebral infraction, were predominant causes. Overall, a critical mortality threshold was reached when the heat index exceeded approximately 37 degrees C, which corresponds to human body temperature. A linear regression model based on the heat indices above 37 degrees C, with a 3 day lag time, accounted for 63% of the abnormally increased mortality (> or = +2 standard deviations). CONCLUSIONS: This study revealed that elderly persons, those over 65 years old, are more vulnerable to mortality due to abnormal heat waves in Seoul, Korea. When the daily maximum heat index exceeds approximately 37 degrees C, blood circulation-related mortality significantly increases. A linear regression model, with respect to lag-time, showed that the heat index based on a human model is a more dependable indicator for the prediction of hot weatherrelated mortality than the ambient air temperature.; Summary

English Abstract

Distribution of Calcaneal Bone Density According to the Mechanical Strain of Exercise and Calcium Intake in Premenarcheal Girls.: Eun Kyung Shin, Ki Suk Kim, Hee Young Kim, In Sook Lee, Hyo Jee Joung, Sung Il Cho; J Prev Med Public Health. 2005;38(3):291-297.

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Abstract PDF: OBJECTIVE
The effects of exercise on bone density have been found to be inconsistent in previous studies. We conducted a cross-sectional study in premenarcheal girls to test two hypotheses to explain these inconsistencies. Firstly, "the intensity of mechanical strain, in terms of the ground reaction force (GRF), has more important effects on the bone mass at a weight-bearing site", and secondly, "calcium intake modifies the bone response to exercise". METHODS: The areal bone mineral density was measured at the Os calcis, using peripheral dual energy X-ray absorptiometry, in 91 premenarcheal girls aged between 9 and 12 years. The intensity of mechanical strain of exercise was assessed by a self-report questionnaire and scored by the GRF as multiples of body weight, irrespective of the frequency and duration of exercise. The energy and calcium intake were calculated from the 24-hour dietary recall. An analysis of covariance (ANCOVA) was used to determine the interaction and main effects of exercise and calcium on the bone density, after adjusting for age, weight, height and energy intake. RESULTS: The difference in the bone density between moderate and low impact exercise was more pronounced in the high than low calcium intake group. The bone density for moderate impact exercise and high calcium intake was significantly higher than that for low impact exercise (p=0.046) and low calcium intake, after adjusting for age, weight, height and energy intake. CONCLUSIONS: Our study suggests that the bone density at a weight-bearing site is positively related to the intensity of mechanical loading exercise, and the calcium intake may modify the bone response to exercise at the loaded site in premenarcheal girls.; Summary

Validation Studies

Development of Internet Addiction Measurement Scales and Korean Internet Addiction Index.: Jae Sung Park; J Prev Med Public Health. 2005;38(3):298-306.

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Abstract PDF: OBJECTIVE
To develop measurement scales of Internet addiction, and propose a Korean Internet Addiction Index (K-IAI) and classification criteria for Internet addiction from the threshold scores developed. METHODS: The identification of the concept of "Internet addiction" was based on the literature review. To select the scales, an exploratory factor analysis was applied. A construct validation was tested by a confirmatory factor analysis (CFA) with a structured equation model (SEM). In testing the validity of the classification criteria, ANOVA and non-recursive models with SEM were applied. RESULTS: Out of 1, 080 questionnaires distributed, 1, 037 were returned, ; a response rate of 96%. The Cronbach-alpha of all items was over 0.75. Using an exploratory factor analysis in the condition of a 6 factor constrain as the study model proposed, 23 of the initial 28 items were identified. In testing the discriminant and convergent validity of the selected 23 scales using CFA with SEM, the Internet addiction model explained about 93% of all variances of the data collected, and all the latent variables significantly explained the designated scales. A K-IAI was proposed using the T-scores of the sum of all factor averages. In the classification of users, the basic concept was a two standard deviation approach of the K-IAI as the criteria of MMPI. The addiction group had a score > or = 70 in the K-IAI, the pre-addiction group between > or = 50 and < 70, and the average user group < 50. The Internet use times of the classified groups were statistically different in the ANOVA and multiple comparisons. CONCLUSIONS: The K-IAI is a reliable and valid instrument for measuring Internet addiction. Moreover, the taxonomy of the groups was also verified using various methods.; Summary

English Abstracts

Correlates of Problem Drinking by the Alcohol Use Disorders Identification Test on Korean College Campus.: Sung soo Chun, Ae ree Sohn; J Prev Med Public Health. 2005;38(3):307-314.

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Abstract PDF: OBJECTIVE
To survey college students with an Alcohol Use Disorder, and analyze the reasons for their disorder. METHODS: The cross-sectional study was conducted at 60 four-year colleges within Seoul and 9 other provinces. The schools and students selected for the study provide a nationally representative sample, and the survey was conducted between May 15th and June 14th 2003. 2, 385 cases were analyzed using questionnaires, which included a series of questions about students' alcohol use and associated problems, as well as an Alcohol Use Disorder Identification Test. RESULTS: 42.3% of students were found to have an Alcohol Use Disorder. The probability of a student having an Alcohol Use Disorder was 1.30 times higher among male compared to female students. Those students not living with their parents or relatives were 1.40 times more likely to have an Alcohol Use Disorder. Those students where the father had a drinking problem and those who admitted that their parents drank heavily while they were growing up were 1.38 and 1.54 times more likely, respectively, to have an Alcohol Use Disorder. Those students attending a general university, joining a student club, attaining less than a B average credit score and those unsatisfied with their education were 1.60, 1.36, 1.41 and 1.27 times more likely, respectively, to have an Alcohol Use Disorder. Those students who had experience of drugs, smoking, binge drinking when they were in the last year of high school and the forceful consumption of mixed alcohol were 3.67, 1.95, 2.15 and 1.76 times more likely, respectively, to have an Alcohol Use Disorder. CONCLUSIONS: College students' with an Alcohol Use Disorder is a very severe and large problem within colleges. An Alcohol Use Disorder is determined by individual and family variables, the college environmental and life variables, as well as behavior variables.; Summary

Mediating Role of Empowerment in the Relations to Job and Organizational Factors, and Job Satisfaction and Organizational Commitment: Empirical Evidence from National University Hospital Employees.: Bang Seob Yoon, Hae Jong Lee; J Prev Med Public Health. 2005;38(3):315-324.

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Abstract PDF: OBJECTIVE
The aim of this study was to examined the mediating role of empowerment in relations to job and organizational factors, and job satisfaction and organizational commitment in hospital organizations. METHODS: Job variety, clarity, significance, and fitness were examined as the job factors, and security, reward justice, and organizational support as the organizational factors. Data were collected from 8 national university hospitals with 1, 289 data points used for the final analysis. RESULTS: All the job factors were found to positively influence empowerment, as were all the organizational factors, with the exception of reward justice. As hypothesiz -ed, empowerment had significant effects on both job satisfaction and organizational commitment, and was the most influential variable of all those examined. CONCLUSIONS: In the relations to job satisfaction, empowerment completely mediated job significance, security and organizational support, and partially mediated all other variables, with the exception of reward justice. In the relations to organizational commitment, empowerment completely mediated job variety and job fitness, and partially mediated all other variables, with the exception of reward justice. The theoretical and practical implications of these results have been discussed.; Summary

The Association of High Sensitivity C-reactive Protein (hsCRP) with Hypertension in Some Rural Residents.: Young Seon Lee, So Yeon Ryu, Jong Park, Myeong Guen Kang, Ki Soon Kim; J Prev Med Public Health. 2005;38(3):325-329.

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Abstract PDF: OBJECTIVE
This study was performed to assess the association between high sensitivity C-Reactive Protein (hsCRP) and hypertension. METHODS: We evaluated the relationship between hsCRP with hypertension and other cardiovascular risk factors, using a cross-sectional survey of 202 people over the age of 50, living in a rural area. A logistic regression analysis was used to study the association between hsCRP and hypertension. The hsCRP levels were divided in quartiles, and the odds ratios (OR), with 95% confidence intervals (95% CI), calculated, using the lowest quartile as a reference. RESULTS: The subjects consisted of 37.1% men and 62.9% women, with a mean (SD) hsCRP level of 1.9 (+/-3.0) mg/l. The overall prevalence of hypertension was 61.4%. The prevalence of hypertension according to the hsCRP quartile was not statistically significant. After adjustment for confounding variables, the prevalence of hypertension according to the subjects in the 2nd, 3rd and 4th hsCRP quartiles were 1.418 (95% CI=0.554-3.628), 1.124 (95% CI=0.392-3.214) and 0.892 (95% CI=0.312-2.547) times higher, respectively, compared to those in the 1st quartile. CONCLUSIONS: The results showed that the level of hsCRP was not a risk factor for hypertension among adults aged over 50 years, living in a rural area. A further study should be performed to find the association between hsCRP and hypertension.; Summary

Effects of Bisphenol A on the Placental Function and Reproduction in Rats.: Chae Kwan Lee, Seog Hyun Kim, Deog Hwan Moon, Jeong Ho Kim, Byung Chul Son, Dae Hwan Kim, Chang Hee Lee, Hwi Dong Kim, Jung Won Kim, Jong Eun Kim, Chae Un Lee; J Prev Med Public Health. 2005;38(3):330-336.

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Abstract PDF: OBJECTIVE
The aim of this study was to investigate the effects of bisphenol A (BPA), an estrogen-like environmental endocrine disrupter, on the placental function and reproduction in rats. The mRNA levels of the placental prolactin-growth hormone (PRL-GH) gene family, placental trophoblast cell frequency and reproductive data were analyzed. METHODS: The pregnancies of F344 Fisher rats (160 g +/- 20 g) were detected by the presence of the copulatory plug or sperm in the vaginal smear, which marked Day 0 of pregnancy. Pregnant rats were divided into three groups. The control group was intraperitoneally injected with a sesame oil vehicle. The two remaining groups were injected with 50 or 500 mg/kg B.W/day of BPA, resuspended in sesame oil, on either days 7 to 11 or 16 to 20 of pregnancy, with the rats sacrificed on either day 11 or 20, respectively. The mRNA levels of PRL-GH and Pit-1a and b isotype genes were analyzed by Northern blot hybridization and reverse transcription-polymerase chain reaction. The hormone concentrations were analyzed by radioimmunoassay, and the frequency of the placental trophoblast cells observed by a histochemical study. Reproductive data, such as the placental weight and litter size, were surveyed on day 20. The fetal weight was surveyed for 4 weeks after birth. A statistical analysis was carried out using the SAS program (version 8.1). RESULTS: The mRNA levels of the PRL-GH gene family, such as placental lactogen I, Iv and II, prolactin like protein A, C and Cv, and decidual prolactin-related protein were significantly reduced due to BPA exposure. The mRNA levels of the Pit-1a and b isotype genes, which induce the expression of the PRL-GH gene family in the rat placenta, were also reduced due to BPA exposure. The PL-Iv and PL-II concentrations were reduced in the BPA exposed group. During the middle to last stage of pregnancy (Days 11-20), a high dose of BPA exposure reduced the frequency of spongiotrophoblast cells, which are responsible for the secretion of the PRL-GH hormones. Reproductive data, such as the placental and fetal weights and the litter size, were reduced, but that of the pregnancy period was extended in the BPA exposed compared to the control group. CONCLUSIONS: BPA disrupts the placental functions in rats, which leads to reproductive disorders.; Summary

Does Non-standard Work Affect Health?.: Il Ho Kim, Do myung Paek, Sung Il Cho; J Prev Med Public Health. 2005;38(3):337-344.

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Abstract PDF: OBJECTIVE
Job insecurity, such as non-standard work, is reported to have an adverse impact on health, regardless of health behaviors. The aim of this study was to examine the relationship between non-standard employment and health in Korea. METHODS: We analyzed a representative weighted sample, which consisted of 2, 112 men and 1, 237 women, aged 15-64, from the 1998 Korea National Health and Nutrition Examination Survey. Non-standard employment included part-time permanent, short time temporary and daily workers. Self-reported health was used as a health indicator. RESULTS: This study indicated that women were more likely to report poorer health than men with standard jobs. Of all employees, 20.3% were female manual workers. After adjusting for potential confounders, such as age, education, equivalent income, marital, social and selfreported economic status and health behavior factors, nonstandard employment was found to be significantly associated with poor health among female manual workers (OR, 1.86; 95% CI, 1.24 to 2.79). No significant association was found in other working groups. CONCLUSIONS: Among female manual workers, nonstandard employees reported significantly poorer health compared with standard workers. This result raises concern as there are increasing numbers of non-standard workers, particularly females.; Summary

Effects of Oxidative DNA Damage Induced by Polycyclic Aromatic Hydrocarbons and Genetic Polymorphism of the Paraoxonase-1 (PON1) Gene on Lung Cancer.: Chul Ho Lee, Kye Young Lee, Kang Hyeon Choe, Yun Chul Hong, Yong Dae Kim, Jong Won Kang, Heon Kim; J Prev Med Public Health. 2005;38(3):345-350.

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Abstract PDF: OBJECTIVE
Polycyclic aromatic hydrocarbons (PAHs), which are risk factors for lung cancer, have been reported to induce oxidative DNA damage. The paraoxonase (PON) plays a significant role in the detoxification of a variety of organophosphorous compounds, with paraoxonase-1 (PON1) being one of the endogenous free-radical scavenging systems in the human body. The aim of this case-control study was to investigate the effects of PAH exposure, oxidative stress and the Q192R polymorphism of PON1 genes, and their interactions in the carcinogenesis of lung cancer. METHODS: One hundred and seventy seven lung cancer patients and 177 age- and sex-matched controls were enrolled in this study. Each subject was asked to complete a questionnaire concerning their smoking habits and environmental exposure to PAHs. The Q192R genotypes of the PON1 gene was examined, and the concentrations of urinary 1-hydroxypyrene (1-OHP), 2-naphthol and 8- hydroxydeoxyguanosine (8-OH-dG) measured. RESULTS: Cigarette smoking was found to be a significant risk factor for lung cancer. The urinary 8-OH-dG level was higher in the patients, whereas the urinary 1-OHP and 2- naphthol levels were higher in the controls. There was a significant correlation between the urinary levels of 8-OHdG and 1-OHP in both the cases and controls. The PON1 polymorphism was associated with an increased risk of lung cancer. Individuals carrying the Q/Q genotype of the PON1 gene were found to be at higher risk of developing lung cancer. There was a significant correlation between the urinary levels of 8-OH-dG and 1-OHP in those with the PON1 Q/Q genotype. CONCLUSIONS: These results lead to the conclusion that PAHs would induce oxidative DNA damage, especially in individuals with the PON1 Q/Q genotype. Therefore, people with the PON1 Q/Q genotype would be more susceptible to lung cancer than those with the R/R or Q/R genotypes of the PON1 gene.; Summary

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