Awareness of the Prevention of Work-Related Diseases among Farmers - Based on Qualitative Research Methods / 農村醫學 地域保健

Objective@#This study was conducted to investigate the awareness of work-related disease prevention of farmers.Method: As a research method, a qualitative focus group interview was conducted in 18 participants. @*Results@#Prevention and management services for work-related diseases of farmers mostly are based on research from other fields and so are not highly effective because their content is not relevant to agricultural work. It has been suggested that such program designers be required to have some appropriate related knowledge, and that incentives and a certification system for participation in such education be established. To analyze work-related diseases of farmers, fields of prevention, diagnosis, treatment, and rehabilitation should be created. They demanded the designation of hospitals and the actualization of compensation for farmers' safety insurance. The work-related diseases to address were include musculoskeletal diseases, pesticide poisoning-related diseases (cardiovascular disease, respiratory disease), psychiatric diseases such as depression, and allergic diseases. However, this must have been the result of the harmful factors they felt during agricultural work. And for farmer patients diagnosed with work-related diseases, it was said to strengthen farmer safety insurance. @*Conclusion@#In order to increase the safely and health effects of agricultural work, it is necessary to prevent and manage work-related diseases of farmers. Projects should be developed in consideration of cultural and economic barriers of farmers and the characteristics of the work.

Associations between Frailty in Older Adults and Malnutrition in Rural Areas: 2019 Updated Version of the Asian Working Group for Sarcopenia

Purpose@#The purpose of this study was to evaluate the prevalence of frailty among an older adult population living in rural communities and to determine if frailty is associated with nutritional status after adjusting for sarcopenia and depression. @*Materials and Methods@#This research used baseline data from the Namgaram-2 study. Frailty was evaluated using the Kaigo-Yobo checklist in an older Korean population. The nutritional statuses of older people were measured using the Korean version of the mini nutritional assessment (MNA). The recent criteria of the Asian Working Group for Sarcopenia were applied for diagnosis of sarcopenia, and depression was assessed using the Geriatric Depression Scale-Short Form. @*Results@#The prevalence of frailty was 18.8% (male: 9.6%; female: 23.4%) and was significantly higher in individuals in their 80s [male, 35.3% (p<0.001); female, 42.3% (p<0.001)], those of poor economic status [male, 18.2% (p=0.012); female, 34.9% (p<0.001)], those with hypertension [female, 27.7% (p=0.008)], those with sarcopenia [male, 34.1% (p<0.001); female, 37.2% (p<0.001)], those with depression [male, 46.4% (p<0.001); female, 51.7% (p<0.001)], and those at high risk of malnutrition [male, 44.4% (p<0.001); female, 51.7% (p<0.001)]. After adjusting for demographic variables, including hypertension, diabetes, sarcopenia and depression, frailty was significantly associated with nutritional status [male: odds ratio (OR)=6.73, 95% confidence interval (CI), 1.84–24.65; female: OR=4.83, 95% CI, 2.88–8.11]. @*Conclusion@#For older adults, MNA is a suitable tool of use in assessing both nutritional status and frailty. Moreover, the nutritional status of older adults appears to be associated with frailty, even after corrections for physical and psychological function.

Barriers related to Walking Activity according to the Age Group of Rural residents / 農村醫學 地域保健

Objective@#This study aimed to report the relationship between walking activity and perceived physical activity barriers after classifying the age group(≤64, 65-74, ≥75). @*Methods@#The subjects were conducted on 1500 residents of two areas, and the walking activity was defined as five or more times a week, 10 minutes or more at a time, and 30 minutes or more per day. Perceived physical activity barriers were lack of time, lack of social support, lack of energy, lack of willpower, and fear of falling. @*Results@#In the group under 64 year, the lack of time (exp(B)=0.819, p=0.002) and the lack of willpower (exp(B)=0.656, p<0.001) were significantly associated. In the 65-74 year old group, the lack of willpower (exp(B)=0.714, p<0.001) and fear of falling (exp(B)=0.787, p=0.003) were a significant association. In the group aged 75 years and over, lack ofwill power (exp(B)=0.734, p<0.001) and fear of falling (exp(B)=0.807, p=0.003) were significantly associated. @*Conclusion@#In order to solve the lack of willpower and lack of time, a walking activity should be performed together at a certain time in the village, and the elderly in the late ages should reduce the fear of falling by performing a fall prevention exercise in parallel.

Validation of the Western Ontario and McMaster Universities Arthritis Index Short Form (WOMAC-SF) and Its Relevance to Disability and Frailty

PURPOSE: This study aimed to evaluate the validity of the Western Ontario and McMaster Universities Arthritis Index Short Form (WOMAC-SF) for the assessment of musculoskeletal disorders. We evaluated whether WOMAC-SF correlated with the World Health Organization Disability Assessment Schedule 12 (WHODAS-12) and Kaigo-Yobo questionnaires for assessing health-outcomes in Korea.MATERIALS AND METHODS: This cross-sectional study used data from the Namgaram-2 cohort. WOMAC, WOMAC-SF, WHODAS-12, and Kaigo-Yobo questionnaires were administered to patients with musculoskeletal disorders, including radiology-confirmed knee osteoarthritis (RKOA), sarcopenia, and osteoporosis. The relationships among WOMAC-SF, WHODAS-12, and Kaigo-Yobo scores were analyzed by stepwise multiple regression analysis.RESULTS: WOMAC-SF was associated with the WOMAC questionnaire. The results of confirmatory factor analysis for the hypothesized model with two latent factors, pain and function, provided satisfactory fit indices. WOMAC-SF pain and function were associated with RKOA. Kaigo-Yobo was associated with WOMAC-SF pain (B=0.140, p=0.001) and WOMAC-SF function (B=0.042, p=0.004). WHODAS-12 was associated with WOMAC-SF pain (B=0.679, p=0.003) and WOMAC-SF function (B=0.804, p<0.001).CONCLUSION: WOMAC-SF was validated for the evaluation of low extremity musculoskeletal disorders and health-related quality of life in a community-based population. Furthermore, we confirmed that WOMAC-SF were reflective of disability and frailty, which affect health outcomes.

Risk Assessment and Intervention of Ergonomic Risk Factor in Beekeeping / 農村醫學 地域保健

OBJECTIVES@#This study investigated musculoskeletal symptoms in upper limbs according to the working environment (job stress) of dental hygienists and examine their relationship with upper limb functions.@*METHODS@#The subjects include 198 dental hygienists in dental hospitals and dental clinics in Pusan and Gyeongnam. The questionnaire was consisted of general characteristics of the subjects, job stress, musculoskeletal symptoms in upper limbs and function (Disability Measurement Tool for Upper Extremity Disorders-11, DASH-11).@*RESULTS@#The study was analyzed their musculoskeletal symptoms in upper limbs according to their general characteristics and found that the symptoms occurred in the neck (39.4%), the shoulders (54.6%), elbows (14.7%), and the hands (50.0%). Job stress was associated with upper limb functions (DASH-11) (model 3, B=5.210, p=0.012) and repeated elbow bending and spreading posture was associated with DASH-11 (model 3, B=6.561, p=0.029). Elbow symptoms were associated with DASH-11 in the upper limbs (B=10.679, p=0.003).@*CONCLUSION@#Dental hygienists are experiencing limitations of upper limb function due to job stress. In particular, even if the correction of their uncomfortable posture is significantly related to the job stress and upper limb function, in order to improve the upper limb function of the dental hygienist, efforts to reduce the job stress as well as the uncomfortable posture are necessary.

Physical disability, perceived dependence and depression in women with osteoarthritis / 農村醫學 地域保健

OBJECTIVE: This study assessed whether both physical disability and perceived dependence relate to depression or whether perceived dependence in personal care activities, household activities, community mobility and recreational activities is an intermediate step in the relationship between physical disability and depressive symptoms. METHODS: Data come from a cross-sectional survey of 209 women, aged 55 or older, with osteoarthritis (OA). Mediation analyses occurred in four step and included logistic regression analyses as outlined by Baron & Kenny. RESULTS: The results from step 1 showed that greater difficulty with each domain of physical disabilities was significantly related to greater perceived dependence. In step 2, greater perceived dependence was significantly associated with greater depressive symptoms in all domains. Step 3 analyses showed that greater physical disabilities in each domain were significantly associated with depression. The final step testing mediation indicated that personal care activities, household activities and community mobility were fully mediated by perceived dependence. That was, once dependence was taken into account, the relationship between physical disabilities and depression was no longer significant. Partial mediation was found for dependence and recreational activity limitations. CONCLUSION: It is important to take into account the experience of perceived dependence as a mediator in understanding the relationship between disability and depression in the domains of personal care, household, and community mobility. To conclude, these findings point to the importance of taking into account an individual's reaction to their disability rather than just focusing on the severity of disability.

Factors Associated with Early Nutritional Status after Radical Gastrectomy in Patients with Gastric Cancer

PURPOSE: The aims of this study was to identify factors associated with nutritional status after radical gastrectomy in patients with gastric cancer at the post 1 month and the post 3-6 months independently. METHODS: Participants consisted of 107 patients at the post 1 month and 131 patients at the post 3-6 months after radical gastrectomy. Data were collected from October 1, 2013 to May 14, 2014 using a Patient-Generated Subjective Global Assessment (PG-SGA), the Hospital Anxiety and Depression Scale (HADS) and the Connor-Davidson Resilience Scale (CD-RISC). RESULTS: Stepwise multiple regression showed that factors associated with nutritional status at 1 month after radical gastrectomy were age (beta=.55, p<.001), anxiety (beta=.25, p=.007), and depression (beta=.23, p=.017), which explained the 42.6% of total variance of nutritional status. However, factors associated with nutritional status at 3-6 months after radical gastrectomy were depression (beta=.41, p=.017), return to work (beta=.20, p<.001), and age (beta=.29, p=.024), which explained 27.1% of the total variance of nutritional status. CONCLUSION: In conclusion, oncology nurses should be sensitive to the risk group of aged, depressed, anxious and delayed return to work patients for nutritional status during the early recovery period after radical gastrectomy.

IgG4-Related Tubulointerstitial Nephritis Accompanied by Henoch-Schonlein Purpura / 대한내과학회지

Tubulointerstitial nephritis is one of the common manifestations of immunoglobulin G (IgG)4-related disease; however, among all cases of tubulointerstitial nephritis undergoing renal biopsies, IgG4-related tubulointerstitial nephritis seems to be relatively rare because of its trivial urinary findings. A previously healthy 54-year-old man was referred to our clinic with a 4-week history of lower leg purpura and renal dysfunction. A kidney biopsy was planned because of bilateral renomegaly, by imaging studies, and elevated serum creatinine levels. Pathological findings in the kidney showed prominent infiltration of IgG4-postive plasma cells in the tubulointerstitium, but not the glumeruli. A skin biopsy revealed leukocytoclastic vasculitis, accompanied by deposition of IgA and C3 in the vascular wall, indicating Henoch-Schonlein purpura (HSP). Although cases of combined IgG4-related disease and microvasculitis, including HSP, are extremely rare, the possibility of an association between two diseases deserves attention.

A Qualitative Study on Attitude, Acceptability, and Adaptation for Home-delivered Meal Services in the Korean Elderly from the Perspective of Life Context / 대한지역사회영양학회지

OBJECTIVES: The purpose of this study was to suggest the strategies for improvement of home-delivered meal services for the elderly, to identify reasons for recipients to get started with the services and to evaluate the attitude, acceptability and adaptation of recipients to the services from the perspective of life context. METHODS: The data was collected through face-to-face in-depth interviews with eighteen low-income elderly recipients of home-delivered meals and analyzed using a qualitative research method. RESULTS: The results were deduced as four themes which comprised of long-term vulnerable socioeconomic contexts resulted in entry to the services, conflicting acceptability to the services, passive adaptation to taking the services, and positive practices to cope with supplement free meals or other services. The service participation was initiated because of a combination of prolonged, vulnerable socioeconomic contexts, including poverty and unexpected life events such as diseases, disability, living alone, aging and unemployment. With regard to taking the services, conflicting acceptability was observed: positive aspects including saving living cost and good quality of meals, and negative aspects including lack of a tailored service and feeling of stigma. Although the recipients needed an individualized service, they did not express their needs and demands for the services and they accepted the unavailability as an accustomed, prolonged vulnerable socioeconomic context. With regard to lack of tailored services, either self-solution such as modification of eating patterns or community-based network and services were used. CONCLUSIONS: We suggest that a system to concretely identify recipients' attitude, acceptability and adaptation for home-delivered meal services should be developed in the establishment of a tailored nutrition support system for the low-income elderly.

The Association of Trust, Social Participation with Self-Rated Health Status: Mediating Effect of Depression / 農村醫學 地域保健

OBJECTIVES: This study was performed to investigate the relationship between individual-level social capital and depression. And, we assessed if depressive symptom mediates the relationship between social capital and self-rated health status. METHODS: Data from the 2011 Community Health Survey were analyzed for this study. We used chi-square tests and analyzed a four step approach in which several regression analyses were conducted and significance of the coefficients was examined at each step. RESULTS: In men, the results of controlling mediating factor (depression): social participation was not significantly associated with self-rated health status(p=0.082), the finding supports that social participation was fully mediated by depression. In women, the relationship between social capital(trust, social participation) and self-rated health status was partially mediated by depression. CONCLUSIONS: In order to increase self rated health status, not only improvement in trust and social participation are needed but effort to reduce depression must be combined.

A Study on Dementia-related Knowledge and Attitudes in Adolescents / 재활간호학회지

PURPOSE: The purpose of this study is to examine adolescents' knowledge and attitudes towards dementia and to provide basic data for educating about knowledge of dementia and strengthening positive attitudes towards dementia. METHODS: This study used a descriptive research design. The subjects were 502 middle and high school students. A questionnaire organized by 16 questions of knowledge and 10 questions of attitudes towards dementia was used. RESULTS: The subjects' knowledge level of dementia was low, and average score was 8.89+/-2.95. The questions with low rate of correct answer were "Dementia is caused by several dozens of diseases such as internal medicine, neurology, psychiatry, etc.", "In spite of the dementia, patients can enjoy their favorite things." The subjects' average score of attitudes towards dementia was 3.72+/-0.58. Questions of negative attitudes were "I don't want to be closed to patients of dementia.", "I watch information or prevention about dementia in mass communications media." The relationship between dementia-related knowledge and attitudes showed positive correlation. CONCLUSION: The result means the mediation is necessary for improving dementia-related knowledge and strengthening positive attitudes in adolescents. The education programs should be proceeded to provide adolescents with correct information about dementia.

Cosmetic Results of Conservative Treatment for Early Breast Cancer / 대한방사선종양학회지

PURPOSE: This study was performed to evaluate the cosmetic outcome of conservative treatment for early breast cancer and to analyze the factors influencing cosmetic outcome. MATERIALS AND METHODS: From February 1992 through January 1997, 120 patients with early breast cancer were treated with conservative surgery and postoperative radiotherapy. The types of conservative surgery were quadrantectomy and axillary node dissection for 108 patients (90%) and lumpectomy or excisional biopsy for 10 patients (8.3%). Forty six patients (38%) received adjuvant chemotherapy (CMF or CAF). Cosmetic result evaluation was carried out between 16 and 74 months (median, 33 months) after surgery. The cosmetic results were classified into four categories, i.e., excellent, good, fair, and poor. The appearances of the patients' breasts were also analyzed for symmetry using the differences in distances from the sternal notch to right and left nipples. A logistic regression analysis was performed to identify independent variables influencing the cosmetic outcome. RESULTS: Cosmetic score was excellent or good in 76% (91/120), fair in 19% (23/120) and poor in 5% (6/ 120) of the patients. Univariate analysis showed that tumor size (T1 versus T2) (p=0.04), axillary node status (N0 versus N1) (p=0.0002), extent of surgery (quadrantectomy versus lumpectomy or excisional biopsy) (p=0.02), axillary node irradiation (p=0.0005) and chemotherapy (p=0.0001) affected cosmetic score. Multivariate analysis revealed that extent of surgery (p=0.04) and chemotherapy (p=0.0002) were significant factors. For breast symmetry, univariate analysis confirmed exactly the same factors as above. Multivariate analysis revealed that tumor size (p=0.003) and lymph node status (p=0.007) affected breast symmetry. CONCLUSION: Conservative surgery and postoperative radiotherapy resulted in excellent or good cosmetic outcome in a large portion of the patients. Better cosmetic results were achieved generally in the group of patients with smaller tumor size, without axillary node metastasis and treated with less extensive surgery without chemotherapy.

LINAC-based Stereotactic Radiosurgery for Meningiomas / 대한방사선종양학회지

PURPOSE: To evaluate the role of LINAC-based stereotactic radiosurgery (SRS) in the management of meningiomas, we reviewed clinical response, image response, neurological deficits for patients treated at our institution. METHODS AND MATERIALS: Between February 1995 and December 1999, twenty-six patients were treated with SRS. Seven patients had undergone prior resection. Nineteen patients received SRS as the initial treatment. There were 7 male and 19 female patients. The median age was 51 years (range, 14~67 years). At least one clinical symptom presented at the time of SRS in 17 patients and cranial neuropathy was seen in 7 patients. The median tumor volume was 4.7 cm3 (range, 0.7~16.5 cm3). The mean marginal dose was 15 Gy (range, 10~20 Gy), delivered to the 80% isodose surface (range, 46~90%). The median clinical and imaging follow-up periods were 27 months (range, 1-71 months) and 25 months (range, 1~52 months), respectively. RESULTS: Of 14 patients who had clinical follow-up of one year or longer, thirteen patients (93%) were improved clinically at follow-up examination. Clinical symptom worsened in one patient at 4 months after SRS as a result of intratumoral edema, who underwent surgical resection at 7 months. Of 14 patients who had radiologic follow-up of one year or longer, tumor volume decreased in 7 patients (50%) at a median of 11 months (range, 6~25 months), remained stable in 6 patients (43%), and increased in one patient (7%), who underwent surgical resection at 44 months. New radiation-induced neurological deficits developed in six patients (23%). Five patients (19%) had transient neurological deficits, completely resolved by conservative treatment including steroid therapy. Radiation-induced brain necrosis developed in one patient (3.8%) at 9 months after SRS who followed by surgical resection of tumor and necrotic tissue. CONCLUSIONS: LINAC-based SRS proves to be an effective and safe management strategy for small to moderate sized meningiomas, inoperable, residual, and recurrent, but long-term follow-up will be necessary to fully evaluate its efficacy. To reduce the radiation-induced neurological deficit for large size meningioma and/or in the proximity of critical and neural structure, more delicate treatment planning and optimal decision of radiation dose will be necessary.

Effects of Postoperative Radiotherapy on Distribution of Bone Metastases in Breast Cancer / 대한방사선종양학회지

PURPOSE: This study was done to evaluate the efficacy of low-dose radiation in reduction of thoracic vertebral metastases in patients with breast cancer. MATERIALS AND METHODS: 109 patients who were treated for bone metastasis from breast cancer from June, 1988 to June, 1998 in the Department of Therapeutic Radiology, Seoul National University were included. Of the 109 patients, 40 patients had been previously treated by postoperative radiotherapy and 69 had not. Postoperative radiotherapy had been given using Co-60 teletherapy device in 30 patients or 6 MV linear accelerator in 10. Thoracic spines from 1 to 10 were usually irradiated except in 1 patient and cervical vertebrae 6 and/or 7 were partially included in 38 patients. A total of 50.4 Gy was given with 1.8 Gy fraction. Metastatic bone diseases were scored in 11 regions, i. e., skull, cervical spine, thoracic spine from 1 to 4, from 5 to 8, 9 and 10, 11 and 12, lumbar spine, pelvis, femur, ribs and others. RESULTS: In no postoperative parasternal irradiation group, lumbar vertebrae were the most common metastatic sites (55.1%) followed by pelvis (44.9%), ribs (40.6%), thoracic vertebrae 11 and 12 (37.7%), thoracic vertebrae between 5 and 8 (36.2%), thoracic vertebrae 9 and 10 (34.8%), and thoracic vertebrae between 1 and 4 (26.1%). In postoperative parasternal irradiation group, lumbar vertebrae and pelvis were also the most common sites of metastases (55.0% both) followed by ribs (37.5%), and thoracic vertebrae 11 and 12 (32.5%). But significant less metastases were seen at thoracic vertebrae from 1 to 10. CONCLUSION: We can find that there were significantly less bony metastases at thoracic vertebrae which had been previously irradiated postoperatively.