A Case of Kienbock's Disease from Repetitive Contact Stress / 대한산업의학회지

OBJECTIVES: Kienbock's disease, which is characterized by osteonecrosis of the lunate bone, causes progressive chronic pain and dysfunction of the hand and wrist. Even though occurrence of the disease was reported approximately 100 years ago and it is suspected to be work-related to some degree, the etiology has not been clearly discribed and the disease has rarely been considered as an occupation-related disease. As such, we submit this case as the first report of Kienbock's disease in Korea, with clinical findings, x-ray, MRI (magnetic resonance imaging) and strain index results along with a literature review. METHODS: The patient was carefully interviewed and her medical records were properly reviewed by the authors with her consent. The authors also visited her factory work site to inspect and videotape the working environment and to conduct an ergonomic evaluation with a strain index. RESULTS: Excessively repeated contact stress was found to be concentrated on her right hand and the environment was discovered to be hazardous from an ergonomic standpoint. The literature review revealed that heavy loads on the hand might be related to the cause or deterioration associated with Kienbock's disease. ; therefore, it is very likely that her disease is related to her work. CONCLUSIONS: There is much evidence to suggest that heavy workloads involving hand and wrist intensive tasks may cause and worsen Kienbock's disease. However, to date epidemiologic studies clarifying the etiology of the disease have not been sufficiently reported. Therefore, further research focusing on the etiology and prevention of the disease are required. In addition, practical guidelines for hand and wrist intensive tasks are needed to prevent disease development and worsening.

Factors Associated with Unmet Needs for Medical Care among Island Inhabitants in Korea / 農村醫學 地域保健

OBJECTIVE: Korea has 3,170 islands with about 188,000 inhabitants. These inhabitants' needs for health services might go unmet because of geographic isolation, slimmer availability of health services, and higher proportion of the elderly compared with the mainland population. Unmet health service needs might result in serious health problems for these island residents. Therefore, the purpose of this study was to investigate their unmet health service needs and related factors from population of Nowha island. METHODS: The survey was conducted from July 30 to August 1 by trained interviewers. Target population were residents in Nohwa island and the sampling method was incomplete quota sampling. General characteristics, socioeconomic status, utilization of health service, and unmet medical service needs were investigated. First univariate and then multivariate logistic analyses were done for the statistical analysis. RESULTS: 324 residents were surveyed and the proportion of unmet health services needs was 26.5%. People living alone and of female sex had increased health services needs based on univariable analysis. From the multivariate analysis, those living alone increased the health services needs. Self-determined low socioeconomic status and medical aid increased the proportion of unmet medical needs, but these were not statistically significant. CONCLUSION: In Nowha island, those who are elder, and of lower socioeconomic status had much higher unmet medical needs. The results suggest the need for more social support by qualified health services to solve this unmet medical needs problem.

The Distribution Pattern and Related Factors of Waist-to-Hip Ratio in Middle Aged

BACKGROUND: The regional fat distribution is known to be related with some cardiovasular risk factors independently to total body fat amount. Regional fat distribution pattern can be assessed by waist to-hip ratio(WHR). WHR distribution patterns depend on age, sex, race and show regional difference. But, our own unique data are inadequate, so we tried to investigate distribution patterns, cut off points and related factors of WHR in middle aged men and women among Korean. METHODS: The study population were middle aged men and women above 40 years old who visited our hospital for routine check up from April to July, 1996. We measured height, weight, blood pressure, waist circumference, hip circumference, fasting blood sugar and total cholesterol in 1,000 persons. We gathered data about diet habits, exercise, smoking and drinking status by standard questionnaire. We analized above data by using SAS for Window 6.10. RESULTS: The study population numbers of men and women were 494 and 499, and average ages of men and women were 49.3 and 50.5 years respectively. For men, the average WHRs as a whole were 0.895, and 0.893, 0.893 and 0.911 in their forties, fifties and above sixties respectively. For women, the average WHRs as a whole were 0.827, and 0.816, 0.837 and 0.850 in their forties, fifties and above sixties respectively. The percentage above WHR 1.0, 0.95, and 0.90 in men were 2.4%, 11.7% and 46% and the percentage above WHR 0.90, 0.85, and 0.80 in women were 8.2%, 32.9% and 68.7%. Adjusting by age, body mass index, WHR was significantly correlated with weight, systolic blood pressure, diastolic blood pressure in men only. For men, WHR was associated with alcohol drinking positively and with exercise negatively. For women, WHR was associated with alcohol drinking and smoking status positively. CONCLUSIONS: The WHR had a tendency to increase according to age. The 90th percentile points in men and women were 0.957 and 0.894 respectively. WHR was related with several cardiovascular risk factors and several life styles.