A Cohort Study on the Association between Psychotropics and Hip Fracture in Korean Elderly Women

To test the hypothesis that the intake of psychotropics may increase the risk of hip fracture, a cohort study was conducted upon elderly Korean women. The Korean Elderly Pharmacoepidemiology Cohort was constructed from members of the Korea Medical Insurance Corporation over 65 yr of age who were living in Busan Metropolitan City in 1993. Study participants (n=6,043) were female respondents to a self-administered question survey. Information on the intake of psychotropics was obtained from the drug prescription database, which contained all psychotropic prescriptions during any hospital admission over the two-year period between January 1, 1993 and December 31, 1994. The cohort follow-up has been conducted with information on hip fracture being collected from the Korea Medical Insurance Corporation medical treatment claims database over the four year period between January 1, 1993 and December 31, 1996. Three hundred and three subjects had received 745 psychotropics prescriptions and 56 cases of hip fracture were found. After adjusting for age, body mass index, and drinking history, it was found that the intake of psychotropics significantly increased the risk of hip fracture (adjusted odds ratio, 4.24; 95% confidence interval, 1.89-9.52). This study suggests that the intake of psychotropics might be an important risk factor for hip fracture in elderly Korean women.

Nested Case-control Study on the Association between Alcohol and the Risk of Proximal Hip Fracture in the Elderly People in Korea / 한국역학회지

OBJECTIVE: To assess the association between alcohol drinking and hip fracture in the elderly people in Korea. BACKGROUND: Hip fracture is known as one of the major health problems because of its high incidence and serious consequences in the elderly people. The association between alcohol consumption and hip fractures has not been directly evaluated yet in Korea. So we conducted a nested case-control study to investigate the relationship between alcohol consumption and hip fracture in the Korean elderly people. DESIGN: Nested case-control study from the Korea Elderly Pharmacoepidemiology Cohort (KEPEC), in Pusan, Korea. METHODS: Seventy incident cases have been selected since 1993, and 280 controls have been matched with the cases by age and gender among the KEPEC. Average alcohol intake was calculated by multiplying frequency and amount of drinking and unit capacity of each alcohol type. Odds ratios of alcohol intake on the hip fracture and their confidence intervals were computed by using multiple logistic regression with Windows version SAS 6.12. RESULTS: The elderly people's drinking rate is lower than the young people in Korea. In univariate analysis, crude odds ratio was 0.26 in male and adjusted odds ratio after contolling for age, smoking status, medication history, physical activity and body mass index was 0.36 in male. So current drinking reduces the risk of hip fracture. Adjusted odds ratio after controlling for age, smoking status, medication history, physical activity and body mass index odds ratio was 0.24 in female with moderate drinking. CONCLUSION: We found that alcohol consumption reduces the risk of hip fracture in the elderly Korean. However, we could not explain the plausible mechanism with our data yet. So, we suggest the further study for elucidating the possible mechanism of the finding including the possible association between nutritional status, alcohol drinking and bone marrow density in the elderly.

Cohort Study on the Association getween Smoking and Proximal Hip Fracture in the Elderly People in Korea / 한국역학회지

OBJECTIVE: To assess the association between cigarette smoking and hip fracture by using the Korea Pharmacoepidemiology Cohort(KPEC). BACKGROUND: Hip fracture is known as one of the major health problems because of its high incidence and serious consequences in the elderly people. Cigarette smoking, old age, female and low body weight have been reported as risk factors for osteoporosis which is regarded as one of the risk factors for hip fracture. But the relationship between cigarette smoking and hip fracture has not been directly evaluated yet. So we conducted a prospective cohort study to investigate the relationship between cigarette smoking and hip fracture in the Korean elderly. DESIGN: Prospective cohort study on the 8,994 elderly person aged 65 or more in Pusan, Korea between 1993 to 1996. METHODS: The Korea Phamacoepidemiology Cohort(KPEC) has been constructed with three kinds of data sources. One is from the Korea Medical Insurance Corporation; Medical Insurance Claims Database and Enrollee's Database. Other sources are from directly constructed pharmacy database and questionnaire data. incidence density and relative risk of smoking for hip fracture were estimated by using the KPEC database. Age and gender specific incidence density was calculated by dividing the number of hip fracture cases by person-years of the follow-up the cohort. Relative risks and their confidence intervals were computed by using multiple logistic regression by Windows version SAS 6.12. RESULTS: The level of incidence density in female was higher than that in male, which was increasing with age in both gender. In the multivariate analysis, we observed significant relationship between soking and hip fracture in female(PR=1.94(1.01-3.76)) in the larger amount smoking group, after adjusting for the confounders; age, alcohol drinking, medication history, physical activity and body mass index, the relative risk became slightly decreased to 1.70(0.84-3.46). CONCLUSION: Accoding to this result, we suggest that effective anti-smoking campaign should be established as soon as possible for the Korean elderly women.

PCR and RFLP-based CYP2D6(B) and CYP2D6(T) Genotyping for Korean Lung Cancer Cases and Controls / 예방의학회지

The genetically determined CYP2D6 activity is considered to be associated with cancer susceptibility with inter-individual variation. Genetic polymorphism of CYP2D6(B) and CYP2D6(T) was determined by the two polymerase chain reaction(PCR) and BstN1 and EcoN1 restriction fragment length polymorphisms(RFLP) for 67 lung cancer cases and 95 healthy volunteer controls. The cases were composed of 26 squamous cell carcinoma, 14 small cell carcinoma, 10 adenocarcinoma, 3 large cell undifferentiated carcinoma, and 14 not histologically diagnosed. The results were gained from the 142 subjects (57 cases and 85 controls) who observed successfully in two PCR and BstN1/EcoN1 RFLP. Only one and no mutant allele of the CYP2D6(B) and CYP2D6(T) gene was detected, that is, the frequency of mutant allele was very low; 0.7%(1/142) and 0%(0/142), respectively. Detected mutant allele of the CYP2D6(B) was heterozygous type(WM). The odds ratios for lung cancer susceptibility with CYP2D6(B) and CYP2D6(T) genotype were not calculated. These results are similar to the previous understanding that the mutant allele is very rare in Orientals compared to Caucasians, therefore, it considered that CYP2D6(B) and CYP2D6(T) genotypes have maybe no association with lung cancer susceptibility in Koreans. This is the basic data of CYP2D6(B) and CYP2D6(T) genotypes for Koreans. It would be hepful for further study to determine lung cancer susceptibility of Koreans with the data about CYP1A1, CYP2E1, GSTM1 from future study.

An Epidemiologic Study on Death Caused by Cancer in Pusan / 예방의학회지

This study surveyed and measured the level and structure of cancer deaths and their trends over time for offering the fundamental data of the cancer prevention and control in Pusan city in the future. Authors conducted the study of descriptive epidemiology using materials derived from the computerized data of total 3,722 certified cancer deaths in Pusan city from January 1 to December 31, 1993 registered on the National Statistical Office, the Republic of Korea. The obtained results were as follows: 1. According to the total registered cases of deaths(16,331 cases) in Pusan city during 1993, cancer(3,722 cases) and cerebrovascular disease(2,718 cases) were the first and second cause of deaths as 23.1% and 16.9%, respectively. These pattern showed the change between cancer(14.7%) and cerebrovascular disease(18.5%) in order of frequency in comparison to 1982. Also, the total number of cancer deaths was increased in comparison to 1982. The rate of death certification by physicians was 87.1% of all registered deaths, which was increased to 6.8% in comparison to 1982(80.3%). 2. Crude death rate and cancer specific death rate was 4.06 per 1,000 populations and 93.8 per 100,000 populations(male:117.8, female:70.0), respectively. The former was similar to that of 1982, but the latter was increased to 1.6 times as that of 1982. 3. Age-adjusted cancer specific death rate by standardization with whole country population was 111.9(male:141.5, female:106.7) per 100,000 populations, higher than not age-adjusted cancer specific death rate(93.8), and the sex difference was statistically significant with male predominance(p<0.05). 4. Cancer specific death rate by age was generally increased with age and most of cancer deaths(male:91.8%, female:88.5%) occurred since 40 years old. 5. The major cancer(cancer specific death rate per 100,000 populations) in male was liver(30.6) followed by stomach(25.6), lung(21.9), and GB and EHBD(5.7), in female stomach(15.7), liver(9.9), lung(7.3), and uterus(6.9). The relative frequency of the leading three cancer among total cancer deaths marked 66.3% in male and 47.1% in female, and decreased in comparison to 1982(male:72.2%, female:54.5%). 6. The total ratio of male to female cancer specific death rate showed 1.68 to 1 with male predominance. And the ratio was above 2.0 in larynx, oral cavity & pharynx, esophagus, liver, lung, bladder cancer and the ratio was 1.0~1.9 in stomach, pancreas, gall bladder and EHBD, brain, rectum and anus cancer, leukemia, but the ratio was reversed in thyroid and colon cancer. In conclusion, cancer was the first cause of deaths. The proportion of lung cancer was increased, that of stomach & uterine cancer was decreased relatively, and liver cancer was constantly higher proportion. In the future, it is necessary to conduct the further investigations on the cancer risk factors considering areal specificity.

Assessment of Validity of RT-PCR and EIA for The Detection of Hepatitis C Virus Infection / 예방의학회지

This study was conducted to estimate the validity of reverse transcriptase-polymerase chain reaction(RT-PCR) compared to enzyme immunoassay(EIA) for the detection of hepatitis C virus (HCV) infection. ElA for antibody to HCV(anti-HCV) and RT-PCR for HCV was executed on the subjects from Pusan and kyungnam area with questionnaire survey to collect some relating factors of HCV infection As the result from 617 cases, the prevalence of flcv infection was 1.5% by ElA and 3.7% by RT-PCR(p<0.05), and the age standardized rate was 1.7% and 3.4% by ElA and RT-PCR, respectively. The prevalence of hepatitis B surface antigen(HBsAg) was 6.8% by enzyme linked immunosorbent assay(ELlSA) and the age standardized rate was 7.7%. It was the higher in male group comparing to female group(p<0.01). Both of the prevalence of HCV and HBsAg were higher in elevated asparate aminotransferase(AST) and alanine aminotransferase (ALT) group than in normal AST and ALT group(p<0.01). There was no specific risk factor of HCV infection. Though the degree of agreement of EIA and RT-PCR by gamma statistics was 97.2%, it showed a significant difference between the two methods(p<0.01). For the detection of HCV infection, positive predictive value of ElA was 66.7 % and negative predictive value of EIA was 97.2%. This study suggests that negative result to anti-HCV by ElA didn't mean the free state of HCV infection, therefore it would be helpful that further monitoring for HCV infection by RT-PCR in the case of elevated AST and ALT and/or clinically suspected.

Risk Factors of Hypertension and The Effect of These Factors on Blood Pressure / 한국역학회지

This study was conducted to find out the risk factors of hypertension and the effect of thesefactors on blood pressure. The eighteen factors were collected on the subjects of 932 from November 1994 to January 1995 through questionnaire and laboratory test - those were age, sex, education level, body mass index(BMI), family history of hypertension (FHH), triglyceride (TG), blood sugar and lactate dehydrogenase(LDH), etc. The status of blood pressure was classified by the classification of hypertension proposed by Joint National Committee of hypertension, USA. The prevalence of diastolic hypertension was 17.7% and the prevalence of systolic hypertension was 11.6 %. In the frequency analysis on the status of blood pressure, by age, education level, smoking habit, RM, BMI, FBS, LDH, TG, the prevalences were significantly different for both diastolic and systolic hypertension(p(0. 05). By stepwise logistic regression with dichotemization of blood pressure, the following odds ratios were significantly high (p, 0.05) - for diastolic hypertension, age 1.973, BMI 2. 106, FHH 2, 102, LDH 2. 773, TG 1.715, and for systolic hypertension, age 4.414, BMI 1.563, FHH 2.125, RM 0.487, LDH 3.814, TG 2. 707. By multiple regression analysis with blood pressure as dependent variable and these factors as independent variables, the regression equationswere diastolic hypertension =51.07+0.20.age+0.07 BMI+0.02.TG+0.02.LDH+3.22.FHH, and systolic hypertension = 88. 59+0.23.age+0.06.BMI+5.46.FHH-2.62.RM+0.03.LDH+0,03.TG By this study, the significant risk factors of hypertension were age, BMI, TG, family history of hypertension, LDH, and efficient control of hypertension would be expected through control of these factors.

Olfactory Dysfunction in Chromium Exposed Workers / 예방의학회지

Chromium is one of the representative toxic substance by occupational exposure which damage the mucosa of respiratory tract including nasal septal perforation. The aim of this study is to evaluate the effect of chromium exposure on olfactory function and to obtain the fundamental information about chromium exposure. The authors performed olfactory function test, laboratory tests and questionnaire interview on the subject of three groups, that is, two exposed groups and one nonexposed group from May 1 to June 30, 1994. Exposed group 1 was 15 male workers without nasal septal perforation, exposed group 2 was 15 male workers with nasal septal perforation among 103 workers in 22 chromium plating factories, and nonexposed group was 15 male medical students. The gathered informations were histories of chromium exposure, habits of smoking and alcohol drinking, the concentrations of chromium in serum and urine, and asparate aminotransferase(AST), alanine aminotransferase(ALT), gamma-gluutamyl transferase,etc. Olfactory function was checked by T and T olfectometer using phenyl ethyl alcohol(material A), methyl cyclopentenolone(material B), iso-valeric acid(material C), gamma-undecalactone(material D), skatole(material E) and the results were expressed by detection threshold(DT) and recognition threshold(RT). There was a significant difference between exposed groups and nonexposed group in A, B, C, D, E substances by DT and in A, B, C, D substances by RT(p<0.01) The degree of olfactory dysfunction was highest in the exposed group 2 and lowest in the nonexposed group in all five substance by Dt and it was same in A B, D substance RT and the difference of RT and DT. As summary, olfactory dysfunction by chromium exposure was recognized and the degree of olfactory dysfunction was higher in the exposed group with nasal septal perforation. Therefore, it would be helpful to apply olfactory function test for the early detection of olfactory dysfunction, and this test would be considered as the basic tool within workers' compensation system.

Neuroendocrine Effects in Occupational Solvents Exposure / 대한산업의학회지

Long term occupational exposure to solvent mixtures may cause adverse effects to the central nervous system with neurobehavioral symptoms. And some organic solvents have been suggested to cause impairment of tuberoinfundibular dopaminergic activity and neurochemical mechanisms controlling pituitary secretion. For the purpose of assessing neuroendocrine effects in occupational solvents exposure, hormonal study settings (shoes-manufacturing industry & fishing products industry) and compared with nonexposed controls (33men, 85women). Male workers exposed to solvent mixtures had significantly lower plasma level of follicle-stimulating hormone (FSH) than nonexposed male controls. While female workers exposed to solvent mixtures had significantly lower plasma levels of growth hormone (GH), and thyroid-stimulating hormone (TSH) than nonexposed female controls. The results of significant decrease in plasma concentrations of pituitary hormones (FSH, GH, and TSH) in workers exposed solvent mixtures indicate that occupational exposure to solvent mixtures may induce neuroendocrine effects through an effect on hypothalamic pituitary axis.