Prevalence of Diabetes Mellitus and Prediabetes in Dalseong-gun, Daegu City, Korea

BACKGROUND: The aim of the present study was to determine the population-based prevalence of diabetes mellitus (DM) and prediabetes in a rural district of Daegu City, Korea. METHODS: Between August and November 2003, a community-based health survey of adults aged 20 years and older was performed in the rural district of Dalseong-gun in Daegu City. A total of 1,806 of all eligible individuals agreed to participate. Fasting plasma glucose was measured in all participants. Two hour oral glucose tolerance was measured in the 1,773 participants for whom there was neither an established diagnosis of DM nor evidence of DM according to fasting glucose levels. The prevalence of DM and prediabetes was determined according to the 2003 criteria of the American Diabetes Association. Subjects with prediabetes were classified into one of three categories of glucose intolerance: isolated impaired fasting glucose (IFG); isolated impaired glucose tolerance (IGT); or combined IFG and IGT. RESULTS: The prevalence of DM was 12.2%. The highest prevalence rates were observed in subjects in their seventies. A total of 34.7% of all subjects who were assigned a diagnosis of DM in the present study had not been diagnosed previously. The prevalence of prediabetes was 22.7%. The highest prevalence rates were observed in subjects in their fifties. CONCLUSION: The present study identified prevalence rates of 12.2% for DM (age-standardized prevalence rate [ASR], 6.8%), and 22.7% for prediabetes (ASR 18.5%). These results emphasize the need for community health promotion strategies to prevent or delay the onset of DM in individuals with prediabetes.

Analysis by Delphi Survey of a Performance Evaluation Index for a Salt Reduction Project

The purpose of this study was to analyze the performance evaluation index for a salt reduction project. Questionnaires were developed in order to investigate salt reduction programs nationwide. The evaluation index and programs were analyzed through the case study of a salt reduction program in public health centers. The validity of the salt reduction program's evaluation index was determined based on study of the Delphi survey and on discussion with nutrition and health care professionals. The Delphi survey showed that daily salt intake was the most valid nutritional evaluation index. Stroke mortality and stomach cancer mortality were good health care evaluation indexes. The method for measuring salt intake that had the greatest validity was a 24-hour urine collection. However, 24-hour urine collection had the lowest score for ease of performance. The combined scores of validity and ease of performance showed that the survey method for dietary attitude and dietary behavior, dietary frequency analysis (DFQ 15), and a salty taste assessment, in that order, were proper methods. The high reliability of the salty taste assessment indicated that the percentage of the population that exhibits proper salt intake (2,000 mg sodium or less daily) and the percentage of the population that consumes low-salt diets as nutritional evaluation indexes also will be helpful to evaluate performance of salt reduction programs.

Evaluation of the Effectiveness of a Salt Reduction Program for Employees

The purpose of this paper was to evaluate the effectiveness of a salt reduction education program. Subjects participating in this study were 251 employees (166 in the "educated" group, 85 in the "non-educated" group) at 8 hospital and industry food service operations in Daegu. After the salt reduction education program was carried out, a salty taste assessment of both groups was conducted. The educated group had statistically significant differences and the noneducated group did not have statistically significant differences. In terms of nutrition knowledge, while the nutrition knowledge of the educated group was increased (p < 0.001), that of the non-educated group rose at a rate of 0.92. In terms of dietary attitude, the educated group exhibited increased preference toward less salty foods when compared to the noneducated group (p < 0.001). Regarding dietary behavior, the score of the educated group was improved (p < 0.001), thereby indicating a preference for less salty taste. This means that nutrition education had influence on dietary behavior. However, after education, sodium excretion for the educated group was not significantly decreased, compared to before education. The results show that there was a positive correlation between salty taste assessment and dietary attitude and behavior for a high-salt diet. There was a positive relationship between attitude for a high-salt diet and sodium intake; when people prefere a more salty taste, they eat more sodium. Therefore, in order to change dietary preference away from salty taste and to decrease sodium intake, a nationwide, systematic and continuous salt reduction education program is needed.

Study on the Development and Evaluation of Validity of Salty Taste Assessment Tool

The purpose of this study was to assess and evaluate salty taste preferences. Samples for the salty taste test were made by adding sodium chloride to soybean sprout soup at five different concentrations: 0.08% (unsalty); 0.16% (slightly unsalty); 0.31% (neither unsalty nor salty); 0.63% (slightly salty); and 1.25% (salty). Over 4,210 subjects were randomly selected and tested over a three-year period from 2005 to 2007 in Daegu. The results of the taste test were as follows: Fortyfive percent of the subjects preferred soup with a salty taste and slightly salty taste. Most subjects preferred soup with a 0.31% concentration of sodium chloride. There were positive relationships between intensity and preference in 0.08%, 0.16%, and 0.31% concentrations, but there were negative relationships between intensity and preference in 0.63% and 1.25% concentrations (p < 0.01). Upon examining a relationship between the taste assessment results and salty eating attitude scores, it was found that the subjects who preferred slightly salty and salty taste showed higher total scores in terms of habitual preference for/enjoyment of eating salty foods than the other groups. Comparing the taste test results with the subjects' stated preference, it was found that 70.3% of the subjects who were classified as preferring salty taste recognized this preference and 53.3% of the subjects who were classified into the population than tends to eat slightly salty food responded that they also tend to prefer a salty taste. Based on these results, this salty taste assessment study can be used as a practical and useful nutrition education tool for assessing and possibly reducing salt intake.

Development and Evaluation of Nutrition Education Program for Sodium Reduction in Foodservice Operations / 대한지역사회영양학회지

The purpose of this study was to develop a nutrition education program for dietary salt reduction using various nutrition education materials. The effect of a 5-week nutrition education program on salty taste assessment, nutrition knowledge, salt attitude for a high-salt diet, salt content in food, and individual satisfaction with the salt concentration of meals during the education period was evaluated. Nutrition education materials included two animations, a pamphlet, panels, and a website, as well as other training resources. Subjects participating in this study were 335 employees (164 male, 171 female) at 15 foodservice operations in Daegu. Preference for higher levels of salty taste and food containing higher amounts of salt were lowered. Knowledge regarding the necessity for dietary salt reduction was higher (p < 0.001) than before nutrition education, and salt content in a meal was reduced. As the program progressed, average salt concentrations of soups were significantly lowered (p < 0.05), and there was greater satisfaction with the lower concentration (p < 0.001). This was a positive indication of the program's success. In addition, it was found that subjects who participated in the program several times have changed their preference to lower levels of salty taste and have increased their nutrition knowledge (p < 0.05, p < 0.001). Thus, the positive effect of this 5-week nutrition education program developed for, and applied to, foodservice employees, concerning dietary salt reduction was confirmed.

Incidence of Hypertension in a Cohort of an Adult Population / 예방의학회지

OBJECTIVES: This study was performed in order to assess the incidence of hypertension based on two-years follow-up of a rural hypertension-free cohort in Korea. METHODS: The study cohort comprised 2,580 subjects aged above 20 (1,107 men and 1,473 women) of Chung-Song County in Kyungpook Province judged to be hypertensive-free at the baseline examination in 1996. For each of two examinations in the two-year follow-up, those subjects free of hypertension were followed for the development of hypertension to the next examination one year (1997) and two years later (1998). The drop-out rate was 24.7% in men and 19.6% in women. Hypertension was defined as follows 1) above mild hypertension as a SBP above 140 mmHg or a DBP above 90 mmHg, 2) above moderate hypertension as a SBP above 160 mmHg or a DBP above 100 mmHg or when the participant reported having used antihypertensive medication after beginning this survey. RESULTS: The age-standardized incidence of above mild hypertension was 6 per 100 person years (PYS) in men and that of above moderate hypertension was 1.2. In women, the age-standardized rate for above mild hypertension was 5.7 and 1.5 for above mild and moderate hypertension, respectively. However, the rates of incidence as calculated by the risk method were 4.8% and 1.0% in men and 4.6%, 1.2% in women, respectively. In both genders, incidence was significantly associated with advancing age(p<0.01), In men, the incidences of above moderate hypertension by age group were 0.5 per 100 PYS aged 20-39, 0.7 aged 40-49, 1.7 aged 50-59, 3.6 aged 60-69, and 5.8 aged above 70(p<0.01). In women, those the incidence measured 0.6 per 100 PYS aged 20-39, 1.8 aged 40-49, 1.3 aged 50-59, 3.3 aged 60-69, and 5.6 aged above 70(p<0.01). After age 60, the incidence of hypertension increased rapidly. CONCLUSIONS: The incidence data of hypertension reported in this study may serve as a reference data for evaluating the impact of future public efforts in the primary prevention of hypertension in Korea.

The Risk Factors for the Development of Hypertension in a Rural Area - An 1-Year Prospective Cohort Study / 예방의학회지

OBJECTIVES: This study was performed to identify the risk factors related to the development of hypertension in a rural area. METHOD: Total of 3,573 subjects in Chung-Song County were interviewed and examined in 1996. The study cohort comprised 2,580 hypertension-free subjects aged above 20. One-year follow up was completed for 1,781 subjects(69.0%) in 1997. General characteristics(age, gender, education level, economic status, marital status), the family history of hypertension, diet, alcohol, smoking, coffee, stress, past history of oral contraceptive and menopausal status in female, height, weight, waist and hip circumference, baseline blood pressure, and serum total cholesterol were considered as risk factors. RESULTS: Multivariate analysis using logistic regression model indicated that age(RR=1.50, 95% CI; 1.15-1.96), the family history of hypertension(RR=2.11, 95% CI; 1.04-4.26), waist-hip ratio(WHR) (RR=2.09, 95% CI; 1.15-3.79), and baseline systolic blood pressure(130-139/ yes/no-->no) (RR=3.32, 95% CI; 1.01-10.87), baseline systolic blood pressure(120-129/<120mmHg: RR=2.00, 95% CI; 1.02-3.90)(130-139/<120mmHg: RR=2.64, 95% CI; 1.34-5.20) and baseline diastolic blood pressure(85-89/<80mmHg)(RR=4.09, 95% CI; 1.86-8.96) were identified as risk factors. CONCLUSIONS: Age and high normal blood pressure were significant risk factors for the development of hypertension above the borderline level. In addition, the family history of hypertension and WHR in men, and the change of menopausal status in women might be significant risk factors in Korea.

Therapeutic Compliance and Its Related Factors of Patients with Hypertension in Rural Area / 예방의학회지

OBJECTIVE: The purpose of this study was to examine the therapeutic compliance and its related factors in the rural hypertensives. METHOD: A questionnaire survey and blood pressure measurement were performed to 3,876 residents of a rural area, and 660 hypertensives were selected as subjects of study. The study employed a hypothetical model which was composed of constructs from the health belief model and KAP model. The analysis techniques employed included contingency table analysis and structural equation modeling. RESULT: The proportion of those who were compliant to the treatment of hypertension was 44.2% of subjects. As the result of structural equation modeling, when patients had more favorable attitude toward treatment, higher perceived benefit, or lower perceived barriers to treatment, the therapeutic compliance was significantly higher(T>2.0). When patients had more knowledge about hypertension, or higher perceived severity of hypertension, the attitude toward the treatment of hypertension was more favorable significantly(T>2.0). And when patients had the support for treatment from family or neighbor, the attitude toward treatment was more favorable(T>2.0). When patients had experience of health education, they had more knowledge, higher perceived susceptibility of complication, perceived severity for hypertension, and perceived benefit of treatment, compare to patients without health education(T>2.0). CONCLUSION: In consideration of above findings, in order to improve the therapeutic compliance in the rural hypertensives, it would be necessary to change attitude, perception, knowledge about hypertension and its treatment, by various methods such as effective health education and programs for maintaining the supportive environment for hypertension treatment.

An Intervention Study on Integration of Family Planning and Maternal/Infant Care Services in Rural Korea / 예방의학회지

This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. THE SPECIFIC OBJECTIVES WERE: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i) FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the medically supervised deliveries, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. STUDY DESIGN: The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum "package" program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and "before and after" surveys were conducted to measure the change. SERVICE INPUT: This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. METHOD OF EVALUATION: a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed. b. Neverthless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the "intergration process" itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltructure, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable. Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. SUMMARY OF FINDINGS: A) PROGRAM EFFECTS AND IMPACT. 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 78% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller. 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) & delivery care (45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregnancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) EFFECTS ON INTERACTIVE LINKAGE. 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in carrying for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, 85-90% of the services provided by the health workers were other than FP/MCH, mainly for immunization such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs. 31%) and for more combined care (45% vs. 23%). C) ORGANIZATION FACTORS (ADMINISTRATIVE INTEGRATIVE ISSUES). 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub-center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwives's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea). 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through planning practice. 2) Goal consensus in FP/MCH should be made among the health workers & administrators, especially to emphasize the need of care of "wanted" child. But there is a long way to go to realize the "real" integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (ii) there should be a health sub-center director who can provide leadership training for managing the integrated program. There is a need for "organizational support", if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the management of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Workers, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.

A Study on the Morbidity of rural populations(Seosan County Choong Nam province) / 예방의학회지

At the preliminary survey of Seosan demonstration project for integration of family planning and maternal and child health service, 6 questions about morbid conditions of all household members were included. Definition of morbid condition used at the survey was self-conceived physical or mental infirmity which had been caused by diseases or accidents, resulting in obstacles to ordinary daily life for past 30 days. Analyzing those morbidity data, the following results were obtained. 1. The morbid person rate was 192.2 per 1,000 persons and the morbidity rate 214.2 per 1,000 persons. 2. The percentage of household which had at least one morbid person was 61.9% and average number of morbidity per one household was 1.1. 3. Analyzing the 1st morbid condition of the total 4,433 morbid persons, morbidity rate of male was 194.6 per 1,000 persons and that of female was 189.8 per 1,000 persons. 4. The highest age specific morbidity rate was that of 0~4 years of age, and it was 304.3 per 1,000 persons. The lowest was that of 10~14 years of age and the rate of 93.8 per 1,000 persons. 5. The following was the order of five major diseases which were classified according to 17 International Classification of Diseases. (1) Symptoms and Ill defined conditions : 17.3% (2) Disease of the Digestive system : 15.7% (3) Infections and Parasitic disease : 14.3% (4) Disease of the Respiratory system : 13.7% (5) Disease of the Nervous system and sense organs : 9.4%. 6. 30 leading morbid conditions were described in Table III-2 and which composed 70.6% of total morbid conditions. 7. The percentage of the morbid conditions of which duration was longer than 90 days was 40.5%. 8. Of the total 4,433 morbid persons, 4,394 morbid persons responded for the morbid condition management method. Of those, Hospital & clinic (35.3%), drug store (40.0%), herb drug store (3.6%), health center (2.2%) ware selected for the 1st place or method for management morbid condition, and 18.0% did not search for morbid condition management.