Effects of changes in lifestyle and biological parameters on blood lipid levels in middle aged men

BACKGROUND: Death from coronary heart disease is increasing and this study is to evaluate the effect of longitudinal changes of lifestyle and biological parameters on the blood lipid levels, as the risk factor of the coronary heart disease. METHODS: Total cholesterol and total cholesterol to HDL-cholesterol ratio (atherosclerogenic index) as an indicator for risk of coronary heart disease were examined longitudinally in a sample (n = 463) of middle-aged men by 2 years. The independent variables were body mass index, smoking, alcohol, exercise, diastolic blood pressure, uric acid. All data was drawn from questionnaire, blood chemistry, and review of chart. RESULTS: ANOVA test according to categorized variables revealed that for total cholesterol, uric acid (P<0.01) and diastolic blood pressure (P<0.01), and for atherosclerogenic index, and body mass index (P<0.001) were significant. In correlation analysis, total cholesterol was associated with uric acid (r=0.20, P<0.001), diastolic blood pressure (r=0.15, P <0.001) and body mass index (r=0.03, P<0.05), and for atherosclerogenic index so was body mass index (r=0.18, P<0.001). In regression, uric acid (beta=6.07, P <0.001), diastolic blood pressure (beta=0.36, P <0.01) for total cholesterol, and body mass index (beta=0.22, P <0.001) for atherosclerogenic index were significant. But changes in alcohol consumption, smoking, and exercise were not statistically significant. CONCLUSION: In order to reduce risks of coronary heart disease, the more aggressive medical intervention for the uric acid, DBP, and BMI, would be essential. This study was done without medical intervention. So, further study with intervention, adequate duration and intensity for parameters modification is required.

The Compliance of the Patients advised Additional Laboratory Test or Treatment in the Periodic Health Screening

BACKGROUND: Recent increase in use of the periodic health screening is due to a concern for health. But study of patient's compliance with recommended periodic health screening has not yet been conducted. This study was accomplished to clarify which aspect to be considered in order to increase patient's compliance after health screening. METHODS: This study was done from March 3 to May 15 in 1997 by Hanil health care center, Among 370 workers in a state-run corporation who received health screening tw? years ago, 170 men were advised to receive an additional laboratory test or treatment at the time. They were asked to fill out a questionnaire and were inte?iewed by doctors to evaluate their compliance. 162 of 170 patients(95.3%) were enrolled in the study, except 8 patients who did not answer the questionnaire. RESURTS: The mean age of patients was 54 years. Most of them were technicians and managers, graduated from high school or higher, and had an annual income of at least 35,000,000 won. The disease of requiring an additional test or treatment were in the order of liver disease, hypertension, gastrointestinal disease, urologic disease and abnormal urinalysis. 68 patients(42%) were compliant and 94 patients(58%) were noncompliant. For reasons of noncompliance,27 patients(28.7%) answered "because l had no symptoms", 20 patients(21.2%) answered "because I didn't think I needed the test or the treatment" and 12 patients(12.7%) answered "because I was busy". The factors influencing compliance were analyzed through chi-square or Fisher's exact test. Their compliance was highly related to the patients'insight into the necessity of the test. the existing disease, and the reporting method of the health screening results. It was not associated with the patients'feeling about their health status, the health behaviors such as smoking and drinking, occupational factors, distance from shire homes to the hospital, or the presence of a hospital near home for those who didn't live in Seoul. The independent effect of the factors influencing the compliance was evaluated by means of stratified analysis. The only independent factor associated with the compliance was the patients' insight. The compliance according to diseases was higher than average in hypertension, liver disease, diabetes mellitus and urologic disease, and lower than average in pulmonary disease, gastrointestinal disease, thyroid disease, cardiac disease, opthalmologic disease and abnormal urinalysis. CONCLUSIONS: The most influencing factor related to compliance was the patient's insight into the necessity of the further testing. We should consider a proper way to increase compliance on health screening. Direct counseling, if possible, is recommended following health screening and way to increase patient's compliance utiliging mail report as another.