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.

Association between nutritional status, sarcopenia, and frailty in rural elders / 農村醫學 地域保健

Objectives@#Frailty and sarcopenia are recent important concepts in elder health care. Sarcopenia is the most important factor influencing frailty, and exercise and nutritional status are known to affect sarcopenia. The purpose of this study was to identify the relationship between nutritional status, sarcopenia, and frailty. @*Methods@#This study was a cross-sectional design. The subjects of this study were 411 elderly people aged 65 or older from 10 villages in Gyeongnam. The survey tools were the K-FRAIL for frailty, the GDS-SF for depression, the SARC-F questionnaire for sarcopenia, and the DETERMINE for nutritional status. Frequency analysis, the chi-square test, and multiple logistic regression analysis were performed using the SPSS 25.0 program. @*Results@#As a result of the chi-square test, there was a significant difference in the nutritional status and the frailty proportion (p<0.001), and there was a significant difference between frailty and suspected sarcopenia (p<0.001). After adjustment, nutritional status was significantly associated with sarcopenia (OR=2.946, p<0.001). In addition, nutritional status was significantly associated with frailty (OR=2.958, p<0.001), and sarcopenia also had a significant effect on frailty (OR=5.898, p<0.001). Finally, even after including sarcopenia, nutritional status had a significant effect on frailty (OR=2.246, p=0.002). @*Conclusions@#Nutritional status can have both a direct effect on frailty and an indirect effect through sarcopenia, and it was found that sarcopenia also affects frailty. Therefore, it is necessary to evaluate sarcopenia and nutritional status and to evaluate their levels in the elderly and to take appropriate interventions.

Successful Factors of Smoking Cessation for Male Workers from Small and Medium Enterprises Registered with Local Tobacco Control Center / 農村醫學 地域保健

Objectives@#The aim of the study is to identify the success factors of 6 months of smoking cessation targeting male workers in small and medium-sized businesses. @*Methods@#The subjects of this study were smoking male workers who had got the visiting services at a tobacco control center to stop smoking from January 2018 to December 2020. Total number of the participants was 767. @*Results@#The male workers in small and medium enterprises had a success rate of 20.2% for smoking cessation for 6 months. With multiple logistic regression, the factors causing the differences in the success rate for 6 months of the workers were as follows. - The odds ratios (ORs)(95% confidence interval, CI) of the age group of under 29 and 40-49 years were 0.10 (0.03-0.29) and 0.43 (0.24-0.76), respectively, compared to the 50 years and older group. The ORs (95% CI) of the daily average of smoking group of 11-20 and more than 21 were 0.52(0.34-0.80) and 0.46(0.24-0.90), respectively, when compared to the group of 1-10. The ORs (95% CI) of the supporting persons for quitting smoking group of with spouse and other family were 1.99(1.18-3.34), compared to the group with no one. @*Conclusions@#This study showed that the chance of success for smoking cessation for 6 months is higher when the subjects have spouses and other family Supporting persons for quitting smoking. And it also shows that the less they smoke a day and the older they are, the more likely it is to succeed in quitting smoking.

Community Care for Cancer Patients in Rural Areas: An Integrated Regional Cancer Center and Public Health Center Partnership Model / 한국호스피스완화의료학회지

Purpose@#The accessibility of medical facilities for cancer patients affects both their comfort and survival. Patients in rural areas have a higher socioeconomic burden and are more vulnerable to emergency situations than urban dwellers. This study examined the feasibility and effectiveness of a cancer care model integrating a regional cancer center (RCC) and public health center (PHC). @*Methods@#This study analyzed the construction of a safety care network for cancer patients that integrated an RCC and PHC. Two public health institutions (an RCC in Gyeongnam and a PHC in Geochang County) collaborated on the development of the community care model. The study lasted 13 months beginning in February 2019 to February 2020. @*Results@#The RCC developed the protocol for evaluating and measuring 27 cancer-related symptoms, conducted education for PHC nurses, and administered case counseling. The staff at the PHC registered, evaluated, and routinely monitored patients through home visits. A smartphone application and regular video conferences were incorporated to facilitate mutual communication. In total, 177 patients (mean age: 70.9 years; men: 59%) were enrolled from February 2019 to February 2020. Patients’ greatest unmet need was the presence of a nearby cancer treatment hospital (83%). In total, 28 (33%) and 44 (52%) participants answered that the care model was very helpful or helpful, respectively. @*Conclusion@#We confirmed that a combined RCC-PHC program for cancer patients in rural areas is feasible and can bring satisfaction to patients as a safety care network. This program could mitigate health inequalities caused by accessibility issues.

Correlational Analysis of Bone Health Status and Vitamin D-Related Biomarkers in Women Working in Agriculture

Objective@#The purpose of this study was to investigate the status of bone health in women working in agriculture and analyze the associations between bone health and various vitamin D-related biomarkers. @*Methods@#This observational study enrolled women working in agriculture (n = 210) and control occupations (n = 180). The concentration of serum total 25-hydroxy vitamin D [25(OH)D] was measured using the Elecsys Vitamin D Total Kit, and serum vitamin D-binding protein (VDBP) was measured by enzyme-linked immunosorbent assay (ELISA). Along with albumin, 25(OH)D and VDBP were used to calculate the concentrations of bioavailable and free 25(OH)D. Bone mineral density (BMD) and T-score were measured at lumbar 1–4 and the femur neck using dual-energy X-ray absorptiometry. To identify factors affecting BMD, log-linear model and linear regression analysis were performed for statistical analysis. @*Results@#Agricultural women workers showed higher serum concentrations of bioavailable 25(OH)D (12.8 ± 3.7 vs. 8.7 ± 5.1 ng/mL) and lower VDBP concentrations (201.8 ± 45.0 vs. 216.0 ± 68.2 μg/ mL) than control women. The association between these two vitamin D related-biomarkers and femur neck BMD were confirmed through univariable and multivariable linear model analysis. Although lumbar BMD did not differ between groups, the agricultural group displayed a lower femur BMD and a 4.3-fold increase in the risk of osteoporosis compared with the control group. @*Conclusions@#Women working in agriculture showed lower femur BMD than the control group. Of the vitamin D-related biomarkers tested, bioavailable 25(OH)D and VDBP were associated with BMD. As bioavailable 25(OH)D levels are affected mainly by VDBP levels, VDBP may play a role in the lower femur neck BMD values observed in the agricultural group. Thus, the measurement of VDBP concentration might be considered a simple and non-invasive method for measuring bone health status.

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.

Cohort Profile: Firefighter Research on the Enhancement of Safety and Health (FRESH), a Prospective Cohort Study on Korean Firefighters

40 years or new hires with less than 1 year of service.

What is the Role of Coordinators in the Secondary Fracture Prevention Program?

Background@#The purpose of this study is to search for reports on the clinical effectiveness of FLS being implemented worldwide through the systematic review, analyze the roles of coordinators in each study, and provide basic data for the development of future coordinator education programs. @*Methods@#A systematic search of the literature using the Medline, PubMed, and EMBASE databases and the Cochrane Library was conducted for using the following keywords: ‘osteoporosis’ AND ‘fractures’ AND ’secondary prevention’. Finally, 65 studies are included in this study. @*Results@#At the coordinator-based fracture liaison service (FLS) center, the coordinator (often a nurse) acts as a central player in the establishing of patient connections, orthopedic surgeons, radiologists, and attending physicians. Coordinators help bridge the nursing gap by supporting identification, investigation, initiation of treatment, and patient follow-up. Medics has opened the way to effectively manage patients at high risk of developing another fracture. In addition, nurses are in a unique and important role as nurses responsible for enhancing their daily lives by building relationships with patients and families. @*Conclusions@#The coordinator in the FLS program plays an important role in the multidisciplinary management of vulnerable fractures, as well as in the diagnosis and treatment of osteoporosis and in maintaining continuity of treatment. In the future, the broader role of coordinators should be systematically organized and developed into accredited educational programs.

Individual-level Associations Between Indicators of Social Capital and Alcohol Use Disorders Identification Test Scores in Communities With High Mortality in Korea / 예방의학회지

Objectives@#This study examined associations among social capital indicators (social participation and generalized trust) at the individual level and alcohol use, which was quantified using Alcohol Use Disorders Identification Test (AUDIT) scores. @*Methods@#In total, there were 8800 participants in community health interviews, including 220 adults sampled systematically from a resident registration database of each of 40 sub-municipal administrative units of local (city or county) governments. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated using polychotomous logistic regression. @*Results@#The aORs for abstainers versus people with AUDIT scores of 0-7, based on 3 questions on generalized trust, in comparison to those with no positive responses, were 1.15 (95% CI, 0.99 to 1.34) for 1 positive response, 1.16 (95% CI, 0.98 to 1.37) for 2 positive responses; and 1.39 (95% CI, 1.20 to 1.61) for 3 positive responses. The aORs for abstainers versus people with AUDIT scores of 0-7, in comparison to participation in no organizations, were 0.61 (95% CI, 0.54 to 0.69) for participation only in informal organizations; 2.16 (95% CI, 1.57 to 2.99) for participation only in religious organizations; 2.41 (95% CI, 1.10 to 5.29) for participation only in volunteer organizations; and 0.65 (95% CI, 0.57 to 0.74) for participation in formal organizations. Participants in formal social organizations, regardless of their participation in informal organizations, were more likely to have AUDIT scores of 8-15 (aOR, 1.29; 95% CI, 1.04 to 1.60) or ≥16 (aOR, 1.65; 95% CI, 1.22 to 2.23) than to have scores of 0-7. @*Conclusions@#Our findings may have implications for health policy to reduce alcohol problems.

Performance of a Community-based Noncommunicable Disease Control Program in Korea: Patients 65 Years of Age or Older

Background@#In Korea, the Korean Community-based Noncommunicable Disease Prevention and Control Program (KCNPC) was implemented in 2012 for the management of patients with chronic diseases. Nineteen primary care clinics, public health centers, and education and consulting centers (ECCs) participated in the implementation of this program. This study assessed the effectiveness of this chronic disease control model by comparing mortality rate and the incidence of complications between patients participating in the KCNPC program and a control group. @*Methods@#Using data from the National Health Insurance Service and data from hypertension and diabetes patients registered with 19 ECCs between January 1, 2010 and December 31, 2012, hypertension and diabetes patients who had been treated at a clinic were selected. The final analysis included 252,900 patients, with the intervention group and control group having 126,450 patients each. Survival for the two groups was analyzed using the Kaplan-Meier method. Complications were analyzed using the Cox proportional hazards model. @*Results@#The 5-year survival rate in the intervention group (0.88) was higher than that in the control group (0.86). Cox proportional hazards analysis showed that the intervention group had lower risk for mortality (0.84; 95% confidence interval [CI], 0.82–0.86) compared to the control group. Hospitalization due to complications and the proportional risk of hospitalization were also lower in the intervention group. @*Conclusion@#The KCNPC model for prevention and control of chronic disease in Korea was found to be effective for hypertension and diabetes patients. Therefore, the KCNPC will be necessary to strengthen the capabilities of local communities, primary medical institutions, and individuals for prevention and control of chronic disease. Expanding the efficient prevention and control policies of the KCNPC to a nationwide scale may be effective as has been demonstrated through limited implementation in some regions.

Anthropometric analysis of the eyeball exposure area in Koreans

Background@#Eyelids vary in morphology and structure depending on age, sex, and race. Usually, one-dimensional measurements are used to evaluate blepharoplasty outcomes. However, in recent years, three- or four- directional enlargements of the eyelid have been used for blepharoplasty in Asian patients, and the outcomes of techniques such as lateral canthoplasty or canthotomy and medial epicanthoplasty with increased scleral area cannot be analyzed using marginal reflex distance 1 or the area of corneal exposure. Therefore, we describe the use of a measurement method based on the eyeball exposure area (EEA). @*Methods@#To obtain normal EEA values by age and sex, 320 individuals were recruited. The participants were divided into eight age groups (n=40 in each group: female subjects, n=20; male subjects, n=20): 10–19, 20–29, 30–39, 40–49, 50–59, 60–69, 70–79, and 80–89 years. The EEA value was obtained by dividing the exposed area by the total eyeball area. The normal EEA values and differences in EEA according to age and sex were calculated. @*Results@#The mean EEA values for male and female subjects were 66.86% ±9.20% and 71.48%±10.48%, respectively. In each age group, the EEA values of females were higher than those of males. EEA decreased significantly with age in both male and female subjects (P<0.05). @*Conclusions@#We determined normal EEA values according to age and sex. EEA can be used as an indicator of the outcome of blepharoplasty.

Directions and Current Issues on the Policy of Prevention and Management for Hypertension and Diabetes, and Development of Chronic Disease Prevention and Management Model in Korea / 農村醫學 地域保健

Objectives@#The purpose of this manuscript was to propose the policy and perspectives of prevention and management for hypertension and diabetes in Korea. @*Methods@#Authors reviewed the chronic disease prevention and management projects and models were executed in Korea until now, and analyzed and evaluated their performances. @*Results@#In the circumstances of Korea, the following several requisites should be improved ; Specific Korean strategy for development and pursuing of national level policy agenda for chronic disease management must be established. There are a need to establish several means of supplementing the weaknesses of the current chronic disease management policies and programs. Firstly, development and distribution of contents of guidelines on the systematic project execution regime (regarding systematization of local community, subjects and contents of the projects) with guarantee for the quality of chronic disease prevention and management are necessary. Secondly, there is a need for development of information system that can lead the chronic disease management programs currently being implemented. Thirdly, there is urgent need to develop resources such as cultivation of manpower and facilities for provision of education and consultation for the patients and holders of risk factors of chronic disease. Fourthly, there is a need for means of securing management system and financial resources for operation of policies and programs. @*Conclusions@#The results can be able to use as a road map, models, and direction and strategies of policies for chronic disease prevention and management of Korea.

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.

The Effect of Health Promotion Program on the Frailty of Rural Elderly Women Implemented at Primary Health Care Posts / 農村醫學 地域保健

OBJECTIVE: This study was conducted to examine the effects of a health promotion program on the health condition of rural elderly women implemented at primary health care posts using Korean Frailty Index. METHODS: The research was designed a nonequivalent control group pretest-posttest setting. The participants in this study were 50 residents (intervention group: 25, control group: 25) selected from 4 villages 2 primary health care posts in J city Gyeongsangnam-do. The health promotion program was conducted at the primary health care posts twice a week for 12 weeks. This program consisted of basic exercises(Gukseondo + Theraband muscle strength training) and additional activities(including modified Theraband activity, rubber ball exercise, ball massage, nutrition class, singing class). Collected data were analyzed by descriptive statistics, paired t-test, and repeated measures ANOVA with SPSS 21.0. RESULTS: Results of the health promotion program showed that the health conditions(measured by perceived health status, frailty score, upper/lower flexibility, maximum grip strength, dynamic balance test Timed Up and Go) of the experimental group(25) all statistical significantly improved. CONCLUSION: Study findings indicate that the health promotion program implemented at primary health care posts on rural elderly women is effective and can contribute to a developed health promotion program for local residents in the future.

Prevalence of Upper Extremity Musculoskeletal Diseases and Disability among Fruit Tree Farmers in Korea: Cross-Sectional Study

PURPOSE: The aim of this study was to examine the prevalence of upper extremity musculoskeletal (MSK) diseases and to identify factors influencing disability among fruit tree farmers in Korea. MATERIALS AND METHODS: Of the 1150 subjects of the Namgaram study, 460 fruit tree farmers completed a questionnaire and underwent clinical evaluations, including physical assessments, laboratory tests, simple radiographic examinations, and magnetic resonance imaging studies of the upper extremities. Disability was assessed using the Disabilities of the Arm, Shoulder, and Hand outcome measure. Data were analyzed with descriptive statistics and regression analyses using SPSS Win 24.0. RESULTS: The prevalences of upper extremity MSK diseases were 60.4% for rotator cuff tear, 20.9% for golf elbow, 40.9% for tennis elbow, and 58.0% for hand osteoarthritis. Disability in fruit farmers was associated with female sex (B=−4.47, p<0.001), smoking (B=−4.00, p=0.026), depression (B=2.83, p<0.001), working hours (B=0.96, p=0.001), injuries of the arms (B=10.78, p<0.001) and shoulders (B=6.75, p<0.001), and numbers of upper extremity MSK diseases (B=2.02, p=0.001), with 26.5% of the variance explained (R2=0.265, Durbin-Watson test=1.81, p<0.001). CONCLUSION: Fruit tree farmers remain at risk for MSK diseases of the upper extremities. Disability tended to worsen with more MSK diseases. It is necessary to not only educate farmers about prevention strategies, but also to develop an effective management system for agricultural work-related MSK diseases and a surveillance system at the government level for the health problems of farmers.

Incidence and Mortality of Osteoporotic Refractures in Korea according to Nationwide Claims Data

PURPOSE: Studies on the incidence and mortality of refractures after primary osteoporotic fracture are limited by the relatively rare incidence of such refractures and small sample sizes. The objectives of this research were: 1) to determine the incidence of osteoporotic refractures and fracture locations and 2) to assess mortality rates associated with osteoporotic refracture over a median follow up of 3 years using nationwide claim database. MATERIALS AND METHODS: Patients over 50 years of age who had an osteoporotic fracture that was confirmed operationally were enrolled. Refracture was defined as that after 6 months of an untreated period. Mortality rate was calculated using the Charlson comorbidity index and was analyzed using Cox proportional hazards regression analysis. RESULTS: A total of 18956 first-time instances of osteoporotic fracture were reported between 2007 and 2012 after a median follow up of 3.1 years (range, 1 to 7 years). Among 18956 patients, 2941 (15.50%) experienced refracture. After follow up for 1 year, cumulative mortality rates for re-fracture and non-refracture groups were 9.1% and 7.2%, respectively. After adjusting for covriates, mortality rate was 1.2 times greater in patients with re-fracture than in patients without re-fracture over a median follow up of 3 years (hazard ratio: 1.20, 95% confidence interval: 1.08–1.34, p<0.001). CONCLUSION: The incidence of osteoporotic re-fracture in this nationwide study was 15.5%, and the mortality rate of re-fracture patients was 1.2 times higher than that of non-refracture patients over a median follow up of 3 years.

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.

Effect of Burnout on Post-traumatic Stress Disorder Symptoms Among Firefighters in Korea: Data From the Firefighter Research on Enhancement of Safety & Health (FRESH) / 예방의학회지

OBJECTIVES@#It is well-known that post-traumatic stress disorder (PTSD) among firefighters contributes to their job-related stress. However, the relationship between burnout and PTSD in firefighters has rarely been studied. This study therefore explored the association between burnout and its related factors, such as trauma and violence, and PTSD symptoms among firefighters in Korea.@*METHODS@#A total of 535 firefighters participated in the Firefighter Research on Enhancement of Safety & Health study at 3 university hospitals from 2016 to 2017. The 535 participants received a baseline health examination, including questionnaires assessing their mental health. A Web-based survey was also conducted to collect data on job-related stress, history of exposure to violence, burnout, and trauma experience. The associations among burnout, its related factors, and PTSD symptoms were investigated using structural equation modeling.@*RESULTS@#Job demands (β=0.411, p<0.001) and effort-reward balance (β=-0.290, p<0.001) were significantly related to burnout. Burnout (β=0.237, p<0.001) and violence (β=0.123, p=0.014) were significantly related to PTSD risk. Trauma (β=0.131, p=0.001) was significantly related to burnout; however, trauma was not directly associated with PTSD scores (β=0.085, p=0.081).@*CONCLUSIONS@#Our results show that burnout and psychological, sexual, and physical violence at the hands of clients directly affected participants’ PTSD symptoms. Burnout mediated the relationship between trauma experience and PTSD.

The Association of Perceived Neighborhood Walkability and Environmental Pollution With Frailty Among Community-dwelling Older Adults in Korean Rural Areas: A Cross-sectional Study / 예방의학회지

OBJECTIVES@#The aim of this study was to evaluate the associations of frailty with perceived neighborhood walkability and environmental pollution among community-dwelling older adults in rural areas.@*METHODS@#The participants were 808 community-dwelling men and women aged 65 years and older in 2 rural towns. Comprehensive information, including demographics, socioeconomic status, grip strength, polypharmacy, perceived neighborhood environment (specifically, walkability and environmental pollution), and frailty, was collected from participants using face-to-face interviews conducted between June and August 2018. Perceived neighborhood walkability was measured using 20 items that were selected and revised from the Neighborhood Environment Walkability Scale, the Neighborhood Walkability Checklist from the National Heart Foundation of Australia, and the Physical Activity Neighborhood Environment Survey. The Kaigo-Yobo Checklist was used to assess participants’ frailty.@*RESULTS@#The overall prevalence of frailty in this community-dwelling population was 35.5%. Sex, age, cohabitation status, educational attainment, employment status, grip strength, and polypharmacy were significantly associated with frailty. In the logistic regression analysis, frailty was associated with low perceived neighborhood walkability (adjusted odds ratio [aOR], 0.881; 95% confidence interval [CI], 0.833 to 0.932; p<0.001) and severe perceived neighborhood environmental pollution (aOR, 1.052; 95% CI, 1.017 to 1.087; p=0.003) after adjusting for sex, age, cohabitation status, educational attainment, employment status, monthly income, grip strength, and polypharmacy.@*CONCLUSIONS@#More studies are warranted to establish causal relationships between walkability and environmental pollution and frailty.