Impact of Comorbid Disease Burden on Clinical Outcomes of Female Acute Myocardial Infarction Patients / 전남의대학술지

Owing to the paucity of information on the clinical outcomes in female patients with acute myocardial infarction (AMI) in relation to the comorbid disease burden, we explored the differences in their clinical outcomes and identified predictive indicators.A total of 3,419 female AMI patients were stratified into two groups: Group A (those with zero or one comorbid diseases) (n=1,983) and Group B (those with two to five comorbid diseases) (n=1,436). Five comorbid conditions were considered: hypertension, diabetes mellitus, dyslipidemia, prior coronary artery disease, and prior cerebrovascular accidents. The primary outcome was major adverse cardiac and cerebrovascular events (MACCEs). The incidence of MACCEs was higher in Group B than in Group A in both the unadjusted and propensity score-matched data. Among the comorbid conditions, hypertension, diabetes mellitus, and prior coronary artery disease were found to be independently associated with an increased incidence of MACCEs. Higher comorbid disease burden was positively associated with adverse outcomes in the female population with AMI. Since both hypertension and diabetes mellitus are modifiable and independent predictors of adverse outcomes after AMI, it may be necessary to focus on the optimal management of blood pressure and glucose levels to improve cardiovascular outcomes.

Difference of Clinical Outcomes According to Left Ventricular Hypertrophy and Its Subtype in Korean Patients with Acute Myocardial Infarction / 대한내과학회지

Background/Aims@#Left ventricular hypertrophy (LVH) on clinical outcomes in patients with acute myocardial infarction (AMI) is not clear. This study was performed to investigate the effect of abnormal left ventricular geometry on clinical outcomes in Korean patients with AMI. @*Methods@#A total of 852 consecutive patients with AMI were divided into two groups: normal left ventricular geometry (n = 470; 389 males) and LVH (n = 382; 214 males) groups. Major adverse cardiac events (MACEs) were defined as cardiac death, recurrent myocardial infarction, and rehospitalization. @*Results@#During the clinical follow-up period of 21 ± 7.8 months, MACEs developed in 173 patients (20.0%), and the rate was higher in the LVH than normal left ventricular geometry groups (25.5% vs. 16.0%, respectively, p = 0.001). According to Kaplan-Meier survival curves, the MACE-free survival rate was significantly lower in the LVH group than in the left ventricular geometry group (p = 0.008). The rates of MACEs and all-cause mortality differed among the AMI with concentric remodeling, concentric hypertrophy, and eccentric hypertrophy subgroups (11.2% vs. 15.5% vs. 22.1%, respectively, p = 0.046). Eccentric hypertrophy was a predictive factor of MACE according to Cox proportional hazards analysis (hazard ratio 1.804, confidence interval 1.034-3.148, p = 0.038). @*Conclusions@#LVH is a predictor of poor outcomes in patients with AMI, and eccentric hypertrophy is associated with a worse prognosis compared with concentric remodeling and concentric hypertrophy. Therefore, Korean patients with AMI and LVH, especially eccentric hypertrophy, require more careful observation and intensive treatment.

Predictors of Ischemic Cardiomyopathy in Patients with Acute Myocardial Infarction who Underwent Percutaneous Coronary Intervention / 대한내과학회지

Background/Aims@#Many patients with acute myocardial infarction (AMI) suffer from heart failure due to progressive ischemic left ventricular (LV) remodeling. This study investigated the predictors of ischemic cardiomyopathy (ICMP) in patients with AMI who underwent successful percutaneous intervention. @*Methods@#A total of 547 patients with AMI were divided into two groups: ICMP (n = 66, 67.1 ± 11.9 years, 78.8% males) and non-ICMP (n = 481, 62.5 ± 12.2 years, 70.1% males). @*Results@#On echocardiography, the LVEF was significantly decreased (41.7 ± 10.5 vs. 55.4 ± 10.3%, p 55 mm (OR 4.511, 95% CI 1.561–13.038, p = 0.005), and ratio of early mitral inflow velocity to mitral annular early diastolic velocity (E/e’) ≥ 15 (OR 3.270, 95% CI 1.168–9.155, p = 0.024) were independent predictors of ICMP development. @*Conclusions@#The present study demonstrates that a larger LV size, lower LV function, and increased E/e’ (≥ 15) were independent predictors of ICMP. Therefore, the development of ICMP should be carefully monitored in AMI patients with these features.

Difference of Clinical Outcomes According to Left Ventricular Hypertrophy and Its Subtype in Korean Patients with Acute Myocardial Infarction / 대한내과학회지

Background/Aims@#Left ventricular hypertrophy (LVH) on clinical outcomes in patients with acute myocardial infarction (AMI) is not clear. This study was performed to investigate the effect of abnormal left ventricular geometry on clinical outcomes in Korean patients with AMI. @*Methods@#A total of 852 consecutive patients with AMI were divided into two groups: normal left ventricular geometry (n = 470; 389 males) and LVH (n = 382; 214 males) groups. Major adverse cardiac events (MACEs) were defined as cardiac death, recurrent myocardial infarction, and rehospitalization. @*Results@#During the clinical follow-up period of 21 ± 7.8 months, MACEs developed in 173 patients (20.0%), and the rate was higher in the LVH than normal left ventricular geometry groups (25.5% vs. 16.0%, respectively, p = 0.001). According to Kaplan-Meier survival curves, the MACE-free survival rate was significantly lower in the LVH group than in the left ventricular geometry group (p = 0.008). The rates of MACEs and all-cause mortality differed among the AMI with concentric remodeling, concentric hypertrophy, and eccentric hypertrophy subgroups (11.2% vs. 15.5% vs. 22.1%, respectively, p = 0.046). Eccentric hypertrophy was a predictive factor of MACE according to Cox proportional hazards analysis (hazard ratio 1.804, confidence interval 1.034-3.148, p = 0.038). @*Conclusions@#LVH is a predictor of poor outcomes in patients with AMI, and eccentric hypertrophy is associated with a worse prognosis compared with concentric remodeling and concentric hypertrophy. Therefore, Korean patients with AMI and LVH, especially eccentric hypertrophy, require more careful observation and intensive treatment.

Association between Body Mass Index and Prevalence of Asthma in Korean Adults / 전남의대학술지

We evaluated the association between body mass index (BMI) and the prevalence of asthma. Using data from the 2015 Korean Community Health Survey, 214,971 participants aged between 19 and 106 years were included in this study. Asthma was defined based on the self-report of physician diagnosis. BMI was classified as underweight (<18.5 kg/m²), normal weight (18.5 kg/m²≤BMI<23.0 kg/m²), overweight (23.0 kg/m²≤ BMI<27.4 kg/m²), and obese (≥27.5 kg/m²) based on the BMI categories for Asians by the World Health Organization. Multiple logistic regression analysis was performed with sampling weights to evaluate the association between BMI and asthma after adjusting for age, educational level, income, type of residential area, smoking status, alcohol consumption, physical activity, hypertension, and diabetes. In men, BMI had an inverted J-shaped association with the prevalence of asthma, with an odds ratio of 1.88 (95% confidence interval [CI]: 1.89–2.24) for underweight and 1.12 (95% CIs: 0.97–1.29) for obesity. In women, BMI had a J-shaped association with the prevalence of asthma, with an odds ratio of 1.05 (95% CIs: 0.91–1.22) for underweight and 2.29 (95% CIs: 2.06–2.56) for obesity. In conclusion, in a nationally representative sample of Korean adults, the association between BMI and the prevalence of asthma varied between the sexes. This suggests that malnutrition and obesity are involved in the pathophysiology of asthma.

Impact of Gender Differences in Elderly Patients with Acute Myocardial Infarction / 대한내과학회지

BACKGROUND/AIMS@#It is well known that gender differences are associated with clinical outcomes in patients with acute myocardial infarction (AMI). However, it is not clear whether gender differences affect the prognosis of elderly patients with AMI.@*METHODS@#We analyzed the incidence of in-hospital complications and mortality in the Korea Acute Myocardial Infarction Registry-National Institutes of Health from November 2011 to June 2015. This study included elderly patients (≥ 75 years) diagnosed with AMI.@*RESULTS@#A total of 2,953 patients were eligible for this study. Among them, 1,529 (51.8%) patients were female, and the mean age of the female group was older than that of the male group (80.7 ± 4.4 vs. 79.6 ± 4.0 years, respectively, p < 0.001). Elderly females utilized emergency medical services less frequently compared with elderly males (11.5 vs. 15.4%, respectively, p < 0.001). Elderly female AMI patients had a similar rate of in-hospital mortality compared with elderly males (7.1 vs. 8.4%, respectively, p = 0.196). The rate of major cardiac adverse events (MACEs) was lower in elderly females than males during a 12-month follow-up (hazard ratio [HR] 1.19, 95% confidence interval [CI] 1.00-1.41, p = 0.045). According to multivariate analysis, the male gender is an independent factor for predicting 1-year MACEs (HR 1.37, 95% CI 1.14-1.65, p < 0.001).@*CONCLUSIONS@#No significant differences in peri-procedural complications or in-hospital mortality were observed between male and female elderly patients with AMI. However, elderly female patients had a more favorable prognosis than male patients during a 1-year clinical follow-up.

Clinical characteristics and outcomes in acute myocardial infarction patients with versus without any cardiovascular risk factors

BACKGROUND/AIMS@#Although cardiovascular (CV) risk factors are well established, some patients experience acute myocardial infarction (AMI) even without any risk factors.@*METHODS@#We analyzed total 11,390 patients (63.6 ± 12.6 years old, 8,401 males) with AMI enrolled in Korea Acute Myocardial Infarction Registry-National Institute of Health from November, 2011 to December, 2015. Patients were divided into two groups according to the presence of any CV risk factors (group I, without risk factors, n = 1,420 [12.5%]; group II, with risk factors, n = 9,970 [87.5%]). In-hospital outcomes were defined as in-hospital mortality and complications. One-year clinical outcomes were defined as the composite of major adverse cardiac events (MACE).@*RESULTS@#Group I was older (67.3 ± 11.6 years old vs. 63.0 ± 12.7 years old, p < 0.001) and had higher prevalence of female gender (36.2% vs. 24.8%, p < 0.001) than the group II. Group I experienced less previous history of angina pectoris (7.0% vs. 9.4%, p = 0.003) and the previous history of cerebrovascular accidents (3.4% vs. 6.9%, p < 0.001). In-hospital mortality (2.6% vs. 3.0%, p = 0.450) and complications (20.6% vs. 20.0%, p = 0.647) were no differences between the groups. And 1 year clinical outcomes (5.7% vs. 5.1%, p = 0.337) were no differences between the groups. In multivariate logistic regression analysis, serum creatinine level (hazard ratio, 1.35; 95% confidence interval, 1.05 to 1.75; p = 0.021) were independent predictors of 1 year MACE in patients without any CV risk factors.@*CONCLUSIONS@#Elderly female patients were prone to develop AMI even without any modifiable CV risk factors. We suggest that more intensive care is needed in AMI patients without any CV risk factors who have high serum creatinine levels.

Impact of Gender Differences in Elderly Patients with Acute Myocardial Infarction / 대한내과학회지

BACKGROUND/AIMS: It is well known that gender differences are associated with clinical outcomes in patients with acute myocardial infarction (AMI). However, it is not clear whether gender differences affect the prognosis of elderly patients with AMI. METHODS: We analyzed the incidence of in-hospital complications and mortality in the Korea Acute Myocardial Infarction Registry-National Institutes of Health from November 2011 to June 2015. This study included elderly patients (≥ 75 years) diagnosed with AMI. RESULTS: A total of 2,953 patients were eligible for this study. Among them, 1,529 (51.8%) patients were female, and the mean age of the female group was older than that of the male group (80.7 ± 4.4 vs. 79.6 ± 4.0 years, respectively, p < 0.001). Elderly females utilized emergency medical services less frequently compared with elderly males (11.5 vs. 15.4%, respectively, p < 0.001). Elderly female AMI patients had a similar rate of in-hospital mortality compared with elderly males (7.1 vs. 8.4%, respectively, p = 0.196). The rate of major cardiac adverse events (MACEs) was lower in elderly females than males during a 12-month follow-up (hazard ratio [HR] 1.19, 95% confidence interval [CI] 1.00-1.41, p = 0.045). According to multivariate analysis, the male gender is an independent factor for predicting 1-year MACEs (HR 1.37, 95% CI 1.14-1.65, p < 0.001). CONCLUSIONS: No significant differences in peri-procedural complications or in-hospital mortality were observed between male and female elderly patients with AMI. However, elderly female patients had a more favorable prognosis than male patients during a 1-year clinical follow-up.

Impacts of Diastolic Function on Clinical Outcomes in Young Patients with Acute Myocardial Infarction / 대한내과학회지

BACKGROUND/AIMS: The impact of left ventricular (LV) diastolic function and filling pressure on clinical outcomes in young patients with acute myocardial infarction (AMI) has been poorly studied. Therefore, the aim of this study was to investigate the impact of LV diastolic function and LV filling pressure on major adverse cardiac events (MACEs) in young patients with AMI. METHODS: A total of 200 young patients (males < 45 year, females < 55 year) with AMI were divided into two groups according to the diastolic function; normal (n = 46, 39.5 ± 5.3 years) versus abnormal (n = 154, 43.5 ± 5.1 years). RESULTS: Despite regional wall motion abnormalities, normal LV diastolic function was not uncommon in young AMI patients (23.0%). During the 40 months of clinical follow-up, MACEs developed in 26 patients (13.0%); 14 re-percutaneous coronary intervention (7.0%), 8 recurrent MI (4.0%), and 4 deaths (2.0%). MACEs did not differ between the normal and abnormal diastolic function group (13.6% vs. 10.9%, p = 0.810), but MACEs were significantly higher in the high LV filling pressure group than the normal LV filling pressure group (36.8% vs. 10.5%, p < 0.001). On multivariate analysis, high LV filling pressure was an independent predictor of MACEs (hazard ratio 3.022, 95% confidence interval 1.200–7.612, p = 0.019). CONCLUSIONS: This study suggested that measurement of the LV filling pressure (E/e' ratio) would be useful in the risk stratification of young patients with AMI. However, it would be necessary to monitor this category of patient more carefully.

Predictors of One-Year Mortality in Smokers with Acute Myocardial Infarction / 대한내과학회지

BACKGROUND/AIMS: It is well known that smoking is associated with clinical outcomes in patients with acute myocardial infarction (AMI). In this study, we aimed to predict the one-year mortality in AMI patients that smoked. METHODS: Of the AMI patients who were enrolled in the Korean Acute Myocardial Infarction Registry-National Institutes of Health study, 5,110 were current smokers (57.1 ± 11.6 years, male 95%), and these patients were included in the present study. Patients were divided into two groups; group I (survival group, n = 4,844, 56.5 ± 11.3 years, male 95%) and group II (deceased group, n = 266, male 88%). Clinical characteristics, coronary angiographic findings, procedural characteristics, and independent factors related to one-year mortality were analyzed. RESULTS: In group II, the incidence of hypertension and diabetes were significantly higher than in group I, and the patients were significantly older. Patients with history of angina pectoris, myocardial infarction, and heart failure were significantly more common in group II than in group I. Smoking duration and pack-years of smoking were also significantly longer in group II than in group I. Multivariate analysis revealed that creatine > 2 mg/dL, left ventricular ejection fraction < 40%, Killip class ≥ II, age ≥ 65 years, and post-percutaneous coronary intervention thrombolysis in myocardial infarction (post-PCI TIMI) flow ≤ II were independent factors of mortality during the one-year follow-up. CONCLUSIONS: The predictors of one-year mortality in AMI patients with smoking were renal and left ventricular dysfunction, high Killip class, old age, and low post-PCI TIMI flow.

Lead, Mercury, and Cadmium Exposure in the Korean General Population

BACKGROUND: Lead (Pb), mercury (Hg), and cadmium (Cd) are well-known environmental pollutants. They are unnecessary in the biological processes of humans. This study was performed to estimate the representative background exposure levels to the metals by measuring concentrations in whole blood of the Korean general population. METHODS: This population-based cross-sectional study included 4,000 subjects (1,886 males and 2,114 females) 0–83 years of age in 2010 and 2011. Adult subjects (≥ 19 years of age) were collected by sex- and age-stratified probability method, and preschool- and school-aged subjects were recruited by a cluster sampling method. Written consent was provided prior to blood sampling. Pb and Cd blood concentrations were determined by a flameless atomic absorption spectrophotometry, and blood Hg was analyzed by a direct Hg analyzer. RESULTS: The geometric mean, median and 95th percentile of blood Pb was 1.82 µg/dL, 1.83 µg/dL, and 3.78 µg/dL, respectively. The respective values were 2.92 µg/L, 2.87 µg/L, 9.12 µg/L for Hg, and 0.56 µg/L, 0.59 µg/L, 2.20 µg/L for Cd. Blood Pb and Hg were higher in males than in females, but no sex difference was observed, respectively, in subjects 0–4 years of age for Pb and in subjects less than 20 years for Hg. However, blood Cd was higher in females than in males and no sex difference was observed in subjects < 30 years of age. CONCLUSION: This study provides representative data of human exposure to Pb, Hg, and Cd covering whole age groups of the general population in Korea.

Korean research project on the integrated exposure assessment of hazardous substances for food safety

OBJECTIVES: This survey was designed to conduct the first nationwide dietary exposure assessment on hazardous substances including the intakes of functional food and herbal medicine. In this paper, we introduced the survey design and the results of the dietary exposure status and internal exposure levels of lead (Pb), cadmium (Cd), and mercury (Hg). METHODS: We selected 4867 subjects of all ages throughout Korea. We conducted a food survey, dietary survey, biomonitoring, and health survey. RESULTS: Pb and Cd were the highest (median value) in the seaweed (94.2 mug/kg for Pb; 594 mug/kg for Cd), and Hg was the highest in the fish (46.4 mug/kg). The dietary exposure level (median value) of Pb was 0.14 mug/kg body weight (bw)/d, 0.18 mug/kg bw/d for Cd, and 0.07 mug/kg bw/d for Hg. Those with a blood Pb level of less than 5.00 mug/dL (US Centers for Disease Control and Prevention, reference value for those 1 to 5 years of age) were 99.0% of all the subjects. Those with a blood Cd level with less than 0.30 mug/L (German Federal Environmental Agency, reference value for non-smoking children) were 24.5%. For those with a blood Hg level with less than 5.00 mug/L (human biomonitoring I, references value for children and adults, German Federal Environmental Agency) was 81.0 % of all the subjects. CONCLUSIONS: The main dietary exposure of heavy metals occurs through food consumed in a large quantity and high frequency. The blood Hg level and dietary exposure level of Hg were both higher than those in the European Union.

Korean research project on the integrated exposure assessment of hazardous substances for food safety

OBJECTIVES: This survey was designed to conduct the first nationwide dietary exposure assessment on hazardous substances including the intakes of functional food and herbal medicine. In this paper, we introduced the survey design and the results of the dietary exposure status and internal exposure levels of lead (Pb), cadmium (Cd), and mercury (Hg). METHODS: We selected 4867 subjects of all ages throughout Korea. We conducted a food survey, dietary survey, biomonitoring, and health survey. RESULTS: Pb and Cd were the highest (median value) in the seaweed (94.2 mug/kg for Pb; 594 mug/kg for Cd), and Hg was the highest in the fish (46.4 mug/kg). The dietary exposure level (median value) of Pb was 0.14 mug/kg body weight (bw)/d, 0.18 mug/kg bw/d for Cd, and 0.07 mug/kg bw/d for Hg. Those with a blood Pb level of less than 5.00 mug/dL (US Centers for Disease Control and Prevention, reference value for those 1 to 5 years of age) were 99.0% of all the subjects. Those with a blood Cd level with less than 0.30 mug/L (German Federal Environmental Agency, reference value for non-smoking children) were 24.5%. For those with a blood Hg level with less than 5.00 mug/L (human biomonitoring I, references value for children and adults, German Federal Environmental Agency) was 81.0 % of all the subjects. CONCLUSIONS: The main dietary exposure of heavy metals occurs through food consumed in a large quantity and high frequency. The blood Hg level and dietary exposure level of Hg were both higher than those in the European Union.

Changes of Risk factors of Metabolic Syndrome among the Elderly in the Rural Area after Two Years / 農村醫學 地域保健

OBJECTIVES: This study was performed to examine the healthy lifestyle influenced on the metabolic syndrome among the elderly in the rural area. We examined the changes of risk factors of metabolic syndrome after two years. METHOD: Out of 134 who did health screening at the J county health center from July 1 to August 31, 2006, 65 aged people confirmed to metabolism syndrome were selected as subjects. For the final analysis, 62 aged people who revisited after two years were selected our subjects. The data were analyzed using SPSS PC+ 12.0 program for descriptive, Chi-square test, t-test and ANOVA analysis. RESULT: The result of this study indicated that 62 metabolic syndrome patients in 2006 decreased into 53, and women were higher than men. The difference in the metabolic syndrome came from level of education, smoking, health practices, and past illness history. CONCLUSION: Therefore, the change of lifestyle needs to be induced by the level of education, and for the group of smoking, non-exercise, and past illness history not only regular checkups to prevent metabolic syndrome but also education to have interest on themselves may need intensively.

Relationship between White Blood Cell Counts and the Metabolic Syndrome / 農村醫學 地域保健

OBJECTIVES: This study was attempted to identify the relationship between white blood cell counts and the metabolic syndrome. METHODS: This study included 394 adults who visited the medical checkup center placed in Gwangju, January 1, 2008 to December 31, 2008. Index of blood test and physical checkup were performed on the study such as triglyceride, HDL-cholesterol, fasting sugar and white blood cell counts. Logistic regression analysis was used to evaluate the association between white blood cell counts, white blood cell differential count and metabolic syndrome with an adjustment age and smoking status. RESULTS: The prevalence rate of metabolic syndrome was 25.3% among males and 13.3% among females, and was particularly high among males in their 40s. The increase in white blood cell counts lead to high prevalence of metabolic syndrome for both males and females. As white blood cell counts increased, the values of body mass index and cardiovascular risk factors were increased significantly. The odds ratio for elevated white blood cell counts increased significantly in the subjects with each components of the metabolic syndrome compared to the subjects without them, The lymphocyte counts in the white blood cell differential counts were higher in patients with metabolic syndrome than in those without. CONCLUSIONS: High level of white blood cell counts in normal range can be used as indicator in chronic inflammation. Increased white blood cell counts were significantly associated with metabolic syndrome.

Accuracy of Death Certificates Completed by Medical Students / 農村醫學 地域保健

OBJECTIVES: The purpose of this research was to evaluate the ability of completing death certificates among medical students. METHODS: The self-administered questionnaires were completed, during May to August 2007, by 380 medical students in senior. The questionnaire was composed of 10 cases to write the death certificate. The cause-of-deaths written by students were compared with the gold standards and their errors in the certificates also evaluated. RESULTS: Mean agreement score for 10 underlying cause-of-deaths completed on the lowest line of part I in the death certificate (UC1) was 4.8+/-1.7, and for underlying cause-of-death selected by a coder of the death certificates (UC2) was 5.6+/-1.5. The UC1 and UC2 were significantly higher among the students having the case-oriented education for death certificate than others. For the major errors in the certificates completed by students, the students having the error with no antecedent cause were highest, the error with two or more conditions secondly highest. Mean number of errors was significantly lower in the case-oriented education group than others. CONCLUSIONS: Errors are common in the death certificates completed by medical students in senior. The accuracy of death certification may be more improved with the case-oriented education than the traditional method.

Effect of Exercise Program of a Public Health Subcenter for Middle and Old Aged Women in an Urban Area / 農村醫學 地域保健

OBJECTIVES: This study was to identify the changes of body fat, blood pressure, blood glucose and serum lipid of middle and old aged women after participation in exercise program which includes aerobic(dance sports) and anaerobic(dumbbell gymnastics) exercises. METHODS: One hundred women aged from 55 to 72 were surveyed before and after an exercise program. The exercise program was provided to the subjects performed during 6 months from July, 2007 to December, 2007 at a public health subcenter in Gumi City. Questionnaire survey for general characteristics, anthropometric measurement and blood test were taken before starting the program and anthropometric measurement and blood test after completing the program. RESULTS: Body Weight, body fat and blood pressure showed significant change after the exercise program(p0.05). Waite circumference decreased, however did not show statistically significant difference. CONCLUSIONS: It was effective to participate in dance sports and dumbbell gymnastics exercise regularly. All of the positive changes through the study showed that there should be the program for middle and old aged women to exercise actively and also the middle and old aged women need have a active exercise habits as regular as possible. Additional studies confirming the results of this study are needed to compare the effects of the dance sports and dumbbell gymnastics exercise on the other age groups.

Effect of Nutrition Support Program for the Elderly in a Rural Community / 農村醫學 地域保健

OBJECTIVES: This study was performed to assess the effects of nutrition support for the elderly in rural communities. METHODS: The data for this study were obtained from 148 aged over 65 years in G district(70 intervention group and 78 control group). General characteristics, physical health status, food intake, dietary habits, knowledge of nutrition and nutrition risk factors of the subjects were examined by individual interview. The participants were divided into two groups through the first questionnaire of nutrition: nutritional intervention group(nutritional intervention and education of nutrition) and control group(education of nutrition alone). RESULTS: Nutritional intervention group showed significant increase of energy intake to 87.4% from 71.0% and of most nutrients except vitamin A and niacin after intervention. After nutritional intervention program, depression index was significantly decreased and changes of food habits, self-efficacy and conviction indices were significantly increased. CONCLUSIONS: This study showed that the nutritional intervention serving foods for short-term intervention period was very effective in improving the nutritional status. In addition, it suggested that it was not enough for nutritional improvement of the elderly to provide public health education or counseling alone, therefore, for achieving its goals, it should be needed proper nutritional supply to them.

Clonorchis Sinensis Control Intervention at a Sumjin Riverside Area / 農村醫學 地域保健

OBJECTIVES: This study was performed to investigate the changes in the prevalence and its related factors of the Clonorchis sinensis(C.S.) in the inhabitants at Goksung-Gun along Sum-Jin river after C.S. control intervention. METHODS: The subjects were 416 among 699 in the 8 same villages selected by stratified cluster sampling in 1999. The formalin-esther sedimentaion technic was used for the C.S. egg detection and the questionnare for the related factors. The study was carried on from February, 2005 to March, 2005. RESULTS: The prevalence of C.S. decreased significantly from 19.0% in 1999 to 11.3% in 2005. The signicicant factors in 1999 such as sex, age, area, raw fish eating habit and drink habit were not significant statistically. On the other hand factors such as the awareness of C.S. and the health behavior were changed significantly(p=0.034, p=0.021). CONCLUSIONS: These results suggest that C.S. prevalence became lower than previous study five years ago. But its control intervention should be extened to the general population regardless of sex, age, area, raw fish eating habits, drink habit and we need to make an effort to improve the awareness and the health behavior of C.S..

Association between Health Risk Factors and Mortality over Initial 6 Year Period in Juam Cohort / 農村醫學 地域保健

OBJECTIVES: This study was conducted to investigate the association between health risk factors and mortality in Juam cohort. METHODS: The subjects were 1,447 males and 1,889 females who had been followed up for 68.5 months to 1 January 2001. Whether they were alive or not was confirmed by the mortality data of the National Statistical Office. A total of 289 persons among them died during the follow-up period. The Cox's proportional hazard regression model was used for survival analysis. RESULTS: Age, type of medical insurance, self cognitive health level, habit of alcohol drinking, smoking, exercise and BMI level were included in Cox's proportional hazard model by gender. The hazard ratio of age was 1.07(95% CI: 1.05-1.10) in men, 1.09(95% CI: 1.06-1.12) in women. The hazard ratio of medical aid(lower socioeconomic state) was 1.43(95% CI 1.02-2.19) in women. The hazard ratios of current alcohol drinking and current smoking were respectively 1.69(95% CI: 1.01-2.98), 1.52(95% CI: 1.02-2.28) in women. The hazard ratio of underweight was 1.56(95% CI 1.08-2.47) in men. The hazard ratios of underweight, normoweight, overweight, and obesity were respectively 1.63(95% CI: 1.02-2.67), 1.0(referent), 0.62(95% CI: 0.32-1.63), 1.27(95% CI: 0.65-3.06), which supported the U-shaped relationship between body mass index and mortality among the men over 65. CONCLUSIONS: The health risk factors increasing mortality were age, underweight in male, age, lower socioeconomic state, current alcohol drinking, current smoking in female. To evaluate long-term association between health risk factors and mortality, further studies need to be carried out.