Success and Barrier Factors of Integrated Health Promotion Program to Improve Health Indicators: Hypertension Registration Program in Goseong, Gangwon / 農村醫學 地域保健

OBJECTIVES: The purpose of this study was to examine the success and barrier factors of hypertension registration program in Goseong community health center proven improving hypertension treatment rate by community health survey. METHODS: We conducted a qualitative research using both a performance review of the program and in-depth interviews with the 8 operators who had worked for this program in April 2018. RESULTS: In this study, the success factors were analysed as follows: First, the willingness to improve health indicators, second, the implementation of large-scale projects, third, improving program processes, fourth, continuous efforts for achievement of goal, not output or reward, and the barrier factors are as follows. First, uniform output monitering, second, evaluation after the fashion of contest, third, the confusing concept of an integrated health promotion program, fourth, the attitude of the person worried with task change. CONCLUSIONS: This study suggested that the health community health center should follow the basic principles of public health, and the central government should introduce a health policy of decentralization.

Relationship between Sleep and Mental Health in Middle School Female Students / 農村醫學 地域保健

OBJECTIVES: The purpose of this study was to examine the relationship between sleep and mental health in middle school female students. METHODS: For this purpose, We analyzed the data of 15,477 for middle school female students among the 2016 Korea Youth Risk Behavior Web-based Survey by multiple logistic regression based on the complex sample design. RESULTS: Sleep duration of middle school female students in Korea were significantly associated with perceived stress, depressive experience, and suicidal idea, and subjective sleep satisfaction were significantly associated with perceived stress, depressive experience in results of multiple logistic regression. CONCLUSION: Sleep duration and subjective sleep satisfaction have a significant impact on the mental health of middle school female students. Therefore, in-depth research and policies to mental health of middle school female students through sleep duration and subjective sleep satisfaction increase are required.

Relationship between Health Behavior and Subjective Unhappiness in High School Students / 農村醫學 地域保健

OBJECTIVES: We studied the relationship between health behavior and subjective unhappiness in high school students. METHODS: Using 27,097 responses from the 2015 Korea Youth Risk Behavior Web-based Survey for general high school students. we analyzed by multiple logistic regression based on the complex sample design. RESULTS: Unhappiness was positively related with the low economic status, smoking, drinking, fast foods intake, and negatively related with fruit intake in results of multiple logistic regression. CONCLUSIONS: Health behaviors have a significant impact on the unhappiness of high school students. Therefore, in-depth research and policies to decrease unhappiness of high school students through health promotion are required.

Performances and Limitations of the Health Community Organization Project in 148 Village, Gangbuk-gu / 農村醫學 地域保健

OBJECTIVES: The purpose of this study was to examine the performances and limitations of health community building project of 148 village in Gangbuk-gu, Seoul on community health organization perspective. METHODS: We conducted a qualitative study using both a systematic review of this project and in-depth interviews with the operators who had worked for the project from January 2012 to December 2012. RESULTS: In this project, activists worked by gathering the opinions of the residents and focusing on their growth. The residents themselves established a community health care plan. Based on social determinants of health, they continued projects to solve residents' needs. A variety of programs were activated by providing a health cafe, which was an alternative public participation health promotion space that was not a clinic or a public health center. As the various entities gathered, there were difficulties related to interests and role sharing, and there were limitations such as the fact that the performance and limit of the pilot project could not be clearly predicted beforehand. CONCLUSIONS: This case suggested that new possibility of health and medical movement, approaching health issues by the way of community organization principle. Through the health community building project as community health organization perspective is expanded, health promotion effect will be created in the whole society.

Exploring the Non-Linear Relationship between Alcohol Consumption and Depression in an Elderly Population in Gangneung: The Gangneung Health Study

PURPOSE: The purpose of this study was to examine a J-shaped relationship between alcohol consumption and depression among the elderly in South Korea. MATERIALS AND METHODS: Cross-section data were drawn from a community-based sample of individuals 60 years of age and older (n=1819). Respondents completed the Alcohol Use Disorders Intensification Test (AUDIT) and the Korean Beck Depression Inventory. Using a regression approach, the effect of alcohol consumption as a non-linear effect was assessed in relation to gender, marital status, exercise, smoking, age, education, and physical and mental health. RESULTS: AUDIT total score were found to exert linear and quadratic effects that were significantly associated with higher depression scores among sample respondents. The results lend support to a J-shaped relationship between alcohol use and depression, wherein abstainers and problem drinkers were at a higher risk of depression. CONCLUSION: This study confirms a J-shaped (i.e., curvilinear) relationship between alcohol consumption and depression among elderly South Koreans, similar to that frequently found in studies of Western-based samples. The findings of this study, therefore, imply the applicability of the J-shaped relationship hypothesis for non-Western society samples and within different cultural contexts.

Exploring the Non-Linear Relationship between Alcohol Consumption and Depression in an Elderly Population in Gangneung: The Gangneung Health Study

PURPOSE: The purpose of this study was to examine a J-shaped relationship between alcohol consumption and depression among the elderly in South Korea. MATERIALS AND METHODS: Cross-section data were drawn from a community-based sample of individuals 60 years of age and older (n=1819). Respondents completed the Alcohol Use Disorders Intensification Test (AUDIT) and the Korean Beck Depression Inventory. Using a regression approach, the effect of alcohol consumption as a non-linear effect was assessed in relation to gender, marital status, exercise, smoking, age, education, and physical and mental health. RESULTS: AUDIT total score were found to exert linear and quadratic effects that were significantly associated with higher depression scores among sample respondents. The results lend support to a J-shaped relationship between alcohol use and depression, wherein abstainers and problem drinkers were at a higher risk of depression. CONCLUSION: This study confirms a J-shaped (i.e., curvilinear) relationship between alcohol consumption and depression among elderly South Koreans, similar to that frequently found in studies of Western-based samples. The findings of this study, therefore, imply the applicability of the J-shaped relationship hypothesis for non-Western society samples and within different cultural contexts.

The Immunogenicity of a Single Dose of Hepatitis A Virus Vaccines (Havrix(R) and Epaxal(R)) in Korean Young Adults

PURPOSE: Assessing the immunogenicity of a single dose of hepatitis A virus (HAV) vaccines is important because some people receive only a single dose. However, previous studies have shown variable results and have not examined the effects of demographic characteristics other than gender. This study was performed to examine the immunogenicity of a single dose of HAV vaccine according to the vaccine type and demographic characteristics in young adults. MATERIALS AND METHODS: Seronegative medical school students were randomly allocated to receive either Havrix or Epaxal. RESULTS: After approximately 11 months, the seroconversion rate in 451 participants was 80.7%. In men, the Havrix group showed a significantly higher seroconversion rate (81.9%) than the Epaxal group (69.2%), whereas both vaccine groups showed similarly high immunogenicity in women (Havrix: 90.1%, Epaxal: 92.9%; P for interaction=0.062). According to the results of a multivariate analysis, Epaxal showed significantly lower immunogenicity than Havrix only in men. Age, obesity, drinking, smoking, and follow-up time did not significantly affect seroconversion in either gender. CONCLUSION: The seroconversion rate of single-dose HAV vaccines was low in men, particularly in those who received Epaxal. Our results suggest that gender effects should be considered when comparing the immunogenicity of different HAV vaccines.

Pre- and Post-Angioplasty Perfusion CT with Acetazolamide Challenge in Patients with Unilateral Cerebrovascular Stenotic Disease

OBJECTIVE: Perfusion computed tomography (PCT) has the ability to measure quantitative value and produce maps of mean transit time (MTT), cerebral blood flow (CBF), and cerebral blood volume (CBV). We assessed cerebral hemodynamics by using these parameters and acetazolamide (ACZ) challenge for pre- and post-procedural evaluation in patients with unilateral cerebrovascular stenotic disease. METHODS: Thirty patients underwent pre-procedural PCT with ACZ challenge, and 24 patients (80%) was conducted follow up PCT after angioplasty with same protocol. The mean MTT, CBF, and CBV were measured and compared in both middle cerebral arterial (MCA) territories before and after ACZ challenge. Hemispheric ratio and percent change after ACZ challenge were calculated before and after angioplasty. RESULTS: The mean stenosis rate was 76.6%. Significant increases in MTT (32.6%, p=0.000) and significant decreases in CBF (-14.2%, p=0.000) were found in stenotic side MCA territories. After ACZ challenge, there were significant changes in MTT (37.4%, p=0.000), CBF (-13.1%, p=0.000), and CBV (-10.5%, p=0.001) in pre-procedural perfusion study. However, no significant increases were found in MTT, or decreases in CBF and CBV in post-procedural study. There were no significant changes after ACZ challenge also. In addition, the degrees of these changes (before and after ACZ challenge) were highly correlated with the stenotic degrees in pre-procedural perfusion study. CONCLUSION: PCT with ACZ challenge appears to be a useful tool to assess the cerebral perfusion status especially in patients with unilateral symptomatic stenotic disease.

The Prevalence of Chronic Diseases, Status of Health Behaviors and Medical Service Utilization: Focused on Female Blue-Collar Workers / 農村醫學 地域保健

OBJECTIVE: Despite the increasing number of female participation in employment, blue-collar women have been exposed to higher health risk. This study is to describe the prevalence of chronic diseases, health behaviors, and medical service utilization of female blue-collar workers. METHODS: Data were derived from the 2001 Korea National Health and Nutrition Survey (KNHANES). The sample was made up of 37,108 male and female participants aged 20 or over selected nation-wide by probability sampling from Korea. This study applied the logistic regression for nominal variables such as disease prevalence and health behaviors and with the regression for continuos variables such as the length and costs of medical services. RESULTS: In general, women's prevalence of chronic illness and uncured rate were significantly higher than male, and especially female blue-collar workers had the highest prevalence, uncured rate, unhealthy status, and perceived stress. However, the medical care cost was the lowest in female blue-collar workers. CONCLUSIONS: The findings suggest that female blue-collar workers were more likely to experience health problems, and that despite the highest health risk, health service is not effectively utilized, and health policy maker should take consider of special status of female blue collar workers who are in health inequality.

Identifying barriers to Papanicolaou smear screening in Korean women: Korean National Health and Nutrition Examination Survey 2005 / 부인종양

OBJECTIVE: This study was conducted to provide a nationwide analysis on barriers to cervical cancer screening in Korea. METHODS: Data used for this study was obtained in a survey called Korean National Health and Nutrition Examination Survey (KNHANES) 2005, which collected data from 2,590 Korean women aged older than 21 years who had not had a hysterectomy and were eligible for Papanicolaou (Pap) smears. Multivariate analysis was adopted to control each demographic factor and unhealthy behavior variable. Demographic factors included age, education, income, job and region; health-related behavior factors were defined as current smoking, obesity, hormone replacement therapy and disability. RESULTS: The study found that cervical cancer screening rate was significantly positively associated with income (odds ratio [OR], 1.002; 95% confidence interval [CI], 1.001 to 1.002), with education (OR, 1.324; 95% CI, 1.030 to 1.703), with job (OR, 1.420; 95% CI, 1.030 to 1.957), and with hormone replacement therapy (OR, 3.732; 95% CI, 2.354 to 5.916). Meanwhile, the age (OR, 0.977; 95% CI, 0.968 to 0.985), disability (OR, 0.358; 95% CI, 0.143 to 0.894) and smoking (OR, 0.447; 95% CI, 0.280 to 0.715) were significantly negatively associated with one's chances to take cervical cytology. CONCLUSION: In order to increase the rates of Korean women taking Pap test, cervical cancer screening programs will have to pay special attention to the elderly, low-income group, smokers, and the disabled.

Development of Health Service Weight for Resource Allocation and Performance Monitoring / 農村醫學 地域保健

OBJECTIVES: This study was conducted to estimate health service weight for resource allocation and performance monitoring using Basic Priority Rating System. METHODS: The Health service would be classified according to New Health Plan 2010, and Burden of disease collected from preceding studies. The data of severity of health problem and effectiveness of intervention were collected through the survey of experts' suggestion. The health service weight was estimated in the formula which is Basic Priority Rating System. RESULTS: In the result of analysis, the health service weight of Infectious disease was ranked highest at 58.97% followed by Anti-smoking campaign(14.07%), Hypertension(3.87%), Diabetes mellitus(3.40%), Cancer(2.90%), Cardiovascular-Cerebrovascular diseases(2.86%), Physical activity(2.10%), Moderate drinking(2.07%), Medical examination(1.92%), Mental health promotion(1.72%), Serious mental illnesses(1.62%), Nutrition(1.52%), Oral health promotion(1.15%), Oral diseases(1.10%), Addiction(0.73%). CONCLUSIONS: We think the result of this study provides a rational basis for resource allocation and performance monitoring of health service.

Health Status and Medical Utilization of Women in Rural Area / 農村醫學 地域保健

OBJECTIVES: This study was conducted to examine health inequality for gender and region in Korea. Especially it focused on health status such as disease prevalence and medical utilization of rural women. METHODS: Data from the Korea national health and nutrition survey in 2001 were used. The final sample size was 37,108 individuals with age 20 and over. This study applied the logistic regression for nominal variables such as disease prevalence and unmet care needs and with the regression for continuos variables such as the length and costs of medical services. RESULTS: Rates of disease prevalence and unmet care needs for chronic disease in rural area are higher than those in middle cities and big cities, and regional differences of those for women are more than those for mens with controlling ages. There could be interaction effect with region and sex. CONCLUSIONS: This study suggests that health policy maker should take consider of special status of rural women who are in health inequality.

Work-Family Conflict and Job Satisfaction of Two-Income Family / 대한산업의학회지

OBJECTIVES: Work-family conflict can arise from two opposite directions: the experiences at work interfere with family life and the experiences in the family interfere with work life. This study explored the effects of the presence of two income sources on the association between work-family conflict and job attitude. METHODS: Responses to structured survey questionnaires were received from 236 two-income families living in the Seoul Metropolitan Area. RESULTS: A differential effect was observed between single-income families and two-income families. Higher job satisfaction was related with lower work interference with family (WIF) among single-income families and with lower family interference with work (FIW) among two-income families. CONCLUSIONS: Employee welfare programs need to be expanded to enhance job satisfaction for the increasing number of two-income families.

Serum Lipid Profiles after Abstinence in Korean Male Patients With Alcohol Dependence

OBJECTIVES: The treatment of alcohol dependence requires maintaining abstinence. However, some previous studies have suggested that the abstinence may increase the cardiovascular risk in patients with alcohol dependence. The aim of the present study was to examine the effect of alcohol abstinence on lipid profile in Korean male patients with alcohol dependence. METHODS: Twenty-eight male patients with alcohol dependence were recruited from a psychiatric unit located at Gangneung Dongin Hospital. Lipid profiles of the patients were compared before and after a month of alcohol abstinence. RESULTS: After abstinence of 1 month, high-density lipoprotein(HDL) cholesterol and triglyceride(TG) level was significantly decreased(p=0.000; p=0.0086, respectively). Low-density lipoprotein(LDL) cholesterol level showed a tendency to increase(p=0.066). Total cholesterol level also showed a tendency to decrease (p=0.074). CONCLUSIONS: These results show that acute abstinence of alcohol might paradoxically aggravate dyslipidemia in patients with alcohol dependence. Thus, this study shows that more concern associated with cardiovascular risk is needed during short-term abstinence period.

The Effect of Work Conditions on Job Stress of Social Workers / 農村醫學 地域保健

OBJECTIVE: This study was conducted to investigate the effect of work conditions on job stress of social workers in Seoul. METHOD: For this survey, a self-reported questionnaire was administrated to 1,000 social workers working in all of organization for social welfare practice in Seoul. The number of responded questionnaires was 431. Multiple linear regression analysis was used for job stress as the dependent variables and control variables. RESULTS: The result of multiple linear regression analysis indicated that regular rest breaks had significantly effect on job stress level but long working hours did not. When regular rest breaks was guaranteed job stress of social workers significantly lowered 8.4 point. In addition standardized regression coefficients and partial R2 of regular rest breaks was the highest score among the variables. CONCLUSION: This study suggests that it is the most important to guarantee regular rest breaks in the work schedule in order to alleviate job stress of social workers.

Level of Job Stress among Social Workers at Social Welfare Agencies in Seoul / 대한산업의학회지

OBJECTIVES: To investigate the level and variation of job stress according to social welfare organizations and work conditions among social workers in Seoul. METHODS: For this survey, a self-reported questionnaire was administrated to 1,000 social workers working in organizations for social welfare practice in Seoul. A total of 432 completed questionnaires were received (43.2% response rate). RESULTS: Social workers working in welfare organizations for the aged had higher job stress in the areas of job demand, insufficient job control and lack of reward than those in other welfare organizations. In addition, higher job stress was found in those in charge of both service and administrational work, without regular time for rest, working over 10 hours, in the frontline and senior grade. CONCLUSIONS: This study confirms the importance of guaranteeing regular time for breaks in the work schedule and of considering the service and administrational work ratio in job arrangement in order to alleviate stress of social workers.

The Relationship of Alcohol Use and Stress / 신경정신의학

OBJECTIVES: This study was designed to assess the relationship between alcohol use and stress. METHODS: The study subjects were 1,261 people who drink among the 2,565 people who lived in Gangneung. We investigated the sociodemographic characteristics, Short Form-12 (SF-12), Global Assessment of Recent Stress (GARS) and Alcohol Use Disorder Identification Test (AUDIT). RESULTS: In Problem drinking group the GARS was significantly positively associated with the AUDIT (p=0.02). In Social drinking group sex (p<0.001) and age (p=0.02) is significantly associated with the AUDIT. CONCLUSION: This study showed the significantly positively association between stress and alcohol use. We think that the intervention and active management of the stress can prevent the alcohol problem.

Out-of-pocket health expenditures among adult Koreans with cancer / 대한내과학회지

BACKGROUND: Out-of-pocket health expenditures defined as the charges for services not covered by health insurance have received only sporadic attention. The purpose of this study was to determine the impact of sociodemographic and health characteristics on out-of-pocket health expenditures. METHODS: We used data from the 2001 National Public Health and Nutrition Survey, a nationally representative survey of community-dwelling individuals. The final sample size for this analysis was 61 individuals with age 20 and older cancer patients in Korea. Using a multiple linear regression model to control for differences in sociodemographics, self-reported health status, hospital length of stay, time since perception, and insurance status, the out-of-pocket health expenditures were estimated. RESULTS: Mean monthly out-of-pocket health expenditures were 399,300 won. The highest mean out-of-pocket health expenditures were paid by those with lung cancer, 820,000 won. In the regression analysis, insurance status, resident area, hospital length of stay, and time since perception were statistically significant determinants. Thus, those with higher hospital days, National Health Insurance, metropolitan, and more than 1 year of time since perception experienced higher economic burden. CONCLUSIONS: Policymakers should consider out-of-pocket health expenditure difference by diverse characteristics.

Determinants of Private Clinics' Productivity: a Comparison of City and County Clinics in Korea

This study was designed to assess determinants of private clinics' productivity, and to compare city and county clinics in South Korea. We analyzed the revenue and patient data from all 9, 212 private clinics in South Korea. This data was obtained from the Korean National Health Insurance Corporation, during the period between 1996 and 1999. We used a mixed model for repeatedly measured data. The following listed variables were used in our analysis: sex and age of physician, number of beds of clinics, competitiveness of medical institution, inhabitants' incomes, the proportion of elderly in the administrative unit, and time effects. Age, sex, number of beds, and specialty were found to be the most relevant determinants for the productivity of private clinics in both urban and rural settings, and number of clinics and beds per 100, 000 and income of the administrative unit were found to be significant determinants, but only in city environments.

Prevalence And Management Status Of Diabetes Mellitus In Korea / 대한내과학회지

BACKGROUND: Through analyzing 1998 National Health Nutrition Survey (NHNS) data, we investigated the prevalence of diabetes mellitus (DM) and several basic factors reflecting the status of DM control: health behaviors, HbA1c level and the prevalence of hypertension among DM patients. METHODS: The NHNS selected 200 districts which represented the national population of Korea and surveyed all inhabitants within the districts. National Health Examination Survey (NHES) and National Health Behaviors Survey (NHBS) surveyed all inhabitants within the related districts. We analyzed the prevalence and management status of DM through analyzing the National Health Interview Survey (NHIS) data of 39,331 responders and NHES data of 10,876 participants. RESULTS: According to NHIS the prevalence of DM was 2.26% for male, 2.03% for female. 11.0% of DM patients exercised more than three times per week. 32.7% were current smokers. 43.1% were drinkers. 30.0% of DM patients had hypertension, but only 15.8% of them controlled blood pressure. From NHES the prevalence of DM was 9.73% for male, 7.95% for female. 10.5% of DM patients exercised more than three times per week. 36.5% were current smokers. 57.4% were drinkers. 45.3% of DM patients had >8% of HbA1c level. 38.1% of DM patients had hypertension, but only 5.3% of them properly controlled blood pressure. CONCLUSION: Considering the results of previous studies, the prevalence of DM have increased rapidly. The level of recognition of patients to control DM, however, was not enough to prevent late complications. Therefore national health policy should be reset to register DM patients and manage them properly.