Community-wide Early Response to COVID-19 in Dongnae-gu of Busan City / 農村醫學 地域保健

Objectives@#We did this study to summarize and review and charcterize the community-wide early response to COVID-19 in Dongnae-gu of Busan Metropolitan City where first confirmed case of COVID_19 occurred in Busan. @*Methods@#Research team from college of medicine participated as advisor to response team of local government. Research team consulted and educated and interviewed response team and wrote and reviewed COVID-19 white paper of local government. @*Results@#Political commitment of District mayor made possible community-wide co-operation between public-private section. Early mobilization of District-wide resource was possible through political commitment. Whole-of-government response developoed to whole-of-society approach including economic support. @*Conclusions@#Proactive community-wide response were mobilized under commitment of city mayor of local government to address the first CIVID-19 incidence in Busan Metropolitan City.

Relationship between the Subjective-Objective Oral Health Status and Oral Health Related Quality of Life in the Elderly / 치위생과학회지

The purpose of this study was to analyze the relationship between objective oral health status determined by dentists, self-perceived subjective oral health status, and oral health related quality of life (OHRQoL) in the elderly. The related factors affecting OHRQoL in the elderly were also surveyed. Four hundred and thirty elderly individuals who visited the three public health centers and four dental clinics in Busan were selected by convenience sampling. Twelve dental hygienists investigated the subjective oral health status and OHRQoL using the 14-item Oral Health Impact Profile (OHIP-14) and twentyone dentists examined the objective oral health status, including healthy remaining teeth, treated remaining teeth, functional remaining teeth, missing teeth, and non-treated missing teeth. Data were analyzed using SPSS ver. 12.0. OHRQoL was higher when oral and periodontal status was perceived as healthy, when there was no toothache, no interference in mastication, and when study subjects had the ability of food softening. It was also higher when study subjects had ≥20 remaining teeth and <9 missing teeth, and were wearing denture. The related factors affecting OHRQoL of the elderly were the type of medical insurance, toothache, ability of food softening, perception of periodontal status, and the number of healthy remaining teeth. There was a significant relationship between the subjective-objective oral health status and OHRQoL in the elderly. A continuous oral health care system aimed at retaining ≥20 healthy remaining teeth is needed to improve oral health and OHRQoL for the elderly, especially for the elderly receiving medical aid.

Changes in skin reactivity and associated factors in patients sensitized to house dust mites after 1 year of allergen-specific immunotherapy

BACKGROUND: Allergen-specific immunotherapy (SIT) can significantly improve symptoms and reduce the need for symptomatic medication. OBJECTIVE: The aim of this study was to investigate changes in skin reactivity to house dust mites (HDMs) as an immunologic response and associated factors after 1 year of immunotherapy. METHODS: A total of 80 patients with allergic airway diseases who received subcutaneous SIT with HDMs from 2009 to 2014 were evaluated. The investigated parameters were basic demographic characteristics, skin reactivity and specific IgE for HDM, serum total IgE level, blood eosinophil counts, and medication score. RESULTS: The mean levels of skin reactivity to HDMs, blood eosinophil counts, and medication scores after 1 year were significantly reduced from baseline. In univariate comparison of the changes in skin reactivity to HDMs, age ≤30 years, HDMs only as target of immunotherapy, and high initial skin reactivity (≥2) to HDMs were significantly associated with the reduction in skin test reactivity. In multivariate analysis, high initial skin reactivity and HDMs only as target allergens were significantly associated with changes in skin reactivity to HDMs. In the receiver operating characteristic curve of the initial mean skin reactivity to HDMs for more than 50% reduction, the optimal cutoff value was 2.14. CONCLUSION: This study showed significant reductions in allergen skin reactivity to HDMs after 1 year of immunotherapy in patients sensitized to HDMs. The extent of initial allergen skin reactivity and only HDMs as target allergen were important predictive factors for changes in skin reactivity.

High Proportion of Nervous System Disease among Major Cause of Under-Five Death in Korea; Compared with OECD 14 Nations (2005-2010) / 고신대학교의과대학학술지

OBJECTIVES: To compare the mortality rate of children under ages five from different countries by their causes and to explore the cause of death that is relatively higher in South Korea and came up with measures for resolution. METHODS: The statistics were based from section ICD(International Classification of Diseases)-10 of WHO(World Health Organization) Mortality Database. Among the OECD(Organization for Economic Cooperation and Development) countries, 15 countries with higher GDP(Gross Domestic Product) than South Korea were studied by the mortality rate from 2005 to 2010 sorted into two groups: 0 year group and 1-4 years group. Then the cause of death investigated in detail. RESULTS: Among the 15 countries, average mortality of 0 year group in Korea ranked 8th and the average mortality of 1-4 years group ranked 4th out of 15. There were no significance in the mortality of 0 year group caused by any specific disease, but unnatural death was ranked 2nd after the United States. The natural death of 1-4 years group was ranked 6th, and the unnatural death was ranked 2nd after the Unites States. Among the natural deaths of 1-4 years group, the cause of death significantly higher was found to be disease G(nervous system disease). Among the subgroups of disease G, the orders went epilepsy, cerebral palsy, paralysis, and inflammatory disease. CONCLUSIONS: We have identified major causes of death of children under age 5. The highest proportion of cause of death in 1-4 years group was nervous system disease and we have proposed resolution. Henceforth, this data will be used as a foundational data for formulating policies relation to the Mother-Child Health.

Policy proposal for health-promoting physical activity in Korea

In the Republic of Korea, a health-promoting physical activity policy model have never been proposed in the health care professions, although the Health Plan 2020 has been updated recently. Using the physical activity policy model from leading countries, an opinion survey of health care practitioners and researchers was performed in July of 2011. The results reflected the Korean situation. Some environmental and informational approaches were commonly suggested. For national policy, community-wide campaigns, school-based enhancement of physical education, and the creation of physical activity infrastructure and facilities were universally suggested. For regional policy, enhanced access to places for physical activity combined with information outreach activities, social support interventions, and facilities for independent walking were suggested. Participants did not approve of the reduction of insurance rates for active and fit persons highly especially among researches. The opinions of researchers were more realistic and conservative than those of practitioners. The opinions about national policy and regional policy were somewhat different. For the Korean medical profession, research and development on the specific subjects prioritized from this survey are needed to develop evidence-based Korean policies for health-promoting physical activity.

The Relationship between Trust in Healthcare System and Health Examination Participation / 農村醫學 地域保健

OBJECTIVES: This study was conducted to investigate the relationship between vertical trust in the healthcare system and participation in routine health examinations. METHODS: Data from the 2008 Pusan Health Survey were analyzed for this study. Multiple logistic regression analyses were performed to investigate the influence of possible confounders (sex, age, education, monthly mean household income, horizontal trust) on participation in routine health examinations according to trust in the healthcare system. RESULTS: In a total sample of 7,683 participants, 3,756 (48.9%) were classified as health examination participants. Respondents with high trust in the healthcare system had significantly higher odds ratios of participation, 1.17 (95% CI 1.03-1.33), after multiple adjustments. CONCLUSION: Vertical trust in the healthcare system was significantly associated with higher odds of participation in routine health examinations. Improvements to the healthcare system have potential for increasing participation in routine health examinations.

Physical activity recommendations and guidelines based on a new paradigm

As new physical activity recommendations and guidelines have spread globally since 1996, scrutiny of the evolution of national physical activity recommendations and guidelines for application to the Korean medical field iare needed. Retrieving literatures and electric database confined to aerobic activity of adult. Most findings were based on the results of epidemiological and behavioral studies of physical activity and health. Most national physical activity recommendations and guidelines have a 'physical activity for health' paradigm instead of an 'exercise for fitness' paradigm. Most stressed the health benefits of accumulation of moderate intensity of a wide variety of physical activity and the importance of the total amount rather than the specific frequency, intensity, time, or type of physical activity. Some used scientific health behavior theories. Research-based applications of evidence based physical activity policy to Korean medical practice are suggested. Korean medical field could have initiatives in comprehensive physical activity policy in Korean health promotion if actively adopting the new physical activity for health paradigm.

Assessment of Community Capacity Building Ability of Health Promotion Workers in Public Health Centers / 예방의학회지

OBJECTIVES: This study was performed to assess the community capacity building ability of health promotion workers of public health centers and to identify influential factors to the ability. METHODS: The subjects were 43 public officers from 16 public health centers in Busan Metropolitan City. Questionnaire was developed based on 'Community Capacity Building Tool' of Public Health Agency of Canada which consists of 9 feathers. Each feather of capacity was assessed in 4 point rating scale. Univariate analysis by characteristics of subjects and multivariate analysis by multiple regression was done. RESULTS: The mean score of the 9 features were 2.35. Among the 9 feathers, 'Obtaining resources' scored 3.0 point which was the highest but 'Community structure' scored 2.1 which was the lowest. The mean score of the feathers was relatively lower than that of Canadian data. The significant influential factors affecting community capacity building ability were 'Service length', 'Heath promotion skill level', 'Existence of an executive department' and 'Cooperative partnership for health promotion'. According to the result of multiple linear regression, the 'Existence of an executive department' had significant influence. CONCLUSIONS: Community capacity building ability of subjects showed relatively lower scores in general. Building and activating an executive department and cooperative partnerships for health promotion may be helpful to achieve community capacity building ability.

Assessment of Village Health Worker Training Program in Tuguegarao, Philippine / 예방의학회지

OBJECTIVES: This study was performed to evaluate the effectiveness of 'village health worker training program' which aimed to build community participatory health promotion capacity of community leaders in villages of low developed country and to develop methods for further development of the program. METHODS: The intervention group were 134 community leaders from 25 barangays (village). Control group were 149 form 4 barangays. Intervention group participated 3-day training program. Questionnaire was developed based on 'Health Promotion Capacity Checklist' which assessed capacity in 4 feathers; 'knowledge', 'skill', 'commitment', and 'resource'. Each feather was assessed in 4 point rating scale. Capacity scores between intervention group and control group were examined to identify changes between the pre- and post-intervention periods. A qualitative evaluation of the program was conducted to assess the appropriateness of the program. The program was conducted in Tuguegarao city, Philippine in January, 2009. RESULTS: The result showed significant increases in the total health promotion capacity and each feather of health promotion capacities between pre and post assessment of intervention group. But there was no significant change in that of control group. Participants marked high level of satisfaction for preparedness, selection of main subjects and education method. Qualitative evaluation revealed that training program facilitated community participatory health promotion capacity of participants. CONCLUSIONS: This study suggested that the Village health worker training program is effective for building health promotion capacity of community leaders and it can be a main method for helping low developed countries with further development.

Development of Village Health Worker Training Program in Tuguegarao, Phillipines / 農村醫學 地域保健

OBJECTIVES: The purpose of this study was to develop and execute the village heath worker(VHW) training program which based on short term overseas medical volunteer and medical mission. METHODS: Through case studies of previous VHW program and review articles about the state of medical volunteer and medical mission, we developed the VHW training program. Pilot test of the program was carried out in Tugeugarao city, Phillipines on July, 2008. The subject were 32 persons from 15 villages around Tuguegarao city. After training we surveyed regarding the satisfaction of training and the degree of getting knowledge and skills. RESULTS: Through article review, we got the common subjects of previous VHW training program and the limitations of overseas medical volunteer and medical mission. We developed VHW training program aiming to community health promotion through community participation and community change. The main text was "Where There Is No Doctor" of Hesperian Foundation. The program executed through 1 day intensive lecture and practice. The satisfaction of the program was 8.95+/-1.70 on 10 point rating scale. CONCLUSIONS: We strongly expect VHW training program can be available as new model of short overseas medical volunteer as well as medical mission if we could systemize it with the confirming subject before training, management after training and continuous support through connection with the field.

Effects of Low Intensity Exercise Program with Telephone Coaching on Physical Fitness in the Elderly Served Home Visiting Nursing Care / 기본간호학회지

PURPOSE: The purpose of this study was to determine the effects of low intensity exercise program with telephone coaching on the physical fitness of elderly people who are receiving home visiting nursing care. METHOD: This study was conducted using a non-equivalent control group pretest-posttest design. The participants were 61 elders. Elders (34) in the experimental group performed low intensity exercise and of these 16 received telephone coaching. The low intensity exercise program consisted of stretching, muscle strengthening with an elastic band, massage, and ball exercise, five days a week, for sixteen weeks. Data were collected from July 2007 to December 2007. chi-square-test, ANCOVA with SPSS WIN 11.0 program were used to analyse the data. RESULTS: There were statistical differences in the right grasping power in the right hand (p=0.021), Raising behind of right arm (p=0.006), Raising behind of left arm (p=0.007). CONCLUSION: These results indicate, that a low intensity exercise program with telephone coaching can help improve physical fitness in elders receiving served home visiting nursing care.

Introduction of Health Impact Assessment and Healthy Cities as a Tool for Tackling Health Inequality / 예방의학회지

In order to reduce the health inequalities within a society changes need to be made in broad health determinants and their distribution in the population. It has been expected that the Health impact assessment(HIA) and Healthy Cities can provide opportunities and useful means for changing social policy and environment related with the broad health determinants in developed countries. HIA is any combination of procedures or methods by which a proposed 4P(policy, plan, program, project) may be judged as to the effects it may have on the health of a population. Healthy city is one that is continually creating and improving those physical and social environments and expanding those community resources which enable people to mutually support each other in performing all the functions of life and in developing to their maximum potential. In Korea, social and academic interest regarding the HIA and Healthy Cities has been growing recently but the need of HIA and Healthy Cities in the perspective of reducing health inequality was not introduced adequately. So we reviewed the basic concepts and methods of the HIA and Healthy Cities, and its possible contribution to reducing health inequalities. We concluded that though the concepts and methods of the HIA and Healthy Cities are relatively new and still in need of improvement, they will be useful in approaching the issue of health inequality in Korea.

A Nested Case Control Study on Risk Factors for Coronary Heart Disease in Korean / 예방의학회지

OBJECTIVE: To elucidate risk factors for coronary heart diseases among Korean males. METHODS: A nested case control study was conducted among a Korea Medical Insurance Cooperation(KMIC) cohort composed of 108,802 males. The cases included 246 male patients who were admitted to hospital due to coronary heart diseases from 1993 to 1997 (I20-25 by ICD) and whose diagnosis was confirmed by the protocol by WHO MONICA Project(1994). The control group was composed of 483 patients selected by frequency matching considering age and resident area from an inpatient care group without coronary heart disease during the same period. For study cases and the controls, the results of a health check-up in 1990 and a questionnaire on life style in 1992 were received through the KMIC. Some additional information was collected by telephone interviews during October 1999. RESULTS: Multiple logistic regression analysis showed that the odds ratio(OR) of coronary heart diseases among past smokers and current smokers as compared to non-smokers were 1.94(95% CI : 1.14-3.31) and 2.20(95% CI : 1.35-3.59), respectively. The OR among persons who drank 4 cups or more of caffeinated beverages such as coffee or tea daily as compared to persons who drank one cup for 2-3 days was 2.56(95% CI : 1.07-6.12). The OR among persons with high normal BP and stage 3 hypertension against normotension were 2.51(95% CI : 1.44-4.37) and 5.08(95% CI : 2.38-10.84). The OR among persons whose blood cholesterol were 240 mg/dL or more against lower than 200mg/dL was 2.24(95% CI : 1.43-3.49). CONCLUSION: Smoking, drinking of excessive caffeinated beverages, hypertension and high blood cholesterol were proven to be significant risk factors for coronary heart diseases among Korean males.

Risk Factors for Cerebrovascular Disorders in Koreans / 예방의학회지

OBJECTIVES: To identify the risk factors of cerebrovascular disorders(CVD) in Koreans using a nested case-control study. METHODS: The cohort consisted of beneficiaries who had taken health examinations of the Korea Medical Insurance Corporation (KMIC cohort: 115,600 persons) in 1990 and 1992 consecutively. Four hundred and twenty five (425) cases were selected following the validation of diagnosis among 2,026 reported CVD (I60-I68) inpatients during the year from 1993 to 1997. Controls were matched (1:1) with age and gender of the cases among inpatients without CVD during the same period. The source of data in this study were the files of the 1990 health examinations and the 1992 health questionnaires, as well as an additional telephone survey undertaken from March to November 1999. RESULTS: In a bivariate analysis and multiple logistic regression analysis, risk factors for total CVD were hyperglycemia and hypertension. Unrespectively, the odds ratio of ex-smoker was significantly lower than that of those who had never smoked. The risk factors for ischemic CVD also were hyperglycemia and hypertension. However, only blood pressure was found to be a risk factor for hemorrhagic CVD. Hypercholesterolemia was not a risk factor for total CVD, ischemic CVD, and hemorrhagic CVD. CONCLUSION: We concluded that the most important risk factor for CVD (including subtype) in Koreans was hypertension.

The Accuracy of ICD codes for Cerebrovascular Diseases in Medical Insurance Claims / 예방의학회지

OBJECTIVES: We attempted to assess the accuracy of ICD codes for cerebrovascular diseases in medical insurance claims (ICMIC) and to investigate the reasons for error. This study was designed as a preliminary study to establish a nationwide surveillance system. METHODS: A total of 626 patients with medical insurance claims who indicated a diagnosis of cerebrovascular diseases during the period from 1993 to 1997 was selected from the Korea Medical Insurance Corporation cohort (KMIC cohort: 115,600 persons). The KMIC cohort was 10% of those insured who had taken health examinations in 1990 and 1992 consecutively. The registered medical record administrators were trained in the survey technique and gathered data from March to May 1999. The definition of cerebrovascular diseases in this study included cases which met one of two criteria (Minnesota, WHO) or 'definite stroke' in CT/MRI finding. We questioned the medical record administrators to explain the error if the final diagnoses were not coded as stroke. RESULTS: The accuracy rate of the ICMIC was 83.0% (425 cases). Medical records were not available for 8.2% (51 cases) due to the closing of hospitals, the absence of a computer system or omission of medical record, etc. Sixty-three cases (10.0%) were classified as impossible to interpret due to insufficient records in 'major clinical symptoms' or 'neurological deficits'. The most common reason was 'to meet review criteria of medical insurance benefits (52.9%)'. The department where errors in the ICMIC occurred most frequently was the department for medical insurance claims in the hospital. CONCLUSION: The accuracy rate of the ICMIC was 83.0%.

Evaluation of Day Hospital Program in the National Rehabilitation Hospital

OBJECTIVE: Day hospital program for the brain injured patients has been developed and conducted as a model project in the National Rehabilitation Hospital of Korea since August 1998. This article is to present our 1-year experience and evaluate the efficacy and effectiveness of the program. METHOD: All patients treated in day hospital from August 1998 to July 1999 were included. Functional Independence Measure (FIM), ESCROW (Environment, Social support, Cluster of family members, Resources, Outlook, Work or School status), Medical Outcome Study 36-item Short Form Survey (SF-36) were assessed at admission and discharge. Patient satisfaction was surveyed at discharge. Program cost was compared with that of inpatient control group. RESULTS: 1) Among 51 subjects (32 males, 19 females, mean age 57), 48 suffered stroke and 2 had traumatic brain injury. Average length of stay was 10 weeks and 45 patients (88.2%) were discharged to home. 2) FIM total score, motor subtotal score and cognitive subtotal score were all incresed significantly (p<0.01). 3) ESCROW score was also improved significantly (p<0.01). 4) SF-36 showed significant improvement in physical functioning, role limitation-emotional, mental health and general health (p<0.05). 5) 95.1% answered satisfaction with the program and 73.2% reported health enhancement. 6) Program costs were significantly lower than the inpatient group (p<0.01). CONCLUSION: Day hospital seems to be a useful program for comprehensive rehabilitation for the brain injured, and needs to be pervaded throughout the country with proper payment.

A Study on the Risk Factors of Low Back Pain in Computer Terminal Operators / 대한산업의학회지

Low back pain in computer terminal operators is a very common but important symptom. While the occupational risk factors of low back pain were approved obscurely, there have been few studies on analysis or understanding of occupational risk factors. Therefore, we studied occupational risk factors of low back pain, especially for ergonomic factors as well as general characteristics of workers. We selected 98 subjects for this study, computer terminal operators ordinary using computers in Pusan. We calculated the subjective severity of low back pain of each operator by the Low Back Pain Scoring System. The relation of low back pain score to general characteristics of worker was also analyzed. We analyzed the relationship between low back pain score and individual efforts to prevent low back pain. We measured the ergonomic factors of each computer terminal operator - Trunk Jnclination(TI), Arm Flexion(AF), Elbow Angle(EA), Head Tilting(HT), Knee Angle(KA), using of foot plate and gap between the popliteum and chair. The correlations between these ergonomic factors and low back pain score were then analyzed. And the results are as follows: 1. The prevalence rate of low back pain in computer terminal operators was 39.8% in this study, when low back pain score was converted by the low back pain scoring system. 2. According to general characteristics of workers related to low back pain, the scores were higher in the older age group, the married and the longer work carriers. (p < 0.05) 3. In the analysis of the relationship between low back pain score and individual effort to prevent low back pain, regular exercise, history of schooling for prevention of low back pain, and declaration of intention to participate in low back pain education or exercise were stastistically significant(p < 0.05). And the more severe the low back pain, the higher the intention to participate in low back pain education they had in this study. 4. In the analyses of relationships or correlations between low back pain score and each of the 7 categories of ergonomic factors, only head tilting had a weak reverse correlation with low back pain(r=-0.2999, p < 0.01). From now on, cohort studies for the risk factors of low back pain of workers, who have been forced to work in non-ergonomical positioning at the work site, will be necessary. On the background of these ergonomic studies, the occupational health profession should be required to manage ergonomic working conditions.

A Study on Immunity of Welders / 대한산업의학회지

The authors examined human immunity indicators such as CD4, CD8, Natural Killer (NK) cell, IgG, IgA, and IgM, and heavy metals such as Pb, Cr, Cd to evaluate the health hazard of welders. We selected total 126 male subjects, 60 welders who had more than 5 year working history as an exposure group, and 66 office workers and medical college students as a control group. This immunity evaluation approach is the first newly designed study that has never been tried in past studios on welder's heath evaluation. And the results were as follows. 1. Total lymphocyte count of peripheral blood was significantly higher in welder group, 2,615+/-650 ea/microliter compared with 2,368+/-681 ea/microliter in control group (p or =0.05). 3. IgG, IgA, and IgM in welder group were 15.9 mg/dl, 2.7 mg/dl, and 1.5 mg/dl, respectively, and 15.6 mg/dl, 2.9 mg/dl and 1.7 mg/dl in control group. There was no statistical significance between two groups(p> or =0.05). 4. Blood lead, cadmium and chromium concentrations were 4.2+/-1.8 microgram/dl, 0.4+/-0.38 microgram/dl, 1.2+/-0.6 microgram/dl in welder group and 3.2+/-1.7 microgram/dl, 0.44+/-0.29 microgram/dl, 1.1+/-0.6 microgram/dl in control group, respectively, and these value were within normal ranges.

A Study on obesity pattern and related factors of the doctors / 예방의학회지

The author surveyed overall obesity indicies and factors concerned with obesity such as dietary intake, physical activity, stress and life style with the subject of doctors. The number of subjects was total 508 with 396 men and 112 women. They were subgrouped into surgical part, medical part and service and basic part by speciality. And also subgrouped into intern and resident, pay doctor, and practitioner by working type. The results were as follows. 1) Obesity indices: BMI of total doctor was 23.1+/-2.8, and WHR was 0.87+/-0.08 and overweight prevalence(BMI>25.0) was 23.6 %. It was within normal limit but slightly over the Korean standard. The degree of obesity indices of subgroups by speciality was "surgical part > medical part > service and basic part", and by working type was "practitioner > pay doctor > intern and resident". 2) Dietary intake and Physical activity: Average dietary intake was 2148+/-451 kcal/day. The degree of dietary intake by speciality was "surgical part > medical part > service and basic part". By working type it was "practitioner > pay doctor > intern and resident". Average physical activity was 29+/-5 METs/day. The degree of physical activity also showed similar pattern. But there was no significant difference among each groups. 3) Comparison between over-weight and non-over-weight group: The items that showed significant difference between two groups were dietary intake, skip breakfast, regular exercise, smoking, heavy drinking, chronic disease etc.

A Study on the Factors related to the Cognitive Impairment of the Elderly in a Rural Area / 예방의학회지

To investigate the factors which affecting the cognitive impairment of the 60 or more age group, the authors surveyed for the subjects in some area of Kyungnam Province. 201 studied subjects were tested for cognitive function with mini-mental state examination(MMSE). Information on demographic characteristics and life style has been collected through direct interview. The concentration of Al and Ca of subject's drinking water, which might be related with cognition, was measured by Inductively Coupled Argon Plasma Spectrometer. The main results were summarized as follows. 1. The prevalence rate of cognitive impairment was 18.4% in male and 45.2% in female and this sexual difference was statistically significant(p=0.03). And the uneducated or illiterated showed significantly high prevalence rate of cognitive impairment(p=0.02). 2. In stratified analysis by sex and education year, we can not see significant trend indicating the neurotoxic effects of aluminum and protective effects of calcium to the cognitive function(p>0.05). 3. The correlation between the concentration of aluminum in drinking water and the MMSE score in whole subjects showed weak negative relationship(r=-0.066). But there was no statistical significance(p=0.434).