Jang-Rak Kim

Gamma-glutamyltransferase, Alcohol, and Blood Pressure: A Four Year Follow-up Study

PURPOSE We performed this study to see: 1) whether gamma-glutamyltransferase (GGT) was a predictor for hypertension irrespective of amount of alcohol consumption; and 2) whether the relationship between alcohol consumption and blood pressure (BP) was different depending on GGT. METHODS This study included 8170 healthy male workers in a steel manufacturing company who had undergone health examinations in both 1994 and 1998. RESULTS The adjusted relative risk (RR) for hypertension over four years among those with GGT >or=30 U/L at baseline was 1.6 (95% confidence interval (CI): 1.1-2.4), compared to those with GGT < 30 U/L. This relationship was shown only in drinkers. Among subjects with GGT < 30U/L, no matter how much the subjects drank, the risk of hypertension in drinkers was similar with that of non-drinkers. However, among those with GGT >or=30 U/L, adjusted RRs for light, moderate, and heavy drinkers compared to non-drinkers were 1.4 (95% CI: 0.5-4.5), 5.2 (95% CI: 1.5-18.0), and 5.3 (95% CI: 1.0-27.6). CONCLUSIONS This study showed that elevated GGT could be a predictor for hypertension in drinkers and the relationship between alcohol consumption and hypertension was shown only among those with GGT >or= 30 U/L at baseline. These findings suggest that increased serum GGT levels may reflect individual susceptibility to the blood pressure raising effect of alcohol.

Effect of exercise intensity and frequency on lipid levels in men with coronary heart disease: Training Level Comparison Trial.

The objective of the Training Level Comparison Trial was to determine whether a more intense exercise program versus a less intensive program has additional favorable effects on blood lipids in men with coronary heart disease (CHD) over a 12-month period. The study-a randomized, controlled trial conducted at 2 clinical centers-enrolled 185 patients with documented CHD. A simple randomization procedure led to unequal numbers of patients in the 2 interventions: 82 in the low-intensity and 103 in the high-intensity group. Target heart rate during exercise corresponded to 50% of maximum oxygen uptake (VO(2 max)) +/- 5 beats/min in the low-intensity group and 85% +/- 5 beats/min in the high-intensity group. The intensity of exercise made little difference on lipid improvements. However, the attendance rates for the 6- and 12-month periods (percentage of total exercise sessions attended) were significantly related to increased high-density lipoprotein (HDL) cholesterol (r(s) [Spearman rank correlation coefficient 0.20 to 0.26, p <0.05]), and decreases in the ratios of low-density lipoprotein (LDL)-to-HDL cholesterol (LDL:HDL, r(s) = -0.24 to -0.28, p < 0.01) and total-to-HDL cholesterol (total:HDL, r(s) = -0.25 to -0.29, p < 0.01) at 6 and 12 months. The relation of the attendance rate to LDL:HDL and total:HDL ratios remained significant in repeated-measures regression analysis. Exercise frequency may be more important than intensity in improving HDL cholesterol and LDL:HDL and total:HDL ratios in men with CHD.

Factors associated with cancer screening intention in eligible persons for national cancer screening program

OBJECTIVES To identify factors associated with cancer screening intention using the Theory of Planned Behavior (TPB). METHODS Among 55,920 eligible persons for National Cancer Screening Program (NCSP) in J city, 1,100 individuals were contacted. Of these, 797 were interviewed using a structured questionnaire. Thirty-six responses were excluded due to incomplete data. The remaining 761 completed questionnaires were analyzed to find factors associated with cancer screening intention. RESULTS Cancer screening intention was significantly associated with behavioral attitude (p<0.01) and subjective norm (p<0.01), but not with perceived behavioral control (p=0.29) in the TPB model. These three constructs explained 29.7% of cancer screening intention in multiple linear regression analysis. External factors such as socio-demographic status, health and health behavior variables explained 8.9% of screening intention. Among them, household monthly income, past cancer screening experience, exercise and daily eating habit were significantly associated with screening intention. CONCLUSIONS Cancer screening intention may be influenced by focusing attitude, subjective norm in TPB model and other external factors. However, further studies are warranted to identify factors influencing cancer screening intention and behavior.

Associations between Sleep Quality, Daytime Sleepiness, with Perceived Errors during Nursing Work among Hospital Nurses

Objectives: The objective of this study was to identify the influence of shift work on sleep quality, daytime sleepiness, and perceived errors during nursing work among hospital nurses. Methods: The study subjects were 209 hospital nurses working in two general hospitals in South Korea. The data were collected through self-administered questionnaires in May 2013. Sleep quality was measured using Korea Pittsburgh Sleep Quality Index (PSQI-K), daytime sleepiness was measured using Epworth Sleepiness Scale (ESS), and perceived errors in past 6 months during nursing duty hours with the tool developed in this study. Results: The sleep quality was significantly worse among rotating shift nurses when compared to fixed day duty nurses. However, the odds ratio (OR) of 1.92 (95% confidence interval(CI): 0.58-6.37) adjusted for sociodemographic variables, health behaviors, and working environment in logistic regression was not significant. There was no significant difference in the daytime sleepiness between rotating shift nurses and fixed day duty nurses in both simple and multivariable analyses. There were significantly more perceived errors in rotating shift nurses than fixed day duty nurses. However, the OR of 1.26 (95% CI: 0.38-4.21) adjusted for sociodemographic variables, health behaviors, working environment, sleep quality, and daytime sleepiness in logistic regression was not significant. Depression (OR=3.31, 95% CI: 1.11-9.84) and daytime sleepiness(OR=1.18, 95% CI: 1.07-1.30) were significantly associated with perceived errors in logistic regression. Conclusion: This study suggested shift work among hospital nurses had no independent influence of sleep quality, daytime sleepiness, and perceived errors. However, daytime sleepiness had independent influence of perceived errors. More studies are warranted to achieve more reliable conclusion.

The Relationship between Fish Consumption and Blood Mercury Levels in Residents of Busan Metropolitan City and Gyeongnam Province

The study subjects were 299 residents of Busan (male: 65, female: 234) and 185 residents of Namhae (male: 69, female: 116), South Korea. Demographic characteristics, current smoking, current drinking, fish consumption per week, past history of amalgam treatment, and residential district were recorded by trained interviewers in June and July, 2009. We considered a portion of fish to be equivalent to 70 gm weight, and calculated amounts of fish consumed per week.Using chi-square tests, t-tests, ANOVA, and multiple linear regression analysis, we estimated the relationships between blood mercury levels and amount of fish consumed per week and other factors.

Association of social capital at the individual level with physical activity in communities with high mortality in Korea

The aim of this study was to investigate the association of various dimensions of social capital at the individual level with physical activity. We used data from community health interviews conducted in 40 sub-municipal-level administrative units with high mortality from August to October in 2010, 2011 or 2012 for health projects in South Korea. The 8800 study subjects included 220 adults from each administrative unit, who were sampled systematically using the resident registration database. The physical activity level was defined according to the intensity, duration and frequency of self-reported physical activity. Social capital indicators were assessed with measures used in other health surveys or studies. Adjusting for gender, age, marital status, educational level, occupation, food security (a proxy for socio-economic status), administrative unit and self-rated health, we calculated the adjusted odds ratio (AOR) with a 95% confidence interval (CI) of participating in physical activity based on various measures of social capital using multivariate logistic regression analysis. Social participation in both informal and formal organizations compared with no social participation, higher generalized trust compared with lower trust and higher perceived control at both the community and individual levels compared with lower perceived control at both levels increased the odds of being physically active [AOR = 1.25 (95% CI: 1.10-1.41), 1.36 (95% CI: 1.19-1.54) and 1.31 (95% CI: 1.17-1.48), respectively]. Various social capital measures at the individual level were found to be associated with physical activity independently of each other and of confounders in communities with high mortality in Korea.

The Mid-Term Outcome Evaluation of Community Organization: Three-year Experience of Health Plus Happiness Plus Projects in Gyeongsangnam-Do

Objective: This study was performed to explore the effectiveness of community organization as a strategy for health promotion. Methods: We used data from community health interviews from 6 administrative sections (eup, myeon, or dong) with high mortality from August to October, conducted once in both 2010 and 2013 as part of the Health Plus Happiness Plus Projects based on the concept of community empowerment in Gyeongsangnam-do Province. For 2010, the study subjects comprised a systematic sampling of 220 adults from each of the six sections for a total of 1320 subjects, and for 2013, 200 from each section for a total of 1200 subjects. We compared main health behavior indicators and empowerment score between these two years. Results: Smoking prevalence in men was 47.4% in 2013, and 47.7% in 2010, respectively. Prevalence of walking 5 days or more per week was 35.6% in 2013, significantly lower than 46.2% in 2010. Also, during that period, both biennial health examination rate and biennial gastric cancer screening rate among those 40 years of age and over significantly increased from 57.7% to 63.6% and from 49.3% to 55.0%, respectively. Mean empowerment score at the community level significantly increased from 12.6 to 14.0. Conclusions: This study suggests that the three-year implementation of community organization might have helped to increase the participation rate of biennial health examinations including cancer screenings in the community. However, this was not the case for smoking cessation and walking. Further studies are needed for evidence-based health promotion.

Associations of Generalized Trust and Social Participation at the Individual Level with Unmet Healthcare Needs in Communities with High Mortality

Background The aim of this study was to investigate whether generalized trust and/or social participation at an individual level have negative associations with unmet healthcare needs. Methods Door-to-door interviews were conducted by trained interviewers to collect information. The 8,800 study participants included 220 adults sampled systematically using the resident registration database from 40 sub-municipal-level administrative units in Korea. Unmet healthcare needs were measured subjectively by the following question: “During the past 12 months, was there ever a time when you felt that you needed healthcare (excluding dental care) but did not receive it?” The responses were classified as either “yes” or “no.” Results The adjusted odds ratios (ORs) for unmet healthcare needs based on one positive response, two positive responses, and three positive responses to the three items of generalized trust compared to no positive responses were 0.92 (95% confidence interval [CI], 0.77–1.09), 0.90 (95% CI, 0.74–1.09), and 0.73 (95% CI, 0.61–0.87), respectively. The adjusted ORs for unmet healthcare needs based on social participation only in informal organizations, only in formal organizations, and in both informal and formal organizations compared to no social participation were 0.83 (95% CI, 0.71–0.98), 0.97 (95% CI, 0.77–1.21), and 0.97 (95% CI, 0.82–1.15), respectively. The covariates included in the multiple logistic regression were sociodemographic variables (gender, age, marital status, educational level, occupation, food security, and administrative unit), self-rated health, and perceived stress. Conclusion Therefore, generalized trust and social participation in informal organizations can decrease the incidence of unmet healthcare needs.