• Healthcare Informatics Research
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• 제24권4호
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• pp.346-358
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• 2018

Objectives: The association between obstructive sleep apnea (OSA) and mortality or serious cardiovascular events over a long period of time is not clearly understood. The aim of this observational study was to estimate the clinical effectiveness of continuous positive airway pressure (CPAP) treatment on an outcome variable combining mortality, acute myocardial infarction (AMI), and cerebrovascular insult (CVI) during a follow-up period of 15.5 years ($186{\pm}58$ months). Methods: The data set consisted of 978 patients with an apnea-hypopnea index (AHI) ${\geq}5.0$. One-third had used CPAP treatment. For the first time, a data-driven causal Bayesian network (DDBN) and a hypothesis-driven causal Bayesian network (HDBN) were used to investigate the effectiveness of CPAP. Results: In the DDBN, coronary heart disease (CHD), congestive heart failure (CHF), and diuretic use were directly associated with the outcome variable. Sleep apnea parameters and CPAP treatment had no direct association with the outcome variable. In the HDBN, CPAP treatment showed an average improvement of 5.3 percentage points in the outcome. The greatest improvement was seen in patients aged ${\leq}55$ years. The effect of CPAP treatment was weaker in older patients (>55 years) and in patients with CHD. In CHF patients, CPAP treatment was associated with an increased risk of mortality, AMI, or CVI. Conclusions: The effectiveness of CPAP is modest in younger patients. Long-term effectiveness is limited in older patients and in patients with heart disease (CHD or CHF).

• Yonsei Medical Journal
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• 제59권9호
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• pp.1057-1063
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• 2018

Purpose: Coronary artery spasm (CAS) and diabetes mellitus (DM) are implicated in endothelial dysfunction, and insulin resistance (IR) is a major etiological cause of type 2 DM. However, the association between CAS and IR in non-diabetic individuals has not been elucidated. The aim of the present study was to evaluate the impact of IR on CAS in patients without DM. Materials and Methods: A total of 330 eligible patients without DM and coronary artery disease who underwent acetylcholine (Ach) provocation test were enrolled in this study. Inclusion criteria included both hemoglobin A1c <6.0% and fasting glucose level <110 mg/dL without type 2 DM. Patients were divided into quartile groups according the level of homeostasis model assessment of insulin resistance (HOMA-IR): 1Q (n=82; HOMA-IR<1.35), 2Q (n=82; $1.35{\leq}HOMA-IR<1.93$), 3Q (n=83; $1.93{\leq}HOMA-IR<2.73$), and 4Q (n=83; $HOMA-IR{\geq}2.73$). Results: In the present study, the higher HOMA-IR group (3Q and 4Q) was older and had higher body mass index, fasting blood glucose, serum insulin, hemoglobin A1c, total cholesterol, and triglyceride levels than the lower HOMA-IR group (1Q). Also, poor IR (3Q and 4Q) was considerably associated with frequent CAS. Compared with Q1, the hazard ratios for Q3 and Q4 were 3.55 (95% CI: 1.79-7.03, p<0.001) and 2.12 (95% CI: 1.07-4.21, p=0.031), respectively, after adjustment of baseline risk confounders. Also, diffuse spasm and accompanying chest pain during Ach test were more strongly associated with IR patients with CAS. Conclusion: HOMA-IR was significantly negatively correlated with reference diameter measured after nitroglycerin and significantly positively correlated with diffuse spasm and chest pain.

• 대한지역사회영양학회지
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• 제28권5호
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• pp.404-413
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• 2023

Objectives: This study compared serum lipid concentration according to drinking habits. Methods: We analyzed data from the 7th Korea National Health and Nutrition Examination Survey (KNHANES VII). The study included 8,525 adults (3,651 males and 4,874 females), aged 30 - 59 years. Results: There were differences in age, gender, education level, smoking status, physical activity, and waist circumference between drinkers and abstainers. The serum low-density lipoprotein-cholesterol (LDL-C) level of the drinkers was lower than those of the abstainers (P < 0.05). The serum triglyceride (TG) and high-density lipoprotein-cholesterol (HDL-C) concentrations were highest in the group that consumed alcohol 'more than twice a week' relative to the other groups (P < 0.001). The LDL-C and atherogenic index (AI) levels were lowest in the 'more than twice a week' drinking group compared to the other groups (P < 0.001). The serum TG and HDL-C concentrations were the highest in the '7 glasses/time' group (P < 0.001). The serum LDL-C concentration was the lowest in the '7 glasses/time' group (P < 0.001). Notably, the higher the frequency of binge drinking (7 glasses or more), the higher the concentration of TG (P < 0.001). The serum HDL-C concentration was significantly higher in the 'no binge' and 'more than once a week' groups compared to the other groups (P < 0.001). The serum LDL-C concentration and AI score were the lowest in the 'more than once a week' group (P < 0.001). Conclusions: As the quantity and frequency of drinking increased, the serum TC concentration increased. Moreover, an increase in the serum HDL-C concentration led to a decrease in AI. The factors exacerbating cardiovascular disease increased simultaneously due to drinking. Our results suggest that for individuals with hypertriglyceridemia and patients with low HDL-cholesterolemia, separate guidelines based on the quantity and frequency of alcohol consumption are warranted.

• 농촌의학ㆍ지역보건
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• 제18권1호
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• pp.43-54
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• 1993

In order to find the factors associated with the death of hypertensives, 12 year follow-up study for 267 hypertensives whose average blood pressure were 140/90 mmHg or above during their first health screening in 1979-1980 at YongJin Township, Wanju Country, North Cholla Province by the Community Health Team of Chonju Presbyterian Medical Center. The study results are as follows : 1. Initial general characteristics of hypertensives were studied. The age distribution of studied hypertensives showed 27.3% in 40-49 years, 25.8% in 50-59 years, 29.6% in 60-69 years and 17.2% In 70 + years old group. Marital status showed that 82.8% of hypertensives had their wife or husband. 74. 5% were employed on agriculture. 56.5% of hypertensives were illiterate. 2. Among the hypertensives, 91.6% of male and 22.8% of female reported that they were smokers. 82.6% of hypertensives had body mass index lower than 25 Kg/$m^2$. 46.8% of average systolic blood pressure were 160mmHg or above and 54.3% of average diastolic blood pressure were 95mmHg or above. 3. Twenty percent of hypertensives reported that they were treating hypertension at the beginning of follow up, while 68.5% reported that they were not treated. 28.1% reported that they were treating hypertension within 6 months before last follow-up. but 69.3% reported that they were not treated for hypertension within Ii months before last follow up. So 50.6% were classified as never treated group and 41.2% as treated group. 4. Average blood pressure for initial 3 years were calculated. The change of average systolic blood pressure was observed as $161.3{\pm}19.4mmHg$ at the first year, $145.6{\pm}28.0mmHg$ at the second year and $141.4{\pm}37.2mmHg$ at the third year. Average diastolic blood pressure were changed from $96.2{\pm}14.4mmHg$ at the first year to $90.6{\pm}18.6mmHg$ at the second year and $86.4{\pm}22.9mmHg$ at the third year. 5. By the follow-up of hypertensives, 54 hypertensives (46.2%) among 117 male hypertensives and 50 hypertensives (33.3%) among 150 female hypertensives died for 12 years. 42.6% of male death and 52.0% of female death were caused by cerebrovascular diseases. 6. Through univariate statistical test about the association between general characteristics or cardiovascular risk factors of hypertensives and mortality for 12 years, age variable among male and among female age, marital status, occupation. educational level. systolic blood pressure and treatment status were shown as significant variable to influence upon the mortality. 7. By multiple logistic regression analysis, among male age and systolic blood pressure were selected as significant variable to be associated with the total mortality for 12 years. Among female age, systolic blood pressure and treatment status were selected as statistically significant variable to be associated with the total mortality for 12 years.

• Journal of Preventive Medicine and Public Health
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• 제52권2호
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• pp.131-139
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• 2019

Objectives: Self-reporting can be used to determine the incidence and prevalence of hypertension (HTN). The present study was conducted to determine the validity of self-reported HTN and to identify factors affecting discordance between self-reported and objectively measured HTN in participants in the Ravansar Non-Communicable Diseases (RaNCD) cohort. Methods: The RaNCD cohort included permanent residents of Ravansar, Iran aged 35-65 years. Self-reported data were collected before clinical examinations were conducted by well-trained staff members. The gold standard for HTN was anti-hypertensive medication use and blood pressure measurements. The sensitivity, specificity, positive and negative predictive values, and overall accuracy of self-reporting were calculated. Univariate and multivariate logistic regression were used to examine the discordance between self-reported HTN and the gold standard. Results: Of the 10 065 participants in the RaNCD, 4755 (47.4%) were male. The prevalence of HTN was 16.8% based on self-reporting and 15.7% based on medical history and HTN measurements. Of the participants with HTN, 297 (18.8%) had no knowledge of their disease, and 313 (19.9%) had not properly controlled their HTN despite receiving treatment. The sensitivity, specificity, and kappa for self-reported HTN were 75.5%, 96.4%, and 73.4%, respectively. False positives became more likely with age, body mass index (BMI), low socioeconomic status, and female sex, whereas false negatives became more likely with age, BMI, high socioeconomic status, smoking, and urban residency. Conclusions: The sensitivity and specificity of self-reported HTN were acceptable, suggesting that this method can be used for public health initiatives in the absence of countrywide HTN control and detection programs.

• Journal of Nutrition and Health
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• 제42권6호
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• pp.559-566
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• 2009

본 연구에서 직장 남성 근로자 739명 (39세 이하 그룹: 240명, 40대 그룹: 276명, 50대 그룹: 223명)을 대상으로 e-mail 영양교육이 신체계측치, 체구성 및 심혈관 질환 위험인자에 미치는 영향을 조사하고자 하였다. 검진 시 1회, 약 10분의 면대면 영양상담 후 15개 주제의 영양교육자료를 월 1회, 10회에 걸쳐 e-mail을 통해 제공하였으며, 그 결과를 요약하면 다음과 같다. 1) 1년간의 e-mail 영양교육 후, 전체 연구대상자의 체지방률 (p < 0.001), 복부지방률 (p < 0.001), 총 콜레스테롤(p < 0.01), 수축기 혈압 (p < 0.01), 이완기 혈압 (p < 0.05)이 유의적으로 감소하였다. 2) 연령 그룹별로 살펴보면, 체지방률과 수축기 혈압은 세군 모두에서 유의적으로 감소하였고, 총 콜레스테롤은 39세 이하 그룹에서만 유의적으로 감소하였다 (p < 0.01). 3) 영양교육 전, 39세 이하 그룹의 대사증후군 유병률은 25%, 40대 그룹은 27.2%, 50대 그룹은 36.3%의 분포를 보였다. E-mail 영양교육 후, 39세 이하 그룹의 대사증후군 유병률은 18.3%, 40대 그룹은 27.5%, 50대 그룹은 35.4%로 교육 전에 비해 영양교육 후 39세 이하 그룹에서의 대사증후군 유병률이 유의적으로 감소하였다 (p < 0.05). 이상과 같이 본 연구에서 e-mail교육 프로그램은 직장인들에게 신체계측치 및 심혈관 질환 위험인자 감소에 효과가 있음이 확인되었다. 따라서 종합검진 후 1년의 자기관리를 위한 e-mail 영양교육 자료를 개발하여 적용했다는데 본 연구의 의의가 있다고 본다. 본 연구의 결과를 토대로 e-mail 교육 프로그램의 효과를 평가하기 위한 확대연구와 효과의 지속기간에 대한 장기적인 추적연구를 통해 직장인의 건강증진 및 사내 복지향상과 의료비 절감을 위해 회사 지원 하에 질환에 따른 적절한 영양관리 프로그램으로 적용 될 수 있기를 기대한다.

• 대한영양사협회학술지
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• 제6권2호
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• pp.125-135
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• 2000

Hypertension is a well-known degenerative disease whose prevalence rate increases with age. Management of high blood pressure is a critical concern in preventive strategies to reduce the morbidity and mortality for cardiovascular disease. The purpose of this study was to examine the dietary characteristics of hypertensive program participants, and to establish strategies based on their nutritional needs. Hypertensive patients were enrolled in the program in a public health center or in a local elderly center, at Suwon, in 1999-2000. Trained dietitians interviewed 62 enrollees(24-hour recall) and related variables. Mean body mass index of the subjects was 25.0kg/m². 30.7% of the subjects had a family history of hypertension. The majority of them ate regularly and partook of all available side dishes. They consumed grains and vegetables regularly, but seldom ate dairy products or food prepared with oil. Male enrollees frequently consumed more processed food and animal fat than did female enrollees(p<0.05). An analysis of the percentage of RDA(Recommended Dietary Allowances of Korea 1995) showed that but for ascorbic acid, enrollees consumed nutrients below the RDA. The food group intake pattern was not diverse, thus only 8.1% of enrollees consumed all food groups in a day. An analysis of eating attitude showed that 64.5% of enrollees always added salt to beef soup. Male enrollees showed low food-related self-efficacy compared to female enrollees, especially with reference to reduction of instant food intake(p<0.01), increase in vegetable intake(p<0.01), reduction of monosodium glutamate(MSG) intake(p<0.01). and not overeating(p<0.05). Their perceived barriers for participating in hypertension nutrition programs included lack of time, program necessity non-recognition, and program comprehension difficulty. These results suggest that nutrition education program necessity non-recognition, and program comprehension difficulty. These results suggest that nutrition education programs for community hypertensive patients should focus on increasing participant consumption of foods, expecially dairy products, and desirable eating attitudes. It also suggests that the program should consider should consider encouraging self-efficacy in changing eating behavior.

• 한국산업보건학회지
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• 제9권1호
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• pp.87-98
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• 1999

The objectives of this study were to evaluate exposures to airborne methylene chloride and postshift carboxyhemoglobin (COHb) in blood of workers engaged in processes using blowing or cleaning agents, and to investigate correlation between methylene chloride concentrations and the blood COHb levels of workers. The geometric mean (GM) of workers' exposures (8 hour-time weighted averages, TWA) to airborne methylene chloride during cleaning molds using rags wetted with the solvent in the manufacture of flexible polyurethane foam (GM = 61.4 ppm), during operating the dip tank for cleaning molds in the manufacture of lens (GM = 61.0 ppm), and during cleaning the blowing nozzles by spraying the solvent in the manufacture of shoes (GM = 117.2 ppm) were exceeded the American Conference of Governmental Industrial Hygienists (ACGIH) Threshold Limit Value ($TLV^{(R)}$)-Time Weighted Average (TWA) (50 ppm). The COHb levels were significantly different among groups (p<0.05). The average COHh levels in blood of non-smoking workers were 2.0% in. low-level (<50 ppm) exposure group, and 3.9 % in high-level (>50ppm) exposure group. The average COHb levels in smoking workers were 3.1% in low-level exposure group, and 4.8% in high-level exposure group. The blood COHb levels of no-exposed workers to methylene chloride were 1.8% in non-smoking group, and 2.8% in smoking group. It was found that the COHb level dependeds on the methylene chloride concentration and smoking habit, and was highly correlated with methylene chloride concentration in air. The correlation coefficient was 0.81 among non-smoking workers. The estimated COHb level (3.6%) and 95% upper confidence limit (4.0%) corresponding to TLV-TWA of methylene chloride exceeded the current ACGIH Biological Exposure Index (COHb 3.5%) for carbon monoxide. The estimated COHb level (5.4%) at 100 ppm exceeded the standard (5%) recommended by National Institute for Occupational Safety and Health (NIOSH) for preventing adverse cardiovascular effect. The estimated COHb value and 95% upper confidence limit at 25 ppm of the Occupational Safety and Health. Adminstration (OSHA) Permissible Exposure Limit-TWA (PEL-TWA) were 2.6% and 3.0%, respectively. It is suggested that COHb in blood be kept below 3.0% to comply with OSHA PEL-TWA.

• 대한통합의학회지
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• 제12권2호
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• pp.89-100
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• 2024

Purpose : The objective of this study was to determine the major factors influencing the onset of diabetes and prediabetes and for collection of the basic data required to reduce the prevalence of diabetes and plan for administration of an effective health care system. By classifying the level of blood sugar management according to three categories: normal, prediabetes, and diabetes diagnosis, and determining the causes of diabetes in consideration of various variables, we will conduct an analysis of the main factors to be addressed for effective management of blood sugar and for preparation of basic data for use in early management. Methods : In this study, an analysis of raw data from the 8th National Health and Nutrition Examination Survey collected over a period of three years from 2019 to 2021, including 8,110 subjects in 2019, 7,359 subjects in 2020, and 7,090 subjects in 2021 was performed. A total of 22,559 subjects were aged 19 years or older, and 15,821 subjects were classified as subjects for inclusion in the final analysis. In the analysis, categorical variables were tested for difference, analysis of continuous variables using regression was performed, and analysis of influencing factors was performed using multinomial logistic analysis. Result : Significant factors related to the onset of diabetes and prediabetes included age (p<.001), marital status (p<.001), occupation (p<.001), hypertension (p<.001), dyslipidemia (p<.001), cardiovascular disease (p=.008), alcohol (p=.030) smoking (p=.005), systolic blood pressure (p<.001), diastolic blood pressure (p<.001), body mass index (p<.001) and waist circumference (p=.037), blood triglycerides (p<.001), and blood cholesterol (p<.001). Conclusion : Diabetes, a complex disease affected by a variety of diseases, requires active management from the prediabetes stage, and providing an appropriate level of medical information and services to elderly individuals without family support is considered a long-term health care system requirement in Korean society where the demographic structure is changing. In particular, determining the causes of prediabetes and development of a preventive approach to administering the health care system will be important for efficient management of diabetic patients.

• 농촌의학ㆍ지역보건
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• 제35권1호
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• pp.67-76
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• 2010

광주지역의 한 종합병원 수검자를 대상으로 백혈구 수와 대사증후군과의 관련 요인을 분석하고자 단면 연구를 시행한 결과 대사증후군의 유병률은 남성이 25.2%, 여성은 13.3%로 나타났으며, 연령별 유병률은 남성은 40대에서, 여성은 60세 이상에서 가장 높은 유병률을 보였고 남녀 모두 백혈구수가 증가 할수록 대사증후군의 유병률이 높게 나타났다. 대사증후군과 백혈구수와의 로지스틱 회귀분석의 결과에서는 남, 여 모두 백혈구 수가 증가 할수록 대사증후군의 위험도가 증가하였다. 결론적으로 본 연구에서는 비록 정상범위 일지라도 증가된 백혈구 수는 대사증후군과 연관성이 있다는 것을 확인할 수 있으며, 대사증후군 기준을 충족시키는 항목수가 많을수록 백혈구 수는 증가하는 경향을 보였고, 백혈구 수를 네 개의 군으로 나누었을 때 백혈구 구분수가 증가할수록 대사증후군의 유병률도 증가하고 있었다. 백혈구수와 백혈구 감별계산이 대사증후군을 예측하는 인자로 가치가 있는지는 광범위한 대단위 연구와 시간적 순서에 의해 인과관계를 규명하는 코호트연구가 필요하다고 생각된다.