PURPOSE: Problem-based learning(PBL) experiences applied in the field of screening for chronic disease during the course of Community Medicine for the 3rd grade medical students were summarized. This study was aimed to train medical students the health appraisal ability and also the ability for public health education and promotion with health-oriented concept rather than disease-oriented one. And also it was aimed to train students to know what to learn and how to search the informations they need for themselves. STUDY SUBJECT AND METHOD: Three to four students in one team spent one and half days(Friday and Saturday) of one-week practical course of Community Medicine. Assigned materials were the medical records which are the files with the results of automated multiphasic screening tests which were applied to generally healthy people. Students were supposed to find, evaluate, solve or manage the real problems encountered from the multiphasic screening test results. RESULTS: The students accepted this self-directed learning process and small group discussion and also health-oriented human approach as new experiences and stimulants.
Chronic Disease* ; Community Medicine ; Education ; Humans ; Learning ; Mass Screening* ; Medical Records ; Multiphasic Screening ; Problem-Based Learning ; Public Health ; Students, Medical

Adult ; Carbon Disulfide ; poisoning ; Case-Control Studies ; Female ; Humans ; Male ; Middle Aged ; Multiphasic Screening ; Neural Conduction ; Occupational Diseases ; diagnosis ; physiopathology

In order to develop questionnaire estimating vinyl chloride monomer(VCM) exposure levels, to reset selection criteria for detailed tests, to measure current VCM exposure levels, to evaluate the mutagenic effects of VCM exposures and to develop multiphasic screening method of PVC- or VCM-handling workers, VCM concentrations of work environments were measured and tentative self-administrative questionnaire, physical examination, sister chromatid exchange(SCE) test and some clinical chemical test were applied to 195 men who had been handling VCM or PVC(Exposed Group) and 37, in the same factories without exposure to VCM or in polyethylene- or polypropylene-related factories(Control Group). Mean VCM concentrations of work environments were 0.268+/-0.183 ppm under PVC synthesis processes, 0.160+/-0.200 ppm under VCM synthesis process, 0.076+/-0.111 ppm under PVC pipe producing processes, 0.090+/-0.108 ppm under PVC wall paper, sheet, or film producing processes, 0.071+/-0.051 ppm under PVC floor producing processes, 0.243+/-0.250 ppm under PVC sash producing processes, and 0.020+/-0.031 ppm under triming process. VCM levels of work environments under manual resin mixing processes (0.209+/-0.168 ppm)were higher than those of the others (0.209+/-0.168 ppm) (p-value<0.05). There was no VCM-related symptoms, the positive response rates of which were higher in the Exposed Group. Overall abnormal rate in clinical chemistry test of the Exposed Group was higher than that of the Control Group, but due to extermely low exposure level of exposure group and to small sample size of the Control Group, no statistical significance was found(p-value>0.05). SCE frequencies of the Exposed Group were significantly higher than those of Contorl Group(p-value<0.05) and those of test-abnormal persons were higher than those of test-normal persons. SCE frequencies linearly increased with not only current but also cumulative VCM exposure levels(p-value<0.05). These results suggest that adverse health effect may ensue from VCM exposure to as low as 1 ppm. But SCE frequencies had no statistically significant correlation with drinking amounts, smoking amoutns, or radiation dose equivalents. Questionnaire was revised by referring to these results and formula estimating cumulative VCM exposure levels based on occupational history in questionnaire were made. In addition, were presented methods evaluating work environments and multiphasic screening test for PVC workers.
Chromatids ; Clinical Chemistry Tests ; Drinking ; Humans ; Male ; Multiphasic Screening* ; Patient Selection ; Physical Examination ; Polyvinyl Chloride* ; Polyvinyls* ; Questionnaires ; Sample Size ; Siblings ; Sister Chromatid Exchange ; Smoke ; Smoking ; Vinyl Chloride*

OBJECTIVETo study the effects of carbon disulfide (CS(2)) on the health of workers, and to provide the basis for the further preventive measures.

METHODSThe occupational health examination of 881 workers exposed to CS(2) in a chemical fiber factory was carried out according to the national technical standard of occupational health surveillance. The time weighted average concentrations (TWA) of CS(2) in the workshops of short silk and long silk exceeded the national standard, The workers in these two workshops served as the high exposure group. The workers of the other workshops were classified as low exposure group, in which TWA met the national standard. All exposed workers were also divided into long-term exposure group and short-term exposure group on the basis of average exposure years (16 years). The statistical analysis was used by t test, χ(2), and fisher exact test.

RESULTSThe symptom rates of numbness, fatigue, dizziness, insomnia and headache were 12.5%, 8.5%, 8.2%, 7.5%, and 7.2% respectively. The abnormal rates of superficial sensation, three fibrillation, achilles tendon reflex, patellar reflex, EMG, hypertension, triglycerides, low-density lipoprotein, and apolipoprotein B were 33.0%, 26.1%, 20.8%, 18.6%, 10.8%, 33.4%, 24.5%, 17.0% and 9.3% respectively. Among the high exposure group, the abnormal detectable rates of dizziness, headache, fatigue, insomnia, numbness, achilles tendon reflex, superficial and deep sensation, EMG, hypertension, ECG, total cholesterol, triglyceride and low density lipoprotein in long-term exposure group were significantly higher than those in short-term exposure group (P < 0.05 or P < 0.01). However, among the low exposure group, the abnormal rates of the insomnia achilles tendon reflex and superficial sensation in long term exposure group were significantly higher than those of short term exposure group (P < 0.05 or P < 0.01). The detected rates of hypertension, triglycerides, low-density lipoprotein, creatinine and uric acid were in males significantly greater than those in females (P < 0.05 or P < 0.01).

CONCLUSIONLong-term exposure to high concentrations of CS(2) could lead to the damage of nervous system, elevate blood pressure and promote the development and progression of hyperlipemia and atherosclerosis. Furthermore, CS(2) had greater effects on blood pressure and lipid in males than in females.

Adult ; Carbon Disulfide ; adverse effects ; Cardiovascular System ; Chemical Industry ; Female ; Health Status ; Humans ; Male ; Middle Aged ; Multiphasic Screening ; Nervous System Diseases ; epidemiology ; Occupational Exposure ; Young Adult

Adult ; China ; epidemiology ; Female ; Humans ; Male ; Middle Aged ; Multiphasic Screening ; Pregnancy ; Prenatal Diagnosis ; Rural Population ; Spouses ; Young Adult ; beta-Thalassemia ; epidemiology ; prevention & control

OBJECTIVE: To evaluate the feasibility of screening for pediatric obstructive sleep apnea hypopnea syndrome (OSAHS) according to OSA-18,physical examination and electronic nasopharyngoscopy. METHOD: Outpatients with snoring received questionnaire, physical examination and electronic nasopharyngoscopy in Pediatric Sleep Center of Beijing Children's Hospital from 2009.1 to 2009.12. All children were divided into OSAHS or non-OSAHS group based on the results of polysomnography (PSG). The material was compared between these two groups. RESULT: The differences of age,tonsil scores, adenoid scores,total OSA-18 sores, the loudness of snoring scores, sleep asthma or suffocation scores, worrying lack of oxygen scores were significant (P < 0.05). And then put them into the logistic equation Y and make ROC analysis, if Y is higher than 0. 735, these children were more likely with OSAHS. The sensitivity was 62.7% and the specificity was 79.4%. CONCLUSION It is feasible to screen for pediatric OSAHS according to questionnaire, physical examination and electronic nasopharyngoscopy.
Adolescent ; Child ; Child, Preschool ; Feasibility Studies ; Female ; Humans ; Infant ; Male ; Multiphasic Screening ; standards ; Polysomnography ; Sleep Apnea, Obstructive ; diagnosis ; Snoring ; diagnosis ; Surveys and Questionnaires

To improve wellness and quality of life by recognizing the health effects of stress, the author estimated the relationships between stress, subjective symptoms and clinical diagnosis through a questionnaire and a battery of specified laboratory tests - electrocardiography, blood pressure, cholesterol, aspartate aminotransferase(AST), alanine aminotransferase(ALT), gamma glutamyl transferase(gamma-GTP), fasting blood sugar, gastro-endoscopy or UGI, abdominal sonography, etc. The data was gathered from 337 clients who were undergoing multiphasic screening program at a University Hospital from January to March 1998. The mean age of subjects was 46.5+/-11.2 years and the mean of body mass index was 24.0+/-3.7kg/m2. The mean level of stress was 18.5+/-6.0 expressed as the score out of 40. By general characteristics and life style among male, mean level of stress was significantly higher in case of lower socioeconomic status, habitual drug use, longer daily working time(>10 hours), no regular exercise, drinkers, irregular meal, skipping breakfast(p<0.05). In case of female, that was significantly higher in case of lower education, lower socioeconomic status, longer daily working time(>10 hours), no regular exercise, drinkers, smokers, irregular meal, skipping breakfast(p<0.05). Significant correlations were observed between stress and subjective symptoms in all kinds of organ system(p<0.01). Correlation coefficients of stress among male were relatively high with neuro-psychiatric symptom(gamma=0.476) and cardio-vascular symptom(gamma=0.361) in order, and correlation coefficients of stress among female was highest with neuro-psychiatric symptom(gamma=0.371). The prevalence of the diagnosis through the battery of laboratory tests was high in upper gastrointestinal disorders and hypercholesterolemia in order in both sex group. Among male the mean score of stress was significantly high in ulcerative peptic disorder of upper gastrointestine and hepatopathy in order (p<0.05) . Among female that was significantly high in diabetes mellitus. In summary, it is likely that there are associations between stress, subjective symptoms and clinical diagnosis. To promote wellness and quality of life through, therefore, it would be of value that periodic stress evaluation program and stress management including appropriate control of smoking and drinking, regular exercise and meal.
Alanine ; Aspartic Acid ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Cholesterol ; Diabetes Mellitus ; Diagnosis* ; Drinking ; Education ; Electrocardiography ; Fasting ; Female ; Humans ; Hypercholesterolemia ; Life Style ; Male ; Meals ; Multiphasic Screening* ; Prevalence ; Quality of Life ; Surveys and Questionnaires ; Smoke ; Smoking ; Social Class ; Stress, Psychological* ; Ulcer

Since the 1960's, Korea has achieved rapid economic growth, longer life expectancy, accelerated urbanization and a westernization of diet. Cardiovascular disease has become the leading cause of death; however the prevalence of ischemic heart disease(IHD) remains low. A cross-sectional multiphasic screening service for 18,426 persons aged 30 64 years in a Medical Aid Program in Kyonggi-do Province was conducted from 1991 to 1993. Total cholesterol(TC), Fasting blood glucose(FBG), blood pressure(BP), and electrocardiographic(EKG) data were collected. The result as follows; 1. On the EKG findings, the age-adjusted prevalence of myocardial ischemia and myocardial infarction was 1.45% in men and 2.06% in women. 2. The mean blood pressure was 122.9/78.8mmHg. The age-adjusted prevalence of hypertension was 11.05% in men and 9.02% in women. The prevalence of hypertension showed increasing tendency according to age increase. In all age group, the prevalence of hypertension was higher in men than women. 3. The mean total cholesterol level was 184.4mg/dl in men and 189.2mg/dl in women. The age-adjusted prevalence of hypercholesterolemia was 4.88% in men and 5.67% in women. The total cholesterol level showed increasing tendency according to age increase, except 55 64 age group in men. 4. The prevalence of hyperglycemia is 5.8%. The age-adjusted prevalence of hyperglycemia is 6.72% in men and 4.50% in women. The prevalence of hyperglycemia showed increasing tendency according to age increase. 5. On the EKG findings, the prevalence of myocardial ischemia and myocardial infarction was higher in hypertension than normal, in all age group of men and women less than 40 years-old. Only in women more than 40 years-old, the prevalence of myocardial ischemia and myocardial infarction was higher in hypercholesterolemia and hyperglycemia. Nevertheless there is not statistical association between ischemic heart disease and previous risk factors in other age group, the prevalence of myocardial ischemia and myocardial infarction was higher in hypertension, hypercholesterolemia and hyperglycemia than normal. The result of this study suggest that relationships between major risk factor of ischemic heart disease and ischemic heart disease is similar to existing theory.
Adult ; Blood Glucose* ; Blood Pressure ; Cardiovascular Diseases ; Cause of Death ; Cholesterol* ; Diet ; Economic Development ; Electrocardiography* ; Fasting* ; Female ; Gyeonggi-do ; Heart ; Humans ; Hypercholesterolemia ; Hyperglycemia ; Hypertension* ; Korea ; Life Expectancy ; Male ; Multiphasic Screening ; Myocardial Infarction ; Myocardial Ischemia* ; Prevalence ; Risk Factors ; Urbanization

OBJECTIVETo analyze the clinical characteristics of 267 cases with occupational chronic carbon disulfide (CS(2)) poisoning and to provide the basis for revising the items of periodical medical examination of workers occupationally exposed to CS(2).

METHODSThe subjects of present study were 267 patients with mild CS(2) poisoning diagnosed according to "Diagnostic Criteria of Occupational Chronic Carbon Disulfide Poisoning (GBZ4-2002)" from April in 2006 to May in 2010. All patients were from the same chemical fiber factory. When a subject was diagnosed as patient with CS(2) poisoning, who should interview with questionnaire which included the illness and occupational history, symptoms, individual habits. The physical examination, nervous test, cardiovascular test, biochemical test and electromyogram were performed.

RESULTSThe rate of decreased motor conduction velocity was 87.3% (233/267 roots). The highest detection rate of slowing conduction velocity was the common peroneal motor nerve which was 48.6% (138/248 roots) and the second was median motor nerve with delay rate of 37% (155/419 roots). The main symptoms of the patients were neurasthenia, numbness and paresthesia. The rates of abnormal achilles tendon reflex and knee jerk reflex in patients were were 79.4% and 49.8%, respectively. The detected rates of patients with ST-segment changes and hypertension were 19.1% and 27.5%, respectively. The rates of hypertension, systolic pressure and diastolic pressure were 27.3%, 22.5% and 21.1%, respectively. The rates of lactate dehydrogenase (LDH), triglycerides (TG) and low density lipoprotein (LDL) were high. The detected rates of urine acid, indirect bilirubin and total bilirubin in male patients were higher than those in female patients. In addition, the abnormal detected rate of urea nitrogen and indirect bilirubin increased with exposure years.

CONCLUSIONOccupational chronic CS(2) poisoning mainly affects the nervous system, as well as liver and kidney function. Detecting the median and common peroneal motor nerve conduction velocities could be the screening indicators for the peripheral nerve injury induced by CS(2) in the occupational exposure population during the periodical occupational medical examinations.

Adult ; Aged ; Carbon Disulfide ; poisoning ; Chemical Industry ; Female ; Humans ; Kidney ; drug effects ; physiopathology ; Liver ; drug effects ; physiopathology ; Male ; Middle Aged ; Multiphasic Screening ; Nervous System ; drug effects ; physiopathology ; Neural Conduction ; Occupational Exposure

OBJECTIVETo understand the occupational hazards of ammonium perchlorate dust on operating workers and to provide the basis preventive measures for protecting the workers' health.

METHODS36 workers exposed to ammonium perchlorate dust and 48 unexposed workers from one factory were selected as the exposure and control groups. Investigations on the general condition, sampling of dust in the workplaces and a special medical examination were conducted for two groups, including occupational history, clinical manifestations, blood routine test, hepatic and renal functions, indexes of thyroid hormone, spirometric test and chest X-ray.

RESULTSThe total dust concentration of AP in the batch plant reached to 51.63 ± 43.27 mg/m(3), exceeding the U.S. Occupational Safety and Health Administration (OSHA) permission exposure limits. The systolic blood pressure in the exposure group was higher than that of the control group (146.14 ± 21.03 VS 134.67 ± 18.58), and the difference was statistically significant (P < 0.05). The detection rates of the cumulative total symptoms, short of breath and skin itch symptoms in the exposure group were significantly higher than those in the control group (86.11% VS 66.67%; 30.56% VS 12.50%) (P < 0.05), respectively. FT(3) level in the exposure group significantly lowered than the control group, and the difference was statistically significant (P < 0.01); The pulmonary function result showed that FEV1/FVC% in the exposure group was lower than that in the control group (106.50 ± 28.99 VS 111.70 ± 19.72), but the difference was not significant. X-ray examination revealed one case of pulmonary X-ray abnormalities in the exposure group, diagnosis of pneumoconiosis, and one case with about 1.0 × 1.0 small nodules detected on the left of lung door area in the control group.

CONCLUSIONSThe systolic blood pressure of workers in the exposure group was significantly higher, which could not exclude related to the exposure to AP dust; The T(3) levels in the exposure workers were lower than those in the control group, which may due to AP exposure, suggesting that long-term chronic exposure to AP dust may affect thyroid function.

Adult ; Air Pollutants, Occupational ; Blood Pressure ; Case-Control Studies ; Dust ; Female ; Health Surveys ; Humans ; Male ; Middle Aged ; Multiphasic Screening ; Occupational Exposure ; Perchlorates ; adverse effects ; Quaternary Ammonium Compounds ; adverse effects ; Thyroid Function Tests