남성 근로자의 건강관련 행태와 건강수준과의 관련성

함정오,김화성,이성수,우극현,안규동,이병국 순천향대학교 산업의학연구소 2001 순천향산업의학 Vol.7 No.1

This study was conducted to evaluate the health related behaviors associated with blood pressure, results of liver function and renal function, and anemia indices. Study subjects were 499 male workers who visited to General Health Screening Center of A hospital located in Chonan. Data were collected from March to December 1996. By the questionnaire, the informations of health related behaviors such as, age, smoking and drinking habits, food intake habit, sleeping time, stress were obtained. Height, weight and blood pressure were measured by a trained nurse. The level of total Cholesterol, HDL Cholesterol, triglyceride, fasting blood sugar, glutamate oxaloacetate transaminase(GOT), glutamate pyruvate transaminase (GPT), r-glutamyl transferase(rGTP), blood urea nitrogen(BUN), serum creatinine(Cr), hemoglobin(Hb), hematocrit(Hct), hepatitis B surface antigen were selected as biometric test variables. Statistical analysis, such as t-test, Chi square-test, stepwise multiple regression, multiple logistic regression were performed using SAS package program. There were significant differences in age, systolic blood pressure, total cholesterol, GOT, GGT, BUN, Hb, and Hct between drinkers and non-drinkers, and significant differences in age, body mass index(BMI), systolic blood pressure, diastolic blood pressure, rGTP, BUN, and Hb between smokers and non-smokers . Triglyceride, age, BMI, and HDL cholesterol were found to be positivc independent predictors of blood pressure, but drinking habit(mild drinking group vs. non-drinking group) and pack-year of smoking were negative predictors of blood pressure. Logistic analysis of systolic hypertensive related condition indicated that triglyceride(OR=1.003, 95% CI; 1.000-1.006), total cholesterol(OR=1.008, 95% CI; 1.000-1.016), and pack-years of smoking (OR=0.972, 95% CI; 0.952-0.994) were significantly contribution to dependent variable, Logistic analysis of diastolic hypertensive related condition revealed that age3(≥50 years vs. <40 years) (OR=4.702 (95% CI; 1.919-11.521), age2(40-49 years vs. <40 years) (OR=4.702 (955 CI; 1.919-11.521), triglyceride (OR=1.005, 95% CI; 1.002-1.008), pack-years of smoking(OR=0.972, 95% CI; 0.951-0.993), and meal regularity (yes vs. no) (OR=0.618, 95% CI; 0.383-0.991) were significantly contribution to dependent variable. Triglyceride, total cholesterol, fasting blood sugar, and animal food intake(yea vs. no) were found to be positive independent predictors to BMI, but HDL and stress(yes vs. no) were negative predictors. Logistic analysis of abnormal BMI condition indicated that total cholesterol(OR= 1.013, 95% CI; 1.007-1.020) and HDL cholesterol (OR=0.943, 95% CI; 0.916-0.972) were significantly contribution to dependent variable. BMI, HBs Ag, and the frequency of drinking were found to be positive independent predictors to GOT, but meal regularity(yes vs. no) were negative predictors. Logistic analysis of abnormal GOT condition indicated that HBs Ag(yes vs. no)(OR-6.666, 95% CI; 1.724-25.779), BMI(OR=1.199, 95% CI;1.015-1.416), and meal regularity(yes vs. no)(OR=0.248, 95% CI; 0.096-0.639) were significantly contribution to dependent variable. BMI, and HBs Ag were found to be positive independent predictors to GPT, but meal regularity(yes vs. no) were negative predictors. Logistic analysis of abnormal GPT condition showed that only BMI (OR=1.301, 95% CI; 1.301(1.176-1.440) was significantly contribution to dependent variable. BMI and the frequency of drinking were found to be positive independent predictors to rGTP, but meal regularity(yes vs. no) were negative predictors. Logistic analysis of abnormal rGTP conditionindicated that BMI(OR=1.340, 95% CI; 1.197-1.499), Alc5(abovc 5 times/week vs. non-drinking) (OR=21.733, 95% CI; 3.671-128.684), Alc4(3-4 times/week vs. non-drinking) (OR=4.533, 95% CI; 1.463-14.049), Alc3(1-2 times/week vs. non-drinking) (OR=3.918, 95% CI; 1.406-10.916), and meal regularity(yes vs. no) (OR=0.405, 95% CI; 0.221-0.740) were significantly contribution to dependent variable. BMI and age were found to be positive independent predictors to BUN, but stress(yes vs. no) and pack-year of smoking were negative predictors. Logistic analysis of abnormal BUN condition indicated that only age3(≥50 years vs. <40 years) (OR=4.808 (95% CI; 1.307-17.676) was significantly contribution to dependent variable. BMI was found to be positive independent predictors to Hb and Hct, respectively, but regular exercise(yes vs. no) was negative predictors to Hb and Hct, respectively. With above results, it was found that age, BMI, level of serum triglyceride, and level of serum total cholesterol were significantly associated with hypertension and that BMI was significantly associated with abnormal results of liver function tests and especially the frequency of drinking was associated with abnormal rGTP. Also the workers with meal regularity habits, compared to those with meal irregularity habits, were lower prevalence of hypertension and abnormal liver function tests, therefore the meal regularity habits seem to be reflected good health related behaviors.

대기중 휘발성 유기화합물질의 검출한계와 정량한계에 대한 연구

이상열,안규동 순천향대학교 산업의학연구소 1997 순천향산업의학 Vol.3 No.1

Volatile organic compounds(VOCs) are emitted as air pollutant from many petrochemical process. The measurement for these materials are difficult, because of a very little amount existed in atmosphere. This study was conducted in order to investigate the limit of detection(LOD) and limit of quantitaion(LOQ) for VOCs measurement. The concentrations of VOC's LOD and LOQ were assayed by gas chromatography with flame ionization detection(GC/FID). The results are as follows; 1. LOD and LOQ of acrylonitrile were 0.0114㎍/㎖, 0.0144㎍/㎖, respectively. 2. LOD and LOQ of benzene were 0.0136㎍/㎖, 0.0150㎍/㎖, respectively. 3. LOD and LOQ of 1.3-butadiene were 0.0114㎍/㎖, 0.0136㎍/㎖, respectively. 4. LOD and LOQ of 2-butanone was 0.1016㎍/㎖, 0.1073㎍/㎖, respectively. 5. LOD and LOQ of carbon Tetrachloride were 0.0065㎍/㎖, 0.0188㎍/㎖, respectively. 6. LOD and LOQ of c--hexane were 0.0112㎍/㎖, 0.0143㎍/㎖, respectively. 7. LOD and LOQ of ethylbenzene were 0.0112㎍/㎖, 0.0131㎍/㎖, respectively. 8. LOD and LOQ of n-hexane were 0.0172㎍/㎖, 0.0582㎍/㎖, respectively. 9. LOD and LOQ of styrene were 0.0122㎍/㎖, 0.0142㎍/㎖, respectively. 10. LOD and LOQ of tetrachloroethylene were 0.0121㎍/㎖, 0.0320㎍/㎖, respectively. 11. LOD and LOQ of 1.1.1-trichloroethane were 0.0016㎍/㎖, 0.0062㎍/㎖, respectively. 12. LOD and LOQ of trichloroethylene were 0.0064㎍/㎖, 0.0183㎍/㎖, respectively. 13. LOD and LOQ of toluene were 0.0136㎍/㎖, 0.0148㎍/㎖, respectively. 14. LOD and LOQ of xylene were 0.0140㎍/㎖, 0.0154㎍/㎖, respectively.

대구지역 영세사업장의 작업환경 측정실태와 인식도

이성미,이종영,김두희,이종화,장봉기 순천향대학교 산업의학연구소 1996 순천향산업의학 Vol.2 No.1

This study was conducted to examine both actual status and understanding of the workshop environment of the small sized companies with 30 or less employees in and around Taegu city, Korea by analysing the questionnaire with 400 small sized manufacturing companies from the end of Mar. to the end of June 1993 according to their employee number and business type. The result of this study is summarized as follows. The job title of the respondents showed that the president accounted for 34.3% which was highest, particularly, which showed the highest percent in the companies with 5-9 employees. The management of workshop environment indicated that the response of 'Very Necessary' accounted for 52.0% which was higher. Thus it was shown that the owner and manager's understanding of the workshop environment was higher. However, the response of 'No Enough Money' for investment in improvement of workshop environment indicated that the president accounted for 51.1% which was also higher. 54.3% of all subjects considered their workshop environment as not good, while 66.5% answered that the workshop environment has effect on the health of employees. The actual status of industrial accidents occurred from January to December 1992 showed 18.7% frequency, while their business type was that the metal and machinery industries accounted for 24.8%. In addition, their size indicated that 16-29 employees accounted for 26.5% which was higher than that of other companies with different sizes. Regarding the question of understanding whether their workshop is the subject required for measuring the workshop environment, it was shown that the response of 'No Understanding' accounted for 57.0%. Based on their size, the companies with 5-9 employees accounted for 37.6%, while on their business types the metal and machinery industries accounted for 31.2% which showed the lowest understanding. In case of the companies understanding as the subject required for measurement of their workshop environment, the harmful element acting as a problem in their workshop indicated that the response of 'Too Noisy' accounted for 37.8%, and 'Too Serious Dust' for 11.8%, when the noise appeared as the most serious harmful element in all workshops. Among the companies required for measuring the workshop environment, it was shown that the workshops which did not carry out the required measurement accounted for 24.4%. Of the workshops which carried out the measurement required for their workshop environment, the frequency of annual two times accounted for 40.1% which was highest. Based on their size, it was shown that the companies with 16-29 employees accounted for 52.6% which was highest. The use of their measured data and execution of required improvement showed that the response of 'Good' was totally high. Also the keeping result of their measured list indicated that the response of 'Good' accounted for 72.3%. Based on the above result, the understanding of needs for control of workshop environment was high. However, the actual improvement of workshop environment was not so active as their understanding. Because the health of all employees is closely related to the harmful workshop environment and working conditions, it will be necessary for the government to support the improvement of workshop environment of these small sized companies with insufficient capability of investment, to suggest its direction and to continuously encourage and inspect their measurement of workshop environment.

의료기사의 누적 외상성 증후군 증상에 관한 조사

박찬호,리갑수,이성수,안규동,이병국 순천향대학교 산업의학연구소 2001 순천향산업의학 Vol.7 No.1

The cumulative trauma disorder is a disease group of musculoskeletal systems developed by repeated work, which became greate concern in occupational health problem in Korea recently. Many paramedicals working in the department of Laboratory, Radiology, and Rehabilitation of the hospital have been engaged in the simple repetitive hard works causing cumulative trauma disorder. This is the study on the cumulative trauma disorder in those medical technicians. Total 285 (180 male, 105 female) medical technicians and office workers working in the hospital were surveyed with the self-administered questionnaires. They included the questions such as age, sex, marital status, education, height, weight, smoking and drinking history as a general characteristics and work department, kind of work, work duration, work conditions as a work characteristics. And also subjective symptoms related with the work in each region of body area were questioned. Among the work conditions, there were significant differences between medical technicians and office workers (e.g., high in medical technicians) in daily works lifting patients or heavy equipments, works moving continuously and rapidly, works with uncomfortable position, works keeping neck and upper arms in uneasy position. Complained rate of subjective symptoms was significantly higher in physical therapist and in the group of work duration over 10 years. The significant symptoms were pain, abnormal sensation, burning sensation. The significant factors affecting the subjective symptoms were female and work duration over 10 years for wrist area, female and current smoking for knee or ankle area, physical therapist, work duration between 6 and 9 years for lumbar area, female and radiologic technicians and work duration over 6 years for shoulder area. None was significant for neck area.

무보수 호흡용 보호구 착용이 2차 제련 연작업자들의 연폭로지표에 미치는 영향

이영구,황보영,리갑수,이성수,안규동,이병국 순천향대학교 산업의학연구소 1997 순천향산업의학 Vol.3 No.1

It is often impossible to improve working condition in small scaled lead industries due to inherent old work process and lack of capital to improve it. This is particularly true in secondary smelting industries in Korea. Alternative ways to protect workers in these industries are respiratory protection and job shift if at all possible to less harmful workplace. This study intended to evaluate the effect of maintenance free respirator and job shift of lead workers to other non-lead workplace on the level of lead exposure of workers in terms of blood zinc protoporphyrin as an index of lead absorption and intoxication of lead workers. Seventy three workers of one secondary smelting industry whose work duration was more than 4 months were studied. All workers were classified into 4 groups such as managemental workers(8), non-lead workers(14), lead workers(44) and shift workers(7). Personal data such as age and work duration were collected and air concentration of lead in each workplace were also measured. Blood ZPP was chosen as an index of biological monitoring and was measured regularly once a month for 5 months study period. The results obtained were as follows: 1. There were no significant differences of mean blood ZPP during 5 months study period in management workers and non-lead workers showing the range of 23.1-26.5 ㎍/100ml and 22.2-24.2 ㎍/100ml respectively. 2. Rapid reduction of mean blood ZPP from first month (203.0 ± 106.7 ㎍/ 100ml) to third month (128.4 ± 75.1 ㎍/100ml) was noticed and after 3 months period there was no further reduction of blood ZPP in lead workers. 3. The initial mean blood ZPP of shift workers who moved to non-lead workplace was 394.3 ± 114.9 ㎍/100ml and their mean blood ZPP were steadily decreased every month from 344.3 ± 98.4 ㎍/100ml of first month to129.9 ± 33.5 ㎍/100ml of 4th month). 4. The average reduction rate of blood ZPP based on initial blood ZPP was 37.0% in lead workers for 3 months period and 67.1% in shift workers for 4 months period. With above results it was observed that respiratory protection and work shift could protect lead workers from lead exposure by reducing lead exposure in secondary smelting industry which had fairly bad working condition. But for a complete prevention of lead poisoning, it has certain limitation and should be used as an interim method until fundamental engineering control of workplace.

우리나라 연 작업자들의 연폭로 수준에 관한 연구

조인숙,김용배,리갑수,김화성,황규윤,장봉기,이성수,안규동,이병국 순천향대학교 산업의학연구소 1999 순천향산업의학 Vol.5 No.1

To assess lead exposure in Korean lead workers, 2047 male lead workers in 17 lead using industries were studied. Study population were divided into 4 occupation categories such as storage battery industry(type 1), secondary smelting and litharge making industries(type 2), PVC stabilizer making industries(type 3) and primary smelting and related industries (type 4). Blood lead and zinc protoporphyrin in whole blood (ZPP) were selected as an index of lead exposure. Hemoglobin and hematocrit were also checked. Fifteen questionnaires of lead related symptoms were provided to all lead workers and filled up by themselves and confirmed by medical doctors. Personal variables such as age, work duration, smoking and drinking habits were also collected. the results were as follows. 1) The mean blood lead, ZPP and hemoglobin of all lead workers were 29.7+12.6㎍/100㎖, 56.5+38.6㎍/100㎖ and 14.6+1.3 gm/100㎖ respectively. 2) While the mean blood lead of lead workers in type 1, 2, 3 and 4 were 28.6+11.6㎍/100㎖, 46.2+15.3 ㎍/100㎖, 46.8+12.1 ㎍/100㎖ and 26.2+10.2 ㎍/100㎖, the mean value of blood ZPP of those workers were 53.6+32.6 ㎍/100㎖, 108.1+87.1 ㎍/100㎖, 98.9 +54.9 ㎍/100㎖ and 45.8+19.5 ㎍/100㎖ respectively. 3) The percents of lead workers whose blood lead were 40-59.9 ㎍/100㎖ and over 60.0 ㎍/100㎖ were 17.6% and 2.1% respectively. Those whose blood lead were 40-59.9 ㎍/100㎖ and over 60.0 ㎍/100㎖ were 15.18% and 0.96% for type 1, 43.59% and 21.79% for type 2, 58.89% and 12.22% for type 3 and 11.82% and 0% for type 4 respectively. 4) The percents of lead workers whose blood ZPP were 100-149 ㎍/100㎖ and over 150 ㎍/100㎖ were 5.17% and 3.17% respectively. Those whose blood ZPP were 100-149 ㎍/100㎖ and over 150 ㎍/100㎖ were 4.66% and 2.04% for type 1, 10.26% and 25.64% for type 2, 23.33 and 13.33% for type 3 and 1.28% and 0.32% for type 4 respectively. 5) The prevalence rate of smoking and drinking of male lead workers in all lead industries were 70.8% and 71.0% respectively. While the mean blood lead of smoker, non-smoker, drinker and non-drinker were 30.24+12.58 ㎍/100㎖, 28.35+12.7 ㎍/100㎖, 30.24 ㎍/100㎖ and 28.74 ㎍/100㎖ respectively, the mean blood ZPP of those were 55.7+37.1 ㎍/100㎖, 58.4+41.9 ㎍/100㎖, 55.7+36.5 ㎍/100㎖ and 58.4+43.3 ㎍/100㎖ respectively. 6) While the correlation of hematocrit corrected blood lead with other lead exposure variables were higher than non-corrected blood lead, the correlation of log-transformed ZPP with other lead exposure variables were higher than non-corrected blood ZPP. 7) The most frequent symptom among 15 lead related symptom questionnaires was 'general fatigue' and the next one was 'feeling irritated with disturbance' and least one was 'acute abdominal pain around the umbilicus' in all lead workers. The overall prevalence of lead workers in storage battery industry and primary lead smelting industry were higher than secondary lead smelting and PVC stabilizer making industries. 8) The prevalence of lead related symptoms was a little higher in 13 symptoms in smokers than non-smokers and in 14 symptoms in drinker than non-drinkers, but they were not statistically significant. 9) Stepwise multiple regression analysis, using overall symptom prevalence as a dependent variable blood lead, blood ZPP, hemoglobin, age, work duration, drinking and smoking habits as independent variables, indicated that smoking habit, drinking habit and age were significantly contributed to the dependent variable. 10) The slopes of simple linear regression of blood lead (independent variable) with blood ZPP and log-transformed ZPP as dependent variable were different among 4 types of lead industries. The slope of lead industries with low mean blood lead were less steeper than those with high mean blood lead.

一部 樂器의 演奏音에 의한 暴露歷이 聽力에 미치는 影響

박종안,장봉기,이종화,안규동,이영세 순천향대학교 산업의학연구소 1997 순천향산업의학 Vol.3 No.1

This study was carried out to evaluate the effect of playing musical instruments on hearing threshold level from May to October, in 1997. Pure tone audiometric tests was provided to musical instruments playing group of total 117 subjects(Samullnori; 35, military band; 25, symphony orchestra; 46, piano; 11), and reference group of total 7,477 subjects, selected after excluding workers with history of ear disease, of ototoxic drug administration, of noise induced hearing loss at workplace in Pohang industrial area. In addition, noise exposure levels of musical instrument players were assessed by noise dosimetry(exchange rate; 5dB, threshold level; 80dB, criterion level; 90dB), and produced age-adjusted hearing threshold level(=hearing threshold level of musical instrument player - hearing threshold level in same age of normal population group). The age-adjusted hearing threshold levels were analyzed by musician's career. The results were as follows; 1. The hearing threshold level of reference group was revealed more increased as within 4.98dB to 6.89dB at 1 KHz and within 5.26dB to 14.46dB at 4 KHz by ages than "the Standard of Age-adjusted Hearing Loss by Frequency(OSHA)" used for special health examination in the Ministry of Labour. 2. Equivalent continuous sound exposure level (Leq) by the group of instrumentalist was as following; within 104.95 to 112.62dB in samullnori, the highest, within 100.18 to 103.49dB in military band, within 77.00 to 82.74dB in symphony orchestra and 81.54dB in piano, the lowest. Playing maximum sound level by each musical instrument was as following; 122.8dB in Kkwaenggwari, the highest, 122.7dB in Changgo, 121.8dB in Alto saxophone, 115.5dB in Trumpet, 119.2dB in Horn, 112.8dB in Pungmul Buk and Ching, 112.5dB in Clarinet. 3. Average age-adjusted hearing threshold levels of instrumentalists were -0.65±6.38dB in left ear, -0.92±6.59dB in right ear at 1 KHz, and -1.14±12.88dB in left ear, -1.53±12.77dB at 4 KHz, which were better than normal, but the average age-adjusted hearing threshold levels of Samullnori players were 1.23±5.22dB in left ear, 1.94±6.91dB in right ear at 1KHz, and 8.40±15.75dB in left ear. 7.13±14.97dB in right ear at 4KHz, which were worse than normal. 4. Hearing threshold level in Samullnori players was increased with their career at 4 KHz, especially it increased rapidly when the musicians had played over 10years. It showed that there was a significant relationship between hearing threshold level and the career (P<0.01).

충남 서부지역에서 분리한 Salmonella 및 Shigella 균속의 신고에 관한 연구

이기호,이병국 순천향대학교 산업의학연구소 1997 순천향산업의학 Vol.3 No.1

The goal of this study is to compare the occurance of communicable diseases with their reported rate and to present the problems of reporting system of these diseases. The author investigated occurances of typhoid fever, paratyphoid fever and bacterial dysentery isolated from seven general hospitals in westen area of Choongnam province from 1990 to 1996. And then I compared it with 'Communicable Disease Report' published form National Institute of Health. The estimated report rate were 47/126(37.3%) for typhoid fever, 2/99(2.0%) for paratyphoid fever and 32/43(74.4%) for bacterial dysentery and the total reported rate for 3 above infectious disease was 81/268(30.2%). The estimated incidence rate(cases per 100,000) of 1995 and 1996 were 3.9 & 1.1 for typhoid fever, 2.2 & 5.0 for paratyphoid fever, 0.6 & 0.9 for bacterial dysentery and 6.7 & 7.0 for three infectious disease as a total. The reporting rate of communicable diseases was showed decreased tendency in recent years.

유기용제 폭로 근로자의 자각증상에 관한 연구

엄영익,신혜련,우극현,안규동,이병국 순천향대학교 산업의학연구소 1997 순천향산업의학 Vol.3 No.1

To investigate the relationship of subjective symptoms of organic solvent exposed workers with their exposure level and urinary excretion of hippuric acid, 61 male workers who worked in 5 organic solvent using industries were studied. 89 workers were randomly selected from workers group for detailed health examination who visited hospital and had no exposure history to organic solvent as a control group. Personal air concentrations of organic solvent were checked for all organic solvent workers and urinary concentration of hippuric acid for both exposed and control group were also measured. Subjective symptom questionnaire of 31 organic solvent related item were provided to all workers and filled up by themselves and rechecked by medical doctor. The results obtained were as follows: 1. The overall prevalence rate of symptoms were significantly higher in exposed group than control group with statistical difference of 13 symptoms. 2. The overall prevalence rate of symptoms seemed to be increased by the exposure level of organic solvent. 3. The excretion of hippuric acid was more closely related to the level of toluene exposure than the level of mixed organic solvent exposure. 4. In the analysis of multiple stepwise regression using hippuric acid concentration as dependent variable and the concentration of each organic solvents as independent variables, only toluene had significant relationship with hippuric acid and none of other solvent did not affect on the concentration of hippuric acid. 5. In the analysis of multiple stepwise regression using symptom prevalence as dependent variable and the concentration of each organic solvents as independent variables, toluene had most significant effect to the symptom prevalence and the contribution of other solvents was minimal.

건강진단 수진자의 당뇨위험요인 및 건강행태의 변화에 관한 5년 추적관찰 조사

김주자 순천향대학교 산업의학연구소 1998 순천향산업의학 Vol.4 No.1

This study was done to observe the change of risk factors and health behavior among health examines between baseline and 5 year follow-up examinations. For the study, 484 subjects who had regular health examinations on 1900 and on 1995 were selected. The subjects were divided into 3 subgroups, i.e., Normal, IGT-Ⅰ, IGT-Ⅱ groups depending on the criteria combined with fasting and 1 hour postprandial blood sugar. The results were as follows; 1. The subject was consisted of 383 male (79.1%) and 101 female (20.9%), 484 in total. Subgroups were consisted of 306 Normal group (63.2%), 159 IGT -Ⅰ group (32.9%) and 19 IGT-Ⅱ group (3.9%). The highest age distribution was in the 40-49 age group all three groups. Most of them were office workers for males and housewives for females. 2. The mean levels of risk factors at baseline were ccompared to the mean levels after follow-up. Age, fasting and 1 hour postprandial blood sugar levels, relaive body weight, triglyceride, total cholesterol were significantly increased after follow-ups, especially in the Normal group. And also the majority of risk factors were increasing according to the level of subgroups i.e., the IGT-Ⅱ, IGT-Ⅰ, Normal group in order, for both baseline and followup examinations. 3. The changes of various health behaviors were observed between baseline and follow-up examinations. Such habits as regular exercise, change of weight, smoking, liquor, coffee drinking significantly changed to more desirable health behavioral patterns during follow-ups, but consuming salty, greasy or regular meals, concept on one's body weight, and daily activity did not significantly changed. In conclusion, more intensive interventions such as screening, health education, etc., were needed for all subgroups.