a12.PDF

Size: px

Start display at page:

Download "a12.PDF"

불현 경
5 years ago
Views:

1 , 1, 1, 2, 1, 1, 1, 1, = Ab st ra c t = Re la tio ns hip o f Le v e l o f Stre ss, Life Sty le, Subje c tiv e Sy m pto ms a nd C linic a l Dia g no s is in C lie nts ta ke n Multip ha s ic Sc re e ning Pro g ra m J un- H an P ark 1, J in- H o Chun 1, Jang - M i K ang 2, By ung - Chul S on 1, Dae- H wan K im 1, Chang - H ee L ee 1, K ui- W on J eong 1, Sang - H wa Urm 1, D ep artm ent of P reventive M edicine, Colleg e of M edicine, I nj e Univers ity 1 Graduate S chool of P ublic H ealth, I nj e Univers ity 2 T o impr ov e w ellnes s an d quality of life by r ecognizin g the health effect s of str es s, the auth or estim ated the relation ship s betw een stress, subjectiv e symptom s an d clinical diagn osis throu gh a qu estionnaire and a battery of specified laboratory test s - electrocardiography, blood pres sure, cholesterol, aspartate amin otran sferase (A ST ), alanine amin otran sferase (A LT ), g amm a glutamyl tran sferase (- GT P ), fasting blood sug ar, gastro- endoscopy or UGI, abdomin al sonography, etc. T he data w as gathered from 337 client s w ho w ere underg oing multiph asic screening program at a Univ ersity Hospital from Janu ary to M arch T he m ean ag e of subjects w as y ear s and th e m ean of body m ass index w as kg/ m 2. T he m ean lev el of stress w a s expressed as the score out of 40. By g eneral characteristics and life style am on g m ale, mean lev el of stres s w as significantly high er in case of low er socioeconomic statu s, habitual drug u se, long er daily w orking tim e (> 10 hour s ), no regular ex ercise, drinker s, irregular m eal, skippin g breakfa st (p< 0.05). In case of fem ale, that w as significantly higher in case of low er edu cation, low er socioeconom ic statu s, lon ger daily w orkin g tim e (> 10 hour s ), n o regular ex ercise, drinkers, smoker s, irregular m eal, skippin g breakfast (p< 0.05). Significant correlation s w ere ob serv ed betw een stres s and subjectiv e symptom s in all kinds of organ sy stem (p< 0.01). Correlation coefficient s of stress am ong m ale w ere relativ ely high w ith n euro- psy chiatric symptom (=0.476) and cardio- v ascular symptom (=0.361) in order, an d correlation coefficients of stress am ong fem ale w a s highest w ith neuro- psy chiatric symptom (=0.371). T he prev alence of the diagnosis through the battery of laboratory test s w as high in upper g astrointestinal disorder s an d hypercholesterolemia in order in both sex group. A mong male the m ean score of stress w as significantly high in ulcer ativ e peptic disor der of upper g astr oint estin e an d hepatopathy in order (p < 0.05). Am ong fem ale that w as significantly high in diabetes m ellitu s. In summ ary, it is likely that there are association s betw een stress, subjectiv e symptom s an d clinical diagn osis. T o prom ote w ellness and qu ality of life through, therefore, it w ould be of v alu e that periodic stress ev aluation program an d stres s m an agement in cludin g apropriate control of sm oking and drinkin g, regular ex ercise an d m eal. key w ords : stress, subjectiv e symptom s, life style 1997.

2 .... -,,,. (homeostasis ) (Chrou sosgold, 1992)., (stressor ). (Lipow ski, 1985). (Lazaru s, 1978; Reiser, 1984;, 1996). (, 1996) (Uhlenhuth, 1973;, 1989) (KolbBrodie, 1982;, 1996). (p sy chosom atic disease)(cobb Rose, 1973;, 1996;, 1996), (Jenkin s, 1971; Hayn es, 1978) (M atthew s, 1987; Hu dson, 1988), (Bak erbarcai, 1970; CobbRose, 1973; Robin sonfuller, 1985;, 1992), (, 1989;, 1997), (LintonKam w en do, 1989), (, 1986), (, 1998).,,,,, (BreslowEn strom, 1980; W iley Cam ach o, 1980; M etzner, 1983;, 1990;, 1994;, 1998).,,,,.

3 ( 175, 162). 2..,,.,,,,,,.,,,,,,,,,,,,,,,,,,,,,,, ,,,,. (1997) , 15-22, ,,..,,,,,,. 0.1cm 0.1 (Body M ass Index, BMI=W t ()/ Ht (m 2 )), 20.0, , 25.0 (T alleyphillips, 1988; Garrow, 1991)

4 , (complete bundle branch block ), (My ocardial isch emia or infarction ), Joint National Committee on Detection, Ev alu ation and T reatm ent of High Blood Pressure (JNC )(1978)140Hg 90 Hg, 221/ (, 1996), 57 (1997) 120/. Alanine amin otran sferase (A LT )46U/ L A spartate aminotran sferase (A ST ) 51U/ L - Glutamyl tran sferase (- GT P ) 78U/ L, 46U/ L (, 1998),. (UGI),. 4. PC SA S (v er 6.12), 2 - test,,, t - ANOVA..

5 % %, 23.5% %27.1%. 22.9% 20.0%, 79.1%80.8%.,,,, (1). p - () < (27.4) 75 (42.9) 30(17.1) 22(12.6) 47(29.0) 44(27.2) 39(24.1) 32(19.7) 95 (28.2) 119 (35.3) 69 (20.5) 54 (16.0) (/ ) < ( 6.9) 89 (50.9) 74 (42.3) 22(13.6) 102(63.0) 38(23.5) 34 (10.1) 191(56.7) 112(33.2) (27.4) 87 (49.7) 40(22.9) 38(23.5) 80(49.4) 44(27.1) 86 (25.5) 167 (49.5) 84 (25.0) (22.9) 131(77.1) 30(20.0) 120(80.0) 69 (21.6) 251(78.4) (79.1) 33 (20.9) 20(16.7) 120(83.3) 145 (47.8) 153 (52.2) * (80.8) 31(19.2) 45(36.9) 77(63.1) 175 (61.8) 108 (38.2) 2. (, ),,,,., (2).

6 N p - N p - () < (/ ) < ,, 1,,. 1,.,, 1,,,, 1, (3).

7 N p - N p ( ) < ( ) ( ) < ,,, 1.,.,, 1 (4).

8 N p - N p () (=0.476), (=0.361) (=0.371)(5).

9 * (0.0001) (0.0135) (0.0001) (0.0002) (0.0001) (0.0306) (0.0050) (0.0052) (0.0001) (0.0001) (0.0156) (0.0080) (0.0003) (0.0008) (0.0017) (0.0330) 6. (81.1% ), (33.1% ), (14.3% ) (85.9% ).,. (85.2% ), (31.5% ), (19.1% ), (14.2% ), (18.0% ), (6.2% )(89.1% ). (6).

10 N (%) p - N (%) p (10.9) (19.1) (89.1) (80.9) (33.1) (31.5) (66.9) (68.5) (10.9) (14.2) (89.1) (85.8) ( 6.9) ( 6.2) (63.1) (93.8) (14.3) ( 8.0) (85.7) (92.0) (81.1) (85.2) (18.9) (14.8) (85.9) (89.1) (14.1) (10.9)

11 . 20. (H olmesrahe, 1967; Kessler, 1985), (Lipow ski, 1985). (Lazaru s, 1978 ; Reiser, 1984;, 1996), (Hinkle, 1997)., (, 1988;, 1997).,,. 46.5, %. 22.9%, 20.0% 79.1%80.8%. (, 1988;, 1990). 30. (, 1988;, 1996), (, 1988;, 1996). (1989) (1996),,,. (, 1989;, 1994;, 1997). (, 1989;, 1995;, 1996;, 1997).,

12 .,,,. 1 10, 16,. (, 1994;, 1996), (, 1990;, 1994).,,. BreslowEn strom (1980), W ileycam acho (1980),..,,,,,,, (p< 0.01), (=0.476), ( =0.361)(=0.371),, (1997) (1988).,. (W hiteh ead, 1978; Sh apirolehrer, 1980;, 1995). (81.1% ) (33.1% ) (85.0% ) (31.5% ).,. 53.1%, 57.3%, 71.4% (, 1988).

13 (Uhlenhuth, 1973;, 1989) (KolbBrodie, 1982;, 1996) (CobbRose, 1973;, 1996;, 1996), (Jenkin s, 1971; H aynes, 1978), (M atth ew s, 1987; Hudson, 1988), (BakerBarcai, 1970; CobbRose, 1973; Robin sonfuller, 1985;, 1992), (, 1989;, 1997), (LintonKamw endo, 1989), (, 1986), (, 1998). (1987),,,, (1996), (1996). KolbBrodie (1982),,,. (W hitehead, 1978). 78% 73%, 58% (, 1992). 8% 65%(Dim sdaleh erd, 1982). (1996). (1988) (1992). (Jenkin s, 1971; H aynes, 1973), (M atthew s, 1987; Hu dson, 1988), (Dim sdaleh erd, 1982),., 1,,,.,,,.

14 .,,, , PC SA S , , 22.9%27.1%. (, ), 1 (10 ),,,,, ( ), (, ), 1 (10),,,, (p< 0.05).,,,,,,, (p < 0.01), (=0.476), (=0.361) (=0.371).,,.,,,.

15 , ;31(6): ; 27 (3): ;27 (3): ,,,,, ;19 (1):13-23,, ;35 (4): , ;26(3): ,,.,. 1988;27 (5): ,, ;28 (2): , ;25 (3): ,,.,. 1997;30(4): ,,,.,. 1997;18 (8): , 1995, p ,,, ;19 (2); , 1998, pp ,,.,. 1994;33 (6); ,.,, 1996, ;23 (1); , ;3 (2): ,,, ;35(5): ,, ;35 (5): ,,, ;21(2):

16 ADA Int ernation al Expert Com m ittee on the diagn osis and classification of Diabet es m ellitu s. Diabetes care 1997;20: Baker L, Barcai A. P sy chosomatic aspect of diabetes m ellitu s in m odern trends psy chosomatic m edicine, v ol 2, edited by Hillow. New York, A pplletion - Century Croft s, 1970, pp Breslow L, En strom JE. P er sistence of health h abit s an d th eir relation ship to m ortality. Prev ent M ed 1980;9: Chrou sos GP, Gold PW. T h e con cept of stress an d stress sy stem disorder. JA MA 1992;267: Cobb S, Rose RM. Hyperten sion, peptic ulcer, and diabetes in air traffic controller s, JAMA 1973;224 (4); Dim sdale JE, H erd JA. Variablility of plasm a lipids in respon se to em otion al arou sal. P sy chosom M ed 1982;44: Garrow JS. Nutrition in Ox ford tex tb ook of public health,2nd ed. Oxford Univ Press, 1991, pp86-90 H aynes SG, Lev in e S, Scotch N, F einleib M, Kannel W B. T he relation ship of psy chosocial factor s to coronary heart disease in th e F ramin gham stu dy. Am J Epidemiol 1978; 107 (5): Hinkle LE. T he concept s of stress in the biological an d social scien ces. In P sy ch osom atic M edicine; current trends and clinical application, edited Lipow ski ZJ, Lipsitt DR, Whybrow PC, New York, Ox ford Univ. Press, 1997, pp H olm es T H, Rah e RH. T h e social readju stment rating scale. J P sy chosom Research 1967;11: Hudson T W, Reinh art M A, Stew art GK. Clinical pr ev entiv e m edicin e: Health prom otion and disease prev ention 1st ed. Boston, Little Brow n and Company, 1988, pp Jenkin s CD. P sy ch ologic and social precur sor s of coronary h eart disease. N Engl J M ed 1971;284: Kes sler RC, Price RH, W ortman, CB. Social factors in p sy ch opath ology : stress, social support, an d coping processes. Ann Rev P sy chol 1985;36: Kolb LC, Brodie H KH. M odern clinical psy chiatry 10th ed. Philadelphia, W B Saun der s Co., 1982, pp Lazaru s RS. P sy ch ological stress an d copin g in adaptation and illn ess, In P sy chosomatic M edicin e: curr ent trends and clinical application s, edit ed by Lipow iski ZJ, Lipstt DR an d W hybrow PC. New York, Oxford Univ Press, 1978, pp14-26 Linton SJ, Kam w en do K. Risk factor s in th e psy chosocial w ork env ironm ent for neck and sh oulder pain in secretaries. J Occup M ed 1989;31(7): Lipow ski ZJ. P sychosom atic m edicine liaison psychiatry. New York, Plenum M edical Book Co., 1985, pp71-90

17 M atthew s KA, Cottingt on EM, T albott E, Kuller LH. Str es sful w ork con dition s an d diastolic blood pressur e am on g blue collar factory w orker s. Am J Epidemiol 1987;126: M etzner HL, Carm an W J, H ou se J. H ealth practices, risk factors and chronic disease in T echm sch. Prev ent M ed 1983;12: Reiser MF. P sy ch ophy siology of stres s and its sequ elae. In min d, brain, body : tow ard a conv ersance of psy ch oan aly sis an d neurobiology. N ew York, Basic Book s Inc., 1984, pp Robin son N, F uller JH. Role of life ev ent s an d difficulties in the on set of diabetes m ellitu s. J P sy chosom Research 1985;29 (6): Shapiro S, Lehrer PM. P sy chophy siologcal effect s of autog enic training an d progres siv e relax ation. Biofeedback an d Self regulation 1980;5 (2): T alley M J, Phillip s SF. Nom ulcer dy spep sia : pot ential cau se an d pathophy siology. A nn Int M ed 1988;108: T h e fifth report of Joint N ational Committee on Detection, Ev aluation an d T reatment of High Blood Pressure: Arch Intern M ed 1993, 153:164 Uhlenhuth EH. Symptom configuration and life ev ent. Arch Gen P sy chiatr 1973;28: W hitehead W E. Biofeedback in the treatm ent of g astrointestinal disorders. Biofeedback and Self regulation 1978;3 (4): W iley JA, Cam ach o T C. Life style and Future Health : Eviden ce from the Alabam a County stu dy. Prev M ed 1980;9:1-21

PDF

PDF :,,. 1., (m en opau se)'.,.,,, (empty n est syn drom e)',, (Kizilay, 1992).. 40 50., (vital force), (spiritu al w ell- being ). (, 1984)..,,,,,,. (, 1994).,., (W elln ess ). (Spiritu al w ell- bein g ),.,,,,,,.,,..