, - A b s tract - T he A s s ociation betw een Job Characteris tic s, P sy cho s oc ial D is tre s s and Hom ocy s teine B on g S uk Ch a, S an g B aek Koh, S ei Jin Ch ang Department of Preventiv e Medicine and In stitut e of Occupational Medicine, W onju College of Medicine, Yon sei University, W onju, Korea T his study w as carried out to as ses s the relation ship betw een job strain, psy chosocial distress an d hom ocy steine. T he study design w as cross - sectional, an d included 152 indu strial w ork er s in middle sized city. A self- admin stered questionnaire measured g en eral ch aracteristic, job strain and psy chosocial distress. Blood w as draw n into EDT A tube, an d total pla sm a h om ocy stein e w as m easured by HPLC. Hom ocy steine in the high job dem an d group w as significantly high er th an that in the low job dem and. Cholesterol in the high job control group w a s significantly higher than that in th e low job contr ol. H om ocy st eine w as significantly high er in the high job str ain gr oup th an that in th e other group. F olate and vitamin B12 show ed a significantly negativ e corr elation w ith h om ocy stein e. Multiple regression analy sis w as u sed to determine w heth er the p sy ch osocial distr es s and other v ariable contributed t o ex plainin g the hom ocy stein e. Stress correlates w ith the hom ocy steine. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Key W ord : Job ch aracteristics, Job straine, psy chosocial distress, h om ocy stein e - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - * 1998
I., -. Depue (1986), H ou se (1986). (An esh en sel, 1992).. Karasek (1988) (high strain group ). T heorell (1991),. (John son H all, 1988; John son, 1989).,., (preclinical stag e) (Schulte, 1993)..,, (Piper, 1989; Green John son,1990; Schnall, 1992). (h om ocy stein e), (Glueck, 1995; Verhoef, 1996). (m ethionine). S - aden osylm ethionin e S - adenosylhom ocy syteine. (adenosine), tran ssulfuration, rem ethylation (Ueland Refsum, 1989). v itamin e B 12 folate.,,. v itamin e B 1 2 folate, folate..
.,,,., F olate Vitamin B 1 2.,.
II. 1) W 50 152.,,. v itamin e,. ethylene diamine tetraacetic acid (EDT A ) 10cc,,. 2) (,,,,,, ) (, ),,, BMI,,,. ( ) John son Hall(1988) (Job Content Questionnaire: JCQ ). 2, 10,,, 2-1- 0. 0-6, 0-30, ( ) ( ). Karasek (1979) 4, (m edian ).,,, (, 1997). Goldberg GH Q- 60 45 (1993) PW I(P sy chosocial W ell- bein g In dex ). PW I Likert 4 (0-1- 2-3)., 75,. 10. EDT A, 2 (15, 4, 4300rpm )
- 70. HPLC. folate vitamin B 12 radiolig and bin ding. (, HDL ) Hitachi- 747. 3), t -, folate vitamin B12..
III. 1. 20 16.4%, 30 58.6%, 40 21.1%, 50 3.9%. 85 55.9%, 44.1%.,, 32, 120 78.9%. 50.7%,,,,. 61.8%, 86.8%. 27.4% ( 1). 2.. (p < 0.05), (p > 0.05), (p < 0.05) ( 2). 3. Karasek 4,, 3. 8.0 m ol/ L 9.1 m ol/ L (p< 0.05). 75,. (p< 0.05),. folate vitamin B 12 ( 4)..,, ( 5)., folate vitamin B 12. folate vitamin B 12, folate vitamin B 1 2 (p< 0.01) ( 6). 3.,,,,,,,, 15% ( 7).
IV.,. (stan dard risk factor ),,,,, (W ilhelm sen, 1973; Kannel, 1976). 1. (fatty streak ),,.,,.,,, (Alfth an, 1994; Lolin, 1996) Stamfer (1992), Clark (1991),,.,.,. 7.7 m ol/ L 9.1 m ol/ L,. (Karsek, 1988; Piper, 1989; Reed, 1989; Schnall, 1990; Alterman, 1994), Kara sek (1979),., (cy stathione b eta syn sth eta se, m ethylen e tetrafolate reductase ) (vitamine B 1 2, vitamin e B 6, folate). F olate Vitamin B 12, v itamin e,. folate Vitamin B 12. Bou shey (1995) folic acid, folic acid 5 (Framingham H eart Study )
folate vitamin B 12 (Selhub, 1996). (early biological effect ),..,,,.. V., W 50 152.,.,..,. F olate vitamin B 12, folate..
V I...., 1993, 121-159,,,,,.. 1997; 30(1): 129-143. A lfth an G, Pekkan en J, Jauhiainen M. Relation of serum hom ocy steine an d liporotein (a ) con centration to atherosclerotic disea se in a prospectiv e F innish population based study. Athrosclerosis 1994; 106: 9-19 A lt erm an T, Shekelle R, Vern on SW, and Buran KD. Decision latitu de, p sy chologic dem an ds, job strain, an d coron ary h eart disease in the w estern electric study. Am J Epidemiol. 1994;139:620-627 A neshen sel CS. Social stress : th eory an d reseach. A nn Rev Sociol 1992; 18: 15-38 Bou shey CJ, Beresford SA, Om enn GS, M otulsky A G. A Quantitativ e assessment of plasm a h om ocy stein e a s a risk factor for v ascular disea se. JA MA 1995; 274: 1049-1057 Clark R, Daly L, Robbin son K. Hyperh om ocy stein e: an independent risk factor or for v ascular disease. N Eng J M ed 1991; 324: 1149-55 Depu e RA, M onroe SM. Con septu alization and m easurem ent of hum an disorder in life stress r esearch : T he problem of chronic disturbance. P sy chological Bulletin 1986; 99: 36-51 Glueck CJ, Shaw O, Lang JE, T racy T, Siev e- Smith L, W an g Y. Eviden ce that hom ocy st eine is an independent risl factor for athr osclerosis in hyperlipidem ic patient s. Am J Card 1995; 75: 132-136 Green KL, John son JV. T he effect s of psy ch osocial w ork org anization on pattern s of cig arette sm orking am on g male chemical plant employ ee. Am J Public H ealth 1990; 80: 1368-1371 H ou se JS, Strecher V, M etzn er HL, Robbin s CA. Occupation al stress an d health among men and w omen in th e T ecum seh Community health stu dy. J H ealth Soc Behav 1986; 27: 66-77
John son JV, H all EM. Job strain, w ork place social support an d cardiov a scular disease: a cross - sectional study of a r andom sample of the S w edish w orkin g population. A m J Public Health 1988; 78: 1336-1342 John son JV, Hall EM, T heorell T. Combined effect s of job strain and social isolation an cardiov a scular disease m orbidity and m ortality in a ran dom sample of th e Sw edish m ale w orking population. Scand J W ork Env iron Health 1989; 15: 271-279 Kann el W B, M cgee D, Gordon T. A g eneral cardiov ascular risk profile : th e F ramingham study. Am J Cardiol 1976; 38: 46-51 Kara sek RA. Job dem an ds, job desion latitude,and m ental str ain : im plication s of job redesign. A dmin Sci Q 1979; 24: 285-307. Kara sek RA, T h eorell T, Schw artz JE, Schn all PL, Piper CF, Mich cla JL. Job characteristics in relation to the prev alen ce of my ocardial infarction in the US h ealth ex am in ation surv ey (HE S ) and the health and nutrition ex amination surv ey (HANES ). Am J Public H ealth 1988; 78: 910-918 Lolin YI, San derson JE, Ch eng SK, Chan CF, Pand CP, W oo KS, M asarei JRL. Hyperh om ocy stein emia and prem ature coronary artery disea se in th e Chin ese. H eart 1996; 76: 117-122 Pieper C, LacCroix AZ, Karasek RA. T he relation of psy ch ological dem an sion s of w ork w ith coronary h eart disease risk factor s : a m eta - analy sis of fiv e United States data bases. Am J Epidemiol. 1989; 129: 483-494 Reed DM, LaCroix AZ, Karasek RA, Miller FD, M aclean CA. Occupational strain an d th e in ciden ce of coronary heart disease. A m J Epidemiol 1989; 129: 495-502 Schnall PL, Pieper C, Schw artz JE, Karasek RA, Schlu ssel Y, Dev ereux R, Gnau A, A lderm an M, W arren K, Pickerrin g T G. T h e relation ship betw een job strain, w orkplace diastolic blood pr es sure, an d left v entricular m ass in dex. Result s of case- control study JA MA 1990; 263: 1929-1935 Schnall PL, Schw artz JE, Landsb ergis PA, W arren K, Pickering T G. Relation betw een job strain, alcohol, an d ambulatory blood pressure. Hyperten sion 1992; 19: 488-494 Schulte PA. A con ceptual and historical framew ork for m olecular epidemiology. Schelte PA, Perera FP (eds ), M olecular epidemiology principle an d practices. A cademic Press 1993; 4-36
Selhub J, Jacqu es PJ, Bostom A G, D 'A g ostino RB. A s sociation b etw een plasm a h om ocy stein e concentration an d ex tracranial carotid artery stenosis. N Eng J M ed 1995; 332: 286-291 Stamfer MJ, M alinow MR, W ilett W C. A prospectiv e study of plasma hom ocy steine an d risk of my ocardial infarction in US phy sician s. JAMA 1992; 268: 877-881 T hreoll T, Per ski A, Orth - Gom er K, H am sten A, F aire U. T he effect s of the strain of returnin g to w ork on the risk of cardiac death aftera fir st my ocardial infarction b efore th e age of 45. Int J Cardiol 1991; 30: 61-67 U elan d PM,Refsum H. Pla sm a homocy steine, a risk factor for v ascular disease: Pla sm a levels in health, disease, and drug therpy. J Lab Clin M ed 1989; 114 (5): 473-501 V erhoef P, Stampfer MJ, Burin g JE, Gaziano JM, Allen RH, Stabler SP. Hom ocy stein e metab olism an d risk of my ocardial infarction : relation w ith v itamin B6, B 1 2, and folate. Am J Epidemiol 1996; 143 (9): 845-859 W ilhelm sen L, W edel H, T ibblin G. Multiv ariate analy sis of risk factor for coron ary heart disease. Circulation 1973; 48: 950-958
T able 1. General characteristics Variable N o % Variable No % A g e Religion 29 25 16.4 None 77 50.7 30 39 89 58.6 Christian 40 26.3 40 49 32 21.1 Bu ddist 27 17.8 50 6 3.9 Catholic 3 2.0 Other 5 3.3 Education High school 85 55.9 Sm okin g Colleg e 67 44.1 Yes 94 61.8 No 58 38.1 M arrital statu s Sin gle 32 21.1 Alcohol M arried 120 78.9 Yes 132 86.8 No 20 13.2 Incom e 99 48 31.6 Regular ex ercise 100 150 55 36.2 Yes 40 27.4 150 49 32.2 No 106 72.6
T able 2. Comparison of param eter s according to job dem an d an d job decision latitude Job dem and Job decision latitude Low High High Low p v alue p v alu e M ean S.D. M ean S.D. M ean S.D. M ean S.D. A g e 36.3 7.8 33.9 5.6 0.03 35.4 7.0 34.9 7.0 0.67 BMI(Kg/ m 2 ) 23.4 2.6 23.9 3.2 0.31 23.9 3.3 23.3 2.4 0.18 Cholesterol(m g/ dl) 176.9 39.5 184.1 32.6 0.22 174.4 39.3 187.2 31.7 0.03 HDL (m g/ dl) 50.7 13.7 49.9 13.4 0.72 52.3 14.6 48.7 12.3 0.11 T rigly ceride (m g/ dl) 163.7 86.5 167.6 96.1 0.79 153.5 82.3 179.5 98.7 0.08 H om ocy stein e ( m ol/ L ) 7.8 2.5 8.7 2.2 0.02 8.1 2.3 8.6 2.6 0.21 F olate (ng/ ml) 1.8 0.8 1.8 0.7 0.94 1.9 0.6 1.8 0.8 0.39 Vitamin B 12 (nmol/ L ) 246.1 89.1 233.3 90.4 0.38 256.2 85.2 221.2 91.5 0.02 T able 3. Comparison param eter s according to job strain Job strain Low High p v alu e M ean S.D. M ean S.D. A g e 35.6 7.2 33.3 5.8 0.09 BMI(Kg/ m 2 ) 23.7 3.1 23.4 2.2 0.54 Cholesterol(m g/ dl) 178.3 37.0 187.6 33.8 0.20 HDL (m g/ dl) 53.1 15.8 49.6 12.8 0.26 T rigly ceride (m g/ dl) 164.1 87.3 171.2 104.4 0.72 H om ocy stein e ( m ol/ L ) 8.0 2.5 9.1 1.9 0.02 F olate (ng/ ml) 1.8 0.7 1.8 0.7 0.81 Vitamin B 12 (nmol/ L ) 243.8 87.8 225.9 96.3 0.31
T able 4. Comparison param eter s according to psy chosocial stres s P sy chosocial stress Low High p v alu e M ean S.D. M ean S.D. A g e 35.8 7.1 33.9 6.7 0.09 BMI(Kg/ m 2 ) 23.6 2.7 23.7 3.2 0.76 Cholesterol(m g/ dl) 175.4 37.4 186.5 35.8 0.07 HDL (m g/ dl) 50.8 12.8 49.8 14.2 0.66 T rigly ceride (m g/ dl) 160.4 91.1 171.6 91.5 0.46 H om ocy stein e ( m ol/ L ) 7.7 2.7 9.1 1.5 0.00 F olate (ng/ ml) 1.9 0.8 1.7 0.6 0.07 Vitamin B 12 (nmol/ L ) 234.9 88.3 247.8 91.1 0.38 T able 5. M ean v alue of hom ocy stein e, folate and vitamin B 12 according to life- style factor H om ocy stein e ( m ol/ L ) p v alue F olate (ng/ ml) p v alue Vitamin B 12 (nm ol/ L ) p v alue M ean S.D. M ean S.D. M ean S.D. Sm okin g Yes 8.4 2.6 0.11 1.9 0.7 0.42 246.7 95.3 0.52 No 7.5 2.2 1.8 0.7 236.4 88.1 Alcoh ol Yes 8.3 2.3 0.13 1.8 0.7 0.09 238.6 86.4 0.43 No 7.3 3.1 2.1 0.8 263.7 118.6 Ex ercise Yes 8.1 2.5 0.76 1.8 0.7 0.72 237.1 83.5 0.77 No 8.2 2.3 1.9 0.8 241.6 93.8
T able 6. T he correlation betw een job characteristic, psy chosocial stress, hom ocy steine, folate and vitamine B 1 2 Stres s Job dem and Job decision latitude H om ocy stein e F olate Job dem an d 0.39 * * Job decision latitude - 0.37 * * - 0.01 hom ocy stein 0.23 * 0.11-0.05 F olatet - 0.11 0.01 0.01-0.32 * * Vitamin B 12-0.06-0.09 0.11-0.49 * * 0.47 * * *: p < 0.05 **: p < 0.01 T able 7. Multiple regression of hom ocy steine on selected v ariable Independent v ariable Beta p v alue A ge - 0.11 0.18 Smoking 0.05 0.51 Alcohol 0.15 0.06 Ex ercise - 0.07 0.37 Cholesterol 0.08 0.36 HDL - 0.07 0.44 T riglyceride 0.09 0.32 Job dem and 0.09 0.27 Job decision latitude - 0.02 0.74 P sy ch osocial stress 0.23 0.01 R square 0.15 A dj R square 0.11 F v alue 3.41 p v alu e 0.002