- 'Informed Consent' in Public Health Activities: Based on the Universal Declaration on Bioethics and Human Rights, UNESCO.
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Kwang Ho Meng
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J Prev Med Public Health. 2008;41(5):339-344.
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DOI: https://doi.org/10.3961/jpmph.2008.41.5.339
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 Abstract
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- OBJECTIVES
The objective of this paper is to discuss the importance of obtaining informed consent for conducting epidemiological studies and public health activities, based on the Report of the UNESCO's Working Group on Informed Consent. METHODS: The Report of the UNESCO's Working Group on Informed Consent was reviewed and discussed in connection with the ethical considerations of public health activities and epidemiological research. RESULTS: It was at the Nuremberg Trial for the German war criminals of the Second World War that the principle of 'consent' was first stated as a consequence of the medical abuses carried out during the War. As a result of the Trial, the Nuremberg Code came out in 1947. Since then, various international declarations or ethical principles on 'informed consent' have been developed and published. These ethical principles on 'informed consent' have mostly to do with the clinical research that involves human subjects, and not with epidemiological studies and public health activities. However, UNESCO recently issued a comprehensive Report on Informed Consent based on the Universal Declaration on Bioethics and Human Rights adopted in 2005, and this included detailed guidelines on informed consent in epidemiological studies and public health activities. CONCLUSIONS: Universal Declaration on Bioethics and Human Rights emphasizes the principle of autonomy to protect the human rights of the human subjects involved in any public health activities and epidemiological research. As a practical guideline, obtaining informed consent is strongly recommended.
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Citations
Citations to this article as recorded by  - Differences Between Patient and Provider Perceptions of Informed Decision Making About Epidural Analgesia Use During Childbirth
Holly Bianca Goldberg, Allison Shorten
The Journal of Perinatal Education.2014; 23(2): 104. CrossRef - A European study on alcohol and drug use among young drivers: the TEND by Night study design and methodology
Roberta Siliquini, Simone Chiadò Piat, Francisco Alonso, Axel Druart, Marcin Kedzia, Antonio Mollica, Valeria Siliquini, Daniel Vankov, Anita Villerusa, Lamberto Manzoli
BMC Public Health.2010;[Epub] CrossRef
- Future of Preventive Medicine Education in Korea: Hopes and Challenges.
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Kwang Ho Meng
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J Prev Med Public Health. 2006;39(1):7-12.
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- Throughout the century, based on the precedent set by Flexner in the United States, almost every subsequent report on the reform of medical education has pointed out the need for more prevention-oriented teaching in the curriculum. This has been particularly so in countries like Korea where the basic public health services have been so important for the improvement of health of the people. And, in fact, preventive medicine and public health have contributed a great deal to the prevention of communicable diseases and prolongation of life expectancy. Recently, however, along with the educational reform that emphasizing the interdisciplinary teaching, integration of basic science and clinical education, and centralization of responsibility for the medical education curriculum, concerns are being voiced by preventive medicine educators. These concerns are primarily centered around the fear that the implementation of interdisciplinary, centrally administered courses would result in a weakening of content and teaching expertise as well as a loss of departmental power and control. This paper foresees that preventive medicine and public health will be more important in Korea in the future and proposes that preventive medicine educators will have to step forward and turn the challenges of curricula restructuring into opportunities to expand the role of preventive medicine in the curricula of their institutions.
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- A Case-control Study of the Relationships between Reproductive Factors and Degree of Dysplasia of the Colorectal Adenoma and Cancer.
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Se Young Lee, Won Chul Lee, Kyu Yong Choi, Mi Kyung Kim, Jin Hee Lee, Kwang Ho Meng
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Korean J Prev Med. 2003;36(3):279-288.
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Evidence for an effect of reproductive factors on colorectal carcinogenesis is not yet consistent. Little research has been conducted to investigate whether reproductive factors were associated with colorectal adenomas that are the precursors of colorectal cancer. We evaluated the relationships between reproductive factors and the degree of dysplasia of the colorectal adenoma and cancer as colorectal adenoma-carcinoma sequence. METHODS: For this study, 241 adenoma cases with histo-pathologically confirmed incident colorectal adenoma, 76 cancer cases with colorectal cancer and 1677 controls were collected from Our Lady of Mercy Hospital, The Catholic University of Korea, during 1994-1999. Before colonoscopy, information on demographic characteristics, reproductive factors, life style habits and dietary intake were obtained by interviewed questionnaire. Adjusted OR and 95% CI were estimated by using polytomous logistic regression model. Potential confounders that were selected based on the goodness of fit statistics and interaction between risk factors were considered in this adjustment. The Wald statistic was calculated to test the heterogeneity of the odds ratios for each case. RESULTS: Postmenopausal women with natural menopause were found to be positively associated with the risk of mild dysplasia adenoma (multivariate-adjusted OR : 2.59, 95% CI=1.1-6.2). Parity was found to be negatively associated with the risk of colorectal cancer (age-adjusted OR : 0.40, 95% CI=0.2-0.9), but did not significantly decrease the risk of colorectal cancer (multivariate-adjusted OR : 0.95, 95% CI=0.3-2.9). No associations were seen between age at menarche, breast feeding, induced abortion, oral contraceptive use, menopausal types, menopausal age or hormone replacement therapy (HRT) and the degree of dysplasia of the colorectal adenoma and cancer. However, none of these associations differed significantly between the degree of dysplasia of the colorectal adenoma and cancer. CONCLUSIONS: These findings suggest that postmenopausal women with natural menopause may experience increased risk of mild dysplasia adenoma among colorectal adenoma-carcinoma sequence.
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- The Awareness and Countermeasures against Harmful Effect of Passive Smoking in Korean Adults.
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Hong Seok Sim, Kang Sook Lee, Hyun Sook Hong, Kwang Ho Meng
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Korean J Prev Med. 2000;33(1):91-98.
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This study is to evaluate the awareness, attitude, practice and the countermeasures against passive smoking in Korean adults. METHODS: By self-administered questionnaires, we assessed the knowledge, attitude, behavior for passive smoking and the countermeasure for reduction of it's harmful effects in 289 men and 238 women. RESULTS: The subjects that have heard about passive smoking were 96.8% in total and well known were 26.4% of current smoker, 56.6% of ex-smoker, and 14.8% of non-smoker(p=0.001). The irritative symptom from passive smoking was the most frequent in non-smokers and the most common place where exposed to passive smoking was public place. For attitude against passive smoking in 'no smoking allowed area', ex-smokers were the most active to recommend to stop smoking. And for opinion about establishment of 'no smoking allowed area', the restriction by law was the best acceptable method in smokers, exsmokers, and nonsmokers. In marking of 'no smoking allowed area', 69.9% of smokers answered no smoking, but in non-marking area only 6.3% stop smoking. When smokers were recommended to stop smoking, the more subjects stop smoking with good feeling in marking area, but the less in non-marking area. The factor associated the high awareness of passive smoking were aged(OR=1.07, 1.03-1.12), men(OR=4.34, 2.32-8.46). The persons who have known well about passive smoking had good attitude and behavior to prevent of harmful effect of passive smoking. CONCLUSIONS: This study suggested that education program would be necessary to reduce the passive smoking.
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- Estimation of Disease Code Accuracy of National Medical Insurance Data and the Related Factors.
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Euichul Shin, Yong Mun Park, Yong Gyu Park, Byung Sung Kim, Ki Dong Park, Kwang Ho Meng
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Korean J Prev Med. 1998;31(3):471-480.
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- This study was undertaken in order to estimate the accuracy of disease code of the Korean National Medical Insurance Data and disease the characteristics related to the accuracy. To accomplish these objectives, 2,431 cases coded as notifiable acute communicable diseases (NACD) were randomly selected from 1994 National Medical Insurance data file and family medicine specialists reviewed the medical records to confirm the diagnostic accuracy and investigate the related factors. Major findings obtained from this study are as follows: 1. The accuracy rate of disease code of NACD in National Medical Insurance data was very low, 10.1% (95% C.I.: 8.8-11.4). 2. The reasons of inaccuracy in disease code were 1) claiming process related administrative error by physician and non-physician personnel in medical institutions (47.0%), 2) input error of claims data by key punchers of National Medical Insurer (31.3%) and 3) diagnostic error by physicians (21.7%). 3. Characteristics significantly related with lowering the accuracy of disease code were location and level of the medical institutions in multiple logistic regression analysis. Medical institutions in Seoul showed lower accuracy than those in Kyonngi, and so did general hospitals, hospitals and clinics than tertiary hospitals. Physician related characteristics significantly lowering disease code accuracy of insurance data were sex, age group and specialty. Male physicians showed significantly lower accuracy than female physicians; thirties and forties age group also showed significantly lower accuracy than twenties, and so did general physicians and other specialists than internal medicine/pediatric specialists. This study strongly suggests that a series of policies like 1) establishment of peer review organization of National Medical Insurance data, 2) prompt nation-wide expansion of computerized claiming network of National Medical Insurance and 3) establishment and distribution of objective diagnostic criteria to physicians are necessary to set up a national disease surveillance system utilizing National Medical Insurance claims data.
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- Health risks related to shift work among female workers of major manufacturing industries in Korea.
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Euichul Shin, Kwang Ho Meng
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Korean J Prev Med. 1991;24(3):279-286.
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- Much of the working population in developing countries are engaged in shift work now and the number of shift workers is not expected to decrease in the future mostly because the need for continuity of production is increasing. Therefore, the possible effects of shift work on health are of particular interest, and in fact, there have been many epidemiological studies on shift work since the first world war. However, no studies on health effects of shift work have been reported in Korea, and the existing studies in western world have arrived at quite different conclusions mainly because the conditions of work other than shift work, such as age and selection of workers, work environment, and labor conditions also influence the health of workers. This study was firstly carried out in Korea to investigate the health risks related to shift work with 2,093 female workers randomly selected from three major manufacturing industries in proportion to total number of female workers in those industries. Differences of work conditions other than shift work in this study were adjusted by multivariate analysis. Major findings obtained from this study are as follows: 1. There were significant differences between shift and day workers in the distribution of age, type of industry, condition of noise and dust, regularity of mealtime, working position, and working duration. Shift workers tended to be younger, to have shorter working duration, to have more irregular mealtime, to work in standing position, and to work under more noisy and dusty environment than day workers. 2. Univariate analysis showed that shift work increased the Todai Health Index (THI) scores of digestive tract, respiratory tract, and mental instability symptom categories. Shift work also increased days of sickness absence and number of industrial accident per 100 workers per month. 3. Multivariate analysis that adjusted the differences of demographic, occupational and non-occupational health-related working conditions showed that digestive tract symptoms and mental instability symptom scores were significantly higher in shift workers than those in day workers. Based on those study results, it is concluded that the shift work has significant effects on some psychophysiological conditions of the workers and the effects are also influenced by several other personal and working conditions.
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- Maternal Factors Associated with the Premature Rupture of Membrane in the Low Birth Weight Infant Deliveries.
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Kang Sook Lee, Won Chul Lee, Kwang Ho Meng, Choong Hoon Lee, Soo Pyung Kim
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Korean J Prev Med. 1988;21(2):207-216.
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- Premature rupture of membrane is the most frequent cause of low birth weight infant delivery which increase the maternal and fetal morbidity and perinatal mortality. A retrospective case-control study was performed on 315 mothers who delivered low birth weight infants(< or = 2.5kg) with premature rupture of membrane and as control group 546 mothers who delivered normal birth weight infants(2.9-3.7kg) without premature rupture of membrane were chosen. The results obtained from this study were as follows: 1. The proportion of low birth weight infants due to premature rupture of membrane among all low birth weight infant deliveries was 14.5%, and this is equivalent to 1.1% among all deliveries. 2. The most significant maternal risk factor of low birth weight infant deliveries with premature rupture of membrane was infections on vagina, cervix and uterus during pregnancy. Compared with control, adjusted odds ratio was 7.61(95% confidence interval(CI) 1.88-30.88, p=0.004). Other significant maternal risk factors were the history of induced abortion, spontaneous abortion, and the experience of premature delivery. The risk ratios were 1.82, 2.07, 4.42, respectively. 3. Breech presentation did increase the risk of low birth weight infant delivery with infant delivery with premature rupture of membrane against control(Adjusted odds ratio=2.66, 95% CI 1.35-5.26, p=0.005). 4. Mothers who had not taken antenatal care were having higher risk of low birth weight infant delivery with premature rupture of membrane against control(Adjusted odds ratio=1.73, 95% CI 1.35-5.26, p=0.004). These study results show that maternal factors such as the infection of genital organs during pregnancy, the history of induced abortion and breech presentation are significantly associated with the premature rupture of membrane in the low birth weight deliveries, and that most of these risk factors are controllable ones through proper antenatal cares.
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- A Study on the Epedemiological Characteristics of Industrial Ocular Injuries.
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Won Chul Lee, Sang Moon Chung, Kang Sook Lee, Kwang Ho Meng, Seung Han Lee
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Korean J Prev Med. 1988;21(1):113-120.
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- A total of 181 cases of industrial ocular injuries hospitalized and treated at the St. Mary's Hospital, Seoul during the 5-year period was studied on their epidemiological characteristics. Of there patients 96.7% were males, and 43.6% were in twenties, 49.7% of the cases were injured on left eyes. There were no statistically significant differences in frequencies of study subjects by day of the week and month of the year. Most common injury hour were between 10- < 12 AM(13.6%) and between 2- < 4 PM(20%). Of the total 101 cases, 37.6% were working less than 6 months, and 73.7%, less than 2 years. Of the total, 42.3% were involved in machinery work and 13.9%, in construction work. According to the American National Standard Method of recording basic facts relating to the nature and occurrence of work injuries, 62% among all source of injuries was metal item and the most common accident type was struck by flying objects(76.2%). Among 181 cases, only 2 cases wearing protective equipment when the accidents occurred.
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