Journal of Preventive Medicine and Public Health

Volume 40(4); July 2007

English Abstracts

Introduction and Evaluation of Communicable Disease Surveillance in the Republic of Korea.: Ok Park, Bo Youl Choi; J Prev Med Public Health. 2007;40(4):259-264.; DOI: https://doi.org/10.3961/jpmph.2007.40.4.259

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Effective communicable disease surveillance systems are the basis of the national disease prevention and control. Following the increase in emerging and re-emerging infectious diseases since late 1990s, the Korean government has strived to enhance surveillance and response system. Since 2000, sentinel surveillance, such as influenza sentinel surveillance, pediatric sentinel surveillance, school-based sentinel surveillance and ophthalmological sentinel surveillance, was introduced to improve the surveillance activities. Electronic reporting system was developed in 2000, enabling the establishment of national database of reported cases. Disweb, a portal for sharing communicable disease information with the public and health care workers, was developed. In general, the survey results on usefulness and attributes of the system, such as simplicity, flexibility, acceptability, sensitivity, timeliness, and representa-tiveness, received relatively high recognition. Compared to the number of paid cases of national health insurance, reported cases by national notifiable disease surveillance system, and various sentinel surveillance system, the result of the correlation analysis was high. According to the research project conducted by KCDC, the reporting rate of physicians in 2004 has also greatly improved, compared with that in 1990s. However, continuous efforts are needed to further improve the communicable disease surveillance system. Awareness of physicians on communicable disease surveillance system must be improved by conducting education and information campaigns on a continuous basis. We should also devise means for efficient use of various administrative data including cause of death statistics and health insurance. In addition, efficiency of the system must be improved by linking data from various surveillance system.

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Cancer Registration in Korea: The Present and Furtherance.: Yoon Ok Ahn; J Prev Med Public Health. 2007;40(4):265-272.; DOI: https://doi.org/10.3961/jpmph.2007.40.4.265

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It was not until 1975 that cancer registration was initiated in Korea; voluntary registration of cancer patients of training hospitals throughout the country began under the auspices of the Korean Cancer Society(KCS). However, an official cancer registration, the Korea Central Cancer Registry(KCCR), began on July 1st, 1980. Forty-five training and two non-training hospitals throughout the country initiated registration of patients in whom neoplasms had been found. Data related to case information specified are to be sent to the KCCR at the National Medical Center(it moved at National Cancer Center in 2000). The initial cancer registration of KCS was merged to the KCCR in 1980. Although the KCCR covers most all the large training hospitals in Korea, it cannot provide incidence data. It is, however, the only of its kind in the world, being neither hospital nor population based. The first population based cancer registry(PBCR) was launched in a small county, Kangwha(it has around 80,000 inhabitants), by Yonsei University Medical College in 1983. All data were collected by active methods, and incidence statistics for 1986-1992 appeared in Vol VII of the CI5. Another PBCR, Seoul Cancer Registry(SCR), started in 1991. It was supported by a civilian foundation, the Korean Foundation for Cancer Research. The basic idea of case registration of SCR was the incorporation of KCCR data to PBCR, e. g. dual sources of case registration, i.e., from the KCCR and also including cases diagnosed in small hospitals and other medical facilities. Assessing completeness and validity of case registration of SCR, the program and methodology used by the SCR was later extended to other large cities and areas in Korea, and the PBCR in each area was established. Cancer incidence statistics of Seoul for 1993- 1997, Busan for 1996-1997, and Daegu for 1997-1998, as well as Kangwha for 1993-1997, appeared eventually in Vol VIII of the CI5. The Korean or 'pillar' model for a PBCR is a new one. The KCCR data file is a reliable basis, as a pillar, for a PBCR in each area. The main framework of the model for such a registry is the incorporation of a KCCR data file with data from additionally surveyed cases; the data related to cancer deaths, medical insurance claims, and visit-and abstract surveillance of non-KCCR medical facilities. Cancer registration has been adopted as a national cancer control program by Korean government in 2004 as the Anti-Cancer Act was enacted. Since then, some officers have tried to launch a nation-wide PBCR covering whole country. In the meantime, however, cancer registration was interrupted and discontinued for years due to the Privacy Protection Law, which was solved by an amendment of the Anti-Cancer Act in 2006. It would be premature to establish the nation-wide PBCR in Korea. Instead, continuous efforts to improve the completeness of registration of the KCCR, to progress existing PBCRs, and to expand PBCRs over other areas are still to be devoted. The nation-wide PBCR in Korea will be established eventually with summation of the PBCRs of the Korean model.

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Circulatory Disease Surveillance System in Korea.: Byung Yeol Chun; J Prev Med Public Health. 2007;40(4):273-277.; DOI: https://doi.org/10.3961/jpmph.2007.40.4.273

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Abstract PDF: The purpose of establishing the circulatory disease surveillance system in Korea is to ensure that the problems of circulatory disease importance are being monitored efficiently and effectively. The goals of circulatory disease surveillance system are to monitor the epidemiological trends of circulatory disease and to evaluate the outcome of health activity for controlling circulatory diseases. Surveillance system are being updated to achieve the needs for the integration of the surveillance and information system, the establishment of data standards, the electronic exchange of data, and changes in the goals of circulatory disease surveillance system to facilitate the response of this system to manage the national health problem effectively. This article provides the target diseases and determinant indicators to be monitored, structure of circulatory disease surveillance system, and many tasks and related activities that should be applied to this system.; Summary

Review

Adverse Drug Reaction Surveillance System in Korea.: Nam Kyong Choi, Byung Joo Park; J Prev Med Public Health. 2007;40(4):278-284.; DOI: https://doi.org/10.3961/jpmph.2007.40.4.278

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Despite extensive researches and pre-market clinical trials, only limited information on the adverse drug reactions (ADRs) of a drug can be collected at the time of market approval from regulatory agency. ADRs constitute a major public health problem. Post-marketing surveillance of drugs is important to detect signals for ADR. In Korea, one of the main methods for monitoring the safety of marketed drugs is spontaneous reporting system of suspected ADRs. Re-examination and re-evaluation system are in force for monitoring safety of new market approval drugs and currently under marketing drugs, respectively. Recently, regional pharmacovigilance centers were designated from Korean Food and Drug Administration for facilitating ADR surveillance. Over recent years, with the development of information technology, there has been an increased interest in establishing data mining system for detecting signals from Health Insurance Review Agency database. The purpose of this paper is to review the current status of Korean ADR surveillance system and suggest the possible solutions for developing active pharmacovigilance system in Korea.

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English Abstracts

Seroprevalence of Brucellosis among Risk Population in Gyeongsangbuk-do, 2006.: Kwan Lee, Hyun Sul Lim, Woo Won Park, Sung Hwan Kim, Do Young Lee, Mi Yeoun Park, Youngju Hur; J Prev Med Public Health. 2007;40(4):285-290.; DOI: https://doi.org/10.3961/jpmph.2007.40.4.285

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Abstract PDF

OBJECTIVES
Cases of human brucellosis in Korea have recently increased due to the increasing incidence of bovine brucellosis. The authors conducted this study to elucidate the status of brucellosis through seroepidemiologic study. METHODS: We selected our study population from a high risk group. We conducted a questionnaire survey and obtained blood samples to determine the seroprevalence of brucellosis antibodies for 10 days in February, 2005. The titers of brucellosis were measured by the combination of standard tube agglutination test (STA) and enzyme-linked immunosorbent assay (ELISA) test. RESULTS: Our study subjects comprised 1,075 cases: 971 livestock workers, 51 veterinarians, and 53 artificial inseminators. In the STA test, 27 cases (2.5%) had titers of greater than or equal to 1:20. Of 1,068 cases (7 cases were excluded due to previous brucellosis), 7 cases of brucellosis were diagnosed with titers of 1:160, giving a seroprevalence of brucellosis of 0.66%. The seroprevalence in the male group was 0.95%, and that of livestock workers, veterinarians, and artificial inseminators was 0.52%, 4.17%, and 0.00%, respectively. The Spearman's correlation coefficient between the positive rate of bovine brucellosis per capita and household and human brucellosis was 0.806 and 0.744, respectively. The concordance rate between the Korea National Institute of Health and the Gyeongsangbuk-do Institute of Health and Environment by the STA and ELISA tests was 94.7% and 100.0%, respectively. CONCLUSIONS: The study results indicated in higher seroprevalence rate among veterinarians than among livestock workers and artificial inseminators. Because veterinarians may be exposed to this high risk, effective working guidelines for veterinarians to guard against brucellosis must be developed. Moreover, more extensive epidemiologic research for laboratory workers and meat handlers is needed.

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Information Sources and Knowledge on Infant Vaccination according to Online Communities.: Inyoung Choi, Mieun Chung, Soon Choy, Sukil Kim; J Prev Med Public Health. 2007;40(4):291-296.; DOI: https://doi.org/10.3961/jpmph.2007.40.4.291

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Abstract PDF

OBJECTIVES
To explore the information sources and knowledge on infant vaccinations of pro-vaccination community members and anti- accination community members on the internet. METHODS: An online survey of 245 parents from three pro-vaccination communities and 92 parents from one antivaccination community was conducted from June 7 to June 23, 2006. RESULTS: Parents from pro-vaccination communities usually gained the information regarding vaccination efficacy and risk mainly from healthcare providers (49.8%) and mass media (47.7%). Pro-vaccination community members considered healthcare providers as the most credible sources of information on vaccination, whereas the anti-vaccination community members usually gained their information regarding vaccine efficiency and risk from Internet child-care cafes and online vaccination communities. Parents of the anti-vaccination community considered the internet as the most credible information source (77.6% for efficacy, 94.8% for risk). In addition, the major reason why anti-vaccination community members didn't vaccinate and, will not vaccinate, was concern about possible side effects of the vaccine. The knowledge level on infant vaccination, education and economic status was higher in the anti-vaccination community. CONCLUSIONS: On-line communities concerned with vaccination are getting popular. The influence of antivaccination parents on the Internet is expected to be high. The government and healthcare providers need to increase their efforts to improve the credibility of information about vaccination. Our findings suggest that online communication regarding vaccinations needs to be considered as a means to increase vaccination rates.

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Validation Studies

Validity of Expired Carbon Monoxide and Urine Cotinine Using Dipstick Method to Assess Smoking Status.: Su San Park, Ju Yul Lee, Sung Il Cho; J Prev Med Public Health. 2007;40(4):297-304.; DOI: https://doi.org/10.3961/jpmph.2007.40.4.297

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Abstract PDF

OBJECTIVES
We investigated the validity of the dipstick method (Mossman Associates Inc. USA) and the expired CO method to distinguish between smokers and nonsmokers. We also elucidated the related factors of the two methods. METHODS: This study included 244 smokers and 50 exsmokers, recruited from smoking cessation clinics at 4 local public health centers, who had quit for over 4 weeks. We calculated the sensitivity, specificity and Kappa coefficient of each method for validity. We obtained ROC curve, predictive value and agreement to determine the cutoff of expired air CO method. Finally, we elucidated the related factors and compared their effect powers using the standardized regression coefficient. RESULTS: The dipstick method showed a sensitivity of 92.6%, specificity of 96.0% and Kappa coefficient of 0.79. The best cutoff value to distinguish smokers was 5-6ppm. At 5 ppm, the expired CO method showed a sensitivity of 94.3%, specificity of 82.0% and Kappa coefficient of 0.73. And at 6 ppm, sensitivity, specificity and Kappa coefficient were 88.5%, 86.0% and 0.64, respectively. Therefore, the dipstick method had higher sensitivity and specificity than the expired CO method. The dipstick and expired CO methods were significantly increased with increasing smoking amount. With longer time since the last smoking, expired CO showed a rapid decrease after 4 hours, whereas the dipstick method showed relatively stable levels for more than 4 hours. CONCLUSIONS: The dipstick and expired CO methods were both good indicators for assessing smoking status. However, the former showed higher sensitivity and specificity and stable levels over longer hours after smoking, compared to the expired CO method.

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English Abstracts

Awareness, Treatment, and Control Rates of Hypertension and Related Factors of Awareness among Middle Aged Adult and Elderly in Chuncheon: Hallym Aging Study(HAS).: Jin Young Jeong, Yong Jun Choi, Soong Nang Jang, Kyung soon Hong, Young ho Choi, Moon ki Choi, Dong Hyun Kim; J Prev Med Public Health. 2007;40(4):305-312.; DOI: https://doi.org/10.3961/jpmph.2007.40.4.305

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OBJECTIVES
To estimate the awareness, treatment and control rate, as well as to identify the awareness-related factors for hypertension. METHODS: The study participants were 482 adults (men 206, women 276), aged 45 or over, diagnosed with hypertension and living in Chuncheon. The awareness rate was defined as the proportion of persons among those with hypertension who had previously been diagnosed by a physician. The treatment rate was defined as the proportion of persons who had used anti-hypertensive medication, among those who were aware of their hypertension. The control rate was defined as the proportion of persons who kept blood pressure normal, among those who had been treated for their hypertension. Multivariable logistic regression analysis was carried out for the awarenessrelated factors using SAS VER 8.1. RESULTS: The awareness, treatment, and control rate were 55.8% (53.4% for men; 57.6% for women), 89.6% (87.2% for men; 91.2% for women), and 34.4% (28.1% for men; 38.6% for women), respectively. The awarenessrelated factors included a family history of hypertension (odds ratio[OR], 5.63; 95% confidence interval[95% CI]=1.53-20.72), smoking([Ex; OR 0.38, 95% CI= 0.15- 0.96)], [Current; OR 0.28, 95% CI=0.10-0.80]), and alcohol intake ([Ex; OR 3.22, 95% CI 1.03-10.09],[Current; OR 3.36, 95% CI=1.30-8.71]) for men, and education(OR 2.23, 95% CI=1.10-4.53), body mass index(OR 2.72, 95% CI=1.13-6.53), and self-rated health(OR 2.38, 95% CI=1.07-5.30) for women. CONCLUSIONS: The awareness rate of hypertension among the middle aged and elderly in Chuncheon was 55.8%. The related factors of awareness were gender specific. Further studies are needed to elucidate the putative reasons for these gender differences.

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Body Mass Index and Risk of Hemorrhagic Stroke in Korean Adults: Case-control Study.: Seon Ha Kim, Yong Seok Lee, Seung Mi Lee, Byung Woo Yoon, Byung Joo Park; J Prev Med Public Health. 2007;40(4):313-320.; DOI: https://doi.org/10.3961/jpmph.2007.40.4.313

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OBJECTIVES
To evaluate the association between body mass index (BMI) and hemorrhagic stroke. METHODS: A case-control study was conducted on 2,712 persons (904 cases, 904 hospital controls, and 904 community controls) participating in an Acute Brain Bleeding Analysis study from October 2002 to March 2004. Two controls for each case were matched according to age and gender. The information was obtained by trained interviewers using standardized questionnaire. A conditional logistic regression model was used to estimate the association between BMI and the frequency of having a hemorrhagic stroke. RESULTS: Obese men (25.0 < or = BMI < 30.0 kg/m2) had an odds ratios (OR) of 1.39 (95% CI 1.03 to 1.87) a hemorrhagic stroke, compared to men with a normal BMI (18.5 to 24.9 kg/m2). Conversely, women with lower BMI had a higher risk of having hemorrhagic stroke. With respect to subtypes of hemorrahagic stroke, we observed about a three-fold increase in the risk of intracerebral hemorrhage (ICH) in the highly obese group. However, these trends were not significant in patients with subarachnoid hemorrhages. CONCLUSIONS: Obesity was identified as one of the risk factors in hemorrhagic stroke, in particular ICH. Conversely, in women, a lean body weight increases the risk of hemorrhagic stroke. Consequently, managing one\s weight is essential to reduce the risks of hemorrhagic stroke.

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Multicenter Study

Cigarette Smoking, Alcohol Consumption, Tuberculosis and Risk of Lung Cancer: The Korean Multi-center Cancer Cohort Study.: Jisuk Bae, Jin Gwack, Sue Kyung Park, Hai Rim Shin, Soung Hoon Chang, Keun Young Yoo; J Prev Med Public Health. 2007;40(4):321-328.; DOI: https://doi.org/10.3961/jpmph.2007.40.4.321

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OBJECTIVES
The aim of this study was to evaluate the roles of cigarette smoking, alcohol consumption, tuberculosis, and their interactions in the risk of lung cancer in a Korean cohort. METHODS: The study subjects comprised 13,150 males and females aged above 20 years old. During the follow up period from 1993 to 2002, 79 lung cancer cases were identified by the central cancer registry and the national death certificate database. Information on cigarette smoking, alcohol consumption and the history of physiciandiagnosed tuberculosis was obtained by interview. Indirect chest X-ray findings were also evaluated to ascertain tuberculosis cases. Cox proportional hazard models were used to estimate relative risks (RR) and 95% confidence intervals (CI) after adjusting for age and gender. RESULTS: Cigarette smoking was statistically significantly associated with an increased risk of lung cancer [for current smokers, RR = 2.33 (95% CI = 1.23 - 4.42) compared to non-smokers]. After further adjustment for cigarette smoking, both alcohol consumption and tuberculosis showed no statistically significant association with the risk of lung cancer [for current drinkers, RR = 0.80 (95% CI = 0.48 - 1.33) compared to non-drinkers] [for tuberculosis cases, RR = 1.17 (95% CI = 0.58 - 2.36) compared to noncases]. There was no statistically significant interaction between cigarette smoking and alcohol consumption (pinteraction = 0.38), or cigarette smoking and tuberculosis (p-interaction = 0.74). CONCLUSIONS: Although cigarette smoking was confirmed as a risk factor of lung cancer in this cohort study, this study suggests that alcohol consumption and tuberculosis may not be associated with the risk of lung cancer.

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English Abstract

Effects of Private Health Insurance on Health Care Utilization and Expenditures in Korean Cancer Patients: Focused on 5 Major Cancers in One Cancer Center.: Jin Hwa Lim, Kui Son Choi, Sung Gyeong Kim, Eun Cheol Park, Jae Hyun Park; J Prev Med Public Health. 2007;40(4):329-335.; DOI: https://doi.org/10.3961/jpmph.2007.40.4.329

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OBJECTIVES
To identify the effects of supplemental private health insurance on health care utilization and expenditure under the mandatory National Health Insurance(NHI) system in Korea. METHODS: The data were collected by the National Cancer Center in Korea. Cancer patients who were newly diagnosed with stomach (ICD code, C16), lung(C33-C34), liver (C22), colorectal cancer(C18-C20) or breast(C50) cancer were included as study subjects. Data were gathered using a structured questionnaire from face-to-face interviews, the hospital Order Communication System (OCS) and medical records. Clinical, socio-demographic and private health insurance related factors were also gathered. The differences of health care utilization and expenditure were compared between those who have private health insurance and those who do not using t-test and multivariable regression analysis. RESULTS: Individuals with private health insurance spent larger inpatient costs than those without, but no differences were found in utilization in other service such as hospital admissions, hospital days and physician visits. CONCLUSIONS: We found that private health insurance exerts a significant effect on the health care expenditure in inpatient service. These study results can provide a rational basis to plan a national health policy regarding private health insurance. Further studies are needed to investigate the impacts of private health insurance on cancer patients' outcomes and survival rates.

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