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Volume 48(6); November 2015
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Special Article
Structural Factors of the Middle East Respiratory Syndrome Coronavirus Outbreak as a Public Health Crisis in Korea and Future Response Strategies
Dong-Hyun Kim
J Prev Med Public Health. 2015;48(6):265-270.   Published online November 30, 2015
DOI: https://doi.org/10.3961/jpmph.15.066
  • 37,700 View
  • 210 Download
  • 20 Crossref
AbstractAbstract PDF
The recent Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak has originated from a failure in the national quarantine system in the Republic of Korea as most basic role of protecting the safety and lives of its citizens. Furthermore, a number of the Korean healthcare system’s weaknesses seem to have been completely exposed. The MERS-CoV outbreak can be considered a typical public health crisis in that the public was not only greatly terrorized by the actual fear of the disease, but also experienced a great impact to their daily lives, all in a short period of time. Preparedness for and an appropriate response to a public health crisis require comprehensive systematic public healthcare measures to address risks comprehensively with an all-hazards approach. Consequently, discussion regarding establishment of post-MERS-CoV improvement measures must focus on the total reform of the national quarantine system and strengthening of the public health infrastructure. In addition, the Korea Centers for Disease Control and Prevention must implement specific strategies of action including taking on the role of “control tower” in a public health emergency, training of Field Epidemic Intelligence Service officers, establishment of collaborative governance between central and local governments for infection prevention and control, strengthening the roles and capabilities of community-based public hospitals, and development of nationwide crisis communication methods.
Summary

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    Ock-Joo Kim
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  • Current status of personnel and infrastructure resources for infection prevention and control programs in the Republic of Korea: A national survey
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    Journal of Preventive Medicine and Public Health.2015; 48(6): 274.     CrossRef
Perspectives
Implementation of Quaternary Prevention in the Korean Healthcare System: Lessons From the 2015 Middle East Respiratory Syndrome Coronavirus Outbreak in the Republic of Korea
Jong-Myon Bae
J Prev Med Public Health. 2015;48(6):271-273.   Published online November 24, 2015
DOI: https://doi.org/10.3961/jpmph.15.059
  • 12,159 View
  • 227 Download
  • 3 Crossref
AbstractAbstract PDF
Quaternary prevention should be implemented to minimize harm to patients because the ultimate goal of medicine is to prevent disease and promote health. Primary care physicians have a major responsibility in quaternary prevention, and the establishment of clinical epidemiology as a distinct field of study would create a role charged with minimizing patient harm arising from over-medicalization.
Summary

Citations

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  • Contribuições técnicas e socioculturais da prevenção quaternária para a atenção primária à saúde
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    Jong-Myon Bae
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    Marc Jamoulle
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Costly Lessons From the 2015 Middle East Respiratory Syndrome Coronavirus Outbreak in Korea
Sang-il Lee
J Prev Med Public Health. 2015;48(6):274-276.   Published online November 25, 2015
DOI: https://doi.org/10.3961/jpmph.15.064
  • 15,587 View
  • 170 Download
  • 22 Crossref
AbstractAbstract PDF
Since the Middle East respiratory syndrome (MERS) outbreak in the Republic of Korea (hereafter Korea) began on May 11, 2015, a total of 186 persons have been infected by the MERS coronavirus, 38 of whom have died. With this number, Korea becomes second only to the Kingdom of Saudi Arabia in the ranking of cumulative MERS cases. In this paper Korea’s unique experience of an outbreak of MERS will be summarized and discussed briefly.
Summary

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A New Measure for Assessing the Public Health Response to a Middle East Respiratory Syndrome Coronavirus Outbreak
Sung-il Cho
J Prev Med Public Health. 2015;48(6):277-279.   Published online November 30, 2015
DOI: https://doi.org/10.3961/jpmph.15.069
  • 10,866 View
  • 84 Download
  • 2 Crossref
AbstractAbstract PDF
Contact monitoring is an essential component of the public health response to a Middle East respiratory syndrome coronavirus outbreak, and is required for an effective quarantine to contain the epidemic. The timeliness of a quarantine is associated with its effectiveness. This paper provides a conceptual framework to describe the process of contact monitoring, and proposes a new measure called the “timely quarantined proportion” as a tool to assess the adequacy of a public health response.
Summary

Citations

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Review
Hormonal Replacement Therapy and the Risk of Lung Cancer in Women: An Adaptive Meta-analysis of Cohort Studies
Jong-Myon Bae, Eun Hee Kim
J Prev Med Public Health. 2015;48(6):280-286.   Published online November 9, 2015
DOI: https://doi.org/10.3961/jpmph.15.054
  • 11,873 View
  • 124 Download
  • 26 Crossref
AbstractAbstract PDF
Objectives
Approximately 10% to 15% of lung cancer cases occur in never-smokers. Hormonal factors have been suggested to lead to an elevated risk of lung cancer in women. This systematic review (SR) aimed to investigate the association between hormonal replacement therapy (HRT) and the risk of lung cancer in women using cohort studies.
Methods
We first obtained previous SR articles on this topic. Based on these studies we made a list of refereed, cited, and related articles using the PubMed and Scopus databases. All cohort studies that evaluated the relative risk of HRT exposure on lung cancer occurrence in women were selected. Estimate of summary effect size (sES) with 95% confidence intervals (CIs) were calculated.
Results
A total of 14 cohort studies were finally selected. A random effect model was applied due to heterogeneity (I-squared, 64.3%). The sES of the 14 articles evaluating the impact of HRT exposure on lung cancer occurrence in women indicated no statistically significant increase in lung cancer risk (sES, 0.99; 95% CI, 0.90 to 1.09).
Conclusions
These results showed that HRT history had no effect on the risk of lung cancer in women, even though the sES of case-control studies described in previous SR articles indicated that HRT had a protective effect against lung cancer. It is necessary to conduct a pooled analysis of cohort studies.
Summary

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Original Articles
Determinants of Poor Self-rated Health in Korean Adults With Diabetes
Hwi-Won Lee, Minkyo Song, Jae Jeong Yang, Daehee Kang
J Prev Med Public Health. 2015;48(6):287-300.   Published online October 23, 2015
DOI: https://doi.org/10.3961/jpmph.15.048
  • 9,812 View
  • 113 Download
  • 18 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
Self-rated health is a measure of perceived health widely used in epidemiological studies. Our study investigated the determinants of poor self-rated health in middle-aged Korean adults with diabetes.
Methods
A cross-sectional study was conducted based on the Health Examinees Study. A total of 9759 adults aged 40 to 69 years who reported having physician-diagnosed diabetes were analyzed with regard to a range of health determinants, including sociodemographic, lifestyle, psychosocial, and physical variables, in association with self-rated health status using multivariate logistic regression models. A p-value <0.05 was considered to indicate statistical significance.
Results
We found that negative psychosocial conditions, including frequent stress events and severe distress according to the psychosocial well-being index, were most strongly associated with poor self-rated health (odds ratio [OR]Frequent stress events, 5.40; 95% confidence interval [CI], 4.63 to 6.29; ORSevere distress, 11.08; 95% CI, 8.77 to 14.00). Moreover, younger age and being underweight or obese were shown to be associated with poor self-rated health. Physical factors relating to participants’ medical history of diabetes, such as a younger age at diagnosis, a longer duration of diabetes, insulin therapy, hemoglobin A1c levels of 6.5% or more, and comorbidities, were other correlates of poor reported health.
Conclusions
Our findings suggest that, in addition to medical variables, unfavorable socioeconomic factors, and adverse lifestyle behaviors, younger age, being underweight or obese, and psychosocial stress could be distinc factors in predicting negative perceived health status in Korean adults with diabetes.
Summary

Citations

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A 9-year Trend in the Prevalence of Allergic Disease Based on National Health Insurance Data
Byoungin Yoo, Yoonhyung Park, Kwanjun Park, Hoseob Kim
J Prev Med Public Health. 2015;48(6):301-309.   Published online November 13, 2015
DOI: https://doi.org/10.3961/jpmph.15.011
  • 8,923 View
  • 160 Download
  • 18 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
To investigate trends in the prevalence of allergic disease over a 9-year period.
Methods
Using National Health Insurance Service (NHIS) data, the annual number of patients with allergic disease was obtained for each regional subdivisions (small cities, counties, and districts) from 2003 to 2011. Annual populations for each sub-region were obtained and used to calculate the standardized prevalence. To compare prevalence within the study period, data was standardized spatially and temporally. For standardization, demographic data was used to obtain the registered population and demographic structure for 2010, which was used to perform direct standardization of previous years. In addition, a geographic information system (GIS) was used to visualize prevalence for individual sub-regions, and allergic diseases were categorized into five groups according to prevalence.
Results
The nationwide outpatient prevalence of allergic rhinitis increased approximately 2.3-fold, from 1.27% in 2003 to 2.97% in 2013, while inpatient prevalence also increased approximately 2.4-fold,. The outpatient prevalence of asthma increased 1.2-fold, and inpatient prevalence increased 1.3-fold. The outpatient prevalence of atopic dermatitis decreased approximately 12%, and inpatient prevalence decreased 5%.
Conclusions
There was a large difference between prevalence estimated from actual treatment data and prevalence based on patients’ self-reported data, particularly for allergic rhinitis. Prevalence must continually be calculated and trends should be analyzed for the efficient management of allergic diseases. To this end, prevalence studies using NHIS claims data may be useful.
Summary

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The Relationship of Socioeconomic and Behavioral Risk Factors With Trends of Overweight in Korea
Jin Hee Shin, Matthew E. Dupre, Truls Østbye, Gwen Murphy, Mina Silberberg
J Prev Med Public Health. 2015;48(6):310-318.   Published online November 17, 2015
DOI: https://doi.org/10.3961/jpmph.15.001
  • 8,419 View
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AbstractAbstract PDF
Objectives
Previous studies have shown that overweight (including obesity) has increased significantly in Korea in recent decades. However, it remains unclear whether this change has been uniform among all Koreans and to what extent socioeconomic and behavioral factors have contributed to this increase.
Methods
Changes in overweight were estimated using data from the 1998, 2001, 2005, 2007-2009, and 2010-2012 Korea National Health and Nutrition Examination Survey (n=55 761).
Results
Overweight increased significantly among men but not among women between 1998 and 2012. Changes in socioeconomic and behavioral factors over the time period were not associated with overall trends for both men and women. However, we found significant differences in the prevalence of overweight relative to key risk factors. For men, overweight increased at a significantly greater rate among the non-exercising (predicted probability [PP] from 0.23 to 0.32] and high-calorie (PP from 0.18 to 0.37) groups compared to their active and lower-calorie counterparts, respectively. For women, overweight increased only among the non-exercising (PP from 0.27 to 0.28) and low-income (PP from 0.31 to 0.36) groups during this period.
Conclusions
These findings suggest that programs aimed at reducing overweight should target Korean men and women in specific socioeconomic and behavioral risk groups differentially.
Summary

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Factors Determining Children’s Private Health Insurance Enrolment and Healthcare Utilization Patterns: Evidence From the 2008 to 2011 Health Panel Data
Jawoon Shin, Tae-Jin Lee, Sung-il Cho, Seung Ah Choe
J Prev Med Public Health. 2015;48(6):319-329.   Published online November 16, 2015
DOI: https://doi.org/10.3961/jpmph.15.057
  • 9,103 View
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  • 4 Crossref
AbstractAbstract PDF
Objectives
Parental socioeconomic status (SES) exerts a substantial influence on children’s health. The purpose of this study was to examine factors determining children’s private health insurance (PHI) enrolment and children’s healthcare utilization according to PHI coverage.
Methods
Korea Health Panel data from 2011 (n=3085) was used to explore the factors determining PHI enrolment in children younger than 15 years of age. A logit model contained health status and SES variables for both children and parents. A fixed effects model identified factors influencing healthcare utilization in children aged 10 years or younger, using 2008 to 2011 panel data (n=9084).
Results
The factors determining children’s PHI enrolment included children’s age and sex and parents’ educational status, employment status, and household income quintile. PHI exerted a significant effect on outpatient cost, inpatient cost, and number of admissions. Number of outpatient visits and total length of stay were not affected by PHI status. The interaction between PHI and age group increased outpatient cost significantly.
Conclusions
Children’s PHI enrolment was influenced by parents’ SES, while healthcare utilization was affected by health and disability status. Therefore, the results of this study suggest disparities in healthcare utilization according to PHI enrollment.
Summary

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Current Status of Infection Prevention and Control Programs for Emergency Medical Personnel in the Republic of Korea
Hyang Soon Oh, Dong Choon Uhm
J Prev Med Public Health. 2015;48(6):330-341.   Published online November 25, 2015
DOI: https://doi.org/10.3961/jpmph.15.058
  • 10,116 View
  • 117 Download
  • 2 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
Emergency medical personnel (EMPs) are pre-hospital emergency responders who are at risk of exposure to infections and may also serve as a source for the transmission of infections. However, few studies of infection control have specifically addressed EMPs in the Republic of Korea (hereafter Korea). The goal of this study was to assess the current status of infection prevention and control programs (IPCPs) for EMPs in Korea.
Methods
A cross-sectional survey was conducted to quantitatively assess the resources and activities of IPCPs. A total of 907 EMPs in five metropolitan cities completed a structured questionnaire from September 2014 to January 2015. The data were analyzed using descriptive statistics, multi-response analysis, and the chi-square test.
Results
The mean age of the participants was 34.8±15.1 years. IPCPs were found to have weaknesses with regard to the following resources: the assignment of infection control personnel (ICP) (79.5%), hand hygiene resources such as waterless antiseptics (79.3%), the use of paper towels (38.9%), personal protective equipment such as face shields (46.9%), and safety containers for sharps and a separated space for the disposal of infectious waste (10.1%). Likewise, the following activities were found to be inadequately incorporated into the workflow of EMPs: education about infection control (77.5%), post-exposure management (35.9%), and the decontamination of items and spaces after use (88.4%). ICP were found to have a significant effect on the resources and activities of IPCPs (p<0.001). The resources and activities of IPCPs were found to be significantly different among the five cities (p<0.001).
Conclusions
IPCPs for EMPs showed some limitations in their resources and activities. IPCPs should be actively supported, and specific IPCP activities for EMPs should be developed.
Summary

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JPMPH : Journal of Preventive Medicine and Public Health