Journal of Preventive Medicine and Public Health

Volume 52(1); January 2019

Review

High Temperatures and Kidney Disease Morbidity: A Systematic Review and Meta-analysis: Woo-Seok Lee, Woo-Sung Kim, Youn-Hee Lim, Yun-Chul Hong; J Prev Med Public Health. 2019;52(1):1-13. Published online November 20, 2018; DOI: https://doi.org/10.3961/jpmph.18.149

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Abstract Summary PDF Supplementary Material

Objectives
In recent years, serious concerns have been raised regarding the impacts of rising temperatures on health. The present study was conducted to investigate the relationship between elevated temperatures and kidney disease through a systematic review and meta-analysis.
Methods
In October 2017, 2 researchers independently searched related studies in PubMed and Embase. A meta-analysis was conducted using a random-effects model, including only studies that presented odds ratios, relative risks, or percentage changes, along with 95% confidence intervals (CIs). The characteristics of each study were summarized, and the Egger test and funnel plots were used to evaluate publication bias.
Results
Eleven studies that met the criteria were included in the final analysis. The pooled results suggest an increase of 30% (95% CI, 20 to 40) in kidney disease morbidity with high temperatures. In a disease-specific subgroup analysis, statistically significant results were observed for both renal colic or kidney stones and other renal diseases. In a study design–specific subgroup analysis, statistically significant results were observed in both time-series analyses and studies with other designs. In a temperature measure–specific subgroup analysis, significant results were likewise found for both studies using mean temperature measurements and studies measuring heat waves or heat stress.
Conclusions
Our results indicate that morbidity due to kidney disease increases at high temperatures. We also found significant results in subgroup analyses. However, further time-series analyses are needed to obtain more generalizable evidence.

Summary

Korean summary
최근들어 기온상승에 따른 건강영향과 관련하여 전 세계적으로 심각한 우려가 제기되고 있으며, 저자들은 이에 착안하여 본 연구에서 체계적 문헌고찰과 메타분석을 통해 기온상승과 신장질환 발생간의 연관성을 연구하고자 하였다. 연구결과에서는 임계온도 이상으로 기온이 상승하면 참고치에 비해 신장질환으로의 이환율이 30% (95% 신뢰구간, 20% 에서 40%) 증가함을 보였고, 부집단 분석에서도 역시 유의한 결과를 나타내었다. 그러나 보다 일반화 가능한 근거를 얻기 위해서는 기온상승과 신장질환 발생에 관한 더 많은 시계열 분석 연구가 필요할 것으로 사료된다.

Citations

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Methods

Health Indicators Related to Disease, Death, and Reproduction: Jeoungbin Choi, Moran Ki, Ho Jang Kwon, Boyoung Park, Sanghyuk Bae, Chang-Mo Oh, Byung Chul Chun, Gyung-Jae Oh, Young Hoon Lee, Tae-Yong Lee, Hae Kwan Cheong, Bo Youl Choi, Jung Han Park, Sue K. Park; J Prev Med Public Health. 2019;52(1):14-20. Published online January 23, 2019; DOI: https://doi.org/10.3961/jpmph.18.250

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Abstract Summary PDF Supplementary Material

One of the primary goals of epidemiology is to quantify various aspects of a population’s health, illness, and death status and the determinants (or risk factors) thereof by calculating health indicators that measure the magnitudes of various conditions. There has been some confusion regarding health indicators, with discrepancies in usage among organizations such as the World Health Organization the, Centers for Disease Control and Prevention (CDC), and the CDC of other countries, and the usage of the relevant terminology may vary across papers. Therefore, in this review, we would like to propose appropriate terminological definitions for health indicators based on the most commonly used meanings and/or the terms used by official agencies, in order to bring clarity to this area of confusion. We have used appropriate examples to make each health indicator easy for the reader to understand. We have included practical exercises for some health indicators to help readers understand the underlying concepts.

Summary

Korean summary
본 논문에서는 질병과 사망, 출생 관련 지표들의 개념과 종류를 설명하고, 특히 연구자들이 흔히 혼동하여 사용하는 지표들에 대한 적절한 정의를 제시하였다. 또한 지표들의 예시를 부록으로 수록하여 독자들이 지표의 개념을 보다 쉽게 습득하도록 돕고자 하였다.

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Original Articles

Impact of Regional Cardiocerebrovascular Centers on Myocardial Infarction Patients in Korea: A Fixed-effects Model: Sang Guen Cho, Youngsoo Kim, Youngeun Choi, Wankyo Chung; J Prev Med Public Health. 2019;52(1):21-29. Published online November 28, 2018; DOI: https://doi.org/10.3961/jpmph.18.154

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Abstract Summary PDF Supplementary Material

Objectives
The Regional Cardiocerebrovascular Center (RCCVC) Project designated local teaching hospitals as RCCVCs, in order to improve patient outcomes of acute cardiocerebrovascular emergencies by founding a regional system that can adequately transfer and manage patients within 3 hours. We investigated the effects of RCCVC establishment on treatment volume and 30-day mortality.
Methods
We constructed a panel dataset by extracting all acute myocardial infarction cases that occurred from 2007 to 2016 from the Health Insurance Review and Assessment Service claims data, a national and representative source. We then used a panel fixed-effect model to estimate the impacts of RCCVC establishment on patient outcomes.
Results
We found that the number of cases of acute myocardial infarction that were treated increased chronologically, but when the time effect and other related covariates were controlled for, RCCVCs only significantly increased the number of treatment cases of female in large catchment areas. There was no statistically significant impact on 30-day mortality.
Conclusions
The establishment of RCCVCs increased the number of treatment cases of female, without increasing the mortality rate. Therefore, the RCCVCs might have prevented potential untreated deaths by increasing the preparedness and capacity of hospitals to treat acute myocardial infarction patients.

Summary

Korean summary
권역심뇌혈관질환센터 설립 사업은 지역별로 심뇌혈관센터를 지정/육성하여, 심뇌혈관질환 발생시 3시간 이내 진료체계를 구축함으로써 급성심근경색과 뇌졸중의 급성기 응급상황에 대한 대응을 강화하고자 시행되었다. 본 연구는 권역심뇌혈관질환센터 설립 정책으로 인해 시술 건수와 30일 내 사망 등과 같은 치료 성과가 지역 수준에서 향상되었는지 살펴보기 위해 건강보험 청구자료로 지역 수준 패널자료를 구축하여 권역심뇌혈관질환센터 설립의 효과를 추정하였다. 분석 결과, 시계열적 효과와 관련 변수를 통제하였을 때 권역심뇌혈관질환센터 설립 이후 설립 지역에서 여성의 치료 사례 수가 통계적으로 유의하게 증가하였고, 사망률은 유의미한 변화가 관찰되지 않았다. 따라서 권역심뇌혈관질환센터 설립은 대비성 향상과 치료 사례 수 증가를 통해 추가적인 치료를 받은 급성심근경색 환자의 잠재적인 원외 사망을 방지하는 효과가 있는 것으로 판단된다.

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Self-esteem as a Moderator of the Effects of Happiness, Depression, and Hostility on Suicidality Among Early Adolescents in Korea: Yeun-Soon Choi, Hee Kyoung Shin, Dae-Yong Hong, Jang-Rak Kim, Yune-Sik Kang, Baekgeun Jeong, Ki Soo Park, Key Hyo Lee; J Prev Med Public Health. 2019;52(1):30-40. Published online January 2, 2019; DOI: https://doi.org/10.3961/jpmph.18.095

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195 Download
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Abstract Summary PDF Supplementary Material

Objectives
The purpose of this study was to investigate the role of self-esteem as a moderator of the factors influencing suicidality among middle-schoolers.
Methods
Moderated multiple regression analysis was applied to assess the influence of happiness, depression, and hostility on suicidality and to determine the degree to which self-esteem served as a moderator of those relationships. Data were collected from 268 students at a middle school in Busan, Korea, using a self-administered structured questionnaire.
Results
Happiness, depression, and hostility had significant direct effects on suicidality. Self-esteem showed no direct effect, but had a significant moderating effect on the relationship between hostility and suicidal behavior.
Conclusions
These results suggest that various interventions, such as counseling programs, should be designed to alleviate hostility and depression and to enhance happiness and self-esteem among early adolescents.

Summary

Korean summary
본 연구는 중학생의 자살성향에 영향을 주는 주요 요인을 식별하고, 자아존중감의 조절효과를 확인하여 청소년 자살예방 방안 모색을 위한 실마리를 제공하고자 하였다. 실증자료의 분석 결과 자살성향에 행복, 우울, 적대감이 유의한 직접효과, 그리고 조절변수인 자아존중감이 적대감과 상호작용하여 유의한 조절효과를 보였다(p<0.05). 청소년 자살 예방의 실효성을 높이기 위해서는 행복감의 증진, 우울과 적대감의 완화 등 원인변수에 대한 개입과 동시에 조절변수인 자아존중감을 향상시키기 위한 가정과 학교의 체계적인 노력이 필요함을 시사한다.

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Cancer Patients’ Utilization of Tertiary Hospitals in Seoul Before and After the Benefit Expansion Policy: Sanghyun Cho, Youngs Chang, Yoon Kim; J Prev Med Public Health. 2019;52(1):41-50. Published online January 4, 2019; DOI: https://doi.org/10.3961/jpmph.18.166

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Abstract Summary PDF Supplementary Material

Objectives
The aim of this study was to investigate cancer patients’ utilization of tertiary hospitals in Seoul before and after the benefit expansion policy implemented in 2013.
Methods
This was a before-and-after study using claims data of the Korean National Health Insurance Service from 2011 to 2016. The unit of analysis was inpatient episodes, and inpatient episodes involving a malignant neoplasm (International Classification of Diseases, Tenth Revision codes: C00-C97) were included in this study. The total sample (n=5 565 076) was divided into incident cases and prevalent cases according to medical use due to cancer in prior years. The tertiary hospitals in Seoul were divided into two groups (the five largest hospitals and the other tertiary hospitals in Seoul).
Results
The proportions of the incident and prevalent episodes occurring in tertiary hospitals in Seoul were 34.9% and 37.2%, respectively, of which more than 70% occurred in the five largest hospitals in Seoul. Utilization of tertiary hospitals in Seoul was higher for inpatient episodes involving cancer surgery, patients with a higher income, patients living in areas close to Seoul, and patients living in areas without a metropolitan city. The utilization of the five largest hospitals increased by 2 percentage points after the policy went into effect.
Conclusions
The utilization of tertiary hospitals in Seoul was concentrated among the five largest hospitals. Future research is necessary to identify the consequences of this utilization pattern.

Summary

Korean summary
2014년부터 2016년까지 암 발생자 입원의 34.9%가 서울 소재 상급종합병원에서 이루어졌으며, 그중 73.9%가 5대 상급종합병원에서 이루어졌다. 4대 중증질환 보장성 강화 정책 후에 암환자의 서울 소재 상급종합병원 이용은 6.1%(2% 포인트) 증가하였으며, 5대 상급종합병원 이용률은 증가(정책 전: 23.6%, 정책 후: 25.8%), 그 외 서울 소재 상급종합병원 이용률은 감소하였다(정책 전: 9.3%, 정책 후: 9.1%).

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Woo-Ri Lee, Kyu-Tae Han, Mingee Choi, Seojin Park, Woorim Kim
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Descriptive Analysis of Gastric Cancer Mortality in Korea, 2000-2020
Tung Hoang, Hyeongtaek Woo, Sooyoung Cho, Jeeyoo Lee, Sayada Zartasha Kazmi, Aesun Shin
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Poor People and Poor Health: Examining the Mediating Effect of Unmet Healthcare Needs in Korea: Youngsoo Kim, Saerom Kim, Seungmin Jeong, Sang Guen Cho, Seung-sik Hwang; J Prev Med Public Health. 2019;52(1):51-59. Published online January 23, 2019; DOI: https://doi.org/10.3961/jpmph.18.162

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Abstract Summary PDF Supplementary Material

Objectives
The purpose of this study was to estimate the mediating effect of subjective unmet healthcare needs on poor health. The mediating effect of unmet needs on health outcomes was estimated.
Methods
Cross-sectional research method was used to analyze Korea Health Panel data from 2011 to 2015, investigating the mediating effect for each annual dataset and lagged dependent variables.
Results
The magnitude of the effect of low income on poor health and the mediating effect of unmet needs were estimated using age, sex, education level, employment status, healthcare insurance status, disability, and chronic disease as control variables and selfrated health as the dependent variable. The mediating effect of unmet needs due to financial reasons was between 14.7% to 32.9% of the total marginal effect, and 7.2% to 18.7% in lagged model.
Conclusions
The fixed-effect logit model demonstrated that the existence of unmet needs raised the likelihood of poor self-rated health. However, only a small proportion of the effects of low income on health was mediated by unmet needs, and the results varied annually. Further studies are necessary to search for ways to explain the varying results in the Korea Health Panel data, as well as to consider a time series analysis of the mediating effect. The results of this study present the clear implication that even though it is crucial to address the unmet needs, but it is not enough to tackle the income related health inequalities.

Summary

Korean summary
이 연구에서는 2011년부터 2015년까지의 한국의료패널 자료를 이용하여 미충족의료과 불건강의 관련성을 살펴보고, 불건강을 매개하는 미충족의료의 크기를 추정했다. 미충족의료는 개인고정효과를 보정하였을 때 불건강에 유의한 영향 준다는 것을 확인할 수 있었고, 미충족의료가 매개하는 저소득의 건강 효과는 저소득이 불건강에 미치는 전체 효과 중 일부에 지나지 않았으며, 효과의 크기는 분석 연도 별로 일정하지 않게 나타났다. 이는 건강불평등을 줄이기 위한 정책 개입에서 미충족의료 해소가 유의미한 정책 목표로 가치가 있지만 그 한계 또한 명확하다는 것을 의미한다.

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Brief Reports

A Cross-sectional Study of Cancer Knowledge and Beliefs Among Faith-based Chinese in the USA Versus Taiwan: Su-I Hou, Xian Cao; J Prev Med Public Health. 2019;52(1):60-65. Published online January 20, 2019; DOI: https://doi.org/10.3961/jpmph.17.051

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Abstract PDF: Objectives
This study examined cancer knowledge, beliefs, and practice among faith-based Chinese in the USA versus Taiwan to gain better understandings on how environment and culture might play a role for tailored cancer education programs.
Methods
A self-administered survey included a validated 10-item Cancer Screening Belief Scale (CSBS), an 8-item Cancer Screening Knowledge Test (CSKT), and a 14-item cancer Warning Signs Test (CWST) was administered. Participants were recruited from 9 Chinese churches (5 in the USA and 4 in Taiwan).
Results
A total of 372 Chinese participated, 50% lived in the USA and 50% in Taiwan. Mean age was 44.31 (standard deviation, 14.74), 60% males, and majority had college education (85%). Taiwan participants scored higher on both CSKT (6.13 vs. 5.52; p<0.001) and CWST (6.80 vs. 5.38; p<0.001). Although perceived screening benefits and barriers were similar, Taiwan participants endorsed higher on screening norms (11.67 vs. 10.82; p<0.001). Taiwan participants also indicated more doctor recommending cancer screenings (42.1% vs. 29.6%; p=0.015), USA participants were more likely to have had annual health exams (65.4% vs. 48.9%; p=0.002). Regression results showed that those resided in the USA were 2.38 times more likely to report annual health exams. Married status (odds ratio [OR], 2.85), college education (OR, 2.38), doctor’s recommendation (OR, 2.87), no family cancer history (OR, 2.47), and those with lower barriers were significant factors on annual health exams.
Conclusions
Taiwan participants scored higher on cancer knowledge and screening norms, while more USA participants reported annual health exams. Taiwan’s universal healthcare might play a role on the different healthcare seeking patterns.; Summary

Notified Incidence of Tuberculosis in Foreign-born Individuals in Jeju Province, Republic of Korea: Dae Soon Kim, Jong-Myon Bae; J Prev Med Public Health. 2019;52(1):66-70. Published online December 21, 2018; DOI: https://doi.org/10.3961/jpmph.18.246

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Abstract Summary PDF Supplementary Material: Objectives
In the Republic of Korea (ROK), the notified incidence of tuberculosis in foreign-born individuals (NITFBI) has increased recently, as has the rate of multidrug-resistant (MDR) and rifampicin-resistant (RR) tuberculosis in foreigners staying in the ROK. As Jeju Province in ROK has a no-visa entry policy, control programs for NITFBI should be consolidated. The aim was to evaluate the status of NITFBI, with a focus on the distribution of MDR/RR tuberculosis by nationality.
Methods
Data on tuberculosis incidence in individuals born in Jeju Province and in foreign-born individuals were extracted from the Korean Statistical Information Service of Statistics Korea, and the Infectious Disease Surveillance Web Statistics of the Korea Centers for Disease Control and Prevention, respectively.
Results
Among all notified incident cases of tuberculosis, the proportion of NITFBI increased from 1.46% in 2011 to 6.84% in 2017. China- and Vietnam-born individuals accounted for the greatest proportion of the 95 cases of NITFBI. Seven cases of MDR/RR tuberculosis were found, all involving patients born in China.
Conclusions
In Jeju Province, ROK, NITFBI might become more common in the near future. Countermeasures for controlling active tuberculosis in immigrants born in high-risk nations for tuberculosis should be prepared in Jeju Province, since it is a popular tourist destination.; Summary

Korean summary
제주도는 국제자유도시를 천명하면서, 30일 무비자 입국을 허용하고 있다. 이에 따라 외국인 결핵환자가 증가하고 있다. 제주도 결핵 신환자 신고 중 외국인의 분율은 2011년 1.46%에서 2017년 6.84%로 증가했으며, 약제 내성에 있어서는 총 7건이었다. 향후 제주도내 외국인 결핵환자 신고수가 증가하는 가운데 약제내성 결핵환자도 증가할 수 있음을 예측하고, 외국인에 대한 활동성 결핵관리 정책을 보완하고 지침을 강화할 필요가 있다.

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