Journal of Preventive Medicine and Public Health

Brief Report

Missing Occupation, Missing Risk: Insights From COVID-19 Case Investigation Data in Busan, South Korea: Jin-Hwan Kim, Daseul Moon, Changhoon Kim; J Prev Med Public Health. 2026;59(2):204-210. Published online March 12, 2026; DOI: https://doi.org/10.3961/jpmph.25.718

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Abstract Summary PDF Supplementary Material: Objectives
This study evaluated the quality and analytic utility of occupational data in coronavirus disease 2019 (COVID-19) case investigation records from Busan, South Korea, during the period of comprehensive surveillance in 2020–2021, when occupation was inconsistently integrated into routine case reporting despite its importance for infection-risk assessment.
Methods
We analyzed 25 283 confirmed COVID-19 cases reported between February 21, 2020, and December 31, 2021. Occupational information was extracted from investigation forms, epidemiological reports, and electronic medical records. We assessed completeness, internal inconsistencies, and codability to the Korean Standard Classification of Occupations (KSCO), and examined temporal trends across pandemic phases. Descriptive statistics and manual reviews of free-text entries were conducted.
Results
Occupational information was recorded for nearly all investigated cases in 2020–2021 (>99%), but entries were often vague (“unemployed,” “other”) or institutional (“school,” “hospital”), which limited their utility. A minority of entries could be standardized to KSCO 1–3-digit categories because of ambiguous wording or contradictions between occupation and workplace. Although data collection virtually ceased in 2022 and 2023 after individual-level investigations were discontinued, patterns in the 2020–2021 dataset already showed that design flaws in the occupation field reduced analytic value.
Conclusions
Busan’s early COVID-19 surveillance system recorded occupation for nearly all cases but produced limited analyzable information. The disconnect between data entry and analytic usefulness highlights the need for structured, dual occupation–industry coding, searchable picklists, and real-time quality checks so that occupational risk can be systematically identified and incorporated into future pandemic preparedness and response.; Summary

Korean summary
본 연구는 코로나바이러스감염증-19에 대한 전수감시가 이루어지던 2020-2021년 시기에 부산광역시 확진자 역학조사에 포함된 직업 정보의 질과 그 활용 가능성을 평가했다. 약 2년 동안 약 99% 이상의 확진자에서 직업 정보가 기입되어 있었으나 “무직”, “기타” 등의 모호한 기재나 “학교”, “병원”과 같은 기관 수준의 기재가 빈번해 활용 가능성은 제한적이었다. 자료 입력과 분석적 유용성 간의 괴리는 향후 감염병 대비 및 대응에서 직업적 위험을 체계적으로 파악하고 반영하기 위해, 구조화된 직업-산업 이중 입력 체계, 검색 기반 폐쇄형 입력 기능, 실시간 자료 질 점검 체계 도입이 필요함을 시사한다.

Key Message
- Occupation is critical for infection-risk assessment, yet occupation was not systematically collected during the COVID-19 pandemic. - In Busan, although occupational information was recorded for most confirmed COVID-19 cases reported between February 2020 and December 2021, many entries contained workplace names or industry categories instead of specific occupations, limiting standardization and analytic utility. - To improve the quality of occupational data in future pandemic preparedness, dual occupation–industry coding, searchable picklists, and real-time quality checks are needed.

Original Articles

Exposure to Benzene, Toluene, Ethylbenzene, and Xylenes and Risk of Depression: A Cross-sectional Study of a National Sample of Korean Adults: Hyun-Wook Park, Byung-Sun Choi, Bomi Park, Wanhyung Lee, Weon-Young Lee; J Prev Med Public Health. 2026;59(1):95-104. Published online November 6, 2025; DOI: https://doi.org/10.3961/jpmph.25.522

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Abstract Summary PDF Supplementary Material: Objectives
Benzene, toluene, ethylbenzene, and xylenes (BTEX) are co-occurring neurotoxicants that are structurally similar aromatic hydrocarbons sharing common metabolic pathways and mechanisms of toxicity. This study investigated the effects of BTEX exposure on depression and aimed to identify the primary contributors to depression risk.
Methods
We conducted a cross-sectional analysis of 1733 adults from the 2020–2021 Korea National Health and Nutrition Examination Survey. BTEX exposure was quantified based on urinary metabolite concentrations: S-phenylmercapturic acid (SPMA) for benzene, benzylmercapturic acid for toluene, the sum of phenylglyoxylic acid and mandelic acid for ethylbenzene, and methylhippuric acid for xylenes. Depression was defined according to self-reported physician diagnosis. Logistic regression was used to estimate the risk associated with individual chemicals, while weighted quantile sum (WQS) regression was employed to assess mixture effects and identify the primary toxicant. Sensitivity analyses were performed to address potential confounding by tobacco smoke.
Results
Urinary SPMA concentrations were significantly higher in individuals with depression. Logistic regression revealed a significant association between SPMA levels and depression (odds ratio, 2.62; 95% confidence interval, 1.34 to 5.13). Although the overall BTEX mixture was not significantly associated with depression after covariate adjustment in WQS models, SPMA consistently emerged as the major contributor. The association between SPMA and depression remained robust in sensitivity analyses excluding participants exposed to tobacco smoke.
Conclusions
Benzene exposure was associated with an increased risk of depression in the general Korean adult population. Therefore, strengthened environmental regulations on benzene could help reduce the public health burden of depression.; Summary

Korean summary
본 연구는 2020–2021년 국민건강영양조사 자료를 활용하여 한국 성인에서 요중 벤젠, 톨루엔, 에틸벤젠, 자일렌 대사체 농도와 우울증 위험 간의 연관성을 분석하였다. 분석 결과, 벤젠의 대사체인 요중 S-phenyl-mercapturic acid는 우울증 위험 증가와 연관성을 보였다. 흡연 요인을 제외한 민감도 분석에서도 연관성은 일관되게 유지되어, 벤젠 노출 저감을 위한 환경적 관리 강화가 우울증 예방에 기여할 수 있음을 시사한다.

Key Message
This study investigated the association between urinary metabolites of benzene, toluene, ethylbenzene, and xylene and depression risk among Korean adults, using data from the Korea National Health and Nutrition Examination Survey 2020–2021. The findings indicated a significant association between urinary S-phenyl-mercapturic acid, a metabolite of benzene, and an increased risk of depression. This association remained robust after excluding smoking factors, underscoring the potential benefits of improved environmental management in reducing benzene exposure to prevent depression.

The Role of Hydrometeorological Factors in Leptospirosis Transmission in Central Java, Indonesia: Yoerdy Agusmal Saputra, Ladyka Viola Aulia Armawan, Mona Lisa, Disa Hijratul Muharramah, Laura Dwi Pratiwi; J Prev Med Public Health. 2025;58(6):553-562. Published online June 26, 2025; DOI: https://doi.org/10.3961/jpmph.25.114

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Abstract Summary PDF: Objectives
This study investigates the relationship between hydrometeorological factors and leptospirosis cases in Central Java to elucidate disease spread patterns.
Methods
An ecological study design was utilized, incorporating spatial elements by integrating geographic information systems (GIS) with statistical techniques. The analysis included data on temperature, humidity, rainfall, solar radiation, flooding, and monthly leptospirosis cases recorded from 2018 to 2022. Data sources comprised the Ministry of Health of the Republic of Indonesia, the Meteorology, Climatology, and Geophysics Agency, and the Central Java Provincial Water Resources Management Center. The study employed correlation tests, multiple linear regression, and spatial data visualization.
Results
Correlation analysis indicated that monthly leptospirosis cases were significantly and positively correlated with minimum temperature (r=0.423; p=0.001), humidity (r=0.589; p<0.001), and rainfall (r=0.413; p=0.001). In contrast, maximum temperature (r=-0.355; p=0.005) and solar radiation (r=-0.431; p=0.001) showed significant negative correlations. Subsequent multiple linear regression showed that higher monthly leptospirosis was associated with higher humidity.
Conclusions
The findings offer essential insights for developing a comprehensive, science-based leptospirosis management strategy. A recommended approach is to establish a spatial monitoring system aimed at identifying high-risk areas, especially those with increased humidity and frequent flooding.; Summary

Key Message
This ecological GIS-based study analyzed monthly leptospirosis cases and hydrometeorological variables (2018–2022) across Central Java to identify the hydrometeorological role in leptospirosis transmission. Correlation and multiple linear regression found humidity as the only statistically significant predictor—each 1% increase associated with 0.07 additional monthly cases—while minimum temperature and rainfall showed positive correlations and maximum temperature and solar radiation showed negative correlations. Spatial overlays highlighted higher burdens in humid, flood-prone districts and support using spatial monitoring and hydrometeorology-informed early warning systems.

Systematic Review

Theory-Based Interventions to Improve Medication Adherence Among Patients With Hypertension in Primary Healthcare and the Community: A Systematic Review: Tri Yulianti, Anna Wahyuni Widayanti, Susi Ari Kristina, Nanang Munif Yasin; J Prev Med Public Health. 2025;58(4):348-359. Published online February 17, 2025; DOI: https://doi.org/10.3961/jpmph.24.651

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Abstract Summary PDF

Objectives
Numerous interventions have been implemented to enhance adherence to antihypertensive medications, yet only a few have utilized health behavioral theories. The research quality and efficacy of these theory-based studies remain undetermined. This systematic review aimed to provide a thorough description of research that employed health behavior theories to improve medication adherence in patients diagnosed with hypertension, particularly in primary healthcare and community settings.
Methods
PubMed and Scopus were searched for randomized clinical trials that employed health behavioral theories to improve medication adherence in patients with hypertension, published in English between 2013 and 2023. Data were extracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Joanna Briggs Institute critical appraisal tool was used to evaluate the risk of bias.
Results
Of the 446 studies initially identified, only 10 met the inclusion criteria and were included in this systematic review. Eight studies employed a single theory, and 2 applied a combination of theories, with Social Cognitive Theory and the Transtheoretical Model being the most predominant. Six trials demonstrated a notable enhancement in medication adherence, while 5 studies were assessed to have a high risk of bias.
Conclusions
Although not all studies employed a complete theoretical framework, the majority indicate that utilizing theory can enhance medication adherence.

Summary

Key Message
Developing complex interventions to improve medication adherence in hypertensive patients requires a theoretical framework to increase efficacy. Theoretical frameworks utilized included the predisposing, reinforcing, and enabling constructs in educational diagnosis and evaluation (PRECEDE) model, social cognitive theory (SCT), the transtheoretical model (TTM), motivational interviewing (MI), and information-motivation-behavioral (IMB) skills models as single or combination theories. Research studies applying theoretical frameworks frequently neglect to elucidate the rationale for selecting a specific theory and its underlying mechanisms. Still, most studies that applied theories have successfully enhanced medication adherence. Additional research with a rigorous design and theory is needed to improve medication adherence.

Citations

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A Systematic Literature Review: Effectiveness of Social Cognitive Therapy on Hypertension Treatment Adherence
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The Journal for Nurse Practitioners.2026; 22(2): 105676. CrossRef
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Patient Preference and Adherence.2026; Volume 20: 1. CrossRef

Perspective

Epidemiological Model for Conventional Tobacco Control Measures and Tobacco Endgame Policies: Heewon Kang, Sung-il Cho; J Prev Med Public Health. 2023;56(5):481-484. Published online September 26, 2023; DOI: https://doi.org/10.3961/jpmph.23.239

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Abstract Summary PDF Supplementary Material

Epidemiological models, also known as host-agent-vector-environment models, are utilized in public health to gain insights into disease occurrence and to formulate intervention strategies. In this paper, we propose an epidemiological model that incorporates both conventional measures and tobacco endgame policies. Our model suggests that conventional measures focus on relationships among agent-vector-host-environment components, whereas endgame policies inherently aim to change or eliminate those components at a fundamental level. We also found that the vector (tobacco industry) and environment (physical and social surroundings) components were insufficiently researched or controlled by both conventional measures and tobacco endgame policies. The use of an epidemiological model for tobacco control and the tobacco endgame is recommended to identify areas that require greater effort and to develop effective intervention measures.

Summary

Korean summary
이 연구는 기존의 담배규제와 관련된 역학 모형을 확장하여 담배 수요를 줄이기 위한 조치인 MPOWER 정책과 담배 종결전의 주요 정책을 아우르는 개념적 모형을 제시하였다. 각 정책을 개념적 모형 내 배치한 결과, MPOWER 정책은 모형 내 구성요소 간의 연결을 끊는 것을 목표로 하는 반면, 종결전 정책은 모형 내 요소들을 영구적으로 변화시키거나 제거하려는 특성을 가지고 있는 것으로 나타났다. 담배규제정책이 개체, 병원체, 벡터 및 환경 요소에 대한 균형 잡힌 포트폴리오를 갖추고 있는지 평가하기 위해 이 개념적 모형을 활용할 수 있다.

Key Message
We extended the conceptual epidemiological model for tobacco control by incorporating measures to reduce the demand for tobacco (MPOWER measures) and key endgame policies. The model suggests that MPOWER measures focus on disconnecting the relationships between model components, while endgame policies aim to permanently change or eliminate the components themselves. This model can be used to examine whether a country or jurisdiction's tobacco control policy maintains a balanced portfolio across agent, host, vector, and environmental factors.

Citations

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Firefighters as a Key Alliance Group to Advocate for Tobacco Control Policies in Korea
Heewon Kang, Susan Park, Sung-il Cho
Journal of Preventive Medicine and Public Health.2026; 59(1): 105. CrossRef
Public support for tobacco endgame policies in South Korea: Findings from the 2020 International Tobacco Control Korea Survey
Heewon Kang, Wonjeong Yoon, Hong Gwan Seo, Sungkyu Lee, Sujin Lim, Gil-yong Kim, Su Young Kim, Steve S Xu, Mi Yan, Anne C K Quah, Janet Chung-Hall, Lorraine V Craig, Coral E Gartner, Geoffrey T Fong, Sung-il Cho
Tobacco Control.2025; 34(e1): e33. CrossRef
Extent and Characteristics of Illegal Tobacco Sales on Social Media X
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Journal of the Korean Society for Research on Nicotine and Tobacco.2025; 16(1): 17. CrossRef
Prosociality and public support for tobacco control policies among South Korean adults: A cross-sectional study
Jaeyoung Ha, Heewon Kang, Ichiro Kawachi, Jieun Hwang, Sung-il Cho
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Original Article

Gender Inequalities in Mental Health During the COVID-19 Pandemic: A Population-based Study in Korea: Minku Kang, Sarah Yu, Seung-Ah Choe, Daseul Moon, Myung Ki, Byung Chul Chun; J Prev Med Public Health. 2023;56(5):413-421. Published online August 19, 2023; DOI: https://doi.org/10.3961/jpmph.23.170

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Abstract Summary PDF Supplementary Material

Objectives
This study explored the effect of the coronavirus disease 2019 (COVID-19) pandemic on psychosocial stress in prime working-age individuals in Korea, focusing on gender inequalities. We hypothesized that the impact of COVID-19 on mental health would differ by age and gender, with younger women potentially demonstrating heightened vulnerability relative to men.
Methods
The study involved data from the Korea Community Health Survey and included 319 592 adults aged 30 years to 49 years. We employed log-binomial regression analysis, controlling for variables including age, education, employment status, marital status, and the presence of children. The study period included 3 phases: the period prior to the COVID-19 outbreak (pre–COVID-19), the early pandemic, and the period following the introduction of vaccinations (post-vaccination).
Results
The findings indicated that women were at a heightened risk of psychosocial stress during the early pandemic (relative risk [RR], 1.01; 95% confidence interval [CI], 0.98 to 1.05) and post-vaccination period (RR, 1.07; 95% CI, 1.04 to 1.10) compared to men. This pattern was prominent in urban women aged 30-34 years (pre–COVID-19: RR, 1.06; 95% CI, 1.02 to 1.10; early pandemic: RR, 1.16; 95% CI, 1.08 to 1.25; post-vaccination period, RR, 1.22; 95% CI, 1.14 to 1.31).
Conclusions
The COVID-19 pandemic has exerted unequal impacts on psychosocial stress among prime working-age individuals in Korea, with women, particularly those in urban areas, experiencing a heightened risk. The findings highlight the importance of addressing gender-specific needs and implementing appropriate interventions to mitigate the psychosocial consequences of the pandemic.

Summary

Korean summary
코로나19 대유행이 국내 경제활동인구의 정신건강에 미친 젠더화된 영향을 조사하였다. 연구대상자는 2017-2021년 지역사회건강조사 조사대상자 319,592명이다. 연구 결과, 대유행 이후 30-39세 연령대 여성의 스트레스 수준이 남성에 비하여 현저히 증가한 것으로 나타났으며, 사회적 거리두기를 엄격하게 시행하였던 도시 지역에서 이러한 경향이 두드러졌다. 이번 연구 결과는 대유행 대응 노력에서 취약 집단을 지원하기 위한 중재 정책의 필요성을 강조한다

Key Message
We investigate the gendered impact of the COVID-19 pandemic on the mental health of the working-age population in Korea, focusing on ages 30-49, utilizing data from the Korea Community Health Survey (KCHS) from 2017 to 2021 including 319,592 participants. Findings reveal a notable increase in stress levels among women in the 30-39 age group after the pandemic compared to men, accentuating in urban areas with stringent social distancing measures. Our results underscore the necessity for intervention policies to support vulnerable groups in pandemic response efforts.

Citations

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Resilience Factors Mitigate the Impact of (COVID)-19 Concerns on Depressive Symptoms
Young-Mee Kim, Sung-il Cho
American Journal of Health Behavior.2025; 49(2): 27. CrossRef
Psychological distress and compliance with sanitary measures during the Covid-19 pandemic
Irwin Hecker, Solène Wallez, Honor Scarlett, José Luis Ayuso-Mateos, Richard Bryant, Giulia Caggiu, Claudia Conflitti, Katalin Gémes, Josep Maria Haro, Vincent Lorant, Roberto Mediavilla, Ellenor Mittendorfer-Rutz, Anna Monistrol-Mula, Matteo Monzio Compa
PLOS One.2025; 20(7): e0317272. CrossRef
Hwa-byung (anger syndrome) as a risk factor for suicidal ideation in MZ generation: a survey study in South Korea
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BMC Psychiatry.2024;[Epub] CrossRef

Brief Report

Effects of Forest Therapy on Psychological Improvement in Middle-aged Women in Korea: Bum-Jin Park, Won-Sop Shin, Chang-Seob Shin, Poung-Sik Yeon, Chung-Yeub Chung, Si-Hyung Lee, Dong-Jun Kim, Youn-Hee Kim, Chang-Eun Park; J Prev Med Public Health. 2022;55(5):492-497. Published online September 20, 2022; DOI: https://doi.org/10.3961/jpmph.22.086

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Abstract Summary PDF Supplementary Material

Objectives
Women experience more stress in middle age than in other periods of their lives. Therefore, health management programs that enable middle-aged women to cope with and manage stress are needed. This study investigated the psychological effects of a meditation-focused forest therapy program among 53 middle-aged women living in urban areas in Korea.
Methods
Participants were divided into 2 groups: one group underwent the program for 3 days in a forest, followed by 3 days in an urban environment, and the other group underwent the program for 3 days in the urban environment, followed by 3 days in the forest. The psychological effects of the forest therapy program were evaluated using the Profile of Mood States-Brief (POMS-B). Differences in mood state before and after the program conducted in the forest (experimental group) and in the urban environment (control group) were evaluated using the paired-samples t-test.
Results
The program in the forest significantly reduced tension, depression, anger, fatigue, and confusion among the domains of the POMS-B. The program in the urban area significantly reduced tension, but not depression, anger, fatigue, or confusion.
Conclusions
Meditation-focused forest therapy programs are expected to contribute to promoting psychological health and enhancing the quality of life of middle-aged women.

Summary

Korean summary
중년 여성이 건강을 관리할 수 있는 프로그램이 필요하다. 이 연구는 명상 중심의 산림치유 프로그램이 중년 여성의 심리적 건강 증진에 효과적인지 검증하기 위해 프로그램 시행 전후에 참가자의 기분상태(POMS-B)를 측정하여 비교하였다. 결과에 의하면 긴장, 우울, 분노, 피곤, 혼돈이 통계적으로 유의하게 감소하였다.

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Original Articles

The Role of CYP2B6*6 Gene Polymorphisms in 3,5,6-Trichloro-2-pyridinol Levels as a Biomarker of Chlorpyrifos Toxicity Among Indonesian Farmers: Jen Fuk Liem, Dwi A. Suryandari, Safarina G. Malik, Muchtaruddin Mansyur, Dewi S. Soemarko, Aria Kekalih, Imam Subekti, Franciscus D. Suyatna, Bertha Pangaribuan; J Prev Med Public Health. 2022;55(3):280-288. Published online May 16, 2022; DOI: https://doi.org/10.3961/jpmph.21.641

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Abstract PDF Supplementary Material

Objectives
One of the most widely used pesticides today is chlorpyrifos (CPF). Cytochrome P450 (CYP)2B6, the most prominent catalyst in CPF bioactivation, is highly polymorphic. The objective of our study was to evaluate the role of CYP2B6*6, which contains both 516G>T and 785A>G polymorphisms, in CPF toxicity, as represented by the concentration of 3,5,6-trichloro-2-pyridinol (TCPy), among vegetable farmers in Central Java, Indonesia, where CPF has been commonly used.
Methods
A cross-sectional study was conducted among 132 vegetable farmers. Individual socio-demographic and occupational characteristics, as determinants of TCPy levels, were obtained using a structured interviewer-administered questionnaire and subsequently used to estimate the cumulative exposure level (CEL). TCPy levels were detected with liquid chromatography-mass spectrometry. CYP2B6*6 gene polymorphisms were analyzed using a TaqMan® SNP Genotyping Assay and Sanger sequencing. Linear regression analysis was performed to analyze the association between TCPy, as a biomarker of CPF exposure, and its determinants.
Results
The prevalence of CYP2B6*6 polymorphisms was 31% for *1/*1, 51% for *1/*6, and 18% for *6/*6. TCPy concentrations were higher among participants with CYP2B6*1/*1 than among those with *1/*6 or *6/*6 genotypes. CYP2B6*6 gene polymorphisms, smoking, CEL, body mass index, and spraying time were retained in the final linear regression model as determinants of TCPy.
Conclusions
The results suggest that CYP2B6*6 gene polymorphisms may play an important role in influencing susceptibility to CPF exposure. CYP2B6*6 gene polymorphisms together with CEL, smoking habits, body mass index, and spraying time were the determinants of urinary TCPy concentrations, as a biomarker of CPF toxicity.

Summary

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Juan Pablo Betancourt Arango, Alejandro Patiño Ospina, Gonzalo Taborda Ocampo, Jhon Alexander Fiscal Ladino
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Heliyon.2023; 9(6): e16435. CrossRef

Hepatitis A Outbreak in a Facility for the Disabled, Gyeonggi Province, Korea: An Epidemiological Investigation: Yeonhwa Chang, Chanhee Kim, Nayoung Kim, Joon Jai Kim, Heeyoung Lee; J Prev Med Public Health. 2021;54(5):370-375. Published online September 2, 2021; DOI: https://doi.org/10.3961/jpmph.21.349

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Abstract Summary PDF

Objectives
The number of cases of hepatitis A virus (HAV) infections has sharply increased in Korea, especially among young adults. In this study, an HAV outbreak in a facility for disabled people was investigated, and we found epidemiological differences both between 2 different generations and between generally abled and disabled groups.
Methods
We analyzed the incubation period and attack rate of an HAV outbreak and investigated the prevalence of HAV antibodies among the staff and residents of a facility for the disabled. We performed a retrospective cohort study during the HAV outbreak, which lasted from February 8 to 25, 2019, including examinations of HAV antibody tests and post-exposure HAV vaccination for the staff or residents of the facility.
Results
There were 9 confirmed cases in 2 staff members and 7 residents. Among 53 people (30 staff and 23 residents), except for the 9 confirmed cases and 1 staff member with a known history of HAV infection, HAV seroprevalence was seen in 16.7% of the staff under 40 years of age and 95.2% of those over 40 years of age, while the corresponding rates in the residents were 0.0% and 58.8%, respectively.
Conclusions
This result implies that it is necessary to prioritize HAV vaccination for vulnerable groups and workers of residential care facilities.

Summary

Korean summary
본 연구는 장애인 거주시설에서 발생한 A형간염 유행 사례를 다루고 있다. 그 결과 거주시설 소속의 장애인들은 종사자들보다 높은 발병률(attack rate)을 나타냈을 뿐만 아니라, 비슷한 연령의 일반 인구집단보다 낮은 항체유병률을 나타내는 것으로 확인되었다. 거주시설 소속의 장애인들과 같이 취약한 인구집단은 예방접종 이력을 확인하기 어려울 뿐만 아니라 병원체에 자연스럽게 노출 기회가 적을 수밖에 없기 때문에, 예방접종 정책 수립 시 우선 접종의 대상으로 고려될 필요가 있다.

Citations

Citations to this article as recorded by

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Special Article

Introduction to Mediation Analysis and Examples of Its Application to Real-world Data: Sun Jae Jung; J Prev Med Public Health. 2021;54(3):166-172. Published online May 7, 2021; DOI: https://doi.org/10.3961/jpmph.21.069

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706 Download
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Abstract Summary PDF

Traditional epidemiological assessments, which mainly focused on evaluating the statistical association between two major components-the exposure and outcome-have recently evolved to ascertain the in-between process, which can explain the underlying causal pathway. Mediation analysis has emerged as a compelling method to disentangle the complex nature of these pathways. The statistical method of mediation analysis has evolved from simple regression analysis to causal mediation analysis, and each amendment refined the underlying mathematical theory and required assumptions. This short guide will introduce the basic statistical framework and assumptions of both traditional and modern mediation analyses, providing examples conducted with real-world data.

Summary

Korean summary
본 리뷰에서는 전통적으로 쓰여왔던 회귀분석 기반 매개요인분석방법과 인과적 매개요인분석방법에 대하여 간략히 소개하며, 또한 예시를 들어 설명하고 있다. 매개요인 분석 전에는 필요한 가정들이 맞는 지를 확인하는 것이 중요하다. 또한 분석결과를 올바르게 해석하는 것 또한 요구된다. 이러한 방법은 그동안의 노출-결과만을 다루는 단순 역학연구을 뛰어넘어, 인구집단연구에서 매커니즘을 밝히는 도구로서 유용하게 쓰일 것이다.

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Original Articles

Public Sector Workers’ Mental Health in Argentina: Comparative Psychometrics of the Perceived Stress Scale: Agustín Ramiro Miranda, Ana Veronica Scotta, Ana Lucía Méndez, Silvana Valeria Serra, Elio Andrés Soria; J Prev Med Public Health. 2020;53(6):429-438. Published online October 5, 2020; DOI: https://doi.org/10.3961/jpmph.20.229

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221 Download
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Abstract PDF

Objectives
Given that Argentinian public-sector workers are highly exposed to stressful conditions, and that the psychometric properties of the widely used Perceived Stress Scale (PSS) should be evaluated in different settings, this work aimed to compare the psychometric properties of the Latin American Spanish PSS-10 and PSS-4 and to identify the optimal scale for stress assessment.
Methods
A sample of 535 participants was randomly divided into 2 groups to evaluate dimensionality by exploratory and confirmatory factor analyses. The reliability of both scales was also evaluated. Convergent validity was estimated using the Executive Complaints Questionnaire, the average variance extracted, and the composite reliability. Discriminant validity was based on the correlation with the Utrecht Work Engagement Scale and the phi-square correlation between the components.
Results
The factor analyses supported bidimensionality of the PSS-10 (stress and coping), which showed a better fit than the PSS-4. Moreover, the reliability of the PSS-10 was higher, whereas the PSS-4 did not achieve adequate values of internal consistency. The PSS-10 was also correlated significantly with all validation scales, and presented proper internal convergent and divergent validity.
Conclusions
The PSS-10 is a reliable and structurally valid instrument to measure perceived stress and coping in a Latin American Spanish-speaking population with high work demands, and the findings of this study expand our knowledge on the geographical and sociocultural applicability of the PSS.

Summary

Citations

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Abstract Summary PDF Supplementary Material

Objectives
It is well-known that post-traumatic stress disorder (PTSD) among firefighters contributes to their job-related stress. However, the relationship between burnout and PTSD in firefighters has rarely been studied. This study therefore explored the association between burnout and its related factors, such as trauma and violence, and PTSD symptoms among firefighters in Korea.
Methods
A total of 535 firefighters participated in the Firefighter Research on Enhancement of Safety & Health study at 3 university hospitals from 2016 to 2017. The 535 participants received a baseline health examination, including questionnaires assessing their mental health. A Web-based survey was also conducted to collect data on job-related stress, history of exposure to violence, burnout, and trauma experience. The associations among burnout, its related factors, and PTSD symptoms were investigated using structural equation modeling.
Results
Job demands (β=0.411, p<0.001) and effort-reward balance (β=-0.290, p<0.001) were significantly related to burnout. Burnout (β=0.237, p<0.001) and violence (β=0.123, p=0.014) were significantly related to PTSD risk. Trauma (β=0.131, p=0.001) was significantly related to burnout; however, trauma was not directly associated with PTSD scores (β=0.085, p=0.081).
Conclusions
Our results show that burnout and psychological, sexual, and physical violence at the hands of clients directly affected participants’ PTSD symptoms. Burnout mediated the relationship between trauma experience and PTSD.

Summary

Korean summary
535명의 현직소방관을 대상으로 소방공무원에서 업무관련스트레스, 폭력노출, 외상노출, 소진(번아웃), 외상후 스트레스 장애(PTSD) 증상 설문을 시행하였고, 구조방정식 통해 업무스트레스에 의한 소진이 PTSD에 주는 영향과 다른 요인간의 연관성을 분석하였다. 그 결과, 업무 환경에서의 높은 직무요구수준과 낮은 노력-보상 균형은 소진을 증가시키며, 업무스트레스에 의한 소진과 근무 중 겪게 되는 폭력노출 경험은 PTSD 점수와 양의 연관관계를 보였다. 반면, 업무 도중 외상사건 경험은 PTSD 점수와 직접적으로 유의한 연관관계를 보이지 않았으나, 소진을 통한 간접적으로 영향을 주는 것을 확인하였다.

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Perspective

Introduction of Phylodynamics for Controlling the HIV/AIDS Epidemic in Korea: Jong-Myon Bae; J Prev Med Public Health. 2018;51(6):326-328. Published online October 22, 2018; DOI: https://doi.org/10.3961/jpmph.18.150

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Abstract Summary PDF Supplementary Material: As over 1000 new cases of HIV/AIDS occur in Korea annually, preventive health programs against HIV/AIDS are urgently needed. Since phylodynamic studies have been suggested as a way to understand how infectious diseases are transmitted and evolve, phylodynamic inferences can be a useful tool for HIV/AIDS research. In particular, phylodynamic models are helpful for dating the origins of an epidemic and estimating its basic reproduction number. Thus, the introduction of phylodynamics would be a highly valuable step towards controlling the HIV/AIDS epidemic in Korea.; Summary

Korean summary
국내 HIV/AIDS 신환자가 지속적으로 발생하고 있는 상황에서, 다른 나라에서는 HIV 감염관리에 계통역동학을 적용하고 있다. 이는 감염원과 감염경로를 알아내고, 기본재생산지수를 산출하도록 해주기 때문이다. 따라서 국내 HIV/AIDS 관리를 위해 계통역동학 적용을 적극 제안한다.”

Special Article

Proving Causation With Epidemiological Evidence in Tobacco Lawsuits: Sun Goo Lee; J Prev Med Public Health. 2016;49(2):80-96. Published online March 31, 2016; DOI: https://doi.org/10.3961/jpmph.16.002

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Abstract PDF Supplementary Material

Recently, a series of lawsuits were filed in Korea claiming tort liability against tobacco companies. The Supreme Court has already issued decisions in some cases, while others are still pending. The primary issue in these cases is whether the epidemiological evidence submitted by the plaintiffs clearly proves the causal relationship between smoking and disease as required by civil law. Proving causation is difficult in tobacco lawsuits because factors other than smoking are involved in the development of a disease, and also because of the lapse of time between smoking and the manifestation of the disease. The Supreme Court (Supreme Court Decision, 2011Da22092, April 10, 2014) has imposed some limitations on using epidemiological evidence to prove causation in tobacco lawsuits filed by smokers and their family members, but these limitations should be reconsidered. First, the Court stated that a disease can be categorized as specific or non-specific, and for each disease type, causation can be proven by different types of evidence. However, the concept of specific diseases is not compatible with multifactor theory, which is generally accepted in the field of public health. Second, when the epidemiological association between the disease and the risk factor is proven to be significant, imposing additional burdens of proof on the plaintiff may considerably limit the plaintiff’s right to recovery, but the Court required the plaintiffs to provide additional information such as health condition and lifestyle. Third, the Supreme Court is not giving greater weight to the evidential value of epidemiological study results because the Court focuses on the fact that these studies were group-level, not individual-level. However, group-level studies could still offer valuable information about individual members of the group, e.g., probability of causation.

Summary

Citations

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Brief Report

Epidemiological Investigation of an Outbreak of Salmonellosis in Gyeongju, Korea: Seok-Ju Yoo, Hyun-Sul Lim, Kwan Lee; J Prev Med Public Health. 2014;47(3):177-181. Published online May 30, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.3.177

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Abstract PDF

Objectives

A salmonellosis outbreak occurred within a community of Gyeongju residents who ingested catered food from a wedding in June 2009. We aimed to epidemiologically investigate the probable vehicle of the infection.

Methods

We conducted a retrospective cohort study on 34 local residents who ingested the wedding food.

Results

Among the 34 residents, 31 (91.2%) reported symptoms of infection after eating the food. Among all of the wedding foods, pan-fried foods were highly associated with the diarrheal attack rate. On bacteriological examination, Salmonella species were detected in the pan-fried foods among the leftover foods and in 17 of the 31 stool specimens from the cases. There were five different types of pan-fried foods, but the onset of symptoms was independent of the ingredients used. We found that the pan-fried food was prepared at a food store in Seoul and that eggs were a common ingredient.

Conclusions

The major cause of the salmonellosis in this population was presumed to be the pan-fried food prepared with contaminated eggs. These food items might have been partially undercooked because of their irregular shape, which allowed the Salmonella species to survive and multiply before ingestion.

Summary

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Original Articles

Association Between Socioeconomic Status and Obesity in Adults: Evidence From the 2001 to 2009 Korea National Health and Nutrition Examination Survey: Jihye Kim, Shreela V. Sharma, Sung Kyun Park; J Prev Med Public Health. 2014;47(2):94-103. Published online March 31, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.2.94

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Abstract PDF

Objectives

The present study examined relationships between socioeconomic status (SES) and obesity and body mass index (BMI) as well as the effects of health-related behavioral and psychological factors on the relationships.

Methods

A cross-sectional population-based study was conducted on Korean adults aged 20 to 79 years using data from the 2001, 2005, and 2007 to 2009 Korea National Health and Nutrition Examination Survey. Multivariate logistic and linear regression models were used to estimate odds ratios of obesity and mean differences in BMI, respectively, across SES levels after controlling for health-related behavioral and psychological factors.

Results

We observed significant gender-specific relationships of SES with obesity and BMI after adjusting for all covariates. In men, income, but not education, showed a slightly positive association with BMI (p<0.05 in 2001 and 2005). In women, education, but not income, was inversely associated with both obesity and BMI (p<0.0001 in all datasets). These relationships were attenuated with adjusting for health-related behavioral factors, not for psychological factors.

Conclusions

Results confirmed gender-specific disparities in the associations of SES with obesity and BMI among adult Korean population. Focusing on intervention for health-related behaviors may be effective to reduce social inequalities in obesity.

Summary

Citations

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The Relationship Between Psychosocial Stress and Allergic Disease Among Children and Adolescents in Gwangyang Bay, Korea: Mee-Ri Lee, Bu-Soon Son, Yoo-Ri Park, Hye-Mi Kim, Jong-Youn Moon, Yong-Jin Lee, Yong-Bae Kim; J Prev Med Public Health. 2012;45(6):374-380. Published online November 29, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.6.374

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Abstract PDF

Objectives

Stress is considered a causal factor in many diseases, allergic disease being one of them. The prevalence of allergic disease is increasing in Korea, but the relationship between allergic symptoms and stress is not empirically well known. We aimed to evaluate the relationship between allergy-related symptoms and stress in children and adolescents.

Methods

We investigated 698 children and adolescents living in Gwangyang Bay, Korea, using a multi-stage cluster sampling method. Using the International Study of Asthma and Allergies in Childhood and the Psychosocial Well-being Index, these subjects were surveyed on allergy-related symptoms and psychosocial stressors in their lives, respectively. We used a multivariate logistic analysis for odds ratios for the complaint rate of allergic symptoms, after adjusting for age, gender, household income, body mass index, and residence.

Results

After adjustments, lifetime rhinitis (odds ratio [OR], 1.024), rhinoconjunctivitis (OR, 1.090), diagnosis of itchy eczema (OR, 1.040), treatment of itchy eczema (OR, 1.049), 12-month allergic conjunctivitis (OR, 1.026), diagnosis of allergic conjunctivitis (OR, 1.031), and treatment of allergic conjunctivitis (OR, 1.034) were found to be significantly associated with stress.

Conclusions

Our results support the notion that there is a relationship between stress and allergic symptoms in children and adolescents. Further research into any causal relationship between stress and allergies, as well as preventative public health plans for decreasing stress in children and adolescents are needed.

Summary

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Changes in Air Temperature and Its Relation to Ambulance Transports Due to Heat Stroke in All 47 Prefectures of Japan: Shoko Murakami, Nobuyuki Miyatake, Noriko Sakano; J Prev Med Public Health. 2012;45(5):309-315. Published online September 28, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.5.309

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Abstract PDF

Objectives

Changes in air temperature and its relation to ambulance transports due to heat stroke in all 47 prefectures, in Japan were evaluated.

Methods

Data on air temperature were obtained from the Japanese Meteorological Agency. Data on ambulance transports due to heat stroke was directly obtained from the Fire and Disaster Management Agency, Japan. We also used the number of deaths due to heat stroke from the Ministry of Health, Labour and Welfare, Japan, and population data from the Ministry of Internal Affairs and Communications. Chronological changes in parameters of air temperature were analyzed. In addition, the relation between air temperature and ambulance transports due to heat stroke in August 2010 was also evaluated by using an ecological study.

Results

Positive and significant changes in the parameters of air temperature that is, the mean air temperature, mean of the highest air temperature, and mean of the lowest air temperature were noted in all 47 prefectures. In addition, changes in air temperature were accelerated when adjusted for observation years. Ambulance transports due to heat stroke was significantly correlated with air temperature in the ecological study. The highest air temperature was significantly linked to ambulance transports due to heat stroke, especially in elderly subjects.

Conclusions

Global warming was demonstrated in all 47 prefectures in Japan. In addition, the higher air temperature was closely associated with higher ambulance transports due to heat stroke in Japan.

Summary

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English Abstracts

The Effect of Exposure Factors on the Concentration of Heavy Metals in Residents Near Abandoned Metal Mines.: Sanghoo Kim, Yong Min Cho, Seung Hyun Choi, Hae Joon Kim, Jaewook Choi; J Prev Med Public Health. 2011;44(1):41-47.; DOI: https://doi.org/10.3961/jpmph.2011.44.1.41

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Abstract PDF

OBJECTIVES
This study assessed the factors that have an influence on the residents exposed to heavy metals, and we utilized the findings to establish the proper management of abandoned metal mines in the future. METHODS: For a total of 258 residents who lived close to abandoned mines in Gangwon-province and Gyeonggi-province, the exposure factors and biomarkers in their blood and urine were comparatively analyzed via multiple regression analysis. RESULTS: The blood levels of lead and mercury and the cadmium levels in urine were found to be higher in the study group than that in the average Korean. For the blood levels of heavy metals according to each exposure factor, all of them were found to be significantly higher in both of the group residing for a longer period of time and the group living closer to the source of pollutants. Multiple regression analysis disclosed that all the heavy metals, except lead, in their blood were significantly reduced in proportion to the increased distance of inhabitancy from the mines. Their other biomarkers were within the normal ranges. CONCLUSIONS: We found that the distance between the residential village and the mines was a factor that affects the blood level of heavy metals in the villagers. This finding could be an important factor when developing a management model for the areas that surround abandoned metal mines. (ED note: I much like this important study.)

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Power Estimation and Follow-Up Period Evaluation in Korea Radiation Effect and Epidemiology Cohort Study.: In Seong Cho, Minkyo Song, Yunhee Choi, Zhong Min Li, Yoon Ok Ahn; J Prev Med Public Health. 2010;43(6):543-548.; DOI: https://doi.org/10.3961/jpmph.2010.43.6.543

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Abstract PDF

OBJECTIVES
The objective of this study was to calculate sample size and power in an ongoing cohort, Korea radiation effect and epidemiology cohort (KREEC). METHOD: Sample size calculation was performed using PASS 2002 based on Cox regression and Poisson regression models. Person-year was calculated by using data from '1993-1997 Total cancer incidence by sex and age, Seoul' and Korean statistical informative service. RESULTS: With the assumption of relative risk=1.3, exposure:non-exposure=1:2 and power=0.8, sample size calculation was 405 events based on a Cox regression model. When the relative risk was assumed to be 1.5 then number of events was 170. Based on a Poisson regression model, relative risk=1.3, exposure:non-exposure=1:2 and power=0.8 rendered 385 events. Relative risk of 1.5 resulted in a total of 157 events. We calculated person-years (PY) with event numbers and cancer incidence rate in the non-exposure group. Based on a Cox regression model, with relative risk=1.3, exposure:non-exposure=1:2 and power=0.8, 136 245PY was needed to secure the power. In a Poisson regression model, with relative risk=1.3, exposure:non-exposure=1:2 and power=0.8, person-year needed was 129517PY. A total of 1939 cases were identified in KREEC until December 2007. CONCLUSIONS: A retrospective power calculation in an ongoing study might be biased by the data. Prospective power calculation should be carried out based on various assumptions prior to the study.

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Correlations Between Climate Change-Related Infectious Diseases and Meteorological Factors in Korea.: Si Heon Kim, Jae Yeon Jang; J Prev Med Public Health. 2010;43(5):436-444.; DOI: https://doi.org/10.3961/jpmph.2010.43.5.436

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Abstract PDF

OBJECTIVES
Infectious diseases are known to be affected by climate change. We investigated if the infectious diseases were related to meteorological factors in Korea. METHODS: Scrub typhus, hemorrhagic fever with renal syndrome (HFRS), leptospirosis, malaria and Vibrio vulnificus sepsis among the National Notifiable Infectious Diseases were selected as the climate change-related infectious diseases. Temperature, relative humidity and precipitation were used as meteorological factors. The study period was from 2001 through 2008. We examined the seasonality of the diseases and those correlations with meteorological factors. We also analyzed the correlations between the incidences of the diseases during the outbreak periods and monthly meteorological factors in the hyper-endemic regions. RESULTS: All of the investigated diseases showed strong seasonality; malaria and V. vulnificus sepsis were prevalent in summer and scrub typhus, HFRS and leptospirosis were prevalent in the autumn. There were significant correlations between the monthly numbers of cases and all the meteorological factors for malaria and V. vulnificus sepsis, but there were no correlation for the other diseases. However, the incidence of scrub typhus in hyper-endemic region during the outbreak period was positively correlated with temperature and humidity during the summer. The incidences of HFRS and leptospirosis had positive correlations with precipitation in November and temperature and humidity in February, respectively. V. vulnificus sepsis showed positive correlations with precipitation in April/May/July. CONCLUSIONS: In Korea, the incidences of the infectious diseases were correlated with meteorological factors, and this implies that the incidences could be influenced by climate change.

Summary

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Seung Hyun Lee, Young-Sun Lee, In Yong Lee, Jae Won Lim, Hee-Kwan Shin, Jae-Ran Yu, Seobo Sim
The Korean Journal of Parasitology.2012; 50(4): 327. CrossRef
Work-related diseases of agricultural workers in South Korea
Sangchul Roh
Journal of the Korean Medical Association.2012; 55(11): 1063. CrossRef
Comparison of the Awareness and Knowledge of Scrub Typhus between Case and Control Groups
Kwan Lee, Byeong-Chan Park, Hyun-Sul Lim, Sun-Seog Kweon, Jin-Su Choi, Jang-Rak Kim, Keon-Yeop Kim, So-Yeon Ryu
Journal of agricultural medicine and community health.2012; 37(1): 1. CrossRef

Crisis Intervention for Workers in Severely Stressful Situations After Massive Layoffs and Labor Disputes.: Jong Min Woo, Jeong Ho Chae, Soo Chan Choi; J Prev Med Public Health. 2010;43(3):265-273.; DOI: https://doi.org/10.3961/jpmph.2010.43.3.265

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OBJECTIVES
Due to the economic crisis and globalization, many workers have been suffering from severe occupational stress due to job insecurity and struggles related to downsizing and restructuring. This study aims to assess the stress levels among workers involved in fierce labor disputes and massive layoffs and to evaluate their specific needs and satisfaction with counseling services set up to help workers cope with severely stressful situations? METHODS: The authors provided crisis intervention to workers in traumatic situations to compare the differential level of stress responses and needs among the workers remaining employed in a large auto factory, those laid off by it, and those laid off by other companies in the same region (Pyeongtaek, Gyeonggi Province). We measured stress levels using the worker's stress response inventory (WSRI) and heart rate variability (HRV), and assessed workers' satisfaction with the counseling services. RESULTS: 502 workers participated in the program. Fifty-seven percent of them consulted with occupational problems. The mean WSRI score of the workers remaining employed in the automobile factory was higher than that of the unemployed (employed: 39.8+/-19.9, unemployed: 29.3+/-18.8). Ninety-five percent of workers responded that they were satisfied or very satisfied with the counseling services. CONCLUSIONS: This study suggests the urgent need for the establishment of a national crisis intervention program dedicated to supporting workers in severely stressful situations.

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Review

Risk Assessment and Pharmacogenetics in Molecular and Genomic Epidemiology.: Sue K Park, Ji Yeob Choi; J Prev Med Public Health. 2009;42(6):371-376.; DOI: https://doi.org/10.3961/jpmph.2009.42.6.371

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In this article, we reviewed the literature on risk assessment (RA) models with and without molecular genomic markers and the current utility of the markers in the pharmacogenetic field. Epidemiological risk assessment is applied using statistical models and equations established from current scientific knowledge of risk and disease. Several papers have reported that traditional RA tools have significant limitations in decision-making in management strategies for individuals as predictions of diseases and disease progression are inaccurate. Recently, the model added information on the genetic susceptibility factors that are expected to be most responsible for differences in individual risk. On the continuum of health care, from diagnosis to treatment, pharmacogenetics has been developed based on the accumulated knowledge of human genomic variation involving drug distribution and metabolism and the target of action, which has the potential to facilitate personalized medicine that can avoid therapeutic failure and serious side effects. There are many challenges for the applicability of genomic information in a clinical setting. Current uses of genetic markers for managing drug therapy and issues in the development of a valid biomarker in pharmacogenetics are discussed.

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Thaís de Almeida Pedrete, Caroline de Lima Mota, Eline Simões Gonçalves, Josino Costa Moreira
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Effect of genetic and environmental influences on cardiometabolic risk factors: a twin study
György Jermendy, Tamás Horváth, Levente Littvay, Rita Steinbach, Ádám L Jermendy, Ádám D Tárnoki, Dávid L Tárnoki, Júlia Métneki, János Osztovits
Cardiovascular Diabetology.2011; 10(1): 96. CrossRef

Evaluation Studies

An Evaluation of Sampling Design for Estimating an Epidemiologic Volume of Diabetes and for Assessing Present Status of Its Control in Korea.: Ji Sung Lee, Jaiyong Kim, Sei Hyun Baik, Ie Byung Park, Juneyoung Lee; J Prev Med Public Health. 2009;42(2):135-142.; DOI: https://doi.org/10.3961/jpmph.2009.42.2.135

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OBJECTIVES
An appropriate sampling strategy for estimating an epidemiologic volume of diabetes has been evaluated through a simulation. METHODS: We analyzed about 250 million medical insurance claims data submitted to the Health Insurance Review & Assessment Service with diabetes as principal or subsequent diagnoses, more than or equal to once per year, in 2003. The database was re-constructed to a 'patient-hospital profile' that had 3,676,164 cases, and then to a 'patient profile' that consisted of 2,412,082 observations. The patient profile data was then used to test the validity of a proposed sampling frame and methods of sampling to develop diabetic-related epidemiologic indices. RESULTS: Simulation study showed that a use of a stratified two-stage cluster sampling design with a total sample size of 4,000 will provide an estimate of 57.04% (95% prediction range, 49.83 - 64.24%) for a treatment prescription rate of diabetes. The proposed sampling design consists, at first, stratifying the area of the nation into "metropolitan/city/county" and the types of hospital into "tertiary/secondary/primary/clinic" with a proportion of 5:10:10:75. Hospitals were then randomly selected within the strata as a primary sampling unit, followed by a random selection of patients within the hospitals as a secondly sampling unit. The difference between the estimate and the parameter value was projected to be less than 0.3%. CONCLUSIONS: The sampling scheme proposed will be applied to a subsequent nationwide field survey not only for estimating the epidemiologic volume of diabetes but also for assessing the present status of nationwide diabetes control.

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Diabetes Epidemics in Korea: Reappraise Nationwide Survey of Diabetes "Diabetes in Korea 2007"
Ie Byung Park, Jaiyong Kim, Dae Jung Kim, Choon Hee Chung, Jee-Young Oh, Seok Won Park, Juneyoung Lee, Kyung Mook Choi, Kyung Wan Min, Jeong Hyun Park, Hyun Shik Son, Chul Woo Ahn, Hwayoung Kim, Sunhee Lee, Im Bong Lee, Injeoung Choi, Sei Hyun Baik
Diabetes & Metabolism Journal.2013; 37(4): 233. CrossRef
Development of a Sampling Strategy and Sample Size Calculation to Estimate the Distribution of Mammographic Breast Density in Korean Women
Jae Kwan Jun, Mi Jin Kim, Kui Son Choi, Mina Suh, Kyu-Won Jung
Asian Pacific Journal of Cancer Prevention.2012; 13(9): 4661. CrossRef

English Abstract

'Informed Consent' in Public Health Activities: Based on the Universal Declaration on Bioethics and Human Rights, UNESCO.: Kwang Ho Meng; J Prev Med Public Health. 2008;41(5):339-344.; DOI: https://doi.org/10.3961/jpmph.2008.41.5.339

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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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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

Original Article

Psychological Distress and Occupational Injury: Findings from the National Health Interview Survey 2000-2003.: Jaeyoung Kim; J Prev Med Public Health. 2008;41(3):200-207.; DOI: https://doi.org/10.3961/jpmph.2008.41.3.200

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OBJECTIVES
This study examined whether serious psychological distress (SPD) is associated with occupational injury among US employees. METHODS: The employed population aged 18-64 years was examined (n=101,855) using data from the National Health Interview Survey (NHIS) 2000-2003. SPD was measured using the Kessler 6-item Psychological Distress Scale (K-6), a screening scale designed to identify persons with serious mental illness. The predicted marginal prevalence of psychological distress and occupational injury with the adjusted odds ratio were estimated using multiple logistic regression analyses. RESULTS: The age-adjusted 3-month prevalence of occupational injury was 0.80+/-0.12% in workers with SPD, which was 37% greater than in workers without SPD (0.58+/-0.03%). The odds of occupational injury in workers with SPD were higher compared to workers without SPD (OR=1.34, 95% CI=0.93-1.92), after controlling for sex, age, race, education, occupation, and activity limitation by at least one medical condition. Male, service and blue collar occupation, and activity limiation by co-morbidity showed significantly higher odds of occupational injury for workers with SPD. CONCLUSIONS: The findings suggest that SPD accounts for an increased likelihood of occupational injury among US employees. A further longitudinal study is needed to differentiate the mechanism or causal pathways linking individual injury risk at the workplace, SPD, and socioeconomic factors.

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English Abstracts

Cohort Study on the Association between Alcohol Consumption and the Risk of Colorectal Cancer in the Korean Elderly.: Hoi Jeong Lim, Byung Joo Park; J Prev Med Public Health. 2008;41(1):23-29.; DOI: https://doi.org/10.3961/jpmph.2008.41.1.23

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OBJECTIVES
We examined the association between alcohol consumption and incidence of colorectal cancer in elderly Koreans. METHODS: The cohort members (n=14,304) consisted of 4,834 males and 9,470 females derived from the Korea Elderly Pharmacoepidemiologic Cohort (KEPEC), a population-based dynamic cohort. They were aged 65 years old or older and lived in Busan between 1993-1998; they were beneficiaries of the Korean Medical Insurance Corporation (KMIC). Baseline information was surveyed by a self-administered, mailed questionnaire. This study population was restricted to 14,304 participants who reported alcohol drinking habits on the questionnaire and had not been diagnosed with colorectal cancer at baseline. The adjusted hazard ratios (aHR) of status, type, frequency and daily average amount of alcohol consumption were computed with Cox's proportional hazard model, with the never-drinkers as a reference group and controlling for age and gender. RESULTS: After 4.82 person-years of mean follow-up 112 cases of colorectal cancer occurred. The incidence densities of colorectal cancer were 161 (95% CI=123-200) for never-drinkers, 219 (95% CI=125-339) for ex-drinkers, and 137 (95% CI=84-189) for current-drinkers per 100,000 person-year. The status, type, frequency, and daily average amount of alcohol consumption were not significantly related to the incidence of colorectal cancer after controlling for age and gender. CONCLSIONS: There was no significant association between alcohol consumption and colorectal cancer among elderly people after controlling for age and gender.

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Shi-Ming Lai, Hong-Hong Zhu, Zhi-Juan Gan, Bi-Yun Zheng, Zhao-Hui Xu, Zhi-Cheng Wang, Xiao-Fang Liao
Preventive Medicine Reports.2024; 44: 102807. CrossRef
Wine consumption and colorectal cancer risk: a meta-analysis of observational studies
Weisong Xu, Hui Fan, Zhijuan Han, Yufeng Liu, Yiping Wang, Zhenming Ge
European Journal of Cancer Prevention.2019; 28(3): 151. CrossRef
Marital status and education as risk factors for colorectal cancer
A. Ruseva, D. Tochev, Z. Boneva, Y. Assyov, L. Georgieva, D. Nikolovska
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Consumption of beer and colorectal cancer incidence: a meta-analysis of observational studies
Cheng Zhang, Min Zhong
Cancer Causes & Control.2015; 26(4): 549. CrossRef
Alcohol Drinking, Cigarette Smoking and Risk of Colorectal Cancer in the Korean Multi-center Cancer Cohort
Sooyoung Cho, Aesun Shin, Sue K. Park, Hai-Rim Shin, Soung-Hoon Chang, Keun-Young Yoo
Journal of Cancer Prevention.2015; 20(2): 147. CrossRef
The relationship between mild alcohol consumption and mortality in Koreans: a systematic review and meta-analysis
Ji-Eun Park, Tae-young Choi, Yeonhee Ryu, Sung-Il Cho
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Attributable fraction of alcohol consumption on cancer using population-based nationwide cancer incidence and mortality data in the Republic of Korea
Sohee Park, Hai-Rim Shin, Boram Lee, Aesun Shin, Kyu-Won Jung, Duk-Hee Lee, Sun Ha Jee, Sung-Il Cho, Sue Kyung Park, Mathieu Boniol, Paolo Boffetta, Elisabete Weiderpass
BMC Cancer.2014;[Epub] CrossRef
Alcohol drinking and colorectal cancer risk: an overall and dose–response meta-analysis of published studies
V. Fedirko, I. Tramacere, V. Bagnardi, M. Rota, L. Scotti, F. Islami, E. Negri, K. Straif, I. Romieu, C. La Vecchia, P. Boffetta, M. Jenab
Annals of Oncology.2011; 22(9): 1958. CrossRef
Alcohol intake and risk of colorectal cancer: Results from the UK Dietary Cohort Consortium
J Y Park, C C Dahm, R H Keogh, P N Mitrou, B J Cairns, D C Greenwood, E A Spencer, I S Fentiman, M J Shipley, E J Brunner, J E Cade, V J Burley, G D Mishra, D Kuh, A M Stephen, I R White, R N Luben, A A Mulligan, K-T Khaw, S A Rodwell
British Journal of Cancer.2010; 103(5): 747. CrossRef
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Sang-Wook Yi, Jae Woong Sull, John Alderman Linton, Chung Mo Nam, Heechoul Ohrr
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Baseline alcohol consumption, type of alcoholic beverage and risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition-Norfolk study
Jin Young Park, Panagiota N. Mitrou, Christina C. Dahm, Robert N. Luben, Nicholas J. Wareham, Kay-Tee Khaw, Sheila A. Rodwell
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A Novel Polymorphism rs1329149 of CYP2E1 and a Known Polymorphism rs671 of ALDH2 of Alcohol Metabolizing Enzymes Are Associated with Colorectal Cancer in a Southwestern Chinese Population
Huan Yang, Yanhong Zhou, Ziyuan Zhou, Jinyi Liu, Xiaoyan Yuan, Ketaro Matsuo, Toshiro Takezaki, Kazuo Tajima, Jia Cao
Cancer Epidemiology, Biomarkers & Prevention.2009; 18(9): 2522. CrossRef

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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Seok-Ju Yoo, Hyun-Sul Lim, Kwan Lee
Journal of agricultural medicine and community health.2014; 39(4): 222. CrossRef
Evaluation and Selection of Multilocus Variable-Number Tandem-Repeat Analysis Primers for Genotyping Brucella abortus Biovar 1 Isolated from Human Patients
Subok Lee, Kyu-Jam Hwang, Mi-Yeoun Park, Seon-Do Hwang, Hee-Youl Chai, Hyuk Chu, Sang-Hee Park
Osong Public Health and Research Perspectives.2013; 4(5): 265. CrossRef
Application of the Microagglutination Test for Serologic Diagnosis of Human Brucellosis
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Osong Public Health and Research Perspectives.2012; 3(1): 19. CrossRef
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Kum-Bal Choi, Hyun-Sul Lim, Kwan Lee, Young-Sun Min
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Seroprevalence and Risk Factors of Brucellosis among Slaughterhouse Workers in Korea
Seok-Ju Yoo, Young-Sill Choi, Hyun-Sul Lim, Kwan Lee, Mi Yeoun Park, Chaeshin Chu, Young-A Kang
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Jeoung-Ha Sim, Mi-A Son
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Strategy Considerations in Genome Cohort Construction in Korea.: Joohon Sung, Sung Il Cho; J Prev Med Public Health. 2007;40(2):95-101.; DOI: https://doi.org/10.3961/jpmph.2007.40.2.95

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Abstract PDF: Focusing on complex diseases of public health significance, strategic issues regarding the on-going Korean Genome Cohort were reviewed: target size and diseases, measurements, study design issues, and followup strategy of the cohort. Considering the epidemiologic characteristics of Korean population as well as strengths and drawbacks of current research environment, we tried to tailor the experience of other existing cohorts into proposals for this Korean study. Currently 100,000 individuals have been participating the new Genome Cohort in Korea. Target size of de novo collection is recommended to be set as between 300,000 to 500,000. This target size would allow acceptable power to detect genetic and environmental factors of moderate effect size and possible interactions between them. Family units and/or special subgroups are recommended to parallel main body of adult individuals to increase the overall efficiency of the study. Given that response rate to the conventional re-contact method may not be satisfactory, successful follow-up is the main key to the achievement of the Korean Genome Cohort. Access to the central database such as National Health Insurance data can provide enormous potential for near-complete case detection. Efforts to build consensus amongst scientists from broad fields and stakeholders are crucial to unleash the centralized database as well as to refine the commitment of this national project.; Summary

Change of Cognitive Function and Associated Factors among the Rural Elderly: A 5-Year Follow-up Study.: Sang Kyu Kim, Pock Soo Kang, Tae Yoon Hwang, Joon Sakong, Kyeong Soo Lee; J Prev Med Public Health. 2007;40(2):162-168.; DOI: https://doi.org/10.3961/jpmph.2007.40.2.162

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OBJECTIVES
This prospective population-based cohort study was conducted to evaluate the risk factors of cognitive impairment and the degree of cognitive function change through a 5-year follow-up. METHODS: The baseline and follow-up surveys were conducted in 1998 and 2003, respectively. Among 176 subjects who had normal cognitive function in the baseline study, 136 were followed up for 5 years. The cognitive function was investigated using the Korean version of the Mini-Mental State Examination (MMSE-K). The collected data were analyzed using SPSS and Stata. RESULTS: Of the 136 subjects analyzed, 25 (18.4%) were cognitively impaired. Old age and low social support in the baseline survey were risk factors for cognitive impairment after 5 years. In the generalized estimating equation for 128 subjects except severe cognitive impairment about the contributing factors of cognitive function change, the interval of 5 years decreased MMSE-K score by 1.02 and the cognitive function was adversely affected with increasing age, decreasing education and decreasing social support. CONCLUSIONS: Although the study population was small, it was considered that the study results can be used to develop a community-based prevention system for cognitive impairment.

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Journal of Geriatric Oncology.2012; 3(4): 359. CrossRef
Apolipoprotein E Polymorphism and Cognitive Function Change of the Elderly in a Rural Area, Korea
Sang-Kyu Kim, Tae-Yoon Hwang, Kyeong-Soo Lee, Pock-Soo Kang, Hee-Soon Cho, Young-Kyung Bae
Journal of Preventive Medicine and Public Health.2009; 42(4): 261. CrossRef

Statistical Issues in Genomic Cohort Studies.: Sohee Park; J Prev Med Public Health. 2007;40(2):108-113.; DOI: https://doi.org/10.3961/jpmph.2007.40.2.108

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Abstract PDF: When conducting large-scale cohort studies, numerous statistical issues arise from the range of study design, data collection, data analysis and interpretation. In genomic cohort studies, these statistical problems become more complicated, which need to be carefully dealt with. Rapid technical advances in genomic studies produce enormous amount of data to be analyzed and traditional statistical methods are no longer sufficient to handle these data. In this paper, we reviewed several important statistical issues that occur frequently in large-scale genomic cohort studies, including measurement error and its relevant correction methods, cost-efficient design strategy for main cohort and validation studies, inflated Type I error, gene-gene and gene-environment interaction and time-varying hazard ratios. It is very important to employ appropriate statistical methods in order to make the best use of valuable cohort data and produce valid and reliable study results.; Summary

Review

Dioxins and Health: Human Exposure Level and Epidemiologic Evidences of Health Effects.: Jae Yeon Jang, Ho Jang Kwon; Korean J Prev Med. 2003;36(4):303-313.

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Abstract PDF: General information is summarized, that is necessary to introduce a scientific assessment of the human health and exposure issue concerning dioxin and dioxin-like compound. Scientific literatures were reviewed to assess the background exposures to the dioxin-like compounds for normal residents. Epidemiologic studies were also reviewed to assess malignant and nonmalignant effects of dioxins. In 1997, the International Agency for Research on Cancer classified 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin (TCDD) as a human carcinogen, primarily based on occupational cohort studies. The US Environmental Protection Agency made the same decision in it's Draft Dioxin Reassessment. Epidemiologic evidences point to a generalized excess of all cancers, without any pronounced excess at specific sites. Reported non-cancer effects included a range of conditions affecting most systems. Among them, chloracne, elevation in gamma glutamyl transferase (GGT), and alterations in reproductive hormones are related to TCDD. Other adverse outcomes, such as lipid concentrations, diabetes, circulatory and heart diseases, immunologic disorders, neurobehavioral effects, and developmental outcomes require further study before their respective relationships to TCDD can be more definitively assessed.; Summary

Original Articles

Specimen Storage and Analysis for Genomic Epidemiology.: Yun Chul Hong, Kwan Hee Lee; Korean J Prev Med. 2003;36(3):209-212.

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Abstract PDF: Because of advances of technologies in the field of genomic epidemiology in the recent years, specimen collection, storage and analysis became an essential part of research methodologies. DNA is now being used in epidemiologic studies to evaluate genetic risk factors and specimens other than the fresh whole blood can be used for PCR. Therefore, All nucleated cells, such as buccal swabs and urine specimens, are suitable for DNA analysis. For an unlimited source of genomic DNA, EBV transformation of lymphocytes can be used for immortalization. However, the type of specimen collected in genomic epidemiologic studies will depend on the study where the epidemiologist play a leading role for the design. We also briefly described various kinds of analysis for SNP that is an essential part of the genomic epidemiology.; Summary

The Exposure Status and Biomarkers of Bisphenol A in Shipyard Workers.: Sang Baek Koh, Cheong Sik Kim, Jun Ho Park, Bong Suk Cha, Jong Ku Park, Heon Kim, Soung Hoon Chang; Korean J Prev Med. 2003;36(2):93-100.

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Abstract PDF: OBJECTIVES
Because shipyard workers are involved with various manufacturing process, they are exposed to many kinds of hazardous materials. Welders especially, are exposed to bisphenol-A (BPA) during the welding and flame cutting of coated steel. This study was conducted to assess the exposure status of the endocrine disruptor based on the job-exposure matrix. The effects of the genetic polymorphism of xenobiotic enzyme metabolisms involved in the metabolism of BPA on the levels of urinary metabolite were investigated. METHODS: The study population was recruited from a shipyard company in the K province. A total of 84 shipbuilding workers 47 and 37 in the exposed and control groups, respectively, were recruited for this study. The questionnaire variables included, age, sex, use of personal protective equipment, smoking, drinking and work duration. The urinary metabolite was collected in the afternoon and correction made for the urinary creatinine concentration. The of the CYP1A1, CYP2E1 and UGT1A6 genotypes were investigated using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methods with the DNA extracted from venous blood. RESULTS: The urinary BPA level in the welders group was significantly higher than in the control group (p< 0.05). The urinary BPA concentration with the wild type UGT1A6 was higher than the other UGT1A6 genotypes, but with no statistical significant. From themultiple regression analysis of the urinary BPA, the regression coefficient for job grade was statistically significant (p< 0.05). CONCLUSIONS: The grade of exposure to BPA affected the urinary BPA concentration was statistically significant. However, the genetic polymorphisms of xenobiotics enzyme metabolism were not statistically significant. Further investigation of the genetic polymorphisms with a larger sample size is needed.; Summary

Associations between Air Pollution and Asthma-related Hospital Admissions in Children in Seoul, Korea: A Case-crossover Study.: Jong Tae Lee; Korean J Prev Med. 2003;36(1):47-53.

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Abstract PDF: OBJECTIVES
I used a case-crossover design to investigate the association between air pollution, and hospital admissions for asthmatic children under the age of 15 years in Seoul, Korea METHODS: I estimated the changes in the levels of hospitalization risk from theinterquartile (IQR) increase in each pollutant concentrations, using conditional logistic regression analyses, with controls for weather information. RESULTS: Using bidirectional control sampling, the results from a conditional logistic regression model, with controls for weather conditions, showed the estimated relative risk of hospitalization for asthma among children to be 1.04 (95% confidence interval (CI), 1.01-1.08) for particulate matter with an aerodynamic diameter less than or equal to 10m (IQR=40.4ug/m3) ; 1.05 (95% CI, 1.00-1.09) for nitrogen dioxide (IQR=14.6ppb) ; 1.02 (95% CI, 0.97-1.06) for sulfur dioxide (IQR=4.4ppb) ; 1.03 (95% CI, 0.99-1.08) for ozone (IQR=21.7ppb) ; and 1.03 (95% CI, 0.99-1.08) for carbon monoxide (IQR=1.0ppm). CONCLUSIONS: This empirical analysis indicates the bidirectional control sampling methods, by design, would successfully control the confounding factors due to the long-term time trends of air pollution. These findings also support the hypothesis that air pollution, at levels below the current ambient air quality standards of Korea, is harmful to sensitive subjects, such as asthmatic children.; Summary

Physical Activity and Hip Fracture in Elderly People: A Cohort Study in Korea.: Kyung Eun Youn, Seung Mi Lee, Yooni Kim, Byung Joo Park; Korean J Prev Med. 2002;35(4):351-358.

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Abstract PDF: OBJECTIVE
To evaluate the relationship between physical activity and the risk of hip fracture in the elderly Korean people. METHODS: The study population was a Physical Activity Subcohort (n=8,908) extracted from the Korean Elderly Pharmacoepidemiological Cohort (KEPEC). Physical activity information was obtained from a mailed questionnaire surveys. The outcome data was collected from claims data gathered between Jan. 1993 and Dec. 1998. A hospital survey relating to potential cases was conducted to confirm the final diagnoses. The abstracted data was reviewed by a medical doctor before the final diagnoses were confirmed. A mailing questionnaire survey was performed to obtain information on potentially confounding variables, including alcohol intake, smoking habits, weight, height and postmenopausal duration. There were 79 confirmed cases hospitalized due to hip fractures between Jan. 1993 and Dec. 1998. Relative risk of physical activity scores on the hip fracture, and their 95% confidence intervals, were estimated by a Cox's proportional hazard model using SAS for Windows ver. 6.12. RESUJLTS: Compared to the reference group, the adjusted relative risk of hip fracture associated with the most physical active category; after controlling for age, weight and alcohol intake in the males, and for weight, alcohol intake and postmenopausal duration in the females, were 1.04 (95% CI=0.35-3.06) and 0.44 (95% CI=0.26-0.77), respectively. CONCLUSIONS: Physical activity may protect elderly women from hip fracture.; Summary

Reproductive History and Hip Fracture in the Elderly Women in Korea: A Cohort Study.: Seung Mi Lee, Yooni Kim, Koung Eun Youn, Byung Joo Park; Korean J Prev Med. 2002;35(4):305-312.

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Abstract PDF: OBJECTIVES
The reproductive history of women has been suggested to have a possible influence on the risk of osteoporotic fractures. The purpose of this study was to assess the association between reproductive history and hip fractures in the elderly women. METHODS: The study subjects were drawn from women members of the Korean Elderly Pharmacoepidemiologic Cohort (KEPEC), aged 65 years or over, whose reproductive histories were available, and who were beneficiaries of the Korea Medical Insurance Corporation (KMIC) in 1993 and lived in Busan city, Korea. The information on reproductive histories, and possible confounders, were collected from mailed questionnaires. Potential hip fracture cases were collected from the claims data obtained between 1993 and 1998, with a hospital survey conducted to confirm the final diagnoses. Rate ratios and their 95% confidence intervals, were calculated using a Cox's proportional hazard model. RESUJLTS: Following up 5,219 women for 6 years, 51 cases were confirmed with hip fractures. When adjusted for age, weight and physical activity, the rate ratio of hip fractures in women who had given birth three or more times was 0.56 (95% CI: 0.25 - 1.25), compared with those who had given birth two or less times. When adjusted for age, number of births, weight and physical activity, the rate ratio in women who first gave birth when younger than 22 years was 0.60 (95% CI: 0.34 - 1.08) compared with those who had giving birth at 22 years or older. CONCLUSIONS: According to these findings, an early age when first giving birth might decrease the risk of hip fractures in elderly Korean women.; Summary

Epidemiologic Investigation on an Outbreak of Cholera in Gyeongsangbuk-do, Korea, 2001.: Jun Ho Lee, Hyun Sul Lim, Kwan Lee, Jun Chul Kim, Sang Won Lee, Un Yeong Go, Byung Kuk Yang, Jong Koo Lee, Moon Sik Kim; Korean J Prev Med. 2002;35(4):295-304.

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Abstract PDF: OBJECTIVES
This study was carried out to investigate the cause, magnitude and transmission route of the cholera outbreak in 2001. METHODS: The study population were those persons who ingested foods at the restaurant, were confirmed as cholera patients, had symptoms of diarrhea and served as workers at the restaurant. A questionnaire survey and microbiological examinations on the microbes isolated from rectal swabs were conducted. Of the cases, 316 food histories were surveyed by an analysis of the restaurant menu. RESUJLTS: There were 139 confirmed cases of cholera reported in Korea in 2001. Of these, 104 were related to the restaurant. By region, Gyeongsangbuk-do had the highest incidence with 91 cases. Of these 91 cases, 74 had ingested foods at the restaurant, 2 were employees and 3 were secondary infection cases within the families. The results of the odds ratio analysis of the 316 persons having ingested foods at the restaurant were as follows: sandwiches 5.07 (95% CI, 1.85-14.59), soybean curd 2.45 (95% CI, 1.09-5.56), noodles 2.34 (95% CI, 1.24-4.42), steamed squid 2.01 (95% CI, 1.17-3.47) and vinegared rice 1.82 (95% CI, 1.08-3.09). It was certain the restaurant in question was the cause of the 2001 outbreak. CONCLUSIONS: We suspected that more than one restaurant employee contaminated foods served at the restaurant. In addition, eating raw fishes purchased at the Pohang Fisheries infected the employees of the restaurant. There is a possibility that these raw fishes were themselves contaminated by cholera bacilli in the sea.; Summary

An Approach to Survey Data with Nonresponse: Evaluation of KEPEC Data with BMI.: Jieun Baek, Weechang Kang, Youngjo Lee, Byung Joo Park; Korean J Prev Med. 2002;35(2):136-140.

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Abstract PDF: OBJECTIVES
A common problem with analyzing survey data involves incomplete data with either a nonresponse or missing data. The mail questionnaire survey conducted for collecting lifestyle variables on the members of the Korean Elderly Phamacoepidemiologic Cohort(KEPEC) in 1996 contains some nonresponse or missing data. The proper statistical method was applied to evaluate the missing pattern of a specific KEPEC data, which had no missing data in the independent variable and missing data in the response variable, BMI. METHODS: The number of study subjects was 8,689 elderly people. Initially, the BMI and significant variables that influenced the BMI were categorized. After fitting the log-linear model, the probabilities of the people on each category were estimated. The EM algorithm was implemented using a log-linear model to determine the missing mechanism causing the nonresponse. RESULTS: Age, smoking status, and a preference of spicy hot food were chosen as variables that influenced the BMI. As a result of fitting the nonignorable and ignorable nonresponse log-linear model considering these variables, the difference in the deviance in these two models was 0.0034(df=1). CONCLUSION: There is a lot of risk if an inference regarding the variables and large samples is made without considering the pattern of missing data. On the basis of these results, the missing data occurring in the BMI is the ignorable nonresponse. Therefore, when analyzing the BMI in KEPEC data, the inference can be made about the data without considering the missing data.; Summary

A Study on the Seropositivity of HBsAg among Biennial Health Examinees: A Nation-wide Multicenter Survey.: Dae Sung Kim, Young Sik Kim, Jae Yong Kim, Yoon Ok Ahn; Korean J Prev Med. 2002;35(2):129-135.

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Abstract PDF: OBJECTIVE
The primary objective of this study was to estimate the prevalence of HBsAg-positives in the late 1990's among Korean adults. In addition, we evaluated the association of age, a residential area, a vaccination rate, a family history of chronic liver diseases and a past history of acute liver disease with the seropositivity of HBsAg, and estimated the prevalence of chronic HBV infection by follow-up for 6 month or more. METHODS: A total of 10 areas, six metropolitan and four small cities, were selected. In each cities, one health screening center was selected for recruitment of study subjects. The study subjects were enrolled from a general health examination program that is provided by medical insurance companies. Questionnaires on various risk factors were administered to the study subjects. Sera was drawn and tested for HBsAg by radioimmunoassay. HBeAg and ALT were also tested for those of HBsAg positive. The HBsAg positives was retest for HBsAg 6 months later. RESULTS: Among the study subjects (n= 1816), the seroprevalence of HBsAg was 5.5% (95% CI= 4.5%-6.6%), 7.4% in men (95% CI= 5.8-9.4) and 3.6% in women (95% CI= 2.5-5.0). A past history of acute liver disease and a family history of chronic liver diseases was shown to be risk factors for HBsAg positivity. Among the 31 HBsAg-positives, negative seroconversion rate was estimated to be 3.2 %, Thus, prevalence of chronic HBV infection was estimated to be 5.3% (95% CI= 3.7-6.6). CONCLUSION: In this study, the HBsAg seroprevalence rate was lower than that of the other studies in 1980's, particularly in young adult and women. Considering the public health importance of liver cancer and chronic liver diseases, the further effort is needed to prevent and reduce the HBV infection.; Summary

Drug Utilization Review of Antiulcerative Agents in Korean Elderly Inpatients.: Wonsik Lee, Seung Mi Lee, Hye Won Koo, Byung Joo Park; Korean J Prev Med. 2002;35(1):41-48.

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Abstract PDF: OBJECTIVES
To review the drug prescription pattern of antiulcerative agents for elderly inpatients. METHODS: The study population comprised inpatients of community hospitals who were members of the Korean Elderly Pharmacoepidemiologic Cohort (KEPEC), aged 65 years or over, beneficiaries of the Korea Medical Insurance Corporation (KMIC) and residing in Busan city in 1993. The drug prescription information was collected from the claims data of hospitals where the cohort members received medical care between January 1993 and December 1994. The information included personal identification, age, gender, diagnosis, drug dosage, date of hospital admission and name of medical institutions where the study subjects received drug prescriptions. The data analysis produced outcomes in terms of distribution of antiulcerative agents by class and by medical institution and trend of relative prescription. Analysis was also performed in terms of combined prescriptions of antiulceratives and drugs that could induce risk from drug interaction with antiulceratives. RESULTS: The number of patients prescribed antiulcerative agents was 1,059 (64.9%) male and 1,724 (65.5%) female among the total inpatients. An antacid and composite agent was the most frequently prescribed antiulcerative agent (70.8%), followed by H2 antagonist (16.0%). Among the potential drugs that could induce risk from drug interaction with the antiulcerative agents, diazepam was the most frequently prescribed. The proportion of diazepam co-prescription was 22.5% of the total cimetidine prescriptions and 14.5% of the total omeprazole prescriptions. CONCLUSIONS: Antiulcerative drugs were frequently prescribed in the elderly inpatients. The adverse drug reaction could possibly be due to drug interaction. The study results could be used as fundamental data for further drug utilization review of antiulcerative agents.; Summary

Epidemiologic Methods and Study Designs for Investigating Adverse Health Effects of Ambient Air Pollution.: Jong Tae Lee, Ho Kim; Korean J Prev Med. 2001;34(2):119-126.

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Abstract PDF: Air pollution epidemiologic studies are intrinsically difficult because the expected effect size at general environmental levels is small, exposure and misclassification of exposure are common, and exposure is not selective to a specific pollutant. In this review paper, epidemiologic study designs and analytic methods are described, and two nationwide projects on air pollution epidemiology are introduced. This paper also demonstrates that possible confounding issues in time-series analysis can be resolved and the impact on the use of data from ambient monitoring stations may not be critical. In this paper we provide a basic understanding of the types of air pollution epidemiologic study designs that be subdivided by the mode of air pollution effects on human health (acute or chronic). With the improvements in the area of air pollution epidemiologic studies, we should emphasize that elaborate models and statistical techniques cannot compensate for inadequate study design or poor data collection.; Summary

Issues in Air Pollution Epidemiologic Studies.: Eun Hee Ha, Ho Jang Kwon; Korean J Prev Med. 2001;34(2):109-118.

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Abstract PDF: The purpose of this review is to discuss the debate concerning the interpretation of epidemiologic studies on particles and health effects. Study of the 1952 air pollution disaster in London established that very high levels of particulate-based smog can cause dramatic increases in daily mortality. However, recent epidemiologic studies have reported statistically significant health effects and mortality due to low levels of air pollution. The statistical significance does not prove causation in observational studies; therefore it is necessary to evaluate these associations. There are arguments for and against each of the numerous studies using Hill's criteria, however the body of accepted evidence supports the causal association. In particular, a high level of consistency in the estimated effect of PM10 has been observed across studies worldwide. The mechanism of the relationship between air pollution and health effects is not obvious. The mechanism of particle-induced injury may involve the production of an inflammatory response by the particulate. The harvesting and the threshold effect are also major concerns regarding the health effects of air pollution. However, current epidemiologic findings indicate that linear models lacking a threshold are appropriate for assessing the effect of particulate air pollution on daily mortality even at current levels.; Summary

Epidemiologic Survey on Outbreak of Dermatosis Associated with Ants, Pachycondyla chinensis.: Geun Ryang Bae, Hyun Sul Lim, Byung Jin Kim; Korean J Prev Med. 1999;32(3):421-426.

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Abstract PDF: OBJECTIVES
An outbreak of dermatosis occurred at a city gas manufacturing factory in Pohang in Aug, 1998. The authors conducted a study to find the cause and prevent the dermatosis. METHODS: We conducted a questionnaire survey of 73 workers in the factory twice, once on Aug. 14th and then Sept. 11th, 1998. Also, a dermatologist examined their skin lesions. We suspected ants as the cause, so we collected them for identification. RESULTS: Twelve cases of dermatosis were identified with an attack rate of 16.4%. The attack rates were not different by age, educational level or tenures. The attack rates were 66.6% among production workers, 2.0% among clerical workers, 16.7% among tank trailer drivers and 0% among guards. The attack rate among production workers was significantly higher than that of the others (p<0.01). There were no histories of the same dermatosis for the past one year. Histories of other skin diseases and allergies were very rare in both cases with skin diseases and control. Multiple, pruritic, rice-grained to bean sized erythematous macules or papules with a central biting point could be found after initial severe itching occurred. Three cases showed signs of dermatosis with an allergic nature. The onset of dermatosis was between July 30 and Aug 12 and the durations varied from 5 days to over a month. The most frequent sites of skin lesions were the chest and abdomen (66.6%), and they were also observed on the neck (33.3%), arms (33.3%), shoulders (16.7%) and back (16.7%). Over 10 ants with their wings were collected in the work place and identified as Pachycondyla chinensis, subfamily Ponerinae. CONCLUSIONS: We thought that the outbreak of dermatosis was brought about by the ants flying into the work place through the open windows. Further studies on the factors contributing to the prosperity of the ants in this area are needed.; Summary

Immunotoxicity among Farmers Exposed to Pesticides.: Wonjin Lee, Chae Sung Lim, Kun Sei Lee, Soung Hoon Chang; Korean J Prev Med. 1999;32(3):347-354.

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Abstract PDF: OBJECTIVE
This paper examines the possible toxicity to immune system in farmers chronically exposed to pesticides. METHODS: We compared 43 male farmers exposed to pesticides with 29 male residents who had neither past nor current pesticides exposure. The selected variables for studying immunotoxicity were WBC, CD3, CD4, CD8, CD19, CD56, IgG, IgA, IgM, and IL-2. As part of the baseline questionnaires for the immunotoxicity, subjects were asked about kinds of farming, pesticides exposure and medical history. RESULTS: None of the variables for studying immunotoxicity showed statistically significant difference between the two groups. Although the results were not statistically significant, CD4 and the CD4/CD8 ratio decreased and CD8 increased. These effects showed a dose response change with exposure level. In the exposed group, the values of CD3, CD4, CD4/CD8 and CD19 decreased and those of the CD8 and CD56 increased compared to the non-exposed group. Also there was higher prevalence of self-reported disease in the exposed group compared to the non-exposed group. CONCLUSIONS: Although statistically significant differences in indices of immunotoxicity in farmers exposed to pesticides were not shown, the results suggest that pesticides may decrease immune function. More advanced test methods for immunotoxicity need to be developed and tested in larger population to detect immunotoxic effects of pesticides.; Summary

A Meta-analysis of Ambient Air Pollution in Relation to Daily Mortality in Seoul, 1991~1995.: Jong Tae Lee, Douglas W Dockery, Chun Bae Kim, Sun Ha Jee, Yong Chung; Korean J Prev Med. 1999;32(2):177-182.

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Abstract PDF: OBJECTIVES
To reexamine the association between air pollution and daily mortality in Seoul, Korea using a method of meta-analysis with the data filed for 1991 through 1995. METHODS: A separate Poisson regression analysis on each district within the metropolitan area of Seoul was conducted to regress daily death counts on levels of each ambient air pollutant, such as total suspended particulates (TSP), sulfur dioxide (SO2), and ozone (O3), controlling for variability in the weather condition. We calculated a weighted mean as a meta-analysis summary of the estimates and its standard error. RESULTS: We found that the p value from each pollutant model to test the homogeneity assumption was small (p<0.01) because of the large disparity among district-specific estimates. Therefore, all results reported here were estimated from the random effect model. Using the weighted mean that we calculated, the mortality at a 100 microgram/m3 increment in a 3-day moving average of TSP levels was 1.034 (95% CI 1.009-1.059). The mortality was estimated to increase 6% (95% CI 3-10%) and 3% (95% CI 0-6%) with each 50 ppb increase for 3-day moving average of SO2 and 1-hr maximum O3, respectively. CONCLUSIONS: Like most of air pollution epidemiologic studies, this meta-analysis cannot avoid fleeing from measurement misclassification since no personal measurement was taken. However, we can expect that a measurement bias be reduced in a district-specific estimate since a monitoring station is better representative of air quality of the matched district. The similar results to those from the previous studies indicated existence of health effect of air pollution at current levels in many industrialized countries, including Korea.; Summary

A study on manganese health hazards among experienced welders.: Gyu Hoi Kim, Hyun Sul Lim, Sun Hee Yu; Korean J Prev Med. 1998;31(4):644-665.

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Abstract PDF: This study was conducted to evaluate the health hazards and to develop early diagnostic methods of the manganism in experienced welders and to know the meaning of signal intensities on the brain Magnetic Resonance images. It was carried out from December 1996 to February 1997 with 277 male welders, the duration of welding was at least 5 years or more. The study was consisted of a questionnaire, physical examination and measurements of blood and urine manganese concentrations. Brain Magnetic Resonance imaging was done on 19 study subjects by random sampling. As the duration of welding increases, the positive rates of clinical symptoms, neurological examinations and blood manganese concentrations were also increased. However, physical examinations and urine manganese concentrations were not statistically significant with the duration of welding. Authors couldn't observe any Parkinsonism-like diseases. There were statistically significant correlations between duration of welding and blood manganese concentrations(r=0.16, p<0.01). There were not statistically significant correlations between duration of welding and urine manganese concentrations(r=0.06). There were statistically significant correlations between blood and urine manganese concentrations(r=0.34, p<0.01). By viewing brain Magnetic Resonance images, 13 welders(68.4 %) among 19 welders were found to have signal intensities. The positive rates of clinical symptoms, physical examinations, neurological examinations and blood and urine manganese concentrations were not statistically different between those with signal intensities and those without signal intensities. We would like to suggest that some non-specific clinical symptoms and neurological signs are correlated with the duration of welding but any Parkinsonism-like diseases had not been observed with these welders. Next we suggest that the high signal intensities on T1WI of brain Magnetic Resonance images are not the sign of manganese intoxication but the sign of manganese deposition.; Summary

The effects of aircraft noise on the hearing loss, blood pressure and response to psychological stress.: Sang Hwan Han, Soo Hun Cho, Kyungshim Koh, Ho Jang Kwon, Mina Ha, Yeong Su Ju, Myung Hee Shin; Korean J Prev Med. 1997;30(2):356-368.

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Abstract PDF: In effort to determine whether aircraft noise can have health effects such as hearing loss, hypertension and psychological stress, a total of 111 male professors and administrative officers working a college near a military airport in Korea(exposed group) and a total of 168 males and 112 females matched by age groups(control groups) were analyzed. Personal noise exposure and indoor and outdoor sound level of jet aircraft noise were measured at the exposed area. And pure tone, air conduction test and measurement of blood pressure were given to the exposed(males) and matched control groups(males and females). BEPSI(Brief Encounter Psychological Instrument) and psychological response to aircraft noise were examined for the exposed group. The noise dosimetry results revealed time-weighted averages(TWAs) that ranged from 61 to 68 dBA. However the levels encountered during taking off jet airplanes reached 126 dBA for two half minutes time period. The audiometric test showed that mean values of HTL(hearing threshold level) in exposed group at every frequency(500, 1,000, 2,000, 4,000, and 8,000 Hz were much lower than them of male and female control groups. And in old age groups, interaction of age and noise was observed at 8,000 Hz in both ears(p< 0.05). Conclusively, aircraft noise does not appear to induce hearing loss directly, but may decreased hearing threshold level by interaction of aging process and noise exposure. However, difference of mean values of exposed and control groups on blood pressure was not significantly. In psychological test, annoyance was the most severe psychological response to noise in exposed group, but mean value of BEPSI was not correlated with job duration in exposed group; Summary

An Epidemiologic Study on an Outbreak of Dermatosis Associated with Moths at a Factory.: Hyung Sul Lim, Cheol Jung, Doohie Kim, Yeol Oh Sung, Jung Ran Kim, Yoo Hang Shin; Korean J Prev Med. 1996;29(2):359-370.

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Abstract PDF: An outbreak of dermatosis occurred at a machinery manufacture factory in kyongju on Aug 1995. Authors conducted a questionnaire survey among 92 workers in the factory and a dermatologist examined their skin lesions. Authors also collected moths and identified them. The results are as follows; 1. Forty-two cases of dermatosis were identified with attack rate of 45.7%. Attack rate was not different by company, age, sex, educational level and duration of employment. Attack rate was 47.8% among productive workers, 25.0% among clerical workers and 100.0% among patrolmen. 2. Two cases among 42 dermatosis cases and three subjects among 50 non-cases had a history of same dermatosis last year. Four of dermatosis cases had a history of dermatosis among their family members. 3. skin lesions of the cases were scattered or grouped rice-sized erythematous papules or vesicles. Duration of dermatosis from the onset to the time of survey was from one day to more than 30 days. The most frequent site of skin lesion was the arms(81.0%), and it was also observed at the neck(47.6%), abdomen(45.2%), chest(42.9%), legs(38.1%) and back(35.7%). skin lesion was aggravated with sweating(31.0%), after shower(16.7%) and with scratching(l1.9%). 4. Moths were collected and identified as Euproetis subflava(Bremer). Many poisons stings were observed on their wngs which is harmful to human. 5. Contact with moths' wing droppings to two authors on their forearms for provocation resulted in severe immediate pain followed by prolonged pruritus. Erythematous macules quickly appeared and suoceeded by firm wheal-like red papules. Authors thought that the outbreak of dermatosis was brought about by Euproetix subflava(Bremer). Further studies on the factors contributing to the prosperity of the moths in this area are needed.; Summary

A study on results of short-course chemotherapy of patients with pulmonary tuberculosis registered at Seoul city health centers.: Hye Sook Park, Eun Hee Ha, Cha Hyung Wie; Korean J Prev Med. 1995;28(2):487-496.

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Abstract PDF: This study was performed for the comparison of the therapeutic efficiency between 6-month (2tHER/4HER) and 9-month (9HER) short-course chemotherapy under the programe conditions for pulmonary tuberculosis in terms of sputum AFB negative conversion rate, remedial interruption rate and cost effectiveness analysis. Two hundreds and ninty three patients treated with 9HER and 641 treated with 2HERZ/4HER had been discharged from 22 health centers in Seoul from May 1, 1993 to April 30, 1994. Seven hundreds and seventeen was subsequently analysed excluding 217 patients due to remedial interruption. The results: 1. Bacteriological negative conversion rate in 9HER regimen and 2HERZ/4HER regimen was 97.8% and 96.4% respectively (p>0.05). But the early treatment period, negative conversion rate in 2HERZ/4HER regimen was very higher than in 9HER regimen(p<0.01). 2. Remedial interruption rate for 9HER regimen and 2HERZ/4HER regimen was 34.1% and 13.6% respectively. The primary reason for the interruption was transfering to other clinics and this interruption was high within 3months. 3. Cost effectiveness for 2HERZ/4HER regimen was higher than 9HER regimen. The difference cost effectiveness ratio was 2.33 at the first sputum test and 1.69 at the last sputum test.; Summary

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