Journal of Preventive Medicine and Public Health

Volume 38(4); November 2005

English Abstracts

Overview of Pandemic Influenza.: Woo Joo Kim; J Prev Med Public Health. 2005;38(4):373-378.

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Abstract PDF: Influenza virus has a unique characteristics of annual epidemics of acute respiratory disease with attack rate of 10%-30% of the population. It is also the classical emerging infectious disease causing global pandemics when new antigenic shift occur. This antigenic shift is the key to its ability to evoke periodic pandemics, and it has caused at least 3 pandemics in 20th century. I reviewed these 3 pandemics in their natural courses and the epidemiology of the recent emerging influenza A viruses, especially the H5 and H7 subtypes. I described the epidemics of these viruses in human population and why we should be prepared to these viruses.; Summary

Modelling the Impact of Pandemic Influenza.: Byung Chul Chun; J Prev Med Public Health. 2005;38(4):379-385.

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Abstract PDF: The impact of the next influenza pandemic is difficult to predict. It is dependent on how virulent the virus is, how rapidly it spreads from population to population, and the effectiveness of prevention and response efforts. Despite the uncertainty about the magnitude of the next pandemic, estimates of the health and economic impact remain important to aid public health policy decisions and guide pandemic planning for health and emergency sectors. Planning ahead in preparation for an influenza pandemic, with its potentially very high morbidity and mortality rates, is essential for hospital administrators and public health officials. The estimation of pandemic impact is based on the previous pandemics- we had experienced at least 3 pandemics in 20th century. But the epidemiological characteristics - ie, start season, the impact of 1st wave, pathogenicity and virulence of the viruses and the primary victims of population were quite different from one another. I reviewed methodology for estimation and modelling of pandemic impact and described some nations's results using them in their national preparedness plans. And then I showed the estimates of pandemic influenza impact in Korea with FluSurge and FluAid. And, I described the results of pandemic modelling with parameters of 1918 pandemic for the shake of education and training of the first-line responder health officials to the epidemics. In preparing influenza pandemics, the simulation and modelling are the keys to reduce the uncertainty of the future and to make proper policies to manage and control the pandemics.; Summary

The Preparedness Plan for Influenza Pandemic.: Duk Hyoung Lee, Ki dong Park; J Prev Med Public Health. 2005;38(4):386-390.

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Abstract PDF: Influenza A viruses periodically cause worldwide epidemics, or pandemics, with high rates of illness and death. A pandemic can occur at any time, with the potential to cause serious illness, death and social and economic disruption throughout the world. Historic evidence suggests that pandemics occurred three to four times per century. In the last century there were three influenza pandemics. The circumstances still exist for a new influenza virus with pandemic potential to emerge and spread. The unpredictability of the timing of the next pandemic is underlined by the occurrence of several large outbreaks of highly pathogenic avian influenza since the early 1980s. In 1999, the World Health Organization published the Influenza pandemic plan. The role of WHO and guidelines for national and regional planning. And in 2005, WHO revised the global influenza preparedness plan for new national measures before and during pandemics. This document outlines briefly the Korean Centers for Disease Control's plan for responding to an influenza pandemic. According to the new pandemic phases of WHO, we set up the 4 national levels of preparedness and made guidelines for preventing and control the epidemics in each phase. And also we described the future plans to antiviral stockpiles and pandemic vaccine development.; Summary

Socioeconomic Differentials in Health and Health Related Behaviors: Findings from the Korea Youth Panel Survey.: Young Ho Khang, Sung Il Cho, Seungmi Yang, Moo Song Lee; J Prev Med Public Health. 2005;38(4):391-400.

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Abstract PDF: OBJECTIVE
This study examined the socioeconomic differentials for the health and health related behaviors among South Korean middle school students. METHODS: A nationwide cross-sectional interview survey of 3, 449 middle school second-grade students and their parents was conducted using a stratified multi-stage cluster sampling method. The response rate was 93.3%. The socioeconomic position indicators were based on selfreported information from the students and their parents: parental education, father's occupational class, monthly family income, out-of-pocket expenditure for education, housing ownership, educational expectations, educational performance and the perceived economic hardships. The outcome variables that were measured were also based on the self-reported information from the students. The health measures included self-rated health conditions, psychological or mental problems, the feelings of loneliness at school, the overall satisfaction of life and the perceived level of stress. The health related behaviors included were smoking, alcohol drinking, sexual intercourse, violence, bullying and verbal and physical abuse by parents. RESULTS: Socioeconomic differences for the health and health related behaviors were found among the eighth grade boys and girls of South Korea. However, the pattern varied with gender, the socioeconomic position indicators and the outcome measures. The prevalence rates of the overall dissatisfaction with life for both genders differed according to most of the eight socioeconomic position indicators. All the health measures were significantly different according to the perceived economic hardship. However, the socioeconomic differences in the self-rated health conditions and the psychosocial or mental problems were not clear. The students having higher socioeconomic position tended to be a perpetrator of bullying while those students with lower socioeconomic position were more likely to be a victim. CONCLUSIONS: The perceived economic hardships predicted the health status among the eighth graders of South Korea. The overall satisfaction of life was associated with the socioeconomic position indicators. Further research efforts are needed to explore the mechanisms on how and why the socioeconomic position affects the health and health related behaviors in this age group.; Summary

Heavy Metal as Risk Factor of Cardiovascular Disease : An Analysis of Blood Lead and Urinary Mercury.: Dae Seon Kim, Eun Hee Lee, Seung Do Yu, Jung Hoon Cha, Seung Chul Ahn; J Prev Med Public Health. 2005;38(4):401-407.

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Abstract PDF: OBJECTIVES
We wanted to investigate the relationship between heavy metal, especially lead and mercury, to the blood pressure and cholesterol level in children. METHODS: This study was undertaken in three primary schools and the study subjects were a total of 274 children. The lead in the blood and the urine mercury were analyzed by performing atomic absorption spectroscopy. RESULTS: All of participants' blood lead levels and urine mercury concentrations were below the suggested level of concern according to the criteria of the CDC and ATSDR. We found no significant correlation between lead, mercury and the blood pressure. The blood lead level did not show any relationship with the blood pressure and cholesterol. However, the urine mercury levels were associated with the serum cholesterol. CONCLUSION: Our study suggests that mercury can induce an increase of cholesterol as a risk factor of myocardial infraction and coronary/cardiovascular disease.; Summary

Out-of-pocket Health Expenditures by Non-elderly and Elderly Persons in Korea.: Sung Gyeong Kim, Seung Hum Yu, Woong Sub Park, Woo Jin Chung; J Prev Med Public Health. 2005;38(4):408-414.

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Abstract PDF: OBJECTIVES
The purpose of this study was to determine the impact of the sociodemographic and health characteristics on the out-of-pocket health spending of the individuals aged 20 and older in Korea. METHODS: We used the data from the 2001 National Public Health and Nutrition Survey. The final sample size was 26, 154 persons. Multiple linear regression models were used according to the age groups, that is, one model was used for those people under the age of sixty-five and the other was used for those people aged sixty-five and older. In these analyses, the expenditures were transformed to a logarithmic scale to reduce the skewness of the results. RESULTS: Out-of-pocket health expenditures for those people under the age of 65 averaged 14, 800 won per month, whereas expenditures for those people aged 65 and older averaged 27, 200 won per month. In the regression analysis, the insurance type, resident area, self-reported health status, acute or chronic condition and bed-disability days were the statistically significant determinants for both age groups. Gender and age were statistically significant determinants only for the non-elderly. CONCLUSIONS: The findings from this study show that the mean out-of-pocket health expenditures varied according to the age groups and also several diverse characteristics. Thus, policymakers should consider the out-of-pocket health expenditure differential between the elderly and nonelderly persons. Improvement of the insurance coverage for the economically vulnerable subgroups that were identified in this study should be carefully considered. In addition, it is necessary to assess the impact of out-of-pocket spending on the peoples' health care utilization.; Summary

The Association of Obesity and Left Colonic Adenomatous Polyps in Korean Adult Men.: Chang Sup Kim, Moon Chan Kim, Hae Kwan Cheong, Tae Heum Jeong; J Prev Med Public Health. 2005;38(4):415-419.

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Abstract PDF: OBJECTIVES
We wanted to evaluate the relationship between obesity and left colonic adenomatous polyps in Korean adult men. METHODS: This study was conducted among 575 adults men (aged between 40 and 69), who had colonoscopy done from January to December 2002 during a routine health examination at Health Promotion Center, Ulsan University Hospital. The patients' colons were examined up to splenic flexure by using fiberoptic colonoscopy. A questionnaire survey on behavioral factors and physical measurements were also done. The body mass index (BMI) and waist-hip ratio (WHR) were used as the indices of obesity. The BMI was categorized into three levels: normal (BMI < or =22.9), overweight (23< or =BMI< or =24.9), and obese (BMI> or =25.0). The WHR was categorized into four levels with cutoff points at the 30th, 60th, and 90th percentile of the control group. Age, education, smoking, alcohol use and exercise were controlled for by performing multiple logistic regression analysis. RESULTS: There were 99 cases of colonic adenomatous polyps. Four hundred seventy six subjects with normal colonoscopy findings served as the control. The BMI and WHR were associated with the adenomatous polyps (odds ratio, 1.81 [95% CI=1.02-3.19] for a BMI> or =25.0 as compared with a BMI< or =22.9, odds ratio, 3.94 [95% CI=1.77- 8.77] for a WHR > or =0.95 as compared with a WHR< or =0.86). The BMI was not associated with the risk of adenomatous polyps after additional adjustment was made for the WHR, but the association between the WHR and adenomatous polyps was still positive and independent of the BMI (odds ratio, 4.15 [95% CI=1.63-10.59]). CONCLUSIONS: The results support that obesity, and particularly abdominal obesity, can be associated with an increased risk of incurring colonic adenomatous polyps.; Summary

Alibi Verification and the PCR Method to Estimate the Source of Epidemic for a Few Notified Cases of S. sonnei.: Sin Jae Lee, Dai ha Koh, Chai Hyun Yoon; J Prev Med Public Health. 2005;38(4):420-424.

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Abstract PDF: OBJECTIVES
A few culture-confirmed cases of S. sonnei have been notified from Korean hospitals. The source of epidemic can't be firmly determined in such cases because of the rarity of this illness in the local communities and the timing of the outbreaks. The objective of this study is to estimate the source of epidemic by investigating the patients' lifestyles. METHODS: Alibi verification was used to access the presumed source of the epidemic. PCR (Polymerase Chain Reaction) was used to rapidly detect the genes of Shigella in water specimens. RESULTS: The common lifestyle trait among the Shigellainfected patients was connected with Mt. Martyr in J city, Korea. The first patient's son had gone on a pilgrimage to Mt. Martyr with 41 friends and he had only eaten rice cakes on April 5th; the second patients had visited Mt. Martyr with their mother for a picnic on April 12th; the third patient had visited Mt. Martyr with 22 friends for a pilgrimage and the patient had only drunk holy water on April 13th. Therefore, the holy water of Mt. Martyr was reckoned to be the source of the epidemic. PCR detected the genes of Shigella two days before the S. sonnei was confirmed. CONCLUSION: The patients' lifestyles for 7 days before the onset of symptoms should be determined in terms of time, place and contacted people to find the source of infection when cases with food poisoning are seen in the hospital setting.; Summary

Epidemiologic Study of Clonorchis Sinensis Infestation in a Rural Area of Kyongsangnam-do, South Korea.: Young Hee Ju, Jin Kyoung Oh, Hyun Joo Kong, Woon Mok Sohn, Jung Il Kim, Kap Yeol Jung, Yoon Gyu Kim, Hai Rim Shin; J Prev Med Public Health. 2005;38(4):425-430.

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Abstract PDF: OBJECTIVES
To investigate the prevalence of Clonorchis sinensis infestation and to determine the associated risk factors among a population in a part of the rural area of Gyeongsangnam-do, Korea, which is an area known to have a high mortality from liver cancer and a high infection of C. sinensis. METHODS: The study population consisted of those people who have lived in rural areas and who were over 40 years old. This study was performed in 5 areas during the period from 1999 to 2003. Informed consents were obtained from the 2, 381 study participants, and these people were interviewed about their life style habits with using the structured questionnaire that was administered by trained staff members. The subjects underwent blood sampling and their stool specimens were examined by using the Formalin-ether sedimentation technique. RESULTS: Among the study subjects (N=2, 381), the positivity for C. sinensis in the stool was 34.4% (95% CI= 36.3-42.5) ; it was 39.4% (95% CI=36.3-42.5) in the males and 30.9% (95% CI=28.5-33.3) in the females. The positivity for C. sinensis was associated with current alcohol drinking (odds ratio=1.8, 95% CI: 1.5-2.1) and raw fish consumption (odds ratio 1.2, 95% CI: 0.9-1.6). CONCLUSION: The present study confirmed the high prevalence of C. sinensis in the study subjects. It is necessary to establish consistent medical management and education programs for the treatment and prevention of C. sinensis infestation in the rural inhabitants of Korea.; Summary

Seroprevalence of Measles Antibody and its Attributable Factors in Elementary Students of Routine 2-dose Schedule Era with Vaccination Record.: Geun Ryang Bae, Hyun Sul Lim, Un Yeong Goh, Byung Guk Yang, Young Taek Kim, Jong Koo Lee; J Prev Med Public Health. 2005;38(4):431-436.

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Abstract PDF: OBJECTIVES
We investigated the seroprevalence of the measles antibody and its attributable factors for the students who underwent routine 2-dose Schedule Era. METHODS: The subjects were 996 students of the national measles seroepidemiologic study in December 2000 who had vaccination records. We conducted a questionnaire survey and we performed serologic testing for the measles specific IgG by using an enzyme linked immunosorbent assay. RESULTS: The coverage for the first dose of the MMR vaccination at 12-15 months of age was 95.1% and the coverage for the second dose of MMR at 4-6 years of age was 35.0%. The proportion of subjects undergoing 2- doses of MMR decreased as the age of the subjects increased. The seropositive rate of the measles antibody was significantly high in the second dose vaccinees (93.5% in the second dose group, 84.7% in the non-second dose group, p< 0.001) and it was 72.0% in the 0-dose group, 85.4% in the 1-dose group and 93.7% in the 2-dose group (p< 0.001). Two point eight percent of the subjects had a past history of measles infection. On the multiple logistic regression analysis, the first and second dose (odds ratio, 8.54; 95% CI.=3.05-23.91), the first dose (odds ratio, 3.06; 95% CI.=1.20-7.81) and the outbreak in the year 2000 (odds ratio, 1.89; 95% CI.=1.24-2.88) were the significant factors for the eropositivity. CONCLUSIONS: Maintaining high coverage with a 2-dose vaccination program would be the decisive factor to prevent an outbreak of measles and to eliminate measles in Korea.; Summary

Folate and Homocysteine Levels during Pregnancy affect DNA Methylation in Human Placenta.: Bo hyun Park, Young Ju Kim, Jong soon Park, Hwa young Lee, Eun hee Ha, Jung won Min, Hye sook Park; J Prev Med Public Health. 2005;38(4):437-442.

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Abstract PDF: OBJECTIVES
DNA methylation is one of the best characterized epigenetic mechanisms that play a regulatory role in genome programming and imprinting during embryogenesis. In this present study, we investigated the association between DNA methylation in the human placenta and the maternal folate and homocysteine concentrations on the Methylenetetrahydrofolatereductase (MTHFR) genetic polymorphism during pregnancy. METHODS: We investigated 107 pregnant women who visited Ewha Woman's University Hospital for prenatal care during their 24~28 weeks-period of gestation. During the second trimester, we measured the serum homocysteine and folate concentrations. The MTHFR 677 genetic polymorphism was determine by performing PCR-RFLP assay. The expression of DNA methylation in the human placentas was estimated by using immunohistochemistry method. RESULTS: Serum folate was negatively correlated with the serum homocysteine concentration for all the MTHFR genotypes. We found positive correlation between the folate concentrations and the DNA methylation in the human placenta (p< 0.05). An increasing concentration of homocysteine was associated with reduced DNA methylation in the human placenta. The coefficient value was -2.03 (-3.77, -0.29) on the regression model (p< 0.05). CONCLUSION: These findings suggest that the maternal folate and homocysteine levels along with the MTHFR 677 genetic polymorphism during pregnancy affect the DNA methylation in the human placenta.; Summary

Validation Studies

Reliability of Education and Occupational Class: A Comparison of Health Survey and Death Certificate Data.: Hye Ryun Kim, Young Ho Khang; J Prev Med Public Health. 2005;38(4):443-448.

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Abstract PDF: OBJECTIVES
This study was done to evaluate the reliability of education and occupational class between using the health survey and the death certificate data. METHODS: The 1998 National Health and Nutrition Examination Survey (NHANES) was conducted on a crosssectional probability sample of South Korean households, and it contained unique 13-digit personal identification numbers that were linked to the data on mortality from the Korean National Statistical Office. The data from 263 deaths were used to estimate the agreement rates and the Kappa indices of the education and occupational class between using the NHANES data and the death certificate data. RESULTS: The simple and weighted Kappa indices for education were 0.60 (95% CI=0.53-0.68) and 0.73 (95% CI=0.67-0.79) respectively, if the educational level was grouped into five categories: no-formal-education, elementary-school, middle-school, high-school and college or over. The overall agreement rate was 71.9% for these educational groups. The magnitude of reliability, as measured by the overall agreement rates and Kappa indices, tended to increase with a decrease in the educational class. The number of non-educated people with using the death certificate data was smaller than that with using the NHANES data. For the occupational class (manual workers, non-manual workers and others), the Kappa index was 0.40 (95% CI=0.30-0.51), which was relatively lower than that for the educational class. Compared with the NHANES, the number of non-manual workers for the deceased who were aged 30-64 tended to be increased (8 to 12) when using the death certificate data, whereas the number of manual workers tended to be decreased (59 to 41). CONCLUSIONS: The socioeconomic inequalities in the mortality rates that were based on the previous unlinked studies in South Korea were not due to a numerator/denominator bias. The mortality rates for the manual workers and the no-education groups might have been underestimated.; Summary

English Abstracts

Biosafety of Microbiological Laboratories in Korea.: Jin Yong Lee, Sang Jun Eun, Ki dong Park, Jong Kyun Kim, Jeong Soo Im, Yoo Sung Hwang, Yong Ik Kim; J Prev Med Public Health. 2005;38(4):449-456.

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Abstract PDF: OBJECTIVES
The biosafety level (BSL) practiced in microbiology laboratories in Korea according to the laboratory biosafety manual published by the World Health Organization (WHO) was evaluated using the data obtained by a survey. METHODS: Under the advise of Clinical Laboratory Physicians, 144 types of microorganisms were screened based on the guidelines of biosafety in microbiological and biomedical laboratories published by the US Center for Disease Control and Prevention and classified into 1-4 risk groups. A questionnaire containing 21 questions in 5 areas was developed using the biosafety manual by published WHO. Of the 1, 876 different organizations sent the survey, 563 responded to the survey (response rate: 30.0%). The species of microoganisms handled by as well as the biosafety level in microbiology laboratories were analyzed. RESULTS: There were 123 species of microorganisms handled in microbiology labs in Korea. The BSL required in 512 microbiology labs was answered by the survey responders as the first grade in 33 labs (6.4%), 2nd in 437 (85.4%), 3rd in 42 (8.2%), and 4th in none. The average number of items satisfied was 12.2, showing only a 57.9% satisfactory rate and normal distribution. CONCLUSIONS: The state of overall observance of BSL in most microbiology labs of Korea was evaluated as lagging compared with the standard set up by WHO. Therefore, the Korean government need to produce and distribute a biosafety manual in microbiology laboratories and make efforts to prevent this threat through measures such as training in biosafety in microbiology labs.; Summary

Epidemiologic Investigation on an Outbreak of Salmonellosis in Yeongcheon-si, 2004.: Hyun Sul Lim, Young Sun Min, Hwan Seok Lee; J Prev Med Public Health. 2005;38(4):457-464.

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Abstract PDF: OBJECTIVES
An outbreak of salmonellosis occurred among the students and staff of D primary school in Yeongcheon-si, 2004. This investigation was carried out to prevent any recurrence of this outbreak and to study the infection source and transmission of the salmonellosis. METHODS: The authors conducted a questionnaire survey among 1, 205 students and staff members from D primary school about the ingestion of the school lunch and drinking water, and the manifestation of their symptoms. The author examined rectal swabs, the tap water and microorganism cultures, and we also investigated the dining facility and water supply facility. RESULTS: The diarrheal cases were defined as the confirmed cases or the persons who had diarrhea more than one time with symptoms such as fever, vomiting and tenesmus. The diarrheal attack rate was 28.0%. Ingestion of fried bean curd with egg had a significantly high association with the diarrheal attack rate (p< 0.05), and the relative risk of the fried bean curd with egg was 10.68 (95% CI=3.88-29.41), as was determined by logistic regression analysis. The bacterial counts in the tap water of the food preparation room and toilet (first floor) exceeded the maximum permissible counts. S. Enteritidis bacteria were only cultured from the fried bean curd with egg of all the supplied foods on September 3, 2004. CONCLUSIONS: The major cause of salmonellosis was presumed to be the contaminated bean curd via contaminated tap water due to a water leak of a school water pipe. This contaminated bean curd was under prepared, which allowed the S. Enteritidis to survive and multiply prior to its ingestion.; Summary

Air Pollution and Respiratory Symptoms of School Children in a Panel Study in Seoul.: Bo Eun Lee, Eun Hee Ha, Hye sook Park, Ho Kim, Hyun Jung Lee, Yeon Kyoung Lee, Seung Joo Lee, Yun Chul Hong; J Prev Med Public Health. 2005;38(4):465-472.

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Abstract PDF: OBJECTIVES
The aim of this study was to assess the effect of air pollution on the daily respiratory symptoms of elementary school children in Seoul. METHODS: Using the panel study design, we collected diary data for the children's respiratory symptoms during the 1st day~15th day of April, July, October and December in 2003 among the 2nd and 3rd grade elementary school students. We merged the respiratory symptom data with the ambient air pollution data that was monitored by Ministry of Environment. Using a generalized estimate equation, we evaluated the relationship between the daily symptoms of the subjects and the exposure to air pollution after controlling for various potential confounders. RESULTS: The nitrogen dioxide (NO2) exposure of the current day significantly increased the upper respiratory symptoms (adjusted odds ratio=1.12, 95% CI=1.01-1.24) and the lower respiratory symptoms (adjusted odds ratio=1.18, 95% CI=1.06-1.31) in the elementary school children. The sulfur dioxide (SO2) and carbon monoxide (CO) exposure in the current day was associated with the lower respiratory symptoms (adjusted odds ratio=1.12, 95% CI=1.01-1.25 for SO2; adjusted odds ratio=1.16, 95% CI=1.02-1.32 for CO). CONCLUSIONS: We found that exposure to air pollution affects the daily respiratory symptoms in children. This study suggests that the effect on children's health? due to the short term changes in air pollution levels needs to be considered as an important public health problem.; Summary

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