Journal of Preventive Medicine and Public Health

Volume 45(5); September 2012

Special Article

The Singapore Field Epidemiology Service: Insights Into Outbreak Management: Peng-Lim Ooi, Theresa Seetoh, Jeffery Cutter; J Prev Med Public Health. 2012;45(5):277-282. Published online September 28, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.5.277

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Field epidemiology involves the implementation of quick and targeted public health interventions with the aid of epidemiological methods. In this article, we share our practical experiences in outbreak management and in safeguarding the population against novel diseases. Given that cities represent the financial nexuses of the global economy, global health security necessitates the safeguard of cities against epidemic diseases. Singapore's public health landscape has undergone a systemic and irreversible shift with global connectivity, rapid urbanization, ecological change, increased affluence, as well as shifting demographic patterns over the past two decades. Concomitantly, the threat of epidemics, ranging from severe acute respiratory syndrome and influenza A (H1N1) to the resurgence of vector-borne diseases as well as the rise of modern lifestyle-related outbreaks, have worsened difficulties in safeguarding public health amidst much elusiveness and unpredictability. One critical factor that has helped the country overcome these innate and man-made public health vulnerabilities is the development of a resilient field epidemiology service, which includes our enhancement of surveillance and response capacities for outbreak management, and investment in public health leadership. We offer herein the Singapore story as a case study in meeting the challenges of disease control in our modern built environment.

Summary

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Original Articles

Effect of Preexisting Musculoskeletal Diseases on the 1-Year Incidence of Fall-related Injuries: Won Kyung Lee, Kyoung Ae Kong, Hyesook Park; J Prev Med Public Health. 2012;45(5):283-290. Published online September 28, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.5.283

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Abstract PDF

Objectives

People who have chronic diseases, as well as gait imbalance or psychiatric drug use, may be susceptible to injuries from falls and slips. The purpose of this study was to evaluate the effect of musculoskeletal diseases on incidental fall-related injuries among adults in Korea.

Methods

We analyzed data from the 4th Korea National Health and Nutrition Examination Survey (2007-2009), which are national data obtained by a rolling survey sampling method. The 1-year incidence of fall-related injuries was defined by health service utilization within the last year due to injury occurring after a slip and fall, and musculoskeletal diseases included osteoarthritis, rheumatoid arthritis, osteoporosis, and back pain. To evaluate the effects of preexisting musculoskeletal diseases, adults diagnosed before the last year were considered the exposed group, and adults who had never been diagnosed were the unexposed group.

Results

The weighted lifetime prevalence of musculoskeletal disease was 32 540 per 100 000 persons. Musculoskeletal diseases were associated with a higher risk of fall-related injury after adjustment for sex, age, residence, household income, education, occupation, visual disturbance, paralysis due to stroke, and medication for depression (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.03 to 1.93). As the number of comorbid musculoskeletal diseases increased, the risk of fall-induced injuries increased (p-value for trend <0.001). In particular, patients who had any musculoskeletal condition were at much higher risk of recurrent fall-related injuries (OR, 6.20; 95% CI, 1.06 to 36.08).

Conclusions

One must take into account the risk of fall-related injuries and provide prevention strategies among adults who have musculoskeletal diseases.

Summary

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The Socioeconomic Burden of Coronary Heart Disease in Korea: Hoo-Sun Chang, Han-Joong Kim, Chung-Mo Nam, Seung-Ji Lim, Young-Hwa Jang, Sera Kim, Hye-Young Kang; J Prev Med Public Health. 2012;45(5):291-300. Published online September 28, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.5.291

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Abstract PDF

Objectives

We aimed to estimate the annual socioeconomic burden of coronary heart disease (CHD) in Korea in 2005, using the National Health Insurance (NHI) claims data.

Methods

A prevalence-based, top-down, cost-of-treatment method was used to assess the direct and indirect costs of CHD (International Classification of Diseases, 10th revision codes of I20-I25), angina pectoris (I20), and myocardial infarction (MI, I21-I23) from a societal perspective.

Results

Estimated national spending on CHD in 2005 was $2.52 billion. The majority of the spending was attributable to medical costs (53.3%), followed by productivity loss due to morbidity and premature death (33.6%), transportation (8.1%), and informal caregiver costs (4.9%). While medical cost was the predominant cost attribute in treating angina (74.3% of the total cost), premature death was the largest cost attribute for patients with MI (66.9%). Annual per-capita cost of treating MI, excluding premature death cost, was $3183, which is about 2 times higher than the cost for angina ($1556).

Conclusions

The total insurance-covered medical cost ($1.13 billion) of CHD accounted for approximately 6.02% of the total annual NHI expenditure. These findings suggest that the current burden of CHD on society is tremendous and that more effective prevention strategies are required in Korea.

Summary

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Alcohol Consumption and Mortality in the Korean Multi-center Cancer Cohort Study: En-Joo Jung, Aesun Shin, Sue K. Park, Seung-Hyun Ma, In-Seong Cho, Boyoung Park, Eun-Ha Lee, Soung-Hoon Chang, Hai-Rim Shin, Daehee Kang, Keun-Young Yoo; J Prev Med Public Health. 2012;45(5):301-308. Published online September 28, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.5.301

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Abstract PDF

Objectives

To examine the association between alcohol consumption habit, types of beverages, alcohol consumption quantity, and overall and cancer-specific mortality among Korean adults.

Methods

The alcohol consumption information of a total of 16 320 participants who were 20 years or older from the Korean Multi-center Cancer Cohort were analyzed to examine the association between alcohol consumption habit and mortality (median follow-up of 9.3 years). The Cox proportional hazard model was used to estimate the hazard ratio (HR) of alcohol consumption to mortality adjusting for age, sex, geographic areas, education, smoking status, and body mass index.

Results

Alcohol drinkers showed an increased risk for total mortality compared with never drinkers (HR, 1.72; 95% confidence interval [CI], 1.38 to 2.14 for past drinkers; HR, 1.21; 95% CI, 1.06 to 1.39 for current drinkers), while past drinkers only were associated with higher risk for cancer deaths (HR, 1.84; 95% CI, 1.34 to 2.53). The quantity of alcohol consumed per week showed a J-shaped association with risk of mortality. Relative to light drinkers (0.01 to 90 g/wk), never drinkers and heavy drinkers (>504 g/wk) had an increased risk for all-cause and cancer deaths: (HR, 1.18; 95% CI, 0.96 to 1.45) and (HR, 1.39; 95% CI, 1.05 to 1.83) for all-cause mortality; and (HR, 1.55; 95% CI, 1.15 to 2.11) and (HR, 2.07; 95% CI, 1.39 to 3.09) for all cancer mortality, respectively. Heavy drinkers (>504 g/wk) showed an elevated risk for death from stomach and liver cancers.

Conclusions

The present study supports the existence of a J-shaped association between alcohol consumption quantity and the risk of all-cause and cancer deaths. Heavy drinkers had an increased risk of death from cancer overall and liver and stomach cancer.

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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Smoking Is Associated With Abdominal Obesity, Not Overall Obesity, in Men With Type 2 Diabetes: Ji Eun Yun, Heejin Kimm, Young Ju Choi, Sun Ha Jee, Kap Bum Huh; J Prev Med Public Health. 2012;45(5):316-322. Published online September 28, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.5.316

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Abstract PDF

Objectives

Abdominal obesity increases mortality and morbidity from cardiovascular disease and there is a possibility that smoking effects obesity. However, previous studies concerning the effects of smoking on obesity are inconsistent. The objective of this study was to examine whether smoking is positively related to abdominal obesity in men with type 2 diabetes.

Methods

Subjects consisted of 2197 type 2 diabetic patients who visited Huh's Diabetes Center from 2003 to 2009. Indices of abdominal obesity were defined as visceral fat thickness (VFT) measured by ultrasonography and waist circumference (WC). Overall obesity was defined as body mass index (BMI).

Results

Statistically significant differences in WC and VFT by smoking status were identified. However, there was no statistical difference in BMI according to smoking status. Means of WC and VFT were not significantly higher in heavy smokers and lower in mild smokers. Compared to nonsmokers, the BMI confounder adjusted odds ratio and 95% confidence interval for VFT in ex-smokers and current-smokers were 1.70 (1.21 to 2.39) and 1.86 (1.27 to 2.73), respectively.

Conclusions

Smoking status was positively associated with abdominal obesity in type 2 diabetic patients.

Summary

Citations

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Brief Report

Trends in Ischemic Heart Disease Mortality in Korea, 1985-2009: An Age-period-cohort Analysis: Hye Ah Lee, Hyesook Park; J Prev Med Public Health. 2012;45(5):323-328. Published online September 28, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.5.323

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Abstract PDF

Objectives

Economic growth and development of medical technology help to improve the average life expectancy, but the western diet and rapid conversions to poor lifestyles lead an increasing risk of major chronic diseases. Coronary heart disease mortality in Korea has been on the increase, while showing a steady decline in the other industrialized countries. An age-period-cohort analysis can help understand the trends in mortality and predict the near future.

Methods

We analyzed the time trends of ischemic heart disease mortality, which is on the increase, from 1985 to 2009 using an age-period-cohort model to characterize the effects of ischemic heart disease on changes in the mortality rate over time.

Results

All three effects on total ischemic heart disease mortality were statistically significant. Regarding the period effect, the mortality rate was decreased slightly in 2000 to 2004, after it had continuously increased since the late 1980s that trend was similar in both sexes. The expected age effect was noticeable, starting from the mid-60's. In addition, the age effect in women was more remarkable than that in men. Women born from the early 1900s to 1925 observed an increase in ischemic heart mortality. That cohort effect showed significance only in women.

Conclusions

The future cohort effect might have a lasting impact on the risk of ischemic heart disease in women with the increasing elderly population, and a national prevention policy is need to establish management of high risk by considering the age-period-cohort effect.

Summary

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Correspondences

Letter to the Editor: The Increasing Hepatitis A Incidence in Korea: Is It Possible Within a Limited Time?: Pegah Karimi Elizee, Seyed Moayed Alavian, Seyyed Mohammad Miri; J Prev Med Public Health. 2012;45(5):329-330. Published online September 28, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.5.329

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Author Response: The Increasing Hepatitis A Incidence in Korea: Is It Possible Within a Limited Time?: Joo Youn Seo, Moran Ki, Bo Youl Choi; J Prev Med Public Health. 2012;45(5):331-332. Published online September 28, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.5.331

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Corrigendum

Corrigendum: The authors found errors in our published article: Quantitative Analysis of Cancer-associated Gene Methylation Connected to Risk Factors in Korean Colorectal Cancer Patients: Ho-Jin Kang, Eun-Jeong Kim, Byoung-Gwon Kim, Chang-Hun You, Sang-Yong Lee, Dong-Il Kim, Young-Seoub Hong; J Prev Med Public Health. 2012;45(5):333-333. Published online September 28, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.5.333; Corrects: J Prev Med Public Health 2012;45(4):251

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