Publications by authors named "Seung-Sik Hwang"

166 Publications

Lung Cancer in Korea.

J Thorac Oncol 2021 Dec;16(12):1988-1993

Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. Electronic address:

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http://dx.doi.org/10.1016/j.jtho.2021.09.007DOI Listing
December 2021

Spatiotemporal distribution of varicella in the Republic of Korea.

J Med Virol 2021 Nov 5. Epub 2021 Nov 5.

Department of Epidemiology, School of Public Health, Seoul National University, Seoul, Republic of Korea.

Varicella is a highly contagious disease caused by the varicella-zoster virus (VZV). Given its tendency to cluster geographically, spatial analyses may provide a better understanding of the pattern of varicella transmission. We investigated the spatial characteristics of varicella in Korea and the risk factors for varicella at a national level. Using national surveillance and demographic data, we examined the spatial distribution of incidence rates and their spatial autocorrelation and calculated Moran's index. Spatial regression analysis was used to identify sociodemographic predictors of varicella incidence at the district level. An increasing tendency in the annual incidence of varicella was observed over a 12-year period (2006-2018), with a surge in 2017. There was a clear positive spatial autocorrelation of the varicella incidence rate during the surveillance period. During 2006-2014, High-High (HH) clusters were mostly confined to the northeast region and neighboring districts. The spatial error model showed that population density had a negative coefficient and childhood percentage, percentage of children under 12 years of age among the total population, had positive coefficient, whereas vaccine coverage was insignificant. The varicella incidence according to geographic region varied with population density, childhood percentage, suggesting the importance of community-level surveillance and monitoring strategies.
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http://dx.doi.org/10.1002/jmv.27434DOI Listing
November 2021

A Systematic Review of Spatial and Spatio-temporal Analyses in Public Health Research in Korea.

J Prev Med Public Health 2021 Sep 26;54(5):301-308. Epub 2021 Aug 26.

Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Korea.

Objectives: Despite its advantages, it is not yet common practice in Korea for researchers to investigate disease associations using spatio-temporal analyses. In this study, we aimed to review health-related epidemiological research using spatio-temporal analyses and to observe methodological trends.

Methods: Health-related studies that applied spatial or spatio-temporal methods were identified using 2 international databases (PubMed and Embase) and 4 Korean academic databases (KoreaMed, NDSL, DBpia, and RISS). Two reviewers extracted data to review the included studies. A search for relevant keywords yielded 5919 studies.

Results: Of the studies that were initially found, 150 were ultimately included based on the eligibility criteria. In terms of the research topic, 5 categories with 11 subcategories were identified: chronic diseases (n=31, 20.7%), infectious diseases (n=27, 18.0%), health-related topics (including service utilization, equity, and behavior) (n=47, 31.3%), mental health (n=15, 10.0%), and cancer (n=7, 4.7%). Compared to the period between 2000 and 2010, more studies published between 2011 and 2020 were found to use 2 or more spatial analysis techniques (35.6% of included studies), and the number of studies on mapping increased 6-fold.

Conclusions: Further spatio-temporal analysis-related studies with point data are needed to provide insights and evidence to support policy decision-making for the prevention and control of infectious and chronic diseases using advances in spatial techniques.
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http://dx.doi.org/10.3961/jpmph.21.160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8517372PMC
September 2021

mHealth Interventions for Lifestyle and Risk Factor Modification in Coronary Heart Disease: Randomized Controlled Trial.

JMIR Mhealth Uhealth 2021 09 24;9(9):e29928. Epub 2021 Sep 24.

Department of Prevention and Management, School of Medicine, Inha University Hospital, Inha University, Incheon, Republic of Korea.

Background: Self-management of lifestyle and cardiovascular disease risk factors is challenging in older patients with coronary heart disease (CHD). SMS text messaging could be a potential support tool for self-management and the most affordable and accessible method through a mobile phone. High-quality evidence had been lacking, and previous studies evaluated the effects of SMS text messaging on the subjective measures of short-term outcomes. Recently, a large-sized randomized controlled trial in Australia reported promising findings on the objective measures upon 6-month follow-up. However, an examination of the effectiveness of such interventions in an Asian population with unique demographic characteristics would be worthwhile.

Objective: This study examined the effectiveness of a 1-way SMS text messaging program to modify the lifestyle and cardiovascular disease risk factors of patients who underwent the first percutaneous coronary intervention (PCI).

Methods: A parallel, single-blinded, 1:1 random allocation clinical trial was conducted with 879 patients treated through PCI. They were recruited during hospital admission from April 2017 to May 2020 at 2 university hospitals in the Republic of Korea. In addition to standard care, the intervention group received access to a supporting website and 4 SMS text messages per week for 6 months regarding a healthy diet, physical activity, smoking cessation, and cardiovascular health. Random allocation upon study enrollment and SMS text messaging after hospital discharge were performed automatically using a computer program. The coprimary outcomes were low-density-lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), and BMI. The secondary outcomes were change in lifestyle and adherence to the recommended health behaviors.

Results: Of the eligible population, 440 and 439 patients who underwent PCI were assigned to the intervention and control groups, respectively. The 1-way SMS text messaging program significantly enhanced physical activity (P=.02), healthy diet (P<.01), and medication adherence (P<.04) among patients with CHD. Hence, more people were likely to control their cardiovascular disease risk factors per the recommendations. The intervention group was more likely to control all 5 risk factors by 62% (relative risk 1.62, 95% CI 1.05-2.50) per the recommendations. On the other hand, physiological measures of the primary outcomes, including LDL-C levels, SBP, and BMI, were not significant. Most participants found the SMS text messaging program useful and helpful in motivating lifestyle changes.

Conclusions: Lifestyle-focused SMS text messages were effective in the self-management of a healthy diet, exercise, and medication adherence, but their influence on the physiological measures was not significant. One-way SMS text messages can be used as an affordable adjuvant method for lifestyle modification to help prevent the recurrence of cardiovascular disease.

Trial Registration: Clinical Research Information Service (CRiS) KCT0005087; https://cris.nih.go.kr/cris/search/detailSearch.do/19282.
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http://dx.doi.org/10.2196/29928DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8501404PMC
September 2021

Epidemiological and spatio-temporal characteristics of COVID-19 in Rwanda.

Glob Epidemiol 2021 Nov 4;3:100058. Epub 2021 Aug 4.

Department of Public Health Science, Seoul National University, Seoul, Republic of Korea.

Background: The coronavirus disease 2019 (COVID-19) has taken millions of lives and disrupted living standards at individual, societal, and worldwide levels, causing serious consequences globally. Understanding its epidemic curve and spatio-temporal dynamics is crucial for the development of effective public health plans and responses and the allocation of resources. Thus, we conducted this study to assess the epidemiological dynamics and spatio-temporal patterns of the COVID-19 pandemic in Rwanda.

Methods: Using the surveillance package in R software version 4.0.2, we implemented endemic-epidemic multivariate time series models for infectious diseases to analyze COVID-19 data reported by Rwanda Biomedical Center under the Ministry of Health from March 15, 2020 to January 15, 2021.

Results: The COVID-19 pandemic occurred in two waves in Rwanda and showed a heterogenous spatial distribution across districts. The Rwandan government responded effectively and efficiently through the implementation of various health measures and intervention policies to drastically reduce the transmission of the disease. Analysis of the three components of the model showed that the most affected districts displayed epidemic components within the area, whereas the effect of epidemic components from spatial neighbors were experienced by the districts that surround the most affected districts. The infection followed the disease endemic trend in other districts.

Conclusion: The epidemiological and spatio-temporal dynamics of COVID-19 in Rwanda show that the implementation of measures and interventions contributed significantly to the decrease in COVID-19 transmission within and between districts. This accentuates the critical call for continued intra- and inter- organization and community engagement nationwide to ensure effective and efficient response to the pandemic.
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http://dx.doi.org/10.1016/j.gloepi.2021.100058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8333025PMC
November 2021

A Health Information Quality Assessment Tool for Korean Online Newspaper Articles: Development Study.

J Med Internet Res 2021 07 29;23(7):e24436. Epub 2021 Jul 29.

Liver Korea, Seoul, Republic of Korea.

Background: Concern regarding the reliability and accuracy of the health-related information provided by online newspaper articles has increased. Numerous criteria and items have been proposed and published regarding the quality assessment of online information, but there is no standard quality assessment tool available for online newspapers.

Objective: This study aimed to develop the Health Information Quality Assessment Tool (HIQUAL) for online newspaper articles.

Methods: We reviewed previous health information quality assessment tools and related studies and accordingly developed and customized new criteria. The interrater agreement for the new assessment tool was assessed for 3 newspaper articles on different subjects (colorectal cancer, obesity genetic testing, and hypertension diagnostic criteria) using the Fleiss κ and Gwet agreement coefficient. To compare the quality scores generated by each pair of tools, convergent validity was measured using the Kendall τ ranked correlation.

Results: Overall, the HIQUAL for newspaper articles comprised 10 items across 5 domains: reliability, usefulness, understandability, sufficiency, and transparency. The interrater agreement for the article on colorectal cancer was in the moderate to substantial range (Fleiss κ=0.48, SE 0.11; Gwet agreement coefficient=0.74, SE 0.13), while for the article introducing obesity genetic testing it was in the substantial range, with values of 0.63 (SE 0.28) and 0.86 (SE 0.10) for the two measures, respectively. There was relatively low agreement for the article on hypertension diagnostic criteria at 0.20 (SE 0.10) and 0.75 (SE 0.13), respectively. Validity of the correlation assessed with the Kendall τ showed good correlation between tools (HIQUAL vs DISCERN=0.72, HIQUAL vs QUEST [Quality Evaluation Scoring Tool]=0.69).

Conclusions: We developed a new assessment tool to evaluate the quality of health information in online newspaper articles, to help consumers discern accurate sources of health information. The HIQUAL can help increase the accuracy and quality of online health information in Korea.
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http://dx.doi.org/10.2196/24436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8367132PMC
July 2021

Mobility restrictions were associated with reductions in COVID-19 incidence early in the pandemic: evidence from a real-time evaluation in 34 countries.

Sci Rep 2021 07 2;11(1):13717. Epub 2021 Jul 2.

London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.

Most countries have implemented restrictions on mobility to prevent the spread of Coronavirus disease-19 (COVID-19), entailing considerable societal costs but, at least initially, based on limited evidence of effectiveness. We asked whether mobility restrictions were associated with changes in the occurrence of COVID-19 in 34 OECD countries plus Singapore and Taiwan. Our data sources were the Google Global Mobility Data Source, which reports different types of mobility, and COVID-19 cases retrieved from the dataset curated by Our World in Data. Beginning at each country's 100th case, and incorporating a 14-day lag to account for the delay between exposure and illness, we examined the association between changes in mobility (with January 3 to February 6, 2020 as baseline) and the ratio of the number of newly confirmed cases on a given day to the total number of cases over the past 14 days from the index day (the potentially infective 'pool' in that population), per million population, using LOESS regression and logit regression. In two-thirds of examined countries, reductions of up to 40% in commuting mobility (to workplaces, transit stations, retailers, and recreation) were associated with decreased cases, especially early in the pandemic. Once both mobility and incidence had been brought down, further restrictions provided little additional benefit. These findings point to the importance of acting early and decisively in a pandemic.
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http://dx.doi.org/10.1038/s41598-021-92766-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8253807PMC
July 2021

Disease severity classification and COVID-19 outcomes, Republic of Korea.

Bull World Health Organ 2021 Jan 28;99(1):62-66. Epub 2020 Oct 28.

Department of Public Health Science, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.

Problem: The surge in coronavirus disease 2019 (COVID-19) cases overwhelmed the health system in the Republic of Korea.

Approach: To help health-care workers prioritize treatment for patients with more severe disease and to decrease the burden on health systems caused by COVID-19, the government established a system to classify disease severity. Health-care staff in city- and provincial-level patient management teams classified the patients into the different categories according to the patients' pulse, systolic blood pressure, respiratory rate, body temperature and level of consciousness. Patients categorized as having moderate, severe and very severe disease were promptly assigned to beds or negative-pressure isolation rooms for hospital treatment, while patients with mild symptoms were monitored in 16 designated facilities across the country.

Local Setting: The case fatality rate was higher in the city of Daegu and the Gyeongsangbuk-do province (1.6%; 124/7756) than the rest of the country (0.5%; 7/1485).

Relevant Changes: From 25 February to 26 March 2020, the ratio of negative-pressure isolation rooms per COVID-19 patient was below 0.15 in the city of Daegu and the Gyeongsangbuk-do province. In the rest of the country, this ratio decreased from 5.56 to 0.63 during the same period. Before the classification system was in place, eight (15.7%) out of the 51 deaths occurred at home or during transfer from home to health-care institutions.

Lessons Learnt: Categorizing patients according to their disease severity should be a prioritized measure to ease the burden on health systems and reduce the case fatality rate.
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http://dx.doi.org/10.2471/BLT.20.257758DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924894PMC
January 2021

Prevalence and predictors of heated tobacco products use among male ever smokers: results from a Korean longitudinal study.

BMC Public Health 2021 02 8;21(1):316. Epub 2021 Feb 8.

Division of Public Health Science, Graduate School of Public Health, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea.

Background: This study examined sociodemographic and tobacco-related factors of heated tobacco products (HTPs) use among adult ever smokers in South Korea where the sales of HTPs have been rapidly increasing since their launch in June 2017.

Methods: Before the launch of HTPs in Korea, participants comprised male ever smokers (234 current smokers and 37 quitters) who participated in the Korea National Health and Nutrition Examination Survey from 2015 to 2017 through one-to-one interview survey and agreed to participate in the follow-up surveys through telephone in December 2017. Data were analyzed using logistic regression, to explore sociodemographic and smoking behavior-related factors of HTPs use.

Results: Overall, 10.7% (29/271) of participants responded to using HTPs and 8.1% (22/271) were current HTPs users at the time of the follow-up survey. Multivariate analysis showed that HTPs use is associated with middle age (36 to 49 years old) (aOR = 3.72, CI = 1.16-12.0) (vs. ≥ 50 years), higher income (4Q vs 1Q: aOR = 2.71, CI = 1.16-6.34), and higher educational level (college or higher: aOR = 2.40, CI = 0.87-6.60). Also, vaping experience at baseline was highly associated with HTPs use (aOR = 3.11, CI = 1.22-7.93 for the former experience; aOR = 9.14, CI = 2.34-35.6 for current). However, smoking amount and level of motivation for smoking cessation were not found to be predictors of future HTPs use when limited to current smokers at baseline.

Conclusions: The results showed that vaping experience regardless of current smoking behavior and higher socioeconomic status were found to be associated with subsequent HTPs use among ever smokers. Further studies are required to explore whether this association is causal.
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http://dx.doi.org/10.1186/s12889-021-10344-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871562PMC
February 2021

Development and validation of prediction equations for the assessment of muscle or fat mass using anthropometric measurements, serum creatinine level, and lifestyle factors among Korean adults.

Nutr Res Pract 2021 Feb 12;15(1):95-105. Epub 2020 Jun 12.

Department of Family Medicine, Seoul National University Hospital, Seoul 03080, Korea.

Background/objectives: The measurement of body composition, including muscle and fat mass, remains challenging in large epidemiological studies due to time constraint and cost when using accurate modalities. Therefore, this study aimed to develop and validate prediction equations according to sex to measure lean body mass (LBM), appendicular skeletal muscle mass (ASM), and body fat mass (BFM) using anthropometric measurement, serum creatinine level, and lifestyle factors as independent variables and dual-energy X-ray absorptiometry as the reference method.

Subjects/methods: A sample of the Korean general adult population (men: 7,599; women: 10,009) from the Korean National Health and Nutrition Examination Survey 2008-2011 was included in this study. The participants were divided into the derivation and validation groups via a random number generator (with a ratio of 70:30). The prediction equations were developed using a series of multivariable linear regressions and validated using the Bland-Altman plot and intraclass correlation coefficient (ICC).

Results: The initial and practical equations that included age, height, weight, and waist circumference had a different predictive ability for LBM (men: R = 0.85, standard error of estimate [SEE] = 2.7 kg; women: R = 0.78, SEE = 2.2 kg), ASM (men: R = 0.81, SEE = 1.6 kg; women: R = 0.71, SEE = 1.2 kg), and BFM (men: R = 0.74, SEE = 2.7 kg; women: R = 0.83, SEE = 2.2 kg) according to sex. Compared with the first prediction equation, the addition of other factors, including serum creatinine level, physical activity, smoking status, and alcohol use, resulted in an R that is higher by 0.01 and SEE that is lower by 0.1.

Conclusions: All equations had low bias, moderate agreement based on the Bland-Altman plot, and high ICC, and this result showed that these equations can be further applied to other epidemiologic studies.
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http://dx.doi.org/10.4162/nrp.2021.15.1.95DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7838475PMC
February 2021

The Association between Community Water Fluoridation and Bone Diseases: A Natural Experiment in Cheongju, Korea.

Int J Environ Res Public Health 2020 12 9;17(24). Epub 2020 Dec 9.

Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul 08826, Korea.

The present study aimed to investigate the association between bone diseases and community water fluoridation (CWF). An ecological study with a natural experiment design was conducted in Cheongju, South Korea, from 1 January 2004 to 31 December 2013. The community water fluoridation program was implemented in Cheongju and divided into CWF and non-CWF areas. To observe adverse health effects related to bone diseases, we conducted a spatio-temporal analysis of the prevalence of hip fracture, osteoporosis, and bone cancer in residents who have lived in CWF and non-CWF areas using National Health Insurance Service data. First, we used standardized incidence ratios to estimate the disease risk. Second, the hierarchical Bayesian Poisson spatio-temporal regression model was used to investigate the association between the selected bone diseases and CWF considering space and time interaction. The method for Bayesian estimation was based on the R-integrated nested Laplace approximation (INLA). Comparing the CWF area with the non-CWF area, there was no clear evidence that exposure to CWF increased health risks at the town level in Cheongju since CWF was terminated after 2004. The posterior relative risks (RR) of hip fracture was 0.95 (95% confidence intervals 0.87, 1.05) and osteoporosis was 0.94 (0.87, 1.02). The RR in bone cancer was a little high because the sample size very small compared to the other bone diseases (RR = 1.20 (0.89, 1.61)). The relative risk of selected bone diseases (hip fractures, osteoporosis, and bone cancer) increased over time but did not increase in the CWF area compared to non-CWF areas. CWF has been used to reduce dental caries in all population groups and is known for its cost-effectiveness. These findings suggest that CWF is not associated with adverse health risks related to bone diseases. This study provides scientific evidence based on a natural experiment design. It is necessary to continue research on the well-designed epidemiological studies and develop public health prevention programs to help in make suitable polices.
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http://dx.doi.org/10.3390/ijerph17249170DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7764285PMC
December 2020

Protective effect of predator species richness on human hantavirus infection incidence.

Sci Rep 2020 12 10;10(1):21744. Epub 2020 Dec 10.

Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, South Korea.

Are predators of rodents beneficial for public health? This question focuses on whether predators regulate the spillover transmission of rodent-borne diseases. No clear answer has emerged because of the complex linkages across multiple trophic levels and the lack of accessible data. Although previous empirical findings have suggested ecological mechanisms, such as resource partitioning, which implies protective effects from predator species richness, epidemiological evidence is needed to bolster these arguments. Thus, we investigated the association between predator species richness and incidence of rodent-borne haemorrhagic fever with renal syndrome in the human population using district-level longitudinal data of 13 years for South Korea. With the exception of districts with low species richness, we found a significant negative association between the incidence of haemorrhagic fever with renal syndrome and the species richness of both avian and mammalian predators; the trends for both predator types were similar. Thus, biodiversity conservation may benefit public health.
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http://dx.doi.org/10.1038/s41598-020-78765-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7728771PMC
December 2020

Association of early-onset diabetes, prediabetes and early glycaemic recovery with the risk of all-cause and cardiovascular mortality.

Diabetologia 2020 11 21;63(11):2305-2314. Epub 2020 Aug 21.

Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea.

Aims/hypothesis: The increasing incidence of diabetes among young adults is a disease burden; however, the effects of early-onset diabetes, prediabetes and glycaemic recovery on CVD or mortality remain unclear. We aimed to investigate the association of these factors with 10 year all-cause mortality, CVD mortality and CVD incidence in Korean young adults.

Methods: This large and longitudinal cohort study included data from the Korean National Health Insurance Service-National Health Information Database; 2,502,375 young adults aged 20-39 years without diabetes mellitus and CVD at baseline were included. Glycaemic status was measured twice, first in 2002-2003 and second in 2004-2005. Changes in fasting glucose levels were evaluated according to fasting glucose status: normal fasting glucose (NFG; <5.5 mmol/l), impaired fasting glucose (IFG; 5.5-6.9 mmol/l), and diabetic fasting glucose (DFG; ≥7.0 mmol/l). Primary outcomes were all-cause and CVD mortality risk. The secondary outcome was incidence of CVD, including acute myocardial infarction and stroke. All outcomes arose from the 10 year follow-up period 1 Jan 2006 to 31 December 2015.

Results: Individuals with NFG at baseline, who were subsequently newly diagnosed with diabetes and prediabetes (IFG), had increased all-cause mortality (HR [95% CI] 1.60 [1.44, 1.78] and 1.13 [1.09, 1.18], respectively) and CVD incidence (1.13 [1.05, 1.23] and 1.04 [1.01, 1.07], respectively). In those with DFG at baseline, early recovery to NFG and IFG was associated with decreased all-cause mortality (0.57 [0.46, 0.70] and 0.65 [0.53, 0.81], respectively) and CVD incidence (0.70 [0.60, 0.81] and 0.78 [0.66, 0.91], respectively). Among patients with IFG at baseline, early recovery to NFG was associated with decreased CVD mortality (0.74 [0.59, 0.93]).

Conclusions/interpretation: Early-onset diabetes or prediabetes increased CVD risks and all-cause mortality after the 10 year follow-up. Furthermore, recovery of hyperglycaemia could reduce the subsequent 10 year risk for CVD incidence and all-cause mortality. Graphical abstract.
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http://dx.doi.org/10.1007/s00125-020-05252-yDOI Listing
November 2020

COVID-19 in South Korea: epidemiological and spatiotemporal patterns of the spread and the role of aggressive diagnostic tests in the early phase.

Int J Epidemiol 2020 08;49(4):1106-1116

Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.

Background: South Korea experienced the novel coronavirus disease (COVID-19) outbreak in the early period; thus data from this country could provide significant implications for global mitigation strategies. This study reports how COVID-19 has spread in South Korea and examines the effects of rapid widespread diagnostic testing on the spread of the disease in the early epidemic phase.

Methods: We collected daily data on the number of confirmed cases, tests and deaths due to COVID-19 from 20 January to 13 April 2020. We estimated the spread pattern with a logistic growth model, calculated the daily reproduction number (Rt) and examined the fatality pattern of COVID-19.

Results: From the start date of the epidemic in Korea (18 February 2020), the time to peak and plateau were 15.2 and 25 days, respectively. The initial Rt was 3.9 [95% credible interval (CI) 3.7 to 4.2] and declined to <1 after 2 weeks. The initial epidemic doubling time was 3.8 days (3.4 to 4.2 days). The aggressive testing in the early days of the epidemic was associated with reduction in transmission speed of COVID-19. In addition, as of 13 April, the case fatality rate of COVID-19 in Korea was 2.1%, suggesting a positive effect of the targeted treatment policy for severe patients and medical resources.

Conclusions: Our findings provide important information for establishing and revising action plans based on testing strategies and severe patient care systems, needed to address the unprecedented pandemic.
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http://dx.doi.org/10.1093/ije/dyaa119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7454567PMC
August 2020

Effect of COVID-19 on Tuberculosis Notification, South Korea.

Emerg Infect Dis 2020 Oct 16;26(10):2506-2508. Epub 2020 Jul 16.

After South Korea raised its infectious disease alert to the highest level in response to coronavirus disease emergence, tuberculosis notification during the first 18 weeks of 2020 decreased significantly from the same period for each year during 2015-2019. Adequate measures to diagnose, control, and prevent tuberculosis need to be maintained.
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http://dx.doi.org/10.3201/eid2610.202782DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7510739PMC
October 2020

Temporal trends in out-of-hospital cardiac arrest outcomes in men and women from 2008 to 2015: A national observational study.

Am J Emerg Med 2021 03 30;41:174-178. Epub 2020 Jan 30.

Department of Emergency Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea.

Background: We compared the temporal trends in survival and neurological outcomes after out-of-hospital cardiac arrest (OHCA) in men and women.

Methods: A nationwide, population-based observational study enrolled adults with OHCA of presumed cardiac origin from 2008 to 2015. The main outcomes were survival and neurological recovery. We performed trend analyses of potential risk factors and outcomes. Adjusted odd ratios (aOR) were calculated using multivariate logistic regression analysis after adjusting for confounders. To assess whether outcomes had improved over time in both sexes, we calculated the yearly risk-adjusted survival rates and neurological recovery rate for the study period.

Results: We included 121,900 patients in the final analysis. Women comprised 36.2% of the patients. During the study, survival improved in both sexes, from 3.2% to 7.9% in men and from 1.8% to 3.7% in women. Neurological recovery improved in men from 1.1% to 5.9% and in women from 0.7% to 2.3%. The risk-adjusted survival rates increased significantly in men from 3.2% in 2008 to 5.7% in 2015 (p for trend <0.01); these rates did not increase to the same degree in women (from 1.8% in 2008 to 3.4% in 2015; p for trend <0.01). After adjusting for confounders, the risk-adjusted neurological recovery rate increased from 1.1% in 2008 to 4.3% in 2015 (p for trend <0.01) in men. This improvement trend was lower in women (from 0.7% in 2008 to 1.5% in 2015, p for trend <0.01).

Conclusions: The outcomes of OHCA improved in both sexes during the study period. The degree of improvement in outcomes was higher in men than in women.
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http://dx.doi.org/10.1016/j.ajem.2020.01.055DOI Listing
March 2021

Association Between Air Conditioning Use and Self-reported Symptoms During the 2018 Heat Wave in Korea.

J Prev Med Public Health 2020 Jan 26;53(1):15-25. Epub 2019 Nov 26.

Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea.

Objectives: The purpose of this study was to investigate the health effects of air conditioning use during the 2018 heat wave in Korea, included the highest temperature ever recorded in the nation.

Methods: The participants in this study were 1000 adults aged 19 years and older recruited from across Korea. The participants were asked about their experience of symptoms of various diseases, disruptions of their daily lives, and use of air conditioning during the heat wave. The associations between air conditioning use during the heat wave and health outcomes were analyzed using the chi-square test and multiple logistic regression models.

Results: Among participants who lacked air conditioning in the main space where they spent time outside the home, 33.9%, 8.1%, 43.5%, and 19.4% experienced symptoms of heat-related, cardiovascular, nervous system diseases, and air-conditioningitis, respectively. In comparison, participants who did have air conditioning outside the home experienced the same symptoms at proportions of 21.0%, 1.9%, 26.8%, and 34.2%, respectively (p=0.027, 0.007, 0.007, and 0.023, respectively). Among participants who had no air conditioner at home, 10.0% were absent from school or work due to the heat wave. In contrast, among participants who had an air conditioner at home, only 3.7% were absent as a result of the heat wave (p=0.007).

Conclusions: When air conditioning was not used at home or in the main space where participants spent time outside the home during the 2018 heat wave, adverse health effects were more prevalent, but the risk of air-conditioningitis was reduced.
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http://dx.doi.org/10.3961/jpmph.19.171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7002994PMC
January 2020

The Ability of Different Scoring Systems to Predict Mortality in Chronic Obstructive Pulmonary Disease Patients: A Prospective Cohort Study.

Respiration 2019;98(6):495-502. Epub 2019 Oct 30.

Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality, therefore the prediction of mortality in COPD patients is crucial. In the current study, the abilities of different categorization systems to predict mortality in stable COPD patients from a prospective cohort were compared.

Methods: The ability to predict mortality was compared in terms of discrimination by Harrell's C (HC) index and calibration using graphical comparison among the GOLD (Global Initiative for Chronic Obstructive Lung Disease) 2011, GOLD 2017, GOLD grade, BODE (BMI, Airflow Obstruction, Dyspnea, Exercise), updated BODE, BODEx (BMI, Airflow Obstruction, Dyspnea, Exacerbation), e-BODE (Exacerbation and BODE), ADO (Age, Dyspnea, Airflow Obstruction), COPD prognostic index (CPI), and simplified/optimized B-AE-D (BMI, Acute Exacerbation, Dyspnea) indexes.

Results: The study included 520 patients, of whom 63 died during a median 40-month follow-up period. Combined prediction systems exhibited higher discrimination properties than single predictors. The CPI exhibited the highest with a HC of 0.768, followed by the simplified B-AE-D (HC 0.761), ADO (HC 0.760), and optimized B-AE-D (HC 0.756). The BODE and its variants other than the ADO exhibited relatively lower HCs (0.656-0.705), and GOLD exhibited the lowest discrimination ability among the combined indices (HCs 0.628-0.637). Subjective symptom questionnaires such as the modified Medical Research Council (mMRC) scale (HC 0.693) and SGRQ (HC 0.679) exhibited the highest ability to predict mortality among the single indices.

Conclusion: The ADO, simplified B-AE-D, optimized B-AE-D, and GOLD 2017 exhibited good calibration properties, but the CPI did not. The simplified and optimized B-AE-Ds and the ADO index had good discrimination and calibration properties for the prediction of mortality in stable COPD patients.
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http://dx.doi.org/10.1159/000502826DOI Listing
September 2020

Prevalence, Awareness, Treatment, and Control of Hypertension in Korea.

Sci Rep 2019 07 29;9(1):10970. Epub 2019 Jul 29.

Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Korea.

The purpose of the present study was to describe the temporal trends in prevalence and management status of hypertension in Korea between 1998 and 2015. Data of adults who were aged 30 years or older were extracted from the Korea National Health and Nutrition Examination Survey, a nationwide representative population-based survey. Hypertension was prevalent in 30.5% of Korean adults. The age and sex standardized prevalence showed little change between 1998 and 2015. The elderly population and men showed higher prevalence. The rates of awareness, treatment, and control showed substantial improvements among hypertensive subjects between 1998 and the time period of 2007‒2009 (awareness, from 23.5 to 66.3%; treatment, from 20.4 to 60.3%; and control, from 4.9 to 42.1%), after which the numbers reached a plateau and no significant changes were observed subsequently (67.3%, 63.6%, and 46.2%, respectively, between 2013 and 2015). The management status remained poor especially among the young population and in men. In conclusion, the hypertension prevalence remained stable at approximately 30% in Korea between 1998 and 2015. While awareness, treatment, and control of hypertension improved remarkably, the young population and particularly men showed a suboptimal management status.
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http://dx.doi.org/10.1038/s41598-019-46965-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6662850PMC
July 2019

Abdominal fatness and cerebral white matter hyperintensity.

J Neurol Sci 2019 Sep 12;404:52-57. Epub 2019 Jul 12.

Department of Public Health Sciences, Seoul National University Graduate School of Public Health, Seoul, South Korea.

Although obesity has been proven as a risk factor of metabolic and cardiovascular diseases, there have been few studies addressing the association between obesity and cerebral white matter hyperintensity (WMH) volume with controversial findings. In this study, we evaluated the relationship between abdominal fat distribution and WMH volume in a neurologically healthy population. We performed an observational study in a consecutive series of subjects who were examined during voluntary health check-ups between January 2006 and December 2013. We directly measured both visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) using abdominal computed tomography. The WMH volumes were also recorded quantitatively. A total of 2504 subjects were included in this study. In multivariate analysis, the relationship between SAT and WMH volume remained significant (β = -0.170, standard error [SE] = 0.065, P = .006) after adjusting for confounding factors. The protective effects of SAT on the WMH volume were more prominent in female participants (β = -0.295, SE = 0.138, P = .033) and in severely obese participants (β = -0.358, SE = 0.167, P = .033). Conclusively, we demonstrated a negative association between SAT and WMH volume in a healthy population.
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http://dx.doi.org/10.1016/j.jns.2019.07.016DOI Listing
September 2019

The relationship between hormone replacement therapy and periodontal disease in postmenopausal women: a cross-sectional study the Korea National Health and Nutrition Examination Survey from 2007 to 2012.

BMC Oral Health 2019 07 15;19(1):151. Epub 2019 Jul 15.

Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea.

Background: The purpose of this study was to investigate the relationship between hormone replacement therapy (HRT) and periodontal disease in postmenopausal women using data from the 4th and 5th Korea National Health and Nutrition Examination Survey (KNHANES).

Methods: The study included data from 5,482 postmenopausal women aged 45-74 years in the 2007-2012 KNHANES. The use of female HRT for at least one month was reclassified as HRT+/HRT-. The Community Periodontal Index of Treatment Needs (CPITN) was used to assess periodontal status. Propensity score matching (PSM) was used to control selection bias, and factors affecting education, family income, and age of menopause were used as covariates in PSM. A chi-square test was used to confirm the bivariate relationship between the variables. Binary logistic regression analysis was used to adjust for confounders (age, education, family income, body mass index, age of menopause, alcohol, smoking, dental clinic visits in the past one year, use of oral care products and frequency of tooth brushing per day).

Results: After adjusting for all covariates, HRT was associated with periodontal disease (OR: 0.79; 95% CI: 0.66-0.94). In particular, the relationship between HRT and periodontal disease was more evident in those with menopause under 45 years of age disease (OR: 0.55; 95% CI: 0.35-0.87).

Conclusions: The results of this study supported that it is important that hormone therapy be actively considered in the policy towards postmenopausal women. Especially, health programs such as hormone replacement therapy, non-smoking, and use of oral care products are needed for women who undergo premature menopause.
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http://dx.doi.org/10.1186/s12903-019-0839-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6631997PMC
July 2019

Space-Time Relationship between Short-Term Exposure to Fine and Coarse Particles and Mortality in a Nationwide Analysis of Korea: A Bayesian Hierarchical Spatio-Temporal Model.

Int J Environ Res Public Health 2019 06 14;16(12). Epub 2019 Jun 14.

Department of Mathematics, Hanyang University, Seoul 04763, Korea.

Previous studies have shown an association between mortality and ambient air pollution in South Korea. However, these studies may have been subject to bias, as they lacked adjustment for spatio-temporal structures. This paper addresses this research gap by examining the association between air pollution and cause-specific mortality in South Korea between 2012 and 2015 using a two-stage Bayesian spatio-temporal model. We used 2012-2014 mortality and air pollution data for parameter estimation (i.e., model fitting) and 2015 data for model validation. Our results suggest that the relative risks of total, cardiovascular, and respiratory mortality were 1.028, 1.047, and 1.045, respectively, with every 10-µg/m increase in monthly PM (fine particulate matter) exposure. These findings warrant protection of populations who experience elevated ambient air pollution exposure to mitigate mortality burden in South Korea.
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http://dx.doi.org/10.3390/ijerph16122111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6617003PMC
June 2019

Spatial analysis to assess the relationship between human and bovine brucellosis in South Korea, 2005-2010.

Sci Rep 2019 04 30;9(1):6657. Epub 2019 Apr 30.

Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea.

The first case of human brucellosis in South Korea was reported in 2002, and cases of human infection continue to occur. Although an association between human and bovine brucellosis has been identified, the spatial relationship has not been studied in South Korea. Here, we analysed the spatial patterns of human and bovine brucellosis retrieved from the human and veterinary surveillance data, as well as the spatial correlation between human and bovine brucellosis and associated factors that contribute to its occurrence. The risk of human brucellosis was analysed using a Bayesian spatial model with potential risk factors. Our results show that, for both human and bovine brucellosis, hotspots were clustered in the southeast regions of Korea, whereas coldspots were clustered in the northwest regions of Korea. Our study suggests that the risk of human brucellosis increases in rural regions with the highest risk of bovine brucellosis. Collaborative strategies between human and veterinary health sectors (e.g, public health intervention and region-specific eradication programs for bovine brucellosis) would reduce the burden of brucellosis in South Korea.
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http://dx.doi.org/10.1038/s41598-019-43043-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6491422PMC
April 2019

Effect of sun exposure versus oral vitamin D supplementation on serum 25-hydroxyvitamin D concentrations in young adults: A randomized clinical trial.

Clin Nutr 2020 03 21;39(3):727-736. Epub 2019 Mar 21.

Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Republic of Korea.

Background: Vitamin D inadequacy is associated with a wide range of diseases. However, optimal strategies to improve vitamin D status, especially in Asian populations, remain unclear. We tested the hypotheses that (1) relevant sun exposure or oral vitamin D supplementation would significantly increase serum 25-hydroxyvitamin D (25OHD) concentrations compared with placebo, (2) sun exposure and supplementary vitamin D would be similar in serum 25OHD increases, and (3) the two interventions may have different effects on cardio-metabolic markers.

Methods: In this 8-week randomized placebo-controlled clinical trial including vitamin D-deficient adults in Seoul (37 °N), Korea, changes in serum 25OHD concentrations were compared between the sun exposure (daily ≥20-30 min around noon, n = 50), oral vitamin D (500 IU/d, n = 50), and control (placebo, n = 50) groups.

Results: Both sun exposure and oral vitamin D effectively increased serum 25OHD concentrations. Compared with placebo, the between-group least-squares mean (LSM) differences in changes were 2.2 ng/mL (95% CI: 0.2, 4.2) in the sun exposure group and 8.5 ng/mL (6.5, 10.5) in the oral vitamin D group. Increases in serum 25OHD were greater with oral vitamin D than with sun exposure (LSM difference in changes = 6.3 ng/mL, 95% CI: 4.3, 8.3). More participants in the oral vitamin D group (54.2%) achieved serum 25OHD concentrations ≥20 ng/mL at week 8 than those in the sun exposure (12.2%) or control (4.3%) groups. Compliance with sun exposure advice was relatively low, and only those with adequate compliance had a significant increase in serum 25OHD. Changes in the cardio-metabolic markers were mostly insignificant in all groups.

Conclusions: Enhanced sun exposure and 500 IU/d of oral vitamin D supplementation significantly increased serum 25OHD concentrations. However, our protocol for sun exposure was not as effective as 500 IU/d of oral vitamin D supplementation. This trial was registered at clinicaltrials.gov as NCT03310242.
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http://dx.doi.org/10.1016/j.clnu.2019.03.021DOI Listing
March 2020

Risk of acute exacerbations in chronic obstructive pulmonary disease associated with biomass smoke compared with tobacco smoke.

BMC Pulm Med 2019 Mar 22;19(1):68. Epub 2019 Mar 22.

Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea.

Background: Risk of exacerbations in chronic obstructive pulmonary disease (COPD) associated with biomass smoke has not been well addressed, although biomass smoke is similar in composition to tobacco smoke.

Methods: To investigate whether the risk of exacerbations in COPD associated with biomass smoke differs from that in COPD associated with tobacco smoke, we recruited patients with COPD from two Korean multicenter prospective cohorts. In a multiple linear regression model, the standardized regression coefficient (β) of biomass smoke exposure ≥25 years was most similar to that (β) of tobacco smoke exposure ≥10 pack-years (β = - 0.13 and β = - 0.14). We grouped patients with COPD into four categories based on the above cut-offs: Less Tobacco-Less Biomass, Less Tobacco-More Biomass, More Tobacco-Less Biomass, and More Tobacco-More Biomass. The main outcome was the incidence of moderate or severe exacerbations.

Results: Among 1033 patients with COPD, 107 were included in Less Tobacco-Less Biomass (mean age: 67 years, men: 67%), 40 in Less Tobacco-More Biomass (mean age: 70 years, men: 35%), 631 in More Tobacco-Less Biomass (mean age: 68 years, men: 98%), and 255 in More Tobacco-More Biomass (mean age: 69 years, men: 97%). The incidence rates of exacerbations were not significantly different between Less Tobacco-More Biomass and More Tobacco-Less Biomass (adjusted incidence rate ratio, 1.03; 95% confidence interval, 0.56-1.89; P = 0.921). No interaction between sex and tobacco and biomass smoke was observed. When propensity score matching with available covariates including age and sex was applied, a similar result was observed.

Conclusions: Patients with COPD associated with biomass smoke and those with COPD associated with tobacco smoke had a similar risk of exacerbations. This suggests that patients with COPD associated with biomass smoke should be treated actively.
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http://dx.doi.org/10.1186/s12890-019-0833-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429752PMC
March 2019

Poor People and Poor Health: Examining the Mediating Effect of Unmet Healthcare Needs in Korea.

J Prev Med Public Health 2019 Jan 23;52(1):51-59. Epub 2019 Jan 23.

Department of Preventive Medicine, Graduate School of Public Health, Seoul National University, Seoul, Korea.

Objectives: The purpose of this study was to estimate the mediating effect of subjective unmet healthcare needs on poor health. The mediating effect of unmet needs on health outcomes was estimated.

Methods: Cross-sectional research method was used to analyze Korea Health Panel data from 2011 to 2015, investigating the mediating effect for each annual dataset and lagged dependent variables.

Results: The magnitude of the effect of low income on poor health and the mediating effect of unmet needs were estimated using age, sex, education level, employment status, healthcare insurance status, disability, and chronic disease as control variables and selfrated health as the dependent variable. The mediating effect of unmet needs due to financial reasons was between 14.7% to 32.9% of the total marginal effect, and 7.2% to 18.7% in lagged model.

Conclusions: The fixed-effect logit model demonstrated that the existence of unmet needs raised the likelihood of poor self-rated health. However, only a small proportion of the effects of low income on health was mediated by unmet needs, and the results varied annually. Further studies are necessary to search for ways to explain the varying results in the Korea Health Panel data, as well as to consider a time series analysis of the mediating effect. The results of this study present the clear implication that even though it is crucial to address the unmet needs, but it is not enough to tackle the income related health inequalities.
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http://dx.doi.org/10.3961/jpmph.18.162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6378385PMC
January 2019

Effect of National Implementation of Telephone CPR Program to Improve Outcomes from Out-of-Hospital Cardiac Arrest: an Interrupted Time-Series Analysis.

J Korean Med Sci 2018 Dec 26;33(51):e328. Epub 2018 Nov 26.

Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea.

Background: In cardiac arrest, the survival rate increases with the provision of bystander cardiopulmonary resuscitation (CPR), of which the initial response and treatment are critical. Telephone CPR is among the effective methods that might increase the provision of bystander CPR. This study aimed to describe and examine the improvement of neurological outcomes in individuals with out-of-hospital acute cardiac arrest by implementing the nationwide, standardized telephone CPR program.

Methods: Data from the emergency medical service-based cardiac arrest registry that were collected between 2009 and 2014 were used. The effectiveness of the intervention in the interrupted time-series study was determined via a segmented regression analysis, which showed the risk ratio and risk difference in good neurological outcomes before and after the intervention.

Results: Of 164,221 patients, 148,403 were analyzed. However, patients with unknown sex and limited data on treatment outcomes were excluded. Approximately 64.3% patients were men, with an average age of 63.7 years. The number of bystander CPR increased by 3.3 times (95% confidence interval [CI], 3.1-3.5) after the intervention, whereas the rate of good neurological outcomes increased by 2.6 times (95% CI, 2.3-2.9 [1.6%]; 1.4-1.7). The excess number was identified based on the differences between the observed and predicted trends. In total, 2,127 cases of out-of-hospital cardiac arrest (OHCA) after the intervention period received additional bystander CPR, and 339 cases of OHCA had good neurological outcomes.

Conclusion: The nationwide implementation of the standardized telephone CPR program increased the number of bystander CPR and improved good neurological outcomes.
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http://dx.doi.org/10.3346/jkms.2018.33.e328DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6291408PMC
December 2018

Association Between Changes in Hemoglobin Concentration and Cardiovascular Risks and All-Cause Mortality Among Young Women.

J Am Heart Assoc 2018 08;7(16):e008147

2 Department of Biomedical Sciences Seoul National University Graduate School Seoul South Korea.

Background Anemia is considered to increase the risk of mortality in high-risk populations, but its effect has not been examined among young populations. This study aimed to determine the effect of hemoglobin (Hb) concentration and its changes on the risk of acute myocardial infarction ( AMI ), stroke, cerebrovascular disease and all-cause mortality among young women. Methods and Results We analyzed data from the Korean National Health Information Database on 808 143 women aged 20 to 39 years without any cardiocerebrovascular disease. A 1-time Hb concentration and changes in Hb over a 2-year period were calculated as exposures. Participants were followed for a median of 10 years to determine the risk of AMI , stroke, cerebrovascular disease, and all-cause mortality. There were U- or J-shaped associations between Hb concentration or change in Hb and AMI , stroke, cerebrovascular disease, and all-cause mortality. Increasing the Hb concentration from normal to high increased the risk for AMI (hazard ratio [95% confidence interval]: 1.49 [1.08-2.04]). With regard to the risk for stroke, increasing the Hb concentration from a normal to a high range increased the risk (hazard ratio [95% confidence interval]: 1.10 [1.02-1.35]), and decreasing the Hb concentration from a high to a normal range decreased this risk (hazard ratio [95% confidence interval]: 0.80 [0.60-0.97]). Improving anemia to the normal Hb range decreased all-cause mortality (hazard ratio [95% confidence interval]: 0.81 [0.69-0.94]); however, overcorrection of Hb concentration (Hb≥14.0 g/dL) was not significant. Conclusions These findings suggest that regular Hb analysis may assist in identifying young women who are at risk of AMI , stroke, cerebrovascular disease, and all-cause mortality.
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http://dx.doi.org/10.1161/JAHA.117.008147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6201397PMC
August 2018

The Epidemiological Influence of Climatic Factors on Shigellosis Incidence Rates in Korea.

Int J Environ Res Public Health 2018 10 10;15(10). Epub 2018 Oct 10.

Department of Preventive Medicine College of Medicine, Eulji University, Daejeon 34824, Korea.

Research has shown the effects of climatic factors on shigellosis; however, no previous study has evaluated climatic effects in regions with a winter seasonality of shigellosis incidence. We examined the effects of temperature and precipitation on shigellosis incidence in Korea from 2002⁻2010. The incidence of shigellosis was calculated based on data from the Korean Center for Disease Control and Prevention (KCDC, Cheongju, Korea), and a generalized additive model (GAM) was used to analyze the associations between the incidence and climatic factors. The annual incidence rate of shigellosis was 7.9 cases/million persons from 2002⁻2010. During 2007⁻2010, high incidence rates and winter seasonality were observed among those aged ≥65 years, but not among lower age groups. Based on the GAM model, the incidence of shigellosis is expected to increase by 13.6% and 2.9% with a temperature increase of 1 °C and a lag of two weeks and with a mean precipitation increase of 1 mm and a lag of five weeks after adjustment for seasonality, respectively. This study suggests that the incidence of shigellosis will increase with global climate change despite the winter seasonality of shigellosis in Korea. Public health action is needed to prevent the increase of shigellosis incidence associated with climate variations.
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http://dx.doi.org/10.3390/ijerph15102209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6210993PMC
October 2018

Korean Cardiac Arrest Research Consortium (KoCARC): rationale, development, and implementation.

Clin Exp Emerg Med 2018 Sep 30;5(3):165-176. Epub 2018 Sep 30.

Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.

Objective: This study aimed to describe the conceptualization, development, and implementation processes of the newly established Korean Cardiac Arrest Resuscitation Consortium (KoCARC) to improve out-of-hospital cardiac arrest (OHCA) outcomes.

Methods: The KoCARC was established in 2014 by recruiting hospitals willing to participate voluntarily. To enhance professionalism in research, seven research committees, the Epidemiology and Preventive Research Committee, Community Resuscitation Research Committee, Emergency Medical System Resuscitation Research Committee, Hospital Resuscitation Research Committee, Hypothermia and Postresuscitation Care Research Committee, Cardiac Care Resuscitation Committee, and Pediatric Resuscitation Research Committee, were organized under a steering committee. The KoCARC registry was developed with variables incorporated in the currently existing regional OHCA registries and Utstein templates and were collected via a web-based electronic database system. The KoCARC study population comprises patients visiting the participating hospitals who had been treated by the emergency medical system for OHCA presumed to have a cardiac etiology.

Results: A total of 62 hospitals volunteered to participate in the KoCARC, which captures 33.0% of the study population in Korea. Web-based data collection started in October 2015, and to date (December 2016), there were 3,187 cases compiled in the registry collected from 32 hospitals.

Conclusion: The KoCARC is a self-funded, voluntary, hospital-based collaborative research network providing high level evidence in the field of OHCA and resuscitation. This paper will serve as a reference for subsequent KoCARC manuscripts and for data elements collected in the study.
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http://dx.doi.org/10.15441/ceem.17.259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6166039PMC
September 2018
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