Longitudinal and Cross-Sectional Genetic Diversity in the Korean Peninsula Based on the P vivax Merozoite Surface Protein Gene

Objectives

Vivax malaria has reemerged and become endemic in Korea. Our study aimed to analyze by both longitudinal and cross-sectional genetic diversity of this malaria based on the P vivax Merozoite Surface Protein (PvMSP) gene parasites recently found in the Korean peninsula.

Methods

PvMSP-1 gene sequence analysis from P vivax isolates (n = 835) during the 1996-2010 period were longitudinally analyzed and the isolates from the Korean peninsula through South Korea, the demilitarized zone and North Korea collected in 2008-2010 were enrolled in an overall analysis of MSP-1 gene diversity.

Results

New recombinant subtypes and severe multiple-cloneinfection rates were observed in recent vivax parasites. Regional variation was also observed in the study sites.

Conclusion

This study revealed the great complexity of genetic variation and rapid dissemination of genes in P vivax. It also showed interesting patterns of diversity depending, on the region in the Korean Peninsula. Understanding the parasiteninsula. Under genetic variation may help to analyze trends and assess the extent of endemic malaria in Korea.     

Social network effects on post-traumatic stress disorder (PTSD) in female North Korean immigrants

Objectives

The goal of this paper is to examine the social network effects on post-traumatic sdress disorder (PTSD) in female North Korean immigrants who entered South Korea in 2007. Specifically, it attempts to verify if the density and composition of networks make a difference after controlling for the network size.

Methods

A multivariate logistic regression is used to probe the effects of social networks using the North Korean Immigrant Panel data set. Because the data set had only completed its initial survey when this paper was written, the analysis was cross-sectional.

Results

The size of the support networks was systematically related to PTSD. Female North Korean immigrants with more supporting ties were less likely to develop PTSD, even after controlling for other risk factors (odds-ratio for one more tie was 0.8). However, once we control for the size of the network, neither the density nor the composition of the networks remains statistically significant.

Conclusions

The prevalence of the PTSD among female North Korean immigrants is alarmingly high, and regardless of the characteristics of supporting network members, the size of the supporting networks provides substantial protection. This implies that a simple strategy that focuses on increasing the number of supporting ties will be effective among North Korean immigrants who entered South Korea in recent years.     

A Study on the Characteristics of Infrequent and Frequent Outpatients Visiting Korean Traditional Medical Facilities

Objectives

This study was intended to analyze the characteristics of infrequent and frequent outpatients visiting Korean medical facilities, and find the related variables of frequent users.

Methods

The data source was the Report on the Usage and Consumption of Korean Medicine (2011) published by the Ministry of Health and Welfare and Korea Institute for Health and Social Affairs. We analyzed outpatient data using SAS 9.2.

Results

As much as 46.6% of the patients used Korean medical services over 11 times in 3 months. The proportion of frequent users increased depending on age, and their proportion was high in the low-income and low-education group. People with musculoskeletal disease, stroke, hypertension, and obesity were more likely to use Korean medical services. In general, patients were satisfied with their treatment, with frequent outpatients being more satisfied than infrequent outpatients. In logistic regression analysis, age and musculoskeletal disease were significant determinants of frequency of use of Korean medical services.

Conclusion

Age, musculoskeletal disease, and specific diseases were highly associated with frequent Korean medical utilization.     

Food security experiences of displaced North Korean households

BACKGROUND/OBJECTIVES

Food shortage situation in North Korea has gained much interest, however food insecurity caused by the food shortage in North Korean households has not been much investigated. This study examined food security experiences and food consumption pattern of displaced North Korean households currently living in South Korea.

SUBJECTS/METHODS

Food security experience among 51 North Korean households living in South Korea was examined using the Household Food Insecurity Access Scale (HFIAS) in three time points: immediately before childbirth, immediately before leaving North Korea, and immediately before entering South Korea. Meal/snack consumption frequencies and food diversity were also examined.

RESULTS

Food security situation was the worst at the time of immediately before leaving North Korea with the average HFIAS score of 10.05. The households that were food insecure, they tended to be "severely" insecure. Although majority of the subjects reported having three or more meals a day, food diversity in their diet was very low with the average food diversity score of 2.17 immediately before childbirth and 1.74 immediately before leaving North Korea. Their diet appeared to heavily rely on grain and vegetable.

CONCLUSIONS

This study is one of few that specifically examined food security of North Korean households with a pre-developed scale, and that demonstrated food security situation at different time points in quantified terms. Replicating this study with different groups of North Korean households for different time points would allow more complete understanding of impacts of food shortage. Food diversity score could provide a good way to examine changes of food consumption occurring to North Koreans in the process of adaptation. More attention to the changes occurring during adaption to South Korea should be given to understand the process and impact and to prepare public nutrition policy for the re-unified Korea.     

Analysis of Kimchi,vegetable and fruit consumption trends among Korean adults: data from the Korea National Health and Nutrition Examination Survey (1998-2012)

BACKGROUND/OBJECTIVES

The purpose of this study is to analyze daily kimchi, vegetable and fruit consumption by general characteristics and vegetable and fruit consumption from 1998 to 2012 by the Korean population based on the data of the KNHANES (Korea National Health and Nutrition Examination Survey).

SUBJECTS/METHODS

This study is based on the 1998-2012 KNHNES. Analysis data on 54,700 subjects aged 19 years and older were obtained from health behavior interviews and the 24-hour dietary recall method.

RESULTS

Daily kimchi consumption and portion size of kimchi decreased significantly from 1998 to 2012 (adjusted P for trend < 0.0001). Meanwhile, daily consumption of both non-salted vegetable and fruit with and without kimchi did not significantly change between 1998 and 2012. Reduced consumption of kimchi, non-salted vegetable, and fruit was observed for both genders as well as daily meal episodes and cooking locations. Male and female subjects with insufficient non-salted vegetable and fruit intake were increased 1.4 times and 1.3 times, respectively, in 2012 than 1998. All subjects consumed at least 400 g/day of non-salted vegetable, fruit, and kimchi in each survey year, although they consumed insufficient amounts (< 400 g/day) of non-salted vegetable and fruit without kimchi.

CONCLUSIONS

Since Koreans generally consume high amounts of fermented vegetables, including kimchi, total vegetables and fruit. Consumption of these foods by the Korean adult population reached 400 g, which is the recommended intake of the WCRF/AICR. Based on this result, it is necessary to promote consumption of kimchi in the Korean population and research the development of low sodium kimchi in the future.     

Toward a quantitative estimate of future heat wave mortality under global climate change

Background

Climate change is anticipated to affect human health by changing the distribution of known risk factors. Heat waves have had debilitating effects on human mortality, and global climate models predict an increase in the frequency and severity of heat waves. The extent to which climate change will harm human health through changes in the distribution of heat waves and the sources of uncertainty in estimating these effects have not been studied extensively.

Objectives

We estimated the future excess mortality attributable to heat waves under global climate change for a major U.S. city.

Methods

We used a database comprising daily data from 1987 through 2005 on mortality from all nonaccidental causes, ambient levels of particulate matter and ozone, temperature, and dew point temperature for the city of Chicago, Illinois. We estimated the associations between heat waves and mortality in Chicago using Poisson regression models.

Results

Under three different climate change scenarios for 2081–2100 and in the absence of adaptation, the city of Chicago could experience between 166 and 2,217 excess deaths per year attributable to heat waves, based on estimates from seven global climate models. We noted considerable variability in the projections of annual heat wave mortality; the largest source of variation was the choice of climate model.

Conclusions

The impact of future heat waves on human health will likely be profound, and significant gains can be expected by lowering future carbon dioxide emissions.     

Impact of Parental Socioeconomic Status on Childhood and Adolescent Overweight and Underweight in Korea

Background

The prevalence of overweight and underweight is steadily increasing among children and adolescents. To explore the relationship between parental socioeconomic status and body mass index, we examined levels of overweight and underweight among representative samples of children and adolescents in South Korea.

Methods

We analyzed data from the 2009 Korean Survey on the Obesity of Youth and Children, conducted by the National Youth Policy Institute. The sample response rate for this survey was 93.9%. After excluding 745 subjects who had missing information on age, height, or weight, 9411 subjects were included. To measure parental socioeconomic status, 4 categories were assessed by using a structured questionnaire: subjective economic status, parental education level, parental occupational status, and family structure. We used the chi-squared test in univariable analysis and multinomial logistic regression in multivariable analysis.

Results

Multinomial logistic regression analysis identified sex, education level, parental interest in weight management, and parental body shapes as statistically significant characteristics affecting overweight in children, and sex, place of residence, parental interest in weight management, and paternal and maternal body shapes as statistically significant characteristics affecting underweight (P < 0.05).

Conclusions

Underweight and overweight coexist among adolescent Korean males of low socioeconomic status, which indicates that these conditions can coexist in developed countries. Appropriate interventions to address both overweight and underweight in adolescents are required.Key words: childhood and adolescent overweight and underweight, Korea, parental factors, risk factor, socioeconomic status     

A Study of Mental Health Literacy Among North Korean Refugees in South Korea

Objectives:

This study aimed to investigate North Korean refugees’ knowledge of mental illnesses and treatments and analyze the factors affecting this knowledge.

Methods:

Subjects were selected via a snowball sampling method, and the survey outcomes of 152 North Korean refugee participants were analyzed. The factors affecting knowledge of mental illnesses were analyzed via a regression analysis by constructing a multivariate model with mental illness knowledge score as the dependent variable.

Results:

The North Korean refugees’ mental illness scores ranged from 3 to 24 points, with an average score of 13.0. Regarding the factors that influence mental illness knowledge, the subjects with South Korean spouses and those who had spent more time in South Korea had higher knowledge scores. Furthermore, the subjects who considered the mental health of North Korean refugees to be a serious issue revealed lower knowledge scores than those who did not believe it was a serious issue. The subjects who visit psychiatric clinics showed higher knowledge scores than those who do not. The South Korean subjects who had at least a college education exhibited higher scores than did those without advanced education. The subjects who are satisfied with life in South Korea manifested a higher mental illness knowledge score than those who are not.

Conclusions:

This study is significant as being the first study to ever measure and evaluate the level of North Korean refugees’ knowledge of mental illnesses. In addition, the evaluations of North Korean refugees’ mental illness knowledge and influencing factors while residing in South Korea created basic data that formed the foundation of an effort to enhance mental health literacy and provide proper mental health services. The results of this study can be utilized to solve mental health problems that might frequently occur during the unification process of North and South Korea in the future.     

Trends in Gender-based Health Inequality in a Transitional Society: A Historical Analysis of South Korea

Objectives

This study examined the trends in gender disparity in the self-rated health of people aged 25 to 64 in South Korea, a rapidly changing society, with specific attention to socio-structural inequality.

Methods

Representative sample data were obtained from six successive, nationwide Social Statistics Surveys of the Korean National Statistical Office performed during 1992 to 2010.

Results

The results showed a convergent trend in poor self-rated health between genders since 1992, with a sharper decline in gender disparity observed in younger adults (aged 25 to 44) than in older adults (aged 45 to 64). The diminishing gender gap seemed to be attributable to an increase in women''s educational attainment levels and to their higher status in the labor market.

Conclusions

The study indicated the importance of equitable social opportunities for both genders for understanding the historical trends in the gender gap in the self-reported health data from South Korea.     

Global climate change and children's health: threats and strategies for prevention

Background

Global climate change will have multiple effects on human health. Vulnerable populations—children, the elderly, and the poor—will be disproportionately affected.

Objective

We reviewed projected impacts of climate change on children’s health, the pathways involved in these effects, and prevention strategies.

Data sources

We assessed primary studies, review articles, and organizational reports.

Data synthesis

Climate change is increasing the global burden of disease and in the year 2000 was responsible for > 150,000 deaths worldwide. Of this disease burden, 88% fell upon children. Documented health effects include changing ranges of vector-borne diseases such as malaria and dengue; increased diarrheal and respiratory disease; increased morbidity and mortality from extreme weather; changed exposures to toxic chemicals; worsened poverty; food and physical insecurity; and threats to human habitation. Heat-related health effects for which research is emerging include diminished school performance, increased rates of pregnancy complications, and renal effects. Stark variation in these outcomes is evident by geographic region and socioeconomic status, and these impacts will exacerbate health disparities. Prevention strategies to reduce health impacts of climate change include reduction of greenhouse gas emissions and adaptation through multiple public health interventions.

Conclusions

Further quantification of the effects of climate change on children’s health is needed globally and also at regional and local levels through enhanced monitoring of children’s environmental health and by tracking selected indicators. Climate change preparedness strategies need to be incorporated into public health programs.     

Food and Nutrient Intakes According to Income in Korean Men and Women

Objectives

The present study investigated associations between income and intake of nutrients and food in adults (n = 11,063) from the fourth Korea National Health and Nutrition Examination Survey 2007–2009.

Methods

To examine relationships between individual dietary intake and anthropometric measures and family income, multiple linear regression models were constructed for each outcome variable. All models were adjusted for age, education, energy intake, smoking, body mass index, and physical activity.

Results

For men, intakes of protein, calcium, phosphorus, potassium, and vitamin C were lower in low-income compared to high-income groups. For women, intakes of protein and niacin were lower in low-income groups. Lowest income group ate less dairy products in men and less fruits and fishes or shellfishes in women.

Conclusion

Low-income groups had severe food insecurity and low diet quality compared to high-income groups. The study results will provide direction for public health efforts regarding dietary intakes according to economic status among Korean men and women.     

Estimation of curcumin intake in Korea based on the Korea National Health and Nutrition Examination Survey (2008-2012)

BACKGROUND/OBJECTIVES

Turmeric and its active component curcumin have received considerable attention due to their many recognized biological activities. Turmeric has been commonly used in food preparation and herbal remedies in South Asia, leading to a high consumption rate of curcumin in this region. However, the amount of curcumin in the Korean diet has not yet been estimated, where turmeric is not a common ingredient.

SUBJECTS/METHODS

This study utilized the combined data sets obtained from the Korea National Health and Nutrition Examination Survey conducted from 2008 to 2012 in order to estimate the curcumin intake in the Korean diet. The mean intake of curcumin was estimated from the amount of curcumin-containing foods (curry powder and ready-made curry) consumed using reported curcumin content in commercial turmeric and curry powders.

RESULTS

Only 0.06% of Koreans responded that they consumed foods containing curcumin in a given day, and 40% of them were younger than 20 years of age. Curcumin-containing foods were largely prepared at home (72.9%) and a significant proportion (20.4%, nearly twice that of all other foods) was consumed as school and workplace meals. The estimated mean turmeric intake was about 0.47 g/day corresponding to 2.7-14.8 mg curcumin, while the average curry powder consumption was about 16.4 g, which gave rise to curcumin intake in the range of 8.2-95.0 mg among individuals who consumed curcumin. The difference in estimated curcumin intake by using the curcumin content in curry powder and turmeric may reflect that curry powder manufactured in Korea might contain higher amounts of other ingredients such as flour, and an estimation based on the curcumin content in the turmeric might be more acceptable.

CONCLUSIONS

Thus, the amount of curcumin that can be obtained from the Korean diet in a day is 2.7-14.8 mg, corresponding to nearly one fourth of the daily curcumin intake in South Asia, although curcumin is rarely consumed in Korea.     

Importance-satisfaction analysis of street food sanitation and choice factor in Korea and Taiwan

BACKGROUND/OBJECTIVES

The present study investigated Korean and Taiwan adults on the importance of and the satisfaction with street food sanitation and street food choice factor, in order to present management and improvement measures for street foods.

SUBJECTS/METHODS

The present study conducted a survey on 400 randomly chosen adults (200 Korean, 200 Taiwanese). General characteristics, eating habits, street food intake frequency, and preference by type of street food of respondents were checked. Respondents'' importance and satisfaction of street food hygiene and selection attributes were also measured. In order to test for the difference between groups, χ²-test and t-test were performed. ISA was also performed to analyze importance and satisfaction.

RESULTS

Results showed that the importance of sanitation was significantly higher than satisfaction on all items in both Korea and Taiwan, and the satisfaction with sanitation was higher in Taiwan than in Korea. According to ISA results with street food sanitation, satisfaction was low while importance was high in both Korea and Taiwan. In terms of street food choice factor, importance scores were significantly higher than satisfaction scores on all items. In addition, satisfaction scores on all items except ''taste'' were significantly higher in Taiwan than in Korea.

CONCLUSIONS

A manual on sanitation management of street foods should be developed to change the knowledge and attitude toward sanitation by putting into practice a regularly conducted education. Considering the popularity of street foods and its potential as a tourism resource to easily publicize our food culture, thorough management measures should be prepared on sanitation so that safe street food culture should be created.     

Association Between Local Government Social Expenditures and Mortality Levels in Korea

Objectives

We examined the association between social expenditures of the local government and the mortality level in Korea, 2004 to 2010.

Methods

We used social expenditure data of 230 local governments during 2004 to 2010 from the Social Expenditure Database prepared by the Korean Institute for Health and Social Affairs. Fixed effect panel data regression analysis was adopted to look for associations between social expenditures and age-standardized mortality and the premature death index.

Results

Social expenditures of local governments per capita was not significantly associated with standardized mortality but was associated with the premature death index (decline of 1.0 [for males] and 0.5 [for females] for each expenditure of 100 000 Korean won, i.e., approximately 100 US dollar). As an index of the voluntary effort of local governments, the self-managed project ratio was associated with a decline in the standardized mortality in females (decline of 0.4 for each increase of 1%). The share of health care was not significant.

Conclusions

There were associations between social expenditures of the local government and the mortality level in Korea. In particular, social expenditures per capita were significantly associated with a decline in premature death. However, the voluntary efforts of local governments were not significantly related to the decline in premature death.     

Trends in nutrient intakes and consumption while eating-out among Korean adults based on Korea National Health and Nutrition Examination Survey (1998-2012) data

BACKGROUND/OBJECTIVES

Eating-out among Korean people has become an important part of modern lifestyle due to tremendous growth of the food service industry and various social and economic changes. This study examined trends in meal patterns and meal sources while eating-out among Korean adults aged 19 years and older.

SUBJECTS/METHODS

Data were from the 1998-2012 KNHNES (Korea National Health and Nutrition Examination Survey) by the 24-hour dietary recall method. This study included 55,718 adults aged 19 years and older. For analysis of eating-out frequency, data were categorized by source of meals and serving place.

RESULTS

Average frequency of meals consumed away from home increased from 1998 to 2012, although it remained lower than that of meals at home. In addition, male, unmarried, employed, higher educated, and high income individuals more frequently consumed meals away from home. Moreover, sodium intake while eating-out significantly increased from 2,370 mg in 1998 to 2,935 mg in 2012. Lastly, percentage contributions of daily total protein intake, fat intake, and sodium intake from eating-out increased to more than half (53-55%) in 2012 compared with 47-48% in 1998.

CONCLUSIONS

As eating-out has grown in popularity, greater recognition of public health and nutritional education aimed at promoting healthy food choices is needed. In addition to developing consumer education for overall healthier eating patterns, individuals who are younger, unmarried, higher educated, and males are especially at risk and require attention.     

The Economic Burden of Epilepsy in Korea, 2010

Objectives

The purposes of this study were to evaluate the prevalence of epilepsy and to estimate the cost of epilepsy in Korea, 2010.

Methods

This study used a prevalence based approach to calculate the cost of epilepsy. Claims data from the Korean national health insurance and data from the Korea health panel, the Korea National Statistical Office''s records of causes of death, and labor statistics were used to estimate the cost of epilepsy. Patients were defined as those who were hospitalized or visited an outpatient clinic during 2010 with a diagnosis of epilepsy (International Classification of Diseases 10th revision codes G40-G41). Total costs of epilepsy included direct medical costs, direct non-medical cost and indirect costs.

Results

The annual prevalence of treated epilepsy was 228 per 100 000 population, and higher in men. The age-specific prevalence was highest for teenagers. The total economic burden of epilepsy was 536 billion Korean won (KW). Indirect cost (304 billion KW) was 1.3 times greater than direct cost (232 billion KW). By gender, the male (347 billion KW) were more burdened than the female (189 billion KW). The estimated cost in young age younger than 20 years old was 24.5% of the total burden of epilepsy.

Conclusions

A significant portion of the economic burden of epilepsy is borne by people in young age. To reduce the economic burden of epilepsy, effective prevention and treatment strategies are needed.     

A Note on Obesity as Epidemic in Korea

Objective

To analyze the incidence of obesity in adults aged 19–59 years in Korea and predict its trend in the future.

Methods

We considered a two-compartmental deterministic mathematical model Susceptible-Infected-Susceptible (SIS), a system of difference equations, to predict the evolution of obesity in the population and to propose strategies to reduce its incidence.

Results

The prevention strategy on normal-weight individuals produced a greater improvement than that produced by treatment strategies.

Conclusions

Mathematical model sensitivity analysis suggests that obesity prevention strategies are more effective than obesity treatment strategies in controlling the increase of adult obesity in Korea.     

Epidemiology and outcome of cardiac arrests reported in the lay-press: an observational study

Objective

The aims of this study were to evaluate the frequency with which cardiac arrests are reported in newspapers, assess the level of detail reported and ascertain whether this coverage gives a realistic portrayal of cardiac arrest outcomes to the lay-reader.

Design

Observational study.

Setting

All UK newspaper articles published between 1 January 2010 and 30 June 2010.

Participants

Articles containing the words ‘cardiac arrest’, ‘CPR’ or ‘resuscitation’ were screen for eligibility. Any articles not involving reference to a real cardiac arrest were excluded.

Main outcome measures

Data relating to patient demographics, arrest characteristics, treatment (CPR and defibrillation) and survival using the Utstein template were extracted. The results were then compared with cardiac arrest statistics from epidemiological studies.

Results

Six hundred and forty-eight articles were reviewed, 203 of which referred to individual cardiac arrest events; 22 events occurred in-hospital and 181 occurred out-of-hospital. In the out-of-hospital cardiac arrest (OHCA) group 32 (17.7%) were reported to survive to hospital discharge, almost all with good neurological outcome. The median age group was 31–45-year-olds, 52 (28.7%) were women and 40 were children. Seventy-five percent of victims received bystander CPR with 13 being attended to by lay-responders using AEDs, eight of which presented with a shockable rhythm of which six made a full recovery.

Conclusion

Survival to hospital discharge rate among newspaper reports was double that of complete epidemiological studies of OHCAs in urban environments. Newspapers may give readers an over-optimistic portrayal of cardiac arrest survival and neurological outcome following successful resuscitation.     

Environmental Health Indicators of Climate Change for the United States: Findings from the State Environmental Health Indicator Collaborative

Objective

To develop public health adaptation strategies and to project the impacts of climate change on human health, indicators of vulnerability and preparedness along with accurate surveillance data on climate-sensitive health outcomes are needed. We researched and developed environmental health indicators for inputs into human health vulnerability assessments for climate change and to propose public health preventative actions.

Data sources

We conducted a review of the scientific literature to identify outcomes and actions that were related to climate change. Data sources included governmental and nongovernmental agencies and the published literature.

Data extraction

Sources were identified and assessed for completeness, usability, and accuracy. Priority was then given to identifying longitudinal data sets that were applicable at the state and community level.

Data synthesis

We present a list of surveillance indicators for practitioners and policy makers that include climate-sensitive health outcomes and environmental and vulnerability indicators, as well as mitigation, adaptation, and policy indicators of climate change.

Conclusions

A review of environmental health indicators for climate change shows that data exist for many of these measures, but more evaluation of their sensitivity and usefulness is needed. Further attention is necessary to increase data quality and availability and to develop new surveillance databases, especially for climate-sensitive morbidity.