Case of Crohn’s Disease Initially Misdiagnosed as Intestinal Tuberculosis Due to Active Pulmonary Tuberculosis / 대한소화기학회지

Differentiating Crohn’s disease (CD) from intestinal tuberculosis (TB) is a challenge. In patients suspected of having CD or intestinal TB compounded with active pulmonary TB in its early stages, clinicians often lean towards a diagnosis of intestinal TB. A 14-year-old female patient was admitted with symptoms of abdominal pain and diarrhea with hematochezia. Colonoscopy revealed a stricture of the ileocecal valve and scattered longitudinal ulcers. Initial chest radiography showed consolidation in the left lower lobe of the lung. Chest CT revealed branching nodular opacities and consolidation. The TB PCR of the bronchial washing fluid was positive. The patient was diagnosed with pulmonary and intestinal TB. The colonoscopy findings favored CD. Despite this, anti-tubercular therapy was initiated based on the radiology findings and PCR test. After treatment with anti-tubercular therapy, the patient’s diarrhea and abdominal pain worsened despite the improvement observed on her chest radiography. Follow-up colonoscopy revealed aggravation of her ulcers. The patient was diagnosed with CD and treated with prednisolone and mesalazine. Her clinical condition improved, and follow-up colonoscopy showed significant improvement of the ulcers. This case highlights the need for caution in diagnosis and suggests that clinicians consider reevaluation in similar cases.

Evaluation of Hypertension Prevention and Control Programs in Lima, Peru

OBJECTIVES: The Korea International Cooperation Agency (KOICA) established 4 health centers to provide hypertension screening and a health support program in a deprived urban area of Lima, Peru. This case report provides a mid-term evaluation of the KOICA’s hypertension prevention and control programs. METHODS: A follow up study was performed on 663 residents who were diagnosed with prehypertension or hypertension (Stage 1 and 2) in the 4 KOICA health centers. Patients participated in programs designed to prevent and control hypertension through education sessions over the course of 6 months. Using simple descriptive statistics and computer simulations, we evaluated the effect of hypertension prevention and control programs on the participants. RESULTS: The KOICA health programs appeared to significantly contribute to lowering the blood pressure (BP) of the participants. The total number of participants with normal BP increased from none to 109. Overall, the female and younger patients responded better to the KOICA programs than the male and older participants. In addition, the average systolic BP, diastolic BP, and body mass index of all participants was significantly reduced. CONCLUSION: The KOICA programs were effective at lowering blood pressure, particularly amongst the prehypertension group than the Stage 1 and 2 hypertension groups. This suggests that providing an extensive screening service for adults with prehypertension will help control hypertension in the early stages.

GIS-based Association Between PM10 and Allergic Diseases in Seoul: Implications for Health and Environmental Policy

PURPOSE: The role of PM10 in the development of allergic diseases remains controversial among epidemiological studies, partly due to the inability to control for spatial variations in large-scale risk factors. This study aims to investigate spatial correspondence between the level of PM10 and allergic diseases at the sub-district level in Seoul, Korea, in order to evaluate whether the impact of PM10 is observable and spatially varies across the subdistricts. METHODS: PM10 measurements at 25 monitoring stations in the city were interpolated to 424 sub-districts where annual inpatient and outpatient count data for 3 types of allergic diseases (atopic dermatitis, asthma, and allergic rhinitis) were collected. We estimated multiple ordinary least square regression models to examine the association of the PM10 level with each of the allergic diseases, controlling for various sub-district level covariates. Geographically weighted regression (GWR) models were conducted to evaluate how the impact of PM10 varies across the sub-districts. RESULTS: PM10 was found to be a significant predictor of atopic dermatitis patient count (P<0.01), with greater association when spatially interpolated at the sub-district level. No significant effect of PM10 was observed on allergic rhinitis and asthma when socioeconomic factors were controlled for. GWR models revealed spatial variation of PM10 effects on atopic dermatitis across the sub-districts in Seoul. The relationship of PM10 levels to atopic dermatitis patient counts is found to be significant only in the Gangbuk region (P<0.01), along with other covariates including average land value, poverty rate, level of education and apartment rate (P<0.01). CONCLUSIONS: Our findings imply that PM10 effects on allergic diseases might not be consistent throughout Seoul. GIS-based spatial modeling techniques could play a role in evaluating spatial variation of air pollution impacts on allergic diseases at the sub-district level, which could provide valuable guidelines for environmental and public health policymakers.

The Impact of Poverty on Self-Rated Health in Philippines: A Mediated Moderation Model of Health Behaviors and Family and Friend Support / 보건행정학회지

BACKGROUND: Socio-economical status, represented by poverty, is a potent factor in predicting health status, because preventable illness and death occurs due to poverty and socio-economical situation. This study aims to provide information towards on the correlation between poverty and self-rated health in consideration of elements of health behaviors and family and friend support in Philippines. METHODS: Data was collected on 15th to 28th of February 2011 by using structured questionnaire through interview method. Study area is Antipolo and Tondo in Manila, Philippines. Sample size was 1,100 but only 658 cases was analyzed due to incomplete questionnaire. RESULTS: Results show that the poverty has direct negative influence on self-rated health, while the presence of family and friend support decreased negative influence. And through the analysis of mediated moderation model, similarly poverty has also indirect negative effect on self-rated health by health behaviors and family and friend support. Especially, regular exercise was found to be a major variable that mediates poverty and self-rated health. CONCLUSION: In conclusion, to improve the self-rated health state of respondents need to provide emotional support especially from family and friends. Also regular exercise should be encouraged by raising health awareness through continuous health education and promotion for the residents in order to develop health behaviors.

Food deserts in Korea? A GIS analysis of food consumption patterns at sub-district level in Seoul using the KNHANES 2008-2012 data

BACKGROUND/OBJECTIVES: The concept of "food deserts" has been widely used in Western countries as a framework to identify areas with constrained access to fresh and nutritious foods, providing guidelines for targeted nutrition and public health programs. Unlike the vast amount of literature on food deserts in a Western context, only a few studies have addressed the concept in an East Asian context, and none of them have investigated spatial patterns of unhealthy food consumption from a South Korean perspective. SUBJECTS/METHODS: We first evaluated the applicability of food deserts in a Korean setting and identified four Korean-specific unhealthy food consumption indicators, including insufficient food consumption due to financial difficulty, limited consumption of fruits and vegetables, excessive consumption of junk food, and excessive consumption of instant noodles. The KNHANES 2008-2012 data in Seoul were analyzed with stratified sampling weights to understand the trends and basic characteristics of these eating patterns in each category. GIS analyses were then conducted for the data spatially aggregated at the sub-district level in order to create maps identifying areas of concern regarding each of these indicators and their combinations. RESULTS: Despite significant reduction in the rate of food insufficiency due to financial difficulty, the rates of excessive consumption of unhealthy foods (junk food and instant noodles) as well as limited consumption of fruits and vegetables have increased or remained high. These patterns tend to be found among relatively younger and more educated groups, regardless of income status. CONCLUSIONS: A GIS-based analysis demonstrated several hotspots as potential "food deserts" tailored to the Korean context based on the observed spatial patterns of undesirable food consumption. These findings could be used as a guide to prioritize areas for targeted intervention programs to facilitate healthy food consumption behaviors and thus improve nutrition and food-related health outcomes.

Exploring Household-level Risk Factors for Self-reported Prevalence of Allergic Diseases Among Low-income Households in Seoul, Korea

PURPOSE: Indoor risk factors for allergic diseases in low-income households in Korea have been characterized only partially. We evaluated the prevalences of atopic dermatitis, asthma, and allergic rhinitis in Seoul, Korea, to identify key housing and behavioral risk factors of low-income households. METHODS: Statistical analysis of the prevalence of these diseases and various risk factors was conducted using data from a 2010 Ministry of Environment household survey. Logistic regression models were generated using data from 511 low-income household apartments in districts of Seoul. RESULTS: In general, housing factors such as renovation history (P<0.1) and crowding status (P<0.01) were associated with allergic rhinitis, whereas behavioral factors such as frequency of indoor ventilation (P<0.05) and cleaning (P<0.1) were inversely correlated with atopic dermatitis. Indoor smoking was a major trigger of asthma and atopic dermatitis in low-income households (P<0.05). The presence of mold and water leakage in houses were the most important risk factors for all three diseases (P<0.05). CONCLUSIONS: Various risk factors play a role in triggering allergic diseases among low-income households in Seoul, and health or environmental programs mitigating allergic diseases should be tailored to address appropriate housing or behavioral factors in target populations.