Nationwide cervical cancer screening in Korea: data from the National Health Insurance Service Cancer Screening Program and National Cancer Screening Program, 2009–2014 / 부인종양

OBJECTIVE: The rates of participation in the Korean nationwide cervical cancer screening program and the rates of abnormal test results were determined. METHODS: The database of the National Health Insurance Service (NHIS) was used during the study period (2009–2014). RESULTS: The participation rate increased from 41.10% in 2009 to 51.52% in 2014 (annual percentage change, 4.126%; 95% confidence interval [CI]=2.253–6.034). During the study period, women ≥70 years of age had the lowest rate of participation (range, 21.7%–31.9%) and those 30–39 years of age the second-lowest (27.7%–44.9%). The participation rates of National Health Insurance beneficiaries (range, 48.6%–52.5%) were higher than those of Medical Aid Program (MAP) recipients (29.6%–33.2%). The rates of abnormal results were 0.65% in 2009 and 0.52% in 2014, with a decreasing tendency in all age groups except the youngest (30–39 years). Every year the abnormal result rates tended to decrease with age, from the age groups of 30–39 years to 60–69 years but increased in women ≥70 years of age. The ratio of patients with atypical squamous cells of undetermined significance compared with those with squamous intraepithelial lesions increased from 2.71 in 2009 to 4.91 in 2014. CONCLUSION: Differences related to age and occurring over time were found in the rates of participation and abnormal results. Further efforts are needed to encourage participation in cervical cancer screening, especially for MAP recipients, elderly women and women 30–39 years of age. Quality control measures for cervical cancer screening programs should be enforced consistently.

Risk Factors on Suicidal Ideation and Suicidal Attempt among Community dwelling Older Adults: Based on 2014 Community Health Survey / 재활간호학회지

PURPOSE: The purpose of this study was to investigate the factors affecting suicidal ideation and suicidal attempts of older adults aged 65 years and older. METHODS: A part of the 2014 Community Health Survey data were used for analysis. Responses of 3,287 older adults living in Chungbuk province were analyzed using complex sample multiple logistic regression analysis. RESULTS: The percentages of older people who experienced suicidal ideation and attempt during the past year were 21.7% and 0.8%, respectively. Limitation of daily living activities, pain/discomfort, stress and depression were significant risk factors of older adults' suicidal ideation. The significant risk factor of suicidal attempt was suicidal ideation, followed by depression and limitation of daily activities. The frequencies of elderly people using professional counseling related to the stress, depression or suicidal ideation were very low showing 2.1%, 1.8%, and 1.4% respectively. The protective impact of counselling on suicidal ideation and attempt were not able to be identified because of the low rate of participation of counselling program in this study. CONCLUSION: The common risk factors of suicidal ideation and attempt were depression and the limitation of daily activity; therefore, community services for them should be emphasized. In addition, there should be an effort to increase the utilization rate of professional counselling and to identify the effects of counselling on the prevention of suicidal behaviors.

The Influence of Community Characteristics on Food Insecurity Korean Adults / 보건행정학회지

BACKGROUND: This study was conducted to analyze the influence of socioeconomic characteristics of community on the food insecurity under the control of personal socioeconomic factors which may be influence to the food security. METHODS: Food insecurity and individual socioeconomic characteristics were obtained from 2012 community health survey. Socioeconomic characteristics of communities were extracted from the data of Statistics Korea and local governments. Personal socioeconomic factors were sex, age, educational status, job, and monthly family income. Socioeconomic characteristics of communities were administrative district (urban vs. rural), senior population rate, degree of financial self reliance, degree of financial independence, portion of welfare budget, number of welfare facilities, and unemployment rate. We analysed the relationships between the food insecurity and socioeconomic characteristics of community using multi-level analysis under the control of personal characteristics. RESULTS: On personal level age, sex, education status, and monthly family income were related with food insecurity. On community level administrative district (urban vs. rural), degree of financial independence, unemployment rate, and proportion of welfare budget among local general government accounts were related to individual food insecurity. Rural area, district with low levels of financial independence, low portion of welfare budget, and greater unemployment rate showed a higher level of food insecurity. CONCLUSION: To reduce the level of food insecurity in a community it is necessary to decrease the unemployment rate, in addition to providing support from the central government by increasing the proportion of the welfare budget so that both factors contribute to raising the degree of financial independence.

Factors Affecting the Validity of Self-Reported Data on Health Services from the Community Health Survey in Korea

PURPOSE: As a follow-up for the validity study of Community Health Surveys (CHSs), the purpose of this study was to evaluate the factors affecting the accuracy of CHSs by investigating subjects' characteristics. MATERIALS AND METHODS: We used data from 11,217 participants (aged 19 years or older) who had participated in the CHS, conducted by a local government in 2008 and analyzed the variables affecting the sensitivity and specificity of hospitalization and outpatient visit. RESULTS: Multivariate logistic regression analysis showed that, factors related with the sensitivity of hospitalization and outpatient visit questions were gender, age, marital status, chronic diseases, medical checkup, the subjective health status and necessary medical services. Factors related with the specificity were gender, marital status, educational background, chronic diseases, medical checkup, alcohol consumption, necessary medical services and sadness. CONCLUSION: This study revealed the subject-related factors associated with the validity of the CHS. Efforts to improve the sensitivity and the specificity from self-report questionnaires should consider how the characteristics of subjects may affect their responses.

Variation in the Numbers of Red Blood Cell Units Transfused at Different Medical Institution Types from 2006 to 2010 in Korea

BACKGROUND: This study aimed at assessing the number of red blood cell (RBC) units transfused at different types of medical institution and examining the characteristics of transfusion recipients. METHODS: We calculated and compared the number of transfusion recipients, total RBC units transfused, and RBC units transfused per recipient. Study data were extracted from insurance benefits reimbursement claims for RBC units at the Health Insurance Review & Assessment Service from 2006 to 2010. RESULTS: Between 2006 and 2010, the number of recipients of RBC units increased from 298,049 to 376,445, the number of RBC units transfused increased from 1,460,799 to 1,841,695, and the number of RBC units transfused per recipient changed from 4.90 to 4.89. The number of recipients aged > or =65 yr increased from 133,833 (44.9%) in 2006 to 196,127 (52.1%) in 2010. The highest number of RBC units was transfused to patients with neoplastic diseases (31.9%) and diseases of the musculoskeletal system and connective tissue (14.4%). More than 80% of the total number of RBC units were transfused at tertiary and general hospitals. However, this composition rate was slightly decreasing, with the composition rate for hospitals increasing from 12.6% to 16.3%. CONCLUSIONS: This study revealed an increase in the number of RBC units transfused over a 5-yr period due to an increase in the number of transfused recipients, especially recipients aged > or =65 yr; moreover, the number of RBC units transfused differed based on medical institution type. These results provide fundamental data on RBC transfusions required for future research.

Factors Affecting Diabetic Screening Behavior of Korean Adults: A Multilevel Analysis

PURPOSE: We investigated the role of individual and community level factors on diabetes screening test behavior. METHODS: We used individual-level data from 170,193 adults aged 30 years or older who were not diagnosed with diabetes and participated in the 2009 community health survey. Community-level data includes 253 communities and were collected from various national statistics. Multilevel logistic regression analysis was conducted. RESULTS: The rate of diabetes screening within the year prior to this study was 53.2%. Community variance of Model I, Model II and Model III was 0.236, 0.252 and 0.238, respectively. The proportional change in variance of Model II and Model III was -6.8% and -1.2%. The odds ratio for participation of diabetic screening of areas with bottom financial independence compared to areas with top was 0.84 (95% confidence interval, 0.74-0.96); the odds ratio of areas with top internist compared to areas with bottom was 1.15 (95% confidence interval, 1.01-1.31). CONCLUSION: This study identified a contextual effect influencing the participation of Korean adults in diabetes screening. It is necessary to develop specific policies that consider not only individual factors, but also community factors relating to individual behaviors to increase the likelihood of diabetes screening.

Time Trends of Allergic Rhinitis and Effects of Residence on Allergic Rhinitis in Korea From 1998 Through 2007-2009

PURPOSE: Longitudinal changes in the prevalence of self-reported physician-diagnosed allergic rhinitis (AR) in Korea and the association between the prevalence of AR and type of residence area among Korean males and females in 1998, 2001, 2005 and 2007-2009 were evaluated. METHODS: Age-standardized prevalence was calculated using the Korea National Health and Nutrition Examination Survey (KNHANES) I-IV. Stratified factors of sex, age, and socioeconomic status were adjusted to compare the prevalence of AR in relation to residential area by multiple logistic analysis. RESULTS: The prevalence of AR increased by tenfolds from 1.2 % in 1998 to 12.0 % in 2007-2009. The trends for prevalence of AR were also statistically significant (p < .05). The age-standardized prevalence of AR among urban females was higher (13.9%) than that in rural females (11.5%). After adjustment for survey years, age, socioeconomic levels and asthma, the odds of AR were higher in urban than rural residents, except for males in 1998. CONCLUSION: The prevalence of AR in Korea has increased over the past decade, and living in an urban area may be a susceptible factor. For prevention and management of AR, further evaluations of contributing factors and mechanisms underlying differences in AR are needed.

Factors Affecting Preparation Stage to Quit Smoking in Men

PURPOSE: This study was done to investigate factors affecting preparation stage to quit smoking in men. METHODS: Based on data from the Community Health Survey conducted in Chungbuk Province in 2008, we estimated rates and odds ratio (OR) of smoking cessation intention for 2,639 men who were current smokers. Multivariate logistic regression analyses were used to identify factors affecting preparation stage to quit smoking. RESULTS: Among current male smokers, the rate of smoking cessation intention was 17.1%. The OR of factors affecting smoking cessation was as follows: Compared to men with middle school education, the OR for rate of smoking cessation intention in men with high school education was 1.47 (p=.018), and for college or higher, 1.55 (p=.017). Compared to being single, the OR for cohabitation after marriage was 1.61 (p=.011) and living alone after marriage, 2.23 (p=.005). The OR for attempt to quit smoking, exposure to secondhand smoke and participation in smoking education were 6.80 (p<.001), 1.32 (p=.020) and 1.69 (p=.005), respectively. CONCLUSION: Results of this study show that it is necessary to decrease exposure to secondhand smoke and to increase participation in smoking cessation education targeting current smokers to move them from precontemplation or contemplation stage to preparation stage.

Pre- and Post-transfusion Testing for Hepatitis B Virus Surface Antigen and Antibody in Blood Recipients: A Single-Institution Experience in an Area of High Endemicity

BACKGROUND: Hepatitis B remains the most common transfusion-transmitted viral infection. We explored the current status of pre-transfusion screening and post-transfusion follow-up testing for hepatitis B virus (HBV) surface antigen (HBsAg) and antibodies (anti-HBs) in blood recipients from an area of high HBV endemicity. METHODS: A total of 7,780 blood recipients were transfused with at least 1 unit of blood component at a single university hospital in Korea between January 2006 and December 2009. Their medical records were reviewed, and their demographic and transfusion-related data were analyzed. RESULTS: Pre-transfusion HBsAg and anti-HBs levels were tested in 77.6% (6,037/7,780) of the recipients. The results varied widely according to recipient age. In all, 32.8% (1,982/6,037) of the recipients who were tested had dual negative pre-transfusion results for HBsAg and anti-HBs and, therefore, were at increased risk of HBV transmission. Post-transfusion follow-up testing for HBsAg and/or anti-HBs was performed in 22% (436/1,982) of the increased-risk group. CONCLUSIONS: Our data show that current transfusion-related laboratory testing practice is not sufficient to properly investigate possible post-transfusion infections. Routine laboratory tests, including HBsAg and anti-HBs, should be recommended in transfusion guidelines.

Validity of Self-reported Healthcare Utilization Data in the Community Health Survey in Korea

To evaluate the sensitivity and specificity of Community Health Survey (CHS), we analyzed data from 11,217 participants aged > or = 19 yr, in 13 cities and counties in 2008. Three healthcare utilization indices (admission, outpatient visits, dental visits) as comparative variables and the insurance benefit claim data of the Health Insurance Review & Assessment Service as the gold-standard were used. The sensitivities of admission, outpatient visits, and dental visits in CHS were 54.8%, 52.1%, and 61.0%, respectively. The specificities were 96.4%, 85.6%, and 82.7%, respectively. This is the first study to evaluate the validity of nationwide health statistics resulting from questionnaire surveys and shows that CHS needs a lot of efforts to reflect the true health status, health behavior, and healthcare utilization of the population.

Application of Magnetic Resonance Imaging and Magnetic Resonance Angiography as Diagnostic Measures for the First Attack of Suspected Cerebrovascular Diseases in Korea

PURPOSE: No precise data are available showing how magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) can be applied to diagnosis for the first attack of a suspected cerebrovascular disease in Korea. The purpose of this study was to evaluate the application level of MRI and MRA as diagnostic tools and the related factors to the use of these techniques. MATERIALS AND METHODS: This study used the health benefit claim data of 89,890 patients who were hospitalized for the first time due to suspected cerebrovascular disease in 2007 without having visited medical institutions as an outpatient or inpatient from 2003 to 2006. RESULTS: Of the 89,890 cases, 28.4% took both MRI and MRA, 10.7% took only MRI and 6.9% took only MRA. The related factors identified in the multivariate logistic regression analysis were gender, type of insurance, type of medical institution, type of department, duration of hospitalization, and type of disease. CONCLUSION: This study showed that the application level of MRI and MRA as diagnostic measures for the first attack of a suspected cerebrovascular diseases varied depending on several factors. It is necessary to study more accurate levels of computerized tomography (CT), computerized tomography angiography (CTA), MRI or MRA as measures to diagnose a first attack of suspected cerebrovascular disease.

Self-rated Health Level Comparisons by the Criteria of Precarious Employment Status: The Korean Labor and Income Survey / 대한산업의학회지

OBJECTIVE: The purpose of this paper is to analyze the effects of precarious employment status on the level of self-rated health, based on various criteria, by participants in the Korean Labor and Income Panel Survey. METHODS: Data were obtained from 3,268 subjects(2,057 men and 1,211 women), who participated in the 2005-2006 Korean Labor and Income Panel Survey. Group A was classified as Non-precarious employment by both the Ministry of Labor (MoLab) and the Korea Labor and Society Institute (KLSI). The group B was classified as Non-precarious employment by the MoLab and as precarious employment by the KLSI. The group C is classified as Non-precarious employment by both MoLab and KLSI. Outcome variables were self-rated health and a panel logistic regression analysis was performed on the data. RESULTS: The level of self-rated health was worse among group B males (OR: 1.45, C.I:1.00~2.11) and group C males (OR: 1.69, C.I:1.35~2.10) compared to group A males. A substantial difference(57.8%) in the level of self-rated health between groups A and B was attributed to the sociodemographic characteristics of the populations. The difference in self-rated health between groups A and C was explained by work environments(15.7%), as well as by sociodemographic characteristics(26.1%). For female workers, the level of self-rated health in group B and C was worse than in group A, but this finding was not statistically significant. CONCLUSIONS: These findings suggested that the policy to improve the working environment, as well as a more comprehensive effort to reduce the disparity, is needed for the precarious employment worker.

Validity of Measles Immunization Certificates Submitted upon Enrollment in an Elementary School in Korea / 예방의학회지

OBJECTIVES: To increase the booster vaccination rate, the Korean government legislated a measles vaccination for elementary school students in 2001, requiring parents to submit a certificate of vaccination upon the admission of the students to elementary school. The purpose of this study was to evaluate the validity of measles vaccination certificates which were issued to parents. METHODS: Using questionnaire survey data of 890 general practitioners and 9,235 parents in 2005, we investigated the evidence for booster vaccination certificates of measles. RESULTS: In the survey of general practitioners, 59.5% of the certificates depended on the medical records of clinic, 13.5% was immunization booklets, 23.7% was re-immunizations, 1.9% was confirmation of record of other clinics, and 1.4% was parents' statements or requests without evidence. In the survey of parents, 36.2% of the certificates depended on the medical records of clinic, 43.4% was immunization booklets, 18.0% was reimmunizations, and 2.4% was parents statements or requests without evidence. CONCLUSIONS: Our findings show that a majority of the booster vaccination certificates of measles was issued on the basis of documented vaccinations and it means that the implementation of the law requiring the submission of elementary school students' vaccination certificates has been very successful in Korea.

The Cost of Occupational Health and Safety in Manufacturing Factories / 대한산업의학회지

OBJECTIVE: This study evaluated the cost for occupational health and safety in manufacturing factories in Korea according to the factory's size and the industrial classification. METHODS: The costs to prevent occupational injuries and promote the general health of the workers were calculated by using the data of The Occupational Safety and Health Survey in Korea in the year of 2005 and the data of the Industrial Accident Compensation Insurance (IACI) premiums at the same factories for the year of 2004. RESULTS: The mean cost per one worker was as follows: 990,000 won for the factory with 5~49 workers, 869,000 won for the factory with 50~299 workers and 1,773,000 won for the factory with more than 300 workers. In the factories with 5~49 workers and 50~299 workers, the premium for the IACI was the largest portion of the cost (62.8% and 52.8%, respectively) and the cost for gear to protect workers from dangerous machineries was the next biggest portion of the cost (20.1% and 19.1%, respectively). The largest portion of the cost in the factories with more than 300 workers was the premium for the IACI (37.5%). CONCLUSIONS: The investment costs to prevent occupational injuries and to promote the general health of the workers were very diverse according to the size of the factories and the industrial classification. To reduce the occupational injuries and to promote the general health of the workers, systematic and continuous approaches to evaluate the investment costs for the occupational health and safety are required.

The Cost of Occupational Health and Safety in Manufacturing Factories / 대한산업의학회지

OBJECTIVE: This study evaluated the cost for occupational health and safety in manufacturing factories in Korea according to the factory's size and the industrial classification. METHODS: The costs to prevent occupational injuries and promote the general health of the workers were calculated by using the data of The Occupational Safety and Health Survey in Korea in the year of 2005 and the data of the Industrial Accident Compensation Insurance (IACI) premiums at the same factories for the year of 2004. RESULTS: The mean cost per one worker was as follows: 990,000 won for the factory with 5~49 workers, 869,000 won for the factory with 50~299 workers and 1,773,000 won for the factory with more than 300 workers. In the factories with 5~49 workers and 50~299 workers, the premium for the IACI was the largest portion of the cost (62.8% and 52.8%, respectively) and the cost for gear to protect workers from dangerous machineries was the next biggest portion of the cost (20.1% and 19.1%, respectively). The largest portion of the cost in the factories with more than 300 workers was the premium for the IACI (37.5%). CONCLUSIONS: The investment costs to prevent occupational injuries and to promote the general health of the workers were very diverse according to the size of the factories and the industrial classification. To reduce the occupational injuries and to promote the general health of the workers, systematic and continuous approaches to evaluate the investment costs for the occupational health and safety are required.

Effect of Aircraft Noise of the Air Force on Noise Sensitivity, Psychosocial Status and Behaviour of Elementary Students / 農村醫學 地域保健

OBJECTIVES: We evaluated the effect of the aircraft noise on the behavior and affect status of the local elementary school students. METHODS: The daytime noise levels of the exposed and control areas were compared and the self answered questionnaires from 272 students and their parents of the exposed area and 91 of the control area were collected. The questionnaires are regarding the noise sensitivity and the psychosocial status of the students, noise sensitivity of the parents and the parents' behavioral evaluation for their children. RESULTS: The mean noise level of the exposed area (67.6 dB(A)) showed higher level than the control area (57.1 dB(A), 58.2 dB(A), 60.2 dB(A)) and it was statistically significant. The mean score for noise sensitivity and the mean score for brief mental exam. in the exposed students were lower than the mean scores in the control group but they were not statistically significant (p=0.056 & 0.165). The mean score for behavioral evaluation of students by their parents in the exposed area(15.5) was higher than the mean score in the control group(13.2) and it was statistically significant(p=0.043). The mean score for noise sensitivity in the exposed parent(27.5) was higher than the mean score in the control group(24.1) and it was statistically significant(p=0.045). CONCLUSIONS: This study revealed that the noise sensitivity of the parents affected the behavioral evaluation of the students than noise-exposure itself. The further study is needed to evaluate relationship between aircraft noise and it's effect on children's health.

Factors Affecting the Designation of Cerebrovascular Diseases as Work-Related in Administrative Litigation

The purpose of this study was to identify factors that could be used as standardized criteria for evaluating occupational diseases in initial assessments or requests for examination. Using 100 administrative litigation cases on the work-relatedness of cerebrovascular diseases (CVDs) by the Seoul Branch of the Korea Labor Welfare Corporation (KLWC) from 1997 to 2002, we estimated the relationship between the investigated variables and designation of the work-relatedness of the CVD. As for the age, the odds ratio of the acceptance rate of a case as work-related in subjects over 60 yr of age was 0.08 (95% CI, 0.01-0.75), which was compared to subjects under 30 yr of age. Regarding working hours, the odds ratio of the acceptance rate of a case as work-related in CVDs in those over 56 hr was 9.50 (95% CI, 1.92-47.10) when compared to those less than 56 hr. As for the benefit type, the odds ratio of the acceptance rate of a case as work-related in medical benefits was 5.74 (95% CI, 1.29-25.54), compared to survivor benefits. As for the criteria for defining situations as work overload, the odds ratio of the acceptance rate of a case as work-related in injured workers was 12.06 (95% CI, 3.12-46.62), compared to that in non-injured workers. Our findings show that the criteria for defining situations of work overload played an important role in assessing the work-relatedness of CVDs in administrative litigation, and it is necessary to make the scientific evidence on judgement of workrelatedness on overwork.

Effect of Sodium Benzoate on Change of Urinary Hippuric Acid and Methyl Hippuric Acid among Workers Coexposed to Toluene and Xylene / 대한산업의학회지

OBJECTIVES: This study was performed to investigate the effect of drink containing sodium benzoate on the change of urinary hippuric acid (UHA) and methyl hippuric acid (UMHA) excretion among workers coexposed to low toluene and xylene. METHODS: Study subjects were 55 male shipbuilders who were divided into 3 groups; nonexposed group (n=10, who were not exposed to organic solvent and had drunk sodium benzoate), exposed A group (n=24, who were coexposed to toluene and xylene, and had drunk sodium benzoate), and exposed B group (n=21, who were coexposed to toluene and xylene, and had not drunk sodium benzoate). The study methodology consisted of questionnaire survey, urinary analysis for metabolites of toluene and xylene before and after drinking with or without sodium benzoate, and personal air sampling of toluene and xylene. RESULTS: Before drinking, there was no significant difference in UHA or UMHA between the exposed A and B groups. After 1.5 hour of drinking, UHA of the exposed A group was significantly higher than that of the exposed B group. After 3 hours, however, UHA of the exposed A group was decreased to the level of the exposed B group, regardless of the ambient toluene level. UMHA exhibited no significant difference between the exposed A and B groups regardless of time and ambient toluene level. The regression model showed that drinking of sodium benzoate was positively correlated with UHA after 1.5 hours of drinking, but not after 3 hours. In addition, sodium benzoate didn't affect UMHA. CONCLUSIONS: This study showed that sodium benzoate initially increased UHA temporally but that its effect disappeared after 3 hours. In the medical examination of toluene exposure workers, the ingestion of drink containing sodium benzoate should be forbidden during the 3 hours prior to urinary sampling.

Prevalence of Hazardous and Harmful Alcohol Consumption Using Alcohol Use Disorders Identification Test in Chungju Area / 예방의학회지

OBJECTIVES: To investigate the prevalence of hazardous and harmful alcohol use, which are a subthreshold of alcohol related disorders. METHODS: Direct-interview questionnaires to 1,183 rural persons (489 male, 694 female) were conducted in Chungju-city from July 2 to 26, 1998. As a screening instrument, the alcohol use disorders identification test (AUDIT) was used. RESULTS: The prevalence of alcohol use was 41.7%. In males, it was 66.3% and in females, it was 24.4%. The mean of the AUDIT score of males and females was 13.2 and 5.6, respectively. As WHO guideline, the prevalence of hazardous alcohol use in males and females was 80.3% and 20.7%, respectively. This suggests that the prevalence of 'hazardous drinking' and 'harmful drinking' was 45.4% and 29.3% for males and 1.2% and 2.4% for females, respectively. CONCLUSIONS: This study presented the prevalence of hazardous and harmful drinking of a rural population in Korea and reviewed those health problems. Further evaluation to detect and treat lower alcoholic drinkers is recommended