Does Drinking Culture Induce Problematic Alcohol Use? Evidence From a Military Representative Survey in Korea.

OBJECTIVE: To examine the relationship between problematic alcohol use and contributing factors among Korean professional soldiers. METHODS: Cross-sectional data of 2,646 participants collected by 2014 military-wide representative health survey was analyzed. Multivariate logistic models were used to identify contributing factors for problematic alcohol use. Problematic alcohol use was defined by the Alcohol Use Disorders Identification Test (AUDIT) questionnaire as hazardous (8≤ AUDIT <16) or harmful (AUDIT ≥16). Tolerant drinking culture was measured by the Drinking Culture Questionnaire. RESULTS: Hazardous alcohol use was found in 56.9% of men and 46.8% of women and harmful use in a further 16.2% of men and 5.4% of women. In univariate analyses, perceived health status, subjective sleep quality, depression, and drinking culture were related to the outcome variable. In multivariate models controlling covariates, the likelihood of problematic alcohol use was significantly increased by man gender, being single, current/past smoking, and tolerant/permissive drinking culture. In those with harmful alcohol consumption, tolerant drinking culture was a particularly powerful influence. CONCLUSION: A substantial proportion of Korean professional soldiers demonstrated problematic alcohol use. Tolerant drinking culture was shown to have a significant influence on problematic alcohol use in the military. Our findings underscore the need for public health policies that address this drinking culture to mitigate negative health consequences and preserve the forces' combat readiness.

Does suicidal ideation and depressive mood of parents affect their adolescent children's mental health?

BACKGROUND: Depression in adolescence is a social problem that has detrimental effects on an individual's physical and mental health and increases health care burden on families and society. This study investigates the connection between mental illness among parents and their adolescent children in Korea. METHODS: The sample included parents of 5315 adolescents (12-24 years) and data were obtained from the Korea National Health and Nutrition Survey (KNHANES) from 2007 to 2017. Family based comprehensive questionnaires were used. Multivariate logistic regression models were performed to estimate odds ratios (ORs) at 95% confidence intervals (95% CIs). RESULTS: The main findings showed that daughters with depressed mothers were 1.92 times more likely to experience depression and 1.64 times more likely to have suicidal ideations. In particular, when father was suicidal, his daughter had a 2.59 times higher risk of suicidal thoughts than father was not depressed and had no suicidal thoughts. Sons' depressive mood was rarely affected by the psychological status of mothers and fathers. LIMITATION: There are under-report issue of feelings and study design is cross-sectional. CONCLUSIONS: This study showed gender differences in the association between parents' and adolescents' experience of depression. Thus, the daughter's psychological state was found to be strongly associated with the psychological state of both parents.

Complementing conventional infectious disease surveillance with national health insurance claims data in the Republic of Korea.

Surveillance remains an important tool for timely outbreak detection and response. Many countries, including Korea, have established national infectious disease surveillance systems with clinical notification. We aimed to evaluate the National Health Insurance Claims-based Surveillance (NHICS) compared to conventional passive report-based National Infectious Diseases Surveillance (NIDS). Reported to claimed cases ratios (R/C ratio) were evaluated from monthly notifiable disease cases captured by NIDS and NHICS. The relationships between 26 infectious diseases and each surveillance system were analysed using Pearson's correlation analysis and linear regression. There was an overall increase in R/C ratio from 2010-2017 (0.37 to 0.78). In 22 infectious diseases, there was a correlation between NIDS and NHICS. Moreover, claim-based surveillance showed less fluctuating disease incidence rates than report-based surveillance for specific infectious diseases, such as varicella, mumps, and scarlet fever. However, for infectious diseases with episodic outbreaks or low incidence, it was difficult to assess NHICS usefulness. Claim-based surveillance is less affected by limitations of conventional report-based surveillance systems, such as reporting rate. Given delays in claim systems, a claim-based surveillance is expected to be complementary to conventional systems for the detection of various infectious diseases with the advancement of bio-information technology.

Malaria control and chemoprophylaxis policy in the Republic of Korea Armed Forces for the previous 20 years (1997-2016).

BACKGROUND: Vivax malaria reemerged along the Demilitarized Zone (DMZ), Republic of Korea (ROK), in 1993. While it was hypothesized that vivax malaria would spread throughout the peninsula, nearly all cases were due to exposure near the DMZ. To reduce spillover of vivax malaria to the civilian community, the ROK Ministry of National Defense (MND) initiated malaria prevention policies including a large-scale chemoprophylaxis programme in malaria high-risk areas in 1997. The present study investigated the overall changes in the incidence of malaria among ROK soldiers and the mass chemoprophylaxis program from 1997 to 2016. RESULTS: Peak numbers of vivax malaria were reported in 2000, with most cases reported near the DMZ, before declining to the current levels. To combat the rapid increase in the number of malaria cases and its expansion throughout the ROK, the MND implemented mosquito control and personal protection programmes. The MND also implemented a large-scale vivax malaria chemoprophylaxis programme using hydroxychloroquine (400 mg weekly) in 1997, and primaquine (15 mg × 14 days) as terminal chemoprophylaxis in 2001. Additionally, an improved medical system enabled the rapid detection and treatment of malaria to reduce morbidity and decrease transmission of malaria from humans to mosquitoes. Following the full implementation of these programmes, the incidence of vivax malaria declined in both ROK Armed Forces and civilian populations. Subsequently, several changes in the ROK Armed Forces chemoprophylaxis programme were implemented, including the reduction of the period of hydroxychloroquine prophylaxis by 2 months (2008) and other changes in the chemoprophylaxis policy, e.g., only ROK Armed Forces personnel in moderate risk groups received terminal primaquine chemoprophylaxis (2011), and in 2016, the discontinuation of terminal primaquine chemoprophylaxis in moderate-risk area. CONCLUSIONS: The resurgence of vivax malaria in the ROK Armed Forces personnel near the DMZ was successfully suppressed through the implementation of a mass malaria chemoprophylaxis programme initiated by the MND in 1997, as well as several other factors that may have contributed to the reduction of malaria transmission since 2000. Given the current malaria situation in the ROK and North Korea, it is necessary to reevaluate the ROK Armed Forces and civilian malaria control policies.

Social capital as a key determinant of willingness to join community-based health insurance: a household survey in Nepal.

OBJECTIVES: Although community-based health insurance (CBHI) schemes have been considered as an intermediate stage to achieve universal health coverage (UHC) in low-resource settings, there is a knowledge gap on ways to make it better. STUDY DESIGN: More than 4000 Nepalese households were randomly selected and surveyed. METHODS: Logistic and multivariate multinomial regressions were estimated. RESULTS: Overall, 88% of included household heads were willing to join CBHI, 61% were willing to pay annual premium less than 600 Nepalese rupees (US$5.6) per household, and more than a half (53%) responded that the government should subsidize a significant portion of the premium. Results showed that a higher level of social capital was significantly related with an increase in odds of accepting higher premiums, while individuals' health status and age did not have such associations. Individuals with bonding social capital were more likely to be inclined to join CBHI. Persons who said they can lend money for a living expense (bonding capital) did not want the government to subsidize the scheme, while this negative association would be reversed if persons had both bonding and bridging social capitals. CONCLUSION: We found significantly positive relationships between social capital and willingness to join and willingness to pay for CBHI in Nepal. Policymakers, aiming to achieve UHC, should be advised that bonding and bridging social capital have differing relationships with willingness to cooperate the external funding sources.

Febrile Respiratory Illness Associated with Human Adenovirus Type 55 in South Korea Military, 2014-2016

An outbreak of febrile respiratory illness associated with human adenovirus (HAdV) occurred in the South Korea military during the 2014-15 influenza season and thereafter. Molecular typing and phylogenetic analysis of patient samples identified HAdV type 55 as the causative agent. Emergence of this novel HAdV necessitates continued surveillance in military and civilian populations.

Syndromic Surveillance System for Korea-US Joint Biosurveillance Portal: Design and Lessons Learned.

Driven by the growing importance of situational awareness of bioterrorism threats, the Republic of Korea (ROK) and the United States have constructed a joint military capability, called the Biosurveillance Portal (BSP), to enhance biosecurity. As one component of the BSP, we developed the Military Active Real-time Syndromic Surveillance (MARSS) system to detect and track natural and deliberate disease outbreaks. This article describes the ROK military health data infrastructure and explains how syndromic data are derived and made available to epidemiologists. Queries corresponding to 8 syndromes, based on published clinical effects of weaponized pathogens, were used to classify military hospital patient records to form aggregated daily syndromic counts. A set of ICD-10 codes for each syndrome was defined through literature review and expert panel discussion. A study set of time series of national daily counts for each syndrome was extracted from the Defense Medical Statistical Information System between January 1, 2011, and May 31, 2014. A stratified, adjusted cumulative summation algorithm was implemented for each syndrome group to signal alerts prompting investigation. The algorithm was developed by calculating sensitivity to sets of 1,000 artificial outbreak signals randomly injected in the dataset, with each signal injected in a separate trial. Queries and visualizations were adapted from the Suite for Automated Global bioSurveillance. Findings indicated that early warning of outbreaks affecting fewer than 50 patients will require analysis at subnational levels, especially for common syndrome groups. Developing MARSS to improve sensitivity will require modification of underlying syndromic diagnosis codes, engineering to coordinate alerts among subdivisions, and enhanced algorithms. The bioterrorist threat in the Korean peninsula mandates these efforts.

Clinical Characteristics and Factors Influencing the Occurrence of Acute Eosinophilic Pneumonia in Korean Military Personnel.

Acute eosinophilic pneumonia (AEP) is an uncommon inflammatory lung disease, and limited data exist concerning the clinical characteristics and factors that influence its occurrence. We retrospectively reviewed the records of AEP patients treated at Korean military hospitals between January 2007 and December 2013. In total, 333 patients were identified; their median age was 22 years, and all were men. All patients presented with acute respiratory symptoms (cough, sputum, dyspnea, or fever) and had elevated levels of inflammatory markers including median values of 13,185/µL for white blood cell count and 9.51 mg/dL for C-reactive protein. All patients showed diffuse ground glass opacity/consolidation, and most had pleural effusion (n = 265; 80%) or interlobular septal thickening (n = 265; 85%) on chest computed tomography. Most patients had normal body mass index (n = 255; 77%), and only 30 (9%) patients had underlying diseases including rhinitis, asthma, or atopic dermatitis. Most patients had recently changed smoking habits (n = 288; 87%) and were Army personnel (n = 297; 89%).The AEP incidence was higher in the Army group compared to the Navy or Air Force group for every year (P = 0.002). Both the number of patients and patients with high illness severity (oxygen requirement, intensive care unit admission, and pneumonia severity score class ≥ III) tended to increase as seasonal temperatures rose. We describe the clinical characteristics of AEP and demonstrate that AEP patients have recently changed smoking habits and work for the Army. There is an increasing tendency in the numbers of patients and those with higher AEP severity with rising seasonal temperatures.

Do Working Hours and Type of Work Affect Obesity in South Korean Female Workers? Analysis of the Korean Community Health Survey.

BACKGROUND: The prevalence of obesity and the female labor participation rate have been rapidly increasing in South Korea. To examine the relationship between these factors, we investigated the association between timing and type of work and obesity in the Korean female working population. METHODS: Data collected by the 2008 Community Health Survey (CHS) were analyzed using a complex, stratified, multistage, probability cluster sampling method. Descriptive analysis of relevant variables was performed using the chi-square test, and work-related variables by work type were identified using multivariate logistic regression. The relationship between long working hours, night/shift work, and body-mass index in female workers and explanatory, stratifying, and dependent variables and covariates was analyzed using multiple logistic regression models. RESULTS: A total of 42,234 CHS participants were eligible for study inclusion. Among both manual and nonmanual workers, working less than 40 (adjusted odds ratio [aOR] 1.18, 95% confidence interval [CI] 1.07-1.31 and aOR 1.29; 95% CI 1.09-0.52, respectively) or more than 60 (aOR 1.18, 95% CI 1.06-1.30 and aOR 1.28, 95% CI 1.04-1.57, respectively) hours per week was significantly associated with obesity after controlling for covariates. However, working type (day or night/shift) was significantly associated with obesity only in nonmanual workers (aOR 1.20, 95% CI 1.01-1.42). When we controlled working type in the model, manual workers who work more than 60 hours show higher likelihood of being obese (OR 1.10, 95% CI 1.02-1.18). CONCLUSION: Working fewer (<40) or more than (>60) hours per week is significantly associated with obesity in the Korean female working population, regardless of the type of work. The type of work (day vs. night/shift work) was significantly associated with obesity only in only nonmanual workers.

Vaccination policy in Korean armed forces: current status and future challenge.

Infectious diseases have historically resulted in suspended or cancelled military operations. Vaccination for disease prevention is a critical component of the military's force readiness doctrine. Until recently, Korea had not recognized the importance of vaccinating military personnel. However, a 2011 meningococcal disease outbreak at an army recruit training center led to dramatic changes in the paradigm of traditional medical practice in the Korean armed forces. A new vaccination policy was formed by a 2012 Military Healthcare Service Act. Since then, Neisseria meningitidis, hepatitis A, and measles-mumps-rubella vaccines have been routinely administered to all new recruits early in basic training to ensure protection against these diseases. All active-duty soldiers also receive seasonal influenza vaccination annually. Despite quantitative improvements in vaccination policies, several instances of major infectious diseases and adverse vaccine reactions have threatened soldier health. In the future, vaccination policies in the Korean armed forces should be based on epidemiologic data and military medical research for vaccine use and safety management.

Is suicidal ideation linked to working hours and shift work in Korea?

OBJECTIVE: This study attempted to use the community health survey (CHS) to identify the effect of long working hours (long WHs) and night/shift work on suicidal ideation among the employed population of Korea. METHODS: This study used data from 67,471 subjects who were administered the 2008 CHS which obtained information regarding sociodemographic characteristics, health behaviors and working environment, using structured questionnaires and personal interviews. We adopted multiple logistic regression models for gender and employment stratification. RESULTS: Among male employees, suicidal ideation was significantly associated with only moderately long WHs (51-60 hours), after controlling covariates (adjusted odds ratio [aOR], 1.30; 95% confidence interval [95%CI], 1.07 to 1.57). Self-employed/male employer populations had higher suicidal ideation when they had moderately long WHs (aOR, 1.23; 95%CI, 1.01 to 1.50) and very long WHs (over 60 hours) (aOR, 1.31; 95%CI, 1.08 to 1.59). Among the female population, suicidal ideation was significantly association with moderately long WHs in the employee group (aOR, 1.31; 95%CI, 1.08 to 1.58) and moderately (aOR, 1.35; 95%CI, 1.08 to 1.69) and very (aOR, 1.33; 95%CI, 1.07 to 1.65) long WHs in the self-employed/employer group. Shift work was a significant predictor only in the female population in the employee groups (aOR, 1.45; 95%CI, 1.23 to 1.70). CONCLUSIONS: Long WHs and shift work were associated with suicidal ideation when taking into account gender and employment differences. The harmful effects of exceptionally long WHs in Korea, among other Organization for Economic Co-operation and Development (OECD) countries, raise concerns about public and occupational health. To address the issue of long WHs, labor policies that reduce maximum working hours and facilitate job stability are needed.

Influence of illness and unhealthy behavior on health-related early retirement in Korea: Results from a longitudinal study in Korea.

OBJECTIVES: The aim of this study was to elucidate the effect of illness and unhealthy behavior on early retirement due to health problems (ERdHP) using Korean longitudinal data. METHODS: This study used data collected from 3,508 subjects enrolled in the first to fourth phases of the Korean Longitudinal Study of Ageing (KLoSA). This study was conducted from 2006 to 2012 using structured questionnaires on retirement, morbidities, and health-related behaviors. We adopted the Cox proportional hazard model to investigate the effects of diagnosed disease and health-related behaviors on ERdHP. RESULTS: Participants who smoked, were obese, or suffered from hypertension, diabetes, malignancy, heart disease, stroke, or arthritis had a significantly higher risk of health-related early retirement after adjustment for gender, age, and occupation. Further, risk factors such as lack of exercise, stroke, arthritis, obesity, and malignancy differentially affect early retirement by gender. CONCLUSIONS: This is the first study, that we are aware of, to examine the effect of illness and unhealthy behavior on ERdHP in Asia, using Korean longitudinal data. We found that hypertension, diabetes, malignancy, arthritis, cardiovascular and cerebrovascular diseases, smoking, and obesity increased the risk of ERdHP. To enhance the sustain ability of labor in an aging society, more studies on ERdHP are needed.

Social determinants of smoking behavior: the Healthy Twin Study, Korea.

OBJECTIVES: The purpose of this study was to identify any influence of socioeconomic status on smoking and smoking cessation in a situation where genetic factors are controlled. METHODS: The sample for this study was 2502 members of the twins and families cohort who participated in the Korean Healthy Twins Study from 2005 to 2009. Groups of brothers or sisters, including twins and fraternal twins, were compared in terms of smoking and smoking cessation behaviors according to differences in socioeconomic status and gender. RESULTS: In a situation with complete control of genetic factors, results showed that the daily smoking amount, cumulative smoking amount, and dependence on nicotine decreased with higher-status occupations, and the rate of smoking and amount of cumulative smoking decreased with higher levels of education. Regarding smoking cessation behavior, a higher level of education was associated with a lower smoking cessation rate, and no significant gender differences were found. CONCLUSIONS: Environmental factors had a stronger influence on smoking behavior than did genetic factors. Genetic factors had greater influence on smoking cessation than did environmental factors; however, this requires verification in further studies.

Disparities in health care utilization among urban homeless in South Korea: a cross-sectional study.

OBJECTIVES: We examined health care disparities in Korean urban homeless people and individual characteristics associated with the utilization of health care. METHODS: We selected a sample of 203 homeless individuals at streets, shelters, and drop-in centers in Seoul and Daejeon by a quota sampling method. We surveyed demographic information, information related to using health care, and health status with a questionnaire. Logistic regression analysis was adopted to identify factors associated with using health care and to reveal health care disparities within the Korean urban homeless population. RESULTS: Among 203 respondents, 89 reported that they had visited health care providers at least once in the past 6 months. Twenty persons (22.5%) in the group that used health care (n = 89) reported feeling discriminated against. After adjustment for age, sex, marital status, educational level, monthly income, perceived health status, Beck Depression Inventory score, homeless period, and other covariates, three factors were significantly associated with medical utilization: female sex (adjusted odds ratio [aOR, 15.95; 95% CI, 3.97 to 64.04], having three or more diseases (aOR, 24.58; 95% CI, 4.23 to 142.78), and non-street residency (aOR, 11.39; 95% CI, 3.58 to 36.24). CONCLUSIONS: Health care disparities in Seoul and Daejeon homeless exist in terms of the main place to stay, physical illnesses, and gender. Under the current homeless support system in South Korea, street homeless have poorer accessibility to health care versus non-street homeless. To provide equitable medical aid for homeless people, strategies to overcome barriers against health care for the street homeless are needed.