Epidemiology and Health

Volume 29 (2); December 2007

Brief Communication

Introduction of Relative Survival Analysis Program: Using Sample of Cancer Registry Data with Stata Software.: Kyu Won Jung, Hyun Joo Kong, Seon Hee Yim, Young Joo Won, Joohon Sung, Hai Rim Shin; Korean J Epidemiol. 2007;29(2):222-229.

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Abstract PDF: Abstract
Patient survival is one of the most important measures for the evaluation of progress in cancer patient care across the wide spectrum from diagnosis to treatment. The optimal monitoring method for cancer patient survival is to estimate survival based on representative data from cancer patients in the population, which is only achievable through using population-based cancer registration data. Relative survival is used to compare the survival experience in a study cohort that expected to result from background population mortality rates. This technique is useful when the cause of death is not accurate or not available, since it provides a measure of excess mortality in a group of patients with a certain disease. The purpose of this article is to demonstrate the procedures for estimating relative survival using the statistical software Stata. For this survival analysis to show the procedure, the example data set was randomly selected from the National Cancer Incidence Database, which was used in a recent article reporting the overall relative survival of cancer patients diagnosed during 1993-2002 in Korea.; Summary

Original Articles

A Prospective Study of the Epidemiology of Out-of-Hospital Pediatric Cardiopulmonary Arrest.: Seung hoon Hahn, Won chul Lee; Korean J Epidemiol. 2007;29(2):211-221.

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Abstract PDF: Abstract
PURPOSE
Data regarding out-of-hospital pediatric cardiopulmonary arrest have been limited to the retrospective study. This study was performed to analyze the epidemiology and outcome of out-of-hospital pediatric cardiopulmonary arrest(CPA) with the international consensus in a single hospital.
METHODS
Children less than 15 years old who entered emergency department with CPA, between 1st March 2004 and 31st July 2007, were included this study. Data were recorded prospectively following Utstein's template. The characteristics and outcomes of patients were analyzed.
RESULTS
Cardiopulmonary arrests occurredin total of 37 of 21,339 children presented to emergency department during 41 months study period. 15 out of 37 with CPA had return of spontaneous circulation (ROSC) after resuscitation, 4 survived to be discharged from the hospital. The rate of ROSC in the respiratory arrest is higher than the cardiac arrest. Trauma was the most common cause of out-of-hospital pediatric cardiopulmonary arrest. No children who had more 20 minutes of cardiopulmonary resuscitation (CPR) or took more than 3 doses of epinephrine survived.
CONCLUSIONS
The 10.4% survival rate after out-of-hospital pediatric CPA is poor. The respiratory arrest is more favorable. Education of basic life support for publics is needed to increase the rate of ROSC and survival from out-of-hospital pediatric cardiopulmonary arrest.; Summary

Reporting of National Notifiable Infectious Diseases (NNIDs) and Related Characteristics.: Ye soon Kim, Kee ho Park, Hyo soon Yoo, Jun wook Kwon, Euichul Shin; Korean J Epidemiol. 2007;29(2):200-210.

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Abstract PDF: Abstract
communicable diseases. The purposes of the study is to estimate reporting proportion of National Notifiable Infectious Diseases(NNIDs) and investigate characteristics related to reporting using KAP(knowledge, attitude, practice) model.
METHOD
We surveyed randomly selected 2,185 physicians (speciality: internal medicine, family medicine, pediatrics, dermatology, general physicians) of their knowledge, attitude, and practice of NNIDs reporting through self-administered mail questionnaires. Of them, 231 physicians responded (response proportion: 10.6%).
RESULT
The reporting proportion was estimated to 27.0%. Recognition level (knowledge) of NNIDs was relatively high with proportion of 69.4%, and attitude (public health importance) of reporting was 65.8%. Multiple logistic regression analysis showed that knowledge, attitude significantly affected physicians' reporting in a positive direction (O.R. 6.2, 6.2 respectively). Whereas, senior age group, specialty (family medicine, pediatrics, dermatology) showed significantly lower reporting. General (tertiary care) hospital level of care showed significantly higher reporting practice (alpha=0.05).
CONCLUSION
The NNIDs reporting proportion, 27.0% is similar with those studied recently. Continuous efforts to increase the performance level of communicable diseases surveillance system. Of those, restructuring surveillance systems considering characteristics of notifiable diseases classes must be stressed. Educational approach of physicians needs to be tailored specially to newly-designated diseases such as Group II, Designated Group NNIDs.; Summary

Development of Risk Prediction Model for Cardiovascular Disease Using Intima Media Thickness of Carotid Artery Among Community-Dwelling Elderly.: Jin Young Jeong, Kyung Soon Hong, Soong Nang Jang, Young Ho Choi, Moon Gi Choi, Sang Kon Lee, Hyun Ah Kim, Seok Won Park, Na Rae Hong, Dong Hyun Kim; Korean J Epidemiol. 2007;29(2):187-199.

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Abstract PDF: Abstract
PURPOSE
This study was performed to develop risk prediction model for cardiovascular disease using intima-media thickness (IMT) of carotid artery among the community dwelling elderly.
METHODS
Follow-up survey was conducted in 2007 to measure the IMT of carotid artery, which is known as a preclinical marker of atherosclerotic change, among participants at the baseline survey of Hallym Aging Study (HAS) in 2004. They were categorized into two groups; increased IMT > or = 0.9 mm and normal IMT < 0.9 mm. To evaluate which factors are independently related with the increased IMT, multiple logistic regression analysis was done. Based on the regression coefficients of these factors weighed by the magnitude of the effect estimates, we calculated the risk scores for increased IMT for every participants. ROC curve was plotted for the each cutoff point of risk scores and its fitness was tested using Area Under the Curve (AUC). Finally, we calculated risk ratios for the increased IMT according to the level of risk based on the risk scores.
RESULTS
Several factors were found as related factors for the increased IMT in the multiple logistic regression: age (beta=0.15), cholesterol (beta=0.01), insulin (beta=0.13), and pulse pressure (beta=0.90) for men, and age (beta=0.08), family history of diabetes mellitus (beta=0.94) and stroke (beta=0.79), alcohol drinking (beta=0.39), and high cholesterol (beta=0.77) for women. We assigned the weighed value for each factors. The average risk scores were 14.48 (range 9.69-18.76) for men and 4.59 (range 2.41-7.48) for women. The Area Under the Curve (AUC) were 0.77 for men and 0.71 for women. We also observed the higher risk of increased IMT as the risk scores increased.
CONCLUSION
Based on the results, we expect to predict the level of the risk for the increased IMT, which is preclinical marker for atherosclerotic change, among the elderly.; Summary

The Association Between Adiponectin and Diabetes in the Korean Population.: Sun Ha Jee, Hee Yeon Lee, Sun Ju Lee, Ji Eun Yun, Eun Jung Jee, Hye Yun Song, Sang Yeun Kim, Jungyong Park, Hyon Suk Kim; Korean J Epidemiol. 2007;29(2):176-186.

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Abstract PDF: Abstract
BACKGROUND
As indicators of obesity, waist circumference (WC), body mass index (BMI), and adiponectin are well known risk factor for diabetes mellitus. The objectives of this study were to measure the independent association between these obesity indicators and diabetes and to examine the combined effect of these indicators on diabetes in a Korean population.
METHODS
The WC, BMI, and serum adiponectin were measured in 6,505 healthy Koreans and were classified into tertile groups for men and women. The independent and combined associations of the obesity indicators with diabetes were measured using logistic regression analyses. Diabetes was defined as fasting serum glucose greater than 126 mg/dL or taking medication.
RESULTS
Levels of adiponectin were inversely associated with BMI and WC and directly associated with age and high density lipoprotein cholesterol (HDL) cholesterol (P <0.001). After adjusting for age, WC, and other lifestyle factors, low levels of adiponectin were associated with an increased prevalence of diabetes. Further adjustment for HDL cholesterol and triglyceride attenuated this association in both men and women. The best cut-off value of adiponectin in terms of identifying the presence of diabetes was 5.5 /ml with a sensitivity and specificity of 46.7% and 63.9% for men and 9.5 /ml with a sensitivity and specificity of 68.2% and 55.2 for women.
CONCLUSIONS
These results suggest that adiponectin was associated with diabetes. The association was independent of WC and was partly modified by HDL and triglyceride. There were no effect modifications of adiponectin with WC on diabetes.; Summary

Development of ELISA-kit of Quantitative Analysis for Adiponectin and Their Correlation with Cardiovascular Risk Factors.: Sun Ha Jee, Seungbok Lee, Sungsik Min, Jungyong Park, Hyon Suk Kim, Sang Yeun Kim, Ji Eun Yun, Sun Ju Lee, Eun Jung Jee, Hee Yeon Lee, Hye Yun Song; Korean J Epidemiol. 2007;29(2):165-175.

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Abstract PDF: Abstract
PURPOSE
S: To develop a rapid, sensitive, qualitative ELISA-kit for serum adiponectin and examine correlation with adiponectin and cardiovascular risk factors.
METHODS
On the base of monoclonal antibodies against adiponectin, apply indirect ELISA to study the performance parameter of the kit. The correlation was examined between adiponectin and cardiovascular risk factors including waist circumference, body mass index, triglyceride, and HDL cholesterol.
RESULTS
The limited concentration of detection of the ELISA-kit was 1ug/ml. Linearity with R&D system and AdipoGen with this ELISA-kit was acceptable: the linear equation with R&D system was y=1.0116x + 0.4629 (R2=0.97) and linear equation with AdipoGen was y=0.9562x + 1.1961 (R2=0.93), respectively. The average recovery rate of the ELISA-kit ranged 92 to 104%. The correlation coefficient of waist circumference with adiponectin was -0.2276 (p<0.0001) among men and -0.2328 (p<0.0001) among women.
CONCLUSION
This ELISA-kit was quick, sensitive, and stable and can be used to determine adiponectin in serum.; Summary

Characteristics of Injury in a University Hospital.: Younsu Shin, Soonduck Kim, Jesuk Lee; Korean J Epidemiol. 2007;29(2):155-164.

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Abstract PDF: Abstract
PURPOSE
This study was performed to provide the basic data in the establishment of preventive countermeasures for injury by analyzing the characteristics of injury, and risk factors of injury.
METHODS
From 2,059 injury patients among 19,947 patients admitted between January and December, 2004 at a university hospital located in Gyeonggi-do, 500 injury patients were sampled randomly by systematic sampling. A total of 500 questionnaires was collected and used for this study. The statistical SPSS was used to analyze data that included chi-square, fisher's exact test.
RESULTS
Injury patients among total admission patients was 10.3%. In both general characteristics of injury and non-injury patients, gender, age, length of stay was significant. As the cause of injury were compared with those of injury external causes, type, place, site, and time of injury were significant. As the cause of injury were compared with the characteristics of related-injury, surgery, multiple injuries, mental history, consciousness at the time emergency room visit, length stays were significant.
CONCLUSION
With regard to general characteristics, injury external causes, injury-related causes, and factors such as sex, age, occupation, and educational background were related to each other. Injury does not occur by accident or unexpectedly. Therefore, if preventive attention is focused on individuals with high risk factors of injury, the incidence rate will be diminished.; Summary

Analysis of Studies on Colorectal Cancers Published in Korean Medical Journals Between 1967 and 2004.: Eunkyoung Paik, Soonduck Kim, Jesuk Lee; Korean J Epidemiol. 2007;29(2):146-154.

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Abstract PDF: Abstract
PURPOSE
The study analyzed and categorized the colorectal cancers related medical journals published in Korea by the name of the journal, research materials, study method, statistical method and by content of study for the quality improvement of colorectal cancers related studies.
METHODS
The authors reviewed a total of 567 colorectal cancer-related studies published in the Korean medical journals during the period 1967 and 2004 and kept in the National Assembly Library. The distribution of research materials, study method, statistical method and content of these studies were analyzed by the 5 year publication interval.
RESULTS
By study period, the number of published studies steeply increase during the period between 2000 and 2004. As the research materials, hospital patients(64.6%) and In-vitro(16.6%) were the most prevalently used research materials, but health adults were the lowest research materials by only taking up 0.4%. In study methods, patient follow up studies(28.7%) and human in vitro experimental(27.9%) were prevalent, and human in vitro experimental were relatively the most popular performed studies during the years of 1990-1994. As the statistical method, life table and survival analysis(27.0%) were the mostly performed methods, and the use of statistical method was applied in nearly all studies. The contents of the studies mainly focused on the patient prognostic estimations(27.6%) of therapeutic safety & efficacy(25.6%), but only the 4.1% of risk factors studies. Among the 109 studies which analyzed the survival term 78.9% of the studies mainly used the 5 year term in the analysis of survival rates.
CONCLUSION
The results of the study could be utilized as the basic data for the quality improvement of further colorectal cancers related studies.; Summary

Plan and Operation of the 4th Korea National Health and Nutrition Examination Survey (KNHANES IV).: Kyungwon Oh, Jeongmi Lee, Bongsuk Lee, Sanghui Kweon, Yeonkyung Lee, Youngtaek Kim; Korean J Epidemiol. 2007;29(2):139-145.

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Abstract PDF: Abstract
The general aim of Korea National Health and Nutrition Examination Survey (KNHANES) was to assess the health and nutritional status in the Korean population. The KNHANES began in 1998 and has been conducting as a series of surveys : 1998(1st), 2001(2nd), 2005(3rd) and 2007-2009(4th). Specific aims were, in a cross-sectional study of nationally representative samples of the noninstitutionalized civilian Korean population aged > or = 1 year (4,600 households each year), to monitor trends the prevalence, awareness, treatment and control of selected chronic diseases, monitor trends in nutritional status and risk behaviors, and analyze risk factors for chronic diseases. For these purposes, with standardized high-quality methods, extensive data on health and nutrition are collected by health interview, health examination (physical examination, clinical measurements and tests) and dietary interview. In 2007, the 4th KNHANES became a continuous annual survey by highly trained field staff. In addition, the 4th KNHANES expanded examination components (addition of oral examination, pulmonary function test and laboratory test items such as ferritin, vitamin D, insulin, manganese, and arsenic), simplified survey procedure, and strengthened quality control. Further works will be focused on the selection of new examination and interview components, planning of KNHANES follow-up survey, continuous training of field staff and quality control, and improvement of dietary survey method.; Summary

The Current System and Future Directions of Health Examination Survey.: Soon Young Lee, Bo Youl Choi, Kyungwon Oh, Eunkyeong Jeong, Soo Jeong Kim; Korean J Epidemiol. 2007;29(2):129-138.

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PDF: Abstract; Summary

The Current Status and the Perspectives of Nutrition Survey.: Mi Kyung Kim, Kirang Kim, Cho Il Kim, Kyungwon Oh, Yoo Jin Oh, Bo Youl Choi; Korean J Epidemiol. 2007;29(2):111-128.

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Abstract PDF: Abstract
The Korea National Health and Nutrition Examination Survey is a nationwide health survey in Korea. This survey is composed of three parts: the Health Interview Survey, the Health Examination Survey, and the Nutrition Survey. The aim of this study was to refine the nutrition survey system in the Korean National Health and Nutrition Examination Survey (KNHANES). Based on the literature review, we summarized international survey systems and the limitations of the current system in Korea and proposed an improved system. We suggested the following: 1) A government agency which will be exclusively responsible for KNHANES overall is needed. 2) The current short-term nutrition survey should be a year-round survey. 3) The objectives of this survey should be written with more clarity and detail. 4) Biochemical measures in relation to nutritional status should be added. 5) The budget to set up various databases in the nutrition survey should be increased. 6) Various other issues should be addressed, including the definition of raw data (i.e., whether nutrient intake data per day is raw data), ethical issues in survey techniques, and strategies to produce evidence for the public using this survey data. Not all suggestions could be adopted in the short-term, but should be integrated into long-term goals for survey system improvement.; Summary

The Current Status and the Direction for Development of the Health Interview Survey.: Eunjeong Kang, Myoung Hee Kim, Yeon Kyeng Lee, Bo Youl Choi; Korean J Epidemiol. 2007;29(2):103-110.

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Abstract PDF: Abstract
The Health Interview Survey in the Korean National Health and Nutrition Examination Survey is a major source for planning and evaluating the national health promotion policy. The aim of the study is to find the areas for improvement of the current Health Interview Survey in light of its stated purpose and to propose possible means for the improvement. In terms of the survey content, there were several areas that needed improvement: the lack of comparability across the waves, the limit of the number of questions due to the Nutrition Survey and the Examination Survey, non-availability of seasonal statistics, and the dearth of evidence on socioeconomic position variables. To make improvements in the survey content, there is a need to clarify the purpose of the HIS in the KNANES. Second, more items need to be developed to produce the indicators of the Health Plan 2010. Third, core questions and elective questions should be defined. Fourth, multi-level socioeconomic position indicators need to be developed. In terms of the survey methods, the difficulty of managing interviewers and the inefficiency of data input and processing were found to be the areas for improvement. Possible solutions include a survey through the year and the introduction of the CAPI system. In addition, we suggest that a two-year survey period to better synchronize with the local health interview surveys which should be the major data source for the community health promotion plan.; Summary

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