Epidemiology and Health

Special Article

Evidence integration on health damage for humidifier disinfectant exposure and legal presumption of causation: Mina Ha, Taehyun Park, Jong-Hyun Lee, Younghee Kim, Jungyun Lim, Yong-Wook Baek, Sol Yu, Hyen-Mi Chung, Kyu Hyuck Chung, Hae-Kwan Cheong, Review Committee for the Epidemiological Correlations between Humidifier Disinfectants Exposure and Health Effects; Epidemiol Health. 2023;45:e2023095. Published online October 24, 2023; DOI: https://doi.org/10.4178/epih.e2023095

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Inhalation exposure to humidifier disinfectants has resulted to various types of health damages in Korea. To determine the epidemiological correlation necessary for presuming the legal causation, we aimed to develop a method to synthesize the entire evidence.
METHODS
Epidemiological and toxicological studies are systematically reviewed. Target health problems are selected by criteria such as frequent complaints of claimants. Relevant epidemiologic studies are reviewed and the risk of bias and confidence level of the total evidence are evaluated. Toxicological literature reviews are conducted on three lines of evidence including hazard information, animal studies, and mechanistic studies, considering the source-to-exposure-to-outcome continuum. The confidence level of the body of evidence is then translated into the toxicological evidence levels for the causality between humidifier disinfectant exposure and health effects. Finally, the levels of epidemiological and toxicological evidence are synthesized.
RESULTS
Under the Special Act revised in 2020, if the history of exposure and the disease occurred/worsened after exposure were approved, and the epidemiological correlation between the exposure and disease was verified, the legal causation is presumed unless the company proves the evidence against it. The epidemiological correlation can be verified through epidemiological investigations, health monitoring, cohort investigations and/or toxicological studies. It is not simply as statistical association as understood in judicial precedents, but a general causation established by the evidence as a whole, i.e., through weight-of-the-evidence approach.
CONCLUSIONS
The weight-of-the-evidence approach differs from the conclusive single study approach and this systematic evidence integration can be used in presumption of causation.; Summary

Korean summary
저자들은 가습기살균제 노출로 인한 건강피해의 법적 인과관계 추정요건인 역학적 상관관계를 확인하기 위한 과정으로서 체계적 문헌고찰과 역학과 독성학의 전체 과학적 근거를 체계적으로 종합하는 방법을 제시하였다. 이것은 법적 증거 방법에서 개별 연구가 가지는 제한점이나 불확실성을 이유로 배척하지 않고, 전체 증거의 부분으로서 종합적으로 접근하는 것을 통해 사실 관계에 도달하는 방법이다. 이 전체증거접근법은 향후 인과관계 추정에서 전범(model)이 될 수 있다.

Key Message
We establish a systematic method for integrating a body of scientific evidence of epidemiology and toxicology to verify the epidemiological correlation, which is essential for presuming legal causation of health damages due to exposure to humidifier disinfectants. In terms of a legal proof, this method does not exclude individual studies due to their limitations or uncertainty but integrates them as part of a body of evidence to arrive at a conclusion that better reflects the truth of the evidence. This weight-of-the-evidence approach can be a model for future causal inference.

COVID-19: Original Article

Effect of socioeconomic disparities on the risk of COVID-19 in 8 metropolitan cities in the Korea: a community-based study: Myung-Jae Hwang, Shin Young Park, Tae-Ho Yoon, Jinhwa Jang, Seon-Young Lee, Myeongsu Yoo, Yoo-Yeon Kim, Hae-Kwan Cheong, Donghyok Kwon, Jong-Hun Kim; Epidemiol Health. 2022;44:e2022107. Published online November 15, 2022; DOI: https://doi.org/10.4178/epih.e2022107

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Abstract

OBJECTIVES
Socioeconomic disparities have been reported as major risk factors contributing to the spread of coronavirus disease 2019 (COVID-19) at the community level. We conducted an epidemiological study on COVID-19 incidence risk using area-based deprivation indices (DIs) reflecting the characteristics of the susceptible population.

METHODS

A database of the confirmed COVID-19 cases in 8 metropolitan cities in Korea from January 20, 2020 to December 31, 2021 was combined with area-based DI scores and standardized prevalence rates of diabetes and hypertension from the Korean Community Health Survey. Relative risk (RR) levels were estimated using a generalized linear model with a Poisson distribution by age group.

RESULTS

The risk of COVID-19 incidence generally increased with increasing age, especially in patients aged ≥75 years. The RR of COVID-19 incidence per interquartile range increment of the composite deprivation index (composite DI) was 1.54 (95% confidence interval [CI], 1.34 to 1.70). Notably, in the first wave, the risk of COVID-19 incidence was approximately 3 times higher in the region with the lowest socioeconomic status than in the region with the highest status (RR, 3.08; 95% CI, 2.42 to 3.78 based on the the composite DI and RR, 3.13; 95% CI, 2.53 to 3.83 based on the social deprivation index).

CONCLUSIONS

This study provides scientific evidence that socioeconomic deprivation is an important risk factor for the spread of COVID-19. This finding suggests that a mid-term to long-term strategy is needed to protect susceptible populations and reduce the burden of COVID-19 in the community.

Summary

Korean summary
한국의 COVID-19 발생 위험은 지역박탈수준이 높은 지역에서 증가하였고, 특히 유행 초기 75세이상 연령층에서 뚜렷하게 증가하는 것으로 나타났다. 따라서 지역사회수준에서 사회경제적 여건을 고려하여 취약집단에서의 발생위험을 감소시키기 위해 중장기 전략을 세워야 한다는 것을 시사한다.

Key Message
There is a need to develop long-term strategies to reduce the risk of COVID-19 outbreaks in vulnerable populations in areas with poor socioeconomic conditions

Citations

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The current state of graphical abstracts and how to create good graphical abstracts
Jieun Lee, Jeong-Ju Yoo
Science Editing.2023; 10(1): 19. CrossRef
Social deprivation and SARS-CoV-2 testing: a population-based analysis in a highly contrasted southern France region
Jordi Landier, Léa Bassez, Marc-Karim Bendiane, Pascal Chaud, Florian Franke, Steve Nauleau, Fabrice Danjou, Philippe Malfait, Stanislas Rebaudet, Jean Gaudart
Frontiers in Public Health.2023;[Epub] CrossRef

Data Profile

Establishment of the Korea National Health and Nutrition Examination Survey air pollution study dataset for the researchers on the health impact of ambient air pollution: Myung-Jae Hwang, Jisun Sung, Miryoung Yoon, Jong-Hun Kim, Hui-Young Yun, Dae-Ryun Choi, Youn-Seo Koo, Kyungwon Oh, Sungha Yun, Hae-Kwan Cheong; Epidemiol Health. 2021;43:e2021015. Published online February 8, 2021; DOI: https://doi.org/10.4178/epih.e2021015

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Abstract

To provide a nationwide representative dataset for the study on health impact of air pollution, we combined the data from the Korea National Health and Nutrition Examination Survey with the daily air quality and weather data by matching the date of examination and the residential address of the participants. The database of meteorological factors and air quality as sources of exposure data were estimated using the Community Multiscale Air Quality model. The linkage dataset was merged by three ways; administrative district, si-gun-gu (city, county, and district), and geocode (in latitude and longitude coordinate units) based on the participants’ residential address, respectively. During the study period, the exposure dataset of 85,018 individuals (38,306 men and 46,712 women) whose examination dates were recorded were obtained. According to the definition of exposure period, the dataset was combined with the data on short-term, mid-term, and long-term exposure to air pollutants and the meteorological indices. Calculation of the daily merged dataset’s average air pollution linked by si-gun-gu and geocode units showed similar results. This study generated a daily average of meteorological indices and air pollution exposure dataset for all regions including rural and remote areas in Korea for 11 years. It is expected to provide a platform for the researchers studying the health impact of air pollution and climate change on the representative population and area, which may facilitate the establishment of local health care plans by understanding the residents’ health status at the local as well as national level.

Summary

Korean summary
-2007년부터 2017년까지 11년간 국민건강영양조사의 검진조사 대상자의 검진일자와 지리정보를 기준으로 85,018명에 대해 기상 및 대기오염 모델링 자료를 결합하여 조사 대상자의 거주지주소를 이용하여 시·군·구 단위와 주소 기반 위경도 좌표를 기준으로 각각 노출자료를 결합함. -대기오염의 단기노출, 중기노출, 장기노출의 건강영향을 평가하기 위해 지연효과(lag effect)를 적용하여 각 건강자료와 결합함. -기상 및 대기오염 모델링 자료와 연계된 국민건강영양조사의 활용을 위한 data profile을 제시함.

Key Message
-We built a dataset for air pollution research by combining meteorological and air pollution modeling data through CMAQ for 85,018 individuals based on the date of examination and geographic information of the Korea National Health and Nutrition Examination Survey participants for 11 years, from 2007 to 2017. -Each exposure data was combined based on si-gun-gu (city, county, and district) and geocode (in latitude and longitude coordinate units) based on the participants’ residential address. -To evaluate the health effects of short-, medium- and long-term air pollution exposure, the lag values of days, months, and years was applied and combined with each health data. -A data profile was presented for the Korea National Health and Nutrition Examination Survey linked to meteorological and air pollution modeling data.

Citations

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Association between ambient particulate matter levels and hypertension: results from the Korean Genome and Epidemiology Study
Sewhan Na, Jong-Tae Park, Seungbeom Kim, Jinwoo Han, Saemi Jung, Kyeongmin Kwak
Annals of Occupational and Environmental Medicine.2023;[Epub] CrossRef
Effect of Short- to Long-Term Exposure to Ambient Particulate Matter on Cognitive Function in a Cohort of Middle-Aged and Older Adults: KoGES
Jane J. Lee, Ji Hyun Kim, Dae Sub Song, Kyoungho Lee
International Journal of Environmental Research and Public Health.2022; 19(16): 9913. CrossRef
Long-Term Effects of Ambient Particulate and Gaseous Pollutants on Serum High-Sensitivity C-Reactive Protein Levels: A Cross-Sectional Study Using KoGES-HEXA Data
Ji Hyun Kim, Hae Dong Woo, Sunho Choi, Dae Sub Song, Jung Hyun Lee, Kyoungho Lee
International Journal of Environmental Research and Public Health.2022; 19(18): 11585. CrossRef
Effects of exposure to ambient air pollution on pulmonary function impairment in Korea: the 2007-2017 Korea National Health and Nutritional Examination Survey
Soo Beom Choi, Sungha Yun, Sun-Ja Kim, Yong Bum Park, Kyungwon Oh
Epidemiology and Health.2021; 43: e2021082. CrossRef

Original Articles

A small window into the status of malaria in North Korea: estimation of imported malaria incidence among visitors from South Korea: Jisun Sung, Hae-Kwan Cheong, Ah-Young Lim, Jong-Hun Kim; Epidemiol Health. 2020;42:e2020068. Published online November 21, 2020; DOI: https://doi.org/10.4178/epih.e2020068

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Abstract Summary PDF: Abstract
OBJECTIVES
This study aimed to develop hypotheses on trends in malaria incidence in North Korea using malaria incidence among South Korean visitors to North Korea.
METHODS
The number of South Korean tourists who visited Mount Kumgang from 2000 to 2008 and the number of South Korean employees at the Kaesong Industrial Complex from 2005 to 2015 were obtained from the Korean Statistical Information Service. The number of malaria cases among South Koreans who visited North Korea was obtained from a previous report. The incidence of malaria per 100,000 person-years was calculated using these data and compared with the malaria incidence in North Korea derived from published articles.
RESULTS
A high incidence of malaria in 2001 and a sharp decline in the following years were observed in both South and North Korean data. Since then, North Korean data showed a relatively low and stable incidence, but the incidence among South Koreans visiting North Korea increased in 2006. Considering the trends in mass primaquine preventive treatment, floods, and economic growth rate, the incidence of malaria may have increased in North Korea in 2006. Since 2009, the incidence of malaria decreased gradually according to both South and North Korean data.
CONCLUSIONS
The trends of malaria incidence in North Korea could be reflected through its incidence among South Koreans who visited North Korea. For future inter-Korean collaboration aiming to eradicate malaria, we propose that a North Korean malaria monitoring system be established applying this method.; Summary

Korean summary
본 연구는 2000-2008년 금강산을 여행한 대한민국 국민과 2005-2015년 개성공단에서 근무한 대한민국 국민에서의 말라리아 발생률을 추정하여 국제사회에 보고된 북한의 말라리아 발생률과 비교 평가하였다. 향후 남북한의 교류가 활성화 되었을 때 북한을 방문하고 돌아온 국민에서의 말라리아 발생률 자료를 사용하여 북한 현지에서의 말라리아 발생률 현황 추이를 살펴볼 수 있을 것으로 보인다.

Trends of accidental carbon monoxide poisoning in Korea, 1951-2018: Jong-Hun Kim, Ah-Young Lim, Hae-Kwan Cheong; Epidemiol Health. 2020;42:e2020062. Published online August 31, 2020; DOI: https://doi.org/10.4178/epih.e2020062

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Carbon monoxide (CO) poisoning from coal briquette combustion has been a major public health problem in Korea. In this study, we estimated the time trends of the consumption of anthracite coal and the number of CO poisoning victims over the past 7 decades, in the context of changes in heating facilities.

METHODS

Using Population and Housing Census data and energy statistics, we estimated the number of houses using briquettes as heating fuel between 1951 and 2018. After estimating the incidence of CO poisoning in housing units by heating facility type, we determined the ratio of the number of household members who experienced CO poisoning to the overall number of household members. Finally, we estimated the distribution of the victims according to poisoning severity, excluding victims of intentional exposure.

RESULTS

We estimated that, overall, over 26 million people experienced CO poisoning between 1951 and 2018 in Korea. The household consumption of anthracite peaked in 1986, but the number of victims of CO poisoning peaked at approximately 1 million people in 1980. From 1951 to 2018, the cumulative number of CO poisoning victims comprised approximately 22,830,000 mild cases, 3,570,000 severe cases, and 65,000 deaths.

CONCLUSIONS

The peak in the number of CO poisoning victims occurred 6 years earlier than the peak in the number of people using briquettes for heating. This gap resulted from improvements in briquette heating systems. This finding provides a quantitative basis for epidemiological studies on the health outcomes of CO poisoning in the Korean population.

Summary

Korean summary
과거에 연탄을 난방 연료로 사용함으로써 발생하였던 일산화탄소 중독 사고는 한국 사회에서 주요한 공중 보건 문제였다. 본 연구에서는 지난 70년간 연탄 소비에 따른 일산화탄소 중독 피해자 규모를 추정하였다. 본 연구에서 산출된 결과들은 일산화탄소 중독으로 인하여 지속적으로 나타날 수 있는 건강 피해에 대한 역학 연구의 정량적 근거를 제공하고 있다.

Citations

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Trends in mortality related to unintentional poisoning in the South Asian region from 1990 to 2019: analysis of data from the Global Burden of Disease Study
Nadeem Ullah Khan, Uzma Khan, Umerdad Khudadad, Asrar Ali, Ahmed Raheem, Shahan Waheed, Junaid Abdul Razzak
BMJ Open.2023; 13(2): e062744. CrossRef
Prevalence of Carbon Monoxide Poisoning and Hyperbaric Oxygen Therapy in Korea: Analysis of National Claims Data in 2010–2019
Eunah Han, Gina Yu, Hye Sun Lee, Goeun Park, Sung Phil Chung
Journal of Korean Medical Science.2023;[Epub] CrossRef
Acute carbon monoxide poisoning in Shandong, China: an observational study
Lina Zhang, Di Wu, Mingyue Xu, Yonghui Bian, Youcun Wang, Guangkai Gao, Qing Sun
Chinese Medical Journal.2022; 135(13): 1539. CrossRef
Development of delayed neurologic sequelae in acute carbon monoxide poisoning cases caused by briquette-based kotatsu
Makoto Onodera, Yasuhiko Tsukada, Tsuyoshi Suzuki, Kotaro Sorimachi, Kenichi Ebihara, Lubna Sato, Rie Zenda, Satoshi Ueno, Kazuki Sugaya, Ken Iseki
Medicine.2021; 100(16): e25009. CrossRef

Ambient air quality and subjective stress level using Community Health Survey data in Korea: Myung-Jae Hwang, Hae-Kwan Cheong, Jong-Hun Kim, Youn Seo Koo, Hui-Young Yun; Epidemiol Health. 2018;40:e2018028. Published online June 28, 2018; DOI: https://doi.org/10.4178/epih.e2018028

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Air pollution causes various disease in exposed populations, and can lead to premorbid health effects manifested as both physical and psychological functional impairment. The present study investigated the subjective stress level in daily life in relation to the level of air pollution.

METHODS

Data from the Community Health Survey (2013), comprising 99,162 men, and 121,273 women residing in 253 healthcare administrative districts, were combined with air pollutant concentration modelling data from the Korean Air Quality Forecasting System, and were stratified by subjective stress levels into five strata for multiple logistic regression. Levels of exposure were divided into five quintiles according to the annual concentration of nitrogen dioxide (NO2), and were analyzed using a single-pollutant model using NO2 concentration only, and a multi-pollutant model adjusted for the concentration of particulate matter <10 μm in diameter.

RESULTS

Analysis of men and women in various age groups showed the highest odds ratio (OR) for subjective stress level at the highest NO2 concentration quintile in men and women aged 30–64 years (men: 2.91; 95% confidence interval [CI], 2.12 to 4.01; women: 1.82; 95% CI, 1.32 to 2.51). As the NO2 concentration quintile increased, the OR increased. Men showed higher ORs than women in all strata.

CONCLUSIONS

In the present study, annual NO2 concentrations were found to be associated with subjective stress levels. This association was especially clear among socioeconomically active men and women aged 30-64 years.

Summary

Korean summary
2013년 지역사회건강조사를 이용하여 253개 보건행정지역단위로 Korean Air Quality Forecasting System (KAQFS) 대기물질농도 모델링자료를 결합하여 주관적 스트레스 정도에 따라 5분위로 범주화하여 다항로지스틱회귀을 하였다. 본 연구에서는 연평균 NO2농도와 주관적 스트레스 정도가 관련이 있는 것으로 나타났다. 특히, 사회 경제적 활동이 활발한30세 이상 65세 미만의 남성과 여성에서 관련성이 뚜렷하게 나타났다.

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Climate change and mental health in Korea: A scoping review
Jiyoung Shin, Juha Baek, Sumi Chae
Journal of Climate Change Research.2023; 14(6-2): 989. CrossRef
Long-term air pollution exposure, greenspace and health-related quality of life in the ECRHS study
Anne Boudier, Iana Markevych, Bénédicte Jacquemin, Michael J. Abramson, Simone Accordini, Bertil Forsberg, Elaine Fuertes, Judith Garcia-Aymerich, Joachim Heinrich, Ane Johannessen, Bénédicte Leynaert, Isabelle Pin, Valérie Siroux
Science of The Total Environment.2022; 849: 157693. CrossRef
The impact of black carbon (BC) on mode-specific galvanic skin response (GSR) as a measure of stress in urban environments
Xiuleng Yang, Juan Pablo Orjuela, Emma McCoy, Guillem Vich, Esther Anaya-Boig, Ione Avila-Palencia, Christian Brand, Glòria Carrasco-Turigas, Evi Dons, Regine Gerike, Thomas Götschi, Mark Nieuwenhuijsen, Luc Int Panis, Arnout Standaert, Audrey de Nazelle
Environmental Research.2022; 214: 114083. CrossRef
Effects of ambient air pollution on psychological stress and anxiety disorder: a systematic review and meta-analysis of epidemiological evidence
Tanwi Trushna, Vikas Dhiman, Dharma Raj, Rajnarayan R. Tiwari
Reviews on Environmental Health.2021; 36(4): 501. CrossRef
Green space, air pollution, traffic noise and saliva cortisol in children
Lizan D. Bloemsma, Alet H. Wijga, Jochem O. Klompmaker, Gerard Hoek, Nicole A. H. Janssen, Marieke Oldenwening, Gerard H. Koppelman, Erik Lebret, Bert Brunekreef, Ulrike Gehring
Environmental Epidemiology.2021; 5(2): e141. CrossRef
Effects of exposure to ambient air pollution on pulmonary function impairment in Korea: the 2007-2017 Korea National Health and Nutritional Examination Survey
Soo Beom Choi, Sungha Yun, Sun-Ja Kim, Yong Bum Park, Kyungwon Oh
Epidemiology and Health.2021; 43: e2021082. CrossRef
Impacts of ambient air pollution on glucose metabolism in Korean adults: a Korea National Health and Nutrition Examination Survey study
Myung-Jae Hwang, Jong-Hun Kim, Youn-Seo Koo, Hui-Young Yun, Hae-Kwan Cheong
Environmental Health.2020;[Epub] CrossRef
A Development of PM Concentration Reanalysis Method using CMAQ with Surface Data Assimilation and MAIAC AOD in Korea
Youn-Seo Koo, Dae-Ryun Choi, Hui-Young Yun, Geon-Woo Yoon, Joung-Beom Lee
Journal of Korean Society for Atmospheric Environment.2020; 36(4): 558. CrossRef
Short-Term Impacts of Ambient Air Pollution on Health-Related Quality of Life: A Korea Health Panel Survey Study
Myung-Jae Hwang, Jong-Hun Kim, Hae-Kwan Cheong
International Journal of Environmental Research and Public Health.2020; 17(23): 9128. CrossRef

Asymptomatic Middle East Respiratory Syndrome coronavirus infection using a serologic survey in Korea: Yeong-jun Song, Jeong-Sun Yang, Hee Jung Yoon, Hae-Sung Nam, Soon Young Lee, Hae-Kwan Cheong, Woo-Jung Park, Sung Han Park, Bo Youl Choi, Sung Soon Kim, Moran Ki; Epidemiol Health. 2018;40:e2018014. Published online April 15, 2018; DOI: https://doi.org/10.4178/epih.e2018014

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Abstract Summary PDF

Abstract

OBJECTIVES
The rates of asymptomatic infection with Middle East Respiratory Syndrome (MERS) coronavirus vary. A serologic study was conducted to determine the asymptomatic MERS infection rate in healthcare workers and non-healthcare workers by exposure status.

METHODS

Study participants were selected from contacts of MERS patients based on a priority system in 4 regions strongly affected by the 2015 MERS outbreak. A sero-epidemiological survey was performed in 1,610 contacts (average duration from exposure to test, 4.8 months), and the collected sera were tested using an enzyme-linked immunespecific assay (ELISA), immunofluorescence assay (IFA), and plaque reduction neutralization antibody test (PRNT). Among the 1,610 contacts, there were 7 ELISA-positive cases, of which 1 exhibited positive IFA and PRNT results.

RESULTS

The asymptomatic infection rate was 0.060% (95% confidence interval, 0.002 to 0.346). The asymptomatic MERS case was a patient who had been hospitalized with patient zero on the same floor of the hospital at the same time. The case was quarantined at home for 2 weeks after discharge, and had underlying diseases, including hypertension, angina, and degenerative arthritis.

CONCLUSIONS

The asymptomatic infection was acquired via healthcare-associated transmission. Thus, it is necessary to extend serologic studies to include inpatient contacts who have no symptoms.

Summary

Korean summary
2015년 국내 MERS 유행시에 자가격리를 시행하였던 접촉자 약 15,000명 (의료인과 비의료인 포함) 중에서 주요 유행지역, 노출 강도 등을 고려하여 선별된 3,291명을 대상으로 무증상 감염여부를 확인하기 위한 혈청 역학조사를 수행하였다. 최종 검사에 참여한 1,610명 중에서 7명이 ELISA 양성 반응을 보였고, 그 중 1명이 IFA와 PRNT에서도 양성 반응을 보여 무증상 감염률은 0.060%(95% CI: 0.002-0.346)로 기존 연구에 비하여 낮았다. 최종 양성을 보인 1명은 노출 당시 1번환자와 가까운 병실에 입원하였던 환자였다.

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MERS-CoV seroconversion amongst Malaysian Hajj pilgrims returning from the Middle East, 2016–2018: results from the MERCURIAL multiyear prospective cohort study
Jefree Johari, Robert D. Hontz, Brian L. Pike, Tupur Husain, Norhayati Rusli, Rozainanee Mohd-Zain, Vunjia Tiong, Hai-Yen Lee, Boon-Teong Teoh, Sing-Sin Sam, Chee-Sieng Khor, Shih-Keng Loong, Juraina Abd-Jamil, Siti-Sarah Nor'e, Hasmawati Yahaya, Naim Che
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Rapid diagnostics of coronavirus disease 2019 in early stages using nanobiosensors: Challenges and opportunities
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Talanta.2021; 223: 121704. CrossRef
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Estimation of the size of the iatrogenic Creutzfeldt-Jakob disease outbreak associated with cadaveric dura mater grafts in Korea: Byoung-Hak Jeon, Jinseob Kim, Ganghyun Kim, Soochul Park, SangYun Kim, Hae-Kwan Cheong; Epidemiol Health. 2016;38:e2016059. Published online December 19, 2016; DOI: https://doi.org/10.4178/epih.e2016059

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Abstract Summary PDF

Abstract

OBJECTIVES
This study estimated the overall incidence of iatrogenic Creutzfeldt-Jakob disease (iCJD) based on dura graft cases in Korea using a mathematical model.

METHODS

We estimated the number of annual dura grafts performed between 1980 and 1995 by applying the proportion of dura grafts recorded by the Health Insurance Review Agency claim dataset in Korea to the number of nationwide neurosurgery cases. The distribution of the incubation period was assumed to fall under a Weibull distribution with density function or a log-logistic distribution with density function.

RESULTS

The total number of neurosurgery procedures performed from 1980 to 1995 was estimated to be 263,945, and among those operations, 37% used dura graft products. Between the years of 1980 and 2020, our model predicted that the total number of iCJD cases would be between 14.9 and 33.2 (95% confidence interval [CI], 13.4 to 50.9). Notably, we estimated that the cumulative number of iCJD cases caused by dura grafts between 1980 and 2011 was approximately 13.3 to 27.3 (95% CI, 12.2 to 40.6).

CONCLUSIONS

Based on our model, we postulate that the incidence of iCJD will sharply decline from 2012 to 2020. However, additional new cases are still expected, which necessitates a strong national surveillance system.

Summary

Korean summary
국내 경막유래 의인성 크로이츠펠트-증후군 환자의 발생규모 추정 본 연구는 국내 가용한 모든 자료원을 활용하여 국내 의인성 CJD 위험인구를 추산하고 이를기반으로 발생 가능한 의인성 CJD 환자의 규모를 수학적 모형을 통해 추산하는 것을 목적으로 시행하였으며, 예측모형 결과 2020년까지 가파르게 감소할것으로 보이나, 추가 발생에 대비한 국가감시체계의 강화가 필요할것으로 사료된다.

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Interventions to reduce the risk of surgically transmitted Creutzfeldt–Jakob disease: a cost-effective modelling review
Matt Stevenson, Lesley Uttley, Jeremy E Oakley, Christopher Carroll, Stephen E Chick, Ruth Wong
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MERS-Original Article

Preventive behaviors by the level of perceived infection sensitivity during the Korea outbreak of Middle East Respiratory Syndrome in 2015: Soon Young Lee, Hee Jeong Yang, Gawon Kim, Hae-Kwan Cheong, Bo Youl Choi; Epidemiol Health. 2016;38:e2016051. Published online November 16, 2016; DOI: https://doi.org/10.4178/epih.e2016051

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study was performed to investigate the relationship between community residents’ infection sensitivity and their levels of preventive behaviors during the 2015 Middle East Respiratory Syndrome (MERS) outbreak in Korea.

METHODS

Seven thousands two hundreds eighty one participants from nine areas in Gyeonggi-do including Pyeongtaek, the origin of the outbreak in 2015 agreed to participate in the survey and the data from 6,739 participants were included in the final analysis. The data on the perceived infection sensitivity were subjected to cluster analysis. The levels of stress, reliability/practice of preventive behaviors, hand washing practice and policy credibility during the outbreak period were analyzed for each cluster.

RESULTS

Cluster analysis of infection sensitivity due to the MERS outbreak resulted in classification of participants into four groups: the non-sensitive group (14.5%), social concern group (17.4%), neutral group (29.1%), and overall sensitive group (39.0%). A logistic regression analysis found that the overall sensitive group with high sensitivity had higher stress levels (17.80; 95% confidence interval [CI], 13.77 to 23.00), higher reliability on preventive behaviors (5.81; 95% CI, 4.84 to 6.98), higher practice of preventive behaviors (4.53; 95% CI, 3.83 to 5.37) and higher practice of hand washing (2.71; 95% CI, 2.13 to 3.43) during the outbreak period, compared to the non-sensitive group.

CONCLUSIONS

Infection sensitivity of community residents during the MERS outbreak correlated with gender, age, occupation, and health behaviors. When there is an outbreak in the community, there is need to maintain a certain level of sensitivity while reducing excessive stress, as well as promote the practice of preventive behaviors among local residents. In particular, target groups need to be notified and policies need to be established with a consideration of the socio-demographic characteristics of the community.

Summary

Korean summary
2015년 한국에서 발생한 메르스 유행 시 지역 주민이 인식하는 민감도와 예방행위 수준을 파악하고 연관성을 밝히고자 2015년 경기도 9개 시의 지역사회건강조사 대상자 6,739명을 대상으로 감염 민감도와 예방행위 등을 조사 분석하였다. 감염 민감도는 성별, 연령, 직업, 건강행위와 연관성이 있었으며, 감염에 대한 민감도가 높을수록 스트레스를 많이 받는 한편, 예방행위 실천에 긍정적인 영향을 미침을 알 수 있었다. 따라서 감염병 유행 시 지나친 스트레스는 줄이되 공중보건 위기에 대한 적정 수준의 민감도를 유지하고, 인구사회학적 특성을 고려한 관리정책이 요구된다.

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Ronel Sewpaul, Musawenkosi Mabaso, Allanise Cloete, Natisha Dukhi, Inbarani Naidoo, Adlai S Davids, Tholang Mokhele, Khangelani Zuma, Sasiragha Priscilla Reddy
Psychology, Health & Medicine.2023; 28(1): 260. CrossRef
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Won Mo Jang, Un-Na Kim, Deok Hyun Jang, Hyemin Jung, Sanghyun Cho, Sang Jun Eun, Jin Yong Lee
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Mi Ah Han
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MERS-Original Article

Epidemiologic features of the first MERS outbreak in Korea: focus on Pyeongtaek St. Mary’s Hospital: Kyung Min Kim, Moran Ki, Sung-il Cho, Minki Sung, Jin Kwan Hong, Hae-Kwan Cheong, Jong-Hun Kim, Sang-Eun Lee, Changhwan Lee, Keon-Joo Lee, Yong-Shik Park, Seung Woo Kim, Bo Youl Choi; Epidemiol Health. 2015;37:e2015041. Published online September 17, 2015; DOI: https://doi.org/10.4178/epih/e2015041

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study investigated the epidemiologic features of the confirmed cases of Middle East Respiratory Syndrome (MERS) in Pyeongtaek St. Mary’s Hospital, where the outbreak first began, in order to identify lessons relevant for the prevention and control of future outbreaks.

METHODS

The patients’ clinical symptoms and test results were collected from their medical records. The caregivers of patients were identified by phone calls.

RESULTS

After patient zero (case #1) was admitted to Pyeongtaek St. Mary’s Hospital (May 15-May 17), an outbreak occurred, with 36 cases between May 18 and June 4, 2015. Six patients died (fatality rate, 16.7%). Twenty-six cases occurred in the first-generation, and 10 in the second-generation. The median incubation period was five days, while the median period from symptom onset to death was 12.5 days. While the total attack rate was 3.9%, the attack rate among inpatients was 7.6%, and the inpatients on the eighth floor, where patient zero was hospitalized, had an 18.6% attack rate. In contrast, caregivers and medical staff showed attack rates of 3.3% and 1.1%, respectively.

CONCLUSIONS

The attack rates were higher than those of the previous outbreaks in other countries. The outbreak spread beyond Pyeongtaek St. Mary’s Hospital when four of the patients were moved to other hospitals without appropriate quarantine. The best method of preventing future outbreaks is to overcome the vulnerabilities observed in this outbreak, such as ward crowding, patient migration without appropriate data sharing, and the lack of an initial broad quarantine.

Summary

Korean summary
평택성모병원에서는 총 36명의 메르스 환자가 발생하여 이중 6명이 사망하였다. 또한 평택성모병원 유행의 발병률은 기존에 알려진 것보다 높았다. 한국의 메르스 유행이 시작된 평택성모병원에서 나타난 초기 방역 부족, 적절한 정보공유 없이 환자들이 병원간에 이동하는 것, 혼잡한 병동 문제 등의 감염병 전파 취약점을 극복하는 것이 향후 새로운 감염병 유행을 막을 수 있는 최선의 방법이 될 것이다.

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Original Articles

The Validity and Reliability of Characterizing Epilepsy Based on an External Review of Medical Records: Bong Su Kang, Hae-Kwan Cheong, Ki-Young Jung, Sang Hyeon Jang, Jae Kook Yoo, Dong Wook Kim, Soo-Eun Chung, Seo-Young Lee; Epidemiol Health. 2013;35:e2013006. Published online August 23, 2013; DOI: https://doi.org/10.4178/epih/e2013006

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Abstract PDF

Abstract

<sec><title>OBJECTIVES</title>Our goal is to validate diagnosing and characterizing epilepsy based on a medical record survey by external reviewers.</sec><sec><title>METHODS</title>We reviewed medical records from 80 patients who received antiepileptic drugs in 2009 at two hospitals. The study consisted of two steps; data abstraction by certified health record administrators and then verification by the investigators. The gold standard was the results of the survey performed by the epileptologists from their own hospital.</sec><sec><title>RESULTS</title>The specificity was more than 90.0% for diagnosis and activity, and for new-onset seizures. The sensitivity was 97.0% or more for diagnosis and activity and 66.7-75.0% for new-onset epilepsy. This method accurately classified epileptic syndromes in 90.2-92.9% of patients, causes in 85.4-92.7%, and age of onset in 78.0-81.0%. Kappa statistics for inter-rater reliability and test-retest reliability ranged from 0.641-0.975, which means substantial to near-perfect agreement in all items.</sec><sec><title>CONCLUSIONS</title>Our data suggest that epilepsy can be well identified by external review of medical records. This method may be useful as a basis for large-scale epidemiological research.</sec>

Summary

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Burden of Disease of Multiple Sclerosis in Korea: Soo-Eun Chung, Hae-Kwan Cheong, Jae-Hyun Park, Ho Jin Kim; Epidemiol Health. 2012;34:e2012008. Published online November 30, 2012; DOI: https://doi.org/10.4178/epih/e2012008

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Abstract

<sec><title>OBJECTIVES</title>Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. There are few reports on the burden of disease of MS, worldwide. The authors aim to estimate burden of disease and estimate the epidemiologic indexes of MS in Korea using available epidemiologic data.</sec><sec><title>METHODS</title>Epidemiologic indexes were computed using DISMOD II software based on prevalence from nationwide survey, incidence estimated from extrapolation, mortality from National Statistics Office, and duration of disease from literature as input indexes. We calculated disability-adjusted life year (DALY) as a measure of premature mortality and disability, equivalent to years of healthy life lost due to a given condition.</sec><sec><title>RESULTS</title>The incidence of MS in Korea was 0.1 per 100,000, higher in female than in male. The highest incidence was estimated in the age group between 35 and 44 years in male and age group between 25 and 29 years in female. Total burden of disease of MS was 1,394 DALY, comprised of 292 (21%) years of life lost and 1,101 (79%) years lived with disability. The mean age at onset of MS was 33 years old in men and 32 years old in female. Estimated duration of disease was 35 years in men and 40 years in female. Most of the DALY of MS occurred in the adult population between 25 and 54 years of age.</sec><sec><title>CONCLUSION</title>Although MS is a rare disease in Korea, most of the DALY arises from young people, which results in a major financial burden on the patient, family, health system and society.</sec>

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Brief Communication

A Fatal Case of Disseminated Tuberculosis Coincident with Measles-Rubella Vaccination: Hae-Kwan Cheong, Byung-Guk Yang, Young Mo Sohn, Il-Hoon Kwon, Jun Chul Kim, Hangmi Kim, Jung Ran Kim; Epidemiol Health. 2010;32:e2010002. Published online April 26, 2010; DOI: https://doi.org/10.4178/epih/e2010002

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The authors report a fatal case of disseminated tuberculosis in a 14-yr-old girl, which developed immediately after a measles-rubella (MR) vaccination. Despite a markedly accelerated clinical course which led to death within two weeks, the authors could not identify any possible cause of the tuberculosis aggravation in this case, with the exception of the MR vaccination. The possible role that MR vaccination had on the clinical course of tuberculosis in this case is discussed.; Summary

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