Dae-Kyu Oh

Prospective Study of Optimal Obesity Index Cutoffs for Predicting Development of Multiple Metabolic Risk Factors: The Korean Genome and Epidemiology Study

Background In this prospective cohort study, we estimated the risk of developing more than 1 metabolic risk factor, using different obesity indices. In addition, we investigated the relative usefulness of the obesity indices for predicting development of such risk factors and calculated optimal cutoffs for the obesity indices. Methods The cohort comprised 10 038 representative residents of a small city and a rural county who were recruited in 2001–2002. Follow-up examinations were conducted every 2 years. Among the 3857 participants without metabolic syndrome at baseline, 1102 new cases occurred during the 6-year follow-up. Receiver operating characteristic (ROC) curves for the obesity indices were plotted to compare the usefulness of the obesity indices. Results The numbers of new cases of multiple metabolic risk factors among people in the highest quintiles of body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), and waist-height ratio at the baseline examination were 2 to 3 times those in the lowest quintiles. The area under the ROC curve for WHR was significantly higher than that for BMI. The optimal BMI cutoff was 24 kg/m2 in men and women, and the optimal WC cutoffs were 80 cm and 78 cm in men and women, respectively. Conclusions Both overall obesity and central obesity predicted risk of developing multiple metabolic risk factors, and WHR appeared to be a better discriminator than BMI. To prevent development of metabolic diseases among Koreans, it might be useful to lower the cutoff for abdominal obesity, as defined by WC.

The burden and characteristics of tuberculosis/human immunodeficiency virus (TB/HIV) in South Korea: a study from a population database and a survey.

BackgroundAlthough, in South Korea, human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS) keeps increasing and tuberculosis(TB) burden is still significant, there have been few reports on TB/HIV cases. In this study, we investigated the burden and characteristics of TB/HIV patients in South Korea, an area with intermediate burden of TB and a low prevalent area with HIV/AIDS.MethodsWe identified patients with TB and cases with HIV between January 1 2001 and December 31 2005, from nationwide reporting system (TBnet and HIV/AIDS registry) through an electronic record linkage method. A questionnaire survey was also conducted and determined the rate of diagnosis of HIV among TB cases in public health units in 2005.ResultsThe number of cases with both HIV and TB was 137 (0.07% among 197,562 TB cases) and the newly detected TB/HIV cases per 100,000 population was increasing annually: 2001, 0.025; 2002, 0.031; 2003, 0.025; 2004, 0.071; 2005, 0.095. Males between 20 and 59 years of age accounted for 87.6% of TB/HIV patients. Compared with patients with TB alone, those with TB/HIV had a higher percentage of extrapulmonary TB (8.0% vs 19.0%; p < 0.0001). The standardized prevalence ratio (SPR) of HIV among patients with TB was 18.46 (95% CI, 15.50-21.83). SPR of HIV among male TB patients aged 20-59 and extrapulmonary TB cases was 39.64 (95% CI, 32.87-47.40) and 43.21 (95% CI, 28.22-63.31) respectively. Through a questionnaire survey of public health units, six patients (0.08%) were confirmed as having HIV among 7,871 TB patients in public health centers in 2005, which is similar to the result from the study through nationwide reporting systems.ConclusionsThe prevalence rate of TB/HIV patients is still low but increasing in South Korea. Physicians should consider performing HIV tests among TB patients, especially in higher-risk groups, such as young males with extrapulmonary TB in South Korea.

Glutamine suppresses airway neutrophilia by blocking cytosolic phospholipase A(2) via an induction of MAPK phosphatase-1.

Neutrophils are inflammatory cells that may contribute in a crucial way to the pathophysiology of steroid-resistant severe asthma. We previously reported that the nonessential amino acid l-glutamine (Gln) suppressed the recruitment of neutrophils into the airway in a murine model of asthma. In this study, we investigated the mechanisms by which Gln exerts beneficial effects in airway neutrophilia. We used the model we previously developed, which is suitable for examining sequential early asthmatic events, including neutrophil infiltration. Gln suppressed airway neutrophilia in a CXC chemokine-independent way. Airway neutrophilia was associated with cytosolic phospholipase A2 (cPLA2) and 5-lipoxygenase (5-LO) activities. p38 MAPK, the upstream pathway of cPLA2 and 5-LO, played a key role in inducing airway neutrophilia. Gln inhibited not only the phosphorylation of cPLA2 and p38 MAPK but also leukotriene B4 levels in the airways. Gln induced the early induction of MAPK phosphatase-1 (MKP-1) protein, a negative regulator of p38. MKP-1 small interfering RNA abrogated all the effects of Gln. Our results suggest that pathways involving p38/cPLA2/5-LO have a major role in airway neutrophilia. Gln suppresses airway neutrophilia via inhibiting p38 MAPK and its downstream pathways in an MKP-1–dependent way, which may provide a novel therapeutic strategy for pulmonary neutrophilic inflammatory diseases.

Effects of Chronic Disease Management Based on Clinics for Blood Pressure or Glycemic Control in Patients with Hypertension or Type 2 Diabetes Mellitus

Objective: This study aimed to examine the effects of chronic disease management program based on clinics for blood pressure control or glycemic control in patients with hypertension or type 2 diabetes mellitus in Incheon. Methods: An observational follow up study was done on 11,501 patients registrated at clinics from January 1st to December 31st, 2010 in Incheon. Experience of education and mandatory laboratory tests were assessed with the registration data and income status was identified by National Health Insurance data. The odds ratio and 95% confidence intervals were derived from logistic regression models. Results: The experience of education has a positive effect for blood pressure control in the non-control group with hypertension at the time of registration (Odds ratio 1.357, confidence intervals: 1.112~1.655). The experience of mandatory laboratory tests has a positive effect for blood pressure control in the control group with hypertension at the time of registration (Odds ratio 1.738, confidence intervals: 1.387~2.178). But the effects of the experience of education and mandatory laboratory test in patients with type 2 diabetes mellitus were not identified. Conclusions: This study revealed the relationship between the experience of education or mandatory laboratory testing and blood pressure control in patients with hypertension.

IgG immune complex induces the recruitment of inflammatory cells into the airway and TNF-mediated late airway hyperresponsiveness via NF-κB activation in mice.

Background. Many of the inflammatory proteins that are expressed in asthmatic airways are regulated, at least partially, by nuclear factor (NF)-κB. Blockade of NF-κB activity has resulted in attenuation of the cardinal features of asthma. Thus, delineating the mechanisms involved in NF-κB activation in asthma might provide an interesting approach to improving the management of asthma. However, despite its importance, the mechanism for NF-κB activation in asthma has not yet been determined. Objective. To examine the role of IgE and IgG antibodies (Abs) in the activation of NF-κB in mouse lungs. Methods. To examine the effect of IgE, mice underwent intratracheal (i.t.) instillation of an IgE immune complex (IgE-IC) (anti-2,4-dinitrophenyl hapten (DNP) IgE + DNP-BSA or DNP-OVA) and anaphylactogenic anti-IgE (LO-ME-2). For IgG, mice underwent i.t. instillation with a complex of anti-chicken gamma globulin (CGG) IgG1 mAb + CGG. NF-κB activation was determined by gel shift assay. Small interfering RNA was used for blockade of p50 expression. The effect of tumor necrosis factor (TNF) blockade was determined using anti-TNF Ab. A previously established murine model of asthma was used to assess airway hyperresponsiveness (AHR). Results. A single i.t. instillation of either IgE-IC or LO-ME-2 failed to induce activation of NF-κB in the lungs. In contrast, single i.t. instillation of IgG-IC was capable of inducing NF-κB activation, as well as NF-κB-dependent proinflammatory molecules, such as TNF and CXC chemokines. Pretreatment of p50 small interfering RNA decreased bronchoalveolar lavage fluid levels of TNF and macrophage inflammatory protein-2 induced by IgG-IC instillation. Single i.t. instillation of IgG-IC caused the recruitment of neutrophils and macrophages into the airway and TNF-mediated late AHR, but failed to induce Th2 cell-mediated asthmatic phenotypes. Conclusion. IgG, but not IgE, is the major Ab that induces not only NF-κB activation and NF-κB-dependent proinflammatory molecules in the lungs but also subsequent recruitment of inflammatory cells into the airway and TNF-mediated late AHR.

The Effects of Adherence on Hypertension Control among Newly Diagnosed Hypertension Patients

Background: This study is to research on how hypertension control is associated with adherence in newly diagnosed hypertension patients. Methods: The study is based on 255,916 patients who were diagnosed with hypertension in 2009 and didn`t have any previous medical history of hypertension or associated complication for the past year using data collected by National Health Insurance Corporation. Newly diagnosed hypertension patients are divided into two group by visiting medical center numbers (more than 300 days was adherence group, if not non-adherence group). Patients are considered to have successfully controlled their hypertension based on blood pressure measured by health examination. Chi-square test and logistic regression, repeated measured analysis of variance was used to analyze. Results: The relations between adherence and hypertension control show that 1.12 times of patients in adherence group was able to control their hypertension. The additional analysis proves that adherence group are more decreased level of blood pressure than non-adherence group except for patients who are over 70. Comparison of the average of systolic blood pressure and diastolic blood pressure between adherence and non-adherence groups shows that the blood pressure has been significantly among the adherence group. Conclusion: The study proves that constant treatment for hypertension could control the blood pressure and encourages patients to put more effort for persistent treatment. It also shows that hypertension treatment are more effective in younger patients than the elderly and strategies of approaching are different depending on age.

Association of Cigarette Prices with the Prevalence of Smoking in Korean University Students: Analysis of Effects of the Tobacco Control Policy.

BACKGROUND Increased pricing of cigarettes might be one of the most effective approaches for reducing the prevalence of smoking. This study aimed to investigate the effects of increasing cigarette prices through taxation by a tobacco intervention policy on the changes in smoking prevalence in Korean university students. MATERIALS AND METHODS The participants in this study were 23,047 healthy university students aged 18-29 years from a health examination in 2011-2015. We investigated the adjusted prevalence of daily and occasional smoking before and after increasing cigarette prices through taxation. RESULTS The prevalence of occasional smoking was significantly decreased in 2015 from 2014 in both male (from 10.7% in 2014 to 5.4%) and female (from 3.6% to 1.1%) students, but the prevalence of daily smoking did not decrease significantly. The frequency of individuals who had attempted smoking cessation during the past year was significantly higher among occasional smokers in male students (90.2%) compared with daily smokers (64.9%). For female students, there were no differences in experience of smoking cessation, willingness for smoking cessation, or E-cigarette experience between daily and occasional smokers. CONCLUSIONS We found that a policy of increasing cigarette prices through taxation is associated with decreases in the prevalence of occasional smokers, who have relatively lower nicotine dependence compared with individuals who smoke daily. The results of our study suggest that social support and direct intervention for smoking cessation at the community level are needed for university students alongside the pricing policy.

The Effect of a Clinic Based Incentive Program on Medication Adherence among Patients with Hypertension or Diabetes Mellitus in Incheon

Background: This study was conducted to evaluate the factors affecting adherence in patients with hypertension and type 2 diabetes mellitus before and after a clinic based patient incentive program in Incheon. Methods: An observational follow-up study was done for 28,355 patients in one registered group and 245,598 patients in a non-registered group from March 16th 2009 to December 31th 2010 in Incheon. The registration, mandatory laboratory tests and number of clinic visits were collected by merging the Incheon Chronic Disease Management System data and the National Health Insurance Corporation (NHIC) data. As a measure of patient adherence, we used a variable of prescription days from the NHIC and defined above 80% of average prescription days as an appropriate patient adherence. Repeated measures analysis of variance and logistic regression were used to analyze the differences in patient adherence and factors affecting adherence. Results: The changes in prescription days for the registered group are larger than for the non-registered group. In the logistic regression model, including the variables with sex, age, income status and number of clinic visits, the registered group exhibited a higher Odds ratio in the patient adherence. Conclusion: This study revealed the association between registration and appropriate patient adherence in patients with hypertension or type 2 diabetes mellitus.

The Effects of Adherence and Hypertension Control on Complication among Newly Diagnosed Hypertension Patients

Background: This study aimed to research on how adherence and blood control could make a difference when it comes to develop complications. Methods: The study’s subjects were 255,916 patients who were newly diagnosed with hypertension in 2009 using data collected by National Health Insurance Cooperation. Patients are considered as a group under adherence if visit days and prescription days are more than 300 days. Patients are considered to have successfully controled their hypertension based on actual value measured by National Health Insurance Cooperation and the study takes a look at whether they were diagnosed with complications of cerebrocardiovascular disease in 2012. Chi-square test and logistic regression was used to analyze. Results: Patients who were able to control their hypertension show 0.80 times chance of developing cerebrovascular disease, and 0.89 times chance of developing cardiocerebrovascular disease. The group of adherence shows lower chance of developing complication in general than the group of non-adherence. Conclusion: The study revealed that hypertension’s constant treatment could control the blood pressure and prevent complications. It is important that encourages patients to effort for persistent treatment for reducing complication.

Suggestions for establishing a sustainable risk communication platform for carcinogenic factors.

Given the steady increase in the number of cancer patients and media reports on controversial carcinogens related to occupation and lifestyle, people’s interest in cancer is growing. Since the Korean government pledged to overcome cancer, establishing its “Conquering Cancer 10-Year Plan” in 1966, the “Conquering Cancer” policy has achieved an increased cancer survival rate; however, the number of cancer patients is constantly increasing, due to the factors of aging, lifestyle, and environment. Of those people who achieve the average life expectancy (77 years for men and 84 years for women), it is estimated that two out of five men (38.1%) and one out of three women (33.8%) will suffer from cancer [1]. Under these circumstances, recent media reports on the carcinogens found in everyday products such as drinks, bags, and sportswear—as well as an announcement by the International Agency for Research on Cancer (IARC) about the carcinogenicity of diesel combustion—have caused national repercussions and a debate about cancer risks. Individuals’ ability to communicate about various health risks through a variety of media, digital devices, and widespread social network services (SNS) has enabled social discourse and arguments to develop at a much faster rate than would have been the case in the age of traditional media. Topics addressed during various debates about carcinogens have ranged from the impact of short-term and local factors to the damage caused by longer-term and global factors. It is common for many risks faced in modern society (the “risk society”) to develop uncontrollably, even if they start as short-term or disconnected risks. Risk communications in modern society can be described as a long-term, complicated form of communication, in which various agents are intricately connected with one another—not the simple, one-way communication style of a single agent (for example, the government) communicating with the general public. This trend is increasingly reinforced through the development of new media such as the Internet, mobile devices, and SNS. For this reason, communications related to carcinogenic risk factors may evolve to an uncontrollable level because of one-sided media coverage and people’s excessive production of SNS messages. The most significant factors include the following: the gap between the risk perceptions of experts, government, and the general public; the general public’s lack of professional knowledge; the understanding imbalance between the expert group and the general public. All of these factors increase people’s distrust of information delivery and amplify their anxiety about risk factors. A process of agreement through mutual communication is therefore needed, essentially because social discourse about risk issues (being closely connected to socially formed value issues) cannot be created solely on the basis of objective, expert technical judgments. To establish national strategies for communicating carcinogenic risk factors to the public, while building a virtuous system of communication agents who can speak on behalf of the public, industry, media, and governments (including public institutions), researchers need to explore the following considerations: first, the ways in which information related to carcinogenic factors will flow; second, when and how people’s awareness, knowledge and attitudes toward carcinogenic factors are formed, together with how they change and respond; and third, when and how agents of communication at the national level should respond. The US has established an extensive survey data network called the Health Information National Trends Survey (HINTS), which provides data on how people use health facts, as well as information on various cancers, health communications, health service and Internet use, social networking, smoking, doctor-patient communications, sports, and nutrition. The HINTS was established by the Health Communication and Informatics Research Branch of Cancer Control and Population Sciences, an organization affiliated with the National Cancer Institute (NCI). NCI established HINTS because the rapidly changing environment for health communications led to an awareness of the monitoring problem. There was also a consensus on the need to examine people’s awareness of, attitude toward, and knowledge about various types of cancer, as well as their understanding of the environments available to effectively manage cancer. If surveys are conducted and analyzed continuously, it will become possible to systemically analyze people’s information data usage patterns and problems, as well as health communication differences in relation to types of cancer and the impact of the media on people. Developed countries actively conduct studies using big data to analyze and predict social issues in various ways. It is acknowledged that big data analysis can help detect developing risk issues, negative public opinions, and controversies, reducing the social costs of responding and acting to improve people’s quality of life and solve worldwide problems. One typical example involves Google, the global search engine, which, in 2009, calculated the frequency of search queries related to the flu, predicted flu activities in many countries around the world, and made its service available to users. In addition to these structured analyses, unstructured SNS-driven big data analysis has emerged as a central issue that currently influences various aspects of the public and private sectors. A study by Sadilek et al. [2] on big data processing showed how Twitter was used to identify disease factors, track the path of infection between individuals, and predict the spread of infectious diseases. Global positioning system (GPS)-tagged tweets (approximately 4.5 million), a subset of the 16 million tweets collected, were analyzed to extract those containing disease-related terms. From these, it was possible to derive a correlation between places where people with a disease factor were co-located, the size of their social networks, and their likelihood of contracting a disease. In the meantime, a study by Christakis & Fowler [3] that had been collecting data for 32 years, persuasively argued that the prevalence of obesity might partly be influenced by one’s social network. Between 1971 and 2003, the body mass index of 12,067 people in a specific area were collected and analyzed to assess whether their weight changes were correlated with the weight changes of friends, family members, neighbors, and other people around them. These studies indicate the need to consider SNS data in assessing potential health risks in the society.