Hyeongsu Kim

The clinical role of IL‐23p19 in patients with rheumatoid arthritis

Objective: To determine the clinical implications of the over‐expression of synovial and circulating interleukin (IL)‐23p19 and the correlation between IL‐23p19 and other cytokines such as IL‐17, tumour necrosis factor (TNF)α, and IL‐1β in rheumatoid arthritis (RA). Methods: Synovial fluid (SF) and sera of 22 patients with RA were obtained during knee arthrocentesis and stored at −20°C. Tender/swollen joint counts, 100‐mm visual analogue scale (VAS), erythrocyte sedimentation rate (ESR), C‐reactive protein (CRP), rheumatoid factor (RF), and antibodies to cyclic citrullinated peptide (anti‐CCP Ab) were measured. Bony erosions were determined by X‐rays. Serum and SF IL‐23p19, IL‐17, TNFα, and IL‐1β concentrations were measured by sandwich enzyme‐linked immunosorbent assay (ELISA). Results: The concentration of IL‐23p19 correlated with the concentration of IL‐17 in SF and sera, and with the concentrations of TNFα and IL‐1β in sera. SF IL‐23p19 concentration was higher in patients who had bony erosions than those who had not. However, there was no correlation between IL‐23p19 concentrations and other clinical parameters of RA. Conclusion: Upregulated IL‐23p19 in SF might be involved in joint destruction in RA through interplay with other cytokines such as IL‐17, TNFα, and IL‐1β.

Lung cancer risk and cigarette smoking, lung tuberculosis according to histologic type and gender in a population based case-control study

We examined whether the strength of the association of cigarette smoking differs according to histological type and gender, and assessed other risk factors, in particular, tuberculosis. We recruited cases from the Korean Academy of Tuberculosis and Respiratory Diseases and controls from Chungju, a local site of the Korean Multi-Center Cancer Cohort. We matched one case to one control for females and two cases to one control for males according to age (<or=44, 45-69, and >or=70 years old). We used unconditional logistic regression to calculate the odds ratio (OR) and 95% confidence interval (CI) to estimate lung cancer risk by histologic type for males and females separately. The OR (95% CI) of 40 or more pack-years smoked relative to never smokers was 6.78 (4.17-11.00), 3.49 (1.83-6.33), and 2.72 (1.57-4.72) for males, and 13.72 (3.23-58.18), 12.18 (3.12-47.57), and 7.11 (1.78-28.43) for females for squamous cell, adenocarcinoma, and small cell carcinoma, respectively. Among males, the respective OR (95% CI) for past and current history of lung tuberculosis was 3.21 (2.12-4.90), 2.69 (1.63-4.45), and 1.52 (0.83-2.78), and for females was 2.40 (1.30-4.42), 4.20 (2.75-6.39), and 1.37 (0.61-3.06). Our findings provide additional evidence that women are more susceptible to the carcinogenic effects of tobacco, smoking has a higher risk for squamous cell and small cell carcinoma than adenocarcinoma, and tuberculosis is a potential risk factor for certain lung cancer histologic types.

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

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

Validation of self-reported cancer incidence at follow-up in a prospective cohort study.

Self-reported cancer is a valuable epidemiological tool for identifying cases in cohort studies. The cost, time, and resources required, in addition to the efficiency in ascertaining cases, need to be considered when deciding between active and passive follow-up approaches. Because Korean families hold a family-centered approach when making decisions (1), it is not uncommon for patients to be unaware of their cancer diagnosis or status. A total of 20% of physicians and 33% of family members opposed patient notification of his or her disease status (2), and only 35% of Korean-Americans would tell a patient about a terminal prognosis (1). Because of these cultural differences and, thus, inaccuracies in self-reported information that arise, there is a need to examine the appropriateness of the active follow-up

Estrogen Receptor-1 Genetic Polymorphisms for the Risk of Premature Ovarian Failure and Early Menopause

BACKGROUND The aim of this study was to investigate the role of the estrogen receptor 1 (ESR1) genetic polymorphisms for early menopause that was classified as premature ovarian failure (POF) and early menopause (EM) and to examine whether the associations of ESR1 genetic variants are different for POF and EM. METHODS We selected 100 POF cases and matched 100 EM cases and 200 normal menopause (NM) controls from the Korean Multi-Center Cohort. Among them, we restricted idiopathic POF and EM cases vs NM controls by excluding POF/EM cases with medical/surgical causes. The XbaI (rs9340799) and PvuII (rs2234693) in the ESR1 gene were genotyped. The single-nucleotide polymorphism (SNP) and haplotype effects were analyzed by multivariate logistic regression and haplotype analysis. Also nominal polytomous logistic regression was used to find whether ESR1 genetic variants are differently associated with POF and EM. RESULTS The global p values for idiopathic POF and EM were 0.08 and 0.39 (SNP-based), and <0.001 and 0.12 (haplotype-based), respectively. The XbaI genetic variant containing the X allele was marginally significantly associated with a reduced risk of idiopathic POF (OR = 0.6, 95% CI 0.3-1.0). The P-x haplotype and diplotypes significantly decreased the risk of idiopathic POF (OR = 0.5, 95% CI 0.2-0.9; OR = 0.4, 95% CI 0.2-0.9, respectively). In contrast from POF, the P-x haplotypes and diplotypes insignificantly increased the risk for both idiopathic EM (p(polytomous) = 0.009 for P-x haplotype; p(polytomous) = 0.02 for P-x diplotypes). CONCLUSION Our results suggest that the ESR1 gene including PvuII and XbaI polymorphisms may modify the risk of idiopathic premature ovarian failure (POF) but not idiopathic early menopause (EM) risk.

Design and preliminary results of a metropolitan lifestyle intervention program for people with metabolic syndrome in South Korea

INTRODUCTION The Seoul Metabolic Syndrome Management (SMESY) project, a metropolitan lifestyle intervention program aimed at decreasing the risk of metabolic syndrome to the residents of the city, has recently been implemented in 2011. METHODS Our target population consisted of residents of Seoul who were 30-64 years old. Subjects visiting a Public Health Center were screened for five risk factors for metabolic syndrome and then divided into three groups according to the number of the risk factors: active counseling, for having more than three risk factors; motivational guide, for having one or two; and information support for having none. Members of the active counseling group, the main target of the project, were provided with monthly in-person counseling on health-related lifestyle choices, as well as a follow-up examination every 3 months during the 12-month program. RESULTS In the active counseling group, subjects showed statistically significant improvements in all five risk factors and the average number of retained risk factors decreased from 3.5 to 2.7. However, the percentage of active counseling group members who attended at least 3 out of the 4 sessions provided was only 11.3%. As for the motivational guide group and the information support group, clinically significant improvements were not observed and the percentage of members who attended all sessions were 10.4% and 11.8%, respectively. CONCLUSIONS Increased public participation for the ongoing project is expected to lead to great positive changes in the health of people with metabolic syndrome.

Factors Affecting Preparation Stage to Quit Smoking in Men

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

Evaluation of the Hypertension Disease Management Program in Korea

This study evaluated how the Hypertension Disease Management Program (HDMP) affects patient’s blood pressure, knowledge, health behaviors, and use of medical services. Evaluation was performed by 2 measures, which were before and after comparison within the management group (n = 210) and comparison between the management group and control group (n = 1050) in 2005. Systolic and diastolic blood pressure of management group significantly decreased from 137.5 and 86.0 mm Hg to 131.2 and 83.8 mm Hg (P < .001, P < .01), respectively. Dieting, snack control, consumption of low-sodium meals, low-cholesterol meals, and fruits or vegetables, regular checking of blood pressure, and stress management techniques significantly increased after HDMP. However, there was no significant difference in the use of medical service between the disease management group and the control group. This study showed that the HDMP improved lifestyle and reduced blood pressure on the disease management group, but changed neither medical costs nor use of medical services. Long-term evaluation should be performed to determine if the HDMP reduce medical costs and use of medical services.

Cost-effectiveness analysis of 5 years of postoperative adjuvant tamoxifen therapy for korean women with breast cancer: Retrospective cohort study of the korean breast cancer society database

OBJECTIVE This study aimed to evaluate the cost-effectiveness of postoperative adjuvant tamoxifen therapy using data from a Korean breast cancer registry. METHODS In this retrospective, observational cohort study, patients were selected from the Korean Breast Cancer Society database. Women with stage I, II, or III breast cancer (diagnosed between 1981 and 2005), for whom information about tamoxifen use (20 mg/d for 5 years) and estrogen-receptor and/or progesterone-receptor status was available, were included. Cost-effectiveness was calculated from the perspective of Korean society. Using a decision analytic model based on standard clinical flow, incremental cost-effectiveness ratios (ICERs) for overall survival were calculated with stratification by disease stage and hormone-receptor status. One-way sensitivity analyses were also conducted. All results were represented as US dollars (US

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

1 approximately 1000 Korean won, in year-2005 values). RESULTS A total of 17,579 patients were included in the analysis (10,694 tamoxifen users, 6885 nonusers). Among those with stage I or II breast cancer, ICERs for estrogen-receptor positive (ER+)/progesterone-receptor positive (PR+) tamoxifen users ranged from