Kyoung Ae Kong

Deaths from pesticide poisoning in South Korea: trends over 10 years.

ObjectivesPesticide poisoning is a major cause of death in the world. The objective of this study was to examine the trends of pesticide poisoning deaths and their epidemiologic characteristics in South Korea.MethodsWe evaluated the age-standardized mortality rates from pesticide-related deaths (intentional self-poisoning, accidental poisoning, assault, undetermined intent poisoning) in South Korea from 1996 through 2005, using registered death data obtained from the Korea National Statistical Office. The regional rurality index was calculated and correlation analyses were used to estimate the association with pesticide poisoning mortality.ResultsThe number of pesticide poisoning deaths from 1996 through 2005 was 25,360, which accounted for 58.3% of the total poisoning fatalities. The age-standardized mortality rates by pesticide poisoning significantly increased from 4.42 to 6.42 per 100,000 population, whereas the total death rate was decreased in the same period. Intentional self-poisoning was the majority cause of death from pesticides (84.8% of total pesticide poisoning deaths). The majority of the pesticide poisoning deaths were men, over 50xa0years old, with education less than middle school, and residing in rural areas. The rate of pesticide poisoning deaths was the highest in the farming period and was significantly correlated with the rurality index of each region.ConclusionsPesticide poisoning deaths substantially increased during the 10-year study period, and showed demographic, seasonal and regional variations. More intensive intervention efforts to reduce pesticide mortality should become a public health priority in South Korea.

Association of STAT4 polymorphism with rheumatoid arthritis and systemic lupus erythematosus: a meta-analysis

STAT4 is a transcription factor that has been implicated in the pathogenesis of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Recently, several reports has documented that a STAT4 haplotype is associated with RA, SLE and Sjogren’s syndrome. To summarize and review these findings, we conducted a meta-analysis of all relevant reports published before September 2008. Studies on STAT4 rs7574865 single nucleotide polymorphism (SNP) of RA and SLE were identified using PubMed. Meta-analyses were performed for 15,609 patients with RA and 15,793 controls from 14 published studies and for 2,478 patients with SLE and 5,058 controls from 8 published studies. Meta-odds ratios (ORs) and 95% confidence intervals (CIs) based on random effects models were calculated for all available studies. The overall ORs for the minor T allele of STAT4 rs7574865 SNP were 1.27 (95% CI 1.20–1.34) in RA and 1.57 (95% CI 1.44–1.71) in SLE. Asian controls have significantly higher allele frequency (32%) for the minor T allele of STAT4 rs7574865 SNP than population of European origin (22%), however, there was no significant difference of ORs for RA and SLE by ethnicity. No apparent effect of anti-CCP positivity was found in stratified analysis. The risk of STAT4 genotype for SLE was significantly higher than for RA in populations of European origin and Asian. The results of our meta-analysis demonstrated that STAT4 rs7574865 SNP is significantly associated with RA and SLE. In addition to specific alleles of HLA-DRB1, the minor T allele of STAT4 rs7574865 SNP is a common RA risk factor in populations of European origin and Asian.

Association between deprivation status at community level and outcomes from out-of-hospital cardiac arrest: a nationwide observational study.

STUDY OBJECTIVESnWe sought to examine the association between area deprivation and outcomes of out-of-hospital cardiac arrest in Korea.nnnMETHODSnData were obtained from the emergency medical service (EMS) system. A nationwide OHCA cohort database from January 2006 to December 2007 was constructed via hospital chart review and ambulance run sheet data. We enrolled all EMS-assessed OHCA victims and excluded cases without available hospital outcome data or residential address. The Carstairs index was used to categorize districts according to level of deprivation into five quintiles, from (Q1, the least deprived) to (Q5, the most deprived). Main outcomes were survival to hospital discharge, survival to admission, and return of spontaneous circulation (ROSC).nnnRESULTSn34,227 patients were included. Initial rhythm, witnessed status, attempted bystander cardiopulmonary resuscitation (CPR), CPR by EMS, CPR in the emergency department (ED), and elapsed time interval significantly varied according to area deprivation level (p < 0.001). OHCA outcomes were consistently worse in the most deprived areas. The adjusted OR (95% CI) for survival to hospital discharge was 0.58 (0.45-0.77) in the most deprived areas compared to the least deprived areas.nnnCONCLUSIONnCommunity deprivation was strongly associated with survival among out-of-hospital cardiac arrest patients in Korea.

Characteristics and self-rated health of overlap syndrome.

Background and objective Overlap syndrome shares features of both asthma and chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate characteristics of overlap syndrome and their effect on self-rated health (SRH). Methods We analyzed data from the Fourth Korea National Health and Nutrition Examination Survey of 2007–2009. Subjects with acceptable spirometry and available wheezing history were included. Subjects were classified into four groups based on forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) results and the presence or absence of self-reported wheezing for the previous 12 months: 1) COPD group, defined as having FEV1/FVC <0.7 without self-reported wheezing history; 2) asthma group, defined as having self-reported wheezing history without FEV1/FVC <0.7; 3) overlap syndrome group, having both FEV1/FVC <0.7 and wheezing history; and 4) non-obstructive disease (NOD) group, having neither FEV1/FVC <0.7 nor self-reported wheezing. SRH was categorized as better or lower based on responses to a questionnaire. Results From a total 9,104 subjects, 700 were assigned to the COPD group, 560 to the asthma group, 210 to the overlap syndrome group, and 7,634 to the NOD group. Compared to the other groups, subjects in the overlap syndrome group were more likely to have low lung function, a high proportion of smokers, low socioeconomic status, short education duration, lower SRH, and past diagnosis of pulmonary tuberculosis or bronchiectasis. Multiple logistic regression analysis revealed that both overlap syndrome and asthma groups were independently associated with lower SRH after adjustment for age, sex, socioeconomic status, education level, smoking status, comorbidities, and lung function. Female, old age, low education level, low economic status, smoker and other comorbidities were also associated with lower SRH. Conclusion Overlap syndrome was accompanied by high morbidity and was associated with lower SRH, which needs more appropriate care.

Prospective biomarker evaluation in patients with osteonecrosis of the jaw who received bisphosphonates

Bone biomarkers have been suggested for the risk assessment for osteonecrosis of the jaw, a serious complication associated with bisphosphonate (BP) use; however, no consensus has been reached. This study investigated the possible associations between bone biomarkers and the development of bisphosphonates-related osteonecrosis of the jaw (BRONJ). This is a case-control study of 37 patients with BRONJ (age, 73.6±11.2years) who had at least 1 sample available at diagnosis, out of which, 35 were taking BPs for osteoporosis and 2 patients for bone metastasis. Age- and gender-matched 37 patients who had been exposed to BPs for >24months and had no evidence of BRONJ after dentoalveolar surgery served as control group. The association between biomarkers (osteocalcin [OC], deoxypyridinoline [DPD], C-terminal telopeptide of collagen I [CTX], N-terminal telopeptides [NTX], bone-specific alkaline phosphatase [BAP], and parathyroid hormone [PTH]) and BRONJ development, the effects of BP discontinuation on biomarkers, and the performance of biomarkers for risk assessment were investigated. In our study, the PTH levels were found to be significantly higher in BRONJ patients compared to controls (P<0.05). But the OC, DPD, CTX, NTX, and BAP levels were not significantly different between the 2 groups (P>0.05). The CTX level in reference to a 150pg/mL cutoff was also not significant for BRONJ development (P>0.05). Among BRONJ patients who discontinued BP, in a linear mixed model, only CTX showed a significant increase over time (β=0.002, P=0.007). The cutoff PTH level was >41.52pg/mL (AUC=0.719, P=0.009), and that of CTX was ≤0.094ng/mL (AUC=0.619, P=0.069). In conclusion, there is insufficient evidence for the risk prediction for BRONJ of current bone biomarkers; additional research is necessary.

Risk factors for chronic obstructive pulmonary disease among never-smokers in Korea

Background Chronic obstructive pulmonary disease (COPD) patients include those who have never smoked. However, risk factors other than smoking in never-smokers have not been elucidated sufficiently. This study investigated the risk factors for COPD among never-smokers in Korea using population-based data. Methods The data were retrieved from the Korean National Health and Nutrition Survey IV conducted from 2007 to 2009. Among subjects aged 40 years or older who underwent appropriate pulmonary function tests, never-smokers not diagnosed with asthma and not showing a restrictive pattern on pulmonary function tests were enrolled. Risk factors of COPD in never-smokers were analyzed using logistic regression models. Results Among 24,871 participants in the representative Korean cohort, 3,473 never-smokers were enrolled. COPD patients accounted for 7.6% of the never-smokers. In the logistic regression analysis, low education status (odds ratio [OR]: 2.0; 95% confidence interval [CI]: 1.2–3.2), occupational exposure (OR: 2.6; 95% CI: 1.3–5.3), a history of tuberculosis (OR: 4.5; 95% CI: 2.3–8.7), bronchiectasis (OR: 6.0; 95% CI: 1.4–25.4), male sex (OR: 4.2; 95% CI: 2.6–6.7), advanced age (60–69 years vs 40–49 years; OR: 3.8; 95% CI: 2.0–7.0), and being underweight (body mass index <18.5 vs 18.0–24.9 kg/m2; OR: 3.1; 95% CI: 1.0–9.4) were associated with the development of COPD. Conclusion Low education status, manual labor, a history of tuberculosis and bronchiectasis, as well as male sex, advanced age and being underweight were risk factors for COPD in Korean never-smokers.

Occupational radiation doses among diagnostic radiation workers in South Korea, 1996–2006

This study details the distribution and trends of doses of occupational radiation among diagnostic radiation workers by using the national dose registry between 1996 and 2006 by the Korea Food and Drug Administration. Dose measurements were collected quarterly by the use of thermoluminescent dosimeter personal monitors. A total of 61 732 workers were monitored, including 18 376 radiologic technologists (30 %), 13 762 physicians (22 %), 9858 dentists (16 %) and 6114 dental hygienists (9.9 %). The average annual effective doses of all monitored workers decreased from 1.75 to 0.80 mSv over the study period. Among all diagnostic radiation workers, radiologic technologists received both the highest effective and collective doses. Male radiologic technologists aged 30-49 y composed the majority of workers receiving more than 5 mSv in a quarter. More intensive monitoring of occupational radiation exposure and investigation into its health effects on diagnostic radiation workers are required in South Korea.

Prevalence and changes in chronic diseases among South Korean farmers: 1998 to 2005

BackgroundEpidemiologic studies have suggested a unique pattern of disease among farmers in Western countries, but limited information is available about the magnitude of disease prevalence and their changes over time in Asian farmers. The aim of this study was to compare the prevalence and changes in chronic diseases among farmers with those of other occupational groups in South Korea.MethodsUsing data from three consecutive cross-sectional national surveys: the Korean National Health and Nutrition Examination Survey 1998 (n = 39,060), 2001 (n = 37,769), and 2005 (n = 34,145), we calculated age and gender-standardized prevalence of chronic diseases by the direct method and compared the prevalence changes from 1998 to 2005.ResultsFemale farmers had significantly higher chronic disease prevalence than other occupational groups in all three surveys. Arthritis was the most prevalent chronic disease among farmers for both men and women. Compared with other populations, farmers demonstrated a higher prevalence of arthritis and intervertebral disc disorders. Farmers showed higher prevalence changes for intervertebral disc disorders than other occupational workers.ConclusionOur findings support that South Korean farmers have a distinct pattern of diseases prevalence from other populations. More detailed studies investigating the risk of musculoskeletal diseases and intensive intervention efforts to reduce the prevalence these diseases, particularly among female farmers, are required.

Association of antioxidant vitamins and oxidative stress levels in pregnancy with infant growth during the first year of life.

OBJECTIVEnWhereas there are numerous reports in the literature relating the impact of maternal nutritional status on subsequent birth outcome, much less is known about the long-term impact on infant growth after birth. Therefore, we conducted a prospective cohort study to investigate the association of maternal micronutrient status (vitamins A, C and E, folate) and oxidative stress status in pregnancy with infant growth during the first year of life.nnnDESIGNnProspective cohort study.nnnSETTINGnOutpatient clinic of obstetrics, Ewha Womans University Hospital, Seoul, South Korea.nnnSUBJECTS AND METHODSnTwo groups were constructed for this study - the Ewha pregnancy cohort (n = 677) and the infant growth cohort comprising follow-up live newborns of all the recruited pregnant women (n = 317). Maternal serum vitamin and urinary oxidative stress levels were collected and infant weights and heights were measured at birth and at 6 and 12 months after birth.nnnRESULTSnDivision of the subjects into folate-deficient and normal groups revealed that infant weight and height at 0, 6 and 12 months were adversely affected by folate deficiency. High maternal vitamin C was associated with increased infant weight and height at birth and after birth.nnnCONCLUSIONnOur findings indicate the importance of preventing folate deficiency and supplementing vitamin C during pregnancy.

Clinical implication of an impaired fasting glucose and prehypertension related to new onset atrial fibrillation in a healthy Asian population without underlying disease: a nationwide cohort study in Korea

AimsnFor healthy populations without comorbidities, whether prehypertension and impaired fasting glucose (IFG) are associated with new onset atrial fibrillation (AF) is not well known.nnnMethods and resultsnWe included 366u2009507 subjects (age ≥20u2009years) not diagnosed with non-valvular AF from the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC) from 2003 to 2008. In total, 139u2009306 subjects diagnosed with AF-related comorbidities were excluded, and a 227u2009102 healthy population was followed up until 2013. The body mass index (BMI), blood pressure (BP), and fasting blood glucose (BG) level were acquired during National health check-ups. Subjects with IFG [hazard ratio (HR) 1.16, Pu2009=u20090.017] had a higher AF risk and the diastolic BP (HR 1.11, Pu2009=u20090.045) was a stronger indicator for an AF incidence than the systolic BP. After dividing the subjects into two mutually exclusive groups, AF incidence was increased dramatically by the combination effect of both prehypertension and an IFG in BMI <25u2009kg/m2 group, but, in BMI ≧25u2009kg/m2 group, did not show this tendency. An IFG related to AF risk was more prominent in the BMI <25u2009kg/m2 population (HR 1.18, Pu2009=u20090.025) than those with a BMI ≥25u2009kg/m2, and subjects with both an IFG and prehypertension had a greater AF risk (HR 1.27, Pu2009=u20090.016) than those without.nnnConclusionnEven in a healthy Asian populations without comorbidities, prehypertension and IFG were important risk factors of AF. Specifically, when prehypertension, including systolic and diastolic BPs, was finally combined with the IFG, the risk of new onset AF was increased especially in the BMI <25u2009kg/m2 group.