Multi-drug resistant tuberculosis is an emerging threat to humans. Despite steady efforts of the national tuberculosis control program, current prevalence of multi-drug resistant tuberculosis rate is increasing in Korea. In Korea, it is effective to both improve the medical transfer system on tuberculosis, and also to make a new tuberculosis patient control system with integrated public-private sector. Improvement focused on the new medical transfer system is a suitable model considering current situation of the Korean medical system. This model can be achieved by replacing the traditional drug susceptibility test method, which requires a long turnaround time, with rapid molecular biological method, and improving the overall process of specimen transport system, report system, and guidelines for tuberculosis, as well. Using such model, doctors can discover multi-drug resistant tuberculosis patients at an earlier stage, prescribe appropriate drugs at the right time, and effectively support directly observed treatment short course strategy. Therefore, this new model for improvement of multi-drug resistant tuberculosis control program, medical transfer system-focused public-private integrated system, can present an effective tool for enhancing and modifying functions of the current national tuberculosis programme in Korea.
Humans ; Korea ; Prevalence ; Tuberculosis ; Tuberculosis, Multidrug-Resistant

OBJECTIVES: The surveillance of infectious diseases, which is crucial in public health, may also suffer from poor community support. In South Korea, the government operates several national surveillance system for the National notifiable infectious diseases(NNID). Some programs work satisfactorily but other programs may not be fully accepted at the community level which result in low participation and delayed report. METHODS: May 2003, to improve the blind side of the National Surveillance System, a district health agency initiated a community based surveillance system for infectious diseases called as Communicable Disease Information Sharing System (CDISS) to complement the national program. As the name suggests, it underscores the mutual benefit of surveillance for public and private health sectors through partnership. With collaboration of participating private clinics and hospitals around the district, the health agency collects data and provides the health practitioners more up-to-dated information on the trend of infectious diseases than National level information. Total population of study area, Dong-gu which locate in the center of Gwangju-metropolitan city, is about 120,000 in 2005. Reporting facilities consist of 6 daycare clinics, 3 hospitals, and 1 university hospital, 2 local public health organizations. RESULTS: CDISS was introduced in May 2003, and full system has been successfully operated since March 2004 with 10 participating facilities. Each reporting facility regularly sends the weekly reporting form, filled with the number of patients in last week, to Dong-gu District Health Center in every Wednesday. All data were organized in tables and graphs by weekly summarizing the reporting data and interpreted information. Feedback is done to reporting facilities until Friday through faxes, email, website (http://kjdisweb.richis.org) ?at least a week earlier than National Surveillance System.If reported data exceeded epidemic alert level, the community warnings are issued through mass-media and other means of public communication.During the period of CDISS operation, some epidemic events and sporadic outbreak occurred in Dong-gu were detected well-earlier than the notification at national level, such as chickenpox, viral enteritis, and epidemic keratoconjunctivitis(EKC). CONCLUSIONS: The program has been functioning successfully with active community participation and revealed to be economic and effective way of disease surveillance in the community. Several episodes of disease epidemic were reported by the program well before the recognition of the epidemic at the national level. We suggest that the community surveillance program may well complement national surveillance system.
Chickenpox ; Communicable Diseases ; Complement System Proteins ; Consumer Participation ; Cooperative Behavior ; Electronic Mail ; Enteritis ; Humans ; Information Dissemination ; Public Health ; Republic of Korea

PURPOSE: Prevalence of metabolic syndrome is increasing markedly in rural area of Korea. Alcohol drinking and smoking are the main risk factors which shows the highest prevalence rate among the risk factors of metabolic syndrome. The aim of this study was to investigate the association between metabolic syndrome and alcohol drinking and smoking histories in a rural area of Korea. METHODS: Data was obtained from 1,332(507 men, 825 women) individuals aged over 40 years who lived in rural area of Chungju city in 2007. Metabolic syndrome was defined by NCEP ATP III criteria and waist circumference was defined by WHO-APR(Asia Pacific Region). Data analysis was carried out using SAS version 8.02. RESULTS: In men, adjusted odds ratio for metabolic syndrome was 2.78(1.09-7.05) for current alcohol drinker, 2.75(1.38-5.51) for past alcohol drinker, 3.25(1.58-6.67) for under 21 years old at start of alcohol drinking, 2.62(1.12-6.11) for light alcohol drinker, 6.01(2.65-13.64) for heavy alcohol drinker. In women, all the alcohol related risk factors were not statistically significant with metabolic syndrome. For all the smoking related risk factors were not statistically significant with metabolic syndrome in men and women. Adjusted odds ratio of alcohol drinking habits for each components of diagnostic criteria of metabolic syndrome was significant for high blood pressure, high fasting glucose and hypertriglyceridemia in men and abdominal obesity in women. Adjusted odds ratio of cigarette smoking habits for each components of diagnostic criteria of metabolic syndrome was significant for abdominal obesity in women. CONCLUSION: Controlling alcohol drinking habits in men should be reinforced in order to prevent the metabolic syndrome in a rural area of Korea.
Adenosine Triphosphate ; Aged ; Alcohol Drinking ; Fasting ; Female ; Glucose ; Humans ; Hypertension ; Hypertriglyceridemia ; Korea ; Light ; Male ; Obesity, Abdominal ; Odds Ratio ; Phenothiazines ; Prevalence ; Risk Factors ; Smoke ; Smoking ; Statistics as Topic ; Waist Circumference

PURPOSE: People with a family history of mood disorder are more likely to have depression. This study compared the characteristics of non-psychotic major depression disorder according to family history of depression. METHOD: Subjects were total of 817 persons recruited for the CRESCEND-K multicenter trial. Characteristics of depression and suicide history of patients with and without a family history of depression were assessed. Family history was determined through self-report. RESULTS: Of 817 participants, 12.4% had a positive family history of depression. Those with family history of depression reported an earlier age at onset of MDD, and more psychiatric comorbidity. Severity of depression and anxiety were not different according to family history of depression. There were no difference in attempted suicide history, number of attempted suicide and age at onset of 1st attempted suicide according to such a family history. CONCLUSION: Patients with family history of depression reported earlier onset of MDD and more history of psychiatric comorbidity.
Anxiety ; Comorbidity ; Depression ; Depressive Disorder, Major ; Humans ; Mood Disorders ; Suicide ; Suicide, Attempted

PURPOSE: The most effective and basic Tb preventive measure is BCG vaccination. Even though the Intradermal vaccination method in BCG vaccination is known to be the most accurate method in preventing the advanced Tb, nowdays most of the Korean civilian hospitals utilize multipuncture BCG vaccination method ,which is quite contrary to the national standard intradermal vaccination method. Therefore I decided to inform and educate the pregnant women who would be in a position to choose the BCG vaccination method. This will help them understand the BCG vaccination methods properly. We should urge the intradermal method which is acknowledged as the national standard vaccination method. METHODS: The questionnaire was mailed twice to 214 pregnant women requring the antenatal care who visited any of the 9 health centers in Busan from the period of Aug to Oct. 2007. The 1st questionnaire was done in 214 pregnant women prior to education concerning the BCG vaccination methods and Tb, and the 2nd questionnaire was done after education. Contents of the questionnaire were general knowledges for BCG vaccination method, intention of selection for BCG vaccination, knowledges for the adverse effect, etc. Data analysis was performed utilizing SPSS (ver12) and the pregnant women's change in concept was comparatively analyzed with percentage, chi-square -test . RESULTS: Considering the general characteristics of the pregnant women who participated in the study, the highest percentage was noticed in their 15-28 gestational weeks (60.8%), Age over 30 (70.1%), Education level-college graduate (76.6%). Recognition to the presence of two types BCG vaccination method was 27.6% before education and 95.3% after education which showed a marked improvement (p=0.0001). After education, 82.2% of pregnant women decided to choose intradermal BCG vaccination method at birth which was 23.4% before education (p=0.0003). Despite the fact that intradermal BCG method is the national standard vaccination method, some of them prefer multipuncture BCG vaccination method, because most of the scars (41.3%), the civilian hospitals do it (35.7%), because of the lack of the education and information from the health centers and public institutions (17.4%). The future selection of BCG vaccination methods as follows: before education, intradermal BCG vaccination 31.0%, multipuncture BCG vaccination 14.6%, uncertain 54.4%, and after education, intradermal BCG vaccination 72.4%, multipuncture BCG vaccination 2.8%, uncertain 24.8% (p<0.0001). CONCLUSIONS: The pregnant women were not fully aware of intradermal and multipuncture BCG vaccination methods. Through education and information, it was possible for them to thoroughly recognize the BCG vaccination methods. In order to urge the intradermal BCG vaccination method, the health centers and public institutions need to educate and inform the pregnant women regarding the intradermal BCG vaccination method which is the standard vaccination method in Korea.
Cicatrix ; Female ; Humans ; Intention ; Mycobacterium bovis ; Parturition ; Postal Service ; Pregnant Women ; Statistics as Topic ; Vaccination ; Surveys and Questionnaires

BACKGROUND AND OBJECTIVES: Aseptic meningitis is a disease of children with seasonal outbreak in summer. In spite of high morbidity, it is not notifiable without reported nationwide morbidity. The authors estimated incidence of aseptic meningitis and its descriptive characteristics and time- and space-clustering pattern. SUBJECTS AND METHODs: Cases of aseptic meningitis were extracted from National Health Insurance payment request data of National Health Insurance Corporation from January 1996 to December 2001. Cases were classified by region, institution, and hospitalization. Standardized incidence was calculated and compared by the region, month of the year whether there is any clustering. RESULTS: Nationwide incidence of aseptic meningitis among children under 15 years old over the six year period was 3.48 per 1,000 per year. Incidence was higher in female (2.80/1,000) compared to male (4.02/1,000). Age-specific incidence was highest in 5 years old. Annual incidence was highest in 1997 (8.44/1,000) and lowest in 2000 (0.79 /1,000) with outbreak every 3 or 4 years. Outbreak was mostly confined in summer months, between May and Septe- mber. However, seasonal pattern was variable by year. Southern provinces and metropolitan areas had higher incidences and pattern was more prominent in the years with higher outbreak. Time-dependent pattern of the disease from south to north was not prominent. DISCUSSIONS AND CONCLUSIONS: We have calculated the nationwide incidence of the aseptic meningitis over six year period. In terms of aseptic meningitis, using National Health Insurance data for the estimation of the incidence is a plausible method for the surveillance of the disease.
Child ; Cluster Analysis ; Enterovirus ; Female ; Hospitalization ; Humans ; Incidence ; Korea ; Male ; Meningitis, Aseptic ; National Health Programs ; Seasons

OBJECTIVES: Hebei Spirit oil spill accident has brought about the worst coastal oil contamination in Korean history. Following the accident, residents and volunteers, number exceeding a million from nationwide, were exposed to chemicals from the crude oil itself and dispersants, including volatility organic compounds (VOCs), polycyclic aromatic hydrocarbons (PAHs), and heavy metals through the clean-up works over months. This study was undertaken to investigate the effect of clean-up work on the peripheral nerve function and psychologic status of the residents after a prolonged exposure to clean-up work after the oil spill exposure. METHODS: We performed a study on the residents of Jango-do Island, Chungnam, on 5 and 12 January 2008, six to eight weeks after the accident. A questionnaire on general characteristics, Korean Beck Depression Inventory (K-BDI), color vision test (Lanthony desaturated D-15 test), and vibration perception threshold test were done. Among 210 residents with 30 years or older, 63 (30%) finished questionnaires and completed at least one among K-BDI, color vision test, or vibration perception threshold test. Descriptive statistics was done on the residents. RESULTS: The residents participated in clean-up work for average 20 days, max 30 days, during 6 weeks following the accident. Average work hours were 7.4 hours per day, max 10 hours. On K-BDI, 21 (33.3%) had a severe depressive state. Mean color confusion index was 1.29 in the right and 1.20 in the left. Mean vibration perception threshold was 3.69 VU (right) and 3.55 VU (left), respectively. DISCUSSIONS AND CONCLUSIONS: Compared to literature report, the residents had higher depression scale. Color vision threshold was not higher compared to general population near an industrial complex. Vibration perception threshold was significantly higher than the residents of similar age living near an abandoned mine in southern coastal area only in the age group of forties. These suggests there is some evidence of neuropsychiatric effect related to oil cleaning work and a mid- and long-term study of the oil exposure health effects with continuous monitoring should be done for the exposed residents in the affected area.
Color Vision ; Depression ; Disasters ; Hazardous Substances ; Humans ; Metals, Heavy ; Peripheral Nerves ; Petroleum ; Petroleum Pollution ; Polycyclic Hydrocarbons, Aromatic ; Sensation Disorders ; Vibration ; Volatilization ; Surveys and Questionnaires

PURPOSE: To estimate the reporting rate of tuberculosis in one medium-sized city in Korea. METHODS: Data claimed by national health insurance corporationand notification data of KTBS (Korea Tuberculosis Surveillance System) were compared through medical record-linkage method. Regarding the cases that were claimed medical care fee as tuberculosis but not notified to KTBS, we reviewed medical charts of the patients and investigated the reasons of failure to notify. RESULTS: Number of cases claimed health insurance fee as tuberculosis occurrences in Cheonan was 2,331 in 2007, while 956 cases were matched as notified cases to KTBS after electronic record-linkage by personal identifier. Among remaining 1,375 cases that were not matched, real missed cases through medical record review survey were found to be 104. The reasons of failure to notify were because of 'not tuberculosis patients' (500, 36.4%), 'notified in 2006' (421, 30.6%), 'diseases coding error' (341, 24.8%) and 'notified as other diseases' (9, 0.7%). Therefore, the corrected reporting rate was calculated at 93% (95% CI: 91.6% - 94.2%). Notably, reporting rate of clinics (58.1%) was significantly lower than those of hospitals (93.4%) or general hospitals (96.6%). CONCLUSIONS: All cases of tuberculosis diagnosis, which were claimed and not notified, were verified, the reporting rate was not as low as that of the data known through media. However, to reach the goal of tuberculosis elimination (reporting rate over 95%), more effort into improvement of the reporting system is necessary.
Clinical Coding ; Disease Notification ; Electronics ; Electrons ; Fees and Charges ; Hospitals, General ; Humans ; Insurance, Health ; Mandatory Reporting ; Medical Record Linkage ; Medical Records ; National Health Programs ; Private Sector ; Tuberculosis

This study was conducted to elucidate the related factors with the decreased physical function in the community- dwelling elderly in Chuncheon. We used data obtained from Hallym Aging Study(HAS) from January to May in 2007. The participants were 505 elderly aged 65 years or over after excluding those who didn't complete physical function test and aged < 65. The measurement of physical function was based on the "Health Aging and Body Composition Study Physical Performance Battery(H-ABC PPB)" that included semi-tandem stance, tandem stance, single leg stance, 6m general walk, 6m narrow walk, and chair stand test. And we also included grip strength test. Overall physical function based on H-ABC PPB decreased with age in both men and women. Smoking appeared to increase the risk of decreased function of chair stand in women (adjusted OR=3.8, 95% CI=1.2-12.6). Regular exercise was found to reduce the risk of decreased physical function in both men(Balance OR=0.5, 95% CI=0.2-1.0; Usual walk OR=0.4, 95% CI=0.2- 0.9) and women(Balance OR=0.4, 95% CI=0.2-1.0; Usual walk OR=0.3, 95% CI=0.1- 0.9); Narrow walk OR=0.2, 95% CI=0.1-0.8). Higher level of education seemed to be associated with higher functional performance. It needs further researches on the effect of education on the physical function of the elderly in this population.
Aged ; Aging ; Body Composition ; Female ; Hand Strength ; Humans ; Leg ; Male ; Smoke ; Smoking ; Social Class

PURPOSE: This study was conducted to investigate the association of gamma-glutamyltransferase (GGT) with metabolic syndrome among non-diabetic adults. METHODS: This study was conducted in a rural area, South Korea from August, 2003 to November, 2003. The study subjects were 1,023 sampled persons aged from 40 years and older (male 377, female 646). We analyzed the association between GGT with metabolic syndrome by multiple logistic regression analysis using SAS 9.1 version. RESULTS: The prevalence of metabolic syndrome in this study was 28.8%. The prevalence of metabolic syndrome was increased by quartiles of serum GGT level (P for trend <0.05). The prevalence of metabolic alterations fitting the criteria of the metabolic syndrome by quartiles of serum GGT level were almost significantly increased except for the criterion of low high density lipoprotein (HDL) cholesterol with adjustment for age and alcohol intake. Among 5 components of metabolic syndrome, the criterion of high serum triglyceride was most powerfully associated with serum GGT level in both gender. CONCLUSIONS: This study shows that serum GGT level was significantly associated with metabolic syndrome even after excluding diabetic adults.
Adult ; Aged ; Cholesterol ; Diabetes Mellitus ; Female ; gamma-Glutamyltransferase ; Humans ; Lipoproteins ; Logistic Models ; Metabolic Syndrome X ; Oxidative Stress ; Phenothiazines ; Prevalence ; Republic of Korea