OBJECTIVES: Using the population-based cancer registry in Jejudo, we found that Jejudo had lower incidence in stomach cancer than other regions in Korea. The aim of this study was to evaluate reasons for this difference. METHODS: Citrus is the leading agricultural production in Jejudo, suggesting that lower cancer incidence in Jejudo could be explained by citrus fruit intake. We evaluated this hypothesis with quantitative systematic review (QSR). RESULTS: Stomach cancer incidence was significantly lower, with a summary odds ratio (SOR) after QSR of 0.72 [95% CI=0.64-0.81]. In addition, the SOR of pancreatic cancer tended to be lower at 0.83 [95% CI=0.70-0.98]. The SOR of prostate cancer was slightly higher at 1.03 [0.89-1.19]. CONCLUSIONS: Quantitative systematic reviews for the effect of citrus fruit intake on cancer occurrence suggested that lower cancer incidence in Jejudo could be explained by intake of citrus fruits.
*Citrus ; Female ; Humans ; Incidence ; Korea/epidemiology ; Male ; Neoplasms/*epidemiology ; Odds Ratio ; Pancreatic Neoplasms/epidemiology ; Prostatic Neoplasms/epidemiology ; *Registries ; Stomach Neoplasms/epidemiology

OBJECTIVES: This study was performed using a longitudinal approach to explore the predictors for current smoking among male high school students. METHODS: Baseline data was collected in May 2004 through a self-administrated questionnaire completed by 607 male students in a technical high school in Daegu city, Korea. Subsequently, their smoking behaviors were followed one year after. Among the 544 followed participants, data for 439 non-smokers in the first year was used in longitudinal analysis. Current smokers were defined as those respondents who had smoked one or more cigarettes within the 30 days preceding the survey. Several potential predictors for smoking were investigated including smoking history (never, experimental, former smoker), sociodemographic factors, environmental factors, attitudes toward smoking, and behavioral factors. Logistic regression was used to predict smoking with SPSS ver. 12.0. RESULTS: According to multiple logistic regression analysis, those students who were more likely to smoke after one year were former smokers (OR: 2.12, 95% CI=1.01-4.44), current drinkers (OR: 2.55, 95% CI=1.33-4.89), who had four or five smokers among five best friends (OR: 3.43. 95% CI=1.14-10.30). In addition, those who had smokers among family members besides parents or siblings (OR: 1.66, 95% CI=0.92-2.98), exhibited a high level of subjective stress (OR: 1.77, 95% CI=0.96-3.26), or had a very good relationship with friends (OR: 1.93, 95% CI=0.99-3.75) were also more likely to smoke albeit with marginal statistical significance (p<0.1). CONCLUSIONS: A smoking prevention program aimed at high school students may be more effective with due consideration of the predictors highlighted in this study. However, further studies with larger sample size and various target populations are necessary to find potential predictors not found in this study but suggested in other longitudinal studies.
Adolescent ; *Adolescent Behavior ; Alcohol Drinking/epidemiology ; Family ; Follow-Up Studies ; Humans ; Korea/epidemiology ; Logistic Models ; Male ; Prospective Studies ; Questionnaires ; Smoking/*epidemiology/prevention & control/psychology ; Socioeconomic Factors ; *Students ; Time Factors

OBJECTIVES: The purpose of the current study was to evaluate the usefulness of the following four comorbidity indices in gastric cancer patients who underwent surgery: Charlson Comorbidity Index (CCI), Cumulative Illness rating scale (CIRS), Index of Co-existent Disease (ICED), and Kaplan-Feinstein Scale (KFS). METHODS: The study subjects were 614 adults who underwent surgery for gastric cancer at K hospital between 2005 and 2007. We examined the test-retest and inter-rater reliability of 4 comorbidity indices for 50 patients. Reliability was evaluated with Spearman rho coefficients for CCI and CIRS, while Kappa values were used for the ICED and KFS indices. Logistic regression was used to determine how these comorbidity indices affected unplanned readmission and death. Multiple regression was used for determining if the comorbidity indices affected length of stay and hospital costs. RESULTS: The test-retest reliability of CCI and CIRS was substantial (Spearman rho=0.746 and 0.775, respectively), while for ICED and KFS was moderate (Kappa=0.476 and 0.504, respectively). The inter-rater reliability of the CCI, CIRS, and ICED was moderate (Spearman rho=0.580 and 0.668, and Kappa=0.433, respectively), but for KFS was fair (Kappa=0.383). According to the results from logistic regression, unplanned readmissions and deaths were not significantly different between the comorbidity index scores. But, according to the results from multiple linear regression, the CIRS group showed a significantly increased length of hospital stay (p<0.01). Additionally, CCI showed a significant association with increased hospital costs (p<0.01). CONCLUSIONS: This study suggests that the CCI index may be useful in the estimation of comorbidities associated with hospital costs, while the CIRS index may be useful where estimatation of comorbiditie associated with the length of hospital stay are concerned.
Adult ; Aged ; Comorbidity/trends ; Data Interpretation, Statistical ; Gastrectomy ; Humans ; Length of Stay ; Logistic Models ; Male ; Middle Aged ; Neoplasm Staging ; Statistics, Nonparametric ; Stomach/pathology ; Stomach Neoplasms/*epidemiology/mortality/pathology/surgery

OBJECTIVES: This study was conducted to examine the factors implicated when people start smoking again after a 6 month cessation, and was carried out at the smoking cessation clinic of a public health center. METHODS: The study subjects were 191 males who had attended the smoking cessation clinic of a public health center for 6 months in an attempt to quit smoking. Data was collected, by phone interview, regarding individual smoking habits, if any, over the 6 month study period. The factors which may have caused an individual to smoke again were examined. This study employed a health belief model as it theoretical basis. RESULTS: Following a 6 month cessation, 24.1% of the study group began to smoke again during the 6 month test period. In a simple analysis, the factors related to individuals relapsing and smoking again included barriers of stress reduction, body weight gain and induction of smoking by surroundings among perceived barriers factor of our health belief model (p<0.05). In multiple logistic regression analysis for relapsed smoking, significant factors included barriers of stress reduction and induction of smoking by surroundings (p<0.05). The most important reason of for an individual to relapse into smoking was stress (60.9%) and the most likely place for a relapse to occur was a drinking establishment (39.1%). CONCLUSIONS: Our results indicate that both regular consultations and a follow-up management program are important considerations in a public health center program geared towards maintaining smoking cessation.
Follow-Up Studies ; Humans ; Interviews as Topic ; Male ; Middle Aged ; Motivation ; *Public Health ; Regression Analysis ; Smoking/*epidemiology/*prevention & control ; *Smoking Cessation ; Stress, Physiological ; Time Factors ; Weight Gain

OBJECTIVES: The changing population age structure and rapidly increasing medical costs make providing high-quality, effective medical care for the elderly a challenge. This study assessed the satisfaction with medical care in terms of comprehensiveness, general satisfaction, and accessibility among community-dwelling Korean elders. METHODS: Data were obtained from a nationwide representative sample of the older adults(aged 65 years old or older) living in the community, who participated in a 2006 telephone survey conducted using random digit dialing (n=881). General satisfaction, comprehensiveness and accessibility were measured using a 10-item satisfaction survey questionnaire. Descriptive analysis was used to assess the distribution of each of three components of subjective satisfaction. Analysis of covariance (ANCOVA) was used to examine the association of each of the three components with socioeconomic variables. RESULTS: Comprehensiveness and general satisfaction were low among older people with a high socioeconomic status. Accessibility was evaluated as low among older people of low socioeconomic status, those living in rural areas and those who were medical aid beneficiaries. CONCLUSIONS: Urgent interventions should be considered in order to improve accessibility to medical care for elders of low socioeconomic status and those living in rural communities. Given the rapid aging of the population, we need to develop a monitoring system to improve the quality of geriatric care.
Aged ; Aged, 80 and over ; Data Interpretation, Statistical ; Delivery of Health Care/*utilization ; Education ; Female ; *Health Services Accessibility ; Humans ; Income ; Insurance, Health ; Korea ; Male ; Marital Status ; *Personal Satisfaction ; Questionnaires ; Socioeconomic Factors

OBJECTIVES: This study was performed to evaluate the relationship between C-reactive protein (CRP) and carotid intima-media thickness (carotid IMT) in a population of middle-aged Koreans. METHODS: A total of 1,054 men and 1,595 women (aged 40-70 years) from Kanghwa County, Korea, were chosen for the present study between 2006 and 2007. We measured high-sensitivity CRP and other major cardiovascular risk factors including anthropometrics, blood pressure, blood chemistry, and carotid ultrasonography. Health related questionnaires were also completed by each study participant. Carotid IMT value was determined by the maximal IMT at each common carotid artery. The relationship between CRP level and carotid IMT was assessed using multiple linear and logistic regression models after adjustment for age, body mass index, menopause (women), systolic blood pressure, total/HDL cholesterol ratio, triglyceride level, fasting glucose, smoking, and alcohol consumption. RESULTS: Mean carotid IMT values from the lowest to highest quartile of CRP were 0.828, 0.873, 0.898, and 0.926 mm for women (p for trend<0.001), and 0.929, 0.938, 0.949, and 0.979 mm for men (p for trend=0.032), respectively. After adjustment for major cardiovascular risk factors, the relationship between CRP and carotid IMT was significant in women (p for trend=0.017), but not in men (p for trend=0.798). Similarly, adjusted odds ratio of increased IMT, defined as the sex-specific top quartile, for the highest versus lowest CRP quartiles was 1.55 (95% CI=1.06-2.26) in women, but only 1.05 (95% CI=0.69-1.62) in men. CONCLUSIONS: CRP and carotid IMT levels appear to be directly related in women, but not in men.
Adult ; Aged ; Arteriosclerosis/blood/*diagnosis/pathology ; C-Reactive Protein/*analysis ; Carotid Artery Diseases/blood/*diagnosis/pathology ; *Carotid Artery, Common/pathology ; Data Interpretation, Statistical ; Female ; Humans ; Korea ; Male ; Middle Aged ; Odds Ratio ; Risk Factors ; Sex Factors ; Tunica Intima/*pathology ; Tunica Media/*pathology ; Young Adult

OBJECTIVES: Whilst hypertension exerts a negative effect on several organs there have been few studies regarding its effect on pulmonary function. The objective of this study was to examine the relationship between hypertension and pulmonary function in rural Korean adults. METHODS: In 2006, 2534 people were recruited, aged 40 to 70, in Kangwha County. We selected 1454 (male: 624, female: 830) participants whose pulmonary function results were repeatable. Blood pressure (BP) was measured twice and the average calculated. Participants were divided into two groups (hypertensive group and non-hypertensive group) in accordance with The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Pulmonary function was measured by dry rolling seal spirometry. Forced expiratory volume in the one second and forced vital capacity were converted into percent-predicted values based on average pulmonary function amongst Koreans. RESULTS: The number of hypertensive participants in the present study was 460 (male: 205, female: 255) and the number of non-hypertensive participants was 994 (male: 419, female: 575). Our findings have shown that the mean values for expiratory volume in the one second and forced vital capacity were significantly lower for hypertensive people than for non-hypertensive people, among women (P=0.002 for forced expiratory volume in the one second, P<0.001 for forced vital capacity volume). Odds ratio analysis revealed that hypertensive participants were more likely to have lower pulmonary function than non-hypertensive participants, again significantly among women. CONCLUSIONS: The pulmonary function of hypertensive women was significantly lower than that of non-hypertensive women aged 40-70.
Adult ; Age Factors ; Aged ; Female ; Humans ; Hypertension/*physiopathology ; Korea ; Lung/*physiopathology ; Male ; Middle Aged ; Respiratory Function Tests ; Rural Population ; Sex Factors ; Spirometry

OBJECTIVES: The purpose of this study was to analyze the association between the pattern of prophylactic antibiotic use (PAU) and the surgical site infection (SSI) rate for major surgeries in Korea. METHODS: We retrospectively reviewed the medical records of patients who underwent cardiac, colon and gastric surgery, hysterectomies and hip/knee replacements at 20 hospitals, and inclusive of over 500 beds. We randomly sampled 60 cases per surgery type for patients discharged between September and November, 2006. A total fo 2,924 cases were included in our analysis. Cox's proportional hazard analysis was conducted to evaluate the association between the pattern of PAU and SSI rate. RESULTS: The proportion of patients who received their first prophylactic antibiotics (PA) 1 hour before incision was 65.5%, who received inappropriate PAs was 80.8%, and the proportion of patients whose PA was discontinued within 24 hours of surgery was 0.5%. The average duration of PAU after surgery was 9 days. The relative risk (RR) of SSI in patients who received their first PA more than 1 hour before incision was significantly higher than for those who received it within 1 hour prior to incision (RR=8.20, 95% CI=4.81-13.99). Inappropriate PA selection increased SSI rate, albeit with marginal significance (RR=1.97, 95% CI=0.96-4.03). Also, prolonged PAU following surgery had no effect on SSI rate. CONCLUSIONS: These results suggest that the pattern of PAU in the surgeries examined was not appropriate. Errors in the timing of PAU and of PA selection increase SSI rate. SSI rate remained unaltered following prolonged PAU after surgery.
Adolescent ; Adult ; Aged ; *Antibiotic Prophylaxis/methods ; Female ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Postoperative Care ; Preoperative Care ; Proportional Hazards Models ; Retrospective Studies ; Risk ; Surgical Wound Infection/*epidemiology/prevention & control

OBJECTIVES: This study was conducted to estimate the socioeconomic cost of injuries in South Korea. METHODS: We matched claims data from national health insurance, automobile insurance and industrial accident compensation insurance (IACI), and mortality data obtained from the national statistical office from 2001 to 2003 by patients' unique identifier. Socioeconomic cost included both direct cost and indirect cost: the direct cost was injury-related medical expenditure and the indirect cost included loss of productivity due to healthcare utilization and premature death. RESULTS: The socioeconomic cost of injuries in Korea was approximately 1.9% of the GDP from 2001 to 2003. That is, 12.1 trillion KRW (Korean Won) in 2001, 12.3 trillion KRW in 2002, and 13.7 trillion KRW in 2003. In 2003, direct medical costs were 24.6% (3.4 trillion KRW), the costs for loss of productivity by healthcare utilization were 13.0% (1.8 trillion KRW), and the costs for loss of productivity by premature death were 62.4% (8.6 trillion KRW). CONCLUSIONS: In this study, the socioeconomic cost of injuries in Korea between 2001 and 2003 was estimated by using not only health insurance claims data, but also automobile insurance, IACI claims and mortality data. We conclude that social efforts are required to reduce the socioeconomic cost of injuries in Korea, which represented approximately 1.9% of the GDP for the time period specified.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; *Cost of Illness ; Efficiency ; Female ; *Health Care Costs ; Humans ; Infant ; Infant, Newborn ; Inpatients ; Korea ; Length of Stay ; Male ; Middle Aged ; Outpatients ; Socioeconomic Factors ; Wounds and Injuries/*economics/mortality

OBJECTIVES: Isolated cleft lip with or without cleft palate (CL/P) is among the most common human birth defects, with a prevalence of approximately 1 in 700 live births. The B-Cell Leukemia/lymphoma 3 (BCL3) gene has been suggested as a candidate gene for CL/P based on association and linkage studies in some populations. This study tests for an association between markers in BCL3 and isolated, non-syndromic CL/P using a case-parent trio design, while considering parent-of-origin effects. METHODS: Forty case-parent trios were genotyped for two single nucleotide polymorphisms (SNPs) in the BCL3 gene. We performed a transmission disequilibrium test (TDT) on individual SNPs, and the FAMHAP package was used to estimate haplotype frequencies and to test for excess transmission of multi-SNP haplotypes. RESULTS: The odds ratio for transmission of the minor allele, OR (transmission), was significant for SNP rs8100239 (OR=3.50, p=0.004) and rs2965169 (OR=2.08, p=0.027) when parent-of-origin was not considered. Parent-specific TDT revealed that SNP rs8100239 showed excess maternal transmission. Analysis of haplotypes of rs2965169 and rs8100239 also suggested excess maternal transmission. CONCLUSIONS: BCL3 appears to influence risk of CL/P through a parent-of-origin effect with excess maternal transmission.
Adolescent ; Adult ; Algorithms ; Alleles ; Chi-Square Distribution ; Child ; Child, Preschool ; Chromosomes, Human, Pair 19/genetics ; Cleft Lip/*genetics ; Cleft Palate/*genetics ; Female ; Genetic Markers ; Genetic Predisposition to Disease ; Genotype ; Haplotypes ; Humans ; Infant ; Korea ; Male ; Monte Carlo Method ; Odds Ratio ; Polymorphism, Single Nucleotide/*genetics ; Risk Factors ; Young Adult