Background/Aims: We examined the efficacy and safety of tegoprazan as a part of first-line triple therapy for Helicobacter pylori eradication. Methods: A randomized, double-blind, controlled, multicenter study was performed to evaluate whether tegoprazan (50 mg)-based triple therapy (TPZ) was noninferior to lansoprazole (30 mg)-based triple therapy (LPZ) (with amoxicillin 1 g and clarithromycin 500 mg; all administered twice daily for 7 days) for treating H. pylori. The primary endpoint was the H. pylori eradication rate. Subgroup analyses were performed according to the cytochrome P450 (CYP) 2C19 genotype, the minimum inhibitory concentration (MIC) of amoxicillin and clarithromycin, and underlying gastric diseases. Results: In total, 350 H. pylori-positive patients were randomly allocated to the TPZ or LPZ group. The H. pylori eradication rates in the TPZ and LPZ groups were 62.86% (110/175) and 60.57% (106/175) in an intention-to-treat analysis and 69.33% (104/150) and 67.33% (101/150) in a per-protocol analysis (non-inferiority test, p=0.009 and p=0.013), respectively. Subgroup analyses according to MICs or CYP2C19 did not show remarkable differences in eradication rate. Both first-line triple therapies were well-tolerated with no notable differences. Conclusions TPZ is as effective as proton pump inhibitor-based triple therapy and is as safe as first-line H. pylori eradication therapy but does not overcome the clarithromycin resistance of H. pylori in Korea

목적: 이 연구는 2019학년도 역학조사관 입문교육 과정에 참여한 29명의 수습과정생에게 참여형 자기주도 학습 역학조사관 연수 프로그램(FETP)의 효과와 만족도 등 역량 변화를 분석해 그 결과를 향후 과정 개발의 참고 자료로 활용하고자 하였다. 방법: 교육 프로그램의 만족도와 교육 후 모듈에 대한 역량 변화를 평가하는 연구가 수행되었다. 만족도와 역량의 차이 비교는 크루스칼 왈리스 검정(Kruskal-Wallis test)를 실시하였고, 역량의 차이는 윌콕슨 부호순위검정(Wilcoxon signed rank test)에 의해 이루어 졌다. 결과: 2019년 FETP에 참여한 역학조사관 중 여성은 48.3% 였으며, 40세 미만은 9.4% 였다. 역학조사관 입문교육과정 모듈(역학조사, 보건통계 및 정보통계, 감염병 국가 체계, 감염병 질환 감시 체계, 진단 및 실험실 검사, 생물 안전 및 관리, 주요 감염성질환 관리와 조사, 커뮤니케이션, 협동과 리더십, 일반과정)별 만족도는 실무적 도움, 전문성, 기능, 태도 등에서 4점(5점 만점)을 초과하였고, 전체 4.2±0.21(5점 만점)점으로 높은 수준이였다, 모듈의 교육훈련 전후 평균 점수는 2.25±0.91, 3.68±0.63점 등으로 유의한 향상이 있었으며, 모든 모듈 및 하위 주제들도 유의한 향상이 있었다(p<0.001). 그 중에서 현장역학조사 경험이 가장 높은 변화가 있었고, 표본 수집과 실무가 가장 낮은 역량 변화가 있었다. 결론: 2019년 진행된 입문교육 과정은 수료 후 학생들의 역량은 개선되었고, 만족도는 높은 편이었다. 참여형 자기주도학습의 촉진은 역량을 향상시킬 뿐만 아니라 보건 종사자들의 자신감을 높일 수 있었다.

Background: Despite high coverage (~98%) of universal varicella vaccination (UVV) in the Republic of Korea since 2005, reduction in the incidence rate of varicella is not obvious.The study aimed to evaluate the vaccine effectiveness (VE) of one-dose UVV by timeline and severity of the disease. Methods: All children born in Korea in 2011 were included for this retrospective cohort study that analyzed insurance claims data from 2011–2018 and the varicella vaccination records in the immunization registry. Adjusted hazard ratios by Cox proportional hazard models were used to estimate the VE through propensity score matching by the month of birth, sex, healthcare utilization rate, and region. Results: Of the total 421,070 newborns in the 2011 birth cohort, 13,360 were matched for age, sex, healthcare utilization rate, and region by the propensity score matching method. A total of 55,940 (13.29%) children were diagnosed with varicella, with the incidence rate 24.2 per 1000 person-year; 13.4% of vaccinated children and 10.4% of unvaccinated children. The VE of one-dose UVV against any varicella was 86.1% (95% confidence interval [CI], 81.4–89.5) during the first year after vaccination and 49.9% (95% CI, 43.3–55.7) during the 6-year followup period since vaccination, resulting in a 7.2% annual decrease of VE. The overall VE for severe varicella was 66.3%. The VE of two-dose compared to one-dose was 73.4% (95% CI, 72.2–74.6). Conclusion We found lower long-term VE in one-dose vaccination and waning of effectiveness over time. Longer follow ups of the vaccinated children as well as appropriately designed studies are needed to establish the optimal strategy in preventing varicella in Korea.

Background: Despite high coverage (~98%) of universal varicella vaccination (UVV) in the Republic of Korea since 2005, reduction in the incidence rate of varicella is not obvious.The study aimed to evaluate the vaccine effectiveness (VE) of one-dose UVV by timeline and severity of the disease. Methods: All children born in Korea in 2011 were included for this retrospective cohort study that analyzed insurance claims data from 2011–2018 and the varicella vaccination records in the immunization registry. Adjusted hazard ratios by Cox proportional hazard models were used to estimate the VE through propensity score matching by the month of birth, sex, healthcare utilization rate, and region. Results: Of the total 421,070 newborns in the 2011 birth cohort, 13,360 were matched for age, sex, healthcare utilization rate, and region by the propensity score matching method. A total of 55,940 (13.29%) children were diagnosed with varicella, with the incidence rate 24.2 per 1000 person-year; 13.4% of vaccinated children and 10.4% of unvaccinated children. The VE of one-dose UVV against any varicella was 86.1% (95% confidence interval [CI], 81.4–89.5) during the first year after vaccination and 49.9% (95% CI, 43.3–55.7) during the 6-year followup period since vaccination, resulting in a 7.2% annual decrease of VE. The overall VE for severe varicella was 66.3%. The VE of two-dose compared to one-dose was 73.4% (95% CI, 72.2–74.6). Conclusion We found lower long-term VE in one-dose vaccination and waning of effectiveness over time. Longer follow ups of the vaccinated children as well as appropriately designed studies are needed to establish the optimal strategy in preventing varicella in Korea.

Objective: This study investigated the current work status of emergency medical services (EMS) personnel and the differences in perception between EMS personnel and medical directors (MD) regarding on-line medical oversight in a province. Methods: A total of 1,781 EMS personnel and 51 medical directors were surveyed. The questionnaire consisted of the basic demographic data, work status, perception of on-line medical oversight, and the upcoming national pilot project of the expanding firefighter EMS personnel’s clinical scope. The survey was conducted from May 17 to 27, 2019. Results: The response rates for EMS personnel and MD were 73.7% and 65.3%, respectively. Of the local EMS personnel, 86.8% were male. The average age and field career was 33.5±6.2 years and 50 months, respectively. The proportion of nurse and 1st-grade emergency medical technicians were 30.6% and 35.7%. The EMS personnel and MD answered ‘on-scene basic life support’ and ‘patient’s refusal of transport’, respectively, as the most unnecessary medical oversight. Both responded to the main problem of current medical oversight as ‘request for unnecessary medical oversight.’ EMS personnel responded that all items in the national pilot project of expanding firefighter EMS personnel’s clinical scope would be helpful, while MD reported that only ‘use of epinephrine in anaphylactic patient’ and ‘use of pre-hospital 12 lead electrocardiogram in chest pain patient’ would helpful (P<0.01). Conclusion There was a certain difference in perception of the most unnecessary medical oversight and the upcoming national pilot project of expanding the clinical scope of firefighter EMS personnel between EMS personnel and MD.

Objective: This study investigated the current work status of emergency medical services (EMS) personnel and the differences in perception between EMS personnel and medical directors (MD) regarding on-line medical oversight in a province. Methods: A total of 1,781 EMS personnel and 51 medical directors were surveyed. The questionnaire consisted of the basic demographic data, work status, perception of on-line medical oversight, and the upcoming national pilot project of the expanding firefighter EMS personnel’s clinical scope. The survey was conducted from May 17 to 27, 2019. Results: The response rates for EMS personnel and MD were 73.7% and 65.3%, respectively. Of the local EMS personnel, 86.8% were male. The average age and field career was 33.5±6.2 years and 50 months, respectively. The proportion of nurse and 1st-grade emergency medical technicians were 30.6% and 35.7%. The EMS personnel and MD answered ‘on-scene basic life support’ and ‘patient’s refusal of transport’, respectively, as the most unnecessary medical oversight. Both responded to the main problem of current medical oversight as ‘request for unnecessary medical oversight.’ EMS personnel responded that all items in the national pilot project of expanding firefighter EMS personnel’s clinical scope would be helpful, while MD reported that only ‘use of epinephrine in anaphylactic patient’ and ‘use of pre-hospital 12 lead electrocardiogram in chest pain patient’ would helpful (P<0.01). Conclusion There was a certain difference in perception of the most unnecessary medical oversight and the upcoming national pilot project of expanding the clinical scope of firefighter EMS personnel between EMS personnel and MD.

Objective: This study aimed to investigate the perception of emergency medical service (EMS) providers and medical directors toward the field skill proficiency of EMS providers. We further examined differences in perception according to the certification and hospital career of individuals. Methods: This survey was conducted enrolling all active EMS providers in Busan, Ulsan, and Gyeongnam, as well as emergency physicians who participated in direct medical direction. Pre-developed questionnaires were sent as text messages to individual EMS providers and emergency physicians using an internet-based survey tool (Google Forms).Questionnaires were composed of 25 items in 7 categories: “airway management”, “ventilatory support”, “circulatory support”, “field assessment and management of trauma patients”, “field assessment and management of patients with chest pain”, “field assessment and management of patients with neurologic symptoms”, and “other items”. The response was based on a five-point Likert scale, where 0 score indicated no experience at all. Results: The questionnaire was distributed to 1,781 EMS providers and 52 medical directors; of these, 1,314 (73.7%) EMS providers and 34 (65.3%) medical directors completed the survey. EMS providers rated themselves as above average (3 points) for most of the questions. However, the majority responded that they had no experience or low proficiency in endotracheal intubation and prehospital delivery (median 2; interquartile range [IQR], 0-3). Conversely, medical directors assessed the EMS provider’s proficiency as above average in use of I-gel, recognition of hypoglycemia, field management of trauma patients, use of oropharyngeal and nasopharyngeal airway, use of laryngeal mask airway, and optimal oxygen supply (median, 4; IQR, 3-4), but responded with low scores for most other questions. Based on the EMS provider certification, nurses scored themselves more proficient than level-1 emergency medical technicians (EMTs) for intravenous access (P<0.001), whereas level-1 EMTs recognized themselves more proficient than nurses for endotracheal intubation (P<0.001), use of Magill forceps (P=0.004), and pediatric cardiopulmonary resuscitation (P<0.001). Conclusion This study recognized the discrepancies in the perception of EMS provider’s field skill proficiency, as perceived by EMS providers and medical directors, and between level-1 EMTs and nurses. We propose that regional EMS authorities need to make persistent efforts to narrow these perception gaps through effective educational programs for EMS providers and medical directors.

Although coronavirus disease 2019 (COVID-19) is an ongoing pandemic, the mean serial interval was measured differently across nations. Through the Korean national COVID-19 contact tracing system, we were able to investigate personal contacts in all symptomatic cases in Korea from January 20 to August 3, 2020. The mean serial interval was calculated by the duration between the symptom onset of the infector and infectee, and became shorter after the case definition changed to include not-imported cases in Korea on February 20, 2020. The mean serial interval before and after this fifth case definition was 6.12 and 3.93 days based on the infectors' symptom onset date, respectively, and 4.02 days in total with the median of 3 days. Older age and women lead to longer serial intervals.

One of the primary goals of epidemiology is to quantify various aspects of a population’s health, illness, and death status and the determinants (or risk factors) thereof by calculating health indicators that measure the magnitudes of various conditions. There has been some confusion regarding health indicators, with discrepancies in usage among organizations such as the World Health Organization the, Centers for Disease Control and Prevention (CDC), and the CDC of other countries, and the usage of the relevant terminology may vary across papers. Therefore, in this review, we would like to propose appropriate terminological definitions for health indicators based on the most commonly used meanings and/or the terms used by official agencies, in order to bring clarity to this area of confusion. We have used appropriate examples to make each health indicator easy for the reader to understand. We have included practical exercises for some health indicators to help readers understand the underlying concepts.

OBJECTIVES: Many studies have explored the relationship between short-term weather and its health effects (including pneumonia) based on mortality, although both morbidity and mortality pose a substantial burden. In this study, the authors aimed to describe the influence of meteorological factors on the number of emergency room (ER) visits due to pneumonia in Seoul, Korea. METHODS: Daily records of ER visits for pneumonia over a 6-year period (2009-2014) were collected from the National Emergency Department Information System. Corresponding meteorological data were obtained from the National Climate Data Service System. A generalized additive model was used to analyze the effects. The percent change in the relative risk of certain meteorological variables, including pneumonia temperature (defined as the change in average temperature from one day to the next), were estimated for specific age groups. RESULTS: A total of 217 776 ER visits for pneumonia were identified. The additional risk associated with a 1°C increase in pneumonia temperature above the threshold of 6°C was 1.89 (95% confidence interval [CI], 1.37 to 2.61). Average temperature and diurnal temperature range, representing within-day temperature variance, showed protective effects of 0.07 (95% CI, 0.92 to 0.93) and 0.04 (95% CI, 0.94 to 0.98), respectively. However, in the elderly (65+ years), the effect of pneumonia temperature was inconclusive, and the directionality of the effects of average temperature and diurnal temperature range differed. CONCLUSIONS The term ‘pneumonia temperature’ is valid. Pneumonia temperature was associated with an increased risk of ER visits for pneumonia, while warm average temperatures and large diurnal temperature ranges showed protective effects.