OBJECTIVES: The goal of this study was to investigate the short-term effect of ambient air pollution on emergency department (ED) visits in Seoul for asthma according to patients’ prior history of allergic diseases. METHODS: Data on ED visits from 2005 to 2009 were obtained from the Health Insurance Review and Assessment Service. To evaluate the risk of ED visits for asthma related to ambient air pollutants (carbon monoxide [CO], nitrogen dioxide [NO₂], ozone [O₃], sulfur dioxide [SO₂], and particulate matter with an aerodynamic diameter <10 μm [PM₁₀]), a generalized additive model with a Poisson distribution was used; a single-lag model and a cumulative-effect model (average concentration over the previous 1-7 days) were also explored. The percent increase and 95% confidence interval (CI) were calculated for each interquartile range (IQR) increment in the concentration of each air pollutant. Subgroup analyses were done by age, gender, the presence of allergic disease, and season. RESULTS: A total of 33 751 asthma attack cases were observed during the study period. The strongest association was a 9.6% increase (95% CI, 6.9% to 12.3%) in the risk of ED visits for asthma per IQR increase in O₃ concentration. IQR changes in NO₂ and PM₁₀ concentrations were also significantly associated with ED visits in the cumulative lag 7 model. Among patients with a prior history of allergic rhinitis or atopic dermatitis, the risk of ED visits for asthma per IQR increase in PM₁₀ concentration was higher (3.9%; 95% CI, 1.2% to 6.7%) than in patients with no such history. CONCLUSIONS: Ambient air pollutants were positively associated with ED visits for asthma, especially among subjects with a prior history of allergic rhinitis or atopic dermatitis.
Air Pollutants ; Air Pollution* ; Asthma* ; Dermatitis, Atopic ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Insurance, Health ; Korea ; Nitrogen Dioxide ; Ozone ; Particulate Matter ; Rhinitis, Allergic ; Seasons ; Seoul ; Sulfur Dioxide

OBJECTIVES: A clean India is the responsibility of all Indians. One of the objectives of the Swachh Bharat Abhiyan (Clean India Initiative) is to bring about behavioural changes regarding healthy sanitation practices. While large-scale programs in India have increased latrine coverage, they have to some extent failed to bring behavioural changes ensuring optimal latrine use, including the safe disposal of child faeces, which is a significant source of exposure to faecal pathogens. Hence, this study was done to explore child faeces disposal practices in rural West Bengal and to elicit the determinants of unhygienic faeces disposal. METHODS: Data collection was done using an interview method among the mothers of 502 under-5 children, following a pre-designed, semi-structured schedule during house-to-house visits in a set of villages in the Hooghly district of West Bengal. RESULTS: The prevalence of unsafe disposal of child faeces was 72.4%, and maternal education, per capita income, and water source were found to be significantly associated with unsafe child faeces disposal. CONCLUSIONS: This study draws attention to the unsafe disposal of child faeces in this area of India and raises questions about the efficiency of sanitation campaigns in rural India that focus on expanding coverage rather than emphasizing behavioural changes, which are crucial to ensure the safe disposal of child faeces. Thus, it is urgently necessary to strengthen efforts focusing on behavioural changes regarding the safe disposal of child faeces in order to minimise adverse health outcomes.
Appointments and Schedules ; Child* ; Data Collection ; Education ; Humans ; India* ; Methods ; Mothers ; Prevalence ; Rural Health ; Sanitation ; Toilet Facilities ; Water

OBJECTIVES: The objective of this study is to investigate associations between contextual characteristics and unmet healthcare needs in South Korea after accounting for individual factors. METHODS: The present study used data from the 2012 Korean Community Health Survey (KCHS) of 228 902 adults residing within 253 municipal districts in South Korea. A multilevel analysis was conducted to investigate how contextual characteristics, defined by variables that describe the regional deprivation, degree of urbanity, and healthcare supply, are associated with unmet needs after controlling for individual-level variables. RESULTS: Of the surveyed Korean adults, 12.1% reported experiencing unmet healthcare needs in the past. This figure varied with the 253 districts surveyed, ranging from 2.6% to 26.2%. A multilevel analysis found that the association between contextual characteristics and unmet needs varied according to the factors that caused the unmet needs. The degree of urbanity was associated with unmet need due to "financial burden" (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.42 to 0.66 for rural vs. metropolitan), but not unmet need due to "service not available when needed." There were no significant associations between these unmet need measures and regional deprivation. Among individual-level variables, income level showed the highest association with unmet need due to "financial burden" (OR, 5.63; 95% CI, 4.76 to 6.66), while employment status showed a strong association with unmet need due to "service not available when needed." CONCLUSIONS: Our finding suggests that different policy interventions should be considered for each at-risk population group to address the root cause of unmet healthcare needs.
Adult ; Delivery of Health Care* ; Employment ; Health Services Accessibility ; Health Surveys ; Humans ; Korea* ; Multilevel Analysis ; Population Groups ; Residence Characteristics

OBJECTIVES: This study investigated the association between perceived ethnic discrimination and depressive symptoms among biethnic adolescents in South Korea. METHODS: We performed a cross-sectional study of 4141 biethnic adolescents using data from the 2012 National Survey of Multicultural Families. Perceived ethnic discrimination was measured using the question “Have you ever been discriminated against or ignored because either of your parents is not a Korean?” with an assessment of depressive symptoms over the past 12 months. Logistic regression was applied to examine potential associations between perceived ethnic discrimination and depressive symptoms. RESULTS: Among 4141 biethnic adolescents, 558 (13.5%) reported having experienced ethnic discrimination. The most common discriminatory perpetrators were friends (n=241, 5.8%), followed by strangers (n=67, 1.6%). Depressive symptoms were related to experience of ethnic discrimination (odds ratio [OR], 3.80; 95% confidence interval [CI], 2.89 to 4.98) after adjusting for potential confounders. In an analysis focusing on the perpetrators of discrimination, depressive symptoms were found to be associated with perceived ethnic discrimination from friends (OR, 3.95; 95% CI, 2.75 to 5.68), teachers (OR, 4.53; 95% CI, 2.16 to 9.51), family members and relatives (OR, 3.89; 95% CI, 1.59 to 9.48), neighbors (OR, 2.48; 95% CI, 1.14 to 5.38), and strangers (OR, 2.49; 95% CI, 1.30 to 4.79). Furthermore, the OR for depressive symptoms among those exposed to 1, 2, or 3 or more discriminatory perpetrators were 3.61 (95% CI, 2.49 to 5.24), 3.61 (95% CI, 1.68 to 7.74), and 6.69 (95% CI, 2.94 to 15.22), respectively. CONCLUSIONS: According to our findings, friends were the most common perpetrators of discrimination and the experience of ethnic discrimination was associated with depressive symptoms among biethnic adolescents in South Korea.
Adolescent* ; Cross-Sectional Studies ; Depression* ; Discrimination (Psychology)* ; Friends ; Humans ; Korea* ; Logistic Models ; Parents ; Republic of Korea

OBJECTIVES: Diagnostic medical radiation workers in Korea have been officially monitored for their occupational radiation doses since 1996. The purpose of this study was to design models for reconstructing unknown individual radiation doses to which diagnostic radiation technologists were exposed before 1996. METHODS: Radiation dose reconstruction models were developed by using cross-sectional survey data and the personal badge doses of 8167 radiologic technologists. The models included calendar year and age as predictors, and the participants were grouped into six categories according to their sex and facility type. The annual doses between 1971 and 1995 for those who were employed before 1996 were estimated using these models. RESULTS: The calendar year and age were inversely related to the estimated radiation doses in the models of all six groups. The annual median estimated doses decreased from 9.45 mSv in 1971 to 1.26 mSv in 1995, and the associated dose variation also decreased with time. The estimated median badge doses from 1996 (1.22 mSv) to 2011 (0.30 mSv) were similar to the measured doses (1.68 mSv to 0.21 mSv) for the same years. Similar results were observed for all six groups. CONCLUSIONS: The reconstruction models developed in this study may be useful for estimating historical occupational radiation doses received by medical radiologic technologists in Korea.
Cross-Sectional Studies ; Humans ; Korea* ; Occupational Exposure

OBJECTIVES: C-reactive protein (CRP), an inflammatory biomarker, has been widely used as a preclinical marker predictive of morbidity and mortality. Although many studies have reported a positive association between CRP and mortality, uncertainty still remains about this association in various populations, especially in rural Korea. METHODS: A total of 23 233 middle-aged participants (8862 men and 14 371 women) who were free from cardiovascular disease, cancer, and acute inflammation (defined by a CRP level ≥10 mg/L) were drawn from 11 rural communities in Korea between 2005 and 2011. Blood CRP concentration was analyzed as a categorical variable (low: 0.0-0.9 mg/L; intermediate: 1.0-3.0 mg/L; high: 3.1-9.9 mg/L) as well as a continuous variable. Each participant’s vital status through December 2013 was confirmed by death statistics from the National Statistical Office. Cox proportional hazard models were used to assess the independent association between CRP and mortality after adjusting for other risk factors. RESULTS: The total quantity of observed person-years was 57 975 for men and 95 146 for women, and the number of deaths was 649 among men and 367 among women. Compared to the low-CRP group, the adjusted hazard ratio for all-cause mortality of the intermediate group was 1.17 (95% confidence interval [CI], 0.98 to 1.40) for men and 1.27 (95% CI, 1.01 to 1.61) for women, and the corresponding values for the high-CRP group were 1.98 (95% CI, 1.61 to 2.42) for men and 1.41 (95% CI, 1.03 to 1.95) for women. Similar trends were found for CRP evaluated as a continuous variable and for cardiovascular mortality. CONCLUSIONS: Higher CRP concentrations were associated with higher mortality in a rural Korean population, and this association was more prominent in men than in women.
C-Reactive Protein* ; Cardiovascular Diseases ; Female ; Humans ; Inflammation ; Korea ; Male ; Mortality* ; Proportional Hazards Models ; Republic of Korea ; Risk Factors ; Rural Population ; Uncertainty

OBJECTIVES: Previous epidemiological studies about oxidative stress and depression are limited by hospital-based case-control design, single-time measurements of oxidative stress biomarkers, and the small number of study participants. Therefore, in this study, we analyzed the association between biomarker of oxidative stress and depressive symptom scores using repeatedly measured panel data from a community-dwelling elderly population. METHODS: From 2008 to 2010, a total of 478 elderly participants residing in Seoul, Korea, were evaluated three times. Participants underwent the Korean version of the Short Form Generic Depression Scale (SGDS-K) test for screening depression, and urinary malondialdehyde (MDA) levels were measured as an oxidative stress biomarker. We used a generalized estimating equation with a compound symmetry covariance structure to estimate the effects of oxidative stress on depressive symptom scores. RESULTS: A two-fold increase in urinary MDA concentration was significantly associated with a 33.88% (95% confidence interval [CI], 21.59% to 47.42%) increase in total SGDS-K scores. In subgroup analyses by gender, a two-fold increase in urinary MDA concentration was significantly associated with increased SGDS-K scores in both men and women (men: 30.88%; 95% CI, 10.24% to 55.37%; women: 34.77%; 95% CI, 20.09% to 51.25%). In bivariate analysis after an SGDS-K score ≥8 was defined as depression, the third and the fourth urinary MDA quartiles showed a significantly increased odds ratio(OR) of depression compared to the lowest urinary MDA quartile (third quartile OR, 6.51; 95% CI, 1.77 to 24.00; fourth quartile OR, 7.11; 95% CI, 1.99 to 25.42). CONCLUSIONS: Our study suggests a significant association between oxidative stress and depressive symptoms in the elderly population.
Aged* ; Biomarkers ; Case-Control Studies ; Depression* ; Depressive Disorder ; Epidemiologic Studies ; Female ; Humans ; Korea ; Male ; Malondialdehyde ; Mass Screening ; Oxidative Stress* ; Seoul

OBJECTIVES: Central obesity plays a major role in the development of many chronic diseases, including cardiovascular disease and cancer. Chronic stress may be involved in the pathophysiology of central obesity. Although several large-scale genome-wide association studies have reported susceptibility genes for central adiposity, the effects of interactions between genes and psychosocial stress on central adiposity have rarely been examined. A recent study focusing on Caucasians discovered the novel gene early B-cell factor 1 (EBF1), which was associated with central obesity-related traits via interactions with stress levels. We aimed to evaluate EBF1 gene-by-stress interaction effects on central adiposity traits, including visceral adipose tissue (VAT), in Korean adults. METHODS: A total of 1467 Korean adults were included in this study. We selected 22 single-nucleotide polymorphisms (SNPs) in the EBF1 gene and analyzed their interactions with stress on central adiposity using additive, dominant, and recessive genetic modeling. RESULTS: The four SNPs that had strong linkage disequilibrium relationships (rs10061900, rs10070743, rs4704967, and rs10056564) demonstrated significant interactions with the waist-hip ratio in the dominant model (p(int)<0.007). In addition, two other SNPs (rs6556377 and rs13180086) were associated with VAT by interactions with stress levels, especially in the recessive genetic model (p(int)<0.007). As stress levels increased, the mean values of central adiposity traits according to SNP genotypes exhibited gradual but significant changes (p<0.05). CONCLUSIONS: These results suggest that the common genetic variants for EBF1 are associated with central adiposity through interactions with stress levels, emphasizing the importance of managing stress in the prevention of central obesity.
Adiposity* ; Adult ; B-Lymphocytes* ; Cardiovascular Diseases ; Chronic Disease ; Gene-Environment Interaction ; Genome-Wide Association Study ; Genotype ; Humans ; Intra-Abdominal Fat ; Linkage Disequilibrium ; Models, Genetic ; Obesity ; Obesity, Abdominal ; Polymorphism, Single Nucleotide ; Waist-Hip Ratio

OBJECTIVES: This study was conducted to investigate the current status of outsourcing in Korean hospital information systems and the factors influencing its introduction. METHODS: The authors surveyed 136 hospitals located in Seoul and its surrounding vicinities from June 7 to June 23, 2006. The facilitators and inhibitors to outsourcing in hospital information systems were derived from literature and expert reviews. Multiple logistic regression analysis was applied to identify the major influencing factors on outsourcing in hospital information systems. RESULTS: Eighty-six (63.2%) of the 136 hospitals surveyed, which were mainly tertiary hospitals, responded to using outsourcing for their hospital information systems. "Hardware and software maintenance and support," "application development," and "management of service and staff" were the major areas of outsourcing. Outsourcing had been employed for 4~7 years by 45.5% of the hospitals and the proportion of the budget used for outsourcing was less than 20%. A need for an extension in outsourcing was agreed on by 76.5% of the hospitals. The multiple logistic regression analysis showed that both consumer satisfaction and security risk have an influence on hospital information system outsourcing. CONCLUSIONS: Outsourcing in hospital information systems is expected to increase just as in other industries. One primary facilitator to outsourcing in other industries is consumer satisfaction. We found that this was also a facilitator to outsourcing in hospital information systems. Security risk, which is usually considered an inhibitor to information technology outsourcing, was proven to be an inhibitor here as well. The results of this study may help hospital information systems establish a strategy and management plan for outsourcing.
Security Measures ; Outsourced Services/economics/*utilization ; Maintenance ; Logistic Models ; Korea ; Hospital Information Systems/*organization & administration ; Health Services Research ; Decision Making, Organizational ; Consumer Satisfaction ; Computer Security

OBJECTIVES: Nitrogen dioxide (NO2) has been inconsistently associated with gradual decreases in lung function. Here, we studied the effects of NO2 exposure in asthmatics by examining the association between changes in lung function and concentrations of NO2 which were personally measured. METHODS: Peak expiratory flow (PEF) and daily personal exposures to NO2 were recorded on 28 patients with asthma (confirmed by methacholine provocation test) over 4 weeks. We used generalized estimating equations to assess the relationship between personal NO2 exposure and PEF, adjusting for potential confounders such as age, gender, outdoor particulate matter, temperature, humidity, and exposure to environmental tobacco smoke. RESULTS: The personal NO2 exposures were higher than the corresponding ambient levels. The mean personal: ambient ratio for NO2 was 1.48. The personal NO2 exposures were not associated with the morning PEF, evening PEF, or the diurnal PEF variability. However, environmental tobacco smoke was negatively associated with both the morning and evening PEF. CONCLUSIONS: Among the asthmatic adults who participated in this study, we found no apparent impact of personal NO2 exposures on the peak expiratory flow.
Tobacco Smoke Pollution/adverse effects/analysis ; Time Factors ; Peak Expiratory Flow Rate/*drug effects ; Nitrogen Dioxide/*adverse effects ; Male ; Lung/*drug effects/physiology ; Korea/epidemiology ; Inhalation Exposure/*adverse effects/analysis ; Humans ; Female ; Asthma/epidemiology/*physiopathology ; Air Pollution, Indoor/adverse effects/analysis