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Volume 40; 2018
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Review Papers
Data resource profile: the National Health Insurance Research Database (NHIRD)
Liang-yu Lin, Charlotte Warren-Gash, Liam Smeeth, Pau-Chung Chen
Epidemiol Health. 2018;40:e2018062.   Published online December 27, 2018
DOI: https://doi.org/10.4178/epih.e2018062
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AbstractAbstract PDFSupplementary Material
Abstract
Electronic health records (EHRs) can provide researchers with extraordinary opportunities for population-based research. The National Health Insurance system of Taiwan was established in 1995 and covers more than 99.6% of the Taiwanese population; this system’s claims data are released as the National Health Insurance Research Database (NHIRD). All data from primary outpatient departments and inpatient hospital care settings after 2000 are included in this database. After a change and update in 2016, the NHIRD is maintained and regulated by the Data Science Centre of the Ministry of Health and Welfare of Taiwan. Datasets for approved research are released in three forms: sampling datasets comprising 2 million subjects, disease-specific databases, and full population datasets. These datasets are de-identified and contain basic demographic information, disease diagnoses, prescriptions, operations, and investigations. Data can be linked to government surveys or other research datasets. While only a small number of validation studies with small sample sizes have been undertaken, they have generally reported positive predictive values of over 70% for various diagnoses. Currently, patients cannot opt out of inclusion in the database, although this requirement is under review. In conclusion, the NHIRD is a large, powerful data source for biomedical research.
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Population data science: advancing the safe use of population data for public benefit
Kerina Helen Jones, David Vincent Ford
Epidemiol Health. 2018;40:e2018061.   Published online December 25, 2018
DOI: https://doi.org/10.4178/epih.e2018061
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AbstractAbstract PDF
Abstract
The value of using population data to answer important questions for individual and societal benefit has never been greater. Governments and research funders world-wide are recognizing this potential and making major investments in data-intensive initiatives. However, there are challenges to overcome so that safe, socially-acceptable data sharing can be achieved. This paper outlines the field of population data science, the International Population Data Linkage Network (IPDLN), and their roles in advancing data-intensive research. We provide an overview of core concepts and major challenges for data-intensive research, with a particular focus on ethical, legal, and societal implications (ELSI). Using international case studies, we show how challenges can be addressed and lessons learned in advancing the safe, socially-acceptable use of population data for public benefit. Based on the case studies, we discuss the common ELSI principles in operation, we illustrate examples of a data scrutiny panel and a consumer panel, and we propose a set of ELSI-based recommendations to inform new and developing data-intensive initiatives.We conclude that although there are many ELSI issues to be overcome, there has never been a better time or more potential to leverage the benefits of population data for public benefit. A variety of initiatives, with different operating models, have pioneered the way in addressing many challenges. However, the work is not static, as the ELSI environment is constantly evolving, thus requiring continual mutual learning and improvement via the IPDLN and beyond.
Summary

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Original Articles
Comparison of self-reported and accelerometer-assessed measurements of physical activity according to socio-demographic characteristics in Korean adults
Seung Won Lee, Jee-Seon Shim, Bo Mi Song, Ho Jae Lee, Hye Yoon Bae, Ji Hye Park, Hye Rin Choi, Jae Won Yang, Ji Eun Heo, So Mi Jemma Cho, Ga Bin Lee, Diana Huanan Hidalgo, Tae-Hoon Kim, Kyung Soo Chung, Hyeon Chang Kim
Epidemiol Health. 2018;40:e2018060.   Published online November 29, 2018
DOI: https://doi.org/10.4178/epih.e2018060
  • 14,711 View
  • 168 Download
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Previous studies have shown relatively low correlations between self-reported and accelerometer-assessed physical activity (PA). However, this association differs by socio-demographic factors, and this relationship has not been fully investigated in the general population. Thus, we investigated the correlation between self-reported and accelerometer-assessed PA and whether it differed by demographic and socioeconomic factors among the Korean general population.
METHODS
This cross-sectional study included 623 participants (203 men and 420 women) aged 30 to 64 years, who completed a PA questionnaire and wore a wrist-worn accelerometer on the non-dominant wrist for 7 days. We examined the agreement for metabolic equivalent task minutes per week (MET-min/wk) between the 2 measures and calculated Spearman correlation coefficients according to demographic and socioeconomic factors.
RESULTS
The kappa coefficient between tertiles of self-reported and accelerometer-assessed total MET-min/wk was 0.16 in the total population, suggesting overall poor agreement. The correlation coefficient between the 2 measurements was 0.26 (p<0.001) in the total population, and the correlation tended to decrease with increasing age (p for trend <0.001) and depression scores (p for trend <0.001).
CONCLUSIONS
We found a low correlation between self-reported and accelerometer-assessed PA among healthy Korean adults, and the correlation decreased with age and depression score. When studying PA using accelerometers and/or questionnaires, age and depression need to be considered, as should differences between self-reported and accelerometer-assessed PA.
Summary
Korean summary
역학연구에서 신체활동량 측정에 가장 많이 사용되는 설문조사와 가속도계 착용법인데, 두 가지 방법으로 측정한 신체활동량은 상관성이 그리 높지 않으며, 대상자 특성에 따라서도 일치도가 다른 것으로 보고되고 있다. 따라서, 비교적 건강한 중년의 한국 성인을 대상으로 자가설문과 가속도계 조사를 사용해 측정한 신체활동량의 관련성을 조사해보았다. 이 연구는 전향적 코호트 연구의 기반조사 결과를 이용한 단면연구로, 지역사회 거주하는 30-64세 성인 623명(남성203명, 여성 420명)을 대상으로 하였으며, 신체활동을 자가보고 설문조사와 3축 가속도계를 7일간 손목에 연속착용하여 측정하고 두 방법으로 측정한 신체활동량을 비교하였다. 전체 대상자에서 두 방법으로 측정한 신체활동량 삼분위(tertile) 값의 일치도를 조사했을 때 Kappa 통계량은 0.16 이었으며 Spearman 상관계수는 0.26 (p<0.001)이었다. 나이가 많을수록 우울증상이 많을수록 두 방법 간 일치도와 상관성이 낮아지는 경향을 보였다.

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Estimating causal associations of atopic dermatitis with depression using the propensity score method: an analysis of Korea Community Health Survey data, 2010-2013
Hayon Michelle Choi, Dahye Kim, Whanhee Lee, Ho Kim
Epidemiol Health. 2018;40:e2018059.   Published online November 29, 2018
DOI: https://doi.org/10.4178/epih.e2018059
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Numerous studies have reported associations between atopic dermatitis (AD) and depression, but the causal relationship between the 2 diseases has not been established. Therefore, this study used the propensity score method to investigate whether there was a positive causal effect of AD on depression in 16 regions (cities and provinces) in Korea.
METHODS
The study analyzed 16 regions (cities and provinces) in Korea, using data obtained from the Korea Community Health Survey for the years 2010-2013. Propensity score matching was used to estimate the causal influence of AD on depression in Korea.
RESULTS
After propensity score matching, the standardized difference for each covariate among the 16 regions (cities and provinces) was less than 1, indicating a balance between the case and control groups. At the national level, those diagnosed with AD had a 2.31 times higher risk for being diagnosed with depression than those who had not been diagnosed with AD. In particular, the risk was highest in North Jeolla Province (odds ratio [OR], 4.87; 95% confidence interval [CI], 2.28 to 10.43) and lowest in Gwangju (OR, 1.82; 95% CI, 0.87 to 3.79), and the OR for Seoul was 2.23 (95% CI, 1.66 to 2.99).
CONCLUSIONS
This study provides insights into how causal inferences can be derived from observational studies, through an analysis of Korea Community Health Survey data. Furthermore, the study results have implications for region-specific guidelines for preventive health policies targeting depression.
Summary
Korean summary
성향 점수 매칭을 이용하여 전국 및 16개 시/도 별 아토피 피부염과 우울증 사이의 인과성을 추정한 결과, 전국에서 아토피 피부염을 진단 받은 사람이 진단 받지 않은 사람들에 비해 우울증 위험도가 2.38배 높았다(CI: 1.29-4.38).

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  • Epidemiology of mental health comorbidity in patients with atopic dermatitis: An analysis of global trends from 1998 to 2022
    Xiao‐ce Cai, Si‐han Wang, Chun‐xiao Wang, Liu Liu, Jiao Wang, Yu‐hong Shen, Xin Li
    Journal of the European Academy of Dermatology and Venereology.2024; 38(3): 496.     CrossRef
  • Risk of depression in patients with atopic dermatitis: An updated systematic review and meta‐analysis of children, adolescent and adult groups
    Lihua Cao, Jiangwei Su, Fang Tian, Yang Zhou, Songchun Liu, Fanglu Lou
    Journal of Paediatrics and Child Health.2024;[Epub]     CrossRef
  • Analysis of Quality of Life and Mental Health in Patients With Atopic Dermatitis, Asthma and Allergic Rhinitis Using a Nation-wide Database, KNHANES VII
    Gyu Na Lee, Ha Yeh Rin Koo, Kyungdo Han, Young Bok Lee
    Allergy, Asthma & Immunology Research.2022; 14(2): 273.     CrossRef
  • Eczema is a shared risk factor for anxiety and depression: A meta-analysis and systematic review
    Qing Long, Hongxia Jin, Xu You, Yilin Liu, Zhaowei Teng, Yatang Chen, Yun Zhu, Yong Zeng, Dong Keon Yon
    PLOS ONE.2022; 17(2): e0263334.     CrossRef
  • Impairment of Quality of Life and Mental Health Status in Adult-Onset Atopic Dermatitis
    Juhwan Yoo, Ha Yeh Rin Koo, Kyungdo Han, Young Bok Lee
    Annals of Dermatology.2022; 34(4): 278.     CrossRef
  • Combined Oral and Topical Application of Pumpkin (Cucurbita pepo L.) Alleviates Contact Dermatitis Associated With Depression Through Downregulation Pro-Inflammatory Cytokines
    Maha Jameal Balgoon, Maryam H. Al-Zahrani, Soad Al Jaouni, Nasra Ayuob
    Frontiers in Pharmacology.2021;[Epub]     CrossRef
  • Association of atopic dermatitis with suicide risk among 788,411 adolescents
    Yechan Kyung, Min Hwan Choi, Yoo Jung Jeon, Ju Suk Lee, Jun Hwa Lee, Seon Hui Jo, Sung Hoon Kim
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Brief Communication
Emergence of Neisseria meningitidis W135 in Cote d’Ivoire: laboratory based-surveillance
Man-Koumba Soumahoro, Clarisse Kouamé-Elogne, Jean-Claude Anné, Soualihou Noufé, Kouakou Christophe N’Guessan, Adèle Kacou-N’Douba, Thomas Hanslik, Mireille Dosso
Epidemiol Health. 2018;40:e2018058.   Published online November 28, 2018
DOI: https://doi.org/10.4178/epih.e2018058
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AbstractAbstract PDF
Abstract
OBJECTIVES
To describe the emergence of Neisseria meningitidis (Nm) W135 in Côte d’Ivoire and its characteristics compared to NmA.
METHODS
Data on Nm samples isolated at the National Reference Center for meningitis in Côte d’Ivoire between 2007 and 2012 were analyzed. Socio-demographic data and biological information on the samples were extracted from the database. Categorical variables, such as sex and the serotype of the bacteria, were compared using the Fisher exact test, while the distribution of continuous variables, such as age, was compared using the Wilcoxon test.
RESULTS
Among the 175 Nm samples, 57 were NmA, 4 were NmB, 13 were NmC, and 99 were NmW135. The geographical distribution of NmA and NmW135 did not show a significant difference according to age or sex. NmW135 was more common than NmA in the northern health districts of Cote d’Ivoire (85.9 vs. 45.5%; p<0.001). No sample of NmA has been isolated since 2009, while 95% of the type W135 samples were isolated between 2010 and 2012.
CONCLUSIONS
This study highlighted the emergence of NmW135 in Côte d’Ivoire, as well as the simultaneous disappearance of NmA. It is important to improve laboratory-based surveillance of meningitis to assess trends in the circulation of bacteria and to detect the emergence of new serogroups earlier.
Summary

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    Cyrille H. Haddar, Aude Terrade, Paul Verhoeven, Berthe-Marie Njanpop-Lafourcade, Mireille Dosso, Fati Sidikou, Ali Elhaj Mahamane, Jean-Pierre Lombart, Aziza Razki, Eva Hong, Alain Agnememel, Evelyne Begaud, Yves Germani, Bruno Pozzetto, Muhamed-Kheir Ta
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Editorial
Lessons from radiation epidemiology
Won Jin Lee
Epidemiol Health. 2018;40:e2018057.   Published online November 14, 2018
DOI: https://doi.org/10.4178/epih.e2018057
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
Radiation epidemiology has developed as a specialized field and has unique characteristics compared to the other fields of epidemiology. Radiation exposure assessment is highly quantified and health risk assessment can yield precise risks per unit dose in each organ. At the same time, radiation epidemiology also emphasizes the uncertainty of the estimated doses and risks. More radiation epidemiologists work in radiation societies rather than those of epidemiology. This specialization deepens the research of radiation studies but also results in fragmentation from general epidemiology. In addition to continued involvement with radiation-related sciences, therefore, more efforts to communicate with the other fields of epidemiology are necessary for radiation epidemiology.
Summary
Korean summary
방사선 역학은 역학의 세부 전공분야로서 다른 역학 분야와 구별되는 특성들이 있다. 노출 및 건강영향 평가에서의 정량화된 접근방법을 비롯하여 방사선 역학의 많은 장점들은 다른 역학분야에서도 응용될 필요가 있다. 이러한 전문화는 역학 연구의 내용을 깊게 발전시키는데 큰 역할을 하고 있는 반면, 일반 역학 분야와 분열되는 단점도 있다. 따라서 기존 방사선 관련 학문들과의 지속적인 교류뿐 아니라 다른 역학분야와의 활발한 교류를 통해 방사선 역학 및 전체 역학분야를 발전시키는 것이 중요하다.

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    Riccardo Quaranta, Gian Marco Ludovici, Guglielmo Manenti, Pasqualino Gaudio, Andrea Malizia, A. Lyoussi, F. D’Errico, M. Carette, M. Joyce, R. Hodák, I. Jenčič, P. Le Dû, M. Morichi, S. Pospíšil, C. Reynard-Carette, L. Snoj, L. Vermeeren
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Epidemiologic Investigation
A foodborne outbreak of gastroenteritis caused by Vibrio parahaemolyticus associated with cross-contamination from squid in Korea
Sun-Wha Jung
Epidemiol Health. 2018;40:e2018056.   Published online November 13, 2018
DOI: https://doi.org/10.4178/epih.e2018056
  • 16,072 View
  • 252 Download
  • 23 Web of Science
  • 24 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Water-borne diseases caused by Vibrio parahemolyticus are often known to cause gastritis when raw or undercooked seafood is eaten. It is very rare that Vibrio gastritis caused by ingesting non-seafood products occurs on a large scale. On September 19, 2017, a large-scale Vibrio gastritis occurred after the city residents consumed food at a bazaar held in a welfare center in Jungnang-gu, Seoul.
METHODS
The total number of visitors was approximately 299, and 237 (79.3%) of them showed symptoms. Among those who showed symptoms, 116 (48.9%) consulted the hospital, and 53 (45.6%) were hospitalized. Among the 299 exposed individuals, 174 (58.1%) responded to this survey: 163 (93.6%) with and 11 (6.4%) without symptoms. This study was retrospectively conducted by investigating the exposed individuals. To investigate the spread of infection, medical staff of hospitals in the epidemic area were interviewed, exposed individuals surveyed, microbiological testing conducted, and ingredient handling and cooking processes investigated.
RESULTS
A total of 237 individuals, including 6 food handlers, were affected (prevalence, 79.2%). During the microbiological testing, V. parahemolyticus was found in 34 patients and 4 food handlers. In the consumption analysis, the relative risk of kimbap was 6.79 (confidence interval 1.10 to 41.69). In-depth investigation found that squid, an ingredient of Korean pancake, and egg sheets, an ingredient of kimbap, were prepared using the same cutting board and knife, which were thought to be the cause of cross-contamination that led to a large-scale outbreak of Vibrio gastritis.
CONCLUSIONS
A recent large-scale outbreak of Vibrio gastritis occurred due to the cross-contamination with kimbap during the preparation process of squid rather than the actual consumption of seafood. Thus, a more stringent hygiene management is necessary during the processing and management of food to prevent infections associated with V. parahemolyticus.
Summary
Korean summary
비브리오 장염은 흔히 날 것이나 덜 익힌 해산물을 섭취하였을 경우 잘 생기는 것으로 알려져 있다. 그러나 해산물을 처리하는 과정에서 생긴 교차 감염에 의해서도 비브리오 장염이 생길 수 있으며 이로 인하여 대규모의 유행이 발생할 수 있다. 이에 보다 철저한 위생관리와 교육이 필요하다

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Original Articles
Domestic elder abuse and associated factors in elderly women in Tehran, Iran
Negar Piri, Parisa Taheri Tanjani, Soheila Khodkarim, Koorosh Etemad
Epidemiol Health. 2018;40:e2018055.   Published online November 10, 2018
DOI: https://doi.org/10.4178/epih.e2018055
  • 14,539 View
  • 212 Download
  • 17 Web of Science
  • 20 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
Elderly people are often abused in many ways, with serious and lasting consequences. Elder abuse remains one of the most hidden forms of family conflict, and its frequency is anticipated to be rising in many countries that are rapidly experiencing population aging. The purpose of this study was to investigate the status of domestic elder abuse in elderly women in Tehran, Iran and to identify associated factors.
METHODS
This cross-sectional study was conducted in 2017 among 260 women aged 60 and over, selected through multistage random sampling. Information on abuse and its risk factors was collected through interviews with the elderly in their homes. In order to measure domestic elder abuse, the validated Domestic Elderly Abuse Questionnaire was used. The ordinal logistic test was used in Stata version 12 to identify factors related to elder abuse.
RESULTS
Overall, 90.4% of the subjects had experienced at least 1 type of abuse, among which authority deprivation (68.5%) was the most common and rejection (11.2%) the least common. The ordinal logistic analysis showed that the likelihood of experiencing more severe severe abuse was significantly higher in elderly people over 72 than in those aged 60-62 years (odds ratio, 2.07; 95% confidence interval, 1.03 to 4.17).
CONCLUSIONS
Domestic elder abuse was found to be common in older women. Old age was an important risk factor for domestic elder abuse in elderly women in Tehran. Managing and preventing elder abuse is an important issue that needs to be addressed.
Summary

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    Nishtha Malhotra, M. S. Shivaswamy
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    Shiva Raj Acharya, B. K. Suman, Sandip Pahari, Yong Chul Shin, Deog Hwan Moon
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Incidence of varicella in children in Jeju-do, Korea, 2005-2016: age-period-cohort analysis
Jinhee Kim, Ji-Eun Kim, Jong-Myon Bae
Epidemiol Health. 2018;40:e2018054.   Published online November 8, 2018
DOI: https://doi.org/10.4178/epih.e2018054
  • 14,951 View
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Although the nationwide inoculation rate of varicella vaccine was approximately 95% in Korean children recently, the number of notified varicella cases is unexpectedly continuously increasing till now. To suggest some hypotheses regarding this discrepancy, an age-period-cohort (APC) analysis as a descriptive epidemiology study was conducted for children residing in Jeju-do, Korea.
METHODS
The raw data were obtained from the nationwide database for insurance claim of healthcare fee provided by the National Health Insurance Service, Korea. The selection criteria were children aged 2-13 years who visited any healthcare center due to varicella from 2005 to 2016 while residing in Jeju-do. After calculating the birth cohort-specific crude incidence rates by age and year, the intrinsic estimator method was used to perform the APC analysis.
RESULTS
As the annual crude incidence rates decreased with increasing age between 2005 and 2016, the age and period effects also decreased. The intrinsic estimator coefficients suggesting the cohort effect shifted from positive to negative in 2011, the starting year of free varicella vaccine program in Jeju-do.
CONCLUSIONS
The results suggested that inoculated varicella vaccines have preventive effects. However, further studies to evaluate waning immunity would be needed.
Summary
Korean summary
2011년 이후 생후 12-15개월 유아에게 수두백신 무상접종을 시행해 오고 있는 제주도에 있어서, 수두발생 신고건수가 증가하는 괴리 현상에 있어, 국민건강보험공단의 수진자료를 확보하여 연령-기간-코호트 (age-period-cohort, APC) 분석을 시행하였다. 그 결과 연령이 증가하고 연도가 최근으로 올수록 수두 발생에 대한 연령과 기간효과는 점점 감소하는 반면, 수두백신 무상접종이 시작된 2011년을 전후해서 코호트 효과는 양에서 음으로 전환하였다. 따라서 현재 접종하고 있는 수두 백신은 수두발생을 예방하는 효과가 있으며, 돌발수두 발생은 이차백신 실패로 볼 수 있다.

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  • The comparison of seroconversion rates among different varicella vaccines administered Turkish children; MAV/06 and vOka
    Zuhal Umit, Zumrut Sahbudak Bal, Aysin Zeytinoglu, Tansu Gulbahar Aydogan, Ozlem Bag, Gizem Guner Ozenen, Ferda Ozkinay, Zafer Kurugol
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Life expectancy of HIV-positive patients after diagnosis in Iran from 1986 to 2016: A retrospective cohort study at national and sub-national levels
Mohammad Mirzaei, Maryam Farhadian, Jalal Poorolajal, Parvin Afasr Kazerooni, Katayoun Tayeri, Younes Mohammadi
Epidemiol Health. 2018;40:e2018053.   Published online November 7, 2018
DOI: https://doi.org/10.4178/epih.e2018053
  • 12,801 View
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  • 7 Web of Science
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AbstractAbstract PDF
Abstract
OBJECTIVES
Little is known about the life expectancy of individuals with human immunodeficiency virus (HIV) in Iran. This study therefore aimed to estimate the life expectancy of HIV-positive patients in Iran.
METHODS
In this retrospective cohort study, we extracted data from the Center for Disease Control and Prevention of the Ministry of Health and Medical Education and the Death Registration System. We included patients aged 20 years and older who had a specified date of diagnosis. We estimated life expectancy and its 95% confidence intervals (CIs) using Chiang’s methodology.
RESULTS
The overall life expectancy at the national level was 23.1 years (95% CI, 22.6 to 23.5). Life expectancy was 21.6 years (95% CI, 21.1 to 22.0) for men and 32.7 years (95% CI, 31.4 to 34.0) for women. The life expectancy of patients who did or did not receive antiretroviral therapy (ART) was 37.0 years (95% CI, 36.2 to 37.8) and 15.5 years (95% CI, 15.1 to 15.9), respectively. The life expectancy of patients with or without tuberculosis (TB) was 21.6 years (95% CI, 20.4 to 22.9) and 36.5 years (95% CI, 35.7 to 37.4), respectively.
CONCLUSIONS
The life expectancy of Iranian HIV-positive patients was found to be very low. To improve their longevity, improvements in ART coverage and the control and treatment of TB are advised.
Summary

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Data Profile
National Epidemiologic Survey of Thyroid cancer (NEST) in Korea
Chang-Mo Oh, Hyun-Joo Kong, Eunyang Kim, Hyejin Kim, Kyu-Won Jung, Sohee Park, Young-Joo Won
Epidemiol Health. 2018;40:e2018052.   Published online October 26, 2018
DOI: https://doi.org/10.4178/epih.e2018052
  • 14,829 View
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AbstractAbstract PDF
Abstract
The Korea Central Cancer Registry conducted the National Epidemiologic Survey of Thyroid cancer (NEST) to investigate changes in the epidemiological and clinical characteristics of thyroid cancer patients between 1999 and 2008. The NEST was designed to collect representative samples of patients with thyroid cancer diagnosed in the years 1999, 2005, and 2008 using a proportionally stratified and systematic random sampling method. Among 42,891 participants diagnosed with thyroid cancer, 5,796 participants were included in the final study population. This survey collected information on diagnostic methods and date, route of diagnosis, prior medical history and history of thyroid-related disease, tumor, lymph node, metastasis and collaborative stage, and treatment. The NEST dataset was also linked to the cause-of-death database from Statistics Korea. The mean age of the study participants was 46.9 years. The ratio of men to women was 1:5.5. In the analysis of the histologic type of cancer, the proportion of papillary thyroid carcinoma showed an increasing trend (p<0.01). In contrast, the proportion of distant metastasis and the mean tumor size of thyroid cancers showed decreasing trends over time (p<0.01, respectively).
Summary

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Original Articles
Seasonality of tuberculosis in the Republic of Korea, 2006-2016
Eun Hee Kim, Jong-Myon Bae
Epidemiol Health. 2018;40:e2018051.   Published online October 20, 2018
DOI: https://doi.org/10.4178/epih.e2018051
  • 14,572 View
  • 196 Download
  • 13 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
While the seasonality of notified tuberculosis has been identified in several populations, there is not a descriptive epidemiological study on the seasonality of tuberculosis in Korea. This study aimed to evaluate the seasonality of tuberculosis in Korea from 2006 to 2016.
METHODS
Data regarding notified cases of tuberculosis by year and month was obtained from the Infectious Diseases Surveillance Yearbook, 2017 published by the Korea Centers for Disease Control and Prevention. Seasonal decomposition was conducted using the method of structural model of time series analysis with simple moving averages.
RESULTS
While the trough season was winter from 2006 to 2016, the peak season was summer between 2006 and 2012, but shifted to spring between 2013 and 2016.
CONCLUSIONS
Notified tuberculosis in Korea also showed seasonality. It is necessary to evaluate factors related to the seasonality of tuberculosis for controlling tuberculosis.
Summary
Korean summary
2006-2016년 신고된 신환자의 연보를 근거로 결핵발생의 계절성 여부를 분석한 결과, 2006-2012년까지는 여름, 2013년이후는 봄에 발생 신고율이 높은 계절성을 확인하였다. 계절성을 야기하는 이유들을 찾아서 향후 결핵 예방에 활용할 필요가 있다.

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Development and validation of a sunlight exposure questionnaire for urban adult Filipinos
Marc Gregory Yu, Nina Castillo-Carandang, Maria Elinor Grace Sison, Angelique Bea Uy, Katrina Lenora Villarante, Patricia Maningat, Elizabeth Paz-Pacheco, Eileen Abesamis-Cubillan
Epidemiol Health. 2018;40:e2018050.   Published online October 11, 2018
DOI: https://doi.org/10.4178/epih.e2018050
  • 16,166 View
  • 196 Download
  • 5 Web of Science
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AbstractAbstract PDF
Abstract
OBJECTIVES
To develop and validate a self-reported sunlight exposure questionnaire (SEQ) for urban adult Filipinos.
METHODS
The study included adults (19-76 years old) in Metro Manila, Philippines, well-versed in the Filipino (Tagalog) language and had resided in Metro Manila for at least 1 year. Exclusion criteria included pregnancy, active skin disorders, and immunocompromised states. An expert panel created a questionnaire in Likert-scale format based on a conceptual framework and 4 existing instruments. The study proceeded in 4 phases: questionnaire item development, translation and back-translation, pretesting, and construct validity and reliability testing using factor analysis, the Cronbach alpha coefficient, and the paired t-test.
RESULTS
A 25-item, self-administered, Filipino (Tagalog) SEQ answerable using a 4-point Likert scale was created. The questionnaire was administered to 260 adult participants twice at a 2-week interval, with all participants completing both the first and second rounds of testing. All questionnaire items possessed adequate content validity indices of at least 0.86. After factor analysis, 3 questionnaire domains were identified: intensity of sunlight exposure, factors affecting sunlight exposure, and sun protection practices. Internal consistency was satisfactory for both the overall questionnaire (Cronbach alpha, 0.80) and for each of the domains (Cronbach alpha, 0.74, 0.71, and 0.72, respectively). No statistically significant differences were observed in the responses between the first and second rounds of testing, indicating good test-retest reliability.
CONCLUSIONS
We developed a culturally-appropriate SEQ with sufficient content validity, construct validity, and reliability to assess sunlight exposure among urban adult Filipinos in Metro Manila, Philippines.
Summary

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Association of appendicular skeletal muscle mass with carotid intima-media thickness according to body mass index in Korean adults
Ji Eun Heo, Hyeon Chang Kim, Jee-Seon Shim, Bo Mi Song, Hye Yoon Bae, Ho Jae Lee, Il Suh
Epidemiol Health. 2018;40:e2018049.   Published online October 7, 2018
DOI: https://doi.org/10.4178/epih.e2018049
  • 15,254 View
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The combined effects of obesity and appendicular skeletal muscle (ASM) on atherosclerosis, especially in middleaged populations, remain poorly understood. This cross-sectional study investigated the effects of ASM on carotid intima-media thickness (IMT) according to body mass index (BMI) in middle-aged Korean adults.
METHODS
Herein, 595 men and 1,274 women aged 30-64 years completed questionnaires and underwent health examinations as part of the Cardiovascular and Metabolic Disease Etiology Research Center cohort. ASM was measured via bioelectrical impedance analysis and adjusted for weight (ASM/Wt). IMT was assessed using B-mode ultrasonography; highest quartile of IMT was defined as gender-specific top quartile of the IMT values. Higher BMIs was defined as a BMI over 25.0 kg/m2 .
RESULTS
Compared to the highest ASM/Wt quartile, the lowest ASM/Wt quartile was significantly associated with highest quartile of IMT in men with lower BMIs (adjusted odds ratio [aOR], 2.78; 95% confidence interval [CI], 1.09 to 7.13), but not in those with higher BMIs (aOR, 0.59; 95% CI, 0.24 to 1.91). In women, there was no significant association of low skeletal muscle mass with highest quartile of IMT, regardless of BMI.
CONCLUSIONS
Low appendicular skeletal muscle mass is associated with carotid arterial wall thickening in men with lower BMIs, but not in men with higher BMIs. Our findings suggest that the risk of atherosclerosis may be low in middle-aged Korean men with appropriate body weight and skeletal muscle mass maintenance.
Summary
Korean summary
한국 중년 성인을 대상으로 사지근육양과 죽상경화증(경동맥 내중막 두께≥75 percentile)의 관련성을 체질량지수(≥25, <25 kg/m2)로 층화하여 평가하였다. 체질량지수 25 kg/m2 미만인 남자에서는, 사지근육양이 낮으면 죽상경화증의 위험이 유의하게 높았으나, 체질량지수 25 kg/m2 이상인 남자에서는 관련성이 없었다. 반면 여자에서는 체질량지수에 상관없이 사지근육양과 죽상경화증의 독립적인 관련성이 관찰되지 않았다.

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The survival rate of patients with beta-thalassemia major and intermedia and its trends in recent years in Iran
Alireza Ansari-Moghaddam, Hossein Ali Adineh, Iraj Zareban, Mehdi Mohammadi, Mahtab Maghsoodlu
Epidemiol Health. 2018;40:e2018048.   Published online October 3, 2018
DOI: https://doi.org/10.4178/epih.e2018048
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AbstractAbstract PDF
Abstract
OBJECTIVES
Thalassemia is a common genetic disease in Iran, especially in the north and south of Iran. The present study sought to determine the survival rate of patients with thalassemia in highly endemic regions of Iran and its variation in patients born before and after 1971.
METHODS
The present historical cohort study extracted data from the health records of patients with beta-thalassemia major, beta-thalassemia intermedia, and sickle beta-thalassemia who had presented to thalassemia treatment centers in the past years. The collected data were analyzed using the Kaplan-Meier test, the log-rank test, and the chi-square test.
RESULTS
Of the total of 5,491 medical records (2,647 men and 2,634 women; mean age, 23.81±11.32 years), 3,936 belonged to patients with beta-thalassemia major, and 999 and 89 to patients with beta-thalassemia intermedia and sickle beta-thalassemia, respectively. In 467 cases, the type of thalassemia was not clear. The cumulative survival rate was calculated as 0.92, 0.83, 0.74, and 0.51 by ages 25, 35, 45, and 55, respectively. The hazard ratio of death was 4.22 (p<0.05) for beta-thalassemia major and 0.77 for beta-thalassemia intermedia (p=0.70). It was calculated as 1.45 for men patients and as 3.82 for single patients.
CONCLUSIONS
The present study showed relatively high survival rates in patients with thalassemia. The survival of patients was unfavorable in poorer regions (Zahedan and Iranshahr). Factors including women gender, a higher level of education, being married, and living in metropolises decreased the risk of death at younger ages and improved survival.
Summary

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