Korean Patients Presenting with Advanced Human Immunodeficiency Virus Disease: Epidemiological Features by Age Group

We explored factors influencing presentation with advanced human immunodeficiency virus (HIV) disease by age group. Data were derived from a city-wide cross-sectional survey of 759 HIV-infected adults living in Seoul, Korea. The significance of each observed factor was assessed via multivariate logistic regression. 

Of subjects aged 20-34 years, lower educational level had a positive influence on presentation with advanced HIV disease; those recently diagnosed with HIV were more likely to be presented with advanced HIV disease. Of the subjects aged 35-49 years, those w ith advanced HIV disease were more likely to have been diagnosed during health check-ups or via clinical manifestations. Of the subjects aged ≥ 50 years, presentation with advanced HIV disease was significantly more common in older subjects and less common among individuals diagnosed with HIV in 2000-2006. 

In conclusion, a lower educational level in younger subjects and more advanced age in older subjects positively influence the presentation of advanced HIV disease.

Full article at:   http://goo.gl/wa5zKL

By:  Cho Ryok Kang,1,7 Ji Hwan Bang,1,2 Sung-Il Cho,1,3 Kui Nam Kim,4 Hee-jin Lee,4 Bo Yeong Ryu,1,7 Soo Kyung Cho,1,7 Young Hwa Lee,1,3 Myoung-don Oh,1,5 and Jong-Koo Lee1,6

¹Seoul Center for Infectious Disease Control, Seoul, Korea.

²Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.

³Department of Epidemiology, Seoul National University Graduate School of Public Health, Seoul, Korea.

⁴Division of Life & Health, Seoul Metropolitan Government, Seoul, Korea.

⁵Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

⁶Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea.

⁷Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul, Korea.

Corresponding author.

Address for Correspondence: Ji Hwan Bang, MD. Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center 20 Boramaero 5-gil, Dongjak-gu, Seoul 07061, Korea. Tel: +82.2-870-3209, Fax: +82.2-831-2826, Email:moc.liamg@hcribdnuor

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Predictors of Default from Treatment for Tuberculosis: A Single Center Case–Control Study in Korea

Default from tuberculosis (TB) treatment could exacerbate the disease and result in the emergence of drug resistance. 

This study identified the risk factors for default from TB treatment in Korea. This single-center case–control study analyzed 46 default cases and 100 controls. Default was defined as interrupting treatment for 2 or more consecutive months. 

The reasons for default were mainly incorrect perception or information about TB (41.3%) and experience of adverse events due to TB drugs (41.3%). 

In univariate analysis, low income (< 2,000 US dollars/month, 88.1% vs. 68.4%, P = 0.015), absence of TB stigma (4.3% vs. 61.3%, P< 0.001), treatment by a non-pulmonologist (74.1% vs. 25.9%, P < 0.001), history of previous treatment (37.0% vs. 19.0%, P = 0.019), former defaulter (15.2% vs. 2.0%, P = 0.005), and combined extrapulmonary TB (54.3% vs. 34.0%, P = 0.020) were significant risk factors for default. 

In multivariate analysis, the absence of TB stigma (adjusted odd ratio [aOR]: 46.299, 95% confidence interval [CI]: 8.078–265.365, P < 0.001), treatment by a non-pulmonologist (aOR: 14.567, 95% CI: 3.260–65.089, P < 0.001), former defaulters (aOR: 33.226, 95% CI: 2.658–415.309, P = 0.007), and low income (aOR: 5.246, 95% CI: 1.249–22.029, P = 0.024) were independent predictors of default from TB treatment. 

In conclusion, patients with absence of disease stigma, treated by a non-pulmonologist, who were former defaulters, and with low income should be carefully monitored during TB treatment in Korea to avoid treatment default.

Full article at:   http://goo.gl/1IU8Qh

By:  Cheol-Kyu Park,1 Hong-Joon Shin,1 Yu-Il Kim,1 Sung-Chul Lim,1 Jeong-Sun Yoon,1 Young-Su Kim,1 Jung-Chul Kim,2and Yong-Soo Kwon1

¹Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea.

²Department of Surgery, Chonnam National University Hospital, Gwangju, Korea.

Corresponding author.

Address for Correspondence: Yong-Soo Kwon, MD. Department of Internal Medicine, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju 61469, Korea. Tel: +82.62-220-6575, Fax: +82.62-225-8578, Email: rk.ca.unj@nowky

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Risk Factors for Hepatitis C Virus (HCV) Infection in Areas with a High Prevalence of HCV in the Republic of Korea in 2013

BACKGROUND/AIMS:

The prevalence of hepatitis C virus (HCV) infection in Busan, Gyeongnam, and Jeonnam Provinces in Korea is more than twice the national average. This study aimed to examine whether demographic and lifestyle characteristics are associated with HCV infection in these areas.

METHODS:

A case control study was performed at three study hospitals. HCV cases were matched with two controls for sex and age. Patient controls were selected from non-HCV patients at the same hospital. Healthy controls were subjects participating in medical checkups. Conditional logistic regression models were used.

RESULTS:

A total of 234 matched-case and patient- and healthy-control pairs were analyzed. The significant risk factors for both controls were sharing razors (adjusted odds ratio [aOR], 2.39 and 3.29, respectively) and having more than four lifetime sexual partners (aOR, 2.15 and 6.89, respectively). Contact dockworkers (aOR, 1.91) and tattoos (aOR, 2.20) were significant risk factors for the patient controls. Transfusion (aOR, 5.38), a bloody operation (aOR, 5.02), acupuncture (aOR, 2.08), and piercing (aOR, 5.95) were significant risk factors for the healthy controls. Needle stick injuries and intravenous drug abuse were significant in the univariate analysis.

CONCLUSIONS:

More education concerning the dangers of sharing razors, tattoos and piercings is required to prevent HCV infection. More attention should be paid to needle stick injuries in hospitals and the community.

Full article at:  http://goo.gl/0O7JnR

By:  Sohn HS1, Kim JR2, Ryu SY3, Lee YJ4, Lee MJ5, Min HJ6, Lee J7, Choi HY8, Song YJ9, Ki M8.

• 1Department of Preventive Medicine, Inje University College of Medicine, Busan, Korea.
• 2Department of Preventive Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.
• 3Department of Preventive Medicine, Chosun University Medical School, Gwangju, Korea.
• 4Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea.
• 5Department of Health and Medical Administration, Suncheon Jeil College, Suncheon, Korea.
• 6Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.
• 7Department of Internal Medicine, Chosun University Medical School, Gwangju, Korea.
• 8Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.
• 9Department of Preventive Medicine, College of Medicine, Eulji University, Daejeon, Korea. 
• Gut Liver. 2016 Jan 23;10(1):126-32. doi: 10.5009/gnl14403.

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Vitamin C Deficiency of Korean Homeless Patients Visiting to Emergency Department with Acute Alcohol Intoxication

Vitamins are essential micronutrients for maintenance of tissue functions. Vitamin deficiency is one of the most serious and common health problems among both chronic alcoholics and the homeless. However, the vitamin-level statuses of such people have been little studied. We evaluated the actual vitamin statuses of alcoholic homeless patients who visited an emergency department (ED). 

In this study the blood levels of vitamins B1, B12, B6, and C of 217 alcoholic homeless patients were evaluated retrospectively in a single urban teaching hospital ED. Vitamin C deficiency was observed in 84.3% of the patients. The vitamin B1, B12, and B6 deficiency rates, meanwhile, were 2.3%, 2.3%, and 23.5%, respectively. Comparing the admitted patients with those who were discharged, only the vitamin C level was lower. (P=0.003) In fact, the patients' vitamin C levels were markedly diminished, vitamin C replacement therapy for homeless patients should be considered in EDs.

Below:  Scatter plots of blood levels of vitamins. The lower lines represent lower-normal levels, and the upper lines, upper-normal levels.

Full article at:   http://goo.gl/6a3CF5

By:   Hui Jai Lee, Jonghwan Shin, Kijeong Hong, and Jin Hee Jung

Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.

Corresponding author.

Address for Correspondence: Jonghwan Shin, MD. Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20 Boramae-5-gil, Dongjak-gu, Seoul 07061, Korea. Tel: +82.2-870-2662, Fax: +82.2-831-2826, Email:moc.revan@renihsyks

J Korean Med Sci. 2015 Dec; 30(12): 1874–1880.

Published online 2015 Nov 30. doi:  10.3346/jkms.2015.30.12.1874

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A Significant Increase in the Incidence of Central Precocious Puberty among Korean Girls from 2004 to 2010

Few studies have explored the trends in central precocious puberty (CPP) in Asian populations. This study assessed the prevalence and annual incidence of CPP among Korean children.

Using data from the Korean Health Insurance Review Agency from 2004 to 2010, we reviewed the records of 21,351 children, including those registered with a diagnosis of CPP for the first time and those diagnosed with CPP who were treated with gonadotropin-releasing hormone analogs.

The prevalence of CPP was 55.9 per 100,000 girls and 1.7 per 100,000 boys, respectively. The overall incidence of CPP was 15.3 per 100,000 girls, and 0.6 per 100,000 boys. The annual incidence of CPP in girls significantly increased from 3.3 to 50.4 per 100,000 girls; whereas in boys, it gradually increased from 0.3 to 1.2 per 100,000 boys. The annual incidence of CPP in girls consistently increased at all ages year by year, with greater increases at older ages (≥6 years of age), and smaller increases in girls aged < 6 years. In contrast, the annual incidence remained relatively constant in boys aged < 8 years, while a small increase was observed only in boys aged 8 years. The increase of annual incidence showed significant differences depending on age and gender (P <0.0001).

The annual incidence of CPP has substantially increased among Korean girls over the past 7 years. Continued monitoring of CPP trends among Korean children will be informative.

Below:  The annual incidence of central precocious puberty among Korean children

Full article at: http://goo.gl/WYaoLL

By:

Shin Hye Kim, Mi-Jung Park

Department of Pediatrics, Sanggye Paik Hospital, Inje University, College of Medicine, Seoul, Korea

Kyoung Huh

Kium Pediatric Clinic, Seoul, Korea

Sungho Won

Department of Public Health Science, Seoul National University, Seoul, Korea

Kuk-Wha Lee

Division of Pediatric Endocrinology, Mattel Children's Hospital at University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, California, United States of America

  

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Sexually Transmissible Infections in Middle & High School Students: Experience Rates, Risk Factors & Relationship with Mental Health – Results from the Korean Youth Risk Behaviour Web-Based Survey

Sexually transmissible infections (STIs) in adolescents are an important heath problem. However, the understanding of STIs among adolescents is poor. Rates of and risk factors for ever having a STI and relationships between ever having a STI and mental health in adolescents was investigated. 

Data from the Korea Youth Risk Behaviour Web-based Survey (KYRBS) were used. The KYRBS is an anonymous, self-administered online survey. To achieve a representative sample of Koreans, researchers used a stratification, clustering and multi-stage sampling method. Data from adolescents who had not had sexual intercourse and surveys with missing data concerning sexual experience were excluded. Finally, 31 363 participants were included.

The rate of ever having a STI was 10.0%. A total of 26.5% of adolescents who have had sexual experience report always using contraceptives, and condoms are the most popular contraceptives (69.0%). Contraceptive method (condom) and elementary school sexual debut (elementary school, OR: 1.000, middle school, OR: 0.235, 95% CI: 0.181–0.305; high school, OR: 0.128, 95% CI: 0.094–0.173) were significantly correlated with ever having a STI in the multivariate analysis. Depressed mood, suicidal ideation and suicide attempts were significantly associated with ever having a STI after adjusting for potential confounders. 

STIs are common diseases in adolescents who have sexual experience and are significantly associated with mental health. Development of preventive measures and treatment policies including mental counselling for adolescents with STI are needed.

Purchase full article at: http://goo.gl/uZnb2G

By: Hanna Kwon ^A, Hee Cheol Kang ^A and Jun Ho Lee ^B C 

^A Department of Family Medicine, Yonsei University College of Medicine, Yonsei-Ro, Seodaemun-Gu, Seoul 120-752, Korea. 
^B Department of Urology, National Police Hospital, Garakbon-dong, Songpa-gu, Seoul 138-708, Korea. 
^C Corresponding author. Email: sinbanpolee@gmail.com 

  

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Substance Use and Sexual Behaviors of Adolescents in Multicultural Families in Korea

To investigate the substance use and sexual behavior of adolescents in multicultural families compared with adolescents in Korean families in South Korea.

Data from the 2013 Korean Youth Risk Behavior Web-Based Survey collected from 66,591 adolescents aged 12-18 years (mean age 14.89±1.76 years) were analyzed. We classified the adolescents into four groups: those whose father and mother were born in South Korea, those whose father was born in South Korea but whose mother was not, those whose mother was born in South Korea but whose father was not, and those whose father and mother were not born in South Korea. Experiences with alcohol, cigarette, and drug use and sexual relations were investigated.

Compared with adolescents whose fathers and mothers were born in Korea, adolescents whose fathers were born in Korea but whose mothers were not were less likely to use alcohol and cigarettes. Adolescents whose mothers were born in Korea but whose fathers were not and adolescents whose fathers and mothers were both born outside Korea were more likely to use cigarettes and drugs and to have sexual relations.

These results indicate that adolescents whose fathers were not born in Korea and whose fathers and mothers were both born outside Korea are at greater risk for cigarette and drug use and risky sexual behaviors. For these high risk groups, health education should include dependency prevention program, safety issue, and health screening as well as programs aimed at preventing substance use and sexual activity.

Table 3

Adolescents' substance use and sexual relations according to their parents' birthplaces

AOR: odd ratios adjusted for gender, age, area of residence, parents' educational level, parent coresidence, and socioeconomic status

Full article at: http://goo.gl/EWWUAy

By: Park S1.

• 1Department of Psychiatry, Seoul National Hospital, Seoul, Republic of Korea.  

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The Effect of Early Menarche on the Sexual Behaviors of Korean Female Adolescents

This study examined the relationships between early menarche and sexual behaviors among Korean female adolescents.

We analyzed data from the eighth Korea Youth Risk Behavior Web-based survey that was conducted on female high school students in grades 10-12. The survey included 17,867 students, and 974 students were assigned to the early menarche group because they had experienced menarche when they were in grade four or below, and 16,893 students were assigned to the normal menarche group because they had experienced menarche during or after grade five. The characteristics of the sexual behaviors in the early menarche and normal menarche group were analyzed.

The early menarche group was at a higher risk of intersexual kissing or petting, intersexual intercourse, homosexual kissing or petting, homosexual intercourse, being the victim or the assailant of sexual assaults, intercourse without any contraception, and pregnancy than the normal menarche group.

Early menarche is associated with risky sexual behaviors among adolescent females; therefore, developing comprehensive sexual health education programs and tools for early intervention are required for children who are expected to experience early menarche.

Table 2

The effect of early menarche on the sexual behaviors from the Korea Youth Risk Behavior Web-based survey (2012)

Values are presented as number (%).

OR, odds ratio; CI, confidence interval.

a)Odds ratio (adjusted for sociodemographic variables of paternal educational level, maternal educational level, living with both parents, academic performance and household income) for early menarche group for event compared with normal menarche group.

Full article at: http://goo.gl/emmQQb

By: Ji In Cheong, MD,1 Chang Hun Lee, MD,2 Jae Hong Park, MD, PhD,2 Byeong Jin Ye, MD, PhD,3 Kyoung Ah Kwon, MD,1 Young Seok Lee, MD, PhD,1 and Jae Ho Yoo, MD1

¹Department of Pediatrics, Dong-A University College of Medicine, Busan, Korea.

²Department of Psychiatry, Dong-A University College of Medicine, Busan, Korea.

³Department of Occupational and Environmental Medicine, Dong-A University College of Medicine, Busan, Korea.

Corresponding author.

Address for correspondence: Jae Ho Yoo, MD. Department of Pediatrics, Dong-A University Hospital, Dong-A University College of Medicine, 26 Daesingongwon-ro, Seo-gu, Busan 49201, Korea. Tel: +82-51-240-2883, Fax: +82-51-242-2765, Email: rk.ca.uad@odnedep

   

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Pulmonary Impairment in Tuberculosis Survivors: The Korean National Health and Nutrition Examination Survey 2008-2012

Pulmonary tuberculosis (TB) can affect lung function, but studies regarding long-term follow-up in patients with no sequelae on chest X-ray (CXR) have not been performed. We evaluated lung functional impairment and persistent respiratory symptoms in those with prior pulmonary TB and those with prior pulmonary TB with no residual sequelae on CXR, and determined risk factors for airflow obstruction.

We used data from adults aged ≥ 40 years from the annual Korean National Health and Nutrition Examination Surveys conducted between 2008 and 2012. P values for comparisons were adjusted for age, sex, and smoking status.

In total of 14,967 adults, 822 subjects (5.5%) had diagnosed and treated pulmonary TB (mean 29.0 years ago). The FVC% (84.9 vs. 92.6), FEV₁% (83.4 vs. 92.4), and FEV₁/FVC% (73.4 vs. 77.9) were significantly decreased in subjects with prior pulmonary TB compared to those without (p < 0.001, each). In 12,885 subjects with no sequalae on CXR, those with prior pulmonary TB (296, 2.3%) had significantly lower FEV₁% (90.9 vs. 93.4, p = 0.001) and FEV₁/FVC% (76.6 vs. 78.4, p < 0.001) than those without. Subjects with prior pulmonary TB as well as subjects with no sequalae on CXR were more likely to experience cough and physical activity limitations due to pulmonary symptoms than those without prior pulmonary TB (p < 0.001, each). In total subjects, prior pulmonary TB (OR, 2.314; 95% CI, 1.922–2.785), along with age, male, asthma, and smoking mount was risk factor for airflow obstruction. In subjects with prior pulmonary tuberculosis, inactive TB lesion on chest x-ray (OR, 2.300; 95% CI, 1.606–3.294) were risk factors of airflow obstruction.

In addition to subjects with inactive TB lesion on CXR, subjects with no sequelae on CXR can show impaired pulmonary function and respiratory symptoms. Prior TB is a risk factor for airflow obstruction and that the risk is more important when they have inactive lesions on chest X-ray. Hence, the patients with treated TB should need to have regular follow-up of lung function and stop smoking for early detection and prevention of the chronic airway disease.

Below: Lung functions according to the presence of prior pulmonary tuberculosis.

(A) In all study subjects; (B) In subjects with normal chest X-rays. FVC: forced vital capacity; FEV1: forced expiratory volume in 1 second.

Below:  Respiratory symptoms according to the presence of prior pulmonary tuberculosis.

(A) In all study subjects; (B) In subjects with normal chest X-rays. pvalues were adjusted for age, sex, and smoking status.

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By: Jae-Woo Jung, Jae-Chol Choi, Jong-Wook Shin, Jae-Yeol Kim, Byoung-Whui Choi, In-Won Park, Department of Internal medicine, Chung-Ang University College of Medicine, Seoul, Korea

  

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Identifying Barriers to Human Immunodeficiency Virus Testing for Men Who Have Sex with Men in South Korea

The principal objective of this study was to identify the barriers to testing for men who have sex with men (MSM) in Korea, something that might prove useful in future studies of this nature.

This study was conducted at gay bars nationwide in Korea. After considering several offline locations (gay bars) where MSM candidates are commonly located, random recruitment was performed using time–location sampling. A total of 944 individuals participated in this survey. A total sample of 921 cases (23 cases were excluded) was used for analysis. A self-administered questionnaire measuring the individuals' demographics, human immunodeficiency virus (HIV)/AIDS knowledge, stigma, phobia, optimism bias, self-efficacy for condom use, and sexual practices was used.

About 61.8% (N = 569) of respondents reported having been tested at least once in their lifetime, and 38.9% (N = 358) acknowledged being tested within the past 12 months. After adjusting for age, education, and number of partners in a logistic regression analysis, awareness of testing place [odds ratio (OR) = 4.04], exposure to HIV prevention campaign (1.54), fear (OR = 1.13), and discrimination toward people with HIV/AIDS (OR = 0.94) were the main factors associated with HIV testing.

To accomplish widespread HIV testing for Korean MSM, the accessibility of testing centers and advertisement of voluntary counseling and testing to MSM are needed.

Table 2

HIV testing related behavior.

Characteristics		N	%
Number of partners (past 6 mo)	0	157	17.0
	1	303	32.9
	2–5	325	35.3
	6 and more	136	14.7
Condom usea (N = 685) (at last sexual encounter)	Yes	401	58.5
	No	284	41.5
Reported STIs	Yes	103	11.2
	No	818	88.8
Reported HIV	Yes	11	1.2
	No	838	91
	Not Sure	72	7.8
Total		921	100.0

HIV = human immunodeficiency virus; STI = sexually transmitted infection.

aPersons having had one and more partners in the past 6 months.

Table 4

Factors affecting HIV testing behavior.

		Model 1		Model 2		Model 3
		β	OR	β	OR	β	OR
Age (y)	19–29 (ref.)
	20–29	0.225	1.25	0.119	1.13	0.107	1.11
	30–39	0.074	1.08	−0.014	0.99	−0.128	0.88
	40–49	0.230	1.26	0.357	1.43	0.407	1.50
Education	High school and less (ref.)	—	—	—	—	—	—
	2 y of college	0.290	1.34	0.249	1.28	0.258	1.29
	4 y college and more	0.285	1.33	0.100	1.11	0.063	1.07
Number of partners	2 and less (ref.)	—	—	—	—	—	—
	3–5	–.133	0.88	−0.177	0.84	−0.216	0.81
	6 and more	0.490	1.63 *	0.319	1.38	0.221	1.25
Condom use	No (ref.)	—	—	—	—	—	—
	Yes	0.139	1.15	0.017	1.02	−0.016	0.98
HIV knowledge				0.169	1.18 *	0.132	1.14
Discrimination				−0.074	0.93 ***	−0.065	0.94 ***
Fear				0.120	1.13 **	0.122	1.13 **
Condom self-efficacy				0.064	1.07	0.053	1.06
Awareness of testing place						1.397	4.04 ***
Exposure to HIV prevention campaigning						0.433	1.54 *

* p < 0.05; ** p < 0.01; *** p < 0.001.

HIV = human immunodeficiency virus; OR = odds ratio; ref. = reference group.

Full article at: http://ht.ly/SZPkC 

By: Aeree Sohn,a,∗ Byonghee Cho,b and Harvey A. Kennedyc

^bGraduate School of Public Health, Seoul National University, Seoul, Korea

^c

aDepartment of Health Management, Sahmyook University, Seoul, Korea

bGraduate School of Public Health, Seoul National University, Seoul, Korea

cGraduate School of Health and Social Welfare, Sahmyook University, Seoul, Korea

aDepartment of Health Management, Sahmyook University, Seoul, Korea

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