• Journal of Preventive Medicine and Public Health
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• v.54 no.6
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• pp.471-480
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• 2021

Objectives: Cadmium is widely used, leading to extensive environmental and occupational exposure. Unlike other organs, for which the harmful and carcinogenic effects of cadmium have been established, the hepatotoxicity of cadmium remains unclear. Some studies detected correlations between cadmium exposure and hepatotoxicity, but others concluded that they were not associated. Thus, we investigated the relationship between cadmium and liver damage in the general population. Methods: In total, 11 838 adult participants from National Health and Nutrition Examination Survey 1999-2015 were included. Urinary cadmium levels and the following liver function parameters were measured: alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transferase (GGT), total bilirubin (TB), and alkaline phosphatase (ALP). Linear and logistic regression analyses were performed to assess the associations between urinary cadmium concentrations and each liver function parameter after adjusting for age, sex, race/ethnicity, annual family income, smoking status, alcohol consumption status, physical activity, and body mass index. Results: The covariate-adjusted results of the linear regression analyses showed significant positive relationships between log-transformed urinary cadmium levels and each log-transformed liver function parameter, where beta±standard error of ALT, AST, GGT, TB, and ALP were 0.049±0.008 (p<0.001), 0.030±0.006 (p<0.001), 0.093±0.011 (p<0.001), 0.034±0.009 (p<0.001), and 0.040±0.005 (p<0.001), respectively. Logistic regression also revealed statistically significant results. The odds ratios (95% confidence intervals) of elevated ALT, AST, GGT, TB, and ALP per unit increase in log-transformed urinary cadmium concentration were 1.360 (1.210 to 1.528), 1.307 (1.149 to 1.486), 1.520 (1.357 to 1.704), 1.201 (1.003 to 1.438), and 1.568 (1.277 to 1.926), respectively. Conclusions: Chronic exposure to cadmium showed positive associations with liver damage.

• Journal of Preventive Medicine and Public Health
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• v.40 no.6
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• pp.505-511
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• 2007

Objectives : While cervical cancer is one of the leading cancers among women worldwide, there are a number of effective early detection tests available. However, the participation rates in cervical cancer screening among Korean women remain low. After the nationwide efforts in 1988 and thereafter to encourage participation in cervical cancer screening, few studies have investigated the effects of socioeconomic inequality on participation in cervical cancer screening. The purpose of this study was to investigate 1) the level of socioeconomic disparities in receiving cervical cancer screening by age group and 2) if there was an improvement in reducing these disparities between 1995 and 2001. Methods : Using data from the Korean National Health Status, Health Behavior and Belief Survey in 1995, the Korean National Health and Nutrition Examination Surveys from 1998 and 2001 (sample sizes of 2,297, 3,738, and 3,283), age-standardized participation rates were calculated according to education level, equivalized household income, and job status. Odds ratios and the relative inequality index (RII) were also calculated after controlling for age. Results : Women with lower education levels were less likely to attend the screening test, and the disparities by education level were most pronounced among women aged 60 years and older. The RIIs among women 60 years and older were 3.64, 4.46, and 8.64 in 1995, 1998, and 2001, respectively. Higher rates of participation were reported among those in the highest income category, which was more notable among the middle aged women (40s and 50s). An inconsistent trend in the rate of participation in cervical cancer screening by occupational level was found. Conclusions : Indicators of socioeconomic position seem to have varying impacts on the inequalities in the rates of participation in cervical cancer screening according to age group. These results demonstrate the need for more aggressive and age-based interventions and policy programs to eliminate the remaining inequalities.

• Journal of Industrial Convergence
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• v.19 no.5
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• pp.69-77
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• 2021

This study identified vitamin E associated with metabolic syndrome and metabolic syndrome components among Korean adults aged over 19 years. Secondary data from the 2016-2018 Korean National Health and Nutrition Examination Survey were used for this study. Data from 6,425 were analyzed by logistic regression analysis using a complex sample procedure. As a result of logistic regression analysis, the odds ratio was increased in the group with high vitamin E levels compared to the group with normal vitamin E levels. There are metabolic syndrome (Adjusted Odds Ratio [AOR]: 1.889, 95% Confidence Interval [CI]: 1.550-2.303, p<.001), abdominal obesity (AOR: 1.444, CI: 1.205-1.730, p<.001), hyperglyceridemia(AOR: 3.182, CI: 2.641-3.835, p<.001), systolic blood pressure (AOR: 1.711, CI: 1.446-2.026, p<.001), diastolic blood pressure (AOR: 1.806, CI: 1.521-2.144, p<.001), low high density lipoprotein cholesterol (AOR: 1.558, CI: 1.060-2.290, p=.024). Therefore vitamin E was associated with metaboic syndrome and metabolic syndrome components. So when providing nursing intervention for people with metabolic syndrome, education on vitamin E should be actively included.

• Korean Journal of Clinical Pharmacy
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• v.24 no.1
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• pp.33-38
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• 2014

Background: Diabetes is accompanied by complications. One of the chronic complications, diabetic retinopathy is the most common cause of the loss of eyesight and thus has enormous impacts on the quality of life to the patients. It has been reported that thorough glucose regulation can prevent or postpone the outset of diabetic retinopathy in diabetic patients and that the patients who received anti-diabetic manage & care education would be capable of more thorough glucose-level regulation than those who did not. Method: This study set out to investigate the current state of education on anti-diabetic manage & care in South Korea and connections between anti-diabetic manage & care education and occurrence of diabetic retinopathy in diabetic patients based on the Korea National Health and Nutrition Examination Survey of 2011. Results: Of the 410 diabetes patients, 74 received anti-diabetic manage & care education, which means that only 15% of diabetic patients benefited from the education in the nation. The occurrence rate of diabetic retinopathy was 28% in the education group and 24% in the non-education group with no significant differences between them. The anti-diabetic manage & care education group recorded a higher occurrence rate of diabetic retinopathy, one of the chronic diabetic complications, than the non-education group contrary to the hypothesis. One of the reasons was that the educated group had a significantly longer duration of diabetes and significantly higher HbA1c than the noneducated group, which indicates that anti-diabetic manage & care education is provided to those who have progressed farther along the course of diabetes instead of the early stage and cannot regulate their glucose-level well in the nation. Conclusion: Those findings raise a need for active educational policies in order to provide anti-diabetic manage & care education under the goals of preventing complications through anti-diabetic education for many patients in early stages of diabetes.

• The Korean Journal of Applied Statistics
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• v.27 no.5
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• pp.705-715
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• 2014

Metabolic syndrome is a major factor for cardiovascular disease that can develop into a variety of complications such as stroke disease. This study utilizes a Bayesian network to model metabolic syndrome. In addition, we tried to find the best risk combinations to diagnose metabolic syndrome. We confirmed that the combinations are difference according to individual characteristics. The paper used data from 4,489 adults who responded to all health interview questions from the the $5^{th}$ Korea National Health and Nutrition Examination Survey conducted in 2010.

• Korean Journal of Clinical Laboratory Science
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• v.53 no.4
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• pp.342-352
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• 2021

We used data from the 7th Korea National Health and Nutrition Examination Survey (KNHANES) (2016~2018) to investigate an association between high sensitivity C-reactive protein (hsCRP) and uric acid in the obese. Obesity was defined as a body mass index (BMI) of 25 kg/m² or more, severe obesity as a BMI of 30 kg/m² or more, and morbid obesity as a BMI of 35 kg/m² or more. In the complex samples multiple logistic regression, despite adjustment by adding major risk factors, the odds ratio (OR) for obesity was higher in the group with high levels of both, hsCRP and uric acid than the reference group at all stages (obesity, OR 1.89, P<0.001 vs. severe obesity, OR 5.04, P<0.001 vs. morbid obesity, OR 8.20, P<0.001). The association between hsCRP and uric acid in obese patients increased from 1.89 to 8.20 as the obesity level increased, suggesting that participants with increased BMI were significantly affected by hsCRP and uric acid. Moreover, the interaction between hsCRP and uric acid was statistically significant even in the model corrected for major confounding factors (P for interaction=0.009).

• Korean Journal of Community Nutrition
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• v.23 no.4
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• pp.352-365
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• 2018

Objectives: The Korean Food Composition Table (KFCT) was first published in 1970, and has since been updated every five years by the Rural Development Administration (RDA). This study was conducted to introduce the development strategies, features, and challenges of the $9^{th}$ revision of the KFCT. Methods: Due to the increasing demands of nutrient database users and generators, the RDA started a new research project in 2013 to improve the quantity and quality of data for the $9^{th}$ revision of the KFCT. Over 1,000 food items frequently consumed in Korea were selected as key foods using the results of the Korean National Health and Nutrition Examination Survey. About 200 raw materials and processed food items were collected and analyzed every year. Target nutrients that were analyzed by collaborative labs, such as, sugars, selenium, iodine, and biotin, were increased from 22 to 43. Analytical sample handling procedures and data quality evaluation systems were also established in collaboration with 10 contracted labs. Data were evaluated for data quality according to the FAO/INFOODS, CODEX, and AOAC guidelines. Results: The $9^{th}$ revision contains data on 3,000 food items and up to 43 and 140 food nutrients for the printed table and the excel database file, respectively. Overall, 1,485 data items were newly added, 973 of which were provided by the RDA and 512 were cited from foreign nutrient databases. The remaining 1,515 food items were maintained as in the $8^{th}$ revision. Conclusions: The KFCT provides the basic infrastructure for food and nutrition policy, research, and dietary practice in South Korea. The use of the KFCT has increased exponentially in the past few years in both public and private sectors; accordingly, increased efforts should be paid to the preparation, improvement, and maintenance of KFCT.

• Korean Journal of Health Education and Promotion
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• v.33 no.2
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• pp.57-66
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• 2016

Objectives: This study investigated the relationship between smoking status and depressive symptoms among Korean adults. Methods: We used the data of 17,871 adults aged 19 years or older from the fifth Korea National Health and Nutrition Examination Survey(2010-2012). The subjects were classified as nonsmokers, former smokers, and current smokers by gender. Logistic regression analysis was used to calculate the odds ratios(ORs) and the 95% confidence intervals(CIs) for the effects of smoking status on depressive symptoms, and depression diagnosed by a doctor. Results: Compared to nonsmokers, the ORs of depressive symptoms for current smokers were 1.11(95% CI, 1.11-1.12) among males, and 1.64(95% CI, 1.63-1.64) among females. Compared to former smokers, the ORs of depressive symptoms for current smokers were 1.05(95% CI, 1.05-1.05) among males, and 1.89(95% CI 1.88-1.90) among females. Compared to nonsmokers, the ORs of depression for current smokers were 0.94(95% CI, 0.94-0.95) among males, and 1.40(95% CI, 1.39-1.41) among females. Compared to former smokers, the ORs of depression for current smokers were 1.09(95% CI, 1.09-1.10) among males, and 0.99(95% CI, 0.99-1.00) among females. Conclusions: Smoking is associated with depressive symptoms among Korean adults. Therefore, it is necessary to consider depressive symptoms with the management of tobacco control policies.

• Journal of The Korean Ophthalmological Society
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• v.58 no.11
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• pp.1260-1268
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• 2017

Purpose: Strabismus affects any age and represents various functional or non-functional eye problems. This population-based study was conducted to determine the prevalence of strabismus and nystagmus in South Korea according to various sociodemographic factors. Methods: We acquired data from the Korea National Health and Nutrition Examination Survey, a nation-wide cross-sectional survey and examinations of the non-institutionalized civilian population in South Korea (n = 30,538), conducted from July 2008 to December 2011. The prevalence of strabismus and nystagmus were verified, and associated sociodemographic factors was evaluated. Results: The overall prevalence of strabismic disorder in participants over 3 years of age was $1.4{\pm}0.1%$ (95% confidence interval [CI] 1.3-1.6%; $1.5{\pm}0.1%$ in males, $1.3{\pm}0.1%$ in females). The prevalence of exodeviation (15 or more prism diopters), esodeviation (10 or more prism diopters), vertical deviation, and other complicated strabismus and nystagmus was 1.0%, 0.2%, 0.2%, 0.1% and 0.1% respectively. The prevalence was highest in the 6 to 15-year age group ($1.9{\pm}0.3%$), and lowest in the 40 to 49 years age group ($0.8{\pm}0.1%$) (p = 0.005). There were no statistically significant differences for gender, region, residential area, household income, educational level and occupation. Conclusions: This nation-wide epidemiologic study demonstrated that the prevalence of strabismus and nystagmus according to various sociodemographic factors in South Korea was not statistically significant except for age group. Further investigations are required based on more surveys to better recognize the etiologic or risk factors that may be related to strabismus and nystagmus.

• Communications for Statistical Applications and Methods
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• v.29 no.5
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• pp.547-559
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• 2022

For a chi-squared test, which is a statistical method used to test the independence of a contingency table of two factors, the expected frequency of each cell must be greater than 5. The percentage of cells with an expected frequency below 5 must be less than 20% of all cells. However, there are many cases in which the regional expected frequency is below 5 in general small area studies. Even in large-scale surveys, it is difficult to forecast the expected frequency to be greater than 5 when there is small area estimation with subgroup analysis. Another statistical method to test independence is to use the Bayes factor, but since there is a high ratio of data dependency due to the nature of the Bayesian approach, the low expected frequency tends to decrease the precision of the test results. To overcome these limitations, we will borrow information from areas with similar characteristics and pool the data statistically to propose a pooled Bayes test of independence in target areas. Jo et al. (2021) suggested hierarchical Bayesian pooling models for small area estimation of categorical data, and we will introduce the pooled Bayes factors calculated by expanding their restricted pooling model. We applied the pooled Bayes factors using bone mineral density and body mass index data from the Third National Health and Nutrition Examination Survey conducted in the United States and compared them with chi-squared tests often used in tests of independence.