Health Security Ideas of Major Political Groups and the US Military Government during the Liberation Period (1945-1948) in Korea.

The liberation period in Korea was when creative imagination and various debates existed about plans for political, economic, and social systems. Among them was the debate over the national health security underlying the social safety net. Although the US influenced the Korean health security after liberation, major political groups on the Korean peninsula also expressed various opinions. However, previous studies have shown little interest in national health security, which operates the public health and medical care systems. To overcome these limitations, this study focuses on the ideas on national health security presented by major political groups, analyzing the reply proposal of "Jonpyong" and the health care proposal of the US military government, which has not been reviewed before. The opinions of major political groups including the right-wing Im-hyop and left-wing Min-chon diverged on national health security issue regarding insurance coverage, measures to secure financial resources, items of insurance benefits, and measures to stabilize the supply and demand of medical personnel. The claims of the US military government can be understood by "Labor Problems and Policies in Korea (Korean Subcommittee)," "Korean Labor Report (Stewart Meacham)," and "Proposed Political Platform Provisional Korean Democratic Government (Sub-commission #2)." The major political groups and the US military government agreed on the need for social protection against death, old age, disability, disease, injury, and unemployment. All of them claimed national health security, in which the roles of the private sector and the government were mixed, should be gradually introduced. The major political groups, in particular, proposed to (1) set workers as beneficiaries of insurance, (2) share financial resources jointly among the state, employers, and workers, and (3) promote the expansion of the number of doctors and medical institutions and prefer cooperative operations of the hospitals established in small administrative units. This paper argues that the ideas on national health security during the liberation period did not completely deviate from the global trend immediately after World War II when countries tried to expand the number of people covered by national health security and strengthen its coverage. Although these ideas were not fully reflected in the Constitution of 1948, it is significant in that the Constitution codified for the first time the state's responsibility for those who have no ability for living due to their health conditions.

A Multi-level Analysis of Factors Affecting Participation in Health Screenings in Korea: A Focus on Household and Regional Factors.

OBJECTIVES: This study divided the factors that affect participation in health screenings into individual, household, and regional levels and conducted a multi-level analysis to identify the factors related to participation in health screenings. METHODS: Participants from the 2017 Community Health Survey were classified into 2 groups (under 40 and 40 or older). A multi-level logistic regression analysis was conducted to identify the factors that affected participation in health screenings. RESULTS: The screening rate of the participants was 69.7%, and it was higher among participants aged 40 and older (80.3%) than it was among participants younger than 40 (49.8%). At the individual level, the factors that influenced participation in health screenings included age, economic activity, smoking status, physician-diagnosed hypertension, and a moderate or high physical activity level. At the household level, the odds ratio of participation in health screenings was high for participants who lived in single-person households, lived with a spouse, earned a high monthly household income, and were not beneficiaries of national basic livelihood security. At the regional level, the odds ratio at the 95% confidence interval level of participation in health screenings was high for participants who had trust in the local community and lived in an area with a proportionally high social welfare budget. CONCLUSIONS: This study analyzed nationalwide data and confirmed that individual, household, and regional characteristics affected participation in health screenings. Therefore, policies that prioritize the improvement of regional level factors and especially household level factors are likely to be the most effective for improving the screening rate.

Life and Ideas of LEE Kap-Soo: Focusing on the Ideas and Activities Related to Eugenics.

Lee Kap-Soo (April 23, 1889-December 5, 1973) graduated from Gyeongseong Medical College in 1920, went to Germany to study, and returned to Korea after graduating from Berlin University in 1924. On September 14, 1933, he played a leading role in the founding of the Joseon Eugenics Society, and he contributed eugenic ideas through written publications and lectures. He was a leading eugenicist who continued his activities related to eugenics, such as re-establishing the Korean National Eugenics Society and making efforts to enact the Eugenics Act after Korea's liberation from Japanese occupation. His ideas on eugenics were then a rapid acceptance of the world's times and science, and his ideas were an expanded eugenics that emphasized the nation. He actively carried out the campaign for eugenics and maintained a consistent stance before and after liberation. His eugenic ideas and activities show that Korean society was not free from the influence of eugenics that was gaining popularity around the world. His eugenic ideas were related to enlightenment, but the basis of eugenics was the logic of discrimination and exclusion. In particular, his eugenic ideas and activities have caused pain to Hansen's patients through forced isolation and discontinuation. In addition, his doctrine of eugenics still holds sway in Korean society. The history of Lee Kap-Soo's life and eugenics-related activities shows the important points and characteristics of the history of eugenics in Korean society before and after the liberation from Japan, and furthermore provides an important clue in understanding and explaining the colonial vestige in Korean society, economic growth first ideology, enthusiasm for scientific development, and competitive social culture.

Psychological Distress among Adolescents in Laos, Mongolia, Nepal, and Sri Lanka.

PURPOSE: The purpose of this study was to explore psychological distress and examine the relationship between this distress and individual, family, and school factors among adolescents in four low- and middle-income countries (LAMICs) in Asia (i.e., Laos, Mongolia, Nepal, and Sri Lanka). METHODS: A total of 4,098 adolescents attending public schools in the four LAMICs were surveyed as part of the Healthy School Development Project, which aimed to develop school capacity for improving (1) health among all school members and (2) the school environment through tailored school health programs. Psychological distress, family factors (i.e., parental understanding and monitoring, and parental tobacco and alcohol use), and school factors (i.e., having close friends, not bullied, school attendance, and health education) were assessed using self-report questionnaires. Data were collected from September to November in 2012 and 2013. Data analysis comprised descriptive statistics, Chi-squared testing, and logistic regression. RESULTS: Over half of the participants were women (53.2%-64.1%), and 33.7% (in Sri Lanka) to 53.8% (in Laos) were aged older than 15 years. Approximately 32.9% reported the presence of psychological distress; moreover, 7.9%-13.2% reported suicidal ideation. Parental monitoring and being bullied were associated with psychological distress in all four countries. CONCLUSION: One-third of adolescents experience psychological distress across these four LAMICs, which poses a substantial public health issue. Adolescents can benefit from family and school-based approaches for screening, ameliorating, and preventing psychological distress.

The Establishment and operation of Longjing Medical College - The History of Longjing Medical College as Frontier History: Focusing on its 'Disconnection' and 'Continuity'.

Longjing Medial College, established in Longjing, Yanbian, China on September 12, 1945, existed for about 1 year and 6 months until it was renamed as the Medical Department of Dongbei Junzheng Daxue Jilin Fenxiao in April 1947. However, there are only few records and studies on Longjing Medical College in Yanbian as well as in Korea. In order to fill the gap, this study attempted to restore the history of Longjing Medical College built in Yanbian, China immediately after the liberation. In particular, it analyzed how and why the Longjing Medical College was founded and operated, and which relations the college had with the post-war medical educational institutions, focusing on the 'disconnection' and 'continuity' in the historical sense. Since the establishment of Manchukuo, the Japanese colonial government had made it a major "frontier" and actively promoted the mass migration of Japanese and Koreans. For them, the government also set up three Exploitation Medical Schools in 1940. As a part of these three institutions, Longjing Exploitation Medical School educated more than 150 students by 1945, of which about one third was Korean. After the liberation, the Longjing Educational Alliance decided to pursue the return-movement of the Longjing Exploitation Medical School and took over the institution. On September 12, 1945, Longjing Medical College opened at the school site of Longjing Exploitation Medical School. Longjing Medical College was founded by people who had 'the perspective of Korean nationality' in an atmosphere where the 'ethnicity' of the Koreans exercised considerable power. Nevertheless, in 1946, when the Chinese Civil War began and the Yanbian region became an important base of the Chinese Communist Party, the Party began to expand and strengthen their influences in the region. Accordingly, the operation rights of Longjing Medical College were transferred to the Yanbian Administrative offices of Supervision and Government of Jirinsheng which were the administrative institution by the Chinese Communist Party in turns. In the end, Longjing Medical College was reorganized into the Medical Department of Dongbei Junzheng Daxue Jilin Fenxiao (1947. 3) and the first branch of the Chinese Medical College (1948. 1), a medical education institution focused on nurturing the medical personnel required for the Chinese Civil War. In January 1949, the first branch moved to Harbin, merged with the second branch there, and was transformed into Harbin Medical College. Afterwards, the Yanbian Koreans played a major role to establish Yanbian Medical College in a basis of the teachers and buildings left by the moving-out of the first branch(1948. 10. 1). Now, Yanbian Medical College is the official body of Yanbian University Medical Center. Longjing Medical College, which has such a complicated history, is partially 'disconnected' from the Yanbian medical educational institutions in the post-war era in terms of its possession, operation objective, and academic system. However, many of the early members of the Longjing Medical College were not only teachers and students of the Longjing Exploitation Medical School, but also a few of them continued to teach at the Medical Department of Dongbei Junzheng Daxue Jilin Fenxiao, the first branch of the Chinese Medical College, and Yanbian Medical College. Particularly, several members actively participated in the establishment of each school or in the position of the top leader of the school. Also, all the medical education institutions referred to above used the building and facilities of Longjing Exploitation Medical School until the period of Yanbian Medical College. As such, the history of Longjing Medical College as frontier history, gives us a difficult, but significant question on the meanings of 'disconnection' and 'continuity' in history and their implications.

Characteristics of Drug Resistant Tuberculosis in Sanatoria of North Korea.

Although several reports about drug-resistant tuberculosis (TB) in North Korea have been published, a nationwide surveillance on this disease remains to be performed. This study aims to analyze the drug resistance patterns of Mycobacterium tuberculosis among the patients in the sanatoria of North Korea, especially during the period when second-line drugs (SLDs) had not yet been officially supplied to this country. The Eugene Bell Foundation (EBF) transferred 947 sputum specimens obtained from 667 patients from 2007 to 2009 to the Clinical Research Center, Masan National Tuberculosis Hospital (MNTH), South Korea. Four hundred ninety-two patients were culture positive for TB (73.8%). Drug susceptibility test (DST) was performed for the bacilli isolated from 489 patients. Over 3 quarters of the cases (76.9%) were multidrug-resistant (MDR)-TB. Additionally, 2 patients had extremely drug-resistant (XDR)-TB. Very high resistance to first-line drugs and low resistance to fluoroquinolones (FQs) and injectable drugs (IDs) except for streptomycin (S) were detected. A small but significant regional variation in resistance pattern was observed. Big city regions had higher rate of MDR-TB, higher resistance to FQs and IDs than relatively isolated regions. In conclusion, significant number of drug-resistant TB was detected in North Korean sanatoria, and small but significant regional variations in resistance pattern were noticeable. However, the data in this study do not represent the nationwide drug resistance pattern in North Korea. Further large-scale evaluations are necessary to estimate the resistance pattern of TB in North Korea.

Validity analysis on merged and averaged data using within and between analysis: focus on effect of qualitative social capital on self-rated health.

OBJECTIVES: With an increasing number of studies highlighting regional social capital (SC) as a determinant of health, many studies are using multi-level analysis with merged and averaged scores of community residents' survey responses calculated from community SC data. Sufficient examination is required to validate if the merged and averaged data can represent the community. Therefore, this study analyzes the validity of the selected indicators and their applicability in multi-level analysis. METHODS: Within and between analysis (WABA) was performed after creating community variables using merged and averaged data of community residents' responses from the 2013 Community Health Survey in Korea, using subjective self-rated health assessment as a dependent variable. Further analysis was performed following the model suggested by WABA result. RESULTS: Both E-test results (1) and WABA results (2) revealed that single-level analysis needs to be performed using qualitative SC variable with cluster mean centering. Through single-level multivariate regression analysis, qualitative SC with cluster mean centering showed positive effect on self-rated health (0.054, p<0.001), although there was no substantial difference in comparison to analysis using SC variables without cluster mean centering or multi-level analysis. CONCLUSIONS: As modification in qualitative SC was larger within the community than between communities, we validate that relational analysis of individual self-rated health can be performed within the group, using cluster mean centering. Other tests besides the WABA can be performed in the future to confirm the validity of using community variables and their applicability in multi-level analysis.

The Establishment of Wonsan Laborers' Hospital during the Japanese Occupation and Its Significance.

On July 3, 1928, the Wonsan Labor Union established the Wonsan Laborers' Hospital in Seoku-dong, Wonsan for the purpose of reducing medical consultation fees for its members. The union's efforts to improve the welfare of its members include the establishment of an educational institute, a consumers union, a barbershop, and a relief department. The Laborers' Hospital, which began with ten wards, was led by a team of two doctors, one midwife, two pharmacists, and four nurses. The two doctors were Cheol-sun Cha and Jeong-kwon Lee, and the midwife/nurse was Sun-jeong Kim. Union members received a 40% discount on medicine, and this was utilized by a daily average of 60 to 70 workers, or 21,000 workers annually. The Laborers' Hospital was clearly distinct from medical facilities founded as charity institutions in that funds were raised by the recipients themselves, and that the recipients formed a community based on their common status as laborers. However, the Wonsan Laborers' Hospital was shut down in roughly April 1929 due to the breaking of the general strike, and the heightened suppression of union activities prevented any additional opening of laborers' hospitals until Korea's liberation from Japan. Nevertheless, the history of the Wonsan Laborers' Hospital represents a key development in Korea's health coverage. It is not adequate to declare, as was the case in past research, Korea's health coverage to be simply an imitation of the Western system and lacking its own history. Despite some differences in scale and operation, the development of health coverage in the Korean peninsula is in line with the history of health coverage development in the West. The Wonsan Laborers' Hospital, founded and operated by the laborers themselves, thus holds great significance in the history of Korea's health coverage, The findings of this study are expected to stimulate new and more diverse discussions on the history of health coverage in Korea.

A new strategy for tuberculosis control in North Korea.

Tuberculosis is one of the most prevalent diseases in North Korea. Despite some positive accomplishments by current aid projects, it is still necessary to investigate the existing aid system. The following are necessary for improvement: sustaining a high degree of expertise, cooperation among various related parties including the international community, mediation to induce this cooperation, a more active role of the South Korean government, and encouragement of North Korea to more actively participate. Achieving these will help solve the issues of current tuberculosis aid projects in North Korea and lead to more successful outcomes.

The timing of surgery and mortality in elderly hip fractures: A retrospective, multicenteric cohort study.

BACKGROUND: Early surgery is recommended for elderly hip fracture patients, but some studies show no clear advantage. The benefits of early surgery may differ according to the medical environment in different countries. The purpose of this study was to identify the potential benefits of early surgery in elderly hip fracture patients by evaluating the effect of timing of surgery on mortality. MATERIALS AND METHODS: A retrospective study was conducted at multiple centers on hip fracture patients aged over 65 years. The primary outcome was 1 year mortality and the secondary outcomes were 30-day/6-month mortality and complications during admission. The effect of time to surgery on mortality was analyzed using a Cox proportional-hazards model. RESULTS: Among the 874 patients, 162 (18.5%) received surgery within 3 days and their 1-year mortality rate was 9.9%. However, the 1-year mortality rate for the delayed surgery group was 12.5%. After adjustment for potential confounders, the 1-year mortality rates in patients who received surgery in 3-7 days (Hazard ratio = 1.0; 95% confidence interval [CI]: 0.7-1.6) and over 7 days (hazard ratio = 1.3; 95% CI: 0.9-1.8) were not significantly different. In addition, the time to surgery did not have a significant effect on 30-day mortality, 60-day mortality or complications arising during hospitalization. CONCLUSIONS: The time to surgery did not affect short and long term mortality or the in hospital complication rate in elderly hip fracture patients. We recommend concentrating more on optimizing the condition of patients early with sufficient medical treatment rather than being bound by absolute timing of surgery.

Reliability and validity of a scale for health-promoting schools.

Despite a growing body of research regarding the health-promoting schools (HPS) concept from the World Health Organization (WHO), research on measuring of the HPS is limited. This study aims to develop a scale for assessing the status of the HPS based on the WHO guidelines and to evaluate the reliability and validity of the scale. After completing the translation and back-translation process, the content validity of the 50-item scale for HPS (SHPS) was assessed by an expert committee review and pretested with 17 teachers. A stratified, random sampling design was used. A total of 728 teachers from 94 schools completed a self-administered questionnaire. The total sample was randomly divided into three groups for exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and cross-validation. The EFA suggested seven factors, including 37 items, and the CFA confirmed these factors. In a second-order factor analysis, the second-order seven-factor model had acceptable fit indices (root mean square error of approximation 0.07, comparative fit index 0.98) with stability over validation sample and whole sample. Thus, the first-order seven factors (school nutrition services [three-item, α = 0.87], healthy school policies [six-item, α = 0.87], school's physical environment [10-item, α = 0.91], school's social environment [four-item, α = 0.88], community links [six-item, α = 0.91], individual health skills and action competencies [three-item, α = 0.89], and health services [five-item, α = 0.86]) loaded significantly onto the second-order factor (HPS [37-item, α = 0.97]). In conclusion, the SHPS is a reliable and valid measurement tool for assessing the states of the HPS in the Korean school context. It will be useful for comprehensively assessing schools' needs and monitoring the progress of school health interventions.

What factors affect the success rate of the first attempt at endotracheal intubation in emergency departments?

STUDY OBJECTIVE: This study aimed to determine the factors associated with successful endotracheal intubation (ETI) on the first-attempt in an emergency department. METHOD: We studied all of the ETI data at two urban emergency departments over a 5-year period. We assessed the intubator's specialty and training level, intubation method, device used, predicted airway difficulty and cause of ETIs. Univariate and multivariate logistic regression models were used to identify factors affecting the first-attempt success (FAS) of ETI in emergency departments. RESULTS: A total of 1478 adult ETIs were analysed. A multivariate logistic analysis revealed that factors such as a non-difficult airway (OR=5.11; 95% CI 3.38 to 7.72), senior physicians (2nd-year to 4th-year resident and attending physicians) (OR=2.39; 95% CI 1.61 to 3.55) and the rapid sequence intubation/induction (RSI) method (OR=2.06; 95% CI 1.04 to 3.03) had significant associations with the FAS for emergency medicine (EM) physicians. For non-EM physicians, however, a non-difficult airway was the only independent predictor of FAS (OR=3.10; 95% CI 1.82 to 5.28). CONCLUSIONS: The predicted airway difficulty was the major factor associated with FAS in emergency department ETI on adults regardless of intubator's specialty. Especially in EM physician group, level of training and using of RSI also affecting on first-attempt success. The overall ETI success rate on first attempt was 80.1%, but EM physicians had success rate of 87.3%. Systematic technical and non-technical airway skill training focused on RSI and continuous quality control and ETI recording could help non-EM physicians increase their FAS rate.

Factors related to household food insecurity in the Republic of Korea.

OBJECTIVE: To examine the prevalence of food insecurity and to identify factors that contribute to it in the Republic of Korea. DESIGN: A cross-sectional study. SETTING: Data were selected from a secondary data set, the third Korean Welfare Panel Study. Household food insecurity was measured with a six-item Korean version of the US Household Food Security Survey Module. The differences in proportions or means of household characteristics, householder's characteristics, economic status and social benefits by food insecurity status were tested with the χ2 or t test. The independent associations of food insecurity with each characteristic were assessed with multivariate logistic regression analysis. SUBJECTS: The sample size consisted of 6238 households. RESULTS: The prevalence of food insecurity was 5.3 % among all households and 25.7 % among low-income households. Risk factors that were associated with a higher risk of food insecurity included living alone, unemployment, no job, low household income and living in a leased or rented home. For low-income households, living in a leased or rented home increased the risk of food insecurity. Among food-insecure households, 26.1 % of the full sample of households and 34.3 % of low-income households were participating in food assistance programmes. CONCLUSIONS: Food insecurity among the Korean population was related to household type, income, job status and housing. Food assistance programmes were not enough to completely alleviate food insecurity.

[The effect of catastrophic health expenditure on the transition to poverty and the persistence of poverty in South Korea].

OBJECTIVES: The low benefit coverage rate of South Korea's health security system has been continually pointed out. A low benefit coverage rate inevitably causes catastrophic health expenditure, which can be the cause of the transition to poverty and the persistence of poverty. This study was conducted to ascertain the effect of catastrophic health expenditure on the transition to poverty and the persistence of poverty in South Korea. METHODS: To determine the degree of social mobility, this study was conducted among the 6311 households that participated in the South Korea Welfare Panel Study in both 2006 and 2008. The effect of catastrophic health expenditure on the transition to poverty and the persistence of poverty in South Korea was assessed via multiple logistic regression analysis. RESULTS: The poverty rate in South Korea was 21.6% in 2006 and 20.0% in 2008. 25.1 - 7.3% of the households are facing catastrophic health expenditure. Catastrophic health expenditure was found to affect the transition to poverty even after adjusting for the characteristics of the household and the head of the household, at the threshold of 28% or above. CONCLUSIONS: 25.1% of the households in this study were found to be currently facing catastrophic health expenditure, and it was determined that catastrophic health expenditure is a cause of transition to poverty. This result shows that South Korea's health security system is not an effective social safety net. As such, to prevent catastrophic health expenditure and transition to poverty, the benefit coverage of South Korea's health security system needs to the strengthened.

[Analysis for the impact of adulthood and childhood socioeconomic positions and intergenerational social mobility on adulthood health].

OBJECTIVES: There are at least three conceptual models for the effects of the childhood social environment on adult health: the critical period model, the social mobility model, and the cumulative risk model. However, few studies have investigated all three different models within the same setting. This study aims to examine the impact of childhood and adulthood socioeconomic positions and intergenerational social mobility over the life course on the health in adulthood based both on the critical period model and the social mobility model. METHODS: This study was conducted on 9583 adults aged between 25 and 64 years old and they were the respondents to the Korea Welfare Panel Study (2006). A multivariate logistic regression analysis was carried out, using the critical period model and the social mobility model out of the life course approaches, to look into the impact of childhood and adulthood socioeconomic positions and intergenerational social mobility on the health status in adulthood. RESULTS: Household income and occupation out of the adulthood socioeconomic position indicators had an independent influence on the adulthood health status. The childhood socioeconomic position indicators, except for the place of childhood residence, affected the adulthood health status even after adjustment for the adulthood socioeconomic position. The effect of intergenerational social mobility was also statistically significant even after adjusting for the adulthood socioeconomic position, but it became insignificant when the childhood socioeconomic position was additionally adjusted for. CONCLUSIONS: Adulthood health is indeed affected by both the childhood and adulthood socioeconomic positions as well as intergenerational social mobility. This result shows that a life course approach needs to be adopted when dealing with health issues.

[The life of Dr. RO Kishun, a reflection of modern Korean medical history of the borders].

RO Kishun was born on February 2, 1893 in Ongjin County, Hwanghae Province of Joseon Korea. He graduated from the Medical Training Center, a campus associated with the Joseon Government-General Hospital, in 1915, and from Kyushu Imperial University School of Medicine in 1917. He continued his medical study at the university in 1929, majoring in biochemistry, and earned a doctorate in medicine in 1932. Dr. RO, one of the earliest pioneers in Korean biochemistry, was active in his research, publishing four studies in the Japanese Journal of Biochemistry between 1931 and 1932. After returning from Japan in 1932, Dr. RO opened a medical practice in Mokpo and Busan, port cities situated on the southern tip of Korea. Later in 1936, he moved north to Manchuria (northeast China) to practice medicine at the International Hospital in Mukden (present-day Shenyang). He also served as president of Tumen Public Hospital between 1942 and 1946. When Japan signed unconditional surrender bringing World War II to an end, Dr. RO relocated to Yanbian and began providing medical training to ethnic Koreans. In October 1946, he was appointed dean of the First Branch School of China Medical University in Longjing, and in October 1948 the first dean of Yanbian Medical School, the predecessor of Yanbian University College of Medicine. Dr. RO dedicated his life to medical practice, teaching and training students, and mentoring younger faculty. A brilliant clinician, he also inspired and helped his colleagues with his outstanding ability to diagnose and treat patients. He was one of the founding members of Yanbian University College of Medicine. RO Kishun died on June 7, 1957 at age 64. Ethnic Koreans hailed him as Sinui (literally, the physician of God), and a bronze statue of himself was erected in front of the medical college in 1988. Dr. RO's life brings modern historians' attention to the issue of determining geographical territories and nationality, in that his life unfolded at the borderlands or frontiers of Joseon Korea, China, and Japan, where the history of the three nations met and intermingled with one another. He was a biochemist and researcher, practicing physician and medical professor of the era under Japanese Rule and the one following it. In modern Korean medicine, his life is viewed as a history of the borders, or a transnational legacy going beyond individual history of Korea, China, and Japan.

[The association between public social expenditure and suicides: evidence from OECD countries].

OBJECTIVES: This study aimed to examine the association between public social expenditure (PSE) and suicides in the 27 countries of the Organization for Economic Cooperation and Development (OECD) from 1980 to 2003. METHODS: The age-standardized suicide rates and their annual change (%) were obtained from the OECD Health Data 2007. As a measure of social protection, the PSE (% GDP) was used. The covariates included the annual divorce rate (/100,000 population), fertility rate (number of children/woman aged 15 to 49 years), GDP per capita (US$PPP), male unemployment rate (%), life expectancy (years) and alcohol consumption (liter/capita) for each country, which were all obtained from the OECD Health Data 2007 and the OECD Social Indicators 2006. Using hierarchical linear models that included these covariates, the effects of PSE on suicides (Model 1) and the annual percent change (Model 2) were examined (Model 3). Also, sub-sample analyses were done for six countries that experienced political/economic transition. RESULTS: We could not find significant effects of PSE on suicides (Model 1), but we observed significantly negative effects on the annual percent change for men and women (Model 2). Such findings were replicated in the sub-sample analysis, and moreover, the effect size was much larger (Model 3). CONCLUSIONS: Our finding suggests that social welfare protection can be a pivotal factor for suicide epidemiology, and especially in countries experiencing a social crisis or transition.

[The concept and measurement of food security].

OBJECTIVES: During the past two decades, food deprivation and hunger have been recognized to be not just the concerns of only underdeveloped or developing countries, but as problems for many affluent Western nations as well. Many countries have made numerous efforts to define and measure the extent of these problems. Based on these efforts, the theory and practice of food security studies has significantly evolved during the last decades. Thus, this study aims to provide a comprehensive review of the concept and measurement of food security. METHODS AND RESULTS: In this review, we introduce the definition and background of food security, we describe the impact of food insecurity on nutrition and health, we provide its measurements and operational instruments and we discuss its applications and implications. Some practical information for the use of the food security index in South Korea is also presented. CONCLUSIONS: Food security is an essential element in achieving a good nutritional and health status and it has an influence to reduce poverty. The information about the current understanding of food security can help scientists, policy makers and program practitioners conduct research and maintain outreach programs that address the issues of poverty and the promotion of food security.

Cost-benefit analysis of haemophilus influenzae type B immunization in Korea.

An economic evaluation of Haemophilus influenzae type b (Hib) immunization was conducted to examine whether Hib immunization should be included in Korea's national immunization program. The costs and benefits included direct and indirect values and an estimation of the economic efficiency. We determined that a universal Hib immunization program in Korea would prevent 17 deaths and 280 invasive Hib cases. When we assumed the one Hib immunization cost as 26,000 won, the national Hib immunization would cost 34.6 billion won. Costs for various Hib diseases were estimated at 26.8 billion won (11.8 billion won from direct costs and 14.9 billion won from indirect costs). A benefit-cost ratio of 0.77 showed that the economic efficiency of the integration of Hib immunization in Korea is low because of the low incidence rate of Hib disease and high price of vaccine. However, if the Hib immunization cost decrease to less than 20,000 won, a benefit-cost ratio increase to 1.0 and above, integrating Hib immunization into the national immunization program with economic efficiency can be considered.

A dose-response relationship between types of physical activity and distress.

This study aimed to examine whether a dose-response relationship exists between psychological distress and types of physical activity (total, occupational, and leisure-time). The study subjects (233 men and 313 women) were recruited for a study on cardiovascular disease in the Yangpyeong community located in South Korea. The type and characteristics of physical activity were measured with a modified version of the Stanford 5 city project's questionnaire by well-trained interviewers using a standard protocol. The Psychological Well-being Index-Short Form was used to assess psychological distress. Both the intensity and duration of time in either total physical activity or occupational physical activity (OPA) were not related to the distress score. However, a long duration of time (1 hr/day) in severely intensive (> or =6 metabolic equivalent) OPA was related to a high distress score in men (14.1 for none vs. 19.7, p-for-trend=0.005), even after the adjustment for leisure-time physical activity (LTPA). A long duration in time (1 hr/day) in LTPA was related to a lower distress score in men independent of their OPA (16.7 for none vs. 13.1, p-for-trend=0.02). In conclusion, the dose-response relationship of physical activity on psychological distress appeared to differ among the different types of activities. The type of activity may be an important determinant of whether physical activity produces psychological benefits.