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Volume 20 (2); December 1998
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Original Articles
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A literature Review Study on Kawasaki Disease with Special Concern on Causal Hypothesis.
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Joung Soon Kim, Jung Il Choi
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Korean J Epidemiol. 1998;20(2):288-318.
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Kawasaki disease that had been identified and reported as a new syndrome complex by a Japanese pediatrician Kawasaki in 1967 still remains as a disease of unknown etiology despite the enormous research efforts throughout the world. We conducted this literature review study with an attempt to formulate causal gypothesis on Kawasaki disease based on research findings published. Summarizing the research results in terms of clinical, pathologic and epidemiologic characteristics we could characterize the causative agent as followings: (1) The agent should have high infectivity and low pathogenicity causing generalized infection, perhaps with more frequent inapparent infection than apparent infection, particularly among immunocompromized, feeble children by preceded infection, (2) The target organ of the agent seems to be endothelial cells of arteries, (3) The agent appears to take airborne transmission route in very special environment where the agent can be supplied by reservoirs other than human beings, and (4) the agent should be quite ubiquitous around human living environment resulting in high herd immunity among adult population. For the time being we propose Coxiella burneti as a possible causative agent that could satisfy the most of the above characteristics.
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A study on epidemiologic characteristics and factors associated with excess hospitalization of the patients injured by traffic accident.
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Mi Woon Kim, Joung Soon Kim, Min Kyung Lim
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Korean J Epidemiol. 1998;20(2):279-287.
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The occurrence of injuries and death caused by traffic accidents have been increasing during last few decades in Korea, which resulted in enormous personal, social and economic loss in terms of death, disability, labour days and medical costs incurred for treatment. Generally, it is well known and even became an hot sociopolitical issue that the duration of hospital stay for traffic accident patients are much longer than that of other patients with the similar condition. The objective of the study is to find out epidemiologic characreristics and management pattern of traffic accident patients in a general hospital of medium-sized, industrialized town. This study was carried out on 177 cases injured by motor vehicle accidents, who were admitted and treated in a general hospital from Feb. 1, 1997 to Sept. 30, 1997. The results obtained are as followings: The most of the patients(44%) were 20-30 years old age group although the occurrence of injuries was more frequent among older ages, 50's for male and 60's for female being 2.1 times more frequent among male. The traffic accidents occurred most frequently(14.1%) in the morning(06:00-08:00) and afternoon(14:00-16:00), and on Saturdays(20.3%); the (14.1% traffic accidents were frequent during weekends for passengers whereas it was more frequent during weekdays for pedestrian. Old and child pedestrians were most vulnerable subjects to traffic accidents. The most common site injured was head(19.9%) and the injury types were fracture of lower extremity(9.3%), skull fracture(8.6%) and rib fracture(8.6%) for both sexes; rib fractures/thoracic spine fractures(12.0%) for female and tibia/ fibula fractures(11.6%) for male. Mean days of hospital stay presumptively judged by the doctor who examined, made diagnosis and admitted the patient was 43.8 days compare to 38.4 days of actual mean days of hospitalixation. On the other hand, the optimal mean days of hospital stay for the patients determined by two doctors independently was estimated to be 26.6 days. Thus the difference between actual days of hospitalization and optimal days of hospitalization was 11.7 days, which can be regarded as excess hospitalization days. It consists 30.5% of actual hospitalization days, an enormous waste of resources. The only factor associated with this excess hospitalization was payment responsibility for the hospital cost; when the hospitalization expenses are to be paid by the person inflicted the injury there were always excess days of hospitalization regardless of insurance status.
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Current Status of Multicenter Cancer Cohort Study with Biological Materials Bank in Korea.
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Keun Young Yoo, Hai Rim Shin, Song Hun Chang, Jung Myung Choi, Chang Yup Kim, Kun Sei Lee, Won Jin Lee, Dae Hee Kang, Bu Ok Lee, Duck Hee Lee, Sue Kyung Park, Joo Hon Sung, Yeong Su Ju, Dae Sung Kim, Jong Won Kang, Soo Hun Cho
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Korean J Epidemiol. 1998;20(2):275-278.
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This cohort study is a collaborative effort of 8 institutions. The goal is to establish a large scale cohort that can be followed for 10 or more years to assess the relationship between life-styles and cancer occurrence, and to evaluate the role of environmental exposures in the development of six major sites of cancers(stomach, liver, lung, colorectum, uterine cervix and female breast) in the rural population. Since 1993, 11,304 men and women aged over 35 living in four areas have been recruited. The number of target population is 30,000 persons, which is expected to be successfully recruited until 1999. Each subject has completed a detailed questionnaire on general life-styles, reproductive factors, and agricultural chemical exposures through the interview. Anthropometric measurements with body fat composition and the routine clinical laboratories were examined. For the cancer-free cohort, physical examination by the physicians and serologic tests for hepatitis markers, some tumor markers, and lipid profile have been done, but not all. In order to provide an opportunity to incorporate barious biomarkers of exposure and effect as well as genetic susceptibility, a biologic tissue bank has been established from blood and urine sample(plasma, WBC buffy-coat, RBC clots, and urine supernatant) stored at-70degrees C.
Re-examination of changes in exposere to risk factors will be done periodically. Disease occurrence will be ascertained by the active(mainly through diagnosis by physicians) and the passive surveillance(through both death certificate and screening of medical utilization records).
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Prediction of future breast cancer mortality in Korea.
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Sue Kyung Park, Young Khi Lim, Keun Young Yoo
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Korean J Epidemiol. 1998;20(2):267-274.
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A recent increase in the number of deaths and mortality rates of breast cancer occurred in Korean women. The increases shows a indirect increase in incidence of breast cancer. The number of deaths from breast cancer and the mortality rate in the future would be of use in the perspectives of breast cancer control and management in Korea. This study is to forecast cancer deaths and age-adjusted death rates in the future(2000-2015 year) by fitting modelling, assuming present trends continue. The number and mortality rate of breast cancer were fitted and estimated by simple linear regression mode. Estimated crude death rates for breast cancer per 100,000 persons were 5 person in 2000, 5.99 person in 2005, 6.98 person in 2010, and 7.79 person en 1015. The observed age-adjusted death rates per 100,000 persons were 1.08 person in 1980, 2.03 person in 1985, 2.49 person in 1990, and 3.29 person in 1995 and the estimated age-adjusted death rates per 100,000 persons were 4.01 person in 2000, 4.72 person in 2005, 5.42 person in 2010, and 6.14 person in 2015. Future estimated increase rate of the number of death is 2 times as many as the estimated rate in population-increase. Particularly noteworthy was an increasing tendency of the age-specific death rate with the ages in death, as like a mortality pattern of breast cancer in western females. These findings suggest that cohort effect might significantly contribute to the increase of the number and mortality of breast cancer in Korean women.
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The Changing Pattern of Cigarette Smoking of Students in Junior and Senior High Schools in Korea: 1988-1997.
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Il Suh, Sun Ha Jee, Soh Yoon Kim, Dong Choun Shin, Soh Yeon Ryu, Il Soon Kim
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Korean J Epidemiol. 1998;20(2):257-266.
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In order to examine the actual condition of smoking, the change of knowledge and the attitude on smoking of the students attending junior and senior high schools in Korea, the survey was performed six times ranging from 1988 to 1997. The first two years, the survey was performed only for male students. Since 1991, both male and female students were surveyed. The students in junior and senior high school were selected by a random sampling method and surveyed by mail. In this survey, the number of classes of Junior and senior high schools in Korea was a sampling unit, and the classes were selected in proportion to the number of classes of each city and each county. The total number of respondents was 3,437 in 1988, 3,055 in 1989, 6,087 in 1991(2,923 of male, 3,164 of female), 7,067 in 1993(3,162 of male, 3,905 of female), 5,412 in 1995(2,598 of male, 2,814 of female), 4,754 in 1997(2,281 of male, 2,473 of female).
The results obtained from the data analysis are as follows; 1.The ratio of smokers among male junior high school students has increased from 1.8% in 1988 to 3.9% in 1997.
The ratio of smokers among female junior high school students has increased from 1.2% in 1991 to 3.9% in 1997.
The ratio of smokers among male senior high school students has increased from 23.9% in 1988 to 35.3% in 1997. The ratio of smokers among male senior high school students has increased from 23.9% in 1988 to 35.3% 1997. And the ratio of smokers among female senior high school students has increased from 3.0% in 1991 to 8.7% in 1997. Especially the ratio of smokers among female junior high school students is same as that of male in 1997. 2. With respect to areas, the number of current smokers and the experienced ones was higher in the county than in the city in 1988. But in 1997, the number of current smokers and the experienced one is higher in the city than in the county. 3. In respect of whether or not there is a smoker among the member of a family, the odds ratio of smoking among the male senior high school students was 1.70 in 1988 and 1.94 in 1997. the odds ratio of smoking among female senior high school students was 1.43 in 1991 and 1.98 in 1997. This result showed that the effect of family smoking on adolescent smoking has not decreased.
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Cohort Study on the Association getween Smoking and Proximal Hip Fracture in the Elderly People in Korea.
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Byung Joo Park, Kui Oak Jung, Jong Myon Bae, Hye Won Koo, Dae Sung Kim
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Korean J Epidemiol. 1998;20(2):246-256.
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OBJECTIVE: To assess the association between cigarette smoking and hip fracture by using the Korea Pharmacoepidemiology Cohort(KPEC).
BACKGROUND: Hip fracture is known as one of the major health problems because of its high incidence and serious consequences in the elderly people. Cigarette smoking, old age, female and low body weight have been reported as risk factors for osteoporosis which is regarded as one of the risk factors for hip fracture. But the relationship between cigarette smoking and hip fracture has not been directly evaluated yet. So we conducted a prospective cohort study to investigate the relationship between cigarette smoking and hip fracture in the Korean elderly.
DESIGN: Prospective cohort study on the 8,994 elderly person aged 65 or more in Pusan, Korea between 1993 to 1996.
METHODS: The Korea Phamacoepidemiology Cohort(KPEC) has been constructed with three kinds of data sources. One is from the Korea Medical Insurance Corporation; Medical Insurance Claims Database and Enrollee's Database. Other sources are from directly constructed pharmacy database and questionnaire data. incidence density and relative risk of smoking for hip fracture were estimated by using the KPEC database. Age and gender specific incidence density was calculated by dividing the number of hip fracture cases by person-years of the follow-up the cohort. Relative risks and their confidence intervals were computed by using multiple logistic regression by Windows version SAS 6.12.RESULTS
The level of incidence density in female was higher than that in male, which was increasing with age in both gender. In the multivariate analysis, we observed significant relationship between soking and hip fracture in female(PR=1.94(1.01-3.76)) in the larger amount smoking group, after adjusting for the confounders; age, alcohol drinking, medication history, physical activity and body mass index, the relative risk became slightly decreased to 1.70(0.84-3.46).CONCLUSION
Accoding to this result, we suggest that effective anti-smoking campaign should be established as soon as possible for the Korean elderly women.
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A Case-Control Study on Risk Factors of CHD: Vegetable consumption and risk for CHD in Korean men.
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Kyung Won Oh, Il Suh, Kang Hee lee, Chung Mo Nam, Suk Il Kim, Hyung Gon Kang, Sun Ha Jee, Seung Yun Cho, Won Heum Shim
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Korean J Epidemiol. 1998;20(2):234-245.
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The purpose of this study was to investigate the association of vegetable consumption with the incidence of CHD in Korean men by a case-control study. The case group consisted of 108 patients with EKG-confirmed myocardial infarct or angiographically-confirmed(>or=50% stenosis) angina pectoris admitted to a university teaching hospital in Seoul, Korea.
Controls were 142 age-matched patients admitted to the departments of ophthalmology and orthopedic surgery at the same hospital. Dietary intake was assessed by a nutritionist using a semiquantitative food frequency method, while body mass index (BMI), tobacco use, and past history of cardiovascular disease were determined during an interview and examination. The consumption of vegetables was classified by the average frequency of intake(less than 3 times/week, 3~4 times/week, 5~6 times/week, more than once/day). The percentage of subjects who consumed vegetables less than 3 times per week was 29.6% for cases and 17.6% for controls; while men who consumed vegetavle more than once per day were 16.7% for cases and 32.4% for controls. After the adjustment for age, body mass index, and tobacco use, the odds ratio of men who consumed vegetables at least once per day was 0.38(95% confidence interval, 0.18-0.85) compared with men who consumed vegetables less than three times per week. These results suggested that in a population with a relatively low fat intake, consumption of vegetables at least once per day may reduce the risk of CHD in men.
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Identification of Dietary Factors Related to Hypertension, Diabetes, Hyperlipidemia, and Obesity using Neural Network.
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Sim Yeol Lee, Hee Young Paik, Song Min Yoo, Hong Kyu Lee
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Korean J Epidemiol. 1998;20(2):226-233.
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This study was performed to find out nutritional factors associated with identification of chronic disease using neural network model. A dietary survey with 24-hour recall method was conducted together with a health survey including health qustionnaire, physical examination and glucose tolerance test to 2037 adults over 30 years of age in rural area of Korea. Subjects have been classified into groups with and without disease depending on each disease criteria(groups with desease include those who are newly diagnosed to have diabetes, hypertension, hyperlipidemia and obesity, respictively). Neural network method has been applied to predict disease using selected 3 nutrients out of 12 nutrient elements as input information and resulting outputs which designate either disease or without disease group. Backpropagation learning algorithm has been applied to train neural network structure assigning weight factors connecting each node. 20 subjects from both disease and without disease group have been collected to train neural network structure and remaining subjects were later used in order to test the validity of the trained structure. In order to quantify contrivution ratio of each nutrients for predictiong disease status, number of appearance frequency of each nutrients in the top 20 prediction rate has been compared. When a nutrient used 10 times for prediction, its appearance rate was calculated to be 50%. vitamin C, vitamin A and iron showed appearance rate of 70%, 40% and 30%, respectively for predicting diavetes. vitain C, Fat and beta-carotene showed appearance rate of 60%, 60% and 40% for predicting hypertension. For predicting hyperlipidemia, appearance rate of vitamin C, iron and energy was 65%, 55% and 30%, respectively. From the study, vitamin C was shown to be prominent in predicting chronic disease groups from subjects.
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Socioeconomic Differentials in Mortality: A Cohort Study in 759,665 Korean men.
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Yun Mi Song
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Korean J Epidemiol. 1998;20(2):219-225.
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BACKGROUND
The relationship between Socioeconomic status(SES) and mortality, commonly studied in the developed countries but not in the less developed countries, was evaluated in a cohort of 759,665 Korean male public servants aged 30-64.METHODS
Data on the biological and social characteristics, SES defined as the grade of monthly salary were obtained from the Korea Medical Insurance Corporation. Vital status of the study subjects was followed-up from 1992 to 1996 through the dataset of the Korea National Statistical Office. The risk of ortality associated with SES was estimated using Cow proportional hazard model.RESULTS
There were total 13,330 deaths during the five-year follow-up period. Lowest-SES group had significantly increased risk of all-cause mortality compared to the highest-SES group(Relative risk [RR]: 1.52). Mortality from cancer(RR=1.19) and cerebrovascular disease(RR=1.58) were also significantly increased in the lowest SES group.
Mortality from ischemic heart desease, however, had no relationship with SES.CONCLUSIONS
Socioeconomic differentials in mortality were reconfirmed in Korean men. The differences in the relationship between mortality and SES according to the specific cause of death suggest that SES influence health through the various pathways.
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The Cross-sectional Study on the Relationship of Health Behavior and Immune Function.
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Soon Young Lee, Yeon Sook Yun, Ki Whan Kim, Seon Woo Kim, Ju Won Park
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Korean J Epidemiol. 1998;20(2):212-218.
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To investigate the association of individual health behaviors with imune response against tumor or viral infection, peripheral blood lymphocytes of 185 healthy males in aged from 35 to 44 years for natural killer(NK) cell activity, frequencies of lymphocytes subsets and proliferation response of T and B cell. NK cell activity was determined by Cr release activity assay and lymphocytes subsets were counted using surface antigens(CD4, CD8, CD56) by flow cytometry. The responsiveness of T and B were measured as proliferation stimulated by mitogens. Subjects were classified into four distinct lifestyle patterns, health promotive lifestyle, passive lifestyle, fitness lifestyle and hedonic lifestyle from information on their health behaviors(cigarette smoking, alcohol consumption, and physical activity). Health promotive lifestyle had the highest NK cell activity(Lu30/10(6)CD56) which was significantly higher than hedonic lifestyle)p<0.05). The responsiveness of T cell was significantly lower in passive lifestyle and hedonic lifestyles compared to health promotive lifestyle and fitness lifestyles(p<0.05). However, there was no significant difference in the responsiveness of B cell, CD4, and CD8 among four lifestyles. This cross-sectional study showed the NK cell activity in individuals with desirable health behaviors was lower. The variation of immunity among individuals was not considered in this study, hence the intervention study reflection individual variations is recommended.
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An Epidemiological Investigation of an Outbreak of Rubella Occurred in a Male High School in Kyongju.
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Hae Kwan Cheong, Hyun Sul Lim, Cheol Jung, Gyoung Yim Ha
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Korean J Epidemiol. 1998;20(2):202-211.
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This epidemiological study was carried out to investigate the sources of infection and modes of transmission of an outbreak of rubella that occurred among male high school students in Kyongju in march, 1996. 770 male students(286 third grade, 262 second grade, 222 first grade students) were selected as the study subjects. A questionnaire was completed by the subjects. The anti-Rubella antibodies IgM and IgG were examined and tested by ELISA on all sera from 770 students and the environmental status of class rooms, the dormitory conditions and study rooms were tested. The positive IgM result rate was 17.8% and when the IgM negative was combined with IgG positive the results was 74.9%. IgM IgG negative rates were 7.3%, however, out of a total 770 students. Amongst the older students, the IgM positive rate showed an increase(p<0.01). Out of 137 cases(with a cummulative incidence rate of 71.0%), there were 97 apparant cases(cummulative incidence rate 50.3%) and 40 inapparent cases(cummulative incidence rate 20.7%). Again, the cummulative incidence rate showed an increase in the older students(p<0.04). In the apparent cases, major symptoms included eruption(96.9%), fever(85.6%), lymphadenitis(82.5%), generalized aches and muscle tenderness(76.3%), and a sore throat(61.9%). These symptoms lasted anywhere from 2 degrees =/ 13 days, the average duration being 4 days in length. Initially, there were 9 people on third grade and suspected origin was from more than 2 external sources. It progressed from the upper grades down to the lower grades. In dormitory students, the cummulative incidence ratio was 1.70 and 1.78 amongst study room students.
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An Epidemiological Survey on a Salmonella enteritidis Outbreak in Kyongju, Korea.
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Mee Kyung Kim, Hyun Sul Lim, Cheol Jung, Gyoung Yim Ha
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Korean J Epidemiol. 1998;20(2):187-201.
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This study was conducted to investigate the cause and magnitude of food poisoning among residents and visitors for a birthday party in a rural area of Kyongju city in september, 1996. The total subjects were 137 persons, 119 residents(53 males, 66 females), including 7 hospitalixed patients and 18 visitors(8 males, 10 females). The investigation consisted of an interview survey, a study on clinical characteristics for the patients hospitalized, bacteriological examinations of the underground water and microbiologic examinations on microbes isolated from the patients. The population at risk was 59 persons(24 males, 35 females). The attack rate was 50.0%(12 cases) for males, 48.6% for females(17 cases). The cases were distributed evenly for all age groups. The attack rates for each party-food and possible fooe groups were not significantly different. Most clinical symptoms were significantly more frequent among cases than non-ases: abdominal pain(73.1%), diarrhea(73.1%), chilliness(69.2%), fever(65.4%), anorexia(61.5%), nausea(53.8%), general weakness(50.0%) and dizziness(50.0%) were the major symptoms among the cases.
The admission rate among the cases was 24.1%(1 male, 6 females). In the stool cultures, Salmonella species group D was isolated from 6 persons of 85 examinees. It was identified as Salmonella enteritidis by serological diagnosis. The samples of underground water were assessed Enon-compatible for drinking in 10 wells(83.3%) of this rural area and it was suggested that it could have been contaminated from cattle feces. There were two wells in the party house, one of them was contaminated by bacterias including E. coli. The contaminated water was stored in a water tank located on the rooftop. This water was used for dish washing and cooking. Wd concluded that the cause of this epidemic was the underground water contaminated by Salmonella enteritidis from guman carriers or domestic animal carriers.
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