OBJECTIVES The surveillance of infectious diseases, which is crucial in public health, may also suffer from poor community support. In South Korea, the government operates several national surveillance system for the National notifiable infectious diseases(NNID). Some programs work satisfactorily but other programs may not be fully accepted at the community level which result in low participation and delayed report.
METHODS
May 2003, to improve the blind side of the National Surveillance System, a district health agency initiated a community based surveillance system for infectious diseases called as Communicable Disease Information Sharing System (CDISS) to complement the national program. As the name suggests, it underscores the mutual benefit of surveillance for public and private health sectors through partnership.
With collaboration of participating private clinics and hospitals around the district, the health agency collects data and provides the health practitioners more up-to-dated information on the trend of infectious diseases than National level information. Total population of study area, Dong-gu which locate in the center of Gwangju-metropolitan city, is about 120,000 in 2005. Reporting facilities consist of 6 daycare clinics, 3 hospitals, and 1 university hospital, 2 local public health organizations.
RESULTS
CDISS was introduced in May 2003, and full system has been successfully operated since March 2004 with 10 participating facilities. Each reporting facility regularly sends the weekly reporting form, filled with the number of patients in last week, to Dong-gu District Health Center in every Wednesday. All data were organized in tables and graphs by weekly summarizing the reporting data and interpreted information. Feedback is done to reporting facilities until Friday through faxes, email, website (http://kjdisweb.richis.org) ?at least a week earlier than National Surveillance System.If reported data exceeded epidemic alert level, the community warnings are issued through mass-media and other means of public communication.During the period of CDISS operation, some epidemic events and sporadic outbreak occurred in Dong-gu were detected well-earlier than the notification at national level, such as chickenpox, viral enteritis, and epidemic keratoconjunctivitis(EKC).
CONCLUSIONS
The program has been functioning successfully with active community participation and revealed to be economic and effective way of disease surveillance in the community. Several episodes of disease epidemic were reported by the program well before the recognition of the epidemic at the national level. We suggest that the community surveillance program may well complement national surveillance system.
PURPOSE Prevalence of metabolic syndrome is increasing markedly in rural area of Korea. Alcohol drinking and smoking are the main risk factors which shows the highest prevalence rate among the risk factors of metabolic syndrome. The aim of this study was to investigate the association between metabolic syndrome and alcohol drinking and smoking histories in a rural area of Korea.
METHODS
Data was obtained from 1,332(507 men, 825 women) individuals aged over 40 years who lived in rural area of Chungju city in 2007. Metabolic syndrome was defined by NCEP ATP III criteria and waist circumference was defined by WHO-APR(Asia Pacific Region). Data analysis was carried out using SAS version 8.02.
RESULTS
In men, adjusted odds ratio for metabolic syndrome was 2.78(1.09-7.05) for current alcohol drinker, 2.75(1.38-5.51) for past alcohol drinker, 3.25(1.58-6.67) for under 21 years old at start of alcohol drinking, 2.62(1.12-6.11) for light alcohol drinker, 6.01(2.65-13.64) for heavy alcohol drinker. In women, all the alcohol related risk factors were not statistically significant with metabolic syndrome. For all the smoking related risk factors were not statistically significant with metabolic syndrome in men and women. Adjusted odds ratio of alcohol drinking habits for each components of diagnostic criteria of metabolic syndrome was significant for high blood pressure, high fasting glucose and hypertriglyceridemia in men and abdominal obesity in women. Adjusted odds ratio of cigarette smoking habits for each components of diagnostic criteria of metabolic syndrome was significant for abdominal obesity in women.
CONCLUSION
Controlling alcohol drinking habits in men should be reinforced in order to prevent the metabolic syndrome in a rural area of Korea.
PURPOSE People with a family history of mood disorder are more likely to have depression. This study compared the characteristics of non-psychotic major depression disorder according to family history of depression.
METHOD
Subjects were total of 817 persons recruited for the CRESCEND-K multicenter trial. Characteristics of depression and suicide history of patients with and without a family history of depression were assessed. Family history was determined through self-report.
RESULTS
Of 817 participants, 12.4% had a positive family history of depression. Those with family history of depression reported an earlier age at onset of MDD, and more psychiatric comorbidity. Severity of depression and anxiety were not different according to family history of depression. There were no difference in attempted suicide history, number of attempted suicide and age at onset of 1st attempted suicide according to such a family history.
CONCLUSION
Patients with family history of depression reported earlier onset of MDD and more history of psychiatric comorbidity.
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PURPOSE The most effective and basic Tb preventive measure is BCG vaccination. Even though the Intradermal vaccination method in BCG vaccination is known to be the most accurate method in preventing the advanced Tb, nowdays most of the Korean civilian hospitals utilize multipuncture BCG vaccination method ,which is quite contrary to the national standard intradermal vaccination method. Therefore I decided to inform and educate the pregnant women who would be in a position to choose the BCG vaccination method. This will help them understand the BCG vaccination methods properly.
We should urge the intradermal method which is acknowledged as the national standard vaccination method.
METHODS
The questionnaire was mailed twice to 214 pregnant women requring the antenatal care who visited any of the 9 health centers in Busan from the period of Aug to Oct. 2007.
The 1st questionnaire was done in 214 pregnant women prior to education concerning the BCG vaccination methods and Tb, and the 2nd questionnaire was done after education. Contents of the questionnaire were general knowledges for BCG vaccination method, intention of selection for BCG vaccination, knowledges for the adverse effect, etc. Data analysis was performed utilizing SPSS (ver12) and the pregnant women's change in concept was comparatively analyzed with percentage, chi-square -test .
RESULTS
Considering the general characteristics of the pregnant women who participated in the study, the highest percentage was noticed in their 15-28 gestational weeks (60.8%), Age over 30 (70.1%), Education level-college graduate (76.6%). Recognition to the presence of two types BCG vaccination method was 27.6% before education and 95.3% after education which showed a marked improvement (p=0.0001). After education, 82.2% of pregnant women decided to choose intradermal BCG vaccination method at birth which was 23.4% before education (p=0.0003). Despite the fact that intradermal BCG method is the national standard vaccination method, some of them prefer multipuncture BCG vaccination method, because most of the scars (41.3%), the civilian hospitals do it (35.7%), because of the lack of the education and information from the health centers and public institutions (17.4%). The future selection of BCG vaccination methods as follows: before education, intradermal BCG vaccination 31.0%, multipuncture BCG vaccination 14.6%, uncertain 54.4%, and after education, intradermal BCG vaccination 72.4%, multipuncture BCG vaccination 2.8%, uncertain 24.8% (p<0.0001).
CONCLUSIONS
The pregnant women were not fully aware of intradermal and multipuncture BCG vaccination methods.
Through education and information, it was possible for them to thoroughly recognize the BCG vaccination methods. In order to urge the intradermal BCG vaccination method, the health centers and public institutions need to educate and inform the pregnant women regarding the intradermal BCG vaccination method which is the standard vaccination method in Korea.
BACKGROUND AND OBJECTIVES: Aseptic meningitis is a disease of children with seasonal outbreak in summer. In spite of high morbidity, it is not notifiable without reported nationwide morbidity. The authors estimated incidence of aseptic meningitis and its descriptive characteristics and time- and space-clustering pattern.
SUBJECTS AND METHODs: Cases of aseptic meningitis were extracted from National Health Insurance payment request data of National Health Insurance Corporation from January 1996 to December 2001. Cases were classified by region, institution, and hospitalization. Standardized incidence was calculated and compared by the region, month of the year whether there is any clustering.
RESULTS
Nationwide incidence of aseptic meningitis among children under 15 years old over the six year period was 3.48 per 1,000 per year. Incidence was higher in female (2.80/1,000) compared to male (4.02/1,000). Age-specific incidence was highest in 5 years old. Annual incidence was highest in 1997 (8.44/1,000) and lowest in 2000 (0.79 /1,000) with outbreak every 3 or 4 years. Outbreak was mostly confined in summer months, between May and Septe- mber. However, seasonal pattern was variable by year.
Southern provinces and metropolitan areas had higher incidences and pattern was more prominent in the years with higher outbreak. Time-dependent pattern of the disease from south to north was not prominent.
DISCUSSIONS
AND CONCLUSIONS: We have calculated the nationwide incidence of the aseptic meningitis over six year period. In terms of aseptic meningitis, using National Health Insurance data for the estimation of the incidence is a plausible method for the surveillance of the disease.
Summary
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Korean J Epidemiol. 2008;30(2):239-251. Published online December 31, 2008
OBJECTIVES Hebei Spirit oil spill accident has brought about the worst coastal oil contamination in Korean history.
Following the accident, residents and volunteers, number exceeding a million from nationwide, were exposed to chemicals from the crude oil itself and dispersants, including volatility organic compounds (VOCs), polycyclic aromatic hydrocarbons (PAHs), and heavy metals through the clean-up works over months. This study was undertaken to investigate the effect of clean-up work on the peripheral nerve function and psychologic status of the residents after a prolonged exposure to clean-up work after the oil spill exposure.
METHODS
We performed a study on the residents of Jango-do Island, Chungnam, on 5 and 12 January 2008, six to eight weeks after the accident. A questionnaire on general characteristics, Korean Beck Depression Inventory (K-BDI), color vision test (Lanthony desaturated D-15 test), and vibration perception threshold test were done. Among 210 residents with 30 years or older, 63 (30%) finished questionnaires and completed at least one among K-BDI, color vision test, or vibration perception threshold test.
Descriptive statistics was done on the residents.
RESULTS
The residents participated in clean-up work for average 20 days, max 30 days, during 6 weeks following the accident. Average work hours were 7.4 hours per day, max 10 hours. On K-BDI, 21 (33.3%) had a severe depressive state.
Mean color confusion index was 1.29 in the right and 1.20 in the left. Mean vibration perception threshold was 3.69 VU (right) and 3.55 VU (left), respectively.
DISCUSSIONS
AND CONCLUSIONS: Compared to literature report, the residents had higher depression scale. Color vision threshold was not higher compared to general population near an industrial complex. Vibration perception threshold was significantly higher than the residents of similar age living near an abandoned mine in southern coastal area only in the age group of forties. These suggests there is some evidence of neuropsychiatric effect related to oil cleaning work and a mid- and long-term study of the oil exposure health effects with continuous monitoring should be done for the exposed residents in the affected area.
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PURPOSE To estimate the reporting rate of tuberculosis in one medium-sized city in Korea.
METHODS
Data claimed by national health insurance corporationand notification data of KTBS (Korea Tuberculosis Surveillance System) were compared through medical record-linkage method. Regarding the cases that were claimed medical care fee as tuberculosis but not notified to KTBS, we reviewed medical charts of the patients and investigated the reasons of failure to notify.
RESULTS
Number of cases claimed health insurance fee as tuberculosis occurrences in Cheonan was 2,331 in 2007, while 956 cases were matched as notified cases to KTBS after electronic record-linkage by personal identifier. Among remaining 1,375 cases that were not matched, real missed cases through medical record review survey were found to be 104. The reasons of failure to notify were because of 'not tuberculosis patients' (500, 36.4%), 'notified in 2006' (421, 30.6%), 'diseases coding error' (341, 24.8%) and 'notified as other diseases' (9, 0.7%). Therefore, the corrected reporting rate was calculated at 93% (95% CI: 91.6% - 94.2%). Notably, reporting rate of clinics (58.1%) was significantly lower than those of hospitals (93.4%) or general hospitals (96.6%).
CONCLUSIONS
All cases of tuberculosis diagnosis, which were claimed and not notified, were verified, the reporting rate was not as low as that of the data known through media.
However, to reach the goal of tuberculosis elimination (reporting rate over 95%), more effort into improvement of the reporting system is necessary.
This study was conducted to elucidate the related factors with the decreased physical function in the community- dwelling elderly in Chuncheon. We used data obtained from Hallym Aging Study(HAS) from January to May in 2007. The participants were 505 elderly aged 65 years or over after excluding those who didn't complete physical function test and aged < 65. The measurement of physical function was based on the "Health Aging and Body Composition Study Physical Performance Battery(H-ABC PPB)" that included semi-tandem stance, tandem stance, single leg stance, 6m general walk, 6m narrow walk, and chair stand test. And we also included grip strength test. Overall physical function based on H-ABC PPB decreased with age in both men and women.
Smoking appeared to increase the risk of decreased function of chair stand in women (adjusted OR=3.8, 95% CI=1.2-12.6).
Regular exercise was found to reduce the risk of decreased physical function in both men(Balance OR=0.5, 95% CI=0.2-1.0; Usual walk OR=0.4, 95% CI=0.2- 0.9) and women(Balance OR=0.4, 95% CI=0.2-1.0; Usual walk OR=0.3, 95% CI=0.1- 0.9); Narrow walk OR=0.2, 95% CI=0.1-0.8). Higher level of education seemed to be associated with higher functional performance. It needs further researches on the effect of education on the physical function of the elderly in this population.
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PURPOSE This study was conducted to investigate the association of gamma-glutamyltransferase (GGT) with metabolic syndrome among non-diabetic adults.
METHODS
This study was conducted in a rural area, South Korea from August, 2003 to November, 2003. The study subjects were 1,023 sampled persons aged from 40 years and older (male 377, female 646). We analyzed the association between GGT with metabolic syndrome by multiple logistic regression analysis using SAS 9.1 version.
RESULTS
The prevalence of metabolic syndrome in this study was 28.8%. The prevalence of metabolic syndrome was increased by quartiles of serum GGT level (P for trend <0.05). The prevalence of metabolic alterations fitting the criteria of the metabolic syndrome by quartiles of serum GGT level were almost significantly increased except for the criterion of low high density lipoprotein (HDL) cholesterol with adjustment for age and alcohol intake. Among 5 components of metabolic syndrome, the criterion of high serum triglyceride was most powerfully associated with serum GGT level in both gender.
CONCLUSIONS
This study shows that serum GGT level was significantly associated with metabolic syndrome even after excluding diabetic adults.
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OBJECTIVES We wanted to investigate the marital state and job satisfaction of female office workers.
METHODS
The data was analyzed from a cross-sectional survey of 995 female office workers. Information was obtained about the job satisfaction, sociodemographics, health behaviors, and job-related characteristics. Multiple regression analysis was used to test for the related factors of job satisfaction by marital state among female office workers.
RESULTS
The mean score of individual items on job satisfaction was significantly higher in married than in unmarried women(p=0.014). Job satisfaction was associated with stress, employment type in unmarried women, whereas it was related with employment type in married women on a multiple regression analysis (p<0.001; p=0.006; p=0.026, respectively).
CONCLUSIONS
Our findings suggest that job satisfaction is significantly higher in married than in unmarried women and it may be affected by job-related factor like employment type. Further research is needed to establish proper strategies for improving job satisfaction of female office workers.
PURPOSE To investigate the prevalence rates of overweight and obesty, and their associations in children and adolescents(12-18years) who were defined as normal weight, overweight , and obese.
METHODS
Korean National Health and Nutrition Examination Survey 2005 raw data was utilized. The data on the 669 subjects aged 12-18 consisted of variables from the health interview survey, health examination and nutrition survey, and health consciousness behavior survey. Overweight and obesity was evaluated by established body mass index criteria. Chi-squire and Fisher exact test were performed to analyze differences among normal, overweight and obese groups according to basic characteristics and health consciousness behavior. Logistic regression was used to analyze risk factors for the overweight and obese groups.
RESULTS
Overweight and obesity prevalence rates were 11.7% and 8.1%, respectively. Of the subjects from urban regions, 20% were overweight and 12.2% were obese. Of those from semi-urban regions, 10.2% were overweight and 3.8% were obese. Of those from rural regions, 9.0% were overweight and 10.1% were obese. The obesity rate in semi-urban regions were 0.38% times lower than the rural rate.
CONCLUSIONS
Geographical location constitutes a risk factor for overweight and obesity, which may influence preventative and education programs aimed at schools and the general community.
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Objective: The aim of this study was to compare the diagnostic accuracy of the Pap test, liquid-based cytology (LBC), and human papillomavirus (HPV) testing used as screening methods for the early detection of cervical cancer in Korea.
Materials and Methods: Articles reporting the sensitivity and specificity of each screening method that were published between 1995 and March 2008 were retrieved from MEDLINE and KoreaMed. A meta-analysis was conducted to calculate pooled estimates for the sensitivity and specificity of each method. Only cases with histological confirmation were included, and cervical cancer was defined as samples exhibiting cervical intraepithelial neoplasia 2 or worse. In cytological tests, findings of atypical squamous cells of undetermined significance or worse were considered positive.
Results
Of the 24 studies, 15 studies of the Pap test, 3 studies of LBC, and 4 studies of HPV met the inclusion criteria and were included in the meta-analysis. The meta-analysis showed that the sensitivity was highest for LBC (92%), followed by HPV testing (83%) and the Pap test (76%), and the specificity of LBC was the highest (79%), followed by the Pap test (76%) and HPV testing (59%). However, except for the sensitivity of LBC (heterogeneity p-value = 0.682), significant heterogeneity was found among the results of the studies (heterogeneity p-value < 0.0001).
Discussion
Due to the significant heterogeneity among the studies, the results of this meta-analysis are limited in representing the accuracy of each test method. The accuracy and cost-effectiveness of cervical cancer screening methods should be further evaluated.
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PURPOSE In May 2008, a diarrhea outbreak occurred among students of in a girls' high school (S school) in Sangju-si, Korea. An epidemiological investigation was carried out to clarify the cause and transmission route of the outbreak.
METHODS
S school has been providing meals directly since July 2007. We conducted a questionnaire survey among 591 persons, and examined 283 rectal swabs and 98 environmental specimens. The patient case was defined as a member of S school who had diarrhea more than one time in a day, accompanied with one or more symptoms among abdominal pain or tenesmus from May 19th to May 26th 2008.
RESULTS
The attack rate was 24.0%. Bacillus cereus were cultured from three of the rectal swabs and five of the preserved foods. It was suspicious that contamination was possible in seasoning vegetables, and we found some foods were seasoned with spices after being cooled by moving cooler for about 20 minutes. Enterotoxin positive B. cereus were cultured from two foods cooled by moving cooler.
Enterotoxin negative B. cereus were cultured from two environmental specimens of the moving cooler.
CONCLUSIONS
We presumed the cause of the diarrhea outbreak in S school was food poisoning by B. cereus. Because enterotoxin positive B. cereus were cultured from rectal swabs and foods, and the symptoms were corresponded. We estimated the outbreak was occurred by this process that B.
cereus in the moving cooler contaminated foods during cooling and then rapidly proliferated.
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Despite many countries' current effort to make mathematical models for pandemic influenza (PI) and predict the impact of an outbreak, natural history of PI is remains incomplete, so that any assumption or model is unable to completely predict the impact. Our objective is to review and summarize previous studies on parameters and models of PI, and to make suggestions for the controls in order to decrease the impact of PI. We searched PubMed to retrieve literature about the PI model systematically . Reference lists and review papers on the topic were searched, as well. We found 35 articles that examined the PI model over the period of May 2003 to August 2008. We reviewed modelling methods that were focused on the PI, and their parameters i.e. latent period, and basic reproductive number (R0). Then, we summarized PI controls: antivirals, vaccines, and social distancing.
Recent studies showed with mathematical models that Targeted Antiviral Prophylaxis (TAP) is the best strategy for containing PI at the source. In case of an outbreak, quick measures of social distancing, including therapeutic and prophylatic antiviral for cases and closing contacts - school closure, workplace closure, border quarantine, and home isolation - were found to be most effective. We reviewed strengths and weaknesses of models that are adaptable in Korea, and summarized their parameters. It is our hope that these strategies with various interventions give important information for future preparation for and response to PI in Korea.
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The term and concept of emerging infectious diseases (EID) has been burgeoned out in the early 1990s and EID were expected as the most important public health problems of all of countries and global community as a whole. EID have been confirmed as the most important health and security problems when the global community has been experienced a lot of outbreaks of EID including avian influenza in Hong Kong (1997), Nipah encephalitis in Malaysia and Singapore (1999), and anthrax bioterrorism in U.S.A. (2001), and SARS outbreaks in global community (2003). Pandemic influenza could be a big disaster in global community in the near future in the situation of the occurrence of H5N1 avian influenza and it's human cases in southeastern Asian countries. This paper described the EIDs in terms of two epidemiologic transition theories, and described the important EID in global community since 1970s and reviewed the remarkable emerging and re-emerging infectious diseases in Korea since 1990. Seven factors contributing to EID and the convergence model for EID were introduced. In conclusion, the preparedness and response plan of public health authority the role of epidemiologist was suggested.
Especially the cooperative activities between epidemiologists and other field or sector's professionals were emphasized to find out the etiology or risk factors of EID and preparedness and response plan.
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