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Cholera in Korea, 1991: models of transmission.
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Han Joong Kim, Il Suh, Hee Choul Oh, Kyoo Sang Kim, Sun Ha Jee, Soon Young Lee, Sun Hee Lee
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Korean J Epidemiol. 1991;13(2):123-139.
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Abstract
In August-September 1991，Korea had a cholera epidemic caused by Vibrio El Tor Ogawa with 92 bacteriologically confirmed cases and 8 deaths.
Seochun-gun Choongnam, Kunsan-si and Okgu-gun Chunbuk area, which are located near the mid-west coast of the country, were mainly affected. Vibrio cholerae were isolated from sewage water, sea water, squid and shell-fish tested during the epidemic, and an epidemiologic study found that consumption of raw shellfish or fish was the most probable source of cholera infection.
Vibrio cholerae were thought to have spread from foreign countries and there were some evidence that an environmental reservoir of cholera might play a role in the transmission of cholera in this epidemic.
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Summary
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A stochastic model for determining the number of outpatient-visits
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Dong Ki Kim, Han Joong Kim
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Korean J Epidemiol. 1984;6(1):62-69.
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Abstract
It is a hypothesized that the number of outpatient visits can be represented by some of three different probability models, i.e., the truncated Poisson, Zeta, and logarithmic series distributions.
Maximum likelihood estimates of parameters of above distributions were obtained by using grouped data according to the number of visits. A X2 goodness of fit test was also made to compare the fits of the three distributions, and the value of this statistic was classified and compared according to the types of medical care facilities.
For the study, we analized the 1,900,000 data claimed at the Korea Medical Insurance Corporation for three months in 1984.
The results are summarized as follows:
1. Based on the likelihood ratio statistic as a test criterion, both the truncated poisson and Zeta distribution are not appropriate for the model of the number of outpatient visits. The results show that the expected frequencies of the truncated Poisson are smaller than the observed in the tail, but those of Zeta are larger in it.
2. The logarithmic series distribution it found to provide a good fit to data in case of University Hospital, General Hospital, and Hospital. When we apply this distribution in the 10 common diseases, the estimates of the parameter vary from 0.39567 to 0.54176 for University Hospita, from 0.45329 to 0.65387 for General Hospital, and from 0.55104 to 0.77625 for Hospital. This finding might be applicable to the health utilization study, for example, outpatient administrations etc.
3. On the other hand, in case of Clinic, even the logarithmic series distribution cannot be fitted to the data well. The characteristic of clinic utilization such as little variety of its patterns regardless of a large numbers could be the reason of the above results. It is reserved for a further research to construct the compound or modified distributions which are able to explain the number of outpatient visits in case of Clinic.
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Summary
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Validity of interviewees responses in health interview survey
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Dae Kyu Oh, Han Joong Kim, Kyung Yong Lee
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Korean J Epidemiol. 1984;6(1):70-77.
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Abstract
The validity of interviewees' responses on the numbers of medical utilization, visits and medication days in a health interview survey were measured. Memory recalls within two weeks and four weeks were also measured. The influences of different types of interviewers and characteristics of respondents were also tested.
The records of requested bills to the heatlth insurance corporation from clinics and hospitals were used as reference information against the validy measurement.
The health interview survey which was used for this study was conducted as a part of a study on impact of health insurance on the medical care utilization in Kangwha county in June 1983.
Followings are summary of the results.
1. As an individual, the agreement rates between two records within two weeks of memory on the numbers of spells, visits and medication days were 98.0%, 68.8% and 46.9% respectively. Within four weeks of memory, the agreement rates were 96.8% 68.4% and 42.1% respectively.
2. As a group, the interviewees’ responses on the numbers of visits and medication days were slightly under-reported to 0.95 within two weeks of memory and 0.20 within 4 weeks of memory.
3. The agreement rates of two different types of interviewers (medical and sociology students) showed no difference.
4. The agreement rates were highest when respondents were head of the household and those of housewife, grand parents, children and kinds were the next in order.
5. The higher the educational level of respondents the higher the agreement rates were seen. Among those respondents who had education of high school and above showed highest agreement rates and even showed over-reporting tendency.
6. There was no difference in agreement rates between male and female respondents.
7. The higher the level of age, the higher the agreement rates were observed.
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Summary
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The cancer registry program in Kangwha County: The first report (July 1982- June 1984)
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Il Soon Kim, Han Joong Kim, Hee Chul Oh, Byong Soo Kim, Yoon Lee
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Korean J Epidemiol. 1984;6(1):100-111.
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Abstract
The Cancer Registry Program in Kangwha County, the firs community based cancer registry program in Korea, has been launched since July 1, 1982. Two factors made it possible to develop this program in Kangwha County. One is that the county-wide compulsory health insurance program initiated by the government has been implemented in the county as an experiment from July 1, 1982. This health insurance program has largely removed the economic barrier of the people in the medical care utilization and also under the health insuraance program the medical utilization records are being piled up in the office of health insurance cooperatives in the form of the bill requested by the clinics and hospitals after they treat patients. The second factor is the availability of the community hospital in the county, which has been serving the Kangwha population for the past 5 years. This means that cancer patients in the county can easily seek medical care and their medical records re easily available.
Since early 1970’s the mortality patterns of the Korean population has been changed from the infection diseases to the non-infections chronic diseases. Among chronic diseases stroke and malignant neoplasms have been reported to be the leading causes of death. It is, therefore, urgent for epidemiologist to collect very basic information on the magnitude and incidence of various such diseases for the epidemiologic studies and disease control as well. The first systematic step to challenge the cancer should be the cancer registry program.
The number of target population of the Cancer Registry Program in Kangwha County is 88,851 as of December 31, 1983. The initial detection of cancer was made by reviewing all the bills requested from the various clinics and hospitals compiled in the office of the Regional Health Insurance Cooperatives. All the malignant neoplosms (ICD 140-208 in 9th edition) were included in the program.
The diagnosis of cancer was confirmed by a team of physician and a nurse with the medical records kept in the clinics and hospitals based on the diagnostic criteria recommended by WHO. Home visitings were also made to those of cancer cases confirmed in every 6 months for the follow up and for the collection of relevant information directly from the patients.
223 cancer cases were registered during the first two years of the program. The annual incidence rate adjusted by the world population for male was 147.6 and for female 99.8 per 100,000 population.
The most common cancer was the stomach cancer which comprised 37.7% of total cancer cases in both sexes. The annual incidence rate of the stomach cancer was 64.9 in male and 30.6 in female per 100,000 population. The lung cancer (24.3) and liver cancer(13.9) were the next common cancer in mate. The cervical cancer (19.7) was the second commonest cancer in female.
The survival rates of patients with cancer after the appearance of the first symptom and also after the diagnosis were low in general due to the delayed detection and inadequate treatment. The medical seeking patterns were also studied.
The small number of the target population appears to be one of the weak points of the Program. The complete follow up with home visiting is identified as the strong point of the program.
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Summary
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Treatment behavior and changes of illness for pulmonary tuberculosis patients in Korea
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Han Joong Kim
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Korean J Epidemiol. 1984;6(1):137-157.
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Abstract
A follow-up study was made for those pulmonary tuberculosis patients who were radiologically identified during the Nationwide Pulmonary Tuberculosis Prevalence Survey in 1980 in order to study the treatment behavior and change in disease after the elapsing of a certain period. The follow-up study was made in August and September 1982. And the discriminant analysis was used to identify major detertminants for the treatment behavior and the disease change of the pulmonary tuberculosis patients and major findings were as follows.
1. The determinants for the treatment behavior were circumstance for detection, severity (findings of X-ray examination and sputum test in 1980), level of education, residential area, mobilization, income, family size and occupation.
2. The most important factor for the treatment was the circumstance of detection, actively detected group received more treatment than passively detected group.
3. The hit rate was 69.6% for the prediction of the treatment behavior in discriminant analysis function with above variables.
4. The determinants for the recovery from the pulmonary tuberculosis were severity of the disease (findings of sputum in 1980), age, duration of smoking, income, presence of cavity, TREAT score, residential area, occupation and sex.
5. The hit rate was 68.7% for the prediction of the recovery in discriminant analysis function with above variables.
6. Discriminant analysis could be used usefully in multivariate analysis for the binaryoependent variables.
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Summary
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