Epidemiology and Health

Joung Soon Kim

78 Articles

Lessons learned from new emerging infectious disease, Middle East Respiratory Syndrome coronavirus outbreak in Korea: Joung Soon Kim; Epidemiol Health. 2015;37:e2015051. Published online November 17, 2015; DOI: https://doi.org/10.4178/epih/e2015051

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Abstract

Summary

Korean summary
어떤 새로운 전염성 병원체가 침입할지 모르는 상황에서 모든 보건 의료계 전문가들은 눈을 크게 뜨고 감시를 게을리 하지 말아야 하며 사태가 발생하면 즉각 우리가 알고 있는 관리 원칙에 입각하여 기관간, 전문분야간, 지역간 원활한 협동 하에 지식과 기술을 발휘하여 과감히 조처해야한다. 전염병관리는 전쟁과 같아서 순간의 머뭇거림이 승패를 결정하므로 이번 메르스의 경우처럼 작은 이기적 이해 때문에 머뭇거리다 실기하여 수십 배의 손실을 초래할 수도 있음을 명심해야 한다.

Citations

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Analysis of Covid-19 in densely populated States/Union Territories of India
Mili Priya, Anshuman Kumar Singh, Abhishek Kumar, Robin Kumar, Krishnakant Chaubey
WEENTECH Proceedings in Energy.2021; : 363. CrossRef
Middle East Respiratory Syndrome (MERS) Virus—Pathophysiological Axis and the Current Treatment Strategies
Abdullah M Alnuqaydan, Abdulmajeed G Almutary, Arulmalar Sukamaran, Brian Tay Wei Yang, Xiao Ting Lee, Wei Xuan Lim, Yee Min Ng, Rania Ibrahim, Thiviya Darmarajan, Satheeshkumar Nanjappan, Jestin Chellian, Mayuren Candasamy, Thiagarajan Madheswaran, Ankur
AAPS PharmSciTech.2021;[Epub] CrossRef
MERS coronavirus outbreak: Implications for emerging viral infections
Awad Al-Omari, Ali A. Rabaan, Samer Salih, Jaffar A. Al-Tawfiq, Ziad A. Memish
Diagnostic Microbiology and Infectious Disease.2019; 93(3): 265. CrossRef
The impact of social media on risk perceptions during the MERS outbreak in South Korea
Doo-Hun Choi, Woohyun Yoo, Ghee-Young Noh, Keeho Park
Computers in Human Behavior.2017; 72: 422. CrossRef
Effects of operational decisions on the diffusion of epidemic disease: A system dynamics modeling of the MERS-CoV outbreak in South Korea
Nina Shin, Taewoo Kwag, Sangwook Park, Yon Hui Kim
Journal of Theoretical Biology.2017; 421: 39. CrossRef
Global research trends of Middle East respiratory syndrome coronavirus: a bibliometric analysis
Sa’ed H. Zyoud
BMC Infectious Diseases.2016;[Epub] CrossRef

Epidemiologic Transition of Communicable Diseases in Korea: Academia's Contributions to the National Communicable Disease Prevention and Control Programs.: Joung Soon Kim, Hae Kwan Cheong; Korean J Epidemiol. 2006;28(1):4-21.

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Abstract PDF: Abstract
This paper describes the transition of communicable diseases in Korea since 1970s. Some of Korean's general living background and health indicators are introduced, followed by trends in the changes during the last several decades in socioeconomic, demographic, and living environmental status, which are closely associated with the transition of communicable diseases. The current incidence of classified, notifiable disease, the incidence by year, and the transition of communicable diseases are presented. Governmental responses to prevent and control communicable diseases, including both emerging and re-emerging infectious diseases, which have become recognized as having public health importance are described. Finally, the role played by academia during the last several decades in the successful control of communicable diseases is analyzed.; Summary

The Role of Epidemiology against Emerging and Reemerging Diseases.: Joung Soon Kim, Min Jung Ko; Korean J Epidemiol. 2001;23(1):1-22.

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Abstract PDF: Abstract
PURPOSE
Due to remarkable developments in technology and great efforts made by Health Organizations, most of infectious diseases had been under control. However, ecological changes and biological variations resulted in emerging and re-emerging infectious diseases, which threaten the global health and may have the possibility of being abused as biological weapon. Therefore it is indispensable to understand the latest information and knowledge in order to cope with the emergency situation.
RESULTS
In Korea, several reemerging diseases such as Malaria, Hepatitis A, Shigellosis, Mumps, and food poisoning has been increasing conspicuously since 1990. Also Diphtheria, plague, yellow fever and dengue fever have been potential threats, considering substantial international trades.
CONCLUSION
There have many newly emerged and re-emerged infectious diseases identified in recent few decades in Korea. Thus as epidemiologic professionals, we have to get ready, particularly following missions to be carried out : 1) to keep eyes open to look for emerging and reemerging diseases continuously and keep up the latest global information, 2) establish the co-operational organizations to prepare immediate action against the sudden outbreak, 3) publicize, educate, establish and perform the missions, taking initiative in training clinicians, 4) upgrade professional competency by familiarizing ourselves with epidemiologic investigations, and 5) fulfill the responsibilities as health keepers of the nation.; Summary

A literature Review Study on Kawasaki Disease with Special Concern on Causal Hypothesis.: Joung Soon Kim, Jung Il Choi; 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.; Summary

A study on epidemiologic characteristics and factors associated with excess hospitalization of the patients injured by traffic accident.: Mi Woon Kim, Joung Soon Kim, Min Kyung Lim; 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.; Summary

Nationwide Telephone Survey on Leisure Time Physical Activity among Koreans.: Sung Hee Lee, Tae Woo Yoo, Joung Soon Kim; Korean J Epidemiol. 1998;20(1):113-125.

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Epidemiologic research has demonstrated that varying grade of physical activity has protective effects on several chronic diseases, including coronary heart disease, hypertension, diabetes mellitus, osteporosis, anxiety and depression. Despite the importance of physical activity as an health promotion factor, there have been only a few research data available in Korea. This telephone interview survey on randomly sampled 1,060 adultsaged 15-69 years was carried out to find out the prevalence of self-reported leisure-time physical activity among Korean adults in terms of health promotion practice. The nationwide telephone interview survey was conducted from April through May 1997. Multistage stratified random sampling method was used for sample selection, the respondent was randomly selected from an entire group of adults who lived at the residence connected with the telephone number. A total of 1,060 adults were interviewed and the interviewees' leisure-time physical activity was categorized into four patterns: 'physically inactive', 'irregularly active', 'regularly active, not intensive', and 'regularly active, intensive'. About 53% of the respondents were physically inactive, 15% irregularly active, 14% regularly active, and only 18% were regularly active, intensive. Women were less active than men anc persons of lower socioeconomic status(SES) were less active than higher SES. Physical activity was not significantly associated with smoking status, drinking pattern and overweight, but negatively associated with daily smoking amount and total duration of smoking in smokers. Individuals with higher lever of physical activity were more likely to check blood pressure regularly and have had screening examination for stomach cancer. Conclusively, the proportion of Korean people who perform appropriate level of physical activity in terms of health promotion is still very low, thus an enforced intervention program becomes indispensable to achieve the national health goal by the year 2000.; Summary

The Relationship Between Cholesterol Level and Mortality in Korean Women.: Yun Mi Song, Joo Hon Sung, Jai Jun Byeon, Joung Soon Kim, Oh Young Park; Korean J Epidemiol. 1997;19(2):131-146.

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BACKGROUND
There were many efforts to evaluate the relationship between cholesterol and mortality. But almost all of them have been performed on male western people who have higher mean cholesterol concentration than oriental people and have different disease pattern from women's. So, upto now, the relationship of cholesterol to mortality in women with low cholesterol concentration was not well known. We carried out this study to investigate the relationship in Korea women whose mean cholesterol level was lower than that of western people and men.
METHOD
Study subjects included in were 100,363 Korean women aged 30-65 years. They undertook multiphasic health examination provided by Korea Medical Insurance Corporation between March 1990 and July 1990, and had no history of cancer and no significant medical illnesses which could change blood cholesterol level. Study subjects were followed for 5.5 years until December 1995 and it was determined whether each subject was dead or alive using the mortality data from the Korea National Statistical office and the Korea Medical Insurance Corporation. Nonlinear ralationship between serum total cholesterol and mortality was investigated with the use of quadratic regression and with dummy variables using the 158-180mg/dl group as the comparison group. To analyzing the relationship between cholesterol concentra-tion and mortality with controlling for age, smoking, alcohol drinking, exercise, diastolic blood pressure, body mass index, pay level, Cox propor-tional hazard model was used.
RESULT
During the follow-up period, there were 369 deaths. Mean cholesterol concentration of study subjects was 182.8mg/dl There was no significant association between serum cholesterol and total mortality, but women with cholesterol concentrations below 130mg/dl showed slightly increased risk of death(RR=1.20). Cholesterol had an inverse relationship with mortality from stroke, and women with cholesterol concentrations below 130mg/dl had higher risk of death from stroke(RR=3.28). Although there was no statistical significance,risk of mortality from hemorrhagic stroke in women with very low cholesterol concentration was markedly higher than in women with cholesterol concentrations above 130mg/dl. Mortality relationship with cholesterol. And women with cholesterol concentrations higher than 203mg/dl had abruply increased risk for death from ischemic heart disease.
CONCLUSION
Through this study, we could observe an inverse J shaped relationship between cholesterol concentration and mortality in Korean women. The increased risk of mortality from hemorrhagic stroke in people with very low cholesterol concentration supports the previous report which proposed low cholesterol level as a significant risk factor of hemorrhagic stroke. In spite of the lack of statistical signi-ficance, greately increased risk of mortality from ischemic heart disease in people with cholesterol higher than 203mg/dl suggests that cholesterol concentration at the upper end of distribution can be a significant risk factor of ischemic heart disease in women.; Summary

Emerging and Re-emerging Infectious Diseases in Korea.: Joung Soon Kim, Byung Chul Chun; Korean J Epidemiol. 1997;19(2):81-94.

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Abstract PDF: Abstract
No abstract available.; Summary

Prevalence and Epidemiologic Characteristics of Hypertension in a Rural Adult Population.: Joung Soon Kim, Un Yeong Ko, Yong Moon, Min Kyung Lim, Min Joung Ko; Korean J Epidemiol. 1996;18(1):55-63.

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To determine the prevalence and risk factors of hypertension we performed cross-sectional study in a rural area. We measured BP and body mass index(BMI), and interviewed adult residents over 30-year-old age. 337 males and 357 females participated the survey. BP was checked twice and the mean was used to determine age and sex specific mean BP and prevalence of hypertension. Prevalence of definite hypertension(BP>or=160/95 or on medication) was 14. 0% in males and 17. 7% in females. Risk factor for hypertension was analysed by multiple logistic regression; age (10years: OR=l. 7) and BMI(1 BMI unit: OR=l. 2) were positively associated with hypertension but smoking(1 pack year: OR=0.9) was shown to have inverse relationship.; Summary

Accident as a public health problem in Korea and strategies of epidemiologic study on road traffic accidents.: Joung Soon Kim; Korean J Epidemiol. 1995;17(2):214-224.

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Mortality and morbidity caused by accidents among Koreans have been increasing steadily and more strikingly from motor vehicle traffic accidents since 1980's, when owning and driving car became a fashionable and ubiquitous life style among Koreans. The proportion of deaths from accidents among all deaths was 9. 5% in 1983 and increased to 14. 8% in 1993. Moreover the mortality rate from the motor vehicle traffic accident increased more than three folds along with eight folds increased number of vehicles during the same period.; Summary

A Study on Epidemiological Characteristics of Nosocomial Infection in Korea.: Joung Soon Kim, Sung Eun Lee; Korean J Epidemiol. 1995;17(2):137-155.

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In Korea, the nosocomial infection control program is not well estabilished. This study was carried out to investigate the incidence rate of nosocomial infection occurred among patients of 18 hospitals for 7 days ; cases of hospital infection per 10,000 patients discharged during the same period in Korea. The study was done in 18 volunteer hospitals and nosocomial infection cases for 7 days were collected retrospectively. The result was as follows; 1. The incidence rate of nosocomial infection for 7 days was 578 cases per 10, 000 patients discharged. 2. Pneumonia was the most prevalent nosocomial infection ; the incidence rate 112.7 cases per 10,000 discharges. The incidence rate of urinary tract infection was 85. 7 cases and that of septicemia was 36. 7 cases per 10, 000 discharges. 3. The incidence rate of nosocomial infection among patients of neurosurgery department was the highest(2,742 cases per 10,000 discharges). And the incidence rate of nosocomial infection was 6 times higher among the patients of intensive care unit than that of general ward. The reasons of higher nosocomial infection rate of intensive care unit and neurosurgery appeared to be due to many invasive procedures. Thus the priority in nosocomial infection control program must be given to those groups.; Summary

Epidemiological Study on the Mumps Epidemic: In one Primary School in Hwasung-Kun, Kyonggi-Do.: Joung Soon Kim, Bo Youl Choi, Hung Bae Park, Young Jon Shin, Jeong Il Son, Mo Ran Ki, Yong Wha Oh, Keum Nie Bang, In Suk Choi; Korean J Epidemiol. 1995;17(1):105-115.

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In the last years, according to the increasing incidence of measles and other viral diseases, it have been needed to study on not only the fundamental epidemiological characteristics of mumps and measles but also judgement on the effectiveness of vaccine that meet our domestic situation. The author carried out questionnaire to obtain epidemiological characteristics and vaccine efficacy of mumps on epidemics of mumps in one primary school in Hwasung-kun, Kyonggi Do from Feb. to July, 1994. The results are summarized as follows: 1. Total students was 556, but 446(78.4%) responded to the questionnaire. Among that 446,130(29. 1%) have suffered from mumps. From 9 to 10 year old students had the high attack rates, especially 10 year olds has the highest(39. 7%). 2. From Feb. 2, 1994, first case was on, to July 6, 1994, the epidemic was continues, and attack rate was higest in May(50. 5%). 3. Among the 130 mumps patients, 5 have suffered from complication(3.8%) : encephalitis 3(2 in male, 1 in female). 4. Vaccination rate was 91%, and as ages were lowered, the rates were higher. 5. Attack rate was higher in group who had time interval after vaccination less than 5 years than total attack rate, and was higher in group who had been vaccined after 5 year old. 6. Attack rate in vaccinated group was 27.3%. 7. Vaccine efficacies, be judged by three methods of analysis according to case definition and vaccination status, were 37.4 39. 2%. 8. Factors that have significantly affected the mumps epidemic were vaccination status and vaccination age.; Summary

A Review Study on Health Impacts of Agent Orange.: Young Joo Park, Joung Soon Kim; Korean J Epidemiol. 1994;16(1):84-115.

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In order to understand epidemiologic characteristics of dioxins related health impacts, 107 diox in-related literatures published up to May, 1993 were thoroughly reviewed. The results obtained are as follows: 1. Review studies on dioxins can be classified into two types : one is studies concentrated on one specific subject related to dioxins such as the effects on skin, birth outcomes, metabolic machanisms in the human body, major sources of exposure to the general population, immunotoxicity, association between dioxins and cancers, and research methods on effects of dioxins. The other is review studies dealing with overall aspects of dioxins, among which the report published by Academy of Science of United Stateds of America in 1993 is the most recent one. 2. Judging by consistency of results and biological plausibility, there were three groups of diseases ; diseases having causal relationship, having possibilities of causal relationship, and having no causal relationship for the time being. 1) The diseases showing causal relationship were lung cancer, Hodgkin 'disease, non-Hodgkin 'lymphoma, soft tissue sarcoma, chlordane, and polyneuropathy 2) the diseases showing possibilities of causal relationship were stomach cancer, lymphatic and haematopoietic cancer, multiple myeloma, skin cancer, diseases of digestive system, and CNS deformity among children born to the people exposed. 3) The diseases showing no causal relationship were oral and laryngeat cancer, esophageal cancer, prostate cancer, kidney cancer, bladder cancer, brain and CNS cancer, diseases of circulatory and respiratory systems. There were numerous diseases of digestive system, which showed difficulty in establishing definite causal relationship owing to the lack of consistency among researchers. 3. Even though papers dealt with dioxinrelated mortality and morbidity studies showed high mortality rate from accident, biological plausibility explaining causal relationship between them should be sought further. 4. There was a high prevalence of hearing loss among Vietnam veterans, and it seemed rather related to the explosive noise in combat than dioxin itself. 5. The current TCDD levels of Vietnam veterans were almost the same as those of the general population.; Summary

Epiderniologic Characteristics and Trends of Leptospirosis in Korea by Literature Review.: Sung Soo Kim, Joung Soon Kim; Korean J Epidemiol. 1994;16(1):66-83.

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In order to understand the epidemiologic characteristics and trends of Leptespirosis in Korea, year book of acute infectious disease and literatures published were thoroughly reviewed. The results obtained are as follows: 1. The outbreak of Leptospirosis in Korea has decreased during recent years. Most of the patients occured in Semptember, October, and November. Seventy nine percent of reported patients occured in north Choongchung, south Choongchung, and Kyunggi province in 1987-1991. 2. Leptospires isolation rates were ranged from 0.2% to 16.0% among normal healthy person, higher in rural residents than military personnels. 3. Total of 92 strains were isolated from human in six years from 1984 to 1990. Its main serogroups were Icterhaemorrhagiae and Canicola, predominantly consisted of serovar lai, copenhageni and canicola. Eighteen strains of Biflexa were also isolated from healthy persons and patients. 4. The proportion of Leptospirosis among patients with acute febrile episode has decreased since 1985. Sero-positive rate of male among patients with acute febrile episode is higher than that of female. Sixty percent of sero-positive patients with acute febrile episode was older than 40-year of age. The seropositive rates were consistently the highest in harvest season than other seasons. Residents of north Choongchung, north Chunlla, south Chunlla, Kyunggi, and north Choongchung provinces showed higher seropositive rates than those of other ones. Main serogroups positive to most sera of Koreans were Icterohaemorrhagiae and Canicola. 5. The sero-positive rate of normal healthy persons ranged from 2.0 to 25. 6% ; the sero-positive rate of rural area was 4 to 8 times higher than that of healthy urban people. Little difference was observed in sero-positive rate by age group among above 40 years old people, although it was higher in male by sex, in farmers by occupation and in some provinces by area.; Summary

A seroepidemiological study on leptospiral infection in a ruralcommunity.: Soon Jin Lee, Seok Yong Lee, Bo Youl Choi, Ung Ring Ko, Sae Jung Oh, Joung Soon Kim; Korean J Epidemiol. 1992;14(1):79-90.

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A seroepidemiological follow-up survey for antibody to Leptospirae was undertaken twice, the first one in Oct.-Dec. 1988 and the second in Dec. 1989-Mar. 1990 among adult inhabitants of over 20 years of age in Yang-pyeong Gun, Kyeong-ki Do. The sera of 480 persons in 1988 and 328 persons in 1989 were tested for Leptospirae by microscopic agglutination test (MAT) and interview was used for additional inforamtion. The serologic test was performed against 4 strains, which were Icterohemorrhagiae lai and Canicola canicola Hond Utrecht IV as standard strains, and 6P-049-1 and YP-35-1 as strains isolated in 1986 in Korea, in accordance with WHO guideline. The results of the test showed that 106 of 480 sera(22.1%) in 1988, and 84 of 328 sera(25.6%) in 1989 turned out to be positive to Leptospirae. The seropositive rates for Leptospirae by district in 1988 and 1989 were 12.9~33.3% and 15.0~42.2% respectively and the difference was statistically significant. One district, mainly a commercial area was newly added in 1989. The seropositive rate of that district was 15% and it was significantly low when compared with 32.8% of seropositive rate of the other rural districts. No difference was observed among age groups of 20~30, 40~50 and over 60 years as well as among sexes. The seropositive rate of farmers and non-farmers were 23.0% versus 10.0% in 1988 and 31.1% versus 17.7% in 1989 showing higher rate among farmers. A total of 143 persons were followed up 14 months and it was observed that 37.0% (10/27) of seropositive subjects remained positive, and 31.9%(37/116) of seronegatives were converted to seropositive. The duration of persistent antibody titer over 1 : 80 against Leptospirae that be calculated by formula(prevalence=incidence*duration) was 8.3 months. As for the seropositive reaction with or without febril illness, 29.3% (17/58) of subjects with febrile illness and 24.7 (66/267) of subjects without febrile illness turned out to be positive, showing no significant difference between them.; Summary

A study on the health status of the inhabitants exposed to cementdust.: Hae Kwan Cheong, Joung Soon Kim, Byung Soon Choi, Chung Bum Kim, Sung Il Cho, Yun Mi Song, Hyun Sul Lim; Korean J Epidemiol. 1992;14(1):59-69.

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A health impact of environmental cement dust exposure among inhabitants around a cement factory was carried out with special emphasis on finding bronchial asthma cases in this area. Questionnaire survey and physical examination were done on 437 persons in two villages located within 1km distance from the cement factory. On the basis of questionnaire survey and physical examination, 56 persons with suspicion of bronchial asthma were screened, who were further examined to establish diagnosis by physical examination, pulmonary function test and bronchodilator test.
Results
are as follows : 1. Inhabitants in surveyed area had high prevalence of acute and chronic diseases, particularly respiratory diseases and dermatologic diseases. 2. Respiratory symptoms complained were sputum(23.9%), cough(23.0%), dyspnea(19.1%), chest tightness(14.6%), and wheezy breath sound(13.1%). On physical examination, pterygium(29.5%), decreased breath sound(3.0%), wheezing(3.3%), and rales(2.7%) were found. 3. On diagnostic examination, 32 cases (prevalence rate 7.3%) of bronchial asthma and 10 current cases (prevalence rate 2.3%) of bronchial asthma were confirmed. Thus it is postulated that high prevalence of bronchial asthma and respiratory diseases in this area may be related to environmental exposure to the cement dust. Further study, however, such as bronchial provocation test may be necessary to establish definite conclusion on causal relationship between bronchial asthma and environmental cement dust exposure.; Summary

A study on leptospiral infection status and biological characteristics of the strains isolated from wild rats in some areas of Korea.: Seon Il Park, Joung Soon Kim; Korean J Epidemiol. 1991;13(2):169-184.

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In order to study Leptospiral infection status and biological characteristics of the strains isolated from wild rats, a total of 34 wild rats were captured alive from three locations including Hwasung-gun, Yangju-gun and Seoul city during the period of four months from the December 1990 to the March 1991. Rodents were anesthetisized with ether, blood was taken from heart puncture and then autopsied. Blood and kidney specimens were inoculated into tubes of EMJH semisolid medium and incubated at 30°C for six weeks. These cultures were examined 6 times by dark field microscopy at weekly intervals. Serogroup and serovar of isolates were identified by micro-agglutination test and cross-agglutination absorption test Lung, liver and kidney were sectioned with a sharp scalpel and touch printed on slide glasses and then silver-stained. Blood specimens were allowed to clot and sera were collected for serologic test. These procedures were necessary to see the distribution of Leptospira by tissues and antibody titer as the length of infection gets longer. Pathogenicity test and horizontal infection test were also carried out on Guinea pigs and mice with the strains isolated. The summarized results are as followings : 1. Kidney tissue and blood sample from 34 rats were cultured for Leptospira and four(11.8%) strains were isolated. All strains belonged to Leptospira interrogans Icterohemorrhagiae serogroutp 1 out of 1 Apodemus agrarius, 2 out of 10 Rattus rattus, 1 out of 16 Rattus norvegicus, none out of 7 Mus musculus. Of 4 isolates, cultured H-9 was identified as Serogroup Icterohemorrhagiae serovar lai. 2. Leptospiras were seen in 8 of 34 (23.5%) silver-stained kidney sections, 5 in lung sections (14.7%), and 4 in liver sections (11.8%) 3. All strains isolated were Gram negative, resistant to 5-FU, sensitive to 8-Azaguanine, spherical conversion in 1 M NaCl ; typical Leptospiras with hook in E.M. were observed These strains did not grow in 13℃ culture temperature. Thus all strains demonstrated Leptospim interrogans characteristics. 4. The overall Leptospira seropositive rate was 20.6% (7 samples/ in 34 blood of wild rats. Of 7 seropositive rat sera, 3 (8.8%) were positive for L. Icterohemorrhagiae, 2 (5.9%) for 87M-67 (local lai), one showed cross reaction between L. Sejroe and L. Bataviae. 5. As Guinea pigs and mice were inoculated intraperitoneally with 1 ml of 7 day old culture containing approximately 2 x 108org/ml of Y-2 isolated strain, massive hemorrhage and inflammatory cell infiltration (lymphocyte, plasma cell,) were major pathological findings in heimatoxylin-eosin stained sections. LD50 by probit analysis was 1.87 x 1011 org/ml [y(probit)=-13.530+1.644 Log x] and horizontal infection between mice was confirmed. 6. Leptospires were seen in blood of experimental animals at 24 hours after experimental inoculation and they disappeared around 288 hours. Leptospires were observed in liver first and then in all organs by 4 days after experimental infection. 7. Antibody was detectable in 2 days after the experimental infection and then increased gradually. Although the titer dropped incidentally to 1 : 20 at 6 days after infection, relatively high titer was maintained from 12 days of infection. Key words : Leptospira, wild rat isolation, serology, histopathology.; Summary

A study on validity and usefulness of various tests for mass screening of diabetes mellitus: Joung Soon Kim, Soon Gyu Yun; Korean J Epidemiol. 1990;12(2):137-143.

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Abstract PDF: Abstract
This study was carried out to determine validity and usefulness of various tests for mass screening of diabetes mellitus prior to the national diabetes mellitus prevalence survey. The tests studied include capillary blood sugar value measured by Glucometer II in comparison with verified Oxidase method, validity of fasting blood sugar and 2hrs. postprandial blood sugar and urine sugar test by uristix(Ames Co.)，and usefulness of some risk factors as a screening tool. The results obtained are as follows : 1. Capillary blood sugar values measured by Glucometer II showed 0.872 correlation coefficient with the values measured by oxidase method : the Glucometer II measurement of blood sugar appeared to be very useful, particularly in a field survey, owing to its high validity and its technical simplicity. 2. The sensitivity and the specificity of fasting blood sugar based on WHO diagnostic criteria (FBS : ≥ 120 mg/dl and 2hr. PPBS ≥ 200mg/dl) was 100% and 93.3% respectively. On the other hand these of 2hr. PPBS were all 100%. Therefore it would be most valid and economic for diabetes mass survey if ≥ 120mg/dl FBS is used for screening and then confirmed by ≥ 200mg/dl 2hr. PPBS. 3. Urine sugar test was neither sensitive nor specific enough to be useful in diabetes screening. 4. Risk factors such as family history of diabetes mellitus, overweight or obesity and sex did not show strong association with the presence of diabetes mellitus so as to discriminate or select out diabetics from nondiabetic normal population. 5. More deterministic conclusion may be expected when over 20,000 subjects studied are analyzed.; Summary

Disease pattern of Korean aged population: Joung Soon Kim; Korean J Epidemiol. 1990;12(2):144-152.

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Abstract PDF: Abstract
The proportion of aged population among Koreans had been relatively low till 1970's. The percent of the age group older than 65 years was 3.5% in 1975, 4.6% in 1989 and estimated to be around 6.4% in the year 2000. This stydy was done by reviewing mortality and morbidity data of the group to identify some major diseases that lead them to deaths and make suffer them from for the specified age group. Leading causes of deaths among the aged population in 1988 were cerebro-vascular diseases, hypertensive diseases, malignant neoplasm of stomach, cardiac dysrhythmia, and chronic obstructive lung diseases ; senility as cause of death increased in its frequency as age advanced. On the other hand, the five most frequent disease among the group for which they have utilized medical facilities were diseases of musculoskeletal system and connective tissues, hypertensive diseases, diseases of nervous system, diseases of ear and mastoid process, and dislocation, sprain and strains for male ; diseases of musculoskeletal system and connective tissues, hypertensive diseases, dislocation, sprain and strains, and diseases of nervous system for females. Detailed information is presented in tables.; Summary

A study on the effect of noise exposure to the health of a population: Sung Il Cho, Joung Soon Kim, Hyun Sul Lim, Hae Kwan Cheong, Byung Soon Choi; Korean J Epidemiol. 1990;12(2):153-164.

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For the purpose of evaluating the effect of noise exposure to the health of a population in a village near an air force shooting practice site, a cross-sectional study was conducted from April 1 to April 23 in 1989, on the inhabitants of the village as exposed group and on the population of another provincial village as nonexposed group, which was similar to the exposed in socioeconomic status but had not been exposed to the environmental noise. Subjective symptoms, pulse rate, blood pressure, and pure tone thresholds were compared in the exposed group and the nonexposed group. 150 and 93 subjectes studied were analyzed in each group. The results were as follows : 1) There was a significant difference between the two groups in the frequency of subjective symptoms including otalgia, hearing loss, tinnitus, ear fullness, nausea, diarrhea, indigestion, and anxiety. 2) There was no significant difference between the two groups in average pulse rate, while significant differences were seen in average systolic and diastolic arterial blood pressures, which were 138± 23.2mmHg and 84.5±14.4mmHg in the exposed group and 126.8±19.3mmHg and 73.8±11.3mmHg in the nonexposed group. The prevalence of hypertension by WHO criteria was 24.0% in the exposed group and 8.6% in the nonexposed group, of which difference was statistically significant. 3) There was no significant difference between the two groups in average hearing loss value, while the prevalence of hearing impairment in the exposed and the nonexposed group was 24.0% and 13.4% each according to the criteria of 500, 1000, 2000Hzx pure tone average greater than 26dB, showing a significant difference between the two groups. 4) As the duration of residence increased the hearing loss value increased in the exposed group, but age-corrected percentage hearing loss did not show any increase ; further study may be necessary to determine whether the significantly high prevalence of hearing loss in the exposed group was due to the environmental noise exposure.; Summary

Usefulness of epidemiologic study data obtained by joint survey with 6th National Tuberculosis Prevalence Survey: Joung Soon Kim; Korean J Epidemiol. 1990;12(2):211-215.

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Perspective and transition of death causes among Koreans: Joung Soon Kim; Korean J Epidemiol. 1989;11(2):155-174.

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Electromicroscopic study on morphological structure of leptospires: Joung Soon Kim, Chul Jong Yoon; Korean J Epidemiol. 1989;11(2):183-190.

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Six reference strains and three locally isolated strains of leptospires were electronmicroscopically studied to examine possibility of differentiating serovars. Fifty leptospires from each serovar were randomly taken from specimen to measure their length, width, number of coiling and handedness of coiling. Means and standard deviations of each measure were computed and tested for difference by Tukey’s HSD test. Handedness of coiling was measured in terms of proportion in Percentage. Tightness of coiling was compared by number of coiling per micrometer of length. Summarized results and conclusion are as following: 1. Each measuring index was not specific enough to differentiate serovar although there was a strong tendency to be similar for the same serovar or serogroup. 2. When all indices were used in combination the specificity of the measurement increased with better differentiation between serovars, suggesting that if a few more indices are added to, and the validity and reliability of this preliminary study is confirmed, the method could be very useful.; Summary

A study on leptospiral infection among cows and pigs by culture and microagglutination test: Joung Soon Kim, Hee Jung Kim, Yong Heo, Sun Il Park, Byung Chun Lee, Hyun Chil Mun, Sung Sam Kim, Young Hee Oh; Korean J Epidemiol. 1989;11(2):191-197.

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This study of leptospiral infections among cows and pigs were carried out to find out possible role of these domestic animals as an infection source for humans, and the magnitude of economic loss due to abortions caused by leptospiral infections among these domestic animals. Blood samples of 459 cows in May and 446 heads in November 1989 were collected from 19 villages of Kyunggi Province. These samples were cultured and serologically tested. Kidney of 200 pigs from all over the country were collected from a governmental slaughter house and cultured for isolation of leptospires.
Results
obtained are as followings: 1. Only one strain of leptospires, most strongly reactive to Pomona antibody, was isolated from duplicated cultures of 905 cow blood samples in EMJH medium. 2. Serological test by MAT with seven reference strains and three locally isolated strains was positive in 12% of the sample in May and 26% in November samples; positive rate increased slightly as the age of cows increased, however, there was no difference in positive rate by sex, type of cow and area. 3. There was no statistically significant association between abortion history among cows(one year-period) and positive MAT. 4. No leptospires was isolated from 200 pig kidneys cultured, probably because they were all too young to be infected; most of them were around six-month old and raised in professional pig farms.; Summary

Prevalence rates and epidemiological characteristics of chronic diseases among Koreans in the demonstration area of health insurance program: Joung Soon Kim, Moon OK Ryun, Hyo Jee Joung; Korean J Epidemiol. 1989;11(2):246-262.

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Rapid industrialization and an enormous economic growth during last decades since 1960 has changed disease pattern considerably in Korea; from infectious diseases to degenerative diseases in terms of major causes of mortality and morbidity. This study was carried out in the six health insurance demonstration areas with around 620,000 population to identify chronic diseases of public health importance by collecting and analyzing data for its prevalence and epidemiologic characteristics. The definition of chronic disease is adopted from the operational definition of chronic condition used in USA health survey though crude. The results are summarized as followings: 1. The overall prevalence rate of chronic diseases per 100,000 population was 8193 persons for males and 11070 persons for females, 1.4 times more among females. musculoskeletal system, diseases of the nervous system, mental disorders, chronic obstructive lung diseases and hypertensive diseases for males, diseases of musculoskeletal system, mental disorders, diseases of nervous system, hypertensive diseases and chronic obstructive lung diseases for females. 3. The chronic diseases that revealed higher prevalence more than two times among male population than female were syphilis and other venereal diseases(x 3.4), malignant neoplasms of respiratory organs(x 2.2), and open wounds(x 2.2); diseases of higher prevalence among females were malignant neoplasms of genitourinary system(x 5), malignant neoplasms of bone, connective tissue(x 2. Five leading chronic diseases were diseases of 2.1), and neoplasms of unspecified nature(x 2.3). 4. When the chronic diseases of this study as compared with that of other countries, i.e., data of interview survey in Japan(1980) and U.S.A.(1986), the prevalence of chronic diseases of infectious nature such as tuberculosis and diseases of ear and mastoid precess are much higher among Koreans but the diseases of degenerative nature such as hypertensive diseases, cerebrovascular diseases, chronic obstructive lung diseases, ischemic heart diseases, diseases of pulmonary circulation and diabetes mellitus were much lower among Koreans.; Summary

A study on relationship between serum lipids level, dietary intake and weight for length index (WLI) for middle school children: Hyeo Ja Joung, Joung Soon Kim; Korean J Epidemiol. 1989;11(1):42-57.

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This study was carried out to evaluate the correlation between serum lipids level, dietary intake and weight for length Index(WLI) which are cardiovascular risk factors, on 182 middle school children. Information on the general characteristics of the children were collected by questionnaire self recorded, the serum lipids level was measured by the enzyme method, and dietary intake was measured by a 24-hours recall method. All data were analyzed by means of X2-test, Pearson Correlation and Mean. The following findings were obtained from the study: 1. Twenty two subjects out of the 182(12%) turned out to have obesity according to WLI criterion. 2. The correlation between mother’s education, level and WLI was statistically significant, whereas the correlation between other environmental factors and WLI was not statistically significant. 3. The Correlations between nutrient intake and WLI, nutrient intake and serum lipids level were not significant- Serum TG level and WLI, however, showed positive correlation and serum HDLC level and WLI did negative correlation. 4. WLI and TG/PchE ratio, WLI and TG/HDLC ratio, and WLI and PchE/HDLC ratio revealed positive correlation. However, the correlation between WLI and TC/TG ratio was negative. The correlation between WLI and TG/HDLC ratio was stronger than any other indices. 5. Serum TC level and HDLC level, and serum TC level and PchE level were positively correlated, whereas serum TG level and HDLC level was negatively correlated. 6. The correlation between nutrient intake and serum lipids level was not statistically significant.; Summary

A study on the HBsAg positive rate among Korean adults and the immunogenicity of hepatitis B vaccine: Ho Cheol Shin, Joung Soon Kim; Korean J Epidemiol. 1989;11(1):98-106.

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This study was carried out on 4347 Korean adults from 1986 to 1988 in order to understand HBsAg positive rate among healthy Korean adults and the negative seroconversion rate of HBsAg in the HBsAg carrier group during 2 years of observation period, and to assess the immunogenicity of hepatitis B vaccine 2 years after vaccination. Between February and April 1986, 4347 persons, who were randomly cluster sampled among employees of Korea Electric Co., were screened for evidence of HBV infection. After screening test of HBV infection hepatitis B vaccine was given to these who showed no evidence of HBV infection between May and November 1986. Then the HBsAg carriers and vaccinees were followed up for serological re-examination between February and May 1988. All blood samples were tested for HBV markers (HBsAg, HBsAb, and HBeAg) by EIA and for aminotransferase. Hepatitis B vaccine (Hepavax-B, KGC) was given intramuscularly in the buttock at 0, 1, 6 months. And Z-test and Chi-square analysis were performed for statistical analysis of the results. Summaries of the results are as followings: 1) The HBsAg positive rate of the study population was 7.5% and was highest among 35-39 years of age group (9.2%, p<0.05) and in Cheju-Do by area(17.1%, p<0.05). 2) The HBsAg negative conversion rate of HBsAg carriers was 7.9% during 2 years of observation period. And the rate of elevated aminotransferase for the HBeAg positive HBsAg carriers(29.4%) was higher than that of HBeAg negative group(11.1%). (Df=1, X2=10.96, p<0.005, OR=3.3) 3) The HBsAb positive rate of vaccinees received 3 doses of Hepavax-B was 73.9% and was higher than that of group received 2 doses (73.3%, p>0.05), that of group received 1 doses(57.1%, P<0.01), and that of group received none(48.8% p< 0.01).; Summary

A seroepidemiological study of rubella on female employees in an university hospital by ELISA method: Yeo Jin Chung, Joung Soon Kim; Korean J Epidemiol. 1989;11(1):107-114.

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This study was carried out in 1988 on 435 randomly sampled females out of 1,728 female workers in an university hospital in order to obtain herd immunity level and its epidemiological characteristics. The presence of rubella antibody was checked by ELISA method(Rubazyme Diagnostic Kit-Ab-bott Laboratory) with the sera collected during periodic medical examination in 1987. Also Self-recorded questionnaire survey on demographic characteristics, history of vaccination and natural infection of rubella, and knowledge on relationship between the rubella infection during pregnancy and congenital malformation of the baby. The results obtained are summarized as followings: 1. The overall positive rate or rubella antibody detected by ELISA kit was 78.2%; there was no statistically significant differences of rubella antibody positive rate between age groups, duration of employment and specialty departments. The positive rate was significantly different, however, between professions, i.e., laboratory technicians showed the highest positive rate(93.3%) but pharmacists and dietician’s positive rate revealed the lowest(58.3%), which suggested the antibody positive rate was associated with the degree of exposure to the rubella virus. 2. On the question about the past history of natural infection and immunization of rubella, over one-half of the respodents checked on “status unknown”, and only 8.5% of them admitted having the history of infection and vaccination. Nevertheless there was no demonstrable association between the past history and the rubella antibody status, presence or absence. 3. On the question about knowledge concerning clinical characteristics, mode of transmission of rubella virus and association between rubella infection and fetal malformation, only 69% of the respondents acknowledged and it showed statistical difference between professions. The major source of information was formal education in professional schools. (This study was supported by Public Health Research Foundation); Summary

Global density of AIDS patient per one million population by continent and country as of August 31, 1988: Joung Soon Kim; Korean J Epidemiol. 1988;10(2):157-163.

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AIDS has become a pandemic ever since the initial recognition in 1981, and experts state the pandemic is still in its early stages difficult to gauge, but appearently threateming global health. This paper is prepared in order to provide with correct information on the global distribution of AIDS patient by means of AIDS patient density (cumulative AIDS pts per unit of population) in determining global rank of AIDS occurrence. The conventional way of expressing rank with the absolute number of AIDS patients would not be as useful as the density presentation in terms of epidemiological understanding of the pandemic. The materials utilized are WHO Weekly Epidemiological Record: AIDS Data As At August 31, 1988 and 1986 population data in WHO Annual Statistics, 1987. Summarized results are as followings: 1. One hundred forty countries(78.7%) out of 178 countries, which informed the presence or absence of AIDS patient to WHO reported to have AIDS patients; the percent of countries having AIDS patients among countries informed to the WHO was 93.3% in European continent, 90.9% in American continent, 86.5% in African, 57.9% in Asian and 35.7% in Oceanian. Number of total AIDS patient per million of the population for each continent were 119 patients in American, 41 in Oceanian, 26 in African, 19 in European and 0.1 in Asian continent. Geobal average/million was 23 patients. 2. AIDS patient Density(per million population) by country ranged from 0 to 1345 pateints; in African continent there were six countries where the number of AIDS patient per million was over one hundred-Congo(700), Brundi(290), Uganda(250), Central African Republic(164), Rwanda(157) and Zambia(144); in American continent smaller resort areas with fewer population had higher AIDS density, and there were 9 countries with more than 100 AIDS patients/million population-French Quiana(1345), Bahamas(803), Bermuda(339), U.S.A. (297), Guadeloupe(220), Barbados(217), Haiti(203), Trinidad & Tobago(189) and Mortinigue(116); in Asian continent only one country, Qatar of which population is 335 thousands had 100 patients/105; in Europe continent, there was no single country with more the 100 AIDS patients/million population and the density was rather homogeneous ranging from 13~79 AIDS patients/106; in Oceaneon countries, 25~59 patients/million. 3. Global rank for AIDS density was entirely different from the rank based on absolute number of AIDS patients. The rank for first top ten is in order of Congo, U.S., Brundi, Uganda, Haiti, Trimidad & Tobago, Central African Republic, Rwanda and Kenya among countris with more than one million population. On the other hand the top ten country by the absolute number of AIDS patient was U.S., France, Uganda, Bragil, Germany F.R., Italy, Kenya, Canada, U.K., and Tanzania. 4. In Korea six AIDS patients and 30 HIV infected persons have been officially reported currently. When the 1(AIDS patient): 50~100(HIV infected) ratio is projected, 300~600 HIV infected persons are estimated, implying that only one tenth of them has been detected and reported.; Summary

Discriminant analysis on symptoms and signs and HFRS in Korea for early diagnosis: Joung Soon Kim, Young Joon Kim, Yong Heo, Won Young Lee, Cheong Dae Suh, Hae Kong Byun; Korean J Epidemiol. 1988;10(2):246-253.

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The major diseases causing hemorrhagic feb rile syndrome in Korea are Leptospirosis, Scrul Typhus, and HFRS (Hemorrhagic Fever with Renal Syndrome). Therefore, methods to provide a correct differ ential diagnosis is urgently required for the selection of adequate treatment in the early stage of infection, which will definitely help to reduce the mortality and/or the occurance of complications and duration of illness. At present, a differential diagnosis in early stage in very difficult because the epidemiological and clinical characteristics of them are much alike. Although the only reliable way of differentiation is antibody test, it is not applicable for those in early stage since a rise in specific antibody levels to be detectable requires 1 week after infection. The purpose of this study is to provide criteria which may help to specify Leptospirosis, Scrub Typhus, and HFRS for the early diagnosis and selection of proper treatment. One hundred and forty eight hospitalized patients because of high fever (more than 38°C) and similar symptoms with above mentioned diseases were studied for one year (Sep. 1987-Oct. 1988). Isolation of Leptospire and serologic test were done. Serologic test results for HFRS was obtained from medical record. Micro Agglutination Test(MAT) for Leptospirosis and Indirect Fluorescent Antibody test(IFAT) for Scrub Typhus were employed. The major findings are summarized as follows; 1) Four strains of leptospire were isolated. Sero-positive rates were 32.5 for Leptospire and 12.2% for Scrub Typhus. Among 148 patients, 24 cases (16.2%) were confirmed to be leptospiral infection by the bacterial isolation and/or serology. And 13 cases (8.8%) were confirmed to be R. tsutsugamushi infection by the serologic test. Among 25 patients who were transfered because of their suspicious symptoms of HFRS, only 9 patients were identified as Korea Antigen positives. 2) The majority (69%) of the Leptospiral positive sera reacted with locally isolated L. icterohamorragiae and canicola. The majority (77%) of the Rickettsial positive sera reacted with Gilliam strain. Among positive sera for Gilliam strain, 18% were found to cross-react with Kato strain. 3) The average duration of illness due to the infections were 71 days by HFRS (the longgest), 36 days by Leptospirosis, and 20 days scrub typhus, which was statistically significant. 4) Chi-square analysis and discriminant analysis were done to clarify the differences in clinico-physical findings of these infections which may differ from each other. Discriminant analysis was done by use of 37 symptoms, 27 physical signs and 4 vital signs as independent variables and 3 groups (Leptospirosis, scrub typhus, HFRS) as dependent variables. Chi-square analysis revealed that sputum and hemathemesis in Leptospirosis, abdominal reflect¬ed tenderness in scrub typhus and oliguria in HFRS were selected as the significant variables. Discriminant analysis also revealed that chest pain in Leptospirosis, CVA tenderness and high respiration rate in scrub typhus and oliguria, flask pain and peak diastolic blood pressure in HFRS were the significant variables.; Summary

Epizootiology of canine leptospirosis in a rural area in Korea: Joung Soon Kim, Yong Heo, Byung Cheon Lee; Korean J Epidemiol. 1988;10(2):254-258.

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Inspite of the fact that studies on human Leptospirosis in Korea has been accumulated especially following the year 1984 when the disease was firstly confirmed in this country by Kim et.al., recent reports on the Leptospirosis in animals are not available enough. As a part of the major research works designed to study the Leptospirosis in farm animals, the results were obtained from studies on 231 dogs in Hwasung-gun area. Bacterial isolation and determination of serum antibody levels were attempted. These results were then comparatively studied with the age, sex, species, general conditions, and the types of animal keeping. The findings are summarized as follows; 1) Two isolates were confirmed to be Leptospire by culturing the blood specimen in EMJH media. The dogs from which the bacteria were isolated were Korean native, female, 4 month old, and has been released without special care. And the rectal temperature of these animals were significantly higher than normal, which suggested that the animals were sick. 2) Anti-leptospire antibody positive rate for the dogs confirmed by MAT tests was 19.5%, 23% of these reacted with local L. icterohaemorrhagiae Copenhageni and 40% of them with local L. canicola. 3) Serum antibody positive rates were not significantly varied by sex and age. The antibody positive rates of the street dogs were significantly higher than those of dogs cared strictly at house. And all of the sero-positive dogs were native breed. These facts suggest that chance of exposure to the risky environment would be the key factor for the leptospirial infection.; Summary

A study on epidemiology of leptospirosis in military personnel in Korea: bacterial isolation and serologic analysis: Joung Soon Kim, Yong Heo, Won Young Lee, Sang Soo Bae, Hae Kong Byun; Korean J Epidemiol. 1988;10(2):259-262.

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This report is a part of study results on Leptospirosis Control Campaign in Army. Total number of persons subjected in this study was 1, 889 which were studied in two seasons, 860 in autumn (October-November 1987) and 1029 in early summer (May-June 1988). The studies were mainly divided in two parts which includes epidemiological analysis and char acterization of the subjected population by interview survey and microbiological analysis including serologic studies on the same subjects to provide base line data for the Leptospirosis control which is an important health problem not only in military but also in general population in this country. The results are summarized as follows; 1) In bacterial isolation studies only 2 isolates were confirmed to be Leptospire and these two isolates demonstrated strong reaction with anti-L. icterohaemorrhagiae lai serum. 2) The percent of antibody positives serum to Leptospire confirmed by microagglutination tests(MAT) were 10.1% in autumn (1987) and 9.3% in early summer (1988). The difference in two study periods was not significant. 3) The seroconversion rate after the exposure to the field (military trainings) was 8.4%, which were tested a month after the exposure. No significant changes in seroconversion rates observed in 3 consecutive years since 1986(7.6%) were recognized. 4) The differences in antibody positive rates by their ranks, duration in military, their specialties and present military activities were not significant. Especially, those who served in military for a long time were found to have almost the same antibody positive rate compare to those served for shorter period of time.; Summary

Epidemiologic characteristics of cancer mortality and morbidity among Koreans: Joung Soon Kim; Korean J Epidemiol. 1988;10(1):1-29.

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Cancer has been a major cause of death among Koreans since 1970’s. This study was carried out to characterize the cancer occurrence among Koreans by analyzing mortality and morbidity data. The source of data on cancer mortality is annual reports on the cause of death statistics produced by National Bureau of Statistics, EPB Korea and annual World Health Statistics; on morbidity of cancer is prevalence survey of 1987 for the populations of six health insurance demonstration project areas. Mortality rate and prevalence rate per 100,000 population were plotted on the semi-logarithmic paper by cancer site, sex and age groups for comparison. Observed results are as followings: 1. Mortality rates per 100,000 caused by all sites cancer among Koreans in 1985 were 95.0 for males and 54.7 for females which were much lower than that of Japanese males(191.1)and females(126.9). 2. The most frequent cancer site causing death was in order of stomach, lung, esophagus, leukemia and larynx for male, and in order of stomach, uterus(part unspecified), lung, leukemia and breast for female; malignant neoplasms of rectum and rectosigmoid, liver(primary), bladder, lung, prostate, female breast and uterine cervix were much lower among Koreans when compared with Japanese and USA populations. 3. The mortality age curves of various cancer for Koreans, in which the mortality rates were higher among younger age groups and much lower among older age groups(over 65-year of age)than those of Japanese and USA populations, suggested that the effort to make valid diagnosis for older ages was lacking. 4. Age adjusted prevalence rate of all site cancer per 100,000 was 225 for male and 189 for female; the prevalence of cancer strikingly increased from 35-44 years old age group up to 65-74 years group tappering off after the age 75-year. 5. The four major cancer site in the prevalence study data were stomach(33.3%), lung(13.1%), liver and intrahepatic bile duct(12.5%) and lymphatic & hematopoietic tissue(6.8%)for male; stomach(19.8%), uterine cervix(15.9%), breast(7.2%) and liver(6.7%) for female. The frequency distribution of the cancer by site was quite similar to other studies such as Kang-wha cancer registry and hospital admission study on cancer patients among policy holders of Korean Medical Insurance Corporation. 6. The prevalence rates of cancer occurred almost every site were higher among males than females, and the age curves of the prevalence were almost identical to that of mortality data.; Summary

Current status of cancer research and future goals: Won Young Lee, Joung Soon Kim; Korean J Epidemiol. 1988;10(1):64-74.

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The current status of cancer research have been briefly summarized to clarify the problems remained to be solved for the cancer control. Cancer control program can be divided into three steps which are the general principle of disease control; the primary, the secondary, and the tertiary prevention. For the primary prevention, it is neccessary to iden¬tify the etiologic agent for the desease to be controlled. It has been reported that the agents associated with human cancers cannot be singled out. Furthermore, the genes which act a critical role(s) in pathways of tumorigenesis are our own in every normal cells. Thus, the primary prevention for the cancer can not be applicable at present except for the public health education especially when a certain risk factors are avoidable by changing human behaviors and working environments(eg; smoking and lung cancer). The tertiary prevention provides measures to help the persons recovered from the cancer to adapt to the society. However, this is applicable only when the secondary prevention measures are satisfactory and successful. Therefore, the only step we have to put our major efforts for the cancer control today may be the field of research for the secondary prevention. Since the secondary prevention depend upon the measures for the diagnosis and therapy for the patients suffering from the cancer, this is the urgently needed field not only for the patients but also the medical workers in this fields. Chemotherarpy and radiotherapy except surgery are the methods of cell killing by use of cytotoxic effect of the chemotherapeutics and radiation. The others are hyperthermia and photodynamic therapy which are not widely used at present. All of these methods have the limitation in use mainely due to the lack of the specificty. One of the methods to increase the specificity of these method were the introduction of the immunologic tools including monoclonal antibodies which can be used independently or in combinatory ways. However, practical value of the methods were not so much appreciated due to the heterogeneic nature of the tumor cells in various aspects. Also the use of the various types of the biological response modifiers have been extensively studied for the clinical applications. Those have been proved to be strong immune-adjuvants in vitro. Their role(s) in vivo especially for the tumor control remained to be analized. Emergence of the resistant cells, especially the fraction of the stem cell population following tumor therapy regardless the types of the therapy, chemotherapy or radiotherapy is the major problem to be solved. Thus, it is necessary to develope highly sensitive and specific chemotherapeutic method which may kill only the tumor cells leaving the normal cells alive. Efforts must be focused on the search and development of new agents. This may be the primary task in cancer control today. Because the development of new agents includes not only the new source of chemeotherapeutics but also the agents which can provide a certain complementary fuctions to the defects found in chemotherapy, radiotherapy, immunotherapy, and hyperthermia to maximize the efficiency of the therapy.; Summary

An epidemiological investigation of typhoid fever outbreaks in a hot spring resort town and its satellite rural villages: Joung Soon Kim, Yong Heo, Sung Soo Lee, Duk Hyoung Lee, Kun Young Shon, Sung Woo Lee; Korean J Epidemiol. 1988;10(1):92-101.

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An epidemiological investigation was carried out to identify source of infection and mode of transmission of typhoid fever outbreak, which has occurred in a hot spring resort town and its satellite rural villages from the begining of the march 1988. The investigation was carried out for two days, April 16th and 17th, on hospitalized patients and the villages where confirmed cases had been reported. The results obtained are as followings： 1. The S. Typhi isolated from 47 patients were all the same phage type that was untypable phage Type. 2. The incidence rate of typhoid fever among surveyed population, the populations belong to the same Ban (about 20-50 households) of the patients re¬ported, was 13.2% in hot spring resort town and 9.8% for the satellite villagers. 3. The incidence showed no difference between male and female population as a whole although for the age groups of 0-9 years old and 10-19 years old the incindence rates were much higher among males, and for the age groups of 20-29 years old, 30-39 years, and 40-49 years the rates were higher among females; for the age group of 20-29 years, female’s rate was as high as 5 times of males. The lowest rate was found among older ages. 4. The study results suggested that the source of infection was primarily water supply contaminated by sewage; the central water supply has been under repair for replacement of broken pipes almost for a month, from the end of February and the begining of April, in on and off fashion. Supportive data are presented in the text.; Summary

Validity of reported cases by estimating proportion of reported cases: Joung Soon Kim; Korean J Epidemiol. 1987;9(2):157-160.

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A study on the epidemiologic trends of reported major-communicable disease in Korea: Sie Baek Han, Joung Soon Kim; Korean J Epidemiol. 1987;9(2):236-263.

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In Korea several changes have occured in patterns of health and disease due to improved economic situation, living standard and medical technology. The objective of this study is to understand the changing patterns of the major communicable diseases in Korea during last several decades. The trends of incidence and mortality and the changing patterns of epidemiologic characteristics of the major communicable diseases, which occured in Korea during the period from 1910 to 1986 were studied by reviewing reported cases to the Ministry of Health and Social Affairs. Some important features obtatined are as follows. 1) The trends of incidence and mortality of reported communicable diseases showed gradual increase until 1950’s. After the great epidemic occured in pre and post-Korean War period at the boundary of 1950’s, it showed a sudden decrease and remained at a certain level by 1960's. There has been further decrease in 1970’s & 1980's. Fatality rate has remakably dropped since the introduction of antibiotics. 2) The age group which used to show the highest incidence rate for water-borne diseases such as cholera, typhoid fever, paratyphoid fever has been changed to older age group by year. Age specific incidence rates of diphtheria and Japanese B. encephalitis were higher among younger ages between 0 and 14 years but the differences among age groups are getting smaller by year. 3) The differences of incidence between male and female, and among age groups were considered to be determined by chance of exposure but not by susceptibility. 4) In seasonal variation of water-borne communicable diseases such as cholera, typhoid fever, paratyphoid fever, dysentery and Japanese B. encephalitis and poliomyelitis, the occurences were higher during summer compared with other seasons, wheares the occurences of respiratory communicable diseases such as diphtheria, whooping cough, measles were higher in winter and spring. Seasonal fluctuation, however, became less prominent in 1980’s than the past decades. 5) Geographical distribution of water-borne communicable diseases (cholera, typhoid fever, paratyphoid fever, dysentery etc.) and respiratory communicable diseases (diphtheria, whooping cough, measles etc.) showed that metropolitan cities such as Seoul and Busan had higher incidence and fatality rates than other smaller cities or towns.; Summary

Epidemiologic characteristics of leptospiral infection in healthy population in special service and their neighboring civilians in Korea: Joung Soon Kim, J.S Kim, Y Heo, H.W Chung, W.Y Lee, Y.C Hahn, H.G Byun, J.D Suh, H.K Chung; Korean J Epidemiol. 1987;9(2):264-270.

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The specific aim of this study was to provide epidemiologic information on leptospiral infection in healthy population in special service. These are considered to be the most important group in leptospirosis control not only due to the fact that they have frequent chance of exposure to the potentially dangerous environment for leptospiral infection but also the fact that an efficient preventive measure is urgently required for them. Seven hundred and fifty six service men and 197 their civilian neighbor were subjected for the study. The study included an epidemiologic analysis of the population through interview survey and this was further supported by bacteriologic and serologic confirmatory tests. Leptospira were isolated from the peripheral blood samples from those cases. The isolation positive rate were 0.5% of service men and 1.3% of the civilians. Percent of sereum antibody positives for microagglutination test (MAT) were varied from 8.3% of service men to 12.1% of the civilians. When the same population were subjected to the bacteridogical and serologic studies following the exposure to the time of harvesting, the percent of positives in both tests were increased 2.5 times comapared to those found in the same population before harvest season. Almost all of the bacteria positives (6/7) were found to be cases of inapparent infection. Only one out of the seven suffered from mild symptoms of leptospirosis complaining fever, conjuctival hemorrhage, headache, and nausea. More than half (53%) of the serum samples were reacted with L. icterohemorrhagiae serovar lai and 22% with L. irterohemorrhagiae serovar copenhageni. The rests (25%) were reacted with other groups, L. bataviae, L. canicola, L. grippothyposa, L. automnalis, and L. semaranga. none of the bacteria positives were antibody positives. The seroconversion rate following the expousre (harvest period) were 7.6% in service men and 9.3% in civilians, which were studies on month after the time.; Summary

An epidemiologic study of phlebitis due to intravenous infusion in an university hospital: S.E Lee, Joung Soon Kim; Korean J Epidemiol. 1987;9(2):271-277.

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Since phlebitis following intravenous (IV) infusion which is the most widely used in medical care for patients has remained as a frequent and important hospital infection, it is neccessary to have a fundamental epidemiologic information on the incidence for a successful control program. Two hundred and eighty one patients registered in two general surgical units of an university hospital were studied to find out the incidence rate of the IV induced phlebitis and risk factors involved in it for 2 months from August to September, 1987. Following are summary of the findings; 1) One hundred and ten cases (39.1%) out of 281 patients discharged from the surgical units had experienced phlebitis during the study period. The incidence rate of phlebitis (per 100 IV infused cases) was 14.6. 2) Among various IV devices, the use of IV cannula was found to be the most risky, which caused the highest incidence rate (per 100) 16.9. None of the other devices was comparable to IV cannula in terms of the incidence rate. 3) Proporional increase in incidence rate of phlebitis by the duration of continuous use of the IV infusion was observed. Almost one third of the IV infused cases for more than 73 hours found to have phlebitis. 4) The higher incidence rate as noticed in patients who were in old age group and hospitalized longer. 5) Forty eight percent of the phlebitis cases were classified into severity grade 2 and 3. In conclusion, the incidence rate of phlebitis found in this study was 14.6 per 100 IV infusions and 39.1 per 100 patients discharged and experienced phlebitis is much higher than that of U.S. And the risk factors identified were the devices used for the intravenous infusion, lenth of the hospitalization and age of the patients. This finding strongly suggests that more aggressive preventive intevention need to be excuted, especially for better preparation of the IV devices and selection of the safest method.; Summary

Epidemiologic characteristics of leptospirosis and febrile disease in population in special service at high risk of infection: Joung Soon Kim, Yong Heo, H.W Chung, W.Y Lee, H.G Byun, J.D Suh, C.M Sung, M.Y Ahn, J.M Choi, S.J Lee, Y.C Hahn; Korean J Epidemiol. 1987;9(2):278-287.

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This is a part of serial works on leptospirosis. In this study, a correct characterization of all of the hemorrhagic disease accompanying high fever which might be caused by various agents such as leptospira, rickettsia, viruses, and others if any was attempted by classifying the symptoms and identifing the etiologic agent which is responsible for the cases. And also serologic studies along with fundamental epidemiologic investigation on the clinical signs of the patients selected from the study area were done to draw a comprehensive conclusion. The specific aim which is the major focus of this part of study is to find out prevalence rate of true leptospira patients among patients with high fever and to characterize the clinical pictures, such as clinical signs and symptoms, which might be specific for the true cases of leptospiral infection which is confirmed by bacterial isolation from the cases. One hundred and nineteen patients hospitalized because of high fever (more than 38°C) for more than 24 hours were studied during 10 month (Aug., 1986-May 1987). The findings are summarized as follows; 1) At the time of admission, leptospira isolation rate was 5.8% (6/103) and this became 13.7% (7/44, average 8.4%) after one week of hospitalization. 2) The serum samples were testeded for the presence of the antibodies specific to 22 different servar in which 3 strains isolated in this laboratory from human blood employing microagglutination tests. The positive rate was 34.9% when the first blood samples which were collected at the time of admission tested. And it became 50.9% when the second samples were tested one after the first. The antibody conversion rate within one week was 32.4%. Only one out of 16 cases who were antibody positive at the first test was found to be negatively converted. When these were grouped by their antibody titer, 83.7% of whole antibody positive samples (64) demonstrated antibody titer 1.400 or lower and only 3.1% of them demonstrated higher than 1:3200. 3) Significantly higher positive rate were found when the sera were tested with the fresh strains isolated from that area. The majority (32.4%) of the sera from Chullwon area positively reacted with locally isolated L. icterhemorrhagiae lai and 17.1% of sera from Yangoo area with locally isollated L. canicola. In Chullwon area, 65% of the serum samples were identified belonging to 3 serovars, L. icterohemorrhagiae lai (32.4%), L. canicola (14.7%), and L. ictervhemorrhagiae copenhageni (17.6%). In Yangoo area, 54% of the scrum samples were positive for 4 serovars, L. icterohemorrhagiae lai (14.6%), L. hebdomadis (12.2%), L. icterohemorrhagiae copenhageni (9.8%) and above mentioned local isolate. 4) among 92 patients with high fever 19 cases (20.2%) were confirmed to be leptospiral infection by the both tests for bacterial isolation and serology. Sixteen cases (16%) were the suspicious cases of leptospirosis. The rest of them, 60 patients (63.8%) were found to be uninfected with the bacteria. 5) When the seasonal changes of incidence of the feverrile disease were comparatively analyzed, the cases belonged to confirmed as leptospirosis occured maily in Autumn whereas the others occured throughout the year except the spring in which time a slight decreased cases were recorded. The incidence of the confirmed cases were higher in groups which had been exposed to field trainings. Sore throat, runny nose, hematemesis, and muscle pain were found to be significantly frequent signs complained by the confirmed cases and diastolic blood pressure of the cases was higher. 6) amomg the confirmed cases only 5.3% of them were primarily diagnosed as leptospirosis and majority were diagnosed as fever with unknown reason (47.3%) when they were adimitted because of the high fever. Whereas among the cases confirmed as uninfected 25% was fever with unknown reason and 46.7% for the others. The proportion of cases diagnosed as leptospirosis was 5.0%.; Summary

Current occurrence status of febrile hemorrhagic syndrome complex in Korea: Joung Soon Kim; Korean J Epidemiol. 1986;8(2):183-188.

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A study on the genetic effect of cadmium on mouse: Hai Won Chung, Jong Kyu Kim, Joung Soon Kim; Korean J Epidemiol. 1986;8(2):260-268.

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This study was carried out in order to evaluate the genetic effect of cadmium on mouse by measuring rates of chromosome aberration and sperm abnormality. The study was done to explore the possibility of utilizing the measurements as an indicator or for the degree of exposure to environmental toxic pollutants. The results of the study summarized are as follows: 1) The frequency of chromosome aberration was increased as the dose of cadmium was increased 2) The frequency of sperm with abnormal head shape also was increased as the dose of cadmium was increased and the frequency of sperm abnormalities was higher in the group autopsized after 4 weeks from the cadmium I.P. injection than the group after 6 weeks 3) The sperm head count in cauda epididymides was decreased as the dose of cadmium was increased. And the density of sperm after 4 weeks from cadmium injection was lower than that after 6 weeks. Different susceptibility in different age of mice to cadmium was not observed for all doses of cadmium except 1mg / kg administered group. The sperm density for the mice given 1mg / kg cadmium injection was lower in 10-week-old mice than that in 32-week old mice. 4) The weight loss of tests was observed as the doses of cadmium was increased 5) Seminiferous necrosis and calcification were observed in the mice to which 3mg / kg and 5mg / kg cadmium were administered. 6) Therefore it was considered that the measurement of chromosome aberration and sperm abnormalities could be useful indicator in measuring genetic effect of environmental toxic pollutants.; Summary

A study on health impact of a river pollution neighboring industrialized big city on the rural people residing along the river: Joung Soon Kim, Seung Wook Lee, H.S Yoon, Y Heo, S.J Yang, T.W Ha, H.K Hong, Y.W Lee, H.H Kwon, D.H Lee, H.C Kim; Korean J Epidemiol. 1986;8(1):37-95.

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This study is conducted to identify any adverse health impact for the rural residents living along a certain river in Korea. The river actually accomodates all the industriral and domestic waste-water discharged from its neighboring big city. Unfortunately, the river is being served for farming water residents, while the current water cleaning system does not function satisfactorily. It means a possibility that the polluted water can contaminate underground water which is the main source of drinking water in the area. The aim of the study is to determine the contamination level of heavy metals and evaluate the health impact of the residents with a linkage to the river pollution. The study is proceeded under the following steps. 1) The area is divided into two parts where the water is used for the farming or not. They formed study and control area. For the residents within the sites, study and control groups were formed. 2) Between the two, any statistical significance was pursued for the following items, (1) the contamination levels by the metals in drinking water source, soil, farming products, farming products, and fishes which live in the water where the river joins the main river, (2) the contamination levels of rural residents, blood samples, and (3) by physicians the health evaluation results by clinical and pathological tests for the residents. 3) the correlation between the blood contamination levels and the health results, 4) the correlation between the blood and environmental pollution levels were studied. In spite of several limitations from the nature of the study, The findings were summarized as follows： 1) No statistical significance was found in the differences between the groups with regard to age, sex, occupation, economic status, education levels, pregnancy history, number of household members, and medical insurance status. 2) No statistical significance were found with regard to smoking habit, proportions of drinking, boiled water, number of days using pesticides and number of pregnancy poisoning, frequency of monthly meat intake. But a significance was found in the number of fish intake, while almost nobody took fishes from the river. 3) Most of the residents(93%) think the river is harmful to their health and 34% among them addressed that the river contamination is the cause of various dermatitis. 4) Stillbirth rate was significantly higher in the study group, but no correlation was found with the metal contamination. 5) The study group showed significantly higher complaints for 24 symptoms believed to appear with metal contamination, but no correlation was found. No correlation was found when the symptoms are grouped into 17 disease classification, either. 6) Neurological symptoms and clinical screening tests did not show any significant difference between the groups. Past disease history showed the same thing. 7) The results of diagnoses by physicians are classified into three groups from normal to abnormal. The control groups had higher proportion of the normal, but conjunctiva abnormaly, unspecified digestive ulcer, symptoms of abdomen and pelvic area, gasritis and duodenum inflammation were more frequent in the control group. Neurologic findings by a specialist did not show any difference. 8) The values of laboratory tests for hematopoietic system, kidney, and liver functions as indices of health measurements didn’t show any significance. 9) For the level of heavy metal contamination in blood, those of Cu, Cd, Pb but Zn were statistically higher than those determined by the National Envoronmental Protection Institute for the Yang-pyong-kun residents. For Pb, Zn, Ni at 0.1% and Hg at 5%, the values from the control groups was rather higher than those in the study group. However, at was seen that the level of Cd of the study group was higher than the control groups at 5%. They failed to show any consistent pattern, but the males has higher value than the females for Cd, Zn, Hg and lower value for Cu, Pb with statistical significance. 10) The proportions of residents above the permissible levels for the metal contamination were determined. The proportions for Pb and Zn showed that those for the control group were statistically higher than those for the study group. They were 42.3% for Pb and 6.3% for Zn, respectively, in the control group. For the case group, they were 19.3% for Pb and 4.6% for Mn, respectively. The proportions of residents who had abnormal level for more than 2 kinds of heavy meatals was 10.2% and for more than 3 kinds 0.8%. 11) The health evaluation results were linked with the classification of metal levels into the normal and abnormal groups. The abnormal group in Mn level seemed to have high proportion of lassitude, but its reliability was very low because of the sample size of 1. Also, the proportion of no symptoms was significantly higher in the group abnormally contaminated by Pb and Zn rather in the normal group. The clinical evaluation results showed that the Pb-and Zn-high groups had more frequently hearing difficulty, the Pb-high conjuntictiva problem, the Zn-high group neurotoxic disturbance and hearing difficulty. The neurological findings showed that inflammation, neurotoxic disturbance and hearing difficulty in the Mn-and Pb-high group, respectively. Also, various pathological tests did not show any significance. 12) The water quality was examined for the river and drinking water. The river seemed to be polluted by not heavy metal but various organic materials. This can be backed up by high levels of COD, BOD, and DO. The drinking water classified into underground water, well and simple-lined pump didn’t bear any significant difference from that in the control area and was believed to be generally appropriate for drinking. In the simple-lined pump and well water, the levels of Cu, Pb, and Ni were slightly higher than in the foot site river. It needs further attention to find Hg, As, Cr in the well water which did not exist in the river. 13) The sample of fishes to determine heavy metal contamination level was taken in the main river around the various sites where the river joins. While the site difference couldn’t be identified because of the fish morbidity, the levels were below being serious. However, the levels of Pb and Hg were slightly higher but not significant. 14) For the farmig product, nine crops sampled. The levels of Pb and Zn were significantly higher in brown rice, corns, garlics, while the others were below the permissible level. This results are consistent with the residents results But no significance were found when compared to the control area, while some metals show higher levels in the contral area. 15) The metal contaminatin levels in the soil of the study area were significantly higher for Pb, Zn and Mn. Although the Mn level in the residents blood is very low, the high levels for of Pb and Zn need attention beeanse they were also high in the crops. 16) The correlation between the soil and crops did not show any consistent pattern. However, in certain sites, the high correlations were found and suspected due to the confounding factors such as the regional nature of soil contamination, pesticides and fertilizer. 17) For the corelation between the blood and environmental contaminations, the levels of metals except Mn which showed the high levels in the soil and crops were also high in the blood. The relatively great portion of the residetns with high levels can cause serious health impact. However, the origin of their contamination seems to come from the soil not from the river. It deserves a further investigation on this matter.; Summary

HBsAg positive rate among Korean urban and rural middle school children: Joung Soon Kim, Moon Ho Chung, Seong Che Suh; Korean J Epidemiol. 1986;8(1):115-126.

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This study was carried out on about 25,000 Korean middle school children in 1984 in order to understand epidemiologic characteristics of HBsAg positive status as a part of study entitled “physical and intellectual development of Korean children in relation to family formation pattern”. The HBsAg was tested by modified immunodiffusion test. Summarized results are as following: 1) HBsAg positive rates in four different areas, namely urban well-to-do, urban slum, mountainous area, coastal area were significantly different each another, the coastal area being the highest (9.0% for male and 7.1% for female). 2) There was no statistical difference by age, 12-16 years of age, in the same area and sex, however, male children showed higher positive rates than female children in all areas. 3) The HBsAg positive rates were higher among the children whose father's professional status and mother's educational level were lower than those children with higher socioeconomic status. 4) The HBsAg positive rates were higher among the children who were from the larger family with higher crowding index, with more numerous siblings and with later birth orders than the children with fewer siblings and earlier birth orders.; Summary

An epidemiology study on nosocomial infection of an university hospital in Seoul: Sung Eun Lee, Joung Soon Kim; Korean J Epidemiol. 1986;8(1):147-173.

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Nosocomial infection has become a problem of public health in medical cost and health problem. We have no incidence rate data in Korean. So this study tries to survey epidemiological feature of nosocomial infection in a university hospital. From November 1985 to January 1986, this study was done. The result was as follows; 1) The incidence rate of nosocomial infection was 576.7 persons per 10,000 discharges. The incidence rate of nosocomial infection by type of infection was that urinary tract infection was 143.4 cases and respiratory infection was 117.2 cases and post operative wound infection was 84.8 cases per 10,000 discharges. In internal medicine, respiratory infection was 25.7% of total nosocomial infection. In general surgery, post operative wound infection was 24.1% of total nosocomial infection. The causal micro-organisms of nosocomial infection were Pseudomonas(16.1%), E. coli(13.7%), Staphylococcus(14.7%), Serratia(7.1%) and etc. The total resistance of micro-organism which caused nosocomial infection, was 62.4% for 13 types of antibiotics. 2) The risk factor of nosocomial infection was tested by comparison of two groups, with hospital infection and without hospital infection. The duration of hospitalization was appeared very significant risk factor of nosocomial infection (X2 = 211.6**). The medical diagnosis was also appeared a significant risk factor(X2=45.7**) and medical speciality leaded the same result(X2 = 95.3**). 3) The total time of surveillance for nosocomial infection was 4.75 hours per day in hospital of 1,200 beds. It was only time for chart review and microbiological finding. For manpower study, it is requested that time for patient visiting and miscellaneous time.; Summary

A study on leptospiral infection among healthy young men, a special group by leptospira isolation from blood culture in an endemic area of Korean hemorrhagic fever: Joung Soon Kim, H.K Chung, H.W Chung, S.S Lee, J.K Kim, W.Y Lee, H.K Byun; Korean J Epidemiol. 1986;8(1):174-181.

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This study was carried out on special groups consisted of homogeneous healthy and young Korean males stationed middle part of Korea, in order to understand the magnitude of subclinical leptospiral infection among these special groups and particularly the reationship between leptospirosis and Korean hemorrhagic fever that have shown similarity in many aspects. One hundred eighteen subjects from the well-known endemic area of KHF and 406 subjects from non-endemic area were interviewed for the information on their behavior and environments exposed for the last one month on weekly basis; all study subjects were blood drawn for leptospira isolation by culture in newly developed media, YUMC-5050. From the vicinity of stations studied 25 rats were captured alive, anesthesized with ether and autopsied. Lungs, liver and kidney were sectioned with a sharp scalpel and touch printed on slide glasses. These specimens were stained by IF techeique and examined for the presence of leptospiral bacteria. Summarized results of the study are as followings： 1) The overall leptospira culture positive rate was 2.8% that was much lower than that of Korean healthy rural farmers(16%). 2) Twelve out of 15 leptospira positives were followed up to 2 months by re-culturing their blood and found none of them remained positive. 3) Leptospira culture positive rate was 9 times higher among the groups stationed in KHF endemic area(9.3%) than those stationed in non-endemic area 4) The leptospira positive status did not have any statistical correlation with the variables such as the length of stay in current station, former residence area and educational level 5) The behavioral and environmental characteristics also failed to reveal any statistical association with the leptospiral positive status 6) Clinical symptoms and signs experienced during the last one month were more frequent and various among leptospira negatives than among positives 7) Nineteen Rattus norvegicus and Rattus rattus examined by organ touch printed specimens with IF technique showed leptospira positive in 24 rats, 96% positive rate; 22 rats had leptospira in all three organs, one in kidney and liver, and the other one only in kidney; Summary

On special edition for AIDS prevention strategy: Joung Soon Kim; Korean J Epidemiol. 1985;7(2):147-148.

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Principle of AIDS prevention: Joung Soon Kim; Korean J Epidemiol. 1985;7(2):177-182.

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Panel discussion : AIDS control: Il Soon Kim, Yong Ik Kim, Joung Soon Kim, Taik Sung Nam, Hak Kyun Shin, Yoon Ok Ahn, Won Ha Yoo, Won Young Lee, Jung Bock Lee; Korean J Epidemiol. 1985;7(2):187-191.

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A study on developing evaluative indices for assessment of communicable disease control activities of health agencies: Joung Soon Kim, H.S Shim, S.S Bae, D.K Oh; Korean J Epidemiol. 1985;7(2):228-239.

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Even though there had been a steady decrease of communicable diseases since the Korean war, the communicable disease control program is still a major public health problem among others in Korea. For recent several years the government has been awarding prize for the health center that was assessed to be an examplary institute in performance of communicable disease control activities, in order to facilitate the activity through mutual competition. This particular study was carried out to develop evaluative indices which should be valid and objective; the conventional way of assessing CDC activities of health centers has been subjected to a dispute among the eligible institutes for the prize due to deficient validity. This study consisted of three phase of data collection; preliminary study to obtain information necessary in formulating and planning the major study, in which all kind of health agencies including local public health laboratories, hospital and clinics and health centers were studied extensively to identify their roles in CDC program; and major study to develop evaluative indices; and the feasibility study on sampled health center directors to validate the validity and utility of the indices. The evluative indices developed by the researchers have been revised many times in accordance with the study results and the recommandation of the advisory committee. The finalized indices were evaluated by health center directors, who approved the indices being valid and appropriate. We decided to report this research results to share our valuable experience that relatively valid evaluative indices can be developed by stepwise exploration, even when there are few valid information available.; Summary

An epidemiological study on subclinical Leptospiral infection among rural Koreans by Leptospira isolation in blood culture: Joung Soon Kim, J.K Lee, H.W Chung, S.J Yang, H.S Lim, W.Y Lee; Korean J Epidemiol. 1985;7(2):253-258.

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A clinical syndrome complex that had been known as epidemic pulmonary hemorrhagic fever in Korea since 1975 has been proved to be leptospiral infection by Kim et al. in 1984. Even though hundreds of cases have been reported for the last 10 years, few information on the status of leptospiral infection among general population at risk is available. This study was carried out in a small rural community with 189 population in 41 household to estimate subclinical leptospiral infection rate. The study consisted of interview, medical examination by doctors, and blood sampling. The first study in which only 50 inhabitants completed the study on November 3rd, and the second one for the drop-outs on December 17th, 1985. The blood specimens were inoculated to a newly developed artificial media by Lee, YUMC-5050, which had been demonstrated to be quite sensitive, silver stained in two weeks of culture and examined under microscope for the characteristic leptospiral bacteria. Since leptospiral positives were found only among the first study group, probably due to the optimal timing for culture (November 3rd), but none of 40 specimens sampled in the second study was culture positive, the data analysis had to be depended upon the first study population. Among six positives re-cultured in the second study period, only one remained positive and five became negative within one and half month. The summarized findings are as followings： 1) Leptospira culture positive rate was 16% average; 23% for males and 11% for females. The cases were net clustered to any particular age group but rather even for all active ages. Protective immunity for older ages was not evidenced. 2) Clinical symptoms and signs experienced by the study subjects during the last one month were not significantly different in kind and frequency between leptospira positives and negatives except one case each for hematuria and lymphadenpathy in positive group. Two out of eight positives had mild clinical manifestation competible to leptospiral infection but six of them were typical of subclinical infection. 3) Enviromental factors exposed also were not different between leptospira culture positives and negative, probably owing to the fact that these farmers were exposed to all environments in multiplicity making it difficult to find out the difference for any environmental particulars.; Summary

A study on the status of reporting typhoid fever cases admitted: Yoon Goo Kim, Tae Wha Joung, Chul Song, Myung Won Lee, Joung Soon Kim, Dae Kyu Oh; Korean J Epidemiol. 1985;7(2):240-252.

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The objective of this study is to find out current status of reporting and managing one of the most important communicable diseases in Korea, typhoid fever, as well as identifying reasons of poor reporting in order to provide necessary information for an improved reporting system. This study was carried out on typhoid fever patients who had been admitted to hospitals located in Seoul during the year of 1984. On the reasons and problems associated with poor reporting, the medical staff, both regular and house staff, were surveyed through structured self-recording questionnaire with the help of hospital administration offices. Information on the hospitalized cases were collected from laboratory and medical records and reported cases from health centers. The summarized results are as followings: 1) The total number of typhoid fever cases reported to the health centers and city government was 403 patients of whom only 103 cases(26%) were bacteriologically confirmed by isolating S. typhi. Eighty percent of these patients were reported by hospitals. 2) On the other hand, the total number of confirmed cases identified in study hospitals were 489 patiens among whom only 16.4% had been reported to the health centers. The reporting rate varied widely ranging from 0% to 57% by medica institute regardless of type of the hospital. 3) The analysis of the patient group revealed that there were more females than males and 56% of the patients belonged to the 20~39 years age group. There was no difference in person characteristics between reported and non-reported cases. The number of cases occurred by month did not show much difference although there was a tendency of clustering more cases in winter season. 4) The average duration of the illness from the onset to the hospital admission was about 12 days and 63% of these patiens had received medical care of some sort before the admission. Also the average duration of hospitalization was about 12 days. The duration of admission was significantly longer for reported group when compared with that of non-reported group (p<0.001). 5) Follow-up care for the discharged patients was done only for a part of patients (54%), the worst the follow-up stool cultures for only 11% of the patients. 6) The major reasons for not reporting typhoid fever cases stated by the medical doctors were complicated and bothersome administrative process demanded by health center when they report a case(47%) and possibility of misdiagnosis(28%). The most of the medical staff, however, strongly showed their insight or sense of responsibility for reporting communicable diseases. 7) The necessity of nurse epidemiologist employed in hospital for control of hospital infection and reporting communicable diseases was recognized by 62% of the doctors, and 52% of them showed a strong intention to adopt the system. The larger the hospitals the more doctors agreeing the new system, the nurse epidemiologist.; Summary

A study on hepatitis B virus markers and formation of anti-HBs after hepatitis B vaccination in healthy Korean population: Young Sik Kim, Joung Soon Kim, Bong Yul Huh; Korean J Epidemiol. 1985;7(1):8-15.

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The positive rate of Hepatits B Virus markers and Anti-HBs formation after Hepatitis B-Vaccination were studied by RPHA or RIA technique in 1,015 (male 502, female 513) healthy Koreans, from May 1983 to April 1985 at the Department of Family Medicine, Seoul National University Hospital. And the following results were obtained; 1) The HBsAg was detected in 92 among 1,015 with positive rate of 9.0%. The positive rate of HBsAg was higher in male (11.8%) than in female (6.4%) 2) The positive rate of Anti-HBs was 27.7% (289/1,015) and difference between sexes was insignificant. 3) The positive rate of one or more markers among HBsAg, Anti-HBc, Anti-HBs was 57.6% (345/599). 4) The positive rate of HBeAg among HBsAg positives was 47.6% (20/42). 5) Elevated SGOT(>25 IU/L) or SGPT (>29 IU/l) was significantly higher in HBsAg positives (15.2%) than that of Anti-HBs positives (3.9%) and both negatives (2.6%). 6) The Anti-HBs became positive in 72.9% (70/96) of the vaccinated group and 7.7% (2/26) of the unvaccinated control group according to the 21-raonth follow-up test. 7) After 7.9 months follow up, the positive rate of HBsAg among initial HBsAg positives was 89.2% (33/37), and two cases of HBsAg positives developed acute viral hepatitis and improved, and the other two cases were revealed chronic hepatitis clinically.; Summary

An epidemiological study on HBsAg and anti-HBs prevalence in relation to liver function tests among farmers in Korea: Joung Soon Kim, Won Young Lee, S.W Lee, Hee Sup Yoon, Sook Ja Yang, D.H Lee, H.C. Kim; Korean J Epidemiol. 1985;7(1):16-27.

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This study was carried out in a rural area for the adult population older than 20 years of age to find out the prevalence of HBsAg and Anti-HBs among the population, and particularly the relationship between the presence of HBsAg and liver function tests during November 1984. Six hundred fourteen persons were interviewed according to structured questionnaire, examined by physician, and blood was drawn for the tests. For the detection of HBsAg and Anti-HBs Eliza method was used. The liver function test including SGOT, SGPT, alkaline phosphatase, total bilirubin and albumin was done in an university hospital laboratory of clinical pathology. The results summarized are as followings: 1. The prevalence rate of HBsAg positive was 13.0% and Anti-HBs positive was 43.6% among the population studied. The age adjusted positive rate by sex showed higher rate in males(14.6%) than females(12.7%) for HBsAg, whereas the positive rate was higher in females than males for anti-HBs although these differences by sex were not statistically significant (p〉0.05). 2. The age specific positive rate for both HBsAg and anti-HBs revealed peaks on 30~39 yrs. age group even though the Anti-HBs showed a slight increase for the age group older than 60 years. 3. The HBsAg positive rate was the highest (17.6%) among simple labourers accompanied by the highest positive rate of anti-HBs (58.8%) and then farmers, sales worker, clerical workers showed higher positive rate in order when the positive rates were compared by occupation. Also the lower socioeconomic class revealed higher positive rate. 4. The positive rates of both HBsAg and Anti-HBs were not different statistically between alcohol drinkers and non-drinkers, cigarette smokers and non-smokers, and the group with past history of liver disease and that without the history. 5. The HBsAg positive group when compared with HBsAg and Anti-HBs negative group showed 1.9 times more in family history of liver disease, 1.5 times in surgical operation, 1.4 times in blood transfusion. 6. The abnormal liver function test was found to be much more frequent among persons with past or present history of liver disease than those without; 84.2% versus 17.9%. By each item of the liver function test the HBsAg positive group had 1.6 times more abnormal value of bilirubin, 1.3 times of SGPT, and 1.2 times of SGPT than those who were negative for both HBsAg and Anti-HBs. The SGOT/SGPT ratio was not statistically different between two groups HBsAg positive and negative.; Summary

An outbreak of Legionellosis (Pontiac fever) in ICU of K hospital, Korea: Joung Soon Kim, Sung Woo Lee, Han Soup Shim, Dae Kyu Oh, Min Kee Cho, Hee Bok Oh, Je Hong Woo, Yun Sop Chong; Korean J Epidemiol. 1985;7(1):44-58.

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Early in the morning of July 21，1984 three ICU patients out of eleven died within three hours, and also several medical as well as nursing staff working in ICU of K hospital became seriously ill. The hospital has about 500 beds and located in the middle of Seoul City with good reputation. The hospital started remodeling of the building from the middle of July with an extensive ground excavation to bury cables, particularly around the ICU. The hospital is furnished with central heating/cooling system but for some reason there was a box air-conditioning attached to the window facing to outside where the ground excavation was going on. An epidemiological investigation was carried out from July 25, 1984 in order to identify the entity of the outbreak by the governmental epidemiology team although the hospital insistingly incriminated the deaths of the ICU patients to their serious conditions and clustered occurrence of the illness among the staff to influenza-like croup. The epidemiologic investigation consisted of interview and blood collection for the ICU staff, medical record reviews for the deceased, and environmental survey of the hospital including the ICU. Also an additional study was conducted following the initial study from which legionellosis was suspected as the cause of the outbreak; the interview survey was extended to the entire nursing staff of the hospital, medical record review to all ICU patients and specimen collections for the agent isolation such as water collection from tap water, cooling tower of the central cooling system and the box air-conditioning, and dust from the ICU and its vicinities. Unfortunately, however, any autopsy of the deceased was not performed because they had been hurried already when the investigation started; also the effort of the team to collect blood specimen for the serological test from the ICU patients discharged and the entire nursing staff interviewed failed due to hospital’s reluctance for the additional study. Therefore the investigation had to rely upon the interview survey on the whole nursing staff in identifying the focus of exposure to the legionella and the serological test results on ICU staff only. In order to confirm the peculiarity of the outbreak to that particular place, ICU of K hospital, the ICU nursing staff of S hospital located in Seoul were also interviewed and serologically tested. The results of the epidemiological investigation summarized are as followings: 1) The clinical and epidemiological characteristics of the illness that had occurred among the ICU staff were so typical that there was no alternative to consider but non-pneumonic legionellosis (pontiac fever). 2) There were 23 legionellosis patients diagnosed clinically among 26 hospital staff who had been exposed to the ICU environment more than two hours during 32 hour-period between 08 hour of July 19, 1984 and 24 hour of July 20, 1984 ; the attack rate was 88.5%. 3) In serological test by means of IFA test on paired sera against antigens of fourteen serogroups, 14 person’s sera out of 19 reacted positively only against the antigen of L. gormanii. Two out of 14 clinical legionellosis reacted negatively, and two persons out of five healthy staff exposed showed positive results. Accordingly inapparent infection rate among positives of the serological test was 14.3%. The infection rate based on result of serological test among those who were exposed to the ICU during the estimated duration of Legionella contamination and serologically tested (17 persons) was 94% ; one nurse whose serological test revealed negative had serious and typical feature of legionellosis clinically. 4) The most frequent symptoms of the non-pneumonic legionellosis among serologically confirmed cases were fever (100%), malaise (92%), chills (83%), headache (83%), generalized myalgia (83%), and anorexia (83%). The duration of the illness was 2~3 days in most of the cases. 5) The expired three patients in the early morning, July 21, 1984 with admission diagnosis of bleeding gastric ulcer, liver cirrhosis and acute myocardial infarction had abnormal chest X-ray findings; one with increased density on RLL and two with pulmonary edema before the death. Among seven survivals who had been exposed to the ICU environment during the risk period five patients had revealed abnormal chest X-ray, two of them with definite pneumonia. 6) The duration of exposure to the Legionella contaminated environment estimated from the association between the disease occurrence and the time of exposure was most likely from around midnight of July 19 to that of July 20, 1984. 7) The incubation period that was estimated from the duration of exposure and onset time of the illness ranged from 20 hours to 42 hours. 8) The clinical pathological laboratory results between serology positives and negatives revealed no difference except the CBC; electrolyte, liver and kidney functions were all within normal limits, however, about the half the confirmed cases showed leucocytosis with relative increase of segmented white cells and lymphocytes. 9) The interview survey on clinical manifestation of the illness for all nursing staff of the hospital showed prominant clustering at a point of time only for the ICU staff, which, implies the occurrence of the legionellosis was peculiar to the ICU within the hospital. The interview and serological survey on the same illness during the same period for the ICU nursing staff of S hospital located in Seoul as a control yielded negative results of serological test against the L. gormanii. One of ten nurses, however, showed 1 : 128 antibody titer to L. pncumophila serogroup 1 suggesting there had been sporadic legionella infection in Korea although this is the first report on legionellosis outbreak in Korea. 10) The effort to isolate the legionella organism from water and dust specimens collected in ICU itself and its vicinities was failed; probably well-planned experiment such as aerosol exposure of guinea pigs with water from box airconditioner and the soil extract from the ground excavated might have produced positive results. 11) It was inferred that the source of ICU contamination by the Legionella could have been the box airconditioner attached to the window outside of which an extensive ground excavation was going on to bury cables; L. gormanii had been aspirated to the airconditioner, multiplied in the water of airconditioner, and aerosol sprayed into the ICU.; Summary

An evaluation study on the Korean national tuberculosis control program by literature reviews: Joung Soon Kim, Gill Han Bai, In Sook Lee; Korean J Epidemiol. 1985;7(1):59-105.

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The Korean national tuberculosis control program reduced the prevalence rate of tuberculosis from 5.1% in 1965 to 2.5% in 1980, for which many people including the responsible policy makers tend to think the tuberculosis is no more health problem to deal with seriously, and there has been an argument whether the program should be continued futher or not. At this crucial point of time this study was carried out in an attempt to evaluate the tuberculosis control program in terms of effort, performance, adequacy of performance, efficiency and process by reviewing all the available literatures relevant to the control program, particularly the national tuberculosis prevalence survey data collected every five-year from the 1965. Despite the long term effort to control tuberculosis as a priority national intervention program tuberculosis is still major health problem in Korea; currently the deaths due to tuberculosis count about 15,000 per year ranking 4th among all causes of death and tuberculosis patients count about 852,000 when projected the prevalence rate 2.5% of 1980 to the total population. Moreover only 340,000 (40%) patients out of 850,000 estimated patients have been identified and under the treatment, and that among these identified patients less than half would complete the full course of the treatment until they become free from the disease. Thus in summary one fifth of the patients estimated achieved ultimate goal of the program. Taking the reduction trend of death and prevalence rate of tuberculosis during last 15 years into account, it may take around 20 years to reduce the prevalence rate to 1% or under 1% even when the control program in current scale goes on. From the results of the study it is concluded that reinforcement of the control program is indispensable, reinforced budgetary and legal input. Detailed data used for the evaluation are presented in tables and some strategies to increase the efficiency of the program are discussed.; Summary

A case-control study on the relationship between anemia and dietary factors among middle school children: Sug Yeong Lee, Joung Soon Kim; Korean J Epidemiol. 1985;7(1):106-124.

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This case-control study was carried out on anemia group (≤31% of Hct) and healthy control group (≥40% for male, ≥37% for female) selected from the middle school pupils in Korea as a part of the research “Physical and Mental Development of Korean Children in Relation to Family Formation Pattern” from march to July 1984. The objective of this study was to pursue risk factors of the anemia by estimating ∅(odds ratio), and by the dose-response relationship between major factors and ∅(estimated odds ratio), and by identifying the important variables through pear-son's correlation coefficient and multiple regression analysis on the variables which have been considered to effect on Hct value directly or indirectly. In this study, 47 pupils in case group were match with 94 students in control group. The matched variables were age, sex and school. The results summarized are as followings; 1) In comparison of two groups for the variables, such as the economic status, MB score, FD score, iron, vitamin A, thiamin, vitamin B12 and pantothenic acid, showed statistical significant difference, whereas the other variables revealed no difference between the case and control group. 2) Among the variables that showed statistical association with anemia, MB score, FD score, irno, protein, folate, vitamin B12, vitamin A also showed a significant dose-response relationship with the estimated relative risk ratio when the socioeconomic status was controlled. Therefore, anemia in this study group was largely due to iron-deficiency, folate and vitamin BI2 deficiency. 3) In addition, it was identified that iron was the most significant variable influencing Hct value directly, and food behavior and socioeconomic status influencing Hct value indirectly according to multiple regression analysis. —This study was partially supported by WHO, Special Programme of Research in Human Reproduction.—; Summary

On special edition for cause identification of epidemic pulmonary hemorrhagic fever: Joung Soon Kim; Korean J Epidemiol. 1984;6(1):1-1.

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A study on the validity of vasectomy status for both the husband vasectomized and his spouse: Joung Soon Kim, Yong Heo, Jin Soo Lee, I-cheng Chi; Korean J Epidemiol. 1984;6(1):54-61.

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The objective of this study is to validate the vasectomy status reported by both the husband vasectomized and his spouse prior to the main epidemiological study of cardiovascular diseases in Korean men with special concern for vasectomy as a risk factor of the disease. The study was carried out in Choonchun city and Chunseong county which have been served by the Community Health Program of Seoul National University for more than ten years. The records of vasectomy for the men living in these areas have been kept accurate by the local family planning association since 1972 providing an unique opportunity for this type of study. With assistance of the community health program staff, the list of vasectomized subjects including the address was obtained from the family planning association. The total number of eligibles were 512 in Choonchun city and 142 in Chunseong county. The principle of sample selection was based on the longer duration since the vasectomy among eligibles who were available for the interview. Fifty couples from Choonchun city and fifty couples from Chunseong county were selected for the study and matched by their neighborhood control couples for whom the husbands were not vasectomized. Starting from the December of 1983, ten MPH students, five male-female pairs visited these 200 couples home and interviewed. The husbands and wives were interviewed at the same time but separately by the same sex interviewer to avoid communication barrier between the interviewees and interviewers, and the bias that could occur due to opinion exchange between the husband and wife prior to the interview. The results obtained are as followings: 1. The mean age at the time of vasectomy was 34.4±5.0 years while the age at the time of interview was 42.9±5.9 years with about 8 years of duration from the vasectomy to the interview. The duration of marriage till the vasectomy was 8.8 years average 2. In reporting of vasectomy status, the sensitivity and the sensitivity were 0.99 and 1.0 respectively in both husbands and wives. Kappa, an index value of agreement between husband and wife on vasectomy status, was also 0.99. The agreement rate between the year recorded and the year stated on the year of vasectomy was 36.4% in husband and 31.0% in wife. The agreement rate, however, within two year difference between recorded and stated year of vasectomy was 79.2% in husband and 84.4% in wife. These agreement rates were lower than that of the year of marriage (p < 0.01) 3. In multiple regression analysis using the duration since the vasectomy recorded (A) as dependent variable and the duration stated (B), age (C), level of education (D) as independent variables, the coefficient of determination (R2) was the higher when they were transformed to natural logarithm. The regression models duration of vasectomy from the data provided by interview are as follows: LNA(husband) = -0.199+0.760LNB+0.144LNC+0.101LND :R2=0.57 LNA(wife) = 1.311+0.725LNB-0.203LNC :R2=0.54 The scatergram between the records duration and the estimated duration by the model fitted better than the duration stated, when 20 samples randomly selected from the data were tried. (This study was supported by the Family Health International, Research Triangle Park, N.C.); Summary

An epidemiological study of cerebrovascular disease through stroke registry and case-control study on risk factors in semi-urban and rural communities: Joung Soon Kim, M.H Chung, H.S Yoon, B.Y Heo, S.J Yang; Korean J Epidemiol. 1984;6(1):112-123.

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This study was carried out from November 1982 to October 1984 on Chuncheon City and Chunseong County where the population is about 210,000. The objective of the research was to study natural history of cerebrovascular diseases through stroke registry and to indentify risk factors of the disease by case control study in order to formulate strategy of stroke control program. Stroke registry was encouraged for the patients by distributing circulars to the community leaders, professional associations, hospitals, clinics and public doctors in addition to the propaganda through mass media. Also the responsible community nurse visited villages, hospitals and clinics to make the stroke patients registered. When stroke patients registered to the stroke clinic these patients were examined at the stroke clinic in every Tuesday and Thursday by utilizing postcard appoint system. At the same time they were interviewed and checked for height, weight, blood pressure, chest x-ray, electrocardiogram, and blood chemistry. For the case-control study on risk factors relatively new patients were selected and matched with their neighbor controls of the same sex and the similar age. Since the risk factors of stroke identified were found to be very similar to that of hypertension, other set of case-control study on hypertension risk factors was also carried out to examine confounding effects of these variables. Stroke management pattern, social problems encountered by the families with stroke patient, and activity index of the patients at three months after the onset and at the time of the study were also surveyed by interview. The results and conclusion obtained are as followings: 1) The total number of stroke patients registered were only 305 during the two-year study period. This number is estimated to be about 10% of patients existing in the communities according to the sample survey of one township within the study area. Thus the study on natural history of stroke was not able to be accomplished due to the lack of representativeness for the patients registered. The major reason of low registration was reported to be the difficulty of attending the clinic and that the registration was not accounted to be helpful for them by patients themselves and their family. 2) Among 154 cases who were subjected to the case-control study on the risk factors of cerebrovascular disease, about half of them were new patients and only a few cases were old cases over one year after the onset. Most patients(76%) were older than 50 years of age. Cerebral infacrtion was the predominant pathological type, and 13% of the patients had previous experience of stroke prior to this attack. At the time of onset 15% tof them had loss of consciousness, motor paralysis in 90% and speech disturbance in 63%. 3) Among the risk factors examined for the association with the stroke by case-control study, and analysed by paired marginal test(McNemar’s X2 test) and estimated relative risk ratio, hypertension, family history of stroke, overweight, duration of smoking, left ventricular hypertrophy, serum total cholesterol, and uric acid showed significant statistical association the hypertension revealing the most strong association. Stepwise multiple regression also showed the similar pattern. On the other hand when the hypertension was controlled, these variables did not show any association. Furthermore when the result of case-control study on risk factors of hypertension was compared with that of stroke by means of estimated relative risk ratio, the association strength of almost all variables in both stroke and hypertension was quite identical. Therefore it was concluded that other variables beside the hypertension were not causally associated but secondarily associated with the occurrence of cerebrovascular diseases by the intervened third factor, the hypertension; the hypertension was the most confirmatory risk factor of the cerebrovascular diseases among the variables examined. 4) Management pattern of the stroke patiens showed that only 20% of them was attended medically within the day of onset, among whom over 60% utilized Chinese medicine and 29% utilized modern medical facilities. The patients treated continuously comprised only 35% and the rest of the patients were either stopped treatment or treated intermittently. The functional ability measured by activity index showed that the proportion of the patients with high score(ability of self-care) was 28% at the three months from the onset but the proportion increased up to 68% at the time of the study. 5) The most serious social and family problem incurred by the stroke was economic difficulty due to the loss of job for the patients themselves, and the activity limitation of the family members to take care of the patient. Home visited nursing care system may be worth to intervene for a community based stroke control program. (This study was supported by WHO Research Grant); Summary

Case-control study on psychosexual impact of vasectomy: Yong Heo, Joung Soon Kim, Hee Sup Yoon, Sook Ja Yang, In Sook Lee; Korean J Epidemiol. 1984;6(1):124-136.

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The objective of this research is to study psychosexual impacts of vasectomy by means of case-control study in order to provide more valid information on the subject because most of the similar studies have been criticized as having various methodological defects. In this study one hundred vasectomized men and their wives were randomly selected from a rural and semi-urban communities and matched with non-vasectomized neighbors of the cases to achieve higher validity of the data by isolating the impacts of vasectomy from a set of other possible confounding variables such as age, socioeconomic status and occupation. The study was carried out from the December 1983 to the January 1984. The most cases were vasectomized during the period between 1972 and 1979 according to the record obtained from the local family planning association. The information were collected by interviewing husband and wife at the same time but separately to minimize bias that might occur from mutual communication prior to the interview. The summary of the results obtained are as followings: 1. General characteristics of the subjects studied 1) At the time of vasectomy the mean age was 34.4 years and the average number of children and son was 3.2 and 1.7 respectively. The mean duration of marriage till the vasectomy was 8.9 year. The average number of son at the time of the study was 1.7 for the case group contrast to 1.5 for the control group of which difference was statistically significant (p=0.035) although the total number of children was the same. 2) There was no difference between the case and control groups in the level of education and occupation. 3) The motivation of the sterilization stated by the cases of vasectomy was enough number of children and economic reason in 70.8%. The reason of selecting vasectomy among other contraceptive methods were the simplicity, low failure rate and less complication of the vasectomy in the majority of the cases (85.2%). 2. Psychosexual impacts of vasectomy 1) In psychosexual impacts classified into four categories, i.e. tiredness of sex, sxiness, frequency of coitus and sexual satisfaction, the proportion of husband reporting ‘No Change’ was significantly less at the time of interview than the time 2-3 years right after the vasectomy. On the other hand, in both sexiness and coitus frequency the proportion of husband reporting ‘Decreased’ were significantly higher at the time of interview than the time 2-3 years after the vasectomy. 2) Responses of husband and wife on the husband’s psychosexual change at the time of interview in case and control groups showed that the proportion of couples reporting ‘No Change’ was higher, and reporting 'Decreased' was lower in case group than in control group. Particularly the differences in the sexiness and frequency of coitus between the case and control groups were statistically significant (p=0.005) being decreased more in control group. 3) The proportion of husband reporting 'Decreased’ in sexual activities was positively in proportion to the age whereas the proportion reporting ‘No Change’ was negatively in proportion to the age for both case and control groups. 4) The agreement rate between the responses of husband and wife on the husband’s psychosexual change was low for both case and control couples (overall value of kappa=0.21-0.37).; Summary

Epidemiologic characteristics of the 1982 Japanese encephalitis epidemic occurred in Korea: Joung Soon Kim, In Sook Lee, Hyun Sool Lim, Chu Won Lee, Suk Woo Shin; Korean J Epidemiol. 1983;5(1):1-28.

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In 1982, about 2,000 cases of Japanese encephalitis have occurred despite the governmental effort such as the early warning of the increased vector mosquito density, vaccination campaign and other control measures. Japanese encephalitis had been endemic in Korea with small and large epidemics since the JE virus was isolated in 1949; The JE cases had been remarkably reduced to a few hundred cases since 1969 for over a decade, which increased suddely in 1982. In order to identify responsible factors of the epidemic, all reported cases and a part of hospital patients through medical record survey were analysed. Cases suspicious of encephalitis were reported to Ministry of Health and Social Affairs through, national administrative channel and the final confirmation of the disease was based on the HI antiboy titer of which criteria were set up by the government; it was defined as true encephalitis case when the antibody titer was over 1 : 160 and the subsequent tests stowed fourfold increase in case the first test less than 1 : 160. The hospital medical record survey was carried out on 54% of all reported cases. Summary of the study results is as followings: Among 2975 reported cases about 40% of them were confirmed to be true Japanese encephalitis, about 20% were confirmed to be negative serologically, and the rest of the cases reported never been re-test following the first tests that were negative. Accordingly if the same positive rate is applied for the unconfirmed cases, the total true cases of Japanese encephlaitis estimated to be 2,112 cases. When confirmed cases were compared with total reported cases in the date of onset, age and sex specific incidence rate, duration between the first medical attendence and the onset, duration of hospital admission and the type of medical facility utilized, the both groups showed the similar patterns so that it was unable to characterize them separately. Only with the confirmed cases of Japanese encephalitis the incidence rate of the disease was 3.1 per 100,000 population for whole Korean. The incidence rate varied by province from 2.0 in Gangweon to 7.1 in Chungbug Province; in the agricultural rural area the incidence rate was 3 times higher than in metropolitan area being the higher in South-western part of the country than Northeastern part. Also the disease started from the Southwest moving toward the Northeast which coincided with the time of vector mosquito density Peaks. The age specific incidence rates were higher among younger ages between 5 and 15 years and males 1.7 times higher than females. The majority(87%) of the patients had received medical attention within five days from the onset. The duration of hospital admission was 138.5 days. The case fatality rate was 3.3% being Higher among females, and younger children in females and older ages in males. Among total deaths about one third of death occurred within one week and 97% in two weeks. The sero-conversion for the specific antibody by the JE viral infection was found to be so slow that the serological test as the confirmatory evidence was inefficient; The positive conversion occurred in 46% of confirmed cases in one week and 78% in two weeks after the onset of the disease. The human epidemic of Japanese encephalitis showed association with the densities of pigs and vector population when data were comparatively analysed. The medical record survey in which 1692 cases out of 2,975 reported cases were included, showed that only 41% of them were confirmed as true Japanese encephalitis, 5% as non-encephalitis cases and 59% never had follow-up confirmatory test but negative in single serological test. The final diagnosis on discharge varied widely; Japanese encephalitis 32.6%, suspected Japanese encephalitis 6.6%, meningo-encephalitis 6.1%, viral encephalits 3.1%, encephalitis 23.6%, epidemic encephalitis 4.4%, and aseptic meningitis 5.5% which comprised 83% of total cases studied. Also the specific antibody positive rate varied by the final diagnosis ranging from 18% for aseptic meningitis to 62% for epidemic encephalitis. When these diseases were compared with each another in epidemiologic and clinical charateristics, they were very similar except meningo-encephalitis, viral encephalitis and aseptic meningitis that revealed a little differences in many aspects as presented in tables of text. This study was supported by Korean Institute of Population and Health.; Summary

An epidemiologic study of cerebrovascular diseases through stroke registry and case-control study on risk factors in semi-urban and rural communities of about 210,000 population, Korea (I): Joung Soon Kim, M.H Chung, H.S Yoon, I.S Chun, I.S. Lee, B.Y Huh; Korean J Epidemiol. 1983;5(1):55-66.

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This study was carried out in a semi-urban town, Chun-cheon City and a rural area, Chunseong County from November 1982 in order to understand natural history of cerebrovascular diseases and to identify risk factors of the disease occurring in the community. This is the intermediate report on the result obtained for one year period. During the period 205 patients were registered through adminstrative(Ban) and hospital channels. Among those 98 cases have occurred within one year from the time when the research started. These cases were throughly studied by interview, medical examination with chest x-ray, electrocardiogram, blood chemistry, and measurement of height and weight. Each case was matched with one’s neighbour of the same sex and ±3 years of age. These controls were also studied exactly the same as the cases. All the measurements were compared in patient-control pairs by Mc-Nemar’s marginal test. A cross-sectional study was also carried out on one township of the rural community which was followed by a case-control study of hypertension on risk factors; this cross-sectional study was intended to make base-line survey to get ready for a small scale cohort study on the risk factors of cerebrovascular diseases, to estimate registration rate of the cerebrovascular patients, and to differentiate the risk factors of cerebrovascular disease from the risk factors of cerebrovascular disease from the risk factors of hypertension. The matched cerebrovascular patient-control group was 58 pairs and hypertension patient-control group was 98 pairs for the analysis. Despite the small number examined, several factors showed statistically significant association; hypertention, mental stress, duration of cigarette smoking, left ventricular hypertrophy with cerebrovascular disease, hypertension being the most strongly associated. The most of the risk factors of cerebrovascular disease such as mental stress, left ventricular hypertrophy and family history also showed association with hypertension. However, over-weight and high serum triglycerides showed association with only hypertension, and the duration of cigarette smoking with only cerebrovascular disease. Thus the study result strongly suggests that the single most important risk factor of cerebrovascular disease is hypertension, and other factors that showed association with the cerebrovascular disease have operated indirectly through hypertension. A definite conclusion may be derived when the study is completed on the subject. This study was supported by China Medical Board and World Health Organization grant.; Summary

A literature review study on mental disorders in Korea: Soon Ja Cho, Joung Soon Kim; Korean J Epidemiol. 1983;5(1):118-139.

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The purpose of this literature review study was carried out to identify epidemiological characteristics of mental disorders occurring frequently among Koreans. It was intended mainly to deal with the prevalence of mental disorders, particularly schizophrenia, manic-depressive reaction, epilepsy, general paresis and a few other cases during the period from 1960 to 1979. In this literature review, all available paper and articles published were carefully reviewed. As a result, some salient features were found as the followings： 1. In 1960’s, the average prevalence of mental disorders was 4.2 persons per 1,000 inhabitants, whereas the average prevalence was 4.9 persons per 1,000 inhabitants in 1970’s. With regard to the prevalence of mental disorder by sexes, the prevalence rate of all mental disorders in male was much higher than the female except the case of schizophrenia, of which prevalence rate was higher than that of male throughout 1960's. On the other hand the prevalence rate in 1970’s was higher for males in all mental disorders for all ages. The modal age of onset of mental disorders was much younger than the modal age at the time of survey. Throughout 1960's and 1970’s, as many as 392 persons out of all the 515 schizophrenic suffered from the disease longer than 4 years. On the other hand, as many as 814 patients comprising 77.7% out of all the 1,047 mental disease patients suffered longer than 4 years from the conditions. The prevalence of mental disorders by educational level showed the tendency that the prevalence rate increased as the educational level became higher. With regard to the area characteristics the average prevalence rate of all mental disorders was 4.1 persons per 1,000 inhabitants in islands and 4.8 persons in the rural areas of the mainloud. The prevalence rate by religion was 5.7 persons per 1,000 persons for Buddhists, and 18.3 persons per 1,000 persons for both Catholic and Protestants. The result showed that the prevalence rate in the people with religion were as high as 8 times than those without religions. 2. Some characteristics of the patients on numerator analysis obstained from the literature were as followings: As many as 167 persons out of the 354 patients were found to have the pre-morbid personality. Almost all of the cases of schizophrenic comprising 55.0%, manic-depressive reaction patients comprising 79.6%, epilepsy patients comprising 38.8% had the tendency of having premorbid personality. With regard to the body-type of the patients, nearly 48.3% out of all the schizophrenics had asthentic types whereas others had diverse body-type unabling to characterize. About one third of the patients had family history of mental disorders. With regard to the marital status, 34.6% of the patients had been leading normal marital life and 46.1% out of all the patients had not been married, while the beleaved and separated patients comprised 10.7%. On the treatment status, 105 persons out of 203 patients never been treated. Only 33 patients(13.6%) made use of various medical facilities, while 38 persons (15.6%) made use of drug stores for medication. Those who relied on herb medicine were 56 patients(23.0%). Only 38 patients(7.1%) had been treated by psychiatric doctors. The frequency of treatement per patient treated was 1.6 times (Kumgu country only). 3. In addition to the community studies, following information was obtained from hospital statistics, SNU hospital and Yonsei University hospital. The proportion of neuropsychiatric patients hospitalized in SNU hospital out of all the inpatients comprised 9.5% during the period from 1964 to 1965, while in the case of outpatients the proportion decreased gradually from the highest 4.5% in 1970~1971 to the lowest 2.2% in 1980. The proportion of patients suffering from schizophrenia was 49.0% in 1968 and 1970, which was 38.8% in 1974. The proportion of those suffering from neurosis showed gradual increase from 16.1% in 1968 to 27.3% in 1971. Likewise the proportion of those suffering from manic-depressive reaction also increased from 3.2% in 1970 to 10.1% in 1975.; Summary

An epidemiologic investigation to identify source of infection in an epidemic of typhoid fever occurred in W city, 1983: Joung Soon Kim; Korean J Epidemiol. 1983;5(1):140-147.

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An epidemiological investigation was carried out in order to identify the source of infection in an epidemic of typhoid fever, which occurred from February 20 and ended by March 11, 1983 in Wcity of Korea, with population about 140,000. The analysis of confirmed cases and sample survey on the groups of patient’s family and healthy family led the conclusion that the source of infection was the tap water supplied by the second water plant, which supplies 90% of the water for the city, based on the following findings: (1) The incidence rate per 10,000 population was as low as 8.7 involving all ages with the highest rate among children 5~9 years of age and relatively high occurrence among housewives, which is a typical characteristic of water-born epidemic of the disease. (2) The frequency distribution of the cases by the date of onset showed a single peak positively skewed, all cases occurred within the range of one incubation period suggesting one single exposure to the agent. (3) The geographical distribution of the cases showed a strong association with the water supply status from the second water supply plant. (4) The result of the sample survey on patient's family and healthy family showed difference only in source of drinking water; there was no difference between two groups in food markets they utilized and the foods they have eaten during the Lunar New Year Holiday, when was estimated to be the time of exposure. (5) Most of the cases surveyed by interview had a peculiar characteristics such as young children, housewives, and persons with habit enjoying raw water and foods, who all had vulnerability to the exposure and infection for low dose agent.; Summary

A study of epidemiologic transition in Korea: In Sook Lee, Joung Soon Kim; Korean J Epidemiol. 1982;4(1):52-89.

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Several changes have occured in patterns of health and disease during the process of national development; a process that is made up a complex network of social, economic, cultural, environmental, and health components. The pace, type and extent of these changes as well as of their determinants and consequences are described in terms of the theory of the epidemiologic transition by A.R.Omran. The theory of epidemiologic transition focuses on the complex changes in pattern of health and disease over time and the interactions between these patterns and their economic, demographic, and sociologic determinants. There can be little doubt that such a transition is still under way in less developed societies. Changes in patterns of disease and death that occur during the transition can be characterized as moving through three distinct phases: the Age of Pestilence and Famine, the Age of Receding Pandemics, and The Age of Degenerative and Man-Made Disease. Depending upon the pace of change and particulars of the transition in the modern era, three models of the epidemiologic transition can be delineated: the classical model, an accelerated model and the delayed model. This study was carried out in order to classify the Epidemiologic transitional period in Korea by analysing all available national statistics from the end of the Joseon Dynasty to the present. The result of the study summerized are as followings: 1. In social and economic profiles, the age of receding pandemics which is characterized by the early stage of industrialization and improved living standards as well as improved environmental stanitation fits into the period between 1940's and 1970's. This period may be devided into two periods, pre-war and post-war period at the boundary of 1955. 2. In demographic profiles, the age of receding pandemics coincided with the period (1940’s-1970’s), which is characterized by decreased mortality rate and progressively increasing population growth rate. 3. In Mortality & Diseases profiles, the age of receding pandemics also covers the same period, 1940’s-1970’s characterized by decreased mortality yet with occasional epidemics and famines. During the transition from infectious-disease to degenerative-disease predominance, the level of mortality for women that had been cosistantly higher than that of men was started to move to lower level. 4. In community health profiles, systemic health services were organized in 1955, however mordern nationwide comprehensive health programs were develoepd in 1977. 5. Epidemiologic transition in Korea took place with rapid industrialization, modernization, and urbanization accompanied by demographic changes as well as changes of disease patterns, the infectious diseases being replaced by the degenerative and mon-mode diseases in the causes of morbidity and mortality. The age of receding pandemics in this sense coincide the period between 1940’s and the middle of 1970's. The model of Korean epideniologic transition is certainly an accelerated model which took only 35 years or 40 years to accomplish the last age of the transition from the frist age.; Summary

A study on the research contents and application of epidemiologic concepts in the research papers entitled as "An epidemiologic study" published in Korea: Joung Soon Kim, Ju Bok Ko; Korean J Epidemiol. 1982;4(1):90-104.

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This study was carried out to identify the scope of epidemiologic studies and appropriate application of epidemiologic concepts in Korea by reviewing papers entitled as epidemiological study, which have been published in academic and professional journals from 1960 to the present. Even with the limitation of this study due to exclusion of all epidemiological studies that did not have the subject title and to the crude classification of epidemiologic concepts examined, the result may be valuable for the institutes of educating health personnel in further planning of epidemiology teaching/training. The results obtained are summarized as followings: 1. Total research papers with subject title as epidemiological study reviewed were 168 among which 55 papers were study of hospital data and 113 papers were community data. The distribution of the papers by the scope of the study showed that 18 percent of 168 papers was simple numerator analysis without control group, not belonging to epidemiologic study; about 20% out of 168, 25 papers from hospital data and 8 papers from epidemic study which were also the numerator analysis only, had some contents of natural history; in 113 community studies including 17 epidemic studies and 96 cross-sectional studies only 9 papers were incidence study and all 96 papers were prevalence study of decriptive nature. There was no single paper that dealt with more sophisticated research methods such as cohort study, case control study, intervention study, and even clinical trials. 2. The research papers based on hospital data expressed and interpreted relative frequency by various variables as incidence rate in 78% of 55 papers, explaining the variables as contributing or risk factors with probability concepts even without control group. Furthermore, the papers that the interpretation and conclusion derived from the data were justifiable were less than 40%.; Summary

A study on heterogeneity of chromosome and tumorigenicity in a mouse tumor cell line: Hai Won Chung, Joung Soon Kim, Won Young Lee; Korean J Epidemiol. 1982;4(1):158-174.

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The effects of culture conditions on the distribution of chromosome number in mouse Sarcoma 180 Y.S. cells were studied in respect to heterogeneity of their chromosome number and their tumorigenicity; four subpopulations separated by ficoll gradient centrifugation from in vivo cultured tumor cells demonstrated different tumorigenic properties and the hypotetraploid cells were found to be the most tumorigenic. The results summarized are as follows 1. The tumor cell populations were heterogeneous in their chromosome number and their tumorigenicity, and these heterogeneity could be changed by different culture conditions. The chromosome numbers of tumor cells cultured in vivo were varied from 15 to 140 with modal number of 110-120, while those cultured in vitro ranged from 60 to over 300 with modal number of 121-130. Frequency distribution of hypotetraploid cells in in vivo cultures was 22.3% whereas it was 2.4% in in vitro cultures. 2. When the tumor cells were cultured in vitro and inoculated into the peritoneum of mice, the frequency of cells with high chromosome number of more than 300 (15n) was increased from 1.2% to 8.6% and 33.1% as the passage number increased. Hypotetraploid cells were increased along with serial in vitro to in vivo passage. 3. Tumor producing ability in cells cultured in vitro was increased from 20% to 25% and 40% in accordance with serial in vivo passage thereafter. It is, therefore, suggested that altered characteristics of tumor cells cultured in vitro appeared to be reversed into their original properties by maintaining them in vivo. 4. When the tumor cells were separated by 10%, 15% and 20% ficoll concentration gradient, the highest relative frequency of hypotetraploid cells were found in 10% ficoll concentration. Fifty percent survival days of mice inoculated with these subpopulations were 25.3 days, 28.7 days and 29.4 days for each subpopulation separated by the concentration of 10%, 15% and 20% ficoll respectively. From the above results it is suggested that cells with high hypotetraploid among the heterogeneous tumor cell population appeared to be an important factor responsible for tumor producing ability.; Summary

A study of the effect of radiation on chromosome number and tumorigenicity in a mouse tumor cell line: Hai Won Chung, Joung Soon Kim, Won Young Lee; Korean J Epidemiol. 1982;4(1):175-188.

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The effects of radiation on the distribution of chromosome number in mouse Sarcoma 180 Y.S. cells were studied in respect to heterogeneity of their chromosome number and their tumorigenicity. The results summarized are as follows: 1. Modal chromosome number were shifted from 111-120 to 101-110 when the tumor cells were irradiated with 300 rad - 700 rad of γ-rays, which is in the range within the sublethal irradiation dose (700 rad). The overall distribution of chromosome number, however, was not much different from that of control ceils. Frequency distribution of hypofcetraploid cells decreased gradually by increased radiation dose, for example in control the proportion of hypotetraploid cells was 22.3% whereas the proportion decreased to 16.4% in 100 rad irradiation group, 14.5% in 200 rad, 14.8% in 300 rad, 12.9% in 500 rad, and 5.9% in 700 rad irradiation group. 2. The tumorigenicity measured by the fifty percent survival day of inoculated mice, was also reduced according to the increased radiation dose; fifty percent survival days of mice inoculated with irradiated tumor cells (104 cells/mouse) in vivo by probit analysis were 25.2, 27.2 and 30.8 days with rariation dose of 0, 300 and 700 rad respectively on day 1 after irradiation. Similar results were obtained on day 6 after irradiation and fifty percent survival days were 23.0, 27.3 and 29.8 days at 0, 300 and 700 rad respectively. Tumorigenicity of the cells was proportional to the dose of cells inoculated, but it was proportionally decreased to the radiation dose. Moreover these results were consistent with Sarcoma producing ability in syngenic mice and the DNA synthetic ability in irradiated tumor cells. Considering these findings in relation to the chromosome number of the tumor cells, the reduction of tumorigenicity by γ-radiation seems to be correlated with reduction of hypotetraploid cells. Meanwhile when tumor cells were cultured in vitro, the proportions of cells with more than 200 chromosomes were increased in accordance as the radiation dose increased; 14.3% in control, 18.4% in 500 rad and 23.6% in 700 rad irradiation group. 3. Proportions of hypotetraploid tumor cells cultured in vivo after in vivo irradiation with 700 rad were 5.4% and 6% on day 1 and 6 after irradiation respectively, and 12.7%, 10% and 9% according to serial vivo passage thereafter. On the other hand the proportions of cells with more than 200 chromosomes in in vitro cultures after in vitro irradiation with 700 rad were increased to 23.6% from 14.3% on day 2, which was then decreased to 11% on day 20 after irradiation. 4. It may be concluded that repeated sampling of tumor cells and follow-up studies are necessary during the entire clinical course from early stage of the disease in the same patient because cytogenetic feature of tumor ceil population varied all the time according to their varying culture conditions and irradiation. Furthermore the tumor cell study may be of great help in determination of the subsequent treatment method after radiotherapy and/or chemotherapy for an effective and efficient management of cancer patient.; Summary

A review study of cerebrovascular diseases in Korea: Won Hee Rhee, Joung Soon Kim; Korean J Epidemiol. 1981;3(1):1-22.

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Cerebrovascular diseases in Korea is an important health problem since mortality and mobidity have been increasing rapidly. Cerebrovascular diseases marked the 1st rank of cause specific death rate in 1979. The objective of this review study is to understand epidemiologic characteristics of this disease so as to provide necessary information for preventive measures. The results are summarized as followings: 1. The C.V.D became the 1st rank of death causes in 1979's from 3rd in 1953’s. 2. C.V.D specific death rate per 100,000 population was 19.6 for both sexs in 1958-1959 death certificate study, whereas it was 93.7 for both sexes in 1979 death certificate data. 3. The secular trends of C.V.D death rate showed gradual increase for all age groups. Specific death rate in male was higher than that in female. 4. Prevalence rate of stroke per 100,000 population was 193.7 in 1979 Seoul community study, whereas it was 159.7 in Kang-Wha county study. In Kang Whacounty incidence rate of stroke was 254, death rate 195 per 100,000, and fatality rate per year was 65.8%. 5. Most of the morbidity data were hospital materials analysed only numerators with out even control groups. Relative frequencies of pathologic types in C.V.D. were as follows: Cerebral Hemorrhage ranged from 31.0% to 70.2%, Cerebral Thrombosis 11.9%-46.0%, Subarachroidal Hemorrhage 4.1%-28.0%, Cerebral Embolism 1.6%-9.7%. 6. Sex ratio of C.V.D patient ranged from 0.9:1 to 2.3:1. 7. Major symptoms and signs at the time of onset were motor-paralysis, motor-paresis, headache, nausea & vomiting, dysarthria, and coma. 8. Abnormal findings of E.C.G among C.V.D patients ranged from 77.4% to 92.1%, above Grade II fundoscopic finding ranged 48.4%-74.6%, and bloody cerebrospinal fluid finding ranged 36.3%-59.4%. 9. Fatality rate of C.V.D by pathologic types during admission was : Cerebral Hemorrhage ranged from 18.8% to 73.2%, Cerebral Thrombosis ranged 3.9%-15.6%, Subarachnoidal Hemorrhage ranged 6.4%-50.0%, Cerebral Embolism 7.1%-75.0%. 10. Survival periods for fatal cases of C.V.D were 47.0% within 24hrs, 66.2% within 2-3 days and 90.3% within 1 week respectively. 11. Major contributing factors for occurrence of C.V.D studied by various workers were mental and physical stresses at the time of onset, and related to the presence of hypertension. Cerebrovascular accident was found to be the most frequent cause of death among hypertensive patients. 12. It was found that further necessary information for effective preventive measures will be; 1) mortality and morbidity based on population study 2) data on naturae history of C.V.D by well designed epidemiologic study 3) data from registration of C.V.D.; Summary

An household-interview survey of stroke on sampled Seoul population, Korea: Joung Soon Kim; Korean J Epidemiol. 1981;3(1):23-36.

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Mortality and morbidity due to stroke have shown a trend of increase in recent decades and became an important public health problem, being the major cause of death and disability. Despite the urgent necessity of control program for the stroke at national level, epidemiologic information on the stroke to establish efficient program are rarely available. This study was carried out during the September and October of 1979 on 14,423 house-holds(63,603 persons) of Seoul sampled randomly by Tong unit from five categories of socioeconomic stratification. The interview was conducted by trained health workers with structured questionnaires. The ultimate objective of the study was to collect information on prevalence, functional level of the disability, and management pattern of the stroke by selected variables. Because of the limited validity of the study method, interview survey, other research such as incidence, fatality ratio, risk factors, and natural history of stroke were reserved for another opportunity to study. The results obtained are as followings: 1. The point prevalence rates of the stroke per 100,000 population surveyed were 181.1 for male, 122.5 for female and 150.9 for both sexes. Age adjusted rates with 1975 Korean census population for comparison were 227.8 for male, 157.7 for female and 193.7 for both sexes, which were much higher than that of rural Korean, Kang Wha County. Age, Sex and socioeconomic class adjusted rate of stroke for the Seoul population was 201.1 per 100,000. 2. Age specific prevalence rates for both sexes showed a steep increase as age advanced after the age of 40 years; the increase was more prominent for females of 50’s age group. 3. Age adjusted prevalence rate of the stroke by socioeconomic class that was based on the proportion of households under medical assistance program in Tong unit were 209.7/100,000 for high class area residents (0-4.9% of households receiving medical assistance from the gov.), 174.1 for middle class (5.0-9.9%), and 185.4 for low class(over 10%). 4. Among the disability resulted from the stroke hemiplegia was the most frequent one being over half of the disability for both sexes；right side for males and left side for females were predominantly involved. Speech and visual disturbances were 16.5% and 15.5% respectively. Quadriplegia that was 14.7% appeared to be overnumerated for debilitated older ages. 5. Functional level of the patients classified by WHO group in terms of performance in activities of daily living and avocational and occupational activities showed that only 6.9% of the patients belonged to class I, no significant impairments, 27.6% to class II, mildly impaired, 46.0% to class III，moderately impaired, and 19.5% to class IV, severely impaired. 6. Among 87 out of 96 patients who could provide information on treatment at the onset of stroke, 13.8% of them were hospitalized, 19.6% attended out-patient clinic, 10.3% purchased drugs from drug stores, and 33.3% were treated by Chinese medicine mainly of acupuncture. 7. Twenty of 87 patients never been treated；the older the age and lower the socioeconomic status, the less treatment. Actively treated cases at the onset of the stroke seemed to have better results in terms of functional recovery.; Summary

An epidemiologic study of postoperative wound infections: Sung Chong Cho, Joung Soon Kim; Korean J Epidemiol. 1981;3(1):77-87.

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Postoperative wound infection has been frequent complications in surgical operations. The prevention of the infection in emergency and elective surgical wounds is the most important issue and problems for surgeons. The wound infection is still troublesome matter to surgeons despite the development of antiseptic technique and prophylaxis with antibiotics. Furthermore, the infection has become more serious problem in hospital practice throughout the country since antibiotic resistant bacteriae in hospital environment have increased. This study was carried out in order to understand epidemiologic characteristic of postoperative wound infections on cases of various surgical operation in a provincial hospital. All wounds were examined and followed up to about 7 days after operation by one surgeon. All purulent exudates of infected surgical wounds were cultured by swabbing the wound and then bacteriae were isolated. All specimens collected from nasal cavity, throat and skin of patients and surgical team members were also cultured for species identification. The results were matched with the bacterial species isolated from the surgical wound to assume source of the wound infection. The results obtained are as followings: 1. The overall wound infection rate was 10.5%, which was similar to other studies on postoperative wound infection reported. 2. The wound infection rate was about two times higher for the emergency operation than for the elective operation. 3. The wound infection rate by sex was similar and the rate is highest for the age group of 50’s among all age groups. 4. The wound infection by degree of contamination was 2.9% for clean operative wound, 12.4% for clean-contaminated operative wound, 22.4% for contaminated operative wound and 27.3% for dirty operative wound. 5. In the wound infection by preoperative hospitalization, it was found that the longer the duration of preoperative hospitalization, the more likely to develop wound infection. 6. In the wound infection by duration of operation the infection rate increased proportionately to the length of operation up to 3 hours, then slightly decreased thereafter. 7. By type of operation the infection rate varied; the operation of gastrointestinal tract revealed much higher infection rate due to fecal contamination compared with the clean operation such as thyroidectomy, herniorrhaphy or mastectomy. 8. Coagulase positive staphylococcus was most prevalent pathogen among bacterial species isolated from the infected wounds. 9. Bacteriological survey of surgical team members and patients to identify presumptive source of infection revealed that surgical team carried staphylococcus in 11.8%, streptococcus in 10.7%. The carrier rate was lower in scrub nurses and higher in patients among all subjects surveyed. 10. The most frequent suspected source of postoperative wound infection was surgical specimen, and 1.8% of the infection was from the skin of the patient himself. 11. The most prevalent bacterial species of airborne postoperative wound infection was coagulase positive staphylococcus. 12. The cleaning of operation room by using Ultraviolet ray, Helmet aspiration system, suction system or laminar air flow system and also surgical plastic drap may be used to reduce the wound infection.; Summary

Recommendations on efficient control measures of cholera to the government: Joung Soon Kim; Korean J Epidemiol. 1980;2(1):23-25.

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A review study on epidemiological characteristics of EI Tor cholera epidemics in Korea: Joung Ae Lee, Joung Soon Kim; Korean J Epidemiol. 1980;2(1):53-81.

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El Tor Cholera epidemics have been reported 5 times in Korea since 1963(1963, 1964, 1969, 1970 and 1980). In order to determine the epidemiological patterns of the disease, 91 research papers were reviewed. The results summerized are as follows: 1) The incidence rate and the mortality rates were higher in old age group than those of young age group. Those rates of males were higher than those of females. 2) The fatality rates in recent epidemics have been lower than those of old ones. 3) The range of epidemic periods was 1-3 months. All the reported epidemics were spread nation wide besides the epidemic of 1964. The routes of transmission of the epidemics were not confirmed 4) The average duration of illness was 3-4 days, and the average duration of excretion of El Tor Cholera Vibrio was 3.3-6 days. 5) The causative organism of all epidemics was El Tor in biotype and ogawa in serotype, but that of the epidemic of 1980 was Inada in serotype. 6) Many problems in control measures and management of communicable disease were identified and discussed. It is recommended that the government concered with health of the people should be prepared to better manage communicable disease effectively.; Summary

A study on the interaction of liver fluke infection and oral contraceptives in Korean women: Sang In Kim, Joung Soon Kim, Ung Ik Kim, Han Ik Cho; Korean J Epidemiol. 1980;2(1):97-110.

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A study of hypertension on medium-sized city population: Joo Young Kim, Joung Soon Kim, Young Woo Lee; Korean J Epidemiol. 1979;1(1):55-67.

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This study was conducted on an apartment resident older than 15 years of age inhabiting in a medium-sized city of Korea. The objective of the study was to measure prevalence hypertension and hypertensive heart disease, and to identify contributing factors relevant to the occurrence of hypertension. The apartment selected for the study consisted of 1,200 households with 3,333 residents oder then 15 years. The socioeconomic status is rather lower than the Korean average; the apartment was built aided by the Korean Government for this people who lost their houses and shelters around the railroad station-a slum-at the explosion accident in 1977. The population composition by age and sex was not much different from the Korean average though with much higher proportion of illiterates. Blood pressure was measured twice in spaced time and information necessary to identify risk factors were collected through household interview by trained nurses. The definitions of definite and borderline hypertension were based on WHO criteria, and the criteria for hypertensive heart disease was adopted from the US National Health Survey. Seventy percent of the eligible residents were checked for blood pressure and interviewed individually. Electrocardiogram and indirect chest x-ray, however, were taken only on about 40% of the eligible. The resulted summarize as following； 1. Mean systolic and diastolic blood pressures were higher among males than females with gradual increase as age advances for both sexes. 2. The prevalence of definite hypertension was 7.5% for males 8.0% for females, which also showed an increase with age；the prevalence of borderline hypertension was 16.0% for males and 7.1% for females. 3. The percent of hypertensive heart disease among the patients with definite hypertension was 35.8% for males and 41.7% for females. Among borderline hypertensive patients 5.9% only females had hypertensive heart disease. An estimated prevalence of hypertensive heart disease was 2.6% for males and 4.1% for females. 4. Relative body weight and family history of hypertension were most strongly associated with hypertension ; relative salt intake, cigarette smoking and alcohol drinking did not show definite association. 5. Among patients with definite hypertension 63.2% were diagnosed as hypertension by medical doctors of whom only 38.5% have been on treatment. Thirty nine patients out of 78 treated stayed in definite hypertension, 18 patients became borderline hypertension, and only 6 patients to the level of normotension.; Summary

Hypertensive diseases among rural adults: Joung Soon Kim; Korean J Epidemiol. 1979;1(1):69-75.

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This study was carried out in 1976 on rural adult population older than 15 years. The study population was randomly sampled by village unit, in which 9.2% of the total households and 9.3% of the total population was included. The population studied consisted of 663 males and 813 females comprising 45% of the population sampled. Following the individual interview by household visit, each individual was examined by medical doctor at the temporary local clinic furnished with simple laboratory tests. Some sophisticated laboratory tests and cases who needed further diagnostic study were refered to hospitals. Criteria for hypertension and hypertensive heart disease were based on WHO criteria and U.S. Health Survey criteria. Blood pressure was measured twice for each individual, the first by a trained nurse and the second by examining doctor, and averaged. Measurements of height and weight to compute relative body weight were done by trained nurses at the tield. The result s obtained are as following： 1. The mean systolic blood pressure was 127±8.4 mmHg for males and 123.1±17.5 mrmHg for females, and it increased with advancing ages ; for example the mean systolic blood pressure for 15-19 years was 120±11.4 mmHg compared with 140.3±25.3 mmHg for the group older than 70 years in males. The increase of the mean blood pressure was the most abrupt at age 50 years . 2. The mean diastolic blood pressure was 82.4±11.7 mmHg for males and 80.7±11.4 mmHg for females with slow and gradual increase in accordance with the advancing ages. 3. The prevalences of definite and borderline hypertension were 7.7% and 9.5% for males whereas they were 6.5% and 8.1% for females respectively. As was in the case of mean systolic blood pressure, the prevalence of definite hypertension showed abrupt increase at age 50 years for both sexes. 4. The prevalence of hypertensive heart disease among the study population was 2.1%, the proportion of hypertensive heart disease was 3.9% and 25.0% among borderline hypertensives and definite hypertension patients respectively. 5. Frequency and distribution of other diseases except the hypertensive heart disease did not show much difference between normotensives and hypertensives. 6. Among suspected contributing factors to the hypertension analysed, the association of hypertension with relative body weight appeared to be the most strong. Also when age was controlled to 45 years and the above, alcohol drinkers had significantly higher risk of hypertension than non-drinkers. 7. The multiple correlation coefficient on relationship between the variation of blood pressure and some selected variables, i.e., age, socioeconomic status, relative body weight, and degree of cigarette smoking, was 0.305 being able to explain the relationship only in 9.3% for systolic blood pressure and 6% for diastolic blood pressure by these tour variables.; Summary

Leptospira interrogans "Korea" isolated from patients with epidemic pulmonary hemorrhagic fever: Won Young Lee, Bong Ki Lee, Joo Deuk Kim, Joung Soon Kim, Sang Ok Kim; Korean J Epidemiol. ;6(1):36-46.

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Eight strains of Leptospira were isolated from patients with epidemic pulmonary hemorrhagic fever and natural rice field water samples. Sera from 23 out of 35 patients were strongly reacted with the isolated bacteria by slide agglutination test, immunofluorescent test and ELISA test. The major reacting immunoglobulins were IgM and IgG in the sera. All of the strains were equally pathogenic for guinea pig and mice, which were confirmed by pathology, immune-pathology and bacterial analysis of the sacrificed and dead animals with febrile symptom following the bacterial inoculation. The representative pathologic feature was massive hemorrhage due to diapedesis in the lung and intracellular existence of the bacterial antigens in liver and kidney, which were equally fluorescent positive for IgM, IgA, IgG and C3. The characteristics of the bacteria examined by pathogenicity, morphology and some of cultural behavior in artificial media were matched with Leptospira interrogans. Three strains electron microscope and the bacteria were found to be tightly coiled and the helix handedness was counter clock-wise (left). It is generally accepted that pathogenic spiral bacteria reported up to date are coiled clockwise (right). Therefore, it was concluded that the bacteria isolated from the patients via animal inoculation were the responsible agent for the human infection. They can be characterized as Leptospira interrogans according to pathogenicity, cultural behavior except the fact that their left handed coil. Thus, the bacteria were tentatively named as Leptospira "Korea”.; Summary

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