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Epidemiologic Study for the Association between Phenol Contaminated Drinking Water and Poor Pregnancy Outcomes in Taegu City.
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Jung Han Park, Ju Young Lee
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Korean J Epidemiol. 2000;22(1):20-31.
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Abstract
From 14 to 17 March 1991 the Nakdong River which is a major source of drinking water for Taegu was contaminated with phenol that was spilled out of a factory in Gumi industrial park. Many people who drank the contaminated water complained of various symptoms and were apprehensive of possible adverse effect to the fetus.
This study was conducted to examine the effect of drinking water contaminated with phenol on pregnancy outcome in Taegu. All of livebirths and stillbriths delivered in the 5 General Hospitals in Taegu during 1 year from 1 April 1991 were included for this study. For this duration, total number of babies delivered in the 5 General Hospitals was 21,196. Among them, 77.7%(16,468) were delivered from women living in Taegu and it accounted for 47.5% of 34,688 livbirths registered in Taegu during the same period. The babies born to the women living in Taegu were divided into phenol-exposed and unexposed groups. Exposed group was the residents of the area where contaminated water was supplied and they accounted for 81.4% of the women included for this study. Unexposed group was the residents of the area where drinking water was not contaminated with phenol and they accounted for 18.6% of the study subjects. Data were abstracted from the hospital records. All the rates were adjusted for the maternal age and parity by direct method.
The abortion rates for the exposed group was 1.7 per 1,000 abortions and livebirths and 1.6 for the unexposed group.
The stillbirth rate for the exposed group was 10.5 per 1,000 livebirths and stillbirths 20 weeks of gestation and 9.5 for unexposed group. The early neonatal death rate(within the 1st week after birth) for the exposed group was 7.8 per 1,000 livebirths and 5.4 for the unexposed group. The perinatal death rate for the exposed group was higher as 14.1 per 1,000 livebirths and stillbirths 28 weeks of gestation than 10.8 for the unexposed group. The proportions of intrauterine growth retardation(IUGR) were 2.7% for the exposed group and 3.3% for the unexposed group. Congenital anomaly incidence rates per 1,000 livebirths was 7.4 for the exposed group and 8.4 for the unexposed group. The low birthweight incidence rate for the exposed group was 6.6% and 6.5% for the unexposed group. These differences between two groups were not statistically significant. The premature birth rate(< 37 completed gestational week) was 6.0% for the exposed group and 4.8% for the unexposed group and the difference was statistically significant(p<0.05).
Monthly variation of these indices did not show any clue that suggested concurrent change with the phenol contamination of the drinking water.
There were no sufficient evidence that could support the hypothesis of adverse effects of phenol contaminated water on pregnancy outcome, such as abortion, stillbirth, premature birth, IUGR, congenital anomalies and early neonatal death.
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An Epidemiologic Investigation of Typhoid Fever Outbreak in 0hchun Middle and High Schools Located in Young-il Gun Kyungpook Province.
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Jung Han Park, Ju Young Lee, Do Young Lee
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Korean J Epidemiol. 1995;17(1):94-104.
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An epidemiologic investigation was conducted to identify the source of infection and the mode of transmission of typhoid fever outbreak occurred in Ohchun middle and high schools located in Young il Gun, Kyungpook Province from May 21 to Jun 4, 1994. Four out of 13 hospitalized students in three general hospitals in Pohang City were culture positive typhoid fever (Salmonella typhi Group D). Review of the in and outpatient logbooks of the three general hospitals in Pohang City, county health center and local clinics in the vicinity of the Ohchun middle and high schools suggested that the outbreak was confined to the schools. Drinking water source of the schools was two underground water pumps that had no treatment facilities; one in northern end and the other in southern end of the main school building.
However, the southern water pump was closed on April 28, 1994 because a recent test for the water revealed E-coli suggesting a possible fecal contamination. Two hundred twenty students stated that they had experienced symptoms related to typhoid fever since April l, 1994 in a self administered questionaire survey of all of the 2, 226 students. Personal interviews with these 220 students were performed to confirm the clinical history together with a rectal swab culture for typhoid fever and Widal test. A total of 39 patients were detected; 15 confirmed cases (culture-positive) and 24 suspected cases (symptom positive with equal to or greater than 1:160 titer of Salmonella O-antibody or 1:320 titer of H-antibody titer in Widal test). The epidemic curve showed a unimodal curve with a peak on the second week(17 May, 1994) and tailed down to the 5th week (22 28 May, 1994). The overall incidence rate of typhoid fever was 1.8 per 100 students; 1.5 (1.6 for male, 1.5 for female) in the middle school and 2. 4 (6. 2 for male, 0. 4 for female) in the high school. When contrasted with the students who did not drink water at all in the school, the relative risks of incidence rate of typhoid fever for the students who drank the underground water of the school, both underground water and water brought from home, or water brought from home only were 55.5, 19.0, and 3.0 respectively. Three classes which had especially high incidence rates of typhoid fever were located in the southern part of the main school building, where the contaminated underground water pump is located. These findings suggested that the source of infection was the contaminated underground water of the school. Both of the two underground water pumps were closed permanently and the public running water was supplied to the schools.
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A Case-Control Study of Risk Factors for Hemorrhagic Fever with Renal Syndrome in Korean Soldiers.
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Jung Han Park, Min Hae Yeh, Yeon Ja Hwang, Kenneth E Dixon
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Korean J Epidemiol. 1994;16(1):41-53.
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A case-control study was conducted to identify the specific risk fatctors for hemorrhagic fever with renal syndrome(HFRS) in Korean soldiers. The case group consisted of 196 confirmed HFRS patients who were admitted to the Capital Armed Forces General Hospital between I November 1989 and 15 January 1992 and were 25 years old or younger.
The control group consisted of 258 non-HFRS patients who were admitted to the same hospital and meeting following conditions; onset of symptom was within five days before or after the onset date of case, had regular military activities up to the onset of symptom, and no noticeable signs for the diagnosis. Most of the cases and controls came from the units located in Kyonggi province (61.7% of cases, 75.9% of controls) and Kangwon province (31.6% of cases, 15.5% of controls). The distribution of places where the cases and controls had moved into during 60 days period prior to admission was similar to that of the base units.
Among 196 cases, 89.3% occurred in October through December and 46.9% in November. Significant risk factor was the field living condition. The odds ratio (OR) for sleeping in a tent vs not sleeping in a tent during 60 days period prior to admission was 1.55 (95% CI=1.07-2.25) and that for sleeping on the bare ground or in a vehicle was 3. 63 (95% CI=1.48-8.86). Other statistically significant risk factors were advanced tac tical training (OR=1.51, 95% CI=1.02-2.24), drinking surface water (OR=1.83, 95% CI=1.21-2.77), exposure to indoor dust (OR=1.58, 95% CI=1.05-2. 37), fixing trench (OR=1.63, 95% CI=1.12-2.37) and having seen Apodemus in the outdoors (OR=4. 61, 95% CI=2.12-10.02). Most of these risk factors were related with camping (field living condition) and thus the interaction between each risk factor and camping was examined by cross tabulation. None of the ORs for five risk factors was statistically significant for the cases who had no camping.
However all of the ORs for the cases who had camping were increased and statistically significant ;2.27 for advanced tactical training, 2.64 for drinking surface water, 2.14 for exposure to indoor dust, 2.91 for fixing trench, and 7.58 for having seen Apodemus in outdoors. It was revealed in this study that the highest risk factor for HFRS is camping in the area where the Apodemus inhabits.
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A survey on prevalence of smoking and knowledge and attitude towardsmoking in female industrial workers.
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Soon Ok Choi, Jung Han Park
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Korean J Epidemiol. 1991;13(2):146-158.
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To define the prevalence of smokers among the female industrial workers and their knowledge and attitude toward smoking, a self-administered questionnaire survey was conducted on 1,478 female workers of six electric and textile manufacturing industries in Gumi Industrial Complex in May-June, 1990.
Of the 1,388 workers who completed the questionnaire. 7.3% was current smokers and 4.5% was exsmokers. The prevalence of smoker increased with age. The prevalence of smoker was higher in the married workers than in the single women, in the workers living with their family than in those at the domitory, and in the primary school or college graduates than in the middle or high school graduates. Such differential prevalence rates, however, was attributed to the increased prevalence of smokers with age.
Regarding the health effect of smoking, 91.7% of the non-smokers answered that it is harmful while 54.4% of the current smokers answered so. About three quarters of the respondents regarded the nicotine harmful but most of them answered that tar, carbonmonoxide, and other chemical materials are not harmful. Eighty percent of the respondents acknowledged the harmful effects of smoking on the respiratory disease but only about 30% acknowledged the harmful effects on the gastric and duodenal ulcer, heart disease and liver disease.
The percentage of the respondents who believed that the smoking lowers the brain function was 85.5% among the non-smokers and 63.4% among the smokers. The percentage of the respondents who approved the harmful effect of passive smoking was 96.2% among the non-smokers and 85.1% among the smokers. Also 94.3% of the non-smokers approved the fact that smoking during the pregnancy is very harmful to fetus and 70.3% of the smokers approved the fact.
One quarter of the current smokers have had education for anti-smoking and 60% of the women who had anti-smoking education strongly supported the necessity of such education. Among all the study subjects, 62.5% wanted to make the smokers stop smoking through anti-smoking education, 17.1% wanted to arrange smoking rooms, and 13.6% wanted to prohibit smoking at the workplaces.
Such findings as many of the respondents had no accurate knowledge about the health effects of smoking and many of them demanded the anti-smoking education suggest that the anti-smoking education program is needed for the working women.
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Effect of anti-smoking education on knowledge, attitude and behavior of cigarette smoking of enlisted men
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Young Sook Shim, Jung Han Park
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Korean J Epidemiol. 1988;10(2):210-218.
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To test the effect of anti-smoking education on knowledge, attitude and behavior of cigarette smokers, a pre-test questionnaire was administered to all of 192 enlisted men of two army units in the vicinity of Taegu in December, 1986. After the pre-test, anti-smoking education that composed of slide show for one hour in the first day and video-tape for one hour in the next day was done for 97 enlisted men in one unit (experimental group) while 95 enlisted men of the other unit (control group) were left alone. A post-test questionnaire was administered to all of the enlisted men of both units four weeks after the pre-test.
The percentage of correct answers to the questions pertaining to the health effect of smoking in the pre-test was 54.8% for the experimental group and 56.6% for the control group. There was no significant correlation between the level of knowledge of smoking and the education level of enlisted men. The percentage of correct answers in the post-test (the same questionnaire as the pre-test) was 78.2% for the experimental group which was a significant change and it was 56.4% for the control group.
After the anti-smoking education, 12.5% of the men who smoked 10 cigarettes or less per day and 15.4% of the men who smoked 11-20 cigarettes had stopped smoking but none of the men who smoked over 21 cigarettes stopped smoking. Besides, 50.0% of smokers of 10 cigarettes or less per day, 72.3% of smokers of 11-20 cigarettes and 87.6% of smokers of 21 cigarettes had reduced the number of cigarettes they smoked. Changes in the amount of smoking after anti-smoking education had no relationship with the education level and knowledge of smoking of the enlisted men but a significantly higher percentage of th men who had an intention or will to stop smoking had stopped smoking or reduced smoking amount than those who had no such intention or will.
However, two-thirds of the men who had no intention or will to stop smoking had either stopped smoking or reduced smoking amount after the anti-smoking education. Major reason for stop smoking was the increased concern about the health hazards of cigarettes smoking.
These findings indicate that a short anti-smoking education stimulates the smokers to stop smoking or reduce smoking amount significantly and the change of smoking behavior is not much related with the knowledge of smokings, educational level and duration of smoking but related with number of cigarettes smoked per day and intention or will to stop smoking, thus, anti-smoking education should focus on motivating the smokers to stop smoking.
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