Epidemiology and Health

Brucellosis: An Overview.: Hyun Sul Lim, Young Goo Song, Han Sang Yoo, Mi Yeoun Park, Jong Wan Kim; Korean J Epidemiol. 2005;27(1):26-36.

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Brucellosis is zoonotic disease of worldwide distribution and still remains endemic in some developing countries. The main pathogenic species worldwide are B. abortus, responsible for bovine brucellosis, B. melitensis. The B. abortus is most common in Korea. Each Brucella spp. has a preferred natural host that serves as a reservoir of infection. The incubation period varies between 5 and 60 days, and Brucella infection may be asymptomatic or symptomatic. The majority of patients complained of fever (undulating fever), sweats, malaise, anorexia, and arthralgia. The diagnosis of brucellosis requires the isolation of Brucella from blood or body tissues, or the combination of suggestive clinical presentation and positive serology. There were first patients in 2002, thereafter 16 patients in 2003, and 47 patients in 2004, the human brucellosis are increasing more gradually in Korea. Brucellosis is an occupational risk for farmers, veterinarians, and abattoir workers. The main sources of Brucella are infected animals or their products, such as milk, blood, carcasses, and abortion products. Routes of transmission of the infection to humans include direct contact with infected animals and their secretions through cuts and abrasions in the skin, by way of infected aerosols inhaled or via the ingestion of unpasteurized dairy products. A combination of doxycycline and streptomycin has been used widely in brucellosis. Prevention of brucellosis in human still depends on the eradication or control of the disease in animal hosts, the exercise of hygienic precautions to limit exposure to infection through occupational activities and the effective heating of dairy products, and other potentially contaminated foods. Also, physicians and veterinarians must be concerned about specific environments and clinical patterns of brucellosis.; Summary

Anthrax: An Overview.: Hyun Sul Lim, Young Goo Song, Han Sang Yoo, Seong Won Keun, Jong Wan Kim; Korean J Epidemiol. 2005;27(1):12-25.

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Human anthrax has been a zoonotic disease affecting those who have close contact with animals or animal products contaminated with the spore-forming bacterium Bacillus anthracis. Now the incidence of anthrax in herbivores and human are rare, but it remains an important health problem in Korea because anthrax is seen as one of the most likely biological weapon. The B. anthracis forms a spore, which is resistant to drought, heat and numerous disinfectants, and the spore can remain viable and infective in the environment for decades. There are three major forms of human disease depending on how infection is contracted, cutaneous, inhalation and ingestion. Inhalational anthrax is the most common form, but the events in the Korea show that gastrointestinal anthrax is the most common. Several cases of anthrax have been reported in Korea. In recent years, 2 cases of bovine anthrax and 5 cases of human anthrax occurred in Changnyeong-gun, 2000, but it haven't occurred any more so far. The most useful microbiological test remains the standard blood culture. Confirmatory diagnostic tests such as polymerase chain reaction can also be used and may help in early diagnosis. Prompt clinical suspicion and rapid administration of effective antimicrobials are essential for treatment of anthrax. Ciprofloxacin or doxycycline should be used for initial intravenous therapy until antimicrobial susceptibility results are known. The best measure to eliminate human anthrax is control in domestic animals by effective surveillance and by immunization of animals in endemic areas. Also, the government must establish countplan for knowledge and rational policies in dealing with potential bioterrorism attacks.; Summary

Introduction of zoonses in Korea.: Seung churl Park, Byung Chul Chun, Ki Dong Park; Korean J Epidemiol. 2005;27(1):1-11.

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Many new human pathogens that have emerged or reemerged worldwide originated from animals or from products of animal origin. Many animal species as well as categories of agents have been involved in the emergence of diseases. Nearly all of these emergent disease episodes have involved zoonotic infectious agents; that is, they have involved the transmission of the etiologic agent to humans from an ongoing reservoir life cycle in animals or arthropods. Control of zooneses depends on attempts to reduce vector populations of limit contact with reservior species. But in most instances, the control efforts require environmental or human behavioral modification in addition to direct efforts at vector population reduction. We described the general ecological characteristics of zoonses and epidemiologic features of 7 important zoonoses in Korea-anthrax, brucellosis, rabies, E. coli O157 infection, japanese B encephalitis, bovine spongiform encephalitis and variant Creutzfelt-Jacob diseases, and high pathogenic avian influenza. We have made some suggestions in this article. First the network of medical field and veterinary field(including experts and governmental organization) should be systematically organized in zoonosis surveillance, epidemic investigation, outbreak control and so forth. Second, we should practically prepare the new emerging epidemics-including pandemic and bioterrorism in connection with zoonoses control. Third, we need ecological and epidemiological basic studies on zoonoses in Korea, and finally, the zoonoses control policy should be connected food safety.; Summary

Studies on the Association between Phenylpropanolamine (PPA) and Hemorrhagic Stroke in Other Countries.: Seung Mi Lee, Byung Woo Yoon, Byung Joo Park; Korean J Epidemiol. 2004;26(2):1-7.

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OBJECTIVES
Phenylpropanolamine (PPA) had been used widely as cold remedies or appetite suppressants. However, products containing PPA were withdrawn in sequence in the US, Japan, and Korea due to the increased risk of hemorrhagic stroke. The purpose of this paper was to review safety issues related with the PPA use and hemorrhagic stroke in view of pharmacoepidemiology and pharmacovigilance.
METHODS
AND MATERIALS: Researches conducted for evaluating the association between the PPA use and hemorrhagic stroke in other countries were reviewed, which involved case reports, case series, case-control studies, and cohort studies.
RESULTS
In terms of pharmacologic and clinical features, PPA may increase the risk of hemorrhagic stroke through increased blood pressure, heart rate, or vasculitis. The association between the PPA use and hemorrhagic stroke among young women was suggested by case reports from spontaneous adverse events reporting systems or medical journals. The cohort study, using the large prescription database in the US and published in 1984, failed to reveal the association in the population aged below 65. The case-control study conducted as the Yale Hemorrhagic Stroke Project, published in 2000, was the first study to find the association between the PPA as appetite suppressants and hemorrhagic stroke among women ages 18-49 years by well-designed analytic epidemiological research. It led to withdrawal of all products containing PPA in the US and many other countries since 2000. However, the association between PPA and cerebral hemorrhage could not be confirmed by the case-control study conducted in Mexico due to inappropriate recruitment of control group.
CONCLUSIONS
During several years case reports have suggested that hemorrhagic stroke could be induced by PPA, and the Yale Hemorrhagic Stroke Project revealed the association by case-control study and provided a useful model for pharmacovigilance. Nevertheless, their finding could not be applied to other population such as elderly women and male population. And they could not provide any evidence on the association between PPA and stroke when PPA was used as cold remedy taken daily dose below 100mg.; Summary

Status on Occurrence and Preventive Measures of Disasters in Korea.: Hyun Sul Lim; Korean J Epidemiol. 2003;25(2):47-61.

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Disasters are emergencies of a severity and magnitude resulting in deaths, injuries, illness and/or property damage that cannot be effectively managed by the application of routine procedures or resources. These events are caused by nature, the result of technological or manmade error. Natural disasters include typhoon, flood, heavy snowfall, drought, famine, and earthquake. Natural disasters are unpreventable and, for the most part, uncontrollable. Technological or manmade disasters include fire, nuclear accidents, bombings, and bioterrorism. The severity of damage caused by natural or technological disasters is affected by population density in disaster-prone areas, local building codes, community preparedness, and the use of public safety announcements and education on how to respond correctly at the first signs of danger. Recovery following a disaster varies according to the public's access to pertinent information, pre-existing conditions that increase or reduce vulnerability, prior experience with stressful situations, and availability of sufficient savings and insurance. Epidemiology can be used to investigate the public health and medical consequences of disasters. The aim of disaster epidemiology is to ascertain strategies for the prevention of both acute and chronic health events. Disaster epidemiology includes rapid needs assessment, disease control strategies, assessment of the availability and use of health services, surveillance systems for both descriptive and analytic investigations of disease and injury, and research on risk factors contributing to disease, injury, or death. With both disasters and the number of people affected by such events on the increase, the importance of disasters as a public health program is now widely recognized in Korea. The epidemiologists must do their best effort for prevention of disasters.; Summary

Bias related to Nutritional Epidemiology.: Won Chul Lee, Jin Hee Lee; Korean J Epidemiol. 2003;25(1):39-46.

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Bias is the main problem that should be considered in epidemiologic research. Information bias caused by measurement error and confounding caused by total energy intake are listed as the main biases in nutritional epidemiology and the concept, fact and the methods for adjusting effects of these biases are discussed. The biases which can be caused during the nutritional epidemiologic research process are listed and discussed. The pros and cons of the continuous data and categorical data of the nutrients and the ways how to categorize the data are reviewed. During the analysis of food and nutrient data, multiple comparison and publication bias are prone to be encountered, and these should be considered in interpretation of the results. Understanding of the biases will lead us to make valuable nutritional epidemiologic research and these lead the application of the research results to control the prevalent noncommunicable diseases.; Summary

Cancer Epidemiology and Prevention.: Keun Young Yoo, Hai Rim Shin; Korean J Epidemiol. 2003;25(1):1-15.

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Cancer is one of the main cause of death worldwide. There are about 10 million new cases every year, and more than 6 million persons will die of the disease in a year. Many factors are responsible for the recent increase in cancer. Changing lifestyles, in particular as regards tobacco smoking, alcohol drinking and diet, also play a crucial part. Several different types of scientific studies contribute to identifying the causes of human cancer. IARC's prestigious series of Monographs on the Evaluation of Carcinogenic Risks to Humans publishes authoritative reports on the risks posed by potentially carcinogenic agents and exposures. Most cancers are thought to be caused by factors related to lifestyle and environment. In particular, tobacco, chronic infections and diet are involved in a substantial number of new cancers. Tobacco is responsible for about 15% of all cancers throughout the world. Chronic infections with viruses, bacteria and parasites are responsible for 16% of all cancers. It has been hypothesized that 30% of all cancers could be prevented by appropriate diet and physical activity. Other known causes of cancer, such as occupational, genetic, and reproductive factors, plays a lesser role in the global burden of cancer. Many types of cancer seem to be cluster in families, occurring more often in close relatives of affected individuals. The risks that a person inheriting a defect in a person inheriting a defect in a cancer susceptibility gene will develop a certain type of cancer must be estimated, and the role of environmental factors in modifying these risks must be ascertains. Researches into the causes of cancer has revealed how many of the most common cancers can be prevented. Detection of many forms of the disease at an early stage can greatly improve the prospects for effective treatment, reducing deaths and enhancing quality of life.; Summary

Food, Nutrient, and the Risk of Breast Cancer.: Myung Hee Shin; Korean J Epidemiol. 2002;24(2):164-170.

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Nutrients are the primary dietary component that are of interest in studying the diet-disease relationships because they give us more direct biological mechanisms. However, exploring the associations of the foods or food groups with disease occurrence could also give us an important information in the causal relationships between diet and diseases. When there are no specific nutrient that was shown to be related to a disease, a relationship between a certain food and the disease could provide a new hypothesis for the responsible components. If an association exists with both the overall intake of a nutrient and more than one food source of that nutrient, it is more likely that the association is causal. On the other hand, foods with similar nutrient components could have different effects on our body due to a complex interaction between the nutrients within the food. Epidemiologists should employ both approach (nutrient and food) in order to have an unbiased assessment for the association between diet and diseases. We will take an example of a cohort study which looked at the association between dairy products, calcium, and vitamin D and the risk of breast cancer.; Summary

The Effects of Psychosocial Factors in the Stress Process.: Sei Jin Chang; Korean J Epidemiol. 2002;24(2):148-163.

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For the past three decades, considerable attentions have been paid to the search for stressors, stress outcomes and stress modifiers that may reduce the impact of exposure to environmental stressors. Especially medical sociologists and psychologists in medical parts, had an intellectual contribution to the development of stress research. They have presented an excellent opportunity to examine how deeply well-being is affected by the socially structured arrangements of people's lives and by the continuous experiences that result from these arrangements. The predominant concern has been with the role of coping resources, especially social support, coping and so on. The majority of studies report modest but significant positive association between life event levels and physical and mental symtomatology. In particular, the importance of considering psychosocial factors that may modify the effects of stressors on the risk factors for diseases or onset of illness has been emphasized increasingly. Clearly, stress is a complex process in which social, psychological and physiological environments simultaneously affect well-being. This study was performed to document the effect of psychosocial factors such social support, coping, personality traits which had been well known as stress modifiers in the stress process.; Summary

Relationship between Stress and Biomarkers.: Sang Baek Koh; Korean J Epidemiol. 2002;24(2):137-147.

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Stress can induce modifications in the central nervous(CNS), autonomic nervous and neuroendocrine system. Thus, the stress response has long been measured in laboratory experiments by biochemical changes in the hormone systems that are referred to as the sympathetic nervous system(SNS) and pituitary-adrenocortical axes(HPA). These axes react to acute stress or chronic stress. The activation of these two particular pathways result in elevated serum levels of catecholamines, cortisol, ACTH, dopamine, and others hormones. But there is considerable debate about the relevance of traditional laboratory stress findings to real-life situation. The neurobiology of stress is a key step to the understanding of stress-induced changes of immune functions. The immune system operates in communication with brain and endocrine system. Because of this extensive communication, the immune system can influence how we feel and behave. The stress are associated with endocrine and autonomic changes that can inhibit immune system function. The concept of neurocardiology renders plausible the various theoretical constructs of stress as they relate to circulatory vascular disease. Detailed reviews of the anatomic connections between the brain and the heart and of experimental and clinical data on the role of the CNS in cardiac dysfunction can be found elsewhere. In this study, we reviewed that stress was associated with cardiovascular disease mortality through the known cardiovascular risk factors(hypertension, heart rate variability, homocycteine, and clotting system).; Summary

Stress and Cardiovascular Disease.: Byung Yeol Chun; Korean J Epidemiol. 2002;24(2):131-136.

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Stress is a newly recognized risk factor that appears to contribute to all recognized mechanisms underlying cardiac events, specifically, by clustering of traditional cardiovascular risk factors, endothelial dysfunction, myocardial ischemia, plaque rupture, thrombosis, and malignant arrhythmia. And it is necessary to study on the role of stress in the causation of developing cardiovascular disease by a direct hormonal effect on heart or an indirect behavioral change. A better understanding of the behavioral and physiologic associations between psychological stress and cardiovascular disease will assist researchers in developing effective approaches for reducing or reversing the damaging effects of stress and may lead to further reductions of CVD morbidity and mortality in Korea.; Summary

Methods for Estimation of Nationwide Cancer Incidence from Population-based Cancer Registries .: Jong Myon Bae, Choong Won Lee, Duk Hee Lee, Yoon Ok Ahn; Korean J Epidemiol. 2002;24(1):1-6.

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While there has not been a nationwide cancer incidence data yet, it is necessary to consider a preferable method for estimation of nationwide cancer incidence under the cancer registry system in Korea. Some papers and texts related to estimate a nationwide cancer incidence were searched and reviewed. It could be summarized into 5 major methods: (1) for having only mortality data for all cancers, (2) of using major demographic factors, (3) of using nationwide mortality data, (4) of using nationwide mortality and survival data, and (5) of considering cancer risk factors. Among the methods, second method of using major demographic factors would be preferable in Korean situation; Summary

Is Breast Cancer Incidence Rate Further Increasing in Korea?.: Keun Young Yoo, Hai Rin Shin, Sue Kyung Park, Ha Chung Yoon, Ae Sun Shin, Dae Hee Kang, Dong Young Noh, Kuk Jin Choe; Korean J Epidemiol. 2001;23(2):1-7.

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Abstract: Abstract
Breast cancer ranks second to stomach cancer as a primary cancer site. An increasing trend in mortality and morbidity of breast cancet has been shown since 1980s. Studies on migrant populations, in which higher incidences were shown than population in their motherlands, indicated the importance of environmental factors on breast cancer development. Older age, family history of breast cancer, early menarche, late menopause, late full-term pregnancy, never-having had a breast-fed child, and postmenopausal obesity were idenrified as risk factors in Korea. These are not different from risk factors detected in western countries. Nevertheless, a ^-shape age-specific incidences surve is shown in Korea shose incidence is relatively low. In western countries, where incidence rates are high, the incidences increase with age in a straight line. This difference may be explained by the "Estrogen-Augmented-:rogesterone Hypothesis" that is relevant to sex hormones. In fact, a nuch lower estradiol levels was reported in Korean women compared to those in American. On the other hand, genetic polymorphism is expected for future research on breast cancer etiology. Only preventive strategies based on epidemiology of breast cancer in Korea may effective to counter this malignancy in Korean women.; Summary

Epidemiological Researches on the Health Hazards in Veterans of United States of America.: Hyun Sul Lim; Korean J Epidemiol. 2001;23(1):23-35.

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The Department of Veterans Affairs(VA) maintains some large automated databases that provide the opportunity for studying long-term health effects of military service. The Beneficiary Identification and Record Locator Subsystem(BIRLS) is an excellent source of vital status information on veterans. The VA Patient Treatment File(PTF) is a computerized hospital discharge abstract system of inpatient records, including patients' demographic data, surgical and procedural transactions, and patient movements and diagnosis. The computerized Agent Orange Registry data include veteran's name, address, some information on military service, and findings at the time of his physical examination. The US conducted 235 atmospheric nuclear tests from 1945 through 1962. Many of the 250,000 test participants were exposed to low levels of radiation. The overall average radiation dose was estimated as 0.6 rem per year. In 1976, a claim relating acute myelocytic leukemia to radiation exposure from nuclear weapon testing received extensive publicity. Several thousand "atomic veterans" have sought medical care and compensation from VA for medical conditions that they believe are related to the nuclear weapon testing. Many WWII veterans have contracted the US VA about health problems that they attribute to their exposure to mustard gas. From 1962 to 1971, 75 million liters of herbicides, including over 41 million liters of the phenoxy herbicide Agent Orange, were sprayed on almost 9% of Vietnam. Many studies have been conducted to determine the association of various cancers with military service in Vietnam. Some diseases have been compensated for Vietnam veterans. Health problems reported following the Gulf War include a wide variety of symptoms similar to those found in acute combat reaction, posttraumatic stress disorder, and chronic fatigue. Health problems associated with war have continued and in some ways intensified. Therefore, The United States developed a plan for establishing a national center for the study of war-related illnesses and post-deployment health issues.; 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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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

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