Epidemiology and Health

Volume 10 (2); December 1988

Report

Public affairs reporting: Korean Society of Epidemiology; Korean J Epidemiol. 1988;10(2):299-301.

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List

List of membership: Korean Society of Epidemiology; Korean J Epidemiol. 1988;10(2):293-298.

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Article

Articles of association: Korean Society of Epidemiology; Korean J Epidemiol. 1988;10(2):292-292.

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Original Articles

Descriptive analysis of medical care utilization during the 24th Seoul Olympic Games: Myongsei Sohn, Seung Hum Yu, Eun Cheol Park, Chun Bae Kim, Young Doo Lee, Byung Ryun Cho, Un Hang Shin; Korean J Epidemiol. 1988;10(2):281-291.

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In order to sum up the cumulative quantity and ratio of practice delivered during the 24th Seoul Olympic Games to the participating athletes and officials, descriptive study was derived from the Olympic Health Management Information System(OHMIS) in the SLOOC. There were analyzed with the quantity of disease incidence and physician visit dividing by the total participating person. 1. The average physician visit per the participating athletes in Seoul amounted 0.49 was smaller than 0.75 at L.A. and 0.53 at Montreal, however, if A.T. service is considered the ratio, was about the same level with that of L.A. 2. Venue medical services utilization was much larger with amounted 72.4%, whereas village medical center’s utilization was smaller with 26.9%. The number of out-patient physician visit per hundred persons during 2 weeks period in venue clinic was 22.4 times and village medical center was 8.33 times and athletes, officials and others’ medical demand excluding spectators was 30.9 times. 3. The quantity of medical demand increased as the number of athletes and officials increased, however, the increase of utilization rate was not so significant. 4. The medical demand was calculated by continents respectively, and Africa, central and south America, middle east Asia proved to higher rate than more industrialized continent or region. 5. The Medical demand according to sports, event can be ranked from higher to lower in such order as arranged as follows: Yachting, Wrestling Tennis, and Soccor, etc. The medical demand according to international classification of disease-9, accident and injury ranked highest.; Summary

Medical care expenditure of hospitalized patients in general hospitals: Joung Soon Moon; Korean J Epidemiol. 1988;10(2):263-280.

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This study was conducted covering 504 patients discharged from 5 general hospitals in Seoul area from July to August, 1988, in order to estimate the medical care expenditures and to determine the factors affecting the expenditures. The results of the study were as follows: 1. The average medical care expenditure for a patient was estimated to 758,238.5won. The average direct and indirect medical care expenditure for a patient were 654,405.0won and 103,832.6won, respectively. The ratio of indirect medical care expenditure to direct expenditure was 0.34. 2. The average medical care expenditure for a patient of insurance was estimated to 641,572. 3won, their average direct and indirect medical care expenditure for a patient were 533,976.8won and 107,595.5won, respectively. The ratio of indirect medical care expenditure to direct expenditure was 0.38. 3. The average medical care expenditure for a patient of non-insurance was estimated to 1,575,935.6won, their average direct and indirect medical care expenditure for a patient were 1,489,929.0won and 86,006.6won, respectively. The ratio of indirect medical care expenditure to direct expenditure was 0.10. 4. From the multiple regression analysis on direct medical care expenditures of the total studied patients the following ten variables were statistically significant; indirect medical care expenditure, method of payment, having or not having surgical procedure and caretaker, position of chief physician, department of Internal Medicine, family income, disease Group I , patient’s marital status and age. The variables of indirect medical care expenditure, educational background, having or not having surgical procedure and caretaker, position of chief physician, size of room, and department of Internal Medicine were statistically significant in case of insurance patients, while the variables of length of stay, disease group II，size of room, indirect medical care expenditure, having or not having surgical procedure, department of General Surgery, and residence area were statistically significant in case of non-insurance patients. 5. From the multiple regression analysis on indirect medical care expenditures of the total studied patients the following seven variables were statistically significant; direct medical care expenditure, having or not having caretaker, method of payment, department of Chest-Plastic-Orthopedic & Neuro-Surgery, residence area length of stay, and patient’s sex. The variables of direct medical care expenditure, having or not having caretaker, length of stay, department of Chest-Plastic-Orthopedic & Neurosurgery, residence area, student group, and sex of patient were statistically significant in case of insurance patients, while the variables of direct medical care expenditure, residence area, having or not having caretaker, type of family, age and marital status of patient, and blue collar worker were statistically significant in case of non-insurance patients.; 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

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

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

Factors affecting the blood pressure in children: Jong Ku Park, Myung Keyn Lee, Sei Jin Chang, Bong Suk Cha; Korean J Epidemiol. 1988;10(2):239-245.

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Blood pressure of 1,306 school children aged 6 to 12 years has been measured in May to June 1988 at Wonsung county, Kangwon, Korea. The objectives of this study were to identify the distribution of blood pressure in school children, and the factors related to that. The general patterns of distributions of blood pressures were similar to that of other countries. However, the mean systolic and diastolic blood pressure by age were lower than that of U.S. children especially in the younger age groups. There is a progressive rise of blood pressure of approximately 2.0 mmHg systolic pressure and diastolic pressure per year of age for male and 2.4 mmHg systolic and 1.5 mmHg diastolic pressure for female. The older aged, the taller, the weightier, those with higher Kaup index, and females showed the higher systolic and diastolic blood pressures. In multiple regression analysis, 24.2% of the variation in systolic blood pressure was explained with weight, temperature, pulse rate, and measuring time and 16.8% of that in diastolic blood pressure was explained with weight, pulse rate, and age.; Summary

A seroepidemiologic study on scrub typhus in Koje island: Il Suh, Sang Nae Cho, Il Soon Kim, Young Joon Kim, Joon Yong Bang, Eun Cheol Park, Kyung Jong Lee, Ki Hong Jeun, Moon Shik Kim, Dae Kyu Oh; Korean J Epidemiol. 1988;10(2):230-238.

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In order to examine the past infection rate an incidence of Scrub typhus a seroepidemiologi study was performed in Koje County. Paired serums were collected from 518 residents in Sadeung and Koje myun. Serum were analyzed by ELISA for detection o IgG to R. tsutsugamushi, and were also analyzed by Microscopic Agglutination test for Leptospirosis. First serum were collected from Aug. 25 to Aug. 31, 1987 and second serum were collected from Jan. 13 to Jan 31, 1988. The result summarized as follows: 1. One hunderd seventy people(33.9%) had a experience of infection by R. tsutsugamushi： among 501 subjects. The past infection rate was significantly higher in female than that in male and it was increased according to age. By occupation farmers showed the highest infection rate. 2. The incidence rate of Scrub typhus was estimated 4.7%(19 people among 405 subjects) during the study period. The incidence rate was also significantly higher in female than that in male and 40-49 age group showed the highest incidence rate. 3. Two people(0.4%) were reacted to Microscopic Agglutnation test for Leptospirosis. Among 501 sujects and these two people were also reacted to ELISA for Scrub typhus.; Summary

A study on cigarette smoking of male students in middle and high school in Korea: Il Suh, Hae Sook Lee, Myongsei Sohn, Il Soon Kim, Dong Choun Shin, Young Yee Choi; Korean J Epidemiol. 1988;10(2):219-229.

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In order to examine the smoking rate, knowlege and attitude on smoking of male students attending middle and high school in Korea a study was performed at the period between July 11 and July 23, 1988. In each grade 10 classes were sampled and surveyed and the total number of respondents was 3,437. The results were as follows; 1. Proportion of current smoker among middle school students was less than 3%, but it was increased very rapidly among high school students. So proportion of smoker was 9.5%, 19.1% and 40.4% among first second and third grade students respectively. Proportion of ex-smoker was 16.9% among middle school students and 28.1% among high school students. Proportion of current smoker and ex-smoker were significantly higher among students in city than students in rural area. 2. Proportion of smoker and ex-smoker among students who had smoker in their family were significantly higher than those who had no smoker in their family. 3. Most frequent motivation to smoking was “from curiosity(40.0%)” among smokers in middle school and “to release stress(31.0%)” among smokers in high schools. 4. The proportion of smokers who smoke a cigarette regularly was 31.3% among smokers in middle school and 51.7% among smokers in high school. Sixty percent of smokers in middle school smoked less than 5 cigarettes per day and 76.0% of smokers in high school smoked less than 10 cigarettes per day. 5. Almost all respondents(99.1% in middle school, 98.8% in high school) knew about the harmful effect of cigarette smoking on health and cigarette smoking was regarded as undesirable behavior to 79.5% of middle school students and 49.3% of high school students. 6. Most smokers(63.3% in middle school, 73.8% in high school) wanted to quit smoking due to the harmful effect of cigarette smoking on health. So family factors were found to be significantly correlated with smoking students. A effective method to release stress and to quit smoking should to be suggested for students.; Summary

Effect of anti-smoking education on knowledge, attitude and behavior of cigarette smoking of enlisted men: Young Sook Shim, Jung Han Park; 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.; Summary

An epidemiological study on outbreaks of food poisoning in some industries: Yong Tae Yum, Dong Yun Seo; Korean J Epidemiol. 1988;10(2):204-209.

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Since the author was asked to be in charge of special epidemiological investigation on outbreaks of food poisoning among workers of 3 industries(A, B and C) in Goo-Mee industrial complex, a survey team had made an epidemiological study to confirm diagnosis, and to verify source of infection and course of transmission for 5 days in Oct. 1986. The summarized results were as follows; 1. A total of 130 cases(6.5%) out of 2,000 workers in A industry on 29 August, 41 cases(14.7%) out of 880 workers in B on 14 October, and 30 cases(1.6%) out of 1,900 workers in C on 15 October 1986 were admitted to S. Hospital in Goo-Mee industrial complex complaining of high fever, vomiting, nausea, chillness, abdominal pain, headach under the impression of food poisoning. 2. Microorganisms of Vibrio parahemolyticus were cultured from stools of 39(33.6%) cases among 116 sampled cases. 3. Case-control studies to detect source of infection revealed that brown seaweeds in A and green lavers(sea lettuces) in B and C industries were the sources showing odd ratios of 12.5 and 16.2 with P values of less than 0.001. 4. In industry A, heated brown seaweeds were contaminated again with organisms in sea water from original container, and in industry B and C, raw green lavers which were immersed in sea water were served only after salting and seasoning without boiling process. Vibrio parahemolyticus in sea water was the source of contamination.; Summary

Prevalence of coal workers' pneumoconiosis in Kangreung and Taeback areas: Kyung Yong Rhee, Ho Keun Chung; Korean J Epidemiol. 1988;10(2):195-203.

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Authors surveyed prevalence rate of coal workers’ pneumoconiosis in coal miners in Kangreung and Taeback areas. Because of difference of working conditions including concentration and composition of coal dust in workplace between two areas, difference of prevalence rate between two areas will be expected. Sample size was 2,913 coal miners; 161 coal miners(6.2% of total coal miners in Kangreung area) in Kangreung area, and 2,752 coal miners(11.1% of total coal miners in Taeback area), selected randomly according to coal mining company by size of workers. Data was collected by record of regular health screening test in 1986, and chest x-ray films of all study subjects were read by one radiologist to eliminated inter-observer variation. There is no difference of prevalence of coal workers’ pneumoconiosis between two areas, respectively 18.5% in Taeback, 18.6% in Kangreung(including suspicious case) in spite of difference of working conditions, characteristics of coal miners. And there was correlation between employing year, migration history and prevalence rate of coal workers’ pneumoconiosis: prevalence rate in longer employing coal miners was higher than that in shorter employing coal miners(under 1 year: 4.6%, 1-5 year: 7.2%, 5-10 years: 19.7%, 10 year and over: 43.9%), and that of migratory coal miners higher than that of non-migratory coal miners(non-migratory: 17.2%, migratory: 25%).; Summary

Evaluation of a community health services based on the basic health indicators: Seung Hyun Han, Kyung Hee Chung, Bang Sook; Korean J Epidemiol. 1988;10(2):174-194.

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This study attempted to measure the effects of a community health works conducted in Soyi and Wonnam townships in Eumseong County from August 1985 in terms of several health indicators. The community health works are primary consisted of (1) coaching PHC personnel to functionalize their work with emphasis on MCH, (2) organizing & training VHWs to link providers & consumbers, and (3) publishing a monthly village health newsletter. Data was collected through a baseline(or before) survey in July 1985 prior to the start and an after survey two years later. The study area was Soyi & Wonnam townships and the control area was Maingdong township. The survey population were 1,542 eligible women living in 3,787 households residing in the three townships for the baseline survey and 1,440 eligible women in 3,706 households for the after survey. The following is a summary of study results. First, there were no significant social, economic, and demographical differences by area at each survey, and there were no inter-area differences except for the tendency for decreased crude birth rate(from an average of 11.1 to 9.7) and increased mortality rate(from an average of 7.3 to 10.8) in all three areas. The three townships showed slight reduction in their total fertility rate(TFR) in each of Soyi, Wonnam, and Maingdong townships, slumped from 2.5 to 2.2(Soyi) and 2.3 to 2.0(Wonnam), and 3.0 to 2.4(Maingdong), respectively. Second, the family planning(FP) acceptance rate increased from 71% to 77% tubectomy accounting for over 50% in all three areas, and no significant inter-area differences. Third, in regard to the acceptance rate of maternal and child health(MCH) care, the prenatal care rate rose from 66.5% to 80.4% among women with pregnancy experiences over the last two years(before each survey), with Soyi showing a high utilization rate of 85.2% due to such efforts as an operation of the mobile prenatal clinic of the public health physicians(PHP) from the Maternal and Child Health Center(MCHC). The rate of women receiving prenatal care more than 3 times in this township also climbed to 40% from 61%, thus being relatively higher than other townships. In regard to the side of prenatal care, the Project area has a 30% utilization rate of the MCHC which is higher than the control area(6%). Accordingly, a rise in the MCHC utilization rate may be forecasted, should the Project be continued. The home delivery rate was lowered from the 48% of the before survey to the 23% of the after survey, showing a relatively apparent increase in the rate of institutional delivery. About 77% of the births in the Project area were delivered at institutions; 30% did so at the MCHC and about 43% at hospitals and clinics. In the control area, there were about 75% of deliveries at institutions; 24% at MCHC and 46% at hospitals & clinics, indicating no difference from the project area. The basic vaccination rate was over 90% in the project area but remained at 70% in the control township. There was also a tendency for the control area to lag behind in vaccination rates for hepatitis, M.M.R., and Japanese B encephalitis. Fourth, looking at utilization rate of the medical and health care institutions for their illness, there are no mainfested areal and periodical differences, but there were about 20% of people who perceived their disease yet unmet their needs(who feel they have a disease but do not treat it). Also there were an extremely poor utilization rate of the health subcenters(5 to 7%) where a young public health physician is assigned in lieu of Army services for 3 yrs. The results of this study have the following limitations in demonstrating the effects of the project. First, the time of the After survey was not the end of the project and so there was too early to assess the program input effects to be revealed. Second, because of the nature of the project which was not designed experimentally but primary to coach health personnel, there were no pre-determined of health indicators to be evaluated prior to the start, and it was difficult to set an appropriate health indicators to be evaluated. Third, the involvement of the surveyors in morbidity study varied in their training & skills, so that there were validity problems regarding morbidity items in both surveys. Fourth, changes in the social, economic, and cultural conditions and problems caused by health policies and health adminstration of the community could not be controlled. Nevertheless, a preliminary results shows that in the utilization of primary health care, there were significant effects on maternal and child health care works which represent personal health services(preventive aspects), but none whatsoever in the treatment aspects. This shows that programs which induce community participation, such as the organization and training of village health workers(VHW) and the publicaton of ''Village Health News”(newsletter), were fairly influential, but that the implementation of treatment functions did not take place. In other words, the problem points of this project were: First, primary health care institutions are functionally deficient in their ability to carry out their work, esp. primary care(clinical aspects). Second, there was the lack of organized systematic and technical linkages such as connections between public health institutions and private or secondary medical care institutions. Third, there were no particular support systems which could solve geographic and economic accessibility problems. And fourth, there were not sufficient health education program to improve their health & illness behaviour in the community. Consequently, should all such problems not be solved at a political(strategical) level, then(one would think that) it is hard to expect for the effectiveness primary health care works to achieve the goal of “Health for all by 2,000".; Summary

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