Epidemiology and Health

Volume 22 (2); December 2000

Original Articles

Development of Stress Measurement Tools in Korean Dental Laboratory Technicians.: Ji Hwan Kim, Won Chul Lee, Kang Sook Lee, Chul Lee, Kinam Jin; Korean J Epidemiol. 2000;22(2):171-171.

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Abstract PDF: Abstract
PURPOSE
This study was performed to develop a proper self-administered survey instrument which can be used to measure psychiatric stress symptoms in Korean dental laboratory technicians, and to investigate the relationship between the symptom dimensions and stress inducing factors, such as psychological distress, stress inducing overload, work demand, work procedure and so forth in them.
METHODS
Prepared questionnaires were mailed to 1,000 dental laboratory technicians who were systematically selected. There were 786 responses to the questionnaires. All the data obtained were analyzed with SAS program.
RESULTS
Fifty items for the stress symptom checklist for dental technician(SCLD) were selected after a pilot test, interviews and literature reviews. Stress symptoms were classified into the following 6 categories, i.e, somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, and hostility symptom. Factor analysis for validity was carried out for corroboration, using the SCL-90-R as a standard.
CONCLUSION
SCLD had the reasonable reliability and validity. We believe that this study provides validity and reliability for new self-report questionnaire, it will make a significant contribution to assessment of stress symptoms.; Summary

The Analysis of the Correlation of Diabetes Mellitus Incidence and Prevalence with Body Mass Index among Adults Registered in a Health Promotion Center of a University Hospital.: Sang Hoon Ahn, Jung Soon Kim; Korean J Epidemiol. 2000;22(2):159-170.

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Abstract PDF: Abstract
BACKGROUND
The prevalence and incidence of diabetes mellitus in Korea are higher than western countries. Despite the fact that obesity is an important risk factor of DM, western obesity criteria by BMI level has been used in Korea, which was based on the data derived from the western people having higher average body mass index(BMI) and lower DM incidence than Koreans. Therefore, this study was performed to find out the BMI level, at which point the risk of developing DM increases and its incidence per year.
METHODS
13,301 men and women who visited the Health Promotion Center at Seoul National University Hospital between March 1, 1995 and February 28, 1999 were studied. Factors attributable to DM including BMI were investigated. BMI was categorized in detail to find out the critical point of BMI with increased DM. The incidence of DM per year was investigated by analysing the cohort consisting of people who have visited the center more than once.
RESULTS
The risk factors of DM revealing significant statistical association were age, systolic blood pressure, total cholesterol, triglyceride and BMI. The age-sex adjusted odds ratio at BMI 24.0 was 1.950(95% CI 1.089~3.492) compared to the reference BMI(<21.0) when applying the current diagnostic criteria of DM(140mg/dl), and it was 1.635(95% CI 1.018~2.627) at BMI 22.0 by the new criteria of DM(126mg/dl). Crude incidence rate of DM was 0.9% by the current criteria and 2.1% by the new criteria.
CONCLUSIONS
Current WHO obesity criteria by BMI that we use in Korea should be readjusted(the criteria of overweight lowered from BMI 25.0 to 24.0, and obesity from 30.0 to 27.0 for Koreans), particularly in the aspect of prevention of DM for Korean people. Crude incidence rate of DM was 0.9%, much higher than that of western people, which calls for national concern on prevention and management of DM.; Summary

Epidemiologic Investigation of a Mumps Outbreak in a Middle School in Pohang, Korea: Effect of vaccination during outbreak.: Byung Chan Park, Hae Kwan Cheong, Hyun Sul Lim, Duck Soo Kim, Doohie Kim; Korean J Epidemiol. 2000;22(2):148-158.

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Abstract PDF: Abstract
BACKGROUND
There was a widespread outbreak of mumps at elementary and middle schools in Pohang city in March 1999. We have carried out an epidemiologic survey to trace the source and mode of transmission of the outbreak, as well as evaluating the effect of vaccination as a measure of controlling the outbreak.
METHODS
Questionnaire survey on 959 students showed that attack rate was 10.7%. There was no significant difference between genders in terms of attack rates. However, second graders outnumbered other groups as 16.9%, comparing to 8.1% among first graders and to 7.0% in the third graders.
RESULTS
Cases of mumps were reported in 1998, primarily in the neighboring elementary schools. The disease was also reported earlier in 1999, sporadically. In March, however, number of the cases was sharply on the rise as the middle schools opened for a new semester. Our investigation revealed that infection stemmed from more than three different sources, particularly in the classes of second graders, and then spread to all students, corresponding to the distance between students. Effect of vaccination during the outbreak was pretty good: attack rate of the group vaccinated since May 1st, considering the maximum latent period of infections (21 days), was 0.8%, comparing to 5%. The efficiency of vaccination marked 84.8%.(95% confidence interval 79.66-89.94) Although the authors recommended the students to wear flue masks and wash their hands as often as possible to screen infections among the students, it turned out that such measures had little effect for the prevention of spread.
CONCLUSIONS
The number of mumps cases dropped remarkably among vaccinated the students the prevalent period of the disease. Authors concluded that is effective to control the outbreak if it is done at early stage.; Summary

Survival Rate and Prognostic Factors of Cancer Patients Diagnosed in a University Hospital.: Un Je Park, Tae Yong Lee, Sug Gu Lee, Sun Young Kim; Korean J Epidemiol. 2000;22(2):136-147.

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Abstract PDF: Abstract
PURPOSE
This study was conducted to investigate case-fatality rates and survival rates, prognostic factors of prevalent five cancers(stomach, lung, liver, cervix, colon) in a university hospital located in Taejon City.
METHODS
2,158 cancer patients who have admitted the hospital from Jan. 1, 1991 to Dec. 31, 1998 were analysed. The higher ratio of outbreak and growing were selected among the investigated cancer data for over 100 of subjects in Korean cancer patient was examined into two method. The one is medical record and the other is affirm a government office for existence or not.
RESULTS
The lung cancer was discovered for the highest fatality rate. The crude 5-year survival rate of all cancer patients was 43.9% and that in male was higher than that in female. The 5-year survival rate of stomach cancer patients were 49.7%, that treated with combined(operation and chemotherapy) were 66.2%, that with metastasis to lymph node were 48.1%, and distant metastasis were 31.9%. Lung cancer patients were 25.9%, that treated with operation were 42.7%, and that with metastasis to lymph node were 29.3%. Hepatoma patients were 25.5%, that treated with operation were 37.8%. Uterine cervix cancer patients were 74.8%, that treated with operation were 95.0%, that with metastasis to lymph node were 83.3%, and distant metastasis 74.8%. Colon cancer patients were 41.8%, that treated with operation were 50.2%, that with metastasis to lymph node were 33.4%. Prognostic factors affecting survival rate among stomach cancer patients were age, operation, operation with cancer chemotherpy, and metastais to lymph node and distant matastasis. Prognostic factors of uterine cervix cancer was age, and that of colon cancer were operation with radiotherapy, metatasis to lymph node and distant metastasis.
CONCLUSION
case-fatality rate in male were higher than that in female, and increased with age. The cancer survival rate of female is high, the high in over 40 years group, and operation is exposed in the highest survival rate, also significant difference in metastasis level.; Summary

Actual Conditions and Pitfalls of Death Statistics Based on the Current Death Registration System in Korea.: Jin Ho Chun, Kyung Sook Lee; Korean J Epidemiol. 2000;22(2):124-135.

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Abstract PDF: Abstract
BACKGROUND
Death statistics is the most basic one among health-related statistics. This study was conducted to propose actual data to improve the quality of death statistics through a review of the contents of total registered death reports which are primary sources of death statistics.
METHODS
The author reviewed the recent regulations about the death registration and analyzed contents of the total 1,383 death certificates written out from January, 1998 to December, 1999 in a county of Kyungsangnamdo, Korea.
RESULTS
The two laws - the Family Registration Act and the Medical Act that mainly control death registration, and the two legal forms - death certificates and death report form that actually used were not accorded. This is a reason why there occurred frequent mistakes in the current death registration. Also, there was no way to correct the incomplete contents of death certificate primarily written by doctors. Among 1,383 death report cases, 83.9% of death was due to illness. The causes of the death were generally incredible; diverse expression even on the same disease, incorrect and inadequate expression, not standardized by standard classification of disease, and unwritten or 'unknown' especially in case of the intermediate underlying and underlying cause. The major place of death was home(67.8%) and medical facilities(22.3%). And, it considered that the welfare facilities should be added as one of the place of death. The proportion of the doctors' diagnosis for death was as high as 96.6%, however, the death certificates issued by a clinic had many problems in aspect of accuracy and completeness. In the time spent for the death report, 98.0% reported within the legal term of one month.
CONCLUSIONS
The authors propose the followings to improve the quality of death statistics. First of all, contents of the two laws should be unified. Secondly, concerns and professionalism of the personnel who deal with death registration are should be strengthened. Thirdly, the regular and reinforcing training for the doctors and the officials who issue the death certificates should be emphasized with consistent upgrade of the standard guidelines. Fourthly, the death reporting system should be qualified through the validation of the contents of the death report forms, i.e., checked by medical doctor or medical professionals in the Community Health Center in the process of the receipt, informing, and report.; Summary

Segregation Analysis of Serum LDL-cholesterol in Korean Families of Coronary Heart Disease Patients.: Jung Yong Park, Sun Ha Jee, Kyung Soon Song, Won Heum Shim, Soo Jeong Kim; Korean J Epidemiol. 2000;22(2):116-123.

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Abstract PDF: Abstract
PURPOSE
S: The aim of this study was to investigate the familial correlation of lipid profile and the mode of inheritance of LDL-cholesterol through segregation analysis. The study population included 414 family members of 67 Probands who had a coronary heart disease.
METHODS
Gene frequency(qH) of the allele for high LDL-cholesterol levels, means of each genotypes, and other putative gene related parameters were estimated. Maximum likelihood methods were used to fit several genetic and nongenetic modes of inheritance to these data to determine if an unobserved Mendelian major gene could explain the familial distribution of LDL-cholesterol. LDL-cholesterol levels were adjusted for age, gender, body mass index, smoking and alcohol consumption.
RESULTS
LDL-cholesterol levels revealed familial correlation among spouses, parent-offsprings and siblings with correlations of 0.10, 0.22, and 0.32, respectively. The heritability of LDL-cholesterol was 53%. Two models of inheritance in LDL-cholesterol distribution, the Mendelian codominant model and the polygenic equal transmission model were found. Comparison of these two models in each family among 67 families showed that thiry-six families favored the major gene model with Mendelian codominant and thirty-one families favored the polygenic model of equal transmission. In families favoring Mendelian codominant inheritance, means of each genotypes; LL, HL, HH were 102.1, 143.3, 248.4 mg/dl and gene frequency of H allele was 0.08. In families favoring equal transmission inheritance, means of each genotypes were 101.6, 122.7, 185.5 mg/dl and gene frequency of H allele was 0.14.
CONCLUSIONS
In conclusion, families of coronary heart disease patients of this study showed substantial familial correlation and results suggested that variation in LDL-cholesterol may be influenced by major gene effect.; Summary

A Forecasting Model for the Epidemic of Nationally Notifiable Communicable Diseases in Korea.: Yonggyu Park, Hyoung Ah Kim, Kyung Hwan Cho, Euichul Shin, Kwang Ho Meng; Korean J Epidemiol. 2000;22(2):108-115.

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PURPOSE
S: The authors derived two forecasting models which can be used as objective tools for detecting epidemics and predicting the future frequencies of communicable diseases.
METHODS
In this study, regression analysis using trigonometric functions, Box and Jenkins's seasonal ARIMA model were applied to the monthly accumulated data of five nationally notifiable communicable diseases from January 1987 to December 1998 in Korea.
RESULTS
Between two forecasting models, seasonal ARIMA model gives more precise predicted frequencies than regression model in the neighborhood of the current time points and future time, but the regression model is better in overall agreement between the predicted and observed frequencies during 7 years(1992-1998).
CONCLUSIONS
These forecasting models can be usefully applied in deciding and carrying out a national policy in preventing epidemics in the future, and graphic program is much helpful to understand the present status of disease occurrence.; Summary

An Epidemiologic Investigation of Shigella Sonnei Outbreak at a Primary School in Taegu city.: Byung Yeol Chun, Keon Yeop Kim, Ki Soo Park, Sang Won Lee, Young Joo Hur, Sun Hee Park, Ki Sang Kim, Sang Won Lee, Soon Ja Kim, Young Sook Hong; Korean J Epidemiol. 2000;22(2):101-107.

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Abstract PDF: Abstract
PURPOSE
S: This study was conducted to determine the source of infection and mode of transmission of the shigellosis outbreak on March 27, 1998 at a primary school in Taegu city.
METHODS
On-site interview using a standard questionnaire and rectal swab were conducted to 1,629 peoples who ate lunch on March 26 and 1,389 peoples who contacted with suspected cases. And bacteriological examination for 91 environmental materials and 25 food items were performed.
RESULTS
Of the 1,629 persons who ate lunch on March 26, seventy three had culture-confirmed S. sonnei infection(first attack rate: 4.5%). And additional fifty four had shigellosis among those 1,389 persons who might be exposed to the suspected cases(second attack rate: 3.9%). A total of 730 persons who complained one of four typical symptoms or more were treated as suspected cases(first attack rate of suspected cases: 44.8%). S. sonnei was never isolated from water, foods, and other environmental materials. The median incubation period was estimated about two days. The common symptom reported were diarrhea(88.7%), fever(73.4%), abdominal pain(54.7%), and vomiting episode(38.4%) in order. The shorter duration of the outbreak and the large proportion of cases involving students who ate lunch on March 26 are consistent with fecal-oral transmission, although the limited epidemiologic data obtainable do not clearly define the route of transmission.
CONCLUSIONS
Thus the outbreak reported here appear to be related to the unsanitary conditions of food facility in this school.; Summary

An Epidemiological Investigation of Bacterial Dysentery Outbreak in Busan(Pusan), 1999.: Hai Rim Shin, Duk Hee Lee, Heung Man Sul, Sang Won Lee, Young Ju Huh; Korean J Epidemiol. 2000;22(2):93-100.

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Abstract PDF: Abstract
BACKGROUND
In March 1999, six children who attended a nursery school became ill with acute gastroenteritis by Shigella sonnei. The majority of the children became sick one day after sharing a snack which was served from one of the children's home. By the time the outbreak of dysentery was recognized, the rest of family members of the children became also sick. The nursery school was located in a crowded residential area. EPIDEMIOLOGIC INVESTIGATION: After active and passive surveillance was established on patients with diarrhea, 438 patients were registered. Among them, 252 patients were considered to have simple diarrhea, but the rest (186 patients) suffered from more than three consecutive diarrheas. Shigella sonnei was isolated from 75 patients. The first attack rate was estimated at 50.0%, the second, 25.6%-34.3% and the third, 13.5%. The epidemic lasted for two months spreading further from person to person in the highly populous area. The active surveillance was implemented after the occurrence of the secondary attack of dysentery among the residents, who had no obvious direct contact with people associated with the nursery school.
CONCLUSION
This investigation demonstrates the need for prompt implementation of active surveillance when Shigella infection is recognized in a highly populous city.; Summary

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