Epidemiology and Health

Volume 26 (2); December 2004

Original Articles

Incidence of complication and societal cost of measles in Korea, 2000.: Weon Young Lee, Moran Ki, Jin Kyoung Oh, Jong Koo Lee, Myung Bin Kim, Bo Youl Choi; Korean J Epidemiol. 2004;26(2):71-80.

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Abstract PDF: Abstract
OBJECTIVES
To estimate the complication rate and the societal cost of measles, a survey was conducted in Seoul, Jeonju city, and Kyonggi province in 2001.
METHODS
A telephone survey was conducted in Jeonju city (175/307) and four local areas of Kyonggi province (793/1,238) to gather information on the complications of measles. To estimate societal cost, the telephone survey was conducted for the sampled subject by complication type and the age group. The response rate was 78% (180/230). Paid bills were examined for direct cost estimation, and the time cost and the transportation expense were analyzed for indirect cost estimation.
RESULTS
The incidence of a complication of measles was 3.1% which found to be higher in younger age group. The incidence of pneumonia, otitis media, and encephalitis were 2.1%, 0.8%, and 0.2% respectively. Direct and indirect costs of in-patients without a complication were $417.00 (US $1.00 = 1,000 won) and $256.00 per case, respectively, and the out-patients who have no complication were $54.00 and $65.00, respectively. The average cost for a patient with measles without complication was $119.00 as the result. The societal cost of encephalitis was high as $6,660. Estimated total societal cost of measles ranges from $14 million to $69 million in the year 2000.
CONCLUSION
Complication rate of measles was fairly low compared to foreign countries. The lower rate could result from the difference in vaccination rate and the age distribution of the measles patients. The cost of measles without complication was not high. However, the cost for the complication and the total disease burden caused by measles shown to be high in the year 2000.; Summary

Status on Influenza Vaccination in Some Community Health Centers.: Hyun Sul Lim, Geun Ryang Bae, Young Sun Min, Young Taek Kim, Yeon Kyeng Lee; Korean J Epidemiol. 2004;26(2):62-70.

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Abstract PDF: Abstract
PURPOSE
This study was conducted to improve the Korean influenza management system and to determine the status of influenza vaccination in some community health centers through a survey of the officers in charge of influenza vaccination.
METHODS
The authors conducted a questionnaire survey by e-mail for the officers in charge of influenza vaccination of 8 community health centers in Daegu-si, 5 community health centers in Ulsan-si and 25 community health centers in Gyeongsangbuk-do. The authors developed a questionnaire including selection methods of the influenza vaccination objects, results of influenza vaccination in 2002, problems of influenza vaccination, the population within the respondents`jurisdiction and so on.
RESULTS
The proportion of influenza vaccination at community health centers among all residents in the 2002-2003 influenza season was 3.8% in Daegu-si, 14.8% in Ulsan-si, 15.1% in urban Gyeongsangbuk-do and 24.9% in rural Gyeongsangbuk-do. The proportion of influenza vaccination at community health centers among priority cases for vaccination was 12.9% in Daegu-si, 43.1% in Ulsan-si, 39.3% in urban Gyeongsangbuk and 41.6% in rural Gyeongsangbuk-do. The officers in charge of influenza vaccination stated that the problems of influenza vaccination were deficiencies in preparatory examination such as manpower shortage. Twenty-five persons stated as a problem that influenza vaccinations conducted in the hospitals were hardly reported, and fifteen of these clarified that this was due to hospital indifference.
CONCLUSIONS
The authors examined all community health centers of Daegu-si, Ulsan-si, and Gyeongsangbuk-do, and investigated the vaccination states and problems that health officers were dealing with. Therefore, this study is meaningful with its basic data for the management of domestic influenza vaccination.; Summary

A Study on the Relationship of Internet Addiction and Depression in College students.: Joon Ho Lee, Chung Bok Lee, Na Hyung Jun, Nu Li Jun, Won Jae Jung, Hoo Yoen Lee, Eun Cheol Park, Myung Il Hahm; Korean J Epidemiol. 2004;26(2):54-61.

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Abstract PDF: Abstract
OBJECTIVES
To investigate the relationship of internet addiction and depression, and evaluate other possible related factors.
METHODS
Data was based on the questionnaires from 300 college students in Seoul. Gender, age, major, family income, academic performance, people they live with, location, and main use of internet were included. We used Young`s Internet Addiction Test and Beck Depression Inventory(BDI) to measure the depression and addiction degree.
RESULTS
In logistic regression analysis, it was found that gender, depression degree and main use of internet were significant variables. There were 136 males, 144 females in this study, and the risk of being addicted to internet were 10.9 times(CI:2.67~44.68) higher in male than female. People with moderate depression (Beck`s Depression Inventory(BDI) Score>20) also had higher risk(11.4 times, CI:2.03~63.95) to be addicted in internet than normal group. Lastly, in case of internet use, people who use internet for games and chatting were 6.38(CI:1.38~29.63) and 4.84 times(CI:1.30~18.06) risky compare to the group with web surfing.
CONCLUSION
The result of this study suggests that there is noticeable relationship of internet addiction and depression. However we do not have evidence of exact relation between them, therefore more studies should be done.; Summary

Heritability and segregation analysis of the level of HDL-cholesterol.: Ji Eun Yun, Chung Mo Nam, Il Suh, Sun Ha Jee; Korean J Epidemiol. 2004;26(2):43-53.

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Abstract PDF: Abstract
OBJECTIVES
The purpose of this study was to investigate the familial correlation and heritability in HDL cholesterol through segregation analysis.
METHODS
This study, based on data from 11,117 Korean individuals ascertained pedigrees who had participated in 1998 and 2001 Korean National Health & Nutrition Examination Survey. The subjects of segregation analysis were 4,688 Korean who had more than five members in their family.
RESULTS
Serum lipid levels revealed strong familial correlation among spouses, parent-offspring and siblings with low correlation of spouse. The heritability of HDL cholesterol was 54.8% after controlling for age, age2, gender, agexgender, waist circumference, smoking, alcohol drinking, exercise and education. Two models of inheritance, the Mendelian dominant model and the Mendelian codominant model were found in HDL cholesterol. In the codominant model, the predicted HDL-cholesterol for genotype AA, AB, and BB were 44.96, 49.13, and 69.67 mg/dl, respectively. However the Mendelian codominant model only was found in high risk families.
CONCLUSIONS
In conclusion, randomly ascertained Korean families of this study showed strong familial aggregation in HDL cholesterol. The results suggested that the variations in HDL cholesterol may be influencing by major effect of gene.; Summary

Sentinel Surveillance System for Pediatric Communicable Diseases.: Young Ohk Yoo, Eun Kyeong Jeong, Ok Park, Byung Chul Chun; Korean J Epidemiol. 2004;26(2):32-42.

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Abstract PDF: Abstract
PURPOSE
The purpose of this study is to review the process for establishing a pediatric communicable diseases sentinel surveillance system, and the results of operation based on the accumulated data to understand the descriptive epidemiologic characteristics of pediatric communicable diseases.
METHODS
A sentinel surveillance system for pediatric communicable diseases was developed in May 2001 with the 202 doctors in pediatric clinics who participated voluntarily. The target diseases for sentinel surveillance were measles, mumps, rubella, chicken pox and aseptic meningitis. The case definitions of those diseases for surveillance were divided into confirmed cases and suspected cases by the diseases definitions of national notifiable diseases system. The participants should report as soon as possible when they diagnosed measles, mumps, rubella cases including suspected ones. But chicken pox and aseptic meningitis cases were reported once a week in regular base including zero report. We collected the data from May 2001 to December 2003 and showed the descriptive epidemiologic characteristics of each disease.
RESULTS
The average reporting proportion among survellance doctors has been increased, about 88% in 2003. For measles, 206 cases were reported in 2001, 10 cases in 2002, and 2 cases in 2003. Children under the age of 2 (53.4 %) showed the highest. Among the measles cases, 86.4% had no previous vaccination history. In case of mumps, 246 cases in 2001, 241 in 2002, and 566 cases in 2003 were reported. Mumps showed seasonality, highest from April to June in each year. The sex ratio was about 1.5(M:F = 6:4). Among the reported cases, 76.9 % had previous MMR immunization history at least one time. For Rubella, 9 cases in 2001, 3 in 2002, and no case were reported in 2003. The chicken pox case proportion per 100 pediatric consultations showed peak in from May to June and from November to January. 3-5 year-old children (45.7%) were showed high proportion by age.
CONCLUSION
This study described the process of establishing and operating a system for the pediatric communicable disease sentinel surveillance. We analyzed the desriptive epidemiologic characteristic of the reported data from May 2001 to December 2003. These data maybe useful to build the policy of public health management for communicable diseases control system and vaccine preventable diseases.; Summary

Reliability and Validity of the Modified Korean Version of Baecke Questionnaire on Physical Activity.: Ji Young Lee, Young Ho Yun, Eun Cheol Park, Hong Wan Seo, Ju Huk Lee, Hai Rim Shin, Kui Son Choi; Korean J Epidemiol. 2004;26(2):20-31.

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Abstract PDF: Abstract
PURPOSE
Our main goal is to test the reliability and validity of the Korean version of Baecke questionnaire on physical activity by using 507 men and women aged 20-70 years.
METHOD
This study was carried out using the cancer screening participants of the National Cancer Center. All subjects were sent the Korean version of Baecke questionnaire by mail to measure their physical activity.
RESULTS
The mean score on the sport index during leisure-time for men was significantly higher than that for women. In contrast, the mean score of the work index for men was significantly lower than that for women. Cronbach`s alphas for work, sport and leisure-time index were 0.75, 0.81 and 0.39 for men, respectively, and 0.67, 0.75 and 0.35 for women respectively. By a principal components analysis the three conceptually meaningful factors were distinguished, except for the leisure-time factor. Due to the low cronbach`s alphas and undistinguished factors, work and sports factors were used on the final analysis, excluding the leisure time factor, in the Korean version of Baecke`s questionnaire. Two-factor analysis was used to assess the validity of work items and sports items. Work factor and sports factor were definitely distinguished as two factors. Multiple regression analysis showed that lean body mass was significantly related the work index(p<0.0001) and sports index (p<0.05).
CONCLUSION
Our results suggest that the modified Korean version of Baecke`s questionnaire is appropriate to assess the physical activity in Koreans.; Summary

Distribution and Correlates of Obesity in a Korean Rural People.: Jong Ku Park, Sang Baek Koh, Myung Gun Kang, Jin Baek Kim, Sook Jung Hyun, Ju Hee Hong, Jun Ho Park, Sei Jin Chang; Korean J Epidemiol. 2004;26(2):8-19.

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Abstract PDF: Abstract
OBJECTIVE: The aim of present study was to assess the distribution and correlates of obesity in a Korean rural people using both body mass index(BMI) and body fat percent.
METHODS
A total of 1,243 participants were recruited using a two-staged stratified sampling. A structured questionnaire was used to ask their sociodemographics (gender, age, marital status, educational background, and etc.) and health-related behaviors (smoking, drinking, and regular exercise etc.). The data of weight-for height, and body fat percent were also collected by physical examination. For the estimation and analysis of correlates of obesity, we used BMI(>or=25kg/m2) and body fat percent(male>or=25%, female>or=30) as a cut-point of obesity. All analyses were stratified to three age groups(>20, 20-39, 40>or=).
RESULTS
The prevalence of obesity in this study was higher than that in previous studies. This study showed that 32.6% (male: 33.7%, female: 31.7%) of participants according to BMI, and 45.6% (male: 43.8%, female: 47.4%) of them according to body fat percent were obese group. Logistic regression analysis showed that, in the criteria of BMI, while obesity was associated with female and low educational background under the age of 40, prevalence of obesity was higher in non smokers over the age of 40. In case of body fat percent crteria, single(unmarried, divorced, separated, widowed) were more likely to be obese in male aged 20 to 39 years. In the group aged 40 years and over, risk of obesity was higher in female than in male.
CONCLUSION
This result suggests that obesity is common in Korean rural areas, especially among adolescents and female aged 40 years or over, and the risk factors for obesity were different by age. It is required that health management program focusing on obesity and its adverse outcomes should be developed in a community setting.; Summary

Review

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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Abstract PDF: Abstract
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

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