Epidemiology and Health

Volume 27 (2); December 2005

Original Articles

A Case-Control Study to Identify the Risk Factors of School Accidents.: Mi Young Ji, Young Sool Park, Sung Eun Yi; Korean J Epidemiol. 2005;27(2):80-94.

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The purpose of the study was to analyze the risk factors of school accidents. The study subjects were 408 students of a middle school in a municipal city. Among them, 204 students who met with an accident and received first-aid treatment in school health room at any time from March 2 to July 15, 1999, were selected as the school accident group. And the remaining 204 students were cases' matched control, who had never been experienced any school accident from elementary school days to July 15, 1999, For data collection, the structured questionnaire, and interview were adopted. The findings of this study were as below: There were significant differences personal and familial characteristics residential form(p=0.04); active disposition (p=0.02); impatient disposition(p=0.02); family environment(p=0.01); and father image(p=0.00), and the school life characteristics; achievement(p=0.00); observance of school order(p=0.00); school adjustment(p=0.00), the health characteristics; school health room(p=0.00); medical institute they usually used(p=0.00); sleeping hours(p=0.03); bath or shower(p=0.01); hand washing(p=0.04), and wearing glasses(p=0.02), and the characteristics of accident disposition; accident experience(p=0.00); the characteristics of accident disposition(p=0.00). Multiple logistic analysis were showed that religion, adaption to school life and school accomplishment were the significant predictors to school accident prevalence. To reduce school accident, accident-prevention program should be developed practically and concretely in consideration of student's personal characteristics. In addition, accident-prevention education should be implemented under the link between home and school, so that students could prevent accident for themselves.; Summary

A Study on the Epidemiologic Characteristics of Scrub Typhus in Gyeongsangbuk-do, 1999-2001.: Young Sun Min, Hyun Sul Lim, Kwan Lee, Cheoll Jung, Hae Kwan Cheong; Korean J Epidemiol. 2005;27(2):70-79.

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Abstract PDF: Abstract
ONJECTIVE: This study was carried out to investigate the epidemiologic characteristics and magnitudes of scrub typhus (tsutsugamushi disease) in Gyeongsangbuk-do, Korea.
METHODS
Resources of data collected were epidemiologic surveillance report to public health centers on each disease occurrence. The authors reviewed 344 epidemiologic surveillance reports for cases of scrub typhus developed in Gyeongsangbuk-do, Korea from Jan 1, 1999 to Dec 31, 2001.
RESULTS
The scrub typhus cases were 376 during three year period, and the incidence was significantly higher in the county area than in the city area. Incidence of scrub typhus was increasing each year. In 344 epidemiologic surveillance reports, the job of the cases was farmer (67.2%), housewife (4.7%), clerk (3.5%). Two hundred ninety eight cases (86.6%) have experienced outdoor activities before development of the scrub typhus. The outdoor places of exposure were dry field (64.8%), rice field (51.7%), hill (12.8), and grass field (9.7%). The symptoms reported were fever (93.3%), headache (83.7%), chill (69.5%), and rash (54.4%).
CONCLUSIONS
Incidence of scrub typhus was increasing in Gyeongsangbuk-do, Korea, this phenomenon may be related to change of climate, the reporting rate of disease and outing activities. Good surveillance and adequate analysis of epidemiologic data is a essential for the prevention of the disease. With this result, high risk population was identified and effective intervention should be done to prevent the disease.; Summary

Study of nosocomial pneumoniae in ICU of a hospital.: Yeoun Aeng Kim, Soon Duck Kim, Je Suk Lee; Korean J Epidemiol. 2005;27(2):61-69.

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PURPOSE
As a retrospective study by using of medical records, this was to investigate the incidence rate of nosocomial pneumonia and risk factors and to determine the causing agent.
METHODS
Subjects were 336 patients during the period from January 2003 through December 2003. Nosocomial pneumonia was defined according to the definition(CDC, 1992).The statistical SPSS was used to analyze data that included chi-square, t-test and multiple logistic regression.
RESULTS
The actual number of patients with nosocomial pneumonia turned out to be 42 out of total 336 patients during the survey period. The incidence rate was 125 per 1,000 patients and 16.7 patients per 1,000 patient-days, which is comparable with 217 patients with ventilator-associated pneumonia per 1,000 patients and 34.8 per 1,000 patient-days. The significant risk factors for nosocomial pneumonia were identified as cardiomegaly based on chest radiography (OR=4.93; 95% CI=1.11-21.94), cerebral hemorrhage(OR=6.27; 95% CI=1.63-24.16), cerebral infarction(OR=4.39; 95% CI=1.05-18.40) and the duration of admission (OR=5.57; 95% CI=3.14-9.88). Causing agents of nosocomial pneumonia were Staphylococcus aureus 21.8%, Pseudomonas aeruginosa 17.4% and Acinetobacter baumani 17.4%. Ventilator-associated pneumonia were Acinetobacter baumani 27.5%, Staphylococcus aureus 24.2%, Pseudomonas aeruginosa 13.8%.
CONCLUSIONS
The cardiomegaly at admission, diagnosis and duration of admission were considered to enhance the incidence rate of nosocomial pneunoniae. Further studies and intervention actions would be necessary to deal with the nosocomial pneunoniae.; Summary

Reproducibility of information on cardiovascular risk factors and self-rated health status collected in the National Health Insurance Corporation health examination among 94,183 Korean military personnel.: Ki Ho Park; Korean J Epidemiol. 2005;27(2):51-60.

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While health examination data from the National Health Insurance Corporation (NHIC) have been used by many researchers for investigating the risk factors of cardiovascular disease or cancer, most studies have used measurements made on a single occasion at the start of the study (baseline measurements only) or 2 initial measurements in the beginning of the study period for their analyses. This study was conducted to investigate the reproducibility of information on cardiovascular risk factors and self-rated health status collected in the NHIC health examinations by performing measurement and re-measurement data analysis techniques. A total of 94,183 military personnel, including commissioned and noncommissioned officers and public service workers, who had participated in both the 1998 and 2001 NHIC health examinations were included in this study. Reproducibility was excellent regarding height, weight, and body mass index. However, reproducibility was unsatisfactory for cardiovascular risk factors and self-rated health status. In particular, low reproducibility was exhibited for blood pressure and physical exercise in both men and women. This study emphasizes the importance of considering regression dilution biases when conducting studies for disease risk factors using large population cohort data.; Summary

Insulin resistance and cancer.: Hee Jin Kim, Sun Ha Jee; Korean J Epidemiol. 2005;27(2):38-50.

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Both obesity and diabetes have been proposed as risk factors of cancer. Obesity may be a more significant health problem, which can increase the risk of cancer and cardiovascular disease, which is the most common cause of death. Insulin resistance and metabolic syndrome are suspected of being correlated with cancer risk. Most studies are carried out on the assumption that obesity, diabetes, cardiovascular disease, and cancer are different conditions. However, they have common risk factors-smoking, obesity, and physical inactivity. Although the pathways leading to these diseases are unknown, we brought a focus into the multi-dimensional pathways instead of single pathogenesis. The interaction between pathogenesis can be thought to start from risk factors, and through pathogenesis, diseases can also lead to a severe cause of death. Epidemic of obesity and diabetes is a significant and growing public health problem. This paper reviewed the evidences of the correlation between insulin resistances and cancer and we explored whether insulin resistance may contribute to carcinogenesis.; Summary

The Role of the Epidemiological Causality of the Association between Smoking and Lung Cancer.: Kyung Hwan Lee, Hyun Hee Kang; Korean J Epidemiol. 2005;27(2):28-37.

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It is generally accepted that acknowledgment of the causality of the association between smoking and lung cancer plays a crucial role in imposing liability on tobacco manufacturers in tobacco-related cases. However, acknowledgment of the epidemiological causality of the association is merely a precondition to putting liability on tobacco manufacturers; it does not play a crucial role. Smokers smoke manufactured tobacco by their right to choose according to their self-decision; therefore, it is not reasonable to place all liability concerning lung cancer on tobacco manufacturers. This paper studies the dual structure of the causality of the association between tobacco manufacturing and smoking as well as smoking and lung cancer. It can be understood that tobacco manufacturers must be held liable for lung cancer caused by smoking when there was intentional concealment or insufficient provision of information on the harmfulness of tobacco and the addictiveness of nicotine. The epidemiological causality of the association is the minimum scientific and legal precondition to placing liability on tobacco manufacturers for lung cancer caused by smoking. However, striving for protection and promotion of national health by, for instance, promoting antismoking programs, the epidemiological causality of the association adequately plays a social role when viewed from a public health perspective.; Summary

Controlled Clinical Trial

Application of Epidemiology to the Tobacco Lawsuit Cases in KOREA.: Hong Gwan Seo, Hyung Joon Jhun; Korean J Epidemiol. 2005;27(2):20-27.

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Over the half of last century, epidemiology has witnessed that tobacco causes lung cancer. Therefore, lung cancer lawsuits against tobacco companies have been raised in many countries. However, a discrepancy between epidemiology dealing with population-based causal association and lawsuit dealing with individual-based evidence has happened. This article discusses application of epidemiology to the tobacco lawsuit cases in Korea. Epidemiological studies such as double blind randomized controlled clinical trials and cohort studies give clinicians important information on decision-making for the treatment of an individual patient and predicting prognosis. Epidemiological data have also been applied to the diagnosis of a worker's claim on occupational disease or work-related disorder. Illegality is generally recognized in the court when direct causal relationship between offending action(s) and damage(s) is proved and the damaged must prove illegality of the offender(s). The probability theory was emerged to reduce the responsibility especially when a plaintiff has a difficulty in proving causal relationship and illegality due to long-term duration or complexity or poor condition of the plaintiff such as environmental lawsuit cases. In relation to the probability theory, a theory was raised that a causal relationship is proved legally if an epidemiological causal relationship between offending action(s) and damage(s) is proved. Based on these evidences and theories, we show our opinion that epidemiological data are applicable to the individuals such as tobacco lawsuit cases in Korea.; Summary

Original Article

Smoking and lung cancer: foundation of modern epidemiology.: Hae Kwan Cheong; Korean J Epidemiol. 2005;27(2):1-19.

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Since its introduction to western world in 16th century, smoking has been one of the most popular parts of human life. Its health hazards, however, has rarely been evaluated before mid 20th century. After early suggestion of association with lip cancer and pipe smoking, which was falsely associated with the heat of the pipe smoking, association between rapidly increasing incidence of lung cancer and increasing popularity of smoking habit in the western world has been suggested in late 1940s. Initial case-control studies, in spite of its proneness to various biases, aroused the relevance of the relationship. It was supported by following well-designed case-control studies and new method, cohort studies in both coast of the Atlantic. Consistency of the results of epidemiologic studies and additional support from animal experiments made the causal relationship to be accepted from scientific community, and finally from public and governments. Establishment of criteria of causal relationship was also established in the process of investigation of the relationship between smoking and lung cancer. Smoking is most common cause attributable to lung cancers in most of the world. It is also responsible for the many cancers, including larynx, bladder, oral cavity, esophagus, pancreas, kidney, stomach, liver, and myeloid leukemia; and cardiovascular disorders, respiratory disorders, and other degenerative disorders. Passive (or environmental tobacco) smoking has also been found to be hazardous. Establishment of causal relationship between smoking and lung cancer has been a landmark in the development of epidemiologic methods and concepts, which played the key role in the evaluation of risk factors and preventive intervention on the chronic degenerative disorders.; Summary

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