Epidemiology and Health

Public affairs reporting: Korean Society of Epidemiology; Korean J Epidemiol. 1987;9(2):295-297.

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List of membership: Korean Society of Epidemiology; Korean J Epidemiol. 1987;9(2):289-294.

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Articles of association: Korean Society of Epidemiology; Korean J Epidemiol. 1987;9(2):288-288.

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Epidemiologic characteristics of leptospirosis and febrile disease in population in special service at high risk of infection: Joung Soon Kim, Yong Heo, H.W Chung, W.Y Lee, H.G Byun, J.D Suh, C.M Sung, M.Y Ahn, J.M Choi, S.J Lee, Y.C Hahn; Korean J Epidemiol. 1987;9(2):278-287.

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This is a part of serial works on leptospirosis. In this study, a correct characterization of all of the hemorrhagic disease accompanying high fever which might be caused by various agents such as leptospira, rickettsia, viruses, and others if any was attempted by classifying the symptoms and identifing the etiologic agent which is responsible for the cases. And also serologic studies along with fundamental epidemiologic investigation on the clinical signs of the patients selected from the study area were done to draw a comprehensive conclusion. The specific aim which is the major focus of this part of study is to find out prevalence rate of true leptospira patients among patients with high fever and to characterize the clinical pictures, such as clinical signs and symptoms, which might be specific for the true cases of leptospiral infection which is confirmed by bacterial isolation from the cases. One hundred and nineteen patients hospitalized because of high fever (more than 38°C) for more than 24 hours were studied during 10 month (Aug., 1986-May 1987). The findings are summarized as follows; 1) At the time of admission, leptospira isolation rate was 5.8% (6/103) and this became 13.7% (7/44, average 8.4%) after one week of hospitalization. 2) The serum samples were testeded for the presence of the antibodies specific to 22 different servar in which 3 strains isolated in this laboratory from human blood employing microagglutination tests. The positive rate was 34.9% when the first blood samples which were collected at the time of admission tested. And it became 50.9% when the second samples were tested one after the first. The antibody conversion rate within one week was 32.4%. Only one out of 16 cases who were antibody positive at the first test was found to be negatively converted. When these were grouped by their antibody titer, 83.7% of whole antibody positive samples (64) demonstrated antibody titer 1.400 or lower and only 3.1% of them demonstrated higher than 1:3200. 3) Significantly higher positive rate were found when the sera were tested with the fresh strains isolated from that area. The majority (32.4%) of the sera from Chullwon area positively reacted with locally isolated L. icterhemorrhagiae lai and 17.1% of sera from Yangoo area with locally isollated L. canicola. In Chullwon area, 65% of the serum samples were identified belonging to 3 serovars, L. icterohemorrhagiae lai (32.4%), L. canicola (14.7%), and L. ictervhemorrhagiae copenhageni (17.6%). In Yangoo area, 54% of the scrum samples were positive for 4 serovars, L. icterohemorrhagiae lai (14.6%), L. hebdomadis (12.2%), L. icterohemorrhagiae copenhageni (9.8%) and above mentioned local isolate. 4) among 92 patients with high fever 19 cases (20.2%) were confirmed to be leptospiral infection by the both tests for bacterial isolation and serology. Sixteen cases (16%) were the suspicious cases of leptospirosis. The rest of them, 60 patients (63.8%) were found to be uninfected with the bacteria. 5) When the seasonal changes of incidence of the feverrile disease were comparatively analyzed, the cases belonged to confirmed as leptospirosis occured maily in Autumn whereas the others occured throughout the year except the spring in which time a slight decreased cases were recorded. The incidence of the confirmed cases were higher in groups which had been exposed to field trainings. Sore throat, runny nose, hematemesis, and muscle pain were found to be significantly frequent signs complained by the confirmed cases and diastolic blood pressure of the cases was higher. 6) amomg the confirmed cases only 5.3% of them were primarily diagnosed as leptospirosis and majority were diagnosed as fever with unknown reason (47.3%) when they were adimitted because of the high fever. Whereas among the cases confirmed as uninfected 25% was fever with unknown reason and 46.7% for the others. The proportion of cases diagnosed as leptospirosis was 5.0%.; Summary

An epidemiologic study of phlebitis due to intravenous infusion in an university hospital: S.E Lee, Joung Soon Kim; Korean J Epidemiol. 1987;9(2):271-277.

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Since phlebitis following intravenous (IV) infusion which is the most widely used in medical care for patients has remained as a frequent and important hospital infection, it is neccessary to have a fundamental epidemiologic information on the incidence for a successful control program. Two hundred and eighty one patients registered in two general surgical units of an university hospital were studied to find out the incidence rate of the IV induced phlebitis and risk factors involved in it for 2 months from August to September, 1987. Following are summary of the findings; 1) One hundred and ten cases (39.1%) out of 281 patients discharged from the surgical units had experienced phlebitis during the study period. The incidence rate of phlebitis (per 100 IV infused cases) was 14.6. 2) Among various IV devices, the use of IV cannula was found to be the most risky, which caused the highest incidence rate (per 100) 16.9. None of the other devices was comparable to IV cannula in terms of the incidence rate. 3) Proporional increase in incidence rate of phlebitis by the duration of continuous use of the IV infusion was observed. Almost one third of the IV infused cases for more than 73 hours found to have phlebitis. 4) The higher incidence rate as noticed in patients who were in old age group and hospitalized longer. 5) Forty eight percent of the phlebitis cases were classified into severity grade 2 and 3. In conclusion, the incidence rate of phlebitis found in this study was 14.6 per 100 IV infusions and 39.1 per 100 patients discharged and experienced phlebitis is much higher than that of U.S. And the risk factors identified were the devices used for the intravenous infusion, lenth of the hospitalization and age of the patients. This finding strongly suggests that more aggressive preventive intevention need to be excuted, especially for better preparation of the IV devices and selection of the safest method.; Summary

Epidemiologic characteristics of leptospiral infection in healthy population in special service and their neighboring civilians in Korea: Joung Soon Kim, J.S Kim, Y Heo, H.W Chung, W.Y Lee, Y.C Hahn, H.G Byun, J.D Suh, H.K Chung; Korean J Epidemiol. 1987;9(2):264-270.

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The specific aim of this study was to provide epidemiologic information on leptospiral infection in healthy population in special service. These are considered to be the most important group in leptospirosis control not only due to the fact that they have frequent chance of exposure to the potentially dangerous environment for leptospiral infection but also the fact that an efficient preventive measure is urgently required for them. Seven hundred and fifty six service men and 197 their civilian neighbor were subjected for the study. The study included an epidemiologic analysis of the population through interview survey and this was further supported by bacteriologic and serologic confirmatory tests. Leptospira were isolated from the peripheral blood samples from those cases. The isolation positive rate were 0.5% of service men and 1.3% of the civilians. Percent of sereum antibody positives for microagglutination test (MAT) were varied from 8.3% of service men to 12.1% of the civilians. When the same population were subjected to the bacteridogical and serologic studies following the exposure to the time of harvesting, the percent of positives in both tests were increased 2.5 times comapared to those found in the same population before harvest season. Almost all of the bacteria positives (6/7) were found to be cases of inapparent infection. Only one out of the seven suffered from mild symptoms of leptospirosis complaining fever, conjuctival hemorrhage, headache, and nausea. More than half (53%) of the serum samples were reacted with L. icterohemorrhagiae serovar lai and 22% with L. irterohemorrhagiae serovar copenhageni. The rests (25%) were reacted with other groups, L. bataviae, L. canicola, L. grippothyposa, L. automnalis, and L. semaranga. none of the bacteria positives were antibody positives. The seroconversion rate following the expousre (harvest period) were 7.6% in service men and 9.3% in civilians, which were studies on month after the time.; Summary

A study on the epidemiologic trends of reported major-communicable disease in Korea: Sie Baek Han, Joung Soon Kim; Korean J Epidemiol. 1987;9(2):236-263.

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In Korea several changes have occured in patterns of health and disease due to improved economic situation, living standard and medical technology. The objective of this study is to understand the changing patterns of the major communicable diseases in Korea during last several decades. The trends of incidence and mortality and the changing patterns of epidemiologic characteristics of the major communicable diseases, which occured in Korea during the period from 1910 to 1986 were studied by reviewing reported cases to the Ministry of Health and Social Affairs. Some important features obtatined are as follows. 1) The trends of incidence and mortality of reported communicable diseases showed gradual increase until 1950’s. After the great epidemic occured in pre and post-Korean War period at the boundary of 1950’s, it showed a sudden decrease and remained at a certain level by 1960's. There has been further decrease in 1970’s & 1980's. Fatality rate has remakably dropped since the introduction of antibiotics. 2) The age group which used to show the highest incidence rate for water-borne diseases such as cholera, typhoid fever, paratyphoid fever has been changed to older age group by year. Age specific incidence rates of diphtheria and Japanese B. encephalitis were higher among younger ages between 0 and 14 years but the differences among age groups are getting smaller by year. 3) The differences of incidence between male and female, and among age groups were considered to be determined by chance of exposure but not by susceptibility. 4) In seasonal variation of water-borne communicable diseases such as cholera, typhoid fever, paratyphoid fever, dysentery and Japanese B. encephalitis and poliomyelitis, the occurences were higher during summer compared with other seasons, wheares the occurences of respiratory communicable diseases such as diphtheria, whooping cough, measles were higher in winter and spring. Seasonal fluctuation, however, became less prominent in 1980’s than the past decades. 5) Geographical distribution of water-borne communicable diseases (cholera, typhoid fever, paratyphoid fever, dysentery etc.) and respiratory communicable diseases (diphtheria, whooping cough, measles etc.) showed that metropolitan cities such as Seoul and Busan had higher incidence and fatality rates than other smaller cities or towns.; Summary

The effects of age, birth cohort and body mass index on blood pressure in Korean young adults: Chung Yill Park, Won Chul Lee, Kwang Ho Meng; Korean J Epidemiol. 1987;9(2):228-235.

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This study used longitudinal data of 1,348 men and 1,115 women who were employed in financial businesses and followed up for more than 5 years by the Catholic Industrial Medical Center, Catholic University Medical College from 1964 to 1986 to investigate whether there are differences in blood pressure and body mass index among different birth cohorts and whether blood pressure is associated with age and body mass index in each birth cohort. Subjects were classified into 5 birth cohorts in males (1940-44, 1945-49, 1950-54, 1955-59, 1960-64) and into 3 birth cohorts in females (1954-54, 1955-59, 1960-64). An association between systolic blood pressure and age was shown in 3 birth cohorts (1960-64 cohort in males, 1955-59, 1960-64 cohort in females) and the association between diastolic blood pressure and age was shown in 3 birth cohorts (1955-59, 1960-64 cohort in males, 1960-64 cohort in females). The association between body mass index and age was statistically significant in all 5 cohorts in males. In females, it showed U shape (decreased until 24 yrs old and after that it increased) in all 3 cohorts. The mean blood pressure of each birth cohort was not statistically different among different birth cohorts but mean body mass index showed increasing trends as years go by. Stepwise multiple regression demonstrated that age and body mass index were explaining less than 5% of total variance of systolic blood pressure (and diastolic pressure) in males and females.; Summary

An epidemiologic study on sudden unknown fever in intravenous therapy: Sung Eun Lee, Kang Won Choi; Korean J Epidemiol. 1987;9(2):217-227.

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There was a sudden unknown fever related to IV therapy in a university Hospital from Aug. to Sep. 1986. This study tries to survey epidemiological feature of sudden fever and to investigate the cause of sudden fever. The results were as follows; 1) There was 55 cases of unknown fever related to IV therapy. The incidence rate was 2 persons per 1,000 inpatients, 29.3 persons per 1,000 discharges, 2.1 persons per 1,000 IV fluids, 3.2 persons per 1,000 IV devices and 2.5 persons per 1,000 IV sets. 2) To confirm this episode as epidemic, follow-up study was done in 2 general surgery nursing units from Aug. to Sep. 1987, in which there had been 26 cases of unknown fever in 1986. There was no case of sudden fever in follow-up study. 3) The pattern of this sudden fever was chill (55 cases), fever over 38°C (45 cases), neurologic sign (4 cases) and gastro-intestinal sign (5 cases). In 26 cases (47.2%), the onset of the fever was within 1 hour after starting of IV therapy. And in 29 cases (52.7%), the fever was developed within 100 cc or less infusion. 4) To confirm the cause, microbiological culture and pyrogen test were done. In 12 microbiological cultures, there was one positive (the microorganism was S. epidermis) and in 25 pyrogen tests, one pyrogen test was found out positive. 5) To prevent such episode, active hospital infection control program is recommended in each hospital and a positive national supervision on medical equipments should be necessary.; Summary

Physical characteristics of workers and industrial accidents: Yong Joon Kim, Il Soon Kim, Il Suh, Kee Hong Chun; Korean J Epidemiol. 1987;9(2):205-216.

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To investigate the relationship between physical characteristics of workers and industrial accidents, a case-control study was carried out using matched samples of 281 injured workers and 843 non-injured workers. Age, types of work and duration of employment were matched, and their physical characteristics at the time of employment were analzed.
Results
were summarized below; 1) Physical characteristics such as hearing ability, body weight, and visual acuity in the injured group were significantly lower than those in control group whereas measurements of blood pressure, hemoglobin, and urinalysis and color blindness showed no differences in two groups. 2) The relative risks of physical characteristics for industrial accidents, expressed in terms of odds ratios, were 13.2 for hearing loss, 1.8 for impairment of visual acuity and 1.6 for underweight. 3) Hearing ability, body weight, and visual acuity were selected as significant factors influencing industrial accidents based on log-linear model. Odds ratio from logistic regression analysis were 3.6 for hearing loss. 1.3 for underweight, 1.2 for the impairment of visual acuity. Since physical characteristics such as hearing impairement. underweight, and impairement of visual acuity were shown to increases industrial accident risk, the workers with these problems revealed at employment or periodic health examination should be assigned to the job which is more suitable for their physical fitness. Especially, those of who have hearing impairment should be closely supervised in order to prevent industrial accident since it was identified as the most significant risk factor among the three.; Summary

The health status reflected on annual routine physical examination for employees of an enterprise in Seoul: Hi Seop Yoon, In Suk Chon; Korean J Epidemiol. 1987;9(2):193-204.

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This study is to compare the frequency and to show epidemiologic characteristics of the diseases prevaling in the occupational society by analyzing the results of routine physical examination for employees. Attention of this study, especially, has been paid to hypertension and diabetes mainly affecting and becoming causes of labor loss. The results were as follows: 1) The diseases appearing to the persons who are engaging in occupations were as follows: hypertension 6.8%, liver disease 5.5%, kidney disease 3.4%, anemia 1.5%, diabetes 1.3%, syphilis 1.1%, pulmonary tuberculosis 0.7%, other disease 0.9% 2) The mean of systolic-diastolic blood pressure showed increasing trend as getting older. Mean of blood pressure in man (123.0/82.0 mmHg) was rather higher than that in woman (112.1/74.7 mmHg). 3) Prevalence of hypertension increased as getting older, prevalence of hypertension in man (11.1%: standardization rate 8.3%)was higher than in woman (1.4%: standardization rate 2.5%). 4) The mean of cholesterol in man was 185.7±39.1 mg/dl and that in woman was 165.9±32.9 mg/dl. Low cholesterol level was more in woman than in man, and high cholesterol level was more in man than in woman. 5) In relations between hypertension and cholesterol, the frequency of hypertensive group showed increasing trend as being high cholesterol level. 6) In relations between hypertension and urine protein, the positive rate of urine protein was higher in hypertensive group than in normal group. 7) Blood sugar level showed increasing trend as getting older. The mean of blood sugar in man (96.6± 23.9mg/dl) was higher than in woman (88.4±12.3mg/dl). Low blood sugar level was more in woman than in man and high blood sugar level was more in man than in woman. 8) The positive rate of urine sugar showed increasing trend as getting older and as being high blood sugar. 9) In relations between blood sugar and cholesterol, the rate of high cholesterol increased as being high blood sugar. 10) In relations between cholesterol and the positive rate of urine sugar, the positive rate of urine sugar increased as being high cholesterol.; Summary

Hepatitis B virus infection rate of orphans: Sung Kook Lee, Min Hae Yeh, Gi Dog Ahn, Byung Yeol Chun, Chang Eun Kim; Korean J Epidemiol. 1987;9(2):183-192.

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To determine the hepatitis B virus (HBV) infection rate of orphans and take preventive measures against the hepatitis B virus, the hepatitis B virus infection rate by age, residence duration in orphanages and residence before admission of 249 orphans(male 143, female 106) in 2 orphanages among 21 orphanages which are located in Busan was analyzed and measured for HBsAg, anti-HBs, and anti-HBc, HBeAg with RPHA and RIA method from April 1 to April 28, 1987. Overall HBsAg positive rate was 6.4% and rate for male (9.1%) was statistically significant higher than that for female (2.8%) (P<0.05). Anti-HBs positive rate was 44.6% (48.3% for male, 39.6% for female) and anti-HBc positive rate that executed orphans of HBsAg and anti-HBs negative was 14.8% (19.7% for male, 9.8% for female). Accordingly the hepatitis B virus infection rate (HBV) was 58.2% and the infection rate for male (65.7%) was higher than that for female (48.1%) (P<0.01). HBsAg positive rate by preschool age (under 5 years old) was 8.7%; elementary school age (6-11 years old), 8.3%; junior school age (12-14 years old), 4.8%; senior school age (15 years and over), 4.4% and preschool children were the highest in HBsAg positive rate. HBV infection rate for 5 years old and under was 30.4%; 52.1% for 6-11 years old; 66.1% for 12-14 years old; 69.1% for 15 years and over and the infection rate was increased as age increased. The infection rate by duration of residence in orphanages was 50.3% for 4 years under; 77.4% for 5-9 years; 80.7% for 10 years above and the infection rate by duration was in proportion to their residence duration. The infection rate by residence before admission was 53.5% for home; 75.5% for orphanages; 57.1% for temporary residence and the orphanage residence group was the highest. HBsAg positive rate among HBsAg poisitive orphans (68.8%) was so high and HBV infection rate of orphans with HBeAg positive person in the same room was 64.1% HBV infection rate of orphans with HBeAg negative person in the same room was 55.1% and orphans who live with HBeAg positive person showed the high positive rate, but there isn’t statistically significant difference. Three orphans among 16 HBsAg positive orphans were the HBV patients and HBsAg positive rate related to the result of liver function test greatly. As result of this study, 58.2% orphans among young aged orphans were infected with the hepatitis B virus, and HBsAg positive rate of workers at restaurant was 40.0% and that of workers at office or room was 27.3%. HBeAg positive rate among HBsAg positive workers in orphanage was 80.8%. HBV infection rate of adults in orphanage was 81.6%. There findings suggest that the high HBV infection rate of orphans should be attributed to the high HBeAg positive rate among workers in orphanage by horizontal transmission of HBV through close personal contact. So it is recommended to test new orphans soon after the admission to the orphanage and immunize all the susceptible orphans. Also it is necessary to observe continually after seperating any HBeAg positive orphans who can infect the other.; Summary

Genesis of essential hypertension: role of genetic and environmental factors: Kwang Ho Meng; Korean J Epidemiol. 1987;9(2):176-182.

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In reviewing the growth of knowledge concerning hypertension, especially essential hypertension, it is sobering and rather depressing to realize how little progress has been made in our understanding of its etiology. Despite spectacular advances in elucidating the pathophysiological mechanisms that control blood pressure levels and concomitant improvements in treatment as well as voluminous and enthusiastic reasearch, we are still powerless to prevent the rise in blood pressure that is so characteristic a feature of aging in our societies. Again, this is because we still know very little about the etiology of the hypertension. This paper reviews research articles particularly on the role of genetic and environmental factors in the genesis of essential hypertension, and discuss some controversial points the researchers allege in their respective researches.; Summary

Trend and control strategy of legal communicable disease: Panel discussion; Korean J Epidemiol. 1987;9(2):172-175.

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New communicable disease and its control: S.W Lee; Korean J Epidemiol. 1987;9(2):170-171.

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