Epidemiology and Health

Hyun Sul Lim

29 Articles

An Epidemiological Investigation on an Outbreak of Bacillus Cereus Food Poisoning in a Girls' High School in Sangju-si, Korea, 2008.: Hyun Dong Lee, Sun Ok Lee, Hyun Sul Lim, Kyoung Chan Lee, Kyu Jin Chang, Young A Kang; Korean J Epidemiol. 2008;30(2):168-177. Published online December 31, 2008; DOI: https://doi.org/10.4178/kje.2008.30.2.168

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Abstract

PURPOSE
In May 2008, a diarrhea outbreak occurred among students of in a girls' high school (S school) in Sangju-si, Korea. An epidemiological investigation was carried out to clarify the cause and transmission route of the outbreak.

METHODS

S school has been providing meals directly since July 2007. We conducted a questionnaire survey among 591 persons, and examined 283 rectal swabs and 98 environmental specimens. The patient case was defined as a member of S school who had diarrhea more than one time in a day, accompanied with one or more symptoms among abdominal pain or tenesmus from May 19th to May 26th 2008.

RESULTS

The attack rate was 24.0%. Bacillus cereus were cultured from three of the rectal swabs and five of the preserved foods. It was suspicious that contamination was possible in seasoning vegetables, and we found some foods were seasoned with spices after being cooled by moving cooler for about 20 minutes. Enterotoxin positive B. cereus were cultured from two foods cooled by moving cooler. Enterotoxin negative B. cereus were cultured from two environmental specimens of the moving cooler.

CONCLUSIONS

We presumed the cause of the diarrhea outbreak in S school was food poisoning by B. cereus. Because enterotoxin positive B. cereus were cultured from rectal swabs and foods, and the symptoms were corresponded. We estimated the outbreak was occurred by this process that B. cereus in the moving cooler contaminated foods during cooling and then rapidly proliferated.

Summary

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Validity and Reliability of a Questionnaire on the Knowledge, Attitudes, Perceptions and Practices toward Food Poisoning among Malaysian Secondary School Students: A Pilot Study
Pawitra Ramu, Malina Osman, Noor Azira Abdul Mutalib, Musheer A. Aljaberi, Kuo-Hsin Lee, Chung-Ying Lin, Rukman Awang Hamat
Healthcare.2023; 11(6): 853. CrossRef
Epidemiological Investigation for Outbreak of Food Poisoning Caused byBacillus cereusAmong the Workers at a Local Company in 2010
Kum-Bal Choi, Hyun-Sul Lim, Kwan Lee, Gyoung-Yim Ha, Kwang-Hyun Jung, Chang-Kyu Sohn
Journal of Preventive Medicine and Public Health.2011; 44(2): 65. CrossRef

Case Series of Pediatric Mycoplasma Pneumoniae Pneumonia Inpatients in A Hospital.: Young Sun Min, Hyun Sul Lim; Korean J Epidemiol. 2006;28(1):112-118.

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Abstract PDF: Abstract
OBJECTIVES
The aim of this report is to examine characteristics of pediatric Mycoplasma Pneumoniae pneumonia inpatients.
METHODS
The authors conducted a medical record survey among 236 children under seventeen were hospitalized in a university hospital due to Mycoplasma Pneumoniae pneumonia, 2001-2003. The author reviewed gender, age, address, developed date of symptoms, admission day, discharge day, etc.
RESULTS
The number of inpatients was increased during late summer and fall. The mean age of all cases was 3.7+/-2.9 years old. One hundred ninety three cases (81.8%) had lung infiltration findings. The mean symptomatic period was 11.9+/-6.4 days (maximum 44 days, minimum 4 days, median 10 days), the mean hospital length of stay was 5.2+/-2.5 days (maximum 17 days, minimum 0 day, median 5 days).
DISCUSSION
The authors reviewed characteristics during last 3 years for Mycoplasma Pneumoniae pneumonia. This report is meaningful with its basic data for the epidemiologic characteristics of Mycoplasma Pneumoniae pneumonia inpatients.; Summary

Perspectives of Communicable Disease Surveillance in Korea.: Hyun Sul Lim; Korean J Epidemiol. 2006;28(1):28-35.

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Abstract PDF: Abstract
Environmental and climatic changes and the mobility of ever-increasing numbers of people increase the risks for the emergence and reemergence of infectious diseases. Since communicable disease trends change rapidly, many nations have developed individualized communicable disease surveillance systems. In Korea, notification of the incidence of communicable diseases has been the most important form of surveillance since 1954. In addition, the government has established various surveillance systems since the late 1990s. Current problem areas of surveillance systems are the low reporting rate, a lack of representativeness, a lack of participation, and poor utilization. The government has not fully evaluated these systems. For many diseases, it is of critical importance to maintain the confidentiality of surveillance data. Issues of confidentiality are critical and must be considered in order to obtain valid data and protect those surveyed. In the future, we have to improve the reporting rate, enhance collaborations with veterinarians and gain the full support from the governmental departments of agriculture and defense. Surveillance systems should be evaluated regularly. The most dynamic and important part of surveillance is the feedback mechanism. To develop positive feedback, we must disseminate the collected and analyzed information and give reimbursement to the reporters. We have to built close partnerships with governmental agencies, international organizations, research institutes, private health corporations, and academia.; 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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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

Accidents Status of Freshmen for 2 Months before Entrance University.: Young Sun Min, Hyun Sul Lim; Korean J Epidemiol. 2005;27(1):173-181.

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Abstract PDF: Abstract
OBJECTIVES
In recent years, Korea has experienced a loss of manpower and economy due to accidents. The consequences have been comprehensive. Nevertheless, there have been few recent Korean studies on adult accidents. Therefore, this study was carried out to examine the incidence pattern of accidents for 2 months before entering university among university freshmen.
METHODS
The subjects were 1,920 university freshmen who visited the university health center for health examination from March 8 to 12, 2004, and self-reported questionnaire was given to the subjects. The authors developed a questionnaire including age, gender, place and type of high school, experience of accidents, occurrence time and type of accidents and so on.
RESULTS
The monthly incidence of accident was 9.9 per 1,000 population. The accident cases were 28 in male and 10 in female, and the incidence of males was significantly higher than females. The frequent accident states were 15 cases in 'Ordinary life' (39.8%), 10 in 'Sports activities' (26.3%), 9 in 'Walking' (23.7%) and so on. The accident types were 13 cases of 'Tumbling over' (34.2%), 12 of 'Crash' (31.6%), 8 of 'Traffic accident' (21.0%) and so on. The frequent injury types were 19 cases of 'Sprain' (50.0%), 15 of 'Contusion' (38.4%) and 2 of 'Laceration' (5.3%). One's own carelessness was the most frequent cause of accident (65.8%). After the accident, 28 cases(73.7%) visited the hospital, 7 (18.4%) were hospitalized, and 3 (7.9%) underwent surgery.
CONCLUSIONS
Because the most frequent cause of accidents was one's own carelessness, self-consciousness and attention are needed. The authors expect that this study will go far toward increasing concern of researchers and administrators for the accidents among adults.; Summary

Prevalence and Risk Factors of Green Tobacco Sickness among Korean Tobacco Harvesters, 2003.: Kwan Lee, Hyun Sul Lim; Korean J Epidemiol. 2005;27(1):129-139.

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Abstract PDF: Abstract
OBJECTIVES
This study was carried out to understand the prevalence and risk factors of green tobacco sickness (GTS) among Korean tobacco harvesters.
METHODS
The authors conducted a questionnaire among the tobacco harvesters (842 persons from 449 out of 500 tobacco harvesting households) in Cheongsong-gun for 4 days from Sep 1 to 4, 2003.
RESULTS
The study subjects contained 440 males and 402 females. The prevalence of GTS in 2003 was 39.2%, and was significantly higher in females (53.4%) than in males (25.6%, p<0.01). The incidence density of GTS according to the number of workdays in 2003 was 11.5 spells/100 person-days. The GTS symptoms reported by the tobacco harvesters in 2003 were nausea in 320 cases (97.0%), dizziness in 311 cases (94.2%), headache in 264 cases (80.0%) and vomiting in 209 cases (63.3%) etc. Through multiple logistic regression, the factors significantly associated with GTS were found. Odds ratio for smoking, age over sixty(compared with under forties), and working over 10 hours(compared with under 10 hours) were respectively 0.23 (95% CI: 0.16~0.33), 0.46 (95% CI: 0.23~0.93), and 1.53 (95% CI: 1.12~2.10).
CONCLUSIONS
Our studies before this, there were significant recall bias by time lag between harvesting period and survey time. We tried to study promptly after harvesting tobacco leaves to solve this recall bias. More extensive epidemiologic studies, and educations for harvesters are expected.; Summary

Brucellosis: An Overview.: Hyun Sul Lim, Young Goo Song, Han Sang Yoo, Mi Yeoun Park, Jong Wan Kim; Korean J Epidemiol. 2005;27(1):26-36.

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Brucellosis is zoonotic disease of worldwide distribution and still remains endemic in some developing countries. The main pathogenic species worldwide are B. abortus, responsible for bovine brucellosis, B. melitensis. The B. abortus is most common in Korea. Each Brucella spp. has a preferred natural host that serves as a reservoir of infection. The incubation period varies between 5 and 60 days, and Brucella infection may be asymptomatic or symptomatic. The majority of patients complained of fever (undulating fever), sweats, malaise, anorexia, and arthralgia. The diagnosis of brucellosis requires the isolation of Brucella from blood or body tissues, or the combination of suggestive clinical presentation and positive serology. There were first patients in 2002, thereafter 16 patients in 2003, and 47 patients in 2004, the human brucellosis are increasing more gradually in Korea. Brucellosis is an occupational risk for farmers, veterinarians, and abattoir workers. The main sources of Brucella are infected animals or their products, such as milk, blood, carcasses, and abortion products. Routes of transmission of the infection to humans include direct contact with infected animals and their secretions through cuts and abrasions in the skin, by way of infected aerosols inhaled or via the ingestion of unpasteurized dairy products. A combination of doxycycline and streptomycin has been used widely in brucellosis. Prevention of brucellosis in human still depends on the eradication or control of the disease in animal hosts, the exercise of hygienic precautions to limit exposure to infection through occupational activities and the effective heating of dairy products, and other potentially contaminated foods. Also, physicians and veterinarians must be concerned about specific environments and clinical patterns of brucellosis.; Summary

Anthrax: An Overview.: Hyun Sul Lim, Young Goo Song, Han Sang Yoo, Seong Won Keun, Jong Wan Kim; Korean J Epidemiol. 2005;27(1):12-25.

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Human anthrax has been a zoonotic disease affecting those who have close contact with animals or animal products contaminated with the spore-forming bacterium Bacillus anthracis. Now the incidence of anthrax in herbivores and human are rare, but it remains an important health problem in Korea because anthrax is seen as one of the most likely biological weapon. The B. anthracis forms a spore, which is resistant to drought, heat and numerous disinfectants, and the spore can remain viable and infective in the environment for decades. There are three major forms of human disease depending on how infection is contracted, cutaneous, inhalation and ingestion. Inhalational anthrax is the most common form, but the events in the Korea show that gastrointestinal anthrax is the most common. Several cases of anthrax have been reported in Korea. In recent years, 2 cases of bovine anthrax and 5 cases of human anthrax occurred in Changnyeong-gun, 2000, but it haven't occurred any more so far. The most useful microbiological test remains the standard blood culture. Confirmatory diagnostic tests such as polymerase chain reaction can also be used and may help in early diagnosis. Prompt clinical suspicion and rapid administration of effective antimicrobials are essential for treatment of anthrax. Ciprofloxacin or doxycycline should be used for initial intravenous therapy until antimicrobial susceptibility results are known. The best measure to eliminate human anthrax is control in domestic animals by effective surveillance and by immunization of animals in endemic areas. Also, the government must establish countplan for knowledge and rational policies in dealing with potential bioterrorism attacks.; 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

Epidemiologic Investigation into an Outbreak of Typhoid Fever Recognized by Electronic Data Interchange in Gyeongsangbuk-do, 2003.: Hyun Sul Lim, Young Sun Min, Kwan Lee, Sang Hyuk Lim; Korean J Epidemiol. 2004;26(1):59-68.

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Epidemiologic Investigation into an Outbreak of Typhoid Fever Recognized by Electronic Data Interchange in Gyeongsangbuk-do, 2003 PURPOSE: Fourteen cases of typhoid fever occurred in Gyeongsan-si, Gyeongsangbuk-do from May 22 to July 19, 2003. Especially, 6 cases were students of Y University located in Gyeongsan-si. This investigation was carried out to study the infection source and transmission of typhoid fever and to institute an effective prevention counterplan.
METHODS
The authors conducted an epidemiologic survey from June 25, 2003 among the 14 cases, restaurants and employees of the whole neighborhood of Y University. Widal test was carried out for the restaurant employees and schoolmates of the 13-year-old case Miss Kim. The authors executed a pulsed field gel electrophoresis (PFGE) for Salmonella typhi cultured from 9 cases. The authors collected data about chloride and turbid levels of treated water from April to June in Gyeongsan-si water treatment plant and repair work records of waterworks pipe line in Gyeongsan-si city hall.
RESULTS
All cases had used restaurants of the whole neighborhood of Y University within 2 months before the typhoid fever symptoms were developed, but the restaurant that was rarely visited by any of the patients had a case to be matched. In the results of the Widal test, 9 out of 45 of subjects (20.0%) were suspicious cases or showed a value to suggest past infection. In the results of PFGE test, there were 3 subtypes, and each subtype had a similar DNA fragments array. In all cases the patients drank tap water when they visited the restaurants. The restaurants provided drinking water from filtered tap water rather than boiled water, and all patients had drunk this water. The chlorine level of the treated water was the normal value in the Gyeongsan-si water treatment plant, but in 2 times the value was the minimum standard level. There was water pipe construction work in some regions of the whole neighborhood of Y University. The number of gastrointestinal patients in 2003 was approximately 2 times that in 2002 at the health center in Y University.
CONCLUSIONS
The possibility that typhoid fever was generated in the whole neighborhood of Y University is very high. Among various possibilities, the highest possibility is the pollution of tap water intake by water leakage of a water pipe. There was no case of patient infection after strengthening of the tap water disinfection. Thorough disinfection, boiled drinking water and a periodic carrier inspection are necessary to prevent additional local occurrences of these typhoid infections.; Summary

Epidemiological Characteristics and Changes of Prevalence for Green Tobacco Sickness among Korean Tobacco Harvesters.: Joo Sub Lee, Sung Han Bae, Hyun Sul Lim, Kwan Lee; Korean J Epidemiol. 2004;26(1):39-49.

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Abstract PDF: Abstract
PURPOSE
This study was carried out to investigate the epidemiological characteristics and changes of prevalence for green tobacco sickness (GTS) for 2 years.
METHODS
The author conducted a questionnaire survey on the tobacco harvesters (875 persons from 478 out of 555 tobacco harvesting households surveyed last year) in Cheongsong-gun for 4 days from May 26 to 29, 2003.
RESULTS
The study subjects comprised 456 males and 419 females. The prevalence of GTS in 2002 was 50.5%, which was significantly higher than the 43.0% in 2001 (p<0.01). The incidence density of GTS in 2002 was 11.3 spells/100 person?working-days, which was lower than the 12.1 spells in 2001. Regardless of risk factors such as smoking, workingdays, and working hours, the prevalence of GTS in 2002 was higher than that in 2001. Among various GTS symptoms reported by the tobacco harvesters in 2002, cases of nausea were increased, while diarrhea, dyspnea and cough were decreased compared with 2001. The degree of GTS symptoms in 2002 was increased in 198 cases (64.5%), and decreased in 42 cases (13.7%). The proportion of harvesters who underwent treatment from their local medical facilities in 2002 was significantly decreased compared with that in 2001.
CONCLUSIONS
In Korea, there are many tobacco-harvesting households, most of which may be stricken with GTS. It is very important for doctors to diagnose the disease exactly and to develop prevention methods for GTS. I expect that more extensive epidemiological studies including the incidence and associated risk factors will be needed. In addition, surveillance system and measurements of urinary cotinine should be conducted.; Summary

Analysis of Transmission Mode of Confirmed Shigellosis in Gyeongju, Korea.: Cheoll Jung, Hyun Sul Lim, Gyoung Yim Ha, Hee Su Kim; Korean J Epidemiol. 2004;26(1):1-16.

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Abstract PDF: Abstract
PURPOSE
This study was carried out to investigate the sources of infection and modes of transmission of an 107 (54males, 53 females) confirmed shigellosis in Gyeongju from Sept. 24 to Oct. 24, 1998.
METHODS
We reviewed hospital records of all confirmed shigellosis. Thirty-two strains of Shigella sonnei isolated were analyzed in order to trace the source of infections by plasmid profile, antimicrobial drug resistance pattern, biotyping and pulsed-field gel electrophoresis (PFGE).
RESULTS
The first source of infection was estimated to be contaminated underground water and simple piped water caused by leakage from the cess pool. Antimicrobial drug resistance pattern showed that all strains were multi-resistant. All isolates had the same XbaI and SfiI PFGE patterns, indicating the epidemiological relationship of the outbreaks strains in this area. The major characteristics of diarrhea were watery (84.2%) in nature. The clinical symptoms among the diarrheal cases included abdominal pain (86.1%), fever (83.2%), headache (78.2%), chill (45.5%) and tenesmus (41.6%). Six cases were asymptomatic. From initial manifestation to admission were 6.2+/-1.6 (median 6) days, so it could be transmitted to others in this infective period. Duration of admission were 5.5 +/-2.4 (median 6) days. We can find familial mean secondary attack rate were 38.5%.
CONCLUSION
It's transmission to other areas were certified by contaminated water and contact with shigellosis, and unknown cases were estimated to be transmitted by contacts with inapparent infection. By plasmid profile and PFGE, the epidemiological relationship of the outbreaks strains in this area seemed to be the same micro-organisms.; Summary

Status on Occurrence and Preventive Measures of Disasters in Korea.: Hyun Sul Lim; Korean J Epidemiol. 2003;25(2):47-61.

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Abstract PDF: Abstract
Disasters are emergencies of a severity and magnitude resulting in deaths, injuries, illness and/or property damage that cannot be effectively managed by the application of routine procedures or resources. These events are caused by nature, the result of technological or manmade error. Natural disasters include typhoon, flood, heavy snowfall, drought, famine, and earthquake. Natural disasters are unpreventable and, for the most part, uncontrollable. Technological or manmade disasters include fire, nuclear accidents, bombings, and bioterrorism. The severity of damage caused by natural or technological disasters is affected by population density in disaster-prone areas, local building codes, community preparedness, and the use of public safety announcements and education on how to respond correctly at the first signs of danger. Recovery following a disaster varies according to the public's access to pertinent information, pre-existing conditions that increase or reduce vulnerability, prior experience with stressful situations, and availability of sufficient savings and insurance. Epidemiology can be used to investigate the public health and medical consequences of disasters. The aim of disaster epidemiology is to ascertain strategies for the prevention of both acute and chronic health events. Disaster epidemiology includes rapid needs assessment, disease control strategies, assessment of the availability and use of health services, surveillance systems for both descriptive and analytic investigations of disease and injury, and research on risk factors contributing to disease, injury, or death. With both disasters and the number of people affected by such events on the increase, the importance of disasters as a public health program is now widely recognized in Korea. The epidemiologists must do their best effort for prevention of disasters.; Summary

Outbreak of Salmonellosis Misdiagnosed with Amebiasis in Gumi City and Chilgok County, Korea.: Hyun Sul Lim, Geun Ryang Bae, Tai Soon Yong; Korean J Epidemiol. 2002;24(1):54-62.

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Abstract PDF: Abstract
PURPOSE
S: In May 29, 1999, the health department in Gumi city received a report from a local pediatrician that three children who attended a kindergarten were diagnosed with amebic dysentery. By May 31, fifteen more children from the same kindergarten were diagnosed with amebic dysentery. We conducted an investigation in order to verify the diagnosis, and to implement appropriate control measures.
METHODS
We conducted a questionnaire survey on 264 children in 3 kindergarten in Gumi city. Furthermore, 726 children in 4 kindergarten and 13 academies in Chilgok county whose lunch is supplied by the same unlicensed catering company were monitored for diarrheal symptoms.
RESULTS
Of 264 children in Gumi city, 74 children fitted the case definition (attack rate, 28%). Of 726 children in Chilgok county, 50 children were reported to have diarrheal symptoms. The clinical picture was dominated by the following symptoms; abdominal pain (85.1%), fever (83.8%), headache (50.0%), chilling (45.9%), vomiting (28.4%). The median duration of diarrhea was 2 days, and the median frequency of diarrhea was 3 times/day. Salmonella Typhimurium of the same antibiogram pattern were isolated from fifteen cases. However, no evidence of amebiasis was found from laboratory results or epidemiologic pattern.
CONCLUSIONS
: This epidemic was caused by Salmonella Typhimurium, which were present in lunch supplied by the unlicensed catering company. Improvement of the diagnostic ability in local health centers as well as public health centers and reinforcement of strict protocols regarding appropriate management of catering services should be emphasized; Summary

Green Tobacco Sickness on Tobacco Harvesters in a Korean Village.: Hyun Sul Lim, Kwan Lee; Korean J Epidemiol. 2002;24(1):29-36.

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Abstract PDF: Abstract
PURPOSE
This study was conducted to understand the proportion and the risk factors of green tobacco sickness (GTS).
METHODS
The authors conducted a questionnaire among tobacco harvesters; 94 people from 59 households at a village in Youngduk-gun from Feb 1 to Feb 3, 2002.
RESULTS
The study group contained 49 females and 45 males. The mean durations of employment and the length of the working day were 23.3 14.2 years and 11.8 2.7 hours, respectively. The symptoms related to tobacco harvest were dizziness in 64 cases (68.1%), headache in 46 cases (48.9%), nausea in 45 cases (47.9%), sore eyes in 37 cases (39.4%), and vomiting in 36 cases (38.3%). The experience of GTS up until 2001 was 70.2%. The proportion of GTS in 2001 was 67.0% and was significantly higher in females (84.9%, p<0.01). The proportion of GTS by work days in 2001 was 16.4 spells/100 person days. The proportion of non-smokers was significantly higher than smokers (p<0.01). Therefore, smoking was negatively associated with GTS. The use of gloves and wristlets significantly increased the proportion of GTS (p<0.05). Through multiple logistic regression, significantly associated factors with GTS were found to be smoking (OR=0.18, 95% CI: 0.06-0.54), wearing of gloves (OR=9.20, 95% CI: 1.27-66.52), and sweating (OR= 3.52, 95% CI: 1.08-11.47). Of those who reported GTS in 2001, 65.6% underwent treatment from the local medical facilities. The distribution of the medical facilities utilized was pharmacies 39.3%, and medical health centers 26.2%.
CONCLUSIONS
: In Korea, there are many tobacco harvesters, and most may be stricken with green tobacco sickness. In the future it is hoped that more extensive epidemiological studies will be conducted; Summary

An Epidemiologic Study on Sudden Deaths of Cattle Occurred in Kyongju.: Hyun Sul Lim, Hae Kwan Cheong, Jung Ran Kim, Ik Jung Kim, Gyoung Yim Ha; Korean J Epidemiol. 2001;23(1):59-68.

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Abstract PDF: Abstract
PURPOSE
This study was conducted to provide the baseline data for the epidemiologic and microbiologic investigation for the etiology of sudden deaths of cattle in Sara-Ri, Seo Myun, Kyongju.
METHODS
This survey was performed between April 11 and 22, 1994. Epidemiologic investigation consisted of interview of the residents, as well as pathologic and microbiologic test on tissues and blood samples from cardiac puncture.
RESULTS
The dead numbers of cattle were 149 in 35 households during about 20 years. The cows(63.9%) were more than bulls(36.1%) and most of them were raised in playpen(95.7%). The first death occurred in 1974, and then number of deaths increased until 1994. Besides the age of cattle at death was over two years old (88.3%), most of them(69.4%) died within one hour after onset of noticeable symptom by the farmers. The most common symptom of cattle at death was 'sudden death after screaming(71.1%)' and 'seizure (33.3%)'. Colonies from blood of case 3 showed double hemolysis in blood agar plate. The microbiologic test results in the culture of Clostridium perfringens. The pathological features were characterized as most of renal tubules revealed coagulative necrosis. Some gram-positive bacilli are scattered in interstitium.
CONCLUSIONS
Above results suggest C. perfringens as a possible pathogen of this ourbreak in livestock. The possibility of human infection, although nonfatal, and lack of vaccination against C. perfringens raises a need for stronger preventive action toward this communicable disease of cattle on this village.; Summary

Epidemiological Researches on the Health Hazards in Veterans of United States of America.: Hyun Sul Lim; Korean J Epidemiol. 2001;23(1):23-35.

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Abstract PDF: Abstract
The Department of Veterans Affairs(VA) maintains some large automated databases that provide the opportunity for studying long-term health effects of military service. The Beneficiary Identification and Record Locator Subsystem(BIRLS) is an excellent source of vital status information on veterans. The VA Patient Treatment File(PTF) is a computerized hospital discharge abstract system of inpatient records, including patients' demographic data, surgical and procedural transactions, and patient movements and diagnosis. The computerized Agent Orange Registry data include veteran's name, address, some information on military service, and findings at the time of his physical examination. The US conducted 235 atmospheric nuclear tests from 1945 through 1962. Many of the 250,000 test participants were exposed to low levels of radiation. The overall average radiation dose was estimated as 0.6 rem per year. In 1976, a claim relating acute myelocytic leukemia to radiation exposure from nuclear weapon testing received extensive publicity. Several thousand "atomic veterans" have sought medical care and compensation from VA for medical conditions that they believe are related to the nuclear weapon testing. Many WWII veterans have contracted the US VA about health problems that they attribute to their exposure to mustard gas. From 1962 to 1971, 75 million liters of herbicides, including over 41 million liters of the phenoxy herbicide Agent Orange, were sprayed on almost 9% of Vietnam. Many studies have been conducted to determine the association of various cancers with military service in Vietnam. Some diseases have been compensated for Vietnam veterans. Health problems reported following the Gulf War include a wide variety of symptoms similar to those found in acute combat reaction, posttraumatic stress disorder, and chronic fatigue. Health problems associated with war have continued and in some ways intensified. Therefore, The United States developed a plan for establishing a national center for the study of war-related illnesses and post-deployment health issues.; 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

Development of Lipoma among Residents Exposed to Glass Fiber Waste.: Hyun Sul Lim, Hae Kwan Cheong, Ji Yong Kim, Jung Ran Kim, Kiyoshi Sakai, Naomi Hisanaga; Korean J Epidemiol. 1999;21(2):159-175.

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This study was conducted to determine the relationship between exposure to glass fiber waste from an insulator factory and the development of cluster of lipomas among local residents in suburb Incheon, Korea. Authors surveyed 152 residents(71 males and 81 females) living near an insulator factory with a questionnaire and physical examination. Unused and disposed fiberglass from the waste site, along with ground water samples were examined under light and polarizing microscope and scanning electron microscope(SEM). Subcutaneous tumors excised from three of the residents were also examined under light and polarizing microscope, SEM with energy dispersive X-ray analysis(EDX), and transmission electron microscope(TEM). Analysis of elemental composition of the fibers and fiber concentration was done by with EDX under SEM and TEM after low temperature ashing. Twelve(7.9%) had subcutaneous tumors among the 152 residents. Tumors were surgically excised from 3 of them and they were all lipomas, consisting of mature fat tissue. These lipomas contained abundant birefringent fibers and particles under polarizing microscope. The concentrations of the fibers were 6.7, 71.8 and 499.2 million fibers per gram dry tissue, respectively. The birefringent fibers were composed of needle shaped particles with rectangular fractured ends up to 17 micrometer in length and 0.5 micrometer in diameter. EDX and x-ray diffraction analysis of the fibers showed that 71 to 100% of the fibers were magnesium silicate, talc. Magnesium silicate fibers were also found in the glass fiber sampled from the waste site. Glass fibers and magnesium silicate fibers were also identified in the ground water. Based on the fact that the magnesium silicate fibers found in the lipomas were similar in morphology and elemental composition to those found in the ground water and those from the waste site, these particles are likely to be introduced into the gastrointestinal tract through consumption of the contaminated ground water. It is suggested that fibrous magnesium silicate, talc, a component of fiberglass waste, may be associated with the development of lipomas.; Summary

Occupational Relationship of Cancer Patients Diagnosed in Two University Hospitals.: Geun Ryang Bae, Hyun Sul Lim, Doohie Kim; Korean J Epidemiol. 1999;21(1):64-71.

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OBJECTIVES
This study was performed to evaluate the occupational relationship on 190 cases of cancer selected out of 622 cases of cancer registered in two university hospitals from January 1, 1996 to December 31, 1997.
METHODS
The selection criteria was for the patient to be more than 40 years old with lung, liver, urinary bladder, nasal cavity and skin cancer or leukemia. We reviewed the medical records to update the missing data and occupational histories. Telephone interviews were used to obtain complete occupational histories on the subjects.
RESULTS
The sites of cancer in the order of relative frequency was lung (51.0%), followed by liver (32.9%), urinary bladder (14.1%) and skin (2.0%) in male, liver (41.5%), followed by lung (31.7%), skin (19.5%) and urinary bladder (7.3%) in female. The occupational histories of 190 cases with suspected cancer-causing occupations were recorded 5.8% on the doctor's medical records and 33.2% on the nursing records. The response rates of the telephone interviews were 87.4%. The distribution of occupation according to the telephone interviews was farmer (47.7%), office worker (16.1%), salesman (12.8%), production worker (6.7%), simple laborer (3.4%) and unknown (13.4%) in male, housewife (63.4%), farmer (17.1%), saleswoman (9.8%) and unknown (9.8%) in female. And there were two cases of suspected occupational relationships in the lung cancer cases.
CONCLUSIONS
We could not discover definite cases of occupational cancer but found out two cases of suspected occupational relationships. Occupational cancer is likely to increase in the near future, so the efforts to detect occupational relationships with cancer should be continued.; Summary

Incidence Density and Risk Factors of Low Back Pain among the Workers in a Welding Material Manufacturing Factory.: Ju Tae Park, Hyun Sul Lim; Korean J Epidemiol. 1999;21(1):36-52.

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This study was performed to understand the incidence density and detect the risk factors of occupational low back pain. A cross-sectional study was conducted with a questionnaire in a welding material manufacturing factory in October, 1993. Therefore, we selected 140 workers who had never complained of low back pain as cohorts. Also, we added 236 newly entered persons who had never complained of low back pain. The total number of cohorts were 376 workers. And then we continued with a questionnaire survey in October, 1996 and with a questionnaire survey and medical examinations by a specialist in October, 1997. Follow-ups were done for 337 workers. The number of newly developed low back pain among workers were 127. The characteristics of low back pain were as follows. The durations of pain were less than or equal to 2 days (42.6%), from 3 days to less than 1 week (8.7%), from 1 week to less than 1 month (11.0%), 1 month or more (6.2%). The frequency was everyday (7.9%), once per week (21.3%), once per month (14.2%), once per 2-3 months (9.4%), once per 5 months (11.0%). The severity of pain was slight (9.4%), mild (33.1%), moderate (13.4%), severe (10.2%) and very severe (1.6%). The onset of most low back pain was insidious (41.7%). The diagnosis of low back pain was muscle strain (37.8%), lumbar sprain (23.6%) and myofacial pain syndrome (3.9%). The number of newly developed low back pain among workers were 127, their incidence density was 15.7 per 100 person-years. In univariate analysis, age, marital status, educational level, smoking habit, category of job, tenures and frequency of stretching exercises showed a statistical significance. The multivariate logistic regression analysis confirmed that category of job and tenures (p<0.05) were independent risk factors for low back pain among workers. The number of newly developed occupational low back pain among production workers were 71, their incidence density was 11.3 per 100 person-years. In univariate analysis, age, marital status, educational level, regular exercise, tenures, posture of waist and lifting of heavy materials showed a statistical significance. The multivariate logistic regression analysis confirmed that posture of waist (p<0.05) and lifting of heavy materials (p<0.1) were independent risk factors for occupational low back pain among production workers.; Summary

An Epidemiological Investigation of an Outbreak of Rubella Occurred in a Male High School in Kyongju.: Hae Kwan Cheong, Hyun Sul Lim, Cheol Jung, Gyoung Yim Ha; Korean J Epidemiol. 1998;20(2):202-211.

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This epidemiological study was carried out to investigate the sources of infection and modes of transmission of an outbreak of rubella that occurred among male high school students in Kyongju in march, 1996. 770 male students(286 third grade, 262 second grade, 222 first grade students) were selected as the study subjects. A questionnaire was completed by the subjects. The anti-Rubella antibodies IgM and IgG were examined and tested by ELISA on all sera from 770 students and the environmental status of class rooms, the dormitory conditions and study rooms were tested. The positive IgM result rate was 17.8% and when the IgM negative was combined with IgG positive the results was 74.9%. IgM IgG negative rates were 7.3%, however, out of a total 770 students. Amongst the older students, the IgM positive rate showed an increase(p<0.01). Out of 137 cases(with a cummulative incidence rate of 71.0%), there were 97 apparant cases(cummulative incidence rate 50.3%) and 40 inapparent cases(cummulative incidence rate 20.7%). Again, the cummulative incidence rate showed an increase in the older students(p<0.04). In the apparent cases, major symptoms included eruption(96.9%), fever(85.6%), lymphadenitis(82.5%), generalized aches and muscle tenderness(76.3%), and a sore throat(61.9%). These symptoms lasted anywhere from 2 degrees =/ 13 days, the average duration being 4 days in length. Initially, there were 9 people on third grade and suspected origin was from more than 2 external sources. It progressed from the upper grades down to the lower grades. In dormitory students, the cummulative incidence ratio was 1.70 and 1.78 amongst study room students.; Summary

An Epidemiological Survey on a Salmonella enteritidis Outbreak in Kyongju, Korea.: Mee Kyung Kim, Hyun Sul Lim, Cheol Jung, Gyoung Yim Ha; Korean J Epidemiol. 1998;20(2):187-201.

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This study was conducted to investigate the cause and magnitude of food poisoning among residents and visitors for a birthday party in a rural area of Kyongju city in september, 1996. The total subjects were 137 persons, 119 residents(53 males, 66 females), including 7 hospitalixed patients and 18 visitors(8 males, 10 females). The investigation consisted of an interview survey, a study on clinical characteristics for the patients hospitalized, bacteriological examinations of the underground water and microbiologic examinations on microbes isolated from the patients. The population at risk was 59 persons(24 males, 35 females). The attack rate was 50.0%(12 cases) for males, 48.6% for females(17 cases). The cases were distributed evenly for all age groups. The attack rates for each party-food and possible fooe groups were not significantly different. Most clinical symptoms were significantly more frequent among cases than non-ases: abdominal pain(73.1%), diarrhea(73.1%), chilliness(69.2%), fever(65.4%), anorexia(61.5%), nausea(53.8%), general weakness(50.0%) and dizziness(50.0%) were the major symptoms among the cases. The admission rate among the cases was 24.1%(1 male, 6 females). In the stool cultures, Salmonella species group D was isolated from 6 persons of 85 examinees. It was identified as Salmonella enteritidis by serological diagnosis. The samples of underground water were assessed Enon-compatible for drinking in 10 wells(83.3%) of this rural area and it was suggested that it could have been contaminated from cattle feces. There were two wells in the party house, one of them was contaminated by bacterias including E. coli. The contaminated water was stored in a water tank located on the rooftop. This water was used for dish washing and cooking. Wd concluded that the cause of this epidemic was the underground water contaminated by Salmonella enteritidis from guman carriers or domestic animal carriers.; Summary

A Case of Ulceroglandular Tularemia Occurred In Korea.: Hyun Sul Lim, Hae Kwan Cheong, Woo Sup Ahn, Moon Youn Kim, Dong Hoon Kim; Korean J Epidemiol. 1998;20(1):32-38.

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Tularemia is a zoonosis caused by Francisella tularensis. It is primarily a disease of wild animals. Human infection is incidental and usually results from interaction with biting or blood-sucking insect, wild or domestic animals or the environment. It is common in United States. An increasing number of cases have been reported from the Scandinavian countries, eastern Europe, Siberia, and Japan. But In Korea it has not been reported. A 40-year old male visited the department of Surgery on Jan 13, 1997 complaining multiple swollen lymph-nodes on his axillae and upper right arm for about ten days. On Dec 25, 1996, he found a dead wild rabbit at mountainside nearby, cooked it himself and ate it with his friends. He informed us that he got light injury on both hands while he was walking on the mountainside. On Dec 28, he started to suffer from high fever, fatigue and loss of appetite lasting for a day. After medication at a local clinic for several day, symptoms were somewhat relieved. A week later(Jan 4, 1997), several erythematous lesions developed on his both hands, which left ulcerations on the skin. Both axillary lymph nodes were swollen at both sides, but not tender. He visited the department of surgery on Jan 13 and he admitted on Jan 15. During hospitalization, the lymph nodes were surgically removed from both axillae and upper left arm. On microbiologic examination, small aerobic gram negative coccobacilli were grown on the chocolate agar plate in aerobic condition with 5% CO2 at 37 degrees centigrade. On Feb 10, fine needle aspiration from the liver abscess was done, drawing 3 ml of yellowish thick pustular material, but the microorganism was not isolated at the smear and culture of this material in the same condition as described above. After admission, he was treated with antibiotics(cefazole and marocin). His general conditions and laboratory results, including liver function, were markedly improved. He was discharged on Feb 12 and appears well on subsequent follow-ups. The microorganism and lymph nodes were sent to Centers for Disease Control and Prevention in the United States for further evaluation. A twostep indirect immunoalkaline phosphatase technique using an anti-F. tularensis antibody was performed on the lyph nodes having a positive reaction. The immunohistochemical stain demonstrated intense positivity in the stellate abscesses and fine granular reaction in some of the vessels in the paracortical region. Also F. tularensis was identified in the agar plug by culture morphology and immunofluorescence antibody test. We report a case of F. tularensis in Korea for the first time. Further studies were recommened for epidemiological characteristics and prevention of the disease.; Summary

An Epidemiologic Study on the Health Hazards of Inhabitants chronically exposed to Glass Fiber.: Hyun Sul Lim, Yun Chul Hong, Jung Ran Kim, Hae Kwan Cheong, Ji Yong Kim, Nam Won Paik, Hoe Kyeong Cheong, Chong Han Lem; Korean J Epidemiol. 1995;17(1):76-93.

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Fiberglass, as a substitute of asbestos, is used for more than 60 years as a insulator material. Health hazards including irritation of skin, mucosa and respiratory system associated with use of fiberglass is reported. Many studies on the fibrogenicity and carcinogenicity of fiberglass was conducted but evidence is not sufficient to confirm the carcinogenicity or fibrogenicity. Authors studied the health hazards among 152 inhabitants(71 men and 81 women) from 32 households living around the fiberglass factory which produced the fiberglass insulators and glasswool panels for 20 years. Questionnaire survey on household and persons, examination of underground water, pathologic examination of subcutaneous tumors and examination of fiberglass in tumor tissues were done. The results are as follows; 1. Fiberglass concentration of underground water sampled from 33 households in the study area was 13. 7-95. 9 fiber/cc with the diameter to length ratio more than 1:20. 2. Prevalence of dermatosis among study subjects was 23.0 % (35 cases). Prevalence was not associated with the distance from the factory nor duration of exposure. 3. There were 15 cases of subcutaneous tumor with prevalence of 9. 9 %. Age of subcutaneous tumor cases was all above 30 year-old except one cases, who was 5 year old child, who lived in the surveyed area since he was born. Prevalence of subcutaneous tumor was significantly high in area A(42.9 %) than area B(4.6 %, p<0.01). Prevalence of subcutaneous tumor was higher in long-term exposed inhabitants, but was not statistically significant. 4. Pathologic examination exhibits partly encapsulated fat tissue masses and cut surfaces were pale yellow with gritty sensation. The masses consist of mature fat cells showing variation in size and shape. On polarizing microscope, the peripheries of tumors include small irregular threads of doubly refractile material probably represent glass fibers in fibrocollagenous tissue. Concentration of fiberglass in tissue was 5.1-10.2 fiber/rag wet tissue in case 1, 25.8-184.9 fiber/mg wet tissue in case 2 and 40.8-126.5 fiber/mg wet tissue in case 3. Length of fiberglass was shorter than that in underground water. 5. Cases of malignant tumor among inhabitants since last 10 years were 4, 3 of whom was developed in a same household just near the factory. Diagnoses of malignancy cases were stomach cancer, stomach and esophageal cancer, oral cavity cancer, and stomach cancer with liver metastasis. On review examination of tissues of endoscopic biopsy specimen from a case of stomach cancer, there was adenocarcinoma with no evidence of fiberglass materials. Authors concluded there is evidences that fiberglass was strongly associated with the development of the health hazards including dermatosis and benign subcutaneous tumor. However, the association of fiberglass exposure with the development of malignant tumor was not clear, although strongly suggested. For the prevention of development of further health hazards, it is recommended that under ground water source should be closed and further experimental study to confirm the mechanism of the tumorigenesis and follow up survey on the inhabitants should be conducted.; Summary

A study on the health status of the inhabitants exposed to cementdust.: Hae Kwan Cheong, Joung Soon Kim, Byung Soon Choi, Chung Bum Kim, Sung Il Cho, Yun Mi Song, Hyun Sul Lim; Korean J Epidemiol. 1992;14(1):59-69.

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A health impact of environmental cement dust exposure among inhabitants around a cement factory was carried out with special emphasis on finding bronchial asthma cases in this area. Questionnaire survey and physical examination were done on 437 persons in two villages located within 1km distance from the cement factory. On the basis of questionnaire survey and physical examination, 56 persons with suspicion of bronchial asthma were screened, who were further examined to establish diagnosis by physical examination, pulmonary function test and bronchodilator test.
Results
are as follows : 1. Inhabitants in surveyed area had high prevalence of acute and chronic diseases, particularly respiratory diseases and dermatologic diseases. 2. Respiratory symptoms complained were sputum(23.9%), cough(23.0%), dyspnea(19.1%), chest tightness(14.6%), and wheezy breath sound(13.1%). On physical examination, pterygium(29.5%), decreased breath sound(3.0%), wheezing(3.3%), and rales(2.7%) were found. 3. On diagnostic examination, 32 cases (prevalence rate 7.3%) of bronchial asthma and 10 current cases (prevalence rate 2.3%) of bronchial asthma were confirmed. Thus it is postulated that high prevalence of bronchial asthma and respiratory diseases in this area may be related to environmental exposure to the cement dust. Further study, however, such as bronchial provocation test may be necessary to establish definite conclusion on causal relationship between bronchial asthma and environmental cement dust exposure.; Summary

A study on the effect of noise exposure to the health of a population: Sung Il Cho, Joung Soon Kim, Hyun Sul Lim, Hae Kwan Cheong, Byung Soon Choi; Korean J Epidemiol. 1990;12(2):153-164.

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For the purpose of evaluating the effect of noise exposure to the health of a population in a village near an air force shooting practice site, a cross-sectional study was conducted from April 1 to April 23 in 1989, on the inhabitants of the village as exposed group and on the population of another provincial village as nonexposed group, which was similar to the exposed in socioeconomic status but had not been exposed to the environmental noise. Subjective symptoms, pulse rate, blood pressure, and pure tone thresholds were compared in the exposed group and the nonexposed group. 150 and 93 subjectes studied were analyzed in each group. The results were as follows : 1) There was a significant difference between the two groups in the frequency of subjective symptoms including otalgia, hearing loss, tinnitus, ear fullness, nausea, diarrhea, indigestion, and anxiety. 2) There was no significant difference between the two groups in average pulse rate, while significant differences were seen in average systolic and diastolic arterial blood pressures, which were 138± 23.2mmHg and 84.5±14.4mmHg in the exposed group and 126.8±19.3mmHg and 73.8±11.3mmHg in the nonexposed group. The prevalence of hypertension by WHO criteria was 24.0% in the exposed group and 8.6% in the nonexposed group, of which difference was statistically significant. 3) There was no significant difference between the two groups in average hearing loss value, while the prevalence of hearing impairment in the exposed and the nonexposed group was 24.0% and 13.4% each according to the criteria of 500, 1000, 2000Hzx pure tone average greater than 26dB, showing a significant difference between the two groups. 4) As the duration of residence increased the hearing loss value increased in the exposed group, but age-corrected percentage hearing loss did not show any increase ; further study may be necessary to determine whether the significantly high prevalence of hearing loss in the exposed group was due to the environmental noise exposure.; Summary

Development of pneumoconiosis among inhabitants around a briquet factory: a case report: Hae Kwan Cheong, Hyun Sul Lim, Jung Jin Cho, Jae Jun Byeon, Yong Tae Ahn, Yup Yoon, Jung Gi Im; Korean J Epidemiol. 1988;10(1):102-108.

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In 1987, Chang and collegues reported a case of biopsy proven anthracosis developed in a housewife living around a briquet factory in Seoul. It was suggested that her anthracosis was a result of long-term environmental exposure to coal dust from the factory and coal storage site of 700 meters distance from her house. The possibility of development of anthracosis due to environmental exposure was debated but of further cases was strongly suggested. Authors examed 87 persons living within 1km distance from the factory to detect the additional cases of pneumoconiosis. The exam consisted general informations including occupational exposure to dust, medical history on chronic illness including respiratory illness, physical exam by physicians and chest PA. Chest films were interpreted by two chest radiologists independently without giving prior information about each case. Each interpretation was compared and only those that both radiologists concommitantly interpreted as pneumoconiosis were accepted as cases. Result of interpretation was evaluated with clinical information taken by physicians. Three cases of pneumoconiosis and 3 cases of suspects were found. 1. Of 3 cases of pneumoconiosis, the first case, 45 years old female, was index case already diagnosed by Chang et al. Another one, 49 years old male, has been employed in the briquet factory in that area for 10 years. Another one, 38 years old male, living in that area for 7 years without previous history of dust exposure, was supposed to be developed the disease after environmental exposure to coal dust. 2. Of 3 cases of suspects, a case, 62 years old male, had 15 years of occupational exposure to coal dust. Another two cases, 63 years old females, had no occupational history but each had medical history of diabetes and chronic obstructive lung disease.; Summary

A survey on two epidemics of diarrheal disease in a rural area of Korea: Hyun Sul Lim; Korean J Epidemiol. 1980;2(1):89-96.

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In July and August, 1980, two epidemics of dierrheal disease were occurred in a rural area of Korea. In order to characterize these epidemics epidemiologically, including causative agent and the mode of transmission, a field investigations were conducted during the out-breaks by household interview, collection and examination of specimens Obtained results and findings from these studies are summarized as follows； <The first example of epidemic> 1. Incidence rate in studied population was 34.4% for all population. Age specific incidence rate of 5-9 year age group, however, was extremely high as 80.0%. Incidence rate by sex was not significantly different. 2. These illnesses were clinically characterized by watery dierrhea(100.0%), mucoid diarrhea (90.9%), fever(72.7%), headache(54.5%), and chill(54.5%). 3. Shigella Sonnei was isolated by microbiological examination. 4. The mode of transmission was not clearly confirmed although the spring (1) was strongly suspected being common vehicle according to the result of the epidemiologic study. <The second example of epidemic> 1. Incidence rate for the studied population was 55.6%. Incidence rate of female was significantly higher (61.0%) than males Incidence rate by age was not significantly different. 2. These illnesses were clinically characterized by watery diarrhea (100.0%), tenesmus(60.0%), abdominal pain(47.5%), and mucoid diarrhea(40.0%). 3. Incidence rate was 66.0% in population using simple piped water supply system (1) only, but 26.3% in population using both simple piped water supply system (1) and (2). Therefore, simple piped water supply system (1) perhaps has played an important role in this epidemic as common vehicle. 4. Detailed mode of infection was not clearly identified.; Summary

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