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An evaluation study on the Korean national tuberculosis control program by literature reviews
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Joung Soon Kim, Gill Han Bai, In Sook Lee
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Korean J Epidemiol. 1985;7(1):59-105.
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Abstract
The Korean national tuberculosis control program reduced the prevalence rate of tuberculosis from 5.1% in 1965 to 2.5% in 1980, for which many people including the responsible policy makers tend to think the tuberculosis is no more health problem to deal with seriously, and there has been an argument whether the program should be continued futher or not.
At this crucial point of time this study was carried out in an attempt to evaluate the tuberculosis control program in terms of effort, performance, adequacy of performance, efficiency and process by reviewing all the available literatures relevant to the control program, particularly the national tuberculosis prevalence survey data collected every five-year from the 1965.
Despite the long term effort to control tuberculosis as a priority national intervention program tuberculosis is still major health problem in Korea; currently the deaths due to tuberculosis count about 15,000 per year ranking 4th among all causes of death and tuberculosis patients count about 852,000 when projected the prevalence rate 2.5% of 1980 to the total population. Moreover only 340,000 (40%) patients out of 850,000 estimated patients have been identified and under the treatment, and that among these identified patients less than half would complete the full course of the treatment until they become free from the disease. Thus in summary one fifth of the patients estimated achieved ultimate goal of the program.
Taking the reduction trend of death and prevalence rate of tuberculosis during last 15 years into account, it may take around 20 years to reduce the prevalence rate to 1% or under 1% even when the control program in current scale goes on.
From the results of the study it is concluded that reinforcement of the control program is indispensable, reinforced budgetary and legal input.
Detailed data used for the evaluation are presented in tables and some strategies to increase the efficiency of the program are discussed.
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Summary
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Case-control study on psychosexual impact of vasectomy
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Yong Heo, Joung Soon Kim, Hee Sup Yoon, Sook Ja Yang, In Sook Lee
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Korean J Epidemiol. 1984;6(1):124-136.
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Abstract
The objective of this research is to study psychosexual impacts of vasectomy by means of case-control study in order to provide more valid information on the subject because most of the similar studies have been criticized as having various methodological defects.
In this study one hundred vasectomized men and their wives were randomly selected from a rural and semi-urban communities and matched with non-vasectomized neighbors of the cases to achieve higher validity of the data by isolating the impacts of vasectomy from a set of other possible confounding variables such as age, socioeconomic status and occupation.
The study was carried out from the December 1983 to the January 1984. The most cases were vasectomized during the period between 1972 and 1979 according to the record obtained from the local family planning association.
The information were collected by interviewing husband and wife at the same time but separately to minimize bias that might occur from mutual communication prior to the interview.
The summary of the results obtained are as followings:
1. General characteristics of the subjects studied
1) At the time of vasectomy the mean age was 34.4 years and the average number of children and son was 3.2 and 1.7 respectively. The mean duration of marriage till the vasectomy was 8.9 year. The average number of son at the time of the study was 1.7 for the case group contrast to 1.5 for the control group of which difference was statistically significant (p=0.035) although the total number of children was the same.
2) There was no difference between the case and control groups in the level of education and occupation.
3) The motivation of the sterilization stated by the cases of vasectomy was enough number of children and economic reason in 70.8%. The reason of selecting vasectomy among other contraceptive methods were the simplicity, low failure rate and less complication of the vasectomy in the majority of the cases (85.2%).
2. Psychosexual impacts of vasectomy
1) In psychosexual impacts classified into four categories, i.e. tiredness of sex, sxiness, frequency of coitus and sexual satisfaction, the proportion of husband reporting ‘No Change’ was significantly less at the time of interview than the time 2-3 years right after the vasectomy. On the other hand, in both sexiness and coitus frequency the proportion of husband reporting ‘Decreased’ were significantly higher at the time of interview than the time 2-3 years after the vasectomy.
2) Responses of husband and wife on the husband’s psychosexual change at the time of interview in case and control groups showed that the proportion of couples reporting ‘No Change’ was higher, and reporting 'Decreased' was lower in case group than in control group. Particularly the differences in the sexiness and frequency of coitus between the case and control groups were statistically significant (p=0.005) being decreased more in control group.
3) The proportion of husband reporting 'Decreased’ in sexual activities was positively in proportion to the age whereas the proportion reporting ‘No Change’ was negatively in proportion to the age for both case and control groups.
4) The agreement rate between the responses of husband and wife on the husband’s psychosexual change was low for both case and control couples (overall value of kappa=0.21-0.37).
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Summary
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Epidemiologic characteristics of the 1982 Japanese encephalitis epidemic occurred in Korea
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Joung Soon Kim, In Sook Lee, Hyun Sool Lim, Chu Won Lee, Suk Woo Shin
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Korean J Epidemiol. 1983;5(1):1-28.
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Abstract
In 1982, about 2,000 cases of Japanese encephalitis have occurred despite the governmental effort such as the early warning of the increased vector mosquito density, vaccination campaign and other control measures. Japanese encephalitis had been endemic in Korea with small and large epidemics since the JE virus was isolated in 1949; The JE cases had been remarkably reduced to a few hundred cases since 1969 for over a decade, which increased suddely in 1982. In order to identify responsible factors of the epidemic, all reported cases and a part of hospital patients through medical record survey were analysed. Cases suspicious of encephalitis were reported to Ministry of Health and Social Affairs through, national administrative channel and the final confirmation of the disease was based on the HI antiboy titer of which criteria were set up by the government; it was defined as true encephalitis case when the antibody titer was over 1 : 160 and the subsequent tests stowed fourfold increase in case the first test less than 1 : 160. The hospital medical record survey was carried out on 54% of all reported cases.
Summary of the study results is as followings:
Among 2975 reported cases about 40% of them were confirmed to be true Japanese encephalitis, about 20% were confirmed to be negative serologically, and the rest of the cases reported never been re-test following the first tests that were negative. Accordingly if the same positive rate is applied for the unconfirmed cases, the total true cases of Japanese encephlaitis estimated to be 2,112 cases. When confirmed cases were compared with total reported cases in the date of onset, age and sex specific incidence rate, duration between the first medical attendence and the onset, duration of hospital admission and the type of medical facility utilized, the both groups showed the similar patterns so that it was unable to characterize them separately.
Only with the confirmed cases of Japanese encephalitis the incidence rate of the disease was 3.1 per 100,000 population for whole Korean. The incidence rate varied by province from 2.0 in Gangweon to 7.1 in Chungbug Province; in the agricultural rural area the incidence rate was 3 times higher than in metropolitan area being the higher in South-western part of the country than Northeastern part. Also the disease started from the Southwest moving toward the Northeast which coincided with the time of vector mosquito density Peaks. The age specific incidence rates were higher among younger ages between 5 and 15 years and males 1.7 times higher than females. The majority(87%) of the patients had received medical attention within five days from the onset. The duration of hospital admission was 138.5 days. The case fatality rate was 3.3% being Higher among females, and younger children in females and older ages in males. Among total deaths about one third of death occurred within one week and 97% in two weeks.
The sero-conversion for the specific antibody by the JE viral infection was found to be so slow that the serological test as the confirmatory evidence was inefficient; The positive conversion occurred in 46% of confirmed cases in one week and 78% in two weeks after the onset of the disease.
The human epidemic of Japanese encephalitis showed association with the densities of pigs and vector population when data were comparatively analysed.
The medical record survey in which 1692 cases out of 2,975 reported cases were included, showed that only 41% of them were confirmed as true Japanese encephalitis, 5% as non-encephalitis cases and 59% never had follow-up confirmatory test but negative in single serological test.
The final diagnosis on discharge varied widely; Japanese encephalitis 32.6%, suspected Japanese encephalitis 6.6%, meningo-encephalitis 6.1%, viral encephalits 3.1%, encephalitis 23.6%, epidemic encephalitis 4.4%, and aseptic meningitis 5.5% which comprised 83% of total cases studied. Also the specific antibody positive rate varied by the final diagnosis ranging from 18% for aseptic meningitis to 62% for epidemic encephalitis.
When these diseases were compared with each another in epidemiologic and clinical charateristics, they were very similar except meningo-encephalitis, viral encephalitis and aseptic meningitis that revealed a little differences in many aspects as presented in tables of text.
This study was supported by Korean Institute of Population and Health.
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A study of epidemiologic transition in Korea
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In Sook Lee, Joung Soon Kim
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Korean J Epidemiol. 1982;4(1):52-89.
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Abstract
Several changes have occured in patterns of health and disease during the process of national development; a process that is made up a complex network of social, economic, cultural, environmental, and health components. The pace, type and extent of these changes as well as of their determinants and consequences are described in terms of the theory of the epidemiologic transition by A.R.Omran. The theory of epidemiologic transition focuses on the complex changes in pattern of health and disease over time and the interactions between these patterns and their economic, demographic, and sociologic determinants. There can be little doubt that such a transition is still under way in less developed societies. Changes in patterns of disease and death that occur during the transition can be characterized as moving through three distinct phases: the Age of Pestilence and Famine, the Age of Receding Pandemics, and The Age of Degenerative and Man-Made Disease.
Depending upon the pace of change and particulars of the transition in the modern era, three models of the epidemiologic transition can be delineated: the classical model, an accelerated model and the delayed model.
This study was carried out in order to classify the Epidemiologic transitional period in Korea by analysing all available national statistics from the end of the Joseon Dynasty to the present. The result of the study summerized are as followings:
1. In social and economic profiles, the age of receding pandemics which is characterized by the early stage of industrialization and improved living standards as well as improved environmental stanitation fits into the period between 1940's and 1970's.
This period may be devided into two periods, pre-war and post-war period at the boundary of 1955.
2. In demographic profiles, the age of receding pandemics coincided with the period (1940’s-1970’s), which is characterized by decreased mortality rate and progressively increasing population growth rate.
3. In Mortality & Diseases profiles, the age of receding pandemics also covers the same period, 1940’s-1970’s characterized by decreased mortality yet with occasional epidemics and famines. During the transition from infectious-disease to degenerative-disease predominance, the level of mortality for women that had been cosistantly higher than that of men was started to move to lower level.
4. In community health profiles, systemic health services were organized in 1955, however mordern nationwide comprehensive health programs were develoepd in 1977.
5. Epidemiologic transition in Korea took place with rapid industrialization, modernization, and urbanization accompanied by demographic changes as well as changes of disease patterns, the infectious diseases being replaced by the degenerative and mon-mode diseases in the causes of morbidity and mortality. The age of receding pandemics in this sense coincide the period between 1940’s and the middle of 1970's. The model of Korean epideniologic transition is certainly an accelerated model which took only 35 years or 40 years to accomplish the last age of the transition from the frist age.
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