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Volume 10 (1); June 1988
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Korean Society of Epidemiology
Korean J Epidemiol. 1988;10(1):125-130.
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Korean Society of Epidemiology
Korean J Epidemiol. 1988;10(1):124-124.
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Original Articles
A study on the effect of regional health insurance upon the appendectomy rate
Yo Hwan Yang, Il Soon Kim, Hee Choul Oh
Korean J Epidemiol. 1988;10(1):109-123.
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The objective of this study is to identify the change of the incidence and patterns of appendectomy due to the introduction of regional health insurance. In order to compare the appendectomy rate before and after the introduction of regional health insurance, survey was performed in Kangwha county were the regional health insurance has implemented for all residents since July 1, 1982. Seventy risidents from 3 townships (Seonwon, Buleun and Naega Myun) had received appendectomy from July 1, 1977 to June 30, 1982 and 790 people among all residents in the county had received appendectomy for the next 5 years(1982. 7.1-1987. 6.30). The results are as follows: 1. The appendectomy rate before insurance was 8.7/10,000, but it was increased significantly to 22.4/10,000 after the insurance. 2. The appendectomy rate among young age group was increased remarkably, especially, the rate was increased by 12.4 times for female teen age group. 3. While the percentage of perforated appendicitis among appendectomy cases was decreased after the insurance, the rate of perforated appendicitis per 10,000 population was increased to only 1.9 times. 4. The appendectomy rate was increased more in the high economic group than that in low economic group. 5. During the 5 years after insurance, while the appendectomy rate had been increased steadily, complicated appendicitis rate had not been increased annually. Perforated appendicitis rate was slightly increased, but it was not statistically significant. 6. Higher levels of appendectomy rates in all clinical types were noted in high economic group compared with the low economic group. 7. Appendectomy rates and perforated appendicitis rate among the residents in islands (the lowest accessibility group) were higher than those of Myun and Eup. But it was not statistically significant. From this result it was found that there are remarkable increase in appendectomy rate and appendicitis rate in Korean rural area after the implementation of regional health insurance. The reason for such increase may be due to the spontaneous remissions of appendicitis before insurance without surgery. To understand this phenomenon, there is a need to study the natural history of appendicitis in population for the further study.
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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.
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An epidemiological investigation of typhoid fever outbreaks in a hot spring resort town and its satellite rural villages
Joung Soon Kim, Yong Heo, Sung Soo Lee, Duk Hyoung Lee, Kun Young Shon, Sung Woo Lee
Korean J Epidemiol. 1988;10(1):92-101.
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An epidemiological investigation was carried out to identify source of infection and mode of transmission of typhoid fever outbreak, which has occurred in a hot spring resort town and its satellite rural villages from the begining of the march 1988. The investigation was carried out for two days, April 16th and 17th, on hospitalized patients and the villages where confirmed cases had been reported. The results obtained are as followings: 1. The S. Typhi isolated from 47 patients were all the same phage type that was untypable phage Type. 2. The incidence rate of typhoid fever among surveyed population, the populations belong to the same Ban (about 20-50 households) of the patients re¬ported, was 13.2% in hot spring resort town and 9.8% for the satellite villagers. 3. The incidence showed no difference between male and female population as a whole although for the age groups of 0-9 years old and 10-19 years old the incindence rates were much higher among males, and for the age groups of 20-29 years old, 30-39 years, and 40-49 years the rates were higher among females; for the age group of 20-29 years, female’s rate was as high as 5 times of males. The lowest rate was found among older ages. 4. The study results suggested that the source of infection was primarily water supply contaminated by sewage; the central water supply has been under repair for replacement of broken pipes almost for a month, from the end of February and the begining of April, in on and off fashion. Supportive data are presented in the text.
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Effects of maternal age and parity on twin in births in Korea
Kwang Ho Meng, Suck Chan Kim, Suck Ho Shin, Jae Shin Ahn
Korean J Epidemiol. 1988;10(1):86-91.
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Positive effects of increasing maternal age and parity on the incidence of twinning have been well documented by several investigators in United States and other Europian countries. This case-control type of study attempted to confirm the association in Korea at first by using hospital records from Kangnam St. Mary’s hospital, Seoul.
Case
s are total of 101 twin births born in 1982-1986 and controls are 1315 singletons born in 1986. Information other than maternal age and parity such as season of birth, gestation period, birth weight and methods of delivery were also collected and compared between singletons and twins. No significant associations were found in frequency distribution of twins and singletons by maternal age and parity. However the estimated risk of twinning for women aged 35 years and over was 2.19 times higher than for women aged 34 years and less, and the risk ratio was statistically significant (odds ratio=2.19, 95% C.I.=1.13-4.23). Less impressive associations of maternal age and parity with incidence of twin births seems to be ascribed to decreased maternal age and parity in recent years in Korea.
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Morbidity rate and health care utilization in coal miners
Kyung Yong Rhee, Ho Keun Chung
Korean J Epidemiol. 1988;10(1):75-85.
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In order to investigate healthy worker effect in morbidity rate and health care utilization of coal miners, the author surveyed morbidity rate of coal miners, iron miners and cement manufacturing workers as comparison groups from April to May in 1986. Structured questionnaire interview was used by medical student as well trained interviewer for survey. Subject of this study was sampled randomly, and sample size was 1,825 workers totally; 632 coal miners, 265 iron miners, 928 manufacturing workers. The major findings were as follows: 1) After adjusting general characteristics, morbidity rate of coal miners was higher than that of other two groups(coal miners: 59%, iron miners: 49%, manufacturing workers: 25%). 2) After adjusting general characteristics, unmet need rate of coal miners was higher than that of other two groups(coal miners: 65%, iron miners: 50%, manufacturing workers: 46%). 3) Distribution of respondent by reason for non-visit to health care facilities in each groups were different. Major two reasons in each group were follows: not severe(51.3%) and poor(13.9%) in coal miners, not severe(84.6%) and busy(4.6%) in iron miners, not severe(82.9%) and busy(2.7%) in manufacturing workers. 4) There was no healthy worker effect in morbidity rate of coal miners and iron miners, but in manufacturing workers healthy worker effect was controversial because of morbidity rate of general population. 5) Number of visit to hospital and clinic within two weeks per worker was 0.296 in coal miners and in iron miners that was 0.328, and in manufacturing workers that was 0.164. 6) Patterns of health care utilization in each group were very similar. Drug store was most accessible health care facility because of its geographical accessibility and health care cost. And hospital and clinic were also available health care facilities because of health insurance.
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Current status of cancer research and future goals
Won Young Lee, Joung Soon Kim
Korean J Epidemiol. 1988;10(1):64-74.
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The current status of cancer research have been briefly summarized to clarify the problems remained to be solved for the cancer control. Cancer control program can be divided into three steps which are the general principle of disease control; the primary, the secondary, and the tertiary prevention. For the primary prevention, it is neccessary to iden¬tify the etiologic agent for the desease to be controlled. It has been reported that the agents associated with human cancers cannot be singled out. Furthermore, the genes which act a critical role(s) in pathways of tumorigenesis are our own in every normal cells. Thus, the primary prevention for the cancer can not be applicable at present except for the public health education especially when a certain risk factors are avoidable by changing human behaviors and working environments(eg; smoking and lung cancer). The tertiary prevention provides measures to help the persons recovered from the cancer to adapt to the society. However, this is applicable only when the secondary prevention measures are satisfactory and successful. Therefore, the only step we have to put our major efforts for the cancer control today may be the field of research for the secondary prevention. Since the secondary prevention depend upon the measures for the diagnosis and therapy for the patients suffering from the cancer, this is the urgently needed field not only for the patients but also the medical workers in this fields. Chemotherarpy and radiotherapy except surgery are the methods of cell killing by use of cytotoxic effect of the chemotherapeutics and radiation. The others are hyperthermia and photodynamic therapy which are not widely used at present. All of these methods have the limitation in use mainely due to the lack of the specificty. One of the methods to increase the specificity of these method were the introduction of the immunologic tools including monoclonal antibodies which can be used independently or in combinatory ways. However, practical value of the methods were not so much appreciated due to the heterogeneic nature of the tumor cells in various aspects. Also the use of the various types of the biological response modifiers have been extensively studied for the clinical applications. Those have been proved to be strong immune-adjuvants in vitro. Their role(s) in vivo especially for the tumor control remained to be analized. Emergence of the resistant cells, especially the fraction of the stem cell population following tumor therapy regardless the types of the therapy, chemotherapy or radiotherapy is the major problem to be solved. Thus, it is necessary to develope highly sensitive and specific chemotherapeutic method which may kill only the tumor cells leaving the normal cells alive. Efforts must be focused on the search and development of new agents. This may be the primary task in cancer control today. Because the development of new agents includes not only the new source of chemeotherapeutics but also the agents which can provide a certain complementary fuctions to the defects found in chemotherapy, radiotherapy, immunotherapy, and hyperthermia to maximize the efficiency of the therapy.
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A literature review of vitamin A and cancer
Hyun Kyung Moon
Korean J Epidemiol. 1988;10(1):51-63.
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Controversy
Does dietary fat play a major role in the epidemic of coronary heart disease?
Kwang Ho Meng
Korean J Epidemiol. 1988;10(1):44-50.
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In this paper, controversy on the role of dietary fat in the epidemic of coronary heart disease is reviewed. Majority view among those from not only public health disciplines but also from those cardiologists and investigators involved in public health considera¬tions of atherosclerosis research is that the coronary heart disease is a public health phenomenon of affluent cultures and mass hyperlipidemia is a prime requisite for mass atherosclerosis. Because of this, in most of the western countries, the official line since 1950 for management of the epidemic of coronary heart disease has been a dietary treatment. This diet-heart propaganda was further escalated by the recommendations from the American Heart Association. However, some researchers have different view on diet-heart hypothesis and this paper reviews some of the evidences that they consider the hypothesis is wrong. Methodological issues to be considered in ending the diet-heart question are also discussed.
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Special editions
Cancer registered in Korea
Il Suh, Il Soon Kim
Korean J Epidemiol. 1988;10(1):40-43.
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Cancer risk factors of Koreans
Soo Yong Choi
Korean J Epidemiol. 1988;10(1):30-39.
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Epidemiologic characteristics of cancer mortality and morbidity among Koreans
Joung Soon Kim
Korean J Epidemiol. 1988;10(1):1-29.
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Cancer has been a major cause of death among Koreans since 1970’s. This study was carried out to characterize the cancer occurrence among Koreans by analyzing mortality and morbidity data. The source of data on cancer mortality is annual reports on the cause of death statistics produced by National Bureau of Statistics, EPB Korea and annual World Health Statistics; on morbidity of cancer is prevalence survey of 1987 for the populations of six health insurance demonstration project areas. Mortality rate and prevalence rate per 100,000 population were plotted on the semi-logarithmic paper by cancer site, sex and age groups for comparison. Observed results are as followings: 1. Mortality rates per 100,000 caused by all sites cancer among Koreans in 1985 were 95.0 for males and 54.7 for females which were much lower than that of Japanese males(191.1)and females(126.9). 2. The most frequent cancer site causing death was in order of stomach, lung, esophagus, leukemia and larynx for male, and in order of stomach, uterus(part unspecified), lung, leukemia and breast for female; malignant neoplasms of rectum and rectosigmoid, liver(primary), bladder, lung, prostate, female breast and uterine cervix were much lower among Koreans when compared with Japanese and USA populations. 3. The mortality age curves of various cancer for Koreans, in which the mortality rates were higher among younger age groups and much lower among older age groups(over 65-year of age)than those of Japanese and USA populations, suggested that the effort to make valid diagnosis for older ages was lacking. 4. Age adjusted prevalence rate of all site cancer per 100,000 was 225 for male and 189 for female; the prevalence of cancer strikingly increased from 35-44 years old age group up to 65-74 years group tappering off after the age 75-year. 5. The four major cancer site in the prevalence study data were stomach(33.3%), lung(13.1%), liver and intrahepatic bile duct(12.5%) and lymphatic & hematopoietic tissue(6.8%)for male; stomach(19.8%), uterine cervix(15.9%), breast(7.2%) and liver(6.7%) for female. The frequency distribution of the cancer by site was quite similar to other studies such as Kang-wha cancer registry and hospital admission study on cancer patients among policy holders of Korean Medical Insurance Corporation. 6. The prevalence rates of cancer occurred almost every site were higher among males than females, and the age curves of the prevalence were almost identical to that of mortality data.
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Epidemiol Health : Epidemiology and Health