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Volume 6 (1); December 1984
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Original Articles
Treatment behavior and changes of illness for pulmonary tuberculosis patients in Korea
Han Joong Kim
Korean J Epidemiol. 1984;6(1):137-157.
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A follow-up study was made for those pulmonary tuberculosis patients who were radiologically identified during the Nationwide Pulmonary Tuberculosis Prevalence Survey in 1980 in order to study the treatment behavior and change in disease after the elapsing of a certain period. The follow-up study was made in August and September 1982. And the discriminant analysis was used to identify major detertminants for the treatment behavior and the disease change of the pulmonary tuberculosis patients and major findings were as follows. 1. The determinants for the treatment behavior were circumstance for detection, severity (findings of X-ray examination and sputum test in 1980), level of education, residential area, mobilization, income, family size and occupation. 2. The most important factor for the treatment was the circumstance of detection, actively detected group received more treatment than passively detected group. 3. The hit rate was 69.6% for the prediction of the treatment behavior in discriminant analysis function with above variables. 4. The determinants for the recovery from the pulmonary tuberculosis were severity of the disease (findings of sputum in 1980), age, duration of smoking, income, presence of cavity, TREAT score, residential area, occupation and sex. 5. The hit rate was 68.7% for the prediction of the recovery in discriminant analysis function with above variables. 6. Discriminant analysis could be used usefully in multivariate analysis for the binaryoependent variables.
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Case-control study on psychosexual impact of vasectomy
Yong Heo, Joung Soon Kim, Hee Sup Yoon, Sook Ja Yang, In Sook Lee
Korean J Epidemiol. 1984;6(1):124-136.
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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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An epidemiological study of cerebrovascular disease through stroke registry and case-control study on risk factors in semi-urban and rural communities
Joung Soon Kim, M.H Chung, H.S Yoon, B.Y Heo, S.J Yang
Korean J Epidemiol. 1984;6(1):112-123.
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This study was carried out from November 1982 to October 1984 on Chuncheon City and Chunseong County where the population is about 210,000. The objective of the research was to study natural history of cerebrovascular diseases through stroke registry and to indentify risk factors of the disease by case control study in order to formulate strategy of stroke control program. Stroke registry was encouraged for the patients by distributing circulars to the community leaders, professional associations, hospitals, clinics and public doctors in addition to the propaganda through mass media. Also the responsible community nurse visited villages, hospitals and clinics to make the stroke patients registered. When stroke patients registered to the stroke clinic these patients were examined at the stroke clinic in every Tuesday and Thursday by utilizing postcard appoint system. At the same time they were interviewed and checked for height, weight, blood pressure, chest x-ray, electrocardiogram, and blood chemistry. For the case-control study on risk factors relatively new patients were selected and matched with their neighbor controls of the same sex and the similar age. Since the risk factors of stroke identified were found to be very similar to that of hypertension, other set of case-control study on hypertension risk factors was also carried out to examine confounding effects of these variables. Stroke management pattern, social problems encountered by the families with stroke patient, and activity index of the patients at three months after the onset and at the time of the study were also surveyed by interview. The results and conclusion obtained are as followings: 1) The total number of stroke patients registered were only 305 during the two-year study period. This number is estimated to be about 10% of patients existing in the communities according to the sample survey of one township within the study area. Thus the study on natural history of stroke was not able to be accomplished due to the lack of representativeness for the patients registered. The major reason of low registration was reported to be the difficulty of attending the clinic and that the registration was not accounted to be helpful for them by patients themselves and their family. 2) Among 154 cases who were subjected to the case-control study on the risk factors of cerebrovascular disease, about half of them were new patients and only a few cases were old cases over one year after the onset. Most patients(76%) were older than 50 years of age. Cerebral infacrtion was the predominant pathological type, and 13% of the patients had previous experience of stroke prior to this attack. At the time of onset 15% tof them had loss of consciousness, motor paralysis in 90% and speech disturbance in 63%. 3) Among the risk factors examined for the association with the stroke by case-control study, and analysed by paired marginal test(McNemar’s X2 test) and estimated relative risk ratio, hypertension, family history of stroke, overweight, duration of smoking, left ventricular hypertrophy, serum total cholesterol, and uric acid showed significant statistical association the hypertension revealing the most strong association. Stepwise multiple regression also showed the similar pattern. On the other hand when the hypertension was controlled, these variables did not show any association. Furthermore when the result of case-control study on risk factors of hypertension was compared with that of stroke by means of estimated relative risk ratio, the association strength of almost all variables in both stroke and hypertension was quite identical. Therefore it was concluded that other variables beside the hypertension were not causally associated but secondarily associated with the occurrence of cerebrovascular diseases by the intervened third factor, the hypertension; the hypertension was the most confirmatory risk factor of the cerebrovascular diseases among the variables examined. 4) Management pattern of the stroke patiens showed that only 20% of them was attended medically within the day of onset, among whom over 60% utilized Chinese medicine and 29% utilized modern medical facilities. The patients treated continuously comprised only 35% and the rest of the patients were either stopped treatment or treated intermittently. The functional ability measured by activity index showed that the proportion of the patients with high score(ability of self-care) was 28% at the three months from the onset but the proportion increased up to 68% at the time of the study. 5) The most serious social and family problem incurred by the stroke was economic difficulty due to the loss of job for the patients themselves, and the activity limitation of the family members to take care of the patient. Home visited nursing care system may be worth to intervene for a community based stroke control program. (This study was supported by WHO Research Grant)
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The cancer registry program in Kangwha County: The first report (July 1982- June 1984)
Il Soon Kim, Han Joong Kim, Hee Chul Oh, Byong Soo Kim, Yoon Lee
Korean J Epidemiol. 1984;6(1):100-111.
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The Cancer Registry Program in Kangwha County, the firs community based cancer registry program in Korea, has been launched since July 1, 1982. Two factors made it possible to develop this program in Kangwha County. One is that the county-wide compulsory health insurance program initiated by the government has been implemented in the county as an experiment from July 1, 1982. This health insurance program has largely removed the economic barrier of the people in the medical care utilization and also under the health insuraance program the medical utilization records are being piled up in the office of health insurance cooperatives in the form of the bill requested by the clinics and hospitals after they treat patients. The second factor is the availability of the community hospital in the county, which has been serving the Kangwha population for the past 5 years. This means that cancer patients in the county can easily seek medical care and their medical records re easily available. Since early 1970’s the mortality patterns of the Korean population has been changed from the infection diseases to the non-infections chronic diseases. Among chronic diseases stroke and malignant neoplasms have been reported to be the leading causes of death. It is, therefore, urgent for epidemiologist to collect very basic information on the magnitude and incidence of various such diseases for the epidemiologic studies and disease control as well. The first systematic step to challenge the cancer should be the cancer registry program. The number of target population of the Cancer Registry Program in Kangwha County is 88,851 as of December 31, 1983. The initial detection of cancer was made by reviewing all the bills requested from the various clinics and hospitals compiled in the office of the Regional Health Insurance Cooperatives. All the malignant neoplosms (ICD 140-208 in 9th edition) were included in the program. The diagnosis of cancer was confirmed by a team of physician and a nurse with the medical records kept in the clinics and hospitals based on the diagnostic criteria recommended by WHO. Home visitings were also made to those of cancer cases confirmed in every 6 months for the follow up and for the collection of relevant information directly from the patients. 223 cancer cases were registered during the first two years of the program. The annual incidence rate adjusted by the world population for male was 147.6 and for female 99.8 per 100,000 population. The most common cancer was the stomach cancer which comprised 37.7% of total cancer cases in both sexes. The annual incidence rate of the stomach cancer was 64.9 in male and 30.6 in female per 100,000 population. The lung cancer (24.3) and liver cancer(13.9) were the next common cancer in mate. The cervical cancer (19.7) was the second commonest cancer in female. The survival rates of patients with cancer after the appearance of the first symptom and also after the diagnosis were low in general due to the delayed detection and inadequate treatment. The medical seeking patterns were also studied. The small number of the target population appears to be one of the weak points of the Program. The complete follow up with home visiting is identified as the strong point of the program.
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Statistical study of 21-year period on cancer patients of cancer research hospital
J.O Lee, S.Y Choi, T.K Yun, Y.K Kim, T.W. Kang, K.B Park, H.J Ahn, K.H Lee, E.D Lee, S.I Chin, H.J Chang, K.S Moon, Y.S Shin, S.Y Yoo, S.H Seo, M.S Paik, J.H Lee, K.S Hong, K.H Kim, J.J Chang
Korean J Epidemiol. 1984;6(1):85-99.
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Analytical studies of internal quality control status in clinical chemistry: total protein, albumin, globulin, and cholesterol
Chang Kyou Lee
Korean J Epidemiol. 1984;6(1):78-84.
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Abstract
An internal quality control status analysis on some biochemistries tested in a University Hospital laboratory, a participating member of the External Quality Control Program, but not maintaining the internal quality control program regularly. The test items were total protein, albumin, globulin and cholesterol, and the period of collective data accumulated was from January to December of 1982. 1. The quality control status of total protein in months of January, July, August, September, October and November exceeded the allowable error of 0.21, and it consequently showed low precision while the plus proportional error in accuracy was noticed. 2. In albumin test, it had shown unstable tendency in months of April, June, July, August, September, October and November exceeding the allowable error of 0.11,consequently, lowering the precision. Its accuracy, with the proportional error in the systematic error, was also unsatisfactory. 3. Both precision and accuracy were out of the acceptable range in globulin test quality control status with the allowable error of 0.19 was exceeded in months of January, February, March, April, August, September and November, and the proportional error in the systematic error caused the unsatisfactory phenomenon in accuracy. 4. Both precision and accuracy were out of the acceptable range in cholesterol test quality control status with the allowable error of 8.6 was exceeded in months of January, April, May, June, August, September and October, and the constant error in the systematic error caused the unsatisfactory phenomenon in accuracy. 5. The standards of the allowable error of four chemistry items was established for the domestic reference. 6. Regressive order of the CV mean values were albumin (4.23%), total protein (4.7%), cholesterol (7.28%) and globulin(9.20%) respectively. 7. The results of tested items that fall out of the acceptable range were 4 in August and September, 3 in January, April, October and November, 2 in June July, and 1 in February, March and May.
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Validity of interviewees responses in health interview survey
Dae Kyu Oh, Han Joong Kim, Kyung Yong Lee
Korean J Epidemiol. 1984;6(1):70-77.
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Abstract
The validity of interviewees' responses on the numbers of medical utilization, visits and medication days in a health interview survey were measured. Memory recalls within two weeks and four weeks were also measured. The influences of different types of interviewers and characteristics of respondents were also tested. The records of requested bills to the heatlth insurance corporation from clinics and hospitals were used as reference information against the validy measurement. The health interview survey which was used for this study was conducted as a part of a study on impact of health insurance on the medical care utilization in Kangwha county in June 1983. Followings are summary of the results. 1. As an individual, the agreement rates between two records within two weeks of memory on the numbers of spells, visits and medication days were 98.0%, 68.8% and 46.9% respectively. Within four weeks of memory, the agreement rates were 96.8% 68.4% and 42.1% respectively. 2. As a group, the interviewees’ responses on the numbers of visits and medication days were slightly under-reported to 0.95 within two weeks of memory and 0.20 within 4 weeks of memory. 3. The agreement rates of two different types of interviewers (medical and sociology students) showed no difference. 4. The agreement rates were highest when respondents were head of the household and those of housewife, grand parents, children and kinds were the next in order. 5. The higher the educational level of respondents the higher the agreement rates were seen. Among those respondents who had education of high school and above showed highest agreement rates and even showed over-reporting tendency. 6. There was no difference in agreement rates between male and female respondents. 7. The higher the level of age, the higher the agreement rates were observed.
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A stochastic model for determining the number of outpatient-visits
Dong Ki Kim, Han Joong Kim
Korean J Epidemiol. 1984;6(1):62-69.
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Abstract
It is a hypothesized that the number of outpatient visits can be represented by some of three different probability models, i.e., the truncated Poisson, Zeta, and logarithmic series distributions. Maximum likelihood estimates of parameters of above distributions were obtained by using grouped data according to the number of visits. A X2 goodness of fit test was also made to compare the fits of the three distributions, and the value of this statistic was classified and compared according to the types of medical care facilities. For the study, we analized the 1,900,000 data claimed at the Korea Medical Insurance Corporation for three months in 1984. The results are summarized as follows: 1. Based on the likelihood ratio statistic as a test criterion, both the truncated poisson and Zeta distribution are not appropriate for the model of the number of outpatient visits. The results show that the expected frequencies of the truncated Poisson are smaller than the observed in the tail, but those of Zeta are larger in it. 2. The logarithmic series distribution it found to provide a good fit to data in case of University Hospital, General Hospital, and Hospital. When we apply this distribution in the 10 common diseases, the estimates of the parameter vary from 0.39567 to 0.54176 for University Hospita, from 0.45329 to 0.65387 for General Hospital, and from 0.55104 to 0.77625 for Hospital. This finding might be applicable to the health utilization study, for example, outpatient administrations etc. 3. On the other hand, in case of Clinic, even the logarithmic series distribution cannot be fitted to the data well. The characteristic of clinic utilization such as little variety of its patterns regardless of a large numbers could be the reason of the above results. It is reserved for a further research to construct the compound or modified distributions which are able to explain the number of outpatient visits in case of Clinic.
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A study on the validity of vasectomy status for both the husband vasectomized and his spouse
Joung Soon Kim, Yong Heo, Jin Soo Lee, I-cheng Chi
Korean J Epidemiol. 1984;6(1):54-61.
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Abstract
The objective of this study is to validate the vasectomy status reported by both the husband vasectomized and his spouse prior to the main epidemiological study of cardiovascular diseases in Korean men with special concern for vasectomy as a risk factor of the disease. The study was carried out in Choonchun city and Chunseong county which have been served by the Community Health Program of Seoul National University for more than ten years. The records of vasectomy for the men living in these areas have been kept accurate by the local family planning association since 1972 providing an unique opportunity for this type of study. With assistance of the community health program staff, the list of vasectomized subjects including the address was obtained from the family planning association. The total number of eligibles were 512 in Choonchun city and 142 in Chunseong county. The principle of sample selection was based on the longer duration since the vasectomy among eligibles who were available for the interview. Fifty couples from Choonchun city and fifty couples from Chunseong county were selected for the study and matched by their neighborhood control couples for whom the husbands were not vasectomized. Starting from the December of 1983, ten MPH students, five male-female pairs visited these 200 couples home and interviewed. The husbands and wives were interviewed at the same time but separately by the same sex interviewer to avoid communication barrier between the interviewees and interviewers, and the bias that could occur due to opinion exchange between the husband and wife prior to the interview. The results obtained are as followings: 1. The mean age at the time of vasectomy was 34.4±5.0 years while the age at the time of interview was 42.9±5.9 years with about 8 years of duration from the vasectomy to the interview. The duration of marriage till the vasectomy was 8.8 years average 2. In reporting of vasectomy status, the sensitivity and the sensitivity were 0.99 and 1.0 respectively in both husbands and wives. Kappa, an index value of agreement between husband and wife on vasectomy status, was also 0.99. The agreement rate between the year recorded and the year stated on the year of vasectomy was 36.4% in husband and 31.0% in wife. The agreement rate, however, within two year difference between recorded and stated year of vasectomy was 79.2% in husband and 84.4% in wife. These agreement rates were lower than that of the year of marriage (p < 0.01) 3. In multiple regression analysis using the duration since the vasectomy recorded (A) as dependent variable and the duration stated (B), age (C), level of education (D) as independent variables, the coefficient of determination (R2) was the higher when they were transformed to natural logarithm. The regression models duration of vasectomy from the data provided by interview are as follows: LNA(husband) = -0.199+0.760LNB+0.144LNC+0.101LND :R2=0.57 LNA(wife) = 1.311+0.725LNB-0.203LNC :R2=0.54 The scatergram between the records duration and the estimated duration by the model fitted better than the duration stated, when 20 samples randomly selected from the data were tried. (This study was supported by the Family Health International, Research Triangle Park, N.C.)
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Special editions
A report on one autopsy case identified as Leptospirosis among epidemic pulmonary hemorrhagic fever patients
I.J. Choi, T.S Kim, S.Y Jin, G.C Shin, M.R Choi, K.H Choi, Y.H Shim
Korean J Epidemiol. 1984;6(1):52-53.
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Clinical features of the case identified as Leptospirosis serologically
J.S Lee, S.C Yoon, H.Y Lee, K.R Ahn, S.K Kim, J.K Chi
Korean J Epidemiol. 1984;6(1):47-51.
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Leptospira interrogans "Korea" isolated from patients with epidemic pulmonary hemorrhagic fever
Won Young Lee, Bong Ki Lee, Joo Deuk Kim, Joung Soon Kim, Sang Ok Kim
Korean J Epidemiol. ;6(1):36-46.
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Abstract
Eight strains of Leptospira were isolated from patients with epidemic pulmonary hemorrhagic fever and natural rice field water samples. Sera from 23 out of 35 patients were strongly reacted with the isolated bacteria by slide agglutination test, immunofluorescent test and ELISA test. The major reacting immunoglobulins were IgM and IgG in the sera. All of the strains were equally pathogenic for guinea pig and mice, which were confirmed by pathology, immune-pathology and bacterial analysis of the sacrificed and dead animals with febrile symptom following the bacterial inoculation. The representative pathologic feature was massive hemorrhage due to diapedesis in the lung and intracellular existence of the bacterial antigens in liver and kidney, which were equally fluorescent positive for IgM, IgA, IgG and C3. The characteristics of the bacteria examined by pathogenicity, morphology and some of cultural behavior in artificial media were matched with Leptospira interrogans. Three strains electron microscope and the bacteria were found to be tightly coiled and the helix handedness was counter clock-wise (left). It is generally accepted that pathogenic spiral bacteria reported up to date are coiled clockwise (right). Therefore, it was concluded that the bacteria isolated from the patients via animal inoculation were the responsible agent for the human infection. They can be characterized as Leptospira interrogans according to pathogenicity, cultural behavior except the fact that their left handed coil. Thus, the bacteria were tentatively named as Leptospira "Korea”.
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Bacteriological studies on Leptospirosis in Korea (1984)
Min Kee Cho, Sung Bok Paik, Hee Bok Oh, Chul Song
Korean J Epidemiol. 1984;6(1):16-26.
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A bacteriological investigation was conducted on haemorrhagic mimicking pneumonia, which was prevalent in rural areas in Wonju, Gangwon-do and Gwangju, Jeonnam between August and Octo-ber 1984. The following results were found. 1. Leptospira interrogans was separated and identified from two patients. 2. Leptospira interrogans was separated and identified from seven out of 45 field mice collect-ed from the area that had the case of leptospira interrogans in Wonju and Gwangju. 3. The nine separated strains were all found to have pathogenicity from the guinea pig. 4. Two strains separated from the humans and five strains from the field mice all belonged to the same serotype group and were identified as leptospira interrogans serogroup ictero-haemorrgagiae. 5. The separated strains were confirmed to have the typical leptospira interrogans form and mobility. An observation through electron microscope revealed the following: width 0.1–0.15 µm, length 6–15 µm, wave length of the coil 0.2–0.5 µm, number of pitches of coil 18–23, two periplasmic flagella, and a clockwise twist direction of the coil. 6. A total of 32 (91%) out of 35 hospitalized patients in Wonju and Gwangju possessed anti-bodies to leptospira interrogans (isolates) and the seroprevalence of the healthy control group such as the patients’ family members and people living in the same environment was just 2% (1 out of 51 people).
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An analytic epidemiological study to test the hypothesis, Leptospirosis as the cause of epidemic pulmonary hemorrhagic fever in Korea
J.S Kim, C.W Lee, D.K Oh, S.D In, Y.H Lee, W.H Cho, W.Y Lee, S.O Kim
Korean J Epidemiol. 1984;6(1):8-15.
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This study was carried out to test the causal hypothesis, leptospirosis, of the epidemic pulmonary hemorrhagic fever on the outbreak occurred from the middle of September, 1984 in Korea. The outbreak has occurred right after the group work to tie the fallen rice plants following flood just like the one that had occurred in 1975. This particular disease characterized by fever, chill, malaise and nausea/vomiting in the begining of the onset and chest pain, hemoptysis, and dyspnea in the later stage of the illness, had been reported frequently since 1975 as a disease of unknown etiology. The disease has been occurred predominantly among farmers during the harvest season, particularly among those who worked in wet rice paddies located in montainous area without protection for abraised skin injuries. The fatality rate reported ranged from 5 to over 50%, the direct cause of death being asphyxia due to the massive pulmonary hemorrhage. Despite the continuous research the etiologic agent of the disease has been remained unknown. The objective of this study was to test the specific hypothesis, leptospiral infection, which was derived from the literature review on the papers published ; the clinical, pathological and epidemiological features of the disease was considered to be fitting mostly well among others to that of leptospirosis. The patients who were admitted or have been admitted to hospital with diagnosis of epidemic pulmonary hemorrhagic fever were matched with their family members, villagers, and fellow soldiers who did not have the disease but worked in the same environment. Both groups were interviewed with a structured questionnaire and paired blood and urine specimens were collected. In order to increase the test validity one batch of the specimen was sent to KNIH laboratory and the other to the Dept. of Microbiology of Yonsei Medical School blindly for the laboratory works. Environmental survey was also carried out on rice paddies located at mountainous site in an endemic area where the source of water for cultivation was spring water. There were innumerable rodent holes along the paddy banks with assively accumulated ears of rice plant. From these paddies about three liters of water was collected for laboratory work. Also forty five wild rodents were trapped from two endemic areas for the study. These specimens were primarily inoculated to guinea pigs and mice for culture and then in a specific media to utilize for the serological test. The results obtained from the study are as followings: 1. Letospiral organisms were isolated from nine patients, the water collected from rice paddies of endemic area, and seven wild rodents, all of which strains made the Koch’s postulate satisfactory. 2. The incidence rate of the disease among military service men was 2.7/1,000 person-day exposed and showed a cumulative effect of exposure; longer the duration of exposure, higher the incidence. 3. The incubation period calculated from the military service men ranged from 3-11 days and 8 days of mean incubation period when estimated from the epidemic curve. 4. KNIH laboratory reported the spiral organisms isolated were all fitted well to the description of L. interrogans icterohemorrhagiae with specific serological reaction to the known antigen, whereas the spital organisms isolated by the Dept. of Microbiology, Yonsei Medical School have left-handed tight coils even though other characteristics fits well to the description of L. interrogans. The problem involved in the discrepancy on taxonomical aspect of the leptospiral organisms isolated between two laboratories may be settled down when the on-going studies are completed. This is the first report on leptospirosis epidemic identified bacteriologically in Korea.
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Clinical characteristics of epidemic pulmonary hemorrhagic fever summarized from papers published
Kang Won Choi
Korean J Epidemiol. 1984;6(1):3-7.
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Epidemiol Health : Epidemiology and Health