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Volume 7 (2); December 1985
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Korean Society of Epidemiology
Korean J Epidemiol. 1985;7(2):325-327.
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List
List of membership, board and staff
Korean Society of Epidemiology
Korean J Epidemiol. 1985;7(2):324-324.
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Article
Articles of association
Korean Society of Epidemiology
Korean J Epidemiol. 1985;7(2):319-324.
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Original Articles
A literature review study on accidents in Korea
Wha Ki Hong
Korean J Epidemiol. 1985;7(2):299-318.
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There has been a significant decline of infectious disease due to an improvement in economic situation, living standard and medicine. But Accidents have rather increased and become a major cause of death. This study attempts to identify the epidemiologic characteristics of accidents in Korea. Basic information on the magnitude and incidence of various kinds of accidents was collected in order to be of use for the epidemiologic research and prevention of accidents. Specifically, patterns and causes of accidents which occurred in Korea during the period from 1960 to 1984 were investigated. One hundred and thirty-six articles and statistics published since 1960 were carefully reviewed. Some important features obtained are as follows: Injury and poisoning due to accidents have become the leading death cause recently. Forty to fifty per cents of all patients who visited emergency room had suffered accidents. The most frequent accident type was traffic accident in male, and poisoning in female. Among accident patients in emergency room, there were more male patients than female patients(sex ratio> 1.0) and more patients in the age group of 1~4 years than any other age levels. Since the hospital materials analysed only numerators and the validity of study materials have not been tested, this study gives no conclusive results about such important epidemologic factors as incidence, risk factors, and natural history of accidents.
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Study on the nutritional health status of preschool children and its influencing factors
Sook Bang, Young Ok Kim, Hae Kyung Jung, Seung Hyun Han
Korean J Epidemiol. 1985;7(2):284-298.
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The primary objectives of this field appraisal were i) measuring nutritional health status of preschool children under age six ii) identification of responsible factors determining the variation of nutritional status among the target population. In measuring the nutritional health status of preschool children under six, three categories of nutritional indicators such as anthropometric index, biochemical index and clinical signs of deficiency were studied. To identify the responsible factors determining the nutritional health status of the target group, two statistical analysis had been carried out, initially, variation of nutritional health status has been examined by various explanatory factors. The next analysis examined the relative importance of each variable in explaining the variation of nutritional health status using multiple regression analysis. A summary of the findings are as follows; i) concerning the nutritional health status of the study population, this study indicated that contrary to the popular belief that no nutrition problem exists in Korea, there was considerable “under nutrition” among preschool children. The incidence of growth failure based on weight, height and skinfold-thickness was 12.8%, 10.5% and 15.1% respectively. Anemia among them was 7.1% (Hb below 11g/100ml). Clinical signs of Vitamin B2 deficiency was 7.9%. In explaining the variation of nutritional health status between individuals the study indicated that: 1) in examining the variation of nutritional health status of preschool children, there was significant variation of growth (especially weight) founded by the nutrient intake level. Nutritional health status of preschool children varied not only by sex of child, birth interval, birth order, mothers age at birth, but also genetic factor such as hight of father and by the socioeconomic factors of the household. 2) In case of multiple regression analysis using weight-for-age as dependent variable, household socio-economic status and parental factors appear to be the most important factors. The second most significantly factors were dietary related variables such as duration of breast feeding and dietary and mothers time alloted to child care. The above finding lead us to a nutrition policy implication that there should be better nutritional care program for the preschool children by the nutrition education for the mother.
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A proposal on the effects of hepatitis B virus vaccine
M.S Lee, S.E Lee, S.C Chang, S.Y Cho, B.Y Choi, S.B Han
Korean J Epidemiol. 1985;7(2):274-283.
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A study on the positive rate of HBsAg and Anti-HBs and the relationship between HBsAg positive and some liver function tests among the multiphasic health screening examinees
Se Hoon Lee, Chang Yong Cho, Kwang Ho Meng
Korean J Epidemiol. 1985;7(2):265-273.
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Because of high positive rate of HBsAg among population, its relationship with liver disease and abnormal liver functions has been an important issue in recent years in Korea. To measure the positive rates of HBsAg and Anti-HBs by different population characteristics and to investigate the relationship of HBsAg positivity with liver functions 2,479 subjects who have visited Multiphasic Health Screening Unit, Kangnam St. Mary's Hospital were studied. The results obtained from this study were as follows: 1) Positive rate of HBsAg of total study subjects was 9.7%, and it was significantly higher in males(10.8%) than in females(7.4%). 2) In male aged 20~29, the positive rate of HBsAg was as high as 16.3, and it was gradually decreased as age increased. In female, however, there was the tendency of increment in positive rate of HBsAg as age increased. Positive rate of HBsAg was the highest in sales and service workers(12.1%) and the lowest in laborers and agricultural workers(8.3%). The difference was even statistically significant. 3) Positive rate of Anti-HBs in all study subjects was 37.4%, and those who revealed negative response both in HBsAg and Anti-HBs were 53.3%. 4) HBsAg positivity was statistically associated with abnormal values of liver function tests, such as SGOT, SGPT and TTT. Those with HBsAg positive have abnormal SGOT, SGPT and TTT odds radios of 2.87,2.67 and 2.70, respectively relative to those with HBsAg negative. These odds ratio was even increased to 4.18, 3.34 and 3.13 respectively if those with HBsAg positive and Anti-HBs negative were compared with those HBsAg negative and Anti-HBs positive.
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A study on the anti-HBs prevalence between occupationally risk and non-risk groups in terms of hepatitis B virus exposure
Hee Choul Oh, Il Soon Kim
Korean J Epidemiol. 1985;7(2):259-264.
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This study was performed to find HBsAg and Anti-HBs prevalence between the two groups. One group, defined as occupationally risk group, consists of persons who treat patients personally or who deal with blood as their daily activity. The other group, defined as occupationally non-risk group, consists of remaining persons in the study. The data were collected from the annual screening physical check-up which was performed in 1984 for 2,631 teaching, clerical and other personnel of Y university. RPHA method was used for the detection of HBsAg and Anti-HBs. The results from the analysis are summarized as follows: 1) No difference was observed in HBsAg positive rate between occupationally risk (6.9%) and non-risk group(7.1%) but showed significant difference in HBsAg or Anti-HBs positive rate between the two groups(24.2% and 19.4%, P<0.01). This finding suggests that there is higher risk to expose to Hapatitis B Virus(HBV) in occupationally risk group than in non-risk one. 2) Difference in HBsAg or Anti-HBs positive rate between occupationally risk and non-risk group was statistically significant for the 20~29 age group but not for the remaining age groups. This finding suggests that vaccination against hepatitis B(HB) is highly recomrmanded to this age group especially for those who take this highly risk occupation.
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An epidemiological study on subclinical Leptospiral infection among rural Koreans by Leptospira isolation in blood culture
Joung Soon Kim, J.K Lee, H.W Chung, S.J Yang, H.S Lim, W.Y Lee
Korean J Epidemiol. 1985;7(2):253-258.
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A clinical syndrome complex that had been known as epidemic pulmonary hemorrhagic fever in Korea since 1975 has been proved to be leptospiral infection by Kim et al. in 1984. Even though hundreds of cases have been reported for the last 10 years, few information on the status of leptospiral infection among general population at risk is available. This study was carried out in a small rural community with 189 population in 41 household to estimate subclinical leptospiral infection rate. The study consisted of interview, medical examination by doctors, and blood sampling. The first study in which only 50 inhabitants completed the study on November 3rd, and the second one for the drop-outs on December 17th, 1985. The blood specimens were inoculated to a newly developed artificial media by Lee, YUMC-5050, which had been demonstrated to be quite sensitive, silver stained in two weeks of culture and examined under microscope for the characteristic leptospiral bacteria. Since leptospiral positives were found only among the first study group, probably due to the optimal timing for culture (November 3rd), but none of 40 specimens sampled in the second study was culture positive, the data analysis had to be depended upon the first study population. Among six positives re-cultured in the second study period, only one remained positive and five became negative within one and half month. The summarized findings are as followings: 1) Leptospira culture positive rate was 16% average; 23% for males and 11% for females. The cases were net clustered to any particular age group but rather even for all active ages. Protective immunity for older ages was not evidenced. 2) Clinical symptoms and signs experienced by the study subjects during the last one month were not significantly different in kind and frequency between leptospira positives and negatives except one case each for hematuria and lymphadenpathy in positive group. Two out of eight positives had mild clinical manifestation competible to leptospiral infection but six of them were typical of subclinical infection. 3) Enviromental factors exposed also were not different between leptospira culture positives and negative, probably owing to the fact that these farmers were exposed to all environments in multiplicity making it difficult to find out the difference for any environmental particulars.
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A study on the status of reporting typhoid fever cases admitted
Yoon Goo Kim, Tae Wha Joung, Chul Song, Myung Won Lee, Joung Soon Kim, Dae Kyu Oh
Korean J Epidemiol. 1985;7(2):240-252.
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The objective of this study is to find out current status of reporting and managing one of the most important communicable diseases in Korea, typhoid fever, as well as identifying reasons of poor reporting in order to provide necessary information for an improved reporting system. This study was carried out on typhoid fever patients who had been admitted to hospitals located in Seoul during the year of 1984. On the reasons and problems associated with poor reporting, the medical staff, both regular and house staff, were surveyed through structured self-recording questionnaire with the help of hospital administration offices. Information on the hospitalized cases were collected from laboratory and medical records and reported cases from health centers. The summarized results are as followings: 1) The total number of typhoid fever cases reported to the health centers and city government was 403 patients of whom only 103 cases(26%) were bacteriologically confirmed by isolating S. typhi. Eighty percent of these patients were reported by hospitals. 2) On the other hand, the total number of confirmed cases identified in study hospitals were 489 patiens among whom only 16.4% had been reported to the health centers. The reporting rate varied widely ranging from 0% to 57% by medica institute regardless of type of the hospital. 3) The analysis of the patient group revealed that there were more females than males and 56% of the patients belonged to the 20~39 years age group. There was no difference in person characteristics between reported and non-reported cases. The number of cases occurred by month did not show much difference although there was a tendency of clustering more cases in winter season. 4) The average duration of the illness from the onset to the hospital admission was about 12 days and 63% of these patiens had received medical care of some sort before the admission. Also the average duration of hospitalization was about 12 days. The duration of admission was significantly longer for reported group when compared with that of non-reported group (p<0.001). 5) Follow-up care for the discharged patients was done only for a part of patients (54%), the worst the follow-up stool cultures for only 11% of the patients. 6) The major reasons for not reporting typhoid fever cases stated by the medical doctors were complicated and bothersome administrative process demanded by health center when they report a case(47%) and possibility of misdiagnosis(28%). The most of the medical staff, however, strongly showed their insight or sense of responsibility for reporting communicable diseases. 7) The necessity of nurse epidemiologist employed in hospital for control of hospital infection and reporting communicable diseases was recognized by 62% of the doctors, and 52% of them showed a strong intention to adopt the system. The larger the hospitals the more doctors agreeing the new system, the nurse epidemiologist.
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A study on developing evaluative indices for assessment of communicable disease control activities of health agencies
Joung Soon Kim, H.S Shim, S.S Bae, D.K Oh
Korean J Epidemiol. 1985;7(2):228-239.
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Even though there had been a steady decrease of communicable diseases since the Korean war, the communicable disease control program is still a major public health problem among others in Korea. For recent several years the government has been awarding prize for the health center that was assessed to be an examplary institute in performance of communicable disease control activities, in order to facilitate the activity through mutual competition. This particular study was carried out to develop evaluative indices which should be valid and objective; the conventional way of assessing CDC activities of health centers has been subjected to a dispute among the eligible institutes for the prize due to deficient validity. This study consisted of three phase of data collection; preliminary study to obtain information necessary in formulating and planning the major study, in which all kind of health agencies including local public health laboratories, hospital and clinics and health centers were studied extensively to identify their roles in CDC program; and major study to develop evaluative indices; and the feasibility study on sampled health center directors to validate the validity and utility of the indices. The evluative indices developed by the researchers have been revised many times in accordance with the study results and the recommandation of the advisory committee. The finalized indices were evaluated by health center directors, who approved the indices being valid and appropriate. We decided to report this research results to share our valuable experience that relatively valid evaluative indices can be developed by stepwise exploration, even when there are few valid information available.
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A study on the theoretical property and applied range of odds ratio
Kyung Hee Park, Seung Wook Lee
Korean J Epidemiol. 1985;7(2):202-227.
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The odds ratio, termed the cross-product ratio and the relative odds, has been used as the measure of degree of association in 2X2 contingency table. The literature on odds ratio is vast, but it is poorly integrated. This paper presents to try to get sharp understanding through the study for whole integration on the basic cencept and theoretical properties and applied range of odds ratio by means of literature consideration. The content of study is summarized as follows: In 1887, the odds ratio originally was proposed by Korosy as a natural measure of association on the efficacy of small pox vaccination, but, in his paper, was not given operational interpretation and it was difficult to compare meaningfully its values for 2X2 contingency tables. It was not used for a long time from then on. Afterwards, many statisticians have studied on the statistical property of odds ratio. For rare diseases, the odds ratio is a close approximation to the relative risk. Further, the odds ratio is directly estimable from case-control study data, even though the relative risk is not. Odds ratio has its proper invariance and nice mathematical property of log-odds transformation, called the logit. Because of these property, much attention has given to its use by epidemiologists, statisticians and a number of study has been presented. The methods of estimation of odds ratio has been studied according to statistical technique for controlling bias due to potential confounding factors, and the scope of its practical use has been very wide. In this paper, their methods are introduced, and illustrated.
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Analysis of selection bias in a case-control study
Yoon Ok Ahn
Korean J Epidemiol. 1985;7(2):195-201.
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Several situations in case-control studies, such as using hospital controls, prevalent cases, special surveillance groups, and low participation rate, necessitate evaluation of selection biases. A case-control study of renal adenocarcinoma which has been conducted in 100 towns around Boston, U.S.A., showed low participation (interviewed) rate, 41.1% and 62.0% among cases and controls, respectively. By comparing medial abstract data of interviewed and not-interviewed cases, interviewed data of controls and mail-questionaire data of not-interviewed controls, it was possible to estimate selection odds ratio for selected 8 variables and to assess selection bias associated with smoking, obesity, renal caluli, and hypertension. The conclusions drawn were as follows; 1) It is certain that a considerable number of factors served as actual selection factors in case-control study. 2) The interpretability of certain association resulted from interviewed data was strengthened and weakened by analysis of selection bias. For the valid explanation of study results of interviewed data, the evaluation of selection bias should be quite valuable and necessary. 3) The simplified schematic presentation of theoretical aspects of selection bias can be useful to analyse it afterward, while, there are no standardized methods of data collection for the evaluation of selection bias.
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Controversy
High-dose vitamin C and cancer
Kwang Ho Meng
Korean J Epidemiol. 1985;7(2):192-194.
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Special edition
Panel discussion : AIDS control
Il Soon Kim, Yong Ik Kim, Joung Soon Kim, Taik Sung Nam, Hak Kyun Shin, Yoon Ok Ahn, Won Ha Yoo, Won Young Lee, Jung Bock Lee
Korean J Epidemiol. 1985;7(2):187-191.
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Epidemiol Health : Epidemiology and Health