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Volume 8 (1); June 1986
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Korean Society of Epidemiology
Korean J Epidemiol. 1986;8(1):345-345.
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Korean Society of Epidemiology
Korean J Epidemiol. 1986;8(1):343-344.
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Korean Society of Epidemiology
Korean J Epidemiol. 1986;8(1):338-342.
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Korean Society of Epidemiology
Korean J Epidemiol. 1986;8(1):337-337.
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Original Articles
A study on leptospiral infection among healthy young men, a special group by leptospira isolation from blood culture in an endemic area of Korean hemorrhagic fever
Joung Soon Kim, H.K Chung, H.W Chung, S.S Lee, J.K Kim, W.Y Lee, H.K Byun
Korean J Epidemiol. 1986;8(1):174-181.
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Abstract
This study was carried out on special groups consisted of homogeneous healthy and young Korean males stationed middle part of Korea, in order to understand the magnitude of subclinical leptospiral infection among these special groups and particularly the reationship between leptospirosis and Korean hemorrhagic fever that have shown similarity in many aspects. One hundred eighteen subjects from the well-known endemic area of KHF and 406 subjects from non-endemic area were interviewed for the information on their behavior and environments exposed for the last one month on weekly basis; all study subjects were blood drawn for leptospira isolation by culture in newly developed media, YUMC-5050. From the vicinity of stations studied 25 rats were captured alive, anesthesized with ether and autopsied. Lungs, liver and kidney were sectioned with a sharp scalpel and touch printed on slide glasses. These specimens were stained by IF techeique and examined for the presence of leptospiral bacteria. Summarized results of the study are as followings: 1) The overall leptospira culture positive rate was 2.8% that was much lower than that of Korean healthy rural farmers(16%). 2) Twelve out of 15 leptospira positives were followed up to 2 months by re-culturing their blood and found none of them remained positive. 3) Leptospira culture positive rate was 9 times higher among the groups stationed in KHF endemic area(9.3%) than those stationed in non-endemic area 4) The leptospira positive status did not have any statistical correlation with the variables such as the length of stay in current station, former residence area and educational level 5) The behavioral and environmental characteristics also failed to reveal any statistical association with the leptospiral positive status 6) Clinical symptoms and signs experienced during the last one month were more frequent and various among leptospira negatives than among positives 7) Nineteen Rattus norvegicus and Rattus rattus examined by organ touch printed specimens with IF technique showed leptospira positive in 24 rats, 96% positive rate; 22 rats had leptospira in all three organs, one in kidney and liver, and the other one only in kidney
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An epidemiology study on nosocomial infection of an university hospital in Seoul
Sung Eun Lee, Joung Soon Kim
Korean J Epidemiol. 1986;8(1):147-173.
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Nosocomial infection has become a problem of public health in medical cost and health problem. We have no incidence rate data in Korean. So this study tries to survey epidemiological feature of nosocomial infection in a university hospital. From November 1985 to January 1986, this study was done. The result was as follows; 1) The incidence rate of nosocomial infection was 576.7 persons per 10,000 discharges. The incidence rate of nosocomial infection by type of infection was that urinary tract infection was 143.4 cases and respiratory infection was 117.2 cases and post operative wound infection was 84.8 cases per 10,000 discharges. In internal medicine, respiratory infection was 25.7% of total nosocomial infection. In general surgery, post operative wound infection was 24.1% of total nosocomial infection. The causal micro-organisms of nosocomial infection were Pseudomonas(16.1%), E. coli(13.7%), Staphylococcus(14.7%), Serratia(7.1%) and etc. The total resistance of micro-organism which caused nosocomial infection, was 62.4% for 13 types of antibiotics. 2) The risk factor of nosocomial infection was tested by comparison of two groups, with hospital infection and without hospital infection. The duration of hospitalization was appeared very significant risk factor of nosocomial infection (X2 = 211.6**). The medical diagnosis was also appeared a significant risk factor(X2=45.7**) and medical speciality leaded the same result(X2 = 95.3**). 3) The total time of surveillance for nosocomial infection was 4.75 hours per day in hospital of 1,200 beds. It was only time for chart review and microbiological finding. For manpower study, it is requested that time for patient visiting and miscellaneous time.
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A literature review study on nosocomial infection
Nam yi Kim
Korean J Epidemiol. 1986;8(1):127-146.
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It is generally recognized that nosomial infection has been one of the major obstacles for improving health conditions in spite of the considerable decline of infectious disease due to progress in medical technology and medicine. The purpose of this study is to examine epidemiologic characteristics of nosocomical infection and to find out effectives measures for preventing them. The main sources of references are the medical journals published from 1960 to 1985 from which the basic information on nosocomial infection, such as incidence of nosocomial infection, major pathohens, and antibiotics resistancy rate of pathogens were collected. For this analysis more than 180 articles related to nosocomial infection were reviewed. The major findings of the analysis can be summarized as follows. 1) The incidence rate of nosocomial infection is about 5~6%, and it has a tendency to be declined over time. 2) The nosocomial infection is more frequently found in the area of lower respiratory, urinary tract, surgical wound, and infection for these areas constitute more than 50% of the total incidence of infection. 3) The incidence rate of nosocomial infection is higher for surgery than other clinics. 4) The nosocomial infection is caused by E. coli, Klebsiella, Pseudomonas, Staphylococci, and Proteus. The use of antibiotics produced antibiotics resistant organism which may change the frequency of pathogen for nosocomial infection. 5) Staphylococci is more likely to infect for surgical wound and new born infants, but which shows a high resistancy rate for antibiotics. 6) Gram negative pathogens is the most important pathogens for nosocomial infection. The blood stream infection is frequently caused by it particularly for the aged, infant and those who have underlying disease. 7) Legionnaires' disease and pontiac fever are caused by Legionella pneumophyla which is related to air conditioning water. 8) Lower respiratory infection is attributable to continuous use of respiratory aid. Pneumonia caused by Gram negative pathogens is typical of them. 9) Urinary tract infection is one of the most popular nosocomial infection which is mainly occasioned by use of urinary catheter. The typical pathogen of it is E. coli which has high resistancy rate for antibiotics. 10) The incidence rate of sungical wound infection is dependent upon duration of surgery, physical condition of a patient, and degree of contamination of surgical wound. The pathogens have been changed from Gram(十) organisms to Gram (一) organisms which has high resistancy rate for antibiotics. 11) The infection after blood transfusion is caused by the transfer of pathogens through contaminated blood of donors. 12) The infection related to injection is due to contamination of needles and syringes and injection area as well as hands of personnel. 13) The main causes of nosocomia inflection are hospital environments, patients and pathogens. 14) The following measures can be suggested to prevent nosocomial infection: isolation, hand washing, aseptic operation, vaccination of hospital personnel and education of nosocomial infection for patients and hospital personnel. But the most important and effective one seems to be an establishment of nosocomial infection control committee and monitoring nosocomial infection by full time nurse epidemiologist.
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HBsAg positive rate among Korean urban and rural middle school children
Joung Soon Kim, Moon Ho Chung, Seong Che Suh
Korean J Epidemiol. 1986;8(1):115-126.
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This study was carried out on about 25,000 Korean middle school children in 1984 in order to understand epidemiologic characteristics of HBsAg positive status as a part of study entitled “physical and intellectual development of Korean children in relation to family formation pattern”. The HBsAg was tested by modified immunodiffusion test. Summarized results are as following: 1) HBsAg positive rates in four different areas, namely urban well-to-do, urban slum, mountainous area, coastal area were significantly different each another, the coastal area being the highest (9.0% for male and 7.1% for female). 2) There was no statistical difference by age, 12-16 years of age, in the same area and sex, however, male children showed higher positive rates than female children in all areas. 3) The HBsAg positive rates were higher among the children whose father's professional status and mother's educational level were lower than those children with higher socioeconomic status. 4) The HBsAg positive rates were higher among the children who were from the larger family with higher crowding index, with more numerous siblings and with later birth orders than the children with fewer siblings and earlier birth orders.
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An analytic review on the trends of cesarean section among hospital deliveries in Korea
Kyoo jean Lee, Jae Woong Hong
Korean J Epidemiol. 1986;8(1):96-114.
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This study reviews 34 studies on the Cesarean sections among hospital deliveries published after 1960 in Korea. Some of them were insufficient to describe the basis of rates calculated. These are supplemented by the informations gathered from the registry of maternity patients and annual reports of each hospital. The results are summarized as follows: 1) The rates of Cesarean section among hospital deliveries were rapidly increasing since 1970’s in all of the hospitals involved. Those reached over 30% at several hospitals in 1980’s. Higher rates were seen among deliveries at large size hospitals and university hospitals. The variations of these-rates would be explained by the characteristics of mothers who selected the specific hospital for their delivery. But most of the studies reviewed are lacking in such kinds of information. 2) The cause-specific rates of Cesarean section among hospital deliveries were high in cephalopelvic disproportion, previous section, and malpresentations in this order. 3) The risks of death of mother or newborn infant after delivery by Cesarean section were significantly declined during recent twenty years. These might be due to the improvement of technology of operation and of treatment, and universality of Cesarean section. 4) The frequent complications of Cesarean section were unknown fever, wound and urinary infections etc. The incidence of these complications were varied with hemoglobin level at admission, type of section, time gap between ruptured membrane and operation, and duration of labor.
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A study on health impact of a river pollution neighboring industrialized big city on the rural people residing along the river
Joung Soon Kim, Seung Wook Lee, H.S Yoon, Y Heo, S.J Yang, T.W Ha, H.K Hong, Y.W Lee, H.H Kwon, D.H Lee, H.C Kim
Korean J Epidemiol. 1986;8(1):37-95.
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This study is conducted to identify any adverse health impact for the rural residents living along a certain river in Korea. The river actually accomodates all the industriral and domestic waste-water discharged from its neighboring big city. Unfortunately, the river is being served for farming water residents, while the current water cleaning system does not function satisfactorily. It means a possibility that the polluted water can contaminate underground water which is the main source of drinking water in the area. The aim of the study is to determine the contamination level of heavy metals and evaluate the health impact of the residents with a linkage to the river pollution. The study is proceeded under the following steps. 1) The area is divided into two parts where the water is used for the farming or not. They formed study and control area. For the residents within the sites, study and control groups were formed. 2) Between the two, any statistical significance was pursued for the following items, (1) the contamination levels by the metals in drinking water source, soil, farming products, farming products, and fishes which live in the water where the river joins the main river, (2) the contamination levels of rural residents, blood samples, and (3) by physicians the health evaluation results by clinical and pathological tests for the residents. 3) the correlation between the blood contamination levels and the health results, 4) the correlation between the blood and environmental pollution levels were studied. In spite of several limitations from the nature of the study, The findings were summarized as follows: 1) No statistical significance was found in the differences between the groups with regard to age, sex, occupation, economic status, education levels, pregnancy history, number of household members, and medical insurance status. 2) No statistical significance were found with regard to smoking habit, proportions of drinking, boiled water, number of days using pesticides and number of pregnancy poisoning, frequency of monthly meat intake. But a significance was found in the number of fish intake, while almost nobody took fishes from the river. 3) Most of the residents(93%) think the river is harmful to their health and 34% among them addressed that the river contamination is the cause of various dermatitis. 4) Stillbirth rate was significantly higher in the study group, but no correlation was found with the metal contamination. 5) The study group showed significantly higher complaints for 24 symptoms believed to appear with metal contamination, but no correlation was found. No correlation was found when the symptoms are grouped into 17 disease classification, either. 6) Neurological symptoms and clinical screening tests did not show any significant difference between the groups. Past disease history showed the same thing. 7) The results of diagnoses by physicians are classified into three groups from normal to abnormal. The control groups had higher proportion of the normal, but conjunctiva abnormaly, unspecified digestive ulcer, symptoms of abdomen and pelvic area, gasritis and duodenum inflammation were more frequent in the control group. Neurologic findings by a specialist did not show any difference. 8) The values of laboratory tests for hematopoietic system, kidney, and liver functions as indices of health measurements didn’t show any significance. 9) For the level of heavy metal contamination in blood, those of Cu, Cd, Pb but Zn were statistically higher than those determined by the National Envoronmental Protection Institute for the Yang-pyong-kun residents. For Pb, Zn, Ni at 0.1% and Hg at 5%, the values from the control groups was rather higher than those in the study group. However, at was seen that the level of Cd of the study group was higher than the control groups at 5%. They failed to show any consistent pattern, but the males has higher value than the females for Cd, Zn, Hg and lower value for Cu, Pb with statistical significance. 10) The proportions of residents above the permissible levels for the metal contamination were determined. The proportions for Pb and Zn showed that those for the control group were statistically higher than those for the study group. They were 42.3% for Pb and 6.3% for Zn, respectively, in the control group. For the case group, they were 19.3% for Pb and 4.6% for Mn, respectively. The proportions of residents who had abnormal level for more than 2 kinds of heavy meatals was 10.2% and for more than 3 kinds 0.8%. 11) The health evaluation results were linked with the classification of metal levels into the normal and abnormal groups. The abnormal group in Mn level seemed to have high proportion of lassitude, but its reliability was very low because of the sample size of 1. Also, the proportion of no symptoms was significantly higher in the group abnormally contaminated by Pb and Zn rather in the normal group. The clinical evaluation results showed that the Pb-and Zn-high groups had more frequently hearing difficulty, the Pb-high conjuntictiva problem, the Zn-high group neurotoxic disturbance and hearing difficulty. The neurological findings showed that inflammation, neurotoxic disturbance and hearing difficulty in the Mn-and Pb-high group, respectively. Also, various pathological tests did not show any significance. 12) The water quality was examined for the river and drinking water. The river seemed to be polluted by not heavy metal but various organic materials. This can be backed up by high levels of COD, BOD, and DO. The drinking water classified into underground water, well and simple-lined pump didn’t bear any significant difference from that in the control area and was believed to be generally appropriate for drinking. In the simple-lined pump and well water, the levels of Cu, Pb, and Ni were slightly higher than in the foot site river. It needs further attention to find Hg, As, Cr in the well water which did not exist in the river. 13) The sample of fishes to determine heavy metal contamination level was taken in the main river around the various sites where the river joins. While the site difference couldn’t be identified because of the fish morbidity, the levels were below being serious. However, the levels of Pb and Hg were slightly higher but not significant. 14) For the farmig product, nine crops sampled. The levels of Pb and Zn were significantly higher in brown rice, corns, garlics, while the others were below the permissible level. This results are consistent with the residents results But no significance were found when compared to the control area, while some metals show higher levels in the contral area. 15) The metal contaminatin levels in the soil of the study area were significantly higher for Pb, Zn and Mn. Although the Mn level in the residents blood is very low, the high levels for of Pb and Zn need attention beeanse they were also high in the crops. 16) The correlation between the soil and crops did not show any consistent pattern. However, in certain sites, the high correlations were found and suspected due to the confounding factors such as the regional nature of soil contamination, pesticides and fertilizer. 17) For the corelation between the blood and environmental contaminations, the levels of metals except Mn which showed the high levels in the soil and crops were also high in the blood. The relatively great portion of the residetns with high levels can cause serious health impact. However, the origin of their contamination seems to come from the soil not from the river. It deserves a further investigation on this matter.
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Case-control study on some risk factors and status of disease control of hypertension in rural community
Sung Hyun Han, Yang Ho Kim, Sung Soo Lee
Korean J Epidemiol. 1986;8(1):23-36.
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The main objectives of this study were to find the important risk factors of hypertension in rural area, to establish the criteria of diagnosis of hypertension at public health care level, and to develop proper educational materials for its prevention and care by community health workers. This study is a part of Eumseong Community Health Project supportes by GTZ(West German Government) and the government of Republic of Korea. 330 perceived cases of hypertension were first screened by health interview and examinations, and 146 cases were diagnosed as a hypertension group. For comparison, 176 cases were as signed as a control group. Therefore, a total of 322 cases were selected for this study. The results of this study can be summarized as fellows; 1) The significant influencing risk factors to the hypertension was genetic factors, amount of salt intake, degree of obesity, level of serum cholesterol and urine protein, and the findings of EKG. The logit regression analysis indicated that among these risk factors, the first in explaining of value was the findings of EKG(1.21) and the next, amount of salt intake (0.58) serum cholesterol level (0.48), genetic factors (0.32). 2) For treatment of hypertension, it was found that only 23.6% of them visited clinic or hospital once or more and 39.3% used drug store, herb-medicine and other indegeneous methods. But 47.1 % of them were “never treated” for hypertension 3) In care of patients by family members, only 22.9% of the patients have been cared by family members (spouse and/or child) but the lest of them said they were neglected to care by their family members. The results of this study revealed that the hypertension patients and their family members did not consider hypertension as a serious problem and made little efforts to receive proper care. Also, no public health program of this chronic disease have yet provided. Based on this findings in rural Korea, the authors urged that it is urgently needed to formulate the hypertention control and care program for its prevention and early case findings.
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A study on concern with cervical cancer and attitudes toward a screening examination among rural Koreans
Kyung Hee Lee, Soo Young Chi, Taik Koo Yun
Korean J Epidemiol. 1986;8(1):11-22.
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A survey was carried out during the period from October to November of 1985 to obtain information on concern with cancer and its symptom, attitudes toward a screening examination and demographic and socioeconomic aspects in the decision to the screening. Interviewed were 1,355 married women who participated in the screening examination and 278 married women selected by simple random sampling in Yangju-Gun, Gyounggi-Do. The results summarized are as followings: 1) Among the population tested, 1,351 women (99.7%) was negative, 2 positive and 2 dysplasia. 2) The participants in the screening examination tended to be younger, better educated and better economic status than the nonparticipants. 3) Fifty-two percent of the participants and 33.6 percent of the nonparticipants reported that there had been times when they wondered if they had cervical cancer. 4) The participants tended to report more symptoms of cervical cancer than the nonparticipants. 5) There was general agreements among the paricipants and the nonparticipants on “Pap tests should be taken every year” and “If caught in its early stages, cervical cancer can be cured”. 6) Among the population studied 25% had been tested. The proportion tested was 27% in the partticipants and 15% in the nonparticipants respectively. 7) Proportions of women tested less than two years, between two and four years ago and more than 4 years were 14%, 8% and 3% respectively. 8) The proportion not tested in the past five years was 72% in the participants and 84% in the nonparticipants respectively. Proportions of women tested only once, twice and three or more were 23%, 2% and 1% in the participants, and 14%, 1% and 3% in the nonparticipants.
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Predicting the global spread of new infectious agents
Gill Han Bai
Korean J Epidemiol. 1986;8(1):7-10.
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Randomized clinical trial vs. historical control studies
Kwang Ho Meng
Korean J Epidemiol. 1986;8(1):1-6.
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Epidemiol Health : Epidemiology and Health