Epidemiology and Health

Original Articles

A decision tree model for traffic accident prediction among food delivery riders in Thailand: Muslimah Molo, Suttida Changsan, Lila Madares, Ruchirada Changkwanyeun, Supang Wattanasoei, Supa Vittaporn, Patcharin Khamnuan, Surangrat Pongpan, Kasama Pooseesod, Sayambhu Saita; Epidemiol Health. 2024;46:e2024095. Published online November 26, 2024; DOI: https://doi.org/10.4178/epih.e2024095

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Abstract

OBJECTIVES
Food delivery riders (FDRs) play a crucial role in the food delivery industry but face considerable challenges, including a rising number of traffic accidents. This study aimed to examine the incidence of traffic accidents and develop a decision tree model to predict the likelihood of traffic accidents among FDRs.

METHODS

A cross-sectional study was conducted with 257 FDRs in Chiang Mai and Lampang Province, Thailand. Participants were interviewed using questionnaires and provided self-reports of accidents over the previous 6 months. Univariable logistic regression was used to identify factors influencing traffic accidents. Subsequently, a decision tree model was developed to predict traffic accidents using a training and validation dataset split in a 70:30 ratio.

RESULTS

The results indicated that 45.1% of FDRs had been involved in a traffic accident. The decision tree model identified several significant predictors of traffic accidents, including delivering food in the rain, job stress, fatigue, inadequate sleep, and the use of a modified motorcycle, achieving a prediction accuracy of 66.5%.

CONCLUSIONS

Based on this model, we recommend several measures to minimize accidents among FDRs: ensuring adequate sleep, implementing work-rest schedules to mitigate fatigue, managing job-related stress effectively, inspecting motorcycle conditions before use, and exercising increased caution when delivering food during rainy conditions.

Summary

Citations

Citations to this article as recorded by

Modeling Riding and Stopping Behaviors at Motorcycle Box Intersections: A Case Study in Chiang Mai City, Thailand
Wachira Wichitphongsa, Nopadon Kronprasert, Moe Sandi Zaw, Pongthep Pisetsit, Thaned Satiennam
Infrastructures.2025; 10(4): 97. CrossRef
The Impact of Conservative Estimated Time of Arrival Algorithm on Food Delivery Rider Behaviors
Miao Yu, Hailiang Chen, Yuan Cheng, Yu Jeffrey Hu
SSRN Electronic Journal.2023;[Epub] CrossRef

An outbreak of Clostridium perfringens infection on a training ship anchored in Busan, Korea: Seonmi Kim, Hyunjin Son; Epidemiol Health. 2024;46:e2024086. Published online November 7, 2024; DOI: https://doi.org/10.4178/epih.e2024086

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Abstract Summary PDF

Abstract

OBJECTIVES
In September 2023, an outbreak of food-borne disease occurred among students on a training ship docked in Busan. This was an epidemiological investigation with the aim of improving infection prevention activities and group meal service practices on board ships.

METHODS

In this study, a case was defined as an individual who experienced diarrhea more than twice a day during their training period aboard the training ship. A total of 171 exposed individuals including 6 food handlers was well-defined; therefore, a retrospective cohort study was conducted. We administered a questionnaire and conducted laboratory tests including 38 rectal swab samples. Relative risk (95% confidence interval) for each food item was calculated.

RESULTS

Of the 165 students and school staff members, 41 met the case definition, resulting in an attack rate of 24.8%; all cases were students. The shape of the epidemic curve was unimodal, with the peak from 00:00 to 06:00 on September 7, 2023. Clostridium perfringens was detected in 9 cases, and no other pathogens were found. Significant relative risk was shown in 11 different food items.

CONCLUSIONS

C. perfringens was the causative pathogen of this outbreak on the training ship. Due to the lack of preserved food samples, the exact source of infection could not be confirmed. Ships are not classified as collective dining facilities, leaving them in a management blind spot. Therefore, specialized guidelines, voluntary inspections by the operating entities, and continuous education for managers and staff are necessary.

Summary

Korean summary
부산의 훈련선에서 발생한 식중독은 Clostridium perfringens에 감염되어 발생한 것으로 확인되었으며, 165명 중 24.8%가 감염되었고, 2023년 9월 7일 0시에서 6시 사이에 유행곡선의 정점을 기록했다. 본 연구는 선박이 집단 급식시설로 분류되지 않아 관리의 사각지대에 놓인 점을 감안하여, 전문적인 가이드라인과 지속적인 교육, 자발적인 점검이 필요함을 제언하고 있다.

Key Message
A food-borne disease outbreak occurred on a training ship in Busan, affecting a significant number of people with Clostridium perfringens infection. Among the 165 people, the attack rate was 24.8%, with the epidemic peak occurring between 0:00 and 06:00 on September 7, 2023. This study recommends implementing specialized guidelines, voluntary inspections, and continuous education to improve infection prevention practices on ships, which are not classified as collective dining facilities and thus remain in a management blind spot.

Citations

Citations to this article as recorded by

Antimicrobial Resistance on Ships: A Narrative Review
Yusuff Adebayo Adebisi, Adeola Bamisaiye, Don Eliseo-Lucero Prisno
Infectious Diseases Now.2025; 55(2): 105027. CrossRef

Changes in food sufficiency among Korean adults in urban and rural areas during the COVID-19 pandemic: an analysis of the 7th and 8th Korea National Health and Nutrition Examination Survey: Sarang Jeong, Jin-Young Jeong, Sohyun Park; Epidemiol Health. 2024;46:e2024045. Published online April 16, 2024; DOI: https://doi.org/10.4178/epih.e2024045

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Abstract Summary PDF: Abstract
OBJECTIVES
Understanding changes in food sufficiency within various demographic groups during emergency situations, such as the global coronavirus disease 2019 (COVID-19) pandemic, is crucial in formulating public health policies for future preparedness. This study investigated potential differences between urban and rural residents in food sufficiency trends during the COVID-19 pandemic and examined how these changes varied according to socio-demographic factors.
METHODS
This cross-sectional study analyzed data from 19,724 adults aged 20 years and older, utilizing information from the 7th-8th Korea National Health and Nutrition Examination Survey (2018-2021).
RESULTS
In urban areas, across all subpopulations, food sufficiency improved significantly during the COVID-19 period relative to pre-pandemic levels (p<0.001). However, in rural regions, a significant increase in food sufficiency during the COVID-19 era was observed only among female, with an odds ratio of 1.42 (95% confidence interval, 1.06 to 1.89). Nevertheless, no significant interaction terms were found between region and various socio-demographic factors regarding changes in food sufficiency during the COVID-19 period.
CONCLUSIONS
During the COVID-19 pandemic, food sufficiency among urban residents improved compared to the pre-pandemic era, whereas their rural counterparts saw no such improvement. Additionally, no significant interaction was detected between urban versus rural areas and changes in food sufficiency during the COVID-19 period. These findings indicate the need for targeted food policies to prepare for potential future pandemics, particularly in rural areas, where food sufficiency did not improve.; Summary

Korean summary
- 본 연구는 COVID-19 팬데믹 동안 도시와 농촌 지역의 성인들 사이에서 식품 충분성의 변화를 조사하고, 이 변화를 사회인구학적 요인에 따라 분석하였다.
- 연구 결과, 코로나19 기간 동안 도시 지역의 다양한 인구통계학적 하위 그룹에서 식품 충분성이 크게 증가했으며, 농촌 지역에서는 여성들을 제외하고는 유의미한 변화가 나타나지 않았다.
- 본 연구는 향후 팬데믹 대비를 위한 식품 충분성 정책을 개발할 때 인구통계학적 요인과 지역적 차이를 고려하는 것이 중요하며, 특히 농촌 지역에서의 필요성을 강조한다.

Key Message
- This study examined changes in food sufficiency among adults in urban and rural areas during the COVID-19 pandemic, focusing on socio-demographic factors.
- Findings revealed that food sufficiency significantly increased in urban areas across various demographic subgroups during the COVID-19 period, while rural areas showed no significant overall change, except for an increase among women.
- The study highlights the importance of considering socio-demographic factors and regional differences, particularly the need for targeted food assistance programs in rural areas, for future pandemic preparedness.

Epidemiologic Investigation

Salmonellosis outbreaks linked to eggs at 2 gimbap restaurants in Korea: Jun Suk Eun, Joohyun Han, Ji-Hyun Lim, Eunkyung Shin, Junyoung Kim, Da-Jung Ko, Jaeil Yoo, Sungil Kim, Jin Sook Kim, Jung Sub Park, Ji-Hyuk Park; Epidemiol Health. 2024;46:e2024036. Published online March 7, 2024; DOI: https://doi.org/10.4178/epih.e2024036

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Salmonellosis outbreaks occurred at 2 restaurants 2 days apart, and an epidemiological investigation was conducted to determine whether the outbreaks were connected.

METHODS

Case studies were conducted for both outbreaks. Stool samples were collected from individuals, and food samples were collected from the restaurants. Pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing analyses were performed on outbreak-related Salmonella enterica serovar Enteritidis (Salmonella Enteritidis) isolates. Traceback investigations were also conducted for the ingredients from gimbap restaurants A and B.

RESULTS

In total, 106 people from gimbap restaurant A and 5 from gimbap restaurant B met the case definition. Salmonella Enteritidis was detected in samples from 2 food handlers, 22 patients, and 1 food (iceberg lettuce) at gimbap restaurant A and from 1 patient at gimbap restaurant B. According to PFGE, all isolates were identified as SEGX01.089. The molecular typing of all isolates showed the same pattern, and the genetic distance was close according to phylogenetic analysis. Eggs were the only food ingredient that was supplied to both gimbap restaurants.

CONCLUSIONS

The outbreaks were caused by Salmonella Enteritidis, and the source of infections was suspected to be contaminated eggs. To prevent foodborne outbreaks of Salmonella, restaurants should heat eggs sufficiently, and egg farms need to establish management systems that prevent Salmonella infections.

Summary

Korean summary
동일한 도시의 두 식당에서 2일 간격으로 살모넬라감염증 유행이 발생하여, 원인을 확인하고 두 유행 간에 연관이 있는지를 규명하기 위해 역학조사를 시행하였다. 병원체에 대한 유전자형 분석과 식재료 역추적조사 결과를 바탕으로 두 유행은 Salmonella Enteritidis에 의해 발생하였고, 감염원은 동일한 농장에서 공급된 오염된 계란으로 추적하였다.

Key Message
Salmonellosis outbreaks occurred at 2 restaurants in the same city 2 days apart, and epidemiological investigations were conducted to identify the causes and determine whether the outbreaks were connected. Based on the genetic characterization of the pathogens and traceback investigation of the food ingredients, the outbreaks were caused by Salmonella Enteritidis and the source of infection was traced to contaminated eggs, which were supplied from the same farm.

Citations

Citations to this article as recorded by

Gompertz-derived growth kinetics of Salmonella enterica serovar Bareilly inoculated in precooked ingredients for Gimbap
Jae-Hyun Yoon, Hyunji Song, Euijin Choo, Sun-Young Lee
Food Science and Biotechnology.2025; 34(10): 2353. CrossRef
2019–2022년 국내 수인성‧식품매개감염병 원인세균 병원체 감시현황
문의 홍, 은경 신, 준영 김, 재일 유
Public Health Weekly Report.2024; 17(45): 1941. CrossRef

Original Article

Food literacy and its relationship with food intake: a comparison between adults and older adults using 2021 Seoul Food Survey data: Seulgi Lee, Sohyun Park, Kirang Kim; Epidemiol Health. 2023;45:e2023062. Published online July 3, 2023; DOI: https://doi.org/10.4178/epih.e2023062

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Abstract Summary PDF

Abstract

OBJECTIVES
This study was conducted to examine the differences in food literacy between adults and older adults and the association of food literacy with food group intake.

METHODS

In total, 4,039 participants from the 2021 Survey for Food Consumption in Seoul were included in this study. The intake of whole grains, high-protein foods, total vegetables, vegetables excluding kimchi and pickles, fresh fruits, and milk and dairy products was assessed using a simple food frequency questionnaire. Food literacy was measured using a food literacy measurement questionnaire.

RESULTS

With the exception of milk and dairy, adults had a significantly higher proportion of insufficient food intake than older adults (p<0.001). Both adults and older adults with sufficient food group consumption had higher food literacy scores. Notably, the difference in food literacy scores by level of food intake was highest for fresh fruits (p<0.001). After adjusting for confounding factors affecting food literacy scores, a higher score was associated with a lower probability of having insufficient food intake in all food groups for both adults and older adults. Specifically, those in the highest food literacy score quartile were less likely to have insufficient intake of vegetables (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.28 to 0.43) and fresh fruits (OR, 0.32; 95% CI, 0.24 to 0.43), compared to the lowest quartile.

CONCLUSIONS

Improving food literacy is an important factor for promoting healthy food intake in older adults as well as adults. Therefore, it is necessary to develop intervention programs to work toward this goal.

Summary

Korean summary
건강정보 이해능력(health literacy)은 노인에서 만성질환이나 인지능력과의 관련성이 보고되고 있으나 영양정보 이해능력(food literacy)에 대한 연구는 미비하다. 급변하는 식이 환경에서 식사 및 영양과 관련된 정보를 올바르게 이해하고 판단할 수 있는 영양정보 이해능력은 노인성 질환 예방에 중요하다. 본 연구에서 영양정보 이해능력과 식품군 섭취와의 상관성을 분석한 결과 영양정보 이해능력이 높은 노인이 건강한 식품 섭취 부족 위험이 낮았다. 특히 과일 섭취 부족 위험은 영양정보 이해능력이 높은 노인에서 뚜렷하게 낮았다. 국내 영양정보 이해능력 연구는 초기 단계로 주로 성인 대상으로 연구가 이루어져서 본 연구에서의 결과는 그 의의가 크며, 영양정보 이해능력 향상은 성인과 마찬가지로 노인에서도 건강한 식품 섭취를 위한 중요한 요인으로서 이를 위한 프로그램 개발이 필요할 것으로 사료된다.

Key Message
The study on food literacy among older adults in Korea is significant as previous research has mostly focused on adults. The results showed that older adults with higher food literacy score had lower risk of insufficient food intake as compared with those with lower food literacy score. Specifically, the risk of insufficient fresh fruits intake was the lowest among older adults with higher food literacy score. Therefore, improving food literacy is an important factor for promoting healthy food consumption among older adults.

Citations

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Does Health Literacy Mediate Sociodemographic and Economic Inequalities in Fruit and Vegetable Intake? An Analysis of Slovenian National HLS19 Survey Data
Andrej Kirbiš, Stefani Branilović, Maruša Lubej
Foods.2025; 14(3): 378. CrossRef
Self-perceived food literacy in relation to the quality of overall diet and main meals: A cross-sectional study in Japanese adults
Kentaro Murakami, Nana Shinozaki, Tsuyoshi Okuhara, Tracy A. McCaffrey, M. Barbara E. Livingstone
Appetite.2024; 196: 107281. CrossRef
Status of Food Literacy and Association with the Nutrition Quotient among Korean Adults
Geum-Bi Ryu, Young-Ran Heo
Human Ecology Research.2024; 62(3): 399. CrossRef

Epidemiologic Investigation

Epidemiological investigation of a food-borne outbreak in a kindergarten, Jeju Province, Korea: Kyoung Mi Kim, Eun Suk Cho, Seong Bae Ahn, Eun Ok Kang, Jong-Myon Bae; Epidemiol Health. 2023;45:e2023047. Published online April 17, 2023; DOI: https://doi.org/10.4178/epih.e2023047

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
On Monday, September 6, 2021, at a kindergarten in Jeju Province, a large number of children vomited and developed food poisoning symptoms, and this necessitated an epidemiological investigation.

METHODS

The team surveyed symptoms and food intake history of kindergarten children, teachers, and workers who ate lunch between September 2 (Thursday) and September 6 (Monday), excluding weekends. In addition to rectal swabs, environmental samples from preserved foods, cooking utensils, drinking water, and refrigerator handles were collected. Pulsed field gel electrophoresis (PFGE) for genetic fingerprint analysis was also performed.

RESULTS

There were 19 cases among 176 subjects, which indicated an attack rate of 10.8%. The epidemic curve showed a unimodal shape, and the average incubation period was 2.6 hours. While no food was statistically significant in food intake history, the analysis of 35 rectal smear samples detected Bacillus cereus in 7 children, 4 teachers, and 1 cooking staff. Enterotoxins were also detected in 12 samples. Out of 38 environmental samples, B. cereus and enterotoxins were detected in the morning snack cereal, lunch bean sprouts, and afternoon snack steamed potatoes on Monday, September 6th. The result of the PFGE test on 10 isolates of B. cereus showed that there was no genetic homology.

CONCLUSIONS

Our results indicated that this outbreak was simultaneously caused by various strains of B. cereus from the environment.

Summary

Korean summary
모 유치원에서 제공한 급식 취식아동에서 발열이 없고 구토형의 주증상인 식중독이 발생되었다. 평균 잠복기 2.6시간 (최소 0.8, 최대 4.5시간)이며, 인체 및 환경 검체에서 바실러스 세레우스 균이 분리되었다. 이에 해당 집단발생은 구토형 바실러스 세레우스 감염증에 의한 식중독을 결론지었다.

Key Message
A large number of children in a kindergarten vomited suddenly. The average incubation period was 2.6 hours (min 0.8, max 4.5 hours) with uni-modal shape in the epidemic curve. Bacillus cereus and entertoxin were detected in rectal smear and environmental samples.

Citations

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Surge of acute gastroenteritis outbreaks due to rising norovirus GII.4 transmission in Seoul childcare centers and kindergartens in 2022 compared to 2019–2021
Euncheol Son, Young-Hoon Kim
Archives of Virology.2024;[Epub] CrossRef

COVID-19: Health Statistics

Changes in food and nutrient intakes in Korean adults before and during the COVID-19 pandemic: data from the 2011-2020 Korea National Health and Nutrition Examination Survey: Kyungwon Oh, Suyeon Park, Sihyun Park, Sungha Yun, Hongseok Choi, Eun Kyeong Jeong; Epidemiol Health. 2023;45:e2023015. Published online February 1, 2023; DOI: https://doi.org/10.4178/epih.e2023015

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study was to examine the changes in dietary habits and food and nutrient intakes between before (2019) and during (2020) the coronavirus disease 2019 (COVID-19) pandemic from the Korea National Health and Nutrition Examination Survey (KNHANES).

METHODS

A total of 54,995 participants aged ≥19 years who participated in the 2011-2020 KNHANES were included. The 10-year trend (2011-2020) and differences between 2019 and 2020 for dietary habits and food and nutrient intakes were estimated using SAS.

RESULTS

In the past 10 years (2011-2020), the dietary habits (increase in skipping meals and eating out), food intake (increase in meats and decrease in fruits and vegetables), and nutrient intake (increase in fat and decrease in sodium) in adults have changed. When comparing between 2019 and 2020, there were 4.6%p decrease in the eating out more than once a day. On the other hand, there were no significant differences in the intakes of food, energy and most of nutrients between 2019 and 2020, except for the proportion of energy intake from fat (1.0%p increase) and carbohydrate (1.0%p decrease).

CONCLUSIONS

Although a change in dietary habits from before to during the COVID-19 pandemic was observed, food and nutrient intakes have not deteriorated markedly and appear similar to the trends in the past 10 years. Throughout the COVID-19 pandemic, it is necessary to monitor the effects of changes in dietary habits on health as well as food and nutrient intakes.

Summary

Korean summary
코로나19 유행 전, 후 비교 시, 외식 감소, 가정식 섭취 증가 등 식생활은 변화가 있었으나 주요 식품 및 영양소 섭취는 큰 변화없이 최근 10년간의 추이가 지속되고 있었다.

Key Message
Although a change in dietary habits from before to during the COVID-19 pandemic was observed, food and nutrient intakes have not deteriorated markedly and appear similar to the trends in the past 10 years in Korean adults.

Citations

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Comparative study on the health and dietary habits of Korean male and female adults before and after the coronavirus disease 2019 pandemic: utilizing data from the 8th Korea National Health and Nutrition Examination Survey (2019–2021)
Chaemin Kim, Eunjung Kim
Korean Journal of Community Nutrition.2024; 29(1): 65. CrossRef
Assessing dietary bisphenol A exposure among Koreans: comprehensive database construction and analysis using the Korea National Health and Nutrition Examination Survey
Yoonjoo Lee, Jiyun Baek, Youngjoo Kwon
Food Additives & Contaminants: Part A.2024; 41(8): 1018. CrossRef
Association of dietary habits with general and abdominal obesity in Korean children and adolescents: cluster analysis of nationwide population survey data
Ye-Jin Yun, Yu-Jin Kwon, Yaeji Lee, Seok-Jae Heo, Ji-Won Lee
Frontiers in Endocrinology.2024;[Epub] CrossRef
Analysis of the characteristics of dietary information acquisition and perceptions on the Dietary Reference Intakes for Koreans among Korean adults
Soo-Hyun Kim, Hyojee Joung
Journal of Nutrition and Health.2024; 57(6): 653. CrossRef

Original Article

Positive association of unhealthy plant-based diets with the incidence of abdominal obesity in Korea: a comparison of baseline, most recent, and cumulative average diets: Sukyoung Jung, Sohyun Park; Epidemiol Health. 2022;44:e2022063. Published online August 2, 2022; DOI: https://doi.org/10.4178/epih.e2022063

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Different approaches for analyzing repeated dietary measurements may yield differences in the magnitude and interpretation of findings. We aimed to compare 3 dietary measurements (baseline, most recent, and cumulative average) in terms of the association between plant-based diet indices (PDIs) and incident abdominal obesity in Korean adults aged 40-69 years.

METHODS

This study included 6,054 participants (54% women) free of abdominal obesity (defined as waist circumference ≥90 cm for men and ≥85 cm for women) at baseline. As exposures, baseline, most recent, and cumulative average measurements for PDI, healthy-PDI (hPDI), and unhealthy-PDI (uPDI) were created. A Cox proportional-hazard model was used to estimate the hazard ratios (HRs) for abdominal obesity.

RESULTS

During 45,818 person-years of follow-up (median, 9 years), we identified 1,778 incident cases of abdominal obesity. In the multivariable-adjusted analysis, a higher uPDI was associated with a higher risk of abdominal obesity in both total and stratified analyses. The findings were consistent across all approaches (Q5 vs. Q1: HRbaseline=1.70; 95% confidence interval [CI], 1.46 to 1.98; HRmost recent=1.52; 95% CI, 1.30 to 1.78; HRcumulative average=1.76; 95% CI, 1.51 to 2.06 in the total set). PDI showed no meaningful association with abdominal obesity risk in any analyses. hPDIaverage had a suggestive inverse association with abdominal obesity risk in men, and hPDIbaseline had a positive association with abdominal obesity risk in women.

CONCLUSIONS

Greater adherence to unhealthy plant-based diets may increase the risk of developing abdominal obesity in Korean adults. The findings were generally consistent across all approaches.

Summary

Korean summary
본 연구는 한국인 유전체역학조사사업의 안성안산코호트 조사에 참여한 40-69세 한국 성인 6,054명을 대상으로 식물성 기반의 식이 지수와 복부비만 간 연관성이 식이 노출 기간(기반, 최근, 누적 노출)에 따라 어떻게 다른지 비교 분석하였다. 건강하지 않은 식물성 기반의 식이 지수 점수가 높을수록 복부비만 발생 위험이 증가하였고, 식이 노출 기간에 관계없이 일관된 결과를 보였다. 식물성 기반의 식이가 반드시 건강에 유익한 것은 아니며, 정제된 곡물, 탄산음료, 사탕 등 간식류를 많이 먹는 식이 패턴은 식물성 기반 식이라 할지라도 복부비만 위험을 증가시킬 수 있으므로 주의가 필요하다.

Key Message
Unhealthy plant-based diets, including refined grains, sugar-sweetened beverages, sweets and desserts, and salty plant foods, can have a negative effect on abdominal obesity in Korean adults regardless of its exposure duration.

Citations

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Plant‐based and sustainable diet: A systematic review of its impact on obesity
Sara P. Mambrini, Claudia Penzavecchia, Francesca Menichetti, Andrea Foppiani, Alessandro Leone, Marta Pellizzari, Federica Sileo, Alberto Battezzati, Simona Bertoli, Ramona De Amicis
Obesity Reviews.2025;[Epub] CrossRef
Plant-based diets and the gut microbiome: findings from the Baltimore Longitudinal Study of Aging
Xinyi Shen, Curtis Tilves, Hyunju Kim, Toshiko Tanaka, Adam P Spira, Chee W Chia, Sameera A. Talegawkar, Luigi Ferrucci, Noel T Mueller
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Epidemiologic Investigation

Investigation of a human brucellosis outbreak in Douz, Tunisia, 2018: Nejib Charaa, Rabaa Ghrab, Aicha Ben Othman, Mohamed Makhlouf, Hejer Ltaief, Nissaf Ben Alaya, Mohamed Chahed; Epidemiol Health. 2022;44:e2022048. Published online May 18, 2022; DOI: https://doi.org/10.4178/epih.e2022048

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Abstract Summary PDF

Abstract

OBJECTIVES
In 2017, the incidence of human brucellosis in Tunisia was 9.8 per 100,000 population. In the Douz district, 2 cases were reported in March 2018. Prior to that date, the last indigenous cases to be reported in Douz had been in 2015. This study aimed to identify the source of this new contamination and recommend control interventions.

METHODS

This case-control study included residents of Douz who presented with clinical symptoms of brucellosis and had a subsequent Wright test antibody titer ≥ 1/160. The controls were neighbors of the infected cases who had a negative Rose Bengal test. Univariate and multivariate analyses were performed to estimate the odds ratios of risk factors. Goats belonging to the cases and controls were actively screened.

RESULTS

Twenty-five infected cases and 52 uninfected controls were enrolled. All infected cases had consumed goat milk and 92% had purchased it from the same breeder. Consumption of goat milk from this breeder (adjusted odds ratio [aOR], 30.78; 95% confidence interval [CI], 6.47 to 235.91) and overall consumption of raw goat milk (aOR, 14.84; 95% CI, 2.04 to 310.44) were independent risk factors for brucellosis. The breeder had 18 goats, 5 of which were smuggled from a neighboring country. Three of those goats were diagnosed with brucellosis.

CONCLUSIONS

Consumption of raw milk from smuggled sick goats was the main risk factor in this outbreak. The sick goats were slaughtered and an education campaign was conducted. Vaccination, control of cross-border animal movements, and control of goat milk sales must be strengthened to prevent the spread of brucellosis in southwestern Tunisia.

Summary

Key Message
Human brucellosis, despite being a major economic and health problem and the availability of proven control methods, is still endemic in North African countries. The scarcity of epidemiological data, under-reporting, certain weaknesses in surveillance systems and the lack of well-conducted outbreak investigations, contribute to this endemic state. This field epidemiological investigation of a human brucellosis outbreak highlighted the importance of serological surveillance, the slaughter of infected animals, vaccination, control of animal movements across borders and pasteurization of milk in the fight against this disease.

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Long ignored but making a comeback: a worldwide epidemiological evolution of human brucellosis
Zhiguo Liu, Liping Gao, Miao Wang, Min Yuan, Zhenjun Li
Emerging Microbes & Infections.2024;[Epub] CrossRef
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Jerina Rugji, Zeki Erol, Fulya Taşçı, Laura Musa, Ambreen Hamadani, Migena Gjoni Gündemir, Esa Karalliu, Shahida Anusha Siddiqui
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Native circulating Brucella melitensis lineages causing a brucellosis epidemic in Qinghai, China
Hongmei Xue, Zhijun Zhao, Jianling Wang, Li Ma, Jiquan Li, Xuxin Yang, Lingling Ren, Liqing Xu, Zhiguo Liu, Zhenjun Li
Frontiers in Microbiology.2023;[Epub] CrossRef

Original Article

Association between dietary and suicidal behaviors in adolescents in Korea based on the Youth Risk Behavior Survey (2015-2020): Youngrong Lee, Ye Jin Jeon, Jee-Seon Shim, Sun Jae Jung; Epidemiol Health. 2022;44:e2022033. Published online March 12, 2022; DOI: https://doi.org/10.4178/epih.e2022033

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study explored the association between dietary and suicidal behaviors of Korean adolescents and investigated differences in this association in children of immigrant parents.

METHODS

The sample (n=368,138) was collected from the Korea Youth Risk Behavior Survey from 2015 to 2020. Participants who agreed to provide family information (n=313,689) were classified according to their parents’ nationality. The study variables were 11 self-reported dietary behaviors, and their composite dietary behaviors (i.e., nutrient deprivation and unhealthy food consumption) that resulted from principal component analysis. The association between study variables and suicide-related outcomes (i.e., suicidal ideation, suicide planning, and suicide attempts) was analyzed by multiple logistic regression with adjustment for covariates. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated.

RESULTS

Participants who skipped key meals and foods were more likely to have attemped suicide (aOR [95% CI]: skipping breakfast ≥5 days/wk, 1.28 [1.21 to 1.35]; consuming fruits <1 times/wk: 1.42 [1.32 to 1.52]; consuming vegetables <1 times/wk: 1.72 [1.53 to 1.93]; consuming milk <3 times/wk: 1.07 [0.99 to 1.16]). The associations were prominent in third culture kids (TCKs) (aOR [95% CI]: 2.23 [1.61 to 3.09]; 2.32 [1.61 to 3.35]; 2.63 [1.50 to 4.60]; 1.69 [1.09 to 2.63], respectively). Participants who consumed unhealthy foods (fast food, caffeinated and sugary drinks) more frequently were more likely to have attempted suicide (aOR, 1.55; 95% CI, 1.38 to 1.73). This association was also more prominent in TCKs (aOR, 2.08; 95% CI, 1.08 to 4.01).

CONCLUSIONS

Our findings indicate a positive association between unfavorable dietary behaviors and outcomes related to suicide, and this association appears to be notable in adolescents with immigrant parents.

Summary

Korean summary
• 한국 청소년의 식이 행동과 자살 행동 사이의 연관성과 한국인 부모와 이민자 부모 자녀에서 위의 연관성 차이를 조사하였다. • 청소년의 결식 빈도 증가, 과일, 야채, 우유 섭취 감소는 자살 행동과 유의한 연관성이 있었으며 이민자 부모를 둔 청소년에서 연관성의 크기가 더 컸다. • 패스트푸드, 카페인, 가당 음료, 인스턴트 음식을 더 자주 섭취하는 청소년은 자살을 시도할 가능성이 더 높았으며 이민자 부모를 둔 청소년에서 더 큰 연관성을 보였다.

Key Message
The study found positive associations between undesirable dietary behaviors (e.g., skipping breakfast, increased consumption of fast food or instant food product) and outcomes related to suicide (i.e., suicide ideation, planning, and attempt) in Korean adolescents, and these associations appear to be prominent in adolescents with immigrant parents than those with Korean parents.

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Breakfast consumption was associated with suicidal ideation, plan, and attempt: a population-based cross-sectional study
Yunshu Zhang, Keqing Li, Lili Zhang, Long Sun
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Trends in health behaviors and mental health among Korean adolescents in Korea over 5 years, 2017–2021: focusing on the comparisons before and during the COVID-19 pandemic
Mi-Sun Lee, Dong Jun Kim, Hooyeon Lee
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Association between body shape misperception and unhealthy eating behaviors among Korean adolescents
Yejin Kim, Bomgyeol Kim, Vasuki Rajaguru, Sang Gyu Lee, Tae Hyun Kim
Nutrition Research and Practice.2023; 17(6): 1143. CrossRef

Epidemiologic Investigation

An outbreak of hepatitis A associated with salted clams in Busan, Korea: Hyunjin Son, Miyoung Lee, Youngduck Eun, Wonseo Park, Kyounghee Park, Sora Kwon, Seungjin Kim, Changhoon Kim; Epidemiol Health. 2022;44:e2022003. Published online December 29, 2021; DOI: https://doi.org/10.4178/epih.e2022003

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
In July 2019, there were multiple reports on patients with hepatitis A among the visitors of a restaurant in Busan. The current study presents the results of an epidemiological investigation and outlines the supplementary measures that would help with hepatitis A control.

METHODS

A cohort study was conducted for all 2,865 customers who visited restaurant A from June to July. Using a standardized questionnaire, participants reported the presence of hepatitis A symptoms and whether they had consumed any of 19 food items. As for participants who had visited public health centers, their specimens were collected.

RESULTS

From the study cohort, 155 participants (5.4%) had confirmed hepatitis A. The epidemic curve was unimodal, and the median number of days from the restaurant visit to symptom onset was 31 days. A genotype analysis indicated that 89 of 90 tested patients had hepatitis A virus (HAV) genotype 1A. The results of a multivariate logistic regression analysis indicated that the ingestion of salted clams increased the risk of hepatitis A by 68.12 times (95% confidence interval [CI], 9.22 to 510.87). In an unopened package of salted clams found and secured through traceback investigation, HAV genotype 1A was detected.

CONCLUSIONS

To prevent people from ingesting uncooked clams, there needs to be more efforts to publicize the dangers of uncooked clams; the food sampling test standards for salted clams should also be expanded. Furthermore, a laboratory surveillance system based on molecular genetics should be established to detect outbreaks earlier.

Summary

Korean summary
2019년 7월, 부산시의 한 식당을 방문한 사람에서 다수의 A형간염 환자가 신고되었다. 2019년 6월 1일부터 7월 28일까지 해당 식당을 방문하여 카드 결제를 한 사람과 동반자 2,865명 전체를 대상으로 코호트 조사를 수행하였다. A형간염에 확진 된 사람은 총 155명으로 발병률은 5.4%였다. 다변량 로지스틱 회귀분석 결과 조개젓 섭취는 A형간염 발병 위험을 68.62배(95% CI, 9.22 to 510.87) 증가시키는 것으로 나타났다. 익히지 않은 조개류를 섭취하지 않도록 더욱 홍보를 강화해야 한다.

Key Message
In July 2019, there were multiple reports on patients with hepatitis A among the visitors of a restaurant in Bu¬san. A cohort study was conducted for all 2,865 customers who visited the restaurant from June to July. From the study cohort, 155 participants (5.4%) had confirmed hepatitis A. The results of a multivariate logistic regression analysis indicated that the ingestion of salted clams increased the risk of hepatitis A by 68.12 times. To prevent people from ingesting uncooked clams, there needs to be more efforts to publicize the dangers of uncooked clams.

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Gender differences in hepatitis A seropositivity rates according to the Republic of Korea’s vaccination policy
Hyunjin Son, Sunhyun Ahn, Wonseo Park, Gayoung Chun, Unyeong Go, Sang Gon Lee, Eun Hee Lee
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Investigating the spatio-temporal variation of hepatitis A in Korea using a Bayesian model
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Original Article

Trends in food and nutrient intake over 20 years: findings from the 1998-2018 Korea National Health and Nutrition Examination Survey: Sanghui Kweon, Jin Young Park, Myungsook Park, Yangha Kim, So Yeong Yeon, Leena Yoon, Sungha Yun, Suyeon Park, Ji Eun Yang, Youngtaek Kim, Ok Park, Kyungwon Oh; Epidemiol Health. 2021;43:e2021027. Published online April 19, 2021; DOI: https://doi.org/10.4178/epih.e2021027

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We aimed to examine the current status and trends of food and nutrient intake in the Korean population over the past 20 years using the data from the Korea National Health and Nutrition Examination Survey (KNHANES).

METHODS

We conducted a survey of 116,284 subjects over the age of one year in Korea, who participated in the KNHANES between 1998 and 2018. We collected data on the subjects’ intake for the day before using the 24-hour recall method. The annual percent change (APC) in the food groups and nutrient intake were calculated using SAS and Joinpoint software.

RESULTS

The intake of grains (APC=-0.4, p<0.05) and vegetables (APC=-0.8, p<0.05) was observed to decrease. In contrast, the intake of beverages, meat, dairy, and eggs increased. In particular, beverage intake increased by more than four times (APC=9.2, p<0.05). There was no significant change in energy intake. However, the proportion of energy intake from carbohydrates decreased by approximately 5%p (APC=-0.3, p<0.05), whereas that from fat increased by approximately 5%p (APC= 1.1, p<0.05). Additionally, there were decreases in the proportion of energy intake from breakfast and homemade meals and increases in the energy intake from snacks, dining out, and convenience food. The intake of vitamin C (APC=-3.2, p<0.05) and sodium (APC=-2.3, p<0.05) significantly decreased.

CONCLUSIONS

Over the past 20 years, there has been decreases in the intake of grains, vegetables, carbohydrates, sodium, and vitamin C and increases in the intake of beverages, dairy, meat, eggs, and fat. Since nutritional status is an important factor in the prevention and management of chronic diseases, it should be continuously monitored.

Summary

Korean summary
국민건강영양조사(1998-2018) 자료를 활용하여 우리 국민의 지난 20년간의 식품 및 영양소 섭취 현황 및 추이를 분석한 결과, 곡류, 채소류, 탄수화물, 나트륨, 비타민 C 섭취 감소, 음료류, 우유류, 육류, 난류, 지방 섭취 증가 등 식품 및 영양소 섭취에 변화가 있었다.

Key Message
We examined the current status and trends of food and nutrient intake in the Korean population using the data from the 1998-2018 Korea National Health and Nutrition Examination Survey. Over the past 20 years, there have been decreases in the intake of grains, vegetables, carbohydrates, sodium, and vitamin C and increases in the intake of beverages, dairy, meat, eggs, and fat.

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Systematic Review

Food frequency questionnaires developed and validated in Iran: a systematic review: Arezoo Rezazadeh, Nasrrin Omidvar, Katherine L. Tucker; Epidemiol Health. 2020;42:e2020015. Published online March 30, 2020; DOI: https://doi.org/10.4178/epih.e2020015

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Abstract PDF

Abstract

OBJECTIVES
To systematically review and identify food frequency questionnaires (FFQs) developed for the Iranian population and their validation and reproducibility in order to determine possible research gaps and needs.

METHODS

Studies were selected by searching for relevant keywords in the PubMed, Scopus, Science Direct, Google Scholar, SID, and Iranmedex databases, unpublished data, and theses in November 2016 (updated in September 2019). All English-language and Persian-language papers were included. Duplicates, articles with unrelated content, and articles only containing a protocol were excluded. The FFQs were categorized based on: (1) number of food items in to short (≤80 items) and long (>80 items) and; (2) the aim of the FFQ to explore total consumption pattern/nutrients (general) or to detect specific nutrient(s)/food group(s) (specialized).

RESULTS

Sixteen reasonably validated questionnaires were identified. However, only 13 presented a reproducibility assessment. Ten FFQs were categorized as general (7 long, 3 short) and 6 as specialized (3 long, 3 short). The correlation coefficients for nutrient intake between dietary records or recalls and FFQs were 0.07-0.82 for long (general: 0.07-0.82 and specialized: 0.26-0.67) and 0.20-0.67 for short (general: 0.24-0.54 and specialized: 0.20-0.42) FFQs. Long FFQs showed higher validity and reproducibility than short FFQs. Reproducibility of FFQs was acceptable (0.32-0.89). The strongest correlations were reported by studies with shorter intervals between FFQs.

CONCLUSIONS

FFQs designed for the Iranian population appear to be appropriate tools for dietary assessment. Despite their acceptable reproducibility, their validity for assessing specific nutrients and their applicability for populations other than those they were developed for may be questionable.

Summary

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Original Article

A large outbreak of Salmonella enterica serovar Thompson infections associated with chocolate cake in Busan, Korea: Youngduck Eun, Hyesun Jeong, Seungjin Kim, Wonseo Park, Byoungseon Ahn, Dongkeun Kim, Eunhee Kim, Eunhee Park, Sunhee Park, Inyeong Hwang, Hyunjin Son; Epidemiol Health. 2019;41:e2019002. Published online January 9, 2019; DOI: https://doi.org/10.4178/epih.e2019002

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434 Download
41 Web of Science
44 Crossref

Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aimed to reveal the epidemiologic characteristics of the outbreak of gastroenteritis caused by Salmonella enterica serovar Thompson in Busan Metropolitan City and to identify points for improvement to prevent of food-borne disease outbreak.

METHODS

This was a case-control study. The control group comprised asymptomatic students in the same classes of the cases. The presence or absence of symptoms, ingestion of each food provided by school meal service, and commonly ingested foods in addition to those foods in meal service were investigated. Moreover, specimens collected from rectal swab, preserved foods, and environmental surface were tested.

RESULTS

Of the 6,092 subjects, 1,111 (1,083 students, 22 school personnel, and 6 foodservice employees) were included in the case group; this corresponded to an 18.4% attack rate. Symptoms included diarrhea (n=1,051, 94.6%), abdominal pain (n=931, 83.8%), febrile sensation (n=502, 45.2%), and vomiting (n=275, 24.8%). The epidemic curves of each 10 schools were unimodal. Investigation of food intake showed a significantly high odds ratio for chocolate cake in 5 out of the 10 schools. Laboratory test detected Salmonella enterica serovar Thompson both in rectal swab specimens of 9 schools and in collected preserved chocolate cakes of 9 schools. Pulsed-field gel electrophoresis test result showed that Salmonella enterica seorvar Thompson isolated from human and foods were the same.

CONCLUSIONS

The source of infection for the Salmonella enterica serovar Thompson outbreak in the 10 schools of Busan Metropolitan City is chocolate cake. Traceback investigation for origin of contaminated food in food-borne disease outbreak and safety control during food production should be more enhanced.

Summary

Korean summary
이 연구는 2018년 9월 부산광역시 10개 학교에서 급식으로 제공된 초콜릿 케익으로 인해 발생한 살모넬라 톰슨 감염증 대규모 유행의 역학 조사 결과이다. 학교 급식과 같은 대규모 집단급식은 원재료에서 급식 제공까지 안전하게 관리되어야 하며 식품매개감염병 집단 발생 역학조사에 있어 오염원에 대한 체계적 역추적 조사와 기관 간 협업의 중요성을 강조하였다.

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Epidemiologic Investigation

A foodborne outbreak of gastroenteritis caused by Vibrio parahaemolyticus associated with cross-contamination from squid in Korea: Sun-Wha Jung; Epidemiol Health. 2018;40:e2018056. Published online November 13, 2018; DOI: https://doi.org/10.4178/epih.e2018056

19,448 View
262 Download
25 Web of Science
25 Crossref

Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Water-borne diseases caused by Vibrio parahemolyticus are often known to cause gastritis when raw or undercooked seafood is eaten. It is very rare that Vibrio gastritis caused by ingesting non-seafood products occurs on a large scale. On September 19, 2017, a large-scale Vibrio gastritis occurred after the city residents consumed food at a bazaar held in a welfare center in Jungnang-gu, Seoul.

METHODS

The total number of visitors was approximately 299, and 237 (79.3%) of them showed symptoms. Among those who showed symptoms, 116 (48.9%) consulted the hospital, and 53 (45.6%) were hospitalized. Among the 299 exposed individuals, 174 (58.1%) responded to this survey: 163 (93.6%) with and 11 (6.4%) without symptoms. This study was retrospectively conducted by investigating the exposed individuals. To investigate the spread of infection, medical staff of hospitals in the epidemic area were interviewed, exposed individuals surveyed, microbiological testing conducted, and ingredient handling and cooking processes investigated.

RESULTS

A total of 237 individuals, including 6 food handlers, were affected (prevalence, 79.2%). During the microbiological testing, V. parahemolyticus was found in 34 patients and 4 food handlers. In the consumption analysis, the relative risk of kimbap was 6.79 (confidence interval 1.10 to 41.69). In-depth investigation found that squid, an ingredient of Korean pancake, and egg sheets, an ingredient of kimbap, were prepared using the same cutting board and knife, which were thought to be the cause of cross-contamination that led to a large-scale outbreak of Vibrio gastritis.

CONCLUSIONS

A recent large-scale outbreak of Vibrio gastritis occurred due to the cross-contamination with kimbap during the preparation process of squid rather than the actual consumption of seafood. Thus, a more stringent hygiene management is necessary during the processing and management of food to prevent infections associated with V. parahemolyticus.

Summary

Korean summary
비브리오 장염은 흔히 날 것이나 덜 익힌 해산물을 섭취하였을 경우 잘 생기는 것으로 알려져 있다. 그러나 해산물을 처리하는 과정에서 생긴 교차 감염에 의해서도 비브리오 장염이 생길 수 있으며 이로 인하여 대규모의 유행이 발생할 수 있다. 이에 보다 철저한 위생관리와 교육이 필요하다

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