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Epidemiologic Investigation
An outbreak of neurologic symptoms among patients exposed to an unknown stench in a high school near an industrial complex: an epidemiological investigation
Kiook Baek, Seongmin Jo, Chulyong Park, Joon Sakong
Epidemiol Health. 2022;44:e2022105.   Published online November 9, 2022
DOI: https://doi.org/10.4178/epih.e2022105
  • 3,551 View
  • 98 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Seven students at a high school in Korea visited the emergency room with non-specific neurological symptoms after a stench was noticed during a school entrance ceremony. In relation to this incident, 105 patients visited medical institutions over 5 days. A team of environmental and epidemiological experts was assembled to investigate the incident.
METHODS
Our team of experts participated in the investigation 1 month post-incident. Previously, only air samples had been analyzed. We received results of air samples analyzed by other investigators, medical records of some students, and data from police interviews of patients. Additional investigation and interviews were conducted, and the events were reconstructed in spatial and temporal order.
RESULTS
A cluster of patients was observed on the south side and parts of the north side of the upper floor. A stench like that reported during the incident had been noticed for about 2 years near the school. Students consistently described a similar stench occurring frequently in the vicinity of the school. According to student statements, the odor mainly resembled something burning. The carboxyhemoglobin levels of some students were observed to be >1.5%.
CONCLUSIONS
In the investigation, 2 suspected sources were identified: a science room storing chemicals downstairs from the auditorium and various industrial facilities near the school. Combining the scattered evidence, we considered a toxic puff of gas, perhaps from brief incineration or leakage in a specific area, to be the likely cause of the incident. We describe our approach and the limitations encountered during the investigation.
Summary
Korean summary
본 논문은 일개 고등학교에서 원인미상의 악취와 함께 100명 이상의 환자가 발생한 사건에 대한 조사과정을 담은 문헌이다. 본 연구진은 사건 발생 후 약 1달 후에 조사진에 합류하였으며, 발생 당시 환자 분포 점지도 작성, 인근 지역 사업장 및 악취발생 장소 점지도 작성, 사건 전후 시계열적 사건분석, 기상자료, 관계자 인터뷰 자료 분석 등의 역학적 기법을 동원하여 원인을 인근 지역에서 발생한 퍼프 가스의 유입으로 추정하였다. 본 사건의 원인은 결국 미제로 종결되었지만 추후 유사 사례 발생시 본 조사의 방법론을 참고할 수 있을 것이며, 의료진의 조기 개입을 수행하지 못함으로 인한 초기 상세 인터뷰 자료 확보, 생체 시료 수집 등이 이루어지지 못한 본 조사 과정의 한계점을 반면교사로 삼을 수 있을 것이다.
Key Message
This paper presents an investigation of an outbreak of over 100 patients experiencing an unexplained odor in a high school. The research team utilized epidemiological methods, including dot mapping, temporal analysis of events, and interview data analysis. The source of the odor was estimated to be the inflow of puff gas from surrounding areas. Although the toxic puff gas discharge facility was not identified, sharing the experience from this investigation could help with future investigations of similar incidents.
Original Articles
Substance abuse behaviors among university freshmen in Iran: a latent class analysis
Kourosh Kabir, Ali Bahari, Mohammad Hajizadeh, Hamid Allahverdipour, Mohammad Javad Tarrahi, Ali Fakhari, Hossein Ansari, Asghar Mohammadpoorasl
Epidemiol Health. 2018;40:e2018030.   Published online July 2, 2018
DOI: https://doi.org/10.4178/epih.e2018030
  • 11,904 View
  • 208 Download
  • 7 Web of Science
  • 6 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
Substance abuse behaviors among university freshmen in Iran are poorly understood. This study aimed to identify, for the first time, subgroups of university freshmen in Iran on the basis of substance abuse behaviors. Moreover, it examined the effects of socio-demographic characteristics on membership in each specific subgroup.
METHODS
Data for the study were collected cross-sectionally in December 2013 and January 2014 from 4 major cities in Iran: Tabriz, Qazvin, Karaj, and Khoramabad. A total of 5,252 first-semester freshmen were randomly selected using a proportional cluster sampling methodology. A survey questionnaire was used to collect data. Latent class analysis (LCA) was performed to identify subgroups of students on the basis of substance abuse behaviors and to examine the effects of students’ socio-demographic characteristics on membership in each specific subgroup.
RESULTS
The LCA procedure identified 3 latent classes: the healthy group; the hookah experimenter group; and the unhealthy group. Approximately 82.8, 16.1, and 2.1% of students were classified into the healthy, hookah experimenter, and unhealthy groups, respectively. Older age, being male, and having a family member or a close friend who smoked increased the risk of membership in classes 2 and 3, compared to class 1.
CONCLUSIONS
Approximately 2.1% of freshmen exhibited unhealthy substance abuse behaviors. In addition, we found that older age, being male, and having a close friend or family member who smoked may serve as risk factors for substance abuse behaviors.
Summary

Citations

Citations to this article as recorded by  
  • Current and life-time alcohol consumption in Iranian students: a systematic review and meta-analysis
    Neda Soleimanvandiazar, Salah Eddin Karimi, Mahboobeh Kamali, Marziyeh Moradi, Leila Janani, Saeed Ghanbari, Azadeh Mottaghi, Mojtaba Piri, Leila Ghalichi, Marzieh Nojomi
    Journal of Substance Use.2023; 28(6): 809.     CrossRef
  • Neighborhoods and adolescent polysubstance use in Jamaica
    Amrita Gill, Erica Felker-Kantor, Colette Cunningham-Myrie, Lisa-Gaye Greene, Parris Lyew-Ayee, Uki Atkinson, Wendel Abel, Simon G. Anderson, Katherine P. Theall
    PeerJ.2023; 11: e14297.     CrossRef
  • Designing and Psychometrically Evaluating Students’ Common Types of Misconceptions about Substance Abuse Inventory: A Methodological Study
    Hamid Sharif-Nia, Tahereh Heidari, Mehran Zarghami, Azar Ramezani Toyeh, Parvin Ghasemi Mianaee, Vahid Ganji, Hamideh Azimi Lolaty
    Journal of Nursing and Midwifery Sciences.2023;[Epub]     CrossRef
  • Latent Classes of Substance Use in Young Adults – A Systematic Review
    Martha Charlotta de Jonge, Andrea Johanna Bukman, Lonneke van Leeuwen, Simone Arianne Onrust, Marloes Kleinjan
    Substance Use & Misuse.2022; 57(5): 769.     CrossRef
  • Prevalence of hookah smoking among Iranian pupils and university students: An updated systematic review and meta‐analysis
    Hamid Zaheri, Yosra Raziani, Nesa Khademi, Yousef Moradi, Hossein Shahriari, Reza Ghanei‐Gheshlagh
    The Clinical Respiratory Journal.2022; 16(6): 425.     CrossRef
  • Lifestyle behaviors among undergraduate nursing students: A latent class analysis
    Tassia T. S. Macedo, Fernanda C. Mussi, Debra Sheets, Ana C. P. Campos, Ana L. Patrão, Caren L. M. Freitas, Melissa A. S. Paim
    Research in Nursing & Health.2020; 43(5): 520.     CrossRef
Oral symptoms significantly higher among long-term khat (Catha edulis) users in Ethiopia
Ayalew Astatkie, Meaza Demissie, Yemane Berhane, Alemayehu Worku
Epidemiol Health. 2015;37:e2015009.   Published online February 19, 2015
DOI: https://doi.org/10.4178/epih/e2015009
  • 19,390 View
  • 211 Download
  • 5 Web of Science
  • 8 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
Associations between khat (Catha edulis) chewing and different adverse oral-dental health conditions have been reported, yet evidence is still lacking. This study was designed to investigate the association between long-term regular khat chewing and self-reported oral symptoms.
METHODS
A cross-sectional study was conducted on a sample of 1,255 university students in southern Ethiopia. Data on khat chewing status, a range of oral symptoms and other pertinent variables were collected using self-administered questionnaires. The association between long-term regular khat chewing and oral symptom count was investigated using negative binomial regression.
RESULTS
The mean oral symptom count among long-term regular khat chewers was 1.75 (standard deviation [SD], 2.18; standard error [SE], 0.31), whereas that among those who were not long-term regular khat chewers was 1.18 (SD, 1.68; SE, 0.10). After adjustment for other variables, long-term regular khat chewers had approximately 50% more oral symptoms than those who were not long-term chewers did (adjusted count ratio, 1.53; 95% confidence interval, 1.12 to 2.10).
CONCLUSIONS
Long-term khat chewing negatively affects the oral health of young university students.
Summary

Citations

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  • Awareness and practice of oral hygiene and its relation to socio-demographic factors among patients attending general OPD
    Tusneem Haider, Zeeshan Yousaf, Abdul Ghaffar Khan, Saman Fatima
    Pakistan BioMedical Journal.2022; 5(1): 311.     CrossRef
  • Effect of finishing protocols and staining solutions on color stability of dental resin composites
    Chamunorwa Marufu, Bernina K. Kisumbi, Olivia A. Osiro, Fred O. Otieno
    Clinical and Experimental Dental Research.2022; 8(2): 561.     CrossRef
  • Awareness and practice of oral hygiene and its relation to socio-demographic factors among patients attending general OPD
    Tusneem Haider, Zeeshan Yousaf, Abdul Ghaffar Khan, Saman Fatima
    Pakistan BioMedical Journal.2022;[Epub]     CrossRef
  • Determinants of dental caries among adolescent patients attending Hospitals in West Wollega Zone, Western Ethiopia: A case-control study
    Tsega Tola Guracho, Emiru Merdassa Atomssa, Obsa Amante Megersa, Tadesse Tolossa, Zhaoqiang Zhang
    PLOS ONE.2021; 16(12): e0260427.     CrossRef
  • Social Habits and Other Risk Factors that Cause Tooth Loss: An Associative Study Conducted in Taiz Governorate, Yemen
    Fawzia I Shaabi, Nashwan A Noman, Adel A Aladimi, Baleegh A Alkadasi, Mohammed A Alraawi, Gassan M Al-Iryani, Asaad Khalid
    The Journal of Contemporary Dental Practice.2019; 20(4): 428.     CrossRef
  • Khat (Catha edulis) and its oral health effects: An updated review
    Sadeq A. Al‐Maweri, Saman Warnakulasuriya, Abdulaziz Samran
    Journal of Investigative and Clinical Dentistry.2018;[Epub]     CrossRef
  • Khat and synthetic cathinones: emerging drugs of abuse with dental implications
    Worku Abebe
    Oral Surgery, Oral Medicine, Oral Pathology and Or.2017;[Epub]     CrossRef
  • Oral Lesions Induced by Chronic Khat Use Consist Essentially of Thickened Hyperkeratinized Epithelium
    Ochiba Mohammed Lukandu, Lionel Sang Koech, Paul Ngugi Kiarie
    International Journal of Dentistry.2015; 2015: 1.     CrossRef
The Associations between Social Support, Health-Related Behaviors, Socioeconomic Status and Depression in Medical Students
Yoolwon Jeong, Jin Young Kim, Jae Seon Ryu, Ko eun Lee, Eun Hee Ha, Hyesook Park
Epidemiol Health. 2010;32:e2010009.   Published online November 24, 2010
DOI: https://doi.org/10.4178/epih/e2010009
  • 18,633 View
  • 148 Download
  • 33 Crossref
AbstractAbstract PDF
Abstract
<sec><title>OBJECTIVES</title><p>The objective of this study was to estimate the prevalence of depression in medical students and to evaluate whether interpersonal social support, health-related behaviors, and socio-economic factors were associated with depression in medical students.</p></sec><sec><title>METHODS</title><p>The subjects in this study were 120 medical students in Seoul, Korea who were surveyed in September, 2008. The subjects were all women and over the age of 20. Their age, body mass index (BMI), quality of sleep, diet, household income, smoking, alcohol consumption, exercise levels, and self-reported health status were surveyed. The degree of perceived social support was measured using the interpersonal support evaluation list (ISEL). Depression was evaluated using the center for epidemiology studies depression scale (CES-D).</p></sec><sec><title>RESULTS</title><p>The mean CES-D score was 14.1±8.6 and 37.1% of the participants appeared to suffer from depression. Low levels of perceived interpersonal support increased the risk of depression by more than 10 times and having higher household income did not necessarily decrease the risk of depression.</p></sec><sec><title>CONCLUSION</title><p>Medical students have a relatively high level of depression. Efforts should be made to encourage social support in order to promote mental health in medical students.</p></sec>
Summary

Citations

Citations to this article as recorded by  
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    Konstantinos N. Fountoulakis, Nor Aziah Alias, Sarah Bjedov, Nikolaos K. Fountoulakis, Xenia Gonda, Jan Hilbig, Miro Jakovljević, Barbara Kulig, Girija Mahale, Alexandros Manafis, Muftau Mohammed, Ilia Nadareishvili, Alvydas Navickas, Mikaella E. Patsali,
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    Journal of Korean Medical Science.2023;[Epub]     CrossRef
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Test-retest Reliability of a Self-Administered Smoking Questionnaire for Middle and High School Students.
Sun Ha Jee, Ji Eun Yoon, Soyoung Won, Sujung Kim, Il Suh
Korean J Epidemiol. 2003;25(1):16-23.
  • 6,339 View
  • 12 Download
AbstractAbstract PDF
Abstract
PURPOSE
Since 1988, the annual or biannual survey was conducted by Korean Association of Smoking and Health (KASH) to examine the smoking rate, knowledge and attitude on smoking of students attending middle and high school in Korea. The objective of this study was to investigate the test-retest reliability of self-administered smoking questionnaire for Korean middle and high school students.
METHODS
For the test-retest study, we sampled 30 school among 106 schools which participated in annual survey on June of 2002. Among 30 schools, 26 schools (86.7%) were responded for this study.
RESULTS
1) For the subjects of 1st and 2nd surveys, there were no difference on smoking related variable including attitude, knowledge, perceived health status, father's smoking status, friend's smoking status, willingness to smoke, and readiness to quit smoking 2) For middle school students among male, current smoking rates were 3.5% for 1st survey and 3.0% for 2nd survey, which was statistically no significant. For high school students, however, current smoking rate of 1st survey was higher (21.1%) than that of 2nd (18.2%), although the rate was not significantly differed. 3) For middle school students among female, current smoking rates were 1.1% for 1st survey and 3.3% for 2nd survey, which was statistically no significant. Corresponding rate for high school students were 9.8% and 11.4%, respectively.
CONCLUSION
The results indicated that smoking questionnaire has been conducted by KASH is reliable for use in estimation for prevalence of smoking for middle and high school students.
Summary
Epidemiol Health : Epidemiology and Health
© Korean Society of Epidemiology.