Journal of Preventive Medicine and Public Health

Original Article

Relationship Between Social Isolation, Seclusion, and Suicidal Ideation Among Young Adults: An Analysis of Data From the 2022 Survey on the Lives of Young People in Korea: Jiwon Shin, Hyun Yang, Mu Won Lee, Hae Yean Park, Suyeong Bae; J Prev Med Public Health. 2025;58(5):496-504. Published online May 8, 2025; DOI: https://doi.org/10.3961/jpmph.24.792

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Abstract Summary PDF Supplementary Material: Objectives
This study aimed to investigate the current status of social isolation and seclusion among young adults in Korea and to analyze their association with suicide risk.
Methods
We utilized data from 14 966 young adults aged 19-34 years from the 2022 Survey on the Lives of Young People. Social isolation and seclusion were defined as independent variables, and suicidal ideation within the past year was set as the dependent variable. Propensity score matching (PSM) was employed to reduce the risk of selection bias, and logistic regression analysis was conducted to examine the associations between social isolation, seclusion, and suicidal ideation.
Results
Of the participants, 266 individuals (1.8%) were socially isolated, and 67 individuals (0.5%) were secluded. Associations were observed between social isolation and suicidal ideation (population-weighted adjusted model: odds ratio [OR], 2.43, p=0.003; population-weighted PSM model: OR, 2.03, p=0.037), as well as between seclusion and suicidal ideation (population-weighted adjusted model: OR, 4.15, p=0.004; population-weighted PSM model: OR, 3.87, p=0.010) across all models.
Conclusions
Being socially isolated or secluded is associated with an increased risk of suicidal ideation among young adults aged 19-34 years. Preventive policies and tailored support systems are urgently needed to address these risks. This study contributes to the development of specific policies for mitigating social isolation and supporting the reintegration of young adults aged 19-34 years into society.; Summary

Korean summary
본 연구는 2022년 청년 삶 실태조사 원자료를 이용하여 한국 청년의 사회적 고립·은둔과 자살 생각의 연관성을 분석하였다. 연구 결과, 사회적으로 고립되거나 은둔하는 청년은 그렇지 않은 청년에 비해 자살 생각을 할 위험이 유의하게 높은 것으로 나타났다. 이는 고립·은둔 청년들의 자살 위험성을 확인하고, 이들의 사회 재통합을 돕기 위한 예방적 정책과 맞춤형 지원 시스템 마련이 시급함을 시사한다.

Key Message
Using data from the 2022 Survey on the Lives of Young People, this study demonstrates that young adults (aged 19-34) in Korea experiencing social isolation or seclusion face a significantly increased risk of suicidal ideation. These findings identify socially isolated and secluded young people as a critical high-risk group for suicide. This underscores the urgent need for proactive public health policies and tailored support systems to prevent suicide by addressing social isolation and seclusion and promoting societal reintegration among this vulnerable population.

Review

Qualitative Research in Healthcare: Necessity and Characteristics: Jeehee Pyo, Won Lee, Eun Young Choi, Seung Gyeong Jang, Minsu Ock; J Prev Med Public Health. 2023;56(1):12-20. Published online January 10, 2023; DOI: https://doi.org/10.3961/jpmph.22.451

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138 Crossref

Quantitative and qualitative research explore various social phenomena using different methods. However, there has been a tendency to treat quantitative studies using complicated statistical techniques as more scientific and superior, whereas relatively few qualitative studies have been conducted in the medical and healthcare fields. This review aimed to provide a proper understanding of qualitative research. This review examined the characteristics of quantitative and qualitative research to help researchers select the appropriate qualitative research methodology. Qualitative research is applicable in following cases: (1) when an exploratory approach is required on a topic that is not well known, (2) when something cannot be explained fully with quantitative research, (3) when it is necessary to newly present a specific view on a research topic that is difficult to explain with existing views, (4) when it is inappropriate to present the rationale or theoretical proposition for designing hypotheses, as in quantitative research, and (5) when conducting research that requires detailed descriptive writing with literary expressions. Qualitative research is conducted in the following order: (1) selection of a research topic and question, (2) selection of a theoretical framework and methods, (3) literature analysis, (4) selection of the research participants and data collection methods, (5) data analysis and description of findings, and (6) research validation. This review can contribute to the more active use of qualitative research in healthcare, and the findings are expected to instill a proper understanding of qualitative research in researchers who review qualitative research reports and papers.

Summary

Korean summary
이 원고는 질적연구 방법론의 필요성 및 특징과 함께 보건의료 분야에서 질적연구 방법론이 활용된 선행 연구들을 정리하였다. 이는 보건의료 분야의 사회과학적 특성을 더 잘 드러내는 질적연구 방법론의 적용 및 확대에 도움이 될 것이다.

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Special Articles

Cohort Profile: Korean Tuberculosis and Post-Tuberculosis Cohort Constructed by Linking the Korean National Tuberculosis Surveillance System and National Health Information Database: Dawoon Jeong, Hee-Yeon Kang, Jinsun Kim, Hyewon Lee, Bit-Na Yoo, Hee-Sun Kim, Hongjo Choi; J Prev Med Public Health. 2022;55(3):253-262. Published online April 22, 2022; DOI: https://doi.org/10.3961/jpmph.21.635

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Abstract Summary PDF Supplementary Material

We aimed to review the current data composition of the Korean Tuberculosis and Post-Tuberculosis Cohort, which was constructed by linking the Korean Tuberculosis Surveillance System (KNTSS; established and operated by the Korean Disease Control and Prevention Agency since 2000) and the National Health Information Database (NHID; established by the National Health Insurance Service in 2012). The following data were linked: KNTSS data pertaining to patients diagnosed with tuberculosis between 2011 and 2018, NHID data of patients with a history of tuberculosis and related diseases between 2006 and 2018, and data (obtained from the Statistics Korea database) on causes of death. Data from 300 117 tuberculosis patients (177 206 men and 122 911 women) were linked. The rate of treatment success for new cases was highest in 2015 (86.7%), with a gradual decrease thereafter. The treatment success rate for previously treated cases showed an increasing trend until 2014 (79.0%) and decreased thereafter. In total, 53 906 deaths were confirmed among tuberculosis patients included in the cohort. The Korean Tuberculosis and Post-Tuberculosis Cohort can be used to analyze different measurement variables in an integrated manner depending on the data source. Therefore, these cohort data can be used in future epidemiological studies and research on policy-effect analysis, treatment outcome analysis, and health-related behaviors such as treatment discontinuation.

Summary

Korean summary
TB Post 코호트(Korean Tuberculosis and Post-Tuberculosis Cohort)는 한국의 결핵 모니터링 및 관리에 대한 인구집단 수준에서의 새로운 근거를 마련하고자 구축한 우리나라 결핵 환자 코호트입니다. 국가 결핵감시체계의 일환으로 구축된 질병관리청의 결핵신고자료와 국민건강보험공단의 국민건강정보DB 자료, 통계청 사망원인 자료의 연계로 구축되었으며, 각 자료원이 보유한 정보를 활용하여 통합적인 결핵 환자 연구가 가능할 것으로 기대하고 있습니다. 결핵의 정책 효과 연구뿐만 아니라, 치료 성공, 실패, 중단 등 치료결과에 대한 영향 요인 및 환자들의 건강 관련 행태에 대한 역학 연구 등 향후 다양한 연구에 활용될 수 있을 것으로 기대됩니다.

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Nationwide Treatment Outcomes of Patients With Multidrug/Rifampin-Resistant Tuberculosis in Korea, 2011–2017: A Retrospective Cohort Study (Korean TB-POST)
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Application of Standardization for Causal Inference in Observational Studies: A Step-by-step Tutorial for Analysis Using R Software: Sangwon Lee, Woojoo Lee; J Prev Med Public Health. 2022;55(2):116-124. Published online February 11, 2022; DOI: https://doi.org/10.3961/jpmph.21.569

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302 Download
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Abstract Summary PDF Supplementary Material

Epidemiological studies typically examine the causal effect of exposure on a health outcome. Standardization is one of the most straightforward methods for estimating causal estimands. However, compared to inverse probability weighting, there is a lack of user-centric explanations for implementing standardization to estimate causal estimands. This paper explains the standardization method using basic R functions only and how it is linked to the R package stdReg, which can be used to implement the same procedure. We provide a step-by-step tutorial for estimating causal risk differences, causal risk ratios, and causal odds ratios based on standardization. We also discuss how to carry out subgroup analysis in detail.

Summary

Korean summary
본 논문에서는 standardization 방법을 이용하여 risk difference, relative risk, risk ratio와 같은 인과성 효과를 R software을 이용하여 도출하는 튜토리얼을 제공합니다. 간암환자의 치료를 예시로, 합성 데이터를 이용한 치료제의 사망에 대한 인과적 효과를 탐색하는 튜토리얼을 제공합니다. 추가적으로, 인과성 관련 기본 이론을 집약적으로 설명하였고, standardization을 이용한 subgroup analysis 수행 방법이 제공됩니다.

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Original Articles

Bacterial Contamination and Disinfection Status of Laryngoscopes Stored in Emergency Crash Carts: Jae Hyung Choi, Young Soon Cho, Jung Won Lee, Hee Bong Shin, In Kyung Lee; J Prev Med Public Health. 2017;50(3):158-164. Published online April 4, 2017; DOI: https://doi.org/10.3961/jpmph.17.013

28,586 View
240 Download
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Abstract PDF

Objectives
To identify bacterial contamination rates of laryngoscope blades and handles stored in emergency crash carts by hospital and area according to the frequency of intubation attempts.
Methods
One hundred forty-eight handles and 71 blades deemed ready for patient use from two tertiary hospitals were sampled with sterile swabs using a standardized rolling technique. Samples were considered negative (not contaminated) if no colonies were present on the blood agar plate after an 18-hour incubation period. Samples were stratified by hospital and according to the frequency of intubation attempts (10 attempts per year) using the χ²-test and Fisher exact test.
Results
One or more species of bacteria were isolated from 4 (5.6%) handle tops, 20 (28.2%) handles with knurled surfaces, and 27 (18.2%) blades. No significant differences were found in microbial contamination levels on the handle tops and blades between the two hospitals and two areas according to the frequency of intubation attempts. However, significant differences were found between the two hospitals and two areas in the level of microbial contamination on the handles with knurled surfaces (p<0.05).
Conclusions
Protocols and policies must be reviewed to standardize procedures to clean and disinfect laryngoscope blades and handles; handles should be re-designed to eliminate points of contact with the blade; and single-use, one-piece laryngoscopes should be introduced.

Summary

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Determinants of Poor Self-rated Health in Korean Adults With Diabetes: Hwi-Won Lee, Minkyo Song, Jae Jeong Yang, Daehee Kang; J Prev Med Public Health. 2015;48(6):287-300. Published online October 23, 2015; DOI: https://doi.org/10.3961/jpmph.15.048

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Abstract PDF Supplementary Material

Objectives
Self-rated health is a measure of perceived health widely used in epidemiological studies. Our study investigated the determinants of poor self-rated health in middle-aged Korean adults with diabetes.
Methods
A cross-sectional study was conducted based on the Health Examinees Study. A total of 9759 adults aged 40 to 69 years who reported having physician-diagnosed diabetes were analyzed with regard to a range of health determinants, including sociodemographic, lifestyle, psychosocial, and physical variables, in association with self-rated health status using multivariate logistic regression models. A p-value <0.05 was considered to indicate statistical significance.
Results
We found that negative psychosocial conditions, including frequent stress events and severe distress according to the psychosocial well-being index, were most strongly associated with poor self-rated health (odds ratio [OR]_{Frequent stress events}, 5.40; 95% confidence interval [CI], 4.63 to 6.29; OR_{Severe distress}, 11.08; 95% CI, 8.77 to 14.00). Moreover, younger age and being underweight or obese were shown to be associated with poor self-rated health. Physical factors relating to participants’ medical history of diabetes, such as a younger age at diagnosis, a longer duration of diabetes, insulin therapy, hemoglobin A_1c levels of 6.5% or more, and comorbidities, were other correlates of poor reported health.
Conclusions
Our findings suggest that, in addition to medical variables, unfavorable socioeconomic factors, and adverse lifestyle behaviors, younger age, being underweight or obese, and psychosocial stress could be distinc factors in predicting negative perceived health status in Korean adults with diabetes.

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Special Article

The Role of Major Donors in Health Aid to the Democratic People's Republic of Korea: Haewon Lee, Deborah Y. Ahn, Soyoung Choi, Youngchan Kim, Hyunju Choi, Sang Min Park; J Prev Med Public Health. 2013;46(3):118-126. Published online May 31, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.3.118

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Abstract PDF

We investigated the major trends in health aid financing in the Democratic People's Republic of Korea (DPRK) by identifying the primary donor organizations and examining several data sources to track overall health aid trends. We collected gross disbursements from bilateral donor countries and international organizations toward the DPRK according to specific health sectors by using the Organization for Economic Cooperation and Development creditor reporting system database and the United Nations Office for the Coordination of Humanitarian Affairs financial tracking service database. We analyzed sources of health aid to the DPRK from the Republic of Korea (ROK) using the official records from the ROK's Ministry of Unification. We identified the ROK, United Nations Children's Fund (UNICEF), World Health Organization (WHO), United Nations Population Fund (UNFPA), and The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) as the major donor entities not only according to their level of health aid expenditures but also their growing roles within the health sector of the DPRK. We found that health aid from the ROK is comprised of funding from the Inter-Korean Cooperation Fund, private organizations, local governments, and South Korean branches of international organizations such as WHO and UNICEF. We also distinguished medical equipment aid from developmental aid to show that the majority of health aid from the ROK was developmental aid. This study highlights the valuable role of the ROK in the flow of health aid to the DPRK, especially in light of the DPRK's precarious international status. Although global health aid from many international organizations has decreased, organizations such as GFATM and UNFPA continue to maintain their focus on reproductive health and infectious diseases.

Summary

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Original Article

Changes in the Distribution of Maternal Age and Parity and Increasing Trends in the Low Birth Weight Rate in Korea Between 1995 and 2005: Jisuk Bae, Jung Han Park, Yoo Keun Park, Jong-Yeon Kim, Sang-Won Lee, Soon-Woo Park; J Prev Med Public Health. 2011;44(3):111-117. Published online May 17, 2010; DOI: https://doi.org/10.3961/jpmph.2011.44.3.111

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Abstract PDF

Objectives

This study measured the impact of shifts in maternal age and parity on the increase in the low birth weight (LBW) rate in Korea.

Methods

We obtained raw data for all 6 397 945 live births registered at the Korea National Statistical Office between 1995 and 2005. We calculated the proportion of increment in the LBW rate due to changes in the distribution of maternal age and parity (AP-dis) and the proportion due to changes in the age- and parity-specific LBW rate (AP-spe).

Results

The LBW rate increased from 3.02% in 1995 to 4.28% in 2005. The multiple birth rate increased from 1.32% to 2.19% during the same period. Of the 1.26% points increment in the LBW rate, 0.64% points occurred among singleton births and 0.62% points occurred among multiple births. Changes in the AP-dis accounted for 50% of the increase in the LBW rate among singleton births, but did not contribute to the increase in the LBW rate among multiple births. The remainder of the total increment in the LBW rate was explained by the increase in the AP-spe.

Conclusions

This study demonstrated that shifts in maternal age and parity among singleton births and increased multiple births were important contributors to the increment in the LBW rate. This study also revealed that the increase in the AP-spe was an equally important contributor as the shifts in maternal age and parity to the increment in the LBW rate among singleton births and was a major contributor among multiple births.

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Research Support, Non-U.S. Gov't

Relationship Between Depression Anxiety Stress Scale (DASS) and Urinary Hydroxyproline and Proline Concentrations in Hospital Workers.: Keou Won Lee, Soo Jeong Kim, Jae Beom Park, Kyung Jong Lee; J Prev Med Public Health. 2011;44(1):9-13.; DOI: https://doi.org/10.3961/jpmph.2011.44.1.9

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Abstract PDF

OBJECTIVES
Although increased reactive oxygen species (ROS) is caused by stress accelerates collagen degradation, there was no data on the relationship between stress and urinary hydroxyproline (Hyp) and proline (Pro), a good marker of collagen degradation. The purpose of this study was to evaluate the relationship between depression, anxiety, and stress (DAS) and concentrations of urinary Hyp and Pro. METHODS: 97 hospital employees aged 20 to 58 were asked to fill out comprehensive self-administrated questionnaires containing information about their medical history, lifestyle, length of the work year, shit-work and DAS. Depression Anxiety Stress Scale (DASS) was applied to evaluate chronic mental disorders. Urine samples were analyzed using High Performance Liquid Chromatography (HPLC) with double derivatization for the assay of hydroxyproline and proline. RESULTS: The mean value of Hyp and Pro concenturation in all subjects was 194.1+/-113.4 micromol/g and 568.2+/-310.7 micromol/g. DASS values and urinary Pro concentrations were differentiated by sex (female > male, p < 0.05) and type of job (nurse > others, p < 0.05). In the stepwise multiple linear regressions, urinary Hyp and Pro concentrations were influenced by stress (Adjusted r2 = 0.051) and anxiety and job (Adjusted r2 = 0.199), respectively. CONCLUSIONS: We found that stress and anxiety were correlated with urinary Hyp and Pro concentrations. To identifying a definite correlation, further study in large populations will be needed.

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Brief Communication

An Outbreak of Novel Influenza A (H1N1) in the English Language Institute.: Joon Hyung Kim, Han Sung Lee, Hye Kyung Park, Jin Seok Kim, Sang Won Lee, Seong Sun Kim, Jong Koo Lee; J Prev Med Public Health. 2010;43(3):274-278.; DOI: https://doi.org/10.3961/jpmph.2010.43.3.274

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Abstract PDF

OBJECTIVES
This report describes the results of an investigation on an outbreak of novel influenza A (H1N1) in an English language Institute in Seoul, Korea in May 2009. METHODS: In this outbreak, novel influenza A (H1N1) was confirmed in 22 of 91 trainees, trainers and staff members. The trainees and 2 staff members were isolated in an assigned facility and the rest were isolated in their homes after we discovered the first patient with novel influenza A (H1N1). After the isolation, the people in the assigned facility were educated to use N95 respirators and they received oseltamivir for prophylaxis. RESULTS: The initial findings in this study suggest that the symptoms were mild and similar to those of seasonal influenza. The classmates and roommates of the infected patients were more likely to get infected with novel influenza A (H1N1) than the trainees who were not classmates or roommates of the patients (OR: 3.19, 95% CI=0.91 - 11.11 for classmates and OR: 40.0, 95% CI=7.4-215.7 for roommates). CONCLUSIONS: The public health response seems successful in terms of preventing the spread of this virus into the local community.

Summary

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In-Flight Transmission of Novel Influenza A (H1N1)
Joon Hyung Kim, Dong-Han Lee, Sang-Sook Shin, Chun Kang, Jin Seok Kim, Byung Yool Jun, Jong-Koo Lee
Epidemiology and Health.2010; 32: e2010006. CrossRef

Original Articles

Professional Job Perception, Job Stress and Job Satisfaction of Westerm Doctors and Oriental Doctors Practicing at Local Clinic.: Jong Yeon Kim, Sin Kam, Yune Sik Kang, Yong Kee Cho, Sang Won Lee, Dae Gu Jin, Soon Gi Ahn, Byung Yeol Chun, Min Hae Yeh; J Prev Med Public Health. 2004;37(1):44-50.

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Abstract PDF: OBJECTIVE
This study was conducted in order to investigate the professionalism, job stress and job satisfaction in western and oriental doctors in Korea. METHODS: The authors conducted a survey using a selfadministered questionnaire, conducted between August and September, 2001. The study subjects were 457 western doctors and 161 oriental doctors practicing at local clinics in Daegu City. RESULTS: For the professionalism scale, the score for 'belief in service to the public' of western doctors was significantly higher than that of oriental doctors (p< 0.05) whereas the scores for 'sense of calling to the field' and 'feeling of autonomy' were higher in oriental doctors (p< 0.01). For the job stress scale, the scores for 'work factor', and 'clinical responsibility/decision factor' of western doctors were significantly higher than those of oriental doctors (p< 0.01). Of the western doctors, 59.7% expressed satisfaction with their job as a doctor, 69.5% responded that the role of a doctor was appropriate to their aptitude, and 61.8% answered that they wouldn't consider other kinds of job even if offered. In case of oriental doctors, these responses were83.1%, 82.5%, and 82.3%, espectively. CONCLUSION: The job stress scores of western doctors were higher than those of oriental doctors, but the job satisfaction was lower. The reasons for the above results are not clear. Further studies are required to understand the characteristics of job stress and job satisfaction in doctors.; Summary

Professional Job Perception, Job Stress and Job Satisfaction of Doctors Practicing in Local Clinic in Daegu City.: Dae Gu Jin, Sin Kam, Yune Sik Kang, Yong Kee Cho, Sang Won Lee, Jong Yeon Kim, Soon Gi Ahn, Byung Yeol Chun, Min Hae Yeh; Korean J Prev Med. 2003;36(2):153-162.

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Abstract PDF: OBJECTIVE
This study was conducted in order to investigate professional job perception, job stress and job satisfaction in doctors. METHOD: The authors conducted a survey using a self-administered questionnaire, conducted between August and September, 2001. The study subjects were 457 doctors practicing at local clinics in Daegu City. RESULTS: For the professionalism scale, the score for 'sense of calling to field' and 'feeling of autonomy' were relatively high. Age, working hours per day, and perception of socioeconomic status significantly influenced the professionalism scale scores (p< 0.01). For the job stress scale, the scores for 'clinical responsibility/ decision' factor were the highest of all the surveyed factors. Working hours per day significantly influenced the job stress scores (p< 0.01). To investigate the overall relationship between the variables, the authors conducted a linear structural equation model analysis. The equation was statistically appropriate and a good fit. The job stress, and the professionalism factors, respectively influenced job satisfaction negatively and positively (T> 2.0). The working hours per day and status perception also influenced their job satisfaction (T> 2.0). CONCLUSION: To promote the job satisfaction of doctors, the development of coping tools and other intervention methods are needed to increase doctor's professional job perception and reduce their job stress. Further studies are required to understand the characteristics of job satisfaction and for its promotion with doctors.; Summary

Cause of Enterohemorrhagic Escherichia coli Infection in Ulju County, Korea.: Geun Ryang Bae, Sang Won Lee, Byung Guk Yang, Bok Kwon Lee, Jae Gu Park, Byeong Hun Hwang, Hyun Sul Lim; Korean J Prev Med. 2003;36(1):77-84.

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Abstract PDF: OBJECTIVES
Two related cases of Hemolytic-Uremic Syndrome (HUS) were reported to the Korea National Institute of Health in May, 2001. Shiga toxin 2 genes were detected in both stool samples. We suspected an enterohemorrhagic Escherichia coli (EHEC) infection as the cause of the HUS, and conducted an investigation to find the source of the infection and its route of transmission. METHODS: We performed case investigations on these two related HUS cases, and obtained interviews and rectal swabs form the family members and other close contacts. Additionally, we performed rectal swabs on the cattle raised by the household of the index patient. RESULTS: We found a 20 month old index patient and a 6 year-old cousin had developed HUS, where there had been a 2 day history of contact with the index, and bacteriological examinations for these two patients revealed, indistinguishably, the same E. coli O171. The grandmother of the index patient was found to be asymptomatic, but E. coli O26 was isolated. We also found a probable case in the mother of the cousin. She reported a history of contact with the index, and developed bloody diarrhea of 3 days duration. The test results for the cattle revealed E. coli O26 in one cow, and E. coli O26 and O55 in another. E. coli O26, which was isolated in both cows and the grandmother of the index, were indistinguishably the same. CONCLUSIONS: We found that the E. coli O26 in the grandmother had originated from the cows, and that the E. coli O171 found in the index patient had been transmitted to the cousin through person-to-person contact.; Summary

Epidemiologic Investigation on an Outbreak of Cholera in Gyeongsangbuk-do, Korea, 2001.: Jun Ho Lee, Hyun Sul Lim, Kwan Lee, Jun Chul Kim, Sang Won Lee, Un Yeong Go, Byung Kuk Yang, Jong Koo Lee, Moon Sik Kim; Korean J Prev Med. 2002;35(4):295-304.

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Abstract PDF: OBJECTIVES
This study was carried out to investigate the cause, magnitude and transmission route of the cholera outbreak in 2001. METHODS: The study population were those persons who ingested foods at the restaurant, were confirmed as cholera patients, had symptoms of diarrhea and served as workers at the restaurant. A questionnaire survey and microbiological examinations on the microbes isolated from rectal swabs were conducted. Of the cases, 316 food histories were surveyed by an analysis of the restaurant menu. RESUJLTS: There were 139 confirmed cases of cholera reported in Korea in 2001. Of these, 104 were related to the restaurant. By region, Gyeongsangbuk-do had the highest incidence with 91 cases. Of these 91 cases, 74 had ingested foods at the restaurant, 2 were employees and 3 were secondary infection cases within the families. The results of the odds ratio analysis of the 316 persons having ingested foods at the restaurant were as follows: sandwiches 5.07 (95% CI, 1.85-14.59), soybean curd 2.45 (95% CI, 1.09-5.56), noodles 2.34 (95% CI, 1.24-4.42), steamed squid 2.01 (95% CI, 1.17-3.47) and vinegared rice 1.82 (95% CI, 1.08-3.09). It was certain the restaurant in question was the cause of the 2001 outbreak. CONCLUSIONS: We suspected that more than one restaurant employee contaminated foods served at the restaurant. In addition, eating raw fishes purchased at the Pohang Fisheries infected the employees of the restaurant. There is a possibility that these raw fishes were themselves contaminated by cholera bacilli in the sea.; Summary

Incidence of Hypertension in a Cohort of an Adult Population.: Byung Yeol Chun, Sin Kam, Hee Sook Oh, Sang Won Lee, Kook Hyeun Woo, Moon Young Ahn; Korean J Prev Med. 2002;35(2):141-146.

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Abstract PDF: OBJECTIVES
This study was performed in order to assess the incidence of hypertension based on two-years follow-up of a rural hypertension-free cohort in Korea. METHODS: The study cohort comprised 2,580 subjects aged above 20 (1,107 men and 1,473 women) of Chung-Song County in Kyungpook Province judged to be hypertensive-free at the baseline examination in 1996. For each of two examinations in the two-year follow-up, those subjects free of hypertension were followed for the development of hypertension to the next examination one year (1997) and two years later (1998). The drop-out rate was 24.7% in men and 19.6% in women. Hypertension was defined as follows 1) above mild hypertension as a SBP above 140 mmHg or a DBP above 90 mmHg, 2) above moderate hypertension as a SBP above 160 mmHg or a DBP above 100 mmHg or when the participant reported having used antihypertensive medication after beginning this survey. RESULTS: The age-standardized incidence of above mild hypertension was 6 per 100 person years (PYS) in men and that of above moderate hypertension was 1.2. In women, the age-standardized rate for above mild hypertension was 5.7 and 1.5 for above mild and moderate hypertension, respectively. However, the rates of incidence as calculated by the risk method were 4.8% and 1.0% in men and 4.6%, 1.2% in women, respectively. In both genders, incidence was significantly associated with advancing age(p<0.01), In men, the incidences of above moderate hypertension by age group were 0.5 per 100 PYS aged 20-39, 0.7 aged 40-49, 1.7 aged 50-59, 3.6 aged 60-69, and 5.8 aged above 70(p<0.01). In women, those the incidence measured 0.6 per 100 PYS aged 20-39, 1.8 aged 40-49, 1.3 aged 50-59, 3.3 aged 60-69, and 5.6 aged above 70(p<0.01). After age 60, the incidence of hypertension increased rapidly. CONCLUSIONS: The incidence data of hypertension reported in this study may serve as a reference data for evaluating the impact of future public efforts in the primary prevention of hypertension in Korea.; Summary

Job Stress and Its Related Factors in South Korean Doctors.: Yune Sik Kang, Sin Kam, Sang Won Lee, Byung Yeol Chun, Min Hae Yeh; Korean J Prev Med. 2001;34(2):141-148.

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Abstract PDF: OBJECTIVE
To investigate the sources, extent and related factors in South Korean doctors. METHODS: The study subjects were 934 doctors in Taegu, Kyungpook Province, Korea(540 independent practitioners, 105 employed at hospitals and 289 residents in training). Information concerning job stress was obtained using a 9-item questionnaire. Information regarding related factors such as demographic characteristics(age, sex, marital status), perceptions on the socioeconomic status of doctors and working conditions(work time, on-call days per week) was also obtained by self-administered questionnaire during April and May, 2000. RESULTS: Major sources of job stress included clnical responsibility/judgement factor, patient factor and work loading factor. The job stress score of residents was the highest among three groups. The score was lower in older doctors. The score was low among those who thought doctors socioeconomic status was not good. The longer the work time, the higher the job stress score was. Multiple regression analysis was conducted to control for the mutual influence of independent variables. In regression analysis, the score of residents was higher than practitioners. Work time and socioeconomic status perception had negative effects on job stress score. CONCLUSION: The average job stress score of the doctors was high. Age, work type, working conditions and perceptions of socioeconomic status were found to besignificantly related to job stress score. Although the job stress of doctors is somewhat inevitable due to the nature of the doctor's job, control of work time, development of coping tools and other intervention methods are needed to reduce job stress of doctors. Further studies are required to understand the characteristics of job stress and reduce the job stress of doctors.; Summary

Therapeutic Compliance and Its Related Factors of Patients with Hypertension in Rural Area.: Sang Won Lee, Sin Kam, Byung Yeol Chun, Min Hae Yeh, Yun Sik Kang, Keon Yeop Kim, Young Sook Lee, Ki Soo Park, Jae Hee Son, Hee Sook Oh, Moon Young Ahn, Pu Dol Lim; Korean J Prev Med. 2000;33(2):215-225.

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Abstract PDF: OBJECTIVE
The purpose of this study was to examine the therapeutic compliance and its related factors in the rural hypertensives. METHOD: A questionnaire survey and blood pressure measurement were performed to 3,876 residents of a rural area, and 660 hypertensives were selected as subjects of study. The study employed a hypothetical model which was composed of constructs from the health belief model and KAP model. The analysis techniques employed included contingency table analysis and structural equation modeling. RESULT: The proportion of those who were compliant to the treatment of hypertension was 44.2% of subjects. As the result of structural equation modeling, when patients had more favorable attitude toward treatment, higher perceived benefit, or lower perceived barriers to treatment, the therapeutic compliance was significantly higher(T>2.0). When patients had more knowledge about hypertension, or higher perceived severity of hypertension, the attitude toward the treatment of hypertension was more favorable significantly(T>2.0). And when patients had the support for treatment from family or neighbor, the attitude toward treatment was more favorable(T>2.0). When patients had experience of health education, they had more knowledge, higher perceived susceptibility of complication, perceived severity for hypertension, and perceived benefit of treatment, compare to patients without health education(T>2.0). CONCLUSION: In consideration of above findings, in order to improve the therapeutic compliance in the rural hypertensives, it would be necessary to change attitude, perception, knowledge about hypertension and its treatment, by various methods such as effective health education and programs for maintaining the supportive environment for hypertension treatment.; Summary

Relationship between Blood Pressure and Impairment of Cognitive Function In Some Rural Residents Aged 60-64.: Choong Won Lee, Moo Sik Lee, Jong Chan Chun; Korean J Prev Med. 2000;33(2):208-214.

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Abstract PDF: OBJECTIVES
Face-to-face interviews were conducted to investigate the relationship between blood pressure and the impairment of cognitive function in rural elderly (N=932) aged 60-64 in Dalsung County, April to September in 1996 METHODS: Impairment of cognitive function was defined as a score of less than 23 by the Korean version of the Mini-Mental State Examination (MMSEK). Blood pressure was measured once in each subject using a portable automatic sphygmomanometer. RESULTS: By univariate logistic regression on males, no category of systolic blood pressure bore statistical significance. Groups with diastolic blood pressures of, less than 80 mmHg, 90-94 mmHg, and more than 95mmHg had odds ratios of more than one compared with the reference group (80-89 mmHg). This was most significant in the group with blood pressures lower than 80 mmHg, which had a statistically significant odds ratio of 1.68 (95 % confidence interval Cl; 1.02-2.75). No category of blood pressure was statistically significant in females. Multivariate logistic regression for males, with adjustment for age, educational attainment, smoking, alcoholic drinking, body mass index, atherosclerotic disease, and antihypertensive medication use, did not alter the odds ratios significantly in terms of systolic blood pressure. However, the group with diastolic blood pressure of less than 80 mmHg had an increased odds ratio of 2.01 (95 % Cl; 1.15-3.52) compared with the reference group. In females, systolic blood pressure did not alter the odds ratio, but the group with a diastolic blood pressure of less than 80 mmHg had a statistically significant odds ratio of 0.57 (95% Cl; 0.37-0.89). CONCLUSIONS: These results suggest that the relationship between blood pressure and cognitive function status is stronger diastolic than systolic blood pressure and that there is a complex relationship between blood pressure and cognitive function by sex.; Summary

The Risk Factors for the Development of Hypertension in a Rural Area - An 1-Year Prospective Cohort Study.: Hee Sook Oh, Byung Yeol Chun, Sin Kam, Min Hae Yeh, Yun Sik Kang, Keon Yeop Kim, Young Sook Lee, Ki Soo Park, Jae Hee Son, Sang Won Lee, Moon Young Ahn; Korean J Prev Med. 2000;33(2):199-207.

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Abstract PDF: OBJECTIVES
This study was performed to identify the risk factors related to the development of hypertension in a rural area. METHOD: Total of 3,573 subjects in Chung-Song County were interviewed and examined in 1996. The study cohort comprised 2,580 hypertension-free subjects aged above 20. One-year follow up was completed for 1,781 subjects(69.0%) in 1997. General characteristics(age, gender, education level, economic status, marital status), the family history of hypertension, diet, alcohol, smoking, coffee, stress, past history of oral contraceptive and menopausal status in female, height, weight, waist and hip circumference, baseline blood pressure, and serum total cholesterol were considered as risk factors. RESULTS: Multivariate analysis using logistic regression model indicated that age(RR=1.50, 95% CI; 1.15-1.96), the family history of hypertension(RR=2.11, 95% CI; 1.04-4.26), waist-hip ratio(WHR) (RR=2.09, 95% CI; 1.15-3.79), and baseline systolic blood pressure(130-139/<120mmHg)(RR=3.34, 95% CI; 1.47-7.60) were significant risk factors associated with the development of hypertension above the borderline level in male. In female, age(RR=1.06, 95% CI; 1.03-1.09), change in menopausal status(no--> yes/no-->no) (RR=3.32, 95% CI; 1.01-10.87), baseline systolic blood pressure(120-129/<120mmHg: RR=2.00, 95% CI; 1.02-3.90)(130-139/<120mmHg: RR=2.64, 95% CI; 1.34-5.20) and baseline diastolic blood pressure(85-89/<80mmHg)(RR=4.09, 95% CI; 1.86-8.96) were identified as risk factors. CONCLUSIONS: Age and high normal blood pressure were significant risk factors for the development of hypertension above the borderline level. In addition, the family history of hypertension and WHR in men, and the change of menopausal status in women might be significant risk factors in Korea.; Summary

Epidemiologic Investigation of an Outbreak of Shigellosis in Kyongju, Korea.: Hyun Sul Lim, Cheol Jung, Geun Ryang Bae, Yeong Joo Hur, Sang Won Lee, Eun Kyeong Jeong; Korean J Prev Med. 2000;33(1):1-9.

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Abstract PDF: OBJECTIVES
This study was carried out to investigate the sources of infection and modes of transmission of an outbreak of shigellosis that occurred among pupils of "M" primary school and residents near the school in Kyongju from Sept. 24 to Oct. 24, 1998. METHODS: The subjects who completed a questionnaire and a rectal swab for microbiologic examinations were 1,534 persons (781 males, 753 females), including 469 pupils of "M" primary school (268 males, 201 females). Bacteriological examinations of underground water and simple piped water were done. RESULTS: The attack rate of diarrhea was 28.7% in the subjects from Sept. 24 to Oct. 24, 1998. There was no difference in attack rate of diarrhea by gender, but it was significantly higher in the pupils of "M" primary school than others (p<0.01). The attack rate of diarrhea by resident areas was no different to the pupils of "M" primary school, but was significantly higher in the residents of Mohwa 2 Ri except pupils that "M" primary school is located in (p<0.01). The distribution of date of onset revealed the exposure date to be Sept, 22 and 23 in consideration of incubation periods and common source outbreak followed propagative spread in the epidemic curve. The major characteristics of diarrhea were watery (89.1%) in nature, 1~3 days (72.5%) in duration, 2~3 times (63.9%) in frequency. The clinical symptoms among the diarrheal cases included abdominal pain (74.1%), fever (56.4%), headache (55.9%), chill (40.4%) and tenesmus (31.4%). CONCLUSIONS: The source of infection was estimated to be contaminated underground water and simple piped water caused by leakage from the cess pool. It is highly necessary that the management of drinking water and cess pools should be done thoroughly.; Summary

Effects of Change in Obestiy and Life Style Factors on Blood Pressure and Serum Cholesterol - 3-year Follow-up among Workers in a Steel Manufacturing Industry -.: Myung Hwa Ha, Duk Hee Lee, Song Kwon Lee; Korean J Prev Med. 1999;32(3):415-420.

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Abstract PDF: OBJECTIVES
We investigated the effects of changes in obesity and life style factors, such as cigarette smoking, alcohol drinking, and exercise, on the changes in blood pressure and serum cholesterol among Korean men. METHODS: This study included 7,205 healthy male employees in the steel manufacturing industry. Each subject underwent health examination in 1994 and was re-examined in 1997. The study subjects were classified into four categories, according to changes in body mass index (BMI) (loss; stable; mild gain; severe gain), cigarette smoking (quitter; non-smoker; smoker continued; smoker started), alcohol drinking (quitter; non-drinker; drinker continued; drinker started) and exercise (more exercise; continuous regular exercise; continuous irregular or no exercise; less exercise), respectively. We evaluated the relationship between the categories of change in those independent variables and the changes in blood pressure and serum cholesterol, adjusted for BMI in 1994 and age by analysis of variance. RESULTS: The change in systolic blood pressure was positively associated with the changes in BMI (p<0.001) and drinking (p=0.001), but negatively with smoking (p=0.004), compared to the first category of each independent variables. The systolic blood pressure was significantly less increased in the continuous smoking group than quitter or non-smoker. The changes in diastolic blood pressure and serum cholesterol appeared to have statistically significant linear relationships only with the change in BMI. The change in exercise showed a marginal significance with diastolic blood pressure (p=0.088). CONCLUSIONS: These prospective data emphasize the importance of obesity as a determinant of the changes in blood pressure and serum cholesterol. In addition, the changes in smoking and drinking habits can affect systolic blood pressure.; Summary

Senior Medical Students' Attitudes toward and Knowledge about Breastfeeding.: Mi Young Lee, Mi Jung Kang, Choong Won Lee, Kyu Bok Jin, Eun Jung Suh, Jae Suk Ahn, Suk Kwon Suh; Korean J Prev Med. 1999;32(1):95-100.

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Abstract PDF: OBJECTIVES
This study surveyed medical students attending clerkship to assess their attitude toward and knowledge about breastfeeding, and self-confidence to manage common breast-feeding problems. METHODS: A self-report questionnaire was administered to the 323 medical students at four medical colleges in Taegu in May 1997. The response rate was 92.9%, but the respondents used in the final data analysis were 245 (75.8%) due to missing variables. RESULTS: Overall, respondents showed equivocal attitudes toward breastfeeding (mean score 2.9 on a 6-point scale). Knowledge about breastfeeding was substantially low with the median % correct 39.2%. Of nine knowledge areas, weak areas were especially "contraindications and barriers to breastfeeding", "use of breastfeeding aids", "expression and storage of breast milk". Those reported to be confident to manage common breastfeeding problems were only 25.7%. Correlations between knowledge and self-confidence were not statistically significant except in college A (r=0.35, p<0.05). Correlations between knowledge and attitude were not significant. CONCLUSIONS: These results suggest that medical students attending clerkship in Taegu show equivocal attitudes toward breastfeeding, low self-confidence to manage common breastfeeding problems and have substantially limited level of knowledge. There should be more concerted efforts to improve this situation on the part of those involved in breastfeeding education.; Summary

The Incidence Rate of Coronary Heart Disease in City Area.: Byung Yeol Chun, Kwon Bae Kim, Kee Sik Kim, Young Jo Kim, Yoon Nyun Kim, Chang Yoon Kim, Wee Hyun Park, Dong Gu Shin, Bong Sub Shin, Jong Joo Lee, Choong Won Lee, Sung Gug Chang, Jae Eun Jun, Yong Keun Cho, Shung Chuil Chae, Gi Yong Choi, Young Ae Ha, Young Sook Lee; Korean J Prev Med. 1998;31(3):395-403.

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Abstract PDF: To estimate the incidence rate of coronary heart disease in Korea, of all residents of the Taegu city aged 25 or above, those who had an acute MI or fatal coronary event between 1 July 1996 and 30 June 1997 were registered. Seven hundreds and eight patients were registered during the study period(685 were identified at hospital and 23 were autopsy cases). Age-standardized annual incidence rate of men in city area was 93 per 100,000(95% CI; 61-142) and 33(95% CI; 16-67) in women(100 in men and 20 in women aged 35-64). The incidence was rapidly increased after age 40 in men, however, in women after age 60. Twenty-eight-days case fatality rate was 45% in men and 47% in women. However, in the age group of 45-59 case fatality rate in women was two times higher than that in men. In conclusion, crude annual incidence rate of CHD in city area was 73 per 100,000 in men and 33 in women. The age-standardized annual incidence of CHD in men(93 per 100,000) was 3.2 times higher than that in women (33 per 100,000) in Korea.; Summary

Application of HHIE-S(Hearing Handicap Inventory for the Elderly-Screening version) to screening test of noise-induced hearing loss.: Mi Young Lee, Suk Kwon Suh, Choong Won Lee; Korean J Prev Med. 1996;29(3):539-554.

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Abstract PDF: The study conducted from May to September in 1994 to investigate applicability of the Hearing Handicap Inventory for the Elderly-Screening version(HHIE-S) in parallel with the puretone audiometer to the initial screening test of noise-induced hearing loss(NIHL) in some noise-exposed workers. Subjects were selected by systemic sampling that took every fifth person from 6,700 workers taking the annual occupational health examination by the department of Health Maintenance of Dongsan Hospital Keimyung University in Taegu. The authors administered the pure-tone audiometric test and self-reported questionnaire of HHIE-S including items of sociodemographic and job-related variables concurrently. The final subjects analysed were 1,019(488 males and 531 females) excluding fourteen persons who had many missing values in their questionnaires. The reliability coefficients of HHIE-S scale by Cronbach's alpha were 0.84. In the univariate analysis of hearing handicap measured by the HHIE-S, work duration, military service and the hearing threshold loss at 1kHz and 4kHz was the only selected variable explaining the hearing handicap in males and hearing threshold loss at 1kHz and 4kHz, age, and work duration were selected in females. In ROC curves for HHIE-S scores against NIHL as gold standard which was defined by the follow-up audiogram as more than 30dB of the average of 0.5/1/2kHz and 50dB at 4kHz, the optimal cutoff for the parallel HHIE-S appeared to be 8. The results suggest that HHIE-S appeared to have some reliability and validity in this data and might be used in screening NIHL in parallel with pure-tone audiometer in noise-exposed workers.; Summary

Predictors of breast-feeding discontinuation in some followed-up hospital-delivered mothers.: Choong Won Lee, Moo Sik Lee, Jong Won Park, Mi Young Lee, Mi Joung Kang, Dong Hoon Shin, Se Youp Lee; Korean J Prev Med. 1995;28(4):845-862.

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Abstract PDF: We followed prospectively some hospital-delivered mothers to identify characteristics of those not initiated breast-feeding and predictors of breast-feeding discontinuation in monthly telephone interviews. Recruits were composed of 482 mothers who delivered their babies at one university hospital and one OB/GYN clinic in september to November 1991. Breast-feeding discontinuation was defined as switch to 100% formula lasting more than one week regardless of solid foods. Average age of the study subjects was 27.3 years of age(standard deviation 3.2). Multiple logistic regression analysis indicated native place, occupation, method of delivery and method of feeding considered to be better for maternal health were statistically significant(p<0.1) between initiators and non-initiators of breast feeding. In starting cohort(N=242) of those initiated breast-feeding, that median of breast-feeding discontinuation were 5 months and 25th and 75th percentiles were 3 and 9 months respectively. I Cox's proportional hazard model, mothers with 10~13 years of education were 2.63 times (95% confidence interval, CI 1.50~4.60 ) more likely to discontinue than those with less than 9 years of education and those with more than 13 years of education were 3.55 time (95% CI 1.99~6.33). Compared with house wife, mothers with part-time jobs were 1.99 times (95% CI 0.86~4.57) more likely to discontinue and those with employed full-time were 1.55 times (95% CI 0.96~2.51). These results suggest that the predictors of initiation and discontinuation of breast-feeding may be different and different target populations should be selected to promote initiation and to prevent discontinuation of breast-feeding according to the period after birth.; Summary

Anger-coping types and hypertension in some employed men.: Choong Won Lee, Jong Won Park, Se Youp Lee; Korean J Prev Med. 1995;28(2):462-472.

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Abstract PDF: This study examined the relation between anger-coping types and hypertension in employed men aged 40-60 who consented to participate during the biannual physical checkup in the department of health management in 1988. The subjects analyzed were five hundred thirteen excluding those having hypertension history and/or current antihypertensive medications. Anger-coping types were constructed from the Harburg's model with two hypothetical anger-provoking situations involving wife and boss. Hypertensives were defined more than 140mmHg systolic blood pressure and/or 90mmHg diastolic blood pressure. Hypertensives were one hundred fifty two(29.6%) and those who suppressed their anger were 61.6%0 and 62.8% in wife and boss situations respectively. Items of anger, guilt, protest, and suppressed anger in wife situation showed odds ratios of 0.78-0.94 without statistical significance. But four items in boss situation showed odds ratios more than 1, especially anger-in types of anger item had 1.58 times the prevalence of hypertension of anger-out types(95% confidence intervals(CI) 1.06~2.35) and subjects who indicated that suppressed their anger had 1.55 times the prevalence of hypertension of those who expressed their anger(95% CI l.03~2.32). For anger suppressed vs. expressed types of total suppressed anger index, prevalence of hypertension was 1.31(95% CI 0.83~2.08). After adjusting for age, body mass index, smoking and drinking, the odds ratios were slightly increased in both situations except guilt items compared with univariate analysis. These results suggest that the relation between Harburg's anger-coping model and hypertension is replicated partially in this subjects.; Summary

Leukocyte count and hypertension in the health screening data in some rural and urban residents.: Choong Won Lee, Nung Ki Yoon, Sung Kwan Lee; Korean J Prev Med. 1991;24(3):363-372.

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Abstract PDF: We used the health screening data of some rural and urban residents to examine the cross-sectional association between leukocyte count and hypertension. The 206 male and 203 female rural residents were selected by multi-stage cluster sampling method in Kyungsan-Kun area of Kyungbuk province in 1985 and 600 urban residents were selected by the same sampling method as the rural residents in Daegu city of the same province in 1986 compatible with age-sex distribution of Daegu city of 1985 census, but of whom 384 actually responded. The rest of 600 were replaced by age and sex with those who were members of the medical insurance plan visiting the health management department of the university hospital to get the biannual preventive medical checkups. Excluded in the analysis were those having hypertensive history, diseases and extreme outlying values of the screening tests, leaving 373 rural and 571 urban residents. Leukocyte count was measured with ELT-8 Laser shadow method and the unit cells/mm3. Blood pressures were determined with an aneroid sphygmomanometer with pre-standardized method and hypertensives were defined as those showing systolic blood pressure more than 140 mmHg and / or diastolic blood pressure more than 90 mmHg. Total residents pooled (N=944) showed a significant difference between hypertensives and normotensives (6965.93+/-1997.01 vs 6490.61+/-1941.32, P=0.00) and in rural residents was noted the similar significant difference (P=0.03). None of significant differences were noted in any stratum stratified by residency and sex. Compared to the lowest quintile of WBC, 2/5 quintile showed odds ratio 0.99 (95% CI 0.90-2.21), 4/5 quintile 1.76 (95% CI 1.14-2.72), and highest quintile 1.80 (1.15-2.82) in the total residents. Likelihood ratio test for linear trend for in indicated a significant trend (x2 trend=5.53, df=1, P<0.05). There were no other significant odds ratios compared to the lowest quintile of WBC in strata stratified by residency and sex. The odds ratios in total residents which had showed significant odds ratios became nonsignificant and of reduced magnitude after controlling age, frequency of smoking and drinking with multiple logistic regression. In each stratum, it changed magnitudes of odds ratios slightly and unstably. None of the trend tests showed any significant trend. These results suggest that the Friedman et al's finding of association between leukocyte count and hypertension may be due to an statistical type I error result in from the data dredging in an exploratory study, in which more than 800 variables were screened as possible predictors of hypertension.; Summary

Body fat distribution and hypertension.: Choong Won Lee, Nung Ki Yoon; Korean J Prev Med. 1991;24(1):57-69.

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Abstract PDF: This study examined the cross-sectional association of body fat distribution with hypertension as well as the superiority of medical calf skinfold measured as peripheral fat distribution over the conventional triceps skinfold using 450 Korean Navy divers selected by authors' convenience in 1990. Their mean age was 27.9 and range of it was 19-51. The centrally located body fat was approximated by subscapular from these skinfold measures to reflect central versus peripheral fat distribution pattern: 2 ratios and 2 differences. After controlling age and overall obesity (body mass index), prevalence odds ratios of the 2/4, 3/4, 4/4 quartiles of subscapular skinfold comparing with lowest 1/4 quartile were 2.05 (95% confidence interval, CI 1.18-3.59), 2.02 (95% CI 1.06-3.86), 4.00 (95% CI 1.99-8.06) respectively. The difference of subscapular and medical calf skinfolds was associated with hypertension (odds ration 2.45, 95% CI 1.28-4.68 comparing highest with lowest quartiles). Triceps and medical calf skinfolds alone did not show any odds ratio not including unity. The adjusted odds ratios were generally reduced in small magnitude compared with crude odds ratios not adjusted for age and overall obesity. The medical calf skinfold appeared to be more representative of peripheral body fat distribution than triceps skinfold. These findings suggest that central fat distribution rather than peripheral distribution is associated with hypertension independent of age and overall level of obesity and medical calf skinfold may replace conventional triceps skinfold in predicting peripheral distribution of body fat.; Summary

Type A behavior pattern and social control of parents.: Choong Won Lee, Nung Ki Yoon, Suk Kwon Suh, Dong Hoon Shin; Korean J Prev Med. 1990;23(1):22-32.

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Abstract PDF: Associations between type A behavior pattern (TABP) and parental social control were examined by a questionnaire survey in a sample of 803 undergraduates of the three universities in Daegu city in 1988. TABP was assessed by the Student Jenkins Activity Survey (SJAS, short from) and social control of parents by Bernstein and Brandis' Index of control and communication which were both dichotomized by median. The mean age of the sample was 20.7 (standard deviation, 2.2) and mean of total score of SJAS was 5.6 with it standard deviation and median, 2.7 and 5, respectively. In stratified analysis for TABP-social control association by the native place, sex and socioeconomic status (SES), males of rural origin with low SES showed odds ratio (OR), 2.49 but those with high 0.40. For females of rural origin, those with low SES showed OR, 1.02, whereas those with high SES did 0.35. For those who was of urban origin, males with low SES had OR 1.27, and those with high SES did 1.29. Females with high SES showed 0.85 and those with low SES 0.67. None of the TABP-social control associations among the strata showed confidence intervals not including unity. In multiple logistic regression by native place, for those with rural origin the only term showed a statistically significance was the social control-SES of parents interaction, OR 3.99 (95% confidence interval, 1.03-15.46). For those of urban origin, none of the terms are statistically significant. These results suggest a social upward mobility by education of the rural disadvantaged group and a Confucian idea that regards academic achievement as one of social virtues, both of which may reflect the different sociocultural structures from the West.; Summary

Study of the Amount and Share of Drug Cost in the Total Medical Fee under Medical Insurance Scheme.: Chu Won Lee, Oh Surk Hahn; Korean J Prev Med. 1989;22(2):223-235.

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Abstract PDF: To grasp the idea about how drugs are used under Medical Insurance Scheme, the amount and share of drug cost in the total medical fee have been reviewed and analyzed for different types of patients(in-patient out-patient), medical institutions and frequently seen diseases and following findings were revealed. In 1986, drug cost took 32.78% of total medical fee for in-patients and 32.98% for out-patients averaged over 30% share as a whole. When drug cost per case in 1980 be indexed to 100, it has shown steady growth to become 200 for in-patients and about 150 for out-patients in 1986. The contribution of drug cost to the total medical fee is, regardless of patient type-in-patients and out-patients, the highest in University hospitals and followed by General hospitals, Hospitals and Clinics in descending order. That for the most frequent 10 diseases came out the highest, 79% with the essential benign hypertension of out-patients in the General hospitals, 61% for the gastric ulcer of out-patients in Hospitals and 33% for the female genital disease of out-patient in Clinics. The drug cost of oral formula was contributed the most, 7.93% by cardiovascular agents followed by hepatic detoxicants(5.47%) and out-patients(4.93%), and that of injectable formula was contributed the most by antibiotics(24.17%), followed by protein amino-acid preparations(6.19%). The order of drug usage by specially for the in-patients was the highest with internal medicine followed by general surgery and E.N.T, and that for the out-patients was in the order of Internal medicine, neuropsychology and Ob/Gy. This study revealed that the drug dependency was characteristically different to specialty. In view of the fact that drug cost on average exceeds over 30% of total medical fee, proper drug administration appears to be vitally important for the financial standing of the Medical Insurance Scheme. As a consequence, drug usage guidelines including antibiotics usage shall be established first of all and the voluntary participation for the regulation of drug usage and propagation of the guidelines to medical institutions are strongly coerced.; Summary

The Relationship of Psychosocial Factors to Blood Pressure.: Choong Won Lee, Sung Kwan Lee; Korean J Prev Med. 1988;21(1):99-112.

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Abstract PDF: Questionnaires and blood pressure measurements were administered to 279 medical school undergraduates in 1987 to investigate the relationship between psychosocial factors and blood pressure as well as reliability and validity of the Framingham Type A Behavior Scale(FTA). The reliability coefficients of SCL-90-R and FTA measured by Spearman-Brown haves split test were 0.57-0.91, The factors of FTA extracted by principal component analysis were hard-driving competitiveness factor and impatience factor(2-factor solution). The total score of FTA was positively correlated with relative weight and place raised but the correlations were insignificant, and had significantly positive but weak correlations with depression, anxiety hostility, paranoid, and psychoticism subscales of SCL-90-R. In the univariate analysis of blood pressures, relative weight and family history were significant in systolic pressure in males and economic status was significant in blood pressures in both sexes. For diastolic pressure, relative weight and frequency of alcohol intake were significant in males and relative weight was in females. After controlling relative weight, the frequency of alcohol intake for diastolic pressure and economic status for systolic pressure were significant in males. The important variables selected by stepwise regression analysis were relative weight and economic status for systolic pressure of males and relative weight and the frequency of alcohol to the model, changing coefficient of determination 0.206 to 0.217. In females, economic status and relative weight were selected for systolic pressure and for diastolic pressure body mass index alone, but the model of blood pressure for females was considered to be unstable due to small sample size(56). FTA was unrelated to the blood pressures in both sexes.; Summary

Epidemiological Trend of Japanese Encephalitis in Korea.: Chu Won Lee, Dae Kyu Oh; Korean J Prev Med. 1987;20(1):137-146.

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Abstract PDF: The following facts have been identified as a result of epidemiogical trend and characteristic of Japanese Encephalitis in Korea for the last 20 years. First: The Epidemiological period which was ten-year and three-year in the past has been disappeared following the start of immunization program at 1970. Second: The incidence rate was much higher in the south and West areas than northeast area of Korea. City and province with the highest incidence rate was Chungcheong Nam Province and Cholla Buk Province. Third: Regardless of scope of prevalence, the main season that 90 percent of total incidence occurs in one month from mid-September. Fourth: The number of case by age was that 80 percent of total patients is children aged 3-15. Recently there is an increase in the number of patients who are elderly people. Fifth: The study on the ecological conditions of mosquito including wintering and effectiveness of immunization for Japanese Encephalitis and duration on antibody should be done. Sixth: There has been no case of Japanese Encephalitis during last three years since 1984 mainly due to disinfecting to eradicate mosquitos, immunization for vulnerable group of people aged 3-15, individual precaution not to be bitten by mosquito, improvement sanitation. While there has been no case of Japanese Encephalitis during last three years, there is possibility that Japanese Encephalitis becomes prevalent again anytime since its virus has been isolated continuously from the natural reservoirs.; Summary

Epidemiological and Serological Investigation on Epidemic Encephalitis in Korea.: Chu Won Lee, Kyung Ho Kim, In Dal Kim; Korean J Prev Med. 1974;7(2):403-404.

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Abstract PDF: No abstract available.; Summary

English Abstracts

Estimation of Smoking Prevalence among Adolescents in a Community by Design-based Analysis.: Soon Woo Park, Jong Yeon Kim, Sang Won Lee, Jung Han Park, Yeon Oh Yun, Won Kee Lee; J Prev Med Public Health. 2006;39(4):317-324.

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Abstract PDF: OBJECTIVES
This study was conducted to estimate the unbiased smoking prevalence and its standard errors among adolescents in a large city in Korea, by designbased analysis. METHODS: All the students in Daegu city were stratified by grade, gender and region, and then schools as primary sampling units (PSU) were selected by probability proportional to size (PPS) sampling. One or two classes were sampled randomly from each grade, from 5th grade in elementary schools to the 3rd grade in high schools. The students anonymously completed a standardized selfadministered questionnaire from October to December 2004. The total number of respondents was 8,480 in the final analysis, excluding the third graders in the general high schools because of incomplete sampling. The sampling weight was calculated for each student after poststratification adjustment, with adjustment being made for the missing cases. The data were analyzed with Stata 8.0 with consideration of PSU, weighting and the strata variables. RESULTS: The smoking prevalence (%) and standard errors for male students from the fifth grade in elementary schools to the second grade in high schools were 0.93[0.47, 1.83[ 0.74, 3.16[1.00, 5.12[1.02, 10.86[1.13, 15.63[2.44 and 17.96[2.67, and those for the female students were 0.28[ 0.28, 1.17[0.73, 3.13[0.60, 1.45[0.58, 3.94[0.92, 8.75 [1.86 and 10.04[1.70, sequentially. CONCLUSIONS: The smoking prevalence from this study was much higher than those from the other conventional studies conducted in Korea. The point estimates and standard errors from the design-based analysis were different from those of the model-based analysis. These findings suggest the importance of design-based analysis to estimate unbiased prevalence and standard errors in complex survey data and this method is recommended to apply to future surveys for determining the smoking prevalence for specific population.; Summary

Factors Associated with Perceived Peer Smoking Prevalence among Adolescents.: Soon Woo Park, Sang Won Lee, Jong Yeon Kim, Jung Han Park; J Prev Med Public Health. 2006;39(3):249-254.

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Abstract PDF: OBJECTIVES
This study was conducted to examine the factors related to the perceived peer smoking prevalence for adolescents. METHODS: A self-administrated questionnaire was administered to 352 students in a technical high school in Kangwon Province in May, 2002. The questions included in the questionnaire were concerned with the estimated number of smokers among ten students of the same grade in their school, the sociodemographic characteristics, the smoking-related behaviors and attitudes, and the smoking-related environments. All the students had their expiratory carbon monoxide level measured with EC50 Micro-Smokerlyzer? to verify their smoking status. Multiple regression analysis was applied for data analysis using Windows SPSS 11.5. RESULTS: The former and current smokers overestimated the peer smoking prevalence. Multiple regression analysis for estimating the peer smoking prevalence for the male showed that the perceived smoking prevalence was higher in the female students than in the male students, higher in those students whose mothers had a higher educational level, who had smoked more frequently, who had more best friends smoking, and who had a higher actual smoking rate of the class. For estimating the peer smoking prevalence for the female, the perceived smoking prevalence was higher in the female students than in the male students, higher in those who smoked more frequently, whose five best friends smoked, who had higher actual smoking rate of the class, and who had smoking siblings. CONCLUSIONS: This study showed that a higher perceived peer smoking rate is related with their own smoking history and smoking frequency, the smoking related environment, and gender. Smoking prevention and smoking cessation programs need to focus on correcting the falsely perceived smoking prevalence.; Summary

Research Support, Non-U.S. Gov't

Epidemiologic Investigation on Sporadic Occurrence of Shigellosis in a Subcounty of Cheongwon County in Chungbuk Province in 2003.: Yong Jae Lee, Ue Kyoung Hwang, Jong Suk Kim, Jun Young Kim, Ja Seol Koo, Bok Kwon Lee, Jong Won Kang; J Prev Med Public Health. 2005;38(2):182-188.

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Abstract PDF: OBJECTIVES
This study was undertaken to investigate the source of infection and mode of transmission of shigellosis, which occurred sporadically among residents and students in a subcounty of Cheongwon county, Chungbuk province, Korea, from June 4 to July 3 2003. METHODS: 692 subjects completed a questionnaire and provided a swab for microbiological examinations, and 7 environmental specimens were examined for bacterial organisms. PFGE (pulsed-field gel electrophoresis) and fingerprinting were performed to find the genetic relationship among the temporally associated sporadic isolates. RESULTS: A total of 29 patients had symptoms consistent with the case definition, with 13 confirmed and 16 suspected cases. The frequency of diarrhea was 6 times or more a day (80.8%), with a duration of 1 to 4 days (88.5%) in most cases. The most common symptoms accompanying the diarrhea were fever (80.9%) followed by abdominal pain (76.9%), headache (65.4%), chill (61.5%), vomiting (46.2%) and tenesmus (15.4%). The epidemic curve was characteristic of a person-to-person transmission. The PFGE and fingerprinting demonstrated identical or similar DNA patterns among the 3 Shigella sonnei isolates (A51, A53 and A61 types) found in this outbreak. CONCLUSION: A genetically identical strain of S. sonnei was estimated to be the cause of this outbreak, and the mode of transmission was most likely person-to-person.; Summary

English Abstract

Development of Measurement Scale for the Quality of Life in Hypertensive Patients.: Keon Yeop Kim, Byung Yeol Chun, Sin Kam, Sang Won Lee, Ki Soo Park, Shung Chull Chae; J Prev Med Public Health. 2005;38(1):61-70.

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Abstract PDF: OBJECTIVES
To develop a tool for multidimensional measurement of the quality of life, which was psychometrically sound, short, and easy to administer for patients with hypertension. METHODS: A sample of 1, 115 hypertensive patients aged 20 or above in Cheong-Song County was studied from June 1997 to October 1998. In the development of the instrumental stage, the authors first conceptualized the quality of life. Item generation, item reduction, and questionnaire formatting were followed. Item-level (item descriptive, missing%, item internal consistency, item discriminant validity) analysis, scale-level (scale descriptive, floor and ceiling effect) analysis, and other tests (Cronbach's alpha, inter-dimension correlations, factor analysis, clinical validity) were performed to evaluate the validity and reliability of the new measurement scale. After 1 year, responsiveness and confirmatory factor analysis were performed. RESULTS: The results of both item-level and scale-level analyses were acceptable. An acceptable degree of internal consistency was observed for each of the dimensions (Cronbach's alpha was 0.60 or higher). Inter-dimension correlations were below 0.50 and the factor analysis result was the same as the intended dimension structure. Correlation coefficients between perceived health status, stress and dimensions were proven to be acceptable. The result of comparing dimensional score means among ADL and MMSE-K groups above 60 years was statistically significant (p< 0.05). The result of confirmatory factor analysis concluded that the dimensional structure model was well fitted. However, the result of responsiveness test using sensitivity and specificity was unsatisfactory. CONCLUSIONS: The newly developed measurement scale is psychometrically reliable and valid instrument for measuring quality of life in hypertensive patients.; Summary

Original Articles

Non-Fatal Injuries among Preschool Children in Daegu and Kyungpook.: Soon Woo Park, Youn Jeong Heo, Sang Won Lee, Jung Han Park; J Prev Med Public Health. 2004;37(3):274-281.

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Abstract PDF: OBJECTIVES
This study was performed to investigate the injury rates and risk factors for preschool children in Daegu city and Kyungpook province. METHOD : A questionnaire survey about medically attended injuries during the preschool period was performed in nine primary schools located in Daegu city, Pohang city and Goryung County. The overall injury rate was estimated using person-year. The causes and patterns of the injuries, and their risk factors were examined. RESULT : A total of 469 medically attended injuries were reported in 330 of the 959 study subjects during the preschool period. The overall annual injury rate was 7.5 per 100 children. The injury rate increased sharply during the period from infant (2.4) to 1 year of age (7.5), and the peak injury rate (9.2) was reported for 5 year olds. The most common causes of injuries were falling (36.0%), followed by being struck by an object (23.7%), and traffic accidents (14.1%). Among the traffic accidents, 72.8% occurred while playing on the road, riding a bicycle or roller-skating. A proportional hazard model showed that males (hazard ratio=1.49, p< 0.001 compared with female) and the mother's higher education level (hazard ratio of college or higher= 1.51, p=0.013; high school=1.32, p=0.085 compared with those of middle school or lower) were significant risk factors of childhood injury. CONCLUSION: The results of this study suggested that efforts for children's safety should be made, especially from the toddler stage, and in male children. To develop a more specific childhood injury prevention program, a surveillance system for injuries should be established. Further study of the relationship between mother's occupation and injury rates is also needed.; Summary

Smoking Behaviors and Its Relationships with Other Health Behaviors among Medical Students.: Soon Woo Park, Jung Han Park, Sang Won Lee, Hyun Sul Lim, Jong Tae Lee, Yune Sik Kang; J Prev Med Public Health. 2004;37(3):238-245.

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Abstract PDF: OBJECTIVES
This study was conducted to examine the smoking behaviors and the relationship between smoking and other health behaviors among medical students. METHODS: A self-administrated questionnaire was administered to a sample of 1, 775 students from four medical schools between April and May 2003. Due to the small number of female smokers, the characteristics of smoking behaviors were analyzed only for males. RESULTS: A total of 1, 367 students (920 males and 447 females) completed the questionnaires, with an overall response rate of 77.7%. The smoking rates for males and females were 31.5, and 2.2%, respectively. Among the male smokers, 70.7% smoked daily, and 39.0% smoked one pack or more per day. Male students on medical course were more likely to smoke daily, and one pack or more per day, than those on premedical course. Male daily smokers desired to quit smoking less than occasional smokers, and 65.0% of male daily smokers were not ready to quit compared with 37.8% of the occasional smokers. Among the male daily smokers, 29.6% were severely nicotine dependent. The most common reason for not to quit smoking among male smokers was 'no alternative stress coping method' (44.4%), followed by 'lack of will power' (25.4%), and 'no need to quit' (19.4%). Compared with male non-smokers, male smokers were more likely to drink alcohol more often and in larger amounts, take coffee more often, eat breakfast less regularly, and be overweight or obese. CONCLUSIONS: The results of this study suggest that many male medical students were serious smokers, especially those on medical course. It is necessary to install a smoking prevention program for pre-medical students, provide effective smoking cessation methods for smokers, teach positive stress coping methods, and make the school environment suitable for coping with stress.; Summary

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