경기도 지역 임신부를 대상으로 한 풍진 항체 양성률에 대한 혈청 역학적 연구

기모란,최보율,신영전,박항배,윤배중,한중석,Ki, Mo-Ran,Choi, Bo-Youl,Shin, Young-Jeon,Park, Hung-Bae,Youn, Bae-Joong,Hahn, Joong-Surk 대한예방의학회 1997 Journal of Preventive Medicine and Public Health Vol.30 No.2

The vaccinations of susceptible children and postpubertal females are the major means to prevent congenital rubella syndrome(CRS). Another means for reducing the CRS is therapeutic abortion or fetal monitoring for women who are infected in the first four months of pregnancy. We could not estimate the incidence of CRS in Korea, because there was no surveillance system for rubella and CRS. Nationwide vaccination program for 15months infant had been started early 1980s. So, most women at childbearing age during study period were not received rubella vaccination. We set forth CRS management system for pregnant women in two rural county of Kyonggi province, Korea. In this system, the presence of rubella IgG and IgM antibodies for early pregnant women were examined with MEIA(Microparticle Enzyme Immunoassay) method by IMx automated analyzer $Abbott^(R)$. The infected pregnant women followed up in order to confirm their childrens CRS. This study was carried out from Mu. 1993 to Jun. 1994, and pregnant women examined were 874 persons. The results were summarized as follows. The overall positive .ate of rubella IgG antibody was 94.5%(826/874). The positive rate was significantly increase as the age increased, and reached 100% in pregnant women who were over 35 years old. This results suggest that a meaningful number of women are infected during childbearing years. The geometric mean titer of IgG of sero-positive subjects was significantly declined as the age increased. On the question about history of URI symptoms and rash in pregnancy, 20.7% of respondents checked on URI symptoms with .ash, 13.5% only URI symptoms without .ash, and 65.8% no symptoms. However there was no demonstrable association between the rubella like infection history in pregnancy and the rubella IgG and IgM antibody status. Rubella infection .ate in pregnant women was 0.9%(95% CI 0.4-1.8%). Two of these 8 infected pregnancies were terminated by therapeutic abortion. One of them was not followed. Five babies had no gross anomalies at birth. In Dec. 1996, three of five babies were normal appeared infants. Two of them were not followed. Throughout this study results, we confirmed the need of CRS management system for pregnant women, in Korea.

임상시험에서 비교군 설정 및 무작위 배정과 맹검

기모란 ( Mo Ran Ki ) 대한임상종양학회 2007 Korean Journal of Clinical Oncology Vol.3 No.1

청소년 비만과 부모의 사회경제적 수준의 연관성 -서울, 양평, 중국 연변지역 중학생을 대상으로-

기모란,김미경,방금녀,허춘영,안동현,강윤주,최보율,Ki, Mo-Ran,Kim, Mi-Kyoung,Fang, Jin-Nu,Xu, Chun-Ying,Ahn, Dong-Hyon,Kang, Yun-Ju,Choi, Bo-Youl 대한예방의학회 1999 예방의학회지 Vol.32 No.1

Objectives. Few studies have attempted to explain the association between socioeconomic status (SES) and obesity in Korea Especially the studies on same race with different SES at same time are good for SES influence estimation. The present study highlights the influence of SES of parents on adolescent obesity. The subjects are the same race, but live in different areas, with different SES, Seoul and Yangpung in Korea, and Yanbian in China. Methods. The cross-sectional study was conducted in Mar-Jun 1996. We carried out anthropometry, 24 hour-recall diet survey, self-reported questionnaire about sociodemographic characteristics and physical activity. For SES indicators, we used income and education of parents. Results. The relationship between SES of parents, defined as educational status, and obesity in boys in Korea and China is direct, but not significant. The relationship is inverse and nonsignificant among Korean girls, However, for the Korean girls in severe obesity, the relationship is significant. For the Korean-Chinese girls, there is an inverse relationship between the education level and obesity but a direct relationship between the income level of parents and obesity. For the Korean adolescent, there are a direct association between the SES of parents and the nutrients factors such as energy, protein, and fat intake. The energy expenditure of adolescent has no relationship with SES of parents. Conclusion. Among boys, the higher the SES, the greater the risk of obese. Among girls in Korea and Korean-Chinese, on the other hand, the lower the educational status of parents, the greater the risk of obese.

노인전문요양시설에서 발생한 옴 유행 역학조사

기모란(Mo-Ran Ki),문현진(Hyun-Jin Moon),조현(Hyoun Cho) 한국역학회 2006 Epidemiology and Health Vol.28 No.1

  Objectives: To investigate an outbreak of scabies that occurred in geriatricfacilities located in Kyounggi-province, Korea, between September 2004 and September 2005.   Methods: We carried out an epidemiologic investigation on the scabies outbreak. All workers except two were interviewed and the charts of the patients were reviewed.   Results: Among workers, the attack rate was 58.6% (17/29). The rate was 86.0%(37/43) in patients. Secondary cases also occurred among the family members of workers, with a secondary attack rate of 15.8%. The 95% confidence interval was 6o/~31.3%. The transmission of scabies began from one index case who had scabies and moved from another facility. She was hospitalized on the 4th floor of this facilitywhere dependent patients resided. After the activities (picnic and yard sale) in May 2005, and the ward rotation of care givers between the 3rd and 4th floor in July 2005, the incidence of scabies increased. The last cases occurred in Sep. 2005.   Conclusions: This outbreak investigation has importance because it is the first report of ascabies outbreak in geriatric long-tenn care facilities in Korea. Recently, the reports on a scabies epidemic are increasing "With the augmentation of geriatric long-tenn care facilities.   It is important to educate and inform workers and staff in long-tenn care facilities about scabies and other contagious skin diseases. More facilities for senility and dementia "Will be opened and we need to lookinto contagious diseases in long-term care facilities.

전염병 설명 모형과 모의시험

기모란(Mo-ran Ki) 한국역학회 2006 Epidemiology and Health Vol.28 No.1

  Modeling and simulations of infectious diseases are useful tools to estimate epidemic size and determine effective intervention methods. Models are idealized, simplified representations of reality. Therefore, a simple model should be the first design, with complex models always able to be added later to better represent reality. The following recommendations are made to ensure accurate simulations: (1) minimal feasible complexity, (2) mathematically well-defined, models should be constructed "With well characterized stochastic processes rather than "ad-hoc"behavioral models, (3) if predictions are being made, unknown parameters need to be robustly estimated using the model from epidemiological data, (4) where data is unavailable, a detailed sensitivity analysis needs to be undertaken, and (5) even if models are only being used to explore dynamics, sensitivity analysis is important to understand mechanisms.   For the effective control of infectious diseases "With models and simulations, we need effective information systems (laboratory and clinical data) for communicable disease control as a permanent infrastructure, closer collaboration between academic and service providers on new developments in communicable disease control, and enhanced monitoring of veterinary infections and "minor" zoonoses, particularly in resources poor settings.

청소년의 혈청 지질 분포와 비만, 영양, 운동량의 연관성

기모란,김미경,김기랑,방금녀,강윤주,최보율,Ki, Mo-Ran,Kim, Mi-Kyung,Kim, Ki-Rang,Fang, Jin-Nu,Kang, Yun-Ju,Choi, Bo-Youl 대한예방의학회 2000 Journal of Preventive Medicine and Public Health Vol.33 No.1

Objectives : To assess the prevalence rate of dyslipidemia and the level of related factors in adolescents groups in Seoul and Yangpyong area. Methods : Design; School based survey during May-Jun 1996 in Seoul and Yangpyong county. Subject; 2,453 boys and girls, aged 13 to 19 years; 1,137 Seoul and 1,316 Yangpyong county. Main Outcome Measures; Prevalence rates of raised serum total cholesterol, triglycerides, LDL-cholesterol, decreased HDL-cholesterol, obesity, and levels of energy intake and expenditure Results : Energy intake and fat intake of boys were higher than those of girls and they were higher in Seoul. Energy expenditure per day of boys was bigger than that of gins too. Prevalence rate of obesity was higher in boys of Seoul(15.2%) and girls in Yangpyong county(14.0%). Serum lipid profiles(total cholesterol, triglycerides, LDL-cholesterol) were higher among girls and all prevalence rates of dyslipidemia were higher in boys in Seoul and in girls in Yangpyong county. Especially, girls(29.1%) in Yangpyong had raised serum cholesterol level$(\geq170\;mg/dl)$. In contrast, boys in Seoul had higher level of decreased HDL-cholesterol(46.8%) compared to Yangpyong(23.6%). The relationships between serum lipid profiles and relative weights and sex are highly significant. And the relationship between triglycerides and energy intake is significant(p=0.038). But, the associations between serum lipid profiles and energy expenditure had borderline significances Conclusions : Hypercholesterolemia rates in girls were higher. Obesity prevalence rate was highest in boys of Seoul. Relative weight and sex are significantly related to lipid profiles. Therefore, Korea is in need of preventive strategies for different obesity and gender groups.

부모의 사회경제적 수준이 도시와 농촌 중고등학생의 영양소 섭취에 미치는 영향

김미경,기모란,방금녀,김기량,최보율,권영준,이상선,김찬,강윤주,Kim, Mi-Kyung,Ki, Mo-Ran,Bang, Kum-Nyu,Kim, Ki-Rang,Choi, Bo-Youl,Kwon, Young-Jun,Lee, Sang-Sun,Kim, Chan,Kang, Yun-Ju 대한지역사회영양학회 1998 대한지역사회영양학회지 Vol.3 No.4

This study was conducted to assess the nutrient intake patterns among urban and rural adolescents and to investigate the effects due to parent's socioeconomic status and other factors, such as mother's job, family type and regular exercise on that pattern. 2,455 middle and high school students living in Seoul and Yangpong, Kyounffi-Do participated in a self-administered questionnaire that was used to collect data. The one-day dietary intake was surveyed through a 24-hour recall method. The factors significantly different between urban and rural adolescents according to monthly income, parent's education level, mother's job, family type and exercise. Income, the parents' education level and regular exercise were associated with the patterns of nutrient intakes as a percent of the RDA. So, when adjusted for parental income, the father's and mother's education level and regular exercise, there were no signifcant differences within the patterns of nutritional intake between urban and rural adolescents. The results provided the information regarding the determinants of nutrient status among adolescents and were expected to be helpful for planning school health promotion programs.

소아 무균성 뇌막염의 역학적 연구를 위한 건강보험자료원의 유용성 평가

박수경,기모란,손영모,김호,정해관,Park, Sue-Kyung,Ki, Mo-Ran,Son, Young-Mo,Kim, Ho,Cheong, Hae-Kwan 대한예방의학회 2003 Journal of Preventive Medicine and Public Health Vol.36 No.4

Objectives : Aseptic meningitis is a major cause of Korean childhood morbidity late spring and early summer. However, the nationwide incidences of the disease have not been reported. This study was conducted to evaluate the availability of National Health Insurance data (NHID) for the study of an epidemiological trend in the surveillance of aseptic meningitis in children. Methods : All the claims, under A87, A87.8, and A87.9 by ICD-10, among children below 15 years of age, to the National Health Insurance Corporation, between January and December 1998, were extracted. A survey of the medical record of 3,874 cases from 136 general hospitals was peformed. The availability of the NHID was evaluated by the three following methods: 1) The diagnostic accuracy (the positive Predictive value : proportion of the confirmed aseptic meningitis among the subjects registered as above disease-codes in NHID) was evaluated through a chart review, and according to age, gender, month and region of disease-occurrence. 2) The distribution of confirmed cases was compared with the distribution of total subjects from the NHID, for subjects in General hospitals, or the subjects surveyed. 3) The proportion of confirmed CSF test was confirmed, and the relating factor, which was the difference in CSF-test rate, analyzed. Results : Among 3,874 cases, CSF examinations were peformed on 1,845 (47.6%), and the CSF-test rates were different according to the medical utility (admission vs. OPD visit) and the severity of the symptoms and signs. The diagnostic accuracy for aseptic meningitis, and during the epidemic (May-Aug) and sporadic (Sept-Apr) periods, were 85.0 (1,568/1,845), 86.0 (1,239/l,440) and 81.2% (329/405), respectively. The distributions by age, sex, month or period (epidemic/sporadic) and region, in the confirmed cases, were similar to those in the NHID, in both the subjects at General hospitals and in those surveyed, to within ${\pm}7%$. Conclusions : In this paper, the NHID for the subjects registered with an aseptic meningitis disease-code might be available for an epidemiological study on the incidence-estimation of childhood aseptic meningitis, as the NHID could include both the probable and definite cases. On the basis of this result, further studies of time-series and secular trend analyses, using the NHID, will be peformed.

MMR 백신 부작용 발생 실태 - 보건소 전화 조사를 통한 전향적 연구 -

이진수,기모란,손영모,Lee, Jin Soo,Ki, Mo Ran,Sohn, Young Mo 대한소아감염학회 2000 Pediatric Infection and Vaccine Vol.7 No.2

Purpose : Adverse events(AE) associated with vaccination have not been systematically monitored in Korea. But since 1994, several deaths after inactivated mouse brain derived Japanese encephalitis vaccine injection arouse the safety problem of immunization in the public, and a evaluation of vaccination program including the effectiveness and safety problem had been started. We have been using MMR vaccine containing Japanese mumps vaccine strains, which are known to be associated with the high rate of adverse events including aseptic meningitis, for the last decade. Methods : We conducted a prospective study of vaccine adverse events associated with MMR vaccine through a tracking system using telephone calls. We followed up 7,594 cases of MMR vaccinees. Results : Reported adverse events included fever, couvulsion, parotitis, and aseptic meningitis. Nine cases of parotitis and seven cases of aseptic meningitis were recognized during follow up period. The incidence of both parotitis and aeptic meningitis was $85.1/10^5$, for Urabe mumps strain. For Hoshino strain, the incidence of parotitis and aseptic meningitis was $158.0/10^5$ and $94.8/10^5$, respectively. Conclusions : The incidence of adverse events was to be a higher than that of natural infection in Korea and was comparable to the results of studies done in other countries. 목 적 : 일본산 볼거리 백신주를 포함한 MMR 백신의 부작용을 알아보기 위하여 전화 조사라는 전향적인 방법을 통해 백신 부작용의 양상과 빈도, 부작용이 백신주 별로 차이가 있는지 알아보고자 하였다. 방 법 : 보건소 전화 조사를 통한 전향적 방법으로, 접종 후 2주, 4주에 백신 접종자들에게 전화로 부작용 여부를 조사하고 증상이 있을 때에 PCR이나 배양 검사를 통해 확인하였다. 결 과 : 발열 반응은 2차 조사에서 Urabe주 3.9%, Hoshino주 4.6%, Rubini주 0.3%로 백신주에 따라 유의한 차이를 보였다. 경련은 5례로 0.07%였으나 Rubini주 접종자 수가 적어 비교가 어려웠고 이하선염은 8례로 0.12%였으며 백신주간에 차이는 없었으나 1997년의 자연 발생률보다 높았다. 뇌수막염이 의심되었던 7례 중 1례에서 검사가 가능하였고 뇌척수액에서 볼거리 바이러스를 확인하였다. MMR 백신 접종자에서 임상 증상 기준으로 진단된 무균성 뇌수막염 발생률은 1998년 바이러스성 뇌막염 환자 발생률 보다 높았다. 결 론 : 전향적 연구 결과 MMR 백신 접종 후의 부작용으로는 무균성 뇌막염, 이하선염, 경련, 발열 등이 조사되었고 현재 사용되고 있는 일본산 MMR 백신에 함유되어 있는 볼거리주는 외국에서의 연구결과와 동일한 이하선염 및 무균성 뇌막염을 일으킬 생물학적 가능성을 지니고 있으므로 국내에서 MMR 백신 접종 후 상당수에서 이하선염이나 무균성 뇌막염 환자가 발생하였을 가능성이 있을 것으로 사료되나 부작용 발생 보고 체계를 갖추고 있지 않은 관계로 실제 부작용 발생 실태를 파악하지 못하고 있는 것으로 사료된다.

Capture-recapture 방법을 이용한 1998년 제주도 볼거리 유행시 보고 자료의 완전성 평가

김명희,박진경,기모란,허영주,김정순,최보율,Kim, Myoung-Hee,Park, Jin-Kyoung,Ki, Mo-Ran,Hur, Young-Joo,Kim, Joung-Soon,Choi, Bo-Youl 대한예방의학회 2000 Journal of Preventive Medicine and Public Health Vol.33 No.3

Objectives : To estimate mumps incidence during the study period and to evaluate the completeness of case reporting. Methods : Capture-recapture methods, originally developed for counting wildlife animals, were used. The data sources were 1) the National Notifiable Communicable Disease Reporting System (NNCDRS; 848 cases), 2) the School Health Reporting System, temporarily administered by the Division of Education (SHRS; 1,026 cases), and 3) a survey of students (785 cases). We estimated the number of unobserved mumps cases by matching the three data sources and fitting loglinear models to the data. We then determined the estimated total number of mumps cases by adding this to the number of observed cases. Completeness was defined as the proportion of observed cases from each source to the total of estimated cases. Results : The total number of observed cases was 1,844 and the total number of estimated cases was 1,935 (95%, CI: $1,878\sim2,070$). The overall completeness was 43.8% of the NNCDRS, 53.0% of the SHRS, and 40.6% of the survey. However, completeness varied by area and age. Conclusion : Although the completeness of NNCDRS data appeared higher than in the past, it is difficult to generalize this result In Korea, it is possible to estimate the size of health hazards relatively cheaply and quickly, by applying capture-recapture methods to various data using a multiple data collection system.