We conducted an epidemiologic study to understand temporal and spatial patterns of hemorrhagic fever with renal syndrome (HFRS) in the Republic of Korea (ROK). We estimated the incidence among civilians in endemic areas through the active surveillance system during the major epidemic periods, from September to December, between 1996 and 1998. We also estimated the prevalence among Korean military personnel from 1995 to 1998. In addition, we assessed seroprevalence, subclinical infection rate, and vaccination rates in both civilians and military personnel. The incidence in civilians ranged from 2.1 to 6.6 per 100, 000 person-months. The annual prevalence in the military personnel was 40-64 per 100, 000 military populations, and remained generally constant throughout the study period with seasonal variation. This is the prospective epidemiologic data set on HFRS in the ROK since the inactivated Hantaan virus vaccine was licensed for use in the late 1990s. These results will be invaluable in establishing a national immunization program against HFRS.
Vaccination/statistics & numerical data ; Seroepidemiologic Studies ; Seasons ; Population Surveillance ; Military Personnel ; Korea ; Incidence ; Humans ; Hemorrhagic Fever with Renal Syndrome/*epidemiology/prevention & control ; Disease Outbreaks/*statistics & numerical data

INTRODUCTIONThere is interest in surveillance systems for outbreak detection at stages where clinical presentation would still be undifferentiated. Such systems focus on detecting clusters of syndromes in excess of baseline levels, which may indicate an outbreak. We model the detection limits of a potential system based on primary care consults for the detection of an outbreak of severe acute respiratory syndrome (SARS).

MATERIALS AND METHODSData from an averaged-sized medical centre were extracted from the Patient Care Enhancement System (PACES) [the electronic medical records system serving the Singapore Armed Forces (SAF)]. Thresholds were set to 3 or more cases presenting with particular syndromes and a temperature reading of >or=38oC (T >or=38). Monte Carlo simulation was used to insert simulated SARS outbreaks of various sizes onto the background incidence of febrile cases, accounting for distribution of SARS incubation period, delay from onset to first consult, and likelihood of presenting with T >or=38 to the SAF medical centre.

RESULTSValid temperature data was available for 2,012 out of 2,305 eligible syndromic consults (87.2%). T >or=38 was observed in 166 consults (8.3%). Simulated outbreaks would peak 7 days after exposure, but, on average, signals at their peak would consist of 10.9% of entire outbreak size. Under baseline assumptions, the system has a higher than 90% chance of detecting an outbreak only with 20 or more cases.

CONCLUSIONSSurveillance based on clusters of cases with T >or=38 helps reduce background noise in primary care data, but the major limitation of such systems is that they are still only able to confidently detect large outbreaks.

Adult ; Body Temperature ; Cluster Analysis ; Communicable Diseases, Emerging ; epidemiology ; Computer Simulation ; Fever ; diagnosis ; Hospitals, Military ; utilization ; Humans ; Medical Records Systems, Computerized ; Middle Aged ; Military Medicine ; Military Personnel ; statistics & numerical data ; Monte Carlo Method ; Personnel, Hospital ; statistics & numerical data ; Primary Health Care ; statistics & numerical data ; Referral and Consultation ; statistics & numerical data ; Sentinel Surveillance ; Severe Acute Respiratory Syndrome ; diagnosis ; epidemiology ; Singapore ; epidemiology

PURPOSE: The South Korean (SK) government monopolizes the tobacco industry and is accused of pushing smoking on captive military personnel. However, estimating the association between military service and smoking is difficult, since military service is required for all SK men and the few civilian waivers are usually based on smoking determinants, e.g., social status. MATERIALS AND METHODS: Using a quasi-experimental design we validly estimate the association between military service and smoking. Military service was assigned by immigration patterns to the United States, instead of an experimenter, by comparing Korean Americans who happened to immigrate before or after the age(s) of mandated service. Smoking promotion in the military was also described among SK veterans, to identify the probable mechanisms for veterans' smoking tendencies. RESULTS: Veterans were 15% [95% confidence interval (CI), 4 to 27] more likely to ever-puff and 10% (95% CI, 0 to 23) more likely to ever-smoke cigarettes, compared to a similar group of civilians. Among veterans, 92% (95% CI, 89 to 95) recalled cigarettes were free, 30% (95% CI, 25 to 35) recalled smokers were given more work breaks and 38% (95% CI, 32 to 43) felt explicit "social pressure" to smoke. Free cigarettes was the strongest mechanism for veterans' smoking tendencies, e.g., veterans recalling free cigarette distribution were 16% (95% CI, 1 to 37) more likely to ever-smoke than veterans not recalling. CONCLUSION: These patterns suggest military service is strongly associated with smoking, and differences between veterans and civilians smoking may carry over long after military service. Given military service remains entirely in government purview, actively changing military smoking policies may prove most efficacious. This highlights the importance of recent bans on military cigarette distribution, but policies eliminating other smoking encouragements described by veterans are necessary and could effectively reduce the smoking prevalence by as much as 10% in SK.
Adolescent ; Adult ; Aged ; Humans ; Male ; Middle Aged ; Military Personnel/*statistics & numerical data ; Republic of Korea/epidemiology ; Smoking/*epidemiology ; Young Adult

OBJECTIVETo assess the incidence, types and risk factors of military training-related injuries in recruits of Chinese People's Armed Police Forces (CPAPF).

METHODSA cohort study was made on the risk factors of injuries in 805 male recruits during the military training from December 25, 1999 to December 25, 2000.

RESULTSA total of 111 recruits (14%) experienced one or more injuries, and the cumulative incidence was 16.1 injuries per 100 soldiers in a year. And 77.7% of the injuries belonged to overuse injuries of the skeletal and muscular systems, the most common type of which was stress fractures. Most injuries occurred in the 3rd month of training. Univariate analysis and logistic regression analysis of possible risk factors for overuse injuries were carried out, and a number of risk factors were identified: history of agricultural labor, history of lower limb injury, flatfoot and less running exercise before entry into the army. But a suitable body mass index (BMI) was a protective factor. Examination of age, body height, smoking, body flexibility and frequency of 2-mile running revealed no significant association with the injuries.

CONCLUSIONSHistory of agricultural labor, history of lower limb injury, flatfoot, less running exercise before entry into the army and lower BMI were risk factors of the overuse injuries. In order to decrease the incidence of overuse injuries, the young people with good physical ability and shapely body type should be selected during conscription. During the training, nutrition should be improved so as to decrease the incidence of injuries.

Adolescent ; Adult ; China ; epidemiology ; Humans ; Incidence ; Male ; Military Personnel ; statistics & numerical data ; Physical Fitness ; Wounds and Injuries ; epidemiology

OBJECTIVETo evaluate the efficacy and safety of interventional therapy in structural heart diseases in 38 PLA hospitals.

METHODSData including patient number underwent interventional therapy for structural heart disease, procedure details, immediate procedural complications were retrospectively collected in all the military hospitals between January 2005 and December 2006.

RESULTSSuccessful interventional therapy was achieved in 8692 out of 8862 patients (98.08%) with structural heart disease. Transcatheter closure of ventricular septal defect (VSD), atrial septal defect (ASD) and patent ductus arteriosus (PDA), and percutaneous balloon dilatation of mitral valve stenosis (MS) and pulmonary valve stenosis (PS) were the most performed procedures (97.99%). Up to 91.23% patients underwent transcatheter closure with domestic devices. The incidence of procedure-related complications was 4.33% (n = 384) which were most frequently associated with VSD closure. The commonest procedural complications included conduction blockades (n = 260), residue shunt (n = 42), device detachment (n = 30) and tricuspid incompetence (n = 22). Although the procedures performed in 2005 and 2006 increased 57.32% compared with those in 2003 and 2004, the success rate and the incidence of complications remained unchanged.

CONCLUSIONPercutaneous treatment of structural heart disease is a safe and feasible alternative to surgery. Simulate complications arise long after the treatment, which suggests the importance of long-term follow-up for those patients who hare undergone interventional therapy.

Catheterization ; Heart Defects, Congenital ; epidemiology ; therapy ; Hospitals, Military ; statistics & numerical data ; Humans ; Military Personnel ; Mitral Valve Stenosis ; epidemiology ; therapy ; Pulmonary Valve Stenosis ; epidemiology ; therapy ; Surveys and Questionnaires ; Treatment Outcome

OBJECTIVETo investigate the acceptability and influential factors of Voluntary HIV Counseling and Testing (VCT) among the Chinese and Ethiopian peacekeepers in Liberia so as to conduct more effective health education of AIDS and enhance the acceptance of VCT.

METHODSAn anonymous questionnaire was used to investigate the attitudes to VCT among 518 Chinese (aged 23-51) and 648 Ethiopian (aged 25-49) peacekeepers in Liberia.

RESULTSThe rates of those who claimed to have never heard of HIV/AIDS were 8.1% and 7.9% in the Chinese and Ethiopian subjects respectively, with no significant differences (P > 0.05) in between. Among those who had heard of HIV/ AIDS, 407 (85.5%) Chinese and 449 (75.2%) Ethiopians expressed their willingness to accept VCT, with a significant difference (P < 0.05) between the two groups. Statistic analysis indicated that the acceptance of VCT was as- sodiated with schooling and knowledge on HIV/AIDS in both groups as well as with the susceptibility to HIV among the Ethiopian subjects.

CONCLUSIONThe acceptability of VCT is obviously lower among those with less schooling and less knowledge of HIV/AIDS. It is important to carry out information-oriented education to increase VCT acceptability among the peacekeepers in the area with a high incidence of AIDS.

Acquired Immunodeficiency Syndrome ; prevention & control ; China ; Counseling ; methods ; statistics & numerical data ; Ethiopia ; Health Knowledge, Attitudes, Practice ; Humans ; Liberia ; Male ; Mass Screening ; methods ; psychology ; statistics & numerical data ; Military Personnel ; psychology ; Surveys and Questionnaires

OBJECTIVETo investigate the incidence of metabolic syndrome (MS) and the distribution of constitutional pattern in elderly retired personnel of the People's Liberation Army.

METHODSAdopting the method of cross-sectional field investigation, from June to December in 2008, the investigation questionnaires were completed by the aged over 60 and collected from 69 military retired residences in the 4 cities of Shanghai, Nanjing, Hangzhou and Qingdao. Other data, including demographic characteristics, physiological characteristics, life style and former medical history, were collected and analyzed. The statistical analysis for the database was drawn up by the software Epidata 3.0.

RESULTSA total of 4,502 people were included in this study, and 35.3% of them were diagnosed with MS. There was no obvious difference in mobility among ages (60 to 69, 70 to 79 and over 80, P>0.05). Referring to the MS patients in the 70s age group, both the phlegm-dampness and dampness-heat constitutional types were evidently higher than those in the 60s age group (P=0.019, P=0.008); while MS patients in 80s and older showed a significantly lower incidence of dampness-heat constitution than those in the 60s (P=0.00); and ql-deficiency constitution was obviously higher in the 80s age group than those in the other two groups (P=0.00). The top 3 constitutions in MS people were, respectively, phlegm-dampness, dampness-heat and qi-deficiency constitution; while in non-MS people, the top 3 constitutions were gentleness, qi-deficiency and phlegm-dampness. When the patient's body mass index (BMI) was more than 25 kg/m(2), the rate of phlegm-dampness and dampness-heat constitution significantly increased, while the rate of qi-deficiency constitution declined; the discrepancy was significant (P=0.00).

CONCLUSIONSThe prevalence rate of MS in military senior people was 35.3%, which did not vary among the three age groups. Phlegm-dampness, dampness-heat and qi-deficiency constitution were the three dominant constitutional types seen in the MS patients. The distribution of constitution formation was different in MS people and non-MS people. For different dimensions of BMI, the proportion of each kind of constitutions was varied.

Aged ; Aged, 80 and over ; Body Constitution ; Body Mass Index ; China ; epidemiology ; Humans ; Medicine, Chinese Traditional ; Metabolic Syndrome ; epidemiology ; Middle Aged ; Military Personnel ; statistics & numerical data ; Prevalence ; Retirement ; statistics & numerical data

OBJECTIVE: This study was designed to describe the trends in body mass index (BMI) during 6 years (2002 - 2008) and to identify associations between these trends and the amount of physical activity of South Korean career soldiers. METHOD: This study targeted the 40 993 (38 857 men and 2136 women) of the 58 657 career soldiers who had undergone four (2002, 2004, 2006, and 2008) biennial medical examinations conducted by the National Health Insurance Corporation; 17 664 soldiers with missing data on height, weight, and physical activity were excluded. A linear mixed-regression model was used to categorize changes in BMI due to age versus those due to amount of physical activity. RESULTS: Career soldiers experienced significant increases in BMI compared with baseline data gathered in 2002. The increases in each age group were as follows: men aged 20- 29: 1.16, men aged 30 - 39: 0.61, men aged 40 - 49: 0.05, women aged 20- 29: 0.35, women aged 30- 39: 0.30, women aged 40-49: 0.26, and women aged 50- 59: 0.21. However, men aged 50 or older showed significant decreases (as high as 0.5) in BMI compared with baseline data obtained in 2002. They also experienced significant decreases in BMI compared with those who reported no physical activity. The differences between baseline and final BMIs were: 0.02 for men exercising 1- 2 times per week, -0.07 for men exercising 3-4 times per week, -0.19 for men exercising 5-6 times per week, -0.21 for men exercising seven times per week, -0.05 for women exercising 1- 2 times per week, -0.19 for women exercising 3- 4 times per week, -0.30 for women exercising 5-6 times per week, and -0.30 for women exercising seven times per week. CONCLUSIONS: Obesity in South Korean career soldiers increased markedly between 2002 and 2008, and our data showed that the amount of physical activity was inversely related to increases in BMI. Policies to prevent obesity are needed to reduce this trend.
Adult ; *Body Mass Index ; Female ; Humans ; Male ; Middle Aged ; Military Personnel/*statistics & numerical data ; *Motor Activity ; Obesity/diagnosis ; Regression Analysis ; Republic of Korea

OBJECTIVES: The aim of this study was to investigate whether the health status of Republic of Korea Air Force (ROKAF) soldiers changed after one year of military service. METHODS: We selected 483 ROKAF soldiers from the 11 749 recruits who participated in the 2011 physical examination. The selected soldiers underwent another physical examination in 2012 for advancement to senior airman. Data from 2011 and 2012 were merged. To collect data on lifestyle, a questionnaire was sent to all included subjects via the military intranet e-mail service. RESULTS: The percentage of recruits with an abnormal alanine transaminase level (normal range <40 IU/L) decreased from recruitment (13.7%) to the following year (2.7%). Moreover, the percentage of obese soldiers (body mass index > or =25 kg/m2) decreased from recruitment (20.5%) to the following year (10.4%). There was a significant change in mean duration of exercise carried out each day before (0.8+/-1.3 hours) and after (1.0+/-0.7 hours) joining the ROKAF service. CONCLUSIONS: These ROKAF soldiers were generally in good health before and after joining the armed service. After one year of military service, the health status of most soldiers improved, especially with respect to body mass index and alanine transaminase level.
Alanine Transaminase/blood ; Asian Continental Ancestry Group ; Body Mass Index ; Exercise ; *Health Status ; Humans ; Internet ; Life Style ; Military Personnel/*statistics & numerical data ; Questionnaires ; Republic of Korea

OBJECTIVETo compare the blood antioxidant levels and dietary antioxidant intakes between pilots and non-flight staff of the Army Force in The Islamic Republic of Iran.

METHODSThirty-seven helicopter pilots and 40 non-flight staff were included in this study. Their general characteristics were recorded and their weight, height, and waist circumference were measured. Their daily intake of energy and nutrients including antioxidants was assessed using a semi-quantitative food frequency questionnaire. Serum levels of total antioxidant capacity (TAC), malondialdehyde (MDA), and glutathione reductase (GR), glutathione peroxidase (GPx), superoxide dismutase (SOD), and catalase (CAT) in red blood cells were also measured.

RESULTSThe median erythrocytes SOD, serum MDA level and the mean serum level of TAC and erythrocytes GPx were significantly higher in pilots than in non-flight staff. The median vitamin C intake was significantly lower in pilots than in non-flight staff. The serum MDA levels were similar in non-flight staff and pilots when their vitamin C intake was ⋜168 mg and significantly lower in non-flight staff than in pilots when their vitamin C intake was >168 mg.

CONCLUSIONThe serum MDA level is lower in non-flight staff than in pilots when their vitamin C intake level is high, indicating that pilots need more vitamin C than non-flight staff.

Adult ; Aerospace Medicine ; Antioxidants ; metabolism ; Ascorbic Acid ; administration & dosage ; Cross-Sectional Studies ; Diet ; Humans ; Male ; Middle Aged ; Military Personnel ; statistics & numerical data