Appl Clin Inform 2010; 01(02): 79-95
DOI: 10.4338/ACI-2009-12-RA-0024
Research Article
Schattauer GmbH

Acute Diarrheal Syndromic Surveillance

Effects of Weather and Holidays
H.J. Kam
1   Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
,
S. Choi
2   Department of Emergency, School of Medicine, Ajou University School of Medicine, Suwon, South Korea
,
J.P. Cho
2   Department of Emergency, School of Medicine, Ajou University School of Medicine, Suwon, South Korea
,
Y.G. Min
2   Department of Emergency, School of Medicine, Ajou University School of Medicine, Suwon, South Korea
,
R.W. Park
1   Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
› Institutsangaben
Weitere Informationen

Correspondence to:

Rae Woong Park, M.D., Ph.D.
Department of Biomedical Informatics
Ajou University School of Medicine
Wonchon-dong, Yeongtong-gu, Suwon, Gyeonggi-do
442-749, Korea
Telefon: +82-31-219-5342   
Fax: +82-31-219-4472   

Publikationsverlauf

Received 12. Dezember 2009

Accepted 06. April 2010

Publikationsdatum:
20. Dezember 2017 (online)

 

Summary

Objective: In an effort to identify and characterize the environmental factors that affect the number of patients with acute diarrheal (AD) syndrome, we developed and tested two regional surveillance models including holiday and weather information in addition to visitor records, at emergency medical facilities in the Seoul metropolitan area of Korea.

Methods: With 1,328,686 emergency department visitor records from the National Emergency Department Information system (NEDIS) and the holiday and weather information, two seasonal ARIMA models were constructed: (1) The simple model (only with total patient number), (2) the environmental factor-added model. The stationary R-squared was utilized as an in-sample model goodness-of-fit statistic for the constructed models, and the cumulative mean of the Mean Absolute Percentage Error (MAPE) was used to measure post-sample forecast accuracy over the next 1 month.

Results: The (1,0,1)(0,1,1)7 ARIMA model resulted in an adequate model fit for the daily number of AD patient visits over 12 months for both cases. Among various features, the total number of patient visits was selected as a commonly influential independent variable. Additionally, for the environmental factor-added model, holidays and daily precipitation were selected as features that statistically significantly affected model fitting. Stationary R-squared values were changed in a range of 0.651-0.828 (simple), and 0.805-0.844 (environmental factor-added) with p<0.05. In terms of prediction, the MAPE values changed within 0.090-0.120 and 0.089-0.114, respectively.

Conclusion: The environmental factor-added model yielded better MAPE values. Holiday and weather information appear to be crucial for the construction of an accurate syndromic surveillance model for AD, in addition to the visitor and assessment records.

Citation: Kam HJ, Choi S, Cho JP, Min YG, Park RW. Acute diarrheal syndromic surveillance – effects of weather and holidays. Appl Clin Inf 2010; 1: 79–95 http://dx.doi.org/10.4338/ACI-2009-12-RA-0024


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Conflict of Interest

All of the authors of this work hereby declare that there were no conflicts of interest or any other relationships that could have inappropriately influenced this study.

  • References

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  • 2 Henning KJ. What is syndromic surveillance. MMWR Morb Mortal Wkly Rep. 2004; 53 Suppl. 5-11.
  • 3 Green MS, Kaufman Z. Surveillance for early detection and monitoring of infectious disease outbreaks associated with bioterrorism. Isr Med Assoc J 2002; 4 (Suppl. 07) 503-506.
  • 4 Buehler JW, Berkelman RL, Hartley DM, Peters CJ. Syndromic surveillance and bioterrorism-related epidemics. Emerg Infect Dis. 2003; 9 (Suppl. 10) 1197-1204.
  • 5 Cho JP, Min YG, Choi SC. Syndromic surveillances based on the emergency department. J Prev Med Public Health. 2008; 41 (Suppl. 04) 219-224.
  • 6 Buckeridge DL. Outbreak detection through automated surveillance: a review of the determinants of detection. J Biomed Inform. 2007; 40 (Suppl. 04) 370-379.
  • 7 Bravata DM, McDonald KM, Smith WM, Rydzak C, Szeto H, Buckeridge DL. et al. Systematic review: surveillance systems for early detection of bioterrorism-related diseases. Ann Intern Med. 2004; 140 (Suppl. 11) 910-922.
  • 8 Larkin M. Technology and public health. Lancet Infect Dis 2002; 2 (Suppl. 07) 448-449.
  • 9 Bravata D, Rahman M, Luong N, Divan H, Cody S. A comparison of syndromic incidence data collected by triage nurses in Sata Clara county with regional infectious disease data.]. Journal of Urban Health 2003; 80: i112.
  • 10 Doroshenko A, Cooper D, Smith G, Gerard E, Chinemana F, Verlander N. et al. Evaluation of syndromic surveillance based on National Health Service Direct derived data-England and Wales. MMWR Morb Mortal Wkly Rep. 2005; 54 Suppl. 117-122.
  • 11 Yuan CM, Love S, Wilson M. Syndromic surveillance at hospital emergency departments-southeastern Virginia. MMWR Morb Mortal Wkly Rep. 2004; 53 Suppl 56-58.
  • 12 Wu TS, Shih FY, Yen MY, Wu JS, Lu SW, Chang KC. et al. Establishing a nationwide emergency department-based syndromic surveillance system for better public health responses in Taiwan. BMC Public Health. 2008; 8: 18.
  • 13 Muscatello DJ CT, Kaldor J, Zheng W, Chiu C, Correll P, Jorm L. An automated, broad-based, near real-time public health surveillance system using presentations to hospital Emergency Departments in New South Wales, Australia. BMC Public Health. 2005; 5: 141.
  • 14 Miller B, Kassenborg H, Dunsmuir W, Griffith J, Hadidi M, Nordin JD. et al. Syndromic surveillance for influenzalike illness in ambulatory care network. Emerg Infect Dis. 2004; 10 (Suppl. 10) 1806-1811.
  • 15 Heffernan R, Mostashari F, Das D, Karpati A, Kulldorff M, Weiss D. Syndromic surveillance in public health practice, New York City. Emerg Infect Dis. 2004; 10 (Suppl. 05) 858-864.
  • 16 Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) [Internet].. [cited 2010 March 25]. Available from: http://www.dhss.mo.gov/ESSENCE/index.html
  • 17 Ansaldi F, Orsi A, Altomonte F, Bertone G, Parodi V, Carloni R. et al. Emergency department syndromic surveillance system for early detection of 5 syndromes: a pilot project in a reference teaching hospital in Genoa, Italy. J Prev Med Hyg. 2008; 49 (Suppl. 04) 131-135.
  • 18 Reis BY, Mandl KD. Time series modeling for syndromic surveillance. BMC Med Inform Decis Mak. 2003; 3: 2.
  • 19 Doyle TJ, Bryan RT. Infectious disease morbidity in the US region bordering Mexico, 1990-1998. J Infect Dis 2000; 182 (Suppl. 05) 1503-1510.
  • 20 Balter S, Weiss D, Hanson H, Reddy V, Das D, Heffernan R. Three years of emergency department gastrointestinal syndromic surveillance in New York City: what have we found. MMWR Morb Mortal Wkly Rep. 2005; 54 Suppl. 175-180.
  • 21 Hripcsak G, Soulakis ND, Li L, Morrison FP, Lai AM, Friedman C. et al. Syndromic surveillance using ambulatory electronic health records. J Am Med Inform Assoc. 2009; 16 (Suppl. 03) 354-361.
  • 22 Quenel P, Dab W. Influenza A and B epidemic criteria based on time-series analysis of health services surveillance data. Eur J Epidemiol. 1998; 14 (Suppl. 03) 275-285.
  • 23 Stoto MA SM, Mariono LT. Syndromic Surveillance: Is it Worth the Effort. Chance. 2004; 17 (Suppl. 01) 19-24.
  • 24 Kleinman KP, Abrams A, Mandl K, Platt R. Simulation for assessing statistical methods of biologic terrorism surveillance. MMWR Morb Mortal Wkly Rep. 2005; 54 Suppl. 101-108.
  • 25 Wang L, Ramoni MF, Mandl KD, Sebastiani P. Factors affecting automated syndromic surveillance. Artif Intell Med. 2005; 34 (Suppl. 03) 269-278.
  • 26 Magruder SF. Evaluation of over-the-counter pharmaceutical sales as a possible early warning indicator of human disease. In Johns Hopkins APL technical digest Johns Hopkins University Applied Physics Laboratory; 2003: P349-P353.
  • 27 Davies GR, Finch RG. Sales of over-the-counter remedies as an early warning system for winter bed crises. Clin Microbiol Infect. 2003; 9 (Suppl. 08) 858-863.
  • 28 Hogan WR, Tsui FC, Ivanov O, Gesteland PH, Grannis S, Overhage JM. et al. Detection of pediatric respiratory and diarrheal outbreaks from sales of over-the-counter electrolyte products. J Am Med Inform Assoc. 2003; 10 (Suppl. 06) 555-562.
  • 29 Levy K, Hubbard AE, Eisenberg JN. Seasonality of rotavirus disease in the tropics: a systematic review and meta-analysis. Int J Epidemiol. 2009; 38 (Suppl. 06) 1487-1496.
  • 30 Callejas D, Estevez J, Porto-Espinoza L, Monsalve F, Costa-Leon L, Blitz L. et al. Effect of climatic factors on the epidemiology of rotavirus infection in children under 5 years of age in the city of Maracaibo, Venezuela. Invest Clin. 1999; 40 (Suppl. 02) 81-94.
  • 31 Ghazi HO, Khan MA, Telmesani AM, Idress B, Mahomed MF. Rotavirus infection in infants and young children in Makkah, Saudi Arabia. J Pak Med Assoc. 2005; 55 (Suppl. 06) 231-234.
  • 32 Chung JB, Ahn ME, Ahn HC, You KC, Kim H, Cho JW. et al. Early Aberration Reporting System Modelling of Korean Emergency Syndromic Surveillance System for Bioterrism. Journal of the Korean Society of Emergency Medicine. 2003; 14 (Suppl. 05) 638-645.
  • 33 Jones SS, Thomas A, Evans RS, Welch SJ, Haug PJ, Snow GL. Forecasting daily patient volumes in the emergency department. Acad Emerg Med. 2008; 15 (Suppl. 02) 159-170.
  • 34 Ivanov O, Gesteland PH, Hogan W, Mundorff MB, Wagner MM. Detection of pediatric respiratory and gastrointestinal outbreaks from free-text chief complaints. AMIA Annu Symp Proc. 2003: 318-322.
  • 35 Irvin CB, Nouhan PP, Rice K. Syndromic analysis of computerized emergency department patients’ chief complaints: an opportunity for bioterrorism and influenza surveillance. Ann Emerg Med. 2003; 41 (Suppl. 04) 447-452.
  • 36 Marsden-Haug N, Foster VB, Gould PL, Elbert E, Wang H, Pavlin JA. Code-based syndromic surveillance for influenzalike illness by International Classification of Diseases, Ninth Revision. Emerg Infect Dis. 2007; 13 (Suppl. 02) 207-216.
  • 37 Campbell J, Francesconi S, Boyd J, Worth L, Moshier T. Environmental air sampling to detect biological warfare agents. Mil Med. 1999; 164 (Suppl. 08) 541-542.
  • 38 Fricker Jr RD, Hegler BL, Dunfee DA. Comparing syndromic surveillance detection methods: EARS’ versus a CUSUM-based methodology. Stat Med. 2008; 27 (Suppl. 17) 3407-3429.
  • 39 The Korea center for disease control and prevention (KCDC).. [Internet]. [cited 2010 March 25]. Available from: http://www.cdc.go.kr
  • 40 National Emergency Medical Center (NEMC).. [Internet]. [cited 2010 March 25]. Available from: http://www.nemc.go.kr/eng/major/major_information.jsp
  • 41 Josseran L, Caillere N, Brun-Ney D, Rottner J, Filleul L, Brucker G. et al. Syndromic surveillance and heat wave morbidity: a pilot study based on emergency departments in France. BMC Med Inform Decis Mak. 2009; 9: 14.
  • 42 Turner RM, Muscatello DJ, Zheng W, Willmore A, Arendts G. An outbreak of cardiovascular syndromes requiring urgent medical treatment and its association with environmental factors: an ecological study. Environ Health. 2007; 6: 37.
  • 43 Cifuentes E, Suarez L, Solano M, Santos R. Diarrheal diseases in children from a water reclamation site in Mexico city. Environ Health Perspect. 2002; 110 (Suppl. 10) A619-A624.
  • 44 Simanjuntak CH, Larasati W, Arjoso S, Putri M, Lesmana M, Oyofo BA. et al. Cholera in Indonesia in 1993-1999. Am J Trop Med Hyg. 2001; 65 (Suppl. 06) 788-797.
  • 45 Rowland MG. The Gambia and Bangladesh: the seasons and diarrhoea. Dialogue Diarrhoea. 1986; 26: 3.
  • 46 Sutra S, Srisontrisuk S, Panpurk W, Sutra P, Chirawatkul A, Snongchart N. et al. The pattern of diarrhea in children in Khon Kaen, northeastern Thailand: I. The incidence and seasonal variation of diarrhea. Southeast Asian J Trop Med Public Health. 1990; 21 (Suppl. 04) 586-593.
  • 47 Hashizume M, Armstrong B, Hajat S, Wagatsuma Y, Faruque AS, Hayashi T. et al. Association between climate variability and hospital visits for non-cholera diarrhoea in Bangladesh: effects and vulnerable groups. Int J Epidemiol. 2007; 36 (Suppl. 05) 1030-1037.
  • 48 Curriero FC, Patz JA, Rose JB, Lele S. The association between extreme precipitation and waterborne disease outbreaks in the United States, 1948-1994. Am J Public Health. 2001; 91 (Suppl. 08) 1194-1199.
  • 49 Korea Meteorological Administration (KMA).. [Internet]. [cited 2010 March 25]. Available from: http://www.kma.go.kr/sfc/sfc_03_02.jsp
  • 50 Schweigler LM, Desmond JS, McCarthy ML, Bukowski KJ, Ionides EL, Younger JG. Forecasting models of emergency department crowding. Acad Emerg Med. 2009; 16 (Suppl. 04) 301-308.
  • 51 Box GEP, Jenkins GM, Reinsel GC. Time Series Analysis: Forecasting and Control. San Francisco, CA: Holeden day; 1970
  • 52 Eberhard ML, Nace EK, Freeman AR, Streit TG, da Silva AJ, Lammie PJ. Cyclospora cayetanensis infections in Haiti: a common occurrence in the absence of watery diarrhea. Am J Trop Med Hyg. 1999; 60 (Suppl. 04) 584-586.
  • 53 Begier EM, Sockwell D, Branch LM, Davies-Cole JO, Jones LH, Edwards L. et al. The National Capitol Region’s Emergency Department syndromic surveillance system: do chief complaint and discharge diagnosis yield different results. Emerg Infect Dis. 2003; 9 (Suppl. 03) 393-396.

Correspondence to:

Rae Woong Park, M.D., Ph.D.
Department of Biomedical Informatics
Ajou University School of Medicine
Wonchon-dong, Yeongtong-gu, Suwon, Gyeonggi-do
442-749, Korea
Telefon: +82-31-219-5342   
Fax: +82-31-219-4472   

  • References

  • 1 Mostahari F, Hartman J. Syndromic surveillance: a local perspective. J Urban Health 2003; 80 2 Suppl. 1 i1-i7.
  • 2 Henning KJ. What is syndromic surveillance. MMWR Morb Mortal Wkly Rep. 2004; 53 Suppl. 5-11.
  • 3 Green MS, Kaufman Z. Surveillance for early detection and monitoring of infectious disease outbreaks associated with bioterrorism. Isr Med Assoc J 2002; 4 (Suppl. 07) 503-506.
  • 4 Buehler JW, Berkelman RL, Hartley DM, Peters CJ. Syndromic surveillance and bioterrorism-related epidemics. Emerg Infect Dis. 2003; 9 (Suppl. 10) 1197-1204.
  • 5 Cho JP, Min YG, Choi SC. Syndromic surveillances based on the emergency department. J Prev Med Public Health. 2008; 41 (Suppl. 04) 219-224.
  • 6 Buckeridge DL. Outbreak detection through automated surveillance: a review of the determinants of detection. J Biomed Inform. 2007; 40 (Suppl. 04) 370-379.
  • 7 Bravata DM, McDonald KM, Smith WM, Rydzak C, Szeto H, Buckeridge DL. et al. Systematic review: surveillance systems for early detection of bioterrorism-related diseases. Ann Intern Med. 2004; 140 (Suppl. 11) 910-922.
  • 8 Larkin M. Technology and public health. Lancet Infect Dis 2002; 2 (Suppl. 07) 448-449.
  • 9 Bravata D, Rahman M, Luong N, Divan H, Cody S. A comparison of syndromic incidence data collected by triage nurses in Sata Clara county with regional infectious disease data.]. Journal of Urban Health 2003; 80: i112.
  • 10 Doroshenko A, Cooper D, Smith G, Gerard E, Chinemana F, Verlander N. et al. Evaluation of syndromic surveillance based on National Health Service Direct derived data-England and Wales. MMWR Morb Mortal Wkly Rep. 2005; 54 Suppl. 117-122.
  • 11 Yuan CM, Love S, Wilson M. Syndromic surveillance at hospital emergency departments-southeastern Virginia. MMWR Morb Mortal Wkly Rep. 2004; 53 Suppl 56-58.
  • 12 Wu TS, Shih FY, Yen MY, Wu JS, Lu SW, Chang KC. et al. Establishing a nationwide emergency department-based syndromic surveillance system for better public health responses in Taiwan. BMC Public Health. 2008; 8: 18.
  • 13 Muscatello DJ CT, Kaldor J, Zheng W, Chiu C, Correll P, Jorm L. An automated, broad-based, near real-time public health surveillance system using presentations to hospital Emergency Departments in New South Wales, Australia. BMC Public Health. 2005; 5: 141.
  • 14 Miller B, Kassenborg H, Dunsmuir W, Griffith J, Hadidi M, Nordin JD. et al. Syndromic surveillance for influenzalike illness in ambulatory care network. Emerg Infect Dis. 2004; 10 (Suppl. 10) 1806-1811.
  • 15 Heffernan R, Mostashari F, Das D, Karpati A, Kulldorff M, Weiss D. Syndromic surveillance in public health practice, New York City. Emerg Infect Dis. 2004; 10 (Suppl. 05) 858-864.
  • 16 Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) [Internet].. [cited 2010 March 25]. Available from: http://www.dhss.mo.gov/ESSENCE/index.html
  • 17 Ansaldi F, Orsi A, Altomonte F, Bertone G, Parodi V, Carloni R. et al. Emergency department syndromic surveillance system for early detection of 5 syndromes: a pilot project in a reference teaching hospital in Genoa, Italy. J Prev Med Hyg. 2008; 49 (Suppl. 04) 131-135.
  • 18 Reis BY, Mandl KD. Time series modeling for syndromic surveillance. BMC Med Inform Decis Mak. 2003; 3: 2.
  • 19 Doyle TJ, Bryan RT. Infectious disease morbidity in the US region bordering Mexico, 1990-1998. J Infect Dis 2000; 182 (Suppl. 05) 1503-1510.
  • 20 Balter S, Weiss D, Hanson H, Reddy V, Das D, Heffernan R. Three years of emergency department gastrointestinal syndromic surveillance in New York City: what have we found. MMWR Morb Mortal Wkly Rep. 2005; 54 Suppl. 175-180.
  • 21 Hripcsak G, Soulakis ND, Li L, Morrison FP, Lai AM, Friedman C. et al. Syndromic surveillance using ambulatory electronic health records. J Am Med Inform Assoc. 2009; 16 (Suppl. 03) 354-361.
  • 22 Quenel P, Dab W. Influenza A and B epidemic criteria based on time-series analysis of health services surveillance data. Eur J Epidemiol. 1998; 14 (Suppl. 03) 275-285.
  • 23 Stoto MA SM, Mariono LT. Syndromic Surveillance: Is it Worth the Effort. Chance. 2004; 17 (Suppl. 01) 19-24.
  • 24 Kleinman KP, Abrams A, Mandl K, Platt R. Simulation for assessing statistical methods of biologic terrorism surveillance. MMWR Morb Mortal Wkly Rep. 2005; 54 Suppl. 101-108.
  • 25 Wang L, Ramoni MF, Mandl KD, Sebastiani P. Factors affecting automated syndromic surveillance. Artif Intell Med. 2005; 34 (Suppl. 03) 269-278.
  • 26 Magruder SF. Evaluation of over-the-counter pharmaceutical sales as a possible early warning indicator of human disease. In Johns Hopkins APL technical digest Johns Hopkins University Applied Physics Laboratory; 2003: P349-P353.
  • 27 Davies GR, Finch RG. Sales of over-the-counter remedies as an early warning system for winter bed crises. Clin Microbiol Infect. 2003; 9 (Suppl. 08) 858-863.
  • 28 Hogan WR, Tsui FC, Ivanov O, Gesteland PH, Grannis S, Overhage JM. et al. Detection of pediatric respiratory and diarrheal outbreaks from sales of over-the-counter electrolyte products. J Am Med Inform Assoc. 2003; 10 (Suppl. 06) 555-562.
  • 29 Levy K, Hubbard AE, Eisenberg JN. Seasonality of rotavirus disease in the tropics: a systematic review and meta-analysis. Int J Epidemiol. 2009; 38 (Suppl. 06) 1487-1496.
  • 30 Callejas D, Estevez J, Porto-Espinoza L, Monsalve F, Costa-Leon L, Blitz L. et al. Effect of climatic factors on the epidemiology of rotavirus infection in children under 5 years of age in the city of Maracaibo, Venezuela. Invest Clin. 1999; 40 (Suppl. 02) 81-94.
  • 31 Ghazi HO, Khan MA, Telmesani AM, Idress B, Mahomed MF. Rotavirus infection in infants and young children in Makkah, Saudi Arabia. J Pak Med Assoc. 2005; 55 (Suppl. 06) 231-234.
  • 32 Chung JB, Ahn ME, Ahn HC, You KC, Kim H, Cho JW. et al. Early Aberration Reporting System Modelling of Korean Emergency Syndromic Surveillance System for Bioterrism. Journal of the Korean Society of Emergency Medicine. 2003; 14 (Suppl. 05) 638-645.
  • 33 Jones SS, Thomas A, Evans RS, Welch SJ, Haug PJ, Snow GL. Forecasting daily patient volumes in the emergency department. Acad Emerg Med. 2008; 15 (Suppl. 02) 159-170.
  • 34 Ivanov O, Gesteland PH, Hogan W, Mundorff MB, Wagner MM. Detection of pediatric respiratory and gastrointestinal outbreaks from free-text chief complaints. AMIA Annu Symp Proc. 2003: 318-322.
  • 35 Irvin CB, Nouhan PP, Rice K. Syndromic analysis of computerized emergency department patients’ chief complaints: an opportunity for bioterrorism and influenza surveillance. Ann Emerg Med. 2003; 41 (Suppl. 04) 447-452.
  • 36 Marsden-Haug N, Foster VB, Gould PL, Elbert E, Wang H, Pavlin JA. Code-based syndromic surveillance for influenzalike illness by International Classification of Diseases, Ninth Revision. Emerg Infect Dis. 2007; 13 (Suppl. 02) 207-216.
  • 37 Campbell J, Francesconi S, Boyd J, Worth L, Moshier T. Environmental air sampling to detect biological warfare agents. Mil Med. 1999; 164 (Suppl. 08) 541-542.
  • 38 Fricker Jr RD, Hegler BL, Dunfee DA. Comparing syndromic surveillance detection methods: EARS’ versus a CUSUM-based methodology. Stat Med. 2008; 27 (Suppl. 17) 3407-3429.
  • 39 The Korea center for disease control and prevention (KCDC).. [Internet]. [cited 2010 March 25]. Available from: http://www.cdc.go.kr
  • 40 National Emergency Medical Center (NEMC).. [Internet]. [cited 2010 March 25]. Available from: http://www.nemc.go.kr/eng/major/major_information.jsp
  • 41 Josseran L, Caillere N, Brun-Ney D, Rottner J, Filleul L, Brucker G. et al. Syndromic surveillance and heat wave morbidity: a pilot study based on emergency departments in France. BMC Med Inform Decis Mak. 2009; 9: 14.
  • 42 Turner RM, Muscatello DJ, Zheng W, Willmore A, Arendts G. An outbreak of cardiovascular syndromes requiring urgent medical treatment and its association with environmental factors: an ecological study. Environ Health. 2007; 6: 37.
  • 43 Cifuentes E, Suarez L, Solano M, Santos R. Diarrheal diseases in children from a water reclamation site in Mexico city. Environ Health Perspect. 2002; 110 (Suppl. 10) A619-A624.
  • 44 Simanjuntak CH, Larasati W, Arjoso S, Putri M, Lesmana M, Oyofo BA. et al. Cholera in Indonesia in 1993-1999. Am J Trop Med Hyg. 2001; 65 (Suppl. 06) 788-797.
  • 45 Rowland MG. The Gambia and Bangladesh: the seasons and diarrhoea. Dialogue Diarrhoea. 1986; 26: 3.
  • 46 Sutra S, Srisontrisuk S, Panpurk W, Sutra P, Chirawatkul A, Snongchart N. et al. The pattern of diarrhea in children in Khon Kaen, northeastern Thailand: I. The incidence and seasonal variation of diarrhea. Southeast Asian J Trop Med Public Health. 1990; 21 (Suppl. 04) 586-593.
  • 47 Hashizume M, Armstrong B, Hajat S, Wagatsuma Y, Faruque AS, Hayashi T. et al. Association between climate variability and hospital visits for non-cholera diarrhoea in Bangladesh: effects and vulnerable groups. Int J Epidemiol. 2007; 36 (Suppl. 05) 1030-1037.
  • 48 Curriero FC, Patz JA, Rose JB, Lele S. The association between extreme precipitation and waterborne disease outbreaks in the United States, 1948-1994. Am J Public Health. 2001; 91 (Suppl. 08) 1194-1199.
  • 49 Korea Meteorological Administration (KMA).. [Internet]. [cited 2010 March 25]. Available from: http://www.kma.go.kr/sfc/sfc_03_02.jsp
  • 50 Schweigler LM, Desmond JS, McCarthy ML, Bukowski KJ, Ionides EL, Younger JG. Forecasting models of emergency department crowding. Acad Emerg Med. 2009; 16 (Suppl. 04) 301-308.
  • 51 Box GEP, Jenkins GM, Reinsel GC. Time Series Analysis: Forecasting and Control. San Francisco, CA: Holeden day; 1970
  • 52 Eberhard ML, Nace EK, Freeman AR, Streit TG, da Silva AJ, Lammie PJ. Cyclospora cayetanensis infections in Haiti: a common occurrence in the absence of watery diarrhea. Am J Trop Med Hyg. 1999; 60 (Suppl. 04) 584-586.
  • 53 Begier EM, Sockwell D, Branch LM, Davies-Cole JO, Jones LH, Edwards L. et al. The National Capitol Region’s Emergency Department syndromic surveillance system: do chief complaint and discharge diagnosis yield different results. Emerg Infect Dis. 2003; 9 (Suppl. 03) 393-396.