Journal of Preventive Medicine and Public Health

Methods

Health Indicators Related to Disease, Death, and Reproduction: Jeoungbin Choi, Moran Ki, Ho Jang Kwon, Boyoung Park, Sanghyuk Bae, Chang-Mo Oh, Byung Chul Chun, Gyung-Jae Oh, Young Hoon Lee, Tae-Yong Lee, Hae Kwan Cheong, Bo Youl Choi, Jung Han Park, Sue K. Park; J Prev Med Public Health. 2019;52(1):14-20. Published online January 23, 2019; DOI: https://doi.org/10.3961/jpmph.18.250

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Abstract Summary PDF Supplementary Material

One of the primary goals of epidemiology is to quantify various aspects of a population’s health, illness, and death status and the determinants (or risk factors) thereof by calculating health indicators that measure the magnitudes of various conditions. There has been some confusion regarding health indicators, with discrepancies in usage among organizations such as the World Health Organization the, Centers for Disease Control and Prevention (CDC), and the CDC of other countries, and the usage of the relevant terminology may vary across papers. Therefore, in this review, we would like to propose appropriate terminological definitions for health indicators based on the most commonly used meanings and/or the terms used by official agencies, in order to bring clarity to this area of confusion. We have used appropriate examples to make each health indicator easy for the reader to understand. We have included practical exercises for some health indicators to help readers understand the underlying concepts.

Summary

Korean summary
본 논문에서는 질병과 사망, 출생 관련 지표들의 개념과 종류를 설명하고, 특히 연구자들이 흔히 혼동하여 사용하는 지표들에 대한 적절한 정의를 제시하였다. 또한 지표들의 예시를 부록으로 수록하여 독자들이 지표의 개념을 보다 쉽게 습득하도록 돕고자 하였다.

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

The Validity and Reliability of a Screening Questionnaire for Parkinson's Disease in a Community.: Jong Hun Kim, Hae Kwan Cheong, Chong Sik Lee, Sung Eun Yi, Kun Woo Park; J Prev Med Public Health. 2010;43(1):9-17.; DOI: https://doi.org/10.3961/jpmph.2010.43.1.9

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Abstract PDF

OBJECTIVES
Parkinson's disease is one of the most common neurodegenerative diseases in the elderly population. In order to estimate the prevalence of Parkinson's disease in the community, the application of a good screening tool is essential. We evaluated the validity and reliability of a Parkinson's disease screening questionnaire and propose an alternative measure to improve its validity for use in community surveys. METHODS: We designed the study in a three-phase approach consisting of a screening questionnaire, neurologic examination, and confirmatory examination. A repeated survey was administered to patients with disease detected in the community and on 150 subjects. We examined internal consistency using Cronbach's alpha test, test-retest reliability using the kappa statistic, and validity using sensitivity, specificity, and ROC curves. Unadjusted odds ratios were utilized for the estimation of weights for each questionnaire item. RESULTS: The Cronbach's alpha of the questionnaire was 0.708. The kappa statistic for test-retest reliability was good to generally fair in most of the items. When newly proposed weighting scores were used, the optimum cut-off value was 7/8. When cut-off value was 5/6 for surveying prevalence in a community, the sensitivity was 0.98, and the specificity was 0.61, with simultaneous improvement in reliability. CONCLUSIONS: We recommend 5/6 as the ideal cut-off value for the survey of PD prevalence in community. This questionnaire designed for the Korean community could help future epidemiologic studies of PD.

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English Abstracts

BTEX Exposure and its Health Effects in Pregnant Women Following the Hebei Spirit Oil Spill.: Byung Mi Kim, Eun kyo Park, So Young LeeAn, Mina Ha, Eun Jung Kim, Hojang Kwon, Yun Chul Hong, Woo Chul Jeong, Jongil Hur, Hae Kwan Cheong, Jongheop Yi, Jong Ho Kim, Bo Eun Lee, Ju Hee Seo, Moon Hee Chang, Eun Hee Ha; J Prev Med Public Health. 2009;42(2):96-103.; DOI: https://doi.org/10.3961/jpmph.2009.42.2.96

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Abstract PDF

OBJECTIVES
We evaluated the health effects of exposure to BTEX (Benzene, Toluene, Ethylbenzene, m,p-Xylene, o-Xylene) in the Taean area after the Hebei Spirit oil spill. METHODS: We used a questionnaire survey to look for health effects among 80 pregnant women 2 to 3 months following the Hebei Spirit oil spill. Their BTEX exposures were estimated using the CALPUFF method. We then used a multiple logistic regression analysis to evaluate the effects of BTEX exposure on the women's health effets. RESULTS: Pregnant women who lived near the accident site reported more symptoms of eye irritation and headache than those who lived farther from the site. There was a trend of decreasing symptoms with an increase in distance from the spill site. Pregnant women exposed to higher ambient cumulative levels of Xylene were significantly more likely to report symptoms of the skin (OR 8.01 95% CI=1.74-36.76) in the first day after the accident and significantly more likely to report abdominal pain (OR 3.86 95% CI=1.02-14.59 for Ethylbenzene, OR 6.70 95% CI=1.82-24.62 for Xylene) during the 1st through 4th days following the accident. CONCLUSIONS: This study suggests that exposure to BTEX from an oil spill is correlated with an increased risk of health effects among pregnant women. This implies the need to take proper measures, including the development of a national policy for environmental health emergencies and a plan for studying the short- and long-term chronic health effects associated with such spills.

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The Effects of Wearing Protective Devices among Residents and Volunteers Participating in the Cleanup of the Hebei Spirit Oil Spill.: Seung Min Lee, Mina Ha, Eun Jung Kim, Woo Chul Jeong, Jongil Hur, Seok Gun Park, Hojang Kwon, Yun Chul Hong, Eun Hee Ha, Jong Seung Lee, Bong Chul Chung, Jeongae Lee, Hosub Im, Yeyong Choi, Yong Min Cho, Hae Kwan Cheong; J Prev Med Public Health. 2009;42(2):89-95.; DOI: https://doi.org/10.3961/jpmph.2009.42.2.89

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Abstract PDF

OBJECTIVES
To assess the protective effects of wearing protective devices among the residents and volunteers who participated in the cleanup of the Hebei Spirit oil spill. METHODS: A total of 288 residents and 724 volunteers were surveyed about symptoms, whether they were wearing protective devices and potential confounding variables. The questionnaires were administered from the second to the sixth week following the accident. Spot urine samples were collected and analyzed for metabolites of 4 volatile organic compounds (VOCs), 2 polycyclic aromatic hydrocarbons (PAHs), and 6 heavy metals. The association between the wearing of protective devices and various symptoms was assessed using a multiple logistic regression adjusted for confounding variables. A multiple generalized linear regression model adjusted for the covariates was used to test for a difference in least-square mean concentration of urinary biomarkers between residents who wore protective devices and those who did not. RESULTS: Thirty nine to 98% of the residents and 62-98% of volunteers wore protective devices. Levels of fatigue and fever were higher among residents not wearing masks than among those who did wear masks (odds ratio 4.5; 95% confidence interval 1.23-19.86). Urinary mercury levels were found to be significantly higher among residents not wearing work clothes or boots (p<0.05). CONCLUSIONS: Because the survey was not performed during the initial high-exposure period, no significant difference was found in metabolite levels between people who wore protective devices and those who did not, except for mercury, whose biological half-life is more than 6 weeks.

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Psychological Health in Residents Participating in Clean-up Works of Hebei Spirit Oil Spill.: Minkyo Song, Yun Chul Hong, Hae Kwan Cheong, Mina Ha, Hojang Kwon, Eun Hee Ha, Yeyong Choi, Woo Chul Jeong, Jongil Hur, Seung Min Lee, Eun Jung Kim; J Prev Med Public Health. 2009;42(2):82-88.; DOI: https://doi.org/10.3961/jpmph.2009.42.2.82

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Abstract PDF

OBJECTIVES
Our objective was to examine and evaluate the psychological health of the residents of Taean during the cleanup of the Hebei Spirit (HS) oil spill and to review some factors associated with the results. METHODS: A community survey of 71 men and women was conducted 8 weeks after the HS oil spill. Questionnaires used were the PWI (Psychological Well-being Index) scale for psychosocial distress, the CES-D (Center for Epidemiologic Studies-Depression) scale for depressive symptoms, and a questionnaire created to assess suicidal impulses. RESULTS: The overall prevalence of high-risk psychosocial distress among the study group was 64.2%. The percentages of respondents with scores on the CES-D Scale above 16 and above 21 were 77.6% and 62.7%, respectively. The percentage of respondents categorized as having suicidal impulses was 18.3%. When compared with unexposed groups in the general population taken from various sources, the residents of Taean were 6.5 times as likely to have high stress and 9.4-9.7 times as likely to be depressed. No significant difference in the rate of suicidal impulse was found between the residents of Taean and the general population. Factors associated with high stress, depression, and suicidal impulses were age, a change in income, educational level, number of days working on the cleanup, and positive responses to questions about "affected daily activity" and "hospital visit due to work on cleanup." CONCLUSIONS: The results suggest that the HS oil spill had a significant impact on the psychological health of residents of Taean, but the comparability of the unexposed groups is a limitation of the study.

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Cancer Incidence Trend in the Hebei Spirit Oil Spill Area, from 1999 to 2014: An Ecological Study
Kyung-Hwa Choi, Myung-Sook Park, Mina Ha, Jong-Il Hur, Hae-Kwan Cheong
International Journal of Environmental Research and Public Health.2018; 15(5): 1006. CrossRef
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Ju-Yeon Lee, Sung-Wan Kim, Kyung-Yeol Bae, Jae-Min Kim, Il-Seon Shin, Jin-Sang Yoon
Comprehensive Psychiatry.2017; 77: 38. CrossRef
Psychological Vulnerability of Residents of Communities Affected by the Hebei Spirit Oil Spill
Kyung-Hwa Choi, Myung-Ho Lim, Mina Ha, Jung Nam Sohn, Jong-Won Kang, Young-Hyun Choi, Hae-Kwan Cheong
Disaster Medicine and Public Health Preparedness.2016; 10(1): 51. CrossRef
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Blanca Laffon, Eduardo Pásaro, Vanessa Valdiglesias
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Hwi-Won Lee, Minkyo Song, Jae Jeong Yang, Daehee Kang
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Hee Jung Yang, Hae Kwan Cheong, Bo Youl Choi, Min-Ho Shin, Hyeon Woo Yim, Dong-Hyun Kim, Gawon Kim, Soon Young Lee
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Seongjin Hong, Jong Seong Khim, Jongseong Ryu, Seong-Gil Kang, Won Joon Shim, Un Hyuk Yim
Ocean & Coastal Management.2014; 102: 522. CrossRef
Crude Oil Spill Exposure and Human Health Risks
Mark A. D'Andrea, G. Kesava Reddy
Journal of Occupational & Environmental Medicine.2014; 56(10): 1029. CrossRef
Children's Mental Health in the Area Affected by the Hebei Spirit Oil Spill Accident
Mina Ha, Woo-Chul Jeong, Myungho Lim, Hojang Kwon, Yeyong Choi, Seung-Jin Yoo, Su Ryun Noh, Hae-Kwan Cheong
Environmental Health and Toxicology.2013; 28: e2013010. CrossRef
Changes of Eating Habits of the Residents of Taean, Korea after the Herbei Oil Spill Accident Based on Focus Group Interviews
Ji Hyun Park, Sung Ok Kwon, Woo Cheol Jeong, Jong Il Huh, Se-Young Oh
Korean Journal of Community Nutrition.2011; 16(4): 466. CrossRef
The Adverse Health Effects of Oil Spills: A Review of the Literature and a Framework for Medically Evaluating Exposed Individuals
Barry S. Levy, William J. Nassetta
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Acute Health Effects of the Hebei Oil Spill on the Residents of Taean, Korea
Cheol-Heon Lee, Young-A Kang, Kyu-Jin Chang, Chang-Hoon Kim, Jong-Il Hur, Jae-Youn Kim, Jong-Koo Lee
Journal of Preventive Medicine and Public Health.2010; 43(2): 166. CrossRef
The Distinction of Cleanup Works of Hebei Spirit Oil Spill in Peak Expiratory Flow between Pre-works and Post-works
Im-Ju Kang, Sung-Youn Choi, Jae-Eun Lee, Mi-Hye Seo, Byoung-Kwon Ghim
Korean Journal of Family Medicine.2009; 30(11): 848. CrossRef

Scientific Basis of Environmental Health Contingency Planning for a Coastal Oil Spill.: Young Min Kim, Hae Kwan Cheong, Jong Ho Kim, Jong Hun Kim, Kumsook Ko, Mina Ha; J Prev Med Public Health. 2009;42(2):73-81.; DOI: https://doi.org/10.3961/jpmph.2009.42.2.73

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Abstract PDF

OBJECTIVES
This study presents a scientific basis for the establishment of an environmental health contingency plan for dealing with accidental coastal oil spills and suggests some strategies for use in an environmental health emergency. METHODS: We reviewed the existing literature, and analyzed the various fundamental factors involved in response strategies for oil spill. Our analysis included data derived from Hebei Spirit oil spill and used air dispersion modeling. RESULTS: Spill amounts of more than 1,000 kl can affect the health of residents along the coast, especially those who belong to vulnerable groups. Almost 30% of South Korean population lives in the vicinity of the coast. The area that is at the highest risk for a spill and that has the greatest number of people at risk is the stretch of coastline from Busan to Tongyeong. The most prevalent types of oil spilt in Korean waters have been crude oil and bunker-C oil, both of which have relatively high specific gravity and contain volatile organic compounds, polycyclic aromatic hydrocarbons, and metals. In the case of a spill of more than 1,000 kl, it may be necessary to evacuate vulnerable and sensitive groups. CONCLUSIONS: The government should establish environmental health planning that considers the spill amount, the types of oil, and the distance between the spot of the accident and the coast, and should assemble a response team that includes environmental health specialists to prepare for the future oil spill.

Summary

Citations

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Cancer Incidence Trend in the Hebei Spirit Oil Spill Area, from 1999 to 2014: An Ecological Study
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Human health and ecological assessment programs for Hebei Spirit oil spill accident of 2007: Status, lessons, and future challenges
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Osong Public Health and Research Perspectives.2017; 8(5): 358. CrossRef
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Hebei Spirit Oil Spill Exposure and Subjective Symptoms in Residents Participating in Clean-Up Activities
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A Literature Review on Health Effects of Exposure to Oil Spill.: Mina Ha, Won Jin Lee, Seungmin Lee, Hae Kwan Cheong; J Prev Med Public Health. 2008;41(5):345-354.; DOI: https://doi.org/10.3961/jpmph.2008.41.5.345

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Abstract PDF

OBJECTIVES
Our objective is to review and summarize the previous studies on the health effects of exposure to oil spills in order to make suggestions for mid- and long-term study plans regarding the health effects of the Hebei Spirit oil spill occured in Korea. METHODS: We searched PubMed to systemically retrieve reports on the human health effects related to oil spill accidents. The papers' reference lists and reviews on the topic were searched as well. RESULTS: We found 24 articles that examined seven oil spill accidents worldwide over the period from 1989 to August 2008, including the Exxon Valdes, Braer, Sea Empress, Erika, Nakhodka, Prestige and Tasman Spirit oil spills. Most of the studies applied cross-sectional and short-term follow-up study designs. The exposure level was measured by assessing the place of residence, using a questionnaire and environmental and personal monitoring. Studies on the acute or immediate health effects mainly focused on the subjective physical symptoms related to clean-up work or residential exposure. Late or mid-term follow-up studies were performed to investigate a range of health effects such as pulmonary function and endocrine, immunologic and genetic toxicity. The economic and social impact of the accidents resulted in the socio-psychological exposure and the psychosocial health effects. CONCLUSIONS: Studies of the health effects of exposure to oil spills should consider a range of health outcomes, including the physical and psychological effects, and the studies should be extended for a considerable period of time to study the long-term chronic health effects.

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Original Article

Assessment of the Availability of Health Insurance Data for Epidemiologic Study of Childhood Aseptic Meningitis.: Sue Kyung Park, Hae Kwan Cheong, Moran Ki, Young Mo Son, Ho Kim; Korean J Prev Med. 2003;36(4):349-358.

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Abstract PDF: 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 performed. 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 performed 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, 239/1, 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 +/-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 performed.; Summary

Editorial

Health Effect of Dioxin.: Hae Kwan Cheong; Korean J Prev Med. 2003;36(4):323-324.

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Abstract PDF: No abstract available.; Summary

Original Articles

Evaluation of Measles Vaccine Effectiveness in a Community Outbreak.: Byung Chan Park, Hae Kwan Cheong, Sue Kyung Park; Korean J Prev Med. 2002;35(1):33-40.

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Abstract PDF: OBJECTIVE
From an analysis of a community outbreak of measles in Youngju, Gyeongbuk, in March 2000, the authors evaluated the effectiveness of the measles vaccination and its determinants to provide an epidemiologic basis for the establishment of a vaccination policy. METHODS: Information was collected regarding the vaccinations from the health records of four primary schools and through a questionnaire survey of the parents of students in two middle and two high schools (N=4638). Measles cases were surveyed from the patient list of each school and from case reports in the public health center. The attack rate and vaccine effectiveness of measles was evaluated by school; grade; frequency, region, and institution of vaccination. RESULTS: The attack rate of measles, 6.3% among the total subjects, was higher in middle school students (15.8%) than in primary (2.0%, p<0.05) and high school students (8.9%, p<0.05). The attack rate of the unvaccinated group was 4.6-fold higher than the vaccinated group in primary schools (p<0.05). Vaccine effectiveness was 83.2% among lower graders of primary schools, 34.0% among higher graders of primary schools, 26.1% in middle schools, and -7.0% in high schools. In multiple logistic regression analysis, grade in school (odds ratio, 0.77; 95% CI=0.67-0.87) and frequency of vaccination (odds ratio, 0.57; 95% CI=0.37-0.88) were significant predictors of the outcome. CONCLUSIONS: We concluded that the explosive outbreak of measles in this area resulted from both inadequate vaccination coverage and secondary failure of vaccination. There was no evidence of any effect of the cold chain system on the vaccine failure.; Summary

Comparative Epidemiologic Survey of Measles in Two Primary Schools.: Sue Kyung Park, Jee Hee Kim, Joo Yeon Lee, Byoung Kuk Na, Woo Joo Kim, Hae Kwan Cheong; Korean J Prev Med. 2001;34(2):131-140.

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Abstract PDF: OBJECTIVES
During March-May, 2000, a measles outbreak occurred at Youngduk, Korea. This county is divided into two areas with different historical and socioeconomic background. The outbreak occurred in one of these areas. We conducted a comparative epidemiologic study on the two areas in order to evaluate the factors related to the epidemic. MATERIALS AND METHODS: We selected two groups, grades 3 and 5 in a primary schools in each area. We investigated outbreak-related factors using parent-questionnaires, the vaccination history from the students health record and the records concerning the recent measles-outbreak from the local health center. Serologic test on measles-IgG and -IgM antibody was done. RESULTS: The infection rate was 31.6% for the epidemic area and 3.7% for non-the epidemic area according to clinical or serological criteria (p<0.001). No difference was seen in the measles vaccination rate, residence at the time of vaccination or past measles infection history between the two areas. In the epidemic area, the attack rate for the 4-6 year-old MMR booster group(20.5%) was higher than the non-booster group(32.4%), but was not found significantly. Vaccine efficacy was 29.6% in the epidemic area and 87.0% in the non-epidemic area (p<0.001). The IgG level and positive rate were significantly different between the two areas (median 10727 IU/ml, 98.9% in epidemic area; median 346 IU/ml, 85.9% in the non-epidemic area, p<0.001). However, the IgG level and positive rate between the measles-cases and non-cases were not significantly different. CONCLUSIONS: This outbreak took place in mostly vaccinated children. These results suggest that a reduction of herd immunity for immunity failure after vaccination may be one of the feasible factors related to the outbreak pattern in the two areas. The results of the IgG level and positive rate suggest that re-establishment of a normal value for IgG level and of a qualitative method for IgG are needed.; Summary

A Study on the Correlation between Categorization of the Individual Exposure Levels to Agent Orange and Serum Dioxin Levels Among the Korean Vietnam Veterans.: Joung Soon Kim, Han K Kang, Hyun Sul Lim, Hae Kwan Cheong, Min Kyung Lim; Korean J Prev Med. 2001;34(1):80-88.

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Abstract PDF: OBJECTIVES
In an epidemiologic study on the health impact of Agent Orange exposure, the valid estimation of exposure level is the most important step. Based on recent studies, we examined the correlation between exposure levels categorized by personal exposure estimates and serum 2,3,7,8-tetrachlorodibenzo-p-dioxin (2,3,7,8-TCDD, Dioxin), exploring the possibility of utilizing the exposure level as a surrogate for the estimate of exposure to agent orange. METHODS: During the study period (Jan 1996-Feb 1996), blood specimens of 745 subjects taken randomly among 1,329 persons and kept frozen, were analyzed for 2,3,7,8-TCDD and six other dioxin congeners. The serum dioxin and congeners were measured in 1998 by CDC ,adjusted for serum lipids. We categorized the total exposure scores into five groups based on Agent Orange exposure data collected by interview and military records. Pearson and Spearman's correlation coefficients & multiple regression analysis were used to identify the relationship of the exposure level categorized with serum concentration of 2,3,7,8-TCDD, and six other dioxin congeners. RESULTS: Dioxin and the other congeners, except 1,2,4,6,7,8-HpCDD, showed significant correlations to exposure categories (p<0.005); 2,3,7,8-TCDD and OCDD showed positive correlations, whereas the other congeners did negative. The values of 2,3,7,8-TCDD differed according to exposure category and proportionally increased from the low exposure group to the high, a dose-response relationship, even after other possible confounding variables were adjusted for. In multiple regression analysis, age(beta=0.033), dioxin(beta=0.433), 1,2,3,7,8-PeCDD(beta=0.998), 1,2,3,4,7,8-HxCDD(beta=0.773), 1,2,3,6,7,8-HxCDD(beta=0.255), 1,2,3,7,8,9-HxCDD(beta=3.468), 1,2,3,4,6,7,8-HpCDD(beta=0.109) were found to be significantly related to the total exposure score(p<0.005). CONCLUSION: This study demonstrated that the use of such categorizations as a surrogate measure of agent orange exposure in identifying exposure degrees in a health impact study is valid.; Summary

A Case of Metal Fume Fever Associated with Copper Fume in a Welder.: Hyun Sul Lim, hae Kwan Cheong; Korean J Prev Med. 1998;31(3):414-423.

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Abstract PDF: Metal fume fever has been known as an occupational disease is induced by intense inhalation of fresh metal fume with a particle size smaller than 0.5 nm to 1 nm. The fumes originate from heating metals beyond their boiling point, as happens, for example, in welding operations. Oxidation usually accompanies this process. In most cases, this syndrome is due to exposure to zinc oxide fumes; however, other metals like copper, magnesium, cadmium, manganese, and antimony are also reported to produce such reactions. Authors report a case of metal fume fever suspected to be associated with copper fume inhalation. The patient was a 42-year-old male and was a smoker. He conducted inert gas tungsten arc welding on copper-coated materials without safety precautions such as a protective mask and adequate ventilation. Immediately after work, he felt metallic taste in his mouth. A few hours after welding, he developed headache, chilling sensation, and chest discomfort. He also complained of myalgia, arthralgia, feverish sensation, thirst, and general weakness. Symptoms worsened after repeated copper welding on the next day and subsided gradually following two weeks. Laboratory examination showed a transient increase of neutrophil count, eosinophilia, elevated erythrocyte sedimentation rate, and positive C-reactive proteinemia. Blood and urine copper level was also increased compared to his wife. Before this episode, he experienced above complaints several times after welding with copper materials but welding of other metals did not produce any symptoms. It was suggested that copper fume would have induced metal fume fever in this case. Further investigations are needed to clarify their pathogenic mechanisms.; Summary

A Study on the Pervalence and Risk Factors of Liver Dysfunction among the Workers in Chemical Factors.: Hae Kwan Cheong, Joung Soom Kim; Korean J Prev Med. 1997;30(1):103-128.

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Abstract PDF: The object of this study is to evaluate the possibility of chemical-induced liver disorder among workers exposed to various chemicals and to classify the the liver function abnormalities by causes and to analyse the risk factors for each liver disorders. A cross-sectional study including questionnaire survey, physical examination, laboratory tests and ultrasonography of liver was conducted on 1,126 workers, 459 workers in a coal chemical plant(company A) and 667 workers in an insulation material manufacturing factory(company B). An industrial hygienist reviewed the chemicals used in both companies and evaluated the work environments to classify the workers by chemical exposure semiquantitatively. The results are as follows; 1. Of 459 workers in company A, 83 workers(18.1 %) are classified as nonexposed, 163(35.5%) as short-term exposure group, 155(33.8 %) as intermediately exposed group and 58(12.6 %) as long-term exposed group based on the mean daily exposure to hepatotoxic chemicals evaluated by an industrial hygienist. Of 667 workers in company B, 484(72.6 %) workers were classified as nonexposed and 183(35.5 %) as exposed. 2. Workers with SGOT level higher than 40 IU/l were 46(10.0 %) in company A and 77(11.5 %) in company B, and those with SGPT level higher than 35 IU/l were 118(25.7 %) in company A and 198(29.7 %) in company B. The differences were not significant between companies and between exposure groups(p>0.05). Workers with ?-GT level higher than 62 IU/l were 29(6.3 %) in company A and 77(11.5 %) in company B(p<0.01). The difference between exposure groups was not significant(p>0.05) within companies. Workers with liver function abnormalities(defined as SGOT higher than 40 IU/l or SGPT higher than 35 IU/l, Ministry of Labor, 1989) were 338(30.0 %) among 1,126 workers. Of 338 workers with liver function abnormalities 139(12.3 %) had fatty liver by ultrasonography, 79(7.0 %) had alcoholic liver(defined as workers with liver function abnormalities with weekly alcohol consumption greater than 280 g for more than 5 years), 54(4.8 %) had hepatitis B, 12(1.1 %) had hepatitis C and the other 114(33.7 %) was not otherwise classified. Prevalences of alcoholic liver and fatty liver were significantly lower in company A(prevalence ratio 0.24 for alcoholic liver, p<0.001; prevalence ratio 0.76 for fatty liver, p<0.05) but prevalences of liver disorders between exposure groups within companies were not significant(p>0.05). 3. Summary prevalence ratios(SPR) of liver function abnormalities, fatty liver and other liver disorders, adjusted by age and company were not significantly higher in exposed group in any chemicals(p>0.05) but in some chemicals, SPRs were significantly lower. 4. On simple analysis of risk factors for liver function abnormalities, prevalence odds ratio(POR) of those with age between 30 and 39 was 1.54(p<0.01) and those with age over 40 was 1.51(p<0.01). POR of those with histories of liver disorders and general anesthesia was 1.77(p<0.001) and 4.02 for those with overweight and 6.23 for those with obesity, defined by body mass index(p<0.001). 5. On logistic regression analysis, risk factors of liver function abnormality were fatty liver(POR 2.92 for grade 1, 12.15 for grade 2), presence of hepatitis B surface antigen(POR 3.62) and obesity(POR 5.38 for overweight and 16.52 for obesity). Presence of hepatitis B surface antigen(POR 0.18) was the only preventive factor of fatty liver. Company(POR 0.30) and obesity(POR 2.49 for overweight, 4.52 for obesity) were related to the alcoholic liver. Obesity(POR 2.94 for overweight) was the only significant risk factor of hepatitis B and there was no significant risk factor for liver function abnormality not otherwise classified. It is concluded that the evidence of liver disorder related with chemical exposure is not evident in these factories. It is also postulated that fatty liver and alcoholic liver is most common causes of liver function abnormalities among workers and effort for weight control and improvement of life style should be done.; Summary

A Study on the Establishment of Management Methods about Occupational Dermatoses.: Hyun Sul Lim, Hae Kwan Cheong, Byung Soon Choi, Ji Yong Kim, Yeol Oh Sung, Yang Ho Kim; Korean J Prev Med. 1996;29(3):617-638.

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Abstract PDF: Occupational dermatosis is one of the most prevalent occupational disorders. However, the extent of the occupational dermatoses including incidences and prevalencies of each disease entity, and etiologic materials are not yet well stated in Korea. Authors reviewed the literatures on the statistic data and reports on the occupational dermatoses, and surveyed on the occupational dermatoses in two factories, and surveyed the physicians responsible to the occupational dermatoses with formed questionnaire. The results are as follows; 1. Among medical journals published since 1964, there were 31 articles on the occupational dermatoses. Of 31 articles, 18 were case reports and all others were review articles. Of 18 case reports, 9 were epidemiologic survey. The Workers' Periodic Health Examinations revealed that prevalence of the occupational dermatoses was highest(4.36 per 10,000 workers) in 1974, but number of the cases reported were decreased sharply since 1978 with some tendency to increase since 1987. There were 2,240 reported cases of occupational dermatoses between 1966 and 1992, which is 1.90% of all the reported occupational diseases. Skin infection and injuries due to chemicals were most frequent and there were 6 cases of skin cancer. 2. In an epidemiological survey on the dermatoses among 995 workers in a metal product manufacturing factory and 225 workers with acne, 130 workers with scar, 123 workers with deformity of toe nails. Scars, photosensitivity dermatitis, deformity of finger and toe nails, and acne were more prevalent in the metal product manufacturing factory(p<0.05). In the metal product manufacturing factory, workers treating organic solvents and oils had more dermatoses than those without treating the materials(p<0.05). On the skin patch performed on 16 workers in the metal product manufacturing factory, there were 8 cases of irritation dermatitis and 5 cases of contact dermatitis. Prevalence of contact dermatitis in the metal product manufacturing factory was 1.3%. 3. On the questionnaire survey, 34 dermatologists, 29 doctors of preventive medicine, and 22 family physician replied. The proportion of occupational etiology among all dermatoses assumed by the physicians were below 9%, and the most important occupational dermatosis in Korea was contact dermatitis. Main etiologic materials related to the occupational dermatosis were organic solvent, acid and alkali, and metals. The reason for the scarcity of report of occupational dermatoses were difficulty in diagnosis and physician's ignorance of the occupational etiology. They replied that to prevent the occupational dermatosis in the workplace, the use of protective devices was most important, and development of diagnostic criteria on the occupational dermatoses is urgent. Above results shows us that there is many workers with occupational dermatoses, but they are mostly unreported. Measures to prevent and manage the occupational dermatoses are not satisfactory at present. Hence, authors suggest measures for the precises diagnosis, report and prevention of the occupational dermatoses. a. Dernatikigustm orevebtuve physician, and industrial hygienist should work as a team to examine the high risk group and establish the preventive measures. b. Disease entities, diagnostic criteria of occupational dermatoses should be listed, criteria for the compensation and job fitting at recruitment should be established, and manual for the proper treatment and effective prevention of each occupational dermatosis should be developed. c. Patch test antigens against each occupational category should be developed and it should be available to any physicians responsible. d. To facilitate the diagnosis of occupational dermatoses by the doctors responsible for the Workers' Periodic Health Examination, development of standardized questionnaire, education on the techniques of the patch test, and cooperation with the dermatologist in diagnosis of occupational dermatoses is essential.; Summary

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