의과대학 연구동에서 발생한 유행성출혈열 역학조사

조수헌,강대희,김성권,김익상,홍성태,주영수,Cho, Soo-Hun,Kang, Dae-Hee,Kim, Suhng-Gwon,Kim, Ik-Sang,Hong, Sung-Tae,Ju, Young-Su 대한예방의학회 1999 Journal of Preventive Medicine and Public Health Vol.32 No.3

Background : In April 6, 1990, a male researcher who has worked at a research unit at the Basic Research Building of Seoul National University(SNU) College of Medicine admitted to SNU Hospital due to persistent fever. He was diagnosed serologically as hemorrhagic fever with renal syndrome(HFRS). Another female researcher in the same unit was also diagnosed as HFRS at the same hospital several days later. Epidemic investigation of HFRS was conducted to determine the magnitude of the problems since these two cases were strongly suspected to have laboratory-acquired infections of HFRS. Methods : All researchers and employees working at the Basic Research Building(BRB) of SNU College of Medicine as of April 1, 1996 were recruited for the study, information on symptoms of HFRS and history of contact to experimental animals were collected by self-administered questionnaires and serological tests among study subjects were also conducted by indirect immunofluorescent antibody(IFA) to hantavirus. The experimental animals were also serologically tested for infection with hantavirus by IFA. Results : Among 218 surveyed, six researchers and an animal caretaker had hantavirus antibodies above 1:20 in IFA titer. Five of seven sero-positive subjects had antibodies above 1:640 in IFA titer and had shown clinical symptoms compatible to HFRS during Jan. 1 to Apr, 20, 1996. The sero-positive persons had handled animals more frequently than sero-negative persons (OR, 19,68; 95% Cl, 1.11-350.40) and handling animals at the animal quarter at School of Public Health(SPH) had shown consistently higher risk to get infected with hantavirus irrespective of types of animals handled (OR, 4.90-6.37). Sero-positivity of rats of the aniamal quarter at BRB was 30-60%, whereas 80% of rats at SPH tested were shown sero-positivity. Conclusion: There was a epidemic of HFRS in research units of a medical school during the period from Jan. through Apr, Further investigation is needed to determine the extent and the mode of transmission of the laboratory-acquired infection with hantavirus in other research facilities.

인천시 고잔동에서 제기된 유리섬유에 의한 건강피해 역학 조사

조수헌,주영수,김경렬,이강근,홍국선,은희철,송동빈,홍재웅,권호장,하미나,한상환,성주헌,강종원,Cho, Soo-Hun,Ju, Yeong-Su,Kim, Kyung-Ryul,Lee, Kang-Kun,Hong, Kug-Sun,Eun, Hee-Chul,Song, Dong-Bin,Hong, Jae-Woong,Kwon, Ho-Jang,Ha, Mi-Na,Han, Sang 대한예방의학회 1997 예방의학회지 Vol.30 No.1

In September 1994, residents of Gozan-dong, Incheon City, made a petition to the government about their health problems which might be caused by previous glass fibre landfill nearby 'H' company. In february 1995, at regular academic meeting of occupational and environmental medicine, a research team of 'D' University presented that they had found glass fibres in groundwater of the area through their survey. They were suspicious of probable association between ingestion of groundwater contaminated with glass fibres and skin tumors among residents. A joint research team was formed and carried out the survey of environment concerning groundwater and its glass fibre existence, and health assessment of residents in the area and industrial workers of 'H' company during May to November, 1995. Analysis of groundwater flow system indicates that the flow lines from the glass fibre landfill pass through or terminate at the 6 houses around the landfill. This means that the groundwater of the 6 houses around the glass fibre landfill could be affected by some possible contaminants from the landfill, but the groundwater quality of the other houses was irrelevant to the landfill. The qualitative and qualitative analyses for glass fibres in 54 groundwater samples including those from the nearby 6 houses, were carried out using SEM equipped with EDS, resulting in no evidence for the presence of glass fibres in the waters. Major precipitates, formed in waters while boiling, were identified as calcium carbonates, in particulary, aragonites in needle form. The results of health assessments of 889 residents in Gozan-dong, participated in this study, showed statistically significant differences in past medical histories of skin tumor and respiratory disease between the exposed group (31 persons who inhabited in 6 houses around the landfill) and the control group, but no significant differences in past medical histories of other diseases, such as cancer mortality, current gastroscopic findings, current skin diseases and respiratory diseases, etc. Also, we could not prove any glass fibres in excised specimens of 9 skin tumors in both groups and there were no health problems possibly associated with glass fibres in employees of the 'H' company. After all, we could not authenticate the association, raised by prior investigators, between groundwater streams, assumedly contaminated with glass fibres or not, and specific disease morbidities or common disease/symptom prevalences. That is, we could not find any glass fibres in groundwater as the only exposure factor of this study hypothesis, and there were not enough certain evidences such as increasing disease prevalences, for examples, skin, respiratory and gastrointestinal diseases etc, possibly related to glass fibre exposure, in exposed group. As a matter of course, the conditions for confirming causal association, for example, strength of the association, consistency of the association, specificity of the association, temporality of the association and dose-response relationship etc, have not been satisfied. In conclusion, we were not able to certify the hypothesis that contamination of groundwater with glass fibres might cause any hazardous health effects in residents who used it for drinking.

경기도 시화공단 지역주민의 악취오염과 관련된 건강영향 평가

조수헌,김선민,주영수,김재용,최성우,Cho, Soo-Hun,Kim, Sun-Mean,Kim, Young-Su,Kim, Jae-Yong,Choi, Seong-Woo 대한예방의학회 1999 예방의학회지 Vol.32 No.4

Objectives: In recent days, the problem of odor pollution in community near Sihwa Industrial complex, Kynuggi Province is becoming of significant public concern. We have investigated the health effects of the Sihwa residents from odor pollution comparing with other less polluted areas. Methods: The Ansan and Kuri Cities were selected as control areas. The parents of the elementary and middle school students in these three areas were surveyed with structured questionnaire twice, Nov 1997 and Jure 1998 each. As a exposure index, the ambient air concentrations of five major air pollutants(particulates, $O_3,\;SO_2,\;NO_2$, CO) and subjective odor perception were used. We have focused health outcomes such as the prevalence of nonspecific irritant symptoms, respiratory disease among family members and the score of qualify of life(QOL). Results: Although the mean concentrations of major air pollutants except particulates were similar or lower in Sihwa than other areas, the odor perception rate and the monthly odor perception days were significantly higher. It suggested that odor producing chemical compounds are the major source of environmental pollution problem. There were higher prevalence rates of nonspecific irritant symptoms and respiratory disease among family members in Sihwa than other control areas. The QOL score was also lower in Sihwa. The odor perception proved to be a most important factor in reporting adverse health effects and lowering the QOL score. Conclusion: The residents living near Sihwa industrial complex were suffering from more adverse health symptoms and poorer QOL status than control areas. And it may be due to environmental odor pollution from industrial complex. Therefore, further research will be needed for monitoring of the responsible chemicals emitted from industries.

군용 항공기 이륙소음이 청력, 혈압, 스트레스 및 주관적 인지도에 미치는 영향

한상환,조수헌,고경심,권호장,하미나,주영수,신명희,Han, Sang-Hwan,Cho, Soo-Hun,Koh, Kyung-Shim,Kwon, Ho-Jang,Ha, Mi-Na,Ju, Yeong-Su,Shin, Myung-Hee 대한예방의학회 1997 예방의학회지 Vol.30 No.2

In effort to determine whether aircraft noise can have health effects such as hearing loss, hypertension and psychological stress, a total of 111 male professors and administrative officers working a college near a military airport in Korea(exposed group) and a total of 168 males and 112 females matched by age groups(control groups) were analyzed. Personal noise exposure and indoor and outdoor sound level of jet aircraft noise were measured at the exposed are3. And pure tone, air conduction test and measurement of blood pressure were given to the exposed(males) and matched control groups (males and females). BEPSI(Brief Encounter Psychological Instrument) and psychological response to aircraft noise were examined for the exposed group. The noise dosimetry results revealed time-weighted averages(TWAs) that ranged from 61 to 68 dBA. However the levels encountered during taking off jet airplanes reached 126 dBA for two half minutes time period. Th, audiometric, test showed that mean values of HTL(hearing threshold level) in exposed group at every frequency(500, 1,000, 2,000, 4,000, and 8,000 Hz were much lower than them of male and female control groups. And in old age groups, interaction of age and noise was observed at 8,000 Hz in both ears(p<0.05). Conclusively, aircraft noise does not appear to induce hearing loss directly in high frequency, but may decreased hearing threshold level by interaction of aging process and noise exposure. However, difference of mean values of exposed and control groups on blood pressure was not significantly. In psychological test, annoyance was the most severe psychological response to noise in exposed group, but mean value of BEPSI was not correlated with job duration in exposed group.

대기오염과 천식발작의 관련성에 관한 시계열적 연구

주영수,조수헌,Ju, Young-Su,Cho, Soo-Hun 대한예방의학회 2001 예방의학회지 Vol.34 No.1

Objectives : To evaluate the hypothesis that increasing ambient levels of ozone or particulate matter are associated with increased emergency room visits for asthma and to quantify the strength of association, if any, between these. Methods : Daily counts of emergency room visits for asthma, air quality, and weather data were collected from hospitals with over 200 beds and from monitoring Stations in Seoul, Korea from 1994 through 1997. Daily counts of emergency mom visits for asthma attack were analyzed using a general additive Poisson model, with adjustment for the effects of secular trend, seasonal variation, Sunday and holiday, temperature, and humidly, according to levels of ozone and particulate matter. Results : The association between daily counts of emergency room visits for asthma attack and ozone levels was statistically significant in summer(from June to August), and the RR by unit inclement of 100 ppb ozone was 1.30(95% CI = $1.11\sim1.52$) without lag time. With restriction of the period from April to September in 1996, the RR was 1.37(95% CI = $1.06\sim1.76$), and from June to August in 1995, the RR was 1.62(95% CI = $1.12\sim2.35$). In the data for children$(5\sim14yr)$, the RR was 2.57(95% CI = $1.31\sim5.05$) with restriction of the period from April to September in 1997. There was no Significant association between TSP levels and asthma attacks, but a slight association was seen between PM10 levels and asthma attacks in a very restricted period. Conclusion : There was a statistically significant association between ambient levels of ozone and daily counts of emergency room visits for asthma attack. Therefore, we must make efforts to effectively minimize air pollution, in order to protect public health.

체중 잔차를 이용한 12세 아동의 정상 폐기능 예측식

강종원,성주헌,조수헌,주영수,Kang, Jong-Won,Sung, Joo-Hon,Cho, Soo-Hun,Ju, Yeong-Su 대한예방의학회 1999 Journal of Preventive Medicine and Public Health Vol.32 No.1

Objectives. Changes in lung function are frequently used as biological markers to assess the health effects of criteria air pollutants. We tried to formulate the prediction models of pulmonary functions based on height, weight, age and gender, especially for children aged 12 years who are commonly selected for the study of health effects of the air pollution. Methods. The target pulmonary function parameters were forced vital capacity(FVC) and forced expiratory volume in one second(FEV1). Two hundreds and fifity-eight male and 301 female 12-year old children were included in the analysis after excluding unsatisfactory tests to the criteria recommended by American Thoracic Sosiety and excluding more or less than 20% predicted value by previous prediction equations. The weight prediction equation using height as a independent variable was calculated, and then the difference of observed weight and predicted weight (i.e. residual) was used as the independent variable of pulmonary function prediction equations with height. Results. The prediction equations of FVC and FEV1 for male are FVC(ml) = $50.84{\times}height(cm)+7.06{\times}weight$ residual 4838.86, FEV1(ml) = $43.57{\times}height(cm)+3.16{\times}weight$ residual - 4156.66, respectively. The prediction equations of FVC and FEV1 for female are FVC(ml) = $42.57{\times}height(cm)+12.50{\times}weight$ residual - 3862.39, FEV1(ml) = $36.29{\times}height(cm)+7.74{\times}weight$ residual - 3200.94, respectively. 환경오염과 관련된 건강효과 연구에서 흡연, 직업 등 교란변수의 영향을 효과적으로 배제할 수 있으면서 폐기능검사가 제대로 시행될 수 있는 연구대상으로 선호되고 있는 특정 연령층인 12세 학동의 보다 정확한 FVC와 FEV1 예측식을 만 들고자 전국 11개 중학교의 학생들(남자 256명, 여자 301명)을 대상으로 측정된 신장, 체중, 그리고 폐기능검사 값으로 신장-체중의 회귀식을 유도하였고, 이를 통해 12세 인구의 신장별 표준체중을 산출하였다. 이 표준체중과 실측체중의 차이인 잔차를 독립변수로 하여 폐기능 예측 식을 남녀별로 만들었는데, 남자의 경우는, FVC(ml) = 50.84 $\times$ 신장(cm) + 7.06 $\times$ 체중 잔차 - 4838.86, FEV1(m1) = 43.57 $\times$ 신장(cm) + 3.16 $\times$ 체증 잔차 4156.66 이었다. 여자에서는 FVC(ml) = 42.57 $\times$ 신장(cm) + 12.50 $\times$ 체중 잔차 - 3862.39, 그리고 FEV1(ml) = 36.29 $\times$ 신장(cm) + 7.74 $\times$ 체중 잔차 - 3200.94 이었다. 이렇게 얻어진 예측값들의 설명력(R2)은 남자에서 FVC, FEV1가 각각 0.708, 0.670이었고, 여자에서는 FVC, FEV1가 각각 0.580, 0.513이었다.

Receiver Operating Characteristic 분석법을 이용한 업무관련성 근골격계질환 설문지 개발

권호장,주영수,조수헌,강대희,성주헌,최성우,최재욱,김재영,김돈규,김재용,Kwon, Ho-Jang,Ju, Yeong-Su,Cho, Soo-Hun,Kang, Dae-Hee,Sung, Joo-Hon,Choi, Seong-Woo,Choi, Jae-Wook,Kim, Jae-Young,Kim, Don-Gyu,Kim, Jai-Yong 대한예방의학회 1999 예방의학회지 Vol.32 No.3

ROC곡선의 AUC는 측전도구의 기준 타당도를 나타내는 가장 일반화된 지표다. 본 연구는 ROC분석법을 이용하여 현행의 근로자건강진단에서 업무관련성 근골격계 질환의 고위험군을 변별하는 표준 설문지를 개발하고자 하였다. 컴퓨터를 이용하는 선박 설계업 종사자 89명, 전화번호 안내원 113명, 일반 직업 여성 79명, 주부 89명 등 총 370명의 일차 연구대상군에 대한 재활의 학과 전문의의 최종 진단결과를 기준으로 1996년에 개발된 '근로자의 신체 증상에 관한 설문지'의 응답결과를 비교하였다. 근골격계 질환과의 관련성이 높은 문항조합을 선정하고 문항별 가중치를 산출하기 위해 로짓회귀분석, 상관분석 등을 실시하였으며, 문항조합 및 가중치 산출방법이 서로 다른 4가지 설문모형에 따른 AUC를 비교 하였다. 또한, 국내 모 자동차조립공장 근로자 225명의 설문결과와 산업의학 전문의의 진단결과 자료를 이용하여 4가지 설문모형의 AUC 재현도를 확인하였다. 분석 결과, 통계적으로 유의 한 차이는 없었으나 문항수를 줄여도 문항별 응답수준별 가중치를 부여하면 AUC가 일관되게 증가함을 확인하였다. 증상문항 4개와 신체부위문항 7개를 통합한 11개 문항에 가중치를 부여하는 모형이 변별력, 재현도, 편의성 측면에서 우수한 것으로 나타나, 이를 기준으로 새로운 업무관련성 근골격계 질환 설문지를 설계할 수 있었다. 문항수가 적으면서도 타당도는 높은 설문지를 개발하고, 상대적인 비교평가에 쓰일 수 있는 정량적 가중치를 제시한 것이 본 연구의 주요성과라 할 수 있다. 본 연구는 전문의 사이의 진단기준 차이를 고려하지 못한 점, 다양한 인구집단에 적용할만한 절대적인 참고치를 제시하지 못한 점 등에서 한계가 있다. 그러나, '측정 도구의 정량적 타당도 검증을 통한 질병 감시용 도구 개발'이라는 본 연구의 기본 취지 및 접근방법은 향후 조직적인 질병 예방활동에 활용될 여지가 있을 것이다. Objectives: Receive Operating Characteristic(ROC) curve with the area under the ROC curve(AUC) is one of the most popular indicator to evaluate the criterion validity of the measurement tool. This study was conducted to develop a standardized questionnaire to discriminate workers at high-risk of work-related musculoskeletal disorders using ROC analysis. Methods: The diagnostic results determined by rehabilitation medicine specialists in 370 persons(89 shipyard CAD workers, 113 telephone directory assistant operators, 79 women with occupation, and 89 housewives) were compared with participant's own replies to 'the questionnair on the worker's subjective physical symptoms'(Kwon, 1996). The AUC's from four models with different methods in item selection and weighting were compared with each other. These 4 models were applied to 225 persons, working in an assembly line of motor vehicle, for the purpose of AUC reliability test. Results: In a weighted model with 11 items, the AUC was 0.8155 in the primary study population, and 0.8026 in the secondary study population(p=0.3780). It was superior in the aspects of discriminability, reliability and convenience. A new questionnaire of musculoskeletal disorder could be constructed by this model. Conclusion: A more valid questionnaire with a small number of items and the quantitative weight scores useful for the relative comparisons are the main results of this study. While the absolute reference value applicable to the wide range of populations was not estimated, the basic intent of this study, developing a surveillance fool through quantitative validation of the measures, would serve for the systematic disease prevention activities.

서울지역 대기오염이 호흡기계질환에 미치는 단기영향에 관한 환자교차연구

이영주,이종태,신동천,임형준,조수헌,주영수,Lee, Young-Ju,Lee, Jong-Tae,Shin, Dong-Chun,Im, Hyoung-June,Cho, Soo-Hun,Ju, Young-Su 대한예방의학회 2001 예방의학회지 Vol.34 No.3

Objectives : To evaluate the hypothesis that air pollution could increase emergency room visits for respiratory diseases, and if so, to quantify the strength of association between those. Methods : We compiled daily records of hospital emergency room visits for respiratory diseases in Seoul, from November 1. 1955 to October 31. 1996, by using medical utilization data of unscheduled visits. In addition, air quality and weather data for the same period was collected. And a case-crossover design was applied by adopting conditional logistic regression analysis to determine the relationship between air pollutants and emergency room visits for respiratory diseases. In particular, the control periods were chosen by a bidirectional paired matching technique 7, 14, and 21 days before and after the case periods. Results : Only ozone was associated with the increased number of emergency room visits for respiratory diseases. The relative risk according to a 30ppb increase of ozone concentration (24hr mean, lagged 1day) was 1.91(95% confidence interval = 1.78-2.05). Conclusion : There was a statistically significant association between the ambient ozone and daily emergency room visits for respiratory diseases.

직업성 요통환자에서 재활 프로그램(Back School Program) 도입의 비용-편익분석

주영수,하미나,한상환,권호장,조수헌,김창엽,김선민,Ju, Yeong-Su,Ha, Mi-Na,Han, Sang-Hwan,Kwon, Ho-Jang,Cho, Soo-Hun,Kim, Chang-Yup,Kim, Sun-Min 대한예방의학회 1996 예방의학회지 Vol.29 No.2

Although occupational low back pain accounts for $20\sim40%$ of all occupational illness and injury, there are limited numbers of studies regarding the effectiveness of back school program. The objective of this study was to evaluate the economic benefit of back school program for early return to work of occupational low back pain patients in the current occupational injury compensation and management system. The cost-benefit analysis in this study was conducted to evaluate the relative magnitude of benefit to cost. The total cost was estimated by calculating the value of components in back school program according to governmental budget protocol. The back school program was consisted of three major approaches, pain center, work-hardening program and funcional restoration program and each of components had various facilities and experts. The total amount of cost was estimated as 250,866,220 won per year. The most promising type of back school program were quite intensive (a 3 to 5-week stay in a specialized center), therefore, if we adopted the 5-week stay course, 10 courses could be held in a year. Following to the medical act, 20 patients per doctor could participate in a each course, ie, total 200 patients in a year. As a result, we could estimate the cost of 1,254,331 won a patient. We estimated the benefit by using data of a few local labor offices about average medical treatment beneficiary and off-duty beneficiary of 46 occupational low back pain patients in 1994. Ullman and Larsson (1977) mentioned that the group of chronic low back pain patients who participated in back school program needed less time to recover by 48.4% of beneficiary duration. And in the trying to estimate the benefit, we asked 10 rehabilitation board certificate doctors about reduction proportion of treatment cost by introducing back school program. The answered reduction proportions were in the range of $30\sim45%$, average 39%. As a final result, we could see that the introduction of back school program in treatment of chronic occupational low back pain patients could produce the benefit to cost ratio as 3.90 and 6.28. And we could conclude that the introduction of back school program was beneficial to current occupational injury compensation and management system.

한국판 국제 소아천식 및 알레르기 질환 연구 설문지의 신뢰도 및 타당도 연구

최성우,주영수,김대성,김재용,권호장,강대희,이상일,조수헌,Choi, Seong-Woo,Ju, Yeong-Su,Kim, Dae-Sung,Kim, Jae-Yong,Kwon, Ho-Jang,Kang, Dae-Hee,Lee, Sang-Il,Cho, Soo-Hun 대한예방의학회 1998 예방의학회지 Vol.31 No.3

Recent increases of asthma and allergies in childhood made the need for a standardized approach to international and regional comparisons of their prevalence and severity. To address these issues, 'International Study of Asthma and Allergies in Childhood (ISAAC)' is currently underway. In Korea, 'Nationwide Study of Asthma and Allergies in Korean Children' began in 1995 according to ISAAC protocol. ISAAC written and video questionnaires were used in this survey, but their reliability and validity were not evaluated properly yet. In this study, our aim was to evaluate the reliability and validity of two kinds of questionnaires and their usefulness in international and regional comparisons. The test and retest of two questionniares were completed by male(n=110) and female(n=111) middle school students with two and three weeks interval each. Kappa(or weighted kappa) were calculated from each questions and validity coefficients were estimated from those statistics. In Korean version of written questionnaire, the questions for allergic rhinitis, atopic dermatitis, allergic conjunctivitis, and food allergy proved to have high kappa values (or weighted kappa values) and validity coefficients and they can be used in further studies without any correction. But some questions about asthma(especially nocturnal cough, wheezing in exercise, and severe asthma) and drug allergy need to be revised for better under-standing to study subjects. Video questionnaire has the same degree of reliability and validity when compared to written questionnaire and this is the unexpected result. Accordingly, it also need to be revised to overcome the racial and cultural differences of the study subjects. In conclusion, the Korean version of written and video questionnaires may be considered to be useful methods in international and regional comparisons of asthma and allergic diseases in childhood after correction of some questions.