대기오염 역학연구의 주요 쟁점들

하은희,권호장,Ha, Eun-Hee,Kwon, Ho-Jang 대한예방의학회 2001 예방의학회지 Vol.34 No.2

우리는 이 글에서 대기오염의 건강영향, 특히 사망에 대한 역학 연구 결과를 해석하는데 논란이 되고 있는 쟁점들을 고찰하였다. 과거 런던스모그 때와 같은 극심한 대기오염 사건 때는 그로 인한 건강영향도 매우 자명하여 별다른 논란의 소지가 없었다. 그러나 오늘날 우리가 경험하는 수준의 대기오염은 눈에 바로 띨 정도의 건강영향을 초래하지는 않기 때문에 많은 연구에서 관찰되는 통계적 유의성이 인과적 관련성을 의미하는지에 대한 많은 논란이 있다. Hill의 인과성기준에 비추어 대기오염에 관한 역학 연구 결과들을 평가해보면 각 기준 별로 부합되는 소견과 그렇지 않은 소견이 같이 존재하지만 전체적으로는 인과적인 관련성을 지지하는 증거들이 많은 편이다. 특히 세계 여러 지역에서 수행된 연구들에서 공통된 결과들이 나오는 것이 인과성을 지지해주는 강력한 근거라고 할 수 있다. 대기오염이 사망을 증가시킨다고 가정할때 구체적으로 어떤 병태 생리적인 기전을 통해서 증가시키는지는 아직 충분히 밝혀져 있지 않다. 현재까지의 역학연구 결과들과 동물실험 결과들을 종합해보면 대기오염 물질이 일차적으로 폐포에 염증을 유발하고 이에 따라 이차적으로 혈장의 응고성이 증가하거나, 심장에 대한 자율신경조절에 이상이 생겨서 사망위험이 증가한다는 가설이 가장 폭넓은 지지를 받고 있다. 시계열분석에서 나타나는 대기오염에 의한 초과사망자들이 어떤 특성을 가지고 있는지에 대한 논란도 많다. 대기오염이 아니더라도 곧 사망할 사람들이 대기오염 때문에 몇 일 앞당겨 사망한다는, 즉 추수효과에 의한 것이라는 것이 상식적인 판단이지만 최근의 연구들은 추수효과 외에도 대기오염에 의해 실질적인 수명의 감소가 있다는 증거들을 제시하고 있다. 대기오염 물질과 사망의 양-반응 관계가 어떤 모양일지, 그리고 문턱값이 존재하는지의 여부도 중요한 관심사이다. 특히 문턱값의 존재 여부는 대기오염 관리 대책과도 밀접한 관계가 있다. 대기환경 기준을 정해서 대기오염 수준을 관리하는 현재의 대책은 문턱간의 존재를 전제하고 있기 때문이다. 그러나 현재까지의 증거를 종합해보면 대기오염과 사망의 관련성은 문턱값이 없는 선형적 관계일 가능성이 높다. 따라서 향후 대기오염 관리대책에서는 대기오염 물질의 평균농도를 낮추려는 노력을 병행하여야 할 것을 생각한다. The purpose of this review is to discuss the debate concerning the interpretation of epidemiologic studies on particles and health effects. Study of the 1952 air pollution disaster in London established that very high levels of particulate-based smog can cause dramatic increases in daily mortality. However, recent epidemiologic studies have reported statistically significant health effects and mortality due to low levels of air pollution. The statistical significance does not prove causation in observational studies; therefore it is necessary to evaluate these associations. There are arguments for and against each of the numerous studies using Hill's criteria, however the body of accepted evidence supports the causal association. In particular, a high level of consistency in the estimated effect of PM10 has been observed across studies worldwide. The mechanism of the relationship between air pollution and health effects is not obvious. The mechanism of particle-induced injury may involve the production of an inflammatory response by the particulate. The harvesting and the threshold effect are also major concerns regarding the health effects of air pollution. However, current epidemiologic findings indicate that linear models lacking a threshold are appropriate for assessing the effect of particulate air pollution on daily mortality even at current levels.

유럽 각국의 산업보건제도-덴마크 (Denmark)

하은희,박혜숙,김정연,Ha, Eun-Hui,Park, Hye-Suk,Kim, Jeong-Yeon 대한산업보건협회 1999 산업보건 Vol.132 No.-

유럽 각국의 산업보건제도-아일랜드 (Ireland)

하은희,박혜숙,김정연,Ha, Eun-Hui,Park, Hye-Suk,Kim, Jeong-Yeon 대한산업보건협회 1999 산업보건 Vol.129 No.-

조선업 생산직 근로자들의 산업보건서비스에 대한 만족도 및 필요도

하은희 大韓産業醫學會 1998 대한직업환경의학회지 Vol.10 No.1

In order to make an effective occupational health service program in a shipbuilding industry, I surveyed the workers' recognition of current occupational health service provided in health department of the workplace, their satisfaction with it and their need of future service. During 4 months in 1995(from April lst to July 31th), structured questionnaires were administered to 680 participants in health education program in shipbuilding industry in Inchon.. Most of them were men. They were young workers of 20-29 years old and their work tenures were short(5 years or less). They knew that main activity of current OHS was treatment of disease in workplace, but their satisfaction with current OHS was not good. Their satisfaction with management of general diseases was high in the case of acute disease, namely, URI, diarrhea, abdominal pain, however their need of future service in general diseases was high in the case of chronic disease, namely, hepatitis, back pain and so on. Their concern of work related disease, their recognition of and satisfaction with preplacement medical examination was high, and they need more medical care of occupational disease. In working environmental management service, recognition of and satisfaction with the activities related to the personal protectives, safety management were high, and they need highly communication of environmental evaluation and improvement of working environment. The opinions of workers strongly showed the need of improvement in specific health examination and evaluation of work environment. Conclusively the workers were not satisfied with current in plant occupational health service. They wanted better services, especially in the medical care of occupational disease and the management of work environment.

유럽 각국의 산업보건제도-그리스 (Greece)

하은희,박혜숙,김정연,Ha, Eun-Hui,Park, Hye-Suk,Kim, Jeong-Yeon 대한산업보건협회 1998 산업보건 Vol.127 No.-

철강제조업 생산직 남성 근로자의 건강행태에 관한 연구

하은희,임현술,위자형,곽정옥,Ha, Eun-Hee,Lim, Hyun-Sul,Wie, Cha-Hyung,Kwak, Jung-Ok 대한예방의학회 1996 예방의학회지 Vol.29 No.1

This study was carried out to evaluate the relations among workers' general characteristics, work-related behaviors and health related behaviors in a steel industry with 1,134 workers in Pohang. The results were as follows; 1. The mean age of workers was 50 years old and working duration was 15 years and over. Most of them were married(94.5%) and had studied beyond high school (53.0%). They performed three shift work and most of them(63.0%) had experienced industial accidents. The frequency of noise and dust exposure was defined by a minimum of 6 hours per day, and workers complained about noise exposure(62.9%) and dust(55.6%). There were current smokers(67.7%), current drinkers(74.3%) and current exercising workers(32.3%) in the industry. The number of cigarette consumption in current drinkers was significantly high $(13.6{\pm}8.4\;pieces/day)$ and the alcohol consumption in current smokers was significantly high$(104.5{\pm}113.5\;g/wk)$. And the number of cigarette consumption of exercisers was significantly low and the alcohol consumption of exercisers was higher than non-exercisers. 3. The ratio of current smokers on frequent noise in exposed workers versus non-exposed workers was not significantly high but the current drinkers in frequent noise and dust exposed workers was significantly higher than non-exposed. 4. The normal levels of SGOT workers in non-smokers were significantly higher than in current smokers, and the normal levels of LFT (SGOT, SGPT, $\gamma-GTP$ workers in nondrinkers were significantly high. The normal levels of SBP and DBP workers in current smokers were not significantly high but were significantly high in non-drinkers. 5. The ratio of current smokers in voters unsatisfied with their job and working condition was higher than non-smokers, but the ratio of current drinkers in workers satisfied with their job and working condition were higher. 6. The significant factors for SGOT and $\gamma-GTP$ were age, the drinking amount and BMI. But the only significant factor for r-GTP was BMI. The significant factors for DBP were age, the alcohol consumption and BMI. And the significant factors for SBP were age, BMI.

전국 MCS와 BRI 유병률 조사 전략(학회 차원)_환경성질환 증상유병률 조사 연구(안)

하은희,장태원,서춘희,홍윤철,김정원,채유미,장규진,채홍재,김병권,김환철,이미영,임종한 대한직업환경의학회 2012 대한직업환경의학회 학술대회 논문집 Vol.2012 No.11

산모(태아) 및 영유아 환경적 위험요인 : Mothers and Children's Environmental Health (MOCEH) 코호트 연구 중심

하은희,김병미 대한직업환경의학회 2009 대한직업환경의학회 학술대회 논문집 Vol.43 No.-

우리나라 어린이 환경보건 코호트 구축 방안

하은희,정경숙,임종한,김병미,김환철,김양호 대한직업환경의학회 2014 대한직업환경의학회 학술대회 논문집 Vol.2014 No.11

일부 여자대학교 학생들의 영양지식, 태도, 식행동 및 식품섭취상태와 그 관련요인에 관한 연구 - 1학년, 4학년 중심으로 -

하은희,김선희,강지용,Ha, Eun-Hee,Kim, Sun-Hee,Kang, Ji-Yong 대한예방의학회 1990 Journal of Preventive Medicine and Public Health Vol.23 No.4

This study was conducted to analyze the relations among nutritional knowledge, nutrional attitude, eating practice and total nutritional diagnosis and also to find the influencing factors of them. The survey was done during the period from April 1990 to June 1990 and the target population were Ewha Womans University students (freshmen and senior) of whom 1,354 peoples were surveyed. The summarized results are as follows ; 1. For the teaming environment, the percentage of completion on nutritional knowledge course was 28.6% and among them the department of foods and nutrition had the highest score(100.0%) and the next was dept. of medicine (53.4%). 2. To find the relation which the nutritional knowledge, nutritional attitude, eating practice and the total nutritional diagnosis influence on one another, the multiple correlation analysis was done. The attitude and the practice were highly correlated with total nutritional diagnosis, but the correlation between nutritional knowledge and total nutrional diagnosis was not significant. The correlation between the practice and nutritional knowledge which were positively and significantly correlated with attitude respectively was positive but not significant. 3. The difference which were analyzed by department, grade and completion on knowledge course on the nutritional knowledge, attitude, eating practice were significant (p<0.01) by ANOVA. 4. The significant variables on nutritional diagnosis are the eating practice points, the grade, the knowledge course, the breakfast and the attitude ($r^2=10.3%$) by multiple regression analysis. This study has the limitation that it did not consider the environmental factors of dietary life such as dietary culture, family environment, cultural habit. Therefore important points of these dietary studies are to extend to the practical nutritional education and dietary improvement for the national health not restricted to the local area or local population.