아동기 주의력결핍 과잉행동장애의 유해환경인자

권호장(Ho Jang Kwon),하미나(Mina Ha),김붕년(Bung Nyun Kim),임명호(Myung Ho Lim) 대한소아청소년정신의학회 2016 소아청소년정신의학 Vol.27 No.4

Attention-deficit hyperactivity disorder (ADHD) is a common, childhood-onset, neuropsychiatric disorder with an estimated prevalence of 2–7.6% in Korean children. Although the etiology of ADHD is not well understood, evidence from genetic factor and environmental factor studies suggests that ADHD results from a gene environmental interaction. In the current study, we reviewed the evidence for and clinical implications of the hypothetical roles of organophosphate pesticides, organochlorine pesticides, polychlorinated biphenyls, phthalate, bisphenol, polyfluoroalkyl chemicals, polycyclic aromatic hydrocarbons, mercury, lead, arsenic, cadmium, manganese, tobacco, alcohol as harmful risk factors in the development of ADHD.

Children's Health and Environmental Research (CHEER) Study in Korea

Ho-Jang Kwon(권호장) 환경독성보건학회 2008 한국독성학회 심포지움 및 학술발표회 Vol.- No.-

이산화질소 개인 노출량이 기관지천식 환자의 최대호기유속에 미치는 영향

권호장,이상규,지영구,이상록,황승식,Kwon, Ho-Jang,Lee, Sang-Gyu,Jee, Young-Koo,Lee, Sang-Rok,Hwang, Seung-Sik 대한예방의학회 2007 예방의학회지 Vol.40 No.1

Objectives : Nitrogen dioxide $(NO_2)$ has been inconsistently associated with gradual decreases in lung function. Here, we studied the effects of $NO_2$ exposure in asthmatics by examining the association between changes in lung function and concentrations of $NO_2$ which were personally measured. Methods : Peak expiratory flow (PEF) and daily personal exposures to $NO_2$ were recorded on 28 patients with asthma (confirmed by methacholine provocation test) over 4 weeks. We used generalized estimating equations to assess the relationship between personal $NO_2$ exposure and PEF, adjusting for potential confounders such as age, gender, outdoor particulate matter, temperature, humidity, and exposure to environmental tobacco smoke. Results : The personal $NO_2$ exposures were higher than the corresponding ambient levels. The mean personal: ambient ratio for $NO_2$ was 1.48. The personal $NO_2$ exposures were not associated with the morning PEF, evening PEF, or the diurnal PEF variability. However, environmental tobacco smoke was negatively associated with both the morning and evening PEF. Conclusions : Among the asthmatic adults who participated in this study, we found no apparent impact of personal $NO_2$ exposures on the peak expiratory flow.

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

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.

설문지에 의한 대기오염의 호흡기계 증상 발현에 관한 조사연구

권호장,조수헌,김선민,하미나,한상환,Kwon, Ho-Jang,Cho, Soo-Hun,Kim, Sun-Min,Ha, Mi-Na,Han, Sang-Hwan 대한예방의학회 1994 예방의학회지 Vol.27 No.2

A cross-sectional study was conducted in an effort to investigate the effect of air pollution on respiratory symptoms. Two groups of female aged more than 20 living in the unpolluted rural area of Taebul (n=159) and urban area of Taegu (n=140) were selected. The ATS-DLD-78 questionnaire was translated into Korean and administered with minor modification. The proportion of smoker was less than 1% in both area. Exposure to smoking and higher educational level were more frequent in Taegu. Age-adjusted prevalence rates of 'chronic cough', 'chronic sputum', 'wheezing', and 'dyspnea' were higher in Taegu than in Taebul. In particular, the prevalence rate of 'chronic sputum' in Taegu was found to be higher, which was statistically significant. Exposure to smoking and education level were not concerned with all respiratory symptom prevalence rates. In conclusion, this study Indicates that an urban factor is related to the rates of respiratory symptoms in Korea.

고성 폐금속 광산 오염 사건의 교훈

권호장,Kwon, Ho-Jang 한국환경보건학회 2011 한국환경보건학회지 Vol.37 No.5

The Goseong abandoned mine accident was a typical case of long-term sequela resulting from environmental disruption during the rapid economic development of Korea. While the final conclusion of epidemiologic investigation was that residents surrounding the abandoned mine were simply exposed to cadmium from the abandoned mine without any patient contracting 'itai-itai' disease, not only did residents around the abandoned mine suffer enormous psychological and economic damage, but people in neighbouring communities did as well when the entire area was stigmatized as an contaminated area. Environmental civic groups and the government worked together to solve the problem by forming a joint committee which held the right of decision in any matter to be determined. By inviting all the stakeholders to participate in the joint committee, a transparent investigation was guaranteed and the results of investigation and recommendations to solve the problem were accepted by all involved. Even though the environmental health division in Ministry of Environment has developed considerably and built up a capacity to deal with environmental accidents, the process which was adopted to solving the Goseong abandoned mine accident can be useful to settle environmental health issues with severe conflicts among stakeholders.

다이옥신과 건강: 인체 노출 수준 및 건강영향에 대한 역학적 연구

장재연,권호장,Jang, Jae-Yeon,Kwon, Ho-Jang 대한예방의학회 2003 예방의학회지 Vol.36 No.4

General information is summarized, that is necessary to introduce a scientific assessment of the human health and exposure issue concerning dioxin and dioxin-like compound. Scientific literatures were reviewed to assess the background exposures to the dioxin-like compounds for normal residents. Epidemiologic studies were also reviewed to assess malignant and nonmalignant sweets of dioxins. In 1997, the International Agency for Research on Cancer classified 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) as a human carcinogen, primarily based on occupational cohort studies. The US Environmental Protection Agency made the same decision in it's Draft Dioxin Reassessment. Epidemiologic evidences point to a generalized excess of all cancers, without any pronounced excess at specific sites. Reported non-cancer effects included a range of conditions affecting most systems. Among them, chloracne, elevation in gamma glutamyl transferase(GGT), and alterations in reproductive hormones are related to TCDO, Other adverse outcomes, such as lipid concentrations, diabetes, circulatory and heart diseases, immunologic disorders, neurobehavioral effects, and developmental outcomes require further study before their respective relationships to TCDD can be more definitively assessed.

대기오염 역학연구의 주요 쟁점들

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

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.

2002년 봄 서울 지역에 발생한 심한 황사가 일별 사망에 미치는 영향

황승식,권호장,조수헌,Hwang, Seung-Sik,Kwon, Ho-Jang,Cho, Soo-Hun 대한예방의학회 2005 예방의학회지 Vol.38 No.2

Objectives: During the spring of 2002, an unprecedented 2 Asian dust events were experienced in Seoul. On those days, the $PM_{10}$ was surprisingly increased, with daily $PM_{10}$ averages exceeding $600\;and\;700{\mu}g/m^3$ on March 21 and April 8, respectively. Accordingly, public concern relating to the possible adverse health effects of these dust events has increased, as the dust arrives in Korea after having flown over heavily industrialized eastern China. We investigated the effects of these Asian dust events on the mortality during the spring of 2002, in Seoul, Korea. Methods: The total number of deaths per day during the spring of 2002 in Seoul was extracted form the mortality records of the National Statistical Office. We constructed 14 Asian dust days (March 17-March 23, April 7-April 13) and 42 control days during the 56 day study period (March 3-April 27) with respect to the days of the week. The daily average numbers of deaths between the Asian dust and control days were analyzed, with adjustment for meteorological variables and pollutants. Results: The daily PM10 average during the Asian dust weeks was $295.2{\mu}g/m^3$, which was significantly higher than during the control days (p<0.001). The daily average number of deaths from all causes during the Asian dust days was 109.9; 65.6 for those aged 65 years and older, 6.7 from respiratory causes (J00-J99) and 25.6 from cardiovascular causes (I00-I99). The estimated percentage increases in the rate of deaths were 2.5% (95% CI=-5.0-10.6) from all causes; 2.2% (95% CI=-7.4-12.8) for those aged 65 years and older, and 36.5% (95% CI=0.7-85.0) from respiratory causes, but with a 6.1% (95% CI=-19.7-9.7) decrease in deaths from cardiovascular causes. Conclusion: The Asian dust events were found to be weakly associated with the risk of death from all causes. However, the association between dust events and deaths from respiratory causes was stronger. This suggests that persons with advanced respiratory diseases may be susceptible to Asian dust events.

서울시의 대기오염과 일별 사망자 수의 관련성에 대한 시계열적 연구

조수헌,권호장,Cho, Soo-Hun,Kwon, Ho-Jang 대한예방의학회 1999 예방의학회지 Vol.32 No.2

Objectives: To examine the relationship between air pollution exposure and mortality in Seoul for the years of 1991-1995, Methods: Daily counts of death were analyzed by general additive Poisson model, with adjustment for effects of secular trend, seasonal factor, day of the week, heat wave, temperature, and humidity. Pollution variables were ozone, nitrogen dioxide, total suspended particles(TSP), and sulfur dioxide. Results: Daily death counts were associated with ozone(1 day before), nitrogen dioxide(1 day before), TSP(2 days before), sulfur dioxide(2 days before). The association with ozone was most statisfically significant and independent of other air pollutants. Increase of 100 ppb in ozone was associated with 0%(95% Cl= 2%-10%) increase in the daily number of death, This effect was greater in persons aged 65 and older. The relative risks of death from respiratory disease and cardiovascular disease were greater than for all-cause mortality in each pollutant. After ozone level exceeds 25 ppb, the dose-response relationship between mortality and ozone was almost linear. However, the effect of TSP, sulfur dioxide, and nitrogen dioxide on mortality might be confounded with each other. Conclusion: Daily variations in air pollution within the range currently occurring in Seoul might have an adverse effect on daily mortality.