Obituary: Dr. Hyun-Sul Lim’s (1952-2018) life as an epidemiologist, occupational and environmental medicine researcher, and family physician

1 Dr. Hyun-Sul Lim passed away on June 21, 2018 (Figures 1 and 2). He had suffered from gallbladder cancer, which was detected in June 2017. He was buried in Catholic Yongin Park Cemetery on June 23, 2018. He left his wife, one son, and one daughter. I vividly remember a scene from 37 years ago, in March 1981, when I visited Chunseong-gun Health Center in Chuncheon, Korea, where he was the director. At that time, the medical college I attended, Seoul National University College of Medicine, had implemented a curriculum entitled “Community Medicine Practice.” When I and other friends visited Chunseong-gun Health Center, he welcomed us kindly and gave us guidelines for approaching members of the community. Three of us, including me, moved to Dong-myeon Subsidiary Health Center. We stayed there for 5 days and sought a research theme. We eventually finished our work successfully, and the results were presented before him and other friends. He encouraged us and emphasized the importance of community health. Although that meeting with him was short, I had the chance to meet him frequently when I worked at Seoul National University College of Medicine as a research and education assistant from March 1986 to February 1988. After moving to Hallym University in March 1988, I remained in touch with him. Although Dr. Lim was 4 years senior than me as an alumnus, we maintained a close relationship that originated from our experiences in Chuncheon in 1981. Dr. Lim graduated from Seoul National University College of Medicine in 1978, and received his MPH (Master of Public Health) Open Access

RESULTS: The average checklists score was 9.74 (out of 15 points), which increased significantly after education was provided (by 0.84, p<0.001).
The participants demonstrated improved practices in recording storage temperatures (p=0.016), storing vaccines in the center of the refrigerator (p=0.004), storing vaccines with other medication and non-medical items (p=0.031) after education. The average score calculated from the questionnaires was 10.48 (out of 14 points), which increased after education (by 1.03, p<0.001).
CONCLUSIONS: This study suggests that vaccine storage practices and awareness are inadequate, but can be partially improved by providing relevant education. Repetitive education and policy-making are required to store vaccines safely because one-off education and unenforced guidelines offer limited efficacy. BACKGROUND AND OBJECTIVES: Firefighters face serious risks to their health and safety in the performance of their duties. In addition to the diverse occupational hazards well-known to the public, firefighters are also occasionally exposed to high levels of noise, such as sirens, horns, and electronic alerting signals.
MATERIALS AND METHODS: We first measured the noise emitted by two fire trucks and one ambulance. Next, we enrolled 171 firefighters (164 males, seven females). We designated the employees of a private school as controls for the firefighter group. After selecting workers, including audiometric testing at 1,000 and 4,000 Hz, the groups were age-and gender-matched.
Both groups were included separately for the right and left ears at pure-tone test frequencies at 1,000 and 4,000 Hz. We chose the better ear thresholds and analyzed the differences in hearing levels at each frequency and each age group between the firefighters and controls.
RESULTS: The sound pressure levels of the siren in and out of an ambulance, the first fire truck, and the second fire truck were 99.3 dB (A) and 108.9 dB (A), 92.3 dB (A) and 108.3, and 78.8 dB (A) and 99.0 dB (A), respectively. At 4,000 Hz, the hearing threshold was significantly increased by work period (p<0.01). Each hearing threshold level was significantly higher than controls (p<0.01).
CONCLUSIONS: Many of the noise sources produce sounds exceeding 90 dB (A), and some firefighters may be exposed for brief periods to levels that exceed 105-110 dB (A). The hearing threshold level in firefighters is higher than the general population and noise-induced hearing loss in firefighters is possible. In the future, consistent, effective, and long-standing implementation of hearing conservation programs are needed, and special health examinations for hearing levels in firefighters must be Praziquantel is the drug of choice for clonorchiasis. Since clonorchiasis is endemic in most river basins, praziquantel has been widely used for 30 years in Korea. A 54-year-old Korean woman suffered from hypersensitive reactions, such as nausea, dyspnea, rash, and urticaria after taking the first dose of praziquantel to treat clonorchiasis. She ingested one dose again and the same symptoms appeared, and she was treated at a clinic with anti-histamines. She tried one more dose with anti-histamines but found the same symptoms. Later, she was found to pass eggs of Clonorchis sinensis and medicated with flubendazole. The hypersensitive reaction to praziquantel is rare but occurs. This is the 5th case report in the world. METHODS: We conducted a questionnaire survey among 193 persons, and we examined 21 rectal swabs and 6 environmental specimens. We also delegated the Daegu Bukgu public health center to examine 3 food service employees and 5 environmental specimens from the P buffet which served a buffet on June 30. The patient case was defined as a worker of L Corporation and who participated in the company meal service and who had diarrhea more than one time. We also collected the underground water filter of the company on July 23.
RESULTS: The attack rate of diarrhea among the employees was 20.3%. The epidemic curve showed that a single exposure peaked on July 1. The relative risk of attendance and non-attendance by date was highest for the lunch of June 30 (35.62; 95% CI, 2.25 to 574.79). There was no specific food that was statistically regarded as the source of the outbreak. Bacillus cereus was cultured from two of the rectal swabs, two of the preserved foods and the underground water filter. We thought the exposure date was lunch of CONCLUSIONS: Our results indicate that the degree of disability can be reduced by decreasing prehospital delayed time. We suggest that education of high risk groups and establishment of emergency services as well as a transport system for stroke patients are required to reduce the degree of disability due to stroke. RESULTS: The attack rate was 21.3% (111/520) between January 29 and February 10, and norovirus GII was isolated from 12 of 21 students. Food handlers had no symptoms and their stool samples were negative. The case-control study revealed that seasoned soy bean sprouts {odds ratio (OR): 2.542, 95% CI=1.315-4.915} and drinking water from the purifiers in the cafeteria (OR: 2.854, 95% CI=1.107-7.358) supplied on February 3 were significant risk factors for the outbreak. Water pipes and waste pipes were located in the same place where was filled with some water and trace of high water level was detected.
CONCLUSIONS: The major risk factors for this norovirus outbreak were presumed to be the contaminated seasoned soy bean sprouts and drinking water from the purifiers in the cafeteria. More strict personal and environmental hygiene need to be enforced to prevent such outbreaks. RESULTS: The awareness levels for brucellosis, Q fever, and EHEC were 90.2%, 2.5% and 56.6%, respectively. Awareness of brucellosis and EHEC were tended to increase with higher number of school years. Television was the most common route of information for these zoonoses. Most common responses for questions concerning the method of transmission for each zoonoses, 'Contact with parturient fluid or placenta of animal' was 63.2% for brucellosis, 'Ingestion of raw meat or residual product' was 66.7% and 64.2% for Q fever and EHEC, respectively. The most common reason why dairy farmers think that it is difficult to prevent zoonoses was the inconvenience of wearing protection. CONCLUSIONS: Education programs for zoonoses, especially Q fever, are needed for dairy farmers. In addition, publicity information activities about prevention of zoonoses are needed for high risk groups, such as the dairy farmers surveyed. Health care workers encounter many physical hazards in hospitals, including ionizing radiation, noise, and heat. Ionizing radiation is used in hospitals for diagnostic radiology, therapeutic radiology, dermatology, nuclear medicine, and in radiopharmaceutical laboratories. Radiation hazards may also exist in areas where radioactive materials are stored or discarded. Occupational exposure to ionizing radiation can lead to erythema or radiodermatitis. Ionizing radiation can cause gene mutation and chromosomal alteration. Other somatic effects that result from irradiation include several types of cancers (myelogenous leukemia, bone cancer, skin cancer, thyroid cancer, etc.), cataracts, aplastic anemia, and sterility.
The chief methods for reducing doses of ionizing radiation from external X-rays and gamma rays are to limit the time of exposure, increase the distance from the source of the exposure, shield the source with protective materials, and avoid unnecessary exposures. Improved equipment, knowledge, and reduced exposures can greatly reduce the risk of radiation exposure for workers. Many work areas in hospitals were identified as noisy enough to decrease productivity. Noise may trigger changes in cardiovascular, endocrine, neurological, and other physiological functions. Working in high-noise areas makes it difficult for workers to communicate among themselves or to concentrate on critical job functions. Many places in hospitals including the laundry, boiler room, and kitchen may be hot during the summer months, especially in older facilities that have inadequate ventilation and cooling systems. Health care workers should pay attention to health disorders caused by physical factors to protect themselves against many hazards in hospitals. RESULTS: The subjects' urinary t,t-MA concentration (geometric mean and geometric standard deviation) was 0.28 mg/g creatinine (2.62). No significant differences between different occupations among the chemical workers were found. The urinary t,t-MA concentrations in the smokers and non-smokers were 0.32 mg/g creatinine (2.44) and 0.25 mg/g creatinine (2.77) respectively, and the difference was statistically significant (p<0.05). There was no significant difference in the platelet count based on occupation and the smoking history. There was significant correlation between log(platelet) and log(t,t-MA)(r=-0.116 p=0.039). The regression equation log(platelet) = -0.002xAge + [-0.029xlog(t,t-MA)] + 2.436, R2=0.032, was calculated from linear regression analysis with log(platelet) as the dependent variable. Cross-tabulation between 2 subgroups that were divided by the 90-percentile level of the t,t-MA (0.819 mg/g creatinine), and 2 subgroups that were divided by the 10-percentile level of the platelet count (175,000) was conducted. Higher distribution in subgroup with platelet count below 175,000 was demonstrated in the subgroup with a urinary t,t-MA above the 90-percentile, with an odds ratio of 3.01.
CONCLUSIONS: The study may be limited by not taking into account factors such as smoking quantity and sorbic acid, which may confound urinary the t,t-MA concentration as well as medication and infection that may affect the platelet count. Yet it is meaningful that the correlation between the urinary t,t-MA concentration and the platelet count was found through linear regression analysis and the chi-square test, and further, this outcome may be used as a basis for a study to establish the acceptable limit of urinary t,t-MA in Korea. OBJECTIVES: The prevalence of work-related musculoskeletal symptoms (WMS) among Korean dairy farmers has not been investigated. The purpose of this study was to assess the prevalence of WMS and to evaluate the relationship between WMS and risk factors. METHODS: Self-developed questionnaires including the questionnaire developed by the Korean Occupational Safety and Health agency (KOSHA) were used to investigate WMS among dairy farmers in Gyeonggi Province, Korea. We informed selected dairy farmers about the study and sent the questionnaires by registered mail. They visited a public health center nearby or a branch of public health center on the appointed date and skillful researchers identified or conducted the questionnaires by interview. We analyzed 598 (32.8%) of the 1824 dairy farmers. Multiple logistic regression was implemented to estimate the odds ratios of risk factors. RESULTS: The mean age of the respondents was 50.4 +/-8.7 years and the proportion of males was 63.0%. The prevalence of WMS at any site was 33.3%. The prevalence of neck WMS was 2.2%, shoulders 10.0%, arms/elbows 5.0%, hands/wrists/fingers 4.2%, low back 11.5%, and legs/feet 11.7%. The adjusted odds ratio of low back WMS for milking 4 or more hours per day was 4.231 (95% CI = 1.124 -15.932) and statistically significant.
Low back WMS (2.827, 95% CI = 1.545 -5.174) was significantly decreased by education. CONCLUSIONS: Low back WMS increased with milking hours and milking 4 or more hours per day was significantly associated with low back WMS. Low back WMS was significantly reduced with education. We hope that there will be increased attention about WMS in dairy farmers and the subject of future investigations. There are many work-related injuries and diseases of fisheries in Korea. Fishermen have exposed to harmful environment, such as natural disasters, ultraviolet, noise, vibration, organic solvents, ergonomic risk factors, loss of fresh water and food, and psychologic stress. They have suffered from numerous work-related health problems, including musculoskeletal disorders, cardiovascular diseases, infectious diseases, pyschological diseases, decompression sickness, and so on. Sea accidents can cause deaths of fishermen and if sea pollution is occurred, fishermen have a great economic damage. However, the concern of these injuries and diseases has been little because they are small in number and have decreased. Fisheries are important core industries, so the problems of fisheries have to be solved by a government. But work-related injuries and diseases are not investigated properly and accurate diagnoses are not made due to loss of concern. We hope that this article will be a cornerstone to solving the work-related problems of fisheries. showed that the infection of shigellosis was happened in foreign countries.
We assumed the water from Angkor-Watt was contaminated by S. flexneri. We could not able to test environmental specimens because of the infection is thought to be occurred in foreign countries.
CONCLUSIONS: Most common infectious diseases from foreign countries are transmitted by water or food. Travellers to foreign countries must take caution for communicable diseases and must do report and get appropriate treatment when symptoms developed after travel.

The Status of Diabetes Mellitus and Effects of Related Factors on Heart
Rate Variability in a Community.
BACKGROUND: This study was performed to examine the status of diabetes mellitus (DM) in the community and effects of related factors on heart rate variability (HRV). METHODS: The author conducted HRV testing, a questionnaire survey, and blood chemistry analysis for fasting blood sugar (FBS) and HbA1c levels in 855 patients in a community over a period of 10 days, from August 14 to 25,2006. The subjects were divided into a DM group and normal group by our study criteria. RESULTS: The proportion of DM was 12.6% and increased with old age. The mean measures of HRV (SDNN, Tp, Vlf, Lf, Hf, Lf/Hf) in the DM group were 22.7 (1.6) msec, 364.9 (2.7) msec2, 174.1 (3.0) msec2, 88.1 (3.2) msec2, 55.3 (3.2) msec2, and 1.6 (2.6), respectively, while those in the normal group were 32.2 (1.6) msec, 676.6 (2.8) msec2, 295.7 (3.1) msec2, 169.2 (3.4) msec2, 117.2 (3.2) msec2, and 1.4 (2.6), respectively. All parameters except for Lf/Hf were significantly lower in the DM group than in the normal group (P < 0.01). The Spearman's correlation coefficients between HRV and FBS or HbA1c were SDNN -0.222/-0.244 (P < 0.01), Tp -0.211/-0.212 (P < 0.01), Vlf -0.149/-0.132 (P < 0.01), Lf -0.188/-0.235 (P < 0.01), Hf -0.207/-0.204 (P < 0.01), and Lf/Hf (P > 0.05), respectively. CONCLUSION: This study shows that the DM group had a reduced HRV and increased pulse rate in comparison with the normal group. According to our results, the HRV test may be used accessorily for the early detection of cardiovascular autonomic neuropathy (CAN) and its related factors, as well as to prevent CAN. OBJECTIVE: This study was conducted to investigate the hygienic state and awareness of drink vending machines in a city.
METHODS: Twelve of the most frequently used vending machines in various areas were selected in October 2008. As soon as fresh samples of milk coffee and adlay tea were collected in sterile containers from each machine, the temperature was measured. The samples were carried on ice to the laboratory to test total plate counts and Escherichia coli contamination. College students were inquired about drink vending machine hygiene by implementing self-developed questionnaires.
RESULTS: The temperature of 6 milk coffee samples (50.0%) and 8 adlay tea samples (66.7%) turned out to be inadequate. The total plate counts of milk coffee samples were all adequate, although 9 adlay tea samples (75.0%) were inadequate. All the beverage samples were negative for E. coli. In questionnaires obtained from 74 users of coffee vending machines, only 2 (2.7%) expected the hygienic state of vending machines to be good. There were 27 people (33.3%) that knew the existence of hygiene-related laws for vending machines.
CONCLUSIONS: This study reveals that the hygienic state of drink vending machines insufficiently reaches the standard for the hot beverage and that most people are not aware of importance of vending machine hygiene. It is necessary to make improvement in the hygiene of vending machines and public awareness in this city. Finally, 213 patents were included in this study. We investigated the degree of paraquat exposure, the Glasgow coma scale, vital signs, blood laboratory tests, calculated SOFA score, and Yamaguchi Index on first hospital day. The prognostic prediction was compared between SOFA score and Yamaguchi Index. OBJECTIVES: The incidence of zoonoses in Korea has increased recently.
However, the study of high risk groups for zoonoses has not been conducted to date in Korea. Thus, we did this study to obtain data on brucellosis among slaughterhouse workers in Korea. METHODS: We evaluated the structure of slaughterhouses and the process of slaughtering by reviewing the relevant literature and doing field studies. We visited 73 slaughterhouses and 62 residual products handle houses across the country. In addition, we conducted a questionnaire survey of the work activities, and obtained blood samples in order to determine the seroprevalence and risk factors of brucellosis. The titers of brucellosis antibodies were measured using the standard tube agglutination test (SAT). We diagnosed subjects as seropositive for Brucellosis if the titers were more than 1:160. The data collected was evaluated using SPSS ver. 17.0. RESULTS: We included 1,503 subjects and obtained 1,482 blood samples among them: 849 workers involved in slaughtering, 351 handlers of residual products, 190 inspectors and their assistants, and 92 grading testers and their assistants. The seroprevalence of brucellosis among the slaughterhouse workers was 0.8% (95% CI=0.4-1.5). Broken down, the seroprevalence of brucellosis among the workers involved in slaughtering was 0.7% (95% CI=0.3-1.6), the handlers of residual products was 1.7% (95% CI=0.7-3.9) respectively. Risk factors for contracting brucellosis among slaughterhouse workers were being splashed with cattle blood around the mouth, cattle secretions around the body and not putting on protective apron while at work. CONCLUSIONS: An educational program is needed for high risk groups on zoonoses about the prevention of infection. Thus, effective working guidelines for workers who participate in the slaughter of animals must be developed in order to protect them from zoonoses. A 52-year-old man was found dead in the driver's seat of his tank lorry.
The tank lorry was used to transport industrial wastewater to a disposal plant; the material was transferred into a storage tank with the help of compressed air. The wastewater contained methylene chloride and 2-chloropyridine. No respiratory protective equipment was used while working under these conditions. The autopsy report showed extensive edema and congestion of the brain, lung, and intraperitoneal organs. The concentrations of methylene chloride in lung and brain were reported at 398 and 67 mg/kg, respectively. We investigated the incidence of insulin resistance syndrome (IRS) according to the criteria of diagnoses suggested by the American College of Endocrinology/ American Association of Clinical Endocrinologists and the risk factors associated with the development of IRS. Among 2,048 subjects without a history of/or drug treatment for hypertension, diabetes, dyslipidemia with normal findings at baseline, 1,578 subjects aged 20-59 yr were followed prospectively for 2 yr. The incidence of IRS was 6.9 per 100 persons/year. The relative risk (RR) due to age was 1.03 (95% CI: 1.00-1.05) with every one-year increase in age. The RR associated with an abnormal waist-hip ratio group (> or =0.9) was increased by 1.74 (95% CI: 1.17-2.58) compared to the normal group (<0.9); RR associated with abnormal alanine transferase was increased (> or =35 IU/L) by 1.70 (95% CI: OBJECTIVES: To propose a screening dose based on the probability of causation (PC) to simplify the evaluation procedure for the work-relatedness of the cancers occurring among Korean radiation workers.
METHODS: Under the PC uncertainty distribution, the screening dose was defined in which the maximum PC is equivalent to 50% for single exposure to radiation, after which the values were calculated according to three significance levels: 90%, 95%, and 99%. By using the screening doses for each cancer, we also predicted the number of compensations for the occupational cancers among the current Korean radiation workers to determine a reasonable criterion for the significance level.
RESULTS: If the cumulative dose received by a radiation worker with cancer is less than the screening dose, then PC can not be greater than 50%, i.e., the case can not be awarded as an occupational disease. The numbers of compensation cases for a future decade were predicted to be 3-5, 4-6, and 6-10 at the significance levels of 90%, 95%, and 99%, respectively. CONCLUSIONS: The procedure to evaluate the occupational disease was greatly simplified by using the screening dose for evaluation. A criterion of 95% was recommended as the PC upper limit following consideration for the results of the predicted cases for compensation and the economic Infectious waterborne and foodborne diseases pose a considerable threat to human health and the economy of individuals, families, and nations. They are the results of ingestion of contaminated water and food stuffs. They have increased recently in Korea. The reasons include the increase in international travels and trade, microbial adaptation, and changes in the food production system, human demographics and behavior as well as the climate change. The contributing factors of infectious waterborne and foodborne outbreaks in institutional settings and at home were reviewed through the epidemiological investigations of them. The most commonly reported diseases (possibly of waterborne origin) were typhoid fever, shigellosis, and viral hepatitis A. The sources of infection were any drinking water including well, spring, mountain, tap, and sea water. The water was contaminated with raining ground water, leakage from the damaged septic tank or pipes. The most commonly identified agents (possibly of foodborne origin) were norovirus, pathogenic E. coli, S. aureus, Salmonella spp., and V. parahemolyticus. The mechanisms of infection were raw food, secondary contamination of the raw food and unsafe storage, contaminations from food handlers, or contaminated water. While cholera was often due to sea water, raw or under-processed seafood were important epidemiological pathways for cholera transmission. Owing to the globalization, imported cases of infectious waterborne and foodborne diseases have been increasing.
We should recognize the outbreak rapidly and strengthen the surveillance.
Also epidemiological investigations should start timely and be done thoroughly with repeat the situation, if necessary. RESULTS: Mean disability duration for minor cervical sprain was 18.8 days, that of moderate cervical disc herniation was 56.2 days, that of serious cervical disc herniation was 141.5 days, that of minor lumbar sprain was 21.2 days, that of moderate lumbar disc herniation was 53.5 days, that of serious lumbar disc herniation was 128.1 days, that of sprain of 3 major joint in lower limb without desmorrhexis was 24.0 days, and that of dislocation or desmorrhexis of 3 major joint in lower limb was 101.2 days.
CONCLUSION: Disability duration of the representative musculoskeletal diseases comparable to AIS code in 4th edition of Korean standard classification of diseases was presented and this study can be utilized as a basic recommended disability duration of automobile injured persons. METHOD: This study was comprised of 88 hands of 49 subjects with symptoms consistent with CTS without median mononeuropathy who were recruited during a community health examination and followed after two years. 88 hands of 44 people with age and sex-matched healthy controls were followed for comparison. Symptoms and electrodiagnostic findings were compared between the two groups.
RESULTS: 62 hands of the symptomatic group had persistent symptoms after 2 years while 16 hands of the control group had symptoms consistent with CTS.
Median motor distal latencies were significantly delayed after two years in the symptomatic group (p<0.05). Median sensory latencies were also delayed in the symptomatic group, but this was not statistically significant (p=0.064). The occurrence rate of median mononeuropathy at wrist was significantly higher in the symptomatic group than in the control group We calculated means, standard deviations, modes, medians, maximums, minimums, and points of inflection for the lengths of admission of patients with these disorders.
RESULTS: The mean length of admission for carpal tunnel syndrome was 8.0+/-6.2 days, that of Raynaud's syndrome was 10.5+/-7.7 days, that of internal derangements of the knee was 12.9+/-11.8 days, that of unspecified internal derangements of the knee was 13.3+/-13.0 days, that of cervical disc disorder with radiculopathy was 16.8+/-19.0 days, that of other cervical disc displacements was 15.9+/-15.9 days, that of lumbar and other intervertebral disc disorders with radiculopathy was 14.9 +/-13.8 days, that of unspecified intervertebral disc displacements was 14.9+/-13.9 days, that of unspecified synovitis and tenosynovitis was 12.5+/-9.9 days, that of ganglions was 7.5+/-7.3 days, that of fasciitis, NEC, was 19.8+/-24.7 days, that of adhesive capsulitis of the shoulder was 15.2+/-15.5 days, that of impingement syndrome of the shoulder was 11.4+/-12.0 days, that of medial epicondylitis was 11.2+/-7.3 days, that of lateral epicondylitis was 12.1+/-11.5 days, that of myalgias was 12.4+/-19.5 days, that of sprain and strain of the cervical spine was 12.4+/-10.2 days, that of sprain and strain of the lumbar spine was 12.3+/-10.9 days, that of a current tear of the meniscus was 13.3+/-13.2 days, and that of sprain and strain involving the cruciate ligaments of the knee was 18. RESULTS: The number of inpatients was increased during late summer and fall. The mean age of all cases was 3.7+/-2.9 years old. One hundred ninety three cases (81.8%) had lung infiltration findings. The mean symptomatic period was 11.9+/-6.4 days (maximum 44 days, minimum 4 days, median 10 days), the mean hospital length of stay was 5.2+/-2.5 days (maximum 17 days, minimum 0 day, median 5 days).

Perspectives of Communicable Disease Surveillance in Korea.
Environmental and climatic changes and the mobility of ever-increasing numbers of people increase the risks for the emergence and reemergence of infectious diseases. Since communicable disease trends change rapidly, many nations have developed individualized communicable disease surveillance systems. In Korea, notification of the incidence of communicable diseases has been the most important form of surveillance since 1954. In addition, the government has established various surveillance systems since the late 1990s. Current problem areas of surveillance systems are the low reporting rate, a lack of representativeness, a lack of participation, and poor utilization. The government has not fully evaluated these systems. For many diseases, it is of critical importance to maintain the confidentiality of surveillance data. Issues of confidentiality are critical and must be considered in order to obtain valid data and protect those surveyed. In the future, we have to improve the reporting rate, enhance collaborations with veterinarians and gain the full support from the governmental departments of agriculture and defense. Surveillance systems should be evaluated regularly. The most dynamic and important part of surveillance is the feedback mechanism. To develop positive feedback, we must disseminate the collected and analyzed information and give reimbursement to the reporters.
We have to built close partnerships with governmental agencies, international organizations, research institutes, private health corporations, and academia. Prevalence of CWP was also significantly higher in female compared to male (19.2% vs 4.0%, p<0.001). Prevalence of CWP also showed increasing trend in the ascending order of age in decade (p<0.001). Except for age and sex, hating vegetables is an associated factor for the development of FMS in CWP [OR 18.7 (95% CI 2.4,145.3)] and diabetes is a risk factor for the development of FMS in normal population [OR 3.7 (95% CI 1.1, 11.9)] on multivariate analyses. Furthermore, we should strengthen our cooperation with aspects of clinical and drug epidemiology in many fields including public health, statistics, and dietetics. Finally, we should raise the level of international cooperation with many countries, including North Korea, to prevent diseases and promote health. Preventive medicine is a science in which practice is as important as theory. We must aim to nurture preventive medicine specialists who practice in many areas of society with the goal of preventing diseases, promoting health, improving fertility, and securing healthy elderly life for individuals and the entire population. To this end, we will endeavor to promote both theoretical and practical components of academic development. RESULTS: The study subjects contained 20 males and 20 females in each groups, and the major age group was the fifth decade (22 cases, 27.5%). The mean values for the total health behavior scores after the DM education program in the PC and WC group were 16.2 +/-1.9, and 16.2 +/-1.7 respectively, and were significantly higher than that before the education program (11.4 +/-2.1, 15.3 +/-1.9, P < 0.05). The mean FBS levels after the DM education program in the PC and WC groups were 130.2 +/-22.8 mg/dL, and 116.2 +/-16.6 mg/dL respectively, and was significantly lower than that before the education program (186.3 +/-33.5 mg/dL, 135.3 +/-16.3 mg/dL, P < 0.05). The mean HbA1c levels after the DM education program in the PC and WC groups were 7.0 +/-0.8%, and 6.2 +/-0.4% respectively, which were significantly lower than that before the education program (9.2 +/-1.4%, 6.5 +/-0.4%, P < 0.05). RESULTS: The scrub typhus cases were 376 during three year period, and the incidence was significantly higher in the county area than in the city area. Incidence of scrub typhus was increasing each year. In 344 epidemiologic surveillance reports, the job of the cases was farmer (67.2%), housewife (4.7%), clerk (3.5%). Two hundred ninety eight cases (86.6%) have experienced outdoor activities before development of the scrub typhus. The outdoor places of exposure were dry field (64.8%), rice field (51.7%), hill (12.8), and grass field (9.7%). The symptoms reported were fever (93.3%), headache (83.7%), chill (69.5%), and rash (54.4%).
CONCLUSIONS: Incidence of scrub typhus was increasing in Gyeongsangbuk-do, Korea, this phenomenon may be related to change of climate, the reporting rate of disease and outing activities. Good surveillance and adequate analysis of epidemiologic data is a essential for the prevention of the disease. With this result, high risk population was identified and effective intervention should be done to prevent the disease. work areas, and we examined their occupations, the date they developed symptoms, the progress of their symptoms, whether or not they were treated, their current status, whether or not they consumed raw milk and raw meat, and if their work was related to cattle breeding and the related details.
We reviewed the results of the blood tests and medical records and we examined the cattle's barn. RESULTS: There were 3 patients in 2003 and 11 patients in 2004. All of their brucella antibody titer exceeded 1: 160. The patients' symptoms were fever, myalgia, malaise, chills and an influenza-like illness, but the clinical signs were absent on the medical records. Brucella abortus were cultured from 3 of the patients' blood samples. CONCLUSIONS: When the authors discovered the transmission routes, they were divided into 4 different sorts. The first route was related to cattle birth such that patients touched the calves or placentas that were infected with the Brucella species. The second route was related to performing artificial insemination on the cattle and the semen that was used for artificial insemination. The third route was due to the ingestion of raw meat and milk. The last route was due to sexual intercourse between the patients. The diarrheal cases were defined as the confirmed cases or the persons who had diarrhea more than one time with symptoms such as fever, vomiting and tenesmus. The diarrheal attack rate was 28.0%. Ingestion of fried bean curd with egg had a significantly high association with the diarrheal attack rate (p< 0.05), and the relative risk of the fried bean curd with egg was 10.68 (95% CI=3.88-29.41), as was determined by logistic regression analysis. The bacterial counts in the tap water of the food preparation room and toilet (first floor) exceeded the maximum permissible counts. S. Enteritidis bacteria were only cultured from the fried bean curd with egg of all the supplied foods on September 3, 2004. CONCLUSIONS: The major cause of salmonellosis was presumed to be the contaminated bean curd via contaminated tap water due to a water leak of a school water pipe. This contaminated bean curd was under prepared, which allowed the S. Enteritidis to survive and multiply prior to its ingestion. Therefore, this study was carried out to examine the incidence pattern of accidents for 2 months before entering university among university freshmen.
METHODS: The subjects were 1,920 university freshmen who visited the university health center for health examination from March 8 to 12, 2004, and self-reported questionnaire was given to the subjects. The authors developed a questionnaire including age, gender, place and type of high school, experience of accidents, occurrence time and type of accidents and so on.
RESULTS: The monthly incidence of accident was 9.9 per 1,000 population.
CONCLUSIONS: Because the most frequent cause of accidents was one's own carelessness, self-consciousness and attention are needed. The authors expect that this study will go far toward increasing concern of researchers and administrators for the accidents among adults. Human anthrax has been a zoonotic disease affecting those who have close contact with animals or animal products contaminated with the spore-forming bacterium Bacillus anthracis. Now the incidence of anthrax in herbivores and human are rare, but it remains an important health problem in Korea because anthrax is seen as one of the most likely biological weapon. The B.
anthracis forms a spore, which is resistant to drought, heat and numerous disinfectants, and the spore can remain viable and infective in the environment for decades. There are three major forms of human disease depending on how infection is contracted, cutaneous, inhalation and ingestion. Inhalational anthrax is the most common form, but the events in the Korea show that gastrointestinal anthrax is the most common. Several cases of anthrax have been reported in Korea. In recent years, 2 cases of bovine anthrax and 5 cases of human anthrax occurred in Changnyeong-gun, 2000, but it haven't occurred any more so far. The most useful microbiological test remains the standard blood culture. Confirmatory diagnostic tests such as polymerase chain reaction can also be used and may help in early diagnosis. Prompt clinical suspicion and rapid administration of effective antimicrobials are essential for treatment of anthrax.
Ciprofloxacin or doxycycline should be used for initial intravenous therapy until antimicrobial susceptibility results are known. The best measure to eliminate human anthrax is control in domestic animals by effective surveillance and by immunization of animals in endemic areas. Also, the government must establish countplan for knowledge and rational policies in dealing with potential bioterrorism attacks. primary and middle school relating to the ingestion of school lunch and the manifestation of symptoms. Also, the author investigated the drinking water, feeding facility and reconstructed cooking process of the food presumed to be the cause of the shigellosis. The diarrhea cases were defined as confirmed cases and those cases who had had diarrhea more than one time, accompanied with symptoms such as fever, vomiting and tenesmus.
RESULTS: From rectal swabs 20 people, between June 28 and July 4, 2003, were confirmed with shigellosis. The diarrhea attack rate was 40.0%. Those who had ingested tomatoes and cubed radish kimchi had significantly higher diarrhea attack rates (p< 0.05), with the relative risk of tomatoes being 2.69 (95% CI: 0.98-7.42). The major cause of shigellosis was presumed to be from contaminated tomatoes due to cooking with rubber gloves containing holes. CONCLUSION: The cooks in charge of school lunches must make doubly sure to not only attend to their sanitation, but also to manage the table wear and items used in providing school lunches. The health care authority should introduce higher-leveled criteria for health care among cooks, so that they Ten suspected GTS cases were compared to 10 controls matched for residence, age, and sex. Urinary cotinine was analyzed with a reverse-phase high performance liquid chromatography (HPLC) system and expressed as geometric mean and standard deviation. The data collected were evaluated using the SPSS/win statistical package and the urinary cotinine concentrations between the two groups were analyzed by Mann-Whitney U test.
RESULTS: In both the 10 cases and controls, there were 3 males and 7 females. Ages ranged from 22 to 70 years old. Half of the cases were reported within the 6 hours between 12:00 pm and 17:59 pm. The median time from starting work to initially feeling ill was 4.3 hours (min. 2.5; max.

76.9).
CONCLUSIONS: Our study suggests that many tobacco harvesters may suffer from GTS in Korea. Therefore, it is very important for doctors to diagnose exactly the GTS. Also we must develop the methods which can prevent GTS, and simple methods of analysis for urinary cotinine. METHODS: The authors conducted a questionnaire survey among 1, 730 students from 2 middle schools and 1 technical high school in Gyeongju city. For statistical analysis the chi-square test was used, and chi-square for trend method showing a level of significance less than p< 0.05 was proven to be significant. Variables which were proven to be significant in univariate analysis were analysed by multiple logistic regression.
RESULTS: The attack rate was 57.1%. The student groups with rubbing one's own eyes, computer usage, and sharing cellular phone had a significantly higher AHC attack rate (p< 0.05). According to the multiple logistic regression, the odds ratios for male, high school, computer use, sharing cellular phone, and rubbing one's own eyes were significant (p< 0.05).
CONCLUSION: The most significant feature of this outbreak was that many students rubbed their own eyes following contact with AHC patients in a deliberate attempt to avoid going to school. Other transmission methods were computer usage and sharing cellular phone. In the future, health and school authorities must plan new strategies for the prevention of AHC. RESULTS: Seven of 9 workers were diagnosed with dermatosis and 3 subjects (cases 2, 4 and 6) with Mathias's 7 criteria were confirmed as having occupational dermatologic diseases and were diagnosed as irritant contact dermatitis. Two subjects (cases 1 and 9) with over 5 criteria were evaluated as suspicious status. The remaining 2 subjects (cases 3 and 5) were not compatible with those criteria. The main sources of this outbreak were suggested to be the wasted solvents in the factory of car accessories and aluminum products because the subjects (cases 2, 4, 6, 1 and 9) had the positive skin reaction against those sources in 'as is 'patch test. Due to the small number of female smokers, the characteristics of smoking behaviors were analyzed only for males.
RESULTS: A total of 1, 367 students (920 males and 447 females) completed the questionnaires, with an overall response rate of 77.7%. The smoking rates for males and females were 31.5, and 2.2%, respectively. Among the male smokers, 70.7% smoked daily, and 39.0% smoked one pack or more per day. Male students on medical course were more likely to smoke daily, and one pack or more per day, than those on premedical course. Male daily smokers desired to quit smoking less than occasional smokers, and 65.0% of male daily smokers were not ready to quit compared with 37.8% of the occasional smokers. Among the male daily smokers, 29.6% were severely nicotine dependent. The most common reason for not to quit smoking among male smokers was 'no alternative stress coping method' (44.4%), followed by 'lack of will power' (25.4%), and 'no need to quit' (19.4%). Compared with male non-smokers, male smokers were more likely to drink alcohol more often and in larger amounts, take coffee more often, eat breakfast less regularly, and be overweight or obese.
CONCLUSIONS: The results of this study suggest that many male medical students were serious smokers, especially those on medical course. It is necessary to install a smoking prevention program for pre-medical students, provide effective smoking cessation methods for smokers, teach positive stress coping methods, and make the school environment suitable for coping with stress. RESULTS: All cases had used restaurants of the whole neighborhood of Y University within 2 months before the typhoid fever symptoms were developed, but the restaurant that was rarely visited by any of the patients had a case to be matched. In the results of the Widal test, 9 out of 45 of subjects (20.0%) were suspicious cases or showed a value to suggest past infection. In the results of PFGE test, there were 3 subtypes, and each subtype had a similar DNA fragments array. In all cases the patients drank tap water when they visited the restaurants. The restaurants provided drinking water from filtered tap water rather than boiled water, and all patients had drunk this water. The chlorine level of the treated water was the normal value in the Gyeongsan-si water treatment plant, but in 2 times the value was the minimum standard level. There was water pipe chill (45.5%) and tenesmus (41.6%). Six cases were asymptomatic. From initial manifestation to admission were 6.2+/-1.6 (median 6) days, so it could be transmitted to others in this infective period. Duration of admission were 5.5 +/-2.4 (median 6) days. We can find familial mean secondary attack rate were 38.5%.
CONCLUSION: It's transmission to other areas were certified by contaminated water and contact with shigellosis, and unknown cases were estimated to be transmitted by contacts with inapparent infection. By plasmid profile and PFGE, the epidemiological relationship of the outbreaks strains in this area seemed to be the same micro-organisms. cases (6.2%) that were believed to be related to the patients' occupations.
The hazards that these 10 patients had previously been exposed to were silica, organic solvents, tin, copper, lead, cadmium, and other hazards.
CONCLUSIONS: Through this study, 10 cases that were reportedly related to occupational chronic renal failure were discovered. Further studies such as a case-control study of occupational risk factors related to chronic renal failure will be needed. The major occupational diseases among health care workers in Korea include infectious, cerebrocardiovascular, and musculoskeletaf diseases. Infectious diseases such as tuberculosis, viral hepatitis, and chicken pox would be compensated as occupational diseases among health care workers. Also cerebro cardiovascular diseases would be compensated if they had overworked. Many other diseases would be compensated if they had workrelatedness. The decision of the person responsible for determining the workrelatedness of a disease must be based on an evaluation of the available information. Evidence presented by qualified professionals will generally be sufficient to answer the following questions: (1) has the disease condition been clearly established? (2) has it been shown that the disease can result from the suspected agent (s)? (3) has exposure to the agent been demonstrated? (4) has exposure to the agent been shown to be of a sufficient degree and/or duration to result in the disease condition? (5) has non-occupational exposure to the agent been ruled out as a causative factor? have all special circumstances been weighed? (7) has the burden of proof of causation been metdid the evidence prove that the disease resulted from, or was aggravated by, conditions at work? If the answers to all of the above are "Yes", the decision can be made that the disease is occupational in origin. Occupational safety and health programs are not yet sufficient in Korea. Occupational safety and health programs are very important to health care workers, and so special management, policies, and laws relevant to these issues should be promulgated. Disasters are emergencies of a severity and magnitude resulting in deaths, injuries, illness and/or property damage that cannot be effectively managed by the application of routine procedures or resources. These events are caused by nature, the result of technological or manmade error. Natural disasters include typhoon, flood, heavy snowfall, drought, famine, and earthquake. Natural disasters are unpreventable and, for the most part, uncontrollable. Technological or manmade disasters include fire, nuclear accidents, bombings, and bioterrorism.
The severity of damage caused by natural or technological disasters is affected by population density in disaster-prone areas, local building codes, community preparedness, and the use of public safety announcements and education on how to respond correctly at the first signs of danger.
Recovery following a disaster varies according to the public's access to pertinent information, pre-existing conditions that increase or reduce vulnerability, prior experience with stressful situations, and availability of sufficient savings and insurance.
Epidemiology can be used to investigate the public health and medical consequences of disasters. The aim of disaster epidemiology is to ascertain strategies for the prevention of both acute and chronic health events.
Disaster epidemiology includes rapid needs assessment, disease control strategies, assessment of the availability and use of health services, surveillance systems for both descriptive and analytic investigations of disease and injury, and research on risk factors contributing to disease, injury, or death. With both disasters and the number of people affected by such events on the increase, the importance of disasters as a public health program is now widely recognized in Korea. The epidemiologists must do their best effort for prevention of disasters. OBJECTIVES: As health care workers suffer from various hazards in hospital, an occupational safety and health program is very important to them. This study was conducted to investigate the status of the occupational safety and health programs of several hospitals in Korea.

METHODS:
We conducted a questionnaire survey on 941 hospitals in Korea. All questionnaires were posted to the department of general affairs at each hospital and responses were received from 108 hospitals (11.5%). Eight responses were excluded because of insufficient data and the remaining 100 questionnaires were analyzed. The collected data were evaluated using the SPSS 10.0 statistical package and the demands for occupational safety and health programs between two groups were analyzed by RIDIT analysis.
RESULTS: The study subjects were 53 general hospitals and 47 hospitals. An occupational safety and health committee, infection control committee, safety manager, health manager, activities for vaccination, reports for needle stick injury and records related to occupational injury were more likely to be present in general hospitals than hospitals (p<0.05). Demands for occupational safety and health were higher in general hospitals than hospitals. Especially, demands for measurement of working environment, improvement of ventilatory system, management of chemical materials and supply of protective equipment were significantly higher in general hospitals than hospitals (p<0.05).
CONCLUSIONS: We concluded from the findings of our study that occupational safety and health programs are not yet sufficient in Korean hospitals. So, we expect that special management, policies and laws for health care workers will be promulgated. A rare human case of gastroenteritis and eosinophilic ascites associated with gastric trichuriasis is described. The patient was a 32-yr-old woman who was working in a farm near Pohang, Korea. She complained of abdominal pain, diarrhea, and vomiting. Endoscopic examination found focal linear hyperemia on the mucosa of the stomach antrum, and endoscopic biopsy confirmed eosinophilic inflammation of the mucosa and submucosa of the stomach, terminal ileum, and cecum. The biopsy specimen of the stomach included a female Trichuris trichiura which was covered by many inflammatory cells on its surface. Ascites and intestinal wall thickening was found by CT scan, and Douglas pouch centesis aspirated bloody ascites which included many eosinophils. She was medicated with prednisolone and albendazole and cured. She is the first case of eosinophilic inflammation of the gastrointestinal tract and ascites associated with trichuriasis in the stomach. indistinguishably, the same E. coli O171. The grandmother of the index patient was found to be asymptomatic, but E. coli O26 was isolated. We also found a probable case in the mother of the cousin. She reported a history of contact with the index, and developed bloody diarrhea of 3 days duration. The test results for the cattle revealed E. coli O26 in one cow, and E. coli O26 and O55 in another. E. coli O26, which was isolated in both cows and the grandmother of the index, were indistinguishably the same. Nicotine is a liquid alkaloid present in tobacco leaves at a 1~6% concentration. Green tobacco sickness is an occupational illness caused by absorption of nicotine through skin exposed to wet tobacco leaves. It occurs throughout the world in tobacco-growing areas. The almost universal symptoms of weakness, nausea, vomiting, diarrhea, and dizziness may be confused with pesticide poisoning or heat stress illness. Since its recognition in the 1970s, green tobacco sickness is self-limited, usually lasting 1 to 2 days. There is no antidote, so treatment is supportive (for example, intravenous fluids for hypotension, antiemetics). The diagnosis can beconfirmed by measuring the nicotine concentration in the serum or urine, but its half-life is only 3~4 hours. Cotinine, the major nicotine metabolite, has a half-life of 36 hours, and thus is more useful. Young workers may be at higher risk for green tobacco sickness. Tobacco use is thought to offer weak protection by inducing tolerance. Handling tobacco that is wet from rain or dew increase the risk of green tobacco sickness.
Repeated daily exposure over more than a week may also increase the risk.
Green tobacco sickness is preventable by use of protective clothing and by avoiding skin contact with wet tobacco. When clothing becomes wet from environmental dampness or sweating, it should be changed to maintain an effective barrier. The best treatment is avoidance of poisoning : in addition to wearing gloves, long pants and a full shirt, workers picking or handling tobacco leaves should clean their hands frequently. OBJECTIVES: The following is a report on a case of cold sensitization in a worker who served as a forklift truck driver in a cold storage warehouse for 5 years from 1996. METHODS: We examined the patient's blood chemistry and infrared computerized thermographic measurements. We also reviewed the environmental temperatures at his workplace and interviewed other workers.
RESULTS: The worker was a 32-year-old male who had worked in a cold storage warehouse for 5 years (1996)(1997)(1998)(1999)(2000). He complained of headaches, arthralgia, and slight dyspnea after 2 years work serving as a forklift truck driver in a cold storage facility. In the laboratory record of his blood and those of others, the C-reactive protein, rheumatoid facror, anti-nuclear antibody, cryoglobulin and other blood chemistries were all negative except that the anti-streptolysin O titer was reactive and alkaline phosphatase was also increased. The radiologic findings were normal. Using infrared computerized thermographic measurements, the patient's hands were at around 30 degrees C and below in the first infrared image and around 27 degrees C in the third image. Accordingly, he was diagnosed as having cold sensitization, which occurs in persons exposed to cold for long time, especially below freezing point.
CONCLUSIONS: We confirmed that the cold sensitization occurred in this patient as an occupational disease due to an exposure to cold. To prevent cold injury, we must modify work procedures, begin comprehensive medical surveillances, educate workers on risks of cold, and increase workers awareness of safety regulations in the workplace. RESULTS: From the emergency records, we were able to identify 20 individuals that had been exposed to occupational hazards in the underground storage facilities. Among these 20 cases, 13 were due to asphyxiation (resulting in 7 deaths) and 7 were due to falls. In the first atmospheric tests, performed on Feb 25, 1998, the O2 level inside the underground storage facility, located about 5~6 meters below the surface, was 20.6% and the CO2 level was about 1,000 ppm. CO, H2S and NH4 were not Many of the 250,000 test participants were exposed to low levels of radiation. The overall average radiation dose was estimated as 0.6 rem per year. In 1976, a claim relating acute myelocytic leukemia to radiation exposure from nuclear weapon testing received extensive publicity. Several thousand "atomic veterans" have sought medical care and compensation from VA for medical conditions that they believe are related to the nuclear weapon testing. Many WWII veterans have contracted the US VA about health problems that they attribute to their exposure to mustard gas. Oxygen deficiency has been frequent in a closed space. Wood consumes oxygen and discharges carbon dioxide instead of photosynthesis in closed space without light, so do some microorganisms on the surface. We experienced a case that a healthy insect-proofer fell down and died of asphyxia on stair-board at 7 m below the hatch of the cargo-hold shipping wood.
Analysis of gases in cargo-hold revealed O2; 12.3%, CO; 105 ppm, CH4; 2.7%, and H2S; 1.9% at 1 m below the hatch, and then O2; 6.1%, CO; 220 ppm, CH4; 2.9%, and H2S; 2.3 ppm at 2.5 m below the hatch. Autopsy findings were unremarkable. We justiced the cause of death asphyxia due to oxygen deficiency. As seen in this case, the serious oxygen deficiency was accounted for oxygen consumption by wood and microorganisms. METHODS: For 7 days in May 1999, this research was taken on 489 male students ranging from 6th to 12th grade. We randomly selected a class for every group and from these classes we operated physical examinations, self-reported questionnaires and from a rehabilitation doctor, MPS test was taken. Thoracic kyphosis and lumbar lordosis were also taken by using the inclinometer. We defined MPS as a regional pain complaint, palpable taut band that is painful on compression.
RESULTS: The shoulder MPS prevalence of the subjects were 29.7 persons/100 persons.
The statistics revealed that as grades went up, the percentage significantly increased in the MPS prevalence. As of case-control study, 145 students who were tested postive in all aspects were placed as cases, and 176 students who were perfectly normal as controls on risk factors. As a result of comparing the student groups who were satisfied with their chairs to the student groups were not satisfied, the latter showed a significantly higher odds ratio (p<0.01). By the multiple logistic regression test, we concluded that the MPS disease was prevailed far more in the students in The birefringent fibers were composed of needle shaped particles with rectangular fractured ends up to 17 micrometer in length and 0.5 micrometer in diameter. EDX and x-ray diffraction analysis of the fibers showed that 71 to 100% of the fibers were magnesium silicate, talc. Magnesium silicate fibers were also found in the glass fiber sampled from the waste site.
Glass fibers and magnesium silicate fibers were also identified in the ground water.
Based on the fact that the magnesium silicate fibers found in the lipomas were similar in morphology and elemental composition to those found in the ground water and those from the waste site, these particles are likely to be introduced into the gastrointestinal tract through consumption of the contaminated ground water. It is suggested that fibrous magnesium silicate, METHODS: The selection criteria was for the patient to be more than 40 years old with lung, liver, urinary bladder, nasal cavity and skin cancer or leukemia. We reviewed the medical records to update the missing data and occupational histories. Telephone interviews were used to obtain complete occupational histories on the subjects. RESULTS: The sites of cancer in the order of relative frequency was lung (51.0%), followed by liver (32.9%), urinary bladder (14.1%) and skin (2.0%) in male, liver (41.5%), followed by lung (31.7%), skin (19.5%) and urinary bladder (7.3%) in female. The occupational histories of 190 cases with suspected cancer-causing occupations were recorded 5.8% on the doctor's medical records and 33.2% on the nursing records. The response rates of the telephone interviews were 87.4%. The distribution of occupation according to the telephone interviews was farmer (47.7%), office worker (16.1%), salesman (12.8%), production worker (6.7%), simple laborer (3.4%) and unknown (13.4%) in male, housewife (63.4%), farmer (17.1%), saleswoman (9.8%) and unknown (9.8%) in female. And there were two cases of suspected occupational relationships in the lung cancer cases.
CONCLUSIONS: We could not discover definite cases of occupational cancer but found out two cases of suspected occupational relationships.
Occupational cancer is likely to increase in the near future, so the efforts to detect occupational relationships with cancer should be continued. This study was performed to understand the incidence density and detect the risk factors of occupational low back pain. A cross-sectional study was conducted with a questionnaire in a welding material manufacturing factory in October, 1993. Therefore, we selected 140 workers who had never complained of low back pain as cohorts. Also, we added 236 newly entered persons who had never complained of low back pain. The total number of cohorts were 376 workers. And then we continued with a questionnaire survey in October, 1996 and with a questionnaire survey and medical examinations by a specialist in October, 1997. Follow-ups were done for 337 workers.
The number of newly developed low back pain among workers were 127. The characteristics of low back pain were as follows. The durations of pain were less than or equal to 2 days (42.6%), from 3 days to less than 1 week (8.7%), from 1 week to less than 1 month (11.0%), 1 month or more (6.2%).
The number of newly developed low back pain among workers were 127, their incidence density was 15.7 per 100 person-years. In univariate analysis, age, marital status, educational level, smoking habit, category of job, tenures and frequency of stretching exercises showed a statistical significance. The multivariate logistic regression analysis confirmed that category of job and tenures (p<0.05) were independent risk factors for low back pain among workers.
The number of newly developed occupational low back pain among production workers were 71, their incidence density was 11.3 per 100 person-years. In This study was conducted to evaluate the health hazards and to develop diagnostic methods of glass fiber workers. We examined 40 male glass fiber workers (exposure group) and 57 male non-glass fiber workers (reference group) with a questionnaire, physical examination, chest x-ray and pathological examination in Mar, 1997. Also we examined 65 male glass fiber workers (exposure group) and 42 male non-glass fiber workers (reference group) with the same methods also we did some energy-dispersive x-ray analyses with a scanning electron microscopic examination in Sep. 1997.
Most of the clinical symptoms were significantly more frequent among the exposure group than the reference group. Coughing (32.5%), itching of the nose (30.0%), irritation of eyes (27.5%), irritation of the nose (25.0%) and sputum (22.5%) were the major symptoms among the exposure group in Mar.
1997. Only itching of the nose was significantly more frequent in Sep. 1997. No cases of pneumoconiosis were observed among the groups and there were no differences in chest abnormalities between the exposure group with the reference group on both examinations. The prevalence of dermatosis among the exposure group was 20.0% (8 cases) and the cumulative prevalence was 72.5% (29 cases) in Mar. 1997. The prevalence of dermatosis among the exposure group was 23.1% (15 cases) and the cumulative prevalence was 58.5% with IgG positive the results was 74.9%. IgM IgG negative rates were 7.3%, however, out of a total 770 students. Amongst the older students, the IgM positive rate showed an increase(p<0.01). Out of 137 cases(with a cummulative incidence rate of 71.0%), there were 97 apparant cases(cummulative incidence rate 50.3%) and 40 inapparent cases(cummulative incidence rate 20.7%). Again, the cummulative incidence rate showed an increase in the older students(p<0.04). In the apparent cases, major symptoms included eruption(96.9%), fever(85.6%), lymphadenitis(82.5%), generalized aches and muscle tenderness(76.3%), and a sore throat(61.9%).
These symptoms lasted anywhere from 2 degrees =/ 13 days, the average duration being 4 days in length. Initially, there were 9 people on third grade and suspected origin was from more than 2 external sources. It progressed from the upper grades down to the lower grades. In dormitory students, the cummulative incidence ratio was 1.70 and 1.78 amongst study room students. The aim of this study is to develop health risk appraisal tools about health promotion at the worksite for employees. We performed this study by two steps: one step was to develop a HRA questionnaire of worksites in Korea, another was to evaluate the reliability of the questionnaire. For developing HRA questionnaire, we reviewed scientific examples at first, and then weighted the score by delphi. To evaluate the reliability of developed questionnaire, we carried out survey by test-retest method. A total of 131 employees completed HRA questionnaire on two times. The results are as follows. The total score of health risk in unhealthy workers was higher than that of healthy workers. The range of test-retest reliability of responses to the questionnaire was 0.57-0.94. Therefore it seems that this questionnaire was very suitable to assess the health behavior of workers.
In conclusion, the developed HRA questionnaire can be used as a tool for evaluating health behavior and for providing health counseling materials. Prevalence of Allergic Diseases of Workers Exposed to Phthalic Anhydride.
Phthalic anhydride (PA) is widely used in the production of alkyd and unsaturated polyester resins. It has been reported that some workers exposed to PA have developed dermatitis, rhinitis and asthma. The authors intended to investigate the prevalence of PA induced allergic diseases and to develop preventive measures of occupational diseases. Forty-five male workers from PA production and handling were selected as an exposure group.
Forty-four male workers not handling PA at the same factory were chosen as a reference group. A symptom questionnaire, doctor's examination, eosinophil count, serum-total IgE and PA-specific IgE were done on the subjects. There were no significant differences in age, educational level, tenure or smoking habits between groups. Most clinical symptoms were significantly more frequent among the exposure group than the reference group: sneezing(62.2 %), rhinorrhea(57.8 %), nasal stuffiness(53.3 %), coughing(44.4 %) and nasal itching(35.6 %) were the major symptoms among the exposure group (p<0.01, p<0.05). There were no significant differences in eosinophil count and serum-total IgE between groups but the mean level in PA-specific IgE, in the exposure group, was statistically significantly higher than the reference group (p<0.01). Abnormal rates of eosinophil count, serum-total IgE and PA-specific IgE were not significantly different from each other. The prevalence rate was 68.9 % (31 cases) for allergic rhinitis in the exposure group, statistically significantly higher than the reference group (p<0.01). The prevalence rate was 6.7 %(3 cases) for bronchial asthma and contact dermatitis in the exposure group, not more statistically significant than the reference group. In the exposure group, the prevalence rate for age, educational level, tenure, smoking habits and use of protective devices are not statistically significant. In PA-specific IgE, sensitivity is 10.8 %, specificity is 100.0 %, positive predictability is 100.0 % and negative predictability is 61.2 % when criteria point is 3.5 KU/l or above. As a result, it was recognized that the exposure group had a high prevalence of PA induced allergic rhinitis. Also, in diagnosis of PA induced allergic diseases, medical histories and specific symptoms were the most important where as eosinophil count, serum total IgE are the only indirect informations. PA-specific IgE has been needed to evaluate the meanings more. 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 for about ten days. On Dec 25, 1996, he found a dead wild rabbit at mountainside nearby, cooked it himself and ate it with his friends. He informed us that he got light injury on both hands while he was walking on the mountainside. On Dec 28, he started to suffer from high fever, fatigue and loss of appetite lasting for a day. After medication at a local clinic for several day, symptoms were somewhat relieved. A week later(Jan 4, 1997), several erythematous lesions developed on his both hands, which left ulcerations on the skin. Both axillary lymph nodes were swollen at both sides, but not tender. He visited the department of surgery on Jan 13 and he admitted on Jan 15. During hospitalization, the lymph nodes were surgically removed from both axillae and upper left arm. On microbiologic examination, small aerobic gram negative coccobacilli were grown on the chocolate agar plate in aerobic condition with 5% CO2 at 37 degrees centigrade. On Feb 10, fine needle aspiration from the liver abscess was done, drawing 3 ml of yellowish thick pustular material, but the microorganism was not isolated at the smear and culture of this material in the same condition as described above. After admission, he was treated with antibiotics(cefazole and marocin). His general conditions and laboratory results, including liver function, were markedly improved. He was discharged on Feb 12 and appears well on subsequent follow-ups. The microorganism and lymph nodes were sent to Centers for Disease Control and We experienced three cases of high signal intensity observed by Brain Magnetic Resonance Imaging in CO2 arc welders of steel-frame manufacturing industry. Case 1 was a 35 years old man who has been an CO2 arc welder for 10 years, admitted a sudden onset of tonic clonic seizure. He complained fever, chilling and myalgia since 3 days before admission. On admission, in the test of manganese exposure indices, manganese concentrations of blood, urine and scalp hair were 5.17 microgram/dL, 22.00 microgram/l and 31.25 ppm respectively. Case 2 was a 35 years old man who has been an CO2 arc welder for 20 years. On admission, He complained fatigue, numbness and weakness of extremities, and decrease of libido. In the test of manganese exposure indices, manganese concentrations of blood, urine and scalp hair were 6.34 microgram/dL, 14.62 microgram/l and 57.87 ppm respectively. In neurologic examination, Palmo-mentis reflex and Myerson sign were observed.
Case 3 was a 33 years old man who has been an CO2 arc welder for 16 years.
On admission, He complainer loss of appetite, numbness of extremities, fatigue and decrease of attention. In the test of manganese exposure indices, manganese concentrations of blood, urine and scalp hair were 5.14 microgram/dL, 13.79 microgram/l and 50.08 ppm respectively. In neurologic examination, Myerson sign was observed. In brain magnetic resonance imaging, T1WI showed symmetrical high signal intensity in basal ganglia and midbrain of three cases. Authors argued that they were developed by manganese exposure, and we considered that follow up study would be necessary. Tularemia is a major laboratory acquired zoonoses caused by Francisella tularensis that have high virulence, and usually transmitted to humans from direct contact with infected wild animals like rabbits or insect vectors like ticks. Clinical tularemia can be divided with 6 major syndromes that are delineated by the mode of organism aquisition, in which ulceroglandular type is the most common. F. tularensis have 3 different biogroups which have homogeneous antigenecity, type A (biogroup tularensis), type B (biogroup palearctica) and biogroup novicida, and can be confirmed by serology most frequently. In the domestic area, there was no reports of tularemia in humans or presence of bacteria in the reservoirs. Authers experienced a case of tularemia which is suspected as F. tularensis type B, ulceroglandular type. A healthy 40-year-old man admitted the hospital for lymph node swelling in both axillary and upper arm area and for furuncles in both forearm and palm. He contacted with dead rabbit and eated it after cooking before 20 days from admission day. In laboratory cultures, F. tularensis did not grow in any of the routine or anaerobic culture media except for one blood agar plate at 5 days. After subculturing that to cystine containing chocolate agar plate at 37C degree, 5% CO2 incubator, we could see the accelerating growth of colony. In microbiological test, it was oxidase and urease negative. In acid production in cystine trypticase agar base, it was glucose positive and sucrose, maltose, glycerol negative.
In agglutinating test, F. tularensis antiserum titer (Difco, USA) with isolates was 1:160 or over and antibody titer to F. tularensis antigen (Difco, USA) was 1:320 or over. Anti-F. tularensis-IF assay and Anti-F. Chronic subdural hematoma usually occurs as a consequence of minor trauma.
But, chronic subdural hematoma of occupational origin has not been reported yet in Korea. We experienced a case of chronic subdural hematoma induced by repeated trauma to the head. The patient was a 45-year-old male. He complained of repeated headache and nausea. By the computed tomogram, he diagnosed as chronic subdural hematoma and took the operation. He was not an alcoholism and had no intracranial disease nor coagulopathy. We studied all possibilities through working environment and personal environment survey. As a result, we decided the case as an example of cumulative trauma disorder to the head by occupational origin. We report a case of chronic subdural hematoma in the worker exposed repeated head trauma of occupational origin. Injuries to the menisci occur in a variety of ways, most commonly with a twist, pivot, squat, or valgus stress to the knee. Tear patterns are classified to longitudinal, horizontal, or transverse features according to the mechanism of injury. Work-related meniscal tear usually occurs with a repetitive usage of the foot, hence it can be classified as a cumulative traumatic disorder. We found a 47 year-old female worker who had been taking charge of repetitive foot-switch stepping for 8 years. She suffered from pain in the right knee since 5 months ago. Tenderness along the medial joint line of the right knee was observed and pain was aggravated with full flexion of the right knee. On magnetic resonance imaging, high signal intensity was observed at the posterior horn of the medial meniscus of the right knee. Degenerative longitudinal and transverse complex tear in the medial meniscus was observed on arthroscopy. Arthroscopic partial meniscectomy was performed. We surveyed the work process and the health status of co-workers. It turned out that the work process was compatible to injure the meniscus and nine out of fourteen co-workers(64.3%) complained pain of the knee. No other factors related to her meniscal tear could be found except for the situation at her work. Therefore, we conclude that meniscal tear is related to the repetitive stepping of foot switch.
Respiratory symptoms of workers exposed to the fume containing manganese.
To evaluate the effect of manganese on the respiratory system, we investigated the respiratory symptoms of 63 male workers exposed to fume containing manganese (Mn), iron (Fe), and silica (Si), and compared them with those of 66 male workers not exposed to the fume in a manganese alloy smelting factory. The prevalence ratios of the seven respiratory symptoms were not different between two groups. The presence of any respiratory symptom was not related with the age, duration of employment, smoking status of workers, and exposure to fume. In furnace workers, it was not related with the airborne Mn, Fe, and Si concentration in the total or respirable fume. Airborne Mn concentrations of all 4 furnaces in the respirable fume were below 1 mg/m(3). There were two suspicious cases of pneumoconiosis among furnace workers and one definite case(1/2) among casting workers who were not exposed to fume. The above results suggest that the exposure to the low airborne Mn concentration is not related with respiratory symptoms and pneumoconiosis. However, it is necessary to study the respiratory effects of Mn using the symptom questionnaire with consideration of the severity and persistence of symptoms and the time interval from exposure. RESULTS: There were no significant difference statistically in age, level of education and work duration in both groups. It was statistically significant that the degree of wrist use was more frequent in repetitive job group than in non-repetitive job group(P<0.01). Musculoskeletal symptoms, such as pain and numbness on affected joints were more common in repetitive job group than in non-repetitive job group. Affected side was bilateral in three joints and right only in two joints(P<0.01, P<0.05). The prevalence of ganglions in repetitive job group(6 subjects, 6.0%) was much higher statistically than that in the non-repetitive job group(2 subjects, 1.3%). In a comparison of two groups according to the existence of ganglions, no stasistically significant differences were found in age, level of education and work duration. However, duration of wrist use was Occupational asthma is an important occupation-related disease. We experienced a case of asthma induced by chromium. After discovery, chromium has been widely used in industry. Health effects of chromium and its compounds are contact dermatitis (allergic and irritant), mucosal irritation, basal septal perforation, asthma, and lung cancer. Their toxicity depends on valency, solubility, concentration, pH, exposure duration and route. The patient was a 47-year-old male and an ex-smoker. He complained of cough, sputum and dyspnea while working. Total eosinophil count was elevated but serum IgE value was normal. Bronchoprovocation test with 0.5 % (w/v) chromium solution revealed early and late asthmatic responses. Although his initial methacholine bronchial challenge test shoved a negative result, bronchial hyperresponsiveness developed after bronchoprovocation test with chromium solution. After discharge, he has complained of an intermittent dyspnea. It was suggested that chromium could induce occupational asthma in exposed workers. Further investigations are needed to clarify their pathogenetic mechanisms. Interview survey and dermatological examination have been performed to investigate the health problems of workers continuously exposed to coal-tar pitch. The phototoxicity of coal-tar pitch was confirmed by the photopatch tests for six healthy adults. The main results are followings; 1. There was no special history of allergic diseases in both the exposed and non-exposed group.
2. The frequency of the phototoxic dermatosis and the coal-tar acne in the exposed group was significantly greater(p<0.05) than that of the control group. In the exposed group, the phototoxic dermatosis and the coal-tar acne were observed in nine workers(90%) and seven workers(70%), respectively. However, those disease were not observed in the control group.
3. Five results(83%) were positive to the photopatch test for coal-tar pitch 48 hours after UVA irradiation. But the lesion was subsiding 72 hours after UVA irradiation.
4. Malignant cancers were not reported among workers ever exposed to coal-tar pitch.
In conclusion, it appears that workers exposed to coal-tar pitch have high risks of phototoxic dermatosis and coal-tar acne. A health policy should be provided to prevent phototoxic dermatosis among coal-tar pitch workers.
More studies are required to determine malignancy. Nerve conduction velocity test was abnormal in 11 (19.2%) among 57 workers.
Among disorders categorized as work-related, 131 (50.4%) were diagnosed to have fatigue myalgia of levator scapulae, 108 (41.5%) had cervical strain or sprain, 47 (18.1%) had fatigue arthralgia of phalangeal joints, and 47 (18.1%) had probable carpal tunnel syndrome, in 10 (3.8%) of those diagnosis was confirmed electrophysiologically. Age, seniority, work duration at present job, workload nor location of facilities were associated with the prevalence of symptoms nor specific diagnoses on simple statistical analysis and multiple logistic regression, which deems to be due to highly selected and homogeneous characteristics of the study subjects. Above results shows that cumulative trauma disorders are very prevalent among directory assistance operators and elaborate effort is needed to reduce the cumulative trauma disorders among the operators. 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 industrial 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 +/-8.4 pieces/day) and the alcohol consumption in current smokers was significantly high(l04.5 +/-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 abnormal 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 workers 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. To assess the status of safety accidents, authors reviewed and analysed the records of safety accidents of a welding material manufacturing factory at pohang city from January 1989 to December 1993. The results are; 1. The total incidence of safety accidents was 295 spells for five years. 2.
Average age of workers with accident was 35.7 years. Average duration of employment was 6.2 years and the duration of employment increased as the year increased. 3. There was no statistical significance on season, month, weekday and time by year in the incidence of safety accidents. The most frequent part of body injured was upper and the most frequent type of injury was abrasion. 4. Mean admission rate of safety accidents was 12.6% and the ratio of treated spells as occupational injury was 7.8%. 5. The most frequent cause of injury was worker's mistake and the most frequent action for the prevention of further accidents was safety education. 6. The incidence rate of safety accidents on 1993 was 116.2 spells per l,000 persons. Above results suggest that to prevent safety accidents, safety education should be done continuously, the environmental and human factors were controlled and more exact reporting system of safety accidents was needed.
An Epidemiologic Study on the Health Hazards of Inhabitants chronically exposed to Glass Fiber.
Fiberglass, as a substitute of asbestos, is used for more than 60 years as a insulator material. Health hazards including irritation of skin, mucosa and respiratory system associated with use of fiberglass is reported. Many studies on the fibrogenicity and carcinogenicity of fiberglass was conducted but evidence is not sufficient to confirm the carcinogenicity or fibrogenicity. Authors studied the health hazards among 152 inhabitants(71 men and 81 women) from 32 households living around the fiberglass factory which produced the fiberglass insulators and glasswool panels for 20 years.
Questionnaire survey on household and persons, examination of underground water, pathologic examination of subcutaneous tumors and examination of fiberglass in tumor tissues were done. The results are as follows; 1.
Fiberglass concentration of underground water sampled from 33 households in the study area was 13. 7-95. 9 fiber/cc with the diameter to length ratio more than 1:20. 2. Prevalence of dermatosis among study subjects was 23.0 % (35 cases). Prevalence was not associated with the distance from the factory nor duration of exposure. 3. There were 15 cases of subcutaneous tumor with prevalence of 9. 9 %. Age of subcutaneous tumor cases was all above 30 year-old except one cases, who was 5 year old child, who lived in the surveyed area since he was born. Prevalence of subcutaneous tumor was significantly high in area A(42.9 %) than area B(4.6 %, p<0.01). Prevalence of subcutaneous tumor was higher in long-term exposed inhabitants, but was not statistically significant. 4. Pathologic examination exhibits partly The results were as follows; 1. There was a significant difference in urinary fluoride level (p<0.01), but not in age, in tenure(p>0.05) among workers by the job title.
2. By the two radiologists, eight cases were read as bone fluorosis. The prevalence rate of bone fluorosis was 20.5%.
3. There was not a significant difference in general characteristic such as age, tenure and in muculoskeletal signs and symptoms between the fluorosis group and the normal group.
4. However, a close relationship between the occurence of the change of bone density and the degree of fluorde exposure such as burn was found.
The difficulties in diagnosing fluorosis result from the questionable sensitively of x-ray techniques and from the non-specific associated signs and symptoms. A quantitative method such as densitometry to assessosteosclerosis and bone structure alteration and a follow-up study are needed. There are many studies on the neurobehavioral symptoms due to organic solvent exposure using questionnaire. However there is little published evidence on validity and reliability of the questionnaire on the neurobehavioral symptoms. In present study, the authors tested the validity and reliability of our questionnaire, which was designed for screening neurobehavioral disturbance in organic solvent exposer. Questionnaire was administered to the workers of one paint manufacturing plant and one coil manufacturing plant. In order to evaluate validity of the questionnaire, the average questionnaire scores of two plants were compared. The average score of paint manufacturing plant were higher than that of coil manufacturing plant and the difference was statistically significant. After adjustment of age, duration of employment, education, smoking history and alcohol consumption, significance was maintained. Test-retest reliability was evaluated by kappa statistics. More than 50% of question items showed values of kappa above 0.4, Cronbach coefficient alpha whoch reflects internal consistency of the questionnaire was 0.86. Overall the data showed that validity and reliability of the questionnaire were generally acceptable. Workers', periodic health examination is the main tools used to manage the health problems of most workers in Korea. The most common health problem found in workers' periodic health examination is liver disorder. Liver disorder is also one of the most common health problems in general population and one of the leading causes of mortality in adult population.
Regulation proposed by government (NO. 207, Ministry of Labor, 1992) defines the criteria for selection of workers with the liver dysfunction for further evaluative examination and the examination items used for diagnosis of the workers with liver dysfunction. This study was designed to evaluate the proficiency of each examination items presently defined in Regulation and propose the optimal examination items for detection of the liver disorders found by workers' periodic health examination. Study subjects are 186 workers with abnormal liver function tests in screening examination of workers' periodic health ex amination. Questionnaire survey including past history of liver disorder, drinking history, height and weight was done.
Physical examination by physician, routine test items defined by Regulation (SGOT, SGPT, gamma-GTP, protein, albumin, total and direct bilirubin, alkaline phoshatase, alpha-feto protein, HBsAg and anti-HBs), anti-HCV antibody test and liver ultrasonography were done. Results are as follows; 1. Result of evaluative examination utilizing only the items defined in Regulation was; There were 75 workers with suspected liver disorder(40.3%), 63 with no liver dysfunction(33.90%), 13 with suspected hepatitis B(7.0%), 10 workers with hepatitis B(5.4%) 10 workers with hepatitis B carrier state(5.4%), 10 with alcoholic liver disorders(5.4%), 5 with fatty liver(2.7%). When alternative diagnostic criteria applying additional examination items (drinking history, body mass index, anti-HCV antibody and ultrasonography) diagnosability of liver disorder was increased. When all four items were included, final results were; 23 workers (l7.8%) with hepatitis B(10 carriers, 13 suspects and 10 hepatitis B), 10(5.4%) with hepatitis C(4 carriers, 5 suspects and 1 hepatitis C), 13(7.0%) with alcoholic liver disorder, 45 (24.2%) with fatty liver (40 suspects, 5 fatty liver), 41 0%) with suspected liver disorders and 44(23.7%) with normal liver. 2. Of examination items defined by Regulation, only SGOT, SGPT, gamma-GTP and HBsAg were significantly different in abnormal rate and mean value, and all other laboratory findings did not showed significant difference between two groups. Drinking history, body mass index and anti-HCV antibody test which are the items that authors included in this study, also showed significant difference between two groups. Utilization of body mass index(BMI) for abnormal liver function group in diagnosis of fatty liver had high specificity(97.6%) but sensitivity (22.3%) was low.
Therefore we suggest that SGOT, SGPT, gamma-GTP, HBsAg, alcohol drinking history, BMI and anti-Hcv Ab were useful for diagnosis of liver disorders among worker's periodic health examination. The incidence rate of the disease was 65.1% for males, 41.7% for females and the cases were distributed evenly for all age groups. The group ingested raw meat showed higher incidence than the group ingested cooked meat. There was no case among people who did not eat the meat. 2. The most clinical symptoms were significantly more frequent among cases than non-cases; sore throat (57%), nausea (51%), fever(47%), indigestion(43%), Glass Fiber is manufactured from typical glass-making raw materials, silicon dioxide with various metals and other elements. There are three distinct types of commercial glass fiber products: glass wool, an entangled mass of interlocking fibers; continuous glass filament, a product with a more ordered arrangement of fibers; and special-purpose glass fiber, a small-diameter fiber (less than 3 um) .
We report a case of glass fiber-induced health hazard due to continuous glass filament from fiber reinforced plastics (FRF) as car interior material. A 40 years old man complained a sudden onset of severe itching on whole body, especially neck and forearms while driving a new car. He also complained burning of eyes, sore throat and productive cough.
We diagnosed the glass fiver-induced skin lesion by placing skin scraping on a slide glass and examining the specimen under a microscope. We found same fibers from the air samples in the car and from the material of the interior surface of the car by the microscopic examination. Therefore we confirmed that the patient's symptoms and signs were induced by glass fiber. To estimate the manganese (Mn, below) exposure of workers in the ferromanganese manufacture factory and to evaluate its health effects, airborne, blood and urine Mn concentration measurements, questionnaire and other neurologic examinations were performed on 80 Mn-handing productive male workers (exposed group), 47 non-Mn-handling productive male workers (internal control group) and 144 productive male workers in other factory (external control group).
The results obtained were as follows; The highest airborne Mn fume concentration among the work process was found at charging (0.42 mg/m3), and ferromanganese crushing process (1.14 mg/m3) was the highest in Mn dust. However all of them were below threshold limit value. Mean Mn concentrations in blood and urine of crushing workers were higher than those of other part workers. Among all of them, workers whose urine Mn concentration were exceed normal reference level (10 microgram/l) were 31 (18.5%). There was statistically significant correlation between airborne and urine Mn concentration (r=0.60), and so between airborne and blood Mn concentration (r=0.49), while there was no statistically significant correlation between blood and urine Mn concentration. Mean Mn concentration in airborne (0.60 mg/m3), urine (6.92 microgram/l) and blood (3.16 microgram/dl) in exposed group were significantly higher than those of control groups (p<0.01). Clinical symptoms such as excessive sweating, hypoesthesia, libido change, anosmia, decreased visual acuity and difficulty in writing showed higher positive rate in exposed group.
Positive rate of clinical signs such as eye blinking and masked face in exposed group was higher than external control group. However clinical and laboratory findings such as blood pressure, blood chemistry, grip strength in exposed group were not statistically different from those of control groups.
The results suggested that further studies were followed to evaluate the workers whose blood Mn concentration were below normal reference level but urine Mn concentrations above normal reference level, and to establish the questionnaire and the diagnostic tools to detect the Mn poisoning workers  A study on diagnostic criteria of noise-induced hearing loss among workers in an iron foundry.
This study was carried out to evaluate diagnostic criteria of noise-induced hearing loss (NIHL) among workers in an iron foundry. Of 1,093 workers under the observation of noise-specific health examination, 184 workers were selected by way of first and second screening audiometric examination.
A questionnaire survey, otological examinations, Rinne test and audiometric test were performed and the results were as follows; The degree of hearing impairment in the left ear was more severe than in the right ear(p<0.05).
The difference between hearing threshold of the first and the second hearing test at 1,000 Hz was about 5 dB with a narrow range of deviations while the difference at 4,000 Hz was about -7dB with a wide range. Of the total study workers, 84.8% were tested within 15 hours away from noise exposure, and the rest after 16 hours. This study has identified that mean hearing loss at 4,000 Hz showed a significant statistical difference among the two study groups while mean hearing loss by 4-divided classification did not. The same phenomena were observed between the group with and without tinnitus and between the group with and without difficulty in hearing(p<0.05). Among 184 workers, 10 workers(5.4%) diagnosed as NIHL by old diagnostic criteria in contrast to 150 workers diagnosed as NIHL by the new diagnostic criteria. There was a significant difference between the two groups in the average hearing loss at 4,000 Hz and 4-divided classification(p<0.01), but there were no significant difference in age, the duration of employment, blood pressure and the duration wearing the personal hearing protector(p>0.05). If we apply Early Loss Index(ELI) method, some workers in younger age group diagnosed as NIHL by the new diagnostic criteria were fallen into within the normal range. In the mean time older age group show reverse results in contrast to the above finding.
It is too early to confirm the value of the usage of the new diagnostic criteria in hearing examination. Further study is called for to verify the value of this criteria. A study has been conducted on developing questionnaire to serve as on site diagnostic tools for the early detection of neuropsychiatric impairment among workers chronically exposed to low-level organic solvents. Two drafts of tentative questionnaire have been developed as follows ; several question items were selected from questionnaires which were administered to workers exposed to organic solvents in previous studies and were grouped into each symptom category based on the presence of its association using Guttman scaling method, then these selected items were reviewed by neuropsychiatry specialists. The final draft of the questionnaire (total symptom score=36) was developed by selecting 33 question items which had more than a 0.88 Guttman coefficient of reproducibility in each symptom category from a pilot study in which these tentative questionnaires were administered to workers manufacturing soles. Three plants using organic solvents and one plant never using organic solvents as a control group were selected to test the reliability and validity of the developed questionnaires. The major organic solvent in the workplace environment detected by a personal air sampler and GC/MSD was toluene. The concentration of toluene in air from the department using organic solvent was statistically different from that of the department never using organic solvent. The concentration of toluene from almost all of the workplace did not exceed the allowable level. There was no statistically significant difference between the concentration of urinary hippuric acid from the workers of the department using organic solvent and that of the department never using it. Total symptom score of the plant never using organic solvents was 9.8 and those of the three plants using organic solvents were 15.6, 14.7, and 13.7 respectively. In order to evaluate the validity of the questionnaires, the workers from two different department of the plant in which usage of organic solvents are totally different were compared. The total symptom score was 17.8 for workers of the department using organic solvent and 13.5 for the department never using organic solvent and scores of each symptom group between exposure and non-exposure group also showed statistically significant difference. The finding that total symptom score of the usefulness of the developed questionnaire to assess the health effects of chronic exposure to organic solvents. The correlation coefficient, which was calculated to evaluate the test-retest reliability, was 0.581(p=0.001). The coefficient of Crohnbach which reflects the internal consistency of the questionnaire was 0.91. In conclusion, the reliability of the questionnaire was well maintained over the time lapse between the two administrations of the questionnaire and despite the seasonal difference. To test if exposure history to rifle fire or cannonade training during military duty can induce hearing loss, history of personal military service and history of gunshot exposure were asked to 228 male college students with self-administrative questionnaire. Otoscopic examination and Rinne's test were performed if any abnormal finding was detected by pure-tone audiometry. Average hearing threshold levels of 500 Hz, 1,000 Hz, 2,000 Hz, 4,000 Hz and threshold levels at 4,000 Hz were calculated for 112 students who were remained after exclusion of cases with history of ear disease, of ototoxic drug administration, and of neuropsychiatric disease, and mean of those were compared between group of students who have completed military duty (completed group) and group of those who have not (not-completed group), and between group exposed(exposed group) and group unexposed to gunshot sound(unexposed group). Mean of average hearing threshold level and mean of threshold levels at 4,000 Hz of completed group and those of exposed group were higher than those of not-completed group and unexposed group, respectively. Proportion of cases that average threshold level was greater than 40 dB of threshold levels at 4,000 Hz was greater than 50 dB were higher also in completed group and exposed group than in duty not-completed group and unexposed group, respectively. Multiple linear regression analysis including age, duration of military service, degree of gunshot sound exposure as independent variables and average hearing threshold level as dependant variable, was performed in order to estimate the effect of age on hearing, and any considerable effect of age on hearing could not be found. In conclusion, hearing impairment can be induced by rifle fire or cannonade training. Formaldehyde exposure in the plywood manufacturing factory.
In the plywood manufacturing factory established in 1979, female 3 workers who had exposed to adhesives containing formaldehyde for more than 48 months of duration suffered from eye, nasal, oral, throat and skin irritation and dyspnea as chief complaints. The actual level of the exposure to formaldehyde were not estimated when the exposed workers started to have above symptoms. The environmental monitoring of workplace was measured on April 25, 1990, and the concentration of formaldehyde revealed 0.2 ppm, however the exhaustive ventilatory system was already installed at that time. Twenty six subjects from entire factory were examined by questionnaire, physical examination and spirometry, etc. on August 22, 1990. Significant difference was observed in symptoms and signs of nasal, oral and throat irritation between teh exposed group with longer duration and that with short duration. When the exposed group with longer duration was compared to the group of nonexposed, symptoms and signs of nasal, oral, throat and skin irritation, chest tightness and dullness were significantly increased in the former group. The results of the spirometric test showed that the forced vital capacity and the forced expiratory volume at 1 second were decreased amont the exposed group with longer duration but not significant. Obtained results and findings from this survey are summarized as follows; 1. The total spray days of 413 males were 3,114 days and avarage spray days per person were 7.54 days. Also avarage spray hours per person were 4.7 hours. 2. The incidence rate per 100 persons of self-recognized skin manifestation was 12.6 persons and incidence rate per spray day was 2.7 percent. The incidence rate per 1Q0 persons of self-recognized intoxication was 23.0 persons and incidence rate per spray day was 3.6 percent. 3. In cases where mask was not used, when it was syrayed in hot weather, when stronger solution was used, the results were higher percentage in self-recognized intoxication (P<0.01). 4. The symptoms of self-recognized intoxication were headache (55.8%), dizziness (46.9%),. nausea (17.7%), fatigue (17.0%), and vomiting (17.0;%). 5. Number of intoxication per 100 used standardized unit by agrochemicals was parathion (93.8 spells), sumithion (91.8 spells) and folithion (66.7 spells). 6. Treatment was done by health facility utilization (27 cases), visits to drug store (13 cases) and visits to health center (7 cases).
PubMed only articles (16 were less aware about the fact that mites are mainly found in the bushes and that long sleeves and full-length pants and boots helped prevent scrub typhus.
However, more were aware of the eschar lesion as a characteristic sign of scrub typhus. Work related risk factors such as having a wetland or puddles of water surrounding the house, dry field farming and working in the livestock industry were significantly associated with the scrub typhus. Health promotion strategies, for health effects. Multiple logistic regression analysis was used to analyze the relationship between exposure to pollution from industrial complexes and health conditions. After adjusting for age, sex, smoking status, occupational exposure, level of education, and body mass index, the residents near the industrial complexes were found to have more respiratory symptoms, such as cough (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.06 to 1.31) and sputum production (OR, 1.13; 95% CI, 1.03 to 1.24), and symptoms of atopic dermatitis (OR, 1.10; 95% CI, 1.01 to 1.20). Among residents of the industrial complexes, the prevalence of acute eye disorders was approximately 40% higher (OR, 1.39; 95% CI, 1.04 to 1.84) and the prevalence of lung and uterine cancer was 3.45 times and 1.88 times higher, respectively, than those among residents of the control area.
This study showed that residents living in the vicinity of industrial complexes have a high risk of acute and chronic diseases including respiratory and allergic conditions. These results can be used as basic objective data for developing health management measures for individuals residing near industrial complexes. The association among ferruginous body, uncoated fibers, asbestos and non-asbestos fibers in lung tissue in terms of length.
To demonstrate the correlations between the concentrations of ferruginous body as well as uncoated fiber both of which can be observed with phase-contrast microscope and the concentration of various inorganic fibers including asbestos which requires the observation with TEM or SEM, we measured those indices among Japanese and Korean cases. Though the concentration of ferruginous body in lung tissue is an important index of asbestos exposure, uncoated fibers observed with phase-contrast microscope might be another index especially in such cases with relatively low exposure due to their history of living in a general environment.
However, to establish the reliability of uncoated fibers as an index of asbestos exposure, analysis with more cases and from various backgrounds must be carried out. BACKGROUNDS: An outbreak of lung injury among South Korean adults was examined in a hospital-based case-control study, and the suspected cause was exposure to humidifier disinfectant (HD). However, a case-control study with community-dwelling controls was needed to validate the previous study's findings, and to confirm the exposure-response relationship between HD and lung injury.
METHODS: Each case of lung injury was matched with four community-dwelling controls, according to age (±3 years), sex, residence, and history of childbirth since 2006 (for women). Environmental risk factors, which included type and use of humidifier and HD, were investigated using a structured questionnaire during August 2011. The exposure to HD was calculated for both cases and controls, and the corresponding risks of lung injury were compared.
RESULTS: Among 28 eligible cases, 16 patients agreed to participate, and 60 matched controls were considered eligible for this study. The cases were more likely to have been exposed to HD (odds ratio: 116.1, 95% confidence interval: 6.5-2,063.7). All cases were exposed to HDs containing polyhexamethyleneguanidine phosphate, and the risk of lung injury increased with the cumulative exposure, duration of exposure, and exposure per day.
CONCLUSIONS: This study revealed a statistically significant exposure-response relationship between HD and lung injury. Therefore, continuous monitoring and stricter evaluation of environmental chemicals' safety should be conducted. CONCLUSIONS: Although confounding by alcohol intake was not completely ruled out, our findings demonstrate an association between PAHs exposure and elevation in serum liver enzymes. Urinary 2-naphthol is a biomarker of exposure to PAHs that is associated with liver toxicity.
A study of the status of exposure to polycyclic aromatic hydrocarbons (PAHs) in relation to its metabolites among workers in a Korean chemical factory.
The study was conducted to evaluate the status of worker exposure to polycyclic aromatic hydrocarbons (PAHs) through the measurement of urinary metabolites such as 1-hydroxypyrene (OHP) and 2-naphthol. A survey using a questionnaire involving 326 workers with measurement of urinary metabolites of 1-OHP and 2-naphthol was conducted. The differences in urinary 1-OHP and 2-naphthol concentrations, and changes in work, smoking habits and lifestyle were analyzed. The number of male subjects was 314 (96.3%), the largest age group was the fifth decade (170 cases, 52.1%). The urinary 1-OHP and 2-naphthol concentrations were significantly higher in the production workers. The urinary 1-OHP and 2-naphthol concentrations were significantly higher in smokers. In a multiple regression model, log (1-OHP) increased in smokers and production workers, while log (2-naphthol) only increased in smokers. Our results suggest that workers in this factory were exposed to PAHs from non-occupational as well as occupational sources. The occupational exposure to PAHs can be reduced through the improvement of the process, but the exposure due to smoking can be prevented only by giving up smoking. Asymptomatic healthy slaughterhouse workers in South Korea carrying Shiga toxin-producing Escherichia coli.
A total of 1602 stool samples from healthy employees in a slaughter company were screened by PCR for Shiga toxin (Stx)-producing Escherichia coli (STEC). The PCR product of Stx-encoding genes was detected in 90 (5.6%) of 1602 stool samples.
Among the 90 stx-positive workers, the Residual Products Handlers and Slaughterers had rates of 8.0% and 6.0%--higher than Inspectors, Grading Testers and Livestock Hygiene Controllers at 3.3%, 2.0% and 3.5%, respectively. A community-based case-control study of behavioral factors associated with scrub typhus during the autumn epidemic season in South Korea.
A community-based, case-control study was carried out to investigate risk factors for scrub typhus in South Korea. Cases (n = 299) were defined as persons who were diagnosed serologically within the past two weeks. Two neighborhood control subjects were selected by matching for sex, age, and occupation. Taking a rest directly on the grass, working in short sleeves, working with bare hands, and squatting to defecate or urinate posed the highest risks, with adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of 1.7 (1.2-2.3), 1.6 (1.1-2.4), 1.7 (1.2-2.4), and 2.0 (1.4-2.9), respectively. Wearing a long-sleeved shirt while working, keeping work clothes off the grass, and always using a mat to rest outdoors showed protective associations, with aORs and 95% CIs of 0.5 (0.3-0.9), 0.6 (0.4-0.9), and 0.7 (0.5-0.9), respectively. These results might be useful in the establishment of a detailed control strategy for scrub typhus. Using the database of the Korea Labor Welfare Corporation (KLWC), which is the public organization for workers' compensation in Korea, we analyzed the occupational infectious diseases among the health care workers who were compensated by the Industrial Accident Compensation Insurance (IACI). From January 1998 to December 2004, 307 cases of infectious diseases were approved as being cases of occupational diseases. Women accounted for 83% (254 cases) of the compensated cases. The most common age group was 20-29 yr of age (228 cases, 74.3%). The majority of infections were tuberculosis (203 cases, 66.1%), hepatitis (42 cases, 13.7%), chickenpox (11 cases, 3.6%), AIDS (8 cases, 2.6%) and scabies (7 cases, 2.3%). The major types of occupations were nurses, including 18 aid-nurses (223 cases, 72.6%), doctors (37 cases, 12.1%), clinical pathology technicians (18 cases, 5.9%) and workers who were taking care of patients (8 cases, 2.6%). The mean working duration after infection was 3.9 yr and the mean duration of recuperation was 9.7 months. The most common department where the infected workers were working was the inpatient ward (161 cases, 52.4%), followed by the intensive care unit (51 cases, 16.6%). Through this study, we were able to elucidate the characteristics of occupational infectious diseases among Korean health care workers. These results have to be considered when establishing the management policy for prevention of occupational infectious diseases among Korean health care workers. Also, all knowledge from these Korean cases will be helpful to make good practices to promote occupational safety and health in the new era of globalization.
Comparison of disability duration of lumbar intervertebral disc disorders among types of insurance in Korea.
The incidence of work-related musculoskeletal disorder including low back pain sharply increased since 2000 in Korea. The objectives of the present study are to compare disability duration of lumbar intervertebral disc displacement among types of insurances, and to obtain its appropriate duration. The medical records of all patients whose final diagnosis in discharge summary of chart was lumber specified intervertebral disc displacement (LIVD) in 6 large general hospitals in Korea were reviewed to compare the length of admission and disability among different types of insurances. The information on age, gender, the length of admission, the length of follow-up for LIVD, occupation, operation, combined musculoskeletal diseases, and type of insurance was investigated. 552 cases were selected and analyzed to calculate arithmetic mean, median, mode, and geometric mean of disability duration. There was a significant difference in the length of admission and disability among types of insurance after controlling covariates such as age and combined diseases by the analysis of covariance. The length of admission in cases of IACI and AI was much longer than that of HI, and the length of disability in cases of IACI was much longer than that of HI. Prolonged duration of admission and disability was not assumed due to combined diseases, complication or other unexplainable personal factors in cases of those with industrial accidents compensation insurance and automobile insurance. This means that proper management of evidence-based disability duration guidelines is urgently needed in Korea. 20. Ind Health. 2004 Apr;42(2):171-8.
Airborne asbestos and non-asbestos fiber concentrations in non-occupational environments in Korea.
Both airborne asbestos and non-asbestos fiber concentrations were evaluated in Korean non-occupational environments. The airborne fiber concentrations were analyzed in 96 air samples, from 48 different points, by transmission electron microscopy, with energy-dispersive X-ray analysis. The geometric means of the airborne asbestos and non-asbestos fiber concentrations were 0.62 and 67.86, and 0.30 and 17.47 fibers/liter in urban and rural areas, respectively. There were significant differences in both the airborne asbestos and non-asbestos fiber concentrations between the urban and rural areas (p<0.05). The geometric means of airborne asbestos and non-asbestos fiber concentrations were 0.67 and 37.93, and 0.27 and 30.67 fibers/liter at the points less than 10 m and more than 30 m away from highways, respectively. The airborne asbestos concentrations were significantly higher at the points less than 10 m away than at the points more than 30 m away from highways (p<0.01). To establish reference values for pulmonary asbestos and non-asbestos fiber concentrations in rural Korean residents, and their comparison with those of urban Korean residents and the Japanese, autopsied lung samples from 22 subjects (20 males and 2 females), in Pohang, without known occupational asbestos exposure histories, were analyzed for asbestos and non-asbestos fibers, using transmission electron microscope equipped with an energy dispersive X-ray analyzer. Chrysotile was the major fiber type found in the lungs of the subjects. The residents in Pohang had significantly lower asbestos and non-asbestos fiber concentrations than the Korean urban residents. The Koreans had significantly lower asbestos and non-asbestos fiber concentrations than the Japanese. In order to determine whether Agent Orange exposure was associated with increased frequency of medical problems, we conducted a cross-sectional epidemiologic study of Korean veterans during 1995Korean veterans during -1996 Vietnam and 154 non-Vietnam veterans were included in the study. Exposure to Agent Orange was assessed by structured in-depth interview on the participants' history of service in Vietnam. Health outcomes were assessed by a standardized comprehensive clinical investigation by a group of clinical specialists. The differences in the prevalence of various medical diagnoses were assessed by Cochran-Mantel-Haenszel chi-square tests comparing the exposure levels of Vietnam veterans, adjusting for age. Multiple logistic regression was performed to estimate the effect of "service in Vietnam" adjusting for age, smoking, alcohol, body mass index, education, and marital status. Vietnam veterans had an increased frequency of eczema (odds ratio [OR] = 6.54), radiculopathy (OR = 3.98), diabetes (OR = 2.69), peripheral neuropathy (OR = 2.39), and hypertension (OR = 2.29), compared to non-Vietnam veterans, adjusting for potential confounders. In addition, higher levels of exposure among Vietnam veterans were associated with increased frequency of ischemic heart disease (p < 0.01), valvular heart disease (p < 0.01), and retinopathy (p < 0.01). We conclude that exposure to Agent Orange is associated with various health impacts in Korean Vietnam veterans.