채용시 건강진단 운영 현황에 대한 조사

정해관,임현술 大韓産業醫學會 1995 대한직업환경의학회지 Vol.7 No.2

Preemployment health examination, stipulated by the Occupational Safety and Health Regulations, plays an important role in workers health management. Recently, employers are getting more aware of the importance of screening recruits before employment to decrease the development of occupational disorders and work loss due to health problems. Accordingly, additional test items are being included and selection criteria for preemployment health examination is getting more strict. However, studies and data on preemployment health examination are scarce until now. Authors reviewed preemployment health certificates of 3,261 recruits issued by a university hospital in Pohang from January 3 to December 31, 1993, analyzed regulations on preemployment health examination of 16 companies in the Pohang area, and surveyed 80 health and safety personnel with questionnaire to evaluate the present status of preemployment health examination. Of 3,261 recruits 125(3.8%) failed to recruit. Main causes of failure were chronic liver disease, tuberculosis of undetermined activity. The regulations of 16 companies on preemployment health examination were reviewed. Most companies adopted additional test items in addition to basic test items listed on th Regulation; test of physical strength, pulmonary function test, pure tone audiometer(2000 Hz and 4000 Hz in addition to 1000Hz), exercise provocation test, urine erythrocyte and urobilinogen, complete blood count, stool examination, VDRL, and sputum examination for acid fast bacilli. In most companies, obesity, hearing disturbance, color vision disturbance was included in the selection criteria. Hepatitis B carrier was not accepted in 4 companies, accepted conditionally in 2, and accepted in 5 companies. Of 80 health and safety personnel of companies in the Pohang area, 56(70.0%) perceived preemployment health examination as a tool for selection of recruits and 14(17.5%) as a procedure for job fitting. Most of them were against the acceptance of recruits with hepatitis B carrier, lumbar spine deformity, and hearing disturbance. In conclusion, preemployment health examination is performed mainly for the purpose of selection of healthier employee, but test items and selection criteria is not seem to be adequate. Authors suggest that further studies are needed to select the test items for specific job, and application of selection criteria be restricted only to some specified jobs. Consecutive filing of preemployment health examination to the periodic health examination was also suggested.

복합유기용제 장기 노출자들의 골수충실도 평가를 위한 자기공명영상의 계량적 활용

정해관,최대섭,박건욱,윤환중,김정란,하경임,양승오,김양호 大韓産業醫學會 2002 대한직업환경의학회지 Vol.14 No.2

목 적 : 자기공명영상은 골수의 지방세포와 조혈세포간의 분퐁 차이를 신호강도 차이로 구분할 수 있어 골수 충성도에 대한 평가가 가능하다. 저자들은 유기용제에 장기간 노출된 조선업체 도장공 및 대조군을 대상으로 비참습적인 방법으로 골수 충실도를 평가하는 도구를 개발하기위하여 본 연구를 시행하였다. 방 법 : 1998녀 8월부터 2000년 1월까지 조선소 도장공 중 1개 대학병원에서 유기용제 장기간 사용으로 인한 골수검사 결과 저세포성 골수로 진단 받은 환자 6명(남자 5명, 여자 1명; 평균연령 환자군 46.5세)을 대상으로 말초혈액이 혈액학적 검사, 골수검사 및 요추부 자기공명영상을 실시하였다. 대조군으로는 동일 병원에서 요추부 자기공명영상을 촬영한 환자 132명(남 67명, 여자 65명, 연령 평균 42.5세, 범위 30-59세)을 선정하였다. 요추부 자기공명영상은 T1 및 T2 강조영상의 시상 단면에서 제 12 흉추부터 제 1 천추사이의 추체에서 각반드시 신호강도를 기록하였다. 기준 부위로는 동일 단면의 척추주위근 및 지방조직의 산호강도를 이용하여 각 부위에서 측정한 신호강도를 나누어 골수 신호강도지표를 구하였다. 결 과 : 환자군의 골수 충실도는 20.33-33.6 %이었고 혈액검사상 백혈구수는 2,100-7,600/㎣이었다. 환자군과 대조군 모두에서 각 지표는 제 12흉추에서 아래로 내려갈수록 점차 감소하였다가 제 4 요추 이후 다시 증가하는 양상을 보였다. 환자군과 대조군간의 골수 신호강도지표를 비교하였을 때 T1 강조영상에서 척추주위근을 기준으로 한 골수 신호강도지표가 환자군과 대조군간의 차이를 가장 잘 반영하였으며 환자군이 모든 추체에서 유의하게 높았다. (p<0.05, p<0.01). 대조군의 골수 신호강도지표는 T1 강조영상이 척추주위근을 기준으로 측정하였을 때 여성에서 연령 증가에 따라 모든 측정점에서 골수 신호강도지표는 증가하는 양상을 보였으며 30대와 50대간의 차이는 유의하였다. (p<0.05, p<0.01). 성별에 따른 골수 신호강도지표는 근육을 기준으로 한 골수 신호강도지표에서는 보이지 않았으나 비장을 기준으로 한 골수 신호강도지표는 남녀간에 유의한 차이를 보였다. (p<0.05). 다변량 선형회귀분석에서 연령 및 성별을 보정하였을 때 T1 강조영상의 근육을 기준으로 한 골수 신호강도지표는 환자군에서 대조군에 비하여 제 1 천추에서 0.364 더 높았다. 제 1 천추의 T1 근육을 기준으로 한 골수 신호강도지표의 연령 성별 평균+1 표준편차를 기준으로 하였을 때 6명 중 5명이 그 이상이 분포를 보여 두 군간의 차이가 가장 뚜렷하였다. 결 론 : 저자들은 자기공명영상을 이용하여 골수 충실도를 평가하기 위한 지표를 개발하였고 정상 참고치를 제시하였다. 골수 신호강도지표는 지방조직 함량, 골밀도함께 칼슘 등의 영향을 동시에 반영하지만 이러한 영향을 적절히 보정할 경우 고위험집단에서 골수 충실도를 평가하는데 활용할 수 있음을 확인하였다. 보다 좋은 지표의 개발을 위하여 충분한 표본수를 가진 저세포성 골수 환자집단을 대상으로 후속연구를 수행할 필요가 있다. Objectives : To develop a quantitative and noninvasive method of bone marrow cellularity evaluation in solvent exposed painters. Methods : Six painters (mean 46.5 years, 5 males and one female with hypocellular marrow, and 132 controls were examined using magnetic resonance imaging (MRI). A full examination of the peripheral blood and a bone marrow biopsy was done on each patient. Signal intensities were measured at the vertebral bodies from T12 to S1 on both the T1 and the T2-weighted image (T1WI and T2WI). Signal indices were calculated by dividing the signal indeces of the vertebral bodies by that of the paraspinal muscle and the subcutaneous fat in the same view. Results : The Bone marrow cellularities of the cases painters were between 20.3 % and 33.6 %. Signal indices based on the muscle at T1WI were greater in the cases of the painters compared to those of the controls (p<0.05, p<0.01). Signal indices based on the muscle at T1WI were significantly higher in older women compared with men (p<0.05). After adjusting for age and gender, the signal index of cases at S1 based on muscle of T1WI was higher than that of the controls by 0.364. Five of the six cases had a muscle signal index at S1 of T1WI higher than the mean + 1 standard deviation for the same age group and gender. Conclusions : MR signal indices are influenced by constitutional factors such as fat content. bone density, and the presence of other pathology. However, after adequate adjustment, it can be used as a useful indicator of bone marrow cellularity in a high-risk population.

VDT작업자에서 어깨 근육장애와 혈청 CPK의 관련성

정해관,김수근 大韓産業醫學會 1998 대한직업환경의학회지 Vol.10 No.2

VDT workers are often exposed to static load in the shoulder stabilizing muscle due to repetitive work over long periods. Many investigations were reported the relationships between static load due to repetitive work and regional muscle disorder. However, diagnostic approach to work-related muscle disorder is difficult due to the absence of objective dignostic tools. This study was performed to investigate the relationship between the serum CPK(creatine phosphokinase) concentrations and the shoulder muscle disorders. Results are as follow. 1. Mean serum CPK in total VDT workers was 67.6±28.4 IU/l and workers with abnormal serum CPK were 35(21.5%). 2. Comparison between cases and controls did not show significant difference in the serum CPK level and the distribution of abnormal findings. 3. Sensitivity and sepcificity of the CPK test was 23.0% and 82.0%, respectively. Above results, in accordance with literatures, show that while serum CPK measurement can be useful for the diagnosis of acute muscle injury, it does not adequately reflect the muscle disorders developed by the repetitive work of low tension over long time, such as VDT works.

직업적 아크릴아미드 폭로에 의한 다발성 신경병증

정해관,권용욱,어경윤,김병준,양정선,정철,진영우,이미영,강성규 大韓産業醫學會 1998 대한직업환경의학회지 Vol.10 No.3

Authors report a first Korean case of polyneuropathy in an acrylamide producing factory together with an environmental and epidemiologic survey for the ten workers of the same workplace and 46 workers in the production and manufacturing acrylamide in Ulsan, Korea. The case is 30 years old man who worked in the production of the acrylamide for two years. In August, 1997, he had a weakness of the lower extremity with loss of body weight of 15 Kg which progressed to paresthesia of the limbs, the loss of vibration sense, difficulty in walking, speech disturbance, dysuria, constipation, difficulty in erection and swallowing difficulty. Neurologic examination showed a complete loss of vibration and position sense, and loss of deep tendon reflex in all the limbs. There was a contact dermatitis-like skin lesion on the feet. Electrodiagnostic test showed a generalized polyneuropathy of moderate degree involving motor and sensory component of peripheral and cranial nerves. After 8 months' cessation from exposure and supportive care, his symptoms were completely resolved, but abnormality in electrodiagnostic test and vibrotactile perception threshold still persisted, although much improved than before. There were 11 workers in the same workplace of the case, producing acrylamide by microorganism as a catalyst. Environmental monitoring of the workplace revealed air borne concentration of the acrylamide to be from 0.05 to 0.23 mg/m3 by personal sampling and from 7.65 to 11.65 mg/m3 by area sampling during filter exchanging process, which far exceeds TLV-TWA of 0.03 mg/m3. However, acrylamide was not detected from the plasma of the workers. Symptom questionnaire showed a markedly higher complain of neurologic symptoms, compared to the workers of the other acrylamide producing companies. Electrodiagnostic test showed a several workers are in the lower normal range without definite abnormality. Vibrotactile perception threshold by Vibratron Ⅱ showed a significantly increased threshold in the workers of the same workplace compared to the other acrylamide workers and significantly decreased test score of color vision compared to normal controls. After improvement of the production process and strict wearing of the protective device, most workers reported the improvement of clinical symptoms, but vibrotactile perception threshold was not improved. These result suggests the need for the effective environmental monitoring together with a periodic biological monitoring. Development of effective screening test is urgently needed to control and assess the skin absorption of acrylamide.

전화번호안내원의 누적외상성 장애

정해관,최병순,김지용,유선희,임현술,김용민,어경윤,권용욱 大韓産業醫學會 1997 대한직업환경의학회지 Vol.9 No.1

To evaluate the prevalence of cumulative trauma disorders in relation to ergonomic evaluation of their work, 260 female directory assistance operators employed in three branch facilities of the nation-wide telecommunication company. Ergonomic evaluation of the work status was done by two industrial hygienists through inspection. Workers were surveyed with standardized self-administered questionnaire and examined by family physicians and an orthopaedician for cumulative trauma disorders. Laboratory examination of serum aspartate aminotransferase(AST), creatinine phosphokinase(CPK), aldolase and rheumatoid factor was done and X-ray of cervical spine and both shoulders was taken from all subjects and nerve conduction velocity test was done on 57 subjects with suspected nerve entrapment cases. Cumulative trauma disorders were categorized into 3 category according to work-relatedness of the disorders. On ergonomic evaluation of the working posture and work environment, improvement of work posture revealed inappropriate postures and devices. Mean age of the subjects were 39 years old and more than 80% graduated high school or above. Ninety-eight percent of the workers employed in the company for more than 15 years and 74.6% of the workers worked at the VDT job for more than 4 years. Mean daily work hours was 8.0 hours per day and mean break hours was 90.5 minutes per day with mean extra work hours of 10.7 hours per month. Mean daily calls were 1128.6 calls in maximum and 864-8 calls in minimum. On laboratory examination, 13.(5.0%) workers had abnormal AST, 53(20.4%) had abnormal CPK, and 1(0.4%) had abnormal aldolase level. On x-ray examination of cervical spine, 111(42.7%) had loss of or reversed normal cervical lordosis, 10(3.8%) had narrowing of intervertebral space. 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 seems 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.

Gary Snyder의 생태시학

鄭海成 한국영어교육연구학회 2001 영어교육연구 Vol.- No.22

Gary Snyder is one of the representative American poets with the intuitive and deep sympathies with the wild. He questions about the belief that humankind is separated from and superior to the wild nature. Therefore he wanted to create the poetry that was informed by the basic biological and ecological facts of existence. In his poetry, he wanted to talk about wild things without harming their integrity by language, and to preserve and communicate suchness without falling into an aesthetic distance between subject and object. The purpose of this paper is, first, to examine Snyder's apprehension and wrath for the environmental pollution and the destruction of nature; second, to investigate the correlation between man and the wild. Snyder's poetry does not dramatize his emotional tension or address his inner state, but describes the preservation of natural environment and the interdependent relation between human and wild nature. Snyder's poetic vision is rooted in earth consciousness known to primal peoples across the face of earth during the old ages. And the main subject of his poetry is the land itself. His concept of land holds that the development of a harmonious relationship with man and the natural world is necessary for actual survival as well as for spiritual health. In this point of view, his poetry makes the reader love the wild and promote the perception of the land.

예이츠의 갈등 의식과 극복

鄭海成 한국영어교육연구학회 2002 영어교육연구 Vol.- No.24

Yeats's early poetry showed the dreamy and obscure ideal-world under the influence of the French symbolists and the fin de siecle's aesthetes. But, after this period, he is confronted with the harsh reality. Through this reality, he finds the discord and conflict between his ideal and the real world. This conflict causes him to be distressed about the real world and to grasp the realities of life at the realistic level. And also it makes him dramatize his agony about the actual aspects of human life. Accordingly, in his middle poetry, Yeats' poetic imagination meets the confrontation and conflict between the reality and his ideal. He continues to write his poetry in this dualistic world. Because to him his poetry was the product of the struggle with him. This struggle begins with the establishment of his anti-self or Mask. His poetic imagination goes forward to the synthesis in which self and anti-self are harmonized. Especially, through the principle of Mask, he comes to reach his poetic maturity in the process of the dramatization of mask. And through this synthesis he solves and surmounts the conflict.

망간노출로 인한 신경장해의 임상적 양상

정해관,마샤 라트너,로버트 펠드만 東國大學校醫學硏究所 2002 東國醫學 Vol.9 No.1

망간의 신경독성은 19세기 초 이래 널리 알려져 왔다. 고전적 망간중독은 파킨스증후 군을 유발하나 그 임상적 양상이 파킨슨병과는 명확하게 구별된다는 점이 인정되고 있다. 그러나 최근 들어 망간 노출 농도가 낮아지는 반면 노출인구는 증가하면서 저농도 노출에 의한 신경장해의 범위에 대해서 논란이 있어왔다. 특히 인구 노령화에 따른 각종 신경퇴행성 질환과는 구별도 필요하게 되었다. 저자들은 최근까지 보고된 직업적, 비직업적 망간 노출인구에서의 건강장해에 대한 임상적, 역학적 연구들을 비교 분석하여 망간 노출에 따른 신경장해를 다음과 같은 5가지 범주로 구분하였는데, 이들은 만성 망간중독, 파킨슨병, 추체외로증후군, 임상전 단계 및 변형증후군 등이다. 이와 같은 임상적 구분은 망간 독성의 병태생리를 이해하는데 도움을 줄뿐 아니라 직업적 및 비직업적 망간노출을 평가하는데도 유용한 도구로 사용될 수 있을 것이다. Neurotoxicity of manganese is known since the report of manganism in early 19th century. However, there are controversies on the range of the clinical manifestation of manganese exposure, especially after the introduction of magnetic resonance imaging on the exposure assessment of manganese exposure. The authors categorized various clinical syndromes of neurologic disorders, which are suggested to be related to occupational or non-occupational manganese exposure, into five stages; chronic manganism, Parkinson's disease, extrapyramidal syndrome, subclinical stage, and variant cases. This categorization will be useful in understanding the pathophysiology of the manganese toxicity and could be utilized in assessment of occupational and non-occupational manganese exposure.

일부 지역 도로관리 종사자에서 발견된 흉부 X선상 소음영 소견에 관한 조사

정해관,임현술,최익한,이원재,이현경 동국대학교 경주대학 1993 東國論集 Vol.12 No.-

Authors examined 135 workers(133 males and 2 females) employed in a local road construction and maintenance office lacated in the Pohang area to investigate the presence of pneumoconiosis cases among them. Examination consisted of questionnaire survey, physical examination and chest radiograph. Results are as follows ; 1. Of 135 workers, 8 cases(5.9%) were found to have small opacities of category 0/1 or more on chest radiogtaph. These cases were all males and prevalence was highest in group with age 50 or more(11.1% 3 out of 27 workers) and in froup with 5 to 9 years of employment(9.5%, 4 out of 42 workers). Small Opacities were found only in field workers(8.9%, 8 out of 90 workers) and prevalence of small opacities by job title was 8.8% in overload watchmen(3 out of 34 workers), 8.2% in road sweepers, road repair and maintenance workers(5 out of 56 workers). 2. Prevalence of small opacities on chest radiograph was higher in dusty, outdoor jobs than non-dusty jobs and the difference was statistically significant(P<0.05) 3. There was no statistically significant difference between those with radiological appearance of small opacities and normal subjects in age, educational level, duration of employment, previous dust exposure, past history of respiratory illness and clinical symptoms(P>0.05). 4. Of 8 cases with small opacities on chest radiograph, 1 case had small opacity of category 1/0(s/s) and the other 7 cases had small opacities of category 0/1. Two cases had past history of pulmonary tuberculosis, but radiologic findings were not consistent with tuberculosis. Two cases with less than 5 years of employment had previous history of dust exposure. Although specific etiologic factors were not clear with this study alone, authors suspected that specific geological factors in the Pohang area(soils rich in diatomaceous earth, bentonite and fullers' earth etc.) may have some role in development of small opacities. Above results suggests that follow up investigation for further development and progression of pneumoconiosis and effective measures to prevent dust exposure of road workers are needed.

側貌 頭部放射線 計測法에 의한 混合 齒列期 兒童의 軟組織에 關한 硏究

金善海,徐廷勳 대한치과교정학회 1985 대한치과교정학회지 Vol.15 No.2

The purpose of this study was to investigate the differences in soft tissue characteristics according to the dental or skeletal dysplasia, For this purpose, lateral cephalogram of 153 children (Hellman dental age ⅢB: control group 32, Angle ClⅡ. div. 1 malocclusion group 55, Angle Cl Ⅲ group 66) were traced and measured. For these measurments, following conclusions were made. 1. FH A, FH Sn, FH UL, AA' of the Class Ⅲ group were thicker than those of the normal and Class Ⅱ group, but FH B, FH LL' BB' of the Class Ⅲ group were not significantly different from those of the normal group. 2. FH B, FH LL, BB' of the Class Ⅱ group were thicker than those of the normal and Class Ⅲ group, but FH A, FH Sn, FH UL, AA' of the Class Ⅱ group were not significantly different from those of the normal group. 3. Ans-Sn, FH P were not significantly different in three groups, while PP' of the Class Ⅲ group was thicker than those of the other groups. 4. The lower lips of the Class Ⅱ group were more anterioly everted with respect to the lower incisor inclination than those of the other groups. 5. The severity of skeletal dysplasia was partly camouflaged by the soft tissue.