우리나라 지역 직업성질환 감시체계의 현황과 전망

임종한,장성실,김성아,문재동,채창호,홍윤철,김수영,김진석,김영욱,한상환,이혜숙,원종욱,송동빈,하은희,강성규 대한산업의학회 2001 대한직업환경의학회지 Vol.13 No.2

기존의 특수건강진단과 작업환경측정을 통한 직업병 관리가 진폐증, 소음성난청 등의 소수 특정질환에 국한되고 실제 직업병 발생 규모 파악이나 신종 직업병의 발견에 한계를 보인다는 사실은 산업의학전문가들 사이에서도 공감을 이루고 있다. 미국과 영국 등에서의 직업성질환 감시체계에 대한 경험은 우리 나라의 직업성질환 감시체계 구축에도 새로운 자극제가 되면서, 1998년이후 인천, 대전, 여천, 구미, 부울경 지역에서 지역 직업성질환감시체계를 산업보건관리의 중요한 시스템으로 구축하려는 노력이 확산되고 있다. 새로이 구축되어지는 이들 지역 직업성질환 감시체계는 감시하고자 하는 대상질환, 활용 가능한 인적자원 및 자료원, 지역 의료체계의 특수성 등에 따라서 목적과 방법을 달리하면서 독특한 형태로 발전을 하고 있다. 각 지역단위 감시체계들이 그 상황에 맞게 독특한 목적과 전략들을 발전 시키면서도, 향후 발전할 국가적인 차원의 직업성질환 감시체계 구축을 위하여 직업성질환 감시의 기본 전략 등을 공유하는 등의 노력이 필요하다. 환례 정의 및 기본적인 등록 서식의 공유, 직업성질환 감시 자료원의 발굴, 공동의 정보 네트워크 및 직업성질환 감시 데이터베이스 구축 등 직업성질환 감시활동을 지원하기 위한 여러 기초 인프라 구축에 힘을 모아야 할 것이다. 우리 나라에서 직업성질환 감시체계를 성공적으로 구축하기 위해서는 수집된 자료의 질 관리를 위한 직업성질환 감시의 원칙 제정과 감시 전략의 공유 등이 필요하며, 전국적인 직업성질환 감시체계의 하부구조라고 할 수 있는 지역감시체계의 기초 토대 마련과 강화작업이 절실하게 필요하다.

일부 청소년들에서 흡연노출량에 따른 혈중 카드뮴 농도

장성실,권윤형,배진순,노영만,한진구 韓國學校保健學會 2001 韓國學校保健學會誌 Vol.14 No.2

Objectives: We surveyed the prevalence of smoking among the adolescent population and analysed the correlation of the two exposure biomarkers-concentration of blood cadmium and urinary cotinine-to the smoking status. Methods: Subjects were 193 middle and high school students in Chungnam province. Blood cadmium and urinary cotinine were compared by sex and smoking status. Smoking status were classified by either the concentration of urinary cotinine or subjective answering as a smoker in the questionnaire. Results: Smoking prevalence was 24.6%, 36.2% and 6.7% among all subjects, male and female subjects, respectively. Average smoking amount was 17.5 and 1.5 cigarettes per month among the male subjects and female subjects, respectively Mean concentration of urinary cotinine among the male subjects was 135.57 ㎍/ℓ, and that of female subjects was 116.59 ㎍/. Direct smokers showed higher concentration of urinary cotinine than those of indirect smokers, and subjects with higher urinary concentration showed higher prevalence of smoking, too. Mean concentration of blood cadmium was 0.0572 ㎍/㎗ among the male subjects, and 0.0693 ㎍/㎗ among the female subjects. Among the male subjects, both exposure biumarkers showed significant correlation to the smoking status, but among the female subjects urinary cotinine did not show significant correlation to the smoking status. Conclusion: Concentrations of these two biomarkers suggested that this population had significantly high evironmental tobacco smoking(ETS) and efficient stop-smoking programs to reduce ETS should be directed to this population. Key words : environmental tobacco smoking, urinary cotinine, blood cadmium

대전지역 접촉성 피부염에 대한 감시체계 : 대전1, 2 공단지역 용제 및 특화물 취급자에서 수시건강진단체계 구축 시도를 통한 접촉성 피부염 유병조사

장성실,김수영 대한산업의학회 2000 대한직업환경의학회지 Vol.12 No.2

Objectives : We tried to establish a Regional Occupational Surveillance System (ROSS) for estimating the prevalence and monitoring the trend of occupational dermatitis among 718 manufacturing workers exposed to organic solvents and nonmetallic chemicals in small and medium sized businesses of 1,2 industrial complex area of taejon City. Methods : Through the report from the nurses of Group Occupational Health Management System, we made a case referral and immediate health examination system with occupational medical clinics. We also performed a survey for detecting occupational dermatitis by a self-administered questionnaire. Case must meet 3 criteria; 1) He/she must have one or more significant cutaneous signs and symptoms. 2) The symptom should be changed by the work condition or caused by risk chemicals. 3) Dermatitis should be diagnosed by a doctor. Results : Among the 131 workers(17.7 %) with significant symptoms screened by the questionnaire, 4 workers(0.6 %) met the case definition criteria. And among the 45 workers (6.3 %) referred to the immediate diagnosed system, 14 workers (1.9 %) were strongly suspected to have occupational dermatitis. Conclusions : These prevalence rates were quite underestimated because of deficient recognition of the disease severity among the workers, reversibility of the target diseases, and life-threathening mood due to nationwide economic crisis and the socioeconomic withdrawal of each business. Ultimately, harmonized activities of government, industry, labor unions, volunteer organization and academy relating to occupational health in a community should be encouraged to do creative, consistent efforts for evolution and development of this first trial of ROSS.

초등학교 치아우식 아동의 구강검진 후 관리 실태와 어머니의 구강건강신념과의 관계

배진순,장성실 韓國學校保健學會 1999 韓國學校保健學會誌 Vol.12 No.2

The objective of this study were to evaluate the relation between post-examination management states of dental caries in elementary school students and a mother's dental health beliefs. We systematically chose 10 elementary schools in urban and rural areas of Chungnam Province and determined the first class students of 5 and 6 grade in each school as study subjects. Among 837 participants, 669 students were diagnosed with dental caries after a 1998 periodic dental health examination was answered completely and analysed. The contents of the questionnaire for students were general characteristics, dental health behaviors, notification factors, treatment factors. Their mothers were surveyed by another questionnaire. The contents of the questionnaire for mothers were also general characteristics, dental health behaviors, and dental health beliefs. The result of this study were as follows" 1.The prevalence of dental caries was 65.0% and there was no significant difference between urban and rural areas. 2. Meanwhile, 63.8% of students in urban areas knew the examination result through a doctor's explanation, 52.4% of students in rural areas learned through a school notification letter. 82.9% of all the students let their parents know of their dental caries. 3. Among the dental caries group, 36.3% of the students were treated as for treatment, most students in urban areas visited a dental clinic, but those in rural areas visited the dental dept of a public health center as for the treatment time, 35.9% of the students were treated immediately after the examination. 4.449% of those treated answered that they considered the treatment as a bother and unnecessary due to no pain. 5. Overall, the scores in the dental health beliefs in mothers were low. Especially among the 5 items of susceptibility and seriousness, the scored were very low but the benefit was high. Logistic regression analysis showed that the treatment of a child's dental caries was significantly associated with low scores of benefit in those untreated and high scores among those treated. Considering these results, health education to stimalate a mother's susceptibility and seriousness in health beliefs and for students to learn the need for treatment, including a more detailed post exam management system at the school level should be considered for a higher treatment rate.

충남지역 초등학교의 구강보건관리 실태

배진순,장성실 韓國學校保健學會 2000 韓國學校保健學會誌 Vol.13 No.2

Primary school is regarded as an important period when many health-related behaviors and life-styles begin to be formed. Acquiring them through school heath education has a strong influence on the health promotion of not only the family but also the community. The objectives of this study were to evaluate current oral health care of elementary schools in Chungnam province and to provide information for further development in elementary school oral health. We performed a questionnaire survey to 280 health teachers and among them, 155 teachers answered. The result of this study were as follows: 1. Sixty five percent of the health teachers had little interest in oral health. Major information sources for teaching oral health were books in 58.1% of the 155 teachers and 83.2% of teachers spent 30 minutes to 1hour per day in oral health care practice for the students. 2. Contents of the oral health education were composed of regular and special curriculums, and an average of education time during a semester was 2.6 hours in 3rd grade and 1.3 hours in first and second grade. 60.6% of the teachers made the children practice the proper method of tooth brushing during the education time. 3. Major problems in oral health education were insufficient time, lack of equipment and difficulty in teaching method. The educational media were tooth models among 91.0% and OHP among 85.2% of the teachers. The tooth model was usually used in first to fourth grades and OHP in fifth to sixth grades. But 63.9% health teachers need to develop stronger educational methods using multimedia. 4. Meanwhile the most important strategy of oral health in urban schools was health education that of rural schools was fluoride mouth-rinsing programme. Fluoride mouth-rinsing programmes were performed by 89.0% schools sent the results home through school notification letters, but post-examination management was performed in only 57.1% of then 64.5% of the health teachers do follow-ups on the oral disease of the children after the examination. Only 0.7% of the schools have oral health education plans for the students' parents. Considering these major strategies for elementary school oral health care were health education practicing proper methods of tooth brushing, periodic dental examinations, and fluoride mouth-rinsing programmes. But health teachers need mare time for oral health education, practicing and management, and developing education materials. With regard to the high demand for oral health education and poor follow-up after periodic examination, the oral health education in elementary school should be considered as a formal educational course for more proper management of oral health, including application of major strategies to the children in earlier grades and extorts for increasing recognition and participation of the parents.

가족에서 발생한 신경종성 상피병을 보이는 신경섬유종증 2예

한은실(Eun Sil Han),서성준(Seong Jun Seo),홍창권(Chang Kwun Hong),노병인(Byung In Ro) 대한피부과학회 1994 대한피부과학회지 Vol.32 No.4

We reported two cases of elephantiasis neurofibromatosa in a family. The first case was the son of the second case. Both patients showed huge masses and bone changs. They were treated by surgical excision due t,o functional and cosmetic problems. The histopatholog.c findings of the two cases were consistent with neurofibroma, (Kor J Dermatol 1994; 32(4): 724-723)

작업장 환경의 특성파악

이원철,장성실 가톨릭 대학 산업의학 쎈타 산업의학연구소 1993 韓國의 産業醫學 Vol.32 No.2

직업성 폭로를 제대로 측정하고 위험요인과 질병간의 폭로-반응관계를 제대로 추정하려면, 작업환경이 가능한 한 철저하게 그리고 정밀하게 파악되어야 한다. 가능성이 있는 잠재적인 건강유해인자를 파악하는 첫 단계는 폭로의 유형, 경로, 폭로원을 인지하는 것이다. 그 다음으로 이용가능한 자료원으로 부터 특정물질의 작업장내 농도를 추정하는 것이다. 궁극적으로 이들 농도는 근로자의 고용력과 연관되어 추정되며, 총 체내 부하량을 추정하던가 아니면 개개의 생물학적 표적장기에 근거한 용량을 추정하기 위한 것이다. 용량(dose)이란 일정한 시간동안 표적장기에 머무는 물질의 양을 의미하지만 대개의 경우 직접적으로 측정될수가 없다. 용량율(dose rate)을 대신하여, 우리가 측정할 수 있는 폭로농도를 사용할 수 밖에 없다. 누적폭로량이란, 시간적 개념과 농도의 개념을 합친 것으로서 용량(dose)을 대신하는 값이다. 폭로농동와 누적폭로량은 용량율과 용량에 직선적인 비례관계에 있기만 하다면 믿을만한 대용물이 된다. 산업장을 근거로 한 연구에서 산업위생사나 보건물리학적 조사시에 직접 측정한 작업환경측정치는 용량추정의 가장 좋은 자료원이다. 그러나 측정값이 아무리 좋은 기구로 얻어졌다 해도 평균농도의 참값을 나타낼 수는 없을 것이다. 대개 허용농도한계를 초과하는 지의 여부를 판단하기 위하여 행하는 표본측정값(compliance sampling)은 실제의 폭로 수준보다 과다하게 추정된다. 작업별, 업무별, 장소별로 순차적인 등급을 만들어 이용하는 것이 필요하지만 측정이 이루어지지 못하는 경우에는 개인의 고용기록은 작업환경자료를 근거로 하여 근로자 개개인의 폭로를 측정할 때 가장 흔하게 사용되는 수단이 된다. 생물학적 모니터링은 보조적인 정보제공을 한다. 지역사회 집단을 근거로 한 직업성 위험요인에 관한 연구에서는 산업장을 근거로 한 연구에서보다 덜 정확한 폭로자료를 제공한다. 이런 연구의 자료원에는 사망증명서, 병원 혹은 병상기록, 설문지 등이 있다. 설문지는 일반적으로 지역사회 집단을 근거로 한 연구중 가장 상세한 직업력을 제공하며 특히 고용기록 같은 다른 자료원으로부터 그 응답이 확인될 수 있는 경우에는 더욱 유용하다. 여러 자료원으로 부터 얻어진 다양한 구체적인 정도 및 다양한 정확성을 가진 폭로 자료를 조합해야 하는 것이 대개의 연구에 있어서 당면과제이다. 위험도 추정을 위한 용량-반응관계에 정확히 접근하려면 가장 정확하게 정량적으로 모아진 자료만으로 제한하여 분석하여야 한다. 연구대상을 선별하여 분석에서 제외시키는 것이 이런 접근을 가치있게 하고 측정오차를 최소한의 정도로 줄일 수 있는 방편이 될 것이다. 그러나 이보다는 덜 정확한 자료들을 자료수집과 분석에 이용하는 방법도 있다. 수집된 자료를 상이한 자료원들로 부터 합병하고자 할 경우에는 어느 정도로 유사한 폭로등급으로 일치할 수 있는 지를 보고 결정하여야 한다. 부적절하게 자료를 합병하게 되면 폭로값의 분류오류(misclassification)때문에 편의(bias)가 일어날 수 있다.

대전시 일부 지하상가 공기중 포름알데히드 농도 및 종사자들의 자각증상에 관한 연구

양태웅,장성실 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1

This study was performed to get the fundamental data establishing environmental formaldehyde threshold limit as well as to contribute the health promotion of merchants and customers in two underground shopping-centers in Taejon from Dec. 1997 to Jan. 1998. Formaldehyde concentration and three climate factors-air current, humidity, and temperature-were measured at exit., hallway and inside shops in underground environment, and questionnaire about 15 subjective symptoms among 120 merchants in the inside shops were also surveyed by means of the questionnaire for screening workers exposed formaldehyde in Korea. The results were as follows ; 1. The average formaldehyde concentration in whole area was 0.0299 ppm ; Exit, Hallway and Inside shop were 0.0205 ppm, 0.0325 ppm and 0.0366 ppm, respectively(p<0.000). 2. According to simple regresson analysis, air current(r=-0.2517, p<0.05) and temperature(r=0. 5871, p<0.001) were significantly related to formaldehyde concentration. 3. More than 80% of the merchants have 5 subjective symptoms such as easy fatigahility, headache, throat discomfort, conjunctival injection, and nasal congestion. With all above the results, it can be suggested that environmental formaldehyde threshold limit at underground in Korea be reestablished, regarding related climate factor-air current and temperature-, and the questionnaire for screening subjective symptoms should be developed again for evaluating the evironmental effect of formaldehyde.

여성은행원에서의 스트레스 관련요인

정경태,장성실,이강숙,이연경,이동배 大韓産業醫學會 1999 대한직업환경의학회지 Vol.11 No.1

We surveyed 343 female bank clerks to find out associations between stress and a variety of factors including general, menstruation and reproductive characteristics of the participants. Unmarried women composed the majority of younger, lower income and lower education groups than married did. They also showed higher, though not significantly higher, scores for psychosocial well being index(PWI) and the first three items of the stress survey. And married women scored slightly higher only in the fourth item of the stress survey. Among the subgroups of married and unmarried women, many factors contributed to a higher stress score in two or more items of the stress survey: in unmarried women, lower education level, little physical exercise, and large family inhabitants, in contrast married women, higher monthly income and greater working hours were related to higher stress scores. According to the menstruation factors, subgroups with dysmenorrhea or irregular cycle and scanty bleeding volume in unmarried women and subgroups with dysmenorrhea kin married women showed higher stress scores in PWI. In married women, the proportion of those who have been pregnant was 77.2% and the proportion of those who have experienced spontaneous abortion was 24.1%. Those who have ever experienced two or more spontaneous abortion showed hgher, though not statistically significantly higher, scores for PWI. In conclusion, dysmenorrhea was associated with high stress score in two groups. And the other factors related to higher score of PWI were different between unmarred and married women, which should be considered in a management plan for mental health promotion.

일반건강측정도구(PWI)를 이용한 사무직근로자들의 스트레스와 관련요인

유민규,조영채,장성실 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1

This study was performed to analyze the association of the stress measured through a modified GHQ(General Health Questionnaire) and the related factors including general and occupational characteristics in 998 bank clerks. The results were as follows; 1. Among the subjects, men were 446(56.2%) and women were 348(43.8%). Women composed the majority of younger, lower education, lower income and lower position groups than men. 2. Women workers showed very much higher scores in PWI and four items -Social performance and self-confidence(SS1), Depression(SS2), Sleeping disturbance and anxiety(SS 3), General well-being and vitality(SS4)- of the stress survey. 3. Among women, workers of high risk of stress were 89(25.6%), which was very significantly higher prevalence than that of man workers, 59(13.2%). 4. Increasing the frequencies of weekly drinking alcohol beverage and daily smoking, more daily working time, decreasing the frequency of weekly excercise and sleeping hours related to increasing more than two scores of stress items. 5. In women, lower BMI and education level, more family inhabitants, decreasing sleeping hours related to increasing more than two scores of stress items(PWI, SS1-SS4). Considering above all things, woman workers showed higher scores in all stress items than those of man workers. And the factors related to each stress items were different between men and women, which should be considered in planning any mental health promotion project for these groups.