모 대학병원 입원환자의 직업력 기록에 관한 조사

임현술,김지용,정철 동국대학교 경주대학 1998 東國論集 Vol.17 No.2

From January 9, to January 27, 1996, we surveyed medical records for the occupational history of 352 admitted patients in university hospital located in Pohang city. Also, we interviewed the study subjects about their occupational histories to search for occupational related cases. The results obtained are as follows. The number of males were 205 cases and the number of females were 147 cases. The age and sex distributions of study subjects were not significant (p>0.05). Internal medicine (50.3%), orthopaedics (19.6%), general surgery (8.8%), neurosurgery (5.7%) and obstetrics & gynecology (3.7%) were the major admitted departments of the study subjects. The records of occupational history by doctors were only 9 cases (2.6%) but by nurses were 197 cases (56.0%). And then, there were no detailed descriptions for occupations by doctors and nurses. We would suspect that 18 cases (5.1%) were related to the occupations, of which 13 cases (3.7%) were in occupational injuries and 5 cases (1.4%) were in occupational diseases. It should be emphasized in medical education that the occupational and environmental histories were thoroughly investigated to make a correct diagnosis and appropriate treatment and that the standard forms for occupational history taking should be developed.

원자력 발전소 근로자에서 업무상 질병으로 인정받은 급성 골수성 백혈병 1예

임현술,정해관,김수근,박병찬,이관 東國大學校醫學硏究所 2002 東國醫學 Vol.9 No.2

저자들은 10여 년 동안 원자력 발전소 협력업체에 종사하면서 저선량의 방사선에 노출된 근로자로 급성 골수성 백혈병으로 진단 받고 사망 후 업무상 질병으로 인정된 증례를 보고하는 바이다. 증례에 대한 의무기록과 혈액검사 및 조직검사, 세포유전학 검사를 검토하였으며 환자의 작업 내역, 방사선 피폭량 및 동료 근로자에 대하여 조사하였다. 환자는 35세 남자로 1997년 11월 20일 경북 포항시 소재 D 대학병원에서 용접공에 대하여 실시하는 기타 중금속 특수건강진단(망간)에서 백혈구 수가 μL당 108.9×10³개, 혈색소는 8.6g/dL로 급성 백혈병을 의심하였다. 11월 24일 대구광역시에 위치한 K 대학병원을 방문하여 급성 골수성 백혈병으로 확진되었다. 골수검사에서 이소성 B 임파구성 표지자를 지닌 AML M2로 진단되었고, 염색체 검사에서 필라델피아 염색체가 발견되었으며, 46 XY t(1:4)(p32:p16)의 소견을 보였다. 항암 화학요법을 시행하였고 주기적인 항암 약물요법과 추적 관찰을 시행하였다. 1999년 5월 30일 급성 골수성 백혈병에 의한 합병증인 폐렴 및 패혈증으로 사망하였다. 본 증례의 방사선 피폭량은 1,853 mRem (18.53 mSv)이었으며, 방사선에 의한 암발생 원인확률은 미국 기준으로 5.4-6.1%이었다. 우리나라는 업무상 질병인정 기준에 방사선 노출에 의한 백혈병이 인정된다고 명시하고 있어 업무상 질병으로 인정되었다. 그러므로 우리나라 실정에 맞는 전리방사선 피폭량에 따른 업무상 질병 인정기준을 설정하여야 하며 방사선 피폭 근로자에 대하여 방사선 질환의 감시체계를 운영하여야 한다. Acute myelogenous leukemia (AML) has been known as an occupational disease induced by irradiation. We report a case of acute myelogenous leukemia with a history of low dose irradiation in a nuclear power plant. The authors reviewed the clinical and hematologic features of the case. We also reviewed the job contents of his workplace. We also interviewed other workers in the same workplace. The amounts of radiation exposure were reviewed. The worker was a 35-year-old male who had worked in a nuclear power plant for 11 years (1987-1997). Total amounts of radiation exposure during the work period was 1,853 mRem. He had been diagnosed as AML on November, 1997 at a routine periodic health examination. He died of refractory leukemia on May, 1999. The AML developed in this patient seems to be related to the exposure to radiation. To prevent irradiation injury, we must modify work procedures, begin comprehensive medical surveillance, educate workers on risks of radiation, and increase workers awareness of safety regulations in the workplace.

업무상 질병 인정기준 : 의료기간 종사자의 입장 Health Care Worker's Standpoint

임현술 대한의사협회 2004 대한의사협회지 Vol.47 No.1

철강업체와 용접봉 제조업체에 근무하는 생산직 근로자의 직업성 요통 유병률과 관련 요인

임현술,김수근,김덕수,김두희,이종민,김양호 大韓産業醫學會 1999 대한직업환경의학회지 Vol.11 No.1

A cross-sectional study was conducted for detecting the risk factors and to propose an effective control program for occupational low back pain. The subjects were 1,665 male production workers employed at a steel factory and a welding material manufacturing factory. The data were collected by a self-reported questionnaire and a medical examination with a rehabilitation specialist for ten days in September, 1997. The contents of the questionnaire were as follows: general characteristics, physical characteristics, employment status, type of work, working environment and the experience of low back pain. The number of cases with symptoms of occupational low back pain were 321, so the point prevalence was 19.3 persons/100 persons. The number of cases with a history of occupational low back pain for one year were 554, so the one year period prevalence was 33.3 persons/100 persons. The point and one year period prevalences of occupational low back pain showed no significant differences in age, marital status, educational level and body mass index. The point and one year period prevalences of occupational low back pain showed no significant differences in alcohol drinking, smoking, stretching exercise and regular exercise. The point and one year period prevalences of occupational low back pain were significantly higher in the unsatisfied group that the satisfied group (p<0.01). However, no significant differences were found among tenures and shift work. The point and one year period prevalences of occupational low back pain were significantly higher in the lifting of heavy materials group than the nonlifting group(p<0.01). However, no significant differences were found among posture of the waist and the working posture. Through the multivariate logistic regression, significantly associated factors with occupational low back pain were found to be dissatisfaction with job (point prevalence: OR=1.78, 95% CI: 1.21-2.61: one year prevalence : OR=1.76, 95% CI: 1.26-2.47), lifting of heavy materials(point prevalence OR=1.94 95% CI : 1.44-2.61; one year prevalence: OR=2.17, 95% CI : 1.70-2.77) and tenure (point prevalence : OR=1.03, 95% CI : 1.01-1.06; one year prevalence : OR=1.02, 95% CI : 1.00-1.05).

절삭유와 유기용매에 혼합 폭로된 근로자의 피부질환에 관한조사

임현술,김지용,성열오 동국대학교 경주대학 1993 東國論集 Vol.12 No.-

Cutting oils denature keratin, defat the skin and remove water from it, causing dryness, fissures and frank eczematization. Solvents remove the surface lipid film. Therefore the skin barrier is weakened and the absorption of irritant substances are increased. Saturated hydrocarbons from the solvent and paraffin series are stronger irritant than those from the aromatic series. To evaluate the health effects on skin among cutting oil and solvent exposed workers, self-administrative questionnaire survey was performed on 72 exposed workers and 91 non-exposed workers. The dermatologic examination and patch test were performed on the workers with suspected skin diseases. The results are summarized as follows ; The prevalences of some dermatologic disorders, such as primary irritant dermatitis, dyshidrotic eczema, allergic contact dermatitis and folliculitis were significantly higher among exposed group than non-exposed group(P<0.05). The positive rate of patch test among 16 workers were 6.3% for cutting oil, 18.8% for old solvent, 18.8% for new solventⅠ and 6.3% for new solvent Ⅱ. These results suggest that cutting oil and solvent may be a cause of occupational dermatoses among exposed workers.

채용시 건강진단에서 요ㆍ천추부 단순 방사선 검사의 평가

임현술,김수군,김덕수,이현경,최대섭 대한산업의학회 2000 대한직업환경의학회지 Vol.12 No.2

Objectives : A study was conducted for investigating the status of simple X-rays on lumbo-sacral regions at pre-employment health examination and analysing the effectiveness of simple X-rays on lumbo-sacral regions. Methods : The study data were pre-employment health examination data in a university hospital from Jan 3, 1993 through October of 1997. And, 97 newly employed workers who claimed no low back pawn at pre-employment health examination of a certain company were follow-up survey about low back pain and related factors in April, 1995 and October of 1997. The data were collected by a self-reported questionnaire and a medical examination with a rehabilitation specialist. Results : 1. Taking the simple X-rays on lumbo-sacral regions was 1,591 workers (10.5%) among 15,166 pre-employment health examination from Jan 3, 1993 through October of 1997. And yearly application rates of these X-ray tests have been significantly statistical increasing (p〈0.01). 2. The abnormal findings of simple X-rays on lumbo-sacral regions at pre-employment health examination were 40 workers. But, there was not significantly statistical difference between normal and abnormal group for the complaint rate of low back pain. 3. The number of case with symptoms of low back pain at the follow-up survey were 46, so The incidence density was 37.1 persons/ 100 person-years. And the incidence density was not significantly statistical difference between normal and abnormal group of simple X-rays on lumbo-sacral regions. 4. Through the multivariate logistic regression, significantly associated factors with low back Pain were found to be tenure(OR=0.36, 95%CI : 0.17-0.79), lifting of heavy materials (OR=5.86, 95%CI : 1.58-21.74) . Conclusion : The simple X-rays on lumbo-sacral regions at pre-employment health examination is required further research for utilizing pre-employment health examination according to above results.

우리나라 인수공통전염병의 발생 현황과 관리 대책

임현술,김홍환 약업신문사 1984 의약정보 Vol.10 No.1

코우크로스로의 방출물에 노출된 근로자에서 발생한 폐암 증례

임현술,최정근,권은혜,김헌 大韓産業醫學會 2002 대한직업환경의학회지 Vol.14 No.1

목 적 : 소세포성 폐암으로 진단받은 56세 남자에대하여 과거 21년간 코우크스로에서 근무한 작업력과 폐암과의 관련성을 파악하고자 하였다. 방 법 : 증례에 대한 의무기록가 흉부컴퓨터단층촬영 및 조직검사, 세포검사를 검토하였다. 증례의 작업 내역, 공것 작업환경 측정 결과를 파악하였고 작업환경 측정과 동료근로자에 대한 역학조사를 실시하였다. 작업환경측정은 산업안전보건연구원에서 모든 근로자를 대상으로 2회 반복 측정하였으며, 측정시간은 근로자의 작업시간 전체를 포함한 1일 8시간으로 하였다. 시료채취 및 분석방법은 미국 국립산업안전보건연구소의 공정시험법과 미국 노동부 산업 안전보건청의 공정시험법을 이용하였다. 측정결과의 정확도를 높이소 오차를 줄이기 위하여 측정 전후에 적적한 보정을 실시하고 현장 공시료를 포함하였다. 동료 근로자 40명에 대하여 역학조사를 실시하였고 COEs의 노출정도를 평가하기 위하여 PAHs의 대사산물인 1-OHP와 2-naphthol을 소변에서 분석하였다. 결 과 : P제철 부속의원에서 1996년부터 1999년까지 COEs에 대하여 측정한 결과는 0.01-0.39 ㎎/㎥ 범위로 후발성 콜타르피치물질에 대한 노동부의 노출기준인 0.2 ㎎/㎥르 적용할 때 초과하는 경우가 있었다. 1999년 산업안전보건연구원에서 작업환경을 직접 측정한 결과 전체 측정 건수 136건 중 45건 (33.1 %)이 노출기준을 초과하였다. 동료 근로자 40명에 대한 역학조사에서 특별한 COEs에 의한 건강장해를 발견하지 못하였다. K업체와 S업체의 근로자에 대하여 충북대학교 의과대학 예방의학교실에서 측정한 요중 1-OHP와 2-naphthol은 대조군인 대학생에 비하여 유의하게 높았다(P<0.01). 결 론 : 중례는 21년간 코우크스 제조공정에서 COEs에 노출되었으며, 현재 작업환경측정 결과로 판단할 때 노출기준을 초과하여 노출되는 경우도 있다고 추정되며, 흡연은 COEs가 폐암 발생을 가중시키는 요인으로 작용하였다고 추정된다. 그러므로 증례의 폐암은 코우크스 제조공정에서 노출된 COEs와 관련이 있다고 생각하여 직업성암으로 판단하였다. Objectives : We report a case of lung cancer (small cell carcinoma) occurring in a worker exposed to coke oven emissions. Methods : We examined the chest CT and pathologic findings of the patient. We reviewed previous environmental measurements for coke oven emissions at the workers place of employment. Also we measured the airborne concentrations for coke oven emissions and total polycuclic aromatic hydrocarbons in the work area. Finally, we analyzed the 1-hydroxypyrene and 2-naphthol concentrations in the subjects urine and compared this with student controls. Results : This case was a 56-year-old male who had worked in a coke oven plant within a steel manufacturing factory for 21 years (1977-1998). The airborne concentrations of coke oven emissions at the worksite were above the permissible exposure level (0.2 ㎎/㎥) in 45 cases (33.1%) among 136 workers. The concentrations of 1-hydroxypyrene and 2-naphthol in the subjects urine were statistically significantly elevated as compared with those of controls (P<0.01). Conclusions : We confirmed that the lung cancer occurring in this patient was as an occupational disease due to exposure to coke oven emissions. To prevent occupational cancer in coke oven plant workers, we must remodel the engineering procedure, begin comprehensive medical surveillance, educate workers on risks and the benefits of smoking cessation, and increase awareness of safety regulations in the workplace.

무수프탈산을 취급하는 근로자들의 알레르기 질환 유병 실태

임현술,김수근,김기식 大韓産業醫學會 1998 대한직업환경의학회지 Vol.10 No.4

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 tie 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/ιor 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.

업무상 질병으로 요양 승인된 의료기관 종사자 및 질병의 특성

임현술,안연순 大韓産業醫學會 2003 대한직업환경의학회지 Vol.15 No.2

목적: 의료기관 종사자는 다양한 위험 요인에 노출되어 있지만 지금까지 의료기관 종사자에 대한 건강장해에 대한 관심은 적었다. 본 연구는 의료기관 종사자가 업무상질병으로 요양 승인된 질병 사례를 검토하여 의료기관 종사자의 업무상질병의 종류와 특성을 파악하고자 하였다. 방법: 근로복지공단에서 1999년과 2000년 업무상질병자 또는 기타 재해자로 입력된 전산 자료를 한국산업안전공단 전산망에 연결하여 자료를 다운받아 업무상질병을 재분류한 후 2001년 6월 30일까지 요양 승인된 업무상질병자 5,460명을 파악하였다. 이들 중 의료기관 종사자인 근로자 142명을 대상으로 하여 성별, 연령, 진단명 및 직종을 파악하여 기술역학적 분석을 시행하였다. 결과: 업무상질병자 중에서 의료기관 종사자의 점유율은 1999년과 2000년 각각 2.6%이었다. 질병별 분포는 감염성 질환이 61명(43.0%), 뇌·심장혈관계 질환이 60명(42.3%), 근육골격계 질환이 18명(12.6%), 기타 3명(2.1%)이었다. 성별 분포는 남성 59명(41.5%), 여성 83명(58.5%)으로 여성이 많았다. 연령별 질병별 분포는 20대가 64명(45.1%)으로 가장 많았고, 30대 30명(21.1%), 40대 25명(17.6%), 50대 17명(12.0%), 60대 6명(4.2%)의 순으로 감소하였다. 직종별 질병별 분포는 간호사 및 간호조무사가 64명(45.1%)으로 가장 많았고, 의사 19명(13.4%), 사무직 18명(12.7%), 조리실 10명(7.0%), 영선부 5명(3.5%), 임상병리사 5명(3.5%), 환경미화원 4명(2.8%)의 순이었다. 질병별 분포는 1999년 감염성 질환은 결핵이 21명, 간염은 B형 간염 3명, C형 간염 2명, 수두 1명이었다. 뇌·심장혈관계 질환은 뇌출혈 14명, 뇌경색 7명, 심근경색증 7명이었다. 근육골격계 질환은 좌완관절전위 1명, 요추부 추간판탈출증 2명, 좌측견관절 상부관절 와순파열 및 감입증후군 1명이었다. 2000년 감염성 질환은 결핵이 23명, 간염 5명, 수두 3명, 홍역 3명이었다. 뇌·심장혈관계 질환은 뇌출혈 14명, 뇌경색 4명 심근경색증 12명 심실세동 1명, 중심망막동맥폐쇄 1명이었다. 근육골격계질환은 경추부 추간판탈출증 4명, 요추부 추간판탈출증 4명, 주관절 내상과염 1명, 견관절 극상근 건초염 1명, 수지 활액낭염 1명, 주관절 염좌 1명, 견괄절 충돌증후군 1명, 근막통증 증후군 1명이었다. 결론: 의료기관 종사자의 승인된 업무상질병은 감염성 질환, 뇌·심장혈관계 질환 및 근육골격계 질환이 대부분을 차지하고 있었다. 앞으로 의료기관 종사자의 유해 환경 노출 실태 및 업무상질병 여부를 파악하고 의료기관 종사자를 제도적으로 보호할 수 있는 산업보건 정책이 강구되어야 한다. Objectives: This study was carried out to analyze the characteristics of occupational diseases among health care workers in Korea. Methods: Using the database of the Korea Labor Welfare Corporation (KLWC), 5,460 approved occupational disease cases, between Jan 1, 1999 and Dec 31, 2000, and approved by the Jun 30, 2001, were collected. Of these, the 142 health care worker cases were investigated. Results: The proportion of health care workers among the total cases reported in 1999 and 2000 was 2.6%, respectively. The diseases were infectious in 61(43.0%), cerebro-cardiovascular in 60(42.3%)and musculoskeletal in 18 cases(12.6%). The distributions of the occupational diseases by sex were 59(41.5%)and 83 cases(58.5%), in males and females, respectively. The distributions of the occupational diseases by age were 64(45.1%), 30(21.1%), 25(17.6%) and 17 cases(12.0%), in their 20s, 30s, 40s and 50s, respectively. For the cases of infectious diseases by age there were 48(78.7%) in their 20s and 12(19.7%)in their 30s, for the cases of cerebro-cardiovascular diseases by age there were 17(28.3%)in their 40s, 16(26.7%)in their 50s and 12(20.0%)in their 20s, and for the cases of musculoskeletal diseases there were 7(38.9%)in their 30s and 4(22.2%)in their 20s. The distributions of the cases of occupational diseases by department were 64(45.1%), 19(13.4%), 18(12.7%), and 10(7.0%)in the nursing, doctors, officers, and food services departments, respectively. Conclusions: The major occupational diseases of health care workers, as approved by the KLWC, were the infectious, cerebro-cardiovascular and musculoskeletal diseases. A special management policy must be considered to prevent occupational diseases of health care workers in Korea.