아동기 주의력결핍 과잉행동장애의 유해환경인자

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

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

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

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

이산화질소 개인 노출량이 기관지천식 환자의 최대호기유속에 미치는 영향

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

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

설문지에 의한 대기오염의 호흡기계 증상 발현에 관한 조사연구

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

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

고성 폐금속 광산 오염 사건의 교훈

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

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

Receiver Operating Characteristic 분석법을 이용한 업무관련성 근골격계질환 설문지 개발

권호장,주영수,조수헌,강대희,성주헌,최성우,최재욱,김재영,김돈규,김재용,Kwon, Ho-Jang,Ju, Yeong-Su,Cho, Soo-Hun,Kang, Dae-Hee,Sung, Joo-Hon,Choi, Seong-Woo,Choi, Jae-Wook,Kim, Jae-Young,Kim, Don-Gyu,Kim, Jai-Yong 대한예방의학회 1999 예방의학회지 Vol.32 No.3

ROC곡선의 AUC는 측전도구의 기준 타당도를 나타내는 가장 일반화된 지표다. 본 연구는 ROC분석법을 이용하여 현행의 근로자건강진단에서 업무관련성 근골격계 질환의 고위험군을 변별하는 표준 설문지를 개발하고자 하였다. 컴퓨터를 이용하는 선박 설계업 종사자 89명, 전화번호 안내원 113명, 일반 직업 여성 79명, 주부 89명 등 총 370명의 일차 연구대상군에 대한 재활의 학과 전문의의 최종 진단결과를 기준으로 1996년에 개발된 '근로자의 신체 증상에 관한 설문지'의 응답결과를 비교하였다. 근골격계 질환과의 관련성이 높은 문항조합을 선정하고 문항별 가중치를 산출하기 위해 로짓회귀분석, 상관분석 등을 실시하였으며, 문항조합 및 가중치 산출방법이 서로 다른 4가지 설문모형에 따른 AUC를 비교 하였다. 또한, 국내 모 자동차조립공장 근로자 225명의 설문결과와 산업의학 전문의의 진단결과 자료를 이용하여 4가지 설문모형의 AUC 재현도를 확인하였다. 분석 결과, 통계적으로 유의 한 차이는 없었으나 문항수를 줄여도 문항별 응답수준별 가중치를 부여하면 AUC가 일관되게 증가함을 확인하였다. 증상문항 4개와 신체부위문항 7개를 통합한 11개 문항에 가중치를 부여하는 모형이 변별력, 재현도, 편의성 측면에서 우수한 것으로 나타나, 이를 기준으로 새로운 업무관련성 근골격계 질환 설문지를 설계할 수 있었다. 문항수가 적으면서도 타당도는 높은 설문지를 개발하고, 상대적인 비교평가에 쓰일 수 있는 정량적 가중치를 제시한 것이 본 연구의 주요성과라 할 수 있다. 본 연구는 전문의 사이의 진단기준 차이를 고려하지 못한 점, 다양한 인구집단에 적용할만한 절대적인 참고치를 제시하지 못한 점 등에서 한계가 있다. 그러나, '측정 도구의 정량적 타당도 검증을 통한 질병 감시용 도구 개발'이라는 본 연구의 기본 취지 및 접근방법은 향후 조직적인 질병 예방활동에 활용될 여지가 있을 것이다. Objectives: Receive Operating Characteristic(ROC) curve with the area under the ROC curve(AUC) is one of the most popular indicator to evaluate the criterion validity of the measurement tool. This study was conducted to develop a standardized questionnaire to discriminate workers at high-risk of work-related musculoskeletal disorders using ROC analysis. Methods: The diagnostic results determined by rehabilitation medicine specialists in 370 persons(89 shipyard CAD workers, 113 telephone directory assistant operators, 79 women with occupation, and 89 housewives) were compared with participant's own replies to 'the questionnair on the worker's subjective physical symptoms'(Kwon, 1996). The AUC's from four models with different methods in item selection and weighting were compared with each other. These 4 models were applied to 225 persons, working in an assembly line of motor vehicle, for the purpose of AUC reliability test. Results: In a weighted model with 11 items, the AUC was 0.8155 in the primary study population, and 0.8026 in the secondary study population(p=0.3780). It was superior in the aspects of discriminability, reliability and convenience. A new questionnaire of musculoskeletal disorder could be constructed by this model. Conclusion: A more valid questionnaire with a small number of items and the quantitative weight scores useful for the relative comparisons are the main results of this study. While the absolute reference value applicable to the wide range of populations was not estimated, the basic intent of this study, developing a surveillance fool through quantitative validation of the measures, would serve for the systematic disease prevention activities.

대기오염 역학연구의 주요 쟁점들

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

우리는 이 글에서 대기오염의 건강영향, 특히 사망에 대한 역학 연구 결과를 해석하는데 논란이 되고 있는 쟁점들을 고찰하였다. 과거 런던스모그 때와 같은 극심한 대기오염 사건 때는 그로 인한 건강영향도 매우 자명하여 별다른 논란의 소지가 없었다. 그러나 오늘날 우리가 경험하는 수준의 대기오염은 눈에 바로 띨 정도의 건강영향을 초래하지는 않기 때문에 많은 연구에서 관찰되는 통계적 유의성이 인과적 관련성을 의미하는지에 대한 많은 논란이 있다. Hill의 인과성기준에 비추어 대기오염에 관한 역학 연구 결과들을 평가해보면 각 기준 별로 부합되는 소견과 그렇지 않은 소견이 같이 존재하지만 전체적으로는 인과적인 관련성을 지지하는 증거들이 많은 편이다. 특히 세계 여러 지역에서 수행된 연구들에서 공통된 결과들이 나오는 것이 인과성을 지지해주는 강력한 근거라고 할 수 있다. 대기오염이 사망을 증가시킨다고 가정할때 구체적으로 어떤 병태 생리적인 기전을 통해서 증가시키는지는 아직 충분히 밝혀져 있지 않다. 현재까지의 역학연구 결과들과 동물실험 결과들을 종합해보면 대기오염 물질이 일차적으로 폐포에 염증을 유발하고 이에 따라 이차적으로 혈장의 응고성이 증가하거나, 심장에 대한 자율신경조절에 이상이 생겨서 사망위험이 증가한다는 가설이 가장 폭넓은 지지를 받고 있다. 시계열분석에서 나타나는 대기오염에 의한 초과사망자들이 어떤 특성을 가지고 있는지에 대한 논란도 많다. 대기오염이 아니더라도 곧 사망할 사람들이 대기오염 때문에 몇 일 앞당겨 사망한다는, 즉 추수효과에 의한 것이라는 것이 상식적인 판단이지만 최근의 연구들은 추수효과 외에도 대기오염에 의해 실질적인 수명의 감소가 있다는 증거들을 제시하고 있다. 대기오염 물질과 사망의 양-반응 관계가 어떤 모양일지, 그리고 문턱값이 존재하는지의 여부도 중요한 관심사이다. 특히 문턱값의 존재 여부는 대기오염 관리 대책과도 밀접한 관계가 있다. 대기환경 기준을 정해서 대기오염 수준을 관리하는 현재의 대책은 문턱간의 존재를 전제하고 있기 때문이다. 그러나 현재까지의 증거를 종합해보면 대기오염과 사망의 관련성은 문턱값이 없는 선형적 관계일 가능성이 높다. 따라서 향후 대기오염 관리대책에서는 대기오염 물질의 평균농도를 낮추려는 노력을 병행하여야 할 것을 생각한다. The purpose of this review is to discuss the debate concerning the interpretation of epidemiologic studies on particles and health effects. Study of the 1952 air pollution disaster in London established that very high levels of particulate-based smog can cause dramatic increases in daily mortality. However, recent epidemiologic studies have reported statistically significant health effects and mortality due to low levels of air pollution. The statistical significance does not prove causation in observational studies; therefore it is necessary to evaluate these associations. There are arguments for and against each of the numerous studies using Hill's criteria, however the body of accepted evidence supports the causal association. In particular, a high level of consistency in the estimated effect of PM10 has been observed across studies worldwide. The mechanism of the relationship between air pollution and health effects is not obvious. The mechanism of particle-induced injury may involve the production of an inflammatory response by the particulate. The harvesting and the threshold effect are also major concerns regarding the health effects of air pollution. However, current epidemiologic findings indicate that linear models lacking a threshold are appropriate for assessing the effect of particulate air pollution on daily mortality even at current levels.

서울시의 대기오염과 일별 사망자 수의 관련성에 대한 시계열적 연구

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

대기오염이 인체에 미치는 영향을 정량적으로 분석하기 위하여 1991년부터 1995년까지의 서울시 사망자료와 대기오염 자료를 general additive Poisson model 을 사용하여 분석하였다. 우리 나라에서도 외국의 연구 결과와 마찬가지로 대기 오염 물질의 증가가 사망자 수의 증가에 유의하게 영향을 미치는 것으로 평가되었다. 특히 본 연구에서 나타난 특성은 일반적으로 많이 알려진 분진에 의한 영향 보다는 오존에 의한 영향이 두드러진다는 것이다. 오존은 100ppb가 증가할 때 마다 사망자 수를 3-10% 증가시키는 것으로 평가되었다. 즉 오존주의보가 발령될 때마다 서울시에서는 많게는 평소보다 10%정도의 추가적인 사망이 발생하는 것으로 추정된다. 이러한 연구결과는 우리 나라의 대기오염 양상이 분진과 $SO_2$ 중심의 '런던스모그'형에서 오존과 $NO_2$ 등에 의한 광화학적 스모그로 바뀌고 있는 사실을 감안할 때 시사하는 바가 매우 크다고 할 수 있다. 따라서 앞으로는 병원입원율, 또는 응급실 내원환자수에 대한 오존의 영향을 평가할 수 있는 연구들이 이어져야 할 것으로 생각되며, 더불어 오존 오염을 감소시킬 수 있는 구체적인 정책들이 시급히 시행되어야 할 것으로 생각된다. Objectives: To examine the relationship between air pollution exposure and mortality in Seoul for the years of 1991-1995, Methods: Daily counts of death were analyzed by general additive Poisson model, with adjustment for effects of secular trend, seasonal factor, day of the week, heat wave, temperature, and humidity. Pollution variables were ozone, nitrogen dioxide, total suspended particles(TSP), and sulfur dioxide. Results: Daily death counts were associated with ozone(1 day before), nitrogen dioxide(1 day before), TSP(2 days before), sulfur dioxide(2 days before). The association with ozone was most statisfically significant and independent of other air pollutants. Increase of 100 ppb in ozone was associated with 0%(95% Cl= 2%-10%) increase in the daily number of death, This effect was greater in persons aged 65 and older. The relative risks of death from respiratory disease and cardiovascular disease were greater than for all-cause mortality in each pollutant. After ozone level exceeds 25 ppb, the dose-response relationship between mortality and ozone was almost linear. However, the effect of TSP, sulfur dioxide, and nitrogen dioxide on mortality might be confounded with each other. Conclusion: Daily variations in air pollution within the range currently occurring in Seoul might have an adverse effect on daily mortality.

서울시 환경보건정책 로드맵 수립

임지애,권호장,김신범,최영은,구슬기,정회성,김명한,최경호,Lim, Ji-Ae,Kwon, Ho-Jang,Kim, Shinbum,Chou, Youngeun,Gu, Seulgi,Jeong, Hoi-Seong,Kim, Myung Han,Choi, Kyungho 한국환경보건학회 2014 한국환경보건학회지 Vol.40 No.5

Objectives: The purpose of this study is to introduce the establishment process and results of the Seoul Metropolitan Government's road map on environmental health policy. Methods: The process consisted of expert group meetings, civic participation, research, and questionnaire survey for priority environmental health policy agenda items in Seoul. Results: The announced vision for the environmental health policy was "a healthy environment, safety in Seoul". This policy was established in order to define environment health policy initiatives for a period of five years with an aim to protect Seoul citizens' health from hazardous environmental factors. The resulting Seoul environmental health policy consisted of four areas and 16 key agenda items. The four areas were "Protection for children against hazardous materials", "Enhancement of health and safety of all", "Carcinogen-free and endocrine-disrupting chemical-free Seoul (reducing environmental exposure to hazardous materials), and "Establish the foundation of environmental health policy". Sixteen key agenda items include the enhancement of management of spaces for children, certification of environmental health status at schools, establishment of a unit responsible for the environmental health of children, strengthening environmental health management for susceptible populations (children, the aged, and the socioeconomically vulnerable), management of hazardous materials, physical hazardous factors (noise, radiation, etc.), indoor air quality, and the enhancement of monitoring, research, and regulation of environment health. Conclusion: The Seoul Metropolitan Government established an environmental health policy road map for a five-year period (2013-2017). To implement this environmental health policy, budget allocation, and detailed execution plans are required.

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

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

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