대기오염과 관련된 건강영향을 평가하기 위한 설문 개발

주영수,김대성,강종원,성주헌,강대희,조수헌,백도명,Ju, Yeong-Su,Kim, Dae-Sung,Kang, Jong-Won,Seong, Joo-Heon,Kang, Dae-Hee,Cho, Soo-Hun,Paek, Do-Myung 대한예방의학회 1997 예방의학회지 Vol.30 No.4

This study was conducted to develop and evaluate the reliability and the validity of a questionnaire in order to determine the applicability as a screening tool for estimating environmental exposure and health effects related to air pollution. The questionnaire was developed with adopting some items of others such as ISAAC or ATS-DLD. And then we performed test-retest to 89 middle school students and their mothers at interval of three months. Cohen's Kappa values, weighted Kappa values, Spearman's correlation coefficients, and Pearson's correlation coefficients for each item were computed as reliability coefficients. The validity coefficients and validity coefficient bounds were also obtained by simply using these reliability coefficients. As results, Kappa ranged broadly from 0.10 to 0.61 of the items 'diet', $0.52\sim0.79$ of the environmental tobacco smoke, $0.39\sim0.44$ of the functional categories of surrounding environment, and $0.39\sim0.44$ of the using transportation systems; these items were regarded as confounding factors. For items related to health outcomes, Kappa ranged from -0.02 to 0.37 in the respiratory system of past medical history, and from 0.11 to 0.55 in the current health status. But Kappa of the others were over 0.60. In conclusion, if some items can be corrected or modified, the questionnaire developed in this study can be used as a tool for evaluating environmental exposure and health effects associated with air pollution.

직업성 요통환자에서 재활 프로그램(Back School Program) 도입의 비용-편익분석

주영수,하미나,한상환,권호장,조수헌,김창엽,김선민,Ju, Yeong-Su,Ha, Mi-Na,Han, Sang-Hwan,Kwon, Ho-Jang,Cho, Soo-Hun,Kim, Chang-Yup,Kim, Sun-Min 대한예방의학회 1996 예방의학회지 Vol.29 No.2

Although occupational low back pain accounts for $20\sim40%$ of all occupational illness and injury, there are limited numbers of studies regarding the effectiveness of back school program. The objective of this study was to evaluate the economic benefit of back school program for early return to work of occupational low back pain patients in the current occupational injury compensation and management system. The cost-benefit analysis in this study was conducted to evaluate the relative magnitude of benefit to cost. The total cost was estimated by calculating the value of components in back school program according to governmental budget protocol. The back school program was consisted of three major approaches, pain center, work-hardening program and funcional restoration program and each of components had various facilities and experts. The total amount of cost was estimated as 250,866,220 won per year. The most promising type of back school program were quite intensive (a 3 to 5-week stay in a specialized center), therefore, if we adopted the 5-week stay course, 10 courses could be held in a year. Following to the medical act, 20 patients per doctor could participate in a each course, ie, total 200 patients in a year. As a result, we could estimate the cost of 1,254,331 won a patient. We estimated the benefit by using data of a few local labor offices about average medical treatment beneficiary and off-duty beneficiary of 46 occupational low back pain patients in 1994. Ullman and Larsson (1977) mentioned that the group of chronic low back pain patients who participated in back school program needed less time to recover by 48.4% of beneficiary duration. And in the trying to estimate the benefit, we asked 10 rehabilitation board certificate doctors about reduction proportion of treatment cost by introducing back school program. The answered reduction proportions were in the range of $30\sim45%$, average 39%. As a final result, we could see that the introduction of back school program in treatment of chronic occupational low back pain patients could produce the benefit to cost ratio as 3.90 and 6.28. And we could conclude that the introduction of back school program was beneficial to current occupational injury compensation and management system.

한국판 국제 소아천식 및 알레르기 질환 연구 설문지의 신뢰도 및 타당도 연구

최성우,주영수,김대성,김재용,권호장,강대희,이상일,조수헌,Choi, Seong-Woo,Ju, Yeong-Su,Kim, Dae-Sung,Kim, Jae-Yong,Kwon, Ho-Jang,Kang, Dae-Hee,Lee, Sang-Il,Cho, Soo-Hun 대한예방의학회 1998 예방의학회지 Vol.31 No.3

Recent increases of asthma and allergies in childhood made the need for a standardized approach to international and regional comparisons of their prevalence and severity. To address these issues, 'International Study of Asthma and Allergies in Childhood (ISAAC)' is currently underway. In Korea, 'Nationwide Study of Asthma and Allergies in Korean Children' began in 1995 according to ISAAC protocol. ISAAC written and video questionnaires were used in this survey, but their reliability and validity were not evaluated properly yet. In this study, our aim was to evaluate the reliability and validity of two kinds of questionnaires and their usefulness in international and regional comparisons. The test and retest of two questionniares were completed by male(n=110) and female(n=111) middle school students with two and three weeks interval each. Kappa(or weighted kappa) were calculated from each questions and validity coefficients were estimated from those statistics. In Korean version of written questionnaire, the questions for allergic rhinitis, atopic dermatitis, allergic conjunctivitis, and food allergy proved to have high kappa values (or weighted kappa values) and validity coefficients and they can be used in further studies without any correction. But some questions about asthma(especially nocturnal cough, wheezing in exercise, and severe asthma) and drug allergy need to be revised for better under-standing to study subjects. Video questionnaire has the same degree of reliability and validity when compared to written questionnaire and this is the unexpected result. Accordingly, it also need to be revised to overcome the racial and cultural differences of the study subjects. In conclusion, the Korean version of written and video questionnaires may be considered to be useful methods in international and regional comparisons of asthma and allergic diseases in childhood after correction of some questions.

인천시 고잔동에서 제기된 유리섬유에 의한 건강피해 역학 조사

조수헌,주영수,김경렬,이강근,홍국선,은희철,송동빈,홍재웅,권호장,하미나,한상환,성주헌,강종원,Cho, Soo-Hun,Ju, Yeong-Su,Kim, Kyung-Ryul,Lee, Kang-Kun,Hong, Kug-Sun,Eun, Hee-Chul,Song, Dong-Bin,Hong, Jae-Woong,Kwon, Ho-Jang,Ha, Mi-Na,Han, Sang 대한예방의학회 1997 예방의학회지 Vol.30 No.1

In September 1994, residents of Gozan-dong, Incheon City, made a petition to the government about their health problems which might be caused by previous glass fibre landfill nearby 'H' company. In february 1995, at regular academic meeting of occupational and environmental medicine, a research team of 'D' University presented that they had found glass fibres in groundwater of the area through their survey. They were suspicious of probable association between ingestion of groundwater contaminated with glass fibres and skin tumors among residents. A joint research team was formed and carried out the survey of environment concerning groundwater and its glass fibre existence, and health assessment of residents in the area and industrial workers of 'H' company during May to November, 1995. Analysis of groundwater flow system indicates that the flow lines from the glass fibre landfill pass through or terminate at the 6 houses around the landfill. This means that the groundwater of the 6 houses around the glass fibre landfill could be affected by some possible contaminants from the landfill, but the groundwater quality of the other houses was irrelevant to the landfill. The qualitative and qualitative analyses for glass fibres in 54 groundwater samples including those from the nearby 6 houses, were carried out using SEM equipped with EDS, resulting in no evidence for the presence of glass fibres in the waters. Major precipitates, formed in waters while boiling, were identified as calcium carbonates, in particulary, aragonites in needle form. The results of health assessments of 889 residents in Gozan-dong, participated in this study, showed statistically significant differences in past medical histories of skin tumor and respiratory disease between the exposed group (31 persons who inhabited in 6 houses around the landfill) and the control group, but no significant differences in past medical histories of other diseases, such as cancer mortality, current gastroscopic findings, current skin diseases and respiratory diseases, etc. Also, we could not prove any glass fibres in excised specimens of 9 skin tumors in both groups and there were no health problems possibly associated with glass fibres in employees of the 'H' company. After all, we could not authenticate the association, raised by prior investigators, between groundwater streams, assumedly contaminated with glass fibres or not, and specific disease morbidities or common disease/symptom prevalences. That is, we could not find any glass fibres in groundwater as the only exposure factor of this study hypothesis, and there were not enough certain evidences such as increasing disease prevalences, for examples, skin, respiratory and gastrointestinal diseases etc, possibly related to glass fibre exposure, in exposed group. As a matter of course, the conditions for confirming causal association, for example, strength of the association, consistency of the association, specificity of the association, temporality of the association and dose-response relationship etc, have not been satisfied. In conclusion, we were not able to certify the hypothesis that contamination of groundwater with glass fibres might cause any hazardous health effects in residents who used it for drinking.

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.

체중 잔차를 이용한 12세 아동의 정상 폐기능 예측식

강종원,성주헌,조수헌,주영수,Kang, Jong-Won,Sung, Joo-Hon,Cho, Soo-Hun,Ju, Yeong-Su 대한예방의학회 1999 Journal of Preventive Medicine and Public Health Vol.32 No.1

Objectives. Changes in lung function are frequently used as biological markers to assess the health effects of criteria air pollutants. We tried to formulate the prediction models of pulmonary functions based on height, weight, age and gender, especially for children aged 12 years who are commonly selected for the study of health effects of the air pollution. Methods. The target pulmonary function parameters were forced vital capacity(FVC) and forced expiratory volume in one second(FEV1). Two hundreds and fifity-eight male and 301 female 12-year old children were included in the analysis after excluding unsatisfactory tests to the criteria recommended by American Thoracic Sosiety and excluding more or less than 20% predicted value by previous prediction equations. The weight prediction equation using height as a independent variable was calculated, and then the difference of observed weight and predicted weight (i.e. residual) was used as the independent variable of pulmonary function prediction equations with height. Results. The prediction equations of FVC and FEV1 for male are FVC(ml) = $50.84{\times}height(cm)+7.06{\times}weight$ residual 4838.86, FEV1(ml) = $43.57{\times}height(cm)+3.16{\times}weight$ residual - 4156.66, respectively. The prediction equations of FVC and FEV1 for female are FVC(ml) = $42.57{\times}height(cm)+12.50{\times}weight$ residual - 3862.39, FEV1(ml) = $36.29{\times}height(cm)+7.74{\times}weight$ residual - 3200.94, respectively. 환경오염과 관련된 건강효과 연구에서 흡연, 직업 등 교란변수의 영향을 효과적으로 배제할 수 있으면서 폐기능검사가 제대로 시행될 수 있는 연구대상으로 선호되고 있는 특정 연령층인 12세 학동의 보다 정확한 FVC와 FEV1 예측식을 만 들고자 전국 11개 중학교의 학생들(남자 256명, 여자 301명)을 대상으로 측정된 신장, 체중, 그리고 폐기능검사 값으로 신장-체중의 회귀식을 유도하였고, 이를 통해 12세 인구의 신장별 표준체중을 산출하였다. 이 표준체중과 실측체중의 차이인 잔차를 독립변수로 하여 폐기능 예측 식을 남녀별로 만들었는데, 남자의 경우는, FVC(ml) = 50.84 $\times$ 신장(cm) + 7.06 $\times$ 체중 잔차 - 4838.86, FEV1(m1) = 43.57 $\times$ 신장(cm) + 3.16 $\times$ 체증 잔차 4156.66 이었다. 여자에서는 FVC(ml) = 42.57 $\times$ 신장(cm) + 12.50 $\times$ 체중 잔차 - 3862.39, 그리고 FEV1(ml) = 36.29 $\times$ 신장(cm) + 7.74 $\times$ 체중 잔차 - 3200.94 이었다. 이렇게 얻어진 예측값들의 설명력(R2)은 남자에서 FVC, FEV1가 각각 0.708, 0.670이었고, 여자에서는 FVC, FEV1가 각각 0.580, 0.513이었다.

한국 여성에서의 자궁경부암 발생률

박병주,이무송,안윤옥,최영민,주영수,유근영,김헌,유하성,박태수,Park, Byung-Joo,Lee, Moo-Song,Ahn, Yoon-Ok,Choi, Young-Min,Ju, Yeong-Su,Yoo, Keun-Young,Kim, Hun,Yew, Ha-Seung,Park, Tae-Soo 대한예방의학회 1996 Journal of Preventive Medicine and Public Health Vol.29 No.4

To estimate the incidence of uterine cervix cancer among Korean women, we have conducted a study using the claim data on the beneficiaries of Korea Medical Insurance Corporation (KMIC). All medical records of the potential cases with diagnosis of ICD-9 180, 181, 182, 199, 219, 233 in the claims sent by medical care institutions in the whole country to the KMIC from January 1988 to December 1989, were abstracted and Gynecology specialist reviewed the records to identify the new cases of uterine cervix cancer among the potential cases during the corresponding period. Using these data, the incidence of uterine cervix cancer among Korean women was estimated as of July 1, 1988 to June 30, 1989. The crude rate was estimated to be 17.34(95% CI: $16.76\sim17.92$) per 100,000 and the cumulative rates for the ages $0\sim64\;and\;0\sim74$ were 1.7% and 2.2%, respectively. The age-adjusted rate for the world population was 19.93 per 100,000 which was higher than those of other Asian countries including China and Japan in $1983\sim1987$. The truncated rate for ages $35\sim64$ was 52.05 per 100,000 which was one of the highest in the world. With increasing age, the incidence rate increased to 78.11 per 100,000 in women aged $55\sim59$ years, then it decreased in the older groups. This finding suggests that detecting rate of uterine cervix cancer may decrease in women aged 60 years or older due to inadequate medical care seeking behavior. In the geographical area, the SIR of Jeju province was significantly low but it might be due to statistical unstability by small case numbers.

황사기간 중 천식 환자에서 대기 중 미세먼지(PM10)가 최대호기 유속과 호흡기 증상에 미치는 영향

박정웅 ( Park Jeong Ung ),임영희 ( Im Yeong Hui ),경선영 ( Gyeong Seon Yeong ),안창혁 ( An Chang Hyeog ),이상표 ( Lee Sang Pyo ),정선환 ( Jeong Seon Hwan ),주영수 ( Ju Yeong Su ) 대한결핵 및 호흡기학회 2003 Tuberculosis and Respiratory Diseases Vol.55 No.6

군용 항공기 이륙소음이 청력, 혈압, 스트레스 및 주관적 인지도에 미치는 영향

한상환,조수헌,고경심,권호장,하미나,주영수,신명희,Han, Sang-Hwan,Cho, Soo-Hun,Koh, Kyung-Shim,Kwon, Ho-Jang,Ha, Mi-Na,Ju, Yeong-Su,Shin, Myung-Hee 대한예방의학회 1997 예방의학회지 Vol.30 No.2

In effort to determine whether aircraft noise can have health effects such as hearing loss, hypertension and psychological stress, a total of 111 male professors and administrative officers working a college near a military airport in Korea(exposed group) and a total of 168 males and 112 females matched by age groups(control groups) were analyzed. Personal noise exposure and indoor and outdoor sound level of jet aircraft noise were measured at the exposed are3. And pure tone, air conduction test and measurement of blood pressure were given to the exposed(males) and matched control groups (males and females). BEPSI(Brief Encounter Psychological Instrument) and psychological response to aircraft noise were examined for the exposed group. The noise dosimetry results revealed time-weighted averages(TWAs) that ranged from 61 to 68 dBA. However the levels encountered during taking off jet airplanes reached 126 dBA for two half minutes time period. Th, audiometric, test showed that mean values of HTL(hearing threshold level) in exposed group at every frequency(500, 1,000, 2,000, 4,000, and 8,000 Hz were much lower than them of male and female control groups. And in old age groups, interaction of age and noise was observed at 8,000 Hz in both ears(p<0.05). Conclusively, aircraft noise does not appear to induce hearing loss directly in high frequency, but may decreased hearing threshold level by interaction of aging process and noise exposure. However, difference of mean values of exposed and control groups on blood pressure was not significantly. In psychological test, annoyance was the most severe psychological response to noise in exposed group, but mean value of BEPSI was not correlated with job duration in exposed group.

특수건강진단 자료를 이용한 소음성난청 판정기준의 비교

한상환,조수헌,주영수,하미나,윤덕로,권호장,강대희,성주헌 大韓産業醫學會 1996 대한직업환경의학회지 Vol.8 No.3

Although noise-induced hearing loss (NIHL) is the most prevalent occupational disease in Korea, only 10% of the diagnosed cases are compensated. Old (1989-94) and current diagnostic criteria, criteria for workers' compensation of NIHL in Korea, compensation formulas of American Medical Association/American association of Ophthalmology and Otolaryngology (AMA/AAOO), the Committee on Hearing, Bio-Acoustics, Biomechanics (CHABA), American Academy of Otolaryngology (AAO) recommendation were compared. Each criterion was applied on the audiomety data of 4044 workers (8023 ears), who had received the second line screening test of Special Periodic Health Examination Program for noise-exposed workers during 1991-2. First, the resulting proportions of NIHL cases by employing each criterion were compared and strength of agreement was measured using kappa value. Temporary Threshold Shift (TTS) was corrected by noise free interval, and the reduction ratio of NIHL cases was calculated. Theoretical progression model of NIHL was reconstructed from previous studies on the natural course of NIHL to evaluate the change of diagnosis result of each criterion in the model. The kappa value between old and current criteria was 0.19, 0.55 for current criteria and workers' com. criteria, ranging from 0.08 to 0.78, highest coincidence was observed between current criteria and CHABA formula. The current criteria produce most similar results with CHABA formula. If TTS is corrected for NFI, there is about 14% reduction of NIHL cases. The results of applying on NIHL progression model divided the formulas roughly into 3 groups, of which compensation criteria was the most, old criteria and AAO the least conservative. In conclusion, the result of 4 ㎑ audiometry should be excluded in evaluation of hearing level and a new hearing conservation program should be set out. Current diagnostic criteria has an ambiguity in that managerial concept for prevention and purpose of compensation is mixed up. The current diagnostic criteria and compensation criteria could be incorporated into a new formula which is based on the state of the art test for estimating everyday hearing disability.