대기오염과 천식발작의 관련성에 관한 시계열적 연구

주영수,조수헌,Ju, Young-Su,Cho, Soo-Hun 대한예방의학회 2001 예방의학회지 Vol.34 No.1

Objectives : To evaluate the hypothesis that increasing ambient levels of ozone or particulate matter are associated with increased emergency room visits for asthma and to quantify the strength of association, if any, between these. Methods : Daily counts of emergency room visits for asthma, air quality, and weather data were collected from hospitals with over 200 beds and from monitoring Stations in Seoul, Korea from 1994 through 1997. Daily counts of emergency mom visits for asthma attack were analyzed using a general additive Poisson model, with adjustment for the effects of secular trend, seasonal variation, Sunday and holiday, temperature, and humidly, according to levels of ozone and particulate matter. Results : The association between daily counts of emergency room visits for asthma attack and ozone levels was statistically significant in summer(from June to August), and the RR by unit inclement of 100 ppb ozone was 1.30(95% CI = $1.11\sim1.52$) without lag time. With restriction of the period from April to September in 1996, the RR was 1.37(95% CI = $1.06\sim1.76$), and from June to August in 1995, the RR was 1.62(95% CI = $1.12\sim2.35$). In the data for children$(5\sim14yr)$, the RR was 2.57(95% CI = $1.31\sim5.05$) with restriction of the period from April to September in 1997. There was no Significant association between TSP levels and asthma attacks, but a slight association was seen between PM10 levels and asthma attacks in a very restricted period. Conclusion : There was a statistically significant association between ambient levels of ozone and daily counts of emergency room visits for asthma attack. Therefore, we must make efforts to effectively minimize air pollution, in order to protect public health.

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.

도로다이어트를 위한 차로 폭 축소 시 주행속도 저하에 따른 링크통행시간 분석에 관한 연구

이영우(Lee Young Woo),주영수(Ju Young Soo),최형욱(Choi Hyeoung Wook) 대한토목학회 2010 대한토목학회 학술대회 Vol.2010 No.10

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.

우리나라 성인여성에서 정상 폐활량 예측을 위한 양팔벌린 손끝길이와 신장과의 관계

고원중 ( Won Jung Koh ),주영수 ( Young Su Ju ),김태엽 ( Tae Yub Kim ),박재성 ( Jae Sung Park ),유승도 ( Seung Do Yu ),최광수 ( Kwaung Soo Choi ),백도명 ( Do Myung Paek ),한성구 ( Sung Koo Han ),심영수 ( Young Soo Shim ) 대한결핵 및 호흡기학회 1999 Tuberculosis and Respiratory Diseases Vol.46 No.6

서울지역 대기오염이 호흡기계질환에 미치는 단기영향에 관한 환자교차연구

이영주,이종태,신동천,임형준,조수헌,주영수,Lee, Young-Ju,Lee, Jong-Tae,Shin, Dong-Chun,Im, Hyoung-June,Cho, Soo-Hun,Ju, Young-Su 대한예방의학회 2001 예방의학회지 Vol.34 No.3

Objectives : To evaluate the hypothesis that air pollution could increase emergency room visits for respiratory diseases, and if so, to quantify the strength of association between those. Methods : We compiled daily records of hospital emergency room visits for respiratory diseases in Seoul, from November 1. 1955 to October 31. 1996, by using medical utilization data of unscheduled visits. In addition, air quality and weather data for the same period was collected. And a case-crossover design was applied by adopting conditional logistic regression analysis to determine the relationship between air pollutants and emergency room visits for respiratory diseases. In particular, the control periods were chosen by a bidirectional paired matching technique 7, 14, and 21 days before and after the case periods. Results : Only ozone was associated with the increased number of emergency room visits for respiratory diseases. The relative risk according to a 30ppb increase of ozone concentration (24hr mean, lagged 1day) was 1.91(95% confidence interval = 1.78-2.05). Conclusion : There was a statistically significant association between the ambient ozone and daily emergency room visits for respiratory diseases.

의과대학 연구동에서 발생한 유행성출혈열 역학조사

조수헌,강대희,김성권,김익상,홍성태,주영수,Cho, Soo-Hun,Kang, Dae-Hee,Kim, Suhng-Gwon,Kim, Ik-Sang,Hong, Sung-Tae,Ju, Young-Su 대한예방의학회 1999 Journal of Preventive Medicine and Public Health Vol.32 No.3

Background : In April 6, 1990, a male researcher who has worked at a research unit at the Basic Research Building of Seoul National University(SNU) College of Medicine admitted to SNU Hospital due to persistent fever. He was diagnosed serologically as hemorrhagic fever with renal syndrome(HFRS). Another female researcher in the same unit was also diagnosed as HFRS at the same hospital several days later. Epidemic investigation of HFRS was conducted to determine the magnitude of the problems since these two cases were strongly suspected to have laboratory-acquired infections of HFRS. Methods : All researchers and employees working at the Basic Research Building(BRB) of SNU College of Medicine as of April 1, 1996 were recruited for the study, information on symptoms of HFRS and history of contact to experimental animals were collected by self-administered questionnaires and serological tests among study subjects were also conducted by indirect immunofluorescent antibody(IFA) to hantavirus. The experimental animals were also serologically tested for infection with hantavirus by IFA. Results : Among 218 surveyed, six researchers and an animal caretaker had hantavirus antibodies above 1:20 in IFA titer. Five of seven sero-positive subjects had antibodies above 1:640 in IFA titer and had shown clinical symptoms compatible to HFRS during Jan. 1 to Apr, 20, 1996. The sero-positive persons had handled animals more frequently than sero-negative persons (OR, 19,68; 95% Cl, 1.11-350.40) and handling animals at the animal quarter at School of Public Health(SPH) had shown consistently higher risk to get infected with hantavirus irrespective of types of animals handled (OR, 4.90-6.37). Sero-positivity of rats of the aniamal quarter at BRB was 30-60%, whereas 80% of rats at SPH tested were shown sero-positivity. Conclusion: There was a epidemic of HFRS in research units of a medical school during the period from Jan. through Apr, Further investigation is needed to determine the extent and the mode of transmission of the laboratory-acquired infection with hantavirus in other research facilities.

서울지역의 업무상 뇌ㆍ심혈관질환 인정 여부에 영향을 미치는 요인

이태경(Tae-Kyung Lee),김수근(Soo-Geun Kim),원종욱(Jong-Uk Won),장태원(Tae-Won Jang),조성식(Seong-Sik Cho),주영수(Young-Su Ju),권영준(Young-Jun Kwon),임형준(Hyoung-June Im) 대한직업환경의학회 2010 대한직업환경의학회지 Vol.22 No.3

알레르기 ; 단일기관에서 전산을 통해 수집된 자발적 약물유해반응 보고사례들의 분석

김민강 ( Min Gang Kim ),강혜련 ( Hye Ryun Kang ),김주희 ( Joo Hee Kim ),주영수 ( Young Soo Ju ),박성훈 ( Sung Hoon Park ),황용일 ( Yong Il Hwang ),장승훈 ( Seung Hun Jang ),김동규 ( Dong Gyu Kim ),정기석 ( Ki Suck Jung ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5

저자는 2007년 9월부터 2008년 10월까지 한림대 성심병원에서 보고된 약물유해반응 사례들의 원인약물과 임상양상을 분석하였다. 전산화 시스템을 도입한 이래 보다 효율적으로 약물유해반응을 수집할 수 있었으며, 병동별 약물유해반응 담당자를 정함으로써 안정적인 약물감시체계를 정착시킬 수 있었다. 보고된 1,112건 중 인과성이 있다고 평가된 사례는 980건이었으며, 이 중 원인 약물로 의심되는 약제는 항생제, tramadol, 조영제, 아편계 진통제 순이었다. 보고사례들 나이가 많을수록 증상이 심한 사례의 비율이 높았으며, 성별에 따라서는 여자들의 평균 연령이 남자들보다 높았다. Tramadol, NSAIDs로 인한 약물 유해반응 보고사례에서는 여자가 차지하는 비율이 높았다. 가장 흔한 임상양상은 피부 발진과 두드러기 등의 피부 이상반응이었고, 오심, 구토 등의 소화기계반응이 그 뒤를 이었다. Background/Aims: The recent introduction of computerized surveillance systems has promoted the monitoring of adverse drug reactions (ADRs), a feature that facilitates voluntary reports and enables prompt feedback. To investigate the causative agents and severity of ADRs that occurred in a single hospital, we analyzed the features of 980 ADRs that occurred over 14 months after developing a computerized ADR reporting system in Hallym Sacred Heart Hospital. Methods: ADR data collected prospectively from September 2007 to October 2008 by a computerized reporting system were analyzed. The World Health Organization-Uppsala Monitoring Center (WHO-UMC) criteria were used to determinate causality for each ADR. Results: The number of ADR cases reported voluntarily increased rapidly since the introduction of the computerized ADR reporting system. Of the 980 cases, antibiotics (34.5%) were the most common causative drugs, followed by analgesics such as tramadol and its compound (15.2%), radiocontrast media (7.0%), narcotics (5.9%), and nonsteroidal anti-inflammatory drugs (NSAIDs) (5.5%). Fifty-nine (6.0%) and 206 (21.0%) cases were classified as severe and moderate reactions, respectively. The mean age was older in patients with severe ADRs than in patients with non-severe ADRs. The most common clinical features were skin manifestations, such as pruritus, skin eruptions, and urticaria. Gastrointestinal symptoms including nausea, vomiting, and diarrhea were the second most frequently reported ADRs. Among antibiotics, first-generation cephalosporins were the most frequently reported causative drugs, followed by second-generation cephalosporins, penicillin/β-lactamase inhibitors, and third-generation cephalosporins. While 11.6% of ADRs related to penicillin/β-lactamase inhibitors were classified as severe, there was only one severe ADR (1.1%) for first-generation cephalosporins. Most ADRs were reported equally in men and women, although female cases constituted about two thirds of ADRs associated with tramadol and NSAIDs. Conclusions: We believe that a computerized reporting and replying system promoted the monitoring of ADRs. Antibiotics were reported most frequently as the causative agent of ADRs. Elderly patients seemed to be more susceptible to severe ADRs. With the voluntary reporting system, skin manifestations and gastrointestinal symptoms were detected successfully, while laboratory abnormalities without prominent symptoms seemed to be overlooked. Further efforts to screen for automated ADR signals are required. (Korean J Med 77:601-609, 2009)

사업장 소음 폭로에 의한 일과성 역치 상승과 회복

조수헌,하미나,한상환,주영수,성주헌,강종원,윤덕로,송동빈,이명학,김선태 大韓産業醫學會 1996 대한직업환경의학회지 Vol.8 No.2

To determine the recovery time from noise-induced temporary threshold shift(TTS), a prospective field study was conducted at three worksites where workers are known to be exposed high level of noise. Subjects were selected according to answers on a questionnaire which inquired about otological history and previous noise exposure, including avocational, military and occupational exposures. After excluding employee with past otologic problems, recent exposure to high level noise, and under medications, total 92 employees participated in the study. Among 92 participants, complete consecutive audiometric examinations were carried out at 0∼2 hours, 5∼7 hours, 14∼16 hours after worktime noise exposure on 26 participants wearing hearing protectors and 22 participants wearing no protective devices. The difference between the hearing level 0∼2 hours after noise exposure and 5∼7 hours is statistically significant by paired t-test(p<0.01). The median recovery times calculated from the data of 22 participants wearing no protective hearing devices are 15.6 hours at 4000Hz, and 7.7 hours, 10.3 hours, 8.4 hours at 1000Hz, 2000Hz and 8000Hz respectively. These data suggest that when measuring the pure tone audiometry for noise exposed workers, at least 16 hours noise-free interval is required.