미국과 영국의 직업성질환 감시체계

강성규,송재철,홍윤철,김성아 大韓産業醫學會 2001 대한직업환경의학회지 Vol.13 No.1

직업병을 제대로 예방하기 위해서는 첫 단계로 직업병 발생현황을 정확하게 파악하여야 하는데, 우리나라는 근로자 특수건강진단과 공공보험으로서 산재보험이 있음에도 불구하고 일부 직업병에 대해서는 그 현황을 제대로 파악하지 못하고 있다(강성규 등,2000b) 우리나라의 현재 제도로 잘 파악되지 않는 직업병으로는 천식과 같이 소견은 없으면서 증상이 있거나, 근골격계질환이나 피부질환 같이 유병기간이 짧거나, 암과 같이 발병 후 질병이 계속하여 진행되는 것들이다(강성규 등, 2000a) 이러한 질병에 이환된 근로자는 현실적으로 접근이 어려운 특수건강진단기관의 의사나 산업보건의를 찾기보다는 일반 병원에 방문하여 임상의사의 진료를 받게 된다. 이때 임상의사나 근로자가 질병과 직업과의 관련성을 생각할 수 있다면 산재요양신청을 하게 되고 산재통계에서 공식적으로 직업병으로 집계될 수 있을 것이다. 그러나,실제적으로는 이렇게 진행되는 경우는 거의 없기 때문에 많은 직업병들이 발견되지 않고 있다. 설사, 근로자가 질병이 직업적 노출이나 환경에 의해 발생하였다고 생각한다 하더라도 산재요양에서 얻는 이득이 현 직업을 유지해서 얻는 이득보다 크다는 확신이 서지 않으면 선뜻 산재요양신청을 하지 않을 것이고, 주변에 이러한 사실이 알려지는 것도 꺼리게 될 것이다.직업병감시체계의 첫 번째 목적은 위와 같은 이유로 감추어진 직업병을 통계로 끌어내어 그 크기와 요인을 파악하는 것이다. 규모를 파악한다면 예방우선 순위를 설정하는데 도움을 얻을 것이고, 요인을 파악한다면 구체적인 예방전략을 수립할 수 있을 것이다. 경우에 따라서는 각 개개 사례에 대한 중재를 시도할 수 있을 것이다.직업병에 대한 법적인 보고 의무는 미국과 영국에서 모두 시도하고 있지만, 실제 보고되는 비율은 크지 않다. 오히려, 전문가들이나 산업보건 관계자들이 자율적으로 시도하는 보고체계에서 더 풍부하고 좋은자료를 얻고 있다. 우리나라에서도 현재 법적으로 하고 있는 근로자 건강진단 자료를 감시체계의 한 축으로 활용하고, 다른 한편으로는 의사, 보건관리자, 특수건강진단 기판이 참여하는 직업병감시체계를 구축할 수 있다면, 직업병 예방과 근로자 건강보호라는명제에 한 걸음 더 쉽게 다가갈 수 있을 것이다.

전국 단위 감시체계의 현황과 전망

강성규,안연순,지영구,김형옥,하미나,권호장,백남종,김성아,홍윤철,김재용,강대희,정혜선,하은희 대한산업의학회 2001 대한직업환경의학회지 Vol.13 No.2

직업적 아크릴아미드 폭로에 의한 다발성 신경병증

정해관,권용욱,어경윤,김병준,양정선,정철,진영우,이미영,강성규 大韓産業醫學會 1998 대한직업환경의학회지 Vol.10 No.3

Authors report a first Korean case of polyneuropathy in an acrylamide producing factory together with an environmental and epidemiologic survey for the ten workers of the same workplace and 46 workers in the production and manufacturing acrylamide in Ulsan, Korea. The case is 30 years old man who worked in the production of the acrylamide for two years. In August, 1997, he had a weakness of the lower extremity with loss of body weight of 15 Kg which progressed to paresthesia of the limbs, the loss of vibration sense, difficulty in walking, speech disturbance, dysuria, constipation, difficulty in erection and swallowing difficulty. Neurologic examination showed a complete loss of vibration and position sense, and loss of deep tendon reflex in all the limbs. There was a contact dermatitis-like skin lesion on the feet. Electrodiagnostic test showed a generalized polyneuropathy of moderate degree involving motor and sensory component of peripheral and cranial nerves. After 8 months' cessation from exposure and supportive care, his symptoms were completely resolved, but abnormality in electrodiagnostic test and vibrotactile perception threshold still persisted, although much improved than before. There were 11 workers in the same workplace of the case, producing acrylamide by microorganism as a catalyst. Environmental monitoring of the workplace revealed air borne concentration of the acrylamide to be from 0.05 to 0.23 mg/m3 by personal sampling and from 7.65 to 11.65 mg/m3 by area sampling during filter exchanging process, which far exceeds TLV-TWA of 0.03 mg/m3. However, acrylamide was not detected from the plasma of the workers. Symptom questionnaire showed a markedly higher complain of neurologic symptoms, compared to the workers of the other acrylamide producing companies. Electrodiagnostic test showed a several workers are in the lower normal range without definite abnormality. Vibrotactile perception threshold by Vibratron Ⅱ showed a significantly increased threshold in the workers of the same workplace compared to the other acrylamide workers and significantly decreased test score of color vision compared to normal controls. After improvement of the production process and strict wearing of the protective device, most workers reported the improvement of clinical symptoms, but vibrotactile perception threshold was not improved. These result suggests the need for the effective environmental monitoring together with a periodic biological monitoring. Development of effective screening test is urgently needed to control and assess the skin absorption of acrylamide.

가족기능도지수(Family APGAR Scores)에 관한 기초조사 연구

강성규,윤방부,이혜리,이동배,심운택 대한가정의학회 1984 Korean Journal of Family Medicine Vol.5 No.12

우리나라 직업성 암의 역사와 현황

강성규 東國大學校醫學硏究所 2002 東國醫學 Vol.9 No.1

우리나라에서 암으로 인한 사망이 점차 증가 추세에 있다. 1999년 전체 사망자 중 22.3%(246,539명 중 55,005명)가 암으로 인해 사망하였는데 직업성 폭로가 몇 가지 암의 발생에 기여한다고 알려져 있다. 모든 암의 4% 혹은 폐암의 10%가 직업성 폭로에 의한다고 가정한다면 연간 2,000명이 넘는 암환자가 발생할 수 있지만, 현재까지 기대한만큼 직업성 암의 보고느 많지 않다. 공식적으로 우리나라에서 직업성 암의 발생을 처음으로 보고한 것은 1992년 석면포 공 장에서 근무한 근로자에서 석면에 폭로되어 발생한 중피종의 경우였다. 이어서 많은 직업성 암의 보고가 있었는데, 석면, 크롬, 배출가스, 코크스로배출물, 실리카 등에 의해 발생하는 폐암, 벤젠이나 다른 유기용제에 폭로되어 발생하는 백혈병, 벤조딘솔트에 폭로되어 발생하는 방광암 등 다양하였다. 1992년 부터 11개의 발암물질에 폭로되었던 근로자에서 직업성 암을 조기에 인지하기 위해 퇴직후 건강검진이 시작되었다. 그렇지만 지금까지 퇴직후 건강검진을 통해 밝혀진 직업성암은 아직 없다. 1992년부터 한국근로복지공단은 산업안전보건연구원에 직업성 암에 대한 105건의 심의를 요청하였고, 그중 29건이 직업성 암으로 인정되었다. 이중에는 13건의 폐암, 6건의 혈액암, 6건의 중피종이 있었다. 결론적으로 직업성 암은 잠복기가 길고 일잠적으로 퇴직후에 발견하는 경우가 많기 때문에 직업성 암을 인지하기 위해서는 특별한 관심이 필요하다. The proportion of cancer as a cause of death in Korean has been continuously incresing. In 1999, 22.3%(55,005 of 246,539) of death were caused by cancer. Occupational exposure would have contributed to the development of some cancers. It would have accounted for more than 2,000 cancers in a year if 4% of all cancer or 10% of lung cancer was regarded as arising from the work environment. However, occupational cancer has not been reported as much as expected. The first case of occupational cancer reported officially was mesothelioma caused by asbestos exposure at an asbestos textile industry in 1992. Following the report, many cause of occupational cancers have been reported such as lung cancer due to exposure to asbestos, chromium, exhaust gases, coke oven emissions, and silica, as well as leukemia due to exposure to benzene or other solvent and bladder cancer arising from exposure to benzidine salts. The Health Examination for retirees has been conducted since 1992 in order to detect occupational cancer early in workers who have been exposed to 11 carcinogenic substances. However, to date no occupational cancer has been detected through the Retirees' Health Examination. To date the Korea Labor Welfare Corporation (KLWC) has referred 105 claims for occupational cancer to the Korea Occupational Safety and Health Agency (KOSHA) from 1992. Twenty-nine cases were accepted, including 13 cases of lung cancer, six cases of hematopoietic cancer and six cases of mesothelioma. In conclusion, special attention is required to detect occupational cancer due to their long latency period and the fact they are usually found after retirement.

1990년대 한국의 직업성암

강성규,안연순,정호근 大韓産業醫學會 2001 대한직업환경의학회지 Vol.13 No.4

The proportion of cancer as a cause of dearth in Korean has been continuously increas-ing. In 2000, 24 % (59,020 of 247,346) of deaths were caused by cancer. Occupational exposure would have contributed to the deevelopment of some cancers. It would have accounted for more than 2,000 cancers in a year if 4% of all cancer or 10% of lung cancer was regarded as arising from the work environment. However, occupational cancer has not been reported as much as expected. The first case of occupational cancer reported officially was mesothelioma caused by asbestos exposure at an asbestos textile industry in 1992. Following the report, many cases of occupational cancers have been reported such as lung cancer due to exposure to asbestos, chromium, exhaust gases, coke oven emissions, and silica, as well as leukemia due to exposure to benzene or other solvent and bladder cancer arising from exposure to benzidine salts. The Health Examination for retirees has been conducted since 1992 in order to detect occupational cancer early in workers who have been exposed to 11 carcinogenic sub-stances. However, to date no occupational cancer has been detected through the Retirees' Health Examination. The Korea Labor Welfare Corporation (KLWC) has referred 108 claims for occupational cancer to the Korea Occupational Safety and Health Agency (KOSHA) between 1992 and 2000. Thirty-three cases were accepted, including 14 cases of lung cancer, eight cases of hematopoietic cancer and six cases of mesothelioma. KLWC has accepted the claim for primary lung cancer developed with pneumoconiosis as an occupational cancer, of which there were 31 cases in 1999 and 61 cases in 2000. In conclusion, special attention is required to detect occupational cancer due to their long latency period and the fact they are usually found after retirement.

家族機能度指數(Family APGAR Scores)에 關한 基礎調査 硏究

姜星圭,沈雲澤 충남대학교 의과대학 지역사회의학연구소 1985 충남의대잡지 Vol.12 No.1

This study was investigated the Family APGAR. Scores which was introduced in 1978 as a utilitarian screening instrument for family function by Dr. Smilkstein. The Family APGAR Index Questionnaire consisted of five items : adaptation, partnership, growth, affection and resolve. The Index Score is ranged from 0 to 10 and is divided into three groups; severly dysfunctional 0-3, moderately dysfunctional 4-6, and highly functional 7-10, for evaluating the family function. For this study, 466 high school students were chosen and divided into two groups; Three-choice response format group (Group I) and five-choice response format group (Group Ⅱ ). For comparison, 200 reformatory students whose age were similar to the Group I were selected. The retest was carried out after an interval of two weeks to Group I . The results of this study are as follows. 1. In Group I, the mean Family APGAR Score is 5.45±2.17. The range of inter-item correlations are 0.18-0.34 and item to total correlations are 0.55-0.63. 2. In Group I , 31.4;% belongs to highly functional families, 48.3% moderately dysfunctional families and 20.3% severely dysfunctional families by Smilksteins' classification. 3. The three-choice response format results in good scale qualities and is simpler although fivechoice response format yields some improvement in psychometric qualities of the instrument. 4. The difference in Family APGAR Scores between high school students group and reformatory students group is statistically significant (P<0.01). 5. The coefficiency of test-retest reliability after and interval of two weeks is 0. 3225, which is statistically significant (P<0.001). As a result, this study suggested the possibility that the Family APGAR Scores could be applied to the Korean for evaluating family function.

유기용제의 위해도 평가 및 일부유기용제의 생물학적 폭로지표

강성규,이동배,이영수 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.1

This study was to estimate the total amount of domestic and imported organic solvents production. Potential hazard was evaluated through the amount and physical properties. According to his primary risk assessment, toluene, MEK and perchloroethylene were chosen to analyze the solvents in air and their metabolites in blood and urine for using in biological monitoring in the future. The results were as follws. 1. The amount of organic solvent consumption was about 3 million tons in 1989. Of all organic solvents, 70% were aromatic hydrocabons, 12% alcohols, 5% ketones, 3% aliphatic hydrocabons respectively. Xylene in aromatic hydrocabons, cyclohexane in aliphatic hydrocarbons, methanol in alcohols, acetone in ketones, and trichloroethylene in chlorinated hydrocarbons have been more frequently consumed. 2. Benzene was the most hazardous solvent followed by carbon tetrachloride, methanol, toluene, xylene and its derivatives, dichloromethane, chloroform, ethylene tetrachloride, cyclohexane and MEK. respectively. Of the chlorinated hydrocabons, all except methylchloroform were relatively, hazardous in this assessment. 3. The MEK in urine was a good indicator to pridice MEK exposure. The MEK in blood had high correlation with the MEK in urine. Both the blood and urine MEK were more specific when subjects were exposed to higher level. The urine and blood MEK corresponded to exposure of 200ppm MEK were 1.37mg/l and 2.83mg/l 4. The perchloroethylene in blood and trichloroactic acid in urine were good indicators to predict perchloroethylene exposure. Both the pechloroethylene in blood and trichloroacetic acid in urine were more specific when subjects were exposed to higher level. The perchloroethylene in blood and trichloroacetic acid in urine corresponded to exposure of 50ppm perchloroethylene were 1.43 mg/l and 2.56mg/l 5. The hippuric acid in urine and toluene in blood were good indicators to predict toluene exposure. The corrected hippuric acid with creatinine was more useful to exposure to toluene. The toluene in blood was more useful than the hippuric acid in urine, even if subjects were exposed to lower level. The hippuric acid in urine and toluene in blood corresponed to exposure of 100ppm toluene were 1.71g/g creatinine and 2.06mg/1.

5년간 특수건강진단기관 분석정도관리 결과 분석

강성규,양정선,이미영,박인정,정호근 大韓産業醫學會 2000 대한직업환경의학회지 Vol.12 No.1

목 적 : 1980년대 후반부터 산업보건에서 혈중 및 요중 중금속농도 분석의 정확성 문제가 크게 부각되었다. 같은 시료를 가지고 분석기관마다 보이는 커다란 오차로 인해 직업병 진단 결과에 대한 신뢰성을 크게 감소시켰다. 이에, 노동부에서는 1992년부터 특수건강진단 기관에 대한 생체시료 분석정도관리 프로그램을 시작하였다. 본 연구는 1995년부터 시작된 생체시료 분석정도관리 5년간의 결과를 보고하고, 현재 생물학적모니터링으로 사용되는 항목과 빈도를 조사하고 이 항목의 정도관리 참여율을 비교하여 산업보건 관계 연구나 직업병 관리에 참고할 수 있도록 하기 위해 실시하였다. 방 법 : 생체시료 분석정도관리는 무기와 유기분석분야로 나누어 일년에 전후반기 2회 실시하고 있으며, 지정항목과 자율항목으로 구분하고 있다. 지정항목인 혈중 납과 요중 마뇨산은 분야별로 한 번에 3개 농도수준을 주어 2개 이상이 기준값의 ±15%내외의 범위에 들면 적합한 것으로 판정하고 있으며, 자율항목은 2개의 시료를 주어 2개 모두 기준실험실 평균값의 ±3SD 내외의 범위에 들면 적합한 것으로 판정하고 있다. 결 과 : 지정항목인 혈중 납과 요중 마뇨산 분석은 평균 적합률이 각각 89%, 90% 이었고, 대학기관, 비영리법인, 종합병원, 사업장 자체기관별로 차이는 없었으나 신규 기판의 적합률 70% 수준으로 상대적으로 낮았다. 자율항목의 적합률은 평균 50% 수준이었고, 저농도보다는 고농도의 적합률이 떨어졌다. 국내에서 가장 많이 분석되고 있는 항목은 요중 마뇨산과 혈중 납이었고, 혈중 및 요중 망간도 많이 분석되고 있었다. 요중 삼염화물, 페놀, 만델산, 카드윰, 메칠마뇨산, 크롬 등도 많이 분석되고 있는 항목이었다. 혈중 망간, 요중 수은, 요중 NMF는 정도관리에서 적합판정을 받은 기관의 숫자보다 실제 분석을 하고 있는 기관의 숫자가 많았다. 결 론 : 지난 5년간의 생체시료 분석정도관리 결과 우리나라 분석실험실의 분석능력은 향상되고 있으나, 자율항목에 대한 분석능력은 아직 미흡한 것으로 나타났다. 그리고, 아직 일부 일부 항목에 대해서는 외부 정도관리 없이 분석되고 있는 경우도 있었다. Objective : The accuracy of analytical results of blood and urine heavy metals came out to the main issue on occupational health from late eighties. The discrepancy of the results for same samples from different laboratories made the diagnosis for occupational diseases be unreliable. Therefore, a quality control program for analysis of samples taken from workplace had been introduced in Korea since 1992. This study aims to show the quality control program for analysis of blood and urine samples and its proficient rates from 1992 to 1999 and to know how they have been being used in occupational health. Methods The quality control program runs twice a year with mandatory items of blood lead and urine hippuric acid and voluntary items of blood cadmium and manganese and urine mandellic acid and methyl hippuric acid. Participant laboratories are receiving three levels for each items and two out of three samples have to be qualified for being a profi-cient laboratory for the item. The acceptable range of blood lead and urine hippuric acid is ± 15% and that of the others is within 3 SD (standard deviation) from the reference values. Results : The proficient rates of blood lead and urine hippuric acid was 89%, 90%, repectively, however those of the other voluntary items have been from 51% to 62%. The proficient rates of urine mercury and urine N-methylformamide (NMF), which are introduced since 1999, were very poor. Urine hippuric acid and blood lead were analyzed frequently for the purpose of biological monitoring conducting by special health examination organizations. Urine and blood manganese and urine metabolites of trichloroethylene, urine phenol, methylhippuric acid and cadmium were followed. Conclusions : In conclusion, the quality control program for biological monitoring has dramatically improve the ability of analysing blood and urine samples and eventually con-tributes to diagnose occupational diseases and to prevent occupational poisoning. However, some biological monitoring data, such as urine manganese, mercury and NMF, have been still reported from laboratories that were not accepted as a proficient laboratory.

가정의를 위한 Urinalysis 판독

강성규 의학교육출판사 1987 Korean Journal of Family Medicine Vol.8 No.10