연탄(煉炭)가스중독(中毒)의 발생실태(發生實態)에 관(關)한 연구(硏究)

조수헌,신영수,이덕형,김용익,윤덕로,Cho, Soo-Hun,Shin, Young-Soo,Lee, Doek-Hyoung,Kim, Yong-Ik,Yun, Dork-Ro 대한예방의학회 1985 예방의학회지 Vol.18 No.1

A decade ago a survey on the population-base incidence rate of anthracite coal gas (mainly carbon monoxide) poisonig in Seoul area was investigated, resulting in the incidence rate of 306/10,000 risk population and 1 death/10,000. Another survey on the carbon monoxide poisoning was investigated during 1 year period from Apr. 1983 to Mar. 1984. Total subjects of risk population were 67,740 households covering 353,287 persons. The major findings of this survey are as follows: 1. Household-base incidence rate was 8.4% spell-base 10.4%. 2. The incidence rate was the highest in houses having each of slate roof, cement wall, vinyl floor of bedroom and direct 'ondol' heating system. 3. Average 2.1 person was attacked from one incidence of the poisoning; severity-wise person-base incidence rates per 10,000 were 352 in mild poisoning, 54 in severe poisoning and 1.4 in death-overall incidence rate 407. Several facts were identified which supported that this figure was moderately underestimated. As the incidence of the poisoning is affected by socioeconomic and environmental factors, it is natural that one expects the incidence will decrease in proportion to genernal improvement of the above factors. Thus the results of these two surveys seemed preposterous. But further study suggested that the incidence rate (306/10,000) decade before had been significantly underestimated and corrected-rate should have been 478/10,000 level. 4. Age and sex distribution by the degree of the poisoning was uniform with little statistical difference; overall incidence rates by sex were 339/10,000 in male and 475/10,000 in female with significant statistical difference(p<.01). 5. 5.3% of the patients were treated at hospital or local clinic; 3.0% of the patients were hospitalized. Admission rate in comatose patient(severe poisoning) was 14.2%. In conclusion, carbon monoxide poisoning remains a major health problem by now.

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.

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.

중소기업 근로자 보건관리대행기관 QA 평가지표의 개발과정

조수헌,김선민,김창엽,홍윤철,하은희,Cho, Soo-Hun,Kim, Sun-Min,Kim, Chang-Yup,Hong, Yun-Chul,Ha, Eun-Hee 한국의료질향상학회 1996 한국의료질향상학회지 Vol.2 No.2

Background: Group occupational health program by non-for-profit agency, started five years ago, for management of health problems in small and medium sized industries, is one of the measures to cope with limited human and financial resources in occupational health. The program has been rapidly expanding to include 54 participating institutions, private as well as public, all over the country. In spite of its potential impact on health of employees and practice of occupational health in small and medium sized industries, comprehensive evaluation in terms of quality has not been tried. Objectives : The aim of this study are to develop and apply criteria to assess quality of newly developed Korean group occupational health program. Methods : By defining occupational health services, in particular for small and medium sized industries, as one of the primary health care, we included followings as core elements of sound occupational health program; accessibility, continuity, intersectoral collaboration, comprehensiveness, community participation, technical quality, adequacy, focus on preventive services, acceptability, and workers' satisfaction. Again we divided each elements into five major components of national health system infrastructures developed by World Health Organization; development of health resources organized arrangement or resources, delivery of health care, economic support, and management. In turn, we categorized each component into input, process and outcome aspects. After discussions in expert panel, several criteria were selected for evaluation of program. The criteria were modified according to each group of interviewees. Results: We developed five sets of questionnaire that evaluate the quality of 'Group occupational health program'. Conclusion : The refining of the measurement tool and the continuing evaluation process for the 'Group occupational health institute' should be done further.

급성약물중독(急性藥物中毒)에 관(關)한 조사성적(調査成績)

조수헌,Cho, Soo-Hun 대한예방의학회 1977 Journal of Preventive Medicine and Public Health Vol.10 No.1

The epidemiological informations on 1,828 cases of acute drug intoxication admmitted to the emergency rooms of 5 general hospitals, 4 in Seoul City and 1 in Incheon City from Jan. 1974 to Dec. 1974, were reviewed for statistical analysis. More detailed information on 796 cases from 3 hospitals were available in terms of the causative agent. The general findings obtained are as follows; 1. The sex ratio of the patient is 1.26 females to 1 male and this figure is almost consistent with the reports of previous authors. 49.7% of total cases were found in the age group of 20-29, which indicate the highest in percent distribution of age. 2. The incidence of acute drug intoxication was different by the season as the highest in summer and the lowest in winter. 3. As the cause of the intoxication, the attempted suicide occupied the single highest one with 91.7%. 4. The kind of causative agents varies with seasons as more economic poisons in the summer time and more drugs in the winter time.

만성유기용제 폭로에 의한 정신신경학적 이상소견의 현장진단방법 개발에 관한 연구

조수헌,김선민,권호장,임용현,임현술,Cho, Soo-Hun,Kim, Sun-Min,Kwon, Ho-Jang,Yim, Yong-Hyun,Lim, Hyun-Sul 대한예방의학회 1993 Journal of Preventive Medicine and Public Health Vol.26 No.1

A study has been conducted on developing questionnaires to serve as on site diagnostic tools for the early detection of neuropsychiatric impairment among workers chronically exposed to low-level organic solvents. Two drafts of tentative questionnaires have been developed as follows; several question items were selected from questionnaires which were administered to workers exposed to organic solvents in previous studios and were grouped into each symptom category based on the presence of its association using Guttman scaling method, then these selected items were reviewed by neuropsychiatry specialists. The final draft of the questionnaire (total symptom score=36) was developed by selecting 33 question items which had more than a 0.88 Guttman coefficient of reproducibility in each symptom category from a pilot study in which these tentative questionnaires were administered to workers manufacturing soles. Three plants using organic solvents and one plant never using organic solvents as a control group were selected to test the reliability and validity of the developed questionnaires. The major organic solvent in the workplace environment detected by a personal air sampler and GC/MSD nab toluene. The concentration of toluene in air from the department using organic solvent was statistically different from that of the department never using organic solvent. The concentration of toluene from almost all of the workplace did not exceed the allowable level. There was no statistically significant difference between the concentration of urinary hippuric acid from the workers of the department using organic solvent and that of the department never using it. Total symptom score of the plant never using organic solvents was 9.8 and those of the three plants using organic solvents were 15.6, 14.7, and 13,7 respectively. In order to evaluate the validity of the questionnaires, the workers from two different departments of the plant in which usage of organic solvents are totally dofferemt were compared. The total symptom score was 17.8 for workers of the department using organic solvent and 13.5 for the department never using organic solvent and scores of each symptom group between exposure and non-exposure group also showed statistically significant difference. The finding that total symptom score of the exposure group increased as the duration of employment increased indirectly suggests the usefulness of the developed questionnaire to assess the health effects of chronic exposure to organic solvents. The correlation coefficient, which was calculated to evaluate the test-retest reliability, was 0.581 (p=0.001). The coefficient of Crohnbach which reflects the internal consistency of the questionnaire was 0.91. In conclusion, the reliabilty of the questionnaire was well maintained over the time lapse between the two administrations of the questionnaire and despite the seasonal difference.

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.

환경오염에 의한 건강피해 보도사례

조수헌,김선민,조성일,Cho, Soo-Hun,Kim, Sun-Min,Cho, Sung-Il 대한예방의학회 1993 예방의학회지 Vol.26 No.1

우리나라에서 있어 왔던 환경오염관련 건강피해 문제들의 실상을 파악하고자 1980년부터 1991년까지 국내 16개 주요 일간지에 실린 환경오염관련기사들을 정리하여 다음과 같은 결과를 얻었다. 12년간 환경오염과 관련된 건강피해를 다룬 기사는 93건이었는데 1980년대에는 연간 $1{\sim}11$건 정도 이었으나, 1990년 이후 급증하여 1991년에는 36건이 보도되었다. 보도된 사건은 주로 공업단지 및 대도시에서 발생되었으며, 오염원은 대부분 공장이나 공단, 그리고 교통수단에서 기인되었다. 유해요인은 소음을 제외하고는 정확한 요인이 기술되지 않고 단지 가스, 분진, 악취 등으로 보도된 것이 많았다. 건강피해는 신경계 증상이 가장 많이 거론되었으나 대부분의 경우 정확히 구명된 예는 적었다. 피해를 입고 있다는 주민들의 반응은 요구사항의 내용과 강도, 그리고 관철 방법에 있어서 사안별로 매우 다양하였는데, 이에 대한 행정당국의 대책으로서 즉각적인 대응조처가 강구된 예는 적었다. To understand the possible hazards to health from the environmental pollution in Korea, the articles reported in 16 daily newspapers were collected and analysed. From 1980 to 1991, ninety three cases were reported. Statistics show that, during the last 2 years, there has been a remarkable increases of health problems reported. The main sources of pollution were plants and the transportation facilities. Except the noise, the exact causative factors were, for the most part, not clealy described. Although many residents complained of neurological symptoms, the exact effects on health were not clearly investigated. The responses of the residents were diverse in the contents of the demand and the method of its pushing, however, the government did not show immediate and consistent counterplans.

경기도 시화공단 지역주민의 악취오염과 관련된 건강영향 평가

조수헌,김선민,주영수,김재용,최성우,Cho, Soo-Hun,Kim, Sun-Mean,Kim, Young-Su,Kim, Jae-Yong,Choi, Seong-Woo 대한예방의학회 1999 예방의학회지 Vol.32 No.4

Objectives: In recent days, the problem of odor pollution in community near Sihwa Industrial complex, Kynuggi Province is becoming of significant public concern. We have investigated the health effects of the Sihwa residents from odor pollution comparing with other less polluted areas. Methods: The Ansan and Kuri Cities were selected as control areas. The parents of the elementary and middle school students in these three areas were surveyed with structured questionnaire twice, Nov 1997 and Jure 1998 each. As a exposure index, the ambient air concentrations of five major air pollutants(particulates, $O_3,\;SO_2,\;NO_2$, CO) and subjective odor perception were used. We have focused health outcomes such as the prevalence of nonspecific irritant symptoms, respiratory disease among family members and the score of qualify of life(QOL). Results: Although the mean concentrations of major air pollutants except particulates were similar or lower in Sihwa than other areas, the odor perception rate and the monthly odor perception days were significantly higher. It suggested that odor producing chemical compounds are the major source of environmental pollution problem. There were higher prevalence rates of nonspecific irritant symptoms and respiratory disease among family members in Sihwa than other control areas. The QOL score was also lower in Sihwa. The odor perception proved to be a most important factor in reporting adverse health effects and lowering the QOL score. Conclusion: The residents living near Sihwa industrial complex were suffering from more adverse health symptoms and poorer QOL status than control areas. And it may be due to environmental odor pollution from industrial complex. Therefore, further research will be needed for monitoring of the responsible chemicals emitted from industries.

급성일산화탄소중독치료(急性一酸化炭素中毒治療)에 관(關)한 역학적(疫學的) 연구(硏究) -서울대학교(大學校) 의과대학(醫科大學) 부속병원(附屬病院) 고압산소치료실(高壓酸素治療室)의 환자(患者)를 중심(中心)으로-

조수헌,윤덕로,김인달,Cho, Soo-Hun,Yun, Dork-Ro,Kim, In-Dal 대한예방의학회 1974 예방의학회지 Vol.7 No.2

The authors collected epidemiological and clinical informations on 1,307 CO patients from the questionairefilled by attendants of patients and from the clinical records kept in the hospital. All patients were treated by hyperbaric oxygenation at the Hyperbaric Chamber Unit of Seoul National University Hospital during 5 years, from January, 1969 to December, 1973. The following findings were obtained. 1. Female showed higher incidence rate than male. The highest incidence rate was observed in the age group of 15-29 years in both sex. 2. The most important variable influencing the recovery of the patients was the starting time of treatment. It was evident that earlier the starting time, shorter the recovery time. 3. Duration of admission was within 5 days in 57.1 percent of the admitted cases and 76.1 percent of them was discharged within 8 days. 4. As the complications, pulmonary edema, bronchopneumonia and trophic changes were observed. Also the neurological disorders were found. 5. The fatality rate followed by the hyperbaric oxygenation was 1.07 percent.