Evidence integration on health damage for humidifier disinfectant exposure and legal presumption of causation

Mina Ha(Mina Ha),Taehyun Park(Taehyun Park),Jong-Hyun Lee(Jong-Hyun Lee),Younghee Kim(Younghee Kim),Jungyun Lim(Jungyun Lim),Yong-Wook Baek(Yong-Wook Baek),Sol Yu(Sol Yu),Hyen-Mi Chung(Hyen-Mi Chung) 한국역학회 2023 Epidemiology and Health Vol.45 No.-

OBJECTIVES: Inhalation exposure to humidifier disinfectants has resulted to various types of health damages in Korea. To determine the epidemiological correlation necessary for presuming the legal causation, we aimed to develop a method to synthesize the entire evidence. METHODS: Epidemiological and toxicological studies are systematically reviewed. Target health problems are selected by criteria such as frequent complaints of claimants. Relevant epidemiologic studies are reviewed and the risk of bias and confidence level of the total evidence are evaluated. Toxicological literature reviews are conducted on three lines of evidence including hazard information, animal studies, and mechanistic studies, considering the source-to-exposure-to-outcome continuum. The confidence level of the body of evidence is then translated into the toxicological evidence levels for the causality between humidifier disinfectant exposure and health effects. Finally, the levels of epidemiological and toxicological evidence are synthesized. RESULTS: Under the Special Act revised in 2020, if the history of exposure and the disease occurred/worsened after exposure were approved, and the epidemiological correlation between the exposure and disease was verified, the legal causation is presumed unless the company proves the evidence against it. The epidemiological correlation can be verified through epidemiological investigations, health monitoring, cohort investigations and/or toxicological studies. It is not simply as statistical association as understood in judicial precedents, but a general causation established by the evidence as a whole, i.e., through weight-of-the-evidence approach. CONCLUSIONS: The weight-of-the-evidence approach differs from the conclusive single study approach and this systematic evidence integration can be used in presumption of causation.

Radio-frequency radiation exposure from AM radio transmitters and childhood leukemia and brain cancer.

Ha, Mina,Im, Hyoungjune,Lee, Mihye,Kim, Hyun Joo,Kim, Byung-Chan,Gimm, Yoon-Myoung,Pack, Jeong-Ki School of Hygiene and Public Health of the Johns H 2007 American Journal of Epidemiology Vol.166 No.3

<P>Leukemia and brain cancer patients under age 15 years, along with controls with respiratory illnesses who were matched to cases on age, sex, and year of diagnosis (1993-1999), were selected from 14 South Korean hospitals using the South Korean Medical Insurance Data System. Diagnoses were confirmed through the South Korean National Cancer Registry. Residential addresses were obtained from medical records. A newly developed prediction program incorporating a geographic information system that was modified by the results of actual measurements was used to estimate radio-frequency radiation (RFR) exposure from 31 amplitude modulation (AM) radio transmitters with a power of 20 kW or more. A total of 1,928 leukemia patients, 956 brain cancer patients, and 3,082 controls were analyzed. Cancer risks were estimated using conditional logistic regression adjusted for residential area, socioeconomic status, and community population density. The odds ratio for all types of leukemia was 2.15 (95% confidence interval (CI): 1.00, 4.67) among children who resided within 2 km of the nearest AM radio transmitter as compared with those resided more than 20 km from it. For total RFR exposure from all transmitters, odds ratios for lymphocytic leukemia were 1.39 (95% CI: 1.04, 1.86) and 1.59 (95% CI: 1.19, 2.11) for children in the second and third quartiles, respectively, versus the lowest quartile. Brain cancer and infantile cancer were not associated with AM RFR.</P>

Evaluation report on the causal association between humidifier disinfectants and lung injury

Mina Ha,Soon Young Lee,Seung-sik Hwang,Hyesook Park,Seungsoo Sheen,Hae Kwan Cheong,Bo Youl Choi 한국역학회 2016 Epidemiology and Health Vol.38 No.-

OBJECTIVES: As of November 2011, the Korean government recalled and banned humidifier disinfectants (HDs) from the market, because four case-control studies and one retrospective epidemiological study proved the association between HDs and lung injury of unknown cause. The report reviewed the causal role of HDs in lung injury based on scientific evidences. METHODS: A careful examination on the association between the HDs and lung injury was based on the criteria of causality inference by Hill and the US Surgeon General Expert Committee. RESULTS: We found that all the evidences on the causality fulfilled the criteria (strength of association, consistency, specificity, temporality, biologic gradient, plausibility, coherence, experiment, analogy, consideration of alternative explanations, and cessation of exposure), which proved the unknown cause lung injury reported in 2011 was caused by the HDs. In particular, there was no single reported case of lung injury since the ban in selling HDs in November 2011 as well as before the HDs were sold in markets. CONCLUSIONS: Although only a few epidemiological studies in Korea have evaluated the association between lung injury and the use of HDs, those studies contributed to proving the strong association between the use of the HDs and lung injury, based on scientific evidence.

At a Crossroads : Jump Forward or Fall Behind

Mina Ha 환경독성보건학회 2013 환경독성보건학회지 Vol.28 No.-

Serum total cholesterol and the risk of breast cancer in postmenopausal Korean women

Ha, Mina,Sung, Joohon,Song, Yun-Mi Springer-Verlag 2009 Cancer causes & control Vol.20 No.7

Children’s Mental Health in the Area Affected by the Hebei Spirit Oil Spill Accident

Mina Ha,Woo-Chul Jeong,Myungho Lim,Hojang Kwon,Yeyong Choi,Seung-Jin Yoo,Su Ryun Noh,Hae-Kwan Cheong 환경독성보건학회 2013 환경독성보건학회지 Vol.28 No.-

Objectives Children are one of the most vulnerable populations to the impact of disasters. We aimed to examine children’s mental health in the area affected by the Hebei Spirit oil spill accident on December 7, 2007. Methods A cross-sectional questionnaire survey was conducted using the Korean versions of the Children’s Depression Inventory and State Anxiety Inventory for Children on 1,362 children attending elementary schools in the affected area. The information on distances between the nearest contaminated coastline to the child’s residential house or attending school were obtained using a web-based map by inputting two address points. The symptom risks of depression and state anxiety were estimated by multiple logistic regression analyses adjusted for age, gender, and other covariates. Results Children with the closest distance (in the fourth quartile) to the school from the contaminated coastline showed a significantly higher symptom risk of depression compared to those with the farthest distance (first quartile)(odds ratio, 2.73; 95% confidence interval, 1.40-5.33), while there was no significant association between anxiety symptoms and distance. Conclusions Children, a vulnerable population for mental health impact by the oil spill accident, should be included in mental health programs in the community along with their family as victims of the disaster.

PROPOSAL OF EMOTION RECOGNITION SERVICE IN MOBILE HEALTH APPLICATION

Ha, Mina,Park, Seung-ho,Lee, Yoo-jin 한국디자인학회 2015 한국디자인학회 학술발표대회 논문집 Vol.2015 No.10

Mobile health industry has been combined with IT technology and is attracting attention, and Health Application has been developed to provide users a healthy life style. For this reason, this research intends to suggest a service that fulfills physical wellness, spiritual wellness, and emotional wellness in an aspect of lifestyles of wellness which is an expanded concept of health. Firstly 5 mobile health applications were selected and reviewed in terms of their service trend, and as a result, it turned out that none of those applications had any emotional data but physical one. Additionally, to extract users’ emotion, technological researches were sorted into different categories and analyzed. And the result suggested that text-based emotion recognition technology that enables judging users’ past memory and their tendency and personality is the most suitable for the mobile health service. To design process of emotion recognition system based on the contents of the research, one-dimension emotion model, which is the standard of classifying emotional data and social network service, was set up as a source. Also, using Texblob that provides natural language process, an emotion recognition system that follows the researched process, was developed. Additionally, to study how to approach in aspects UX in this system, it has been combined with persuasive technology. As a result, periodical proposal type service could be shown in 25 ways according to 5 different. In other words, a proposal type service of a health application that considers psychology-cognitive factors such as spiritual wellness and emotional wellness is suggested as a result of the study. In the future, accuracy judgment, development of health application prototype, and satisfaction of proposal type service according to emotion, should be studied.

Children's Mental Health in the Area Affected by the Hebei Spirit Oil Spill Accident

Ha, Mina,Jeong, Woo-Chul,Lim, Myungho,Kwon, Hojang,Choi, Yeyong,Yoo, Seung-Jin,Noh, Su Ryun,Cheong, Hae-Kwan The Korean Society of Environmental Toxicology 2013 환경독성보건학회지 Vol.28 No.-

Objectives Children are one of the most vulnerable populations to the impact of disasters. We aimed to examine children's mental health in the area affected by the Hebei Spirit oil spill accident on December 7, 2007. Methods A cross-sectional questionnaire survey was conducted using the Korean versions of the Children's Depression Inventory and State Anxiety Inventory for Children on 1,362 children attending elementary schools in the affected area. The information on distances between the nearest contaminated coastline to the child's residential house or attending school were obtained using a web-based map by inputting two address points. The symptom risks of depression and state anxiety were estimated by multiple logistic regression analyses adjusted for age, gender, and other covariates. Results Children with the closest distance (in the fourth quartile) to the school from the contaminated coastline showed a significantly higher symptom risk of depression compared to those with the farthest distance (first quartile)(odds ratio, 2.73; 95% confidence interval, 1.40-5.33), while there was no significant association between anxiety symptoms and distance. Conclusions Children, a vulnerable population for mental health impact by the oil spill accident, should be included in mental health programs in the community along with their family as victims of the disaster.

Green chemistry management technology in Korea

Ha, Mina The Korean Society of Environmental Toxicology 2015 환경독성보건학회지 Vol.30 No.-

Cesium-137 Contaminated Roads and Health Problems in Residents: an Epidemiological Investigation in Seoul, 2011

Ha, Mina,Ju, Young-Su,Lee, Won Jin,Hwang, Seung-sik,Yoo, Sang-Chul,Choi, Kyung-Hwa,Burm, Eunae,Lee, Jieon,Lee, Yun-Keun,Im, Sanghyuk KOREAN ACADEMY OF MEDICAL SCIENCE 2018 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.33 No.9

<P><B>Background</B></P><P>In 2011, two roads in a residential area in Seoul were found to be contaminated with the radionuclide cesium-137 (<SUP>137</SUP>Cs). In response to public concerns, an epidemiological study was conducted.</P><P><B>Methods</B></P><P>The standardized cancer incidence ratios in the affected and neighboring regions were calculated based on the central cancer registry. Households in the region were sampled using the random stratified sampling technique, and questionnaires were administered to family members, via home visit and via students in elementary to high schools. Information on duration of residency and frequency of use of the roads was applied to calculate cumulative radiation exposure dose from the roads, alongside with the reported <SUP>137</SUP>Cs contamination amounts. Information on past medical history, perceived risk, anxiety and psychological stress was also obtained. Of the 31,053 residents, 8,875 were analyzed. To examine possible associations between radiation exposure and health problems, logistic regression adjusted for covariates were performed with consideration of the sampling design, population weight and stratification.</P><P><B>Results</B></P><P>No significant association was found between self-informed diseases, including cancers, and estimated radiation exposure dose. According to an increase of radiation level, a significant increase in anxiety in all and a decline in the psychosocial wellbeing of the adults was noted. The risk perception level was higher in the elderly, females, the less educated, and the highest exposed individuals.</P><P><B>Conclusion</B></P><P>This study provides a basis for risk communication with residents and community environmental health policy.</P>