• Journal of Environmental Health Sciences
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• v.40 no.5
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• pp.385-396
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• 2014

Objectives: By conducting a meta-analysis of cohort studies reporting standardized mortality ratios (SMRs) for workers exposed to trichloroethylene, we attempted to adjust for healthy hired effect by applying the same methods as described in a recent report from the Agricultural Health Study. Methods: Among all cohort studies that evaluated the association between all cancer, non-Hodgkin's lymphoma (NHL), kidney cancer, liver cancer and occupational exposure to trichloroethylene, a total of 10 studies reporting SMR values were selected. A random-effects model was used to estimate the summary SMRs or rSMRs and 95% confidence intervals. Relative SMR ($rSMR=SMR_x/SMR_{not\;x}$) was calculated comparing observed and expected counts for all cancer, NHL, kidney cancer, and liver cancer with an independent referent set of values consisting of the observed and expected counts for other causes. Results: The SMR values for all causes ranged from 0.68 to 1.03, suggesting moderate to weak healthy worker effect for the selected studies. When the healthy worker hire effect was taken into account, the summarized risk became statistically significant; the summary SMR of all cancer was 0.95 (0.91-1.00) and the summary rSMR of all cancer was 1.10 (1.04-1.15). The summary SMR of NHL was 1.04 (0.93-1.14) and the summary rSMR of NHL was 1.23 (1.04-1.46). The summary SMR of kidney cancer was 1.08 (0.88-1.33) and the summary rSMR of kidney cancer was 1.23 (1.02-1.49). The summary SMR of liver cancer was 0.88 (0.78-0.99), and the summary rSMR of liver cancer was 0.95 (0.84-1.07). Conclusion: The rSMR method is useful to determine summary risk adjusted for healthy worker effect through meta-analysis.

• Journal of The Korean Society of Emergency Medicine
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• v.28 no.5
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• pp.457-466
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• 2017

Purpose: Traumatic brain injury (TBI) is a significant cause of morbidity and mortality worldwide. Severity of the initial insult is one of the most significant factors affecting outcome following TBI. In order to investigate the mechanisms of cellular injury and develop novel therapeutic strategies for TBI, we designed a standardized animal TBI model and evaluated histological and functional outcomes according to the degree of impact severity. Methods: Male adult C57Bl/6 mice underwent controlled cortical impact (CCI) at varying depths of deflection (1.0-2.0 mm). We performed hematoxylin and eosin staining at 7 days after recovery from TBI. Neurobehavioral characterization after TBI was analyzed by the Barnes maze test, passive avoidance test, open field test, rotarod test, tail suspension test, and light/dark test. Results: We observed a graded injury response according to the degree of deflection depths tested (diameter, 3 mm; velocity, 3 m/s; and duration, 500 ms) compared to sham controls. In the Barnes maze test, the severe TBI (2 mm depth) group showed reduced spatial memory as compared with the sham and mild TBI (1 mm depth) groups at 7 days after TBI. There was a significant difference in the results of the open field test and light/dark test among the three groups. Conclusion: Our findings demonstrate that the graded injury responses following TBI resulted in differential histopathological and behavioral outcomes in a mouse experimental CCI model. Thus, a model of CCI with histologic/behavioral outcome analysis may offer a reliable and convenient design for preclinical TBI research involving mice.

• Clinical and Experimental Pediatrics
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• v.48 no.10
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• pp.1090-1095
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• 2005

Purpose : In the case of serious respiratory distress syndrome(RDS) or relapse of clinical appearances after single treatment, we obtained more effective results with multiple-dose surfactant replacement therapy. We carried out this investigation for comparing and observing clinical progress between single-dose(group S) and multiple-dose(group M) pulmonary surfactant treatment group of neonatal RDS. Methods : We investigated 48 neonates who were diagnosed as RDS and treated with pulmonary surfactant(PS) replacement therapy in NICU of Kyunghee University hospital from January 2002 to March 2004, then we compared and verified clinical progress of 32 neonates in group S with that of 16 neonates in group M. Results : There were no significant statistical differences in average birth weights, average gestational periods, initial pH values of birth, whether operation of resuscitation at that time of birth was made or not, whether prenatal steroid prescription for mother, RDS classification standardized by Bomsel, and ventilation index(VI) before instillation of PS of two groups. However, there was significant statistical difference in a/A $PO_2$(P<0.05). We could observe changes of VI and a/A $PO_2$ within 72 hours have been continuously improved at group S rather than group M. In spite of relapses, group M changed for the better after second dose. There were also no significant differences between the two groups in duration of ventilator therapy, mortality within 28 days after birth, intraventricular hemorrhage by complication, retinopathy of premature, necrotizing enterocolitis, chronic lung diseases, sepsis, and DIC. Conclusion : In these relapse cases, as there were no significant differences in the mortality rate and the occurence of complication between group S and group M, the requirement of multiple-dose PS replacement therapy which brought improvement of prognosis was emphasized.

• Journal of Preventive Medicine and Public Health
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• v.10 no.1
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• pp.166-175
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• 1977

The author have performed an epidemiological study on the accidental deaths at industry from 1970 to 1975, in order to seek for the preventive measures of industrial accident with the under-standing of its cause and characteristics of the accidental deaths. The obtained results were as follows; 1. Total number of deaths for 6 years were 361 (350 males, 11 females). and the mean death rate was 33.8 per 100,000 industrial workers during 6 years. By the highest as 52.9 was in 1974 and the lowest as 13.7 in 1970. By the industry group, the death rate of Electricity, Gas and Water was 149.3, Construction 83.9 and the lowest was Manufacturing as 18.3. 2. Standardized mortality rate of the cases by the age group showed that 20-29 years old group was 43.0, 40-49 years old group 38.1, 30-39 years old group 32.0, and the lowest as 17.9 was under 19 years old group. 3. The cumulative percentage of the cases by years of service showed that under 6 months was 60.4%, under 1 year 72.9%, under 2 years 83.1%. 4. By the month of occurrence, the highest was 15.8% which occurred in August and the lowest was 5.8% in February. The highest as 19.1% was on Friday and the lowest as 11.9% on Monday by the day of a week. 5. By the causes of accident, car accidents was 28.3%, fall accidents 19.1%, accidents by a crash 9.1% in that order. By the location of injury, head was 44.6%, multiple injuries 33.0%, chest 10.5%, and back was the lowest as 1.9%. The distribution of the cases by nature of injury shelved that cerebral contusion and hemorrhage was 39.4%, fracture and dislocation 33.2%, asphyxia 8.0% in that order. 6. The cumulative percentage of the cases by the duration from injury to death showed that the injuried day was 74.2%, within 3 days after injury 88.5%, within 7 days 96.1%. Therefore most of the cases were occurred within 7 days after injury. 7. Byythe daily mean wages, most of the cases as 91.7% were under 2,000 won, and more 4,000 won was 1.6% merely.

• Journal of agricultural medicine and community health
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• v.37 no.1
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• pp.36-51
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• 2012

Objectives: This study was conducted to implement Health Plus Happiness Plus projects in Gyeongsangnam-Do and assess the policy implications of initiatives to address regional health inequalities. Methods: Health Plus Happiness Plus projects were started as strategies to address regional health inequalities in Gyeongsangnam-Do. The principles of these projects are taken from the Health Action Zones initiatives in England: participation, partnership, resource concentration in project areas. The time period for these projects is from 2010 to 2017, and the total budget is 5.6 billion won. In 2010, a 6.8 hundred million won total budget was invested in 17 project areas. Such investments fell into four broad categories: establishment of the means and local framework; survey development to analyze the health determinants; development of an education and training center; and establishment of a technical support center. Results: Education and training programs for practitioners and coordinators were provided, and project teams and project promotion committees were established in project areas. Health survey result briefing meetings were held, and 17 health committees were established in project areas. Conclusions: Health Plus Happiness Plus projects have some problems in relation to participation and partnerships, however, if these principled projects are performed continuously, they will contribute to a reduction of standardized mortality rate and regional health inequalities in Gyeongsangnam-Do and the improvement of residents' well-being in project areas.

• Clinical and Experimental Pediatrics
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• v.51 no.4
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• pp.343-350
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• 2008

Asthma and allergic diseases are one of the most common disorders in children. Due to its increased prevalence, as well as the increased morbidity and mortality from these diseases, asthma and allergic diseases have come to be recognized as a major worldwide public health issue. In addition, socioeconomic burden of asthma and allergic diseases has increased in Korea also. The International Study of Asthma and Allergies in Childhood (ISAAC) investigated the worldwide prevalence of asthma and other allergic diseases using simple standardized methods because of the comparison of asthma and allergic diseases between the countries. In Korea, several epidemiologic studies have been conducted to determine the prevalence of asthma in children. Although these studies showed increased prevalence of asthma among Korean children (from 3.4% in 1964 to 10.1% in 1989), these findings were based on data from small numbers of subjects. The first Nationwide Study of Asthma and Allergies in Korean Children, which utilized the Korean version of ISAAC written and video questionnaire, was conducted in 1995 and the second Nationwide Study of Asthma and Allergies in Korean Children was conducted in 2000, directed by the Korean Academy of Pediatric Allergy and Respiratory Diseases. We report here the prevalence of asthma and other allergic diseases in Korean children and adolescents, and show the changes that occurred over this 5 year period. We also describe the risk factors for development of these diseases in Korean children. We developed Korean versions of the ISAAC written (WQ) and video (AVQ) questionnaires for allergic diseases. In 1995, the enrolled population consisted of 25,117 children selected from 34 elementary school and 14,946 children selected from 34 middle school across the nation, the response rate was 94.8%. In 2000, 27,831 children selected from 34 elementary school and 15,214 children selected from 34 middle school, and the response rate was 96.4%. From these studies, we can confirm that increase of the prevalences of asthma, allergic rhinitis, and atopic dermatitis in Korea, except the prevalence of food allergy. Especially, the video questionnaire showed increases in the lifetime and 12 month prevalence rates of wheeze at rest, exercise-induced wheeze, nocturnal wheeze, nocturnal cough, and severe wheeze over this period of time in middle school children. In addition, the increase of prevalences of symptoms, diagnosis and treatment of atopic dermatitis was noted significantly. Risk factor analysis showed that body mass index (BMI), passive smoking and living with a dog or cat were associated with higher risk of wheeze. Also the occurrence of fever during infancy and the frequent use of antibiotics were associated with the risk of wheeze. In conclusion, during the 5 year period from 1995 to 2000, the prevalences of asthma, allergic rhinitis, and atopic dermatitis has increased in Korean children. BMI, passive smoking, living with a dog or cat, the fever episodes in infancy, and the frequent use of antibiotics in infancy are important risk factors to development of asthma and atopic dermatitis. In the near future, the birth cohort study will be needed to investigate the causes of this increase and the natural course of allergic diseases, then we develop the methods to control asthma and allergic diseases.

• Journal of Chest Surgery
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• v.31 no.12
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• pp.1147-1158
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• 1998

Background: Portable cardiopulmonary bypass(CPB) technique has been used increasingly as a potent and effective option for emergency cardiopulmonary resuscitation(CPR) because it can maintain more stable hemodynamics and provide better survival than conventional CPR techniques. This study was designed to develop a prototype of Korean portable CPB system and, by applying it to CPR, to discriminate whether it would be superior to standard open-chest CPR. Material and Method: By using adult mongrel dogs, open-chest CPR(OCPR group, n=4) and portable-CPB CPR(CPB group, n=4) were compared with respects to restoration of spontaneous circulation(ROSC), hemodynamics, effects on blood cells, blood gas patterns, biochemical markers, and survivals. Ventricular fibrillation-cardiac arrest(VF-CA) of arrest(VF-CA) of 4 minutes followed by basic life support(BLS) of 15 minutes was applied in either group, which was standardized by the protocol of American Heart Association. Then, advanced life support(ALS) was applied to either group under the support of internal cardiac massage or CPB. ALS was maintained until ROSC was achieved but not longer than 30 minutes regardless of the presence of ROSC. All of the measured values were expressed as means±SD percent change from baseline. Result: During the early ALS, higher mean arterial pressure was maintained in CPB group than in OCPR group(90±19 vs. 71±32 %; p<.05) and lower mean pulmonary arterial pressure was also maintained in CPB group than in OCPR group(105±24 vs. 146±6%; p<.05). ROSC was achieved in all dogs. Post-ROSC levels of hematocrit, RBC, and platelet were decreased and plasma free hemoglobin was increased significantly in CPB group compared to OCPR group(p<.05). Changes in blood gas patterns, lactate, and CK-MB levels were not different between groups. Early mortality was seen in 3 dogs in OCPR group(survival time 31±36 hours) and 2 in CPB group(228±153 hours, p=ns). The remainders in both groups showed prolonged survival. Conclusion: These findings indicate that portable CPB can be effective to maintain stable hemodynamics during cardiac arrest, to achieve ROSC and to prolong survival. Further study is needed to refine the portable CPB system and to meet clinical challenges.

• Journal of agricultural medicine and community health
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• v.39 no.1
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• pp.46-58
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• 2014

Objectives: This study was aimed to analyze the trends of cancer incidence and evaluate the quality control of cancer registration data in Jeollabuk-do from 2001 to 2010. Methods: Incidence data of all cancers and indices of quality of cancer registration data in Jeollabuk-do for the 10-year period were obtained from the Population-based Regional Cancer Registry in the Jeonbuk Regional Cancer Center. Trends in crude incidence rate (CR) and age-standardized incidence rate (ASR) for all cancers and incidence rates for major cancer sites by gender were analyzed. Joinpoint regression tool was used to describe and quantify trends. And the completeness and validity of cancer registration data were analyzed. Results: The major cancer sites in males were the stomach (22.2%), lung (16.6%), colorectum (12.8%), liver (12.3%) and prostate (6.2%), and in females were the thyroid (17.8%), stomach (14.7%), breast (11.6%), colorectum (11.5%) and lung (7.7%). Between 2001 to 2010, ASR for all cancers increased 13.7% in men, 68% in women, and 36.5% overall. ASR for all cancers increased by 1.2% per year in males and by 6.7% per year in females from 2001 to 2010. In the quality control of the cancer registration data between 2001 and 2010, death certificate only (DCO%) for men was decreased from 5.6% to 1.3% and DCO% for women decreased from 6.1% to 1.8%. Microscopic verification (MV%) increased in both men and women. And mortality/incidence ratio (MI%) declined in both men and women. Conclusions: The cancer incidence during the 10 years (2001-2010) in Jeollabuk-do was increasing especially for the colorectum and prostate in men, and for the thyroid and breast in women. The overall quality control of the cancer registry was gradually improving.

• Journal of the Korean Regional Science Association
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• v.34 no.2
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• pp.3-19
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• 2018

The objective of this study is to observe the efficiency of clinical performance on the supply and demand of medical resources in Korea. For the empirical analysis, we constructed the dataset on age standardized mortality rate, the number of physician, specialist, surgery, medical institution, ratio of general hospitals of 16 provinces in Korea from 2006 to 2013. The panel probability frontier model is employed as an analysis method and considered heteroscedasticity and autocorrelation of the error in panel data. In addition, the demographic and socioeconomic characteristics of the 16 provinces, unemployment rate, elderly population ratio, GRDP per capita, and ratio of hospitals in comparison to the general hospitals are used to find the effect on the technical efficiency of clinical performance on supply and demand of medical resources. The results are as follows. First, for the clinical performance, the supply side of human resources such as doctors and specialists and the demand side factors such as chronic illness clinic per unit population have a significant influence, respectively. Second, the technical efficiency of clinical performance on the supply and demand of medical resources of each input component was 59-70% in terms of clinical efficiency in each region. Third. estimates of technical efficiency of inputs that affect clinical performance showed a slight increase in all regions during the analysis period, but the increase trend decreased slightly. Fourth, the ratio of the elderly population and GRDP per capita have a positive influence on the technical efficiency of clinical performance on the supply and demand of medical resources. The difference of each efficiency by region is due to the regional differences of the input medical resources and the combination of them and the demographic and socioeconomic characteristics of the region. It is understood that the differences in technological efficiency due to the complexity of supply and demand of medical resources, demographic structure and economic difference affecting clinical performance by region are different.

• Journal of Radiation Protection and Research
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• v.38 no.4
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• pp.214-227
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• 2013

Computed tomographic scan as a screening procedures in asymptomatic individuals has seen a steady increase with the introduction of multiple-raw detector CT scanners. This report provides a brief review of the current controversy surrounding CT cancer screening, with a focus on the radiation induced cancer risks and clinical efficacy. 1. A large study of patients at high risk of lung cancer(the National Lung Screening Trial[NLST]) showed that CT screening reduced cancer deaths by 20%(1.33% in those screened compared with 1.67% in those not screened). The rate of positive screening tests was 24.2% and 96.4% of the positive screening results in the low-dose CT group were false-positive. Radiation induced lung cancer risk was estimated the most important in screening population because ERR of radiation induced lung cancer does not show the decrease with increasing age and synergistic connection between smoking and radiation risk. Therefore, the radiation risk may be on the same order of magnitude as the benefit observed in the NLST. Optimal screening strategy remain uncertain, CT lung cancer screening is not yet ready for implementation. 2. Computed tomographic colonography is as good as colonoscopy for detecting colon cancer and is almost as good as colonoscopy for detecting advanced adenomas, but significantly less sensitive and specific for smaller lesions and disadvantageous for subsequent therapeutic optical colonoscopy if polyps are detected. The average effective dose from CT colonography was estimated 8-10 $mS{\nu}$, which could be a significant dose if administered routinely within the population over many years. CT colonography should a) achieve at least 90% sensitivity and specificity in the size category from 6 and 10 mm, b) offer non-cathartic bowl preparation and c) be optimized and standardized CT parameters if it is to be used for mass screening. 3. There is little evidence that demonstrates, for whole-body scanning, the benefit outweighs the detriment. This test found large portion of patient(86~90.8%) had at least one abnormal finding, whereas only 2% were estimated to have clinically significant disease. Annual scans from ages 45 to 75 years would accrue an estimated lifetime cancer mortality risk of 1.9%. There is no group within the medical community that recommends whole-body CT. No good studies indicate the accuracy of screening CT, at this time. The benefit/risk balance for any of the commonly suggested CT screening techniques has yet to be established. These areas need further research. Therefore wild screening should be avoided.