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Hae Kwan Cheong 19 Articles
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
Epidemiol Health. 2016;38:e2016037.   Published online August 18, 2016
DOI: https://doi.org/10.4178/epih.e2016037
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  • 6 Citations
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
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.
Summary
Korean summary
본 논문에서는 Hill의 기준과 US Surgeon General 전문위원회에서 제시하는 기준에 근거하여 가습기살균제와 폐손상과의 인과성을 검토하였다. 검토결과, 11개 조건(관련성의 강도, 일관성, 특이성, 시간적 선후관계, 생물학적 용량-반응 관계, 개연성, 기존 지식과의 일치성, 실험, 유사성, 다른 가능한 해석에 대한 고려 및 노출의 중단) 을 모두 충족함을 확인하므로 써, 2011년 발생한 원인미상 폐손상의 원인이 가습기살균제 노출로 인한 것임을 알 수 있었다. 무엇보다도 가습기살균제 시판 전에는 원인미상 폐손상이 보고된 바가 없었고, 2011년 11월 가습기살균제 판매중지 이후 폐손상이 한 건도 발생하지 않은 것은 원인미상의 폐손상이 가습기살균제로 인한 것임을 강력하게 지지하는 것으로 판단된다.
Key Message

Citations

Citations to this article as recorded by  
  • New-Onset and Exacerbation of Lung Diseases after Short-Term Exposures to Humidifier Disinfectant during Hospitalization
    Seula Lee, Kyunghee Han, Jeonggyo Yoon, Eun-Kyung Jo, Wonho Yang, Yoon-Hyeong Choi
    Toxics.2022; 10(7): 371.     CrossRef
  • Characterizing Subjects Exposed to Humidifier Disinfectants Using Computed-Tomography-Based Latent Traits: A Deep Learning Approach
    Frank Li, Jiwoong Choi, Xuan Zhang, Prathish K. Rajaraman, Chang-Hyun Lee, Hongseok Ko, Kum-Ju Chae, Eun-Kee Park, Alejandro P. Comellas, Eric A. Hoffman, Ching-Long Lin
    International Journal of Environmental Research and Public Health.2022; 19(19): 11894.     CrossRef
  • Physical analysis reveals distinct responses of human bronchial epithelial cells to guanidine and isothiazolinone biocides
    Tae Yoon Kwon, Jaeseong Jeong, Eunyoung Park, Youngbin Cho, Dongyoung Lim, Ung Hyun Ko, Jennifer H. Shin, Jinhee Choi
    Toxicology and Applied Pharmacology.2021; 424: 115589.     CrossRef
  • Need for individual-based evaluation to determine the association between humidifier disinfectants and health injuries
    Hyeong-Cheol Kim, Hyunil Kim, Eun-Chan Mun, Yesung Lee, Soyoung Park
    Annals of Occupational and Environmental Medicine.2021;[Epub]     CrossRef
  • Strength of Association. Report 1. Graduations of Relative Risk
    А. Котеров, A. Koterov, Л. Ушенкова, L. Ushenkova, Э. Зубенкова, E. Zubenkova, А. Вайнсон, A. Vaynson, М. Калинина, M. Kalinina, А. Бирюков, A. Biryukov
    Medical Radiology and radiation safety.2019; : 5.     CrossRef
  • Causal inference in environmental epidemiology
    Sanghyuk Bae, Hwan-Cheol Kim, Byeongjin Ye, Won-Jun Choi, Young-Seoub Hong, Mina Ha
    Environmental Health and Toxicology.2017; 32: e2017015.     CrossRef
Community mental health status six months after the Sewol ferry disaster in Ansan, Korea
Hee Jung Yang, Hae Kwan Cheong, Bo Youl Choi, Min-Ho Shin, Hyeon Woo Yim, Dong-Hyun Kim, Gawon Kim, Soon Young Lee
Epidemiol Health. 2015;37:e2015046.   Published online October 23, 2015
DOI: https://doi.org/10.4178/epih/e2015046
  • 14,225 View
  • 236 Download
  • 20 Citations
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The disaster of the Sewol ferry that sank at sea off Korea’s southern coast of the Yellow Sea on April 16, 2014 was a tragedy that brought grief and despair to the whole country. The aim of this study was to evaluate the mental health effects of this disaster on the community of Ansan, where most victims and survivors resided.
METHODS
The self-administered questionnaire survey was conducted 4 to 6 months after the accident using the Korean Community Health Survey system, an annual nationwide cross-sectional survey. Subjects were 7,076 adults (≥19 years) living in two victimized communities in Ansan, four control communities from Gyeonggi-do, Jindo and Haenam near the accident site. Depression, stress, somatic symptoms, anxiety, and suicidal ideation were measured using the Center for Epidemiologic Studies-Depression Scale, Brief Encounter Psychosocial Instrument, Patient Health Questionnaire-15, and Generalized Anxiety Disorder 7-Item Scale, respectively.
RESULTS
The depression rate among the respondents from Ansan was 11.8%, and 18.4% reported suicidal ideation. Prevalence of other psychiatric disturbances was also higher compared with the other areas. A multiple logistic regression analysis revealed significantly higher odds ratios (ORs) in depression (1.66; 95% confidence interval [CI], 1.36 to 2.04), stress (1.37; 95% CI, 1.10 to 1.71), somatic symptoms (1.31; 95% CI, 1.08 to 1.58), anxiety (1.82; 95% CI, 1.39 to 2.39), and suicidal ideation (1.33; 95% CI, 1.13 to 1.56) compared with Gyeonggi-do. In contrast, the accident areas of Jindo and Haenam showed the lowest prevalence and ORs.
CONCLUSIONS
Residents in the victimized area of Ansan had a significantly higher prevalence of psychiatric disturbances than in the control communities.
Summary
Korean summary
본 연구는 2014년 4월 16일 발생한 세월호 침몰 사고가 지역사회의 정신건강 수준에 미친 영향을 평가하기 위해 실시하였다. 2014년 지역사회건강조사를 활용, 사고 후 6개월 시점에 조사를 시행하였다. 대부분의 희생자가 발생한 안산시 대상자의 11.8%가 우울군으로 분류되었으며, 18.4%가 자살생각을 호소하였고, 그 밖의 유병률도 대조 지역에 비해 높았다.
Key Message

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    Archives of Suicide Research.2022; 26(1): 14.     CrossRef
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    Jae-Eun Lee, Seol-A Kwon, Eugene Song, Sang Il Ryu
    Social Sciences.2022; 11(3): 117.     CrossRef
  • Development of a Mental Health Application: A Formative Evaluation
    Moon-Heum Cho, Yunjeong Chang, Dong Hun Lee, Yejin Kim
    SAGE Open.2022; 12(4): 215824402211403.     CrossRef
  • Changes in the Levels of Stress Perception, Experiencing Depressive Symptoms and Health-Related Quality of Life of Residents after the 2016 Gyeongju Earthquake
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    International Journal of Environmental Research and Public Health.2021; 18(2): 540.     CrossRef
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    Katelyn O'Donohue, Emily Berger, Louise McLean, Matthew Carroll
    Social Science & Medicine.2021; 276: 113851.     CrossRef
  • Exploring the factors associated with indirect trauma caused by a human-made disaster on the general population: A community study five years after the Sewol ferry incident
    Jongha Lee, Seung-Hoon Lee, Cheolmin Shin, Ho-Kyoung Yoon, Ha Eun Park, Eun Bee Cho, Hae Sun Jung, Young-Hoon Ko
    International Journal of Disaster Risk Reduction.2021; 60: 102262.     CrossRef
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    Sunah Kim, Go-Un Kim, Wongyeong Lee, Jinyoung Park
    International Journal of Environmental Research and Public Health.2021; 18(13): 6715.     CrossRef
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    Hyejin Park, Kisok Kim
    Healthcare.2021; 9(10): 1386.     CrossRef
  • Life Experience of Bereaved Parents After the 2014 Sewol Ferry Disaster in South Korea
    Dong Hun Lee, Minsoo Khang, Jiyoung Shin, Hwa Jung Lee, Jacqueline A. Brown
    OMEGA - Journal of Death and Dying.2020; 80(4): 515.     CrossRef
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    Ju-Yeon Lee, Sung-Wan Kim, Jae-Min Kim
    Chonnam Medical Journal.2020; 56(2): 99.     CrossRef
  • Machine Learning-Based Data Mining Method for Sentiment Analysis of the Sewol Ferry Disaster's Effect on Social Stress
    Min-Joon Lee, Tae-Ro Lee, Seo-Joon Lee, Jin-Soo Jang, Eung Ju Kim
    Frontiers in Psychiatry.2020;[Epub]     CrossRef
  • Development of Korean Disaster Mental Health Support Guidelines: Results of a Scoping Review and a Delphi Survey
    Sang Min Lee, Hee Young Lee, Mi Kyung Lee, Sunju Kim, Sorae Lee, Hae-Woo Lee, Eun Jin Park, Minyoung Sim, Jong-Woo Paik
    Psychiatry Investigation.2019; 16(2): 130.     CrossRef
  • Seasonal changes in suicide in South Korea, 1991 to 2015
    Chi Ting Yang, Paul S. F. Yip, Eun Shil Cha, Yi Zhang, Ghobad Moradi
    PLOS ONE.2019; 14(6): e0219048.     CrossRef
  • A Retrospective and Prospective Follow-up Study of Psychological Distress in the Danwon High School Survivors of the Sewol Ferry Disaster
    Eun Ji Kim, Hee Sun Nam, Hak Beom Kim, Unsun Chung, So Hee Lee, Jeong-Ho Chae
    Psychiatry Investigation.2018; 15(3): 261.     CrossRef
  • Factors Associated with Complicated Grief in Students Who Survived the Sewol Ferry Disaster in South Korea
    So Hee Lee, Hee Sun Nam, Hak Beom Kim, Eun Ji Kim, Jin-Won Noh, Jeong-Ho Chae
    Psychiatry Investigation.2018; 15(3): 254.     CrossRef
  • Natural Course of Posttraumatic Symptoms in Late-Adolescent Maritime Disaster Survivors: Results of A 12-Month Follow-Up Study
    Sang Won Jeon, Ho-Kyoung Yoon, Yong-Ku Kim, Changsu Han, Young-Hoon Ko, Seo Young Yoon, Cheolmin Shin
    Psychiatry Investigation.2018; 15(6): 574.     CrossRef
  • Decision Making Regarding Key Elements of Korean Disaster Psychiatric Assistance Teams Using the Analytic Hierarchy Process
    Sun-Jin Jo, Kyoung-Sae Na, Joo Eon Park, Myung-Soo Lee
    Psychiatry Investigation.2018; 15(7): 663.     CrossRef
  • Changes in the levels of depressive symptoms and anxiety in Ansan city after the 2014 Sewol ferry disaster
    Hee Jung Yang, Gawon Kim, KangUk Lee, Jakyoung Lee, Hae Kwan Cheong, Bo Youl Choi, Soon Young Lee
    Journal of Affective Disorders.2018; 241: 110.     CrossRef
  • Increase in the prescription rate of antidepressants after the Sewol Ferry disaster in Ansan, South Korea
    Kyu-Man Han, Kyoung-Hoon Kim, Mikyung Lee, Sang-Min Lee, Young-Hoon Ko, Jong-Woo Paik
    Journal of Affective Disorders.2017; 219: 31.     CrossRef
  • Mental health status of people isolated due to Middle East Respiratory Syndrome
    Hyunsuk Jeong, Hyeon Woo Yim, Yeong-Jun Song, Moran Ki, Jung-Ah Min, Juhee Cho, Jeong-Ho Chae
    Epidemiology and Health.2016; 38: e2016048.     CrossRef
Six year national trend of childhood aseptic meningitis incidence in Korea, 1996-2001.
Hae Kwan Cheong, Sue Kyung Park, Moran Ki, Kwan Lee
Korean J Epidemiol. 2008;30(2):252-262.   Published online December 31, 2008
DOI: https://doi.org/10.4178/kje.2008.30.2.252
  • 7,278 View
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  • 8 Citations
AbstractAbstract PDF
Abstract
BACKGROUND
AND OBJECTIVES: Aseptic meningitis is a disease of children with seasonal outbreak in summer. In spite of high morbidity, it is not notifiable without reported nationwide morbidity. The authors estimated incidence of aseptic meningitis and its descriptive characteristics and time- and space-clustering pattern. SUBJECTS AND METHODs: Cases of aseptic meningitis were extracted from National Health Insurance payment request data of National Health Insurance Corporation from January 1996 to December 2001. Cases were classified by region, institution, and hospitalization. Standardized incidence was calculated and compared by the region, month of the year whether there is any clustering.
RESULTS
Nationwide incidence of aseptic meningitis among children under 15 years old over the six year period was 3.48 per 1,000 per year. Incidence was higher in female (2.80/1,000) compared to male (4.02/1,000). Age-specific incidence was highest in 5 years old. Annual incidence was highest in 1997 (8.44/1,000) and lowest in 2000 (0.79 /1,000) with outbreak every 3 or 4 years. Outbreak was mostly confined in summer months, between May and Septe- mber. However, seasonal pattern was variable by year. Southern provinces and metropolitan areas had higher incidences and pattern was more prominent in the years with higher outbreak. Time-dependent pattern of the disease from south to north was not prominent.
DISCUSSIONS
AND CONCLUSIONS: We have calculated the nationwide incidence of the aseptic meningitis over six year period. In terms of aseptic meningitis, using National Health Insurance data for the estimation of the incidence is a plausible method for the surveillance of the disease.
Summary
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    Cancer Research and Treatment.2019; 51(4): 1430.     CrossRef
  • Burden of Disease Attributable to Inadequate Drinking Water, Sanitation, and Hygiene in Korea
    Jong-Hun Kim, Hae-Kwan Cheong, Byoung-Hak Jeon
    Journal of Korean Medical Science.2018;[Epub]     CrossRef
  • Impact of Drinking Water Quality on the Development of Enteroviral Diseases in Korea
    Yadav Joshi, Jong-Hun Kim, Ho Kim, Hae-Kwan Cheong
    International Journal of Environmental Research and Public Health.2018; 15(11): 2551.     CrossRef
  • Associations between Meteorological Factors and Aseptic Meningitis in Six Metropolitan Provinces of the Republic of Korea
    Yadav Joshi, Eun-Hye Kim, Jong-Hun Kim, Ho Kim, Hae-Kwan Cheong
    International Journal of Environmental Research and Public Health.2016; 13(12): 1193.     CrossRef
  • Enteroviral Meningitis in Infants
    이우순, 채수안, 이나미
    Journal of the korean child neurology society.2015; 23(4): 159.     CrossRef
  • Factors associated with gout in South Koreans: analysis using the National Health Insurance Corporation and the National Health Screening Exam databases
    Chan Hee Lee, Na Young Sung, Jisoo Lee, Sang-Cheol Bae
    Clinical Rheumatology.2013; 32(6): 829.     CrossRef
  • The Prevalence and Features of Korean Gout Patients Using the National Health Insurance Corporation Database
    Chan Hee Lee, Na Young Sung
    Journal of Rheumatic Diseases.2011; 18(2): 94.     CrossRef
  • Transmission of Seasonal Outbreak of Childhood Enteroviral Aseptic Meningitis and Hand-foot-mouth Disease
    Sue K. Park, Boyoung Park, Moran Ki, Ho Kim, Kwan Lee, Cheoll Jung, Young Mo Sohn, Sung-Min Choi, Doo-Kwun Kim, Dong Seok Lee, Joon Tae Ko, Moon Kyu Kim, Hae-Kwan Cheong
    Journal of Korean Medical Science.2010; 25(5): 677.     CrossRef
Hebei Spirit oil spill exposure and acute neuropsychiatric effects on residents participating in clean-up work.
Jin Hee Eum, Hae Kwan Cheong, Mina Ha, Ho Jang Kwon, Eun Hee Ha, Yun Chul Hong, Ye Yong Choi, Woo Chul Jeong, Jong Il Hur, Seungmin Lee, Eun Jung Kim, Eun Hee Lee, So Young Lee Ahn, Jong Hun Kim
Korean J Epidemiol. 2008;30(2):239-251.   Published online December 31, 2008
DOI: https://doi.org/10.4178/kje.2008.30.2.239
  • 7,295 View
  • 17 Download
  • 5 Citations
AbstractAbstract PDF
Abstract
OBJECTIVES
Hebei Spirit oil spill accident has brought about the worst coastal oil contamination in Korean history. Following the accident, residents and volunteers, number exceeding a million from nationwide, were exposed to chemicals from the crude oil itself and dispersants, including volatility organic compounds (VOCs), polycyclic aromatic hydrocarbons (PAHs), and heavy metals through the clean-up works over months. This study was undertaken to investigate the effect of clean-up work on the peripheral nerve function and psychologic status of the residents after a prolonged exposure to clean-up work after the oil spill exposure.
METHODS
We performed a study on the residents of Jango-do Island, Chungnam, on 5 and 12 January 2008, six to eight weeks after the accident. A questionnaire on general characteristics, Korean Beck Depression Inventory (K-BDI), color vision test (Lanthony desaturated D-15 test), and vibration perception threshold test were done. Among 210 residents with 30 years or older, 63 (30%) finished questionnaires and completed at least one among K-BDI, color vision test, or vibration perception threshold test. Descriptive statistics was done on the residents.
RESULTS
The residents participated in clean-up work for average 20 days, max 30 days, during 6 weeks following the accident. Average work hours were 7.4 hours per day, max 10 hours. On K-BDI, 21 (33.3%) had a severe depressive state. Mean color confusion index was 1.29 in the right and 1.20 in the left. Mean vibration perception threshold was 3.69 VU (right) and 3.55 VU (left), respectively.
DISCUSSIONS
AND CONCLUSIONS: Compared to literature report, the residents had higher depression scale. Color vision threshold was not higher compared to general population near an industrial complex. Vibration perception threshold was significantly higher than the residents of similar age living near an abandoned mine in southern coastal area only in the age group of forties. These suggests there is some evidence of neuropsychiatric effect related to oil cleaning work and a mid- and long-term study of the oil exposure health effects with continuous monitoring should be done for the exposed residents in the affected area.
Summary
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  • Cancer Incidence Trend in the Hebei Spirit Oil Spill Area, from 1999 to 2014: An Ecological Study
    Kyung-Hwa Choi, Myung-Sook Park, Mina Ha, Jong-Il Hur, Hae-Kwan Cheong
    International Journal of Environmental Research and Public Health.2018; 15(5): 1006.     CrossRef
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    Soojin Kim, Jeong-Nam Kim, Laishan Tam, Gwang Tae Kim
    Journal of Public Affairs.2015; 15(4): 404.     CrossRef
  • Community mental health status six months after the Sewol ferry disaster in Ansan, Korea
    Hee Jung Yang, Hae Kwan Cheong, Bo Youl Choi, Min-Ho Shin, Hyeon Woo Yim, Dong-Hyun Kim, Gawon Kim, Soon Young Lee
    Epidemiology and Health.2015; 37: e2015046.     CrossRef
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    Joon‐Young Hur
    Disaster Prevention and Management: An International Journal.2012; 21(3): 288.     CrossRef
  • Psychological Health in Residents Participating in Clean-up Works of Hebei Spirit Oil Spill
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Prevalence and risk factors of irritable bowel syndrome in Korean high school students.
Kyung Tae Lee, Jaehyun Yoo, Bo Kyoung Kim, Hae Kwan Cheong
Korean J Epidemiol. 2007;29(1):21-33.
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AbstractAbstract PDF
Abstract
BACKGROUND
AND OBJECTIVES: Irritable bowel syndrome (IBS) is prevalent in the general population, but there are few reports on bowel habits and IBS in high school students in Korea. This study aims to describe the prevalence of IBS in high school students in Korea and to investigate the influence of lifestyle factors including dietary habits, on the IBS. This study also investigates relationship between anxiety, depression and IBSprevalence. SUBJECTS AND METHODS: This study is a cross-sectional study on 1,018 students (451 males and 567 females) form freshman to senior of a high schools in Seoul. All students were requested to fill in a self-reported questionnaire. IBS was diagnosed based on the Rome II criteria. Those having past medical history of organic gastrointestinal disorders and any one of the 'alarm factors'(e.g. continuous hematochezia, weight loss, or anemic symptom) were excluded from the IBS group. For the evaluation of risk factors on the IBS, we surveyed dietary habit, health behavior, past medical history, the Hollingshed index for the measurement of socioeconomic status, Beck's Anxiety Inventory for the anxiety, and the Children's Depression Inventory for the depression.
RESULTS
The prevalence of IBS was 19.1%. Family history of abdominal discomfort (odds ratio 2.07, 95% 1.46-2.92) and having night snack (odds ratio 1.46, 95% CI 1.09-1.94) were significantly different between the IBS group and non-IBS group. There was a linear trend towards the higher prevalence of IBS with fewer hours of exercise (odds ratio 0.99, 95% CI 0.95-1.04). Menstruation, stress, and irregular eating were the significant provocation factors of IBS. Anxiety and depression was not significantly higher in in the IBS group.
CONCLUSIONS
Prevalence of the IBS in high school students from this study was higher compared with those reported in college students in Korea. This study shows that family history, dietary factors, lifestyle, and grade were significantly related to IBS. From our study, we found that there are multifaceted health aspects required to reduce symptoms, such as dietary education and encouragement to change lifestyle for controlling stress.
Summary
Korean summary
Key Message
International Cooperation in the Control and Prevention of Emerging and Reemerging Infectious Diseases.
Hae Kwan Cheong
Korean J Epidemiol. 2006;28(1):85-91.
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Abstract
This paper discusses the recent increase in the incidence of emerging and reemerging infectious diseases and the role of international cooperation in coping with such public health threats. The historical background and its evolution are reviewed and the need, advantages, and possible areas of international cooperation are presented. A current example and model of international cooperation at various levels is described. Finally, two of the main issues in the process of international cooperation are discussed: the ethical aspect of scientific communication and national interest, and intellectual property issues.
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Key Message
Epidemiologic Transition of Communicable Diseases in Korea: Academia's Contributions to the National Communicable Disease Prevention and Control Programs.
Joung Soon Kim, Hae Kwan Cheong
Korean J Epidemiol. 2006;28(1):4-21.
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Abstract
This paper describes the transition of communicable diseases in Korea since 1970s. Some of Korean's general living background and health indicators are introduced, followed by trends in the changes during the last several decades in socioeconomic, demographic, and living environmental status, which are closely associated with the transition of communicable diseases. The current incidence of classified, notifiable disease, the incidence by year, and the transition of communicable diseases are presented. Governmental responses to prevent and control communicable diseases, including both emerging and re-emerging infectious diseases, which have become recognized as having public health importance are described. Finally, the role played by academia during the last several decades in the successful control of communicable diseases is analyzed.
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A Study on the Epidemiologic Characteristics of Scrub Typhus in Gyeongsangbuk-do, 1999-2001.
Young Sun Min, Hyun Sul Lim, Kwan Lee, Cheoll Jung, Hae Kwan Cheong
Korean J Epidemiol. 2005;27(2):70-79.
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AbstractAbstract PDF
Abstract
ONJECTIVE: This study was carried out to investigate the epidemiologic characteristics and magnitudes of scrub typhus (tsutsugamushi disease) in Gyeongsangbuk-do, Korea.
METHODS
Resources of data collected were epidemiologic surveillance report to public health centers on each disease occurrence. The authors reviewed 344 epidemiologic surveillance reports for cases of scrub typhus developed in Gyeongsangbuk-do, Korea from Jan 1, 1999 to Dec 31, 2001.
RESULTS
The scrub typhus cases were 376 during three year period, and the incidence was significantly higher in the county area than in the city area. Incidence of scrub typhus was increasing each year. In 344 epidemiologic surveillance reports, the job of the cases was farmer (67.2%), housewife (4.7%), clerk (3.5%). Two hundred ninety eight cases (86.6%) have experienced outdoor activities before development of the scrub typhus. The outdoor places of exposure were dry field (64.8%), rice field (51.7%), hill (12.8), and grass field (9.7%). The symptoms reported were fever (93.3%), headache (83.7%), chill (69.5%), and rash (54.4%).
CONCLUSIONS
Incidence of scrub typhus was increasing in Gyeongsangbuk-do, Korea, this phenomenon may be related to change of climate, the reporting rate of disease and outing activities. Good surveillance and adequate analysis of epidemiologic data is a essential for the prevention of the disease. With this result, high risk population was identified and effective intervention should be done to prevent the disease.
Summary
Korean summary
Key Message
Smoking and lung cancer: foundation of modern epidemiology.
Hae Kwan Cheong
Korean J Epidemiol. 2005;27(2):1-19.
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Abstract
Since its introduction to western world in 16th century, smoking has been one of the most popular parts of human life. Its health hazards, however, has rarely been evaluated before mid 20th century. After early suggestion of association with lip cancer and pipe smoking, which was falsely associated with the heat of the pipe smoking, association between rapidly increasing incidence of lung cancer and increasing popularity of smoking habit in the western world has been suggested in late 1940s. Initial case-control studies, in spite of its proneness to various biases, aroused the relevance of the relationship. It was supported by following well-designed case-control studies and new method, cohort studies in both coast of the Atlantic. Consistency of the results of epidemiologic studies and additional support from animal experiments made the causal relationship to be accepted from scientific community, and finally from public and governments. Establishment of criteria of causal relationship was also established in the process of investigation of the relationship between smoking and lung cancer. Smoking is most common cause attributable to lung cancers in most of the world. It is also responsible for the many cancers, including larynx, bladder, oral cavity, esophagus, pancreas, kidney, stomach, liver, and myeloid leukemia; and cardiovascular disorders, respiratory disorders, and other degenerative disorders. Passive (or environmental tobacco) smoking has also been found to be hazardous. Establishment of causal relationship between smoking and lung cancer has been a landmark in the development of epidemiologic methods and concepts, which played the key role in the evaluation of risk factors and preventive intervention on the chronic degenerative disorders.
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Outbreak of Measles among School Ages in Yeongju in 2000.
Hae Kwan Cheong, Geun Ryang Bae, Jin Hwa Jeong, Sue Kyung Park, Byung Chan Park, Jee Hee Kim, Joo Yeon Lee, Byung Kuk Na, Woo Joo Kim
Korean J Epidemiol. 2004;26(1):69-80.
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BACKGROUND
The outbreak of measles from 2000 to 2001 was the biggest epidemic since measles vaccination was introduced in Korea. Outbreak of measles in Yeongju was one of the earliest milestones of the nationwide outbreak in the year 2000. The authors investigated epidemiologic characteristics of the outbreak in this area.
METHODS
The authors estimated attack rate through the investigation of all the school age cases of measles reported to local health authority between March and May, 2000. Case investigation was done to trace the source of the outbreak. One hundred seventy two cases were examined with medical examination, with interview on their clinical manifestations, and with serologic examination on the anti-measles IgM and IgG antibody.
RESULTS
Overall attack rate among the school children was 4.3%, with highest attack rate in middle school students (8.5%). The outbreak began in March in middle schools, which spread to elementary and high schools. IgG was positive in 160(93.0%) cases and IgM was positive in 94(54.6%) cases, among which 90 cases (95.7%) were also positive for IgG. IgM positive cases had higher prevalence of rash (91.5%) compared to those without IgM (70.5%). Diagnostic criteria based on the clinical manifestation and contact history showed the highest sensitivity (92.6%) compared to conventional diagnostic criteria in outbreak (40.4-44.7%) CONCLUSIONS: High proportion of susceptible children in the population due to primary or secondary vaccine failure played a key role in this outbreak. Clinical manifestation was milder than classical measles and adjustment of diagnostic criteria can be helpful in the management of outbreak.
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An Epidemiologic Study on Sudden Deaths of Cattle Occurred in Kyongju.
Hyun Sul Lim, Hae Kwan Cheong, Jung Ran Kim, Ik Jung Kim, Gyoung Yim Ha
Korean J Epidemiol. 2001;23(1):59-68.
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PURPOSE
This study was conducted to provide the baseline data for the epidemiologic and microbiologic investigation for the etiology of sudden deaths of cattle in Sara-Ri, Seo Myun, Kyongju.
METHODS
This survey was performed between April 11 and 22, 1994. Epidemiologic investigation consisted of interview of the residents, as well as pathologic and microbiologic test on tissues and blood samples from cardiac puncture.
RESULTS
The dead numbers of cattle were 149 in 35 households during about 20 years. The cows(63.9%) were more than bulls(36.1%) and most of them were raised in playpen(95.7%). The first death occurred in 1974, and then number of deaths increased until 1994. Besides the age of cattle at death was over two years old (88.3%), most of them(69.4%) died within one hour after onset of noticeable symptom by the farmers. The most common symptom of cattle at death was 'sudden death after screaming(71.1%)' and 'seizure (33.3%)'. Colonies from blood of case 3 showed double hemolysis in blood agar plate. The microbiologic test results in the culture of Clostridium perfringens. The pathological features were characterized as most of renal tubules revealed coagulative necrosis. Some gram-positive bacilli are scattered in interstitium.
CONCLUSIONS
Above results suggest C. perfringens as a possible pathogen of this ourbreak in livestock. The possibility of human infection, although nonfatal, and lack of vaccination against C. perfringens raises a need for stronger preventive action toward this communicable disease of cattle on this village.
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Epidemiologic Investigation of a Mumps Outbreak in a Middle School in Pohang, Korea: Effect of vaccination during outbreak.
Byung Chan Park, Hae Kwan Cheong, Hyun Sul Lim, Duck Soo Kim, Doohie Kim
Korean J Epidemiol. 2000;22(2):148-158.
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Abstract
BACKGROUND
There was a widespread outbreak of mumps at elementary and middle schools in Pohang city in March 1999. We have carried out an epidemiologic survey to trace the source and mode of transmission of the outbreak, as well as evaluating the effect of vaccination as a measure of controlling the outbreak.
METHODS
Questionnaire survey on 959 students showed that attack rate was 10.7%. There was no significant difference between genders in terms of attack rates. However, second graders outnumbered other groups as 16.9%, comparing to 8.1% among first graders and to 7.0% in the third graders.
RESULTS
Cases of mumps were reported in 1998, primarily in the neighboring elementary schools. The disease was also reported earlier in 1999, sporadically. In March, however, number of the cases was sharply on the rise as the middle schools opened for a new semester. Our investigation revealed that infection stemmed from more than three different sources, particularly in the classes of second graders, and then spread to all students, corresponding to the distance between students. Effect of vaccination during the outbreak was pretty good: attack rate of the group vaccinated since May 1st, considering the maximum latent period of infections (21 days), was 0.8%, comparing to 5%. The efficiency of vaccination marked 84.8%.(95% confidence interval 79.66-89.94) Although the authors recommended the students to wear flue masks and wash their hands as often as possible to screen infections among the students, it turned out that such measures had little effect for the prevention of spread.
CONCLUSIONS
The number of mumps cases dropped remarkably among vaccinated the students the prevalent period of the disease. Authors concluded that is effective to control the outbreak if it is done at early stage.
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Development of Lipoma among Residents Exposed to Glass Fiber Waste.
Hyun Sul Lim, Hae Kwan Cheong, Ji Yong Kim, Jung Ran Kim, Kiyoshi Sakai, Naomi Hisanaga
Korean J Epidemiol. 1999;21(2):159-175.
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This study was conducted to determine the relationship between exposure to glass fiber waste from an insulator factory and the development of cluster of lipomas among local residents in suburb Incheon, Korea. Authors surveyed 152 residents(71 males and 81 females) living near an insulator factory with a questionnaire and physical examination. Unused and disposed fiberglass from the waste site, along with ground water samples were examined under light and polarizing microscope and scanning electron microscope(SEM). Subcutaneous tumors excised from three of the residents were also examined under light and polarizing microscope, SEM with energy dispersive X-ray analysis(EDX), and transmission electron microscope(TEM). Analysis of elemental composition of the fibers and fiber concentration was done by with EDX under SEM and TEM after low temperature ashing. Twelve(7.9%) had subcutaneous tumors among the 152 residents. Tumors were surgically excised from 3 of them and they were all lipomas, consisting of mature fat tissue. These lipomas contained abundant birefringent fibers and particles under polarizing microscope. The concentrations of the fibers were 6.7, 71.8 and 499.2 million fibers per gram dry tissue, respectively. The birefringent fibers were composed of needle shaped particles with rectangular fractured ends up to 17 micrometer in length and 0.5 micrometer in diameter. EDX and x-ray diffraction analysis of the fibers showed that 71 to 100% of the fibers were magnesium silicate, talc. Magnesium silicate fibers were also found in the glass fiber sampled from the waste site. Glass fibers and magnesium silicate fibers were also identified in the ground water. Based on the fact that the magnesium silicate fibers found in the lipomas were similar in morphology and elemental composition to those found in the ground water and those from the waste site, these particles are likely to be introduced into the gastrointestinal tract through consumption of the contaminated ground water. It is suggested that fibrous magnesium silicate, talc, a component of fiberglass waste, may be associated with the development of lipomas.
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An Epidemiological Investigation of an Outbreak of Rubella Occurred in a Male High School in Kyongju.
Hae Kwan Cheong, Hyun Sul Lim, Cheol Jung, Gyoung Yim Ha
Korean J Epidemiol. 1998;20(2):202-211.
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This epidemiological study was carried out to investigate the sources of infection and modes of transmission of an outbreak of rubella that occurred among male high school students in Kyongju in march, 1996. 770 male students(286 third grade, 262 second grade, 222 first grade students) were selected as the study subjects. A questionnaire was completed by the subjects. The anti-Rubella antibodies IgM and IgG were examined and tested by ELISA on all sera from 770 students and the environmental status of class rooms, the dormitory conditions and study rooms were tested. The positive IgM result rate was 17.8% and when the IgM negative was combined with IgG positive the results was 74.9%. IgM IgG negative rates were 7.3%, however, out of a total 770 students. Amongst the older students, the IgM positive rate showed an increase(p<0.01). Out of 137 cases(with a cummulative incidence rate of 71.0%), there were 97 apparant cases(cummulative incidence rate 50.3%) and 40 inapparent cases(cummulative incidence rate 20.7%). Again, the cummulative incidence rate showed an increase in the older students(p<0.04). In the apparent cases, major symptoms included eruption(96.9%), fever(85.6%), lymphadenitis(82.5%), generalized aches and muscle tenderness(76.3%), and a sore throat(61.9%). These symptoms lasted anywhere from 2 degrees =/ 13 days, the average duration being 4 days in length. Initially, there were 9 people on third grade and suspected origin was from more than 2 external sources. It progressed from the upper grades down to the lower grades. In dormitory students, the cummulative incidence ratio was 1.70 and 1.78 amongst study room students.
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A Case of Ulceroglandular Tularemia Occurred In Korea.
Hyun Sul Lim, Hae Kwan Cheong, Woo Sup Ahn, Moon Youn Kim, Dong Hoon Kim
Korean J Epidemiol. 1998;20(1):32-38.
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Tularemia is a zoonosis caused by Francisella tularensis. It is primarily a disease of wild animals. Human infection is incidental and usually results from interaction with biting or blood-sucking insect, wild or domestic animals or the environment. It is common in United States. An increasing number of cases have been reported from the Scandinavian countries, eastern Europe, Siberia, and Japan. But In Korea it has not been reported. A 40-year old male visited the department of Surgery on Jan 13, 1997 complaining multiple swollen lymph-nodes on his axillae and upper right arm for about ten days. On Dec 25, 1996, he found a dead wild rabbit at mountainside nearby, cooked it himself and ate it with his friends. He informed us that he got light injury on both hands while he was walking on the mountainside. On Dec 28, he started to suffer from high fever, fatigue and loss of appetite lasting for a day. After medication at a local clinic for several day, symptoms were somewhat relieved. A week later(Jan 4, 1997), several erythematous lesions developed on his both hands, which left ulcerations on the skin. Both axillary lymph nodes were swollen at both sides, but not tender. He visited the department of surgery on Jan 13 and he admitted on Jan 15. During hospitalization, the lymph nodes were surgically removed from both axillae and upper left arm. On microbiologic examination, small aerobic gram negative coccobacilli were grown on the chocolate agar plate in aerobic condition with 5% CO2 at 37 degrees centigrade. On Feb 10, fine needle aspiration from the liver abscess was done, drawing 3 ml of yellowish thick pustular material, but the microorganism was not isolated at the smear and culture of this material in the same condition as described above. After admission, he was treated with antibiotics(cefazole and marocin). His general conditions and laboratory results, including liver function, were markedly improved. He was discharged on Feb 12 and appears well on subsequent follow-ups. The microorganism and lymph nodes were sent to Centers for Disease Control and Prevention in the United States for further evaluation. A twostep indirect immunoalkaline phosphatase technique using an anti-F. tularensis antibody was performed on the lyph nodes having a positive reaction. The immunohistochemical stain demonstrated intense positivity in the stellate abscesses and fine granular reaction in some of the vessels in the paracortical region. Also F. tularensis was identified in the agar plug by culture morphology and immunofluorescence antibody test. We report a case of F. tularensis in Korea for the first time. Further studies were recommened for epidemiological characteristics and prevention of the disease.
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An Epidemiologic Study on the Health Hazards of Inhabitants chronically exposed to Glass Fiber.
Hyun Sul Lim, Yun Chul Hong, Jung Ran Kim, Hae Kwan Cheong, Ji Yong Kim, Nam Won Paik, Hoe Kyeong Cheong, Chong Han Lem
Korean J Epidemiol. 1995;17(1):76-93.
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Fiberglass, as a substitute of asbestos, is used for more than 60 years as a insulator material. Health hazards including irritation of skin, mucosa and respiratory system associated with use of fiberglass is reported. Many studies on the fibrogenicity and carcinogenicity of fiberglass was conducted but evidence is not sufficient to confirm the carcinogenicity or fibrogenicity. Authors studied the health hazards among 152 inhabitants(71 men and 81 women) from 32 households living around the fiberglass factory which produced the fiberglass insulators and glasswool panels for 20 years. Questionnaire survey on household and persons, examination of underground water, pathologic examination of subcutaneous tumors and examination of fiberglass in tumor tissues were done. The results are as follows; 1. Fiberglass concentration of underground water sampled from 33 households in the study area was 13. 7-95. 9 fiber/cc with the diameter to length ratio more than 1:20. 2. Prevalence of dermatosis among study subjects was 23.0 % (35 cases). Prevalence was not associated with the distance from the factory nor duration of exposure. 3. There were 15 cases of subcutaneous tumor with prevalence of 9. 9 %. Age of subcutaneous tumor cases was all above 30 year-old except one cases, who was 5 year old child, who lived in the surveyed area since he was born. Prevalence of subcutaneous tumor was significantly high in area A(42.9 %) than area B(4.6 %, p<0.01). Prevalence of subcutaneous tumor was higher in long-term exposed inhabitants, but was not statistically significant. 4. Pathologic examination exhibits partly encapsulated fat tissue masses and cut surfaces were pale yellow with gritty sensation. The masses consist of mature fat cells showing variation in size and shape. On polarizing microscope, the peripheries of tumors include small irregular threads of doubly refractile material probably represent glass fibers in fibrocollagenous tissue. Concentration of fiberglass in tissue was 5.1-10.2 fiber/rag wet tissue in case 1, 25.8-184.9 fiber/mg wet tissue in case 2 and 40.8-126.5 fiber/mg wet tissue in case 3. Length of fiberglass was shorter than that in underground water. 5. Cases of malignant tumor among inhabitants since last 10 years were 4, 3 of whom was developed in a same household just near the factory. Diagnoses of malignancy cases were stomach cancer, stomach and esophageal cancer, oral cavity cancer, and stomach cancer with liver metastasis. On review examination of tissues of endoscopic biopsy specimen from a case of stomach cancer, there was adenocarcinoma with no evidence of fiberglass materials. Authors concluded there is evidences that fiberglass was strongly associated with the development of the health hazards including dermatosis and benign subcutaneous tumor. However, the association of fiberglass exposure with the development of malignant tumor was not clear, although strongly suggested. For the prevention of development of further health hazards, it is recommended that under ground water source should be closed and further experimental study to confirm the mechanism of the tumorigenesis and follow up survey on the inhabitants should be conducted.
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A study on the health status of the inhabitants exposed to cementdust.
Hae Kwan Cheong, Joung Soon Kim, Byung Soon Choi, Chung Bum Kim, Sung Il Cho, Yun Mi Song, Hyun Sul Lim
Korean J Epidemiol. 1992;14(1):59-69.
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Abstract
A health impact of environmental cement dust exposure among inhabitants around a cement factory was carried out with special emphasis on finding bronchial asthma cases in this area. Questionnaire survey and physical examination were done on 437 persons in two villages located within 1km distance from the cement factory. On the basis of questionnaire survey and physical examination, 56 persons with suspicion of bronchial asthma were screened, who were further examined to establish diagnosis by physical examination, pulmonary function test and bronchodilator test.
Results
are as follows : 1. Inhabitants in surveyed area had high prevalence of acute and chronic diseases, particularly respiratory diseases and dermatologic diseases. 2. Respiratory symptoms complained were sputum(23.9%), cough(23.0%), dyspnea(19.1%), chest tightness(14.6%), and wheezy breath sound(13.1%). On physical examination, pterygium(29.5%), decreased breath sound(3.0%), wheezing(3.3%), and rales(2.7%) were found. 3. On diagnostic examination, 32 cases (prevalence rate 7.3%) of bronchial asthma and 10 current cases (prevalence rate 2.3%) of bronchial asthma were confirmed. Thus it is postulated that high prevalence of bronchial asthma and respiratory diseases in this area may be related to environmental exposure to the cement dust. Further study, however, such as bronchial provocation test may be necessary to establish definite conclusion on causal relationship between bronchial asthma and environmental cement dust exposure.
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A study on the effect of noise exposure to the health of a population
Sung Il Cho, Joung Soon Kim, Hyun Sul Lim, Hae Kwan Cheong, Byung Soon Choi
Korean J Epidemiol. 1990;12(2):153-164.
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Abstract
For the purpose of evaluating the effect of noise exposure to the health of a population in a village near an air force shooting practice site, a cross-sectional study was conducted from April 1 to April 23 in 1989, on the inhabitants of the village as exposed group and on the population of another provincial village as nonexposed group, which was similar to the exposed in socioeconomic status but had not been exposed to the environmental noise. Subjective symptoms, pulse rate, blood pressure, and pure tone thresholds were compared in the exposed group and the nonexposed group. 150 and 93 subjectes studied were analyzed in each group. The results were as follows : 1) There was a significant difference between the two groups in the frequency of subjective symptoms including otalgia, hearing loss, tinnitus, ear fullness, nausea, diarrhea, indigestion, and anxiety. 2) There was no significant difference between the two groups in average pulse rate, while significant differences were seen in average systolic and diastolic arterial blood pressures, which were 138± 23.2mmHg and 84.5±14.4mmHg in the exposed group and 126.8±19.3mmHg and 73.8±11.3mmHg in the nonexposed group. The prevalence of hypertension by WHO criteria was 24.0% in the exposed group and 8.6% in the nonexposed group, of which difference was statistically significant. 3) There was no significant difference between the two groups in average hearing loss value, while the prevalence of hearing impairment in the exposed and the nonexposed group was 24.0% and 13.4% each according to the criteria of 500, 1000, 2000Hzx pure tone average greater than 26dB, showing a significant difference between the two groups. 4) As the duration of residence increased the hearing loss value increased in the exposed group, but age-corrected percentage hearing loss did not show any increase ; further study may be necessary to determine whether the significantly high prevalence of hearing loss in the exposed group was due to the environmental noise exposure.
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Development of pneumoconiosis among inhabitants around a briquet factory: a case report
Hae Kwan Cheong, Hyun Sul Lim, Jung Jin Cho, Jae Jun Byeon, Yong Tae Ahn, Yup Yoon, Jung Gi Im
Korean J Epidemiol. 1988;10(1):102-108.
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Abstract
In 1987, Chang and collegues reported a case of biopsy proven anthracosis developed in a housewife living around a briquet factory in Seoul. It was suggested that her anthracosis was a result of long-term environmental exposure to coal dust from the factory and coal storage site of 700 meters distance from her house. The possibility of development of anthracosis due to environmental exposure was debated but of further cases was strongly suggested. Authors examed 87 persons living within 1km distance from the factory to detect the additional cases of pneumoconiosis. The exam consisted general informations including occupational exposure to dust, medical history on chronic illness including respiratory illness, physical exam by physicians and chest PA. Chest films were interpreted by two chest radiologists independently without giving prior information about each case. Each interpretation was compared and only those that both radiologists concommitantly interpreted as pneumoconiosis were accepted as cases. Result of interpretation was evaluated with clinical information taken by physicians. Three cases of pneumoconiosis and 3 cases of suspects were found. 1. Of 3 cases of pneumoconiosis, the first case, 45 years old female, was index case already diagnosed by Chang et al. Another one, 49 years old male, has been employed in the briquet factory in that area for 10 years. Another one, 38 years old male, living in that area for 7 years without previous history of dust exposure, was supposed to be developed the disease after environmental exposure to coal dust. 2. Of 3 cases of suspects, a case, 62 years old male, had 15 years of occupational exposure to coal dust. Another two cases, 63 years old females, had no occupational history but each had medical history of diabetes and chronic obstructive lung disease.
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Epidemiol Health : Epidemiology and Health