5. 직업병 사례 연구-윤진하(연세대학교)

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flyinyou@gmail.com http://www.manicksorcar.com/child%20labor.jpg

RESEARCH VS. ASSESSMENT

??

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,,,, : :,

vs Validity Reliability Generalization (Qualitative) (Quantitative)

, [ ].

Systematic Epidemiologic Methods Person, Time, Place Evidence level

Hazard environment Occupational Toxicology Industrial (Occupational) Toxicology Workers (Human) Health

Leonid Afremov http://www.boredpanda.com/colourful-oil-paintings-leonid-afremov/

Case Environmental Effect The Institute for Occupational Health

Adelaide Ross Smith(1928)???

Percival Pott (1713-1788) The first occupational cancer (scrotal cancer), by toxin (PAH, coal tar) in occupation (chimney sweep).??

1895, German Surgeon Ludwig Rehn Three cases of bladder cancer in workers exposed to aromatic amines in a fuschin dye factory 1954, RAM CASE, Cancer researcher Tumour of the urinary bladder as an occupational disease in the rubber industry in England and Wales How long?

Sumerian BC 1,000,000 BC 8,000 Fire, Stone Bronze BC 3,500 IRON AD 1712 1735 1771 1824 1851 1874 1896 1902 1920~ 1930~ Modern Cement Asbestos X-ray Plastic Cokes furnace PVC, PS, PET, PP Steam Engine Spinning mill Modern oil Diesel-ship Diesel-car (water power) refinery The Institute for Occupational Health Cited from: ILO encylopaedia of occupational health & safety http://www.ilo.org/oshenc/part-iv/occupational-hygiene/item/575

Case (series) approach serves as a valuable indicator of occupational hazards, primarily in situations where the health outcome is rear and has dramatic manifestations and there is a characteristic exposure that can be identified as the probable cause.

Case study Example

,

1. (coal) (COAL MINE). ADD 1.

2. (UNLOADING) ADD 1..

3.. ADD1. 1 ADD2.

4. ( 6 ),. ADD1..

5. (Hopper and conveyor). ADD1.

6. 1 (Crushing) (hammer) 48. ADD1. 2.

7. (Sorting). ADD1. 13mm 11mm 9mm 2

8. (Mixing) 2 2.

9. (Product). ADD1. 32 1 2 6.

10. (Loading).. ADD1..

( )

A case of lung cancer in a 67-year-old bus garage worker. During the past 16 years (from 30 years ago) Refueled to almost fifty buses, and it takes a 5 hours per day. Cleaned the bus in night and morning. He had 7 pack-years of smoking. and have no familial history of lung cancer The bus terminal was bankrupted, hence we reviewed various literatures for exposure assessment.

BBC news. CNN New York Times. news.

N ACGIH limit value: 20μg/m 3 Elemental Carbon GM GSD Range BUS (Korea) 17 23.0 2.2 1.7 67.2 JY Jeong. Bull.Nat.Sci.,Yong-In Univ.Vol.13.No.1.DEC. 2008 Sampler was located at behind of bus driver Elemental carbon levels were 180.0 / and 200.1 / just behind at exhaust pipe. (ND Lee et al. Health risk assessment of diesel engine exhaust and asbestos in bus garage worker. KOSHA. 2000 [Korean Report])

Date Elemental Carbon ( / ) GM Max Driving Time (Minute) Driving distance ( ) 1 4.7 41.9 238 108 2 3.9 77.8 308 142 3 7.9 54.5 169 78 Back ground concentration: 0.5 / (parked)

Diesel engine exhaust regulation of Korea (ex. CO emission limit value per km driving, 1.4 t vehicle) 8 100% 6 78, 21 78% CO g/km 4 2 26% 12% 8% 0 1991 1996 1997 2002 2006 Hence, the exposure level of diesel engine exhaust before 1990 was 10 times and more high than that after 2006.

Cited from at http://tyemc.co.kr/

What are factors suspected?

Diesel Engine Exhaust Data sampling and analysis were done by Dr. Hyun-Seok Kwag and Dr. Boowook Kim

1000 997 1.4-t truck (parked)= 0.5 μg/m3 100 150 66 130 23 10 1 Tunnel Jumbo Drill Anfo Charger Loader Dump Truck

0.077~0.090 % (0.077~0.090%) X 400 = 0.31~0.36 10 ( 15 ), 3

시료형태작업내용및측정위치측정시간 ( 분 ) 호흡성결정형유리규산 ( mg / m3 ) 기계운전 / 관리 ( 조정실 ) 260 0.015 개인시료 지게차운전 310 0.011 믹서기청소 50 0.156 지역시료조정실앞 313 0.010 호흡성결정형유리규산노출기준 ( mg / m3 ) : 고용노동부 0.05, ACGIH 0.025

Multiple myeloma, 41 years old, male, exposure: 17 years AML, 35 years old, male, exposure: 10 years Benzene etc. NHL in spleen, 57 years old, male, exposure: 32 years The images of MM, AML, NHL were cited from medtube.net, tumblr.com, aafp.org, sciguru.com

Fume(metal) Crystalline silica etc

Hardener(catalyst) Xylensulfonic acid (or benzenesulfonic acid ) Thermal decomposition degree of one -SO 3 H ; 65 kcal = 1 kg x 0.414 kcal/kg x t 1 t 1 = 157 Thermal decomposition degree of two CH 3 ; 2 x 83 kcal = 1 kg x 0.414 kcal/kg x t 2 t 2 = 400

? Job Melting & pouring Automatic molding Shake out Metal fumes Silica Silica, heavy metals Agents benzene

Dusts(mg/m 3 ) -Quartz - - -Respirable dust - - Metals(mg/m 3 ) -Cr 6+ -Nickel Melting Pouring Molding Core making Shake out Fettling 0.0010 0.0002-0.0071 0.0011 ND-0.0122 0.045 ND-0.305 1.1457 0.3024-7.0428 0.003 0.003-0.00 4 0.082 0.001-0.376 1.3258 0.1524-7.0426 0.074 0.014-0.31 5 0.0228 0.0008 0.0004-0.0023 - - - 0.0004-0.323 6 0.0008 ND-0.0101 - - - PAH(mg/m 3 ) -Benzo(a)pyrene ND 0.0029 0.0106 - - - -Benzo(b)fluoranthene 0.0032 0.0127 ND-0.0281 0.0582 - - - -Benzo(k)fluoranthene ND 0.0197 0.0113-0.0281 0.0332 - - - Chemicals(ppm) -Benzene - 0.186 ND-0.273 -Formaldehyde - 0.064 0.222 ND-0.362 0.048 0.030-0.063 0.116-0.115 0.020-0.4 42 - - 0.0176 0.0001-0.236 9 0.196 ND-0.300

Men Women Total Office Product ion Person-years 30,492 126,39 5 Leukemia n o n - Hodgkins lymphom a Lympho - hematop o i e t i c cancer Total 156,88 7 Office Producti on Total Office Producti on Total 11,887 14,396 26,284 42,379 140,791 179,48 7 N 3 9 12 0 2 2 3 11 14 SIR 1.99 1.34 1.46-2.77 1.86 1.61 1.48 1.51 95%CI 0.40-5. 82 0.61-2. 55 0.76-2. 56-0.31-9.9 9 0.20-6. 73 0.32-4.7 1 0.74-2.6 6 N 3 12 15 0 0 0 3 12 15 0.82-2. 53 SIR 2.31 2.01 2.07 - - - 1.95 1.84 1.86 95%CI 0.46-6. 74 1.04-3. 52 1.16-3. 41 - - - 0.39-5.6 9 0.95-3.2 1 N 6 21 27 0 2 2 6 23 29 1.04-3. 07 SIR 2.05 1.59 1.67-1.47 1.01 1.69 1.58 1.60 95%CI 0.75-4. 45 1.01-2. 29 1.10-2. 43-0.17-5.3 2 0.11-3. 66 0.62-3.6 8 1.00-2.3 7 1.07-2. 30

Leukemia in foundry WHO (IARC) reported that foundry work is lung carcinogenic to human (by PAH, coal tar, crystalline silica..) But some occupational toxicologists found cases of leukemia among foundry workers

Case study case can gives hypothesis Raw material à process emission Ex) diesel engine exhaust Welding fume Rubber manufacture

49,

Type of exposure Industrial classification Job classification [1993~2007]* [2008~2012.6] ** asbestos reinforcd plastic production and processing Manufacture of asbestos reinforced 5 machine operators plastic mixing & powder making 1 Manufacture of asbestos containing products U s e o f a s b e s t o s containing products in manufacturing process Handling of asbestos containing products during their work Manufacture of asbestos textiles Textile production and processing machine operators 3 5 Manufacture of stone products Stone splitters 1 Manufacture of cement Supervisor of stone quarry 1 1 M a n u f a c t u r e o f p a r t s a n d accessories for motor vehicles A l u m i n u m d o o r & w i n d o w manufacture and installation Manufacturer of brake lining and pad for motor vehicles 1 2 Manager and officer 2 Installer of aluminum door and window 1 Manufacture of pulp and paper engineering work 1 Health & safety manager 1 Manufacture of basic iron and steel Operator of electric furnace 1 1 Plumber 1 2 Ship breaking 1 Ship building and repairs Ship carpenter 1 1 Arrangement and cleaning 1 1 Assistant for panel work 1 Transportation Maintenance and repairman for taxi 1 Driver(Truck, Bus) 1 Construction Plumber 1 5 Bricklayer 1 scaffolding man 3 Foreman & safety manager 4 Welder 1 Painter 1 Electtrical engineer 1 Fire power generation Operator for differentiator, boiler and turbine 1 Welder 1 Mine Coal worker 2 *YS Ahn and SK Kang, Manufacture Industrial Health of electrical 2009, equipment 47, 113 Unknown The Institute for Occupational 1 Health 122 ** Submitted case of KCOML edited by JH Yoon

4 case Asbestos reinforced Plastic (6 case) 1 case Slip ring 1 case

Commutator A commutator is a rotary electrical switch in certain types of electric motors or electrical generators that periodically reverses the current direction between the rotor and the external circuit.

A grinder of asbestos

Asbestos-reinforced

The exposure levels of asbestos were (fiber/cc) ND ~ 0.0417 during grinding & polishing ND ~ 0.433 during mixing of asbestos ~2002, 6 ton per month ~2007, 1~3 ton per month

Exposure (1 year) 36 years (from 13 years old) MM Exposure (29 years) 29 years (from 18 years old) MM Exposure (20 years) 37 years (from 15 years old) Exposure (15 years) 37 years (from 15 years old) MM MM 1967 1979 1991 2002 2014

Two men One woman One woman

Percival Pott (1713-1788) The first occupational cancer (scrotal cancer), by toxin (PAH, coal tar) in occupation (chimney sweep). VS??

Sumerian BC 1,000,000 BC 8,000 Fire, Stone Bronze BC 3,500 IRON AD 1712 1735 1771 1824 1851 1874 1896 1902 1920~ 1930~ Modern Cement Asbestos X-ray Plastic Cokes furnace PVC, PS, PET, PP Steam Engine Spinning mill Modern oil Diesel-ship Diesel-car (water power) refinery The Institute for Occupational Health Cited from: ILO encylopaedia of occupational health & safety http://www.ilo.org/oshenc/part-iv/occupational-hygiene/item/575

Exposure (1 year) 36 years (from 13 years old) MM Exposure (29 years) 29 years (from 18 years old) MM Exposure (20 years) 37 years (from 15 years old) Exposure (15 years) 37 years (from 15 years old) MM MM 1967 1979 1991 2002 2014

RESEARCH VS. ASSESSMENT

?

http://www.manicksorcar.com/child%20labor.jpg

. Email: flyinyou@gmail.com Research homepage: https://scholar.google.com/citations? hl=ko&user=fze_zwaaaaaj&view_op=list_wor ks&sortby=pubdate