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Background: This study aimed to examine the association between risk of brain tumors and radiofrequency (RF) exposure from mobile phones among young people in Korea and Japan. Methods: This case-control study of brain tumors in young people was conducted in Korea and Japan under the framework of the international MOBI-Kids study. We included 118 patients diagnosed with brain tumors between 2011 and 2015 and 236 matched appendicitis controls aged 10–24 years. Information on mobile phone use was collected through face-to-face interviews. A detailed RF exposure algorithm, based on the MOBI-Kids algorithm and modified to account for the specificities of Japanese and Korean phones and networks, was used to calculate the odds ratios (ORs) for total cumulative specific energy using conditional logistic regression. Results: The adjusted ORs in the highest tertile of cumulative call time at 1 year before the reference date were 1.61 (95% confidence interval [CI], 0.72–3.60) for all brain tumors and 0.70 (95% CI, 0.16–3.03) for gliomas, with no indication of a trend with exposure. The ORs for glioma specifically, were below 1 in the lowest exposure category. Conclusion: This study provided no evidence of a causal association between mobile phone use and risk of brain tumors as a whole or of glioma specifically. Further research will be required to evaluate the impact of newer technologies of communication in the future.

Abstract Background Allergic diseases (ADs) have been increasingly reported in infants and children over the last decade. Diet, especially the inclusion of fish intake, may help to lower the risk of ADs. However, fish also, can bioaccumulate environmental contaminants such as mercury. Hence, our study aims to determine what effects the type and frequency of fish intake have on ADs in six-month-old infants, independently and jointly with mercury exposure. Methods This study is part of the prospective birth cohort: Mothers and Children’s Environmental Health (MOCEH) study in South Korea. Data was collected on prenatal fish intake, prenatal mercury concentration and ADs for infants aged six months for 590 eligible mother-infant pairs. Logistic regression analysis was conducted to evaluate the risk of prenatal fish intake and mercury concentration on ADs in infants. Finally, interaction between fish intake and mercury concentration affecting ADs in infants was evaluated. Hazard ratios of prenatal fish intake on ADs in 6 month old infants were calculated by prenatal mercury exposure. Results Logistic regression analysis showed that white fish (OR: 0.53; 95% CI 0.30–0.94; P

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.

OBJECTIVES Although there is substantial evidence for the short-term effect of fine particulate matter (PM2.5) on daily mortality, few epidemiological studies have explored the effect of prolonged continuous exposure to high concentrations of PM2.5. This study investigated how the magnitude of the mortality effect of PM2.5 exposure is modified by persistent exposure to high PM2.5 concentrations. METHODS We analyzed data on the daily mortality count, simulated daily PM2.5 level, mean daily temperature, and relative humidity level from 7 metropolitan cities from 2006 to 2019. Generalized additive models (GAMs) with quasi-Poisson distribution and random-effects meta-analyses were used to pool city-specific effects. To investigate the effect modification of continuous exposure to prolonged high concentrations, we applied categorical consecutive-day variables to the GAMs as effect modification terms for PM2.5. RESULTS The mortality risk increased by 0.33% (95% confidence interval [CI], 0.16 to 0.50), 0.47% (95% CI, -0.09 to 1.04), and 0.26% (95% CI, -0.08 to 0.60) for all-cause, respiratory, and cardiovascular diseases, respectively, with a 10 μg/m3 increase in PM2.5 concentration. The risk of all-cause mortality per 10 μg/m3 increase in PM2.5 on the first and fourth consecutive days significantly increased by 0.63% (95% CI, 0.20 to 1.06) and 0.36% (95% CI, 0.01 to 0.70), respectively. CONCLUSIONS We found increased risks of all-cause, respiratory, and cardiovascular mortality related to daily PM2.5 exposure on the day when exposure to high PM2.5 concentrations began and when exposure persisted for more than 4 days with concentrations of ≥35 μg/m3. Persistently high PM2.5 exposure had a stronger effect on seniors.

Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder in school-age children and adolescents. However, the reported associations between ADHD and single nutrient intake are inconsistent. The aim of the study was to investigate the relationships between dietary intake changes and the prevalence of ADHD over time with repeat measurements using data from the Children Health and Environment Research (CHEER). To assess changes over time, we used data obtained in 2006 and 2008 (Phases 1 and 2). In this study, there were 2899 children aged 8 years or older in Phase 1 and 2120 children aged 9 years or older in Phase 2 from Korea, and the ADHD scores and dietary intake of 1733 children in Phases 1 and 2 were used in the final analysis. The YN group refers to children whose disease had improved in Phase 2, and the NY group refers to children diagnosed with ADHD in Phase 2. A notable within-group result was the increase in vegetable protein (p = 0.03) in the YN group. A between-group comparison showed that significant changes in nutrient intake could be confirmed most in the NY group, and the YN group tended to have a lower nutrient intake than the NY group. In the correlation of changes in nutrient intake and three subtypes (combined, AD, and HD), the total fat (p = 0.048) and animal protein (p = 0.099) showed a positive correlation with the prevalence of AD. Vegetable iron (p = 0.061 and p = 0.044, respectively), zinc (p = 0.022 and p = 0.007, respectively), vegetable protein (p = 0.074), and calcium (p = 0.057) had inhibitory effects on ADHD and its subtype. In conclusion, management of dietary and nutritional status should be considered to ameliorate ADHD and its subtypes in school-age children, and these relationships require further exploration in other settings.

Abstract Background The association between exposure to secondhand smoke (SHS) during pregnancy and a child’s neurodevelopment has not been established yet. We explored the association between prenatal exposure to SHS and neurodevelopment at 24 months of age considering genetic polymorphism and breastfeeding in 720 mothers and their offspring enrolled in the Korean multicenter birth cohort study (Mothers and Children Environmental Health, MOCEH). Methods We quantified urine cotinine concentrations in mothers once from 12th to 20th gestational weeks and excluded those whose urine cotinine levels exceeded 42.7 ng/ml to represent SHS exposure in early pregnancy. Mental developmental index (MDI) and psychomotor developmental index (PDI) values were measured using the Korean version of the Bayley Scales of Infant Development II (K-BSID-II) at 24 months of age. A general linear model was used to assess the relationship between maternal urinary cotinine level and neurodevelopment. Results MDI scores were inversely associated with cotinine [β = − 2.73; 95% confidence interval (CI): − 5.32 to − 0.15] in children whose mothers had early pregnancy urinary cotinine levels >1.90 ng/ml. No association was evident in children whose mothers had cotinine levels ≤1.90 ng/ml. This negative association was more pronounced in children whose mothers had both Glutathione S-transferases mu 1 (GSTM1) and theta 1 (GSTT1) null type [β = − 5.78; 95% CI: -10.69 to − 0.87], but not in children whose mothers had any present type of GSTM1/GSTT1 [β = − 1.64; 95% CI: -4.79 to 1.52]. The association was no longer significant when children received breast milk exclusively for up to 6 months [β = − 0.24; 95% CI: -4.69 to 4.20] compared to others [β = − 3.75; 95% CI: -7.51 to 0.00]. No significant association was found for PDI. Conclusions Maternal exposure to SHS during pregnancy may result in delayed MDI in early childhood. This effect might be modified by genetic polymorphism and breastfeeding behavior.

Background: The Mothers and Children's Environmental Health study (MOCEH) is a multi-centric prospective birth cohort study investigating effects of various environmental pollutants like heavy metals, endocrine disruptors, air pollutants, nutrition and lifestyle on birth outcomes, growth and development, health and disease of children. In this study, we report all the outcomes from the MOCEH study describing the different environmental pollutants affecting children’s health and disease. Methods: In MOCEH study, 1,751 pregnant women in their first trimester were recruited at 3 centers from 2006 to 2010 in South Korea. The children were followed from birth up to 6 years. Information on health outcomes of children including birth parameters, demographic characteristics, medical and child-rearing history, and nutritional status, were repeatedly obtained through the follow-ups by questionnaires administration, clinical evaluation, and biological specimen collection and measurements. Prenatal and postnatal measurement in biospecimen, i.e., lead, mercury, cadmium, manganese, 1-hydroxypyrene, 2-naphthol, malonadialdehyde, hippuric acid, bisphenol A and phthalate metabolites, and measurement in air samples, i.e., particulate matter, nitrogen dioxide, and total volatile organic compounds were performed. Results: The results show the adverse effect of prenatal exposure to heavy metals like mercury, lead and cadmium on children’s physical, cognitive and neurobehavioral development. Exposure to endocrine disruptors, air pollution, second hand smoke, and mother’s lifestyle during pregnancy affects children’s growth and development. We also identified specific window periods of exposure of pollutants significantly related to children’s health outcomes. Conclusion: The collective results from MOCEH study provide strong scientific evidence that exposures to prenatal and postnatal environmental pollutants have a negative effect on growth and development of children, which will be useful in implementing effective national policy to improve children’s environmental health. Keywords: Birth cohort, Children Environmental health, Environmental pollutants

Abstract Background Several studies have reported the harmful effects of lead poisoning. However, the relationship between lead exposure and oral health of children has not been well defined. The aim of this study was to investigate the relationship between blood lead level (BLL) and oral health status of children. Methods A total of 351 children (aged 7–15 years) were recruited from the pilot data of the Korean Environmental Health Survey in Children and Adolescents, which was designed to examine environmental exposure and children’s health status in South Korea. Blood samples were taken to determine BLLs and oral examinations were performed to assess oral health parameters, including community periodontal index (CPI), gingival index (GI), and plaque index (PI). Information regarding socioeconomic status, oral hygiene behavior, and dietary habits was collected from parents and guardians. Results The participants were divided equally into four quartiles, with quartile I comprised of children with the lowest BLLs. There were significant differences for PI (p

Objectives Although mercury (Hg) exposure is known to be neurotoxic in humans, its effects on liver function have been less often reported. The aim of this study was to investigate whether total Hg exposure in Korean adults was associated with elevated serum levels of the liver enzymes aspartate aminotransferase (AST), alanine transaminase (ALT), and gamma-glutamyltransferase (GGT). Methods We repeatedly examined the levels of total Hg and liver enzymes in the blood of 508 adults during 2010-2011 and 2014-2015. Cross-sectional associations between levels of blood Hg and liver enzymes were analyzed using a generalized linear model, and nonlinear relationships were analyzed using a generalized additive mixed model. Generalized estimating equations were applied to examine longitudinal associations, considering the correlations of individuals measured repeatedly. Results GGT increased by 11.0% (95% confidence interval [CI], 4.5 to 18.0%) in women and 8.1% (95% CI, -0.5 to 17.4%) in men per doubling of Hg levels, but AST and ALT were not significantly associated with Hg in either men or women. In women who drank more than 2 or 3 times per week, AST, ALT, and GGT levels increased by 10.6% (95% CI, 4.2 to 17.5%), 7.7% (95% CI, 1.1 to 14.7%), and 37.5% (95% CI,15.2 to 64.3%) per doubling of Hg levels, respectively, showing an interaction between blood Hg levels and drinking. Conclusions Hg exposure was associated with an elevated serum concentration of GGT. Especially in women who were frequent drinkers, AST, ALT, and GGT showed a significant increase, with a significant synergistic effect of Hg and alcohol consumption.

Objectives: To evaluate prenatal exposure to radiofrequency radiation (RFR) from telecommunication using a mobile phone questionnaire, operator data logs of mobile phone use and a personal exposure meter (PEM). Material and Methods: The study included 1228 mother–infants pairs from the Mothers and Children’s Environmental Health (MOCEH) study – a multicenter prospective cohort study ongoing since 2006, in which participants were enrolled at ≤ 20 weeks of pregnancy, with a follow-up of a child birth and growth to assess the association between prenatal environmental exposure and children’s health. The questionnaire included the average calling frequency per day and the average calling time per day. An EME Spy 100 PEM was used to measure RFR among 269 pregnant women from November 2007 to August 2010. The operators’ log data were obtained from 21 participants. The Spearman’s correlation test was performed to evaluate correlation coefficient and 95% confidence intervals between the mobile phone use information from the questionnaire, operators’ log data, and data recorded by the PEM. Results: The operators’ log data and information from the self-reported questionnaire showed significantly high correlations in the average calling frequency per day (ρ = 0.6, p = 0.004) and average calling time per day (ρ = 0.5, p = 0.02). The correlation between information on the mobile phone use in the self-reported questionnaire and exposure index recorded by the PEM was poor. But correlation between the information of the operators’ log data and exposure index for transmission of mobile communication was significantly high: correlation coefficient (p-value) was 0.44 (0.07) for calling frequency per day, and it was 0.49 (0.04) for calling time per day. Conclusions: The questionnaire information on the mobile phone use showed moderate to high quality. Using multiple methods for exposure assessment might be better than using only one method. Int J Occup Med Environ Health 2016;29(6):959–972

PurposeThe Hebei Spirit Oil Spill occurred on 7 December 2007 and resulted in the spillage of 12 547 kl of crude oil on the coastline near Taean. Historically, this was the largest oil spill in Korean water. The health effect research on Hebei Spirit Oil Spill (HEROS) is a prospective cohort study that aimed to evaluate the long-term health effects of oil spill exposure on residents in the affected community.ParticipantsThe Taean Environmental Health Center initially enrolled adults, adolescents and children living in Taean in 2009 and 2010. Follow-up surveys of participating adults and children were conducted every other year. By 2017, a total of 9585 adults and 2216 children and adolescents were enrolled. Of these, 294 adults and 102 children and adolescents were included in all subsequent surveys.Findings to dateChildren who lived closer to the oil spill site exhibited a lower level of pulmonary function and higher prevalence of allergic rhinitis, than those who lived further away from the oil spill site. Adults who lived in a highly exposed area or participated in clean-up work had higher urine levels of the oxidative stress biomarkers malondialdehyde and 8-hydroxydeoxyguanosine. Changes in haematological parameters during a 3-year period were observed in residents of both sexes in highly exposed areas, in addition to increases in respiratory diseases and mental health problems in female and male participants, respectively.Future plansThe findings of this study will better enable policy makers to develop environmental health policies intended to prevent adverse health effects in residents of communities affected by oil spills, as well as policies regarding the management of future oil accidents. The HEROS study will continue to follow participants in future and will be updated to enable an investigation of long-term health effects.

This study investigated the social outcomes of the Environmental Health Studies of National Industrial Complex (EHSNIC), which have been conducted by the National Institute of Environmental Research (NIER) in eight National Industrial Complex Areas (NICAs) since 2003. Eighteen sessions of focus-group interviews with 85 people were conducted from October 2016 to January 2017. Interviewees were stakeholders from eight NICAs and included resident representatives, environmental nongovernment organizations, local government officials, and environmental health and safety officers from companies. Interview results were divided into six categories: EHSNIC awareness, EHSNIC outcomes, EHSNIC limitations, EHSNIC continuation, EHSNIC improvement directions, and EHSNIC results use. They were then further indexed into 23 divisions. EHSNIC awareness varied across stakeholders. A major EHSNIC outcome is that a continued result database was established, which was used as a reference for environmental improvements. EHSNIC limitations included no proper healthcare actions taken during the EHSNIC study period, a lack of EHSNIC results disclosure, a failure to reflect local specificity, and a lack of validity in the results. Regarding EHSNIC continuation, all stakeholders said EHSNIC should be conducted continuously. EHSNIC improvement directions included conducting studies tailored to each NICA, identifying correlations between pollutant exposure and disease, increasing the sample size, and performing repeated studies. Regarding EHSNIC results use, respondents wanted to use the results as a reference to relocate residents, ensure distance between NICAs and residential areas, provide healthcare support, develop local government policies, and implement firms’ environmental controls. Since EHSNIC aims to identify the health effects of NICAs on residents and take appropriate actions, it should be continued in the future. Even during the study period, it is important to take steps to preventively protect residents’ health. EHSNIC also needs to reflect each NICA’s characteristics and conduct reliable research based on stakeholder participation and communication.

The Environmental Health Study in the Korean National Industrial Complexes (EHSNIC) is a project that aims to monitor the exposure and health effects of environmental pollution among residents of national industrial complexes, as well as propose appropriate environmental health measures. Since its launch in 2003, this project has been initiated in eight national industrial complexes. Currently, it is necessary to review the accomplishments and limitations of the phases 1 and 2 of this project, and establish the direction of the upcoming the phase 3. Thus, the present study has developed principles and goals for the phase 3, considering the rationale and justification of the EHSNIC, and presented specific research contents accordingly. In the phase 3, it is important to improve the methods for exposure assessment and evaluation of health effects, in order to identify clearly the association between the pollutants released from industrial complexes and their health impacts, to develop and to reinforce communication strategies to promote participation of residents of communities near industrial complexes. Nonetheless, it is also important to maintain the basic goal of continuously monitoring the level of exposure to and health effects of environmental pollutants.

The purpose of this review is to summarize the results of studies on of the association between exposure to dental X-rays and health risk. To perform the systematic review, We searched the PUBMED, EMBASE, and MEDLINE databases for papers published before December 15, 2016. A total of 2 158 studies, excluding duplicate studies, were found. Two reviewers independently evaluated the eligibility of each study. The final 21 studies were selected after application of exclusion criteria. In terms of health outcomes, there were 10 studies about brain tumors, 5 about thyroid cancer, 3 about tumors of head and neck areas, and 3 related to systemic health. In brain tumor studies, the association between dental X-ray exposure and meningioma was statistically significant in 5 of the 7 studies. In 4 of the 5 thyroid-related studies, there was a significant correlation with dental diagnostic X-rays. In studies on head and neck areas, tumors included laryngeal, parotid gland, and salivary gland cancers. There was also a statistically significant correlation between full-mouth X-rays and salivary gland cancer, but not parotid gland cancer. Health outcomes such as leukemia, low birth weight, cataracts, and thumb carcinomas were also reported. In a few studies examining health effects related to dental X-ray exposure, possibly increased risks of meningioma and thyroid cancer were suggested. More studies with a large population and prospective design are needed to elaborate these associations further.

Objectives: No children-specified review and meta-analysis paper about the short-term effect of fine particulate matter (PM2.5) on hospital admissions and emergency department visits for asthma has been published. We calculated more precise pooled effect estimates on this topic and evaluated the variation in effect size according to the differences in study characteristics not considered in previous studies. Methods: Two authors each independently searched PubMed and EMBASE for relevant studies in March, 2016. We conducted random effect meta-analyses and mixed-effect meta-regression analyses using retrieved summary effect estimates and 95% confidence intervals (CIs) and some characteristics of selected studies. The Egger’s test and funnel plot were used to check publication bias. All analyses were done using R version 3.1.3. Results: We ultimately retrieved 26 time-series and case-crossover design studies about the short-term effect of PM2.5 on children’s hospital admissions and emergency department visits for asthma. In the primary meta-analysis, children’s hospital admissions and emergency department visits for asthma were positively associated with a short-term 10 μg/m3 increase in PM2.5 (relative risk, 1.048; 95% CI, 1.028 to 1.067; I2=95.7%). We also found different effect coefficients by region; the value in Asia was estimated to be lower than in North America or Europe. Conclusions: We strengthened the evidence on the short-term effect of PM2.5 on children’s hospital admissions and emergency department visits for asthma. Further studies from other regions outside North America and Europe regions are needed for more generalizable evidence.

The industrial complexes built during the course of economic development in South Korea played a pivotal role in the country’s rapid economic growth. However, this growth was accompanied by health problems due to the pollutants released from the industrial complexes inevitably located near residential areas, given the limited land area available in South Korea. This study was conducted to evaluate the exposure to each pollutant emanating from industrial complexes for residents living in nearby areas, and to determine the substances requiring priority attention in future surveys. Pollutants were comprehensively categorized according to their emission and exposure levels based on data previously collected from the study areas. The emission, ambient concentration, and biomarker concentration levels of major pollutants emitted from eight national industrial complexes (Ulsan, Pohang, Gwangyang, Yeosu, Chungju, Daesan, Sihwa, and Banwol) were determined and tabulated. Each of the values was compared with the national/local average values, reference values, or control area concentrations depending on availability. Substances with completed exposure pathways and with high values for emissions, ambient concentrations, and biomarker concentrations were considered the substances posing exposure risks to the residents living near the corresponding industrial complex. The substances requiring continuous monitoring or supplementary exposure investigation were also categorized and presented. Lead and benzene had higher values for emissions, ambient concentrations, and biomarker concentrations in the Ulsan Industrial Complex area; thus, they were most likely to pose exposure risks to residents living in the area’s neighborhoods. In other areas, styrene, xylene, cadmium, nitrogen oxide, trichloroethylene, nickel, manganese, and chromium required continuous monitoring, and arsenic, nickel, manganese, and chromium required biomarker measurements. In conclusion, the substances identified and categorized in this study need to be given appropriate attention in future surveys on exposure risks and health effects related to industrial complexes.

Several epidemiological studies have reported an association between environmental pollution and various health conditions in individuals residing in industrial complexes. To evaluate the effects of pollution from industrial complex on human health, we performed a pooled analysis of environmental epidemiologic monitoring data for residents living near national industrial complexes in Korea. The respiratory and allergic symptoms and the prevalence of acute and chronic diseases, including cancer, were used as the outcome variables for health effects. Multiple logistic regression analysis was used to analyze the relationship between exposure to pollution from industrial complexes and health conditions. After adjusting for age, sex, smoking status, occupational exposure, level of education, and body mass index, the residents near the industrial complexes were found to have more respiratory symptoms, such as cough (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.06 to 1.31) and sputum production (OR, 1.13; 95% CI, 1.03 to 1.24), and symptoms of atopic dermatitis (OR, 1.10; 95% CI, 1.01 to 1.20). Among residents of the industrial complexes, the prevalence of acute eye disorders was approximately 40% higher (OR, 1.39; 95% CI, 1.04 to 1.84) and the prevalence of lung and uterine cancer was 3.45 times and 1.88 times higher, respectively, than those among residents of the control area. This study showed that residents living in the vicinity of industrial complexes have a high risk of acute and chronic diseases including respiratory and allergic conditions. These results can be used as basic objective data for developing health management measures for individuals residing near industrial complexes.

Inferring causality is necessary to achieve the goal of epidemiology, which is to elucidate the cause of disease. Causal inference is conducted in three steps: evaluation of validity of the study, inference of general causality, and inference of individual causality. To evaluate validity of the study, we propose a checklist that focuses on biases and generalizability. For general causal inference, we recommend utilizing Hill’s 9 viewpoints. Lastly, individual causality can be inferred based on the general causality and evidence of exposure. Additional considerations may be needed for social or legal purposes; however, these additional considerations should be based on the scientific truth elucidated by the causal inference described in the present article.

Objectives A stable follow-up participation rate is a very important factor for validity in a cohort study. This study analyzed the factors that affect the participation rate at one hospital-based birth cohort in South Korean. Methods The participants were recruited from the Mothers’ and Children’s Environmental Health study between 2006 and 2010. The analysis targeted 1751 mothers who participated in a birth cohort. We conducted analyses of general characteristics during pregnancy and those of infants at birth that affect the participation rate of the 6-month follow-up survey. Results The participation rate for the 6-month follow-up survey was 60.4%. The participation rate in the follow-up of the subsequent period decreased within a 5% to 10% range compared to the number of subjects. The participation rate of premature infants was 16.9% lower than that of a full-term infant (52.6% vs. 69.5%). Analysis showed a 16.7% difference between the participation rate of low-birthweight infants in follow-ups (53.7%) and the participation rate of infants with normal weight (70.4%). The participation rate of mothers who were employed during pregnancy was significantly lower for the 6-month follow-up compared to the participation rate of mothers who were unemployed during pregnancy. Conclusions In this study, factors such as premature birth, low-birthweight, and the employment status of the mother during pregnancy affected the participation rate of the follow-up survey for the birth cohort at six months. A specific strategy is needed to encourage survey participation for the high risk groups in the follow-ups.

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.

Objectives This study was conducted to describe the regional malaria incidence in relation to the geographic and climatic conditions and describe the effect of altitude on the expansion of malaria over the last decade in Papua New Guinea. Methods Malaria incidence was estimated in five provinces from 1996 to 2008 using national health surveillance data. Time trend of malaria incidence was compared with rainfall and minimum/maximum temperature. In the Eastern Highland Province, time trend of malaria incidence over the study period was stratified by altitude. Spatio-temporal pattern of malaria was analyzed. Results Nationwide, malaria incidence was stationary. Regionally, the incidence increased markedly in the highland region (292.0/100000/yr, p =0.021), and remained stationary in the other regions. Seasonality of the malaria incidence was related with rainfall. Decreasing incidence of malaria was associated with decreasing rainfall in the southern coastal region, whereas it was not evident in the northern coastal region. In the Eastern Highland Province, malaria incidence increased in areas below 1700 m, with the rate of increase being steeper at higher altitudes. Conclusions Increasing trend of malaria incidence was prominent in the highland region of Papua New Guinea, while long-term trend was dependent upon baseline level of rainfall in coastal regions.

Objectives Pyrethroid pesticides are among the most commonly using insecticides in South Korean households and have been the subject of considerable interest among public health professionals for their potential health effects. The objective of this study is to examine the level of urinary 3-phenoxybenzoic acid (3-PBA) among elementary students in South Korea. Methods We conducted a cross-sectional study to evaluate pyrethroid pesticide exposure levels by measuring the urinary metabolites of 3-PBA using a gas chromatography-mass spectrometry method in March 2011. Study participants were 70 Asan-area and Incheon-area elementary students. Results All respondents had values above the detection limit, and the geometric means of 3-PBA in all children were 1.85 μg/L and 1.46 μg/g creatinine. Children with the top 10% urinary levels of 3-PBA were more likely to be girls, under nine years of age, living in a rural area, and living in a residential type apartment. Conclusions South Korean children have a higher concentration of urinary 3-PBA compared with those of other countries. Further research identifying exposure pathways and intervention efforts to reduce environmental pesticide use are needed in South Korea.

Objectives: This survey was designed to conduct the first nationwide dietary exposure assessment on hazardous substances including the intakes of functional food and herbal medicine. In this paper, we introduced the survey design and the results of the dietary exposure status and internal exposure levels of lead (Pb), cadmium (Cd), and mercury (Hg). Methods: We selected 4867 subjects of all ages throughout Korea. We conducted a food survey, dietary survey, biomonitoring, and health survey. Results: Pb and Cd were the highest (median value) in the seaweed (94.2 μg/kg for Pb; 594 μg/kg for Cd), and Hg was the highest in the fish (46.4 μg/kg). The dietary exposure level (median value) of Pb was 0.14 μg/kg body weight (bw)/d, 0.18 μg/kg bw/d for Cd, and 0.07 μg/kg bw/d for Hg. Those with a blood Pb level of less than 5.00 μg/dL (US Centers for Disease Control and Prevention, reference value for those 1 to 5 years of age) were 99.0% of all the subjects. Those with a blood Cd level with less than 0.30 μg/L (German Federal Environmental Agency, reference value for non-smoking children) were 24.5%. For those with a blood Hg level with less than 5.00 μg/L (human biomonitoring I, references value for children and adults, German Federal Environmental Agency) was 81.0 % of all the subjects. Conclusions: The main dietary exposure of heavy metals occurs through food consumed in a large quantity and high frequency. The blood Hg level and dietary exposure level of Hg were both higher than those in the European Union.

Objectives We aimed to assess the radiation exposure for epidemiologic investigation in residents exposed to radiation from roads that were accidentally found to be contaminated with radioactive cesium-137 (137Cs) in Seoul. Methods Using information regarding the frequency and duration of passing via the 137Cs contaminated roads or residing/working near the roads from the questionnaires that were obtained from 8875 residents and the measured radiation doses reported by the Nuclear Safety and Security Commission, we calculated the total cumulative dose of radiation exposure for each person. Results Sixty-three percent of the residents who responded to the questionnaire were considered as ever-exposed and 1% of them had a total cumulative dose of more than 10 mSv. The mean (minimum, maximum) duration of radiation exposure was 4.75 years (0.08, 11.98) and the geometric mean (minimum, maximum) of the total cumulative dose was 0.049 mSv (

Objectives Hospitalized patients are vulnerable to sleep disturbances because of environmental stresses including noise. While most previous studies on hospital noise and sleep have been performed for medical machines in intensive care units, there is a limited data for patients hospitalized in medical wardrooms. The purpose of present study was to measure noise level of medical wardrooms, identify patient-perceived sources of noise, and to examine the association between noise levels and sleep disturbances in hospitalized patients. Methods Noise dosimeters were used to measure noise level in 29 inpatient wardrooms at a university hospital. Sleep pattern and disturbance were assessed in 103 hospitalized patients, using the Pittsburgh Sleep Quality Index (PSQI) and Leeds Sleep Evaluation Questionnaire. Results The mean equivalent continuous noise level for 24 hours was 63.5 decibel A (dBA), which was far higher than 30 dBA recommended by the World Health Organization for hospital wardrooms. Other patients sharing a room were perceived as the most common source of noise by the patients, which was usually preventable. Of the patients in the study, 86% had bad sleep as assessed by the PSQI. The sleep disturbance was significantly correlated with increasing noise levels in a dose response manner. Conclusions Systemic organizational interventions are needed to keep wardrooms private and quiet to reduce sleep disturbance.

BACKGROUND: Concerns have developed for the possible negative health effects of radiofrequency electromagnetic field (RF-EMF) exposure to children's brains. The purpose of this longitudinal study was to investigate the association between mobile phone use and symptoms of Attention Deficit Hyperactivity Disorder (ADHD) considering the modifying effect of lead exposure. METHODS: A total of 2,422 children at 27 elementary schools in 10 Korean cities were examined and followed up 2 years later. Parents or guardians were administered a questionnaire including the Korean version of the ADHD rating scale and questions about mobile phone use, as well as socio-demographic factors. The ADHD symptom risk for mobile phone use was estimated at two time points using logistic regression and combined over 2 years using the generalized estimating equation model with repeatedly measured variables of mobile phone use, blood lead, and ADHD symptoms, adjusted for covariates. RESULTS: The ADHD symptom risk associated with mobile phone use for voice calls but the association was limited to children exposed to relatively high lead. CONCLUSIONS: The results suggest that simultaneous exposure to lead and RF from mobile phone use was associated with increased ADHD symptom risk, although possible reverse causality could not be ruled out.

Abstract Objective To assess adolescent and young adult males’ perceptions regarding gender equity in La Romana, Dominican Republic. Methods We used the Gender Equitable Men (GEM) scale among males aged 15–24, who reported level of agreement with gender equity attitudes, establishing 0.01–0.5 = “low gender equitable”, 0.51–0.79 = “medium gender equitable” and 0.8–1 = “high gender equitable”. We established p

Objectives: Fatigue leads to an increase in joint restoration errors because of nervous system fatigue and a lack of understanding of joint position and imbalance that may be due to the changes in walking patterns and excessive pressure on bones and soft tissue structures, which may ultimately lead to injuries in climbers. Accordingly, this study investigates the effect of fatigue on the restoration error of the knee and ankle joint angles. Methods: This was a quasi-experimental study. A total of 35 mountaineers aged 20-35 years were selected by the non-random sampling method. This research was conducted on September 10, 2022, at the Tochal Climbing Rout in Velenjak, Tehran City, Iran. The tests were taken before and after a mountaineering program for a distance of 8 km at an average speed. The position sense of knee and ankle joints was evaluated using the Mobimed, which is a type of electrogoniometer. The normal distribution of the data was statistically analyzed using the Shapiro-Wilk test, and the data were analyzed using the paired t-test. The SPSS software, version 24, was used for all statistical operations (P≤0.05). Results: The findings showed that fatigue causes errors and significant changes in the restoration of knee and ankle joint angles and 30° (P=0.003), 45° (P=0.004), 60° (P=0.007), dorsiflexion of 10° (P=0.009) and plantar flexion of 20° (P=0.001), the restoration and sense of position is disturbed, which shows that fatigue is effective in understanding the state of the joints. Discussion: Fatigue increases the error of restoration of the knee and ankle joint angles, which can reduce the optimal performance of the muscles around the joints by reducing the person’s understanding of the angles and the sense of the joint position.

Abstract Background The objective of this study was to evaluate the safety, tolerability, pharmacokinetics, and pharmacodynamics of PF‑06835375, a potent selective afucosyl immunoglobulin G1 antibody targeting C-X-C chemokine receptor type 5 (CXCR5) that potentially depletes B cells, follicular T helper (Tfh) cells, and circulating Tfh-like (cTfh) cells, in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Methods This first-in-human, multicenter, double-blind, sponsor-open, placebo-controlled Phase 1 study recruited patients aged 18–70 years with SLE or RA. In Part A, patients received single doses of intravenous PF-06835375 (dose range: 0.03–6 mg) or placebo in six sequential single ascending dose (SAD) cohorts. In Part B, patients received repeat doses of subcutaneous PF-06835375 (dose range: 0.3–10 mg) or placebo on Days 1 and 29 in five multiple ascending dose (MAD) cohorts. Tetanus/Diphtheria (Td) and Meningococcal B (MenB/Trumenba™) vaccines were administered at Day 4 (Td and MenB) and Week 8 (MenB only) to assess PF-06835375 functional effects. Endpoints included treatment-emergent adverse events (TEAEs), pharmacokinetic parameters, pharmacodynamic effects on B and cTfh cells, and biomarker counts, vaccine response, and exploratory differential gene expression analysis. Safety, pharmacokinetic, and pharmacodynamic endpoints are summarized descriptively. The change from baseline of B and Tfh cell-specific genes over time was calculated using a prespecified mixed-effects model, with a false discovery rate

Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), also known as APO2L, has emerged as a highly potential anticancer agent because of its capacity to effectively trigger apoptosis in tumor cells by specifically binding to either of its death receptors (DR4 or DR5) while having no adverse effects on normal cells. Nevertheless, its practical use has been hindered by its inefficient pharmacokinetics characteristics, the challenges involved in its administration and delivery to targeted cells, and the resistance exhibited by most cancer cells towards TRAIL. Gene therapy, as a promising approach would be able to potentially circumvent TRAIL-based cancer therapy challenges mainly through localized TRAIL expression and generating a bystander impact. Among different strategies, using nanoparticles in TRAIL gene delivery allows for precise targeting, and overcoming TRAIL resistance by combination therapy. In this review, we go over potential mechanisms by which cancer cells achieve resistance to TRAIL and provide an overview of different carriers for delivering of the TRAIL gene to resistant cancer cells, focusing on different types of nanoparticles utilized in this context. We will also explore the challenges, and investigate future perspectives of this nanomedicine approach for cancer therapy.