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From 2002 through 2015, hundreds of people died of fatal lung injuries associated with the use of humidifier disinfectants (HDs) in Korea. Several chemical disinfectants used for household humidifiers were later clinically confirmed to cause HD-associated lung injury (HDLI). The aim of this study is to evaluate the registered lung disease cases and to compare the distribution of HDLI patients, including deaths, by HD use characteristics including types of HD and HD brands categorized by age group. A total of 530 registered were clinically examined through two rounds of investigations conducted from July 2013 until April 2015. Information on HD use was obtained from a structured questionnaire and home investigations. Approximately one-half of the patients (n=221) were clinically confirmed to be associated with the use of HDs. Pregnant women (n=35, 16%) and pre-school children≤6years old (n=128, 58%) accounted for most of the HD-associated lung injury patients (n=163, 74%). Sixty-seven percent of HDLI patients developed HDLI after less than one year of HD use. HD products containing polyhexamethylene guanidine phosphate (PHMG) were the most frequently used among confirmed HDLI patients (n=123, 55.7%), followed by oligo (2-(2-ethoxy) ethoxyethyl guanidinium (PGH) (n=24, 10.9%) and a mixture of chloromethylisothiazolinone (CMIT) and methylisothiazolinone (MIT) (n=3, 1.4%). Other HDs did not appear to be linked to HDLI. The majority of the HDLI patients (n=85, 38.5%) was found to use only Oxy Saksak® products containing PHMG. The development of HDLI was clinically found to be associated with the use of several HD products containing PHMG and PGH, and to lesser extent, CMIT/MIT.

Humidifier disinfectant lung injury is an acute lung disease attributed to recurrent inhalation of certain disinfectant aerosols emitted from room humidifiers. An outbreak of this toxic lung injury occurred in South Korea from 1995 until all humidifier disinfectant products were recalled from the consumer market by the government in 2011.A nationwide study was conducted to ascertain and classify all potential cases of humidifier disinfectant lung injury in Korea and to assess dose-response relationships.By several mechanisms, clinicians and the general public were invited to report all suspected cases of humidifier disinfectant lung injury to public health officials in South Korea. A committee was convened to define diagnostic criteria based on pathologic, radiologic, and clinical findings for index cases, combined with assessment of environmental exposure to humidifier disinfectants. Clinical review and environmental assessments were performed and later combined to determine overall likelihood of disease for each study participant, classified as definite, probable, possible, or unlikely. Survival time from exposure to onset of symptoms was analyzed to assess dose-response relationships. Three broad categories of risk factors were examined: (1) biological susceptibility, (2) temporal cycle of exposure and recovery, and (3) spatial conditions and density of disinfectant.Of 374 possible cases identified and reviewed, 329 were unanimously classified by the diagnostic committee, as follows: 117 definite, 34 probable, 38 possible and 140 unlikely cases. A total of 62 individuals with definite or probable disease died. Risk factors examined for polyhexamethyleneguanidine phosphate exposure that were found to be significant in shortening survival included age 4 years or younger at onset, use of disinfectant for 7 days per week, airborne density of 800 μg/m(3) or more of disinfectant, and daily exposure 11 or more hours in duration.Dose-response analysis indicated that development of humidifier disinfectant lung injury and death were associated strongly with recurrent, intense, acute exposure without sufficient recovery time between exposures, more so than long-term cumulative exposure. These findings may explain some reversible or clinically unapparent cases among coexposed family members.

In 2009, asbestos was finally banned in Korea, about 70 years after the first opening of asbestos mines under Japanese control. After having presented the history of asbestos industry, together with its regulations and health effects over time, we constructed narrative analyses of how the asbestos issue under the prevailing risk system was managed by whom and for what purpose, to provide context for the change. We could identify five different phases: laissez-faire, politico-technical, economic–managerial, health-oriented cultural, and human rights-based post-cultural risk systems. The changes leading to the asbestos ban evolved over different phases, and each phase change was necessary to reach the final ban, in that, without resolving the previous issues by examining different categories of potential alternatives, either the final ban was not possible or, even if instituted, could not be sustained. An asbestos ban could be introduced when all the alternatives to these issues, including legitimate political windows, economic rationalizations, health risk protections, and human rights sensitivities, were available. We think the alternatives that we had were not in perfect shape, but in more or less loosely connected forms, and hence we had to know how to build solidarities between different stakeholders to compensate for the imperfections.

Department of Environmental Health, Korea National Open University*Citizen's Center for Environment and Health**Department of Occupational and Environment Health, School of Public Health, Seoul National UniversityABSTRACTBackground: In Korea, a healthy 36-year-old man developed acute interstitial pneumonitis soon after inhalinga waterproofing spray which he had applied at home to his outdoor jacket. Objectives: The objectives of this study were to review cases of varying degrees of respiratory toxicity andpoisoning in connection with the use of waterproofing spray and summarize major reasons for cases ofpoisoning. Methods: We searched articles reporting on a combination of a waterproofing agent and/or respiratorysymptoms, including acute respiratory syndrome, lung injury, pneumonia, pulmonary toxicity, and respiratorydisease. Results: We reviewed a number of cases of varying degrees of respiratory toxicity and poisoning resulting frominhalation of waterproofing spray containing fluorocarbon co-polymer, solvents and propellants reported in avariety of countries. The literature searches concluded that among the ingredients of waterproofing agents,fluorinated polymer may cause acute respiratory health effects.Conclusion: Environmental policy should be implemented in order to prevent consumers from using householdand industrial products including waterproofing agents. In addition, a national surveillance system should becreated to collect cases of poisoning caused by the use of consumer productsKeywords: waterproofing spray, interstitial pneumonitis, fluorocarbon polymer

Exactly 25 years after the Chernobyl nuclear disaster, 11th of March 2011 the Fukushima nuclear accident occurred in Japan and was ranked at level 7 same to the Chernobyl. A Korean and Japanese joint civil survey was conducted around Fukushima on April 13-17. The radiation survey data clearly shows a large hotspot area between 20 km and 50 km radius north and west direction from the accident reactors, with the highest radiation recorded being 55.64 in the air, 99.89 in the surface air, and 36.16 in a car, respectively. 3.65 in the air and 6.89 in the surface air were detected at the playground of an elementary school in Fukushima City. Spring came with full cherry blossoms in Fukushima, but it was silent spring of radiation contamination. Interviews with Fukushima nuclear refugees reveal serious problems about Japanese nuclear safety systems, such as there was no practical evacuation drill within 1-10 km and no plan at all for 10-30 km areas. Several reforms items for Korean nuclear safety system can be suggested: minimization of accident damage, clear separation of regulatory and safety bureaus with a new and independent administrating agency, community participation and agreement regarding the safety system and levels, which is the major concern of 80% Korean. To tackle threats of nuclear disaster in neighboring nations like China, a new position entitled `Ambassador for nuclear safety diplomacy` is highly necessary. The nuclear safety of Korea should no longer be the monopoly of those nuclear engineers and limited technocrats criticized as a `nuclear mafia`.

Although workplace asbestos concentrations (AC) have been reported several times, the past environmental AC are relatively poorly studied. Due to the harmful effects of the asbestos industry, production has moved from early industrialized countries (Japan), to late industrialized countries (Korea), and finally to industrializing countries (Indonesia). The purpose of this study was to determine current occupational exposure levels and evaluate neighborhood environmental exposure levels in an Indonesian asbestos textile factory through collaboration among three generation of industrialized countries. Asbestos concentrations were measured inside and outside of the factory and compared with simulated data. ACs in the factory were similar to those of 1980s and 1990s levels in the Korean factory that transferred the machines. Environmental ACs were dispersed according to wind direction. There were no significant differences between monitored and simulated data, and correlation coefficients between downwind, upwind, and middle wind directions were high, with some statistical significance. This study can be used to estimate past environmental ACs to understand the causality of asbestos related diseases. Because of the small sample size and specific weather conditions, a large-scale study of various asbestos exposure sources, including asbestos cement factories, shipyards, and mines, and various atmospheric conditions is required.

We report on genetic identification of ‘whale meat’ purchased in sushi restaurants in Los Angeles, CA (USA) in October 2009 and in Seoul, South Korea in June and September 2009. Phylogenetic analyses of mtDNA cytochrome b sequences confirmed that the products included three species of whale currently killed in the controversial scientific whaling programme of Japan, but which are protected from international trade: the fin, sei and Antarctic minke. The DNA profile of the fin whale sold in Seoul established a match to products purchased previously in Japan in September 2007, confirming unauthorized trade between these two countries. Following species identification, these products were handed over to the appropriate national or local authorities for further investigation. The illegal trade of products from protected species of whales, presumably taken under a national permit for scientific research, is a timely reminder of the need for independent, transparent and robust monitoring of any future whaling.

Once released into the air, humidifier disinfectants became tiny nano-size particles, and resulted in chemical bronchoalveolitis. Families had lost their most beloved members, and even some of them became broken. Based on an estimate of two million potential victims who had experienced adverse effects from the use of humidifier disinfectants, we can say that what we have observed was only the tip of the iceberg. Problems of entire airways, as well as other systemic effects, should be examined, as we know these nano-size particles can irritate cell membranes and migrate into systemic circulation. The story of humidifier disinfectant is not finished yet.

Background In South Korea, a cluster of acute lung disease patients included lung injury disease suspected of being caused by the use of humidifier disinfectants. We examined the relationship between humidifier disinfectant exposure and clinically diagnosed humidifier disinfectant-associated lung injury (HDLI) in a family-based study. Methods This case-control study included 169 clinically confirmed HDLI cases and 303 family controls who lived with the HDLI patients. A range of information on exposure to humidifier disinfectants was obtained using a structured questionnaire and field investigations. Odds ratios (ORs) and confidence intervals (CIs) were estimated using unconditional logistic regression models that were adjusted for age, sex, presence of a factory within 1 km of residence, and the number of household chemical products used. Results HDLI risk increased approximately two-fold or more among the highest quartile compared with the lowest quartile in terms of the hours sleeping in a room with an operating humidifier treated with disinfectant (adjusted OR = 2.0, 95 % CI = 1.1-3.7), average hours of disinfectant-treated humidifier use per day (adjusted OR = 2.1, 95 % CI = 1.0-4.5), airborne disinfectant intensity (adjusted OR = 2.6, 95% CI = 1.2-5.3), and cumulative disinfectant inhalation level (adjusted OR = 2.0, 95% CI = 1.0-4.1). HDLI risk increased as the distance of the bed from humidifier gets shorter; compared with longer distance (> 1 m), the odds ratio was 2.7 for 0.5 to 1 m (95 % CI = 1.5-5.1) and 13.2 for

Objectives As public concern on possible harmful effects of mobile phone in children has been raised, information of epidemiological characteristics of mobile phone use in children and adolescents will be essential for public health policy. Methods Using three databases (n=21,693) collected from 2008 to 2011, we examined characteristics of mobile phone ownership and use, and socioeconomic positions (SEP) in Korean children and adolescents. Results The ownership rate and the amount of mobile phone use were higher in females than males, in higher school grades than lower grades, and at 2011 than 2008. The average age of first mobile phone ownership was shown to decrease from 12.5 years in currently high school students to 8.4 years in currently elementary school students at 2011. More than 90% of children in the 5th grade owned a mobile phone. More children owned a mobile phone in lower SEP communities than in higher SEP. Children with parents educated less than those with parents educated more were more likely to own and use mobile phone. Conclusions Considering the epidemiological characteristics of mobile phone use, precautionary measures to prevent unnecessary exposure to mobile phones are needed in children and adolescents.

Out of 143 countries that consumed asbestos between 2003 and 2007, only 44 have banned asbestos. This study tried to explain why some countries have banned asbestos while others have not, based on a synthesis that asbestos ban policy of a country will rely on a process of cognition of threats and exploration of safer alternatives.As we hypothesized that increased social cost of mesothelioma, capacity of health-related infrastructures, and policy diffusion from adjacent countries were related to asbestos ban adoption, published databases of asbestos ban years, mesothelioma mortality, country rankings in health care and human rights standings, and distribution of banning countries over 14 regions were analyzed accordingly.The average mesothelioma death rate was significantly higher for countries with asbestos bans than in those with no ban (4·59 versus 1·83/million). No-ban countries had less well-developed health-related infrastructures. Among European countries, there was a tendency toward geographical diffusion of asbestos ban policy from Nordic to Western and then other European countries over the years. Even though aberrant cases were also noted where bans were instituted even without mesothelioma database, these were rather exceptions than rules.Risk cognition is a complex process, but the presence of well-functioning health infrastructures, as well as the increased social cost of mesothelioma, that can make the plight of asbestos victims visible to the eyes of public and policy makers, may have contributed to this process. Asbestos ban policy from adjacent countries might have facilitated the adoption of alternative solutions.

Background In a study of asbestos industry transfers in Asia, we examined the transfer of health and safety measures at the time of industry transfer and resulting health outcomes thereafter. Methods Field surveys were conducted in Japan, Germany, Indonesia, and South Korea over a 5 year period beginning in 2007. The surveys involved interviews and field assessments of health and safety conditions. Results Even when there were transfers of entire engineering plant processes, we observed that the health and safety measures that should have accompanied the transfer, including technical capacities of risk assessment and management, regulatory protection, and cultural practices, were not actually transferred. According to work environment assessment records, there were differences in airborne asbestos levels of approximately 5–6 fibers/cc between the exporting and importing sides of the transfer. This amounted to a 10 years of time delay in comparable health and safety conditions. These differences resulted in repeated adverse health consequences at each factory operation site. Conclusions Dangerous transfers of asbestos industry technology have occurred repeatedly over the years with the result that Asia has become the largest consumer of asbestos in the world. No effective internationally accepted safety measures have been introduced in the region. The study results support the need for both improved public awareness and international cooperation, such as sharing of substitute material technologies by the exporting countries, and provide the rationale for the creation of an Asian fund for asbestos victims. Am. J. Ind. Med. 56:335–346, 2013. © 2012 Wiley Periodicals, Inc.

The Hebei Spirit oil spill occurred in December 2007 approximately 10 km off the coast of Taean, South Korea, on the Yellow Sea. However, the exposure and potential effects remain largely unknown. A total of 50 surface and subsurface sediment samples were collected from 22 sampling locations at the spill site in order to determine the concentration, distribution, composition of residual crudes, and to evaluate the potential ecological risk after two years of oil exposure. Samples were extracted and analyzed for 16 polycyclic aromatic hydrocarbons (PAHs), 20 alkyl-PAHs, 15 aliphatic hydro- carbons, and total petroleum hydrocarbons using GC-MSD. AhR-mediated activity associated with organic sediment extracts was screened using the H4IIE-luc cell bioassay. The response of the benthic invertebrate community was assessed by mapping the macrobenthic fauna. Elevated concentrations of residual crudes from the oil spill were primarily found in muddy bottoms, particularly in subsurface layers. In general, the bioassay results were consistent with the chemistry data in a dose-dependent manner, although the mass-balance was incomplete. More weathered samples containing greater fractions of alkylated PAHs exhibited greater AhR activity, due to the occurrence of recalcitrant AhR agonists present in residual oils. The macrobenthic population distribution exhibits signs of species-specific tolerances and/or recolonization of certain species such as Batillaria during weathering periods. Although the Hebei Spirit oil spill was a severe oil exposure, it appears the site is recovering two years later.

The Hebei Spirit oil spill episode (December 7, 2007) has affected the western coastal area of South Korea; however, there is limited information on the potential toxicity of the oil spill to the ecosystem or humans. The potential toxicity of sediments collected from the affected area (n = 22) 2 years after the spill was evaluated. Acute lethal toxicity tests using Vibrio fischeri and Moina macrocopa and tests for genotoxicity and alteration of steroidogenesis using chicken DT40 cells and H295R cells, respectively, were conducted. Both crude and weathered oil extracts were evaluated in order to link the observed toxicity in the sediment extracts to the oil spill. Whereas toxicity to bacteria and daphnids was observed in only two elutriate samples, 10 of the 22 sediment extracts showed genotoxic potential in DT40 cells. The mechanisms of genotoxicity involved nucleotide excision repair (XPA(-/)), homologous recombination (RAD54(-/-)), and translesion synthesis pathways (REV3(-/-)). In addition, nine sediment extracts caused significantly greater production of E2 in H295R cells, and significant up-regulation of CYP19, CYP11B2, and 3βHSD2 by sediment extracts was observed. The pattern of toxicities observed in both crude and weathered oil samples was similar to that observed in the sediment extracts. The genotoxicicity and endocrine-disruption potential of the sediment extracts suggest a need for long-term followup for such toxicity in humans and wildlife in this area.

Objectives This study was conducted to examine the relationship between crude oil exposure and physical symptoms among residents participating in clean-up work associated with the Hebei Spirit oil spill, 2007 in Korea. Methods A total of 288 residents responded to a questionnaire regarding subjective physical symptoms, sociodemographic characteristics and clean-up activities that occurred between two and eight weeks after the accident. Additionally, the urine of 154 of the respondents was analyzed for metabolites of volatile organic compounds (VOCs) and polycyclic aromatic hydrocarbons (PAHs) and heavy metals. To compare the urinary levels of exposure biomarkers, the urine of 39 inland residents who were not directly exposed to the oil spill were analyzed. Results Residents exposed to oil remnants through clean-up work showed associations between physical symptoms and the exposure levels defined in various ways, including days of work, degree of skin contamination, and levels of some urinary exposure biomarkers of VOCs, metabolites and metals, although no major abnormalities in urinary exposure biomarkers were observed. Conclusions This study provides evidence of a relationship between crude oil exposure and acute human health effects and suggests the need for follow-up to evaluate the exposure status and long-term health effects of clean-up participants.

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

Objectives To assess the protective effects of wearing protective devices among the residents and volunteers who participated in the cleanup of the Hebei Spirit oil spill. Methods A total of 288 residents and 724 volunteers were surveyed about symptoms, whether they were wearing protective devices and potential confounding variables. The questionnaires were administered from the second to the sixth week following the accident. Spot urine samples were collected and analyzed for metabolites of 4 volatile organic compounds (VOCs), 2 polycyclic aromatic hydrocarbons (PAHs), and 6 heavy metals. The association between the wearing of protective devices and various symptoms was assessed using a multiple logistic regression adjusted for confounding variables. A multiple generalized linear regression model adjusted for the covariates was used to test for a difference in least-square mean concentration of urinary biomarkers between residents who wore protective devices and those who did not. Results Thirty nine to 98% of the residents and 62-98% of volunteers wore protective devices. Levels of fatigue and fever were higher among residents not wearing masks than among those who did wear masks (odds ratio 4.5; 95% confidence interval 1.23-19.86). Urinary mercury levels were found to be significantly higher among residents not wearing work clothes or boots (p Conclusions Because the survey was not performed during the initial high-exposure period, no significant difference was found in metabolite levels between people who wore protective devices and those who did not, except for mercury, whose biological half-life is more than 6 weeks.

Objectives : Our objective was to examine and evaluate the psychological health of the residents of Taean during the cleanup of the Hebei Spirit (HS) oil spill and to review some factors associated with the results. Methods : A community survey of 71 men and women was conducted 8 weeks after the HS oil spill. Question- naires used were the PWI (Psychological Well-being Index) scale for psychosocial distress, the CES-D (Center for Epidemiologic Studies-Depression) scale for depressive symptoms, and a questionnaire created to assess suicidal impulses. Results : The overall prevalence of high-risk psycho- social distress among the study group was 64.2%. The percentages of respondents with scores on the CES-D Scale above 16 and above 21 were 77.6% and 62.7%, respectively. The percentage of respondents categorized as having suicidal impulses was 18.3%. When compared with unexposed groups in the general population taken from various sources, the residents of Taean were 6.5 times as likely to have high stress and 9.4-9.7 times as likely to be depressed. No significant difference in the rate of suicidal impulse was found between the residents of Taean and the general population. Factors associated with high stress, depression, and suicidal impulses were age, a change in income, educational level, number of days working on the cleanup, and positive responses to questions about affected daily activity and hospital visit due to work on cleanup. Conclusions : The results suggest that the HS oil spill had a significant impact on the psychological health of residents of Taean, but the comparability of the unexposed groups is a limitation of the study.

Background This study describes 17 families with 38 lung injury patients (14 males, 24 females; 22 preschool-age children less than six years of age and 16 individuals of 13–50 years) who used disinfectant added to humidifiers in the home. Methods Clinical examination and humidifier disinfectant-use histories were taken, and a thorough home investigation was performed to assess exposure to humidifier disinfectant. Results Nine of the patients (three pregnant females, six preschool-age children) died soon after they first developed lung damage. Six (16%) were pregnant females and 22 (58%) were preschool-aged children younger than six years. The patients used humidifier disinfectant products containing either polyhexamethylene guanidine phosphate (PHMG, n = 36) or oligo(2-(2-ethoxy)ethoxyethyl guanidinium chloride (PGH, n = 2). Twenty-six patients (68%) used the brand "Oxy"®, which contains PHMG. Of the ten patients with fatal lung injury, nine were found to have used PHMG. Conclusions Our findings suggest that the use of humidifier disinfectant products containing either PGH or PHMG can cause lung injury, especially in preschool-age children younger than six years and pregnant women.