Earticle

지구온난화는 과거와 다른 자연재해 및 환경에 변화를 줌으로써 지구상에 막대한 피해를 주고 있다. 이와 같이 인간의 건강을 위협하는 여러 요인중에 호흡기 질환을 일으키는 것으로는 스모그가 대표적인 사례이며, 최근 의 뉴스를 살펴보면, 극심한 유해 스모그로 인해 많은 사람이 호흡기 질환으로 입원한다는 보고가 있다. 본 연구는 SARIMA 모델을 사용하여 풍속 및 풍향을 예측하고, 예측된 값과 과거 평균값을 비교하여 이상기후를 감지하는 시스템을 제안한다. 이를 위해 G 지역의 10년간의 풍향, 풍속 데이터를 수집하였고, 예측된 값이 과거와 크게 달 라질 경우, 해당 지역 주민들에게 SNS 또는 긴급재난문자를 통해 경고를 발송하여 인명 피해를 줄이고 대응할 수 있는데 활용할 수 있다.

Global warming is causing enormous damage to the Earth by causing natural disasters and environmental changes that are different from the past. Among the various factors that threaten human health, smog is a representative example of respiratory disease, and recent news reports show that many people are hospitalized with respiratory diseases due to extreme harmful smog. This study proposes a system that uses the SARIMA(Seasonal ARIMA) model to predict wind speed and direction and detects abnormal weather by comparing the predicted values with past averages. To this end, we collected wind direction and wind speed data for the past 10 years in Region G, and if the predicted values differ significantly from the past, we can use this to reduce casualties and respond by sending warnings to local residents via SNS or emergency disaster text messages.

본 연구에서는 지난 10년간 우리나라 각 지역별 기후변화 인자(온도, 습도, 강수량)와 미세먼지의 농도를 관찰하고 기후변화 관련 질병의 보 건경영적 손실가치를 분석하였다. 즉, 각 지역별 기후변화 인자 및 미세먼지의 발생 농도와 기후변화 원인 질병(호흡기 질환, 만성폐쇄성 질환, 간질성 폐질환 등)의 환자 수, 의료비 등을 추적하였으며, 기후변화 인자와 환자 수 및 의료비의 인과관계를 계량적 기법으로 추정하였다. 분석 결과, 첫째로 기후요소가 호흡기 질환 환자 수에 미치는 영향에 대한 분석은 고정효과모형의 추정결과를 기반으로 하는 경우 전국의 평균기온이 상승할수록 기후변화 관련 질환 환자 수도 증가하는 경향이 있다. 또한 일교차가 클수록, 미세먼지와 초미세먼지 농도가 상승할수 록 관련 질환 환자 수가 증가한다. 두 번째로 패널 VAR 모형의 충격반응 함수를 이용하여 추정한 결과 평균 기온 1도 상승에 따라 1년간 환자 수가 1.71%, 의료비용은 1.365% 증가한다. 이 결과 2018년 1년간 의료비용(85,187억원)에 적용하는 경우 의료비용 증가폭은 최대 1,163억원에 달한다.

This study observed climate change factors (temperature, humidity, precipitation) and fine dust concentrations in each region of Korea over the past 10 years, and analyzed the healthmanagement loss value of climate change diseases. As a result of the analysis, first, the analysis of the effect of climate factors on the number of respiratory disease patients tends to increase the number of patients with climate change diseases as the average temperature increases, based on the estimation results of the fixed-effect model. Second, as a result of estimation using the impulse-response function of the panel VAR model, the number of patients increases by 1.71% and medical expenses by 1.365% per year as the average temperature rises by 1 ℃. As a result, when applied to medical expenses (85,187 billion Kwon) for one year in 2018, the increase inmedical damage cost reaches amaximumof 116.3 billion Kwon. This study introduced a new technique to analyze the causal relationship between climate change factors and the loss costs of climate change disease.

Background: Respiratory troubles have economic impacts in countries where livestock industry is an important segment of the agricultural sector, as well as these problems may cause significant economic losses for bovine producers. Various practical methods are used to assess diseases that affect the bovine respiratory system. Ultrasonography is a noninvasive tool that has been used frequently in diagnosis of various animal diseases. The present study was designed to establish whether thoracic ultrasonography is a diagnostic tool for detection of respiratory troubles in weaned buffalo and cattle calves, as well as to assess its prognostic value in comparison with clinical respiratory scores. Thirty five (15 buffalo and 20 cattle) calves were included. Twelve (6 buffalo and 6 cattle) clinically healthy calves were enrolled as controls. Results: Based on physical examinations, clinical respiratory scores (CRS), ultrasound lung scores (ULS) and postmortem findings, animals were classified into 4 groups as pulmonary emphysema (n = 8), interstitial pulmonary syndrome (n = 7), bronchopneumonia (n = 12), and pleurisy (n = 8). The mean values of CRS and ULS were significantly higher in diseased calves (P < 0.01). In calves with pulmonary emphysema and interstitial syndrome, thoracic ultrasonography revealed numerous comet-tail artifacts, which varied in numbers and imaging features. Furthermore, variable degrees of pulmonary consolidation with alveolograms and bronchograms were noticed in bronchopneumonic calves. In addition, thick irregular or fragmented pleura with pleural effusions and fibrin shreds were imaged in calves with pleurisy. A weak correlation was calculated between CRS and ULS (r = 0.55, P < 0.01). Hematologically, the counts of white blood cells, activities of aspartate aminotransferase and partial tensions of carbon dioxide were significantly increased in all diseased groups. Serum concentrations of total globulins were higher in claves with bronchopneumonia (P < 0.05). The partial tension of oxygen was decreased in all diseased calves (P < 0.05). Conclusions: Thoracic ultrasonography is a diagnostic tool for various lung troubles and assessment the grade and severity of pulmonary diseases, as well as it can be used as a follow-up tool for evaluating the prognosis of respiratory troubles and monitoring the efficacy of therapies.

본 연구는 호흡기 질환 환자의 성격 유형에 따른 수면 장애와 관련된 요인을 확인하고자 하였다. 본 연구에 서 성격 유형은 MBTI, 수면 장애는 PSQI 도구를 사용하였다. 전체 대상자 중 수면 장애가 있는 환자는 151명, 수 면 장애가 없는 환자는 30명이었다. 다변량 분석 결과 호흡 운동(OR=0.245, p=.008)과 성격유형에서 S-N의 선호경 향(OR=19.153, p=.034)이 수면 장애와 유의한 관련이 있는 것으로 나타났다. 호흡 운동은 개인적 요인 중 수면 장애 와 가장 관련성이 높은 요인이었고, 수면의 질이 좋지 않은 그룹에서는 기질의 하위 그룹별로 수면의 질에 차이가 있었다. 특히 인식기능의 S-N 선호 경향은 수면 장애의 관련 요인에 영향을 미쳤다. 그러므로 수면 장애를 예방하 거나 개별화된 치료 전략을 수립하기 위해서는 기질이나 개인의 선호도를 이해하는 것은 도움이 될 수 있다.

This study investigated the relevant factors associated with sleep disturbance according to personality types in patients with respiratory disease. We used a Korean standardized questionnaire adapted from the Myers–Briggs Type Indicator and the Korean version of the Pittsburgh Sleep Quality Index. Of the total eligible, 151 patients had sleep disturbances, and 30 had no sleep problems. Multivariate analysis showed that breathing exercises (OR=0.245, p=.008) and S-N of preference (OR=19.153, p=.034) were significantly associated with sleep disturbance. Breathing exercises were the most relevant factor for sleep disturbance in plausible factors. There were differences in sleep quality for each temperament subgroup in the poor sleep quality group. Notably, the SN personality preference impacted the relevant factors of sleep disturbance.

본 연구의 목적은 중소병원 간호사를 대상으로 급성 호흡기 감염병 관련 개인보호장비에 대한 지식, 태도 및 착탈 수행도의 상관관계를 파악하기 위함이다. 2021년 08월 10일부터 9월 07일까지 B광역시 에 소재한 300병상 미만의 4개 중소병원 간호사 159명을 대상으로 자료수집을 실시하였다. 수집된 자료는 SPSS 프로그램을 이용하여 분석하였다. 개인보호장비에 대한 지식, 태도, 착탈 수행도 평균 은 각각 14.13±2.23점, 3.98±0.56점, 4.30±0.56점이었다. 개인보호장비에 대한 태도와 착탈 수행도 (r=.27, p<.001)는 유의한 양의 상관관계를 보였으며, 지식은 태도(r=.13, p=.089), 착탈 수행도(r=.13, p=.091)와 유의한 상관관계가 없었다. 결론: 중소병원 간호사들의 개인보호장비에 대한 착탈 수행도 의 향상을 위해서는 1회성이 아닌 주기적인 교육과 상황별 모의 훈련이 수행되어야 할 것이다. 또한 급성 호흡기 감염과 관련된 원내 대응 지침의 지속적인 업데이트와 이를 공유하기 위한 전달 체계의 활성화가 이루어져야 할 것이다.

This study was conducted to investigate the correlation between knowledge, attitude, performance of donning and doffing of personal protective equipment related to acute respiratory infectious diseases for nurses working in small and medium-sized hospitals. The survey was conducted on 159 nurses working at four small and medium hospitals with less than 300 beds located in B city, from august 10, 2021 to september 7. The collected data were analyzed using the SPSS program. The averages of knowledge, attitude, and performance of donning and doffing of personal protective equipment were 14.13±2.22, 3.98±0.56, and 4.30±0.56, respectively. Attitude showed a significant positive correlation with the performance of donning and doffing(r=.27, p<.001), knowledge did not show a significant correlation with attitude(r=.13, p=.089) and performance of donning and doffing(r=.13, p=.091). As a result of this study, periodic education and simulated training for each situation should be conducted rather than once in order to improve the performance of donning and doffing of nurses in small and medium hospitals on personal protective equipment.

2015년 메르스 사태를 검토하면서 호흡기 바이러스 감염병의 국가대응 거버넌스 문제점과 개선방향을 제시하고자 한다. 먼저 거버넌스의 개념을 개관하고, 2015년 메르스 대처하는 과정의 문제점과 메르스 사태 이후 제시된 해결방안을 재조명해 보고자 한다. 2015년 메르스 발생시 문제점은 크게, 시민과 민간 병원의 소극적 참여, 실질적인 환류와 학습의 부족, 국내외 주체간의 의사소통과 이를 중재할 컨트롤 타워 부재, 정부의 정보 공유 제한과 그로 인한 근거없는 소문생성, 그리고 이에 대한 경제적 회복 문제가 있고 이들은 아직도 크게 개선되었다고 보기 어렵다. 본 연구에서는 이러한 문제점을 개선하기 위한 방향으로 국내외 공공기관, 시민과 민간 의료기관은 물론 언론 등 적극적으로 감염병 국가대응 관리거버넌스에 참여와, 실질적인 환류를 통한 학습, 국내외의 거버넌스 주체 및 기관간 의사소통과 정보 공유를 제시하였다. 또한 컨트롤 타워 확립 및 재난발생 지역과 그 외의 지역의 경제적 문제에 대한 대처방안을 해결하는 거버넌스가 지속적으로 보완 발전되어야 할 것을 제언한다.

The 2015 Korean Middle East Respiratory Syndrome (MERS) required the government to evaluate the readiness and preparedness of the existing national response system in preparation for the next outbreak of respiratory viral infectious disease. This study reexamines the current national response management governance strategies in Korea to evaluate if it can prevent and respond to a large-scale infectious diseases and suggests directions for future governance. After reviewing the definition of governance, this study revisits various issues and problems occurred during the government’s response to the 2015 MERS outbreak and proposes possible solutions for the national response governance in Korea to adopt to prevent the future outbreak.

Purpose: Effects of information on management practices for children suffering from respiratory communicable diseases and their parents were investigated. Methods: The experimental group consisted of 30 children who were in-patients suffering from a respiratory communicable disease and their parents. During their hospitalization, for 30 min each day, the children and their parents received education that included information about disease management including symptoms, prevention and environmental hygiene. The information was developed using illustrations and photoshop. The control group consisted of 30 children who were in-patients and their parents. They received the usual nursing care without any of the above education. The instruments used in this study were the bibliographies of respiratory disease management. 2 test, independent t-test, and Mann-Whitney U test with SPSS 11.5 were used to analyze the data. Results: Significant differences between the experimental and control groups were found for management of symptoms (Z=4.350, p<.001) and environmental hygiene (Z=4.033, p=.000), but not for prevention (Z=4.033, p=.149). Conclusion: The results indicate that providing information was effective for management practice of symptoms and environmental hygiene, but not for prevention management for the children and their parents. Therefore programs should be developed to promote prevention management.

Influenza virus is a major cause of respiratory infection in the epidemic season. Especially, the elderly with underlying health problems are at increased risk for complications of influenza. The objective of this study was to investigate that influenza vaccination can reduce the hospital admission rate related to the respiratory diseases. This study was a retrospective study of two age groups, who are the healthy children aged 6 months to 9 years (n=237) and the adults aged over 20 years with respiratory disease (n=327). The vaccinated groups were compared to the controls that were matched in sex and age. The children were vaccinated in winter season of 1995-96 and the adults were vaccinated in 1996-97. The efficacy of influenza vaccine was evaluated with the number of outpatient visits in children group, the admission rate and the mean admission days in both children and adult group. As results, there were not significant differences between the vaccinated and the control group of children. In the elderly over 61 years, however, the influenza vaccination can reduce the admission rate $(8.9\%\;vs.\;25.6\%,\;p<0.05)$ and the mean admission days (1.3 vs. 3.8 days, p<0.05) compared to the control. In conclusion, influenza vaccination can effectively reduce the events related to respiratory infection in the elderly than the children. The elderly should be recommended for influenza vaccination.

Objectives: This study analyzed the prescription characteristics of medication for acute respiratory diseases before and after pay-for-performance to provide basic data on effective medical quality management policies. Methods: The research data were collected from the 2013-2014 sample cohort of the National Health Insurance Corporation, from Internal Medicine, Pediatrics, Otorhinolaryngology, Family Medicine and General practitioner clinics (classification of disease codes: J00-J06, J20-J22, J40 outpatients). Results: The antibiotics prescription rates decreased from 43.9% in 2013 to 43.5% in 2014 when the major diagnosis was for upper respiratory infections and increased from 62.0% in 2013 to 62.5% in 2014 when the major diagnosis was for lower respiratory infections. Conclusions: There is a need to identify the correct antibiotic prescription method by expanding the current assessment standards. Such standards must include acute lower respiratory infections and minor diagnoses as the current evaluation techniques focus only on the major diagnosis of acute upper respiratory infections.

Purpose: The purpose of this study was to provide basic data for improving the response capacity of 119 EMS systems by analyzing the effects of particulate matter on cardio-cerebrovascular and respiratory symptoms in the pre-hospital stage. Methods: We examined 46,389 patients who transferred to the hospital with complaints of cardiopulmonary arrest and cardio-cerebrovascular and respiratory symptoms by 119 ambulances in Incheon from 2016 to 2018. Results: The probability of 119 emergency dispatch for patients with cardiopulmonary arrest increased 2.8-4.0% from the day of symptom onset until two days before hospital presentation as particulate matter 10μm or less in diameter(PM10) increased by 10μg/m3 (OR=1.028; 95% CI=1.014–1.041, p=0.000, lag 0), (OR=1.040; 95% CI=1.024–1.056, p=0.000, lag 1), (OR=1.032; 95% CI=1.016–1.049, p=0.000, lag 2). Meanwhile, emergency dispatch increased 3.6-6.1% for PM2.5 in creased by 10μg/m3 (OR=1.046; 95% CI=1.024–1.068, p=0.000, lag 0), (OR=1.061; 95% CI=1.035– 1.088, p=.000, lag 1), and (OR=1.036; 95% CI=1.010–1.063, p=0.006, lag 2). Conclusion: Emergency medical technicians (EMTs) who respond to 119 calls should rapidly and accurately evaluate patients and provide professional emergency care by identifying the characteristics of the vulnerable groups relative to particulate matter size. To prevent the occurrence and exacerbation of symptoms caused by particulate matter, EMTs should be prepared and equipped with a response system for high particulate matter in the EMS system.

Objective: Taking action on health inequalities starts with the production of information laying out the problems of inequalities, but Korean society has no national database to view related data at a glance. This study aimed to compare Korean national database with the Public Health Profile (PHP), a health inequality database of the UK. Methods: Data were collected from the websites of government and relevant organizations in the both countries between March and August 2020, which was updated in August 2021. Two themes including Co-occurring substance misuse and mental health issues in mental health and INteractive Health Atlas of Lung conditions in England were selected for comparison in terms of data accessibility, data usability and data visualization. Results: The British PHP is being served on a web-based platform, Fingertips. The data collected at the regional level were presented on 31 health inequality themes. The data are displayed at a level that can be compared between comparable communities, and visualized into various tables and figures. Comparable Korean data were scattered in several themes and websites, and mostly provided as a 17 administrative region base, which was too vast to make a meaningful comparisons. Conclusion: The findings proposed several considerations which could be useful for establishing a database of health inequality in the Korean society.

Patients with acute respiratory diseases, such as Middle East Respiratory Syndrome (MERS) due to COVID-19, must wear masks, protective clothing, face shields, and gloves to prevent infection during treatment and performance. Even if it is applied to disabled people, families who protect them are severely mentally tired from severe physical fatigue and stress from exposure to high-risk infectious diseases. As such, the spread of infectious diseases such as respiratory diseases has not only caused difficulties in using existing welfare and medical services but also caused various problems throughout the daily life of disabled people due to the prolonged infectious disease, and its scope is gradually expanding. Therefore, it should not be overlooked that disabled people may experience various difficulties, from the spread of infectious diseases such as respiratory diseases to isolation, diagnosis, and treatment, and it is time to actively assess the life changes felt by families caring for disabled people and consider and research to provide adequate services. According to the survey of disabled people is being conducted in the context of the spread of infectious diseases such as respiratory diseases, while research on the spread of infectious diseases such as respiratory diseases is rare for parents with disabilities. There is a need for additional investigation into the characteristics in other areas of everyday life, including the health field, which is deteriorating through prior research. Therefore, through this survey, the purpose of this study is to investigate the life changes of parents with disabilities in the context of the spread of infectious diseases such as respiratory diseases and to compare and analyze them to find out how parents were affected by each type of disability. It will be used as evidence to identify more necessary needs and problems for parents with disabilities in the spread of infectious diseases such as respiratory diseases and to provide more appropriate health care and welfare services in the future.

Objectives: In recent years, transboundary air pollution from mainland East Asia has led to growing concerns about air pollution in Japan. Air pollution is reportedly associated with the exacerbation of respiratory diseases. In this study, we assessed the effects of air pollution on respiratory symptoms and the health status of participants with and without chronic respiratory diseases. Methods: Participants (n=2753) with and without chronic respiratory diseases who visited healthcare facilities in Japan during February from 2010 to 2015 filled out a self-report questionnaire regarding their symptoms and perceived health status. Participants were followed up during April-May and June-July. Results: Oxidant concentrations were associated with respiratory symptoms, overall health, and quality of life (QoL). Suspended particulate matter (SPM) and particulate matter <$2.5{\mu}m$ levels were associated with physical fitness; SPM was also associated with QoL. Recent experience of an Asian sand dust event had a significant effect on allergic symptoms, change in health, and QoL. Conclusions: Respiratory symptoms were more strongly affected by oxidants than by other pollutants. Significant associations of air pollutants were found with a comprehensive range of items related to perceived health status, including overall health and QoL. Although the effects of air pollutants on respiratory symptoms and health status were more apparent among patients with respiratory diseases, the adverse effects of air pollutants were significant even among participants without such conditions.

Interstitial lung diseases are heterogeneous entities with diverse clinical presentations. Among them, idiopathic pulmonary fibrosis and connective tissue disease-associated interstitial lung disease are specific categories that pulmonologists are most likely to encounter in the clinical field. Despite the accumulated data from extensive clinical trial and observations, we continue to have many issues which need to be resolved in this field. In this update, we present the review of several articles regarding the clinical presentation, prognosis and treatment of patients with idiopathic pulmonary fibrosis or connective tissue disease-associated interstitial lung disease.

Respiratory diseases in dogs and cats can be classified into respiratory problems brought about as a result of a specific abnormality of the respiratory system; so called primary respiratory disease, and bronchopulmonary problems which occur as a consequence of heart failure; so called secondary respiratory disease. This section will concentrate predominantly on considerations regarding the treatment of primary respiratory diseases. This includes agents used to facilitate bronchodilation, to reduce coughing and various expectorants and mucolytics. In addition, the optimal fluid therapy and various ways of oxygen delivery with complication will be discussed with emphasis In order to understand the indications for, and action of, various drugs used in the treatment of respiratory disease an understanding of normal respiratory physiology is important and these considerations is described in this section for helping to understand further for readers.

Purpose: We aimed to evaluate the respiratory illness-related hospital visits (out-patient clinics, emergency room, and re-admission) of preterm infants, and compare them according to corrected age and prematurity. Methods: We reviewed the medical records of preterm infants born at <37 weeks of gestation admitted to the neonatal intensive care unit (NICU) at Inha University Hospital between January 2012 and June 2015. Infant follow-up appointments in both neonatology and pulmonology out-patient clinics occurred for at least 2 years after NICU discharge. Results: The proportion of infants who visited the hospital due to any respiratory illness was as high as 50% until 12 months of corrected age, and subsequently decreased over time. Hospital admission was significantly higher in early preterm infants (<34 weeks of gestation) compared to late preterm infants (≥34 and <37 weeks of gestation). The proportion of infants who were re-admitted due to lower respiratory tract illness was significantly higher until 6 months of corrected age compared to the later, and did not differ between early and late preterm infants. Conclusion: The proportion of hospital visits of preterm infants due to respiratory disease was high until 12 months of corrected age. Most notably, the re-admission proportion from lower respiratory tract illness was high under 6 months in both early and late preterm infants. Preterm infants within this age that are visiting the hospital with respiratory symptoms should be carefully observed and followed up.

Epidemiological evidences and clinical as well as experimental observations have suggested a link between asthma and occupations. This relationship also involves other aspects like nonimmunologic exposures in the environment that can increase the chance of developing work related asthma and respiratory diseases. The purpose of this pamphlet is to supply information of work related diseases, which will give patients suffering with asthma, an intelligent understanding of their disease, and thus stimulate their interest so that they will cooperate more readily with their allergist. Recognizing the symptoms, causes, risk factors, diagnosis and treatment is an important part of managing occupational asthma and related diseases, so that it helps in decline of this rapidly increasing prevalence throughout the world.

OBJECTIVES: Humidifier disinfectants (HDs) were sold in Korea from 1994 until their recall in 2011. We examined the incidence patterns of 8 respiratory diseases before and after the HD recall and estimated the attributable risk in the Korean population.METHODS: Using National Health Insurance data from 2002 to 2019, we performed age?cohort?period and differences-in-diffference analyses (comparing periods before vs. after the recall) to estimate the population-attributable fraction and the excess number of episodes. The database comprised 51 million individuals (99% of the Korean population). The incidence of 8 diseases?acute upper respiratory infection (AURI), acute lower respiratory infection (ALRI), asthma, pneumonia, chronic sinusitis (CS), interstitial lung disease (ILD), bronchiectasis, and chronic obstructive pulmonary disease (COPD)?was defined by constructing episodes of care based on patterns of medical care and the clinical characteristics of each disease.RESULTS: The relative risks (RRs) for AURI, ALRI, asthma, pneumonia, CS, and ILD were elevated among younger individuals (with an RR as high as 82.18 for AURI in males), whereas chronic conditions such as bronchiectasis, COPD, and ILD showed higher RRs in older individuals. During the HD exposure period, the population-attributable risk percentage ranged from 4.6% for bronchiectasis to 25.1% for pneumonia, with the excess number of episodes ranging from 6,218 for ILD to 3,058,861 for CS. Notably, females of reproductive age (19-44 years) experienced 1.1-9.2 times more excess episodes than males.CONCLUSIONS: This study provides epidemiological evidence that inhalation exposure to HDs affects the entire respiratory tract and identifies vulnerable groups.