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Bahk J.,Seoul National University | Choi Y.,Asian Citizens Center for Environment and Health | Lim S.,Kyung Hee University | Paek D.,Seoul National University
International Journal of Occupational and Environmental Health

Background: 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. Method: 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. Results: 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 healthrelated 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. Conclusion: 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. © W. S. Maney & Son Ltd 2013. Source

Park D.,Korea University | Leem J.,Inha University | Lee K.,Korea University | Lim H.,Asian Citizens Center for Environment and Health | And 9 more authors.
Environmental Health: A Global Access Science Source

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. © 2014 Park et al.; licensee BioMed Central Ltd. Source

Park D.U.,Korea University | Friesen M.C.,U.S. National Institutes of Health | Roh H.S.,Data Analytics Team | Choi Y.Y.,Asian Citizens Center for Environment and Health | And 11 more authors.
Indoor Air

We conducted a comprehensive humidifier disinfectant exposure characterization for 374 subjects with lung disease who presumed their disease was related to humidifier disinfectant use (patient group) and for 303 of their family members (family group) for an ongoing epidemiological study. We visited the homes of the registered patients to investigate disinfectant use characteristics. Probability of exposure to disinfectants was determined from the questionnaire and supporting evidence from photographs demonstrating the use of humidifier disinfectant, disinfectant purchase receipts, any residual disinfectant, and the consistency of their statements. Exposure duration was estimated as cumulative disinfectant use hours from the questionnaire. Airborne disinfectant exposure intensity (μg/m3) was estimated based on the disinfectant volume (ml) and frequency added to the humidifier per day, disinfectant bulk level (μg/ml), the volume of the room (m3) with humidifier disinfectant, and the degree of ventilation. Overall, the distribution patterns of the intensity, duration, and cumulative exposure to humidifier disinfectants for the patient group were higher than those of the family group, especially for pregnant women and patients ≤6 years old. Further study is underway to evaluate the association between the disinfectant exposures estimated here with clinically diagnosed lung disease. © 2015 John Wiley & Sons A/S. Source

Park D.-U.,Korea University | Choi Y.-Y.,Asian Citizens Center for Environment and Health | Ahn J.-J.,Asian Citizens Center for Environment and Health | Lim H.-K.,Asian Citizens Center for Environment and Health | And 13 more authors.

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 disinfectantassociated 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 <0.5 m (95 %CI = 2.4-73.0). Conclusions: The use of household humidifier disinfectants was associated with HDLI risk in a doseresponse manner. © 2015 Park et al. Source

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