Proving Causation With Epidemiological Evidence in Tobacco Lawsuits / 예방의학회지

Recently, a series of lawsuits were filed in Korea claiming tort liability against tobacco companies. The Supreme Court has already issued decisions in some cases, while others are still pending. The primary issue in these cases is whether the epidemiological evidence submitted by the plaintiffs clearly proves the causal relationship between smoking and disease as required by civil law. Proving causation is difficult in tobacco lawsuits because factors other than smoking are involved in the development of a disease, and also because of the lapse of time between smoking and the manifestation of the disease. The Supreme Court (Supreme Court Decision, 2011Da22092, April 10, 2014) has imposed some limitations on using epidemiological evidence to prove causation in tobacco lawsuits filed by smokers and their family members, but these limitations should be reconsidered. First, the Court stated that a disease can be categorized as specific or non-specific, and for each disease type, causation can be proven by different types of evidence. However, the concept of specific diseases is not compatible with multifactor theory, which is generally accepted in the field of public health. Second, when the epidemiological association between the disease and the risk factor is proven to be significant, imposing additional burdens of proof on the plaintiff may considerably limit the plaintiff's right to recovery, but the Court required the plaintiffs to provide additional information such as health condition and lifestyle. Third, the Supreme Court is not giving greater weight to the evidential value of epidemiological study results because the Court focuses on the fact that these studies were group-level, not individual-level. However, group-level studies could still offer valuable information about individual members of the group, e.g., probability of causation.

Role of mitogen-activated protein kinase pathway in chloracne / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To investigate the role of mitogen-activated protein kinase (MAPK) signal transduction pathway in chloracne.</p><p><b>METHODS</b>Immunohistochemical technique was used to detect the expression of phosphorylated epidermal growth factor receptor (p-EGFR) and p-MAPK proteins in the epithelium of chloracne group and control group.</p><p><b>RESULTS</b>p-EGFR and p-MAPK was found in all chloracne tissues, whereas no expression of p-EGFR and p-MAPK protein was found in control group. In the skin of chloracne patients, p-EGFR was mainly distributed in the membrane and the cytoplasm, especially in the vicinity of membrane; major positive signal of p-MAPK was in core and serosity.</p><p><b>CONCLUSION</b>EGFR and MAPK phosphorylation is found in chloracne tissues. MAPK signal transduction pathway is one important molecular mechanism of chloracne.</p>

A Clinical Study of Dermatoses of Korean Vietnam Veterans Exposed to Agent Orange / 대한피부과학회지

BACKGROUND: Scientific and epidemiologic studies have shown that several dermatoses of Vietnam veterans were caused by Agent Orange. Most of the previous studies on Vietnam veterans have been about the relationship between systemic diseases including limited dermatoses and Agent Orange, but there have been no clinical studies of dermatoses of Korean Vietnam veterans exposed to Agent Orange. OBJECTIVE: We conducted this study to find out the distribution and characteristics of dermatoses of Korean Vietnam veterans exposed to Agent Orange. METHODS: A total of 19, 262 Korean Vietnam veterans who received their first dermatological examination at Seoul Veterans Hospital between January 1997 and December 2003 were included in this study, which consisted of a skin examination and 15-item questionnaire. RESULTS: 1. The distribution of dermatoses groups were as follows: pruritus, psychocutaneous disorders, and neurocutaneous dermatoses (36.1%), dermatomycosis and deep mycosis (20.5%), eczema (11.6%), diseases of the skin appendages (3.6%), epidermal and adnexal nevi and tumors (2.1%), drug eruption, erythema, and urticaria (1.8%), and papulosquamous diseases (1.5%). 2. Pruritus (31.6%) was the most frequent dermatosis in all age groups. 3. The frequency of dermatoses related to exposure to Agent Orange were as follows: seborrheic dermatitis (4.8%), chronic urticaria (1.7%), psoriasis vulgaris (1.2%), xerotic eczema (0.5%), photosensitive dermatitis (0.2%), chloracne (0.1%), soft tissue sarcoma (0.1%), and malignant tumors (0.01%). 4. With regard to regional groups of dispatch in Vietnam, QuiNhon (20.1%) was the most frequent area of dispatch. There was no statistically significant difference in frequency of dermatoses related to exposure to Agent Orange between Dian, where larger amounts of Agent Orange were sprayed, and the other regional groups. 5. For duration of dispatch in Vietnam, there was no statistically significant difference in frequency of dermatoses related to exposure to Agent Orange between two groups of duration. CONCLUSION: This study showed the distribution and characteristics of dermatoses of Korean Vietnam veterans exposed to Agent Orange, and may be helpful as the fundamental epidemiologic data of dermatoses of Korean Vietnam veterans for dermatologists to examine.

Skin Diseases among Veterans Exposed to Herbicides Used in Vietnam

BACKGROUND: The herbicides used in Vietnam were later found to be extremely contaminated with 2,3,7, 8-tetrachlorodibenzo-rho-dioxin (TCDD). The carcinogenecity of the product was for all cancers combined. The risk of soft tissue sarcoma, lung cancer, and lymphoma, chloracne, peripheral neuropathy and other diseases were found to be increased. Although many veterans exposed to herbicides had chronic skin diseases with variable clinical features, there were few researches about herbicides-related skin diseases. The purpose of this study was to investigate the characteristics of herbicides-related skin diseases and to provide epidemiologic information. METHODS: This study has been reviewed in the clinical findings of 127 veterans with skin diseases exposed to herbicides who visited Kosin University Gospel Hospital during the 5 years from January of 1997 to December of 2001. RESULTS: The age distribution was in the range of 47~68 years. The mean age was 54.6 years old. All patients were male. In the duration, 34 patients (26.8%) developed skin diseases for 6~10 years, 21 patients (16.5%) for 16~20 years, and 21 patients (16.5%), 25 years. In the incidence, seborrheic dermatitis was the most frequently observed in 45 patients (35.4%) followed by eczematous dermatitis in 41 patients (32.3%), xerotic eczema in 23 (18.1%) and pruritic dermatoses in 21 (16.5 %). In the incidence ratio of skin diseases with systemic diseases, chronic urticaria was the most highly observed with 100% (1/1) followed by fungal infection in 70% (7/10), other diseases in 66.6% (6/9), seborrheic dermatitis in 64.4% (29/45), eczematous dermatitis in 56.1% (23/41), and xerotic eczema in 52.2% (12/23). Sixty eight patients had skin diseases with systemic disease. Hypertension and diabetes were most frequently observed with 24 and 23 patients, respectively. The order of incidence was as follows: liver disease, gastroduodenal ulcer, peripheral neuropathy, chronic gastroenteritis, and hyperlipidemia. Mycosis fungoides was found in 4 cases and monoclonal T cell gamma receptor gene rear-rangement was detected in 2 cases (50%). CONCLUSION: Skin diseases among veterans exposed to herbicides used in Vietnam was chronic and showed variable clinical features. It was difficult to confirm the relationship between skin diseases and herbicides, but further researches are required to seek guidelines for the evaluation of skin diseases.

Dioxins and Health: Human Exposure Level and Epidemiologic Evidences of Health Effects / 예방의학회지

General information is summarized, that is necessary to introduce a scientific assessment of the human health and exposure issue concerning dioxin and dioxin-like compound. Scientific literatures were reviewed to assess the background exposures to the dioxin-like compounds for normal residents. Epidemiologic studies were also reviewed to assess malignant and nonmalignant effects of dioxins. In 1997, the International Agency for Research on Cancer classified 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin (TCDD) as a human carcinogen, primarily based on occupational cohort studies. The US Environmental Protection Agency made the same decision in it's Draft Dioxin Reassessment. Epidemiologic evidences point to a generalized excess of all cancers, without any pronounced excess at specific sites. Reported non-cancer effects included a range of conditions affecting most systems. Among them, chloracne, elevation in gamma glutamyl transferase (GGT), and alterations in reproductive hormones are related to TCDD. Other adverse outcomes, such as lipid concentrations, diabetes, circulatory and heart diseases, immunologic disorders, neurobehavioral effects, and developmental outcomes require further study before their respective relationships to TCDD can be more definitively assessed.

A Case of Chloracne Due to Exposure to Defoliating Agent During Vietnam war / 대한피부과학회지

Chloracne is a refractory acneiform eruption due to halogenated polyaromatic compound(eg. dioxin, dibenzofurans, polychlorinated biphenyls, etc.). 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin, a kind of dioxin isomer, contained in the Agent Orange which was used for defoliating agent during Vietnam war. It is characterized by recalcitrant comedones and cyst predominantly in the malar and postauricular area. Lesions of the penis and scrotum are also relatively frequent. The key pathological feature is the non-inflammatory keratinization of pilosebaceous unit. The meibomian glands are typically affected. Xerosis, conjunctivitis, pigmentation, follicular hyperkeratosis, actinic elastosis are occasionally associated with chloracne. We report a case of typical chloracne due to exposure to defoliating agent during Vietnam war in a 54-year-old-man who shows typical clinical and histopathological features.

A Study on the Health Status of Korean Vietnam Veterans' Children: A Result of Questionnaire Survey on Vietnam Veterans of Pusan Area Who Diagnosed as Cases by Korean Veteran's Hospital Diagnostic Criteria / 예방의학회지

OBJECTIVES: To propose the referential data to evaluate the health impacts of Vietnam veterans' children whose father were exposed to herbicides in Vietnam War. METHODS: Vietnam veterans who visited to Pusan Veteran Hospital for medical care were recruited from April to October, 1998. They were 71 and asked about their own combat history, symptoms and illness, and health status of their 182 children. The informations were collected by direct and phone interview. Exposure estimation was also performed as exposure score depending on year and unit of participation, and personal episodes related to exposure to herbicide in the war. It classified into three groups; lower( or =53) exposure group. RESULTS: The mean age and the period into the combat of the veterans were 52.8 years and 15.0 months. The mean exposure score was 18.1+/-9.9, and mainly distributed in lower (46.5%) and moderate(52.1%) exposure group. Most(90.1%) of them were diagnosed as sequelae(21 cases) and suspected sequelae(43 cases) of the herbicides by Korean veteran's hospital diagnostic criteria. The major sequelae was peripheral neuropathy 13 cases, chloracne 5 cases, and the major suspected sequelae was hypertension 20 cases, diabetes mellitus 18 cases, liver disease 12 cases, central neuropathy 11 cases, etc. About birth, 42.2% and 16.9% experienced spontaneous abortion and stillbirth, respectively. The mean exposure score was higher in stillbirth experience group(p0.05). CONCLUSIONS: These results were depend on their own answers, and expectation for compensation did not excluded, therefore, this study may have limitations: inaccuracy of informations due to recall bias and response bias. Nevertheless, through this study, we could image the fundamental aspect for health impacts of Vietnam veterans' children for preparing the national control program and policy. A large scale epidemiologic study with valid exposure assessment on the health impacts of Vietnam veterans' children is recommneded.