Surveillance and epidemiologic investigation in public health emergencies caused by infectious diseases

Public health emergencies caused by infectious diseases are the greatest threat to mankind in the 21st century, and pose an even more significant threat than nuclear weapons. The first step in preparing for and responding to such public health emergencies is to conduct thorough surveillance and rapid epidemiological investigations. Especially in the case of public health emergencies, most information is not smoothly transmitted. Therefore, it is necessary to evaluate the emergency and to collect data quickly and efficiently by defining the minimum necessary data and information. In addition, these data should be analyzed and interpreted promptly, and countermeasures and strategies should be developed and utilized in preparedness and response activities. Epidemiological investigations should also be carried out promptly in accordance with the emergency situation, and in particular, if the infection source is not known, maximal measures should be taken to prevent epidemiologists from becoming infected. In order to carry out surveillance and epidemiological investigations effectively in the future in the event of a public health emergency, continuous efforts should be made to nurture professional manpower, international cooperation, and use of the latest information technology.

Declaración de paz / Peace declaration

En nuestra ciudad, tuvimos el calor de la vida familiar, los profundos lazos humanos de la comunidad, festivales que armonizaban cada estación, una cultura tradicional y edificaciones que perduraron a través de la historia, así como parajes regados por los ríos donde los niños jugaban. A las 8:15 A.M. del 6 de agosto de 1945, todo lo antes mencionado fue destruido por una sola bomba atómica. Bajo la nube en forma de hongo, yacía una madre abrazada a su niño carbonizado, incontables cadáveres flotaban en los ríos, y los edificios se quemaban hasta desaparecer en la tierra. Decenas de miles de personas resultaron quemadas en medio de aquellas llamas. Al final de ese año, 140 000 vidas irremplazables habían sido tomadas, que incluían coreanos, chinos surasiáticos y prisioneros de guerra norteamericanos. Aquellos que lograron sobrevivir, grotescamente distorsionados, sufrieron serios daños físicos y emocionales, afectados además por una severa discriminación y por prejuicios. Muchos niños se vieron obligados a robar y a pelear repetidamente para poder sobrevivir: un pequeño niño que quedó huérfano por la bomba atómica todavía vive en solitario; una esposa fue obligada al divorcio cuando se descubrió su exposición a las radiaciones. El sufrimiento continúa. ''Madotekure'', este es el grito rompecorazones de los ''hibakushas'' que quieren a Hiroshima ­su ciudad natal, a sus familiares, a sus propios cuerpos y mentes­ que vuelvan a ser como todos eran. Cien años después de la apertura del Salón de Exhibiciones de la Prefectura Comercial de Hiroshima y 70 años después del bombardeo atómico, el Domo de la bomba atómica todavía vigila sobre Hiroshima. Frente a este testigo de la historia, deseo que todos nosotros, encaremos una vez más, todo lo que la bomba atómica hizo y que abracemos completamente el espíritu de los hibakushas. Mientras tanto, nuestro mundo todavía se crispa con más de 15,000 armas nucleares, y los hacedores de política en las potencias nucleares continúan atrapados en su pensamiento provinciano, repitiendo de palabra y de acción su intimidación nuclear. Conocemos ahora los innumerables accidentes e incidentes que nos han llevado al borde de una guerra nuclear o de explosiones nucleares. Hoy en día, nos lamentamos igualmente acerca del terrorismo nuclear. Mientras existan las armas nucleares, cualquier persona puede convertirse en un hibakusha en cualquier momento. Si eso ocurriera, el daño traspasaría indiscriminadamente las fronteras nacionales. Gente del mundo, por favor, escucha atentamente las palabras de los hibakushas, y aceptando profundamente el espíritu de Hiroshima, contempla el problema nuclear como el tuyo ­es de donde proviene la paz''. Estos conmovedores mensajes, forjados en un recipiente de sufrimiento y de penas, trasciende el odio y el rechazo. Su espíritu es la generosidad y el amor por la humanidad; su objetivo es el futuro del género Ahora es el momento para iniciar nuestras acciones al respecto. Los jóvenes han comenzado las suyas; publican sus mensajes, organizan marchas y lanzan toda una variedad de esfuerzos para lograrlo. Trabajemos todos unidos en la construcción de una enorme explosión del suelo. En este fundamental 70 aniversario, el promedio de edad de los hibakushas es de 80 años. La ciudad de Hiroshima trabajará aún más para preservar los hechos del bombardeo, diseminándolos al resto del mundo para las futuras generaciones. Al mismo tiempo, como Presidente de los Alcaldes Para la Paz, ahora con más de 6,700 ciudades miembros, Hiroshima actuará con determinación, haciendo todo lo que esté a nuestro alcance para acelerar las negociaciones internacionales con el fin de realizar una convención mundial para la abolición de las armas nucleares en el año 2020. ¿No es este el rol adecuado de los hacedores de políticas para proporcionarle felicidad a sus respectivas poblaciones basado en la generosidad y el amor de la humanidad? En las reuniones de estos hacedores de política se habla incansablemente al respecto ­por lo que esto sería el primer paso hacia la abolición de las armas nucleares. El paso siguiente sería crear, a través de la confianza que fuéramos capaces de logar, amplios y versátiles sistemas de seguridad que no dependan del poderío militar. Trabajar con paciencia y perseverancia para alcanzar dichos sistemas será vital, y requerirá que promocionemos a través de todo el mundo el paso a la paz real planteada por el pacifismo de la Constitución Japonesa. La reunión cumbre a ser celebrada en Ise-Shima, Japón, el próximo año, y la reunión previa a la misma de ministros exteriores que se llevará a cabo en Hiroshima, constituirán oportunidades perfectas para enviar un mensaje acerca de la abolición de las armas nucleares. El Presidente Obama, y otros políticos, vengan, por favor, a las ciudades que fueron destruídas con las bombas atómicas, y escuchen a los hibakushas con sus propios oídos, para que encuentren la realidad de esos bombardeos. Seguramente, ustedes serán conminados a iniciar una discusión dentro de un marco legal que incluya una convención sobre armas nucleares. Nosotros recabamos del gobierno japonés, en su papel de puente entre los estados nucleares y no nucleares, a guiar a todas las naciones durante estas discusiones, y ofrecemos a Hiroshima como anfitrión para el diálogo y los servicios del mismo. En adición, pedimos la mayor compasión por nuestros viejos hibakushas y por tantas otras personas que sufren en la actualidad los efectos de la radiación, y que se exprese mediante mayores medidas de apoyo. En particular, demandamos expansión de las áreas de lluvia negra. Ofreciendo nuestras más sentidas plegarias por el descanso pacífico de las víctimas de las bombas atómicas, expresamos también nuestra gratitud a los hibakushas y a todos nuestros predecesores que han trabajado tan duro a través de todas sus vidas para reconstruir Hiroshima y por abolir las armas nucleares. Finalmente, apelamos a toda la población del mundo: Renueven su determinación. Trabajemos unidos con todas nuestras fuerzas por la abolición de las armas nucleares y por la consecución de una prolongada paz mundial(AU)

Genetic radiation risks: a neglected topic in the low dose debate

OBJECTIVES: To investigate the accuracy and scientific validity of the current very low risk factor for hereditary diseases in humans following exposures to ionizing radiation adopted by the United Nations Scientific Committee on the Effects of Atomic Radiation and the International Commission on Radiological Protection. The value is based on experiments on mice due to reportedly absent effects in the Japanese atomic bomb (Abomb) survivors. METHODS: To review the published evidence for heritable effects after ionising radiation exposures particularly, but not restricted to, populations exposed to contamination from the Chernobyl accident and from atmospheric nuclear test fallout. To make a compilation of findings about early deaths, congenital malformations, Down’s syndrome, cancer and other genetic effects observed in humans after the exposure of the parents. To also examine more closely the evidence from the Japanese A-bomb epidemiology and discuss its scientific validity. RESULTS: Nearly all types of hereditary defects were found at doses as low as one to 10 mSv. We discuss the clash between the current risk model and these observations on the basis of biological mechanism and assumptions about linear relationships between dose and effect in neonatal and foetal epidemiology. The evidence supports a dose response relationship which is non-linear and is either biphasic or supralinear (hogs-back) and largely either saturates or falls above 10 mSv. CONCLUSIONS: We conclude that the current risk model for heritable effects of radiation is unsafe. The dose response relationship is non-linear with the greatest effects at the lowest doses. Using Chernobyl data we derive an excess relative risk for all malformations of 1.0 per 10 mSv cumulative dose. The safety of the Japanese A-bomb epidemiology is argued to be both scientifically and philosophically questionable owing to errors in the choice of control groups, omission of internal exposure effects and assumptions about linear dose response.

Poorly Differentiated Squamous Cell Carcinoma in an Atomic Bomb Survivor

No abstract available.

The Encounter between Oral History and Narrative Medicine: A Preliminary Study / 의사학

In this article, we will examine the theory and practice of encounters between oral history and narrative medicine in view of storytelling. Man is a storytelling animal. Our experience is understood, reconstructed and transmitted as a story and we can find the meaning of life through a story. Oral history is a specific practice and method of research. It refers to the process of recording interviews with people who have something to say, transcribing the record and interpretating the written text to conduct the study of the past. Therefore story is a basic tool of oral history. There has been also growing interest regarding the narrative features of medicine. Especially the illness narrative is one of the most powerful tools in this context. An illness narrative is a patient's story about his illness, including the meaning of the illness in his life. Illness as a specific event of life can only be understood through a story of patient. How can we combine oral history and narrative medicine altogether? We propose two subjects, one is 'healing' and the other is 'the social'. The goal of medicine is healing of suffered people. It is well known that storytelling has a healing effect. Conducting oral history is not only 'recovery history' but also is helping people to have a well organized memory and integrate that into his whole life story. The use of oral history as a means of empowerment should be extended referring the healing effect of medicine. On the other hand, modern medicine has a tendency to reduce the problem of health and illness as an individual one. However story of illness can reveal the dominance of modern biomedicine in the contemporary and have political implications. Oral history deals with memory. Personal memory can only be understood in the context of social and cultural backgrounds. Collective memory is necessary in building community history. Medicine should learn from oral history's social dimensions. In this context, life of KIM Hyeongyul who was activist for second generation Korean Atomic Bomb Victims will be a good example of encounters between oral history and narrative medicine.

The health effects of low-dose radiation exposure

Low dose radiation has been defined as doses in the range under 100 mSv of low linear energy transfer (low-LET) radiation. There are two sources of ionizing radiation: natural and artificial radiation. Medical radiation exposure is the most common artificial radiation exposure. The frequency and volume of medical radiation exposure has markedly increased because of recent developments in medical technology. Radiation protection is now a concern due to the increasing use of computed tomography (CT) scans and diagnostic X-rays. This article introduced several models and hypotheses regarding the possible carcinogenic risks associated with low-LET radiation. Although opinions vary on the health effects of low level radiation exposure, current studies of medical radiation rely on exposure information collected prospectively, including cohort studies such as atomic bomb survivor studies. Although there are differences in perspective, the majority of studies have supported 'linear-no-threshold model without threshold' between low-LET radiation and the incidence of cancer risk. There is a need for further studies on medical radiation exposure including CT and positron emission tomography in order to understand the health effects of low-LET radiation, including the cancer incidence.

Risk Factors for Breast Cancer, Including Occupational Exposures

The knowledge on the etiology of breast cancer has advanced substantially in recent years, and several etiological factors are now firmly established. However, very few new discoveries have been made in relation to occupational risk factors. The International Agency for Research on Cancer has evaluated over 900 different exposures or agents to-date to determine whether they are carcinogenic to humans. These evaluations are published as a series of Monographs (www.iarc.fr). For breast cancer the following substances have been classified as "carcinogenic to humans" (Group 1): alcoholic beverages, exposure to diethylstilbestrol, estrogen-progestogen contraceptives, estrogen-progestogen hormone replacement therapy and exposure to X-radiation and gamma-radiation (in special populations such as atomic bomb survivors, medical patients, and in-utero exposure). Ethylene oxide is also classified as a Group 1 carcinogen, although the evidence for carcinogenicity in epidemiologic studies, and specifically for the human breast, is limited. The classification "probably carcinogenic to humans" (Group 2A) includes estrogen hormone replacement therapy, tobacco smoking, and shift work involving circadian disruption, including work as a flight attendant. If the association between shift work and breast cancer, the most common female cancer, is confirmed, shift work could become the leading cause of occupational cancer in women.

Quantitative Assessment of Radiation Doses from Computed Tomography of Patients in the Emergency Department Following Trauma Team Activation

PURPOSE: Emergency physicians utilize multiple computed tomography (CT) scans in acute evaluation of patients with multiple traumas. By its nature, CT involves larger radiation doses than conventional X-ray films do. A significant association was reported between radiation dose and increasing risk of cancer in atomic bomb survivors and radiation workers. The object of this study was to investigate the amount (dose) of CT radiation in patients who activated the trauma team during the first 24 hours of their stay in the emergency department. METHODS: This study was designed as a retrospective analysis of radiologic and medical data. We reviewed 39 trauma patients who activated the trauma team of our emergency department between January 2008 and April 2009. Individual radiation dose reports calculated by the CT scanner were used to determine radiation dose from each CT scan. Radiation doses calculated by CT scanners were converted to effective dose by multiplying by a conversion coefficient. RESULTS: A total of 33 patients were enrolled. Among these patients, 24(72.7%) were male. The mean age was 41.88+/-16.13 years. The mean Revised Trauma Score was 6.94+/-1.16. The mean Injury severity score was 22.85+/-10.34. The mean number of total CT scans was 3.61+/-1.22. The median effective dose of the total CT scans was 68.81 mSv, with an intraquartile range of 56.30 to 88.41 mSv. CONCLUSION: Trauma patients in the emergency department following trauma team activation are exposed to clinically significant radiation doses from CT imaging during the first 24 hours of their stay.

Preparedness for terrorism: managing nuclear, biological and chemical threats

The management of nuclear, biological and chemical (NBC) terrorism events is critical to reducing morbidity and mortality in the next decade; however, initial patient care considerations and protective actions for staff are unfamiliar to most front-line clinicians. High explosive events (bomb and blast) remain the most common type of terrorism and are easy to detect. Conversely, some types of terrorist attacks are more likely to be unsuspected or covert. This paper explains the current threat of terrorism and describes clues for detection that an event has occurred. Specific criteria that should lead to a high suspicion for terrorism are illustrated. The manuscript outlines initial actions and clinical priorities for management and treatment of patients exposed to nuclear/radiological, biological, chemical and combined agents (for example an explosion involving a chemical agent). Examples of terrorist events include: a nuclear explosion, an aerosolised release of anthrax (biological), dissemination of sarin in a subway (chemical), and the detonation of a radiologic dispersion device or "dirty bomb" (combined explosive and radiological). Basic principles of decontamination include potential risks to healthcare providers from secondary exposure and contamination. Unique issues may hinder clinical actions. These include coordination with law enforcement for a crime scene, public health entities for surveillance and monitoring, hazardous materials teams for decontamination, and the media for risk communications. Finally, the importance of personal preparedness is discussed.

Epidemiological Researches on the Health Hazards in Veterans of United States of America / 한국역학회지

The Department of Veterans Affairs(VA) maintains some large automated databases that provide the opportunity for studying long-term health effects of military service. The Beneficiary Identification and Record Locator Subsystem(BIRLS) is an excellent source of vital status information on veterans. The VA Patient Treatment File(PTF) is a computerized hospital discharge abstract system of inpatient records, including patients' demographic data, surgical and procedural transactions, and patient movements and diagnosis. The computerized Agent Orange Registry data include veteran's name, address, some information on military service, and findings at the time of his physical examination. The US conducted 235 atmospheric nuclear tests from 1945 through 1962. Many of the 250,000 test participants were exposed to low levels of radiation. The overall average radiation dose was estimated as 0.6 rem per year. In 1976, a claim relating acute myelocytic leukemia to radiation exposure from nuclear weapon testing received extensive publicity. Several thousand "atomic veterans" have sought medical care and compensation from VA for medical conditions that they believe are related to the nuclear weapon testing. Many WWII veterans have contracted the US VA about health problems that they attribute to their exposure to mustard gas. From 1962 to 1971, 75 million liters of herbicides, including over 41 million liters of the phenoxy herbicide Agent Orange, were sprayed on almost 9% of Vietnam. Many studies have been conducted to determine the association of various cancers with military service in Vietnam. Some diseases have been compensated for Vietnam veterans. Health problems reported following the Gulf War include a wide variety of symptoms similar to those found in acute combat reaction, posttraumatic stress disorder, and chronic fatigue. Health problems associated with war have continued and in some ways intensified. Therefore, The United States developed a plan for establishing a national center for the study of war-related illnesses and post-deployment health issues.

Clinical and Histopathologic Observations of Primary Cutaneous Squamous Cell Carcinomas / 대한피부과학회지

BACKGROUND: Squamous cell carcinoma(SCC) is the most common skin cancer in Korea and its incidence is increasing. OBJECTIVE: Our purpose was to evaluate the clinical and histopathological characteristics of SCC. METHODS: Forty cases of cutaneous SCC slides were retrieved from the files of the surgical pathology division of the National Medical Center. Hematoxylin and eosin stained sections were re-examined microscopically by two dermatologists independently. For the cases of reconfirmed SCC, clinical characteristics including incidence, age and sex distribution, location and underlying conditions and histopathologic grading by Broder's grade system were evaluated. For 3 control cases controls and 17 cases of the SCCs, cytokeratin expression patterns on immunohistochernical staining using monoclonal antithodies MNF 116, RCK 102 and NCL 5D3 were observed. RESULTS: 1. Of 40 specimens, 33 specimens(73.3%) were histologically reconfirmed as true cutaneous SCCs. 2. The most commonly involved age group was the fifth decade of life and the median age when diagnosis was made was 57.3. 24 male patients and 9 female patients were involved and the ratio of male to female was 2.67: 1. 3. Most commonly involved sites were face and lower extremities and the incidence of occurrence on sun exposed areas increased in accordance with an increase of the age. 4. Underlying conditions such as burn scars, osteomyelitis or atomic bomb exposure were associated in 455% of SCCs. 5. Histopathologic grading of 33 cases of SCCs by Broder's grade was performed as follows.:23 cases(67.7%) of grade I, 8 cases(24.2%) of grade II and 2 cases(6.1%) of grade III. 6. The cytokeratin expressio pattern on immunohistochemical staining for 3 of the control cases and 17 cases of SCCs showed some differences between the highly and poorly differentiated groups of SCCs. CONCLUSION: We evaluated the clinical and histopathological characteristics of primary cutaneous SCCs in the National Medical Center from september 1978 to August 1993.

A Case of Lichen Planus / 대한피부과학회지

A case of Lichen planus in 41 year old with predisposing emotional factor is reported here and reviewed therapeutic experiences and reveiwed of literatures. This patient who has been suffering from pruritic, dull erythematous maculo-papular eruptions of trunk and extremites which was preoccupied with imagination as if she were exposed sequela to atomic bomb explosion in Japan, World War II, is presented.