Evaluation of the Public Health Emergency Response to the COVID-19 Pandemic in Daegu, Korea During the First Half of 2020 / 예방의학회지

Objectives@#This study evaluated the response in Daegu, Korea to the first wave of the coronavirus disease 2019 (COVID-19) pandemic according to a public health emergency response model. @*Methods@#After an examination of the official data reported by the city of Daegu and the Korea Centers for Disease Control and Prevention, as well as a literature review and advisory meetings, we chose a response model. Daegu’s responses were organized into 4 phases and evaluated by applying the response model. @*Results@#In phase 1, efforts were made to block further transmission of the virus through preemptive testing of a religious group. In phase 2, efforts were concentrated on responding to mass infections in high-risk facilities. Phase 3 involved a transition from a high-intensity social distancing campaign to a citizen participation–based quarantine system. The evaluation using the response model revealed insufficient systematic preparation for a medical surge. In addition, an incorporated health-related management system and protection measures for responders were absent. Nevertheless, the city encouraged the participation of private hospitals and developed a severity classification system. Citizens also played active roles in the pandemic response by practicing social distancing. @*Conclusions@#This study employed the response model to evaluate the early response in Daegu to the COVID-19 pandemic and revealed areas in need of improvement or maintenance. Based on the study results, creation of a systematic model is necessary to prepare for and respond to future public health emergencies like the COVID-19 pandemic.

The Development of Evaluation Methods for Outcomes in Medical Humanities Curriculum of a Medical School / 계명의대학술지

This study was performed to select the proper assessing methods for learning outcomes in undergraduate education of medical humanities (MH), and to evaluate whether student assessments in MH curricula are related to the graduate outcomes (GO)and/or periodic phase outcomes (PO). We searched the reasonable assessing methods for GO and PO of MH curricula of Keimyung University School of Medicine (KUSM). The outcomes are composed of six competencies including patient care, communication, patient support, professionalism, problem solving and research, and self-development. Then, we analyzed whether student assessments carried out during formal MH curricula properly achieved their PO, furthermore their GO. Four competencies including communication, patient support, professionalism, self-development were lightened to be closely related to outcomes for MH. Only the component of problem solving was settled to be related to MH in the competency of problem solving and research. The competency of patient care was excluded from the relationship with MH. The assessing methods for the GO and three PO recommended from educational experts, and there were various available assessing methods based on medical situations and clinical contexts including direct observation of clinical skills, 360 degree feedback, peer review, self-assessment, project-based assessment, portfolio-based assessment, discussion & presentation-based assessment, log-based assessment. For the outcome-achieving from formal MH curricula, the MH programs of phase-1 (1st and 2nd grades) almost accomplished the PO of communication, patient supporting and professionalism, and considerably accomplished the PO of problem solving and self-development. The MH programs of phase-2 (3rd and 4th grades) accomplished considerably their PO as the competencies of professionalism and problem solving, and partially as communication, patient supporting and self-development. However, as only one program, public health law, was provided for MH program in phase-3 (5th and 6th grades), the extra methods to evaluate their MH outcomes are needed. Many assessing methods can be available for the most MH competencies consisting of the GO of KUSM, and the proper assessing methods for each MH competency should be selected based on programs and learning contexts in MH education. While formal MH curricula of the school variously accomplished the MH competencies of GO according to periodic phases of curricula, it is recommended to enhance the feasibility and effectiveness of evaluation for GO in MH curricula of the school.

A Brief Telephone Severity Scoring System and Therapeutic Living Centers Solved Acute Hospital-BedShortage during the COVID-19 Outbreak in Daegu, Korea

With the epidemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2, the number of infected patients was rapidly increasing in Daegu, Korea. With a maximum of 741 new patients per day in the city as of February 29, 2020, hospital-bed shortage was a great challenge to the local healthcare system. We developed and applied a remote brief severity scoring system, administered by telephone for assigning priority for hospitalization and arranging for facility isolation (“therapeutic living centers”) for the patients starting on February 29, 2020. Fifteen centers were operated for the 3,033 admissions to the COVID-19 therapeutic living centers. Only 81 cases (2.67%) were transferred to hospitals after facility isolation. We think that this brief severity scoring system for COVID-19 worked safely to solve the hospital-bed shortage. Telephone scoring of the severity of disease and therapeutic living centers could be very useful in overcoming the shortage of hospital-beds that occurs during outbreaks of infectious diseases.

Directions and Current Issues on the Policy of Prevention and Management for Hypertension and Diabetes, and Development of Chronic Disease Prevention and Management Model in Korea / 農村醫學 地域保健

Objectives@#The purpose of this manuscript was to propose the policy and perspectives of prevention and management for hypertension and diabetes in Korea. @*Methods@#Authors reviewed the chronic disease prevention and management projects and models were executed in Korea until now, and analyzed and evaluated their performances. @*Results@#In the circumstances of Korea, the following several requisites should be improved ; Specific Korean strategy for development and pursuing of national level policy agenda for chronic disease management must be established. There are a need to establish several means of supplementing the weaknesses of the current chronic disease management policies and programs. Firstly, development and distribution of contents of guidelines on the systematic project execution regime (regarding systematization of local community, subjects and contents of the projects) with guarantee for the quality of chronic disease prevention and management are necessary. Secondly, there is a need for development of information system that can lead the chronic disease management programs currently being implemented. Thirdly, there is urgent need to develop resources such as cultivation of manpower and facilities for provision of education and consultation for the patients and holders of risk factors of chronic disease. Fourthly, there is a need for means of securing management system and financial resources for operation of policies and programs. @*Conclusions@#The results can be able to use as a road map, models, and direction and strategies of policies for chronic disease prevention and management of Korea.

Implementation of a care coordination system for chronic diseases / 영남의대학술지

The number of people with chronic diseases has been increasing steadily but the indicators for the management of chronic diseases have not improved significantly. To improve the existing chronic disease management system, a new policy will be introduced, which includes the establishment of care plans for hypertension and diabetes patients by primary care physicians and the provision of care coordination services based on these plans. Care coordination refers to a series of activities to assist patients and their families and it has been known to be effective in reducing medical costs and avoiding the unnecessary use of the hospital system by individuals. To offer well-coordinated and high-quality care services, it is necessary to develop a service quality assurance plan, track and manage patients, provide patient support, agree on patient referral and transition, and develop an effective information system. Local governance should be established for chronic disease management, and long-term plans and continuous quality improvement are necessary.

Implementation of a care coordination system for chronic diseases / 영남의대학술지

The number of people with chronic diseases has been increasing steadily but the indicators for the management of chronic diseases have not improved significantly. To improve the existing chronic disease management system, a new policy will be introduced, which includes the establishment of care plans for hypertension and diabetes patients by primary care physicians and the provision of care coordination services based on these plans. Care coordination refers to a series of activities to assist patients and their families and it has been known to be effective in reducing medical costs and avoiding the unnecessary use of the hospital system by individuals. To offer well-coordinated and high-quality care services, it is necessary to develop a service quality assurance plan, track and manage patients, provide patient support, agree on patient referral and transition, and develop an effective information system. Local governance should be established for chronic disease management, and long-term plans and continuous quality improvement are necessary.

Projections of Demand for Cardiovascular Surgery and Supply of Surgeons

BACKGROUND: While demand for cardiovascular surgery is expected to increase gradually along with the rapid increase in cardiovascular diseases with respect to the aging population, the supply of thoracic and cardiovascular surgeons has been continuously decreasing over the past 10 years. Consequently, this study aims to achieve guidance in establishing health care policy by analyzing the supply and demand for cardiovascular surgeries in the medical service area of Korea. METHODS: After investigating the actual number of cardiovascular surgeries performed using the National Health Insurance claim data of the Health Insurance Review and Assessment Service, as well as drawing from national statistics concerning the elderly population aged 65 and over, this study estimated the number of future cardiovascular surgeries by using a cell-based model. To be able to analyze the supply and demand of surgeons, the recent status of new surgeons specializing in thoracic and cardiovascular surgeries and the ratio of their subspecialties in cardiovascular surgeries were investigated. Then, while taking three different scenarios into account, the number of cardiovascular surgeons expected be working in 5-year periods was projected. RESULTS: The number of cardiovascular surgeries, which was recorded at 10,581 cases in 2014, is predicted to increase consistently to reach a demand of 15,501 cases in 2040—an increase of 46.5%. There was a total of 245 cardiovascular surgeons at work in 2014. Looking at 5 year spans in the future, the number of surgeons expected to be supplied in 2040 is 184, to retire is 249, and expected to be working is 309—an increase of −24.9%, 1.6%, and 26.1%, respectively compared to those in 2014. This forecasts a demand-supply imbalance in every scenario. CONCLUSION: Cardiovascular surgeons are the most central resource in the medical service of highly specialized cardiovascular surgeries, and fostering the surgeons requires much time, effort, and resources; therefore, by analyzing the various factors affecting the supply of cardiovascular surgeons, an active intervention of policies can be prescribed for the areas that have failed to meet the appropriate market distributions.

Reconstruction of Radiation Dose Received by Diagnostic Radiologic Technologists in Korea / 예방의학회지

OBJECTIVES: Diagnostic medical radiation workers in Korea have been officially monitored for their occupational radiation doses since 1996. The purpose of this study was to design models for reconstructing unknown individual radiation doses to which diagnostic radiation technologists were exposed before 1996. METHODS: Radiation dose reconstruction models were developed by using cross-sectional survey data and the personal badge doses of 8167 radiologic technologists. The models included calendar year and age as predictors, and the participants were grouped into six categories according to their sex and facility type. The annual doses between 1971 and 1995 for those who were employed before 1996 were estimated using these models. RESULTS: The calendar year and age were inversely related to the estimated radiation doses in the models of all six groups. The annual median estimated doses decreased from 9.45 mSv in 1971 to 1.26 mSv in 1995, and the associated dose variation also decreased with time. The estimated median badge doses from 1996 (1.22 mSv) to 2011 (0.30 mSv) were similar to the measured doses (1.68 mSv to 0.21 mSv) for the same years. Similar results were observed for all six groups. CONCLUSIONS: The reconstruction models developed in this study may be useful for estimating historical occupational radiation doses received by medical radiologic technologists in Korea.

Effect of Staged Education Program for Hypertension, Diabetes Patients in a Community (Assessment of Quality of Life Using EQ-5D) / 農村醫學 地域保健

OBJECTIVE: This study was conducted in order to evaluate an education program for cardio-cerebrovascular high-risk patients. METHODS: To evaluate patients' quality of life, EQ-5D was used and an organized survey was conducted via calls and interviews for hypertension, diabetes patients who had visited the KHyDDI(Korea Hypertension Diabetes DaeguInitiative) education center or 70 clinics through out the nation. RESULTS: The subjects included 537 patients, 320 of who were in the clinic education and 217 of who were in the education center program. Sixty eight of the subjects went through the EQ-5D evaluation before and after the education program. In the EQ-5D index distribution of their quality of life before the education program, there was a statistically significant difference in gender(p<0.001) with higher points among males. Regarding age, there was a statistically significant difference between those aged over 65 years and under 65(p<0.001), with higher points in the group under the age of 65. Further, the EQ-5D 5 scope index was statistically significant different before and after receiving the education(p<0.05). CONCLUSION: Therefore, the KHyDDI staged education program is effective for improving the quality of life. Moreover, it could contribute to the complications of the disease through a variety of approaches by considering both gender and age.

Community-based Nutritional Management for Secondary Prevention of Diabetic Macrovascular Diseases / 임상당뇨병

Community health projects focusing on secondary prevention of diabetic macrovascular diseases have become increasingly common. In Daegu, Korea, a metropolitan hypertension diabetes management project has been developed in which community primary physicians refer clinic patients to education centers or clinical education teams for target education on lifestyle modification through technology-based information networks. Call centers provide information on lifestyle management and encourage continuous treatment through periodic calls and SMS. Integrative education is presented by doctors, dietitians, exercise specialists, and nurses. This project was developed in response to an educational need study of patients and educators. Patients participating in the program showed significant improvement in both self-efficiency and in clinical outcomes.

Development and Evaluation of a Community Staged Education Program for the Cardiocerebrovascular Disease High-risk Patients / 農村醫學 地域保健

OBJECTIVE: This study was conducted to evaluate an education program for cardiocerebrovascular high-risk patients. METHODS: This program was developed according to Tyler's model for curriculum development. To evaluate the effects of this program, we measured clinical outcome change (weight, waist circumference, systolic blood pressure, diastolic blood pressure) and behavior change stages (checking blood pressure, blood sugar levels, doing physical activity, consistent maintenance of food intake, eating low amounts of salt, abstention from tobacco and alcohol) before and 4 weeks after participation in the education program. The group of subjects consisted of High-risk group patients who attended basic program(32 patients), and staged program(37 patients) during KHyDDI meetings from Oct. 2009 to May 2010. RESULTS: The staged educational program was developed three aspects(disease, nutrition and exercise)and three stages(basic, in-depth and individual education). In the staged education program, the evaluations were made by measuring clinical outcome and stage of behavior before and after education. Significant differences were found in waist circumference, systolic blood pressure, diastolic blood pressure, consistent maintenance of food intake(p<0.05), and eating low salt(p<0.001) and their self efficacy. CONCLUSION: In the practice-oriented staged education program, significant differences were found in the clinical outcomes and stage of behavior before and after education. Possible limitations of the study include the small number of participating subjects and the short follow-up management period, but the results indicate that continued application of this program could contribute to the prevention of cardiocerebrovascular diseases for the elderly patients with long periods of chronic diseases.

Effects of Nutritional Education Practice Program for Cardiocerebrovascular High-risk Group at the Education Information Center / 대한지역사회영양학회지

This research was performed to investigate the effects of NEP (Nutritional Education Practice) program developed by KHyDDI (Korea Hypertension Diabetes Daegu Initiative) for hypertension and diabetes patients. The subjects were 116 patients (hypertension 70, diabetes 46) who had completed basic education program at the education information center and four-session program was implemented for them. Nutrient intake was analyzed and compared before and after the program by 24-hr recall method and evaluate weight, waist circumference, body fat, blood pressure and eating habits in terms of nutrition knowledge, eating behavior, salty taste assessment. The improved results after the program were observed in weight, waist circumference, body fat ratio, blood pressure, slightly salty taste in salty taste assessment, nutrition knowledge, eating behavior, sodium, energy, carbohydrate and protein intake ratio to total energy (p < 0.001). Therefore, this program is effective in the improvement of weight, waist circumference and eating behavior, and the continued management would lead to the prevention of cardio-cerebrovascular diseases in the community.

Prevalence of Diabetes Mellitus and Prediabetes in Dalseong-gun, Daegu City, Korea

BACKGROUND: The aim of the present study was to determine the population-based prevalence of diabetes mellitus (DM) and prediabetes in a rural district of Daegu City, Korea. METHODS: Between August and November 2003, a community-based health survey of adults aged 20 years and older was performed in the rural district of Dalseong-gun in Daegu City. A total of 1,806 of all eligible individuals agreed to participate. Fasting plasma glucose was measured in all participants. Two hour oral glucose tolerance was measured in the 1,773 participants for whom there was neither an established diagnosis of DM nor evidence of DM according to fasting glucose levels. The prevalence of DM and prediabetes was determined according to the 2003 criteria of the American Diabetes Association. Subjects with prediabetes were classified into one of three categories of glucose intolerance: isolated impaired fasting glucose (IFG); isolated impaired glucose tolerance (IGT); or combined IFG and IGT. RESULTS: The prevalence of DM was 12.2%. The highest prevalence rates were observed in subjects in their seventies. A total of 34.7% of all subjects who were assigned a diagnosis of DM in the present study had not been diagnosed previously. The prevalence of prediabetes was 22.7%. The highest prevalence rates were observed in subjects in their fifties. CONCLUSION: The present study identified prevalence rates of 12.2% for DM (age-standardized prevalence rate [ASR], 6.8%), and 22.7% for prediabetes (ASR 18.5%). These results emphasize the need for community health promotion strategies to prevent or delay the onset of DM in individuals with prediabetes.

What is the 'objective' differential factor of diarrhea in infancy?: Normal state versus diarrheal illness in infants with chronic frequent and loose stool / 소아과

PURPOSE: This study aimed to identify 'objective' differential factors for normal frequent loose stool (NFLS) and diarrheal illness with dehydration and nutritional deficiency (DIDN) among infants with chronic frequent loose stool (CFLS). METHODS: Data were analyzed from infants under 2 years of age with CFLS who had been transferred from general pediatricians. These 46 patients were divided into 2 groups (NFLS versus DIDN). Nocturnal stool was defined as evacuation between 10 pm and 6 am. Maximal stool amount/day (measured using the mother's hand) was specified as the highest score during the period of CFLS obtained by adding up each evacuation's score (range, 0-2 points). RESULTS: There were 36 cases of NFLS and 10 of DIDN. A failure to gain weight (P=0.0001), fever (P=0.0079), colic/abdominal pain (P=0.0014), gross blood in stool (except allergic proctocolitis) (P=0.0113), nocturnal stool (P=0.0001), and the score of stool amount (P=0.0001) were found to significantly differentiate the groups. A failure to gain weight was observed in 39% of even NFLS. The frequency, mucus content, and microbiological findings of stools, as well as diaper dermatitis were not found to significantly differentiate the groups. CONCLUSION: NFLS was more common than DIDN in infants with CFLS. The most 'objective' differential factors were nocturnal stool and the score of stool amount (> or =7 points/day).

Estimation of Sodium Intake of Adult Female by 24-Hour Urine Analysis, Dietary Records and Dish Frequency Questionnaire (DFQ 55)

This study assesses the sodium intake of adults by 24-hour urine analysis, dietary records review and a food intake questionnaire. Subjects were 236 adult female in Daegu. The results are summarized as follows: Sodium intake as indicated by the 24-hour urine analysis was 5,805.4 +/- 3836.8 mg. This was significantly higher than intake indicated by dietary records (4415.4 +/- 1935.1 mg) and the dish frequency questionnaire (DFQ 55)(4293.5 +/- 1526.5 mg). The results of the 24-hour urine analysis and DFQ 55 showed that sodium intake was higher for the 65-to-74-year-old age group than for other age groups (p < 0.05, p < 0.05). Review of dietary records to examine typical sodium intake by food groups showed that 53.7% of the sodium consumed by subjects in all age groups came from seasonings and spices (2399.0 +/- 1526.5 mg). The analysis of sodium intake by food groups using DFQ 55 showed 34.2% of their sodium came from consumption of kimchi (p < 0.001) and kimch, soup, stew and fish jorim accounted for 57.8% of total sodium intake. The results indicate positive correlation between age and sodium intake, as shown by the 24-hour urine analysis and food intake questionnaire (p < 0.05). Therefore, these results would be valuable as basic data for planning nutrition education for sodium intake reduction.

Diagnostic Analysis of Patients with Essential Hypertension Using Association Rule Mining / 대한의료정보학회지

OBJECTIVES: The purpose of this study was to analyze the records of patients diagnosed with essential hypertension using association rule mining (ARM). METHODS: Patients with essential hypertension (ICD code, I10) were extracted from a hospital's data warehouse and a data mart constructed for analysis. Apriori modeling of the ARM method and web node in the Clementine 12.0 program were used to analyze patient data. RESULTS: Patients diagnosed with essential hypertension totaled 5,022 and the diagnostic data extracted from those patients numbered 53,994. As a result of the web node, essential hypertension, non-insulin dependent diabetes mellitus (NIDDM), and cerebral infarction were shown to be associated. Based on the results of ARM, NIDDM (support, 35.15%; confidence, 100%) and cerebral infarction (support, 21.21%; confidence, 100%) were determined to be important diseases associated with essential hypertension. CONCLUSIONS: Essential hypertension was strongly associated with NIDDM and cerebral infarction. This study demonstrated the practicality of ARM in co-morbidity studies using a large clinic database.

The Medical Doctors' Opinion of Public Health Center on the Development and Supply of Medical Doctor for Public Health Sector / 農村醫學 地域保健

OBJECTIVES: This study, as for activating measures for capable medical physicians to penetrate into the public health sector, is to provide a basic informations which are used for the enlargement of human resources of physicians in the public health sector, by investigating the perception of physicians, who are now working in the public health center, on the training and development of physicians in the public health sector. METHODS: The subjects of this study were 126 individuals. The data was analyzed by frequency analysis using SPSS ver. 17.0K. RESULTS: According to the investigation of 'how to support physicians in public health sector', the necessity of almost questions is considered to be important. Especially, regarding to investigation on 'obstacles of physicians' entrance to public health sector', 'relatively low salary' and 'lack of promotion chances' were thought to be considerable. The most significant education programs to work for public health sector is to improve the ability of health administration planning and service performance. CONCLUSIONS: The important methods to reinforce and easily obtain the human resources of physicians in public health sector are not only to improve the penetration of physicians to public health sector, but also to enhance the ability of present physicians, even though sufficient recruitment of physicians is essential.

Drinking and Its Relationship with Smoking among University Students / 農村醫學 地域保健

OBJECTIVES: This study examines the drinking behaviors and the relationship between drinking and smoking behaviors among some Korean university students. METHODS: A self-administered questionnaire survey was conducted in May, 2006. A total of 1,163 students(715 male and 448 female) completed questionnaires, who were randomly selected in a university in Gyeongsangbuk-Do, Korea. RESULTS: The overall drinking and smoking rates for male subjects were 88.7% and 37.2%, and those for females were 83.5% and 2.2%, respectively. Among the male drinkers 39.9% smoked, while 16.0% of the male non-drinkers were smokers. As male drinkers drink more often, heavier amount per drinking episode, even on a binge, their smoking rate was high. The subjects reported there was positive reinforcement between drinking and smoking behaviors. CONCLUSIONS: The drinking rate of students was relatively high, especially for male students drinking behavior was strongly correlated with smoking behavior. Health promotion programs should be targeted at university students considering drinking and smoking behaviors simultaneously.

Farmers'Syndrome and its Risk Factors of Vinylhouse and Non-vinylhouse Farmers in Gyeongbuk Province Rural Area / 대한산업의학회지

OBJECTIVES: This study was performed to estimate the risk factors affecting the farmers'syndrome of vinylhouse and non-vinylhouse farmers in the Gyeongbuk Province rural area. METHODS: As a cross-sectional study, a questionnaire survey was conducted from 2003 to 2005. Data was collected from 243 vinylhouse farmers and 236 non-vinylhouse farmers. The data from 394 subjects were used for the final analysis. We surveyed their lifestyle, 8 components of farmers'syndrome and characteristics of farm work. RESULTS: For the vinylhouse and non-vinylhouse workers, 32.0% and 34.0% were positive for farmers syndrome, while 48.3% and 43.5% were suspicious, respectively. The differences between the two groups were not significant. For both groups, the most frequent symptom of farmers'syndrome was lumbago, followed by paresthesia of hand or foot, and shoulder stiffness. Among the vinylhouse workers, the rates of wearing protective equipment and washing the skin after spraying pesticide were significantly lower than among the non-vinylhouse workers. From multiple logistic regression analysis, the risk factors significantly associated with farmers'syndrome were sex {odds ratio (OR)=3.12, 95% confidence interval (CI)=1.42-6.89} and hours of farming per day (OR=2.63, 95%CI=1.22-5.65) among vinylhouse workers. However, sex (OR=4.24, 95%CI=1.87-9.65) was the only the risk factor significantly associated with farmers'syndrome among the non-vinylhouse workers. CONCLUSIONS: In conclusion, educational programs and attention to the female farmers were needed in particular. In addition, it was recommended that the farmers wear protective equipment continuously from opening the coverlets of the pesticide container to the completion of pesticide spraying, and wash the skin immediately after contact with pesticides.

Three Cases of High Signal Intensity by Brain Magnetic Resonance Imaging in CO2 arc Welders / 대한산업의학회지

We experienced three cases of high signal intensity observed by Brain Magnetic Resonance Imaging in CO2 arc welders of steel-frame manufacturing industry. Case 1 was a 35 years old man who has been an CO2 arc welder for 10 years, admitted a sudden onset of tonic clonic seizure. He complained fever, chilling and myalgia since 3 days before admission. On admission, in the test of manganese exposure indices, manganese concentrations of blood, urine and scalp hair were 5.17 microgram/dL, 22.00 microgram/l and 31.25 ppm respectively. Case 2 was a 35 years old man who has been an CO2 arc welder for 20 years. On admission, He complained fatigue, numbness and weakness of extremities, and decrease of libido. In the test of manganese exposure indices, manganese concentrations of blood, urine and scalp hair were 6.34 microgram/dL, 14.62 microgram/l and 57.87 ppm respectively. In neurologic examination, Palmo-mentis reflex and Myerson sign were observed. Case 3 was a 33 years old man who has been an CO2 arc welder for 16 years. On admission, He complainer loss of appetite, numbness of extremities, fatigue and decrease of attention. In the test of manganese exposure indices, manganese concentrations of blood, urine and scalp hair were 5.14 microgram/dL, 13.79 microgram/l and 50.08 ppm respectively. In neurologic examination, Myerson sign was observed. In brain magnetic resonance imaging, T1WI showed symmetrical high signal intensity in basal ganglia and midbrain of three cases. Authors argued that they were developed by manganese exposure, and we considered that follow up study would be necessary.