Journal of Preventive Medicine and Public Health

Methods

Health Indicators Related to Disease, Death, and Reproduction: Jeoungbin Choi, Moran Ki, Ho Jang Kwon, Boyoung Park, Sanghyuk Bae, Chang-Mo Oh, Byung Chul Chun, Gyung-Jae Oh, Young Hoon Lee, Tae-Yong Lee, Hae Kwan Cheong, Bo Youl Choi, Jung Han Park, Sue K. Park; J Prev Med Public Health. 2019;52(1):14-20. Published online January 23, 2019; DOI: https://doi.org/10.3961/jpmph.18.250

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Abstract Summary PDF Supplementary Material

One of the primary goals of epidemiology is to quantify various aspects of a population’s health, illness, and death status and the determinants (or risk factors) thereof by calculating health indicators that measure the magnitudes of various conditions. There has been some confusion regarding health indicators, with discrepancies in usage among organizations such as the World Health Organization the, Centers for Disease Control and Prevention (CDC), and the CDC of other countries, and the usage of the relevant terminology may vary across papers. Therefore, in this review, we would like to propose appropriate terminological definitions for health indicators based on the most commonly used meanings and/or the terms used by official agencies, in order to bring clarity to this area of confusion. We have used appropriate examples to make each health indicator easy for the reader to understand. We have included practical exercises for some health indicators to help readers understand the underlying concepts.

Summary

Korean summary
본 논문에서는 질병과 사망, 출생 관련 지표들의 개념과 종류를 설명하고, 특히 연구자들이 흔히 혼동하여 사용하는 지표들에 대한 적절한 정의를 제시하였다. 또한 지표들의 예시를 부록으로 수록하여 독자들이 지표의 개념을 보다 쉽게 습득하도록 돕고자 하였다.

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English Abstracts

Study on the Health Status of the Residents near Military Airbases in Pyeongtaek City.: Hyunjoo Kim, Sangchul Roh, Ho Jang Kwon, Ki Chung Paik, Moo Yong Rhee, Jae Yun Jeong, Myung Ho Lim, Mi Jin Koo, Chang Hoon Kim, Hae Young Kim, Jeong Hun Lim, Dong Hyun Kim; J Prev Med Public Health. 2008;41(5):307-314.; DOI: https://doi.org/10.3961/jpmph.2008.41.5.307

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Abstract PDF

OBJECTIVES
We conducted an epidemiologic survey to evaluate the effect of the aircraft noise exposure on the health of the residents near the military airbases in Pyeongtaek City. METHODS: The evaluation of environmental noise level, questionnaire survey, and health examination were performed for 917 residents. The study population consisted of four groups: subjects who lived in the village close to the fighter airbase (high exposure), subjects who lived along the course of fighters (intermediate exposure), and subjects near a helicopter airbase, and the control group. RESULTS: The prevalence of the aircraft noise related accident and irritable bowel syndrome in the exposure groups were higher than that of the control group. The risks of noise induced hearing loss, hypertension and diabetes mellitus were higher in the exposed groups than in the control group. The prevalence of anxiety disorder and primary insomnia were higher in the exposed groups than in the control group. Prevalence odd ratios of the risk for primary insomnia after adjusting age, sex, agricultural noise, and occupation were 4.03 [95% confidence interval (95% CI) 1.56-10.47] for the subject near the helicopter airbase, 1.23 (95% CI 0.40-3.76) for those intermediately exposed to fighter noise, and 4.99 (95% CI 2.14-11.64) for those highly exposed to fighter noise. CONCLUSIONS: The results of the present study suggest that the aircraft noise may have adverse effects on hearing function, cardiovascular health and mental health. Therefore, it seems to be needed to take proper measures including the control of the aircraft noise and the management of the exposed people's health.

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Mohammad Javad Zare Sakhvidi, Fariba Zare Sakhvidi, Amir Houshang Mehrparvar, Maria Foraster, Payam Dadvand
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The Prevalence of Functional Gastrointestinal Disorders in the Chinese Air Force Population
Wenming Wu, Xu Guo, Yunsheng Yang, Lihua Peng, Gaoping Mao, Hyder Qurratulain, Weifeng Wang, Gang Sun
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Spatial Analysis of Air Pollution and Lung Cancer Incidence and Mortality in 7 Metropolitan Cities in Korea. .: Seung Sik Hwang, Jin Hee Lee, Gyu Won Jung, Jeong Hun Lim, Ho Jang Kwon; J Prev Med Public Health. 2007;40(3):233-238.; DOI: https://doi.org/10.3961/jpmph.2007.40.3.233

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Abstract PDF

OBJECTIVES
We aimed to assess the relationship between long-term exposure to air pollution and lung cancer in the Republic of Korea. METHODS: Using the Annual Report of Ambient Air Quality in Korea, Annual Report of National Cancer Registration, and Annual Report on the Cause of Death Statistics, we calculated the standardized mortality ratio (SMR) and standardized incidence ratio (SIR) of lung cancer for both sexes in 74 areas from 7 Korean metropolitan cities. We performed random intercept, Poisson regression using empirical Bayes method. RESULTS: Both SMRs and SIRs in the 7 metropolitan cities were higher in women than in men. Mean SIRs were 99.0 for males and 107.0 for females. The association between PM(10) and lung cancer risk differed according to gender. PM(10) was not associated with the risk of lung cancer in males, but both incidence and mortality of lung cancer were positively associated with PM(10) in females. The estimated percentage increases in the rate of female lung cancer mortality and incidence were 27% and 65% at the highest PM(10) category (> or = 70 microgram/m(3)), compared to the referent category (<50 microgram/m(3)). CONCLUSIONS: Long-term exposure to PM(10) was significantly associated with female lung cancer incidence in 7 Korean metropolitan cities. Further study is undergoing to estimate the relative risk of PM(10) using multi-level analysis for controlling individual and regional confounders such as smoking and socioeconomic position.

Summary

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Effects of Personal Exposure to Nitrogen Dioxide on Peak Expiratory Flow in Asthmatic Patients.: Ho Jang Kwon, Sang Gyu Lee, Young Koo Jee, Sang Rok Lee, Seung Sik Hwang; J Prev Med Public Health. 2007;40(1):59-63.; DOI: https://doi.org/10.3961/jpmph.2007.40.1.59

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Abstract PDF

OBJECTIVES
Nitrogen dioxide (NO2) has been inconsistently associated with gradual decreases in lung function. Here, we studied the effects of NO2 exposure in asthmatics by examining the association between changes in lung function and concentrations of NO2 which were personally measured. METHODS: Peak expiratory flow (PEF) and daily personal exposures to NO2 were recorded on 28 patients with asthma (confirmed by methacholine provocation test) over 4 weeks. We used generalized estimating equations to assess the relationship between personal NO2 exposure and PEF, adjusting for potential confounders such as age, gender, outdoor particulate matter, temperature, humidity, and exposure to environmental tobacco smoke. RESULTS: The personal NO2 exposures were higher than the corresponding ambient levels. The mean personal: ambient ratio for NO2 was 1.48. The personal NO2 exposures were not associated with the morning PEF, evening PEF, or the diurnal PEF variability. However, environmental tobacco smoke was negatively associated with both the morning and evening PEF. CONCLUSIONS: Among the asthmatic adults who participated in this study, we found no apparent impact of personal NO2 exposures on the peak expiratory flow.

Summary

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The statistical evaluation and comparison of ADMS-Urban model for the prediction of nitrogen dioxide with air quality monitoring network
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In Vitro

Exposure Assessment of PCDD/Fs and Monitoring of Health Effects on Workers and Residents near the Waste Incinerators in Korea.: Jong Han Leem, Yun Chul Hong, Kwan Hee Lee, Ho Jang Kwon, Jae Yeon Jang; Korean J Prev Med. 2003;36(4):314-322.

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Abstract PDF: OBJECTIVES
In this study, the exposure status of the hazardous substances from incinerators, such as polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs), were studied, and the relationship between the exposure of these hazardous substances and their heath effects on the workers and residents near municipal solid waste (MSW) incinerators and an industrial incinerator investigated. METHODS: Between July 2001 and June 2002, 13 workers at two MSW incinerators, 16 residents from the area around the two MSW incinerators, 6 residents from the control area, and further 10 residents near an industrial incinerator, estimated to emit higher levels of hazardous substances, were interviewed. Information, including sociodemographic information, personal habits, and work history, detailed gynecologic and other medical history were collected through interviews. Blood samples were also collected from 45 subjects, and analyzed for PCDD/DFs, by high resolution gas chromatography - high resolution mass spectrometry, using the US EPA 1613 method. In addition to the questionnaire survey, urinary concentrations of 8-hydroxydeoxyguanosine (8-OH-dG) and malondialdehyde (MDA) were measured as oxidative injury biomarkers. The urinary concentrations of 8-OH-dG were determined by in vitro ELISA, and the MDA by HPLC, using an adduct with thiobarbituric acid. RESULTS: The PCDD/DFs concentrations in the residents near the industrial incinerator were higher than those in the controls, workers and residents near the MSW incinerators. The average TEQ (Toxic Equivalencies) concentrations of the PCDD/DFs in residents near the industrial incinerator were 53.4pg I-TEQs/g lipid. The estimated daily intakes were within the tolerable daily intake range (1-4 pg I-TEQ/Kg bw/day) suggested by WHO (1997) in only 30% to the people near the industrial incinerator. Animal studies have already shown that even a low body burden of PCDD/DFs, such as 10ng TEQ/kg bw, can cause oxidative damage in laboratory animals. Our study also showed that the same body burden of PCDD/DFs can cause oxidative damage to humans. CONCLUSIONS: The exposures to PCDD/DFs and the oxidative stress of residents near the industrial incinerator, were higher than those in the controls, workers and residents near the MSW incinerators. Proper protection strategies against these hazardous chemicals are needed. Because a lower body burden of PCDD/Fs, such as 10ng TEQ/kg bw, can cause oxidative damage, the tolerable daily intake range should be restrictedly limited to 1pg I-TEQ/kg bw/day.; Summary

Review

Dioxins and Health: Human Exposure Level and Epidemiologic Evidences of Health Effects.: Jae Yeon Jang, Ho Jang Kwon; Korean J Prev Med. 2003;36(4):303-313.

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Abstract PDF: 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.; Summary

Original Articles

Perceptions of the Asian Dust: Analysis of the Newspaper Articles about the Asian Dust.: Hyoung June Im, Mina Ha, Soo Hun Cho, Ho Jang Kwon; Korean J Prev Med. 2003;36(3):298-301.

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Abstract PDF: OBJECTIVES
There is an increasing concern for the social, economic, environmental and health effects of the Asian dust (Hwang-sa in Korean language) in Korea. In this study, we intended to indirectly determine ordinary people's perception about the Asian dust by analyzing the contents of newspaper articles dealing with it. METHODS: By using article searching services in the internet websites of three newspaper companies, we collected newspaper articles dealing with the Asian dust during the period from January 1st of 1998 to December 31st of 2002. We classified the articles into four categories: those forecasting the occurrence of the Asian dust, those about measures to cope with it, those about its occurrence in the neighboring foreign countries, and those about its effects. In particular, we analyzed articles about the health effects of the Asian dust more distinctly. RESULTS: A total of 1, 225 articles dealing with the Asian dust were found during the 5 year period. The number of articles increased from 102 in 1998 to 518 in 2002, approximately a five-fold increase. The numbers of articles about health effects, environmental effects and economical effects were 191 (44%), 171 (41%) and 147 (34%), respectively. It was reported that various diseases such as respiratory diseases (87%), eye problems (69%), and skin diseases (12%) were associated with the Asian dust. CONCLUSION: The increasing concern for the negative effects of the Asian dust necessitates more studies about this field. As the effects of the Asian dust are various, the information on the major concern of ordinary people could help establish the research agendas and measures for the Asian dust.; Summary

Quantifying the Burden of Cardiovascular Disease Attributable to Total Suspended Particulate and Sulfur Dioxide Using Years Lived with Disability.: Seok Jun Yoon, Beom Man Ha, Jong Won Kang, Ho Jang Kwon; Korean J Prev Med. 2002;35(2):92-98.

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Abstract PDF: OBJECTIVE
To estimate the burden of cardiovascular disease attributable to the total suspended particulates (TSP) and sulfur dioxide (SO2) in Korea using the YLD (years lived with disability) measurement. METHODS: Congestive heart failure(CHF) and myocardial infarction (MI) were chosen as the main cardiovascular diseases whose causes are attributable to the TSP and SO2 levels. In order to calculate the YLD (years lived with a disability), the following parameters in the formula were estimated. : the incidence rate, the case fatality rate, The expected duration of a disability and the average age of onset were estimated. The expected duration of a disability and the average age of onset were calculated using the DISMOD method, as developed by the GBD researchers. The burden of cardiovascular disease due to TSP and SO2 was estimated using the number of years that the patient lived with a disability. RESULTS: The YLD of the CHF due to the TSP and SO2 was attributed to the TSP (94.4 person-year) and SO2 levels (35.0 person-year). The YLD of the MI due to the TSP and SO2 was attributed to the TSP (148.4 person-year) and SO2 levels(27.6 person-year). CONCLUSION: The YLD method employed in this study was appropriate for quantifying the burden of cardiovascular disease. Therefore, it would provide a rational basis for planning a national health policy regarding the disease burden of the risk factors in Korea.; Summary

Issues in Air Pollution Epidemiologic Studies.: Eun Hee Ha, Ho Jang Kwon; Korean J Prev Med. 2001;34(2):109-118.

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Abstract PDF: The purpose of this review is to discuss the debate concerning the interpretation of epidemiologic studies on particles and health effects. Study of the 1952 air pollution disaster in London established that very high levels of particulate-based smog can cause dramatic increases in daily mortality. However, recent epidemiologic studies have reported statistically significant health effects and mortality due to low levels of air pollution. The statistical significance does not prove causation in observational studies; therefore it is necessary to evaluate these associations. There are arguments for and against each of the numerous studies using Hill's criteria, however the body of accepted evidence supports the causal association. In particular, a high level of consistency in the estimated effect of PM10 has been observed across studies worldwide. The mechanism of the relationship between air pollution and health effects is not obvious. The mechanism of particle-induced injury may involve the production of an inflammatory response by the particulate. The harvesting and the threshold effect are also major concerns regarding the health effects of air pollution. However, current epidemiologic findings indicate that linear models lacking a threshold are appropriate for assessing the effect of particulate air pollution on daily mortality even at current levels.; Summary

Development of Work-related Musculoskeletal Disorder Questionnaire Using Receiver Operating Characteristic Analysis.: Jaiyong Kim, Ho Jang Kwon, Yeongsu Ju, Soo Hun Cho, Daehee Kang, Joohon Sung, Seong Woo Choi, Jae Wook Choi, Jae Young Kim, Don Gyu Kim; Korean J Prev Med. 1999;32(3):361-373.

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Abstract PDF: OBJECTIVES
Receive Operating Characteristic(ROC) curve with the area under the ROC curve(AUC) is one of the most popular indicator to evaluate the criterion validity of the measurement tool. This study was conducted to develop a standardized questionnaire to discriminate workers at high-risk of work-related musculoskeletal disorders using ROC analysis. METHODS: The diagnostic results determined by rehabilitation medicine specialists in 370 persons(89 shipyard CAD workers, 113 telephone directory assistant operators, 79 women with occupation, and 89 housewives) were compared with participant's own replies to 'the questionnair on the worker's subjective physical symptoms'(Kwon, 1996). The AUC's from four models with different methods in item selection and weighting were compared with each other. These 4 models were applied to 225 persons, working in an assembly line of motor vehicle, for the purpose of AUC reliability test. RESULTS: In a weighted model with 11 items, the AUC was 0.8155 in the primary study population, and 0.8026 in the secondary study population(p=0.3780). It was superior in the aspects of discriminability, reliability and convenience. A new questionnaire of musculoskeletal disorder could be constructed by this model. CONCLUSION: A more valid questionnaire with a small number of items and the quantitative weight scores useful for the relative comparisons are the main results of this study. While the absolute reference value applicable to the wide range of populations was not estimated, the basic intent of this study, developing a surveillance tool through quantitative validation of the measures, would serve for the systematic disease prevention activities.; Summary

Air Pollution and Daily Mortality in Seoul.: Ho Jang Kwon, Soo Hun Cho; Korean J Prev Med. 1999;32(2):191-199.

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Abstract PDF: OBJECTIVES
To examine the relationship between air pollution exposure and mortality in Seoul for the years of 1991-1995. METHODS: Daily counts of death were analyzed by general additive Poisson model, with adjustment for effects of secular trend, seasonal factor, day of the week, heat wave, temperature, and humidity. Pollution variables were ozone, nitrogen dioxide, total suspended particles(TSP), and sulfur dioxide. RESULTS: Daily death counts were associated with ozone(1 day before), nitrogen dioxide(1 day before), TSP(2 days before), sulfur dioxide(2 days before). The association with ozone was most statistically significant and independent of other air pollutants. Increase of 100 ppb in ozone was associated with 6%(95% CI= 2%-10%) increase in the daily number of death. This effect was greater in persons aged 65 and older. The relative risks of death from respiratory disease and cardiovascular disease were greater than for all-cause mortality in each pollutant. After ozone level exceeds 25 ppb, the dose-response relationship between mortality and ozone was almost linear. However, the effect of TSP, sulfur dioxide, and nitrogen dioxide on mortality might be confounded with each other. CONCLUSION: Daily variations in air pollution within the range currently occurring in Seoul might have an adverse effect on daily mortality.; Summary

Reliability and Validity of the Korean Version of ISAAC Questionnaire.: Seong Woo Choi, Yeong Su Ju, Dae Sung Kim, Jae Yong Kim, Ho Jang Kwon, Dae Hee Kang, Sang Il Lee, Soo Hun Cho; Korean J Prev Med. 1998;31(3):361-371.

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Abstract PDF: Recent increases of asthma and allergies in childhood made the need for a standardized approach to international and regional comparisons of their prevalence and severity. To address these issues, "International Study of Asthma and Allergies in Childhood (ISAAC)" is currently underway. In Korea, "Nationwide Study of Asthma and Allergies in Korean Children" began in 1995 according to ISAAC protocol. ISAAC written and video questionnaires were used in this survey, but their reliability and validity were not evaluated properly yet. In this study, our aim was to evaluate the reliability and validity of two kinds of questionnaires and their usefulness in international and regional comparisons. The test and retest of two questionnaires were completed by male(n=110) and female(n=111) middle school students with two and three weeks interval each. Kappa(or weighted kappa) were calculated from each questions and validity coefficients were estimated from those statistics. In Korean version of written questionnaire, the questions for allergic rhinitis, atopic dermatitis, allergic conjunctivitis, and food allergy proved to have high kappa values(or weighted kappa values) and validity coefficients and they can be used in further studies without any correction. But some questions about asthma(especially nocturnal cough, wheezing in exercise, and severe asthma) and drug allergy need to be revised for better understanding to study subjects. Video questionnaire has the same degree of reliability and validity when compared to written questionnaire and this is the unexpected result. Accordingly, it also need to be revised to overcome the racial and cultural differences of the study subjects. In conclusion, the Korean version of written and video questionnaires may be considered to be useful methods in international and regional comparisons of asthma and allergic diseases in childhood after correction of some questions.; Summary

Reliability for Multiple Reviewers by using Loglinear Models.: Byung Joo Park, Sung Im Lee, Young Jo Lee, Dong Hyun Kim, Ho Jang Kwon, Jong Myon Bae, Myung Hee Shin, Mi Na Ha, Sang Whan Han; Korean J Prev Med. 1997;30(4):719-728.

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Abstract PDF: To guarantee the inter-reviewer reliability is very important in evaluating the quality of large number of clinical research papers by multiple reviewers. We cannot find reports on statistical methods for evaluating reliability for multiple raters in clinical research field. The purpose of this paper is to introduce the statistical methods focused on kappa statistic and five kinds of loglinear models for, which can be applied when evaluating the reliability of multiple raters. We have applied these methods to the result of a project, in which seven reviewers have evaluated the quality of 33 papers with regard to four aspects of paper contents including study hypothesis, study design, study population, study method, data analysis and interpretation. Among the five loglinear models including Symmetry model, Conditional symmetry model, Quasi-symmetry model, Independence model, and Quasi-independence model, Quasi-symmetry model shows the best model of fitting. And the level of reliability among seven reviewers revealed to be acceptable as meaningful.; Summary

The effects of aircraft noise on the hearing loss, blood pressure and response to psychological stress.: Sang Hwan Han, Soo Hun Cho, Kyungshim Koh, Ho Jang Kwon, Mina Ha, Yeong Su Ju, Myung Hee Shin; Korean J Prev Med. 1997;30(2):356-368.

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Abstract PDF: In effort to determine whether aircraft noise can have health effects such as hearing loss, hypertension and psychological stress, a total of 111 male professors and administrative officers working a college near a military airport in Korea(exposed group) and a total of 168 males and 112 females matched by age groups(control groups) were analyzed. Personal noise exposure and indoor and outdoor sound level of jet aircraft noise were measured at the exposed area. And pure tone, air conduction test and measurement of blood pressure were given to the exposed(males) and matched control groups(males and females). BEPSI(Brief Encounter Psychological Instrument) and psychological response to aircraft noise were examined for the exposed group. The noise dosimetry results revealed time-weighted averages(TWAs) that ranged from 61 to 68 dBA. However the levels encountered during taking off jet airplanes reached 126 dBA for two half minutes time period. The audiometric test showed that mean values of HTL(hearing threshold level) in exposed group at every frequency(500, 1,000, 2,000, 4,000, and 8,000 Hz were much lower than them of male and female control groups. And in old age groups, interaction of age and noise was observed at 8,000 Hz in both ears(p< 0.05). Conclusively, aircraft noise does not appear to induce hearing loss directly, but may decreased hearing threshold level by interaction of aging process and noise exposure. However, difference of mean values of exposed and control groups on blood pressure was not significantly. In psychological test, annoyance was the most severe psychological response to noise in exposed group, but mean value of BEPSI was not correlated with job duration in exposed group; Summary

Health Assessment for Glass Fibre Landfill at Gozan-dong, Inchon.: Soo Hun Cho, Yeong Su Ju, Kyung Ryul Kim, Kang Kun Led, Kug Sun Hong, Hee Chul Eum, Dong Bim Song, Jae Woong Hong, Ho Jang Kwon, Mi Na Ha, Sang Hwan Han, Jpp Heon Seong, Jong Won Kang; Korean J Prev Med. 1997;30(1):77-102.

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Abstract PDF: In September 1994, residents of Gozan-dong, Incheon City, made a petition to the government about their health problems which might be caused by previous glass fibre landfill nearby "H" company. In February 1995, at regular academic meeting of occupational and environmental medicine, a research team of "D" University presented that they had found glass fibres in groundwater of the area through their survey. They were suspicious of probable association between ingestion of groundwater contaminated with glass fibres and skin tumors among residents. A joint research team was formed and carried out the survey of environment concerning groundwater and its glass fibre existence, and health assessment of residents in the area and industrial workers of "H" company during May to November, 1995. Analysis of groundwater flow system indicates that the flow lines from the glass fibre landfill pass through or terminate at the 6 houses around the landfill. This means that the groundwater of the 6 houses around the glass fibre landfill could be affected by some possible contaminants from the landfill, but the groundwater quality of the other houses was irrelevant to the landfill. The qualitative and quatitative analyses for glass fibres in 54 groundwater samples including those from the nearby 6 houses, were carried out using SEM equipped with EDS, resulting in no evidence for the presence of glass fibres in the waters. Major precipitates, formed in waters while boiling, were identified as calcium carbonates, in particulary, aragonites in needle form. The results of health assessments of 889 residents in Gozan-dong, participated in this study, showed statistically significant differences in past medical histories of skin tumor and respiratory disease between the exposed group (31 persons who inhabited in 6 houses around the landfill) and the control group, but no significant differences in past medical histories of other diseases, such as cancer mortality, current gastroscopic findings, current skin diseases and respiratory diseases, etc. Also, we could not prove any glass fibres in excised specimens of 9 skin tumors in both groups and there were no health problems possibly associated with glass fibres in employees of the "H" company. After all, we could not authenticate the association, raised by prior investigators, between groundwater streams, assumedly contaminated with glass fibres or not, and specific disease morbidities or common disease/symptom prevalences. That is, we could not find any glass fibres in groundwater as the only exposure factor of this study hypothesis, and there were not enough certain evidences such as increasing disease prevalences, for examples, skin, respiratory and gastrointestinal diseases etc, possibly related to glass fibre exposure, in exposed group. As a matter of course, the conditions for confirming causal association, for example, strength of the association, consistency of the association, specificity of the association, temporality of the association and dose-response relationship etc, have not been satisfied. In conclusion, we were not able to certify the hypothesis that contamination of groundwater with glass fibres might cause any hazardous health effects in human who used it for drinking.; Summary

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