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Original Article
Correlations Among Maternal and Infant Factors, Lead Exposure, and Serum Prolactin Levels During Lactation: A Cross-sectional Study in Indonesia
Linda Ratna Wati, Djanggan Sargowo, Tatit Nurseta, Lilik Zuhriyah, Bambang Rahardjo
J Prev Med Public Health. 2023;56(5):422-430.   Published online August 22, 2023
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AbstractAbstract AbstractSummary PDF
Prolactin is vital for breastfeeding and milk production, and its secretion is influenced by factors related to the mother, infant, and environment. To date, no study has concurrently investigated the correlation of these factors with serum prolactin levels during lactation. Therefore, the objective of this study was to investigate the correlations among maternal and infant factors, lead exposure, and serum prolactin levels during lactation.
A cross-sectional approach was employed in Surabaya, Indonesia, among 110 exclusively lactating mothers. The mothers’ daily diets were determined using multiple 24-hour recalls, while blood lead levels were measured with inductively coupled plasma mass spectrometry. Serum prolactin levels were assessed using the electrochemiluminescence immunoassay. For bivariate analysis, we employed the Spearman correlation, Mann-Whitney, and Kruskal-Wallis tests, while for multivariate analysis, we utilized multiple linear regression.
The average serum prolactin level of the lactating mothers was 129.19±88.96 ng/mL. Positive correlations were found between serum prolactin levels and breastfeeding frequency (p < 0.001), protein intake (p < 0.001), and calcium intake (p = 0.011) but had negative correlation with blood lead levels (p < 0.001) and vitamin B6 intake (p = 0.003). Additionally, prolactin levels were not significantly associated with maternal age; parity; intake of calories, vitamin D, vitamin E, zinc, folic acid, magnesium, or iron; infant age; or infant sex.
Breastfeeding frequency had a stronger positive relationship with serum prolactin levels than protein and calcium intake. However, lead exposure was associated with reduced serum prolactin levels during lactation. Consequently, specific interventions from policymakers are necessary to manage breastfeeding in mothers exposed to lead.
Key Message
Prolactin secretion is influenced by factors related to the mother, infant, and environment, and this study was to investigate the correlations among maternal and infant factors, lead exposure, and serum prolactin levels during lactation. In total 110 exclusively lactating mothers were included, with information on their socio-demographic, daily diet, blood lead level, prolactin level, and infant characteristics. Breastfeeding frequency had a stronger positive relationship with serum prolactin levels than protein and calcium intake. However, lead exposure was associated with reduced serum prolactin levels during lactation. Consequently, specific interventions from policymakers are necessary to manage breastfeeding in mothers exposed to lead.
Case Report
Effective Decontamination and Remediation After Elemental Mercury Exposure: A Case Report in the United States
Kelly Johnson-Arbor, Brian Schultz
J Prev Med Public Health. 2021;54(5):376-379.   Published online August 26, 2021
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  • 90 Download
  • 1 Crossref
AbstractAbstract PDF
Elemental mercury exposure can result in significant toxicity. Source decontamination and remediation are often required after larger elemental mercury exposures, but the details of these processes are infrequently reported. In the case described herein, a 64-year-old woman and her husband were exposed to elemental mercury in their home after the husband purchased it online for the purpose of recreational barometer calibration. After the mercury reportedly spilled during the calibration process, a vacuum cleaner was used to decontaminate the affected surface; this led to extensive mercury contamination of the home. The couple was relocated from the home while remediation occurred over the course of several weeks. Vacuum cleaning of an elemental mercury spill can lead to extensive volatilization and recirculation of mercury vapor. For smaller mercury spills, careful removal of visible mercury beads by using an eyedropper, cardboard, and masking tape is recommended. Larger spills require professional decontamination and remediation and may necessitate involvement of governmental resources. Vacuum cleaning should not be used as an initial method of decontamination after elemental mercury exposure. Careful attention to source decontamination can reduce the emotional and financial costs associated with extensive remediation after elemental mercury exposure.


Citations to this article as recorded by  
  • Environmental fate of aquatic pollutants and their mitigation by phycoremediation for the clean and sustainable environment: A review
    S. Thanigaivel, Saranya Vinayagam, Lalitha Gnanasekaran, R. Suresh, Matias Soto-Moscoso, Wei-Hsin Chen
    Environmental Research.2024; 240: 117460.     CrossRef
Original Article
Airborne Nicotine Concentrations in the Workplaces of Tobacco Farmers
Seok-Ju Yoo, Sung-Jun Park, Byoung-Seok Kim, Kwan Lee, Hyun-Sul Lim, Jik-Su Kim, In-Shik Kim
J Prev Med Public Health. 2014;47(3):144-149.   Published online May 30, 2014
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  • 121 Download
  • 13 Crossref
AbstractAbstract PDF

Nicotine is a natural alkaloid and insecticide in tobacco leaves. Green tobacco sickness (GTS) is known as a disease of acute nicotine intoxication among tobacco farmers. Until now, GTS has been recognized globally as a disease that results from nicotine absorption through the skin. However, we assumed that GTS might also result from nicotine inhalation as well as absorption. We aimed to measure the airborne nicotine concentrations in various work environments of Korean tobacco farmers.


We measured the nicotine concentrations in the tobacco fields, private curing barns, and joint curing barns of farmers from July to October 2010. All sampling and analyses of airborne nicotine were conducted according to the National Institute for Occupational Safety and Health manual of analytic methods.


The airborne nicotine concentrations (geometric mean [geometric standard deviation]) in the tobacco field were 83.4 mg/m3 (1.2) in the upper region and 93.3 mg/m3 (1.2) in the lower region. In addition, the nicotine concentration by personal sampling was 150.1 mg/m3. Similarly, the nicotine concentrations in the private curing barn, workers in curing barns, the front yard of the curing barn, and in the joint curing barn were 323.7 mg/m3 (2.0), 121.0 mg/m3 (1.5), 73.7 mg/m3 (1.7), and 610.3 mg/m3 (1.0), respectively.


The nicotine concentration in the workplaces of tobacco farmers was very high. Future studies should measure the environmental concentration of nicotine that is inhaled by tobacco farmers.



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  • Socio-environmental risks associated with the green tobacco sickness in farmers: a case-control study
    Marcia Casaril dos Santos Cargnin, Marta Regina Cezar-Vaz, Caroline Ottobelli Getelina, Clarice Alves Bonow
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    Dilaram Acharya, Kwan Lee
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English Abstracts
Epidemiological Investigation for Outbreak of Food Poisoning Caused by Bacillus cereus Among the Workers at a Local Company in 2010.
Kum Bal Choi, Hyun Sul Lim, Kwan Lee, Gyoung Yim Ha, Kwang Hyun Jung, Chang Kyu Sohn
J Prev Med Public Health. 2011;44(2):65-73.
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  • 161 Download
  • 7 Crossref
AbstractAbstract PDF
In July 2 2010, a diarrhea outbreak occurred among the workers in a company in Gyeungju city, Korea. An epidemiological investigation was performed to clarify the cause and transmission route of the outbreak. METHODS: We conducted a questionnaire survey among 193 persons, and we examined 21 rectal swabs and 6 environmental specimens. We also delegated the Daegu Bukgu public health center to examine 3 food service employees and 5 environmental specimens from the P buffet which served a buffet on June 30. The patient case was defined as a worker of L Corporation and who participated in the company meal service and who had diarrhea more than one time. We also collected the underground water filter of the company on July 23. RESULTS: The attack rate of diarrhea among the employees was 20.3%. The epidemic curve showed that a single exposure peaked on July 1. The relative risk of attendance and non-attendance by date was highest for the lunch of June 30 (35.62; 95% CI, 2.25 to 574.79). There was no specific food that was statistically regarded as the source of the outbreak. Bacillus cereus was cultured from two of the rectal swabs, two of the preserved foods and the underground water filter. We thought the exposure date was lunch of June 30 according the latency period of B. cereus. CONCLUSIONS: We concluded the route of transmission was infection of dishes, spoons and chopsticks in the lunch buffet of June 30 by the underground water. At the lunch buffet, 50 dishes, 40 spoons, and chopsticks were served as cleaned and wiped with a dishcloth. We thought the underground water contaminated the dishes, spoons, chopsticks and the dishcloth. Those contaminated materials became the cause of this outbreak.


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    Won Choi, Sang-Soon Kim
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    Nadja Jessberger, Richard Dietrich, Per Einar Granum, Erwin Märtlbauer
    Toxins.2020; 12(11): 701.     CrossRef
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    Korean Journal of Environmental Health Sciences.2016; 42(3): 189.     CrossRef
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    Dong-Min Kim, Sang-Kook Park, Kye-Heon Oh
    The Korean Journal of Microbiology.2016; 52(3): 260.     CrossRef
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Socioeconomic Costs of Food-Borne Disease Using the Cost-of-Illness Model: Applying the QALY Method.
Hosung Shin, Suehyung Lee, Jong Soo Kim, Jinsuk Kim, Kyu Hong Han
J Prev Med Public Health. 2010;43(4):352-361.
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  • 126 Download
  • 20 Crossref
AbstractAbstract PDF
This study estimated the annual socioeconomic costs of food-borne disease in 2008 from a societal perspective and using a cost-of-illness method. METHODS: Our model employed a comprehensive set of diagnostic disease codes to define food-borne diseases with using the Korea National Health Insurance (KNHI) reimbursement data. This study classified the food borne illness as three types of symptoms according to the severity of the illness: mild, moderate, severe. In addition to the traditional method of assessing the cost-of-illness, the study included measures to account for the lost quality of life. We estimated the cost of the lost quality of life using quality-adjusted life years and a visual analog scale. The direct cost included medical and medication costs, and the non-medical costs included transportation costs, caregiver's cost and administration costs. The lost productivity costs included lost workdays due to illness and lost earnings due to premature death. RESULTS: The study found the estimated annual socioeconomic costs of food-borne disease in 2008 were 954.9 billion won (735.3 billion won-996.9 billion won). The medical cost was 73.4 - 76.8% of the cost, the lost productivity cost was 22.6% and the cost of the lost quality of life was 26.0%. CONCLUSIONS: Most of the cost-of-illness studies are known to have underestimated the actual socioeconomic costs of the subjects, and these studies excluded many important social costs, such as the value of pain, suffering and functional disability. The study addressed the uncertainty related to estimating the socioeconomic costs of food-borne disease as well as the updated cost estimates. Our estimates could contribute to develop and evaluate policies for food-borne disease.


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Original Articles
Prevalence and Risk Factors of Green Tobacco Sickness among Korean Tobacco Harvesters.
Hyun Sul Lim, Kwan Lee, Si Hyun Nam
J Prev Med Public Health. 2004;37(1):37-43.
  • 2,259 View
  • 89 Download
AbstractAbstract PDF
This study was carried out to understand the prevalence and risk factors of green tobacco sickness (GTS) among Korean tobacco harvesters. METHODS: The authors conducted a questionnaire among the tobacco harvesters (1, 064 persons from 555 out of 723 tobacco harvesting households) in Cheongsong-gun for 4 days from May 7 to 10, 2002. RESULTS: The study subjects were 550 males and 514 females. The recognition and experience of GTS up until 2001 were 96.4% and 61.9%, respectively. The prevalence of GTS in 2001 was 42.5%, and was significantly higher in females than in males (59.0% vs. 26.6%, p< 0.01). The incidence density of GTS according to the number of workdays in 2001 was 12.3 spells/100 person' days. The GTS symptoms reported by the tobacco harvesters in 2001 were dizziness in 441 cases (97.6%), nausea in 414 (91.6%), headache in 349 (77.2%) and vomiting in 343 (75.9%). The use of gloves, hat and wristlets, sweating at work and the number of working hours significantly increased the prevalence of GTS (p< 0.05). Multiple logistic regression analysis was used to determine the factors significantly associated with GTS. Odds ratios for smoking, working over 10 hours and sweating at work were 0.26 (95% CI: 0.19-0.35), 1.64 (95% CI: 1.26-2.14) and 1.60 (95% CI: 1.14-2.25), respectively. Of those who reported GTS in 2001, 311 cases (68.8%) underwent treatment from their local medical facilities. CONCLUSION: In Korea, there are many tobaccoharvesting households, and most may be stricken with GTS. More extensive epidemiological studies, including heincidence and associated risk factors, are expected and a surveillance system including measurements of cotinine in urine should be conducted.
Nephropathy in Chronic Lead Poisoning.
Byoung Gwon Kim, Sung Ryul Kim, Young Seoub Hong, Seo Hee Rha, Jung Man Kim, Kap Yull Jung, Joon Youn Kim
Korean J Prev Med. 1996;29(1):43-50.
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AbstractAbstract PDF
We experienced a case of nephropathy in chronic lead poisoning. The patient was 43-year-old male who has been working in secondary lead smelting plant for ]4 years. On admission, blood pressure was 160/90 mmHg and the others were non-specific. In past history, he received chelating agent administration for lead poisoning irregularly and medicated for gout, and the blood lead concentration was 180.0 microgram/dl on 2 months before admission. Smoking habit has been 1 pack per day for 15 years and drinking habit has been 1 bottle of Soju per day but less now. In liver function test, AT/ALT were 27/28 IU/l and gamma-GT was 456 IU/l. In blood test, Hb:11. 5 g/dl , Hct: 34.0% and basophilic stipplings were found in peripheral blood smear. Chest PA was normal and abdominal ultrasonographic finding was non-specific except fatty liver. In the test of lead exposure indices, pbB: 83.0 microgram/dl, pbU: 28.3 microgram/l, and blood ZPP was 300.0 microgram/dl. And in renal function test, BUN: 31.4 mg/dl, blood creatinine: 2.7mg/dl, blood uric acid: 9.1 mg/dl, urinary albumin: 100.0 mg/g creatinine, urinary a alpha 1-microglobulin: 120.5 mg/g creatinine, urinary beta2-mioroglobulin: 183.8 microgram/g creatinine, and 24 hours urinary creatinine clearance was 31.9 ml/min. The ultasonoguided renal biopsy showed the global sclerosis of glomerulus, moderate atrophy and loss of tubule, and interstitial fibrosis in light microscopy. There were diffuse losses of brush border of proximal tubule in electronmicroscopy.
A Study on the Manganese Exposure and Health Hazard among Manganese Manufacturing Woman Workers.
Hyun Sul Lim, Ji Yong Kim, Hae Kwan Cheong, Hoe Kyung Cheong
Korean J Prev Med. 1995;28(2):406-420.
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AbstractAbstract PDF
No abstract available.
Multiple Brain Calcification in Chronic Lead Poisoning.
Sung Ryul Kim, Byoung Gwon Kim, Young Seoub Hong, Do Won Dam, Soon Seob Choi, Kap Yull Jung, Joon Youn Kim
Korean J Prev Med. 1995;28(2):398-405.
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  • 22 Download
AbstractAbstract PDF
We experienced a case of occupational lead poisoning employed in a secondary lead smelting plant for 12 years. The patient was 39-year-old male and had been felt dizziness, recent memory impairment and intermittent severe abdominal pain for 2 years. On admission, blood lead level was 92.9 microgram/dl, urinary lead level was 19,9 microgram/l and zinc protoporphyrin level was 226.0 microgram/dl. On the blood test, hemoglobin was 10.6 g/dl and showed normocytic normochromic anemia. There were no abnormal findings in the biochemical and hormonal tests. Decrease of I.Q. and use of words in speaking were found in the psychiatric and psychologic examinations. We observed the finding of motor polyneuropathy in the nerve conduction velocity test. Computed tomographic finding showed calcification lesions in the basal ganglia, dentate nuclei, caudate nuclei, and especially characteristic multiple calcifications were located in the subcortical white matter.
National Survey of Injury and Poisoning on a Representative Sample Population of Koreans.
Joung Soon Kim, Sung Soo Kim, Sung Chill Chang
Korean J Prev Med. 1994;27(3):447-464.
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AbstractAbstract PDF
Despite the public health importance of injury and poisoning in terms of its high mortality and incidence, epidemiologic information to be utilized are scarce in Korea. This study was carried out in 1990 on a representative sample population (about 55,000 persons) along with the 6th National Tuberculosis prevalence survey in order to estimate the magnitude of injury and poisoning occurrence and to identify its epidemiologic characteristics which can be aided for establishing preventive strategy pre-tested and structured questionnaire was used by trained interviewer to collect data including general information of the person, various information on the injury and poisoning during the past one year such as time and place of its occurrence, its nature and external causes, type of medical institute attended, duration of treatment and outcome of the accident occurred. In analysis of the data collected incidence rates per 1000 persons by sex, age group and its nature as well as external causes and relative frequencies were calculated. The result obtained are as follows; 1. The incidence rate per 1000 was 30 for both sexes, 39 for male and 22 for female, male being 1.8 times more frequent than female. Age adjusted incidences were not much different from the crude rates. Age group specific rate curve showed binodal shape in both sexes, small peaks in preschool children and higher peaks in older ages. The incidence rate per 1000 people by area was highest in Jeon-bug province (57/1000) and the lowest in Daegu city (11/1000). 2. The place where the injuries occurred were road in 46%, with the boundary of house in 25 %, and working place in 12%. The injuries and poisoning had occurred more frequently during the months from March to August of the year than other months. 3. The relatively frequent injuries by its nature were contusion with intact skin surface (19%), fracture of upper limb (13%), open wound of head neck and trunk (12%) and fracture of lower limb (11%) among males: contusion with intact skin surface (28%), sprains and strains of joints and adjacent muscle(14%), fracture of upper limb(10%) and fracture of lower limb (9%) among females. Higher incidence rate among males than females were fracture of skull(4.5times) open wound and fractures of limbs (2-3 times). Age specific rate of injuries and poisoning by its nature showed increasing pattern by age in fractures of upper and lower limbs and sprains & strains of joints whereas the age group of 30's showed highest incidence in open wounds of upper limb. Fractures of radius and ulna in upper limb, fractures of tibia & fibula and ankle in lower limb were most frequent among fractures of upper and lower limbs. The frequent injuries among sprains and strains of joints and adjacent muscles were that of ankle, foot and back and among open wound were that of head and fingers. 4. Relative frequency of injuries and poisoning by external causes showed following order: other accidents(25%), accidental falls (23%), motor vehicle accident (22%) and other road vehicle accident (l4%) among males and accidental falls (37%), motor vehicle accident (24%) and other accident (l8%) among females. The external causes revealing higher incidences among males than females, were other road vehicle accident (4.8times), vehicle accident not elsewhere classifiable (4.4 times), accidental poisoning (4.4 times), accidents due to natural and environmental factors (2.8times), and suicide & self-inflicted injuries (2.8 times). Age specific incidence by external causes for frequent injuries showed that incidence of other accident steadily increased from 10's till age 50's; motor vehicle traffic accident increased from age 20's and dropped after age 60's; on the other hand accidental fall increased strikingly by age. The most frequent external causes among motor vehicle traffic accidents was motor vehicle traffic accident involving collision with pedestrian (69%), pedal cycle accident (30%) and other road vehicle accident (71%) among other road vehicle accidents; falls on same level from slipping, tripping or standing (44%) and other falls from one level to another among accidental falls; accidents caused by machinery (32%) for male and striking against or struck accidentally by objects or person for female among other accidents. 5. seventy nine percent of the injuries and poisonings were treated in general hospital or hospital/clinic. The duration of treatment ranged from a few days to 123 weeks; the majority (52%) took under 2 weeks, 36% for 3-8 weeks and 40% over 21 weeks. 6. The accident resulted in full recovery of normal healthy state in 62%, residual functional defects in 21% and on process of treatment in 16%.
Case Report
Mass paraquat poisoning in a small island community: case report.
Sung Woo Lee, Tae Wha Chung, Kang Won Choi, Jung Ki Lim, Duk Hyoung Lee
Korean J Prev Med. 1989;22(4):454-465.
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AbstractAbstract PDF
In a small island community with a population of less than 100 residents, nine persons died and five experienced severe illness during the period from November 1986 to May 1988. Their initial symptoms were sore throat and fever. Renal failure and hepatitis developed which one week after the onset. Oral mucosal ulcer developed in some cases. After one week, progressive respiratory failure and dyspnea developed evidently and severe respiratory distress and hypoxia preceded those fatal cases. Chest X-ray findings revealed bilateral diffuse multiple cystic lesion with occasional multiple large emphysematous bullae. Based on these features paraquat poisoning was diagnosed and route of poisoning was investigated. In three sources of drinking water, trace amount of paraquat was detected in November 1988, six months after the incidence of recent fatal case. In November 1988, soybean sauces and soybean pastes from 12 households were found contaminated with high concentration of paraquat, the cause of this mass poisoning has been suggested.

JPMPH : Journal of Preventive Medicine and Public Health