초록

o 어린이 환경보건 출생코호트 인프라 구축
- 사업추진 프로토콜 마련 및 교육홍보
- 출생코호트 협력병원 및 보건소 구축

ㅇ 임신부 16,924명 모집, 건강영향조사 추진
- 식생활, 식습관, 집 주변환경, 인구학적 특성 등 설문조사
- 생체시료(혈, 뇨) 채혈, 분석

o 대규모 코호트DB와 국가 빅데이터 연계방안 마련
(출처: 프리즘)

Abstract ▼

V. Results

1. Organizational Structure

In order to expand the recruitment nationwide, pregnant women were recruited from South Gyeonggi, Daejeon, and Jeonbuk regions in addition to existing participants from Seoul, North Gyeonggi, Incheon, Gangwon, Chungjeong, Gwangju, Jeonnam, Daegu,

V. Results

1. Organizational Structure

In order to expand the recruitment nationwide, pregnant women were recruited from South Gyeonggi, Daejeon, and Jeonbuk regions in addition to existing participants from Seoul, North Gyeonggi, Incheon, Gangwon, Chungjeong, Gwangju, Jeonnam, Daegu, Gyeongbuk, Busan, Gyeongnam, and Jeju regions. In the case of the Main cohort, 30 university hospitals, obstetrics and gynecology clinics, and 19 public health centers participated across Korea. In the case of the Core cohort, a total of 28 nationwide recruitment agencies participated including 27 university hospitals, obstetrics and gynecology clinics, and one public health center.

2. Research Protocol Development and Applications

In order to carry out an efficient, standardized cohort project, a recruitment protocol for pregnant women; a questionnaire to evaluate the effects of environmental exposure; a protocol for bio-sample collection, transfer and analysis; and an environment monitoring system were prepared and an investigation was carried out following these procedures. In addition, an Institutional Review Board (IRB) deliberation was approved for tracking the infants and young children including the development of a standardized questionnaire, growth and development tests, neurocognitive development tests, and a protocol for medical examinations.

3. Core Cohort and Main Cohort Management

A. Status Report
· A total of 16,934 pregnant women (1,855 for the detailed cohort and 15,079 for the large-scale cohort) were recruited to participate in a health impact survey, involving a questionnaire and the acquisition and analysis of biological samples.
· A participation rate of 93.7% was achieved for a follow-up investigation during the last stage of pregnancy and a participation rate of 86.8% was achieved for umbilical cord blood sampling at birth.
· For infants, a participation rate of 90% was achieved for follow-up tests on growth and cognitive development.

B. Questionnaire Results
a. Pregnant woman
· Demographic characteristics: Almost half (49.5%) of the participants were aged between 30 and 35, 54.7% have an average monthly income of between 2 million and 4 million won, and 76.5% received a college education or higher.
· Living Environment: It was found that 90.6% of participants lived in urban areas and 67.9% lived in a house less than 100 m from the nearest road serviced by public transport.
· Housing Type: It was found that 69.3% of the participants lived in apartments, 23.8% in multiplex/row houses, and 6.2% in detached houses. For cooking, 87.9% of the respondents used gas (LPG or LNG). Furthermore, 23.6% of the respondents had moved into a new house less than one year ago.
· Smoking and Alcohol Consumption: The survey indicated that 13.7% of participants had smoked more than five packs of cigarettes in their lifetime, 3.1% had smoked during pregnancy, 18.4% were regularly exposed to secondhand smoke, 74.6% had consumed alcohol before pregnancy, and 4.9% had consumed alcohol during pregnancy.
· Lifestyle Factors: The survey indicated that 25.0% of participants use perfume, 15.5% use hair products, 86.7% use makeup, and 29.4% use antibacterial products

b. Children aged 6 months
· Primary caregiver: The primary caregivers for 91.6% of children are the mother and/or father, 5.9% are grandparents, and 2.5% are nannies or nursery teachers.
· Indirect smoking: The primary caregiver smokes in the case of 1.8% of children, another house member apart from the primary caregiver smokes in the case 36.3% of children, and 7.5% of children reported to be exposed to indirect smoking.
· Feeding type: Colostrum feeding occurred for 94.3% of children. Breastfeeding (15.1%) and powdered milk (5.6%) were used as primary feeding strategies for children, whereas 79.4% of parents used a mixed feeding strategy.
· Baby food: 86.9% of children had started eating baby food, 53.7% of the children were fed from a glass milk container, and 31.0% were fed in a plastic milk container.
· Disease history: 76.6% of children had received a medical examination and 27.9% had been diagnosed with either eczema, fever, or atopic dermatitis.

4. Data Linkage Strategy

· The National Health Insurance Services has agreed to provide big data from their infants and child screening database, medical care database, and other relevant information.
· As of December 2016, big data linkage success rate is 99.4% of 3,228 participants recruited in 2015(500 participants from the detailed cohort and 2,728 participants from the large-scale cohort) who signed agreement paper to provide information of their newborns babies.
· A review to form a big data cohort study with the babies born in Ko-CHENS recruitment period (2015 to 2019) using National Health Insurance Services’ delivery code has been undertaken. The

5. Education and Promotion

· The Ko-CHENS project will require continuous follow-up for a 20-year period. Developing rapport between researchers and participants is critical. The study aims to enhance the research expertise of the program through the production of training materials on rapport building with participants. In addition, continuous promotion to participants of the benefits of the study and the importance of follow-up, testing methods, and operation of the cohort trial was conducted.
· Seven online events were held to encourage the participation of pregnant women in the study and it was promoted in buses and subways close to the new recruitment areas for pregnant women in 2016. In addition, a child environmental safety exhibition was held, promoting the birth cohort study and the potential improvements in child health.

6. International cooperation

· The study was presented at two birth cohort international conferences held by the International Network on Children’s Health and Environmental Safety (INCHES) in Barcelona, Spain (September 2016) and the Environmental and Child Health International Birth Cohort Group (ECHIBCG) in Paris, France (November 2016) to introduce Ko-CHENS and discuss future co-operation.
· Ko-CHENS was also introduced through participation in other international conferences and symposiums.
· Experts from the program also participated in the International Society for Environmental Epidemiology - Asia Chapter (ISEE AC) conference in June 2016 in Japan; the Prenatal Programming and Toxicity (PPTOX) conference in November 2016, also in Japan; as well as the and Nanjing International Symposium in November 2016, in China.
(출처: Abstract 20p)

목차 Contents

• 표지 ... 1
• 제출문 ... 2
• 요약문 ... 5
• Abstract ... 19
• 목차 ... 27
• 표목차 ... 29
• 그림목차 ... 34
• I. 어린이 환경보건 출생코호트연구계획 ... 36
• 1장. 연구배경 및 필요성 ... 37
• 1절. 국내외 동향 ... 37
• 2절. 연구의 필요성 ... 46
• 2장. 연구 개요 및 최종목표 ... 47
• 1절. 연구 개요 ... 47
• 2절. 연구 방법 ... 50
• 3장. 추진 체계 ... 54
• 4장. 연도별 추진일정 ... 56
• Ⅱ. 2차년도 과업 내용 및 방법 ... 57
• 1장. 과업 범위 ... 58
• 2장. 과업내용 및 방법 ... 59
• Ⅲ. 2차년도 과업 결과 ... 67
• 1장. 어린이 환경보건 출생코호트 기반 구축 ... 68
• 2장. 어린이 환경보건 출생코호트 프로토콜 개발 및 적용 ... 72
• 1절. 상세코호트 ... 72
• 2절. 대규모 코호트 ... 87
• 3장. 상세 및 대규모 코호트 운영 ... 90
• 1절. 코호트 모집 및 추적 결과 ... 90
• 2절. 설문조사 결과에 따른 임신부 전체 (상세 및 대규모 코호트) 특성 ... 93
• 3절. 출생아 6개월(상세코호트) 설문조사 및 인지/성장발달 검사 결과 ... 107
• 4절. 임신부의 생체시료 환경유해물질 농도 분석결과 및 요인분석 ... 153
• 5절. 참여자(임신부) 가구 내 실내환경 및 개인노출 측정 결과 및 요인 분석 ... 269
• 4장. 빅데이터 연계 사업 ... 293
• 5장. 어린이 환경보건 출생코호트 교육, 홍보 사업 ... 301
• 1절. 어린이 출생코호트 교육 사업 ... 301
• 2절. 어린이 출생코호트 홍보 사업 ... 305
• 3절. 어린이 출생코호트 국제 네트워크 사업 ... 310
• Ⅳ. 결 론 ... 312
• 1장. 결과 ... 313
• 2장. 제언 ... 325
• Ⅴ. 기대성과 ... 326
• Ⅵ. 참고문헌 ... 329
• 끝페이지 ... 335