Viral lower respiratory tract infections (LRTIs), including rhinovirus and respiratory syncytial virus during early childhood, have been linked to subsequent asthma. However, the impact of other respiratory viruses remains unclear. We analyzed nationwide Korean data from January 1, 2008, to December 31, 2018, utilizing the national health insurance database. Our study focused on 19 169 meticulously selected children exposed to severe respiratory infections requiring hospitalization with documented viral pathogens, matched with 191 690 unexposed children at a ratio of 1:10 using incidence density sampling. Our findings demonstrate that asthma exacerbation rates were higher among the exposed cohort than the unexposed cohort over a mean follow-up of 7.8 years. We observed elevated risks of asthma exacerbation and newly developed asthma compared to the unexposed cohort. Hospitalization due to rhinovirus, respiratory syncytial virus, influenza, metapneumovirus, and adenovirus was related to increased asthma exacerbations. Notably, we found a stronger association in cases of multiple LRTI hospitalizations. In conclusion, our study shows that early childhood respiratory viral infections are related to subsequent asthma exacerbations and new asthma diagnoses.

Conventional categorical data imputation techniques, such as mode imputation, often encounter issues related to overestimation.If the variable has too many categories, multinomial logistic regression imputation method may be impossible due to computational limitations.To rectify these limitations, we propose a two-stage imputation method.During the first stage, we utilize the Boruta variable selection method on the complete dataset to identify significant variables for the target categorical variable.Then, in the second stage, we use the important variables for the target categorical variable for logistic regression to impute missing data in binary variables, polytomous regression to impute missing data in categorical variables, and predictive mean matching to impute missing data in quantitative variables.Through analysis of both asymmetric and non-normal simulated and real data, we demonstrate that the two-stage imputation method outperforms imputation methods lacking variable selection, as evidenced by accuracy measures.During the analysis of real survey data, we also demonstrate that our suggested two-stage imputation method surpasses the current imputation approach in terms of accuracy.

Although South Korea is a high-income country, its trauma system is comparable to low- and middle-income countries with high preventable trauma death rates of more than 30%. Since 2012, South Korea has established a national trauma system based on the implementation of regional trauma centers and improvement of the transfer system; this study aimed to evaluate its effectiveness. We compared the national preventable trauma death rates, transfer patterns, and outcomes between 2015 and 2017. The review of preventable trauma deaths was conducted by multiple panels, and a severity-adjusted logistic regression model was created to identify factors influencing the preventable trauma death rate. We also compared the number of trauma patients transferred to emergency medical institutions and mortality in models adjusted with injury severity scores. The preventable trauma death rate decreased from 2015 to 2017 (30.5% vs. 19.9%, p < 0.001). In the severity-adjusted model, the preventable trauma death risk had a lower odds ratio (0.68, 95% confidence interval: 0.53–0.87, p = 0.002) in 2017 than in 2015. Regional trauma centers received 1.6 times more severe cases in 2017 (according to the International Classification of Diseases Injury Severity Score [ICISS]; 23.1% vs. 36.5%). In the extended ICISS model, the overall trauma mortality decreased significantly from 2.1% (1008/47 806) to 1.9% (1062/55 057) (p = 0.041). The establishment of the national trauma system was associated with significant improvements in the performance and outcomes of trauma care. This was mainly because of the implementation of regional trauma centers and because more severe patients were transferred to regional trauma centers. This study might be a good model for low- and middle-income countries, which lack a trauma system.

The Korean National Environmental Health Survey (KoNEHS) program provides useful information on chemical exposure, serves as the basis for environmental health policies, and suggests appropriate measures to protect public health. Initiated on a three-year cycle in 2009, it reports the concentrations of major environmental chemicals among the representative Korean population. KoNEHS Cycle 3 introduced children and adolescents into the analysis, where the blood and urine samples of 6167 participants were measured for major metals, phthalates, phenolics, and other organic compounds. Lead, mercury, cadmium, metabolites of DEHP and DnBP, and 3-phenoxybenzoic acid levels of the Korean adult population tended to decrease compared to previous survey cycles but remained higher than those observed in the US or Canada. Both bisphenol A (BPA) and trans,trans-muconic acid concentrations have increased over time. Heavy metal concentrations (blood lead, and cadmium) in children and adolescents were approximately half that of adults, while some organic substances (e.g., phthalates and BPA) were high. BPA showed higher levels than in the US or Canada, whereas BPF and BPS showed lower detection rates in this cycle; however, as these are increasingly used as a substitute for BPA, further research is necessary. As environmental chemicals may affect childhood health and development, additional analyses should assess exposure sources and routes through continuous observations.

Objectives The aim of this study was to investigate influencing factors of using Korean medicine services (KMS) using the 2017 Korean Medicine Utilization Survey (KMUS). Methods Demographic statistics of the survey were summarized and influencing factors of the KMS experience and the intention to visit KMS were analyzed using logistic regression model with complex sample design. Influencing factors were specified based on Andersen's behavioral model of health care utilization and factors associated with individual recognitions of KMS. Additionally, using the ordinary logistic regression model without complex sample design, the survey data were analyzed to compare the results. Results In the logistic regression analysis, sex, age, health condition, presence of chronic disease, a degree of knowledge about Korean Medicine, and a view about herbal medicine safety were statistically significant both in the KMS experience, and the intention to visit KMS. Marital status was statistically significant in the KMS experience, while family income, a view about the cost of KMS were statistically significant in the intention to visit KMS. Conclusion Individual recognitions of KMS and enabling components should be considered when establishing KMS policies. In addition, future studies analyzing KMUS need to take into account the complex sample design features of the survey to avoid statistically misleading results. Keywords: Korean Medicine Utilization Survey, health care utilization, complex sample survey

Background: Although South Korea is a high-income country, its trauma system is comparable to that of low- and middle-income countries (LMICs) with high preventable trauma death rates (PTDRs) (>30%). Since 2012, South Korea has established a national trauma system based on the implementation of regional trauma centers (RTCs) and improvement of the transfer system; this study evaluated its effectiveness.Methods: We compared the national PTDRs, transfer patterns, and outcomes between 2015 and 2017. The trauma death review was conducted by multiple panels and a severity-adjusted logistic regression model was created to identify factors influencing the PTDR. We also compared the number of trauma patients transferred to emergency medical institutions and mortality in models adjusted with injury severity scores.Findings: The PTDR decreased from 2015 to 2017 (30·5% vs. 19·9%, p<0·0001). In the severity-adjusted model, the preventable trauma death risk had a lower odds ratio (0·68, 95% confidence interval: 0·53–0·87, p=0·0024) in 2017 than in 2015. RTCs received 1·6 times more severe cases in 2017 (according to the International Classification of Diseases Injury Severity Score [ICISS]; 23·1% vs. 36·5%). In the extended ICISS model, the overall trauma mortality decreased significantly from 2·1% (1,008/47,806) to 1·9% (1,062/55,057) (p=0·041). Interpretation: The national trauma system establishment was associated with significant improvements in performance and outcomes. This was mainly because of the implementation of RTCs where more severe patients were transferred. This study may be a good model for LMICs, which lack a trauma system.Funding Statement: This study was funded by the Ministry of Health and Welfare, Republic of Korea.Declaration of Interests: We declare no competing interests.Ethics Approval Statement: Approval (E-1811-005-982) from the Institutional Review Board of Seoul National University Hospital.

Background: Solar irradiation affects sensitization to aeroallergens and the prevalence of allergic diseases. Little is known, however, about how the time and amount of solar irradiation during pregnancy affects such risks in children. We aimed to find out how solar irradiation during pregnancy affects sensitization to aero-allergens and the prevalence of allergic diseases in children. Methods: This population-based cross-sectional study involved 7301 aged 6 years and aged 12 years children. Maternal exposure to solar irradiation during pregnancy was evaluated using data from weather stations closest to each child's birthplace. Monthly average solar irradiation during the second and third trimesters was calculated with rank by quartiles. Risks of allergic sensitization and allergic disease were estimated. Results: Relative to the first (lowest) quartile, the adjusted odds ratio (aOR) for allergic sensitization in the fourth (highest) quartile was lowest within solar irradiation during pregnancy months 5-6 (aOR = 0.823, 95% CI 0.720-0.942, p < 0.05). During months 9-10, the aOR for allergic sensitization for the fourth was higher than the first quartile of solar irradiation (aOR = 1.167, 95% CI 1.022-1.333, p < 0.05). Similar results were observed when solar irradiation was analyzed as a continuous variable during months 5 (aOR = 0.975, 95% CI 0.962-0.989, p < 0.001) and month 9 (aOR = 1.018, 95% CI 1.004-1.031, p = 0.003). Increased solar irradiation during months 7-8 increased the risk of asthma (aOR = 1.309, 95% CI 1.024-1.674, p = 0.032). Conclusions: Maternal exposure to solar irradiation during the second trimester of pregnancy associated with reduced aeroallergen sensitization, whereas solar irradiation during the third trimester was related to increased sensitization to aeroallergens. Copyright (C) 2017, Japanese Society of Allergology. Production and hosting by Elsevier B.V.

Purpose: This study aimed to examine the perception of food allergy among parents and school health instructors in Korea. Methods: A nationwide epidemiological survey in Korea was conducted in September 2015. From 17 cities and provinces, a total of 1,000 elementary, middle and high schools were selected by stratified random sampling. Parents and school health instructors were surveyed using a questionnaire on the perception of food allergy. Results: The prevalence of food-induced anaphylaxis was 22.3%. Of 252 children with anaphylaxis, 47.6% were prescribed epinephrine auto-injector (EAI). Forty-three parents (37.7%) were educated about the use of EAI. Parents carrying their own EAI at all times or keeping them at schools were 5.6% and 3.8%, respectively. For the food allergen-labeling system, 42.1% of parents read food labels, and 32.1% were satisfied with the system. Only 35.2% of school health instructors received education on food allergy and anaphylaxis, and 42.5% of them knew how to use EAI. There were 70 children (9.4%) with anaphylaxis in school, and 75.9% of schools had the emergency management system. Conclusion: The awareness of Korean parents and school health instructors on food allergy is still low, and many parents are dissatisfied with the food allergen labeling system. Many school health instructors have difficulty in using EAI in case of anaphylaxis and are insufficiently educated about food allergy. Therefore, it is necessary to establish more systematic food allergy management plans by providing high-quality education to parents and school health instructors and by utilizing legal systems.

Exposure to harmful environmental factors is particularly detrimental to younger children. We investigated the relationship between environmental tobacco smoke (ETS) exposure in pre-schoolers at home and the level of high-sensitivity C-reactive protein (hs-CRP), a predictive factor for cardiovascular disease. This study was conducted in 2014 and was based on the data of preschool children from the Korean Environmental Health Survey in Children and Adolescents (2012 to 2014), a nationally representative sample. Of 577 children, aged three to five years, 482 were eventually selected for the analysis after excluding those with missing variables, or whose hs-CRP level exceeded the reference value. The proportion of pre-school children exposed to ETS at home was 14.8%. The odd ratios (OR)s of hs-CRP > 1mg/L were 4.90 (95% Confidence Interval (CI) = 1.04–23.17) and 11.66 (95% CI = 1.90–71.65) in the groups exposed to ETS 3–4 times and ≥5 times daily, respectively, compared to the non-exposed group. The risk of elevated levels of hs-CRP showed an increasing trend proportionally to the increase in ETS exposure frequency (p for trend = 0.03). Anti-smoking educational programs for parents and guardians may be helpful to reduce ETS exposure at home.

Purpose This study aimed to determine the prevalence of immediate-type food allergy (FA) among schoolchildren in Korea. Methods A nationwide, cross-sectional study was performed in September 2015. A stratified random sample of 50,000 participants was selected from children and adolescents aged 6-7 years (n=17,500), 9-10 years (n=17,500), 12-13 years (n=7,500), and 15-16 years (n=7,500). Parents were asked to complete a questionnaire on the detailed history of immediate-type FA. Results A total of 32,001 (64.0%) responded to the questionnaire survey, and 29,842 children (59.7%) were analyzed after adjusting for missing data. The number of the cases in each age group was 9,671 (6-7 years), 9,756 (9-10 years), 5,169 (12-13 years), and 5,246 (15-16 years). The prevalence of lifetime perceived FA was 15.82%. The prevalence of current immediate-type FA was 4.06% in total, with 3.15% in 6- to 7-year-olds, 4.51% in 9- to 10-year-olds, 4.01% in 12- to 13-year-olds, and 4.49% in 15- to 16-year-olds. Among individual food items, peanut (0.22%) was the most frequent causative food, followed by hen's egg (0.21%), cow's milk (0.18%), and buckwheat (0.13%). Among the food groups, fruits (1.41%), crustaceans (0.84%), tree nuts (0.32%), and fish (0.32%) were the most common offending foods. The prevalence of food-induced anaphylaxis was 0.97%. The most frequent causative food of anaphylaxis was peanut (0.08%), followed by cow's milk (0.07%), buckwheat (0.06%), and hen's egg (0.06%), while fruits (0.28%), crustaceans (0.18%), tree nuts (0.12%), and fish (0.09%) were the most commonly responsible food groups. Conclusions The prevalence of current immediate-type FA and food-induced anaphylaxis in Korean schoolchildren in 2015 was 4.06% and 0.97%, respectively. Peanuts, cow's milk, hen's egg, fruits, crustaceans, and tree nuts are common allergens.

Background: This study examined levels of blood lead and mercury, and urinary cadmium, and associated sociodemographic factors in 3-18 year-old Korean children and adolescents.Materials and methods: We used the nationally representative Korean Environmental Health Survey in Children and Adolescents data for 2012-2014 and identified 2388 children and adolescents aged 3-18 years. The median and 95th percentile exposure biomarker levels with 95% confidence intervals (CIs) were calculated. Multivariate regression analyses were performed on log transformed exposure biomarker levels adjusted for age, sex, area, household income, and father's education level. The median exposure biomarker levels were compared with data from Germany, the US, and Canada, as well as the levels of Korean children measured at different times.Results: The median levels of blood lead and mercury, as well as urinary cadmium were 1.23 mu g/dL, 1.80 mu g/L, and 0.40 mu g/L (95% CIs, 1.21-1.25, 1.77-1.83, and 0.39-0.41, respectively). The blood lead levels were significantly higher in boys and younger children (p < 0.0001) and children with less educated fathers (p = 0.004) after adjusting for covariates. Urinary cadmium level increased with age (p < 0.0001). The median levels of blood mercury and urinary cadmium were much higher in Korean children and adolescents than those in their peers in Germany, the US, and Canada. Blood lead levels tended to decrease with increasing age and divergence between the sexes, particularly in the early teen years. Median levels of blood lead and urinary cadmium decreased since 2010.Conclusion: Sociodemographic factors, including age, sex, and father's education level were associated with environmental exposure to heavy metals in Korean children and adolescents. These biomonitoring data are valuable for ongoing surveillance of environmental exposure in this vulnerable population. (C) 2016 The Authors. Published by Elsevier GmbH. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background: Aeroallergen sensitization is related to the coexistence of allergic diseases, but the nature of this relationship is poorly understood. The aim of this study was to clarify the relationship of polysensitization with allergic multimorbidities and the severity of allergic diseases. Methods: This study is a cross-sectional analysis of 3,368 Korean children aged 6-7 years-old. We defined IgE-mediated allergic diseases based on structured questionnaires, and classified the sensitivity to 18 aeroallergens by logistic regression and the Ward hierarchical clustering method. The relationship of polysensitization (positive IgE responses against 2 or more aeroallergens classes) with allergic multimorbidities (coexistence of 2 or more of the following allergic diseases: asthma, rhinitis, eczema, and conjunctivitis) and severity of allergic diseases was determined by ordinal logistic regression analysis. Results: The rate of polysensitization was 13.6% (n = 458, 95% CI 12.4-14.8) and that of allergic multimorbidity was 23.5% (n = 790, 95% CI 22.0-24.9). Children sensitized to more aeroallergens tended to have more allergic diseases (rho = 0.248, p < 0.001), although the agreement between polysensitization and multimorbidity was poor (kappa = 0.11, p < 0.001). The number allergen classes to which a child was sensitized increased the risk of wheezing attacks (1 allergen: adjusted odds ratio [aOR] 2.22, 4 or more allergens: aOR 9.39), absence from school (1 allergen: aOR 1.96, 3 allergens: aOR 2.08), and severity of nasal symptoms (1 allergen: aOR 1.61, 4 or more allergens: aOR 4.38). Conclusion: Polysensitization was weakly related to multimorbidity. However, the number of allergens to which a child is sensitized is related to the severity of IgE-mediated symptoms.

Objectives: This study estimated the adult Korean daily intake of acrylamide (AA) and investigated its relationship with demographic, lifestyle and dietary habits by using urinary concentrations of N-acetyl-S-(2-carbamoylethyl)-cysteine (AAMA). Methods: Human data (n=1870) was collected in a nationwide cross-sectional biomonitoring program representing the population (18-69 years) residing in South Korea. Urinary AAMA was analyzed with a LC-MS/MS system. Daily intakes of AA were estimated using mass daily AAMA, which was calculated through urinary AAMA concentration and daily creatinine excretion. Statistical analysis was performed with SAS procedures for calculating geometric means, confidence intervals and the exponentiated beta coefficient of multiple linear regressions. Results: Daily intake of AA was estimated at $0.475{\mu}g/kg$ body weight (BW) per day (95% confidence interval (CI): 0.447-0.503). In the case of current smokers, AA intake was $0.957{\mu}g/kg$ BW per day (95% CI: 0.847-1.067), which was significantly higher than that of former smokers and never smoked (p<0.0001). The strong affecting factors were age (95% CI: 0.68-1.14; p=0.0180), education level (95% CI: 1.05-1.42; p=0.0163), body mass index (BMI) (95% CI: 1.00-1.82; p<0.0001), and smoking status (95% CI: 0.97-3.05; p<0.0001). Korean dietary habits increasing AA intake were coffee (p=0.0005), cup noodles (p=0.0010) and canned foods (p=0.0005). Meanwhile, foods decreasing AA intake were fresh fruit (p=0.0076), cooked beef (p=0.0335) and cooked pork (p=0.0147). Conclusion: The Korean daily intake of AA in adults was estimated to be similar with those found in developed countries. The factors increasing daily AA intake were coffee, cup noodles and canned foods, and decreasing factors were fresh fruit, cooked beef and cooked pork.

Background: Previous studies have indicated that phthalate exposure may influence the development of children, but the current data are limited, and controversy remains regarding the sex-specific and age-specific effects of phthalate exposure.Methods: We investigated the sex- and age-specific associations of current phthalate exposure with neurobehavioral development scores in a nationally representative sample of 6-18-year-olds participating in the Korean Environmental Health Survey in Children and Adolescents (KorEHS-C). Neurobehavioral development was assessed using the Korean Child Behavior Checklist (CBCL, N =1723) and the Korean Attention Deficit Hyperactivity Disorder Rating Scale (ARS, N=867). We measured the concentrations of phthalate metabolites in urine samples using high-performance liquid chromatography tandem mass spectrometry. The associations between urine phthalate metabolite concentrations and neurobehavioral development were examined by survey regression analysis for complex sampling and penalized regression splines using a generalized additive model.Results: Survey regression analysis revealed that a higher mono-n-butyl phthalate (MnBP) level was associated with social (b=0.60; 95% confidence interval = 0.15-1.05), thought (0.55; 0.08-1.03), and attention (0.68; 0.21-1.14) problems on the CBCL. A significant association was found between the MnBP level and the ARS hyperactivity subscale score (0.42; 0.05-0.58). Higher levels of MnBP (0.87; 0.20-1.54), mono-2-ethyl-5-oxohexyl phthalate (MEOHP, 0.61; 0.11-1.11) and mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP, 0.51; 0.04-0.97) were associated with an increase in thought problems among the girls. Among the younger children aged 6-11 years, significant positive associations between the MnBP (0.71; 0.09-1.33), MECPP (0.74, 0.14-1.34), MEOHP (0.65; 0.10-1.20), and MEHHP (0.71; 0.21-1.21) levels and social problems and between the MnBP (1.11; 0.37-1.84), MEOHP (0.64; 0.13-1.15), and MEHHP (0.66; 0.18-1.14) levels and attention problems were observed. The penalized regression splines for the age specific relationships between the urinary MnBP, MEOHP, and MEHHP levels and social and attention problems exhibited positive supralinear relationships with downward curvature in the 6-11 year age group. In contrast, the score for social problems exhibited nearly linear relationships with these levels in the 12-18 year age group.Conclusions: In this national sample, increased phthalate exposure exhibited supralinear associations with social, thought and attention problems in children aged 6-11 years, who showed greater vulnerability to phthalate exposure. The results highlight the need for the environmental regulation of phthalate exposure in younger children, even at low dosages. (C) 2016 Elsevier GmbH. All rights reserved.

Introduction The Korea Environmental Health Survey in Children and Adolescents (KorEHS-C) purposed to collect a representative data of environmental exposure and related health status on a national level. In 2014, the KorEHS-C 4 to monitor pre-school children was conducted. We aimed to examine the relationship between levels of blood lead, mercury and urinary cadmium and environment of childcare facilities where children attended. Methods A representative sample of 577 children aged 3 to 5 years attended in 63 childcare facilities, nurseries and kindergartens, which were randomly selected from 5 stratified sampling regions in nationwide was analyzed. The information of environment of childcare facilities was obtained by interviews with childcare center directors or nursing teachers. Multivariate linear regression analysis was performed to analyze the association between environment of child care facilities and heavy metal levels, ie., lead(μg/㎗), mercury(μg/ℓ) in blood and cadmium(μg/ℓ) and urine, after adjustment for covariates. Statistical analyses were weighted using the survey analyses based on the complex sampling frame. Results The geometric mean of blood lead mercury and urinary cadmium were 1.34μg/㎗, 1.55μg/ℓ and 0.39μg/ℓ, respectively. At facilities where outdoor smoking was allowed, children's heavy metal level in blood was higher than among children at facilities where smoking was totally banned even outdoor. At facilities that were recently renovated, children's urine cadmium level was significantly higher than among children at facilities that were older than 10 years. At facilities using environmentally friendly materials in construction, cadmium level in urine among children was significantly lower than among those at facilities using general materials. . Conclusion We found that heavy metal concentration was correlated with environment of childcare facilities, suggesting a necessity to control the environment of childcare facilities.

Purpose: This study aimed to analyze the prevalence of allergic diseases in Korean schoolchildren according to their residential areas in 2010.Methods: A nationwide, cross-sectional study was conducted in children aged 6-7 years (n = 4,003) and adolescents aged 12-13 years (n = 4,112) who were randomly selected. Demographic and disease- related information was obtained through a Korean version of ISAAC (International Study of Asthma and Allergies in Childhood) questionnaire, and skin prick tests for 18 inhalant allergens were performed.Results: There was statistically significant regional difference in the prevalence of allergic rhinitis (AR) (P < 0.05). The regions with highest and lowest prevalence in 12- to 13-year-old children were as follows: Chungcheong and Honam in "Diagnosis of AR, ever" (33.7% vs. 24.5%), Jeju and Yeongnam in "Treatment of AR, last 12 months" (25.5% vs. 18.0%), Chungcheong and Yeongnam in "Rhinitis with sensitization" (31.6% vs. 23.6%). The regions with highest and lowest prevalence in 6-7 years old children were as follows: Yeongnam and Seoul in "Diagnosis of AR, ever" (42.1% vs. 31.0%), Yeongnam and Jeju in "Treatment of AR, last 12 months" (31.8% vs. 21.9%), Jeju and Seoul in "Rhinitis with sensitization" (26.0% vs. 18.4%). We also found a regional difference in inhalant allergens among the children with "rhinitis with sensitization".Conclusion: The prevalence of AR in children differs according to residential areas in a nationwide survey in 2010 while there is no significant regional difference in the prevalence of asthma and AD.

ratio (aOR), 1.486; 95% confidence interval (CI), 1.189-1.856), family history of paternal AR (aOR, 3.208; 95% CI, 2.460-4.182), family history of maternal AR (aOR, 3.138; 95% CI, 2.446-4.025), antibiotic use in infancy (aOR, 1.547; 95% CI, 1.228-1.949), mold exposure during infancy (aOR, 1.416; 95% CI, 1.103-1.819), mold exposure during the last 12 months (aOR, 1.285; 95% CI, 1.012-1.630), and sensitization on skin prick tests (aOR, 2.596; 95% CI, 2.055-3.279). Risk factors for atopic current AR were the same as those of current AR, whereas breast-milk feeding (aOR, 0.720; 95% CI, 0.530-0.976) was a protective factor. Sensitized allergens as risk factors for cur- rent AR were Dermatophagoides pteronyssinus, Dermatophagoides farina, ragweed, mugwort, oak, alder, birch, Japanese hop, cat, and dog.