Annals of Occupational and Environmental Medicine

Volume 38; 2026

Original Article

Risk of sleep disturbance associated with work-related activities during free time in South Korea: a cross-sectional study with mediation analysis: Ohwi Kwon, Hye-Eun Lee, Mo-Yeol Kang; Ann Occup Environ Med 2026;38:e11. Published online March 20, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e11

Abstract PDF Supplementary Material: Background
This study aims to investigate the associations between work-related activities during free time, including frequency of working during free time and use of communication devices for work during free time, and sleep disturbance. It further explores the underlying mechanisms through mediation analysis.
Methods
Data were analyzed from 21,473 participants of the seventh Korean Working Conditions Survey (KWCS, 2023). Multivariable logistic regression was employed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for sleep disturbance. Three sequential models were constructed to evaluate the effects of weekly working hours and shift work on sleep disturbance risk. Mediation analysis was conducted to identify pathways linking work-related activities during free time and sleep disturbance.
Results
Those who worked during their free time daily showed significantly higher risk of sleep disturbance (OR: 4.17; 95% CI: 2.64–6.58). Similarly, daily use of communication devices for work during free time was associated with an increased risk (OR: 1.83; 95% CI: 1.57–2.13). These associations remained robust even after adjusting for weekly working hours and shift work. Mediation analysis revealed that "worry about work while at home" was the primary mediator for device use (13.7%; 95% CI: 0.11–0.18), while "feeling too tired for housework after work" was the strongest mediator for working during free time (26.6%; 95% CI: 0.22–0.32).
Conclusions
The results indicate that engaging in work-related activities during free time elevates the risk of sleep disturbance, independent of long working hours or shift patterns. Mediation analysis revealed that the strongest effects were driven by the behavioral and psychological dimensions of work–family conflict. These findings suggest that sleep disturbance arises primarily from the erosion of work–life boundaries, fueled by persistent work-related rumination and the spillover of professional burdens into free time.

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Review

Factors associated with work-related musculoskeletal disorders using machine learning approaches: a systematic review: Muhammad Irfan Mohd Sallehhudin, Siti Munira Yasin, Mohamad Rodi Isa, Tajul Rosli Razak, Muhamad Syazni Mohamad Asraff, Nur Adilla Che Rameli, Muhammad Muaz Shahriman-Teruna, Muhammad Muzzammil Mohamad Salleh, Mohamad Zuhair Mohamed Yusoff, Muhammad Hariz Ammar Khebir; Ann Occup Environ Med 2026;38:e10. Published online March 19, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e10

Abstract PDF Supplementary Material: Background
Work-related musculoskeletal disorders (WRMSDs) remain a major cause of occupational disability and productivity loss worldwide. Traditional statistical methods have identified numerous associated factors; however, they often struggle to capture complex non-linear relationships and interactions across multiple domains of risk. Machine learning (ML) offers an alternative analytical approach for modelling such multidimensional relationships.
Methods
Following the PRISMA 2020 guidelines (PROSPERO: CRD420250605234), literature searches were conducted in Web of Science, Scopus, and PubMed for studies published between 2020 and 2025. Eligible studies applied ML methods to identify factors associated with WRMSDs using cross-sectional study designs. Included studies were appraised using the Joanna Briggs Institute Critical Appraisal Checklist for analytical cross-sectional studies.
Results
Ten studies met the inclusion criteria, representing workers from healthcare, transport, manufacturing, and service sectors across Asia, Africa, and Europe. Frequently applied ML algorithms included random forest, support vector machine, and artificial neural networks, demonstrating strong internal discriminative performance (area under the receiver operating characteristic curve: 0.80–0.99), although the absence of external validation in several studies suggests a potential risk of overfitting. Commonly identified factors included age, sex, awkward posture, vibration exposure, prolonged working hours, stress, and burnout. Psychosocial factors, including post-traumatic stress disorder, job stress, and depression, were ranked among the most influential predictors within ML models.
Conclusions
ML models demonstrate strong capability in discriminating WRMSDs risk and identifying multidimensional risk factors compared with traditional statistical approaches. These models highlight complex interrelationships between ergonomic and psychosocial exposures. Future research should incorporate external validation, objective exposure measurements, and standardized ML reporting frameworks to enhance methodological transparency and generalizability.

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Original Article

Association between working ≥10 hours per day and satisfaction with work environment among wage workers in Korea: a cross-sectional study using data from the 7th Korean Working Conditions Survey: Rae-Yun Kim, Dong-Woo Kim, Yoon-Soo Jang, Na-Rae Lee, June-Hee Lee, Kyung-Jae Lee; Ann Occup Environ Med 2026;38:e9. Published online March 18, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e9

Abstract PDF Supplementary Material: Background
Long working hours have been associated with adverse physical and mental health outcomes; however, evidence regarding their relationship with satisfaction with work environment remains limited, particularly when long working hours are defined using a specific daily threshold. This study examined the association between working ≥10 hours per day and satisfaction with work environment among Korean wage workers, focusing on the cumulative number of such workdays per month.
Methods
This cross-sectional study analyzed data from the 7th Korean Working Conditions Survey. A total of 24,269 wage workers aged ≥18 years were included after excluding self-employed workers, unpaid family workers, shift workers, and respondents with missing data. Working ≥10 hours per day was categorized as 0, 1–9, and ≥10 days per month. Satisfaction with work environment was categorized as satisfied or dissatisfied. Multiple logistic regression analyses were conducted to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for dissatisfaction with work environment according to the number of long working days, adjusting for demographic and occupational characteristics.
Results
Compared with workers who did not work ≥10 hours per day, those who worked 1–9 days and ≥10 days per month showed progressively higher levels of dissatisfaction with work environment. After adjustment for demographic and occupational factors, the odds of dissatisfaction with work environment were significantly higher among workers who worked ≥10 hours per day for 1–9 days per month (OR: 1.380; 95% CI: 1.145–1.665) and ≥10 days per month (OR: 2.106; 95% CI: 1.627–2.725), demonstrating a dose–response relationship.
Conclusions
Among the analytic sample of Korean wage workers included in this study, working ≥10 hours per day was associated with greater dissatisfaction with work environment, with a dose–response pattern according to the number of long working days per month.

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Case Report

Severe bilateral hydrocarbon pneumonitis requiring surgical drainage following accidental aspiration of industrial cleaning solvent in a seafarer: a case report: Sang-Heon Cho, Jong Gill Jeong; Ann Occup Environ Med 2026;38:e8. Published online March 11, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e8

Abstract Abstract in Korean PDF: Background
Hydrocarbon pneumonitis is typically self-limiting, and severe complications, such as lung abscesses, are rare. Here, we report the case of a seafarer who developed bilateral lung abscesses after aspirating an industrial cleaning solvent, highlighting the aggravating role of delayed medical care and improper first-aid measures in a maritime setting.
Case presentation
A 46-year-old seafarer presented with dyspnea, 3 days after accidentally ingesting a hydrocarbon-based solvent that he mistook for water. Although he immediately spat out the fluid, he aspirated a small amount. His condition rapidly deteriorated to necrotizing pneumonia with bilateral lung abscesses, as confirmed by chest computed tomography. Despite empirical antibiotic therapy, the abscess worsened, necessitating a video-assisted thoracic surgery for drainage. The patient recovered after surgery and underwent a prolonged course of antibiotic therapy.
Conclusions
This case underscores the potential for life-threatening complications from industrial solvent aspiration, exacerbated by delayed medical care and forceful spitting. Strict workplace safety protocols, including the prohibition of storing chemicals in food containers to avoid confusion, and awareness about not inducing vomiting after ingestion, are essential to prevent such severe occupational injuries.; Background:
탄화수소에 의한 폐렴은 일반적으로 자연 치유되는 경과를 보이며, 폐농양과 같은 심각한 합병증은 드물다. 본 증례에서는 산업용 세척 용제를 흡인한 후 양측성 폐농양으로 발전한 선원의 사례를 보고하며, 특히 해상 환경에서의 지연된 의료 처치와 부적절한 응급처치가 병세를 악화시키는 요인임을 강조하고자 한다.
Case presentation:
46세 선원이 탄화수소 계열의 용제를 물로 오인하여 우발적으로 섭취한 지 3일 후 호흡곤란을 주소로 내원하였다. 환자는 즉시 액체를 뱉어냈으나, 그 과정에서 소량을 흡인하였다. 환자의 상태는 급격히 악화되어 괴사성 폐렴 및 양측성 폐농양으로 진행되었으며, 이는 흉부 컴퓨터단층촬영을 통해 확인되었다. 경험적 항생제 치료에도 불구하고 농양은 악화되었고, 결국 배농을 위한 비디오 흉강경 수술을 시행하였다. 환자는 수술 후 회복되었으며, 장기간의 항생제 치료를 받았다.
Conclusions:
본 증례는 산업용 용제 흡인이 생명을 위협하는 합병증을 유발할 수 있음을 보여주며, 이러한 위험은 의료 처치의 지연과 흡인 위험을 높이는 강하게 뱉어내는 행위로 인해 더욱 악화될 수 있음을 시사한다. 혼동을 방지하기 위해 식품 용기에 화학물질 보관을 금지하는 등의 엄격한 작업장 안전 수칙 준수와, 섭취 후 억지로 구토를 유발하지 않아야 한다는 점에 대한 인식 제고는 이러한 심각한 직업성 손상을 예방하는 데 필수적이다.

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Case Report

Multiple chemical sensitivity triggered by an automobile mechanic's indirect exposure to volatile organic compounds in the Republic of Korea: a case report: Dong-Hoon Cheon, Yoon-Ji Kim, Dongmug Kang, Youngki Kim, Eun-Soo Lee, Ki-Hun Kim, Se-Yeong Kim; Ann Occup Environ Med 2026;38:e7. Published online February 26, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e7

Abstract Abstract in Korean PDF: Background
Multiple chemical sensitivity (MCS) lacks definitive biomarkers, making differential diagnosis reliant on exclusion and symptom reproducibility. In automobile repair shops, volatile organic compounds (VOCs) from cleaning agents pose risks not only to primary users but also to co-workers via indirect exposure. We report a case of MCS suspected to be triggered solely by bystander VOC exposure, highlighting the clinical significance of uncaptured peak exposures in Korea.
Case presentation
A 23-year-old mechanic experienced recurrent headaches, throat irritation, and nausea immediately after co-workers used aerosolized cleaners in a poorly ventilated workspace. Symptoms consistently improved when he was away from work. Routine clinical evaluations were unremarkable. Although the patient underwent surgery for chronic rhinosinusitis, the symptoms persisted specifically upon re-exposure, effectively ruling out structural otorhinolaryngologic causes. Mental health screening indicated only mild depressive symptoms, insufficient to account for the severity of the physical symptoms. The Quick Environmental Exposure and Sensitivity Inventory (QEESI) scores were in the "suggestive" range for MCS. While routine workplace monitoring (8-hour time-weighted average [TWA]) showed non-detectable solvent levels, the nature of aerosol application suggested uncaptured short-term peak exposures. Based on the distinct temporal relationship, the patient was placed under medical observation and assessed as fit for work with restrictions on solvent exposure.
Conclusions
This case highlights the role of indirect VOC exposure as a trigger for MCS symptoms even when routine TWA monitoring indicates minimal concentrations. The discrepancy likely stems from the brief peak exposures triggering central sensitization, underscoring the limitations of standard monitoring. Management strategies must focus on peak-exposure control and fitness-for-work assessments that mandate strict avoidance of organic solvents, regardless of average ambient concentrations.; 국내 자동차 정비사의 휘발성 유기화합물 간접 노출에 의해 유발된 다중화학물질과민증: 증례 보고
배경
다중화학물질과민증(Multiple Chemical Sensitivity, MCS)은 명확한 바이오마커가 부족하여 배제 진단과 증상의 재현성에 의존하여 진단된다. 자동차 정비 현장에서 발생하는 휘발성 유기화합물(VOCs)은 직접 사용자뿐만 아니라 간접 노출되는 주변 작업자에게도 건강상의 위험을 초래한다. 본 저자들은 한국의 일반적인 작업환경측정 체계에서 포착되지 않는 단기 피크 노출(peak exposure)의 임상적 중요성을 강조하며, 간접 노출에 의해 유발된 MCS 사례를 보고하고자 한다.
증례
보고: 23세 남성 정비사가 환기가 불충분한 작업장에서 동료들이 에어로졸 세정제를 사용할 때마다 반복적인 두통, 인후 자극 및 오심을 경험하였다. 증상은 작업장을 벗어났을 때 일관되게 호전되는 양상을 보였다. 일반적인 임상 검사 결과는 정상 범위였으며, 만성 비부비동염 수술 후에도 유기용제 재노출 시 증상이 지속되어 이비인후과적 구조적 원인은 배제되었다. 정신건강 스크리닝 결과는 경미한 우울 증상만을 보였으며, 이는 신체 증상의 심각성을 설명하기에 불충분하였다. 한국판 QEESI(Quick Environmental Exposure and Sensitivity Inventory) 설문 결과 MCS '시사(Suggestive)' 범위에 해당하였다. 작업환경측정 결과(8시간 시간가중평균, TWA)는 유기용제 불검출 수준이었으나, 에어로졸 사용 특성상 측정되지 않은 단기 피크 노출이 의심되었다. 뚜렷한 시간적 인과관계를 바탕으로 환자는 의학적 관찰 대상이 되었으며, 유기용제 노출 제한을 조건으로 '조건부 작업 적합' 판정을 받았다.
결론
본 증례는 통상적인 TWA 측정치가 낮음에도 불구하고 간접적인 VOC 노출이 MCS 증상의 트리거가 될 수 있음을 시사한다. 이러한 불일치는 단기 피크 노출이 중추 감작(central sensitization)을 유발하기 때문으로 보이며, 이는 표준 측정 방식의 한계를 보여준다. MCS의 관리는 평균 노출 농도와 관계없이 피크 노출 제어 및 엄격한 유기용제 노출 회피를 포함하는 업무적합성 평가에 초점을 맞추어야 한다.

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Original Article

Acute health effects of accidental exposure to lithium hydroxide at a battery material production plant: Chul Gab Lee, Soo Hyeong Park, Ji Won Kang, Si Woo Hwang, Hyeo Na Kim, Hyeon Kyeong Ko; Ann Occup Environ Med 2026;38:e6. Published online February 9, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e6

Abstract Abstract in Korean PDF: Background
Lithium hydroxide (LiOH) is increasingly used in electric vehicle battery production; however, its health effects in the work environment remain underreported. This study characterizes the acute health effects on workers following accidental occupational exposure to LiOH at a Korean lithium plant in March 2024.
Methods
We analyzed health effects from two LiOH exposure accidents on March 6 and 9, 2024, involving 50–100 kg powder spills. Two datasets were examined: acute symptoms from 115 workers who visited hospitals immediately after exposure, and a symptom severity survey from 474 workers conducted 2 weeks post-exposure. Workers were stratified by distance from the leak source (<10 m, 10–20 m, >20 m) and respirator use. Univariate general linear modeling was applied to analyze the relationship between symptom occurrence and both the distance from the exposure source and respirator use.
Results
Among workers visiting hospitals immediately, local irritation symptoms predominated: sore throat (58.3%), cough (28.7%), and skin dermatoses (17.4%). Systemic symptoms included headache (45.2%), nausea (18.3%), chest tightness (12.2%), and dizziness (9.6%). Two-week follow-up revealed overall symptom improvement; severe cough decreased from 22.2% to 10.1%. However, despite general improvement, a significant portion of workers reported persistent respiratory issues, including cough (28.7%) and sputum production (31.0%). Symptom severity showed a significant dose-response relationship with proximity to the source (p < 0.001). While respirator use offered initial protection (p = 0.021), this effect was not statistically significant after 2 weeks.
Conclusions
Occupational LiOH exposure caused acute irritation and systemic symptoms, demonstrating immediate tissue damage consistent with its alkalinity and systemic toxicity upon absorption. As lithium battery production expands globally, these results emphasize the necessity for developing specific occupational exposure limits and medical surveillance guidelines for lithium compounds.; 수산화리튬 누출 사고에 따른 급성 건강영향
배경
수산화리튬((LiOH)은 전기차 배터리 생산에 필수적인 소재이나, 직업환경의학 영역에서 건강영향에 대한 문헌은 부족하다. 본 연구는 2024년 3월 수산화리튬 생산공장에서 발생한 두 차례의 사고에 따른 노동자의 급성 건강 영향에 대해 조사 결과이다.
방법
2024. 3. 6일과 9일 두 차례에 걸쳐 수산화리튬 생산설비 시운전 중 실리콘 연결부 파열로 50~100kg의 분말이 누출되어 발생한 급성건강 영향의 2개의 데이터를 분석하였다. 하나는 누출사고 당시 한 병원 방문자 115명의 증상이며, 다른 하나는 노출 2주후에 474명을 대상으로 한 설문조사 결과이다. 국소증상과 전신증상 호소율을 기록하고, 이들 증상이 노출원과의 거리(<10m, 10~20m, >20m) 및 호흡 보호구를 착용 유무에 따른 심각도에 차이가 있는지 단변량 일반 선형 모델링을 적용하여 분석하였다.
결과
사고 직후 병원을 방문한 노동자에서 국소 자극 증상이 가장 흔하게 나타났으며, 인후통(58.3%), 기침(28.7%), 피부 질환(17.4%) 등이었다. 전신 증상으로는 두통(45.2%), 메스꺼움(18.3%), 가슴 답답함(12.2%), 어지럼증(9.6%) 등이 있었다. 2주 후 추적 관찰 결과에서 전반적인 증상 호전이 있었는데, 심한 기침은 22.2%에서 10.1%로 감소했다. 그러나 전반적인 증상 개선에도 불구하고, 상당수의 노동자는 기침(28.7%)과 가래(31.0%)를 포함한 호흡기 문제를 지속적으로 호소했다. 증상 심각도는 노출원과 거리에 따라 의미한 상관관계를 보였으며(p<0.001), 호흡기 보호구 착용은 초기에는 보호 효과를 제공했지만(p=0.021), 2주 후에는 통계적으로 유의미한 효과가 나타나지 않았다.
결론
수산화리튬에 누출 사고에 노출된 노동자에서 국소적인 자극 및 전신 증상을 유발했으며, 이는 수산화리튬의 알칼리성과 흡수 시 전신 독성에 부합하는 즉각적인 조직 손상으로 추정된다. 리튬 배터리 생산이 전 세계적으로 확대됨에 따라, 수산화리튬에 대한 구체적인 직업적 노출 한계와 의학적 감시 지침을 개발해야 한다.

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Case Report

Case series: from ventilation failure to substitution success in occupational lead poisoning at a Korean indoor firing range: Chul Gab Lee, Soo Hyeong Park; Ann Occup Environ Med 2026;38:e5. Published online February 9, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e5

Abstract Abstract in Korean PDF: Background
Indoor firing ranges are globally recognized as high-risk settings for occupational and recreational lead exposure due to the use of lead-based ammunition and frequently inadequate ventilation systems. In Korea, however, public health surveillance and regulatory oversight have remained limited. This case series empirically demonstrates that in high-emission settings like indoor firing ranges, ventilation upgrades are insufficient. Source substitution with lead-free primer ammunition proved to be the only definitive intervention.
Case presentation
In late 2023, an index case presenting with abdominal pain was found to have a blood lead level (BLL) of 55 μg/dL, prompting a government-mandated investigation. Nine male shooting instructors (tenure: 4–65 months) were subsequently identified with BLLs ranging from 38.2–73.2 μg/dL, while airborne lead concentrations (ALC) reached 0.51 mg/m³—10 times the occupational exposure limit (OEL: 0.05 mg/m³). During a 3-month closure to upgrade ventilation, workers received chelation therapy (CaNa₂EDTA and D-penicillamine), which reduced their BLLs to 3.2–25.7 μg/dL. However, 2 months after reopening, post-intervention ALC remained elevated at 0.0797 mg/m³, still exceeding the OEL, and BLLs rebounded to 16.2–53.3 μg/dL. A substitution strategy was then implemented, replacing lead-based ammunition with copper-clad, lead-free primer rounds. This intervention decreased ALC to <0.003 mg/m³ and lowered BLLs to 4.9–23.1 μg/dL. Despite the reduced airborne concentrations, several workers continued to exhibit BLLs around 20 μg/dL, suggesting subtle ongoing exposure and mobilization of bone-stored lead.
Conclusions
This cluster demonstrates that in environments where hazardous agents are continuously generated, such as indoor firing ranges, engineering controls alone, such as improved ventilation, may not provide adequate protection. Substitution—the most effective intervention within the hierarchy of controls—was essential for eliminating exposure. Furthermore, the toxicokinetics of bone lead in chronically exposed adults highlight the need for ongoing monitoring and cautious decision-making regarding treatment and return-to-work planning.; 한국의 한 실내사격장에서 발생한 직업성 납중독: 개입위계 체계의 실패와 성공 사례보고
배경
실내 사격장은 납 기반 탄약의 사용과 불충분한 환기 시스템으로 인해, 직업적 및 레저 활동 시 납 노출 위험이 높은 환경으로 전 세계적으로 알려져 있다. 그러나 한국에서는 이에 대한 공중 보건학적 감시나 규제적인 감독이 없었다. 본 증례 보고는 국내 한 실내 사격장 노동자(사격 코치)에서 발생한 집단 중증 납 중독 사례를 분석하여, 고농도 노출 환경에서 환기 개선과 같은 공학적 대책의 한계를 살펴보고, 유해 물질 대체(substitution)를 통한 근본적 해결의 중요성을 강조하고자 한다.
증례
2023년 말, 심한 복통을 호소한 지표 환자(index case)의 혈중 납 농도(BLL)가 55 µg/dL로 확인되면서 정부 주도의 역학 조사가 실시되었다. 해당 사격장의 사격 코치 9명(근무 기간: 4~65개월)의 혈중 납 농도(Blood lead level, BLL)은 38.2~73.2 µg/dL 범위였으며, 작업환경측정에 의한 사격장 실내 납 농도(Airborne lead concentration, ALC)는 0.51 mg/m³로 노출 기준(Occupational exposure limit, OEL: 0.05 mg/m³)의 10배를 초과했다. 환기 설비 개선을 위한 3개월간 폐쇄 기간 동안 킬레이션 요법(CaNa₂EDTA 및 D-penicillamine)을 시행하여 BLL이 3.2~25.7 µg/dL로 감소했다. 그러나 환기 시스템을 대폭 개선하여 재가동했음에도 불구하고, 2개월 후 ALC는 0.0797 mg/m³로 여전히 기준치를 초과했고, 복귀한 근로자들의 BLL은 16.2~53.3 µg/dL로 급격히 재상승했다. 이에 따라 납 기반 탄약을 구리 피복 및 무연 뇌관(lead-free primer) 탄약으로 전면 교체하는 대체 전략이 시행되었다. 그 결과 ALC는 0.003 mg/m³ 미만으로 감소하였고, BLL 또한 4.9~23.1 µg/dL로 감소하여 안정화되었다. 다만, ALC의 획기적 감소에도 불구하고 일부 노동자의 BLL이 20 µg/dL 수준을 유지한 것은 뼈에 축적된 납의 재분배(mobilization) 영향으로 추정된다.
결론
본 사례는 실내 사격장과 같이 유해 인자가 지속적으로 발생하는 환경에서는 환기 개선 등의 공학적 대책만으로는 근로자를 충분히 보호할 수 없음을 시사한다. 따라서 산업안전보건의 ‘위험성 관리의 위계(Hierarchy of Controls)’ 중 가장 효과적인 조치인 ‘대체(substitution)’를 통해 오염원을 원천적으로 제거하는 것이 필수적이다. 아울러 만성 고농도 노출 근로자의 경우, 체내 축적된 납의 독성동태학적 특성을 고려하여 치료 및 업무 복귀 결정 시 장기적인 모니터링과 신중한 접근이 요구된다.

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Original Article

Association between outdoor clothing use and serum perfluoroalkyl substances (PFAS): Korean National Environmental Health Survey cycle 4: Keon Woo Kim, Jisoo Kang, Seong-yong Cho, Seongyong Yoon, Daehwan Kim, Hyun Woo Park; Ann Occup Environ Med 2026;38:e4. Published online January 8, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e4

Abstract Abstract in Korean PDF Supplementary Material: Background
Perfluoroalkyl substances (PFAS) are used in various products, and PFAS have been detected in outdoor clothing. PFAS can be absorbed into the human body via oral ingestion, inhalation, and dermal contact. In this study, we examined the association between the frequency of using outdoor clothing and serum PFAS concentrations in the Korean population using data from cycle 4 (2018–2020) of the Korean National Environmental Health Survey.
Methods
Data from 2,993 adult participants were analyzed. The participants were classified into low-concentration and high-concentration groups based on the 75th percentile concentration of serum PFAS. The use of outdoor clothing was categorized into three groups: non-use, <4 times a week, and ≥4 times a week. The odds ratio (OR) for serum PFAS levels associated with use of outdoor clothing was determined through logistic regression analysis, adjusted for demographic characteristics, health-related factors, PFAS-treated items, dietary factors, and ventilation time.
Results
ORs for high serum PFAS were higher in groups using outdoor clothing compared to the non-user group. In males, the adjusted ORs for the < 4 times a week and ≥ 4 times a week outdoor clothing usage group were as follows: perfluorooctanoic acid (PFOA), 1.26 (95% confidence interval [CI]: 1.10–1.44) and 1.70 (1.40–2.07); perfluorohexanesulfonic acid (PFHxS), 1.49 (1.16–1.92) and 1.70 (1.22–2.37); and perfluorononanoic acid (PFNA), 1.34 (1.19–1.51) and 1.68 (1.38–2.05), respectively. In females, the respective ORs were as follows: PFOA 1.32 (95% CI: 1.19–1.46) and 1.53 (1.01–2.32); PFHxS, 1.46 (1.08–1.96) and 2.63 (2.10–3.29); PFNA, 1.38 (1.22–1.55) and 1.45 (1.07–1.96).
Conclusions
In adults, elevated serum PFAS levels were associated with increased frequency of using outdoor clothing.; 제4기(2018-2020) 국민환경보건 기초조사 자료를 이용한 아웃도어 의류 착용과 혈청 과불화화합물과의 관계
목적
과불화화합물(PFAS)은 방수 및 방유 효과를 가지고 있어 아웃도어 의류를 포함한 일회용 식품 포장, 조리 기구, 가구 등 다양한 제품에 사용된다. 선행 연구에 따르면 PFAS가 아웃도어 의류에서 검출되었다. PFAS는 경구섭취, 흡입, 피부접촉 등의 경로를 통해 인체에 흡수되며 체내에 장기간 잔류하면서 간기능, 신기능, 생식기능 등의 저하 증상을 유발할 수 있다. 본 연구에서는 한국 국민환경보건 기초조사(KoNEHS) 4주기(2018-2020)의 데이터를 사용하여 한국 인구의 아웃도어 의류 사용 빈도와 혈청 PFAS농도와의 연관성을 확인하고자 한다.
방법
KoNEHS 4주기의 데이터를 이용하여 2,993명의 성인 참가자를 분석하였다. 혈청 PFAS의 75 번째 백분위 수 농도를 기준으로 저농도군과 고농도군으로 나누었다. 아웃도어 의류 사용은 미사용, 주 당 4회 미만, 주 당 4회 이상으로 세 군으로 분류하였다. 아웃도어 의류 사용에 관한 혈청 PFAS의 오즈비는 인구통계학적 특성, 건강 관련 특성, PFAS 사용 물품, 식이요인 그리고 환기 시간을 보정한 후 로지스틱 회귀분석을 사용하여 구하였다
결과
본 연구에서는 아웃도어 의류를 사용하지 않는 군에 비해 주 4회 미만 사용군 및 주4회 이상 사용군에서 혈청 PFAS 고농도군에 속할 OR 값이 높게 나왔다. 남성에서 주 4회미만 사용군 및 주 4회이상 사용군에서 PFOA의 고농도군에 해당될 adjusted OR는 1.26(95% CI; 1.10-1.44) 및 1.70(95% CI; 1.40-2.07)이었다PFHxS는 1.49(95%CI; 1.16-1.92) 및 1.70(95%CI; 1.22-2.37), PFNA는 1.34(95% CI; 1.19-1.51) 및 1.68(95% CI; 1.38-2.05), 이었다. 여성의 경우 주 4회미만 사용군 및 주 4회이상 사용군에서 PFOA의 고농도군에 해당될 adjusted OR는 1.32(95% CI; 1.19-1.46) 및 1.53(95% CI; 1.01-2.32)이었다. PFHxS는 1.46(95%CI; 1.08-1.96) 및 2.63(95%CI; 2.10-3.29), PFNA는 1.38(95% CI; 1.22-1.55) 및 1.45(95% CI; 1.07-1.96) 이었다.
결론
성인에서 아웃도어 의류 착용 횟수가 많을수록 혈청 PFAS(PFOA, PFOS, PFHxS, PFNA, PFDeA) 농도가 증가하였다.

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Review

Impacts of heat on sleep quality among heat-exposed workers: a systematic review: Maarthi Raja, Vidhya Venugopal, D. C. Mathangi, Suvarna Jyothi Kantipudi, K. Mahesh Kumar, Somnath Panda, Latha Perumal Kamalakkannan; Ann Occup Environ Med 2026;38:e3. Published online January 8, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e3

Abstract PDF Supplementary Material: Climate change is intensifying occupational heat exposure, posing risks not only for heat-related illness but also for sleep, which is essential for recovery, safety, and productivity. Heat-exposed workers are highly vulnerable due to prolonged exposure, limited access to cooling, and poor housing. This systematic review aimed to synthesise global evidence on how occupational heat exposure affects sleep quality among workers across different occupations and settings. A systematic review was conducted following Synthesis without Meta-Analysis (SWiM) guidelines. PubMed, Scopus, and Google Scholar were searched (2000–2025) for studies involving adult workers (≥18 years) reporting both heat exposure and sleep outcomes. The review was registered with PROSPERO (ID: CRD420251125735). Of 7,108 records screened, 11 studies met the inclusion criteria. Studies spanned Asia, Australia, North America, and global cohorts. Heat exposure consistently impaired sleep quality and duration. Using Pittsburgh Sleep Quality Index, Actigraphy, and self-reports, common complaints included difficulty falling asleep (64%), restlessness (54%), non-restorative sleep (54%), night sweats (36%), and reduced total sleep time (45%). Night-time temperatures above 25°C and high workplace wet bulb globe temperature values were strongly linked with reduced sleep efficiency and delayed sleep onset. Vulnerable groups included shift workers, petrochemical and steel labourers, women, older adults, and low-income workers in urban heat islands and poorly ventilated housing. Occupational heat exposure disrupts sleep, compounding daytime strain and creating a dual burden for workers. Integrating sleep into heat stress management through cooling interventions, better housing, and revised work–rest schedules is critical for workers well-being in a warming climate.

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Original Article

Development of criteria for health examination of high-risk occupational groups and application to female fishers: Delphi study: Hye-min Kim, Jungwon Kim, Kunhyung Kim, Hansoo Song; Ann Occup Environ Med 2026;38:e2. Published online January 8, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e2

Abstract Abstract in Korean PDF Supplementary Material: Background
The objective of this study was to establish criteria for designing health examination programs and selecting appropriate examination items for high-risk occupational groups and to apply these criteria specifically to female fishers.
Methods
The first Delphi survey comprised five domains and 15 specific criteria for identifying relevant health screening items for high-risk occupations. The second survey included open-ended questions addressing inconsistencies identified in the first survey and sought suggestions for additional items. In the third Delphi survey, specific health screening items were proposed for female fishers, and experts directly evaluated these items according to the finalized selection criteria.
Results
Twenty-eight experts participated in this study. The first and second Delphi rounds facilitated the finalization of selection criteria for health screening items, consisting of five domains: Domain 1, Priority of target disease; Domain 2, Applicability of early detection and intervention; Domain 3, Scientific evidence of medical test method; Domain 4, Acceptability of medical test method; and Domain 5, Effectiveness of examination. Content validity ratios for these criteria ranged between 0.429 and 1.000. Based on the established criteria, experts evaluated eight proposed screening items for female fishers in the third round of the Delphi survey. Bone density, bioelectrical impedance analysis, cardiovascular disease risk factors, and fundoscopy were evaluated as appropriate; however, no agreement was reached on the early detection and intervention areas for degenerative lumbar disease, knee osteoarthritis, and upper extremity disease, as well as on the effectiveness for upper extremity disease and chronic obstructive pulmonary disease.
Conclusion
This study successfully established comprehensive criteria for selecting diseases targeted by health examinations in high-risk occupational groups. The practical application of these criteria proved effective in assessing the appropriateness of specific health screening items.; 고위험 직업군 건강검진 기준 개발 및 여성 어업종사자에의 적용: 델파이 조사
배경
본 연구의 목적은 고위험 직업군을 위한 건강검진 프로그램 설계 기준과 적절한 검사 항목을 선정하는 기준을 수립하고, 이를 여성 어업종사자에게 구체적으로 적용하는 것이었다.
방법
첫 번째 델파이 조사에서는 고위험 직업군의 건강검진 항목을 선정하기 위한 5개 영역과 15개의 기준을 설정하였다. 두 번째 조사에서는 첫 번째 조사에서 발견된 불일치를 해소하고 추가 항목에 대한 제안을 받기 위해 개방형 질문을 포함하였다. 세 번째 델파이 조사에서는 여성 어업종사자에게 적용할 건강검진 항목을 제안하고, 전문가들이 최종 선정 기준에 따라 해당 항목을 평가하였다.
결과
본 연구에는 28명의 전문가가 참여하였다. 첫 번째와 두 번째 델파이 조사에서는 건강검진 항목 선정 기준이 확정되었으며, 이 기준은 다음의 5개 영역으로 구성되었다: <영역 1: 대상 질병의 우선순위>, <영역 2: 조기 발견 및 개입의 적용 가능성>, <영역 3: 의학적 검사 방법에 대한 과학적 근거>, <영역 4: 의학적 검사 방법의 수용 가능성>, <영역 5: 검사의 효과성>. 각 기준의 내용 타당도 비율은 0.429에서 1.000 사이였다. 확립된 기준에 따라, 세 번째 델파이 조사에서 여성 어업종사자를 위한 8개 건강검진 항목이 평가되었으며, 골밀도, 생체 전기 저항 분석, 심혈관 질환 위험 인자, 안저 검사는 적절한 항목으로 평가되었으나, 퇴행성 요추 질환, 무릎 골관절염, 상지 질환 및 만성 폐쇄성 폐질환의 조기 발견 및 개입 영역과 상지 질환과 만성 폐쇄성 폐질환의 효과성에 대해서는 전문가들 간의 합의가 이루어지지 않았다.
결론
본 연구는 고위험 직업군의 건강검진을 위한 질병 선정 기준을 성공적으로 확립하였다. 이 기준을 실제로 적용함으로써 특정 건강검진 항목의 적절성을 평가하는 데 효과적임을 확인하였다.

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Original Article

Work-life balance and effort-reward imbalance, and their interaction, associated with presenteeism among Korean wage workers: Based on 6th Korean working conditions survey: Sang-Hyeon Kim, Eun-Chul Jang, Soon-Chan Kwon, In-ho Lee, Jisuk Yun, Ui Chan Jung, Young-Sun Min; Ann Occup Environ Med 2026;38:e1. Published online January 8, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e1

Abstract Abstract in Korean PDF Supplementary Material: Background
This study investigated the relationship between work-life balance (WLB), effort-reward imbalance (ERI), and presenteeism among Korean wageworkers through two models used simultaneously.
Methods
Data from the 6th Korean Working Conditions Survey for 28,669 Korean workers, including 13,513 men and 15,156 women, were analyzed. All analyses were performed with pre-designed weight. Multiple logistic regression analysis was used to analyze the association between WLB, ERI, and presenteeism among Korean workers. The participants were classified into the following four groups: group 1, status of both WLB and ERI is “balanced”; group 2, WLB and ERI status are “imbalanced” and “balanced”, respectively; group 3, WLB and ERI status are “balanced” and “imbalanced”, respectively; group 4: status of both WLB and ERI is “imbalanced.”
Results
We found that WLB and ERI were associated with presenteeism in both men and women. Depending on their WLB and ERI status, women generally had a higher tendency of presenteeism than men. Multiple logistic regression shows that, in most models and groups, there is an increased odds ratio (OR) for presenteeism in both men and women compared to the reference value. Moreover, the OR in both men and women gradually increased in groups 2, 3, and 4 compared with group 1. When considering both WLB and ERI status simultaneously, ERI had a greater impact on presenteeism than WLB. Furthermore, it was found that a synergistic effect of presenteeism manifests when both WLB and ERI are in a state of imbalance simultaneously.
Conclusions
Using the two models simultaneously, we found an association between WLB, ERI, and presenteeism according to sex with a synergistic effect among Korean workers. Our research suggests that active interventions targeting WLB and ERI are necessary to reduce presenteeism, which ultimately leads to decreased productivity.; 한국 임금근로자의 일과 삶의 균형, 노력-보상 불균형과 프리젠티즘의 관련성
배경
일-삶 균형 상태, 노력-보상 불균형 상태와 프리젠티즘과의 관계를 각각 다룬 여러 연구가 있었으나 이를 동시에 조사한 연구 결과는 제한적이다. 본 연구는 한국 임금근로자를 대상으로 일-삶-균형 상태, 노력-보상 불균형 상태를 동시에 고려하여 프리젠티즘의 관련성을 확인하고자 하였다.
방법
본 연구는 제 6차 근로환경조사를 활용하여 그 중 선별된 임금근로자 28,669명을 대상으로 자료를 수집하였다. 변수로 대상자의 일반적인 특성 및 교육수준, 수입수준, 사업장 규모, 교대근무 여부 등 직업적 특성이 포함되었다. 본 연구의 종속변수인 프리젠티즘은 그 여부에 따라 두가지 범주로 나누었다. 주요 독립변수인 일-삶의 균형, 노력-보상 불균형 상태는 ‘균형’, ‘불균형’ 두가지 범주로 나누어 평가하였다. 다중 로지스틱 회귀 분석은 남녀 각각에 대해 시행하였고, 일-삶 균형 상태, 노력-보상 불균형 상태와 프리젠티즘의 연관성을 평가하였다. 대표성 있는 도출을 위해 모든 통계분석에는 사전에 계산된 가중치를 적용하였다.
결과
일과 삶의 균형(WLB)과 노력-보상 불균형(ERI)이 남녀 모두에서 프리젠티즘과 연관되어 있음을 발견하였다. WLB 및 ERI 상태에 따라 여성은 일반적으로 남성보다 프리젠티즘 경향이 더 높았다. 다중 로지스틱 회귀 분석에 따르면, 대부분의 모델과 집단에서 기준 값 대비 남녀 모두 프리젠티즘의 오즈비가 증가했다. WLB와 ERI 상태를 동시에 고려할 때, ERI가 WLB보다 프리젠티즘에 더 큰 영향을 미치는 것으로 나타났다. 더불어 WLB와 ERI가 동시에 불균형 상태일 때 프리젠티즘의 시너지 효과가 나타남이 확인되었다.
결론
두 모델을 동시에 적용한 결과, 한국 근로자 집단에서 남녀 모두에서 일과 삶의 균형과 노력-보상 불균형이 충족되지 않을 경우 프리젠티즘이 나타나고 이는 시너지 효과가 나타남을 확인하였다. 본 연구는 궁극적으로 생산성 저하를 초래하는 프리젠티즘을 줄이기 위해서는 일과 삶의 균형과 노력-보상 불균형에 초점을 맞춘 적극적인 개입이 필요함을 시사한다.

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