Annals of Occupational and Environmental Medicine

Volume 20 (2); June 2008

Case Reports

A Case of Caplan's Syndrome with Silicosis: Jun Pyo Myong, Kyeong Yeon Kim, Young Lim; Korean Journal of Occupational and Environmental Medicine 2008;20(2):160-164. Published online June 30, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.2.160

BACKGROUND
Caplan originally described a condition, now reffered to as Caplan's syndrome or Caplan's disease, where progressive massive fibrosis was exhibited by coal miners with multiple pulmonary nodules, and rheumatoid arthritis. This syndrome is very rare in Korea.
CASE
REPORT: The patient was a 49-year old male, with occupational history as a stonemason for 25 years. Silicosis was diagnosed by chest X-ray, while rheumatoid arthritis was diagnosed by immunological examination. Caplan's syndrome was confirmed based on these findings, occupational history, and clinical symptoms.
DISCUSSION
The authors report on the patient's Caplan's syndrome, with a particular focus on his silicosis.

Citations

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Overlap syndrome with Sjögren’s syndrome and systemic sclerosis in a steel rolling mill worker: a case report
Min-Kee Yi, Won-Jun Choi, Sung-Woo Han, Seng-Ho Song, Dong-Hoon Lee, Sun Young Kyung, Sang-Hwan Han
Annals of Occupational and Environmental Medicine.2016;[Epub] CrossRef
A Case of Rheumatoid Pneumoconiosis Presenting with Pleuritis and Pericarditis
Myung Soo Park, Dae Gil Kang, Eun Ju Jung, Ki Jong Oh, Jong Seop Sim, Eun Jung Kim, Changhwan Kim
Korean Journal of Medicine.2013; 84(3): 428. CrossRef
A Case of Caplan's Syndrome Presenting as Acute Onset Polyarthritis
Han Hee Ryu, Sung Hae Chang, Hye Won Kim, Kichul Shin, Eun Bong Lee, Jae Joon Yim, Yeong Wook Song
Journal of Rheumatic Diseases.2011; 18(1): 36. CrossRef

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A Case-study of a Plastering and Waterproof Worker Suffering from Silicosis and Lung Cancer: Kyoo Sang Kim, Min Heui Jo, Byung kyu Kim; Korean Journal of Occupational and Environmental Medicine 2008;20(2):153-159. Published online June 30, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.2.153

Abstract PDF

OBJECTIVES
We report on a case-study of a silicosis sufferer with lung cancer, who was exposed to cement dust through plastering and waterproof work in the construction industry.
METHODS
We reviewed his personal history including employment, medical record and estimated level of carcinogenic materials in the work place in order to evaluate the possible source of his lung cancer.
RESULTS
The patient was a non-smoker and there was no family history of lung cancer. His medical record did not reveal anything of concern. He was exposed to cement dust while he had worked for 20 years as a plasterer and waterproof worker. After complaining of chest pain, he was examined and subsequently diagnosed with lung cancer (RUL, adenocarcinoma; cT4N2M1). He was treated in a hospital for 3 months before passing away. Radiological evaluation by high resolution computed tomography (HRCT) revealed micronodules with a profusion category 1 (p/p, 1/1) in the perilymphatic distribution, which indicated silicosis. Small amounts of cement dust which included silica was identified by environmental evaluation of his work place. He never worked with asbestos related material, which was confirmed by HRCT examination.
CONCLUSIONS
We concluded that the patient's silicosis with lung cancer was an occupational-caused disease due to exposure to cement dust.

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Analysis of Cost Benefit Related to Appointing a Health Care Manager in the Construction Industry
Hye-Sun Jung, Jee-Seon Yi, In-Jae Shin, Eun-Hi Choi
Korean Journal of Occupational Health Nursing.2016; 25(2): 130. CrossRef
Assessment for the Physiological Workload of Warterproof Workers
Tae-Kyung Lim, Sang-Min Park, Dong-Eun Lee
Journal of the Architectural Institute of Korea Structure & Construction.2015; 31(6): 33. CrossRef
Occupational Cancers with Chemical Exposure and their Prevention in Korea: A Literature Review
Kyung-Taek Rim
Asian Pacific Journal of Cancer Prevention.2013; 14(6): 3379. CrossRef
Occupational Respiratory Cancer in Korea
Hye-Eun Lee, Hyoung Ryoul Kim
Journal of Korean Medical Science.2010; 25(Suppl): S94. CrossRef

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A Case of Epitheloid Sarcoma on Metal Cutoff Worker: Min Gi Kim, Kyoo Sang Kim, Tae Woo Kim, Hyung Woo Ryu, Jae Hong Ryoo; Korean Journal of Occupational and Environmental Medicine 2008;20(2):147-152. Published online June 30, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.2.147

Abstract PDF: BACKGROUND
Soft tissue sarcoma is a rare condition with many causative factors. However a soft tissue sarcoma from a metallic foreign body and injury is rare. We report a case of a soft tissue sarcoma caused by a metallic foreign body and injury.
CASE
The patient had been worked as a metal cutter for 17 years. While working, his palms were constantly pricked by small metallic splinters, which were generally removed after work. On march 2004, he had palpitated mass on his right palm. On November 2006, a right hand x-ray showed a mass and metallic foreign body at the 1st volar space which was confirmed to be an epitheloid sarcoma. All metallic products of his workplace contained chromium and Nickel. which are known to cause soft tissue sarcomas. A review of the literature revealed foreign-body and injury induced oxidative and nitrative stress to be associated with a developing sarcoma. In addition, Cr and Ni are associated with the development of sarcoma. Therefore it was concluded this case of epitheloid sarcoma was associated with his employment.
CONCLUSION
A soft-tissue sarcoma associated with a metal foreign-body and injury is rare and their relationship is difficult understand. If a case of sarcoma is encountered on a metal associated worker, their job association should be considered.

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Exposure Level of Trichloroethylene in Stevens-Johnson Syndrome Due to Occupational Exposure: 3 Case Reports and a Review of Other Cases: Sun Wung Lee, Eun A Kim, Dae Sung Kim, Dong hee Koh, Seong Kyu Kang, Byung Kyu Kim, Min Ki Kim; Korean Journal of Occupational and Environmental Medicine 2008;20(2):132-146. Published online June 30, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.2.132

Abstract PDF

BACKGROUND
Trichloroethylene (TCE) has been reported to be related to severe generalized exfoliative dermatitis frequently accompanied by toxic hepatitis. The measurements of environmental exposure were limited in the previous case reports and the reported exposure values were also diverse. We reviewed three cases of Stevens-Johnson syndrome associated with TCE. The work environment was measured by the Korea Occupational Safety and Health Agency (KOSHA) after the cases occurred. From the study results, we intended to clarify the relationship between TCE exposure level and Stevens- Johnson syndrome.
CASE
REPORT: Case 1. A 24-year-old Filipino female worker developed a skin rash 35 days after starting to use TCE for degreasing. The skin rash developed into a bullous eruption and the liver function findings were abnormal. She was diagnosed with Stevens-Johnson syndrome and toxic hepatitis. She died of hepatic failure 39 days after the onset of the first symptom. She had no previous history of taking medicine or viral infection. The work environment measured 22.0 to 32.3 ppm (personal exposure level) with TWA. Case 2. A 47-year-old Korean male worker developed a skin rash, 20 days after starting to use TCE for degreasing. The skin rash developed into a bullous eruption and the liver function findings were abnormal. He was diagnosed with Stevens-Johnson syndrome, toxic hepatitis and sepsis. He died of hepatic failure and sepsis 42 days after the onset of the first symptom. He had no previous history of taking medicine or viral infection. The work environment measured 30.1 ppm (personal exposure level) and 116.5~229.7 ppm (area exposure level close to the degreasing machine) with TWA. Case 3. A 22-yearold Vietnamese female worker developed a skin rash 30 days after starting to use TCE for degreasing. The skin rash developed into a bullous eruption and the liver function findings were abnormal. She was diagnosed with Stevens-Johnson syndrome and toxic hepatitis. Her symptoms improved and she was discharged 37 days after the onset of the first symptom. She had no previous history of taking medicine or viral infection. The work environment measured 107.2 ppm (personal exposure level) with TWA.
DISCUSSION
These three case reports and the previously reported cases indicated that the majority of people susceptible to TCE develops Stevens-Johnson syndrome after high-level TCE exposure (above the TWA occupational exposure limit of 50 ppm). Therefore, work environmental survey and improvements to the TCE degreasing process are essential to prevent high exposure. Furthermore, considering the consistency of the latency period in symptoms and the possibility of sensitization in low-level exposure, we recommend that the first specific health examination also should be conducted 1 month after workers have commenced working.

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The Korean Journal of Hepatology.2009; 15(Suppl 6): S29. CrossRef

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Cement Burn from Waterproof Work: A Case Study: Jaehyeok Ha, Soo Geun Kim, Min Gi Kim, Euna Kim; Korean Journal of Occupational and Environmental Medicine 2008;20(2):127-131. Published online June 30, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.2.127

Abstract PDF: BACKGROUND
Portland cement, which is a common material used in the construction industry, is known to cause caustic burns due to its alkalinity. Although cement burns are frequent and can be severe, many workers are inadequately aware of its risks.
CASE
A 39-year-old man presented with exudative lesions and pain on his right hand after working with wet cement during waterproof work. The patient stated that wet cement entered his protective glove and he did not wash the cement off for 3 hours. Debridement of necrotic tissue and skin grafting was performed on his second and fifteenth hospital day respectively.
CONCLUSION
The prevention of cement burns can be improved by extensive risk instruction and the provision of adequate skin protection.

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A Case of Raynaud's Phenomenon of both Feet in a Rock Drill Operator with Hand-arm Vibration Syndrome: Nari Choy, Chang Sun Sim, Jae Kuk Yoon, Suk Hwan Kim, Hyoung Ook Park, Ji Ho Lee, Cheol In Yoo; Korean Journal of Occupational and Environmental Medicine 2008;20(2):119-126. Published online June 30, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.2.119

Abstract PDF

BACKGROUND
There have been many studies on hand-arm vibration syndrome (HAVS) for almost a century. The Stockholm Workshop scale has been accepted as a useful tool in diagnosing HAVS. Although they are not standard tests for diagnosis, cold provocation test and plethysmography of the fingers are commonly used as objective measurements to confirm the vascular component of HAVS. However, there are only a handful of case reports and studies worldwide on Raynaud's phenomenon in the toes. We report the case of a patient with HAVS who developed Raynaud's phenomenon in the toes after the vibration exposure had ceased. To our knowledge, this is the first report of this entity in Korea.
CASE
REPORT: A 58-year-old male, who had been diagnosed with HAVS in 2003, first noticed white toes in the summer of 2006 after immersing his feet in cold water. He had been working as a rock drill operator since 1976 for almost 30 years and had symptoms on his fingers since 1992. He underwent the cold provocation test, photoplethysmography, Nerve conduction velocity, and basic laboratory tests to rule out other causes of secondary Raynaud's phenomenon. To describe the severity of his feet, it could be classified as vascular stage 2 and sensorineural stage 1 if we were to apply the Stockholm Workshop scale.
CONCLUSIONS
The patient showed vibration-induced white toes, and we would like to share the results of objective findings related to his condition. When diagnosing HAVS, symptoms of the feet should be assessed by the occupational and environmental medicine physicians. Further studies are needed to standardize test methods to diagnose "vibration-induced white toes."

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Original Articles

The Association among Exposure of Bisphenol A, Genetic Polymorphism of Metabolic Enzyme and Urinary Metabolite: Sang Baek Koh, Jun Ho Park, Su Song Yun, Sung Su Oh, Sei Jin Chang, Sun Haeng Choi, Bong Suk Cha; Korean Journal of Occupational and Environmental Medicine 2008;20(2):112-118. Published online June 30, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.2.112

Abstract PDF

OBJECTIVES
To examine bisphenol A (BPA) exposure with subjects in the manufacturing industry and to determine its correlation with metabolites according to genetic polymorphism of metabolic enzymes.
METHODS
The study subjects comprised 104 workers in the manufacturing industry, 64 and 40 in the exposed and control groups, respectively. The questionnaire variablesincluded age, use of protective equipment, smoking habit and alcohol intake. Their urine samples were collected in the afternoon and urinary BPA concentration was measured by revising with the urinary creatinine concentration. The genetic polymorphism of the metabolic enzymes was examined by using restriction fragment length polymorphism (RFLP) after extracting DNA from leucocytes.
RESULTS
The minimum and maximum BPA level of the exposed group during working time was 34.22 and 221.20 ng/mg, respectively. The urinary BPA concentration was significantly higher in the exposed groups than in the control group. There was no significant difference in the urinary BPA level according to genetic polymorphism of CYP1A1 and CYP2E1, but UGT1A6 showed a significant difference. In multiple regression analysis on the urinary and airborne BPA levels, UGT1A6, use of protective equipments and workplaces were significant variables.
CONCLUSIONS
The urinary BPA concentration was affected by the levels to which workers were exposed during their working time and was considered to be metabolized by UGT1A6.

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Seon‐Kyung Park, Heon‐Jun Lee, Eugene Song, Yerin Jung, Hyun Jung Yoo, Jeong‐Eun Oh, Hyeong‐Moo Shin, Jung‐Hwan Kwon
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Job Stress and Psychosocial Stress among Firefighters: Jaehyeok Ha, Dong Il Kim, Byung Sung Seo, Won Sool Kim, Seungho Ryu, Soo Geun Kim; Korean Journal of Occupational and Environmental Medicine 2008;20(2):104-111. Published online June 30, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.2.104

Abstract PDF

OBJECTIVES
This study was performed to assess the level of job and psychosocial stresses in Korean firefighters, and to evaluate the determinants of psychosocial stress.
METHODS
The study subjects comprised 1,712 male firefighters working in Seoul, Busan, and Kyungnam in 2006. We collected information about demographic and job-related characteristics, healthrelated behaviors, Korean Occupational Stress Scale (KOSS), and psychosocial Well-being Index (PWI) through self-administered questionnaires. Statistical analyses were done by using the chi-square-test and logistic regression model.
RESULTS
The multiple logistic regression analyses indicated that the proportion of high-risk psychosocial stress is significantly higher in the groups with high job stress level in 'lack of rewards' (OR=2.90, 95% CI=2.18-3.85), 'occupational climate' (OR=1.92, 95% CI=1.47-2.51), 'job demand' (OR=1.72, 95% CI=1.32-2.23), 'job insecurity' (OR=1.53, 95% CI=1.17-2.01), 'interpersonal conflict' (OR=1.53, 95% CI=1.16-2.01), 'physical environment' (OR=1.45, 95% CI=1.11-1.89), and 'organizational injustice' (OR=1.38, 95% CI=1.04-1.85).
CONCLUSIONS
Psychosocial stress might be adversely influenced by job stressors for the most part. Firefighters need job stress management to minimize their psychological problems.

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Musculo-skeletal Symptoms of Municipal Sanitation Workers and Ergonomic Evaluation on Upperlimb: Jun Pyo Myong, Hyang Ki Lee, Hyoung Ryoul Kim, Hye Sun Jung, Eun Hee Jeong, Woong Nam, Jung Wan Koo; Korean Journal of Occupational and Environmental Medicine 2008;20(2):93-103. Published online June 30, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.2.93

Abstract PDF

OBJECTIVES
The aim of this study was to estimate musculo-skeletal symtoms of municipal sanitation workers and to evaluate working conditions of municipal sanitation workers to search for the factors related to musculo-skeletal symptoms.
METHODS
We conducted a descriptive cross-sectional survey. The study subjects were comprised of 543 municipal sanitation workers in some divisions of Seoul and the Gyeonggi province. Musculo-skeletal analysis was done by using the modified criteria of NIOSH musuclo-skeletal symptoms, RULA and, REBA. Statistical analysis was done by using the chi-square test, multiple logistic regression analysis.
RESULTS
72.2% of the subjects complained musculo-skeletal symptoms (39.6% on the upperlimbs, 30.0% on the lumbar region, 27.4% on the legs). For the musculo-skeletal symptoms criteria (1~3), street cleaners complained of more musculo-skeletal symptoms than the solid waste collectors, after classifying the jobs of sanitation workers. On logistic regression analysis of the musculo-skeletal "symptoms criteria1" positive groups, age was related to the criteria positive (prevalence odds ratio=1.018, 95% CI: 0.993-1.046). The worktime was significantly related to 'criteria positive 1 and, 2' (prevalence odds ratio=2.165 (95% CI: 1.156-4.131), 2.187 times (95% CI: 1.071-4.651)). The RULA score, the subtotal A score of RULA, the REBA score and , the total A REBA score of the upperlimbs of solid waste collectors were higher than those of the street cleaners.
CONCLUSIONS
In spite of the lower ergonomic evaluation score of the street cleaner, the street cleaners complained of more musculo-skeletal symptoms than did the solid waste collectors due to more frequent repetitive motions, a longer work time (over 10 hours) etc. It is suggested that the sanitation workers need to use the proper methods to avoid musculo-skeletal disease.

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Ji-Hyuk Park, Hyun-Sul Lim, Kwan Lee
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The Impact of Noise Expose on the Hearing Threshold Extended High Frequency: Nam Jeong Kim, Joong Keun Kwon, Ji Ho Lee; Korean Journal of Occupational and Environmental Medicine 2008;20(2):81-92. Published online June 30, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.2.81

Abstract PDF

OBJECTIVES
To determine how extended high frequency is affected by noise exposure and other factors that maybe have adverse effects.
METHODS
Pure tone audiometry for usual frequencies (250-8000 Hz) and extended high frequencies (1000-16000 Hz) was conducted for 331 workers at a manufacturing company from 2004 to 2005. History of noise exposure, military service, tinnitus, alcohol drinking, smoking, ear diseases, and noisy hobbies were taken by interview. T-test, ANOVA, and multiple regression was conducted according to the frequency to evaluate the factors that could affect extended high frequency hearing.
RESULTS
The noise-exposed group had significantly poorer hearing than the noise-unexposed in the frequency range 2000-16000 Hz. The hearing deteriorated with increasing age through all the frequencies. High frequency hearing of 14000 Hz was significantly worse in the noise-exposed group in their 30s. Noise exposure during military service had a bad effect on hearing, especially for the noise-unexposed group. Tinnitus was associated with poorer hearing in both noise-exposed and noise-unexposed groups. Workers with noisy hobbies exhibited better hearing in the noise-unexposed group, contrary to our expectation. Extended high-frequency hearing was affected by aging, ear protection, and noisy hobbies. In extended high frequency, 14000 Hz was especially related with noise exposure history.
CONCLUSIONS
Extended high frequency, especially 14000 Hz, could be used as an indicator of noiseinduced hearing loss and should be considered as a screening test for workers in noisy environments.

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Stress of Noise on Dental Technician
Ju Hee Lee
Journal of Korean Acedemy of Dental Technology.2014; 36(2): 111. CrossRef

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The Relationship between Job Stress and the Common Cold: Dong Hyun Kim, Shin Goo Park, Hwan Cheol Kim, Eui Cheol Lee, Jeong Hoon Kim, Jong Han Leem; Korean Journal of Occupational and Environmental Medicine 2008;20(2):74-80. Published online June 30, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.2.74

Abstract PDF: OBJECTIVES
To investigate the relationship between job stress and the common cold which is one of the most common infectious disease.
METHODS
A KOSS (Korean Occupational Stress Scale)-based questionnaire survey was conducted targeting 6,699 workers, of which 4,637 questionnaires were returned and the data for 237 were excluded due to poor response and having pulmonary disease other than common cold. Consequently, 4,400 (65.7%) returned questionnaires were analyzed. Multiple logistic regression analysis and multiple linear regression, adjusted for daily life stress, confounding variables and both, were used to evaluate the relationship between job stress and the common cold.
RESULTS
After adjustment for confounding variables and daily life stress, most of the subscales of job stress contributed to an increased risk of common cold.
CONCLUSIONS
These results indicated that job stress may play a significant role in increasing the risk of the common cold and that further preventive efforts and studies are needed to reduce job stress and address infectious disease caused by job stress among Korean employees.

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The Health Status Including Biologic Exposure Indices of Migrant Workers: Based on 2005 Special Health Examination Data: Yoon Hee Song, Kyoo Sang Kim, Sun Wung Lee, Sun Haeng Choi; Korean Journal of Occupational and Environmental Medicine 2008;20(2):63-73. Published online June 30, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.2.63

Abstract PDF

OBJECTIVES
To investigate the general health status and severity of exposure to hazardous agents - with a focus on heavy metals - of migrant workers utilizing the 2005 Special Health Examination data.
METHODS
With data from the 2005 Special Health Examination, we examined the biologic exposure indices and several major clinical exam items of 25,086 migrant workers in the whole country in comparison with those of 19,616 native Korean workers in Kyunggi-do province. Of these we chose homogeneous samples from the same 3 health service centers in Kyunggi-do. (native workers:19,616, migrant workers:1,886) to be more precise.
RESULTS
The results from the samples of the 3 centers were as follows. Blood lead (natives: 6.09 microgram/dl migrants: 8.37 microgram/L) and cadmium (natives: 0.29 microgram/dl, migrants: 0.36 microgram/L) were higher in the migrant workers than in the native Korean workers, whereas the biologic exposure indices of organic solvents were higher in the native workers. As for major clinical exam items, the liver battery was worse in the natives with incidence of abnormal AST/ALT level (natives: 8.1/6.8% migrants: 5.7/5.4%, p-value<0.01 for AST). Anemia was more prevalent in the migrant workers (natives: 9.0% migrants: 11.0%, p-value<0.05).
CONCLUSIONS
Migrant workers in Korea are more frequently or more severely exposed to a hazardous working environment containing heavy metals. However, we were not able to explain the results for the exposure indices or organic solvents, and such an explanation will require further study in the future.

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Migrant well-being and undocumented status in South Korea: a cross-sectional assessment of physical, psychological, social well-being, and health behaviors
Sun Yeop Lee, Woong-Han Kim, Jongho Heo
International Journal for Equity in Health.2024;[Epub] CrossRef
Occupational Characteristics and Health Status of Vietnamese Male Migrant Workers in the Republic of Korea
Ohwi Kwon, Ji-Hun Song, Jeong-Ok Kong, Seong-Won Ma, Young Shin Lee, Joonho Ahn
Safety and Health at Work.2023; 14(3): 267. CrossRef
Vulnerable Factors Affecting Urinary N-Methylformamide Concentration among Migrant Workers in Manufacturing Industries in Comparison with Native Workers in the Republic of Korea (2012–2019)
Kyung-Eun Lee, Kayoung Park, Dong Joon Park, Sungkyun Park
International Journal of Environmental Research and Public Health.2022; 19(20): 13450. CrossRef

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