Annals of Occupational and Environmental Medicine

Volume 18 (3); September 2006

Case Report

A Case of Acute Organotin Poisoning: Yu Jung Kim, Yangho Kim, Kyoung Sook Jeong, Chang Sun Sim, Nari Choy, Jongchul Kim, Jun Bum Eum, Yoshiaki Nakajima, Yoko Endo, Cheol In Yoo; Korean Journal of Occupational and Environmental Medicine 2006;18(3):255-262. Published online September 30, 2006; DOI: https://doi.org/10.35371/kjoem.2006.18.3.255

BACKGROUND
Although organotin compounds are widely used as PVC stabilizers, catalysts and biocides, their effects on humans are not well known. However, their acute intoxication is known to cause neurotoxicity in the central nervous system, renal toxicity, and hepatotoxicity. As there has been no previously published case of organotin intoxication in Korea, we report here the first Korean case of acute exposure to organotin.
CASE
REPORT: A 43-year-old male with disorientation and behavioral change was admitted to a hospital. He had been working as a tank cleaner for several different companies in the previous 8 years and a week before admission, he had cleaned a tank containing dimethyltin (DMT) for 4 days. A day after finishing the job, he suffered decreased memory, behavioral change and progressive mental deterioration when he arrived at the emergency room. The result of spinal tapping was negative but on the 4th day of admission he deteriorated into a state of coma along with metabolic acidosis and severe hypokalemia. High levels of DMT and trimethyltin (TMT) were detected in a highly sensitive urine analysis. After conservative treatment and chelation therapy, the patient showed some clinical improvement but the neurological defects persisted.
CONCLUSION
The patient appeared to have been intoxicated from the acute exposure to a high level of organotin while cleaning the tank.

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Acute Occupational Poisoning in Korea
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Original Articles

Incidence of Dimethylacetamide Induced Toxic Liver Injury among Workers in a Synthetic Fiber Manufacturing Company: Yong Seok Jang, Seong Yong Yoon, Seong Yong Jo, Tae Sung Choi, Jay Young Yoo, Kuck Hyun Woo, Bong Goo Ha, Sang Jae Jung, Byung Yeol Chun, Jin Seok Kim; Korean Journal of Occupational and Environmental Medicine 2006;18(3):246-254. Published online September 30, 2006; DOI: https://doi.org/10.35371/kjoem.2006.18.3.246

Abstract PDF

OBJECTIVES
The main goal of this study was to find the incidence of the dimethylacetamide (DMAc) induced toxic liver injury among workers who were exposed to DMAc for about 5 years in a synthetic fiber factory.
METHODS
In our investigation, total 1,021 workers had been exposed to DMAc from 1st February, 2000 to 30th June, 2004. Among them, 24 workers who had initial abnormal hepatic enzyme level or was viral hepatitis B carrier were excluded. Finally, 997 DMAc exposed workers were followed up for their incidence of toxic liver injury. To find out DMAc induced toxic liver injury case, we carried out regular examinations including liver enzyme tests such as AST and ALT.
RESULTS
We followed up 997 workers and among them 72 cases coincided with our case definition. Incidence density method was 6.05 per 100 person-year. and, a cumulative incidence by life table method was 0.0965 within a year. The incidence of the DMAc-induced toxic liver injury peaked at 4 to 5 in weeks after employment. There was no toxic liver injury case within second week after exposure to DMAc. Five new cases developed in 2th to 3th week, 25 cases in 4th to 5th week, 14 cases in 6th to 7th week, 12 cases in 8th to 9th week, 5 cases in 10th to 11th week, 4 cases in 12th to 13th week, 4 cases in 14th to 15th week, 1 case in 16th to 17th week, 1 case in 30th to 31th week, and there was one case in 48th to 49th week.
CONCLUSIONS
The incidence rate of toxic liver injury was considerably high during the 1st year after a worker is placed. So it is needed to take careful monitoring of hepatic enzyme level for newly exposed worker.

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A review of life table applications and an introduction of its application method
Kyoungjin Shin, Boseung Choi
Journal of the Korean Data and Information Science Society.2013; 24(6): 1159. CrossRef
Occupational Hepatic Disorders in Korea
Hyoung Ryoul Kim, Tae Woo Kim
Journal of Korean Medical Science.2010; 25(Suppl): S36. CrossRef
Current status of liver diseases in Korea: Toxic and alcoholic liver diseases
Kyung-Ah Kim
The Korean Journal of Hepatology.2009; 15(Suppl 6): S29. CrossRef

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Influences of Job Stressors on Psychosocial Well-being, Fatigue and Sleep Sufficiency among Firefighters: Kun Hyung Kim, Jung Won Kim, Sung Hoon Kim; Korean Journal of Occupational and Environmental Medicine 2006;18(3):232-245. Published online September 30, 2006; DOI: https://doi.org/10.35371/kjoem.2006.18.3.232

Abstract PDF

OBJECTIVES
To measure the job stressors and stress responses among firefighters.
METHODS
We created a structured, self-reported questionnaire about job stressors using Karasek's Job Content Questionnaire (JCQ), psychosocial stress using Psychosocial Well-being Index, Short Form(PWI-SF) and fatigue using Multidimensional Fatigue Scale (MFS). The questionnaire also included sociodemographic data, job-related factors, and health-related behaviors. We collected questionnaires from 104 male firefighters, 35 male emergency medical service (EMS) rescuers and 28 male administrators in three different municipal fire departments in Busan from September 23 to October 2, 2003. Chi-square test and multiple logistic regression analysis were used to examine the job stressors using SPSS (10.0). The statistical significance level was 0.05.
RESULTS
Both PWI-SF and MFS scores increased in the order of EMS rescuers, firefighters and administrators. Using multiple logistic regression analysis, sleep insufficiency showed statistically significant effects on both PWI-SF (OR=5.19, 95% CI=2.14~12.57) and MFS (OR=2.13, 95% CI=1.02~4.46). Alcohol drinking (OR=0.28, 95% CI=0.10~0.75) had a protective effect on MFS. The odds ratios in job loss and shiftwork were 3.44 (95% CI=1.25~9.42) and 8.69 (95% CI=2.87~26.36) on MFS. Monthly income showed a statistically significant effect on both MFS (OR=5.09, 95% CI=1.34~19.41) and sleep sufficiency (OR=7.27, 95% CI=1.62~32.61). However, there was no statistical significance among the JCQ items on either PWI-SF or MFS.
CONCLUSIONS
Firefighters in this study had potential psychosocial stress and moderate level of fatigue scale. As a causal factor for these outcomes, sleep insufficiency and job loss, lower monthly income and shiftwork were statistically significantly, which confirm the need for countermeasures to ensure optimal sleep time and to raise monthly income. Further follow-up study using more in-depth interview is also required to identify the effects of both alcohol consumption and job loss.

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Predictors of Return to Work and Job Retention after Work-Related Injury or Illness: Hee Tae Kang, Hyoung June Im, Yong Kyu Kim, Young Su Ju, Hwa Pyung Lee, Jeong Min Kim, Young Jun Kwon; Korean Journal of Occupational and Environmental Medicine 2006;18(3):221-231. Published online September 30, 2006; DOI: https://doi.org/10.35371/kjoem.2006.18.3.221

Abstract PDF

OBJECTIVES
This research was conducted to investigate workers'return to work rate after work-related injury or illness and to determine which factors could predict return to work and job retention.
METHODS
From the documents held by the six local branches of the Korea Labor Welfare Corporation(KLWP), 2,464 cases of work-related injury or illness which had telephone numbers were identified from September to December, 2003. Data about the employment status was gained from 921 occupationally injured workers through telephone questionnaire and was merged with the electronic data obtained from KLWP with included information of the workers whose worker's compensation period was ended from 2002 to 2004. Finally the data for 516 workers was analysed by logistic regression using SAS 9.0.
RESULTS
The return to work rate was 50.3% and the job retention rate was 28.3%. Decreased return to work rate was associated with old age, shorter employment duration, longer treatment duration, higher disability grade, lower average wage and manual worker. Decreased job retention rate was associated with a smaller number of employees, shorter employment duration and work in the construction industry.
CONCLUSIONS
This research highlighted the numerous occupationally injured workers who couldn't return to work and the multiple factors that were associated with the return to work or job retention. Based on this and related research, rehabilitation programs which consider the issues of return to work and job retention have to be implemented.

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Sanghun Nam, Suyeong Bae, Ickpyo Hong
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Relationship between workers’ return to work, job retention and income in industrial accidents in Korea: a longitudinal study
Suk Won Bae, Inchul Jeong, Jin-Ha Yoon, Seung Wook Lee, Tae Hyun Kim, Jong-Uk Won
BMJ Open.2021; 11(4): e039948. CrossRef
Changes in Income after an Industrial Accident According to Industry and Return-to-Work Status
Suk Won Bae, Sarah Soyeon Oh, Wha Me Park, Jaehoon Roh, Jong-Uk Won
International Journal of Environmental Research and Public Health.2019; 16(14): 2603. CrossRef
Pre-injury job characteristics and return to work among injured workers in South Korea: differences by socio-demographic and injury-related characteristics
Soo Kyung Park, Chung Kwon Lee
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Inchul Jeong, Jae Bum Park, Hyoung Ryoul Kim, Jin-Ha Yoon, Jong-Uk Won, Jaehoon Roh
Journal of Korean Medical Science.2018;[Epub] CrossRef
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The effects of individual, occupational, and supportive factors on successful return to work using a structural equation model
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Occupational Stress on Risk Factors for Cardiovascular Diseases and Metabolic Syndrome: Jung Jin Cho, Ji Yong Kim, Jung Soo Byun; Korean Journal of Occupational and Environmental Medicine 2006;18(3):209-220. Published online September 30, 2006; DOI: https://doi.org/10.35371/kjoem.2006.18.3.209

Abstract PDF

OBJECTIVES
The aim of the study was to examine the relationship between occupational stress and cardiovascular risk factors including metabolic syndrome in a working population.
METHODS
A cross-sectional population-based survey was conducted among Koreans working in several industries. They were questioned about: demographic factors, marital status, education, personal history, alcohol intake, smoking, and physical activity , while their occupational stress was assessed using the Korean Occupational Stress Scale (KOSS). The subjects were measured for height, weight, blood pressure, waist circumference, fasting plasma glucose, cholesterol, triglycerides, HDL-cholesterol and LDLcholesterol. Regression analyses to determine the relationships between occupational stressors using KOSS and cardiovascular risk factors were performed using multivariate models with adjustment for potential confounders.
RESULTS
A total of 2,097 workers (1,770 men and 327 women) were included. Multiple logistic regression analysis (socio-demographics and potential confounders) demonstrated a positive association between high interpersonal conflicts and hypertension, a negative association between high job insecurity and diabetes and no association between any KOSS subscale and metabolic syndrome and obesity. Multiple linear regression, adjusted for socio-demographics and potential confounders demonstrated a negative association between low HDL-cholesterol and poor physical environments, high job demand and poor job insecurity and no association between lipid profiles and other KOSS sub-scales.
CONCLUSIONS
A few KOSS sub-scales such as interpersonal conflicts showed a positive association with hypertension in Korean workers. Neverthelsss, some measures of occupational stress showed a negative association with diabetes and HDL-cholesterol in cross-sectional population-based survey. We therefore decided to conclude this association by longitudinal study.

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Case Series for Occupational Skin Disorders in Carbon Fiber Exposed Packing Workers: Hye Eun Lee, Chang Bum Byun, Sinye Lim, Seung Ho Jeon, Sang Yong Oh, Hyoung Ryoul Kim, Soon Choi, Domyung Paek, Mijin Park; Korean Journal of Occupational and Environmental Medicine 2006;18(3):199-208. Published online September 30, 2006; DOI: https://doi.org/10.35371/kjoem.2006.18.3.199

Abstract PDF: OBJECTIVES
We report an outbreak of skin disorder in semiconductor packing workers. Through an evaluation of the degree of work-relatedness in this case, we aim to develop a method to overcome such health problems in the workplace.
METHODS
A questionnaire investigating the job characteristics and skin symptoms was administered to 51 packing workers working in a semiconductor production factory and 49 questionnaires returned. The 16 subjects in the exposure group and 12 in the non-exposure group underwent doctor's examination and patch test. Two of 28 subjects were excluded in patch test. We investigated the work environment and carbon fiber level which was the potential causative agent.
RESULTS
Forty-five (91.8%) of 49 packing workers complained of itching and stinging. Three of 14(21.4%) in the exposure group and 3 of 11 (27.3%) in the non-exposure group were positive at 48hr reading of patch test for carbon fiber and carbon fiber paper. None was positive at 96hr reading of patch test. Prominent carbon fibers were microscopically observed on the surface of the packing box and the fiber diameter, measured up to 6.0~7.5 micrometer, was likely to induce skin irritation to skin. To avoid worker's direct contact with to carbon fiber, carbon fiber paper box was substituted by a wax coated carbon fiber paper box was substituted for the original carbon fiber paper box, which caused and the workers' symptoms to of workers disappeared.
CONCLUSION
The probably cause of this outbreak of skin disorder was mild irritant contact dermatitis for carbon fiber. To prevent outbreaks of such occupational skin disorder like this, workers should avoid direct contact with carbon fiber.

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The Prevalence of Playing-Related Musculoskeletal Disorders of Music College Freshmen Playing String Instruments: Jaewoo Koh, Soo jin Lee, Yong Kyu Kim, Inah Kim, Soon Chan Kwon, Si Bog Park, Mi Jung Kim, Seongwoo Kim, Kyoungok Park, Hyunmi Kim, Jaegwang Song, Jaechul Song; Korean Journal of Occupational and Environmental Medicine 2006;18(3):189-198. Published online September 30, 2006; DOI: https://doi.org/10.35371/kjoem.2006.18.3.189

Abstract PDF

OBJECTIVES
This study was conducted to investigate the prevalence of playing-related musculoskeletal disorders (PRMDs) of some music college freshmen majoring in string instruments.
METHODS
The study subjects were 199 freshmen majoring in strings at three colleges in Seoul and surrounds. The symptom prevalence and related factors of PRMDs were surveyed with a self-administered questionnaire. The Southampton Protocol was used to diagnose PRMDs.
RESULTS
The freshmen had played for 9 years and 7 months on average. The symptom prevalence of PRMDs according to the modified-NIOSH surveillance criteria was 73.4%. The shoulder was the most prevalent symptom complaint site. The prevalence of PRMDs by the Southampton Protocol was 54.3% and myofascial pain syndrome was the most common. The instrument (violin or viola vs. cello or bass), regular breaks, self perceived evaluation of playing posture and regular computer use had a significant association with the symptom prevalence of PRMDs in univariate logistic regression analysis (p<0.05). The instrument, regular breaks and regular computer use were significant variables affecting the symptom prevalence of PRMDs in multivariate logistic regression analysis (p<0.05).
CONCLUSIONS
This study suggests that music college freshmen playing strings are a high risk group for musculoskeletal disorders. Therefore, the prevention of PRMDs requires the establishment of an ergonomic playing-environment, and the education of comfortable posture and stretching program such as musical warming up and physical stretching. It is especially important to form an effective treatment and rehabilitation system based on earlier diagnosis for musicians who are suffering from the PRMDs.

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Musicians' Medicine: Musculoskeletal Problems in String Players
Han-Sung Lee, Ho Youn Park, Jun O Yoon, Jin Sam Kim, Jae Myeung Chun, Iman W. Aminata, Won-Joon Cho, In-Ho Jeon
Clinics in Orthopedic Surgery.2013; 5(3): 155. CrossRef
The Prevalence of Playing-related Musculoskeletal Disorders of Traditional Korean Musical Instrument Player
Jung Yong Kim, Seung Nam Min, Young Jin Cho, Jun Hyeok Choi
Journal of the Ergonomics Society of Korea.2012; 31(6): 749. CrossRef

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Comparison of the Standard Threshold Shift Criteria for Evaluating Hearing Conservation Programs: Chang Sun Sim, Kyoung Sook Jeong, Yu Jung Kim, Na Ri Choy, Choong Ryeol Lee, Hun Lee, Jong Pil Jung, Ok Hyun Kim, Yo Weon Lee, Seung Rim Yang, Sung Soo Oh, Ji Ho Lee; Korean Journal of Occupational and Environmental Medicine 2006;18(3):179-188. Published online September 30, 2006; DOI: https://doi.org/10.35371/kjoem.2006.18.3.179

Abstract PDF: OBJECTIVES
Workers from a factory was selected to compare 8 standard threshold shift criteria with the Korean diagnostic criteria of noise-induced hearing loss for this cohort study.
METHODS
From 1990 to 1999, 491 workers at a manufacturing company with complete record of the hearing test covering the range of 0.5~6 kHz for 10 consecutive years were finally selected. Eight standard threshold shift criteria (15 dB once, NIOSH (1972), 10 dB average 3~4 kHz, OSHA STS, AAOHNS, 15 dB twice, 15 dB 1~4 kHz, OSHA STS twice) along with the Korean standard for diagnosing the noise-induced hearing loss (the average hearing threshold at 0.5, 1 and 2 kHz) were compared to calculate the degree of the threshold shift and the minimum time required to detect the change.
RESULTS
Those workers showing at least one positive shift in the 'once'criteria of NIOSH (1972) were 92.5%; the 'average'criteria of 10 dB average 3~4 kHz were 35.8%; 'twice'criteria of 15 dB twice were 44.4%. The duration from the baseline to the year showing the first positive shift was from 3.2 +/- 3.1 years (NIOSH, 1972) to 6.0 +/- 2.1 years (OSHA STS twice). The percentage of true positive shift ranging from 20.4% (AAO-HNS) to 69.8% (NIOSH, 1972). There were 10 (2%) which met the Korean diagnostic criteria of noise-induced hearing loss.
CONCLUSIONS
Currently the concept of hearing threshold shift in diagnosing the hearing loss was adopted in Korea thus in this study we determined the validity and the effect of the various hearing threshold shift criteria and showed that NIOSH (1972) criteria was the best of all. In the future, hearing data from various manufacturing workers should be compared to thoroughly evaluate the threshold shift criteria and to establish adequate standard for Korean workers.

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The Health Effects of Formaldehyde during an Anatomy Dissection Course: Si Young Park, Chang Yoon Kim, Joo Young Kim, Joon Sakong; Korean Journal of Occupational and Environmental Medicine 2006;18(3):171-178. Published online September 30, 2006; DOI: https://doi.org/10.35371/kjoem.2006.18.3.171

Abstract PDF

OBJECTIVES
This study evaluated the acute health effect of formaldehyde during an anatomy dissection course.
METHODS
The formaldehyde concentrations in a gross anatomy laboratory were measured and analyzed during an anatomy dissection course attended by eighty medical students. The Pulmonary Function Test and three tests of the Korean Computerized Neurobehavioral Test (digit classification, digit addition and symbol digit) were given to thirty of the eighty medical students at the pre- and post-exposure. A questionnaire survey was administered to the eighty medical students at the pre- and post-exposure.
RESULTS
The differences in the mean FVC and FEV(1) were statistically significant (p<0.01) at the preand post-exposure. In the low exposed group (<2 ppm), only the decreases in FEV(1) on post-exposure were statistically significant (p<0.05) compared with FEV(1) on pre-exposure. In the high exposed group (> or = 2 ppm), decreases in both FVC and FEV(1) on post-exposure were statistically significant (p<0.05). The overall performance on the digit classification, digit addition and symbol digit of the Korean Computerized Neurobehavioral Test on post-exposure was lower than that on pre-exposure. In the low exposed group, the performances on the digit classification and symbol digit were lower than those on pre-exposure. In the high exposed group, the performances on digit classification, digit addition and symbol digit were lower than those on pre-exposure. Complaints involving the eyes, nose and throat increased substantially on post-practice compared with pre-practice in both groups. There were statistically significant differences in the complaints involving the eyes, nose and throat between the pre-practice and post-practice in both groups (p<0.05). There were more complaints in the high exposed group than in the low exposed group.
CONCLUSIONS
Formaldehyde exposure during a dissection can decrease the pulmonary function and neurobehavioral performance, and can increase the complaints involving the eyes, nose and throat. The effect on the symptoms, pulmonary function and neurobehavioral performance is positively correlated with the formaldehyde level.

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Effect of Sodium Benzoate on Change of Urinary Hippuric Acid and Methyl Hippuric Acid among Workers Coexposed to Toluene and Xylene: Kyunghee Jung-Choi, Sounghoon Chang, Hyeongsu Kim, Wonki Oh, Sang Baek Koh, Kunsei Lee, Suekyung Park; Korean Journal of Occupational and Environmental Medicine 2006;18(3):163-170. Published online September 30, 2006; DOI: https://doi.org/10.35371/kjoem.2006.18.3.163

Abstract PDF: OBJECTIVES
This study was performed to investigate the effect of drink containing sodium benzoate on the change of urinary hippuric acid (UHA) and methyl hippuric acid (UMHA) excretion among workers coexposed to low toluene and xylene.
METHODS
Study subjects were 55 male shipbuilders who were divided into 3 groups; nonexposed group (n=10, who were not exposed to organic solvent and had drunk sodium benzoate), exposed A group (n=24, who were coexposed to toluene and xylene, and had drunk sodium benzoate), and exposed B group (n=21, who were coexposed to toluene and xylene, and had not drunk sodium benzoate). The study methodology consisted of questionnaire survey, urinary analysis for metabolites of toluene and xylene before and after drinking with or without sodium benzoate, and personal air sampling of toluene and xylene.
RESULTS
Before drinking, there was no significant difference in UHA or UMHA between the exposed A and B groups. After 1.5 hour of drinking, UHA of the exposed A group was significantly higher than that of the exposed B group. After 3 hours, however, UHA of the exposed A group was decreased to the level of the exposed B group, regardless of the ambient toluene level. UMHA exhibited no significant difference between the exposed A and B groups regardless of time and ambient toluene level. The regression model showed that drinking of sodium benzoate was positively correlated with UHA after 1.5 hours of drinking, but not after 3 hours. In addition, sodium benzoate didn't affect UMHA.
CONCLUSIONS
This study showed that sodium benzoate initially increased UHA temporally but that its effect disappeared after 3 hours. In the medical examination of toluene exposure workers, the ingestion of drink containing sodium benzoate should be forbidden during the 3 hours prior to urinary sampling.

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