Annals of Occupational and Environmental Medicine

Volume 24 (3); September 2012

Case Reports

An Occupational Erythema Multifome Case of a Worker Exposed to Dichlone and 3,3'-Dichlorobenzidine in a Dye Manufacturing Process: Jae Seung Yong, Jung Won Kim, Eun A Kim; Korean Journal of Occupational and Environmental Medicine 2012;24(3):311-318. Published online September 30, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.3.311

Abstract PDF: BACKGROUND
In Korea, the only case of occupational erythema multiforme was found to be due to Bolivian rosewood, but there has been no case due to occupational chemicals in the manufacturing industry. Here, we report a case of erythema multiforme caused by dichlone and 3,3'-dichlorobenzidine(DCB) in a dye worker.
CASE
REPORT: We report a 43-year-old male worker manifesting erythema multiforme-like skin lesions during the DCB synthesis, The patient's dermatitis was relieved when he avoided the process, and it became aggravated when he restarted his work. Patch and prick tests confirmed positive irritant reactions to two chemicals.
CONCLUSION
This case was diagnosed as erythema multiforme based on clinical manifestations. Symptoms worsened upon exposure to chemicals while avoiding exposure improved symptoms. Skin test results showed that dichlone and 3,3'-dichlorobenzidine induced irritant reactions. We assume that erythema multiforme occurring in workers is an occupational skin disease likely caused by dichlone and 3,3'-dichlorobenzidine.

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A Suspicious Case of Chloroform Induced Acute Toxic Hepatitis in Laboratory Worker: Dae Gwang Lee, Chang Hwan Lee, Keun Ho Jang, Hong Jae Chae, Jai Dong Moon; Korean Journal of Occupational and Environmental Medicine 2012;24(3):304-310. Published online September 30, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.3.304

OBJECTIVES
To report upon a case of toxic hepatitis in a worker exposed to chloroform.
METHODS
A 28-year-old female who had worked as chemical analysis engineer in a laboratory using chloroform was hospitalized due to nausea, vomiting and generalized weakness. The authors evaluated her using blood tests, abdominal CT scan and her occupational history.
RESULTS
The blood tests revealed acute toxic hepatitis. Other causes of hepatitis such as viral, drug induced or alcoholic hepatitis could be excluded. But autoimmune hepatitis couldn't be totally ruled out(ANA (++), IgG(serum) 1780 mg/dL). After admission, her symptoms improved and her liver enzyme levels(AST and ALT) were markedly reduced. She returned to her workplace after discharge. Afterwards, however, her liver enzyme levels increased again one week after returning to her workplace. Subsequent to a job change, her liver enzyme levels reduced and normalized after eight weeks. The airbone laboratory chloroform ranged from 3.155 to 9.037 ppm.
CONCLUSIONS
The authors presume that this patient's liver injury was related to an interaction of chloroform toxicity and a predisposition to autoimmune hepatitis. The rapid improvement of the clinical symptoms and the progressive normalization of the liver function tests once the chloroform exposure eliminated supports the diagnosis.

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A Study Regarding the Work Fitness of a Manufacturing Worker Suffering from a Stroke and Muscle Weakness: Eun Kwang Ryu, Jae Seung Yong, Jung Won Kim; Korean Journal of Occupational and Environmental Medicine 2012;24(3):294-303. Published online September 30, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.3.294

Abstract PDF: OBJECTIVES
Occupational health and safety guidelines have the goals of protecting workers, helping them to adapt to their working environment, and to promote their health and ability. In the work fitness evaluations done by occupational medicine doctors, one of their subjective duties is to assess a worker's working ability so as not to affect the health of the worker or his/her co-workers. A worker's functional capacity and reasonable accommodations should be considered. We studied a case regarding cerebral hemorrhage and muscle weakness after renal disease.
CASE
This patient was a male who worked at a tobacco company. He suffered from acute renal failure in 2003. In 2004, during his treatment, a convulsion-seizure occurred. This patient had non-specific findings in family history, blood studies, urinary analysis, mental status examination, and showed no signs of depression. There was a decrease in muscle power found during a physical examination. As a result, an occupational and environmental doctor and an industrial hygienist went to the worker's company in order to analyze the workers tasks. They concluded that there were some problems regarding the worker' s daily activities. When considering reasonable accommodation it was determined that such cases could work in the qualify control department instead of current job, assembly department.
CONCLUSIONS
Throughout this case, we considered the work compatibility of the various complications arising from a cerebral hemorrhage and convulsion-seizure disease which occurred to a factory worker who suffered from acute renal failure. We recommend it essential to create work compatibility guidelines regarding this case presentations, ensuring consistency to the efforts made by health care workers and physicians.

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A Case of Epilepsy and Assessments of Fitness for Work: Kyoung Han Kim, Min Choi, Se Eun Kim, Tae Won Jang, Hyoung Ryoul Kim, Jung Wan Koo; Korean Journal of Occupational and Environmental Medicine 2012;24(3):287-293. Published online September 30, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.3.287

Abstract PDF: BACKGROUND
Epilepsy affects an individual's ability to work as well as their daily activities. Patients with epilepsy have difficulties in finding and maintaining jobs, and they may not have opportunities to perform adequately. Therefore, evaluation of work-fitness is important for patients with epilepsy. In this report, the authors reviewed a case of epilepsy and discussed aspects of the case for evaluation of work-fitness.
CASE
REPORT: A 43-year-old man with epilepsy visited the hospital for evaluation of work-fitness. His job consisted of forklift driving and crane operation using a remote control. As a seizure attack could threaten worker's safety, we recommended a job change. The employer refused to approve a job change due to the company's circumstances, so we recommended several conditions, including continuous medication, use of protective equipment, restriction of night-shift work, restriction of strenuous exercise, and profound sleep. An epilepsy event occurred during the follow-up period, prompting his company to evaluate his work. There were frequent movements of forklift operations and workers in the workplace, so we recommended restriction of forklift driving and a job change if possible. As a result, the employer changed his job and we recommended "capable of performing work without any conditions".
CONCLUSION
For evaluation of work-fitness in patients with epilepsy, adequate job analysis, assessment of patient's medical conditions, and interviews of coworker and employers should be conducted. It is also important to let the employer make the best decision in terms of the patient's health and coworker's safety.

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Original Articles

The Association between Shift Work and Bone Mineral Density : analysis of 2008-2009 Korean National Health and Nutrition Examination Survey: Jong Ho Wang, Goeun Lee, Jun Taek Song, Jongho Kwon, Hyunrim Choi, Kyunghee Jung-Choi, Sinye Lim; Korean Journal of Occupational and Environmental Medicine 2012;24(3):274-286. Published online September 30, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.3.274

Abstract PDF

OBJECTIVES
The objectives of this study were to explore the association between shift work and the bone mineral density in a representative sample of Korean workers.
METHODS
He data from the Fourth Korean National Health and Nutrition Examination Survey (2008-2009) was used. The participants were Korean workers aged 16 to 60 years. Logistic regression analysis was applied to determine the association between shift work and the bone mineral density after controlling for covariates using the SAS version 9.3 package program.
RESULTS
The blood vitamin D level in shift workers was significantly lower than that of day workers in both males and females. In male shift workers, shift work was significantly associated with a decreased bone mineral density in the femoral neck (odds ratio(OR) 1.42, 95% confidence interval(CI)=1.05~1.92) and lumbar spine (OR 1.53, 95% CI=1.09~2.15) compared to day workers. After controlling for covariates, this association was still significant. In the case of female shift workers, shift work was significantly related to a decreased bone mineral density in the total femur (OR 2.84, 95% CI=1.69~4.79) and lumbar spine (OR 1.58, 95% CI=1.12~2.24). After controlling for covariates, this risk was not statistically significant.
CONCLUSIONS
The blood vitamin D level of shift workers was significantly lower than that of day workers. In male shift workers, shift work can decrease the bone mineral density in the femoral neck and lumbar spine. Prospective studies with information on the shift work intensity and duration and exposuredata to explain mechanisms will be needed.

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Jongho Kwon, Jung-Woo Park, Jin-Soo Park, Seyoung Kim, Hyunrim Choi, Sinye Lim
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Association between serum vitamin D and depressive symptoms among female workers in the manufacturing industry
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The association between shift work and hyperuricemia in steelmaking male workers
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Harin Jeong, Sujin Hong, Yunjeong Heo, Hosun Chun, Daeseong Kim, Jongtae Park, Mo-yeol Kang
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Association between Job Stress, Psychosocial Well-being and Presenteeism, Absenteeism: Focusing on Railroad Workers: Inn Shil Ryu, Dae Soon Jeong, In Ah Kim, Jae Hoon Roh, Jong Uk Won; Korean Journal of Occupational and Environmental Medicine 2012;24(3):263-273. Published online September 30, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.3.263

Abstract PDF

OBJECTIVES
The purpose of this study was to determine the current status of presenteeism and absenteeism among railroad workers as well as to investigate whether or not job stress level and psychosocial well-being status are associated with presenteeism and absenteeism.
METHODS
As the cross-sectional design, a self-reported questionnaire using the Korean Occupational Stress Scale(KOSS), Psychosocial Well-being Index(PWI), and Work Productivity and Impairment-General Health(WPAI-GH) was administered to railroad workers. Univariate and multivariate logistic regressions were used to analyze the association between job stress, psychosocial well-being status and presenteeism, absenteeism in 1,099 subjects.
RESULTS
Among the study subjects, 52.0% and 22.0% experiened presenteeism and absenteeism, respectively. Job stress level in railroad workers was higher than that in general workers. Multivariate logistic regression with presenteeism as the dependent variable showed an elevated odds ratio of 3.56(95% CI 1.48-8.54) in the highest job stress group, and an odds ratio of 3.20(95% CI 1.94-5.26) in the high-risk psychosocial stress group. There was no significant association between job stress level and absenteeism, whereas weak association between psychosocial stress and absenteeism was found.
CONCLUSIONS
Since railroad workers have a high level of job stress and elevated experience of presenteeism, a management strategy is required to control presenteeism and absenteeism in order to promote railroad workers' health and safety.

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Jihyun Kim, Yeong-Kwang Kim, Sung-Ho Leem, Jong-Uk Won
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Yoo-Mi Chae, Jeong-bae Rhie, Sook Lee
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Ji Hyun Lee, Eun Kyung Choi, Hyang Ok Oh, Hye Kyung Moon, Sang Min Lee
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Cross Sectional Study on the Prevalence of Attention Deficit Hyperactivity Disorder and Associated Factors among Elementary School Students Living nearby Shihwa-Banwol Industrial Complex: Dong Won Kim, Jeong Eun Lee, Woo Chul Jung, Ki Chul Nam, Ye Won Bang, Se Jin Kim, Soo Young Kim; Korean Journal of Occupational and Environmental Medicine 2012;24(3):252-262. Published online September 30, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.3.252

Abstract PDF

OBJECTIVES
The aims of this study were to examine the prevalence of Attention Deficit Hyperactivity Disorder(ADHD) as well as the relationship between ADHD and related factors among elementary school students living nearby Shihwa-Banwol industrial complex.
METHODS
A cross-sectional survey was conducted on 573 elementary students living nearby Shihwa-Banwol industrial complex. Dupaul ADHD rating scales were used for assessment of ADHD. Information on age, gender, birth weight, family history, environmental factors including second-hand smoke, house income, house type, bring up a child, road proximity and behavioral factors including outside activity time, eating habits, and cell phone usage were based on data from self-administered questionnaires. Multiple logistic regression analysis was performed, and all odds ratios were adjusted according to age and gender.
RESULTS
The prevalence of ADHD was 9.4%, and those aged 10 years were the most affected. Male elementary school students were 3.19 times (95% CI:1.71~5.93) more likely to have ADHD than females. ADHD was significantly associated with family history of mental disease (adjusted OR 8.69; 95%CI 1.93~39.22), lack of cell phones usage (adjusted OR 2.27; 95%CI 1.21~4.26), a road adjacent to child's residence (adjusted OR 2.21; 95%CI 1.20~4.05) and lack of seafood consumption (adjusted OR 2.08; 95%CI 1.08~4.00).
CONCLUSIONS
More research effort should be focused on determining the prevalence of ADHD and relevant factors among children living nearby industrial complexes.

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Blood lead, parental marital status and the risk of attention-deficit/hyperactivity disorder in elementary school children: A longitudinal study
Won-Jun Choi, Ho-Jang Kwon, Myung Ho Lim, Ji-Ae Lim, Mina Ha
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Sumin Lee, Jae-Won Choi, Kyoung-Min Kim, Jun Won Kim, Sooyeon Kim, Taewoong Kang, Johanna Inhyang Kim, Young Sik Lee, Bongseog Kim, Doug Hyun Han, Jae Hoon Cheong, Soyoung Irene Lee, Gi Jung Hyun, Bung-Nyun Kim
Journal of the Korean Academy of Child and Adolescent Psychiatry.2016; 27(4): 236. CrossRef

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Risk Factors for Absenteeism due to Work related Musculo-skeletal Disorders among Korean Employees: Sang Gil Lee, Jong Eun Kim, Young Ki Kim, Oh Jun Kwon, Dong Mug Kang; Korean Journal of Occupational and Environmental Medicine 2012;24(3):239-251. Published online September 30, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.3.239

Abstract PDF

OBJECTIVES
Absenteeism due to musculo-skeletal disorders (MSDs) of workers is an important index of occupational health. Since research on its causes is rare in Korea, the risk factors for absenteeism due to MSDs should be studied.
METHODS
Using the 2nd Korean working condition survey data, we investigated the prevalence of absenteeism due to MSDs. We also analyzed the risk factors for absenteeism by multiple logistic regression analysis in Korean employees.
RESULTS
Prevalence of absenteeism due to MSDs was 0.7% in all employees, 0.5% in men, and 0.9% in women. In logistic regression analysis, gender, age, presence of a representative worker organization, working on tight deadlines, and pace of work dependent on automated equipment/machine were risk factors of absenteeism due to MSDs for both sexes. For males, working time, working at a very high speed were additional risk factors. For females, pace of work dependent on numerical production, performance, and targets were additional risk factors. Although not included in the multiple logistic regression analysis, handling heavy loads in both sexes and average monthly income for women were risk factors in the univariate analysis.
CONCLUSIONS
For absenteeism due to MSDs, the presence of a representative worker organization, along with work pace and its determinants were important risk factors.

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Effect of an Active Tailored Exercise Program on Pain and Oswestry Disability Index in Automobile Manufacturing Workers with Musculoskeletal Symptoms of the Low Back
Won-Ho Kim
Journal of The Korean Society of Physical Medicine.2019; 14(3): 109. CrossRef
Effect of Physical Therapy Based Tailored Exercise Program on Pain, Accident incidence Rates, and Lost Days of Work in Manufacturing Worker: Single Subject Design
Kwon-Woo Lee, Won-Ho Kim
Journal of The Korean Society of Physical Medicine.2017; 12(2): 113. CrossRef
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Kyoung-A Han
Journal of the Korea Academia-Industrial cooperation Society.2015; 16(3): 1928. CrossRef
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Seo-Yeon Choi, Dong-Hyun Park
Journal of the Korea Safety Management and Science.2014; 16(3): 101. CrossRef

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The Relationships between Enterprise-scale Levels, Safety and Health Information Provisions in the Workplace, and the Consequential Attack Rate of Occupational Disease and Injuries: In Kyung Park, Kyung Jong Lee, Soon Young Lee, Jae Beom Park, Kyoung Bok Min; Korean Journal of Occupational and Environmental Medicine 2012;24(3):229-238. Published online September 30, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.3.229

Abstract PDF

OBJECTIVES
We investigated the associations between enterprise-scale levels, the information supplied regarding workplace safety and health, and occupational injury and disease using a nationally representative sample of Korean workers.
METHODS
We used data from the '2006 Working Condition Survey' performed by the Korean Occupational Safety & Health Agency. Demographic variables, employment characteristics, workplace hazards, enterprise-scale levels, information supplied regarding workplace safety and health, and occupational injury and disease were included for the study.
RESULTS
Subjects who had high incomes, or who were male, full-time workers, or shift workers were more likely to provide safety and health information at work, compared to other workers' groups. The larger the enterprise-scale level, the more likely they would offer information on safety and health at work. Workers who worked in small companies, especially those with less than 10 employees, were the most likely respondents to provide safety and health information. In the corresponding logistic regression, the presence of occupational injuries and disease was significantly associated with the provision of health and safety information, the enterprise-scale level had little correlation.
CONCLUSIONS
Our findings suggest that the provision of health and safety information is a critical factor regarding occupational injuries and disease. Proper safety and health education, even in small companies, may contribute to a decrease in occupational disease and injury.

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Relationship between occupational injuries and the provision of safety and health information: data from the 4th Korean working conditions survey
Ju-il Seo, Gab-Sik Shin, Min Gi Kim, Young-Sun Min
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Association between Job-related Factors and Musculoskeletal Symptoms in University Hospital Healthcare Workers: Yoonbum Choi, Soo Jin Lee, Jae Chul Song, Kyu Jung Bae, Hwanjin Park; Korean Journal of Occupational and Environmental Medicine 2012;24(3):217-228. Published online September 30, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.3.217

Abstract PDF

OBJECTIVES
To investigate the prevalence of musculoskeletal symptoms in university hospital healthcare workers and to evaluate the job-related factors that affect musculoskeletal symptoms.
METHODS
A questionnaire was administered to health care workers who work at the university hospital. The self-reported questionnaire included the following information: general characteristics, health behaviors, job-related factors, depression symptom, ergonomic factor, job stress, and musculoskeletal symptoms. Ergonomic factor was measured by ANSI Z-365, depression symptom by CES-D, job stress by KOSS-26 and musculoskeletal symptoms by NIOSH questionnaire.
RESULTS
A total of 1,198(64.2%) of 1,842 respondents answered and 1,183 were included in the final study population. The prevalence of musculoskeletal symptoms was 53.3%. The prevalence of musculoskeletal symptoms of males and females was 25.6% and 63.9%, respectively. After adjusting for confounding factors, total job stress score(OR=3.05, 95% CI=1.62~5.74), depression symptom(OR=2.18, 95% CI=1.07~4.43), ANSI Z-365 high risk group(OR=5.33, 95% CI=2.08~13.66) in males and total job stress score(OR=2.14, 95% CI=1.53~3.00), three-shift work(OR=1.81, 95% CI=1.26~2.60), nurses(OR=1.82, 95% CI=1.22~2.73), and ANSI Z-365 high risk group(OR=3.33, 95% CI=1.58~7.03) in females were significantly associated with musculoskeletal symptoms.
CONCLUSIONS
Shift work, nurses, ANSI Z-365 high risk group, depression symptom and job stress were related with musculoskeletal symptoms. In order to prevent musculoskeletal disorders, ergonomic improvements and stress reduction are required.

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Ki Yong Kim, Won Jong Kim
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RahIl Hwang, Kyung Ha Kim, Min Hyun Suk, Sung Won Jung
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Hye-Jin Kim, Kyung-Ja June, Gyeyoung Shin, Jina Choo
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The General Characteristics and Results of the Cold Provocation Test in the Risk Group of HAVS: Jae Kook Yoon, Chang Sun Sim, Myoung Soon Oh, Joo Hyun Sung, Ji Ho Lee, Choong Ryeol Lee, Yangho Kim, Cheol In Yoo, Hun Lee; Korean Journal of Occupational and Environmental Medicine 2012;24(3):207-216. Published online September 30, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.3.207

Abstract PDF

OBJECTIVES
The cold provocation test for diagnosing the vascular component in hand-arm vibration syndrome (HAVS) is likely to be accepted as an objective test, and a few studies have been performed. However, controversy has continued regarding the diagnostic performance of this method. Although objective methods such as plethysmography and laser doppler flowmetry have been studied, they have not received as much attention as other diagnostic methods. Therefore, our study aim was to spread the awareness of HAVS by reporting the results of the cold provocation test in a hand-transmitted vibration exposure group.
METHODS
The study subjects were 549 workers who had been exposed to hand-transmitted vibrations and reported symptoms in their hands. While the subject immersed both their hands in 10degrees C water for 10 minutes, the skin temperature of 10 fingers was recorded from pre-immersion time to 20 minute postimmersion including 10 minutes immersion time. The recovery rates were calculated from the recorded skin temperatures. The 'decreased recovery rate' criteria were less than 30% at 5 minutes post-immersion and 60% at 10 minute post-immersion.
RESULTS
Of the subjects, 69.1% and 30.9% had more severe symptoms in the right and left hands, respectively. The mean finger skin temperature of the right hand after cold-water immersion for 10 minutes was approximately 10degrees C, which increased gradually with time, but they did not reach the baseline temperature at 20 minutes post-immersion. The deviations of the skin temperature in the subjects were higher in the recovery phase than in the baseline and cold immersion phase. The 3rd finger of both hands showed the lowest 5-minute recovery rate among the fingers examined, and the left 4th finger and right 3rd finger showed the lowest 10-minute recovery rate. Of the subjects, 37.6% and 10.4% of subjects showed a lower recovery rate at 5 and 10 minutes in at least one finger, respectively, while 10.2% showed a lower recovery rate at both 5 and 10 minutes simultaneously in at least one finger.
CONCLUSIONS
The larger deviations in the recovery phase than in the other phases indicated that interindividual differences are more prominent in the recovery phase. There might be no benefit in observing the finger skin temperature for an additional 10 minutes after 10 minutes post-immersion. Overall, approximately 10% of the subjects in the HAVS risk group had HAVS.

Citations

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Technetium-99m hand perfusion scintigraphy (Raynaud’s scan) as a method of verification in hand arm vibration syndrome: a review
Taewoong Ha, Hyeoncheol Oh, Jungwon Kim
Annals of Occupational and Environmental Medicine.2022;[Epub] CrossRef
Trend of Human Vibration Research in Korea
Hee-Sok Park
Journal of the Ergonomics Society of Korea.2013; 32(4): 293. CrossRef

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