Annals of Occupational and Environmental Medicine

Volume 20 (4); December 2008

Case Report

A Case of Reactive Airways Dysfunction Syndrome in a Synthetic Resin Manufacture Factory: So Young Park, Jong Seong Lee, Boo Wook Kim, Joung Oh Lee, Kyu Chul Park, Byung Soon Choi; Korean Journal of Occupational and Environmental Medicine 2008;20(4):372-378. Published online December 31, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.4.372

Abstract PDF: BACKGROUND
Reactive airways dysfunction syndrome (RADS), which represents between 5% and 18% of new-onset, work-related asthma, remains underreported in spite of increasing reports of occupational asthma cases through occupational asthma surveillance in Korea. We report a 61-year-old male who developed RADS after exposure to a high level of toxic gases from a workplace accident.
CASE
The patient who had worked for 21 years at a PVC manufacture factory and had retained good health until Aug 22, 2007, when he was exposed to PVC (polyvinyl chloride), DEHP (Di (2-Ethylhexyl) Phthalate), dibutyl tin maleate and epoxidized soybean oil gases from a heated mixer. Within several minutes of exposure, he developed coughing, rhinorrhea, dyspnea and wheezing. Pulmonary function tests (PFTs) showed an FVC of 3.81 L(82% of predicted), FEV1 of 1.63 L/s (50% of predicted), FEV1/FVC% of 43 %, and FEV1 of 1.80 L/s that increased by 170 ml and 10.4% in response to bronchodilator. After 7 months of treatment with inhaled steroids and bronchodilators, repeat PFTs showed an FVC of 6.56 L(143.5% of predicted), FEV1 of 3.21 L(99.3% of predicted), and FEV1/FVC% of 48.9%. A methacholine challenge test was negative at a concentration of 25 mg/ml.
CONCLUSION
RADS occurred due to exposure to raw material vapors or their thermal decomposition products.

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Original Articles

Relationship of Shift Work to Cardiovascular and Gastrointestinal Symptoms in Korean Female Workers: Kyung Jae Lee, Joo Ja Kim; Korean Journal of Occupational and Environmental Medicine 2008;20(4):362-371. Published online December 31, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.4.362

Abstract PDF

OBJECTIVES
We wanted to investigate the relationship of shift work to the cardiovascular and gastrointestinal symptoms of Korean female workers.
METHODS
The data was analyzed from a cross-sectional survey of 1,875 Korean female workers. Information was obtained about the shift work, the cardiovascular and gastrointestinal symptoms and the background characteristics. Multiple regression analysis was used to test for the relationship between the cardiovascular and gastrointestinal symptoms and the shift work variables, while controlling for the covariates.
RESULTS
Shift work was more common for blue-collar workers than for office workers. A higher proportion of current smokers and drinkers was observed for shift workers than for day workers. A full-time job was more popular for shift workers than for day workers, while more day workers worked over 8 hours per day than did the shift workers. The mean scores of the cardiovascular and gastrointestinal symptoms were significantly higher for shift workers than for day workers. Shift work was associated with 0.54 more cardiovascular symptoms and with 0.38 more gastrointestinal symptoms on a multiple regression analysis (p=0.001; p=0.020, respectively).
CONCLUSIONS
Our findings suggest that shift work may increase the risks for cardiovascular and gastrointestinal disturbances. Therefore, preventive strategies are needed to control the negative effects of shift work in the workplace.

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The Status and Characteristics of Industrial Accidents for Migrant Workers in Korea Compared with Native Workers: Sun Wung Lee, Kyoo Sang Kim, Tae Woo Kim; Korean Journal of Occupational and Environmental Medicine 2008;20(4):351-361. Published online December 31, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.4.351

Abstract PDF

OBJECTIVES
To analyze the status and characteristics of the industrial accidents of migrant workers with comparison to those of native workers.
METHODS
The industrial accident rate of migrant workers was estimated by the annual number of industrial accidents divided by the total number of annual labor population multiplied by the annual admission rate of industrial accident insurance. The characteristics of industrial accidents for total migrant workers were assessed and compared with those of total native workers (from 2004 to 2006). In addition, we compared the industrial accidental characteristics of the 7,210 native workers and the 458 migrant workers employed in the Incheon area who received compensation from the industrial accident insurance in 2006.
RESULTS
In 2004, 2005 and 2006, the total annual industrial accident rates of the migrant workers were 0.93%, 0.90%, and 1.06%, the injury accident rates were 0.90%, 0.86%, and 1.00%, the number of injury deaths per 10,000 persons were 2.29, 2.22, and 2.39, and the disease rates were 0.011%, 0.014%, and 0.027%, respectively. As for the cause of injury, rolled/jammed and cutting-type injuries were more prevalent in the migrant workers. With the standardization of job category, industry size and work tenure, the rolled/jammed-type injury was still significantly more prevalent in the migrant workers.
CONCLUSIONS
Even considering the exclusion of the possible missing numbers of the submission of industrial accident cases, and the numbers of workplaces not registered for industrial accident insurance, the publicized statistics confirm the higher industrial accident rate of migrant workers compared to ative workers. Especially, the injury death rate was 2.2 times higher for migrant workers than for native workers in 2006. In addition, the remarkably lower occupational disease rate of the migrant workers compared to that of the native workers, suggested that numerous cases of disease were not reported. Finally, the lack of communication and former education that usually lead to the most prevalent injury type, i.e., the rolled/jammed type, supported our conclusion that the migrant workers were in need of more education regarding workplace safety.

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Effect of Muscle Strengthening Exercise on Psychosocial and Physical Status in Farmers: Min Ye Jung, No Yul Yang, In Gyu Yoo, Sang Baek Koh, Kyung Suk Lee, Kyungran Kim, Hyocher Kim; Korean Journal of Occupational and Environmental Medicine 2008;20(4):343-350. Published online December 31, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.4.343

Abstract PDF

OBJECTIVES
To evaluate both the psychosocial and physical effects of muscle strengthening exercise on farmers, and in so doing evaluate their effect on musculoskeletal disorders in farmers.
METHODS
28 subjects participated in our muscle strengthening exercise program. Mean age of subjects was 63+/-13 years. The exercise program was performed 3 times a week during the 8 week studys period. Before and after training various measurements were made: self esteem scale (SES), psychosocial wellbeing index short form (PWI-SF), static and dynamic balance ability, grip strength, arm curl, time up and go (TUG), functional reach, and oswestry disability index.
RESULTS
The muscle strengthening exercise program increased the self-esteem, grip strength and static and dynamic balance of subjects, while psychosocial stress and low back pain levels were decreased significantly (p<0.05).
CONCLUSIONS
The muscle strengthening exercise improved psychosocial and physical status of test subjects. Thus, exercise may be an effective strategy for enhancing the psychosocial and physical health of farmers.

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Change of Urinary Trans, Trans-Muconic Acid before and after Turnaround Process in a Petrochemical Plant: Seung Hyun Kim, Ji Ung Park, Jai Dong Moon; Korean Journal of Occupational and Environmental Medicine 2008;20(4):335-342. Published online December 31, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.4.335

Abstract PDF

OBJECTIVES
This study was performed to estimate the exposure to benzene, one of the most serious health hazards, in four phases of a turnaround in a petrochemical company, and to evaluate the suitability of trans,trans-muconic acid (tt-MA) to act as a biomarker of exposure to low benzene levels.
METHODS
tt-MA was determined in 152 urine samples collected in 4 phases ('before daily work', 'after daily work', 'purge', and 'inspection' of turnaround work) from 19 exposed workers involved in turnaround work and 19 clerical workers. The ambient benzene levels were monitored simultaneously during the 'purge' process of turnaround work in the exposed group.
RESULTS
The median urinary tt-MA for the 4 phases was 0.046 mg/L, 0.082 mg/L, 0.507 mg/L, and 0.468 mg/L in the exposed group and 0.050 mg/L, 0.065 mg/L, 0.269 mg/L, and 0.331 mg/L in the clerical workers, respectively. The median urinary tt-MA for the exposed group was significantly higher than that of the clerical workers during the purge process (P<0.05). In the exposed group, median urinary tt-MA for the 'before daily work' phase was significantly lower than that of the other three phases (P<0.05). Even in the clerical workers, the urinary tt-MA level for the 'before daily work' phase was significantly lower than that of the turnaround (P<0.05). There was a very significant correlation between urinary tt-MA levels and ambient benzene levels (r(s) = 0.795, P<0.01).
CONCLUSION
The turnaround process increased the benzene exposure for all workers, even the clerical workers, in a petrochemical company handling benzene. Urinary tt-MA was found to be suitable as a biomarker for the exposure to low-level benzene.

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Factors Associated with Quality on Sleep of Subway Workers by Shift-Work: Min Gi Kim, Won Chul Lee, Young Min Lee, Jae Hong Ryoo, Hawn Cheol Kim, Seung Won Yoo, Kyung Han Nam; Korean Journal of Occupational and Environmental Medicine 2008;20(4):326-334. Published online December 31, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.4.326

Abstract PDF

BACKGROUND
The sleep quality of subway drivers who work in the dark underground with an rotating shift system is generally poor, which can degrade the quality of a worker's life. This study examined the relationship between the sleep quality of subway worker and shift work by comparing three shift systems (rotating shift system, a three day shift system, and no-shift system).
METHOD
Questionnaires including The short form of the Korean Occupational Stress Scale (KOSS), Pittsburgh Sleep Questionnaire (PSQI), the worker's age, gender, job type, accident, near miss and shift system were given to a total of 1010 workers. The results of 759 qualified questionnaires (75.15 %) were analyzed using the SPSS (ver 12.0) program.
RESULT
The highest level of job stress was found among those working a rotating shift system followed by three shift system and no-shift system. The mean sleep quality score in the rotating shift workers was 5.1 (SD+/-3.2), which was greater than the sleep symptom score (5). 34.8% of rotating shift workers suffered from sleep symptoms. The sleep quality score by shift-work was significantly different. High job demand, strong external locus control, the experience of a near miss or an accident in the workplace during previous year has an adverse affect on the sleep quality. The sleep quality improved in case of a change into a no-shift system or a strong internal locus control.
CONCLUSION
A rotating shift system is more harmful to the quality of sleep in subway workers than a 3 shift system or no-shift system. In addition, job stress, personality, near miss and the experience of an accident affect the sleep quality of subway workers.

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Nicole P. Bowles, Bruce S. McEwen, Carla Boutin‐Foster
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Hu-Yeon Lee, Young-Chae Cho
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Seung Wha Shin, Su Hyun Kim
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Seung Gyo Rhie, In Yong Jang
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Seong-Woo Yun, Kyeong-Ae Oh, Hyun Yun, Jong Park
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Kuem-Sun Han, Eunyoung Park, Young Hee Park, Hee Su Lim, Eun Mi Lee, Leen Kim, Ducksun Ahn, Hyuncheol Kang
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Chronic and Acute Effects of Work-related Factors on Heart Rate Variability: Minjeong Son, Youngki Kim, Sangbum Ye, Jihyun Kim, Dongmug Kang, Jangseong Ham, Yonghwan Lee; Korean Journal of Occupational and Environmental Medicine 2008;20(4):314-325. Published online December 31, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.4.314

Abstract PDF

OBJECTIVES
Reduced heart rate variability (HRV) is one of the serious risk factors for heart diseases. We evaluated the acute and chronic effects of work-related factors on HRV.
METHODS
The five-minute HRV of 85 male workers from an automobile assembly factory were measured at 9 A.M. (before-work) and at 5 P.M. (after-work). The workplace noise, temperature and physical workload levels were measured as work-related factors. We postulated that the HRV measured at beforework represents the chronic effects and the HRV measured at after-work represents the acute effects of work-related factors. We used generalized linear regression analysis with adjusting for the general characteristics and/or the morning HRV.
RESULTS
The subjects exposed to noise or a hot environment showed increased HRV in the afternoon and decreased HRV in the morning. Machine oil and interpersonal conflict decreased the HRV in the morning, but other chemicals did not show any effect on the HRV. A physical workload decreased the HRV in both the morning and afternoon.
CONCLUSION
The physical and chemical environment, psychosocial stress and a physical workload may affect the autonomic nerve system.

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The Health Effects of Mercury on the Cardiac Autonomic Activity According to the Heart Rate Variability: Sinye Lim, Min Cheol Choi, Kee Ock Joh, Domyung Paek; Korean Journal of Occupational and Environmental Medicine 2008;20(4):302-313. Published online December 31, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.4.302

Abstract PDF

OBJECTIVES
The effect of mercury on the cardiovascular system has recently been reported on, but the mechanisms as well as its nature of this effect still need to be confirmed. In this study, the mercury in the hair of a community population was analyzed in relation to the cardiac autonomic activity.
METHODS
A hair sample was obtained from the occiput area and the mercury in the hair was analyzed by using a Direct Mercury Analyzer. We measured the cardiovascular risk factors, including total cholesterol, triglyceride, blood pressure, and the body mass index (BMI). Heart rate variability was assessed for 5 minutes, in the time and frequency domain, by using SA-3000P from the Medi-core(R). company. The association between the mercury in the hair and heart rate variability was assessed after controlling for the other cardiovascular risk factors.
RESULTS
The mean age of the 671 total subjects was 36 years. The geometric mean of the hair mercury was 0.90 ppm. The hair mercury level was elevated in males, adults, smokers and drinkers. Hair mercury and age, the systolic and diastolic blood pressure, total cholesterol, triglyceride, LDL cholesterol and BMI were all positively correlated. However, hair mercury and heart rate, HDL cholesterol, standard deviation of the NN intervals (SDNN), total power (TP), low-frequency (LF), high- frequency (HF) were negatively correlated. In the higher mercury group, heart rate, SDNN, LF and HF indices were significantly lower compared with those of the lower mercury group. Heart rate was decreased 2.6 beats/min, Ln (HF) was decreased 0.131 msec2 and HF norm was decreased 2.550 with a 1 ppm increase of Ln (Hg), according to multiple linear regression analysis after controlling for age, gender and other cardiovascular risk factors.
CONCLUSION
This cross-sectional study showed that mercury may affect the cardiac autonomic activity through parasympathetic dysfunction.

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Association between Job Stress and Alexithymic Traits: Seong Jin Ryu, Ja Hyun Kim, Soon Woo Jang, Hyung Joon Jhun, Byoung Gwon Kim, Jong Tae Park; Korean Journal of Occupational and Environmental Medicine 2008;20(4):295-301. Published online December 31, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.4.295

Abstract PDF

OBJECTIVES
We evaluated the association between job stress and alexithymic traits in Korean workers.
METHODS
Workers (n=521) who visited two university hospitals for medical check-ups were recruited for this study. Job stress was evaluated using the Korean version of Karasek's Job Content Questionnaire (JCQ), and alexithymic traits were assessed using the Korean version of the Toronto Alexithymia Scale (TAS-20K). Crude and adjusted odds ratios (ORs) of job stress scales (job strain, job insecurity, and job dissatisfaction) with alexithymic traits(total TAS score > or =52) were calculated.
RESULTS
High job strain compared with low strain had a high, but insignificant association with alexithymic traits (adjusted OR, 2.26; 95% CI, 0.93-5.44). High job insecurity (adjusted OR, 2.26; 95% CI, 1.21-4.22), and high job dissatisfaction (adjusted OR, 1.99; 95% CI, 1.06-3.74) had significant associations with alexithymic traits.
CONCLUSIONS
This study suggests that job stress is associated with alexithymic traits in workers.

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Retraction Notice to: "Association between Job Stress and Alexithymic Traits" [Korean J Occup Environ Med 20(4) (2008) 295-301] and "Estimated Number of Korean Workers with Back Pain and Population-based Associated Factors of Back Pain: Data from the Four

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The Relationship between Depressive Symptoms, Job Stress and Intensity of Labor among Security Firm Workers: Yoon Hee Song, Jung Ok GongYoo, Inah Kim, Won Jun Choi; Korean Journal of Occupational and Environmental Medicine 2008;20(4):283-294. Published online December 31, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.4.283

Abstract PDF

OBJECTIVES
To investigate the mental health status of security firm workers focusing on job stress, depressive symptoms, and overall psychosocial stress and to determine the relationship between depressive symptoms and the level of distress with changes in labor conditions and intensity.
METHODS
Using a cross-sectional design, a formal survey including basic sociodemographic factors, job-related characteristics, job stress, psychosocial stress, depressive symptoms, and changes in labor conditions and intensity was conducted on workers employed in nine security firms. A total of 1,313 workers replied to the survey. We estimated the relationship between psychosocial stress and depressive symptoms with job stress, and changes in labor conditions and intensity by multivariate logisitic regression analysis.
RESULTS
Severe and intermediate level of depressive symptoms occurred in 18.5% (209) of the workers, and the high risk psychosocial distress groups accounted for 44.2% or the workers. Based on multivariate analysis, the Borg scale (OR=2.43 95%, CI=1.72-3.45), relative labor intensity (OR=1.05, 95% CI=1.00-1.09), high job demand (OR=1.47, 95% CI=1.06-2.06) were significantly associated with depressive symptoms. For psychosocial stress, the Borg scale (OR=2.39, 95% CI=1.84-3.10), relative labor intensity (OR=1.06, 95% CI=1.02-1.09), low job control (OR=1.80, 95%CI=1.38-2.35), and high job instability (OR=1.53, 95%CI=1.02-2.29) were significantly associated with high risk groups.
CONCLUSIONS
This study showed that a large proportion of security firm workers encountered depressive symptoms and psychosocial stress. Also, labor intensity and changes in labor condition (relative work intensity) were influential factors for depressive symptoms and psychosocial stress. Therefore, we conclude that not only an intervention for job stress should be offered, but also a policy toward the systemic problem of labor intensification should be considered.

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