Annals of Occupational and Environmental Medicine

Volume 24 (4); December 2012

Case Report

Seven Cases of Respiratory Symptoms Caused by Acute Ozone Exposure from an Electronics Company: Yong Jun Kwon, Kuck Hyun Woo, Jin Seok Kim, Seong Yong Yoon, In Ung Song, Jay Young Yu, Seong Yong Cho; Korean Journal of Occupational and Environmental Medicine 2012;24(4):449-459. Published online December 31, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.4.449

BACKGROUND
Ozone is a colorless, pungent, and highly reactive gas. It can cause headaches, burning eyes, irritation to the respiratory passages, and dyspnea. This article describes cases of respiratory difficulty associated with acute ozone exposure from an electronics company that manufactures touchscreen.
CASE
REPORT: Seven young female workers visited the Department of Occupational and Environmental Medicine, complaining of cough, dyspnea, and chest discomfort that started within two days at work processing a touchscreen with ozone (0.103 ppm ozone detected in the their workplace). Other; symptoms observed included rhinorrhea, headaches, and dizziness. There was a temporary improvement in symptoms upon taking a day off, but their symptoms deteriorated upon continuing work again-suggesting the ozone exposure in their work environment was responsible for their symptoms. The results of pulmonary function and blood laboratory tests were normal; however, laryngoscopy and nasal endoscopy identified three cases of inflammation on laryngeal, intranasal, or vocal cord regions.
CONCLUSIONS
Based on the levels of ozone detected in the workplace and clinical symptoms presented, we conclude that the respiratory symptoms in these cases were caused by excessive ozone exposures.

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A Study of Ozone Variations in a Semiconductor Fabrication Facility and Office Related to the Ozone Concentration in the Outdoor Air
Ji-Eun Lee, Myung-Koo Jung, Kwang-Min Choi
Journal of Korean Society of Occupational and Environmental Hygiene.2016; 26(2): 188. CrossRef

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Case Report

Detection of Cases and a Cause of Lead Exposure in Korean Steel Company: Bon Hak Koo, Young Ki Kim, Sang Gil Lee, Dong Mug Kang, Jong Eun Kim; Korean Journal of Occupational and Environmental Medicine 2012;24(4):441-448. Published online December 31, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.4.441

Abstract PDF

BACKGROUND
We report cases of high lead exposure in a Korean steel manufacturing company and a likely cause for these cases.
CASE
REPORT: Neurological examinations, neurobehavioral tests, blood tests, and urine tests were performed to detect an association between high lead exposure and physical symptoms for workers in a steel manufacturing company. In order to determine the cause of high lead exposure, the work process and environment was assessed. The highest lead exposure was during the work process. We found that the interior of an oil storage tank was coated with lead-containing paint, leading to severe exposure during the cutting process. In two observations, 4 of 12 workers diagnosed with occupational disease were found to have high exposure to lead from the storage tank and three had increased beta-2 microglobulin levels in the blood (indicative of urinary tract damage).
CONCLUSIONS
Lead management, including routine measurements of the working environment and examinations of lead concentrations in workers, are needed in the korean scrap metal industry. In addition, rules requiring workers to wear personal protective equipment and receive education about lead exposure should be strictly enforced.

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Evaluation of Temporal Trends of Lead Exposure in Korean Workers Using Workplace Monitoring Data
Dong-Hee Koh, Sangjun Choi, Ju-Hyun Park, Sang-Gil Lee, Hwan-Cheol Kim, Inah Kim, Jong-Uk Won, Dae Sung Lim, Hoekyeong Seo, Dong-Uk Park
Journal of Korean Medical Science.2023;[Epub] CrossRef
Occupational Lead Exposure from Indoor Firing Ranges in Korea
Won-Ju Park, Suk-Ho Lee, Se-Ho Lee, Hye-Sik Yoon, Jai-Dong Moon
Journal of Korean Medical Science.2016; 31(4): 497. CrossRef

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Original Article

The Characteristics of Tinnitus and Hearing Threshold: In Workers with Noise Induced Hearing Loss from a Hospital Setting: Nam Jeong Kim, Hyoung Ouk Park, Chang Sun Sim, Choong Ryeol Lee, Young Joo Kwon, Ji Ho Lee; Korean Journal of Occupational and Environmental Medicine 2012;24(4):431-440. Published online December 31, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.4.431

Abstract PDF

OBJECTIVES
This study was carried out to define the relationship between the characteristics of tinnitus and hearing threshold (puretone and speech) in workers with noise induced hearing loss (NIHL).
METHODS
A total of 189 cases(378 ears) from workers with compensation claims for NIHL during 2004-2009 were investigated. Various factors, including age, work carriers, body mass index (BMI), blood pressure, noise exposure level of worksite hearing threshold, speech discrimination score, pitch match, and loudness of tinnitus were analyzed.
RESULTS
The average hearing threshold of all subject was 44.2 dBHL, puretone audiometry thresholds in subjects with tinnitus were lower than the non-tinnitus group (except at 8000 Hz). Using speech audiometry, the tinnitus group showed a lower speech recognition threshold and speech discrimination score. The tinnitus group also had an average tinnitus frequency of 4195.2 Hz, loudness of 73.6 dB, and tinnitus sensation average of 6.0 dBSL. These frequencies of tinnitus were in the lowest puretone audiometry frequencies. Tinnitus loudness had a strong relationship with puretone and speech audiometry thresholds.
CONCLUSIONS
In cases beyond moderate hearing loss, the tinnitus group had a better puretone (except 8000 Hz) and speech hearing status, and most comfortable loudness (MCL) level. In addition, puretone and speech audiometry thresholds increase with tinnitus loudness.

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Original Article

The Relationship between the Korean Occupational Stress Scale and Carotid Intima-Media Thickness among Male Firefighters: Sang Jun Park, Dong Kyun Lim, Mi Young Lee, In Sung Chung; Korean Journal of Occupational and Environmental Medicine 2012;24(4):420-430. Published online December 31, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.4.420

Abstract PDF: OBJECTIVES
This study examined the relationship between job stress and the common carotid intima-media thickness as an indicator of atherosclerosis (cardiovascular disease) among male firefighters in a metropolitan city.
METHODS
Between November and December 2011, a total of 838 participants were analyzed using a questionnaire, which included the participants' general characteristics, job-related factors, health-related behaviors, and job stress. Job stress was measured using the Korean Occupational Stress Scale-Short Form (KOSS-SF). The job stress data was merged with the clinical laboratory data and common carotid intima-media thickness (CIMT) by a medical examination. The relationship between job stress and the CIMT was examined by multiple logistic regression analysis.
RESULTS
Multiple logistic regression analyses adjusted for the general and cardiovascular risk factors revealed, the organizational system (adjusted OR 1.381 95% CI=1.005~1.898) to be associated with the right CIMT. Multiple logistic regression analyses adjusted for general and cardiovascular risk factors and job types, the occupational climate (adjusted OR 1.392, 95% CI=1.009~1.922) was also associated with the right CIMT.
CONCLUSIONS
The level of job stress, particularly in regard to the organizaional system, shows a correlation with the right CIMT. Therefore, further preventive efforts and studies of firefighters will be needed to reduce job stress and help prevent cardiovascular disease.

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Original Article

Occupational Risk Factors Associated with Musculoskeletal Symptoms in Public Workers: Sei Kyun Noh, Ju Hwan Choi, Dong Hoon Shin, Mi Young Lee, In Sung Chung; Korean Journal of Occupational and Environmental Medicine 2012;24(4):410-419. Published online December 31, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.4.410

Abstract PDF: OBJECTIVES
The purpose of this study was to examine the occupational risk factors associated with musculoskeletal symptoms in public workers.
METHODS
In November 2010, 544 participants anwered a survey that included questions on the participants' general characteristics, job-related factors, health-related behaviors, and psychosocial stress. We measured the relationship of risk factors to musculoskeletal symptoms using a logistic regression analysis.
RESULTS
After adjusting for general characteristics, factors associated with occupational musculoskeletal symptoms were gender (OR=2.858, 95% CI=1.701~4.801), unnatural posture (OR=2.386, 95% CI=1.308~4.354), psychosocial stress (OR=4.051, 95% CI=1.336~12.282) and sleep quality (OR=1.672, 95% CI=1.052~2.660).
CONCLUSIONS
These findings suggest that psychosocial stress levels and physical environment (especially in professions requiring an unnatural posture) are related to musculoskeletal symptoms in public workers.

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Original Article

Posttraumatic Stress Disorder and Related Factors in Male Firefighters in a Metropolitan City: Deuk Yong Shin, Man Joong Jeon, Joon Sakong; Korean Journal of Occupational and Environmental Medicine 2012;24(4):397-409. Published online December 31, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.4.397

Abstract PDF

OBJECTIVES
This study was conducted in order to evaluate the prevalence of posttraumatic stress disorder (PTSD) and related factors in male firefighters in Daegu, Korea.
METHODS
A total of 1,261 firefighters from fire stations in Daegu were the subjects of this study. Each firefighter completed a questionnaire on general and occupational matters, experience of traumatic events, and impact of event scale (IES). The IES questionnaire was administered to subjects in order to determine the high risk group for PTSD. We calculated the IES score and determined that an individual was abnormal if the IES score was over 26.
RESULTS
The average IES score of the firefighters was 11.0+/-14.3, and the prevalence of high risk firefighters with PTSD was 15.1%. It was found that 40 years of age, fire sergeant, and emergency medical service personnel showed higher prevalence of PTSD than other groups. The most experienced event among traumatic events was 'witness death of victims or patients'. The results of multiple logistic regression analysis for the high risk PTSD group showed that fire sergeant (OR=2.28, 95% CI: 1.28~4.06), fire lieutenant (OR=2.47, 95% CI: 1.14~5.37), fire captain (OR=2.88, 95% CI: 1.11~7.45), firefighting department (OR=2.04, 95% CI: 1.00~4.17), emergency medical service personnel (OR=3.68, 95% CI: 1.47~9.23), total frequency of traumatic events experienced (OR=1.01, 95% CI: 1.00~1.02), and total type of traumatic event experienced (OR=1.35, 95% CI: 1.25~1.46) were significant variables with regards to the reference group (fire fighter and administration department).
CONCLUSIONS
These findings indicate that the prevalence of PTSD in firefighters is higher than that in the general population, and fire sergeant, fire lieutenant, fire captain, emergency medical service personnel, firefighting department, total frequency of traumatic events experienced, and total type of traumatic event experienced were significant variables for the PTSD high risk group.

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John Langtry, Marcin Owczarek, Donal McAteer, Laurence Taggart, Christina Gleeson, Catherine Walshe, Mark Shevlin
European Journal of Psychotraumatology.2021;[Epub] CrossRef
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Insung Jo, Songhee Lee, Gyhye Sung, Minkyoung Kim, Sanghyuk Lee, Jooeon Park, Kangsoo Lee
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Original Article

Occupational Stress and MMPI-2 Profile of Workers in Some Plants Undergoing Labor Dispute: Chang Ki Choi, Chul Gab Lee, Han Soo Song, Sang Kon Yoo, Seung Yong Shin, Sul Ha Kim; Korean Journal of Occupational and Environmental Medicine 2012;24(4):384-396. Published online December 31, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.4.384

Abstract PDF

OBJECTIVES
To identify changes in relationships with superiors or colleagues at work and family members and social networks at home, based on occupational stress and psychological characteristics in during the process of restructuring some plants undergoing a long-term labor dispute.
METHODS
This study invested 213 workers involved in a long-term labor dispute using the KOSS (Korean Occupational Stress Scale) and the MMPI-2 (Minnesota Multiphasic Personality Inventory) and questionnaires. The KOSS and MMPI-2 scores in accordance with aggressiveness of trade union activity and changes in human relationships were compared. In addition, the odds ratio of whether there were differences in health behavior (perception of health status, smoking, alcohol abuse, medical treatment) and the absenteeism rate was calculated by logistic regression analysis.
RESULTS
For members of the aggressiveness of trade union activity group, the rate at which the relationship between superiors or colleagues deteriorated was high, as was the total KOSS score, occupational system and lack of reward score of KOSS subclass. The depression subclass score of MMPI-2 was generally high, while the score of hypochondriasis, hysteria, psychopathic deviate, hypomania was high, and social introversion was low in the active group. In cases in which there were high score of psychopathic deviate, hypomania and paranoia, there were also signs of negative health behavior.
CONCLUSIONS
Occupational stress caused by a long-term labor dispute, accompanied with depression can result in an aggressive, hostile and vulnerable personalities and have a negative impact on health behavior.

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Changes of depression and job stress in workers after merger without downsizing
Jun Ick Jung, Jun Seok Son, Young Ouk Kim, Chang Ho Chae, Chan Woo Kim, Hyoung Ouk Park, Jun Ho Lee, Young Hoo Shin, Jea Chul Ha
Annals of Occupational and Environmental Medicine.2018;[Epub] CrossRef
Minnesota multiphasic personality inventory as related factor for post traumatic stress disorder symptoms according to job stress level in experienced firefighters: 5–year study
In-Sung Chung, Mi-Young Lee, Sung-Won Jung, Chang-Wook Nam
Annals of Occupational and Environmental Medicine.2015;[Epub] CrossRef

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Original Article

A Study of Psychosocial Stress of Residents Near Asbestos Mines: Young Sik Shin, Yong Jin Lee, Jung Oh Ham, Eun Chul Jang, Chan Ho Park, Min Sung Kang, Seung Kwon Park; Korean Journal of Occupational and Environmental Medicine 2012;24(4):375-383. Published online December 31, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.4.375

Abstract PDF: OBJECTIVES
The purpose of this study is to identify the level of psychosocial stress of residents near asbestos mines, and to investigate the relationship between psychosocial stress and asbestos exposure history as well as, asbestos exposure awareness.
METHODS
The survey was conducted in 297 individuals, by one-on-one interviews with a standard questionnaire including demographic characteristics, health status, asbestos exposure history, and awareness of asbestos exposure. The levels of psychosocial stress were measured through the Psychosocial Wellbeing Index-Short Form(PWI-SF). Multivariate logistic regression was conducted using psychosocial stress as a dependent variable. Demographic characteristics, health status, asbestos exposure history, and asbestos exposure awareness were examined as independent variable.
RESULTS
The average PWI-SF score was 17.5 +/- 8.0, with 40 people (13.5%) in the high-risk stress group (PWI-SF 27 points or more). The group having an asbestos-related occupational history had a 2.53 times higher proportion of psychosocial stress (95% CI: 1.03~6.21). The group recognizing asbestos exposure had an even higher proportion of high psychosocial stress group (4.84 times, 95% CI: 1.41~16.55).
CONCLUSIONS
The incidence of psychosocial stress is significantly higher in residents near asbestos mines having an asbestos-related occupational history who recognize their frequent asbestos exposure. Therefore, mental health is affected by the awareness of environmental asbestos exposure as well as an occupational exposure to asbestos.

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Original Article

Risk Assessment for Cardiovascular Diseases in Male Workers: Comparing KOSHA Guidelines and the Framingham Risk Score System: In Yong Um, Won Jun Choi, Deul Lee, Jae Seok Oh, Min Kee Yi, Jong Wan Yoon, Sang Hwan Han; Korean Journal of Occupational and Environmental Medicine 2012;24(4):365-374. Published online December 31, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.4.365

Abstract PDF

OBJECTIVES
This study aimed to investigate the 10-year risk of cardiovascular disease (CVD) by Framingham risk score (FRS) who classified as "healthy group" by Korean Occupational Safety and Health Agent (KOSHA)' s cardiovascular risk assessment.
METHODS
The subjects of this study were 1,781 male workers in a large steel company. Health status was obtained periodically through medical examinations and questionnaires. We assessed cardiovascular risk using KOSHA guidelines and calculated the 10-year risk of cardiovascular disease using the Framingham risk score for those categorized to the "healthy group" by KOSHA guideline. A closer examination of cardiovascular risk factors was performed in 62 subjects paradoxically placed in the "healthy group" by KOSHA guidelines and the "high-risk group" by FRS.
RESULTS
Among the "healthy group" by KOSHA's cardiovascular risk assessment, 230(15.8%) subjects had more than 3 CVD risk factors and 62(4.2%) subjects were high risk group (more than 20%) in 10-years risk of CVD by Framingham risk score. Modifiable risk factors included cigarette smoking (96.8%), high serum total cholesterol (82.3%), high serum triglyceride (66.1%), insufficient physical activity (66.1%), and obesity (58.1%).
CONCLUSIONS
Among subjects with normal blood pressure, it seems that KOSHA guidelines underestimate CVD risk, identified by the Framingham risk score. For the effective prevention and management of CVD, modifiable risk factors, such as cigarette smoking, dyslipidemia, and obesity, need to be constructively controlled.

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Yunrae Cho, Dong Geon Kim, Byung-Chan Park, Seonhee Yang, Sang Kyu Kim
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Original Article

The Assessment of Pulmonary Function in Dental Technicians: Kyoung Han Kim, Jong In Lee, Min Choi, Jun Pyo Myong, Yong Sang Park, Tae Won Jang, Jung Wan Koo; Korean Journal of Occupational and Environmental Medicine 2012;24(4):356-364. Published online December 31, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.4.356

Abstract PDF: OBJECTIVES
Dental technicians are exposed to various toxic materials in the workplace. The objectives of this study were to assess the pulmonary function of dental technicians and to evaluate the association between work-related factors and pulmonary function of dental technicians.
METHODS
Study subjects were 209 dental technicians in the Korean Dental Technologist Association. A self-report questionnaire including general characteristics, respiratory symptoms, and work-related characteristics was conducted on study subjects, and a pulmonary function test (PFT) was done. Study subjects were classified into two groups(normal and abnormal pulmonary function) based on the pulmonary function test (PFT).
RESULTS
43 subjects (20.6%) among 209 subjects had abnormal pulmonary function. After adjusting for general characteristics such as age, sex, past medical history, familial history, and smoking status, the odds ratio for work duration (per year) was 1.42(95% confidence interval (CI) 1.14~1.83). After adjusting for general and work-related characteristics, the odds ratio for work duration (per year) was 1.48(95% CI 1.18~1.92).
CONCLUSIONS
Dental technicians are exposed to hazardous materials, which might lead to abnormal pulmonary function. A long work duration could increase exposure time, thereby increasing the chance for abnormal pulmonary function. Therefore, pulmonary function tests should be carried out periodically in dental technicians to ensure their pulmonary health.

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Original Article

An Association between Working Schedules and Depression in Public Sector Employees: Hyeon Taek Heo, Dong Won Kim, Jong Seok Lee, Hyeon A Jo, Seong Sil Jang, Soo Young Kim, In Ah Kim; Korean Journal of Occupational and Environmental Medicine 2012;24(4):347-355. Published online December 31, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.4.347

Abstract PDF

OBJECTIVES
This study determined the work schedules of public project workers who work an irregular shift and assessed the effect of these schedules on depression.
METHODS
Study subjects were 2934 laborers who are members of seven labor unions. Each was given a questionnaire requesting basic personal information, habits, socioeconomic status, and work schedules. Information gathered on work schedules included daytime, nighttime, and weekend work hours. Depression was evaluated using the Beck Depression Inventory (BDI), with Laborers who checked "not depressed" and "slightly depressive" categorized to a low-risk group, whereas laborers who checked "depressed" and "severely depressed" were categorized to a high-risk group. We used the Chi-square test and multivariate logistic regression to examine associations between work schedules and depression.
RESULTS
Laborers on an irregular work schedule averaged 47.8 hours/week and laborers who working over 48 hours/week comprised over half (54.5%) of the total population. Laborers performing night work, Sunday work, and Saturday work more than once in a month made up 25.7%, 30.8% and 33.5% of the examined population, respectively. A high-risk for depression was identified in 10.4% of laborers. Using logistic regression, depression was statistically associated with working : over 10 hours a day (OR=1.63, 95% CI 1.10~2.43), night work (OR=2.20, 95% CI 1.46~3.32), Sunday work (OR=1.81, 95% CI 1.15~2.85) and Saturday work (OR=1.82 95% CI 1.18~2.82).
CONCLUSION
A significant number of laborers with irregular working shifts work long hours and on weekends. Depression was significantly associated with this type of work schedule.

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Original Article

Association between Long Working Hours and Suicidal Ideation: Ki Ung Kim, Shin Goo Park, Hwan Cheol Kim, Jong Han Lim, Sung June Lee, Sung Hwan Jeon, Yong Suk Huh; Korean Journal of Occupational and Environmental Medicine 2012;24(4):339-346. Published online December 31, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.4.339

Abstract PDF

OBJECTIVES
This study was conducted to investigate the relationship between long working hours and suicidal ideation.
METHODS
Data based on the fourth Korea National Health and Nutrition Health and Nutrition Examination Survey_(2007~2009) pertaining to a total of 4,539 full-time workers were analyzed. Working hours were divided into four groups (<40 hours/week, 40~51 hours/week, 52~60 hours/week, >60 hours/week). The relationship between working hours and suicidal ideation was then analyzed after adjusting for general and occupational characteristics using a multivariate logistic regression model.
RESULTS
Working 40-51 hours/week showed the lowest suicidal ideation(9.5%), whereas working 52~59 hours/week, over 60 hours/week and less than 40 hours/week showed suicidal ideations of 14.8%, 15.7% and 17.2% respectively. Even after adjusting for general and occupational characteristics, employees working 40~51 hours/week had the lowest suicidal ideation. Working 52~59 hour/week, over 60 hours/week and less than 40 hours/week showed an odds ratios of 1.413(p-value: 0.058), 1.380(p-value: 0.020) and 1.164(p-value: 0.358) respectively.
CONCLUSIONS
The results suggest that working long hours, especially over 60 hours per week, is related to suicidal ideation.

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Review

Multiple Chemical Sensitivity: Hong Jae Chae, Byoung Gwon Kim, Hwan Cheol Kim, Mi Young Lee, Jong Han Leem; Korean Journal of Occupational and Environmental Medicine 2012;24(4):328-338. Published online December 31, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.4.328

Abstract PDF

This article reviews newly available knowledge on multiple chemical sensitivity (MCS), a chronic medical condition characterized by symptoms in multiple organ and caused by exposure to low levels of common chemicals. Although various pathophysiological models have been proposed (including toxicological, immunological or behavioral models), the causes and underlying mechanisms of MCS are still not fully understood. Most patients with MCS were women between the ages of 30 and 50 years. The most frequently reported trigger was a newly constructed home or job site. The common symptoms are vague, non-specific complaints: fatigue, difficulty concentrating, poor memory, sneezing/runny nose, headache, and muscle pain. There are no laboratory markers or specific investigative findings for MCS. The Quick Environmental Exposure and Sensitivity Inventory (QEESI)(c) has been used as a screening questionnaire. Treatment focuses on assisting patients at the earliest possible opportunity to reduce their exposure to unique symptom triggers and known hazardous chemicals. Early comprehensive assessment, medical management, and social and financial support might avoid the deterioration of functions associated with prolonged illness.

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MCS/IEI Prevalence Rate of Workers Around an Accidental Release of Hydrogen Fluoride in Gumi Industrial Complex
Hye-Ji Han, Kuck-Hyeun Woo, Sung-Yong Choi, Byoung-Hak Jeon, Sangjun Choi
Journal of Korean Society of Occupational and Environmental Hygiene.2015; 25(4): 534. CrossRef

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Nonspecific Building Related Illnesses: Chunhui Suh, Eun Hee Ha, Yun Chul Hong, Yoo Mi Chae, Kyu Jin Chang, Jungwon Kim; Korean Journal of Occupational and Environmental Medicine 2012;24(4):319-327. Published online December 31, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.4.319

Abstract PDF: Nonspecific building related illnesses (NBRI) are an array of diverse symptoms related to working in particular buildings. There are numerous contributing factors, including basic factors (temperature, humidity and ventilation) as well as chemicals, dust, microorganisms, and psychosocial factors. At the individual level, taking a careful history is the essential first step. After ruling out other diseases, clinicians can start the symptomatic treatment for NBRI. If a relationship to the building is suspected, a walk through evaluation is very helpful. At the group level, standardized questionnaires and investigations of the building environment can be applied simultaneously. If the prevalence of symptoms are greater than that of general population, appropriate interventions have to be provided for prevention and group health care. In both approaches, it is essential to periodically follow up with symptomatic patients and work environments after an intervention. For the management of NBRI, taking care of the patient's symptoms and maintaining a good indoor environment are important. To achieve this goal, cooperation among workers, building managers, employers and occupational health staff is crucial.

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