Annals of Occupational and Environmental Medicine

Original Article

Relationship between organophosphate and pyrethroid pesticides and metabolic syndrome in Korean farmers: Sungbeom Kim, Sangchul Roh, Min-Gi Kim, Jeongbae Rhie, Jisue Yoon, Sun-In Moon; Ann Occup Environ Med 2024;36:e23. Published online September 20, 2024; DOI: https://doi.org/10.35371/aoem.2024.36.e23

Background
The global use of pesticides steadily increased until the early 2010s. Pesticides play a significant role in agriculture in Korea. Metabolic syndrome is more prevalent in rural areas than in urban areas. This study explored the potential association between organophosphate and pyrethroid pesticide exposure and metabolic syndrome.
Methods
This study enrolled 1,317 individuals who participated in the Pesticide Exposure and Intoxication Study conducted by the Dankook University Hospital Center for Farmers’ Safety and Health from 2014 to 2019. Urinary levels of dimethylphosphate, dimethylthiophosphat, diethylphosphate, and diethylthiophosphate were measured to assess organophosphate pesticide exposure and urinary levels cis-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid, trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid, cis-3-(2,2-dibromovinyl)-2,2-dimethylcyclopropane carboxylic acid, and 3-phenoxybenzoic acid were measured to assess pyrethroid pesticide exposure.
Results
The odds ratio for the 4th quartile group of organophosphate metabolites concentration was 1.48 (95% confidence interval: 1.06–2.09) compared to the 1st quartile group after adjustment for general factors. In addition, a positive trend was observed across the quartile groups of organophosphate metabolites concentration. A positive trend was noted across the quartile groups of organophosphate metabolites in males, while no significant association was observed in females. Furthermore, no significant associations were observed between metabolic syndrome and pyrethroid metabolites concentration.
Conclusions
A positive correlation was observed between the prevalence of metabolic syndrome and the concentrations of urinary organophosphate metabolites, consistent with previous research finding. This association may be attributed to the action of organophosphates as acetylcholinesterase inhibitors, stimulating beta cells in the islets of Langerhans. This can lead to alterations in lipid metabolism and insulin resistance, ultimately leading to metabolic syndrome development. Metabolic syndrome is a major contributor to cardiovascular disease; therefore, it is necessary to identify the risk factors unique to rural areas, such as pesticide exposure.

한국 농업인의 유기인계 및 피레스로이드계 농약과 대사증후군 간의 관계
목적
농약 사용량은 2010년대 초까지 전세계적으로 꾸준히 증가하였으며, 농약은 한국 농업에서 중요한 부분을 차지하고 있다. 대사 증후군은 농촌 지역에서 도시 지역에 비하여 높은 유병률을 보인다. 유기염소계 농약과 대사 증후군 사이의 관련성은 일부 연구된 바 있으나, 다른 종류의 농약 노출과 대사 증후군 사이의 관련성에 대한 연구는 제한적이다. 따라서 본 연구는 유기인계 및 피레스로이드계 농약의 노출과 대사 증후군 사이의 관련성을 조사하고자 한다.
방법
2014년부터 2019년까지 단국대학교병원 농업안전보건센터에서 실시한 농약 노출 및 중독 연구에 참여한 1,317명을 대상으로 연구를 진행하였다. 유기인계 농약 노출 평가를 위해 DMP, DMTP, DEP, DETP의 소변 농도를 측정하였고, 피레스로이드계 농약 노출 평가를 위해 cis-DCCA, trans-DCCA, DBCA, 3-PBA의 소변 농도를 측정하였다. 다변량 로지스틱 회귀분석을 시행하여 농약 노출과 대사증후군 유병률 사이의 관계를 조사하였다.
결과
유기인계 대사체 농도에 따라 4분위 그룹으로 분류하였을 때, 4분위 그룹의 대사증후군 유병률이 오즈비 1.66(95% CI 1.22-2.28)으로 1분위 그룹에 비하여 높았다. 또한, 유기인계 대사체 농도와 대사증후군 유병률은 유의한 경향성을 보였다. 피레스로이드계 대사체 농도에 따라 4분위 그룹으로 분류하였을 때, 3분위 그룹의 대사증후군 유병률이 오즈비 1.51(95% CI 1.11-2.07)로 1분위 그룹에 비하여 높았다. 피레스로이드계 대사체 농도와 대사증후군 사이에 유의한 경향성은 나타나지 않았다.
결론
유기인계 농약 대사체 농도와 대사 증후군의 유병률 사이에 양의 상관 관계가 관찰되었으며, 이전 연구 결과를 보충하는 결과로 나타났다. 대사 증후군의 유병률이 증가하는 기전은 불분명하나, 유기인계 농약은 acetylcholinesterase inhibitor로 작용하므로 랑게르한스 섬의 베타 세포를 자극하고 이에 따른 지질 대사 및 인슐린 저항성의 변화로 인해 나타날 수 있을 것으로 추정된다. 대사 증후군은 심혈관 질환의 주요 원인 중 하나이며, 농촌 지역에서는 의료 접근이 비교적 취약하며 농약과 같은 특수한 위험 요인이 있기 때문에 이러한 위험 요인들을 식별하고 예방하여야 한다.

Citations

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Assessing the association of multi-environmental chemical exposures on metabolic syndrome: A machine learning approach
Yehoon Jo, Mi-Yeon Shin, Sungkyoon Kim
Environment International.2025; 199: 109481. CrossRef

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Original Article

Occupational factors affecting the decline in pulmonary function among male farmers using occupational pesticide in Gyeonggi-do, South Korea: Sooyeon Lee, Jiyoung Han, Seung Hee Woo, Soo-Jin Lee; Ann Occup Environ Med 2022;34:e42. Published online December 8, 2022; DOI: https://doi.org/10.35371/aoem.2022.34.e42

Abstract Abstract in Korean PDF

Background

Occupational pesticide exposure is a potential risk for respiratory health effects. Most clinical studies on pesticide exposure were related to acute exposure, and only a few studies on chronic exposure have been conducted. This study investigated the chronic respiratory health status and the chronic effects of occupational pesticide exposures of farmers in Gyeonggi-do.

Methods

Surveys and pulmonary function tests were conducted on 1,697 farmers in 16 regions of Gyeonggi-do. The structured questionnaire included demographic characteristics, medical history, recent respiratory symptoms and diseases, and work-related conditions, and was conducted through one-on-one interviews. The prevalence of respiratory diseases was compared by the odds ratios (ORs) at 95% confidence intervals (CIs) estimated by logistic regression analysis. Additional multivariate logistic regression analysis was also conducted.

Results

Pesticide work groups showed significant association with an obstructive pattern in the lung function test (unadjusted OR, 2.38; 95% CI, 1.17–5.52). Selected work-related variables of pesticide exposure were ‘start age,’ ‘cumulative duration,’ ‘mixing pesticides,’ and ‘protection(goggle).’ The obstructive pattern of lung function test showed significant associations with mixing pesticides (OR, 2.30; 95% CI,1.07–5.46), and protection (goggle) use (OR, 0.34; 95% CI, 0.12–0.79).

Conclusions

Mixing two or more pesticides showed a significant association. Wearing goggles can be seen as an indicator of awareness of the protective equipment and proper wearing of protective equipment, and loss of pulmonary function can be prevented when appropriate protection is worn.

한국 경기도 지역의 남성 농업인 폐기능 감소에 영향을 주는 직업적요인들
목적
직업적 농약노출은 호흡기 건강영향에 대해 잠재적인 위험을 갖고 있다. 과거 농약노출에 대한 임상연구는 대부분 급성 농약노출에 대한 것이었다. 이번 연구에서는 농약의 직업적 노출에 대한 만성적 호흡기 건강영향을 조사하며, 농약사용에 있어서 어떤 작업변수가 실제 영향을 미치는지 조사한다.
방법
2013년부터 2015년까지 경기도 16개 지역에서 농작업을 하는 농업인 1697명을 대상으로, 농작업현황과 인구학적 정보를 포함한 구조화된 설문조사를 일대일 대면 인터뷰형태로 실시했으며, 동시에 폐기능검사를 실시하였다. 통계적분석방법은 로지스틱 회귀분석으로 95% 신뢰구간에 대하여 폐기능검사에서의 폐쇄성형태, 제한성형태와 최근 6개월의 호흡기증상의 유병률을 오즈비를 구하여 비교하였다. 농약작업과의 세부관계성을 밝히기 위하여 추가적인 다변량-로지스틱회귀분석을 수행하였다.
결과
농약 작업군에서 폐쇄성패턴과 유의한 연관성을 보였다(오즈비: 2.38, 1.17-5.52). 다변량-로지스틱회귀분석 결과, 농약 사용패턴 중 유의미한 변수는 '누적노출년도', '농약작업 시작나이', '농약 혼합', '보호구착용(고글)'로 나타났으며, 폐쇄성패턴과 농약혼합행태, 보호구착용이 유의한 연관성을 보여주었다.
결론
농약에 노출된 농업인은 폐기능감소에 있어 유의한 기능감소를 보여주었다. 농약관련 변수 중에는 양적인 변수들이 유의한 관련성이 있었으며, 고글착용은 적절한 보호구착용의 지표로 볼 수 있으며, 보호효과가 있었다.

Citations

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Occupational status and chronic respiratory diseases: a cross-sectional study based on the data of the Rafsanjan Cohort Study
Zahra Bagheri-Hosseinabadi, Ali Bahreyni, Hosein Basirat, Parvin Khalili, Alireza Vakilian, Fatemeh Amin
BMC Pulmonary Medicine.2024;[Epub] CrossRef

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Research Article

Work-related factors of knee osteoarthritis in Korean farmers: a cross-sectional study: Han Soo Song, Dong Hwi Kim, Gwang Chul Lee, Kweon Young Kim, So Yeon Ryu, Chul Gab Lee; Ann Occup Environ Med 2020;32:e37. Published online November 13, 2020; DOI: https://doi.org/10.35371/aoem.2020.32.e37

Abstract PDF

Background

Several studies have reported a high prevalence of osteoarthritis (OA) of the knee among agricultural workers. We investigated work-related factors that increase the risk of knee OA among Korean farmers.

Methods

Data were extracted from the Jeonnam Center for Farmer's Safety and Health survey, conducted between 2013 and 2015. The sample included 489 farmers (man 240, woman 249). We defined knee OA as radiographic knee OA (≥ Kellgren-Lawrence grade 2) with symptoms (≥ Western Ontario and McMaster Universities Osteoarthritis, Korean version score 29.5). We considered covariates such as cumulative squatting working time (CSWT), cumulative heavy lifting working time (CLWT), body mass index (BMI), and history of knee injury. Odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were calculated for knee OA and adjusted for relevant covariates.

Results

The results of multivariate logistic regression analysis indicated that knee OA was correlated by factors such as sex, age, BMI, history of knee injury, CSWT, and CLWT. Particularly, CSWT > 20,000 hours (OR: 2.83; 95% CI: 1.35–5.92; reference < 10,000 hours) and CLWT > 5,000 hours (OR: 2.62; 95% CI: 1.14–6.06; reference < 2,000 hours) were associated with an increased risk of knee OA after adjustment for covariates.

Conclusions

Squatting posture and heavy lifting associated with farm work might increase the risk of knee OA among Korean farmers.

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Review

Environmentally induced, occupational diseases with emphasis on chronic kidney disease of multifactorial origin affecting tropical countries: Shehani A. Wimalawansa, Sunil J. Wimalawansa; Ann Occup Environ Med 2016;28:33. Published online August 5, 2016; DOI: https://doi.org/10.1186/s40557-016-0119-y

Abstract PDF

Background

Environmentally induced, occupational diseases are increasing worldwide, especially in rural agricultural communities. Poverty-associated malnutrition, environmental hazards and pollution, and lack of access to clean water, safe sanitation, and modern healthcare facilities are often associated with these chronic illnesses.

Method

The authors systematically reviewed occupational public health issues that have been related to the environment. General interpretations of results were included as per the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Pertinent publications from research databases were reviewed on (A) the risk–benefits, (B) the prevalence of risk factors for various diseases, (C) the benefits of not ignoring the risk factors (i.e., broader evidence), and (D) the risks, effects, and outcomes of different types of interventions. The authors used chronic kidney disease of multifactorial origin (CKDmfo) as an example to explore the theme. Emphasis was given to the regions with emerging economies and developing countries located in the vicinity of the equator.

Findings

Geographical, socio-economic and aetiological similarities exist for many chronic non-communicable diseases that are affecting tropical countries around the equator. The authors identified manufacturing, mining, and agriculture as the biggest polluters of the environment. In addition, deforestation and associated soil erosion, overuse of agrochemicals, and irresponsible factory discharge (e.g., chemicals and paint, from rubber and textile factories, etc.), all contribute to pollution. To decrease the escalating incidences of environmentally induced diseases, governments should work proactively to protect the environment, especially watersheds, and take steps to minimise harmful occupational exposures and strictly enforce environmental regulations.

Conclusion

Creating public awareness of environmental issues and their relationship to public health is essential. This includes regular monitoring and periodic publication of the quality of water, air and soil; preventing deforestation and man-made soil erosion, increasing forest and ground cover, preventing occupational injuries, judicious and safe use of agrochemicals, sustainable agriculture and development programs, and implementing legislation to protect and conserve water heriage and the environment. These actions are essential both for a healthier environment and for the health of the people who live in that environment. Such measures would also decrease public health threats from such, including global-warming-related erratic environmental changes and the occurrence and the spread of non-communicable diseases, such as CKDmfo.

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Research Article

Estimated rate of agricultural injury: the Korean Farmers’ Occupational Disease and Injury Survey: Hyeseon Chae, Kyungdoo Min, kanwoo Youn, Jinwoo Park, Kyungran Kim, Hyocher Kim, Kyungsuk Lee; Ann Occup Environ Med 2014;26:8. Published online April 25, 2014; DOI: https://doi.org/10.1186/2052-4374-26-8

Abstract PDF

Objectives

This study estimated the rate of agricultural injury using a nationwide survey and identified factors associated with these injuries.

Methods

The first Korean Farmers’ Occupational Disease and Injury Survey (KFODIS) was conducted by the Rural Development Administration in 2009. Data from 9,630 adults were collected through a household survey about agricultural injuries suffered in 2008. We estimated the injury rates among those whose injury required an absence of more than 4 days. Logistic regression was performed to identify the relationship between the prevalence of agricultural injuries and the general characteristics of the study population.

Results

We estimated that 3.2% (±0.00) of Korean farmers suffered agricultural injuries that required an absence of more than 4 days. The injury rates among orchard farmers (5.4 ± 0.00) were higher those of all non-orchard farmers. The odds ratio (OR) for agricultural injuries was significantly lower in females (OR: 0.45, 95% CI = 0.45–0.45) compared to males. However, the odds of injury among farmers aged 50–59 (OR: 1.53, 95% CI = 1.46–1.60), 60–69 (OR: 1.45, 95% CI = 1.39–1.51), and ≥70 (OR: 1.94, 95% CI = 1.86–2.02) were significantly higher compared to those younger than 50. In addition, the total number of years farmed, average number of months per year of farming, and average hours per day of farming were significantly associated with agricultural injuries.

Conclusions

Agricultural injury rates in this study were higher than rates reported by the existing compensation insurance data. Males and older farmers were at a greater risk of agriculture injuries; therefore, the prevention and management of agricultural injuries in this population is required.

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Original Article

Job Stress and Self-perceived Fatigue in Korean Farmers: Ki Hyun Lee, Sang Baek Koh, Dongmug Kang, Jin Joo Chung, Hyoung Ryoul Kim, In Ah Kim, Kyung Suk Lee, Sook Jung Hyun, Kang Myoung Lee, Jin Ha Yoon, Sung Kyung Kim, In Jung Cho, Jung Kyu Choi, Sung Soo Oh, Bong Suk Cha, Sei Jin Chang; Korean Journal of Occupational and Environmental Medicine 2011;23(2):213-224. Published online June 30, 2011; DOI: https://doi.org/10.35371/kjoem.2011.23.2.213

Abstract PDF

OBJECTIVES
A growing body of research has documented that job stress has a pivotal role in developing adverse health outcomes. However, little is known about the relationship between farmers' job stress and health outcomes. This study was undertaken to identify the relationship between job stress and self-perceived fatigue in Korean farmers.
METHODS
A total of 526 Korean farmers were asked to participate in this study. A self-administered questionnaire was used to assess the participants' general characteristics, job stress and self-perceived fatigue. Job stress was measured using a forty-eight item Farm Stressor Inventory (FSI), and the self-perceived fatigue was estimated by Multidimensional Fatigue Scale (MFS). Binary logistic regression analysis was conducted to examine the relationship between job stress and self-perceived fatigue.
RESULTS
The result showed that job stress was associated with self-perceived fatigue. For the farmers with high job stress, the risk of self-perceived fatigue was more likely to increase compared to those with low job stress. For males, labor intensity (OR, 3.88; 95% CI, 1.91~7.89), job environment (OR, 2.45; 95% CI, 1.22~4.93), social support (OR, 2.10; 95% CI, 1.07~4.13), social isolation (OR, 2.45; 95% CI, 1.15~5.60), financial problems (OR, 3.25; 95% CI, 1.53~6.91), uncertainty (OR, 2.48; 95% CI, 1.30~4.75) and health problems (OR, 5.77; 95% CI, 2.46~13.53) were associated with self-perceived fatigue. For females, job environment (OR, 2.23; 95% CI, 1.22~4.08), social isolation (OR, 2.08; 95% CI, 1.05-4.15), physical environment & weather condition (OR, 2.61; 95% CI, 1.33~5.12), financial problems (OR, 2.87; 95% CI, 1.55~5.32), uncertainty (OR, 3.65; 95% CI, 1.95~6.83) and health problems (OR, 3.38; 95% CI, 1.57~7.27) were associated with self-perceived fatigue.
CONCLUSIONS
This result suggests that farmers' job stress plays a role in the development of fatigue, and job stressors related to fatigue are slightly different according to gender.

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Original Article

Radiological Flattening of Lumbar Lordosis and Related Factors in Some Korean Farmers: Han Soo Song, Sang Kon Yoo, Chang Ki Choi, Chul Gab Lee, Kyung Suk Lee; Korean Journal of Occupational and Environmental Medicine 2010;22(4):279-289. Published online December 31, 2010; DOI: https://doi.org/10.35371/kjoem.2010.22.4.279

Abstract PDF

OBJECTIVES
To determine if agricultural work is related to radiological flattening of lumbar lordosis, and to identify the relationship between of back pain and flat back in selected Korean farmers.
METHODS
Between June 2006 and July 2008, 414 farmers, 155 (37.4%) males and 259 (62.6%) females participated in this study. We collected data on hazardous agricultural work postures and other factors from interviews, surveys, and x-ray views of lateral lumbar. The operational definition of a flat back was below -1 SD of lordotic angle, with a normal distribution between L1 and S1 level. Logistic regression analysis was conducted to evaluate the relationship between flat back and hazardous working posture ratio, sex, the severity of back pain.
RESULTS
Mean lordotic angle was 42.9+/-15.7degrees. Flat back had a higher prevalence in the females (24.7%) than the males (5.8%). The odds ratio of flat back risk is 3.30 (95% CI: 1.46~7.46) in the females compared to the males, 1.31 (95% CI: 0.61~2.79), 4.11 (95% CI: 1.77~9.55) in the group of hazardous working posture ratio compared to the low risk group, 2.78 (95% CI: 1.27~6.07), 5.74 (95% CI: 2.27~14.49) in the group of L4-L5 disc space narrowing compared to normal group, 3.06 (95% CI: 1.27~7.31), 5.45 (95% CI: 1.70~17.46) in the group of lumbar spine compression fracture compared to no fracture. Odds ratio of severe back pain is 2.29 (95% CI: 1.12~4.72) in the group of flat back compared to normal group.
CONCLUSIONS
Hazardous agricultural working postures, such as 'low- lifting, pulling, pushing work and high- squatting posture work' are associated with flat back. Low back pain is significantly associated with flat back group in female farmers.

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Ji-Hyuk Park, Sun-Ja Kim, Seung-Ki Youn, Kisoo Park, Jin Gwack
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Original Article

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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Effect of Exercise on Mental Health in Female Elementary School Teachers
Nami Chun, Hyun Ju Chae
Journal of the Korean Society of School Health.2014; 27(1): 22. CrossRef

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Original Article

Occupational Diseases among Agricultural, Forestry and Fishery Workers Approved by Korea Labor Welfare Corporation: Yeon Soon Ahn, Hyun Sul Lim; Korean Journal of Occupational and Environmental Medicine 2007;19(1):1-16. Published online March 31, 2007; DOI: https://doi.org/10.35371/kjoem.2007.19.1.1

Abstract PDF

OBJECTIVES
To analyze the characteristics of occupational diseases among agricultural, forestry and fishery workers compensated under the Industrial Accident Compensation Insurance that is operated by the Korea Labor Welfare Corporation (KLWC).
METHODS
Using the KLWC database, we collected 667 cases of occupational disease compensated during the 8 years between 1 January 1998 and 31 December 2005. We analyzed the characteristics of occupational diseases using the KLWC electronic data and the data investigated by the Korea Occupational Safety and Health Agency.
RESULTS
KLWC approved 667 cases, including 69 deaths (10.3%). Men accounted for 76.0%of the approved cases. The most common age group was 50~59 years of age (37.3%). The most common size of enterprise was 5 to 49 workers (47.5%). The proportion of occupational diseases was 54.1%, of which 45.9% was work-related. Among occupational diseases, the most common was skin diseases (147 cases, 40.7%), followed by infectious diseases (131 cases, 36.3%), including scrub typhus (123 cases) and intoxication (40 cases, 11.1%). The causal hazardous agents were biological (320 cases, 88.6%), chemical (29 cases, 8.0%), and physical (11 cases, 3.0%). The major type of industry and occupation were forestry (445 cases, 66.7%) and elementary (151 among 235 cases, 89.3%), respectively.
CONCLUSIONS
Major compensated occupational diseases were infectious diseases, including scrubtyphus, skin diseases and toxic disease, which occurred among workers who were older, and had short tenure and elementary occupation, and these workers were out of the occupational health policy. A management policy must be established to prevent occupational diseases occurring in such vulnerable workers.

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Young-Jun Kwon, Soo-Jin Lee
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Won Jin Lee, Eun Shil Cha, Eun Kyeong Moon
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