Annals of Occupational and Environmental Medicine

Original Article

Association between seafood consumption and serum polyfluoroalkyl substance concentrations among Korean adolescents: the Korean National Environmental Health Survey (KoNEHS) cycle 5, 2021–2023: Hyun Joong Kim, Yongjin Kim, Dong-jae Seo, Jaewon Mun, Sunwoo Jeong, Shin-Goo Park, Yangwoo Kim, Hwan-Cheol Kim; Ann Occup Environ Med 2026;e38. Published online August 20, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e38 [Accepted]

Abstract PDF: Background
Per- and polyfluoroalkyl substances (PFAS) are persistent environmental contaminants commonly found in seafood; however, evidence of dietary ingestion among adolescents remains limited. We aimed to evaluate the association between seafood consumption and serum PFAS concentrations among Korean adolescents.
Methods
This cross-sectional study used data from the fifth Korean National Environmental Health Survey (KoNEHS, 2021–2023). We included 827 adolescents aged 12–18 years. Serum concentrations of five PFAS compounds (perfluorooctanoic acid [PFOA], perfluorooctane sulfonic acid [PFOS], perfluorohexane sulfonic acid, perfluorononanoic acid [PFNA], and perfluorodecanoic acid [PFDeA]) were measured. Seafood consumption was assessed using a questionnaire and categorized as rarely consumed, monthly consumption, or weekly consumption. Complex sample general linear models were performed using log-transformed PFAS concentrations.
Results
Compared with rarely consumed, weekly fish consumption was significantly associated with higher serum concentrations of PFOA (B = 1.15; 95% confidence interval [CI]: 0.46–1.83; p = 0.001), PFOS (B = 2.14; 95% CI: 1.23–3.05; p < 0.001), PFNA (B = 0.28; 95% CI: 0.14–0.42; p < 0.001), and PFDeA (B=0.14; 95% CI: 0.05–0.23; p = 0.004), whereas monthly fish consumption was associated with higher PFOS and PFNA. Crustacean consumption showed positive associations with PFOA (B = 1.10; 95% CI: 0.57–1.63; p < 0.001), PFOS (B = 0.93; 95% CI: 0.24–1.61; p = 0.009), PFNA (B = 0.18; 95% CI: 0.08–0.28; p < 0.001), and PFDeA (B = 0.11; 95% CI: 0.05–0.16; p < 0.001) in the monthly group, whereas associations were attenuated in the weekly group. No significant associations were observed for large fish and tuna, seaweed, shellfish, or other seafood.
Conclusions
Fish and crustacean consumption were associated with serum PFAS concentrations among Korean adolescents, whereas other seafood types showed no significant associations. Future prospective studies with more detailed dietary assessments are warranted to clarify causal relationships.

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Original Article

Association between delivery-food consumption frequency and urinary bisphenol concentrations among Korean adults: a nationally representative study (Korean National Environmental Health Survey cycle 5, 2021–2023): Gwisang Park, Hyeyun Lee, Inchul Jeong, Eunhee Ha, Kihun Kim; Ann Occup Environ Med 2026;e37. Published online July 30, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e37 [Accepted]

Abstract PDF: Background
Bisphenol exposure remains a public health concern, particularly as the use of bisphenol analogues such as bisphenol S (BPS) has increased. In the post-pandemic period, delivery-food consumption has become routine in South Korea and may represent an important behavioral pathway for bisphenol exposure. This study examined whether delivery-food consumption in plastic containers is associated with urinary bisphenols among Korean adults.
Methods
This study used adult data from the Korean National Environmental Health Survey (KoNEHS) cycle 5 (2021–2023). Delivery-food consumption frequency (nine categories) was modeled per 1-time-per-month increase. Outcomes were urinary bisphenol A (BPA), BPS, and bisphenol F (BPF). Creatinine-adjusted concentrations were analyzed on the natural log scale using multivariable regression models. Model 1 adjusted for sociodemographic factors, and model 2 additionally adjusted for plastic-related behavioral variables.
Results
Among 4,275 adults with complete bisphenol and urinary creatinine data, delivery-food consumption frequency was positively associated with creatinine-adjusted urinary BPS concentrations (1.49% increase per 1-time-per-month increase; 95% confidence interval [CI]: 0.74–2.24; p < 0.001) after sociodemographic adjustment, whereas associations with BPA (0.32% increase; 95% CI, −0.45 to 1.09; p = 0.416) and BPF (−0.14% change; 95% CI: −1.18 to 0.90; p = 0.787) were not statistically significant. After additional adjustment for plastic-related behavioral variables in model 2, the association remained statistically significant for BPS (1.54%; 95% CI, 0.76–2.33; p < 0.001), whereas the associations with BPA and BPF remained non-significant.
Conclusions
More frequent consumption of delivery foods packaged in plastic containers was independently associated with higher creatinine-adjusted urinary BPS concentrations. Given that common delivery container polymers in Korea are generally bisphenol-free, this association suggests that delivery-related behavior serves as a behavioral surrogate for a bundled exposure scenario. The observed BPS signal may partly reflect cumulative exposure from ancillary materials, such as thermal receipts and labels. Future studies should identify specific delivery-associated sources and migration pathways of bisphenols.

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Original Article

Association between urinary bisphenol levels and metabolic syndrome in Korean adults: a cross-sectional study using the fourth Korean National Environmental Health Survey: Chang Ho Jae, Young Hoo Shin, Chang Ho Chae, Chan Woo Kim, Hyoung Ouk Park, Yong Tae Park, Dae Yeon Kang; Ann Occup Environ Med 2026;e36. Published online July 27, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e36 [Accepted]

Abstract PDF: Background
Bisphenols are representative endocrine-disrupting chemicals, and have shown an association with metabolic disorders. Although the use of alternative bisphenols such as bisphenol F (BPF) and bisphenol S (BPS) has been increasing while that of bisphenol A (BPA) has been declining, limited population-based studies exist in Korea examining the association between these substances and metabolic syndrome (MetS). Therefore, this study aimed to evaluate the association of urinary BPA, BPF, and BPS concentrations with MetS in South Korean adults using data from the fourth Korean National Environmental Health Survey (KoNEHS).
Methods
This study included 2,639 participants from the 2018–2019 KoNEHS. MetS was defined based on the modified National Cholesterol Education Program Adult Treatment Panel III criteria. The fasting blood glucose criterion was replaced with glycated hemoglobin (HbA1c) (≥5.7% or medication use). Urinary BPA, BPF, and BPS concentrations were categorized into tertiles per substance. Weighted binary logistic regression analysis accounting for the complex sampling design was performed to calculate odds ratio (OR) and 95% confidence interval (CI).
Results
In the final adjusted model, urinary BPF concentration demonstrated a significant positive association with MetS, with ORs of 1.320 (95% CI: 1.029–1.693) for T2 and 1.452 (95% CI: 1.122–1.878) for T3. Urinary BPS concentration demonstrated a significant association only in the highest tertile, with an OR of 1.476 (95% CI: 1.067–2.043) for T3. Conversely, urinary BPA concentration did not show a significant association with MetS.
Conclusions
In this study, urinary BPF and BPS concentrations in the general Korean adult population showed a significant positive association with MetS. The study findings may provide a baseline for expanding our understanding of the effects of bisphenols on health. Future long-term, prospective studies involving the general population remain necessary.

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Original Article

Meaning of work in the association between traumatic events experienced and post-traumatic growth among workers in South Korea: a cross-sectional study: Miyoung Kim, Sang Baek Koh, Yujin Kim; Ann Occup Environ Med 2026;e35. Published online July 27, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e35 [Accepted]

Abstract PDF: Background
Traumatic experiences are associated with post-traumatic stress disorder and post-traumatic growth (PTG). Although meaning-making has been emphasized in PTG, little research has examined whether the meaning of work is involved in cross-sectional indirect associations between traumatic events experienced and PTG. In South Korea, research has focused mainly on events meeting the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM), whereas events not meeting DSM criteria among workers remain underexamined.
Methods
This study measured traumatic events experienced, meaning of work, and PTG in 328 workers aged 20 years or older. Traumatic events experienced were classified as events meeting DSM-5 criteria or events not meeting these criteria. Cross-sectional indirect associations were examined using SPSS 21.0 and the PROCESS Macro (model 4).
Results
In cross-sectional indirect-effect models, meaning of work showed a significant indirect association between the total number of traumatic events experienced and PTG. A significant indirect association through meaning of work was also observed for not meeting DSM criteria, whereas no significant indirect association was found for events meeting DSM criteria.
Conclusions
In this worker sample, events not meeting DSM criteria were highly prevalent. Meaning of work may be cross-sectionally associated with how workers interpret and integrate such events. These exploratory findings suggest that meaning-centered approaches may complement workplace mental health interventions, although longitudinal studies are needed to test temporal and causal processes.

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Original Article

Korean occupational and environmental medicine specialists: demand-supply projections: Hee-Tae Kang, Hye-Eun Lee, Mo-Yeol Kang, Chungwon Kang, Kyong sok Shin, Hyeon-Taek Heo, Yong Lim Won, Jungwon Kim; Ann Occup Environ Med 2026;e34. Published online July 27, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e34 [Accepted]

Abstract PDF: Background
Korea has experienced changes in the balance between the demand for and supply of occupational and environmental medicine (OEM) specialists due to recent policy and environmental shifts. This study projected demand and supply for these specialists for 2025–2035, focusing on those working in special health examination institutions and occupational health management agencies.
Methods
Demand was estimated by applying 2024 average workloads per OEM specialist to projected volumes of special health examinations and outsourced occupational health management for 2025–2035 under four scenarios that varied growth in outsourced management and the share of OEM specialists among participating physicians. Supply was projected using registration and official statistics for 1,010 specialists certified by 2025, combined with detailed residency cohort data, assumptions on future quotas, completion, and age at certification, and age-specific proportions working in the two institution types.
Results
Average workloads in 2024 were 4,793 workers per OEM specialist for special health examinations and 9,193 workers per physician for outsourced occupational health management. The number of OEM specialists younger than 90 years is projected to increase from 968 in 2025 to 1,244 in 2035, with those working in the two institution types increasing from 697 to 910. Depending on the scenario, demand in 2035 ranges from 838 to 943 specialists, with supply exceeding demand in three scenarios but remaining 33 specialists short in the most expansionary scenario.
Conclusions
Short‑term shortages of OEM specialists are likely but remain highly manageable, after which surplus capacity is expected. Policy efforts should therefore stabilize OEM residency pipelines and prepare institutional mechanisms to deploy surplus specialists beyond special health examinations and outsourced occupational health management.

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Original Article

Psychometric validation of brief scales for loneliness at work in Korea: the Three-Item Scale for Loneliness at Work (SLAW-3) and Single-Item Scale for Loneliness at Work (SLAW-1): Ganguk Lee, Chunhui Suh, Seongdong Lee, Norito Kawakami; Ann Occup Environ Med 2026;e33. Published online July 24, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e33 [Accepted]

Abstract PDF: Background
Workplace loneliness is an emerging psychosocial risk factor in the occupational health context, but comprehensive assessment instruments are often impractical if large workforce surveys are planned. This study evaluated the measurement properties of two brief workplace loneliness indicators: the Single-Item Scale for Loneliness at Work (SLAW-1) and the Three-Item Scale for Loneliness at Work (SLAW-3).
Methods
Data were obtained from a nationwide online survey of Korean employees (n = 1,000), with proportional sampling by sex, age, and occupation. A subsample (n = 200) underwent 4-week follow-up to assess test–retest reliability. Internal consistency and confirmatory factor analysis were examined for SLAW-3, whereas test–retest reliability was assessed for SLAW-1. Criterion validity was tested against a single-item measure of general loneliness. Convergent validity was examined by deriving correlations with occupational stress and psychological distress, work performance, work engagement, and well-being.
Results
SLAW-3 demonstrated acceptable internal consistency (α = 0.883) and was consistent with a single-factor interpretation. SLAW-1 exhibited moderate 4-week test–retest reliability (r = 0.603). Both scales were associated with workplace loneliness and related psychological and occupational variables, in the expected directions. SLAW-1 was more strongly related to general loneliness, whereas SLAW-3 evidenced stronger associations with workplace loneliness.
Conclusions
SLAW-1 and SLAW-3 appear to be practical brief indicators of workplace loneliness. SLAW-1 may be appropriate for rapid screening, whereas SLAW-3 offers a more context-specific assessment in terms of occupational health research and monitoring.

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Brief Communication

Workers' opinions on working time regulations: results from the 5th Korean Work, Sleep, and Health Study (KWSHS): Jeong Woo Park, Seong-Sik Cho, Mo-Yeol Kang, Min Choi, Jongwoo Lee; Ann Occup Environ Med 2026;e32. Published online July 21, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e32 [Accepted]

Abstract PDF: Although South Korea's average annual working hours have declined over recent decades, the country continues to rank higher among Organisation for Economic Co-operation and Development countries. Despite ongoing policy debates on working time reform, public perspectives on specific regulatory measures among Korean workers remain underexplored. This study analyzed data from the 5th wave of the Korean Work, Sleep, and Health Study (KWSHS). The survey was conducted in September 2024 via an online platform. A total of 5,783 working adults aged 19–70 years were included. Participants were asked about their opinions on five working time regulatory measures, including the current weekly hour cap, extending regulations to small companies and exempt industries, introducing a daily working hours limit, regulating non-essential night work, and restricting weekend work for large supermarkets. A majority of respondents supported all five proposed regulatory measures. Support was highest for introducing a daily working hours cap (72.1% agree or strongly agree), followed by regulating non-essential night work (63.2%), extending the cap to small companies (60.1%), restricting weekend work for large supermarkets (60.7%), and introducing the weekly cap for exempt industries (52.8%). While 34.7% favored reducing the current weekly maximum, 36.5% preferred maintaining the current limit. The survey respondents generally support strengthening working-time regulations. These findings provide workers’ opinions on working-time regulations, although they should be interpreted within the study's limitations (a sample with a higher proportion of office workers).

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Original Article

Association between workplace cooperation and depressive symptoms differs according to employment type: the seventh Korean Working Conditions Survey: Jung Wook Kim, Youngdo Kim, Jung Ho Yang; Ann Occup Environ Med 2026;e30. Published online July 14, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e30 [Accepted]

Abstract PDF Supplementary Material: Background
The relationship between workplace cooperation and mental health has gained increasing attention. However, the extent to which employment type moderates the association between workplace cooperation and depressive symptoms remains underexplored. The present study aimed to investigate the association between workplace cooperation, depressive symptoms, and employment type among South Korean wage workers.
Methods
The present work analyzed data from the seventh Korean Working Conditions Survey (KWCS), including 25,259 wage workers aged 20 years and older. Employment type was categorized as one of regular-, temporary-, or daily laborer. Workplace cooperation was assessed using a five-point Likert scale item regarding cooperation among colleagues. Depressive symptoms were measured using the World Health Organization (WHO)-5 Well-Being Index. Multivariable logistic and linear regression analyses were conducted to evaluate the association between workplace cooperation and depressive symptoms or the WHO-5 Well-Being Index.
Results
Cooperation was significantly associated with lower odds of depressive symptoms in regular workers (odds ratio [OR]: 0.538; 95% confidence interval [CI]: 0.498–0.581), temporary workers (OR: 0.666; 95% CI: 0.561–0.790), and daily laborers (OR: 0.479; 95% CI: 0.339–0.679). The association between workplace cooperation and depressive symptoms differed significantly by employment type (interaction p = 0.016 for temporary vs. regular workers): the inverse association was weaker among temporary workers than among regular workers (interaction OR: 1.261; 95% CI: 1.045–1.522), whereas no significant difference was observed between regular workers and daily laborers (interaction OR: 0.912; 95% CI: 0.651–1.279; p = 0.595).
Conclusion
Workplace cooperation was significantly associated with lower odds of depressive symptoms across all employment types, but the magnitude of this protection varies significantly by employment status.

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Original Article

The relations among workplace verbal abuse, job stress, and good self-rated health among Korean wage workers: Evidence from the 7th Korean Working Conditions Survey (KWCS): Youngdo Kim, Jung Wook Kim, Jung Ho Yang; Ann Occup Environ Med 2026;e29. Published online July 14, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e29 [Accepted]

Abstract PDF: Background
Workplace verbal abuse has increasingly been recognized as a psychosocial hazard affecting employees’ health. Although its direct psychological consequences have been well documented, the mechanisms through which verbal abuse shapes employees’ self-rated health have been less thoroughly examined. In particular, limited empirical attention has been given to the mediating role of job stress in this relationship. The association between workplace verbal abuse and good self-rated health among Korean wage workers was investigated, and the mediating role of job stress in this relationship was further examined.
Methods
Data were drawn from the 7th Korean Working Conditions Survey (KWCS), which included a nationally representative sample of 26,427 wage workers aged 20 years or older. Verbal abuse, job stress, and good self-rated health were assessed using structured self-report items. Multivariable logistic regression analyses were performed to evaluate associations among verbal abuse, job stress, and good self-rated health, with adjustments made for individual- and occupational/workplace-related covariates.
Results
Workplace verbal abuse was significantly associated with higher odds of job stress (odds ratio [OR]: 1.527; 95% confidence interval [CI]: 1.300–1.803; p < 0.001) and lower odds of good self-rated health (OR: 0.641; 95% CI: 0.566–0.726; p < 0.001). Mediation analysis indicated that job stress partially mediated the relationship between verbal abuse and good self-rated health, accounting for 2.38% of the total effect (indirect effect: –0.0021; p < 0.001), while the direct effect of verbal abuse remained significant.
Conclusion
Workplace verbal abuse was associated with poorer good self-rated health, both directly and indirectly through job stress. These findings highlight the need for organizational interventions and policy-level strategies aimed at reducing verbal aggression and mitigating occupational stress.

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Original Article

Relationship between shark meat intake and blood mercury concentration in Korean adolescents: Jeong A Chang, Jeong Woo Park, Joon SaKong; Ann Occup Environ Med 2026;e28. Published online July 13, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e28 [Accepted]

Abstract PDF: Background
Mercury exposure through seafood consumption poses health risks, yet limited research has examined shark meat—a large predatory fish still consumed in Korea—and its association with blood mercury levels in adolescents.
Methods
This cross-sectional study used data from the 3rd Korean National Environmental Health Survey (KNEHS). Multiple linear and logistic regression analyses were performed to assess the association between shark meat intake and blood mercury levels and to estimate the odds ratios for exceeding the reference blood mercury level, adjusting for potential confounders.
Results
Of the 912 participants, 50 (5.5%) were identified as shark meat consumption group. Shark meat consumption was associated with higher blood mercury concentrations (β = 0.41; 95% confidence interval [CI]: 0.23–0.59), with the highest levels observed among those who consumed shark meat within the past 30 days (β = 1.19; 95% CI: 0.30–2.08), those who preferred shark meat (β = 0.67; 95% CI: 0.26–1.08), and those with higher annual intake (β = 0.71; 95% CI: 0.00–1.43). Shark meat consumers had substantially higher odds of exceeding the blood mercury reference level (≥5.8 µg/L; odds ratios: 35.84; 95% CI: 3.39–378.84), with an estimated attributable risk of 97.2% (95% CI: 70.5%–99.7%) and a population attributable risk of 65.7% (95% CI: 11.6%–95.4%). Of the estimated 25,740 (95% range: 11,905–54,913) adolescents aged 12–17 years potentially exceeding this threshold, approximately 16,911 (95% CI: 2,986–24,556) cases may be attributable to shark meat consumption, though these estimates should be interpreted cautiously given the wide confidence intervals.
Conclusion
Shark meat consumption was associated with elevated blood mercury levels in Korean adolescents. Targeted education on its potential health risks is needed to reduce unintended exposure, while maintaining the nutritional benefits of fish consumption.

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Case Report

Sinonasal hemangiosarcoma following juvenile occupational exposure to formaldehyde when breeding farm animals: Daniela Napolitano, Stefania Massacesi, Roberto Calisti; Ann Occup Environ Med 2026;38:e27. Published online July 13, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e27

Abstract PDF: Background
Hemangiosarcomas are heterogeneous malignancies possibly originating in any part of the body, rare in humans. The web of causation of human hemangiosarcomas remains poorly understood, to date, except for subsets of cases which have been recognized in a well-defined causal correlation to vinyl chloride or to ionizing radiation. In 2005, the International Agency for Research on Cancer ranked formaldehyde as a human carcinogen, causally related to both nasopharyngeal cancers and acute non-lymphocytic leukemias; at the time, the evidence in favor of a causal relationship of formaldehyde to sinonasal cancers was stated as “limited”. In 2024, an umbrella review reported a significantly increased risk for sinonasal cancers among formaldehyde-exposed workers.
Case presentation
A sinonasal hemangiosarcoma affecting an Italian male born in 1957, diagnosed in 2022, was reported to the Italian National Registry of Sino-Nasal Cancers (ReNaTuNS); the patient’s occupational history revealed a remote exposure to formaldehyde, used as a disinfectant, when breeding farm animals, from 1967 to 1976. No previous reporting has been found about a possible association between formaldehyde and sinonasal non-epithelial cancers.
Conclusions
Formaldehyde is, in our opinion, a suitable candidate to be considered for playing a causal role in the causation of the neoplasm; formal studies are required to test the hypothesis.

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Original Article

Association between shift work patterns and the incidence of prediabetes and diabetes among night shift workers: a retrospective cohort study: Hyundong Lee, Changil Shin, Minsun Kang, Jae Bum Park, Inchul Jeong, Jaehyuk Jung; Ann Occup Environ Med 2026;e26. Published online July 9, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e26 [Accepted]

Abstract PDF Supplementary Material: Background
Prediabetes and diabetes represent major public health challenges, and shift work has been identified as a significant occupational risk factor. While two-shift systems are gaining preference over conventional three-shift systems, evidence comparing their risks for diabetes and prediabetes remains limited. We aimed to evaluate the risk of developing prediabetes and diabetes according to shift work patterns among night shift workers. Methods: This retrospective cohort study analyzed 14,879 night shift workers at a tertiary hospital in Korea (2016–2022). Participants were classified into two- and three-shift patterns. Incident diabetes and prediabetes were identified based on fasting blood glucose and hemoglobin A1c levels, diagnosis, or medication use. Data were censored at shift change, diagnosis, loss to follow-up, or the end of the study. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for demographics, lifestyle, body mass index, and occupational characteristics including working hours, consecutive night shifts, quick returns, and shift duration. Results: The two-shift group showed significantly higher incidence rates of diabetes and prediabetes than the three-shift group. After adjusting for covariates, two-shift work remained an independent risk factor for diabetes (adjusted HR: 1.43; 95% CI: 1.10–1.87) and prediabetes (adjusted HR: 1.34; 95% CI: 1.20–1.48). Stratified analyses indicated that the increased risk of diabetes associated with two-shift work was prominent in participants working 40 hours and 41–51 hours per week, whereas the association was not significant in those working ≥52 hours. Conclusions: Two-shift work was associated with a significantly higher risk of diabetes and prediabetes compared with three-shift work. Our findings highlight the need to consider specific shift schedules and their potential health effects when designing or selecting workforce systems, rather than focusing solely on productivity or preference.

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Case Report

Basal cell carcinoma and squamous cell carcinoma of the hands in an orthopedic surgeon with occupational radiation exposure from C-arm fluoroscopy in Korea: a case report: Jisue Yoon, Jihye Lee, Seongjin Jeong, Sangchul Roh, Min-Gi Kim, Jeongbae Rhie; Ann Occup Environ Med 2026;e25. Published online July 7, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e25 [Accepted]

Abstract PDF Supplementary Material: Background
Occupational radiation exposure among medical professionals who use fluoroscopic devices is a well-recognized concern. While radiation-induced skin cancer has been reported in interventional radiologists, cases involving orthopedic surgeons with prolonged C-arm fluoroscopy exposure have rarely been described. We present a case of an orthopedic surgeon who developed basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) on the hands after approximately 30 years of occupational radiation exposure from C-arm use during orthopedic surgeries in Korea.
Case presentation
A 62-year-old male orthopedic surgeon who performed C-arm fluoroscopy-assisted surgeries for 30 years without radiation-protective gloves presented with bleeding and skin lesions on his left hand. Hospital records documented an average of 314 C-arm-assisted surgeries per year with an estimated annual C-arm usage of 12,397 minutes. An on-site radiation assessment was conducted in the actual operating room using a simulated patient, with positioning replicated via structured interview. Measurements using an X/gamma survey meter at the surgeon's hand position yielded mean equivalent dose rate of 3.5 mSv/h and a maximum of 5.0 mSv/h, corresponding to estimated annual equivalent doses of 723 and 1,033 mSv/y, both exceeding the regulatory equivalent dose limit for extremities in Korea. The patient had experienced recurrent blistering on both hands for approximately 10 years. Biopsy revealed BCC on the left thumb and SCC on the left second and third fingers, with bilateral chronic radiation dermatitis. Excision and skin grafting were performed on the affected fingers.
Conclusions
This case demonstrates that prolonged C-arm fluoroscopy exposure without adequate hand protection can lead to radiation-induced skin cancers in orthopedic surgeons. The marked discrepancy between trunk-mounted dosimeter readings and estimated hand doses underscores the need for extremity-specific dosimetry. Radiation-protective gloves and regular dermatologic surveillance are essential for medical professionals exposed to ionizing radiation during fluoroscopy-guided procedures.

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Case Report

Recurrent laryngeal leukoplakia in a cook occupationally exposed to cooking oil fumes: a case report: Kyung-Eun Lee, Seong Won Ma, Jiwoon Kwon, Young Shin Lee, Shinhee Ye; Ann Occup Environ Med 2026;38:e24. Published online July 1, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e24

Abstract PDF: Background
This study reports a case of recurrent laryngeal leukoplakia, a precancerous lesion, in a female cook with long-term occupational exposure to cooking oil fumes. In 2022, the Korean Epidemiological Investigation and Evaluation Committee determined that substantial scientific evidence supported the work-relatedness of the case.
Case presentation
A 55-year-old woman working as a cook in group-catering facilities in long-term care hospitals and general hospitals was referred to an otolaryngology clinic after an abnormal laryngeal finding was incidentally detected during routine upper gastrointestinal endoscopy in April 2018. Subsequent laryngoscopy revealed granulation tissue of the left vocal fold. Histopathological examination following laryngeal microsurgery confirmed high-grade dysplasia, leading to a diagnosis of left vocal fold leukoplakia, and the lesion was excised. During follow-up, persistent voice changes and recurrence of the lesion were identified, and repeat excision again demonstrated low- and high-grade dysplasia. The patient had worked as a cook for approximately 14.6 years and routinely performed oil-intensive cooking tasks, including frying, grilling, stir-frying, and battered-dish preparation, for approximately 2–4.5 hours per day. She reported insufficient ventilation during heavy fume generation. She had no history of smoking, passive smoking from her spouse, alcohol consumption, vocal abuse, gastroesophageal reflux disease, or mechanical trauma to the larynx.
Conclusions
This case suggests a possible occupational contribution of repeated intermittent exposure to cooking oil fumes and irritant aldehydes to recurrent laryngeal precancerous lesions among cooks. However, because direct historical exposure measurements were unavailable and this is a single case report, definitive causality cannot be established. Improvement of workplace ventilation and other exposure-control measures should be considered, and further studies with direct exposure assessment are needed.

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Original Article

Current status and demand projections for occupational and environmental medicine specialists: focus on special health examinations and outsourced occupational health management services: Hye-Eun Lee, Hee-Tae Kang, Mo-Yeol Kang, Chungwon Kang, Kyong Sok Shin, Hyeon-Taek Heo, Yong Lim Won, Jungwon Kim; Ann Occup Environ Med 2026;38:e23. Published online July 1, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e23

Abstract Abstract in Korean PDF Supplementary Material: Background
Occupational and environmental medicine (OEM) specialists are key personnel within the occupational health system. Recent developments, such as the introduction of the Serious Accidents Punishment Act and the expansion of occupational health policies targeting vulnerable workers, have highlighted the need to broaden the role of OEM specialists. This study analyzed the current workload of OEM specialists and projected their medium- to long-term demand.
Methods
The demand for OEM specialists was defined as the actual observed service utilization volume under the current legal, institutional, and policy environment. Key work areas were categorized as special health examinations and outsourced occupational health management services. Data sources included administrative records from the Korea Occupational Safety and Health Agency (KOSHA) and the Ministry of Employment and Labor (MoEL), statistics on worker health examination results, and evaluation data from specialized agencies for occupational health management. Demand through 2035 was projected by applying the observed historical growth trend in service utilization. The required number of specialists was calculated by applying the average workload per specialist in the base year.
Results
As of 2025, 577 OEM specialists were working at 255 special health examination institutions. Among the 153 occupational health management agencies, 265 physicians were employed, including 133 OEM specialists. The number of workers requiring services from OEM specialists is predicted to continue growing. Applying the current average workload per physician, an additional 132 special health examination physicians and 92 occupational health management agency physicians will be needed by 2035.
Conclusions
Actual workforce demand may differ from the projections presented in this study depending on changes in policies, industrial structure, service delivery models, and work efficiency. Future studies should incorporate need-based estimates that reflect the diverse roles of OEM specialists and use integrated workforce data to provide more refined projections.; 한국의 직업환경의학과 전문의 현황과 수요 추계 – 특수건강진단과 보건관리위탁을 중심으로
연구 배경: 직업환경의학과 전문의는 산업보건 체계에서 핵심적인 역할을 수행하는 인력으로, 그 수요와 역할은 산업안전보건 관련 법·제도와 정책 환경에 의해 크게 영향을 받는다. 최근 중대재해처벌법 도입과 취약노동자 대상 산업보건정책 확대에 따라 직업환경의학과 전문의의 역할 확장 필요성이 제기되고 있다. 본 연구는 직업환경의학과 전문의의 업무 현황을 분석하고 중장기 수요를 추계하고자 하였다.
연구 방법: 직업환경의학과 전문의 수요를 현행 법·제도 하에서 실제 관찰되는 서비스 이용량에 기반한 요구(demand)로 정의하였다. 주요 업무 영역을 특수건강진단과 보건관리전문기관 위탁업무로 구분하고, 산업안전보건공단 및 고용노동부 행정자료, 근로자건강진단 통계, 보건관리전문기관 평가자료 등을 활용하였다. 과거 서비스 이용량 증가 추세를 적용하여 특수건강진단과 보건관리위탁의2035년까지의 수요를 추계하고, 기준 연도의 전문의 1인당 평균 업무량을 적용하여 필요 인력을 산출하였다.
연구 결과: 2025년 기준 특수건강진단기관 255개소에 직업환경의학과 전문의 577명이 근무하고 있었으며, 보건관리전문기관 153개소에는 의사 265명이 근무하고 있었고 이 중 133명이 직업환경의학과 전문의였다. 수요 추계 결과, 현재의 전문의 1인당 평균 업무량을 적용할 경우 2035년에는 특수건강진단 분야에서 132명, 보건관리전문기관 분야에서 92명의 추가 인력이 필요한 것으로 추계되었다.
결론
정책의 변화, 산업 구조 변화, 서비스 제공 방식 및 업무 효율성의 변화에 따라 실제 인력 수요는 본 연구의 추계와 달라질 수 있다. 향후에는 다양한 역할을 포함한 필요 기반 추계와 통합적인 인력 데이터 구축을 바탕으로 보다 정교한 수요 예측 연구가 필요하다.

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Original Article

Occupational determinants of national health screening participation: an analysis of the Korea National Health and Nutrition Examination Survey (KNHANES), 2007–2023: Chan Young Lee, Jun-Pyo Myong, Mo-Yeol Kang; Ann Occup Environ Med 2026;38:e22. Published online June 24, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e22

Abstract Abstract in Korean PDF Supplementary Material: Background
South Korea operates a national health screening program aimed at early detection of major diseases. Although participation rates have been linked to various socioeconomic and demographic factors, occupational determinants remain insufficiently characterized.
Methods
This study analyzed 37,987 employed wage earners from the Korea National Health and Nutrition Examination Survey conducted between 2007 and 2023. The primary outcome was self-reported health screening program participation within the preceding two years. Occupational characteristics—including classification of occupations, employment status, working hours, work arrangement, and supervisory role—as well as workplace conditions and hazard exposures were examined. Prevalence ratios (PRs) with 95% confidence intervals were calculated for each characteristic. Generalized additive models were used to examine the nonlinear association between weekly working hours and participation rates. Multivariable modified Poisson regression models incorporating interaction terms between occupational characteristics and survey year assessed temporal trends in participation disparities.
Results
The overall health examination rate was 71.32%. Compared with managers, all other occupational categories—except armed forces—had significantly lower PRs of participation, with sales workers showing the lowest. Temporary, daily, non-regular, and part-time workers showed significantly lower PRs. Those working less than 35 or more than 52 hours per week showed significantly lower PRs than the reference group (35–52 hours). An inverted U-shaped association was observed, with participation peaking at approximately 40–50 hours per week. Among workplace conditions, decision-making authority, working under time pressure, and physical hazard exposure were associated with higher participation, whereas prolonged uncomfortable postures and heavy material handling were associated with lower participation. Over the 17-year study period, the adjusted PRs for working hours showed no significant temporal change.
Conclusions
Significant occupational disparities in health screening participation exist among Korean wage earners. Targeted interventions addressing vulnerable occupational groups are warranted to reduce disparities and improve overall worker health outcomes.; 건강검진 참여의 직업적 결정요인: 국민건강영양조사(2007–2023) 분석
목적
한국은 암, 심혈관 질환 등 주요 질병의 조기 발견을 목적으로 국가건강검진 프로그램을 운영하고 있다. 검진 참여율은 다양한 사회경제적·인구학적 요인과 관련이 있는 것으로 알려져 있으나, 직업적 결정요인에 대한 규명은 아직 충분하지 않다.
방법
2007년부터 2023년까지 실시된 한국의 국민건강영양조사(KNHANES) 자료의 임금근로자 37,987명을 대상으로 분석하였다. 주요 결과변수는 최근 2년 이내 건강검진 참여 여부(자가 보고)로 설정하였다. 직종 분류, 고용 형태, 근로 시간, 근무 형태, 관리자 여부 등 직업적 요인과 작업장 환경 및 유해요인 노출을 독립변수로 분석하였다. 각 요인별 비보정 유병률비와 95% 신뢰구간을 산출하였으며, 추가적으로, 주당 평균 근로시간과 일반건강검진 참여률 간의 연관성을 시각화하기 위해 일반화 가법 모델을 사용한 비모수 분석을 수행하였고, 직업적 요인과 조사연도 간 상호작용항을 포함한 다변량 수정된 포아송 회귀분석을 통해 참여 격차의 시간적 추세를 평가하였다.
결과
전체 건강검진 참여율은 71.32%였다. 관리자 직군은 군인을 제외한 모든 직종보다 유병률비가 유의하게 높았고 가장 낮은 직군은 판매 종사자였다. 임시직, 일용직, 비정규직 및 시간제 근로자의 참여율은 해당 요인의 비교군보다 유의하게 낮았다. 주당 평균 근로시간에 따른 비교에서, 35시간 미만 또는 52시간 초과 근무군 모두 대조군(35~52시간)에 비해 유의하게 낮은 유병률비를 나타냈다. 주당 근로 시간과 참여율 사이에는 역U자형 관계가 관찰되었으며, 주 40~50시간 근무 시 참여율이 가장 높았다. 작업장 환경 요인 중 의사결정 권한, 시간 압박 하 근무, 물리적 유해요인 노출은 높은 참여율과 관련이 있었던 반면, 장시간 불편한 자세, 중량물 취급은 낮은 참여율과 관련이 있었다. 17년의 조사 기간 동안, 근로시간에 대한 보정된 유병률비는 유의한 변화를 보이지 않았다.
결론
한국의 임금근로자 사이에는 건강검진 참여의 직업적 요인에 따른 유의한 격차가 존재한다. 이러한 격차를 줄이고 근로자의 전반적인 건강 결과를 개선하기 위해 취약한 직업군을 대상으로 한 맞춤형 개입이 필요하다.

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Original Article

Construction of a musculoskeletal job-exposure matrix in Korea: Myong-Hwan Kim, Eun-Soo Lee, Dongmug Kang, Ki-Hun Kim, Youngki Kim; Ann Occup Environ Med 2026;38:e21. Published online June 18, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e21

Abstract Abstract in Korean PDF Supplementary Material: Background
Musculoskeletal disorders (MSDs) are a major occupational health issue in Korea; however, a standardized job-exposure matrix (JEM) has not been established. This study aimed to develop an MSD-specific JEM using data from the Korean Working Conditions Survey (KWCS) to evaluate the exposure time proportion by job category and body segment.
Methods
Data from the 2nd to 6th KWCS (2006–2020), covering 210,500 workers, were analyzed. The jobs of the subjects were reclassified based on the unit groups of the 7th Korean Standard Classification of Occupations. Exposure time proportion for key MSD risk factors—repetitive movements, awkward postures, heavy lifting, and prolonged standing—was categorized as high, moderate, or low based on self-reported responses. Validity was assessed through expert review and statistical analysis, including Cohen’s kappa coefficients and logistic regression.
Results
Duration-based exposure to musculoskeletal (MS) risk factors was estimated for each occupation. The JEM classified exposure time proportion for three body regions: upper extremity and neck, lower back, and lower extremity. Expert review showed high agreement for the upper extremity and neck and for the lower back (kappa > 0.8), whereas agreement was lower for the lower extremity. Logistic regression analysis indicated an exposure–response relationship between JEM-derived exposure time proportion and MS symptoms for the upper extremity and neck and the lower back.
Conclusions
This study developed Korea’s first MS-specific JEM, providing a standardized framework for occupational MSD risk assessment. The JEM demonstrated strong validity for most body regions and can be a valuable tool for research, workplace risk evaluation, and policy development. Further refinements incorporating detailed job classifications and ergonomic factors are recommended to enhance its applicability.; 한국형 근골격계 질환 위험 평가를 위한 직무-노출 매트릭스(Job-Exposure Matrix, JEM) 구축
배경
근골격계 질환(Musculoskeletal disorders, MSDs)은 한국 내 주요 직업적 건강 문제임에도 불구하고, 표준화된 직무-노출 매트릭스(Job-Exposure Matrix, JEM)는 아직 구축되어 있지 않다. 본 연구는 한국근로환경조사(Korean Working Conditions Survey, KWCS) 데이터를 활용하여 직종 및 신체 부위별 노출 시간 비율을 평가할 수 있는 근골격계 질환 특화 JEM을 개발하는 것을 목적으로 한다.
방법
제2차에서 제6차 한국근로환경조사(2006–2020년) 데이터를 분석하였으며, 총 210,500명의 근로자가 포함되었다. 대상자의 직종은 제7차 한국표준직업분류(Korean Standard Classification of Occupations, KSCO) 단위 그룹을 기준으로 재분류되었다. 반복적인 동작, 부자연스러운 자세, 중량물 들기, 장시간 서 있기 등 주요 근골격계 위험 요인에 대한 노출 시간 비율을 근로자의 자기보고식 응답을 바탕으로 '높음', '보통', '낮음'으로 범주화하였다. 연구의 타당도는 전문가 검토와 Cohen's kappa 계수 및 로지스틱 회귀분석을 포함한 통계적 검증을 통해 평가되었다.
결과
각 직업군에 대한 기간 기반의 근골격계 위험 요인 노출 정도가 추정되었다. 개발된 JEM은 상지 및 목, 요추부, 하지 등 세 가지 신체 부위에 대한 노출 시간 비율을 분류하였다. 전문가 검토 결과, 상지 및 목과 요추부에 대해서는 높은 일치도(kappa > 0.8)를 보였으나, 하지에 대해서는 상대적으로 낮은 일치도를 나타냈다. 로지스틱 회귀분석 결과, JEM을 통해 도출된 노출 시간 비율과 상지 및 목, 그리고 요추부의 근골격계 증상 사이에서 유의미한 노출-반응 관계(exposure-response relationship)가 확인되었다.
결론
본 연구는 국내 최초로 근골격계 질환 특화 JEM을 개발하여 직업적 MSD 위험 평가를 위한 표준화된 틀을 마련하였다. 해당 JEM은 대부분의 신체 부위에 대해 높은 타당성을 입증하였으며, 향후 연구, 작업장 위험 평가, 정책 개발을 위한 유용한 도구로 활용될 수 있을 것이다. 보다 정밀한 직무 분류와 인체공학적 요인을 반영한 후속 연구를 통해 적용성을 더욱 개선할 것을 제언한다.

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Review

Reframing welders’ parkinsonism: from the “idiopathic” label to biological causation and legal recognition: Chul Gab Lee; Ann Occup Environ Med 2026;38:e20. Published online June 17, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e20

Abstract Abstract in Korean PDF Supplementary Material: In Korea, welders diagnosed with “idiopathic Parkinson's disease (iPD)” often face denial of workers’ compensation, as “idiopathic” is interpreted as excluding occupational contribution. This narrative review examines whether a categorical distinction between iPD and “toxic parkinsonism” is defensible on diagnostic, pathological, neuroimaging, epidemiological, causal-inference, and legal grounds. The 2024 NSD-ISS (Neuronal α-synuclein disease Integrated Staging System) and SynNeurGe (Synuclein-Neurodegeneration-Gene) frameworks challenge categorical use of the “idiopathic” label by defining Parkinson's disease (PD)–related disease biologically, irrespective of etiology. Nonhuman primate studies show that chronic low-dose manganese exposure can produce nigrostriatal deficits and α-synuclein aggregation overlapping with PD biology. Dichotomous use of FP-CIT dopamine transporter imaging or levodopa responsiveness to separate manganese poisoning from iPD is therefore scientifically unsound, as chronic welding exposure can induce presynaptic dysfunction and treatment responses indistinguishable from PD. Epidemiological findings diverge methodologically: direct clinical examination has reported elevated parkinsonism prevalence among welders, whereas administrative cohorts have generally found no increased PD risk. This divergence is plausibly explained by differences in case ascertainment, exposure assessment, healthy-worker-survivor selection, and disease latency. Bradford Hill and Rothman frameworks support a causal interpretation, although validated biomarkers and dose-response thresholds remain undefined. Under Korea’s Industrial Accident Compensation Insurance Act, causation is evaluated as a “proximate causal relationship” rather than strict scientific proof. A multi-hit model integrating genetic predisposition, aging, and cumulative environmental exposure supports recognition under this standard, and compensation eligibility should not depend on whether the diagnosis label is ‘PD’ or ‘parkinsonism.’ When parkinsonian symptoms occur in welders with at least approximately 20,000 exposure-weighted welding hours, or with substantial high-intensity exposure such as confined-space welding, inadequate ventilation, or flux-cored arc welding, occupational contribution should be considered under a weight-of-evidence approach. This criterion is sufficient for recognition but is not a necessary condition.; 용접공 파킨슨증(welder’s parkinsonism)의 재조명: '특발성(idiopathic)' 명명에서 생물학적 인과성과 법적 인정으로 (용접 노출과 파킨슨증의 생물학적 인과관계)
우리나라에서 '특발성 파킨슨병(idiopathic Parkinson's disease, iPD)'으로 진단받은 용접공은 산업재해보상에서 배제되는 경우가 적지 않다. 이는 '특발성(idiopathic)'이라는 용어가 직업적 기여를 배제하는 의미로 해석되기 때문이다. 본 종설(narrative review)에서는 특발성 파킨슨병과 독성 파킨슨증(toxic parkinsonism)을 범주적으로 구분하는 것이 진단학적, 병리학적, 신경영상학적 (neuroimaging), 역학적, 인과추론적(causal inference), 법적 측면에서 타당한지를 검토한다.
2024년 제안된 NSD-ISS와 SynNeurGe 체계는 파킨슨병 관련 질환을 병인과 무관하게 생물학적으로 정의함으로써 ‘특발성’이라는 명칭을 범주적으로 사용하는 관행에 문제를 제기한다. 비인간 영장류(nonhuman primate, NHP) 연구에 따르면, 만성 저용량 망간(manganese) 노출은 흑질선조체(nigrostriatal) 결손과 파킨슨병의 생물학적 특징과 중첩되는 알파-시누클레인(α-synuclein) 응집을 유발할 수 있다. 따라서 FP-CIT 도파민 운반체 영상(FP-CIT DAT imaging)이나 레보도파(levodopa) 반응성을 기준으로 망간 중독과 특발성 파킨슨병을 구분하는 것은 과학적으로 타당하지 않다. 만성 용접 노출은 PD와 구별하기 어려운 시냅스전(presynaptic) 기능장애와 치료 반응을 일으킬 수 있기 때문이다.
역학 연구의 결과는 방법론에 따라 갈린다. 직접적인 임상 진찰을 시행한 연구에서는 용접공의 파킨슨증 유병률이 높게 보고된 반면, 행정자료 기반 코호트(administrative cohort) 연구에서는 대체로 파킨슨병 위험 증가가 확인되지 않았다. 이러한 차이는 파킨슨병 사례 확인(case ascertainment) 방식, 노출 평가, 건강근로자 생존효과(healthy-worker-survivor effect), 질병 잠복기의 차이로 설명할 수 있다. 검증된 생체표지자(biomarker)와 용량-반응 기준 값은 아직 확립되지 않았으나, 힐(Bradford Hill)과 로스만(Rothman)의 인과추론 틀은 인과성과의 양립 가능성을 뒷받침한다.
우리나라 「산업재해보상보험법」에서 인과관계는 엄격한 과학적 증명이 아니라 '상당인과관계(proximate causal relationship)’로 판단한다. 유전적 소인, 노화, 누적 환경 노출을 통합하는 다중타격모형(multi-hit model)은 이 기준에 따른 업무관련성 인정을 뒷받침한다. 진단명이 '파킨슨병'인지 '파킨슨증'인지에 따라 보상 여부가 좌우되어서는 안 된다. 누적 노출가중 용접작업 시간(exposure-weighted welding hours)이 약 20,000시간 이상이거나, 밀폐공간 용접·불충분한 환기, 플럭스코어드 아크용접(flux-cored arc welding)과 같이 고강도 노출이 상당한 용접공에게 파킨슨증 증상이 발생한 경우에는, 증거 종합(weight-of-evidence) 접근에 따라 직업적 기여를 고려하여야 한다. 다만 이 기준은 인정을 위한 충분조건이지 필요조건은 아니다.

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Original Article

Occupational differences in benzene-related biomarker levels beyond traditional industrial settings: findings from the Korean National Environmental Health Survey, 2015–2023: Chul Gab Lee; Ann Occup Environ Med 2026;38:e19. Published online June 15, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e19

Abstract Abstract in Korean PDF Supplementary Material: Background
Benzene is a group 1 carcinogen, and urinary trans,trans-muconic acid is a key biomarker of benzene exposure. Whether specific occupational groups in Korea have higher benzene body burdens beyond environmental levels has not been systematically evaluated using national biomonitoring data with smoking-adjusted biomarkers.
Methods
We pooled adult data from three cycles (3rd–5th) of the Korean National Environmental Health Survey (KoNEHS, 2015–2023; n = 10,786). Creatinine-adjusted urinary trans,trans-muconic acid (UttMACr) was analyzed across nine occupation groups using complex-samples general linear models with nested covariates. Sampling weights were rescaled within each cycle to harmonize weight scales across waves. Smoking was controlled using questionnaire-based variables and five-level creatinine-adjusted urinary cotinine (COTCr). Variance decomposition quantified predictors' contributions, and sensitivity analyses included COTCr-stratified models and analyses limited to the economically active population.
Results
Although population geometric mean UttMACr declined by 51% from the 3rd to 5th cycle, occupation remained a significant independent predictor after adjusting for temporal trends, smoking, demographic, and lifestyle covariates (ΔR² = 0.0018, p = 0.003). Cleaning/guard/elementary workers showed the highest elevation in the geometric mean ratio (GMR: 1.13; p < 0.001), followed by food/textile/other manufacturing (GMR: 1.12; p < 0.05) and chemical/metal/machinery manufacturing workers (GMR: 1.08; p < 0.05). COTCr-stratified analyses revealed occupation-specific patterns attenuated in pooled models: among participants with COTCr ≤ 1.0 μg/g creatinine, construction/mining (GMR: 1.62; p < 0.001) and agriculture/fishery (GMR: 1.41; p < 0.01) showed marked elevations.
Conclusions
Population UttMACr levels in Korea declined over time, but occupation-specific differences persisted after adjustment for trends, smoking, and sociodemographic factors. These findings suggest occupational benzene exposures may extend beyond traditionally recognized industrial settings and support more targeted biomonitoring, particularly for worker groups not routinely prioritized in current surveillance programs.; 전통적 산업 환경을 넘어선 직업군 간 벤젠 관련 생체 지표 수준의 차이: 국민환경보건기초조사 (2015–2023) 분석 결과
배경
벤젠은 IARC 1 군 발암물질이며, 소변 trans, trans-뮤콘산(UttMA)은 벤젠 노출의 핵심 생체 지표이다. 한국 일부 직업군에서 일반 환경 노출 수준을 넘어선 높은 체내 벤젠 부담이 존재하는지 흡연 보정 생체 지표를 이용한 전국 단위 분석으로 체계적으로 평가된 바 없다.
방법
국민환경보건기초조사(KoNEHS) 3–5 기(2015–2023) 성인 자료를 통합하였다(N = 10,786). 크레아티닌 보정 소변 ttMA (UttMACr)를 9 개 직업군에 걸쳐 복합표본 일반선형모형으로 분석하였으며, 흡연은 설문 기반 변수 및 5 단계 크레아티닌 보정 소변 코티닌(COTCr)으로 보정하였다. 분산분해를 통해 각 예측변수의 기여도를 정량화하였고, COTCr 층화 분석 및 경제활동 인구(economically active population)만을 한정하여 민감도 분석을 하였다.
결과
인구집단 UttMACr 의 기하평균(GM)은 3 기에서 5 기 사이에 51% 감소하였으며, 시간 추이, 흡연, 인구통계학적 변수 및 생활습관 공변량을 보정 후에도 직업군은 유의한 독립 예측변수로 유지되었다(ΔR² = 0.0018, p = 0.003). 청소·경비·단순노무직에서 기하평균비(GMR)가 가장 높았고(GMR = 1.13, p<0.001), 음식·섬유·기타 제조업(GMR = 1.12, p<0.05), 화학·금속·기계 제조업(GMR = 1.08, p<0.05)이 뒤를 이었다. COTCr 층화 분석에서는 통합 모형에서 명확하지 않던 직업별 패턴이 드러났다: COTCr ≤ 1.0 μg/g creatinine 군에서 건설/광업(GMR = 1.62, p<0.001) 및 농림어업(GMR = 1.41, p<0.01)이 뚜렷한 상승을 보였다.
결론
시간에 따라 UttMACr 는 뚜렷이 감소하였으나, 흡연, 시간 추이, 인구통계학적 요인 보정 후에도 직업군 간 차이는 지속되었다. 이 결과는 직업적 벤젠 노출이 전통적으로 인지된 산업 환경을 넘어 존재할 가능성을 시사하며, 현행 감시 프로그램에서 우선순위에 포함되지 않는 노동자 집단에 대한 보다 표적화 된 생체 모니터링의 필요성을 뒷받침한다.

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Original Article

Occupational health risk assessment, exposure monitoring, and medical surveillance in the UK, EU, and US: a comparative analysis and implications for occupational disease prevention in Korea: Sangjun Choi, Kyong-Hui Lee, Kyung Ehi Zoh, Dong-Hee Koh, Won Kim, Kwonchul Ha, Dong-Uk Park; Ann Occup Environ Med 2026;38:e18. Published online June 15, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e18

Abstract Abstract in Korean PDF: Background
Although most countries maintain occupational safety and health (OSH) legislation to prevent occupational diseases, the legal codification and integration of occupational health risk assessment (HRA), exposure monitoring, and medical surveillance vary substantially across jurisdictions; therefore, this study compared the legal frameworks of Korea, the United Kingdom (UK), the European Union (EU), and the United States (US) to examine the linkage among these elements, assess whether they support estimation of individual cumulative past exposure, and derive implications for improving occupational disease prevention in Korea.
Methods
This qualitative comparative legal analysis examined employer obligations related to quantitative exposure monitoring, HRA, and medical surveillance under the OSH systems of the UK, the EU, the US, and Korea. Primary statutes and subordinate regulations were systematically reviewed to assess how these elements are mandated, linked, and supported by record-keeping provisions enabling cumulative exposure estimation.
Results
The UK and the EU explicitly require HRA as a regulatory starting point and link exposure monitoring and medical surveillance to the outcomes of risk assessment, with targeted hazard-based provisions for intrinsically high-risk agents. The US adopts a hybrid approach, imposing mandatory monitoring and medical surveillance for high-hazard substances under 29 Code of Federal Regulations 1910 Subpart Z while relying on general statutory duties elsewhere. Korea applies broad list-based requirements for exposure monitoring and medical surveillance that are largely independent of HRA outcomes and do not include legally mandated variables necessary for systematic cumulative exposure estimation. In contrast, the UK, the EU, and partially the US provide legal mechanisms, including long-term record-keeping provisions, that enable reconstruction of individual cumulative occupational exposure.
Conclusions
Strengthening the integration of HRA, exposure monitoring, and medical surveillance—together with improved record-keeping structures that support cumulative exposure reconstruction—may contribute to more effective occupational disease prevention and long-term medical surveillance in Korea.; 영국·EU·미국의 질병 위험성평가, 작업환경측정, 질병감시 제도 비교를 통한 한국 직업병 감시제도에 대한 시사점
배경
대부분 국가는 근로자 직업병 예방을 위해 산업안전보건법을 운영하고 있다. 이 중 근로자 질병 위험성평가(위험성평가), 정량적 노출평가(작업환경측정 등), 질병감시제도의 내용과 연계 구조는 다르다.
방법
본 연구는 영국, EU, 미국, 한국의 산업안전보건법 중 노출평가, 위험성평가, 질병감시제도에 대한 의무 내용을 비교하고 고찰했다. 질병 위험 지표인 근로자 개인 과거 누적 노출 추정이 가능한지 기록내용도 포함했다.
결과
영국과 EU는 위험성평가를 질병 감시체계의 출발점으로 명시하고 이를 근거로 정량적 측정과 질병 감시를 연계하고, 일부 고 독성 유해인자(암과 변이원성 물질)에 대해서는 제한적인 유해성 기반 측정과 검진 의무 규정을 두고 있다. 미국은 29 CFR 1910 Subpart Z에 따라 약 30여가지 고 독성 물질에 대해 노출측정과 건강감시를 의무화하고, 그 외 유해인자는 일반적 법적 의무에 기반한 혼합형 제도를 운영한다. 모두 근로자 개인 누적 노출 수준 추정이 가능하도록 노출변수 등이 기록은 물론 보존기한이 30년 이상으로 의무화되어 있다. 반면 한국은 유해성 중심 인자 목록(약 190여 종)을 대상으로 따라 노출과 상관없이 작업환경측정과 질병감시(특수건강검진)를 의무화하고 위험성평가 등 제도와의 연계가 제한적이다. 또한 개인 누적 노출을 추정하기 위한 항목(근무기간별 직무변화, 노출강도 등) 기록 의무도 없다.
결론
한국은 근로자 개인 누적 노출에 기반한 질병 위험을 평가하는 위험성평가, 작업환경측정, 특수건강검진 제도가 서로 연계되어 직업병 감시체계를 강화하는 제도 개선이 필요하다.

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Case Report

Reactive airways dysfunction syndrome following acute lithium hydroxide dust exposure at a battery material production plant: a case series of 16 workers: Chul Gab Lee, Soo Hyeong Park, Jeong Joon Park, Han Soo Song, Hyeon Kyeong Ko, Sung Ho Yoon; Ann Occup Environ Med 2026;38:e17. Published online June 4, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e17

Abstract Abstract in Korean PDF: Background
Reactive airways dysfunction syndrome (RADS) is an acute-onset form of irritant-induced asthma that occurs after a single high-concentration exposure to irritants. Although RADS has been documented for chlorine, ammonia, and acid fumes, no published case series has attributed RADS to lithium hydroxide (LiOH) dust inhalation. We report the clinical features, diagnostic evaluation, and longitudinal management of 16 workers with persistent respiratory symptoms following acute occupational LiOH exposure at a battery cathode material production facility.
Case presentation
In March 2024, a silicone connector failure resulted in the leakage of approximately 50–100 kg of LiOH powder at a facility in Korea, exposing over 500 workers. Sixteen workers (15 men, 1 woman; mean age 53.4 years) with persistent respiratory symptoms were evaluated at the Department of Occupational and Environmental Medicine. Most patients presented with cough and sputum production; 56.3% (9/16) exhibited nocturnal or early-morning exacerbation. Methacholine challenge testing was performed in 10 patients, with positive results in three patients (PC20 [provocative concentration causing a 20% decline in forced expiratory volume in 1 second]: 1.36–6.74 mg/mL). By the Brooks 1985 criteria, one case was classified as definite RADS, four as probable, six as possible, and five as unlikely; American College of Chest Physicians 2008 cross-validation yielded identical classifications. Workers' compensation recipients had significantly longer follow-up (18–23 months) compared to non-recipients (1–3 months). Pharmacological management was symptom-directed, combining leukotriene receptor antagonists, mucolytics, antihistamines, and acid-suppressive therapy.
Conclusions
Acute high-concentration LiOH dust inhalation may induce RADS characterized by persistent respiratory symptoms and bronchial hyperresponsiveness. The extreme alkalinity, high water solubility, and exothermic dissolution of LiOH provide a plausible mechanistic framework for airway injury. Clinicians should consider RADS in workers presenting with persistent respiratory symptoms after alkaline dust exposure, even when routine investigations are unremarkable. Attention should also be given to the psychological burden associated with prolonged, poorly recognized symptoms.; 배터리 소재 생산 공장에서 수산화리튬 분진에 급성 노출된 후 발생한 반응성 기도 기능장애증후군(RADS): 16명 사례
배경
(Background): 반응성 기도 기능장애 증후군(reactive airways dysfunction syndrome, RADS)은 자극 물질에 단 한 번 고농도로 노출된 직후 급성으로 발현하는 자극유발천식(irritant-induced asthma, IIA)의 한 형태이다. 염소(chlorine)나 암모니아(ammonia), 산성 증기에 의한 RADS는 이미 보고되어 왔으나, 수산화리튬(lithium hydroxide, LiOH) 분진 흡입에 의한 RADS 사례는 현재까지 보고된 적이 없다. 본 연구에서는 배터리 양극재 생산시설에서 LiOH에 직업적으로 급성 노출된 후 호흡기 증상이 지속된 16명 노동자의 임상 양상, 진단 평가, 그리고 장기 관리 경과를 보고한다.
증례
(Case Presentation): 2024년 3월, 국내 한 시설에서 실리콘 커넥터의 파손으로 인해 약 50–100 kg의 LiOH 분말이 누출되어 500명 이상의 노동자가 노출되었다. 이 가운데 호흡기 증상이 지속된 16명(남자 15명, 여자 1명; 평균 연령 53.4세)이 직업환경의학(OEMD)에서 치료받았다. 대부분의 환자에서 기침과 객담 증상이 확인되었고, 56.3%(9/16명)에서 야간 또는 새벽 시간대 증상 악화가 관찰되었다. 메타콜린기관지유발검사(methacholine challenge test, MCT)는 10명에서 시행되었으며, 이 중 3명이 양성 소견(PC20 1.36–6.74 mg/mL)을 보였다. Brooks의 1985년 진단 기준을 적용했을 때 확정(definite) RADS 1명, 가능성 높음(probable) 4명, 가능성 있음(possible) 6명, 가능성 낮음(unlikely) 5명으로 분류되었고, ACCP(미국흉부내과학회) 2008 기준을 이용한 교차 평가에서도 동일한 분류 결과가 얻어졌다. 산업재해 보상(workers' compensation, WC) 승인을 받은 환자들은 18–23개월 동안 추적 관찰된 반면, 신청하지 않은 환자들은 1–3개월에 그쳐 추적 기간에 뚜렷한 차이를 보였다. 약물치료는 증상 완화를 목표로 류코트리엔 수용체길항제 (leukotriene-receptor antagonist), 거담제(mucolytics), 항히스타민제 (antihistamines), 위산분비 억제제(acid-suppressive therapy)를 병용하는 방식으로 처방되었다.
결론
(Conclusions): 고농도의 LiOH 분진을 급성으로 흡입할 경우 지속적인 호흡기 증상과 기관지 과민성(bronchial hyperresponsiveness)을 특징으로 하는 RADS가 유발될 수 있다. LiOH의 극단적인 알칼리성, 높은 수용성, 그리고 용해 시의 발열 반응은 기도 손상을 설명할 수 있는 병태생리학적 기전을 뒷받침한다. 따라서 임상의는 알칼리성 분진에 노출된 후 지속적인 호흡기 증상을 호소하는 노동자에 대해 통상적인 검사 소견이 정상이더라도 RADS 가능성을 염두에 두어야 한다. 더불어 장기간 지속되면서 충분히 인정받지 못하는 증상으로 인해 발생하는 심리적 부담에도 주의를 기울여야 한다.

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Original Article

Evaluating the efficacy of prednisolone for silicosis with progressive massive fibrosis in Australia: a pre-post quasi-experimental study: Hayley Barnes, David P. Nadebaum, Daniel Niewodowski, J. K. Khoo, Yuan Z. Lim, Bradley J. Gardiner, Tiffany Lin, Martin H. Cherk, Miranda Siemienowicz, Jyotika D. Prasad, Ryan Hoy; Ann Occup Environ Med 2026;38:e16. Published online June 4, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e16

Abstract PDF Supplementary Material: Background
There has been a resurgence of silicosis, particularly related to artificial stone. There are currently no treatments for silicosis beyond lung transplantation for end-stage disease. This study aimed to evaluate the efficacy of prednisolone in people with artificial stone-associated silicosis–progressive massive fibrosis (PMF).
Methods
This was a pre-post quasi-experimental study, assessing 3 months of prednisolone in adults with artificial stone–associated silicosis with PMF. Outcomes were assessed at 3 and 12 months.
Results
Seven participants completed the study. Baseline positron emission tomography (PET) scans demonstrated increased fluorine-18 fluorodeoxyglucose (18F-FDG) uptake in areas of PMF in all participants. All participants had a significant reduction in maximum standardized uptake value (SUVmax) following prednisolone at 3 months (pre-treatment mean SUVmax 6.7 [standard deviation (SD): 2.6], post-treatment mean SUVmax 4.2 [SD: 1.0], p = 0.012). There was also a non-significant reduction in the % of total lung parenchyma with SUV >1 (49.7% [SD: 36.4] to 45.8% [SD: 28.4], p = 0.527) and a significant reduction in SUV >2.5 (7.0% [SD: 6.3] to 2.4% [SD: 2.2], p = 0.038). There was a non-significant reduction in computed tomography ICOERD well-defined opacity profusion scores and large opacities. There was no significant difference in lung function or St. George's Respiratory Questionnaire. There were no serious adverse events.
Conclusions
There are high levels of inflammation in silicosis-PMF as evidenced by 18F-FDG PET. Short-term prednisolone reduced 18F-FDG PET activity. This suggests a possible therapeutic pathway for people with silicosis-associated PMF in a population with no current treatments. Further research is required to determine the most appropriate immunosuppressive strategy and further assess longer-term outcomes.

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Original Article

Relationship between obstructive sleep apnea risk and low back pain among shift workers in a tire manufacturing factory: Sunjin Jung, Seunghyeon Cho, Suwhan Kim, Kyung Wook Kang, JiHwan Kim, Won-Ju Park; Ann Occup Environ Med 2026;38:e15. Published online May 12, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e15

Abstract Abstract in Korean PDF: Background
Low back pain (LBP) is highly prevalent among industrial workers, and obstructive sleep apnea (OSA) has been increasingly recognized as a factor influencing pain modulation. This study evaluated the association between OSA risk, assessed by the STOP-Bang questionnaire, and LBP among shift workers in a tire manufacturing factory.
Methods
A total of 976 male shift workers from a tire manufacturing factory were analyzed. OSA risk was assessed using the STOP-Bang questionnaire and classified as low, moderate, or high. LBP and musculoskeletal pain were defined as self-reported symptoms occurring within the preceding 6 months. Multivariable logistic regression analyses were performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs).
Results
Compared with workers at low OSA risk, those at moderate and high risk had significantly higher odds of LBP (OR: 1.50; 95% CI: 1.02–2.20; p = 0.038; and OR: 1.75; 95% CI: 1.20–2.55; p = 0.004, respectively). Similarly, moderate and high OSA risk were independently associated with increased odds of musculoskeletal pain (OR: 1.86; 95% CI: 1.26–2.73; p = 0.002; and OR: 1.84; 95% CI: 1.26–2.68; p = 0.002, respectively).
Conclusions
Among male shift workers, elevated OSA risk is independently associated with a higher prevalence of LBP and musculoskeletal pain. Systematic workplace screening for OSA risk using the STOP-Bang questionnaire may support occupational health assessments by identifying shift workers with elevated OSA risk who are more likely to report pain-related morbidity.; 타이어 제조공장 교대근무 근로자에서 폐쇄성 수면무호흡증 위험과 요통 및 근골격계 통증 간의 연관성
배경
요통은 산업 근로자 사이에서 흔히 나타나는 증상이며, 폐쇄성 수면무호흡증은 통증 조절에 영향을 미치는 요인으로 알려져 있다. 본 연구는 타이어 제조공장에서 야간교대근무를 수행하는 근로자를 대상으로 수면무호흡증 위험도와 요통 간의 연관성을 평가하고자 하였다.
방법
타이어 제조공장에서 근무하는 남성 생산직 교대근무자 976명을 대상으로 분석을 수행하였다. 폐쇄성 수면무호흡증 위험도는 STOP-Bang 설문지를 이용하여 낮음, 중간, 높음의 세 집단으로 분류하였다. 요통 및 요통 외 근골격계 통증은 최근 6개월 이내 증상의 경험 여부를 기준으로 정의하였다. 다변량 로지스틱 회귀분석을 통해 교차비와 95% 신뢰구간을 산출하였다.
결과
폐쇄성 수면무호흡증 위험도가 중간 또는 높은 군은 낮은 군에 비해 요통 발생 위험이 유의하게 높았다(중간 위험군: OR 1.50, 95% CI: 1.02–2.20, p = 0.038; 고위험군: OR 1.75, 95% CI: 1.20–2.55, p = 0.004). 요통 외 근골격계 통증 역시 중간 및 고위험군에서 유의한 연관성이 관찰되었다(중간 위험군: OR 1.86, 95% CI: 1.26–2.73, p = 0.002; 고위험군: OR 1.84, 95% CI: 1.26–2.68, p = 0.002).
결론
남성 생산직 교대근무자에서 폐쇄성 수면무호흡증 위험도가 높을수록 요통 및 근골격계 통증의 유병률이 독립적으로 증가하는 것으로 나타났다. 직장 내 수면 관련 질환에 대한 체계적인 관리를 통한 교대근무자의 통증 부담을 경감에 관한 추가적인 연구가 필요하다.

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Original Article

Association between relative handgrip strength and glycemic control among male automobile manufacturing workers using vibration tools in South Korea: Dong-Jae Seo, Hyun Joong Kim, Yongjin Kim, Jaewon Mun, Jong-Han Leem, Shin-Goo Park, Dong-Wook Lee, Hwan-Cheol Kim; Ann Occup Environ Med 2026;38:e14. Published online April 8, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e14

Abstract Abstract in Korean PDF Supplementary Material: Background
Although the association between handgrip strength and glycemic control has been reported, studies conducted exclusively within specific occupational groups remain limited. To explore the association between handgrip strength and metabolic health in industrial settings, this study examined the relationship between relative handgrip strength and glycated hemoglobin (HbA1c) among male automobile manufacturing workers using vibration tools in South Korea.
Methods
Using 66,212 occupational health examination records collected at Inha University Hospital between January 2024 and April 2025, a total of 3,365 workers with HbA1c and handgrip strength measurements were identified. After excluding duplicates (n = 1,536), female workers (n = 2), and records without Hb and estimated glomerular filtration rate, 1,823 male participants were included in the final analysis. Relative handgrip strength was calculated as the maximum value of bilateral grip strength divided by body mass index. Multiple linear regression analyses were conducted to assess the association between relative handgrip strength and HbA1c, adjusting for age, smoking status, alcohol consumption, current hypertension, current dyslipidemia, current hypoglycemic-agents use, family diabetes history, leisure-time physical activity, and resistance exercise.
Results
Relative handgrip strength was inversely associated with HbA1c levels (B: –0.060; 95% confidence interval [CI]: −0.081 to −0.039; p < 0.001). The association was strongest among normoglycemic participants (B: −0.185; 95% CI: −0.305 to −0.065; p = 0.003). Effect size was reduced but significantly associated among individuals with prediabetes (B: −0.115; 95% CI: −0.180 to −0.050; p < 0.001) and further attenuated to a borderline significance in individuals with diabetes (B: −0.023; 95% CI: −0.050 to 0.003; p = 0.082). These findings indicate that greater muscle strength relative to body size is related to better glycemic control.
Conclusions
Handgrip strength was associated with HbA1c levels in industrial workers. This study suggests that handgrip strength may provide complementary information on metabolic health in occupational settings.; 상대악력과 당화혈색소 간의 관계: 진동 공구를 사용하는 한국 자동차제조업 남성 근로자를 대상으로한 연구
목적
악력과 혈당조절 간의 관계는 선행연구에서 보고된 바 있으나, 특정직업군 내에서 수행된 연구는 제한적이다. 본 연구는 진동 공구를 사용하는 한국 자동차제조업 남성 근로자를 대상으로 상대악력과 당화혈색소간의 관계를 조사하였으며, 산업환경에서의 악력이 대사건강에 대한 보조적 정보를 제공할 수 있는 지 살펴보고자 하였다.
방법
2024년 1월부터 2025년 4월까지 인하대병원에서 수집된 66,212건의 건강검진기록을 바탕으로, 당화혈색소와 악력측정, 혈색소와 추정사구체여과율(eGFR) 결과가 모두 포함된 1,823명의 남성근로자를 대상으로 하였다. 상대악력은 양손악력 중 최대값을 체질량지수로 나누어 계산하였다. 연령, 혈색소, eGFR, 흡연여부, 음주여부, 고혈압, 고지혈증, 당뇨가족력, 여가시간 유산소운동, 근력운동을 보정한 후 다중선형회귀분석을 수행하여 상대악력과 당화혈색소간의 관계를 평가했다.
결과
상대악력은 당화혈색소 수치와 음의 상관관계를 보였으며 (B= -0.060, 95% CI -0.081 to -0.039 p < 0.001), 이 관계는 정상군에서 가장 강하게 나타났다 (B = -0.185, 95% CI -0.305 to -0.065, p=0.003). 전당뇨군에서는 효과크기는 줄어들었으나, 통계적으로 유의미한 악력 감소(B = -0.115, 95% CI -0.180 to -0.050 p<0.001)를 보였고, 당뇨군에서는 관계성이 낮아졌고, 경계적 유의성을 보였다 (-0.023, 95% CI -0.050 to 0.003, p=0.082). 이 결과는 높은 악력이 좋은 혈당조절과 관련이 있음을 시사한다.
결론
악력은 간단하고 저비용이며 비침습적인 생체지표로, 산업근로자에서 상대악력이 낮을수록 당화혈색소가 높은 경향을 보였다.

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Original Article

Association between heavy metal exposure and high-sensitivity C-reactive protein in the elderly: Korea National Health and Nutrition Examination Survey (KNHANES) 2016–2017: Jongwon Jung, Ji Young Ryu; Ann Occup Environ Med 2026;38:e13. Published online April 6, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e13

Abstract Abstract in Korean PDF

Background
Cardiovascular diseases (CVDs) are a primary cause of mortality in the elderly. Exposure to heavy metals such as lead, cadmium, and mercury has been suggested to increase CVD risk by inducing reactive oxygen species and inflammatory responses. The elderly are particularly susceptible to heavy metal exposure, which may increase their CVD risk. Despite this potential risk, evidence specifically focusing on the association between blood heavy metal levels and high-sensitivity C-reactive protein (hsCRP), a key predictor of CVDs, in the elderly remains limited. Therefore, the present study aimed to assess the relationship between blood lead, mercury, and cadmium concentrations and hsCRP in the elderly.
Methods
We analyzed 884 subjects (385 men, 499 women) aged 65 years and older without CVD history from the Korea National Health and Nutrition Examination Survey (KNHANES) 2016–2017. Because KNHANES is a two-stage stratified clustered sample, all analyses applied stratum, cluster, and weight. Estimated geometric means (GMs) of hsCRP across demographic factors and heavy metal quartiles were compared using a complex samples general linear model (CSGLM). The association between blood heavy metals and hsCRP was examined using CSGLM, adjusting for age, sex, body mass index, estimated glomerular filtration rate, smoking status, alcohol consumption, education, physical activity, monthly income, and underlying diseases.
Results
The estimated GM of hsCRP differed significantly by blood lead quartile (p = 0.035) and showed a significant increasing trend (p for trend = 0.019). In CSGLM analysis, elevated blood lead concentrations were significantly associated with increased hsCRP (β = 0.176, p = 0.032) after adjustment. However, blood mercury and cadmium concentrations showed no significant associations with hsCRP.
Conclusions
The observed association between blood lead concentrations and hsCRP suggests that elevated blood lead may contribute to increased CVD risk in the elderly. Given the susceptibility of this population, subsequent investigations are warranted to confirm this association and develop preventive strategies.

노인 인구집단에서 중금속 노출과 고감도 C-반응성 단백 사이 연관성 평가: 제 7기 국민건강영양조사 (2016-2017)
목적
심혈관계 질환(CVD)은 한국 노인 사망의 주요 원인이며, 인구 고령화에 따라 그 중요성이 더욱 커지고 있다. 납, 수은, 카드뮴과 같은 중금속 노출은 산화 스트레스와 염증 반응을 유발하여 CVD 위험을 높이는 것으로 알려져 있다. 특히 노인은 생리학적 기능 저하로 인해 이러한 환경 유해인자에 더욱 취약하다. 그러나 기존 연구는 주로 일반 성인을 대상으로 이루어졌으며, 특히 노인 인구에서 혈중 중금속 농도와 CVD의 주요 예측 지표인 고감도 C-반응성 단백(hsCRP)의 연관성을 구체적으로 평가한 연구는 부족한 실정이다. 이에 본 연구는 한국 노인을 대상으로 혈중 중금속 농도와 hsCRP의 연관성을 평가하고자 한다.
방법
본 연구는 2016-2017년 제7기 국민건강영양조사(KNHANES) 자료를 이용하였다. 연구 대상자는 심혈관 질환 진단 이력이 없는 만 65세 이상 노인 중, 혈중 중금속 및 hsCRP 데이터가 온전한 884명을 최종 선정하였다. 자료 분석은 복합표본 설계를 반영한 일반선형모형(CSGLM)을 사용하였다. 인구학적 특성 및 중금속 농도 4분위수에 따른 hsCRP 기하평균을 비교하였으며, 연령, 성별, BMI, eGFR, 흡연, 음주, 교육, 소득, 신체 활동 및 기저질환 유무를 보정한 다중 회귀분석을 통해 중금속 농도와 hsCRP 간의 연관성을 분석하였다.
결과
연구 대상자의 인구학적 특성 중 체질량지수(BMI)가 25 kg/m² 이상인 군에서 hsCRP 수치가 유의하게 높았다. 혈중 납 농도를 4분위수로 나누어 분석한 결과, 납 농도가 증가할수록 hsCRP 수치도 유의하게 증가하는 경향을 보였다(p for trend = 0.019). 주요 교란 변수를 모두 보정한 회귀분석 결과, 혈중 납 농도는 hsCRP 농도와 통계적으로 유의한 양의 연관성(β = 0.176, p = 0.032)을 나타냈다. 반면, 혈중 수은과 카드뮴 농도는 보정 후 hsCRP 수치와 통계적으로 유의한 연관성을 보이지 않았다.
결론
본 연구에서 한국 노인 인구에서 혈중 납 농도와 CVD의 위험 예측 인자인 hsCRP 사이 유의한 연관성을 확인하였다. 이는 노화로 인해 환경 독성에 취약한 노인 집단에서, 혈중 납 농도의 증가가 염증 반응을 통해 심혈관 질환 위험을 높이는 잠재적 요인임을 시사한다. 따라서 고령 인구의 심혈관 건강 증진을 위해 지속적인 중금속 노출 모니터링과 예방적 관리 대책이 필요하다.

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Independent and synergistic effects of sedentary lifestyle and obstructive sleep apnea on hyperuricemia: a nationwide cross-sectional study in Korea
Hyewon Lee, Wanhyung Lee, Seung-Yeon Lee
Frontiers in Public Health.2026;[Epub] CrossRef

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Original Article

Occupational Diseases in Mongolia: A Retrospective Analysis (1975–2023) with a 30-Year Trend Study: Sansartsetseg Tsendjav, Myagmarchuluun Sainnyambuu, Otgonbayar Damdinbazar, Ulzii-Orshikh Ragchaabazar, Gantugs Yundendorj; Ann Occup Environ Med 2026;38:e12. Published online March 24, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e12

Abstract PDF Supplementary Material: Background
Occupational diseases represent a significant global public health challenge, yet reliable data from transitioning economies remain limited. This study aimed to analyze newly confirmed occupational disease cases in Mongolia over a 50-year period (1975–2023), identifying long-term trends and the prevalence of leading disease categories.
Methods
A retrospective, record-based study was conducted using quantitative data from 10,233 officially confirmed and compensated cases of occupational diseases resulting in an officially certified loss of labor capacity. Incidence rates per 100,000 workers were calculated for the 1992–2023 period. Leading diseases were classified by organ system, with focused analyses on respiratory diseases, occupational poisonings, and neurological disorders.
Results
Dust- and particulate-induced respiratory diseases accounted for the largest proportion of cases (57.4%), followed by occupational neurological disorders (16.2%) and occupational poisonings (8.0%). From 1992 to 2023, incidence rates among male workers were consistently 3–7 times higher than those among female workers. Analysis of exposure duration showed mean durations of 13.6 ± 4.9 years for silicosis (J62) and 20.7 ± 10.7 years for inorganic substance poisoning (T57). While respiratory diseases were predominant historically, occupational neurological diseases demonstrated an increasing trend after 2015.
Conclusions
Occupational neurological disorders are showing an increasing trend in Mongolia, reflecting a shift in the national occupational disease pattern. However, as the registry is based on the national compensation framework, these findings likely reflect recognized cases rather than the true epidemiological incidence, suggesting potential underreporting. Strengthening surveillance beyond the compensation system and improving diagnostic capacity for a broader range of work-related conditions are essential for effective prevention and policy development.

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Original Article

Risk of sleep disturbance associated with work-related activities during free time in South Korea: a cross-sectional study with mediation analysis: Ohwi Kwon, Hye-Eun Lee, Mo-Yeol Kang; Ann Occup Environ Med 2026;38:e11. Published online March 20, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e11

Abstract Abstract in Korean PDF Supplementary Material: Background
This study aims to investigate the associations between work-related activities during free time, including frequency of working during free time and use of communication devices for work during free time, and sleep disturbance. It further explores the underlying mechanisms through mediation analysis.
Methods
Data were analyzed from 21,473 participants of the seventh Korean Working Conditions Survey (KWCS, 2023). Multivariable logistic regression was employed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for sleep disturbance. Three sequential models were constructed to evaluate the effects of weekly working hours and shift work on sleep disturbance risk. Mediation analysis was conducted to identify pathways linking work-related activities during free time and sleep disturbance.
Results
Those who worked during their free time daily showed significantly higher risk of sleep disturbance (OR: 4.17; 95% CI: 2.64–6.58). Similarly, daily use of communication devices for work during free time was associated with an increased risk (OR: 1.83; 95% CI: 1.57–2.13). These associations remained robust even after adjusting for weekly working hours and shift work. Mediation analysis revealed that "worry about work while at home" was the primary mediator for device use (13.7%; 95% CI: 0.11–0.18), while "feeling too tired for housework after work" was the strongest mediator for working during free time (26.6%; 95% CI: 0.22–0.32).
Conclusions
The results indicate that engaging in work-related activities during free time elevates the risk of sleep disturbance, independent of long working hours or shift patterns. Mediation analysis revealed that the strongest effects were driven by the behavioral and psychological dimensions of work–family conflict. These findings suggest that sleep disturbance arises primarily from the erosion of work–life boundaries, fueled by persistent work-related rumination and the spillover of professional burdens into free time.; 한국의 자유 시간 동안 업무 관련 활동과 관련된 수면 방해 위험: 중재 분석을 통한 횡단면 연구
목적
본 연구는 자유 시간 동안의 업무 빈도와 업무를 위한 통신 기기 사용을 포함한 자유 시간 동안의 업무 관련 활동과 수면 방해 간의 연관성을 조사하는 것을 목표로 한다. 또한 중재 분석을 통해 그 근본적인 메커니즘을 탐구한다.
방법
제7회 한국 근로조건조사(KWCS, 2023)에 참여한 21,473명의 데이터를 분석했다. 다변량 로지스틱 회귀분석을 사용하여 수면 방해에 대한 오즈비(OR)와 95% 신뢰구간(CI)을 계산했다. 주당 근무 시간과 교대 근무가 수면 방해 위험에 미치는 영향을 평가하기 위해 세 가지 순차적 모델을 구축했다. 자유 시간과 수면 방해를 연결하는 업무 관련 활동 경로를 파악하기 위해 중재 분석을 실시했다.
결과
매일 자유 시간에 근무한 사람들은 수면 방해의 위험이 현저히 높은 것으로 나타났다(OR: 4.17, 95% CI: 2.64–6.58). 마찬가지로, 자유 시간에 업무를 위해 통신 기기를 매일 사용하는 것은 위험 증가와 관련이 있었다(OR: 1.83, 95% CI: 1.57–2.13). 이러한 연관성은 주당 근무 시간과 교대 근무를 조정한 후에도 여전히 견고했다. 중재 분석 결과, "집에서 일하는 동안 업무에 대한 걱정"이 기기 사용의 주요 매개체인 반면(13.7%, 95% CI: 0.105–0.180), "퇴근 후 집안일에 너무 피곤함"이 자유 시간에 근무하는 가장 강력한 매개체인 것으로 나타났다(26.6%, 95% CI: 0.222–0.320).
결론
연구 결과에 따르면 자유 시간에 업무 관련 활동에 참여하면 장시간 근무나 교대 근무 패턴과 무관하게 수면 방해 위험이 높아지는 것으로 나타났다. 중재 분석 결과, 업무-가정 갈등의 행동적, 심리적 측면이 가장 큰 영향을 미치는 것으로 나타났다. 이러한 연구 결과는 수면 방해가 주로 일과 삶의 경계가 침식되어 발생하며, 이는 지속적인 업무 관련 반추와 직업적 부담이 자유 시간으로 전이되는 데서 비롯된다는 것을 시사한다.

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Review

Factors associated with work-related musculoskeletal disorders using machine learning approaches: a systematic review: Muhammad Irfan Mohd Sallehhudin, Siti Munira Yasin, Mohamad Rodi Isa, Tajul Rosli Razak, Muhamad Syazni Mohamad Asraff, Nur Adilla Che Rameli, Muhammad Muaz Shahriman-Teruna, Muhammad Muzzammil Mohamad Salleh, Mohamad Zuhair Mohamed Yusoff, Muhammad Hariz Ammar Khebir; Ann Occup Environ Med 2026;38:e10. Published online March 19, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e10

Abstract PDF Supplementary Material: Background
Work-related musculoskeletal disorders (WRMSDs) remain a major cause of occupational disability and productivity loss worldwide. Traditional statistical methods have identified numerous associated factors; however, they often struggle to capture complex non-linear relationships and interactions across multiple domains of risk. Machine learning (ML) offers an alternative analytical approach for modelling such multidimensional relationships.
Methods
Following the PRISMA 2020 guidelines (PROSPERO: CRD420250605234), literature searches were conducted in Web of Science, Scopus, and PubMed for studies published between 2020 and 2025. Eligible studies applied ML methods to identify factors associated with WRMSDs using cross-sectional study designs. Included studies were appraised using the Joanna Briggs Institute Critical Appraisal Checklist for analytical cross-sectional studies.
Results
Ten studies met the inclusion criteria, representing workers from healthcare, transport, manufacturing, and service sectors across Asia, Africa, and Europe. Frequently applied ML algorithms included random forest, support vector machine, and artificial neural networks, demonstrating strong internal discriminative performance (area under the receiver operating characteristic curve: 0.80–0.99), although the absence of external validation in several studies suggests a potential risk of overfitting. Commonly identified factors included age, sex, awkward posture, vibration exposure, prolonged working hours, stress, and burnout. Psychosocial factors, including post-traumatic stress disorder, job stress, and depression, were ranked among the most influential predictors within ML models.
Conclusions
ML models demonstrate strong capability in discriminating WRMSDs risk and identifying multidimensional risk factors compared with traditional statistical approaches. These models highlight complex interrelationships between ergonomic and psychosocial exposures. Future research should incorporate external validation, objective exposure measurements, and standardized ML reporting frameworks to enhance methodological transparency and generalizability.

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Original Article

Association between working ≥10 hours per day and satisfaction with work environment among wage workers in Korea: a cross-sectional study using data from the 7th Korean Working Conditions Survey: Rae-Yun Kim, Dong-Woo Kim, Yoon-Soo Jang, Na-Rae Lee, June-Hee Lee, Kyung-Jae Lee; Ann Occup Environ Med 2026;38:e9. Published online March 18, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e9

Abstract Abstract in Korean PDF Supplementary Material: Background
Long working hours have been associated with adverse physical and mental health outcomes; however, evidence regarding their relationship with satisfaction with work environment remains limited, particularly when long working hours are defined using a specific daily threshold. This study examined the association between working ≥10 hours per day and satisfaction with work environment among Korean wage workers, focusing on the cumulative number of such workdays per month.
Methods
This cross-sectional study analyzed data from the 7th Korean Working Conditions Survey. A total of 24,269 wage workers aged ≥18 years were included after excluding self-employed workers, unpaid family workers, shift workers, and respondents with missing data. Working ≥10 hours per day was categorized as 0, 1–9, and ≥10 days per month. Satisfaction with work environment was categorized as satisfied or dissatisfied. Multiple logistic regression analyses were conducted to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for dissatisfaction with work environment according to the number of long working days, adjusting for demographic and occupational characteristics.
Results
Compared with workers who did not work ≥10 hours per day, those who worked 1–9 days and ≥10 days per month showed progressively higher levels of dissatisfaction with work environment. After adjustment for demographic and occupational factors, the odds of dissatisfaction with work environment were significantly higher among workers who worked ≥10 hours per day for 1–9 days per month (OR: 1.380; 95% CI: 1.145–1.665) and ≥10 days per month (OR: 2.106; 95% CI: 1.627–2.725), demonstrating a dose–response relationship.
Conclusions
Among the analytic sample of Korean wage workers included in this study, working ≥10 hours per day was associated with greater dissatisfaction with work environment, with a dose–response pattern according to the number of long working days per month.; 한국 임금 근로자의 하루 10시간 이상 근무 일수와 근무환경 만족도와의 연관성
목적
장시간 근무는 근로자의 신체적·정신적 건강에 부정적인 영향을 미치는 주요 직업적 요인으로 알려져 있으나, ‘하루 10시간 이상 근무’라는 구체적 기준을 적용하여 근무환경 만족도와의 연관성을 분석한 연구는 상대적으로 부족하다. 본 연구는 한국 임금근로자를 대상으로 한 달 동안 하루 10시간 이상 근무하는 일수와 근무환경 만족도 간의 연관성을 정량적으로 분석하고자 하였다.
방법
본 연구는 제7차 근로환경조사 자료를 활용한 단면연구이다. 전체 조사 대상자 50,195명 중 18세 미만 근로자, 자영업자 및 무급 가족종사자, 주요 변수에 대한 응답 누락자, 교대근무자를 제외한 24,269명의 임금근로자를 최종 분석 대상으로 선정하였다. 하루 10시간 이상 근무하는 일수는 0일, 1-9일, 10일 이상으로 분류하였다. 근무환경 만족도는 만족과 불만족의 이분형 변수로 재분류하였다. 인구통계학적 특성과 직업적 특성을 보정한 다중 로지스틱 회귀분석을 통해 하루 10시간 이상 근무 일수와 근무환경 만족도 간의 연관성을 분석하였다.
결과
전체 대상자 중 하루 10시간 이상 근무하지 않는 근로자는 95.4%였으며, 1-9일 근무자는 3.3%, 10일 이상 근무자는 1.3%였다. 근무환경 불만족 비율은 하루 10시간 이상 근무 일수가 증가할수록 높아졌다. 보정 후 분석 결과, 하루 10시간 이상 근무 일수가 1-9일인 근로자의 근무환경 불만족 오즈비는 1.380(95%CI: 1.145-1.665), 10일 이상인 근로자는 2.106(95%CI: 1.627-2.725)으로 통계적으로 유의하였다.
결론
본 연구의 분석 대상인 한국 임금근로자 표본에서 하루 10시간 이상 근무는 근무환경 불만족과 유의한 연관성을 보였으며, 장시간 근무 일수가 증가할수록 불만족 수준이 증가하는 용량-반응 양상이 관찰되었다.

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Case Report

Severe bilateral hydrocarbon pneumonitis requiring surgical drainage following accidental aspiration of industrial cleaning solvent in a seafarer: a case report: Sang-Heon Cho, Jong Gill Jeong; Ann Occup Environ Med 2026;38:e8. Published online March 11, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e8

Abstract Abstract in Korean PDF: Background
Hydrocarbon pneumonitis is typically self-limiting, and severe complications, such as lung abscesses, are rare. Here, we report the case of a seafarer who developed bilateral lung abscesses after aspirating an industrial cleaning solvent, highlighting the aggravating role of delayed medical care and improper first-aid measures in a maritime setting.
Case presentation
A 46-year-old seafarer presented with dyspnea, 3 days after accidentally ingesting a hydrocarbon-based solvent that he mistook for water. Although he immediately spat out the fluid, he aspirated a small amount. His condition rapidly deteriorated to necrotizing pneumonia with bilateral lung abscesses, as confirmed by chest computed tomography. Despite empirical antibiotic therapy, the abscess worsened, necessitating a video-assisted thoracic surgery for drainage. The patient recovered after surgery and underwent a prolonged course of antibiotic therapy.
Conclusions
This case underscores the potential for life-threatening complications from industrial solvent aspiration, exacerbated by delayed medical care and forceful spitting. Strict workplace safety protocols, including the prohibition of storing chemicals in food containers to avoid confusion, and awareness about not inducing vomiting after ingestion, are essential to prevent such severe occupational injuries.; 산업용 세척 용제를 우발적으로 흡인한 선원에서 발생한 수술적 배액술이 필요했던 중증 양측성 탄화수소 폐렴에 대한 증례보고
배경
탄화수소에 의한 폐렴은 일반적으로 자연 치유되는 경과를 보이며, 폐농양과 같은 심각한 합병증은 드물다. 본 증례에서는 산업용 세척 용제를 흡인한 후 양측성 폐농양으로 발전한 선원의 사례를 보고하며, 특히 해상 환경에서의 지연된 의료 처치와 부적절한 응급처치가 병세를 악화시키는 요인임을 강조하고자 한다.
증례
46세 선원이 탄화수소 계열의 용제를 물로 오인하여 우발적으로 섭취한 지 3일 후 호흡곤란을 주소로 내원하였다. 환자는 즉시 액체를 뱉어냈으나, 그 과정에서 소량을 흡인하였다. 환자의 상태는 급격히 악화되어 괴사성 폐렴 및 양측성 폐농양으로 진행되었으며, 이는 흉부 컴퓨터단층촬영을 통해 확인되었다. 경험적 항생제 치료에도 불구하고 농양은 악화되었고, 결국 배농을 위한 비디오 흉강경 수술을 시행하였다. 환자는 수술 후 회복되었으며, 장기간의 항생제 치료를 받았다.
결론
본 증례는 산업용 용제 흡인이 생명을 위협하는 합병증을 유발할 수 있음을 보여주며, 이러한 위험은 의료 처치의 지연과 흡인 위험을 높이는 강하게 뱉어내는 행위로 인해 더욱 악화될 수 있음을 시사한다. 혼동을 방지하기 위해 식품 용기에 화학물질 보관을 금지하는 등의 엄격한 작업장 안전 수칙 준수와, 섭취 후 억지로 구토를 유발하지 않아야 한다는 점에 대한 인식 제고는 이러한 심각한 직업성 손상을 예방하는 데 필수적이다.

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Case Report

Multiple chemical sensitivity triggered by an automobile mechanic's indirect exposure to volatile organic compounds in the Republic of Korea: a case report: Dong-Hoon Cheon, Yoon-Ji Kim, Dongmug Kang, Youngki Kim, Eun-Soo Lee, Ki-Hun Kim, Se-Yeong Kim; Ann Occup Environ Med 2026;38:e7. Published online February 26, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e7

Abstract Abstract in Korean PDF: Background
Multiple chemical sensitivity (MCS) lacks definitive biomarkers, making differential diagnosis reliant on exclusion and symptom reproducibility. In automobile repair shops, volatile organic compounds (VOCs) from cleaning agents pose risks not only to primary users but also to co-workers via indirect exposure. We report a case of MCS suspected to be triggered solely by bystander VOC exposure, highlighting the clinical significance of uncaptured peak exposures in Korea.
Case presentation
A 23-year-old mechanic experienced recurrent headaches, throat irritation, and nausea immediately after co-workers used aerosolized cleaners in a poorly ventilated workspace. Symptoms consistently improved when he was away from work. Routine clinical evaluations were unremarkable. Although the patient underwent surgery for chronic rhinosinusitis, the symptoms persisted specifically upon re-exposure, effectively ruling out structural otorhinolaryngologic causes. Mental health screening indicated only mild depressive symptoms, insufficient to account for the severity of the physical symptoms. The Quick Environmental Exposure and Sensitivity Inventory (QEESI) scores were in the "suggestive" range for MCS. While routine workplace monitoring (8-hour time-weighted average [TWA]) showed non-detectable solvent levels, the nature of aerosol application suggested uncaptured short-term peak exposures. Based on the distinct temporal relationship, the patient was placed under medical observation and assessed as fit for work with restrictions on solvent exposure.
Conclusions
This case highlights the role of indirect VOC exposure as a trigger for MCS symptoms even when routine TWA monitoring indicates minimal concentrations. The discrepancy likely stems from the brief peak exposures triggering central sensitization, underscoring the limitations of standard monitoring. Management strategies must focus on peak-exposure control and fitness-for-work assessments that mandate strict avoidance of organic solvents, regardless of average ambient concentrations.; 국내 자동차 정비사의 휘발성 유기화합물 간접 노출에 의해 유발된 다중화학물질과민증: 증례 보고
배경
다중화학물질과민증(Multiple Chemical Sensitivity, MCS)은 명확한 바이오마커가 부족하여 배제 진단과 증상의 재현성에 의존하여 진단된다. 자동차 정비 현장에서 발생하는 휘발성 유기화합물(VOCs)은 직접 사용자뿐만 아니라 간접 노출되는 주변 작업자에게도 건강상의 위험을 초래한다. 본 저자들은 한국의 일반적인 작업환경측정 체계에서 포착되지 않는 단기 피크 노출(peak exposure)의 임상적 중요성을 강조하며, 간접 노출에 의해 유발된 MCS 사례를 보고하고자 한다.
증례
보고: 23세 남성 정비사가 환기가 불충분한 작업장에서 동료들이 에어로졸 세정제를 사용할 때마다 반복적인 두통, 인후 자극 및 오심을 경험하였다. 증상은 작업장을 벗어났을 때 일관되게 호전되는 양상을 보였다. 일반적인 임상 검사 결과는 정상 범위였으며, 만성 비부비동염 수술 후에도 유기용제 재노출 시 증상이 지속되어 이비인후과적 구조적 원인은 배제되었다. 정신건강 스크리닝 결과는 경미한 우울 증상만을 보였으며, 이는 신체 증상의 심각성을 설명하기에 불충분하였다. 한국판 QEESI(Quick Environmental Exposure and Sensitivity Inventory) 설문 결과 MCS '시사(Suggestive)' 범위에 해당하였다. 작업환경측정 결과(8시간 시간가중평균, TWA)는 유기용제 불검출 수준이었으나, 에어로졸 사용 특성상 측정되지 않은 단기 피크 노출이 의심되었다. 뚜렷한 시간적 인과관계를 바탕으로 환자는 의학적 관찰 대상이 되었으며, 유기용제 노출 제한을 조건으로 '조건부 작업 적합' 판정을 받았다.
결론
본 증례는 통상적인 TWA 측정치가 낮음에도 불구하고 간접적인 VOC 노출이 MCS 증상의 트리거가 될 수 있음을 시사한다. 이러한 불일치는 단기 피크 노출이 중추 감작(central sensitization)을 유발하기 때문으로 보이며, 이는 표준 측정 방식의 한계를 보여준다. MCS의 관리는 평균 노출 농도와 관계없이 피크 노출 제어 및 엄격한 유기용제 노출 회피를 포함하는 업무적합성 평가에 초점을 맞추어야 한다.

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Original Article

Acute health effects of accidental exposure to lithium hydroxide at a battery material production plant: Chul Gab Lee, Soo Hyeong Park, Ji Won Kang, Si Woo Hwang, Hyeo Na Kim, Hyeon Kyeong Ko; Ann Occup Environ Med 2026;38:e6. Published online February 9, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e6

Abstract Abstract in Korean PDF

Background
Lithium hydroxide (LiOH) is increasingly used in electric vehicle battery production; however, its health effects in the work environment remain underreported. This study characterizes the acute health effects on workers following accidental occupational exposure to LiOH at a Korean lithium plant in March 2024.
Methods
We analyzed health effects from two LiOH exposure accidents on March 6 and 9, 2024, involving 50–100 kg powder spills. Two datasets were examined: acute symptoms from 115 workers who visited hospitals immediately after exposure, and a symptom severity survey from 474 workers conducted 2 weeks post-exposure. Workers were stratified by distance from the leak source (<10 m, 10–20 m, >20 m) and respirator use. Univariate general linear modeling was applied to analyze the relationship between symptom occurrence and both the distance from the exposure source and respirator use.
Results
Among workers visiting hospitals immediately, local irritation symptoms predominated: sore throat (58.3%), cough (28.7%), and skin dermatoses (17.4%). Systemic symptoms included headache (45.2%), nausea (18.3%), chest tightness (12.2%), and dizziness (9.6%). Two-week follow-up revealed overall symptom improvement; severe cough decreased from 22.2% to 10.1%. However, despite general improvement, a significant portion of workers reported persistent respiratory issues, including cough (28.7%) and sputum production (31.0%). Symptom severity showed a significant dose-response relationship with proximity to the source (p < 0.001). While respirator use offered initial protection (p = 0.021), this effect was not statistically significant after 2 weeks.
Conclusions
Occupational LiOH exposure caused acute irritation and systemic symptoms, demonstrating immediate tissue damage consistent with its alkalinity and systemic toxicity upon absorption. As lithium battery production expands globally, these results emphasize the necessity for developing specific occupational exposure limits and medical surveillance guidelines for lithium compounds.

수산화리튬 누출 사고에 따른 급성 건강영향
배경
수산화리튬((LiOH)은 전기차 배터리 생산에 필수적인 소재이나, 직업환경의학 영역에서 건강영향에 대한 문헌은 부족하다. 본 연구는 2024년 3월 수산화리튬 생산공장에서 발생한 두 차례의 사고에 따른 노동자의 급성 건강 영향에 대해 조사 결과이다.
방법
2024. 3. 6일과 9일 두 차례에 걸쳐 수산화리튬 생산설비 시운전 중 실리콘 연결부 파열로 50~100kg의 분말이 누출되어 발생한 급성건강 영향의 2개의 데이터를 분석하였다. 하나는 누출사고 당시 한 병원 방문자 115명의 증상이며, 다른 하나는 노출 2주후에 474명을 대상으로 한 설문조사 결과이다. 국소증상과 전신증상 호소율을 기록하고, 이들 증상이 노출원과의 거리(<10m, 10~20m, >20m) 및 호흡 보호구를 착용 유무에 따른 심각도에 차이가 있는지 단변량 일반 선형 모델링을 적용하여 분석하였다.
결과
사고 직후 병원을 방문한 노동자에서 국소 자극 증상이 가장 흔하게 나타났으며, 인후통(58.3%), 기침(28.7%), 피부 질환(17.4%) 등이었다. 전신 증상으로는 두통(45.2%), 메스꺼움(18.3%), 가슴 답답함(12.2%), 어지럼증(9.6%) 등이 있었다. 2주 후 추적 관찰 결과에서 전반적인 증상 호전이 있었는데, 심한 기침은 22.2%에서 10.1%로 감소했다. 그러나 전반적인 증상 개선에도 불구하고, 상당수의 노동자는 기침(28.7%)과 가래(31.0%)를 포함한 호흡기 문제를 지속적으로 호소했다. 증상 심각도는 노출원과 거리에 따라 의미한 상관관계를 보였으며(p<0.001), 호흡기 보호구 착용은 초기에는 보호 효과를 제공했지만(p=0.021), 2주 후에는 통계적으로 유의미한 효과가 나타나지 않았다.
결론
수산화리튬에 누출 사고에 노출된 노동자에서 국소적인 자극 및 전신 증상을 유발했으며, 이는 수산화리튬의 알칼리성과 흡수 시 전신 독성에 부합하는 즉각적인 조직 손상으로 추정된다. 리튬 배터리 생산이 전 세계적으로 확대됨에 따라, 수산화리튬에 대한 구체적인 직업적 노출 한계와 의학적 감시 지침을 개발해야 한다.

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Sustainable Working Life Within the Production and Recycling of Lithium-Ion Batteries for Electric Vehicles (GreenWorkLiB)
Klara Midander, Anneli Julander, Erik Rosengren, Sandra Johannesson, Florencia Harari
Batteries.2026; 12(6): 203. CrossRef
Reactive airways dysfunction syndrome following acute lithium hydroxide dust exposure at a battery material production plant: a case series of 16 workers
Chul Gab Lee, Soo Hyeong Park, Jeong Joon Park, Han Soo Song, Hyeon Kyeong Ko, Sung Ho Yoon
Annals of Occupational and Environmental Medicine.2026; 38: e17. CrossRef

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Case Report

Case series: from ventilation failure to substitution success in occupational lead poisoning at a Korean indoor firing range: Chul Gab Lee, Soo Hyeong Park; Ann Occup Environ Med 2026;38:e5. Published online February 9, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e5

Abstract Abstract in Korean PDF: Background
Indoor firing ranges are globally recognized as high-risk settings for occupational and recreational lead exposure due to the use of lead-based ammunition and frequently inadequate ventilation systems. In Korea, however, public health surveillance and regulatory oversight have remained limited. This case series empirically demonstrates that in high-emission settings like indoor firing ranges, ventilation upgrades are insufficient. Source substitution with lead-free primer ammunition proved to be the only definitive intervention.
Case presentation
In late 2023, an index case presenting with abdominal pain was found to have a blood lead level (BLL) of 55 μg/dL, prompting a government-mandated investigation. Nine male shooting instructors (tenure: 4–65 months) were subsequently identified with BLLs ranging from 38.2–73.2 μg/dL, while airborne lead concentrations (ALC) reached 0.51 mg/m³—10 times the occupational exposure limit (OEL: 0.05 mg/m³). During a 3-month closure to upgrade ventilation, workers received chelation therapy (CaNa₂EDTA and D-penicillamine), which reduced their BLLs to 3.2–25.7 μg/dL. However, 2 months after reopening, post-intervention ALC remained elevated at 0.0797 mg/m³, still exceeding the OEL, and BLLs rebounded to 16.2–53.3 μg/dL. A substitution strategy was then implemented, replacing lead-based ammunition with copper-clad, lead-free primer rounds. This intervention decreased ALC to <0.003 mg/m³ and lowered BLLs to 4.9–23.1 μg/dL. Despite the reduced airborne concentrations, several workers continued to exhibit BLLs around 20 μg/dL, suggesting subtle ongoing exposure and mobilization of bone-stored lead.
Conclusions
This cluster demonstrates that in environments where hazardous agents are continuously generated, such as indoor firing ranges, engineering controls alone, such as improved ventilation, may not provide adequate protection. Substitution—the most effective intervention within the hierarchy of controls—was essential for eliminating exposure. Furthermore, the toxicokinetics of bone lead in chronically exposed adults highlight the need for ongoing monitoring and cautious decision-making regarding treatment and return-to-work planning.; 한국의 한 실내사격장에서 발생한 직업성 납중독: 개입위계 체계의 실패와 성공 사례보고
배경
실내 사격장은 납 기반 탄약의 사용과 불충분한 환기 시스템으로 인해, 직업적 및 레저 활동 시 납 노출 위험이 높은 환경으로 전 세계적으로 알려져 있다. 그러나 한국에서는 이에 대한 공중 보건학적 감시나 규제적인 감독이 없었다. 본 증례 보고는 국내 한 실내 사격장 노동자(사격 코치)에서 발생한 집단 중증 납 중독 사례를 분석하여, 고농도 노출 환경에서 환기 개선과 같은 공학적 대책의 한계를 살펴보고, 유해 물질 대체(substitution)를 통한 근본적 해결의 중요성을 강조하고자 한다.
증례
2023년 말, 심한 복통을 호소한 지표 환자(index case)의 혈중 납 농도(BLL)가 55 µg/dL로 확인되면서 정부 주도의 역학 조사가 실시되었다. 해당 사격장의 사격 코치 9명(근무 기간: 4~65개월)의 혈중 납 농도(Blood lead level, BLL)은 38.2~73.2 µg/dL 범위였으며, 작업환경측정에 의한 사격장 실내 납 농도(Airborne lead concentration, ALC)는 0.51 mg/m³로 노출 기준(Occupational exposure limit, OEL: 0.05 mg/m³)의 10배를 초과했다. 환기 설비 개선을 위한 3개월간 폐쇄 기간 동안 킬레이션 요법(CaNa₂EDTA 및 D-penicillamine)을 시행하여 BLL이 3.2~25.7 µg/dL로 감소했다. 그러나 환기 시스템을 대폭 개선하여 재가동했음에도 불구하고, 2개월 후 ALC는 0.0797 mg/m³로 여전히 기준치를 초과했고, 복귀한 근로자들의 BLL은 16.2~53.3 µg/dL로 급격히 재상승했다. 이에 따라 납 기반 탄약을 구리 피복 및 무연 뇌관(lead-free primer) 탄약으로 전면 교체하는 대체 전략이 시행되었다. 그 결과 ALC는 0.003 mg/m³ 미만으로 감소하였고, BLL 또한 4.9~23.1 µg/dL로 감소하여 안정화되었다. 다만, ALC의 획기적 감소에도 불구하고 일부 노동자의 BLL이 20 µg/dL 수준을 유지한 것은 뼈에 축적된 납의 재분배(mobilization) 영향으로 추정된다.
결론
본 사례는 실내 사격장과 같이 유해 인자가 지속적으로 발생하는 환경에서는 환기 개선 등의 공학적 대책만으로는 근로자를 충분히 보호할 수 없음을 시사한다. 따라서 산업안전보건의 ‘위험성 관리의 위계(Hierarchy of Controls)’ 중 가장 효과적인 조치인 ‘대체(substitution)’를 통해 오염원을 원천적으로 제거하는 것이 필수적이다. 아울러 만성 고농도 노출 근로자의 경우, 체내 축적된 납의 독성동태학적 특성을 고려하여 치료 및 업무 복귀 결정 시 장기적인 모니터링과 신중한 접근이 요구된다.

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Original Article

Association between outdoor clothing use and serum perfluoroalkyl substances (PFAS): Korean National Environmental Health Survey cycle 4: Keon Woo Kim, Jisoo Kang, Seong-yong Cho, Seongyong Yoon, Daehwan Kim, Hyun Woo Park; Ann Occup Environ Med 2026;38:e4. Published online January 8, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e4

Abstract Abstract in Korean PDF Supplementary Material

Background
Perfluoroalkyl substances (PFAS) are used in various products, and PFAS have been detected in outdoor clothing. PFAS can be absorbed into the human body via oral ingestion, inhalation, and dermal contact. In this study, we examined the association between the frequency of using outdoor clothing and serum PFAS concentrations in the Korean population using data from cycle 4 (2018–2020) of the Korean National Environmental Health Survey.
Methods
Data from 2,993 adult participants were analyzed. The participants were classified into low-concentration and high-concentration groups based on the 75th percentile concentration of serum PFAS. The use of outdoor clothing was categorized into three groups: non-use, <4 times a week, and ≥4 times a week. The odds ratio (OR) for serum PFAS levels associated with use of outdoor clothing was determined through logistic regression analysis, adjusted for demographic characteristics, health-related factors, PFAS-treated items, dietary factors, and ventilation time.
Results
ORs for high serum PFAS were higher in groups using outdoor clothing compared to the non-user group. In males, the adjusted ORs for the < 4 times a week and ≥ 4 times a week outdoor clothing usage group were as follows: perfluorooctanoic acid (PFOA), 1.26 (95% confidence interval [CI]: 1.10–1.44) and 1.70 (1.40–2.07); perfluorohexanesulfonic acid (PFHxS), 1.49 (1.16–1.92) and 1.70 (1.22–2.37); and perfluorononanoic acid (PFNA), 1.34 (1.19–1.51) and 1.68 (1.38–2.05), respectively. In females, the respective ORs were as follows: PFOA 1.32 (95% CI: 1.19–1.46) and 1.53 (1.01–2.32); PFHxS, 1.46 (1.08–1.96) and 2.63 (2.10–3.29); PFNA, 1.38 (1.22–1.55) and 1.45 (1.07–1.96).
Conclusions
In adults, elevated serum PFAS levels were associated with increased frequency of using outdoor clothing.

제4기(2018-2020) 국민환경보건 기초조사 자료를 이용한 아웃도어 의류 착용과 혈청 과불화화합물과의 관계
목적
과불화화합물(PFAS)은 방수 및 방유 효과를 가지고 있어 아웃도어 의류를 포함한 일회용 식품 포장, 조리 기구, 가구 등 다양한 제품에 사용된다. 선행 연구에 따르면 PFAS가 아웃도어 의류에서 검출되었다. PFAS는 경구섭취, 흡입, 피부접촉 등의 경로를 통해 인체에 흡수되며 체내에 장기간 잔류하면서 간기능, 신기능, 생식기능 등의 저하 증상을 유발할 수 있다. 본 연구에서는 한국 국민환경보건 기초조사(KoNEHS) 4주기(2018-2020)의 데이터를 사용하여 한국 인구의 아웃도어 의류 사용 빈도와 혈청 PFAS농도와의 연관성을 확인하고자 한다.
방법
KoNEHS 4주기의 데이터를 이용하여 2,993명의 성인 참가자를 분석하였다. 혈청 PFAS의 75 번째 백분위 수 농도를 기준으로 저농도군과 고농도군으로 나누었다. 아웃도어 의류 사용은 미사용, 주 당 4회 미만, 주 당 4회 이상으로 세 군으로 분류하였다. 아웃도어 의류 사용에 관한 혈청 PFAS의 오즈비는 인구통계학적 특성, 건강 관련 특성, PFAS 사용 물품, 식이요인 그리고 환기 시간을 보정한 후 로지스틱 회귀분석을 사용하여 구하였다
결과
본 연구에서는 아웃도어 의류를 사용하지 않는 군에 비해 주 4회 미만 사용군 및 주4회 이상 사용군에서 혈청 PFAS 고농도군에 속할 OR 값이 높게 나왔다. 남성에서 주 4회미만 사용군 및 주 4회이상 사용군에서 PFOA의 고농도군에 해당될 adjusted OR는 1.26(95% CI; 1.10-1.44) 및 1.70(95% CI; 1.40-2.07)이었다PFHxS는 1.49(95%CI; 1.16-1.92) 및 1.70(95%CI; 1.22-2.37), PFNA는 1.34(95% CI; 1.19-1.51) 및 1.68(95% CI; 1.38-2.05), 이었다. 여성의 경우 주 4회미만 사용군 및 주 4회이상 사용군에서 PFOA의 고농도군에 해당될 adjusted OR는 1.32(95% CI; 1.19-1.46) 및 1.53(95% CI; 1.01-2.32)이었다. PFHxS는 1.46(95%CI; 1.08-1.96) 및 2.63(95%CI; 2.10-3.29), PFNA는 1.38(95% CI; 1.22-1.55) 및 1.45(95% CI; 1.07-1.96) 이었다.
결론
성인에서 아웃도어 의류 착용 횟수가 많을수록 혈청 PFAS(PFOA, PFOS, PFHxS, PFNA, PFDeA) 농도가 증가하였다.

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Associations between physical exercise and serum per- and polyfluoroalkyl substances (PFAS) concentrations: findings from Korean National Environmental Health Survey Cycle 4 (2018–2020)
Kiook Baek
International Journal of Environmental Health Research.2026; : 1. CrossRef

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Review

Impacts of heat on sleep quality among heat-exposed workers: a systematic review: Maarthi Raja, Vidhya Venugopal, D. C. Mathangi, Suvarna Jyothi Kantipudi, K. Mahesh Kumar, Somnath Panda, Latha Perumal Kamalakkannan; Ann Occup Environ Med 2026;38:e3. Published online January 8, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e3

Abstract PDF Supplementary Material

Climate change is intensifying occupational heat exposure, posing risks not only for heat-related illness but also for sleep, which is essential for recovery, safety, and productivity. Heat-exposed workers are highly vulnerable due to prolonged exposure, limited access to cooling, and poor housing. This systematic review aimed to synthesise global evidence on how occupational heat exposure affects sleep quality among workers across different occupations and settings. A systematic review was conducted following Synthesis without Meta-Analysis (SWiM) guidelines. PubMed, Scopus, and Google Scholar were searched (2000–2025) for studies involving adult workers (≥18 years) reporting both heat exposure and sleep outcomes. The review was registered with PROSPERO (ID: CRD420251125735). Of 7,108 records screened, 11 studies met the inclusion criteria. Studies spanned Asia, Australia, North America, and global cohorts. Heat exposure consistently impaired sleep quality and duration. Using Pittsburgh Sleep Quality Index, Actigraphy, and self-reports, common complaints included difficulty falling asleep (64%), restlessness (54%), non-restorative sleep (54%), night sweats (36%), and reduced total sleep time (45%). Night-time temperatures above 25°C and high workplace wet bulb globe temperature values were strongly linked with reduced sleep efficiency and delayed sleep onset. Vulnerable groups included shift workers, petrochemical and steel labourers, women, older adults, and low-income workers in urban heat islands and poorly ventilated housing. Occupational heat exposure disrupts sleep, compounding daytime strain and creating a dual burden for workers. Integrating sleep into heat stress management through cooling interventions, better housing, and revised work–rest schedules is critical for workers well-being in a warming climate.

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Climate heatwaves and mental health in Asia: Exemplars and insights from the Philippines
Rowalt Alibudbud
Geopsychiatry.2026; 4: 100114. CrossRef

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Original Article

Development of criteria for health examination of high-risk occupational groups and application to female fishers: Delphi study: Hye-min Kim, Jungwon Kim, Kunhyung Kim, Hansoo Song; Ann Occup Environ Med 2026;38:e2. Published online January 8, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e2

Abstract Abstract in Korean PDF Supplementary Material: Background
The objective of this study was to establish criteria for designing health examination programs and selecting appropriate examination items for high-risk occupational groups and to apply these criteria specifically to female fishers.
Methods
The first Delphi survey comprised five domains and 15 specific criteria for identifying relevant health screening items for high-risk occupations. The second survey included open-ended questions addressing inconsistencies identified in the first survey and sought suggestions for additional items. In the third Delphi survey, specific health screening items were proposed for female fishers, and experts directly evaluated these items according to the finalized selection criteria.
Results
Twenty-eight experts participated in this study. The first and second Delphi rounds facilitated the finalization of selection criteria for health screening items, consisting of five domains: Domain 1, Priority of target disease; Domain 2, Applicability of early detection and intervention; Domain 3, Scientific evidence of medical test method; Domain 4, Acceptability of medical test method; and Domain 5, Effectiveness of examination. Content validity ratios for these criteria ranged between 0.429 and 1.000. Based on the established criteria, experts evaluated eight proposed screening items for female fishers in the third round of the Delphi survey. Bone density, bioelectrical impedance analysis, cardiovascular disease risk factors, and fundoscopy were evaluated as appropriate; however, no agreement was reached on the early detection and intervention areas for degenerative lumbar disease, knee osteoarthritis, and upper extremity disease, as well as on the effectiveness for upper extremity disease and chronic obstructive pulmonary disease.
Conclusion
This study successfully established comprehensive criteria for selecting diseases targeted by health examinations in high-risk occupational groups. The practical application of these criteria proved effective in assessing the appropriateness of specific health screening items.; 고위험 직업군 건강검진 기준 개발 및 여성 어업종사자에의 적용: 델파이 조사
배경
본 연구의 목적은 고위험 직업군을 위한 건강검진 프로그램 설계 기준과 적절한 검사 항목을 선정하는 기준을 수립하고, 이를 여성 어업종사자에게 구체적으로 적용하는 것이었다.
방법
첫 번째 델파이 조사에서는 고위험 직업군의 건강검진 항목을 선정하기 위한 5개 영역과 15개의 기준을 설정하였다. 두 번째 조사에서는 첫 번째 조사에서 발견된 불일치를 해소하고 추가 항목에 대한 제안을 받기 위해 개방형 질문을 포함하였다. 세 번째 델파이 조사에서는 여성 어업종사자에게 적용할 건강검진 항목을 제안하고, 전문가들이 최종 선정 기준에 따라 해당 항목을 평가하였다.
결과
본 연구에는 28명의 전문가가 참여하였다. 첫 번째와 두 번째 델파이 조사에서는 건강검진 항목 선정 기준이 확정되었으며, 이 기준은 다음의 5개 영역으로 구성되었다: <영역 1: 대상 질병의 우선순위>, <영역 2: 조기 발견 및 개입의 적용 가능성>, <영역 3: 의학적 검사 방법에 대한 과학적 근거>, <영역 4: 의학적 검사 방법의 수용 가능성>, <영역 5: 검사의 효과성>. 각 기준의 내용 타당도 비율은 0.429에서 1.000 사이였다. 확립된 기준에 따라, 세 번째 델파이 조사에서 여성 어업종사자를 위한 8개 건강검진 항목이 평가되었으며, 골밀도, 생체 전기 저항 분석, 심혈관 질환 위험 인자, 안저 검사는 적절한 항목으로 평가되었으나, 퇴행성 요추 질환, 무릎 골관절염, 상지 질환 및 만성 폐쇄성 폐질환의 조기 발견 및 개입 영역과 상지 질환과 만성 폐쇄성 폐질환의 효과성에 대해서는 전문가들 간의 합의가 이루어지지 않았다.
결론
본 연구는 고위험 직업군의 건강검진을 위한 질병 선정 기준을 성공적으로 확립하였다. 이 기준을 실제로 적용함으로써 특정 건강검진 항목의 적절성을 평가하는 데 효과적임을 확인하였다.

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Original Article

Work-life balance and effort-reward imbalance, and their interaction, associated with presenteeism among Korean wage workers: Based on 6th Korean working conditions survey: Sang-Hyeon Kim, Eun-Chul Jang, Soon-Chan Kwon, In-ho Lee, Jisuk Yun, Ui Chan Jung, Young-Sun Min; Ann Occup Environ Med 2026;38:e1. Published online January 8, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e1

Abstract Abstract in Korean PDF Supplementary Material: Background
This study investigated the relationship between work-life balance (WLB), effort-reward imbalance (ERI), and presenteeism among Korean wageworkers through two models used simultaneously.
Methods
Data from the 6th Korean Working Conditions Survey for 28,669 Korean workers, including 13,513 men and 15,156 women, were analyzed. All analyses were performed with pre-designed weight. Multiple logistic regression analysis was used to analyze the association between WLB, ERI, and presenteeism among Korean workers. The participants were classified into the following four groups: group 1, status of both WLB and ERI is “balanced”; group 2, WLB and ERI status are “imbalanced” and “balanced”, respectively; group 3, WLB and ERI status are “balanced” and “imbalanced”, respectively; group 4: status of both WLB and ERI is “imbalanced.”
Results
We found that WLB and ERI were associated with presenteeism in both men and women. Depending on their WLB and ERI status, women generally had a higher tendency of presenteeism than men. Multiple logistic regression shows that, in most models and groups, there is an increased odds ratio (OR) for presenteeism in both men and women compared to the reference value. Moreover, the OR in both men and women gradually increased in groups 2, 3, and 4 compared with group 1. When considering both WLB and ERI status simultaneously, ERI had a greater impact on presenteeism than WLB. Furthermore, it was found that a synergistic effect of presenteeism manifests when both WLB and ERI are in a state of imbalance simultaneously.
Conclusions
Using the two models simultaneously, we found an association between WLB, ERI, and presenteeism according to sex with a synergistic effect among Korean workers. Our research suggests that active interventions targeting WLB and ERI are necessary to reduce presenteeism, which ultimately leads to decreased productivity.; 한국 임금근로자의 일과 삶의 균형, 노력-보상 불균형과 프리젠티즘의 관련성
배경
일-삶 균형 상태, 노력-보상 불균형 상태와 프리젠티즘과의 관계를 각각 다룬 여러 연구가 있었으나 이를 동시에 조사한 연구 결과는 제한적이다. 본 연구는 한국 임금근로자를 대상으로 일-삶-균형 상태, 노력-보상 불균형 상태를 동시에 고려하여 프리젠티즘의 관련성을 확인하고자 하였다.
방법
본 연구는 제 6차 근로환경조사를 활용하여 그 중 선별된 임금근로자 28,669명을 대상으로 자료를 수집하였다. 변수로 대상자의 일반적인 특성 및 교육수준, 수입수준, 사업장 규모, 교대근무 여부 등 직업적 특성이 포함되었다. 본 연구의 종속변수인 프리젠티즘은 그 여부에 따라 두가지 범주로 나누었다. 주요 독립변수인 일-삶의 균형, 노력-보상 불균형 상태는 ‘균형’, ‘불균형’ 두가지 범주로 나누어 평가하였다. 다중 로지스틱 회귀 분석은 남녀 각각에 대해 시행하였고, 일-삶 균형 상태, 노력-보상 불균형 상태와 프리젠티즘의 연관성을 평가하였다. 대표성 있는 도출을 위해 모든 통계분석에는 사전에 계산된 가중치를 적용하였다.
결과
일과 삶의 균형(WLB)과 노력-보상 불균형(ERI)이 남녀 모두에서 프리젠티즘과 연관되어 있음을 발견하였다. WLB 및 ERI 상태에 따라 여성은 일반적으로 남성보다 프리젠티즘 경향이 더 높았다. 다중 로지스틱 회귀 분석에 따르면, 대부분의 모델과 집단에서 기준 값 대비 남녀 모두 프리젠티즘의 오즈비가 증가했다. WLB와 ERI 상태를 동시에 고려할 때, ERI가 WLB보다 프리젠티즘에 더 큰 영향을 미치는 것으로 나타났다. 더불어 WLB와 ERI가 동시에 불균형 상태일 때 프리젠티즘의 시너지 효과가 나타남이 확인되었다.
결론
두 모델을 동시에 적용한 결과, 한국 근로자 집단에서 남녀 모두에서 일과 삶의 균형과 노력-보상 불균형이 충족되지 않을 경우 프리젠티즘이 나타나고 이는 시너지 효과가 나타남을 확인하였다. 본 연구는 궁극적으로 생산성 저하를 초래하는 프리젠티즘을 줄이기 위해서는 일과 삶의 균형과 노력-보상 불균형에 초점을 맞춘 적극적인 개입이 필요함을 시사한다.

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Brief Communication

Physical performance metrics of police officers in northeastern Mexico according to age groups and sex: Luis E. Carranza-Garcia, Isaac Garcia-Flores, Ricardo Navarro-Orocio, Jose O. Lagunes-Carrasco, Ricardo Lopez-Garcia, Maria C. Enriquez-Reyna; Ann Occup Environ Med 2025;37:e34. Published online November 17, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e34

Abstract PDF: Normative values for the physical fitness of Mexican police officers (POs) by sex and age are scarce. This study describes physical performance percentiles by sex and age group and developed percentile values for POs of northeastern Mexico. A retrospective analysis was conducted on database of 7,519 men and 1,050 women aged 20–59 years. Fitness assessments included anthropometric measures, handgrip strength, Abalakov vertical jump, agility circuit, and 1,000-m run. Officers aged 20–29 outperformed other groups in all tests, except for grip strength, which peaked in the 30–39 group. In both sexes, fitness declined with age. Percentile tables by sex and age offer benchmarks to support performance standards, guide targeted physical activity programs and inform future research on Mexican POs.

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Original Article

Association between urinary polycyclic aromatic hydrocarbon metabolites and the prevalence of respiratory disease in residents living near Pohang Industrial Complex: Minji Kim, Sangwoo Lim, Seongrok Kim, Jea Chul Ha, Hyunjoo Kim, Insung Chung; Ann Occup Environ Med 2025;37:e27. Published online September 22, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e27

Abstract Abstract in Korean PDF: Background
Polycyclic aromatic hydrocarbons are generated from the incomplete combustion of organic materials such as fossil fuels and wood. These compounds, often inhaled, cause respiratory issues like asthma and chronic obstructive pulmonary disease due to oxidative stress and inflammation. Pohang, South Korea’s iron and steel hub, experiences significant polycyclic aromatic hydrocarbons emissions from extensive industrial activities and heavy truck movements. This study investigates the link between urinary polycyclic aromatic hydrocarbons metabolites and respiratory diseases among Pohang residents, considering their cumulative exposure and duration of residency.
Methods
Utilizing data from the National Environmental Research Institute’s health impact assessment conducted between 2012 and 2015, this study included 1,189 participants from Pohang. Urinary concentrations of polycyclic aromatic hydrocarbons metabolites served as exposure indicators. The study assessed the correlation between these metabolite levels and self-reported respiratory diseases, considering variables such as duration of residence, smoking status, and occupational exposures. Statistical analyses involved logistic regression and fixed-effect meta-analysis.
Results
The findings indicate a significant association between elevated levels of polycyclic aromatic hydrocarbons metabolites and an increased risk of respiratory diseases, particularly among those in the highest exposure quartile. The study also found a notable dose-response relationship, emphasizing the heightened risk with longer residency durations near the industrial complex. Despite yearly fluctuations, the trend suggests a persistent risk associated with high polycyclic aromatic hydrocarbons exposure.
Conclusions
Elevated exposure to polycyclic aromatic hydrocarbons near industrial areas such as the Pohang Industrial Complex is significantly associated with an increased prevalence of respiratory diseases. The study underscores the importance of implementing public health strategies to reduce polycyclic aromatic hydrocarbons exposure, especially in industrial regions. Future research should broaden the scope of polycyclic aromatic hydrocarbons metabolites analyzed and consider comprehensive exposure histories to better understand the relationship between polycyclic aromatic hydrocarbons exposure and respiratory health outcomes.; 포항 산업 단지 인근 거주 주민의 요중 PAH 대사물 노출과 호흡기 질환 유병률 간의 연관성
목적
철강 산업은 다양한 유해물질, 특히 다환방향족탄화수소를 방출하는 주요 공해 원인이다. 대한민국 포항은 이러한 산업의 중심지로, 인근 주민의 건강에 다환방향족탄화수소 노출이 미치는 영향을 연구하기에 이상적인 장소이다. 본 연구는 포항 산업 단지 근처에 거주하는 개인들 사이에서 다환방향족탄화수소 노출과 호흡기 질환의 유병률 간의 관계를 평가하고자 한다.
방법
2012년부터 2015년까지 국립환경연구원의 건강 영향 평가 자료를 활용하여, 포항에 거주하는 1,189명의 참가자를 대상으로 연구를 진행하였다. 다환방향족탄화수소 대사물 농도를 노출 지표로 사용하였으며, 이러한 대사물 수준과 자가보고 된 호흡기 질환 사이의 상관관계를 평가하였다. 이 때 거주기간, 흡연상태, 직업노출 등의 변수를 고려하였다. 통계분석에는 로지스틱 회귀분석 및 고정 효과 메타분석이 사용되었다.
결과
소변 내 다환방향족탄화수소 대사물 수준이 높을수록 호흡기 질환 위험이 증가하는 연관성이 발견되었으며, 특히 가장 높은 노출 분위에 속한 참가자들에서 그 위험이 크게 나타났다. 이 연구는 장기간에 걸친 고농도 다환방향족탄화수소 노출이 호흡기 건강에 미치는 심각한 위험을 강조한다.
결론
본 연구는 포항 산업 단지와 같은 산업 지역에서 소변 내 다환방향족탄화수소 대사물 노출이 심각한 건강 위험과 관련이 있음을 강조한다. 연구의 지리적 초점은 산업 단지 인근 거주자들이 환경 유해물질에 취약하다는 점을 보여주며, 이는 표적 공중 보건 개입의 필요성을 시사한다. 공기 정화 시스템 개선, 배출 기준 강화, 환경을 고려한 도시 계획과 같은 전략이 필수적이다.

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Original Article

Analysis of shark meat consumption patterns among young and middle-aged women in Gyeongsangbuk-do, South Korea, using community health survey data: Soyoung Son, Junmin Seong, Chulyong Park, Kiook Baek, Joon Sakong; Ann Occup Environ Med 2025;37:e26. Published online September 9, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e26

Abstract Abstract in Korean PDF: Background
Mercury, particularly in its methylmercury form, significantly affects neurological and developmental functions. In Gyeongsangbuk-do, Republic of Korea, blood mercury levels are elevated due to high fish consumption, especially shark meat. Vulnerable groups, such as pregnant women, are at increased risk as methylmercury can cross the placenta and accumulate in breast milk. This study aimed to investigate the risks of mercury exposure from shark meat consumption among young and middle-aged women in Gyeongsangbuk-do.
Methods
The data of women aged 19–55 years from the 2018 Gyeongsangbuk-do Community Health Survey were included. Survey questions focused on frequency and amount of shark meat consumption, as well as pregnancy status, recent childbirth, and breastfeeding status. The Complex Sample Analysis was used to determine the prevalence and risk of overconsumption. Weekly mercury intake was calculated for respondents who reported their body weight, and the population size exceeding Joint Food and Agriculture Organization/World Health Organization Expert Committee on Food Additives (JECFA) and Ministry of Food and Drug Safety (MFDS)’s threshold was estimated.
Results
Regions where the consumption rate of shark meat exceeds the average for Gyeongsangbuk-do are found to be distributed in the southeastern part of the province. Population estimates revealed that approximately 9,895 women aged 19–55, including 255 who had breastfed in the past year, consumed shark meat exceeding the recommended intake. Based on the maximum recorded mercury concentration (8.93 μg/g), an estimated 2,645 women surpassed the JECFA’s mercury exposure threshold, while 845 exceeded the MFDS’s threshold.
Conclusions
In young and middle-aged women of Gyeongsangbuk-do, approximately 7.1% exceed the single intake limit, while up to 1.9% exceed the JECFA’s provisional tolerable weekly intake (PTWI) and 0.6% exceed the MFDS’s PTWI, suggesting considerable risk that warrants monitoring and guidance. More stringent advisory measures regarding shark meat consumption and updated standards on mercury concentration in shark meat are essential for young and middle-aged women in the province.; 지역사회건강조사 데이터를 이용한 경상북도지역 청년-중년기 여성의 상어고기 섭취 행태 분석
목적
수은, 특히 메틸수은 형태의 수은은 신경 및 발달 기능에 큰 영향을 미친다. 수은이 기타 어류보다 더 높게 축적된 상어고기는 경상북도에서 전통적으로 소비되고 있으며, 경상북도 지역 주민의 혈중 수은 농도가 타 지역에 높게 관찰된 바 있다. 임산부와 어린이와 같은 취약 계층은 메틸수은이 태반을 통과하여 모유에 축적될 수 있기 때문에 상어고기를 섭취에 대한 위험이 더 높다. 본 연구는 2018년 지역사회건강조사 자료를 활용하여, 경상북도 내 청년-중년기 성의 메틸수은 노출에 대한 잠재적 위해도를 조사하고자 하였다.
방법
2018년 경상북도 지역사회 건강조사에 참여한 19~55세 여성 데이터를 바탕으로 상어고기 섭취 특성을 분석하였다. 설문 문항은 상어고기 섭취 여부, 빈도, 섭취량을 포함하였으며, 임신 여부, 최근 출산 여부, 모유 수유 여부를 확인하였다. 복합 표본 분석을 통해 상어고기 섭취 인구 비율과 모집단을 추정하고, 섭취 빈도와 섭취량의 평균 및 최대값을 산출하였다. 체중을 보고한 응답자를 대상으로 주간 수은 섭취량을 계산하였으며, 이를 통해 JECFA와 식약청의 규제 기준을 초과한 인구 규모를 추정하였다.
결과
경상북도 남동부 지역(영천시, 경주시, 청도군, 군위군, 경산시 등)의 상어고기 섭취율이 경상북도 평균 섭취율보다 높은 것으로 나타났다. 모집단 추정 결과, 19~55세 여성 약 9,895명과 지난 1년간 모유 수유를 한 255명이 권장 섭취량을 초과하여 상어고기를 섭취한 것으로 나타났다. 경상북도에서 기록된 최대 수은 농도(8.93 µg/g)를 기준으로, 약 2,645명의 여성이 FAO/WHO JECFA의 수은 노출 기준을 초과하였으며, 845명은 식약청 기준을 초과한 것으로 추정되었다.
결론
인구 추정치를 고려하면, 메틸수은 노출에 대한 민감 집단인 청년-중년기 여성 중 약 7.1%는 1회 섭취 기준, 1.9%는 JECFA PTWI, 0.6%는 식약청 PTWI를 초과해 모니터링과 지도가 필요한 수준의 위험으로 보인다. 가임기 여성의 상어고기에 섭취에 대하여는 지역사회 수준의 적극적 홍보 및 상어고기 내의 수은에 대한 지속적인 모니터링이 필요하다.

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Original Article

Association between sudden work recall and psychological health issues: a cross-sectional analysis of the 6th Korean Working Conditions Survey: Dong-Woo Kim, June-Hee Lee, In-Ho Lee, Kyung-Jae Lee; Ann Occup Environ Med 2025;37:e33. Published online September 8, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e33

Abstract Abstract in Korean PDF: Background
The impact of global integration has led to an increase in non-standard work patterns, threatening workers' health. Psychological health problems, such as anxiety and fatigue, negatively affect workers' health and safety. Sudden work recall, a situation where workers are asked to return to work under unpredictable circumstances, is associated with uncertainty. Research on the relationship between sudden work recall and anxiety and fatigue is limited, and this study aims to investigate this relationship among Korean workers.
Methods
The study used data from the 6th Korean Working Conditions Survey. To analyze the pure effects of sudden work recall, the final sample was limited to 15,702 non-shift workers with a ‘good’ subjective health status. The presence of sudden work recall was categorized into three frequency groups: “several times a month,” “rarely,” and “never.” Anxiety and fatigue were each categorized into "yes" or "no" responses. Multiple logistic regression analysis was performed.
Results
After adjusting for demographic and occupational characteristics, the odds ratio (OR) for anxiety in the 'several times a month' group was 4.066 (95% confidence interval [CI]: 2.787–5.931), indicating a significantly higher risk. Conversely, the OR for the 'rarely' group was 1.363 (95% CI: 0.921–2.017), which was not statistically significant. A similar pattern was observed for fatigue: the 'several times a month' group had a significantly higher risk (OR: 1.875; 95% CI: 1.490–2.359), but the 'rarely' group (OR: 0.955; 95% CI: 0.750–1.215) did not.
Conclusions
The relationship between sudden work recall and psychological health may not be a simple linear one. The results suggest that only a high frequency of sudden work recall is associated with an increased risk of anxiety and fatigue. Therefore, it is necessary to establish appropriate measures and to conduct additional research in this area.; 돌발적 업무 복귀 요청과 심리적 건강 문제의 연관성: 제 6차 근로환경조사를 이용한 단면 분석
목적
세계화로 인한 비정형적 근무 형태의 증가는 노동자의 건강을 위협하고 있다. 특히 불안과 피로와 같은 심리적 건강 문제는 삶의 질과 안전에 부정적인 영향을 미친다. 본 연구는 예측 불가능한 상황에서 갑자기 업무에 복귀하라는 요청을 받는 ‘돌발적 업무 복귀 요청’이 한국 노동자의 불안 및 피로와 어떤 연관성을 가지는지 조사하고자 한다.
방법
본 연구는 제6차 근로환경조사 자료를 활용했으며, 돌발적 업무 복귀 요청의 순수한 영향을 분석하기 위해 교대 근무자와 주관적 건강 상태가 ‘보통’ 이하인 근로자를 제외한 총 15,702명을 최종 분석 대상으로 선정했다. 돌발적 업무 복귀 요청의 빈도에 따라 ‘없음’, ‘드물게’, ‘한 달에 여러 번’으로 범주를 나누었으며, 다중 로지스틱 회귀분석을 통해 돌발적 업무 복귀 요청과 불안 및 피로 간의 연관성을 분석했다.
결과
인구통계학적 및 직업적 특성을 보정한 후, ‘한 달에 여러 번’ 돌발적 업무 복귀를 경험한 그룹은 불안(OR: 4.066, 95% CI: 2.787–5.931)과 피로(OR: 1.875, 95% CI: 1.490–2.359)의 위험이 유의미하게 높았다. 반면, ‘드물게’ 경험한 그룹은 불안(OR: 1.363, 95% CI: 0.921–2.017)과 피로(OR: 0.955, 95% CI: 0.750–1.215) 모두에서 통계적으로 유의미한 연관성이 나타나지 않았다.
결론
돌발적 업무 복귀 요구와 불안 및 피로의 관계는 단순히 선형적이지 않으며, 높은 빈도로 경험할 때만 유의미한 위험 증가와 관련이 있음을 시사한다. 돌발적인 업무 복귀 요청이 신체적 및 정신적 장애를 유발할 수 있는 가능성에 대한 연구는 제한적이며, 이러한 문제를 예방하기 위한 대책이 충분히 발전되지 않았다. 따라서 돌발적 업무 복귀와 관련된 근로자 건강 보호 및 예측 가능한 근무 환경 조성 분야에서 적절한 대책을 수립하고 추가적인 연구를 수행할 필요가 있다.

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Cohort Profile

Occupational and Environmental Health Screening Cohort of Yangsan Korea (OEC-YK): 2012–2023: Dongmug Kang, Eun-Soo Lee, Se-Yeong Kim, Youngki Kim, Youn Hyang Lee, Yoon-Ji Kim; Ann Occup Environ Med 2025;37:e32. Published online September 5, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e32

Abstract Abstract in Korean PDF: The Occupational and Environmental Health Screening Cohort of Yangsan Korea (OEC-YK) was established to monitor long-term health outcomes in workers and environmental high-risk citizens through systematic periodic health examinations. The cohort integrates 623,402 examination instances from 105,768 participants at Pusan National University Yangsan Hospital (2012–2023), encompassing general health checkups, occupational exposure surveillance, cancer screenings, and others including asbestos-related surveillance. Examination types included general health examination (32.4%), cancer screening (20.6%), special health examination (16.2%), night-shift work examination (16.0%), chronic disease screening (4.8%), pre-placement examinations (2.1%), and asbestos-related surveillance (3.6%). At baseline, 59.0% were male and 75.5% were aged between 20 and 59 years. Follow-up rates reached 35.0% at 1 year, 31.9% at 2 years, and 3.2% at 11 years. Notably, the inclusion of systematic asbestos examinations, combined with a national asbestos job exposure matrix, allows detailed study of long-latency occupational diseases. This large-scale longitudinal dataset supports exposure-disease linkage analysis, job-exposure integration, and time-series modeling of worker health trajectories in Korea.; 양산 지역 직업 환경 건강검진 코호트(OEC-YK) : 2012-2023년
양산 지역 직업환경건강검진 코호트(Occupational and Environmental Health Screening Cohort of Yangsan Korea, OEC-YK)는 체계적이고 주기적인 건강검진을 통해 근로자와 환경적 고위험군 시민의 장기적인 건강 영향을 모니터링하기 위해 구축되었다. 본 코호트는 2012년부터 2023년까지 양산부산대학교병원에서 수행한 105,768명의 수검자로부터 수집한 623,402건의 검진 자료를 통합하였으며, 여기에는 일반건강검진, 직업적 노출 감시, 암 검진과 석면 관련 감시를 포함한 기타 사항이 포함되었다. 검진 유형으로는 일반건강검진(32.4%), 암검진(20.6%), 특수건강검단(16.2%), 야간 교대근무 작업자 건강진단(16.0%), 만성질환 검진(4.8%), 배치 전 건강진단(2.1%), 석면 관련 건강검진(3.6%) 등이 포함되었다. 기초 조사 시점에서 남성이 59.0%였고, 20세에서 59세 사이의 연령대가 75.5%를 차지하였다. 추적 관찰률은 1년 시점 35.0%, 2년 시점 31.9%, 11년 시점 3.2%에 도달하였다. 특히, 국가 단위 석면 직업 노출 매트릭스(Job Exposure Matrix)와 연계된 체계적인 석면 건강검진의 도입은 잠복기가 긴 직업성 질환에 관한 정밀한 연구를 가능하게 한다. 이러한 대규모 종단자료는 한국에서의 직업성 노출과 질병 간의 연관성 분석, 직업-노출 정보 통합, 근로자의 건강 경과에 대한 시계열 분석 등을 수행할 수 있는 유용한 자원을 제공한다.

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Original Article

Health effects of weekend work on Korean workers: based on the 6th Korean Working Conditions Survey: Ji-Hyeon Lee, Jin-Young Min, Seok-Yoon Son, Seung-Woo Ryoo, Kyoung-Bok Min; Ann Occup Environ Med 2025;37:e31. Published online September 3, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e31

Abstract Abstract in Korean PDF Supplementary Material: Background
Although weekend work makes up a significant part of work patterns in modern society, research on the health effects of weekend work is relatively limited compared to other types of nonstandard work. This study was conducted to examine the impact of weekend work on the health of Korean workers, aiming to provide evidence to support the development of welfare policies that promote workers’ health.
Methods
This study was conducted using data from the 6th Korean Working Conditions Survey, targeting 35,957 Korean workers who met the research criteria. Based on the survey responses, information was collected on weekend work status and health outcomes, including general health, musculoskeletal pain, headaches or eye pain, fatigue, sleep disorders, depression, anxiety, absenteeism and presenteeism. To examine the association between weekend work and health outcome variables, logistic regression analysis was performed adjusting for sociodemographic and occupational characteristics, with additional stratified analyses conducted according to employment status.
Results
Among the final study population, 11,255 workers, accounting for 30.5% of the total, were weekend workers. After adjusting for sociodemographic and occupational characteristics, weekend work was found to be significantly associated with depression (odds ratio [OR]: 1.08; 95% confidence interval [CI]: 1.00–1.18), anxiety (OR: 1.35; 95% CI: 1.16–1.58), musculoskeletal pain (OR: 1.45; 95% CI: 1.34–1.58), fatigue (OR: 1.49; 95% CI: 1.36–1.62), absenteeism (OR: 1.70; 95% CI: 1.43–2.03), and presenteeism (OR: 1.82; 95% CI: 1.62–2.04). The health effects of weekend work differed between the self-employed and employees, as shown in the results of the stratified analysis.
Conclusions
Weekend work was found to increase the risk of both physical and mental health problems of Korean workers, and the effect varied according to employment status. There is a need to design a comprehensive occupational health policy that reflects the characteristics of different employment statuses.; 한국인 근로자에서 주말근무가 건강에 미치는 영향 : 제6차 근로환경조사 데이터를 활용하여
목적
주말근무는 서비스업 중심의 현대 노동시장에서 상당한 비중을 차지하고 있는 근무 형태이다. 한국에서도 상당수의 근로자들이 주말근무에 종사하고 있지만, 주말근무가 건강에 미치는 영향에 대한 연구는 다른 비표준 근무에 대한 연구에 비해 드물다. 본 연구는 주말근무가 한국인 근로자의 건강에 미치는 영향을 파악하여 근로자 건강 증진을 위한 복지 정책 수립의 근거 자료를 제공하는 것을 목적으로 수행되었다.
방법
본 연구는 제6차 근로환경조사 데이터를 활용하여 연구 기준에 부합하는 한국인 근로자 36,381명을 대상으로 실시되었다. 설문 응답을 바탕으로 주말 근무 여부와 주관적 건강상태, 근골격계 통증, 두통 및 눈의 피로, 전신 피로, 수면 장애, 우울, 불안, 결근 및 프리젠티즘 등의 건강상태에 대한 정보를 수집하였다. 주말근무와 건강변수 간의 연관성을 분석하기 위해 사회인구학적 및 직업적 특성을 보정한 로지스틱 회귀분석을 실시하였으며, 종사상 지위에 따른 층화 분석을 추가로 수행하였다.
결과
최종 선정된 연구 대상자 중 주말근무자는 11,383명(30.46%)이었다. 사회인구학적 및 직업적 특성을 보정한 결과, 주말 근무는 우울(OR 1.09, 95% CI 1.01–1.18), 불안(OR 1.39, 95% CI 1.18–1.63), 근골격계 통증(OR 1.46, 95% CI 1.35–1.58), 피로(OR 1.48, 95% CI 1.36–1.61), 결근(OR 1.72, 95% CI 1.45–2.05), 프리젠티즘(OR 1.84, 95% CI 1.64–2.06)과 유의하게 연관이 있었다. 층화 분석 결과, 주말 근무의 건강영향은 자영업자와 임금근로자 간에 서로 다르게 나타났다.
결론
본 연구는 주말근무와 신체적 및 정신적 건강 상태를 나타내는 다양한 지표 간에 유의한 연관성을 관찰하였다. 주말근무는 한국 노동자의 신체적 및 정신적 건강 문제 위험을 증가시키며, 그 영향은 종사상 지위에 따라 차이가 있었다. 이에 따라 각 종사상 지위의 특성과 위험 요인을 반영한 종합적인 산업보건 정책 설계의 필요성이 대두된다.

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Original Article

Factors affecting heat-related illness symptoms among school food service workers: a cross-sectional study in Korea: Nahyun Kim, Dongwhan Suh, Jia Ryu, Woo Chul Jeong, Yun-Keun Lee, Jinwoo Lee, Hyunjoo Kim; Ann Occup Environ Med 2025;37:e30. Published online September 2, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e30

Abstract Abstract in Korean PDF Supplementary Material: Background
School food service workers are highly likely to develop heat-related illnesses because of their work environment. However, studies that have examined the risk of heat-related illnesses among them are limited. The purpose of this study was to investigate the status of heat exposure, implementation of heat wave countermeasures, and prevalence of heat-related illness symptoms among school food service workers in Korea, and to explore the relationship between them.
Methods
A cross-sectional study was conducted through an online survey of school food service workers from May 25 to June 12, 2023, via three labor unions. We analyzed 6,244 valid responses. We assessed general characteristics, heat-related illness symptoms (heat rash, heat cramps, heat edema, heat exhaustion, heat syncope), duration of heat exposure during heat waves, and heat wave preventive measures. Multiple logistic regression analyses were performed, with adjustments for age, occupation, hypertension, diabetes, and school type.
Results
More than one-third of school food service workers reported heat exposure between May and September exceeding 4 hours daily, and 94.6% experienced at least one heat-related illness symptom during the last year. A dose-response relationship was observed between heat exposure duration and heat-related illness symptoms (p for trend < 0.001). School food service workers who did not have increased rest periods or did not reduce high-heat prepared foods showed significantly higher odds ratios for heat-related illness symptoms.
Conclusions
School food service workers experience substantial heat exposure and a high prevalence of heat-related illness symptoms. The risk of heat-related illness symptoms was associated with extended duration of heat exposure. Increasing rest periods and reducing high-heat food preparation were effective preventive measures. These findings underscore the need for improved heat exposure management and implementation of effective preventive measures to protect the health of school food service workers, with particular attention to appropriate rest periods.; 학교 급식 종사자의 온열질환 증상 위험요인
목적
학교 급식 종사자는 다수의 열원이 존재하는 협소한 공간에서 근무하기 때문에 온열질환 발생 가능성이 높다. 학교 급식 종사자의 작업 중 열 노출 현황, 폭염 대응책 시행, 온열질환 증상 유병률을 조사하고 이들의 관계를 탐구하고자 하였다.
방법
2023. 5. 25- 6. 12까지 학교 급식 관련 3개 노동조합을 통해 온라인 설문조사를 실시해 6,244개의 유효한 응답을 얻었다. 일반적 특성과 온열질환 증상 경험, 폭염 시 근무 중 고온노출 시간, 폭염피해 예방 조치 경험을 조사했다. 온열질환 증상 경험에 관련된 요인을 확인하기 위해 연령, 직종, 고혈압, 당뇨병, 학교 유형을 보정한 다중 로지스틱 회귀분석을 수행했다.
결과
학교 급식 종사자의 3분의 1 이상이 5월부터 9월 사이 일일 4시간을 초과하는 열 노출을 보고했으며, 94.6%가 지난 1년 동안 적어도 하나의 온열질환 질환 증상을 경험했다. 하루 중 고온 노출 시간에 따라 온열질환 증상 경험의 위험은 양반응 관계로 증가했다(P for trend<0.001). 폭염 피해 예방 조치를 경험한 것에 비해 그렇지 않은 경우 온열질환 증상 경험의 위험은 휴게시간 증가(OR=1.86), 고열 제조 반찬 줄임(OR=1.59)에서 통계적으로 유의하게 증가했다.
결론
학교 급식 종사자들은 상당한 열 노출과 높은 온열질환 증상 유병률을 보였다. 온열질환 증상의 위험은 고온 노출이 심할수록 증가하는 것으로 확인되었다. 휴식시간 증가와 고열 제조 음식 조리 감소가 효과적인 예방 조치였다. 이러한 결과는 학교 급식 종사자들의 건강을 보호하기 위한 개선된 열 노출 관리와 효과적인 예방 조치 시행의 필요성을 강조하며, 특히 적절한 휴식시간에 특별한 주의를 기울여야 함을 시사한다.

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Original Article

Occupational skin diseases among cathode material workers in the Korean lithium-ion battery industry: a descriptive case series: Hwa-Yeon Lee, Dong-Hee Koh, Junhyeok Choi, Yong Lim Won; Ann Occup Environ Med 2025;37:e29. Published online September 2, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e29

Abstract Abstract in Korean PDF

Background
Occupational skin diseases are common in industrial settings; however, few studies have examined workers involved in the production of lithium-ion battery cathode-active materials. This study aimed to investigate the patterns and factors associated with skin diseases in these workers.
Methods
Overall, 37 workers with a history of skin disease were recruited from two cathode-active material manufacturing companies. Onsite investigations, semi-structured interviews, and workplace observations were conducted. Information on skin symptoms, affected areas, symptom frequency, and aggravating factors was collected.
Results
The most commonly reported symptoms were pruritus (27.5%), erythema (20.3%), and chemical burns (15.9%). The most commonly affected areas were the hands and forearms (67.6%), whereas 27.0% of workers reported symptoms in unexposed areas, such as the thighs. The symptoms tended to worsen on workdays and improved during holidays. Less-experienced workers reported more frequent symptoms.
Conclusions
Skin diseases during cathode material production appear to be primarily caused by irritants and allergic contact dermatitis, as well as chemical burns caused by exposure to metal dust, such as lithium, nickel, and cobalt. An urgent need exists for appropriate personal protective equipment, improved work environments, and targeted education for new workers.

한국 리튬이온 배터리 산업의 양극재 제조업 근로자에서 발생한 직업성 피부질환: 단면 연구
목적
산업 현장에서 직업성 피부질환은 흔하지만, 리튬이온 배터리 양극활물질 제조공정에 종사하는 근로자를 대상으로 한 피부질환 연구는 거의 없다. 본 연구는 해당 공정 근로자에서의 피부질환 양상과 관련 요인을 파악하고자 하였다.
방법
양극활물질 제조업체 2곳에서 피부질환 경험이 있는 근로자 37명을 대상으로 현장조사, 반구조화 면담, 작업환경 관찰을 실시하였다. 피부 증상, 노출 부위, 증상 빈도 및 악화 요인 등을 조사하였다.
결과
조사 참여 근로자의 주요 증상은 소양감(27.5%), 홍반(20.3%), 화학적 화상(15.9%)이었다. 증상은 손과 팔에 가장 흔하게 나타났으며(47.2%), 18.9%는 허벅지 등 비노출 부위에도 증상을 보고하였다. 근무일에 증상이 악화되고 휴일에 호전되는 경향이 있었다. 경력이 짧은 근로자일수록 증상이 빈번하였다.
결론
양극활물질 제조업에서 확인한 피부질환은 리튬, 니켈, 코발트 등의 금속 분진에 의한 자극성 및 알레르기성 접촉피부염, 화학화상이 주요 원인으로 추정된다. 적절한 보호구 지급과 환경개선, 신입 근로자 대상 교육 체계가 필요하다.

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Original Article

Association between serum iron levels and low-frequency hearing loss in Korean females: Inho Jung, Seunghyeon Cho, Sunjin Jung, JiHwan Kim, Won-Ju Park; Ann Occup Environ Med 2025;37:e28. Published online September 2, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e28

Abstract Abstract in Korean PDF: Background
This study investigates the association between serum iron levels and frequency-specific hearing loss in Korean female population, a topic previously unexplored in auditory health research.
Methods
This study enrolled Korean female participants from the general population. Serum iron levels and hearing thresholds at low (1 kHz) and high (4 kHz) frequencies were assessed, adjusting for potential confounders. Participants were stratified into quartiles based on serum iron levels.
Results
The mean age of the study population was 51.1 ± 10.1 years. Among the 2,987 participants, 344 (11.5%) had abnormal low-frequency hearing thresholds, and 719 (24.1%) had abnormal high-frequency thresholds. Multiple linear regression analysis demonstrated a significant negative association between serum iron levels and low-frequency hearing thresholds (β = –0.012, p = 0.017), whereas no significant association was observed with high-frequency thresholds (β = –0.006, p = 0.352). In a stratified analysis using 50 years (the average menopausal age) as a cutoff, no statistically significant association was identified in participants younger than 50 years. However, in those aged 50 years and older, the negative association between serum iron levels and low-frequency hearing thresholds remained statistically significant.
Conclusions
This study is the first to identify an association between serum iron levels and low-frequency hearing loss in females aged 50 years and older, underscoring the potential role of iron in auditory function. These findings highlight the importance of further research in diverse populations to elucidate the underlying mechanisms and broader clinical implications.; 혈청 철분 수치와 한국 여성의 저주파 난청 간의 연관성
목적
본 연구는 혈청 철분 수치와 특정 주파수 난청 간의 연관성을 조사하였다.
방법
일반 한국인 여성 집단을 대상으로 연구를 진행하였으며, 혈청 철분 수치와 저주파(1 kHz) 및 고주파(4 kHz)에서의 청력 역치를 측정하였다. 또한, 잠재적 교란 변수를 보정한 후 분석을 수행하였다. 연구 대상자는 혈청 철분 수치에 따라 사분위수로 분류하여 분석을 시행하였다.
결과
연구 대상자는 총 2,987명이었으며 평균 연령은 51.1 ± 10.1 이었다. 대상자 중 344명(11.5%)이 저주파 난청을, 719명(24.1%)이 고주파 난청을 보였다. 교란 변수를 보정한 후 선형 회귀 분석을 수행한 결과, 혈청 철분 수치와 저주파 청력 역치 간에는 유의한 역상관 관계가 나타났으나(β = -0.012, p = 0.017), 고주파 청력 역치와는 유의한 연관성이 확인되지 않았다(β = -0.006, p = 0.352). 평균 폐경 연령인 50세를 기준으로 층화 분석을 진행한 결과, 50세 미만에서는 통계적으로 유의한 연관성이 나타나지 않았으나, 50세 이상에서는 이러한 연관성이 유의하게 유지되었다. 이는 혈청 철분 수치가 50세 이상 여성의 저주파 난청과 특히 관련이 있을 가능성을 시사한다.
결론
본 연구는 혈청 철분 수치와 50세 이상 여성의 저주파 난청 간의 연관성을 최초로 규명하였다. 본 연구 결과는 청각 건강에서 철분의 중요성을 강조하며, 보다 다양한 집단을 대상으로 한 추가 연구의 필요성을 제기한다.

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[Special Collection] Paid Sick Leave and Sickness Benefits: Toward the Right to Rest When Sick

Opinion

A sickness benefit for all, leaving no one behind: Daseul Moon, Hongjo Choi; Ann Occup Environ Med 2025;37:e25. Published online July 28, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e25

Abstract Abstract in Korean PDF: South Korea’s pilot sickness benefit program, launched in 2022 across six regions and currently operating in 14 regions as of 2025, represents a critical juncture in the country’s social protection development. While ostensibly designed with inclusive eligibility criteria, the program reveals fundamental paradoxes that illuminate deeper structural inequalities within Korea's dualized labor market. This opinion piece examines how current design choices risk undermining universal health coverage goals by systematically excluding the most precarious workers. The program’s design features—including low replacement rates (60% of the minimum wage) and extended waiting periods—created perverse incentives where the most vulnerable workers accepted the least favorable conditions. This pattern exemplifies what Korpi and Palme termed the “paradox of redistribution,” where targeted approaches ultimately prove less effective than universal ones, with the second phase’s restriction to the bottom 50% income bracket threatening to exacerbate this paradox. Successful implementation will depend on integrating equity, people-centered design, and gender-transformative perspectives into every phase—design, operation, evaluation, and reform. In doing so, South Korea has the opportunity to offer a model of sickness protection that does not simply patch gaps, but actively reshapes the structures that produce health and economic inequalities in the first place.; 모두를 위한 상병수당의 과제
2022년 6개 지역에서 시작되어 2025년 현재 14개 지역에서 시행되고 있는 한국형 상병수당 시범사업은 한국 사회보장의 제도적 발전에 있어 중요한 전환점을 나타낸다. 시범사업은 기존 제도와 비교해 보다 포용적인 자격 기준으로 설계되었지만, 한국의 이중화된 노동시장과 결합한 구조적 불평등을 드러내는 근본적 역설들을 보여주고 있다. 본 논문은 현재의 제도적 설계가 한국의 불안정한 노동자들을 체계적으로 배제하며, 이것이 보편적 건강보장 목표 달성에 장벽으로 작동한다는 점을 분석한다. 1차 시범사업 신청 현황 분석 결과, 낮은 소득대체율(최저임금의 60%)과 긴 대기기간을 포함한 프로그램의 설계 특징들은 가장 취약한 노동자들이 가장 불리한 조건을 받아들이는 역설적 유인을 만들어냈다. 이러한 패턴은 재분배의 역설을 반영하며, 2단계에서 소득 하위 50%로 대상을 제한한 것은 이러한 역설을 심화할 것으로 예상된다. 상병수당 제도의 성공적인 실행은 설계, 운영, 평가, 개혁의 모든 단계에서 형평성, 사람 중심 설계, 젠더 변혁적 관점을 통합하는 데 달려 있다. 이를 통해 건강과 경제적 불평등을 생산하는 구조를 재편하는 제도로서 상병수당을 기대할 수 있을 것이다.

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[Special Collection] Paid Sick Leave and Sickness Benefits: Toward the Right to Rest When Sick

Review

Medical certification in sickness benefit scheme (II): practical approaches for evaluating work disability: Yangwoo Kim, Inah Kim; Ann Occup Environ Med 2025;37:e24. Published online July 28, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e24

Abstract Abstract in Korean PDF Supplementary Material

Work disability evaluation plays a central role in medical certification in sickness benefit schemes. This guides effective decision making for return-to-work timelines. Countries that incorporate it have varied approaches. To improve fairness and consistency, Sweden adopted disease-specific guidelines, particularly for complex health conditions such as mental disorders, cancer, and neurological diseases, whereas in the United Kingdom, a fit note system highlights the ease of fitness-for-work assessments in clinical settings. For a successful implementation of the sickness benefit scheme in Korea, it is essential to review international acumen in work disability evaluation and medical certification. This study also examines challenges that physicians face in certification, factors influencing assessments, and the usefulness of disease-specific guidelines. In many countries, administrative burdens, uncertainty in diagnosis, and ethical conflicts complicate physicians' tasks. Countries such as Sweden, France, and Ireland, have addressed these issues by developing structured certification tools and support systems. Learnings from the recent Korean pilot programs, this review identifies the following core priorities: developing disease-specific guidelines, providing clinical support for physicians’ decisions, and integrating occupational health expertise. These guidelines should function not only as administrative checklists, but also as potential clinical tools that consider both patient functionality and job characteristics. Finally, this study offers policy and practical insights to help design a consistent and fair medical certification system for Korea’s sickness benefit program that encourages timely medical intervention, prevents presenteeism, and promotes sustainable workforce reintegration.

상병수당 제도에서의 의료인증체계(2): 근로능력 평가의 실제
근로능력 평가는 상병수당 의료인증체계에서 가장 핵심적인 요소로, 근로활동불가기간을 정확히 산정하여 근로자의 적절한 직장복귀를 지원한다. 국가마다 근로능력 평가 방식은 상이하며, 형평성과 일관성을 제고하기 위해 스웨덴 등은 질병별 가이드라인을 도입하였다. 특히 스웨덴은 정신질환, 암, 신경계 질환과 같이 평가가 어려운 질병군까지 포함하는 포괄적인 지침을 보유하고 있다. 영국의 핏 노트 제도는 업무적합성 평가를 임상 현장에서 어떻게 적용할 수 있는지에 대한 구체적 사례를 제공한다.
한국의 상병수당 제도가 성공적으로 도입되기 위해서는, 근로능력 평가와 상병수당 의료인증에 관한 국제적 경험을 고찰하는 것이 필수적이다. 본 연구에서는 의료인증 과정에서 의사가 겪는 어려움, 근로능력 평가에 영향을 미치는 요인, 질병별 가이드라인의 활용 가능성 등을 함께 분석하였다. 여러 나라에서 진단 불확실성, 행정 부담, 윤리적 갈등 등으로 인해 의료진이 인증 업무에 어려움을 겪고 있으며, 스웨덴·프랑스·아일랜드 등은 이를 해결하기 위해 구조화된 인증 도구와 지원 체계를 마련하고 있다.
한국의 시범사업 경험을 바탕으로, 본 논문은 질병별 가이드라인 개발, 임상의의 의사결정 지원 체계 마련, 직업보건 전문성의 제도적 통합을 제시하고자 하였다. 이러한 지침은 단순한 행정 문서가 아닌, 환자의 기능과 직무 특성을 반영한 임상 도구로서 기능해야 할 것이다.

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Predictors of prolonged sickness absence after work injuries: a retrospective study using Tukey’s Fence in 66,658 Hong Kong workers
Ziyu Wan, Hayley Y.W. Gu, Heidi K.Y. Lo, Jianfei Xie, Karen P.Y. Liu, Andy S.K. Cheng, Peter H.F. Ng
BMC Public Health.2025;[Epub] CrossRef

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[Special Collection] Paid Sick Leave and Sickness Benefits: Toward the Right to Rest When Sick

Review

Medical certification in sickness benefit schemes (I): theoretical perspectives and return-to-work: Yangwoo Kim, Inah Kim; Ann Occup Environ Med 2025;37:e23. Published online July 28, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e23

Abstract Abstract in Korean PDF Supplementary Material

This study explores the theoretical foundations and practical applications of medical certification within the sickness benefit systems, particularly in the context of Korea’s pilot program and its planned national rollout. While sickness benefit systems have long existed in many Organization for Economic Cooperation and Development (OECD) countries, Korea has only recently initiated pilot projects, largely prompted by the coronavirus disease 2019 pandemic. These systems aim to compensate for income loss due to illness or injury, and medical certification plays a central role in determining eligibility and work ability. This study defines medical certification as a two-stage process: clinical diagnosis and formal assessment of a worker’s ability to return-to-work. The dual nature highlights the distinct objectives of the medical treatment and social security policies. Drawing on international practices, this study reviews the International Classification of Functioning, Disability, and Health (ICF) as a key global framework for assessing disability and work ability, although it acknowledges the limitations of its application to sickness benefits. The research emphasizes a shift in global trends toward return-to-work–oriented certification models, such as the UK’s “fit note” system, which focuses on evaluating fitness-for-work rather than merely documenting illness. Sweden and Japan also offer models that integrate rehabilitation with flexible work accommodations. Three key issues were identified in Korea’s system: the role of medical certification and concerns about moral hazard, the burden of proof and workload on physicians, and public perceptions of the program’s purpose. We believe that medical certification should not only verify illness but also support early intervention and a healthy workforce. Ultimately, this study advocates for a balanced and efficient medical certification system tailored to Korea’s healthcare context closely aligning with labor market policies to ensure long-term sustenance and integration of the sickness benefit program.

상병수당 제도에서의 의료인증체계(1): 이론적 배경과 직장복귀
본 연구는 한국의 시범사업과 향후 전국적 시행을 앞둔 상황에서 상병수당 제도에서 의료인증의 이론적 기반과 실제적 적용을 살펴보고자 하였다. 상병수당 제도는 많은 OECD 국가에서 오래전부터 시행되어 왔으나, 한국에서는 COVID-19 팬데믹을 계기로 최근에야 시범사업이 시작되었다. 이 제도는 질병이나 부상으로 인한 소득 상실을 보상하는 것을 목적으로 하며, 의료증명은 수급 자격 및 업무 수행 능력을 판단하는 핵심적 요소이다.
의료인증은 진단이라는 1단계와, 업무복귀 가능성을 공식적으로 평가하는 2단계로 구성되며, 이는 의료적 목적과 사회보장 정책 목적의 차이를 드러낸다. 국제적 관행을 참고하여, 본 연구는 장애 및 업무능력 평가의 세계적 기준인 ‘기능장애건강국제분류(ICF)’를 검토하되, 이를 상병수당에 적용하는 데 있어 한계점도 지적한다. 연구는 세계적으로 ‘복귀 중심(return-to-work)’ 의료증명 체계로의 전환이 이루어지고 있음을 강조한다. 예를 들어, 영국의 ‘핏 노트(fit note)’ 제도는 단순한 질병 증명에서 벗어나 업무수행 가능성을 평가하는 방식이다. 스웨덴과 일본은 재활과 유연한 업무조정을 포함한 모델을 운영 중이다.
한국 제도 설계에서 중요한 세 가지 이슈는 의료인증의 역할과 도덕적 해이 우려, 의료진의 입증 책임 및 행정 부담, 그리고 제도 목적에 대한 대중의 오해이다. 본 연구는 의료적 증명이 단순한 질병 확인을 넘어 조기 개입과 건강한 노동력 유지로 이어져야 한다고 주장한다.
궁극적으로 본 연구는 한국의 의료이용 환경에 적합하고 노동시장 정책과 조화를 이루는, 균형 있고 효율적인 의료증명 체계의 구축을 제안한다. 이는 상병수당 제도의 지속 가능성과 신뢰성을 확보하는 데 핵심적인 요소다.

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Impact of sick leave on general practitioner visits among Serbia’s working population
Snezana Knezevic, Tamara Gajic, Dragan Vukolic, Tatjana Marinkovic, Aleksandar Stevanovic, Dragan Marinkovic, Nela Djonovic, Dalibor Stajic
Srpski arhiv za celokupno lekarstvo.2026; 154(1-2): 68. CrossRef
Medical certification in sickness benefit scheme (II): practical approaches for evaluating work disability
Yangwoo Kim, Inah Kim
Annals of Occupational and Environmental Medicine.2025; 37: e24. CrossRef

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[Special Collection] Paid Sick Leave and Sickness Benefits: Toward the Right to Rest When Sick

Review

Introducing statutory paid sick leave in South Korea: necessity and key considerations: Jinwoo Lee; Ann Occup Environ Med 2025;37:e22. Published online July 28, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e22

Abstract Abstract in Korean PDF Supplementary Material: South Korea remains one of the few Organization for Economic Cooperation and Development countries without a statutory paid sick leave system or a public sickness benefit program. This paper examines the necessity of introducing statutory paid sick leave in South Korea and outlines key considerations for its implementation. The “right to rest when sick” is a fundamental health and labor right that ensures workers can recover from illness without risking job loss or income insecurity. A comparative review of international systems demonstrates that most countries have institutional mechanisms to support workers during non-work-related illnesses or injuries through paid sick leave and/or sickness benefits. In contrast, South Korean workers—especially those in small workplaces or non-regular employment—face limited access to such protections. The absence of these systems exacerbates social inequality and increases the risk of presenteeism and delayed medical care. Introducing statutory paid sick leave is not only a public health investment but also a measure to promote labor rights, reduce productivity losses, and prevent poverty caused by illness. The implementation of such a system must ensure universal coverage, prohibit employer retaliation, and be integrated with future sickness benefit programs to create a comprehensive social safety net.; 한국에서의 법정 유급병가 필요성과 도입 시 고려할 지점
한국은 법정 유급병가 제도 및 공적 질병수당 제도가 없는 몇 안 되는 OECD 국가 중 하나이다. 본 논문은 한국에서 법정 유급병가 제도의 도입 필요성을 검토하고, 제도 설계 시 고려해야 할 주요 사항들을 제시한다. ‘아플 때 쉬는 권리’는 노동자가 질병으로부터 회복할 수 있도록 보장하는 기본적인 건강권이자 노동권이다. 국제 비교를 통해 다수 국가들이 유급병가와 질병수당 제도를 통해 업무 외 질병 또는 부상 시 노동자를 지원하는 제도적 장치를 갖추고 있음을 확인할 수 있다. 반면, 한국의 노동자들—특히 소규모 사업장 종사자나 비정규직—은 이러한 보호로부터 배제되어 있는 경우가 많다. 이로 인해 사회적 불평등이 심화되고, 프리젠티즘(presenteeism) 및 의료 이용 지연의 위험이 증가하고 있다. 법정 유급병가 제도의 도입은 공중보건에 대한 투자일 뿐만 아니라, 노동권을 증진하고 생산성 손실을 줄이며 질병으로 인한 빈곤을 예방하는 수단이다. 제도 도입 시 보편적 적용, 사용자 불이익 조치 금지, 향후 수병수당 제도와의 연계를 통한 포괄적 사회안전망 구축이 핵심적으로 고려되어야 한다.

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