Annals of Occupational and Environmental Medicine

Original Article

Association of heavy metal complex exposure and neurobehavioral function of children: Minkeun Kim, Chulyong Park, Joon Sakong, Shinhee Ye, So young Son, Kiook Baek; Ann Occup Environ Med 2023;35:e23. Published online July 6, 2023; DOI: https://doi.org/10.35371/aoem.2023.35.e23

Abstract Abstract in Korean PDF Supplementary Material PubReader ePub

Background

Exposure to heavy metals is a public health concern worldwide. Previous studies on the association between heavy metal exposure and neurobehavioral functions in children have focused on single exposures and clinical manifestations. However, the present study evaluated the effects of heavy metal complex exposure on subclinical neurobehavioral function using a Korean Computerized Neurobehavior Test (KCNT).

Methods

Urinary mercury, lead, cadmium analyses as well as symbol digit substitution (SDS) and choice reaction time (CRT) tests of the KCNT were conducted in children aged between 10 and 12 years. Reaction time and urinary heavy metal levels were analyzed using partial correlation, linear regression, Bayesian kernel machine regression (BKMR), the weighted quantile sum (WQS) regression and quantile G-computation analysis.

Results

Participants of 203 SDS tests and 198 CRT tests were analyzed, excluding poor cooperation and inappropriate urine sample. Partial correlation analysis revealed no association between neurobehavioral function and exposure to individual heavy metals. The result of multiple linear regression shows significant positive association between urinary lead, mercury, and CRT. BMKR, WQS regression and quantile G-computation analysis showed a statistically significant positive association between complex urinary heavy metal concentrations, especially lead and mercury, and reaction time.

Conclusions

Assuming complex exposures, urinary heavy metal concentrations showed a statistically significant positive association with CRT. These results suggest that heavy metal complex exposure during childhood should be evaluated and managed strictly.

소아 신경 행동 기능과 중금속 복합 노출의 관련성
목적
중금속 노출은 많은 국가에서 공중보건 관련해서 큰 과제이다. 중금속 노출에 따른 신경계의 영향을 보기 위한 과거 연구들 에서는 노출의 경우 단일 중금속에 대한 노출을, 노출에 따른 결과로는 임상적 징후 또는 질환의 진단을 중점으로 이루어졌다. 본 연구는 중금속 복합 노출과 준임상적 수준을 포함한 신경 행동 기능의 관계를 확인하기 위해 계획되었다.
방법
소변 중 수은, 납, 카드뮴 분석과 한국형 컴퓨터 신경행동검사중 부호 숫자 짝짓기 검사와 선택 반응 시간 검사를 211명의 10-12세의 소아들에게 시행한 자료를 바탕으로, 반응 시간과 소변 중 중금속 수치를 성별과 연령을 보정하여 편상관분석과 회귀분석으로 분석하였다. 그 중 유의미한 결과가 확인되는 항목에 대해 복합노출에 대한 분석을 Bayesian Kernel Machine regression, Weighted Sum Regression analysis, Quantile G-computation 기법을 활용하여 심층 분석하였다.
결과
부호숫자 짝짓기 검사의 경우 203건, 선택반응 검사의 경우 198건에 대해 분석을 수행하였다. 부호숫자 짝짓기 검사의 경우 단일 중금속과 편상관분석 및 다중회귀분석에서 유의미한 관련성이 보이지 않았다. 선택반응 검사의 경우 편상관분석상 개별 중금속과는 별다른 관계를 보이지 않았으나 다중회귀분석에서 수은 및 납과 유의미한 관련성을 보였다. 복합노출에 대한 분석방법인 Bayesian Kernel Machine regression, Weighted Sum Regression analysis, Quantile G-computation 기법에서 소변 중 중금속과 선택 반응 시간 검사의 반응시간 간에 양의 상관관계를 보였으며, 세 분석에서 비교적 일관되게 복합노출 시 수은과 납이 선택 반응 시간 검사의 반응시간에 양의 상관관계를 보였다. 카드뮴의 경우 뚜렷한 양의 상관관계를 보이지 않거나 그 기여도가 적었다.
결론
본 연구 샘플의 요중 수은, 납, 카드뮴의 범위는 임상적인 증상을 나타낼 수 있는 것으로 알려진 여러 기준 수준에 비해 매우 낮은 수준에 있으나, 그 범위 내에서도 선택 반응 검사와 중금속의 복합노출은 통계적으로 유의한 반응시간 차이를 보였다. 위 결과는 소아 중금속 복합 노출이 매우 낮은 농도 수준에서도 신경계에 영향을 미친다는 가능성을 제시하며, 이는 중금속 노출에 대한 더욱 민감하고 엄격한 관리가 필요함을 보여주는 결과이다.

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Research Article

Performance assessment on the Korean Computerized Neurobehavioral Test using a mobile device and a conventional computer: an experimental study: Young Seok Byun, Sung Kyu Park, Joon Sakong, Man Joong Jeon; Ann Occup Environ Med 2018;30:55. Published online August 29, 2018; DOI: https://doi.org/10.1186/s40557-018-0264-6

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Background

The Korean Computerized Neurobehavioral Test (KCNT) is a psychological assessment tool used as part of Workers’ Special Health Examinations in Korea. Due to the spread of mobile technology, this study aimed to compare results of the KCNT administered on a tablet PC versus a desktop computer, and, therefore, assess the clinical applicability of mobile devices.

Methods

A total of 72 participants enrolled in this study. Their age, sex, and years of formal education were collected during an interview, as well as their typing speed. The test battery comprised five subtests: Simple Reaction Time test, Choice Reaction Time test, Digit Addition test, Symbol-Digit Substitution test, and Finger Tapping Speed test. Participants repeated the KCNT test battery in a randomly assigned order using four different testing systems: a desktop computer equipped with a conventional 106-key keyboard (System 1), a desktop computer equipped with a simplified keyboard (System 2), a tablet PC with a simplified 17-key on-screen keyboard (System 3), and a tablet PC equipped with a simplified keyboard (System 4).

Results

Results of the Digit Addition test did not differ significantly for different testing systems. In contrast, results of the Simple Reaction Time test, Choice Reaction Time test, Symbol-Digit Substitution test, and Finger Tapping test were lower for the tablet PC (Systems 3 and 4) compared to the desktop computer (Systems 1 and 2). Systems 1 and 2 did not show significantly different results. Performance on System 3 was inferior to that on System 4, only for the Choice Reaction Time test and Finger Tapping Speed test. There were also significant differences in performance by computer familiarity when adjusted for age and education; however, the performance of each group on the test systems showed similar patterns.

Conclusions

It is not recommended to use a tablet PC to administer the KCNT to evaluate neurobehavioral performance for the Simple Reaction Time test and Choice Reaction Time test; however, tablet PCs with an on-screen keyboard may be used to perform the Digit Addition test, and the Symbol-Digit Substitution test and Finger Tapping Speed test to a limited degree.

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Research Article

Effects of computer familiarity and computer type on the performance of Korean computerized neurobehavioral test: Nak Joon Baek, Gun Il Park, Young Seok Byun, Man Joong Jeon, Joon Sakong; Ann Occup Environ Med 2016;28:44. Published online September 9, 2016; DOI: https://doi.org/10.1186/s40557-016-0129-9

Abstract PDF PubReader ePub

Background

It is thought that computer familiarity has increased significantly since 2004 as well as the use of computers. This study aimed to evaluate the effects of computer familiarity and types of keyboard and computer on the performance of the Korean computerized neurobehavioral test (KCNT), and to identify which parameters of KCNT were affected by aforementioned factors.

Methods

A total of 85 subjects were classified into three groups of computer familiarity by Korean typing speed. Their age, gender and the level of education were also collected. The parameters of KCNT included simple reaction time, choice reaction time, addition, symbol digit, and finger tapping speed. The test was conducted using three types of computers: a laptop computer, a laptop computer with a simplified keyboard, and a desktop computer with a simplified keyboard.

Results

Parameters including the simple reaction time, choice reaction time, addition, and symbol digit, and the finger tapping speed of non-dominant hand showed no significant differences in the results among the three groups by computer familiarity after age and educational years were controlled as covariates. The mean reaction time of the simple reaction time and the choice reaction time with a simplified keyboard was significantly shorter compared to that with a typical keyboard. With regard to type of computer, the mean reaction time of the simple reaction time and the choice reaction time was significantly reduced when performed with the desktop computer with a simplified keyboard.

Conclusions

Unlike previous study results, the choice reaction time, the addition, and the finger tapping speed of dominant hand were the only parameters affected by the computer familiarity. Both the type of keyboard and the type of computer significantly influenced the simple reaction time and the choice reaction time. Therefore, it is recommended to use a desktop computer with a simplified keyboard for such parameters.

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Performance assessment on the Korean Computerized Neurobehavioral Test using a mobile device and a conventional computer: an experimental study
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Original Article

Association Between Blood Lead Concentration and Computerized Neurobehavioral Performance in Korean Elementary School Students: Yeon Cheol Kim, Man Joong Jeon, Yun Chul Hong, Chul Gab Lee, Mi Na Ha, Ho Jang Kwon, Joon Sakong; Korean Journal of Occupational and Environmental Medicine 2011;23(2):183-191. Published online June 30, 2011; DOI: https://doi.org/10.35371/kjoem.2011.23.2.183

Abstract PDF

OBJECTIVES
This study was conducted to evaluate association between computerized neurobehavioral performance and blood lead concentration in Korean elementary school students.
METHODS
The subjects were 1,077 elementary school students of Seoul, Busan, Daegu and Gwangju. Blood lead concentration was measured and computerized neurobehavioral performance tests were performed.
RESULTS
Blood lead concentration of the subjects was in the range of 0.20 and 7.39 microg/dl. The geometric mean of the subjects' blood lead concentration was 1.41 microg/dl. As blood lead concentration increased, reaction time to the symbol digit tended to increase significantly and linearly. As a result of LOWESS(locally weighted scatterplot smoothing), increasing reaction time to the symbol digit was observed.
CONCLUSIONS
As blood lead concentration under the CDC (center for disease control and prevention) reference value increased, reaction time to the symbol digit tended to increase. But, as the number of subjects over 3 microg/dl is small, it is difficult to make a definite conclusion. If confounding variables are controlled properly in a follow-up study, we can obtain a more definite conclusion.

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Association of heavy metal complex exposure and neurobehavioral function of children
Minkeun Kim, Chulyong Park, Joon Sakong, Shinhee Ye, So young Son, Kiook Baek
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Performance assessment on the Korean Computerized Neurobehavioral Test using a mobile device and a conventional computer: an experimental study
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The association between lead concentration in the blood and neurobehavioral performance of children
Dae-Seon Kim, Seungchul Ahn, Seungdo Yu, Eun-Hee Lee
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Evaluation of reliability of computerized neurobehavioral tests in Korean children
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Original Article

Association of Blood Mercury Level and Neurobehavioral Performance in Korean Elementary School Students: Joon Sakong, Man Joong Jeon, Sung Ho Yun, Yun Chul Hong, Chul Gab Lee, Young Ki Kim, Mina Ha, Ho Jang Kwon; Korean Journal of Occupational and Environmental Medicine 2010;22(4):324-330. Published online December 31, 2010; DOI: https://doi.org/10.35371/kjoem.2010.22.4.324

Abstract PDF

OBJECTIVES
This study was conducted to examine the effect of blood mercury on neurobehavioral performance in Korean elementary school students.
METHODS
We measured the blood mercury concentration in 1,077 elementary school students from Seoul, Busan, Daegu and Gwangju, then the students underwent computerized neurobehavioral test.
RESULTS
The mean concentration of blood mercury of study subjects was 2.10 microg/L. An increased blood mercury was associated with an increased reaction time in digit addition and symbol digit.
CONCLUSIONS
The blood mercury concentration of study subjects was very high compared to findings in a foreign country. We found several associations between blood mercury level and neurobehavioral performance.

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Performance assessment on the Korean Computerized Neurobehavioral Test using a mobile device and a conventional computer: an experimental study
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Original Article

Relationship between Blood Lead Concentration and Neurobehavioral Function of Children: Kwang Seub Park, Jae Yong Park, Joon Sakong; Korean Journal of Occupational and Environmental Medicine 2009;21(2):131-142. Published online June 30, 2009; DOI: https://doi.org/10.35371/kjoem.2009.21.2.131

Abstract PDF

OBJECTIVES
To evaluate effects of lead on the central nervous system of children by measuring blood lead concentration, computerized neurobehavioral function and intelligence of elementary school students.
METHODS
The study was conducted with 208 elementary school students living in the vicinity of Pohang Industrial Complex in October and November, 2005. Data on demographic characteristics, living environments and lifestyle habits were collected from subjects.
RESULTS
Blood lead levels of elementary school students ranged from 0.76-4.97 microg/dl, which is below the 10 microg/dl recommended level of CDC. The blood lead levels were similar with those reported in other domestic and international studies. Neurobehavioral tests revealed that most third grade students reacted slowly and their speed declined in simple reaction time (p<0.05), choice reaction time (p<0.05), symbol digit substitution (p<0.01), finger tapping speed nondominant hand (p<0.05) as blood lead levels increased. Sixth grade students demonstrated significance in test performance, and displayed blood lead levels of 2.00-4.00 microg/dl. Results of intelligence testing showed significantly low performance in IQ (p<0.05), vocabulary ability (p<0.05), reasoning ability (p<0.05), mathematical ability (p<0.05) and perception ability (p<0.05) among third grade students who displayed high levels of blood lead concentration. Sixth grade students showed significantly low performance in vocabulary ability (p<0.05) at high level of blood lead concentration. The difference in mean IQ scores between the group with blood lead level of < or =2.00 microg/dl and the group with blood lead level > or =3.00 microg/ dl was 3.21 in third grade students and 4.28 in sixth grade students. Low academic achievement was observed among third grade students (p<0.05) and six grade students (p<0.05) as the average blood lead level increased. Correlation analysis on the association of blood lead concentration with neurobehavioral tests revealed a positive correlation between blood lead levels and reaction time of choice reaction time and symbol digit substitution in third grade students. A positive correlation was observed between blood lead levels and reaction time of symbol digit substitution and finger tapping speed in sixth grade students. There was a negative correlation between blood lead levels and reasoning ability of third grade students (r=-0.247) and vocabulary ability of six grade students (r=-0.255).
CONCLUSION
There have been few studies on the effects of blood lead on the central nervous systems of children in Korea. The study supports the findings of earlier studies that blood lead has an impact on children. However, the study did not confirm significant association of blood lead concentration with each neurological and motor test conducted for this study due to a small sample size and relatively low blood lead levels of elementary school students. Further studies using a similar assessment methods would be helpful to evaluate the effects of low blood lead levels on the central nervous systems of children.

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Original Article

Assessment of Changes in Computerized Neurobehavioral Performance across Multiple Test Sessions: Sung Tae Chung, Man Joong Jeon, Joon Sakong; Korean Journal of Occupational and Environmental Medicine 2007;19(4):251-258. Published online December 31, 2007; DOI: https://doi.org/10.35371/kjoem.2007.19.4.251

Abstract PDF

OBJECTIVE: A cross-sectional study was performed to assess changes in computerized neurobehavioral performance across multiple test sessions for developing a valid performance level and reducing test time.
METHODS
The study was conducted on 118 male car painters exposed to low-dose, mixed organic solvents. The study controls were 113 unexposed reference workers matched for age and educational year from different sections of the same factory. Each worker completed a medical and occupational exam and questionnaire. Three tests of the Swedish Performance Evaluation System (5 minutes of Simple Reaction Time, 9 sessions of Symbol Digit, and 4 sessions of Finger Tapping Speed) were administered to each group.
RESULTS
The mean age, mean duration of employment, and mean years of education were 33 years, 6.7 years, and 12 years in both groups, respectively. The mean reaction times of the Simple Reaction Time increased with the lapse of time. The known group difference between the exposed and control groups was larger for the first minute than for the successive 3 minutes. Both groups showed improved performance across the first to the seventh sessions on Symbol Digit. Following the seventh session, the performance levels of Symbol Digit had worsened. The t statistic of the two groups was the largest when the two mean reaction times were calculated from the sessions of the fifth to the seventh. In the dominant and non-dominant hands, the number of taps increased and decreased, respectively, across the sessions on Finger Tapping Speed. The known group difference was the largest when comparing the performances from the first to the second sessions.
CONCLUSIONS
For valid interpretation and timesaving in computerized neurobehavioral tests, the following is recommended: one practice and one test session for Simple Reaction Time, four practice and three test sessions for Symbol Digit, and one practice and two test sessions for Finger Tapping Speed.

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Original Article

The Effects of Indoor Air Quality on the Neurobehavioral Performance of Elementary School Children: Dae Seop Kim, Sun Ju Kim, Si Young Park, Man Joong Jeon, Gyu Tae Kim, Chang Yoon Kim, Jong Hak Chung, Sung Ok Baek, Joon Sakong; Korean Journal of Occupational and Environmental Medicine 2007;19(1):65-72. Published online March 31, 2007; DOI: https://doi.org/10.35371/kjoem.2007.19.1.65

Abstract PDF

OBJECTIVES
Most studies on the indoor air quality of newly built schools have focused only on the number of schools exceeding a standard or on subjective symptoms, such as sneezing, irritated eyes and an irritated nose. However, there has been no report on how poor indoor air quality affects children's academic performance. This study evaluated the effects of indoor air quality on the neurobehavioral performance of elementary school children.
METHODS
This study measured the indoor air pollutants and compared children's performance, using a computerized neurobehavioral test, between a newly built and a 12-year-old school. In addition, a questionnaire was administered regarding the indoor air quality related symptoms of children in a newly built and a 12-year-old school.
RESULTS
In the newly built school, the formaldehyde levels in the 1st and 4th classes with an open window were 34.6 and 27.3 microgram/m3, respectively. The levels in the 1st and 4th classes with the window closed were 80.2 and 127.1 microgram/m3, respectively. In the 12-year-old school, the formaldehyde levels in 1st and 4th class with open and closed window were 12.6 and 7.5 microgram/m3, and 19.8 and 25.2 microgram/m3, respectively. With respect to total volatile organic compounds, the levels in the 1st and 4th classes with the window open in the newly built school were 87.2 and 428.2 microgram/m3, respectively. In the 1st and 4th classes with the window closed, the total volatile organic compounds were 1,283.5 and 1,715.4 microgram/m3, respectively. In the 12-year-old school, the total volatile organic compounds were 240.9 and 150.8 microgram/m3, and 371.9 and 448.0 microgram/m3 in the 1st and 4th classes, respectively. In the case of a newly built school, the performance of the students in the neurobehavioral test in the 4th class with the window closed was 8.3% lower than for those in the 1st class with the window closed, but was only 5.9% lower when the windows were open. There was a statistical significant difference in the total numbers of symptoms between the two schools.
CONCLUSIONS
These results suggest a proper evaluation of the indoor air quality within schools is required into both the level of contamination and the health effects of these contaminants toward children.

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Performance assessment on the Korean Computerized Neurobehavioral Test using a mobile device and a conventional computer: an experimental study
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Original Article

Blood Lead Levels in Umbilical Cord and Neonatal Neurobehavioral Status: Jung Are Kim, Seong Ah Kim, Chae Yong Lee, Sang Jae Jung, Byung Yeol Chun; Korean Journal of Occupational and Environmental Medicine 2005;17(1):58-69. Published online March 31, 2005; DOI: https://doi.org/10.35371/kjoem.2005.17.1.58

Abstract PDF: OBJECTIVES
To investigate the relation between umbilical cord blood lead level lower than 10 microgram/dl and neonatal neurobehavioral performance.
METHODS
Umbilical cord blood lead level, as an indicator for prenatal exposure to lead, and Brazelton neonatal behavioral assessment scale (NBAS), as an indicator for effect, were determined in 86 neonates in Gumi, Kyungpook, Korea. The blood levels were measured by graphite furnace atomic absorption spectrophotometer. Development was assessed by NBAS at birth in 86 neonates and at 1 month in 55 neonates.
RESULTS
The mean cord blood lead levels of the 86 and 55 neonates were 3.90 +/- 0.71 microgram/dl (range 2.24 - 5.39 microgram/dl) and 3.88 +/- 0.70 microgram/dl (range 2.24~5.03 microgram/dl), respectively. We used the median value of 4 microgram/dl to divide into low- and high- lead level groups. There was a significant difference in the peak of excitement at birth, and in the animate visual, inanimate visual, inanimate auditory, activity level, peak of excitement, and liability of states at one month, between the two groups. For cluster scores, motor system and state organization scores showed significant differences between the two groups. For adjusting the potential confounding effect of intial difference, differences of the scores between the two groups at one month were analysed with ANCOVA. The results of ANCOVA showed the significant difference between the two groups.
CONCLUSIONS
The findings suggest that prenatal low-level lead exposure, even lower than 10 microgram/dl, might affect the neonatal neurobehavioral development.

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Original Article

Effect of the Type of Computer on Computerized Neurobehavioral Performance Tests: Gyu Tae Kim, Chang Yoon Kim, Joon Sakong; Korean Journal of Occupational and Environmental Medicine 2004;16(3):276-286. Published online September 30, 2004; DOI: https://doi.org/10.35371/kjoem.2004.16.3.276

Abstract PDF

OBJECTIVES
It is difficult to carry and set up a large numbers of computers when computerized neurobehavioral tests are performed to many subjects. There are difficulties in mobilizing and resetting desktop computers and so, the use of desktop computers will decrease due to the recent increasing popularity of laptop computers. However, it is essential that there is no difference between the tests performed on a laptop and on a desktop computer. This study was conducted to estimate the effect that the type of computer has on computerized neurobehavioral performance tests.
METHODS
Three types of computers were applied. Type 1 was a normal laptop computer. Type 2 was a laptop computer that was remodeled and equipped with a modified keyboard. A common desktop computer with a remodeled keyboard as type 3. The computerized tests included Simple Reaction Time, Choice Reaction Time, Symbol Digit, and Finger Tapping Speed. A total of 60 subjects were examined by the identical tester in the same testing conditions. The computers were randomly allocated, which were used in the test and let examinees take tests with the separate computers.
RESULTS
There were no significant differences among the computers for the results of the Simple Reaction Time and Finger Tapping Speed tests. The mean reaction time, error number of Choice Reaction Time and mean reaction time, correct mean reaction time, error number of Symbol Digit produced significantly different results among the three types of computers.
CONCLUSION
This study indicates that with only a laptop computer the Simple Reaction Time test using the space bar was useful. But with the laptop computer, the Choice Reaction Time test using the four-direction key and the Symbol Digit test using the upper end number key were unsuitable. The keyboard should be developed further for the Choice Reaction Time and Symbol Digit tests. Among the three computers, we recommend the use of the desktop computer with the remodeled keyboard which the examinees are familiar with and the laptop computer with the remodeled keyboard.

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Performance assessment on the Korean Computerized Neurobehavioral Test using a mobile device and a conventional computer: an experimental study
Young Seok Byun, Sung Kyu Park, Joon Sakong, Man Joong Jeon
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Effects of computer familiarity and computer type on the performance of Korean computerized neurobehavioral test
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Original Article

Effects of Familiarity with Computer and Type of Keyboard on Computerized Neurobehavioral Performance Tests: Man Joong Jeon, Chang Yoon Kim, Jong Hak Chung, Woo Taek Lim, Joon Sakong; Korean Journal of Occupational and Environmental Medicine 2004;16(2):178-190. Published online June 30, 2004; DOI: https://doi.org/10.35371/kjoem.2004.16.2.178

Abstract PDF

OBJECTIVES
A stratified cross-over study was conducted to evaluate the effects of familiarity with computer on the performance of computerized neurobehavioral tests. Effects of keyboard type on the relationship between familiarity with computer and performance of computerized neurobehavioral tests were also examined.
METHODS
We tested 70 persons classified into three groups according to degree of familiarity with computer: Group 1 was people with no computer competency, Group 2 had slight working experience on the computer, and Group 3 were highly competent and efficient on the computer. For each group, we executed 4 tests of the Korean version of the Swedish Performance Evaluation System (Simple Reaction Time, Addition, Symbol Digit, and Finger Tapping Speed). Three types of keyboard were applied for all three groups. Type 1 keyboard was a conventional layout with 106 keys. We removed the unused keys except for the 17 which were used in the test and remodeled the normal keyboard into Type 2 keyboard with 17 keys (10 numeric keys, 4 arrow keys, space bar, and both Ctrl keys). Type 3 keyboard with 11 keys consisted of 10 numeric keys and the space bar was newly developed for the computerized neurobehavioral performance test.
RESULTS
It was found that Simple Reaction Time, Addition, and Finger Tapping Speed were not affected by familiarity with computer and type of keyboard. The mean reaction time of Symbol Digit adjusted by age and educational level with Type 1 keyboard was found to have significant difference among the three groups (F=3.347, p=0.041). The performance of Symbol Digit in Group 1 was found to be significantly lower than that in Group 2. The performances of Symbol Digit measured with Types 2 and 3 keyboards were not found to have significant differences among the three groups. In Groups 1 and 3, the performances of Symbol Digit measured with Type 1 keyboard were found to be significantly lower than those of other keyboards.
CONCLUSIONS
According to the above results, Simple Reaction Time, Addition, and Finger Tapping Speed have high priority over other neurobehavioral tests for the workers having varying degrees of computer familiarity. It is also suggested that familiarity with computer and keyboard type needs to be considered in interpretation of the performance of Symbol Digit. We recommended executing the computerized neurobehavioral test with keyboards 2 or 3 to reduce the effect of computer familiarity.

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Performance assessment on the Korean Computerized Neurobehavioral Test using a mobile device and a conventional computer: an experimental study
Young Seok Byun, Sung Kyu Park, Joon Sakong, Man Joong Jeon
Annals of Occupational and Environmental Medicine.2018;[Epub] CrossRef
Effects of computer familiarity and computer type on the performance of Korean computerized neurobehavioral test
Nak Joon Baek, Gun Il Park, Young Seok Byun, Man Joong Jeon, Joon Sakong
Annals of Occupational and Environmental Medicine.2016;[Epub] CrossRef
Assessment of Availability of Korean Computerized Neurobehavioral Test in Patients with Brain Injury
Tae-Hoon Kim, Man-Joong Jeon, Joon Sakong
The Journal of the Korea Contents Association.2013; 13(6): 339. CrossRef
Neurobehavioral Changes of Shipyard Painters Exposed to Mixed Organic Solvents
Choong Ryeol LEE, Kyoung Sook JEONG, Yangho KIM, Cheol In YOO, Ji Ho LEE, Young Hee CHOI
INDUSTRIAL HEALTH.2005; 43(2): 320. CrossRef

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Original Article

Assessment of Neurobehavioral Performance Among Rotogravure Printing Workers Exposed to Toluene: Soo Young Chung, Seong Kyu Kang, Dae seong Kim, Se Hoon Lee; Korean Journal of Occupational and Environmental Medicine 2004;16(2):115-128. Published online June 30, 2004; DOI: https://doi.org/10.35371/kjoem.2004.16.2.115

Abstract PDF

OBJECTIVES
The aims of this study were to investigate the occupational exposure level to toluene among rotogravure printers and neurobehavioral effects among them.
METHODS
Fifty rotogravure printers and 147 controls participated in this study. Environmental and biological monitoring was performed for the investigation of toluene exposure level, and neurobehavioral performance test were performed by using the Behavioral Assessment and Research System with Korean language instructions(BARS-K).
RESULTS
The major results were as follows; 1. Geometric mean toluene concentrations in the ambient air of 5 rotogravure printing workplaces were 10.5 (GSD 5.9)~181.9 (GSD 17.7), with a grand total of 56.7 (GSD60.9) ppm. 2. The geometric mean urinary hippuric acid level for rotogravure printers of 5 workplaces were 0.31 (GSD 0.11)~5.14 (GSD 0.55), with the grand total of 1.87 (GSD 2.06) g/g creatinine. 3. There was a linear correlation between hippuric acid levels in urine and the exposed toluene in air: urine hippuric acid (g/g creatinine)=0.03 toluene (ppm) + 0.15 (r=0.899, p<0.01, n=50). 4. After adjustment for confounders, significant associations were found between toluene exposure and Digit span forwards, Digit span backwards, Tapping preferred hand, Symbol digit and Selective attention trials.
CONCLUSIONS
1. Rotogravure printers were occupationally exposed to relatively high concentration to toluene, and their neurobehavioral performances were decreased. 2. The BARS neurobehavioral testing program, which minimizes the use of text in the instructions, was very effective in overcoming the cultural barriers in neurobehavioral testing.

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Evaluation of environmental and biological monitoring methods for toluene exposure assessment in paint industry
Mansour A. Balkhyour, Radhouane Chakroun, Faycal Faidi
Saudi Journal of Biological Sciences.2023; 30(2): 103538. CrossRef

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Original Article

Impact of Subject and Time Related Factors on Reliability of Neurobehavioral Tests: Joon Sakong, Man Joong Jeon, Nak Jung Sung, Gyu Tae Kim; Korean Journal of Occupational and Environmental Medicine 2003;15(2):188-195. Published online June 30, 2003; DOI: https://doi.org/10.35371/kjoem.2003.15.2.188

Abstract PDF: OBJECTIVES
This study was conducted to select neurobehavioral tests that are more reliable and less affected by subjects characteristics and test conditions.
METHODS
Five computerized and five traditional neurobehavioral tests and retests were administered to 85 medical school students and 35 hospital workers. The computerized tests consisted of the Simple Reaction Time, Addition, Symbol Digit, Digit Span, and Finger Tapping Speed, while the traditional tests comprised the Benton Visual Retention test, Digit Symbol, Digit Span, Pursuit Aiming, and pegboard. In addition, the effects of various factors on the reliability of the neurobehavioral tests, including age, sex, educational level, computer familiarity, test intervals, and test time of day, were also evaluated.
RESULTS
Among the computerized neurobehavioral tests, the reliability of Addition, Symbol Digit, Digit Span, and Finger Tapping Speed were not affected significantly by age, sex, test interval, or computer familiarity. It was found that Finger Tapping Speed is not affected by educational level. When the time of retest was incongruous with the time of the first test, test-retest reliability was lower in most neurobehavioral tests except computerized Addition, Digit Span, and Finger Tapping Speed, and traditional Symbol Digit.
CONCLUSIONS
These results suggest that the computerized Addition, Symbol digit, Digit Span, and Finger Tapping Speed, and the traditional Digit Symbol are more satisfactory for our purposes. These results should facilitate selection of the most appropriate tests for periodical evaluation of the central nervous system of workers exposed to neurotoxic substances in Korea.

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Original Article

Assessment of Neurobehavioral Performance among Welders Exposed to Manganese: Nak Jung Sung, Joon Sakong, Jong Hak Chung, Dae Seong Kim, Joong Jung Lee, Jong Tae Park; Korean Journal of Occupational and Environmental Medicine 2000;12(3):327-337. Published online September 30, 2000; DOI: https://doi.org/10.35371/kjoem.2000.12.3.327

Abstract PDF

OBJECTIVES
A cross sectional study was carried out in the welders exposed to manganese and control group. The aim of this study was to assess the adverse effects of manganese on central nervous system of welders.
METHODS
The study group consisted of 49 welders and the reference group, 49 workers matched with welders for age and educational level in automobile manufacturing company. Concentration of manganese in welding hume, in blood, and cumulative exposure index(CEI) were determined for each subject. For each group, computerized neurobehavioral test including Simple Reaction Time, Digit Symbol, Digit Span, and Finger Tapping Speed of Swedish Performance Evaluation System were applied.
RESULTS
Exposure level of manganese in welders were very low(mean CEI 0.069). Welders exposed to manganese had slower response speed, slower motor steadiness, and shorter memory span than control group. But these differences were not statistically significant. The performance of Finger Tapping Speed tended to lower as environmental and biological exposure index got higher. Other neurobehavioral tests were found to have a little association with the exposure indices.
CONCLUSIONS
There was no significant difference of neurobehavioral performance between welders and control group. This study indicates that Finger Tapping Speed measuring motor steadiness might be a one of useful tests for early detection of adverse effects of welding on central nervous system.

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Effects of computer familiarity and computer type on the performance of Korean computerized neurobehavioral test
Nak Joon Baek, Gun Il Park, Young Seok Byun, Man Joong Jeon, Joon Sakong
Annals of Occupational and Environmental Medicine.2016;[Epub] CrossRef
A Study on the Total, Particle Size-Selective Mass Concentration of Airborne Manganese, and Blood Manganese Concentration of Welders in a Shipbuilding Yard
Jong Su Park, Pan Gyi Kim, Jee Yeon Jeong
Journal of Korean Society of Occupational and Environmental Hygiene.2015; 25(4): 472. CrossRef
Occupational Psychiatric Disorders in Korea
Kyeong-Sook Choi, Seong-Kyu Kang
Journal of Korean Medical Science.2010; 25(Suppl): S87. CrossRef
Neurobehavioral Changes of Shipyard Painters Exposed to Mixed Organic Solvents
Choong Ryeol LEE, Kyoung Sook JEONG, Yangho KIM, Cheol In YOO, Ji Ho LEE, Young Hee CHOI
INDUSTRIAL HEALTH.2005; 43(2): 320. CrossRef

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Original Article

Performance of Neurobehavioral Tests Among Welders Exposed to Manganese: Youngwoo Jin, Yangho Kim, Kyoo Sang Kim, Euna Kim, Young Sook Cho, Yong Chul Shin, Changho Chai, Younghyu Choi, Se Hoon Lee, Young Hahn Moon; Korean Journal of Occupational and Environmental Medicine 1999;11(1):1-12. Published online March 31, 1999; DOI: https://doi.org/10.35371/kjoem.1999.11.1.1

Abstract PDF

To study neurobehavioral effects for manganese fume exposure of welders, we administrated questionnaire about subjective symptom, related with manganese exposure. Neurobehavioral Core Test Battery of World Health Qrganization(NCTB) and finger tapping for 98 welders and 29 non-welding workers. We adopted welding duration as a criterion for exposure assessment, because of the lack of the longitudinal valid data and differences in airborne concentrations of manganese in welding types, such as shielded metal arc and CO2 arc welding. Neurologic, musculoskeletal and concentration symptoms were significantly increased by increase of welding duration. Performance of finger tapping preferred hand, Santa Ana dexterity test preferred hand and correct number of pursuit aiming were significantly decreased by increase of welding duration. These results comparable with previous studies that suggest neurobehavioral test, especially motor test, to be an appropriate tool to detect early neurobehavioral abnormalities related with manganeses exposure.

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Thomas Vlasak, Tanja Dujlovic, Alfred Barth
Environmental Pollution.2023; 332: 121884. CrossRef
Derivation of an occupational exposure level for manganese in welding fumes
Lisa A. Bailey, Laura E. Kerper, Julie E. Goodman
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Neurobehavioral Deficits and Parkinsonism in Occupations with Manganese Exposure: A Review of Methodological Issues in the Epidemiological Literature
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Safety and Health at Work.2013; 4(3): 123. CrossRef
Neuropsychological effects of low-level manganese exposure in welders
Wisanti Laohaudomchok, Xihong Lin, Robert F. Herrick, Shona C. Fang, Jennifer M. Cavallari, Ruth Shrairman, Alexander Landau, David C. Christiani, Marc G. Weisskopf
NeuroToxicology.2011; 32(2): 171. CrossRef
Occupational Psychiatric Disorders in Korea
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Journal of Korean Medical Science.2010; 25(Suppl): S26. CrossRef
Exposure-Response Relationship and Risk Assessment for Cognitive Deficits in Early Welding-Induced Manganism
Robert M. Park, Rosemarie M. Bowler, Harry A. Roels
Journal of Occupational & Environmental Medicine.2009; 51(10): 1125. CrossRef
State-of-the-Science Review: Does Manganese Exposure During Welding Pose a Neurological Risk?
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Journal of Toxicology and Environmental Health, Part B.2007; 10(6): 417. CrossRef
High signal intensity on magnetic resonance imaging as a predictor of neurobehavioral performance of workers exposed to manganese
Yong Chul Shin, Euna Kim, Hae-Kwan Cheong, Sungil Cho, Joon Sakong, Kyoo Sang Kim, Jung Sun Yang, Young-Woo Jin, Seong-Kyu Kang, Yangho Kim
NeuroToxicology.2007; 28(2): 257. CrossRef
Sequelae of fume exposure in confined space welding: A neurological and neuropsychological case series
Rosemarie M. Bowler, Sanae Nakagawa, Marija Drezgic, Harry A. Roels, Robert M. Park, Emily Diamond, Donna Mergler, Maryse Bouchard, Russell P. Bowler, William Koller
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NeuroToxicology.2006; 27(3): 373. CrossRef

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Original Article

Neurobehavioral Performance Changes of Chronic Exposure to Organic Solvents among Textile Processing Workers: Seon Hee Yang, Moo Sik Lee, Dong Hoon Shin; Korean Journal of Occupational and Environmental Medicine 1998;10(2):227-239. Published online May 31, 1998; DOI: https://doi.org/10.35371/kjoem.1998.10.2.227

Abstract PDF: The study was conducted to predict the risk of chronic exposure by neurobehavioral test and to use it as a basic source of the management for workers exposed to organic solvents. The exposed group was selected from coating department of textile processing industry. The unexposed group was selected from those who visited the clinic to take an annual check-up. The author administered WHO-NCTB (neurobehavioral core test battery). Also, Scandinavian Questionnaire 16 was tested by self-administration to find the correlation between subjective symptoms and NCTB results, and to assess the availability of the Questionnaire in mass screening test concurrently. The final analysed subjects were 78 (27 in exposed group and 51 in unexposed group) workers except who had a neurologic disease or systemic disease affecting the central nervous system. In Questionnaire study, there was no significant difference in total neurotoxic symptom scores between the exposed and the unexposed group. In NCTB, the exposed group had lower mean scores than the unexposed group for all tests. When the effect by age and education were considered, there was a statistically significant difference only in pursuit timing test. This study suggests the availability of NCTB and the Questionnaire for the assessment of neurobehavioral change in workers exposed to organic solvents.

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Original Article

Interrelation of Neuropsychiatric Symptom and Neurobehavioral Test among Workers Exposed to Organic Solvents: Joon Sakong, Jong Hak Chung, Hak Yong Lee; Korean Journal of Occupational and Environmental Medicine 1997;9(1):49-60. Published online February 28, 1997; DOI: https://doi.org/10.35371/kjoem.1997.9.1.49

Abstract PDF

A cross-sectional study of 118 car painters and controls of 113 workers was performed to investigate the interrelation between self-reported neuropsychiatric symptom and neurobehavioral performance using Scandinavian Questionnaire 16, Zung anxiety, depression scale and Swedish performance evaluation system (simple reaction time, symbol digit, digit span, finger tapping speed). The typical symptoms characteristic of painter's syndrome were not found and no significant association was found between solvent exposure and !total score of neuropsychiatric symptom but neurobehavioral performance of simple reaction time, symbol digit and digit span had association with solvent exposure. No significant associations were found between total score of neurotoxic symptom, anxiety scale, depression scale and the neurobehavioral performance. In factor analysis, the factor of questionnaire 16 measuring function of memory demonstrated no significant association with the factor of neurobehavioral test items measuring short term memory.

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Performance assessment on the Korean Computerized Neurobehavioral Test using a mobile device and a conventional computer: an experimental study
Young Seok Byun, Sung Kyu Park, Joon Sakong, Man Joong Jeon
Annals of Occupational and Environmental Medicine.2018;[Epub] CrossRef
Occupational Neurological Disorders in Korea
Eun-A Kim, Seong-Kyu Kang
Journal of Korean Medical Science.2010; 25(Suppl): S26. CrossRef
Usefulness of Color Vision Test for Early Detection of Neurological Damages by Neurotoxic Substances
Eun-Hee Lee, Kyungho Choi, Hong Jae Chae, Domyung Paek
Journal of Preventive Medicine and Public Health.2008; 41(6): 397. CrossRef

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Original Article

Effects of Number and Method of Visual Stimuli on Simple Reaction Time: Jee Sung Kim, Sung Ah Kim, Chae Yong Lee, Soon Woo Park, Si Hyun Nam, Jong Young Lee, Ji Yeon Son; Korean Journal of Occupational and Environmental Medicine 1996;8(3):477-489. Published online December 31, 1996; DOI: https://doi.org/10.35371/kjoem.1996.8.3.477

Abstract PDF

In. order to evaluate the effects of number and method of visual stimuli on simple reaction time and determine the proper number of trials, simple reaction time of the computerized test of NTOS (Neurobehavioral Test for Occupational Screening) was carried out on 240 medical students. The prominent difference was found between male and female on simple reaction time. Regarding the effect of number based on the parameters of measures and the purpose of test itself, 64 trials was considered as proper number. The mean reaction time was different according to the methods of visual stimuli, such as color and size(p<0.05). The larger and more intence visual stimuli were, the faster sim-ple reaction time was. In respect to sex, that difference was similar. But, there was no difference depending upon whether the each result of each trial was showed on the monitor. The subjects, however, showed much interest when the result showed. Further studies, including the various variables on visual stimuli, are required to compare among various studies.

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Performance assessment on the Korean Computerized Neurobehavioral Test using a mobile device and a conventional computer: an experimental study
Young Seok Byun, Sung Kyu Park, Joon Sakong, Man Joong Jeon
Annals of Occupational and Environmental Medicine.2018;[Epub] CrossRef

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Original Article

The Development of Systemic Health Management Program in the Small Scale Industry using Organic Solvents: Application of Neurobehavioral Core Test Battery(NCTB): Soo Hun Cho, Sang Hwan Han, Mi Na Ha, Dork Ro Yun, Ho Jang Kwon; Korean Journal of Occupational and Environmental Medicine 1995;7(2):258-268. Published online October 31, 1995; DOI: https://doi.org/10.35371/kjoem.1995.7.2.258

Abstract PDF: It is known that there appear some nonspecific and delicate changes in neuropsychiatric aspect on the workers when they are exposed for a long period to low concentrated organic solvents in the work places. Therefore, it give rise to the necessity of developing a program for the health supervisor stationed in the work place to supervise these neurobehavioral health affection. In addition to the questionnaire posed to the workers exposed to organic solvents, the study team conducted NCTB(Neurobehavioral Core Test Battery) respectively on an exposed group and a non-exposed group to organic solvents. The study team compared the results and decided whether or not to apply the results to the evaluation program of health affection. The study team divided 132 workers in 6 car repairing factories and 2 textile printing factories into exposed group and non-exposed group, pairing them off into 66 research objects according to their age, sex, and job. Neurobehavioral test was conducted on 6 items, except the POMS test, of NCTB developed by the World Health 0rganization (WHO) . The study team conducted examinations of working environment on the exposed and non-exposed groups of each work place. The analysis of the collected materials for examinations were conducted with GC-MS. The concentration of the mix-ture in the air, relative to their respective threshold limit values (TLV) was calculated according to the formula of the ACGIH and the Korean threshold limits. The results indicated that for two of eight factories samples the recommended concentration limits for mixtures was exceeded. Of the six tests, the'digit span forward','digit span backward'and'digit symbol' produced conspicuous statistical differences between the two groups (p<0.1) as a result of compairing the test values by means of paired t-test. The results of respective analysis of the car repairing factories and textile printing factories revealed that the textile printing factories had greater differences between the exposed and the non-exposed than in the car repairing factories. It is presumably because the textile printing workers are continuously exposed to the organic solvents during working hours, whereas the car repairing workers are exposed only when they are doing painting works. The NCTB is assessed very useful in examining the neurobehavioral health affection under the exposure to organic solvents, and, therefore, the study team expects that the NCTB will play an important part in the course of developing a health program for the workers exposed to organic solvents.

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Original Article

Validity and Reliability of Data Derived from Questionnaire on Neurobehavioral Symptoms: Ho Jang Kwon, Soo Hun Cho, Hyun Sul Lim; Korean Journal of Occupational and Environmental Medicine 1995;7(1):21-27. Published online February 28, 1995; DOI: https://doi.org/10.35371/kjoem.1995.7.1.21

Abstract PDF

There are many studies on the neurobehavioral symptoms due to organic solvent exposure using questionnaire. However there is little published evidence on validity and reliability of the questionnaire on the neurobehavioral symptoms. In present study, the authors tested the validity and reliability of our questionnaire, which was designed for screening neurobehavioral disturbance in organic solvent exposer. Questionnaire was administered to the workers of one paint manufacturing plant and one coil manufacturing plant. In order to evaluate validity of the questionnaire, the average questionnaire scores of two plants were compared. The average score of paint manufacturing plant were higher than that of coil manufacturing plant and the difference was statistically significant. After adjustment of age, duration of employment, education, smoking history and alcohol consumption, significance was maintained. Test-retest reliability was evaluated by kappa statistics. More than 50% of question items showed values of kappa above 0.4, Cronbach coefficient alpha whoch reflects internal consistency of the questionnaire was 0.86. Overall the data showed that validity and reliability of the questionnaire were generally acceptable.

Citations

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Occupational Neurological Disorders in Korea
Eun-A Kim, Seong-Kyu Kang
Journal of Korean Medical Science.2010; 25(Suppl): S26. CrossRef

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Original Article

A Computer-Administered Neurobehavioral Evaluation of Workers Exposed to Organic Solvents: Jong Hak Chung, Chang Yoon Kim, Joon Sakong; Korean Journal of Occupational and Environmental Medicine 1994;6(2):219-241. Published online September 30, 1994; DOI: https://doi.org/10.35371/kjoem.1994.6.2.219

Abstract PDF

A cross-sectional study was performed to evaluate the effects of chronic exposure to solvent on neurobehavioral performance of solvent exposed 89 workers engaged in a video tape manufacturing fatory. A control group of 43 workers was selected fro different sections of the factory. The mean age and the mean duration of employment were 29 years and 5.4 years. Each workers completed a medical and occupational questionnaire. Adverse effects on the central nervous system were assessed by self reported Scandinavian questionnaire 16, New Anxiety-Depression Scale and seven test of Swedish Performance Evaluation System. These included simple reaction time, choice reaction time, digit classification, finger tapping speed, additions, symbol digit and digit span. Several potential confounding factors were included as indepedent variables in all analysis of neurobehavioral tests and symptoms. These included age, sex, educational level, familiarity with computer, alcohol drinking and amount of smoking. No significant associations were found between solvent exposure and total symptom score and mood score, Although the mean duration of employment was 5.4 years, comparison of mean performance scores adjusted for confounding factors showed a significantly poorer performance on choice reaction time(p<0.05), digit classification (p<0.01), additions (p<0.01) and symbol digit(p<0.01) in exposed group. Factor matrix of neurobehavioral tests produced by varimax rotation showed three distinct factors, which correspond to assessments of "memory", "coordination" and "response speed". These factors accounted for 62.6% of the total variance of the sample. Familiarity with computer was found to be associated with performance of symbol digit and amount of smoking appeared to slow finger tapping speed. Male and college graduate workers have less errors than others. There were no significant correlation between neurotoxic symptom score and performance of neurobehavioral tests.

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INDUSTRIAL HEALTH.2005; 43(2): 320. CrossRef

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