Annals of Occupational and Environmental Medicine

Original Article

Impact of neck posture and insulating stick use on neck disability in Korean line workers: a cross-sectional study: Bounggyun Ju, Jaehoo Lee, Hye-min Kim, Chul Gab Lee, Hansoo Song; Ann Occup Environ Med 2024;36:e11. Published online April 15, 2024; DOI: https://doi.org/10.35371/aoem.2024.36.e11

Abstract Abstract in Korean PDF Supplementary Material PubReader ePub: Background
Occupational neck disability is a prevalent issue, especially among line workers, who are often exposed to elevated levels of cervical ergonomic stress. The aim of this study was to investigate the impact of neck posture and insulating stick use on neck disability in a specific occupational group in Korea.
Methods
This cross-sectional study was conducted among 483 line workers in Gwangju and Jeonnam, Korea. Data were collected using the Neck Disability Index, Cervical Degenerative Index, and a structured questionnaire focusing on demographic and occupational factors. Logistic regression analysis was applied to determine the adjusted odds ratio (OR) and 95% confidence interval (CI) for neck posture and factors related to neck disability.
Results
Neck disability prevalence was 17.2% among the participants. Multivariate logistic regression analysis showed that factors related to neck disability included age over 60 years (adjusted OR: 3.08; 95% CI: 1.63–5.83), depression (adjusted OR: 8.33; 95% CI: 3.85–18.00), a history of cervical trauma (adjusted OR: 2.13; 95% CI: 1.04–4.40), and radiological degenerative changes in the cervical spine (adjusted OR: 2.33; 95% CI: 1.26–4.33). In particular, the adjusted OR of neck disability among live-line workers was 2.10 (95% CI: 1.12–3.92) when compared with support workers (model 1). Other analysis models showed that use of insulating sticks for more than 10 hours per week (adjusted OR: 2.46; 95% CI: 1.32–4.61) and higher neck extension (adjusted OR: 2.98; 95% CI: 1.14–3.46) were significant work-related risk factors (model 2,3).
Conclusions
Neck posture, age, depression, cervical trauma history, degenerative changes in the cervical spine, and use of insulating sticks are significant risk factors for neck disability among line workers in Korea. These findings highlight the need to improve the working environment and reduce the burden of cervical ergonomic stress among line workers.; 한국 배전보수원의 목 부담자세와 절연스틱사용이 목 장애에 미치는 영향
목적
직업성 목 장애는 특히 높은 수준의 목 부담에 자주 노출되는 배전보수원 사이에서 흔한 문제다. 본 연구는 배전보수원을 대상으로 목 부담자세와 절연스틱사 용이 목 장애에 미치는 영향을 알아보고자 한다.
방법
본 단면연구는 광주와 전남 지역의 배전보수원 483명을 대상으로 실시되었다. 목 장애 지수, 경추퇴행성 지수, 인구통계학적 및 직업적 요인에 초점을 맞춘 구조화된 설문지를 사용하여 데이터를 수집했다. 목 부담자세와 목 장애 관련 요인에 대한 보정 교차비와 95% 신뢰구간(CI)을 알아보기 위해 로지스틱 회귀분석을 시행하였다.
결과
목 장애 유병률은 활선작업자(22.6%)에서 가장 높았으며, 연령이 높아질수록 증가하는 경향을 보였다. 목 장애 관련 요인은 우울증(8.13, 95% CI: 4.02~16.43), 경추 외상 병력(3.53, 95% CI: 1.88~6.63), 경추 방사선학적 퇴행성 변화(2.35, 95% CI: 1.36-4.07)였다. 직업적 요인으로 활선작업자의 보정교차비는 2.10 (95% CI: 1.12-3.92)이었고, 절연스틱을 주당 10시간 이상 사용하는 경우 보정교차비는 2.46 (95% CI: 1.32-4.61)이었다. 또한, 높은 목 신전 부담의 보정교차비는 1.98 (95% CI: 1.14-3.46)이었다.
결론
연령, 우울증, 경추 외상, 경추의 퇴행성 변화와 같은 일반적 요인뿐만 아니라 활선작업, 절연스틱 사용, 목 부담 자세와 같은 직업적 요인은 국내 배전보수원의 목 장애를 유발하는 위험 요인이다. 이러한 결과는 배전보수원의 작업환경 개선의 필요성을 시사한다.

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Special Article

Approval status and characteristics of work-related musculoskeletal disorders among Korean workers in 2020: Eun-woo Cha, Sae-mi Jung, Il-ho Lee, Dae Hwan Kim, Eui Hyek Choi, In-ah Kim, Yong-kyu Kim, Kyung-joon Lee, Yang Won Kang, Ho-gil Kim, Young-ki Kim; Ann Occup Environ Med 2022;34:e31. Published online October 26, 2022; DOI: https://doi.org/10.35371/aoem.2022.34.e31

Abstract Abstract in Korean PDF PubReader ePub

Background

This study aimed to investigate the characteristics of work-related musculoskeletal disorders (WRMSDs) in occupational disease claims and identify patterns of WRMSDs for each body part by industry and occupation.

Methods

This study analyzed the raw data of occupational disease claims for musculoskeletal disorders deliberated by the Occupational Disease Decision Committee of the Korea Workers’ Compensation & Welfare Service in 2020. The data was classified into 6 body parts with the highest numbers of occupational disease cases by using the complete enumeration data on principal diagnoses and 4 types of subdiagnoses in the raw data. The characteristics and approval rates of WRMSDs by body part, industry and occupation were examined and summarized.

Results

A total of 13,015 occupational disease cases for WRMSDs were classified, and lumbar spinal (back) diseases accounted for the largest proportion of claimed diseases, followed by shoulder, elbow, wrist, knee, and neck diseases in a descending order. The occupations with the highest and second highest numbers of occupational disease cases by body part were found to be automobile assemblers and production-related elementary workers for the neck, school meal service workers and cooks for the back, construction frame mold carpenters and school meal service workers for the shoulder, elementary workers in mining and food service workers for the elbow, food service workers and automobile parts assemblers for the wrist, and ship welders and school meal service workers for the knee.

Conclusions

This study examined the characteristics and approval status of WRMSDs by body part and occupation. Based on the study results, management strategies for the prevention of WRMSDs should be established regarding occupations with a high risk of WRMSDs for each body part.

업무상 근골격계질환의 2020년 산업재해 승인 현황과 특성
목적
본 연구는 업무 관련 근골격계 질환(WMSD)의 특성과 신체 부위에 따른 업종 및 직종별 WMSD 승인율을 분석하기 위해 실시됐다.
방법
2020년 근로복지공단 업무상질병판정위원회에서 심의된 근골격계질환 신청건의 원자료를 활용하여 분석하였다. 원자료의 주상병과 네가지 부상병 정보 전수를 활용하여, 상병신청건수가 많은 6개의 신체부위로 구분하였다. 각 부위별로 업종 및 직종에 대하여 특성과 승인율을 정리 하였다.
결과
WMSD 신청건수는는 총 13015건이 분류되었고, 이중 요추질환이 가장많았고, 어깨, 팔, 손목, 무릎, 경추 순으로 이어졌다. 부위별로 신청건수가 많았던 직종으로 경추는 자동차조립, 제조관련단순종사원, 요추는 급식조리사, 조리사, 어깨는 건설형틀목공, 급식조리사, 팔은 광업단순종사원, 급식조리사, 손목은 급식조리사, 자동차부품조립, 무릎은 조선용접공, 급식조리사로 조사됐다.
결론
신체 부위별 직종에 따른 WMSD의 특성 및 승인율 등을 살펴보았다. 이러한 결과를 바탕으로 신체 부위별 고위험 직종에 대하여 WMSD 예방을 위한 관리 전략이 수립되어야 한다.

Citations

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Seong-Uk Baek, Won-Tae Lee, Min-Seok Kim, Myeong-Hun Lim, Jin-Ha Yoon, Jong-Uk Won
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Research Article

The association between long working hours and work-related musculoskeletal symptoms of Korean wage workers: data from the fourth Korean working conditions survey (a cross-sectional study): Jae-Gwang Lee, Guang Hwi Kim, Sung Won Jung, Sang Woo Kim, June-Hee Lee, Kyung-Jae Lee; Ann Occup Environ Med 2018;30:67. Published online December 3, 2018; DOI: https://doi.org/10.1186/s40557-018-0278-0

Abstract PDF PubReader ePub

Background

It has been reported that long working hours are hazardous to the workers’ health. Especially, work-related musculoskeletal disorders (WMSDs) have been considered as one of the significant health issues in workplace. The objective of this study was to identify the association between long working hours and work-related musculoskeletal symptoms.

Methods

The analysis was conducted using data from the Fourth Korean Working Conditions Survey (KWCS). Subjects of this study were 24,783 wage workers and divided into three groups according to the weekly working hours, which were ≤ 40, 41–52 and > 52 h. The relationship between long working hours and work-related musculoskeletal symptoms was analyzed by multivariate logistic regression method after adjusting for general, occupational characteristics including specific working motions or postures and psychosocial factors.

Results

Approximately 18.4% of subjects worked more than 52 h per week and 26.4 and 16.4% of male subjects and 33.0 and 23.4% of female subjects experienced work-related upper and lower limb pains, respectively, over the last 12 months. Moreover, the prevalence of upper and lower limb pain was increased in both genders as the weekly working hours increased. The odds ratios (ORs) of upper limb pain for those working 41–52 h and more than 52 h per week when adjusted for general, occupational characteristics including specific motions or postures and psychosocial factors were 1.36 and 1.40 for male workers and 1.26 and 1.66 for female workers compared to the reference group, respectively. Furthermore, ORs of lower limb pain for the same weekly working hour groups were 1.26 and 1.47 for male workers and 1.20 and 1.47 for female workers, respectively.

Conclusions

Long working hours were significantly related to work-related musculoskeletal symptoms in Korean wage workers and appropriate interventions should be implemented to reduce long working hours that can negatively affect workers’ health.

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Research Article

Comparison of work-related musculoskeletal symptoms between male cameramen and male office workers: Han-Seur Jeong, Byung-Seong Suh, Soo-Geun Kim, Won-Sool Kim, Won-Cheol Lee, Kyung-Hun Son, Min-Woo Nam; Ann Occup Environ Med 2018;30:28. Published online May 2, 2018; DOI: https://doi.org/10.1186/s40557-018-0243-y

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Background

Previous studies have classified cameramen’s job as physiologically heavy work and identified the risk factors of work-related musculoskeletal disorders (WRMDs) in cameramen. However, those studies limited their research subjects to cameramen. In this study, we compared the frequency and severity of WRMDs between cameramen and office workers.

Methods

A total of 293 subjects working in four broadcasting companies in Korea were recruited. A questionnaire survey was conducted for a month, starting in October 2016. The subjects were divided into cameramen and office workers according to their occupation. We compared the frequency and severity of WRMDs and ergonomic risk assessment results between the two groups.

Results

The high-risk WRMD group had a higher proportion of cameramen than office workers. Moreover, the high ergonomic risk group also had a higher proportion of cameramen than office workers for WRMDs in the upper extremities and waist+lower extremities. In the multivariable-adjusted model comparing cameramen and office workers, the odds ratio (OR) with 95% confidence interval (95% CI) for high-risk WRMDs was 3.50 (95% CI: 1.92–7.72) for the upper extremities and 3.18 (95% CI: 1.62–6.21) for the waist and the lower extremities. The ORs by body parts were 3.11 (95% CI: 1.28–7.57) for the neck, 3.90 (95% CI: 1.79–8.47) for the shoulders, and 4.23 (95% CI: 1.04–17.18) for the legs and feet.

Conclusions

Our study suggests that cameramen are at high risk of WRMDs. Workplace improvements and management of the neck, shoulders, and lower extremities, which are susceptible to WRMDs, are necessary to prevent musculoskeletal disorders among cameramen.

Citations

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The Association Between Shoulder Pain and Disability Among Saudi Office Workers
Abdullah H Alzahrani, Bijad Alqahtani
Cureus.2023;[Epub] CrossRef
Musculoskeletal symptoms and their associated risk factors among Saudi office workers: a cross-sectional study
Reem S. AlOmar, Nouf A. AlShamlan, Saad Alawashiz, Yaser Badawood, Badr A. Ghwoidi, Hassan Abugad
BMC Musculoskeletal Disorders.2021;[Epub] CrossRef

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Research Article

Characteristics of occupational musculoskeletal disorders of five sectors in service industry between 2004 and 2013: Hyun-Woo Choi, Young-Ki Kim, Dong-Mug Kang, Jong-Eun Kim, Bo-Young Jang; Ann Occup Environ Med 2017;29:41. Published online September 19, 2017; DOI: https://doi.org/10.1186/s40557-017-0198-4

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Background

‘Work related musculoskeletal disorders (WRMSDs)’ have been mostly reported in the manufacturing industry but recently the occurrence of industrial injuries has been constantly increasing in the service industry. This research is going to analyze the data about workers’ compensation for WRMSDs in five different service sectors and identify characteristics of occupations with the highest approved occupations.

Methods

According to the data released from the Korea Worker’s Compensation & Welfare Service, the overview of 12,730 cases of workers’ compensation for WRMSDs in five service sectors from 2004 to 2013 is going to be analyzed and the source data is going to be classified by the Korean Standard Classification of Occupations to select the top five occupations that have the highest number of approval.

Results

After selecting each five occupations from the service sector that have work related musculoskeletal disorders, the result showed that the occupation with the highest number of approval in the health and social care sector were the early childhood educators, cooks in the school canteens in education services sector, garbage collectors in the sanitation and similar services sector, deliverymen in wholesale and retail, consumer goods repair and building cleaners in general management businesses such as those in building maintenance. The major event observed in the top five occupations was the overexertion and reaction as a cause of WRMSDs. The day when the WRMSDs mostly occurred was on Monday and the most likely time was 10 am. The median days away from work and lost working days are 29–90 days and 0–50 days respectively. The difference in each occupation was observed in year of service, age, and gender.

Conclusions

83.21% of the approved cases of workers’ compensation for WRMSDs occurred in the top 25 occupations in all of the five service sectors, which meant that the approval of workers’ compensation is concentrated in specific occupations. This research is going to suggest preventive measures for work related musculoskeletal disorders in the service industry and to help prioritize the preventive measures.

Trial registration

Not applicable.

Citations

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Research Article

Hazards and health problems in occupations dominated by aged workers in South Korea: Jungsun Park, Soo Geun Kim, Jong-shik Park, Boyoung Han, Kab Bae Kim, Yangho Kim; Ann Occup Environ Med 2017;29:27. Published online June 26, 2017; DOI: https://doi.org/10.1186/s40557-017-0177-9

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Background

South Korea’s population is aging more rapidly than any other country. Aging of the productive population will lead to shortage of labor and the decreasing quality of the labor force in South Korea. South Korea needs health care strategies to support the establishment of work environments that are appropriate for elderly workers who have reduced physical capacity. This paper aims to identify occupations that are dominated by aged workers and assess the exposure to hazards and work-related health problems of aged workers in these occupations.

Methods

We identified the 20 occupations in South Korea that employ the most aged workers (at least 55 years-old), among all 149 occupations that are defined as minor categories (identified by three digits) by the Korean Standard Classification of Occupations (KSCO). Exposure to hazards and work-related health problems of individuals in these occupations were evaluated by analyzing the results of the fourth Working Conditions Survey of 2014.

Results

Among the 20 occupations that employ the most aged workers, ‘Elementary Occupations’, which the KSCO classifies as major category (9), had the largest proportion of aged workers. After this, there were five occupations of skilled manual workers and six occupations of skilled non-manual workers. Aged workers in elementary and skilled manual occupations reported frequent exposure to job-specific hazards, such as noise, vibrations, high and low temperatures, solvents, and chemicals. Relative to other workers, aged workers in the occupations reported more frequent exposure to ergonomic hazards, such as tiring or painful positions, carrying or moving heavy loads, and repetitive movements, and also reported more work-related musculoskeletal disorders and general fatigue. Injury due to accident was common in machinery-handling occupations.

Conclusion

Job-specific hazards should be reduced to prevent occupation-related disorders in elementary and skilled manual occupations that are dominated by aged workers.

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Research Article

Relationship between Psychosocial Risk Factors and Work-Related Musculoskeletal Disorders among Public Hospital Nurses in Malaysia: Nur Azma Amin, Rusli Nordin, Quek Kia Fatt, Rahim M Noah, Jennifer Oxley; Ann Occup Environ Med 2014;26:23-23. Published online August 9, 2014; DOI: https://doi.org/10.1186/s40557-014-0023-2

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Objective

This study examined the relationships between psychosocial work factors and risk of WRMSDs among public hospital nurses in the Klang Valley, Malaysia.

Methods

We conducted a cross-sectional study among 660 public hospital nurses. A self-administered questionnaire was used to collect data on the occurrence of WRMSDs according to body regions, socio-demographic profiles, occupational information and psychosocial risk factors. 468 questionnaires were returned (response rate of 71%), and 376 questionnaires qualified for subsequent analysis. Univariate analyses were applied to test for mean and categorical differences across the WRMSDs; multiple logistic regression was applied to predict WRMSDs based on the Job Strain Model’s psychosocial risk factors.

Results

Over two thirds of the sample of nurses experienced discomfort or pain in at least one site of the musculoskeletal system within the last year. The neck was the most prevalent site (48.94%), followed by the feet (47.20%), the upper back (40.69%) and the lower back (35.28%). More than 50% of the nurses complained of having discomfort in region one (neck, shoulders and upperback) and region four (hips, knees, ankles, and feet). The results also revealed that psychological job demands, job strain and iso-strain ratio demonstrated statistically significant mean differences (p < 0.05) between nurses with and without WRMSDs. According to univariate logistic regression, all psychosocial risk factors illustrated significant association with the occurrence of WRMSDs in various regions of the body (OR: 1.52–2.14). Multiple logistic regression showed all psychosocial risk factors were significantly associated with WRMSDs across body regions (OR: 1.03–1.19) except for region 1 (neck, shoulders and upper back) and region 4 (hips, knees, ankles, and feet). All demographic variables except for years of employment were statistically and significantly associated with WRMSDs (p < 0.05).

Conclusions

The findings indicated the high prevalence of WRMSDs in many body regions, and the risks of developing WRMSDs according to the various body regions were associated with important psychosocial risk factors based on the job strain model. These findings have implications for the management of WRMSDs among public hospital nurses in the Klang Valley, Malaysia.

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Case Report

Design and Evaluation of Ergonomic Interventions for the Prevention of Musculoskeletal Disorders in India: Somnath Gangopadhyay, Samrat Dev; Ann Occup Environ Med 2014;26:18-18. Published online July 1, 2014; DOI: https://doi.org/10.1186/2052-4374-26-18

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Background

Improper workstation, work procedures and tools are found to be the risk factors for the development of musculoskeletal disorders among the informal sector workers of the developing countries. Low cost ergonomic interventions can effectively improve such adverse conditions.

Case presentation

In the present article some studies related to design interventions in different informal and agricultural sectors were discussed and their efficacies were analyzed. It was observed that with the help of appropriate interventions musculoskeletal disorders were reduced, adverse physiological conditions were improved when awkward postures were corrected and ultimately the organisational productivity was increased.

Conclusion

Proper implementation of ergonomic interventions can ultimately improve the economy of the nation.

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Research Article

Work-related Musculoskeletal Disorders in Korea and Japan: A Comparative Description: Eun-A Kim, Minori Nakata; Ann Occup Environ Med 2014;26:17-17. Published online June 24, 2014; DOI: https://doi.org/10.1186/2052-4374-26-17

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Objectives

Work related Musculoskeletal disorders (WMSD) is one of the most important problem in occupational health system of Korea and Japan, where the OHS system developed in similar socio-cultural environment. This study compared WMSD in Korea and Japan to review similarities and differences in their historical background, and development of prevention policies.

Methods

Scientific articles, government reports, and related official and non-official statistics on WMSD since the 1960s in Japan and Korea were reviewed.

Results

The historical background and basic structure of the compensation system in Korea and Japan largely overlapped. The issuing of WMSD in both countries appeared as upper limb disorder (ULD), named occupational cervicobrachial diseases (OCD) in Japan, and neck-shoulder-arm syndrome (NSA) 30 years later in Korea, following the change from an industrial structure to automated office work. Both countries developed manuals for diagnosis, guidelines for workplace management, and prevention policies. At present, compensation cases per covered insurers for WMSD are higher in Korea than in Japan, due to the social welfare system and cultural environment. Prevention policies in Korea are enforced more strongly with punitive measures than in Japan. In contrast, the Japanese system requires autonomous effort toward risk control and management, focusing on specific risky processes.

Conclusions

WMSD in Korea and Japan have a similar history of identification and compensation structure, yet different compensation proportions per covered insurer and prevention policies. Follow-up study with international cooperation is necessary to improve both systems.

Citations

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Research Article

Automation of Workplace Lifting Hazard Assessment for Musculoskeletal Injury Prevention: June T Spector, Max Lieblich, Stephen Bao, Kevin McQuade, Margaret Hughes; Ann Occup Environ Med 2014;26:15-15. Published online June 24, 2014; DOI: https://doi.org/10.1186/2052-4374-26-15

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Objectives

Existing methods for practically evaluating musculoskeletal exposures such as posture and repetition in workplace settings have limitations. We aimed to automate the estimation of parameters in the revised United States National Institute for Occupational Safety and Health (NIOSH) lifting equation, a standard manual observational tool used to evaluate back injury risk related to lifting in workplace settings, using depth camera (Microsoft Kinect) and skeleton algorithm technology.

Methods

A large dataset (approximately 22,000 frames, derived from six subjects) of simultaneous lifting and other motions recorded in a laboratory setting using the Kinect (Microsoft Corporation, Redmond, Washington, United States) and a standard optical motion capture system (Qualysis, Qualysis Motion Capture Systems, Qualysis AB, Sweden) was assembled. Error-correction regression models were developed to improve the accuracy of NIOSH lifting equation parameters estimated from the Kinect skeleton. Kinect-Qualysis errors were modelled using gradient boosted regression trees with a Huber loss function. Models were trained on data from all but one subject and tested on the excluded subject. Finally, models were tested on three lifting trials performed by subjects not involved in the generation of the model-building dataset.

Results

Error-correction appears to produce estimates for NIOSH lifting equation parameters that are more accurate than those derived from the Microsoft Kinect algorithm alone. Our error-correction models substantially decreased the variance of parameter errors. In general, the Kinect underestimated parameters, and modelling reduced this bias, particularly for more biased estimates. Use of the raw Kinect skeleton model tended to result in falsely high safe recommended weight limits of loads, whereas error-corrected models gave more conservative, protective estimates.

Conclusions

Our results suggest that it may be possible to produce reasonable estimates of posture and temporal elements of tasks such as task frequency in an automated fashion, although these findings should be confirmed in a larger study. Further work is needed to incorporate force assessments and address workplace feasibility challenges. We anticipate that this approach could ultimately be used to perform large-scale musculoskeletal exposure assessment not only for research but also to provide real-time feedback to workers and employers during work method improvement activities and employee training.

Citations

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Research Article

Relationship between Occupational Stress and Work-related Musculoskeletal Disorders in Korean Male Firefighters: Min Gi Kim, Kyoo-Sang Kim, Jae-Hong Ryoo, Seung-Won Yoo; Ann Occup Environ Med 2013;25:9-9. Published online July 4, 2013; DOI: https://doi.org/10.1186/2052-4374-25-9

Abstract PDF PubReader ePub

Objectives

A growing body of literature has documented that job stress is associated with the development of work-related musculoskeletal disorders (WMSDs). However, the association of WMSDs with job stress has not yet been fully studied in Korean male firefighters. The purpose of this study was to determine the status of WMSDs in almost all Korean male firefighters and to clarify the effect of job stress on the occurrence of WMSDs.

Methods

The study design was cross-sectional, and 21,466 firefighters were recruited. The study design included a structured questionnaire to assess general characteristics, the Korean Occupational Stress Scale (optional KOSS-26), Center for Epidemiologic Studies-Depression Scale (CES-D), and WMSDs. The chi-square test, and univariate and multivariate logistic regression analyses were used to look for a correlation between general characteristics and job stress, and the occurrence of WMSD.

Results

Back pain is the most common WMSD. Among the job stress subgroup, physical environment, job demands, organizational system, occupational climate, lack of reward and job insecurity were related to the occurrence of WMSDs. However, insufficient job control and interpersonal conflict were not related to the occurrence of WMSDs.

Conclusion

Job stress was related to the occurrence of WMSDs in Korean male firefighters. To reduce the occurrence of WMSDs, a job stress management program may be required.

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Original Article

The Prevalence of Musculoskeletal Symptoms and the Ergonomic Risk Factors among Oriental Melon-growing Farmers: Kyu Jung Bae, Kyoung Sook Lee, Yong Ku Kong, Gyung Jae Oh, Soo Jin Lee; Korean Journal of Occupational and Environmental Medicine 2011;23(1):1-8. Published online March 31, 2011; DOI: https://doi.org/10.35371/kjoem.2011.23.1.1

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