Annals of Occupational and Environmental Medicine最新文献

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.