Association of work–life balance with occupational injury and work-related musculoskeletal pain among Korean workers

Background@#The concept of work-life balance (WLB) has become an important issue in workers' health and safety. This study aims to investigate the relationship between WLB and occupational injury and work-related musculoskeletal pain.Method: The study included 27,383 workers who participated in the Fifth Korean Working Conditions Survey. Participants were divided into good WLB and poor WLB groups based on their responses to the five question items which comprised two dimensions: workon-life conflict (items, 1–3) and life-on-work conflict (items 4 and 5). Occupational injury and musculoskeletal pain were also assessed using the question items. The χ 2 test and multivariate logistic regression analyses were performed to examine the relationship of WLB to occupational injury and musculoskeletal pain while considering socio-demographic and occupational characteristics and ergonomic and psychological risk factors. @*Results@#Of the 27,383 participants, 252 (0.9%) had experienced an occupational injury and 6,408 (23.4%) had musculoskeletal pain. The poor WLB group had higher injury rates for both men (1.7%) and women (0.9%) than the good WLB group (1.1% and 0.4%, respectively).Additionally, the prevalence of musculoskeletal pain was higher for both men and women in the poor WLB group (25.2% and 28.0%, respectively) than for men and women in the good WLB group (18.7% and 23.6%, respectively). In the logistic regression analysis, the adjusted odds ratio of WLB for occupational injury was 1.37 (95% confidence interval [CI]: 1.06–1.78), and that for musculoskeletal pain was 1.14 (95% CI: 1.07–1.21), showing positive associations of WLB with both occupational injury and musculoskeletal pain. @*Conclusions@#Poor WLB causes an increase in occupational injury and musculoskeletal pain.Therefore, an improvement in WLB may reduce the incidence of occupational injury and musculoskeletal pain among workers. Social and policy-related initiatives are needed to improve workers' WLB to reduce occupational injury and musculoskeletal pain.

Association of work–life balance with occupational injury and work-related musculoskeletal pain among Korean workers

Background@#The concept of work-life balance (WLB) has become an important issue in workers' health and safety. This study aims to investigate the relationship between WLB and occupational injury and work-related musculoskeletal pain.Method: The study included 27,383 workers who participated in the Fifth Korean Working Conditions Survey. Participants were divided into good WLB and poor WLB groups based on their responses to the five question items which comprised two dimensions: workon-life conflict (items, 1–3) and life-on-work conflict (items 4 and 5). Occupational injury and musculoskeletal pain were also assessed using the question items. The χ 2 test and multivariate logistic regression analyses were performed to examine the relationship of WLB to occupational injury and musculoskeletal pain while considering socio-demographic and occupational characteristics and ergonomic and psychological risk factors. @*Results@#Of the 27,383 participants, 252 (0.9%) had experienced an occupational injury and 6,408 (23.4%) had musculoskeletal pain. The poor WLB group had higher injury rates for both men (1.7%) and women (0.9%) than the good WLB group (1.1% and 0.4%, respectively).Additionally, the prevalence of musculoskeletal pain was higher for both men and women in the poor WLB group (25.2% and 28.0%, respectively) than for men and women in the good WLB group (18.7% and 23.6%, respectively). In the logistic regression analysis, the adjusted odds ratio of WLB for occupational injury was 1.37 (95% confidence interval [CI]: 1.06–1.78), and that for musculoskeletal pain was 1.14 (95% CI: 1.07–1.21), showing positive associations of WLB with both occupational injury and musculoskeletal pain. @*Conclusions@#Poor WLB causes an increase in occupational injury and musculoskeletal pain.Therefore, an improvement in WLB may reduce the incidence of occupational injury and musculoskeletal pain among workers. Social and policy-related initiatives are needed to improve workers' WLB to reduce occupational injury and musculoskeletal pain.

Guidelines for recognition of occupational cancers in Korea: the results of scientific review by Korean Society of Occupational and Environmental Medicine (2013–2016)

This thematic collection includes the articles to review eleven occupational cancer related risks or working conditions and to propose the guidelines of S. Korea.

Correction to: Guidelines for recognition of occupational cancers in Korea: the results of scientific review by Korean Society of Occupational and Environmental Medicine (2013–2016)

The authors flagged that the spelling of author YangHo Kim was incorrect. It is published on the original manuscript as Yang Ho Kim, but should be spelt YangHo Kim.

Psychological effects of a disastrous hydrogen fluoride spillage on the local community

BACKGROUND: On September 27, 2012, at 3:43 pm, a hydrogen fluoride spill occurred in a manufacturing plant located at the 4th complex of the Gumi National Industrial Complex in Gumi City, South Korea. The present study aimed to evaluate the psychological effects of the hydrogen fluoride spill on the members of the community and to investigate their relationships with physical symptoms and changes in psychological effects occurring as time passed after the accident. METHODS: The 1st phase involved a survey of 1359 individuals that was conducted 1 month after the spill, and the 2nd phase involved a survey of 711 individuals that was conducted 7 months after the accident. The questionnaires included items for assessing demographic characteristics, hydrogen fluoride exposure level, physical symptoms, and psychological status. Physical symptoms were assessed to determine the persistence of irritations. Psychological status was assessed to investigate the impact of event level using the Impact of Event Scale – Revised Korean version (IES-R-K), and the anxiety level was assessed using the Beck Anxiety Inventory (BAI). RESULTS: As the hydrogen fluoride exposure level increased, the impact of event and anxiety levels increased significantly both 1 and 7 months after the accident (p < 0.05). The mean score of the impact of event levels decreased significantly from 33.33 ± 14.64 at 1 month after the accident to 28.68 ± 11.80 at 7 months after the accident (p < 0.05). The mean score of the anxiety levels increased significantly from 5.16 ± 6.59 at 1 month after the accident to 6.79 ± 8.41 at 7 months after the accident (p < 0.05). The risk of persistent physical symptoms at 7 months after the accident was significantly higher in females. The risk of persistent physical symptoms also increased significantly, with increasing age, hydrogen fluoride exposure, and impact of event levels (p < 0.05). CONCLUSIONS: The present study found that the impact of event level and anxiety level increased with increasing hydrogen fluoride exposure. Anxiety levels persisted even after time passed. The risk of persistent physical symptoms at 7 months after the accident was higher in females, and it increased with increasing age, hydrogen fluoride exposure level, and impact of event levels.

Effectiveness of a Comprehensive Stress Management Program to Reduce Work-Related Stress in a Medium-Sized Enterprise

OBJECTIVES: To assess the effectiveness of a comprehensive workplace stress management program consisting of participatory action-oriented training (PAOT) and individual management. METHODS: A comprehensive workplace stress management program was conducted in a medium-sized enterprise. The baseline survey was conducted in September 2011, using the Korean Occupational Stress Scale (KOSS) and Worker's Stress Response Inventory (WSRI). After implementing both organizational and individual level interventions, the follow up evaluation was conducted in November 2011. RESULTS: Most of the workers participated in the organizational level PAOT and made Team-based improvement plans. Based on the stress survey, 24 workers were interviewed by a researcher. After the organizational and individual level interventions, there was a reduction of several adverse psychosocial factors and stress responses. In the case of blue-collar workers, psychosocial factors such as the physical environment, job demands, organizational system, lack of rewards, and occupational climate were significantly improved; in the case of white-collar workers, the occupational climate was improved. CONCLUSIONS: In light of these results, we concluded that the comprehensive stress management program was effective in reducing work-related stress in a short-term period. A persistent long-term follow up is necessary to determine whether the observed effects are maintained over time. Both team-based improvement activities and individual interviews have to be sustainable and complementary to each other under the long-term plan.

Acute Symptoms in Firefighters who Participated in Collection Work after the Community Hydrogen Fluoride Spill Accident

OBJECTIVES: This study aimed to analyze the relationship between clinical status and work characteristics of firefighters and other public officers who engaged on collection duties in the site of the hydrogen fluoride spill that occurred on September 27, 2012, in Gumi City, South Korea. METHODS: We investigated the clinical status, personal history, and work characteristics of the study subjects and performed physical examination and several clinical examinations, including chest radiography, echocardiography, pulmonary function test, and blood testing in 348 firefighters, police officers, volunteer firefighters, and special warfare reserved force who worked at the hydrogen fluoride spill area. RESULTS: The subjects who worked near the accident site more frequently experienced eye symptoms (p = 0.026), cough (p = 0.017), and headache (p = 0.003) than the subjects who worked farther from the accident site. The longer the working hours at the accident area, the more frequently the subjects experienced pulmonary (p = 0.027), sputum (p = 0.043), and vomiting symptoms (p = 0.003). The subjects who did not wear respiratory protective devices more frequently experienced dyspnea than those who wore respiratory protective devices (p = 0.013). In the pulmonary function test, the subjects who worked near the accident site had a higher decease in forced vital capacity than the subjects who worked farther from the site (p = 0.019); however, no statistical association was found between serum calcium/phosphate level, echocardiography result, chest radiographic result, and probation work characteristics. CONCLUSIONS: The subjects who worked near the site of the hydrogen fluoride spill, worked for an extended period, or worked without wearing respiratory protective devices more frequently experienced upper/lower respiratory, gastrointestinal, and neurological symptoms. Further follow-up examination is needed for the workers who were exposed to hydrogen fluoride during their collection duties in the chemical plant in Gumi City.

Occupational Factors Associated with Changes in the Body Mass Index of Korean Male Manual Workers

OBJECTIVES: This study was carried out to analyze and compare the occupational factors that could influence changes in body mass index (BMI) in male manual workers stratified into short-term and long-term work experience groups. METHODS: The subjects were 299 male manual workers (sampled systematically) from 27 workplaces, who had undergone travelling medical examinations at a university hospital between March 28 and May 10, 2013, and had also undergone medical examinations at the same hospital in 2012. Their general and occupational characteristics were investigated through a structured, self-administered questionnaire. The BMI at each point in time was calculated based on the anthropometric results of the medical examinations. Multiple regression analyses were conducted on outcomes of the BMI change and predictors composed of the general and occupational characteristics, with the subjects stratified into groups with 5 years or less (short-term) versus more than 5 years (long-term) of work experience at the present post. RESULTS: In the short-term work experience group, the BMI increases of 3-shift workers and groups reporting disagreement with feeling "insufficient job control" and "lack of reward" at work, two of the subscales of job stress, were significantly higher than those of daytime workers and high-stress groups, respectively. In the long-term work experience group, However, although the BMI increase for 3-shift workers was also significantly higher than that of daytime workers, none of the job stress factors were significantly associated with a BMI increase, whereas the social factors of education and marital status were significant, and some lifestyle factors (such as smoking and regular exercise) were also significant. CONCLUSION: This study showed that, except for 3-shift work, the factors associated with BMI increase could differ depending on the length of job experience. Consequently, different strategies may be needed for workers with short-term versus long-term job experience when designing interventions for preventing their obesity.

Acute Symptoms after a Community Hydrogen Fluoride Spill

OBJECTIVES: This study was conducted to describe the demographic characteristics, and clinical signs and symptoms of patients who visited a general hospital because of the release of chemically hazardous hydrogen fluoride that occurred on September 27, 2012 in Gumi City, Korea. METHODS: The medical records at 1 general hospital 9 km from the accident site were reviewed using a standardized survey format. There were 1,890 non-hospitalized and 12 hospitalized patients exposed to hydrogen fluoride between September 27 and October 13 2012. RESULTS: Among the 12 hospitalized patients, 11 were discharged within 1 week and the other was hospitalized for 10 days. The chief complaints were respiratory symptoms such as hemoptysis and shortness of breath, gastrointestinal symptoms, neurologic symptoms, sore throat, and lip burn. The number of non-hospitalized patients exhibited a bimodal distribution, peaking on the first and twelfth days after the accident. Their chief complaints were sore throat (24.1%), headache (19.1%), cough (13.1%), and eye irritation (9.2%); some patients were asymptomatic (6.2%). Patients who visited the hospital within 3 days (early patients) of the spill more often had shortness of breath (27.0%) and nausea (6.3%) as the chief complaints than patients who visited after 3 days (late patients) (3.5% and 2.6%, respectively). However, cough and rhinorrhea were more common in the late patients (14.0% and 3.3%, respectively) than in the early patients (5.0% and 0.0%, respectively). Patients who were closer to the accident site more often had shortness of breath and sputum as the chief complaints than patients who were farther away. The mean serum calcium concentration was 9.37 mg/dL (range: 8.4-11.0 mg/dL); none of the patients had a decreased serum calcium level. Among 48 pulmonary function test results, 4 showed decreased lung function. None of the patients had abnormal urine fluoride levels on the eighth day after exposure. CONCLUSIONS: Patients hospitalized due to chemical hazard release of hydrogen fluoride had acute respiratory, gastrointestinal, and neurologic health problems. Non-hospitalized patients have acute symptoms mainly related to upper respiratory irritation.

Seven Cases of Respiratory Symptoms Caused by Acute Ozone Exposure from an Electronics Company / 대한산업의학회지

BACKGROUND: Ozone is a colorless, pungent, and highly reactive gas. It can cause headaches, burning eyes, irritation to the respiratory passages, and dyspnea. This article describes cases of respiratory difficulty associated with acute ozone exposure from an electronics company that manufactures touchscreen. CASE REPORT: Seven young female workers visited the Department of Occupational and Environmental Medicine, complaining of cough, dyspnea, and chest discomfort that started within two days at work processing a touchscreen with ozone (0.103 ppm ozone detected in the their workplace). Other; symptoms observed included rhinorrhea, headaches, and dizziness. There was a temporary improvement in symptoms upon taking a day off, but their symptoms deteriorated upon continuing work again-suggesting the ozone exposure in their work environment was responsible for their symptoms. The results of pulmonary function and blood laboratory tests were normal; however, laryngoscopy and nasal endoscopy identified three cases of inflammation on laryngeal, intranasal, or vocal cord regions. CONCLUSIONS: Based on the levels of ozone detected in the workplace and clinical symptoms presented, we conclude that the respiratory symptoms in these cases were caused by excessive ozone exposures.

The Association between Trans, Trans-Muconic Acid as a Biomarker for Benzene Exposure and the Platelet Count / 대한산업의학회지

OBJECTIVE: Recent researches suggest that trans,trans-muconic acid (t,t-MA) would be an adequate metabolic biomarker for low-level benzene exposure. Few study have investigated the association between the t,t-MA and platelet count, and this is the primary aim of this study. METHODS: From May 2004 to June 2004, 326 chemical factory workers took part in a questionnaire survey and they underwent urinary t,t-MA and CBC assessment. The questionnaire covered general aspects of health and the occupational and smoking histories. Statistical analyses of outcomes were performed using SPSS 14.0 for Windows. RESULTS: The subjects' urinary t,t-MA concentration (geometric mean and geometric standard deviation) was 0.28 mg/g creatinine (2.62). No significant differences between different occupations among the chemical workers were found. The urinary t,t-MA concentrations in the smokers and non-smokers were 0.32 mg/g creatinine (2.44) and 0.25 mg/g creatinine (2.77) respectively, and the difference was statistically significant (p<0.05). There was no significant difference in the platelet count based on occupation and the smoking history. There was significant correlation between log(platelet) and log(t,t-MA)(r=-0.116 p=0.039). The regression equation log(platelet) = -0.002xAge + [-0.029xlog(t,t-MA)] + 2.436, R2=0.032, was calculated from linear regression analysis with log(platelet) as the dependent variable. Cross-tabulation between 2 subgroups that were divided by the 90-percentile level of the t,t-MA (0.819 mg/g creatinine), and 2 subgroups that were divided by the 10-percentile level of the platelet count (175,000) was conducted. Higher distribution in subgroup with platelet count below 175,000 was demonstrated in the subgroup with a urinary t,t-MA above the 90-percentile, with an odds ratio of 3.01. CONCLUSIONS: The study may be limited by not taking into account factors such as smoking quantity and sorbic acid, which may confound urinary the t,t-MA concentration as well as medication and infection that may affect the platelet count. Yet it is meaningful that the correlation between the urinary t,t-MA concentration and the platelet count was found through linear regression analysis and the chi-square test, and further, this outcome may be used as a basis for a study to establish the acceptable limit of urinary t,t-MA in Korea.

A Case of Peripheral Polyneuropathy Induced by Occupational 2,5-hexanedione Exposure / 대한산업의학회지

OBJECTIVES: This study is a case report of 2,5-hexanedione induced occupational peripheral polyneuropathy. We also investigated the peripheral nerve function of all workers who had been exposed to 2,5-hexanedione in the same process. METHODS: In June, 2006, a 2,5-hexanedione exposed worker complained of both hand numbness. He received neurologic, radiologic, laboratorial and electrophysiologic evaluation, including measurements of workplace environment. Five months after cessation of exposure to 2,5-hexanedione, a follow-up electrophysiologic examination was done. We evaluated the peripheral nerve function of 2,5-hexanedione exposed workers by comparing 13 male 2,5-hexanedione exposed workers who were in same company with the patient and 5 male workers who had not been exposed to 2,5-hexanedione. RESULTS: Under electrophysiologic examination, there were abnormalities in sensory and motor nerve velocity, terminal latency, and F-latency of both median nerve and ulnar nerve. After 5 months, the patient symptoms and the results of follow-up electrophysiologic examinations were improved. Comparing the 2,5-hexanedione exposed group with the unexposed group, the sensory nerve velocity of the median and ulnar nerves in the exposed group was decreased. The motor nerve velocity of the peroneal nerve, and sensory nerve velocity of the median and sural nerves were decreased. Terminal latency of median, ulnar, peroneal, and tibial nerves in the exposed group were increased compared with the unexposed group(<0.05). CONCLUSIONS: 2.5-hexandione can induce peripheral polyneuropathy in male workers.

Incidence of Dimethylacetamide Induced Toxic Liver Injury among Workers in a Synthetic Fiber Manufacturing Company / 대한산업의학회지

OBJECTIVES: The main goal of this study was to find the incidence of the dimethylacetamide (DMAc) induced toxic liver injury among workers who were exposed to DMAc for about 5 years in a synthetic fiber factory. METHODS: In our investigation, total 1,021 workers had been exposed to DMAc from 1st February, 2000 to 30th June, 2004. Among them, 24 workers who had initial abnormal hepatic enzyme level or was viral hepatitis B carrier were excluded. Finally, 997 DMAc exposed workers were followed up for their incidence of toxic liver injury. To find out DMAc induced toxic liver injury case, we carried out regular examinations including liver enzyme tests such as AST and ALT. RESULTS: We followed up 997 workers and among them 72 cases coincided with our case definition. Incidence density method was 6.05 per 100 person-year. and, a cumulative incidence by life table method was 0.0965 within a year. The incidence of the DMAc-induced toxic liver injury peaked at 4 to 5 in weeks after employment. There was no toxic liver injury case within second week after exposure to DMAc. Five new cases developed in 2th to 3th week, 25 cases in 4th to 5th week, 14 cases in 6th to 7th week, 12 cases in 8th to 9th week, 5 cases in 10th to 11th week, 4 cases in 12th to 13th week, 4 cases in 14th to 15th week, 1 case in 16th to 17th week, 1 case in 30th to 31th week, and there was one case in 48th to 49th week. CONCLUSIONS: The incidence rate of toxic liver injury was considerably high during the 1st year after a worker is placed. So it is needed to take careful monitoring of hepatic enzyme level for newly exposed worker.

A Case of Toxic Hepatitis in a Worker Exposed to a Cleansing Agent Mainly Composed of Methylene Chloride / 대한산업의학회지

OBJECTIVES: To report a case of toxic hepatitis in a worker exposed to a cleansing agent mainly composed of methylene chloride. METHODS: A 27-year-old female worker who had worked in an inspection and packing position of semiconductor parts in a factory using methylene chloride as a metal cleansing solvent was hospitalized due to fever, chill and generalized aches. We evaluated her with blood tests, abdominal ultrasonographic scan and abdominal CT scan and also took her occupational history. RESULTS: The patient showed acute hepatitis in blood and radiologic tests after admission. The serologic tests for viral hepatitis A, B, C and autoimmune hepatitis were negative. She had no history of significant alcohol use, recent medication or drug allergy. After admission, her symptoms were improved and liver enzyme levels(AST and ALT) were markedly reduced. She returned to her workplace after discharge. Thereafter, however, her previous symptoms were recurred and she was hospitalized again 2 days after returning to her workplace. After this second admission, she showed acute hepatitis in blood tests and her symptoms were improved and liver enzyme levels were markedly reduced with the same pattern as those of the first admission. On the 11th day of the second admission, liver enzyme levels were normalized and she was discharged from hospital. CONCLUSIONS: We presume that this patient`s liver injury was related to the methylene chloride presence at her workplace due to her clinical symptoms, blood tests, radiologic tests and occupational history.

Incidence and related factors of fatty liver among male workers / 대한산업의학회지

OBJECTIVE: This study was conducted to investigate the incidence rate of fatty liver and it's related factors based on a three year follow up of multiphasic health screening participants. METHODS: 671 male workers who had participated in both initial and second multiphasic health screening were selected. Initial screening was performed during the year of 1996 to 1997 and second screening was performed during the year of 1999 to 2000. Among them, four hundred and thirty workers who didn't initially have a fatty liver were selected as the final study subjects. They were classified into 2 categories according to the initial and second hepatic ultrasonographic findings; stationary normal(307, 71.4%), and fatty liver incident(123, 28.6%). The incidence rate was calculated using the incidence density method. RESULTS: The incidence rate of fatty liver among the male workers was 9.73 per 100 person-years. The white collar workers had a higher incidence rate(10.66) than the blue collar workers(8.14). The incidence density ratio of alcohol drinking to fatty liver incidence was 1.41, and the incidence density ratio of low vegetable diet was 1.63. The incidence density ratio of obesity was 1.78 for the 100-109% obesity index group, 2.83 for the 110-119% obesity index group, 4.25 for the >or=120% obesity index group over <100%. Smoking, regular exercise, salty food preference, and taking food supplement had no significant effect on the incidence of fatty liver. The fatty liver incident group had higher initial blood pressure, GPT, gamma GTP, fasting blood sugar, HbA1c, uric acid, total cholesterol and triglyceride levels than the stationary normal group. However, there were no differences in the GOT, HDL-cholesterol or LDL-cholesterol levels. In the multiple logistic regression analysis, obesity index and serum triglyceride were found to be major factors in the incidence of fatty liver after controlling age, alcohol drinking, vegetable diet, daily coffee intake, blood pressure, HbA1c, total cholesterol, and uric acid levels. CONCLUSION: The incidence rate of fatty liver among the male workers was 9.73 per 100 person-years. The lifestyles which gave rise to an increasing incidence of fatty liver were those involving excessive alcohol drinking, obesity, and low vegetable diet. Moreover, many cardiovascular disorder related health indices such as blood pressure, and the blood sugar, blood lipid and uric acid levels, were related to the incidence of fatty liver.

Surveillance of Work-related Diseases in Kumi / 대한산업의학회지

OBJECTIVES: Area-based occupational disease surveillance in Kumi (KODS) was used to collect data on occupational diseases. The data was used to estimate the magnitude of the diseases, to analyze for their characteristics, and to find links for their intervention and prevention. METHODS: Since January 2001, occupational physicians and nurses in Occupational Health Service (OHS)have reported six major occupational diseases; occupational musculoskeletal disorders of the upper extremities(MSDUE), occupational dermatoses, toxic hepatitis, occupational asthma (OA), hand-arm vibration syndrome(HAVS), and occupational cancer. For the respective diseases, a reporting sheet and operational diagnostic criteria were developed by the KODS. An analysis of the KODS data, collected over a certain period, was compared with data from the Korea Labor Workers Corporation (KLWC) and the Specific Health Examination (SHE), and the incidence rates of the diseases estimated. RESULTS: Between Jan 2001 and Apr 2002, 287 cases of the six major occupational disease were reported. Of these, there were 132 (46.0%), 100 (34.8%), 34 (11.8%), 16 (5.6%), and 5 (1.7%), cases of MSDUE, occupational dermatoses, toxic hepatitis, OA, and HAVS, respectively. But, there were no cases of occupational cancer. 33 (11.5%) of the incidence were reported via the OHS, 206 (71.7%) from health checkups, and the other 48(16.8%) from other routes. The synthetic fibers and electronic components manufacturing industries accounted for the greatest number of reported cases. With respect to occupation, the greatest numbers of incidence were reported from the elementary occupations, textile workers, assemblers, and cooks and food services worker, in that order. Of the MSDUE cases, carpal tunnel syndrome and epicondylitis were the two most common diseases. Most of the occupational dermatoses were due to contact dermatitis, with organic solvents (59%), nickel (6%), and epoxy resin (5%) accounting for the majority of these cases. All cases of toxic hepatitis were induced by dimethylformamide or dimethylacetamide, which were reported by a unique monitoring system. During same period, there were no cases claimed by workers to the KLWC, and only three cases from SHE, were identified. Using data from workers' number and surveillance, the annual incidences of MSDUE, dermatoses, hepatitis, OA, and HAVS, per 100,000 workers were 63.6, 48.2, 17.9, 7.7, and 2.4, respectively. CONCLUSIONS: These results show that an area-based surveillance system can be very effective for the collection of data on work-related diseases, at least in Kumi.