Health Effects Associated With Humidifier Disinfectant Use: A Systematic Review for Exploration

Background@#It has been 10 years since the outbreak of lung disease caused by humidifier disinfectants in Korea, but the health effects have not yet been summarized. Therefore, this study aims to systematically examine the health effects of humidifier disinfectants that have been discovered so far. @*Methods@#All literature with humidifier disinfectants and their representative components as the main words were collected based on the web, including PubMed, Research Information Sharing Service, and government publication reports. A total of 902 studies were searched, of which 196 were selected. They were divided into four groups: published human studies (group 1), published animal and cytotoxicology studies (group 2), technical reports (group 3), and gray literature (group 4). @*Results@#Out of the 196 studies, 97 (49.5%) were published in peer-reviewed journals as original research. Group 1 consisted of 49 articles (50.5%), while group 2 consisted of 48 articles (49.5%). Overall, respiratory diseases such as humidifier disinfectant associated lung injury, interstitial lung disease, and asthma have a clear correlation, but other effects such as liver, heart, thymus, thyroid, fetal growth, metabolic abnormalities, and eyes are observed in toxicological experimental studies, but have not yet been identified in epidemiologic studies. @*Conclusion@#The current level of evidence does not completely rule out the effects of humidifier disinfectants on extrapulmonary disease. Based on the toxicological evidence so far, it is required to monitor the population of humidifier disinfectant exposure continuously to see if similar damage occurs.

Increased risk of gastric cancer in workers with occupational dust exposure

Background/Aims@#Workers who are exposed to dust in the workplace tend to show a higher incidence of gastric cancer. Nevertheless, scientific evidence to support an association between dust exposure and the risk of gastric cancer is inadequate. This study aimed to investigate whether or not occupational dust exposure influences the risk of gastric cancer. @*Methods@#We collected the electronic data from the Pneumoconiosis Health Examination (PHE) program, provided by the Ministry of Employment and Labor and the Korea Workers’ Compensation and Welfare Service from 2002 to 2017. The PHE database was linked to the National Health Insurances databases. The age-standardized incidence ratio (SIR) and 95% confidence intervals (CIs) of the risk of gastric cancers were evaluated in workers with occupational dust exposure, and the results were compared to those in the general population. @*Results@#From 2004 to 2015, 1,543 cases of gastric cancer were observed in the male participants, as compared with 1,174 of expected cases, which yielded an SIR of 1.314 (95% CI, 1.249 to 1.380). Under dust exposure, the risk of gastric cancer was increased 23.9% in the male participants (95% CI, 19.9 to 27.5), and the degree of impairment of lung function was inversely related to the risk of gastric cancer. @*Conclusions@#Workers with occupational dust exposure were at higher risk of developing gastric cancer than the general population. Thus, future efforts for the prevention of gastric cancer are necessary for dust exposed workers.

A Taxonomy of the Common Tasks and the Development of a Risk Index for Physical Load Assessment in Nursing Job

Background@#Nursing service is a nonroutine work with an excessive physical load and diverse tasks. This study derived representative common tasks based on the frequently occurring tasks with a high physical load in the nursing workers' daily work and developed indicators to evaluate the work risk by reflecting the characteristics of nonroutine work. @*Methods@#Common tasks were classified through the following stages: literature review, first focus group interview (FGI) with experts, first classification of common tasks, second FGI with hospital health managers, a survey of nursing service workers, and the final classification of common tasks for each task type. To develop an objective risk index for physical load assessment, we investigated the frequency and duration of the derived common tasks via survey. @*Results@#Nursing common tasks were categorized into six task types and 56 subtasks. To evaluate the risks of various tasks in nonroutine works, three frequencies and three working time levels were defined by examining the task frequency and working hours. Exposure time was defined to reflect the characteristics of a nonroutine job. The final risk assessment was the product of the exposure time level and job intensity level. From this, four risk action levels were derived. @*Conclusion@#This study has the advantage of solving the problem of focusing on some tasks in evaluating the physical load. It was meaningful in that a new risk assessment index based on exposure time was proposed based on the development of an evaluation scale for frequency and time by reflecting the characteristics of nonroutine work.

Reference Values for Spirometry Derived Using Lambda, Mu, Sigma (LMS) Method in Korean Adults: in Comparison with Previous References

BACKGROUND: The present study aimed to update the prediction equations for spirometry and their lower limits of normal (LLN) by using the lambda, mu, sigma (LMS) method and to compare the outcomes with the values of previous spirometric reference equations. METHODS: Spirometric data of 10,249 healthy non-smokers (8,776 females) were extracted from the fourth and fifth versions of the Korea National Health and Nutrition Examination Survey (KNHANES IV, 2007–2009; V, 2010–2012). Reference equations were derived using the LMS method which allows modeling skewness (lambda [L]), mean (mu [M]), and coefficient of variation (sigma [S]). The outcome equations were compared with previous reference values. RESULTS: Prediction equations were presented in the following form: predicted value = e {a + b × ln(height) + c × ln(age) + M − spline}. The new predicted values for spirometry and their LLN derived using the LMS method were shown to more accurately reflect transitions in pulmonary function in young adults than previous prediction equations derived using conventional regression analysis in 2013. There were partial discrepancies between the new reference values and the reference values from the Global Lung Function Initiative in 2012. CONCLUSION: The results should be interpreted with caution for young adults and elderly males, particularly in terms of the LLN for forced expiratory volume in one second/forced vital capacity in elderly males. Serial spirometry follow-up, together with correlations with other clinical findings, should be emphasized in evaluating the pulmonary function of individuals. Future studies are needed to improve the accuracy of reference data and to develop continuous reference values for spirometry across all ages.

Risk factors associated with mortality from pneumonia among patients with pneumoconiosis

BACKGROUND: The aim of this study was to evaluate factors associated with increased risk of mortality from pneumonia among patients with pneumoconiosis. METHODS: Medical records of 103 pneumoconiosis patients hospitalized for pneumonia were investigated. Seven patients who had lung cancer or other malignancy and 13 patients with insufficient medical record were excluded. Two female patients were excluded due to small number to analyze. The subjects were divided into two groups by clinical outcome of pneumonia, the deceased group and the survival group. The two groups were compared in terms of age, smoking history, episode of recent pneumonia, concomitancy of interstitial fibrosis or fungal ball infection, extent of small opacities, grade of large opacities and results of spirometry. Multiple logistic regression was applied to determine the association between these variables and mortality from pneumonia. RESULTS: The deceased group showed more frequent history of recent pneumonia (p = 0.006), higher prevalence of interstitial fibrosis (p = 0.007) and longer hospitalization period (p = 0.044). The proportion of subjects who had decreased FVC, less than 70 % of predicted value, was higher in the deceased group (p < 0.001). In multiple logistic regression, after adjusting age, smoking history, recent pneumonia, fungal ball, large opacity, profusion and FVC (or FEV1) less than 70 % of predicted value, history of recent pneumonia, concomitancy of interstitial fibrosis, type of pneumoconiosis and fungal ball presented statistically significant association with mortality from pneumonia. CONCLUSIONS: The concomitancy of fungal ball or interstitial fibrosis, history of recent pneumonia within last 90 days, type of pneumoconiosis, FVC less than 70 % of predicted value, FEV1 less than 70 % of predicted value presented statistically significant association with mortality from pneumonia. More attention should be given to patients who have such factors when treating pneumonia with pneumoconiosis.

Diagnosis of perinuclear anti-neutrophil cytoplasmic antibody-associated microscopic polyangiitis in silicotics: case report

BACKGROUND: An association between silica exposure and autoimmune diseases including rheumatoid arthritis, systemic sclerosis, systemic lupus erythematosus, and anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis has been made. CASE PRESENTATION: A 56-year-old male presented with silicosis and had an occupational history of precious metal processing for 30 years and a 30 pack-year smoking history. The patient was diagnosed with pneumoconiosis and received compensation. No other complications were reported for pneumoconiosis. The patient suddenly presented with a non-specific headache for several days and microscopic hematuria was identified upon examination in the outpatient clinic. Following several weeks, the patient presented with aggravated dyspnea and hemoptysis, and his Modification of Diet in Renal Disease estimated glomerular filtration rate indicated acute kidney injury. Diagnostic analysis revealed perinuclear ANCA-associated microscopic polyangiitis (p-ANCA-associated MPA). CONCLUSION: Exposure to silica dust was likely one of the cause of p-ANCA-associated MPA. Possible pathogenic mechanisms of autoimmune diseases in silicotics and emphasis of the necessity for early diagnosis are discussed.

The effect of organisational system on self-rated depression in a panel of male municipal firefighters

OBJECTIVES: The present study evaluated the effects of job stress, including organisational system to self-rated depression through a panel study of male municipal firefighters in the Republic of Korea. METHODS: A panel of 186 municipal firefighters reported self-rated depressive symptoms according to the Beck Depression Inventory (BDI). The effects of job stress were evaluated using the Korea Occupational Stress Scale, taken one year earlier and classified by the median value. Panel members were classified into Depression or Control groups according to BDI scores, with a cut-off level of \'over mild depression' in a follow-up survey. RESULTS: The Depression group included 17 (9.1%) workers. Firefighters who scored high on occupational system had an 8.3 times greater risk of being assigned to the Depression group than those who had not (adjusted odds ratio [OR] = 8.03, 95% confidence interval (CI) = [1.73-37.22]). In contrast, job stress from a \'difficult physical environment' revealed negative risks related to being classified in the Depression group (AOR = 0.20, 95% CI = [0.04-0.92]). CONCLUSIONS: Although the healthy worker effect may be involved, job stress based on perceptions of organisational system was a strong risk factor for depression. A comprehensive approach should be considered that encompasses social issues when assessing or mental health in high-risk groups, as well as the practical issue of physiochemical hazards.

Work-related COPD after years of occupational exposure

BACKGROUND: Cigarette smoking is known as the most important risk factor of chronic obstructive pulmonary disease (COPD). However, occupational exposure to other substances can result in COPD. CASE REPORT: A 76-year-old man with occupational exposures to mixtures of silica dust, gas, and fumes for 10 years and with a 25 pack-year smoking history was diagnosed with COPD. His computed tomogram scan revealed some hyperinflation with emphysematous change in both upper lobes. In the pulmonary function tests, his post-bronchodilator forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1/FVC% were 2.20 L (67% of the predicted value), 1.12 L (52% of the predicted value), and 51%, respectively, indicating moderate COPD. This case of COPD was confirmed as a work-related disease by the Occupational Lung Disease Research Institute in Korea Workers' Compensation & Welfare Service. CONCLUSION: Exposure to various substances such as silica dust, gas, and fumes from furnace and boiler installation was likely the cause of COPD in this patient. Thus, occupational exposure should be considered an important risk factor of COPD.

Work-Related Musculoskeletal Diseases and the Workers' Compensation

The Industrial Accident Compensation Insurance Act (IACIA) regulates the workers' compensation insurance system and the standards for the recognition of occupational diseases (ODs). Since its establishment in 1994, the IACIA has been amended several times. Before 2008, the approval of compensation for work-related musculoskeletal diseases (WMSDs) was decided based on the recommendation of consultants of the Korea Workers' Compensation and Welfare Service (COMWEL). The IACIA was amended in 2008, and since then, the approval of compensation for occupational injuries has been decided based on the recommendation of COMWEL consultants, whereas the approval of compensation for ODs was decided based on the judgment of Committee on Occupational Diseases Judgment (CODJ) which was established in 2008. According to the 2013 amendment to the IACIA, degenerative musculoskeletal diseases among workers engaged in musculoskeletal-burdening work should be considered compensable ODs. Despite some commendable changes to the workers' compensation insurance system, other significant issues persist. To resolve these issues, related organizations including the associations of orthopedic surgery, neurosurgery, and occupational and environmental medicine; Ministry of Employment and Labor; and COMWEL need to work cooperatively.

Relationship between Bone Mineral Density and Moderate to Severe Chronic Kidney Disease among General Population in Korea

Recent studies in Western countries have reported a significant association between glomerular filtration rate (GFR) and bone mineral density (BMD) in the absence of dialysis among the general population. However, there have been few studies regarding renal function and BMD among Korean or Asian subjects with moderate to severe (stage 3 or 4) chronic kidney disease (MS-CKD). The aim of the present study was to investigate the association between MS-CKD and BMD in the general Korean population. BMD, serum creatinine and other measures were obtained from 3,190 subjects (1,428 males and 1,762 females; the fourth Korean National Health and Nutrition Examination Survey). GFR was estimated using the Cockcroft-Gault formula, with adjustment for body surface area. After adjustment for all variables, multiple regression analysis showed that BMD in the femur neck, total femur and lumbar spine were positively associated with eGFR in both males and females. Additional analysis showed that MS-CKD was also significantly associated with osteoporosis in both males and females (odds ratio [OR] 2.20, 95% confidence interval [CI] 1.15-4.20 in males; and OR 1.96, 95% CI 1.33-2.88 in females). Individuals with MS-CKD may be at higher risk of osteoporosis even among Asians.

A Case of Epilepsy and Assessments of Fitness for Work / 대한산업의학회지

BACKGROUND: Epilepsy affects an individual's ability to work as well as their daily activities. Patients with epilepsy have difficulties in finding and maintaining jobs, and they may not have opportunities to perform adequately. Therefore, evaluation of work-fitness is important for patients with epilepsy. In this report, the authors reviewed a case of epilepsy and discussed aspects of the case for evaluation of work-fitness. CASE REPORT: A 43-year-old man with epilepsy visited the hospital for evaluation of work-fitness. His job consisted of forklift driving and crane operation using a remote control. As a seizure attack could threaten worker's safety, we recommended a job change. The employer refused to approve a job change due to the company's circumstances, so we recommended several conditions, including continuous medication, use of protective equipment, restriction of night-shift work, restriction of strenuous exercise, and profound sleep. An epilepsy event occurred during the follow-up period, prompting his company to evaluate his work. There were frequent movements of forklift operations and workers in the workplace, so we recommended restriction of forklift driving and a job change if possible. As a result, the employer changed his job and we recommended "capable of performing work without any conditions". CONCLUSION: For evaluation of work-fitness in patients with epilepsy, adequate job analysis, assessment of patient's medical conditions, and interviews of coworker and employers should be conducted. It is also important to let the employer make the best decision in terms of the patient's health and coworker's safety.

Influence of Job Stress Change on Body Mass Index (BMI) and Waist Circumference among Male White-Collar Workers: A Two-Year Longitudinal Study / 대한산업의학회지

OBJECTIVES: To reveal the influence of job stress change on body mass index (BMI) and waist circumference in white-collar male workers. METHODS: A total of 277 male workers in a Korean R&D company were enrolled between 2008 and 2010. Baseline and follow-up data were collected with structured self-administered questionnaires and anthropometric measurements by nurses. The questionnaire survey included general and work-related characteristics and the Korean Occupational Stress Scale-Short Form (KOSS-SF). The job stress scores in each examination were dichotomized at the median values for the Korean workers and categorized into four groups as follows: Group I: Both low job stress (2008, 2010), Group II: High job stress (2008) & low job stress (2010), Group III: Low job stress (2008) & high job stress (2010), Group IV: Both high job stress (2008, 2010). Multiple logistic regression modeling was used to determine the influence of job stress change on BMI and waist circumference. RESULTS: The adjusted odds ratio for the change in waist circumference above the 75th percentile for Group IV in 'job demand' increased more than in Group I (OR = 2.54 95% CI=1.06~5.55). Also, Group IV in 'job demand' has higher odds ratio for change in BMI above the 75th percentile than Group I (OR=2.25 95% CI=1.01~5.00). Adjusted odds ratios comparing Group II to Group I for the change in waist circumference above the 75th percentile were 0.36 (95% CI=0.15~0.87) in 'inadequate social support', 0.12 (95% CI=0.02~0.98) in 'lack of reward', 0.25 (95% CI=0.08~0.80) in 'total score', respectively. CONCLUSIONS: These results suggest that sustained high job control is a risk factor for abdominal obesity and weight gain. Also, diminished job stress has a negative influence on change in abdominal obesity. Further studies are required to establish job stress intervention plans.

A Case of Sarcoidosis in a Stonemason Exposed to Crystalline Silica / 대한산업의학회지

BACKGROUND: Sarcoidosis is a systemic granulomatous disease that can affect any organ, the exact cause of which is uncertain. Currently, investigations of crystalline silica improve the mechanism how it works the course of autoimmune diseases and some hypothesis supports that it also can attribute to sarcoidosis. CASE REPORT: The patient was a 53-year-old male, who works as a stonemason for 30 years. Sarcoidosis was suspected based on his chest X-ray and CT(Computed tomography). A biopsy was performed and he was indeed diagnosed with sarcoidosis. CONCLUSION: It is thought that sarcoidosis is more prevalent in the people who work at places with a risk of exposure to crystalline silica. This case suggests that if a patient gets sarcoidosis after being exposed to crystalline silica, or after once being diagnosed with silicosis, his or her sarcoidosis may have occurred due to exposure to crystalline silica.

The Assessment of Pulmonary Function in Dental Technicians / 대한산업의학회지

OBJECTIVES: Dental technicians are exposed to various toxic materials in the workplace. The objectives of this study were to assess the pulmonary function of dental technicians and to evaluate the association between work-related factors and pulmonary function of dental technicians. METHODS: Study subjects were 209 dental technicians in the Korean Dental Technologist Association. A self-report questionnaire including general characteristics, respiratory symptoms, and work-related characteristics was conducted on study subjects, and a pulmonary function test (PFT) was done. Study subjects were classified into two groups(normal and abnormal pulmonary function) based on the pulmonary function test (PFT). RESULTS: 43 subjects (20.6%) among 209 subjects had abnormal pulmonary function. After adjusting for general characteristics such as age, sex, past medical history, familial history, and smoking status, the odds ratio for work duration (per year) was 1.42(95% confidence interval (CI) 1.14~1.83). After adjusting for general and work-related characteristics, the odds ratio for work duration (per year) was 1.48(95% CI 1.18~1.92). CONCLUSIONS: Dental technicians are exposed to hazardous materials, which might lead to abnormal pulmonary function. A long work duration could increase exposure time, thereby increasing the chance for abnormal pulmonary function. Therefore, pulmonary function tests should be carried out periodically in dental technicians to ensure their pulmonary health.

The Relationship between the Experience of an Accident and Post Traumatic Stress Disorder in Bus Drivers / 대한산업의학회지

OBJECTIVES: Mental fitness issues have recently become a point of dispute in the field of health. Drivers are occupationally in danger of a possible accident, and are also exposed to other factors aside from accidents that threaten their mental health. The purpose of this research is to examine the level and state of post traumatic stress disorder (PTSD) and overall mental fitness in bus drivers. In addition, we wish to understand the various causes that can influence PTSD. METHODS: From April 1 to June 30, 2009, taking the region and number of workers into consideration, survey sheets were distributed to selected bus drivers who belonged to the public transportation union. The questionnaire included questions on experiences, details of accidents, the characteristics of the working environment, and the status of mental health. We used the Davidson Trauma Scale to investigate PTSD symptoms and the Center for Epidemiological Studies Depression Scale to evaluate depression. RESULTS: Regardless of the type of accident, the group of bus drivers with accident experience showed stronger signs of suffering from PTSD. It seemed that the experience of an accident that caused the death of passengers or conflict with passengers were important factors for PTSD. Within the PTSD group, we found more symptoms of depression, and also this group is more likely to take time off work. CONCLUSIONS: The experience of an accident threatens the mental health of bus drivers. Since bus drivers are responsible for the safety of many citizens, we must work towards finding ways to protect their mental health.

A Case of Primary Osteoarthritis of Both Elbow Joints in a Worker Using Sledge-hammers / 대한산업의학회지

BACKGROUND: The incidence of primary osteoarthritis of elbow is very low in individuals without work-related risk factors, and primary osteoarthritis of the elbow is rarely symptomatic. Because it is difficult to prove these conditions are work-related, the patients with work-related elbow osteoarthritis don't tend to be compensated in Korea. CASE REPORT: The patient was a 51-year old male, with an occupational history as a sledgehammer user for 23 years. He has been complaining of pain for 3 years. Physical examination of the elbow showed painful end-range motion and the radiographs showed osteophytes and, loose bodies, but relatively-preserved joint spaces, which were typical characteristic of primary osteoarthritis. CONCLUSION: The authors report on a case of primary osteoarthritis of both elbows that was associated with repetitive high shear force due to long-term use of the sledgehammer.

Work-related Musculoskeletal Diseases and Occupational Injuries in Health Care Workers

Recently, the health care system of Korea has grown bigger, specialized and modernized, but the healthcare workers' physical well-being is pushed back on the priority list. Musculoskeletal disorders (MSDs) involving days away from work per 10,000 full-time workers are 2.6 according to the statistics of Ministry of Labor, but it is much lesser compared to US statistics, which is 60.5. The smaller number is mainly due to the different method of calculation between Korea and U.S.; the proportion of all the parties of hospital care system is not calculated in Korea and the real portion is underestimated. Even though there was no exact figure regarding MSDs and occupational injuries, MSDs must be acknowledged that lower back pain and trip are most commonly developed due to an excessive strain and unstable position, and the important factor are acknowledged by their occupation, task, psychosocial factor; on the other hand, the occurrence of occupational injuries are influenced by the tenure, psychosocial state, and the level of education. In addition, for the treatment of the health care workers, its work-relatedness must be concerned, and prevention that takes their variable conditions into consideration can have a higher effectiveness.

The Reliability and Validity of the Negative Acts Questionnaire-Revised (NAQ-R) for Nurses for the Assessment of Workplace Bullying / 대한산업의학회지

OBJECTIVE: This study was conducted to assess the reliability, the validity, the psychological characteristics, and the internal structure of the Negative Acts Questionnaire-Revised (NAQ-R) for nurses for the assessment of the workplace bullying. METHODS: A total of 190 female nurses who worked in a university hospital and who had participated in an annual health surveillance program were recruited into the study. A structured questionnaire was used to evaluate each participant's workplace bullying, job stress, and psychosocial wellbeing. Workplace bullying was assessed using the negative acts questionnaire-revised (NAQ-R), job stress was assessed using the Korean Occupational Stress Scale-Short Form (KOSS-SF) and psychosocial wellbeing was assessed using the Psychosocial Wellbeing Index-Short Form (PWI-SF). Resulting answers from the questionnaires were analyzed by chi-square, ANOVA, correlation analysis, and factor analysis. RESULTS: Victims of workplace bullying of nurses in a hospital is 37(19%) based on operational bullying criteria. The Cronbach's alpha for the negative acts questionnaire-revised (NAQ-R) is 0.9260. By exploratory factor analysis, we conclude that 3 factor are most relevant. Criterion validity was satisfied with that a negative acts questionnaire-Revised (NAQ-R) resulting in a statistically significant and positive relationship with PWI-SF , construct validity was satisfied with that NAQ-R has statistically significant and high positive correlation with the occupational climate of the KOSS results. CONCLUSIONS: The negative acts questionnaire-revised (NAQ-R) is a reliable and valid tool for the assessment of workplace bullying in the hospital nurse. By using this tool, we can imply the prevalence of and the condition of workplace bullying among the nurse.

Occupational Diseases among Office Workers / 한양의대학술지

There is no critical factor that can cause typical occupational disease among office workers who have a little chance to exposure to harmful agents like physical factor, chemical factor and biological factor. However they still have possible health risks that cannot be ignored, even if it is neither critical nor dangerous. Over the last two decades, the number of office workers in computer-related fields increased at geometric rates. Ergonomic problems and associated musculoskeletal diseases among office workers were mainly caused by computer use. Also health problems due to indoor air pollution, work overloads and job stress can bring about socio-psychological burden that can cause cardiovascular disease and psychological disorder. To date, almost all studies in occupational medicine were mostly focused on manufacturing workers who were more vulnerable to exposure to harmful environment and workers at special situation. So office worker's health has not been studied thoroughly. Further health studies in office workers who are vulnerable to these diseases should be needed. Also companies need to develop their proper health promotion programs for office workers.

The Relationship between Job Stress and Liver Dysfunction among Male White-Collar Workers / 대한산업의학회지

OBJECTIVES: We wanted to investigate the relationship between job stress and liver dysfunction in Korean male white collar workers. METHODS: A total of 700 male white collar workers who worked at one electronic institute and who participated in an annual surveillance program were recruited: 664(94.9%) workers were initially recruited and the data for 36 workers was excluded due to poor responses and a past history of liver disease. The questionnaire survey included the participants' general characteristics, the job-related factors, the health-related behaviors and job stress. Job stress was assessed using the Korean Occupational Stress Scale-Short Form (KOSS-SF). We merged the job stress data with the individual liver function results by conducting annual surveillance. Multiple logistic regression analysis with adjusting it for the confounding variables, including alcohol drinking and the body mass index (BMI), was used to evaluate the relationship between job stress and liver dysfunction. RESULTS: After adjustment for the confounding variables, the proportion of liver dysfunction cases was significantly higher in the groups with a high level of job stress, as assessed by the 'job demands and total score'. After conducting a stratified analysis with considering alcohol drinking and the BMI, the prevalence odds ratio of liver dysfunction was higher in the groups with a high level of job stress, as assessed by the 'job demands and total score'. CONCLUSIONS: The results of this study suggest that the level of job stress (and especially that assessed by the job demands and total score) is related to liver dysfunction. Thus, further preventive efforts and studies are needed to reduce job stress and address liver dysfunction.