Korean Guideline Development for the Evaluation of Permanent Impairment of the Spine: Proposal by the Korean Academy of Medical Sciences Committee

The criteria for the evaluation of spinal impairment are diverse, complex, and have no standardized form. This makes it difficult and somewhat troublesome to accurately evaluate spinal impairment patients. A standardized guideline was studied for the evaluation of spinal impairment, based on the American Medical Association (AMA) Guides and the McBride method. This guideline proposal was developed by specialty medical societies under the Korean Academy of Medical Sciences. In this study, the grades of impairment were assessed by dividing patients into three different categories: spinal cord impairment, spinal injury impairment and spinal disorder impairment. The affected regions of the spine are divided into three: the cervical region, the thoracic region, and the lumbosacral region. The grade of impairment was differentially evaluated according to the affected region. The restricted range of motion was excluded in the evaluation spinal impairment because of low objectivity. Even though the new Korean guideline for the evaluation of spinal impairment has been proposed, it should be continuously supplemented and revised.

Validity of NIOSH- and Nordic-style Questionnaires in the Screening and Surveillance of Neck and Upper Extremity Work-related Musculoskeletal Disorders / 대한산업의학회지

OBJECTIVES: The study aimed to compare the validity of two questionnaires (NIOSH- and Nordic-style) which are used for the screening and surveillance of neck and upper extremity work-related musculoskeletal disorders. To evaluate the validity, clinical examination was used as the reference. METHODS: Two types of questionnaire were filled out by 208 workers from three different plants in Incheon, Korea. Workers underwent clinical examination by three occupational physicians. The presence of a symptom or sign in at least one body region was regarded as positive in both results of questionnaire and case definition using clinical examination. Validity was evaluated by sensitivity, specificity, positive predictive value, negative predictive value and agreement (Kappa coefficient). For the Nordic-style questionnaire, the sum of the symptom scores was used to yield the ROC curve. RESULTS: The results of the NIOSH-style questionnaire were sensitivity 59.5%, specificity 68.0%, positive predictive value 68.0%, negative predictive value 59.5%, and Kappa coefficient 0.27(95% confidence interval [CI]=0.14~0.40). The results of the Nordic-style questionnaire were sensitivity 73.9%, specificity 68.0%, positive predictive value 72.6%, negative predictive value 69.5%, and Kappa coefficient 0.42 (95% CI=0.30~0.54). For the Nordic-style questionnaire, sensitivity was 72.1% and specificity was 70.1% based on the sum of the symptom scores > or =2. CONCLUSIONS: Both questionnaires demonstrated appropriate validity for the screening and surveillance of work-related musculoskeletal disorders. The selection of questionnaire may depend on the purpose of investigation and characteristics of the work place.

Impact of Subject and Time Related Factors on Reliability of Neurobehavioral Tests / 대한산업의학회지

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

Assessment of Neurobehavioral Performance among Welders Exposed to Manganese / 대한산업의학회지

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

Musculoskeletal Disorders and Related Factors of Symphony Orchestra Players / 대한산업의학회지

OBJECTIVES: Several studies have shown that performance related musculoskeletal disorders present a significant and common health problem for instrument players. This study was conducted to investigate the symptom prevalence rate of performance-related musculoskeletal disorders and risk factors on symphony orchestra players. METHODS: The symptom prevalence rate of musculoskeletal disorders and related factors including demographic factors, occupational factors, psychosocial factors, practice and performance-related behaviors of on 156 symphony orchestra players in Taegu city were surveyed with a self-administered questionnaire. RESULTS: Instrument players have performed for 14. 6 years in average and worked 4. 9 for years in average as a member of symphony orchestra. The subjects consisted of 106 string players, 48 wind players, and 8 percussion players. The symptom prevalence rate of musculoskeletal disorders according to the NIOSH surveillance criteria was 79. 6 % and operational criteria by authors was 45. 9 %. The prevalence rate of viola players was higher than violin players, and the prevalence rate of the bass players was higher than that of the cello players. In univariate analysis, job insecurity, irregular performance, stress from family problems, and performance related psychosomatic strains had a significant association with the prevalence rate of musculoskeletal disorders. In multiple logistic regression, job insecurity, irregular performance, and stress from family problems were significant variables affecting the prevalence rate of musculoskeletal disorders of instrument players. CONCLUSIONS: This study suggest that symphony orchestra players are high risk group of musculoskeletal disorders. Irregular performance schedule and psychosocial stress including job insecurity, and psychosomatic strain were important risk factors of players musculoskeletal disorders. An exercise program such as stretching before and after performance, regular performance schedule and reduction of psychosocial stress might be helpful for prevention of musculoskeletal disorders of instrument players.