Gastric and rectal cancers in workers exposed to asbestos: a case series

"A Systematic Review On Identifying Associated Factors In Deciding Work- Relatedness Of Chronic Back Pain Among Employee "

@#Chronic low back pain is a common and preventable complain amongworkers. Large amount of financial and benefit cost has been spent by the developed countries to prevent, treat and rehabilitate a large number of workers that are exposed to hazards attributing to low back pain. Efforts on primary prevention of low back pain has been challenging due to difficulties in affirming work-relatedness of chronic back pain among workers. As such, efforts have to be focused on the existing literatures to propose acceptable variables to define work-relatedness specific to occupational low back pain. Evidences suggest twisting, frequent manual lifting of objects, duration of daily exposure, coping mechanism towards the pain, body mass index (BMI), smoking status and physical activity are associated with occupational back pain. However, further research efforts are needed to establish stronger evidence and improve the occupational safety and health of our workers that are exposed to all these hazards throughout the day on a daily basis.

Overview of occupational cancer in painters in Korea

Comprehensive consideration is necessary for setting guidelines to evaluate evidence of occupational cancer in painters due to work-related exposure to carcinogens in paint (a phenomenon termed herein as “work-relatedness”). The aim of the present research is to perform a comprehensive review and to suggest criteria for the provision of compensation for occupational neoplasm among painters in Korea. In order to perform a comprehensive review, this study assessed and evaluated scientific reports of carcinogenicities from the International Agency for Research on Cancer (IARC) and the Industrial Injuries Advisory Council (IIAC), as well as reviewed the existing literature about occupational exposure among painters in Korea and the epidemiologic investigations of claimed cases of cancer among painters in Korea. The IARC declares that occupational exposures in commercial painting are classified as Group 1 carcinogens for lung cancer and bladder cancer among painters. The epidemiologic studies show consistent causal relationships between occupational exposure in painters and cancers such as lung cancer [meta relative risk: 1.34 (95% confidence intervals (CIs): 1.23-1.41)] and bladder cancer [meta relative risk: 1.24 (95% CIs: 1.16-1.33)]. In reviewing occupational cancer risks for commercial painters, the Industrial Injuries Advisory Council (IIAC) confirms occupational cancer risks for lung and bladder cancer among commercial painters. According to the IIAC, however, the elevated cancer risks reported in existing literature are not doubled in either lung or bladder cancer in commercial painters relative to the risks of these cancers in the general population. Based on our review of existing Korean articles on the topic, painters are exposed to potential carcinogens including polycyclic aromatic hydrocarbons (PAHs), benzene, hexavalent chrome, crystalized silica, asbestos, and other agents, and relative levels are estimated within commercial painting processes. However, the cancer risks of occupational exposure to Group 1 carcinogens for lung and bladder cancer in painters per se are not fully assessed in existing Korean articles. Total work duration, potential carcinogens in paint, mixed exposure to paints across various industries such as construction and shipbuilding, exposure periods, latent periods, and other factors should be considered on an individual basis in investigating the work-relatedness of certain types of cancer in commercial painters.

Work-related olfactory disorder: a case series and review

BACKGROUND: The olfactory bulb is anatomically exposed and thus can be directly damaged by external stimulation. This can occur as an occupational injury owing to contact with organic solvents or other causes. We present cases of eight patients who sustained occupation-related exposure to potentially toxic substances and later presented with signs and symptoms of anosmia. We examined the occupational and medical characteristics of the patients and evaluated their work-relatedness. CASE PRESENTATION: Case 1: A 50-year-old man performed high-frequency heat treatments for approximately 11 years. He experienced decreased senses for olfaction and taste during the later years culminating in the diagnosis of anosmia after 3 years (high work-relatedness). Case 2: A 54-year-old man whose work involved exposure to various organic solvents, such as spray painting and application of paint and thinners for approximately 4 years, was subsequently diagnosed with anosmia based on rhinorrhea, headache, and loss of olfaction (high work-relatedness). Case 3: A 44-year-old-man who performed spray painting for approximately 17 years developed anosmia (high work-relatedness). Case 4: A 44-year-old man was involved in ship engine cleaning once a month, for approximately 7 h per cleaning session; he was diagnosed with anosmia based on loss of olfaction (low work-relatedness). Case 5: A 41-year-old man worked in ship building block construction for approximately 13 years; anosmia diagnosis was based on loss of olfaction (low work-relatedness). Case 6: A 47-year-old woman performed product inspection and labeling at a plant manufacturing automobile parts; anosmia diagnosis was based on decreased olfaction and taste (low work-relatedness). Case 7: A 50-year-old woman performed epoxy coating in a plant manufacturing automobile parts; anosmia diagnosis was based on diminishing olfaction (low work-relatedness). Case 8: A 57-year-old woman performed cleaning of the area where mobile phone parts were manufactured; anosmia diagnosis was based on diminishing olfaction (low work-relatedness). CONCLUSION: The study results confirmed work-relatedness when the subject was young, and the duration of exposure was long without any other cause of anosmia. Regarding compensation for occupational diseases, work-relatedness can be recognized as a relative concept.

Work-relatedness of lung cancer by smoking and histologic type in Korea

OBJECTIVES: This study investigated the distribution of causative agents related to occupational lung cancer, their relationships with work, and associations between work-relatedness and the histologic type of lung cancer. METHODS: We used data from the occupational surveillance system in Korea in 2013. In addition, data from 1,404 participants diagnosed with lung cancer were collected through interviews. We included the patients' longest-held job in the analysis. Work-relatedness was categorized as "definite," "probable," "possible," "suspicious," "none," or "undetermined." RESULTS: Among the subjects, 69.3% were men and 30.7% were women. Regarding smoking status, current smokers were the most prevalent (35.5%), followed by non-smokers (32.3%), ex-smokers (32.2%). Regarding the causative agents of lung cancer, asbestos (1.0%) and crystalline silica (0.9%) were the most common in definite work-related cases, while non-arsenical insecticide (2.8%) was the most common in probable cases followed by diesel engine exhaust (1.9%) and asbestos (1.0%). Regarding histologic type, adenocarcinoma was the most common (41.7%), followed by squamous cell carcinoma (21.2%). Among current smokers, squamous cell carcinoma was the most common among definite and probable cases (13.4%), while non-small cell lung cancer was the least common (7.1%). Among non-smokers, squamous cell carcinoma was the most common (21.4%), while the least common was adenocarcinoma (1.6%). CONCLUSIONS: Approximately, 9.5% of all lung cancer cases in Korea are occupational-related lung cancer. Well-known substances associated with lung cancer, such as crystalline silica, asbestos, and diesel engine exhaust, are of particular concern. However, the histologic types of lung cancer related to smoking were inconsistent with previous studies when work-relatedness was taken into account. Future studies are required to clarify the incidence of occupational lung cancer in agricultural workers exposed to non-arsenical insecticides and the associations between work-relatedness and the histologic type of lung cancer.

Challenges In Determining Occupational Related Chronic Low Back Pain Among Employees: A Review Of The Literature

Chronic low back pain is a common preventable occupational health illness affecting most workers. Large amount of financial and benefit cost had been spent by the developed countries to prevent, treat and rehabilitate a large number of workers who are exposed to hazards that are attributed to low back pain. Efforts on primary prevention of low back pain had been challenging due to difficulties in affirming work- relatedness of chronic back pain among workers. As such, efforts have to be focused on existing literatures to propose acceptable variables to develop the definition of work- relatedness specific to chronic low back pain. Such identified variables or factors could be used to develop a set of criteria in defining work- related chronic back pain. Literature search using specific work- related and chronic low back pain key words were used. Comparable articles were judged and a summarized result was obtained. These variables could be grouped into individual characteristics, health behaviours, physical conditions at work, work organizations and ergonomic factors. With proper methodology and statistical analysis, tools could be developed to aid physicians in determining work- related chronic low back pain among employees.

Factors Affecting the Designation of Cerebrovascular Diseases as Work-Related in Administrative Litigation

The purpose of this study was to identify factors that could be used as standardized criteria for evaluating occupational diseases in initial assessments or requests for examination. Using 100 administrative litigation cases on the work-relatedness of cerebrovascular diseases (CVDs) by the Seoul Branch of the Korea Labor Welfare Corporation (KLWC) from 1997 to 2002, we estimated the relationship between the investigated variables and designation of the work-relatedness of the CVD. As for the age, the odds ratio of the acceptance rate of a case as work-related in subjects over 60 yr of age was 0.08 (95% CI, 0.01-0.75), which was compared to subjects under 30 yr of age. Regarding working hours, the odds ratio of the acceptance rate of a case as work-related in CVDs in those over 56 hr was 9.50 (95% CI, 1.92-47.10) when compared to those less than 56 hr. As for the benefit type, the odds ratio of the acceptance rate of a case as work-related in medical benefits was 5.74 (95% CI, 1.29-25.54), compared to survivor benefits. As for the criteria for defining situations as work overload, the odds ratio of the acceptance rate of a case as work-related in injured workers was 12.06 (95% CI, 3.12-46.62), compared to that in non-injured workers. Our findings show that the criteria for defining situations of work overload played an important role in assessing the work-relatedness of CVDs in administrative litigation, and it is necessary to make the scientific evidence on judgement of workrelatedness on overwork.

Are Cerebrovascular and Cardiovascular Diseases among Employees Work-related? / 대한산업의학회지

Cerebrovascular and cardiovascular diseases (CVDs) are a major cause of deaths among workers as well as in general population in Korea. The term "Karoshi" in Japan represents work-related cerebrovascular and cardiovascular diseases (WR-CVD) due to excessive overwork. According to the Karasek's Demand-Control Model many prospective studies reported a significant association between working in jobs with high strain and increased likelihood of subsequent development of cardiovascular diseases. However, further understanding of the etiopathology of each different work-relatedness is needed to prevent WR-CVDs effectively. This review was planned to help the readers with knowledge on the etiopathology of the WR-CVDs. Based on the causal or triggering factors, work-relatedness in the literature can be classified into four types: 'accidental type (e.g. sudden cardiac deaths)', 'typical Karoshi type due to extreme overwork', 'maladaptation type due to dramatic change in job characteristics', and 'job stress type due to inherent characteristics'. Even though the outcome of each type is apparently similar, their causes and pathophysiologic mechanisms are quite different. In conclusion, the work-relatedness of CVDs among employees is very limited and usually works as a trigger rather than as the causal factors. A thorough understanding of the etiopathology of WR-CVDs can be very helpful in developing a prevention strategy.

Surveillance of work-related carpal tunnel syndrome in Korea / 대한산업의학회지

OBJECTIVES: Carpal tunnel syndrome (CTS) is one of the most important work related musculo-skeletal diseases in Korea. However, there are few epidemiologic studies on the work-related CTS (WR-CTS). This study aimed to investigate the epidemiologic characteristics of WR-CTS in Korea. METHODS: Data obtained from the"CTS Surveillance System". Physician case-reports in the surveillance were used to document patterns of WR-CTS by age, gender, occupation, sign, symptom, working history. RESULTS: Six hundred and seventy-two cases of WR-CTS were ascertained. of which 314 with complete information on occupational history were analyzed. It has been estimated that as many as 72% of all CTS cases are work-related. The highest proportion of WR-CTS was observed in 'elementary occupation workers', followed by 'skilled agricultural, forestry and fishery workers'. The distributions of WR-CTS cases were similar with respect to age, obesity, and past medical history. The proportion of WR-CTS was higher in females. There was no significant difference in physical examination findings between WR-CTS and non WR-CTS cases. Repetitive work and the inappropriate hand posture seemed to be the risks for WR-CTS. CONCLUSION: WR-CTS is a significant public health problem. The CTS surveillance system is quite useful to elucidate the characteristics of WR-CTS, but it remains of limited use in targeting specific industries and occupations for intervention.

A case of mental ill health caused by job stress after job reallocation / 대한산업의학회지

BACKGROUND: Recently, social concern about occupational stress and disputes, which are surrounded with judgements of work relatedness for various psychiatric sequels, is increasing. OBJECTIVE: We present a case of work-related illness judgement in which panic disorder and adjustment disorder with conversion symptoms were associated with work stress due to job reallocation. METHODS: We performed psychiatric assessment including mental status examination and neuropsychological test batteries. We also assessed job stress profiles using the Korean version of the Occupational Stress Inventory(K-OSI). RESULTS: The patient showed no specific psychological or physical problems and had previously demonstrated suitable coping skills. However, the patients case, who was sensitive to emotional stress, suffered chronic stress symptoms after a role change from a car mechanic to office manager which required continuous interaction with customers and a strong emotional burden. Panic attack and conversion symptoms were judged to be associated with disharmony between individual characteristics and environmental needs. CONCLUSION: It is noteworthy that this is the first reported case considered as a psychiatric illness related with psychological work stress. A further study will be attempted to assign standards of judgment for similar cases through systematic source collection and tool development.

The Work-Related Cases among Bronchial Asthma Diagnosed at a University Hospital in Incheon / 대한산업의학회지

Bronchial Asthma could be developed by occupational origin. 4-16% of bronchial asthmas are known to be related to occupational exposure. However, occupational asthma has not been reported from the periodic occupational health examination, but reported through case report from clinicians. The authors analysed hospital records to find out work-related bronchial asthma and their occupational characteristics at a university hospital in Jnchon. All records which were confirmed as bronchial asthma in adult by an allergist from June, 1996 to May, 1998 were selected. Through record reviewing, any suspected work related asthma was selected and the interview was done by phone or at the out-patient clinic. The possible cases were confirmed by additional tests including specific bronchial provocation test. Sixteen(3. 9%) out of 411 bronchial asthma were confirmed as work-related asthma. Eight cases out of 16 worked at furniture industry, three worked at dye manufacturing and two worked at musical instrument manufacturing industry. Others worked at farm and machinary industry. The confirmed asthmogen were toluene diisocyante(8), reactive dye(3), and grain dust(1). None of the cases was detected as work-related asthma in the periodic health examination. Twelve out of sixteen occupational asthma patients discontinued their work. The results suggested that many patients with occupational asthma were not reported and the periodic health examination was not an effective system for detecting the workrelated asthma. Thus, setting up the surveillance system involving allergist or pulmonologist would be important to detect and prevent occupational asthma.