The Occupational Characteristics and Health Status of Workers in Geographically Isolated and Confined Areas in the Republic of Korea

Background@#This study investigates the safety and health status of geographically isolated and confined workers. @*Methods@#This study was conducted in Baekryeong Island in Korea in 2020. The agestandardized prevalence ratios (aSPR) for occupational injury, unmet medical needs, psychological status, and lifestyle were estimated from the available data. Also, we compared the aSPRs of workers in Baekryeong Island with a reference study population who participated in a nationally representative survey in Korea. @*Results@#The study revealed that Baekryeong Island workers had an increased risk of acquiring health and safety problems compared to the general worker population. The island workers showed a significant increase in unmet medical care (aSPR, 5.319; 95% confidence interval [CI], 3.984–6.958) and occupational injury (aSPR, 8.371; 95% CI, 3.820–15.892). @*Conclusion@#This study identified the safety and health problems of geographically isolated workers in Baekryeong Island. The risk of occupational injury and unmet medical care are simultaneously highlighted in the region's population, thereby underscoring the importance of prevention.

The Occupational Characteristics and Health Status of Workers in Geographically Isolated and Confined Areas in the Republic of Korea

Background@#This study investigates the safety and health status of geographically isolated and confined workers. @*Methods@#This study was conducted in Baekryeong Island in Korea in 2020. The agestandardized prevalence ratios (aSPR) for occupational injury, unmet medical needs, psychological status, and lifestyle were estimated from the available data. Also, we compared the aSPRs of workers in Baekryeong Island with a reference study population who participated in a nationally representative survey in Korea. @*Results@#The study revealed that Baekryeong Island workers had an increased risk of acquiring health and safety problems compared to the general worker population. The island workers showed a significant increase in unmet medical care (aSPR, 5.319; 95% confidence interval [CI], 3.984–6.958) and occupational injury (aSPR, 8.371; 95% CI, 3.820–15.892). @*Conclusion@#This study identified the safety and health problems of geographically isolated workers in Baekryeong Island. The risk of occupational injury and unmet medical care are simultaneously highlighted in the region's population, thereby underscoring the importance of prevention.

The Association Between Long Working Hours and Infertility

Background@#This study aimed to investigate whether working long hours was related to infertility among female Korean workers, while taking age into consideration. @*Methods@#We used data from the 2018 National Survey on Fertility and Family Health and Welfare in Korea that is a cross-sectional, nationally representative, and population-based survey. Infertility was defined as women who were not pregnant after regular unprotected intercourse for a year. Working long hours was classified as ≥52 hours, and subgroups as per age were classified on the basis of being younger or older than 40 years of age. Differences in infertility risk between the long working hour group and none were estimated in crude and fully adjusted logistic regression models with age-group stratification. @*Results@#Of 5,909 Korean female workers, the crude and adjusted odds ratios (95% confidence intervals) of infertility for working long hours were 1.295 (0.948–1.737) and 1.303 (0.921–1.809), respectively. In the subgroup of patients below 40 years of age, the crude and adjusted odds ratios (95% confidence interval) were 1.957 (1.216–3.039) and 1.921 (1.144–3.120), whereas those aged 40 years or older had 0.994 (0.647–1.471) and 0.939 (0.560–1.501), respectively. The weighted prevalence of infertility increased as weekly working hours increased only for the younger than 40-year subgroup. @*Conclusions@#Infertility is associated with working long hours, especially in young-aged workers. Thus, the working schedule must be structured to better suit young female workers.

Acquired Brown Syndrome Secondary to Trochleitis

Purpose@#We report a patient with acquired Brown syndrome, secondary to trochleitis, who improved after intra-trochlear steroid injection.Case summary: An 8-year-old boy presented to the hospital with an abnormal chin-up head posture that had onset suddenly three days prior. Ductions and versions showed elevation limitation, particularly during adduction of the left eye. Prism and alternate cover tests revealed 16-18 prism diopters (PD) of left hypotropia, and 6 PD of left exotropia, in the primary position. Pain in the left eye was exacerbated by looking up or looking inward, or with palpation of the left trochlear region. Brain magnetic resonance imaging revealed bilateral pansinusitis and focal swelling with peripheral enhancement in the left trochlear area, leading to a diagnosis of acquired Brown syndrome associated with trochleitis in the left eye. Symptoms were partially relieved by one month of oral steroid therapy; however, the elevation limitation during adduction persisted in the left eye. Intra-trochlear steroid injection was performed in the left trochlear region and the limitation in eye movement gradually improved thereafter. @*Conclusions@#Intra-trochlear steroid injection facilitates the recovery of eye movement in acquired Brown syndrome secondary to trochleitis.

Multidimensional sleep quality of dependent self-employment workers

Multidimensional sleep quality of dependent self-employment workers

BACKGROUND@#The number of workers in non-standard employment (NSE) is increasing due to industrial change and technological development. Dependent self-employment (DSE), a type of NSE, was created decades ago. Despite the problems associated with this new type of employment, few studies have been conducted on the effects by DSE on health, especially sleep quality. This study aims to determine the relationship between DSE and sleep quality.@*METHODS@#This study analyzed data of 50,250 wage workers from the fifth Korean Working Conditions Survey. Workers that did not respond or refused to answer any questions related to variables were excluded, and finally 36,709 participants were included in this study. A total of 2,287 workers (6.2%) were compared with non-DSE (34,422; 93.8%) workers, and multiple logistic regression analyses were applied.@*RESULTS@#DSE status had a significant association with difficulty falling asleep (odds ratio [OR]: 1.331, 95% confidence interval [CI]: 1.178–1.504), difficulty maintaining sleep (OR: 1.279; 95% CI: 1.125–1.455), and extreme fatigue after waking up (OR: 1.331; 95% CI: 1.184–1.496). A multiple logistic regression of the variables for sleep quality in DSE showed a significant association with exposure to physical factors for all types of poor sleep quality as well as shift work for difficulty maintaining sleep with extreme fatigue after waking up. Long working hours and emotional labor were also associated with extreme fatigue after waking up.@*CONCLUSIONS@#This study shows a significant association between DSE and poor sleep quality, especially when workers were exposed to physical risk factors (noise, vibration, abnormal temperature, etc.) and shift work.

Association between shift work and hyperhomocysteinemia in male workers

BACKGROUND: Shift work is associated with a higher risk of cardiovascular diseases. Here, we sought to assess the relationship between shift work and plasma homocysteine levels. Determining the correlations between shift work and homocysteine levels may provide a better understanding of the mechanisms underlying cardiovascular diseases. METHODS: This study was performed using data from routine health examinations of steel workers in 2017. In total, 431 male workers (70 daytime workers and 361 shift workers) employed on a rolling departure schedule were recruited. Plasma homocysteine levels > 15 μmol/L were considered elevated. The χ2, analysis of variance, and multiple logistic regression analyses were used to examine the association between shift work and plasma homocysteine levels. RESULTS: In comparison to daytime workers, the odds ratio (OR) of hyperhomocysteinemia in individuals with < 10 years of shift work was 1.14 (95% confidence interval [CI]: 0.64–2.03), compared to 2.01 (95% CI: 1.14–3.54) for workers with ≥ 10 years of experience. After adjusting for confounding variables, the adjusted OR for shift workers with < 10 years of experience was 0.95 (95% CI: 0.50–1.80), compared to 2.00 (95% CI: 1.07–3.74) for workers with ≥ 10 years of experience. CONCLUSIONS: The risk of hyperhomocysteinemia was significantly higher in shift workers compared to those working normal daytime hours, particularly among long-term shift workers.

Multidimensional sleep quality of dependent self-employment workers

BACKGROUND@#The number of workers in non-standard employment (NSE) is increasing due to industrial change and technological development. Dependent self-employment (DSE), a type of NSE, was created decades ago. Despite the problems associated with this new type of employment, few studies have been conducted on the effects by DSE on health, especially sleep quality. This study aims to determine the relationship between DSE and sleep quality.@*METHODS@#This study analyzed data of 50,250 wage workers from the fifth Korean Working Conditions Survey. Workers that did not respond or refused to answer any questions related to variables were excluded, and finally 36,709 participants were included in this study. A total of 2,287 workers (6.2%) were compared with non-DSE (34,422; 93.8%) workers, and multiple logistic regression analyses were applied.@*RESULTS@#DSE status had a significant association with difficulty falling asleep (odds ratio [OR]: 1.331, 95% confidence interval [CI]: 1.178–1.504), difficulty maintaining sleep (OR: 1.279; 95% CI: 1.125–1.455), and extreme fatigue after waking up (OR: 1.331; 95% CI: 1.184–1.496). A multiple logistic regression of the variables for sleep quality in DSE showed a significant association with exposure to physical factors for all types of poor sleep quality as well as shift work for difficulty maintaining sleep with extreme fatigue after waking up. Long working hours and emotional labor were also associated with extreme fatigue after waking up.@*CONCLUSIONS@#This study shows a significant association between DSE and poor sleep quality, especially when workers were exposed to physical risk factors (noise, vibration, abnormal temperature, etc.) and shift work.

Association between serum ferritin and hypertension according to the working type in Korean men: the fifth Korean National Health and nutrition examination survey 2010–2012

BACKGROUND: Several studies suggest that serum ferritin concentrations reflect systemic inflammation, and high ferritin levels can increase the risk of hypertension in adult men. Shift work is also known to increase the risk of hypertension; however, there has been no study about the relationship between serum ferritin levels and the prevalence of hypertension according to the working type. METHODS: This cross-sectional study included 4,442 male participants (3,651 daytime workers and 791 shift workers) who participated in the fifth Korean National Health and Nutrition Examination Survey. Hypertension was defined as a systolic blood pressure greater than or equal to 140 mmHg, a diastolic blood pressure greater than or equal to 90 mmHg or the current use of antihypertensive medications regardless of blood pressure values. For the statistical analyses, serum ferritin levels were reclassified into quartiles, and complex sample analyses were used to evaluate the relationship between serum ferritin levels and the prevalence of hypertension according to the working type in this study. RESULTS: Serum ferritin and shift work were positively associated with the prevalence of hypertension. The effect of interaction was above multiplicative. When compared to participants in the lowest serum ferritin quartile, the odds ratio for hypertension for participants in the highest serum ferritin quartile was 1.372 (1.027–1.833) in daytime workers and 2.009 (1.042–3.873) in shift workers after adjustment. CONCLUSIONS: The prevalence of hypertension increased as ferritin levels increased in individuals, especially in shift workers.

Reticulocytosis in screen-printing workers exposed to 2-butoxyethanol and 2-ethoxyethanol

BACKGROUND: Studies on the hematologic toxicity of ethylene glycol ethers in humans are limited. Therefore, the aim of this study was to examine the association between exposure to solvents (containing 2-butoxyethanol and 2-ethoxyethanol) and hematological effects. METHODS: Thirty-four screen-printing workers who were exposed to 2-butoxyethanol and 2-ethoxyethanol and 37 non-exposed clerical workers were selected using data from the health care facilities that provided regular health screening services. Student's t-tests and Pearson's chi-square tests were used to compare differences in hematological parameters between the exposed and the control groups. A multivariate analysis was performed using the multiple logistic regression models to adjust for other variables. RESULTS: The chi-square test showed the reticulocyte percentages and corrected reticulocyte counts to be significantly higher in the exposed group. The t-tests showed a significant increase in white blood cell counts, reticulocyte percentages, and corrected reticulocyte count (i.e., reticulocyte index) in the exposed group, with p-values of 0.002, 0.004, and 0.002, respectively. Multivariate analysis showed the odds ratio for the corrected reticulocyte counts to be 16.30 for the exposed group, when compared with that of the control group. CONCLUSIONS: Exposure to 2-butoxyethanol and 2-ethoxyethanol was significantly associated with reticulocytosis, necessitating the implementation of preventive measures for workers prone to occupational exposure to ethylene glycol ethers.

A Case of Silicone Granuloma in the Neck / 대한이비인후과학회지

Liquid injectable silicone has been used extensively in some countries during the past 5 decades for soft tissue augmentation. Although considered biologically inert, this material has been reported as potentially inducing, after tissue injection, a granulomatous inflammatory response of variable severity. A 73-year-old female patient visited our clinic with neck masses and pain. Her past medical history revealed a face and neck augmentation with silicone about 15 years ago by unqualified medical personnel. Because of the persistent superficial neck pain, we removed the palpated neck masses detected by physical examination and computed tomography. Histopathologic test confirmed silicone granuloma. The neck pain disappeared with the surgery. We have observed the patient for four months with no complications. We herein describe the clinical and microscopic features of a case of silicone-induced granulomas treated by surgical removal.

A Case of Surgically Treated Pulsatile Tinnitus by Sigmoid Sinus Diverticulum and/or Dehiscence (SSDD) / 대한이비인후과학회지

Tinnitus is a bothersome symptom, and definite treatment of tinnitus is unclear. However, somatostatic tinnitus caused by vascular bruit is sometimes treatable. Sigmoid sinus diverticulum and/or dehiscence (SSDD) is common vascular abnormality, which is also known to cause pulsatile tinnitus. An endovascular embolization that can treat SSDD has been reported already, however, an external approach has not been reported yet in Korea. We experienced a 34-year-old woman who had complained of pulsatile tinnitus by SSDD and she was successfully treated with an external apporoach. So we report this case with a review of literatures.

Osteoclast-Like Giant Cell Tumors with a Carcinomatous Component of Parotid Gland / 대한이비인후과학회지

The giant cell tumor of the salivary gland is very rare. A 57-year-old man had noticed a mass in the right parotid area for several weeks. The diagnosis using aspiration cytology was a giant cell tumor possibly with a carcinomatous component. Parotidectomy was carried out. Histologically, the tumor consisted of evenly distributed osteoclast-like giant cells, mononuclear cells and two small foci of a carcinomatous component. Because so little is known about giant cell tumor of the salivary gland, we used the occasion of this case report to describe the cytologic, histologic and immunohistochemical characteristics that we observed.

Comparison of Natural Drainage Group and Negative Drainage Groups after Total Thyroidectomy: Prospective Randomized Controlled Study

PURPOSE: The aim of this study was to compare a negative pressure drain with a natural drain in order to determine whether a negative pressure drainage tube causes an increase in the drainage volume. MATERIALS AND METHODS: Sixty-two patients who underwent total thyroidectomy for papillary thyroid carcinoma (PTC) were enrolled in the study between March 2010 and August 2010 at Gyeongsang National University Hospital. The patients were prospectively and randomly assigned to two groups, a negative pressure drainage group (n=32) and natural drainage group (n=30). Every 3 hours, the volume of drainage was checked in the two groups until the tube was removed. RESULTS: The amount of drainage during the first 24 hours postoperatively was 41.68+/-3.93 mL in the negative drain group and 25.3+/-2.68 mL in the natural drain group (p<0.001). After 24 additional hours, the negative drain group was 35.19+/-4.26 mL and natural drain groups 21.53+/-2.90 mL (p<0.001). However, the drainage at postoperative day 3 was not statistically different between the two groups. In addition, the vocal cord palsy and temporary and permanent hypocalcemia were not different between the two groups. CONCLUSION: These results indicate that a negative pressure drain may increase the amount of drainage during the first 24-48 hours postoperatively. Therefore, it is not necessary to place a closed suction drain when only a total thyroidectomy is done.

Multiple Metastatic Brain Tumor: Complicated with Post-dural Puncture Headache : A case report

Epidural blood patch is an effective management for treatment of severe post-dural puncture headache. Here we describe a case of a patient with hip fracture, who was complained regarded as having suspicious post-dural puncture headache after epidural anesthesia, but it failed to be treated with 4 times of epidural blood patch, and later was diagnosed with multiple metastatic brain tumor.

Inadvertent Epidural Administration of Atracurium and Lidocaine Mixture: A case report / 대한마취과학회지

Epidural administration of opioid and/or local anesthetics during general anesthesia is widespread method for postoperative pain control. Despite of its availability, inadvertent administration of non-epidural medications into epidural space can be associated with serious neurologic sequelae. We report a case of accidental epidural atracurium injection.

Comparison of Cost-Effectiveness of Propofol Using Target-Controlled Infusion (TCI) with Standard Anesthesia Regimens in Major Operations / 대한마취과학회지

BACKGROUND: The purpose of this study was to compare the cost-effectiveness of propofol using a target-controlled infusion (TCI) with two currently used anesthetic regimens during major operations. METHODS: Forty-two patients undergoing major gynecological surgery were divided into three groups according to the period during which the surgeries were performed. Group propofol/TCI (n = 16) received 1% propofol using TCI-50% N2O, Group isoflurane (n = 14) received thiopental 5 mg/kg-isoflurane-50% N2O, and Group enflurane (n = 12) received thiopental 5 mg/kg-enflurane-50% N2O. All patients also received 2 microgram/kg of fentanyl before induction. Concentrations of propofol and volatile anesthetics were varied according to the patient's hemodynamic responses. Consumption of volatile anesthetics was measured by weighing the vaporizers by a precision weighing machine. RESULTS: Biometric data, duration of surgery and of anesthesia were similar in the three groups. Recovery from anesthesia was significantly shorter in the propofol/TCI group. Episodes of postoperative nausea and vomiting in the recovery room were less common in propofol/TCI group. Patient satisfaction was similar in all three groups. Total (intra- and postoperative) costs were significantly higher in the propofol/TCI group. CONCLUSIONS: When compared with the standard anesthetic regimens, the use of propofol using TCI anesthesia during major operations was associated with higher costs, but did not offer any clinically significant advantages in cost-effectiveness over the standard anesthesia regimens.

The Effect of Clonidine Added to Bupivacaine on Intercostal Nerve Block for Postoperative Pain Control / 대한마취과학회지

BACKGROUND: The addition of clonidine to local anesthetics for regional block has been shown to increase the duration of anesthesia and analgesia. This study was designed to determine whether the addition of clonidine to bupivacaine would produce an extension of the analgesic effect after intercostal nerve block (ICNB). METHODS: After informed consent, 30 ASA 1 or 2 patients undergoing appendectomy under general anesthesia were randomly divided into two groups. Before induction of anesthesia, ICNB using a posterior approach was performed with 15 ml of 0.25% bupivacaine plus epinephrine 1:200,000 with (Group BEC; n = 15) or without (Group BE; n = 15) clonidine 75 microgram. Analgesia was assessed by cold testing at 1/min intervals until cold sensation decreased. The duration of analgesia (time between injection and onset of pain) was recorded. We also recorded the visual analogue scale (VAS) of pain, the number of supplemental analgesics, heart rate and blood pressure, and side effects over 24 hours postoperatively. RESULTS: The onset time, duration of analgesia, number of analgesics, and heart rate and blood pressure were comparable in both groups. VAS scores were significantly lower in Group BEC than in Group BE at 12, 16, and 20 hours postoperatively. CONCLUSIONS: The addition of clonidine to bupivacaine with epinephrine may be a useful adjunct and can prolong the duration of analgesia after ICNB without significant side effects.

Carboxyhemoglobin Levels during High and Minimal Flow Anesthesia / 대한마취과학회지

BACKGROUND: Minimal flow anesthesia preserves the moisture content of CO2 absorbents and seems to be a factor inhibiting carbon monoxide generation. In order to assess the safety of minimal flow anesthesia, we studied carboxyhemoglobin (COHb) level in minimal flow anesthesia. METHODS: Forty women, ASA physical status I or II, undergoing total abdominal hysterectomy were randomly allocated to one of two groups with N2O-enflurane anesthesia. Anesthesia was maintained with O2 2 l/min and N2O 2 l/min (group 1) or O2 0.3 l/min and N2O 0.2 l/min (group 2). The arterial COHb levels were measured immediately after induction (T1), 45 min after induction (T2), 75 min after induction (T3), and after recovery from anesthesia (T4). RESULTS: Although there was no statistically significant change in both groups, the COHb level at T3 and T4 increased more than that at T1 in group 1, and that at T3 and T4 decreased more than that at T1 in group 2. There was a significant difference in the COHb level at T4 between group 1 (0.93 0.31%) and 2 (0.68 0.36%) (P <0.05). CONCLUSIONS: These results show that minimal flow anesthesia does not increase the COHb level and may be performed safely.

Neurogenic Pulmonary Edema following Cerebral Aneurysmal Rupture: A case report / 대한마취과학회지

Neurogenic pulmonary edema (NPE) occurs in association with CNS lesions and in the absence of underlying cardiopulmonary disease. The dramatic increase in intracranial pressure (ICP) that follows aneurysmal rupture appears to trigger a massive autonomic discharge which causes virtually instantaneous circulatory adjustments i.e. NPE. When we anesthetize a cerebral aneurysmal patient combined with NPE, not only is there the risk of hypoxemia due to NPE, but also we have difficulty in managing to control hemodynamics and hypervolemia. As we experienced a cerebral aneurysmal patient combined with NPE, we report this case with a review of the literature.