Occupational Lung Cancer Surveillance in South Korea, 2006-2009

OBJECTIVES: The lung cancer mortality in Korea has increased remarkably during the last 20 years, and has been the first leading cause of cancer-related deaths since 2000. The aim of the current study was to examine the time trends of occupational lung cancer and carcinogens exposure during the period 2006-2009 in South Korea, by assessing the proportion of occupational burden. METHODS: We defined occupational lung cancer for surveillance, and developed a reporting protocol and reporting website for the surveillance of occupational lung cancer. The study patients were chosen from 9 participating university hospitals in the following 7 areas: Seoul, Incheon, Wonju, Daejeon, Daegu, Busan, and Gwangju. RESULTS: The combined proportion of definite and probable occupational lung cancer among all lung cancers investigated in this study was 10.0%, 8.6%, 10.7%, and 15.8% in the years 2006 to 2009, respectively, with an average of 11.7% over the four-year study period. The main carcinogens were asbestos, crystalline silica, radon, polyaromatic hydrocarbons (PAHs), diesel exhaust particles, chromium, and nickel. CONCLUSION: We estimated that about 11.7% of the incident lung cancer was preventable. This reveals the potential to considerably reduce lung cancer by intervention in occupational fields.

Clusters of Pneumoconiosis among Residents Near Cement Factories / 대한산업의학회지

OBJECTIVE: This study investigated case clusters of pneumoconiosis among residents near cement factories in Young_Wol, Korea. METHODS: There were 1,396 residents of a total 3,418 residents surveyed for this study. Informations on demographics, health-related behaviors (smoking and drinking), past medical history, and clinical symptoms were collected using a self-administered questionnaire. All study participants underwent a physical examination, including chest X-ray, and physicians' interview. Chest CT (computerized tomography) was taken if there was abnormal finding on chest X-ray and physicians' interview. RESULTS: We detected 5 cases of pneumoconiosis. 2 cases were related to occupational exposure to dust, such as underground mining and the breaking up of concrete. However, 3 cases were not related to occupational or environmental exposure, except that persons were living near cement factories and limestone mines. CONCLUSION: This study suggests that the long-term exposure of cement dust among residents near cement factories and mines may lead to the development of pneumoconiosis.

Absence and Early Leave Status due to Job Stress and its Relationship to Job Stress Factors According to the Korean Occupational Stress Scale among Workers in Small and Medium Scale Industry / 대한산업의학회지

OBJECTIVE: The aim of this study was to examine the actual conditions of absence and early leave due to job stress of 4,350 workers in 83 small and medium scale industries, and its relationship to job stress factors using Korean Occupational Stress Scale-Short Form (KOSS-SF). METHODS: A structured self-reported questionnaire was used to assess each respondent's sociodemographics, job stress, experience of absence and early leave due to job stress. Seven KOSS-SF domains of job stress were used. We estimated the relation of absence and early leave due to job stress and job stress factors using logistic regression analyses. RESULTS: Absence or early leave due to job stress occurred in 7% of male workers and 8% of female workers. Multiple regression analysis revealed a significantly positive association job stress-related absence/early leave and job demand, interpersonal conflict, organizational system, lack of rewards and occupational climate. CONCLUSIONS: Absence and early leave due to job stress is significantly attributed to organizational system and lack of reward for men, and occupational climate and organizational system for women.

Absence and Early Leave Status due to Job Stress and its Relationship to Job Stress Factors According to the Korean Occupational Stress Scale among Workers in Small and Medium Scale Industry / 대한산업의학회지

OBJECTIVE: The aim of this study was to examine the actual conditions of absence and early leave due to job stress of 4,350 workers in 83 small and medium scale industries, and its relationship to job stress factors using Korean Occupational Stress Scale-Short Form (KOSS-SF). METHODS: A structured self-reported questionnaire was used to assess each respondent's sociodemographics, job stress, experience of absence and early leave due to job stress. Seven KOSS-SF domains of job stress were used. We estimated the relation of absence and early leave due to job stress and job stress factors using logistic regression analyses. RESULTS: Absence or early leave due to job stress occurred in 7% of male workers and 8% of female workers. Multiple regression analysis revealed a significantly positive association job stress-related absence/early leave and job demand, interpersonal conflict, organizational system, lack of rewards and occupational climate. CONCLUSIONS: Absence and early leave due to job stress is significantly attributed to organizational system and lack of reward for men, and occupational climate and organizational system for women.

Occupational Chronic Obstructive Pulmonary Disease Cases Evaluated by Workers' Compensation in Korea / 대한산업의학회지

OBJECTIVES: To analyse the characteristics of occupational COPD (Chronic obstructive pulmonary disease) cases that were evaluated by the Occupational Safety and Health Research Institute (OSHRI) of the Korea Occupational Safety & Health Agency (KOSHA). METHODS: Using the OSHRI database from KOSHA, we collected 13 cases of occupational COPD that had been evaluated from 1998 to 2007. RESULTS: Four cases had been evaluated as occupational COPD: 1) a nonsmoking road sweeper exposed to automobile exhaust gases and trash dust; 2) an oxygen welding worker exposed to cadmium fumes; 3) a cotton mill air conditioner cleaning worker exposed to cotton dust; and 4) a foundry grinding worker exposed to dust, gases, vapors and fumes. Nine cases had been evaluated as non-occupational COPD: 1) 4 cases in which smoking was determined to be the main cause rather than occupational exposure; 2) 1 case that was evaluated as another respiratory disease (severe tuberculosis sequelae); 3) 1 case that had been misdiagnosed as COPD; 4) 2 cases in which the exposure levels in the workplace environments were too low; and 5) 1 case that had developed before the employment. Among these 13 cases, a shipyard grinding worker had been evaluated in 2006 as having had a low occupational hazard, but a similar case (a foundry grinding worker) was evaluated as having had a high hazard in 2007. CONCLUSIONS: Proper evaluation of occupational COPD demands an accurate diagnosis of COPD itself and also the exclusion of other respiratory diseases that have similar symptoms; an investigation of the relevant occupatioonal hazards and the amount of the exposure; and a consideration of smoking history. The evaluation should also take into account any substantial loss of life due to occupational hazards as well as any disease-free periods.

Epidemiologic Study of Systemic Inflammatory Response Syndrome in Emergency Department

PURPOSE: Epidemiologic data on emergency department (ED) patients with systemic inflammatory response syndrome (SIRS) are limited. We examined the prevalence, risk factors, etiologies and outcomes for the various forms of the SIRS, as well as their relationships with infection in ED. METHODS: The subjects were 16,718 non-trauma adult patients who visited a 900- bed university hospital ED between November 2006 and October 2007. ED records were reviewed, and all patients meeting the criteria for SIRS were enrolled retrospectively. SIRS patients were further subdivided into four groups (non-infectious SIRS, sepsis, severe sepsis, septic shock). Baseline characteristics, ED dispositions, and prognoses of patients in each group were analyzed. RESULTS: Among 16,718 patients, there were 2,790 SIRS patients (16.7%). The SIRS patient group was composed of 1,546 non-infectious SIRS patients (55.4%), 1,078 sepsis patients (38.6%), 119 severe sepsis patients (4.3%), and 47 septic shock patients (1.7%). ED patients with SIRS were older on average than non-SIRS patients (52 versus 48, p<0.001). The most common sources of SIRS was the gastrointestinal system (28.3%), followed by the respiratory system (22.9%) and the genitourinary system (11.8%). Pneumonia (18.9%) was the single most common cause of infectious SIRS. The admission rate was higher for SIRS patients than for non-SIRS patients (44% versus 21%). The 28-day mortality rate for non-infectious SIRS, sepsis, severe sepsis, and septic shock patients were 4.5%, 1.3%, 25.2%, and 63.8%. Sepsis severity was correlated with increased rates of both hospital admission and mortality (p<0.001). CONCLUSION: 55% of SIRS patients who visited the ED had a non-infectious cause. SIRS patients were older than non-SIRS patients, and hospital and ICU admission rates were also higher. Sepsis severity was correlated with older age, increased hospital admission rate, increased ICU admission rate, and increased mortality rate.

The Relationship between Job Stress and the Common Cold / 대한산업의학회지

OBJECTIVES: To investigate the relationship between job stress and the common cold which is one of the most common infectious disease. METHODS: A KOSS (Korean Occupational Stress Scale)-based questionnaire survey was conducted targeting 6,699 workers, of which 4,637 questionnaires were returned and the data for 237 were excluded due to poor response and having pulmonary disease other than common cold. Consequently, 4,400 (65.7%) returned questionnaires were analyzed. Multiple logistic regression analysis and multiple linear regression, adjusted for daily life stress, confounding variables and both, were used to evaluate the relationship between job stress and the common cold. RESULTS: After adjustment for confounding variables and daily life stress, most of the subscales of job stress contributed to an increased risk of common cold. CONCLUSIONS: These results indicated that job stress may play a significant role in increasing the risk of the common cold and that further preventive efforts and studies are needed to reduce job stress and address infectious disease caused by job stress among Korean employees.

Association Between Job-Stress and VDT Work, and Musculoskeletal Symptoms of Neck and Shoulder Among White-Collar Workers / 대한산업의학회지

Objective: The purpose of this study was to evaluate and compare the association of job stress and working with video display terminal (VDT) to musculoskeletal symptoms of the neck-shoulder which were most common in white-collar workers. METHODS: From 122 workplaces, 1,790 white-collar workers with no trauma, and no history of musculoskeletal disease were selected for the study. The questionnaire survey included general characteristics, work related characteristics, Job Content Questionnaire (JCQ) and musculoskeletal symptoms. Multiple logistic regression, adjusted for age, smoking status, drinking habit, housekeeping, work time, job tenure, and work-load change, were used to evaluate the effects of job stress and VDT-work on the symptoms. RESULTS: The prevalence of neck-shoulder symptoms was overall 24.3% overall. The prevalence odds ratio of job demand (high/low) to neck-shoulder symptoms, adjusted for general and work-related factors, was 1.56 (95% confidence interval 1.12~2.17), and that of job strain (high strain/low strain) was 1.72 (1.07~2.79). However, VDT-work was not associated with neck-shoulder symptoms in the multiple logistic regression model. CONCLUSIONS: To prevent musculoskeletal disorders in white-collar workers, it is important to consider psychosocial factors such as job demand and job strain, as well as VDT-work.

Comparison of Face-to-Face Interview Questionnaires and Medical Records Data for Smoking Habits in Lung Cancer Patients / 결핵및호흡기질환

BACKGROUND: This study evaluated the accuracy of smoking habit from the data obtained from the medical records of lung cancer patients against the data obtained form face-to-face interview questionnaires METHODS: The smoking habits of 225 lung cancer patients were categorized into never smoked, ex-smoker and current smoker in face-to-face interview questionnaire and medical record taken at the time of admission for a diagnosis. The overall agreement between two sources was evaluated. The factors affecting the disagreement between two sources and the level of data omission of the smoking habits in medical records were analyzed suing multiple logistic regression. RESULTS: The smoking habit between two sources showed moderate overall agreement(Kappa (kappa)=0.60). The lowest agreement was observed in the ex-smokers(kappa=0.49). Multivariate analysis revealed an age of 65 or older to be a statistically significant factor associated with the increasing disagreement risk compared with those 64 or younger (OR 3.02; 95% CI 1.58-5.80). The omission rate of smoking habits in the medical records was 18.2%. Adenocarcinoma was shown to be a statistically significant factor of associated with an increasing omission rate compared with squamous cell carcinoma (OR 3.00; 95% CI 1.19-7.59). CONCLUSION: The smoking habits obtained from medical record moderately reflect their true behavior. However, the smoking habit data from medical record should be used with caution when being used in a clinical study or cohort study of lung cancer.

The Availability of Bedside Ultrasonography in Confirming Endotracheal Tube Placement in the Emergency Department

PURPOSE: The goal of this study was to determine the suitability of ultrasonography for detecting endotracheal tube placement in the emergency department. METHODS: Emergency physicians examined patients immediately following intubation or after intubated patients were transferred. A linear ultrasound transducer was placed transversely on the cricothyroid membrane and suprasternal notch in order to check for the "comet head and tail sign"and "double ring sign", and a sagittal view of the neck was also obtained in order to look for the "bold parallel lines sign". Subsequently, simple thoracic sonography and color doppler sonography were used to check for the "lung sliding sign". The examiner evaluated whether the tube was placed in trachea, the esophagus, or the right main bronchus. The accuracy of ultrasonography was calculated, and the required time for ultrasonography was checked. RESULTS: One hundred ten patients were enrolled in the study. The endotracheal tube was placed in the trachea in 107 patients, in the esophagus in 2 patients, and in the right main bronchus in 1 patient. The sensitivity and specificity of ultrasonography were 100%. The bold parallel lines sign and lung sliding sign proved to be good indicators of endotracheal tube placement. The average required time for ultrasonography was 28.6+/-5.8 seconds. It was difficult to determine tube placement by thoracic ultrasonography in patients with pneumothorax, hemothorax, pleural effusion, or empyema. CONCLUSION: Ultrasonography is well suited for confirming endotracheal tube placement in the emergency department.

Analysis of Worker's Compensation Claims for the Cerebrovascular and Cardiovascular Diseases / 대한산업의학회지

OBJECTIVES: This study was performed to provide fundamental data to judge whether or not cerebro and cardiovascular diseases are work-related, by comparing the characteristics between approved and non-approved cases among the worker's compensation claims. METHODS: We collected 12,309 cerebro and cardiovascular disease claims based on the worker's compensation records of the Labor Welfare Corporation from 2000 to 2004. The approved and non-approved cases were analyzed according to factors such as the calendar year, industry, company size, occupation, gender, age group, classification of cerebro and cardiovascular diseases, fatality and underlying diseases. We used x2-test and multivariate logistic regression for the analysis. RESULTS: According to multivariate logistic regression, electricity gas and water supply (OR=4.18, 95% CI=1.43~12.17), construction (OR=2.39, 95% CI=1.22~4.69) and manufacturing (OR=2.10, 95% CI=1.08~4.07) industries had a higher approval rate than mining and quarrying industries. Service workers and sales & marketing department workers (OR=1.90, 95% CI=1.47~2.47), professionals (OR=1.83, 95% CI=1.50~2.23), technicians and associate professionals (OR=1.63, 95% CI=1.35~1.97) and legislators and senior officials and managers (OR=1.62, 95% CI=1.24~2.12) had a higher approval rate than plant and machine operators and assemblers. Female workers had a higher approval rate (OR=1.31, 95% CI=1.13~1.53) than male workers. Cerebrovascular diseases had a higher approval rate (OR=2.75, 95% CI=2.42~3.13) than cardiovascular diseases. Fatal cases had a higher approval rate (OR=6.01, 95% CI=4.89~7.38) than surviving cases. CONCLUSION: For cerebro and cardiovascular diseases, workers' compensation claims are increasing, approval rates are relatively high and factors such as industry, company size, occupation, gender and fatality are related. A remarkable difference in the approval rate was found according to industry and occupation, suggesting the need for further study to identify which factors influence the approval rate. The approval rate for intracerebral hemorrhage arising in the course of employment (COE) was significantly higher than that arising out of employment (AOE), suggesting the need to correct the approval criteria.