Underestimation of smoking hazards and smoking cessation intervention efficiency among healthcare professionals: A cross-sectional study among Korean occupational health nurses.

INTRODUCTION: Occupational health nurses (OHNs) in South Korea who visit the workplace periodically could play a key role in smoking cessation. It would be helpful to assess their understanding of smoking hazards and smoking cessation methods to encourage them to provide smoking intervention services at the workplace. This study aimed to investigate the knowledge of smoking hazards and perceptions of smoking cessation methods among OHNs. METHODS: We conducted an anonymous self-administered cross-sectional questionnaire survey of 108 OHN nurses employed in an occupational health service outsourcing specialized agency with 19 regional branches in Korea from July to August 2019. We assessed the perceptions of the OHNs about smoking interventions, hazards of smoking, and perceived competence to counsel smokers according to training experience, using chi-squared tests and Fisher's exact tests. RESULTS: The majority of the nurses underestimated the smoking-attributable fraction for lung cancer (78.7%), chronic obstructive pulmonary disease (64.8%), and mortality (49.0%), regardless of training experience on smoking cessation, while more than half perceived their skill and knowledge to counsel patients concerning smoking as inadequate (56.5%). However, those trained in smoking cessation interventions felt more competent in smoking cessation counselling, with 52.2% and 29.3% in the trained and non-trained groups, respectively (p=0.019). CONCLUSIONS: The OHNs in this study underestimated smoking hazards and perceived themselves as lacking counselling skills regarding smoking cessation interventions. It is necessary to encourage OHNs to promote smoking cessation by increasing their knowledge, skills and competence in smoking cessation interventions.

Employment Status Transition Predicts Adult Obesity Trajectory: Evidence From a Cohort Study in South Korea.

OBJECTIVES: To investigate the impact of employment status on health by describing obesity trajectories with employment status transitions. METHODS: We used data from the Korean National Health Insurance Service - National Sample Cohort 2006-2015 data. Employment status transitions were measured using four categories: continuously non-employed, continuously employed, transition into employment, and transition out of employment. The time trends in the likelihood of obesity were examined both before and after employment status transition. RESULTS: The time trends of the likelihood of obesity showed a significantly increasing trend in the transition into employment group, especially in younger men, and increasing trends of obesity among the transition out of employment group, especially in older female participants. CONCLUSIONS: This study found increase in obesity prevalence of men after transition into employment and of women after transition out of employment.

Occupational health nurses' personal attitudes toward smoking: A cross-sectional study.

OBJECTIVES: This study aims to investigate if experience in smoking intervention training influences attitudes toward smoking, discuss the role of health management programs of small- and medium-sized enterprises, and analyze the current attitude of occupational health nurses regarding the hazards of smoking and responsibility to smokers to effectively facilitate smoking cessation support programs. METHODS: We conducted an anonymous self-administered cross-sectional survey of 108 nurses employed in occupational health services outsourcing specialized agency in Korea. We assessed the difference in attitude about smoking according to training experience in smoking interventions and perceived competence in counseling smokers using chi-square test and Fisher's exact test. RESULTS: Occupational health nurses with the training experience of smoking interventions tend to perceive the harmful effects of smoking more seriously, compared to occupational health nurses without the training experience (P = .024, Fisher's exact test) and the OHSO nurses with the training experience tend to have professional ethics as health care professionals (P = .017, Fisher's exact test). Occupational health nurses having expertise in smoking cessation counseling tended to have professional ethics (P = .047, Fisher's exact test) and social responsibility as health care professionals (P = .022, Fisher's exact test). CONCLUSION: The occupational health nurses with training experience and expertise in smoking cessation counseling perceive the harmful effects of smoking more strongly and can enhance their professional ethics and social responsibility as health care professionals.

Relationship Between Emotional Labor and Perceived Health Status Among Service and Sales Workers: Findings From the Korea National Health and Nutrition Examination Survey 2007 to 2009.

OBJECTIVES: This study examined the relationship between emotional labor and general health status in a nationally representative sample of South Korean service and sales workers. METHODS: Data were obtained from the 2007 to 2009 Korea National Health and Nutrition Examination Survey. A total of 1907 subjects were included in the analysis. Multiple logistic regression was performed to determine the relationship between emotional labor and perceived health status (PHS). RESULTS: The adjusted odds ratio (95% confidence interval) of poor PHS was 1.869 (1.464 to 2.391) among high emotional labor group, compared with the low emotional labor group as the reference. Perceived stress accounted for 35.57% of the variance in the relationship between high emotional labor and poor PHS. CONCLUSIONS: Emotional labor was associated with increased risk of poor PHS.

Self-Rated Health Trajectory Changes According to Employment Transition: A Korean Prospective Cohort Study.

OBJECTIVE: To investigate the impact of employment transitions on self-rated health (SRH) trajectories. METHODS: We used data from the Korean Labor and Income Panel Study 2003 to 2016. Employment transitions were measured using four categories: continuously non-working, continuously working, labor force exit, and labor force entry. For examination of the time trends in the likelihood of poor SRH, we calculated the annual odds ratios with those from 2003 as the reference, using generalized estimating equations. RESULTS: The time trends in the likelihood of poor SRH showed a significant increasing trend in the labor force exit group, while continuously working group and labor force entry group showed significantly decreasing patterns. CONCLUSIONS: Labor force exit was associated with a substantial increase in prevalence of poor SRH, while labor force entry was associated with a decrease in prevalence of that.

Effect of Socioeconomic Factors on the Relationship Between Musculoskeletal Pain and Ill-Health Retirement in Korea: Results From the Korean Longitudinal Study of Aging.

OBJECTIVE: To investigate the relationship between musculoskeletal pain (MSP) and ill-health retirement (IHR) and modifying role of socioeconomic factors. METHODS: The data used were samples from the Korean Longitudinal Study of Aging from 2006 to 2014. IHR was defined as retirement due to health problems before regular retirement age. Hazard ratio (HR) was calculated using Cox proportional hazards model to determine the effects of MSP and covariance on IHR. RESULTS: People who have "any site of pain" were more likely to experience IHR than people with no pain. In the subgroup analysis, risk of IHR due to MSP was higher in the 60s, white-collar, and high-income earners than the other groups. CONCLUSIONS: MSP has a substantial negative impact on labor force participation, and there was a clear effect modification of socioeconomic status on IHR risk.

The Impact of Working Hours on Cardiovascular Diseases and Moderating Effects of Sex and Type of Work: Results From a Longitudinal Analysis of the Korean Working Population.

OBJECTIVES: The aim of this study was to estimate the risk of cardiovascular disease (CVD) caused by working hours in the South Korean working population stratified by sex and type of work. METHODS: We analyzed longitudinal data from the Korean Longitudinal Study of Aging in 2006. The risk of CVD associated with working hours was estimated using Cox regression analysis. In addition, the analysis was conducted by stratifying the sample by sex and type of work (wage work and self-employment). RESULTS: After adjusting for all covariates, subjects in long working hours (≥50 h/wk) groups showed increased risk of CVD. After sex and type of work stratification, only women and wageworkers showed significantly increased risk of CVD associated with long working hours. CONCLUSIONS: The results demonstrated that increased risk of CVD was associated with long working hours, especially in women and wageworkers.

Bermuda grass pollen allergen implicated in clinically relevant cross-reactivity to multiple grains: A case report.

BACKGROUND: Anaphylaxis is a severe and potentially fatal type of allergic reaction and is characterized by the rapid development of symptoms in the respiratory and circulatory systems, possibly leading to death if not treated properly. Occupational anaphylaxis, which does not exhibit significant differences in pathogenesis from the nonoccupational form, develops in response to work-related triggers. However, the onset of occupational anaphylaxis can also be triggered by other factors. Therefore, an unexpected episode may occur due to exposure to a previously sensitized antigen or cross-reaction in the occupational environment, even if the direct trigger has been removed. Accordingly, it is difficult to diagnosis and treat such cases and ensure avoidance of potential triggers. CASE PRESENTATION: An adult male patient developed anaphylaxis following exposure to grass antigens while replacing and burying sewer pipes at a theme park. He later developed cross-reactivity to other grains. Despite symptomatic treatment, his total serum level of allergen-specific immunoglobulin E (Ig E) antibodies continuously increased, and thus, he was admitted with severe hypersensitivity, at which time his serum levels of Ig E antibodies specific for Bermuda grass, wheat, and rice had also increased. CONCLUSION: In Korea, Bermuda grass is rarely seen and is generally found in athletic fields or theme parks. Following exposure to this relatively rare grass, our patient exhibited new anaphylactic responses to various external antigens. Therefore, we attribute his severe anaphylaxis to sensitization caused by Bermuda grass exposure and cross-reactive hypersensitivity to other grains.

Trichloroethylene Hypersensitivity Syndrome: Should Be Considered When Diagnosing DRESS Syndrome.

Trichloroethylene (TCE) is an organic solvent that is used for degreasing and removing impurities from metal parts. However, this solvent's characteristics and hypersensitivity can produce clinical patterns and laboratory data that mimic drug rash with eosinophilia and systemic symptoms (DRESS) syndrome. Thus, exposure confirmation is critical to making an accurate diagnosis. This is a case of TCE-induced hypersensitivity syndrome (TCE HS) in a 24-year-old Indonesian man who was working in an electro-plating business. He was admitted to a referral hospital after one month of working, and exhibited a fever with skin symptoms. He was administered immunosuppressive therapy based on an assumed diagnosis of DRESS syndrome, although he subsequently experienced cardiac arrest and did not respond to resuscitation. An investigation into his disease history confirmed that he was prescribed medications one week before he developed the skin disease, and had been periodically exposed to TCE for the previous 4 weeks. Based on these findings, it was believed that his clinical course was caused by TCE HS, rather than DRESS syndrome.

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.

Indolent B-Cell Lymphoid Malignancy in the Spleen of a Man Who Handled Benzene: Splenic Marginal Zone Lymphoma.

We present the case of a 45-year-old man with a history of benzene exposure who developed splenic marginal zone lymphoma. For 6 years, he had worked in an enclosed space cleaning instruments with benzene. He was diagnosed with splenic marginal zone lymphoma 19 years after retirement. During his time of working in the laboratory in the 1980s, working environments were not monitored for hazardous materials. We indirectly estimated the cumulative level of past benzene exposure using job-exposure matrices and technical assumptions. Care must be taken in investigating the relevance of occupational benzene exposure in the occurrence of indolent B-cell lymphoma. Because of the long latency period and because occupational measurement data do not exist for the period during the patient's exposure, the epidemiological impact of benzene exposure may be underestimated.

Erratum to: The current condition of the workers' general health examination in South Korea: a retrospective study.

[This corrects the article DOI: 10.1186/s40557-017-0157-0.].

Erratum to: Practice status of specialized agencies for occupational health management of small- to medium-size enterprises and the factors improving their performance: a cross-sectional survey study.

[This corrects the article DOI: 10.1186/s40557-017-0161-4.].

Practice status of specialized agencies for occupational health management of small- to medium-size enterprises and the factors improving their performance: a cross-sectional survey study.

BACKGROUND: We examined the current status of specialized agencies for occupational health management (SAs) and their workforce. Furthermore, we aimed to clarify the current practice status of SA healthcare professionals and factors that influence their performance. METHODS: To examine the current SA workforce, we analyzed data from the 2014 Survey of Current Status of SA and their Workforce from the Ministry of Employment and Labor (MOEL). Furthermore, we mailed out an original questionnaire to SA professionals to determine their current health management status and factors that affect their performance. Data from the respondents (N = 384) were analyzed. RESULTS: In 2014, the workforce performing health management in SAs comprised 232 physicians, 507 nurses, and 312 occupational hygienists, with no significant regional differences in the distribution of physicians and nurses. According to the findings of the questionnaire, the average daily number of worker consultations by physicians and nurses was 22.8, while the average time taken for health management ranged from 74.3 to 104.3 min, depending on the size of the firm. Most of the respondents (41.5%) answered that they were following-up on more than 80% of individuals with illnesses. Among health management tasks, performance scores of "consultations for general diseases" and "consultations for lifestyle habits" were relatively high, whereas health promotion activities at workplaces were relatively low. There was a significant correlation between the utilization of general and special health examination results and task performance. CONCLUSION: Among health management tasks, follow-up management of individuals with illnesses and consultations for disease/lifestyle habits were relatively well performed, whereas health promotion activities at workplaces were not performed well. Among factors that positively influenced SA performance at workplaces, only the utilization of health examination results had significant effects. Therefore, to accomplish health management goals and perform effective health management at workplaces, there is a need to establish a comprehensive system of occupational health service outsourcing integrating health examinations and health management services. Furthermore, the current task system, which focuses on follow-up management, should be expanded to incorporate preventive and health promotion functions-the fundamental functions of occupational health services (OHS).

Participation inequality in the National General Health Examination based on enterprise size.

BACKGROUND: Health examinations are performed so that diseases can be identified and treated earlier. Several studies have evaluated the determinants of participation in health examinations including cancer screening, but few have evaluated the relationship between the size of the enterprise and their participation in Workers' General Health Examinations (WGHE). The aim of the present study was to estimate the association of WGHE participation with the size of the enterprise and the type of policyholder. METHODS: The eligible population from 2006 through 2013 was extracted from the National Health Insurance Service (NHIS) database. The population size ranged from 14-17 million. After adjustment for age and gender, multiple logistic regression analysis was performed to estimate the odds ratios of participating in the WGHE (by age group) based on the type of policyholder (reference: public officers) and the size of the enterprise (reference: enterprise size ≥300 employees), respectively. RESULTS: Workers employed at enterprises with <50 persons were less likely to participate in WGHEs than those employed at enterprises with ≥300 persons. After policyholders were stratified by type (non-office workers vs. public officers), a disparity in the WGHE participation rate was found between the different types of policyholders at enterprises with <50 employees (reference: those employed at enterprises with ≥300 employees); the odds ratios for subjects in their 40s and 50s were 0.2-0.3 for non-office workers vs. 0.8-2.0 for public officers. CONCLUSION: Workplace policyholders at small enterprises comprised a vulnerable group less likely to participate in WGHEs. Efforts should be made to raise the WGHE participation rate among the vulnerable employees belonging to small enterprises, as well as among their dependents.

The current condition of the workers' general health examination in South Korea: a retrospective study.

BACKGROUND: Business owners in the Republic of Korea must take part in the workers' general health examination. However, there have been few formal analyses of the uptake of this examination by employees. In the present study, we examined the rates of participation in medical examinations according to age group, health insurance type, and enterprise size, and then compared these results with those of the national general health screening. Furthermore, we determined the distribution of patients with abnormal results for diabetes and hypertension, and outlined the significance and history of domestic health examinations. METHODS: We started by comparing participation rates extracted from the among health examination data of the National Health Insurance Service from 2006-2013 by sex, age, insurance type, and enterprise size of workplace health insurance beneficiaries (i.e., those whose insurance is provided by their workplace). In addition, we analyzed the prevalence rates of abnormal results for hypertension and diabetes, and explored the history and significance of health examinations in the Republic of Korea. RESULTS: The overall participation rate in the primary health examination in 2006 was 56%, and this increased to 72% in 2013. However, the rates of the secondary screening did not increase much. Among workplace policyholders (i.e., those whose insurance is provided by their workplace), the participation rates of workers in enterprises with less than 50 employees were lower than were those in enterprises with 50 or more employees. Notably, the rates and odds ratios of patients with abnormal results for diabetes and hypertension were relatively high, particularly among those working in smaller enterprises. CONCLUSIONS: Although the workers' general health examination has been replaced with the national general health screening, it remains necessary to ensure uniform health management services among all workers in the Republic of Korea. This can, in turn, promote occupational health and improve working conditions throughout the Republic of Korea.

Effectiveness of workers' general health examination in Korea by health examination period and compliance: retrospective cohort study using nationwide data.

BACKGROUND: Our study evaluated the effectiveness of the Workers' General Health Examination by health examination period and compliance. METHODS: A retrospective cohort of the health examination participants in 2006 (baseline year: N = 6,527,045) was used. We identified newly occurring cardio-cerebrovascular disease over 7 years (from 2007 to 2013). After stratification by age, sex, and national health insurance type, we identified 7 years' cumulative incidence of cardio-cerebrovascular disease by health examination compliance and estimated its relative risk by health examination period and compliance. RESULTS: The compliant group presented a lower cumulative incidence of cardio-cerebrovascular disease than the non-compliant group; this result was consistent across sex, working age (40s and 50s), and workplace policyholder. Relative risk of cardio-cerebrovascular disease by health examination period (1 and 2 years) showed statistically significant results in ischemic heart disease for male participants. Of men in their 40s, office workers (over a 2-year period) presented statistically higher relative risk of ischemic heart disease than non-office workers (over a 1-year period: 1.03; 95% confidence interval, 1.02-1.03). However, there were no consistent results in ischemic cerebrovascular disease and hemorrhagic cerebrovascular disease for men or cardio-cerebrovascular disease for women. CONCLUSION: A 1-year period of Workers' General Health Examinations in non-office workers had a more significant prevention effect on ischemic heart disease than a 2-year period in office workers among working age (40s-50s) men. It is, however, necessary to consider that prevention of cardio-cerebrovascular disease can be partially explained by their occupational characteristics rather than by health examination period.

Chronic Diseases, Health Behaviors, and Demographic Characteristics as Predictors of Ill Health Retirement: Findings from the Korea Health Panel Survey (2008-2012).

PURPOSE: The research aim was to identify demographic characteristics, chronic diseases, and unhealthy behaviors predicting ill health retirement in South Korea. METHODS: Data were collected from 15,407 individuals enrolled in the first through the fifth phases of the Korea Health Panel Survey (2008-2012) using structured questionnaires examining retirement, morbidities, and health-related behaviors. The Cox proportional hazard model was used to examine demographic and clinical characteristics' effects on ill health retirement. Lost years of working life expectancy were calculated for demographic and clinical characteristics. RESULTS: Older, female, and manual workers were more likely to experience ill health retirement, as were respondents reporting poor health-related habits (e.g., heavy drinking, irregular meals, less sleep hours, obesity, and no regular exercise). The chronic diseases most closely associated with ill health retirement were, in order, psychiatric disease, ophthalmologic disease, neurologic disease, infectious disease, and musculoskeletal diseases. The average reduction in working life expectancy was 9.73 years. CONCLUSIONS: Our study results can help contribute to the development of strategies for reducing the risk of ill health retirement and promoting sustainable labor force participation in an aging society.

Delayed hepatobiliary injury in a decompression sickness patient after scuba diving: case report.

We report here the first case of liver injury in a 51-year-old man following a dive to a depth of 40 meters. He presented with typical neurological symptoms affecting the lower limbs. Five days later, he experienced delayed abdominal pain, followed by rapidly progressive liver and adjacent organ injury due to air emboli in the intrahepatic portal vein. He received supportive care and hyperbaric therapy with a U.S. Navy Treatment Table 6 and recovered. Decompression sickness is a disease of protean manifestations. More information about venous gas emboli may be useful for better assessing decompression sickness. In this case, radiologic evaluation of the abdomen and the presentation of air bubbles in the portal vein in computed tomography played an essential role in diagnosing induced venous gas emboli in the liver and adjacent organs.

Does long-term experience of nonstandard employment increase the incidence of depression in the elderly?

OBJECTIVES: Our prospective study aimed to elucidate the effect of long-term experience of nonstandard employment status on the incidence of depression in elderly population using the Korean Longitudinal Study of Ageing (KLoSA) study. METHODS: This study used the first- to fourth-wave cohorts of KLoSA. After the exclusion of the unemployed and participants who experienced a change in employment status during the follow-up periods, we analyzed a total of 1,817 participants. Employment contracts were assessed by self-reported questions:standard or nonstandard employment. The short form of the Center for Epidemiologic Studies Depression Scale (CES-D) served as the outcome measure. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards models to evaluate the association between standard/nonstandard employees and development of depression. RESULTS: The mean age of the participants was 53.90 (±7.21) years. We observed that nonstandard employment significantly increased the risk of depression. Compared with standard employees, nonstandard employees had a 1.5-fold elevated risk for depression after adjusting for age, gender, CES-D score at baseline, household income, occupation category, current marital status, number of living siblings, perceived health status, and chronic diseases [HR=1.461, 95% CI= (1.184, 1.805) ]. Moreover, regardless of other individual characteristics, the elevated risk of depression was observed among all kinds of nonstandard workers, such as temporary and day workers, full-time and part-time workers, and directly employed and dispatched labor. CONCLUSIONS: The 6-year follow-up study revealed that long-term experience of nonstandard employment status increased the risk of depression in elderly population in Korea.