A Study on Karoshi to Make Application for Industrial Accident Compensation in Busan / 대한산업의학회지

OBJECTIVES: Karoshi is a word meaning death from work-overload. Work-related diseases due to continuous overwork are primarily cerebro- and cardio-vascular in nature. In Korea, despite an increase in the incidence of Karoshi, it is not easy to recognise by workmen's compensation in Korea. This study intended to establish basic information concerning the incidence of Karoshi. METHODS: 219 cases were collected based on workers' compensation records of three Busan Regional Centers of Labor Welfare Corporation from 1991 to 1999. The size of workplace, occupation, daily working time, type of working schedule, job tenures, characters of work-overload and duration of work-overload were investigated according of subgroups of general characteristics. Both univariate and multiple logistic regression analyses were used to estimate the relationship between risk factors and a recognition of Karoshi. RESULTS: 1. 61.6 % of total cases were recognized as Karoshi. 30.6 % occurred in a small workplace of less than 50 workers, 34.7 % were drivers or guards, and 48.8 % were more than 50 years old. Additionally, 29.6 % worked more than 12 hours, 37.5 % were irregular hours and shift workers and 21.5 % of the total had been on the job less than 6 months. 2. Of the causes of death, 49.8 % was cerebro-vascular diseases and it was more than cardio-vascular ones. And 80.4 % of total cases was belonged to the recognition-category of the Labour Ministry's Law. The previous disease history was found on 49.8 % of all cases. Of them, hypertension was most common as 21.9 %. 3. 53.9 % of patients were exposed to job hazards such as driving, monitoring, guarding, risky jobs and frequent long-term official trips. 64.7 % recorded a increased work-overload of job contents and working hours. Of the several types of work-overload, 42.5 % displayed long-term physical and psychotic work-overload and 22.2 % exhibited job characteristic work-overload. 4. In this study, work-overload was associated with the incidence of Karoshi in 76.3 % of cases. This rate was higher than the recognition of Workmen's compensation recorded by the Korea Labor Welfare Corporation. Of these, 43.6 % belonged to sufficient factors, 10.4 % partial factors, and 22.3 % were due to aggravating factors. 5. Logistic regression demonstrated that death due to cerebro- and cardio-vascular disease, shorttenure within 6 month was significantly associated with a recognition of Karoshi (p=0.034, OR=3.00, C I = 1 . 0 9~8.30/p=0.016, OR=6.76, CI=1.43~32.07 respectively) and that an increase of work-overload was also associated, but its statistical significance was slightly lower(p=0.081, OR=2.02, CI=0.91.~4.46 ) . However, no association was found between this recognition and overtime work, hazardous job, irregular work schedule, low-income, injury-onset place, or small size of workplace. The elderly group(>50years old) and those with a previous disease history were negatively associated with recognition although the statistical association was low. CONCLUSIONS: Karoshi in Busan occurred frequently in a small workplace of less than 50 workers, especially drivers or guards. Additionally, these cases worked more than 12 hours, were irregular hours and shift workers. The death due to cerebro- and cardio-vascular disease, short-tenure within 6 month was significantly associated with a recognition of Karoshi. However Karoshi in this study occurred frequently in overtime work and high risk groups of work-overload. Therefore, for prevention of Karoshi, work-overload and overtime work need improved and controled.

Comparison of Outcome between Bladder Neck Suspension and Anterior Vaginal Wall Sling in Treatment of Stress Urinary Incontinence / 대한비뇨기과학회지

No abstract available.

The Serum Copper and Zinc Concentration according to the Progression of Pneumoconiosis / 대한산업의학회지

OBJECTIVES: Copper and Zinc, the trace elements of a living body, take a part in immunologic mechanism and induce the pulmonary fibrosis which is the pathologic progress of pneumoconiosis. This study was performed to assist the identification of the pathologic process of pulmonary fibrosis in pneumoconiosis. METHODS: The subjects of this study was 200 diagnosed persons as pneumoconiosis, of whom 100 persons was the visitors in the outpatients departments of pneumoconiosis and 100 admissive pneumoconiosis patients. The serum copper and zinc are measured and com pared. RESULTS: The mean serum copper concentration of visitor group was significantly higher than that of control group, and that of stage V3 subgroup of visitor group was highest because of their advanced fibrosis. But, there was not the difference of serum copper concentration between patient and control group. We thought that the reason was poor nutritional and health status of the patient. The mean of serum zinc concentration of visitor and patient control was lower than that of control group. As the degree of pulmonary fibrosis was more severe from stage Vl, V2, V3 of visitor to stage Pl, P2, P3 of patient, the mean of serum zinc concentration was lower. The ratio of serum copper/zinc of visitor and patient was higher than that of control, and that of patient was higher than that of visitor. Those results showed that the ratio of serum copper/zinc ratio more greatly expressed the degree of progression of pneumoconiosis than only copper or zinc concentration by adjustment of nutritional and health status of the patient. CONCLUSIONS: As above study results, the degree of pulmonary fibrosis of pneumoconiosis could be estimated by means of serum copper/zinc ratio.

The Impact of Lower Urinary Tract Symptom on Sexual Function / 대한남성과학회지

PURPOSE: It is well recognized that the incidence of sexual dysfunction in men increases with age. But the impact of lower urinary tract symptom (LUTS) on sexual dysfunction had not been widely studied. We aimed to ascertain the degree of correlation among sexual dysfunction, LUTS and age. MATERIALS AND METHODS: Between September 1998 and May 1999, 350 healthy Korean men over 50 years old living in Taegu and Kyungpook province were enrolled in the study. All of them completed IIEF (International Index of Erectile Function) 5-item questionnaire, International Prostatic Symptom Score(IPSS), digital rectal examination (DRE) and uroflowmetry. The IIEF, 5-item questionnaire consisted of erectile function (EF), sexual intercourse satisfaction (IS), orgasmic function (OF), sexual desire (SD) and overall satisfaction (OS). Each item was stratified into severe, moderate, mild and no dysfunction. Total men were stratified by IPSS, volume of prostate and maximal flow rate. RESULTS: The prevalence of sexual dysfunction was increased with age. The erectile function was decreased in men with severe symptoms (IPSS >20) in comparison to those without symptoms (IPSS 50gm) in comparison to those with normal prostate (volume of prostate < 21gm). The maximal flow rate was not correlated with sexual dysfunction. CONCLUSIONS: There was a significant number of patients with LUTS who have sexual dysfunction. A trend of increasing sexual dysfunction with increasing after urinary symptom severity and volume of prostate was fond. It is valuable to compare the sexual function after treatment of LUTS with it before treatment.

Efficacy, Satisfaction, and Drop-out Rate of Alprostadil (Prostagladin E1) Intracavernosal Injection According to Etiologic Cause of Erectile dysfunction / 대한남성과학회지

PURPOSE: Intracavernosal self-injection therapy is now being used widely to treat erectile dysfunction. Although several intracavernosal therapies are available, their efficacy and safety have not been studied systematically. We investigates the efficacy and safety of intracavernosal injection of alprostadil (PGE1 ) in patients with erectile dysfunction. MATERIALS AND METHODS: From June 1996 to March 1998, 181 patients with erectile dysfunction were included in this study. Each patient was treated initially with 10micro gram of PGE1 . If the result of the injection was unsatisfactory, 20 micro gram of PGE1 was administered. The erection was evaluated clinically by manual palpation and estimated on a 5-point scale as no response, some enlargement, full enlargement, erection sufficient for intercourse, and full rigidity. In addition, each patient assessed his satisfaction with the treatment using a 3-point scale as poor, fair or good. The erectile dysfunction was classified as psychogenic, vascular, diabetic, neurogenic, or undetermined. To determine possible side effects, penile pain, hematoma, prolonged erection, priapism, and so forth were recorded by a questionnaire. RESULTS: Of the 181 men in this study, 60 (33.2%), 45 (24.9%), 42 (23.2%), 14 (7.7%), and 20 (11.0%) were judged to have psychogenic, vascular, diabetic, neurogenic, and undetermined causes of erectile dysfunction, respectively. A good erectile response to PGE1 was seen in 59 (98.4%), 38 (84.4%), 37 (88.1%), 13 (92.9%), and 16 (80%), respectively, of the patients in these groups. Satisfaction with the treatment was reported by 59 (98.3%), 39 (86.6%), 38 (90.5%), 13 (90%) patients. Only three drug-related side effects were observed: penile pain in 54 patients (33.5%), hematoma in 5 (2.8%), and prolonged erection in 4 (2.4%). Nevertheless, the dropout rate was 46% (83/181). The causes of discontinuation within 3 months were absence of sexual partner (8.8%), recovery of erectile function (9.5%), difficulty of manipulation (19.3%), needle phobia (22.7%), pain (21.5%), and economic status (18.2%). CONCLUSIONS: PGE1 was highly effective at producing an erection satisfactory for vaginal intercourse. The response rate was higher in psychogenic and neurogenic impotence than in vascular and diabetic impotence. Given the freedom from adverse effects such as fibrotic plaques, priapism, and liver dysfunction, PGE1 seems to be a preferable alternative to other drugs for intracavernosal injection therapy and is currently the only FDA-approved drug for this purpose. However, the dropout rate was high. Dilated attention to the procedure and careful follow-up are crucial to achieve maximal success and decrease the dropout rate.

Results of Varicocele Surgery According to Operative Technique / 대한남성과학회지

PURPOSE: A varicocele first develops in early adolescence and can affect testicular growth, function, and histology. Tease gonadotoxic effects, if progressive, may explain why, in adults with infertility, normal fertility returns after varicocele ligation in 20% to 50% of the cases. Therefore, serveral investigators have proposed prophylactic varicocele ligation. Various surgical techniques for varicocelectomy have been described, including high retroperitoneal, inguinal, and laparoscopic approaches. We report our experience using three different operative techniques for surgical correction of varicocele. PATIENTS AND METHODS: Between February 1990 and May 1998, 107 patients with varicocele underwent surgical correction by the Palomo (N=52), modified Palomo (N=32), or Ivanissevich (N=23) technique. All patients had a thorough physical examination, including supine and standing scrotal examination, preoperatively. The indications for surgery included a left testicular volume loss of 3cc or more compared with the right testis, palpable varicocele, and pain. Outcome parameters were persistent or recurrent varicocele and operative time. Postoperative complications were scrotal edema, hydrocele, and testicular atrophy. The postoperative follow-up ranged from 2 to 58 month with an average of 30.2 month. RESULTS: In patients treated with the Palomo technique, postoperative recurrence was seen in one patient, and hydroceles developed in five patients. There was no varicocele recurrence or atrophy of the testis. The mean operative time was 48.2 minutes. Among patients treated with the modified Palomo technique, postoperative persistence and recurrence were seen in three and two patients, respectively. There was no atrophy of the testis. The mean operative time was 54.3 minutes. In patients in whom the Ivanissevich technique was used, postoperative persistence and recurrence were seen in one patient each. Testicular edema or hematoma and atrophy of testis occurred in three patients each. The mean operative time was 62 minutes. CONCLUSIONS: With the Palomo technique, there was only one patient who suffered postoperative recurrence, and there was no significant atrophy of the testis. The mean operative time was shorter than with the other techniques. The Palomo technique is a very effective and relatively fast procedure in our experience.

Two Adult Cases of Clear Cell Sarcoma of Kidney / 대한비뇨기과학회지

Clear cell sarcoma of kidney is highly malignant tumor that tends to occur in young infants, and has a tendency to metastasize to the bone. Our review of the literature disclosed 8 cases as to adults with clear cell sarcoma of kidney until December 1995. There was no report about it in the Republic of Korea. We report two adult patients, a young man and a young woman, who had a clear cell sarcoma of kidney.

A Study on the Risk Factors of Low Back Pain in Computer Terminal Operators / 대한산업의학회지

Low back pain in computer terminal operators is a very common but important symptom. While the occupational risk factors of low back pain were approved obscurely, there have been few studies on analysis or understanding of occupational risk factors. Therefore, we studied occupational risk factors of low back pain, especially for ergonomic factors as well as general characteristics of workers. We selected 98 subjects for this study, computer terminal operators ordinary using computers in Pusan. We calculated the subjective severity of low back pain of each operator by the Low Back Pain Scoring System. The relation of low back pain score to general characteristics of worker was also analyzed. We analyzed the relationship between low back pain score and individual efforts to prevent low back pain. We measured the ergonomic factors of each computer terminal operator - Trunk Jnclination(TI), Arm Flexion(AF), Elbow Angle(EA), Head Tilting(HT), Knee Angle(KA), using of foot plate and gap between the popliteum and chair. The correlations between these ergonomic factors and low back pain score were then analyzed. And the results are as follows: 1. The prevalence rate of low back pain in computer terminal operators was 39.8% in this study, when low back pain score was converted by the low back pain scoring system. 2. According to general characteristics of workers related to low back pain, the scores were higher in the older age group, the married and the longer work carriers. (p < 0.05) 3. In the analysis of the relationship between low back pain score and individual effort to prevent low back pain, regular exercise, history of schooling for prevention of low back pain, and declaration of intention to participate in low back pain education or exercise were stastistically significant(p < 0.05). And the more severe the low back pain, the higher the intention to participate in low back pain education they had in this study. 4. In the analyses of relationships or correlations between low back pain score and each of the 7 categories of ergonomic factors, only head tilting had a weak reverse correlation with low back pain(r=-0.2999, p < 0.01). From now on, cohort studies for the risk factors of low back pain of workers, who have been forced to work in non-ergonomical positioning at the work site, will be necessary. On the background of these ergonomic studies, the occupational health profession should be required to manage ergonomic working conditions.

A Study on Comparison of the Metabolites Related with Working Methods and Immunity of the Toluene diisocyanate-Exposed Workers / 대한산업의학회지

Following recent advanced industrialization. the amount of polyurethane to use as thermal insulating materials, upholstery mattresses and packing materials in automotive and furniture industry is increasing world-widely, and the number of polyurethane-producing worker will be increased. Because the numerous organic solvents are used in polyurethane-producing factory, the workers in this work site is exposed to many organic solvents. Of the organic solvents. Toluene Diisocyanate(TDI) has many hazardous effects to human. The effects of TDI on human are the irritation to respiratory mucosa and gastrointestinal symptoms. Conjunctival irritation, dermal inflammation (redness, pain, vesicular formation) and gastrointestinal symptom(nausea, vomiting, abdominal pain) are reported just after short-term exposure of TDI. TDI is known to give rise to bronchial asthma, as the immune disorder. And because of strongly volatile characteristics of TDI, it is suggested as a more injurious material to human health, especially human immune system, than other organic solvents. Bronchial asthma inducing mechanism of TDI is not clearly known, but on the analogy of TDI-induced symptoms and recent studies, early-onset asthma is type I hypersensitivity reaction mediated by immunoglobulin E(IgE), and late-onset asthma is maybe type III hypersensitivity reaction by circulating IgG. And we know that the complicated human immune function is likely to move in such that mechanisms, there are not studies on immune indices evaluating the bronchial asthma-related immune function. The evaluation of change patterns of humoral immunity including IgE and IgG and cellular immunity including T-helper cell, T-suppressor cell and T-cytotoxic cell will be helpful to evaluate exposure degrees and prognosis in TDI-exposed workers. Because TDA(toluene diamine) as a biological exposure index of TDI becomes the focus of interest, we know that a study on the correlation between urinary TDA and air TDI and immunological indices will make a contribution to biological effect monitoring indicies. We examined human immunity indicators such as WBC. %Lymph (percentile of Lymphocyte in WBC). %T-cell(percentile of T-lymphocyte in total lymphocyte). CD4, CD8, C3, C4, IgA, IgG, IgM, IgE in peripheral blood to evaluate the health hazard of the TDI-exposed workers. And we examined TDA to evaluate correlation between exposure and effect. Total 90 subjects was selected, 45 workers who worked in the polyurethane-producing factories as an exposed group, and 45 cases who were office workers(10 cases), other blue collors(27 cases), and medical college students(8 cases) as a control group. And the results were as follows ; 1. The logarithm of IgE -Log10(IgE)+/-SD- in peripheral blood of a exposed group was significantly higher than a control group, 2 22+/-.62 in case group compared with 1.98+/-.53 in control group.(p0.05). 3. WBC, %Lymph, %T-cell, C3, C4, CD4, CD8, CD4/CDB ratio and IgG in case group were 6,391.1 ea/ml, 37.53%, 59.54%, 76.68 mg/dl, 30.54 mg/dl, 0.76x10(9) ea/L, 0.63x10(9) ea/L, 1.39, and 1606.29 mg/dl, respectively, and 6,974.7 ea/ml, 35.12%, 59.64%, 71.95 mg/dl, 33.94 mg/dl, 0.80x109 ea/L, 0.61x10(9) ea/L, 1.39, and 1581.51 mg/dl in control group. There was no statistical sinificance between two groups. (p>0.05) 4. In the comparison of each other companies, average of individual urinary TDA in polyurethane paint manufacturing companies is higher than that of polyurethane sponge foaming companies. And, the concentration of 2,6-TDA which is a metabolite of well-vaporized 2,6-TDI is higher than that of 2,4-TDA in the polyurethane sponge foaming companies. But, the concentration of 2,4-TDA which is a metabolite of illvaporized but well skin-absorbed 2,4-TDI is higher in polyurethane paint manufactures. 5. There were no statistical significance in the correlations between individual urinary TDA and immunologic indices.