• Journal of The Korean Society of Clinical Toxicology
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• v.21 no.2
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• pp.135-142
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• 2023

Purpose: In patients with glufosinate poisoning, severe neurological symptoms may be closely related to a poor prognosis, but their appearance may be delayed. Therefore, this study aimed to determine whether the Acute Physiology and Chronic Health Evaluation II (APACHE II) score could predict the neurological prognosis in patients with glufosinate poisoning who present to the emergency room with alert mental status. Methods: This study was conducted retrospectively through a chart review for patients over 18 years who presented to a single emergency medical center from January 2018 to December 2022 due to glufosinate poisoning. Patients were divided into groups with a good neurological prognosis (Cerebral Performance Category [CPC] Scale 1 or 2) and a poor prognosis (CPC Scale 3, 4, or 5) to identify whether any variables showed significant differences between the two groups. Results: There were 66 patients (67.3%) with good neurological prognoses and 32 (32.8%) with poor prognoses. In the multivariate logistic analysis, the APACHE II score, serum amylase, and co-ingestion of alcohol showed significant results, with odds ratios of 1.387 (95% confidence interval [CI], 1.027-1.844), 1.017 (95% CI, 1.002-1.032), and 0.196 (95% CI, 0.040-0.948), respectively. With an APACHE II score cutoff of 6.5, the AUC was 0.826 (95% CI, 0.746-0.912). The cutoff of serum amylase was 75.5 U/L, with an AUC was 0.761 (95% CI, 0.652-0.844), and the AUC of no co-ingestion with alcohol was 0.629 (95% CI, 0.527-0.722). Conclusion: The APACHE II score could be a useful indicator for predicting the neurological prognosis of patients with glufosinate poisoning who have alert mental status.

• Annals of Occupational and Environmental Medicine
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• v.35
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• pp.38.1-38.10
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• 2023

Background: Hearing loss (HL) is linked to an elevated risk of cardiovascular diseases (CVDs). The pathogeneses of HL and CVD commonly involve inflammatory responses. Previous studies investigated elevated levels of inflammatory biomarkers in subjects with HL, however, their findings did not demonstrate statistical significance. In our cross-sectional and longitudinal study, we investigated the correlation between HL and increased high-sensitivity C-reactive protein (hsCRP) levels to determine how HL is associated with CVDs. Methods: We conducted a cross-sectional study with workers aged over 18 years who underwent health check-ups at our institution between 2012 and 2018 (n = 566,507), followed by conducting a longitudinal study of workers aged > 18 who underwent health checkups at least twice at our institution between 2012 and 2018 (n = 173,794). The definition of HL was as an average threshold of ≥ 20 dB in pure-tone air conduction at 0.5, 1.0, and 2.0 kHz in both ears. The incidence of increased hsCRP levels throughout the follow-up period was defined as a level exceeding 3 mg/L. Logistic regression and generalized estimating equations were performed to estimate the risk of increased hsCRP levels according to the occurrence of HL in groups stratified by age. Results: In the cross-sectional study, the multivariate-adjusted odds ratio (OR) was 1.17 (95% confidence interval [CI]: 1.02-1.34); the OR was 0.99 (95% CI: 0.80-1.22) in those under 40 and 1.28 (1.08-1.53) in those over 40. In the longitudinal study, the multivariable-adjusted OR was 1.05 (95% CI: 0.92-1.19); the OR was 1.10 (95% CI: 0.90-1.35) in those under 40 and 1.20 (1.01-1.43) in those over 40. Conclusions: This cross-sectional and longitudinal study identified an association between HL and increased hsCRP levels in workers aged over 40 years.

• Annals of Occupational and Environmental Medicine
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• v.35
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• pp.30.1-30.13
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• 2023

Background: Dysmenorrhea and menstrual cycle changes occur in women working shifts. Circadian rhythm disruption and sleep disturbances associated with shift work leads to health problems. We identified chronotypes and the occurrence of insomnia among newly employed university hospital nurses and investigated the association of these factors with menstrual problems. Methods: We conducted pre-placement health examinations for shift workers using self-reported questionnaires between 2018 and 2020. A total of 463 nurses were included in the study. Sociodemographic data, shift work experience, and information on insomnia were collected from health examination data. In addition, details regarding chronotype, dysmenorrhea, irregular and abnormal menstrual cycles, amenorrhea, and contraceptive use were obtained from the questionnaire. Multiple logistic regression analysis was performed to study the association between chronotype, insomnia, and menstrual problems after controlling for age, body mass index, contraceptive use, amenorrhea, and prior shift work. Results: The prevalence rates of dysmenorrhea, irregular menstrual cycles, and longer menstrual cycles were 23.8%, 14.9%, and 4.1%, respectively. The risk of dysmenorrhea increased in the evening-type (odds ratio [OR]: 3.209; 95% confidence interval [CI]: 1.685-6.113) and those with insomnia (OR: 1.871; 95% CI: 1.074-3.261). Additionally, the risk of an irregular menstrual cycle (OR: 2.698; 95% CI: 1.167-6.237) increased in the evening-type, and the risk of a longer menstrual cycle (OR: 4.008; 95% CI: 1.354-11.864) increased in individuals with insomnia. Conclusions: Our findings suggest that dysmenorrhea is promoted in the evening-type and insomnia individuals. There may be an increased risk of irregular menstrual cycles among evening-type nurses and an increased risk of longer menstrual cycles among those with insomnia. Therefore, factors such as evening-type and insomnia should be considered for the prevention of menstrual problems in women performing shift work.

• Annals of Occupational and Environmental Medicine
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• v.35
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• pp.50.1-50.11
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• 2023

Background: The rise in telecommuting or non-face-to-face work owing to the coronavirus disease 2019 pandemic has fueled conversations regarding the "right to disconnect." Although evidence suggests that receiving work-related communications through telecommunication devices outside of work hours may lead to various symptoms and illnesses, limited research has been undertaken on these symptoms. This study therefore aims to investigate the correlation between receiving work communications through telecommunication devices after work hours and the occurrence of work-related headaches and eyestrain in full-time, non-shift white-collar workers. Methods: This study used data from the 6th Korean Working Conditions Survey. The frequency of using telecommunication devices for work purposes outside of working hours was divided into five categories: "Every day," "Several times a week," "Several times a month," "Rarely," and "Never." Work-related headaches and eyestrain were categorized based on a "yes" or "no" response to the survey questions. Descriptive statistics, χ² tests, and multiple logistic regression analyses were performed using SPSS 27.0. Results: After adjusting for sex, age, income level, education, occupation, workplace size, work hours, and sleep disorders, the odds ratio (OR) of work-related headaches and eyestrain based on frequency of telecommunication device usage were as follows: "rarely" (OR: 1.292; 95% confidence interval [CI]: 1.111-1.503), "several times a month" (OR: 1.551; 95% CI: 1.249-1.926), "several times a week" (OR: 1.474; 95% CI: 1.217-1.784), and "every day" (OR: 1.548; 95% CI: 1.321-1.813). Conclusions: Employees who use telecommunication devices for work after regular hours are more susceptible to experiencing work-related headaches and eyestrain compared to those who do not. However, there is a dearth of research examining the physical and mental health impacts of using telecommunication devices for after-hours work. Furthermore, the existing preventative measures in Korea are insufficient. Consequently, it is imperative to develop effective measures and conduct additional research to address this issue.

• Annals of Occupational and Environmental Medicine
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• v.35
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• pp.6.1-6.15
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• 2023

Background: Polycyclic aromatic hydrocarbons (PAHs) are occupational and environmental pollutants generated by the incomplete combustion of organic matter. Exposure to PAHs can occur in various occupations. In this study, we compared PAH exposure levels among occupations based on 4 urinary PAH metabolites in a Korean adult population. Methods: The evaluation of occupational exposure to PAHs was conducted using Second Korean National Environmental Health Survey data. The occupational groups were classified based on skill types. Four urinary PAH metabolites were used to evaluate PAH exposure: 1-hydroxypyrene (1-OHP), 2-naphthol (2-NAP), 1-hydroxyphenanthrene (1-OHPHE), and 2-hydroxyfluorene (2-OHFLU). The fraction exceeding the third quartile of urinary concentration for each PAH metabolite was assessed for each occupational group. Adjusted odds ratios (ORs) for exceeding the third quartile of urinary PAH metabolite concentration were calculated for each occupational group compared to the "business, administrative, clerical, financial, and insurance" group using multiple logistic regression analyses. Results: The "guard and security" (OR: 2.949; 95% confidence interval [CI]: 1.300-6.691), "driving and transportation" (OR: 2.487; 95% CI: 1.418-4.364), "construction and mining" (OR: 2.683; 95% CI: 1.547-4.655), and "agriculture, forestry, and fisheries" (OR: 1.973; 95% CI: 1.220-3.191) groups had significantly higher ORs for 1-OHP compared to the reference group. No group showed significantly higher ORs than the reference group for 2-NAP. The groups with significantly higher ORs for 1-OHPHE than the reference group were "cooking and food service" (OR: 2.073; 95% CI: 1.208-3.556), "driving and transportation" (OR: 1.724; 95% CI: 1.059-2.808), and "printing, wood, and craft manufacturing" (OR: 2.255; 95% CI: 1.022-4.974). The OR for 2-OHFLU was significantly higher in the "printing, wood, and craft manufacturing" group (OR: 3.109; 95% CI: 1.335-7.241) than in the reference group. Conclusions: The types and levels of PAH exposure differed among occupational groups in a Korean adult population.

• Annals of Occupational and Environmental Medicine
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• v.35
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• pp.9.1-9.10
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• 2023

Background: Studies conducted so far on the link between commute time and mental health among Koreans remain insufficient. In this study, we attempted to identify the relationship between commute time and subjective mental health using the 6^th Korean Working Conditions Survey (KWCS). Methods: Self-reported commute time was divided into four groups: ≤ 30 (group 1), 30-60 (group 2), 60-120 (group 3), and > 120 minutes (group 4). Subjective depression was defined as a score of 50 points or less on the WHO-5 well-being index. Subjective anxiety and fatigue were defined as answering 'yes' to the questionnaire on whether they had experienced it over the past year. The analysis of variance, t-test, and χ² test was used to analyze the differences among the characteristics of the study participants according to commute time, depression, anxiety, and fatigue. Odds ratios (ORs) and 95% confidence intervals (CIs) for depression, anxiety, and fatigue according to commute time were calculated using multivariate logistic regression models adjusted for sex, age, monthly income, occupation, company size, weekly working hours, and shift work status. Results: Long commute times showed increased ORs and graded increasing trends for depression, anxiety, and fatigue. The ORs for depression increased significantly in group 2 (1.06 [1.01-1.11]), group 3 (1.23 [1.13-1.33]), and group 4 (1.31 [1.09-1.57]) compared to group 1 (reference). The ORs for anxiety increased significantly in group 2 (1.17 [1.06-1.29]), group 3 (1.43 [1.23-1.65]) and group 4 (1.89 [1.42-2.53]). The ORs for fatigue increased significantly in group 2 (1.09 [1.04-1.15]), group 3 (1.32 [1.21-1.43]), and group 4 (1.51 [1.25-1.82]). Conclusions: This study highlights that the risk of depression, anxiety, and fatigue increases with commute time.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.27 no.4
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• pp.350-365
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• 2023

Backgrounds/Aims: Extra hepatic portal venous obstruction (EHPVO) is the most common cause of portal hypertension in Indian children. While endoscopy is the primary modality of management, a subset of patients require surgery. This study aims to report the short- and long-term outcomes of EHPVO patients managed surgically. Methods: All the patients with EHPVO who underwent surgery between August 2007 and December 2021 were retrospectively reviewed. Postoperative complications were classified after Clavien-Dindo. Binary logistic regression in Wald methodology was used to determine the predictive factors responsible for unfavourable outcome. Results: Total of 202 patients with EHPVO were operated. Mean age of patients was 20.30 ± 9.96 years, and duration of illness, 90.05 ± 75.13 months. Most common indication for surgery was portal biliopathy (n = 59, 29.2%), followed by bleeding (n = 50, 24.8%). Total of 166 patients (82.2%) had shunt procedure. Splenectomy with esophagogastric devascularization was the second most common surgery (n = 20, 9.9%). Nine major postoperative complications (Clavien-Dindo > 3) were observed in 8 patients (4.0%), including 1 (0.5%) operative death. After a median follow-up of 56 months (15-156 months), 166 patients (82.2%) had favourable outcome. In multivariate analysis, associated splenic artery aneurysm (p = 0.007), isolated gastric varices (p = 0.004), preoperative endoscopic retrograde cholangiography and stenting (p = 0.015), and shunt occlusion (p < 0.001) were independent predictors of unfavourable long-term outcome. Conclusions: Surgery in EHPVO is safe, affords excellent short- and long-term outcome in patients with symptomatic EHPVO, and may be considered for secondary prophylaxis.

• Annals of Occupational and Environmental Medicine
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• v.35
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• pp.2.1-2.15
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• 2023

Background: Phthalates are endocrine disrupting chemicals that are widely used in the production of items of daily life such as in polyvinylchloride plastics, insecticides, and medical devices. This study aimed to determine the association between phthalate exposure and shellfish consumption using data from the Korean National Environmental Health Survey (KoNEHS) cycle 3 (2015-2017), which is a nationally representative survey. Methods: In this study, we analyzed the KoNEHS cycle 3 data of 3,333 (1,526 men and 1,807 women) adults aged more than 19 years. Data related to the variables of sociodemographic factors, health-related behaviors, dietary factors, seafood consumption frequency, and urinary phthalate metabolites concentrations were collected. The concentrations of urinary phthalate metabolites of all the participants were divided into quartiles to define high and low concentration groups based on the 75th percentile concentration. A χ² test was conducted to analyze the distribution of independent variables. To analyze the relationship between shellfish consumption and phthalate exposure, the odds ratios (ORs) were calculated using logistic regression analysis. Results: Total adults with shellfish consumption frequency of over once a week showed the following adjusted ORs for high concentrations of the following metabolites compared with the group that consumed shellfish once a week or less: 1.43 (95% confidence interval [CI]: 1.01-2.06) for mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), 1.43 (95% CI: 1.01-2.03) for mono-(2-ethyl-5-carboxypentyl) phthalate (MECPP), 1.57 (95% CI: 1.10-2.24) for ∑di-2-ethylhexyl phthalate (∑DEHP), 2.01 (95% CI: 1.46-2.77) for mono-carboxyoctyl phthalate (MCOP), 1.56 (95% CI: 1.11-2.18) for mono-carboxy-isononly phthalate (MCNP), and 2.57 (95% CI: 1.85-3.56) for mono (3-carboxypropyl) phthalate (MCPP). Conclusions: The concentrations of urinary phthalate metabolites (MEOHP, MECPP, ∑DEHP, MCOP, MCNP, and MCPP) were higher in adults with a higher frequency of shellfish consumption.

• Annals of Occupational and Environmental Medicine
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• v.35
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• pp.4.1-4.11
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• 2023

Background: Shift work has been shown to increase the risk of cardiovascular disease (CVD) based on several evidences. The classic risk factors of CVD include age, hypertension, smoking, obesity and diabetes. Recently, the serum homocysteine level has been reported to be a valuable indicator of CVD risk. This study aimed to determine the variation in serum homocysteine level as a cardiovascular risk indicator among female workers according to shift work. Methods: The data of regular health examination of workers at an electronic manufacturing services company in Yeongnam region, South Korea in 2019 were examined in this study. The investigation was based on a cross-sectional study conducted on 697 female workers (199 day workers and 498 shift workers). The sociodemographic and biochemical characteristics were compared between day workers and shift workers. Through a logistic regression analysis, the odds ratio (OR) of the increased serum homocysteine level in relation to shift work was determined. Results: Compared to female day workers, female shift workers showed significantly higher level of serum homocysteine (8.85 ± 2.16 vs. 9.42 ± 2.04 μmol/mL; p = 0.001). The OR of day workers against shift workers was 1.81 (95% confidence interval [CI]: 1.25-2.63). With the adjustment of variables that may influence the level of serum homocysteine, the adjusted OR was 1.68 (95% CI: 1.09-2.60). Conclusions: The serum homocysteine level was significantly higher in shift workers than in day workers. It is thus likely to be a useful predictor of CVD in shift workers.

• Annals of Occupational and Environmental Medicine
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• v.35
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• pp.22.1-22.9
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• 2023

Background: Shift work increases the risk of chronic diseases, including metabolic diseases. However, studies on the relationship between shift work and renal function are limited. The aim of this study was to investigate the association between shift work and a decreased glomerular filtration rate (GFR). Methods: Data were evaluated for 1,324,930 workers who visited the Korean Medical Institute from January 1, 2016 to December 31, 2020 and underwent a health checkup. Daytime workers were randomly extracted at a ratio of 1:4 after matching for age and sex. In total, 18,190 workers aged over 40 years were included in the analyses; these included 3,638 shift workers and 14,552 daytime workers. Participants were categorized into the shift work group when they underwent a specific health checkup for night shift work or indicated that they were shift workers in the questionnaire. The odds ratio was calculated using a conditional logistic regression to investigate the relevance of shift work for changes in GFR. Results: 35 workers in the shift group and 54 in the daytime group exhibited an estimated GFR (eGFR) value of < 60 mL/min/1.73m² (p < 0.01). The difference in eGFR values between two checkups differed significantly depending on the type of work (p < 0.01); the difference in the shift work group (-9.64 mL/min/1.73 m²) was larger than that in the daytime work group (-7.45 mL/min/1.73 m²). The odds ratio for eGFR reduction to < 60 mL/min/1.73 m² in the shift group versus the daytime group was 4.07 (95% confidence interval: 2.54-6.52), which was statistically significant. Conclusions: The results of this study suggest that eGFR decreases by a significantly larger value in shift workers than in daytime workers; thus, shift work could be a contributing factor for chronic kidney disease (CKD). Further prospective studies are necessary to validate this finding and identify measures to prevent CKD in shift workers.