Annals of Occupational and Environmental Medicine

Brief Communication

Workers' opinions on working time regulations: results from the 5th Korean Work, Sleep, and Health Study (KWSHS): Jeong Woo Park, Seong-Sik Cho, Mo-Yeol Kang, Min Choi, Jongwoo Lee; Ann Occup Environ Med 2026;e32. Published online July 21, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e32 [Accepted]

Abstract PDF: Although South Korea's average annual working hours have declined over recent decades, the country continues to rank higher among Organisation for Economic Co-operation and Development countries. Despite ongoing policy debates on working time reform, public perspectives on specific regulatory measures among Korean workers remain underexplored. This study analyzed data from the 5th wave of the Korean Work, Sleep, and Health Study (KWSHS). The survey was conducted in September 2024 via an online platform. A total of 5,783 working adults aged 19–70 years were included. Participants were asked about their opinions on five working time regulatory measures, including the current weekly hour cap, extending regulations to small companies and exempt industries, introducing a daily working hours limit, regulating non-essential night work, and restricting weekend work for large supermarkets. A majority of respondents supported all five proposed regulatory measures. Support was highest for introducing a daily working hours cap (72.1% agree or strongly agree), followed by regulating non-essential night work (63.2%), extending the cap to small companies (60.1%), restricting weekend work for large supermarkets (60.7%), and introducing the weekly cap for exempt industries (52.8%). While 34.7% favored reducing the current weekly maximum, 36.5% preferred maintaining the current limit. The survey respondents generally support strengthening working-time regulations. These findings provide workers’ opinions on working-time regulations, although they should be interpreted within the study's limitations (a sample with a higher proportion of office workers).

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Original Article

Association between delivery-food consumption frequency and urinary bisphenol concentrations among Korean adults: a nationally representative study (Korean National Environmental Health Survey cycle 5, 2021–2023): Gwisang Park, Hyeyun Lee, Inchul Jeong, Eunhee Ha, Kihun Kim; Ann Occup Environ Med 2026;e37. Published online July 30, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e37 [Accepted]

Abstract PDF: Background
Bisphenol exposure remains a public health concern, particularly as the use of bisphenol analogues such as bisphenol S (BPS) has increased. In the post-pandemic period, delivery-food consumption has become routine in South Korea and may represent an important behavioral pathway for bisphenol exposure. This study examined whether delivery-food consumption in plastic containers is associated with urinary bisphenols among Korean adults.
Methods
This study used adult data from the Korean National Environmental Health Survey (KoNEHS) cycle 5 (2021–2023). Delivery-food consumption frequency (nine categories) was modeled per 1-time-per-month increase. Outcomes were urinary bisphenol A (BPA), BPS, and bisphenol F (BPF). Creatinine-adjusted concentrations were analyzed on the natural log scale using multivariable regression models. Model 1 adjusted for sociodemographic factors, and model 2 additionally adjusted for plastic-related behavioral variables.
Results
Among 4,275 adults with complete bisphenol and urinary creatinine data, delivery-food consumption frequency was positively associated with creatinine-adjusted urinary BPS concentrations (1.49% increase per 1-time-per-month increase; 95% confidence interval [CI]: 0.74–2.24; p < 0.001) after sociodemographic adjustment, whereas associations with BPA (0.32% increase; 95% CI, −0.45 to 1.09; p = 0.416) and BPF (−0.14% change; 95% CI: −1.18 to 0.90; p = 0.787) were not statistically significant. After additional adjustment for plastic-related behavioral variables in model 2, the association remained statistically significant for BPS (1.54%; 95% CI, 0.76–2.33; p < 0.001), whereas the associations with BPA and BPF remained non-significant.
Conclusions
More frequent consumption of delivery foods packaged in plastic containers was independently associated with higher creatinine-adjusted urinary BPS concentrations. Given that common delivery container polymers in Korea are generally bisphenol-free, this association suggests that delivery-related behavior serves as a behavioral surrogate for a bundled exposure scenario. The observed BPS signal may partly reflect cumulative exposure from ancillary materials, such as thermal receipts and labels. Future studies should identify specific delivery-associated sources and migration pathways of bisphenols.

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Original Article

Korean occupational and environmental medicine specialists: demand-supply projections: Hee-Tae Kang, Hye-Eun Lee, Mo-Yeol Kang, Chungwon Kang, Kyong sok Shin, Hyeon-Taek Heo, Yong Lim Won, Jungwon Kim; Ann Occup Environ Med 2026;e34. Published online July 27, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e34 [Accepted]

Abstract PDF: Background
Korea has experienced changes in the balance between the demand for and supply of occupational and environmental medicine (OEM) specialists due to recent policy and environmental shifts. This study projected demand and supply for these specialists for 2025–2035, focusing on those working in special health examination institutions and occupational health management agencies.
Methods
Demand was estimated by applying 2024 average workloads per OEM specialist to projected volumes of special health examinations and outsourced occupational health management for 2025–2035 under four scenarios that varied growth in outsourced management and the share of OEM specialists among participating physicians. Supply was projected using registration and official statistics for 1,010 specialists certified by 2025, combined with detailed residency cohort data, assumptions on future quotas, completion, and age at certification, and age-specific proportions working in the two institution types.
Results
Average workloads in 2024 were 4,793 workers per OEM specialist for special health examinations and 9,193 workers per physician for outsourced occupational health management. The number of OEM specialists younger than 90 years is projected to increase from 968 in 2025 to 1,244 in 2035, with those working in the two institution types increasing from 697 to 910. Depending on the scenario, demand in 2035 ranges from 838 to 943 specialists, with supply exceeding demand in three scenarios but remaining 33 specialists short in the most expansionary scenario.
Conclusions
Short‑term shortages of OEM specialists are likely but remain highly manageable, after which surplus capacity is expected. Policy efforts should therefore stabilize OEM residency pipelines and prepare institutional mechanisms to deploy surplus specialists beyond special health examinations and outsourced occupational health management.

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Original Article

Meaning of work in the association between traumatic events experienced and post-traumatic growth among workers in South Korea: a cross-sectional study: Miyoung Kim, Sang Baek Koh, Yujin Kim; Ann Occup Environ Med 2026;e35. Published online July 27, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e35 [Accepted]

Abstract PDF: Background
Traumatic experiences are associated with post-traumatic stress disorder and post-traumatic growth (PTG). Although meaning-making has been emphasized in PTG, little research has examined whether the meaning of work is involved in cross-sectional indirect associations between traumatic events experienced and PTG. In South Korea, research has focused mainly on events meeting the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM), whereas events not meeting DSM criteria among workers remain underexamined.
Methods
This study measured traumatic events experienced, meaning of work, and PTG in 328 workers aged 20 years or older. Traumatic events experienced were classified as events meeting DSM-5 criteria or events not meeting these criteria. Cross-sectional indirect associations were examined using SPSS 21.0 and the PROCESS Macro (model 4).
Results
In cross-sectional indirect-effect models, meaning of work showed a significant indirect association between the total number of traumatic events experienced and PTG. A significant indirect association through meaning of work was also observed for not meeting DSM criteria, whereas no significant indirect association was found for events meeting DSM criteria.
Conclusions
In this worker sample, events not meeting DSM criteria were highly prevalent. Meaning of work may be cross-sectionally associated with how workers interpret and integrate such events. These exploratory findings suggest that meaning-centered approaches may complement workplace mental health interventions, although longitudinal studies are needed to test temporal and causal processes.

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Original Article

Association between urinary bisphenol levels and metabolic syndrome in Korean adults: a cross-sectional study using the fourth Korean National Environmental Health Survey: Chang Ho Jae, Young Hoo Shin, Chang Ho Chae, Chan Woo Kim, Hyoung Ouk Park, Yong Tae Park, Dae Yeon Kang; Ann Occup Environ Med 2026;e36. Published online July 27, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e36 [Accepted]

Abstract PDF: Background
Bisphenols are representative endocrine-disrupting chemicals, and have shown an association with metabolic disorders. Although the use of alternative bisphenols such as bisphenol F (BPF) and bisphenol S (BPS) has been increasing while that of bisphenol A (BPA) has been declining, limited population-based studies exist in Korea examining the association between these substances and metabolic syndrome (MetS). Therefore, this study aimed to evaluate the association of urinary BPA, BPF, and BPS concentrations with MetS in South Korean adults using data from the fourth Korean National Environmental Health Survey (KoNEHS).
Methods
This study included 2,639 participants from the 2018–2019 KoNEHS. MetS was defined based on the modified National Cholesterol Education Program Adult Treatment Panel III criteria. The fasting blood glucose criterion was replaced with glycated hemoglobin (HbA1c) (≥5.7% or medication use). Urinary BPA, BPF, and BPS concentrations were categorized into tertiles per substance. Weighted binary logistic regression analysis accounting for the complex sampling design was performed to calculate odds ratio (OR) and 95% confidence interval (CI).
Results
In the final adjusted model, urinary BPF concentration demonstrated a significant positive association with MetS, with ORs of 1.320 (95% CI: 1.029–1.693) for T2 and 1.452 (95% CI: 1.122–1.878) for T3. Urinary BPS concentration demonstrated a significant association only in the highest tertile, with an OR of 1.476 (95% CI: 1.067–2.043) for T3. Conversely, urinary BPA concentration did not show a significant association with MetS.
Conclusions
In this study, urinary BPF and BPS concentrations in the general Korean adult population showed a significant positive association with MetS. The study findings may provide a baseline for expanding our understanding of the effects of bisphenols on health. Future long-term, prospective studies involving the general population remain necessary.

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Original Article

Psychometric validation of brief scales for loneliness at work in Korea: the Three-Item Scale for Loneliness at Work (SLAW-3) and Single-Item Scale for Loneliness at Work (SLAW-1): Ganguk Lee, Chunhui Suh, Seongdong Lee, Norito Kawakami; Ann Occup Environ Med 2026;e33. Published online July 24, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e33 [Accepted]

Abstract PDF: Background
Workplace loneliness is an emerging psychosocial risk factor in the occupational health context, but comprehensive assessment instruments are often impractical if large workforce surveys are planned. This study evaluated the measurement properties of two brief workplace loneliness indicators: the Single-Item Scale for Loneliness at Work (SLAW-1) and the Three-Item Scale for Loneliness at Work (SLAW-3).
Methods
Data were obtained from a nationwide online survey of Korean employees (n = 1,000), with proportional sampling by sex, age, and occupation. A subsample (n = 200) underwent 4-week follow-up to assess test–retest reliability. Internal consistency and confirmatory factor analysis were examined for SLAW-3, whereas test–retest reliability was assessed for SLAW-1. Criterion validity was tested against a single-item measure of general loneliness. Convergent validity was examined by deriving correlations with occupational stress and psychological distress, work performance, work engagement, and well-being.
Results
SLAW-3 demonstrated acceptable internal consistency (α = 0.883) and was consistent with a single-factor interpretation. SLAW-1 exhibited moderate 4-week test–retest reliability (r = 0.603). Both scales were associated with workplace loneliness and related psychological and occupational variables, in the expected directions. SLAW-1 was more strongly related to general loneliness, whereas SLAW-3 evidenced stronger associations with workplace loneliness.
Conclusions
SLAW-1 and SLAW-3 appear to be practical brief indicators of workplace loneliness. SLAW-1 may be appropriate for rapid screening, whereas SLAW-3 offers a more context-specific assessment in terms of occupational health research and monitoring.

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Original Article

The association between commute time and both presenteeism and absenteeism: a cross-sectional analysis of the 6th Korean Working Conditions Survey: Tae Jin Ahn, Young-Sun Min, Soon-Chan Kwon, Jisuk Yun, Sang-Ho Oh, Eun-Chul Jang; Ann Occup Environ Med 2026;e31. Published online July 21, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e31 [Accepted]

Abstract PDF: Background
This study examined whether longer commute time is associated with presenteeism and absenteeism among Korean wage workers, in the context of Korea’s comparatively long commutes and growing concerns about work-related productivity loss in an increasingly urbanized society.
Methods
We analyzed 28,349 wage workers from the 6th Korean Working Conditions Survey, excluding individuals younger than 20 years, foreign nationals, telecommuters, self-employed workers, unpaid family workers, and those with missing or incomplete data. Commute time was categorized into ≤60, 61–120, and ≥121 minutes per day. Presenteeism was defined as having worked while sick in the past 12 months (or since starting the current job), and absenteeism as having at least one day of sickness-related absence during the same period. Sex-stratified, survey-weighted multiple logistic regression analyses were performed to estimate odds ratios and 95% confidence intervals while accounting for the complex survey design.
Results
Overall, 82.1% of workers reported commuting ≤60 minutes, 11.2% reported presenteeism, and 3.9% reported absenteeism. Among men, commute times of 61–120 and ≥121 minutes were associated with higher odds of presenteeism, and ≥121 minutes with higher odds of absenteeism compared with ≤60 minutes. Among women, commute times of 61–120 and ≥121 minutes were associated with higher odds of presenteeism, and ≥121 minutes with higher odds of absenteeism, indicating a similar but slightly more pronounced pattern.
Conclusions
Longer commute times were associated with increased odds of both presenteeism and absenteeism among Korean wage workers. In particular, women with commute times of ≥121 minutes showed higher odds of presenteeism than men. Commute time should be recognized as a modifiable factor relevant to occupational health in workplace and public policy, and further longitudinal research is needed to clarify causal pathways and to inform targeted interventions aimed at reducing commuting-related productivity loss.

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Original Article

The relations among workplace verbal abuse, job stress, and good self-rated health among Korean wage workers: Evidence from the 7th Korean Working Conditions Survey (KWCS): Youngdo Kim, Jung Wook Kim, Jung Ho Yang; Ann Occup Environ Med 2026;e29. Published online July 14, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e29 [Accepted]

Abstract PDF: Background
Workplace verbal abuse has increasingly been recognized as a psychosocial hazard affecting employees’ health. Although its direct psychological consequences have been well documented, the mechanisms through which verbal abuse shapes employees’ self-rated health have been less thoroughly examined. In particular, limited empirical attention has been given to the mediating role of job stress in this relationship. The association between workplace verbal abuse and good self-rated health among Korean wage workers was investigated, and the mediating role of job stress in this relationship was further examined.
Methods
Data were drawn from the 7th Korean Working Conditions Survey (KWCS), which included a nationally representative sample of 26,427 wage workers aged 20 years or older. Verbal abuse, job stress, and good self-rated health were assessed using structured self-report items. Multivariable logistic regression analyses were performed to evaluate associations among verbal abuse, job stress, and good self-rated health, with adjustments made for individual- and occupational/workplace-related covariates.
Results
Workplace verbal abuse was significantly associated with higher odds of job stress (odds ratio [OR]: 1.527; 95% confidence interval [CI]: 1.300–1.803; p < 0.001) and lower odds of good self-rated health (OR: 0.641; 95% CI: 0.566–0.726; p < 0.001). Mediation analysis indicated that job stress partially mediated the relationship between verbal abuse and good self-rated health, accounting for 2.38% of the total effect (indirect effect: –0.0021; p < 0.001), while the direct effect of verbal abuse remained significant.
Conclusion
Workplace verbal abuse was associated with poorer good self-rated health, both directly and indirectly through job stress. These findings highlight the need for organizational interventions and policy-level strategies aimed at reducing verbal aggression and mitigating occupational stress.

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Original Article

Association between workplace cooperation and depressive symptoms differs according to employment type: the seventh Korean Working Conditions Survey: Jung Wook Kim, Youngdo Kim, Jung Ho Yang; Ann Occup Environ Med 2026;e30. Published online July 14, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e30 [Accepted]

Abstract PDF: Background
The relationship between workplace cooperation and mental health has gained increasing attention. However, the extent to which employment type moderates the association between workplace cooperation and depressive symptoms remains underexplored. The present study aimed to investigate the association between workplace cooperation, depressive symptoms, and employment type among South Korean wage workers.
Methods
The present work analyzed data from the seventh Korean Working Conditions Survey (KWCS), including 25,259 wage workers aged 20 years and older. Employment type was categorized as one of regular-, temporary-, or daily laborer. Workplace cooperation was assessed using a five-point Likert scale item regarding cooperation among colleagues. Depressive symptoms were measured using the World Health Organization (WHO)-5 Well-Being Index. Multivariable logistic and linear regression analyses were conducted to evaluate the association between workplace cooperation and depressive symptoms or the WHO-5 Well-Being Index.
Results
Cooperation was significantly associated with lower odds of depressive symptoms in regular workers (odds ratio [OR]: 0.538; 95% confidence interval [CI]: 0.498–0.581), temporary workers (OR: 0.666; 95% CI: 0.561–0.790), and daily laborers (OR: 0.479; 95% CI: 0.339–0.679). The association between workplace cooperation and depressive symptoms differed significantly by employment type (interaction p = 0.016 for temporary vs. regular workers): the inverse association was weaker among temporary workers than among regular workers (interaction OR: 1.261; 95% CI: 1.045–1.522), whereas no significant difference was observed between regular workers and daily laborers (interaction OR: 0.912; 95% CI: 0.651–1.279; p = 0.595).
Conclusion
Workplace cooperation was significantly associated with lower odds of depressive symptoms across all employment types, but the magnitude of this protection varies significantly by employment status.

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Original Article

Relationship between shark meat intake and blood mercury concentration in Korean adolescents: Jeong A Chang, Jeong Woo Park, Joon SaKong; Ann Occup Environ Med 2026;e28. Published online July 13, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e28 [Accepted]

Abstract PDF: Background
Mercury exposure through seafood consumption poses health risks, yet limited research has examined shark meat—a large predatory fish still consumed in Korea—and its association with blood mercury levels in adolescents.
Methods
This cross-sectional study used data from the 3rd Korean National Environmental Health Survey (KNEHS). Multiple linear and logistic regression analyses were performed to assess the association between shark meat intake and blood mercury levels and to estimate the odds ratios for exceeding the reference blood mercury level, adjusting for potential confounders.
Results
Of the 912 participants, 50 (5.5%) were identified as shark meat consumption group. Shark meat consumption was associated with higher blood mercury concentrations (β = 0.41; 95% confidence interval [CI]: 0.23–0.59), with the highest levels observed among those who consumed shark meat within the past 30 days (β = 1.19; 95% CI: 0.30–2.08), those who preferred shark meat (β = 0.67; 95% CI: 0.26–1.08), and those with higher annual intake (β = 0.71; 95% CI: 0.00–1.43). Shark meat consumers had substantially higher odds of exceeding the blood mercury reference level (≥5.8 µg/L; odds ratios: 35.84; 95% CI: 3.39–378.84), with an estimated attributable risk of 97.2% (95% CI: 70.5%–99.7%) and a population attributable risk of 65.7% (95% CI: 11.6%–95.4%). Of the estimated 25,740 (95% range: 11,905–54,913) adolescents aged 12–17 years potentially exceeding this threshold, approximately 16,911 (95% CI: 2,986–24,556) cases may be attributable to shark meat consumption, though these estimates should be interpreted cautiously given the wide confidence intervals.
Conclusion
Shark meat consumption was associated with elevated blood mercury levels in Korean adolescents. Targeted education on its potential health risks is needed to reduce unintended exposure, while maintaining the nutritional benefits of fish consumption.

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Original Article

Association between shift work patterns and the incidence of prediabetes and diabetes among night shift workers: a retrospective cohort study: Hyundong Lee, Changil Shin, Minsun Kang, Jae Bum Park, Inchul Jeong, Jaehyuk Jung; Ann Occup Environ Med 2026;e26. Published online July 9, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e26 [Accepted]

Abstract PDF: Background
Prediabetes and diabetes represent major public health challenges, and shift work has been identified as a significant occupational risk factor. While two-shift systems are gaining preference over conventional three-shift systems, evidence comparing their risks for diabetes and prediabetes remains limited. We aimed to evaluate the risk of developing prediabetes and diabetes according to shift work patterns among night shift workers. Methods: This retrospective cohort study analyzed 14,879 night shift workers at a tertiary hospital in Korea (2016–2022). Participants were classified into two- and three-shift patterns. Incident diabetes and prediabetes were identified based on fasting blood glucose and hemoglobin A1c levels, diagnosis, or medication use. Data were censored at shift change, diagnosis, loss to follow-up, or the end of the study. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for demographics, lifestyle, body mass index, and occupational characteristics including working hours, consecutive night shifts, quick returns, and shift duration. Results: The two-shift group showed significantly higher incidence rates of diabetes and prediabetes than the three-shift group. After adjusting for covariates, two-shift work remained an independent risk factor for diabetes (adjusted HR: 1.43; 95% CI: 1.10–1.87) and prediabetes (adjusted HR: 1.34; 95% CI: 1.20–1.48). Stratified analyses indicated that the increased risk of diabetes associated with two-shift work was prominent in participants working 40 hours and 41–51 hours per week, whereas the association was not significant in those working ≥52 hours. Conclusions: Two-shift work was associated with a significantly higher risk of diabetes and prediabetes compared with three-shift work. Our findings highlight the need to consider specific shift schedules and their potential health effects when designing or selecting workforce systems, rather than focusing solely on productivity or preference.

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Case Report

Basal cell carcinoma and squamous cell carcinoma of the hands in an orthopedic surgeon with occupational radiation exposure from C-arm fluoroscopy in Korea: a case report: Jisue Yoon, Jihye Lee, Seongjin Jeong, Sangchul Roh, Min-Gi Kim, Jeongbae Rhie; Ann Occup Environ Med 2026;e25. Published online July 7, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e25 [Accepted]

Abstract PDF: Background
Occupational radiation exposure among medical professionals who use fluoroscopic devices is a well-recognized concern. While radiation-induced skin cancer has been reported in interventional radiologists, cases involving orthopedic surgeons with prolonged C-arm fluoroscopy exposure have rarely been described. We present a case of an orthopedic surgeon who developed basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) on the hands after approximately 30 years of occupational radiation exposure from C-arm use during orthopedic surgeries in Korea.
Case presentation
A 62-year-old male orthopedic surgeon who performed C-arm fluoroscopy-assisted surgeries for 30 years without radiation-protective gloves presented with bleeding and skin lesions on his left hand. Hospital records documented an average of 314 C-arm-assisted surgeries per year with an estimated annual C-arm usage of 12,397 minutes. An on-site radiation assessment was conducted in the actual operating room using a simulated patient, with positioning replicated via structured interview. Measurements using an X/gamma survey meter at the surgeon's hand position yielded mean equivalent dose rate of 3.5 mSv/h and a maximum of 5.0 mSv/h, corresponding to estimated annual equivalent doses of 723 and 1,033 mSv/y, both exceeding the regulatory equivalent dose limit for extremities in Korea. The patient had experienced recurrent blistering on both hands for approximately 10 years. Biopsy revealed BCC on the left thumb and SCC on the left second and third fingers, with bilateral chronic radiation dermatitis. Excision and skin grafting were performed on the affected fingers.
Conclusions
This case demonstrates that prolonged C-arm fluoroscopy exposure without adequate hand protection can lead to radiation-induced skin cancers in orthopedic surgeons. The marked discrepancy between trunk-mounted dosimeter readings and estimated hand doses underscores the need for extremity-specific dosimetry. Radiation-protective gloves and regular dermatologic surveillance are essential for medical professionals exposed to ionizing radiation during fluoroscopy-guided procedures.

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Case Report

Recurrent laryngeal leukoplakia in a cook occupationally exposed to cooking oil fumes: a case report: Kyung-Eun Lee, Seong Won Ma, Jiwoon Kwon, Young Shin Lee, Shinhee Ye; Ann Occup Environ Med 2026;e24. Published online July 1, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e24 [Accepted]

Abstract PDF: Background
This study reports a case of recurrent laryngeal leukoplakia, a precancerous lesion, in a female cook with long-term occupational exposure to cooking oil fumes. In 2022, the Korean Epidemiological Investigation Evaluation Committee determined that substantial scientific evidence supported the work-relatedness of the case.
Case presentation
A 55-year-old woman working as a cook in group-catering facilities in long-term care hospitals and general hospitals was referred to an otolaryngology clinic after an abnormal laryngeal finding was incidentally detected during routine upper gastrointestinal endoscopy in April 2018. Subsequent laryngoscopy revealed granulation tissue of the left vocal fold. Histopathological examination following laryngeal microsurgery confirmed high-grade dysplasia, leading to a diagnosis of left vocal fold leukoplakia, and the lesion was excised. During follow-up, persistent voice changes and recurrence of the lesion were identified, and repeat excision again demonstrated low- and high-grade dysplasia. The patient had worked as a cook for approximately 14.6 years and routinely performed oil-intensive cooking tasks, including frying, grilling, stir-frying, and battered-dish preparation, for approximately 2–4.5 hours per day. She reported insufficient ventilation during heavy fume generation. She had no history of smoking, passive smoking from her spouse, alcohol consumption, vocal abuse, gastroesophageal reflux disease, or mechanical trauma to the larynx.
Conclusions
This case suggests a possible occupational contribution of repeated intermittent exposure to cooking oil fumes and irritant aldehydes to recurrent laryngeal precancerous lesions among cooks. However, because direct historical exposure measurements were unavailable and this is a single case report, definitive causality cannot be established. Improvement of workplace ventilation and other exposure-control measures should be considered, and further studies with direct exposure assessment are needed.

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