Annals of Occupational and Environmental Medicine

Review

Reframing welders’ parkinsonism: from the “idiopathic” label to biological causation and legal recognition: Chul Gab Lee; Ann Occup Environ Med 2026;e20. Published online June 17, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e20 [Accepted]

Abstract PDF: In Korea, welders diagnosed with “idiopathic Parkinson's disease (iPD)” often face denial of workers’ compensation, as “idiopathic” is interpreted as excluding occupational contribution. This narrative review examines whether a categorical distinction between iPD and “toxic parkinsonism” is defensible on diagnostic, pathological, neuroimaging, epidemiological, causal-inference, and legal grounds. The 2024 NSD-ISS (Neuronal α-synuclein disease Integrated Staging System) and SynNeurGe (Synuclein-Neurodegeneration-Gene) frameworks challenge categorical use of the “idiopathic” label by defining Parkinson's disease (PD)–related disease biologically, irrespective of etiology. Nonhuman primate studies show that chronic low-dose manganese exposure can produce nigrostriatal deficits and α-synuclein aggregation overlapping with PD biology. Dichotomous use of FP-CIT dopamine transporter imaging or levodopa responsiveness to separate manganese poisoning from iPD is therefore scientifically unsound, as chronic welding exposure can induce presynaptic dysfunction and treatment responses indistinguishable from PD. Epidemiological findings diverge methodologically: direct clinical examination has reported elevated parkinsonism prevalence among welders, whereas administrative cohorts have generally found no increased PD risk. This divergence is plausibly explained by differences in case ascertainment, exposure assessment, healthy-worker-survivor selection, and disease latency. Bradford Hill and Rothman frameworks support a causal interpretation, although validated biomarkers and dose-response thresholds remain undefined. Under Korea’s Industrial Accident Compensation Insurance Act, causation is evaluated as a “proximate causal relationship” rather than strict scientific proof. A multi-hit model integrating genetic predisposition, aging, and cumulative environmental exposure supports recognition under this standard, and compensation eligibility should not depend on whether the diagnosis label is ‘PD’ or ‘parkinsonism.’ When parkinsonian symptoms occur in welders with at least approximately 20,000 exposure-weighted welding hours, or with substantial high-intensity exposure such as confined-space welding, inadequate ventilation, or flux-cored arc welding, occupational contribution should be considered under a weight-of-evidence approach. This criterion is sufficient for recognition but is not a necessary condition.

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Original article

Occupational determinants of national health screening participation: an analysis of the KNHANES (2007–2023): Chan Young Lee, Jun-Pyo Myong, Mo-Yeol Kang; Ann Occup Environ Med 2026;e22. Published online June 24, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e22 [Accepted]

Abstract PDF: Background
South Korea operates a national health screening program aimed at early detection of major diseases. Although participation rates have been linked to various socioeconomic and demographic factors, occupational determinants remain insufficiently characterized.
Methods
This study analyzed 37,987 employed wage earners from the Korea National Health and Nutrition Examination Survey conducted between 2007 and 2023. The primary outcome was self-reported health screening program participation within the preceding two years. Occupational characteristics—including classification of occupations, employment status, working hours, work arrangement, and supervisory role—as well as workplace conditions and hazard exposures were examined. Prevalence ratios (PRs) with 95% confidence intervals were calculated for each characteristic. Generalized additive models were used to examine the nonlinear association between weekly working hours and participation rates. Multivariable modified Poisson regression models incorporating interaction terms between occupational characteristics and survey year assessed temporal trends in participation disparities.
Results
The overall health examination rate was 71.32%. Compared with managers, all other occupational categories—except armed forces—had significantly lower PRs of participation, with sales workers showing the lowest. Temporary, daily, non-regular, and part-time workers showed significantly lower PRs. Those working less than 35 or more than 52 hours per week showed significantly lower PRs than the reference group (35–52 hours). An inverted U-shaped association was observed, with participation peaking at approximately 40–50 hours per week. Among workplace conditions, decision-making authority, working under time pressure, and physical hazard exposure were associated with higher participation, whereas prolonged uncomfortable postures and heavy material handling were associated with lower participation. Over the 17-year study period, the adjusted PRs for working hours showed no significant temporal change.
Conclusions
Significant occupational disparities in health screening participation exist among Korean wage earners. Targeted interventions addressing vulnerable occupational groups are warranted to reduce disparities and improve overall worker health outcomes.

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Original Article

Construction of a musculoskeletal job-exposure matrix in Korea: Myong-Hwan Kim, Eun-Soo Lee, Dongmug Kang, Ki-Hun Kim, Youngki Kim; Ann Occup Environ Med 2026;e21. Published online June 18, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e21 [Accepted]

Abstract PDF: Background
Musculoskeletal disorders (MSDs) are a major occupational health issue in Korea; however, a standardized job-exposure matrix (JEM) has not been established. This study aimed to develop an MSD-specific JEM using data from the Korean Working Conditions Survey (KWCS) to evaluate the exposure time proportion by job category and body segment.
Methods
Data from the 2nd to 6th KWCS (2006–2020), covering 210,500 workers, were analyzed. The jobs of the subjects were reclassified based on the unit groups of the 7th Korean Standard Classification of Occupations. Exposure time proportion for key MSD risk factors—repetitive movements, awkward postures, heavy lifting, and prolonged standing—was categorized as high, moderate, or low based on self-reported responses. Validity was assessed through expert review and statistical analysis, including Cohen’s kappa coefficients and logistic regression.
Results
Duration-based exposure to musculoskeletal (MS) risk factors was estimated for each occupation. The JEM classified exposure time proportion for three body regions: upper extremity and neck, lower back, and lower extremity. Expert review showed high agreement for the upper extremity and neck and for the lower back (kappa > 0.8), whereas agreement was lower for the lower extremity. Logistic regression analysis indicated an exposure–response relationship between JEM-derived exposure time proportion and MS symptoms for the upper extremity and neck and the lower back.
Conclusions
This study developed Korea’s first MS-specific JEM, providing a standardized framework for occupational MSD risk assessment. The JEM demonstrated strong validity for most body regions and can be a valuable tool for research, workplace risk evaluation, and policy development. Further refinements incorporating detailed job classifications and ergonomic factors are recommended to enhance its applicability.

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Original article

Occupational health risk assessment, exposure monitoring, and medical surveillance in the UK, EU, and US: a comparative analysis and implications for occupational disease prevention in Korea: Sangjun Choi, Kyong-Hui Lee, Kyung Ehi Zoh, Dong-Hee Koh, Won Kim, Kwonchul Ha, Dong-Uk Park; Ann Occup Environ Med 2026;e18. Published online June 15, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e18 [Accepted]

Abstract PDF: Background
Although most countries maintain occupational safety and health (OSH) legislation to prevent occupational diseases, the legal codification and integration of occupational health risk assessment (HRA), exposure monitoring, and medical surveillance vary substantially across jurisdictions; therefore, this study compared the legal frameworks of Korea, the United Kingdom (UK), the European Union (EU) and United States (US) to examine the linkage among these elements, assess whether they support estimation of individual cumulative past exposure, and derive implications for improving occupational disease prevention in Korea.
Methods
This qualitative comparative legal analysis examined employer obligations related to quantitative exposure monitoring, HRA, and medical surveillance under the OSH systems of the UK, the EU, the US, and Korea. Primary statutes and subordinate regulations were systematically reviewed to assess how these elements are mandated, linked, and supported by record-keeping provisions enabling cumulative exposure estimation.
Results
The UK and the EU explicitly require HRA as a regulatory starting point and link exposure monitoring and medical surveillance to the outcomes of risk assessment, with targeted hazard-based provisions for intrinsically high-risk agents. The US adopts a hybrid approach, imposing mandatory monitoring and medical surveillance for high-hazard substances under 29 Code of Federal Regulations 1910 Subpart Z while relying on general statutory duties elsewhere. Korea applies broad list-based requirements for exposure monitoring and medical surveillance that are largely independent of HRA outcomes and do not include legally mandated variables necessary for systematic cumulative exposure estimation. In contrast, the UK, the EU, and partially the US provide legal mechanisms, including long-term record-keeping provisions, that enable reconstruction of individual cumulative occupational exposure.
Conclusions
Strengthening the integration of HRA, exposure monitoring, and medical surveillance—together with improved record-keeping structures that support cumulative exposure reconstruction—may contribute to more effective occupational disease prevention and long-term medical surveillance in Korea.

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Original Article

Occupational differences in benzene-related biomarker levels beyond traditional industrial settings: findings from the Korean National Environmental Health Survey, 2015–2023: Chul Gab Lee; Ann Occup Environ Med 2026;e19. Published online June 15, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e19 [Accepted]

Abstract PDF: Background
Benzene is a group 1 carcinogen, and urinary trans, trans-muconic acid is a key biomarker of benzene exposure. Whether specific occupational groups in Korea have higher benzene body burdens beyond environmental levels has not been systematically evaluated using national biomonitoring data with smoking-adjusted biomarkers.
Methods
We pooled adult data from three cycles (3rd–5th) of the Korean National Environmental Health Survey (KoNEHS, 2015–2023; n = 10,786). Creatinine-adjusted urinary ttMA (UttMACr) was analyzed across nine occupation groups using complex-samples general linear models with nested covariates. Sampling weights were rescaled within each cycle to harmonize weight scales across waves. Smoking was controlled using questionnaire-based variables and five-level creatinine-adjusted urinary cotinine (COTCr). Variance decomposition quantified predictors' contributions, and sensitivity analyses included COTCr-stratified models and analyses limited to the economically active population.
Results
Population geometric mean UttMACr declined by 51% from the 3rd to 5th cycle, occupation remained a significant independent predictor after adjusting for temporal trends, smoking, demographic, and lifestyle covariates (ΔR² = 0.0018, p = 0.003). Cleaning/guard/elementary workers showed the highest elevation in the geometric mean ratio (GMR: 1.13; p < 0.001), followed by food/textile/other manufacturing (GMR: 1.12; p < 0.05) and chemical/metal/machinery manufacturing workers (GMR: 1.08; p < 0.05). COTCr-stratified analyses revealed occupation-specific patterns attenuated in pooled models: among participants with COTCr ≤ 1.0 μg/g creatinine, construction/mining (GMR: 1.62; p < 0.001) and agriculture/fishery (GMR: 1.41; p < 0.01) showed marked elevations.
Conclusions
Population UttMACr levels in Korea declined over time, but occupation-specific differences persisted after adjustment for trends, smoking, and sociodemographic factors. These findings suggest occupational benzene exposures may extend beyond traditionally recognized industrial settings and support more targeted biomonitoring, particularly for worker groups not routinely prioritized in current surveillance programs.

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Original Article

Evaluating the efficacy of prednisolone for silicosis with progressive massive fibrosis in Australia: an observational pilot study: Hayley Barnes, David P. Nadebaum, Daniel Niewodowski, J. K. Khoo, Yuan Z. Lim, Bradley Gardiner, Tiffany Lin, Martin Cherk, Miranda Siemienowicz, Jyotika D. Prasad, Ryan Hoy; Ann Occup Environ Med 2026;e16. Published online June 4, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e16 [Accepted]

Abstract PDF: Background
There has been a resurgence of silicosis, particularly related to artificial stone. There are currently no treatments for silicosis beyond lung transplantation for end-stage disease. To evaluate the efficacy of prednisolone in people with artificial stone-associated silicosis–progressive massive fibrosis (PMF).
Methods
This was a pilot prospective observational clinical trial, assessing 3 months of prednisolone in adults with artificial stone–associated silicosis with PMF. Outcomes were assessed at 3 and 12 months.
Results
Seven participants completed the study. Baseline positron emission tomography (PET) scans demonstrated increased fluorine-18 fluorodeoxyglucose (18F-FDG) uptake in areas of PMF in all participants. All participants had a significant reduction in maximum standardized uptake value (SUVmax) following prednisolone at 3 months (pre-treatment mean SUVmax 6.7 [standard deviation (SD): 2.6], post-treatment mean SUVmax 4.2 [SD: 1.0], p = 0.01). There was also a non-significant reduction in the % of total lung parenchyma with SUV >1 (49.7% [SD: 36.4] to 45.8% [SD: 28.4], p = 0.52) and a significant reduction in SUV >2.5 (7.0% [SD: 6.3] to 2.4% [SD: 2.2], p = 0.03). There was a non-significant reduction in computed tomography ICOERD well-defined opacity profusion scores and large opacities. There was no significant difference in lung function or St. George's Respiratory Questionnaire. There were no serious adverse events.
Conclusions
There are high levels of inflammation in silicosis-PMF as evidenced by 18F-FDG PET. Short-term prednisolone reduced 18F-FDG PET activity. This suggests a possible therapeutic pathway for people with silicosis-associated PMF in a population with no current treatments. Further research is required to determine the most appropriate immunosuppressive strategy and further assess longer-term outcomes.

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Case Report

Reactive airways dysfunction syndrome following acute lithium hydroxide dust exposure at a battery material production plant: a case series of 16 workers: Chul Gab Lee, Soo Hyeong Park, Jeong Joon Park, Han Soo Song, Hyeon Kyeong Ko, Sung Ho Yoon; Ann Occup Environ Med 2026;e17. Published online June 4, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e17 [Accepted]

Abstract PDF: Background
Reactive airways dysfunction syndrome (RADS) is an acute-onset form of irritant-induced asthma that occurs after a single high-concentration exposure to irritants. Although RADS has been documented for chlorine, ammonia, and acid fumes, no published case series has attributed RADS to lithium hydroxide (LiOH) dust inhalation. We report the clinical features, diagnostic evaluation, and longitudinal management of 16 workers with persistent respiratory symptoms following acute occupational LiOH exposure at a battery cathode material production facility.
Case Presentation
In March 2024, a silicone connector failure resulted in the leakage of approximately 50–100 kg of LiOH powder at a facility in Korea, exposing over 500 workers. Sixteen workers (15 men, 1 woman; mean age 53.4 years) with persistent respiratory symptoms were evaluated at the Department of Occupational and Environmental Medicine. Most patients presented with cough and sputum production; 56.3% (9/16) exhibited nocturnal or early-morning exacerbation. Methacholine challenge testing was performed in 10 patients, with positive results in three patients (PC20 [provocative concentration causing a 20% decline in forced expiratory volume in 1 second]: 1.36–6.74 mg/mL). By the Brooks 1985 criteria, one case was classified as definite RADS, four as probable, six as possible, and five as unlikely; American College of Chest Physicians 2008 cross-validation yielded identical classifications. Workers' compensation recipients had significantly longer follow-up (18–23 months) compared to non-recipients (1–3 months). Pharmacological management was symptom-directed, combining leukotriene receptor antagonists, mucolytics, antihistamines, and acid-suppressive therapy.
Conclusions
Acute high-concentration LiOH dust inhalation may induce RADS characterized by persistent respiratory symptoms and bronchial hyperresponsiveness. The extreme alkalinity, high water solubility, and exothermic dissolution of LiOH provide a plausible mechanistic framework for airway injury. Clinicians should consider RADS in workers presenting with persistent respiratory symptoms after alkaline dust exposure, even when routine investigations are unremarkable. Attention should also be given to the psychological burden associated with prolonged, poorly recognized symptoms.

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