Annals of Occupational and Environmental Medicine

Volume 23 (1); March 2011

Original Article

The Association between Nonstandard Employment and Suicidal Ideation: Data from the First~Fourth Korea National Health and Nutrition Examination Surveys: Woncheol Lee, Jaehyeok Ha; Korean Journal of Occupational and Environmental Medicine 2011;23(1):89-97. Published online March 31, 2011; DOI: https://doi.org/10.35371/kjoem.2011.23.1.89

OBJECTIVES
In light of the high percentage of nonstandard workers and the high suicide rates in South Korea since the 1997 economic crisis, we examined the association between nonstandard employment and suicidal ideation among South Korean employees.
METHODS
We analyzed data from the Korean National Health and Nutrition Examination Surveys (KNHANES) I, II, III and IV, conducted in 1998, 2001, 2005 and 2007-2009, respectively (13,632 waged workers aged 20-69 years). Employment status was categorized into standard and nonstandard (part-time, temporary and daily) employment. Prevalence ratios (PRs) for self-reported suicidal ideation were compared between nonstandard and standard workers according to each survey wave.
RESULTS
After adjusting for background variables, the risk for suicidal ideation was consistently higher among nonstandard workers in every survey wave. In women, the PRs for suicidal ideation of nonstandard workers compared with standard ones were 1.24~1.37 and all of them were statistically significant. In men, those PRs were 1.36~1.52 with (marginal) statistical significance except for the First KNHANES (1998). Because nonstandard employment is closely related to other factors of suicidal ideation, these estimates are unlikely to have been underestimated.
CONCLUSIONS
The findings suggest the impact of employment status on suicidal ideation and the need for further prospective investigation that lead to policies aimed at improving the problematic labor markets.

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A Machine Learning Approach for Predicting Wage Workers’ Suicidal Ideation
Hwanjin Park, Kounseok Lee
Journal of Personalized Medicine.2022; 12(6): 945. CrossRef
Mental health and quality of life according to sleep in cancer survivors
Yoonjung Kim
Perspectives in Psychiatric Care.2022; 58(4): 2442. CrossRef
Temporary employment and suicidal ideation in COVID-19 pandemic in Japan: A cross-sectional nationwide survey
Natsu Sasaki, Takahiro Tabuchi, Ryo Okubo, Tomohiro Ishimaru, Mayumi Kataoka, Daisuke Nishi
Journal of Occupational Health.2022;[Epub] CrossRef
Sleep Duration Is Closely Associated with Suicidal Ideation and Suicide Attempt in Korean Adults: A Nationwide Cross-Sectional Study
Yujin Ko, Jieun Moon, Sangsoo Han
International Journal of Environmental Research and Public Health.2021; 18(11): 5594. CrossRef
The Association between Unstable Employment and Suicidal Behavior in Young-Adult Precarious Workers
Yoanna Seong, Eun-Sun Lee, Subin Park
Psychiatry Investigation.2021; 18(7): 661. CrossRef
Association of Bedtime with both Suicidal Ideation and Suicide Planning among Korean Adolescents
Wonjeong Jeong, Yun Kyung Kim, Hyeon Ji Lee, Jieun Jang, Selin Kim, Eun-Cheol Park, Sung-In Jang
International Journal of Environmental Research and Public Health.2019; 16(20): 3817. CrossRef
Employment conditions and use of gastric cancer screening services in Korea: a nationwide survey
Hye-Young Shim, Jae Kwan Jun, Ji-Yeon Shin
BMC Public Health.2019;[Epub] CrossRef
Long and short sleep duration are both associated with suicidal ideation in Korean employees
Young-Chul Shin, Jin-woo Kim, Jin-Mi Seol, Kang-Seob Oh, Dong-Won Shin, Eun-Jin Kim, Se-Won Lim
Sleep and Biological Rhythms.2017; 15(1): 81. CrossRef
The Association between Unemployment and Suicidal Ideation by Gender - Using the Korea National Health and Nutrition Examination Survey 2009 -
Hyun-Kyung Lee, Hye-Sun Jung
Korean Journal of Health Education and Promotion.2014; 31(5): 97. CrossRef
The Effects of Employment Conditions on Smoking Status and Smoking Intensity: The Analysis of Korean Labor & Income Panel 8th–10th Wave
Youn Jung, Juhwan Oh, Soonim Huh, Ichiro Kawachi, Chris Bullen
PLoS ONE.2013; 8(2): e57109. CrossRef
Association between Total Sleep Duration and Suicidal Ideation among the Korean General Adult Population
Jae-Hyun Kim, Eun-Cheol Park, Woo-Hyun Cho, Jong-Yeon Park, Won-Jung Choi, Hoo-Sun Chang
Sleep.2013; 36(10): 1563. CrossRef
Relationship between the Suicidal Ideation of the Married Women and the Characteristics of Their Children
Eunjung Kim, Sunmi Lee, Seungji Lim, Woojin Chung
Health Policy and Management.2013; 23(4): 358. CrossRef

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Original Article

Estimation of Demand and Supply for Occupational and Environmental Medicine Specialties in Korea (II): Demand Estimation and Demand-Supply Balance: Yoomi Chae, Jungwon Kim, Jonghan Leem; Korean Journal of Occupational and Environmental Medicine 2011;23(1):80-88. Published online March 31, 2011; DOI: https://doi.org/10.35371/kjoem.2011.23.1.80

Abstract PDF

OBJECTIVES
To estimate the demand and demand-supply balances of occupational and environmental medical specialties (OEMS) in the target year of 2020.
METHODS
We adopted a new OEMS demand model based on the situations of periodic workers' health examination (PHE) agencies, health management agencies (HMA), and legal enforcement for health and safety systems in Korea. The model uses data selected primarily from the database of the Korean Society of Occupational and Environmental Medicine (KSOEM), a survey for certified members of KSOEM, statistics and internal documents from the Ministry of Employment and Labor (MOEL).
RESULTS
From the data and assumptions, newly demanded OEMS were 193 for workers who had received PHE, and 205 based on total workers for PHE in 2020 for PHE. But no OEMS for HMA area is demanded. Comparing with the calculated numbers of supply estimates, the demand was slightly higher, but could be balanced if MOEL kept consistent and unchanging policies.
CONCLUSIONS
The study results suggest that the demand-supply balance of OEMS is mainly influenced by the policy of MOEL. Further studies are needed examining more detailed data and statistics about PHE agencies, HMA and considering MOEL policies are needed to configuring more sophisticated and need-included estimation.

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Residency programs and the outlook for occupational and environmental medicine in Korea
Youngil Lee, Jungwon Kim, Yoomi Chae
Annals of Occupational and Environmental Medicine.2015;[Epub] CrossRef

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Original Article

Estimation of Demand and Supply for Occupational and Environmental Medicine Specialties in Korea (I): Estimation of Supply: Jungwon Kim, Yoomi Chae, Jonghan Leem; Korean Journal of Occupational and Environmental Medicine 2011;23(1):71-79. Published online March 31, 2011; DOI: https://doi.org/10.35371/kjoem.2011.23.1.71

Abstract PDF

OBJECTIVES
To estimate the supply of occupational and environmental medicine specialties in the target year of 2020.
METHODS
We adopted alternative projection models combined with a demographic method as a supply forecasting method. The model uses data selected primarily from the database of the Korean Society of Occupational and Environmental Medicine (KSOEM), a survey for certified members of KSOEM, audit data from the Ministry of Employment and Labor (MOEL) and Hospital Accreditation. We assumed five viable alternatives in supply forecasting.
RESULTS
Depending on the assumptions, the total occupational and environmental medicine specialties supply ranged from 706 by low-level supply estimates to 754 by high-level supply estimates in 2020. Among them, approximately 81% were estimated to engage themselves in agency for health management and periodic health examinations for workers exposed to hazards.
CONCLUSIONS
The study results suggest that the supply of occupational and environmental medicine specialties is related to the policy of MOEL. Further studies are needed concerning overall policy about health and safety and for the newly demanded market.

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Residency programs and the outlook for occupational and environmental medicine in Korea
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Original Article

The Relationship between Hospital Departments and Risk of Developing Tuberculosis among Nurses Working at a University Hospitalin Korea: Retrospective Cohort Study: Jin Ha Yoon, Sung Soo Oh, Ki Hyun Lee, Sung Kyung Kim, Je Ho Oh, Chung Se Won, Sei Jin Chang, Bong Suk Cha, Ae Yong Eom, Sang Baek Koh; Korean Journal of Occupational and Environmental Medicine 2011;23(1):64-70. Published online March 31, 2011; DOI: https://doi.org/10.35371/kjoem.2011.23.1.64

Abstract PDF: OBJECTIVES
To investigate the occurring characteristics of pulmonary tuberculosis (TB) among nurses working at a university hospital in Korea.
METHODS
A retrospective cohort study was conducted using medical records from a university hospital. A total of 351 nurses without any pulmonary disease were enrolled during 2000~2007, and were followed up until October 2010. To compare with the incidence of TB between occupational subgroups, workplaces were divided into high and low TB-exposure risk departments. For statistical analysis, the relative risks for TB incidences between departments were estimated using Cox proportional hazards models and mean incidences were estimated with person-time years.
RESULTS
Seven cases of TB were observed during 2001 person-years. Five and two cases were observed in the high and low TB-exposure risk departments, respectively. The relative risk of TB infection in the high TB-exposure risk departments were 6.52 (95% CI, 1.26~33.60) compared to that in the low TB-exposure risk department. The mean incidence of TB in the total nurses was 0.350% per person-year.
CONCLUSIONS
According to the concept of occupational and environmental medicine, high TB-exposure risk departments were more likely to be at increased risk of tuberculosis.

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Original Article

Cognition and Practice on Medical Information Protection of Iudustrial Health Care Manager of Small and Medium Sized Enterprises: Soo Jin Jeong, Min Kim, Chae Kwan Lee, Chang Hee Lee, Byung Chul Son, Dae Hwan Kim, Jeong Ho Kim, Jong Tae Lee, Goo Rak Chang, Ki Hun Hong, Chun Hui Suh; Korean Journal of Occupational and Environmental Medicine 2011;23(1):53-63. Published online March 31, 2011; DOI: https://doi.org/10.35371/kjoem.2011.23.1.53

Abstract PDF

OBJECTIVES
This research aimed to know the actual condition and problems of medical information protection at a workplace with the target of industrial health care managers of small and medium-sized enterprises.
METHODS
A self-administered questionnaire was given to industrial health-care managers of 216 enterprises from March 15 to May 17, 2010. The questionnaire was produced by referring to the Act on Personal Information Protection of Public Institutions, etc. This research evaluated agreement of cognition and practice according to 10 items of medical information protection using kappa and cross-analysis of significant factors between cognition and practice of medical information protection and general characteristics.
RESULTS
Cognition about medical information protection appeared to be 85.4-97.1% and its practice appeared to be 44.1-95.3%, so practice was lower than cognition. In addition, the agreement of cognition and practice appeared significantly low (kappa 0.082-0.387). The practice of medical information protection tended to be lower when the managers were older and held a higher job title. Health examination results were being delivered only to workers except for an employer (94.2%), but there were many industrial health-care managers who felt discomfort about their work in group occupational health-care systems (58.1%).
CONCLUSIONS
The practice of protecting medical information by industrial health-care managers was clearly lower than the cognition. Therefore, introduction of educational programs about personal information protection and provision of an independent place for group occupational health care service is urgent. In addition, in order to use the health examination results conveniently in group occupational health services, an institutional complement is necessary.

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Jiwon Kang, GyeongAe Seomun
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Hyun Sang Park, Kwang Il Kim, Jae Young Soh, Young Ho Hyun, Sae Kyun Jang, Sol Lee, Ga Young Hwang, Hwa Sun Kim
JMIR mHealth and uHealth.2020; 8(6): e16723. CrossRef
Perception and Performance about Patients' Medical Information Protection in Allied Health College Students
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Original Article

Second-hand Smoke Exposure and Urine Cotinine Levels by Occupation in the Busan, Ulsan, Kyeongnam Provinces: So Ryong Lee, Soo Jin Jeong, Chun Hui Suh, Chae Kwan Lee, Chang Hee Lee, Byung Chul Son, Dae Hwan Kim, Jeong Ho Kim, Jong Tae Lee, Jin Heon Lee, Moon Young Hwang, Choong Hee Park; Korean Journal of Occupational and Environmental Medicine 2011;23(1):42-52. Published online March 31, 2011; DOI: https://doi.org/10.35371/kjoem.2011.23.1.42

Abstract PDF

OBJECTIVES
Exposure to second-hand smoke varied by smoking rate in the workplace and no-smoking policies. The purpose of this study was to estimate the status of second-hand smoke exposure by occupation through urine cotinine analysis in Busan, Ulsan, and Kyeongnam provinces.
METHODS
Data was obtained from the National Institute of Environmental Research of Korea as 'The 2008 Korea National Survey for Environmental Pollutants in Human Body'. We selected 629 non-smokers who lived in Busan, Ulsan and Gyeongnam provinces. General and occupational characteristics were gathered using a structured questionnaire. Urine cotinine concentrations were analyzed by a gas chromatograph-mass selective detector. Statistical analysis was carried out using the Chi-square test, Student t-test and ANOVA.
RESULTS
The geometric mean (geometric standard deviation) of urine cotinine concentration was 17.11 (2.74) ng/ml. The urine cotinine concentration of the middle school graduate group (18.47 (2.86) ng/ml) was higher than the college graduate group (15.64 (2.60) ng/ml, p=0.212). Also, the cotinine concentration of current drinkers (18.98 (2.47) ng/ml) was higher than non-drinkers (16.15 (2.88) ng/ml, p=0.054). The proportion who smelled smoke was higher in workers (38.5%) than in non-workers (29.7%, p=0.02). Therefore, urine cotinine concentration was higher in workers (17.29 (2.66) ng/ml) than in non-workers (16.97 (2.81) ng/ml) but not at a statistically significant amount (p=0.826). In addition, cotinine concentration between the group who smelled smoke (20.45 (2.42) ng/ml) and the group who did not smelled smoke (15.53 (2.78) ng/ml) was significantly different (p=0.016) in workers but not in non-workers (17.08 (2.42) ng/ml vs 16.92 (2.98) ng/ml, p=0.942). According to the National Center for Health Statistics occupational categories in the US and the Korea Standard Classification of Occupations, the urine cotinine concentration of white collar workers such as technical workers and administrators, professional specialists, and managers was higher (18.01 (2.55) ng/ml) than that of blue collar workers such as plant and machine operators and assemblers, elementary occupations, and craft and related trades workers (15.36 (3.48) ng/ml).
CONCLUSIONS
The workplace is an important contributor to second-hand smoke exposure in Busan, Ulsan and Kyeongnam provinces. Unlike in advanced countries, where anti-smoking policies have been implemented, urine cotinine concentration in people in Busan, Ulsan and Kyeongnam provinces was higher in the white collar group than in the blue collar group. This result might be due to a higher indoor second-hand smoking rate of workplaces in these areas. Further studies are needed to evaluate the correlation between regional characteristics of industries, anti-smoking policies in the workplace, smoking rates and urine cotinine concentrations of workers.

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Kiwoong Ko, Min-Jung Kwon, Song-Hyun Yang, Chul-Jin Moon, Eun Hee Lee, Hee-Yeon Woo, Hyosoon Park
Annals of Laboratory Medicine.2016; 36(5): 427. CrossRef
Decline in non-smoking workers’ urine cotinine levels after increased smoking regulation in Korea
Ju-Hyoung Park, Chae-Kwan Lee, Se-Yeong Kim, Chunhui Suh, Kun-Hyung Kim, Jeong-Ho Kim, Byung-Chul Son, Jong-Tae Lee, Seung-Do Yu, Wookhee Choi, Hosub Im
Annals of Occupational and Environmental Medicine.2015;[Epub] CrossRef

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Original Article

The Effects of Smoking and Drinking on Blood Lead and Cadmium Levels: Data from the Fourth Korea National Health and Nutrition Examination Survey: Boram Lee, Jaehyeok Ha; Korean Journal of Occupational and Environmental Medicine 2011;23(1):31-41. Published online March 31, 2011; DOI: https://doi.org/10.35371/kjoem.2011.23.1.31

Abstract PDF

OBJECTIVES
The purpose of this study is to assess the effects of smoking and drinking on blood lead and cadmium levels based on a dose-response relationship in the general Korean adult population.
METHODS
The study population consisted of 1,901 Koreans, who took part in the 2008 Korean National Health and Nutrition Examination Survey, in which blood lead and cadmium levels were measured. Geometric mean concentrations and their 95% confidence intervals of metals in blood were estimated by analysis of covariance (ANCOVA) adjusting for demographic and lifestyle factors.
RESULTS
We observed a statistically significant dose-response relationship with daily smoking amount/alcohol intake and blood lead/cadmium levels. While daily smoking amount was more consistent with blood cadmium level (0.1-0.2 microg/L per 5 cigarettes), blood lead concentrations were higher as daily alcohol intake increased (0.1-0.2 microg/dL per 10 gram of alcohol).
CONCLUSIONS
Our findings clearly support a relationship between daily smoking amount/alcohol intake and blood lead/cadmium levels, suggesting an additional reason towards efforts to reduce smoking and drinking habits.

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Yosub Joo, Sangchul Roh
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Health Effect and Blood Lead Concentration among Residents in Gwangyang and Yeosu
Heejin Park, Myung-Kyu Park, Tack-Shin Kang, Geun-Bae Kim, Jong-Wha Lee, Bong-Ki Jang, Bu-Soon Son
Korean Journal of Environmental Health Sciences.2016; 42(3): 205. CrossRef
Association of among alcohol consumption and blood vitamin D and lead concentrations: Based on 2010-2012 Korea national health and nutrition examination survey
Ho-Ki An, Jae-Yong Park, Hee-Jung Yoon
Journal of the Korea Academia-Industrial cooperation Society.2015; 16(1): 498. CrossRef
Association between secondhand smoke exposure and blood lead and cadmium concentration in community dwelling women: the fifth Korea National Health and Nutrition Examination Survey (2010–2012)
Se Young Jung, Suyeon Kim, Kiheon Lee, Ju Young Kim, Woo Kyung Bae, Keehyuck Lee, Jong-Soo Han, Sarah Kim
BMJ Open.2015; 5(7): e008218. CrossRef
Simultaneous Exposure to Heavy Metals among Residents in the Industrial Complex: Korean National Cohort Study
Heejin Park, Kyoungho Lee, Chan-Seok Moon, Kyungsook Woo, Tack-Shin Kang, Eun-Kyung Chung, Bu-Soon Son
International Journal of Environmental Research and Public Health.2015; 12(6): 5905. CrossRef
A Study on Concentrations of Heavy Metal in Blood and Urine of Local Area in Korea
Ji-Young Im, Eun-Kyung Chung, Hee-Jin Park, Seungdo Yu, Bong-Ki Jang, Bu-Soon Son
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Original Article

Effect of Hand Transmitted Vibration on the Auditory System: Jae Kook Yoon, Cheol In Yoo, Ji Ho Lee; Korean Journal of Occupational and Environmental Medicine 2011;23(1):18-30. Published online March 31, 2011; DOI: https://doi.org/10.35371/kjoem.2011.23.1.18

Abstract PDF

OBJECTIVES
This study was undertaken to estimate the effect of hand transmitted vibration exposure for long time period on the auditory system in shipyard grinder workers.
METHODS
From 2006 to 2009, the study was carried out on 87 grinder workers for hand transmitted vibration exposure group, with 81 welders who were served as the control group. All subjects were male; at baseline, none of the participants had ear disease or diabetes mellitus. Auditory threshold at different frequencies ranged from 0.25 kHz to 8 kHz for both ear was recorded; the following were also collected from the subjects: age, exposure duration, noise exposure level of investigation year, total cholesterol, systolic/diastolic blood pressure, and smoking history.
RESULTS
In comparison of two groups, mean of age, exposure duration, noise level, total cholesterol, systolic/diastolic blood pressure, smoking rate were not significantly different between the groups. Auditory thresholds of 0.25, 0.5 kHz frequencies in both ear, 1 kHz frequency in right ear, and 8 kHz frequency in left ear were higher in hand-transmitted vibration exposure group than that in the control group at a statistically significant level. After stratification by age 50 years, there were no significant differences between the two groups in less than 50-years old age group, but auditory threshold of 0.25, 0.5, 1 and 8 kHz frequency were significantly different between the two groups in above 50-years old age group. The differences between two groups ranged from 0.4 dB(HL) to 6.7 dB(HL). Multiple linear regression analysis showed that hand transmitted vibration exposure was significant only in 0.25, 0.5 kHz frequency and the regression coefficients of vibration exposure ranged from 3.826 to 5.028 in those frequencies.
CONCLUSIONS
The differences of hearing threshold between two groups only in the 50-years old group were possibly owing to changed peripheral vascular system with autonomic nervous system, and significances only in low frequencies such as 0.25, 0.5 kHz probably mean that hand vibration exposure have been transmitted to auditory organ over long term. Collectively, older people can be more susceptible to hearing loss in the presence of hand transmitted vibration exposure and auditory threshold at low frequency may be more affected by the hand transmitted vibration exposure than high frequency.

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Original Article

Relationship between Musculoskeletal Symptoms and Non-fatal Occupational Injuries in Construction Workers in Korea: Seung Won Yoo, Hye Eun Lee, Dong Hee Koh, Kyoo Sang Kim, Tae Woo Kim, Min Gi Kim, Kyeong Yeol Yu; Korean Journal of Occupational and Environmental Medicine 2011;23(1):9-17. Published online March 31, 2011; DOI: https://doi.org/10.35371/kjoem.2011.23.1.9

Abstract PDF

OBJECTIVES
This study aimed to assess the relationship between musculoskeletal symptoms and non-fatal injuries in construction workers.
METHODS
This was a cross-sectional study involving 1,836 male construction workers in petrochemical plants in Korea. For this study, a structured self-reported questionnaire(KOSHA CODE H-30-2003) was used. Musculoskeletal symptoms were defined as symptoms that affect the operation of the musculoskeletal system, for longer than one week or a frequency of more than once per month. To evaluate the association between musculoskeletal symptoms and non-fatal occupatioanl injuries, multiple logistic-regressions were used after adjusting for age, exercise, smoking status, alcohol consumption, work time, work duration, and income.
RESULTS
A total of 140 workers were involved in non-fatal injuries cases, representing 7.6% prevalence. After adjusting for confounding variables, the logistic regression analyses indicated the group with musculoskeletal symptoms(OR 1.73 95% CI:1.21~2.47) and intensity criteria of musculoskeletal symptoms as related to 'moderate' criteria(OR 1.82 95% CI:1.18~2.81) or 'severe' criteria(OR 2.57 95% CI:1.43~4.63). This identified group was more likely to experience non-fatal occupational injuries. However, a 'mild' criteria(OR 1.00 95% CI:0.51~1.99) was not associated with non-fatal occupational injuries.
CONCLUSIONS
The results indicated a possible association between musculoskeletal symptoms and non-fatal injuries. Hence, strengthening of laws and regulations, effective ergonomic programs and training is necessary to prevent musculoskeletal symptoms.

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Original Article

The Prevalence of Musculoskeletal Symptoms and the Ergonomic Risk Factors among Oriental Melon-growing Farmers: Kyu Jung Bae, Kyoung Sook Lee, Yong Ku Kong, Gyung Jae Oh, Soo Jin Lee; Korean Journal of Occupational and Environmental Medicine 2011;23(1):1-8. Published online March 31, 2011; DOI: https://doi.org/10.35371/kjoem.2011.23.1.1

Abstract PDF

OBJECTIVES
The purpose of this study was to investigate the prevalence of musculoskeletal symptoms in oriental melon-growing farmers and to evaluate the ergonomic risk factors of melon cultivation.
METHODS
The study included 217 subjects growing oriental melons mainly in 3 villages. Subjects were interviewed by means of a structured questionnaire. Instruments used the general features and symptom table of NIOSH to evaluate tasks using ergonomic tools (REBA, OWAS).
RESULTS
A total of 202 final respondents answered. The prevalence of musculoskeletal symptoms based on the NIOSH standard criteria was 162 (75.2%). The prevalence per body part for lower back, knee and shoulder were 102 (50.5%), 86 (42.6%) and 71 (35.1%), respectively. The prevalence of pain complaints of the musculoskeletal symptom was 91 (45.0%). The prevalence of complaints per body part of lower back, knee and shoulder were 54 (26.7%), 41 (20.3%) and 37 (18.3%), respectively. Logistic regression analysis showed men were at higher risk compared to women (OR=2.409, 95% CI=1.071~5.389), and ore than 30 years of work having a higher risk compared to less than 30 years of work (OR=2.445, 95% CI=1.150~5.197). High risk tasks were moving around boxes and nursery plants for planting, transplanting nursery plants, and picking melons.
CONCLUSIONS
Musculoskeletal symptoms were very highly prevalent in oriental melon-growing farmers, showing up in 75.2% of cases. They were exposed to ergonomic high risk factors such as squatting. These risk factors must be improved in some way.

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