Journal of Occupational Health
Online ISSN : 1348-9585
Print ISSN : 1341-9145
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Invited Review
  • Tores Theorell
    Type: INVITED REVIEW ARTICLE
    2019 Volume 61 Issue 1 Pages 3-9
    Published: January 20, 2019
    Released: February 13, 2019
    JOURNALS OPEN ACCESS

    This review provides perspectives on cardiovascular occupational stress research since the 1960s until now. The author argues for closer links between basic science and clinical follow-up examinations of patients. In an excellent way urinary excretion of adrenaline and noradrenaline during wake hours mirrors day to day or week to week variations in sympathomedullary activity which could be related to variations in the patient's and cardiovascular and psychosocial situation. Modern methods for following variations over time in heart contractility should also be related to the patients' psychosocial situation. In addition the author argues for more extensive use of the increasing knowledge regarding regeneration and vagal activity in relation to variations in job conditions and development or prevention of cardiovascular disease.

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Reviews
  • Narufumi Suganuma, Yuji Natori, Hajime Kurosawa, Makiko Nakano, Takahi ...
    Type: REVIEW ARTICLE
    2019 Volume 61 Issue 1 Pages 10-18
    Published: January 20, 2019
    Released: February 13, 2019
    JOURNALS OPEN ACCESS

    Objective: Occupational Lung Disease is an oldest but still a biggest problem in occupational health.

    Methods: Steering Committee members of the Japan Society for Occupational Health (JSOH) Occupational Lung Disease Study Group selected and summarized current topics on occupational lung diseases based on expert opinion, as informed by governmental regulation, public health concerns, and frequently discussed in related academic conferences.

    Results: The topics included in this review are professional education in medical screening skills, 2014 update of Helsinki Criteria, respiratory diseases found in the earthquake and tsunami affected regions, newly recognized occupational lung diseases, and potential respiratory health hazards.

    Discussions: Although occupational lung diseases seem to stay as one of the major concerns in occupational health, screening tools and control measures are standardized for the better prevention of the diseases. As this health problem usually occurs in where the most actively economically developing area is, the patients tend to increase in emerging economic powers with huge population.

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  • Takanari Wakayama, Yuki Ito, Kiyoshi Sakai, Mio Miyake, Eiji Shibata, ...
    Type: REVIEW ARTICLE
    2019 Volume 61 Issue 1 Pages 19-35
    Published: January 20, 2019
    Released: February 13, 2019
    JOURNALS OPEN ACCESS

    Objectives: 2-Ethyl-1-hexanol (2EH), a fragrance ingredient and a raw material for the production of plasticizer di(2-ethylhexyl) phthalate, is responsible for sick building syndrome (SBS). This review aims to clarify the 2EH characteristics as an indoor air pollutant such as indoor air concentration, emission mechanism, toxicity, and clinical effects.

    Methods: Scientific publications in English that has been made available on PubMed as of June 2018 and ad hoc publications in regional languages were reviewed.

    Results: Inhalation exposure to 2EH caused mucous membrane irritation in the eyes, nose, and throat in experimental animals. Studies in human volunteers revealed an increase in olfactory irritation and eye discomfort. There has been increasing evidence of 2EH being present in indoor air in buildings. The primary sources of 2EH emissions are not building materials themselves, but instead the hydrolysis of plasticizers and flooring adhesives. In particular, compounds like di(2-ethylhexyl) phthalate present in polyvinyl chloride flooring materials are hydrolyzed upon contact with alkaline moisture-containing concrete floors. That being said, it may be observed that indoor concentrations of 2EH increased every year during summer.

    Conclusions: Unlike other volatile organic compounds that cause SBS, 2EH can be retained in indoor air for long durations, increasing the likelihood of causing undesirable health effects in building occupants exposed to it. As a precautionary measure, it is important to use flooring materials that do not emit 2EH by hydrolysis, or to dry concrete before covering with flooring materials.

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  • Koji Mori, Takahiro Mori, Tomohisa Nagata, Masako Nagata, Mahoko Iwasa ...
    Type: REVIEW ARTICLE
    2019 Volume 61 Issue 1 Pages 36-53
    Published: January 20, 2019
    Released: February 13, 2019
    JOURNALS OPEN ACCESS

    Objective: A systematic review was performed to study factors of occurrence and improvement methods of presenteeism attributed to diabetes.

    Methods: We set 2 clinical questions; (a) how comorbidities and complications of diabetes induce presenteeism and (b) what interventions or conditions effectively improve presenteeism. Then, we conducted a comprehensive search with MEDLINE/PubMed and Scopus databases and extracted those that met the clinical questions.

    Results: Eighteen papers studied occurrence of presenteeism by comorbidities and complications of diabetes. Most studies were cross-sectional and had a low quality of evidence. However, the associations of hypoglycemia, diabetic neuropathy, and mood disorders with presenteeism were relatively well studied. The papers that discussed effective interventions or conditions for improving presenteeism were very limited.

    Conclusions: Our review suggests that presenteeism attributed to diabetes is mainly caused by hypoglycemia, diabetic neuropathy, and mood disorders. There are very limited evidences, but available information suggests that improving glycemic control, adjusting treatment regimen by evaluating the impact on work, providing psychological support, and developing suitable work accommodations may effectively reduce presenteeism.

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Originals
  • Sara Kwon, Won Kim, Seoyon Yang, Kyoung Hyo Choi
    Type: ORIGINAL ARTICLE
    2019 Volume 61 Issue 1 Pages 54-62
    Published: January 20, 2019
    Released: February 13, 2019
    JOURNALS OPEN ACCESS

    Objectives: We investigated the influence of different types of lifetime occupation on knee osteoarthritis (OA) and pain based on a nationwide survey in Korea.

    Methods: We conducted a cross-sectional study using Korea National Health and Nutrition Examination Survey (KNHANES) from 2010 to 2012. Men ≥50 years old were divided into four occupational groups: white-collar (WC) workers, pink-collar (PC) workers, blue-collar (BC) workers, and agribusiness and low-level (AL) workers. The risks for knee OA and pain development according to occupation were compared to the risks in WC workers, using multiple logistic regression analyses.

    Results: Different occupations were associated with different levels of risk for knee OA and knee pain. The risk for knee OA was higher in BC workers and in AL workers than in WC workers, in order of higher risk. The risk for severe knee OA was likewise higher in AL workers and in BC workers, in order of higher risk. The risk for chronic knee pain was higher in AL workers, BC workers, and PC workers, in order of higher risk. The risk for moderate to severe chronic knee pain was higher in AL workers and BC workers, in order of higher risk.

    Conclusions: The results suggest that occupation might affect the development of knee OA and presence of chronic knee pain in men ≥50 years old. WC workers are least affected by knee OA and chronic knee pain, and AL and BC workers are at clearly higher risk for knee OA and chronic knee pain.

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  • Mo-Yeol Kang, Jun-Pyo Myong, Hyoung-Ryoul Kim
    Type: ORIGINAL ARTICLE
    2019 Volume 61 Issue 1 Pages 63-72
    Published: January 20, 2019
    Released: February 13, 2019
    JOURNALS OPEN ACCESS

    Objectives: To investigate work-related factors that contribute to early retirement due to ill health (ERIH) in middle-aged and elderly people in Korea.

    Methods: Data were collected from a sample from the first through the fifth phases of the Korean Longitudinal Study of Aging which was conducted biennially from 2006 to 2014. ERIH was defined as the retirement of workers due to health problems before their scheduled or regular retirement age as reported in one of the follow-up surveys. Three broad subdomains of working conditions were examined: work arrangements, physical working conditions, and job satisfactions. Hazard ratios of ERIH were estimated by Cox regression.

    Results: Females, older people, unskilled manual workers, and day laborers were more likely to experience ERIH. In adjusted Cox proportional hazard models, the risk for ERIH in male workers was significantly higher among those with the following conditions: high physical demands, awkward posture, dissatisfaction with the working environment, and no industrial compensation insurance or retirement benefits. However, no significant association was found among female participants.

    Conclusions: Occupational class, physical working conditions, job satisfaction, and work arrangement were the potential risk factors for ERIH among male workers in Korea. Moreover, our results revealed gender differences in the risk for ERIH.

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  • Jun-Qin Zhao, Jian-Guo Li, Chun-Xiang Zhao
    Type: ORIGINAL ARTICLE
    2019 Volume 61 Issue 1 Pages 73-81
    Published: January 20, 2019
    Released: February 13, 2019
    JOURNALS OPEN ACCESS

    Objectives: The purposes of this study were to clarify (i) the prevalence of pneumoconiosis among young adults and (ii) the factors associated with pneumoconiosis among young adults to explore targeted solution for control of pneumoconiosis among young adults (aged 24-44 years).

    Methods: The new cases diagnosed from 2001 to 2015 (extracted from the National Occupational Disease and Occupational Health Information Monitoring System) were involved in this research, including information of employer, patient's name, date of birth, gender, date of diagnosis, first year of dust exposure, duration of exposure, aggregation etc

    Results: A total of 1519 pneumoconiosis cases were diagnosed among young adults (21.6% of overall cases). Silicosis was the most common type with acute process of disease. Compared with overall cases, the young patients had shorter duration of exposure, more stage II/III cases and higher aggravation rate; and were even more concentrated in small and medium enterprises where more migrant workers were employed and insufficient protective measures were used. Without further regulation, the prevalence of pneumoconiosis among young adults would bring not only disease suffering for 3000 individuals and their families, but also an annual economic loss up to 180 million yuan for Hebei province till 2025.

    Conclusions: As a typical heavily industrialized province of China, Hebei has severe situation on pneumoconiosis among young adults. Special attention and effort on silica-contacting industries, small and medium enterprises, and migrant workers should be focused in future occupational supervision and regulation among young adults.

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  • Akito Takeuchi, Akira Namera, Norihiro Sakui, Shinobu Yamamoto, Kenji ...
    Type: ORIGINAL ARTICLE
    2019 Volume 61 Issue 1 Pages 82-90
    Published: January 20, 2019
    Released: February 13, 2019
    JOURNALS OPEN ACCESS

    Objectives: The purpose of this study was to develop a simple and accurate gas chromatography-mass spectrometry (GC-MS) method for simultaneous determination of four urinary metabolites from four organic solvents, that is, hippuric acid (HA) from toluene, methylhippuric acid (MHA) from xylene, and mandelic acid (MA) and phenylglyoxylic acid (PGA) from styrene or ethylbenzene for biological monitoring.

    Methods: The four metabolites were directly methyl-esterified with 2,2-dimethoxypropane and analyzed using GC-MS. The proposed method was validated according to the US Food and Drug Administration guidance. The accuracy of the proposed method was confirmed by analyzing a ClinChek®-Control for occupational medicine (RECIPE Chemicals +Instruments GmbH).

    Results: Calibration curves showed linearity in the concentration range of 10-1000 mg/L for each metabolite, with correlation coefficients >0.999. For each metabolite, the limits of detection and quantification were 3 mg/L and 10 mg/L, respectively. The recovery was 93%-117%, intraday accuracy, expressed as the deviation from the nominal value, was 92.7%-103.0%, and intraday precision, expressed as the relative standard deviation (RSD), was 1.3%-4.7%. Interday accuracy and precision were 93.4%-104.0% and 1.2%-9.5%, respectively. The analytical values of ClinChek obtained using the proposed method were sufficiently accurate.

    Conclusions: The proposed method is a simple and accurate which is suitable for routine analyses that could be used for biological monitoring of occupational exposure to four organic solvents.

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  • Carolina Sconfienza, Petra Lindfors, Annika Lantz Friedrich, Magnus Sv ...
    Type: ORIGINAL ARTICLE
    2019 Volume 61 Issue 1 Pages 91-100
    Published: January 20, 2019
    Released: February 13, 2019
    JOURNALS OPEN ACCESS

    Objectives: This longitudinal study aimed to investigate the causal relationships between social support at work and mental health in terms of mental distress. Despite assuming social support at work to be associated with less mental distress, reversed and reciprocal relationships were investigated as well.

    Methods: Self-reports in questionnaires of social support and mental distress were collected longitudinally, with annual measurements over three consecutive years, among 301 office workers (57% women) in Sweden. Cross-lagged structural equation modeling was used to test the hypotheses.

    Results: The reciprocal causation model was considered the best-fitting model. The results suggest that social support and mental distress influenced each other negatively, but with a delayed effect. Specifically, this involves Time 1 levels of social support being negatively associated with Time 2 levels of mental distress, while Time 2 levels of mental distress were negatively associated with Time 3 levels of support.

    Conclusions: The findings partly align with the hypothesis that social support is related to lower levels of mental distress but also suggest that mental distress can reduce levels of social support. While the findings also suggest a mutual interrelation between social support and mental distress, this is not a consistent reciprocal causation. Rather, and due to the variation in reciprocity between time points, it appears to be a cyclical process, which needs further investigation.

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  • Ji-Hwan Kim, Nagyeong Lee, Ja Young Kim, Soo Jin Kim, Cassandra Okechu ...
    Type: ORIGINAL ARTICLE
    2019 Volume 61 Issue 1 Pages 101-109
    Published: January 20, 2019
    Released: February 13, 2019
    JOURNALS OPEN ACCESS

    Objectives: This study investigated whether organizational responses modified the associations between experiencing violence and depressive symptoms among emergency workers.

    Methods: A nationwide survey of 1966 Korean emergency medical service (EMS) providers was analyzed. Experience of workplace violence (ie, physical violence, verbal abuse) was classified into four groups based on the victims’ reporting and organizational responses: (i) “Not experienced,” (ii) “Experienced, not reported,” (iii) “Experienced, reported, responded by organization,”and (iv) “Experienced, reported, not responded by organization.” Depressive symptoms were assessed by 11-item version of the Centers for Epidemiologic Studies Depression Scale.

    Results: Compared to “Not experienced” group, physical violence was significantly associated with depressive symptoms among EMS providers responding “Experienced, not reported” (PR: 1.67, 95% CI: 1.37, 2.03) and “Experienced, reported, not responded by organization” (PR: 2.58, 95% CI: 1.75, 3.82), after adjusting for confounders. No significant difference was detected for workers responding “Experienced, reported, responded by organization” group (PR: 1.45, 95% CI: 0.87, 2.41). Similar trends were observed in the analysis with verbal abuse.

    Conclusions: Our findings suggest that organizational responses could play a critical role in mitigating depressive symptoms among EMS providers who experience violence at work.

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  • Itsuko Ozaki, Izumi Watai, Mariko Nishijima, Nozomu Saito
    Type: ORIGINAL ARTICLE
    2019 Volume 61 Issue 1 Pages 110-120
    Published: January 20, 2019
    Released: February 13, 2019
    JOURNALS OPEN ACCESS

    Objectives: Human support can boost weight reduction in Internet-based weight-loss intervention. However, the most effective way to combine human support and the Internet for weight loss is unclear. This study aimed to examine the effects of two weight-loss programs for male workers aged 18-39 that combined different intensities of human support with website support compared to a delayed-intervention group (control group; CG), in a randomized controlled trial.

    Methods: Seventy-one participants with overweight or obesity were allocated to one of three 12-week treatment programs. The Standard Support Group (SSG) was provided support via website and two face-to-face group guidance sessions, at the beginning and at the end of the program along with monthly general emails throughout the program. The Enhanced Support Group (ESG) received four remote support sessions based on Supportive Accountability (SA) in addition to the SSG. The CG was provided the same program as SSG after the other two groups had completed the program. The primary outcome was body weight reduction.

    Results: ESG participants reduced their weight significantly more than SSG and CG participants (P = 0.038, < 0.001, respectively), and SSG participants reduced their weight significantly more than CG participants (= 0.033).

    Conclusions: The additional remote human support provided to the participants in the ESG was beneficial for weight loss in male workers. The low-intensity program provided to the SSG was also effective. Further studies with more participants in diverse settings and with participants who are less interested in their health and weight management are needed.

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Brief Report
  • Anass Arrogi, Filip Boen, Jan Seghers
    Type: BRIEF REPORT
    2019 Volume 61 Issue 1 Pages 121-127
    Published: January 20, 2019
    Released: February 13, 2019
    JOURNALS OPEN ACCESS

    Objectives: This study evaluated the validity of a smart chair and corresponding smartphone app (chair&app) to measure sitting time and sitting interruptions against camera-derived observation and activPAL.

    Methods: Belgian deskbound university employees (n = 28, 17 women, mean age 30 ± 7.5 years, mean BMI 22.1 ± 2.0 kg/m2) were provided with the chair&app in three conditions: a controlled condition (following a prescribed protocol), a free-living condition (conducting usual office work for 2 hours), and an extended free-living condition (conducting usual office work for three consecutive days). Total sitting time and the number of sitting interruptions were compared between the chair&app and criterion measures (camera observation and activPAL). Criterion validity was assessed using mean differences (95% CI) and intra-class correlation coefficients (ICC; 95% CI).

    Results: In the controlled condition, mean sitting time and number of sitting interruptions differed between chair&app and camera observation by 2.7 (−2.4, 7.9) minutes and −8.0 (−10.4, −5.6) interruptions, respectively. For the free-living condition, there was good agreement between chair&app and camera observation for both sitting time (ICC: 0.74; 0.28, 0.93) and sitting interruptions (ICC: 0.68; 0.10, 0.91). For the extended free-living condition, there was excellent agreement between chair&app and activPAL for sitting time (ICC: 0.89; 0.49, 0.97). Meanwhile, there was poor agreement between chair&app and activPAL for sitting interruptions (ICC: 0.38; −0.04, 0.70).

    Conclusions: Chair&app generally provided reliable measures of desk-based sitting. Consequently, chair&app might be useful as a self-monitoring tool in the workplace context. Further research is needed to explore its usefulness in reducing adults’ desk-based sitting.

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Case Study
  • Jihye Lee, Young Joong Kang
    Type: CASE STUDY
    2019 Volume 61 Issue 1 Pages 128-134
    Published: January 20, 2019
    Released: February 13, 2019
    JOURNALS OPEN ACCESS

    Background: Anaphylaxis is a severe and potentially fatal type of allergic reaction and is characterized by the rapid development of symptoms in the respiratory and circulatory systems, possibly leading to death if not treated properly. Occupational anaphylaxis, which does not exhibit significant differences in pathogenesis from the nonoccupational form, develops in response to work-related triggers. However, the onset of occupational anaphylaxis can also be triggered by other factors. Therefore, an unexpected episode may occur due to exposure to a previously sensitized antigen or cross-reaction in the occupational environment, even if the direct trigger has been removed. Accordingly, it is difficult to diagnosis and treat such cases and ensure avoidance of potential triggers.

    Case presentation: An adult male patient developed anaphylaxis following exposure to grass antigens while replacing and burying sewer pipes at a theme park. He later developed cross-reactivity to other grains. Despite symptomatic treatment, his total serum level of allergen-specific immunoglobulin E (Ig E) antibodies continuously increased, and thus, he was admitted with severe hypersensitivity, at which time his serum levels of Ig E antibodies specific for Bermuda grass, wheat, and rice had also increased.

    Conclusion: In Korea, Bermuda grass is rarely seen and is generally found in athletic fields or theme parks. Following exposure to this relatively rare grass, our patient exhibited new anaphylactic responses to various external antigens. Therefore, we attribute his severe anaphylaxis to sensitization caused by Bermuda grass exposure and cross-reactive hypersensitivity to other grains.

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Field Study
  • Masanori Ogawa, Isamu Kabe, Yasuhiro Terauchi, Shigeru Tanaka
    Type: FIELD STUDY
    2019 Volume 61 Issue 1 Pages 135-142
    Published: January 20, 2019
    Released: February 13, 2019
    JOURNALS OPEN ACCESS

    Objectives: Formaldehyde is routinely used in pathology laboratories. The threshold limit value of formaldehyde determined by American and Japanese organizations is 0.1 ppm, which is similar to the indoor air quality guideline value (0.08 ppm). Therefore, maintaining low formaldehyde concentrations in the workplace is imperative. The purpose of this study was to reduce the concentration of formaldehyde in a hospital pathology laboratory, in which approximately 15 000 pathological diagnoses are conducted yearly, using hardware and software interventions.

    Methods: Although this laboratory had various ventilation systems, the formaldehyde concentration was high. Based on the Japanese work environment measurement system, the workplace was categorized as control class III, suggesting that improvements to workplace conditions were required. First, engineering controls were implemented and workers were asked not to block the ventilation system and not to keep waste fluid tanks open. However, the workplace required further improvement. Next, using a video camera and a formaldehyde detector, we attempted to visually educate workers about how much formaldehyde is emitted from the sample container based on the type of action undertaken.

    Results: After the first intervention, the workplace improved to control class II. Control class II indicates that the workplace condition is between classes I and III; a good workplace condition is classified as class I. Although the work environment was still categorized as control class II after the second intervention, this intervention led to the further improvements.

    Conclusions: The hardware and software interventions and safe working habits were effective in improving the work environment.

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  • Su Gang Cha, Young Seok Byun, Man Joong Jeon, Joon Sakong
    Type: FIELD STUDY
    2019 Volume 61 Issue 1 Pages 143-153
    Published: January 20, 2019
    Released: February 13, 2019
    JOURNALS OPEN ACCESS

    Objectives: We aimed to report the characteristics of diving practice and the incidence of decompression sickness (DCS) among South Korean fishery divers.

    Methods: We sent out questionnaires to 215 registered boat owners, and 196 of the fishery divers responded. The questionnaire was comprised of demographical characteristics, diving-related characteristics, and experiences with DCS. DCS was classified into types I and II based on the symptoms.

    Results: Their average length of career in fishery diving was 18.1 ± 8.5 years. They were working for 10.8 ± 1.9 months per year. The average bottom time was 74.7 ± 23.3 minutes, the average depth was 23.6 ± 6.8 m, and the average surface interval time was 20.7 ± 12.5 minutes. The incidence of DCS symptoms among the total participants was 84.7%. The incidence increased as working days per month and dives per day increased (P < 0.05). An increased average working depth and a short surface interval time tended to reflect an elevated incidence in the DCS symptoms (P < 0.01). Logistic regression analysis revealed working days per month, dives per day, average bottom time, and rapid ascent as risk factors (P < 0.05).

    Conclusions: South Korean fishery divers were shown to be susceptible to DCS because of their repetitive dives for financial reasons. However, they are often beyond the scope of the law. The results of this study suggested that it is necessary to establish the registries of fishery divers.

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