1.Development of criteria for health examination of high-risk occupational groups and application to female fishers: Delphi study
Hye-min KIM ; Jungwon KIM ; Kunhyung KIM ; Hansoo SONG
Annals of Occupational and Environmental Medicine 2026;38(1):e2-
Background:
The objective of this study was to establish criteria for designing health examination programs and selecting appropriate examination items for high-risk occupational groups and to apply these criteria specifically to female fishers.
Methods:
The first Delphi survey comprised five domains and 15 specific criteria for identifying relevant health screening items for high-risk occupations. The second survey included open-ended questions addressing inconsistencies identified in the first survey and sought suggestions for additional items. In the third Delphi survey, specific health screening items were proposed for female fishers, and experts directly evaluated these items according to the finalized selection criteria.
Results:
Twenty-eight experts participated in this study. The first and second Delphi rounds facilitated the finalization of selection criteria for health screening items, consisting of five domains: Domain 1, Priority of target disease; Domain 2, Applicability of early detection and intervention; Domain 3, Scientific evidence of medical test method; Domain 4, Acceptability of medical test method; and Domain 5, Effectiveness of examination. Content validity ratios for these criteria ranged between 0.429 and 1.000. Based on the established criteria, experts evaluated eight proposed screening items for female fishers in the third round of the Delphi survey. Bone density, bioelectrical impedance analysis, cardiovascular disease risk factors, and fundoscopy were evaluated as appropriate; however, no agreement was reached on the early detection and intervention areas for degenerative lumbar disease, knee osteoarthritis, and upper extremity disease, as well as on the effectiveness for upper extremity disease and chronic obstructive pulmonary disease.
Conclusion
This study successfully established comprehensive criteria for selecting diseases targeted by health examinations in high-risk occupational groups. The practical application of these criteria proved effective in assessing the appropriateness of specific health screening items.
2.Relationship Between Magnetic Resonance Imaging-based Knee Cartilage Loss and Work-related Physical Workload in Farmers and Fishers
Hansoo SONG ; Yong Soo CHO ; Hye-min KIM ; Soo Hyeong PARK ; Dong Hwi KIM ; Chul Gab LEE
Safety and Health at Work 2026;17(1):47-55
Background:
This study examined the relationship between work-related physical workload and knee cartilage loss using magnetic resonance imaging (MRI) among farmers and fishers in the Republic of Korea.
Methods:
Bilateral knee MRI and questionnaire data from 545 farmers and 204 fishers aged 40—79 years were analyzed. Cartilage damage was evaluated using the MRI Osteoarthritis Knee Score (MOAKS). Mean cartilage loss scores were compared by sex, age, and body mass index (BMI). Analysis of covariance (ANCOVA) was used to assess associations of cumulative squatting work time (CSWT, hours) and cumulative lifting work time (CLWT, hours) with cartilage loss, adjusting for age and BMI, and stratified by sex.
Results:
Age was the most significant factor associated with cartilage loss, whereas BMI was not. In women, CSWT was significantly associated with medial cartilage loss in the tibiofemoral (TF) joint after adjusting for age and BMI (right: p = 0.036; left: p = 0.021). The CLWT was significantly associated with cartilage loss in the right patellofemoral joint (right: p = 0.005; left: p = 0.051). In men, CLWT showed a significant association only in the right medial TF joint (p = 0.046).
Conclusion
Among Korean farmers and fishers, cumulative squatting and lifting workloads were associated with knee cartilage damage in a compartment- and sex-specific manner.
3.Corrigendum: Correction of Funding in the Article “List of occupational diseases among farmers in Korea: a literature review”
Hansoo SONG ; Seok-Ju YOO ; Won-Ju PARK ; Seunghyeon CHO ; Ki Soo PARK ; Joo Hyun SUNG ; Sang Jin PARK ; Seong-yong YOON ; Kyeongsoo KIM ; Dong-phil CHOI ; Hye-min KIM ; Bounggyun JU ; Kanwoo YOUN
Annals of Occupational and Environmental Medicine 2025;37(1):e16-
4.Occupational stress (KOSS®19): scale development and validation in the Korean context
Hansoo SONG ; Hyoung Ryoul KIM ; Inah KIM ; Jin-Ha YOON ; Sang-Baek KOH ; Sung-Soo OH ; Hee-Tae KANG ; Da-Yee JEUNG ; Dae-Sung HYUN ; Chunhui SUH ; Sei-Jin CHANG
Annals of Occupational and Environmental Medicine 2025;37(1):e12-
Background:
The Korean Occupational Stress Scale (KOSS) was developed in 2004. During this time, industrial structures have evolved, and societal awareness of occupational stress has changed. This study aims to develop and validate a revised version of the Korean Occupational Stress Scale (KOSS®19), tailored for workers, reflecting these changes.
Methods:
The KOSS®19 was developed based on the 26-item KOSS–short form (SF) through a review by eight experts. A survey was conducted including 359 service industry workers, comprising the KOSS®19, Burnout, and Depression scales. The KOSS®19 subscales were restructured, and their reliability and validity were evaluated.
Results:
The KOSS®19 composed of eight subscales: hazardous physical environment (2 items), high job demand (3 items), insufficient job control (2 items), low social support (2 items), job insecurity (2 items), organizational injustice (4 items), lack of reward (2 items), and work-life imbalance (2 items). The reliability and validity of the KOSS®19 were found to be satisfactory.
Conclusions
The KOSS®19 is a suitable tool for assessing occupational stress, effectively replacing the original KOSS and KOSS-SF.
5.Emotional labor (KELS®11): scale development and validation in the Korean context
Da-Yee JEUNG ; Hyoung Ryoul KIM ; Hansoo SONG ; Inah KIM ; Jin-Ha YOON ; Sang-Baek KOH ; Sung-Soo OH ; Hee-Tae KANG ; Dae-Sung HYUN ; Chunhui SUH ; Sei Jin CHANG
Annals of Occupational and Environmental Medicine 2025;37(1):e13-
Background:
Emotional labor refers to the management of emotions and expressions to meet the emotional requirements of a job role. This study aimed to develop a revised version of the Korean Emotional Labor Scale (KELS®11), based on the first edition (KELS-24) introduced in 2014, and to provide practical applications and guidelines for its use in the Korean workplace through a validation process.
Methods:
The revised version of KELS®11 was derived from the 24-item KELS, following a review process involving eight experts. To validate the scale’s reliability and validity, a self-administered survey was conducted among 359 service industry workers using KELS®11, burnout, and depression scales. KELS®11 was reclassified, and its reliability and validity were evaluated. Receiver operating characteristic curve analysis was conducted to establish sex-specific cutoff values (normal vs. high-risk groups).
Results:
KELS®11 was designed to account for individual, organizational, and cultural contexts. It consists of four subscales and 11 items: “emotional regulation” (2 items), “emotional dissonance” (3 items), “organizational monitoring” (2 items), and “organizational protective system for emotional labor” (4 items). KELS®11 demonstrated good validity (content validity ratio: 0.84; item convergence/discriminant validity success rates: 100%; correlation with burnout: r = 0.185–0.436, p < 0.01; correlation with depression: r = 0.128–0.339, p < 0.05) and reliability (Cronbach’s alpha: 0.597–0.795). Additionally, sex-specific reference values were established to determine risk groups based on the intensity of emotional labor exposure.
Conclusions
KELS®11 is a validated and reliable measurement tool designed to assess the intensity and magnitude of emotional labor in the workplace. The revised tool reflects critical considerations in the development of emotional labor measurement scales.
6.Workplace Violence (KWVS®13): scale development and validation in the Korean context
Da-Yee JEUNG ; Hyoung Ryoul KIM ; Hansoo SONG ; Inah KIM ; Jin-Ha YOON ; Sang-Baek KOH ; Sung-Soo OH ; Hee-Tae KANG ; Dae-Sung HYUN ; Chunhui SUH ; Sei-Jin CHANG
Annals of Occupational and Environmental Medicine 2025;37(1):e14-
Background:
Workplace violence refers to any act or threat of physical violence, verbal abuse, harassment, intimidation, bullying, mobbing, or other aggressive and disruptive behaviors that occur at work. This study aims to develop and validate a revision of the Korean Workplace Violence Scale (KWVS®13), based on the first edition of the Korean Workplace Violence Scale (KWVS-24), and to provide practical applications and guidelines for the Korean workplace environment.
Methods:
The revised KWVS®13 was developed by restructuring the 24-item KWVS through a review process involving eight experts. To validate the reliability and validity of KWVS®13, a self-administered survey comprising KWVS®13, burnout, and depression scales was conducted among 359 service industry workers. KWVS®13 was reclassified, and its reliability and validity were assessed. Receiver operating characteristic curve analysis was performed to establish sex-specific cutoff values (normal vs. risk) of the scale.
Results:
KWVS®13 consists of 13 items across four subscales: “psychological and sexual violence from customers” (4 items), “psychological and sexual violence from supervisors or coworkers” (4 items), “physical assault from customers, supervisors, or coworkers” (2 items), and “organizational protective system for workplace violence” (3 items). We found that KWVS®13 shows relatively good validity (content validity ratio for content validity: 0.888; success rate of item convergent and discriminant validity: 100%, and significant correlation coefficient with burnout (r = 0.115–0.83, p < 0.05) and depression (r = 0.098–0.348, p < 0.05) with the exception of Organizational Violence Protection System for Workplace Violence) and reliability (Cronbach’s alpha: 0.827–0.860). The reference values for determining risk groups according to the intensity of exposure to workplace violence are presented separately by sex.
Conclusions
KWVS®13 is a robust and useful measurement tool to objectively and quantitatively assess the intensity and magnitude of workplace violence. It incorporates important considerations for workplace violence assessment and provides a reliable framework for evaluating workplace violence in various professional settings.
7.Sex difference in musculoskeletal disabilities among Korean fishers: a cross-sectional study
Hye-min KIM ; Soo Hyeong PARK ; Bong Gyun JOO ; Ki-Soo PARK ; Jeong Ho KIM ; Hansoo SONG
Annals of Occupational and Environmental Medicine 2025;37(1):e18-
Background:
Fishing is a physically demanding occupation with a high risk of musculoskeletal disabilities (MSDs). Although previous studies have focused on ergonomic risk factors, little attention has been paid to sex differences in the prevalence of MSDs among fishers. This study aimed to assess whether female fishers experience a higher prevalence of MSDs than male fishers and to examine whether this difference persists after adjusting for socioeconomic and occupational factors.
Methods:
We analyzed cross-sectional data from 898 Korean fishers (513 men and 385 women) who participated in the 2021–2022 Fisher Health Survey. MSDs in the upper extremities, lower back, and knees were defined as scores in the top 25% of the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Oswestry Disability Index, and Western Ontario and McMaster Universities Arthritis Index Short Form (WOMAC-SF), respectively. Modified Poisson regression was used to calculate the prevalence ratios (PRs) by sex, with stepwise adjustments for age, socioeconomic factors, and occupational factors.
Results:
Female fishers had significantly higher MSD risk than male fishers across all body regions (fully adjusted PRs: upper extremity, 1.59; lower back, 1.63; knee, 1.44). Sex disparities were most pronounced among those under 60 years of age and remained significant even in older age groups.
Conclusions
The elevated MSD risk among female fishers persisted despite adjusting for conventional risk factors, suggesting the influence of additional factors such as biological susceptibility, domestic labor, and gendered health reporting. Therefore, MSD prevention strategies should include sex-sensitive multidimensional approaches beyond ergonomic interventions.
8.List of occupational diseases among farmers in Korea: a literature review
Hansoo SONG ; Seok-Ju YOO ; Won-Ju PARK ; Seunghyeon CHO ; Ki Soo PARK ; Joo Hyun SUNG ; Sang Jin PARK ; Seong-yong YOON ; Kyeongsoo KIM ; Dong-phil CHOI ; Hye-min KIM ; Bounggyun JU ; Kanwoo YOUN
Annals of Occupational and Environmental Medicine 2025;37(1):e2-
A comprehensive list of occupational diseases among farmers is crucial for both compensation and prevention efforts. In Korea, most farmers are self-employed, and some occupational diseases are compensated through farmer safety insurance. However, it is not harmonized with industrial accident compensation insurance and does not adequately reflect the true burden of occupational diseases among farmers. To address this gap, the authors compiled a list of occupational diseases tailored to Korean farmers by reviewing the International Labor Organization’s list of occupational diseases, the Korean Industrial Accident Compensation Insurance List, the occupational disease lists of other countries, and relevant literature on farmers’ work-related diseases.
9.Impact of neck posture and insulating stick use on neck disability in Korean line workers: a cross-sectional study
Bounggyun JU ; Jaehoo LEE ; Hye-min KIM ; Chul Gab LEE ; Hansoo SONG
Annals of Occupational and Environmental Medicine 2024;36(1):e11-
Occupational neck disability is a prevalent issue, especially among line workers, who are often exposed to elevated levels of cervical ergonomic stress. The aim of this study was to investigate the impact of neck posture and insulating stick use on neck disability in a specific occupational group in Korea. This cross-sectional study was conducted among 483 line workers in Gwangju and Jeonnam, Korea. Data were collected using the Neck Disability Index, Cervical Degenerative Index, and a structured questionnaire focusing on demographic and occupational factors. Logistic regression analysis was applied to determine the adjusted odds ratio (OR) and 95% confidence interval (CI) for neck posture and factors related to neck disability. Neck disability prevalence was 17.2% among the participants. Multivariate logistic regression analysis showed that factors related to neck disability included age over 60 years (adjusted OR: 3.08; 95% CI: 1.63–5.83), depression (adjusted OR: 8.33; 95% CI: 3.85–18.00), a history of cervical trauma (adjusted OR: 2.13; 95% CI: 1.04–4.40), and radiological degenerative changes in the cervical spine (adjusted OR: 2.33; 95% CI: 1.26–4.33). In particular, the adjusted OR of neck disability among live-line workers was 2.10 (95% CI: 1.12–3.92) when compared with support workers (model 1). Other analysis models showed that use of insulating sticks for more than 10 hours per week (adjusted OR: 2.46; 95% CI: 1.32–4.61) and higher neck extension (adjusted OR: 2.98; 95% CI: 1.14–3.46) were significant work-related risk factors (model 2,3). Neck posture, age, depression, cervical trauma history, degenerative changes in the cervical spine, and use of insulating sticks are significant risk factors for neck disability among line workers in Korea. These findings highlight the need to improve the working environment and reduce the burden of cervical ergonomic stress among line workers.
10.Is Farming a Risk Occupation for Cardio-cerebrovascular Diseases? A Scoping Review on Cardio-cerebrovascular Disease Risk in Farmers
Hyeonjun KIM ; Wongeon JUNG ; Sunjin JUNG ; Seunghyeon CHO ; Inho JUNG ; Hansoo SONG ; Ki-Soo PARK ; Seong-Yong YOON ; Joo Hyun SUNG ; Seok-Ju YOO ; Won-Ju PARK
Journal of Preventive Medicine and Public Health 2024;57(6):521-529
Objectives:
In Korea, cardio-cerebrovascular disease (CCVD) is recognized as an occupational disease when sufficient evidence of a work-related burden exists. In 2021, approximately 26.8% of the payments from occupational disease insurance under the Industrial Accident Compensation Insurance Act were allocated to CCVDs. However, due to the specific nature of insurance policies for farmers, CCVD is not acknowledged as an occupational disease in their case.
Methods:
We reviewed studies on the differences in the incidence, prevalence, and mortality rates of CCVDs between farmers and the general population or other occupations and described the exposure of farmers to risk factors for CCVDs.
Results:
Several studies showed that farming is a high-risk occupation for CCVDs, with the following risk factors: long working hours, night work, lack of holidays, and strenuous physical labor; physical factors (noise, cold, heat, humidity, and vibration); exposure to hazardous gases (diesel exhaust, carbon monoxide, hydrogen sulfide, carbon disulfide, nitrogen oxides, and polycyclic aromatic hydrocarbons), pesticides, and dust (particulate matter, silica, and organic dust); exposure to a hypoxic environment; and job-related stress. Social isolation and lack of accessible medical facilities also function as additional risk factors by preventing farmers from receiving early interventions.
Conclusions
Farmers are exposed to various risk factors for CCVDs and are an occupation at risk for CCVDs. More studies are needed in the future to elucidate this relationship. This study lays the groundwork for future research to develop guidelines for approving CCVDs as occupational diseases among farmers.

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