Work-related asthma is the most common occupational lung disease encountered in clinical practice. In adult asthmatics, work-relatedness can account for 15%–33% of cases, but delays in diagnosis remain common and lead to worse outcomes. Accurate diagnosis of asthma is the first step to managing occupational asthma, which can be sensitizer-induced or irritant-induced asthma. While latency has traditionally been recognized as a hallmark of sensitizer-induced asthma and rapid-onset a defining feature of irritant-induced asthma (as in Reactive Airway Dysfunction Syndrome), there is epidemiological evidence for irritant-induced asthma with latency from chronic moderate exposure. Diagnostic testing while the patient is still in the workplace significantly improves sensitivity. While specific inhalational challenges remain the gold-standard for the diagnosis of occupational asthma, they are not available outside of specialized centers. Commonly available tests including bronchoprovocation challenges and peak flow monitoring are important tools for practicing clinicians. Management of sensitizer-induced occupational asthma is notable for the central importance of removal from the causative agent: ideally, removal of the culprit agent; but if not feasible, this may require changes in the work process or ultimately, removal of the worker from the workplace. While workers' compensation programs may reduce income loss, these are not universal and there can be significant socio-economic impact from work-related asthma. Primary prevention remains the preferred method of reducing the burden of occupational asthma, which may include modification to work processes, better worker education and substitution of sensitizing agents from the workplace with safer compounds.
Adult ; Asthma ; Asthma, Occupational ; Case Management ; Diagnosis ; Diagnostic Tests, Routine ; Education ; Humans ; Lung Diseases ; Methods ; Primary Prevention ; Workers' Compensation

BACKGROUND: The aim of this study was to describe the types of diseases that developed in semiconductor workers who have registered with the Korea Workers' Compensation and Welfare Service (KWCWS) and to identify potential common occupational characteristics by the type of claimed disease. METHODS: A total of 55 semiconductor workers with cancer or rare diseases who claimed to the KWCWS were compared based on their work characteristics and types of claimed diseases. Leukemia, non-Hodgkin lymphoma, and aplastic anemia were grouped into lymphohematopoietic (LHP) disorder. RESULTS: Leukemia (n = 14) and breast cancer (n = 10) were the most common complaints, followed by brain cancer (n = 6), aplastic anemia (n = 6), and non-Hodgkin lymphoma (n = 4). LHP disorders (n = 24) accounted for 43%. Sixty percent (n = 33) of registered workers (n = 55) were found to have been employed before 2000. Seventy-six percent (n = 42) of registered workers and 79% (n = 19) among the registered workers with LHP (n = 24) were found to be diagnosed at a relatively young age, ≤40 years. A total of 18 workers among the registered semiconductor workers were finally determined to deserve compensation for occupational disease by either the KWCWS (n = 10) or the administrative court (n = 8). Eleven fabrication workers who were compensated responded as having handled wafers smaller than eight inches in size. Eight among the 18 workers compensated (44 %) were found to have ever worked at etching operations. CONCLUSION: The distribution of cancer and rare diseases among registered semiconductor workers was closely related to the manufacturing era before 2005, ≤8 inches of wafer size handled, exposure to clean rooms of fabrication and chip assembly operations, and etching operations.
Anemia, Aplastic ; Brain Neoplasms ; Breast Neoplasms ; Compensation and Redress ; Environment, Controlled ; Korea ; Leukemia ; Lymphoma, Non-Hodgkin ; Occupational Diseases ; Rare Diseases ; Semiconductors ; Workers' Compensation

PURPOSE: This study aimed to examine the process from occurrence of a hospital nurse's suicide to workers' compensation approval, responses of the parties involved, issues debated during approval deliberations, and significant policy changes resulting from the incident.METHODS: We conducted in-depth interviews with involved parties and collected various documents, including newspaper articles, forum proceedings, and the agency report on determination of workers' compensation. Content analysis was performed on the collected data.RESULTS: A Joint Task Force continuously reported its progress and findings through mass media such as newspaper, radio, and TV. These activities exerted pressure on a government agency to conduct an occupational disease review and significantly impacted the workers' compensation approval. The agency recognized associations between the hospital's inadequate nurse training and the suicide but did not confirm the excessive overtime and workplace harassment experienced by the nurse as causes of the suicide. This case's media coverage and impact resulted in a law prohibiting workplace harassment and a hospital system dedicating at least one nurse to training activities.CONCLUSION: This incident had a significant social impact as the first case of workers' compensation approval for a hospital nurse's suicide. However, the case produced no structural changes in nurses' working conditions such as heavy workloads.
Advisory Committees ; Government Agencies ; Joints ; Jurisprudence ; Mass Media ; Occupational Diseases ; Occupational Health ; Social Change ; Suicide ; Teaching ; Workers' Compensation

The “fourth industrial revolution” (FIR) is an age of advanced technology based on information and communication. FIR has a more powerful impact on the economy than in the past. However, the prospects for the labor environment are uncertain. The purpose of this study is to anticipate and prepare for occupational health and safety (OHS) issues.In FIR, nonstandard employment will be common. As a result, it is difficult to receive OHS services and compensation. Excessive trust in new technologies can lead to large-scale or new forms of accidents. Global business networks will cause destruction of workers' biorhythms, some cancers, overwork, and task complexity. The social disconnection because of an independent work will be a risk for worker's mental health. The union bonds will weaken, and it will be difficult to apply standardized OHS regulations to multinational enterprises.To cope with the new OHS issues, we need to establish new concepts of "decent work” and standardize regulations, which apply to enterprises in each country, develop public health as an OHS service, monitor emerging OHS events and networks among independent workers, and nurture experts who are responsible for new OHS issues.
Commerce ; Compensation and Redress ; Employment ; Mental Health ; Occupational Health ; Periodicity ; Public Health ; Social Control, Formal ; Workers' Compensation

BACKGROUND: Many studies have tried to develop predictors for return-to-work (RTW). However, since complex factors have been demonstrated to predict RTW, it is difficult to use them practically. This study investigated whether factors used in previous studies could predict whether an individual had returned to his/her original work by four years after termination of the worker's recovery period. METHODS: An initial logistic regression analysis of 1,567 participants of the fourth Panel Study of Worker's Compensation Insurance yielded odds ratios. The participants were divided into two subsets, a training dataset and a test dataset. Using the training dataset, logistic regression, decision tree, random forest, and support vector machine models were established, and important variables of each model were identified. The predictive abilities of the different models were compared. RESULTS: The analysis showed that only earned income and company-related factors significantly affected return-to-original-work (RTOW). The random forest model showed the best accuracy among the tested machine learning models; however, the difference was not prominent. CONCLUSION: It is possible to predict a worker's probability of RTOW using machine learning techniques with moderate accuracy.
Accidents, Occupational* ; Dataset ; Decision Trees ; Forests ; Insurance ; Logistic Models ; Machine Learning* ; Odds Ratio ; Return to Work ; Support Vector Machine ; Workers' Compensation

BACKGROUND: To identify work sectors with high risk for work-related musculoskeletal disorders (MSDs) in Korean men and women. METHODS: We analyzed nationwide data to identify ergonomic risk factors in Korean employees. In particular, we analyzed data on exposure to five ergonomic risk factors (painful/tiring postures, lifting/moving heavy materials, standing/walking, repetitive hand/arm movements, and hand/arm vibration) according to employment sector, sex, and age, using the 2014 Fourth Korean Working Conditions Survey. We also used workers' compensation data on work-related MSDs in 2010, which is available by sex. RESULTS: The different work sectors had different gender distributions. “Manufacturing” (27.7%) and “construction” (11.3%) were dominated by males, whereas “human health and social work activities” (12.4%), “hotel and restaurants” (11.7%), and “education” (10.4%) were dominated by females. However, “wholesale and retail trade” and “public administration and defense” employed large numbers of males and females. Furthermore, the work sectors with a greater proportion of work-related MSDs and with multiple ergonomic risk factors were different for men and women. For men, “construction” and “manufacturing” had the highest risk for work-related MSDs; for women, “hotel and restaurants” had the highest risk for work-related MSDs. CONCLUSION: Ergonomic interventions for workers should consider gender and should focus on work sectors with high risk for MSDs, with multiple ergonomic risk factors, and with the largest number of workers.
Employment ; Female ; Humans ; Male ; Posture ; Risk Factors ; Social Work ; Workers' Compensation

OBJECTIVE: We studied recent changes and improvement in compensation for occupational accidents, including the occupational diseases of workers who apply for industrial accident compensation insurance. METHODS: We reviewed the Industrial Accident Compensation Insurance policy, the regulations and case reports of the Korea Worker's Compensation & Welfare Service, research reports, and press articles to confirm the approval process for, recognition criteria of, and recent trends in occupational diseases. RESULTS: The Industrial Accident Compensation Insurance Act applies to workplaces with one or more regular employees. The approval process for occupational diseases is complicated and requires much time and effort. The Korea Workers' Compensation & Welfare Service needs to conduct an investigation of occupational diseases on its own or, if that would be impossible, it should request an epidemiological investigation or consult with an external professional institution. The Committee on Occupational Disease Judgment requires experts from various fields to participate in order to have consistent and objective reviews. Legal adjustments for commuting disasters have been made since 2018. CONCLUSION: The application of the Industrial Accident Compensation Insurance Act should be expanded to protect more workers. We should improve the recognition process of occupational diseases so that it is done simply and quickly, and we should maintain the expertise and objectivity of the Committee on Occupational Disease Judgment.
Accidents, Occupational* ; Compensation and Redress* ; Disasters ; Insurance* ; Judgment ; Korea ; Occupational Diseases* ; Research Report ; Social Control, Formal ; Transportation ; Workers' Compensation

Ataxia-telangiectasia (AT; OMIM 208900) is a rare autosomal recessive inherited progressive neurodegenerative disorder, with onset in early childhood. AT is caused by homozygous or compound heterozygous mutations in ATM (OMIM 607585) on chromosome 11q22. The average prevalence of the disease is estimated at 1 of 100,000 children worldwide. The prevalence of AT in the Republic of Korea is suggested to be extremely low, with only a few cases genetically confirmed thus far. Herein, we report a 5-year-old Korean boy with clinical features such as progressive gait and truncal ataxia, both ankle spasticity, dysarthria, and mild intellectual disability. The patient was identified as a compound heterozygote with two novel genetic variants: a paternally derived c.5288_5289insGA p.(Tyr1763*) nonsense variant and a maternally derived c.8363A>C p.(His2788Pro) missense variant, as revealed by next-generation sequencing and confirmed by Sanger sequencing. Based on claims data from the Health Insurance Review and Assessment Service Republic of Korea, we calculated the prevalence of AT in the Republic of Korea to be about 0.9 per million individuals, which is similar to the worldwide average. Therefore, we suggest that multi-gene panel sequencing including ATM should be considered early diagnosis.
Ankle ; Ataxia ; Ataxia Telangiectasia* ; Child ; Child, Preschool ; Databases, Genetic ; Dysarthria ; Early Diagnosis ; Gait ; Heterozygote ; High-Throughput Nucleotide Sequencing ; Humans ; Insurance, Health ; Intellectual Disability ; Male ; Muscle Spasticity ; Neurodegenerative Diseases ; Prevalence* ; Republic of Korea* ; Spinocerebellar Degenerations

BACKGROUND: This study aimed to enhance understanding of the epidemiologic characteristics of asbestos-related diseases, and to provide information that could inform policy-making aimed at prevention and compensation for occupational asbestos exposure, through analyzing asbestos-related occupational disease claims to Korea Workers’ Compensation and Welfare Service from 2011 to 2015. METHODS: We analyzed 113 workers who filed medical care claims or survivor benefits for asbestos exposure and occupational-related disease from 2011 to 2015. Among these claims, we selected approved workers’ compensation claims relating to malignant mesothelioma and lung cancer, and analyzed the general characteristics, exposure characteristics, pathological characteristics, and occupation and industry distribution. RESULTS: Malignant mesothelioma and lung cancer occurred predominantly in males at 89.7 and 94%, respectively. The mean age at the time of diagnosis for malignant mesothelioma and lung cancer was 59.5 and 59.7 years, respectively, while the latency period for malignant mesothelioma and lung cancer was 34.1 and 33.1 years, respectively. The companies involving exposed workers were most commonly situated within the Busan-Ulsan-Gyeongnam region. Histology results for lung cancer indicated adenocarcinoma as the most common form, accounting for approximately one half of all claims, followed by squamous cell carcinoma, and small cell lung cancer. The most common occupation type was construction in respect of malignant mesothelioma, and shipbuilding in respect of lung cancer. CONCLUSIONS: Considering the long latency period of asbestos and that the peak period of asbestos use in Korea was throughout the mid-1990s, damage due to asbestos-related diseases is expected to show a continued long-term increase. Few studies providing an epidemiologic analysis of asbestos-related diseases are available; therefore, this study may provide baseline data to assist in predicting and preparing for future harm due to asbestos exposure. TRIAL REGISTRATION: DUIH 2018–02–004-001. Registered 28 Februrary 2018.
Adenocarcinoma ; Asbestos ; Carcinoma, Squamous Cell ; Compensation and Redress ; Diagnosis ; Humans ; Korea ; Latency Period (Psychology) ; Lung Neoplasms ; Male ; Mesothelioma ; Occupational Diseases ; Occupations ; Small Cell Lung Carcinoma ; Survivors ; Workers' Compensation

BACKGROUND: The South Korean criteria for occupational diseases were amended in July 2013. These criteria included formaldehyde as a newly defined occupational carcinogen, based on cases of “leukemia or nasopharyngeal cancer caused by formaldehyde exposure”. This inclusion was based on the Internal Agency for Research on Cancer classification, which classified formaldehyde as definite human carcinogen for nasopharyngeal cancer in 2004 and leukemia in 2012. METHODS: We reviewed reports regarding the causal relationship between occupational exposure to formaldehyde in Korea and the development of these cancers, in order to determine whether these cases were work-related. RESULTS: Previous reports regarding excess mortality from nasopharyngeal cancer caused by formaldehyde exposure seemed to be influenced by excess mortality from a single plant. The recent meta-risk for nasopharyngeal cancer was significantly increased in case-control studies, but was null for cohort studies (excluding unexplained clusters of nasopharyngeal cancers). A recent analysis of the largest industrial cohort revealed elevated risks of both leukemia and Hodgkin lymphoma at the peak formaldehyde exposure, and both cancers exhibited significant dose-response relationships. A nested case-control study of embalmers revealed that mortality from myeloid leukemia increased significantly with increasing numbers of embalms and with increasing formaldehyde exposure. The recent meta-risks for all leukemia and myeloid leukemia increased significantly. In South Korea, a few cases were considered occupational cancers as a result of mixed exposures to various chemicals (e.g., benzene), although no cases were compensated for formaldehyde exposure. The peak formaldehyde exposure levels in Korea were 2.70–14.8 ppm in a small number of specialized studies, which considered anatomy students, endoscopy employees who handled biopsy specimens, and manufacturing workers who were exposed to high temperatures. CONCLUSION: Additional evidence is needed to confirm the relationship between formaldehyde exposure and nasopharyngeal cancer. All lymphohematopoietic malignancies, including leukemia, should be considered in cases with occupational formaldehyde exposure.
Biopsy ; Case-Control Studies ; Classification ; Cohort Studies ; Endoscopy ; Formaldehyde ; Hodgkin Disease ; Humans ; Korea ; Leukemia ; Leukemia, Myeloid ; Mortality ; Nasopharyngeal Neoplasms ; Occupational Diseases ; Occupational Exposure ; Plants ; Workers' Compensation