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OBJECTIVES: The association between occupational psychosocial factors and mental health has been studied in several systematic reviews. However, few systematic reviews exist that specifically address suicidal ideation. Therefore, this systematic review and meta-analysis aimed to examine the associations between long working hours, shift work, and suicidal ideation. METHODS: We systematically screened and collected studies published between January 1970 and September 2022 from three electronic databases and Google Scholar. We conducted a meta-analysis using a random-effects model and assessed the risk of bias using a navigation guide. Additionally, the grading of recommendations assessment, development and evaluation (GRADE) approach was used to consider five items, including the risk of bias and publication bias. RESULTS: Twenty-eight articles were included in this meta-analysis. After adjusting for covariates, the overall odds ratio (OR) for long working hours and shift work were 1.44 [95% confidence interval (CI) 1.26–1.63] and 1.34 (95% CI 1.22–1.47), respectively. Compared with those who worked 55 hours per week had a 1.65 (95% CI 1.37–1.98) higher risk of suicidal ideation, and fixed night shift workers had 1.37 (95% CI 1.03–1.83) higher risk than non-shift workers. CONCLUSIONS: Evidence has shown associations between long working hours, shift work, and suicidal ideation. Implementing evidence-based interventions to address these risk factors may help prevent the progression of suicidal ideation. However, further studies are critically needed, especially those using standardized exposure definitions and longitudinal data.

Abstract This study aimed to identify changes in the architecture and performance of the peri‐ankle muscles in patients with chronic ankle instability (CAI) and investigate the relationship between them. In total, 17 subjects were evaluated retrospectively. Each subject underwent anthropometric and isokinetic test, and peroneus longus (PL) and brevis (PB), medial gastrocnemius (MGCM), and tibialis anterior (TA) ultrasound imaging were performed at rest and maximum voluntary contraction (MVC) conditions. Regarding muscle architectural variables, the pennation angle (PA) of the MGCM at rest and the PA of the TA, MGCM, and PL in MVC were significantly reduced on the injured side compared to the intact side. There were no significant differences in muscle thickness of PL, PB, MGCM, and TA observed between intact and injured side during both rest and MVC. Regarding muscle performance parameters, significant decreased were observed in the muscle strength for both limbs in all four directions under the two different conditions. A secondary finding was that the relative PA ratio of the TA showed moderate correlation with the relative dorsiflexion ratio at 30°/s. These findings can provide opportunities to better understand how injuries in patients with CAI may be related to changes in ankle and foot function.

Introduction Delirium in neonates and infants is difficult to screen or assess because of their different developmental features and distinct delirium characteristics compared with those of older children. Some delirium management strategies, including assessment, pharmacological and non-pharmacological interventions, and prevention strategies, have been previously suggested for paediatric delirium. However, whether these strategies are effective for delirium in neonates and infants is unclear. This scoping review aims to explore comprehensive information on delirium in neonates and infants, such as the features of delirium, factors related to delirium, and current assessments and interventions in neonates and infants.Methods and analysis This study will be based on the Joanna Briggs Institute guidelines for scoping review protocol development and follow each stage of the framework proposed by Arksey and O’Malley. Research questions regarding delirium management in neonates and infants will be specified. A wide range of databases, including MEDLINE, EBSCO, Embase and the Cochrane Library, using optimised terms will be searched from 2004 to 2024. The summarised results will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension of the Scoping Reviews checklist.Ethics and dissemination Since this study will review and summarise published scientific literature, ethical approval is not required. The results of this scoping review will be disseminated through conference presentations and peer-reviewed publications. The study findings will be disseminated through seminars for experts so that they can be reflected in practice.

ObjectivesThis study aimed to determine the risk of ischemic heart disease (IHD) and stroke among male couriers in Korea by linking the data from the National Health Insurance (NHI) and National Employee Insurance (NEI) databases.MethodsAs of 2015, the NHI and NEI databases were linked using individual IDs. A cohort of male couriers, aged between 20 and 64 years, (N = 5,012) was constructed using the Korean Employment Insurance Occupational Classification (KECO-2007). For comparison, a cohort of male total wage workers (N = 5,429,176) and a cohort of office workers (N = 632,848) within the same age group were also constructed. The follow-up was conducted until 31 December 2020 to confirm the occurrence of IHD and stroke. The diagnoses were defined using the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes. The criteria included medical services for more than 1 day of hospitalization or more than 2 outpatient visits. The age-standardized incidence ratio (SIR) was calculated to evaluate the risk of occurrence. The hazard ratio (HR) was calculated using the Cox model after adjusting for age, alcohol consumption, smoking, obesity, income level, and employment duration as confounding variables.ResultsThe SIR of IHD for couriers was 1.54 (95% CI 1.31–1.78), while for office workers, it was 1.08 (95% CI 1.06–1.10), compared to male total wage workers. The SIR for stroke was higher for couriers at 1.84 (95% CI 1.40–2.28) and lower for office workers at 0.86, compared to male total wage workers. Couriers had a higher SIR for stroke at 1.84 (95% CI 1.40–2.28) and lower for office workers at 0.86 (0.83–0.89). Compared to total wage workers, couriers had a significantly higher adjusted HR for IHD at 1.60 (95% CI 1.37–1.87) and a higher HR for stroke at 1.39 (95% CI 1.07–1.79). Compared to office workers, couriers had a significantly higher HR for IHD at 1.34 (95% CI 1.13–1.59) as well as for for stroke at 1.43 (95% CI 1.08–1.88).ConclusionThe incidence of IHD and stroke was higher among male couriers compared to male office workers and total wage workers, highlighting the need for implementing public health interventions to prevent IHD and stroke among couriers.

Abstract We aimed to summarize the cancer risk among patients with indication of group I pharmaceuticals as stated in monographs presented by the International Agency for Research on Cancer working groups. Following the PRISMA guidelines, a comprehensive literature search was conducted using the PubMed database. Pharmaceuticals with few studies on cancer risk were identified in systematic reviews; those with two or more studies were subjected to meta-analysis. For the meta-analysis, a random-effects model was used to calculate the summary relative risks (SRRs) and 95% confidence intervals (95% CIs). Heterogeneity across studies was presented using the Higgins I square value from Cochran’s Q test. Among the 12 group I pharmaceuticals selected, three involved a single study [etoposide, thiotepa, and mustargen + oncovin + procarbazine + prednisone (MOPP)], seven had two or more studies [busulfan, cyclosporine, azathioprine, cyclophosphamide, methoxsalen + ultraviolet (UV) radiation therapy, melphalan, and chlorambucil], and two did not have any studies [etoposide + bleomycin + cisplatin and treosulfan]. Cyclosporine and azathioprine reported increased skin cancer risk (SRR = 1.32, 95% CI 1.07–1.62; SRR = 1.56, 95% CI 1.25–1.93) compared to non-use. Cyclophosphamide increased bladder and hematologic cancer risk (SRR = 2.87, 95% CI 1.32–6.23; SRR = 2.43, 95% CI 1.65–3.58). Busulfan increased hematologic cancer risk (SRR = 6.71, 95% CI 2.49–18.08); melphalan was associated with hematologic cancer (SRR = 4.43, 95% CI 1.30–15.15). In the systematic review, methoxsalen + UV and MOPP were associated with an increased risk of skin and lung cancer, respectively. Our results can enhance persistent surveillance of group I pharmaceutical use, establish novel clinical strategies for patients with indications, and provide evidence for re-categorizing current group I pharmaceuticals into other groups.

Purpose This cohort study addresses the need for comprehensive and longitudinal research on police officers’ mental health, focusing on the relationship between occupational factors, individual characteristics and mental health status or suicidality. The Mental COP (Mental health Cohort Of Police officers in Korea) research provides important insights by tracking new police officers over time, contributing to evidence-based interventions and policies to improve their overall mental health and working conditions.Participants Mental Cop is a prospective open cohort study designed for new police officers for police recruitment, expected to graduate after 8 months of education at the Central Police Academy. To date, 6752 individuals have completed the baseline survey and are enrolled in the cohort.Finding to date The study data in Mental COP covered a wide range of issues for first responders, including personal factors, various mental health problems, occupational factors and measured biomarkers of allostatic load, including Heart Rate Variability. The main findings indicate a lower prevalence of mental health problems among those selected as new police officers compared with the general population with notable gender differences. Therefore, closer monitoring of women is required. Furthermore, the study revealed cohort-based differences in mental health, highlighting increased risk related to occupational factors (field training) and the management of vulnerable groups.Future plans Another wave of Mental COP is scheduled for December 2023, with plans for future cohort expansion. Additionally, it will establish a more comprehensive and systematic scientific framework for future investigations by integrating broader medical examinations and National Health Insurance Service Data.

Abstract Background Many previous studies on the reasons behind unmet dental needs focus on economic issues. However, in this research, we aimed to investigate the relationship between long working hours and unmet dental needs while considering the influence of occupational factors in wage workers. Methods This study used data from the Korea National Health and Nutrition Examination Survey (2012–2018) and analyzed a sample of 12,104 wage workers. Unmet dental needs were defined as cases in which individuals did not receive dental care, despite their need for examination or treatment, within the last year. Long working hours were defined as exceeding 52 h per week, based on the standard working hours stipulated by the Labor Standards Act. A binomial model was applied to calculate the prevalence ratio through multivariate logistic regression analysis. Results The prevalence of unmet dental needs was observed in 3,948 cases (32.5%), among which 1,478 attributed their presence to lack of time. The prevalence of unmet dental needs showed an inverse relationship with the education level and household income. The wage workers who worked long hours had the highest prevalence of unmet dental needs. Long working hours were found to be 1.18 times (95% CI 1.07–1.29) more likely to result in unmet dental care compared to working less than 40 h. The relationship between long working hours and unmet dental needs were statistically significant only in men (PR 1.24, 95% CI 1.07–1.43). However, the relationship between long working hours and unmet dental needs owing to time were in both men and women (men: PR 1.59, 95% CI 1.20–2.11, women: PR 1.90, 95% CI 1.48–2.43). Conclusions This study confirmed that long working hours and unmet dental needs are related when occupational factors are taken into consideration, despite the absence of oral health indicators. Using this study as a reference, further research is necessary to identify the underlying causes of unmet dental care and to improve access to dental services in the future.

Abstract Despite the increasing prevalence of lean nonalcoholic fatty liver disease (NAFLD), its risk factors are not well established. We examined the association between long working hours and incident NAFLD in lean Korean workers with emphasis on sex-based effect modification. This cohort study involved 46,113 non-overweight (BMI

Abstract Background Colorectal cancer survivors often experience decline in physical performance and poor quality of life after surgery and during adjuvant therapies. In these patients, preserving skeletal muscle mass and high-quality nourishment are essential to reduce postoperative complications and improve quality of life and cancer-specific survival. Digital therapeutics have emerged as an encouraging tool for cancer survivors. However, to the best of our knowledge, randomized clinical trials applying personalized mobile application and smart bands as a supportive tool to several colorectal patients remain to be conducted, intervening immediately after the surgical treatment. Methods This study is a prospective, multi-center, single-blinded, two-armed, randomized controlled trial. The study aims to recruit 324 patients from three hospitals. Patients will be randomly allocated to two groups for one year of rehabilitation, starting immediately after the operation: a digital healthcare system rehabilitation (intervention) group and a conventional education-based rehabilitation (control) group. The primary objective of this protocol is to clarify the effect of digital healthcare system rehabilitation on skeletal muscle mass increment in patients with colorectal cancer. The secondary outcomes would be the improvement in quality of life measured by EORTC QLQ C30 and CR29, enhanced physical fitness level measured by grip strength test, 30-sec chair stand test and 2-min walk test, increased physical activity measured by IPAQ-SF, alleviated pain intensity, decreased severity of the LARS, weight, and fat mass. These measurements will be held on enrollment and at 1, 3, 6 and 12 months thereafter. Discussion This study will compare the effect of personalized treatment stage-adjusted digital health interventions on immediate postoperative rehabilitation with that of conventional education-based rehabilitation in patients with colorectal cancer. This will be the first randomized clinical trial performing immediate postoperative rehabilitation in a large number of patients with colorectal cancer with a tailored digital health intervention, modified according to the treatment phase and patient condition. The study will add foundations for the application of comprehensive digital healthcare programs focusing on individuality in postoperative rehabilitation of patients with cancer. Trial registration NCT05046756. Registered on 11 May 2021.

In 1945, atomic bombs were dropped on Hiroshima and Nagasaki. Approximately 70 000 Koreans are estimated to have been exposed to radiation from atomic bombs at that time. After Korea’s Liberation Day, approximately 23 000 of these people returned to Korea. To investigate the long-term health and hereditary effects of atomic bomb exposure on the offspring, cohort studies have been conducted on atomic bomb survivors in Japan. This study is an ongoing cohort study to determine the health status of Korean atomic bomb survivors and investigate whether any health effects were inherited by their offspring. Atomic bomb survivors are defined by the Special Act On the Support for Korean Atomic Bomb Victims, and their offspring are identified by participating atomic bomb survivors. As of 2024, we plan to recruit 1500 atomic bomb survivors and their offspring, including 200 trios with more than 300 people. Questionnaires regarding socio-demographic factors, health behaviors, past medical history, laboratory tests, and pedigree information comprise the data collected to minimize survival bias. For the 200 trios, whole-genome analysis is planned to identify de novo mutations in atomic bomb survivors and to compare the prevalence of de novo mutations with trios in the general population. Active follow-up based on telephone surveys and passive follow-up with linkage to the Korean Red Cross, National Health Insurance Service, death registry, and Korea Central Cancer Registry data are ongoing. By combining pedigree information with the findings of trio-based whole-genome analysis, the results will elucidate the hereditary health effects of atomic bomb exposure.

Objectives: This study aimed to identify the current patterns of cancer incidence and estimate the projected cancer incidence and mortality between 2020 and 2035 in Korea. Methods: Data on cancer incidence cases were extracted from the Korean Statistical Information Service from 2000 to 2017, and data on cancer-related deaths were extracted from the National Cancer Center from 2000 to 2018. Cancer cases and deaths were classified according to the International Classification of Diseases, 10th edition. For the current patterns of cancer incidence, age-standardized incidence rates (ASIRs) and age-standardized mortality rates were investigated using the 2000 mid-year estimated population aged over 20 years and older. A joinpoint regression model was used to determine the 2020 to 2035 trends in cancer. Results: Overall, cancer cases were predicted to increase from 265 299 in 2020 to 474 085 in 2035 (growth rate: 1.8%). The greatest increase in the ASIR was projected for prostate cancer among male (7.84 vs. 189.53 per 100 000 people) and breast cancer among female (34.17 vs. 238.45 per 100 000 people) from 2000 to 2035. Overall cancer deaths were projected to increase from 81 717 in 2020 to 95 845 in 2035 (average annual growth rate: 1.2%). Although most cancer mortality rates were projected to decrease, those of breast, pancreatic, and ovarian cancer among female were projected to increase until 2035. Conclusions: These up-to-date projections of cancer incidence and mortality in the Korean population may be a significant resource for implementing cancer-related regulations or developing cancer treatments.

Background Patients with gastric cancer often encounter impaired quality of life and reduced tolerability to adjuvant treatments after surgery. Weight preservation is crucial for the overall prognosis of these patients, and exercise and supplemental nutrition play the main role. This study is the first randomized clinical trial to apply personalized, treatment stage-adjusted digital intervention with wearable devices in gastric cancer rehabilitation intervention for 12 months, commencing immediately after surgery. Methods This is a prospective, multicenter, two-armed, randomized controlled trial and aims to recruit 324 patients from two hospitals. Patients will be randomly allocated to two groups for 1 year of rehabilitation, starting immediately after the operation: a personalized digital therapeutic (intervention) group and a conventional education-based rehabilitation (control) group. The primary objective is to clarify the effect of mobile applications and wearable smart bands in reducing weight loss in patients with gastric cancer. The secondary outcomes are quality of life measured by the EORTC-QLQ-C30 and STO22; nutritional status by mini nutrition assessment; physical fitness level measured by grip strength test, 30-s chair stand test and 2-min walk test; physical activity measured by IPAQ-SF; pain intensity; skeletal muscle mass; and fat mass. These measurements will be performed on enrollment and at 1, 3, 6, and 12 months thereafter. Conclusions Digital therapeutic programs include exercise and nutritional interventions modified by age, body mass index, surgery type and postoperative days. Thus, expert intervention is pivotal for precise and safe calibration of this program. Trial registration Clinicaltrials.gov identifier: NCT04907591 (registration date: June 11, 2020; https://clinicaltrials.gov/ct2/show/NCT04907591 ).

Objectives We introduced the cohort studies included in the Korean Cohort Consortium (KCC), focusing on large-scale cohort studies established in Korea with a prolonged follow-up period. Moreover, we also provided projections of the follow-up and estimates of the sample size that would be necessary for big-data analyses based on pooling established cohort studies, including population-based genomic studies. Methods We mainly focused on the characteristics of individual cohort studies from the KCC. We developed “PROFAN”, a Shiny application for projecting the follow-up period to achieve a certain number of cases when pooling established cohort studies. As examples, we projected the follow-up periods for 5000 cases of gastric cancer, 2500 cases of prostate and breast cancer, and 500 cases of non-Hodgkin lymphoma. The sample sizes for sequencing-based analyses based on a 1:1 case-control study were also calculated. Results The KCC consisted of 8 individual cohort studies, of which 3 were community-based and 5 were health screening-based cohorts. The population-based cohort studies were mainly organized by Korean government agencies and research institutes. The projected follow-up period was at least 10 years to achieve 5000 cases based on a cohort of 0.5 million participants. The mean of the minimum to maximum sample sizes for performing sequencing analyses was 5917–72 102. Conclusions We propose an approach to establish a large-scale consortium based on the standardization and harmonization of existing cohort studies to obtain adequate statistical power with a sufficient sample size to analyze high-risk groups or rare cancer subtypes.

Background: Occupational cancer is a global health issue. The Korean CARcinogen EXposure (K-CAREX), a database of CARcinogen EXposure, was developed for the Korean labor force to estimate the number of workers exposed to carcinogens by industry. The present study aimed to estimate the intensity of exposure to carcinogens by industry, in order to supply complementary information about CARcinogen EXposure intensity to the K-CAREX. Methods: We used nationwide workplace monitoring data from 2014 to 2016 and selected target carcinogens based on the K-CAREX list. We computed the 95th percentile levels of measurements for each industry by carcinogens. Based on the 95th percentile level relative to the occupational exposure limit, we classified the CARcinogen EXposure intensity into five exposure ratings (1–5) for each industry. Results: The exposure ratings were estimated for 21 carcinogenic agents in each of the 228 minor industry groups. For example, 3,058 samples were measured for benzene in the manufacturing industry of basic chemicals. This industry was assigned a benzene exposure rating of 3. Conclusions: We evaluated the CARcinogen EXposure ratings across industries in Korean workers. The results will provide information on the exposure intensity to carcinogens for integration into the K-CAREX. Furthermore, it will aid in prioritizing control efforts and identifying industries of concern.

Abstract The Korean government started to cover part of the price of hearing aids ($200) for individuals with hearing disabilities in 1997, and the reimbursement for a hearing aid increased in 2005 ($300) and again in 2015 ($1000). The aim of this study was to evaluate the annual trend of newly-registered individuals with hearing disability according to the changes of the hearing aid provision scheme. Subjects with newly-registered hearing disabilities were assessed using Korean National Health Insurance Service (KNHIS) data from January 1, 2004, to December 31, 2018. A total of 271,742 individuals were newly registered during the index period. Records of hearing aid prescriptions and hearing aid subsidies were used to assess the adoption of hearing aids. This study also assessed the intervals between registration of hearing disability and the adoption of hearing aids, as well as the number of hearing aid subsidies provided. From 2004 to 2009 there was a slight increase in the number of individuals newly registered with hearing disabilities, and from 2011 to 2015, the number showed a tendency to decrease. Then, from 2015, the number of individuals with hearing disabilities increased abruptly, and the proportion of subjects receiving hearing aid subsidies also increased. Between 2004 and 2018, the time interval from hearing disability registration to hearing aid adoption showed a decreasing trend. We conclude that the annual number of individuals with newly-registered hearing disabilities is affected by the level of the hearing aid subsidy, and there is much unregistered or unaddressed hearing loss prior to the introduction of realistic hearing aid provision.

Abstract Background This study investigated the efficacy of first-generation (cefazolin) and third-generation (ceftizoxime) prophylactic antibiotics in patients undergoing cardiac surgery and the incidence of surgical site infections, hospitalizations, and medical costs. Methods All adult patients (≥ 20 years) undergoing cardiac surgery at one hospital from January 01, 2009, to December 31, 2016, were included in this study. A single prophylactic antibiotic was administered at a dose of 1 g within one hour of the surgical incision and for three days after surgery at eight-hour intervals. After propensity score matching, 194 patients in each antibiotic prophylaxis group (first-generation vs third-generation) were analyzed. Among the 388 patients, the incidence of surgical site infections was compared according to the type of prophylactic antibiotic, and risk factors were evaluated by chi-squared tests followed by multivariate logistic regression analysis. Results The incidence of deep surgical site infections was significantly lower in the first-generation group (5.7%) than in the third-generation group (16.5%). The pathogens isolated from the surgical infection sites were similarly distributed in both groups. However, the prevalence of highly infectious gram-positive bacteria was more than that of gram-negative bacteria (67% vs 23%). The preoperative hospitalization duration, mean operation time, and ventilator use time were similar in both groups, but the postoperative hospitalization duration was significantly shorter in the first-generation group (25.5 days) than in the third-generation group (29.8 days). In addition, the medical costs were lower in the first-generation group (20,594 USD) than in the third-generation group (26,488 USD). Conclusion In conclusion, the first-generation prophylactic antibiotic was better than the third-generation in reducing surgical site infection rates, hospitalization length, and medical expenditures.

Summary: Objective: The prevalence of hemorrhoids has been reported to be 7–14%. However, there have been no large-scale studies. This study aims to investigate the incidence of hemorrhoids in Korea by analyzing big data and to find the associated risk factors. Methods: This was a retrospective analysis using the Health Insurance Cohort database of the National Health Insurance Corporation of Korea in 2002–2015. The study was divided into two models: the diagnostic (DM) and surgical model (SM). Socio-demographic and lifestyle behavioral characteristics were analyzed as risk factors. Results: Overall, 467,567 participants were included. The incidence density of hemorrhoids was 13.9 and 5.7 per 1000 person-years in the DM and SM, respectively. Hemorrhoids occurred more frequently in men and metropolitan areas in both models. The incidence was highest in the 40s. The incidence rates were highest in the high income, smoking, alcohol and the exercise group of 1–4 times a week in both models. The adjusted hazard ratio (HR) was higher in men and decreased with increasing age. It was higher in the metropolitan area. The high-income level and alcohol consumption were risk factors in the DM and SM, respectively. The HR of the exercise group was higher than that of the non-exercise group in both models. Conclusions: The diagnostic and surgical incidence density was 13.9 and 5.7 per 1000 person-years, respectively. Hemorrhoids occurred most frequently in men in their 40s. The metropolitan area, high income level and alcohol consumption were associated with an increased frequency of hemorrhoids.

Abstract The aim of this study is to investigate the epidemiology of ophthalmic complications of retinopathy of prematurity (ROP) after preterm birth using population-based database in South Korea. Using the National Health Insurance database, ophthalmic complications among premature infants born in 2007–2008 during their 10-year follow-up period were identified. Annual cumulative incidence rate and period prevalence of complications at each age were analyzed among those with ROP and those who underwent treatment for ROP (tROP). The hazard ratios (HRs) according to the presence of ROP and treatment for ROP were also analyzed. We identified 18,256 premature infants, 6995 of whom had ROP. The prevalence at 10th year for overall ophthalmic complications was 11.1% and 35.9% among ROP and tROP, respectively. Strabismus, amblyopia, and glaucoma were the three most common complications. The presence of ROP was associated with higher risk of complications (HR 1.53, 95%CI 1.44–1.61) among premature infants, and the presence of treatment for ROP was associated with higher risk of complications (HR 4.31, 95%CI 3.74–4.98) among ROP cases. This study reports the nationwide epidemiologic data on ophthalmic complications of ROP during the first decade of life, which will help advance our understandings and establish national strategies in managing ROP.

Abstract Background Although unintentional pregnancy loss is common, national representative statistics are lacking in high-income East Asian countries undergoing rapid demographic changes. It is necessary to confirm the income inequality of pregnancy loss even in universal national health insurance. Method Using National Health Insurance Service data between 2008 and 2014, the annual prevalence of pregnancy loss was enumerated, and differences in pregnancy loss according to age and income levels were assessed by multivariable Poisson regression. Joint-point regression was used to examine the trend of pregnancy loss. Result On average, there was a 15.0% annual pregnancy loss among 3,941,020 pregnancy cases from 2008 to 2014. Pregnancy loss inequality increased stepwise with income levels except for the highest income group. After adjusting for income levels, the annual percent change of age-standardized prevalence significantly increased by 2.6% every year since 2011. Conclusion Even in high-income countries with universal national health insurance, income inequality in pregnancy loss is observed. Further appraisal is needed to explain the increasing trend of pregnancy loss between 2011 and 2014 even after adjusting income.

Background: In a previous study, we estimated exposure prevalence and the number of workers exposed to carcinogens by industry in Korea. The present study aimed to evaluate the optimal exposure intensity indicators of airborne lead exposure by comparing to blood lead measurements for the future development of the carcinogen exposure intensity database. Methods: Data concerning airborne lead measurements and blood lead levels were collected from nationwide occupational exposure databases, compiled between 2015 and 2016. Summary statistics, including the arithmetic mean (AM), geometric mean (GM), and 95th percentile level (X95) were calculated by industry both for airborne lead and blood lead measurements. Since many measurements were below the limits of detection (LODs), the simple replacement with half of the LOD and maximum likelihood estimation (MLE) methods were used for statistical analysis. For examining the optimal exposure indicator of airborne lead exposure, blood lead levels were used as reference data for subsequent rank correlation analyses. Results: A total of 19,637 airborne lead measurements and 32,848 blood lead measurements were used. In general, simple replacement showed a higher correlation than MLE. The results showed that AM and X95 using simple replacement could be used as optimal exposure intensity indicators, while X95 showed better correlations than AM in industries with 20 or more measurements. Conclusion: Our results showed that AM or X95 could be potential candidates for exposure intensity indicators in the Korean carcinogen exposure database. Especially, X95 is an optimal indicator where there are enough measurements to compute X95 values.

Abstract The aim of this study is to investigate the nationwide incidence and treatment pattern of retinopathy of prematurity (ROP) in South Korea. Using the population-based National Health Insurance database (2007–2018), the nationwide incidence of ROP among premature infants with a gestational age (GA)

OBJECTIVES: The deleterious health effects of long working hours have been previously investigated, but there is a dearth of studies on mortality resulting from accidents or suicide. This prospective study aims to examine the association between working hours and external-cause mortality (accidents and suicide) in Korea, a country with some of the longest working hours in the world. METHODS: Employed workers (N=14 484) participating in the Korean National Health and Nutrition Examination Survey (KNHANES) were matched with the Korea National Statistical Office’s death registry from 2007–2016 (person-years = 81 927.5 years, mean weighted follow-up duration = 5.7 years). Hazard ratios (HR) for accident (N=25) and suicide (N=27) mortality were estimated according to weekly working hours, with 35–44 hours per week as the reference. RESULTS: Individuals working 45–52 hours per week had higher risk of total external cause mortality compared to those working 35–44 hours per week [HR 2.79, 95% confidence interval (CI) 1.22–6.40], adjusting for sex, age, household income, education, occupation, and depressive symptoms. Among the external causes of death, suicide risk was higher (HR 3.89, 95% CI 1.06–14.29) for working 45–52 hours per week compared to working 35–44 hours per week. Working >52 hours per week also showed increased risk for suicide (HR 3.74, 95% CI 1.03–13.64). No statistically significant associations were found for accident mortality. CONCLUSIONS: Long working hours are associated with higher suicide mortality rates in Korea.

Background/Aims The aim of this study was to investigate incidence, survival, and risk factors of cancer in end-stage renal disease (ESRD) patients with hemodialysis using information from the National Health Information Database (NHID). Methods Using the NHID, we identified ESRD patients who started maintenance hemodialysis between 2003 and 2005 in Korea. Patients were followed from initiation of hemodialysis to renal transplantation, death, or December 31, 2016, whichever came first. We calculated the incidence, survival, and risk factors of cancer. Results Of the total 14,382 ESRD patients, 1,124 (7.82%; men:women, 728:396) were diagnosed with cancer during follow-up. The mean duration from the start of hemodialysis to new cancer identification was 64.40 ± 41.81 months. Significant risk factors for the development of new cancer were old age, male sex, and liver disease. Conversely, patients with diabetes showed low risk for new cancer. The colorectum (17.31%) was the most common primary site of cancer in men, followed by the liver (15.8%), stomach (14.29%), lung (13.6%), and kidney (10.3%). In women, the colorectum (14.65%) was also the most common primary site of cancer, followed by the breast (12.88%), thyroid (12.63%), stomach (10.86%), and lung (8.08%). According to the primary site of cancer, breast cancer showed the longest median survival duration (130.93 months), followed by thyroid, kidney, colorectum, bladder, stomach, liver, and lung cancer. On multivariate analyses, overall survival was affected by age and diabetes. Conclusions The cancer incidence of chronic hemodialysis patients was relatively high. Thus, careful monitoring and a specific cancer screening program are needed for chronic hemodialysis patients.

Abstract Background We examined the association between obesity and prostate cancer based on both body mass index (BMI) and waist circumference (WC) using the National Health Insurance System (NHIS) database for the entire male population of Korea. Methods A total of 1,917,430 men who underwent at least one health examination in 2009 without a previous diagnosis of any other cancer were tracked through December 2015. The hazard ratio (HR) and 95% confidence interval (CI) value for the association between prostate cancer and obesity were analyzed using multiple Cox regression model. Since there was a statistically significant interaction between WC and BMI, a multiple HR for prostate cancer was estimated with stratifying both WC and BMI to control the interaction between WC and BMI. Results Without considering WC as an adjustment factor, very weak association between BMI and prostate cancer development risk was observed. When WC was considered as an adjustment factor, no significant change in the HRs for prostate cancer development beyond the reference BMI was observed in the group with WC

ObjectiveThis study aimed to investigate whether severe retinopathy of prematurity (ROP) could be an association factor for neurodevelopmental disorders in premature infants without other risk factors—such as congenital anomalies, birth injuries, and neurological diseases—that may cause developmental delay.MethodsWe used health claims data recorded between 2007 and 2018 in the Korean National Health Insurance Service (KNHIS) database. We recruited a total of 18,256 premature infant born between 2007 and 2008 without congenital anomaly or birth injury (with ROP 6,995, without ROP 11,261) and divided them into four groups as follows: Group A, 209 extremely premature infants [gestational age (GA) < 28] with mild ROP; Group B, 75 extremely premature infants (GA < 28) with severe ROP; Group C, 6,510 other premature infants (28 ≤ GA

Breast cancer survivors may experience spinal deformity following breast cancer surgery. This study investigated the long-term effects of breast cancer surgery on whole-spine alignment. This retrospective study included 200 patients who underwent breast cancer surgery and ≥2 anteroposterior standing whole-spine X-rays. The curvature of the spine was measured using the Cobb angle; changes in Cobb angle between X-rays were compared among three groups according to breast cancer surgery type. The mean interval between initial and follow-up X-ray was 28.46 ± 13.39 months. The change in Cobb angle was 0.40 ± 1.65 degrees and the absolute value of that change was 1.25 ± 1.15 degrees in all patients with breast cancer. There were no significant differences in angular change among groups according to breast cancer surgery type. Most patients showed minimal changes in spinal alignment after breast cancer surgery. Our findings indicate that breast cancer surgery does not negatively affect spinal alignment.

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. Keywords: Fourth industrial revolution, Occupational health and safety, Workers' compensation, Workers' health

Abstract Background The purpose of this study was to investigate the relationship between hormone replacement therapy (HRT) and periodontal disease in postmenopausal women using data from the 4th and 5th Korea National Health and Nutrition Examination Survey (KNHANES). Methods The study included data from 5,482 postmenopausal women aged 45–74 years in the 2007–2012 KNHANES. The use of female HRT for at least one month was reclassified as HRT+/HRT-. The Community Periodontal Index of Treatment Needs (CPITN) was used to assess periodontal status. Propensity score matching (PSM) was used to control selection bias, and factors affecting education, family income, and age of menopause were used as covariates in PSM. A chi-square test was used to confirm the bivariate relationship between the variables. Binary logistic regression analysis was used to adjust for confounders (age, education, family income, body mass index, age of menopause, alcohol, smoking, dental clinic visits in the past one year, use of oral care products and frequency of tooth brushing per day). Results After adjusting for all covariates, HRT was associated with periodontal disease (OR: 0.79; 95% CI: 0.66–0.94). In particular, the relationship between HRT and periodontal disease was more evident in those with menopause under 45 years of age disease (OR: 0.55; 95% CI: 0.35–0.87). Conclusions The results of this study supported that it is important that hormone therapy be actively considered in the policy towards postmenopausal women. Especially, health programs such as hormone replacement therapy, non-smoking, and use of oral care products are needed for women who undergo premature menopause.

Background/Aims Workers who are exposed to dust in the workplace tend to show a higher incidence of gastric cancer. Nevertheless, scientific evidence to support an association between dust exposure and the risk of gastric cancer is inadequate. This study aimed to investigate whether or not occupational dust exposure influences the risk of gastric cancer. Methods We collected the electronic data from the Pneumoconiosis Health Examination (PHE) program, provided by the Ministry of Employment and Labor and the Korea Workers’ Compensation and Welfare Service from 2002 to 2017. The PHE database was linked to the National Health Insurances databases. The age-standardized incidence ratio (SIR) and 95% confidence intervals (CIs) of the risk of gastric cancers were evaluated in workers with occupational dust exposure, and the results were compared to those in the general population. Results From 2004 to 2015, 1,543 cases of gastric cancer were observed in the male participants, as compared with 1,174 of expected cases, which yielded an SIR of 1.314 (95% CI, 1.249 to 1.380). Under dust exposure, the risk of gastric cancer was increased 23.9% in the male participants (95% CI, 19.9 to 27.5), and the degree of impairment of lung function was inversely related to the risk of gastric cancer. Conclusions Workers with occupational dust exposure were at higher risk of developing gastric cancer than the general population. Thus, future efforts for the prevention of gastric cancer are necessary for dust exposed workers.

Abstract Background Research on carcinogens causing occupational cancer has been updated. Further, social interest in occupational cancer has increased. In addition, the standard for recognizing cancer as a work-related disease has also been revised. The present study aims to describe the distribution of occupational cancer claims or its approval rate and their association with work-related variables. Methods We analyzed 1299 claim cases for occupational cancer from 2010 to 2016 provided by the Korea Workers’ Compensation and Welfare Service (KCOMWEL). The status of approval rate was shown by year, sex, industry, occupation, age of diagnosis, duration from employment to diagnosis, and cancer site. Results The approval rate was 39.0% from 2010 to 2016 and tended to increase annually since 2011. Both the number of claims and the approval rate were higher in men. Mining and quarrying showed the highest approval rate (78.4%). The approval rates by age of diagnosis and duration from employment to diagnosis increased as the time periods increased. Respiratory organ had the highest number of claims and the highest approval rate by cancer site. Conclusions The approval rate of occupational cancer has shown an increasing trend since 2011. The increase of occupational carcinogens and cancer sites and the improvement of social awareness about occupational cancer could have resulted in this trend. The present study provides unique, and the latest and most accurate findings on occupational cancer data of recent 7 years that could be helpful to researchers or policy makers on occupational cancer.

Abstract The goal of this study was to review the scientific basis for the recognition of occupational cancer, in relation to hepatitis viral infections in Korea. Most Hepatitis B virus (HBV) infections in Korea occur as vertical infections, but these are decreasing rapidly due to vaccination. Hepatitis C virus (HCV) is known to be transmitted through parenteral routes, but the transmission route is often unclear. Most occupational infections of hepatitis virus involve accidental injuries of medical institution workers while using virus-contaminated medical devices. Many cohort studies and case-control studies have consistently reported that HBV and HCV infection increases the risk of hepatocellular carcinoma (HCC) and the strength of this association is high. Non-Hodgkin’s lymphoma appears to be associated with HCV. Cholangiocarcinoma, pancreatic cancer, leukemia, and thyroid cancer are considered to be less related or unrelated to epidemiological causation. There are no uniform international specific criteria for occupational cancer caused through occupational exposure to a hepatitis virus. In establishing appropriate standards applicable to Korea, there should be sufficient consideration of latency, virus exposure levels and frequency, and other cancers, apart from HCC. In conclusion, we recommend keeping the current specific criteria. However, if a worker is injured at work when using a sharp medical device, and HBV and HCV viral infections are confirmed through serologic tests; if the worker is diagnosed as having a chronic HBV or HCV infection, a subsequent HCC (or Non-Hodgkin’s lymphoma following chronic HCV infection) can then be considered highly related to the worker’s occupation.

Abstract 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.

OBJECTIVE: This study aimed to examine the distribution of working hours and the association between working hours and depressive symptomatology using representative data from a national, population-based survey. METHOD: Data came from the fourth Korean National Health and Nutrition Examination Survey (2007–2009), which employed a systematic, stratified cluster-sampling method. We used logistic regression procedures to estimate the importance of weekly working hours as a predictor of depressive symptomatology. RESULTS: The prevalence of depressive symptomatology was 10.2%. The work week, which averaged 48.3 hours for the sample as a whole, was longer for men (49.8 hours) than women (45.3 hours), and 12.1% of respondents were engaged in shift work. In logistic regression analyses, compared to those working

Objectives: The lung cancer mortality in Korea has increased remarkably during the last 20 years, and has been the first leading cause of cancer-related deaths since 2000. The aim of the current study was to examine the time trends of occupational lung cancer and carcinogens exposure during the period 2006-2009 in South Korea, by assessing the proportion of occupational burden. Methods: We defined occupational lung cancer for surveillance, and developed a reporting protocol and reporting website for the surveillance of occupational lung cancer. The study patients were chosen from 9 participating university hospitals in the following 7 areas: Seoul, Incheon, Wonju, Daejeon, Daegu, Busan, and Gwangju. Results: The combined proportion of definite and probable occupational lung cancer among all lung cancers investigated in this study was 10.0%, 8.6%, 10.7%, and 15.8% in the years 2006 to 2009, respectively, with an average of 11.7% over the four-year study period. The main carcinogens were asbestos, crystalline silica, radon, polyaromatic hydrocarbons (PAHs), diesel exhaust particles, chromium, and nickel. Conclusion: We estimated that about 11.7% of the incident lung cancer was preventable. This reveals the potential to considerably reduce lung cancer by intervention in occupational fields.

Despite the global expansion of supply chains and changes to the production process, few studies since the mid-1990 s and 2000s have examined reproductive risks of the microelectronics industry; we examined the reproductive risks among female microelectronics workers in South Korea.Based on claim data from the National Health Insurance (2008-2012), we estimated age-specific rates of spontaneous abortion (SAB) and menstrual aberration (MA) among women aged 20 to 39 years. We compared data between microelectronics workers and three different control groups: economically inactive women, the working population as a whole, and workers employed in the bank industry. For an effect measure, age-stratified relative risks (RRs) were estimated.Female workers in the microelectronics industry showed significantly higher risk for SAB and MA compared to control groups. The RRs for SAB with reference to economically inactive women, working population, and bank workers in their twenties were 1.57, 1.40, and 1.37, respectively, and the RRs for MA among females in their twenties were 1.54, 1.38, and 1.48, respectively. For women in their thirties, RRs for SAB were 1.58, 1.67, and 1.13, and those for MA were 1.25, 1.35, and 1.23 compared to the three control populations, respectively. All RRs were statistically significant at a level of 0.05, except for the SAB case comparison with bank workers in their thirties.Despite technical innovations and health and safety measures, female workers in microelectronics industry in South Korea have high rates of SAB and MA, suggesting continued exposure to reproductive hazards. Further etiologic studies based on primary data collection and careful surveillance are required to confirm these results.