BACKGROUND:Korea has experienced changes in the balance between the demand for and supply of occupational and environmental medicine (OEM) specialists due to recent policy and environmental shifts. This study projected demand and supply for these specialists for 2025-2035, focusing on those working in special health examination institutions and occupational health management agencies. METHODS:Demand was estimated by applying 2024 average workloads per OEM specialist to projected volumes of special health examinations and outsourced occupational health management for 2025-2035 under four scenarios that varied growth in outsourced management and the share of OEM specialists among participating physicians. Supply was projected using registration and official statistics for 1,010 specialists certified by 2025, combined with detailed residency cohort data, assumptions on future quotas, completion, and age at certification, and age-specific proportions working in the two institution types. RESULTS:Average workloads in 2024 were 4,793 workers per OEM specialist for special health examinations and 9,193 workers per physician for outsourced occupational health management. The number of OEM specialists younger than 90 years is projected to increase from 968 in 2025 to 1,244 in 2035, with those working in the two institution types increasing from 697 to 910. Depending on the scenario, demand in 2035 ranges from 838 to 943 specialists, with supply exceeding demand in three scenarios but remaining 33 specialists short in the most expansionary scenario. CONCLUSIONS:Short-term shortages of OEM specialists are likely but remain highly manageable, after which surplus capacity is expected. Policy efforts should therefore stabilize OEM residency pipelines and prepare institutional mechanisms to deploy surplus specialists beyond special health examinations and outsourced occupational health management.
Background:This study reports a case of recurrent laryngeal leukoplakia, a precancerous lesion, in a female cook with long-term occupational exposure to cooking oil fumes. In 2022, the Korean Epidemiological Investigation and Evaluation Committee determined that substantial scientific evidence supported the work-relatedness of the case. Case presentation:A 55-year-old woman working as a cook in group-catering facilities in long-term care hospitals and general hospitals was referred to an otolaryngology clinic after an abnormal laryngeal finding was incidentally detected during routine upper gastrointestinal endoscopy in April 2018. Subsequent laryngoscopy revealed granulation tissue of the left vocal fold. Histopathological examination following laryngeal microsurgery confirmed high-grade dysplasia, leading to a diagnosis of left vocal fold leukoplakia, and the lesion was excised. During follow-up, persistent voice changes and recurrence of the lesion were identified, and repeat excision again demonstrated low- and high-grade dysplasia. The patient had worked as a cook for approximately 14.6 years and routinely performed oil-intensive cooking tasks, including frying, grilling, stir-frying, and battered-dish preparation, for approximately 2-4.5 hours per day. She reported insufficient ventilation during heavy fume generation. She had no history of smoking, passive smoking from her spouse, alcohol consumption, vocal abuse, gastroesophageal reflux disease, or mechanical trauma to the larynx. Conclusions:This case suggests a possible occupational contribution of repeated intermittent exposure to cooking oil fumes and irritant aldehydes to recurrent laryngeal precancerous lesions among cooks. However, because direct historical exposure measurements were unavailable and this is a single case report, definitive causality cannot be established. Improvement of workplace ventilation and other exposure-control measures should be considered, and further studies with direct exposure assessment are needed.
Background:Hemangiosarcomas are heterogeneous malignancies possibly originating in any part of the body, rare in humans. The web of causation of human hemangiosarcomas remains poorly understood, to date, except for subsets of cases which have been recognized in a well-defined causal correlation to vinyl chloride or to ionizing radiation. In 2005, the International Agency for Research on Cancer ranked formaldehyde as a human carcinogen, causally related to both nasopharyngeal cancers and acute non-lymphocytic leukemias; at the time, the evidence in favor of a causal relationship of formaldehyde to sinonasal cancers was stated as "limited". In 2024, an umbrella review reported a significantly increased risk for sinonasal cancers among formaldehyde-exposed workers. Case presentation:A sinonasal hemangiosarcoma affecting an Italian male born in 1957, diagnosed in 2022, was reported to the Italian National Registry of Sino-Nasal Cancers (ReNaTuNS); the patient's occupational history revealed a remote exposure to formaldehyde, used as a disinfectant, when breeding farm animals, from 1967 to 1976. No previous reporting has been found about a possible association between formaldehyde and sinonasal non-epithelial cancers. Conclusions:Formaldehyde is, in our opinion, a suitable candidate to be considered for playing a causal role in the causation of the neoplasm; formal studies are required to test the hypothesis.
BACKGROUND:There has been a resurgence of silicosis, particularly related to artificial stone. There are currently no treatments for silicosis beyond lung transplantation for end-stage disease. This study aimed to evaluate the efficacy of prednisolone in people with artificial stone-associated silicosis-progressive massive fibrosis (PMF). METHODS:This was a pilot prospective observational clinical trial, assessing 3 months of prednisolone in adults with artificial stone-associated silicosis with PMF. Outcomes were assessed at 3 and 12 months. RESULTS:Seven participants completed the study. Baseline positron emission tomography (PET) scans demonstrated increased fluorine-18 fluorodeoxyglucose (18F-FDG) uptake in areas of PMF in all participants. All participants had a significant reduction in maximum standardized uptake value (SUVmax) following prednisolone at 3 months (pre-treatment mean SUVmax 6.7 [standard deviation (SD): 2.6], post-treatment mean SUVmax 4.2 [SD: 1.0], p = 0.012). There was also a non-significant reduction in the % of total lung parenchyma with SUV >1 (49.7% [SD: 36.4] to 45.8% [SD: 28.4], p = 0.527) and a significant reduction in SUV >2.5 (7.0% [SD: 6.3] to 2.4% [SD: 2.2], p = 0.038). There was a non-significant reduction in computed tomography ICOERD well-defined opacity profusion scores and large opacities. There was no significant difference in lung function or St. George's Respiratory Questionnaire. There were no serious adverse events. CONCLUSIONS:There are high levels of inflammation in silicosis-PMF as evidenced by 18F-FDG PET. Short-term prednisolone reduced 18F-FDG PET activity. This suggests a possible therapeutic pathway for people with silicosis-associated PMF in a population with no current treatments. Further research is required to determine the most appropriate immunosuppressive strategy and further assess longer-term outcomes.
Background: Occupational and environmental medicine (OEM) specialists are key personnel within the occupational health system. Recent developments, such as the introduction of the Serious Accidents Punishment Act and the expansion of occupational health policies targeting vulnerable workers, have highlighted the need to broaden the role of OEM specialists. This study analyzed the current workload of OEM specialists and projected their medium- to long-term demand.Methods: The demand for OEM specialists was defined as the actual observed service utilization volume under the current legal, institutional, and policy environment. Key work areas were categorized as special health examinations and outsourced occupational health management services. Data sources included administrative records from the Korea Occupational Safety and Health Agency (KOSHA) and the Ministry of Employment and Labor (MoEL), statistics on worker health examination results, and evaluation data from specialized agencies for occupational health management. Demand through 2035 was projected by applying the observed historical growth trend in service utilization. The required number of specialists was calculated by applying the average workload per specialist in the base year.Results: As of 2025, 577 OEM specialists were working at 255 special health examination institutions. Among the 153 occupational health management agencies, 265 physicians were employed, including 133 OEM specialists. The number of workers requiring services from OEM specialists is predicted to continue growing. Applying the current average workload per physician, an additional 132 special health examination physicians and 92 occupational health management agency physicians will be needed by 2035.Conclusions: Actual workforce demand may differ from the projections presented in this study depending on changes in policies, industrial structure, service delivery models, and work efficiency. Future studies should incorporate need-based estimates that reflect the diverse roles of OEM specialists and use integrated workforce data to provide more refined projections.
BACKGROUND:South Korea operates a national health screening program aimed at early detection of major diseases. Although participation rates have been linked to various socioeconomic and demographic factors, occupational determinants remain insufficiently characterized. METHODS:This study analyzed 37,987 employed wage earners from the Korea National Health and Nutrition Examination Survey conducted between 2007 and 2023. The primary outcome was self-reported health screening program participation within the preceding two years. Occupational characteristics-including classification of occupations, employment status, working hours, work arrangement, and supervisory role-as well as workplace conditions and hazard exposures were examined. Prevalence ratios (PRs) with 95% confidence intervals were calculated for each characteristic. Generalized additive models were used to examine the nonlinear association between weekly working hours and participation rates. Multivariable modified Poisson regression models incorporating interaction terms between occupational characteristics and survey year assessed temporal trends in participation disparities. RESULTS:The overall health examination rate was 71.32%. Compared with managers, all other occupational categories-except armed forces-had significantly lower PRs of participation, with sales workers showing the lowest. Temporary, daily, non-regular, and part-time workers showed significantly lower PRs. Those working less than 35 or more than 52 hours per week showed significantly lower PRs than the reference group (35-52 hours). An inverted U-shaped association was observed, with participation peaking at approximately 40-50 hours per week. Among workplace conditions, decision-making authority, working under time pressure, and physical hazard exposure were associated with higher participation, whereas prolonged uncomfortable postures and heavy material handling were associated with lower participation. Over the 17-year study period, the adjusted PRs for working hours showed no significant temporal change. CONCLUSIONS:Significant occupational disparities in health screening participation exist among Korean wage earners. Targeted interventions addressing vulnerable occupational groups are warranted to reduce disparities and improve overall worker health outcomes.
In Korea, welders diagnosed with “idiopathic Parkinson's disease (iPD)” often face denial of workers’ compensation, as “idiopathic” is interpreted as excluding occupational contribution. This narrative review examines whether a categorical distinction between iPD and “toxic parkinsonism” is defensible on diagnostic, pathological, neuroimaging, epidemiological, causal-inference, and legal grounds. The 2024 NSD-ISS (Neuronal α-synuclein disease Integrated Staging System) and SynNeurGe (Synuclein-Neurodegeneration-Gene) frameworks challenge categorical use of the “idiopathic” label by defining Parkinson's disease (PD)–related disease biologically, irrespective of etiology. Nonhuman primate studies show that chronic low-dose manganese exposure can produce nigrostriatal deficits and α-synuclein aggregation overlapping with PD biology. Dichotomous use of FP-CIT dopamine transporter imaging or levodopa responsiveness to separate manganese poisoning from iPD is therefore scientifically unsound, as chronic welding exposure can induce presynaptic dysfunction and treatment responses indistinguishable from PD. Epidemiological findings diverge methodologically: direct clinical examination has reported elevated parkinsonism prevalence among welders, whereas administrative cohorts have generally found no increased PD risk. This divergence is plausibly explained by differences in case ascertainment, exposure assessment, healthy-worker-survivor selection, and disease latency. Bradford Hill and Rothman frameworks support a causal interpretation, although validated biomarkers and dose-response thresholds remain undefined. Under Korea’s Industrial Accident Compensation Insurance Act, causation is evaluated as a “proximate causal relationship” rather than strict scientific proof. A multi-hit model integrating genetic predisposition, aging, and cumulative environmental exposure supports recognition under this standard, and compensation eligibility should not depend on whether the diagnosis label is ‘PD’ or ‘parkinsonism.’ When parkinsonian symptoms occur in welders with at least approximately 20,000 exposure-weighted welding hours, or with substantial high-intensity exposure such as confined-space welding, inadequate ventilation, or flux-cored arc welding, occupational contribution should be considered under a weight-of-evidence approach. This criterion is sufficient for recognition but is not a necessary condition.
BACKGROUND:Musculoskeletal disorders (MSDs) are a major occupational health issue in Korea; however, a standardized job-exposure matrix (JEM) has not been established. This study aimed to develop an MSD-specific JEM using data from the Korean Working Conditions Survey (KWCS) to evaluate the exposure time proportion by job category and body segment. METHODS:Data from the 2nd to 6th KWCS (2006-2020), covering 210,500 workers, were analyzed. The jobs of the subjects were reclassified based on the unit groups of the 7th Korean Standard Classification of Occupations. Exposure time proportion for key MSD risk factors-repetitive movements, awkward postures, heavy lifting, and prolonged standing-was categorized as high, moderate, or low based on self-reported responses. Validity was assessed through expert review and statistical analysis, including Cohen's kappa coefficients and logistic regression. RESULTS:Duration-based exposure to musculoskeletal (MS) risk factors was estimated for each occupation. The JEM classified exposure time proportion for three body regions: upper extremity and neck, lower back, and lower extremity. Expert review showed high agreement for the upper extremity and neck and for the lower back (kappa > 0.8), whereas agreement was lower for the lower extremity. Logistic regression analysis indicated an exposure-response relationship between JEM-derived exposure time proportion and MS symptoms for the upper extremity and neck and the lower back. CONCLUSIONS:This study developed Korea's first MS-specific JEM, providing a standardized framework for occupational MSD risk assessment. The JEM demonstrated strong validity for most body regions and can be a valuable tool for research, workplace risk evaluation, and policy development. Further refinements incorporating detailed job classifications and ergonomic factors are recommended to enhance its applicability.
BACKGROUND:Although most countries maintain occupational safety and health (OSH) legislation to prevent occupational diseases, the legal codification and integration of occupational health risk assessment (HRA), exposure monitoring, and medical surveillance vary substantially across jurisdictions; therefore, this study compared the legal frameworks of Korea, the United Kingdom (UK), the European Union (EU), and the United States (US) to examine the linkage among these elements, assess whether they support estimation of individual cumulative past exposure, and derive implications for improving occupational disease prevention in Korea. METHODS:This qualitative comparative legal analysis examined employer obligations related to quantitative exposure monitoring, HRA, and medical surveillance under the OSH systems of the UK, the EU, the US, and Korea. Primary statutes and subordinate regulations were systematically reviewed to assess how these elements are mandated, linked, and supported by record-keeping provisions enabling cumulative exposure estimation. RESULTS:The UK and the EU explicitly require HRA as a regulatory starting point and link exposure monitoring and medical surveillance to the outcomes of risk assessment, with targeted hazard-based provisions for intrinsically high-risk agents. The US adopts a hybrid approach, imposing mandatory monitoring and medical surveillance for high-hazard substances under 29 Code of Federal Regulations 1910 Subpart Z while relying on general statutory duties elsewhere. Korea applies broad list-based requirements for exposure monitoring and medical surveillance that are largely independent of HRA outcomes and do not include legally mandated variables necessary for systematic cumulative exposure estimation. In contrast, the UK, the EU, and partially the US provide legal mechanisms, including long-term record-keeping provisions, that enable reconstruction of individual cumulative occupational exposure. CONCLUSIONS:Strengthening the integration of HRA, exposure monitoring, and medical surveillance-together with improved record-keeping structures that support cumulative exposure reconstruction-may contribute to more effective occupational disease prevention and long-term medical surveillance in Korea.
