Jungwon Kim

Prophylactic dexamethasone decreases the incidence of sore throat and hoarseness after tracheal extubation with a double-lumen endobronchial tube.

BACKGROUND:Postoperative sore throat and hoarseness are common complications after tracheal intubation, particularly after using a double-lumen endobronchial tube (DLT). We conducted a prospective, randomized, double-blind, placebo-controlled study to evaluate the efficacy of dexamethasone for reducing the incidence and severity of postoperative sore throat and hoarseness. METHODS:One hundred sixty-six patients (aged 18–75 yr) scheduled for thoracic surgery with a DLT were enrolled. Before induction of general anesthesia, 0.1 mg/kg dexamethasone (Group D1), 0.2 mg/kg dexamethasone (Group D2), or a placebo (Group P) were infused IV in a double-blind and prospectively randomized manner. Glottic exposure as defined by Cormack and Lehane score, resistance to DLT insertion, number of intubation attempts, time to achieve intubation, and the duration of tracheal intubation were recorded. At 1 h and 24 h after tracheal extubation, the patients were evaluated for sore throat and hoarseness using a visual analog scale (VAS; where 0 = no pain and 100 = worst pain imaginable). RESULTS:One hour after tracheal extubation, the incidence of postoperative sore throat and hoarseness, along with the severity of sore throat were lower in Group D1 (31%, P = 0.021; 11%, P = 0.003; and VAS 12.4, P < 0.001, respectively) and D2 (11%, P = 0.001; 4%, P = 0.001; and VAS 6.6, P < 0.001, respectively) compared with Group P (53%, 36% and VAS 30.9, respectively). Twenty-four hours after tracheal extubation, the incidence of postoperative sore throat, hoarseness, and the severity of sore throat were significantly lower in Group D2 (27%, P = 0.002; 15%, P = 0.001; and VAS 29.9, P < 0.002, respectively) compared with Group D1 (47%, 31%, and VAS = 43.9, respectively) and Group P (57%, 45%, and VAS = 51.3, respectively). There was no complication associated with the dexamethasone administration. CONCLUSION:The prophylactic use of 0.2 mg/kg of dexamethasone significantly decreases the incidence and severity of sore throat and hoarseness 1 h and 24 h after tracheal extubation of a DLT.

The Influence of Head and Neck Position on the Oropharyngeal Leak Pressure and Cuff Position of Three Supraglottic Airway Devices

BACKGROUND: With supraglottic airway devices, such as the laryngeal tube suction (LTS), ProSeal laryngeal mask airway (PLMA) and Cobra perilaryngeal airway (CobraPLA), oropharyngeal leak pressure or cuff position may vary according to changes in the position of the head and neck. We evaluated oropharyngeal leak pressure and cuff pressure of the PLMA, LTS, and CobraPLA in different head and neck positions. METHODS: One-hundred-thirty-nine patients (aged 18-70 yr) scheduled for minor surgical procedures were randomly allocated to one of the supraglottic airway devices. Oropharyngeal leak pressure and cuff pressure were evaluated in four head and neck positions: neutral, 45° of flexion, 45° of extension, and 45° of right rotation. Adverse events (i.e., difficulty in ventilation or gastric insufflation) were assessed during the study. RESULTS: Leak pressures of the PLMA were lowest in the extension (18.5 vs 23.9 and 26.8 cm H2O of LTS and CobraPLA, respectively; P < 0.001) and in the rotation position (25.0 vs 29.4 and 28.5 cm H2O of LTS and CobraPLA, respectively; P < 0.005). With the CobraPLA, gastric insufflations occurred before the oropharyngeal leak in 37 of 45 patients. There were ventilatory difficulties in seven patients with LTS after neck flexion, which required tracheal intubation. CONCLUSIONS: The PLMA showed significantly lower oropharyngeal leak pressures than did the LTS or CobraPLA in the neck extension and rotation positions. Caution is warranted when changing the position of the head and neck when using the Cobra-PLA or LTS as gastric insufflation or ventilatory difficulty may occur.

Occupational Lung Cancer Surveillance in South Korea, 2006-2009

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.

Relationship between Occupational Stress and Gastric Disease in Male Workers

Background Physical and mental health of workers is threatened due to various events and chronic occupational stress. This study was conducted to investigate the relationship between occupational stress and gastric disease in male workers of the shipbuilding industry. Methods Occupational stress measured among a total of 498 workers of a shipbuilding firm who visited the hospital for health examination using the Korean Occupational Stress Scale (KOSS)-short form, and the relationship between sociodemographic factors, health-related behaviors, occupational stress, and gastric disease, and the distribution of occupational stress by sociodemographic factors in the gastric disease group was examined. Results There was no significant association between gastric disease and total occupational stress score and its seven sub-factors. The analysis showed that risk of gastric disease was significantly higher in the Q1 group in which the stress caused by occupational discomfort among seven sub-factors was lowest than that in the Q4 group (odds ratio, 2.819; 95% confidence interval, 1.151 to 6.908). Analysis only on the gastric disease group showed that the stress score of laborers was higher in the four sub-factors than that of office workers (P < 0.05). Analysis on educational background showed that the scores of the three sub-factors were lower in subjects whos highest level of education was high school (P < 0.01). Conclusion This study suggests that it is necessary to improve the culture of Korean collectivism in the workplace and to manage the occupational stress in the low-educated and laborers. It is recommended for future studies to confirm the causal relationship between occupational stress and gastric disease by large scale studies using a KOSS which appropriately reflects workplace culture.

Risk factors of musculoskeletal symptoms in university hospital nurses.

ObjectivesThe purpose of this study was to investigate musculoskeletal symptom prevalence in university hospital nurses and explore the relation between musculoskeletal symptom prevalence and work related factors.MethodsA structured questionnaire was conducted with 620 nurses in a university hospital to look into the characters of responsibility and musculoskeletal symptom prevalence. The questionnaire respondents numbered 534, so the response rate was 86.1%. Among the respondents, three who gave insincere answers were excluded. The final study population was 531 respondents. ANSI Z-365 checklist was applied to look into ergonomic characteristics, and Korean Occupational Stress Scale Short Form was employed to measure job stress.ResultsIn the case of the whole body, symptom prevalence amounted to 70.8%. Regarding each body region, shoulder symptom prevalence accounted for the highest, or 44.8%, waist 40.7%, and neck 33.3% in order. According to multiple logistic regression analysis, in the case of the whole body, the group with a high ANSI checklist grade had odds ratio of 3.59 (95% CI 1.48 ~ 8.76), and the group with high job stress had 3.19 (95% CI 2.01 ~ 5.07).ConclusionRegarding the occupational factors related to musculoskeletal symptoms of university hospital nurses, it was found that ANSI Z-365 checklist high risk group, total job tenure, department, shiftworks, and job stress had high relation with musculoskeletal symptoms. It is necessary to find an ergonomic solution and a stress reduction plan to prevent musculoskeletal disease.

Study of the Relation Between Work-Related Musculoskeletal Disorders · Psychiatric Disorders and Job Stress in Train Drivers

Work related musculoskeletal disorders (WMSDs) have become a hot issue within the Korean workplace for the past several years. Recently, the effect of job related stress on WMSDs, cerebro-cardiovascular diseases, and psychiatric disorders has been steadily increasing. The study conducted questionnaire of Korea version job stress model, WMSDs from NIOSH, CES-D (Center for Epidemiologic Studies Depression Scale), and STAI (State-Trait Anxiety Inventory) against train drivers. The results of this study show that the job stress score of the train drivers is high in the areas of physical environment, job latitude, interpersonal conflict, job insecurity, and organization system. The relation between job stress and WMSDs represented statistical significance in the areas of job demand, interpersonal conflict, job insecurity and organizational system. The relation between job stress and depressive disorders showed statistical significance in the areas of job demand, job insecurity and low reward. Finally, the relation between job stress and anxiety disorders showed statistical significance in areas of job demand, interpersonal conflict, job insecurity, organizational system and low reward.

Regional Frequency Analysis of South Korean Rainfall Data Using FORGEX Method

Rainfall quantiles were estimated by applying the FORGEX method. The circle network and two elliptical ones with the ratios of 1 to 1.5 and 1 to 2.0 were used and compared to find appropriate one for rainfall data. Annual maximum data were collected from 376 sites and standardized by the median. The networks were organized from the subject sites and then pooled and netmax data were collected from each network. Then, the growth curves and quantiles were estimated. When the subject site had small differences of quantiles from index flood method and at-site frequency analysis, those of the estimated quantiles from circle and elliptical networks were small. In contrast, the sites where the quantile differences are big have big differences of quantiles from circle and elliptical networks. The estimated quantiles from the elliptical network are more accurate than those from the circle network, because the ellipse network contains more sites in South Korea. Moreover, the ellipse with ratio of 1 to 2.0 shows closer quantiles to those from index flood method than one with ratio of 1 to 1.5. It is, therefore, found that the FORGEX method with 1 to 2.0 ellipse network is appropriate regional frequency analysis in South Korea.

The Effects of an Online Mind-Body Training Program on Stress, Coping Strategies, Emotional Intelligence, Resilience and Psychological State

The goal of this study was to evaluate the effects of an online mind-body training (MBT) program on participants’ stress, anger, coping strategies, emotional intelligence, resilience, and positive and negative affect. Forty-two healthy women participated in an online MBT program for approximately 8–10 minutes a day for 8 weeks; a control group of 45 healthy women did not participate in the program. Self-report psychological questionnaires were administered before the beginning of the program and at 4 and 8 weeks following its onset. Data from the MBT group and the control group were compared using repeated measures ANOVA and Student’s t-tests. Significant time x group interaction effects were found with respect to stress, coping strategies, anger, emotional intelligence, negative affect and resilience. These results demonstrate beneficial effects of the online MBT program and significant improvements in the psychological capabilities of participants compared with the control group. The effects of online MBT program were similar with those of the previous offline MBT in psychological aspects, suggesting further studies for neuroscientific evidence related stress and emotion of online MBT effects.

Physical Agents and Occupational Disease Compensation: Noise, Vibration, Radiation, and Other Physical Agents

The context of specific criteria for the recognition of occupational diseases (ODs) due to physical agents in the Enforcement Decree of the Industrial Accident Compensation Insurance Act (ED-IACIA) and the Labor Standard Act (LSA) does not describe definite disease along with the agents but listed symptoms or obscure clinical conditions. Moreover, the needs for an amendment of these Acts have recently attracted renewed interest. To establish agreed criteria for compensable ODs due to physical agents, we reviewed the criteria for recognizing ODs on the basis of International Labor Organization (ILO) documents and European Union (EU) guideline. After providing a brief review of the history of OD outbreaks due to physical exposure in South Korea and the responses to them, we describe the basis for the recent amendments to the IACI Act and LSA and assess their appropriateness. On the basis of these findings, this study could be helpful for determining and compensating process of ODs. However, further work is required to ascertain the scientific relationship between diseases caused by physical agents and the exposure criteria. Graphical Abstract

Review of carcinogenicity of hexavalent chrome and proposal of revising approval standards for an occupational cancers in Korea

BackgroundThe objective of this study is to suggest revised recognition standards for occupational disease due to chromium (VI) by reflecting recent domestic and international research works and considering domestic exposure status with respect to target organs, exposure period, and cumulative exposure dose in relation to the chromium (VI)-induced occupational disease compensation.MethodsIn this study, the reports published by major international institutions such as World Health Organization (WHO) International Agency for Research on Cancer (IARC) (2012), Occupational Safety and Health Administration (OSHA) (2006), National Institute for Occupational Safety and Health (NIOSH) (2013), American Conference of Governmental Industrial Hygienists (ACGIH) (2004), National Toxicology Program (NTP) (2014), and Agency for Toxic Substances and Disease Registry (ASTDR) (2012) were reviewed and the recent research works searched by PubMed were summarized.ResultsConsidering the recent research works and the domestic situation, only lung cancer is conserved in the legislative bill in relation to chromium (VI), and the exposure period is not included in the bill. Nasal and paranasal sinus cancer was excluded from the list of cancers that are compensated as the chromium (VI)- induced occupational disease, while lung cancer remains in the list. In the view of legislative unity, considering the fact that only the cancers having sufficient evidence are included in the conventional list of cancers compensated as occupational disease, nasal and paranasal sinus cancer having limited evidence were excluded from the list.The exposure period was also removed from the legislative bill due to the insufficient evidence. Recent advices in connection with cumulative exposure dose were proposed, and other considerable points were provided with respect to individual occupational relevance.ConclusionsIt is suggested that the current recognition standard which is “Lung cancer or nasal and paranasal sinus cancer caused by exposure to chromium (VI) or compounds thereof (exposure for two years or longer), or nickel compounds” should be changed to “Lung cancer caused by exposure to chromium (VI) or compounds thereof, and lung cancer or nasal and paranasal sinus cancer caused by exposure to nickel compounds”.