Won-Ju Park

Coronary artery atherosclerosis associated with shift work in chemical plant workers by using coronary CT angiography

Objectives The aim of this study was to investigate whether shift work is related to elevated risk of coronary artery disease (CAD) by determining the coronary artery calcium (CAC) score and the presence of coronary artery stenosis by using coronary artery CT angiography (CCTA). Methods In this study, 110 male workers participated and underwent a CCTA examination for CAC scoring, which represents coronary artery plaque, and were evaluated for luminal stenosis. All of the participants were working in the same chemical plant, of whom 70 worked day shifts and 40 worked rotating shifts. Results In a multivariate logistic regression analysis, including age, smoking status, alcohol consumption, regular exercise and waist circumference, shift work was associated with a 2.89-fold increase in the odds of developing coronary plaque compared with day work (OR, 2.89; 95% CI 1.07 to 7.82). The association between shift work and coronary plaque was strong after adjustment for age, low-density lipoprotein cholesterol, hypertension and diabetes mellitus (OR, 2.92; 95% CI 1.02 to 8.33). In addition, the number of years of shift work employment was associated with coronary plaque. However, no association was found between shift work and coronary artery stenosis. Conclusions Shift work could induce CAD onset via the atherosclerotic process, and shift work employment duration was associated with an increased risk of atherosclerosis in male workers.

Occupational Lead Exposure from Indoor Firing Ranges in Korea

Military personnel often use ammunitions that contain lead. The present study aimed to identify the risks for lead exposure and lead poisoning among workers at indoor firing ranges. A special health examination, including blood lead level (BLL) testing, was performed for all 120 workers at the indoor firing ranges of the Republic of Korea’s Air Force, Navy, and Armed Forces Athletic Corps. The overall mean BLL was 11.3 ± 9.4 µg/dL (range: 2.0–64.0 µg/dL). The arithmetic mean of the BLL for professional shooters belong to Armed Forces Athletic Corps was 14.0 ± 8.3 µg/dL, while those of shooting range managers and shooting range supervisors were 13.8 ± 11.1 µg/dL and 6.4 ± 3.1 µg/dL, respectively. One individual had a BLL of 64 µg/dL, and ultimately completed chelation treatment (with CaNa2-ethylenediaminetetraacetic acid) without any adverse effects. These findings indicate that indoor firing range workers are exposed to elevated levels of lead. Therefore, when constructing an indoor firing range, a specialist should be engaged to design and assess the ventilation system; and safety guidelines regarding ammunition and waste handling must be mandatory. Moreover, workplace environmental monitoring should be implemented for indoor firing ranges, and the workers should undergo regularly scheduled special health examinations.

Analysis of the change of health status among the republic of Korea air force soldiers during military service.

Objectives: The aim of this study was to investigate whether the health status of Republic of Korea Air Force (ROKAF) soldiers changed after one year of military service. Methods: We selected 483 ROKAF soldiers from the 11 749 recruits who participated in the 2011 physical examination. The selected soldiers underwent another physical examination in 2012 for advancement to senior airman. Data from 2011 and 2012 were merged. To collect data on lifestyle, a questionnaire was sent to all included subjects via the military intranet e-mail service. Results: The percentage of recruits with an abnormal alanine transaminase level (normal range <40 IU/L) decreased from recruitment (13.7%) to the following year (2.7%). Moreover, the percentage of obese soldiers (body mass index ≥25 kg/m2) decreased from recruitment (20.5%) to the following year (10.4%). There was a significant change in mean duration of exercise carried out each day before (0.8±1.3 hours) and after (1.0±0.7 hours) joining the ROKAF service. Conclusions: These ROKAF soldiers were generally in good health before and after joining the armed service. After one year of military service, the health status of most soldiers improved, especially with respect to body mass index and alanine transaminase level.

Seroprevalence of Respiratory Syncytial Virus IgG among Healthy Young Adults in Basic Training for the Republic of Korea Air Force

This investigation enrolled 570 healthy young males gathered from all over the country for military service at the Republic of Korea Air Force boot camp. It confirmed RSV IgG seroprevalence by utilizing the enzyme immunoassay method just prior to undergoing basic training. The mean age of this study was 20.25±1.34 yr old. The results of their immunoassay seroprofiles showed that 561 men (98.4%) were positive, 2 (0.4%) were negative and 7 (1.2%) were equivocal belonging to the grey zone. It was confirmed that RSV is a common respiratory virus and RSV infection was encountered by almost all people before reaching adulthood in Korea. Nine basic trainees belonging to the RSV IgG negative and equivocal grey zone categories were prospectively observed for any particular vulnerability to respiratory infection during the training period of two months. However, these nine men completed their basic training without developing any specific respiratory illness. Graphical Abstract

Patent foramen ovale and asymptomatic brain lesions in military fighter pilots

BACKGROUND AND PURPOSE Previous studies have reported higher incidence of white matter lesions (WMLs) in military pilots. The anti-gravity straining maneuver, which fighter military pilots perform numerously during a flight is identical to the valsalva maneuver. We sought to investigate the prevalence of right-to-left shunt (RLS) associated with WMLs in military pilots. METHODS A prospective study was performed involving military pilots who visited the Airomedical Center. The pilots underwent brain magnetic resonance imaging (MRI) scan and transcranial Doppler (TCD) with intravenous injection of agitated saline solution for the detection of RLS. Periventricular WMLs (PVWMLs) on MRI were graded using Fazekas scale, and deep WMLs (DWMLs) were graded using Scheltenss scale. RESULTS This study included 81 military pilots. RLS on TCD was observed less frequently in non-fighter pilots than in fighter pilots (35.5% vs. 64.5%, p=0.011). Fighter pilot was an independently associated factor with RLS on the TCD. DWMLs were independently associated with RLSs through a patent foramen ovale (PFO) (OR 3.507, 95% CI 1.223-10.055, p=0.02). CONCLUSION The results suggest that DWMLs in military pilots may significantly be associated with RLS via PFO. Additional investigations are warranted.

Blood Lead Level and Types of Aviation Fuel in Aircraft Maintenance Crew

INTRODUCTION This study inquired into any significant difference in blood lead levels (BLLs) among aircraft maintenance crews at the air-bases, each with a different aviation fuel in use, and confirmed an environmental impact of leaded aviation gasoline (AVGAS). METHODS This study included a total of 256 male aircraft maintenance personnel, among whom 105 used only AVGAS as their aviation fuel, while 151 used only jet propellant 8 (JP-8), a kerosene variety. BLLs were measured and the data on related factors were obtained. RESULTS The arithmetic and geometric means of BLLs of the personnel at the airbases that used only AVGAS were 4.20 microg x dl(-1) and 4.01 microg x dl(-1) and that used only JP-8 were 3.79 microg x dl(-1) and 3.57 microg x dl(-1), respectively. The BLLs of the maintenance crew of the main workspace that was located within a 200-m distance from the runway were higher than those of the main workspace that was located 200 m or farther from the runway. The longer the work hours in the runway or the longer the work duration, the higher the BLLs of the maintenance crew. DISCUSSION This investigation exposed the fact that a bodys BLL could be increased by AVGAS emissions through the examination of aircraft maintenance crew. This result is in agreement with results of previous studies that suggest proximity to an airport may be associated with elevated BLLs for adults and children. Collectively, the results of the current study and previous research suggest that long-duration inhabitation and/or activities in close proximity to an air facility should be limited given that lead poses known health risks.

Lead Poisoning at an Indoor Firing Range

In March 2014, a 39-year-old Korean male presented with a 6-month history of various nonspecific symptoms including dizziness, fatigue, asthenia, irritability, elevated blood pressure, palpitation, eyestrain, and tinnitus. His occupational history revealed that he had been working as an indoor firing range manager for 13 months; therefore, he was subjected to a blood lead level (BLL) test. The test results showed a BLL of 64 µg/dL; hence, he was diagnosed with lead poisoning and immediately withdrawn from work. As evident from the workplace environmental monitoring, the level of lead exposure in the air exceeded its limit (0.015–0.387 mg/m3). He received chelation treatment with calcium-disodium ethylenediaminetetraacetic acid (1 g/day) for 5 days without any adverse effects. In the follow-up results after 2 months, the BLL had decreased to 9.7 µg/dL and the symptoms resolved. This report represents the first occupational case of lead poisoning in firing ranges in Korea, and this necessitates institutional management to prevent the recurrence of poisoning through this route. Workplace environmental monitoring should be implemented for indoor firing ranges, and the workers should undergo regularly scheduled special health examinations. In clinical practice, it is essential to question the patient about his occupational history.

Author response: Coronary artery atherosclerosis associated with shift work in chemical plant workers by using coronary CT angiography

We deeply appreciate the comments and suggestions from Rahman Shiri, MD, PhD. In South Korea, general health check-ups are performed by companies according to their labour management agreement. In this study, coronary artery CT angiography (CCTA) was the investigation specified by the labour management agreement. Prior to the test, the participants in this study were interviewed by a clinician. If the participants had any cardiovascular symptoms or a history of cardiovascular disease, they were transferred to specialist cardiology care and excluded from CCTA. Furthermore, the general population in South Korea can undergo self-referred CCTA evaluation as a general health examination regardless of having a clinical …

Changes in the mean hearing threshold levels in military aircraft maintenance conscripts

ABSTRACT Aircraft maintenance crews are constantly exposed to severe aircraft noise. The purpose of this study was to verify whether noise from aircraft adversely affects the hearing threshold levels (HTLs) of aircraft maintenance conscripts during their 2 years of mandatory military service. This study included 3,000 male aircraft maintenance conscripts who work in the military runway area. We measured and analyzed HTLs at 2–4 kHz. The duration of exposure to noise increased with an increase in rank; however, HTLs showed a tendency to decrease. We attributed such contradicting results to the learning effect and adaptation to military service. However, we suspected that sudden deafness in 6 conscripts (0.2%) was due to loud noise in the runway area during military service. The effectiveness of the hearing conservation program for short-term military service personnel could be increased by focusing on preventing sudden deafness and preenlistment baseline audiogram tests.

Respiratory Syncytial Virus Outbreak in the Basic Military Training Camp of the Republic of Korea Air Force

Objectives: An outbreak of acute febrile illness occurred in the Republic of Korea Air Force boot camp from May to July 2011. An epidemiological investigation of the causative agent, which was of a highly infective nature, was conducted. Methods: Throat swabs were carried out and a multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) assay was performed to identify possible causative factors. Results: The mean age of patients who had febrile illness during the study period was 20.24 years. The multiplex RT-PCR assay identified respiratory syncytial virus (RSV) as the causative agent. The main symptoms were sore throat (76.0%), sputum (72.8%), cough (72.1%), tonsillar hypertrophy (67.9%), and rhinorrhea (55.9%). The mean temperature was 38.75°C and the attack rate among the recruits was 15.7% (588 out of 3750 recruits), while the mean duration of fever was 2.3 days. The prognosis was generally favorable with supportive care but recurrent fever occurred in 10.1% of the patients within a month. Conclusions: This is the first epidemiological study of an RSV outbreak that developed in a healthy young adult group. In the event of an outbreak of an acute febrile illness of a highly infective nature in facilities used by a young adult group, RSV should be considered among the possible causative agents.