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Smith TG, Lowndes BR, Schmida E, Lund SB, Linden AR, Rivera M, Gas BL, Hallbeck MS. Course Design and Learning Outcomes of a Practical Online Ergonomics Course for Surgical Residents. J Surg Educ 2022; 79:1489-1499. [PMID: 35907697 DOI: 10.1016/j.jsurg.2022.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/23/2022] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Course content was designed and the learning outcomes assessed for an online ergonomics course for surgical residents. This course could fulfill an optional Surgical Council on Resident Education (SCORE) curriculum on Surgical Ergonomics. DESIGN The online course included five 5-minute modules within the residents' learning system, each ending with an ungraded knowledge question, and a final 5-question multiple-choice retention quiz that allowed infinite attempts. The course was designed by ergonomists and surgeons at a quaternary academic hospital system. Participants were given two weeks to complete the modules. An electronic survey with questions assessing ergonomics knowledge and understanding on a 5-point Likert scale (strongly disagree - strongly agree) was distributed both before and after the course. The post-course survey included three additional questions to elicit feedback regarding learning experience and course design. Descriptive statistics and nonparametric paired comparisons were used to evaluate learning outcomes. SETTING General surgery residency program at an academic medical center in the U.S. PARTICIPANTS Twenty-two general surgery post graduate year 1 residents (PGY1s) were recruited to participate and completed the pre-course survey. Eight out of the 22 participants (36%) completed the online course and quiz; seven (32%) completed the course, quiz, and the post-course survey. RESULTS Participants had high pre-course awareness of the importance of surgical ergonomics, benefits of work-related musculoskeletal disorder (WMSD) prevention, as well as awkward intraoperative postures being an WMSD risk factor. Participants' confidence increased significantly from pre- to post-course in ability to assess risk (p = 0.021), but not in ability or willingness to mitigate risky surgical postures. Participants who completed the quiz answered a median of 4 (IQR: [4, 5]) questions correctly. All participants indicated that they would recommend this course to other residents. CONCLUSIONS These short practical ergonomics online learning modules increased surgical residents' confidence in assessing surgical WMSD risks.
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Affiliation(s)
- Tianqi G Smith
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | | | - Elizabeth Schmida
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Sarah B Lund
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anna R Linden
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Mariela Rivera
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Becca L Gas
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - M Susan Hallbeck
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota; Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota; Department of Surgery, Mayo Clinic, Rochester, Minnesota.
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Hong X, Lee YC, Zhou S. Musculoskeletal symptoms and associated factors among manual porcelain workers at different workstations: a cross-sectional study. Int Arch Occup Environ Health 2022. [PMID: 35616711 DOI: 10.1007/s00420-022-01879-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/04/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To investigate the prevalence of work-related musculoskeletal disorders (WMSDs) symptoms and to identify the associated factors (individual, and work-related) among manual porcelain workers at different workstations. The risk level of each workstation was also assessed based on the working postures for the purpose of improving occupational health. METHODS In total, 349 workers were recruited for this cross-sectional study. The Nordic Musculoskeletal Questionnaire (NMQ) was used to collect data on WMSDs symptoms in nine body regions. The relationship between individual/occupational factors and WMSDs symptoms was determined using multiple logistic regression analysis. The Rapid Entire Body Assessment (REBA) method was applied to classify the risk level of working postures at the five workstations (shaping, trimming, glazing, painting, and burning). RESULTS The prevalence of musculoskeletal discomfort in at least one body region within the past 12 months was 69.1% among the participants: the neck (49.3%), lower back (43.8%), and shoulders (27.5%). Sex, work experience, daily working hours, perceived work fatigue, and workstation, were significantly associated with WMSDs symptoms in different body regions. The REBA indicated that 57.8% and 32.5% of the working postures were in the medium- and above high-risk levels, respectively. CONCLUSION The findings of this study showed a high occurrence of WMSDs symptoms among manual porcelain workers and suggested that both individual and work-related characteristics should be considered to improve occupational health. Furthermore, urgent ergonomic intervention is needed to avoid awkward working postures that cause WMSDs symptoms in porcelain workers, particularly at the shaping and burning workstations.
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Yan TL, Zhang CY, Zhu XJ, Niu DS, Xie TT, Ding XW, Liu BL, Li J. [Comparative analysis of work-related musculoskeletal disorders catalogues]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2022; 40:311-315. [PMID: 35545604 DOI: 10.3760/cma.j.cn121094-20210126-00054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Work-related musculoskeletal disorders (WMSDs) refer to musculoskeletal disorders caused by work or work as the main cause, which are characterized by high prevalence and heavy burden of disease as a global problem. The classification and catalog of occupational diseases is of great significance for guiding the prevention and control of occupational diseases and safeguarding the rights and interests of workers. The types of WMSDs included in the list of occupational diseases vary greatly from country to country, and the regulations on specific pathogenic factors are also inconsistent. By sorting out and analyzing the lists and characteristics of WMSDs at home and abroad, and using the International Statistical Classification of Diseases and Related Health Problems (ICD-10) in occupational health to standardize of WMSDs in various countries, which would lay the foundation for future multi-country WMSDs occupational health registration and disease burden research, and provide a reference for China to revise the WMSDs list.
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Affiliation(s)
- T L Yan
- Beijing Institute of Occupational Disease Prevention and Treatment, Beijing 100093, China
| | - C Y Zhang
- School of Public Health, Shanxi Medical University, Taiyuan 030051, China
| | - X J Zhu
- National Center for Occupational Safety and Health, National Health Commission of the People's Republic of China, Beijing 102308, China
| | - D S Niu
- Beijing Institute of Occupational Disease Prevention and Treatment, Beijing 100093, China
| | - T T Xie
- Beijing Institute of Occupational Disease Prevention and Treatment, Beijing 100093, China
| | - X W Ding
- Beijing Institute of Occupational Disease Prevention and Treatment, Beijing 100093, China
| | - B L Liu
- Beijing Institute of Occupational Disease Prevention and Treatment, Beijing 100093, China
| | - J Li
- Beijing Institute of Occupational Disease Prevention and Treatment, Beijing 100093, China
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Kong YK, Cho MU, Park CW, Kim SY, Kim MJ, Moon J, Lim S, Oh BM, Han B, Choi J, Choi KH. Quantification of physical stress experienced by obstetrics and gynecology sonographers: A comparative study of two ultrasound devices. Appl Ergon 2022; 100:103665. [PMID: 34915350 DOI: 10.1016/j.apergo.2021.103665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/11/2021] [Accepted: 12/03/2021] [Indexed: 06/14/2023]
Abstract
This study aims to quantify the stresses of sonographers using two different ultrasound devices, one of conventional and one of ergonomic design. A total of 20 obstetricians and gynecologists participated in this study, and two types of tasks (scanning and positioning) were evaluated while using the two different devices. To quantify workload, four dependent variables (muscle activity, estimated grip force, subjective comfort rating, and task time) were measured. The muscular activity required while using the conventional device was 14.4% MVC (Maximum voluntary contraction) for the scanning task, which was significantly higher than that of the ergonomic device. The subjective comfort rating for the conventional design was lower than that of the ergonomic design. For the positioning task, the ergonomic device (33.2% MVC) resulted in significantly higher muscle activity in the extensor digitorum (ED) and flexor digitorum superficialis (FDS) than the conventional design (22.2% MVC), whereas the deltoid muscle showed significantly lower activity than in users of conventional design (4.5% MVC). Ergonomically-designed ultrasound devices improve ease of moving and the probe's supporters, reduce physical load and increase ease of use for sonographers. Our results may be used as guidelines for usability testing of ultrasound devices.
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Affiliation(s)
- Yong-Ku Kong
- Department of Industrial Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Min-Uk Cho
- Department of Industrial Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Chae-Won Park
- Department of Industrial Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Seoung-Yeon Kim
- Department of Industrial Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Min-Jung Kim
- Department of Industrial Engineering, Sungkyunkwan University, Suwon, South Korea
| | | | | | - Byung-Mo Oh
- Medical Device Usability Testing Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea; National Traffic Injury Rehabilitation Hospital, Yangpyeong, South Korea
| | - Banseok Han
- Medical Device Usability Testing Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - JunHee Choi
- Medical Device Usability Testing Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Kyeong-Hee Choi
- Department of Industrial Engineering, Sungkyunkwan University, Suwon, South Korea.
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Rafeemanesh E, Khooei A, Niroumand S, Shirzadeh T. A study on musculoskeletal complaints and working postures in pathology specialists in Iran. BMC Musculoskelet Disord 2021; 22:1012. [PMID: 34861852 PMCID: PMC8642988 DOI: 10.1186/s12891-021-04870-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/15/2021] [Indexed: 11/22/2022] Open
Abstract
Background Musculoskeletal disorders (MSDs) are one of the most common causes of occupational injuries and disabilities among health care workers. This study investigates the relationship between musculoskeletal complaints and pathologist postures in laboratories. Method In this cross-sectional study, 40 pathologists were evaluated. MSDs in different body segments of the participants were evaluated by Nordic questionnaire. For postural analysis, 20 min film was recorded while using a microscope by subjects. Posture analysis was done by the Rapid Upper Limb Assessment (RULA) method and their repetitive movements were scored. The data was analyzed by SPSS Version 11.5. Results The mean age and duration of employment of subjects was 36.57 ± 7.54 years and 6.50 ± 6.30 years, respectively. Most MSDs were found in neck (65%), wrist (57.5%), upper back (50%) and lower back (47.5%). The mean RULA grand score was higher in participants with upper back and shoulder pain. A statistically significant relationship was found between the mean RULA grand, the upper back pain (P = 0.02) and the wrist pain (P = 0.003), as well as between the mean RULA B, the neck pain (P = 0.02) and the lower back pain (P = 0.05). The results showed a significant relationship between mean weekly working hours and tight (P < 0.001), wrist (p = 0.01) and ankle (P = 0.008). Conclusion This study revealed high prevalence of MSDs among the pathologists. Therefore, performing ergonomic corrective actions is essential in order to improve their physical conditions at work.
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Affiliation(s)
- Ehsan Rafeemanesh
- Department of Occupational Medicine, Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Khooei
- Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shabnam Niroumand
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Tina Shirzadeh
- Occupational Medicine Department, Faculty of Medicine, Mashhad University of Medical Sciences, Azadi Square. Mashhad, Pardis, Iran.
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Barbe MF, Hilliard B, Fisher PW, White AR, Delany SP, Iannarone VJ, Harris MY, Amin M, Cruz GE, Popoff SN. Blocking substance P signaling reduces musculotendinous and dermal fibrosis and sensorimotor declines in a rat model of overuse injury. Connect Tissue Res 2020; 61:604-619. [PMID: 31443618 PMCID: PMC7036028 DOI: 10.1080/03008207.2019.1653289] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose/Aim: Substance P-NK-1R signaling has been implicated in fibrotic tendinopathies and myositis. Blocking this signaling with a neurokinin 1 receptor antagonist (NK1RA) has been proposed as a therapeutic target for their treatment.Materials and Methods: Using a rodent model of overuse injury, we pharmacologically blocked Substance P using a specific NK1RA with the hopes of reducing forelimb tendon, muscle and dermal fibrogenic changes and associated pain-related behaviors. Young adult rats learned to pull at high force levels across a 5-week period, before performing a high repetition high force (HRHF) task for 3 weeks (2 h/day, 3 days/week). HRHF rats were untreated or treated in task weeks 2 and 3 with the NK1RA, i.p. Control rats received vehicle or NK1RA treatments.Results: Grip strength declined in untreated HRHF rats, and mechanical sensitivity and temperature aversion increased compared to controls; these changes were improved by NK1RA treatment (L-732,138). NK1RA treatment also reduced HRHF-induced thickening in flexor digitorum epitendons, and HRHF-induced increases of TGFbeta1, CCN2/CTGF, and collagen type 1 in flexor digitorum muscles. In the forepaw upper dermis, task-induced increases in collagen deposition were reduced by NK1RA treatment.Conclusions: Our findings indicate that Substance P plays a role in the development of fibrogenic responses and subsequent discomfort in forelimb tissues involved in performing a high demand repetitive forceful task.
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Affiliation(s)
- MF Barbe
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, United States
| | - B Hilliard
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, United States
| | - PW Fisher
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, United States
| | - AR White
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, United States
| | - SP Delany
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, United States
| | - VJ Iannarone
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, United States
| | - MY Harris
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, United States
| | - M Amin
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, United States
| | - GE Cruz
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, United States
| | - SN Popoff
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, United States
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Smith TTG, Barr-Gillespie AE, Klyne DM, Harris MY, Amin M, Paul RW, Cruz GE, Zhao H, Gallagher S, Barbe MF. Forced treadmill running reduces systemic inflammation yet worsens upper limb discomfort in a rat model of work-related musculoskeletal disorders. BMC Musculoskelet Disord 2020; 21:57. [PMID: 32000751 PMCID: PMC6993343 DOI: 10.1186/s12891-020-3085-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 01/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Musculoskeletal disorders can result from prolonged repetitive and/or forceful movements. Performance of an upper extremity high repetition high force task increases serum pro-inflammatory cytokines and upper extremity sensorimotor declines in a rat model of work-related musculoskeletal disorders. Since one of the most efficacious treatments for musculoskeletal pain is exercise, this study investigated the effectiveness of treadmill running in preventing these responses. METHODS Twenty-nine young adult female Sprague-Dawley rats were used. Nineteen were trained for 5 weeks to pull a lever bar at high force (15 min/day). Thirteen went on to perform a high repetition high force reaching and lever-pulling task for 10 weeks (10-wk HRHF; 2 h/day, 3 days/wk). From this group, five were randomly selected to undergo forced treadmill running exercise (TM) during the last 6 weeks of task performance (10-wk HRHF+TM, 1 h/day, 5 days/wk). Results were compared to 10 control rats and 6 rats that underwent 6 weeks of treadmill running following training only (TR-then-TM). Voluntary task and reflexive sensorimotor behavioral outcomes were assessed. Serum was assayed for inflammatory cytokines and corticosterone, reach limb median nerves for CD68+ macrophages and extraneural thickening, and reach limb flexor digitorum muscles and tendons for pathological changes. RESULTS 10-wk HRHF rats had higher serum levels of IL-1α, IL-1β and TNFα, than control rats. In the 10-wk HRHF+TM group, IL-1β and TNFα were lower, whereas IL-10 and corticosterone were higher, compared to 10-wk HRHF only rats. Unexpectedly, several voluntary task performance outcomes (grasp force, reach success, and participation) worsened in rats that underwent treadmill running, compared to untreated 10-wk HRHF rats. Examination of forelimb tissues revealed lower cellularity within the flexor digitorum epitendon but higher numbers of CD68+ macrophages within and extraneural fibrosis around median nerves in 10-wk HRHF+TM than 10-wk HRHF rats. CONCLUSIONS Treadmill running was associated with lower systemic inflammation and moderate tendinosis, yet higher median nerve inflammation/fibrosis and worse task performance and sensorimotor behaviors. Continued loading of the injured tissues in addition to stress-related factors associated with forced running/exercise likely contributed to our findings.
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Affiliation(s)
- Tianqi Tenchi Gao Smith
- Department of Industrial and Systems Engineering, Auburn University, 3323 Shelby Engineering Center, Auburn, AL 36849 USA
- Department of Systems Science and Industrial Engineering, SUNY – Binghamton, Vestal, NY USA
| | - Ann E. Barr-Gillespie
- College of Health Professions, Pacific University, 190 S.E. 8th Avenue, Suite 230, Hillsboro, OR 97123 USA
| | - David M. Klyne
- Department of Anatomy and Cell Biology, Temple University Medical School, 3500 North Broad Street, Philadelphia, PA 19140 USA
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4072 Australia
| | - Michelle Y. Harris
- Department of Anatomy and Cell Biology, Temple University Medical School, 3500 North Broad Street, Philadelphia, PA 19140 USA
| | - Mamta Amin
- Department of Anatomy and Cell Biology, Temple University Medical School, 3500 North Broad Street, Philadelphia, PA 19140 USA
| | | | - Geneva E. Cruz
- Department of Anatomy and Cell Biology, Temple University Medical School, 3500 North Broad Street, Philadelphia, PA 19140 USA
| | - Huaqing Zhao
- Department of Clinical Sciences, Temple University Medical School, 3440 North Broad Street, Philadelphia, PA 19140 USA
| | - Sean Gallagher
- Department of Industrial and Systems Engineering, Auburn University, 3323 Shelby Engineering Center, Auburn, AL 36849 USA
| | - Mary F. Barbe
- Department of Anatomy and Cell Biology, Temple University Medical School, 3500 North Broad Street, Philadelphia, PA 19140 USA
- Anatomy and Cell Biology, Lewis Katz School of Medicine at Temple University, 3500 North Broad Street, Philadelphia, PA 19140 USA
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Lee JG, Kim GH, Jung SW, Kim SW, Lee JH, Lee KJ. The association between long working hours and work-related musculoskeletal symptoms of Korean wage workers: data from the fourth Korean working conditions survey (a cross-sectional study). Ann Occup Environ Med 2018; 30:67. [PMID: 30524733 PMCID: PMC6276142 DOI: 10.1186/s40557-018-0278-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 11/08/2018] [Indexed: 11/19/2022] Open
Abstract
Background It has been reported that long working hours are hazardous to the workers’ health. Especially, work-related musculoskeletal disorders (WMSDs) have been considered as one of the significant health issues in workplace. The objective of this study was to identify the association between long working hours and work-related musculoskeletal symptoms. Methods The analysis was conducted using data from the Fourth Korean Working Conditions Survey (KWCS). Subjects of this study were 24,783 wage workers and divided into three groups according to the weekly working hours, which were ≤ 40, 41–52 and > 52 h. The relationship between long working hours and work-related musculoskeletal symptoms was analyzed by multivariate logistic regression method after adjusting for general, occupational characteristics including specific working motions or postures and psychosocial factors. Results Approximately 18.4% of subjects worked more than 52 h per week and 26.4 and 16.4% of male subjects and 33.0 and 23.4% of female subjects experienced work-related upper and lower limb pains, respectively, over the last 12 months. Moreover, the prevalence of upper and lower limb pain was increased in both genders as the weekly working hours increased. The odds ratios (ORs) of upper limb pain for those working 41–52 h and more than 52 h per week when adjusted for general, occupational characteristics including specific motions or postures and psychosocial factors were 1.36 and 1.40 for male workers and 1.26 and 1.66 for female workers compared to the reference group, respectively. Furthermore, ORs of lower limb pain for the same weekly working hour groups were 1.26 and 1.47 for male workers and 1.20 and 1.47 for female workers, respectively. Conclusions Long working hours were significantly related to work-related musculoskeletal symptoms in Korean wage workers and appropriate interventions should be implemented to reduce long working hours that can negatively affect workers’ health.
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Affiliation(s)
- Jae-Gwang Lee
- Department of Occupational and Environmental Medicine, Soonchunhyang University Hospital, Seoul, South Korea
| | - Guang Hwi Kim
- Department of Occupational and Environmental Medicine, Soonchunhyang University Hospital, Seoul, South Korea
| | - Sung Won Jung
- Department of Occupational and Environmental Medicine, Soonchunhyang University Hospital, Seoul, South Korea
| | - Sang Woo Kim
- Department of Occupational and Environmental Medicine, Soonchunhyang University Hospital, Seoul, South Korea
| | - June-Hee Lee
- Department of Occupational and Environmental Medicine, Soonchunhyang University Hospital, Seoul, South Korea
| | - Kyung-Jae Lee
- Department of Occupational and Environmental Medicine, Soonchunhyang University Hospital, Seoul, South Korea
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