OCCUCON 2022 ABSTRACTS
|Year : 2022 | Volume
| Issue : 1 | Page : 34-48
OCCUCON 2022 Abstracts
|Date of Web Publication||7-Apr-2022|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. OCCUCON 2022 Abstracts. Indian J Occup Environ Med 2022;26:34-48
| Respiratory & hypersensitivity profiling among farmers with pesticide exposure: field- based, cross-sectional study|| |
Nivetha R, Angelin R.G, Muhammed K, Arun S
Introduction: Farmers use pesticides and fertilizers to increase their crop's yield. Pesticides are chemical agents which are potentially toxic to humans and can have both short and long-term effects on health. The effect depends on the quantity, modality of exposure and the use of personal protective equipment. Studies show that the most common health impact of pesticides is respiratory morbidity. This study focuses on identifying the prevalence & clinical profiling of the farmers exposed to pesticides.
Objectives: To assess clinical status and pulmonary function among farmers exposed to pesticides, and to determine the prevalence of respiratory morbidities among farmers residing in rural areas of Puducherry.
Materials and methods: A community-based cross-sectional study was conducted among the farmers residing in rural areas of Puducherry. The sample size was estimated to be 97. Subjects were identified by simple random sampling. Data was collected using a pilot-tested semi-structured questionnaire. Clinical examination and pulmonary function was assessed over a period of two months. The data was analysed using SPSS v16. Data was described using frequencies and proportions. Correlation was used to identify associations.
Results: Among the 110 study participants, 60 (54.5%) were males. The mean age of the study participants was 52 ±12 years. More than two-thirds of our participants had a moderate to severe exposure to pesticides. Mean exposure was over 51.64 ± 45.5 years. 40 (36.4%) participants had pre-existing respiratory morbidity. 58% of farmers had restrictive pulmonary function status and 26% had mixed restrictive – obstructive pulmonary function status. Among the persons with high exposure period, most of them had a restrictive pulmonary function status. 29% of the participants experienced allergic reaction on exposure to pesticides. Dermatological manifestations were identified in more than half of the farmers with moderate and high exposure period.
Conclusion: In rural Puducherry, more than two-thirds of the farmers had moderate to severe occupational exposure to pesticides. One-third of the farmers had pre-diagnosed respiratory morbidities and more than three-fourths had modified respiratory function status. Nearly one-third of farmers experienced allergic reactions on exposure to pesticides.
Recommendation: Ensuring the mandatory supply of PPE on sale of pesticides. Behaviour change communication via peer educator system can enhance the use of PPE and the use of integrated pest management techniques.
Keywords: pesticide exposure, farmer, pulmonary function test, hypersensitivity
| An occupational analysis on wooden toy maker's visual and ocular symptoms and requirements of prescription safety eye wear|| |
Rupa Nivethikka, Syed Ibrahim, Ishwarya Sureshkumar, Janani Suresh, Rashima Asokan
Introduction: Handicraft workers in wood and related materials apply traditional techniques like seasoning, impregnation to prepare wood, straw, clay, shells, and other materials. They carve, mould, assemble, weave, or paint and decorate various articles.
Objective: To understand the visual demand, arrive at vision standards, and provide appropriate safety eye wear for the wooden toy handicraft artisans.
Materials and methods: A cross-sectional observational study was done on artisans involved in wooden toy making. Visual Task Analysis (VTA) was done using Grundy's Task Analysis, to understand the visual demand, light levels and associated occupational hazards. Vision standards were arrived at based on the VTA and occupational history. All participants underwent comprehensive eye examination and prescription safety eye wear were dispensed. Microsoft Excel was used for descriptive analysis.
Results: A total of 136 artisans were examined, of which 120 (88.23%) were male. The mean age was 46.3±9.5 years. The process of toy making involves cutting the wood, sanding, turning, assembling and painting. All the artisans, except artisans in assembly and painting, were exposed to flying wooden pieces and dust, causing physical and ocular hazards. The tasks were observed to be less visually demanding with distance acuity requirement being 6/60 to 6/36 and near visual acuity being N8 in turning section to N55 in case of cutting/sanding. The workplace illumination had combination of day light and localized florescent light which varied from 460lux to 80lux. Visual difficulty was noted among 106 (77.9%) artisans and ocular symptoms mainly consisting of watering and burning sensation in 42(30.8%) artisans. Dust particle fall and associated eye injury was reported in 19 (13.9%) of them. Tasks were highly repetitive along with awkward postures. The prevalence of work related musculoskeletal disorders was 59.5% (n=81). Of which the most commonly reported symptom was lower back pain 26(32.0%) and neck pain 16 (19.7%). Total of 113(83.08%) prescription safety eye wear was dispensed for artisans who are involved in turning, cutting and sanding section. To improve their compliance with spectacles, they were also given separate spectacles for other activities. Further specialty care was required for 20 (14.7%) persons for retinal, glaucoma and cataract evaluations to tertiary eye care centres. Outlining of posture and breaks along with calibrated light level considerations were found to be beneficial.
Conclusion: This study exhibits the current visual status of the unique art workers of India, and the perceived hazards prevailing in the sector. Thus accentuating the standards of vision and safety practices helps in preserving the endangering occupation to the best.
| COVID-19 and comorbidities: Deleterious impact on infected patients|| |
Introduction: Patients with comorbidities such as hypertension or diabetes mellitus are more likely to develop a severe course and disease progression with COVID-19.
Objective: To determine the impact of COVID-19 on patients with comorbidities.
Materials and methods: This is a retrospective analysis of electronic medical records of 1,347 laboratory confirmed COVID-19 cases in employees and beneficiaries of NFC, Hyderabad, from March 2020 to November 2021. Data was extracted from NFC maintained electronical medical records. Age, gender, existing comorbidities, duration of hospitalisation, period of recovery. Data is described using frequencies and proportions.
Results: A total of 1,347 laboratory confirmed cases of COVID-19 NFC, CHSS employees and beneficiaries were studied. 305 patients had hypertension, 244 had diabetes, 92 had thyroid disorders, and 155 had two comorbidities. 27% of COVID-19 patients were hospitalised. Most of the cases were those aged 40-60 years. Of the total 1,347 confirmed cases, 467 were female. Patients with existing comorbid conditions of hypertension, diabetes, thyroid disorders, coronary artery disease or any combination of these, took longer to recover, compared to those without these comorbidities.
Conclusion: Patients with comorbidities should take all necessary precautions to avoid getting infected with SARS CoV-2, as they usually have the worst prognosis.
Keywords: coronavirus, COVID-19, SARS-COV-2, clinical features, comorbidity, diabetes, hypertension
| Knowledge regarding heat stress and practice of personal protective equipment use among healthcare aworkers during the COVID 19 pandemic|| |
Latha PK, Vidhya Venugopal
Introduction: The need for healthcare workers (HCWs) to wear personal protective equipment (PPE) during the coronavirus disease 2019 (COVID-19) pandemic heightens their risk of thermal stress.
Objective: To determine knowledge regarding heat stress and practice of PPE among HCWs during the COVID-19 pandemic.
Materials and methods: A cross-sectional observational study was done among 115 HCWs using a self-designed questionnaire to identify their thoughts on heat stress caused by PPE wear during the COVID-19 pandemic. The ambient temperature, relative humidity (RH), and dew point in their respective locations were recorded using data loggers (EL-USB-2-LCD+, Lascar Electronics, Salisbury, UK). R version 3.6.2 was used to examine the frequency and descriptive statistics from the survey findings. Pearson's chi-square was used to determine associations. A p value of <0.05 was considered statistically significant.
Results: The average wet bulb globe temperature (WBG) reported was 30.0oC (IQR 29.1–31.8oC) according to the heat exposure data. The majority of the 115 HCWs were involved in medical consulting (39%), followed by nursing (29%). The researchers discovered that 50% of the workers (n=57) were wearing 5-6 PPEs and had a fourteen-fold increased risk of developing an undesirable thermal health symptom (95 % CI: 0.77 to 280.24; p=0.0737). In addition, 36% of the participants (n=42) worked between 8 and 10 hours every shift with little or no rest. It was also important to note that 76% (n=88) of them worked in non-air-conditioned environments, and 33% (n=38) of them had excessive workloads, which could add to the employees' heat burden. More than half of them agreed that wearing PPE is extremely inconvenient, and they avoided taking breaks to maintain infection control. The impression of thermal stress was reported by 96% of the participants (n=111), and it was found to be substantially linked with the job they were engaged [OR 0.0654 (95% CI: 0.003- 1.246) P=0.001]. More than half of the participants strongly agreed that appropriate rest and hydration before work could help them lower their thermal stress.
Conclusion: HCWs are cognizant of the effects of heat stress but might not adopt best practices due to various constraints. Ice slurry ingestion could be a practical and effective method for promoting thermal comfort. Adverse effects of heat stress on productivity and judgment of HCWs warrant further investigation.
Keywords: COVID-19, occupational thermal stress, heat illnesses, hydration, frequent rest
| Arrhythmia burden in COVID-19 patients from industrial workforce evaluated by remote patient monitoring technology|| |
MA Mirza, RK Bandaru, S Bala, MM Katika, S Agarwal, M Mannan
Introduction: Early reports from China estimated that overall cardiac arrhythmia prevalence in patients hospitalized for COVID-19 was 17%. A higher arrhythmia incidence (44%) was observed in patients admitted to intensive care unit. The industrial workforce was affected by COVID-19 to a great extent. A noteworthy proportion also suffered from cardiac abnormalities.
Objectives: To determine the incidence of arrhythmia in patients with COVID-19 among the industrial workforce using remote patient monitoring technology.
Materials and methods: This was a retrospective, observational, descriptive study of the industrial workforce from Telangana State, India. Approval of the institutional ethics committee was obtained. The need for informed consent was waived off. Patients who tested positive for COVID-19 by RTPCR and aged above 18 years were eligible. The five-day recording of lead-2 ECG on Vigo Monitoring Solution (Connect Care India Pvt. Ltd) was collected and analysed. Brady-arrhythmia during day time, second degree AV block Type-2 (Mobitz II) during the day time, complete heart block, wide QRST, non-sustained ventricular tachycardia and sinus pause were considered “clinically significant”. The other sub-types were defined as “clinically non-significant”. The ECGs with regular sinus rhythm were interpreted as “normal”. The prevalence of clinically significant, clinically non-significant and normal heart rhythm are described here.
Results: Out of 240 COVID-19 patients who were on-board for remote monitoring, 216 (148 male and 68 female, mean age 51±15 years) met the eligibility criteria and only their ECG were analysed. Among them, 18 were known diabetics, 40 were hypertensive and 31 had both comorbidities. 112 were asymptomatic and 104 were symptomatic. The burden of arrhythmia was found clinically significant in 12 (5.6%) patients, clinically non-significant in 87 (40.4%) and normal among 117 (54%) out of 216 patients.
Conclusion and Recommendation: The remote patient monitoring may be utilized as a tool for early screening of significant arrhythmia which are to be addressed immediately for better clinical outcome. These devices on being integrated into COVID-19 management strategies may contribute to patient satisfaction, emergency alerts, timely management, reducing mortality rate and enhancing the safety of healthcare providers
| A qualitative perspective of construction site migrant workers' plight during COVID-19 lockdown in Bhavnagar (western India)|| |
Ashvinkumar B. Ramana, Mihir P. Rupani, Sweta Singh
Introduction: Coronavirus disease-2019 (COVID-19) is a global pandemic. Nationwide lockdown was one of the preventive measures enforced, that led to travel and work restrictions internationally and domestically. India has a large population of migrant workers. A large proportion of this population was stranded on foreign lands due to the sudden and mismanaged lockdown imposed during early 2020.
Objectives: To identify the impact of the lockdown on the economical, psychological and social life of migrant workers in Bhavnagar city (western India).
Materials and methods: In-depth interviews (IDIs) were conducted among twelve construction-site migrant workers in Bhavnagar city of western India. Data saturation was attained after ten interviews. Additional two interviews were taken to confirm the saturation. All interviews were audio-recorded after obtaining written informed consent, transcribed in English, and analysed in the form of codes and categories.
Results: The migrant workers in our setting perceived unemployment, monetary problems, and difficult subsistence as the pertinent economic issues. Mismanaged migrant exodus, discrimination, mistreatment, lack of social assistance, inability to fulfil their family's expectations and callousness of the authority were perceived as the social concerns. The psychological impact was described by various words like 'fear', 'worry', 'loneliness', 'boredom', 'helplessness', and feeling 'trapped'. Monetary compensation, job opportunities at the native place, and a well-managed migrant exodus were the key expectations from the government. Good employer support, help from government agencies, and a positive attitude during the lockdown period were perceived as the enablers. Lack of facilities to address common ailments, sub-standard care, and frequent COVID-19 tests before their travel were reported as healthcare issues during the lockdown.
Conclusion: COVID-19 lockdown had detrimental effects on the economic, social, and psychological well-being of migrant workers. During such testing times, a few good Samaritans and employers, rather than the government, played the role of being the messiah. Adequate rehabilitation mechanisms should be in place before imposing a lockdown. 'Targeted' cash transfers, ration kits, and a well-managed migrant exodus might mitigate the plight of migrant workers in any such future lockdowns. Future studies can evaluate the feasibility, impact, and cost-effectiveness of such interventions on the lives of migrant workers.
Keywords: COVID-19, lockdown, psychological, economic, social, impact, mitigation, India.
| Elimination of volatile organic compound VOCs exposure at chemical testing laboratory: through effective OHIH assessment|| |
Dhaval Patel, Nasib Jha, Bhavesh Khodadiya, Amit Raiyani
Introduction: Long-term exposure of VOCs (volatile organic compounds) can lead to life-threatening illnesses. Employees in the laboratory are exposed with various VOCs like benzene, xylene and other organic vapours.
Objective: To report the effect of implementing engineering controls (modifying drainage line) in decreasing the concentration of VOCs at a chemical testing laboratory.
Materials and methods: To evaluate chemical exposure, total VOCs survey was conducted to measure VOCs concentration in laboratory. Direct reading instrument (Ultra RAE 3000) with PID sensor was used to measure exposure.
Results: Total VOC concentration was found to be very high (17-20 ppm) in a GC Lab. The activities that generate VOCs are hydrocarbon bottle draining and washing in the bottle washing room. Final VOC concentration after engineering control was 0 ppm.
Conclusions: Laboratory employees are exposed to a high concentration of VOCs like benzene, xylene and other organic vapours. VOCs exposure is completely eliminated after implementation of engineering control. Thus, the hydrocarbon drainage line which is usually routed via GC Lab must be routed to the waste hydrocarbon tank directly, to reduce exposure.
| Perceived morbidity, its risks and catastrophic health expenditure among construction workers: A cross sectional observation from Ahmedabad.|| |
Soundarya S, Ankit V, Ankit S, Rakesh B, Kamalesh S
Introduction: Construction process involves exposure to various physical, chemical, ergonomic hazards which may be further exaggerated by poor living conditions, migrant status and non-availability of social / health insurance.
Objectives: To explore the perceived morbidity and its risks among construction workers at Ahmedabad.
Materials and methods: After obtaining institutional ethics committee approval, a cross-sectional exploratory study was done among all the construction workers from three construction sites at Ahmedabad. Socio-demographic details, morbidity profile and health seeking behaviour was recorded. Data was collected, cleaned and analysed on R software.
Results: A total of 259 participants with mean (SD) age of 28 (9) years and mean monthly income of INR 15,037.00 (8,141.00) were recruited during January - February 2020. 91% of them (n=227) were migrant workers, about 87% of workers had neither self-subscribed medical benefits nor employer-subscribed benefits. 49% (n=126) reported illness among the family members (including self). Factors such as alcohol usage (OR 3.75), living in overcrowded residence (OR 2.9) and sharing the kitchen within the living room (OR 2.17) significantly increased the odds of having illness. Interestingly 28% (n=73) of families of construction workers suffered catastrophic health expenditure (CHE) during the previous one year.
Conclusion: Construction workers experienced high morbidity associated with poor living conditions and lifestyle practices, poor coverage of medical benefits leading to high prevalence of CHE. There is a need for the stakeholders to improve utilization of existing healthcare facilities and facilitate medical benefits to this group of workers.
[TAG:2]Risk of ischemic heart disease among non- smoker urban transit bus drivers: a cross- sectional explorative study [/TAG:2]
Ankit Viramgami, Avinash Pagdhune, Mehul Madia, Moinuddhin Mansuri, Praveen Kumar
Introduction: Drivers working in metropolitan transit services occupationally exposed to vehicular emission which constitutes of various organic and inorganic compounds. Additionally, lifestyle and occupational factors such as shift work, long working hours, dietary habits, sedentary lifestyle and cognitively intensive job enhance the risk for ischemic heart disease (IHD) among drivers.
Objectives: To determine cardiovascular disease risk of non-smoker transit bus drivers.
Materials and methods: Present cross-sectional study has enrolled consenting 187 non- smoking public transit drivers with minimum five years of employment. Relevant socio-demographic, occupational and medical history were collected using pre-tested semi-structured questionnaire. Clinical examination and laboratory tests were carried out with standard techniques. Ischemic heart disease (IHD) risk for individual study participant was evaluated with QRISK3 score. SPSS version 26.0 was used to analyse and interpret the data.
Results: Mean (SD) age and job duration of drivers were 47.3(6.7) and 17.2(7.4) years, respectively. Observed prevalence of hypertension and obesity among drivers was 34.8% and 46%, respectively. High cholesterol-HDL ratio (>5 mg/dl) was observed among 28.3% of drivers. Participants exhibited 1.8 times higher risk for IHD compared to their same age matched peer. On average, the heart age of individual driver was six years higher than his physiological age.
Conclusion: We identified a high prevalence of cardiovascular disease risk factors such as hypertension, obesity and altered lipid profile along with higher IHD risk even among non-smoking individuals (drivers). Emphasis for formulation and implementation of suitable cardiovascular disease preventive measures for this high risk group is recommended.
| Interventional study to assess impact of first aid training program on knowledge, attitude and practices of first aid among construction workers|| |
Vijay Nanasaheb Bade, Bhargavi Vijay Bade
Introduction: Injuries are one of the leading causes of morbidity and mortality worldwide. First aid is the immediate treatment for the purpose of preserving life and minimizing the consequences of injury and illness until professional help is available. Knowledge regarding first aid is essential for every individual. Studies suggest that people who are equipped with adequate knowledge of first aid had a positive impact on morbidity and mortality. Administering first aid to victims in the event of accidents, mishaps and occurrences during work is encouraged
Objective: To assess the knowledge regarding first aid and basic life support among construction site workers in Pune Municipal Corporation Region.
Methodology: Construction site workers including managers, site engineers, personnel responsible for safety and labourers were included in the study. A demonstration on first aid and BLS was done. Their retention of knowledge was assessed by administering a questionnaire based on the demonstration.
Results: When inquired about the importance of first aid and the need for training in the same, the most common responses given by the study participants were that it increases safety, helps save lives, helps relieve pain, makes people more secure, prevents a situation from becoming worse, prevents infection, makes workplaces safer, keeps children safe, reduces recovery time, saves money, it helps us to work with peace of mind, and that it also opens up more job opportunities. We found a statically significance difference in the scores before and after the demonstration activity.
Recommendations: Implementation of first aid training programs among other chemical industries. The effect of first aid training program on workers' self-efficacy in a variety of settings is a possible area for future research.
Keywords: work accidents, first-aid, CPR, industry, occupational medicine, workers
| Ergonomics assessment and survey on work related visual and musculoskeletal disorders symptoms among optometrists|| |
Rashima Asokan, Alisha Regmi, Janani Suresh
Objective: To assess ergonomics, work-related visual and musculoskeletal disorders (MSDs) symptoms among optometrists.
Method: Optometrists working at tertiary eye care hospital, Chennai were included in the study. Optometric procedures were listed and 4 tasks were identified to be evaluated for ergonomics assessment. The selected tasks were computer usage, objective refraction with retinoscopy, vision assessment/subjective refraction and slit lamp examination. The selected optometrists were asked to perform the procedures and were photographed during the examination with prior informed consent. Two optometrists performed the ergonomics assessment using the REBA (Rapid Entire Body Assessment) tool. All the study participants were asked to fill the questionnaire on Work Related Musculoskeletal symptoms and Visual Symptoms. Comparison between the scores from the REBA and subjective symptoms were done using statistical tests.
Results: Sixty optometrists participated in the current study. The task with highest scores indicative of high risk of developing MSDs was retinoscopy with average score of 11.8±0.6 followed by vision assessment with score of 5.5±2.0 indicative of medium risk; PC usage with score of 3.2±1.3 and slit lamp with score of 2.6±1.1 indicative of low risk. Work-Related MSD symptoms were present in 47(78.3%) associated with various optometric procedures. Of them 44(73.3%) reported MSD symptoms associated with their workload and rest 3(5%) reported that they experience symptoms all the time, irrespective of their workload. The most commonly reported sites of discomfort were neck 24(23.1%), lower back 23(22.1%) and shoulder 20(19.2%). The maximum number of symptoms were reported to be associated with retinoscopy 44.2% and PC usage 10.6%. Work-related visual symptoms were present in 35(58.3%) optometrists associated with various optometric procedures. The most commonly reported symptoms were eye fatigue 16(20.5%), dryness 16(20.5%) and blurred vision 12 (15.4%). The maximum number of symptoms were reported to be associated with PC usage 32% and retinoscopy 23.1%.
Conclusion: Retinoscopy was found to be the optometric task with high risk of developing MSD symptoms which requires immediate implementation of change in ergonomics. Neck pain and lower back pain were highly prevalent among the optometrists. Commonly reported visual symptoms were eye fatigue and dryness.
| A study on stress among commercial airline pilots|| |
Swathy Kuppala G
Introduction: Stress is experienced when the environmental demands exceeds a person's adaptive capacity and is associated with health and diseases such as depression and cardiovascular diseases. Perceived stress is the feelings or thoughts that an individual has about how much stress they are under at a given point in time or over a given period. Aviation workers are particularly vulnerable to increased sleepiness, chronic fatigue, and decreased performance, which can adversely impact productivity and safety in domestic flight operations.
Objectives: To determine prevalence of perceived stress among the workers of aviation industry using Cohen perceived stress scale.
Materials and methods: A cross-sectional study was done among ninety commercial airline pilots chosen by convenience sampling. Those with psychiatric illness were excluded from the study. PSS-10 was used collect data. The PSS-10 is a self-report instrument consisting of 10 items. Each of the items on the PSS-10 are rated on a 5-point Likert scale, ranging from 0 (never) to 4 (very often). Total scores range from 0 to 40, with higher scores indicating higher levels of perceived stress. A score of 0-13 was considered as low stress; 14-26 as moderate stress; and 27-40 as high stress. Data was entered in MS excel sheet and analysed using SPSS software version 16. Continuous variables are represented in mean, median, mode and standard deviation. Categorical variables are represented in frequencies and percentages. Chi square test was used to determine the difference between proportions.
Results: The mean perceived stress score was 11.43 (±7.19). The range of scores was from 1-36. The stress level was low in 66, (73.3%), moderate in 19 (21.1%) and severe in 5 (5.6%). Pilots with no recreation had moderate to severe stress while those with recreation had low levels of perceived stress. Subjects with financial problems and family problems perceived higher levels of stress when compared to those without them.
Conclusions: One-fourth of the pilots perceived moderate to severe levels of stress. The stress level is higher among higher age group, female sex and married status. No recreation, family and financial problems increased the level of stress among pilots.
Recommendations: Pilots should be provided with proper rest and recreational activities. Pilots should be frequently counselled for their personal problems and to address their stress. Stress level decreasing activities like yoga and meditation should be encouraged among the pilots.
| Face shield use and its relation to musculoskeletal disorders among health practitioners|| |
Nikitha D, Vidhya Venugopal, PK. Latha , Rekha Shanmugam
Introduction: The COVID-19 pandemic highlighted the importance of the use of personal protective equipment (PPE) such as a face shield, face mask, and protective eyewear by Health Care Workers (HCWs). Research has documented that usage of PPEs could lead to musculoskeletal disorder (MSDs), headache, impingement of neck etc.
Objective: To identify the perceptions of face-shield use and its relation to MSDs among Health Practitioners (HPs).
Materials and methods: An online cross-sectional survey was conducted among 145 Health Practitioners (HPs) in Chennai during April and September 2021 to identify their perceptions about wearing a face shield and MSDs using a validated self-administered questionnaire. We analysed the data using Pearson's chi-squared test on SPSS.
Results: Among 145 HPs, 52.4% reported to have experienced MSDs. 44.7% of the HPs reported MSDs due to continuous wearing of the face shield. This was found to have a significant association. It was found that 95% of the HPs reported discomfort and poor visual clarity. The MSD risk was 3.4 times higher among those HPs using PPEs (95% CI: 1.03-11.28; p=0.035). 72% of them perceived that movement restriction due to PPE had caused MSD. Those who perceived thus, were 2.5 times more likely to experience MSD (95%CI: 1.27-5.07; P =0.007). Although, the duration of PPE use was not associated with MSD, 9% of the HPs who work for more than 6 hrs reported higher MSD. A significant association was found between having previous history of work-related MSDs and prevalence of MSDs among the HPs (OR: 9.5; 95% CI: 2.71-33.53; p=0.000).
Conclusion: Majority of the participants perceived discomfort, lack of visual clarity, movement restriction as factors that were found to be significantly associated with MSD among HPs.
Recommendation: Hence adaptation and proactive intervention are required to safeguard HPs against the detrimental effects of face shields.
Keywords: COVID 19, health care workers, personal protective equipment, face shield, musculoskeletal disorders.
| Occupational exposure to flour dust containing bio-aerosol and its impact on flour mill workers|| |
Pankaj Barfal, Ankit Viramgami, Poonam Vyas, Parveen Mansuri
Introduction: Flour dust is considered a respiratory health hazard among food processing industries since decades.
Objectives: To enumerate the microbial load, and its components in flour dust and to conduct a health risk assessment of the workers for respiratory morbidities.
Materials and methods: A cross-sectional study was carried out from November 2019 to August 2020 at Ahmedabad. Personal air sampler was used to collect environmental dust from processing, grinding, packaging, storage and control sites. The viable cells were captured by Andresen 6 stage viable sampler. Bioaerosols; Endotoxin and (1-3) β-D glucan were measured through LAL method and ELISA kit, respectively. A pre-tested questionnaire was imparted on study participants to capture relevant clinico-epidemiological and occupational details. SPSS v26.0 was used to analyse data.
Results: During an eight- hour work period, the air sample using personal air sampler showed that the concentration of flour dust varied from 1.95 to 478.5 mg/m3 at different units of flour mills. This is above 0.5 mg/m3, as recommended by ACGIH. In the processing and packaging units the mean concentration of endotoxins in the air amounted to 3.47 and 4.34 ng/m3 respectively by LAL method, similarly, (1-3) β-D glucan were estimated 0.15 and 0.10 ng/m3 by commercially ELISA test method. The results showed the workers of processing and packaging unit were more at risk due to elevated level of endotoxins and (1-3) β-D glucan in flour dust as compared to the control reference sites. Airborne bacterial counts ranged between 12.17 to 27.45 cfu/m3 and 1.18 to 2.79 cfu/m3 on Nutrient agar and Mac Conkey's agar media, respectively. Similarly airborne fungal count varied from 20.03 to 44.98 cfu/m3 on Czapek Dox agar media. A total of 152 subjects were enrolled into the study. The frequency of respiratory symptoms that were reported were cough 32(36.36%), phlegm 23(26.13%) and dyspnea 30(34.09%).
Conclusion and recommendation: We recommend the formulation of a mechanism to counter respiratory health hazards among flour mill workers, by the stakeholders. Awareness programs and periodic health examinations with special focus on occupational exposure of flour dust can have a positive impact on the health of flour mill workers.
Keywords: occupational exposure, flour dust, personal air sampler, endotoxin, (1-3) β-d glucan
| The impact of perceived stress on the health of lab technicians: A pilot investigation|| |
Vineeth G Nair
Introduction: Stress and the ability to cope with stress can influence the health and performance of laboratory technicians. This is especially true in the current circumstances of a global pandemic which has placed a tremendous amount of stress on healthcare professionals, including laboratory technicians. However, there is little to no research in India about the relationship between stress and coping abilities and its influence on health and work performance.
Objectives: To assess the self-reported stress levels, perceived coping effectiveness, coping techniques & health behaviours of lab technicians.
Materials and methods: A cross-sectional observational study was done using a structured questionnaire among 152 lab technicians working in a lab chain across 3 states in Western India.
Results: The responses indicated that the lab technicians had less than ideal stress levels. 80.3% reported moderate-to-very high stress levels; 51.3% slept less than 8 hours of sleep per night; 53.3 to 61.2% did not exercise regularly; 30.9% consumed less than 2 servings of fruits and vegetables per day; and 9.2% were classified as binge drinkers. When confronted with workplace stress, 34.1% reported that they consumed more food than usual (28.3% reported that they consumed more junk food), 48.1% reported a loss of appetite and eating less food than usual, 45.4% reported losing sleep. Lab technicians in the “high stress and poor coping” group reported a statistically significant higher number of days feeling worried, tense or anxious, sad or depressed. The attitudes of lab technicians to preventive health in the COVID-19 pandemic (especially considering the increased risk of co-morbidities during the COVID-19 pandemic) were also less than ideal: 83.6% did not undergo a preventive health check-up package in the past year, 55.9% had not visited a doctor for a general physical exam in the past year.
Conclusion: Given the amount of stress and work that has been placed on the diagnostic industry over the past 2 years, it is imperative that we understand the stress levels, coping adequacy and health behaviours of lab technicians who form the backbone of the industry. As the results of this pilot study show, there is an immediate need to implement worksite health promotion programmes focusing on stress reduction, stress management and the development of healthy coping skills.
Keywords: lab technicians, stress, coping mechanisms
| Screening for bone mineral density using quantitative ultrasound method among industrial workers of Hyderabad.|| |
K. Kavya Sri, Sudha Bala, Ranjith Kumar.Y, Sravani Sreeram
Introduction: Osteoporosis is the most common among all age groups due to industrialisation and urbanisation. Quantitative ultrasound (QUS) measurement has been a relatively inexpensive and feasible method to detect this silent killer.
Objectives: To determine the bone mineral density (BMD) among the industrial workers using QUS method and to assess various factors affecting the BMD.
Material and methods: A cross-sectional study was conducted in three industries. A sample of 265 subjects were recruited using simple random sampling. A pre-tested questionnaire schedule was used to collect information on socio-demographic characteristics, fracture history, family history of osteoporosis, nutritional factors, lifestyle, personal habits, body mass index and BMD using QUS method of the right calcaneus heel using standard protocols.
Results: Our study consisted of 114(43%) males and 151(57%) females. Mean T score was found to be -2.45+6.460 among our study subjects using QUS method. Osteopenia was reported among 95(36%) and osteoporosis 113(43%).There was a statistically significant increase in osteoporosis among females compared to males. Significant association was found between osteoporosis and educational status, socio-economic status and sunlight exposure.
Conclusions: Early screening helps to identify the risk group and educate them on preventive strategies at the earliest by creating the awareness and educating on importance of factors such as sunlight exposure to benefit them.
| Awareness regarding first aid and basic life support among high school students and teachers|| |
Vijay Nanasaheb, Bade Bhargavi Bade
Introduction: First aid is the immediate assistance provided to a sick or injured person. Children spend most of their day in schools, and are at greater risk of accidents and injuries. National Disaster Management Guidelines 2016, recommends that school teachers and students be trained in first aid and basic life support.
Objective: To assess the awareness regarding first aid and basic life support among high school students and teachers.
Materials and methods: A cross-sectional study was done among all teachers and students of class eleven and twelve from three cantonment schools in New Delhi. Knowledge was assessed using a twenty-item questionnaire. Demonstration and hands-on training regarding first aid was also given.
Results: A total of 377 subjects were included in the study. The mean knowledge score was 10.96 (SD 2.87). 67.6% participants had a score greater than or equal to 12/20. 29 (7.7%) had good knowledge (>15/20), 214 (56.8%) had average knowledge (11/20 - 15/20) and 107 (35.5%) had poor knowledge (≤10/20).
Conclusion: There was low level of awareness about correct first aid and basic life support. First aid training should be incorporated as a part of school curriculum. Repeated reinforcement of knowledge and skills is essential.
Keywords: basic life support, first aid, schools, students, teachers
| Successful treatment of patients with dreadful and lethal paraquat intoxication among agricultural workers– case series from a tertiary care centre, Hyderabad|| |
Vishwabharathi M, A Veeranna, Rajiv K B, D Srikanth, Dhanalakshmi, Anitha S.
Introduction: Paraquat (1,1 dimethyl 4 4 dipyridylium) is a broad-spectrum liquid weed killer widely available across India. Accidental or deliberate ingestion of paraquat has high mortality rate due to local and systemic toxicity. There are very few published studies on Paraquat poisoning. Limited data is available on mortality related to intoxication. Paraquat is rapidly and incompletely absorbed and largely eliminated unchanged in urine within 12-24 hrs. It causes direct cellular damage by production of superoxide radicals2.
Objective: To describe the effects of paraquat in lethal dose intoxication as a case series in 3 patients who were agricultural workers presented to a tertiary care center in Hyderabad during January 2021 to December 2021.
Methodology and results: Case 1 – A 20 year old male who developed acute renal failure and respiratory failure. He was managed conservatively and methyl prednisolone along with vitamin c and N acetyl cysteine was given. He succumbed to the poison within 72hrs, prior to initiating hemodialysis. Case 2 –A 46 year old male, developed acute renal failure with mild deranged liver parameters, 1 week into hospital stay he developed pulmonary fibrosis. At admission he was initiated on methyl prednisolone, N acetyl cysteine, vitamin C and hemodialysis was performed 3 times. He recovered and was discharged after 4 weeks. Case 3–A 28 year old male, developed oral ulcers, esophagitis and acute renal failure. He was treated with iv cyclophosphamide, Inj. methyl prednisolone, Vitamin C, N acetyl cysteine were given1.Hemoperfusion was initiated within 12 hrs of admission. He was discharged in full health after 3 weeks. All the three patients presented after deliberate paraquat intoxication and received supportive treatment as per requirement.
Conclusion: One patient succumbed and two patients who survived were discharged in full health and are under follow up. Paraquat is a lethal poison, aggressive and timely treatment with immunosuppressants, hemoperfusion and antioxidants improves outcomes limiting permanent lung damage due to pulmonary fibrosis. This incorporates the importance of Occupational health physician as a key management personnel.
Keywords: Paraquat, intoxication, agricultural workers
| Physical and mental health status of police personnel in a selected rural subdivision of Bengaluru Urban District.|| |
Jeganish A, Pretesh R K, Nancy A Gnanaselvam
Introduction: Police personnel perform untiring duties to maintain law and order. Factors such as nature of work, duration of work, working conditions among others influence the health status of these law enforcement personnel.
Objective: To assess the physical and mental health status of police personnel in a selected rural subdivision of Bengaluru Urban District.
Materials and methods: A cross-sectional study was carried out among 142 police personnel in 7 police stations of the selected rural subdivision. Universal sampling technique was used. A structured interview schedule was used to collect the data which included socio-demographic details and occupational details. Patient Health Questionnaire-9(PHQ -9) was used to screen for depression. Perceived Stress Scale (PSS) was used to identify stress. Random Blood Sugar was checked using a glucometer and Blood-Pressure measured using a digital sphygmomanometer
Results: The mean age of the police officers was 40.28 years (SD= 10.27). One hundred and nineteen police personnel in our study population were males. Most of them, (59, 41.5%) officers were head constables by designation. A total of 72 (50.7%) of the studied group were in the pre-obese (overweight) according to the WHO classification of BMI. High Random Blood Sugar values were observed in 8 (5.6%) of the personnel who had no previous history of diabetes mellitus. High blood pressure values were observed in 69 (48.57%) of the personnel who had no previous history of hypertension. The prevalence of high stress was 83.1% and that of mild depression was found to be 33.8%
Conclusions: The prevalence of high blood pressure among the police personnel was found to be on the higher side compared to that of the general population. Prevalence of stress and depression were also found to be on the higher side. The high prevalence of high blood pressure, obesity, perceived stress and depression warrants the need to ensure that these problems are addressed through routine screening and application of the various levels of prevention. As a part of this study, those officers requiring medical advice for their mental and physical health conditions were given one-to-one counselling for lifestyle modifications and referred to the weekly Mental Health Clinic and weekly Non-Communicable Disease Clinic of the nearby Taluk Hospital for further evaluation and management.
Keywords: cross-sectional study, depression, physical health status, police personnel, stress
| Intimate Partner Violence among married women workers of garment factories in Bangalore|| |
Dr. Nancy Angeline Gnanaselvam, Bobby Joseph, Rathnakumari, Sakthi Arasu
Introduction: In India, Intimate Partner Violence is a pattern of violent behavior perpetrated mostly by husbands towards wives, caused by power and control cycles which results in negative physical and mental health consequences for the woman. We aimed to assess the pattern of Intimate Partner Violence among married women workers in selected garment factories of Bangalore
Materials and methods: We interviewed 204 married women in 3 garment factories situated in Bangalore City. Study Tool: World Health Organization Women's Health and Life Survey tool to assess the experience of Intimate Partner Violence. This tool captured emotional, psychological, physical, sexual and economic abuse experienced by women. Impact of dowry on the violence was also assessed. We conducted Key-informant interviews among 3 women who reported all types of violence. Counselling services were provided for all women who reported violence.
Results: Of the 204 married women, 17 women reported life-time experience of various types of violence. Economic violence was reported by all 17 women. Physical violence was reported among 13 and 7 reported emotional violence. Psychological violence was reported by 16 and 2 women reported sexual violence. Violence was aggravated during pregnancy among 3 women. Work capacity was affected due to violence among 10 women. Dowry having negative impact on marital relationship was reported by 3 women. Common causes of violence reported were, substance use in husband, financial difficulties, refusal of sex, work issues in husband such as unemployment and other frustrations, no family support due to love marriage, wife being considered as disobedient and suspicion in relationship.
Conclusion: Garment industry is a feminized sector with more females in the production workforce. Considering the impact of violence on the work and lives of these women, it is important that support system among employees, employees assistance program and empathy from employers be provided to ensure a productive workplace in conditions of human dignity.
Keywords: Intimate partner violence, garment, married women
| Assessment of mental workload and stress levels during the COVID19 outbreak among doctors catering to industrial workforce|| |
Anila Rao, Shyam Sundar Sai , Sudha Bala.
Introduction: Health care providers are vital resources for every country. Their health and safety are crucial not only for continuous and safe patient care, but also for control of any outbreak. Mental workload is a broad multidimensional construct. It refers to a subjective experience of the costs incurred by a physician in performing patient. Mental demand, physical demand, temporal demand, effort, performance and frustration levels are the important dimensions on workload. Recognizing the degree to which we are affected and making strategies to make life better is important.
Objective: To assess the mental workload status of doctors who are catering to mainly industrial workforce and what is its dimension which is putting a toll on them and the degree of stress they are experiencing, and to correlate between workload and stress levels.
Material and Methods: A cross sectional study was carried out in ESIC Medical College and Hospital, from September 1 to December 31 ,2020. Both online and offline survey questionnaires were used to collect the data from doctors working in ESIC hospital, which was started after clearance from IEC and consent from participants. Workload was assessed using NASA task load index which contains 6 dimensions. This was assessed using a scale graded from 0 to 10 and stress levels were assessed using perceived stress scale.
Results: A total of 104 participants responded to the survey of which 40(38.5%) were female and 64(61.5%) were male. The proportion of participants with high mental demand were 68(65.4%), physical demand 44(42.3%), effort demand 74(71.2%), frustration 40(38.5%), performance demand 8(7.7%) and temporal demand 44(42.3%). The proportion of participants with higher levels of workload were 90(86.5%), among whom, females were 37.8 % and males were 62.2 %. The perceived stress scale showed 2(1.9%) of participants were in low stress (score 0-13) And 80(76.9%) were in moderate stress (score 14-26) and 22(21.2%) were in high stress (score 27-40). Among participants with high stress levels 45.5 % were females and 54.5% were males. The calculated overall workload mean scores was 66.23+15.383 and perceived stress was 22.01+5.55 which is positively correlated and statistically significant.
Conclusion: A considerate proportion of doctors' experience high workload and stress levels. Doctors being frontline workers are more vulnerable for mental health problems which are still underreported and is expected to be very considerate. There is a need to implant ways to decrease the stress levels of doctors and for better patient care.
Keywords: mental workload, stress, COVID 19
| Prediction of mental health disorders during COVID 19 pandemic using analytical model|| |
Kiran J. Waghmare
Introduction: Occupational Health Services (OHS) promotes the partnership between employees and their mental well-being at the workplace to ensure the safety and health of the employees by setting and enforcing standards, to minimize fatigue, injury, and ill-health from workplaces. This paper deals with analytical tools especially Machine Learning Modelling which combines operational data with data analysis of stress-related mental disorders due to the COVID pandemic to present complex and competitive medical information to OHS physicians and management.
Objective: To predict the mental health disorder trends from medical history and Covid-19 data samples due to the ongoing COVID pandemic
Materials and methods: The Case study of the computing analytical tools by using data available (COVID 19 positive cases in industry setup) of employees and will be used to track signs and symptoms of mental health disorders of employees and is user friendly and helpful to key decision-makers. This paper deals with attributes of stress-related disorders depending on signs and symptoms and classifies patients into mild, moderate, and severe stress categories.
Results: The resultant mental disorder tendency in employees is related to a stressful environment, both at home and work due to the surge in COVID 19 cases. It may be a cause for mental disorders in the future also. Thus, OH physician may suggest remedial measures to give early-stage treatment for mental health disorders that may impair the mental health and vitality of employees leading to accidents and also preventing potential chronic mental health diseases in future
Conclusion: This analysis will provide healthy, happy & productive employees at the workplace by helping OH physicians in identifying mental health disorders at an early stage and suggesting employees continue positive mental attributes which will promote their health and longevity. Thus, this tool helps in the promotion, prevention, and protection of the health of employees especially the mental aspect which is often ignored.
Keywords: analytical model, prediction, mental health, COVID 19
| Prevalence and determinants of hypertension among blue collar jobs: A pilot observation from Ahmedabad|| |
Rakesh B, Soundarya S, Ankit S, Ankit V, Kamalesh S
Introduction: Hypertension is one of the major risk factors for cerebro-cardiovascular diseases. Lifestyle and workplace factors are potential modifiable causes of hypertension. There is abundant evidence on the association between sedentary work life and hypertension / prehypertension, however there are scarce reports on blue collar workers.
Objective: To estimate the prevalence of hypertension and prehypertension among blue collar (construction) workers of Ahmedabad.
Materials and methods: Present cross sectional exploratory quantitative study was executed after obtaining necessary permissions from the Institute human ethics committee. All construction workers from three construction sites at Ahmedabad were interviewed for their basic socio-demographic and substance use details. Blood pressure and Body Mass Index (BMI) were measured among all participants as per standard protocols. Data was recorded, cleaned and analysed in R software.
Results: The study included 259 construction workers with mean (SD) age of 28 (9) years and 72% of these were males. Tobacco and alcohol usage were reported among 44% and 15% respectively. High proportion of these workers had either pre-hypertension (38%) or hypertension (12%). Factors such as substance use, duration of job, average work hours per day and BMI significantly increased the risk for hypertension.
Conclusion: The prevalence of pre-hypertension was high in these blue-collar workers. Considering the labour-intensive nature of the construction work and the relatively younger population, results from the current study should alarm the public health policy makers to reconsider existing screening and intervention program.
Keywords: Pre-hypertension, blue collar workers
| A study of morbidities among food manufacturing industry workers in Goa|| |
Mhalshekar VK, Mhalshekar SV,Kunkolienkar R, Cacodcar J
Introduction: Food manufacturing industry units are among the most common industries all over the world. It involves a large number of employees required for processing, manufacturing, storage and transportation of food items. Workers are usually sedentary and involve very less physical movement. Chronic illnesses are common among these sedentary workers of which most important are cardiovascular diseases, Hypertension, Obesity, Hypercholesterolemia and Diabetes.
Objectives: To assess selected morbidities among Food Manufacturing Units in Goa and to suggest suitable recommendations to reduce morbidities and enhance productivity.
Materials and methods: This were a retrospective record based cross sectional study was conducted over a period of 2 months. Periodic medical checkup of the workers was conducted. Data included sociodemographic details of the workers and details of periodic medical checkup including- anthropometry (height, weight, BMI), blood investigations like fasting and post prandial blood glucose levels, HbA1c, cholesterol, lipid profile, blood pressure, urine analysis, Vision (Near, Far and color), Hemoglobin, audiometry and ECG. The data analysis was done using and analyzed using SPSS version 23. The results were presented using tables and figures along charts and figures. Chi square test was used to assess association between qualitative variables.
Results: Among the 486 food manufacturing workers, 77% (374) were males and 23% (112) were females. 86% (418) workers were below 40 years and 14% (68) workers were above 40 years. It was observed that 11.1% (52) had obesity with a BMI>30, 19.28% (90) had Hypertension (>140/90) and 24.4% (114) had Diabetes mellitus with HbA1C>6.5 In addition, 5.28% (24) had far vision defect and 9.57% (45) had near vision defect and none had color vision defect. There were 6% (28) workers with hemoglobin less than 11 gm%, 21.14% (99) workers had deranged lipid profile and 2.1% (10) had abnormal ECG findings. Also 4.5% (21) workers were found to have abnormal audiometry tests. Among 486 workers who had done urine routine tests, 4.28% (20) workers were detected with uric acid crystals, 2.4% (11) worker was detected with calcium oxalate crystals and 10.5% (49) worker was detected with glucose in urine. 83.1% (389) workers had normal urine routine microscopy report.
Conclusion: This study highlights the need of periodic medical check-up of the food manufacturing industry workers for timely detection and early management of their health problems. Workers need to be made aware of the morbidities and timely preventive health check-ups. This will help in better efficiency and productivity of these workers.
Keywords: Goa, morbidities, medical check-up, food manufacturing, cardio-vascular
| Impact of ultra-violet radiation and air pollution on ocular health with emphasis on cataract and pterygium among outdoor workers|| |
Ishwarya Suresh, Rashima Asokan, Angayarkanni Narayanasamy, Sharada Ramasubramanyan
Objective: To measure the influence of ocular UV exposure and air pollution on the ocular health of outdoor workers in with emphasis on cataract and pterygium among outdoor workers.
Materials and methods: It was a prospective cross-sectional study where subjects above 21 years of age engaged in outdoor work and exposed to air pollution were enrolled based on inclusion and exclusion criteria. Participants were recruited from four zonal areas such as agricultural, commercial, industrial, and residential zones. All participants underwent a comprehensive ocular examination, tear film evaluation (Schirmer's test and Tear breakup test) and fundus evaluation was performed. All subjects gave a written informed consent. The standardized questionnaire which had details on lifetime residence was administered to all and information regarding erythemal UV dose for the respective location along with number of migrations calculated based on geographic location details from tropospheric emission monitoring internet service (TEMIS) were fitted in the Melbourne visual impairment model. Air pollution data for three and half years were recorded from the central and Tamil Nadu air pollution control board. The Conjunctival ultraviolet auto-fluorescence photography (CUVAF) was used to detect the conjunctival cellular changes with exposure to UV radiation (UVR). Logistic regression was done to estimate the associated risk factors.
Results: There were 235 participants recruited from four zonal areas such as agricultural (n=58), commercial (n=88), industrial (n=19), and residential zones (n=70). 139 participants (59.1%) had ocular disorder (Pterygium = 27, Pinguecula = 54, Cataract = 58) in either of the eyes, and 96 (40.8%) participants were without any ocular disorder. Our results showed that cataract was positively associated with lifetime UV exposure with odds of 4.28 (95% CI: 1.59-11.48, p = value 0.004), conjunctival damage with odds of 2.94 (95% CI: 1.13 – 7.67 p = 0.027) and smoking with odds of 2.96 (95% CI: 1.45 – 6.09, p = 0.003). The CUVAF being a marker for past solar exposure it was found to be positively associated with ocular disorder such as pinguecula OR: 1.01 (95% CI: 1.0 – 1.04, p value = 0.035) and pterygium OR: 1.07 (95% CI: 1.03 – 1.09, p = p = <0.001). Pterygium was also associated with average air pollution levels of OR: 1.04 (95% CI: 1.01 – 1.07) p = 0.019. Both cataract and pterygium showed a weak association with air pollutants like PM2.5, PM10, O3, NO2, and SO2.
Conclusion: The findings report UV exposure along with air pollution to be a higher risk for ophthalmoheliosis and CUVAF to be a potential marker for pre-clinical solar damage on the conjunctival tissue even before the manifestation of the ocular disease. This study provides a support for the association of air pollution levels to be a risk for pterygium.
Keywords: UV exposure, ocular, outdoor workers
| Visual, ocular profile and perceived impact of photochromatic spectacles among saltpan workers in Marakkanam Town, Tamil Nadu|| |
Janani S, Syed Ibrahim A, Rupa Nivethikka R, Soundarya P, Ishwarya S, Rashima A
Introduction and objectives: The current study aimed at understanding the perceived impact of photochromatic spectacles on managing the discomfort glare among the saltpan workers along with the assessment of occupational sun exposure damage and associated morbidities.
Materials and methods: Cross-sectional, observational study, subjects were saltpan works of Marakkanam, Tamil Nadu. The study was done in 3 phases, 1: To understand the work profile, vision demand, and occupational hazardous associated with salt production through Visual Task Analysis (VTA), 2: Perform comprehensive eye examination to profile the visual and ocular symptoms, and 3: Assessment of spectacle compliance and its impact on work. Part of the subjects also underwent conjunctival ultraviolet autofluorescence (CUVAF) imaging, a biomarker for conjunctival Ultraviolet (UV) damage as part of occupational sun exposure. The area of CUVAF will be traced with “ImageJ” software and will be converted to mm2. The cumulative lifetime UV dose/exposure was arrived at based on the location and nature of the occupational task. The images were analysed to find the association between the area of damage, cumulative lifetime UV dose and ocular morbidities.
Results: About 250 saltpan workers (113 male and 137 female) with were a mean age of 49+12 years were part of the study. From VTA, the salt production was observed to be less visually demanding, but hazardous as workers were exposed to reflected sunlight from salt crystals/ brine water causing discomfort glare. Over 128 (72.5%) saltpan workers reported glare and the majority 110(61.8%) by pan field workers. About 130 (73.9%) workers were dispensed spectacles with photochromatic coating and 45(25.2%) were referred for examination to the tertiary eye hospital. The median area of conjunctival UV damage in the right and left eye was 8.24(14.75) mm 2 and 13.18(13.75) mm 2 respectively and the mean cumulative lifetime UV dose was 1.83±0.93. The risk of pterygium was associated with CUVAF scores (OR 1.06, 95% 1.00- 1.14), and for cataracts (OR 1.201, 95% 1.06-1.34) even after adjusting for age and gender. Spectacle compliance at work was 81.7% and workers reported improved visual comfort against the discomfort glare from salt crystals.
Conclusion: The awareness regarding the workplace hazards and management should also be extended to their employers, to provide appropriate safety eyewear and thereby to motivate their employees to use the same. The CUVAF imaging showed sun exposure damage among the saltpan workers and can be used to estimate the conjunctival UV damage among outdoor workers.
Keywords: ocular profile, perceived impact, photochromatic spectacles
| Hot ambient temperature and its impacts on Adverse Pregnancy Outcome (APO)-A preliminary finding of women at outdoor workplaces.|| |
Rekha. S, S. J. Nalini, S. Bhuvana, S. Kanmani, Vidhya Venugopal
Introduction: High ambient temperature has been linked to pregnancy complications and fetal defects among working pregnant women. Heat in the workplace is likely to aggravate Adverse Pregnancy Outcomes (APO), particularly in tropical nations where temperatures are increasing.
Objective: To study the association between occupational heat stress and APO for better interventions.
Materials and methods: We conducted a cohort study with ~500 working pregnant women engaged in moderate to heavy labor in 2014-19 in and around Chennai. Area heat stress measurements were done using Quest temp WBGT Monitor, and physiological heat-strain indicators viz., Core Body Temperature (CBT) was done using Infra-red Thermometer, & Urine specific gravity (USG) was assessed using refractometer. A validated HOTHAPS questionnaire captured self-reported health symptoms. And a follow-up has been done to collect the APO.
Results: Workplace WBGTs exceeded the threshold limit value for 65% workers for safe manual work for moderate/heavy work (Avg. WBGT of 29.4°C±0.7°C). Increase in CBT (0.8 °C ±0.9°C) was above accepted level for 10% and USG >1.025 for about 13% of the workers, indicated moderate dehydration. The prevalence of adverse outcomes like miscarriages among the female workers was 2%, still birth/preterm birth was 6% and low birth weight was 22%. Furthermore, there was a 1.2 times significantly higher odds of adverse fetal/maternal outcomes (OR:95 % CI: 1.03-1.30) with WBGT exposures above TLVs during all trimesters. The study finding established a positive linkage between heat stress and APOs in pregnant women, including miscarriages, stillbirth, and Low Birth Weight (LBW). Our analysis summarizes the relevance of heat stress's effects on pregnant women's health, as well as useful information for investigating the biological underpinnings of APOs and numerous suggestions for preventing heat-related APOs.
Conclusion: We found that temperature has a direct long-term and short-term influence on mother and fetal health. In spite of the smaller sample size, the study provided key insights and reemphasized the need for additional comprehensive cohort studies and sufficient data to build effective policies to protect poor pregnant women from the hazards of heat stress and for enhanced reproductive health.
Keywords: heat stress, pregnant women, physiological strain
| Visual profile among ophthalmic nurses in a tertiary eye care hospital- results from a pilot study|| |
Syed Ibrahim, Rupa Nivethikka, Ishwarya Sureshkumar, Janani Suresh, Rashima Asokan
Introduction: An ophthalmic nurse is a nursing professional that focuses on assessing and treating patients with a variety of eye diseases and injuries. They also assist in ophthalmic surgeries.
Objective: To understand the visual profile and associated work related visual, ocular and musculoskeletal symptoms among ophthalmic nurses in a tertiary eye care hospital.
Materials and methods: The participants were the ophthalmic nurses of a tertiary eye care centre, who underwent comprehensive eye examination with detailed occupational history, refraction, anterior segment evaluation and posterior segment evaluation. We also included specific test related to their tasks. Nature of the tasks, work related visual demand and associated symptoms were elicited from occupational history. Written informed consent was obtained from all participants. Spectacles were prescribed based on their work nature.
Results: A total of 35 participants 33(94%) were female and 2(6%) were male with a mean age of 37± 8.4 years. The major eye symptoms reported were near vision difficulty 12(35%). 11(31%) reported difficulty in near tasks such as reading medicine labels and suturing/handling ampoule. According to their visual demand, 24(69%) nurses needed visual correction. 18 (50%) nurses required near correction (presbyopia) as well. Based on varied working distance, and symptoms of indoor glare, progressive additional lenses with anti-reflection coating were prescribed. A further detailed evaluation on glaucoma was needed for 1 nurse and corneal evaluation for another nurse. One male nurse was found to have colour vision deficiency (Green colour defect). Due to longer working hours and awkward working postures 27(77%) reported work related musculoskeletal disorders (MSD's). Neck pain (13, 37%) followed by shoulder pain (8, 23%) and a combination with other MSD's (6, 17%) (Lower back, knee, hand and leg pain) were predominantly reported.
Conclusion: The study highlights that uncorrected refractive error and presbyopia are common among ophthalmic nurses which impacts their visual efficiency and associated task performance. Thus, we recommend the need for yearly comprehensive eye and general health examination for the ophthalmic nurses.
Keywords: visual study, ophthalmic nurses
| Noise pollution in a tertiary government hospital|| |
Ambilikrishna JS, Sainath Pednekar, Joel Barbosa Noronha, Prince Gautam, Sunidhi Mohandas Vernekar, Rashmi Vijayakumar
Introduction: Noise has always been an important occupational hazard. Higher noise levels can cause hearing problems, while lower intensity sounds can also affect well-being. Exposure to prolonged periods of loud sound can cause high blood pressure, increased risk of ischemic heart disease and sleep disorders and may increase anxiety. In a hospital setting, it may mask cardiac alarms, hamper staff communication and cause stress, mental fatigue & disturbed sleep.
Objectives: (i) To assess the noise level (in dB) in the ICU (intensive care unit), the ENT (Ear-Nose-Throat) general ward, emergency department and out-patient (OP) rooms of the ENT department (ii) To evaluate if the measured noise levels conform to the standards set by the World Health Organization for hospitals
Materials and methods: This was a prospective, descriptive study conducted in Goa Medical College from 24th November 2020 to 26th November 2020 in the ENT general ward, emergency department, ICU and the ENT OPD. A mobile based application called “iNVH” by Robert Bosch Engineering & Business Solutions Pvt Ltd, was used to measure the noise levels in dB. The application was validated using the “Inter-acoustics AC 40 audiometer”. Noise levels were measured at different times of the day and night for 5 minutes in each location. The maximum, minimum and mean dB values were noted over 3 days. Timings for measurement were; in ICU at 4pm and 7am, emergency department at 5:30pm, 11:30pm and 7am, general ward at 11am, 1am and 6am and OP room at 9am, 10am and 12pm.
Results: The mean noise levels measured over 3 days were 73.33 dB in the ICU, 70.69 dB in the emergency department, 73.62 dB in the ENT general ward and 75.61 in the OP room. The overall average noise level all across was 73.68 dB. Most of the high values recorded in the general ward were mostly during the morning hours.
Conclusion: The noise levels in ICU were especially alarming. Constantly beeping monitors, ventilator alarms, infusion pumps, etc. all contributed to the noise. Also, modern equipment along with ringing phones or conversations between staff lead to constantly high values. As per the WHO guidelines, efficacy of hospital staff in treating patients along with their own mental health showed significant decrease above the prescribed noise values. Thus, it is important to conform strictly to these guidelines and to take measures to decrease the noise levels in all areas of the hospital.
Keywords: noise, pollution, occupational hazard
| Impact of accreditation on the quality of healthcare services|| |
Nasib Jha, Paresh Shah
Introduction: Accreditation is usually a voluntary program in which trained external peer reviewers evaluate a healthcare organization's compliance and compare it with pre-established performance standards.
Objectives: To evaluate the impact of accreditation programs on the quality of healthcare services
Materials and methods: We did a systematic review of the policies, standard operating procedures (SOPs), guidelines as per JCI, NABH and NABL standards and objective elements to evaluate the impact of accreditation programs on the quality of healthcare services.
Results: We evaluated the impact of accreditation for medical emergency services, trauma, surgical care, infection control, pain management, fall risk, laboratory quality control, chemical hazard management, equipment management, utility services and contractual services management. It was found that there are significant improvement in the the process/level of care provided by healthcare services by improving the structure and healthcare facilities system. Our study also showed that accreditation programs greatly improved clinical outcomes and the quality of healthcare services and also found enormous positive impact in different subspecialties including emergency management, trauma management and industrial disaster management.
Conclusion: There is consistent evidence that shows that accreditation programs improve the process of care provided by healthcare services. There is considerable evidence to show that accreditation programs improve clinical outcomes of a wide spectrum of clinical conditions. Accreditation programs should be supported as a tool to improve the quality of healthcare services
Keywords: accreditation, quality, healthcare services
| Effects of smoking on bladder carcinoma-a retrospective study|| |
Introduction: Cigarette smoking is a well-established risk factor for bladder cancer. The effects of smoking duration, intensity (cigarettes per day), and total exposure (pack-years); smoking cessation; exposure to environmental tobacco smoke; and changes in the composition of tobacco and cigarette design over time on risk of bladder cancer are unclear. In India, it is ranked 17th in incidence and 19th in mortality with a varying incidence across Indian population. Bladder tumors are more common in industrial areas. (Especially in those associated with petro chemicals) There are marked geographical variations in incidence of bladder cancer across the globe. Similarly, there was significant variation in incidence rates of different regions in India. Highest rates are seen in Delhi in both males and females.
Objectives: (i) To study the age and sex distribution of bladder carcinoma (ii) To study the effect of smoking in various grades of Urothelial (bladder) carcinoma.
Materials and methods: This is a retrospective study which was conducted for a period of two and half years in the Department of pathology from January 2019 to August 2021.The material of the present study consisted of bladder biopsies obtained from TURBT (transurethral resection of bladder tumor) from the department of General surgery. Smoking history from all these patients have been collected and evaluated.
Results: During this study period, total of 41 bladder biopsies of urothelial carcinoma have been studied. Out of 41 samples,36 patients were males and 5 patients were females. 24 cases were in age group 50-60yrs, followed by 9 cases in above 60yrs age group ,6 cases in 40-50 yrs age group and only 2 cases in less than 40 yrs age group. Out of 36 male patients,28 patients had strong history of smoking. No females had significant smoking history. Out of 28 patients, 7 patients were Papillary Urothelial neoplasm of low malignant potential [PUNLMP] (Grade I), 16 patients were Low-grade papillary carcinoma (Grade II) and 5 patients were categorised as High-grade papillary carcinoma (Grade III). Out of 7 cases of Grade I carcinoma, 2 cases had smoking history of greater than 30 pack years (28.5%). 8 patients out of 16 patients in Grade II carcinoma showed smoking history of greater than 30 pack years (50%), followed by 3 patients in Grade III carcinoma showing similar smoking history (60%).
Conclusion: Our study showed most of the patients between 50-60yrs.Male predominance was evident in our study. Our study also showed significant correlation between smoking history and severity of urothelial (bladder) carcinoma. Better prognosis was noted in patients having history of cessation of smoking. These results support the hypothesis that risk of bladder cancer associated with cigarette smoking has increased with time. Prevention efforts should continue to focus on reducing the prevalence of cigarette smoking.
Keywords: smoking, bladder carcinoma
| Assessment of musculoskeletal and sleep disorder along with visual and ocular profile among drivers|| |
Dhanalakshmi S, Janani S, Rupa Nivethikka R, Syed Ibrahim A, Rashima
Objective: To assess visual and ocular profile along with sleep and musculoskeletal disorder among drivers.
Materials and methods Prospective observational study among drivers above 21 years of age, with minimum 2 years of experience were recruited. Comprehensive eye examination was conducted. The drivers who were in need of spectacles were dispensed. Compliance was assessed after 3 months from the date of spectacle distribution through telephonic conversation. Drivers with ocular abnormalities were referred to tertiary eye care centre. The standardized questionnaire was used to understand about sleep patterns and musculoskeletal disorder among drivers.
Results The study included 111 drivers with mean age of 44 years (SD: 9). Average years of experience and hours of driving was found to be 16.47 years (SD: 9) and 10 hours (SD: 3.22) respectively. About 89 (80.18%) drivers had uncorrected refractive error and was dispensed with spectacles of which 91.6% were compliant. Ocular surface disorders were pingecula (24), pterygium (3) and early lens changes (37). About 7 were referred for further evaluation due to posterior segment abnormalities. Prevalence of musculoskeletal disorder was about 69.36%. Out of 78(72%) drivers, 19(18%) had sub-threshold insomnia, 9(8%) had moderate insomnia and 2(2%) had severe insomnia. Work related MSD was strongly associated with distance of driving (OR: 1.009, p value: 0.030) and sleep score (OR: 1.282, p value: 0.008).
Conclusions: 80.18% of drivers were dispensed with glasses for refractive error. Prevalence of musculoskeletal disorder and insomnia was found to be 69.3% and 38.4% respectively.
Keywords: musculoskeletal disorder, sleep disorder, driver
| Alteration of copper homeostasis in hepatic dysfunction|| |
Kuldip Upadhyay, Ankit Viramgami, Rakesh B
Introduction: Copper homeostasis is tightly regulated by intestinal absorption, biliary excretion and intrahepatic storage. As a reflection of hepatic dysfunction and morphological changes, abnormal copper metabolism become clinically important in differential diagnosis of these conditions. Urinary copper clearances were raised in various liver conditions typically like untreated Wilson's disease.
Objective: The objective of the study was to explore the association of urinary copper excretion with hepatic dysfunction.
Materials and methods: The individuals with diagnose Chronic Liver Disease (CLD) conditions were recruited in the study. The 24hrs urinary copper (Cu) levels were estimated as per method 7029 of NIOSH manual of analytical method. The hepatic function parameters including Albumin, Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), Alkaline phosphatase (ALP), direct bilirubin and total bilirubin were estimated by using Meril CliniQuant biochemistry analyser as per the standard method described by the manufacturer. The correlation and regression analysis was performed by using SPSS software.
Results: The study results revealed that urinary cu levels were significant correlated with ALP (r2 = 0.453, p = 0.001) and direct bilirubin (r2 = 0.289, p = 0.042).
Conclusion: The study demonstrate derangement in Cu metabolism among individual with hepatic dysfunction. Therefore, emphasis the need for periodic hepatic evaluation of those workers occupationally exposed to Cu.
Keywords: copper, homeostasis, chronic liver disease
| A cross sectional study on students outlook on online education during COVID-19 pandemic.|| |
Triveni Gawas, A.M. Ferreira
Introduction: Education system has faced lot of challenges during this covid 19 pandemic to ensure proper delivery of education to the students. In spite of the toughest hurdles faced by the education system, it has managed to reach out to students with the digital approach. Though a totally different approach from the traditional teaching, student's apprehension towards the change should not be ignored.
Objective: To assess students view on online classes during the COVID 19 pandemic.
Materials and methods: Study design: Qualitative descriptive cross-sectional study. Study setting: Fr. Agnel college, Pillar. Study participants:12th std students (2020-2021). Study tool: An online questionnaire using Likert scale was administered to the students. Assent/consent was taken before start of the study. Data was be analysed using SPSS software version 22.
Results: Among the students participated 53% of students faced network issues,52% agreed that online education limited their participation in extracurricular activities. Majority of them faced health issues like eye strain, headache and disturbed sleep.
Key words: COVID 19, online classes, traditional teaching, digital, academics.
| Giving a theory on “Perception of Wellness” amongst Industrial employees and its impact on the General Illness cases of the plant.|| |
Soumya Prabhat Jati, Rajiv K Bhandaru, Vishwabharathi M, Veeranna
Introduction: The perception of Wellness in an Industrial ecosystem is a topic which has been seldom explored in the Industrial set up. Catering to a huge employee base in an industry sometimes becomes a tough nut to crack due to many factors like time constraints, lack of sensitivity or lack of drive.
Objectives: (i) To assess the overall wellness among industrial employees (ii) To assess its' impact on the general illness cases of the employees
Materials and methods: It included regular multispeciality camps, conducting health talks, creating health challenges, single speciality camps, increasing visual presence and OHC Renovation.
Results: The overall wellness events were increased by 60% and the increase in participation was found to be 92%. In terms of OPD numbers the employees per day decreased from about 222+ to 150+. The greatest point of observation was that though the in absolute numbers the increase of participation was mere 682; the decrease in OPD numbers was manifold. Now this difference was significant. Even if the number of increased wellness participants stopped coming to the OPD twice the reduction in numbers would be a mere 1364 which still does not explain the massive reduction of about 7 times this number.
Conclusion: When there is a regular streak of wellness activities in an industrial set up it leads to the creation of wellness ambience and a second component, wellness idol generation which can be seen in subsequent years when the total OPD general illness cases fell by more than 90% with the help of COVID-19 Protocols.
Keywords: perception, wellness, ambience, camps, industrial environment
| Analysis of post COVID-19 syndrome in NFC-Hyderabad|| |
Introduction and Objective: To find out the presence of post covid sequelae of lab confirmed cases of COVID-19 among NFC employees.
Material & Methods: The study was conducted among 127 lab confirmed cases of COVID-19, in NFC employees and beneficiaries, using questionnaire to check the presence of post covid sequelae and psychiatric evaluation done using DASS21 scale.
Result: Post COVID 19 sequelae have predominantly been noticed in the age group of 41-60, and followed by in the age group of 21-40. Among these male population reported more number of symptoms, when compared to those of female. The study population evaluated for post covid-19 syndrome at NFC-Hyderabad reported persistence of symptoms in 75% out of 127 patients on whom the study was conducted. A 53.1% Symptoms reported come under chronic fatigue syndrome, 22% come under sinus / nasal problems, rest under gastro-intestinal and respiratory symptoms. We also conducted DASS21 analysis for psychiatry evaluation post COVID-19, and found more than 95% for the population were normal as per DASS21 scale.
Conclusion: We have noticed that a considerable amount of population has experienced this post covid-19 sequelae, so it would be better to establish a protocol to follow up post covid at 4 -6 weeks for Post-acute Covid-19 symptoms and after 12 weeks for Chronic Covid-19, and manage them appropriately.
Keywords: Post COVID-19 syndrome, NFC employee
| Women at work- 'Know before, rather no after: an impartial woman'|| |
Dr. Shyam Kuman Adapa
Introduction: Women are present in all aspects of working in India. In 2021, an estimated 556,000 women were working in agriculture where women can be exposed to pesticides and chemicals, 828,000 women were working in construction, over 14,80,000 women were working in health care and social assistance.
Objectives: To understand the occupational health hazards in women at work and to establish relationship between knowledge of occupational health issues related to handling of pesticides used in farming.
Materials and methods: A total of 420 seasonal female workers in Bhadrak district of the Province of Odisha, India were included in the study. The questionnaire was administered using face-to-face interview method. Questions assessing workplace exposure and effects with respect to pesticides and environment were included.
Results: The mean age of the participants was 35 ±10 years, engaged in farming for a mean duration of 18.5±10.5 days. All were applying pesticides, but none had been trained in the safe use of pesticides. Concerning working practices and health aspects, 26 % stored pesticides in a secured depot (110 out of 420), 43% took empty pesticide containers to houses. (180 out of 220), 84.0% thought that pesticides could have a negative impact on human health (353 out of 420) and 1.2% reported acute poisoning after applying pesticides. (5 out of 420)
Conclusion: The knowledge level of women workers about safe use of pesticides in this study population is very poor. This lack of knowledge on occupational health and safety will have great impact on society indeed. Appropriate training programs should be organized to increase their level of knowledge.
Keywords: women workers, pesticides, occupation
| Hand protection at construction sites|| |
Introduction: The necessity for guidelines which could be applied for preventing and managing risks of hand injury at construction sites includes various preventive and protective measures such as- to identify the hazards and related risks for hand protection, to evaluate the risks present at the site, to select the preventive & protective measures, to choose an appropriate hand protection gear, to inspect and maintain your safety gloves and to train the employees about hand protection.
Objectives: To provide safe operating guidelines for hand protection at construction sites
Materials and methods: The first step in protecting your workers' hands is to evaluate the risks present at your site which was used to determine the right safety glove that can counter the problem.
Results: Risk assessment was done and the main areas of hand injury included- material handling, ergonomics, hand tools, jewellery, safety guards, danger zone and maintenance.
Conclusion: The formulated guidelines were intended to supplement, not to replace requirements stated by central, state government, local authorities and owner. This document sets out the minimum requirements to be followed across the projects, however, sites can exercise additional stringent measures and frame their hand protection measures depending on the site conditions and authority / customer requirements.
Keywords: Hand protection, construction site
| Human capital as an essential component of sustainability reporting during COVID-19: a cross-sectional study among employees in sedentary occupation|| |
Ms. Monika, Dr. Viji B
Introduction: With the ongoing pandemic, sustainability reporting regarding its different components and stakeholders needs modifications accordingly. These modifications are required because of the new challenges and opportunities emerging in the face of Covid-19 with regards to various guiding components of sustainability reporting. One such component that gained much popularity during the pandemic is 'Human Capital'. Maintaining the wellbeing of the employees is one of the essential elements of the human capital of the organization or firm.
Objective: To study the association of sedentary behavior and physical activity of the respondents to their health.
Materials and methods: A cross-sectional study has been conducted within the region of Delhi-NCR for a sample size of 147 which was calculated.
Results: No association of health outcomes was found with sedentary behavior and physical activity. Although no association was found between current health outcomes and sedentary behavior, there had been a tremendous increase in the sedentary lifestyle during the Covid-19 pandemic.
Conclusion: Sustainability reporting should mention a transparent report regarding the physical and mental wellbeing of their employees and shall provide effective solutions for dealing with the long-term impacts of the pandemic on the employees' health.
Keywords: human capital, sedentary behavior, physical activity, health issues
| COVID-19 vaccine induced vasculitis- a case report|| |
Srikanth D, Vishwabharathi M, Veeranna
Introduction: As of June 2021, a total of 120.2 million cases of corona virus disease 2019 (COVID19), with Seven and half lakh COVID 19 related deaths occurred, as estimated by CDC Globally. Vaccination was started by the Government of India to prevent new cases. With the ongoing pandemic, several COVID-19 vaccine agents have received emergency use approval, several adverse effects are being reported with increasing administration of COVID-19 vaccines.
Findings: Here we describe a case of Henoch Schoenlein purpura, a small vessel vasculitis which is usually seen in children with excellent prognosis in adults, on contrary HSP developed in adult male following COVID-19 vaccination had a rapid deteriorating course. Millions of people are being vaccinated around the world, and thus it is conceivable that people may develop other diseases temporally associated with vaccination but which are unrelated to the vaccine itself.
Conclusion: Auto Immune Diseases (AID) can be triggered by vaccine but how do they behave when compared to primary AID both in terms of presentation, prognosis and treatment response are not known, thereby we concluded that Henoch Schoenlein purpura can develop post covid vaccination in adults and may have a rapid course and poor prognosis.
Keywords: COVID-19, Henoch Schonlein Purpura, Vaccine, Auto Immune Disease.
| Shared Experiences and Best Practices|| |
- Sustainability of business support national economy during COVID – 19 pandemic
Sidram K Raut
- Best practices during COVID-19 pandemic during first and second wave - a case study of refinery in oil and gas exploration industry
- Occupational health and its services
- The roadmap to becoming a key management person – “The six + three pillar model” – A case study.
Soumya Prabhat Jati
- Taking care of children as they learn from home
- Impact of occupational health professionals in India
AVNSS Deepthi, Raja Sekhar Mamillapalli
- Vision ergonomics and factors associated with computer vison syndrome among IT professionals at Verna, Goa.
Triveni Gawas, M.S Kulkarni, Rudra Kunkolienkar
- The real-world repercussions of virtual fatigue