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     Table of Contents - Current issue
Coverpage
July-September 2021
Volume 25 | Issue 3
Page Nos. 125-187

Online since Saturday, October 9, 2021

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EDITORIAL  

Research and the occupational health physician p. 125
Bobby Joseph
DOI:10.4103/ijoem.ijoem_297_21  
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ORIGINAL ARTICLES Top

Environmental literacy among college students p. 128
G Usha Shri, Rajnarayan R Tiwari
DOI:10.4103/ijoem.IJOEM_141_20  
Environmental degradation has become a serious source of concern for contemporary society, giving rise to efforts in the way of advocacies, conferences and awareness campaigns at different levels. It has been widely acknowledged that environmental literacy, which is an outcome of environmental education, can provide a strong foundation for future environmental responsiveness, as well as help in the transition towards more sustainable societies and healthy living. The present study carried out among 280 college students including 145 males and 135 females in the age group 17–30 years to assess the levels of environmental knowledge and attitudes. A structured questionnaire was used to gather the information using interview technique as data collection tool. Almost 40% of the subjects were unaware about the environment, while less than half of the respondents were unwilling to protect endangered species, unwilling to change their lifestyle for protecting environment, unconcerned by other's land use, and consider runoff of water and global warming as exaggeration. The overall awareness was about 61.5%, while the attitude towards environmental protection was further lower at 50%. Thus, to conclude there is a need for environmental literacy initiatives at the university level to generate a better appreciation, involvement, and the optimistic ideas necessary to contribute to the quality of our environment.
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Musculoskeletal disorders in tyre manufacturing workers p. 133
Neha Mukkamala, Lata Parmar, Palani Kumar
DOI:10.4103/ijoem.IJOEM_177_20  
Background: Tyre manufacturing workers are at risk of developing WRMSDs as their job repeatedly involves elevated arm postures, lifting of tyres, pushing or pulling trolleys, trunk bending and twisting. Aim: To assess WRMSDs in tyre manufacturing workers. Methodology: This was an observational study involving 99 tyre manufacturing workers. Persons with any history of recent trauma, major hospitalization or surgery in past 12 months were excluded. Workers were screened according to Nordic questionnaire for assessing the musculoskeletal disorders and REBA analysis was done. They were also assessed for flexibility of hamstring using AKE test and isometric endurance of back extensors using Sorenson test. Results: 97% workers were under 30 years of age and 91% were males. The average duration of work was 27 months. In the past 12 months, 36% workers reported low back pain, 24.2% shoulder pain, 24.2% neck pain, 19% knee pain and 20% ankle/foot pain. REBA analysis revealed TBR and PCR manufacturing workers to be at higher and lower end of medium risk category, respectively. Average AKE values were 39.450 and 38.450 on the right and left, respectively, indicating that hamstring tightness was common, average back muscle endurance was 40.68 sec. However, AKE or back muscle endurance was not statistically related to back pain (P > 0.05). Conclusion: Tyre workers showed involvement of multiple joints. LBP was predominant complaint but was not related to hamstrings tightness or back muscle endurance.
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The relationship of grip and pinch strength to musculoskeletal disorders in female carpet weavers in Southeastern Iran, 2019 p. 138
Naser Hashemi Nejad, Mostafa Mohammadian, Ali Akbar Haghdoost, Esmail Charkhloo
DOI:10.4103/ijoem.IJOEM_223_20  
Background: The repetitive and prolonged exertion of grip and pinch strength are current among carpet weaver tasks. The three objectives of this study were (1) to investigate the relationship between symptoms of musculoskeletal disorders and grip and pinch strength of carpet weavers in carpet weaving workshops in Kerman province, (2) to compare the grip and pinch strength of carpet weavers with normal values, and (3) to identify the relationship between hand postures of carpet weavers during work and force exertion. Methods: In this cross-sectional study, grip strength and key, tip and palmar pinch strengths of 101 female carpet weavers aged 20 to 71 years were measured in Kerman province, in 2018. Nordic Musculoskeletal Questionnaire (Extended version) was also used to evaluate musculoskeletal disorders. Results: Bivariate and multivariate linear regression analyses showed that participants who suffered from musculoskeletal disorders had lower grip and pinch strength than others and this decrease was statistically significant in upper back, wrists/hands, and knees. Moreover, there was a significant difference between grip and three types of pinch strength of carpet weavers and normal values. Furthermore, for both hands, the grip strength in the position recommended by American Society of Hand Therapists was significantly greater than that in the normal position carpet weavers usually adopt. Conclusion: Based on the results, the high prevalence of musculoskeletal disorders has led to a significant decrease in the grip and pinch strength of carpet weavers. Therefore, it is necessary to undertake ergonomic interventions in designing the carpet weaving workstation.
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Quantitative assessment of nitrous oxide levels in room air of operation theaters and recovery area: An observational study p. 147
GD Puri, Shyam C Meena, Vinayak Sinha, Amarjyoti Hazarika, Haseeb Hakkim, Ashish Sharma, Kamal Kajal, Neeti Dogra
DOI:10.4103/ijoem.IJOEM_44_19  
Background: Nitrous oxide has been used during surgical anesthesia for many years. However, information about occupational exposure and related risks due to N2O exposure to the health care personnel in India are still poorly understood. Here, we measured the residual N2O levels during the working time of operation theatre room air in our tertiary care hospital. Material and Methods: The air samples were collected from different anesthesia exposure zones on different days for quantitative analysis of available N2O in the room air in respective areas. Nitrous oxide concentrations in the ambient air were also measured to compare outdoor and indoor levels. Observations and Results: Nitrous oxide mixing ratios were found to be 65.61 ± 0.05 ppm, 281.63 ± 0.43 ppm, and 165.42 ± 0.42 ppm in elective surgical theatres of the hospital on three different days whereas in emergency operation theatres of the same hospital levels of N2O were 166.75 ± 0.07 ppm, 510.19 ± 0.30 ppm and 2443.92 ± 0.64 ppm during same period. In elective pediatric surgical theatres levels of N2O were found to be 1132.55 ± 0.70 ppm and 362.21 ± 0.13 ppm on two days of reading respectively. Outdoor levels of N2O in contrast found 0.32 ± 0.01 ppm and was lower by a factor of 1000. Conclusion: We observed the very high ambient concentration of N2O in the surgical theatre's environment (up to 2443 ppm) and recovery areas (up to 50 ppm). It was 5 to 50 times higher ambient concentration of N2O than REL in OT area and 200-7000 times higher ambient concentration of N2O than outdoor ambient air in all surgical theaters other than CTVS OTs.
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Epidemiological correlates of well being at work place and hazards identification and risk assessment amongst saw mill workers in anand, Gujarat p. 152
Deepak B Sharma, Utkarsh M Shah, Uday S Singh
DOI:10.4103/ijoem.ijoem_356_20  
Context: The nature of the work in saw mills carries a huge risk as the workers are exposed to various life-threatening hazards. Aims: This study was conducted to know the “Work place Wellbeing” of the saw mill workers, occupational Hazards identification and Risk assessment (HIRA) including hazard communication, occupational accidents, injuries and diseases. Settings and Design: The study was a cross sectional study amongst workers of saw mills. Methods and Material: A total of 219 saw mill workers were interviewed. “Work place wellbeing”, was studied by using the “Workplace Wellbeing Questionnaire - Black Dog Institute” which includes four areas of workplace wellbeing viz. (1) Work satisfaction, (2) Organizational respect for the employee, (3) Employer care, and (4) Intrusion of work into private life. Reliability analysis was done and Cronbach's alpha was found. Association was found between the work place wellbeing and other demographic and occupational variables. Statistical Analysis Used: Proportions and Mann–Whitney U test. Results: Scores of all the participants fall in the medium scale for “work satisfaction”. For “respect”, 93.6% fall in the medium scale. In “employer care” 97.7% fall in medium category. All the workers scored in the medium scale for the “intrusion in private life”. None of the scores were in low scale for any domain. Injury as an event was reported by 8.22%. Specific disease prevalence was highest for back ache as 72.1%. Hazard communication was done in 40% workers. Conclusions: We found poor working positions at work place and they did suffer from various medical morbidities at the work place.
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Persistent organic pollutants-environmental risk factors for diabetes mellitus?–A population-based study p. 157
Sudha Ramalingam, Ramanujam Narayanan, Sivaselvakumar Muthusamy, Merlin Veronika, Ramalingam Sankaran, William Toscano
DOI:10.4103/ijoem.ijoem_337_20  
Background: Globally, type-2 diabetes mellitus is increasing in epidemic proportions. A major cause of concern in India is the increasing incidence of cases, especially troubling is the observed increase in younger age groups with no risk factors. New evidence suggests that many environmental factors, such as air pollution, persistent organic pollutants (POPs), and environmental estrogens are implicated as risk factors for type-2 diabetes mellitus. Animal and human epidemiological studies have shown ubiquitous lipophilic substances, including POPs, are frequently associated with type-2 diabetes mellitus. Such studies have not been undertaken in Indian youth. Methods: This is a cross-sectional study that explored the association between POPs and type-2 diabetes mellitus in Indian urban and rural population. About 7 ml of venous blood was collected from all consenting patients and serum was separated immediately and was transported to the lab for further analysis. Serum levels of POPs, including organochlorine (OC) compounds and organophosphorus pesticides, were estimated using sample gas chromatography-mass spectrometry (GC-MS). The fasting blood sugar values and the serum levels of POPS were tested using Pearson correlation coefficient. The magnitude of increase in blood sugar corresponding to increase in POPs was analyzed using linear regression analysis. The odds ratios (ORs) were expressed at 95% confidence intervals (CIs). Results: Three OC pesticides and one organophosphate pesticide were strongly associated with increasing blood sugar levels after adjusting for age, sex, and body mass index – lindane (OR 4.95, 95% CI 1.03–23.73), DDT o, p' (OR 3.50, 95% CI 1.04–11.73), dimethoate (OR 19.31, 95% CI 4.22–88.37), and dichlorvas (OR 6.33, 95% CI 1.28–31.18).
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A toolkit for strengthening health care policies and infrastructure of industries in developing countries p. 163
Suvetha Kannappan, Mansi Gupta
DOI:10.4103/ijoem.ijoem_409_20  
Background: The health risks faced by textile workers calls for a workplace health system that is comprehensive and accessible. To enhance the capacity of workplaces to strengthen their health system, a toolkit was developed by the Business for Social Responsibility (BSR), a non-profit global business network and sustainability consultancy. Methods: The Health System Strengthening (HSS) toolkit was designed to provide a set of tools, resources, and concrete steps for the factory management and health staff to work toward continuous improvement of their on-site health systems. It was then implemented with academic collaboration simultaneously In three factories/ in three manufacturing units/ in three workplaces in South India over 6 months to find out its usefulness as a self-reference tool for HSS. Monitoring and evaluation tools and indicators were developed based on the logic framework. Results: The main outcomes of the HSS pilot program include the formation of a health committee which was able to utilize the modules, perform a self-assessment of the health system, and come out with short- and long-term action plans for HSS under expert supervision and guidance. Conclusions: Overall, the toolkit was found to be an effective solution for HSS in industries which require expert guidance for implementation.
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A cross-sectional study on occupational health and safety of municipal solid waste workers in Telangana, India p. 169
KL Ramitha, Thatipally Ankitha, Rayapati Vasuki Alankrutha, CT Anitha
DOI:10.4103/ijoem.ijoem_21_21  
Background: The occurrence of workplace hazards, occupational diseases, and deaths contribute significantly to the increase in the global burden of diseases. The Municipal Solid Waste (MSW) workers experience occupational stressors throughout the process of waste management that affects their well-being and results in high rates of occupational health problems. It is vital to understand the workplace practices and occupational morbidities of the MSW workers to ensure their safety and well-being. In this context, the study aimed to explore the occupational health and safety practices at the place of work among the MSW workers in Karimnagar and Hyderabad in Telangana, India. Methodology: A cross-sectional study was conducted in two cities of Telangana. A total of 394 MSW workers were surveyed. The number of MSW workers in Karimnagar and Hyderabad were 152 and 194, respectively. A pre-tested questionnaire was administered to the MSW workers to study the occupational morbidities and workplace safety practices. Focused group discussions were conducted among the MSW workers in both cities. In-depth interviews of sanitary supervisors in Karimnagar were conducted. Semi-structured questionnaires and interview guides were used with questions on sociodemographic characteristics, health status, work environment, protection strategy, and healthcare utilization. MS Excel and NVivo-12 were used for data analysis. Results: Musculoskeletal problem was the major reported morbidity among the MSW workers (76.6%). Injuries were reported more among the MSW workers in Hyderabad (39.7%) along with a fear of being hit by vehicles while working on the main roads. About 88.7% of the MSW workers had less than secondary education. There was a wage difference between the contract and permanent MSW workers. There was a lack of provision of personal protective equipment and poor working conditions, overall. Lack of basic amenities such as the provision of drinking water and toilets apart from inadequate social security and healthcare facilities was reported. Conclusion: This paper highlights the unsatisfactory working environment and high-occupational morbidities among the MSW workers in Telangana. There was a lack of basic amenities at the workplace making it difficult for the MSW workers. A comprehensive approach which focuses on the health and safety with social security for the MSW workers is required.
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BRIEF COMMUNICATION Top

Exploring the awareness regarding e-waste and its management among electronic repair workers and scrap dealers of South Delhi, India p. 178
Sneha Kumari, Priyanka Sharma, Sanjeet Panesar, Lalit Chandrawanshi, Geeta Yadav, Kishore Jugal
DOI:10.4103/ijoem.IJOEM_48_19  
Introduction: In India, E-waste and its proper disposal is an emerging environmental and public health issue. Aim and Objectives: To assess the level of awareness regarding E-waste and its management among the electronic repair workers and scrap dealers of Delhi. Material and Methods: It was a community based, cross-sectional, descriptive study, was of one year (1st April, 2015-31st March, 2016). Electronic repair workers and scrap dealers were included after getting their written consent and selected by non-probability convenient sampling. A pre-tested, semi- structured, interviewer administered questionnaire was used. The data was entered in MS Excel and was analyzed using the SPSS version 21.0. Results: A total of 300 workers i.e. 150 electronic repair workers and 150 scrap dealers participated. Most of the electronic repair workers (57%) and scrap dealers (48%) were of 20-39 yrs old. 70% of electronic repair workers and 79% of scrap dealers had not heard about e-waste. As education among these groups increases, awareness regarding E-waste also increased and it was statistically significant. Conclusion: Adequate IEC (Information, education and communication) services focusing on health hazards of E-waste should be widely disseminated.
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CASE REPORTS Top

Middle lobe syndrome in silicosis p. 182
Ramakant D Dixit, Jitendra Jalutharia, Mukesh Goyal, Pradeep Chaudhary, Neena Kasliwal
DOI:10.4103/ijoem.ijoem_26_21  
A case of silicosis presenting as middle lobe syndrome is described in a middle-aged female. The diagnosis was confirmed by both bronchoscopy and demonstration of right middle lobe lumen narrowing and compression by calcified hilar lymph nodes on computerized tomographic scan. Simultaneous occurrence of endobronchial silicosis and bronchial stenosis by enlarged calcified peribronchial lymph nodes causing middle lobe syndrome has not been described previously as reported in this case.
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Splenic silicosis: Arare cause of splenic calcifications p. 185
Muniza Bai, Dharm P Dwivedi, Vemuri M Babu, Lakshmi S Warrier, Abhishek S Chauhan
DOI:10.4103/ijoem.ijoem_340_20  
Silicosis, an occupational menace is an irreversible lung disease caused by inhalation of tiny particles of crystalline silica. It is an occupational hazard both in industrialized as well as developing nations. Thoracic involvement is commonly described following exposure to silica, but extrathoracic involvement is a rare occurrence and often an incidental finding. It can manifest as calcifications in the liver, spleen, abdominal, axillary and cervical lymph nodes in addition to intrathoracic involvement. Silicosis as a cause of splenic calcifications often gets buried under the common differentials like tuberculosis, acquired immunodeficiency syndromes, amyloidosis, and Gamna-Gandy bodies. We herein describe a case of chronic complicated silicosis with splenic calcifications which appear similar to intrathoracic calcifications.
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