Official publication of Indian Association of 0ccupational Health
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2006| January-April | Volume 10 | Issue 1
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Using spirometry results in occupational medicine and research: Common errors and good practice in statistical analysis and reporting
NL Wagner, WS Beckett, R Steinberg
January-April 2006, 10(1):5-10
Spirometry appears to be a simple and inexpensive method to measure disorders of the respiratory tract. In reality however, a simple spirometry test requires knowledge and skill to correctly conduct and evaluate the test and its results. This review addresses common misunderstandings in using, evaluating and reporting spirometry results in Occupational Health practice, clinical medicine and research. Results of spirometry need to be evaluated in relation to reference values. The factory medical officer has to decide first whether the test was technically correctly executed and is acceptable for medical interpretation. The next step is to compare results of the individual to published reference values. A 10% reduction of reference values for North Indians and Pakistanis and a 12 to 13% reduction for South Indians is recommended when Caucasian reference tables are used. In occupational health practice the worker's spirometry performance over time needs to be considered. Common errors in reporting summarized results, for instance from groups of workers, are the incorrect use of tests of significance and incorrect presentation of aggregated spirometry results. The loss of respiratory function is recommended as an indicator of difference between two groups. That way, early changes in function can seen without waiting for a drop of function below the usually used 80%-of-predicted limit. This procedure increases the sensitivity of medical surveillance. In research the more precise Lower Limit of Normal should be calculated and used. Correct reference equations, good patient coaching, decision on the technical quality (acceptability) of each spirometry test and critical re-evaluation of the machine's readout
are essential parts of a correct spirometry test. A good understanding how results are calculated is crucial for further statistical evaluation.
Assessment of physiological strain in inland fishing activity
R Biswas, A Samanta
January-April 2006, 10(1):19-23
Ten fishermen aged between 19 and 48 years of age, were examined in the field during inland fishing activity, which they perform individually. Physiological strain in terms of heart rate varied between 86 and 115 beats/min with mean net cardiac cost of 32 beats/min. The average relative cardiac cost was 36%. Analysis of physiological responses revealed that the recommended limits of cardiac strain indices were surpassed during the majority of the fishing period. Average energy cost was estimated to be 3.3 kcal.min-1, which was about 34% of the VO2max. Average intensity of the workload entailed in the whole fishing shift appeared to be moderate and acceptable. Furthermore, the heat load in the working situation did not appear to be a serious threat to the health of the workers. Analysis of work revealed more static exertions in the work. To reduce the postural load and musculoskeletal discomforts of the fishermen, ergonomic interventions are required, which represents a further scope of study.
Altered pituitary hormone secretion in male rats exposed to bisphenol A
AM Gharravi, R Ghorbani, M Khazaei, Pour A Motabbad, M Al Agha, J Ghasemi, P Sayadi
January-April 2006, 10(1):24-27
Bisphenol A (BPA) is a xenobiotic estrogenic compound. This compound has been suspected to have estrogenic effects on reproductive system of males and females. In this present study we investigated possible low-dose effects of BPA on Luteinizing Hormone in rats. Male Wistar rats (12-13 weeks old) were administrated a daily intra peritoneal 10 µg/kgbw/day, 50 µg/kgbw/day, 100 µg/kgbw/day dose of BPA for 6, 6, and 12 days, and one day after last injection, serum level of Luteinizing Hormone was examined by ELISA method. All data were expressed as means ± SE. Two-way ANOVA was performed. Analysis of data showed that in all dose groups, plasma level of Luteinizing Hormone significantly decreased compared to control group. The present study showed that BPA at low doses affects Luteinizing Hormone, one of main hormones in spermatogenesis in the adult Wistar rats, and subsequently alters the steroidgenesis in testicular Leydig cells.
A study of the prevalence of respiratory morbidity and ventilatory obstruction in beauty parlour workers
C Kesavachandran, SK Rastogi, N Mathur, V Bihari, A Singh
January-April 2006, 10(1):28-31
A study was conducted in beauty parlor workers of Lucknow, India, to assess the prevalence of respiratory morbidity and lung function abnormalities compared to their control subjects belonging to the same socioeconomic status and ethnic group, having never been exposed to the workplace of beauty parlor and having not used any cosmetics. Respiratory morbidity and bronchial obstruction based on PEFR study was conducted in 196 beauty parlor workers and 35 control subjects. All the participants were non-smokers and were matched for age, height, weight and socioeconomic status. Peak expiratory flow rate were performed using Peak Flow meter. Symptomatic workers showed bronchial obstruction (28%), and this prevalence was significantly higher (
<0.01) when compared to 6.7% among asymptomatic workers. Bronchial obstruction among female workers (17.9%) was more prevalent (
<0.01) than male workers (1.42). Overall respiratory morbidity among beauty parlor workers showed higher (12.7%) when compared with control group (2.8%) but differences couldn't attain any significance. Although nonsignificant, workers in beauty parlor showed more prevalence (9.4%) of bronchial obstruction based on PEFR than controls (4%). This study showed that beauty parlor workers were more prone to respiratory morbidity and lung function abnormalities, as the study group selected were non-smokers.
Epidemiological surveillance of employees in a mercury thermometer plant: An occupational health study
T Rajgopal, HV Ravimohan, P Mascarenhas
January-April 2006, 10(1):11-18
A cross-sectional epidemiological survey of 255 individuals (130 current permanent employees, 64 contract workers, 55 ex-employees and 6 scrap dealers) coupled with a retrospective cohort study of the occupational health of 290 employees (all permanent employees who ever worked in the factory over a span of 15 years) was conducted in a mercury thermometer plant at Kodaikanal in India. The cross-sectional study done in March 2001 was based on a clinical protocol developed by the US Dept. of Labor, Mines Safety and Health Administration and was supplemented by the analysis of mercury in urine (HgU) through Inductively Coupled Plasma Emission Spectrometry (ICP) and relevant biochemical investigations. Group averages of HgU in this study was 23.8 mg/L and were well within WHO-recommended limits of group means (50 mg/L). Group analysis was supplemented by appropriate individual analysis. The retrospective cohort study (for the years 1988-2001) included clinical evaluation coupled with analysis of biological monitoring done through Cold Vapor Atomic Absorption Spectrometry (CVAAS). Group averages of mercury in urine measured between 12.9 to 31.9 mg/L over the working life of the factory, and they too were supplemented by appropriate individual analysis. The protocol for epidemiological surveillance and indeed for the occupational health surveillance conducted over the life of the factory (biological monitoring, workplace environmental monitoring, shop floor health and safety practices and clinical evaluations) have been independently validated by the Netherlands-based TNO, the All India Institute of Medical Sciences, and the Indian Association of Occupational Health. None of the employees in this factory were found to be suffering from any ill health that could be attributed to Hg exposure.
Occupational exposure to sharps and splash: Risk among health care providers in three tertiary care hospitals in South India
S Tetali, PL Choudhury
January-April 2006, 10(1):35-40
Occupational exposure to blood and body fluids places Health care providers at risk of infection with blood borne viruses including HIV. To understand Health Care Providers' (HCP*) perception of risk of occupational exposure to needles, blood and body fluids, to find out the correlates of exposure and to identify groups of HCP at high risk of sustaining maximum number of such exposures. A cross sectional survey was conducted on HCP in three tertiary care hospitals in Kerala, between August 20th and October 30th, 2004 Chi square test, independent-sample T test and one-way ANOVA was used for analysis. Overall, 74.5% (95% CI 71.3 to 78.2) of the respondents were exposed at least once in the last 12 months. Surgeons were exposed most frequently, with a mean of 3.8 injuries per person per year. Injection needles were responsible for 68% of the injuries. Those who underwent the in-service training program on needle safety were less injured (
=0.001). Only 4% of surgeons had undergone needle safety training. Almost half the surgeons, anesthetists and medical students did not know the reporting procedure and only 10% of anesthetists knew about the provision of Post Exposure Prophylaxis (PEP). A considerable proportion of respondents (85%) (95% CI- 81.2 to 88.5) were concerned about acquiring blood borne infections and 90% were immunized against Hepatitis B. Training of Health care providers is absolutely essential for injury reduction and should take into account the varying incidence of exposure across different occupation groups.
January-April 2006, 10(1):3-4
Assessment of airborne dust associated with chemical plant: A case study
January-April 2006, 10(1):32-34
The process of alumina production involves refining of bauxite ore into tri-hydrated alumina (Al2O3, 3H2O) by chemical method followed by process of calcinations. This method possesses various kinds of dust hazards in its work environment amongst the people involved. Poor health of industrial employees in India is due to its occupational environment (Park & Park, 1970), which is a major concern now-a-days. Attempts have been made to recognize the potential sources of airborne dust and to assess the dust load upon exposed workers at different work sites of alumina plants by comparing the observations with the standard values called 'Threshold Limit Values' (T.L.V.) assigned by the international body ACGIH (American Conference of Governmental and Industrial Hygienists), USA, and also permissible exposure limit values prescribed in the second schedule Section F of Factories Act (Amendment), 1987. Alumina plant operation includes various physical operations like crushing, grinding, conveying, loading, transporting, etc., which generate finer particles. It can cause serious health hazards on inhalation, depending upon its size, shape, constituents and duration of exposure. Out of all these parameters, concentration of respirable fraction of airborne dust (0.5 to 5.0 micron size) and its free silica content have been reported to cause lung fibrosis as well as occupational disorders. In the present study, attempts have been made to make a survey of respirable fraction of the airborne dust (that remains suspended in air for quite an appreciable time) associated with various operations according to job profiles. It also outlines the probable control measures in order to provide a healthy working environment. Present work aims at identifying and evaluating the degree of workplace dust with special reference to respirable fraction and for recommending suitable suggestive control measures for an effective management of occupational environment.
Physicians response to patients telephone calls-pitfalls and solutions
January-April 2006, 10(1):41-42
Telephone medicine is a fast emerging concept and training in telephone medicine skills is limited among physicians. Increased awareness in telephone medicine may assist physicians in minimizing the risk of errors.
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