Recent industrialization and globalizations are changing the Indian occupational morbidity drastically. Traditionally labor-oriented markets are on change towards more automation and mechanization, at the same time general awareness about occupational safety, occupational and environmental hazards were not spread in the society. This review will provide an overview of existing evidence from community based epidemiological studies and address the growing needs for evidence-based occupational health research in India. Review of all published results. Occupational research is seen as more complex issue in India, which Includes child labor; poor industrial legislation; vast informal sector; less attention to industrial hygiene and poor surveillance data across the country. While India experiencing economic transition, occupational research approach should balance between understanding the modern industrial exposures and health risks of traditional sectors like agriculture and plantations. Strategies like modern occupational health legislation, enforcement machinery in sub-district level, training to health professionals, need for epidemiological evidence and international collaborations were discussed to deal with the situation.

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Stress in nurses is an endemic problem. It contributes to health problems in nurses and decreases their efficiency. Documenting the causes and extent of stress in any healthcare unit is essential for successful interventions . Aim : Establishing the existence and extent of work stress in nurses in a hospital setting, identifying the major sources of stress, and finding the incidence of psychosomatic illness related to stress. Materials and Methods: This study used a questionnaire relating to stressors and a list of psychosomatic ailments. One hundred and six nurses responded and they were all included in the study. Stressors were based on four main factors: work related, work interactions, job satisfaction, and home stress. The factors relating to stress were given weights according to the severity. The total score of 50 was divided into mild, moderate, severe, and burnout. Results: Most important causes of stress were jobs not finishing in time because of shortage of staff, conflict with patient relatives, overtime, and insufficient pay. Psychosomatic disorders like acidity, back pain, stiffness in neck and shoulders, forgetfulness, anger, and worry significantly increased in nurses having higher stress scores. Increase in age or seniority did not significantly decrease stress. Conclusion: Moderate levels of stress are seen in a majority of the nurses. Incidence of psychosomatic illness increases with the level of stress. Healthcare organizations need to urgently take preemptive steps to counter this problem.

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Oxidative stress status and Acetylcholinesterase (AChE) activity were studied in blood samples obtained from 61 agricultural workers engaged in spraying organophosphorus (OP) insecticides in the mango plantation, with a minimum work history of one year, in the age range of 12-55 years. Controls were age-matched, unexposed workers, who never had any exposure to OP pesticides. They were evaluated for oxidative stress markers MDA (end product of lipid peroxidation), reduced glutathione (GSH), and Acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) levels in blood. The results showed a marked inhibition of the AChE and BChE activities in the sprayers as compared to the controls. The malondialdehyde(MDA), the last product of lipid peroxidation was found to be increased significantly in sprayers(p<0.05), while depletion in the concentration of antioxidant glutathione(GSH) was also observed in the sprayers but the difference was statistically not significant. It was concluded on the basis of biochemical analysis that pesticides sprayers are exposed to more oxidative stress as evidenced by the changes in antioxidant status. The measurement of the AChE and BChE activities in agricultural workers who spray OPs could be a good biomonitoring factor and is recommended to be performed on a regular basis.

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The incidences of chromosomal aberrations(CAs) as well as sister chromatid exchange frequencies (SCEs) was evaluated from 12 photocopying machine operators working on an average 8-9 hours per day for more than five years. A complete blood picture of each individual was assessed with an automatic particle cell counter. Additionally, blood pressure was measured at the time of blood collection from all photocopying machine operators. For comparison, the control group included another 12 individuals matched according to age, sex, socioeconomic conditions as well as other personal habits. The observations of the present study are indicators of health hazard for, although small, there was a significant increase in the percentage of aberrant cells (P<0.05), total aberrations (P<0.01) as well as total aberrations excluding chromatid gaps (P<0.01) among photocopying machine operators when compared to controls. However, results on SCE analysis of photocopying operators revealed no significant difference from the controls. At the same time all photocopying operators exhibited normal hematological parameters as well as blood pressure values.

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To evaluate the health impact of spraying organophosphorus insecticides (OPs), 34 male sprayers in the mango belt of Malihabad, a small town located 27 km from Lucknow in North India was selected. Plasma butyryl cholinesterase (PBChE) and complete blood count were assessed among sprayers after spraying pesticides and the findings obtained were compared with those determined in a reference group ( n = 18). The most common symptoms observed were burning sensation in the eyes (8.82%), itching/skin irritation (23.52%) and chest symptoms (32.35%) in the exposed workers. Plasma butyrylcholinesterase (PBChE) was significantly decreased in workers. The results indicated significant decrease in the mean value of hemoglobin, hematocrit and platelets count; however, significantly higher count of leukocytes was also observed in the exposed group (sprayers) compared to that observed in the control group (P < 0.05). Monitoring of PBChE in pesticide sprayers could be useful to predict and prevent health hazards of OPs.

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The Healthy Worker Effect (HWE) phenomenon has been under debate since some years. Some epidemiologists regard HWE as an ordinary method problem while others consider it a field of science by itself. This article gives definitions of HWE explained with historical background; discusses factors affecting it and suggests methods to minimize problems associated with it.

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Equipment-induced vibration is widely recognized as a health hazard. It is a physical stressor to which many people are exposed at workplace. Mining industry is no exception. In spite of extensive research undertaken in the developed countries, information on the magnitude of the problem in India is not available. An estimated 1 million workers were engaged in the Indian mining industry in the year 2003. The actual figures could be much higher. Analysis of employees' database of several mines reveals that 18% employees in the Indian mining industry are occupationally exposed to vibration. Large-scale mechanization considerably adds to the severity and complexity of the problem because of 1) increase in the percentage of exposed population and 2) longer duration of exposure. The clinical picture and health outcomes of exposure to hand-arm vibration and whole-body vibration are scantily documented in the Indian context. In view of the health risk and action taken in other countries, we submit that there is an urgent need to develop a practical management strategy for evaluation, monitoring and control of equipment-induced vibration in the mining industry.

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Noise monitoring using "Cirrus sound level" was carried out for 30 min at a height of 1.5 m and 1 m away from the chest during October, 2002 covering 73 locations of ~781 MW power plant. Event Leq and LN cycle were studied to identify the noisy machines and to generate baseline data. Lowest avg. noise 70.37 dB(A) was found at control room while the highest avg, 95.91 dB(A) at F. D. Fan with average 88.04± 6.08 dB(A). Compressors generate second highest noise, 89.98 dB(A). Operators of F.D. Fans are having a fare chance of exposure with >90 dB(A) i.e., beyond the prescribed standard. Noise may not jeopardize employee's life immediately but might be the cause of neurobehavioral change, psychological stress and unhappiness in daily life without showing the symptoms of chronic /acute diseases. Measured data has been compared with TLV of American Conference of Governmental Industrial Hygienists. The quality of life of industrial worker is one of the prime factors for production; hence it should not be neglected. Revision of occupational Indian noise standard is recommended at par with International / European standards. Noise-reducing options are also described. This investigation may help the implementing authority to adopt better policy for better work environment.

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The current mini-review describes the toxic effects of zinc inhalation principally in the workplace and associated complications with breathing and respiration. The International Classification of Functioning, Disability and Health Criteria were used to specifically select articles. Most of the commercial production of zinc involves the galvanizing of iron and the manufacture of brass. The recommended daily allowance for adults is 15 mg zinc/day. Metal fume fever associated with inhalation of fumes of ZnO is characterized by fatigue, chills, fever, myalgias, cough, dyspnea, leukocytosis, thirst, metallic taste and salivation. ZnCl ₂ inhalation results in edema in the alveolar surface and the protein therein the lavage fluid is elevated. Particular pathological changes associated with zinc intoxication include: pale mucous membranes; jaundice; numerous Heinz bodies; and marked anemia. Adequate ambient air monitors for permissible exposure limits, excellent ventilation and extraction systems, and approved respirators are all important in providing adequate protection.

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Electronic waste or e-waste is one of the rapidly growing problems of the world. E-waste comprises of a multitude of components, some containing toxic substances that can have an adverse impact on human health and the environment if not handled properly. In India, e-waste management assumes greater significance not only due to the generation of its own e-waste but also because of the dumping of e-waste from developed countries. This is coupled with India's lack of appropriate infrastructure and procedures for its disposal and recycling. This review article provides a concise overview of India's current e-waste scenario, namely magnitude of the problem, environmental and health hazards, current disposal and recycling operations, existing legal framework, organizations working on this issue and recommendations for action.

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Phthalates are used in commercial products as softners of plastics, solvents in perfumes and additives to hair sprays, lubricants and insect repellents. The wide spread use of phthalate results in multiple human exposure routes i.e., ingestion, inhalation and dermal exposure. In the present review, a detailed account of respiratory toxicity, reproductive toxicity, developmental toxicity, endocrine disruptors and genotoxicity of human exposure to phthalate is mentioned in detail.

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Context: This minireview describes the health effects of antimony exposure in the workplace and the environment. Aim: To collate information on the consequences of occupational and environmental exposure to antimony on physiological function and well-being. Methods: The criteria used in the current minireview for selecting articles were adopted from proposed criteria in The International Classification of Functioning, Disability and Health. Articles were classified from an acute and chronic exposure and toxicity thrust. Results: The proportion of utilised and non-utilised articles was tabulated. Antimony toxicity is dependent on the exposure dose, duration, route (breathing, eating, drinking, or skin contact), other chemical exposures, age, sex, nutritional status, family traits, life style, and state of health. Chronic exposure to antimony in the air at levels of 9 mg/m ³ may exacerbate irritation of the eyes, skin, and lungs. Long-term inhalation of antimony can potentiate pneumoconiosis, altered electrocardiograms, stomach pain, diarrhea, vomiting, and stomach ulcers, results which were confirmed in laboratory animals. Although there were investigations of the effect of antimony in sudden infant death syndrome, current findings suggest no link. Antimony trioxide exposure is predominant in smelters. Mining and exposure via glass working, soldering, and brazing are also important. Conclusion: Antimony has some useful but undoubtedly harmful effects on health and well-being and measures need to be taken to prevent hazardous exposure of the like. Its biological monitoring in the workplace is essential.

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The estimated average daily employment in the Indian mining sector is 5,60,000, which comprises 87% in the public sector and 13% in the private sector, of which around 70,000 are working in metallic mines. The mine workers are exposed to dust of various potentially toxic substances. The common toxicants present in the mining environment are lead, mercury, cadmium, manganese, aluminium, fluoride, arsenic, etc. Inhalation and absorption through the skin are common routes of exposure. Low-dose chronic exposure of toxic substances results in the accumulation of toxicants in the body. Hence, there is a need to monitor the mining environment as well as the miners for these toxicants.

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This study reviews a series of 811 malignant pleural mesothelioma cases, diagnosed at hospitals in Trieste and Monfalcone districts of north eastern Italy, a narrow coastal strip with a population of about three lakh, in the period 1968-2008. The diagnosis was based on histological examination in 801 cases, and cytological findings in 10. Necropsy was performed in 610 cases. Occupational histories were obtained directly from the patients or their relatives through personal or telephone interviews. Routine lung sections were examined for asbestos bodies in 500 cases. In 143 cases asbestos bodies were isolated and counted by chemical digestion of the lung tissue using the Smith-Naylor method. The series included 717 men and 94 women aged between 32 and 93 years (mean 69.2 years). Detailed occupational data was obtained for 732 cases. The majority of patients had marine jobs - shipbuilding (449 cases), maritime trades (56 cases), and port activities (39 cases). The nature of work of other patients included a variety of occupations, with non-shipbuilding industries being the most common. Thirty-four women cleaned the work clothes of family members occupationally exposed and hence had a history of asbestos exposure at home. Most of the patients had their first exposure to asbestos before 1960. The latency period ranged between 13 and 73 years (mean 48.2). Latency period among insulators and dock workers were shorter than other categories. Asbestos bodies were detected on routine lung sections in 343 cases (68.6%). Lung asbestos body burdens after isolation ranged between two to 10 millions bodies per gram of dried tissue. Despite some limitations in the use of asbestos in this area since the 1970s, the incidence of tumor remained high during the last years.

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Pesticides are used extensively throughout the world in agriculture and in pest control as well as for community health purposes. Organophosphate (OP) pesticide self-poisoning is an important clinical problem in rural regions of the developing world that kills an estimated 200,000 people every year. Unintentional poisoning kills far fewer people but is an apparent problem in places where highly toxic OP pesticides are available. Neurologic dysfunction is the best documented health effect of pesticide exposure. High-level exposure has both acute and long-term neurologic signs and symptoms, and adverse effects have been reported in most type of pesticides, including organophosphate (OP), carbamate, organochlorine, and pyrethroid insecticides, herbicides, fungicides, and fumigants. Acute OP pesticide exposure can involve in wide range of both central and peripheral neurologic symptoms. Increased neurologic symptom prevalence may provide early evidence of neurologic dysfunctions, before clinically measurable signs are evident. In this study, we analyzed the cross-sectional data on neurologic signs and symptoms from 225 rural children, both males (n = 132) and females (n = 93) who were occupationally and paraoccupationally exposed to methyl OPs (dichlorvos, fenthion, malathion, methyl parathion) and ethyl OPs (chlorpyrifos, diazinon, ethyl parathion) as they belonged to agricultural families handling, mixing, and spraying the OP pesticides. The children completed a specially designed questionnaire (Q16) on neurologic symptoms associated with pesticide exposure with their parental help. A suitable reference group consisting of rural children (n = 50) never involved in pesticide handling (neither outdoor nor indoor) belonging to similar socioeconomic strata included in the study to compare the prevalence of various neurologic symptoms between the two groups. Among all the neurologic self-reported symptoms, headache, watering in eyes, and burning sensation in eye/face were the most important clinical manifestations attributed to OP pesticide exposure. These symptoms could probably be the consequence of chronic effects of most pesticides on the central nervous system. The muscarinic symptoms reported the maximum prevalence of salivation (18.22%), whereas lacrimation was observed in 17.33% cases, followed by diarrhea in 9.33% cases. The nicotinic clinical manifestations of acute OP poisoning revealed excessive sweating in 13.78% cases and tremors in 9.3% cases followed by mydriasis in 8.4% exposed children. The characteristic cholinergic symptoms, such as insomnia, headache, muscle cramps, weakness, and anorexia were also reported by both male and female exposed children. The high frequency of neurologic symptoms observed in the study may be due to parasympathetic hyperactivity due to the accumulated ACh resulting from AChE inhibition.

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The need for training in Occupational Medicine in India is well known. The majority of company doctors cannot leave their work and join a residence program. The question which course delivery mode - residential or blended or distance education - is appropriate to teach working company doctors is therefore an urgent one. ADULT EDUCATION: Adults learners - in contrast to young students - have a lot prior experiences and knowledge which they want to use. They have tight personal schedules and are very practical and goal-oriented. They usually have a fulltime work. Adults need more guides than lecturers. Immediate use, practice by doing and discussion groups are the most powerful tools in teaching. Lecturing seems to be the most ineffective teaching method. Distance education is widely used already in teaching occupational health & safety and occupational medicine (OSH) in other countries. Almost 100% of all post­graduate teaching in occupational medicine is done by distance education in the U. K. A "blended" course model seems appropriate for Occupational Medicine teaching. It has contact phases and self-learning phases The Indian Association of Occupational Health could play a leading role in expending high quality teaching in Occupational Medicine. These activities would contribute to the Government's goals to strengthen Occupational Health in India. This article discusses distance education and online-teaching as one viable way to deliver high quality training in Occupational Medicine to working company doctors in India.

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Occupational lead exposure caused male reproductive impairment, but information on spermatozoa activity, motility, and maturation is limited. In the above perspective, spermatozoa morphology, motility, activity, and nutritional status in lead exposed workers (7-15 years exposure) were assessed. Low sperm velocity, gross, and forward progressive motility with high stationary motile spermatozoa revealed lowering of sperm cell activity after exposure (P < 0.001), which was supported by higher seminal fructose and reduced sperm ATPase activity. Lowering of seminal plasma total protein with concomitant increase in free amino acid was prevalent as exposure increased (P < 0.001), suggesting disturbance in cellular nutritional status. Prolonged liquefaction time, reduced semen volume, viscosity, seminal plasma protein, fructose, and cholesterol level among workers indicated accessory sex gland dysfunction after occupational lead exposure (P < 0.001). Deterioration of sperm density and morphology was associated with high blood and semen lead of workers (P < 0.001) leading to infertility without altering FSH, LH, and testosterone level.

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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.

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