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     Table of Contents - Current issue
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April-June 2021
Volume 25 | Issue 2
Page Nos. 55-124

Online since Friday, July 9, 2021

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EDITORIAL  

Vaccination as a strategy to prevent or mitigate a potential COVID-19 third wave in India Highly accessed article p. 55
T Rajgopal, Bobby Joseph
DOI:10.4103/ijoem.ijoem_193_21  
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ORIGINAL ARTICLES Top

Study of the basic labor activity of a general practitioner using the time-keeping method on the example of polyclinics of the City of Karaganda, Kazakhstan p. 60
Aigul Mergentay, Dusentay B Kulov, Vitaliy V Koikov, Baurjan K Omarkulov, Talgat S Sergaliev, Gulnazira Imanbayeva, Leila Stabayeva
DOI:10.4103/ijoem.IJOEM_18_20  
Objective: To study and analyze the working time distribution of general practitioners at the outpatient appointment in polyclinics of Karaganda, Kazakhstan. Materials and Methods: The time spent by the general practitioner on all activities was studied by the timing method. Results: a) general practitioners spend a great part of working time for the documentation and organizational measures; therefore, they spend less time for patients; b) it is necessary to maximally unload the doctor from working with documentation. Conclusion: In clinics, it is necessary to properly organize the work of GPs in order to allocate sufficient time to interact with the patients.
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Visual examination standard for forklift and crane operators: A report for 66 operators of a factory in Mumbai p. 63
Prema K Chande, Kalika L Bandamwar
DOI:10.4103/ijoem.IJOEM_54_19  
Context: Forklift and crane industry in India is progressing at a rapid pace and the visual integrity of the operators is crucial for occupational safety. Hence, we performed a vision screening at a factory based in Mumbai. Aims: To evaluate the current visual status of forklift and crane operators working at a factory in Mumbai. Settings and Design: Prospective observational cross-sectional. Methods and Materials: All forklift and crane operators were invited to undertake visual examination that included visual acuity (VA) assessment, refraction, slit-lamp examination, color vision assessment, visual field assessment, and stereopsis. Referrals were made for participants who needed further assessment. Statistical analysis used: Mean and standard deviation were calculated and presented. Results: A total of 66 forklift operators with an average age of 48 years that ranged from 26–60 years completed the study. The average distance VA in LogMAR with current spectacles was 0.1 ± 0.14. The near VA with usual spectacles averaged at 0.63 M ± 0.2 M. The best-corrected VA (BCVA) of 0 LogMAR was not achieved by 12% subjects; however, all participants except one met the 0.3 LogMAR visual acuity criteria. The average stereopsis was 55.8 ± 47.8 with 8% operators had lower than acceptable levels of stereopsis while 7% could not meet the set criteria. One operator had 400 s of an arc and 4 had 100 s of arc stereopsis. Conclusions: The study demonstrates an urgent need to set up standards for vision assessment at the time of employment and frequency of eye examination for forklift and other powered industrial vehicles.
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The effect of high temperature on cardiovascular autonomic function tests in steel plant furnace worker p. 67
Sachin B Rathod, Smita R Sorte, Sandeep Patel
DOI:10.4103/ijoem.IJOEM_193_20  
Background: The high temperature in the working environment could be one of the risk factors for cardiovascular diseases in steel plant workers. The excessive high temperature at the working place leads to altered autonomic activity and is related to more cardiovascular risk. Aims and Objectives: The effect of high temperature on cardiovascular autonomic function tests in steel plant furnace worker. Material and Method: This was a case-control study for which 50 steel plant furnace workers and 50 controls were selected. The cardiovascular sympathetic function status in worker and control were analyzed by three tests: (i) Blood pressure (BP) response to sustained isometric handgrip test, (ii) BP response to the cold pressor test, and (iii) BP response to standing from a supine position (orthostasis). Statistical analysis was done by using an independent t-test. Results: Diastolic BP (DBP) response to sustained isometric handgrip and systolic BP (SBP) and DBP response to the cold pressor test showed that the increase BP in workers were more than controls but the difference was not statistically significant (P > 0.05). SBP response to standing from the supine position showed statistically significant (P < 0.001) greater fall in steel plant workers. Conclusion: The sympathetic autonomic dysfunction was seen in steel furnace workers in response to environmental stressor–excessive heat.
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Healthcare workers exposure to ionizing radiation: Oxidative stress and antioxidant response p. 72
Sarah A Bolbol, Mona F Zaitoun, Sahar A Abou El-Magd, Noha A Mohammed
DOI:10.4103/ijoem.IJOEM_198_20  
Background: Ionizing radiation is well known to cause oxidative stress which is responsible for various health hazards. Controlling healthcare workers' exposure and raising attention toward continuous monitoring is the first step for improving both the health of healthcare workers and the quality of patient care, thus decreasing both human and economic costs. Objectives: To assess oxidative stress by measuring the level of lipid peroxidation, antioxidants, and measure complete blood count (CBC) among healthcare workers exposed to ionizing radiation. Methods: A cross-sectional study conducted at the diagnostic radiology department on 31 healthcare workers exposed to ionizing radiation and a non-exposed group of 31 healthcare workers from outpatient clinics. Malondialdehyde (MDA), superoxide dismutase (SOD), and CBC were measured among both groups. Results: MDA was significantly higher among the exposed group, while the level of SOD was significantly lower. Red blood cells and hemoglobin were significantly lower among the exposed group. The most significant predictor of oxidative stress was the duration of work. Conclusion: Ionizing radiation exposure induce oxidative stress which has an important role in radiation-related health effects. Anemia was the most common hematological health hazards among the exposed group.
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Assessment of bacterial pathogens and their antibiotic resistance in the air of different wards of selected teaching hospitals in Tehran p. 78
Marzieh Montazer, Neda Soleimani, Masoomeh Vahabi, Mehrnosh Abtahi, Korosh Etemad, Rezvan Zendehdel
DOI:10.4103/ijoem.IJOEM_234_19  
Context: Exposure to bio-aerosols in a variety of environments has been of great interest due to the health effects on humans. Hospitals can be the reservoir of these biological agents because of the presence of infectious patients; which can lead to hospital infections and various occupational hazards. In this way, we assessed bacterial contamination in two teaching hospitals in Tehran. Aims: Our purpose in this study assessment of bacterial pathogens and their antibiotic resistance in the air of different wards of selected teaching hospitals in Tehran. Settings and Design: In this study, sampling was done according to NIOSH 0800. Methods and Material: This descriptive study was carried out in the different sections of two hospitals in Tehran. A total of 180 air samples were evaluated according to NIOSH 0800. In each section sampling was performed on the culture media in three stations including primary room, end room, and nursing position then the number of colonies counted. The zone of inhibition was measured in antibiotic disks to determine antibiotic resistance of samples. Statistical Analysis Used: Data analysis was performed using SPSS version 21. Initially, the data were normalized using the Kolmogorov–Smirnov test. The difference between the two hospitals was achieved with Mann–Whitney U test for un-normal distribution data. Results: Bacterial contamination in hospital 2 was significantly higher than the hospital 1(P < 0.001). The median number of colonies in hospital 1 was 129.87 (87.46–268.97) CFU/m3 and 297.97 (217.66–431.85) CFU/m3 for hospital 2. Bacterial contamination in the all of stations in hospital 2 and 87% of samples in hospital 1 was higher than the acceptable range of ACGIH (75 CFU/m3). Conclusions: High bacterial contamination may be related to a lack of hygiene management and poor ventilation system. It seems effective infection control processes, appropriate ventilation systems and supervision systems should be improved.
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Health of farming communities prior to modification of the occupational environment through a watershed development project in Kolar, India p. 84
Adithya Pradyumna, Andrea Farnham, Jürg Utzinger, Mirko S Winkler
DOI:10.4103/ijoem.IJOEM_270_20  
Background: Watershed development (WSD) projects, aimed primarily at enhancing soil and water conservation and supporting livelihoods in semi-arid areas, have the potential to impact health by modifying the occupational and household environments in agrarian communities. To identify and address potential health concerns arising from a planned WSD project in Kolar district, India, a health impact assessment (HIA) was conducted. This necessitated understanding the health status and concerns in the project villages. Objective: To characterize the health of farmers and their household members in close proximity of the planned WSD project. Methods: We carried out a cross-sectional survey between April and July 2019. The study comprised: (i) a household survey covering the four project villages and two comparison villages (e.g. socio-demographic characteristics, occurrence of vector-borne diseases (VBDs), access to safe water, sanitation and hygiene, and utilization of healthcare); and (ii) an anthropometric survey for children under the age of 5 years in the four project villages and four comparison villages. Results: Respondents (n = 333) reported household-level occurrences of VBDs (chikungunya, 3.3%; and dengue, 1.5%), consuming unsafe water (54.5%) and frequent pesticide application in fields (26.7%). The prevalence of child underweight was 23.8%. Conclusions: VBDs, poor water quality and child undernutrition were found to be important local health concerns, amenable for preventive and promotive measures through the planned WSD project. Occupational environments in agricultural settings affect the workers and their households, and comprehensive projects such as WSD can seize the opportunity for improving health of farming and other rural households.
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Adherence and effectiveness of HBV vaccination among healthcare workers in Egypt p. 91
Mohammed Elshaer, Eman Elsayed, Abdel-Hady El-Gilany, Noha El-Mashad, Mostafa Mansour
DOI:10.4103/ijoem.IJOEM_139_20  
Context: Healthcare workers (HCWs) face a potential risk of acquiring different bloodborne pathogens, by occupational exposure to contaminated blood and body fluids. Hepatitis B vaccine is a safe, effective method of conferring long-term protection against HBV infection. Aims: The study aimed to assess the adherence and effectiveness of HBV vaccination among HCWs at Gastrointestinal Surgical Center, Mansoura University, Egypt. Settings and Design: A prospective descriptive study was carried out between June 2019 and December 2019 at Gastrointestinal Surgical Center, Mansoura University, Egypt. Methods and Material: All HCWs with anti-HBs levels below 10 mIU/mL were advised to receive 3 doses of recombinant HBV vaccine, at 0, 1, and 6 months. The anti-HBs levels were checked 3 months after the third dose of the HBV vaccine. Statistical Analysis Used: Data was analyzed using the Statistical Package of Social Science (SPSS) program for windows (version 16). Results: A total of 442 healthcare providers were included. Most of them completed the 3 doses of the vaccine (81.7%), 10.2% refused the vaccine, while 0.9% and 7.2% received 1 and 2 doses, respectively. Odds of vaccination were the highest (88.1%, 273/310) among nurses (OR, 4.7; 95% CI, 2.6–5.2; P ≤ 0.001). The overall anti-HBs positivity of 97% (350/361) was observed. The main reasons for not being vaccinated included the fear of vaccine side effects 25/81 (30.9%) and lack of trust in the vaccine effectiveness 18/81 (22.2%). Conclusions: The outcome of the present study emphasizes the need to apply alternative and innovative measures to build a positive attitude toward the HBV vaccine among HCWs.
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Dealers in black gold: Knowledge attitude, and practices among fecal sludge operators in Bengaluru, Southern Karnataka p. 96
Anissa Mary Thomas Thattil, Nancy A Gnanaselvam, K Rajitha, B Ramakrishna Goud
DOI:10.4103/ijoem.IJOEM_148_20  
Background and Objectives: Fecal sludge management (FSM) is an unorganised sector, which is wrought with occupational health hazards for fecal sludge operators (FSOs). This study was conducted to identify the knowledge, attitude, and practices regarding FSM among FSOs. Study Setting and Design: This cross-sectional study was conducted in a rural area of Anekal Taluk, Bengaluru Urban District, Karnataka and in Hosur, Krishnagiri District, Tamil Nadu. Methods and Materials: Snowball method of sampling was employed and, 60 participants were interviewed using an interviewer administered semi-structured questionnaire. Statistical Analysis: The data has been described using measures of central tendency, frequencies, and percentages. Results: All 60 participants were males with a mean age of 33.7 ± 7.9 years. Majority practised Hindu religion (98.3%) and 95.0% belonged to the scheduled castes; only 3.3% were illiterate. According to modified SLI, 45.0% belonged to high standard of living. The common occupational hazards reported were injuries, social stigma, and alcoholism. Although 91.7% felt that personal protective equipment (PPE) would protect against health hazards, 65.0% felt that it hampered work. Most (86.7%) felt that FSM was attached to social stigma. None reported the use of the full set of required PPE. All participants reported washing their hands and feet with only water at the end of each operation. Conclusion: The knowledge and practices followed by the FSOs were found to be inadequate in this study. Health awareness generation and provision of PPE must be employed to ensure sustained behaviour change.
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Preventive health evaluation in underserved occupational environment: A cross-sectional study of its practice, facilitators, barriers, and benefits among medical practitioners in Nigeria p. 101
Gabriel Uche Iloh, Augustine O Ikwudinma, Ekene A Emeka, Ikechukwu V Obi
DOI:10.4103/ijoem.IJOEM_149_20  
Background: The health of medical doctors (MDs) has been the focus of global concern in addition to the recently modified physician oath now called “The Modern Physician Pledge.” As a member of human family, MDs are also prone to diseases they manage in healthcare environment. Objectives: The study was aimed at describing the practice, facilitators, barriers, and benefits of preventive health evaluation (PHE) in a cross-section of medical practitioners in Nigeria. Methodology: A cross-sectional study done on 178 MDs in Nigeria. Data collection was done using pretested, self-administered questionnaire that elicited information on practice, facilitators, barriers, and benefits of PHE. Self-rated health status was also studied. Practice of PHE was inquired in previous one year. Results: The age of the respondents ranged from 25 to 72 (36 ± 10.2) years. There were 161 (90.5%) males. All the respondents were aware of PHE. One hundred and fifty-five (87.1%) respondents rated their overall health then as excellent; 142 (79.8%) rated their overall health compared to 6 months ago as excellent, while 169 (94.9%) rated their overall health compared to others of their age as excellent. Generally, in all ages and both sexes, the most common PHE was blood pressure (BP) measurements (100%). The commonest female sex-specific PHE was self-breast examinations (100%). Among the males, the most common male-specific PHE was testicular self-examinations (87.0%). The commonest facilitator and barrier were family history of hereditary diseases (100%) and financial restraints (82.0%), respectively. The most common benefit was early detection of diseases (100%). Conclusion: Awareness of PHE was 100% but didn't translate to comparative practice orientation. The most common general PHE was BP checks. The commonest female and male sex-specific PHE was self-breast and testicular examinations respectively. The predominant facilitator and barrier were family history of hereditary diseases and financial restraints. The most common benefit was early detection of diseases.
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Exposure to toluene di-isocyanate and respiratory effects in flexible polyurethane foam industries in Western India p. 106
S Raghavan, Rajnarayan R Tiwari, Pankaj B Doctor, RekhaKashyap, Asif M Mahamad, Parveen R Mansuri
DOI:10.4103/ijoem.IJOEM_158_20  
Background: Flexible foam industry largely uses 2,4 and 2,6 Toluene di-isocyanate as main raw materials and chronic exposure to its result in occupational asthma. The exposure to di-isocyanates might be higher due to the usage of obsolete technology, hand-mixing methods and working in confined spaces with insufficient local exhaust ventilation systems in developing countries. Exposure studies in flexible foam industries have not been done in developing countries. Objective: The present cross-sectional study was conducted to evaluate toluene di-isocyanate (TDI) exposures and respiratory health of the workers working in the seven flexible polyurethane foam industries located in Western India during 2010-2013. Method: A total of 128 personal air samples collected and evaluated for total TDI concentration using improved Occupational Safety and Head Administration method number 42. Then 194 workers were covered for complete clinical examination and spirometry for assessing respiratory health. Results: In all, 17.83% of air samples exceeded the ACGIH TWA-TLV of 0.005 ppm for TDI. Though only 11 (5.6%) workers had respiratory complaints, the spirometry revealed that 19 (9.8%) and four (2.1%) had restrictive and obstructive type of pulmonary function impairment, respectively. Conclusion: The TWA concentration of TDI exceeded at raw material storage, mixing, foaming, block cutting and curing areas in four out of seven industries even in the presence of local exhaust systems. The respiratory health effect is less when compared to exposure to TDI, suitable preventive and control measures were suggested based on the study findings to the stakeholders to prevent the increase of respiratory health effects.
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Ocular injury due to arecanut: A unique occupational hazard in Central Karnataka p. 111
Ankush Gondchawar, HN Ravishankar, Pradeep Sagar, Pradeep Tekade, Suchitra K Biswal, S Mahesha
DOI:10.4103/ijoem.IJOEM_174_20  
Purpose: To evaluate the ocular manifestations and visual outcomes of ocular injury by arecanut. Methods: We analysed cases with ocular injury by arecanut from August 2018 to December 2019, retrospectively. Mode of injury, visual acuity and ocular manifestations of trauma were recorded. Results: Out of the 40 cases, closed globe injuries were seen in 97.5% of cases. All the injuries were due to the direct impact of arecanut during harvesting. The mean age was 45.15 ± 12.84 years. The mean best-corrected visual acuity (BCVA) at presentation was 20/40. A significant number of cases (35%) required surgical intervention. Mean BCVA at final follow-up was 20/30 but 16.66% of cases had BCVA of <20/60 even after definitive therapy. Conclusion: Ocular trauma due to arecanut is an important and preventable cause of visual impairment in central Karnataka. Modifications in harvesting technique would prevent ocular injuries.
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Assessment of squalor in migrant colonies of Thiruvalla Province of Kerala, India using rapid survey technique p. 114
Koshy M Cherian, Abel K Samuel Johnson, Avira Chacko, Bichu P Babu, Marina Rajan Joseph, Alice David, Sangeetha M Varghese
DOI:10.4103/ijoem.IJOEM_200_20  
Background: Domestic squalor refers to households that are extremely cluttered, in a filthy condition, and where the accumulation of items such as personal possessions, rubbish, excrement and decomposing food creates an environment that jeopardizes the health and wellbeing of the occupant(s). In India, an estimated 258 million are migrants. They are more likely to live in squalor due to inferior socio-economic status and no permanent residence. This poses a threat to the health of the migrants and the neighbors. Objective: To assess the squalor and morbidity pattern among the migrants of Migrant colonies in Thiruvalla using Rapid survey technique. Methodology: The state of squalor in migrant colonies was assessed by Lot Quality Assurance Sampling Methodology using the Environment Cleanliness and Clutter Scale (ECCS). The sample size for each lot/colony was '14' dwellings according to LQAS table. The details were collected from 14 inhabitants of different dwellings of the same colony. The inhabitants were selected randomly and were excluded if he belonged to the same dwelling. Fifteen colonies were randomly selected to achieve the sample size of 210 (15*14). The study was done in Tiruvalla municipality. Results and Conclusion: Only two colonies (n = 15) were squalor free. Majority of the dwellings (n = 210) were having an ECCS score between 13 and 15. Common ailments affecting migrants include Common cold, Skin disorders, and dental caries and gastritis. Squalor was found in most of the migrant colonies as they are living in inhuman conditions.
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Assessment of sea sickness in naval personnel: Incidence and management p. 119
Arvind K Gupta, B Vijaya Kumar, Renu Rajguru, KD Parate
DOI:10.4103/ijoem.IJOEM_94_20  
Background: Strategic, operational and tactical superiority of Navy hinges on extremely efficient warships which in turn depend on professionally competent sailors ready to undertake tasks to deliver timely, structured and metered response. Ships and their potentialities are tools to achieve the required strategic advantage which is dependent on the proficiency of sailors. Sailors who are fit ashore may be debilitated on board because of sea sickness. Aims: To study the incidence and severity of sea sickness among 500 naval personnel from various ships. Setting and design: An observational study conducted from May 2019 to March 2020 among 500 naval personnel from various ships of the fleet. Materials and Methods: Motion Sickness Assessment Questionnaire (MSAQ) was used to collect data from personnel of different departments working in different part of ship aged between 20 to 50 years. Results: The majority suffered mild symptoms (78.78%) and did not require any medication. Their symptoms were selflimiting and settled on rest within 24 hours. Moderately severe symptoms were observed among 19.31 % personnel and had to be administered medication and rest for 24 hours. Only 1.91% had severe symptoms and had to be excused from duties along with medication and rest. Conclusion: Sea sickness is unpleasant and has an adverse effect on employability of the sailors. It is mild and self limiting in majority of the personnel not requiring active intervention. Some personnel may require desensitisation along with pharmacotherapy.
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