Bobby Joseph

Spatiotemporal Aspects of Real-Time PM2.5: Low- and Middle-Income Neighborhoods in Bangalore, India

We measured outdoor fine particulate matter (PM(2.5)) concentrations in a low- and a nearby middle-income neighborhood in Bangalore, India. Each neighborhood included sampling locations near and not near a major road. One-minute average concentrations were recorded for 168 days during September 2008 to May 2009 using a gravimetric-corrected nephelometer. We also measured wind speed and direction, and PM(2.5) concentration as a function of distance from road. Average concentrations are 21-46% higher in the low- than in the middle-income neighborhood, and exhibit differing spatiotemporal patterns. For example, in the middle-income neighborhood, median concentrations are higher near-road than not near-road (56 versus 50 μg m(-3)); in the low-income neighborhood, the reverse holds (68 μg m(-3) near-road, 74 μg m(-3) not near-road), likely because of within-neighborhood residential emissions (e.g., cooking; trash combustion). A moving-average subtraction method used to infer local- versus urban-scale emissions confirms that local emissions are greater in the low-income neighborhood than in the middle-income neighborhood; however, relative contributions from local sources vary by time-of-day. Real-time relative humidity correction factors are important for accurately interpreting real-time nephelometer data.

Postnatal depression among women availing maternal health services in a rural hospital in South India

Background and Objective: Postnatal depression, with an estimated prevalence of 13-19%, causes significant impairment of mental health among women worldwide and has long term consequences. However, more than half of all cases are not detected by healthcare providers. Screening for postnatal depression has not been given importance in maternal health programs in India. Our objective was to screen for postnatal depression among women attending a rural hospital in India, immediately postpartum and at 6-8 weeks post-delivery, and to study associated factors. Methods: A cross sectional study was done on 123 postnatal women attending a rural maternity hospital in Karnataka, South India, of whom 74 women were interviewed within one week of childbirth, and 49 women at 6-8 weeks post-delivery. The Edinburgh Postnatal Depression Scale was used to screen for postnatal depression. Results: About 45.5% of the women screened positive for postnatal depression (44.6% of all subjects within one week of delivery and 46.9% at 6-8 weeks after delivery). Postnatal depression was significantly associated with mood swings during antenatal period, staying with the family of birth during pregnancy and away from their husbands, and was significantly higher among women who perceived their life as stressful and having a low self-esteem (P<0.05) Conclusions: This study found a high prevalence of postnatal depression in women in rural Karnataka. This underlines the need for incorporating screening for postnatal depression in the routine care of women during pregnancy and delivery.

Prevalence, pattern, and factors associated with work-related musculoskeletal disorders among pluckers in a tea plantation in Tamil Nadu, India

Context: Musculoskeletal pain is common among tea leaf pluckers and is attributed to the load they carry, long working hours, the terrain, and insufficient job rotations. As a result of this, their health and work capacity are affected. Aims: To assess the prevalence, patterns, and factors associated with work-related musculoskeletal disorders (WRMDs) among pluckers in a tea plantation in Annamalai, Tamil Nadu, India. Settings and Design: This cross-sectional study surveyed 195 pluckers selected by simple random sampling aged between 18 years and 60 years. Materials and Methods: The interview schedule had four parts––sociodemographic detail, Standard Nordic Scale, numeric and facial pain rating tool, and a tool to assess factors associated with WRMDs. Statistical Analysis Used: Statistical Package for the Social Sciences (SPSS) version 16. Results: Prevalence of musculoskeletal pain in the last 12 months and the last 7 days was 83.6% and 78.5%, respectively. The most common site for last 1 year was shoulder (59%) and for last 7 days was the lower back (52.8%). Independent t-test revealed that the mean age of those with pain was 6.59 year more and mean years of employment was 1.38 years more among the workers with pain compared to workers without pain. Increasing morbidities among workers was also significantly associated with an increase in WRMDs on Chi-square test. Conclusions: The prevalence of musculoskeletal pain was high among tea pluckers and the most common site during the last 12 months and the last 7 days was the shoulder and lower back respectively was mild in character. Increase in age and duration of employment was associated with WRMDs.

Quantifying Burnout among Emergency Medicine Professionals

Background: Burnout is a syndrome explained as serious emotional depletion with poor adaptation at work due to prolonged occupational stress. It has three principal components namely emotional exhaustion(EE), depersonalization(DP) and diminished feelings of personal accomplishment(PA). Thus, we aimed at measuring the degree of burnout in doctors and nurses working in emergency medicine department (EMD) of 4 select tertiary care teaching hospitals in South India. Methods: A cross sectional survey was conducted among EMD professionals using a 30-item standardized pilot tested questionnaire as well as the Maslach burnout inventory. Univariate and Multivariate analyses were conducted using binary logistic regression models to identify predictors of burnout. Results: Total number of professionals interviewed were 105 of which 71.5% were women and 51.4% were doctors. Majority (78.1%) belonged to the age group 20-30 years. Prevalence of moderate to severe burnout in the 3 principal components EE, DP and PA were 64.8%, 71.4% and 73.3% respectively. After multivariate analysis, the risk factors [adjusted odds ratio (95% confidence intervals) for DP included facing more criticism [3.57(1.25,10.19)], disturbed sleep [6.44(1.45,28.49)] and being short tempered [3.14(1.09,9.09)]. While there were no statistically significant risk factors for EE, being affected by mortality [2.35(1.12,3.94)] and fear of medication errors [3.61(1.26, 10.37)] appeared to be significant predictors of PA. Conclusion: Degree of burn out among doctors and nurses is moderately high in all of the three principal components and some of the predictors identified were criticism, disturbed sleep, short tempered nature, fear of committing errors and witnessing death in EMD.

Shift work disorder and related health problems among nurses working in a tertiary care hospital, Bangalore, South India

Introduction: Shift Work Disorder (SWD) is a sleep disorder characterized by sleepiness and insomnia, which can be attributed to the person′s work schedule. Awareness of the mechanisms behind shift work related health problems could be essential to schedule the shift work, employment routines, clinical treatment, and selection of employees. Objective: To assess the prevalence of SWD and to identify related health problems among nurses in a tertiary care hospital in Bangalore. Materials and Methods: We conducted a descriptive cross-sectional study in a tertiary care hospital in Bangalore between May and September 2014. Based on simple random sampling, 130 nurses were selected for the study. After obtaining written informed consent from the participants, structured interview schedule using Standard Shift Work Index and Bergen Shift Work Sleep Questionnaire (BSWSQ) was administered. Results: The mean age of the 130 nurses was 27.4 ± 2.64 years. The prevalence of SWD was found to be 43.07%. Headache, back pain, gastritis, and menstrual disorders were the most common complaints, which are found in 78 (60.0%), 75 (57.6%), 42 (32.3%), and 39 (30.0%) cases, respectively. Anxiety and depression was found in 23 (17.6%) and 31 (23.8%) individuals, respectively. We also found a significant association of SWD with increasing age, more number of nights worked in a year, and longer duration of working hours. According to the BSWSQ, 70 (53.8%) nurses were found to have sleep problems. Conclusion: A high prevalence of SWD symptoms calls for a focus on the antecedents of work related sleep problems and appropriate intervention, such as behavioral changes, clockwise rotating shifts, and treatment.

Knowledge, attitudes, and poultry-handling practices of poultry workers in relation to avian influenza in India

Avian influenza (AI) is a viral disease of domestic and wild birds. The recent pandemics caused by highly pathogenic AIA (H5N1) in domestic poultry is currently rated phase 3 by the World Health Organization on the pandemicalert scale. Materials and Methods: A pretested and semistructured survey instrument was administered to both live bird market and poultry farm workers in two most populous cities in Karnataka in South India to collect data on demographics, knowledge, attitude, and practices among them. Results: The mean age was similar among both population groups (31.5 years). There was a higher level of biosecurity practices adopted in poultry farms compared with those adopted in live bird market. Knowledge regarding AI was acceptable but poorly correlated with actual biosecurity practices. Discussion: Live bird market and poultry farm workers have been identified as the weakest link in the prevention and control of the spread of AI in the two most populous cities studied in Karnataka. Conclusion: Risk reduction models of behavior change targeting these groups are important toward the control and prevention of AI spread.

Risk rating in the tea planting industry: The employees' opinion

Background: Workers in the tea planting industry are exposed to a variety of occupational health and safety hazards. Whether the workers perceive the risks involved and to what degree is an interesting point in question. Aims: To identify occupational health and safety risks involved in the tea planting sector and to rate these risks from the workers’ perspective. Settings and Design: Permanent workers from four estates belonging to one tea planting company in southern India were enlisted in this descriptive study Materials and Methods: The sample was randomly and then proportionately selected to give a total number equal to the calculated sample size of 341. Data were collected by reviewing medical records, conducting focus group discussions with field officers and supervisors, worker interviews and key informant interviews with the management in these four estates. Proportions were used to describe occurrence and distribution of work-related injuries. The risks as perceived by the workers were rated on their severity and frequency, using a Risk Rating Matrix. Results and Conclusion: The incidence of injuries was greater among male workers, those working both in the field and factory and those handling multiple tasks. The most common morbidities suffered were “small cuts and abrasions” in about 53%of the workers. Backache and insect bites were assigned the highest risk rating scores. Continued monitoring of the risk assessment by the workers could help in a planned reduction of commonly occurring injuries by agreeing on a specified risk limit.

The health of the healthcare workers

For correspondence: Dr. Bobby Joseph, Community Health and Occupational Health Services, St. John’s Medical College, Bengaluru 560 034, Karnataka, India. E-mail: joseph.bobby@ gmail.com A healthcare worker is one who delivers care and services to the sick and ailing either directly as doctors and nurses or indirectly as aides, helpers, laboratory technicians, or even medical waste handlers. There are approximately 59 million healthcare workers worldwide. Recognizing the vital role played by health care workers as “the most valuable resource for health” the World Health Organization (WHO) had declared the years 2006 to 2015 as the “The decade of the human resources for health.”

Human Bite of a Staff Nurse on a Psychiatric Unit

Occupational violence among health care professionals is a cause for concern, although often neglected especially in developing countries like India. Violence undermines the healing mission of the health care organization and interferes with the ability of the health care team to optimally contribute to positive patient outcomes. The authors discuss a case of a human bite of a staff nurse on a psychiatric unit in a tertiary care Indian hospital. The reported violence against this staff nurse lead to her admission for emergency care followed by emotional stress. Issues related to prevention of occupational violence are also discussed.

Assessment of Post-traumatic stress disorder among disaster affected children in a high school in Uttarkashi district, Uttarakhand, India

Introduction: Disasters are traumatic events, which when experienced may result in a wide range of mental and physical health consequences. Information on mental health disorders among adolescents following natural disasters from developing countries is scant. Objective: The objective was to determine the prevalence of post-traumatic stress disorder (PTSD) among disaster-affected children in a high school in Uttarkashi district, Uttarakhand. Materials and Methods: This was a cross-sectional study, at a high school in Uttarkashi district, Uttarakhand between October and November 2013, 3 months after the disaster. Two hundred and sixty-eight adolescents participated in the study. Institutional ethical clearance was obtained. After obtaining consent from the principal and assent from the students, the Trauma Screening Questionnaire was administered to assess PTSD, and a structured questionnaire was used to ascertain the socio demographic variables. Results: The mean age of the study population was 14.48 with a standard deviation 0.87 years. Of all the adolescents, 166 (61.9%) were males, and 102 (38.1%) were females. The prevalence of probable PTSD was found to be 32.8% with a mean score being 4.3 with a standard deviation of 2.61. There were no statistically significant association between PTSD and specific socio demographic factors. Conclusion: Of all the adolescents studied, 32.8% continued to suffer from trauma-related stress disorder after 3 months of the disaster. As victims continue to suffer from stress disorder even after 3 months, the need for screening continues to be significant especially so when the mental health care has not been in place from the beginning along with other disaster-related support. The findings of the study highlight the need for recognition of post-disaster stress disorders and subsequently providing interventions in adolescent victims in developing countries.