Mercury air, urine monitoring and health effects on occupationally exposed dental healthcare workers in Delhi, India

BACKGROUND

Mercury (Hg) is a toxic heavy metal with multiple uses in various medical devices. Hg is used in dentistry as a restorative material. Such use creates significant exposure to dental practitioners. Hence, it is important to assess the risk created by Hg use in healthcare.

OBJECTIVE

To quantify airborne Hg vapour exposure and Hg levels in dental healthcare workers, and determine the association of various symptoms and diseases to Hg exposure.

METHODS

Air monitoring of Hg vapours were conducted in dental clinics and amalgam rooms. Urine samples were collected from occupationally exposed dental healthcare workers and urine Hg levels were measured. A cross-sectional health survey was conducted in 23 healthcare units of Delhi to determine an association between Hg exposure and various health effects.

RESULTS

Hg vapour concentration ranged from 0.96μg/m3 to 15μg/m3, the highest concentration was recorded in the amalgam room (15μg/m3). Urine Hg levels in healthcare workers (0.51±0.17μg/L) were higher than the control (0.29±0.05μg/L). A cross-sectional health survey revealed a significant prevalence of confusion, forgetfulness, muscle spasm, and tremors by the respondents.

CONCLUSION

Hg concentration in dental clinics may hover above the prescribed safe levels posing a definitive health risk to healthcare workers. Urinary Hg measurements did not reveal an excess of body burden except in one case. Since Hg bio accumulates, it is probable as these workers grow older, they may end up with a higher body burden of Hg that may lead to a variety of adverse health outcomes.

Human Health Risk Assessment due to Heavy Metals in Ground and Surface Water and Association of Diseases With Drinking Water Sources: A Study From Maharashtra, India

BACKGROUND

Contamination of freshwater sources can be caused by both anthropogenic and natural processes. According to Central Pollution Control Board, Maharashtra along with 2 other states, contribute 80% of hazardous waste generated in India, including heavy metal pollution. Hence, it is important to quantify heavy metal concentrations in drinking water sources in such areas.

MATERIALS AND METHODS

Water samples were analyzed for toxic elements (F, As, Cd, Hg, Pb, Ni, Cu, Zn, Mn, and Cr) using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS) Agilent 7500. Health risks due to ingestion and dermal contact was assessed. A total of 557 people were randomly selected, with consumers from all 4 types of water sources that is surface water, hand pump, wells, and municipal water. Spot urine samples were collected from 47 people after considering inclusion and exclusion criteria. Urine was collected for estimating mercury and arsenic levels in the study participants.

RESULTS

Arsenic contributes the most health risk from ingestion from water. Among surface water users, 14 people (32%) reported frequent loose stool (P-value < .05) (OR 2.5), and 11 people (23%) reported frequent abdominal pain (OR 1.9). Hand pump and well water users reported frequent abdominal pain (27%) (OR 1.4) and gastric discomfort (31%) (P-value < .05) (OR 3) respectively. The mean value of urinary Hg and As were 4.91 ± 0.280 and 42.04 ± 2.635 µg/L respectively.

CONCLUSION

Frequent loose stool, gastric discomfort, and frequent abdominal pain were associated with the various sources of drinking water. Urine Hg levels were found higher than the NHANES (USA) Survey. It is recommended that frequent monitoring of drinking water should be enforced around the industrial hub, so that appropriate actions can be taken if present in excess.

Heavy Metal Accumulation in Fruits and Vegetables and Human Health Risk Assessment: Findings From Maharashtra, India

BACKGROUND

Vegetables are consumed enormously by humans all over the world. Consumption of contaminated fruits and vegetables is the most likely route of heavy metal exposure. Hence, it is important to quantify heavy metal concentration in frequently consumed fruits and vegetables.

MATERIALS AND METHODS

The main aim of our study is to investigate heavy metal (Pb, Cd, As, and Hg) contamination in 24 different kinds of vegetables and fruits grown in the industrialized city of Solapur, Maharashtra, India. Potential health risks due to the consumption of fruits and vegetables were assessed. Heavy metal concentration and quality of native soil were also determined. Vegetable and fruit samples were analyzed using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS) Agilent 7500.

RESULTS

The mean concentrations of selected heavy metals in fruits and vegetables analyzed were: Lead (0.17 ± 0.38 mg/kg) > Mercury (0.06 ± 0.09 mg/kg) > Cadmium (0.02 ± 0.007 mg/kg) > Arsenic (0.002 ± 0.003 mg/kg). Among them, garlic showed the highest heavy metal accumulation followed by potato.

CONCLUSION

Overall, vegetables showed higher metal accumulations than fruits. Some vegetables showed alarming levels of human health risk indices such as the Metal Pollution Index (MPI), Health Risk Index (HRI) and Hazard Index (HI), suggesting that reducing the intake amount of these vegetables may lower the adverse health effects.

India: country report on children's environmental health

Children contribute substantially to the burden of disease in India. Most common are problems with outdoor and household air pollution, with solutions not immediately apparent or implementable. Children are also often exposed to heavy metals, industrial chemicals and pesticides. Despite advances in some regions, many children still do not have adequate access to clean water and improved sanitation. Infectious diseases remain a problem, especially for children living in poverty. The children of these regions are now facing the dual problems of undernutrition and stunting on the one hand, and overnutrition and obesity on the other.

Asbestos in commercial indian talc

Background

Easily available commercial Indian talc products widely used in Southeast Asia were examined for the presence of asbestos. Asbestos in talc products carry all risks of asbestos‐related disease.

Methods

Using polarizing light microscopy, transmission electron microscopy (TEM), electron diffraction, and X‐ray analysis, multiple over‐the‐counter Indian talc products were examined for the presence of asbestos.

Results

Results In an initial group of five Indian talc products, one was found to contain tremolite asbestos. The second group of eight products was tested and six of eight contained tremolite asbestos as well. No other regulated amphibole was found.

Conclusion

Large quantities of body talc products containing asbestos are used throughout Southeast Asia and are likely to pose a public health risk for asbestos‐related diseases, especially for the cancers related to asbestos exposure. The country of origin in which the talc examined was sourced for production is unknown to the authors, and further investigation to measure associated public health risk is needed.

Prevention-intervention strategies to reduce exposure to e-waste

As one of the largest waste streams, electronic waste (e-waste) production continues to grow in response to global demand for consumer electronics. This waste is often shipped to developing countries where it is disassembled and recycled. In many cases, e-waste recycling activities are conducted in informal settings with very few controls or protections in place for workers. These activities involve exposure to hazardous substances such as cadmium, lead, and brominated flame retardants and are frequently performed by women and children. Although recycling practices and exposures vary by scale and geographic region, we present case studies of e-waste recycling scenarios and intervention approaches to reduce or prevent exposures to the hazardous substances in e-waste that may be broadly applicable to diverse situations. Drawing on parallels identified in these cases, we discuss the future prevention and intervention strategies that recognize the difficult economic realities of informal e-waste recycling.

Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015

BACKGROUND

Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures.

METHODS

We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).

FINDINGS

Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4-61·9) in 1980 to 71·8 years (71·5-72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7-17·4), to 62·6 years (56·5-70·2). Total deaths increased by 4·1% (2·6-5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8-18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6-16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9-14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1-44·6), malaria (43·1%, 34·7-51·8), neonatal preterm birth complications (29·8%, 24·8-34·9), and maternal disorders (29·1%, 19·3-37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death.

INTERPRETATION

At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems.

FUNDING

Bill & Melinda Gates Foundation.

The case for a global ban on asbestos

BACKGROUND

All forms of asbestos are now banned in 52 countries. Safer products have replaced many materials that once were made with it. Nonetheless, many countries still use, import, and export asbestos and asbestos-containing products, and in those that have banned other forms of asbestos, the so-called "controlled use" of chrysotile asbestos is often exempted from the ban. In fact, chrysotile has accounted for > 95% of all the asbestos used globally.

OBJECTIVE

We examined and evaluated the literature used to support the exemption of chrysotile asbestos from the ban and how its exemption reflects the political and economic influence of the asbestos mining and manufacturing industry.

DISCUSSION

All forms of asbestos, including chrysotile, are proven human carcinogens. All forms cause malignant mesothelioma and lung and laryngeal cancers, and may cause ovarian, gastrointestinal, and other cancers. No exposure to asbestos is without risk. Illnesses and deaths from asbestos exposure are entirely preventable.

CONCLUSIONS

All countries of the world have an obligation to their citizens to join in the international endeavor to ban the mining, manufacture, and use of all forms of asbestos. An international ban is urgently needed. There is no medical or scientific basis to exempt chrysotile from the worldwide ban of asbestos.

Asbestos ban in India: challenges ahead

Rapidly industrializing India is described by the International Monetary Fund as a young, disciplined, and vibrant economy with a projected growth of 6.7% for 2005. The total workforce of 397 million has only 7% of workers employed in the organized sector with construction, where asbestos exposure is prevalent, employing 4.4%. The domestic production of asbestos declined from 20,111 tons in 1998-1999 to 14,340 tons in 2002-2003. The imports from Russia and Canada increased from 61,474 tons in 1997-1998 to 97,884 tons in 2001-2002. The production of asbestos cement products went up from 0.68 million tons in 1993-1994 to 1.38 million tons in 2002-2003. The asbestos industry has been delicensed since March 2003. The number of asbestos-based units stood at 32, with the western state of Maharashtra having the largest number. According to official figures, the industry employs 8000 workers. The occupational exposure standard is still 2 fibers/mL, worse still, mesothelioma is not recognized as an occupational disease. The latest cancer registry data have no information on mesothelioma. The health and safety legislation does not cover 93% of workers in the unorganized sector where asbestos exposures are extremely high. Workers remain uninformed and untrained in dealing with asbestos exposure. Enforcement agencies are not fully conscious of the risks of asbestos exposure. Industrial hygiene assessment is seldom carried out and pathologists do not receive training in identifying mesothelioma histopathologically. The lack of political will and powerful influence of the asbestos industry are pushing India toward a disaster of unimaginable proportion.

FIOH-sponsored newsletter misrepresents asbestos hazards in Zimbabwe

The Finnish Institute of Occupational Health (FIOH) has received support from the World Health Organization (WHO) and the International Labor Office (ILO) to publish the African Newsletter on Occupational Health and Safety. The African Newsletter on Occupational Health and Safety should not be a medium for industry propaganda, or the source of misinformation among the workers of Africa. Instead, FIOH should provide the same level of scientific information in Africa that it does in Finland and other developed countries.

Asbestos-related morbidity in India

In India, locally mined asbestos is not enough for its current needs, hence a great deal of asbestos is imported from Canada. Asbestos products manufacturers have prevailed upon the government to reduce tariffs on imported material. The efforts of the health and safety professionals who joined with nongovernmental organizations to form the Ban Asbestos Network of India (BANI) are being consistently sabotaged by the industry, using its influence and false propaganda that chrysotile asbestos can be safely used in a controlled manner. Weak legislation and lack of data are being exploited by the industry to convince policymakers that asbestos use in India has caused no major health problems. Despite this, the ban-asbestos movement has gained momentum and was able to persuade government to consider banning asbestos use. With the growing strength of the movement it is expected that asbestos manufacturers may find it increasingly difficult to manipulate the government in the future.

Work security impacts in developing countries: India

Given the rapid pace of globalization, newly industrialized countries cannot adequately protect workers from emerging hazards. Only 5-10% of workers in developing countries have access to occupational health services. Work-related health problems are exacerbated by a scarcity of resources, socioeconomic dislocation, and poor general health status. The author considers the case of India and looks at its background in occupational safety and health (OSH) regulation, national health policy, and recent experience. He notes the decline in trade unions and rise of hazardous industries, and presents a case study of the situation in the state of Delhi. He concludes that the progress of OSH has stalled since economic reform. The high rate of injury and illness is a bad omen for productivity. Lowering the guard on safety and health will ultimately harm the businesses that currently seek to profit from it. The well-being of workers may deteriorate further if poor enforcement and widespread ignorance of OSH persist. Labor standards must be reevaluated and responsible legislation must be developed. Training and nutrition subsidies should be offered to increase productivity and improve worker health.

Occupational health in India

The population of India has crossed the billion mark; only one other country (China) shares this distinction. A declining female population and low literacy are negatives in an otherwise vibrant country. The empowerment of females and their role in society has become a point of debate, and radical economic changes are likely, to allow India to join the global economy. Problems in occupational health and safety (OHS) include: OHS legislation that covers only a minority of the working population; child labour; a physician-driven OHS model; little attention to industrial hygiene; poor surveillance of occupational diseases (making it impossible to gauge the burden of illness due to occupational exposures); and a fragile OHS academic base. A silver lining comprises the inclusion of OHS in national health policy and the decision by the Indian Medical Association to educate its members in occupational health. India urgently requires modern OHS legislation with adequate enforcement machinery, and establishment of centres of excellence in occupational medicine, to catch up with the rest of the world.

Musculoskeletal disorders in industrial workers of Delhi

To study the musculoskeletal disorders in industrial workers in Delhi, 631 workers from 60 factories representing small and medium-sized enterprises located in Delhi were interviewed. Many (59.4%) of the workers had musculoskeletal disorders. Tailors, those working near furnaces, cooks, workers in buffing, checking and assembly work, and those working with chemicals had the most joint complaints. Cervical pain was more frequent in tailoring and packing work, whereas lumbar pain was more common in buffing, operators working on presses, those using hand and power tools, and those lifting heavy manual loads. Contract workers had less musculoskeletal morbidity than regular and temporary workers. Skilled workers also had less morbidity. Workers experiencing more job satisfaction reported fewer musculoskeletal disorders. The high prevalence of musculoskeletal disorders in workers needs urgent attention from the health and labor sectors. An ergonomic approach to prevention should be considered. The current manual load handling limits prescribed in the Indian Factory Rules potentially expose workers to back stress. It is also inappropriate to have separate load-lifting limits for men and women. Research is urgently required to determine the safe load handling limits for the Indian working population based on ergonomic principles. Until internationally acceptable safe limits are established, back pain should be a notifiable disease in India.

Awareness about biomedical waste management and infection control among dentists of a teaching hospital in New Delhi, India

All 64 dentists working in a teaching hospital of New Delhi participated in a survey. A pre-tested self-administered questionnaire was used to assess knowledge and practices of biomedical waste management and infection control among these dentists. The results show that not all dentists were aware of the risks they were exposed to and only half of them observed infection control practices. In addition to this, majority of them were not aware of proper hospital waste management. The dentists need to be educated on Biomedical Waste (Management & Handling) Rules, 1998 through extensive training programme.

Occupational health and unemployment in India

Unemployment is a serious problem in India. Rural workers have no stable and durable employment. Educated and women experience more unemployment which is a greater problem in urban than in rural areas. An unemployed takes a long time to find work and secures it at an inadequate remuneration since job seekers far outnumber the available opportunities. Unavailability of social security makes life more difficult for the unemployed. Latest figures place the number of unemployed at 37.2 million. However, the figure is disputed as no national survey to determine the extent of unemployment has been undertaken in India. The health of unemployed has not been an issue. A pilot study was undertaken to assess the effect of tuberculosis on employment in Delhi. Tuberculosis appeared to be a significant cause of unemployment and loss of income specially among unskilled workers. The health and labour ministries may formulate a strategy to promote research and focus on health protection of unemployed.