Association between occupations and selected noncommunicable diseases: A matched case-control among Thai informal workers.

OBJECTIVES: We conducted a matched case-control study of informal workers to determine the association between occupational classification and selected types of noncommunicable diseases (NCDs). METHOD: We extracted data of patients aged ≥18 years from the Thai National Health Security Office database (NHSO) during 2011-2014. Cases were patients who had a primary diagnosis of: diabetes mellitus (E10-E14), hypertension (I10-I15), ischemic heart disease (I20-I25) or stroke (I60-69), or thyroid gland disorder (E00-E07). Controls were patients who had a primary diagnosis of intestinal or parasitic infections (A00-A09 and B25-B99), and were randomly matched 1:1 with cases of the same age and residential area. The four-digit occupation codes recorded in the NHSO were grouped and recoded based on the submajor groups of International Standard Classification of Occupations (ISCO-08) as follows: agricultural workers, unskilled workers, service, and sales workers. Analysis was performed using multivariable conditional logistic regression. RESULTS: Occupation and sex inequalities were present among all the selected NCDs. Higher risk for the four selected NCDs was found among unskilled workers. Stronger risk for cardiovascular disease was present among males, while females had a higher risk for metabolic disorders. CONCLUSIONS: There is a need to understand what are the key factors that increase the risk for NCDs among informal sector workers. Health promotion campaigns are needed to raise awareness among economically and social disadvantaged informal workers about the risk for NCDs. This will require collaboration between public health and the workforce, and allocation of government budgets to address the needs of these workers.

Estimating of the costs of nonfatal occupational injuries and illnesses in agricultural works in Thailand.

Thailand lacks occupational injury and illness (OII) surveillance for its agricultural sector, a sector that comprises 34% of the total Thai workforce but is not covered by the workers compensation system. This study used data from Thailand's Universal Health Care System to estimate the medical costs of OIIs from agricultural work in Thailand. In 2017, OII medical costs totaled $47 million (USD), about ~ 0.2% of the gross domestic product produced by the Thai agricultural sector. We recommend that some of the national funds currently used for medical treatment of OIIs be used instead to develop and implement prevention programs in agriculture. This would improve not only worker health and safety, but also productivity. Availability of data on working conditions, injuries and illnesses, and especially lost time, lost income and productivity, and OII-related costs for the workers and their dependents might enable better public health policy formulation.

Occupational Hazards in the Thai Healthcare Sector.

Healthcare personnel work in vulnerable conditions that can adversely impact physical and/or mental health. This paper aims to synthesize the state of knowledge on work-related illnesses, injuries, and risks experienced by Thai healthcare workers. We found that Thai healthcare personnel, like others worldwide, are at risk for injury related to needle sticks and sharp instruments; infectious diseases due to biological hazards exposure such as airborne pathogens and patient secretions; muscle pain due to workload and long duration of work; and psychological disorders related to stressful working conditions. Because detailed surveillance data are limited for the Thai healthcare workforce, we recommend that additional surveillance data on Thai healthcare workers' health outcomes be collected. Future research efforts should also focus on evidence-based interventions in order to develop methods to prevent and treat occupational health injuries and illnesses acquired in the workplace for Thai healthcare sector workers.

Occupational Safety, Health, and Well-being Among Home-based Workers in the Informal Economy of Thailand.

The objective of this article is to provide a summary of the issues related to occupational safety and health and well-being among workers in the informal economy of Thailand, with a special emphasis on home-based workers. The reviewed literature includes documents and information sources developed by the International Labour Organization, the National Statistical Office of Thailand, peer-reviewed scientific publications, and master's theses conducted in Thailand. This work is part of a needs and opportunities analysis carried out by the Center for Work, Environment, Nutrition and Development--a partnership between Mahidol University and University of Massachusetts Lowell to identify the gaps in knowledge and research to support government policy development in the area of occupational and environmental health for workers in the informal economy.

Informal Workers in Thailand: Occupational Health and Social Security Disparities.

Informal workers in Thailand lack employee status as defined under the Labor Protection Act (LPA). Typically, they do not work at an employer's premise; they work at home and may be self-employed or temporary workers. They account for 62.6 percent of the Thai workforce and have a workplace accident rate ten times higher than formal workers. Most Thai Labor laws apply only to formal workers, but some protect informal workers in the domestic, home work, and agricultural sectors. Laws that protect informal workers lack practical enforcement mechanisms and are generally ineffective because informal workers lack employment contracts and awareness of their legal rights. Thai social security laws fail to provide informal workers with treatment of work-related accidents, diseases, and injuries; unemployment and retirement insurance; and workers' compensation. The article summarizes the differences in protections available for formal and informal sector workers and measures needed to decrease these disparities in coverage.

Occupational health and safety for agricultural workers in Thailand: gaps and recommendations, with a focus on pesticide use.

Over 16.7 million workers in Thailand (42 percent of the working population) are engaged in agriculture, disproportionately from the lower socioeconomic strata of Thai society. Most agricultural workers (over 93 percent) work in the informal sector without the protections of regulations or enforcement of labor or health and safety laws or enrollment in a social security system. Although Thailand's use of herbicides, fungicides, and insecticides is growing, there is little regulation of the sale, use, or application of these potentially toxic chemicals. This paper summarizes the research to date on occupational health and safety for Thai agricultural workers, identifies gaps in pesticide regulations and the current systems for occupational health and safety and social support for Thai agricultural workers, and makes recommendations for future policy and research initiatives to fill the identified gaps.

Health effects of people living close to a petrochemical industrial estate in Thailand.

OBJECTIVE: An acute health effect of people living near the petrochemical industrial estate in Thailand was assessed using a panel study design. MATERIAL AND METHOD: The populations in communities near the petrochemical industrial estates were recruited. The daily air pollutant concentrations, daily percentage of respiratory and other health symptoms reported were collected for 63 days. The effect of air pollutants to reported symptoms of people were estimated by adjusted odds ratios and 95% confidence interval using binary logistic regression. RESULTS: The significant associations were found with the adjusted odds ratios of 38.01 for wheezing, 18.63 for shortness of breath, 4.30 for eye irritation and 3.58 for dizziness for total volatile organic compounds (Total VOCs). The adjusted odds ratio for carbon monoxide (CO2) was 7.71 for cough, 4.55 for eye irritation and 3.53 for weakness and the adjusted odds ratio for ozone (O3) was 1.02 for nose congestion, sore throat and 1.05 for phlegm. CONCLUSION: The results showed that the people living near petrochemical industrial estate had acute adverse health effects, shortness of breath, eye irritation, dizziness, cough, nose congestion, sore throat, phlegm and weakness from exposure to industrial air pollutants.

Health risk assessment of volatile organic compounds in a high risk group surrounding Map Ta Phut industrial estate, Rayong Province.

OBJECTIVE: The health risks of a high-risk group, surrounding Map Ta Phut industrial estate, Rayong, which may be exposed to VOCs through inhalation of contaminated air and dermal contact of contaminated water were assessed. MATERIAL AND METHOD: The health risk was assessed for 19 subjects categorized as children, adult and elderly from Ban plong and Nongfab communities following the US Environmental Protection Agency (EPA) method. The VOC concentrations in ambient air and ground water were monitored by Pollution Control Department (PCD), Ministry of Natural Resources and Environment to represent average VOC exposure of subjects. RESULTS: The lifetime cancer risk of VOCs exposure from inhalation and dermal contact with ground water were 1.32 x 10(-7)-5.21 x 10(6) for elderly 1.18 x 10(-7)-6.20 x 10(-6)for adult and 8.93 x 10(-7)-5.93 x 10(-6) for children. For non-cancer risk, the hazard index was 0.44 for elderly, 0.38-0.42 for adult and 0.55 for children. CONCLUSION: The lifetime cancer risk of the high-risk group living near Map Ta Phut industrial estate was in acceptable range for elderly, adult and children. For non-cancer risk, it is also acceptable.

Assessment of occupational exposure to malathion and bifenthrin in mosquito control sprayers through dermal contact.

OBJECTIVE: To assess occupational exposure of malathion and bifenthrin concentrations by dermal contact and urinary 3-(2-chloro-3, 3, 3-trifluoro-1-propenyl)-2, 2-dimethyl-cyclopropanecarboxylic (TFP) acid, health symptoms developed and the relationship between bifenthrin concentrations and TFP acid in urine of the mosquito control sprayers. MATERIAL AND METHOD: The aerosols of these two pesticides were collected using 100 cm2 cotton patches attached on the skin of upper legs of 54 volunteer of mosquito control sprayers. Their urine samples were also collected before and after application. RESULTS: These subjects exposed to average malathion and bifenthrin concentrations of 0.18 and 0.32 microg/cm2, respectively After application, the average concentration of urinary TFP acid in the sprayers was 39.22 +/- 0.77 mg/g creatinine ranging from 0.58 to 261.19 mg/g creatinine. A significant difference was found between urinary TFP acid levels before and after application (p < 0.001) but the bifenthrin concentrations through dermal contact and urinary TFP acid levels were not significantly correlated (p > 0.05). CONCLUSION: The mosquito control sprayers had dermal contact with smoke of malathion and bifenthrin and some sprayers developed health symptoms after exposure. They should use protective clothing made ofplastic, nylon or polyester to protect sprayers from skin contact.

Ethion exposure and biological monitoring in vegetable farmers.

OBJECTIVE: To modify the method of analysis of urinary diethyl phosphate (DEP) in order to determine the relationship between atmospheric ethion concentration and urinary DEP concentration. MATERIALS AND METHOD: A cross-sectional study was conducted by collecting atmospheric ethion in the breathing zone of 28 farmers following the NIOSH 5600 method. Urine samples were also collected to analyze urinary DEP concentrations by a modified method using a Gas Chromatography-Flame Photometric Detector (FPD). RESULTS: The average atmospheric ethion concentration in the breathing zone of farmers was 0.036 +/- 0.018 mg/m3. The average urinary DEP in pre-shift and post-shift was 0.030 +/- 0.06 and 0.851 +/- 1.80 mg/g of creatinine respectively. The average DEP during work shifts was 0.53 +/- 0.27, and ranged from 0.12 to 1.16 mg/g of creatinine. A high correlation coefficient (r = 0.645) was found between atmospheric ethion concentrations and urinary DEP concentrations at p < 0.001. CONCLUSION: The modified method provided a reliable result and the urinary DEP during work shifts was found to be a reliable biomarker of ethion exposure.

Assessment of nicotine inhalation exposure and urinary cotinine of tobacco processing workers.

OBJECTIVE: To study the composition of tobacco dust, atmospheric nicotine concentration, urinary cotinine excretion and the subjective symptoms of workers in dry tobacco leaf preparation. MATERIAL AND METHOD: The tobacco dust in air of the breathing zone of workers and the urine samples of these workers and a comparison group were collected and analyzed by GC/MS. The accuracy, precision and detection limit of the methods were determined. RESULTS: The tobacco dust contained nicotine and atrazine (a herbicide). The average atmospheric nicotine was 0.105 mg/m3 and urinary cotinine concentrations of post tobacco curing process workers was 3.084 microgram/ml. Moreover, there was a significant correlation between the atmospheric nicotine dust and urinary cotinine excretion (r = 0.987, p < 0.05). The health symptoms of headache, nausea, weakness, dizziness, and increased perspiration reported among workers had a significant relationship with the job characteristics of the post tobacco curing process workers, with a p-value < 0.05. CONCLUSION: Nicotine dust contained a herbicide called atrazine. Nicotine concentrations were highest in the post tobacco curing process where workers reported a lot of adverse symptoms. Urinary cotinine can be used as a biomarker of tobacco dusts' exposure in dry tobacco leave preparation areas.

Assessment of nicotine dermal contact and urinary cotinine of tobacco processing workers.

OBJECTIVE: To assess the dermal contact of nicotine dust, subjective symptoms and urinary cotinine of post curing tobacco workers. MATERIAL AND METHOD: Dermal hand wipes of residual nicotine dust samples, morning urine samples and subjective symptoms were collected from 30 workers. The hand-wipe samples and urine samples were analyzed for nicotine and cotinine by a GC/MS, respectively. RESULTS: The average amount of nicotine on the hands of workers was 0.24 microgram/cm2, while the average urinary cotinine concentration of workers was 3.08 microgram/ml. Moreover, there was a significant correlation between nicotine residue on hands and urinary cotinine excretion at r = 0.978, p < 0.05. There was also a significant relationship between the occupational related nicotine residue on hands and the number of subjective symptoms reported (p < 0.05). CONCLUSION: The nicotine residue on hands could be used as an indicator of occupational nicotine dust exposure which might affect the health of tobacco workers.