Development and psychometric evaluation of an occupational health and safety performance tool for manufacturing companies.

Background: The occupational health and safety (OHS) performance of organizations maybe affected by internal and external factors. According to a literature review, standardized tools for studying these factors are limited. Therefore, the main aim of this study was to examine psychometric properties of a tool for evaluating OHS performance. The tool was used to investigate the relationship between the identified OHS performance influencing factors and occupational injury. Methods: The questionnaire developed through conducting a literature review about the OHS performance and constructing a question pool. The number of items was reduced to 93 after performing a screening process. Sixteen OHS scholars offered feedback on the tool's phrasing and applicability to check face and content validity. Test-retest reliability was examined through intraclass correlation coefficients. 850 questionnaires were distributed at 12 manufacturing companies in the West Azerbaijan province in Iran, 600 valid questionnaires were returned. Exploratory and confirmatory factor analysis were conducted to assess construct validity. Criterion validity was investigated by measuring agreement between its OHS performance scores and occupational injury. A set of regression analyses examined the variables associated with OHS influencing factors. Results: Validity analysis revealed that 93 items had an excellent content validity ratio (>0.79) and content validity index (>0.47). The exploratory factor analysis resulted in eleven OHS performance factors. Thirty-three items were removed because of inadequate reliability. The result of confirmatory factor analysis showed that the OHS performance model is satisfactory. The final 60-item scale's reliability score was 0.96. The safety system was identified as the main influencing factor (3.54 ± 0.65). Participants with more safety training reported more injuries. Safety training and injury experiences, company size, and occupational health and safety management system (OHSMS) adoption affected OHS performance influencing factors. Occupational injuries were linked to company size (OR = 1.39, CI = 1.06-1.82), whereas the absence of OHSMS was connected with an increased risk of occupational injury (OR = 0.09, CI = 0.02-0.55). Conclusions: The developed tool had satisfactory psychometric properties for assessing OHS performance in manufacturing companies. OHS performance could be improved by implementing safety systems and focusing more on incentive programs. Implementing the requirements of an OHSMS may improve the OHS performance and decrease occupational injuries.

Monte Carlo-based probabilistic risk assessment for cement workers exposed to heavy metals in cement dust.

This study assessed the carcinogenic and non-carcinogenic health risks of cement plant workers exposed to chromium (Cr), arsenic (As), cadmium (Cd), and lead (Pb) in cement dust using a probabilistic approach. Air samples were collected according to NIOSH 7900 and OSHA ID-121 methods and analyzed by an graphite furnace atomic absorption spectrometer. The EPA inhalation risk assessment model and Monte Carlo simulation were utilized to assess the health risks. Sensitivity analysis was used to determine the influencing parameters on health risk. The average concentrations of As and Pb exceeded the occupational exposure limit (OEL), reaching a maximum of 3.4 and 1.7 times the OEL, respectively, in the cement mill. Individual metals' cancer risk exceeded the 1E-4 threshold in ascending order of Cd < As < Cr. The mean cancer risk of Cr ranged from 835E-4 (in raw mill) to 2870E-4 (in pre-heater and kiln). Except for Cd, the non-cancer risk of metals exceeded the standard (hazard index, HQ = 1) in the ascending order of Pb < As < Cr. The mean HQ of Cr ranged from 162.13 (in raw mill) to 558.73 (in pre-heater and kiln). After adjusting for control factors, the cancer and non-cancer risks remained over the respective recommended levels. Sensitivity analysis revealed that the concentration of Cr was the most influential parameter on both carcinogenic (78.5%) and non-carcinogenic (88.06%) risks. To protect the health of cement factory employees, it is recommended to minimize cement dust emissions, implement job rotation, and use raw materials with low levels of heavy metals.

Patients' Experiences of Cancer Pain: A Descriptive Qualitative Study.

OBJECTIVE: The aim of this study was to explore the cancer pain experiences of Iranian patients. DESIGN: A qualitative descriptive design was used. METHODS: This qualitative descriptive study was performed on 17 participants between December 2020 and September 2021. Data were collected using semistructured interviews and analyzed by Graneheim and Lundman's content analysis method. RESULTS: Three main categories emerged in relation to patients' experiences of cancer pain. Categories included (1) characteristics of cancer pain, (2) pain self-management strategies, and (3) influence of pain on patient and her/his family. CONCLUSIONS: Most patients believe that pain is God's will, and family members, doctors, and nurses can assist patients cope with pain by respecting this belief and supporting spiritual healing. Strengthening pain management strategies, expanding social networks, and convincing the patients that they are not an interruption to their families can all help patients maintain their fighting spirit and pain tolerance. To provide holistic care, healthcare providers, particularly nurses, should consider the physical, sociocultural, and spiritual aspects of cancer pain.

Probabilistic health risk assessment of occupational exposure to crystalline silica in an iron foundry in Urmia, Iran.

This study aimed to quantify the exposure of foundry workers to crystalline silica and associated cancer and non-cancer health risks using a probabilistic approach. Breathing zone air samples were collected according to the NIOSH 7602 method and analyzed using Fourier transform infrared spectroscopy. The health risks posed by crystalline silica were then assessed using the EPA-developed inhalation risk assessment model and Monte Carlo simulation. The sensitivity analysis was also conducted to determine the contribution of input parameters to the health risks. The mean concentration of crystalline silica in six foundry stations ranged from 0.029 to 0.064 mg m-3, exceeding the occupational exposure limits. The average values of cancer risks were greater than the USEPA level, i.e., 1E - 6 in all workstations of the foundry. Workers in sand preparation and molding stations suffered the greatest cancer risks, with the mean value of 2.35E - 5 and 2.10E - 5, respectively. Non-cancer hazard quotient exceeded 1 in all foundry stations ranging from 1.56 (in melting and pouring) to 3.37 (in sand preparation). The 95% upper-bound values of the health risks decreased by 77.52% and 56.77%, assuming the use of engineering controls and wearing respirators by workers, respectively. Sensitivity analyses indicate that concentration was the most sensitive factor contributing to the carcinogenic (46.13%) and non-carcinogenic (67.08%) risks. These findings can aid managers in gaining a better understanding of the silica risks faced by foundry workers and the role of engineering controls and respirators in protecting workers' health.

Hand anthropometry survey in Iranian adults and comparisons with other populations.

BACKGROUND: Hand anthropometry is useful for designing manual systems such as hand tools, controls, and gloves. There are limited published data on the hand dimensions of Iranian male and female adults. OBJECTIVE: This study was undertaken to measure the hand anthropometric dimensions in Iranian adults to compare data between two genders and also with the corresponding data from other nationalities. METHODS: A total of 34 dimensions of the right hand were measured in 217 male and 128 female adults using a digital caliper and tape. The mean, standard deviation, and the main percentiles are summarized in a table and the mean of each dimension is compared by independent t-tests between genders. Hand dimensions are compared between Iranian and other nationalities such as North Colombian, Korean, Turkish, Nigerian, Bangladeshi, Jordanian, and Vietnamese using the published data. RESULTS: Females had significantly smaller hand dimensions than males in all dimensions ranged from 4.21%to 18.16%, with the largest differences in hand breadths. Compared with other nationalities, the Iranian male and female adults had wider (greater breadth and circumferences) hands with shorter fingers. CONCLUSIONS: The results showed significant differences of hand anthropometry between Iranian and other nationalities which should be included in the design and selection of hand tools for Iranian population.

The Effects of Live-Fire Drills on Visual and Auditory Cognitive Performance among Firefighters.

Introduction: The nature of firefighters' work is characterized by its unexpected emergencies, sleep deprivation, night shift schedules, and smoke exposure during firefighting. Methods: Eighteen firefighters were involved in simulated live-fire activities. Firefighters' health status in terms of cardiovascular and mental conditions was checked by a physician and through reviewing their medical records. Firefighters' cognitive functions were evaluated by visual and auditory continuous performance tests (VCPT and ACPT) and paced visual and auditory serial addition tests (PVSAT and PASAT). Results: VCPT and ACPT scores were lower after the activity relative to baseline. The results revealed that ACPT appears to be more difficult than VCPT. Also, PVSAT and PASAT scores decreased significantly after the experiment. PASAT scores following firefighting tasks experienced a more significant decline compared to those of the PVSAT. Conclusions: These findings suggest that firefighters have visual and auditory cognitive function problems following firefighting activities. In conclusion, auditory cognitive function was more influenced than the visual ability as a result of the experiment.

Assessing the ergonomic exposure for construction workers during construction of residential buildings.

BACKGROUND: Construction workers are at greater risk of musculoskeletal disorders due to their exposure to physical ergonomic risk factors. OBJECTIVES: The purpose of this study is to quantify the ergonomic hazards for workers in the construction of residential buildings. METHODS: In this cross-sectional study, PATH method, a work-sampling observation method, was applied to study the working postures, handled loads, and manual material handling activities in construction workers. A total of 5832 observations were made on 10 workers involved in tasks of three jobs including reinforcing bar, formwork, and pouring concrete. The ergonomic exposure was characterized in terms of percentage of observations made for each task. RESULTS: Non-neutral trunk postures, especially mild and severe flexions, were frequently observed in all job tasks. High-strain leg postures of squatting, kneeling, and leg(s) bent were mostly observed in floor formwork (39%), concrete finishing (5%), and floor rebar construction (52.3%), respectively. The highest proportion of work time with one (5.8%) and two hands (9%) at/above shoulder was observed in column rebar construction. In concrete pouring and rebar cutting, workers were observed in 39.45% and 23.1% of work time doing carry and push/pull activities, respectively. Heavy loads (>15 kg) were mostly observed in concrete pouring and floor formwork tasks. CONCLUSION: In the construction of residential buildings with the concrete structure, workers perform their task with non-neutral postures of trunk and leg and handling heavy loads. The recommended controls could reduce the musculoskeletal stress in rebar tying, concrete pouring, and concrete finishing tasks.

The impact of theory-based educational intervention on improving helmet use behavior among workers of cement factory, Iran.

BACKGROUND: The occurrence of occupational accidents is a serious public health issue in industrial workers and may impose life jeopardizing complications. The aim of the study was to assess the effect of a training intervention based on the theory of planned behavior (TPB) on helmet use of workers in cement factories in Khoy and Urmia, Northwest of Iran. MATERIALS AND METHODS: This study was a controlled quasi-experimental investigation (before and after) which was conducted on 170 workers employed in Khoy and Urmia cement factories, Northwest of Iran. Eighty-five eligible subjects from Khoy (as intervention group) and 85 similar samples from Urmia (as control group) were selected and recruited. A valid and reliable four-part questionnaire was used to collect the data including socio demographic information, awareness, the theory constructs, and the behavior. After completing the study questionnaire and needs assessment, a specific educational program was implemented on the intervention group only. The effects of education were compared between the groups before and after intervention. The posttest was applied 1 month after educational intervention. RESULTS: The mean age of workers in the intervention and control groups was 34.32 ± 8.19 and 33.62 ± 6.17 years, respectively. Before education, the mean score of awareness and helmet use behavior of intervention group was 6.15 ± 3.4 and 5.35 ± 2.8, but after education, those changed into 13.61 ± 3.10 and 9.15 ± 1.65, and the differences were significant (p < 0.01). In addition, before education, the mean score of attitude, subjective norm, behavioral control, and behavioral intention of intervention group was 27 ± 5.17, 37.74 ± 6.92, 29.56 ± 6.17, and 17.65 ± 4.90, respectively. After education, the mean score of those changed into 37.26 ± 4.76, 48.34 ± 5.64, 42 ± 8.07, and 24.79 ± 5.33, respectively, and changes were statistically significant (p < 0.01), while no statistically significant differences were observed in awareness, the behavior, and the theory constructs in the control group after the intervention. CONCLUSION AND RECOMMENDATIONS: The TPB-based educational approach had a remarkable effect on helmet use of workers. Applying this theory to improve workers' personal protective behaviors is recommended and emphasized.

Comparison of the effect of typical firefighting activities, live fire drills and rescue operations at height on firefighters' physiological responses and cognitive function.

This study examined the impact of various types of firefighting activities on firefighters' physiological responses and cognitive function. Each firefighter was engaged in three conditions: (1) Live-fire activities (LFA), (2) Typical firefighting activities (TFA), and (3) Rescue operations at height (ROH). The effects of various types of firefighting activities on the physiological responses and cognitive function were evaluated by heart rate (HR), temporal artery temperature (TT), and the correct response (CR) on a cognitive test. The results indicated that, compared to the baseline, physiological response increased, while information processing performance decreased after the activity. Furthermore, HR and TT were significantly lower at the end of the firefighting activity in the LFA (149.33 bpm; 38.08 °C) compared with the TFA (152.22 bpm; 38.17 °C) and ROH (159.28 bpm; 38.24 °C) conditions. Also, CR was significantly higher at the end of the activity in the LFA and TFA compared with the ROH condition. The results showed that rescue at height was more intensive than the other firefighting tasks in decreasing physiological and cognitive function capacity after the experiment. Practitioner Summary: We assumed that various types of firefighting activities would have different effects on physiological and cognitive functions during firefighting activities. The Findings suggest that rescue at height operations, performed without the use of special protective equipment, was more influential than other firefighting duties in changing firefighters' physiological and cognitive capacity. Abbreviations: CR: correct response; LFA: live-fire activities; TFA: typical firefighting activities; ROH: rescue operations at height; HR: heart rate; TT: temporal artery tempearture; PASAT: pased auditory serila addition teat; FPC: firefighting protective clothing.

Hepatoprotective effect of thymol against subchronic toxicity of titanium dioxide nanoparticles: Biochemical and histological evidences.

The study was aimed to investigate the protective action of thymol against nano titanium dioxide (nano-TiO2) induced hepatotoxicity in rats. To achieve this purpose, the rats were divided into four groups (n = 6) including control, nano-TiO2 (100 mg/kg), nano-TiO2 + thymol (10 mg/kg) and nano-TiO2 + thymol (30 mg/kg). Intragastric (IG) administration of nano-TiO2 for 60 consecutive days caused widespread histological changes and significantly induced oxidative stress in the liver tissues as manifested by the rise in serum transaminase activities accompanied by marked decline of enzymatic (catalase, superoxide dismutase and glutathione peroxidase) and non-enzymatic (ferric reducing antioxidant power and glutathione) antioxidant levels, and rise of malondialdehyde levels in liver tissue. Pretreatment with thymol (IG) prior to nano-TiO2 administration significantly ameliorated all of biochemical and histopathological alterations in a dose-dependent manner. In conclusion, thymol effectively protects against nano-TiO2-induced hepatotoxicity in rats by its antioxidant properties.

Environmental and biological measurements of isoflurane and sevoflurane in operating room personnel.

PURPOSE: The present study aimed to compare the concentration of isoflurane and sevoflurane in the individual's breathing zone and ambient air of operating rooms (ORs), to investigate the correlation between breathing zone levels and urinary concentrations, and to evaluate the ORs pollution in the different working hours and weeks. METHODS: Environmental and biological concentrations of isoflurane and sevoflurane were evaluated at 9ORs. Air samples were collected by active sampling method and urine samples were collected from each subject at the end of the work shift. All samples were analyzed using gas chromatography. RESULTS: The geometric mean ± GSD concentration of isoflurane and sevoflurane in breathing zone air were 1.41 ± 2.27 and 0.005 ± 1.74 ppm, respectively, while in post-shift urine were 2.42 ± 2.86 and 0.006 ± 3.83 µg/lurine, respectively. A significant positive correlation was found between the urinary and environmental concentration of isoflurane (r 2 = 0.724, P < 0.0001). The geometric mean ± GSD values of isoflurane and sevoflurane in ambient air were 2.30 ± 2.43 and 0.004 ± 1.56 ppm, respectively. The isoflurane concentration was different for three studied weeks and significantly increased over time in the ambient air of ORs. CONCLUSIONS: The occupational exposure of OR personnel to isoflurane and sevoflurane was lower than national recommended exposure limits. The urinary isoflurane could be a good internal dose biomarker for monitoring of occupational isoflurane exposure. Considering the accumulation of anesthetic waste gases in the studied ORs, real-time air monitoring is better to be done at the end of the work shift.

Applicability of the comet assay in evaluation of DNA damage in healthcare providers' working with antineoplastic drugs: a systematic review and meta-analysis.

BACKGROUND: Unintended occupational exposure to antineoplastic drugs (ANDs) may occur in medical personnel. Some ANDs are known human carcinogens and exposure can be monitored by genotoxic biomarkers. OBJECTIVE: To evaluate the obstacles to obtaining conclusive results from a comet assay test to determine DNA damage among AND exposed healthcare workers. METHODS: We systematically reviewed studies that used alkaline comet assay to determine the magnitude and significance of DNA damage among health care workers with potential AND exposure. Fifteen studies were eligible for review and 14 studies were used in the meta-analysis. RESULTS: Under random effect assumption, the estimated standardized mean difference (SMD) in the DNA damage of health care workers was 1.93 (95% CI: 1.15-2.71, p < 0.0001). The resulting SMD was reduced to 1.756 (95% CI: 0.992-2.52, p < 0.0001) when the analysis only included nurses. In subgroup analyses based on gender and smoking, heterogeneity was observed. Only for studies reporting comet moment, I2 test results, as a measure of heterogeneity, dropped to zero. Heterogeneity analysis showed that date of study publication was a possible source of heterogeneity (B = -0.14; p < 0.0001). CONCLUSIONS: A mixture of personal parameters, comet assay methodological variables, and exposure characteristics may be responsible for heterogenic data from comet assay studies and interfere with obtaining conclusive results. Lack of quantitative environmental exposure measures and variation in comet assay protocols across studies are important obstacles in generalization of results.

Detection and identification of Legionella species in hospital water supplies through Polymerase Chain Reaction (16S rRNA).

Legionella spp. are important waterborne pathogens that are normally transmitted through aerosols. The present work was conducted to investigate the presence of Legionella spp. and its common species in hospital water supplies. Considering the limitations of culture method, polymerase chain reaction (PCR) assays were developed to detect the gene 16S rRNA irrespective of the bacterial serotype. Four well-established DNA extraction protocols (freeze & thaw and phenol-chloroform as two manual protocols and two commercial kits) were tested and evaluated to release DNA from bacterial cells. A total of 45 samples were collected from seven distinct hospitals' sites during a period of 10 months. The PCR assay was used to amplify a 654-bp fragment of the 16S rRNA gene. Legionella were detected in 13 samples (28.9%) by all of the methods applied for DNA extraction. Significant differences were noted in the yield of extracted nucleic acids. Legionella were not detected in any of the samples when DNA extraction by freeze & thaw was used. Excluding this method and comparing manual protocol with commercial kits, Kappa coefficient was calculated as 0.619 with p < 0.05. Although no meaningful differences were found between the kits, DNA extraction with Bioneer kit exhibited a higher sensitivity than classical Qiagen. Showerheads and cold-water taps were the most and least contaminated sources with 55.5 and 9 percent positive samples, respectively. Moreover two positive samples were identified for species by DNA sequencing and submitted to the Gene Bank database with accession Nos. FJ480932 and FJ480933. The results obtained showed that despite the advantages of molecular assays in Legionella tracing in environmental sources, the use of optimised DNA extraction methods is critical.

The Efficacy of Residual Chlorine Content on the Control of Legionella Spp. In Hospital Water Systems.

BACKGROUND: Outbreaks of legionellosis may be a side effect of institution-water treatment. However, the long-term outcomes and the predictive factors of Legionella prevalence in such systems have still not been fully studied. This study was therefore conducted to investigate the prevalence of Legionella spp. and to evaluate the role of bacteriological water quality parameters on its prevalence and removal in hospital water systems. METHODS: A total of 45 samples were collected from distinct sites at seven hospitals in Tehran, Iran. The prevalence of this bacterium was assayed through a sensitive and specific technique for DNA detection using PCR. Multivariable stepwise regression analysis was used to explore the independent effects of the baseline factors on the incidence of Legionella. Two positive samples were also identified for species by DNA sequencing. RESULTS: Legionella were detected in 31.1% of samples. Showerheads and cold-water taps were the most and the least contaminated sources with 55.3 and 9 percent positive samples, respectively. Total mean of residual chlorine was 0.38 mg/L, with the peak value of 1.7 mg/L. Legionella detection was proportional to the residual chlorine content of water and the results indicated that residual chlorine content is a critical factor in the incidence and proliferation of Legionella (r=-0.33). The prevalence of Legionella also coincided with the prevalence of HPC and amoeba cysts. CONCLUSION: The high positive rate of Legionella colonization shows that hospital-acquired legionellosis might be under diagnosed in studied hospitals. Further, Legionella colonization is independent of the type of water, system characteristics and of preventive maintenance measures.