Prevalence of and Work-Related Factors Associated with Sickness Presenteeism among Nursing Care Providers in Selected Tertiary Hospitals in Bangalore City: A Cross-Sectional Study.

Introduction: Sickness presenteeism is a phenomenon where "workers go to work when ill." The objective of this study was to determine the prevalence of and work-related factors associated with presenteeism among nursing care providers in selected tertiary hospitals in Bangalore city. Methodology: Participants were selected using stratified sampling followed by simple random sampling. A questionnaire was designed to capture socio-demographic information, sickness-related behavior, performance-based self-esteem (PBSE), and selected work-related characteristics. Results: A total of 357 participants were enrolled in the study, 274 were staff nurses (S/N) and 83 were nursing assistants (N/A). About 75% of the participants reported presenteeism at least once in the last year, two-fifths did so in the last 4 weeks and nearly 15% were sick on the day of the interview. The mean Stanford Sickness Presenteeism Scale-6 score was 18.49 ± 3.84. The most frequent reason for presenteeism was "perceived mildness of the disease." In bivariate analysis, those who were younger, male, had children, higher qualifications, chronic ailment/s, financial commitments, lesser work experience, and higher PBSE had higher presenteeism scores. When introduced into a linear regression model, those S/N who had children [Standardized coefficient = 0.23 (0.40-1.97)], higher PBSE scores [Standardized coefficient = 0.385 (0.15-2.55)], and reported sickness absenteeism in the preceding 4 weeks [Standardized coefficient = 0.136 (0.12-1.01)] were significantly associated with higher presenteeism scores. Those N/A who had lesser work experience had higher presenteeism scores [Standardized coefficient = -0.33 (-0.02--0.004)]. Conclusion: Presenteeism is a common phenomenon among nursing care providers. It is imperative that both employers and employees be educated about its ill effects on the individual, fellow staff, and patients, followed by the adoption of preventive measures.

Work-related Musculoskeletal Disorders and Quality of Life Among Staff Nurses in a Tertiary Care Hospital of Bangalore.

Background: Work-related musculoskeletal disorder (WMSD) is a collective and descriptive term used for the symptoms caused or aggravated by work. Significant WMSDs can affect the productivity and Quality of Life (QOL) of nurses. This study was undertaken to estimate the prevalence of WMSDs, identify their risk factors, and find the association, if any. This study also assessed the quality of life of nurses and its association with WMSDs. Methods: This cross-sectional study was conducted among 207 staff nurses at a tertiary care hospital in Bangalore for a period of 7 months (June-2018 to Dec-2018). The nurses were stratified based on their parent department into three broad categories - Medical, Surgical, and Operation Theatre. Stratified random sampling was followed to obtain the required number of nurses from each stratum. Data was collected using a pre-tested semi-structured questionnaire, Nordic Musculoskeletal Questionnaire (NMQ), clinical examination tests, and WHOQOL-BREF. Results: The annual prevalence of WMSDs among the study subjects using NMQ was 168 (81.2%). The prevalence of WMSDs based on clinical examination tests was 67 (32.4%). Repetitive movements at work (OR 9.3, 95% CI 3.4-25.7), working in abnormal postures for prolonged periods (OR 4.7, 95% CI 1.7-12.9), and working even when sick (OR 5.3, 95% CI 2.0-14.1) were the risk factors for WMSDs (P < 0.05). No significant association was found between reported WMSDs (according to NMQ) and QOL. Conclusion: Our study found that the prevalence of WMSDs was high among the staff nurses and it did not affect their QOL significantly. Workshops and training sessions on ergonomics should be regularly conducted at the workplace to prevent WMSDs.

Cortisol Levels in the Peri-implant Sulcular Fluid of Type-2 Diabetic and Non-diabetic Patients with Peri-implantitis.

PURPOSE: Cortisol levels (CL) in peri-implant sulcular fluid (PISF) samples in relation to type-2 diabetes mellitus (T2DM) and peri-implantitis remain unaddressed. It is hypothesi?sed that PISF CL are higher in patients with type-2 diabetes and peri-implantitis than in healthy patients without and with peri-implantitis. The aim was to assess the PISF CL of peri-implantitis patients without and with T2DM. MATERIALS AND METHODS: Peri-implantitis patients with T2DM (group 1), T2DM patients without peri-implantitis (group 2), non-diabetic patients with peri-implantitis (group 3) and non-diabetic patients without peri-implantitis (group 4) were included. Demographics were recorded; and patients' medical and dental records were assessed. Peri-implant modified plaque-index (mPI), modified gingival index (mGI), and probing depth (PD) and crestal bone loss (CBL) were recorded. The PISF was collected and CL were determined. p < 0.01 was considered statistically significant. RESULTS: Each of the four groups included 16 subjects (n = 64) with no difference in mean age. In groups 1 and 2, the mean duration of T2DM was 10.5 ± 0.8 and 10.6 ± 0.4 years, respectively. Mean HbA1c levels (p < 0.01) were higher and clinicoradiographic parameters (p < 0.001) were worse in group 1 than in the other groups. The median PISF volume and mean CL were higher in groups 1 (p < 0.01) and 3 (p < 0.01) than groups 2 and 4. There was a statistically significant correlation between PD and CL in group 3 (p < 0.001). CONCLUSION: Cortisol levels in the PISF are higher in T2DM and non-diabetic patients with peri-implantitis than in healthy individuals with and without peri-implantitis. Hyperglycemia did not influence peri-implant clinicoradiographic parameters and CL in the present patient population.

Study of Latex Glove Associated Dermatoses Among Nurses in a Tertiary Care Hospital.

INTRODUCTION: Natural rubber latex (NRL) is processed from Hevea brasiliensis trees. Allergic reactions to certain proteins in the latex manifest as immediate hypersensitivity reactions and allergic reactions to chemicals added to latex during processing manifest as allergic contact dermatitis. Healthcare workers (HCWs) are at increased risk of developing latex allergies. As little data is available from India, this study was directed toward identifying the prevalence of latex glove-related dermatoses among nurses and the factors leading to it. METHODOLOGY: This cross-sectional study was undertaken among nurses in a private tertiary care hospital. RESULTS: A total of 700 nurses were included in the study. Symptoms of latex allergy were present in 74 (10.6%) of study subjects, out of which 69 (9.9%) had features of contact dermatitis. Patch test was done in 50 subjects and was positive in 12 (24%); among them, patch test antigens were positive in 9 (18%) and a positive result to glove piece was seen in 3 subjects. CONCLUSIONS: Latex allergy in India is a significant problem; though lesser compared to western countries, its prevalence necessitates the development of pre-employment protocols to avoid workplace morbidity.

Impact of a Residential Rural Community-Based Training Program for Medical Students on Cognitive and Affective Domains of Learning in Community Medicine: A Mixed Methods Study.

INTRODUCTION: As part of undergraduate training in community medicine, students of 1st-year MBBS at our medical college in South India undergo rural residential community-based training called Rural Orientation Program (ROP). OBJECTIVE: The objective was to study the impact of ROP at a medical college in South India. METHODOLOGY: Short-term impact was studied immediately before and after ROP using a 30-item questionnaire administered to 142 students. Medium-term impact was studied among 23 students in 2nd-year MBBS. Quantitative component consisted of objective structured practical examination scores and qualitative component documented reflections on learnings. Long-term impact was studied by surveying 287 alumni (batches of 1979 onward) to explore the impact of ROP on their career. RESULTS: We found a significant (P < 0.001) improvement in the median posttest score (21, interquartile range [IQR]: 20-23) when compared to pretest (12, IQR: 10-16). The mean OSPE score was 19.34 ± 3.19 (maximum score = 25) with 54.55% obtaining a score ≥20. Thematic analysis of reflections depicted that students gained insights on factors influencing health and social organizations in rural areas. ROP helped develop empathy toward patients and a holistic approach toward health, in understanding rural dynamics and improved communication skills. CONCLUSION: ROP increases subject knowledge and plays a role in molding attitudes of students toward the care of people in rural areas and improves communication skills. This time-tested model can be replicated in other medical colleges across the country.

Myocardial extracellular volume fraction radiomics analysis for differentiation of reversible versus irreversible myocardial damage and prediction of left ventricular adverse remodeling after ST-elevation myocardial infarction.

OBJECTIVES: Our study sought to explore the prognostic value of radiomic TA (texture analysis) on quantitative ECV (extracellular volume) fraction mapping to differentiate between reversible and irreversible myocardial damage and to predict left ventricular adverse remodeling in patients with reperfused STEMI (ST-elevation myocardial infarction). METHODS: This observational prospective cohort study identified 70 patients (62 ± 9 years, 62 men [85.70%]) with STEMI for TA who consecutively performed native and contrast T1 mapping. Texture features were extracted from each stack of ECV mapping based on ROI (region of interest) analysis. RESULTS: After texture feature selection and dimension reduction, five selected texture features were found to be statistically significant for differentiating the extent of myocardial injury. ROC (receiver operating characteristic) curve analysis for the differentiation of unsalvageable infarction and salvageable myocardium demonstrated a significantly higher AUC (area under the curve) (0.91 [95% CI, 0.86-0.96], p < 0.0001) for horizontal fraction than other texture features (p < 0.05). LVAR (left ventricular adverse remodeling) was predicted by those selected features. The differences in qualitative and quantitative baseline parameters and horizontal fractions were significant between the patients with and without LVAR. LGE (late gadolinium enhancement) and horizontal fraction features of infarcted myocardium in acute STEMI were the only two parameters selected in forming the optimal overall multivariable model for LVAR at 6 months. CONCLUSIONS: Radiomic analysis of ECV could discriminate reversible from irreversible myocardial injury after STEMI. LGE as well as radiomics TA (texture analysis) of ECV may provide an alternative to predict LVAR and functional recovery. KEY POINTS: • ECV quantification was able to differentiate between infarcted myocardium and non-infarcted myocardium. • Radiomics analysis of ECV could discriminate reversible from irreversible myocardial injury. • Radiomics TA analysis shows a promising similarity with LGE findings which could aid the prognosis of myocardial infarction patients.

Do Low Self-Esteem and High Stress Lead to Burnout Among Health-Care Workers? Evidence From a Tertiary Hospital in Bangalore, India.

BACKGROUND: Low self-esteem can be an issue among health-care workers due to the hierarchical medical system. Health-care workers are also in a high pressure environment that can lead to stress and burnout. This study was conducted to estimate the proportion of health-care workers with low self-esteem, high stress, and burnout and the factors associated with these in a private hospital in Bangalore city. METHODS: This cross-sectional study included a random sample of health-care workers of various cadres - doctors, nurses, nursing aides, technicians, and workers in ancillary departments such as laundry, dietary, central sterile supply department, and pharmacy, with probability proportional to size. Rosenberg Scale for Self-esteem, Cohen's Perceived Stress Scale, and Shirom-Melamed Burnout Measure were used as study tools. RESULTS: Among the 306 health-care workers, there were high levels of low self-esteem (48.4%), stress (38.6%), and burnout (48.7%), with the lowest levels being among doctors. Those aged younger than 30 years had significantly lower self-esteem and greater stress. CONCLUSIONS: Health-care workers with low self-esteem were nearly thrice more likely to suffer high stress, Odds Ratio (OR) = 2.84 (1.36-5.92), and those who were stressed had more than three times higher chance of experiencing burnout, OR = 3.6 (2.02-6.55). Path analysis showed that low self-esteem among health-care workers had a direct effect on burnout, as well as an indirect effect through stress (mediator variable). This study indicates the need for screening and counseling for low self-esteem, stress, and burnout as part of a periodic medical examination of all cadres of health workers.

Adult Immunization in Occupational Settings: A Consensus of Indian Experts.

There is an increasing focus on instituting wellness programs at the workplace among organizations in India. Such programs are aimed at improving employee health, which in turn, helps in reducing absenteeism, as well as in increasing work productivity and improving employee engagement. Of note, adult vaccination plays a significant role in ensuring the well-being of employees, as well as in keeping an organization profitable. The burden of vaccine-preventable diseases (VPDs) in adults is increasing in India, causing significant morbidity and disability. Moreover, adult immunization is an underpublicized concept in India. There is an urgent need to create awareness about adult immunization in India, particularly in occupational health settings-both at the employee and employer levels. In view of this, an expert meeting was held under the aegis of the Indian Association of Occupational Health (IAOH) to discuss key issues pertaining to the burden of VPDs in the working population in India and to formulate guidelines on adult vaccination in occupational health settings. This consensus guideline document may act as a guide for organizations across India to create awareness about adult vaccination and also to design workplace vaccination programs to promote better health among employees.

Tackling Corona Virus Disease 2019 (COVID 19) in Workplaces.

Coronaviruses are zoonotic viruses and six species of Coronaviruses are known to cause human disease such as cause common cold, severe acute respiratory syndrome and the Middle East Respiratory Syndrome. In January 2020, scientists in Wuhan, China isolated a novel coronavirus (SARS-CoV-2), responsible for an outbreak of unknown pneumonia that had not been previously reported among humans. This virus spreads from person to person, through respiratory droplets, close contact, and by touching surfaces or objects contaminated by the virus. The incubation period varies between 2 days and 14 days. Symptoms usually include fever, cough, difficulty in breathing, pneumonia, severe acute respiratory syndrome. Older age and co-morbid conditions increase the fatality. Any person with a history of travel to and from COVID-19 affected countries in the past 14 days or any person who has had close contact with a laboratory confirmed COVID-19 are suspect cases and needs evaluation. Currently no vaccine is available and treatment is mainly supportive. Measures at workplace should include- avoiding non-essential travel, identifying and isolating sick employees at the earliest, hand hygiene, respiratory hygiene, environmental hygiene and social distancing.

Awareness, Prevalence and Factors Associated with Respiratory Morbidities Among Selected Petrol Pump Workers in Bengaluru City?

INTRODUCTION: Petrol pump workers are exposed to fumes emanated during petrol filling and vehicular exhaust thus falling prey to several respiratory diseases. OBJECTIVES: To assess the awareness and prevalence of respiratory morbidities among petrol pump workers of selected petrol pumps in Bangalore. METHODOLOGY: This cross-sectional study was conducted among 158 petrol pump workers from 11 selected pumps in Bengaluru. Following IEC approval, the baseline socio-demographic data, knowledge regarding respiratory morbidities and current morbidity pattern were ascertained. Medical examination and Peak Expiratory Flow rate (PEFR) was estimated. RESULTS: The 158 workers were all male, mostly between 18-27 years (65.19%) and high school educated (49.37%). Knowledge regarding respiratory morbidities was 56%, while prevalence of respiratory morbidity was 61%. Those workers who had completed their higher education (>10th standard), earning monthly income (>Rs. 5000) had better knowledge regarding respiratory morbidities. RECOMMENDATION: Pre-employment and regular medical examination including lung function tests and promotion of use of PPEs to be implemented.

Collaboration, Collegiality, and Sharing of Resources: Benefits of a Visiting Professor Exchange Program in Breast Imaging.

The role of a visiting professor (VP) has long been used as a model to share medical knowledge and new advances between different teaching institutions. As with all subspecialties, breast imaging has institution-specific differences in resources and faculty. Sharing of resources between programs can have a profound impact on enriching educational experiences for learners. Our conceptual design of a VP lecture exchange program was between two academic medical centers, Virginia Commonwealth University Health System (VCU) and MedStar Georgetown University Hospital University (MGUH), in the subspecialty of breast imaging. The program was designed to supplement potential areas of weakness in the breast imaging educational curriculum at each respective institution. The program also sought to create opportunities for long-term mentorship and collaboration between institutions. Three faculty members from VCU and three faculty members from MGUH participated for a total of six lectures (three lectures at each site). Participating residents and faculty completed anonymous surveys following each lecture regarding the lecture exchange program experience. The survey responses showed that the VP exchange was well received at both institutions. The VP exchange process was relatively easy to arrange, benefits both institutions, and could even be expanded to the virtual environment.

Analysis of oral and maxillofacial pathology lesions over an 18-year period diagnosed at Kuwait University.

AIMS: The aim of the present study was to determine the range, frequency, prevalence, and distribution of oral lesions submitted for histopathological diagnosis at the oral pathology laboratory at Kuwait University. METHODS: A retrospective analysis was conducted of all cases submitted to the oral pathology laboratory over an 18-year period. Age, sex, histopathological diagnosis, and location of the lesions were recorded. Lesions were classified into 10 diagnostic categories. RESULTS: Of the 697 biopsies examined, the average age of the patients ranged from 1 to 93 years with a mean age of 37.83 ± 16.62 (mean ± SD). The most common diagnostic category was mucosal pathologies (N = 205, 29.4%), followed by odontogenic cysts (N = 158, 22.7%) and reactive lesions (N = 97, 13.9%). The three most common histopathological diagnoses were hyperkeratosis (N = 70), dentigerous cyst (N = 48), and mucocele (N = 44). Twenty-five malignant neoplasms were diagnosed, the majority of them in males. A significant association was observed between age and the group of lesions of the oral cavity (P ≤ 0.001). CONCLUSIONS: The present study provides the first set of data from Kuwait that covers a wide range of oral lesions. Mucosal pathologies were the most frequently diagnosed lesions and the majority of diagnoses were benign.