The influence of occupational heat stress on serum inflammatory cytokines among traditional bakery workers in Iran.

Heat exposure exceeding the ISO7243:1989 standard limit can contribute to health problems among employees in a variety of workplaces. Ignoring heat standard requirements in hot working conditions such as bakeries results in physiologic and health problems, as well as an elevated risk of later illnesses. In this analytical case-control study, the serum levels of four inflammatory factors (interleukin-1 beta, interleukin-6, tumor necrosis factor-α, and C-reactive protein) were assessed using an enzyme-linked immunosorbent assay. 105 male artisan bakers (in four job classifications in bakeries and staff) were compared based on demographic characteristics and inflammatory factors. The findings of the study showed correlations between serum interleukin-1ß, interleukin-6, and C-reactive protein levels and thermal exposure in the occupational environment and employment type. Moreover, some differences in serum level of interleukin-1ß and job type were observed. Heat overexposure affected the increase of interleukin-1ß and C-reactive protein secretion. As a result of years of working in high-temperature conditions, inflammation can lead to subsequent diseases in workers. To protect their health from this occupational hazard, additional safeguards are needed. Our recommendations could also be applied to overly hot work environments that may cause heat stress in workers.

Assessment of Masks Used by Healthcare Workers: Development and Validation of a Mask Qualitative Assessment Tool (MQAT).

Background: Respiratory masks can provide healthcare workers with protection from biological hazards when they have good performance. There is a direct relationship between the visual specifications of a mask and its efficacy; thus, the aim of this study was to develop tools for qualitative assessment of the performance of masks used by healthcare workers. Methods: A mixed-methods design was used to develop a qualitative assessment tool for medical face masks (MFM) and particle filtering half masks (PFHM). The development of domains and items was undertaken using observation and interviews, the opinions of an expert panel, and a review of texts and international standards. The second phase evaluated the psychometric properties of tools. Finally, the validated Mask Qualitative Assessment Tools (MQAT) were used to assess six samples from 10 brands of the two types of masks. Results: MQAT-MFM and MQAT-PHFM shared 42 items across seven domains: "cleanliness," "design," "marking, labeling and packaging," "mask layers," "mask strap," "materials and construction," and "nose clip." MQAT-MFM included one additional item. MQAT-PHFM included another nine items associated with an eighth "Practical Performance" domain, and the valve version had another additional "Exhalation Valve" domain and six items. The evaluation indicated 80% compliance for MFM and 71% compliance for PFHM. "Marking, labeling and packaging" and "Layers" were associated with the least compliance in both types of masks and should be checked carefully for defining mask quality. Conclusion: MQAT can be used for immediate screening and initial assessment of MFM and PHFM through appearance, simple tools, and visual inspection.

Persian version of the work design questionnaire: measurement of its psychometric characteristics.

BACKGROUND: Work design questionnaire (WDQ), as a comprehensive and integrative tool, is one of the most important instruments frequently used to assess work characteristics. The aim of this study was to measure the psychometric characteristics of the Persian version of WDQ. METHODS: Translation and cross-cultural adaptation procedures were applied in translating the original WDQ into Persian. A total of 270 participants participated in this study. The validity of the questionnaire were measured using face validity, content validity, convergent validity, and construct validity based on confirmatory factor analysis (CFA). Reliability was assessed through internal consistency. RESULTS: Mean content validity index was 0.95. The CFA results indicated support for a 21-factor solution. There were significant correlations between dimensions of WDQ and both job satisfaction and perceived stress. Cronbach's alpha of all items was 0.87. CONCLUSION: Results indicated that the WDQ exhibited very good psychometric properties and can be applied as a useful tool to assess work characteristics among Iranian employees. Accordingly, the authors recommend its administration in future studies. The work characteristics was significantly associated with job satisfaction and job stress. Therefore, improved work design would reduce negative consequences, such as job stress, and increase positive behaviors, such as job satisfaction.

The role of oxidative stress in pulmonary function in bakers exposed to flour dust.

Objective. This study aimed to determine the effect of exposure to flour dust on pulmonary function and the role of oxidative stress. Methods. This case-control study was conducted on 163 bakery workers (exposed group) and 177 administrative workers (unexposed group). Pulmonary function and flour dust exposure were measured by spirometry and NIOSH 0500 and 0600 methods. Oxidative stress indices including malondialdehyde (MDA), nitric oxide (NO) and total antioxidant capacity (TAC) were measured in serum samples. Results. The mean respirable and total dust exposure of bakery workers were 2.5 ± 1.72 and 6.53 ± 3.26 mg/m3. The forced vital capacity (FVC) and forced expiratory volume in the first 1 s (FEV1) were significantly lower in the exposed group than in the unexposed group. The levels of MDA and NO were higher in smokers than in non-smokers in the exposed group. The most important variables that predicted FVC and FEV1 were MDA, NO and TAC. With increased exposure to respirable dust, the levels of MDA (ß = 3.39, p < 0.001) and NO (ß = 16.48, p < 0.001) increased and total antioxidant levels decreased (ß = -0.37, p < 0.001). Conclusions. Exposure to flour dust may impair pulmonary function by increasing oxidative stress and weakening antioxidant defense.

Understanding uptake of prevention and mitigation of COVID-19 at work actions in Iran.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has required organizations to make changes to ways of working to prevent and mitigate COVID-19 in employees. OBJECTIVE: To assess the workplace response to COVID-19 in Iran. METHODS: 255 organizations completed a two-part survey. Part 1 collected data describing the business; part 2 comprised the International Labor Organization (ILO) 30-item Prevention and Mitigation of COVID-19 at Work Actions Checklist. A four-point Likert scale was used to score each item according to whether preventative measures had been actioned. RESULTS: We found a dichotomy of commitment to managing COVID-19 at work. 42.5%of organizations had fully implemented the ILO recommended preventative actions, and 45.6%workplaces had not implemented any. Large organizations had significantly more preventative actions than SMEs; the healthcare sector had significantly better COVID-19 mitigation measures in place than construction projects; and organizations with a health and safety management system had significantly more prevention actions in place. CONCLUSIONS: ILO provided a good framework to support risk assessment of COVID-19, however only half the organizations were undertaking the necessary biological hazard control actions to prevent COVID-19 at work. There remains a need to understand the inaction of organizations who do not risk assess despite being in a pandemic.

Musculoskeletal disorders and selecting an appropriate tool for ergonomic risk assessment in the dental profession.

BACKGROUND: Work-related Musculoskeletal Disorders (WMSDs) are major challenges in the occupational health services industry. Dental practitioners are regularly subjected to ergonomic risks, which can cause Musculoskeletal Disorders (MSDs) in various body regions. OBJECTIVE: This comparative cross-sectional study aimed to investigate MSDs and select a proper ergonomic risk assessment method in dental practice. METHODS: This study was conducted on 70 dentists and 70 administrative staff of dental offices (comparison group) from Shahroud, Iran. The Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) and two observational ergonomic risk assessment methods, including Quick Exposure Check (QEC) and Rapid Entire Body Assessment (REBA), were utilized. RESULTS: The results suggested that the mean score of musculoskeletal discomforts was significantly higher in dentists than in the administrative personnel. Additionally, the results of multiple regression analysis technique inferred that job tenure, working hours, and age had a significant impact on total MSDs. Regular exercise was found to significantly reduce neck discomfort complaints. It was also found that QEC was more effective in predicting musculoskeletal discomforts compared to REBA. CONCLUSION: Considering the high incidence of WMSDs in dentists, various interventional measures revolving around ergonomically redesigned workstations, enhanced physical working conditions, and ergonomic training courses are suggested.

Understanding the role of oxidative stress in the incidence of metabolic syndrome and obstructive sleep apnea.

BACKGROUND: Understanding the causes and risk factors of metabolic syndrome is important for promoting population health. Oxidative stress has been associated with metabolic syndrome, and also obstructive sleep apnea. These are two diseases which have common prognostic characteristics for heart disease. The aim of this study was to examine the role of oxidative stress in the concurrent presence of metabolic syndrome and obstructive sleep apnea in a working population. METHODS: Participants were 163 artisan bakers in Shahroud, Iran, routinely exposed to significant heat stress and other oxidative stress indicators on a daily basis as part of their work. Using a cross-sectional design, data relevant to determining metabolic syndrome status according to International Diabetes Federation criteria, and the presence of obstructive sleep apnea according to the STOP-Bang score, was collected. Analyses included hierarchical binary logistic regression to yield predictors of the two diseases. RESULTS: Hierarchical binary logistic regression showed that oxidative stress - alongside obesity, no regular exercise, and smoking - was an independent predictor of metabolic syndrome, but not obstructive sleep apnea. Participants who were obese were 28 times more likely to have metabolic syndrome (OR 28.59, 95% CI 4.91-63.02) and 44 times more likely to have obstructive sleep apnea (OR 44.48, 95% CI 4.91-403.28). Participants meeting metabolic syndrome criteria had significantly higher levels of malondialdehyde (p <  0.05) than those who did not. No difference in oxidative stress index levels were found according to obstructive sleep apnea status. CONCLUSIONS: Our findings suggest that oxidative stress contributes to the onset of metabolic syndrome, and that obstructive sleep apnea is involved in oxidative stress. Whilst obesity, exercise, and smoking remain important targets for reducing the incidence of metabolic syndrome and obstructive sleep apnea, policies to control risks of prolonged exposure to oxidative stress are also relevant in occupations where such environmental conditions exist.

Prediction of metabolic syndrome based on sleep and work-related risk factors using an artificial neural network.

BACKGROUND: Metabolic syndrome (MetS) is a major public health concern due to its high prevalence and association with heart disease and diabetes. Artificial neural networks (ANN) are emerging as a reliable means of modelling relationships towards understanding complex illness situations such as MetS. Using ANN, this research sought to clarify predictors of metabolic syndrome (MetS) in a working age population. METHODS: Four hundred sixty-eight employees of an oil refinery in Iran consented to providing anthropometric and biochemical measurements, and survey data pertaining to lifestyle, work-related stressors and sleep variables. National Cholesterol Education Programme Adult Treatment Panel ІІI criteria was used for determining MetS status. The Management Standards Indicator Tool and STOP-BANG questionnaire were used to measure work-related stress and obstructive sleep apnoea respectively. With 17 input variables, multilayer perceptron was used to develop ANNs in 16 rounds of learning. ANNs were compared to logistic regression models using the mean squared error criterion for validation. RESULTS: Sex, age, exercise habit, smoking, high risk of obstructive sleep apnoea, and work-related stressors, particularly Role, all significantly affected the odds of MetS, but shiftworking did not. Prediction accuracy for an ANN using two hidden layers and all available input variables was 89%, compared to 72% for the logistic regression model. Sensitivity was 82.5% for ANN compared to 67.5% for the logistic regression, while specificities were 92.2 and 74% respectively. CONCLUSIONS: Our analyses indicate that ANN models which include psychosocial stressors and sleep variables as well as biomedical and clinical variables perform well in predicting MetS. The findings can be helpful in designing preventative strategies to reduce the cost of healthcare associated with MetS in the workplace.

Let's get back to work: Preventive biological cycle management of COVID-19 in the workplace.

BACKGROUND: The primary response to the coronavirus (COVID-19) pandemic has been to minimize social contact through lockdown measures. The closure of non-essential businesses to tackle the spread of the coronavirus has had negative consequences for the global economy, production, and employment. OBJECTIVE: To outline how known occupational health principles can be used for preventative management of the coronavirus in workplaces to support resumption of work. METHODS: A discussion of current knowledge of COVID-19, the cost of the lockdown strategy, and preventative biological cycle management. RESULTS: The evidence-based literature indicates that biological cycle management can control the risk of coronavirus infection, provide a suitable and sufficient exit strategy from lockdown, and support getting employees back to work. Adherence to personal protective equipment standards has been insufficient, indicating a need for workplace investment and education. CONCLUSION: Imposed restrictions on workplace operations can be lifted without compromising worker health and safety when a workplace commits to practicing the three principles of biological cycle management.

Excessive Daytime Sleepiness and Safety Performance: Comparing Proactive and Reactive Approaches.

BACKGROUND: Sleep disorders and excessive daytime sleepiness negatively affect employees' safety performance. OBJECTIVE: To investigate the relationship between excessive daytime sleepiness with obstructive sleep apnea and safety performance at an oil construction company in Iran. METHODS: 661 employees consented to participate in this study. Excessive daytime sleepiness was measured with the STOP-BANG questionnaire and Epworth Sleepiness Scale (ESS). To determine how sleepiness would affect the studied occupational incidents, accidents causing injury and near misses, both reactive data and proactive safety performance indices were measured. Demographic and predictor variables were analyzed with hierarchical multiple linear regression. RESULTS: Employees who met the criteria of excessive daytime sleepiness and obstructive sleep apnea had significantly poorer safety performance indicators. STOP-BANG and ESS were significant predictors of safety compliance (ß 0.228 and 0.370, respectively), safety participation (ß 0.210 and 0.144, respectively), and overall safety behavior (ß 0.332 and 0.213, respectively). Further, occupational incidents were 2.5 times higher in workers with indicators of excessive daytime sleepiness and 2 times higher in those with obstructive sleep apnea compared with those without. CONCLUSION: These findings confirmed that excessive daytime sleepiness is a serious safety hazard, and that both reactive and proactive measures are important to understand the relative contribution of predictor variables.

The effect of heat stress on hematological parameters and oxidative stress among bakery workers.

Heat stress causes physiological changes, and changes in hematological parameters and hormonal levels in the human body, known as thermal strain. This study was conducted to determine the effect of exposure to heat stress on hematological parameters and oxidative stress in the bakers of Shahroud City, Iran. A total of 163 bakery workers (exposed group) and 135 office workers (unexposed group) with a minimum of 1-year working experience were selected. Exposure to heat stress was measured using ISO-7243 criteria on the hottest days of the year (late July and August). Wet-bulb globe temperature (WBGT) was calculated based on indoor environments. Oxidative stress indices including malondialdehyde (MDA), nitric oxide (NO), total antioxidant capacity (TAC) in the bakers' and office workers' serum and hematological parameters were measured. Statistical analysis was done through independent t-test, and multivariate linear regression using SPSS v24. Analysis of hematological parameters showed that about 70% and 68% of the bakers had abnormal mean cell volume (MCV) and white blood cell (WBC) count, respectively, while only around 12% of them had abnormal mean cell hemoglobin concentration (MCHC). The counts of red blood cells (RBC), WBC, lymphocytes (LYM), and MCV showed significant differences in different occupational groups (p < 0.05). The levels of MDA and NO were significantly higher in bakers with WBGT more than the threshold value (p < 0.05). The WBGT index for assessing heat stress can be used as a predictor variable for MDA and NO levels. In addition, heat stress exposure could be a risk factor for abnormal WBC, RBC, LYM, and MCV.

Multiple environmental and psychosocial work risk factors and sleep disturbances.

BACKGROUND: This study aimed to investigate the relationship between multiple psychosocial and environmental work risk factors and sleep disturbances. METHODS: This cross-sectional study was conducted among 90 workers in a brick factory in Iran. The health and safety executive (HSE) tool, Epworth Sleepiness Scale (ESS), and Stop-Bang questionnaire were used to determine psychosocial factors, subjective sleepiness, and obstructive sleep apnea (OSA), respectively. Standard objective methods were used to assess the environmental risk factors, including noise, light, heat stress, and respirable particles. RESULTS: Most psychosocial and all environmental work factors were moderately to highly correlated to the ESS score. There were also moderate correlations between the demands (including work load, work patterns, and work environment), role (including a clear understanding of the employees about their role in the organization), and lighting variables and the Stop-Bang score. The results of multivariate logistic regression analysis showed that job control, wet bulb globe temperature (WBGT), and respirable dust were predictive of an ESS score indicating abnormal sleep status and noise was predictive of a Stop-Bang score predictive of OSA. CONCLUSIONS: The results suggest that stressors, especially noise, heat stress, and respirable dust, are related to the employees' indices of sleep disturbance independent of other potential workplace confounding factors. These results can highlight the importance of considering multiple psychosocial and environment work risk factors for implementing occupational health and ergonomics interventional programs to prevent sleep disturbances in the workforce.

Occupational health risk assessment of volatile organic compounds emitted from the coke production unit of a steel plant.

In this study, cancer and non-cancer risks of exposure to volatile organic compounds in the coke production unit of a steel plant were evaluated. To determine individual exposure to benzene, toluene, xylene and ethylbenzene, personal samples were taken from the breathing zone of workers according to National Institute for Occupational Safety and Health (NIOSH) method 1501. Cancer and non-cancer risk assessment was performed, using US Environmental Protection Agency (US EPA) methods. Samples analysis showed that the concentration of benzene in the energy and biochemistry and the benzol refinement sections was higher than occupational exposure limits. The cancer risk for benzene in all sections was significantly higher than allowable limit; the non-cancer risk for benzene in all sections and toluene in the benzol refinement section was also higher than 1.0. In conclusion, the current control measures are not sufficient and should be improved for efficient control of occupational exposures.

The prevalence of metabolic syndrome among Iranian bakers.

BACKGROUND: Metabolic syndrome (MetS) is a group of risk factors that are associated with increased risk for atherosclerotic cardiovascular disease. OBJECTIVE: The objective of this study was to determine the prevalence of metabolic syndrome and its individual components among Iranian bakery workers. METHODS: A cross-sectional study enrolling 163 randomly selected bakery workers from Semnan province (Northeast Iran), was conducted in 2017. A standard questionnaire was used for data collection. Analyses were performed using t-test, one-way ANOVA and Latent Class Analysis (LCA) in R software. RESULTS: The prevalence of MetS was 19.8% among bakery workers. More bakery workers with MetS had no regular exercise (p = 0.001) and worked more than eight hours a day (p = 0.001). In this study, the International Diabetes Federation (IDF) diagnostic criteria had more agreement with the American Heart Association (AHA) (49.1%) than the World Health Organization (WHO) and Adult Treatment Panel (ATP) criteria. Also, the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) had the highest sensitivity for diagnosing MetS. The sensitivity of the four diagnostic methods, WHO, IDF, ATP and AHA, were 45.2%, 61.7%, 67.9% and 64.8%; and their specificity were 98.2%, 100%, 100% and 100%, respectively. CONCLUSION: The prevalence of MetS is high among bakery workers in Iran. Increased physical activity and intake of fruit and vegetables are recommended for the prevention of MetS.

Using Work Ability Index and work-related stress to evaluate the physical and mental fitness of Iranian telecom tower climbers.

BACKGROUND: Working at height has always been considered as one of the most dangerous industrial activities. Workers' fitness including their physical and psychological ability plays a key role in prevention of occupational accidents. This research was conducted to investigate the physical and mental fitness of telecommunication tower climbers as well as their job stress. METHODS: This cross-sectional study was conducted among employees of a contracting company which worked in the field of telecommunication tower installation in Iran during 2016. Sixty out of 93 workers voluntarily participated in this study. Data collection tools were the Persian version of the Work Ability Index (WAI), the Persian version of the Health and Safety Executive (HSE) Stress Indicator Tool and an author-developed measure to assess socio-demographic characteristics. Data was analyzed through statistical tests such as independent t-test, univariate analyses of variance (ANOVAs), Pearson's correlation coefficient, and multivariate linear regression; using SPSS 19 software. RESULTS: Workers' mean ± SD WAI score was 29.17 ± 10.33 and for work-related stress was 3.08 ± 1.80. There was a significant relation between WAI and educational level, job tenure, hours of sleep per day, regular exercise, and second job. The repression modeling explained 67.4% of the total variance (adjusted R2) of the WAI score. Among the dimensions of work related stress, control (ß= 0.21) and changes (ß= -0. 40) were significant predictors of the WAI score. CONCLUSIONS: To improve the worker's work ability, intervention programs should focus on promoting level of job control, sleep quality and exercise. Additionally, implementing a comprehensive macroergonomics and participatory program for increase involvement the workers in organization changes should be considered.

Effects of Work-Related Stress on Work Ability Index among Iranian Workers.

BACKGROUND: Work Ability Index (WAI) is a well-known and valid self-report tool that has been widely used in various studies to identify and avoid early retirement and work-related disability. Nevertheless, very few studies have been carried out to evaluate work ability in Iran. We aimed to investigate the WAI and the effect of work-related stress on it among Iranian workers. METHODS: A cross-sectional, descriptive and analytic study was carried out among 449 workers from five working sectors in three big cities of Iran. Work ability and work-related stress were measured using the Persian version of WAI and the Persian version of Health and Safety Executive Stress Indicator Tool. RESULTS: More than a third of the workers surveyed (34.70%) did not have an appropriate level of work ability (WAI < 37). There was a significant correlation between subscales of work-related stress and the mean score of WAI. Furthermore, the variables of body mass index, sleep quality, exercise activity, job tenure, and three subscales of work-related stress including demands, supervisor support, and role were significant predictors of WAI. CONCLUSION: According to the results of this study, the interventional programs must be focused on improving supervisors support, eliminating ambiguity and conflicts in the role of workers in their job and organization, reducing job demands, improving sleep quality, and increasing exercise activity.

Religion as an empowerment context in the narrative of women with breast cancer.

This paper aims at exploring women's meaningful perception, semantic understanding, and their experiences of breast cancer in a religion context. Accordingly, eight women who had one of their breasts completely removed by surgery (mastectomy) were studied by narrative interviews. In this narrative interview, participants told their life stories since the beginning of disease. Findings showed that religious concepts have a heightened role in the interpretation and understanding of disease, coping strategies, and gaining new concepts for life and death. Two main themes discovered in this research were fatalism on the one hand, and the hope and empowerment on the other. Despite the intrinsic conflict between these two concepts, religion, as a specific cultural and epistemological context, reconciles them; in a way, these polar concepts form a unitary structure of meaning and activity. In this structure, semantic coherence and concrete experience leads women with breast cancer to a new meaningful system, which shapes a new path for living well.