Assessing Health Seeking Behaviors and Economic Consequences of Morbidity in Indian Construction Workers: A Multicenter Study.

Background: Construction laborers succumb to poor health due to the inherent workplace health hazards and poor socio-economic living conditions. With rising healthcare expenses, the increased risk of poor health may aggravate their economic status, pushing them deeper into poverty. Settings and Design: The current cross-sectional multicenter study comprehensively investigated the determinants of health, health-seeking behavior, and poor economic impact regarding catastrophic health expenditure (CHE) among construction laborers. Methods and Material: We collected details on illnesses among self and family members of the construction laborers that required healthcare visits during the previous year and their approximate expenses. Among the 1110 participants with complete data, 37% reported illness requiring a healthcare visit either for self or a family member. Results: Regression models to ascertain demographic and living condition determinants of perceived illness revealed an increased risk of illness when the kitchen is shared with the living space (OR = 1.87) and use unhygienic smoky cooking fuels (OR = 1.87). More than 25% of those who reported illness incurred CHE. Conclusion: We conclude that the frequency of perceived illness and the economic impact, i.e., CHE is relatively higher among the construction laborers. Our results demonstrate that poor living conditions add to the burden of morbidity in construction workers and families. Providing healthcare coverage for this population and engaging and educating them about affordable healthcare are necessary future steps to prevent the worsening of the economic situation.

Association between lead exposure and DNA damage (genotoxicity): systematic review and meta-analysis.

Studies suggest that chronic lead (Pb) exposure may induce deoxyribonucleic acid (DNA) damage. However, there is no synthesised evidence in this regard. We systematically reviewed existing literature and synthesised evidence on the association between chronic Pb exposure and markers of genotoxicity. Observational studies reporting biomarkers of DNA damage among occupationally Pb-exposed and unexposed controls were systematically searched from PubMed, Scopus and Embase databases from inception to January 2022. The markers included were micronucleus frequency (MN), chromosomal aberrations, comet assay, and 8-hydroxy-deoxyguanosine. During the execution of this review, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Mean differences in the biological markers of DNA damage between Pb-exposed and control groups were pooled using the random-effects model. The heterogeneity was assessed using the Cochran-Q test and I2 statistic. The review included forty-five studies comparing markers of DNA damage between Pb-exposed and unexposed. The primary studies utilised buccal and/or peripheral leukocytes for evaluating the DNA damage. The pooled quantitative results revealed significantly higher DNA damage characterised by increased levels of MN and SCE frequency, chromosomal aberrations, and oxidative DNA damage (comet assay and 8-OHdG) among Pb-exposed than the unexposed. However, studies included in the review exhibited high levels of heterogeneity among the studies. Chronic Pb exposure is associated with DNA damage. However, high-quality, multicentred studies are required to strengthen present observations and further understand the Pb's role in inducing DNA damage. CRD42022286810.

Association between occupational lead exposure and immunotoxicity markers: A systematic review and meta-analysis.

Recent evidences suggest the role of chronic lead (Pb) exposure in altering immunological parameters. Present study aimed to systematically review existing literature and synthesize quantitative evidence on the association between chronic Pb exposure and changes in immunological markers. Observational studies reporting immunological markers such as leukocyte derivative counts (CD3+, CD4+, CD8+, CD45+, CD56+, lymphocyte, and total leukocyte), cytokine, Immunoglobulin (Igs), C-reactive protein (CRP) among Pb-exposed and unexposed controls were systematically searched from PubMed, Scopus and Embase digital databases from inception to January 2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adhered during systematic review. Mean differences in the immunological markers between Pb-exposed and control groups were pooled using random-effects model. The heterogeneity was assessed using Cochran-Q test and I2 statistic. The review included forty studies reporting immunological markers in Pb-exposed and unexposed control groups. The occupational Pb-exposed group exhibited significantly higher BLL, impaired immunological markers, characterized by a marginal lowering in lymphocyte count, lymphocyte subsets (CD3+, CD4+, CD4+/CD8+ ratio), IFN-γ and IgG levels, while CD8+, IgM, IgA, IgE, and cytokines (IL-4, IL-6, IL-10, and TNF-α) exhibited a trend of higher values in comparison to the control group. Further, inflammatory marker viz., total leukocyte count was significantly higher among Pb-exposed. The included studies exhibited high levels of heterogeneity. In conclusion, Occupational Pb exposure alters the immunological markers such as the circulating cytokines and leukocyte counts. However, high-quality, multicentered studies are required to strengthen present observations and further understand the Pb's role on the immune system. Prospero Registration ID: CRD42021228252.

Cadmium exposure and DNA damage (genotoxicity): a systematic review and meta-analysis.

Existing literature suggests an association between chronic cadmium (Cd) exposure and the induction of DNA damage and genotoxicity. However, observations from individual studies are inconsistent and conflicting. Therefore current systematic review aimed to pool evidence from existing literature to synthesize quantitative and qualitative corroboration on the association between markers of genotoxicity and occupational Cd exposed population. Studies that evaluated markers of DNA damage among occupationally Cd-exposed and unexposed workers were selected after a systematic literature search. The DNA damage markers included were chromosomal aberrations (chromosomal, chromatid, sister chromatid exchange), Micronucleus (MN) frequency in mono and binucleated cells (MN with condensed chromatin, lobed nucleus, nuclear buds, mitotic index, nucleoplasmatic bridges, pyknosis, and karyorrhexis), comet assay (tail intensity, tail length, tail moment, and olive tail moment), and oxidative DNA damage (8-hydroxy-deoxyguanosine). Mean differences or standardized mean differences were pooled using a random-effects model. The Cochran-Q test and I2 statistic were used to monitor heterogeneity among included studies. Twenty-nine studies with 3080 occupationally Cd-exposed and 1807 unexposed workers were included in the review. Cd among the exposed group was higher in blood [4.77 µg/L (-4.94-14.48)] and urine samples [standardized mean difference 0.47 (0.10-0.85)] than in the exposed group. The Cd exposure is positively associated with higher levels of DNA damage characterized by increased frequency of MN [7.35 (-0.32-15.02)], sister chromatid exchange [20.30 (4.34-36.26)], chromosomal aberrations, and oxidative DNA damage (comet assay and 8OHdG [0.41 (0.20-0.63)]) compared to the unexposed. However, with considerable between-study heterogeneity. Chronic Cd exposure is associated with augmented DNA damage. However, more extensive longitudinal studies with adequate sample sizes are necessary to assist the current observations and promote comprehension of the Cd's role in inducing DNA damage.Prospero Registration ID: CRD42022348874.

Association between Musculoskeletal Pain and Bone Turnover Markers in Long-Term Pb-Exposed Workers.

BACKGROUND: On chronic exposure, Lead (Pb) deposits in the skeletal system, replaces calcium ions, and alters the normal physiological processes, which in turn, lead to stunting, delayed fracture healing, and high resorption of collagen molecules. The present study aimed to assess the association of musculoskeletal pain and discomfort with bone turnover markers (BTMs) among long-term Pb-exposed workers. STUDY DESIGN: A cross-sectional study. METHODS: The study recruited 176 male Pb-exposed workers and 80 control subjects who were matched for age, gender, and socio-economic status. Blood lead levels (BLLs), bone growth markers, such as serum osteocalcin (OC), alkaline phosphatase (ALP), bone alkaline phosphatase (BAP), and bone resorption markers: serum pyridinoline (Pry), deoxypyridinoline (DPry), tartrate-resistant acid phosphatase-5b(TRACP-5b), and hydroxyproline in urine (HyP-U) of participants were investigated. Pain and discomfort in the musculoskeletal system were assessed using Nordic Musculoskeletal Questionnaire. RESULTS: Pb-exposure was significantly associated with musculoskeletal discomfort of the lower back (P<0.001), upper back (P<0.001), and ankle/foot (P=0.011). Among bone formation markers, serum OC was significantly lower in musculoskeletal discomfort of elbows (P=0.033) and ankle/foot (P=0.042). Among bone resorption markers, serum DPry was significantly lower in musculoskeletal discomfort of the neck (P=0.049) and shoulders (P=0.023). HyP-U was significantly higher in musculoskeletal discomfort of shoulders (P=0.035) and lower back (P=0.036). CONCLUSION: As evidenced by the obtained results, Pb-exposure was associated with musculoskeletal discomfort of the lower back, upper back, and ankle/foot. Lower bone formation (serum OC) marker was noted with musculoskeletal discomfort of elbows and ankle/foot. Furthermore, bone resorption markers were associated with musculoskeletal discomfort of the neck, shoulders, and lower back. The findings of the present study suggested that long-term Pb-exposure and BTMs were associated with musculoskeletal discomfort.

Association between aluminium exposure and cognitive functions: A systematic review and meta-analysis.

INTRODUCTION: Chronic Aluminium (Al) exposure is reported to be linked with neuro-cognitive impairment. However, there is limited synthesized information on the role of chronic Al exposure on individual cognitive domains. This knowledge gap is explored here by systematic review and meta-analysis of the published literature. METHODS: Observational studies that reported the association between Al exposure and cognitive functions were systematically searched in PubMed, Scopus and Embase databases since inception to June 2019 and updated on September 2020. PRISMA guidelines were adhered in this study. Meta-analysis was performed using a random-effect model if the included studies exhibited heterogeneity, in the absence of heterogeneity fixed effect model was used. Heterogeneity was assessed using Cochran-Q test and I2 statistic. Risk of bias was assessed using the risk of bias in non-randomized studies of exposures. Sub-group analysis and meta regression analysis were explored. RESULTS: Twenty-three studies including 1781 Al exposed and 1186 unexposed were part of the final results. The pooled standardized mean difference of global cognitive scores (-0.65, 95%CI: -1.09 to -0.22, I2 = 91.09%), memory (-0.45, 95% CI: -0.69 to -0.21, I2 = 81.67%), working memory (-0.3, 95%CI: -0.45 to -0.15, I2 = 0%) and processing speed domains were significantly inferior among Al exposed as compared to unexposed. The other evaluated cognitive domains, such as cognitive flexibility, visuospatial abilities and psychomotor functions did not significantly differ between the two groups. We observed a serious risk of bias in most of the included studies. CONCLUSION: Current pieces of evidence suggest an association between chronic Al exposure and impaired cognitive function in majority of domains including memory, processing speed and working memory while no significant influence in other cognitive domains. However, considering high heterogeneity and low quality of primary evidence, further high-quality studies are necessary for conclusive evidence in this regard.

Blood lead levels and male reproductive hormones: A systematic review and meta-analysis.

Present study aimed to systematically review and synthesise quantitative evidence on association between occupational Lead (Pb) exposure and male reproductive hormones (MRH) and sperm quality from the existing literature. Observational studies investigating the effects of Pb exposure on MRH, sperm-count and sperm motility are systematically searched in PubMed, Scopus and EMBASE databases since inception to May 2019. The PRISMA guidelines are adhered during the entire study procedure and details such as participant characteristics, occupational Pb exposure, MRH, sperm-count and sperm motility from individual articles are extracted to the perform meta-analysis. Sub-group analysis and sensitivity analysis are additionally explored. Further, meta-regression is executed to investigate the influence of participant's age, duration of workplace Pb exposure on the individual outcome parameters. We observed that otherwise normal (fertile) male participants from all studies were within the age range of 25-45 years. Male employees occupationally exposed to Pb exhibited significantly higher blood Pb, lower sperm-count, poor sperm motility and higher serum prolactin levels as compared to the Pb unexposed males. The testosterone, follicle stimulating hormone and luteinising hormone levels of the occupationally Pb exposed participants are comparable to that of unexposed comparators. Studies included for synthesising quantitative evidence had unacceptable levels of heterogeneity. Explorative subgroup or meta-regression analysis had no additional results to the study. Lastly, included studies were driven by publication bias (positive results) and low powered (small sample size) studies. Thus, Pb exposure at workplaces is detrimental to male reproductive function, with lower sperm-count and higher prolactin levels. However, to enumerate the precise quantity of Pb exposure detrimental on male reproductive functions, high quality longitudinal studies with large cohorts are needed.

Assessment of Bone Turnover Biomarkers in Lead-Battery Workers with Long-Term Exposure to Lead.

BACKGROUND: The major portion of lead in the body resides in skeletal system. The bone turnover affects the release of lead into the circulation from bones. The bone turnover biomarkers (BTM) in lead-battery workers with long-term exposure to lead have not been explored yet. OBJECTIVE: To evaluate the BTM (formation and resorption) in lead-battery workers with long-term exposure to lead in lead-battery manufacturing plant. METHODS: 176 male lead-exposed workers and 80 matched comparison group were studied. All participants were examined for blood lead levels (BLLs), bone formation biomarkers- serum osteocalcin (OC), alkaline phosphatase (ALP), bone-specific alkaline phosphatase (BALP)-and bone resorption biomarkers-serum pyridinoline (PYD), deoxypyridinoline (DPYD), tartarate-resistant acid phosphatase-5b (TRACP-5b), and urinary hydroxyproline (UHYP). RESULTS: We found a significantly higher bone formation biomarkers such as BALP (p=0.007) and bone resorption biomarkers, eg, PYD (p=0.048), TRCAP-5b (p=0.001), and UHYP (p=0.001) in lead-exposed workers. A significant (p=0.041) negative correlation (ρ ­0.128) was noted between BLLs and OC. A significant positive correlation was noted between BLLs and TRACP-5b (ρ 0.176, p=0.005) and UHYP (ρ 0.258, p=0.004). Serum OC (p=0.040) and UHYP (p=0.015) levels changed significantly with BLL level. Bone resorption biomarkers levels- PYD, TRACP-5b, and BALP-were higher among those with higher BLLs levels. The duration of exposure was significantly associated with BALP (p=0.037), DPYD (p=0.016), TRACP-5b (p=0.001), and UHYP (p=0.002) levels. CONCLUSION: Long-term lead exposure affects the bone turnover.

Assessment of Lead Exposure and Urinary-δ-aminolevulinic Acid Levels in Male Lead Acid Battery Workers in Tamil Nadu, India.

BACKGROUND: Exposure to lead (Pb) affects multiple health outcomes and physiological systems. In adults, even small increases in blood Pb levels have been associated with decreased glomerular filtration rate, increased risk of hypertension and increased incidence of essential tremor. To date, there have been few Pb-exposure assessments using the United States Occupational Health and Safety Administration (OSHA) regulations. OBJECTIVE: The aim of the present study was to assess Pb-exposure in terms of elevated blood lead levels (BLL) and urinary-δ-aminolevulinic acid (U-δ-ALA) levels of workers exposed to Pb in the lead acid battery industry in Tamil Nadu, India based on Pb exposure regulations set by the American Conference of Governmental Industrial Hygienists (ACGIH) and OSHA. MATERIALS AND METHODS: BLLs and U-δ-ALA were estimated in 449 male workers exposed to Pb across ten different job categories in a lead acid battery factory. Worker BLLs were estimated using atomic absorption spectrophotometry and U-δ-ALA was estimated using spectrophotometry. RESULTS: The Biological Exposure Index of the American Conference of Governmental Industrial Hygienists (BEI-ACGIH) were used to assess Pb exposure. BLLs <30 µg/dL were found in 63.5% of workers, and 36.5% of workers had BLLs>30 µg/dL. The present study also assessed Pb exposure using OSHA regulations and found that 83.3% of workers had BLLs <40 µg/dL and 16.7% of workers had BLLs>40 µg/dL. Among these workers, 0.7% of workers had BLLs >60 µg/dL. An excessive excretion of U-δ-ALA (20-40 mg/L) was noted in pasting area workers (2.6%) followed by executives (2.2%) and assembly workers (0.9%). CONCLUSIONS: Workers in the job categories of pasting and assembly, as well as executives, are at high risk of Pb exposure compared to other job categories. We recommend placing humidifiers on the roof and keeping a water bath closer the to plate cutting area to reduce fugitive Pb dust emissions. We recommended workers with BLLs >60 µg/dL be removed from jobs involving Pb exposure and return to work only when their BLLs are <40 µg/dL. PARTICIPANT CONSENT: Obtained. ETHICS APPROVAL: The study was approved by the ethics committee of the Regional Occupational Health Centre (Southern) Bengaluru, part of the National Institute of Occupational Health of India. COMPETING INTERESTS: The authors declare no competing financial interests.

Assessment of Serum Magnesium Fractions in Workers Exposed to Pb from Pb-Battery Plant.

BACKGROUND: Most of studies assessed the effect of Pb-exposure on serum total magnesium (tMg). The hypomagnesium condition depended on protein concentration in the sample and influence of lifestyle factors. This study assessed the effect of Pb- exposure on serum tMg, corrected Mg (cMg), ionized Mg (iMg), percentage of iMg from tMg, and percentage of iMg from cMg with contemplation of lifestyle factors. STUDY DESIGN: Case control study. METHODS: The serum magnesium fractions were assessed in 176 male Pb-exposed workers in the year 2015 at Tamil nadu in India and 80 control subjects with no occupational exposure of Pb. The serum tMg and albumin concentrations were estimated using diagnostic kit methods. Blood lead levels (BLLs) were estimated using atomic absorbtion spectrophotometer method. The fraction of cMg and iMg were calculated from serum tMg and albumin concentration among individual subjects. RESULTS: The BLLs was significantly (P<0.001) increased in the study group as compared to control. Serum tMg, cMg, iMg, % of iMg from tMg and % of iMg from cMg concentrations were not significantly decreased in the study group as compared to control. Pb-exposure was significantly associated with abnormal frequency distribution of serum iMg (P=0.048) and % of iMg from tMg (P=0.016). Smoking habit was significantly associated with cMg (P=0.039) and % of iMg from cMg concentration (P=0.018). The alcohol consumption was significantly (P=0.049) associated with cMg. CONCLUSION: The Pb-exposure and lifestyle factor such as smoking and alcohol consumption were associated with alteration of serum magnesium fractions.

Effect of Lead Exposure on the Status of Reticulocyte Count Indices among Workers from Lead Battery Manufacturing Plant.

Earlier studies conducted on lead-exposed workers have determined the reticulocyte count (RC) (%), but the parameters of Absolute Reticulocyte Count (ARC), Reticulocyte Index (RI), and Reticulocyte Production Index (RPI) were not reported. This study assessed the effect of lead (Pb) exposure on the status of reticulocyte count indices in workers occupied in lead battery plants. The present cross-sectional study was carried out on 391 male lead battery workers. The blood lead levels (BLL) were determined by using an Atomic Absorption Spectrophotometer. The RC (%) was estimated by using the supravital staining method. The parameters, such as ARC, RI, and RPI, were calculated by using the RC (%) with the red cell indices (RBC count and hematocrit). The levels of RBC count and hematocrit were determined by using an ABX Micros ES-60 hematology analyzer. The levels of reticulocyte count indices - RC (%), ARC, RI, and RPI significantly increased with elevated BLL. The association between BLL and reticulocyte count indices was positive and significant. The results of linear multiple regression analysis showed that the reticulocyte count (ß = 0.212, P < 0.001), ARC (ß = 0.217, P < 0.001), RI (ß = 0.194, P < 0.001), and RPI (ß = 0.208, P < 0.001) were positively associated with BLL. The variable, smoking habits, showed a significant positive association with reticulocyte count indices: RC (%) (ß = 0.188, P < 0.001), ARC (ß = 0.174, P < 0.001), RI (ß = 0.200, P < 0.001), and RPI (ß = 0.151, P < 0.005). The study results revealed that lead exposure may cause reticulocytosis with an increase of reticulocyte count indices.

Effects of lead exposure on the status of platelet indices in workers involved in a lead-acid battery manufacturing plant.

This study was carried out to determine the effect of Pb exposure on the status of platelet indices in workers exposed to Pb during lead-acid battery plant process. Platelet indices and blood lead levels (BLLs) were determined in 429 male workers. BLLs were determined by using an atomic absorption spectrophotometer. Platelet indices in the samples were quantified by using the Sysmex KX-21 hematology analyzer. The levels of platelet count (PLT), plateletcrit (PCT) and mean platelet mass (MPM) were significantly decreased and platelet distribution width (PDW), platelet large cell ratio (P-LCR) and mean platelet volume were increased with an increase in BLLs. The results of linear multiple regression analysis showed that the platelet count (ß -0.143, P=0.005), PCT (ß -0.115, P=0.023) and MPM (ß -0.110, P=0.030) were negatively associated with BLLs and P-LCR (ß 0.122, P=0.016) was positively associated with BLLs. The variable of body mass index showed a positive association with PCT (ß 0.105, P=0.032) and MPM (ß 0.101, P=0.039). The results of the study may indicate that lead exposure may impair coagulation function through endothelial tissue injury and reduction of nitric oxide.

Evaluation of the Relationship between Pro-inflammatory Cyto-kines and Health Hazards in Workers Involved in Hazardous Waste Sites at Karnataka, India.

BACKGROUND: Most of the studies have reported higher occupational health haz¬ards on hazardous waste workers (HWW). However reports regarding the asso¬ciation between health hazards and pro-inflammatory cytokines in HWW are scanty. The present study was undertaken to evaluate the relationship between occupational health hazards and serum pro-inflammatory cytokines in HWW. METHODS: One hundred two subjects working in hazardous waste areas in differ¬ent parts of Bangalore at Karnataka, India were enrolled into the study in 2009. Using questionnaire the respiratory morbidity and other work related problems in HWW was carried. The levels of pro-inflammatory cytokines in study subjects were determined by using Enzyme-linked-immunosorbent assay kits (Pierce Biotechnology, USA). The differences of serum pro-inflammatory cytokines levels between the groups were computed by using non-parametric Mann-Whitney U test. SPSS 10.0 for windows version of statistical software was used in the analy¬sis. RESULTS: The morbidity conditions such as respiratory (34%), musculo-skeletal (24.5%), past illnesses (12.7%), dermatological (11.8%), gastrointestinal (9.8%), injuries due to contact with sharp objects & heavy equipments (7.8%) and nose and eye (4.9%) problems were observed in HWW. The levels of serum pro-inflammatory cytokines such as IL-8 (P=0.041) & TNF-α (P=0.040) significantly increased in landfill area workers and subjects having respiratory symptoms. CONCLUSION: The levels of serum pro-inflammatory cytokines IL-8 & TNF- α were significantly associated with subjects having respiratory symptoms & further supporting that they are inflammatory markers in respiratory symptoms.