Prevalence of Occupational Injury and Knowledge of Post-Exposure Prophylaxis Accessibility among Healthcare Workers in Mogadishu, Somalia

Introduction: Healthcare workers in Mogadishu, Somalia face significant occupational injury risks, particularly needle stick injuries, with 61.1% reporting incidents. This poses a serious threat to their health, leading to infections such as hepatitis B, hepatitis C, and HIV. Despite the high prevalence of injuries, awareness of Post-Exposure Prophylaxis (PEP) accessibility is relatively high, with 84.0% of respondents aware of it. However, there are gaps in knowledge and implementation, as evidenced by variations in availability of PEP. Improving workplace safety measures, providing comprehensive training on injury prevention and PEP protocols, and ensuring consistent availability of PEP in healthcare facilities are crucial steps to safeguard the well-being of healthcare workers in Mogadishu, Somalia. Methods: A cross-sectional study was conducted among hospital workers in Mogadishu, Somalia, focusing on professionals from various healthcare facilities. The study targeted nurses, doctors, laboratory personnel, and pharmacists. Purposive sampling was employed, resulting in a sample size of 383 calculated using Fisher’s sample size formula. Data were collected using coded questionnaires entered into Microsoft Excel 2019 and analyzed with SPSS software to generate frequencies and proportions, presented through frequency tables and pie figures. Results: The study in Mogadishu, Somalia, examined the prevalence of occupational injuries and knowledge of Post-Exposure Prophylaxis (PEP) accessibility among healthcare workers. Findings indicate a high prevalence of injuries, with 61.1% reporting incidents, predominantly needle stick injuries (60.6%). Despite the majority seeking prompt medical attention (72.0%), work-related illnesses affected 53.2% of respondents, notably work-related stress (59.5%). While most received training on injury and illness prevention (68.9%), gaps exist in PEP awareness, with 16.0% unaware of it. Nonetheless, 84.0% were aware, predominantly through health facilities (52.0%). Availability of PEP was reported by 71.3% in healthcare facilities, with variations in shift availability. The majority reported guidelines for PEP use (55.7%). Efforts are needed to bolster PEP awareness and ensure consistent availability in healthcare facilities to safeguard worker health. Conclusion: High prevalence of occupational injuries among healthcare workers, with needle stick injuries being the most common (60.6%). Despite this, 84.0% of respondents were aware of Post-Exposure Prophylaxis (PEP), primarily learning about it from health facilities (52.0%). While 71.3% reported the availability of PEP in their facility, 28.7% noted its unavailability. These results emphasize the need for improved education and accessibility of PEP to mitigate occupational injury risks.

Assessment of Occupational Radiation Exposure for Radiotherapy Healthcare Workers at Kenyatta National Hospital Using Thermoluminescence Dosimeter LiF:Mg,Ti

Kenyatta National Hospital (KNH) is the largest public referral hospital with a comprehensive cancer treatment facility in East and Central Africa. Occupational radiation monitoring is a significant technique for demonstrating compliance of radiation regulatory limits. The objective of the study was to carry out assessment of occupational radiation exposure among radiotherapy personnel at KNH using thermoluminescence dosimeter, TLD. KNH staff were monitored using dosimeter type TLD-100 made of LiF:Mg,Ti, on monthly basis. The reader system used for analysis was Harshaw 8800. The measurement established the average monthly accumulated occupational personnel dose for KNH to be 0.21 mSv and 0.29 mSv for Hp (10) and Hp (0.07) respectively. The accumulated dose results were within the maximum acceptable dose of 1.67 mSv/month and 41.6 mSv/month for Hp (10) and Hp (0.07) respectively. The investigation results were higher than the acceptable public limit of 0.08 mSv/month. Moreover, incidences were noted where the fetus dose limit 0.42 was also exceeded. Evaluation of statistical dose exposure among doctors, nurses and radiographers’ measurement results were within ±0.02 mSv. The study established the average KNH occupational radiation exposure levels for both Hp (10) and Hp (0.07) were within the ICRU recommendation, validating radiation protection safe practice. Data analysis of healthcare workers did not indicate exposure trend biased to any healthcare profession. Hence radiation risk cut across all professional categories. It is recommended that Radiation Monitoring program be reviewed to include non-clinical staff who access the facility. Radiation reporting should not be limited to one facility, but reflect cases where workers are involved in multiple multiple jobs.

A systematic review of occupational exposure to respirable coal mine dust(RCMD)in the U.S.mining industry

Cumulative inhalation of respirable coal mine dust(RCMD)can lead to severe lung diseases,including coal worker's pneu-moconiosis(CWP),silicosis,mixed dust pneumoconiosis,dust-related diffuse fibrosis(DDF),and progressive massive fibrosis(PMF).Statistics from the number of reported cases showed a significant decrease in the progression of respiratory diseases in the 1990s.However,an unexpected increase in the number of CWP cases was reported in the late 1990s.To date,there has been no comprehensive systematic review to assess all contributing factors to the resurgence of CWP cases.This study aims to investigate the effects of various mining parameters on the prevalence of CWP in coal mines.A systematic review using the preferred reporting items for systematic reviews and meta-analysis(PRISMA)method was conducted to investigate the health effects of RCMD exposure and identify the factors that may contribute to the recent resurgence of CWP cases.The systematic review yielded a total of 401 papers,which were added to the database.The total number of 148 and 208 papers were excluded from the database in the process of screening and eligibility,respectively.Then,18 papers were considered for data selection and full-text assessment.The review revealed that factors including geographic location,mine size,mining operation type,coal-seam thickness,coal rank,changes in mining practices,technology advancement,and engi-neering dust control practices are contributing to the recent resurgence of CWP among coal workers.However,the evidence for root causes is limited owing to the methodological constraints of the studies;therefore,further detailed studies are needed.

Occupational exposure to flour dust among bakery workers:prevalence,potential hazards and promising interventions

Occupational exposure to flour dust within bakery environments presents significant health hazards to bakery personnel.Flour dust,generated as a byproduct during baking,becomes airborne during the baking process,thus constituting a respiratory threat.Adverse health consequences include respiratory diseases,skin irritation,allergic reactions,and potential long-term health impacts.Data indicates that a broad segment of bakery workers encounters exposure to flour dust,with specific subgroups,such as bakers and dough mixers,being particularly susceptible.Contributing factors to this exposure encompass insufficient ventilation and a lack of awareness.It is vital to assess exposure levels through air quality monitoring and health surveillance.Efficient interventions encompass engineering solutions(e.g.,ventilation systems,dust extraction),administrative measures(including training and the use of personal protective equipment),and the implementation of occupational health and safety programs.Collaborative efforts with healthcare professionals and regulatory authorities are paramount for achieving success.Case studies underscore the effectiveness of such interventions,resulting in improved worker health,thus underscoring the advantages of protective measures.Challenges in this endeavor include industry resistance to change,financial considerations,and issues related to compliance.Future recommendations entail further research,policy enhancements,and the involvement of industry stakeholders and labor unions in advocating for worker safety.

Metal Exposure and Risk of Diabetes and Prediabetes among Chinese Occupational Workers

Objective To study the association between metal exposure and risk of diabetes and prediabetes among Chinese workers exposed to metals.Methods We used data obtained from the baseline survey of the Jinchang Cohort Study of workers in Jinchang Industry,the largest nickel production company in China.A total of 42,122 workers ≥20 years of age were included in the study.A standardized,structured questionnaire was used to collect epidemiological information.Physical examinations and laboratory tests were conducted to evaluate the health status of the participants and to measure various biomarkers including blood sugar,lipids,and urinary metal concentrations.Logistic regression was used to study the association between occupational groups categorized according to the measured metal levels(office workers,low-level;mining/production workers,mid-level;and smelting/refining workers,high-level)and risk of diabetes and prediabetes.Results The overall prevalence of diabetes and prediabetes was 7.5% and 16.8%,respectively.The adjusted odds ratios for diabetes among mining/production workers and smelting/refining workers compared to office workers were 1.5(95% CI:1.3,1.7)and 3.8(95% CI:3.4,4.3),respectively.No association was observed between these occupational groups and prediabetes in this study.Conclusion Occupations associated with higher levels of metal exposure were associated with an increased risk of diabetes in this cohort.More studies are needed to confirm this observed association.

Occupational exposures and colorectal cancers:A quantitative overview of epidemiological evidence

A traditional belief widespread across the biomedical community was that dietary habits and genetic predisposition were the basic factors causing colorectal cancer.In more recent times,however,a growing evidence has shown that other determinants can be very important in increasing(or reducing) incidence of this malignancy.The hypothesis that environmental and occupational risk factors are associated with colorectal cancer is gaining ground,and high risks of colorectal cancer have been reported among workers in some industrial branches.The aim of this study was to investigate the epidemiologic relationship between colorectal cancer and occupational exposures to several industrial activities,by means of a scientific literature review and meta-analysis.This work pointed out increased risks of colorectal cancer for labourers occupied in industries with a wide use of chemical compounds,such as leather(RR = 1.70,95%CI:1.24-2.34),basic metals(RR = 1.32,95%CI:1.07-1.65),plastic and rubber manufacturing(RR = 1.30,95%CI:0.98-1.71 and RR = 1.27,95%CI:0.92-1.76,respectively),besides workers in the sector of repair and installation of machinery exposed to asbestos(RR = 1.40,95%CI:1.07-1.84).Based on our results,the estimated crude excess risk fraction attributable to occupational exposure ranged from about 11% to about 15%.However,homogeneous pattern of association between colorectal cancer and industrial branches did not emerge from this review.

Occupational exposure to vinyl chloride and liver diseases

Portal hypertension,liver fibrosis,and angiosarcoma of the liver(ASL)have been reported among workers exposed to vinyl chloride monomer(VCM)since the 1970s.In 2007,the International Agency for Research on Cancer established the association of VCM with hepatocellular carcinoma(HCC),though only on the basis of the few cases available.Thereafter,recent reports from the United States cohort and a European sub-cohort of vinyl chloride workers provided compelling evidence of a strong association between cumulative VCM exposure and HCC risk.Further areas of research include the risk of liver cancer at lower levels of exposure and different patterns of risk of ASL and HCC with the time since exposure.The evidence of interaction between VCM exposure and other known liver carcinogens such as alcohol and chronic viral infection provides clues for the health surveillance of exposed workers.Notably,also the risk of VCM-associated chronic liver disease is modulated by alcohol consumption,viral infection,and genetic polymorphism.A counter-intuitive finding from cohort studies of exposed workers is the lower mortality from liver cirrhosis with respect to the general population;this can be attributed to the healthy worker effect and to the selection of liver cancer as the cause of death in the presence of concomitant chronic liver disease.Studies designed to overcome these intricacies confirmed an association between cumulative VCM exposure and the risk of liver cirrhosis.

Hepatocellular carcinoma and the risk of occupational exposure

Hepatocellular carcinoma(HCC)is the most common type of liver cancer.The main risk factors for HCC are alcoholism,hepatitis B virus,hepatitis C virus,nonalcoholic steatohepatitis,obesity,type 2 diabetes,cirrhosis,aflatoxin,hemochromatosis,Wilson’s disease and hemophilia.Occupational exposure to chemicals is another risk factor for HCC.Often the relationship between occupational risk and HCC is unclear and the reports are fragmented and inconsistent.This review aims to summarize the current knowledge regarding the association of infective and non-infective occupational risk exposure and HCC in order to encourage further research and draw attention to this global occupational public health problem.

Establishment of Occupational Exposure Limit for Warfarin in China

This study aims to establish the occupational exposure limit （OEL） in the air for workplace of warfarin based on the available toxicological studies and field investigations by using questionnaire and air monitoring. The clinical therapeutic dose was used as lowest observed effect level （LOEL）, and no observed effect level （NOEL） was achieved by using a safety factor. The highest concentration of warfarin monitored in the worksite of centrifuge washing, drying and packing were 0.029 mg/m3, 0.052 mg/m3 respectively, which did not exceed the OEL 0.2 mg/m3 recommended by NIOSH and ACGIH. Considering its feasibility for enforcement and protection for workers, we recommend OEL 0.2 mg/m3 of warfarin in China.

Relationship between Symptoms, Use of PPE and Habits Related to Occupational Exposure to BTEX Compounds in Workers of Gas Stations in Bahia, Brazil

To show the risks and harm caused by the occupational exposure to the benzene, toluene, ethylbenzene and xylenes compounds (BTEX), the working conditions of 113 persons employed at gas stations in the cities of Riach?o do Jacuipe, Feira de Santana and Salvador in the state of Bahia, Brazil were investigated by experts who correlated protection measures required by law and those applied to the workers. Data collection was performed by help of a questionnaire and non-participant observation record. The age groups of the workers in the three cities surveyed were between 18 to 25 years (30.08%) and 26 to 33 years (34.51%) of the total. The study revealed an association between occupational habits of workers at gas stations and the prevalence of symptoms due to the exposure to the BTEX compounds. Regarding the use of Personal Protective Equipment (PPE) most workers wear boots. The data show that these workers reported symptoms such as headache, rhinitis, leg pain, drowsiness, cough, fatigue, insomnia, tremors and palpitations. These disorders are related back to previous exposure to BTEX compounds which is associated with inadequate occupational habits of the workers which potentiate chemical contamination in their respective environment.

Effect of Occupational Manganese Exposure on Uric Acid Levels in Human Urine

Objective To investigate the effect of long-term and low-level occupational Mn exposure on the level of uric acid （UA） in human urine. Methods In this study, 65 volunteers were recruited, who were working on welding and foundry work in an plant in Gansu province, China. Additionally, 29 control samples were collected from individuals who did not have any history of excessive Mn exposure. An improved high performance liquid chromatography system equipped with a diode-array detector （HPLC-DAD） method was developed to determine the UA level in human urine. A Spectra AA 220 Atomic Absorption Spectrophotometer （AAS） was used to measure the Mn level in the urine. Results The analytical method was validated acceptable accuracy, precision, and recovery significantly lower than that of control samples for concentrations ranging from 3.82-45.84 pg/mL with Overall, the UA levels of Mn exposure samples were （P〈O.O5）. Conclusion The practical method developed here is suitable for both routine monitoring of UA level in human urine and metabolism research. Long-term and low-level occupational Mn exposure may lead to a lower UA level in urine, and UA might be an indicator of the early stage of manganism.

Occupational exposures to blood and body fluids (BBF): Assessment of knowledge, attitude and practice among health care workers in general hospitals in Lebanon

Healthcare workers (HCWs) who are employed in traditional health care workplaces face a serious danger that may threaten their life;it is their exposure to blood and body fluids (BBF). In Lebanon, the introduction of a hospital accreditation system has put a particular emphasis on staff safety, and on the evaluation of professional practice (EPP) programs. Methods: A cross-sectional survey was conducted amongst 277 HCWs working in 4 general hospitals in South Lebanon. Objective: 1) describe the prevalence and the risk factors for occupational exposure to BBF among HCWs;2) evaluate knowledge, attitude, and practices of HCW concerning blood-borne pathogens and adherence to universal safety precautions. Results: The mean age of the respondents was 32.14 years (SD = 10.33), 57.4% were females. 43.3% of HCWs expressed that they use gloves all the time for every activeity of care. 67.1% were aware that needles should not be recapped after use;registered nurses and nursing students were more aware than physicians and nursing assistants (nurse) in this subject. 30% of HCWs declared having had at least one occupational exposure to BBF;62.7% of all accidental exposure was reported to the department responsible for managing exposures. Percutaneous injuries were the most frequently reported. Vaccination coverage was 88.4% for hepatitis B, and 48.4% against influenza. The source patient was tested in 43.4% of reported BBF exposures. Accidental exposure to BBF was more frequent in older people (OR = 3.42;p = 0.03) and the more experienced. Subjects working in intensive care unit ward reported more exposure to BBF (OR = 3;p = 0.04). Participants incurring exposure to BBF resorted to different measures after the injury suggesting a lack of a uniform policy for post-exposure prophylaxis. Conclusion: Exposure to BBF represents an important and frequently preventable occupational hazard for HCWs in Lebanon that requires continuous EPP of HCWs, and a comprehensive approach for prevention and management.

Occupational Exposure to Indium of Indium Smelter Workers

Case reports of indium-related lung disease in workers have raised public concern to the human toxicity of indium （In） and its compounds. However, studies evaluating the exposure or health of workers in In smelting plants are rare. Therefore, in this study, we focused on four In smelting plants, with the main objective of characterizing In in smelter plants in China and discussing the potential exposure biomarkers of In exposure.

Transition from minimal change disease to focal segmental glomerulosclerosis related to occupational exposure:A case report

BACKGROUND Although minimal change disease(MCD)and focal segmental glomerulosclerosis(FSGS)have been described as two separate forms of nephrotic syndrome(NS),they are not completely independent.We report a case of a patient transitioning from MCD to FSGS,review the literature,and explore the relationship between the two diseases.CASE SUMMARY A 42-year-old male welder,presenting with lower extremity edema and elevated serum creatinine,was diagnosed with NS and end-stage kidney disease(ESKD)based on laboratory test results.The patient had undergone a kidney biopsy for NS 20 years previously,which indicated MCD,and a second recent kidney biopsy suggested FSGS.The patient was an electric welder with excessive levels of cadmium and lead in his blood.Consequently,we suspect that his aggravated pathology and occurrence of ESKD were related to metal nephrotoxicity.The patient eventually received kidney replacement therapy and quit his job which involved long-term exposure to metals.During the 1-year follow-up period,the patient was negative for metal elements in the blood and urine and recovered partial kidney function.CONCLUSION MCD and FSGS may be different stages of the same disease.The transition from MCD to FSGS in this case indicates disease progression,which may be related to excessive metal contaminants caused by the patient’s occupation.

Occupational Exposure of Healthcare Workers during COVID-19 Field Surveillance Activities in South India: A Cross-Sectional Qualitative Study

Context: Health Care Workers (HCWs) involved in field-level activities are exposed to COVID-19 which puts them under physical and psychological stress. Aim: The objective of this study was to understand the perception of the health care workers regarding their occupational exposure to COVID-19, including the safety measures used during field surveillance activities. Settings and Design: This cross-sectional study was conducted from June 2020 to July 2020 among the health care workers involved in COVID-19 field containment activities in two south Indian states—Telangana and Tamil Nadu. Methods and Material: Respondents were purposively sampled based on their involvement in the COVID-19 field level activities. Sixteen In-Depth Interviewees (IDIs) were conducted telephonically with medical officers, district epidemiologists, community health workers, sanitary workers, emergency medical technicians, and ambulance coordinators. Statistical Analysis Used: IDIs were analyzed using manual thematic analysis. Results: Seven themes and sub-themes emerged: awareness and training, occupational exposure to COVID-19 and duration, safety measures, occupational burnout, social stigma, psychological violence, and facilitating factors. Respondents felt a high level of occupational exposure to COVID-19 in addition to increased workload and stress due to fear of infection, shortage of workforce, denial of week off, psychological violence, and social stigma which affected them deeply. Support from supervisors and family, and measures ensuring the safety of women were facilitating factors to cope with the situation. Conclusions: It is important to safeguard the general and mental health of field-level health workers involved in COVID-19 activities, to keep their morale high during the continuing pandemic.

Respiratory Morbidity Associated with Long-Term Occupational Inhalation Exposure to High Concentrations of Hydrated Calcium Sulfate Dust

Despite wide application of hydrated calcium sulfate, possible respiratory effects of long-term occupational exposure to high concentrations of this chemical have only been investigated in a limited number of epidemiological studies. This study is undertaken to examine this issue, more thoroughly. This cross-sectional study is carried out at a local gypsum plant in Shiraz, capital of Fars province situated in south western Iran. All exposed subjects (20 male workers) and 20 healthy non-exposed male individuals as the referent group are investigated. Prevalence of respiratory symptoms among the studied subjects is evaluated and they undergo spirometry test (twice for the exposed group and once for the unexposed employees). Moreover, to assess the extent to which workers are exposed to gypsum dust and using standard methods, inhalable and respirable fractions of this compound are measured in different dusty worksites. Average airborne concentration of inhalable dust fraction is estimated to be 24 ± 14.76 mg/m3 which is higher than the recommended threshold limit value (TLV) for this chemical. Respiratory symptoms such as phlegm, wheezing and dyspnea are significantly more prevalent in exposed subjects than in non-exposed employees (p < 0.05). The results of ventilatory function tests (pre- shift) don’t show any significant differences between both groups. However, some post-shift parameters of ventilatory function such as FVC, FEV1 and FEV1/FVC ratio are significantly lower than those of preshift and referent group. Exposure to high atmospheric concentrations of gypsum dust is associated with a significant increase in the prevalence of respiratory symptoms along with acute reversible significant decreases in some parameters of ventilatory function.

Influence of Occupational Noise Exposure on Cognitive Ability of Grinders

Purpose: To investigate whether long-term noise exposure affects the cognitive ability of grinders. Methods: Cumulative noise exposure (CNE) and LAeq.8h determination were used to characterize the level of individual noise exposure;the Montreal Cognitive Assessment (MoCA) test (Beijing version) was used to evaluate cognitive function. Results: We compared the basic situation of workers in different groups and individual noise exposure intensity of grinders was monitored. Multiple linear-regression analysis was made and score of MoCA in different group was finally drawn. Conclusion: CNE and total score of MoCA have the relationship of negative correlation (r = -0.303, p < 0.05) which means long-term occupational noise exposure can affect the cognitive ability of grinders.

Nanotoxicology and Exposure in the Occupational Setting

Nanotechnology refers to the ability to control the composition of molecules and atoms within the range of 1.00 - 100 nm. At this scale, many materials exhibit novel properties when compared with their micro or macro-sized equivalents, including, for example, chemical reactivity, strength, mobility and solubility. Nanoparticles are prime candidates for toxicity because they possess a much greater surface to volume ratio (i.e. the surface area compared to the volume) than larger particles of that same material;they can have biopersistance and higher oxidant capacity, penetrate epithelium and reach interstitial pulmonary region. In an industrial setting, workers may present the main exposure risk potential among humans, and they may be involved in the entire product life cycle. There are needs to protect public and environmental health and safety. Currently, no standards or regulations exist that apply or refer specifically to nanomaterials impacts.

A Bayesian network for estimating hypertension risk due to occupational aluminum exposure

Background The correlation between metals and hypertension,such as sodium,zinc,potassium,and magnesium,has been confirmed,while the relationship between aluminum and hypertension is not very clear.This study aimed to evaluate the correlation between plasma aluminum and hypertension in electrolytic aluminum workers by the Bayesian networks(BN).Methods In 2019,476 male workers in an aluminum factory were investigated.The plasma aluminum concentration of workers was measured by inductively coupled plasma mass spectrometry.The influencing factors on the prevalence of hypertension were analyzed by the BN.Results The prevalence of hypertension was 23.9%in 476 male workers.The risk of hypertension from plasma aluminum in the Q2,Q3,and Q4 groups was 5.20(1.90–14.25),6.92(2.51–19.08),and 7.33(2.69–20.01),respectively,compared with that in the Q1 group.The risk of hypertension from the duration of exposure to aluminum of>10 years was 2.23(1.09–4.57),compared without aluminum exposure.Area under the curve was 0.80 of plasma aluminum and the duration of exposure to aluminum was based on covariates,indicating that aluminum exposure had important predictive value in the prevalence of hypertension in the occupational population.The results of the study using the BN model showed that if the plasma aluminum of all participants was higher than Q4(≥47.86µg/L)and the participants were drinking,smoking,diabetes,central obesity,dyslipidemia,and aged>50 years,the proportion of hypertension was 71.2%.Conclusions The prevalence of hypertension increased significantly with the increase of plasma aluminum level.