Cancer Incidence among Healthcare Workers in Cancer Centers: A 14-Year Retrospective Cohort Study in Thailand

Objective: To identify the situation and possible work-related cancer risks among healthcare workers in cancer centers. Methods: This research was a 14-year retrospective cohort study of 2,331 healthcare workers at the National Cancer Institute and 7 regional cancer centers in Thailand. The study period consisted of a total of 18,939 person-years of observation. The demographic data, such as occupation and work area were collected by self-administered questionnaires or by use of a proxy. The cases were identified by the diagnoses of physicians. The incidence rates for each type of cancer, occupation and work area among the population of this study were compared with the general working population, based on national cancer statistics. The results were reported in terms of Standard Incidence Ratio (SIR) and a 95% confidence interval (CI), using Fisher’s exact method. Findings: There were 12 different types of cancer identified in 35 cases during the 14 years of the study and breast cancer was found to be at the highest number. The overall cancer incidence rates were 221.04 and 173.43 per 100,000 person-years, in males and females, respectively. Leukemia showed statistically significant levels of high SIR among the female healthcare staffs (SIR = 11.54; 95% CI = 2.38–33.72). With regard to occupation, only the male physicians showed significant SIR = 6.02; 95% CI = 1.41–19.93, while this study did not identify significant SIR levels in any of the work areas. Conclusions: This study found that the risk of leukemia was higher than expected among healthcare workers and that physicians may have an increased risk of cancer compared to the general working population, which may be a work-related reflex. However, interpretations should be made with caution due to the small number of cases

Upper extremities musculoskeletal disorders: Prevalence and associated ergonomic factors in an electronic assembly factory

Objectives:To determine the magnitude, distribution and associated ergonomic factors of upper extremities musculoskeletal disorders (UEMSD) among workers of electronic assembly in Thailand. Material and Methods: This was a cross-sectional study. 591 of 853 workers in an electronic and electrical appliance assembly factory in Bangkok, Thailand, participated in this study. A self-administered questionnaire consisting of demographic data and ergonomic factors was collected from October 2010 to January 2011. Clinical examination of each worker was performed by an occupational physician. The criteria for diagnosis of UEMSD came as a result of a consensus reached by a group of orthopedists. The associated factors were analyzed using a multiple logistic regression. Results: The point prevalence of clinically diagnosed UEMSD was as follows: radial styloid tenosynovitis - 13.03% (95% CI: 10.31-15.75), trigger finger - 9.48% (95% CI: 7.11-11.84), carpal tunnel syndrome - 8.12% (95% CI: 5.91-10.33), lateral epicondylitis - 3.38% (95% CI: 1.92-4.85), and medial epicondylitis - 1.69% (95% CI: 0.65-2.73), respectively. The adjusted odds ratio with statistical significance associated with UEMSD was as follows: high force of wrist - 1.78 (95% CI: 1.06-2.99), awkward posture of wrist - 2.37 (95% CI: 1.28-4.37) and contact stress at wrists - 1.75 (95% CI: 1.02-3.00) to develop radial styloid tenosynovitis. For trigger finger, the ratios were awkward posture of fingers - 2.09 (95% CI: 1.12-3.90) and contact stress on finger - 1.86 (95% CI: 1.04-3.34). For medial epicondylitis, it was an awkward posture of using elbows - 3.14 (95% CI: 1.10-8.95). However, this study did not find any associations between repetitive motion and any UEMSD. Conclusions: UEMSD are most commonly found in electronic assembly workers. The relevant parties should provide comprehensive ergonomic resolution for these workers

Etiological investigation of unintentional solvent exposure among university hospital staffs

Aim: This study was done to investigate unintentional solvent exposure in Srinakharinwirot university hospital staffs with unknown etiology. Material and Methods: A multidisciplinary investigation was conducted. Total volatile organic compounds (TVOCs) in working environments were measured. Biomarkers of exposure and self-administered questionnaires about clinical symptoms were collected, during and after the incidence, from the affected workers. Results: The reason behind this event was found to be renovation of the 15 th floor. TVOCs contaminated the air hanging unit of the lower 5th floor via space of the pipeline system of the building. The average TVOC value in the complaint area, on the date of notification, was 9.5 ppm. The symptoms and level of hippuric acid, collected during the incidence, were significantly higher than those collected after the problems were solved. Conclusions: The solvent from the renovation site was a potential source of health hazards for hospital staffs. The relevant authorities should be concerned about implementing a policy for the prevention of indoor pollution in the hospital

The Proportion of Occupationally Related Cholangiocarcinoma: A Tertiary Hospital Study in Northeastern Thailand

Northeastern Thailand registers the highest worldwide incidence of cholangiocarcinoma (CCA). Most of the cases are associated with liver flukes, while unknown causes comprise approximately 10–30% of cases, and these could be due to occupational exposures. Our aim was to determine the magnitude of occupational causes of CCA in a tertiary hospital in northeastern Thailand. We conducted a cross-sectional study with a sample of 220 patients between March and November 2021. Descriptive statistics were used to analyze the findings. Clinical information and telephone interviews were used to explore significant occupational histories. An occupational consensus meeting was held with two occupational physicians, an industrial hygienist, and a hepatobiliary surgeon to decide on the final diagnosis. The response rate was 90.9% (200/220). Based on the medical records and telephone interviews, researchers found that 11 participants had significant exposure. After occupational consensus, it was agreed that the eleven had possible occupational causes, 5.5% (11/200)–54.5% (6/11) being due to asbestos fibers, 45.5% (5/11) due to dichloromethane, and 9.1% (1/11) due to 1,2-dichloropropane. Only 4% (8/200) had occupational histories collected by their treating physicians. Taken together, occupationally related CCA appears to have been underestimated, so improving occupational history taking is needed to properly identify and classify work-related CCA—both for patient treatment and occupational hazard prevention

Upper extremities musculoskeletal disorders: Prevalence and associated ergonomic factors in an electronic assembly factory

Objectives:To determine the magnitude, distribution and associated ergonomic factors of upper extremities musculoskeletal disorders (UEMSD) among workers of electronic assembly in Thailand. Material and Methods: This was a cross-sectional study. 591 of 853 workers in an electronic and electrical appliance assembly factory in Bangkok, Thailand, participated in this study. A self-administered questionnaire consisting of demographic data and ergonomic factors was collected from October 2010 to January 2011. Clinical examination of each worker was performed by an occupational physician. The criteria for diagnosis of UEMSD came as a result of a consensus reached by a group of orthopedists. The associated factors were analyzed using a multiple logistic regression. Results: The point prevalence of clinically diagnosed UEMSD was as follows: radial styloid tenosynovitis - 13.03% (95% CI: 10.31-15.75), trigger finger - 9.48% (95% CI: 7.11-11.84), carpal tunnel syndrome - 8.12% (95% CI: 5.91-10.33), lateral epicondylitis - 3.38% (95% CI: 1.92-4.85), and medial epicondylitis - 1.69% (95% CI: 0.65-2.73), respectively. The adjusted odds ratio with statistical significance associated with UEMSD was as follows: high force of wrist - 1.78 (95% CI: 1.06-2.99), awkward posture of wrist - 2.37 (95% CI: 1.28-4.37) and contact stress at wrists - 1.75 (95% CI: 1.02-3.00) to develop radial styloid tenosynovitis. For trigger finger, the ratios were awkward posture of fingers - 2.09 (95% CI: 1.12-3.90) and contact stress on finger - 1.86 (95% CI: 1.04-3.34). For medial epicondylitis, it was an awkward posture of using elbows - 3.14 (95% CI: 1.10-8.95). However, this study did not find any associations between repetitive motion and any UEMSD. Conclusions: UEMSD are most commonly found in electronic assembly workers. The relevant parties should provide comprehensive ergonomic resolution for these workers

In Vitro Activity of Ceftolozane-Tazobactam and Other Antibiotics against Pseudomonas aeruginosa Infection-Isolates from an Academic Medical Center in Thailand

(1) Background: Resistant Pseudomonas aeruginosa (PA) infections have limited treatment options. Data on the activity of ceftolozane-tazobactam (C-T) against PA in Thailand are limited. Objectives: The objective of this study was to identify the in vitro activity of C-T against general and resistant PA isolates from patients with real clinical infections from the HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC) compared to other antibiotics and to study the resistant molecular patterns of those PA strains which were resistant to C-T. (2) Materials and Methods: This was an in vitro susceptibility study of 100 PA isolates plus an additional seven resistant PA isolates collected from MSMC patients. All PA isolates were tested with susceptibility broth (Sensititre™) and C-T minimal inhibitory concentration (MIC) test strips (Liofilchem, Roseto degli, Abruzzi, Italy). The C-T-resistant PA isolates were analyzed for six β-lactamase genes (blaCTX-M, blaNDM, blaIMP, blaVIM, blaOXA-23 and blaOXA-48) and the mcr-1 gene. (3) Results: A total of 100 PA isolates were collected between January 2020 and January 2021 and between February 2021 and September 2021 for the additional 7 resistant isolates. There were 18 resistant PA isolates (6 MDR, 11 XDR and 1 pan-drug resistant isolate). The overall susceptibility of the initial 100 PA isolates and the 18 resistant PA isolates was 94% and 44.5%, respectively, for C-T. The C-T susceptibility rates for isolates non-susceptible to ceftazidime, piperacillin-tazobactam, carbapenems and antipseudomonal β-lactams were 65.5%, 69.7%, 50% and 44.5%, respectively. Among the 10 isolates which were resistant to C-T, there were only 3 isolates found to have the resistant gene, which included 1 for blaIMP, 1 for blaVIM and 1 for blaNDM. (4) Conclusions: Although C-T was the best susceptibility antibiotic overall for PA isolates and MDR PA isolates at the MSMC, most of the XDR PA isolates and the PDR PA isolate were not susceptible to C-T. The mechanisms for C-T resistance involved multiple factors including the presence of blaIMP, blaVIM and blaNDM