RAJIVGANDHI UNIVERSITY OF THE HEALTH SCIENCES,

KARNATAKA, BANGALORE

ANNEXURE-IIPROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

01 NAME OF THE CANDIDATE AND ADDRESS

Mr. SATHYAPRASAD

1st YEAR M Sc NURSING ,RATHNA COLLEGE OF NURSING, HASSAN.

02 NAME OF THE INSTITUTION RATHNA COLLEGE OF NURSING, B.M ROAD,HASSAN

03 COURSE OF THE STUDY AND SUBJECT MASTERS IN NURSING, 1st YEARCOMMUNITY HEALTH NURSING

04 DATE OF ADMISSION TO COURSE 13/06/2009

05 TITLE OF THE STUDYSTRUCTURED TEACHING PROGRAMME ON PREVENTION OF SELECTED OCCUPATIONAL HEALTH DISEASES AMONG SAW MILL WORKERS.

5.1 STATEMENT OF THE PROBLEM A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING PREVENTION OF SELECTED OCCUPATIONAL HEALTH DISEASES AMONG SAW MILL WORKERS AT THANEERHALLA, HASSAN.

[1]

6. BRIEF RESUME OF INTENDED WORK

6.1. INDRODUCTION

“Work is worship” is an often-heard phrase, but the occupational environment

of the worker cannot be considered apart from domestic environment. Both are

complementary to each other. The worker takes his worries home, and brings to his work

disturbances which arise in his domestic environment. Stress at work which may produce

serious physical or mental symptoms which do not allow man to work efficiently.

Background of the study

A hazard is a situation that poses a level of threat

to life, health, property, or environment. Most hazards are dormant or potential, with only

a theoretical risk of harm; however, once a hazard becomes "active", it can create

an emergency situation. A hazard does not exist when it is happening. Hazard

and vulnerability interact together to create risk.

Ergonomics is now a well recognized discipline and constitutes an integral part of any

advanced health service. The term ‘Ergonomics’ is derived from the Greek word ergon

means work and nomos, meaning law. It simply means ‘fitting the job to the worker’.

Training in ergonomics involves designing of machines, tools, equipment, and

manufacturing processes and the main aim of ergonomics are making a significant

contribution to reduce industrial accidents and overall health and efficiency of the

workers. Occupational health hazards are hazards of exposure to pollution, noise and

vibrations in the working environment. Exposure limits are promoted by the International

Labour Organization (ILO).

The saw mill workers may be exposed to five types of hazards

a) Physical hazards: heat and cold, noise.

b) Chemical hazards: local action on skin, inhalation of dust.

c) Biological hazards: workers may be exposed to infective and parasitic agents at the

work place.

d) Mechanical hazards: The Mechanical hazards in the industry like centre round

machinery, protruding and moving parts. Around 10% of accidents in industries are

said to be due to mechanical causes.

e) Psychosocial hazards: Frustration, lack of job satisfaction etc arises in a worker and

failure to adapt to an alien psychosocial environment 1.

[2]

As such the saw mill dust is of recent aspect because in current year’s the log is cut

using machines and Wood dust is created when machines are used to cut or shape wood

materials. Industries that have a high risk of wood-dust exposure include sawmills,

dimension mills, furniture industries, cabinet makers, and carpenters. Negative health

effects have been associated with professions that shape, cut, or work wood. The

American Conference of Governmental Industrial Hygienists (ACGIH) recognizes wood

dust as a "confirmed" human carcinogen and recommends a limit of 1 milligram per

cubic meter (mg/m3) for hardwoods and 5 mg/m3 for softwoods. The maximum

permissible exposure for nuisance dust is 15 mg/m3, total dust (5 mg/m3, respirable

fraction) 2.

The main and common diseases found in saw mill workers are chronic obstructive lung

diseases, occupational asthma, hypersensitivity pneumonitis and fungal spore infection

respectively. The sawmill workers had a significantly higher prevalence of pulmonary

symptoms compared to the control group Cough (8.6%), sputum production (1.6%),

breathlessness (8.3 %), wheeze (3.1 %). Among the sawmill workers, 179 (78.5%)

reported at least one respiratory symptom compared to 45 (12.1%) of the controls

(p<0.05). Atopy, defined as a positive skin-prick test result with one  or more of the tested

allergens, was very common (80% in subjects with and 50% in those without asthma

symptoms). Of the subjects, 6% were sensitized against pine pollen and 20% against the

tree pollen mix 3.

Approximately 10 to 15% of the adults affected by the disease report an aggravation of

their symptoms while at work and an improvement when away, which implies that they

may be suffering from Occupational Asthma. Thus, when an individual’s Asthma is

caused, not aggravated, by workplace materials, it is defined as Occupational Asthma.

Hypersensitivity pneumonitis is a related condition, with many occupational examples

(e.g. "Farmer's Lung", "Malt Worker's Lung" and "Humidifier Lung" etc.). However,

although overlapping in many cases, hypersensitivity pneumonitis may be distinguished

from occupational asthma in that it isn't restricted to only occupational exposure, and

involves type III hypersensitivity and type IV hypersensitivity rather than type I

hypersensitivity of asthma. Unlike asthma, hypersensitivity pneumonitis targets lung

alveoli rather than bronchi 4.

[3]

The above literature review reveals that the incidence of occupational health diseases are

markedly significant among people working in saw mill, but through health related to,

prevention of selected occupational health diseases among saw mill workers such chronic

obstructive lung diseases, occupational asthma, hypersensitivity pneumonitis and fungal

spore infection we can bring down the mortality and morbidity rates of saw mill workers.

6.2. NEED FOR THE STUDY

PREVENTION IS BETTER THAN CURE

According to the world health report 2002, ambient air pollution causes 5% of trachea,

bronchus and lung cancer, 2% of cardio-respiratory mortality and about 1% of respiratory

mortality globally. This amounts to 1.4% (0.8 million) death and 0.8 % (7.9millon) of

disability during life span 5.

A retrospective cohort study was conducted by Paul A. Demers; Hugh Davies et al on

Respiratory Disease among Sawmill Workers among 11,745 British Columbia sawmill

workers employed in 14 mills between 1979 and 1994. Cumulative exposure for each

participant was calculated by summing the products of exposure level and duration of

employment at each job held. Standardized mortality ratio analyses were conducted for

fatal respiratory disease. Respiratory hospitalization rates among exposed workers were

compared to unexposed workers and rates among sawmill workers were compared to the

general population using Poisson regression. Nine mills used fungicides during the study

period. Overall, 1,136 persons were hospitalized with a diagnosis of respiratory disease

between April, 1985 and July, 1997, including 261 for chronic obstructive pulmonary

disease (COPD) and 105 for asthma. The risk of COPD was elevated among workers who

had been employed for 10 or more years in all three types of mills but did not appear to

increase with further duration of employment. Overall respiratory disease, COPD, and

asthma did not appear to be associated with exposure to any of the fungicides, but very

few COPD and asthma cases were observed among exposed workers 6.

[4]

COPD is a global health concern. It is a major cause of morbidity and mortality worldwide

among occupational health workers (construction workers, saw mill workers), and is

among the top 10 global contributors to the global burden of disease as measured by

disability-adjusted life years.1 in 2002, COPD was the fifth leading cause of death.

According to the World Health Organization, the total numbers of deaths in the world

from COPD are projected to increase by 30% in the next 10 years; by 2030, COPD would

become the fourth leading cause of death worldwide. Among all major chronic diseases,

COPD is the only disease that shows a rising mortality. This trend is predicted to rise

further in the next decades with the escalating increase in the associated risk factors for

COPD and an aging population in many parts of the world7.

A cross-sectional study was conducted by J. Douwes, D. McLean on Pine dust, atopy and

lung function among sawmill workers in which An increased risk of occupational asthma

symptoms has previously been shown in 772 pine sawmill workers. The aim of the study

was to assess the association between dust exposure, lung function  and atopy. The

geometric mean dust concentration was 0.52 mg·m-3. Exposure to dry but not to green

dust was associated with asthma symptoms. Green dust was associated with atopic

sensitization, particularly against outdoor allergens. Forced vital capacity, forced

expiratory volume in one second and peak expiratory flow were significantly lower  in

workers exposed to high levels of green dust (-350 mL, -260 mL and -860 mL·s-1,

respectively) and dry dust (-230 mL, -190 mL and -850 mL·s-1, respectively). These

associations were observed both in subjects with and without asthma symptoms. No

associations with cross-shift changes in lung function were found8.

Based on the literature review and the researcher’s experience it was felt that saw mill

workers are more prone to be affected by occupational health diseases hence assessing

the knowledge of the saw mill workers regarding selected occupational health diseases is

important to identify the mortality and morbidity related to selected occupational health

diseases and also that teaching programs can be effective in reducing mortality and

morbidity among saw mill workers regarding selected occupational health diseases. So

this study is designed to assess the knowledge of saw mill workers regarding

occupational health diseases and to assess the effectiveness of structured teaching

program.

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6.3 PROBLEM STATEMENT:

A study to evaluate the effectiveness of structured teaching programme regarding

prevention of selected occupational health diseases among saw mill workers at

thaneerhalla, Hassan.

6.4 OBJECTIVES OF THE STUDY:

1. To assess the knowledge of saw mill workers regarding Prevention of occupational

health diseases

2. To develop and implement STP regarding Prevention of selected occupational health

diseases among saw mill workers.

3. To evaluate the effectiveness of STP regarding Prevention of selected occupational

health diseases among saw mill workers.

4. To determine the association between knowledge and the selected demographic

variables of saw mill workers.

6.5 HYPOTHESIS

H 1: There will be a significant difference in the level of knowledge after implementing

structured teaching programme regarding Prevention of selected occupational health

diseases among saw mill workers.

H2: There will a significant association between knowledge and their selected demographic

variables of saw mill workers after structured teaching programme.

[6]

6.6 OPERATIONAL DEFINITION

1. Assess: - It is the organized, systematic collection of data from those who fulfill the inclusive criteria.

2. Effectiveness: - It refers to the desired changes in the knowledge level that can be brought by structured teaching programme regarding prevention of selected occupational health diseases among saw mill workers.

3. Structure teaching program: - It refers to planned instructional module regarding selected aspects regarding prevention of occupational health diseases among saw mill workers such as chronic obstructive lung diseases, occupational asthma, hypersensitivity pneumonitis and fungal spore infection. Here after this is referred as STP in this thesis

4. Knowledge: - It refers to the respondent’s verbal response regarding correct relevant information regarding Prevention of selected occupational health diseases among saw mill workers.

5. Selected occupational health diseases which is related to saw mill occupation such aschronic obstructive lung diseases, occupational asthma, hypersensitivity pneumonitis and fungal spore infection.

6. In this study prevention is defined as the measures taken to reduce and control selected occupational health diseases among saw mill workers such as chronic obstructive lung diseases, occupational asthma, hypersensitivity pneumonitis and fungal spore infection.

6.7 CRITERIA FOR SELECTION OF SAMPLE

I: INCLUSION CRITERIA

1. People who all are willing to participate in the study.

2. People, who knows to speak Kannada.

II: EXCLUSIVE CRITERIA

1. People who are not present at the time of data collection.

6.8 DELIMINATION

1. This study is limited to 4 to 6 weeks.2. This study is limited to 60 samples only.

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6.9 SIGNIFICANCE OF STUDY This study will: -

1. Provide updated knowledge about Prevention of selected occupational health diseases among saw mill workers.

6.10 CONCEPTUAL FRAME WORK

This study is based on Kenny’s open system theory.

6.11 REVIEW OF LITERATURE

A study was conducted by Subodh K. Rastogi; Brahma N. Gupta, on Respiratory

Health Effect from Occupational Exposure to Wood Dust in Sawmills, among 109 workers

were used for the study and Spirometric lung functions were recorded (mean age 26.4±8.2

yr) occupationally exposed (mean exposure 8.9±7.7 yr) to soft wood dust in local sawmills

along with 88 unexposed controls (mean age 28.7±9.9 yr) belonging to the same

socioeconomic status to assess the prevalence of respiratory impairment in the exposed

population. The results of the study showed a significantly higher prevalence of overall

respiratory impairment in the exposed group even after standardizing for smoking habits.

The adjusted rate for respiratory impairment in the exposed group was 29.4% as compared

to 2.2% observed in the unexposed controls. The pattern of respiratory abnormality

observed in the sawmill workers was predominantly the restrictive type (28.4%),

indicating lower levels of forced vital capacity (FVC) in the exposed group; while in the

control group, there were none with lung restriction. The prevalence of airflow limitation,

however, was similar in the exposed workers (1.8%) and controls (2.2%), thereby,

indicating that bronchial obstruction was independent of wood dust exposure. It is

concluded that the dust exposure in sawmills is associated mainly with restrictive type of

pulmonary impairment in the exposed workers 9.

[8]

A study was conducted by Padmanabhan S. Jothish and Themath Soman Nayar on

Airborne fungal spores in a sawmill environment in Palakkad District, Kerala, since

Kerala consisted of more number of saw mill that is around 1400 registered saw mill. The

study comprises of Concentration of airborne fungal spores in indoor and outdoor

environments of a sawmill in Palakkad district of Kerala, was studied with Burkard

Personal Slide Sampler from January to December 1997. Total spore concentration in the

indoor and outdoor showed a 3:2 ratio. Higher spore count was observed in indoor in

January and in outdoor in October. Thirty three fungal spore types were identified from

the indoor and twenty six from the outdoor. Aspergillus/Penicillium, Cladosporium,

Nigrospora, Ganoderma, `other basidiospores' and ascospores were the dominant

components of the airspora. Aspergillus/Penicillium, the most dominant spore type in the

indoor contributed 51.19% and Cladosporium, the most dominant spore type in the

outdoor contributed 44.75% of the total spores. The study revealed high prevalence of

predominantly allergenic fungal spores in the sawmill environment10.

A retrospective cohort study was conducted by Paul A. Demers; Hugh Davies et al on

Respiratory Disease among Sawmill Workers among 11,745 British Columbia sawmill

workers employed in 14 mills between 1979 and 1994. Cumulative exposure for each

participant was calculated by summing the products of exposure level and duration of

employment at each job held. Standardized mortality ratio analyses were conducted for

fatal respiratory disease. Respiratory hospitalization rates among exposed workers were

compared to unexposed workers and rates among sawmill workers were compared to the

general population using Poisson regression. Nine mills used fungicides during the study

period. DDAC (didecyldimethyl ammonium chloride), IPBC (3-iodo-2-propynyl butyl

carbamate), TCMTB (2-[thiocyanomethylthio] benzthiazole) and borates. Relatively few

workers had been exposed to the four fungicides: 553 to TCMTB, 322 to borates, 359 to

IPBC, and 478 to DDAC. Record linkage to the Canadian Mortality Database identified

720 deaths between 1950 and 1995. There were 41 deaths due to respiratory disease and

no evidence of an association with fungicide exposure was observed. Overall, 1,136

persons were hospitalized with a diagnosis of respiratory disease between April, 1985 and

July, 1997, including 261 for chronic obstructive pulmonary disease (COPD) and 105 for

asthma. The risk of COPD was elevated among workers who had been employed for 10 or

more years in all three types of mills but did not appear to increase with further duration of

employment 11.

[9]

A study was conducted by A. S. Halstensen et al on determinants of microbial

exposure in grain farming. In which airborne dust was collected by personal sampling

during threshing and storage work on 92 Norwegian farms. The personal exposure for

Bacteria, endotoxin, fungal spores and hyphae, glucans and actinomycetes was quantified

and compared with climatic data expressed as fungal forecasts from the grain growth

season and production practices as reported by farmers. Farmers were exposed to high

levels of microorganisms and their components during dusty grain work. Dust prevention

and protection may reduce microbial exposure, and may be particularly important in areas

with frequent fungal forecasts, when fungal damage has been observed, during storage

work or when handling barley12.

The study was conducted by M. Roponen , M. Seuri ‌ at Laboratory of Toxicology,

National Public Health Institute, Kuopio, Finland on Fungal Spores As Such Do Not

Cause Nasal Inflammation in Mold Exposure .The increased frequency of respiratory

symptoms and diseases among sawmill workers has been linked to occupational exposure

to airborne contaminants, especially to different fungi. Similar adverse health effects,

together with elevated levels of inflammatory mediators in the nasal lavage (NAL) fluid,

have been detected in people working in mold-damaged buildings. However, the indoor

fungal spore concentrations in moldy houses are much lower than those in sawmills. To

study the effect of fungal spores as such on the inflammatory markers in the NAL fluid,

researcher conducted a similar study in sawmill workers who had an intense exposure to

fungal spores. NAL was performed in 11 sawmill workers both during high occupational

microbial exposure and during their vacation. Concentrations of nitric oxide (NO), tumor

necrosis factor-α (TNFα), interleukin (IL)-4, IL-5, and IL-6 in NAL fluid were analyzed,

and occupational exposure to inhalable dust, fungal spores, endotoxins and terpenes was

confirmed by personal monitoring during the day of sampling. There were no differences

between work and vacation in the concentrations of NO and proinflammatory cytokines in

NAL fluid or in the reporting of symptoms, and the levels were lower than in workers at a

moldy school building. The result shows that microbial exposure as such does not

invariably result in inflammatory changes detectable with the NAL method. Researchers

suggested that the type of microbial flora or microbial products in the occupational

environment determines the proinflammatory potency of microbial exposure13.

[10]

A study was conducted by piera boschetto et al on cohort of more than 317000

Swedish male construction workers was followed from 1971 to 1999. Exposure to

inorganic dusts, gases and irritant chemicals, fumes, and wood dusts was based on a job-

exposure matrix. An internal control group with "unexposed" construction workers was

used, and the analyses were adjusted for age and smoking. The study comprises of

statistically significant increase mortality from COPD among those with any airborne

exposure The fraction of COPD among the exposed attributable to any airborne exposure

was estimated as 10.7% overall and 52.6% among never-smokers. Thus, occupational

exposure among construction workers increases mortality due to chronic obstructive

pulmonary disease, even among never smokers. In conclusion, occupational exposure to

dusts, chemicals, gases were considered and the implications of this substantial

occupational contribution to COPD must be considered in research planning, in public

policy decision-making, and in clinical practices14.

A study was conducted by John Mandryk, K. Udeni Alwis, Ailsa D. Hocking on

Work-related symptoms and dose-response relationships for personal exposures and

pulmonary function among woodworkers involving Four sawmills, a wood chipping mill, and

five joineries in New South Wales, Australia, were studied for the effects of personal

exposure to wood dust, endotoxins, D-glucans, Gram-negative bacteria, and fungi on lung

function among woodworkers. Methods used in the study were Personal inhalable and

respirable dust sampling was carried out. The lung function tests of workers were conducted

before and after a work shift. The mean percentage cross-shift decrease in lung function was

markedly high for woodworkers compared with the controls. Dose-response relationships

among personal exposures and percentage cross-shift decrease in lung function and

percentage predicted lung function were more pronounced among joinery workers compared

with sawmill and chip mill workers. Woodworkers had markedly high prevalence of regular

cough, phlegm, and chronic bronchitis compared with controls 15.

[11]

A study was conducted by Wouter Fransman, Dave Mclean et al on Respiratory

Symptoms and Occupational Exposures in New Zealand Plywood Mill Workers to study

work exposure and respiratory symptoms in New Zealand plywood mill workers.

Methods used were Personal inhalable dust (n = 57), bacterial endotoxin (n = 20),

abietic acid (n = 20), terpene (n = 20) and formaldehyde (n = 22) measurements were

taken and a respiratory health questionnaire was administered to 112 plywood mill

workers. Twenty-six percent of the dust exposures were made; Workers

in the composer area (where broken sheets are joined together) were significantly more

highly exposed. Asthma symptoms were more common in plywood mill workers

(20.5%, n = 112) than in the general population [12.8%, n =415, adjusted OR

(95%). Asthma symptoms were associated with duration of employment and were

reported to lessen or disappear during holidays. No  clear association with

any of the measured exposures was found, with the exception of formaldehyde, where

workers with high exposure reported more asthma symptoms (36.4%) than low

exposed workers [7.9%].Plywood mill workers are exposed to inhalable dust, bacterial

endotoxin; abietic acid, terpenes and formaldehyde, and they appear to have an

increased risk of developing work-related respiratory symptoms. These symptoms may

be due to formaldehyde exposure, although a potential causal role for other

exposures cannot be excluded.16

The “feasibility study” was conducted by Dave K. Verma, Cecil Demers et al on

Occupational Exposure to Chemical, Biological, and Physical Agents in Ontario Sawmill and

Veneer / Plywood Plants Two primary research methods were used in the study –

Questionnaires Survey and Observational (walk-thru) Survey. 35 firms responded to the

questionnaire; another 18 firms declined to complete the survey. One was returned and one

reported no longer being in the business. Half of the firms completing the survey reported

employing 100 or more workers. The smallest number of workers reported by a responding

firm was two. Less than 10% of the firms with 5 or less workers responded to the

questionnaire survey. Approximately 55% softwood and 45% hardwood are processed in the

industry. Two or three work shifts are common. On average 19% of the workers employed in

the in dust yare under 25 years of age; 64% of workers are between 25 - 49 years old, 17%

are 50 years and older. With respect to years of service, 17% of the workforce on average had

worked for less than 2 years with their current employer, 21% had 2-5 years of service, and

62% had worked for more than 5 years for the same employer. The responses to the questions

regarding existence of occupational health hazards indicated that most employers and

[12]

employees were aware of health hazards due to exposure to wood dust, noise and mould17.

A Study was conducted by S.N. Gaur et al, in 2006, at New Delhi Tuberculosis

Centre, Institute of Genomics and Integrative Biology; Delhi, to find out current

prevalence of asthma and rhinitis in adult population belonging to Different occupational

strata of urban and rural population of Delhi. In conclusion, the prevalence of asthma

among adults of rural, urban city and urban slum population of Delhi is 13.34%, 7.9% and

11.92%, respectively. The prevalence of allergic rhinitis is 12.55%, 10.6% and 11.97%,

respectively18.

The above literature reviews revealed that the impartment of knowledge among saw mill

workers is necessary, so through health education programme we can improve the

knowledge regarding prevention of selected occupational health diseases among saw mill

workers.

7. MATERIAL AND METHODS OF STUDY

7.1 SOURSE OF DATA :

Data will be collected from saw mill workers using structured interview schedule containing knowledge aspects on Prevention of selected occupational health diseases among saw mill workers.

7.2 THE RESEARCH DESIGN

A Quasi-experimental (one group pre-test post- test design) which includes manipulation and randomization.

SCHEMATIC REPRESENTATION OF RESEARCH STUDY

R

KEY WORDSR - Randomization

O1 - Pre test.

[13]

O1 X O2

O2 - Post test.

X - Structured teaching programme (Intervention) regarding prevention of selected occupational health diseases among saw mill workers.

7.3 METHOD OF DATA COLLECTION

7.31. Research setting: - The study will be conducted in saw mill at thaneerhalla, Hassan.

7.32. Population : - The saw mill workers at thaneerhalla, Hassan.

7.33. Sample : - saw mill worker who fulfills the inclusion criteria.

7.34. Sample size : - Sample comprised of 60 saw mill workers.

7.35. Sample technique a) Probability sampling technique.

b) Simple Random sampling method will be used.

7.36. Collection of data: - Data will be collected by Interview Schedule Method. Pre-test will be conducted and after assessing the pre-test STP will be administered immediately, then after a week post test will be conducted.

7.37. Pilot Study is planned for 10% of population size.

8 VARIABLES:

8.1 Independent Variable:

Structured Teaching Programme on prevention of selected occupational health diseases among saw mill workers such as chronic obstructive lung diseases, occupational asthma, hypersensitivity pneumonitis and fungal spore infection.

8.2 Dependent Variable :

Knowledge towards prevention of selected occupational health diseases among saw mill workers.

8.3 PLAN FOR DATA ANALYSIS: -

A) Descriptive statistics: Mean, Median, Percentage, frequency will be used to describe the knowledge aspect.

B) Inferential statistics: - Chi square Test, Paired ‘T’ test to find out association between knowledge aspect and demographic variables.

[14]

9. ETHICAL CONSIDERATION

Informed consent will be obtained from the chosen sample?Yes, informed consent will be obtained from respondents.

Has ethical clearance being obtained from your institution?Yes, ethical clearance being obtained from your institution.

Has the consent been taken from the saw mill owner and Participants?Yes, the consent been taken from the saw mill owner. After approval by the university individual participants consent will be obtained.

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9 LISTS OF REFERANCES

1. Park .K, Text book of Prevention and Social Medicine, published by banarasidas bhanot, 20th edition, page no 708-709.

2. Thomas L. Bean, Journal of Environment &health wood dust occupation, (1995), vol 62, page no 35.

3. UGheoke .A.J, Wahab .K.W and Erhabor, International Journal of Tropical Medicine2009, vol 4 (1), page No 1-3.

4. Occupational asthma From Wikipedia, the free encyclopedia. http://en.wikipedia.org/wiki/Occupational_asthma.

5. Sagar .A, Bhattacharya .M, Vinod Joon, Indian journal of community medicine, 2007.

6. Paul A. Demers, Hugh Davies, et al, Respiratory Disease among Sawmill Workers, study report from U.S. National Institute for Occupational Safety and Health, 2007, page no 12-13.

7. Wan C. Tan, MD, FCCP; and Tze P. Ng, MD, Journal of the American College of Chest Physicians, 2008, page no 517.

8. J. Douwes, D. McLean, Pine dust, atopy and lung function: a cross-sectional study in sawmill workers, European respiration journal, 2006, vol 28, page no 791-798.

9. Subodh K. Rastogi, Brahma N. Gupta, Respiratory Health Effect from Occupational Exposure to Wood Dust in Sawmills,  American Industrial Hygiene Association Journal,vol50(1),page no 574-578.

10. Padmanabhan S. Jothish and Themath Soman Nayar, Airborne fungal spores in a sawmill environment in Palakkad District, Kerala, India, Aerobiology journal, springer netherland, 2004, vol20(4), page no 75-81.

11. Paul A. Demers, Hugh Davies, et al, Respiratory Disease among Sawmill Workers, study report from U.S. National Institute for Occupational Safety and Health, 2007, page no 12-13.

12. A. S. Halstensen et al, Oxford journal, 2007.

[16]

13. Roponen M , Seuri l M , Fungal Spores As Such Do Not Cause Nasal Inflammation in Mold Exposure, Journal of Informa Health Care Toxology, 2002, Vol. 14(5), Page no 541-549.

14. Piera Boschetto et al, COPD and occupational exposures, Journal of Occupational Medicine and‌Toxicology, 2006.

15. John Mandryk, Udeni Alwis K, et al, Work-related symptoms and dose-response relationships for personal exposures and pulmonary function among woodworkers, American Journal of Industrial Medicine, Volume 35(5), page 481 – 490.

16. Wouter Fransman, Dave Mclean, et al, Respiratory Symptoms and Occupational Exposures in New Zealand Plywood Mill Workers, Published by British  Occupational   Hygiene   Society, 2003, Vol. 47(4), page no 287-295.

17. Dave K. Verma, Cecil Demers et al, Occupational Exposure to Chemical, Biological, and Physical Agents in Ontario Sawmill and Veneer / Plywood Plants, A Research Report WSIB Research Grant, 2001, page no 84-87.

18. Gaur S .N, Gupta K , Rajpal S, Singh A.B, Rohatgi A, Indian J Allergy Asthma Immunol, 2006.

[17]

12 Signature of the candidate

13 Remarks of the guide

14 Name and designation Prof. D Hetzy Suthanakumari, HOD Of Community Health Nursing, Rathna College of Nursing, Hassan.

14.1 Guide Prof. D Hetzy Suthanakumari

14.2 Signature

14.3 Head of the Department Prof. D Hetzy Suthanakumari

14.4 Signature

15 Remarks of the Principal

15.1 Signature

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