Health profile of NPCIL employees

Dr. S K Jain CMS NPCILDr S K Jain CMS NPCIL 1

Dr S K Jain CMS NPCIL 2

NPP Employee’s Health Profile Health of employees is of prime importance for any organization to thrive .NPCIL considers healthy employees as an asset.To take good care of health of employees NPCIL has developed high class medical services through Departmental Hospitals , Dispensaries at each site.Medical services are also extended to surrounding population by respective site hospitals / NGO’s under CSR activities. Dr S K Jain CMS NPCIL 4

• EMPLOYEES HEALTH DATA VIS‐À‐VIS DATA OF OTHER STUDIES CONDUCTED FOR GENERAL PUBLIC• TO DETERMINE AREAS OF IMPROVEMENT• COMPARISON WITH PUBLISHED STUDIES• COMPARISON BETWEEN RADIATION WORKERS AND NON‐RADIATION WORKER Dr S K Jain CMS NPCIL 5

• STUDY HEALTH PROFILE OF THE EMPLOYEES WORKING AT THE NPCIL OPERATING SITE.• BASED ON THE ANNUAL MEDICAL EXAMINATION REPORTS SUBMITTED BY EACH SITE• PERIOD OF STUDY 1995 – 2010 OR AS PER AME COMMENCEMENT• CANCER DATA IRRESPECTIVELY FROM 1995 – 2010 Dr S K Jain CMS NPCIL 6

• ATOMIC ENERGY (FACTORIES) RULES 1996• ALL RADIATION WORKERS – ANNUALLY• ALL WORKERS IN DANGEROUS OPERATIONS – ANNUALLY• ALL DRIVERS / FL OPRT/ CRN OPRT – ANNUALLY & TWICE A YEAR FOR VISION IF >45 YRS• ALL CANTEEN WORKERS – ANNUALLY• ALL NON RADIATION WORKERS ONCE IN FIVE YEARS / THREE YEARS IF > 45 YRS Dr S K Jain CMS NPCIL 7

• HISTORY TAKING• PHYSICAL EXAMINATION• SYSTEMIC EXAMINATION• INVESTIGATIONS Dr S K Jain CMS NPCIL 8

Disease CriterionHypertension(HT) : Joint National Congress on Hypertension – VI (JNC VI)Diabetes Mellitus : Established cases on Treatment / Fasting Glucose > 126 (DM) mg / dl or Post Prandial Blood Glucose >200 mg / dlCoronary Heart : Established cases from In house Medical records/ ECG Disease (CHD)Chronic Obsructive : Established cases from In house Medical records Pulmonary Diseases (COPD)Anaemia : Haemoglobin< 12.5 gm / dl for Males & 12 gm / dl for FemalesMalignancies : Established cases from In house Medical records Dr S K Jain CMS NPCIL 9

Number of Employees of NPCIL undergoing Annual Medical Examination ‐ Year Wise Year Radiation Workers Non Radiation Total Workers1995 1444 233 16771996 1964 274 22381997 4052 1712 57641998 3960 1907 58671999 3665 1324 49892000 3183 863 40462001 4839 778 56172002 5704 1613 73172003 5873 1643 75162004 5326 1925 72512005 5978 2094 80722006 5245 2297 75422007 5489 1823 73122008 5293 2548 78412009 5649 2415 80642010 4942 Dr S K Jain CMS NPCIL 1917 6859 10

• Prevalence Rate is Much Less than those in other studies• Highest prevalence rate for any given year in NPCIL is 7.12% as against Mean prevalence of other studies is 11.75%• Prevalence between radiation & Non Radiation workers is comparable. Dr S K Jain CMS NPCIL 12

• The study shows that the prevalence in NPCIL employees is much less than that found in other studies. • The highest prevalence in percentage found in NPCIL is 13.65% as against 30.03% as the Mean of other studies• Between radiation and non‐radiation workers the variations are very close to each other. Dr S K Jain CMS NPCIL 13

• Prevalence far less than the other studies conducted in general public• Highest Prevalence in NPCIL is 1.82%• Mean Prevalence of other studies conducted in general public is 8.61%• Prevalence among Radiation & Non radiation workers is comparable.• Figures are extremely Promising Dr S K Jain CMS NPCIL 14

• COPD in NPCIL employees is far less than that found in other studies. • Highest prevalence in NPCIL employees for any year is 3.87% as against 8.12% as Mean of other studies.• The prevalence among Radiation & Non Radiation workers is comparable• This is a hallmark of Pollution free work environment Dr S K Jain CMS NPCIL 15

• Cancer cases have been included from the Medical data of the Employees available at the sites• Total of Eighty cases of Cancers have been detected between 1995 – 2010 the study period of 16 years• Statistical values of Average Incidence Rates and Average Death Rates have been calculated for Males, females, and Combined. • Cancer per se was not the immediate cause of death in all the deceased cases, none the less they all have been included for computing the Average Death Rate. Dr S K Jain CMS NPCIL 17

• Number of cases occurring in Males, Females, and both sexes combined since 1995 – 2010• Number of Deaths of Cancer Cases occurring in Males, Females and both sexes since 1995 – 2010• Average total population of Males, Females and Both sexes, between 1995 – 2010. • All rates are number of cases per One Lakh population Dr S K Jain CMS NPCIL 18

• Average Incidence Rate = [(Number of cases occurring/ Average Total Population) x 1,00,000] / Number of Years of the Study Number of Years is 16 Years, 1995 ‐2010• Average Death Rate = [(Number of Deaths / Average Total Population) x 1,00,000] / Number of Years of the Study Number of Years is 16 Years, 1995 ‐2010• These formulae are applied for all three – Males, Females and Combined both sexes. Dr S K Jain CMS NPCIL 19

Cancer Cases NPCIL Operating Sites ‐ Males‐ 1995 ‐ 2010 Total Cases Average [Alive + Total Average National Average National Cases Decease Decease Populati Incidence Incidence Death Death SITES Alive d d] on Rate rate Rate Rate Radia‐ Non Total tion Non Rad Total Radiation Radiation Decease Worker Worker Alive Worker Worker d NAPS 4 1 5 2 0 2 7 1180 37.07 10.59RR SITE 3 8 11 3 10 13 24 2540 59.05 31.98 TMS 2 1 3 7 4 11 14 1711 51.13 40.18 KAPS 6 2 8 3 1 4 12 1017 73.74 24.58 KGS 0 3 3 0 5 5 8 1431 34.94 92.9 21.83 71.2MAPS 6 0 6 5 1 6 12 868 86.4 43.2TOTAL NPCIL 21 15 36 20 21 41 77 8634 55.73 29.67 Dr S K Jain CMS NPCIL 20

Cancer Cases NPCIL Operating Sites ‐ Females‐ 1995 ‐ 2010 Total Cases Average [Alive + Total Average National Average National Deceased Populati Incidence Incidenc Death Death SITES Cases Alive Deceased ] on Rate e Rate Rate Rate Radia‐ Non Radiat Non tion Rad ion Radiati Total Work Work Total Work on Decease er er Alive er Worker d NAPS 0 0 0 0 0 0 0 59 0 0 R.R. SITE 0 0 0 0 0 0 0 121 0 0 T.M.S. 0 0 0 0 1 1 1 146 42.8 42.8 K.A.P.S 0 0 0 0 0 0 0 84 0 105.5 0 65.5 K.G.S. 0 0 0 0 0 0 0 119 0 0 M.A.P.S. 0 1 1 0 1 1 2 96 130.2 65.1 NPCIL 0 1 1 0 2 2 3 616 30.43 20.29 Dr S K Jain CMS NPCIL 23

Cancer Cases NPCIL Operating Sites ‐ Both Sexes 1995 ‐ 2010 Total Cases Average [Alive + Total Average National Average National Deceased Populati Incidence Incidenc Death Death SITES Cases Alive Deceased ] on Rate e rate Rate Rate Radia‐ Non Radiat Non tion Rad ion Radiati Total Work Work Total Work on Decease er er Alive er worker d NAPS 4 1 5 2 0 2 7 1240 35.28 10.08 R.R. SITE 3 8 11 3 10 13 24 2661 56.36 30.53 T.M.S. 2 1 3 7 5 12 15 1857 50.48 40.38 K.A.P.S. 6 2 8 3 1 4 12 1101 68.11 22.7 98.5 68 K.G.S. 0 3 3 0 5 5 8 1550 32.25 20.16 M.A.P.S. 6 1 7 5 2 7 14 963 90.86 45.43NPCIL 21 16 37 20 23 43 80 9250 54.05 29.05 Dr S K Jain CMS NPCIL 26

Organ wise Cancer Distribution in various Categories Males Female Non workers‐ Radiation Radiation All Non Sl.No. Organ Worker Worker Radiation Total 1 Lung 3 4 Nil 7 2 Tongue 4 2 Nil 6 3 Gingivo‐Buccal sulcus 0 1 Nil 1 4 Palate 1 1 Nil 2 6 Adementinoma 1 0 Nil 1 7 Sub Mandibular Gland 1 0 Nil 1 8 Angle of Mouth 1 0 Nil 1 9 Vocal Cord 0 1 Nil 1 10 Tonsil 0 1 Nil 1 11 C.M.L. 6 1 Nil 7 12 A.L.L. 2 0 Nil 2 13 C.L.L. 0 1 Nil 1 14 Hodgkin Lymphoma 2 2 Nil 4 15 Testis 2 1 Nil 3 16 Colon 3 2 Nil 5 17 Rectum Dr S K Jain CMS NPCIL 1 1 Nil 2 29

Organ wise Cancer Distribution in various Categories ‐ contd. MALES Female Workers – Non All Non Radiation Radiation Radiation Sl.No Organ Worker Worker workers Total 18 Stomach 2 0 Nil 2 19 Brain & Meninges 2 1 Nil 3 20 Renal 1 2 Nil 3 21 Larynx 0 1 Nil 1 22 Prostrate 0 1 Nil 1 23 Pyriform Fossa 1 0 Nil 1 24 Omentum 1 0 Nil 1 25 Pancreas 3 1 Nil 4 26 Large Cell Lymphoma 0 1 Nil 1 27 Supra Glottis 0 1 Nil 1 28 Multiple Myeloma 1 2 Nil 3 29 Clivus Chordoma 0 1 Nil 1 30 Bladder 0 3 Nil 3 31 Thyroid 1 1 Nil 2 32 Oesophagus 0 1 Nil 1 33 Secondaries ? Primary 2 2 Nil 4 34 Cervix 1 1 35 Breast 1 1 36 Ovary 1 1 TOTAL 41 36 3 80 Dr S K Jain CMS NPCIL 30

• Average Incidence rates in Males, in Females at TMS and Combined is less than the respective National rates• Average Incidence rate in Females in MAPS is marginally more 130.2 as against the National rate of 105.5. This is a statistical variation due to very small size of the sample study. Only 96 females• Both the cases of cancers in Females in MAPS & one at TMS is among Non Radiation worker Dr S K Jain CMS NPCIL 31

• Average Death Rates among Males, Females and Combined were less than the respective Death rates at all the sites and NPCIL as a whole• Of the Total 80 cases of Cancers detected during the study period, 41 cases were in Radiation Workers and 39 in Non Radiation Workers Dr S K Jain CMS NPCIL 32

• Highest prevalence rate of DM for any given year in NPCIL is 7.12% as against Mean prevalence of other studies is 11.75%• The highest prevalence rate of HT for any given year in NPCIL is 13.65% as against Mean Prevalence of other studies is 30.03% • Highest prevalence rate of CHD for any given year in NPCIL is 1.82% as against Mean Prevalence of other studies is 8.61% Dr S K Jain CMS NPCIL 34

• Highest prevalence of COPD for any given year in NPCIL is 3.87% as against Mean prevalence of other studies is 8.12%• Highest prevalence of Anaemia in NPCIL for any given year is 1.56% as against the National Family Health Survey report for Adult Males as 24%• Average Cancer Incidence rate [per one lakh population] in Males in NPCIL is 55.73 as against National Incidence Rate 92.9 in similar category Dr S K Jain CMS NPCIL 35

• Average Cancer Incidence rate [per one lakh population] in Females in NPCIL is 30.43 as against National Incidence Rate 105.5 in similar category• Average Cancer Incidence rate [per one lakh population] in Both sexes combined in NPCIL is 54.05 as against National Incidence Rate 98.5 in similar category• Average Cancer Death rate [per one lakh population] in Males in NPCIL is 29.67 as against National Death Rate 71.2 in similar category Dr S K Jain CMS NPCIL 36

• Average Cancer Death rate [per one lakh population] in Females in NPCIL is 20.29 as against National Death Rate 65.5 in similar category• Average Cancer Death rate [per one lakh population] in both sexes combined in NPCIL is 29.05 as against National Death Rate 68 in similar category• Out of total 80 cases of Cancers detected in the study period, 41 were Radiation workers whereas 39 were Non Radiation Workers. Dr S K Jain CMS NPCIL 37

• The study over last 16 years – 1995 to 2010 – shows that the prevalence of various diseases among NPCIL employees is not only comparable, but far less than the respective means of various studies conducted in general public• Average Cancer Incidence rates & average cancer death rates in NPCIL employees too is less than respective national rates.• Prevalence of various diseases between Radiation & Non Radiation Workers is comparable to each other except in Anaemia where the Prevalence is more in Non Radiation Workers. Dr S K Jain CMS NPCIL 39

• Workers in NPCIL Operating Sites, do not show any variation in disease pattern and their prevalence is far less than that seen in the general public.• Nor do they have any additional risk factors by virtue of their employment & work. Dr S K Jain CMS NPCIL 40

1)List of Employees’ Details provided by Human Resource, Respective Sites2)Periodical Medical Examinations files at respective site Hospitals3)C‐1 Forms submitted to AERB each year by Respective Site Hospitals, based on Annual Medical Examinations conducted by the CertifyingSurgeon(s) OR Medical Officers at respective sites.4)The Epidemiological study report for each site,issued by Dr.K.A.Dinshaw, the then Director TMC and published serially, available at respective site Hospitals5)Dosimetry details of Cancer patients, as available & provided by the Station Health Physicist, respective sites/stations.6)Medical Literature in form of References (vide below), accessed through Internet 7)Reports of Retrospective Analysis of Health Profile of Employees of Each Sites Prepared by Dr.R.Deolalikar, Certifying Surgeon, NAPS.8)National Cancer Data from Globocan 2008 Dr S K Jain CMS NPCIL 41

• Mentioned in the Report • Total 52 References from Indexed Medical Journals• Internationally Accepted Reports Dr S K Jain CMS NPCIL 42

cms@npcil.co.inDr S K Jain CMS NPCIL 43

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Health profile of NPCIL employees

by Prime Point Foundation, Chennai on Jan 12, 2012

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