The study comprised of cross-sectional survey approved by Research Advisory Committee of People’s Dental Academy, Bhopal in the year 2014. The participants constituted profes­sionals from the field of General Pathology, Microbiology and Oral Pathology in Bhopal. There were in all 132 participants. The participants included were Professors, Associate professors, Lecturers and Post Graduate students from the above mentioned departments. No under-graduate student was included in the survey. An informed consent was obtained from the participants. A structured closed ended questionnaire was designed for the survey [Table/Fig-1]. The questionnaire was in the form of multiple choice questions. The questions were designed in a way which would be simple to understand and answer. The questionnaire had dermographic details (such as age, gender and profession) in the first segment. The next segment consisted of questions pertaining to knowledge, attitude regarding ergonomics and Musculoskeletal disorders. There was no kind of identification on the questionnaire, maintaining complete anonymity. The ques­tions were aimed to gauge the awareness of the participants towards the importance of ergonomics in the use of microscopes. Questions such as knowledge of ergonomics, its importance were asked to the participants to know the awareness levels. The participants were asked to give a positive response regarding sites affected like back pain, neck pain, etc if they were more than a year old. The data recorded was subjected to statistical analysis (chi-square test).

[Table/Fig-1]:

Questionnaire

All the 132 professionals responded to questionnaire. Out of the total 132, 80 were males and 52 were females [Table/Fig-2]. Total number of General pathologists, Microbiologists and Oral Pathologists were 53, 37 and 42 respectively. Most of the respondents were of the age between 20 years and 40 years. On assessing general awareness regarding ergonomics, it was observed that around 50% of the participants were aware of ergonomics and almost the same number of people was aware of its significance [Table/Fig-3]. The results showed that the general pathologists were well informed about ergonomics and its importance in their professional life. It was noted that by far the most common site affected due to long term use of microscope was neck and back followed by eyes, shoulders and arms & wrists by majority of the participants [Table/Fig-4]. Binocular microscopes were the most preferred type. The respondents were aware of neutral spine position and accordingly most of them preferred this posture compared to others [Table/Fig-5].

Ergonomics can be defined as ‘an applied science concerned with designing and arranging thing people use so that the people and things interact most efficiently and safely’ [6]. Our body is not well suited for long hours of microscope working. As there have been advancements in the quality of visualization of tissue specimens by microscopes, there have also been steps taken to improve the workability of microscopes which can be less stressful for the operator [7]. Inspite of this, pathologists and microbiologists have various Work related Musculoskeletal Disorders (WMSDs). The various MSDs caused due to conventional microscopes inspired us to conduct a survey to know if the professionals were well-aware of ergonomics. To our surprise, professionals although related to health profession, did not know the deleterious effects of traditional usage of microscopes. The results showed that 34.1% of Oral pathologists were aware about importance of ergonomics compared to 54.7% of General Pathologists. WMSDs affect head and neck regions. Our study also has shown similar results. 33.3% of Oral Pathologists experienced neck and back problems as compared to 67.9% and 70.3% General Pathologists and Microbiologists. Gopinadh A et al., in their study showed that 73.9% of the participants experienced MSDs and the most common sites affected were back and neck [8]. Jain G and Shetty P observed that 62% of the participants were affected by MSDs [9]. In our study we found that General Pathologists and Microbiologists had similar results. Selective shoulder, arms and/or wrists problems were more frequent in Oral Pathologists. An important observation was that the Oral Pathologists (31%) complained of combination of problems affecting neck, back, eyes, headache, shoulders, arms and wrists. This percentage was very high compared to General pathologists (1.9%) and Micrbiologists (5.4%). The problems of general pathologists were concentrated on back and shoulders. This may be due to the fact that inspite of initial problems of eye and neck in Oral Pathologists, they may not be seeking medical treatment, leading to worsening of the symptoms. According to a study carried out in Switzerland, prevalence of MSDs is common among pathologists. This was in accordance to our study. They concluded that while; increased working hours were positively associated with MSDs, and other factors such as working time at microscopes or ergonomic workplace settings were not. These findings may be due to the fact that ergonomic settings may have been made in the presence of already affected professionals. Also, there was relief in their pain when they shifted from conventional to ergonomic settings. In our study, we found that chair with lower back support or with adjustable heights were preferred for viewing. Despite this preference, still the participants had WMSDs which may be because other working conditions like neutral position and working hours were not followed by them [10]. Our results showed that nearly 50% of the subjects were aware about the (Centres for Disease Control and Prevention) CDC guidelines regarding the permissible usage of microscope in a day to be comfortable to the operator on a long run. The recommended time is five hours per day. The key to good health is to maintain neutral spine position. In a study by Haile EL et al., only 5 out of 25 employees (20%) used the microscope in the neutral neck, shoulder and back postures. Most of the microscopes did not have arm support. In our study we found that 64.2% General Pathologists, 54.1% Microbiologists and 59.5% Oral Pathologists preferred neutral spine position [11]. The reason was this variation may be probably because the survey was carried out in a teaching institute and there was certain level of training and continuing teaching programs. There are 3 natural curves in healthy spine. The neck or cervical spine, which curves gently inward (lordosis), the mid back, or thoracic spine, which curves outward (kyphosis), The low back, or lumbar spine, which also curves inward (lordosis). A neutral spine alignment is when the pelvis is balanced between the two exaggerated anterior and posterior positions [12,13]. When the pelvis is in neutral, the bones at the top of the pelvis back–Posterior Superior Iliac Spine (PSIS)– and front– Anterior Superior Iliac Spine (ASIS)– are level. The chair used for such purposes play a vital role. A good exercise is to make a conscious effort to maintain a proper posture. Another way is to ask colleagues to check is the operator’s posture is correct. The microscopes should be designed in such a way that the arms and wrists of the operator do not strain easily. Eye fatigue can be a serious issue if not addressed properly [14,15]. This means that the optical length of the microscope should be adjusted so as to cause least discomfort for the operator’s eyes. According to Sundaragiri KS et al., neutral erect posture can be obtained if certain modifications are incorporated in the designing of microscopes. These include having an optical path (distance from the ocular lenses to the specimen being viewed) ranging between 45 to 55 cms. Also another consideration should be the angle of the eyepieces which should not go beyond 30⁰ above the horizontal plane [16]. There may be few early signs of WMSDs such as early fatigue, less concentration, muscle stiffness. To standardize microscopes which are ergonomically designed few guidelines given by OSHA (Occupational Safety and Health Administration) {Laboratory Safety: Ergonomics for the Prevention of Musculoskeletal Disorders Fact Sheet} [17] should be followed [Table/Fig-6].

Some authors have advocated that psychological factors can be contributing towards work related musculoskeletal disorders [18].

We are of the opinion that the working environment should be conducive for constructive work. The Reporting rooms in the Pathologists’ working place should be designed in a way that all the things are easily accessible to the operator. Microscope can be connected to a monitor which may be as large as desired. With a competitive market, the operator can have the monitors from the best of the brands. This system not only can reduce eye strain and back strain, but also can have reproducible results.

We also take this opportunity to urge the institutes/organisations to have more and more continuing education programmes, so as to educate professionals regarding ergonomically designed microscopes and work related musculoskeletal disorders which will in turn increase the efficiency of the operators. It has to be borne in mind that disorders caused by conventional microscopes are likely to have slow but sustained deleterious effects.

The adverse effects of using conventional microscopes have received less attention which has lead to various problems related to occupation. A new approach aimed at improving the workability of the professionals has to be adopted. We, through our study, wish to enlighten the readers and all those involved in our profession that WMSDs are like slow poison and hence precautions must be taken in order to prevent them.