Health Problems of IT WorkersPRESENTER- DR. JITENDRA

MODERATOR- DR. SUNEELA GARG

Plan of Presentation Introduction IT industry in India Health determinants Health problems & review Health promotion References

Introduction Information technology is now changing

the focus of business, from production to sales by- automating industrial production and creating a global market for sales.

In early 1980 the IT industry took shape and gained momentum. The expansion of this industry has been phenomenal, now all our essential economic activities are fully loaded with new technological paradigm.

India (IT sector) India is a major IT hub , expansion is

happening fast. And as a proportion of National GDP, the IT sector revenues have grown from 1.2% in financial year1998 to an estimated 7.5% in the 2012 year financial.

In the financial year 2012, the direct employment in the Indian IT sector is expected reached nearly 2.8 million, an addition of 2, 30,000 employees, while indirect job creation was estimated at 8.9 million.

Bangalore , Hyderabad , Gandhinagar , Kolkata have become Indian forms of silicon valley of the USA.Source :- (NASSCOM Strategic Review, 2012).

Source- http://blog.mapsofindia.com/india-business/125/

Companies based on IT services

Banking Financial

services Insurance Hi-tech/

telecom internet

Manufacturing Retail Media,

publishing and

entertainment Construction Healthcare Airlines Transportation Insurance Retail banking Travel and

hospitality Auto

manufacturing

Telecom Pharmaceutical

s Consultancy

The industry employs a relatively younger workforce when compared with other Indian industries. This is evident from the fact that around 35 per cent of employees are in the age group 18-25 and around 41 per cent belong to the 25-30 age brackets.*

The penetration of outsourcing work culture in India has led to erratic working hours among the workers.

Also It can be seen that the number of computer users is increasing, exponentially. With an increase in the frequency, intensity, and popularity of computer use inside and outside of work and at home, the incidence of work-related illnesses and injuries has increased.

(Source:- Indian IT-BPO industry 2009: NASSCOM analysis.)

Source:- Prevalence of Job Stress, General Health Profile and Hypertension among Professionals in theInformation Technology Sector in Bengaluru, India . Rathnaiah Babu, Giridhara

Source:http://www.computerworld.com/s/article/9115418/Graphic_Head_to_toe_hazards_of_the_desk_bound_body

Health problems in IT workers

Physical Mental

Behavioral- Social

Health problems

Stress Depression Sleep disorders Eye strain Repetitive strain injury (RSI) Voice and hearing problems Overweight and obesity Shift work syndrome Body posture problems

Health problems Raised blood pressure Raised blood glucose Abnormal blood lipids Physical inactivity Burnout Fertility issues Tobacco use Harmful alcohol consumption Unhealthy diet (low fruit and vegetable

consumption) Behavioral and social issues

Mental Health Problems

Stress Etiology : - Very little job security Dealing with rude clients Unrealistic performance quotas Sales quotas Constant electronic performance monitoring Captive work schedules Transportation problems Highly repetitive, fast paced workload. Long hours of work, Permanent night shifts. Incredibly high work targets. etc

Source:- DQ-IDC INDIA SURVEY: BPO E-SAT 2004

Stress Symptoms :- Persistent Headache Muscle tension or pain Chest pain Fatigue Change in sex drive Stomach upset Sleep problems Anxiety Restlessness Lack of motivation or

focus Irritability or anger Sadness or depression Overeating or Under

eating Angry outbursts Drug or alcohol abuse Tobacco use Social withdrawal

Unfortunately, most employees are either unaware about this fact that they are facing stress problems , even if they know they hesitate to bring it up because there is a possibilities that they will lose their job or they will get transfer from existing project or lose perks.

Women bear the extra stress of worrying about domestic factors – work and home conflict are associated with high stress in employed women and such stress takes its toll on a woman's physical and mental health. The stress of carrying out two full-time jobs (in the labor force and at home) wears many women out.

Stress

Source:- An Empirical Study on Problems Faced By Women Employees in Information Technology Industry with Special Reference to Coimbatore City , Dr.A.Kumudha1, J. Jancy Rani2

Source:- A Critical Study on Work-life Balance of BPO Employees in India ,Smita R. Chavan . International Conference on Technology and Business Management March 28-30, 2011

N= 259

Source:- Prevalence of Job Stress, General Health Profile and Hypertension among Professionals in theInformation Technology Sector in Bengaluru, India . Rathnaiah Babu, Giridhara

Review :- In DQ IDC E-SAT Survey in 2005 nearly 22 per

cent of the respondents revealed that long work hours played an important part in creating high stress levels at the job. In the survey, one quarter(25%) of respondents said that they find the work stressful, while half(50%) said that it is stressful ‘at times’.

In other survey BPO employees recorded lower scores in tests of speed, learning and memory, and response inhibition. As sleep deprivation, excessive stress, and fatigue negatively affect cognition. *

Stress

* Source- Influence of shift work on cognitive performance in male business process outsourcing employees. Bijavara Shwetha and Honnamachanahalli Sudhakar

Depression Etiology :- Limited scopes in developing a career. Fewer growth opportunities. Mental fatigue. Increasingly punishing physical environments. Poor social support. Relationship issues. Negative communication. Underutilization of skills Lack of leisure time. Work demands.

Depression Review :- In a study conducted among BPO workers in

Delhi they were found to be more depressed than controls. (depression was observed in 62.9% as against only 4.6% in the control group)(p value< 0.001).

They were also seen to suffer more from anxiety disorder (anxiety disorder was found in 33.9%

of BPO workers as against 1.4% of the control group) and the use of stimulants (tea, coffee, and cola), other substances (alcohol, narcotics) was also commoner in this group than in controls(p value<0.002).

Source :- Sleep patterns and their impact on lifestyle, anxiety and depression in BPO workers, Suri J. C et al

Physical Health Problems

Source:- A Critical Study on Work-life Balance of BPO Employees in India ,Smita R. Chavan . International Conference on Technology and Business Management March 28-30, 2011

N= 259

Sleep disorders & Burnout Etiology :- India is situated 5 hours ahead of UK, 10 hours

ahead of New York and 13 hours ahead of Los Angeles.

For corporations, time arbitrage means increased efficiency and cost-savings. But for workers, it results in long hours, an intense work pace, and temporal displacement.

Night-shift employees, such as internet banking, security, call centre workers etc. are particularly vulnerable to such displacement, and it manifests in health and safety problems and social alienation.

Sleep disorders & Burnout Etiology :- Odd shift work. Mono- Postural work. Highly fragmented,

repetitive, fast paced workload.

Long hours of work. Permanent night shifts.

Lack of Exercise. High stress levels. High intake of caffeine

and other substances. Lack of support

mechanism.

•The BOSS syndrome is seen very commonly among young people working in IT sector. •The symptoms of this syndrome include chronic fatigue, insomnia and complete alteration of 24-hour biological rhythm of the body are routine cause for sickness absenteeism. BOSS:- burnout stress syndrome

Sleep disorders & BurnoutReview :- According to the International Labour Organization

(1998), ‘The night shift is the most disruptive of all shifts in terms of physiological adjustment, sleep and wellbeing.’

It disturbs socio-temporal patterns and circadian rhythms, leading to stress and sleep disturbances, all of which increase susceptibility to disease.

Night shifts have been linked to gastrointestinal disorders, such as constipation and diarrhoea , and peptic ulcers, and there is growing evidence of a tie between shift work and coronary heart disease and breast cancer (Davis et al. 2001).

Source:- Davis, S., D. K. Mirick and R. G. Stevens (2001) ‘Night shift work, light at night, and risk of breast cancer’, Journal of the National Cancer Institute, 93, 1557–62

Sleep disorders & Burnout They may also contribute to miscarriages

and low weight and premature births among pregnant workers ( Knutson 2003).

According to a survey done on Indian IT workers 32 per cent of respondents complained of sleep disorders.*

In other study IT workers who sleep for less than 4 hrs a day are found to suffer from muscular and cardiovascular problems, digestive disorders like acidity and indigestion, regular headache. ***- DQ-CMR Best Employer Survey 2012**- A Critical Study on Work-life Balance of BPO Employees in India ,Smita R. Chavan . International Conference on Technology and Business Management March 28-30, 2011

Sleep disorders & Burnout In a study done on New Delhi BPO workers,

their sleep pattern was found to be markedly different from normal. They were sleepier (ESS of 10–14 was found in 51.4% in the BPO group as against 20.5% in the control group) (p value <0.001

And significant correlation was observed between:

sleep score and depression. stress at work. abuse of alcohol. abuse of narcotics. lack of exercise.

Sorce :- Sleep patterns and their impact on lifestyle, anxiety and depression in BPO workersSuri J. C et al. ESS- Epworth sleep score

Shift work syndrome Also known as Asthenopia clinically. Etiology:- The odd work schedule. Night shifts and weekend work . High work demand. Prolonged nocturnal work forces the worker to

invert the ‘activity-rest’ cycle and has been documented to have negative impact on the health and well-being of the workers.

  

It effects work performance and efficiency leading to errors and accidents.

The increased use of caffeine, alcohol or drugs such as amphetamines or sleeping pills by workers trying to overcome the effects of fatigue or trying to get to sleep have also been observed. *

It may cause problems with the social and domestic lives of employees and their families. 

Shift work syndrome

* Sources:- Sleep patterns and their impact on lifestyle, anxiety and depression in BPO workers, Suri J. C et al.

Eye strain Etiology:- Glare. Inappropriate monitor heights. Long hours of uninterrupted computer work. Poor lighting conditions. Computer work is associated with elevated

viewing angle, reduced blinking rate and widening of the ocular surface area produce drying of the eyes and increased eye discomfort.

Soreness, dryness, blurred vision, light sensitivity, headache, all these put together is labeled as the Computer vision syndrome.

Eye strain Review :- In a survey 20 per cent reported eyesight

problems. * Parekh et al (2006) found that the symptoms

increased with duration of span of computer use and with use of improper furniture. The symptoms were also more in spectacle-wearers, compared to non-spectacle users. The visual strain is also related to musculo-skeletal complaints and work stress.

*-Indian IT Industry and Work: A Study of Health Risk among BPO Workers in Bangalore Manoj Kumar Jena, **- DQ-CMR Best Employer Survey 2012

Voice and hearing problems Etiology :-  High demand on the vocal system . Interactive nature of the task . Noise explore through headsets.   Background Noise.(mobile telephones, fax

tones, colleagues etc.) Sharing of headsets. (risk of ear infection.) Symptoms ranges from dry and itchy throat,

hoarseness, frequent clearing of throat, tinnitus, ear ache, itching, vertigo, hearing defect etc to complete voice and hearing loss consistent with duration of harmful exposure.

Voice and hearing problems

Teacher syndrome- inability to speak ( dysphonia), pain, croakiness of voice, irritating cough, poor vocal power, inability to modulate and breathing difficulties.

Review :- Telemarketers/BPO were twice as likely to

report 1 or more symptoms of vocal attrition.  

The prevalence of ear problems and voice problems were 8.5% and 8.5% respectively. *

*- Data quest 'BPO employee survey 2004', Vol XXII No.21, November 15, 2004.

Overweight and obesity Etiology :- Lack of physical activity. Improper & Unhealthy diet. Prolonged sitting hours. Alcohol consumption. Stress, depression. Behavioral & eating disorder Smoking . Sleep disorders. Medications .

Sedentary work profile.

Long shift hours. Inadequate breaks. Compact

workstations & workplace.

Lack of knowledge. Mental stress. Depression. Low self esteem. Night shifts

Overweight & Obesity Review:- In a study conducted by ASSOCHAM prevalence of

obesity among IT sector workers was 18%. It has been noted in other study that a the BMI increases, the CMDQ score significantly increases (P < 0.001), and OSI score also increases (P < 0.001).

Cornell University’s Musculoskeletal Discomfort Questionnaire (CMDQ),

Occupational stress index (OSI).

Source: Effect of Body Mass Index on work related musculoskeletal discomfort and occupational stress of computer workers in a developed ergonomic setup, Jasobanta Sethi1*, Jaspal Singh Sandhu2 and Vijay Imbanathan3 & ASSOCHAM research bureau survey 2009.

Musculoskeletal disorders Etiology :- Poor workstation design . Computer monitors placed above eye level. Work surfaces that were to high. Non-adjustable chairs. Highly repetitive typing or mouse use. Prolonged sitting. Unfavorable physical environment. Long working hours. Low job satisfaction

Work related Musculoskeletal Disorders (WMSD)

Most commonly-  Pains in the neck/shoulder, wrist and back areas.

MSDs include a range of conditions affecting the muscles, tendons, ligaments, joints, and nerves. For eg-

Tendon inflammations (e.g. Tenosynovitis) Nerve compression disorders (e.g. carpal

tunnel syndrome) Low back pain. Regional pain syndromes. etc

Musculoskeletal disorders

Repeated strain injury:- Included under Ergonomic Disorders,

Cumulative Trauma Disorders (CTD). It is a general term used to describe the pain

from muscles, nerves and tendons caused by repetitive movement and overuse.

Most commonly affects Arms. Cold temperatures , Vibrating equipment, Poor

posture , Stress increase the risk of getting RSI.

Musculoskeletal disorders

Review :- Predominant morbidity of musculoskeletal disorders

(MSD) was observed among 56% computer professionals with overall morbidity of 70%. .

Among the MSD, the shoulder (20%), lower back pain (18%), pain in fingers (7%), wrist pain (6%) arm pain while using mouse (5%) constitutes the main findings .

Eighty one percent of data-processing staff attributed their pain and discomfort to work due to poor seating (49%), constant keying (24%), sitting in the same position for hours (23%) and computer set up (12%).

Source :- Working conditions and health among employees at information technology - enabled services : a review of current evidence c. Kesavachandran, s. K. Rastogi, mohan das, asif m. Khan*

Musculoskeletal disorders

Source: Work-related musculoskeletal health disorders among the information technology professionals in India: a prevalence study. S Arun Vijay

Cardiovascular diseasesEtiology :- Smoking. Being overweight or

obese. Lack of physical activity. Too much salt or fat

content in the diet.

Harmful alcohol consumption.

Work Stress. Genetics. Family history. Sleep disorders.

Cardiovascular diseases includes hypertension, diabetes, dyslipidemia , coronary artery disease, stroke etc. It can cause an increase in risk for heart attack, heart failure, sudden death, stroke and cardiac rhythm problems, thus resulting in decreased quality of life and decreased life expectancy.

Cardiovascular diseases Review:- In a study done among IT workers in bengaluru.

The prevalence of hypertension was found to be 31%. Out of which 5% had malignant hypertension.

Odds of getting hypertension for those who have used tobacco in their lifetime was 43% higher compared to those who had never used tobacco.

In ASSOCHAM corporate survey 2009 it was found that  72% of the IT employees are prone to cardiovascular diseases and 38% have alarmingly high cholesterol levels, one of the key risk factors for heart disease.

Source:- Prevalence of Job Stress, General Health Profile and Hypertension among Professionals in theInformation Technology Sector in Bengaluru, India . Rathnaiah Babu, Giridhara

Cardiovascular diseases Review :- Another study identified that night shift BPO employees,

were found to have increased sympathetic activity compared with the day shift employees which is an indicator of unfavorable change in the myocardial system, and thus shows increased risk of cardiovascular disease among the night shift employees.*

In a study done corporate office workers 82% of volunteers were at high risk for developing Type 2 diabetes mellitus. The ADA risk test and Impaired Fasting Glucose were both positive in 14% volunteers. Approximately 30% of office staff was at risk of developing diabetes mellitus.**

 Source :-* Heart Rate Variability Changes in Business Process Outsourcing Employees Working in Shifts. Kirthana U**Assessment of risk for type 2 diabetes mellitus in a office staff with high diabetes-related morbidity. Austin M et al

Behavior-Social Health problems

Tobacco & Harmful alcohol consumption The young IT executives tend to develop certain bad

habits such as alcohol, smoking etc. Even It is not uncommon to find women smoking and drinking alcohol owing to work culture .

Etiology:- Poor Stress management. Low self esteem. Peer pressure. Night shifts. Health problems. Recreational. Fatigue. Relationship issues. Lack of knowledge.

Tobacco & Harmful alcohol consumption Review:- In a 4-arm cluster randomized trial done among

646 IT employees in Mumbai. The prevalence of tobacco dependence was 41%, mainly cigarette smoking. Significantly higher reduction in tobacco consumption of 45% is seen with the use of pharmacotherapy(bupropion) with health education. *

In a study done in Delhi-NCR a large proportion of young BPO employees reported smoking (72% of young men and 43% of young women) and even larger percentages reported the consumption of alcohol (81% and 64%, respectively). **

*Call centre employees and tobacco dependence: Making a difference Mishra GA, MaPV, Gupta SD, Rane PS, Hardikar NM, Shastri SS,** Exploring the Lives of Youth in the BPO Sector, Monisha Vaid

High Risk Behavior Casual sexual relationship and drug

abuse are increasing among IT workers (BPO) and job stress is one of the factors leading to increased sexual activity, drug abuse, and alcoholism.

In terms of age factor, lack of professionalism, financial independence, freedom and cover of the night, — BPO boys and girls are quite susceptible and are easy prey to sex or drug abuses.

High risk behavior directly impacts the productivity of the employee and is also a big threat to individuals health and has a negative impact on the work place.

High Risk Behavior Review:- In a study conducted in IT outsourcing companies

based in Chennai. about one-third of respondents (males - 39.6%, females - 26.1%) had experienced premarital sex.

In other study sexual relations with colleagues 64% and 69% of young men and women.**

Practice of contraception in males 68.6%, females 65.1%.

Multiple partner relations was reported in 65.6% males and 33.1% female employees.

Consumption of illicit drugs (cannabis, cocaine etc )was 23.7% among male and 4.4% among female employees.Source:- * Sexual Behavior among Unmarried Business Process Outsourcing Employees in Chennai: Gender Differences and Correlates Associated with It. Bimal Charles et al, AIDS Prevention and Control Project** Exploring the Lives of Youth in the BPO Sector: Findings from a Study in Gurgaon, Monisha Vaid

Unhealthy diet Etiology:- Working long and odd hours . Sleep disorders. Eating food supplied by external caterers. Limited options for food. Busy work schedule. Snacking along with work. Fasting and feasting. Sleep and digestive disorders can grow into

bigger problems: hypertension, diabetes and heart diseases.

Unhealthy diet Review :- According to a survey done on Indian IT

workers 25 per cent had digestive troubles. Unhealthy diet exposes young employees to various disorders. For eg- Obesity, hypercholesterolemia, digestive disorders, cardiovascular diseases, nutritional disorder etc.

The food habits and nutritional assessment conducted by (Choudhary et al) reveals prevalence of skipping of breakfast (36%), skipping of meals (28%), changed food habits , excess caffeine intake (18%) among IT workers.

*- Source - DQ-CMR Best Employer Survey 2012**- Choudhary SB, Rao V, Suneetha S. Attitude alters the risk for development of RSI in software professionals. Indian J Occup Envt Med 2003;7:32.

Behavioral and Social issues Etiology :- Very little job security. Dealing with rude clients. Unrealistic performance quotas. Constant electronic performance monitoring. Long hours of work. Poor social support (family & friends). Lack of leisure time. Impersonating identities. Competitive environment. High risk behavior. etc.

Other Pyschosocial factors at the work place :- Issues of low control over the environment or task. Poor communication with regard to work matters. Inadequate social support from co

workers/supervisors/managers. Low skilled, highly monotonous, repetitive work with

few career prospects. Lack of consultation (e.g., for new equipment, software

changes, shift pattern changes). Reading pre scripted conversation on phone for a long

time. High work related attrition rate. BOSS syndrome.

Behavioral and Social issues

The behavior issues like- misuse of food, behave erratically in vans, and smoke in public places, misuse of telephones and other resources of the company.

Some of the employees face a problem of split personality – they live in a ‘foreign’ world with foreign names and foreign culture at night, and as poor natives facing a lot of trivial problems in the daytime.

Emotional exhaustion adds to the physical and mental strain of the workers, leading to higher levels of stress and burnout under the electronically monitored work and tightly bureaucratized work regime.

Work-related stress, long working hours and erratic schedules are taking a toll on couples working in IT sector. Women, in particular, lose interest in leading a normal conjugal life .

Work-related stress damages the endocrine system leading to temporary infertility.

Behavioral and Social issues

Owing to irregular working hours, employees have been found unable to fulfill their family responsibilities be it in their role as parents, husbands/wives and sons/daughters as a consequence of which role conflicts is transpiring.

Most of the employees work on Indian holidays too, which causes frustration.

IT workers work long hours and move frequently, are often unable to fulfill family commitments, nurture significant social relationships, or pursue artistic or spiritual interests.

The supervisors themselves reel under the pressure of performance and achieving targets. Hence do not give their time for finding solutions of employees.

Behavioral and Social issues

Review :- A study found Employees in ITES/BPO find it

difficult to have a positive outlook towards life, 25 per cent of respondents, feel that working in night shift is creating major problems for life style as well as managing time with partners and children.*

The results of another study indicate the presence of nine behavioral domains; job control, autonomy, time pressure, length of experience in industry, night shifts, income, appreciation of work, physical environment, work-environment and affective or emotional factors.**Source- *DQ IDC E-SAT Survey in 2005 .**A Qualitative study about occupational stressors and the health of professionals in Information Technology in Bengaluru, India

Behavioral and Social issues

Conclusion The IT industry poses many health hazards to

its employees from digestive disorders to heart attacks. The lifestyle related factors are mostly detrimental to their health which has negative impact not only individuals health but it affects the whole industry.

IT is pertinent for all the stake holders to come foreword and help culminate the health hazards.

Various studies have proved that people working in IT sector have high prevalence of work related diseases and Non communicable diseases, also they need to sensitized regarding various infectious diseases also.

Conclusion Health Problem General population IT workers

1. Stress 19% 51.2%

2. Depression 4.2% 62.9%

3. Sleep disorder 20.5% 51.4%

4. Eye strain 5.46% 20%

5. Voice problems 3.0% 8.5%

6. Hearing problems 2.7% 8.5%

7. Tobacco 26.25% 72%

8. Alcohol 12.5% 81%

9. Hypertension 20% 31%

10. Dyslipidemia 26% 38%

11. Diabetes 9% 14%

12. Drug abuse 6% 20%

13. Musculoskeletal ds

7.23% 56%

14. Digestive disorders

11% 25%

Health Promotion in

IT workers

Thank you !!

Reference 1. A Critical Study on Work-life Balance of BPO

Employees in India ,Smita R. Chavan 2. (BPO Workers Association of the Philippines),

http://www.bpowap.org/tag/bpo-workers-health/3. DQ-CMR Best Employer Survey 20124. Exploring the Lives of Youth in the BPO Sector:

Findings from a Study in Gurgaon, http://www.popcouncil.org/pdfs/wp/India_HPIF/010.pdf

5. www.ijoem.com/article.asp?issn=0019-5278;year=2005;volume=9;issue=3;spage=129;epage=132;aulast=Sudhashree

6. Working conditions and health among employees at information technology - enabled services : a review of current evidence c. Kesavachandran, s. K. Rastogi, mohan das, asif m. Khan* http://www.bioline.org.br/pdf?ms06044

7. Indian IT Industry and Work: A Study of Health Risk among BPO Workers in Bangalore Manoj Kumar Jena, http://www.vvgnli.org/sites/default/files/publication_files/Labour-Development-June-2011.pdf#page=29

8. Effect of Body Mass Index on work related musculoskeletal discomfort and occupational stress of computer workers in a developed ergonomic setup, Jasobanta Sethi1*, Jaspal Singh Sandhu2 and Vijay Imbanathan3, http://www.biomedcentral.com/content/pdf/1758-2555-3-22.pdf

9. Call centre employees and tobacco dependence: Making a difference Mishra GA, MaPV, Gupta SD, Rane PS, Hardikar NM, Shastri SS, http://imsear.hellis.org/handle/123456789/144604

Reference

Reference10.http://www.indianmba.com/Faculty_Column/FC391/fc391.html11.http://www.ilo.org/dyn/normlex/en/f?p

=NORMLEXPUB:12100:0::NO::P12100_ILO_CODE:C17112. Studies on Health Problems of Software People: A Case Study

of Faculty of GCE and GIMT Gurgaon, India Geeta Kumari, K.M.Pandey, Member, IACSIT and S.S.Khanaka, http://www.ijimt.org/papers/70-M459.pdf

13. Occupation related health hazards: online survey among software engineers of south India, http://www.ijms.in/articles/2/1/Occupation-Related-Health-Hazards.html

14. Indian IT-BPO industry 2009: NASSCOM analysis. National Association of Software and Service Company (NASSCOM) 2009, http://www.nasscom.in/upload/5216/IT_Industry_Factsheet-Mar_2009.pdf.

Reference15. Issues and concerns of health among call center

employees , VPSudhashree, KRohith, KShrinivas, http://www.ijoem.com/article.asp?issn=00195278;year=2005;volume=9;issue=3;spage=129;epage=132;aulast=Sudhashree

16. Davis, S., D. K. Mirick and R. G. Stevens (2001) ‘Night shift work, light at night, and risk of breast cancer’, Journal of the National Cancer Institute, 93, 1557–62.

17. Knutsson, A. (2003) ‘Health disorders of shift workers’, Occupational Medicine, 53, 103–8.

19. Pradhan, J.P. and V. Abraham. 2005. Social and Cultural Impact of Outsourcing: Emerging Issues from Indian Call Centers Harvard Asia Quarterly, 9(3): 22–30.

20. Gerr F, Marcus M et al (2002), “A Prospective Study of Computer Users: I. Study Design and Incidence Of Musculoskeletal Symptoms and Disorders”, American Journal of Industrial Medicine, Vol. 41, No. 4, pp. 221- 235.

Reference 21. Lim S Y, Sauter S L and Schnorr T M (1998), “Occupational

Health aspects of Work with Video Display Terminals”, in Environmental and Occupational Medicine, Third Edition, William N Rom (Ed.), Philadelphia, Lippencott-Raven Publishers.

22. Source :- Sharma A K, Khera S and Khandekar J (2006), “Computer Related Health Problems Among Information Technolog Professionals in Delhi”, Indian Journal of Community Medicine, Vol. 31, pp. 36-38.

23. http://www.sunstar.com.ph/cebu/call-agents-face-risks. 24. Sleep patterns and their impact on lifestyle, anxiety and

depression in BPO workers, Suri J. C et al. 25. Exploring the Lives of Youth in the BPO Sector, Monisha Vaid 26. Sexual Behavior among Unmarried Business Process

Outsourcing Employees in Chennai: Gender Differences and Correlates Associated with It. Bimal Charles et al, AIDS Prevention and Control Project

Reference 27. Influence of shift work on cognitive performance in

male business process outsourcing employees. Bijavara Shwetha and Honnamachanahalli Sudhakar

28. Prevalence of Job Stress, General Health Profile and Hypertension among Professionals in the Information Technology Sector in Bengaluru, India . Rathnaiah Babu, Giridhara

29. Heart Rate Variability Changes in Business Process Outsourcing Employees Working in Shifts. Kirthana Kunikullaya U

30. Assessment of risk for type 2 diabetes mellitus in a office staff with high diabetes-related morbidity. Austin M et al

31.  National Sample Survey Organisation (NSSO), Government of India, 1991