Occupational heat exposure and its impact on kidney health among cashew workers

BACKGROUND

Rising temperatures increase workers' risk of heat-related illnesses due to heat stress (HS). Chronic Kidney Disease of unknown etiology (CKDu) is rising in non-agricultural workers in hot climates. Dehydration, heat stress, and physical exertion can damage cashew workers' kidney health.

METHODS

In 2020-2021, 262 cashew workers in Cuddalore, Tamil Nadu were assessed for Wet Bulb Globe Temperature (WBGT), and job-specific American Conference of Governmental Industrial Hygienists standard was used to evaluate workload. "High heat-exposed" meant heat stress exceeded the Threshold Limit Value for safe manual work (27.5 °C for heavy and 28 °C for moderate physical activity). Heat Strain Indicators (HSIs) such as Tympanic Temperature (Ttemp), Sweat Rate (SwR), Urine Specific Gravity (USG), and urine dipstick parameters were measured in all workers, however serum creatinine was measured only in 100 workers. Glomerular Filtration Rate (eGFR) was calculated using the CKD-EPI equation. A standardized questionnaire assessed heat-related health symptoms.

RESULTS

Over 65% of workers experienced wet bulb globe temperature exposures exceeding the threshold limit value (Avg.- wet bulb globe temperature 30.4 °C ± 1.8 °C). Ninety-five percent of heat-exposed workers experienced at least one of the physiological heat strain indicators. The risk of urogenital symptoms was 7.7 times greater among high-heat-exposed workers (95% CI 3.4-17.1), which corroborates well with the measured post shift urine specific gravity (37%). Despite controlling for relevant confounders (age & gender), high-heat-exposed workers had 3.5-fold higher odds of eGFR < 90 ml/min/1.73 m2 compared to less-exposed workers (95% CI 1.1-10.6).

CONCLUSION

Persistent heat stress promotes heat-related disorders in cashew workers and lowers eGFR. This needs further investigation to determine its longer term effects on kidney function. Workplace cooling solutions that reduce heat stress are critically needed to protect the kidneys and ensure occupational health.

Heat stress and adverse pregnancy outcome: Prospective cohort study

OBJECTIVE

To explore the relationship between occupational heat exposure, physiological heat strain indicators and adverse outcomes in pregnant women.

DESIGN

Prospective cohort.

SETTING

Workplaces in Tamil Nadu, India.

SAMPLE

A cohort of 800 pregnant women engaged in moderate to heavy physical work in 2017-2019 and 2021-2022.

METHODS

Participants were recruited at between 8 and 14 weeks of gestation. Occupational heat exposure and heat strain indicators were captured each trimester. 'Heat exposed' was defined as heat stress exceeding the threshold limit value (TLV) for safe manual work (with maximum wet-bulb globe temperatures of 27.5°C for a heavy workload and 28.0°C for a moderate workload). Physiological heat strain indicators (HSIs) such as core body temperature (CBT) and urine specific gravity (USG) were measured before and after each shift. Heat-related health symptoms were captured using the modified HOTHAPS questionnaire.

MAIN OUTCOME MEASURES

The main outcome measures included (1) a composite measure of any adverse pregnancy outcome (APO) during pregnancy (including miscarriage, preterm birth, low birthweight, stillbirth, intrauterine growth restriction and birth defects), (2) a composite measure of adverse outcomes at birth (3) and miscarriage.

RESULTS

Of the 800 participants, 47.3% had high occupational heat exposure. A rise in CBT was recorded in 17.4% of exposed workers, and 29.6% of workers experienced moderate dehydration (USG ≥ 1.020). Heat-exposed women had a doubled risk of miscarriage (adjusted odds ratio, aOR 2.4; 95% confidence interval, 95% CI 1.0-5.7). High occupational heat exposure was associated with an increased risk of any adverse pregnancy and foetal outcome (aOR 2.3; 95% CI 1.4-3.8) and adverse outcome at birth (aOR 2.0; 95% CI 1.2-3.3).

CONCLUSIONS

High occupational heat exposure is associated with HSIs and adverse pregnancy outcomes in India.

Effect of Volatile Organic Compounds on Pulmonary Functions Among Paint Industry Workers of Unorganized Sectors

Background Paint industry workers are constantly exposed to paints and organic solvents that contain a substantial quantity of volatile organic compounds (VOCs). Exposure to VOC emissions could result in pulmonary, neurobehavioral, and hematological consequences. Limited studies have been undertaken in India to assess the health consequences of VOCs among paint industry workers in unorganized sectors. Aim To assess the effects of VOCs on pulmonary function in paint industry workers of unorganized sectors. Methodology A hundred and twenty full-time male construction painters and small-scale paint manufacturing workers aged 25-60 were assessed for respiratory symptoms using a questionnaire, and pulmonary functions using Wright's Peak Expiratory Flow Meter (PEFR). Participants were randomly selected for VOC assessment and the cumulative solvent exposure index was calculated. A pulmonary function test (PFT) was performed on a subset of construction painters (n=30) using a Koko spirometer. Results The concentration of VOCs such as benzene, ethylbenzene, toluene, and xylene (BETX) and dichloromethane levels exceeded American Conference of Governmental Industrial Hygienists (ACGIH) threshold limit values (TLVs) among the paint manufacturing workers. About 52% of paint workers reported respiratory symptoms. Around 22% of the participants showed reduced pulmonary function (PEFR<400 L/min). There was a significant weak negative correlation between PEFR and work experience (r = -0.2, p=0.03). PFT parameters among a subset of construction painters revealed a significant moderate negative correlation with work experience [forced expiratory volume at the onset of the first second (FEV1) (r = -0.6, p=0.001) and forced vital capacity (FVC) (r = -0.53, p=0.005)] and cumulative VOC exposure index [FEV1 (r = -0.53, p = 0.004) and FVC (r = -0.5, p = 0.008)]. Conclusion The concentration of VOCs was higher among paint industry workers of unorganized sectors and they reported respiratory symptoms and diminished pulmonary function. To reduce morbidity, it is critical to enhance awareness about occupational safety and services in these unorganized sectors.

Poor personal protective equipment practices were associated with heat-related symptoms among Asian healthcare workers: a large-scale multi-national questionnaire survey

BACKGROUND

It is pertinent to understand the perceptions of healthcare workers (HCWs) with their associated personal protective equipment (PPE) usage and heat strain symptoms experienced to effectively combat the negative effects of heat stress during treatment and care activities.

METHODS

We evaluated the associated heat stress perceived by HCWs across Asia and validated a questionnaire on perceptions of heat stress, associated PPE usage, and heat strain symptoms experienced. The questionnaire was administered to 3,082 HCWs in six Asian regions. Factor analyses, including Cronbach's alpha, assessed the questionnaire's validity and reliability. Structural equation modelling analysed the effects of knowledge, attitudes and practices, and heat strain symptoms.

RESULTS

The questionnaire was found to be reliable in assessing HCWs' knowledge, and attitudes and practices towards heat stress and PPE usage (both Cronbach's alpha = 0.9), but not heat strain symptoms (Cronbach's alpha = 0.6). Despite knowledge of heat stress, HCWs had negative attitudes and practices regarding PPE usage (β1 = 0.6, p < 0.001). Knowledge (path coefficient = 0.2, p < 0.001), and negative attitudes and practices (path coefficient = 0.2, p < 0.001) of HCWs towards heat stress and PPE usage adversely affected symptoms experienced.

CONCLUSIONS

The questionnaire was not reliable in assessing symptoms. HCWs should, nevertheless, still self-assess their symptoms for early detection of heat strain. To effectively attenuate heat strain, understanding HCWs' attitudes and practices towards PPE usage should guide policymakers in implementing targeted heat management strategies.

Comparison of women's heat risk profiles among those working in indoor and outdoor sectors

Rising temperatures and heat events may affect workers, especially women, by increasing the risk of Heat Related Illnesses (HRIs). We conducted a cross-sectional study among 903 women in outdoor and indoor sectors. We measured Wet Bulb Globe Temperature (WBGT) and physiological Heat Strain Indicators (HSI), as well as self-reported symptoms of HRIs using a HOTHAPS questionnaire. Multivariate Logistic Regression models were used to compare the heat risks. WBGT exposures were high in both the outdoor (Avg. WBGT = 28.8 °C ± 2.4 °C) and indoor (Avg. WBGT = 28.7 °C ± 3.5 °C) sectors. Outdoor Women Workers (OWW) reported higher HRI symptoms (94%vs.81%), and heat exposures were positively correlated with HRIs (AOR: 3.7; 95%CI: 2.4-6.1). OWW showed a 1.5-fold higher risk of measured HSI above safe limits (95%CI: 1.1-2.1) and a 2.1-fold higher risk of urogenital issues (95%CI: 2.1-3.8) than Indoor Women Workers (IWW). Due to direct sun exposure, intensive labor, and a lack of welfare facilities, OWW has a higher HRI risk.

Clinical findings and kidney morphology in chronic kidney disease of unknown cause in India

BACKGROUND

Chronic kidney disease of unknown cause (CKDu) is an emerging health problem in India and other countries worldwide. However, clinical descriptions, including kidney pathology, are scarce.

METHODS

This is a descriptive case series of patients with CKDu from an endemic region in India, with a focus on clinical and biochemical characteristics, kidney biopsy findings, and environmental exposure. Patients with suspected CKDu, aged 20-65, and eGFR 30-80 mL/min/1.73 m2 from rural areas with endemic prevalence of CKDu were included. The exclusion criteria were diabetes mellitus, uncontrolled hypertension, proteinuria >1 g/24 h, or other known kidney diseases. The participants underwent kidney biopsies, and blood and urine samples were collected.

RESULTS

Fourteen participants (3 females, 11 males) with a mean eGFR of 53 (range 29-78) mL/min/1.73 m2 were included. Kidney biopsies showed a combination of chronic tubulointerstitial damage, glomerulosclerosis, and glomerular hypertrophy, with varying degrees of interstitial inflammation. Eight participants had polyuria (diuresis ≥ 3 L/day). The urinary sediments were bland, with no haematuria. Serum potassium and sodium levels were, in most cases, normal but within the lower reference interval.

CONCLUSION

The kidney morphology and clinical characteristics in patients with CKDu in India were similar to those described for CKDu in Central America and Sri Lanka.

Role of yoga in stress management and implications in major depression disorder

Major Depressive Disorder (MDD) is one of the leading causes of disability affecting more than 340 million people and second largest contributor to global burden of disease. Chronic stress is a common risk factor and important contributor for MDD. Stress could be defined as the "perceived inability to cope". Stressful life events are shown to provoke a sequence of psychological and physiological adjustments including nervous, endocrine and immune mechanisms. Stress can lead to elevation of a variety of inflammatory cytokines and stress hormones, can cause autonomic dysfunction and imbalance in neurotransmitters. Yoga can reduce depressive symptoms by alleviating stress. Studies have shown that yoga can reduce inflammation, maintain autonomic balance and also has a role in maintaining the neurotransmitters. It has role on hypothalamic-pituitary-adrenal (HPA) axis, the peripheral nervous system including GABA, limbic system activity, inflammatory and endocrine responses. Yoga along with antidepressants can help in reducing the depressive symptoms in patient with MDD. Yoga is an ideal complementary and alternative therapy for mental health disorders.

Occupational Heat Stress and Kidney Health in Salt Pan Workers

Introduction

Work in heat affects millions of workers. Although kidney function in agricultural workers is increasingly researched, nonagricultural studies are scarce. In coastal salt pans, the absence of occupational exposures to pesticides and other toxicants allows assessment of heat stress alone.

Methods

Seven Indian salt pans were surveyed from 2017 to 2020. Job-specific workload was assessed. Heat stress was characterized as exceeding the wet bulb globe temperature (WBGT)-threshold limit value (TLV) for high and moderate workloads. Preshift and postshift heart rates (HRs), tympanic temperatures, and urine specific gravity (USG) were measured for 352 workers, as were sweat rates (SwR), serum creatinine (SCr), serum uric acid, and urine dipstick. Estimated glomerular filtration rate (eGFR; ml/min per 1.73 m²) was computed. Heat-strain symptoms were assessed using questionnaires.

Results

The mean WBGT was 30.5 ± 1.3 °C (summer) and 27.8 ± 1.9 °C (winter). Water intake during the workday was low, median was one Litre, and most workers (87%) exceeded the TLV for heat stress. Dehydration-related symptoms were frequent in those with high-heat stress, as were cross-shift increases in temperature (≥1°C; 15%), a high USG (≥1.020; 28%), and a high SwR (≥1 l/h; 53%). An eGFR of 60 to 89 ml/min per 1.73 m² was observed in 41% of all workers examined, and 7% had eGFR below 60 ml/min per 1.73 m². The odds ratio for eGFR <90 ml/min per 1.73 m² in workers exceeding the TLV, compared to workers below this limit, adjusted for age and gender was 2.9 (95% CI: 1.3-6.4).

Conclusion

Workplace interventions to prevent heat stress and dehydration in the salt pans and other at-risk industries are urgently required. The findings strengthen the notion that high-heat stress and limited hydration is a risk factor for kidney dysfunction.

Foot reflexology for reduction of blood pressure in hypertensive individual: A systematic review

IMPORTANCE

Hypertension is the modifiable risk factor associated with cardiovascular diseases and all-cause mortality. Foot reflexology has been proposed to reduce the blood pressure for the patients with hypertension but the available evidences are uncertain.

OBJECTIVE

We conducted a systematic review and meta-analysis, know the efficacy of foot reflexology on blood pressure reduction in patients with hypertension.

DATA SOURCES AND SELECTION

A systematic search of electronic databases such as PubMed, Scopus, ClinicalTrials.gov, Embase, and Cochrane library since inception till January 2022. Randomized controlled trial with foot reflexology as an intervention for lowering blood pressure (BP) in hypertensive patients was included in the study.

DATA EXTRACTION AND OUTCOME MEASURES

Data was independently extracted by four authors. Systolic and diastolic blood pressure was the primary outcome measure. Standardized mean difference (SMD) and 95 % confidence interval (CI) were calculated to determine the effect size.

RESULTS

The pooled effect of SBP (SMD: -2.70, 95 % of CI: -6.79, 1.39, I2 - 97 %, P < 0.001) and DBP (SMD: -2.12, 95 % of CI: -5.95, 1.71, I2 - 97 %, P < 0.001) changes are not favorable for foot reflexology in terms of reducing blood pressure.

CONCLUSION

Findings from the studies showed that foot reflexology interventions were not much effective in the reduction of blood pressure among patients with hypertension.

Positioning of Low Alcohol or Alcohol-Free Minoxidil Formulation for the Management of Androgenetic Alopecia: Indian Perspective

Topical minoxidil is used for treating different hair disorders. Even though it is an effective therapy, many patients show poor compliance due to the cost, side effects, and duration of treatment. Topical minoxidil is the mainstay treatment for androgenetic alopecia (AGA). Recently, low alcohol or alcohol-free topical minoxidil formulation has proven to be an alternative for patients suffering from AGA, including those with poor compliance with other therapies. Thus, the current article provides the positioning of low alcohol or alcohol-free topical minoxidil to manage AGA in Indian clinical practice.

Inhaled Silica Nanoparticles Causes Chronic Kidney Disease in Rats

INTRODUCTION

Silica nanoparticles (SiNPs) released during the burning of sugarcane have been postulated to have a role in chronic kidney disease of unknown etiology. We tested the hypothesis that pristine SiNPs of the size present in sugarcane might cause chronic kidney injury when administered through the lung in rats.

METHODS

We administered 200 nm or 300 nm amorphous SiNPs twice weekly (4 mg/dose) or vehicle by oropharyngeal aspiration for 13 weeks to rats followed by sacrifice after an additional 13 weeks (26 weeks total). Tissues were evaluated for presence of SiNPs and evidence of histologic injury.

RESULTS

Both sizes of SiNPs caused kidney damage, with early tubular injury and inflammation (at week 13) that continued to inflammation and chronic fibrosis at week 26 despite discontinuing the SiNP administration. Both sizes of SiNPs caused local inflammation in the lung and kidney and were detected in the serum and urine at week 13, and the 200 nm particles also localized to the kidney with no evidence of retention of the 300 nm particles. At week 26 there was some clearance of the 200 nm silica from the kidneys, and urinary levels of SiNPs were reduced but still significant in both the 200 and 300 nm exposed rats.

CONCLUSIONS

Inhaled SiNPs causes chronic kidney injury that progresses despite stopping the SiNP administration. These findings are consistent with the hypothesis that human exposure to amorphous silica nanoparticles found in burned sugarcane fields could have a participatory role in chronic kidney disease of unknown etiology.

Effect of Yoga on Oxidative Stress in Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis

BACKGROUND

Diabetes mellitus has a significant impact on public health. Oxidative stress plays a major role in the pathophysiology of Type 2 Diabetes Mellitus (T2DM), leading to various complications of T2DM. Yoga is being widely used in the management of T2DM. The primary objective of this systematic review and meta-analysis is to understand the effects of yoga on oxidative stress parameters among adult patients diagnosed with T2DM.

MATERIALS AND METHODS

Electronic databases such as PubMed, Scopus, Cochrane Library and Science Direct from start of the study till March 2020 were searched to obtain eligible studies. Study designs of all nature were included (except case studies and reviews). The primary outcome was Malondialdehyde (MDA) and secondary outcomes included fasting plasma glucose, HbA1C and Superoxide Dismutase (SOD) levels.

RESULTS

A total of four trials with a total of 440 patients met the inclusion criteria. The results of meta-analysis indicated that yoga significantly reduced MDA (SMD: -1.4; 95% CI -2.66 to -0.13; P = 0.03; I2 = 97%), fasting plasma glucose levels (SMD: -1.87: 95% CI -3.83 to -0.09; P = 0.06; I2= 99%), and HbA1c (SMD: -1.92; 95% CI - 3.03 to -0.81; P = 0.0007; I2 = 92%) in patients with T2DM. No such effect was found for SOD (SMD: -1.01; 95% CI -4.41 to 2.38; P = 0.56; I2= 99%).

CONCLUSION

The available evidence suggests that yoga reduces MDA, fasting plasma glucose and HbA1C, and thus would be beneficial in the management of T2DM as a complementary therapy. However, considering the limited number of studies and its heterogeneity, further robust studies are necessary to strengthen our findings and investigate the long-term benefits of yoga.

Chronic Kidney Disease of Unknown Etiology in India: What Do We Know and Where We Need to Go

Chronic kidney disease (CKD) not associated with known risk factors has been reported from parts of India and is presumed to be similar to CKD of unknown etiology (CKDu) that has been described from Central America. The reports from India have been fragmented without clear description of the disease phenotype or its determinants. This paper summarizes the current state of knowledge around CKDu in India based on a review of literature, multi-stakeholder consultation, and a survey of Indian nephrologists. We also contacted individual research groups to solicit data. Our findings suggest that that CKDu is reported from most regions in India; however, it is interpreted differently from the phenotype described from Central America and Sri Lanka. The differences include lack of a clear demographic or occupation group, older age of affected participants, and presence of mild hypertension and low-grade proteinuria. Well-designed prospective field studies with appropriate diagnostic workup are needed to establish the disease burden and identify etiologies, along with socioeconomic and health consequences, the intersection with the environment, and the public health response. Community-based research should phenotype the entire CKD population rather than be restricted to cases with presumed CKDu based on predefined criteria. Guidelines are needed for clinical evaluation, referral, management, and harmonization of clinical documentation and health records. More data are needed to support the existence of a unique CKDu phenotype in India.

Challenges in conducting epidemiological field studies evaluating associations between heat stress and renal health among workers in informal sectors: experiences from India

Well-designed Environmental Epidemiological Studies (EES) play a crucial role in quantifying the influence of environmental exposures and their associated risks on health in the wider population. They provide critical research evidence for identifying and developing interventions to avert adverse health consequences from those exposures. However, uncertainty and variability inherent to any field based EES could hinder the nature and magnitude of association between an exposure and health outcome. This is particularly pronounced in resource limited settings and resource-tight research projects. The present study evaluated the association between occupational heat stress and renal health among informal work sectors in India which had some significant challenges. Informal workers exposed to chronic occupational heat stress had significantly higher adverse renal health outcomes than the unexposed workers. Our field challenges included gaining access and permissions to conduct the study, participant recalls bias and attrition, accurately estimating exposures, confounding from causes of both exposure and disease, and to a large extent tight-funding. Though opportunities are abundant, we must ensure field conditions are optimized to attain study objectives. A keen understanding and sensitivity towards the cultural and work settings is essential for successful project completion. Based on our experiences, we provide strategies to adopt to improve fieldwork and provide recommendations to help overcome the field challenges and achieve better results for future EES studies in developing country settings.

Effect of six months pranayama training on stress-induced salivary cortisol response among adolescents-Randomized controlled study

BACKGROUND

A combination of yoga practices has been documented to reduce stress and stress-induced cortisol levels. The objective of the current study is to examine the effects of six months of a single pranayama practice (Bhramari [Bhr. P]) on reducing salivary cortisol response to the cold pressor test (CPT) among adolescents.

METHODS

Twenty-six healthy adolescents between the ages of 11 and 19 were randomly assigned to either yoga group (n-13) or control group (n-13). Yoga group participants were trained to do Bhr. P for 45 min, thrice a week for six months. All participants underwent CPT at baseline and at end of six months. Saliva samples were collected at baseline (t0), at 20 min (t1), 40 min (t2), and 60 min after the CPT (t3).

RESULTS

Contradictory to our hypothesis, participants in the yoga group exhibited a higher salivary cortisol response to the CPT at t1 (p = 0.04) when compared to the control group. However, the t3 salivary cortisol levels showed a statistically significant reduction (p = 0.03) in yoga group when compared to the control group. A significant interaction with time (F (1, 88) = 316.5, p = .001, ηp²:0.91) and between the group × time (F (3, 88) = 2.83, p = 0.04, ηp²:0.8) was found after the intervention.

CONCLUSIONS

An increase in the cortisol responsiveness observed in the study is an indication of the adaptive capability achieved through regular yoga training, evidenced by an initial rise in cortisol followed by a rapid fall below baseline after 60 min. Further research is required to conclusively determine the changes in cortisol levels over time in response to stress in long-term yoga practitioners.

Valorization of Seafood Processing Discards: Bioconversion and Bio-Refinery Approaches

The seafood industry generates large volumes of waste. These include processing discards consisting of shell, head, bones intestine, fin, skin, voluminous amounts of wastewater discharged as effluents, and low-value under-utilized fish, which are caught as by-catch of commercial fishing operations. The discards, effluents, and by-catch are rich in nutrients including proteins, amino acids, lipids containing good proportions of polyunsaturated fatty acids (PUFA), carotenoids, and minerals. The seafood waste is, therefore, responsible for loss of nutrients and serious environmental hazards. It is important that the waste is subjected to secondary processing and valorization to address the problems. Although chemical processes are available for waste treatment, most of these processes have inherent weaknesses. Biological treatments, however, are environmentally friendly, safe, and cost-effective. Biological treatments are based on bioconversion processes, which help with the recovery of valuable ingredients from by-catch, processing discards, and effluents, without losing their inherent bioactivities. Major bioconversion processes make use of microbial fermentations or actions of exogenously added enzymes on the waste components. Recent developments in algal biotechnology offer novel processes for biotransformation of nutrients as single cell proteins, which can be used as feedstock for the recovery of valuable ingredients and also biofuel. Bioconversion options in conjunction with a bio-refinery approach have potential for eco-friendly and economical management of seafood waste that can support sustainable seafood production.

Effects of 12 sessions of steam bath intervention on spirometry parameters among healthy adult volunteers

OBJECTIVES

Steam bath is extensively used around the world. However, its physiological influence is not understood in detail. Objective of the current study is to examine the effects of 12 sessions of steam bath on spirometric parameters among healthy participants.

METHODS

Forty healthy adult volunteers of both sex (14 male and 26 female) aged 26.38 ± 8 years participated in the study. A steam bath session (10-15 min) was given once a week for 12 weeks. The spirometric parameters [forced expiratory volume in the 1st second (FEV1, L), forced vital capacity (FVC, L), FEV1/FVC ratio (absolute value), maximal mid-expiratory flow (MMEF, L/s) and peak expiratory flow (PEF, L/s)] were measured by Helios 401 spirometer.

RESULTS

Compared to baseline, post-intervention spirometric parameters showed significant (p<0.05) improvement in the FVC (82.40 ± 11.24 to 96.91 ± 18.76), FEV1 (86.13 ± 14.39 to 91.17 ± 12.48), FEV1/FVC ratio (86.96 ± 3.64 to 93.75 ± 4.80), MMEF 25-75% (86.96 ± 3.64 to 94.16 ± 11.57), peak expiratory flow rate (79.82 ± 14.90 to 92.18 ± 18.96).

CONCLUSIONS

Taking steam bath improves the spirometric parameters of healthy adult participants. However, future randomized controlled trials with on a large scale have to done to validate our findings.

Epidemiological evidence from south Indian working population-the heat exposures and health linkage

Changing climate and rising temperatures are predicted to affect millions of workers due to heat stress risks, especially in tropical settings. We used a cross-sectional study design to profile the heat exposures of ~1500 workers from eight-industrial sectors using a QuesTemp wet bulb globe temperature (WBGT) monitor, quantified the heat-strain indicators viz., rise in Core Body Temperature (CBT), Sweat Rate (SwR), and Urine Specific Gravity (USG) by standard methods and evaluated the health impacts of heat stress using a structured questionnaire. Heat exposures (Avg.WBGT: 28.4 ± 2.6 °C) exceeded the Threshold Limit Value (TLV) for 70% of workers and was significantly associated with the rise in CBT >1 °C in 11.3% and elevated USG >1.020 in 10.5% of the workers. The heat-exposed workers had 2.3 times higher odds of reporting adverse health outcomes (84%) compared to the unexposed workers (95% CI: 1.74-3.19; p value ≤ 0.0001). Mild reduction in kidney function observed in 49% of salt - pan workers, and a high prevalence of kidney stones (33%) among the 91 steelworkers subjected to kidney ultrasound had a significant association with chronic high WBGT exposure above the TLV (p value < 0.034). Further, in-depth assessments are warranted to develop strategies for interventions and protective labor policies to avert adverse occupational health and productivity consequences for millions of workers globally, especially in the rising temperature scenario.

Indian monsoon derailed by a North Atlantic wavetrain

The forecast of Indian monsoon droughts has been predicated on the notion of a season-long rainfall deficit linked to a warm equatorial Pacific. Here we show that nearly half of all droughts over the past century differ from this paradigm in that they (i) occur when Pacific temperatures are near-neutral and (ii) are subseasonal phenomena, characterized by an abrupt decline in late-season rainfall. This severe subseasonal rainfall deficit can be associated with a Rossby wave from mid-latitudes. Specifically, we find that the interaction of upper-level winds with an episodic North Atlantic vorticity anomaly results in a wavetrain that curves toward East Asia, disrupting the monsoon. This atmospheric teleconnection offers an avenue for improved predictability of droughts, especially in the absence of telltale signatures in the Pacific.

Heat Stress and Thermal Perception amongst Healthcare Workers during the COVID-19 Pandemic in India and Singapore

The need for healthcare workers (HCWs) to wear personal protective equipment (PPE) during the coronavirus disease 2019 (COVID-19) pandemic heightens their risk of thermal stress. We assessed the knowledge, attitudes, and practices of HCWs from India and Singapore regarding PPE usage and heat stress when performing treatment and care activities. One hundred sixty-five HCWs from India (n = 110) and Singapore (n = 55) participated in a survey. Thirty-seven HCWs from Singapore provided thermal comfort ratings before and after ice slurry ingestion. Differences in responses between India and Singapore HCWs were compared. A p-value cut-off of 0.05 depicted statistical significance. Median wet-bulb globe temperature was higher in India (30.2 °C (interquartile range [IQR] 29.1-31.8 °C)) than in Singapore (22.0 °C (IQR 18.8-24.8 °C)) (p < 0.001). Respondents from both countries reported thirst (n = 144, 87%), excessive sweating (n = 145, 88%), exhaustion (n = 128, 78%), and desire to go to comfort zones (n = 136, 84%). In Singapore, reports of air-conditioning at worksites (n = 34, 62%), dedicated rest area availability (n = 55, 100%), and PPE removal during breaks (n = 54, 98.2%) were higher than in India (n = 27, 25%; n = 46, 42%; and n = 66, 60%, respectively) (p < 0.001). Median thermal comfort rating improved from 2 (IQR 1-2) to 0 (IQR 0-1) after ice slurry ingestion in Singapore (p < 0.001). HCWs are cognizant of the effects of heat stress but might not adopt best practices due to various constraints. Thermal stress management is better in Singapore than in India. Ice slurry ingestion is shown to be practical and effective in promoting thermal comfort. Adverse effects of heat stress on productivity and judgment of HCWs warrant further investigation.