Effect of the Built Environment on the Cumulative Incidence of Acute Diarrheal Diseases: A Community-Based Cohort Study From Underprivileged Areas of Bhopal, India

Background Diarrhea is a major public health problem in under-five children worldwide. Various sociodemographic, environmental, and behavioral factors play a role in the occurrence of diarrheal disease in children under the age of five. This study aims to estimate the cumulative incidence of acute diarrheal diseases during a one-year study period and examine its association with the built environment factors among children under the age of five in selected underprivileged areas of Bhopal. Methodology We conducted this study in Bhopal, a city in central India. We surveyed the underprivileged dwellers of Vajpayee Nagar, Sanjay Nagar, and Mother India Colony of Bhopal city. This is a prospective cohort study with a one-year follow-up period to examine the cumulative incidence of acute diarrheal diseases among under-five-year-old children in the study area. Data were analyzed using SPSS version 25 (IBM Corp., Armonk, NY, USA). Results Data were collected from February 2021 to February 2022. A total of 658 families of eligible children were contacted to participate in the study. After excluding 38 participants for various reasons (denied consent: 3; lost to follow-up: 32; moved out of the study area: 3), data were finally analyzed for 620 participants. In the study among the under-five-year-old children, the cumulative incidence of acute diarrheal diseases was 23.8% (148 out of 620). In our study, lower age (adjusted odds ratio (OR) = 0.86, 95% confidence interval (CI) = 0.75-0.99, p = 0.041) and non-availability of flush latrine in the house (adjusted OR = 4.95, 95% CI = 1.80-13.59, p = 0.002) were statistically associated with a higher incidence of acute diarrheal disease among the study population. Conclusions In our investigation, we observed a cumulative incidence of diarrhea at 23.8% (148 out of 620) among the underprivileged under-five population residing in Bhopal, India. This incidence exhibited significant associations with younger age and the absence of in-house flush latrines.

Prevalence of work-related musculoskeletal disorders and quality of life assessment among garment workers in Tiruppur district, Tamil Nadu

Objectives. The garment industry is a labour-intensive industry, with workers susceptible to musculoskeletal problems, especially those employed in smaller units that lack adequate occupational health provisions. This study aims to determine the prevalence of work-related musculoskeletal disorders (WMSDs) among workers in both large and small garment units and assess their quality of life (QoL). Methods. The study surveyed 746 garment workers, comprising 372 from large units and 374 from small units. Data were collected through the Nordic musculoskeletal questionnaire and the World Health Organization Quality of Life (WHOQOL)-BREF questionnaire, with posture analysis conducted using the rapid upper limb assessment (RULA) and rapid entire body assessment (REBA) scales. Results. The results showed that 32% of workers in large-scale garment units and 43.9% in small-scale garment units reported musculoskeletal symptoms. The occurrence of musculoskeletal disorders (MSDs) was significantly associated with increasing age, smoking, alcohol consumption, job duration, working in shifts and moonlighting. Conclusion. The workers in the garment industry, particularly of small units, are highly susceptible to WMSDs.

Investigating the presence of dioxins in drinking water: implications for public health

The presence of highly toxic dioxins, specifically polychlorinated dibenzo-p-dioxins (PCDDs), in drinking water is a matter of great concern due to their long-lasting nature and harmful effects. In this study, we detected three out of the five dioxin congeners: 2, 3, 7, 8-tetrachlorodibenzodioxin (TCDD), 1, 2, 3, 7, 8-pentachlorodibenzo-p-dioxin (PeCDD), and octachlorodibenzo-p-dioxin (OCDD). The investigation revealed that three dioxins were present in water samples of winter season, while TCDD and OCDD were found in the summer season. The geometric mean concentrations of PCDDs were 229.9 ng/L (winter) and 108.4 ng/L (summer), exceeded the maximum contaminant level of 30 pg/L set by the USEPA in surface water. The estimated daily intake of PCDDs for residents through drinking water was 273.97 ng-WHO2005-TEQ/kg/days during winter and 78.875 ng-WHO2005-TEQ/kg/days during summer. Our study emphasizes the urgent need for further research on persistent organic pollutants in drinking water to safeguard public health and community well-being.

Facilitators and barriers to the uptake of COVID-19 vaccine precaution dose among adult population: qualitative analysis across six different states of India

Introduction

India launched the COVID-19 vaccination drive on 16th January 2021 by vaccinating the adult population above 18 years of age. This was followed by the introduction of an additional precaution dose. As on 18th October 2022, 1,02,66,96,808 (1.02 Billion) first dose and 94, 95, 39,516 (949 Million) second doses of COVID-19 vaccine were administered. However, when compared to the uptake of the primary doses, the precaution dose uptake lagged behind with only 21,75, 12,721 (217 million) doses administered. Even though, the uptake of the primary doses remained optimal, irrespective of different interventions by the Government of India, the uptake of the precaution dose remained poor. In this context, the Ministry of Health & Family Welfare wanted to understand the facilitators and Barriers for precaution dose uptake among adults so that future immunization campaigns could address these issues.

Methods

An exploratory qualitative study was conducted to assess the facilitators and barriers for COVID-19 precaution dose uptake at community level across 6 different states in India. From each of the states, two districts with the highest and lowest rates of COVID-19 vaccine precaution dose uptake were selected. In each of these districts, 2 block Primary Healthcare Centres (PHCs), one with high and one with low uptake were identified. Within these block PHCs, a PHC field area with high and low precaution dose uptakes was identified. From the identified sites a minimum of four IDIs, four FGDs were conducted among the community members. KIIs of the State Immunization Officers, District Immunisation Officers, PHC Medical Officers, healthcare workers like Accredited Social Health Activist/Auxiliary Nurse Midwife were also conducted. The data was audio recorded and it was transcribed, translated and analysed using framework approach.

Results

It was observed that rise in COVID-19 cases prompted the community to take the precaution dose, this along with the cost of hospitalization and the number of productive days being lost as a result of being infected resulted in vaccine uptake. The fear of non-availability of COVID-19 vaccines latter on also prompted people for vaccine uptake. While the barriers were, poor accessibility to vaccination centers, long hours of travel, poor road connectivity and lack of transportation facilities. However, the most prominent barriers observed across all study sites was that a sense of pandemic fatigue and complacency had developed both among the providers as well as the beneficiaries. Other barriers include differences in vaccination schedules and longer duration between the primary doses of some vaccines. Media was identified to be both a barrier and facilitator for Covid-19 Precaution dose uptake. Even though media played an important role in disseminating information in the beginning of the campaign, it was soon followed by the circulation of both misinformation and disinformation.

Discussion

The study identified that dissemination of accurate information and community involvement at each stage of planning and implementation are crucial for the success of any campaign. Efforts should be constantly made to address and re-invent strategies that will be most suitable for the needs of the community. Therefore, in order to ensure successful vaccination campaigns, it is crucial that along with political will it is also important to have a decentralized approach with inter-sectoral coordination with different stakeholders such as healthcare workers, community members and the different departments such as the local self-governments, education department, law & order department etc. These lessons learnt from COVID-19 vaccination campaigns must not be forgotten and must be applied in future vaccination campaigns and while framing public health policies.

A systematic review and meta-analysis of prevalence of seven psychiatric disorders in India

Background

After the National Mental Health Survey in 2016, multiple individual studies showed inconsistencies in the prevalence rates of psychiatric disorders in India. We performed a meta-analysis to estimate an up-to-date pooled estimate of the prevalence of depression, alcohol use disorder (AUD), anxiety disorder (AD), intellectual disability, suicidal attempt/death, autism, and bipolar disorder (BD) in India.

Materials and Methods

We performed a systematic bibliographic search in Pub Med, Global Health Data Exchange (GHDx), and Google Scholar, along with a manual search for peer-reviewed epidemiological studies reporting the prevalence of depression, AUD, AD, MR, suicidal attempt/death, autism, and BD in India from January 1980 till March 2022. Adopting a random-effects model, we performed the meta-analysis using "MetaXL" software.

Results

A total of 79 studies were included: depression (n = 28), AUD (n = 14), AD (n = 12), intellectual disability (n = 8), suicidal attempt/death (n = 7), autism (n = 6) and BD (n = 4). The pooled prevalence of depression and AUD was 12.4% (95% CI 9.4-15.9) (P < 0.001, I2 = 100%) and 21.5% (95% CI 14.1-30.0) (P < 0.001, I2 = 100%), respectively. AD, intellectual disability and suicidal attempt/death showed a prevalence of 11.6% (95% CI 8.1-15.7) (P < 0.001, I2 = 99%), 1% (95% CI 0.5-1.6) (P < 0.001, I2 = 98%) and 0.5% (95% CI 0.3-0.8) (P < 0.001, I2 = 100%), respectively. The meta-analysis in autism and BD showed pooled prevalence of 0.3% (95% CI 0.1-0.6) (P < 0.001, I2 = 96%) and 0.3% (95% CI 0.2-0.4) (P < 0.001, I2 = 78%), respectively. Subgroup analysis showed an increased prevalence of AD in the urban [24.3% (95% CI 3.7-52.9)] and younger [16.7% (95% CI 5.1-32.7)] population. The prevalence of depression and AD increased during the last two decades on decadal prevalence analysis.

Discussion

The findings could be used for appropriate policy measures and guiding subsequent national mental health surveys.

Beneficial role of kaempferol and its derivatives from different plant sources on respiratory diseases in experimental models

Respiratory illnesses impose a significant health burden and cause deaths worldwide. Despite many advanced strategies to improve patient outcomes, they are often less effective. There is still considerable room for improvement in the treatment of various respiratory diseases. In recent years, alternative medicinal agents derived from food plants have shown better beneficial effects against a wide variety of disease models, including cancer. In this regard, kaempferol (KMF) and its derivatives are the most commonly found dietary flavonols. They have been found to exhibit protective effects on multiple chronic diseases like diabetes, fibrosis, and so on. A few recent articles have reviewed the pharmacological actions of KMF in cancer, central nervous system diseases, and chronic inflammatory diseases. However, there is no comprehensive review that exists regarding the beneficial effects of KMF and its derivatives on both malignant- and non-malignant respiratory diseases. Many experimental studies reveal that KMF and its derivatives are helpful in managing a wide range of respiratory diseases, including acute lung injury, fibrosis, asthma, cancer, and chronic obstructive pulmonary disease, and their underlying molecular mechanisms. In addition, we also discussed the chemistry and sources, the absorption, distribution, metabolism, excretion, and toxicity (ADMET) properties, methods to enhance bioavailability, as well as our perspective on future research with KMF and its derivatives.

Molecular surveillance of dengue virus in field-collected Aedes mosquitoes from Bhopal, central India: evidence of circulation of a new lineage of serotype 2

Introduction

Dengue fever is hyperendemic in several Southeast and South Asian countries, including India, with all four serotypes (DENV 1-4) circulating at different periods and in different locations. Sustainable and improved virological and entomological surveillance is the only tool to prevent dengue and other vector-borne diseases.

Objectives

The present study has been carried out to detect and characterize the circulating dengue virus (DENV) in field-collected Aedes mosquitoes in Bhopal, Central India.

Methods

Aedes mosquitoes were collected from 29 localities within Bhopal city during October 2020 to September 2022. DENV infection was assessed in the individual head and thorax regions of Aedes mosquitoes using reverse transcriptase PCR. Positive samples were sequenced, and the circulating serotypes and genotypes were determined using phylogenetic analysis.

Results

DENV RNA was detected in 7 Aedes aegypti and 1 Aedes albopictus, with infection rates of 0.59 and 0.14%, respectively. Phylogenetic analysis revealed all the isolates belonged to DENV serotype 2 and distinctly clustered with the non-Indian lineage (cosmopolitan genotype 4a), which was not recorded from the study area earlier. The time to most common recent ancestor (TMRCA) of these sequences was 7.4 years old, with the highest posterior density (HPD) of 3.5-12.2 years, indicating that this new lineage emerged during the year 2014. This is the first report on the DENV incrimination in both Ae. aegypti and Ae. albopictus mosquitoes collected from Bhopal, Central India.

Conclusion

The observed emergence of the non-Indian lineage of DENV-2 in Bhopal, which again is a first report from the area, coincides with the gradual increase in DENV cases in Bhopal since 2014. This study emphasizes the importance of DENV surveillance and risk assessment in this strategically important part of the country to decipher its outbreak and severe disease-causing potential.

Evaluation of Cytogenetic Alterations in Patients of Chronic Kidney Disease

Introduction

In recent years, there has been a rise in chronic kidney disease (CKD), and it has been estimated that by 2040, CKD will be the fifth most common cause of death globally. In addition to diabetes, hypertension, obesity, hyperlipidemia, and nonalcoholic fatty liver disease commonly associated with CKD, exposure to various toxins as a result of pollution or industrial disasters is also discussed as a cause for multi-organ pathology including kidneys. Although few cytogenetic studies were undertaken to assess the genetic damage in survivors of the disaster, no studies are available on the cytogenetic damage of toxic-gas exposed population having CKD. Therefore, the present multi-group cross-sectional study was undertaken to assess the independent role of CKD as well as toxic gas exposure on cytogenetics.

Methods

The cytogenetic alterations were evaluated through chromosomal aberration analysis and micronuclei assay. The study included 608 study participants divided into four groups on the basis of history of exposure to the leaked gas and presence or absence of CKD.

Results

The results of the study showed no statistically significant difference in cytogenetic damage between gas-exposed and non-exposed patients of CKD, whereas significantly higher cytogenetic damage was observed among gas-exposed participants having CKD compared to gas-exposed participants free from CKD, suggesting that cytogenetic changes could be due to CKD itself.

Conclusions

Thus, to conclude, the cytogenetic alterations observed in the study can be partly attributed to the disease itself.

Dermatological Symptoms among Polyester Dyeing and Printing Workers in Mumbai

Background

Textile is one of the important sectors in the Indian economy. The use of synthetic chemicals is maximum during the wet processing technique, which consists of dyeing, printing and finishing.

Aims and Objectives

This study was conducted to find out the prevalence of occupational dermatological symptoms among the workers employed in the dyeing and printing unit of the textile industry.

Materials and Methods

A cross-sectional study, with a sample of 242 workers, was conducted in three different dyeing and printing factories. The workers were interviewed using a semi-structured questionnaire adapted from the Nordic Occupational Skin Questionnaire.

Results

The prevalence of dermatological symptoms on the hands was found to be 51.7%. The various pattern of lesions included redness in 0.4% to itching in 26% of dyeing and printing workers. Those working for >5 years had 2.21 times higher risk as compared to those working for ≤5 years Odds Ratio (OR): 2.21; 95% Confidence Interval (CI): 1.19-4.11). Similarly, those working in the dyeing section were at 2.94 times higher risk as compared to those working in the printing section (OR: 2.94; 95% CI: 1.58-5.47).

Conclusion

The workers working in the printing and dyeing industry were at risk of developing skin lesions, which can partly be attributed to reactive chemicals used and partly to poor handling practices of the workers.

Assessment of multidrug-resistant profile, multi-locus sequence typing and efflux pump activity in Salmonella Typhimurium isolated from hospital sewage

Salmonella enterica serovar Typhimurium is becoming a leading cause of gastroenteritis and mortality. The use of antibiotics has increased natural resistance of S. Typhimurium to antibiotics. This study aims to isolate and characterize multi-drug-resistant (MDR) Salmonella strains from hospital sewage samples in Bhopal City, central India. The MDR isolates were characterized by molecular identification, antimicrobial resistance patterns, multi-locus sequence typing, and efflux pump activity. Specific genes (hilA, stn, invA, typh, and iroB) were used to confirm S. Typhimurium isolates. The Kirbey-Bauer method was employed to profile antimicrobial resistance using 20 antibiotics. Multi-locus sequence typing confirmed S. Typhimurium using seven housekeeping genes (aroC, dnaN, hemD, hisD, purE, sucA, and thr). Out of five strains, only four were confirmed as S. Typhimurium during MLST analysis. Efflux pump activity was determined using the ethidium bromide (EtBr) cartwheel test. Of the 160 isolates, 38 were presumptively confirmed as S. Typhimurium based on biochemical characterization, and only five MDR Salmonella strains were selected for their resistance against most antibiotics. Efflux pump activity revealed that five out of the four MDR isolates did not retain EtBr inside the cells, indicating pronounced efflux activity. Additionally, the isolated strains showed a specific correlation between the antimicrobial phenotypes and genotypes. The results of this study provide a better understanding of the characterization of S. Typhimurium serotype in Bhopal City. Future studies should focus on understanding changing antimicrobial resistance patterns, pathogenicity, and the genetic background of Salmonella serotypes. Further surveillance activities for antimicrobial-resistant Salmonella in different environmental sources should be prioritized.

A Comparative Study of Work Stress among Working Females Getting Paid and Working Women Unpaid (Housewives) During Pregnancy

Introduction

The potential impact of employment on pregnancy is an important issue as several occupational factors have been reported to be associated with adverse pregnancy outcomes through increased work stress. The current study was undertaken among pregnant women to understand the difference in pregnancy-related stress among pregnant working women getting paid (WWP) and working women unpaid (WWU) (housewives) and to assess workplace stress among working WWP.

Methods

A total of 426 study participants which included 213 participants in each group were recruited from a tertiary care hospital in Chennai. All the study participants were interviewed using an A-Z scale to understand pregnancy-related stress while WWP were also interviewed using Workplace Stress Questionnaire (WSQ).

Results

It was observed that the mean score of WWP was significantly higher than the mean scores of WWU (t = 94.63; df = 1, P = 0.000). Those WWP who were working for >8 h daily had higher scores as compared to those working for ≤8 h.

Conclusion

The study shows that the WWP had work stress in addition to background pregnancy-related stress.

Occupational injuries among female seafood processing workers in Prakasam district, Andhra Pradesh, India

Women play a significant role in the processing of the seafood after the harvesting process and are mostly engaged in grading, peeling, cutting, and packing activities. Injuries during their job make them vulnerable to many problems and lead to many severe consequences. The present study aimed to identify the frequency and factors associated with occupational injuries among the workers in Prakasam district, Andhra Pradesh. This cross-sectional study included 257 women seafood processing workers. Simple random sampling technique was used to select the participants. The data were collected through face to face interviews using a predesigned questionnaire. Data were analyzed using SPSS. The prevalence of injuries among 257 women seafood processing workers was 74.3 percent. Age of the worker, job satisfaction, working hours per day, breaks duration between work, and blanching of hands (paleness of hands due to vasoconstriction) were found to be statistically significantly associated factors with injury occurrence among women seafood processing workers. Thus, to conclude, the frequency of occupational injuries among the women seafood processing workers is high and is associated with several occupational factors.

An assessment of remotely sensed environmental variables on Dengue epidemiology in Central India

In recent decades, dengue has been expanding rapidly in the tropical cities. Even though environmental factors and landscape features profoundly impact dengue vector abundance and disease epidemiology, significant gaps exist in understanding the role of local environmental heterogeneity on dengue epidemiology in India. In this study, we assessed the role of remotely sensed climatic factors (rainfall, temperature and humidity) and landscape variables (land use pattern, vegetation and built up density) on dengue incidence (2012–2019) in Bhopal city, Central India. Dengue hotspots in the city were assessed through geographical information system based spatial statistics. Dengue incidence increased from 0.59 cases in 2012 to 9.11 cases in 2019 per 10,000 inhabitants, and wards located in Southern Bhopal were found to be dengue hotspots. Distributed lag non-linear model combined with quasi Poisson regression was used to assess the exposure-response association, relative risk (RR), and delayed effects of environmental factors on dengue incidence. The analysis revealed a non-linear relationship between meteorological variables and dengue cases. The model shows that the risk of dengue cases increases with increasing mean temperature, rainfall and absolute humidity. The highest RR of dengue cases (~2.0) was observed for absolute humidity ≥60 g/m³ with a 5–15 week lag. Rapid urbanization assessed by an increase in the built-up area (a 9.1% increase in 2020 compared to 2014) could also be a key factor driving dengue incidence in Bhopal city. The study sheds important insight into the synergistic effects of both the landscape and climatic factors on the transmission dynamics of dengue. Furthermore, the study provides key baseline information on the climatic variables that can be used in the micro-level dengue prediction models in Bhopal and other cities with similar climatic conditions.

Dengue, a viral disease transmitted by infected Aedes mosquitoes, is a major public health concern globally. In addition to its increased incidence in recent years, dengue is also spreading to new geographical regions. Local environmental factors are known to modify the mosquito vector density that directly impacts dengue virus transmission. Understanding the influence of environmental factors (meteorological conditions and landscape features) on dengue epidemiology in local settings is important for focused dengue intervention. Here, by utilizing dengue incidence and remotely sensed environmental data from 2012–2019, we have assessed the role of environmental factors in driving dengue virus transmission in the city of Bhopal in Central India. During the study period, a 14.5 fold increase in dengue incidence was observed in Bhopal city, which is way higher than the 2.3 fold increase reported at the national level. The risk of dengue virus transmission was higher with higher temperature and absolute humidity. An increase in built-up area, a proxy for urbanization, was found to be another predictor of increased dengue incidence in Bhopal. These findings can provide a stepping-stone for the development of dengue prediction models and the identification of dengue hotspots in order to improve vector control of this disease in cities with similar environmental conditions.

Factors associated with COVID-19 stigma during the onset of the global pandemic in India: A cross-sectional study

Objective

To assess factors associated with COVID-19 stigmatizing attitudes in the community and stigma experiences of COVID-19 recovered individuals during first wave of COVID-19 pandemic in India.

Methods

A cross-sectional study was conducted in 18 districts located in 7 States in India during September 2020 to January 2021 among adults > 18 years of age selected through systematic random sampling. Data on socio demographic and COVID-19 knowledge were collected from 303 COVID-19 recovered and 1,976 non-COVID-19 infected individuals from community using a survey questionnaire. Stigma was assessed using COVID-19 Stigma Scale and Community COVID-19 Stigma Scale developed for the study. Informed consent was sought from the participants. Univariate and multivariate binary logistic regression analysis were conducted.

Results

Half of the participants (51.3%) from the community reported prevalence of severe stigmatizing attitudes toward COVID-19 infected while 38.6% of COVID-19 recovered participants reported experiencing severe stigma. Participants from the community were more likely to report stigmatizing attitudes toward COVID-19 infected if they were residents of high prevalent COVID-19 zone (AOR: 1.5; CI: 1.2-1.9), staying in rural areas (AOR: 1.5; CI:1.1-1.9), belonged to the age group of 18-30 years (AOR: 1.6; CI 1.2-2.0), were male (AOR: 1.6; CI: 1.3-1.9), illiterate (AOR: 2.7; CI: 1.8-4.2), or living in Maharashtra (AOR: 7.4; CI: 4.8-11.3). COVID-19 recovered participants had higher odds of experiencing stigma if they had poor knowledge about COVID-19 transmission (AOR: 2.8; CI: 1.3-6.3), were staying for 6-15 years (AOR: 3.24; CI: 1.1-9.4) in the current place of residence or belonged to Delhi (AOR: 5.3; CI: 1.04-26.7).

Conclusion

Findings indicated presence of stigmatizing attitudes in the community as well as experienced stigma among COVID-19 recovered across selected study sites in India during the first wave of COVID-19 pandemic. Study recommends timely dissemination of factual information to populations vulnerable to misinformation and psychosocial interventions for individuals affected by stigma.

Musculoskeletal symptoms and associated factors among beauty salon workers in Udupi, Karnataka, India

BACKGROUND: The Indian salon industry is increasing rapidly due to demand for various kinds of beauty and personal care products. Working ability and health conditions of salon workers may be affected by specific work-related activities. Prolonged non-neutral postures, repetitive movements, lack of adequate breaks during work, working at a fast pace, general distress or prolonged standing periods make them vulnerable to musculoskeletal symptoms. OBJECTIVE: The present study was carried out to assess work-related musculoskeletal symptoms among the beauty salon workers of Udupi taluk. METHOD: A total of 240 salon workers were recruited for the study. A semi-structured, interviewer-led questionnaire based on a modified Nordic questionnaire was used to collect data. RESULTS: As many as 80.4% study participants reported work related musculoskeletal pain in one or more body parts. The common body parts affected by pain were neck, shoulder, elbow, wrist/hand, upper back, lower back, legs and ankles/feet. The analysis according to work postures suggested that short repetitive movements, stretching of hands to reach objects, working in the same posture for a longer time and the lack of weekly break from work was significantly associated with musculoskeletal symptoms. CONCLUSION: The beauty salon workers are at risk of developing musculoskeletal symptoms which could benefit from preventive structural, operational and educational measures.

Assessment of exposure to dust, gaseous pollutants and endotoxins in sewage treatment plants of Ahmedabad city, India

BACKGROUND: Sewage treatment plant workers (STPs) are exposed to gaseous pollutants (H2S) and bioaerosols and their health is at risk. OBJECTIVE: The aim of the study was to evaluate exposures to dust, 1,3 Beta D Glucans, endotoxins and gaseous pollutants in different process plants and to provide suitable recommendations. METHODS: Gaseous pollutants and bioaerosols (inhalable dust, 1,3 beta D-glucans and endotoxins) were evaluated in two sewage treatment plants (STPs) of Ahmedabad city, India. The concentration of H2S, CO, CH4 and Cl2 were monitored in two process areas of STPs using real-time gas detectors. The dust, 1,3 beta D-glucans and endotoxins were evaluated as per standard methods. RESULTS: The mean concentration of H2S exceeded the permissible exposure limit of 10 ppm, whereas the concentration of other gaseous pollutants (CO, Cl2 and CH4) were below the permissible exposure limits of Indian Factories Act, 1948. The inhalable dust concentration was also within the permissible exposure limit of 10 mg/m3 as per Indian Factories Act, 1948. CONCLUSIONS: Significant exposures to gaseous and bioaerosols were found in the work environment of STPs. The paired t-test result showed a significant difference between two STPs for H2S, 1,3 beta D-Glucans and endotoxins. STPs were advised to reduce the exposure to H2S and bioaerosols as per CPCB guidelines applicable to India to prevent health effects.

Evaluation of health impacts of the improved housing conditions on under-five children in the socioeconomically underprivileged families in central India: A 1-year follow-up study protocol

Unacceptable housing conditions prevalent in Indian urban slums adversely affect the health of residents. The Government of India initiated the Basic Services to the Urban Poor (BSUP) as a sub-mission under the Jawaharlal Nehru National Urban Renewal Mission (JNNURM), to provide basic services to the urban poor. As per the available scientific literature, the health effects of such improved housing schemes for the poor have not been studied so far in India, especially in under-five children (0-5 years old) who spend most of their time indoors. The present paper describes the protocol for a follow-up research study proposed to fill this gap. This study, funded by the Indian Council of Medical Research (Sanction No. 5/8-4/9/Env/2020-NCD-II dated 21.09.2021), will be conducted in Bhopal in the central Indian province of Madhya Pradesh for over 2 years. We will recruit 320 under-five children each from Group 1 (Beneficiary families residing in the houses constructed under BSUP) and Group 2 (Slum dwelling families eligible for improved housing but who did not avail of benefit). Eligible children will be recruited in the first household visit. During the same visit, we will record clinical history, examination findings and take anthropometric measurements of participants. We will also collect data regarding socio-economic-environmental parameters of the house. During subsequent monthly follow-up visits, we will collect primary data on morbidity profile, anthropometric details and medical history over 1 year. Approval for the study was obtained from the Institutional Ethics Committee of the National Institute for Research in Environmental Health (No: NIREH/BPL/IEC/2020-21/198, dated 22/06/2020). This study will evaluate the impact of different housing conditions on the health of under-five children. Finding of this research will be beneficial in guiding future housing-related policy decisions in low- and middle-income countries.

Non-malignant respiratory illness associated with exposure to arsenic compounds in the environment

Arsenic (As), a toxic metalloid, primarily originates from both natural and anthropogenic activities. Reports suggested that millions of people globally exposed to high levels of naturally occurring As compounds via inhalation and ingestion. There is evidence that As is a well-known lung carcinogen. However, there has been relatively little evidence suggesting its non-malignant lung effects. This review comprehensively summarises current experimental and clinical studies implicating the association of As exposure and the development of several non-malignant lung diseases. Experimental studies provided evidence that As exposure induces redox imbalance, apoptosis, inflammatory response, epithelial-to-mesenchymal transition (EMT), and affected normal lung development through alteration of the components of intracellular signaling cascades. In addition, we also discuss the sources and possible mechanisms of As influx and efflux in the lung. Finally, current experimental studies on treatment strategies using phytochemicals and our perspective on future research with As are also discussed.

Impact of Environmental Pollutants on Gut Microbiome and Mental Health via the Gut–Brain Axis

Over the last few years, the microbiome has emerged as a high-priority research area to discover missing links between brain health and gut dysbiosis. Emerging evidence suggests that the commensal gut microbiome is an important regulator of the gut–brain axis and plays a critical role in brain physiology. Engaging microbiome-generated metabolites such as short-chain fatty acids, the immune system, the enteric nervous system, the endocrine system (including the HPA axis), tryptophan metabolism or the vagus nerve plays a crucial role in communication between the gut microbes and the brain. Humans are exposed to a wide range of pollutants in everyday life that impact our intestinal microbiota and manipulate the bidirectional communication between the gut and the brain, resulting in predisposition to psychiatric or neurological disorders. However, the interaction between xenobiotics, microbiota and neurotoxicity has yet to be completely investigated. Although research into the precise processes of the microbiota–gut–brain axis is growing rapidly, comprehending the implications of environmental contaminants remains challenging. In these milieus, we herein discuss how various environmental pollutants such as phthalates, heavy metals, Bisphenol A and particulate matter may alter the intricate microbiota–gut–brain axis thereby impacting our neurological and overall mental health.

Aging and Microbiome in the Modulation of Vaccine Efficacy

From infancy through to old age, the microbiome plays an important role in modulating the host-immune system. As we age, our immune system and our gut microbiota change significantly in composition and function, which is linked to an increased vulnerability to infectious diseases and a decrease in vaccine responses. Our microbiome remains largely stable throughout adulthood; however, aging causes a major shift in the composition and function of the gut microbiome, as well as a decrease in diversity. Considering the critical role of the gut microbiome in the host-immune system, it is important to address, prevent, and ameliorate age-related dysbiosis, which could be an effective strategy for preventing/restoring functional deficits in immune responses as we grow older. Several factors, such as the host’s genetics and nutritional state, along with the gut microbiome, can influence vaccine efficacy or reaction. Emerging evidence suggests that the microbiome could be a significant determinant of vaccine immunity. Physiological mechanisms such as senescence, or the steady loss of cellular functions, which affect the aging process and vaccination responses, have yet to be comprehended. Recent studies on several COVID-19 vaccines worldwide have provided a considerable amount of data to support the hypothesis that aging plays a crucial role in modulating COVID-19 vaccination efficacy across different populations.

Environmental monitoring and health assessment in an industrial town in central India: A cross-sectional study protocol

Background

Textile industry has been widely implicated in environmental pollution. The health effects of residing near manufacturing industries are not well documented in India, especially in central India. Hence, a cross-sectional environmental monitoring and health assessment study was initiated as per directions of the local authorities.

Methods

Comprehensive exposure data about the concentrations of relevant pollutants in the ambient air and ground water samples in the study area will be collected over one year. Using stratified random sampling, 3003 apparently healthy adults will be selected from the study area. Sociodemographic and anthropometric information, relevant medical and family history, and investigations including spirometry, electrocardiogram, neurobehavioral tests, and laboratory investigations (complete blood count, lipid profile and random blood glucose) will be conducted. Finally Iodine azide test and heavy metal level detection in urine and blood samples respectively will be conducted in a subset of selected participants to assess individual pollution exposure. Ethics approval has been obtained from the Institutional Ethics Committee of the National Institute for Research in Environmental Health (No: NIREH/IEC-7-II/1027, dated 07/01/2021).

Discussion

This manuscript describes the protocol for a multi-disciplinary study that aims to conduct environmental monitoring and health assessment in residential areas near viscose rayon and associated chemical manufacturing industries. Although India is the second largest manufacturer of rayon, next only to China, and viscose rayon manufacturing has been documented to be a source of multiple toxic pollutants, there is a lack of comprehensive information about the health effects of residing near such manufacturing units in India. Therefore implementing this study protocol will aid in filling in this knowledge gap.

Is Air Pollution Associated with Increased Risk of Dementia? A Meta-Analysis of Epidemiological Research

BACKGROUND

There are prevailing inconsistencies in epidemiological research about air pollution being a risk factor for dementia.

OBJECTIVE

We performed meta-analyses to calculate the pooled estimates of the risk of developing dementia due to air pollution exposure.

METHODS AND MATERIALS

We performed a systematic search in PubMed, Google Scholar, The Cochrane Library, and J-GATEPLUS databases for peer-reviewed epidemiological studies reporting the risk of developing all-cause dementia, cognitive decline, Alzheimer's disease (AD), and vascular dementia (VaD) due to exposure to particulate matter with an aerodynamic diameter less than 2.5 μm (PM_2.5) and less than 10 μm (PM₁₀), ozone (O₃), carbon monoxide (CO), nitrogen dioxide (NO₂), nitrogen oxides (NO_X) and sulfur dioxide (SO₂) from the beginning until December 2020. Meta-analysis was performed by adopting the random-effects model using Meta-XL.

RESULTS

In all-cause dementia, the pooled hazard ratio (HR) for PM_2.5 and NO₂ exposure was 1.03 [(95%CI: 1.01-1.06; I² = 99% (P < 0.001)] and 1.00 [(95%CI: 1.00-1.01; I² = 96% (P < 0.001)], respectively. The pooled HR for NO_X was 1.00 [(95%CI: 1.00-1.01; I² = 61% (P = 0.05)]. In AD, the pooled HRs for PM_2.5 and O₃ was 1.08 (95%CI: 1.01-1.15; I² = 99% (P < 0.001)]) and 1.02 (95%CI: 0.96-1.08; I² = 100% (P < 0.001)], respectively. In VaD, the pooled HR for PM_2.5 exposure was 1.03 (95%CI: 1.01-1.06; I² = 91% (P < 0.001)]. In NO₂/NO_X, the results were found to be equivocal. Meta-analysis could not be performed in cognitive decline because of wide variations in assessments methods.

CONCLUSIONS

The present study showed exposure to PM_2.5 as a risk factor for all-cause dementia, AD, and VaD and exposure to O₃ as a possible risk factor for AD. These findings can be used for policy measures and further research.

Establishing the National Institute for Research in Environmental Health, India

Problem

Multiple environmental health issues resulting from pollution and climate change threaten public health in India.

Approach

The Government of India recognized the need for a permanent environmental health research institute; the Indian Council of Medical Research therefore established the National Institute for Research in Environmental Health in Bhopal in 2010. Scientists at the institute assessed the multiple long-term health effects of exposure to methyl isocyanate, and are now conducting research on a wide array of locally relevant environmental health issues.

Local setting

The Union Carbide India Limited pesticide factory in Bhopal was the site of a methyl isocyanate gas leak in 1984, which affected half a million people. The Indian Council of Medical Research set up a coordinating unit in the immediate aftermath, which was upgraded to the Bhopal Gas Disaster Research Centre in 1986 and then the Centre for Rehabilitation Studies in 1995.

Relevant changes

Scientists at the institute undertake environmental monitoring and health risk assessment studies among communities located near polluted areas, such as industrial areas. They are also assessing the training needs of practising physicians, with the aim of developing a curated curriculum to meet the deficiencies in environmental health education in the country.

Lessons learnt

Environmental legislation was introduced in the wake of the disaster and a research institute in environmental health was established. Researchers at the institute have recognized the importance of engaging communities in environmental health research, as well as knowledge dissemination to relevant stakeholders.

Influence of Host Blood Meal Source on Gut Microbiota of Wild Caught Aedes aegypti, a Dominant Arboviral Disease Vector

Blood feeding is an important behavior of Aedes aegypti, a dominant arboviral disease vector, as it can establish and transmit viruses to humans. Bacteria associated with the mosquito gut can modulate the biological characteristics and behavior of disease vectors. In this study, we characterized the gut microbiota composition of human-blood-fed (HF), non-human-blood-fed (NHF) and non-fed (NF) field-collected Ae. aegypti mosquitoes, using a 16S metagenomic approach, to assess any association of bacterial taxa with the blood-feeding behavior of Ae. aegypti. A significant difference in the microbiota composition between the HF and NF mosquito group was observed. A significant association was observed in the relative abundance of families Rhodobacteraceae, Neisseriaceae and Dermacoccaceae in the HF group in contrast to NF and NHF Ae. aegypti mosquitoes, respectively. At the class level, two classes (Rhodobacterales and Neisseriales) were found to be in higher abundance in the HF mosquitoes compared to a single class of bacteria (Caulobacterales) in the NF mosquitoes. These results show that human-blood feeding may change the gut microbiota in wild Ae. aegypti populations. More research is needed to determine how changes in the midgut bacterial communities in response to human-blood-feeding affect the vectorial capacity of Ae. aegypti.

Work Related Musculoskeletal Disorders Among Bus Conductors of Udupi District, Karnataka

BACKGROUND

Government bus conductors are at high risk for work-related musculoskeletal disorders (MSDs) due to the work environment and work conditions. Thus, the present study was undertaken to assess the prevalence and associated factors of musculoskeletal problems among bus conductors.

MATERIALS AND METHODS

This cross-sectional study included 237 bus conductors of government bus depots. The data were collected by interview technique on a structured questionnaire. Self-reported musculoskeletal pain over the last 12 months was the case definition.

RESULTS

The present study revealed that 62.4% of bus conductors had musculoskeletal pain. The multivariate analysis suggested that tobacco smoking, overweight or obesity, and lack of enough breaks during work were significant risk factors for the occurrence of musculoskeletal pain in study participants.

CONCLUSION

Thus, to conclude, the conductors are at risk of musculoskeletal problems, which can be attributed to occupational as well as non-occupational factors.

Chronic Low-dose Exposure to Highly Toxic Gas Phosgene and Its Effect on Peak Expiratory Flow Rate

INTRODUCTION

Phosgene is a highly toxic gas causing irritation of the airways and eyes though at high dose exposure. The effect on airways can be assessed by peak expiratory flow rate (PEFR) which is a cheaper, simple, and easy to perform test under field conditions and routine monitoring. Thus, this study is undertaken to understand the effect of chronic low-dose phosgene exposure on PEFR and the associated factors.

METHODS

This study included 287 workers of phosgene production and captive units. After recording the demographic, occupational, and clinical history on a questionnaire, every participant was subjected to clinical examination, chest radiography, and measurement of PEFR using Spirovit SP-10.

RESULTS

The mean age and mean duration of the job of participants was 42.8 ± 10.4 years and 18.9 ± 9.6 years, respectively. The PEFR was significantly reduced with increasing age, increasing duration in the job, and those having direct exposure.

CONCLUSION

PEFR is affected by chronic low-dose exposure to phosgene.

Effects of ambient air pollution on psychological stress and anxiety disorder: a systematic review and meta-analysis of epidemiological evidence

OBJECTIVES

Ambient air pollution (AAP) is an important risk factor for increased mental health morbidity. Studies have highlighted the effect of AAP on psychological stress and anxiety disorder. However, existing evidence regarding this is largely equivocal. This systematic review with meta-analysis aims to synthesize published evidence to calculate the pooled estimate of the effect of AAP on psychological stress and anxiety disorder.

CONTENT

A systematic bibliographic search was undertaken using PubMed, JGateplus, Google Scholar, and Cochrane Library for observational human studies published in English till 31st March 2020 reporting the effect of AAP on psychological stress and anxiety disorder. Study quality was assessed using the Joanna Briggs Institute critical appraisal tools. Meta-analysis was performed adopting a random-effects model using Meta-XL. Of 412 articles retrieved, a total of 30 articles [AAP and anxiety disorders, (n=17, 57%); AAP and psychological stress, (n=9, 30%) and AAP and both psychological stress and anxiety disorders, (n=4, 13%)] fulfilled the inclusion criteria covering a total population of 973,725 individuals. The pooled estimate (OR) of the effects of PM₁₀ on psychological stress was 1.03 [(95% CI: 1.00, 1.05) (p=0.17, I ²=41%)]. The pooled estimate of the effects of NO₂ and PM₁₀ on anxiety disorder was 0.93 [(95% CI: 0.89, 0.97) (p=0.91, I ²=0%)] and 0.88 [(95% CI: 0.78, 0.98) (p=0.01, I ²=59%)] respectively. The pooled estimate of the effects of PM_2.5 on anxiety Disorder was 0.88 [(95% CI: 0.72, 1.06) (p=0.00, I ²=80%)].

SUMMARY AND OUTLOOK

The present study provides the most updated pooled estimate of the effect of AAP on psychological stress and anxiety disorder. Future studies should focus on longitudinal studies conducted in LIC and LMIC countries using uniform and standardized criteria for exposure and outcome assessment as well as robust adjustment for confounders to minimize methodological heterogeneity resulting in reliable and comparable estimation of environmental mental health burden.

Mucormycosis in COVID-19 pandemic: Risk factors and linkages

Mucormycosis is a serious and potentially fatal fungal infection caused by a type of rare but opportunistic fungal pathogen called mucormycetes. Recently, mucormycosis, also known as black fungus, made severe chaos in India during the second wave (between April and June 2021) of the tragical COVID-19 epidemic by its sudden and devastating surge with up to 50% mortality rate. While the exact cause of its sharp rise suddenly and specifically during the second wave still remains debatable, it has been noted that the people who are diabetic and have recovered from COVID-19 infection are more predisposed to mucormycosis. Nevertheless, the precise reason and mechanism(s) underlying the surge of this deadly infection needs to be investigated to comprehend its pathogenesis and pathological elements and discover rationale preventative/ therapeutic solutions. It is speculated that the indiscriminate use of steroids, antibiotics and zinc as a self-medication practice that increased during the COVID-19 epidemic may have promoted the dysbiosis of gut microbiota thereby inducing immune-suppression and making the risk group highly susceptible to this mycotic disease. In these contexts, this timely article attempts to contemplate and discuss some of the possible factors and potential mechanisms that can help to understand and explain the conundrum of sudden, steep and deadly upsurge of mucormycosis infections during the second wave of COVID-19 epidemic.

Environmental Literacy among College Students

Environmental degradation has become a serious source of concern for contemporary society, giving rise to efforts in the way of advocacies, conferences and awareness campaigns at different levels. It has been widely acknowledged that environmental literacy, which is an outcome of environmental education, can provide a strong foundation for future environmental responsiveness, as well as help in the transition towards more sustainable societies and healthy living. The present study carried out among 280 college students including 145 males and 135 females in the age group 17–30 years to assess the levels of environmental knowledge and attitudes. A structured questionnaire was used to gather the information using interview technique as data collection tool. Almost 40% of the subjects were unaware about the environment, while less than half of the respondents were unwilling to protect endangered species, unwilling to change their lifestyle for protecting environment, unconcerned by other's land use, and consider runoff of water and global warming as exaggeration. The overall awareness was about 61.5%, while the attitude towards environmental protection was further lower at 50%. Thus, to conclude there is a need for environmental literacy initiatives at the university level to generate a better appreciation, involvement, and the optimistic ideas necessary to contribute to the quality of our environment.

Role of air pollution in chronic kidney disease: an update on evidence, mechanisms and mitigation strategies

Air pollution results from a variable and complex mixture of harmful gases and suspended particles and is the most worrisome of all environmental hazards. It is implicated in several non -communicable diseases and is recognized to be a public health problem. Though the initial exposure to air pollution is through the respiratory system, kidneys are thought to be exposed to higher concentrations owing to their filtration function. Chronic kidney disease is the insidious end result of several disease processes which cumulatively form a large healthcare burden, particularly in low- and middle-income countries. There is a growing body of evidence that air pollution may be a contributing factor that leads to CKD by not only its direct effects, but can also compound the effect of other factors/diseases causing kidney injury. PM_2.5 exposure particularly has been implicated, although there is some evidence regarding other air pollutants as well. These pollutants are thought to act on kidneys through several interlinked systemic pathways and mechanisms which individually and collectively damage the nephrons. Long-term exposures seem to gradually diminish renal function and lead to end-stage renal disease. A thorough understanding of the mechanism of kidney injury is the key for formulating and implementing effective strategies for reducing this burden. Maintaining the air quality, promoting education, improving health quality and promotion of targeted nephroprotective measures through effective policy and research support are required in addressing this global public health problem.

Exposure to Toluene Di-isocyanate and Respiratory Effects in Flexible Polyurethane Foam Industries in Western India

Background:

Flexible foam industry largely uses 2,4 and 2,6 Toluene di-isocyanate as main raw materials and chronic exposure to its result in occupational asthma. The exposure to di-isocyanates might be higher due to the usage of obsolete technology, hand-mixing methods and working in confined spaces with insufficient local exhaust ventilation systems in developing countries. Exposure studies in flexible foam industries have not been done in developing countries.

Objective:

The present cross-sectional study was conducted to evaluate toluene di-isocyanate (TDI) exposures and respiratory health of the workers working in the seven flexible polyurethane foam industries located in Western India during 2010-2013.

Method:

A total of 128 personal air samples collected and evaluated for total TDI concentration using improved Occupational Safety and Head Administration method number 42. Then 194 workers were covered for complete clinical examination and spirometry for assessing respiratory health.

Results:

In all, 17.83% of air samples exceeded the ACGIH TWA-TLV of 0.005 ppm for TDI. Though only 11 (5.6%) workers had respiratory complaints, the spirometry revealed that 19 (9.8%) and four (2.1%) had restrictive and obstructive type of pulmonary function impairment, respectively.

Conclusion:

The TWA concentration of TDI exceeded at raw material storage, mixing, foaming, block cutting and curing areas in four out of seven industries even in the presence of local exhaust systems. The respiratory health effect is less when compared to exposure to TDI, suitable preventive and control measures were suggested based on the study findings to the stakeholders to prevent the increase of respiratory health effects.

A Systematic Review and Meta-analysis of Prevalence of Epilepsy, Dementia, Headache, and Parkinson Disease in India

Background

There are wide variations reported in the prevalence rates of common neurological disorders in India leading to huge treatment gap. There is no comprehensive systematic review reporting prevalence of common neurological conditions affecting Indians which is essential for developing and aligning health services to meet patient care.

Objectives

The aim of this study was to perform a systematic review and meta-analysis of prevalence of epilepsy, dementia, headache, and Parkinson's disease (PD) in India from 1980 to 2019.

Methods and Materials

We performed a bibliographic systematic search in PubMed and Google Scholar along with manual search for peer-reviewed cross-sectional studies and community-based surveys reporting prevalence of epilepsy, dementia, headache, and PD in India from January 1980 to July 2019. Meta-analysis was performed adopting a random-effects model using "Metafor" package in R.

Results

The systematic review and meta-analysis included 50 studies [epilepsy (n = 22), dementia (n = 19), headache (n = 6), and PD (n = 3)] including a total of 179,1541 participants of which 5,890 were diagnosed with epilepsy, 1,843 with dementia, 914 with headache, and 121 were diagnosed with PD. The pooled prevalence of epilepsy was 4.7 per 1,000 population (95% CI: 3.8-5.6) with high heterogeneity (P < 0.01, I² = 98%). The prevalence of dementia was found to be 33.7 per 1,000 population (95% CI: 19.4-49.8) (P = 0, I² = 100%). The pooled prevalence of headache and PD were found to be 438.8 per 1,000 population (95% CI: 287.6-602.3) (P < 0.0001, I² = 97.99%), and 0.8 per 1,000 population (95%CI: 0.4-1.3) (P < 0.01, I² = 95%), respectively.

Conclusions

The findings could be used for appropriate policy measures and targeted treatments for addressing these conditions.

Nutraceuticals with anti-inflammatory and anti-oxidant properties as intervention for reducing the health effects of fine particulate matter: Potential and Prospects

Air pollution, especially particulate matter pollution adversely affects human health. A growing pool of evidence has emerged which underscores the potential of individual-level nutritional interventions in attenuating the adverse health impact of exposure to PM2.5. Although controlling emission and reducing the overall levels of air pollution remains the ultimate objective globally, the sustainable achievement of such a target and thus consequent protection of human health will require a substantial amount of time and concerted efforts worldwide. In the meantime, smaller-scale individual-level interventions that can counter the inflammatory or oxidative stress effects triggered by exposure to particulate matter may be utilized to ameliorate the health effects of PM2.5 pollution. One such intervention is incorporation of nutraceuticals in the diet. Here, we present a review of the evidence generated from various in vitro, in vivo and human studies regarding the effects of different anti-inflammatory and antioxidant nutraceuticals in ameliorating the health effects of particulate matter air pollution. The studies discussed in this review suggest that these nutraceuticals when consumed as a part of the diet, or as additional supplementation, can potentially negate the cellular level adverse effects of exposure to particulate pollution. The potential benefits of adopting a non-pharmacological diet-based approach to air pollution-induced disease management have also been discussed. We argue that before a nutraceuticals-based approach can be used for widespread public adoption, further research, especially human clinical trials, is essential to confirm the beneficial action of relevant nutraceuticals and to explore the safe limits of human supplementation and the risk of side effects. Future research should focus on systematically translating bench-based knowledge regarding nutraceuticals gained from in-vitro and in-vivo studies into clinically usable nutritional guidelines.

Road Use Pattern and Street Crossing Habits of Schoolchildren in India

Road traffic accidents (RTAs) contribute significant DALYs in the global burden of diseases. Vulnerable groups particularly pedestrians and children are at an increased risk. Road use pattern, street crossing habits, and road safety awareness are important determinants of RTAs. The present study was carried out to assess the road use pattern and street crossing habits of schoolchildren. This cross-sectional study included 497 schoolchildren of 12–15 years. The interview technique was used as a tool for data collection on a predesigned questionnaire. A total of 40.4% of schoolchildren did not like to go to school alone and wanted somebody from the family to drop them to school. About one quarter of the students were afraid of traffic and expressed their inability to deal with traffic on the road. A total of 10.7% reported crossing the street in groups, and 1.4% reported running while crossing the street. Only 80.9% of students received some form of road safety training, and the parents and schools were the major source of information for such safety training. Age <14 years and a lower level of mother's education were found to be significant contributors for poor road crossing habit in univariate as well as multivariate analysis. The study suggests that the knowledge regarding safe road use and street crossing was lacking among study participants albeit in a small proportion only. Safety aspects can be partly strengthened by imparting practical knowledge about road use pattern, street crossing habits, and road safety procedures.

The herbicide paraquat-induced molecular mechanisms in the development of acute lung injury and lung fibrosis

The herbicide paraquat (PQ; 1,1'-dimethyl-4,4'-bipyridylium dichloride) is a highly toxic organic heterocyclic herbicide that has been widely used in agricultural settings. Since its commercial introduction in the early 1960s, numerous cases of fatal PQ poisonings attributed to accidental and/or intentional ingestion of PQ concentrated formulations have been reported. The clinical manifestations of the respiratory system during the acute phase of PQ poisoning mainly include acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), followed by pulmonary fibrosis in a later phase. The focus of this review is to summarize the most recent publications related to PQ-induced lung toxicity as well as the underlying molecular mechanisms for PQ-mediated pathologic processes. Growing sets of data from in vitro and in vivo models have demonstrated the involvement of the PQ in regulating lung oxidative stress, inflammatory response, epigenetics, apoptosis, autophagy, and the progression of lung fibrosis. The article also summarizes novel therapeutic avenues based on a literature review, which can be explored as potential means to combat PQ-induced lung toxicity. Finally, we also presented clinical studies on the association of PQ exposure with the incidence of lung injury and pulmonary fibrosis.

Futuristic Non-antibiotic Therapies to Combat Antibiotic Resistance: A Review

The looming problem of resistance to antibiotics in microorganisms is a global health concern. The drug-resistant microorganisms originating from anthropogenic sources and commercial livestock farming have posed serious environmental and health challenges. Antibiotic-resistant genes constituting the environmental "resistome" get transferred to human and veterinary pathogens. Hence, deciphering the origin, mechanism and extreme of transfer of these genetic factors into pathogens is extremely important to develop not only the therapeutic interventions to curtail the infections, but also the strategies to avert the menace of microbial drug-resistance. Clinicians, researchers and policymakers should jointly come up to develop the strategies to prevent superfluous exposure of pathogens to antibiotics in non-clinical settings. This article highlights the present scenario of increasing antimicrobial-resistance in pathogenic bacteria and the clinical importance of unconventional or non-antibiotic therapies to thwart the infectious pathogenic microorganisms.

A mixed-methods community-based participatory research to explore stakeholder's perspectives and to quantify the effect of crop residue burning on air and human health in Central India: study protocol

Background

Crop residue burning adversely affects air quality and consequently human health. India, being one of the largest agro-economies of the world, produces around 500 Million tonnes of crop residue annually most of which is burnt on-farm. However, integrated studies that simultaneously quantify the effects of crop residue burning while exploring the subjective determinants of the practice are lacking in India. This paper describes the protocol for a longitudinal mixed methods research study employing a community-based participatory approach to fill this gap.

Methods

Both quantitative and qualitative data will be collected in a rural setting of the central Indian province of Madhya Pradesh, over 1 year. A steering committee comprising of the research team and community representatives will be formed. The proportion of cultivable land burnt in one crop burning season will be estimated. The association between crop residue burning, level of ambient air pollutants, and pulmonary function of village residents will be determined. Focus groups, interviews, and participatory rural appraisal methods will be used to explore stakeholder perspectives about crop residue burning. Potential barriers and opportunities for substituting burning with an alternative crop residue management technique will be ascertained as the basis for future interventions. Ethics approval has been obtained from the Institutional Ethics Committee of the National Institute for Research in Environmental Health (No: NIREH/BPL/IEC/2019–20/1494, dt 06/01/2020).

Discussion

This manuscript describes the protocol for a novel community-based participatory study to investigate thoroughly the phenomenon of crop residue burning from the perspective of the agricultural community through their active collaboration. The lack of comprehensive evidence regarding the factors responsible for crop residue burning in India underlines the importance of implementing this study protocol to fill in this critical gap in knowledge. While acknowledging that findings of this study will be not generalizable to agricultural communities other than the one studied, it is expected that the study will generate baseline evidence that might be beneficial in developing and implementing an appropriate intervention strategy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09844-6.

Occupational respiratory morbidity among hair and beauty salon workers in Udupi taluk, Karnataka, India

BACKGROUND

The Indian hair and beauty salon industry is growing rapidly due to the demand for beauty and personal care services and products. Workers in the industry are vulnerable to several occupational factors such as chemicals, confined space, and poor ventilation. Chemicals in the products used are known or suspected to cause allergies, respiratory, neurological and reproductive health problems and cancer.

METHODS

The present study was carried out to determine the factors associated with the occurrence of respiratory morbidity among hair and beauty salon workers of Udupi taluk, Karnataka, India. A total of 240 salon workers were recruited for the study. A semistructured, interviewer-led questionnaire was used to collect data. Peak expiratory flow rate (PEFR) was done using a JSB peak flow meter.

RESULTS

The frequency of respiratory morbidity among participating beauty salon workers was 19%. Men reported respiratory symptoms more frequently than women. Receiving training on work materials and practices was a significant protective factor (odds ratio = 0.3; 95% confidence interval: 0.1-0.7) for the occurrence of respiratory morbidity. The mean observed PEFR in these workers was significantly lower than their predicted values. While 61.2% of the workers were using some form of personal protective equipment, only 4% of workers used a mask or respiratory protection.

CONCLUSION

Hair and beauty salon workers are at risk of developing respiratory morbidity potentially from harmful exposures and lack of effective control measures at the workplace.

Indoor Air Quality and Sick Building Syndrome: Are Green Buildings Better than Conventional Buildings?

Indoor air quality (IAQ) influences human health, productivity and wellness. Green buildings are believed to have better IAQ. The 'sick building syndrome' (SBS) describes a set of nonspecific symptoms experienced by occupants due to time spent in a building with poor IAQ. Thus this study was undertaken to assess the IAQ in green buildings and compare it with that of conventional buildings. The prevalence of SBS in both types of buildings is also studied. In five pairs of green and conventional buildings measurements of comfort parameters (temperature & relative humidity) and indoor air pollutants using monitors was done. 148 employees which included 84 from green buildings and 64 from conventional buildings were surveyed for SBS using an interviewer-administered questionnaire. The analysis was done using SPSS16 and included Mann Whitney for IAQ pollutant concentrations and Chi-square for the SBS prevalence. Similar indoor air quality was found in both types of buildings. The mean of temperature, CO2 and formaldehyde was statistically lower in green buildings. The SBS prevalence was found to be 38.1% in green buildings and 53.1% in conventional buildings. Thus to conclude the poorly maintained green building does not have any added advantage for occurrence of SBS.

Morbidity profile of communities in Bhopal city (India) vis-à-vis distance of residence from Union Carbide India Limited plant and drinking water usage pattern

Objective:

A cross-sectional study was undertaken to assess the prevalence of morbidities in communities residing at variable distances from the closed down insecticide manufacturing plant premises of Union Carbide India Limited (UCIL), Bhopal, India and to determine association of morbidities, if any, with their drinking water usage pattern and distance of localities from the UCIL plant.

Materials and Methods:

A total of 10,827 individuals belonging to 2,184 families, residing within 0-1 km (Stratum I) and 2.5-5.0 km (Stratum II) radial distances from UCIL plant were surveyed and 9,306 of them (86%) were clinically examined. Data were analyzed to examine the association between the groups of morbidities, likely due to biological and chemical water contamination, and the distance of locality from the UCIL plant. Multiple logistic regression was used to explore the risk factors for morbidities.

Results:

Nearly similar prevalence (25.3% in stratum I, 25.8% in stratum II) and the trend of all-cause morbidities were recorded in the two strata. While morbidities related to gastrointestinal tract system (P < 0.05), auditory system (P < 0.01), neoplasm/cancers (P < 0.01) and congenital anomalies (P < 0.01) were significantly higher in stratum I, the prevalence of hypertension (6.4% stratum II, 4.7% stratum I; P < 0.01) and diabetes mellitus (3.4% stratum II, 2.0% stratum I; P < 0.001) was found significantly higher in stratum II. No association (P > 0.05) was observed between the prevalence of morbidities, likely due to the consumption of biologically or chemically contaminated drinking water, and the distance of locality/stratum from the UCIL plant.

Discussion and Conclusion:

By and large similar pattern of morbidities were recorded in the two strata suggesting that the communities, irrespective of the distance of their residences from UCIL plant or sources of their drinking water, are equally vulnerable to various morbidities.

Dendritic cell engineering for selective targeting of female reproductive tract cancers

Female reproductive tract cancers (FRCs) are considered as one of the most frequently occurring malignancies and a foremost cause of death among women. The late-stage diagnosis and limited clinical effectiveness of currently available mainstay therapies, primarily due to the developed drug resistance properties of tumour cells, further increase disease severity. In the past decade, dendritic cell (DC)-based immunotherapy has shown remarkable success and appeared as a feasible therapeutic alternative to treat several malignancies, including FRCs. Importantly, the clinical efficacy of this therapy is shown to be restricted by the established immunosuppressive tumour microenvironment. However, combining nanoengineered approaches can significantly assist DCs to overcome this tumour-induced immune tolerance. The prolonged release of nanoencapsulated tumour antigens helps improve the ability of DC-based therapeutics to selectively target and remove residual tumour cells. Incorporation of surface ligands and co-adjuvants may further aid DC targeting (in vivo) to overcome the issues associated with the short DC lifespan, immunosuppression and imprecise uptake. We herein briefly discuss the necessity and progress of DC-based therapeutics in FRCs. The review also sheds lights on the future challenges to design and develop clinically effective nanoparticles-DC combinations that can induce efficient anti-tumour immune responses and prolong patients’ survival.

Occupational health training in India: Need for a competency-driven approach

BACKGROUND

In order to cater to the changing business scenario, employment and education profiles of labor, newer occupations, and emerging occupational health challenges, it is time to improve the performance of occupational health professionals by adapting core professional competencies while drawing on global knowledge.

OBJECTIVE

To delineate the competencies required for medical graduates, medical postgraduates, and Masters in Public Health (MPH) graduates practicing occupational health in India.

MATERIALS AND METHODS

First, offline and online literature searches were carried out to enlist the core competencies for occupational health. A draft template was prepared for the identified competencies and stakeholders were asked to rank the listed competencies on a three-point scale stating must, desirable, and not required for each of the three categories of professionals, i.e., medical graduates, medical postgraduates, and MPH graduates.

RESULTS

Through the extensive literature search, 23 competencies were identified for occupational health practitioners. According to stakeholders, five competencies were a must, nine were desirable, and nine were not required by a medical graduate. Similarly for a medical postgraduate, except the ability to judge the ergonomic design of the workplace and working tools, which is considered desirable, all other competencies were considered a must while for an MPH graduate all the enlisted 23 competencies were considered a must by the stakeholders.

CONCLUSION

The framework of occupational health competencies developed through this research can be used to strengthen the training of occupational health professionals in India.

Dermatological and respiratory problems in migrant construction workers of Udupi, Karnataka

Background:

India being a developing country has tremendous demand of physical infrastructure and construction work as a result there is a raising demand of construction workers. Workers in construction industry are mainly migratory and employed on contract or subcontract basis. These workers face temporary relationship between employer and employee, uncertainty in working hours, contracting and subcontracting system, lack of basic continuous employment, lack basic amenities, and inadequacy in welfare schemes.

Objective:

To estimate the prevalence of respiratory and dermatological symptoms among migratory construction workers.

Materials and Methods:

This cross-sectional study was conducted in Manipal, Karnataka, among 340 male migratory construction workers. A standard modified questionnaire was used as a tool by the interviewer and the physical examination of the workers was done by a physician. The statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 15.0.

Result:

Eighty percent of the workers belong to the age group of 18–30 years. The mean age of the workers was 26 ± 8.2 years. Most (43.8%) of the workers are from West Bengal followed by those from Bihar and Jharkhand. The rates of prevalence of respiratory and dermatological symptoms were 33.2% and 36.2%, respectively.

Conclusion:

The migrant construction workers suffer from a high proportion of respiratory and dermatological problems.

Situational analysis of industrial hygienists in India

Background:

Industrial growth in India has resulted in increased employment opportunities thereby inflating the size of the workforce engaged in both organized and unorganized sectors. This workforce is exposed to various occupational factors at workplace and hence is susceptible to occupational diseases, the control of which requires trained occupational health manpower.

Methods:

The present study was undertaken to map the institutions offering courses to develop industrial hygienist in India, estimate the requirement of such occupational health manpower and to design competencies and curriculum for such a course.

Results:

Though there are no norms for the industrial hygienist in the Indian Factories Act, on assumption on the basis of norms provided for Safety Officer, it is estimated that for 26.92 million workforce engaged in organized sector, a total of 5407 Industrial hygienists will be required. Thus there is an estimated deficit of 51% for Industrial hygienist based on current ratio of employment. However on supply side there are only three institutes offering specialized courses on industrial hygiene out of which only one is full time residential course while rest two are offered through distance learning mode.

Conclusions:

Therefore, there is a vital need for the development of industrial hygienist not only in quantity but also in quality so that the workers in industries and communities lead socially and environmentally productive lives.

Does occupational health nursing exist in India?

Background:

Occupational health services are important to develop healthy and productive work forces, which should be delivered through occupational health team. Occupational health nurse (OHN) is an important member of this team and is required to apply nursing principles in conserving the health of workers in occupational settings.

Purpose:

This article attempts to map the occupational health nursing courses in India and design competencies and curriculum for such a course.

Materials and Methods:

Information through the Internet, printed journals, and perspectives of the key stakeholders were the principal sources of data.

Discussion:

In India, there is a need to initiate a course on occupational health nursing to provide occupational health services for the organized and unorganized sector workforce. A certificate course for occupational health nursing for 3–4 months duration offered through contact session mode can be an opportune beginning. However, to cater employed nurses an online course can be another effective alternative. The theoretical part should essentially include modules on occupational diseases, industrial hygiene, and occupational health legislation, whereas the modules on practical aspects can include visits to industries. Taking into account the existing norms of Indian Factories Act for hazardous units of organized sector an estimated 1,34,640 OHNs are required.

Conclusion:

There is a need–supply gap in the number of occupational health nursing manpower in India, which can be attributed to the absence of any course to train such manpower.

Morbidity profile of child labor at gem polishing units of Jaipur, India

BACKGROUND

There are millions of working children worldwide. Several causes are suggested for this social evil of which poverty plays a significant role in whether a child will work.

OBJECTIVE

To determine the morbidity profile in the working children of gem polishing units of Jaipur, India and assess some of its associated socio-economic factors.

METHODS

The present cross-sectional study included 586 gem polishing working children. Using interview, the demographic characteristics, occupational and clinical history of participants were recorded. The reason for taking up the job, income from the job and their desire to attend the school were also asked to assess the social causes of child labor in this region.

RESULTS

The mean±SD age of the working children was 11.3±5.3 years. In most of the instances, parents compelled the child to take up the job. Supposed to increase the family income substantially, the child labor activity failed to do so. On the other hand, the children suffered from several occupational health problems like eyestrain, headache, gastrointestinal complaints (eg, abdominal pain, nausea, vomiting, and diarrhea), musculoskeletal symptoms (e.g., back pain, pain in limbs, neck pain, and joint pains) and skin diseases (e.g., scabies, dermatitis).

CONCLUSION

It seems that the social factors forcing the children to work in the studied region, result in deterioration of their health and affect their growth.