Dileep Mavalankar

Globally, the burden of cardiovascular disease is on the rise. Despite WHO’s and the UN’s frantic efforts, it appears less probable that the 25 by 25 aim will be met. Early identification of at-risk cases using a risk scoring system can aid in achieving these goals, however for primary and secondary prevention, suitability of these scoring systems, for the countries with medium to low resources, including Asians, with respect to accuracies is a challenge as majority of them are developed from non-Asian cohorts. In light of methodological considerations, risk attribution, and policy consequences, we included and described, restricting our search but sytematically, with five widely used global tools for CVD risk 10-year prediction—FRS, WHO CVD, QRISK, ASCVD, and SCORE—and their updated versions, altogether 11, published during 1970-2023. In general, the results of consolidated risk ratings and summarization showed that these algorithms can differentiate CVD 10-yr risk by 63-86% accurately, considering both for internal and external validity. Further, we discuss their methodological perspectives, ad hoc use, and suggest prospects. Registration: Open Science Framework ( https://osf.io/72v48 ) Highlights: Globally and optimally used cardiovascular disease (CVD) risk scoring algorithms have diverse accuracies, generalizability, and levels of evidence based on study designs, analyses, and given gold standards. Although validated fair to excellent, still the performance of these tools can be increased from 12 to 37%, both for internal and external accuracy, which can have a positive impact on cost and public health. Lifestyle and related changes due to gene-environment interaction, these algorithms are liable to change, so we need to update, validate, and fit them accordingly. Implementational, methodological, technological, and cost-related issues need to be addressed for a country or a state-specific algorithm to be up taken, updated, or validated.

Komal Shah, Varna V P, Ujeeta Sharma, Dileep Mavalankar; Response to Letter to Editor: A Statistical commentary on “Does vitamin D supplementation reduces COVID

Climate change-driven temperature increases worsen air quality in places where coal combustion powers electricity for air conditioning. Climate solutions that substitute clean and renewable energy in place of polluting coal and promote adaptation to warming through reflective cool roofs can reduce cooling energy demand in buildings, lower power sector carbon emissions, and improve air quality and health. We investigate the air quality and health co-benefits of climate solutions in Ahmedabad, India—a city where air pollution levels exceed national health-based standards—through an interdisciplinary modeling approach. Using a 2018 baseline, we quantify changes in fine particulate matter (PM_2.5) air pollution and all-cause mortality in 2030 from increasing renewable energy use (mitigation) and expanding Ahmedabad’s cool roofs heat resilience program (adaptation). We apply local demographic and health data and compare a 2030 mitigation and adaptation (M&A) scenario to a 2030 business-as-usual (BAU) scenario (without climate change response actions), each relative to 2018 pollution levels. We estimate that the 2030 BAU scenario results in an increase of PM_2.5 air pollution of 4.13 µg m⁻³ from 2018 compared to a 0.11 µg m⁻³ decline from 2018 under the 2030 M&A scenario. Reduced PM_2.5 air pollution under 2030 M&A results in 1216–1414 fewer premature all-cause deaths annually compared to 2030 BAU. Achievement of National Clean Air Programme, National Ambient Air Quality Standards, or World Health Organization annual PM_2.5 Air Quality Guideline targets in 2030 results in up to 6510, 9047, or 17 369 fewer annual deaths, respectively, relative to 2030 BAU. This comprehensive modeling method is adaptable to estimate local air quality and health co-benefits in other settings by integrating climate, energy, cooling, land cover, air pollution, and health data. Our findings demonstrate that city-level climate change response policies can achieve substantial air quality and health co-benefits. Such work can inform public discourse on the near-term health benefits of mitigation and adaptation.

Most of India’s current electricity demand is met by combustion of fossil fuels, particularly coal. But the country has embarked on a major expansion of renewable energy and aims for half of its electricity needs to be met by renewable sources by 2030. As climate change-driven temperature increases continue to threaten India’s population and drive increased demand for air conditioning, there is a need to estimate the local benefits of policies that increase renewable energy capacity and reduce cooling demand in buildings. We investigate the impacts of climate change-driven temperature increases, along with population and economic growth, on demand for electricity to cool buildings in the Indian city of Ahmedabad between 2018 and 2030. We estimate the share of energy demand met by coal-fired power plants versus renewable energy in 2030, and the cooling energy demand effects of expanded cool roof adaptation in the city. We find renewable energy capacity could increase from meeting 9% of cooling energy demand in 2018 to 45% in 2030. Our modeling indicates a near doubling in total electricity supply and a nearly threefold growth in cooling demand by 2030. Expansion of cool roofs to 20% of total roof area (associated with a 0.21 TWh reduction in cooling demand between 2018 and 2030) could more than offset the city’s climate change-driven 2030 increase in cooling demand (0.17 TWh/year). This study establishes a framework for linking climate, land cover, and energy models to help policymakers better prepare for growing cooling energy demand under a changing climate.

Introduction The present study assessed the prevalence of COVID-19 among people practicing three-step rhythmic breathing (3SRB) exercise and those who were not practicing any breathing exercises, including 3SRB exercise. Methods A community-based cross-sectional observational study was conducted. Data was collected using a self-constructed online google survey tool from July 2020 to August 2020. Results Out of a total 1083 sample, a higher proportion of the participants (41.3%) belonged to the 34-49 years age group, followed by the age group of 50-65 (32.5%). The sample was almost equally distributed; about 51.9% of the population was male, and 48.4% were female. The COVID-19 positivity was recorded almost double (3.1%) in groups not practicing 3SRB exercises compared to a group (1.3%) practicing 3SRB exercises. Furthermore, the practice of 3SRB was significantly associated with a lower percentage of COVID-19 infection (p=0.046). Conclusions Practice of 3SRB is significantly associated with a lower percentage of COVID-19 infection. A future study with a robust methodology is warranted to validate the findings of this study and determine the effects of 3SRB on physiological and biological markers.

The Registry for International Development Impact Evaluations (RIDIE), is a project of the International Initiative for Impact Evaluation (3ie). RIDIE is a registry of impact evaluations related to development in low and middle income countries. The purpose of the registry is to enhance the transparency and quality of evaluation research as well as to provide a repository of impact evaluation studies for researchers, funders, and others.

Introduction: Extreme heat is a significant cause of morbidity and mortality, and the incidence of acute heat illness (AHI) will likely increase secondary to anthropogenic climate change. Prompt diagnosis and treatment of AHI are critical; however, relevant diagnostic and surveillance tools have received little attention. In this exploratory cross-sectional and diagnostic accuracy study, we evaluated three tools for use in the prehospital setting: 1) case definitions; 2) portable loggers to measure on-scene heat exposure; and 3) prevalence data for potential AHI risk factors.Methods: We enrolled 480 patients who presented to emergency medical services with chief complaints consistent with AHI in Ahmedabad, India, from April–June 2016 in a cross-sectional study. We evaluated AHI case definition test characteristics in reference to trained prehospital provider impressions, compared on-scene heat index measured by portable loggers to weather station measurements, and identified AHI behavioral and environmental risk factors using logistic regression.Results: The case definition for heat exhaustion was 23.8% (12.1-39.5%) sensitive and 93.6% (90.9-95.7%) specific. The positive and negative predictive values were 33.5% (20.8-49.0%) and 90.1% (88.5-91.5%), respectively. Mean scene heat index was 6.7°C higher than the mean station heat index (P < 0.001), and station data systematically underestimated heat exposure, particularly for AHI cases. Heat exhaustion cases were associated with on-scene heat index ≥ 49°C (odds ratio [OR] 2.66 [1.13–6.25], P = 0.025) and a history of recent exertion (OR 3.66 [1.30–10.29], P = 0.014), while on-scene air conditioning was protective (OR 0.29 [0.10–0.85], P = 0.024).Conclusion: Systematic collection of prehospital data including recent activity history and presence of air conditioning can facilitate early AHI detection, timely intervention, and surveillance. Scene temperature data can be reliably collected and improve heat exposure and AHI risk assessment. Such data may be important elements of surveillance, clinical practice, and climate change adaptation.

The Indian national health policy encourages partnerships with private providers as a means to achieve universal health coverage. One of these was the Chiranjeevi Yojana (CY), a partnership since 2006 with private obstetricians to increase access to institutional births in the state of Gujarat. More than a million births have occurred under this programme. We studied women’s perceptions of quality of care in the private CY facilities, conducting 30 narrative interviews between June 2012 and April 2013 with mothers who had birthed in 10 CY facilities within the last month. The commonly agreed upon characteristics of a “good (sari) delivery” were: giving birth vaginally, to a male child, with the shortest period of pain, and preferably free of charge. But all this mattered only after the primary outcome of being “saved” was satisfied. Women ensured this by choosing a competent provider, a “good doctor”. They wanted a quick delivery by manipulating “heat” (intensifying contractions) through oxytocics. There were instances of inadequate clinical care for serious morbidities although the few women who experienced poor quality of care still expressed satisfaction with their overall care. Mothers’ experiences during birth are more accurate indicators of the quality of care received by them, than the satisfaction they report at discharge. Improving health literacy of communities regarding the common causes of severe maternal morbidity and mortality must be addressed urgently. It is essential that cashless CY services be ensured to achieve the goal of 100% institutional births.