Priya Dutta

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.

Background: Although many studies have provided evidence for all-cause mortality attributed to extreme temperature across India, few studies have provided a systematic analysis of the association between all-cause mortality and temperature. Objective: To estimate the risk associated with heat waves during two major heat waves of Nagpur occurred in 2010 and 2014. Methods: The association between temperature and mortality was measured using a distributed lag non-linear model (DLNM) and the attributable deaths associated with the heat waves with forward perspective in the DLNM framework. Results: From the ecological analysis, we found 580 and 306 additional deaths in 2010 and 2014, respectively. Moving average results also gave similar findings. DLNM results showed that the relative risk was 1.5 for the temperature above 45 °C; forward perspective analysis revealed that the attributable deaths during 2010 and 2014 were 505 and 376, respectively. Results from different methods showed that heat waves in different years had variable impacts for various reasons. However, all the results were consistent during 2010 and 2014; there were 30% and 14% extra-mortalities due to heat comparing to non-heat wave years. Conclusion: We strongly recommend the city Government to implement the action plans based on this research outcome to reduce the risk from the heat wave in future.

Indian cities struggle with some of the highest ambient air pollution levels in the world. While national efforts are building momentum towards concerted action to reduce air pollution, individual cities are taking action on this challenge to protect communities from the many health problems caused by this harmful environmental exposure. In 2017, the city of Ahmedabad launched a regional air pollution monitoring and risk communication project, the Air Information and Response (AIR) Plan. The centerpiece of the plan is an air quality index developed by the Indian Institute of Tropical Meteorology’s System for Air Quality and Weather Forecasting and Research program that summarizes information from 10 new continuous air pollution monitoring stations in the region, each reporting data that can help people avoid harmful exposures and inform policy strategies to achieve cleaner air. This paper focuses on the motivation, development, and implementation of Ahmedabad’s AIR Plan. The project is discussed in terms of its collaborative roots, public health purpose in addressing the grave threat of air pollution (particularly to vulnerable groups), technical aspects in deploying air monitoring technology, and broader goals for the dissemination of an air quality index linked to specific health messages and suggested actions to reduce harmful exposures. The city of Ahmedabad is among the first cities in India where city leaders, state government, and civil society are proactively working together to address the country’s air pollution challenge with a focus on public health. The lessons learned from the development of the AIR Plan serve as a template for other cities aiming to address the heavy burden of air pollution on public health. Effective working relationships are vital since they form the foundation for long-term success and useful knowledge sharing beyond a single city.

E study was conducted at four different traffic junctions with a cohort of 16 traffic police. For information on health effects, we administered a baseline survey at the start of the study and prospectively followed up with the officers on prevalence of heat-related symptoms. Wet bulb globe temperature (WBGT) levels ranged from 28.2°C to 36.1°C during the study period. Traffic police workers who participated in this study were exposed to WBGT levels higher than the recommended threshold limit value as per American Conference of Governmental Industrial Hygienists guidelines even beyond the hottest months of the season. Our findings suggest that airport measurements by the Indian Meteorological Department may not accurately capture heat exposures among individuals who work in and alongside high-density traffic junctions. Based on our temperature estimates, traffic police are at risk for heat stress. India is likely to experience warmer temperatures and increased heat waves in the coming decades, fueled by climate change. Therefore, it is important to reduce current and future heat-related risks for traffic police workers and similar occupational risk groups by establishing protection strategies. The protocol established in this study for occupational heat exposure assessment could be applied to a larger cohort....

Introduction: Increasing heat waves-particularly in urban areas where construction is most prevalent, highlight a need for heat exposure assessment of construction workers. This study aims to characterize the effects of heat on construction workers from a site in Gandhinagar. Materials and Methods: This study involved a mixed methods approach consisting of a cross sectional survey with anthropometric measurements (n = 219) and four focus groups with construction workers, as well as environmental measurements of heat stress exposure at a construction site. Survey data was collected in two seasons i.e., summer and winter months, and heat illness and symptoms were compared between the two time periods. Thematic coding of focus group data was used to identify vulnerability factors and coping mechanisms of the workers. Heat stress, recorded using a wet bulb globe temperature monitor, was compared to international safety standards. Results: The survey findings suggest that heat-related symptoms increased in summer; 59% of all reports in summer were positive for symptoms (from Mild to Severe) as compared to 41% in winter. Focus groups revealed four dominant themes: (1) Non-occupational stressors compound work stressors; (2) workers were particularly attuned to the impact of heat on their health; (3) workers were aware of heat-related preventive measures; and (4) few resources were currently available to protect workers from heat stress. Working conditions often exceed international heat stress safety thresholds. Female workers and new employees might be at increased risk of illness or injury. Conclusion: This study suggests significant health impacts on construction workers from heat stress exposure in the workplace, showed that heat stress levels were higher than those prescribed by international standards and highlights the need for revision of work practices, increased protective measures, and possible development of indigenous work safety standards for heat exposure.

Introduction: The present study provides a practical importance to assess the magnitude of thermal stress of workers in indoor environment taking into account the workers physiological responses. Method: The study covered indoor workers iron (N=587years) and ceramics (N=426) in three seasons. Thermal measurements were recorded by Wet Bulb Globe Temperature (WBGT) Monitor. The physiological responses include skin temperature, heart rate and blood pressure. Results: The WBGT index in summer month of ceramic (34.9±2.7°C) was higher than iron foundry works (32±1.7°C). The systolic blood pressures in winter month were higher, as compared to summer months (2mm Hg in iron and 11mm Hg in ceramic). About 32% of iron and ceramic workers had working heart rate greater than 100 beats/min and 3% beyond 130 beats/min during the working day. The skin temperature (Tsk) profile and weighted skin temperature (Tsk) were significantly higher in summer, followed by post-monsoon and winter months. Discussion: The study assesses the physiological and thermoregulatory responses of workers to heat stress and strain for their exposure to extreme hot environment. The limit of peripheral thermoregulatory adjustability may be considered beneficial and can be taken away from the fury of high heat.

Recurrent heat waves, already a concern in rapidly growing and urbanizing South Asia, will very likely worsen in a warming world. Coordinated adaptation efforts can reduce heat’s adverse health impacts, however. To address this concern in Ahmedabad (Gujarat, India), a coalition has been formed to develop an evidence-based heat preparedness plan and early warning system. This paper describes the group and initial steps in the plan’s development and implementation. Evidence accumulation included extensive literature review, analysis of local temperature and mortality data, surveys with heat-vulnerable populations, focus groups with health care professionals, and expert consultation. The findings and recommendations were encapsulated in policy briefs for key government agencies, health care professionals, outdoor workers, and slum communities, and synthesized in the heat preparedness plan. A 7-day probabilistic weather forecast was also developed and is used to trigger the plan in advance of dangerous heat waves. The pilot plan was implemented in 2013, and public outreach was done through training workshops, hoardings/billboards, pamphlets, and print advertisements. Evaluation activities and continuous improvement efforts are ongoing, along with plans to explore the program’s scalability to other Indian cities, as Ahmedabad is the first South Asian city to address heat-health threats comprehensively.