Development and validation of an ICP-MS method and its application in assessing heavy metals in whole blood samples among occupationally exposed lead smelting plant workers.

Occupational exposure to heavy metals affects various organ systems and poses a significant health risk to workers. Consequently, its precise estimation is of clinical concern and warrants the need for an analytical method with reliable precision and accuracy. The current study aimed to develop an analytical method using inductively coupled plasma‒mass spectrometry (ICP-MS) to detect trace to elevated levels of potentially toxic elements in human blood. The sample preparation was optimized using a two-step ramp temperature microwave acid digestion program. The toxic elements were quantified using ICP-MS operating in kinetic energy discrimination (KED) mode, adjusting the data acquisition parameters and instrumental settings. The analytical method was validated using standard performance parameters. Each validation parameter was aligned with the acceptable criteria outlined in standard guidelines. The method achieved optimal linearity (r2 > 0.99), recovery (85.60-112.00%), and precision (1.35-7.03%), was capable of detecting the lowest concentrations of 0.32, 0.28, 0.28, and 0.19 µg/L, and was capable of quantifying trace levels of 1.01, 0.88, 0.90, and 0.62 µg/L for arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb), respectively. Post-validation, the method was applied to estimate heavy metals in blood samples from 250 Pb-smelting plant workers, revealing potential health implications of occupational exposure. The cohort analysis revealed that demographic and employment factors were associated with elevated blood Pb levels, leading to symptoms and health risks. Clinical analysis revealed that 33.6% of the participants experienced hypertension. These findings highlight the significant health risks associated with elevated blood Pb levels. The weak but significant correlation with systolic blood pressure underscores the need for improved monitoring and workplace safety. This emphasizes the importance of continuous monitoring, targeted interventions, and enhanced occupational hygiene to protect workers' well-being.

Unraveling the interaction between lead and calcium in occupationally exposed males: an exploratory observation study.

OBJECTIVE: The systemic illnesses associated with chronic lead exposure are partially explained by the interaction between lead and calcium metabolism. Lead exposure is posited to alter calcium levels either by altering calcium homeostasis markers or altering bone remodeling. The present study investigated the interaction between blood lead levels and calcium homeostasis markers and bone remodeling markers among lead-smelting plant workers. METHOD: Adult male workers employed at the lead-smelting plant were clinically investigated as part of their regular occupational health assessment program. Additionally, control participants without occupational lead exposure, employed in administrative and white-collar jobs were invited to participate in the study. Sociodemographic and occupational details were collected by pre-standardized semi-structured questionnaires from all consenting participants, followed by clinical examination and blood collection. Blood lead levels were estimated using microwave-assisted acid digestion and the inductively coupled plasma mass spectrometry technique. Serum calcium and total protein and alkaline phosphatase levels were estimated as per standard biochemical techniques. 25-hydroxy vitamin-D3, calcitriol, and osteocalcin were estimated using the enzyme-linked immunosorbent assay. In addition to comparative analysis for comparing the two groups, independent linear regression models were explored to investigate the associations between serum calcium and blood lead and osteocalcin levels. RESULT: A total of 189 lead-exposed men employed at the lead-smelting plant and 25 male control participants consented to participate. The two groups were similar in age, diet, and body mass index. Occupationally exposed individuals exhibited significantly lower serum calcium and higher bone remodeling markers (osteocalcin and alkaline phosphatase) as compared to controls. However, the serum 25-hydroxy vitamin-D3 and calcitriol levels were not significantly different between the two groups. Lastly, the serum lead and osteocalcin were weakly but significantly associated with serum calcium levels after controlling for variations in total protein, diet, 25-hydroxy vitamin-D3, calcitriol, and alkaline phosphatase in the study participants. CONCLUSION: Current observations reinforce the adverse role of lead exposure on calcium metabolism. Although lead exposure is posited to affect calcium metabolism by multiple pathways, current study observations favor the bone remodeling pathway. The observations recommend periodic screening for calcium and bone health among lead-exposed adults.

Association Between Blood Lead Levels and Thyroid Function: An Updated Systematic Review and Meta-Analysis.

Chronic Lead (Pb) exposure is associated with disrupting certain endocrine levels and is referred to as an endocrine disruptor. Thyroid hormones, involved in regulating numerous physiological functions, are reported with conflicting associations with chronic Pb exposure. This study broadly evaluated the association between long-term lead exposure and thyroid function parameters. In this systematic review, the observational studies documenting the changes in thyroid function parameters between the chronically Pb-exposed and controls were systematically identified from PubMed-Medline, Scopus, and Embase digital databases from the beginning to March 31, 2022. The protocol was previously registered with PROSPERO (ID: CRD42022315520) and executed following PRISMA 2020 guidelines. The random-effects model was used to analyze the mean differences in thyroid function parameters between groups. The classical I2 statistic was applied to assess heterogeneity, while the Newcastle Ottawa Scale was used to assess the risk of various biases. Where data allowed, sub-group, sensitivity, and meta-regression analyses were carried out. The current systematic review included fifteen observational studies. The Pb-exposed have a higher mean blood Pb level [i.e. 28.07 (95% CI 21.43-34.72) µg/dl], significantly higher free T3 [(i.e. 0.48 pg/dl (95% CI 0.05-0.95)] and trend of higher T3. T4, FT4, and TSH levels than controls with high heterogeneity (I2 > 85%). Considering the important role of thyroid hormone in multiple biological functions, the present findings emphasize the requisite for high-quality studies to investigate the association between levels of thyroid function parameters among individuals known for cumulative exposure to Pb. Supplementary Information: The online version contains supplementary material available at 10.1007/s12291-023-01113-8.

Cadmium exposure and DNA damage (genotoxicity): a systematic review and meta-analysis.

Existing literature suggests an association between chronic cadmium (Cd) exposure and the induction of DNA damage and genotoxicity. However, observations from individual studies are inconsistent and conflicting. Therefore current systematic review aimed to pool evidence from existing literature to synthesize quantitative and qualitative corroboration on the association between markers of genotoxicity and occupational Cd exposed population. Studies that evaluated markers of DNA damage among occupationally Cd-exposed and unexposed workers were selected after a systematic literature search. The DNA damage markers included were chromosomal aberrations (chromosomal, chromatid, sister chromatid exchange), Micronucleus (MN) frequency in mono and binucleated cells (MN with condensed chromatin, lobed nucleus, nuclear buds, mitotic index, nucleoplasmatic bridges, pyknosis, and karyorrhexis), comet assay (tail intensity, tail length, tail moment, and olive tail moment), and oxidative DNA damage (8-hydroxy-deoxyguanosine). Mean differences or standardized mean differences were pooled using a random-effects model. The Cochran-Q test and I2 statistic were used to monitor heterogeneity among included studies. Twenty-nine studies with 3080 occupationally Cd-exposed and 1807 unexposed workers were included in the review. Cd among the exposed group was higher in blood [4.77 µg/L (-4.94-14.48)] and urine samples [standardized mean difference 0.47 (0.10-0.85)] than in the exposed group. The Cd exposure is positively associated with higher levels of DNA damage characterized by increased frequency of MN [7.35 (-0.32-15.02)], sister chromatid exchange [20.30 (4.34-36.26)], chromosomal aberrations, and oxidative DNA damage (comet assay and 8OHdG [0.41 (0.20-0.63)]) compared to the unexposed. However, with considerable between-study heterogeneity. Chronic Cd exposure is associated with augmented DNA damage. However, more extensive longitudinal studies with adequate sample sizes are necessary to assist the current observations and promote comprehension of the Cd's role in inducing DNA damage.Prospero Registration ID: CRD42022348874.

Association between lead exposure and DNA damage (genotoxicity): systematic review and meta-analysis.

Studies suggest that chronic lead (Pb) exposure may induce deoxyribonucleic acid (DNA) damage. However, there is no synthesised evidence in this regard. We systematically reviewed existing literature and synthesised evidence on the association between chronic Pb exposure and markers of genotoxicity. Observational studies reporting biomarkers of DNA damage among occupationally Pb-exposed and unexposed controls were systematically searched from PubMed, Scopus and Embase databases from inception to January 2022. The markers included were micronucleus frequency (MN), chromosomal aberrations, comet assay, and 8-hydroxy-deoxyguanosine. During the execution of this review, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Mean differences in the biological markers of DNA damage between Pb-exposed and control groups were pooled using the random-effects model. The heterogeneity was assessed using the Cochran-Q test and I2 statistic. The review included forty-five studies comparing markers of DNA damage between Pb-exposed and unexposed. The primary studies utilised buccal and/or peripheral leukocytes for evaluating the DNA damage. The pooled quantitative results revealed significantly higher DNA damage characterised by increased levels of MN and SCE frequency, chromosomal aberrations, and oxidative DNA damage (comet assay and 8-OHdG) among Pb-exposed than the unexposed. However, studies included in the review exhibited high levels of heterogeneity among the studies. Chronic Pb exposure is associated with DNA damage. However, high-quality, multicentred studies are required to strengthen present observations and further understand the Pb's role in inducing DNA damage. CRD42022286810.

Seroprevalence of IgG antibodies against SARS-CoV-2 among the general population and healthcare workers in India, June-July 2021: A population-based cross-sectional study.

BACKGROUND: India began COVID-19 vaccination in January 2021, initially targeting healthcare and frontline workers. The vaccination strategy was expanded in a phased manner and currently covers all individuals aged 18 years and above. India experienced a severe second wave of COVID-19 during March-June 2021. We conducted a fourth nationwide serosurvey to estimate prevalence of SARS-CoV-2 antibodies in the general population aged ≥6 years and healthcare workers (HCWs). METHODS AND FINDINGS: We did a cross-sectional study between 14 June and 6 July 2021 in the same 70 districts across 20 states and 1 union territory where 3 previous rounds of serosurveys were conducted. From each district, 10 clusters (villages in rural areas and wards in urban areas) were selected by the probability proportional to population size method. From each district, a minimum of 400 individuals aged ≥6 years from the general population (40 individuals from each cluster) and 100 HCWs from the district public health facilities were included. The serum samples were tested for the presence of IgG antibodies against S1-RBD and nucleocapsid protein of SARS-CoV-2 using chemiluminescence immunoassay. We estimated the weighted and test-adjusted seroprevalence of IgG antibodies against SARS-CoV-2, along with 95% CIs, based on the presence of antibodies to S1-RBD and/or nucleocapsid protein. Of the 28,975 individuals who participated in the survey, 2,892 (10%) were aged 6-9 years, 5,798 (20%) were aged 10-17 years, and 20,285 (70%) were aged ≥18 years; 15,160 (52.3%) participants were female, and 21,794 (75.2%) resided in rural areas. The weighted and test-adjusted prevalence of IgG antibodies against S1-RBD and/or nucleocapsid protein among the general population aged ≥6 years was 67.6% (95% CI 66.4% to 68.7%). Seroprevalence increased with age (p < 0.001) and was not different in rural and urban areas (p = 0.822). Compared to unvaccinated adults (62.3%, 95% CI 60.9% to 63.7%), seroprevalence was significantly higher among individuals who had received 1 vaccine dose (81.0%, 95% CI 79.6% to 82.3%, p < 0.001) and 2 vaccine doses (89.8%, 95% CI 88.4% to 91.1%, p < 0.001). The seroprevalence of IgG antibodies among 7,252 HCWs was 85.2% (95% CI 83.5% to 86.7%). Important limitations of the study include the survey design, which was aimed to estimate seroprevalence at the national level and not at a sub-national level, and the non-participation of 19% of eligible individuals in the survey. CONCLUSIONS: Nearly two-thirds of individuals aged ≥6 years from the general population and 85% of HCWs had antibodies against SARS-CoV-2 by June-July 2021 in India. As one-third of the population is still seronegative, it is necessary to accelerate the coverage of COVID-19 vaccination among adults and continue adherence to non-pharmaceutical interventions.

Psychosocial impact of COVID-19 pandemic on healthcare workers in India & their perceptions on the way forward - A qualitative study.

Background & objectives: The healthcare system across the world has been overburdened due to the COVID-19 pandemic impacting healthcare workers (HCWs) in different ways. The present study provides an insight into the psychosocial challenges faced by the HCWs related to their work, family and personal well-being and the associated stigmas. Additionally, the coping mechanisms adopted by them and their perceptions on the interventions to address these challenges were also explored. Methods: A qualitative study was conducted between September and December 2020 through in-depth telephonic interviews using an interview guide among 111 HCWs who were involved in COVID-19 management across 10 States in India. Results: HCWs report major changes in work-life environment that included excessive workload with erratic timings accentuated with the extended duration of inconvenient personal protection equipment usage, periods of quarantine and long durations of separation from family. Family-related issues were manifold; the main challenge being separated from family, the challenge of caregiving, especially for females with infants and children, and fears around infecting family. Stigma from the community and peers fuelled by the fear of infection was manifested through avoidance and rejection. Coping strategies included peer, family support and the positive experiences manifested as appreciation and recognition for their contribution during the pandemic. Interpretation & conclusions: The study demonstrates the psychological burden of HCWs engaged with COVID-19 care services. The study findings point to need-based psychosocial interventions at the organizational, societal and individual levels. This includes a conducive working environment involving periodic evaluation of the HCW problems, rotation of workforce by engaging more staff, debunking of false information, community and HCW involvement in COVID sensitization to allay fears and prevent stigma associated with COVID-19 infection/transmission and finally need-based psychological support for them and their families.

Docosahexaenoic acid supplementation in age-related cognitive decline: a systematic review and meta-analysis.

PURPOSE: To investigate the role of DHA supplementation in preventing age-related cognitive decline (ARCD) in individual cognitive domains by conducting systematic review and meta-analysis. METHODS: Relevant clinical trials were systematically searched at Medline, PubMed, Scopus, Cochrane, ProQuest, and Embase databases since inception to June 2018. The PRISMA guidelines were adhered for data abstraction, quality assessment, and validation of included studies. Study details such as participant characteristics, DHA supplementation, and cognitive function outcome measures, i.e., memory, attention, working memory, and executive function, were extracted to perform meta-analysis according to the Cochrane guidelines. Additional meta-regression and subgroup analyses were performed to detect confounding variables and sensitivity of results, respectively. RESULTS: Ten studies including 2327 elderly individuals were part of the final results. Study exhibited minimal or no pooled incremental effects on memory (0.22, 95%CI = - 0.17 to 0.61, I2 = 94.36%), attention (0.1, 95%CI = - 0.04 to 0.25, I2 = 32.25%), working memory (0.01, 95%CI = - 0.10 to 0.12, I2 = 0%), and executive function (0.03, 95%CI = - 0.05 to 0.11, I2 = 78.48%) among the DHA-supplemented group. The results from standard mean difference between the groups, on memory (0.08, 95%CI = - 0.12 to 0.28, I2 = 76.82%), attention (0.04, 95%CI = - 0.09 to 0.23, I2 = 42.63%), working memory (- 0.08, 95%CI = - 0.26 to 0.10, I2 = 37.57%), and executive function (0.17, 95%CI = - 0.01 to 0.36, I2 = 78.48%) were similar to the results of pooled incremental analysis. Lastly, results remained unaffected by sensitivity and sub-group analyses. CONCLUSIONS: Current pieces of evidence do not support the role of DHA supplementation, in preventing/retarding ARCD of memory, executive function, attention, and working memory. Protocol registered at PROSPERO (ID: PROSPERO 2018 CRD42018099401).

Prevalence of SARS-CoV-2 infection in India: Findings from the national serosurvey, May-June 2020.

BACKGROUND & OBJECTIVES: Population-based seroepidemiological studies measure the extent of SARS-CoV-2 infection in a country. We report the findings of the first round of a national serosurvey, conducted to estimate the seroprevalence of SARS-CoV-2 infection among adult population of India. METHODS: From May 11 to June 4, 2020, a randomly sampled, community-based survey was conducted in 700 villages/wards, selected from the 70 districts of the 21 States of India, categorized into four strata based on the incidence of reported COVID-19 cases. Four hundred adults per district were enrolled from 10 clusters with one adult per household. Serum samples were tested for IgG antibodies using COVID Kavach ELISA kit. All positive serum samples were re-tested using Euroimmun SARS-CoV-2 ELISA. Adjusting for survey design and serial test performance, weighted seroprevalence, number of infections, infection to case ratio (ICR) and infection fatality ratio (IFR) were calculated. Logistic regression was used to determine the factors associated with IgG positivity. RESULTS: Total of 30,283 households were visited and 28,000 individuals were enrolled. Population-weighted seroprevalence after adjusting for test performance was 0.73 per cent [95% confidence interval (CI): 0.34-1.13]. Males, living in urban slums and occupation with high risk of exposure to potentially infected persons were associated with seropositivity. A cumulative 6,468,388 adult infections (95% CI: 3,829,029-11,199,423) were estimated in India by the early May. The overall ICR was between 81.6 (95% CI: 48.3-141.4) and 130.1 (95% CI: 77.0-225.2) with May 11 and May 3, 2020 as plausible reference points for reported cases. The IFR in the surveyed districts from high stratum, where death reporting was more robust, was 11.72 (95% CI: 7.21-19.19) to 15.04 (9.26-24.62) per 10,000 adults, using May 24 and June 1, 2020 as plausible reference points for reported deaths. INTERPRETATION & CONCLUSIONS: Seroprevalence of SARS-CoV-2 was low among the adult population in India around the beginning of May 2020. Further national and local serosurveys are recommended to better inform the public health strategy for containment and mitigation of the epidemic in various parts of the country.

A Multimodal Structural and Functional Neuroimaging Study of Amnestic Mild Cognitive Impairment.

Examination of brain structural and functional abnormalities in amnestic mild cognitive impairment (aMCI) has the potential to enhance our understanding of the initial pathophysiological changes in dementia. We examined gray matter volumes and white matter microstructural integrity, as well as resting state functional connectivity (rsFC) in patients with aMCI (N = 48) in comparison to elderly cognitively healthy comparison subjects (N = 48). Brain volumetric comparisons were carried out using voxel-based morphometric analysis of T1-weighted images using the FMRIB Software Library. White matter microstructural integrity was examined using whole-brain tract-based spatial statistics analysis of fractional anisotropy maps generated from diffusion tensor imaging data. Finally, rsFC differences between the samples were examined by Multivariate Exploratory Linear Optimised Decomposition into Independent Components of the resting state functional magnetic resonance imaging time series, followed by between-group comparisons of selected networks using dual regression analysis. Patients with aMCI showed significant gray matter volumetric reductions in bilateral parahippocampal gyri as well as multiple other brain regions including frontal, temporal, and parietal cortices. Additionally, reduced rsFC in the anterior subdivision of the default mode network (DMN) and increased rsFC in the executive network were noted in the absence of demonstrable impairment of white matter microstructural integrity. We conclude that the demonstrable neuroimaging findings in aMCI include significant gray matter volumetric reductions in the fronto-temporo-parietal structures as well as resting state functional connectivity disturbances in DMN and executive network. These findings differentiate aMCI from healthy aging and could constitute the earliest demonstrable neuroimaging findings of incipient dementia.

Resting-State Functional Connectivity Changes Associated with Visuospatial Cognitive Deficits in Patients with Mild Alzheimer Disease.

BACKGROUND/AIMS: Alzheimer disease (AD) is a neurodegenerative disorder characterized by progressive disconnection of various brain networks leading to neuropsychological impairment. Pathology in the visual association areas has been documented in presymptomatic AD and therefore we aimed at examining the relationship between brain connectivity and visuospatial (VS) cognitive deficits in early AD. METHODS: Tests for VS working memory, episodic memory and construction were used to classify patients with AD (n = 48) as having severe VS deficits (n = 12, female = 4) or mild deficits (n = 11, female = 4). Resting-state functional magnetic resonance imaging and structural images were acquired as per the standard protocols. Between-group differences in resting-state functional connectivity (rsFC) were examined by dual regression analysis correcting for age, gender, and total brain volume. RESULTS: Patients with AD having severe VS deficits exhibited significantly reduced rsFC in bilateral lingual gyri of the visual network compared to patients with mild VS deficits. CONCLUSION: Reduced rsFC in the visual network in patients with more severe VS deficits may be a functional neuroimaging biomarker reflecting hypoconnectivity of the brain with progressive VS deficits during early AD.

Effect of propofol anesthesia on resting state brain functional connectivity in Indian population with chronic back pain.

OBJECTIVE: Functional magnetic resonance imaging (fMRI) studies in healthy volunteers have shown alterations in brain connectivity following anesthesia as compared to the awake state. It is not known if the anesthesia-induced changes in brain connectivity are different in a pathological state. This study aims to evaluate changes in the resting state functional connectivity in the brain, after propofol anesthesia, in patients with chronic back pain (CBP). MATERIALS AND METHODS: Fourteen adults with CBP were included in this prospective study over 6 months. After excluding structural brain pathology, a resting state fMRI was performed in the awake state, and the sequences were repeated after propofol anesthesia. The primary outcome measure was change in resting state connectivity after propofol. Student's t-test was performed between the pre and post-propofol sedation data of all patients with total brain volume as covariates of interest. A repeated measures analysis of variance was used to compare pre- and post-propofol changes in cardiorespiratory parameters. RESULTS: There were 8 male and 6 female patients in the study, and the mean age of the study population was 46.9 ± 11.3 years. Propofol sedation resulted in an increased strength of functional connectivity between the posterior cingulate cortex (PCC) and thalamus in patients with CBP, whereas there was a generalized decrease in functional integration within the large scale brain networks. The changes in cardiorespiratory parameters before and after propofol administration were not statistically significant. CONCLUSION: Strengthening of functional connectivity was seen between PCC and thalamus with decrease in large scale brain networks following propofol anesthesia in patients with CBP. These changes are similar to those previously described in normal volunteers.

Memory and executive functions in persons with type 2 diabetes: a meta-analysis.

Literature suggests that persons with type 2 diabetes mellitus (T2DM) are at risk for cognitive impairment, hence dementia. Common domains reported to be affected in those with T2DM are memory and executive functions. The extent of influence of T2DM on these domains has varied among studies. A systematic review and meta-analysis was carried out to understand whether sub-domains contributed to the variations observed in published research. We searched 'PubMed', 'ScienceDirect', 'SciVerseHub', 'Psychinfo', 'Proquest' 'Ebsco' and 'J-gate Plus' databases for published studies on cognition and T2DM among persons aged 50 years and older. Memory, executive functions and processing speed domain and sub-domain scores were extracted; effect sizes (Cohen's d) were calculated and analysed. Eight hundred seventeen articles were found. After various levels of filtering, 15 articles met the inclusion criteria for quantitative analyses. The analyses indicated that in comparison to controls, persons with T2DM showed decrements in episodic memory (d = -0.51), logical memory (d = -0.24), sub-domain of executive functions which included phonemic fluency (d = -0.35) and cognitive flexibility (d = 0.52), and speed of processing (d = -0.22). We found no difference in the sub-domains of verbal short-term memory and working memory. The meta-analysis revealed a detrimental effect of T2DM on cognitive sub-domains, namely, episodic memory and cognitive flexibility. There was a trend for the logical memory, phonemic fluency and processing speed to be affected. The analysis indicates that T2DM is a detrimental factor on certain cognitive sub-domains, rendering the person vulnerable to subsequent dementia. Copyright © 2016 John Wiley & Sons, Ltd.

Mixed methods study on latent tuberculosis among agate stone workers and advocacy for testing silica dust exposed individuals in India.

The 2021 tuberculosis (TB) preventive treatment guidelines in India included silicosis as a screening group, yet latent TB infection (LTBI) testing for silica-dust-exposed individuals is underemphasized. Focusing on an estimated 52 million silica-dust-exposed workers, particularly agate-stone workers in Khambhat, Gujarat, our study aims to estimate LTBI prevalence, identify predictors, and gather insights from TB and silicosis experts. Employing a sequential explanatory mixed-methods approach, a cross-sectional study involved 463 agate-stone workers aged ≥ 20 years in Khambhat, using IGRA kits for LTBI testing. In-depth interviews with experts complemented quantitative findings. Among agate-stone workers, 58% tested positive for LTBI, with predictors including longer exposure, type of work, and BCG vaccination. Our findings reveal a nearly double burden of LTBI compared to the general population, particularly in occupations with higher silica dust exposure. Experts advocate for including silica-dust-exposed individuals in high-risk groups for LTBI testing, exploring cost-effective alternatives like improved skin sensitivity tests, and shorter TB preventive treatment regimens to enhance compliance. Future research should explore upfront TB preventive treatment for silica-dust-exposed individuals with high LTBI prevalence and optimal exposure duration. This study underscores the urgent need for policy changes and innovative approaches to TB prevention among silica-dust-exposed populations, impacting global occupational health strategies.

Assessing Health Seeking Behaviors and Economic Consequences of Morbidity in Indian Construction Workers: A Multicenter Study.

Background: Construction laborers succumb to poor health due to the inherent workplace health hazards and poor socio-economic living conditions. With rising healthcare expenses, the increased risk of poor health may aggravate their economic status, pushing them deeper into poverty. Settings and Design: The current cross-sectional multicenter study comprehensively investigated the determinants of health, health-seeking behavior, and poor economic impact regarding catastrophic health expenditure (CHE) among construction laborers. Methods and Material: We collected details on illnesses among self and family members of the construction laborers that required healthcare visits during the previous year and their approximate expenses. Among the 1110 participants with complete data, 37% reported illness requiring a healthcare visit either for self or a family member. Results: Regression models to ascertain demographic and living condition determinants of perceived illness revealed an increased risk of illness when the kitchen is shared with the living space (OR = 1.87) and use unhygienic smoky cooking fuels (OR = 1.87). More than 25% of those who reported illness incurred CHE. Conclusion: We conclude that the frequency of perceived illness and the economic impact, i.e., CHE is relatively higher among the construction laborers. Our results demonstrate that poor living conditions add to the burden of morbidity in construction workers and families. Providing healthcare coverage for this population and engaging and educating them about affordable healthcare are necessary future steps to prevent the worsening of the economic situation.

Development and validation of tools to screen occupational mental health and workplace factors influencing it: for the Indian workforce.

An imbalance in the key organizational psychology constructs viz. "Workload", "Reward", "Community", "Control", "Values" and "Fairness" are potential factors leading to negative occupational mental health, i.e. burnout. Burnout, a psychological syndrome is the combination of emotional exhaustion, sense of reduced compassion and accomplishment. To note, the concept of occupational mental health in a nation with second largest workforce is nascent. Further, the utility of existing western tools in Indian subcontinent is limited by culturally inappropriateness, patented, less comprehensible and other factors. Present study attempted to develop tools to screen occupational mental health and workplace areas. Conventional steps involved in psychological tool development, viz. construct identification, drafting of pertinent questions, content validation, field testing of questions and others were adopted. After series of steps, tools for screening occupational mental health and key constructs influencing mental health at workplace (workplace assessment) were developed. The screening tools exhibited adequate test-retest reliability, internal consistency/reliability (cronbach's α>0.73) and correlation (correlation coefficient >0.6) with the general mental health in larger evaluation of 153 consenting workers. The proposed simple and easy to administer tool requires development of normative scores thereby aiding early diagnosis and management of those requiring intervention.

Development and validation of Graphite Furnace Atomic Absorption Spectrometry method and its application for clinical evaluation of blood lead levels among occupationally exposed lead smelting plant workers.

The growing interest in estimating the blood lead levels, for early detection of lead exposure, warranted a need for a validated analytical method for trace levels estimation of lead. The present study aimed to develop an analytical method for detecting trace amounts to elevated levels of lead in human blood using the Graphite Furnace Atomic Absorption Spectrometry technique and its application in evaluating blood lead levels among occupationally exposed individuals. The method validation was performed with standard test parameters including linearity, recovery, precision, method detection limit, and limit of quantification. The validation results for each performance parameter were in agreement with acceptable criteria as per standard guidelines. The correlation was observed as optimum linear (R2 = 0.998) between absorbance and lead concentration range from 0 to 10 µg/dL. The recoveries for spiked samples ranged between 95 and 105%. The calculated value for the method detection limit was 0.16 µg/dL and the limit of quantification was 0.51 µg/dL. The precision for all spiked concentrations was below 10% of the relative standard deviation. Evaluation of lead exposure among occupationally exposed individuals revealed the study population had found average blood lead level (42.80 ± 12.47 µg/dL), which was above the upper acceptable limit suggested by Occupational Safety and Health Administration, USA. The majority of system-specific symptoms were observed among study groups having mean blood lead levels above 40 µg/dL. However, sociodemographic status and employment factors were found possible determinants of the prevalence of high blood lead levels.

Occupational exposure of vehicular emissions and cardiorespiratory risk among urban metropolitan bus drivers: A cross-sectional comparative study.

BACKGROUND: Vehicular emissions on long-term exposure predispose metropolitan bus drivers to cardiorespiratory ailments. OBJECTIVE: To evaluate the cardiorespiratory risk of urban metropolitan bus drivers related to vehicular emission exposure. METHODS: Bus drivers (with service >5 years, n = 254) and their administrative controls (primarily engaged in indoor white collared jobs, n = 73) were recruited. Demographic, occupational and clinical details were collected through pre-validated standardized format. Pulmonary Function Test (PFT) and lipid profile were carried out with standard protocol. Risk for cardiovascular events for preceding 10-years was estimated with WHO/ISH risk prediction chart and QRISK3 score. Exposure assessments for particulate matter (PM) were performed for both groups while duty hours. RESULTS: Exposure of drivers to PM2.5 six times and PM10 five times higher in comparison to administration staff (PM2.5- 970.9 v/s 145.0µg/m3 TWA and PM10- 1111.7 v/s 233.8µg/m3 TWA). Bus drivers exhibited significantly higher prevalence of respiratory symptoms (dyspnea-25% v/s 6.8% and cough-20.1% v/s 9.8%) and compromised PFT (obstructive-21% v/s 5.7% and restrictive-4.2% v/s 2.9%) in comparison to controls. Multivariate regression statistics reveal a significant decline for FEV1/FVC and FEV25-75 % among bus drivers compared to controls, controlling the influence of physiological and environmental factors. The difference between predicted cardiac age and their respective chronological age was twice higher (8.3 v/s 4.3 years) among drivers compared to their administration staff. CONCLUSION: Bus drivers were exposed to high levels of outdoor air pollutants. Further, the drivers exhibited higher risk for ischemic attack and obstructive airway diseases as compared to administration staff.

Need for workplace smoking cessation program among public transit drivers: Evidence from a cross-sectional study in a metropolitan city of Western India.

Background: Air pollution is a significant contributor to respiratory illness globally, and in India, evidence is scarce on whether smoking exacerbates this problem. Objective and Methods: We aimed at assessing if being a smoker among public transit drivers increased risk for respiratory illnesses and affected performance of pulmonary function tests in a cross-sectional study in a metropolitan city of Gujarat, western state of India. We conducted a cross-sectional study among public transit drivers (those who were smoking and not smoking). Administration staff who were not smoking were considered as control group. We collected socio-demographic and medical history including occupational history (N = 296). We collected details of respiratory symptoms with standard tools and assessed pulmonary function tests (PFT) using spirometry. Group differences and regression analyses were conducted in R software. Results: We found that respiratory symptoms among public transit drivers who smoked were higher than those who did not smoke and healthy controls. In PFT diagnosis, drivers who smoke displayed two times higher prevalence of obstructive pattern compared to drivers who did not smoke. There was a significant reduction in the larger as well as the smaller airway functions, reflected in reduction of FEV1/FVC ratio (p < 0.001) and FEF25-75% (p < 0.001), respectively, among drivers who smoked compared to controls. Our results indicate that being a driver with a smoking history leads to a 3.1% greater decrease in the FEV1/FVC ratio and about half a litre reduction in FEF25-75% compared to the drivers who did not smoke. Conclusion: We suggest there is a high need for smoking cessation programmes for public transit drivers as they are at higher risk for respiratory illnesses and reduced pulmonary functions when smoking is added to the existing vehicular exposure.

Factors associated with stigma and manifestations experienced by Indian health care workers involved in COVID-19 management in India: A qualitative study.

Healthcare personnel who deal with COVID-19 experience stigma. There is a lack of national-level representative qualitative data to study COVID-19-related stigma among healthcare workers in India. The present study explores factors associated with stigma and manifestations experienced by Indian healthcare workers involved in COVID-19 management. We conducted in-depth interviews across 10 centres in India, which were analysed using NVivo software version 12. Thematic and sentiment analysis was performed to gain deep insights into the complex phenomenon by categorising the qualitative data into meaningful and related categories. Healthcare workers (HCW) usually addressed the stigma they encountered when doing their COVID duties under the superordinate theme of stigma. Among them, 77.42% said they had been stigmatised in some way. Analyses revealed seven interrelated themes surrounding stigma among healthcare workers. It can be seen that the majority of the stigma and coping sentiments fall into the mixed category, followed by the negative sentiment category. This study contributes to our understanding of stigma and discrimination in low- and middle-income settings. Our data show that the emergence of fear of the virus has quickly turned into a stigma against healthcare workers.