Survival Analysis for Cohort of Bhopal Gas Disaster Victims during 1985-2015.

Context: After the gas tragedy on the night of December 2/3, 1984, at Bhopal, the Indian Council of Medical Research (ICMR) started following up on four population cohorts with different levels of post-disaster mortality from December 3-6, 1984. Aims: The present study was undertaken to estimate the survival time of the cohort, and investigate the risk of mortality based on exposure, gender, and median age. Settings and Design: Survival analysis is generally used to evaluate factors associated with the time to an event of failure or death among any covered population. Methods and Materials: To know the cause of death and mortality rate, a retrospective cohort analysis was conducted on the outcomes of 92,320 individuals with an exposed and non-exposed group from 1985 to 2015 in Bhopal, India. Statistical Analysis Used: Basic survival analysis method, Kaplan-Meier method, and Cox proportional hazard regression model were used to analyze the mortality risk. Results: During the past 30 years, the survivability was 87.25%, and the mortality rate was 7.2% for the cohort population of Bhopal gas survivors. Cox regression analysis showed that exposed, males, and individuals above 21 years (at the time of the disaster) were at higher risk of mortality from 1985 to 2015. Conclusions: During the initial two phases, the mortality was higher in the exposed group, but over time, their survival turned out to be the same in both groups.

Is ambient air pollution a risk factor for Parkinson's disease? A meta-analysis of epidemiological evidence.

Current evidence shows inconsistencies about ambient air pollution (AAP) exposure as a risk factor for Parkinson's disease (PD). We performed meta-analyses to estimate the pooled risk of PD due to AAP exposure. 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 PD due to exposure to PM2.5, PM10, O3, CO, NO2, NOX and SO2; from the beginning until October 2021. The pooled odds ratio (OR) for the effect of NO2 (per 1 µg/m3) and O3 (per 1 ppb) on PD was 1.01[95% CI: 1.00,1.02; I2 = 69% (p = .01)] and 1.01 [95% CI: 1.00,1.02; I2 = 66% (p = .03)], respectively. The ORs for the effects of PM2.5 (per 1 µg/m3) and CO (per 1 ppm) on PD were 1.01 [95% CI: .99,1.03; I2 = 40%] and 1.64 [95% CI: .96,2.78; I2 = 75% (p = .01)], respectively. The study showed the adverse roles of NO2, O3, PM2.5, and CO in increasing the risk for PD.

Development & validation of scales to assess stigma related to COVID-19 in India.

Background & objectives: COVID-19 pandemic has triggered social stigma towards individuals affected and their families. This study describes the process undertaken for the development and validation of scales to assess stigmatizing attitudes and experiences among COVID-19 and non-COVID-19 participants from the community. Methods: COVID-19 Stigma Scale and Community COVID-19 Stigma Scale constituting 13 and six items, respectively, were developed based on review of literature and news reports, expert committee evaluation and participants' interviews through telephone for a multicentric study in India. For content validity, 61 (30 COVID-19-recovered and 31 non-COVID-19 participants from the community) were recruited. Test-retest reliability of the scales was assessed among 99 participants (41 COVID-19 recovered and 58 non-COVID-19). Participants were administered the scale at two-time points after a gap of 7-12 days. Cronbach's alpha, overall percentage agreement and kappa statistics were used to assess internal consistency and test-retest reliability. Results: Items in the scales were relevant and comprehensible. Both the scales had Cronbach's α above 0.6 indicating moderate-to-good internal consistency. Test-retest reliability assessed using kappa statistics indicated that for the COVID-19 Stigma Scale, seven items had a moderate agreement (0.4-0.6). For the Community COVID-19 Stigma Scale, four items had a moderate agreement. Interpretation & conclusions: Validity and reliability of the two stigma scales indicated that the scales were comprehensible and had moderate internal consistency. These scales could be used to assess COVID-19 stigma and help in the development of appropriate stigma reduction interventions for COVID-19 infected, and mitigation of stigmatizing attitudes in the community.

The perspectives of community members on COVID-19-related social stigma and mitigation strategies: A qualitative study in Madhya Pradesh, India.

Aim: Stigma is a well-documented impediment to health-seeking behaviors and treatment adherence. An explicit societal understanding is essential to halt the stigmatization. Studies documented COVID-19-associated stigma among healthcare personnel. However, there is little evidence regarding community perceptions and experiences of the stigma associated with COVID-2019. We described how various communities perceive and experience the stigma associated with the COVID-19 pandemic. Method: We conducted a phenomenological study in three districts of Madhya Pradesh, with both urban and rural areas. We conducted 36 in-depth phone interviews. All the interviews were recorded, transcribed, and translated into English and analyzed using thematic analysis. Results: Two major themes were derived: 1) experiences of coronavirus disease 2019 recovered individuals and community members on discrimination and stigma, and 2) efforts to reduce coronavirus disease 2019-associated discrimination and stigma. Social support is critical in mitigating the adverse effects of stigma and thereby aiding in preventing disease spread. They express gratitude to the local government for moral support. Although activities involving information, education, and communication may be beneficial in reducing the stigma associated with COVID 2019, the mass media have a critical role. Conclusions: The multidisciplinary teams comprising medical, social, and behavioral scientists and communication and media experts should be formed to reduce the risk of ambiguous messages and misinformation related to COVID-19 at primary care at the community level. Furthermore, it is vital for anti-stigma orientation among community members via mass media.

Spirometric Measurement among Polyurethane Foam Mattress-making Workers of India.

BACKGROUND: The polyurethane foam (PUF) mattress-making workers are exposed to isocyanates which are known respiratory toxicants and cause effect on pulmonary volumes and flows. Thus, the study was with a rationale to measure the changes in pulmonary flow and volumes due to isocyanates among PUF mattress-making workers. MATERIALS AND METHODS: The study included 183 male workers from seven PUF making units of western and northern India. Using the interview technique as a tool for data collection, demographic and occupational details of the subjects were recorded on the predesigned and pretested pro forma. The mean of spirometric parameters was compared using one-way ANOVA and t-test. The relation between spirometric parameters and anthropometric parameters was analyzed using the correlation coefficient. RESULTS: The spirometry showed that out of 183 participants, 165 (90.2%) subjects had normal spirometry, 13 (7.1%) had restrictive impairment, and 4 (2.2%) had obstructive impairment. All the mean spirometric values showed a declining trend with increasing age, while only forced expiratory volume in first second and forced vital capacity25%-75% showed a declining trend with increasing duration of employment. The spirometric measurements had a negative correlation with age and positive correlation with height. CONCLUSION: The spirometric values representing the airway flow were affected. The associated factors include age and duration of exposure.

Respiratory health of workers exposed to polyacrylate dust.

BACKGROUND: Polyacrylate (PA) powder dust formed in PA manufacturing units is fine sized, i.e., in nanosize. Although several previous studies reported possible significant adverse effects of nanomaterials, studies on the harmful effect of small-sized PA particles on the respiratory health of the workers are scarce. The present study was carried out to assess the effect of PA on respiratory health and lung volumes/rates among the workers of PA manufacturing unit. MATERIALS AND METHODS: The present cross-sectional study included 84 workers of PA manufacturing unit. Using interview technique as a tool for data collection, demographic, occupational, and clinical details of the workers were recorded on the predesigned pro forma. This was followed by detailed clinical examination, spirometry, chest X-ray ( posteroanterior [PA] view), and high-resolution computed tomography (HRCT) examination of each worker. RESULTS: On the basis of clinical examination, chest radiography, and HRCT, 17.9% of the workers were found to have fibrotic and cavitary changes in lung parenchyma. The production department workers had a higher proportion of respiratory morbidities as compared to supervisory or office staff. Age, gender, smoking habit, and duration of exposure were nonsignificant risk factors for respiratory morbidity. The overall mean forced vital capacity, forced expiratory volume in 1st s, Peak Expiratory Flow Rate (PEFR), (Maximal Mid Expiratory Flow Rate) MMEFR0.2-1.2, and MMEFR25%-75% were 3.19 ± 0.77 L, 2.72 ± 0.67 L, 6.82 ± 1.86 L/s, 5.79 ± 2.03 L/s, and 3.16 ± 1.19 L/s, respectively. Females and those having respiratory morbidity had significantly lower values of all spirometric parameters as compared to their counterparts. CONCLUSIONS: The workers exposed to engineered fine dust of PA may be at risk of respiratory ill-health.

Silica Exposure and Effect on Peak Expiratory Flow: Slate Pencil Workers' Study.

BACKGROUND: Peak expiratory flow (PEF) is a spirometric test that detects obstructive changes in the respiratory tract; has good correlation with the FEV1; and is much less expensive, simpler, and easier to perform under field conditions than FEV1. Chronic silicosis is also known to have obstructive features in advanced stages. Thus, this study was performed to assess the effect of silica exposure on PEF and the factors related to it. METHODS: The present study was carried out among 193 slate pencil cutting workers of Multanpura village of Madhya Pradesh, India. An interview technique was used to record demographic characteristics and occupational history on a predesigned form, which included a questionnaire regarding occupational history and silica-related respiratory morbidities. This was followed by a complete medical examination and measurement of PEF using a spirometer. RESULTS: The mean age was 43.35 ± 11.31 y, and the mean duration of exposure was 18.72 ± 9.33 y. In the present study, PEF was found to be significantly reduced in those age ≥40 y, those who were female, those having duration of exposure >10 y, and those having respiratory morbidity, whereas the reduction in PEF was statistically nonsignificant for smokers. CONCLUSIONS: Higher age, female sex, higher duration of exposure, and respiratory morbidity were found to be important correlates of PEF.