Poor personal protective equipment practices were associated with heat-related symptoms among Asian healthcare workers: a large-scale multi-national questionnaire survey.

BACKGROUND: It is pertinent to understand the perceptions of healthcare workers (HCWs) with their associated personal protective equipment (PPE) usage and heat strain symptoms experienced to effectively combat the negative effects of heat stress during treatment and care activities. METHODS: We evaluated the associated heat stress perceived by HCWs across Asia and validated a questionnaire on perceptions of heat stress, associated PPE usage, and heat strain symptoms experienced. The questionnaire was administered to 3,082 HCWs in six Asian regions. Factor analyses, including Cronbach's alpha, assessed the questionnaire's validity and reliability. Structural equation modelling analysed the effects of knowledge, attitudes and practices, and heat strain symptoms. RESULTS: The questionnaire was found to be reliable in assessing HCWs' knowledge, and attitudes and practices towards heat stress and PPE usage (both Cronbach's alpha = 0.9), but not heat strain symptoms (Cronbach's alpha = 0.6). Despite knowledge of heat stress, HCWs had negative attitudes and practices regarding PPE usage (ß1 = 0.6, p < 0.001). Knowledge (path coefficient = 0.2, p < 0.001), and negative attitudes and practices (path coefficient = 0.2, p < 0.001) of HCWs towards heat stress and PPE usage adversely affected symptoms experienced. CONCLUSIONS: The questionnaire was not reliable in assessing symptoms. HCWs should, nevertheless, still self-assess their symptoms for early detection of heat strain. To effectively attenuate heat strain, understanding HCWs' attitudes and practices towards PPE usage should guide policymakers in implementing targeted heat management strategies.

Heat stress and adverse pregnancy outcome: Prospective cohort study.

OBJECTIVE: To explore the relationship between occupational heat exposure, physiological heat strain indicators and adverse outcomes in pregnant women. DESIGN: Prospective cohort. SETTING: Workplaces in Tamil Nadu, India. SAMPLE: A cohort of 800 pregnant women engaged in moderate to heavy physical work in 2017-2019 and 2021-2022. METHODS: Participants were recruited at between 8 and 14 weeks of gestation. Occupational heat exposure and heat strain indicators were captured each trimester. 'Heat exposed' was defined as heat stress exceeding the threshold limit value (TLV) for safe manual work (with maximum wet-bulb globe temperatures of 27.5°C for a heavy workload and 28.0°C for a moderate workload). Physiological heat strain indicators (HSIs) such as core body temperature (CBT) and urine specific gravity (USG) were measured before and after each shift. Heat-related health symptoms were captured using the modified HOTHAPS questionnaire. MAIN OUTCOME MEASURES: The main outcome measures included (1) a composite measure of any adverse pregnancy outcome (APO) during pregnancy (including miscarriage, preterm birth, low birthweight, stillbirth, intrauterine growth restriction and birth defects), (2) a composite measure of adverse outcomes at birth (3) and miscarriage. RESULTS: Of the 800 participants, 47.3% had high occupational heat exposure. A rise in CBT was recorded in 17.4% of exposed workers, and 29.6% of workers experienced moderate dehydration (USG ≥ 1.020). Heat-exposed women had a doubled risk of miscarriage (adjusted odds ratio, aOR 2.4; 95% confidence interval, 95% CI 1.0-5.7). High occupational heat exposure was associated with an increased risk of any adverse pregnancy and foetal outcome (aOR 2.3; 95% CI 1.4-3.8) and adverse outcome at birth (aOR 2.0; 95% CI 1.2-3.3). CONCLUSIONS: High occupational heat exposure is associated with HSIs and adverse pregnancy outcomes in India.

Comparison of women's heat risk profiles among those working in indoor and outdoor sectors.

Rising temperatures and heat events may affect workers, especially women, by increasing the risk of Heat Related Illnesses (HRIs). We conducted a cross-sectional study among 903 women in outdoor and indoor sectors. We measured Wet Bulb Globe Temperature (WBGT) and physiological Heat Strain Indicators (HSI), as well as self-reported symptoms of HRIs using a HOTHAPS questionnaire. Multivariate Logistic Regression models were used to compare the heat risks. WBGT exposures were high in both the outdoor (Avg. WBGT = 28.8 °C ± 2.4 °C) and indoor (Avg. WBGT = 28.7 °C ± 3.5 °C) sectors. Outdoor Women Workers (OWW) reported higher HRI symptoms (94%vs.81%), and heat exposures were positively correlated with HRIs (AOR: 3.7; 95%CI: 2.4-6.1). OWW showed a 1.5-fold higher risk of measured HSI above safe limits (95%CI: 1.1-2.1) and a 2.1-fold higher risk of urogenital issues (95%CI: 2.1-3.8) than Indoor Women Workers (IWW). Due to direct sun exposure, intensive labor, and a lack of welfare facilities, OWW has a higher HRI risk.

Clinical findings and kidney morphology in chronic kidney disease of unknown cause in India.

BACKGROUND: Chronic kidney disease of unknown cause (CKDu) is an emerging health problem in India and other countries worldwide. However, clinical descriptions, including kidney pathology, are scarce. METHODS: This is a descriptive case series of patients with CKDu from an endemic region in India, with a focus on clinical and biochemical characteristics, kidney biopsy findings, and environmental exposure. Patients with suspected CKDu, aged 20-65, and eGFR 30-80 mL/min/1.73 m2 from rural areas with endemic prevalence of CKDu were included. The exclusion criteria were diabetes mellitus, uncontrolled hypertension, proteinuria >1 g/24 h, or other known kidney diseases. The participants underwent kidney biopsies, and blood and urine samples were collected. RESULTS: Fourteen participants (3 females, 11 males) with a mean eGFR of 53 (range 29-78) mL/min/1.73 m2 were included. Kidney biopsies showed a combination of chronic tubulointerstitial damage, glomerulosclerosis, and glomerular hypertrophy, with varying degrees of interstitial inflammation. Eight participants had polyuria (diuresis ≥ 3 L/day). The urinary sediments were bland, with no haematuria. Serum potassium and sodium levels were, in most cases, normal but within the lower reference interval. CONCLUSION: The kidney morphology and clinical characteristics in patients with CKDu in India were similar to those described for CKDu in Central America and Sri Lanka.

Occupational Heat Stress and Kidney Health in Salt Pan Workers.

Introduction: Work in heat affects millions of workers. Although kidney function in agricultural workers is increasingly researched, nonagricultural studies are scarce. In coastal salt pans, the absence of occupational exposures to pesticides and other toxicants allows assessment of heat stress alone. Methods: Seven Indian salt pans were surveyed from 2017 to 2020. Job-specific workload was assessed. Heat stress was characterized as exceeding the wet bulb globe temperature (WBGT)-threshold limit value (TLV) for high and moderate workloads. Preshift and postshift heart rates (HRs), tympanic temperatures, and urine specific gravity (USG) were measured for 352 workers, as were sweat rates (SwR), serum creatinine (SCr), serum uric acid, and urine dipstick. Estimated glomerular filtration rate (eGFR; ml/min per 1.73 m2) was computed. Heat-strain symptoms were assessed using questionnaires. Results: The mean WBGT was 30.5 ± 1.3 °C (summer) and 27.8 ± 1.9 °C (winter). Water intake during the workday was low, median was one Litre, and most workers (87%) exceeded the TLV for heat stress. Dehydration-related symptoms were frequent in those with high-heat stress, as were cross-shift increases in temperature (≥1°C; 15%), a high USG (≥1.020; 28%), and a high SwR (≥1 l/h; 53%). An eGFR of 60 to 89 ml/min per 1.73 m2 was observed in 41% of all workers examined, and 7% had eGFR below 60 ml/min per 1.73 m2. The odds ratio for eGFR <90 ml/min per 1.73 m2 in workers exceeding the TLV, compared to workers below this limit, adjusted for age and gender was 2.9 (95% CI: 1.3-6.4). Conclusion: Workplace interventions to prevent heat stress and dehydration in the salt pans and other at-risk industries are urgently required. The findings strengthen the notion that high-heat stress and limited hydration is a risk factor for kidney dysfunction.

Inhaled silica nanoparticles cause chronic kidney disease in rats.

Silica nanoparticles (SiNPs) released during the burning of sugarcane have been postulated to have a role in chronic kidney disease of unknown etiology. We tested the hypothesis that pristine SiNPs of the size present in sugarcane might cause chronic kidney injury when administered through the lung in rats. We administered 200- or 300-nm amorphous SiNPs twice weekly (4 mg/dose), or vehicle by oropharyngeal aspiration for 13 wk to rats followed by euthanasia after an additional 13 wk (26 wk total). Tissues were evaluated for the presence of SiNPs and evidence of histological injury. Both sizes of SiNPs caused kidney damage, with early tubular injury and inflammation (at week 13) that continued to inflammation and chronic fibrosis at week 26 despite discontinuation of the SiNP administration. Both sizes of SiNPs caused local inflammation in the lung and kidney and were detected in the serum and urine at week 13, and the 200-nm particles were also localized to the kidney with no evidence of retention of the 300-nm particles. At week 26, there was some clearance of the 200-nm silica from the kidneys, and urinary levels of SiNPs were reduced but still significant in both 200- and 300 nm-exposed rats. In conclusion, inhaled SiNPs cause chronic kidney injury that progresses despite stopping the SiNP administration. These findings support the hypothesis that human exposure to amorphous silica nanoparticles found in burned sugarcane fields could have a participatory role in chronic kidney disease of unknown etiology.NEW & NOTEWORTHY Inhalation of silica nanoparticles (SiNPs) released during the burning of sugarcane has been postulated to have a role in chronic kidney disease of unknown etiology (CKDu). We administered 200- and 300-nm amorphous SiNPs to rats by aspiration and observed kidney damage with tubular injury and inflammation that persisted even after stopping the SiNP exposure. These findings support the hypothesis that human exposure to SiNPs found in sugarcane ash could have a participatory role CKDu.

Chronic Kidney Disease of Unknown Etiology in India: What Do We Know and Where We Need to Go.

Chronic kidney disease (CKD) not associated with known risk factors has been reported from parts of India and is presumed to be similar to CKD of unknown etiology (CKDu) that has been described from Central America. The reports from India have been fragmented without clear description of the disease phenotype or its determinants. This paper summarizes the current state of knowledge around CKDu in India based on a review of literature, multi-stakeholder consultation, and a survey of Indian nephrologists. We also contacted individual research groups to solicit data. Our findings suggest that that CKDu is reported from most regions in India; however, it is interpreted differently from the phenotype described from Central America and Sri Lanka. The differences include lack of a clear demographic or occupation group, older age of affected participants, and presence of mild hypertension and low-grade proteinuria. Well-designed prospective field studies with appropriate diagnostic workup are needed to establish the disease burden and identify etiologies, along with socioeconomic and health consequences, the intersection with the environment, and the public health response. Community-based research should phenotype the entire CKD population rather than be restricted to cases with presumed CKDu based on predefined criteria. Guidelines are needed for clinical evaluation, referral, management, and harmonization of clinical documentation and health records. More data are needed to support the existence of a unique CKDu phenotype in India.

Challenges in conducting epidemiological field studies evaluating associations between heat stress and renal health among workers in informal sectors: experiences from India.

Well-designed Environmental Epidemiological Studies (EES) play a crucial role in quantifying the influence of environmental exposures and their associated risks on health in the wider population. They provide critical research evidence for identifying and developing interventions to avert adverse health consequences from those exposures. However, uncertainty and variability inherent to any field based EES could hinder the nature and magnitude of association between an exposure and health outcome. This is particularly pronounced in resource limited settings and resource-tight research projects. The present study evaluated the association between occupational heat stress and renal health among informal work sectors in India which had some significant challenges. Informal workers exposed to chronic occupational heat stress had significantly higher adverse renal health outcomes than the unexposed workers. Our field challenges included gaining access and permissions to conduct the study, participant recalls bias and attrition, accurately estimating exposures, confounding from causes of both exposure and disease, and to a large extent tight-funding. Though opportunities are abundant, we must ensure field conditions are optimized to attain study objectives. A keen understanding and sensitivity towards the cultural and work settings is essential for successful project completion. Based on our experiences, we provide strategies to adopt to improve fieldwork and provide recommendations to help overcome the field challenges and achieve better results for future EES studies in developing country settings.

Epidemiological evidence from south Indian working population-the heat exposures and health linkage.

Changing climate and rising temperatures are predicted to affect millions of workers due to heat stress risks, especially in tropical settings. We used a cross-sectional study design to profile the heat exposures of ~1500 workers from eight-industrial sectors using a QuesTemp wet bulb globe temperature (WBGT) monitor, quantified the heat-strain indicators viz., rise in Core Body Temperature (CBT), Sweat Rate (SwR), and Urine Specific Gravity (USG) by standard methods and evaluated the health impacts of heat stress using a structured questionnaire. Heat exposures (Avg.WBGT: 28.4 ± 2.6 °C) exceeded the Threshold Limit Value (TLV) for 70% of workers and was significantly associated with the rise in CBT >1 °C in 11.3% and elevated USG >1.020 in 10.5% of the workers. The heat-exposed workers had 2.3 times higher odds of reporting adverse health outcomes (84%) compared to the unexposed workers (95% CI: 1.74-3.19; p value ≤ 0.0001). Mild reduction in kidney function observed in 49% of salt - pan workers, and a high prevalence of kidney stones (33%) among the 91 steelworkers subjected to kidney ultrasound had a significant association with chronic high WBGT exposure above the TLV (p value < 0.034). Further, in-depth assessments are warranted to develop strategies for interventions and protective labor policies to avert adverse occupational health and productivity consequences for millions of workers globally, especially in the rising temperature scenario.

Heat Stress and Thermal Perception amongst Healthcare Workers during the COVID-19 Pandemic in India and Singapore.

The need for healthcare workers (HCWs) to wear personal protective equipment (PPE) during the coronavirus disease 2019 (COVID-19) pandemic heightens their risk of thermal stress. We assessed the knowledge, attitudes, and practices of HCWs from India and Singapore regarding PPE usage and heat stress when performing treatment and care activities. One hundred sixty-five HCWs from India (n = 110) and Singapore (n = 55) participated in a survey. Thirty-seven HCWs from Singapore provided thermal comfort ratings before and after ice slurry ingestion. Differences in responses between India and Singapore HCWs were compared. A p-value cut-off of 0.05 depicted statistical significance. Median wet-bulb globe temperature was higher in India (30.2 °C (interquartile range [IQR] 29.1-31.8 °C)) than in Singapore (22.0 °C (IQR 18.8-24.8 °C)) (p < 0.001). Respondents from both countries reported thirst (n = 144, 87%), excessive sweating (n = 145, 88%), exhaustion (n = 128, 78%), and desire to go to comfort zones (n = 136, 84%). In Singapore, reports of air-conditioning at worksites (n = 34, 62%), dedicated rest area availability (n = 55, 100%), and PPE removal during breaks (n = 54, 98.2%) were higher than in India (n = 27, 25%; n = 46, 42%; and n = 66, 60%, respectively) (p < 0.001). Median thermal comfort rating improved from 2 (IQR 1-2) to 0 (IQR 0-1) after ice slurry ingestion in Singapore (p < 0.001). HCWs are cognizant of the effects of heat stress but might not adopt best practices due to various constraints. Thermal stress management is better in Singapore than in India. Ice slurry ingestion is shown to be practical and effective in promoting thermal comfort. Adverse effects of heat stress on productivity and judgment of HCWs warrant further investigation.

Risk of kidney stone among workers exposed to high occupational heat stress - A case study from southern Indian steel industry.

BACKGROUND: Predicted temperature rise is likely to increase the risks of development and progression of renal/urologic anomalies for workers engaged in physically exerting and high-heat occupations. METHODS: We conducted a cross-sectional study with 340 steelworkers engaged in moderate to heavy labour with ≥3 year's heat exposures and assessed Wet Bulb Globe Temperature (WBGT) and heat-strain indicators. We captured self-reported heat-strain and kidney symptoms using validated questionnaires and subjected 91 workers to renal ultrasound upon referral of an occupational health specialist to detect and confirm any structural renal anomalies/stones. RESULTS: The results show that heat exposures (Avg.WBGT = 33.2 °C ± 3.8 °C) exceeded the Threshold Limit Value (TLV) for 220 workers. 95% of the workers reported symptoms of heat strain and dehydration and significant associations between heat exposures, rise in Core Body Temperature (CBT) (p = 0.0001) and Urine Specific Gravity (USG) (p = 0.018) were observed. Of the 91 workers subjected to renal ultrasound, 33% were positive for kidney/ureteral stones (n = 25) & other structural renal anomalies (n = 5). Renal/urologic anomalies were higher in the heat-exposed workers (AOR = 2.374; 95% C.I = 0.927 to 6.077; p = 0.072) 29% of workers were from exposed group and 4% were from unexposed group. Years of exposure to heat (≥5 vs <5) were significantly associated with the risk of renal anomalies/calculi. CONCLUSION: The preliminary finding concludes that high-heat stress combined with a heavy workload and chronic dehydration are high-risk factors for adverse renal health and calls for the urgent need for cooling interventions, enhanced welfare facilities, and protective labour policies to avert adverse health consequences for few million workers in the climate change scenario.

Association between occupational heat stress and DNA damage in lymphocytes of workers exposed to hot working environments in a steel industry in Southern India.

Occupational heat stress apart from adverse heat-related health consequences also induces DNA damage in workers exposed to high working temperatures. We investigated the association between chronic heat exposures and Micronuclei (MN) frequency in lymphocytes of 120 workers employed in the steel industry. There was a significant increase in the MN-frequency in exposed workers compared to the unexposed workers (X2 = 47.1; p < 0.0001). While exposed workers had higher risk of DNA damage (Adj. OR = 23.3, 95% CI 8.0-70.8) compared to the unexposed workers, among the exposed workers, the odds of DNA damage was much higher for the workers exposed to high-heat levels (Adj. OR = 81.4; 95% CI 21.3-310.1) even after adjusting for confounders. For exposed workers, years of exposure to heat also had a significant association with higher induction of MN (Adj. OR = 29.7; 95% CI 2.8-315.5). Exposures to chronic heat stress is a significant occupational health risk including damages in sub-cellular level, for workers. Developing protective interventions to reduce heat exposures is imperative in the rising temperature scenario to protect millions of workers across the globe.

Climate change-induced heat risks for migrant populations working at brick kilns in India: a transdisciplinary approach.

During the summer of 2015, India was hit by a scorching heat wave that melted pavements in Delhi and caused thousands of deaths, mainly among the most marginalized populations. One such group facing growing heat risks from both occupational and meteorological causes are migrant brick kiln workers. This study evaluates both current heat risks and the potential future impacts of heat caused by climate change, for the people working at brick kilns in India. A case study of heat stress faced by people working at brick kilns near Chennai, India, is the anchor point around which a transdisciplinary approach was applied. Around Chennai, the situation is alarming since occupational heat exposure in the hot season from March to July is already at the upper limits of what humans can tolerate before risking serious impairment. The aim of the study was to identify new pathways for change and soft solutions by both reframing the problem and expanding the solution space being considered in order to improve the quality of life for the migrant populations at the brick kilns. Technical solutions evaluated include the use of sun-dried mud bricks and other locally "appropriate technologies" that could mitigate the worsening of climate change-induced heat. Socio-cultural solutions discussed for empowering the people who work at the brick kilns include participatory approaches such as open re-localization, and rights-based approaches including the environmental sustainability and the human rights-based approach framework. Our analysis suggests that an integrative, transdisciplinary approach could incorporate a more holistic range of technical and socio-culturally informed solutions in order to protect the health of people threatened by India's brick kiln industry.

Occupational Heat Stress Impacts on Health and Productivity in a Steel Industry in Southern India.

BACKGROUND: Workers laboring in steel industries in tropical settings with high ambient temperatures are subjected to thermally stressful environments that can create well-known risks of heat-related illnesses and limit workers' productivity. METHODS: A cross-sectional study undertaken in a steel industry in a city nicknamed "Steel City" in Southern India assessed thermal stress by wet bulb globe temperature (WBGT) and level of dehydration from urine color and urine specific gravity. A structured questionnaire captured self-reported heat-related health symptoms of workers. RESULTS: Some 90% WBGT measurements were higher than recommended threshold limit values (27.2-41.7°C) for heavy and moderate workloads and radiational heat from processes were very high in blooming-mill/coke-oven (67.6°C globe temperature). Widespread heat-related health concerns were prevalent among workers, including excessive sweating, fatigue, and tiredness reported by 50% workers. Productivity loss was significantly reported high in workers with direct heat exposures compared to those with indirect heat exposures (χ2 = 26.1258, degrees of freedom = 1, p < 0.001). Change in urine color was 7.4 times higher among workers exposed to WBGTs above threshold limit values (TLVs). CONCLUSION: Preliminary evidence shows that high heat exposures and heavy workload adversely affect the workers' health and reduce their work capacities. Health and productivity risks in developing tropical country work settings can be further aggravated by the predicted temperature rise due to climate change, without appropriate interventions. Apart from industries enhancing welfare facilities and designing control interventions, further physiological studies with a seasonal approach and interventional studies are needed to strengthen evidence for developing comprehensive policies to protect workers employed in high heat industries.

Heat stress and inadequate sanitary facilities at workplaces - an occupational health concern for women?

BACKGROUND: Health concerns unique to women are growing with the large number of women venturing into different trades that expose them to hot working environments and inadequate sanitation facilities, common in many Indian workplaces. OBJECTIVE: The study was carried out to investigate the health implications of exposures to hot work environments and inadequate sanitation facilities at their workplaces for women workers. DESIGN: A cross-sectional study was conducted with 312 women workers in three occupational sectors in 2014-2015. Quantitative data on heat exposures and physiological heat strain indicators such as core body temperature (CBT), sweat rate (SwR), and urine specific gravity (USG) were collected. A structured questionnaire captured workers perceptions about health impacts of heat stress and inadequate sanitary facilities at the workplace. RESULTS: Workplace heat exposures exceeded the threshold limit value for safe manual work for 71% women (Avg. wet bulb globe temperature=30°C±2.3°C) during the study period. Eighty-seven percent of the 200 women who had inadequate/no toilets at their workplaces reported experiencing genitourinary problems periodically. Above normal CBT, SwR, and USG in about 10% women workers indicated heat strain and moderate dehydration that corroborated well with their perceptions. Observed significant associations between high-heat exposures and SwR (t=-2.3879, p=0.0192), inadequate toilet facilities and self-reported adverse heat-related health symptoms (χ (2)=4.03, p=0.0444), and prevalence of genitourinary issues (χ (2)=42.92, p=0.0005×10(-7)) reemphasize that heat is a risk and lack of sanitation facilities is a major health concern for women workers. CONCLUSIONS: The preliminary evidence suggests that health of women workers is at risk due to occupational heat exposures and inadequate sanitation facilities at many Indian workplaces. Intervention through strong labor policies with gender sensitivity is the need of the hour to empower women, avert further health risks, and also enhance productivity for the few million women workers who contribute largely to the country's economy.

Research in occupational heat stress in India: Challenges and opportunities.

Occupational heat stress is a major health burden with several potential negative health and well-being outcomes. It is only in the recent years medical research has addressed this risk factor. The aim of this paper is to present an overview of studies in the area of occupational heat stress and its health impacts. Research in occupational heat stress in developing countries like India is limited because of several challenges and constraints. Few challenges are permission from industries to publish the data, resistance for change from employers and workers, improper record of heat/any occupational disease by the employer or worker, study design, and paucity in number of studies. Proper education and guidelines can help to overcome some of the constraints. Proper and correct guidelines will help in mitigating the effects of excessive heat exposure on the health of workers. The studies in this area are limited, and the association between occupational heat exposure and health impacts is not clearly established. Hence, carefully designed studies are required to examine this association and thereby provide valuable information to protect worker's health.

Occupational Heat Stress Profiles in Selected Workplaces in India.

Health and productivity impacts from occupational heat stress have significant ramifications for the large workforce of India. This study profiled occupational heat stress impacts on the health and productivity of workers in select organized and unorganized Indian work sectors. During hotter and cooler seasons, Wet Bulb Globe Temperatures (WBGT) were used to quantify the risk of heat stress, according to International workplace guidelines. Questionnaires assessed workers' perceived health and productivity impacts from heat stress. A total of 442 workers from 18 Indian workplaces participated (22% and 78% from the organized and unorganized sector, respectively). Overall 82% and 42% of workers were exposed to higher than recommended WBGT during hotter and cooler periods, respectively. Workers with heavy workloads reported more heat-related health issues (chi square = 23.67, p ≤ 0.001) and reduced productivity (chi square = 15.82, p ≤ 0.001), especially the outdoor workers. Heat-rashes, dehydration, heat-syncope and urinogenital symptoms were self-reported health issues. Cited reasons for productivity losses were: extended-work hours due to fatigue/exhaustion, sickness/hospitalization and wages lost. Reducing workplace heat stress will benefit industries and workers via improving worker health and productivity. Adaptation and mitigation measures to tackle heat stress are imperative to protect the present and future workforce as climate change progresses.

Occupational heat stress and associated productivity loss estimation using the PHS model (ISO 7933): a case study from workplaces in Chennai, India.

BACKGROUND: Heat stress is a major occupational problem in India that can cause adverse health effects and reduce work productivity. This paper explores this problem and its impacts in selected workplaces, including industrial, service, and agricultural sectors in Chennai, India. DESIGN: Quantitative measurements of heat stress, workload estimations, and clothing testing, and qualitative information on health impacts, productivity loss, etc., were collected. Heat strain and associated impacts on labour productivity between the seasons were assessed using the International Standard ISO 7933:2004, which applies the Predicted Heat Strain (PHS) model. RESULTS AND CONCLUSIONS: All workplaces surveyed had very high heat exposure in the hot season (Wet Bulb Globe Temperature =29.7), often reaching the international standard safe work values (ISO 7243:1989). Most workers had moderate to high workloads (170-220 W/m2), with some exposed to direct sun. Clothing was found to be problematic, with high insulation values in relation to the heat exposure. Females were found to be more vulnerable because of the extra insulation added from wearing a protective shirt on top of traditional clothing (0.96 clo) while working. When analysing heat strain--in terms of core temperature and dehydration--and associated productivity loss in the PHS model, the parameters showed significant impacts that affected productivity in all workplaces, apart from the laundry facility, especially during the hot season. For example, in the canteen, the core temperature limit of 38°C predicted by the model was reached in only 64 min for women. With the expected increases in temperature due to climate change, additional preventive actions have to be implemented to prevent further productivity losses and adverse health impacts. Overall, this study presented insight into using a thermo-physiological model to estimate productivity loss due to heat exposure in workplaces. This is the first time the PHS model has been used for this purpose. An exploratory approach was taken for further development of the model.

Air pollution from household solid fuel combustion in India: an overview of exposure and health related information to inform health research priorities.

Environmental and occupational risk factors contribute to nearly 40% of the national burden of disease in India, with air pollution in the indoor and outdoor environment ranking amongst leading risk factors. It is now recognized that the health burden from air pollution exposures that primarily occur in the rural indoors, from pollutants released during the incomplete combustion of solid fuels in households, may rival or even exceed the burden attributable to urban outdoor exposures. Few environmental epidemiological efforts have been devoted to this setting, however. We provide an overview of important available information on exposures and health effects related to household solid fuel use in India, with a view to inform health research priorities for household air pollution and facilitate being able to address air pollution within an integrated rural-urban framework in the future.