Background: Childhood exposure to air pollution exacerbates respiratory conditions and even carries deleterious effects on lung functions in adulthood. It is desirable to establish a non-invasive screening test for children to predict early lung insult with air pollution exposure. The association between serum club cell protein (CC16) and obstructive airway diseases is known, but the same is not explored with air-pollution-related lung insult and pulmonary function test (PFT) parameters. Aim: To investigate the association between urinary CC16 and PFT parameters in children exposed to differing levels of air pollution. Methods: This cross-sectional study recruited 107 children from critically-polluted area (CPA) and 96 age-sex- matched children from non-polluted area (NPA). PFT and urinary CC16 were determined with standard techniques. Air quality parameters were estimated with adherence to National Ambient Air Quality Standards (NAAQS). Results: CPA was observed with 2.5 times poorer Air-Quality-Index compared to NPA. Urinary CC16 levels of children were four-fold higher in CPA compared to NPA (p < 0.001). CPA children were significantly deprived in PFT parameters [FVC(L)-1.86 v/s 2.02, p = 0.01; FEV1(L/s)-1.71 v/s 1.86, p = 0.01 & PEFR(L/s)- 3.25 v/s 3.69, p < 0.001]. While adjusted for physiological parameters, urinary CC16 observed with significant negative association with PFT parameters (FVC: /3 =-0.02, p=0.03; FEV1: /3 =-0.03, p=0.001 & FEF25-75 %: /3 =-0.05, p=0.04). Conclusion: The significant decline in lung function parameters and elevated urinary CC16 levels among children in polluted areas underscore the need for further research to validate urinary CC16 as a reliable screening tool for respiratory health monitoring among children.

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.

Background: Bus drivers are one of the top three occupations with the highest prevalence of work-related musculoskeletal disorders (WRMSDs). The present study aimed to determine the pattern and prevalence of WRMSD among metropolitan bus transit drivers, whose job profiles differ from traditional long-distance bus drivers, and to explore the effect of modifiable lifestyle-related risk factors. Materials and Methods: In this cross-sectional study, consenting 254 metropolitan transit bus drivers (with at least five years of job duration) and 73 age-matched indoor desk job workers (administration staff of the same department) as a comparison group enrolled. Sociodemographic and occupational profile were collected on a semi-closed questionnaire. A modified Nordic questionnaire was used to determine musculoskeletal problems. Anthropometric measurement and haematocrit estimation were performed with standard techniques. All statistical analyses including logistic regression were performed with SPSS 26.0. Results: The prevalence of WRMSDs among bus drivers was twice higher than administration staff (49.2% v/s 28.8%). Drivers experienced significantly higher pain for the lower back (36.6% v/s 11%), knee (29.5% v/s 15.1%), and hip (7.5% v/s 1.4%) in comparison with administration staff. Study reported age, tobacco usage, body mass index (BMI) and job profile of drivers (compared to administration staff) as significant predictors of WRMSDs. Conclusion: WRMSDs were significantly higher among metropolitan bus transit drivers in comparison with administrative staff. Furthermore, WRMSDs are strongly associated with tobacco use and BMI. These modifiable risk factors may be the targets for preventive strategies to reduce the burden of WRMSDs among bus drivers.

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

Context: Lead (Pb) smelting workers are exposed to high lead levels and its adverse health effects. Despite no biological role, regulatory bodies regard blood lead levels (BLL) ≤40 μg/dL as upper acceptable limit in occupationally lead exposed population. Objective: To explore the differences in general health status of individuals with BLL ≤40 μg/dL and >40 μg/dL. Methods: All workers (n = 803) of age >18 years employed in a Pb smelting plant were interviewed with a semi-structured questionnaire to obtain sociodemographics, occupational details, followed by detailed clinical examination. 5 ml of venous blood was collected and BLLs were determined as per standard NIOSH method using GF-AAS technic. A complete general health status was performed including hemoglobin and blood pressure (BP). Results: About 47.7% of the participants exhibited high BLL (>40 μg/dL), while the rest 52.3% were identified to have ≤40 μg/dL. Both groups were grossly similar in the majority of demographic and occupational parameters. Interestingly, both groups had substantially higher fraction of workers with elevated BP. Conclusions: Lead exposed workers with BLL ≤40 μg/dL are at equal risk of health hazards as those with BLL >40 μg/dL. There is a need to revisit the current guidelines on the BLL for workers to protect from the hazards of chronic lead exposure.

Social media offers an opportune platform for educating the public about the recommended interventions during global health emergencies. This case study evaluated information in the popular social media platform YouTube about two key interventions (namely, 'social distancing' and 'hand washing') recommended during coronavirus disease-2019. Using the keywords 'social distancing' and 'hand washing', 77 and 78 videos, respectively, were selected from YouTube through pre-defined criteria. The understandability, actionability and quality of information in these videos were assessed. Cumulatively, the social distancing videos received >9 million views and the hand-washing videos received >37 million views. Thirteen social distancing videos (16.9%) and 46 hand-washing videos (58.9%) provided understandable, actionable and good-quality information. The non-understandable, non-actionable or poor-quality videos had paradoxically more viewer engagements than the understandable, actionable or good-quality videos, respectively. Most social distancing videos came from news agencies (68.8%). Hand-washing videos were mostly uploaded by health agencies or academic institutes (52.6%). The videos were less likely to be understandable and actionable and to be of good quality when uploaded by sources other than health agencies or academic institutes. The paucity of adequate information and the limited representation of 'authoritative' sources were concerning. Strategies for harnessing social media as an effective medium for public health education are necessary during pandemics.

Background and Objective: Fomites are common sources of transmission of certain infections. Infectious pathogens, such as viruses known to cause respiratory tract infections, are common examples of being transmitted by fomites. However, the load of the particular pathogen on these inanimate surfaces is a crucial factor for the transmission. The current study aims at investigating the load of one such viral pathogen on the surfaces of commonly used materials. Methods: Based on the cycle threshold (Ct) values in the diagnostic system using gene amplification for the considered viral pathogen, we categorized the positive samples for high (17 to < 24), moderate (24 to < 31), or mild (31 to < 38) viral load. Five randomly selected samples from each of these category were smeared on commonly used cardboard surface (absorbent surface) and stainless steel (non-absorbent surface). After an observation duration of 90 min, samples from the surfaces were analyzed again for gene amplification using RT-PCR. Results: Viral load/titter positively correlated with the viral material on either of these investigated surfaces post-observation duration. Higher viral load (low Ct) samples exhibited higher probability of being detected on the surfaces than those samples with lower/moderate (high Ct) viral load. Interpretation and Conclusion: Common inanimate surfaces are potential source of the viral transmission, however the viral load on these surfaces are key determinant of such transmission.

Abstract Background and Objectives Silicosis is a neglected and widely prevalent occupational disease in India and several other countries such as China, South Africa, Brazil, etc. It is an irreversible, incurable, and progressive disease with high morbidity and mortality, which is mostly caused by occupational exposure to silica dusts. Silicosis is usually detected at an advanced stage, when effective intervention is not possible. But early detection appears to be a cost‐effective way to control it. There is a need for some suitable biomarker, which could detect silicosis at an early stage for further necessary intervention. This study aimed to estimate the lung damage in silicotic subjects and its relationship with serum CC16 as a proxy marker. The ultimate objective was to explore whether CC16 could be used as a screening tool for early detection of silicosis. Methodology Radiographs of 117 workers having radiological evidences of silicosis were evaluated in accordance with International Labour Organisation (ILO) Classification of chest radiographs and were categorized as mild, moderate, and severe lung damage using a lung damage scoring system, made for the purpose of this study. The concentration of CC16 in serum was determined by enzyme‐linked immunosorbent assay. Result It was observed that serum CC16 values were significantly decreased in relation to increasing lung damage. The mean ± standard deviation (SD) serum CC16 value in mild lung damage group was 8.4 ± 0.87 ng/mL as compared to 4.0 ± 2.10 ng/mL in moderate and 0.7 ± 0.21 ng/mL in high lung damage groups. On the other hand, CC16 value of control (healthy) population was found to be 16.3 ± 3.8 ng/mL. Conclusion Result of the study concluded that serum CC16 might be used as a periodic screening tool for early detection of silicosis and for it's secondary prevention. It may be viewed as a new approach toward control of silicosis, and an appropriate policy may be adopted.

Background: Chronic exposure to lead is detrimental, despite exposed to very low levels. Hematological and cardiovascular system are among the commonly affected systems due to chronic lead exposure. With tremendous progressive usage electrical and electronic products, they are being scrapped, recycled and refurbished by process of e-waste recycling. Primitive e-waste recycling activities are increasingly popular and contributes substantially to the economy and employment. However, the e-waste recycling process is a source of occupational lead exposure. Objective: To evaluate the influence of chronic lead exposure on the hematological and cardiovascular parameters among e-waste recyclers with variable levels of lead exposure. Methodology: All workers from two e-waste recycling units with significantly different lead levels were recruited after informed consent. Socio-demographic, occupational and clinical details of all participants were recorded. Environmental and blood lead levels (BLL) were evaluated using graphite furnace atomic absorption spectroscopy (GF-AAS). The hematological parameters and cardiovascular parameters were assessed using standard tools. Group differences and multivariate regression analysis to achieve the objectives was performed using Statistical Package for Social Science version 17.0. Results: Sixty-four Workers employed (32 from each recycling unit) in these recycling units were exposed to significantly different levels of lead, however the levels were well within the permissible limits. Workers exposed to higher environmental lead levels had significantly higher BLL & diastolic blood pressure (DBP) as compared to their comparators. Further, workers with higher BLL exhibited a trend of reduced hemoglobin as compared to the workers with lower BLL. However, the study observed a trend of changes (hematological & cardiovascular) consistent to the possible homeostasis mechanisms of reduced hemoglobin. Elevation in blood pressure (BP), a known compensatory response to peripheral hypoxia (due to reduced hemoglobin), observed in the current study could either be due to direct and indirect (reduced hemoglobin) influence of lead exposure. Conclusion: Individuals chronically exposed to Lead, despite within the permissible levels can exhibit detrimental effects. Present results indicate the direct and indirect (reducing hemoglobin) mechanisms by which lead would influence BP. Future studies are recommended to confirm the present results.

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.

Introduction: Morbidity and mortality associated with pesticide poisoning is a major public health issue, especially in lower and middle income countries, including India. Timely understanding of poisoning trends is required for improved prevention. The objective of the present study was to analyze the trend of poisoning cases in Ahmedabad, India in the period of 2015-2017.Methods: Detailed history, including demographic data, risk factors, poisoning history, agents involved, and occupational influence were collected for poisoning cases reported to the Poison Information Centre in Ahmedabad. Cholinesterase activity and HPTLC method for detection of sanguinarine in urine were used to investigate the agents of poisoning. Non-parametric tests, such as Chi-square test and Mann-Whitney U Test were applied to test statistical significance between the groups. All statistical analysis was carried out using IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.Results: A total 1373 poisoning cases were investigated. The incidence and fatality rate was found to be higher in males compared to females (M/F ratio 1.89:1). About 91.62% of the poisoning were through the oral route. Erythrocyte cholinesterase activity assay results indicated that 41.29% of the cases were due to organophosphorus/carbamate poisoning. Insecticides were found to be the agent of poisoning in 26.29% cases, and 11.07% of all the cases were agricultural workers. Poisoning with medications, household pesticides and chemicals were also reported. Few cases of food poisoning with sanguinarine were detected.Conclusion: The data presented here suggest that pesticides used for agriculture are the major source of poisonings. Implementation of usage guidelines, educating farmers and vulnerable population, and finding novel alternatives for highly toxic chemicals may be helpful in decreasing the number of poisoning cases.

Background & objectives: Clinically silicosis is diagnosed by chest X-ray showing specific opacities along with history of silica dust exposure. Diagnosis is invariably made at an advanced or end stage when it is irreversible. Moreover, silicosis patients are susceptible to develop tuberculosis. Therefore, a suitable biomarker for early detection of silicosis is needed. This study evaluated the suitability of club cell protein (CC16) as a biomarker for early detection of silicosis. Methods: This pilot study included 121 individuals from X-ray-confirmed/advanced silicosis, moderate silica dust-exposed workers and healthy controls from western India. CC16 levels were quantified in serum samples through ELISA. Sensitivity and specificity of CC16 values at different cut-off points were calculated in both non-smokers and smokers. Results: Serum CC16 level was significantly (P <0.01) decreased in X-ray confirmed advanced silicosis patients (4.7±3.07 ng/ml) followed by moderately exposed workers (10.2±1.77 ng/ml) as compared to healthy non-exposed individuals (16.7±3.81 ng/ml). Tobacco smoking also caused a significant decrease of serum CC16 concentration in both healthy (10.2±1.12 ng/ml) and advanced silicosis workers (2.6±2.28 ng/ml) compared to non-smokers. Sensitivity and specificity of CC16 values were also found to be ≥83 per cent for screening all categories of individuals. Interpretation & conclusions: Because of high sensitivity and specificity, serum CC16 could be used as predictive biomarker for suspicion and early detection of silicosis, which would help in reducing/delaying premature deaths caused by silicosis. It would also control silicotuberculosis additionally.

Coronavirus Disease 2019 (COVID-19) a highly contagious viral respiratory disease has been declared as pandemic due to its global spread across most countries. Social isolation (i.e. physical distancing) and strict embracement of personal hygiene are few demonstrated preventive methods of COVID-19 transmission. All countries, based on the recommendations of World Health Organization (WHO), have adopted lockdown strategy (promoting physical distancing) to prevent COVID-19 transmission in the community including workplaces. In the interest of economic sustenance, many countries have partially relaxed the lockdown policies, to resume selective functioning of factories / organizations / institutes / workplaces. However, in the absence of appropriate occupational health and safety policies, workplaces are a potential threat for COVID-19 transmission & outbreak. The following document reviews the conventional hierarchy of occupational safety and health control measures (i.e. engineering controls, administrative controls and PPE), necessary to prevent COVID-19 outbreaks at workplace, based on the current scientific evidences on COVID-19.