Increased temperatures caused by climate change may have an adverse impact on pregnant women’s health outcomes. Understanding the disparities in heat vulnerabilities between rural and urban pregnant women (RPW and UPW) could help prioritize and develop tailored interventions to protect the most vulnerable. We conducted an observational cohort study from 2018 to 2021 among 680 pregnant women in Tamil Nadu from six districts. We measured the wet bulb globe temperature (WBGT) exposure and Heat Strain Indicators (HSI) such as urine specific gravity and core body temperature using standardised protocols. We used a validated questionnaire to elucidate the self-reported heat strain symptoms (SHSS), adverse pregnancy outcomes (APOs), and adverse birth outcomes (ABOs). A higher percentage of RPWs had WBGT exposure (55

OBJECTIVE:This study developed and validated a composite Occupational Heat Risk and Illness Index (O-HRII) that integrates exposure to risk factors and self-reported symptoms, benchmarked against urine-specific gravity. METHODS:A cross-sectional study was conducted among 400 outdoor workers in Tamil Nadu, India, during peak summer, combining two components: heat exposure risk score, based on validated risk factors, and heat illness symptom score, derived from clinical frameworks. End-of-shift elevated urine-specific gravity (≥1.020) was used as physiological reference for validation. RESULTS:Heat exposure risk score showed strong validity and reliability, whereas heat illness symptom score effectively identified symptomatic workers. The combined O-HRII aligned well with the physiological marker, classifying most workers under moderate-to-severe risk. Importantly, the tool facilitated evidence-based recommendations for immediate on-site use. CONCLUSIONS:The O-HRII is a validated, field-feasible tool for identifying vulnerable outdoor workers and guiding heat-stress interventions.

Background: The rise in global temperature poses significant health risks, particularly for those working outdoor in hot weather. This study examines the impact of heat exposure on working people in Uddanam, Andhra Pradesh, India, known for its high chronic kidney disease (CKD) prevalence. Materials and Methods: This cross-sectional study assessed heat exposure in 596 participants in various occupations in 36 Uddanam villages. Wet bulb globe temperature (WBGT) assessed heat exposures alongside heat stress perception and health impacts during cooler and hotter seasons. A subset was tested for blood and urine to assess kidney function. Results: Participants were mostly males (60.1%) with a median age of 42 years. Among them, 49% were illiterate, 26% smokers, and 41% consumed alcohol. WBGT values were 31.7 +/- 2.2 degrees C and 25.5 +/- 2.5 degrees C in the hotter and cooler seasons, respectively. Occupational heat exposure varied significantly, with agriculture, brick kiln, and construction workers experiencing highest WBGT exposures. WBGT-Threshold limit values were exceeded by 16.7% and 100% workers in cooler vs. hotter seasons, related symptoms. Heat stress index cross-shift changes were greater in heat-exposed participants (OR: 2.4; 95% CI: 1.6-3.5). Among 266 individuals, 76% had eGFR <90mL/ min/1.73m(2), with heat-exposed workers showing increased risk (OR 2.1, 95% CI: 1.1-3.7). Conclusion: This study shows the health consequences of heat exposure in workers from CKDu hotspots like Uddanam, and the necessity for targeted heat stress mitigation and kidney health protection strategies. Further research is needed to determine the causal links between heat exposure and CKDu progression.

Background: Personal protective equipment (PPE) is considered a very essential element in controlling the spread of infection in health care facilities; however, prolonged use of various PPE, especially face shields cause discomfort, neck impingement and restricted movement leading to musculo skeletal disorders (MSDs). Methods: A cross-sectional survey was conducted with 145 Health Practitioners (HPs) at a tertiary care hospital in Chennai, utilising a validated questionnaire from December 2022 to May 2023. Univariate analysis was using Social Sciences (SPSS) Statistics version 23.0. Results: Approximately 52% indicated experiencing MSDs, while 44.7% reported MSDs associated with the prolonged use of face shields in the workplace. The risk of MSDs was 3.4 times higher among individuals who used Personal Protective Equipment (PPE) (95% CI: 1.0–11.2). PPE-related restrictions on movement resulted in MSD for 72% of healthcare professionals, presenting a 2.5-fold risk (95% CI: 1.2-5.0). A significant association was observed between the history of work-related MSDs and their prevalence among healthcare professionals utilising face shields (OR: 9.5; 95% CI: 2.7-33.5). Many HPs reported discomfort, diminished visual clarity and movement restrictions, all of which are associated with MSDs. Although not statistically significant, 9% of healthcare professionals who wore PPE for more than 6 hours/day reported experiencing MSDs. Conclusions: PPEs can serve as a deterrent in certain aspects, yet they are essential for safeguarding HPs from various infections. Customising and utilising tailored PPEs can assist healthcare professionals in safeguarding themselves from both infections and MSDs.

Climate change is exacerbating extreme heat events, and individual cooling measures are becoming vital, particularly in communities lacking access to air conditioning or other cooling systems. This review introduces a new framework that bridges the gap between nutrition and climate adaptation, highlighting the potential of using traditional, nutrient-rich diets as evidence-based, practical methods to help individuals manage heat stress. We integrate biochemical, physiological, epidemiological, and cultural approaches, unlike most studies that have concentrated primarily on engineering or technological interventions, to demonstrate how regular foods help maintain body temperature, hydration, and mitigate inflammation and oxidative stress. Considering nutrition as a means of heat resilience, we can observe that familiar foods can provide cost-effective, easily available, and sustainable solutions to numerous vulnerable groups. Notably, we also discuss how to incorporate such traditional cooling foods into national food programs and school meal schemes, combining the local knowledge with contemporary climate adaptation policies. Although this approach is India-centred, it has broad applicability and can be used to provide a replicable, scientifically based, and culturally informed framework on how community heat resilience can be improved throughout the Global South.

Extreme heat events pose a significant threat to human health, affecting both physical and mental well-being. Women in rural areas suffer from heat exposure due to their gender-specific responsibilities and restricted cooling access, which elevates their climate-related psychological distress. This study examines the intersection between heat exposure, physiological strain, and heat-related mental health burdens among rural women in Tamil Nadu, India. A cross-sectional study was conducted between April and August 2025 across 15 rural villages in Tamil Nadu, India, among 350 rural women. Ambient temperature was quantified using Wet Bulb Globe Temperature (WBGT) monitors (QuestTemp 3 M) during the peak hours. Data was collected using a structured, modified HOTHAPS questionnaire that covered demographics, heat exposure patterns, self-reported heat-related illnesses (HRIs), and the social impacts of heat. Psychological stress due to heat exposures was evaluated using a culturally adapted Hogg Eco-Anxiety Scale (HEAS), a multi-domain tool that measures rumination, affective responses, behavioral changes, and personal impact concerns. Multivariable logistic regression was performed in Statistical Package for the Social Sciences (SPSS) version 16.0 to examine associations between heat exposure and health outcomes, adjusting for age, education, income, and the availability of cooling resources. Participants (mean age 34.5 ± 7.5 years) experienced an average daily WBGT of 30.4 ± 2.3 °C, with 85

Rising global temperatures and extreme heat events have made occupational heat stress a major public health challenge, particularly among outdoor local workers and migrant workers who face prolonged exposure and inadequate protection. Despite their shared risks, the differential vulnerability patterns between these groups remain poorly characterized. The objective was to compare Heat Vulnerability Indexes (HVIs) between outdoor local workers and migrant workers to identify distinct susceptibility patterns and inform targeted interventions. A cross-sectional study was conducted in Tamil Nadu using an in-house, multidimensional Heat Vulnerability Index (HVI). The HVI incorporated socio-demographic, occupational, physiological, and environmental factors measured through field assessments, physiological monitoring, and structured questionnaires. HVI scores were derived using Factor Analysis of Mixed Data and categorized into four levels: low (< -2), moderate (-2 to < 0), high (0 to < 1.5), and extreme (≥ 1.5) vulnerability. Over half of workers exceeded the Threshold Limit Values (TLVs) for safe work heat limits (Local workers: 56

In developing countries that rely heavily on manual labour, heat stress is expected to worsen, affecting health and productivity. No study has been conducted to date on predicting seasonal heat stress and Labour Capacity Loss (LCL) in India; therefore, the present study aims to examine the impact of climatic change scenarios on heat-induced LCL among informal outdoor workers in Southern India. We studied cross-sectional changes in Wet Bulb Globe Temperature (WBGT) and surveyed 1247 workers in five informal outdoor sectors in Tamil Nadu (TN). We use Dunne's empirical approach to measure regional LCL variations throughout three periods till 2099. The results are described using descriptive and multivariate analysis. The results showed that the seasonal WBGTs increase by 1.6 f 0.2 degrees C and 2.3 f 0.2 degrees C (summer) and 0.7 f 0.4 degrees C and 1.4 f 0.4 degrees C (winter) under Representative Concentration Pathway (RCP) 6.0 and RCP 8.5, respectively. Perception data collected from this region's workers already shows significantly higher odds of productivity loss with WBGT exposures (Adjusted Odds Ratio (AOR): 1.6; 95 % CI: 1.2-2.1), hot season (AOR: 15.3; 95 % CI: 11.4-20.5), and heavy workload (AOR: 3.4; 95 % CI: 2.4-4.7). While summer WBGTs exceed 30 degrees C in all three time periods under RCP6.0 and RCP8.5, winter WBGTs surpass safe working conditions in many districts of TN in the third period under RCP8.5. By 2099, under RCP6.0, high/moderate workload summer LCL ranged from 4.5 to 13.3 %, and 1.0-10.1 % under RCP8.5. Our findings show drastic changes in future WBGT and LCL, resulting in significant individual and regional economic losses. To safeguard millions of impoverished informal workers in tropical and subtropical countries, climate mitigation, adaptation, and intervention initiatives are urgently needed.

Climate change is intensifying occupational heat exposure, posing risks not only for heat-related illness but also for sleep, which is essential for recovery, safety, and productivity. Heat-exposed workers are highly vulnerable due to prolonged exposure, limited access to cooling, and poor housing. This systematic review aimed to synthesise global evidence on how occupational heat exposure affects sleep quality among workers across different occupations and settings. A systematic review was conducted following Synthesis without Meta-Analysis (SWiM) guidelines. PubMed, Scopus, and Google Scholar were searched (2000-2025) for studies involving adult workers (≥18 years) reporting both heat exposure and sleep outcomes. The review was registered with PROSPERO (ID: CRD420251125735). Of 7,108 records screened, 11 studies met the inclusion criteria. Studies spanned Asia, Australia, North America, and global cohorts. Heat exposure consistently impaired sleep quality and duration. Using Pittsburgh Sleep Quality Index, Actigraphy, and self-reports, common complaints included difficulty falling asleep (64%), restlessness (54%), non-restorative sleep (54%), night sweats (36%), and reduced total sleep time (45%). Night-time temperatures above 25°C and high workplace wet bulb globe temperature values were strongly linked with reduced sleep efficiency and delayed sleep onset. Vulnerable groups included shift workers, petrochemical and steel labourers, women, older adults, and low-income workers in urban heat islands and poorly ventilated housing. Occupational heat exposure disrupts sleep, compounding daytime strain and creating a dual burden for workers. Integrating sleep into heat stress management through cooling interventions, better housing, and revised work-rest schedules is critical for workers well-being in a warming climate.

Objective: Chronic kidney disease of nontraditional cause (CKDnt) is a significant concern in Mesoamerica and South Asia. Despite research progress, its causes remain unclear and disease burden high. The international workshop was convened to evaluate current evidence and guide public health strategies. Materials and methods: The Fourth International Workshop on CKDnt was held in 2024 and organized by the Consortium for the Epidemic of Nephropathy in Central America and Mexico (CENCAM), in collaboration with the Executive Secretariat of the Council of Ministers of Health of Central America and the Dominican Republic (SE-COMISCA), the Latin American Society of Nephrology and Hypertension (SLANH), the Central American Program for Health, Work and Environment (SALTRA), and the Spanish Agency for International Development Cooperation (AECID). The objective was to provide evidence-based support for the program “Strategy for the Prevention, Mitigation, and Control of CKDnt in Central America and the Dominican Republic”. Results: Participants numbered 165, most from Mesoamerica. Workshop discussions were centered around: (1) the causes of CKDnt, (2) methodological research approaches, and (3) strategies for application of findings. Conclusions: Addressing CKDnt requires coordinated, evidence-based actions at both regional and international levels.

Occupational heat stress is a growing concern, especially among outdoor, physically demanding workers in tropical regions like Tamil Nadu. A total of 1,027 participants in different sectors were surveyed in this cross-sectional study (2024) to determine the effect of low-cost Cooling Foods (CFs) on occupational heat stress. The temperature was measured using the Wet Bulb Globe Temperature (WBGT), with a mean of 29.6 °C ± 3.2 °C; approximately 60% of workers were exposed to levels exceeding the Threshold Limit Value (TLVs). The CF consumers experienced much less heat-related illness (HRI), such as excessive sweating and nausea/vomiting. The non-consumers were more likely to be dehydrated (AOR = 1.5; 95% CI: 1.1-1.9) and had a higher core body temperature (AOR = 1.4; 95% CI: 1.1-1.9). CFs are an affordable and available solution to occupational heat stress; additional research is needed to build robust evidence.

Background Climate change is increasing the frequency and severity of heatwaves across South Asia, with disproportionate impacts on vulnerable populations. Pregnant and lactating women face heightened health risks due to physiological changes, gendered social responsibilities, and constrained access to adaptive resources. Despite this, women’s lived experiences and adaptation practices during pregnancy remain understudied and largely absent from institutional climate responses. This knowledge gap hampers the development of effective, gender-sensitive adaptation policies. Methods This qualitative study, embedded within the Heat in Pregnancy (HiP)-India project, will be conducted in three climatically vulnerable sites: Gurugram (Haryana), Bilaspur (Chhattisgarh), and Puducherry. Guided by a socio-ecological framework, we will conduct in-depth interviews with pregnant and lactating women, focus group discussions with caregivers, and key informant interviews with health workers and local stakeholders, alongside non-participant observations. Interviews will take place during and shortly after the heat season to capture both real-time and reflective experiences. Using purposive sampling, we will recruit 20–25 women per site, along with caregivers and stakeholders, primarily from the HiP-India cohort who have consented to follow-up. Data will be thematically analysed using NVivo, with reporting guided by COREQ standards. Anticipated Results The study will generate contextualised insights into women’s heat-adaptation practices during pregnancy and lactation across diverse agro-climatic zones, document traditional and emerging coping strategies, and identify structural, social, and institutional barriers shaping adaptation capacity. Conclusion By centering women’s lived experiences, this research will inform the design of culturally appropriate, gender-responsive heat adaptation interventions suitable for low-resource settings. Findings will support both practical community-based solutions and evidence-based advocacy for more inclusive climate adaptation policies at local and national levels.

Abstract As global temperatures rise, there is growing evidence that extreme heat will have a detrimental impact on the lives and livelihoods of workers. Despite adaptations being implemented to protect workers, there remain ascertainment challenges in identifying optimal solutions. We need higher spatial and temporal resolution of heat exposure data that is measured longitudinally─day and night, home and workplace, and across seasons and years. Additionally, we need to improve our understanding of how heat impacts individuals; thresholds for heat are dependent on the outcome of interest and the individuals exposed. Through technological advances in environmental sensors and wearable physiological monitors, it is now possible to pursue personalized occupational heat exposure research in situ and at scale, by measuring the longitudinal physiological and health impacts of varying heat exposures. We propose the development of a Personalized Occupational Heat Exposure Index (POHEI) that combines individualized exposures with physiological impact, enabling in situ evaluation of adaptation interventions to protect the lives and livelihoods of workers most at risk of rising heat.

Due to climate change, heat waves are projected to become more frequent and severe in regions like the tropics. In developing nations like India, where manual outdoor work is common, workers are susceptible to heat stress. Seasonal effects on productivity however, are understudied. This research measures productivity loss (PL)  due to heat for informal outdoor labourers in southern India. The study employed a mixed-methods approach to assess seasonal Wet Bulb Globe temperature (WBGT) exposures across 11 districts in Tamil Nadu (TN). Data were collected from 1560 outdoor workers through structured surveys. Statistical analysis incorporated both descriptive statistics and multivariate regression models. Results demonstrate that WBGT measurements exceeded the critical threshold of 30 °C. Analysis of worker perception data revealed significant association between elevated WBGT exposure and a 1.4-fold increased risk of PL (95% Confidence Interval (CI) 1.1–1.8). High workload and seasonal variation emerged as strong predictors of productivity decrements (Adjusted Odds Ratio (AOR) 1.5; 95% CI 1.2–2.1). The results demonstrate severe productivity and economic losses associated with high WBGT levels affecting livelihoods and the regional economy. This underscores the pressing need for mitigatory climate measures and specific interventions to safeguard vulnerable informal workers in the tropics.

Background Preterm birth (PTB) is a major global health issue, causing substantial newborn morbidity and mortality. Limited literature is available on the association between prenatal exposure to heat and air pollution (particularly, particulate matter 2.5 (PM2.5) and black carbon) and the risk of PTB in low- and middle-income countries (LMICs). This review attempts to integrate existing information.Methods A systematic search of numerous databases (Pubmed, Embase, Scopus and grey literature) for peer-reviewed articles published between 2010 and 2024 in LMIC was done using PM2.5, black carbon and ambient heat as exposures with PTB as the outcome. After screening 4524 studies, 32 were included, focusing on various exposure windows throughout pregnancy. The risk of bias assessment was done using the Non-randomised Studies of Exposures tool. Random-effects meta-analyses using the DerSimonian and Laird method were done when three or more studies were available; otherwise, a fixed-effects model was used to estimate the pooled effect sizes.Results Heat exposures were associated with elevated incidences of PTB, especially during the first and third trimesters (OR=1.29 and 1.39, respectively). PM2.5 exposure was also similarly associated, but to a lower extent across all trimesters (OR=1.09). Black carbon exposure also depicted a similar trend, which was during the third trimester (OR=2.74).Conclusion The results point towards a consistent adverse effect on the exposures studied (PM2.5, black carbon, and heat). There is also a dearth of representative data from LMICs where vulnerabilities to climate change, specifically for maternal and child health, are more pronounced. Furthermore, few studies have investigated the impact of combined exposures, highlighting a critical gap in understanding the synergistic effects of these environmental factors. This emphasises the need for more geographically diverse and representative studies to permit policy framing aiming to reduce PTB incidence mediated by environmental factors.PROSPERO registration number The study protocol for this review was registered with PROSPERO-CRD42024563329.

OBJECTIVE:Rising temperatures and extreme weather pose a significant public health threat. Workers in low- and middle-income countries are particularly vulnerable to heat stress, which can lead to psychological repercussions, including climate anxiety. This study investigated the psychological impacts of heat stress and coping strategies among workers in relation to climate anxiety. METHOD:A cross-sectional survey of 800 indoor and outdoor workers was conducted in 2024. Environmental heat stress was measured using a wet bulb globe temperature (WBGT) monitor, defining heat stress as exceeding task-specific threshold limits. Heat strain indicators (HSIs) such as core body temperature (CBT) and urine specific gravity (USG) were assessed alongside perceived heat stress and psychological impacts using a validated HOTHAPS questionnaire. RESULTS:The WBGT exceeded recommended limits for 62% of workers (30.3 ± 5.0 °C). Among heat-exposed workers, 80% reported heat-related health symptoms, with a significant rise in HSIs, including CBT (AOR = 1.9; 95% CI: 1.4-2.7). Psychological symptoms were prevalent in 94% of exposed workers, with heightened risks of climate anxiety (AOR = 2.8), stress (AOR = 2.7), and mental fatigue (AOR = 3.7). Women and summer months showed greater vulnerability. CONCLUSION:Heat stress significantly affects psychological well-being among South Indian workers. Protective workplace policies are crucial to mitigating climate-induced psychological impacts.

Background:Extreme heat exposure - defined as sustained ambient temperatures exceeding local thresholds - has been associated with several adverse pregnancy outcomes, including preterm birth, stillbirth, gestational diabetes and small for gestational age. However, the mechanisms linking environmental heat to these outcomes, and the biological markers that signify individual vulnerability, are not well understood. We present the protocol for a prospective cohort study within the Heat in Pregnancy-India consortium (HiP-India). This study aims to characterise the physiological and pathophysiological responses of the mother, placenta, and fetus to varying levels of temperature, humidity, and air pollution exposure, and to identify the critical windows and mechanisms of heat-related risk during pregnancy. Methods:600 women with singleton pregnancies, with confirmed gestational age by ultrasound between 11-14 weeks, will be recruited prospectively from three distinct climate zones in India: Gurugram, Delhi NCR 'semi-arid'; Bilaspur, Chhattisgarh 'humid sub-tropical and tropical wet and dry'; and Puducherry 'tropical wet and dry'. Each participant will have their level of exposure to heat, humidity and air pollution measured for 24 hours each trimester in their home and/or workplace using individual and area monitoring devices. Perceived heat stress will be captured using a modified HOTHAPS questionnaire, while physiological heat strain will be measured through urinary specific gravity, core body temperature, heart rate and blood pressure. Within 48 hours of environmental monitoring, maternal haemodynamic parameters will be assessed non-invasively. Fetal ultrasound will be performed to evaluate growth and fetal-placental blood flow, and maternal blood samples collected to evaluate circulating biomarkers of placental function and stress. Cardiotocography will be conducted in the third trimester only. Delivery outcomes for both mothers and neonates will be extracted from hospital records and interviews. In a subset of 100 women, markers of lactation physiology will be recorded during the first 2 weeks after delivery. Ethics and dissemination of results:All necessary ethical approvals from relevant committees at participating institutions have been obtained. Written informed consent will be obtained from all participants. The findings from this study are expected to inform climate adaptation strategies and emergency response policies to protect pregnant populations from the impacts of extreme heat, both within India and in other similarly affected regions globally. Results are aimed for journal publication, communicate findings to participants in plain language, disseminating information at conferences and events of similar nature.

Background:Excessive workplace noise poses a significant threat to occupational health, impacting both auditory and nonauditory health. This research examined the nonauditory effects of noise on steel workers. Methods:A cross-sectional study of 80 industrial workers exposed to occupational noise was conducted with approval from the institutional ethics board and management. Nonauditory impacts such as fatigue, headache, vertigo, sleeplessness, and fainting were assessed. Noise levels were measured using an American National Standards Institute sound-level meter, and blood pressure (BP) and heart rate (HR) were recorded before and after shift. Data were analyzed using SPSS (version 20). Results:The study revealed that 57% of workers experienced noise exposure exceeding the American Conference of Governmental Industrial Hygienists threshold limit values, with an average exposure of 88.5 dBA (range: 80.2-96.9 dBA). High-noise exposure was linked to fatigue (54%) and chronic headaches (5%). Preshift and postshift HRs were 82 ± 9 and 92 ± 13 bpm, respectively, while systolic and diastolic BPs averaged 135 ± 17 and 90 ± 11 mmHg, respectively. Significant cross-shift HR differences were observed in the blooming mill (p = 0.002) and bar and roll mill (BRM) (p = 0.010). Noise levels were significantly associated with systolic (p = 0.002) and diastolic (p = 0.001) BP in the bar and roll mill. Conclusion:High occupational noise exposure may have adverse physiological effects. Despite existing regulations, enforcement and compliance remain inadequate. Implementing engineering controls, hearing conservation programs, and stringent policies is crucial to protect workers in high-noise industries.

ABSTRACTHeat waves in Southeast Asia are expected to intensify in the upcoming decades thereby raising the vulnerability of at‐risk workers to heat‐related illnesses (HRIs). Identifying and strengthening workers' self‐protection knowledge is crucial to effective heat adaptation and management. The study aimed to investigate outdoor workers' perceptions of heat‐related risks, changes in protective behavior during hotter seasons, knowledge and awareness of regional heat action plans (HAPs), and protection measures. It aimed to find effective means of communication and strategies for improving heat protection among these workers. We used a validated and structured mixed‐method survey questionnaire and one‐on‐one interviews to assess 140 outdoor workers' heat‐related risk perceptions, protective behavior changes during hot seasons, and knowledge of regional HAPs protective measures in April–July 2022. The estimated worker's seasonal average WBGT exposure using meteorological data was 34.4°C ± 0.02°C, which exceeded acceptable limits. Heat was a big concern for outdoor workers, the study revealed. Workers believed that knowing about heat hazards could help reduce individual risks. Many workers were aware of the heat's health risks but felt the nature of their jobs prevented them from taking precautions. Some workers assumed that business owners' concerns about productivity and cooling costs would prevent government measures to safeguard at‐risk employees from succeeding. Workers responded more positively to business owners' HAP communications. Workers are more likely to use practical, simple sector‐based warning HAPs. We urgently need management policy reforms to protect millions of workers in low‐ and middle‐income countries (LMICs), and the implementation of cost‐effective, practical, and sustainable heat protection infrastructure and behavioral change solutions through trusted channels is crucial.