Adaptation to heat stress: a qualitative study from Eastern India

Heat stress adversely impacts a growing proportion of individuals in India. The heat-related lived experiences of Indians in smaller towns and villages are largely unknown. We conducted seven structured focus group discussions in the town of Dalkhola, West Bengal, India; with 5–10 participants in each group. All conversations were digitally audio recorded, transcribed into Bengali, and then translated to English. Two researchers separately performed a thematic analysis of the transcripts to identify common themes pertaining to the ‘effects of heat’ and ‘coping strategies’ used by participants. A total of 56 (mean age 48.9 ± 17.6; female 61%; Scheduled Tribe 9%) individuals participated. There was wide variation in individual experiences of heat, with some people preferring to work in the winter while others preferred the summer. Housing characteristics, nature of work, gender and access to water and green spaces heavily influenced an individual’s vulnerability to heat stress. Trees were seen as the primary coping strategy for heat stress (regardless of vulnerability), though many participants noted a loss of tree cover in their vicinity. Cool drinking water from public taps and electric fans (particularly table fans) were other preferred coping mechanisms. Many participants did not have adequate access to cool drinking water or electric fans, leading to increased adverse experiences from heat. Based on participant input, several action items were identified for municipal and state/central governments, schools, and private organizations. Individuals affected by heat have a clear preference for nature-based solutions. This is in contrast with the current design of most heat action plans in India, which put more emphasis on infrastructure, information dissemination and behavioral solutions. Various agencies (governments, schools, private organizations) seeking to adapt to increasing heat stress need to better integrate citizen perspectives into their heat action plans

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2