Reducing Air Pollution - Towards making Indore a Smart, Clean, and Healthy City

Introduction: The Government of India initiated the Smart City Mission in 2015 with the aim of comprehensive urban development for 100 cities. Swachh Bharat Mission was also launched nationwide in 2014 with the goal of advancing universal sanitation coverage. Indore was selected as a Smart City; it was also declared the cleanest city in India in 2017 and in 2018 under Swachh Bharat. Indore is also participating in the United States Agency for International Development (USAID) - funded Building Healthy Cities Project, with the objective of improving the health of the city environment. As part of that objective, a closer examination of air pollution levels was conducted.Methodology: Annual average concentrations for sulphur dioxide, nitrogen oxides, and particulate matter (PM2.5 and PM10) from three air pollution measuring stations located in Indore’s Polo Ground (industrial), Kothari Market (commercial), and Kanodia Road, Vijay Nagar (residential) were analysed for trends during the last five years (2013-2017). For 2017, month-wise data were analysed for seasonal variations.Results: The annual average concentration of sulphur dioxide and nitrogen oxides did not change during the preceding five years. A declining trend was observed at all sites in concentration of PM10 from a range of 118-187 μg/m3 in 2013 to 77-81 μg/m3 in 2017. The PM2.5 concentration was measured only since 2016; 2017 levels were less when compared to the preceding year. Lower values were observed during the rainy season (July to September) for all pollutants. It was observed that, during the period, declining trend for PM10, various interventions were initiated in Indore, including night mechanical sweeping of city roads, free left loop roads to reduce traffic congestion, and an efficient systematic collection and disposal of solid waste.Conclusion: Declining trends of air pollution in particulate matter in Indore is evident, possibly due to various measures taken by the Municipal Corporation and Indore Smart City Mission. Further analysis is needed to understand how these trends can be sustained and how they may impact the respiratory health of Indore citizens

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used