Evaluation of the impact of heat stress on the occurrence of occupational injuries: Meta-analysis of observational studies

Effects of Heat Exposure and Ice Slurry Ingestion on Risk-Taking Behavior in Healthcare Workers

PURPOSE

Healthcare workers (HCWs) wearing personal protective equipment (PPE) experience physiological strain that can impair motor and psychological functions, potentially affecting patient care. We assessed the effects of heat exposure on maximal strength and risk-taking behavior among PPE-wearing HCWs and the efficacy of ice slurry to alleviate adverse effects.

METHODS

Seventeen HCWS completed two experimental trials in a crossover design, consuming 5 g·kg -1 of body mass of ambient drink (AMB) or ice slurry (ICE) before donning PPE and undergoing 2 h of simulated decontamination exercise (wet-bulb globe temperature (WBGT): 25.9°C ± 0.8°C, PPE microenvironment WBGT: 29.1°C ± 2.1°C). Body core temperature ( Tc ), heart rate (HR), chest skin temperature ( Tsk ), ratings of perceived exertion (RPE), thermal sensation (RTS), maximal voluntary contraction (MVC), risk-taking behavior (balloon analogue risk-taking task (BART)), and salivary cortisol were assessed.

RESULTS

Predrinking to postdrinking ∆ Tc was greater in ICE (-0.2°C ± 0.1°C) than AMB (-0.0°C ± 0.1°C, P = 0.003). Post-drinking RTS was lower in ICE (2.7 ± 1.2) than AMB (4.1 ± 0.4, P < 0.001). ICE and AMB had similar Tc and HR (both P > 0.05), but Tsk was lower in ICE than AMB ( P = 0.049). A lower MVC (30.3 ± 6.7 vs 27.4 ± 4.9 kg, P = 0.001) and higher BART-adjusted total pump count (472 ± 170 vs 615 ± 174 pumps, P = 0.017) was observed pretrial to posttrial in AMB but absent in ICE (both P > 0.05). Salivary cortisol was similar between trials ( P = 0.42).

CONCLUSIONS

Heat-exposed PPE-wearing HCWs had impaired maximal strength and elevated risk-taking behavior. This may increase the risk of avoidable workplace accidents that can jeopardize HCWs and patient care. Ice slurry ingestion alleviated these heat-related impairments, suggesting its potential as an ergogenic aid.

Association between temperature and occupational injuries in Spain: The role of contextual factors in workers' adaptation

BACKGROUND

Extensive evidence links both cold and hot temperatures to an increased incidence of occupational injuries. Contextual modifiers of the temperature-injury association have been scarcely researched. The present study addresses temporal and spatial variations to identify factors associated with (mal)adaptation to heat and cold among Spanish workers.

METHODS

We assessed the association between daily mean temperature and work injuries using quasi-Poisson time-series regression models in 48 Spanish provinces over the period 1988-2019, with comparative analyses with census and economic data for the sub-periods 1989-1993, 1999-2003, 2009-2013 and 2015-2019. We explored the spatial and spatiotemporal modification of the association by demographic and socioeconomic variables via cross-sectional and longitudinal meta-regressions.

FINDINGS

We found an increased risk of work-injuries by 4 % [95 % CI: 3 %-6 %] and 12 % [95 % CI: 10 %-13 %], for the 1st and 99th percentiles of temperature, respectively, for period 1988-2019. Heat had a greater overall impact than cold, and the groups more vulnerable to heat were male workers, under 35 years, and working in agriculture, construction and hostelry. Vulnerability to heat was highest in the earliest sub-period, while vulnerability to cold rose during periods of both economic expansion and recession. High educational attainment emerged as a protective factor during the warm months in the cross-sectional meta-regressions.

CONCLUSIONS

Our findings suggest an adaptation of Spanish workers to high temperatures over time. However, preventive measures are needed for traditionally exposed workers (agriculture and construction), non-traditionally vulnerable sectors (hostelry), and young, male, and less educated workers during warm months. For cold vulnerability, targeted measures should focus on women, the elderly, and tertiary service workers, especially in colder regions. Addressing temperature vulnerability would enhance worker safety, reduce injuries, and yield economic benefits.

Severity Analysis for Occupational Heat-related Injury Using the Multinomial Logit Model

Background

Workers are often exposed to hazardous heat due to their work environment, leading to various injuries. As a result of climate change, heat-related injuries (HRIs) are becoming more problematic. This study aims to identify critical contributing factors to the severity of occupational HRIs.

Methods

This study analyzed historical injury reports from the Occupational Safety and Health Administration (OSHA). Contributing factors to the severity of HRIs were identified using text mining and model-free machine learning methods. The Multinomial Logit Model (MNL) was applied to explore the relationship between impact factors and the severity of HRIs.

Results

The results indicated a higher risk of fatal HRIs among middle-aged, older, and male workers, particularly in the construction, service, manufacturing, and agriculture industries. In addition, a higher heat index, collapses, heart attacks, and fall accidents increased the severity of HRIs, while symptoms such as dehydration, dizziness, cramps, faintness, and vomiting reduced the likelihood of fatal HRIs.

Conclusions

The severity of HRIs was significantly influenced by factors like workers' age, gender, industry type, heat index , symptoms, and secondary injuries. The findings underscore the need for tailored preventive strategies and training across different worker groups to mitigate HRIs risks.

Extreme Heat and Occupational Health Risks

Climate change poses a significant occupational health hazard. Rising temperatures and more frequent heat waves are expected to cause increasing heat-related morbidity and mortality for workers across the globe. Agricultural, construction, military, firefighting, mining, and manufacturing workers are at particularly high risk for heat-related illness (HRI). Various factors, including ambient temperatures, personal protective equipment, work arrangements, physical exertion, and work with heavy equipment may put workers at higher risk for HRI. While extreme heat will impact workers across the world, workers in low- and middle-income countries will be disproportionately affected. Tracking occupational HRI will be critical to informing prevention and mitigation strategies. Renewed investment in these strategies, including workplace heat prevention programs and regulatory standards for indoor and outdoor workers, will be needed. Additional research is needed to evaluate the effectiveness of interventions in order to successfully reduce the risk of HRI in the workplace.

Mitigating heat effects in the workplace with a ventilation jacket: Simulations of the whole-body and local human thermophysiological response with a sweating thermal manikin in a warm-dry environment

Climate change is increasingly affecting human well-being and will inevitably impact on occupational sectors in terms of costs, productivity, workers' health and injuries. Among the cooling garment developed to reduce heat strain, the ventilation jacket could be considered for possible use in workplaces, as it is wearable without limiting the user's mobility and autonomy. In this study, simulations with a sweating manikin are carried out to investigate the effects of a short-sleeved ventilation jacket on human thermophysiological responses in a warm-dry scenario. Simulations were performed in a climatic chamber (air temperature = 30.1 °C; air velocity = 0.29 m/s; relative humidity = 30.0 %), considering two constant levels of metabolic rate M (M1 = 2.4 MET; M2 = 3.2 MET), a sequence of these two (Work), and three levels of fan velocities (lf = 0; lf=2; lf=4). The results revealed a more evident impact on the mean skin temperature (Tsk) compared to the rectal temperature (Tre), with significant decreases (compared to fan-off) at all M levels, for Tsk from the beginning and for Tre from the 61st minute. Skin temperatures of the torso zones decreased significantly (compared to fan-off) at all M levels, and a greater drop was registered for the Back. The fans at the highest level (lf=4) were significantly effective in improving whole-body and local thermal sensations when compared to fan-off, at all M levels. At the intermediate level (lf=2), the statistical significance varied with thermal zone, M and time interval considered. The results of the simulations also showed that the Lower Torso needs to be monitored at M2 level, as the drop in skin temperature could lead to local overcooling and thermal discomfort. Simulations showed the potential effectiveness of the ventilation jacket, but human trials are needed to verify its cooling power in real working conditions.

Increase in summertime ambient temperature is associated with decreased sick leave risk in Helsinki, Finland

OBJECTIVES

Climate change has increased attention to the health effects of high ambient temperatures and heatwaves worldwide. Both cause-specific mortality and hospital admissions are studied widely, mainly concentrating on warmer climates, but studies focusing on more subtle health effects and cold climates lack. This study investigated the effect of summertime daily ambient temperatures and heatwaves on sick leaves in the employed population in Helsinki, Finland, a Nordic country with a relatively cold climate.

METHODS

We obtained from the City of Helsinki personnel register data on sick leaves for the summer months (June-August) of 2002-2017. We estimated the overall cumulative association of all and short (maximum 3-day) sick leaves with daily mean temperature over a 21-day lag period using a negative binomial regression model coupled with a penalized distributed lag non-linear model (penalized DLNM). The association of sick leaves with heatwaves (cut-off temperature 20.8 °C), and prolonged heatwaves, was estimated using a negative binomial regression model coupled with DLNM. We adjusted the time series model for potential confounders, such as air pollution, relative humidity, time trends, and holidays.

RESULTS

Increasing daily temperature tended to be associated with decreased overall cumulative risk of sick leaves and short sick leaves over a 21-day lag period. In addition, heatwaves and prolonged heatwaves were associated with decreased overall cumulative risk of sick leaves compared to all other summer days: RR 0.87 (95 % CI 0.78 to 0.97) and RR 0.83 (95 % CI 0.70 to 0.98), respectively.

CONCLUSIONS

This research suggests that summertime daily temperatures that are high for this northern location have protective effects on the health of the working population.

Current and projected heatwave-attributable occupational injuries, illnesses, and associated economic burden in Australia

INTRODUCTION

The costs of global warming are substantial. These include expenses from occupational illnesses and injuries (OIIs), which have been associated with increases during heatwaves. This study estimated retrospective and projected future heatwave-attributable OIIs and their costs in Australia.

MATERIALS AND METHODS

Climate and workers' compensation claims data were extracted from seven Australian capital cities representing OIIs from July 2005 to June 2018. Heatwaves were defined using the Excess Heat Factor. OIIs and associated costs were estimated separately per city and pooled to derive national estimates. Results were projected to 2030 (2016-2045) and 2050 (2036-2065).

RESULTS

The risk of OIIs and associated costs increased during heatwaves, with the risk increasing during severe and particularly extreme heatwaves. Of all OIIs, 0.13% (95% empirical confidence interval [eCI]: 0.11-0.16%) were heatwave-attributable, equivalent to 120 (95%eCI:70-181) OIIs annually. 0.25% of costs were heatwave-attributable (95%eCI: 0.18-0.34%), equal to $AU4.3 (95%eCI: 1.4-7.4) million annually. Estimates of heatwave-attributable OIIs by 2050, under Representative Concentration Pathway [RCP]4.5 and RCP8.5, were 0.17% (95%eCI: 0.10-0.27%) and 0.23% (95%eCI: 0.13-0.37%), respectively. National costs estimates for 2030 under RCP4.5 and RCP8.5 were 0.13% (95%eCI: 0.27-0.46%) and 0.04% (95%eCI: 0.66-0.60), respectively. These estimates for extreme heatwaves were 0.04% (95%eCI: 0.02-0.06%) and 0.04% (95%eCI: 0.01-0.07), respectively. Cost-AFs in 2050 were, under RCP4.5, 0.127% (95%eCI: 0.27-0.46) for all heatwaves and 0.04% (95%eCI: 0.01-0.09%) for extreme heatwaves. Attributable fractions were approximately similar to baseline when assuming theoretical climate adaptation.

DISCUSSION

Heatwaves represent notable and preventable portions of preventable OIIs and economic burden. OIIs are likely to increase in the future, and costs during extreme heatwaves in 2030. Workplace and public health policies aimed at heat adaptation can reduce heat-attributable morbidity and costs.

How Does Environmental Temperature Affect Farmworkers' Work Rates in the California Heat Illness Prevention Study?

OBJECTIVE

Estimate the association between environmental temperature (wet bulb globe temperature [WBGT]) and work rate over the course of a workday.

METHODS

Repeated-measures regression was used to identify characteristics impacting work rate in a cross-sectional study of Latino farmworkers. Minute-by-minute work rate (measured by accelerometer) and WBGT were averaged over 15-minute intervals.

RESULTS

Work rate decreased by 4.34 (95% confidence interval [CI], -7.09 to -1.59) counts per minute per degree Celsius WBGT in the previous 15-minute interval. Cumulative quarter hours worked (2.13; 95% CI, 0.82 to 3.45), age (-3.64; 95% CI, -4.50 to -2.79), and dehydration at the end of workday (51.37; 95% CI, 19.24 to 83.50) were associated with counts per minute as were gender, pay type (piece rate vs hourly) and body mass index ≥25 kg/m 2 . The effects of pay type and body mass index were modified by gender.

CONCLUSION

Increased temperature was associated with a decrease in work rate.

Limitations associated with thermoregulation and cardiovascular research assessing laborers performing work in the heat

PURPOSE

To quantify the current literature and limitations associated with research examining thermoregulatory and cardiovascular strain in laborers working in the heat.

METHODS

PubMed, SCOPUS, and SPORTDiscus were searched for terms related to the cardiovascular system, heat stress, and physical work. Qualifying studies included adult participants (18-65 years old), a labor-intensive environment or exercise protocol simulating a labor environment, a minimum duration of 120 min of physical work, and environmental heat stress (ambient temperature ≥26.0°C and ≥30% relative humidity). Studies included at least one of the following outcomes: pre- and peak physical work, core temperature, heart rate (HR), systolic blood pressure, diastolic blood pressure, HR variability, and rate pressure product.

RESULTS

Twenty-one out of 1559 potential studies qualified from our search. There was a total of 598 participants (mean = 28 ± 50 participants per study, range = 4-238 participants per study), which included 51 females (8.5%) and 547 males (91.5%). Of the participants, 3.8% had cardiovascular risk factors (diabetes: n = 10; hypertension: n = 13) and 96.2% were characterized as "healthy". Fifty-seven percent of the included studies were performed in a laboratory setting.

CONCLUSIONS

Studies were predominantly in men (91.5%), laboratory settings (57%), and "healthy" individuals (96.2%). To advance equity in protection against occupational heat stress and better inform future heat safety recommendations to protect all workers, future studies must focus on addressing these limitations. Employers, supervisors, and other safety stakeholders should consider these limitations while implementing current heat safety recommendations.

The Effect of Participatory Heat Education on Agricultural Worker Knowledge

OBJECTIVES

Farmworkers disproportionately experience preventable adverse health effects from heat exposure. We sought to evaluate the effect of participatory heat education on farmworker knowledge.

METHODS

We conducted a parallel, comparison group intervention study to investigate the effectiveness of a Spanish/English participatory, culturally-tailored, heat education-based intervention on farmworker heat knowledge in the Summer 2019. We used convenience sampling to recruit adult outdoor farmworkers from Central/Eastern Washington State, USA. Crews were randomized to receive the intervention (n = 40 participants) versus not receive the intervention (n = 43 participants). We assessed changes in heat knowledge, scored on a scale from 0 to 11, between baseline, immediate post-intervention, and post-season, which was approximately three months after baseline, using the Wilcoxon signed-rank test. We compared differences in knowledge scores from baseline to post-season between groups using analysis of variance.

RESULTS

Average knowledge scores improved from 4.6 (standard deviation [sd] 1.5) to 6.3 (sd 2.0) pre to post season in the intervention group (p < 0.001). There was a greater improvement in pre-post knowledge scores in the intervention (average difference 1.6, sd 2.0) versus the comparison group (average difference 0.41, sd 1.7) (p = 0.04).

CONCLUSIONS

Participatory heat training was effective in improving farmworker heat knowledge over the course of a summer season. Results of this study will be used to guide heat prevention efforts for farmworkers.

TRIAL REGISTRATION

ClinicalTrials.gov Registration Number: NCT04234802.

Human thermal physiological response of wearing personal protective equipment: An educational building semi-open space experimental investigation

With the outbreak and spread of the COVID-19 epidemic, HCWs are frequently required to wear personal protective equipment (PPE) for nucleic acid sample collection in semi-open transition spaces. Wearing PPE causes significant psychological and physical stress in HCWs. In this study, operative temperature (T_op) and wet-bulb globe temperature (WBGT) were used to assess thermal conditions through field experiments, while multiple physiological parameters were measured in the subjects. The results indicated that the subjects showed statistically significant differences in thermal perception and physiological parameters with and without PPE. Using observed increases in heart rate (HR), auditory canal temperature (T_ac), mean skin temperature (MST), and end-tidal CO₂ pressure, subjects were shown to have an increased metabolic rate and heat storage while wearing PPE. Additionally, a decrease in oxygen concentration was also observed, and this decrease may be linked to fatigue and cognitive impairment. Moreover, HR, MST, and T_ac showed a significant linear relationship, which increased with temperature and operative temperature, and the HR response was stronger with PPE than without PPE. The neutral, preferred, and acceptable temperatures were significantly lower with PPE than without PPE, and the deviations for neutral T_op/WBGT were 9.5/7.1 °C and preferred T_op/WBGT was 2.2/4.0 °C, respectively. Moreover, the upper limits of acceptable WBGT, 29.4 °C with PPE and 20.4 °C without PPE, differed significantly between the two phases. Furthermore, the recorded physiological parameter responses and thermal perception responses of the subjects while wearing PPE indicated that they were at risk of thermal stress. Overall, these results suggest that people who wear PPE should focus on their health and thermal stress. This study provides a reference for the development of strategies to counteract heat stress and improve thermal comfort.

Development of a Prototype Observatory of Heat-Related Occupational Illnesses and Injuries through the Collection of Information from the Italian Press, as Part of the WORKLIMATE Project

Exposure to heat is a recognized occupational risk factor. Deaths and accidents at work caused by high temperatures are underestimated. With the aim of detecting and monitoring heat-related illnesses and injuries, a prototype database of occupational events attributable to critical thermal conditions reported in Italian newspapers was created. Information was analyzed from national and local online newspapers using a web application. The analysis was conducted from May to September during the three-year period 2020-2022. Articles concerning 35 occupational heat-related illnesses and injuries were selected; 57.1% of the events were reported in 2022, and 31.4% of total accidents occurred in the month of July 2022, when the Universal Thermal Climate Index daily mean values corresponded to "moderate heat stress" (51.0%) and "strong heat stress" (49.0%). Fatal heat-related illnesses were the most frequent conditions described. In most cases, workers had been involved in outdoor activities in the construction sector. A comprehensive report was created by compiling all relevant newspaper articles to enhance awareness of this issue among relevant stakeholders and promote heat-risk prevention strategies in the current context where heatwaves are becoming increasingly frequent, intense and long-lasting.

Effects of Temperatures and Heatwaves on Occupational Injuries in the Agricultural Sector in Italy

The effects of heat on health have been well documented, while less is known about the effects among agricultural workers. Our aim is to estimate the effects and impacts of heat on occupational injuries in the agricultural sector in Italy. Occupational injuries in the agricultural sector from the Italian national workers' compensation authority (INAIL) and daily mean air temperatures from Copernicus ERA5-land for a five-year period (2014-2018) were considered. Distributed lag non-linear models (DLNM) were used to estimate the relative risk and attributable injuries for increases in daily mean air temperatures between the 75th and 99th percentile and during heatwaves. Analyses were stratified by age, professional qualification, and severity of injury. A total of 150,422 agricultural injuries were considered and the overall relative risk of injury for exposure to high temperatures was 1.13 (95% CI: 1.08; 1.18). A higher risk was observed among younger workers (15-34 years) (1.23 95% CI: 1.14; 1.34) and occasional workers (1.25 95% CI: 1.03; 1.52). A total of 2050 heat-attributable injuries were estimated in the study period. Workers engaged in outdoor and labour-intensive activities in the agricultural sector are at greater risk of injury and these results can help target prevention actions for climate change adaptation.

Association between extreme temperature exposure and occupational injuries among construction workers in Italy: An analysis of risk factors

BACKGROUND/AIM

Extreme temperatures have impact on the health and occupational injuries. The construction sector is particularly exposed. This study aims to investigate the association between extreme temperatures and occupation injuries in this sector, getting an insight in the main accidents-related parameters.

METHODS

Occupational injuries in the construction sector, with characteristic of accidents, were retrieved from Italian compensation data during years 2014-2019. Air temperatures were derived from ERA5-land Copernicus dataset. A region based time-series analysis, in which an over-dispersed Poisson generalized linear regression model, accounting for potential non-linearity of the exposure- response curve and delayed effect, was applied, and followed by a meta-analysis of region-specific estimates to obtain a national estimate. The relative risk (RR) and attributable cases of work-related injuries for an increase in mean temperature above the 75th percentile (hot) and for a decrease below the 25th percentile (cold) were estimated, with effect modifications by different accidents-related parameters.

RESULTS

The study identified 184,936 construction occupational injuries. There was an overall significant effect for high temperatures (relative risk (RR) 1.216 (95% CI: (1.095-1.350))) and a protective one for low temperatures (RR 0.901 (95% CI: 0.843-0.963)). For high temperatures we estimated 3,142 (95% CI: 1,772-4,482) attributable cases during the studied period. RRs from 1.11 to 1.30 were found during heat waves days. Unqualified workers, as well as masons and plumbers, were found to be at risk at high temperatures. Construction, quarry and industrial sites were the risky working environments, as well as specific physical activities like working with hand-held tools, operating with machine and handling of objects. Contact with sharp, pointed, rough, coarse 'Material Agent' were the more risky mode of injury in hot conditions.

CONCLUSIONS

Prevention policies are needed to reduce the exposure to high temperatures of construction workers. Such policies will become a critical issue considering climate change.

High Temperature and Its Association With Work-Related Injuries by Employment Status in South Korea, 2017-2018

OBJECTIVE

This study aimed to determine the association between maximum daily temperature and work-related injuries according to employment status in South Korea.

METHODS

Data on workers' compensation claims and daily maximum temperature between May 20 and September 10, 2017-2018, were collected and analyzed. The absolute temperature risk effect (ATR) was evaluated by comparing the risk effect at 2 temperatures (30°C vs 33°C) across all communities using 2-stage time-series analysis.

RESULTS

The association between high temperatures and work-related injuries was statistically significant in the construction sector (ATR, 1.129; 95% confidence interval [CI], 1.010-1.261). In addition, the findings of this study also demonstrated a higher risk effect among nonpermanent workers (ATR, 1.109; 95% CI, 1.013-1.214) at 33°C versus 30°C when compared with permanent workers (ATR, 0.963; 95% CI, 0.891-1.041).

CONCLUSIONS

This study found a significant association between high temperatures and work-related injuries among nonpermanent workers in South Korea.

Impact of climate change on occupational health and safety: A review of methodological approaches

BACKGROUND

The working population is exposed daily to unavoidable climatic conditions due to their occupational settings. Effects of the weather such as rain, heat, and air pollution may increase the risk of diseases, injuries, accidents, and even death during labor.

OBJECTIVE

This paper aims to summarize the impacts of climate change on workers' health, safety and performance, identifying the risks, affected workplaces and the range of methodological approaches used to assess this problem.

METHODS

A thorough systematic mapping was conducted in seven scientific international databases: Emerald, IEEE Xplore, Science Direct, Scielo, Scopus, SpringerLink, and Web of Science. Three research questions guided the extraction process resulting in 170 articles regarding the impacts of climate change on occupational health and safety.

RESULTS

We found an accentuated trend in observational studies applying primary and secondary data collection. Many studies focused on the association between rising temperatures and occupational hazards, mainly in outdoor work settings such as agriculture. The variation of temperature was the most investigated impact of climate change.

CONCLUSIONS

We established a knowledge base on how to explore the impacts of climate change on workers' well-being and health. Researchers and policymakers benefit from this review, which explores the suitable methods found in the literature and highlights the most recurring risks and their consequences to occupational health and safety.

The effect of the participatory heat education and awareness tools (HEAT) intervention on agricultural worker physiological heat strain: results from a parallel, comparison, group randomized study

BACKGROUND

Farmworkers are at risk of heat-related illness (HRI). We sought to: 1) evaluate the effectiveness of farmworker Spanish/English participatory heat education and a supervisor decision-support mobile application (HEAT intervention) on physiological heat strain; and 2) describe factors associated with HRI symptoms reporting.

METHODS

We conducted a parallel, comparison group intervention study from May-September of 2019 in Central/Eastern Washington State, USA. We used convenience sampling to recruit adult outdoor farmworkers and allocated participating crews to intervention (n = 37 participants) and alternative-training comparison (n = 38 participants) groups. We measured heat strain monthly using heart rate and estimated core body temperature to compute the maximum work-shift physiological strain index (PSImax) and assessed self-reported HRI symptoms using a weekly survey. Multivariable linear mixed effects models were used to assess associations of the HEAT intervention with PSImax, and bivariate mixed models were used to describe factors associated with HRI symptoms reported (0, 1, 2+ symptoms), with random effects for workers.

RESULTS

We observed larger decreases in PSImax in the intervention versus comparison group for higher work exertion levels (categorized as low, low/medium-low, and high effort), after adjustment for maximum work-shift ambient Heat Index (HImax), but this was not statistically significant (interaction - 0.91 for high versus low/medium-low effort, t = - 1.60, p = 0.11). We observed a higher PSImax with high versus low/medium-low effort (main effect 1.96, t = 3.81, p < 0.001) and a lower PSImax with older age (- 0.03, t = - 2.95, p = 0.004), after covariate adjustment. There was no clear relationship between PSImax and the number of HRI symptoms reported. Reporting more symptoms was associated with older age, higher HImax, 10+ years agricultural work, not being an H-2A guest worker, and walking > 3 min to get to the toilet at work.

CONCLUSIONS

Effort level should be addressed in heat management plans, for example through work/rest cycles, rotation, and pacing, in addition to education and other factors that influence heat stress. Both symptoms and indicators of physiological heat strain should be monitored, if possible, during periods of high heat stress to increase the sensitivity of early HRI detection and prevention. Structural barriers to HRI prevention must also be addressed.

TRIAL REGISTRATION

ClinicalTrials.gov Registration Number: NCT04234802 , date first posted 21/01/2020.

Potential Impacts of Different Occupational Outdoor Heat Exposure Thresholds among Washington State Crop and Construction Workers and Implications for Other Jurisdictions

Occupational heat exposure is associated with substantial morbidity and mortality among outdoor workers. We sought to descriptively evaluate spatiotemporal variability in heat threshold exceedances and describe potential impacts of these exposures for crop and construction workers. We also present general considerations for approaching heat policy-relevant analyses. We analyzed county-level 2011-2020 monthly employment (Bureau of Labor Statistics Quarterly Census of Employment and Wages) and environmental exposure (Parameter-elevation Relationships on Independent Slopes Model (PRISM)) data for Washington State (WA), USA, crop (North American Industry Classification System (NAICS) 111 and 1151) and construction (NAICS 23) sectors. Days exceeding maximum daily temperature thresholds, averaged per county, were linked with employment estimates to generate employment days of exceedances. We found spatiotemporal variability in WA temperature threshold exceedances and crop and construction employment. Maximum temperature exceedances peaked in July and August and were most numerous in Central WA counties. Counties with high employment and/or high numbers of threshold exceedance days, led by Yakima and King Counties, experienced the greatest total employment days of exceedances. Crop employment contributed to the largest proportion of total state-wide employment days of exceedances with Central WA counties experiencing the greatest potential workforce burden of exposure. Considerations from this analysis can help inform decision-making regarding thresholds, timing of provisions for heat rules, and tailoring of best practices in different industries and areas.

Work-Related Injuries among Insured Construction Workers Presenting to a Swiss Adult Emergency Department: A Retrospective Study (2016-2020)

Occupational injuries are one of the main causes of Emergency Department visits and represent a substantial source of disability or even death. However, the published studies and reports on construction-occupational accidents in Switzerland are limited. We aimed to investigate the epidemiology of fatal and non-fatal injuries among construction workers older than 16 years of age over a 5-year period. Data were gathered from the emergency department (ED) of Bern University Hospital. A retrospective design was chosen to allow analysis of changes in construction accidents between 2016-2020. A total of 397 patients were enrolled. Compared to studies in other countries, we also showed that the upper extremity and falling from height is the most common injured body part and mechanism of injury. Furthermore, we were able to show that the most common age group representing was 26-35 years and the second common body part injured was the head, which is a difference from studies in other countries. Wound lacerations were the most common type of injury, followed by joint distortions. By stratifying according to the season, occupational injuries among construction workers were found to be significant higher during summer and autumn. As work-related injuries among construction workers are becoming more common, prevention strategies and safety instructions must be optimized.

A potential wearable solution for preventing heat strain in workplaces: The cooling effect and the total evaporative resistance of a ventilation jacket

The increase in average seasonal temperatures has an impact in the occupational field, especially for those sectors whose work activities are performed outdoors (agricultural, road and construction sectors). Among the adaptation measures and solutions developed to counteract occupational heat strain, personal cooling garments represent a wearable technology designed to remove heat from the human body, enhancing human performance. This study aims to investigate the effectiveness and the cooling power of a specific cooling garment, i.e. a ventilation jacket, by quantifying the evaporative heat losses and the total evaporative resistance both when worn alone and in combination with a work ensemble, at three adjustments of air ventilation speed. Standardised "wet" tests in a climatic chamber were performed on a sweating manikin in isothermal conditions considering three clothing ensembles (single jacket, work ensemble and a combination of both) and three adjustments of fan velocity. Results showed a significant increase (p < 0.001) in evaporative heat loss values when the fan velocity increased, particularly within the trunk zones for all the considered clothing ensembles, showing that fans enhanced the dissipation by evaporation. The cooling power, quantified in terms of percent changes of evaporative heat loss, showed values exceeding 100% when fans were on, in respect to the condition of fans-off, for the trunk zones except for the Chest. A significant (p < 0.01) decrease (up to 42.3%) in the total evaporative resistance values of the jacket, coupled with the work ensemble, was found compared to the fans-off condition. Results confirmed and quantified the cooling effect of the ventilation jacket which enhanced the evaporative heat losses of the trunk zones, helping the body to dissipate heat and showing the potential for a heat adaptation measure to be developed.

Workers’ Perception Heat Stress: Results from a Pilot Study Conducted in Italy during the COVID-19 Pandemic in 2020

Many workers are exposed to the effects of heat and often to extreme temperatures. Heat stress has been further aggravated during the COVID-19 pandemic by the use of personal protective equipment to prevent SARS-CoV-2 infection. However, workers’ risk perception of heat stress is often low, with negative effects on their health and productivity. The study aims to identify workers’ needs and gaps in knowledge, suggesting the adaptation of measures that best comply with the needs of both workers and employers. A cross-sectional online questionnaire survey was conducted in Italy in the hottest months of 2020 (June–October) through different multimedia channels. The data collected were analyzed using descriptive statistics; analytical tests and analysis of variance were used to evaluate differences between groups of workers. In total, 345 questionnaires were collected and analyzed. The whole sample of respondents declared that heat is an important contributor to productivity loss and 83% of workers did not receive heat warnings from their employer. In this context, the internet is considered as the main source of information about heat-related illness in the workplace. Results highlight the need to increase workers’ perception of heat stress in the workplace to safeguard their health and productivity. About two-thirds of the sample stated that working in the sun without access to shaded areas, working indoors without adequate ventilation, and nearby fire, steam, and hot surfaces, represent the main injuries’ risk factors.

Knowledge Gaps and Research Priorities on the Health Effects of Heatwaves: A Systematic Review of Reviews

Although extreme weather events have played a constant role in human history, heatwaves (HWs) have become more frequent and intense in the past decades, causing concern especially in light of the increasing evidence on climate change. Despite the increasing number of reviews suggesting a relationship between heat and health, these reviews focus primarily on mortality, neglecting other important aspects. This systematic review of reviews gathered the available evidence from research syntheses conducted on HWs and health. Following the PRISMA guidelines, 2232 records were retrieved, and 283 reviews were ultimately included. Information was extracted from the papers and categorized by topics. Quantitative data were extracted from meta-analyses and, when not available, evidence was collected from systematic reviews. Overall, 187 reviews were non-systematic, while 96 were systematic, of which 27 performed a meta-analysis. The majority evaluated mortality, morbidity, or vulnerability, while the other topics were scarcely addressed. The following main knowledge gaps were identified: lack of a universally accepted definition of HW; scarce evidence on the HW-mental health relationship; no meta-analyses assessing the risk perception of HWs; scarcity of studies evaluating the efficacy of adaptation strategies and interventions. Future efforts should meet these priorities to provide high-quality evidence to stakeholders.

Accuracy of an estimated core temperature algorithm for agricultural workers

There is a substantial burden of occupational health effects from heat exposure. We sought to assess the accuracy of estimated core body temperature (CBT_est) derived from an algorithm that uses sequential heart rate and initializing CBT,¹ compared with gastrointestinal temperature measured using more invasive ingestible sensors (CBT_gi), among outdoor agricultural workers. We analyzed CBT_est and CBT_gi data from Washington State, USA, pear and apple harvesters collected across one work shift in 2015 (13,413 observations, 35 participants) using Bland Altman methods. The mean (standard deviation, range) CBT_gi was 37.7 (0.4, 36.5-39.4)°C. Overall CBT bias (limits of agreement) was -0.14 (±0.76)°C. Biases ranged from -0.006 to -0.75 °C. The algorithm, which does not require the use of ingestible sensors, may be a practical tool in research among groups of workers for evaluating the effectiveness of interventions to prevent adverse occupational heat health effects.

A functional seasonal thermal hot-spot classification: Focus on industrial sites

This study was focused on the metropolitan area of Florence in Tuscany (Italy) with the aim to provide a functional spatial thermal anomaly indicator obtained throughout a thermal summer and winter hot-spot detection. The hot-spot analysis was performed by applying Getis-Ord Gi* spatial statistics to Land Surface Temperature (LST) layers, obtained from Landsat 8 remote sensing data during the 2015-2019 daytime summer and winter period, to delimitate summer hot- and cool-spots, and winter warm- and cold-spots. Further, these ones were spatially combined thus obtaining a comprehensive summer-winter Thermal Hot-Spot (THS_SW) spatial indicator. Winter and summer mean daily thermal comfort profiles were provided for the study area assessing the Universal Thermal Climate Index (UTCI) by using meteorological data available from seven local weather stations, located at a maximum distance of 350 m from industrial sites. A specific focus on industrial sites was carried out by analyzing the industrial buildings characteristics and their surrounding areas (50 m buffer), through the following layers: industrial building area (BA), surface albedo of buildings (ALB), impervious area (IA), tree cover (TC), and grassland area (GA). The novel THS_SW classification applied to industrial buildings has shown that about 50% of the buildings were located in areas characterized by summer hot-spots. Increases in BA and IA revealed warming effects on industrial buildings, whereas increases in ALB, TC, and GA disclosed cooling effects. A decrease of about 10% of IA replaced by TC and GA was associated with about 2 °C decrease of LST. Very strong outdoor heat stress conditions were observed during summer daytime, whereas moderate winter outdoor cold stress conditions were recorded during nighttime until the early morning. The thermal spatial hot-spot classification in industrial areas provides a very useful source of information for thermal mitigation strategies aimed to reduce the heat-related health risk for workers.

Increased labor losses and decreased adaptation potential in a warmer world

Working in hot and potentially humid conditions creates health and well-being risks that will increase as the planet warms. It has been proposed that workers could adapt to increasing temperatures by moving labor from midday to cooler hours. Here, we use reanalysis data to show that in the current climate approximately 30% of global heavy labor losses in the workday could be recovered by moving labor from the hottest hours of the day. However, we show that this particular workshift adaptation potential is lost at a rate of about 2% per degree of global warming as early morning heat exposure rises to unsafe levels for continuous work, with worker productivity losses accelerating under higher warming levels. These findings emphasize the importance of finding alternative adaptation mechanisms to keep workers safe, as well as the importance of limiting global warming.

Outdoor workers may need to adapt to warming by moving labor from midday to cooler hours. Here the authors find this adaptation strategy loses efficacy under additional climate change due to increased heat exposure in the coolest hours of the day.

Compensation incentives and heat exposure affect farm worker effort

Farm workers are exposed to high risk of heat-related illness, especially when their jobs require working outside at a fast pace during hot days. Climate change has increased the number of days with high temperatures, and thereby the amount of time that farm workers are likely exposed to extreme heat. To better understand how high heat exposure affects farm workers, this study investigates how crop workers respond to heat exposure and estimates the effects of different pay and work arrangements on workers' responses to heat exposure. We explore, specifically, whether piece-rate arrangements increase workers' effort during periods with high heat exposure compared to workers paid by hourly wages. We use observational data from detailed measurements of localized heat exposure and individual workers' effort in the field. First, these results show workers adjust their effort in response to heat exposure when the heat exposure level changes. Second, piece-rate arrangements increase workers' effort during work shifts. Third, piece-rate arrangements allow workers to modify their effort more easily during different heat exposure levels. When facing low levels of heat exposure, workers who were paid by piece-rate arrangements exert a higher effort than workers paid by hourly wages, up until WBGT is 26.6˚C. When facing high levels of heat exposure (with WBGT exceeding 29.6˚C), workers paid by piece-rate arrangements lower their effort compared to workers paid by hourly wage arrangements.

Prevention of Occupational Heat-Related Illnesses

High ambient temperatures and strenuous physical activity put workers at risk for a variety of heat-related illnesses and injuries. Through primary prevention, secondary prevention, and treatment, OEM health providers can protect workers from the adverse effects of heat. This statement by the American College of Occupational and Environmental Medicine provides guidance for OEM providers who serve workers and employers in industries where heat exposure occurs.

Health effects of climate change: an overview of systematic reviews

OBJECTIVES

We aimed to develop a systematic synthesis of systematic reviews of health impacts of climate change, by synthesising studies' characteristics, climate impacts, health outcomes and key findings.

DESIGN

We conducted an overview of systematic reviews of health impacts of climate change. We registered our review in PROSPERO (CRD42019145972). No ethical approval was required since we used secondary data. Additional data are not available.

DATA SOURCES

On 22 June 2019, we searched Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Cochrane and Web of Science.

ELIGIBILITY CRITERIA

We included systematic reviews that explored at least one health impact of climate change.

DATA EXTRACTION AND SYNTHESIS

We organised systematic reviews according to their key characteristics, including geographical regions, year of publication and authors' affiliations. We mapped the climate effects and health outcomes being studied and synthesised major findings. We used a modified version of A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) to assess the quality of studies.

RESULTS

We included 94 systematic reviews. Most were published after 2015 and approximately one-fifth contained meta-analyses. Reviews synthesised evidence about five categories of climate impacts; the two most common were meteorological and extreme weather events. Reviews covered 10 health outcome categories; the 3 most common were (1) infectious diseases, (2) mortality and (3) respiratory, cardiovascular or neurological outcomes. Most reviews suggested a deleterious impact of climate change on multiple adverse health outcomes, although the majority also called for more research.

CONCLUSIONS

Most systematic reviews suggest that climate change is associated with worse human health. This study provides a comprehensive higher order summary of research on health impacts of climate change. Study limitations include possible missed relevant reviews, no meta-meta-analyses, and no assessment of overlap. Future research could explore the potential explanations between these associations to propose adaptation and mitigation strategies and could include broader sociopsychological health impacts of climate change.

The multi-level heat education and awareness tools [HEAT] intervention study for farmworkers: Rationale and methods

Background

The burden of adverse health effects from heat exposure is substantial, and outdoor workers who perform heavy physical work are at high risk. Though heat prevention interventions have been developed, studies have not yet systematically evaluated the effectiveness of approaches that address risk factors at multiple levels.

Objective

We sought to test the effectiveness of a multi-level heat prevention approach (heat education and awareness tools [HEAT]), which includes participatory training for outdoor agricultural workers that addresses individual and community factors and a heat awareness mobile application for agricultural supervisors that supports decisions about workplace heat prevention, in the Northwest United States.

Design

We designed the HEAT study as a parallel, comparison, randomized group intervention study that recruited workers and supervisors from agricultural workplaces. In intervention arm crews, workers received HEAT training, and supervisors received the HEAT awareness application. In comparison arm crews, workers were offered non-HEAT training. Primary outcomes were worker physiological heat strain and heat-related illness (HRI) symptoms. In both worker groups, we assessed HRI symptoms approximately weekly, and heat strain physiological monitoring was conducted at worksites approximately monthly, from June through August.

Discussion

To our knowledge, this is the first study to evaluate the effectiveness of a multi-level heat prevention intervention on physiological heat strain and HRI symptoms for outdoor agricultural workers.

Trial registration

ClinicalTrials.gov Registration Number: NCT04234802;

Heat waves and adaptation strategies in a mediterranean urban context

BACKGROUND

Heat waves can be considered as an emerging challenge among the potential health risks generated by urbanization and climate changes. Heat waves are becoming more frequent, long and intense, and can be defined as meteorological extreme events consisting in prolonged time of extremely high temperatures in a particular region. The following paper addresses health threats due to heat waves presenting the case study of Lecce, a city located in Southern Italy; the Mediterranean area is already recognized in international literature as a hot-spot for climate changes. This work assesses the potential impact of two different adaptation strategies.

METHODS

We have tested the effectiveness of cool surfaces and urban forestry as adaptation approaches to cope with heat waves. The microclimate computer-based model "ENVI-met" was adopted to predict thermal scenarios arising from the two proposed interventions. The parameters analysed consisted in temperature and relative humidity.

RESULTS

Urban forestry approach seem to lower temperature (that represents the major cause of urban overheating) better than cool surfaces strategy, but relative humidity produced by the evapotranspiration processes of urban forestry has also negative influences on temperature perceived by pedestrians (thermal discomfort).

CONCLUSION

Vegetation represents both an adaptation and a mitigation strategy to climate changes that guarantees an improvement of air quality, with consequent psychological and physical benefits. Wide campaigns aimed at planting trees and increasing the urban green coverage should be systematically planned and fostered by national, regional and local institutions preferably with the involvement of research departments, schools and citizens' associations.

Analysis of the impact of heat waves on daily mortality in urban and rural areas in Madrid

The objective of this study was to analyze and compare the effect of high temperatures on daily mortality in the urban and rural populations in Madrid. Data were analyzed from municipalities in Madrid with a population of over 10,000 inhabitants during the period from January 1, 2000 to December 31, 2020. Four groups were generated: Urban Metropolitan Center, Rural Northern Mountains, Rural Center, and Southern Rural. The dependent variable used was the rate of daily mortality due to natural causes per million inhabitants (CIE-X: A00-R99) between the months of June and September for the period. The primary independent variable was maximum daily temperature. Social and demographic "context variables" were included: population >64 years of age (%), deprivation index and housing indicators. The analysis was carried out in three phases: 1) determination of the threshold definition temperature of a heat wave (Tumbral) for each study group; 2) determination of relative risks (RR) attributable to heat for each group using Poisson linear regression (GLM), and 3) calculation of odds ratios (OR) using binomial family GLM for the frequency of the appearance of heat waves associated with context variables. The resulting percentiles (for the series of maximum daily temperatures for the summer months) corresponding to Tthreshold were: 74th percentile for Urban Metropolitan Center, 76th percentile for Southern Rural, 83rd for Rural Northern Mountains and 98th percentile for Center Rural (98). Greater vulnerability was found for the first two. In terms of context variables that explained the appearance of heat waves, deprivation index level, population >64 years of age and living in the metropolitan area were found to be risk factors. Rural and urban areas behaved differently, and socioeconomic inequality and the composition of the population over age 64 were found to best explain the vulnerability of the Rural Center and Southern Rural zones.

Occupational heat stress and economic burden: A review of global evidence

BACKGROUND

The adverse effects of heat on workers' health and work productivity are well documented. However, the resultant economic consequences and productivity loss are less understood. This review aims to summarize the retrospective and potential future economic burden of workplace heat exposure in the context of climate change.

METHODS

Literature was searched from database inception to October 2020 using Embase, PubMed, and Scopus. Articles were limited to original human studies investigating costs from occupational heat stress in English.

RESULTS

Twenty studies met criteria for inclusion. Eighteen studies estimated costs secondary to heat-induced labor productivity loss. Predicted global costs from lost worktime, in US$, were 280 billion in 1995, 311 billion in 2010 (≈0.5% of GDP), 2.4-2.5 trillion in 2030 (>1% of GDP) and up to 4.0% of GDP by 2100. Three studies estimated heat-related healthcare expenses from occupational injuries with averaged annual costs (US$) exceeding 1 million in Spain, 1 million in Guangzhou, China and 250,000 in Adelaide, Australia. Low- and middle-income countries and countries with warmer climates had greater losses as a proportion of GDP. Greater costs per worker were observed in outdoor industries, medium-sized businesses, amongst males, and workers aged 25-44 years.

CONCLUSIONS

The estimated global economic burden of occupational heat stress is substantial. Climate change adaptation and mitigation strategies should be implemented to likely minimize future costs. Further research exploring the relationship between occupational heat stress and related expenses from lost productivity, decreased work efficiency and healthcare, and costs stratified by demographic factors, is warranted. Key messages. The estimated retrospective and future economic burden from occupational heat stress is large. Responding to climate change is crucial to minimize this burden. Analyzing heat-attributable occupational costs may guide the development of workplace heat management policies and practices as part of global warming strategies.

Extreme heat and occupational injuries in different climate zones: A systematic review and meta-analysis of epidemiological evidence

BACKGROUND

The link between heat exposure and adverse health outcomes in workers is well documented and a growing body of epidemiological evidence from various countries suggests that extreme heat may also contribute to increased risk of occupational injuries (OI). Previously, there have been no comparative reviews assessing the risk of OI due to extreme heat within a wide range of global climate zones. The present review therefore aims to summarise the existing epidemiological evidence on the impact of extreme heat (hot temperatures and heatwaves (HW)) on OI in different climate zones and to assess the individual risk factors associated with workers and workplace that contribute to heat-associated OI risks.

METHODS

A systematic review of published peer-reviewed articles that assessed the effects of extreme heat on OI among non-military workers was undertaken using three databases (PubMed, Embase and Scopus) without temporal or geographical limits from database inception until July 2020. Extreme heat exposure was assessed in terms of hot temperatures and HW periods. For hot temperatures, the effect estimates were converted to relative risks (RR) associated with 1 °C increase in temperature above reference values, while for HW, effect estimates were RR comparing heatwave with non-heatwave periods. The patterns of heat associated OI risk were investigated in different climate zones (according to Köppen Geiger classification) based on the study locations and were estimated using random-effects meta-analysis models. Subgroup analyses according to workers' characteristics (e.g. gender, age group, experience), nature of work (e.g. physical demands, location of work i.e. indoor/outdoor) and workplace characteristics (e.g. industries, business size) were also conducted.

RESULTS

A total of 24 studies published between 2005 and 2020 were included in the review. Among these, 22 studies met the eligibility criteria, representing almost 22 million OI across six countries (Australia, Canada, China, Italy, Spain, and USA) and were included in the meta-analysis. The pooled results suggested that the overall risk of OI increased by 1% (RR 1.010, 95% CI: 1.009-1.011) for 1 °C increase in temperature above reference values and 17.4% (RR 1.174, 95% CI: 1.057-1.291) during HW. Among different climate zones, the highest risk of OI during hot temperatures was identified in Humid Subtropical Climates (RR 1.017, 95% CI: 1.014-1.020) followed by Oceanic (RR 1.010, 95% CI: 1.008-1.012) and Hot Mediterranean Climates (RR 1.009, 95% CI: 1.008-1.011). Similarly, Oceanic (RR 1.218, 95% CI: 1.093-1.343) and Humid Subtropical Climates (RR 1.213, 95% CI: 0.995-1.431) had the highest risk of OI during HW periods. No studies assessing the risk of OI in Tropical regions were found. The effects of hot temperatures on the risk of OI were acute with a lag effect of 1-2 days in all climate zones. Young workers (age < 35 years), male workers and workers in agriculture, forestry or fishing, construction and manufacturing industries were at high risk of OI during hot temperatures. Further young workers (age < 35 years), male workers and those working in electricity, gas and water and manufacturing industries were found to be at high risk of OI during HW.

CONCLUSIONS

This review strengthens the evidence on the risk of heat-associated OI in different climate zones. The risk of OI associated with extreme heat is not evenly distributed and is dependent on underlying climatic conditions, workers' attributes, the nature of work and workplace characteristics. The differences in the risk of OI across different climate zones and worker subgroups warrant further investigation along with the development of climate and work-specific intervention strategies.

Wet Bulb Globe Temperature and Recorded Occupational Injury Rates among Sugarcane Harvesters in Southwest Guatemala

As global temperatures continue to rise it is imperative to understand the adverse effects this will pose to workers laboring outdoors. The purpose of this study was to investigate the relationship between increases in wet bulb globe temperature (WBGT) and risk of occupational injury or dehydration among agricultural workers. We used data collected by an agribusiness in Southwest Guatemala over the course of four harvest seasons and Poisson generalized linear modelling for this analysis. Our analyses suggest a 3% increase in recorded injury risk with each degree increase in daily average WBGT above 30 °C (95% CI: -6%, 14%). Additionally, these data suggest that the relationship between WBGT and injury risk is non-linear with an additional 4% acceleration in risk for every degree increase in WBGT above 30 °C (95% CI: 0%, 8%). No relationship was found between daily average WBGT and risk of dehydration. Our results indicate that agricultural workers are at an increased risk of occupational injury in humid and hot environments and that businesses need to plan and adapt to increasing global temperatures by implementing and evaluating effective occupational safety and health programs to protect the health, safety, and well-being of their workers.

Steps Towards Comprehensive Heat Communication in the Frame of a Heat Health Warning System in Slovenia

Occupational heat stress has an important negative impact on the well-being, health and productivity of workers and should; therefore, be recognized as a public health issue in Europe. There is no comprehensive heat health warning system in Slovenia combining public health measures with meteorological forecasts. The aim of this research was to provide insight into the development of such a system in Slovenia, turning the communication from the current meteoalarm into a broader system that has more information for different social groups. To achieve this goal, the following steps were used: Analysis of summer temperatures and issued meteoalarms, a survey of the general knowledge about heat among the public, organization and management of two stakeholder symposia, and a final survey on workers' opinions on heat stress and measures, supplemented by interviews with employers. Summer average daily temperature distributions in Slovenia changed during the investigated period (1961-2019) and the mean values increased over time by 2-3 °C. Additionally, the number of days with fulfilled yellow (potentially dangerous) and especially orange (dangerous) meteoalarm conditions increased significantly after 1990. The survey of the general public about heat stress and warnings showed that efforts to raise awareness of heat issues need to be intensified and that public health measures should effectively target vulnerable groups. Stakeholder symposia and further surveys have shown that awareness and understanding of the negative effects of heat stress on health and productivity are still quite low, so effective ways of disseminating information to different sectors while striking the best balance between efficiency, feasibility and economic cost have to be found.

Combined Burden of Heat and Particulate Matter Air Quality in WA Agriculture

Objectives: To evaluate the combined burden of heat and air quality exposure in Washington State agriculture by (1) characterizing the spatiotemporal pattern of heat and PM_2.5 exposures during wildfire seasons; (2) describing the potential impact of these combined exposures on agricultural worker populations; and (3) identifying data gaps for addressing this burden in rural areas.

METHODS

We combined county-level data to explore data availability and estimate the burden of heat and PM_2.5 co-exposures for Washington agricultural workers from 2010 to 2018. Quarterly agricultural worker population estimates were linked with data from a weather station network and ambient air pollution monitoring sites. A geographical information system displayed counties, air monitoring sites, agricultural crops, and images from a smoke dispersion model during recent wildfire events.

RESULTS

We found substantial spatial and temporal variability in high heat and PM_2.5 exposures. The largest peaks in PM_2.5 exposures tended to occur when the heat index was around 85°F and during summers when there were wildfires. Counties with the largest agricultural populations tended to have the greatest concurrent high heat and PM_2.5 exposures, and these exposures tended to be highest during the third quarter (July-September), when population counts were also highest. Additionally, we observed limited access to local air quality information in certain rural areas.

CONCLUSION

Our findings inform efforts about highest risk areas, times of year, and data availability in rural areas. Understanding the spatiotemporal pattern of exposures is consistent with the precision agriculture framework and is foundational to addressing equity in rural agricultural settings.

Air temperatures and occupational injuries in the agricultural settings: a report from Northern Italy (Po River Valley, 2013-2017)

Introduction:

High environmental temperatures are associated with an increased risk for occupational injuries (OIs), particularly where environmental exposure and heat sources in the workplace, are associated with internal heat generation by strenuous muscular work. As a consequence, Agricultural Workers (AWs) are among the most heavily affected occupational groups.

Methods and aims:

The aim of this study was to assess the relationship between environmental temperatures and OIs in AWs from the Po River Valley in the Northern Italy (27,736,158 total inhabitants; mean agricultural workforce of 312,195.6 individuals). Data about OIs from 2013 to 2017, and daily weather for the administrative unit of occurrence were retrieved. Days were classified by a) mininum (Tmin) / maximum (Tmax) air temperatures; b) average day temperature (Tday); c) daily temperature variation (TV), d) relative humidity. Risk for daily OIs was calculated as correspondent Odds Ratios (OR) through a Poisson regression model.

Results:

Estimated incidence for OIs was 66.3/1,000 workers-year. In regression analysis, for every Tday percentile increase equal to 2.5, an OR 1.007 (95% CI, 1.003 to 1.010) was reported. More precisely, higher risk for OIs was associated to Tmax > 25°C (OR 1.143, 95%CI 1.125-1.160) and to Tmax > 25°C + Tmin > 20°C (OR 1.158, 95%CI 1.138-1.179), Tmin < 0°C were associated with a significantly reduced risk (OR 0.879, 95%CI 0.850-0.910), with the notable exception of older age groups (OR 1.348, 95%CI 1.254; 1.449). During timeframes characterized by Tmax > 35°C (i.e. HW time period), the risk was higher during the first day (OR 1.266; 95%CI 1.206-1.330), and again from the fourth day onwards (OR 1.090; 95%CI 1.048 – 1.133). Analysis of TV identified an increased risk for occupational injuries in days characterized by higher variability, and particularly for TV ranging 4.0 – 4.9 (OR 1.042, 95%CI 1.017 – 1.068), and equals to 5.0 or greater (OR 1.143, 95%CI 1.118 – 1.167). Also increased relative humidity was associated with higher risk for OIs (OR 1.096, 95%CI 1.081-1.126, and OR 1.154, 95%CI 1.135-1.173 for relative humidity 70 – 89%, and ≥ 90%).

Conclusions:

Our findings recommend policymakers to develop appropriate procedures and guidelines, in particular for the HW time periods. (www.actabiomedica.it)

Determinants of heat-related injuries in Australian workplaces: Perceptions of health and safety professionals

INTRODUCTION

Hot workplace environments can lead to adverse health effects and contribute to a range of injuries. However, there is limited contextual understanding of heat-related injury occurrence. Gaining the perspectives of occupational health and safety professionals (HSPs) may elucidate the issue and inform targeted interventions.

METHODS

A cross-sectional national online survey was conducted in Australia to characterise HSP perceptions of heat-related injuries; current preventive measures; training, policies and guidelines; and perspectives on barriers for prevention. Results were analysed descriptively and a log-Poisson regression model was used to identify risk factors associated with HSP reported injury occurrence, assessed through prevalence ratio (PR).

RESULTS

Of the 307 HSP survey participants, 74% acknowledged the potential for increased risk of occupational injuries in hot weather. A variety of injury types and mechanisms were reported, including manual handling injuries, hand injuries, wounds or lacerations, and loss of control of power tools. Correlates of reported heat-related injuries included working in the sun without shade [PR: 1.26; 95% CI: 1.07-1.48] and too few rest breaks [PR: 1.28; 95% CI: 1.04-1.44]. Other factors of significance were inadequate hydration; issues with personal protective equipment (PPE) and poor supervision of workers. Only 42% reported that adequate heat training was available and 54% reported the provision for outdoor work to cease in extreme temperatures. It was acknowledged that the frequency of injuries could be reduced with wider adoption of self-pacing, and work/rest regimes. Perceived barriers for prevention included: lack of awareness of physical injury risks, and management concerns about productivity loss and/or deadlines.

CONCLUSION

The findings indicate a range of potentially modifiable work and organisational risk factors such as more suitable PPE and better supervision. More attention to these factors, in conjunction with traditional interventions to reduce heat effects, could enhance injury prevention and labour productivity in people working in hot environments.

Heat-Related Illness Among Latinx Child Farmworkers in North Carolina: A Mixed-Methods Study

Children as young as ten are legally hired for farm work. In North Carolina, many of these hired children are Latinx; they often work long hours during hot and humid summer conditions. Heat-related illness occurs along a continuum of severity ranging from heat cramps and rashes to heat exhaustion and heat stroke, which can be fatal. The literature on the negative health effects of occupational heat exposure is growing; however, few studies have examined this exposure and health outcomes among child agricultural workers. To understand Latinx child farmworkers' experiences of working in heat, we conducted in-depth interviews (n = 30). To estimate the prevalence of heat-related illness symptoms and associated factors, we conducted survey interviews (n = 165). Heat-related illness is common among these child farmworkers. While children often understand the dangers of working in heat, work organization often prevents their taking precautions. Formal workplace protections to prevent heat-related illness are limited.

Heat-related productivity loss: benefits derived by working in the shade or work-time shifting

Purpose

Agricultural workers represent an important part of the population exposed to high heat-related health and productivity risks. This study aims to estimate the heat-related productivity loss (PL) for moderate work activities in sun and shady areas and evaluating the economic cost locally in an Italian farm and generally in the whole province of Florence. Benefits deriving by working in the shade or work-time shifting were provided. Comparisons between PL estimated in Mediterranean (Florence, Italy) and subtropical (Guangzhou, China) areas were also carried out.

Design/methodology/approach

Meteorological data were collected during summers 2017–2018 through a station installed in a farm in the province of Florence and by two World Meteorological Organization (WMO)‐certified meteorological stations located at the Florence and Guangzhou airports. These data were used to calculate the wet-bulb globe temperature and to estimate the hourly PL and the economic cost during the typical working time (from 8 a.m. to 5 p.m.) and by advancing of 1 h and 2 h the working time. Significant differences were calculated through nonparametric tests.

Findings

The hourly PL and the related economic cost significantly decreased (p < 0.05) by working in the shade and by work-time shifting. Higher PL values were observed in Guangzhou than in Florence. The decrease of PL observed by work-time shifting was greater in Florence than in Guangzhou.

Originality/value

Useful information to plan suitable heat-related prevention strategies to counteract the effects of heat in the workplace are provided. These findings are essential to quantify the beneficial effects due to the implementation of specific heat-related adaptation measures to counter the impending effects of climate change.

Air temperatures and occupational injuries in the construction industries: a report from Northern Italy (2000-2013)

The aim of this study was to assess the relationship between environmental temperatures and occupational injuries (OIs) in construction workers (CWs) from a subalpine region of North-Eastern Italy. Data about OIs from 2000 to 2013, and daily weather for the specific site of the events were retrieved. Risk for daily OIs was calculate through a Poisson regression model. Estimated daily incidence for OIs was 5.7 (95%CI 5.5-5.8), or 2.8 OIs/10,000 workers/d (95%CI 2.7-2.9), with higher rates for time periods characterized by high temperatures (daily maximum ≥35°C), both in first 2 d (3.57, 95%CI 3.05-4.11) and from the third day onwards (i.e. during Heat Waves: 3.43, 95%CI 3.08-3.77). Higher risk for OIs was reported in days characterized temperatures ≥95th percentile (OR 1.145, 95%CI 1.062-1.235), summer days (daily maximum ≥25°C , OR 1.093, 95%CI 1.042-1.146). On the contrary, no significant increased risk was found for OIs having a more severe prognosis (≥40 d or more; death). In conclusion, presented findings recommend policymakers to develop appropriate procedures and guidelines, in particular aimed to improve the compliance of younger CWs towards severe-hot daily temperatures.

Risk perception of heat related disorders on the workplaces: a survey among health and safety representatives from the autonomous province of Trento, Northeastern Italy

Introduction

This study will investigate knowledge, attitude and practices towards heat-related health issues in a sample of safety representatives from Northern Italy (H&SRs).

Methods

A cross-sectional questionnaire survey was conducted in 2016-2017 among 298 H&SR. Knowledge status was measured both in general but as well and focusing on first-aid issues. Assessment of risk perception included severity and frequency of heat-related events. Multivariate logistic regression analysis assessed individual and work-related characteristics associated with H&SRs’ risk perception.

Results

258 questionnaires were retrieved (participation rate 86.6%; mean age 48.2 ± 8.4 years). Knowledge status was relatively good on technical/preventive issues (62.3% ± 16.8) and first aid measures (72.6% ± 27.2), but a large share of respondents ignored the risk from exertional heat stroke (35.9%), and for heat strokes elicited by non-environmental heat (e.g. machineries, use of protective equipment, etc. 47.9%). The majority of respondents acknowledged the high frequency of extreme events like heat waves (62.0%), but only 44.6% agreed on their potential health threat, with an unsatisfying cumulative risk perception score (55.4% ± 23.5). A specific first-aid formation course was reported by 49.2% of respondents, while 10.9% had any previous interaction with heat-related disorders. Specific countermeasures for heat waves had been put in place by parent company in 20.1% of cases. Eventually, higher educational achievements (mOR 2.239, 95% CI 1.184-4.233) and a better general knowledge status (mOR 1.703, 95% CI 1.073-2.979) were positive predictors for higher risk perception.

Conclusions

Although H&SRs exhibited a good understanding of heat-related health issues, stakeholders should improve the implementation of specific countermeasures on the workplaces.

Heat related illness among workers in Washington State: A descriptive study using workers' compensation claims, 2006-2017

BACKGROUND

Heat related illness (HRI) places a significant burden on the health and safety of working populations and its impacts will likely increase with climate change. The aim of this study was to characterize the demographic and occupational characteristics of Washington workers who suffered from HRI from 2006 to 2017 using workers' compensation claims data.

METHODS

We used Washington workers' compensation data linked to weather station data to identify cases of work-related HRI. We utilized Occupational Injury and Illness Classification System codes, International Classification of Diseases 9/10 codes, and medical review to identify accepted and rejected Washington State (WA) workers' compensation claims for HRI from 2006 to 2017. We estimated rates of HRI by industry and evaluated patterns by ambient temperature.

RESULTS

We detected 918 confirmed Washington workers' compensation HRI claims from 2006 to 2017, 654 were accepted and 264 were rejected. Public Administration had the highest third quarter rate (131.3 per 100 000 full time employees [FTE]), followed by Agriculture, Forestry, Fishing, and Hunting (102.6 per 100 000 FTE). The median maximum daytime temperature was below the Washington heat rule threshold for 45% of the accepted HRI claims. Latinos were estimated to be overrepresented in HRI cases.

CONCLUSION

The WA heat rule threshold may not be adequately protecting workers and racial disparities are present in occupational HRI. Employers should take additional precautions to prevent HRI depending on the intensity of heat exposure. States without heat rules and with large industry sectors disproportionately affected by HRI should consider regulations to protect outdoor workers in the face of more frequent and extreme heat waves.

Regional Temperature-Sensitive Diseases and Attributable Fractions in China

Few studies have been carried out to systematically screen regional temperature-sensitive diseases. This study was aimed at systematically and comprehensively screening both high- and low-temperature-sensitive diseases by using mortality data from 17 study sites in China located in temperate and subtropical climate zones. The distributed lag nonlinear model (DLNM) was applied to quantify the association between extreme temperature and mortality to screen temperature-sensitive diseases from 18 kinds of diseases of eight disease systems. The attributable fractions (AFs) of sensitive diseases were calculated to assess the mortality burden attributable to high and low temperatures. A total of 1,380,713 records of all-cause deaths were involved. The results indicate that injuries, nervous, circulatory and respiratory diseases are sensitive to heat, with the attributable fraction accounting for 6.5%, 4.2%, 3.9% and 1.85%, respectively. Respiratory and circulatory diseases are sensitive to cold temperature, with the attributable fraction accounting for 13.3% and 11.8%, respectively. Most of the high- and low-temperature-sensitive diseases seem to have higher relative risk in study sites located in subtropical zones than in temperate zones. However, the attributable fractions for mortality of heat-related injuries were higher in temperate zones. The results of this research provide epidemiological evidence of the relative burden of mortality across two climate zones in China.

Heat Exposure and Occupational Injuries: Review of the Literature and Implications

PURPOSE OF REVIEW

The burden of heat-related adverse occupational health effects, as well as traumatic injuries, is already substantial. Projected increases in mean temperatures and extreme events may increase the risk of adverse heat health effects and enhance disparities among exposed workers. This article reviews the emerging literature on the relationship between heat exposure and occupational traumatic injuries and discusses implications of this work.

RECENT FINDINGS

A recent meta-analysis of three case-crossover and five time series studies in industrialized settings reported an association of increasing occupational injuries with increasing heat exposure, with increased effect estimates for male gender and age less than 25 years, although heterogeneity in exposure metrics and sources of bias were demonstrated to varying degrees across studies. A subsequent case-crossover study in outdoor construction workers reported a 0.5% increase in the odds of traumatic injuries per 1 °C increase in maximum daily humidex (odds ratio 1.005 [95% CI 1.003-1.007]). While some studies have demonstrated reversed U-shaped associations between heat exposure and occupational injuries, different risk profiles have been reported in different industries and settings. Studies conducted primarily in industrialized settings suggest an increased risk of traumatic injury with increasing heat exposure, though the exact mechanisms of heat exposure's effects on traumatic injuries are still under investigation. The effectiveness of heat-related injury prevention approaches has not yet been established. To enhance the effectiveness of prevention efforts, prioritization of approaches should take into account not only the hierarchy of controls, social-ecological models, community and stakeholder participation, and tailoring of approaches to specific local work settings, but also methods that reduce local and global disparities and better address the source of heat exposure, including conservation-informed land-use planning, built environment, and prevention through design approaches. Participation of occupational health experts in transdisciplinary development and integration of these approaches is needed.

Nationwide epidemiological study for estimating the effect of extreme outdoor temperature on occupational injuries in Italy

BACKGROUND

Despite the relevance for occupational safety policies, the health effects of temperature on occupational injuries have been scarcely investigated. A nationwide epidemiological study was carried out to estimate the risk of injuries for workers exposed to extreme temperature and identify economic sectors and jobs most at risk.

MATERIALS AND METHODS

The daily time series of work-related injuries in the industrial and services sector from the Italian national workers' compensation authority (INAIL) were collected for each of the 8090 Italian municipalities in the period 2006-2010. Daily air temperatures with a 1 × 1 km resolution derived from satellite land surface temperature data using mixed regression models were included. Distributed lag non-linear models (DLNM) were used to estimate the association between daily mean air temperature and injuries at municipal level. A meta-analysis was then carried out to retrieve national estimates. The relative risk (RR) and attributable cases of work-related injuries for an increase in mean temperature above the 75th percentile (heat) and for a decrease below the 25th percentile (cold) were estimated. Effect modification by gender, age, firm size, economic sector and job type were also assessed.

RESULTS

The study considered 2,277,432 occupational injuries occurred in Italy in the period 2006-2010. There were significant effects for both heat and cold temperatures. The overall relative risks (RR) of occupational injury for heat and cold were 1.17 (95% CI: 1.14-1.21) and 1.23 (95% CI: 1.17-1.30), respectively. The number of occupational injuries attributable to temperatures above and below the thresholds was estimated to be 5211 per year. A higher risk of injury on hot days was found among males and young (age 15-34) workers occupied in small-medium size firms, while the opposite was observed on cold days. Construction workers showed the highest risk of injuries on hot days while fishing, transport, electricity, gas and water distribution workers did it on cold days.

CONCLUSIONS

Prevention of the occupational exposure to extreme temperatures is a concern for occupational health and safety policies, and will become a critical issue in future years considering climate change. Epidemiological studies may help identify vulnerable jobs, activities and workers in order to define prevention plans and training to reduce occupational exposure to extreme temperature and the risk of work-related injuries.

An Occupational Heat-Health Warning System for Europe: The HEAT-SHIELD Platform

Existing heat-health warning systems focus on warning vulnerable groups in order to reduce mortality. However, human health and performance are affected at much lower environmental heat strain levels than those directly associated with higher mortality. Moreover, workers are at elevated health risks when exposed to prolonged heat. This study describes the multilingual "HEAT-SHIELD occupational warning system" platform (https://heatshield.zonalab.it/) operating for Europe and developed within the framework of the HEAT-SHIELD project. This system is based on probabilistic medium-range forecasts calibrated on approximately 1800 meteorological stations in Europe and provides the ensemble forecast of the daily maximum heat stress. The platform provides a non-customized output represented by a map showing the weekly maximum probability of exceeding a specific heat stress condition, for each of the four upcoming weeks. Customized output allows the forecast of the personalized local heat-stress-risk based on workers' physical, clothing and behavioral characteristics and the work environment (outdoors in the sun or shade), also taking into account heat acclimatization. Personal daily heat stress risk levels and behavioral suggestions (hydration and work breaks recommended) to be taken into consideration in the short term (5 days) are provided together with long-term heat risk forecasts (up to 46 days), all which are useful for planning work activities. The HEAT-SHIELD platform provides adaptation strategies for "managing" the impact of global warming.

Association between work in deforested, compared to forested, areas and human heat strain: An experimental study in a rural tropical environment

BACKGROUND

With climate change, adverse human health effects caused by heat exposure are of increasing public health concern. Forests provide beneficial ecosystem services for human health, including local cooling. Few studies have assessed the relationship between deforestation and heat-related health effects in tropical, rural populations. We sought to determine whether deforested compared to forested landscapes are associated with increased physiological heat strain in a rural, tropical environment.

METHODS

We analyzed data from 363 healthy adult participants from ten villages who participated in a two-by-two factorial, randomized study in East Kalimantan, Indonesia from 10/1/17 to 11/6/17. Using simple randomization, field staff allocated participants equally to different conditions to conduct a 90-minute outdoor activity, representative of typical work. Core body temperature was estimated at each minute during the activity using a validated algorithm from baseline oral temperatures and sequential heart rate data, measured using chest band monitors. We used linear regression models, clustered by village and with a sandwich variance estimator, to assess the association between deforested versus forested conditions and the number of minutes each participant spent above an estimated core body temperature threshold of 38.5°C.

RESULTS

Compared to those in the forested condition (n=172), participants in the deforested condition (n=159) spent an average of 3.08 (95% CI 0.57, 5.60) additional minutes with an estimated core body temperature exceeding 38.5°C, after adjustment for age, sex, body mass index, and experiment start time, with a larger difference among those who began the experiment after 12 noon (5.17 [95% CI 2.20, 8.15]).

CONCLUSIONS

In this experimental study in a tropical, rural setting, activity in a deforested versus a forested setting was associated with increased objectively measured heat strain. Longer durations of hyperthermia can increase the risk of serious health outcomes. Land use decisions should consider the implications of deforestation on local heat exposure and health as well as on forest services, including carbon storage functions that impact climate change mitigation.