Practical on-site measurement of heat strain with the use of a perceptual strain index

Agreement between measured and self-reported physiological strain in young adults and older adults with and without common chronic diseases during simulated occupational heat stress

While monitoring physiological strain is recommended to safeguard workers during heat exposure, it is logistically challenging. The perceptual strain index (PeSI) is a subjective estimate thought to reflect the physiological strain index (PSI) that requires no direct monitoring. However, advanced age and chronic diseases (hypertension/type 2 diabetes [T2D]) influence the perception of heat stress, potentially limiting the utility of the PeSI. We therefore assessed whether the relation and agreement between the PeSI and PSI during simulated work in various environmental conditions is modified by age and T2D/hypertension. Thirteen young adults and 37 older adults without (n = 14) and with T2D (n = 10) or hypertension (n = 13) walked on a treadmill (∼200 W/m2) for 180 min or until termination (volitional fatigue, rectal temperature ≥39.5 °C) in 16, 24, 28, and 32 °C wet-bulb globe temperatures. Rectal temperature and heart rate were recorded to calculate PSI (0-10 scale). Rating of perceived exertion and thermal sensation were recorded to calculate PeSI (0-10 scale). The relation between hourly PSI and PeSI was assessed via linear mixed models. Mean bias (95% limits of agreement [LoA]) between PSI and PeSI was assessed via Bland-Altman analysis. PSI increased with PeSI (p < 0.001), but the slope of this relation was not different between young and older adults (p = 0.189) or as a function of chronic disease (within older adults; p = 0.183). The mean bias between PSI and PeSI was small (0.02), but the 95% LoA was wide (-3.3-3.4). Together, a linear relation between PeSI and PSI was observed but agreement between these measures varied considerably across individuals and thus PeSI should not be used as a surrogate marker of PSI. Caution should be taken when utilizing the PeSI to estimate physiological strain on workers.

Agreement between measured and self-reported physiological strain in males and females during simulated occupational heat stress

RATIONALE

Monitoring physiological strain is recommended to safeguard workers during heat exposure, but is logistically challenging. The perceptual strain index (PeSI) is a subjective estimate thought to reflect the physiological strain index (PSI) that requires no physiological monitoring. However, sex is known to influence perceptions of heat stress, potentially limiting the utility of the PeSI.

OBJECTIVES

The objective of this study was to assess whether sex modifies the relationship between PeSI and PSI.

METHODS

Thirty-four adults (15 females) walked on a treadmill (moderate intensity; ~200 W/m2) for 180 min or until termination (volitional fatigue, rectal temperature ≥39.5°C) in 16°C, 24°C, 28°C, and 32°C wet-bulb globe temperatures. Rectal temperature and heart rate were recorded to calculate PSI (0-10 scale). Rating of perceived exertion and thermal sensation were recorded to calculate PeSI (0-10 scale). Relationships between PSI and PeSI were evaluated via linear mixed models. Mean bias (95% limits of agreement [LoA]) between PSI and PeSI was assessed via Bland-Altman analysis. Mean absolute error between measures was calculated by summing absolute errors between the PeSI and the PSI and dividing by the sample size.

FINDINGS

PSI increased with PeSI (p < 0.01) but the slope of this relation was not different between males and females (p = 0.83). Mean bias between PSI and PeSI was small (-0.4 points), but the 95% LoA (-3.5 to 2.7 points) and mean absolute error were wide (1.3 points).

IMPACT

Our findings indicate that sex does not appreciably impact the agreement between the PeSI and PSI during simulated occupational heat stress. The PeSI is not a suitable surrogate for the PSI in either male or female workers.

Association between physiological and perceptual heat strain while wearing stab-resistant body armor

In this study, we explored the association between physiological and perceptual heat strain while wearing stab-resistant body armor (SRBA). Human trials were performed on ten participants in warm and hot environments. Physiological responses (core temperature, skin temperature, and heart rate), and perceptual responses (thermal sensation vote, thermal comfort vote, restriction of perceived exertion (RPE), wetness of skin, and wetness of clothing) were recorded throughout the trials, and subsequently, the physiological strain index (PSI), and perceptual strain index (PeSI) were calculated. The results indicated that the PeSI showed a significant moderate association with the PSI, and was capable of predicting PSI for low (PSI = 3) and high (PSI = 7) levels of physiological strain with the areas under the curves of 0.80 and 0.64, respectively. Moreover, Bland-Altman analysis indicated that the majority of the PSI ranged within the 95% confidence interval, and the mean difference between PSI and PeSI was 0.14 ± 2.02 with the lower 95% limit and upper 95% limit being -3.82 to 4.10, respectively. Therefore, the subjective responses could be used as an indicator for predicting physiological strain while wearing SRBA. This study could provide fundamental knowledge for the usage of SRBA, and the development of physiological heat strain assessment.

Effects of liquid cooling garment on physiological and psychological strain of firefighter in hot and warm environments

This study aimed to explore the effects of a liquid cooling garment on the physiological and psychological strains of firefighters. Twelve participants wearing firefighting protective equipment with the liquid cooling garment (LCG group) and without the liquid cooling garment (CON group) were recruited to conduct human trials in a climate chamber. During the trials, physiological parameters (mean skin temperature (T_sk), core temperature (T_c), and heart rate (HR)) and psychological parameters (thermal sensation vote (TSV), thermal comfort vote (TCV), and rating of perceived exertion (RPE)) were measured continuously. The heat storage, sweating loss, physiological strain index (PSI), and perceptual strain index (PeSI) were calculated. The results indicated that the liquid cooling garment decreased the mean skin temperature (maximum value of 0.62 °C), scapula skin temperature (maximum value of 1.90 °C), sweating loss (26%), and PSI (0.95 scales) with a significant difference (p < 0.05) at some time points when compared with the CON group. Moreover, the liquid cooling garment had little influence (p > 0.05) on core temperature, heart rate, TSV, TCV, RPE, and PeSI. The association analysis indicated that psychological strain had the potential to predict physiological heat strain with an R² value of 0.86 between the PeSI and PSI. This study offers insights into the evaluation of cooling system performance, the design of next-generation cooling systems, and the improvement of firefighters' benefits.

Scoping review on the state of the integration of human physiological responses to evaluating heat-stress

OBJECTIVES

To determine the state of the literature on assessing heat-stress using physiological parameters. To provide recommendations to the nuclear industry regarding worker heat-stress management practices.

METHODS

A scoping review identified relevant articles. A search strategy was developed based on a research question concepts. Identified records were screened with inclusion-exclusion criteria. Included articles underwent data extraction using a qualitative data charting method. A thematic analysis and frequency counts were performed.

RESULTS

1687 articles were identified through four databases. The final inclusion consisted of 34 studies. Articles were classified by determinants of heat exposure risks: core body temperature (direct and indirect), scoring scale including core body temperature, scoring scale including human perception, and others. Heart rate and rectal temperature were the two most utilized physiological measurements.

CONCLUSION

A significant amount of literature examined estimation of core temperature using non-invasive methods, sometimes integrated into wearables. Heat-stress management practices could include perceptual measures to better evaluate heat-strain.

Physiological impacts on construction workers under extremely hot and humid weather

PURPOSE

Construction worker health and safety is a primary concern for construction companies and researchers. Arabian Gulf region, like Saudi Arabia, has been experiencing extremely hot and humid (EHH) weather, which directly affects construction workers' health and safety. This study aims to address the problem of EHH weather conditions and their impacts on construction workers' physiological status.

METHODS

This study assesses the impacts of EHH weather on construction workers' physiological status through the measurement of workers' physical body parameters (age, height, and weight); type of activities; and assigned tasks. Thirty-five multinational workers participated in the measurements, which were conducted in real construction site conditions A quantitative analysis was then applied to quantify the physiological impacts of the weather conditions. Several hypotheses were tested to identify the significant impacts of individual and working aspects on the workers' physiological responses.

RESULTS AND CONCLUSION

The results provide empirical evidence that the recorded Heart Rate (HR) exceeded the acceptable physiological zones for construction workers exposed to extremely hot and humid weather conditions. Physical body parameters, work activities, and worker status significantly influence construction workers' physiological responses. This study recommends adopting a continuous monitoring approach as an early warning system under extremely hot and humid weather conditions.

Heat stress and physiological and perceptual strains of date harvesting workers in palm groves in Jiroft

BACKGROUND

Outdoor workers are exposed to heat caused by atmospheric conditions and solar radiation. More specifically, those working in palm groves are more in danger of heat stresses since they harvest their crops in hot seasons.

OBJECTIVE

This study was aimed at investigating heat stresses and strains in date harvesting workers in groves around Jiroft, Southeastern Iran.

METHODS

This study was a descriptive-analytical one of cross-sectional type. In this study, three environmental indices including Wet Bulb Globe Temperature index (WBGT), Environmental Stress Index (ESI) and Discomfort Index (DI), the physiological strain index (PSI) as well as perceptual strain index (PeSI) were analyzed to investigate stresses and strains in workers. For this purpose, 59 date harvesting workers (36 men and 23 women) in palm groves in Jiroft were analyzed. With accordance to date harvesting season, data collection was carried out from August to September, 2017.

RESULTS

In this research, the means of environmental indices including WBGT, ESI and DI were 32.77°C, 30.39°C and 33.22°C, respectively and they all revealed direct and significant correlation. Moreover, Time-Weighted Average for Wet Bulb Globe Temperature index (WBGT.TWA) was significantly different from Threshold Limit Values for Wet Bulb Globe Temperature index (WBGT.TLV). The scores of the PSI and PeSI were 2.28 and 6.61, respectively.

CONCLUSION

The results of this study indicated that date picking workers were exposed to heat stress more than the reference value of WBGT recommended by American Conference of Governmental Industrial Hygienists (ACGIH). In addition, workers suffered a low degree of physiological strain and a moderate degree of perceptual strain caused by heat stress in palm groves in Jiroft.

Weather and labor productivity in construction: a literature review and taxonomy of studies

Purpose

Climate change and global warming have increased concerns over the influence of weather on workers' health and productivity in construction projects. A significant number of studies can be found in the weather and productivity interplay area. The purpose of this paper is to review the recently published papers in this area to explore the trends of research and topics discussed and to determine knowledge gaps and directions for future research.

Design/methodology/approach

Recent papers published between 2014 and 2019 were synthesized, reviewed and analyzed using bibliometric and text mining analysis.

Findings

The results revealed the trends of publications, the main authors contributed to this area and countries that attracted most of the research papers. Based on the review, this study presented a taxonomy of studies consisting of seven clusters, namely productivity management, seasons, weather factors, participants' conditions, uniform and clothing, work time and health and safety.

Originality/value

This review paper sheds a light into the topics discussed in this area, the interrelationship between the topics and the significant topics that should be continued in the future. Global warming concerns necessitate the need for more studies in tropical countries and countries that are expected to expose to high temperatures and heat stress, which greatly impact labor productivity. The paper highlighted the need to understand how weather influences workers' psychological conditions and subsequently their productivity.

Assessment of Heat Stress Exposure among Construction Workers in the Hot Desert Climate of Saudi Arabia

Objectives

Excessive heat exposure poses significant risks to workers in hot climates. This study assessed the intensity and duration of heat stress exposure among workers performing residential construction in southeastern Saudi Arabia (SA) during the summer, June–September 2016. Objectives were to: identify work factors related to heat stress exposure; measure environmental heat exposure at the construction sites; assess the heat stress risk among workers using the wet bulb globe temperature (WBGT) index; and determine if temperature-humidity indices can be appropriate alternatives to WBGT for managing heat stress risk at the construction sites.

Methods

Worksite walkthrough surveys and environmental monitoring were performed, indoors and outdoors, at 10 construction sites in Al-Ahsa Province. A heat stress exposure assessment was conducted according to the American Conference of Governmental Industrial Hygienists (ACGIH®) guidelines, which uses the WBGT index. WBGT measurements from two instruments were compared. Alternative heat stress indices were compared to the WBGT: the heat index (HI) and humidex (HD) index.

Results

Construction workers were exposed to excessive heat stress, indoors and outdoors over a large part of the work day. Complying with a midday outdoor work ban (12–3 p.m.) was not effective in reducing heat stress risk. The highest intensity of exposure was outdoors from 9 a.m. to 12 p.m.; a period identified with the highest hourly mean WBGT values (31–33°C) and the least allowable working time according to ACGIH® guidelines. Comparison of the alternative indices showed that the HI is more reliable than the HD as a surrogate for the WBGT index in the climate studied.

Conclusion

The extreme heat exposure represents a serious risk. The severity of heat stress and its impact are projected to increase due to climate change, emphasizing the need for immediate improvement of the current required protective measures and the development of occupational heat stress exposure guidelines in SA.

Impacts of cooling intervention on the heat strain attenuation of construction workers

This study aimed to evaluate the effectiveness and practicality of a cooling intervention with a newly designed cooling vest on heat strain attenuation in the construction industry. Fourteen construction workers volunteered to participate in the field study. Each participant took part in two trials, i.e., cooling and control. Construction work included morning and afternoon sessions. Cooling intervention was implemented for 15 and 30 min during the morning and afternoon rest periods, respectively, between repeated bouts of work. Micrometeorological (wet-bulb globe temperature [WBGT]), physiological (tympanic temperature and heart rate), and perceptual (ratings of perceived exertion [RPE] and thermal sensation) measurements were taken during the test. Heat strain indices, including physiological strain index (PSI_HR) and perceptual strain index (PeSI), were estimated accordingly. During the study, construction workers were exposed to a hot environment with a mean WBGT of 31.56 ± 1.87 °C. Compared with the control, physiological and perceptual strain were significantly reduced in the cooling condition during rest and subsequent work periods (p < 0.05; d = 0.24-1.07, small to large cooling effect). Cooling intervention significantly alleviates heat strain in the construction industry. The effectiveness and practicality of a proposed cooling intervention were tested in a field study. Results provide a reference for setting guidelines and promoting application on a range of construction sites.

Decline in Kidney Function among Apparently Healthy Young Adults at Risk of Mesoamerican Nephropathy

Background Epidemic levels of CKD of undetermined cause, termed Mesoamerican nephropathy in Central America, have been found in low- and middle-income countries. We investigated the natural history of, and factors associated with, loss of kidney function in a population at high risk for this disease.Methods We conducted a 2-year prospective, longitudinal study with follow-up every 6 months in nine rural communities in northwestern Nicaragua and included all men (n=263) and a random sample of women (n=87) ages 18-30 years old without self-reported CKD, diabetes, or hypertension. We used growth mixture modeling to identify subgroups of eGFR trajectory and weighted multinomial logistic regression to examine associations with proposed risk factors.Results Among men, we identified three subpopulations of eGFR trajectory (mean baseline eGFR; mean eGFR change over follow-up): 81% remained stable (116 ml/min per 1.73 m2; -0.6 ml/min per 1.73 m2 per year), 9.5% experienced rapid decline despite normal baseline function (112 ml/min per 1.73 m2; -18.2 ml/min per 1.73 m2 per year), and 9.5% had baseline dysfunction (58 ml/min per 1.73 m2; -3.8 ml/min per 1.73 m2 per year). Among women: 96.6% remained stable (121 ml/min per 1.73 m2; -0.6 ml/min per 1.73 m2 per year), and 3.4% experienced rapid decline (132 ml/min per 1.73 m2; -14.6 ml/min per 1.73 m2 per year; n=3 women). Among men, outdoor and agricultural work and lack of shade availability during work breaks, reported at baseline, were associated with rapid decline.Conclusions Although Mesoamerican nephropathy is associated with agricultural work, other factors may also contribute to this disease.

Comparison of heat strain recovery in different anti-heat stress clothing ensembles after work to exhaustion

A hot environment combined with physically demanding tasks can subject workers to a higher risk of heat stress. A series of regulations and guidelines have been proposed to design appropriate anti-heat stress work uniform to reduce body heat strain. The present study aimed to examine heat strain recovery in different anti-heat stress clothing ensembles after work to exhaustion in the heat. 10 healthy males performed intermittent treadmill running/walking to exhaustion, followed by 30min passive recovery sitting in a climatic chamber, which simulated the hot and humid outdoor environment (34°C temperature, 60% relative humidity, 0.3m/s air velocity, and 450W/m² solar radiation). The participants took part in five wear trials in counter-balanced order, including Sportswear, CIC Uniform, NEW Uniform, ICEBANK Cooling Vest, and NEW Cooling Vest, which have different levels of cooling capacity. Core temperature, skin temperature, heart rate, sweat loss, ratings of perceived exertion, and thermal sensations were measured throughout the entire heat exposure period. Physiological heat strain indices, including the physiological strain index (PhSI) and the perceptual strain index (PeSI), were used as a yardstick to quantify and compare the rate of recovery. Significantly lower physiological strain was observed in the newly developed NEW Uniform and NEW Cooling Vest groups compared with the commonly worn CIC Uniform group during recovery. At the end of the recovery period, participants in NEW Cooling Vest achieved the highest recovery (42.18% in PhSI and 81.08% in PeSI), followed by ICEBANK Cooling Vest, Sportswear, NEW Uniform, and CIC Uniform. The cooling capacity of anti-heat stress clothing ensembles and the recovery time significantly affect the rate of recovery in PhSI and PeSI, which may benefit the industry by formulating the appropriate work-rest schedule by considering the clothing effect.

Heat stress intervention research in construction: gaps and recommendations

Developing heat stress interventions for construction workers has received mounting concerns in recent years. However, limited efforts have been exerted to elaborate the rationale, methodology, and practicality of heat stress intervention in the construction industry. This study aims to review previous heat stress intervention research in construction, to identify the major research gaps in methodological issues, and to offer detailed recommendations for future studies. A total of 35 peer-reviewed journal papers have been identified to develop administrative, environmental or personal engineering interventions to safeguard construction workers. It was found that methodological limitations, such as arbitrary sampling methods and unreliable instruments, could be the major obstacle in undertaking heat stress intervention research. To bridge the identified research gaps, this study then refined a research framework for conducting heat stress intervention studies in the construction industry. The proposed research strategy provides researchers and practitioners with fresh insights into expanding multidisciplinary research areas and solving practical problems in the management of heat stress. The proposed research framework may foster the development of heat stress intervention research in construction, which further aids researchers, practitioners, and policymakers in formulating proper intervention strategies.

Role of work uniform in alleviating perceptual strain among construction workers

This study aims to examine the benefits of wearing a new construction work uniform in real-work settings. A field experiment with a randomized assignment of an intervention group to a newly designed uniform and a control group to a commercially available trade uniform was executed. A total of 568 sets of physical, physiological, perceptual, and microclimatological data were obtained. A linear mixed-effects model (LMM) was built to examine the cause-effect relationship between the Perceptual Strain Index (PeSI) and heat stressors including wet bulb globe temperature (WBGT), estimated workload (relative heart rate), exposure time, trade, workplace, and clothing type. An interaction effect between clothing and trade revealed that perceptual strain of workers across four trades was significantly alleviated by 1.6-6.3 units in the intervention group. Additionally, the results of a questionnaire survey on assessing the subjective sensations on the two uniforms indicated that wearing comfort was improved by 1.6-1.8 units when wearing the intervention type. This study not only provides convincing evidences on the benefits of wearing the newly designed work uniform in reducing perceptual strain but also heightens the value of the field experiment in heat stress intervention studies.

Perceived exertion is as effective as the perceptual strain index in predicting physiological strain when wearing personal protective clothing

OBJECTIVE

The perceptual strain index (PeSI) has been shown to overcome the limitations associated with the assessment of the physiological strain index (PSI), primarily the need to obtain a core body temperature measurement. The PeSI uses the subjective scales of thermal sensation and perceived exertion (RPE) to provide surrogate measures of core temperature and heart rate, respectively. Unfortunately, thermal sensation has shown large variability in providing an estimation of core body temperature. Therefore, the primary aim of this study was to determine if thermal comfort improved the ability of the PeSI to predict the PSI during exertional-heat stress.

METHODS

Eighteen healthy males (age: 23.5years; body mass: 79.4kg; maximal aerobic capacity: 57.2ml·kg^-1·min^-1) wore four different chemical/biological protective garments while walking on treadmill at a low (<325W) or moderate (326-499W) metabolic workload in environmental conditions equivalent to wet bulb globe temperatures 21, 30 or 37°C. Trials were terminated when heart rate exceeded 90% of maximum, when core body temperature reached 39°C, at 120min or due to volitional fatigue. Core body temperature, heart rate, thermal sensation, thermal comfort and RPE were recorded at 15min intervals and at termination. Multiple statistical methods were used to determine the most accurate perceptual predictor.

RESULTS

Significant moderate relationships were observed between the PeSI (r=0.74; p<0.001), the modified PeSI (r=0.73; p<0.001) and unexpectedly RPE (r=0.71; p<0.001) with the PSI, respectively. The PeSI (mean bias: -0.8±1.5 based on a 0-10 scale; area under the curve: 0.887), modified PeSI (mean bias: -0.5±1.4 based on 0-10 scale; area under the curve: 0.886) and RPE (mean bias: -0.7±1.4 based on a 0-10 scale; area under the curve: 0.883) displayed similar predictive performance when participants experienced high-to-very high levels of physiological strain.

CONCLUSIONS

Modifying the PeSI did not improve the subjective prediction of physiological strain. However, RPE provided an equally accurate prediction of physiological strain, particularly when high-to-very high levels of strain were observed. Therefore, given its predictive performance and user-friendliness, the evidence suggests that RPE in isolation is a practical and cost-effective tool able to estimate physiological strain during exertional-heat stress under these work conditions.