1
|
Mason HM, King JC, Peden AE, Leicht AS, Franklin RC. The impact of extreme heat on mass-gathering sporting events: Implications for Australia and other countries. J Sci Med Sport 2024; 27:515-524. [PMID: 38796374 DOI: 10.1016/j.jsams.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/21/2024] [Accepted: 04/29/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES As temperatures increase across the globe due to climate change, human exposure to extreme heat is a public health challenge. During sporting events, athletes, officials, spectators, and staff are at risk of heat stress and resulting illness. The objective of this review was to explore the impact of heat on the health outcomes of these groups and the wider health system and discuss implications for outdoor mass-gathering sporting events in Australia. DESIGN A systematic review was undertaken to identify literature published from 2010 to 2023. METHODS Seven databases were searched: Web of Science, SportDiscus, Scopus, Medline, CINAHL, Emcare, and PsychInfo, for relevant key search terms such as heatwave, heat stress, extreme heat, stadium, arena, sports facilit*, sport, athletic, and Olympic. An inductive thematic analysis was undertaken. Articles were quality checked using Joanna Briggs Institute critical appraisal tools and data were extracted, tabulated, and synthesized. RESULTS Forty papers were included in the final analysis: 17 quantitative, and 23 descriptive and qualitative (including reviews). Health outcomes explored across the literature included exertional heat illness, exertional heat stroke, hyperthermia, and general heat related illness. Six recommendation themes emerged: planning, mitigation strategies, medical, policy, research, and education. CONCLUSIONS The impact of heat on health outcomes during sporting events is significant, and should be considered by individuals, coaches, officials, and organizers before, during, and after mass-gathering sporting events. These findings can inform evidence-based preparedness strategies to protect the health of those attending and competing in mass-gathering sporting events now and into the future.
Collapse
Affiliation(s)
- Hannah M Mason
- Discipline of Public Health and Tropical Medicine, James Cook University, Australia
| | - Jemma C King
- Discipline of Public Health and Tropical Medicine, James Cook University, Australia
| | - Amy E Peden
- Discipline of Public Health and Tropical Medicine, James Cook University, Australia; School of Population Health, Faculty of Medicine and Health, University of New South Wales, Australia
| | - Anthony S Leicht
- Sport and Exercise Science, James Cook University, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Australia
| | - Richard C Franklin
- Discipline of Public Health and Tropical Medicine, James Cook University, Australia.
| |
Collapse
|
2
|
Thigpen B, Grundstein A, Yeargin S. Parade safety and planning: A heat balance case study of marching band artists. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2024:1-11. [PMID: 39008819 DOI: 10.1080/15459624.2024.2358171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
Marching band (MB) artists are subject to exertional heat illnesses (EHIs) similar to other active groups like laborers and athletes. Yet, they are an understudied population with no evidence-based heat safety guidelines. Presented here is a case study of the 233rd annual Bristol, RI Independence Day Parade in 2018 that resulted in over 50 EHIs, including 25 from the Saint Anthony Village marching band (MB) from suburban Minneapolis, MN. This research aims to identify the contributing factors that led to the large number of EHIs, as well as guide ensuring the safety of MB artists in future events. A human heat balance model in conjunction with local weather data was used to simulate heat stress on MB artists. Three modeling scenarios were used to isolate the roles of clothing (band uniform vs. t-shirt and shorts), weather (July 4, 2018 vs. 30-year climatology), and metabolic rate (slow, moderate, and brisk marching pacing) on heat stress. The results identify several key factors that increased heat stress. The meteorological conditions were unusually hot, humid, and sunny for Bristol, resulting in reduced cooling from evaporation and convection, and increased radiant heating. Behavioral factors also affect heat stress. The full marching band uniforms reduced evaporative cooling by 50% and the activity levels of marching 4 km over several hours without breaks resulted in conditions that were uncompensable. Finally, it is speculated that a lack of acclimatization for participants from cooler regions may have exacerbated heat-related impacts. These findings highlight several recommendations for MB directors and race organizers, including the use of summer uniforms for anticipated hot conditions, and advance parade planning that includes providing shade/hydration before and after the parade for participants, considering cooler routes that reduce radiant heating and preparing for anticipated heat-related health impacts appropriate for anticipated hot conditions.
Collapse
Affiliation(s)
- Ben Thigpen
- Department of Geography, University of Georgia, Athens, Georgia
| | | | - Susan Yeargin
- Department of Athletic Training, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| |
Collapse
|
3
|
Nye NS, Grubic T, Kim M, O'Connor F, Deuster PA. Universal Training Precautions: A Review of Evidence and Recommendations for Prevention of Exercise-Related Injury, Illness, and Death in Warfighters and Athletes. J Athl Train 2023; 58:232-243. [PMID: 35724358 PMCID: PMC10176841 DOI: 10.4085/1062-6050-0400.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Facing pressure to train for victory, warfighters and athletes encounter numerous health risks that are directly related to their regular physical training. The concept of universal training precautions (UTPs) signifies universal processes designed to prevent unnecessary bodily harm, including injury, illness, and death, during physical training programs. Although no formal guidelines exist for collectively implementing a defined set of UTPs to address a broad scope of exercise-related health risks, recommendations and guidelines have been published relating to preventing sudden death during high school sports and collegiate conditioning sessions. A long list of critical topics must be considered as UTPs, including physical fitness factors, transition-period accommodation, hydration, environmental factors and acclimatization, appropriate recovery, use of medications and dietary supplements, and importantly, leadership. In this article, we outline in detail, with corresponding Strength of Recommendation Taxonomy ratings, what should be considered universal recommendations to minimize the risk of warfighters and athletes coming to harm when participating in group physical activities.
Collapse
Affiliation(s)
| | - Tyler Grubic
- Aviation Survival Training Center, NAS Patuxent River, MD
| | - Michael Kim
- Sports Medicine Clinic, Fort Belvoir Community Hospital, VA
| | | | - Patricia A. Deuster
- USU/MEM Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Silver Spring, MD
| |
Collapse
|
4
|
Mallen C, Dingle G, McRoberts S. Climate impacts in sport: extreme heat as a climate hazard and adaptation options. MANAGING SPORT AND LEISURE 2023. [DOI: 10.1080/23750472.2023.2166574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Cheryl Mallen
- Sport Management, Brock University, Saint Catharines, Canada
| | - Greg Dingle
- Management, Sport and Tourism, La Trobe University College of Arts Social Sciences and Commerce, Bundoora Australia
| | - Scott McRoberts
- International Institute for Sport Business & Leadership, Department of Athletics, University of Guelph Gryphons Athletics Centre, Guelph ON, Canada
| |
Collapse
|
5
|
A History of Heat Health Management Policies in the Singapore Military. Healthcare (Basel) 2023; 11:healthcare11020211. [PMID: 36673577 PMCID: PMC9858648 DOI: 10.3390/healthcare11020211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/26/2022] [Accepted: 12/31/2022] [Indexed: 01/13/2023] Open
Abstract
Our paper, which is the first historical study about heat injuries in Singapore, seeks to situate the Singapore Armed Forces' (SAF) history of heat stress management policies within the national context. Firstly, we observe that since the late 1970s, a research-driven approach has been adopted by the SAF's military medical leaders to formulate a range of policies to address the Forces' high incidence of heat injuries. This has resulted in the introduction of SAF-wide training measures, and the assembling of local scientific research expertise, which has led to a sharp reduction in heat injury incidence from the 1980s to 2000s. Through this, the SAF sought to demonstrate that its heat stress mitigation measures made the Singapore military 'heat proof'. Secondly, the state shaped a soldier safety agenda in the late 2000s on the back of an increasing emphasis on safety and the transformation of the SAF into a highly-educated and technologically-sophisticated force. This meant a shift towards concern about the welfare of every soldier, particularly through the state's drive to eradicate all training-related deaths. Accordingly, the SAF medical military leaders responded to the state's safety agenda by introducing heat stress management research and policies that were oriented towards the target of eradicating deaths due to heat stress. This policy and research direction, as such, has been strongly guided by the state's safety agenda and utilised to demonstrate to the public that all efforts have been taken to comprehensively mitigate the risks of heat.
Collapse
|
6
|
Dee SG, Nabizadeh E, Nittrouer CL, Baldwin JW, Li C, Gaviria L, Guo S, Lu K, Saunders‐Shultz BM, Gurwitz E, Samarth G, Weinberger KR. Increasing Health Risks During Outdoor Sports Due To Climate Change in Texas: Projections Versus Attitudes. GEOHEALTH 2022; 6:e2022GH000595. [PMID: 36254118 PMCID: PMC9363732 DOI: 10.1029/2022gh000595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 06/16/2023]
Abstract
Extreme heat is a recognized threat to human health. This study examines projected future trends of multiple measures of extreme heat across Texas throughout the next century, and evaluates the expected climate changes alongside Texas athletic staff (coach and athletic trainer) attitudes toward heat and climate change. Numerical climate simulations from the recently published Community Earth System Model version 2 and the Climate Model Intercomparison Project were used to predict changes in summer temperatures, heat indices, and wet bulb temperatures across Texas and also within specific metropolitan areas. A survey examining attitudes toward the effects of climate change on athletic programs and student athlete health was also distributed to high-school and university athletic staff. Heat indices are projected to increase beyond what is considered healthy/safe limits for outdoor sports activity by the mid-to-late 21st century. Survey results reveal a general understanding and acceptance of climate change and a need for adjustments in accordance with more dangerous heat-related events. However, a portion of athletic staff still do not acknowledge the changing climate and its implications for student athlete health and their athletic programs. Enhancing climate change and health communication across the state may initiate important changes to athletic programs (e.g., timing, duration, intensity, and location of practices), which should be made in accordance with increasingly dangerous temperatures and weather conditions. This work employs a novel interdisciplinary approach to evaluate future heat projections alongside attitudes from athletic communities toward climate change.
Collapse
Affiliation(s)
- Sylvia G. Dee
- Department of Earth, Environmental, and Planetary SciencesRice UniversityHoustonTXUSA
| | | | | | - Jane W. Baldwin
- Department of Earth System ScienceUniversity of California IrvineIrvineCAUSA
- Lamont‐Doherty Earth ObservatoryColumbia UniversityPalisadesNYUSA
| | - Chelsea Li
- Department of Earth, Environmental, and Planetary SciencesRice UniversityHoustonTXUSA
| | - Lizzy Gaviria
- Department of Earth, Environmental, and Planetary SciencesRice UniversityHoustonTXUSA
| | - Selena Guo
- Department of EconomicsRice UniversityHoustonTXUSA
| | - Karen Lu
- Department of Earth, Environmental, and Planetary SciencesRice UniversityHoustonTXUSA
| | | | - Emily Gurwitz
- Stanford University School of Humanities and SciencesPalo AltoCAUSA
| | - Gargi Samarth
- Department of Earth, Environmental, and Planetary SciencesRice UniversityHoustonTXUSA
| | - Kate R. Weinberger
- School of Population and Public HealthThe University of British ColumbiaVancouverBCCanada
| |
Collapse
|
7
|
Ahn Y, Uejio CK, Rennie J, Schmit L. Verifying Experimental Wet Bulb Globe Temperature Hindcasts Across the United States. GEOHEALTH 2022; 6:e2021GH000527. [PMID: 35386529 PMCID: PMC8975719 DOI: 10.1029/2021gh000527] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 02/17/2022] [Accepted: 02/26/2022] [Indexed: 06/14/2023]
Abstract
Hot and humid heat exposures challenge the health of outdoor workers engaged in occupations such as construction, agriculture, first response, manufacturing, military, or resource extraction. Therefore, government institutes developed guidelines to prevent heat-related illnesses and death during high heat exposures. The guidelines use Wet Bulb Globe Temperature (WBGT), which integrates temperature, humidity, solar radiation, and wind speed. However, occupational heat exposure guidelines cannot be readily applied to outdoor work places due to limited WBGT validation studies. In recent years, institutions have started providing experimental WBGT forecasts. These experimental products are continually being refined and have been minimally validated with ground-based observations. This study evaluated a modified WBGT hindcast using the historical National Digital Forecast Database and the European Centre for Medium-Range Weather Forecasts Reanalysis v5. We verified the hindcasts with hourly WBGT estimated from ground-based weather observations. After controlling for geographic attributes and temporal trends, the average difference between the hindcast and in situ data varied from -0.64°C to 1.46°C for different Köppen-Geiger climate regions, and the average differences are reliable for decision making. However, the results showed statistically significant variances according to geographical features such as aspect, coastal proximity, land use, topographic position index, and Köppen-Geiger climate categories. The largest absolute difference was observed in the arid desert climates (1.46: 95% CI: 1.45, 1.47), including some parts of Nevada, Arizona, Colorado, and New Mexico. This research investigates geographic factors associated with systematic WBGT differences and points toward ways future forecasts may be statistically adjusted to improve accuracy.
Collapse
Affiliation(s)
- Yoonjung Ahn
- Geography DepartmentFlorida State UniversityTallahasseeFLUSA
| | | | - Jared Rennie
- National Centers for Environmental Information (NCEI)National Oceanic and Atmospheric Administration (NOAA)AshevilleNCUSA
| | - Lisa Schmit
- National Weather ServiceNational Oceanic & Atmospheric Administration (NOAA)Silver SpringMDUSA
| |
Collapse
|
8
|
Bouchama A, Abuyassin B, Lehe C, Laitano O, Jay O, O'Connor FG, Leon LR. Classic and exertional heatstroke. Nat Rev Dis Primers 2022; 8:8. [PMID: 35115565 DOI: 10.1038/s41572-021-00334-6] [Citation(s) in RCA: 124] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 12/28/2022]
Abstract
In the past two decades, record-breaking heatwaves have caused an increasing number of heat-related deaths, including heatstroke, globally. Heatstroke is a heat illness characterized by the rapid rise of core body temperature above 40 °C and central nervous system dysfunction. It is categorized as classic when it results from passive exposure to extreme environmental heat and as exertional when it develops during strenuous exercise. Classic heatstroke occurs in epidemic form and contributes to 9-37% of heat-related fatalities during heatwaves. Exertional heatstroke sporadically affects predominantly young and healthy individuals. Under intensive care, mortality reaches 26.5% and 63.2% in exertional and classic heatstroke, respectively. Pathological studies disclose endothelial cell injury, inflammation, widespread thrombosis and bleeding in most organs. Survivors of heatstroke may experience long-term neurological and cardiovascular complications with a persistent risk of death. No specific therapy other than rapid cooling is available. Physiological and morphological factors contribute to the susceptibility to heatstroke. Future research should identify genetic factors that further describe individual heat illness risk and form the basis of precision-based public health response. Prioritizing research towards fundamental mechanism and diagnostic biomarker discovery is crucial for the design of specific management approaches.
Collapse
Affiliation(s)
- Abderrezak Bouchama
- King Abdullah International Medical Research Center, Experimental Medicine Department, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.
| | - Bisher Abuyassin
- King Abdullah International Medical Research Center, Experimental Medicine Department, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Cynthia Lehe
- King Abdullah International Medical Research Center, Experimental Medicine Department, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Orlando Laitano
- Department of Nutrition & Integrative Physiology, College of Health and Human Sciences, Florida State University, Tallahassee, FL, USA
| | - Ollie Jay
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Francis G O'Connor
- Military and Emergency Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Lisa R Leon
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| |
Collapse
|
9
|
Merchant RK, Grundstein A, Yeargin S, Emerson D. Exertional heat illnesses in marching band artists: a case series. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2021; 65:2181-2188. [PMID: 34424411 DOI: 10.1007/s00484-021-02183-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/29/2021] [Accepted: 08/10/2021] [Indexed: 06/13/2023]
Abstract
Marching band (MB) artists frequently spend many hours engaged in outdoor physical activity. Anecdotal evidence and small studies have indicated that MB artists do experience heat-related health problems. Yet, unlike athletes, military personnel, or workers, there is very little research on heat-related hazards among this unique population. Here, we seek to understand the incidence and circumstances under which exertional heat illnesses (EHIs) occur among MB artists over a 31-year period (1990-2020) across the USA. Using an on-line news dataset, we identified 34 separate events and at least 393 total EHIs. Heat syncope (~ 55%) and heat exhaustion (~ 44%) comprised the majority of EHIs, although a small number of exertional heat stroke cases were also reported. EHIs were reported in all types of MB activities with ~ 32% during rehearsal, ~ 29% during parades, ~ 21% during competition, and ~ 15% during a performance. Also, the vast majority of events occurred with high school (~ 88%) marching bands. Finally, EHIs overwhelmingly occurred when the weather was unusually hot by local conditions. In light of these findings, we emphasize the need for MB specific heat polices that incorporate weather-based activity modification, acclimatization, education about EHIs, and access to on-site medical professionals.
Collapse
Affiliation(s)
- Rashawn K Merchant
- Department of Agricultural and Applied Economics, University of Georgia, Athens, GA, 30602, USA
| | - Andrew Grundstein
- Department of Geography, University of Georgia, Athens, GA, 30602, USA.
| | - Susan Yeargin
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Dawn Emerson
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| |
Collapse
|
10
|
Ebi KL, Capon A, Berry P, Broderick C, de Dear R, Havenith G, Honda Y, Kovats RS, Ma W, Malik A, Morris NB, Nybo L, Seneviratne SI, Vanos J, Jay O. Hot weather and heat extremes: health risks. Lancet 2021; 398:698-708. [PMID: 34419205 DOI: 10.1016/s0140-6736(21)01208-3] [Citation(s) in RCA: 325] [Impact Index Per Article: 108.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 12/15/2020] [Accepted: 05/20/2021] [Indexed: 01/18/2023]
Abstract
Hot ambient conditions and associated heat stress can increase mortality and morbidity, as well as increase adverse pregnancy outcomes and negatively affect mental health. High heat stress can also reduce physical work capacity and motor-cognitive performances, with consequences for productivity, and increase the risk of occupational health problems. Almost half of the global population and more than 1 billion workers are exposed to high heat episodes and about a third of all exposed workers have negative health effects. However, excess deaths and many heat-related health risks are preventable, with appropriate heat action plans involving behavioural strategies and biophysical solutions. Extreme heat events are becoming permanent features of summer seasons worldwide, causing many excess deaths. Heat-related morbidity and mortality are projected to increase further as climate change progresses, with greater risk associated with higher degrees of global warming. Particularly in tropical regions, increased warming might mean that physiological limits related to heat tolerance (survival) will be reached regularly and more often in coming decades. Climate change is interacting with other trends, such as population growth and ageing, urbanisation, and socioeconomic development, that can either exacerbate or ameliorate heat-related hazards. Urban temperatures are further enhanced by anthropogenic heat from vehicular transport and heat waste from buildings. Although there is some evidence of adaptation to increasing temperatures in high-income countries, projections of a hotter future suggest that without investment in research and risk management actions, heat-related morbidity and mortality are likely to increase.
Collapse
Affiliation(s)
- Kristie L Ebi
- Center for Health and the Global Environment, University of Washington, Seattle, WA, USA.
| | - Anthony Capon
- Monash Sustainable Development Institute, Monash University, Melbourne, VIC, Australia; Sydney School of Public Health, Sydney, NSW, Australia
| | - Peter Berry
- Faculty of Environment, University of Waterloo, Waterloo, ON, Canada
| | - Carolyn Broderick
- School of Medical Sciences, UNSW Sydney, NSW, Australia; The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Richard de Dear
- Indoor Environmental Quality Laboratory, School of Architecture, Design, and Planning, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | - George Havenith
- Environmental Ergonomics Research Centre, School of Design and Creative Arts, Loughborough University, Loughborough, UK
| | - Yasushi Honda
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - R Sari Kovats
- NIHR Health Protection Research Unit in Environmental Change and Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Wei Ma
- School of Public Health and Climate Change and Health Center, Shandong University, Jinan, China
| | - Arunima Malik
- Discipline of Accounting, Business School, Sydney, NSW, Australia; School of Physics, Faculty of Science, ISA, Sydney, NSW, Australia
| | - Nathan B Morris
- Thermal Ergonomics Laboratory, Sydney, NSW, Australia; Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Lars Nybo
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Sonia I Seneviratne
- Institute for Atmospheric and Climate Science, ETH Zurich, Zurich, Switzerland
| | - Jennifer Vanos
- School of Sustainability, Arizona State University, Tempe, AZ, USA
| | - Ollie Jay
- Thermal Ergonomics Laboratory, Sydney, NSW, Australia; Sydney School of Health Sciences, Sydney, NSW, Australia; Sydney School of Public Health, Sydney, NSW, Australia; Faculty of Medicine and Health, Charles Perkins Centre, Sydney, NSW, Australia
| |
Collapse
|
11
|
Morrissey MC, Casa DJ, Brewer GJ, Adams WM, Hosokawa Y, Benjamin CL, Grundstein AJ, Hostler D, McDermott BP, McQuerry ML, Stearns RL, Filep EM, DeGroot DW, Fulcher J, Flouris AD, Huggins RA, Jacklitsch BL, Jardine JF, Lopez RM, McCarthy RB, Pitisladis Y, Pryor RR, Schlader ZJ, Smith CJ, Smith DL, Spector JT, Vanos JK, Williams WJ, Vargas NT, Yeargin SW. Heat Safety in the Workplace: Modified Delphi Consensus to Establish Strategies and Resources to Protect the US Workers. GEOHEALTH 2021; 5:e2021GH000443. [PMID: 34471788 PMCID: PMC8388206 DOI: 10.1029/2021gh000443] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 06/04/2023]
Abstract
The purpose of this consensus document was to develop feasible, evidence-based occupational heat safety recommendations to protect the US workers that experience heat stress. Heat safety recommendations were created to protect worker health and to avoid productivity losses associated with occupational heat stress. Recommendations were tailored to be utilized by safety managers, industrial hygienists, and the employers who bear responsibility for implementing heat safety plans. An interdisciplinary roundtable comprised of 51 experts was assembled to create a narrative review summarizing current data and gaps in knowledge within eight heat safety topics: (a) heat hygiene, (b) hydration, (c) heat acclimatization, (d) environmental monitoring, (e) physiological monitoring, (f) body cooling, (g) textiles and personal protective gear, and (h) emergency action plan implementation. The consensus-based recommendations for each topic were created using the Delphi method and evaluated based on scientific evidence, feasibility, and clarity. The current document presents 40 occupational heat safety recommendations across all eight topics. Establishing these recommendations will help organizations and employers create effective heat safety plans for their workplaces, address factors that limit the implementation of heat safety best-practices and protect worker health and productivity.
Collapse
Affiliation(s)
- Margaret C. Morrissey
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | - Douglas J. Casa
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | - Gabrielle J. Brewer
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | - William M. Adams
- Department of KinesiologyUniversity of North Carolina at GreensboroGreensboroNCUSA
| | - Yuri Hosokawa
- Faculty of Sports SciencesWaseda UniversitySaitamaJapan
| | | | | | - David Hostler
- Department of Exercise and Nutrition SciencesCenter for Research and Education in Special EnvironmentsBuffaloNYUSA
| | - Brendon P. McDermott
- Department of Health, Human Performance and RecreationUniversity of ArkansasFayettevilleARUSA
| | | | - Rebecca L. Stearns
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | - Erica M. Filep
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | - David W. DeGroot
- Fort Benning Heat CenterMartin Army Community HospitalFort BenningGAUSA
| | | | - Andreas D. Flouris
- Department of Exercise ScienceFAME LaboratoryUniversity of ThessalyTrikalaGreece
| | - Robert A. Huggins
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | | | - John F. Jardine
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | - Rebecca M. Lopez
- School of Physical Therapy & Rehabilitation SciencesMorsani College of MedicineUniversity of South FloridaTampaFLUSA
| | | | - Yannis Pitisladis
- Collaborating Centre of Sports MedicineUniversity of BrightonBrightonUK
| | - Riana R. Pryor
- Department of Exercise and Nutrition SciencesCenter for Research and Education in Special EnvironmentsBuffaloNYUSA
| | - Zachary J. Schlader
- Department of KinesiologySchool of Public HealthIndiana UniversityBloomingtonIAUSA
| | - Caroline J. Smith
- Department of Health and Exercise ScienceAppalachian State UniversityBooneNCUSA
| | - Denise L. Smith
- Department of Health and Human Physiological SciencesFirst Responder Health and Safety LaboratorySkidmore CollegeSaratoga SpringsNYUSA
| | - June T. Spector
- Department of Environmental and Occupational Health SciencesSchool of Public HealthUniversity of WashingtonSeattleWAUSA
| | | | - W. Jon Williams
- Centers for Disease Control and Prevention (CDC)National Personal Protective Technology Laboratory (NPPTL)National Institute for Occupational Safety and Health (NIOSH)PittsburghPAUSA
| | - Nicole T. Vargas
- Faculty of Health SciencesUniversity of SydneySydneyNSWAustralia
| | - Susan W. Yeargin
- Department of Exercise ScienceArnold School of Public HealthUniversity of South CarolinaColumbiaSCUSA
| |
Collapse
|
12
|
Nian Q, Liu J. WITHDRAWN: Construction of the evaluation system of snowboarders' motor function and the risk evaluation of health sports. Work 2021:WOR205359. [PMID: 34308927 DOI: 10.3233/wor-205359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Ahead of Print article withdrawn by publisher.
Collapse
|
13
|
Fung AA, Zhou A, Vanos JK, Schmid-Schönbein GW. Enhanced intestinal permeability and intestinal co-morbidities in heat strain: A review and case for autodigestion. Temperature (Austin) 2021; 8:223-244. [PMID: 34527763 PMCID: PMC8436972 DOI: 10.1080/23328940.2021.1922261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/05/2022] Open
Abstract
Enhanced intestinal permeability is a pervasive issue in modern medicine, with implications demonstrably associated with significant health consequences such as sepsis, multiorgan failure, and death. Key issues involve the trigger mechanisms that could compromise intestinal integrity and increase local permeability allowing the passage of larger, potentially dangerous molecules. Heat stress, whether exertional or environmental, may modulate intestinal permeability and begs interesting questions in the context of global climate change, increasing population vulnerabilities, and public health. Emerging evidence indicates that intestinal leakage of digestive enzymes and associated cell dysfunctions--a process referred to as autodigestion--may play a critical role in systemic physiological damage within the body. This increased permeability is exacerbated in the presence of elevated core temperatures. We employed Latent Dirichlet Allocation (LDA) topic modeling methods to analyze the relationship between heat stress and the nascent theory of autodigestion in a systematic, quantifiable, and unbiased manner. From a corpus of 11,233 scientific articles across four relevant scientific journals (Gut, Shock, Temperature, Gastroenterology), it was found that over 1,000 documents expressed a relationship between intestine, enhanced permeability, core temperature, and heat stress. The association has grown stronger in recent years, as heat stress and potential autodigestion are investigated in tandem, yet still by a limited number of specific research studies. Such findings justify the design of future studies to critically test novel interventions against digestive enzymes permeating the intestinal tract, especially the small intestine.
Collapse
Affiliation(s)
- Anthony A. Fung
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | - Andy Zhou
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | | | | |
Collapse
|
14
|
Vanos JK, Grundstein AJ. Variations in Athlete Heat-Loss Potential Between Hot-Dry and Warm-Humid Environments at Equivalent Wet-Bulb Globe Temperature Thresholds. J Athl Train 2021; 55:1190-1198. [PMID: 33112954 DOI: 10.4085/1062-6050-313-19] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Many organizations associated with sports medicine recommend using wet-bulb globe temperature (WBGT)-based activity-modification guidelines that are uniform across the country. However, no consideration has been given to whether the WBGT thresholds are appropriate for different weather conditions, such as warm-humid (WH) relative to hot-dry (HD), based on known differences in physiological responses to these environments. OBJECTIVE To identify if personnel in regions with drier conditions and greater evaporative cooling potential should consider using WBGT-based activity-modification thresholds that differ from those in more humid weather. DESIGN Observational study. SETTING Weather stations across the contiguous United States. MAIN OUTCOME MEASURE(S) A 15-year hourly WBGT dataset from 217 weather stations across the contiguous United States was used to identify particular combinations of globe temperature, wet-bulb temperature, and air temperature that produce WBGTs of 27.9°C, 30.1°C, and 32.3°C. A total of 71 302 observations were clustered into HD and WH environmental conditions. From these clusters, maximum heat-loss potential and heat-flux values were modeled at equivalent WBGT thresholds with various activity levels, clothing, and equipment configurations. RESULTS We identified strong geographic patterns, with HD conditions predominant in the western half and WH conditions predominant in the eastern half of the country. Heat loss was systematically greater in HD than in WH conditions, indicating an overall less stressful environment, even at equivalent WBGT values. At a WBGT of 32.3°C, this difference was 11 W·m-2 at an activity velocity of 0.3 m·s-1, which doubled for an activity velocity of 0.7 m·s-1. The HD and WH difference increased with the WBGT value, demonstrating that evaporative cooling differences between HD and WH conditions were even greater at a higher, rather than lower, WBGT. CONCLUSIONS Potential heat loss was consistently greater in HD than in WH environments despite equal WBGTs. These findings support the need for further clinical studies to determine the appropriate WBGT thresholds based on environmental and physiological limits to maximize safety while avoiding unnecessary limitations.
Collapse
|
15
|
Hosokawa Y, Adams WM, Casa DJ, Vanos JK, Cooper ER, Grundstein AJ, Jay O, McDermott BP, Otani H, Raukar NP, Stearns RL, Tripp BL. Roundtable on Preseason Heat Safety in Secondary School Athletics: Environmental Monitoring During Activities in the Heat. J Athl Train 2021; 56:362-371. [PMID: 33400785 DOI: 10.4085/1062-6050-0067.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To develop best-practice recommendations using thermal indices to determine work-to-rest ratios and facilitate further implementation of environmental monitoring for heat safety in secondary school athletics in the United States. DATA SOURCES A narrative review of the current literature in environmental monitoring for heat safety during athletics was conducted by content experts. A list of action-oriented recommendations was established from the narrative review and further refined using the Delphi method. CONCLUSIONS Assessment of wet bulb globe temperature at the site of activity throughout the duration of the event is recommended to assist clinicians and administrators in making appropriate decisions regarding the duration and frequency of activity and rest periods. Activity modification guidelines should be predetermined and approved by stakeholders and should outline specific actions to be followed, such as the work-to-rest ratio, frequency and timing of hydration breaks, and adjustment of total exercise duration, equipment, and clothing. Furthermore, integration of exertional heat illness injury data with environmental condition characteristics is critical for the development of evidence-based heat safety guidelines for secondary school athletics. Athletic trainers play an essential role in conducting prospective injury data collection, recording onsite wet bulb globe temperature levels, and implementing recommendations to protect the health and safety of athletes.
Collapse
Affiliation(s)
- Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - William M Adams
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | | | - Earl R Cooper
- Department of ‖Kinesiology, University of Georgia, Athens
| | | | - Ollie Jay
- Faculty of Health Sciences, University of Sydney, Australia
| | - Brendon P McDermott
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville
| | - Hidenori Otani
- Faculty of Health Care Sciences, Himeji Dokkyo University, Hyōgo, Japan
| | - Neha P Raukar
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN
| | - Rebecca L Stearns
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - Brady L Tripp
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville
| |
Collapse
|
16
|
Morris NB, Levi M, Morabito M, Messeri A, Ioannou LG, Flouris AD, Samoutis G, Pogačar T, Bogataj LK, Piil JF, Nybo L. Health vs. wealth: Employer, employee and policy-maker perspectives on occupational heat stress across multiple European industries. Temperature (Austin) 2020; 8:284-301. [PMID: 34485621 PMCID: PMC8409781 DOI: 10.1080/23328940.2020.1852049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 01/16/2023] Open
Abstract
Successful implementation of cooling strategies obviously depends on identifying effective interventions, but in industrial settings, it is equally important to consider feasibility and economic viability. Many cooling interventions are available, but the decision processes affecting adoption by end-users are not well elucidated. We therefore arranged two series of meetings with stakeholders to identify knowledge gaps, receive feedback on proposed cooling interventions, and discuss factors affecting implementation of heat-health interventions. This included four meetings attended by employers, employees, and health and safety officers (n = 41), and three meetings attended primarily by policy makers (n = 74), with feedback obtained via qualitative and quantitative questionnaires and focus group discussions. On a 10-point scale, both employers and employees valued worker safety (9.1 ± 1.8; mean±SD) and health (8.5 ± 1.9) as more important than protecting company profits (6.3 ± 2.3). Of the respondents, 41% were unaware of any cooling strategies at their company and of those who were aware, only 30% thought the interventions were effective. Following presentation of proposed interventions, the respondents rated "facilitated hydration", "optimization of clothing/protective equipment", and "rescheduling of work tasks" as the top-three preferred solutions. The main barriers for adopting cooling interventions were cost, feasibility, employer perceptions, and legislation. In conclusion, preventing negative health and safety effects was deemed to be more important than preventing productivity loss. Regardless of work sector or occupation, both health and wealth were emphasized as important parameters and considered as somewhat interrelated. However, a large fraction of the European worker force lacks information on effective measures to mitigate occupational heat stress. List of abbreviations: OH-Stress: Occupational heat stress; WBGT: Wet Bulb Globe Temperature.
Collapse
Affiliation(s)
- Nathan B. Morris
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Centre for Technology Research and Innovation (CETRI), Lemesos, Cyprus
| | - Miriam Levi
- Epidemiology Unit, Department of Prevention, Local Health Authority Tuscany Center, Florence, Italy
| | - Marco Morabito
- Institute of Bioeconomy (IBE), National Research Council, Florence, Italy
- Center of Bioclimatology (CIBIC), University of Florence, Florence, Italy
| | - Alessandro Messeri
- Institute of Bioeconomy (IBE), National Research Council, Florence, Italy
- Center of Bioclimatology (CIBIC), University of Florence, Florence, Italy
| | - Leonidas G. Ioannou
- FAME Laboratory, Department of Exercise Science, University of Thessaly, Trikala, Greece
| | - Andreas D. Flouris
- FAME Laboratory, Department of Exercise Science, University of Thessaly, Trikala, Greece
| | | | - Tjaša Pogačar
- Department of Agronomy, Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Lučka Kajfež Bogataj
- Department of Agronomy, Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Jacob F. Piil
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Lars Nybo
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
17
|
Grundstein A, Vanos J. There is no ‘Swiss Army Knife’ of thermal indices: the importance of considering ‘why?’ and ‘for whom?’ when modelling heat stress in sport. Br J Sports Med 2020; 55:822-824. [DOI: 10.1136/bjsports-2020-102920] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 11/04/2022]
|
18
|
Hosokawa Y, Vanos J. Extreme heat and health at Tokyo-2020ne: The need for scientific coalition across sectors. Temperature (Austin) 2020; 7:111-113. [PMID: 33015239 DOI: 10.1080/23328940.2020.1796241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Jennifer Vanos
- School of Sustainability, Arizona State University, Tempe, AZ, USA
| |
Collapse
|
19
|
Alele FO, Malau-Aduli BS, Malau-Aduli AEO, J. Crowe M. Epidemiology of Exertional Heat Illness in the Military: A Systematic Review of Observational Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7037. [PMID: 32993024 PMCID: PMC7579124 DOI: 10.3390/ijerph17197037] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/13/2022]
Abstract
Exertional heat illness (EHI) is an occupational hazard among military personnel. This systematic review describes the incidence, risk factors, clinical manifestations, and biomarkers of EHI in the military. Six databases from inception to 28 May 2020 were systematically reviewed using the PRISMA guidelines. Forty-one articles met the inclusion criteria and the incidence of EHI ranged from 0.2 to 10.5 per 1000 person years, while the prevalence rates ranged from 0.3% to 9.3%. Intrinsic risk factors influencing EHI were gender, physical fitness, obesity, previous history of heat illness, and motivation, while the extrinsic factors included hot environmental conditions and service unit. Evidence suggests that loss of consciousness, absence of sweating and confusion were the common clinical features of exertional heat stroke (EHS). The mean core temperature ranged from 40 to 41.6 °C, while elevated levels of creatine phosphokinase, liver enzymes, and creatinine were common biochemical markers of EHS. The findings of the review suggest a variation in the incidence of EHI among military populations possibly due to the varying definitions used. Although some risk factors of EHI were identified, more analytical studies are needed to investigate the association between EHI and other important factors such as acclimatisation and occlusive clothing.
Collapse
Affiliation(s)
- Faith O. Alele
- College of Healthcare Sciences, James Cook University, Townsville QLD 4811, Australia
| | - Bunmi S. Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville QLD 4811, Australia;
| | - Aduli E. O. Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville QLD 4811, Australia;
| | - Melissa J. Crowe
- Division of Tropical Health and Medicine, James Cook University, Townsville QLD 4811, Australia;
| |
Collapse
|
20
|
Scarneo-Miller SE, Belval LN, Yeargin SW, Hosokawa Y, Kerr ZY, Casa DJ. Exertional Heat Illness Preparedness Strategies: Environmental Monitoring Policies in United States High Schools. ACTA ACUST UNITED AC 2020; 56:medicina56100486. [PMID: 32977387 PMCID: PMC7597963 DOI: 10.3390/medicina56100486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/08/2020] [Accepted: 09/14/2020] [Indexed: 11/16/2022]
Abstract
Background and objectives: Environmental monitoring allows for an analysis of the ambient conditions affecting a physically active person’s ability to thermoregulate and can be used to assess exertional heat illness risk. Using public health models such as the precaution adoption process model (PAPM) can help identify individual’s readiness to act to adopt environmental monitoring policies for the safety of high school athletes. The purpose of this study was to investigate the adoption of policies and procedures used for monitoring and modifying activity in the heat in United States (US) high schools. Materials and Methods: Using a cross-sectional design, we distributed an online questionnaire to athletic trainers (ATs) working in high schools in the US. The questionnaire was developed based on best practice standards related to environmental monitoring and modification of activity in the heat as outlined in the 2015 National Athletic Trainers’ Association Position Statement: Exertional Heat Illness. The PAPM was used to frame questions as it allows for the identification of ATs’ readiness to act. PAPM includes eight stages: unaware of the need for the policy, unaware if the school has this policy, unengaged, undecided, decided not to act, decided to act, acting, and maintaining. Invitations were sent via email and social media and resulted in 529 complete responses. Data were aggregated and presented as proportions. Results: Overall, 161 (161/529, 30.4%) ATs report they do not have a written policy and procedure for the prevention and management of exertional heat stroke. The policy component with the highest adoption was modifying the use of protective equipment (acting = 8.2%, maintaining = 77.5%). In addition, 28% of ATs report adoption of all seven components for a comprehensive environmental monitoring policy. Conclusions: These findings indicate a lack of adoption of environmental monitoring policies in US high schools. Secondarily, the PAPM, facilitators and barriers data highlight areas to focus future efforts to enhance adoption.
Collapse
Affiliation(s)
- Samantha E. Scarneo-Miller
- Division of Athletic Training, School of Medicine, West Virginia University, Morgantown, WV 26508, USA
- Correspondence:
| | - Luke N. Belval
- Institute for Exercise and Environmental Medicine, University of Texas Southwestern and Texas Health Resources Presbyterian Hospital Dallas, Dallas, TX 75231, USA;
| | - Susan W. Yeargin
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
| | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Saitama 359-1192, Japan;
| | - Zachary Y. Kerr
- Department of Exercise and Sport Science, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Douglas J. Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA;
| |
Collapse
|
21
|
Morris NB, Jay O, Flouris AD, Casanueva A, Gao C, Foster J, Havenith G, Nybo L. Sustainable solutions to mitigate occupational heat strain - an umbrella review of physiological effects and global health perspectives. Environ Health 2020; 19:95. [PMID: 32887627 PMCID: PMC7487490 DOI: 10.1186/s12940-020-00641-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 08/12/2020] [Indexed: 05/19/2023]
Abstract
BACKGROUND Climate change is set to exacerbate occupational heat strain, the combined effect of environmental and internal heat stress on the body, threatening human health and wellbeing. Therefore, identifying effective, affordable, feasible and sustainable solutions to mitigate the negative effects on worker health and productivity, is an increasingly urgent need. OBJECTIVES To systematically identify and evaluate methods that mitigate occupational heat strain in order to provide scientific-based guidance for practitioners. METHODS An umbrella review was conducted in biomedical databases employing the following eligibility criteria: 1) ambient temperatures > 28 °C or hypohydrated participants, 2) healthy adults, 3) reported psychophysiological (thermal comfort, heart rate or core temperature) and/or performance (physical or cognitive) outcomes, 4) written in English, and 5) published before November 6, 2019. A second search for original research articles was performed to identify interventions of relevance but lacking systematic reviews. All identified interventions were independently evaluated by all co-authors on four point scales for effectiveness, cost, feasibility and environmental impact. RESULTS Following screening, 36 systematic reviews fulfilled the inclusion criteria. The most effective solutions at mitigating occupational heat strain were wearing specialized cooling garments, (physiological) heat acclimation, improving aerobic fitness, cold water immersion, and applying ventilation. Although air-conditioning and cooling garments in ideal settings provide best scores for effectiveness, the limited applicability in certain industrial settings, high economic cost and high environmental impact are drawbacks for these solutions. However, (physiological) acclimatization, planned breaks, shading and optimized clothing properties are attractive alternative solutions when economic and ecological sustainability aspects are included in the overall evaluation. DISCUSSION Choosing the most effective solution or combinations of methods to mitigate occupational heat strain will be scenario-specific. However, this paper provides a framework for integrating effectiveness, cost, feasibility (indoors and outdoor) and ecologic sustainability to provide occupational health and safety professionals with evidence-based guidelines.
Collapse
Affiliation(s)
- Nathan B. Morris
- Department of Nutrition, Exercise and Sports, Section for Integrative Physiology, University of Copenhagen, Copenhagen N, Denmark
| | - Ollie Jay
- Thermal Ergonomics Laboratory, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Andreas D. Flouris
- FAME Laboratory, School of Exercise Science, University of Thessaly, Thessaly, Greece
| | - Ana Casanueva
- Federal Office of Meteorology and Climatology, MeteoSwiss, Zurich Airport, Zurich, Switzerland
- Meteorology Group, Department of Applied Mathematics and Computer Sciences, University of Cantabria, Santander, Spain
| | - Chuansi Gao
- Thermal Environment Laboratory, Division of Ergonomics and Aerosol Technology, Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
| | - Josh Foster
- Environmental Ergonomics Research Centre, Loughborough Design School, Loughborough University, Loughborough, UK
| | - George Havenith
- Environmental Ergonomics Research Centre, Loughborough Design School, Loughborough University, Loughborough, UK
| | - Lars Nybo
- Department of Nutrition, Exercise and Sports, Section for Integrative Physiology, University of Copenhagen, Copenhagen N, Denmark
| |
Collapse
|
22
|
Nunfam VF, Adusei-Asante K, Frimpong K, Van Etten EJ, Oosthuizen J. Barriers to occupational heat stress risk adaptation of mining workers in Ghana. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2020; 64:1085-1101. [PMID: 32130507 DOI: 10.1007/s00484-020-01882-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/15/2020] [Accepted: 02/18/2020] [Indexed: 06/10/2023]
Abstract
Increasing temperature and climate warming impacts are aggravating the vulnerability of workers to occupational heat stress. Adaptation and social protection strategies have become crucial to enhance workers' health, safety, productive capacity and social lives. However, the effective implementation of work-related heat stress adaptation mechanisms appears to be receiving little attention. This study assessed the barriers to occupational heat stress adaptation and social protection strategies of mining workers in Ghana. Based on a mixed methods approach, focus group discussions and questionnaires were used to elicit data from 320 mining workers. Workers' adaptation strategies (water intake, wearing loose and light-coloured clothing, participating in training programmes, taking regular breaks, use of mechanical equipment, use of cooling systems and housing designs) varied significantly across the type of mining activity (p < .001). Workers' social protection measures were adequate. The disparities in workers' social protection measures significantly differed across the type of mining activity (p < .001). Barriers of workers to the implementation of relevant adaptation strategies (inadequate knowledge of coping and adaptive behaviour, lack of regular training on adaptation measures, lack of specific heat-related policy regulations, lack of management commitment and the lack of access to innovative technology and equipment) also differed across the type of mining activity (p < .001). Adaptation policy options and recommendations centred on overcoming the barriers that constrain the adaptive capacity of workers and employers have the potential to reduce workers' vulnerability to occupational heat stress.
Collapse
Affiliation(s)
- Victor Fannam Nunfam
- Edith Cowan University, Perth, Western Australia, Australia.
- Takoradi Technical University, Takoradi, Western Region, Ghana.
- , Joondalup, Australia.
| | | | - Kwasi Frimpong
- Edith Cowan University, Perth, Western Australia, Australia
- Ghana Institute of Management and Public Administration, Accra, Greater Accra Region, Ghana
| | | | | |
Collapse
|
23
|
Tripp B, Vincent HK, Bruner M, Smith MS. Comparison of wet bulb globe temperature measured on-site vs estimated and the impact on activity modification in high school football. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2020; 64:593-600. [PMID: 31863179 DOI: 10.1007/s00484-019-01847-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/01/2019] [Accepted: 12/11/2019] [Indexed: 06/10/2023]
Abstract
Exertional heat stroke is one of the top three causes of death in young athletes, particularly high school football players. Despite evidence that these deaths are completely avoidable with appropriate prevention and treatment, deaths still occur at an alarming rate. Wet bulb globe temperature (WBGT) is the preferred method of both the National Athletic Trainers' Association and American College of Sports Medicine to measure heat intensity. Based on the WBGT, activity modification guidelines (AMG) dictate work-to-rest ratios, activity levels and duration, protective equipment worn, and length and frequency of hydration breaks. Due to the cost of handheld WBGT monitors, smartphone apps that estimate WBGT have been considered an alternative. However, it is unclear how WBGT values estimated by these smartphone apps compare to those measured on-site using handheld WBGT monitors. We compared WBGT values estimated by a commercial smartphone app to those taken on-site at the same time and place. Thirteen athletic trainers measured WBGT in the field during high school football practices over a three-month season in North Central Florida. A paired sample t-test indicated the smartphone app significantly overestimated WBGT (29.0°C ± 4.1°C) compared to on-site measures (26.4°C ± 3.2°C) ( r =0.580; t(943)=-23.38, p <0.0001). The smartphone app-estimated values were consistently greater than on-site measures, resulting in potentially unnecessary activity modifications and cancellations if the app was used in place of on-site handheld WBGT monitors. Despite being significantly cheaper than handheld WBGT monitors, at this time, smartphone apps are not ready for widespread use to guide activity modification decisions.
Collapse
Affiliation(s)
- Brady Tripp
- University of Florida, Gainesville, FL, USA.
| | - Heather K Vincent
- Department of Orthopaedics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Michelle Bruner
- University of Florida, Department of Orthopedics and Rehabilitation, Gainesville, FL, USA
| | - Michael Seth Smith
- University of Florida, Department of Orthopedics and Rehabilitation, Gainesville, FL, USA
| |
Collapse
|
24
|
Vanos JK, Thomas WM, Grundstein AJ, Hosokawa Y, Liu Y, Casa DJ. A multi-scalar climatological analysis in preparation for extreme heat at the Tokyo 2020 Olympic and Paralympic Games. Temperature (Austin) 2020; 7:191-214. [PMID: 33015246 PMCID: PMC7518767 DOI: 10.1080/23328940.2020.1737479] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 12/13/2022] Open
Abstract
Extreme heat can be harmful to human health and negatively affect athletic performance. The Tokyo Olympic and Paralympic Games are predicted to be the most oppressively hot Olympics on record. An interdisciplinary multi-scale perspective is provided concerning extreme heat in Tokyo-from planetary atmospheric dynamics, including El Niño Southern Oscillation (ENSO), to fine-scale urban temperatures-as relevant for heat preparedness efforts by sport, time of day, and venue. We utilize stochastic methods to link daytime average wet bulb globe temperature (WBGT) levels in Tokyo in August (from meteorological reanalysis data) with large-scale atmospheric dynamics and regional flows from 1981 to 2016. Further, we employ a mesonet of Tokyo weather stations (2009-2018) to interpolate the spatiotemporal variability in near-surface air temperatures at outdoor venues. Using principal component analysis, two planetary (ENSO) regions in the Pacific Ocean explain 70% of the variance in Tokyo's August daytime WBGT across 35 years, varying by 3.95°C WGBT from the coolest to warmest quartile. The 10-year average daytime and maximum intra-urban air temperatures vary minimally across Tokyo (<1.2°C and 1.7°C, respectively), and less between venues (0.6-0.7°C), with numerous events planned for the hottest daytime period (1200-1500 hr). For instance, 45% and 38% of the Olympic and Paralympic road cycling events (long duration and intense) occur midday. Climatologically, Tokyo will present oppressive weather conditions, and March-May 2020 is the critical observation period to predict potential anomalous late-summer WBGT in Tokyo. Proactive climate assessment of expected conditions can be leveraged for heat preparedness across the Game's period.
Collapse
Affiliation(s)
| | | | | | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Ying Liu
- Department of Environmental and Occupational Health, University of Montreal, Montreal, Canada
| | - Douglas J. Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| |
Collapse
|
25
|
Parsons IT, Stacey MJ, Woods DR. Heat Adaptation in Military Personnel: Mitigating Risk, Maximizing Performance. Front Physiol 2019; 10:1485. [PMID: 31920694 PMCID: PMC6928107 DOI: 10.3389/fphys.2019.01485] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/21/2019] [Indexed: 12/22/2022] Open
Abstract
The study of heat adaptation in military personnel offers generalizable insights into a variety of sporting, recreational and occupational populations. Conversely, certain characteristics of military employment have few parallels in civilian life, such as the imperative to achieve mission objectives during deployed operations, the opportunity to undergo training and selection for elite units or the requirement to fulfill essential duties under prolonged thermal stress. In such settings, achieving peak individual performance can be critical to organizational success. Short-notice deployment to a hot operational or training environment, exposure to high intensity exercise and undertaking ceremonial duties during extreme weather may challenge the ability to protect personnel from excessive thermal strain, especially where heat adaptation is incomplete. Graded and progressive acclimatization can reduce morbidity substantially and impact on mortality rates, yet individual variation in adaptation has the potential to undermine empirical approaches. Incapacity under heat stress can present the military with medical, occupational and logistic challenges requiring dynamic risk stratification during initial and subsequent heat stress. Using data from large studies of military personnel observing traditional and more contemporary acclimatization practices, this review article (1) characterizes the physical challenges that military training and deployed operations present (2) considers how heat adaptation has been used to augment military performance under thermal stress and (3) identifies potential solutions to optimize the risk-performance paradigm, including those with broader relevance to other populations exposed to heat stress.
Collapse
Affiliation(s)
- Iain T. Parsons
- Academic Department of Military Medicine, Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, United Kingdom
- School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Michael J. Stacey
- Academic Department of Military Medicine, Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, United Kingdom
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - David R. Woods
- Academic Department of Military Medicine, Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, United Kingdom
- Department of Sport and Exercise Endocrinology, Carnegie Research Institute, Leeds Beckett University, Leeds, United Kingdom
| |
Collapse
|
26
|
Motivation for Heat Adaption: How Perception and Exposure Affect Individual Behaviors During Hot Weather in Knoxville, Tennessee. ATMOSPHERE 2019. [DOI: 10.3390/atmos10100591] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Heat is the deadliest meteorological hazard; however, those exposed to heat often do not feel they are in danger of heat-health effects and do not take precautions to avoid heat exposure. Socioeconomic factors, such as the high cost of running air conditioning, might prevent people from taking adaption measures. We assessed via a mixed-methods survey how residents of urban Knoxville, Tennessee, (n = 86) describe and interpret their personal vulnerability during hot weather. Thematic analyses reveal that many respondents describe uncomfortably hot weather based on its consequences, such as health effects and the need to change normal behavior, which misaligns with traditional heat-communication measures using specific weather conditions. Only 55% of those who perceived excessive heat as dangerous cited health as a cause for concern. Respondents who have experienced health issues during hot weather were more likely to perceive heat as dangerous and take actions to reduce heat exposure. Social cohesion was not a chief concern for our respondents, even though it has been connected to reducing time-delayed heat-health effects. Results support using thematic analyses, an underutilized tool in climatology research, to improve understanding of public perception of atmospheric hazards. We recommend a multi-faceted approach to addressing heat vulnerability.
Collapse
|