Preventing heat-related illness among agricultural workers

Heat strain in different hot environments hiking in wildland firefighting garments

Wildland firefighters can work at high intensity in hot environments for extended periods of time. The resulting heat strain may be modified by the environmental conditions (i.e., ambient temperature and humidity [RH]) even at equal wet-bulb globe temperatures (WBGTs). This investigation assessed if a hot and dry condition would create greater strain than moderate and high humidity at equivalent WBGT (28 °C). Twelve participants (age 24 ± 2 year) walked at 40%-50% maximum aerobic capacity for 90 and 40 min separated by a 20 min rest in dry (40 °C, 20% RH), moderate-humidity (34 °C, 50% RH), and high-humidity (29 °C, 90% RH) conditions wearing fire-resistant jacket, pants, gloves, and helmet with the neck and face exposed. Peak core temperature was higher in moderate-humidity (38.9 ± 0.2 °C, p = 0.01) and high-humidity (38.9 ± 0.6 °C, p < 0.01) than dry condition (38.5 ± 0.3 °C). Average net heat gain was less in dry (33 ± 22 W) compared to moderate-humidity (38 ± 23 W, p < 0.01) and high-humidity (39 ± 28 W, p < 0.01). Peak heart rate (174 ± 14 bpm, p = 0.94), physiological strain index (7.7 ± 1.4 score, p = 0.99), perceived exertion (8 ± 2 rating, p = 0.97), and perceptual strain index (7.3 ± 1.6 score, p = 0.99) were not different in high-humidity compared to the dry condition (167 ± 19 bpm, 6.9 ± 1.3 score, 6 ± 2 rating, 7.3 ± 1.7 score, respectively). Whole-body sweat rate (15 ± 6 mL/min, p = 0.58) and thermal sensation (7 ± 1 rating, p = 0.37) were not different. Hiking in a humid condition while wearing protective garments creates greater exertional heat strain compared to a dry condition of equivalent WBGT. Wildland firefighters should consider extra strategies to mitigate hyperthermia when humidity is high.

Burden of non-communicable diseases attributable to high temperature in a changing climate from 1990 to 2019: a global analysis

BACKGROUND

With global climate change, the health threats of ambient high temperature have received widespread attention. However, latest spatio-temporal patterns of the non-communicable diseases (NCDs) burden attributable to high temperature have not been systematically reported. We aimed to analyze vulnerable areas and populations based on a detailed profile for the NCDs burden attributable to high temperature globally.

METHODS

We obtained data from the Global Burden of Diseases (GBD) Study (2019) to describe the temporal and spatial patterns of NCDs burden attributable to high temperature globally from 1990-2019. Then we analyzed the differences by region, sex, and socio-demographic index (SDI). Finally, the age‑period‑cohort (APC) model was utilized to explore the age, period, and cohort effects of NCDs mortality caused by high temperature.

RESULTS

In 2019, the number of deaths and Disability-adjusted life years (DALYs) from high-temperature-related NCDs was about 150,000 and 3.4 million globally, of which about 70% were in South Asia and North Africa and Middle East, and the burden was higher in men. Among 204 countries and territories, the highest age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) were observed in Oman and United Arab Emirates, respectively. The global burden showed an upward trend from 1990 to 2019, with an EAPC of 3.66 (95%CI: 3.14-4.18) for ASMR and 3.68 (95%CI: 3.16-4.21) for ASDR. Cardiovascular diseases were the main contributors to the global burden of high-temperature-related NCDs in 2019. The age and period effect in APC model showed an increasing trend globally. There was a significant negative correlation between SDI and both ASMR (r = -0.17) and ASDR (r = -0.20) from 1990 to 2019.

CONCLUSION

There was an increasing trend of the global burden of high-temperature-related NCDs. The burden was likely to be higher in males and the elderly, as well as in countries and regions with less economically and socially developed and in tropical climates. Surveillance and prevention measures should be implemented with a focus on these vulnerable areas and susceptible populations.

Climatic changes: knowledge and adaptation behavior to heat-related illness among solid waste disposal workers

BACKGROUND

Earth's climate changes are progressing at an alarming rate. One of the most severe effects of climate change is extreme heat. This study aimed to assess knowledge and adaptation behavior to heat-related illness (HRI) among solid waste disposal workers in the 10th of Ramadan City, Egypt, and to study the predictors for their knowledge and adaptation behavior.

METHODS

An exploratory cross-sectional study was conducted on 220 solid waste disposal workers. A structured interview questionnaire was used to assess the studied workers' sociodemographic and occupational characteristics, heat exposure risk, and their knowledge, and adaptation behavior.

RESULTS

The results showed that 40% and 30% of participants had adequate levels of total knowledge and adaptation behavior, respectively. There was a statistically significant relationship between workers' knowledge and both age and education. There was a statistically significant relationship between workers' adaptation behavior and age, duration of employment, working hours, and education. A binary logistic regression for significant predictors of knowledge and adaptation behavior showed that age and education were the most significant predictors.

CONCLUSION

Solid waste disposal workers were at high risk of HRI due to their low levels of knowledge and adaptation behavior regarding HRI. Educational health programs that guide workers to follow healthy behaviors and prevent HRI are recommended.

Occupational Fatigue and Its Relationship with Musculoskeletal Disorders and Heat Stress among the Workers of Summer Crops in Southeast Iran in 2021

Aims

This research aimed to evaluate work fatigue and its relationship with musculoskeletal disorders (MSDs) and heat stress (WBGT) among greenhouse workers in Jiroft County, southeast Iran.

Materials and Methods

This cross-sectional study was carried out between September 2021 and February 2022 among 150 workers in summer crop greenhouses. Data were collected by a demographic questionnaire, the Swedish occupational fatigue inventory (SOFI-20), and the Nordic musculoskeletal questionnaire (NMQ), and wet bulb globe temperature (WBGT) was measured as per ISO 7243. The collected data were analyzed by the χ2 test, logistic regression, and multivariable linear regression in the Stata 17.0 software.

Results

The results showed a higher total fatigue score among the studied workers (mean = 100.71 out of 200). Among the fatigue dimensions, the three dimensions of lack of energy, physical discomfort, and physical exertion had the highest scores of 27.28, 26.71, and 25.71, respectively. The highest rate of MSD prevalence was in the back (54.7%), neck (50.7%), and shoulders (49.3%). Based on ISO 7243, the mean WBGT was beyond the allowed level for most tasks for greenhouse workers. There was a statistically significant relationship between occupational fatigue with MSDs and WBGT.

Conclusion

Given the relatively high score reported for fatigue and its relationship with MSDs and heat stress, it is recommended to conduct further and more applied studies to investigate the approaches to alleviating heat stress and physical ergonomic risk factors in greenhouses in this occupational group.

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update

The Wilderness Medical Society (WMS) convened an expert panel in 2011 to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat illness. The current panel retained 5 original members and welcomed 2 new members, all of whom collaborated remotely to provide an updated review of the classifications, pathophysiology, evidence-based guidelines for planning and preventive measures, and recommendations for field- and hospital-based therapeutic management of heat illness. These recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks or burdens for each modality. This is an updated version of the WMS clinical practice guidelines for the prevention and treatment of heat illness published in Wilderness & Environmental Medicine. 2019;30(4):S33-S46.

Pathways framework identifies wildfire impacts on agriculture

Wildfires are a growing concern to society and the environment in many parts of the world. Within the United States, the land area burned by wildfires has steadily increased over the past 40 years. Agricultural land management is widely understood as a force that alters fire regimes, but less is known about how wildfires, in turn, impact the agriculture sector. Based on an extensive literature review, we identify three pathways of impact-direct, downwind and downstream-through which wildfires influence agricultural resources (soil, water, air and photosynthetically active radiation), labour (agricultural workers) and products (crops and livestock). Through our pathways framework, we highlight the complexity of wildfire-agriculture interactions and the need for collaborative, systems-oriented research to better quantify the magnitude of wildfire impacts and inform the adaptation of agricultural systems to an increasingly fire-prone future.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

Increased temperature was associated with a decrease in work rate.

Work accidents, climate change and COVID-19

The effects brought by climate change and the pandemic upon worker health and wellbeing are varied and necessitate the identification and implementation of improved strategic interventions. This review aims, firstly, to assess how climate change affects occupational accidents, focusing on the impacts of extreme air temperatures and natural disasters; and, secondly, to analyze the role of the pandemic in this context. Our results show that the manifestations of climate change affect workers physically while on the job, psychologically, and by modifying the work environment and conditions; all these factors can cause stress, in turn increasing the risk of suffering a work accident. There is no consensus on the impact of the COVID-19 pandemic on work accidents; however, an increase in adverse mental effects on workers in contact with the public (specifically in healthcare) has been described. It has also been shown that this strain affects the risk of suffering an accident. During the pandemic, many people began to work remotely, and what initially appeared to be a provisional situation has been made permanent or semi-permanent in some positions and companies. However, we found no studies evaluating the working conditions of those who telework. In relation to the combined impact of climate change and the pandemic on occupational health, only publications focusing on the synergistic effect of heat due to the obligation to wear COVID-19-specific PPE, either outdoors or in poorly acclimatized indoor environments, were found. It is essential that preventive services establish new measures, train workers, and determine new priorities for adapting working conditions to these altered circumstances.

Analysis of Exertion-Related Injuries and Fatalities in Laborers in the United States

Laborers are particularly vulnerable to exertional injuries and illnesses, as they often engage in heavy physical work for prolonged hours, yet no studies have examined the top causes of catastrophic exertional injuries and fatalities among this population. The purpose of the investigation was to characterize the top causes of exertional injury and fatality within open access, Occupational Safety and Health Administration (OSHA) reportable data. A secondary analysis of OSHA reported injury and fatality data was performed through open access records from OSHA Severe Injury Reports (2015-2022) and OSHA fatality inspection data (2017-2020), respectively. The research team characterized each reported injury and fatality as "exertion-related" or "non-exertion-related. Injury and fatality rates were reported per 100,000 equivalent full-time worker years and included 95% confidence intervals (95% CI). Of 58,648 cases in the OSHA Severe Injury Report database from 2015-2020, 1682 cases (2.9%) were characterized as exertional (0.20 injuries per 100,000 full-time worker years, 95% CI: 0.19, 0.22). Heat-related injuries encompassed 91.9% of the exertional injuries (n = 1546). From the 2017-2022 OSHA fatality inspection database, 89 (1.9%) of 4598 fatalities were characterized as exertion-related (fatality rate: 0.0160 per 100,000 full-time equivalent workers, 95% CI: 0.009, 0.0134). The exertion-related fatalities primarily consisted of heat-related cases (87.6%). Exertion-related injuries and fatalities were most reported in Southeast states, in the construction and excavation industry, and among nonunionized workers. As heat stress continues to be recognized as an occupational health and safety hazard, this analysis further highlights the need for targeted interventions or further evaluation of the impact of heat stress on construction and excavation workers, nonunionized workers, and workers in Southeastern states.

Occupational health surveillance and detection of emerging occupational diseases among Taiwan farmers, through analysis of national-based farmers' and medico-administrative databases

OBJECTIVES

The purpose of this study was to identify occupational injuries and diseases associated with agriculture in Asia, to provide a reference for prevention and hypotheses for future research.

METHODS

We matched data on agricultural workers (n = 963,124) enrolled in Taiwan's national Farmers Health Insurance since its inception in 1989, to general population controls of the same age, gender, and township. The study population was linked to the National Health Insurance Research Database from 2001 to 2016 for inpatient cases. Logistic regression was used to assess odds ratios for outcomes.

RESULTS

Farmers had 2.76 times the risk of mycotic corneal ulcer (95% CI: 1.96-3.87) and 1.65 times the risk of typhus fever infections (95% CI: 1.47-1.85) compared to the general population. The odds ratio for poisonous animal bites was 2.22 (95% CI: 2.07-2.38), for falling into a storm drain or manhole was 2.04 (95% CI: 1.30-3.20), and for toxic effects from pesticides was 2.01 (95% CI: 1.92-2.11). The toxic effects of organophosphate and carbamate insecticides were correlated with the cultivation of rice, fruit trees, and flowers. Q fever and motorcycle accidents were associated with fruit tree cultivation.

CONCLUSIONS

The study identifies agricultural occupational injuries and diseases that may inform occupational health policy and the development of prevention priorities to prevent occupational hazards for farmers.

Stress Response and Safe Driving Time of Bus Drivers in Hot Weather

PURPOSE

To evaluate the impact of high-temperature environments on bus drivers' physiology and reaction times, and to provide a basis for driver occupational health management.

METHODS

The physiological and reaction indexes of 24 bus drivers under different temperatures were investigated. The statistical analysis method was used to analyze the changes in drivers' physiological stress, the relationship between stress and response ability, and a safe driving time. The Kaplan-Meier survival function was used to analyze the survival rate of bus drivers under different temperatures and driving times.

RESULTS

The results showed that body temperature, heart rate, physiological strain index (PSI), and reaction ability were significantly different among different compartment temperatures. PSI was positively correlated with reaction ability. The safe driving time was 80 min, 73 min, and 53 min, respectively, at 32 °C, 36 °C, and 40 °C. The survival rate decreased to less than 60% at 36 °C when driving continuously for 73 min; it decreased to 20% at 40 °C when driving for 53 min, and it was 0 for 75 min.

CONCLUSIONS

High-temperature environments lead to heat stress of bus drivers, physiological indexes have changed significantly, and behavioral ability is also decreased. The higher the temperature, the lower the survival rate. Improvement measures can be taken from the aspects of convection, conduction, and behavior to ensure the bus driver's physiological health and driving safety under high temperatures and to improve the survival rate.

Occupational heat strain in outdoor workers: A comprehensive review and meta-analysis

The present comprehensive review (i) summarizes the current knowledge on the impacts of occupational heat stress on outdoor workers, (ii) provides a historical background on this issue, (iii) presents a meta-analysis of published data, (iv) explores inter-individual and intra-individual factors, (v) discusses the available heat mitigation strategies, (vi) estimates physical work capacity, labour productivity, and metabolic rate for the year 2030, and (vii) provides an overview of existing policy and legal frameworks on occupational heat exposure. Meta-analytic findings from 38 field studies that involved monitoring 2,409 outdoor workers across 41 jobs in 21 countries suggest that occupational heat stress increases the core (r = 0.44) and skin (r = 0.44) temperatures, as well as the heart rate (r = 0.38) and urine specific gravity (r = 0.13) of outdoor workers (all p < 0.05). Moreover, it diminishes the capacity of outdoor workers for manual labour (r = -0.82; p < 0.001) and is responsible for more than two thirds of the reduction in their metabolic rate. Importantly, our analysis shows that physical work capacity is projected to be highly affected by the ongoing anthropogenic global warming. Nevertheless, the metabolic rate and, therefore, labour productivity are projected to remain at levels higher than the workers' physical work capacity, indicating that people will continue to work more intensely than they should to meet their financial obligations for food and shelter. In this respect, complementary measures targeting self-pacing, hydration, work-rest regimes, ventilated garments, and mechanization can be adopted to protect outdoor workers.

High-Heat Days and Presentations to Emergency Departments in Regional Victoria, Australia

Heat kills more Australians than any other natural disaster. Previous Australian research has identified increases in Emergency Department presentations in capital cities; however, little research has examined the effects of heat in rural/regional locations. This retrospective cohort study aimed to determine if Emergency Department (ED) presentations across the south-west region of Victoria, Australia, increased on high-heat days (1 February 2017 to 31 January 2020) using the Rural Acute Hospital Data Register (RAHDaR). The study also explored differences in presentations between farming towns and non-farming towns. High-heat days were defined as days over the 95th temperature percentile. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes associated with heat-related illness were identified from previous studies. As the region has a large agricultural sector, a framework was developed to identify towns estimated to have 70% or more of the population involved in farming. Overall, there were 61,631 presentations from individuals residing in the nine Local Government Areas. Of these presentations, 3064 (5.0%) were on days of high-heat, and 58,567 (95.0%) were of days of non-high-heat. Unlike previous metropolitan studies, ED presentations in rural south-west Victoria decrease on high-heat days. This decrease was more prominent in the farming cohort; a potential explanation for this may be behavioural adaption.

Risk Factors Related to Perceived Hot Conditions on Outdoor Farms Among Thai Elderly Farmers With Chronic Diseases

Working on outdoor farms affects elderly farmers' health, especially those who have chronic diseases. This study aims to identify the risk factors related to perceived hot conditions on outdoor farms among elderly Thai farmers aged 60 years and older with chronic diseases. A cross-sectional study was conducted on 352 elderly farmers in nine sub-districts of Nong Suea District, Pathum Thani Province, Thailand via convenience sampling. Questionnaires were used as instruments to gather data about demographic and working factors. The risk factors associated with elderly Thai farmers' perceptions of hot conditions on outdoor farms were identified by using binary logistic regression. The most common chronic illnesses were hypertension (35.8%), heart disease (34.4%), and diabetes mellitus (24.5%). More than 60.5% of the participants perceived their hot conditions to be high. The results of binary logistic regression show that low income and work duration ≤8.0 hours per day were risk factors related to perceived hot conditions on outdoor farms (P value < 0.05). These findings may be used by relevant authorities to support elderly farmers by emphasizing the importance of individual and work-related factors. Relevant government agencies should consider formulating working standards in hot conditions specifically for elderly farm workers.

Advanced sensor technologies and the future of work

Exposure science is fundamental to the field of occupational safety and health. The measurement of worker exposures to hazardous agents informs effective workplace risk mitigation strategies. The modern era of occupational exposure measurement began with the invention of the personal sampling device, which is still widely used today in the practice of occupational hygiene. Newer direct-reading sensor devices are incorporating recent advances in transducers, nanomaterials, electronics miniaturization, portability, batteries with high-power density, wireless communication, energy-efficient microprocessing, and display technology to usher in a new era in exposure science. Commercial applications of new sensor technologies have led to a variety of health and lifestyle management devices for everyday life. These applications are also being investigated as tools to measure occupational and environmental exposures. As the next-generation placeable, wearable, and implantable sensor technologies move from the research laboratory to the workplace, their role in the future of work will be of increasing importance to employers, workers, and occupational safety and health researchers and practitioners. This commentary discusses some of the benefits and challenges of placeable, wearable, and implantable sensor technologies in the future of work.

Increased labor losses and decreased adaptation potential in a warmer world

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

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

Prevention of Occupational Heat-Related Illnesses

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

Exercise heat acclimation causes human responses and safety performance improvements

Heat acclimation (HA) is a widely recognized physiological phenomenon of human body in hot environments. HA has many benefits, such aspreventing hyperthermia responses, and is an efficient way to improve human responses to hyperthermal environments. However, it is not known whether HA is dependent on the environmental conditions. Moreover, its mechanism and effect on the safety performance remain unexplored. In this study, we created a climate chamber to simulate a hyperthermal environment. Thirty healthy males were recruited for this study, who were then trained under the same ambient conditions (temperature of 38 °C and relative humidity (RH) of 40%). The training involved running on treadmills (at 5 km/h) to simulate heavy manual labor, and performing heat stress tests (HST) under six different conditions (32 °C/40% RH, 35 °C/40%, 38 °C/40%, 32 °C/70%, 35 °C/70%, and 38 °C/70%). Their physiological indices (rectal temperature, heart rate, sweat loss and skin temperature) and one psychological index (thermal sensation) were measured. Furthermore, a hazard avoidance test device (HATD) was designed to evaluate the individual safety performance by detecting human errors. The results show that training and environmental conditions have different effects on HA. After HA, the physiological and psychological strain were significantly improved. More importantly, HA also helped improve the participants' awareness of the dangers and required emergency responses to face potential hazards. Overall, a reasonable HA training under proper conditions is helpful to ensure the safety of human beings. More research is needed to study the role of HA on safety performance.

Cooling Interventions Among Agricultural Workers: Qualitative Field-Based Study

INTRODUCTION

Agricultural workers perform intense labor outside in direct sunlight and in humid environmental conditions exposing them to a high risk of heat-related illness (HRI). To implement effective cooling interventions in occupational settings, it is important to consider workers' perceptions. To date, an analysis of agricultural workers' experience and perception of cooling devices used in the field while working has not been published.

METHODS

Qualitatively data from 61 agricultural workers provided details of their perceptions and experiences with cooling interventions.

RESULTS

The participants in the bandana group reported the bandana was practical to use at work and did not interfere with their work routine. Cooling vest group participants agreed that the vest was effective at cooling them, but the practicality of using the vest at work was met with mixed reviews.

CONCLUSION

The findings of this qualitative study support and extend existing research regarding personal cooling and heat prevention research interventions with vulnerable occupational groups. Personal cooling gear was well received and utilized by the agricultural workers. Sustainable heat prevention studies and governmental protection strategies for occupational heat stress are urgently needed to reduce the risk of heat-related morbidity, mortality, and projected climate change health impacts on outdoor workers.

Australian firefighters perceptions of heat stress, fatigue and recovery practices during fire-fighting tasks in extreme environments

OBJECTIVES

The aim of this study was to assess current perceptions of heat stress, fatigue and recovery practices during active duty in Australian firefighters.

DESIGN

Prospective survey.

METHODS

473 firefighters from Fire and Rescue New South Wales completed a two-part, 16-item survey. Questions included perceptions of the operational activities and body areas associated with the most heat stress, the most mentally and physically demanding activities, and levels of fatigue felt. Further questions focussed on the use and importance of recovery practices, effectiveness of currently used heat-mitigation strategies and additional cooling strategies for future use.

RESULTS

Around a third of firefighters (62%) reported structural fire-fighting as the hottest operational activities experienced, followed by bushfire-fighting (51%) and rescue operations (38%). The top three responses for which body-parts get the hottest ranked as 'the head' (58%), 'the whole body' (54%) and 'the upper back' (40%), respectively. The majority of firefighters (~90%) stated they always or sometimes use the opportunity to recover at an incident, with the top three being 'sit in the shade' (93%), 'cold water ingestion (drinking)' (90%) and 'removing your helmet, flash hood and jacket' (89%). Firefighters reported higher usefulness for more easily deployed strategies compared to more advanced strategies. Limited age and gender differences were found, although location of active service differences were present.

CONCLUSION

These findings may inform future research, and translation to operational directives for recovery interventions; including exploration of protective gear and clothing, education, resources and provision of cooling methods, as well as recovery aid development.

Sunlight exposure and eye disorders in an economically active population: data from the KNHANES 2008-2012

BACKGROUND

Sunlight exposure is a major risk factor for eye disorders. Most outdoor workers cannot avoid sunlight exposure. This study aimed to analyze the relationship between outdoor sunlight exposure and eye disorders in an economically active population.

METHODS

This study analyzed the 2008-2012 Korea National Health and Nutritional Examination Survey data. Sunlight exposure was categorized as < 5 hours and > 5 hours. We also analyzed the dose-dependent relationship between exposure to sunlight and eye disorders (cataracts, pterygium, and age-related macular degeneration [AMD]) using data from 2010 to 2012 by subdividing the exposure groups into < 2 hours, 2-5 hours, and ≥ 5 hours. Eye disorders were diagnosed by an ophthalmologist. The study participants were stratified by sex, and the results were analyzed using the χ2 test and multiple logistic regression analysis.

RESULTS

In the female group, the odds ratio of pterygium in the high-level sunlight exposure group was 1.47 (95% confidence interval [CI]: 1.15-1.89). Regarding AMD, the odds ratios were 1.42 (95% CI: 1.16-1.73), 1.33 (95% CI: 1.03-1.73), and 1.58 (95% CI: 1.15-2.16) in the total, male, and female groups, respectively. Analysis of the dose-response relationship revealed that the odds ratios of pterygium in the high-level sunlight exposure subgroups of the total and female groups were 1.62 (95% CI: 1.25-2.08) and 2.00 (95% CI: 1.39-2.88), respectively.

CONCLUSIONS

This study demonstrated a relationship between sunlight exposure and eye disorders in an economically active population. Women were found to be especially vulnerable to pterygium. However, additional prospective studies to clarify the pathophysiology of pterygium are needed.

Are Cal/OSHA Regulations Protecting Farmworkers in California From Heat-Related Illness?

OBJECTIVE

Determine compliance with and effectiveness of California regulations in reducing farmworkers' heat-related illness (HRI) risk and identify main factors contributing to HRI.

METHODS

In a cross-sectional study of Latino farmworkers, core body temperature (CBT), work rate, and environmental temperature (WBGT) were monitored over a work shift by individual ingestible thermistors, accelerometers, and weather stations, respectively. Multiple logistic modeling was used to identify risk factors for elevated CBT.

RESULTS

Although farms complied with Cal/OSHA regulations, worker training of HRI prevention and hydration replacement rates were insufficient. In modeling (AOR [95% CI]) male sex (3.74 [1.22 - 11.54]), WBGT (1.22 [1.08 - 1.38]), work rate (1.004 [1.002 - 1.006]), and increased BMI (1.11 [1.10 - 1.29]) were all independently associated with elevated CBT.

CONCLUSION

Risk of HRI was exacerbated by work rate and environmental temperature despite farms following Cal/OSHA regulations.

Heat Stress and Cardiac Strain in French Vineyard Workers

Agricultural workers often produce considerable excess heat due to the physically demanding nature of their activities, increasing their risk of thermal stress in even moderately warm conditions. Few studies have examined the physiological responses to heat load in agriculture. We aimed to assess the heat strain experienced by vineyard workers during canopy management in dry field conditions, and to disentangle the effects of the heat produced by the body and the thermal environment. Thirty workers from five Bordeaux vineyards of southern France were monitored during vine-lifting and trellising (June 2012). The mean heart rate, net cardiac cost, relative cardiac cost, and cardiac workload score were assessed during field activity. As the workers were nested within vineyards, multilevel linear regression models were used for correct inference. Skin temperature increased by an average of 1.0°C. Cardiac indices showed marked differences between individuals. The workload was evaluated as 'heavy' or 'very heavy' for more than one-third of the workers, of whom one experienced heat exhaustion. Above some individual characteristics, we highlighted a contextual effect (air temperature) for the mean heart rate (P = 0.03), the relative cardiac cost (P = 0.01) and, to a lesser extent, a cardiac workload score (P = 0.07). Canopy management by hand in vineyards causes considerable cardiac and thermoregulatory strain. Appropriate instruments should be developed to simultaneously evaluate work intensity, work quality, and productivity at the vineyard level to raise the awareness of both managers and employees about taking preventive measures.

Using Twitter for Nursing Research: A Tweet Analysis on Heat Illness and Health

AIM

To provide an example of a tweet analysis for nurse researchers using Twitter in their research.

DESIGN

A content analysis using tweets about "heat illness + health."

METHODS

Tweets were pulled from Twitter's application programming interface with premium access using Postman and the key words "heat illness + health." All data cleaning and analysis was performed in R Version 3.5.2, and the tweet set was analyzed for term frequency, sentiment, and topic modeling. Principal R packages included LDAvis, tidytext, tm, and zyuzhet.

RESULTS

6,317 tweets were analyzed with a date range of April 6, 2009, to December 30, 2019. The most common terms in the tweets were heat (n = 4,532), illness (n = 4,085), and health (n = 2,257). Sentiment analysis showed that the majority of tweets (55%) had a negative sentiment. Topic modeling showed that there were three topics within the tweet set: increasing impact, prevention and safety, and symptoms.

CONCLUSIONS

Twitter can be a useful tool for nursing researchers, serving as a viable adjunct to current research methodologies. This practical example has facilitated a deeper understanding of the social media representation of heat illness and health that can be applied to other research.

CLINICAL RELEVANCE

Twitter serves as a tool for collecting health information for multiple groups, ranging from clinicians and researchers to patients. By utilizing the plethora of data that comes from the platform, we can work towards developing theories and interventions related to numerous health conditions and phenomena.

Climate Change Impacts and Workforce Development Needs in Federal Region X: A Qualitative Study of Occupational Health and Safety Professionals' Perceptions

Climate change is considered one of the top health threats in the United States. This research sought to (1) to understand the perceptions of occupational health and safety (OHS) professionals regarding the impacts of climate-related hazards on OHS in Region X, and (2) to explore the ideas of these OHS professionals regarding the content of future training programs that would better prepare OHS professionals to identify and mitigate climate-related hazards in Region X. Key informant (KI) interviews with 17 OHS professionals familiar with the climate-related hazards and impacts to OHS in Region X were coded and thematically analyzed. Climate hazards, social and economic impacts from climate-related hazards, and sector-specific worker and workplace impacts from climate-related hazards were described as having interacting relationships that influenced worker health and safety impacts. KIs further described how workplace controls could be used to mitigate OHS impacts of climate-related hazards, and how training of the OHS workforce could influence the ability to successfully implement such controls. Our findings suggest that OHS impacts are sector-specific, influenced by social and economic factors, and can be mitigated through workplace controls designed and implemented by a trained OHS workforce. The findings from this work should inform future educational and training programming and additional research and translation activities in the region, while our approach can inform other regions as they develop regionally specific OHS climate change training and programming.

The Importance of Respiratory Rate Monitoring: From Healthcare to Sport and Exercise

Respiratory rate is a fundamental vital sign that is sensitive to different pathological conditions (e.g., adverse cardiac events, pneumonia, and clinical deterioration) and stressors, including emotional stress, cognitive load, heat, cold, physical effort, and exercise-induced fatigue. The sensitivity of respiratory rate to these conditions is superior compared to that of most of the other vital signs, and the abundance of suitable technological solutions measuring respiratory rate has important implications for healthcare, occupational settings, and sport. However, respiratory rate is still too often not routinely monitored in these fields of use. This review presents a multidisciplinary approach to respiratory monitoring, with the aim to improve the development and efficacy of respiratory monitoring services. We have identified thirteen monitoring goals where the use of the respiratory rate is invaluable, and for each of them we have described suitable sensors and techniques to monitor respiratory rate in specific measurement scenarios. We have also provided a physiological rationale corroborating the importance of respiratory rate monitoring and an original multidisciplinary framework for the development of respiratory monitoring services. This review is expected to advance the field of respiratory monitoring and favor synergies between different disciplines to accomplish this goal.

Examining Agricultural Workplace Micro and Macroclimate Data Using Decision Tree Analysis to Determine Heat Illness Risk

OBJECTIVE

This study was designed to examine the associations between regional weather data and agricultural worksite temperatures in Florida.

METHODS

Florida farmworkers (n = 105) were each monitored using iButton technology paired with simultaneous data from regional weather stations. Conditional inference tree models were developed for (1) regional environmental temperatures and iButton (worksite) temperatures, and (2) regional heat index (HI) and iButton HI.

RESULTS

Worksite temperatures were partitioned by regional temperature at the primary node of 29.1°C. Worksite HI was partitioned at nodes of 33.0°C, 36.0°C, 37.0°C, and 40.0°C. The nodes at 33.0°C and 40.0°C mirror the National Weather Service's category entry points for "extreme caution" and "danger" regarding the risk of developing heat-related illness.

CONCLUSION

Regional weather data have the potential to provide estimations of worksite environmental conditions allowing employers to quickly implement strategies to protect workers.

“We Force Ourselves”: Productivity, Workplace Culture, and HRI Prevention in Florida’s Citrus Groves

Efforts to disseminate heat-related illness (HRI) prevention practices among Latino farmworkers represent a critical occupational safety strategy in Florida. Targeted initiatives, however, require understanding the workplace dynamics that guide agricultural safety behaviors. This article reports focus group data collected in 2018 from citrus harvesters in central Florida and provides an in-depth perspective on the workplace culture that shapes their implementation of heat safety measures. Results indicate that citrus harvesters regularly suffered HRI symptoms yet rarely reported or sought treatment for their injuries. In some cases, the risks of developing HRI were accepted as a facet of agricultural work and harvesters blamed themselves for their illnesses. Implementation of safety practices hinged less on knowledge than on the availability of water and rest breaks and the quality of employer-employee relations and exchanges. Thus, trust was a determinant of workers’ attitudes toward management that contributed to a harvesting operation’s safety climate. Results highlight the difficulties of putting into practice measures that are not rewarded by the workplace culture and suggest that the extent to which intervention strategies promote not only individual safety behaviors but organizational accountability may predict their effectiveness.

Work Adaptations Insufficient to Address Growing Heat Risk for U.S. Agricultural Workers

The over one million agricultural workers in the United States (U.S.) are amongst the populations most vulnerable to the health impacts of extreme heat. Climate change will further increase this vulnerability. Here we estimate the magnitude and spatial patterns of the growing heat exposure and health risk faced by U.S. crop workers and assess the effect of workplace adaptations on mitigating that risk. We find that the average number of days spent working in unsafe conditions will double by mid-century, and, without mitigation, triple by the end of it. Increases in rest time and the availability of climate-controlled recovery areas can eliminate this risk but could affect farm productivity, farm worker earnings, and/or labor costs much more than alternative measures. Safeguarding the health and well-being of U.S. crop workers will therefore require systemic change beyond the worker and workplace level.

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

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

METHODS

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

RESULTS

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

CONCLUSION

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

Hydration Choices, Sugary Beverages, and Kidney Injury in Agricultural Workers in California

PURPOSE

Agricultural workers working in high ambient temperatures are at risk for acute kidney injury. Despite recommendations to maintain hydration, workers likely do not drink enough to protect their renal function. Additionally, new research suggests that rehydration with sugary beverages adds additional risk to kidneys already stressed by high heat and workload. We assessed hydration choices during a work shift and tested associations of rehydration using sugary beverages with acute kidney injury.

METHODS

We recruited a convenience sample of workers on farms over two summers. We estimated acute kidney injury via pre- and post-shift serum creatinine readings from capillary blood samples. We used self-reported measures of the volume and type of fluids workers consumed during their shifts. We also measured changes in core body temperature, ambient temperature, and workload. We used logistic regression to estimate associations of sugary drinks with acute kidney injury, while controlling for physiologic and occupational variables.

FINDINGS

In our sample of 445 participants, we found that men drink more than women do overall, including more than a liter of water than women (2.9 L compared to 1.9 L, respectively). The total volume workers drank was associated with increased odds of acute kidney injury (adjusted odds ratio 1.47, 95% confidence interval 1.09-1.99). We found no association of sugary drinks with acute kidney injury.

CONCLUSIONS

These findings provide important information about what men and women use to hydrate during the work day and suggest that they do not drink enough to maintain adequate hydration. Increased fluid intake during the work day may be a result of vigorous workload, which could explain the increased risk for acute kidney injury. Nurses play an important role in educating agricultural workers about the importance of maintaining hydration at work.

CLINICAL RELEVANCE

This study advances current knowledge of occupational risk factors for acute kidney injury in agricultural workers. Nurses may be the only point of care for this vulnerable population and are therefore in a unique position to educate on the importance of proper hydration during work.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

Purpose

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

Design/methodology/approach

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

Findings

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

Originality/value

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

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

Introduction

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

Methods

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

Results

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

Conclusions

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

An Occupational Heat Stress and Hydration Assessment of Agricultural Workers in North Mexico

Expanding agribusiness in Northern Mexico has increased demand for workers from Southern Mexico, with hundreds of thousands migrating for work annually. Extreme temperatures, physical labor, and low fluid consumption place workers at risk for heat strain and dehydration, commonly underreported hazards in the agricultural industry. The objectives of this pilot study were to assess heat exposure and hydration status of a population of migratory agricultural workers in Northern Mexico throughout the grape harvest season. In addition to demographic information, environmental conditions, hydration status, and core body temperatures were collected. The majority listed Chiapas as their home state, nearly half spoke an Indigenous language, and none had completed high school. The wet-bulb globe temperature was significantly higher during the harvest and post-harvest seasons compared to the pre-harvest season. Across the different seasons, the majority were dehydrated post-shift, and mean core body temperature of workers was not significantly different. This project highlights the need for targeted interventions to improve hydration and prevent heat stress in this region. As the number of warm days is expected to rise each year worldwide, it will be increasingly important to engage in practices to protect vulnerable populations, such as migratory agriculture workers.

"If We Don't Produce, Bring Another:" Work Organization and Tomato Worker Health

Objectives: Specific work processes and management structures that contribute to high rates of occupational illness and injury in agricultural industries are not well described in academic literature. This qualitative study of work organization in the U.S. fresh tomato industry investigates how work processes and management structures impact tomato workers' occupational health. Methods: After conducting literature review and key informant interviews, semi-structured interviews and focus groups were conducted with 36 individuals with experience working in the U.S. fresh tomato industry. Interviews and focus groups were audio-recorded, transcribed, coded, and analyzed using a modified grounded theory approach. Results: These data indicate that participants endured income insecurity and hazardous supervisory practices, including wage theft, retaliation, intimidation, and humiliation, that put them at risk of preventable illness and injury. Support from workers' organizations and health-conscious supervisory practices helped mitigate some of these occupational hazards. Conclusion: Participants' adverse work experiences may be considered sequelae of workers' lack of job control and positions of socioeconomic structural vulnerability. Other aspects of tomato work organization, including health-conscious supervisory practices and the involvement of workers' organizations, indicate that modifying work organization to better safeguard health is possible. Such modifications present compelling opportunities for employers, employees, organizations, community and government leaders, and health care professionals to help create healthier occupational environments for tomato workers.

Wearable Sensor System to Monitor Physical Activity and the Physiological Effects of Heat Exposure

Mobile health monitoring via non-invasive wearable sensors is poised to advance telehealth for older adults and other vulnerable populations. Extreme heat and other environmental conditions raise serious health challenges that warrant monitoring of real-time physiological data as people go about their normal activities. Mobile systems could be beneficial for many communities, including elite athletes, military special forces, and at-home geriatric monitoring. While some commercial monitors exist, they are bulky, require reconfiguration, and do not fit seamlessly as a simple wearable device. We designed, prototyped and tested an integrated sensor platform that records heart rate, oxygen saturation, physical activity levels, skin temperature, and galvanic skin response. The device uses a small microcontroller to integrate the measurements and store data directly on the device for up to 48+ h. continuously. The device was compared to clinical standards for calibration and performance benchmarking. We found that our system compared favorably with clinical measures, such as fingertip pulse oximetry and infrared thermometry, with high accuracy and correlation. Our novel platform would facilitate an individualized approach to care, particularly those whose access to healthcare facilities is limited. The platform also can be used as a research tool to study physiological responses to a variety of environmental conditions, such as extreme heat, and can be customized to incorporate new sensors to explore other lines of inquiry.

Perceptions of Occupational Heat, Sun Exposure, and Health Risk Prevention: A Qualitative Study of Forestry Workers in South Africa

Occupational exposure to heat and solar ultraviolet radiation (UVR) threatens the health and wellbeing of outdoor workers. These threats are likely to increase as a result of climate change. This study examined the perceptions of occupational heat and sun exposure and health risk prevention among forestry workers removing alien invasive vegetation in the Western Cape, South Africa. The linkages between workers’ perceptions of heat, solar UVR, and herbicide exposure and impacts under the current climate were investigated to better understand potential adaptation needs under a changing climate. Using focus group discussions and participatory risk mapping, heat stresses identified by workers were either environmental (e.g., lack of shade) or work-related (e.g., wearing required personal protective equipment). Several heat and solar UVR health impacts were reportedly experienced by workers; local indigenous knowledge and coping mechanisms, such as wearing ochre for sun protection, were used to prevent these impacts. Despite workers’ current efforts to protect their health, existing gaps and opportunities to improve working conditions were identified. Institutional structures for improved reporting of adverse events are imperative, together with awareness and education campaigns about the risks associated with working in hot and sunny environments.

Impacts of weather, work rate, hydration, and clothing in heat-related illness in California farmworkers

BACKGROUND

The primary aim of this study was to investigate the effects of work rate, hydration status, and clothing on core body temperature (CBT) on California farmworkers.

METHODS

Two hundred and eighty-seven farmworkers were recruited in Summer 2015, with 259 participants having sufficient data for analysis. We collected CBT, ambient temperature, work rate, body weight loss, and clothing worn by each participant throughout the work day and demographic data from a questionnaire.

RESULTS

Multiple regression with CBT as the outcome was used to determine the adjusted associations between CBT, environmental heat load, and worker characteristics. The multivariate regression model showed statistically significant associations of CBT with work rate (β = .006, 95% CI [0.004, 0.009]) and wet-bulb globe temperature (β = .03, 95% CI [0.017, 0.05]).

CONCLUSION

Results suggest that among our population workload is the primary modifiable risk factor for heat-related illness. As expected, the ambient temperature was also associated with higher risk.

Physical activity and work activities in Florida agricultural workers

BACKGROUND

Laboring in hot and humid conditions is a risk factor for heat-related illnesses. Little is known about the amount of physical activity performed in the field setting by agricultural workers, a population that is among those at highest risk for heat-related mortality in the United States.

METHODS

We measured accelerometer-based physical activity and work activities performed in 244 Florida agricultural workers, 18 to 54 years of age, employed in the fernery, nursery, and crop operations during the summer work seasons of 2015-2017. Environmental temperature data during the participant's workdays were collected from the Florida Automated Weather Network and used to calculate wet bulb globe temperature (WBGT). Generalized linear mixed model regression was used to examine the association between WBGT on physical activity, stratified by the agricultural sector.

RESULTS

Fernery workers had the highest overall volume of physical activity, spending nearly 4 hours in moderate to vigorous activity per workday. Activity over the course of the workday also differed by the agricultural sector. A reduction on average physical activity with increasing environmental temperature was observed only among crop workers.

CONCLUSIONS

The quantity and patterns of physical activity varied by the agricultural sector, sex, and age, indicating that interventions that aim to reduce heat-related morbidity and mortality should be tailored to specific subpopulations. Some workers did not reduce overall physical activity under dangerously hot environmental conditions, which has implications for policies protecting worker health. Future research is needed to determine how physical activity and climatic conditions impact the development of heat-related disorders in this population.

Workplace Accidents Among Nepali Male Workers in the Middle East and Malaysia: A Qualitative Study

There are many Nepali men working in the Middle East and Malaysia and media reports and anecdotal evidence suggest a high risk of workplace-related accidents and injuries for male Nepali workers. Therefore, this study aims to explore the personal experiences of male Nepali migrants of unintentional injuries at their place of work. In-depth, face-to-face interviews (n = 20) were conducted with male Nepali migrant workers. Study participants were approached at Kathmandu International Airport, hotels and lodges around the airport. Interviews were transcribed and analysed using thematic analysis. Almost half of study participants experienced work-related accident abroad. The participants suggested that the reasons behind this are not only health and safety at work but also poor communication, taking risks by workers themselves, and perceived work pressure. Some participants experienced serious incidents causing life-long disability, extreme and harrowing accounts of injury but received no support from their employer or host countries. Nepali migrant workers would appear to be at a high risk of workplace unintentional injuries owing to a number of interrelated factors poor health and safety at work, pressure of work, risk taking practices, language barriers, and their general work environment. Both the Government of Nepal and host countries need to be better policing existing policies, introduce better legislation where necessary, ensure universal health (insurance) coverage for labour migrants, and improve preventive measures to minimize the number and severity of accidents and injuries among migrant workers.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Elevated Core Temperature in Florida Fernery Workers: Results of a Pilot Study

With expected increases in extreme weather, there may be a greater risk of injury from extreme heat in outdoor worker populations. To plan for future adaptation measures, studies are needed that can characterize workers’ physiologic responses to heat in outdoor settings such as agriculture. The objective of this study was to characterize occupational heat exposure, key vulnerability factors (e.g., gender, energy expenditure), and physiologic heat stress response in a sample of fernery workers. Forty-three fernery workers over 86 workdays were examined regarding heat-related illness (HRI) during the summer months of 2012 and 2013. The key outcome measure was whether a participant’s body core temperature (Tc) reached or exceeded 38.0°C (100.4ºF; Tc38). Participants’ Tc exceeded 38.0°C on 49 (57%) of the workdays, with 30 of 40 participants reaching or exceeding Tc38 on at least one workday. Adjusting for sex, there was a 12% increase in the odds of Tc38 for every 100 kilocalories of energy expended (OR: 1.12; 95% Confidence Interval [CI]: [1.03, 1.21]). Adjusting for energy expenditure, females had 5 times greater odds of Tc38 compared with males (OR: 5.38; 95% CI: [1.03, 18.30]). These findings provide evidence of elevated Tc in Florida fernery workers, indicating an increased risk of occupational HRI, and the need for policy and interventions to address this health risk.

Heat Strain and Hydration of Japanese Construction Workers during Work in Summer

Objectives

The aim was to ascertain hydration and heat strain of construction workers in Japan during the summer who are at the highest risk of heat-related disorders.

Methods

The subjects were 23 construction workers, whose average age was 41, average weight was 69 kg, and average height was 170 cm. We measured thermal working conditions with a wet bulb globe temperature (WBGT) measurement instrument affixed to the helmet of each worker, at fixed points outdoors in the sun and indoors. Heat strain was evaluated for water intake, urine specific gravity (Usg), urine temperature (UT), heart rate (HR), and body weight during work.

Results

The average WBGT measured on the worker helmets over 3 consecutive days was 28.0 ± 0.7, 27.6 ± 0.8, and 27.6 ± 1.1°C. The average water intake was 2.6 l during a work shift. The average Usg, UT, and % HR reserve were the highest in the first half of afternoon work. Seventy-eight percent of the subjects exceeded at least one of the ACGIH TLV physiological guidelines for heat strain in terms of HR and weight loss or a clinically dehydrated level of Usg.

Conclusions

Heat strain was the highest in the first half of afternoon work. The number of dehydrated workers increased during this shift because of insufficient water intake. Adequate hydration is required to decrease the risk of heat-related disorders among construction workers in the summer.

Chronic Kidney Disease Among Workers: A Review of the Literature

For the past two decades, agricultural workers in regions of Central America have reported an epidemic of chronic kidney disease of undetermined etiology (CKDu) that is not associated with established risk factors of chronic kidney disease. Several hypotheses have emerged, but the etiology of CKDu remains elusive and controversial. The aim of this literature review was to describe the potential risk factors of CKDu in Mesoamerica and implications for the U.S. agricultural worker population. PubMed and CINAHL databases were searched for articles published between 2000 and 2018 that examined CKDu in Mesoamerica; 29 original studies were included in this review. CKDu is a multifactorial disease that is often asymptomatic with hallmark characteristics of elevated serum creatinine and blood urea nitrogen (BUN), low glomerular filtration rate, electrolyte abnormalities, and non-nephrotic proteinuria. Reducing the global prevalence of CKDu will require more robust studies on causal mechanisms and on interventions that can reduce morbidity and mortality in vulnerable populations.