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Guidance Notes on Prevention of Heat Stroke at Work

Social and environmental risks as contributors to the clinical course of heart failure

Heart failure is a major contributor to healthcare expenditures. Many clinical risk factors for the development and exacerbation of heart failure had been reported, including diabetes, renal dysfunction, and respiratory disease. In addition to these clinical parameters, the effects of social factors, such as occupation or lifestyle, and environmental factors may have a great impact on disease development and progression of heart failure. However, the current understanding of social and environmental factors as contributors to the clinical course of heart failure is insufficient. To present the knowledge of these factors to date, this comprehensive review of the literature sought to identify the major contributors to heart failure within this context. Social factors for the risk of heart failure included occupation and lifestyle, specifically in terms of the effects of specific occupations, occupational exposure to toxicities, work style, and sleep deprivation. Socioeconomic factors focused on income and education level, social status, the neighborhood environment, and marital status. Environmental factors included traffic and noise, air pollution, and other climate factors. In addition, psychological stress and behavior traits were investigated. The development of heart failure may be closely related to these factors; therefore, these data should be summarized for the context to improve their effects on patients with heart failure. The present study reviews the literature to summarize these influences.

Occupations at risk of contracting zoonoses of public health significance in Québec

INTRODUCTION: Climate change plays an important role in the geographic spread of zoonotic diseases. Knowing which populations are at risk of contracting these diseases is critical to informing public health policies and practices. In Québec, 14 zoonoses have been identified as important for public health to guide the climate change adaptation efforts of decision-makers and researchers. A great deal has been learned about these diseases in recent years, but information on at-risk workplaces remains incomplete. The objective of this study is to paint a portrait of the occupations and sectors of economic activity at risk for the acquisition of these zoonoses. METHODS: A rapid review of the scientific literature was conducted. Databases on the Ovid and EBSCO research platforms were searched for articles published between 1995 and 2018, in English and French, on 14 zoonoses (campylobacteriosis, cryptosporidiosis, verocytotoxigenic Escherichia coli, giardiasis, listeriosis, salmonellosis, Eastern equine encephalitis, Lyme disease, West Nile virus, food botulism, Q fever, avian and swine influenza, rabies, hantavirus pulmonary syndrome) and occupational health. The literature search retrieved 12,558 articles and, after elimination of duplicates, 6,838 articles were evaluated based on the title and the abstract. Eligible articles had to address both concepts of the research issue (prioritized zoonoses and worker health). Of the 621 articles deemed eligible, 110 were selected following their full reading. RESULTS: Of the diseases under study, enteric zoonoses were the most frequently reported. Agriculture, including veterinary services, public administration services and medical and social services were the sectors most frequently identified in the literature. CONCLUSION: The results of our study will support public health authorities and decision-makers in targeting those sectors and occupations that are particularly at risk for the acquisition of zoonoses. Doing so will ultimately optimize the public health practices of those responsible for the health of workers.

Pollutants and sperm quality: A systematic review and meta-analysis

Male fertility and semen quality have declined over recent decades. Among other causes, exposure to environmental and occupational pollution has been linked to adverse reproductive outcomes, but effects on male semen quality are still uncertain. Therefore, the aim of the present study was to conduct a systematic review and meta-analysis to assess current evidence regarding the impact of exposure to tobacco smoke and environmental and occupational pollution on sperm quality in humans. In the meta-analysis, 22 studies are included showing that environmental and occupational pollutants may affect sperm count, volume, concentration, motility, vitality and sperm DNA, and chromatin integrity. All included articles reported significant alterations in at least one of the outcomes studied in association with at least one of the pollutants studied. Considering that sperm quality can be considered a proxy for general health and that pollutants have a dramatic impact on climate change, it would be strongly recommended to better understand the role of pollutants on human, animal, and planetary health.

Heat exposure and workers’ health: A systematic review

OBJECTIVES: Several studies on the health effects of heat exposure on workers have been reported; however, only few studies have summarized the overall and systematic health effects of heat exposure on workers. This study aims to review the scientific reports on the health status of workers exposed to high temperatures in the workplace. METHODS: We reviewed literature from databases such as PubMed and Google Scholar, using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to identify studies that address health effects of heat exposure among workers. RESULTS: In total, 459 articles were identified, and finally, 47 articles were selected. Various health effects of heat exposure on workers have been reported, such as heat-related diseases, deaths, accidents or injuries, effects on the urinary system, reproductive system, and on the psychological system. CONCLUSIONS: Our review suggests that many workers are vulnerable to heat exposure, and this has a health effect on workers.

Fragmentation in the future of work: A horizon scan examining the impact of the changing nature of work on workers experiencing vulnerability

INTRODUCTION: The future of work is characterized by changes that could disrupt all aspects of the nature and availability of work. Our study aims to understand how the future of work could result in conditions, which contribute to vulnerability for different groups of workers. METHODS: A horizon scan was conducted to systematically identify and synthesize diverse sources of evidence, including academic and gray literature and resources shared over social media. Evidence was synthesized, and trend categories were developed through iterative discussions among the research team. RESULTS: Nine trend categories were uncovered, which included the digital transformation of the economy, artificial intelligence (AI)/machine learning-enhanced automation, AI-enabled human resource management systems, skill requirements for the future of work; globalization 4.0, climate change and the green economy, Gen Zs and the work environment; populism and the future of work, and external shocks to accelerate the changing nature of work. The scan highlighted that some groups of workers may be more likely to experience conditions that contribute to vulnerability, including greater exposure to job displacement or wage depression. The future of work could also create opportunities for labor market engagement. CONCLUSION: The future of work represents an emerging public health concern. Exclusion from the future of work has the potential to widen existing social and health inequities. Thus, tailored supports that are resilient to changes in the nature and availability of work are required for workers facing vulnerability.

Environmental risk factors and health: An umbrella review of meta-analyses

Background: Environmental health is a growing area of knowledge, continually increasing and updating the body of evidence linking the environment to human health. Aim: This study summarizes the epidemiological evidence on environmental risk factors from meta-analyses through an umbrella review. Methods: An umbrella review was conducted on meta-analyses of cohort, case-control, case-crossover, and time-series studies that evaluated the associations between environmental risk factors and health outcomes defined as incidence, prevalence, and mortality. The specific search strategy was designed in PubMed using free text and Medical Subject Headings (MeSH) terms related to risk factors, environment, health outcomes, observational studies, and meta-analysis. The search was limited to English, Spanish, and French published articles and studies on humans. The search was conducted on September 20, 2020. Risk factors were defined as any attribute, characteristic, or exposure of an individual that increases the likelihood of developing a disease or death. The environment was defined as the external elements and conditions that surround, influence, and affect a human organism or population’s life and development. The environment definition included the physical environment such as nature, built environment, or pollution, but not the social environment. We excluded occupational exposures, microorganisms, water, sanitation and hygiene (WASH), behavioral risk factors, and no-natural disasters. Results: This umbrella review found 197 associations among 69 environmental exposures and 83 diseases and death causes reported in 103 publications. The environmental factors found in this review were air pollution, environmental tobacco smoke, heavy metals, chemicals, ambient temperature, noise, radiation, and urban residential surroundings. Among these, we identified 65 environmental exposures defined as risk factors and 4 environmental protective factors. In terms of study design, 57 included cohort and/or case-control studies, and 46 included time-series and/or case-crossover studies. In terms of the study population, 21 included children, and the rest included adult population and both sexes. In this review, the largest body of evidence was found in air pollution (91 associations among 14 air pollution definitions and 34 diseases and mortality diagnoses), followed by environmental tobacco smoke with 24 associations. Chemicals (including pesticides) were the third larger group of environmental exposures found among the meta-analyses included, with 19 associations. Conclusion: Environmental exposures are an important health determinant. This review provides an overview of an evolving research area and should be used as a complementary tool to understand the connections between the environment and human health. The evidence presented by this review should help to design public health interventions and the implementation of health in all policies approach aiming to improve populational health.

Working in smoke: Wildfire impacts on the health of firefighters and outdoor workers and mitigation strategies

Wildland firefighters work on wildfire incidents all over the United States and perform arduous work under extreme work conditions, including exposure to smoke. Wildland fire smoke is a mixture of hazardous air pollutants. For assessing wildland firefighter exposure to smoke, most studies measured carbon monoixde (CO) and particulate matter and reported changes in lung health by measured lung function, airway responsiveness, and respiratory symptoms across individual work shifts and single fire seasons. All fire personnel should understand the hazards of smoke and develop ways to mitigate exposure to smoke.

Planetary health and the role of community health workers

In this era, grand challenges lies in biodiversity loss, climate change, and global noncommunicable diseases signify that planet and humanity are in crisis. Scholarly evidence from human and animal kingdom suggest that there is an optimism in planetary health which can provide a unique and novel concept where efforts toward survival and remediation can be made. With accurate navigation, the current challenges can be mitigated leading to a new reality, one in which the core value is the well-being of all. This paper discusses the drivers of planetary health and the role of community health workers (CHWs) in making health-care system more resilient that can produce multiple benefits to community and overall planetary health. A web-based international database such as Google, Google Scholar, SCOPUS/MEDLINE/PubMed, and JSTOR was searched relevant to a planetary health framework. The study findings suggest that CHWs can offer health care interventions through environmental health cobenefits across the spectrum of health effects of climate change cause and effects. These actions have been divided into four major categories (i. health care promotion and prevention, ii. health care strengthening, iii. advocacy, and iv. education and research) that CHWs perform through a variety of roles and functions they are engaged in protecting planetary health. CHWs contribute toward achieving sustainable development goals such as planetary health and focus on environment sustainability and well-being of entire mankind.

Heat warning and public and workers’ health at the time of COVID-19 pandemic

The humanity is currently facing the COVID-19 pandemic challenge, the largest global health emergency after the Second World War. During summer months, many countries in the northern hemisphere will also have to counteract an imminent seasonal phenomenon, the management of extreme heat events. The novelty this year concerns that the world population will have to deal with a new situation that foresees the application of specific measures, including adjunctive personal protective equipment (i.e. facemasks and gloves), in order to reduce the potential transmission of the SARS-CoV-2 virus. These measures should help to decrease the risk of the infection transmission but will also represent an aggravating factor to counteract the heat effects on the population health both at occupational and environmental level. The use of a specific heat health warning system with personalized information based on individual, behavioural and environmental characteristics represents a necessary strategy to help a fast adaptation of the population at a time where the priority is to live avoiding SARS-CoV-2 infection.

Understanding occupational heat exposure in the United States and proposing a quantifying stress index

PURPOSE: Millions of workers exposed to the outdoor environment are extremely susceptible to extreme heat. Although several articles analyzed heat-related illnesses, injuries, fatalities at the country level, few investigated regional and state statistics especially for OSHA Region 4 and the state of Alabama, U.S, which we explored in this study. METHODS: We studied the number of heat-days over 90 °F (32.2 °C) heat-index within our study area, analyzed heat-related injury and illnesses to calculate their incidence rate during 2015 to 2019, observed the nature of such incidents, their monthly occurrence, and incidence trend over average air temperature. We conducted a comparative analysis of heat-related fatalities between construction and all industries. The existing heat regulations by OSHA and some state agencies have also been summarized. RESULTS: We observed the highest mean, maximum heat-days and injury-illness rate in the south and southeast part of Region 4; increase in incidence rate from 0.03 in 2017 to 0.28 per 10,000 employees in 2018 for the contiguous U.S; highest injury-illness rate (HIR) in OSHA Region 1, 4 and 6; highest HIR in Lee, Montgomery, Mobile and Madison counties of Alabama; 34.7% (construction) and 31.3% (all industries) of all cases experiencing nonclassifiable heat-light effects; high fatalities in construction industry with a trend of 1 death/5 years; increased mortality in all occupations with 1 death/2.4 years. We also proposed a Heat-Stress Index (HSI) as a routine heat-stress measure on jobsite. CONCLUSION: The findings from this research and the proposed index can help in understanding heat-related risk at a regional level and implementing workplace interventions.

Perceptions of heat-health impacts and the effects of knowledge and preventive actions by outdoor workers in Hanoi, Vietnam

Extreme heat is an increasing climate threat, most pronounced in urban areas where poor populations are at particular risk. We analyzed heat impacts and vulnerabilities of 1027 outdoor workers who participated in a KAP survey in Hanoi, Vietnam in 2018, and the influence of their mitigation actions, their knowledge of heat-risks, and access to early warnings. We grouped respondents by their main income (vendors, builders, shippers, others, multiple jobs, and non-working) and analyzed their reported heat-health impacts, taking into consideration socioeconomics, knowledge of heat impacts and preventive measures, actions taken, access to air-conditioning, drinking amounts and use of weather forecasts. We applied linear and logistic regression analyses using R. Construction workers were younger and had less knowledge of heat-health impacts, but also reported fewer symptoms. Older females were more likely to report symptoms and visit a doctor. Access to air-conditioning in the bedroom depended on age and house ownership, but did not influence heat impacts as cooling was too expensive. Respondents who knew more heat exhaustion symptoms were more likely to report impacts (p < 0.01) or consult a doctor (p < 0.05). Similarly, those who checked weather updates were more likely to report heat impacts (p < 0.01) and experienced about 0.6 more symptoms (p < 0.01). Even though occupation type did not explain heat illness, builders knew considerably less (40%; p < 0.05) about heat than other groups but were twice as likely to consult a doctor than street vendors (p < 0.01). Knowledge of preventive actions and taking these actions both correlated positively with reporting of heat-health symptoms, while drinking water did not reduce these symptoms (p < 0.01). Child carers and homeowners experienced income losses in heatwaves (p < 0.01). The differences support directed actions, such as dissemination of educational materials and weather forecasts for construction workers. The Red Cross assisted all groups with cooling tents, provision of drinks and health advice.

Occupational heat exposure and breast cancer risk in the MCC-Spain study

BACKGROUND: Mechanisms linking occupational heat exposure with chronic diseases have been proposed. However, evidence on occupational heat exposure and cancer risk is limited. METHODS: We evaluated occupational heat exposure and female breast cancer risk in a large Spanish case-control study. We enrolled 1,738 breast cancer cases and 1,910 frequency-matched population controls. A Spanish job-exposure matrix, MatEmEsp, was used to assign estimates of the proportion of workers exposed (P ? 25% for at least 1 year) and work time with heat stress (wet bulb globe temperature ISO 7243) for each occupation. We used three exposure indices: ever versus never exposed, lifetime cumulative exposure, and duration of exposure (years). We estimated ORs and 95% confidence intervals (CI), applying a lag period of 5 years and adjusting for potential confounders. RESULTS: Ever occupational heat exposure was associated with a moderate but statistically significant higher risk of breast cancer (OR 1.22; 95% CI, 1.01-1.46), with significant trends across categories of lifetime cumulative exposure and duration (P (trend) = 0.01 and 0.03, respectively). Stronger associations were found for hormone receptor-positive disease (OR ever exposure = 1.38; 95% CI, 1.12-1.67). We found no confounding effects from multiple other common occupational exposures; however, results attenuated with adjustment for occupational detergent exposure. CONCLUSIONS: This study provides some evidence of an association between occupational heat exposure and female breast cancer risk. IMPACT: Our results contribute substantially to the scientific literature. Further investigations are needed considering multiple occupational exposures.

Health impacts of climate change on smallholder farmers

The health of smallholder farmers is crucial for ensuring food and nutritional security for two billion people. However, their health is in jeopardy for several reasons including challenges from climate change impacts. Using a narrative literature review supported by field observations and informal interviews with key informants in India, Bangladesh and Malawi, this paper identifies and discusses the health impacts of climate change under four categories: (i) communicable diseases, (ii) non-communicable diseases, (iii) mental health, and (iv) occupational health, safety and other health issues. The health impacts of climate change on smallholder farmers will hamper the realization of many of the United Nations’ Sustainable Development Goals, and a series of recommendations are made to regional and country governments to address the increasing health impacts of accelerating climate change among smallholder farmers.

Heat exposure effect on Ghanaian mining workers: A mediated-moderation approach

The lack of empirical evidence on the effect of heat exposure on the health and safety, productivity, psychological behaviour and social well-being outcomes of small- and large-scale mining workers in Africa has derailed concrete policy directions and interventions. An explanatory cross-sectional survey involving 320 small- and large-scale mining workers was used to assess this research gap. A path analysis was used to model health and safety, productivity, psychological behaviour and social well-being as a function of heat exposure, mediated and moderated by adaptation strategies and barriers, while controlling for age, gender, level of education, years of working experience and workplace environment. Significant direct adverse effects of heat exposure on mining workers’ health and safety, productivity and psychological behaviour outcomes were found. Using a pick-a-point approach, significant difference was found in simple slopes (SS) for heat exposure on adaptation strategies at medium level of barriers and a trend toward significance at the high level of barriers. Except for health and safety outcomes, there were significant conditional indirect effects of heat exposure on the performance outcomes at the medium and high levels of barriers to adaptation strategies. However, there was no evidence of mediated-moderation for heat exposure and health and safety, productivity, psychological behaviour and social well-being outcomes. We have provided empirical evidence to establish heat exposure effect on key performance outcomes of mining workers to initiate and guide the formulation of heat exposure management policies.

Gaps in awareness of climate variability and its impacts on society among health professionals and community workers in Vietnam: Implications for COVID-19 and other epidemic response systems

Estimating the magnitude and risk associated with heat exposure among Ghanaian mining workers

Many occupational settings located outdoors in direct sun, such as open cut mining, pose a health, safety, and productivity risk to workers because of their increased exposure to heat. This issue is exacerbated by climate change effects, the physical nature of the work, the requirement to work extended shifts and the need to wear protective clothing which restricts evaporative cooling. Though Ghana has a rapidly expanding mining sector with a large workforce, there appears to be no study that has assessed the magnitude and risk of heat exposure on mining workers and its potential impact on this workforce. Questionnaires and temperature data loggers were used to assess the risk and extent of heat exposure in the working and living environments of Ghanaian miners. The variation in heat exposure risk factors across workers’ gender, education level, workload, work hours, physical work exertion and proximity to heat sources is significant (p<0.05). Mining workers are vulnerable to the hazards of heat exposure which can endanger their health and safety, productive capacity, social well-being, adaptive capacity and resilience. An evaluation of indoor and outdoor Wet Bulb Globe Temperature (WBGT) in the working and living environment showed that mining workers can be exposed to relatively high thermal load, thus raising their heat stress risk. Adequate adaptation policies and heat exposure management for workers are imperative to reduce heat stress risk, and improve productive capacity and the social health of mining workers.

Community-based maternal health workers’ perspectives on heat risk and safety: A pilot qualitative study

In this study the authors examined how maternal health workers (MHWs) perceive the health risks of extreme heat exposure to pregnant women and fetuses. The authors conducted interviews with 12 MHWs (including midwives and doulas) in El Paso, Texas. Using qualitative analysis, the researchers identified numerous themes. Although heat was not communicated as a major health risk, participants expressed some concern with growing heat exposure and communicated standard protective measures. While all participants were familiar with some heat illness symptoms, they were generally unaware of their clients’ vulnerability. MHWs’ minimal heat-risk knowledge leaves pregnant women and developing fetuses at risk of preventable harm.

Core competencies for health workers to deal with climate and environmental change

Rapid, detrimental climate change and environmental degradation pose real threats to the health, environment, social, economic and technological wellbeing of society (HESET). It has become even more imperative that the health workforce (public health and medical healthcare as well as auxiliary and support workers) be ‘climate-environment’ competent to fulfil their role in managing the environmental public health risks and impacts as climate and environment inevitably continue to change. We developed a broad six-domain competency framework consisting of (1) climate and environment sciences, (2) drivers of climate change (3) evidence, projections and assessments (4) iterative risk management (5) mitigation, adaptation and health co-benefits and (6) collective strategies-harnessing international/regional/local agreements and frameworks. The framework can be used by health/medical trainers to design cross-sectoral sub-competencies and learning content for training health workers to function at local, regional and global levels. Reaching, maintaining and improving the different levels of competency, the health workforce will be increasingly invaluable partners in intra- as well as inter-sectoral responses to climate and environmental risks and impacts.

Climate warming and occupational heat and hot environment standards in Thailand

BACKGROUND: During the period 2001 to 2016, the maximum temperatures in Thailand rose from 38-41(o)C to 42-44(o)C. The current occupational heat exposure standard of Thailand issued in 2006 is based on wet bulb globe temperature (WBGT) defined for three workload levels without a work-rest regimen. This study examined whether the present standard still protects most workers. METHODS: The sample comprised 168 heat acclimatized workers (90 in construction sites, 78 in foundries). Heart rate and auditory canal temperature were recorded continuously for 2 hours. Workplace WBGT, relative humidity, and wind velocity were monitored, and the participants’ workloads were estimated. Heat-related symptoms and signs were collected by a questionnaire. RESULTS: Only 55% of the participants worked in workplaces complying with the heat standard. Of them, 79% had auditory canal temperature ? 38.5(o)C, compared with only 58% in noncompliant workplaces. 18% and 43% of the workers in compliant and noncompliant workplaces, respectively, had symptoms from heat stress, the trend being similar across all workload levels. An increase of one degree (C) in WBGT was associated with a 1.85-fold increase (95% confidence interval: 1.44-2.48) in odds for having symptoms. CONCLUSION: Compliance with the current occupational heat standard protects 4/5 of the workers, whereas noncompliance reduces this proportion to one half. The reasons for noncompliance include the gaps and ambiguities in the law. The law should specify work/rest schedules; outdoor work should be identified as an occupational heat hazard; and the staff should include occupational personnel to manage heat stress in establishments involving heat exposure.

Association between extreme ambient temperatures and general indistinct and work-related road crashes. A nationwide study in Italy

Despite the relevance of road crashes and their impact on social and health care costs, the effects of extreme temperatures on road crashes risk have been scarcely investigated, particularly for those occurring in occupational activities. A nationwide epidemiological study was carried out to estimate the risk of general indistinct and work-related road crashes related with extreme temperatures and to identify crash and occupation parameters mostly involved. Data about road crashes, resulting in death or injury, occurring during years 2013-2015 in Italy, were collected from the National Institute of Statistics, for general indistinct road crashes, and from the compensation claim applications registered by the national workers’ compensation authority, for work-related ones. Time series of hourly temperature were derived from the results provided by the meteorological model WRF applied at a national domain with 5 km resolution. To consider the different spatial-temporal characteristics of the two road crashes archives, the association with extreme temperatures was estimated by means of a case-crossover time-stratified approach using conditional logistic regression analysis, and a time-series analysis, using over-dispersed Poisson generalized linear regression model, for general indistinct and work-related datasets respectively. The analyses were controlled for other covariates and confounding variables (including precipitation). Non-linearity and lag effects were considered by using a distributed lag non-linear model. Relative risks were calculated for increment from 75th to 99th percentiles (hot) and from 25 to first percentile (cold) of temperature. Results for general indistinct crashes show a positive association with hot temperature (RR = 1.12, 95 % CI: 1.09-1.16) and a negative one for cold (RR = 0.93, 95 % CI: 0.91-0.96), while for work-related crashes a positive association was found for both hot and cold (RR = 1.06 (95 % CI: 1.01-1.11) and RR = 1.10 (95 % CI: 1.05-1.16). The use of motorcycles, the location of accident (urban vs out of town), presence of crossroads, as well as occupational factors like the use of a vehicle on duty were all found to produce higher risks of road crashes during extreme temperatures. Mitigation and prevention measures are needed to limit social and health care costs.

An advanced empirical model for quantifying the impact of heat and climate change on human physical work capacity

Occupational heat stress directly hampers physical work capacity (PWC), with large economic consequences for industries and regions vulnerable to global warming. Accurately quantifying PWC is essential for forecasting impacts of different climate change scenarios, but the current state of knowledge is limited, leading to potential underestimations in mild heat, and overestimations in extreme heat. We therefore developed advanced empirical equations for PWC based on 338 work sessions in climatic chambers (low air movement, no solar radiation) spanning mild to extreme heat stress. Equations for PWC are available based on air temperature and humidity, for a suite of heat stress assessment metrics, and mean skin temperature. Our models are highly sensitive to mild heat and to our knowledge are the first to include empirical data across the full range of warm and hot environments possible with future climate change across the world. Using wet bulb globe temperature (WBGT) as an example, we noted 10% reductions in PWC at mild heat stress (WBGT = 18°C) and reductions of 78% in the most extreme conditions (WBGT = 40°C). Of the different heat stress indices available, the heat index was the best predictor of group level PWC (R(2) = 0.96) but can only be applied in shaded conditions. The skin temperature, but not internal/core temperature, was a strong predictor of PWC (R(2) = 0.88), thermal sensation (R(2) = 0.84), and thermal comfort (R(2) = 0.73). The models presented apply to occupational workloads and can be used in climate projection models to predict economic and social consequences of climate change.

Anomalously warm weather and acute care visits in patients with multiple sclerosis: A retrospective study of privately insured individuals in the US

BACKGROUND: As the global climate changes in response to anthropogenic greenhouse gas emissions, weather and temperature are expected to become increasingly variable. Although heat sensitivity is a recognized clinical feature of multiple sclerosis (MS), a chronic demyelinating disorder of the central nervous system, few studies have examined the implications of climate change for patients with this disease. METHODS AND FINDINGS: We conducted a retrospective cohort study of individuals with MS ages 18-64 years in a nationwide United States patient-level commercial and Medicare Advantage claims database from 2003 to 2017. We defined anomalously warm weather as any month in which local average temperatures exceeded the long-term average by ?1.5°C. We estimated the association between anomalously warm weather and MS-related inpatient, outpatient, and emergency department visits using generalized log-linear models. From 75,395,334 individuals, we identified 106,225 with MS. The majority were women (76.6%) aged 36-55 years (59.0%). Anomalously warm weather was associated with increased risk for emergency department visits (risk ratio [RR] = 1.043, 95% CI: 1.025-1.063) and inpatient visits (RR = 1.032, 95% CI: 1.010-1.054). There was limited evidence of an association between anomalously warm weather and MS-related outpatient visits (RR = 1.010, 95% CI: 1.005-1.015). Estimates were similar for men and women, strongest among older individuals, and exhibited substantial variation by season, region, and climate zone. Limitations of the present study include the absence of key individual-level measures of socioeconomic position (i.e., race/ethnicity, occupational status, and housing quality) that may determine where individuals live-and therefore the extent of their exposure to anomalously warm weather-as well as their propensity to seek treatment for neurologic symptoms. CONCLUSIONS: Our findings suggest that as global temperatures rise, individuals with MS may represent a particularly susceptible subpopulation, a finding with implications for both healthcare providers and systems.

A modified physiological strain index for workplace-based assessment of heat strain experienced by agricultural workers

BACKGROUND: As global temperatures rise, increasing numbers of individuals will work in hot environments. Interventions to protect their health are critical, as are reliable methods to measure the physiological strain experienced from heat exposure. The physiological strain index (PSI) is a measure of heat strain that relies on heart rate and core temperature but is challenging to calculate in a real-world occupational setting. METHODS: We modified the PSI for use in field settings where resting temperature and heart rate are not available and used the modified physiological strain index (mPSI) to describe risk factors for high heat strain (mPSI???7) experienced by agricultural workers in Florida during the summers of 2015 through 2017. mPSI was calculated for 221 workers, yielding 465 days of data. RESULTS: A higher heat index (??=?0.185; 95% CI: 0.064, 0.307) and higher levels of physical activity at work (0.033; 95% CI: 0.017, 0.050) were associated with a higher maximum mPSI. More years worked in US agriculture (-0.041; 95% CI: -0.061, -0.020) were protective against a higher maximum mPSI. Out of 23 workdays that a participant experienced a maximum mPSI???7,?22 were also classified as strained by at least one other measure of high heat strain (core temperature [Tc] >38.5°C, sustained heart rate >(180?-?age), and mean heart rate?>?115?bpm). CONCLUSIONS: This study provides critical information on risk factors for elevated heat strain for agricultural workers and suggests a practical approach for using PSI in field-based settings.

Work adaptations insufficient to address growing heat risk for US 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.

Wet bulb globe temperature and recorded occupational injury rates among sugarcane harvesters in southwest Guatemala

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

Using a qualitative phenomenological approach to inform the etiology and prevention of occupational heat-related injuries in Australia

Epidemiological evidence has shown an association between exposure to high temperatures and occupational injuries, an issue gaining importance with environmental change. The aim of this study was to better understand contributing risk factors and preventive actions based on personal experiences. Interviews were conducted with 21 workers from five Australian states using a critical phenomenological approach to capture the lived experiences of participants, whilst exploring contextual factors that surround these experiences. Two case studies are presented: a cerebrovascular injury and injuries among seasonal horticulture workers. Other accounts of heat-related injuries and heat stress are also presented. Risk factors were classified as individual, interpersonal and organizational. In terms of prevention, participants recommended greater awareness of heat risks and peer-support for co-workers. Adding value to current evidence, we have provided new insights into the etiology of the health consequences of workplace heat exposure with workers identifying a range of influencing factors, prevention measures and adaptation strategies. Underpinning the importance of these are future climate change scenarios, suggesting that extended hot seasons will lead to increasing numbers of workers at risk of heat-stress and associated occupational injuries.

The roles of emergency managers and emergency social services directors to support disaster risk reduction in Canada

Emergency managers (EMs) and Emergency Social Services Directors (ESSDs) are essential service providers who fulfill critical roles in disaster risk reduction. Despite being positioned throughout all levels of government, and in the private sector, EMs and ESSDs fulfill roles which occur largely behind the scenes. The purpose of this phenomenological study was to explore the roles of EMs and ESSDs from different regions across Canada. Specifically, we wanted to understand their perceptions of barriers, vulnerabilities and capabilities within the context of their roles. EMs (n = 15) and ESSDs (n = 6) from six Canadian provinces participated in semi-structured telephone interviews. Through content analysis, five themes and one model were generated from the data: 1) Emergency management is not synonymous with first response, 2) Unrealistic expectations for a “side-of-desk” role, 3) Minding the gap between academia and practice with a ‘whole-society’ approach, 4) Personal preparedness tends to be weak, 5) Behind the scenes roles can have mental health implications. We present a model, based on these themes, which makes explicit the occupational risks that EMs and ESSDs may encounter in carrying out the skills, tasks, and roles of their jobs. Identification of occupational risks is a first step towards reducing vulnerabilities and supporting capability. This is particularly relevant in our current society as increased demands placed on these professionals coincides with the increasing frequency and severity of natural disasters due to climate change and the emergence of the world wide COVID-19 pandemic.

The estimated burden of scrub typhus in Thailand from national surveillance data (2003-2018)

BACKGROUND: Scrub typhus is a major cause of acute febrile illness in the tropics and is endemic over large areas of the Asia Pacific region. The national and global burden of scrub typhus remains unclear due to limited data and difficulties surrounding diagnosis. METHODOLOGY/PRINCIPAL FINDINGS: Scrub typhus reporting data from 2003-2018 were collected from the Thai national disease surveillance system. Additional information including the district, sub-district and village of residence, population, geographical, meteorological and satellite imagery data were also collected for Chiangrai, the province with the highest number of reported cases from 2003-2018. From 2003-2018, 103,345 cases of scrub typhus were reported with the number of reported cases increasing substantially over the observed period. There were more men than women, with agricultural workers the main occupational group affected. The majority of cases occurred in the 15-64 year old age group (72,144/99,543, 72%). Disease burden was greatest in the northern region, accounting for 53% of the total reported cases per year (mean). In the northern region, five provinces-Chiangrai, Chiangmai, Tak, Nan and Mae Hong Son-accounted for 84% (46,927/55,872) of the total cases from the northern region or 45% (46,927/103,345) of cases nationally. The majority of cases occurred from June to November but seasonality was less marked in the southern region. In Chiangrai province, elevation, rainfall, temperature, population size, habitat complexity and diversity of land cover contributed to scrub typhus incidence. INTERPRETATION: The burden of scrub typhus in Thailand is high with disease incidence rising significantly over the last two decades. However, disease burden is not uniform with northern provinces particularly affected. Agricultural activity along with geographical, meteorological and land cover factors are likely to contribute to disease incidence. Our report, along with existing epidemiological data, suggests that scrub typhus is the most clinically important rickettsial disease globally.

Steps towards comprehensive heat communication in the frame of a heat health warning system in Slovenia

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

Solar ultraviolet radiation exposure among outdoor workers in Alberta, Canada

BACKGROUND: Outdoor workers are at risk of prolonged and high solar ultraviolet radiation (UVR) exposure, which is known to cause skin cancer. The objectives of this study were to characterize the UVR exposure levels of outdoor workers in Alberta, Canada, and to investigate what factors may contribute to their exposure. METHODS: This study collected objective solar UVR measurements from outdoor workers primarily in Alberta during the summer of 2019. Workers were recruited via the management or health and safety teams from building trade unions and employers. Calibrated, electronic UVR dosimeters were worn by workers on their hardhats, wrists, or lapels for five working days. Data on workers’ demographics, jobs, sun protection behaviors, and personal risk factors were collected using questionnaires, and meteorological data for each sampling day were noted. Mean daily exposure measured as the standard erythemal dose (SED) was calculated and compared to the international occupational exposure limit guideline (1.3 SED). Marginal models were developed to evaluate potential determinants of occupational solar UVR exposure. RESULTS: In total, 883 measurements were collected from 179 workers. On average, workerswere exposed to 1.93 SED (range: 0.03-16.63 SED) per day. Just under half of workers (45%) were exposed to levels exceeding the international exposure limit guideline. In the bivariate analyses, landscape and maintenance workers, as well as trade and recreation workers, had the highest levels of exposure (average: 2.64 and 1.84 SED, respectively). Regional variations were observed, with the “other” cities/regions (outside of Edmonton and Calgary) experiencing the highest average levels (2.60 SED). Workers who placed the dosimeters on their hardhats experienced higher levels compared to the other groups. Exposure was highest on sunny and mixed days. Education, trade, city, dosimeter placement, forecast, hair colour, and number of hours outside were included in the final exposure model, of which trade, dosimeter placement, forecast, and number of hours outside at work were statistically significant. CONCLUSIONS: Exposure to elevated solar UVR levels is common among outdoor workers in Alberta. The study findings can help inform future monitoring studies and exposure reduction initiatives aimed at protecting workers.

Risk factors for occupational heat-related illness among California workers, 2000-2017

BACKGROUND: As climate change increases global temperatures, heat-related morbidity and mortality are projected to rise. Outdoor workers and those who perform exertional tasks are particularly susceptible to heat-related illness (HRI). Using workers’ compensation data, we aimed to describe rates of occupational HRI in California and identify demographic and occupational risk factors to inform prevention efforts. METHODS: We identified HRI cases during 2000-2017 in the California Workers’ Compensation Information System (WCIS) using International Classification of Diseases Ninth and Tenth Revision codes, WCIS nature and cause of injury codes, and HRI keywords. We assigned industry and occupation codes using the NIOSH Industry and Occupation Computerized Coding System (NIOCCS). We calculated HRI rates by sex, age group, year, county, industry, and occupation, and estimated confidence intervals using generalized linear models. RESULTS: We identified 15,996 HRI cases during 2000-2017 (6.0 cases/100,000 workers). Workers aged 16-24 years had the highest HRI rate (7.6) among age groups, and men (8.1) had a higher rate than women (3.5). Industry sectors with the highest HRI rates were Agriculture, Farming, Fishing, and Forestry (38.6), and Public Administration (35.3). Occupational groups with the highest HRI rates were Protective Services (56.6) and Farming, Fishing, and Forestry (36.6). Firefighters had the highest HRI rate (389.6) among individual occupations. CONCLUSIONS: Workers in certain demographic and occupational groups are particularly susceptible to HRI. Additional prevention efforts, including outreach and enforcement targeting high-risk groups, are needed to reduce occupational HRI. Workers’ compensation data can provide timely information about temporal trends and risk factors for HRI.

Risk of kidney injury among construction workers exposed to heat stress: A longitudinal study from Saudi Arabia

Saudi Arabia (SA) is one of the hottest countries in the world. This study was conducted to assess the impact of summer heat stress in Southeastern SA on short-term kidney injury (KI) among building construction workers and to identify relevant risk factors. Measurements of urinary albumin-creatinine ratio (ACR), height, weight, hydration, symptoms, daily work and behavioral factors were collected in June and September of 2016 from a cohort of construction workers (n = 65) in Al-Ahsa Province, SA. KI was defined as ACR ?30 mg/g. Multivariate linear regression analysis was used to assess factors related to cross-summer changes in ACR. A significant increase in ACR occurred among most workers over the study period; incidence of KI was 18%. Risk factors associated with an increased ACR included dehydration, short sleep, and obesity. The findings suggest that exposure to summer heat may lead to the development of KI among construction workers in this region. Adequate hydration and promotion of healthy habits among workers may help reduce the risk of KI. A reduction in work hours may be the most effective intervention because this action can reduce heat exposure and improve sleep quality.

Perception and knowledge of the effect of climate change on infectious diseases within the general public: A multinational cross-sectional survey-based study

Infectious diseases are emerging and re-emerging due to climate change. Understanding how climate variability affects the transmission of infectious diseases is important for both researchers and the general public. Yet, the widespread knowledge of the general public on this matter is unknown, and quantitative research is still lacking. A survey was designed to assess the knowledge and perception of 1) infectious diseases, 2) climate change and 3) the effect of climate change on infectious diseases. Participants were recruited via convenience sampling, and an anonymous cross-sectional survey with informed consent was distributed to each participant. Descriptive and inferential analyses were performed primarily focusing on the occupational background as well as nationality of participants. A total of 458 individuals participated in this study, and most participants were originally from Myanmar, the Netherlands, Spain, United Kingdom and the United States. Almost half (44%) had a background in natural sciences and had a higher level of knowledge on infectious diseases compared to participants with non-science background (mean score of 12.5 and 11.2 out of 20, respectively). The knowledge of the effect of climate change on infectious diseases was also significantly different between participants with and without a background in natural sciences (13.1 and 11.8 out of 20, respectively). The level of knowledge on various topics was highly correlated with nationality but not associated with age. The general population demonstrated a high awareness and strong knowledge of climate change regardless of their background in natural sciences. This study exposes a knowledge gap in the general public regarding the effect of climate change on infectious diseases, and highlights that different levels of knowledge are observed in groups with differing occupations and nationalities. These results may help to develop awareness interventions for the general public.

Occupational heat stress induced health impacts: A cross-sectional study from South Indian working population

Rising temperature and heat stress risks in the changing climate scenario might potentially affect workers globally, especially the ones with strenuous workload in tropical settings. We used a cross-sectional study design to profile the heat exposures of similar to 1900 workers from eight industrial sectors using a QuesTemp Wet Bulb Globe Temperature (WBGT) monitor, quantified select heat-strain indicators viz., rise in Core Body Temperature, Sweat Rate, and Urine Specific Gravity and evaluated the perceived health impacts of heat stress using a structured questionnaire. Heat exposures (average WBGT: 30.1 +/- 2.6 degrees C) exceeded the Threshold Limit Value for 67% workers and was positively associated with the rise in Core Body Temperature >1 degrees C in 13% and elevated Urine Specific Gravity >1.020 in 9% workers. Heat-related health concerns were reported by 86% workers, and the heat-exposed workers had 2.3 times higher odds of adverse health outcomes compared to unexposed workers (p < 0.0001). Exposure to higher WBGT and adverse renal health among salt-pan workers were significantly associated (p = 0.004), and steel workers had 9% prevalence of kidney stones. Evidence presented clearly points to heat stress as a health and productivity risk factor that could have long-term and irreversible health impacts. In-depth assessments are urgently needed to develop scientifically sound preventative interventions and protective labor policies to avert the adverse occupational health and productivity consequences for millions of workers globally, thereby aiding poverty reduction.

Knowledge, attitude and practices of nutrition workers on climate change in Laguna, Batangas and Cavite Provinces, Philippines

Climate Change and malnutrition are two global phenomena that affect millions of population groups. The Philippines is considered one of the most vulnerable countries for extreme natural events and at the same time has a high prevalence of underweight (19.0%) and stunting (28.8%) in 2019 among under five children. The nutritionally vulnerable groups are children, pregnant and lactating women, and elderly. These groups are also greatly affected by climate change-related events then the malnutrition situation is exacerbated. The local nutrition workers are the frontline workers who plan, implement, and monitor nutrition programs. Mainstreaming climate change in the local nutrition planning processes will be facilitated if nutrition workers are knowledgeable. This study aimed to determine the current knowledge, attitudes and practices of nutrition workers and perceptions on how to mainstream climate change in the nutrition sector’s local planning system. A survey was conducted among local nutrition workers. Ninety-five percent of nutrition workers were highly knowledgeable, 86% were with high level of attitudes and 50% were exhibiting moderate level of practices related to climate change. The gaps can be narrowed by capacity building and possibly this can lead to mainstreaming climate change in the local nutrition planning process.

Heat-related injuries in Australian workplaces: Perspectives from health and safety representatives

Introduction: Hot weather poses occupational health and safety concerns for people working in hot environments. It is known that work-related injuries increase during hot weather, yet there is an incomplete understanding of the underlying factors. Methods: A national online survey was conducted in Australia among health and safety representatives (HSRs) to better understand factors contributing to heat-related injuries in workplaces. Risk factors and preventive measures associated with reported injuries were identified using log-poisson regression models. Results: In total, 222 HSRs completed the survey. Overall, 43% reported that injuries or incidents caused by hot/very humid weather occur sometimes or often in their workplace. Factors found to be associated with reported heat-related injuries included ‘the wearing of personal protective equipment (PPE)’ which can hinder the loss of body heat, and ‘inadequate resources and facilities’. ‘Piece-rate workers’ and ‘new workers’ were identified as being at high risk. The most frequently adopted preventive measures for outdoor and indoor workers were the provision of PPE (despite some identified issues) and access to cool drinking water. HSRs reported that less injuries occurred in hot weather among outdoor workers if work was rescheduled to cooler times and shade was provided; and in indoor environments where there was adequate ventilation, heat sources were shielded and workers were able to self-pace. Conclusion: Organisational issues, workplace hazards, personal factors and preventive measures, are all determinants of heat-related injuries in Australian workplaces. Wider adoption of identified prevention measures could reduce the incidence of heat-related injuries in outdoor and indoor workplaces.

Heart rate variability in older men on the day following prolonged work in the heat

Susceptibility to heat illness during physically demanding work in hot environments is greater on the second of two consecutive workdays. While it has been demonstrated that heat storage is exacerbated on the second compared to first workday in older workers (50-65?yr), the effects on heart rate variability (HRV), an established surrogate of cardiac autonomic modulation, remain unclear. This study evaluated HRV in older workers on the day following prolonged work in the heat. Electrocardiogram was recorded in nine older (53-64?yr) males at rest, during three 30-min bouts of semi-recumbent cycling at fixed rates of metabolic heat production (150, 200, 250?W/m(2)), each separated by 15-min recovery. Experiments were conducted in hot-dry conditions (40?°C, 20% relative humidity), immediately prior to (Day 1), and on the day following (Day 2), a prolonged work simulation (?7.5?hr) involving moderate intensity intermittent exercise in hot-dry conditions (38?°C, 34% relative humidity). Core temperature, as well as time, frequency, and nonlinear HRV indices were derived for analysis during rest, the final 5-min of exercise at the highest heat production and recovery. The change in core temperature at the end of work (mean?±SD) was significantly greater on Day 2 (1.0?°C?±0.3) relative to Day 1 (0.8?°C?±0.2; p??0.05). Prolonged work in the heat did not modulate next-day heart rhythms, as reflected by HRV, despite augmented core temperature. While HRV can reflect physiological aspects of cardiac autonomic stressors, these findings indicate it does not provide a means to identify exacerbated heat strain in older workers over consecutive work shifts in the heat.

Heart rate variability in older workers during work under the Threshold Limit Values for heat exposure

BACKGROUND: The Threshold Limit Values (TLV) of the American Conference of Governmental and Industrial Hygienists indicate the levels of heat stress that all workers may be repeatedly exposed to without adverse health effects. In this study, we evaluated heart rate variability (HRV) during moderate-to-heavy work performed continuously or according to different TLV work-rest (WR) allocations in healthy physically active older workers. METHODS: Nine healthy older (58?±?5?years) males performed three different 120-minute conditions in accordance with TLV guidelines for moderate-to-heavy intensity work (360?W fixed rate of heat production) in different wet-bulb globe temperatures (WBGT): continuous cycling at 28°C WBGT (CON), as well as intermitted work performed at WR of 3:1 in 29°C WBGT (WR3:1), and at WR of 1:1 at 30°C (WR1:1). Rectal temperature and HRV (3-lead electrocardiogram [ECG]) were assessed throughout. RESULTS: Coefficient of Variation, Poincaré SD2, and Shannon Entropy were decreased during the CON compared with the WR3:1 when core temperature exceeded 38°C and after 1?hour of continuous work (P?

Heat exposure from tropical deforestation decreases cognitive performance of rural workers: An experimental study

The effect of tropical deforestation on heat exposure and subsequent human health outcomes remains understudied, especially among an increasingly vulnerable population-healthy, adult subsistence workers in rural industrializing tropical countries. We report on a field experiment that estimated the short-term effects of heat exposure from deforestation on cognitive performance. We randomly assigned rural, adult subsistence workers in East Kalimantan, Indonesia to deforested or forested settings, and standard or high incentive piece rate payments. Participants worked in forested or deforested settings for up to 90 min, where ambient and black globe temperatures in deforested areas were, on average, 2.1 degrees C and 10 degrees C higher. After completing the experimental task, participants were asked to take a validated general cognitive assessment test (CAT) and episodic memory test (EMT). We found participants in deforested settings had statistically significant lower scores on both CAT and EMT. Effects were largely driven by heat effects on male participants and those working after noon. Our results highlight how heat exposure from tropical deforestation may lead to declines in cognitive performance even in favorable work settings. Policymakers should consider how land use planning that takes into account the cooling services of trees can play a significant role in increasing resilience to heat from climate and land use change in the tropics.

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.

Heat stress and thermal perception amongst healthcare workers during the COVID-19 pandemic in India and Singapore

The need for healthcare workers (HCWs) to wear personal protective equipment (PPE) during the coronavirus disease 2019 (COVID-19) pandemic heightens their risk of thermal stress. We assessed the knowledge, attitudes, and practices of HCWs from India and Singapore regarding PPE usage and heat stress when performing treatment and care activities. One hundred sixty-five HCWs from India (n = 110) and Singapore (n = 55) participated in a survey. Thirty-seven HCWs from Singapore provided thermal comfort ratings before and after ice slurry ingestion. Differences in responses between India and Singapore HCWs were compared. A p-value cut-off of 0.05 depicted statistical significance. Median wet-bulb globe temperature was higher in India (30.2 °C (interquartile range [IQR] 29.1-31.8 °C)) than in Singapore (22.0 °C (IQR 18.8-24.8 °C)) (p < 0.001). Respondents from both countries reported thirst (n = 144, 87%), excessive sweating (n = 145, 88%), exhaustion (n = 128, 78%), and desire to go to comfort zones (n = 136, 84%). In Singapore, reports of air-conditioning at worksites (n = 34, 62%), dedicated rest area availability (n = 55, 100%), and PPE removal during breaks (n = 54, 98.2%) were higher than in India (n = 27, 25%; n = 46, 42%; and n = 66, 60%, respectively) (p < 0.001). Median thermal comfort rating improved from 2 (IQR 1-2) to 0 (IQR 0-1) after ice slurry ingestion in Singapore (p < 0.001). HCWs are cognizant of the effects of heat stress but might not adopt best practices due to various constraints. Thermal stress management is better in Singapore than in India. Ice slurry ingestion is shown to be practical and effective in promoting thermal comfort. Adverse effects of heat stress on productivity and judgment of HCWs warrant further investigation.

Heat stress monitoring based on heart rate measurements

Currently, occupational heat exposure is usually measured using environmental variables such as the wet bulb globe temperature index. The costs of heat stress monitoring include the acquisition of specialized equipment and the recruitment of trained personnel. In rapidly changing environments, such as outdoor settings, these assessments must be conducted on a daily basis. The wet bulb globe temperature index has been criticized as a measure of heat stress for its failure to account for individual differences in susceptibility to heat stress, age, body mass index, physical fitness, clothing, illnesses and use of alcohol or drugs. The objective of this study was to assess the relationship between heart rate and body temperature in heat-exposed workers to determine whether heart rate can be used to monitor and prevent heat stress and physiological strain. This study was based on previous literature as well as physiological and environmental data collected from 10 individuals engaged in heavy physical labor. Heart rate, which has been recommended by the American Conference of Governmental Industrial Hygienists (ACGIH) as a possible measure of heat stress, follows a similar trend to body temperature with a slight temporal delay. Heart rate monitors with alarm systems could be developed to notify workers when to slow down their activities or take a break for thermal recovery, thereby contributing to the prevention of heat-related illness.

Heat stress, physiological response, and heat-related symptoms among Thai Sugarcane workers

Prolonged or intense exposure to heat can lead to a range of health effects. This study investigated heat exposure and heat-related symptoms which sugarcane workers (90 sugarcane cutters and 93 factory workers) experienced during a harvesting season in Thailand. During the hottest month of harvesting season, wet bulb globe temperature was collected in the work environment, and workloads observed, to assess heat stress. Urine samples for dehydration test, blood pressure, heart rate, and body temperature were measured pre- and post-shift to measure heat strain. Fluid intake and heat-related symptoms which subjects had experienced during the harvesting season were gathered via interviews at the end of the season. From the results, sugarcane cutters showed high risk for heat stress and strain, unlike factory workers who had low risk based on the American Conference of Governmental Industrial Hygiene (ACGIH) threshold limit values (TLVs) for heat stress. Dehydration was observed among sugarcane cutters and significant physiological changes including heart rate, body temperature, and systolic blood pressure occurred across the work shift. Significantly more sugarcane cutters reported experiencing heat-related symptoms including weakness/fatigue, heavy sweating, headache, rash, muscle cramp, dry mouth, dizziness, fever, dry/cracking skin, and swelling, compared to sugarcane factory workers. We conclude that the heat stress experienced by sugarcane cutters working in extremely hot environments, with high workloads, is associated with acute health effects. Preventive and control measures for heat stress are needed to reduce the risk of heat strain.

Economic impacts of climate change and air pollution in China through health and labor supply perspective: An integrated assessment model analysis

An energy supply dominated by the use of fossil fuels causes both climate change and air pollution, which have negative impacts on human capital via both health and productivity. In addition, different people are affected differently because of factors such as age, gender and education level. To enhance the understanding of the benefits of low carbon transition from the labor supply perspective and help to identify strategies of collaborative control for CO2 and local air pollutants in China, an integrated assessment model linking the air quality module and the health impact module with a disaggregated labor sector computable general equilibrium (CGE) economic system is developed and applied in this study. Results show some key findings. First, renewable energy development and carbon capture and storage (CCS) technologies will contribute significantly to GDP in terms of their impact on air quality improvement by 0.99% and 0.54%, respectively, in 2050. Second, due to differences in labor composition, air pollution has, and will continue to have, the greatest impact on sectors with a higher proportion of male and lower-educated workers – such as the coal sector, and it will have the least impact on sectors with a higher proportion of female and higher-educated workers – such as the public administration sector. Third, the different impacts of sector output will increase economic inequality.

Climate change impacts on heat stress in Brazil – Past, present, and future implications for occupational heat exposure

Climate change has caused an increased occurrence of heat waves. As a result of rising temperatures, implications for health and the environment have been more frequently reported. Outdoor labour activities deserve special attention, as is the case with agricultural and construction workers exposed to extreme weather conditions, including intense heat. This paper presents an overview of heat stress conditions in Brazil from 1961 to 2010. It also presents computer-simulated projections of heat stress conditions up to the late 21st century. The proposed climate analysis drew on historical weather data obtained from national weather stations and on reanalysis data, in addition to future projections with the ETA (regarding the model’s unique vertical coordinate) regional forecast model. The projections took into consideration two Representative Concentration Pathways (RCP)-the 4.5 and 8.5 climate scenarios, namely, moderate and high emissions scenarios, respectively. Heat stress was inferred based on the wet-bulb globe temperature (WBGT) index. The results of this climate analysis show that Brazilian outdoor workers have been exposed to an increasing level of heat stress. These results suggest that future changes in the regional climate may increase the probability of heat stress situations in the next decades, with expectations of WBGT values greater than those observed in the baseline period (1961-1990). In terms of spatial distribution, the Brazilian western and northern regions experienced more critical heat stress conditions with higher WBGT values. As a response to the increased frequency trends of hot periods in tropical areas, urgent measures should be taken to review public policies in Brazil. Such policies should include actions towards better working conditions, technological development to improve outdoor labour activities, and employment legislation reviews to mitigate heat impacts on occupational health.

Cooling interventions among agricultural workers: A pilot study

BACKGROUND: Adverse health effects among agricultural workers due to chronic heat exposure have been characterized in the literature as not only due to high ambient temperatures but also due to intensive manual labor in hot and humid conditions. The aim of this study was to use biomonitoring equipment to examine the effectiveness of selected cooling devices at preventing agricultural workers from exceeding the core body temperature threshold of 38.0°C (Tc38) and attenuating heat-related illness symptoms. METHODS: A convenience sample of 84 agricultural workers in Florida was randomized to one of four groups: (a) no intervention, clothing as usual; (b) cooling bandana; (c) cooling vest; and (d) both the cooling bandana and cooling vest. Biomonitoring equipment worn by the participants included core body temperature monitor and an accelerometer to capture physical activity. FINDINGS: A total of 78 agricultural workers completed one intervention workday trial. Compared with the control group, the bandana group had lower odds of exceeding Tc38 (odds ratio [OR] = 0.7, 90% confidence interval [CI] = [0.2, 3.2]) and the vest group had higher odds of exceeding Tc38 (OR = 1.8, 90% CI = [0.4, 7.9]). The simultaneous use of cooling vest and bandana showed an effect little different from the control group (OR = 1.3, 90% CI = [0.3, 5.6]). CONCLUSION/APPLICATION TO PRACTICE: This is the first field-based study to examine cooling intervention among agricultural workers in the United States using biomonitoring equipment. This study found that using a bandana while working in a hot agricultural environment has the potential to be protective against exceeding the recommended Tc38 threshold.

Evaluating the effectiveness of labor protection policy on occupational injuries caused by extreme heat in a large subtropical city of China

Heat Stress and Thermal Perception amongst Healthcare Workers during the COVID-19 Pandemic in India and Singapore

Barriers to occupational heat stress risk adaptation of mining workers in Ghana

Air Temperatures and Occupational Injuries in the Construction Industries: A Report From Northern Italy (2000-2013)

Environmental and occupational risk factors associated with chronic kidney disease of unknown Etiology in West Javanese rice farmers, Indonesia

Effects of a psychological first aid simulated training for pregnant flood victims on disaster relief worker’s knowledge, competence, and self-efficacy

Developing a new index for evaluating physiological safety in high temperature weather based on entropy-TOPSIS model – A case of sanitation worker

Community-based maternal health workers’ perspectives on heat risk and safety: A pilot qualitative study

Cold-related symptoms and performance degradation among Thai poultry industry workers with reference to vulnerable groups: A cross-sectional study

Climate change in Alaska: Social workers’ attitudes, beliefs, and experiences

Chronic kidney disease of non-traditional origin in Mesoamerica: A disease primarily driven by occupational heat stress

Assessment of thermal exposure level among construction workers in UAE using WBGT, HSI and TWL indices

An occupational heat stress and hydration assessment of agricultural workers in north Mexico

A field evaluation of construction workers’ activity, hydration status, and heat strain in the extreme summer heat of Saudi Arabia

Heat-related knowledge, perceptions, and barriers among oil spill cleanup responders

Workplace Heat: An Increasing Threat to Occupational Health and Productivity

The nexus between social impacts and adaptation strategies of workers to occupational heat stress: A conceptual framework

The heat exposure risk to outdoor workers in Brazil

Solar energy industry workers under climate change: A risk assessment of the level of heat stress experienced by a worker based on measured data

Risk factors and mechanisms underlying cross-shift decline in kidney function in Guatemalan sugarcane workers

Physical activity and work activities in Florida agricultural workers

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

Modification of the predicted heat strain (PHS) model in predicting human thermal responses for Chinese workers in hot environments

Interaction between indoor occupational heat stress and environmental temperature elevations during heat waves

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

Impacts of climate change on outdoor workers and their safety: Some research priorities

Heat waves occurrence and outdoor workers’ self-assessment of heat stress in Slovenia and Greece

Heat-related deaths among construction workers in the United States

Heat-related illness in Midwestern Hispanic farmworkers: A descriptive analysis of hydration status and reported symptoms

Heat stress impacts on cardiac mortality in Nepali migrant workers in Qatar

Heat stress perception among native and migrant workers in Italian industries-Case studies from the construction and agricultural sectors

Fanning as an alternative to air conditioning – A sustainable solution for reducing indoor occupational heat stress

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

Estimating personal ambient temperature in moderately cold environments for occupationally exposed populations

Estimating occupational heat exposure from personal sampling of public works employees in Birmingham, Alabama

Elevated core temperature in Florida fernery workers: Results of a pilot study

Effects of hydration practices on the severity of heat-related illness among municipal workers during a heat wave phenomenon

Attending to pesticide exposure and heat illness among farmworkers: Results from an attention placebo-controlled evaluation design

Assessment of heat stress exposure among construction workers in the hot desert climate of Saudi Arabia

An occupational heat-health warning system for Europe: The HEAT-SHIELD platform

A case-crossover study of heat exposure and injury risk among outdoor construction workers in Washington State

Heat-related Training and Educational Material Needs among Oil Spill Cleanup Responders

Without warning: Worker deaths from heat 2014-2016

Workers’ health and productivity under occupational heat strain: a systematic review and meta-analysis

The impact of heat and impaired kidney function on productivity of Guatemalan sugarcane workers

The effect of hot days on occupational heat stress in the manufacturing industry: Implications for workers’ well-being and productivity

Risk factors for heat-related illness in U.S. workers: An OSHA case series

Perceptions of climate change and occupational heat stress risks and adaptation strategies of mining workers in Ghana

Occupational heat exposure among municipal workers

Limited role of working time shift in offsetting the increasing occupational-health cost of heat exposure

Impacts of heat exposure on workers’ health and performance at steel plant in Turkey

Impact of environmental conditions on workers’ productivity and health

Hydration status, kidney function, and kidney injury in Florida agricultural workers

I think the temperature was 110 degrees!: Work safety discussions among Hispanic farmworkers

Heat strain and hydration of Japanese construction workers during work in summer

Health effects of seasonal variation in cardiovascular hemodynamics among workers in forest environments

Evaluation of occupational exposure limits for heat stress in outdoor workers – United States, 2011-2016

Effects of occupational heat exposure on traffic police workers in Ahmedabad, Gujarat

Climate change and occupational heat stress risks and adaptation strategies of mining workers: Perspectives of supervisors and other stakeholders in Ghana

Climate change and rural workers thermal comfort: Historical and future impacts

Classification of heat-related illness symptoms among Florida farmworkers

Assessment of occupational exposure to heat stress and solar ultraviolet radiation among groundskeepers in an eastern North Carolina university setting

Air temperature exposure and agricultural occupational injuries in the autonomous province of Trento (2000-2013, north-eastern Italy)

Actual and simulated weather data to evaluate wet bulb globe temperature and heat index as alerts for occupational heat-related illness

Time-motion analysis as a novel approach for evaluating the impact of environmental heat exposure on labor loss in agriculture workers

Temporal variation in confirmed diagnosis of fever-related malarial cases among children under-5 years by community health workers and in health facilities between years 2013 and 2015 in Siaya County, Kenya

Recruitment, methods, and descriptive results of a physiologic assessment of Latino farmworkers: The California heat illness prevention study

Occupational heat stress and kidney health: From farms to factories

Heat strain, volume depletion and kidney function in California agricultural workers

Heat exposure in Central Florida fernery workers: Results of a feasibility study

Factors affecting heat-related diseases in outdoor workers exposed to extreme heat

Cost of preventing workplace heat-related illness through worker breaks and the benefit of climate-change mitigation

An Overview of Occupational Risks From Climate Change

Workers’ perceptions of climate change related extreme heat exposure in South Australia: A cross-sectional survey

Working smart: An exploration of council workers’ experiences and perceptions of heat in Adelaide, South Australia

The influence of occupational heat exposure on cognitive performance and blood level of stress hormones: A field study report

The effects of heat stress on a number of hematological parameters and levels of thyroid hormones in foundry workers

Impact of climate conditions on occupational health and related economic losses: A new feature of global and urban health in the context of climate change

Heat stress and inadequate sanitary facilities at workplaces – an occupational health concern for women?

Determination of air enthalpy based on meteorological data as an indicator for heat stress assessment in occupational outdoor environments, a field study in Iran

A case-crossover study of heat exposure and injury risk in outdoor agricultural workers

Risk factors for heat-related illness in Washington crop workers

Occupational heat-related illness emergency department visits and inpatient hospitalizations in the southeast region, 2007-2011

Optimal work pattern for construction workers in hot weather: A case study in Hong Kong

Outdoor occupational environments and heat stress in Iran

Perceived heat stress and health effects on construction workers

Heat illness among North Carolina Latino farmworkers

Heat index and adjusted temperature as surrogates for wet bulb globe temperature to screen for occupational heat stress

Extreme heat and occupational heat illnesses in South Australia, 2001-2010

Climate change induced occupational stress and reported morbidity among cocoa farmers in South-Western Nigeria

Characterizing occupational heat-related mortality in the United States, 2000-2010: An analysis using the Census of Fatal Occupational Injuries database

The use of Bayesian inference to inform the surveillance of temperature-related occupational morbidity in Ontario, Canada, 2004-2010

The impact of heatwaves on workers’ health and safety in Adelaide, South Australia

Summer outdoor temperature and occupational heat-related illnesses in Quebec (Canada)

Occupational heat stress and associated productivity loss estimation using the PHS model (ISO 7933): A case study from workplaces in Chennai, India

Incorporating occupational risk in heat stress vulnerability mapping

Human body exergy consumption and thermal comfort of an office worker in typical and extreme weather conditions in Finland

Heat-related illness among Oregon farmworkers

Exposure to ambient heat and urolithiasis among outdoor workers in Guangzhou, China

Effects of occupational heat exposure on female brick workers in West Bengal, India

Climate change and occupational health: A South African perspective

Climate change, workplace heat exposure, and occupational health and productivity in Central America

Safety in the Heat: A comprehensive program for prevention of heat illness among workers in Abu Dhabi, United Arab Emirates

The association between overall health, psychological distress, and occupational heat stress among a large national cohort of 40,913 Thai workers

Symptoms of heat illness among Latino farm workers in North Carolina

Seasonal climate change and the indoor city worker

Health impact of climate change on occupational health and productivity in Thailand

Heat exposure in sugarcane workers in Costa Rica during the non-harvest season

Climate change and occupational heat stress: Methods for assessment

The ‘Hothaps’ programme for assessing climate change impacts on occupational health and productivity: An invitation to carry out field studies

Caring for those who care: The role of the occupational health nurse in disasters

Heat-related deaths among crop workers – United States, 1992-2006

Deploying and using volunteer health practitioners in response to emergencies: Proposed uniform state legislation provides liability protections and workers’ compensation coverage

Disaster preparedness: Occupational and environmental health professionals’ response to Hurricanes Katrina and Rita

Protecting workers: occupational safety and health in response to the covid-19 pandemic

Workplace Safety and Health Guidelines: Managing Heatstress in the Workplace

Farmworkers at Risk: The Growing Dangers of Pesticides and Heat

On the Frontlines: Climate Change Threatens the Health of America’s Workers

An initial estimate of costs and benefits of a water, rest and shade intervention

Exertional Heat Illness: A Clinical and Evidence-Based Guide

Heat in the Workplace: Dialogue Outcome Brief

Working on a Warmer Planet: The effect of heat stress on productivity and decent work

Healthy environments for healthier populations: Why do they matter, and what can we do?

Guía para la gestión de la prevención de riesgos laborales por exposición al calor

1st Meeting of ICOH SCTF (2018-2021) Meeting on the occupational-health and Productivity Impacts of Workplace Heat in Relation to global and Local Climate Change

Assessment of Occupational Heat Strain and Mitigation Strategies in Qatar

Estate sicura – Caldo e lavoro: Guida per i lavoratori

Occupational Exposure to Heat and Hot Environments: Criteria for a Recommended Standard

Climate Change and Labour: Impacts of Heat in the Workplace

Climate change vulnerability assessment: a report assessing how climate change will impact worker health and how to prepare for these impacts

Extreme Heat Events Guidelines: Technical guide for health care workers

Occupational and Environmental Cancer: Recognition and Prevention

Heat in the Workplace

Posters on Heat Waves 2020

Infographic: Working in the Heat

Infographic: Preserving Productivity in Hot Environments

Heat Affects your Health and Productivity

Heat Injuries are Occupational Injuries

Protecting Outdoor Workers from Heat Illness

Heat Safety Tool