Physiological responses and manual performance in humans following repeated exposure to severe cold at night

Safety and health risks for workers exposed to cold thermal environments: A frozen food processing industry perspective

BACKGROUND

Environmental temperatures in the fresh food industry vary from 0°C to 10°C, and go below -20°C for the frozen food industry, representing risk for the health and safety of workers involved.

OBJECTIVE

The aim of this work was to evaluate the cold thermal stress risks for workers working in a frozen food industry.

METHODS

A total of 27 acclimatized workers (13 male and 14 female) participated in a study which was conducted during 11 working days. The thermal sensation questionnaire and the cold work health questionnaire (CWHQ) were applied to all participants. Additionally, 4 workers were chosen to be fully monitored with a thermometer telemetry capsule for measuring the intra-abdominal temperature and 8 skin temperature sensors.

RESULTS

The lowest recorded hand temperature was 14.09°C, lowest forehead 18.55°C, mean skin temperature had variations of 1.10 to 3.20°C along the working period. Highest and most frequent fluctuations were found in the hand and forehead skin temperatures, small changes were found in mean skin temperature.

CONCLUSIONS

Answers to the CWHQ increase concern on clinical forms of "a frigore", and in two cases the mean body temperature decreased below 35.0°C, which is defined in the current literature as a mild form of hypothermia.

Human physiological responses of exposure to extremely cold environments

Extremely cold events have occurred more frequently in the past few years. People exposed to extremely cold exposure could suffer the threats of human health and safety like cold stress and injury. This study aims to investigate human physiological responses of exposure to extremely cold environments and the moment of temperature step. The experiments of 12 subjects exposed to three different cold exposure conditions (-5 °C, -10 °C, -15 °C) were carried out in a climate chamber. Most critical physiological parameters, including the core temperature, local skin temperature, blood pressure, heart rate, respiration rate and blood oxygen saturation, were measured to evaluate human physiological responses. In the particular short term study, the results show that the local skin temperature and blood pressure are the most significant indexes for evaluating the risk of cold strain in extremely cold environment. The finger temperature is a critical index of hand and finger flexibility, and it will lead to serious injuries and reduced manual performance when exposed to below -5 °C for more than 20 min. The high physiological strain at the very beginning moment of cold exposure can significantly affect the ability to make correct judgment and action, and it is suggested that the personnel adapt for 3 min after entering into the extremely cold environment to stabilize physiological parameters and thus enhancing the safety and occupational performance. The experimental data of this study is also of great significance for the development and validation of thermophysiological models.

Skin temperature, sleep, and vigilance

A large number of studies have shown a close association between the 24-hour rhythms in core body temperature and sleep propensity. More recently, studies have have begun to elucidate an intriguing association of sleep with skin temperature as well. The present chapter addresses the association of sleep and alertness with skin temperature. It discusses whether the association could reflect common underlying drivers of both sleep propensity and skin vasodilation; whether it could reflect efferents of sleep-regulating brain circuits to thermoregulatory circuits; and whether skin temperature could provide afferent input to sleep-regulating brain circuits. Sleep regulation and concomitant changes in skin temperature are systematically discussed and three parallel factors suggested: a circadian clock mechanism, a homeostatic hourglass mechanism, and a third set of sleep-permissive and wake-promoting factors that gate the effectiveness of signals from the clock and hourglass in the actual induction of sleep or maintenance of alert wakefulness. The chapter moreover discusses how the association between skin temperature and arousal can change with sleep deprivation and insomnia. Finally it addresses whether the promising laboratory findings on the effects of skin temperature manipulations on vigilance can be applied to improve sleep in everyday life.

Perspectives on the relevance of the circadian time structure to workplace threshold limit values and employee biological monitoring

The circadian time structure (CTS) and its disruption by rotating and nightshift schedules relative to work performance, accident risk, and health/wellbeing have long been areas of occupational medicine research. Yet, there has been little exploration of the relevance of the CTS to setting short-term, time-weighted, and ceiling threshold limit values (TLVs); conducting employee biological monitoring (BM); and establishing normative reference biological exposure indices (BEIs). Numerous publications during the past six decades document the CTS substantially affects the disposition - absorption, distribution, metabolism, and elimination - and effects of medications. Additionally, laboratory animal and human studies verify the tolerance to chemical, biological (contagious), and physical agents can differ extensively according to the circadian time of exposure. Because of slow and usually incomplete CTS adjustment by rotating and permanent nightshift workers, occupational chemical and other contaminant encounters occur during a different circadian stage than for dayshift workers. Thus, the intended protection of some TLVs when working the nightshift compared to dayshift might be insufficient, especially in high-risk settings. The CTS is germane to employee BM in that large-amplitude predictable-in-time 24h variation can occur in the concentration of urine, blood, and saliva of monitored chemical contaminants and their metabolites plus biomarkers indicative of adverse xenobiotic exposure. The concept of biological time-qualified (for rhythms) reference values, currently of interest to clinical laboratory pathology practice, is seemingly applicable to industrial medicine as circadian time and workshift-specific BEIs to improve surveillance of night workers, in particular. Furthermore, BM as serial assessments performed frequently both during and off work, exemplified by employee self-measurement of lung function using a small portable peak expiratory flow meter, can easily identify intolerance before induction of pathology.

Evaluation of occupational cold environments: field measurements and subjective analysis

The present work is dedicated to the study of occupational cold environments in food distribution industrial units. Field measurements and a subjective assessment based on an individual questionnaire were considered. The survey was carried out in 5 Portuguese companies. The field measurements include 26 workplaces, while a sample of 160 responses was considered for the subjective assessment. In order to characterize the level of cold exposure, the Required Clothing Insulation Index (IREQ) was adopted. The IREQ index highlights that in the majority of the workplaces the clothing ensembles worn are inadequate, namely in the freezing chambers where the protection provided by clothing is always insufficient. The questionnaires results show that the food distribution sector is characterized by a female population (70.6%), by a young work force (60.7% are less than 35 yr old) and by a population with a medium-length professional career (80.1% in this occupation for less than 10 yr). The incidence of health effects which is higher among women, the distribution of protective clothing (50.0% of the workers indicate one garment) and the significant percentage of workers (>75%) that has more difficulties in performing the activity during the winter represent other important results of the present study.

Habituation of the metabolic and ventilatory responses to cold-water immersion in humans

An experiment was undertaken to answer long-standing questions concerning the nature of metabolic habituation in repeatedly cooled humans. It was hypothesised that repeated skin and deep-body cooling would produce such a habituation that would be specific to the magnitude of the cooling experienced, and that skin cooling alone would dampen the cold-shock but not the metabolic response to cold-water immersion. Twenty-one male participants were divided into three groups, each of which completed two experimental immersions in 12°C water, lasting until either rectal temperature fell to 35°C or 90min had elapsed. Between these two immersions, the control group avoided cold exposures, whilst two experimental groups completed five additional immersions (12°C). One experimental group repeatedly immersed for 45min in average, resulting in deep-body (1.18°C) and skin temperature reductions. The immersions in the second experimental group were designed to result only in skin temperature reductions, and lasted only 5min. Only the deep-body cooling group displayed a significantly blunted metabolic response during the second experimental immersion until rectal temperature decreased by 1.18°C, but no habituation was observed when they were cooled further. The skin cooling group showed a significant habituation in the ventilatory response during the initial 5min of the second experimental immersion, but no alteration in the metabolic response. It is concluded that repeated falls of skin and deep-body temperature can habituate the metabolic response, which shows tissue temperature specificity. However, skin temperature cooling only will lower the cold-shock response, but appears not to elicit an alteration in the metabolic response.

Work in Artificial Cold Environments

The physiological characteristics of work in cold stores, as a typical artificial cold environment, are reviewed mainly from our various field and experimental studies. There are about 4,000 cold stores in Japan, and 85% of them are kept at temperatures below -20 degrees C. Although the duration of cold exposure per stay in a cold store was very short, forklift workers entered the cold stores very frequently. Cold stress and the decrease in workers' performance were the same as for continuous exposure to cold. Since the peripheral skin temperature of subjects at night is higher than that in the afternoon, they are less likely to feel cold or pain sensation at night. However, there was a marked decrease in rectal temperature and in manual performance. There is an increased risk of both hypothermia and accidents for those who work at night. The cold store workers, however, had adapted to cold through daily repeated cold exposures.

Hypothermia and localized cold injuries

Hypothermia and localized cold injuries are largely preventable with proper preparation for activities in cold environments. Proficient field management is crucial to the final outcome in terms of function and viability because proper care is vital to preventing exacerbation of the initial exposure and injury. Rapid rewarming is optimal when further cold exposure can be avoided reliably. Repetitive freeze-thaw cycles are associated with increased morbidity and tissue loss caused by progressive microvascular injury and thrombosis. The subsequent care is largely supportive and consists of wound care and physical and hydrotherapy to promote optimal functional recovery.

Hypothermia-induced changes of afferent sensory transmission to the VPM thalamus of rats and hamsters

Effects of hypothermia on the afferent somatosensory transmission to the ventroposteromedial (VPM) thalamus were determined in anesthetized rats and hamsters. Hamsters showed a gradual suppression of afferent sensory transmission during cooling (to 18 degrees C) and disinhibition during subsequent warming of body temperature (Tb). However, rats exhibited steep inhibition from Tb 26 degrees C to complete absence of sensory transmission at Tb 20 degrees C and abrupt disinhibition during subsequent warming. Species difference at thalamic level was quite similar to our previous results in the primary somatosensory (SI) cortex, suggesting that changes of sensory transmission observed in the SI cortex may have already occurred at thalamic level. Differences between the cortex and the thalamus were observed only during deep hypothermia in rat and during the final period of warming in hamster. Conduction latencies of thalamocortical system of both species were not influenced during Tb lowering until 24 degrees C (equivalent to brain temperature 25-26 degrees C). These results suggest inherently different adaptability to hypothermia in processing somatosensory information between hibernator and non-hibernator, but similar sustainability of sensory functions of the thalamocortical system during hypothermia in both species.