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Hintz CN, Butler CR. Wearable and ingestible technology to evaluate and prevent exertional heat illness: A narrative review. PM R 2024; 16:398-403. [PMID: 38501700 DOI: 10.1002/pmrj.13155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 03/20/2024]
Abstract
Exertional heat illness remains a constant threat to the athlete, military service member, and laborer. Recent increases in the number and intensity of environmental heat waves places these populations at an ever increasing risk and can be deadly if not recognized and treated rapidly. For this reason, it is extremely important for medical providers to guide athletes, service members, and laborers in the implementation of awareness, education, and measures to reduce or mitigate the risk of exertional heat illness. Within the past 2 decades, a variety of wearable technology options have become commercially available to track an estimation of core temperature, yet questions continue to emerge as to its use, effectiveness, and practicality in athletics, the military, and the workforce. There is a paucity of data on the accuracy of many of these newer devices in the setting of true heat stroke physiology, and it is important to avoid overreliance on new wearable technology. Further research and improvement of this technology are critical to identify accuracy in the diagnosis and prevention of EHI.
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Affiliation(s)
- Courtney N Hintz
- Special Warfare Human Performance Support Group, USAF, San Antonio, Texas, USA
| | - Cody R Butler
- Special Warfare Human Performance Support Group, USAF, San Antonio, Texas, USA
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Iio Y, Tanaka M, Kozai H, Aoyama Y, Mori Y, Seguchi M, Ito M. Association between the experience of exertional heat illness (EHI) and living conditions of collegiate student athletes. Drug Discov Ther 2024; 18:60-66. [PMID: 38355123 DOI: 10.5582/ddt.2023.01094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Exertional heatstroke (EHS), a severe form of exertional heat illness (EHI), is the third leading cause of death in athletes; thus, early detection and prevention of EHI can help prevent EHS, which is a life-threatening condition. This study aimed to clarify the association between the cognizance of experiencing EHI and living conditions and specific EHI symptoms among collegiate athletes. This study was conducted in October 2022 by administering a questionnaire to 237 male collegiate athletes. Of the 215 (90.7%) respondents, 197 (91.6%) provided valid responses; among them, 88 (44.7%) responded they had experienced EHI, while 109 (55.3%) had not. A history of medical examinations due to EHI, having experienced headaches during summer activities, and having read the EHI manual were factors indicating cognizance of EHI. The number of times meals containing a staple food, main dish, and side dish were eaten in a day was a factor in preventing EHI. Early detection of EHI is important for its prevention, and it is important that athletes themselves have knowledge of symptoms and can correctly self-diagnose EHI. Emphasizing the potential of a well-balanced dietary intake has the potential to prevent EHI is crucial.
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Affiliation(s)
- Yoko Iio
- Graduate School of Life and Health Sciences, Chubu University, Aichi, Japan
- Department of Lifelong Sports and Health Sciences, College of Life and Health Sciences, Chubu University, Aichi, Japan
| | - Mamoru Tanaka
- Department of Food and Nutritional Sciences, College of Bioscience and Biotechnology, Chubu University, Aichi, Japan
| | - Hana Kozai
- Department of Food and Nutritional Sciences, College of Bioscience and Biotechnology, Chubu University, Aichi, Japan
| | - Yuka Aoyama
- Graduate School of Life and Health Sciences, Chubu University, Aichi, Japan
- Department of Clinical Engineering, College of Life and Health Sciences, Chubu University, Aichi, Japan
| | - Yukihiro Mori
- Graduate School of Life and Health Sciences, Chubu University, Aichi, Japan
- Department of Nursing, College of Life and Health Sciences, Chubu University, Aichi, Japan
| | - Manato Seguchi
- Graduate School of Life and Health Sciences, Chubu University, Aichi, Japan
| | - Morihiro Ito
- Graduate School of Life and Health Sciences, Chubu University, Aichi, Japan
- Department of Lifelong Sports and Health Sciences, College of Life and Health Sciences, Chubu University, Aichi, Japan
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Taggart SM, Girard O, Landers GJ, Wallman KE. Heat exposure as a cause of injury and illness in mine industry workers. Ann Work Expo Health 2024; 68:325-331. [PMID: 38438158 PMCID: PMC10941724 DOI: 10.1093/annweh/wxae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/07/2024] [Indexed: 03/06/2024] Open
Abstract
The objective of this study was to explore the association between ambient temperature and injuries and illnesses experienced by mine industry workers. Eleven years of de-identified data from a mine industry company in Australia was explored in regards to injuries and illnesses occurring due to outdoor exposure. Each case was filtered for reported symptoms, and meteorological data to match the location of the mine site and date reported were sourced. Of the 18 931 injuries and illnesses observed over the 11-year period, 151 cases of heat-related illness due to outdoor exposure were reported. Twenty-five conditions/symptoms of heat-illness were found, with the most prevalent being dehydration (n = 81), followed by heat rash (n = 40), dizziness (n = 24), and headache (n = 23). The mean number of symptoms reported by each worker was 2 ± 1. There was a positive correlation between ambient temperature and injuries/illnesses (r2 = 0.89, P < 0.001), where, as temperature increased so did the number of reported heat-related illnesses. Underreporting of heat-related illness and injury in the mining industry is likely, which is a risk to the health and wellbeing of employees. Workers require industry specific training about the severity of heat stress and the associated prevention strategies.
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Affiliation(s)
- Sarah M Taggart
- School of Human Sciences (Sport Science, Exercise and Health), The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Olivier Girard
- School of Human Sciences (Sport Science, Exercise and Health), The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Grant J Landers
- School of Human Sciences (Sport Science, Exercise and Health), The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Karen E Wallman
- School of Human Sciences (Sport Science, Exercise and Health), The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
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Vallennie V, Isa SNI, Mazlan AZ, Shaifuddin SNM. Impact of heat stress on health-related symptoms and physiological changes among workers at a palm oil mill in Mukah, Sarawak, Malaysia. Med J Malaysia 2024; 79:82-87. [PMID: 38555890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
INTRODUCTION The palm oil (PO) industry is one of the most important sectors in the Malaysian economy. Workers at PO mills are, however, at risk for a number of health and safety issues, including heat stress, as the PO is one of the industries with high heat exposure. Heat stress occurs when a person's body cannot get rid of excess heat. Heat stress can result in heat cramps, heat exhaustion, heat rash, and heat stroke. It also results in physiological and psychological changes that can have an impact on a worker's performance. Therefore, this study aimed to evaluate the impact of heat stress on health-related symptoms and physiological changes among workers in a PO mill. MATERIALS AND METHODS This cross-sectional study was conducted in a PO mill located in Mukah, Sarawak, Malaysia. Thirty-one workers from the four workstations (sterilizer, boiler, oil, and engine rooms) were selected as the respondents in this study. Wet Bulb Globe Thermometer was used in this study to measure the environmental temperature (WBGTin). Body core temperature (BCT), blood pressure (BP), and heart rate (HR) were recorded both before and after working in order to assess the physiological effects of heat stress on workers. A set of questionnaires were used to determine sociodemographic characteristics of the respondents and their symptoms related to heat stress. Data were then analyzed using SPSS Ver28. RESULTS The WBGTin was found to be above the ACGIH threshold limit value of heat stress exposure in the engine room, sterilizer, and boiler workstations (>28.0°C). Additionally, there was a significant difference in the worker's BCT in these three workstations before and after work (p<0.05). Only the systolic BP and HR of those working at the boiler workstation showed significant difference between before and after work (p<0.05). The most typical symptoms that workers experience as a result of being exposed to heat at work include headache and fatigue. However, statistical analysis using Spearman Rho's test showed that there is no correlation between heat stress level with physiological changes and health-related symptoms among study respondents (p>0.05). CONCLUSION Results of the present study confirmed that workers in PO mill were exposed to high temperatures while at work. Although the evidence indicates the physiological parameters in general are not significantly affected while working, it also demonstrated that worker's body adapts and acclimates to the level of heat. Even so, precautions should still be taken to reduce future heat exposure. It is recommended that a physiological study be carried out that focuses on cognitive function impairment to support the evidence regarding the effects of heat stress on PO mill workers.
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Affiliation(s)
- V Vallennie
- Universiti Teknologi MARA, Faculty of Health Sciences, Centre for Environmental Health and Safety Studies, Puncak Alam Campus, Selangor, Malaysia
| | - S N I Isa
- Universiti Teknologi MARA, Faculty of Health Sciences, Department of Basic Sciences, Puncak Alam Campus, Selangor, Malaysia
| | - A Z Mazlan
- Lake View College, Department of Occupational Safety and Health, Perak, Malaysia
| | - S N M Shaifuddin
- Universiti Teknologi MARA, Faculty of Health Sciences, Centre for Environmental Health and Safety Studies, Puncak Alam Campus, Selangor, Malaysia.
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Deng HP, Pan HY, Yao JH, Yang YX, Mao J. [5 cases of occupational heat illness]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2024; 42:58-61. [PMID: 38311953 DOI: 10.3760/cma.j.cn121094-20211118-221574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Objective: Through the analysis of five cases of occupational heat illness caused by high temperature, we expounded the pathogenesis and summarized the clinical characteristics of heat cramp and heat exhaustion of the newly revised diagnostic criteria for occupational heat illness (GBZ41-2019), in order to prevent the occurrence of occupational heat illness to put forward controllable countermeasures. Methods: According to the occupational history, clinical diagnosis and treatment and the other relevant data submitted by five patients, the diagnosis process was analyzed and summarized. Results: Five patients developed symptoms from July to August in summer, belonging to high-temperature operation. They improved by timely treatment. The symptoms, signs and laboratory tests of the five patients were different, but they were diagnosed as occupational heat illness. Conclusion: Employers should pay attention to the high temperature protection and cooling work, and strengthen the labor protection. If patients with heat cramp and heat exhaustion were timely treated, they could basically recover. Occupational disease diagnosticians should seriously study the new diagnostic criteria of occupational disease and constantly improve their diagnostic ability.
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Affiliation(s)
- H P Deng
- Department of Occupational Health, Suzhou Center for Disease Control and Prevention, Suzhou 215004, China
| | - H Y Pan
- Occupational Health Department of Suzhou Municipal Health Commission, Suzhou 215002, China
| | - J H Yao
- Department of Occupational Health, Suzhou Center for Disease Control and Prevention, Suzhou 215004, China
| | - Y X Yang
- Department of Occupational Health, Suzhou Center for Disease Control and Prevention, Suzhou 215004, China
| | - J Mao
- Department of Occupational Health, Suzhou Center for Disease Control and Prevention, Suzhou 215004, China
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Abbasi M, Golbabaei F, Yazdanirad S, Dehghan H, Ahmadi A. Validity of ten analytical heat stress indices in predicting the physiological parameters of people under various occupational and meteorological conditions. Int J Biometeorol 2024; 68:163-177. [PMID: 37962645 DOI: 10.1007/s00484-023-02580-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/07/2023] [Accepted: 11/06/2023] [Indexed: 11/15/2023]
Abstract
Until now, only a few comprehensive studies have validated analytical heat stress indices in different conditions. The present study aims to investigate the validity of these indicators in predicting the physiological parameters of workers. This cross-sectional study was conducted with 194 male employees working in warm environments. First, demographic information was collected. After participants rested for 30 min, their heart rate and tympanic temperature were measured. The subjects then performed their routine tasks. At the end of 90 min, their heart rate and tympanic temperature were again measured. Additionally, their metabolism rate and clothing thermal insulation were estimated. Environmental parameters were also measured at 30-, 60-, and 90-min time points. Additional information required to compute the indices was recorded. Then, the values of each of the indices were computed. Finally, the validity of the indices was assessed under different conditions. The results indicated that the highest regression coefficients with tympanic temperature were assigned to modified physiologically equivalent temperature (mPET) (0.7515), predicted heat strain (PHS) (0.7201), and predicted mean vote (PMV) (0.7082), index, respectively. Also, the greatest regression coefficients with heart rate belonged to mPET (0.7773), PMV (0.7624), and PHS (0.6479) index, respectively. Based on the results, the highest diagnostic accuracies of receiver operating characteristic (ROC) curves for tympanic temperature were related to indices of mPET, PHS, and PMV with the area under the ROC curve (AUC) of 0.945, 0.931, and 0.930, respectively. Of the studied indices, it was observed that mPET, PHS, PMV, and PPD showed more validity compared to others.
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Affiliation(s)
- Milad Abbasi
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Farideh Golbabaei
- Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeid Yazdanirad
- Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.
- School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran.
| | - Habibollah Dehghan
- Department of Occupational Health Engineering, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Ahmadi
- Modeling in Health Research Center and School of Public Health, Department of Epidemiology and Biostatistics, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Danzig RM, Raunig JM, Acholonu CJ. Exertional Heat Illness-From Identifying Heat Rash to Treating Heat Stroke. Pediatr Ann 2024; 53:e17-e21. [PMID: 38194658 DOI: 10.3928/19382359-20231113-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Heat-related illness commonly affects adolescent patients, especially as summer approaches and global temperature extremes worsen. Basic counseling on sunburn prevention can decrease the risk for future malignancies, and rapidly preventing, identifying, and treating heat stroke can prevent severe morbidity and mortality. This article will review the epidemiology of exertional heat-related illness and the variations in presentations and pathology, from heat rash and sunburn to heat exhaustion and heat stroke. By the end of this review clinicians should be able to identify and treat different heat-related illnesses in adolescents and potentially save a life. [Pediatr Ann. 2024;53(1):e17-e21.].
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Buller MJ, Atkinson E, Driver K, Tharion WJ, Ely BR, Cheuvront SN, Charkoudian N. Individualized monitoring of heat illness risk: novel adaptive physiological strain index to assess exercise-heat strain from athletes to fully encapsulated workers. Physiol Meas 2023; 44:10NT01. [PMID: 37703905 DOI: 10.1088/1361-6579/acf991] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/13/2023] [Indexed: 09/15/2023]
Abstract
Objective. Exercise-heat strain estimation approaches often involve combinations of body core temperature (Tcore), skin temperature (Tsk) and heart rate (HR). A successful existing measure is the 'Physiological Strain Index' (PSI), which combines HR and Tcore values to estimate strain. However, depending on variables such as aerobic fitness and clothing, the equation's 'maximal/critical' Tcore must be changed to accurately represent the strain, in part because high Tsk (small Tcore-Tsk) can increase cardiovascular strain and thereby negatively affect performance. Here, an 'adaptive PSI' (aPSI) is presented where the original PSI Tcorecriticalvalue is 'adapted' dynamically by the delta between Tcore and Tsk.Approach. PSI and aPSI were computed for athletes (ELITE,N= 11 male and 8 female, 8 km time-trial) and soldiers in fully encapsulating personal protective equipment (PPE,N= 8 male, 2 km approach-march). While these were dissimilar events, it was anticipated given that the clothing and work rates would elicit similar very-high exercise-heat strain values.Main results. Mean end HR values were similar (∼180 beats min-1) with higher Tcore = 40.1 ± 0.4 °C for ELITE versus PPE 38.4 ± 0.6 °C (P< 0.05). PSI end values were different between groups (P< 0.01) and appeared 'too-high' for ELITE (11.4 ± 0.8) and 'too-low' for PPE (7.6 ± 2.0). However, aPSI values were not different (9.9 ± 1.4 versus 9.0 ± 2.5 versus;p> 0.05) indicating a 'very high' level of exercise-heat strain for both conditions.Significance. A simple adaptation of the PSI equation, which accounts for differences in Tcore-to-Tsk gradients, provides a physiological approach to dynamically adapt PSI to provide a more accurate index of exercise-heat strain under very different working conditions.
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Affiliation(s)
- Mark J Buller
- US Army Research Institute of Environmental Medicine, 10 General Greene Avenue, Natick, MA 01760, United States of America
| | - Emma Atkinson
- US Army Research Institute of Environmental Medicine, 10 General Greene Avenue, Natick, MA 01760, United States of America
| | - Kyla Driver
- US Army Research Institute of Environmental Medicine, 10 General Greene Avenue, Natick, MA 01760, United States of America
| | - William J Tharion
- US Army Research Institute of Environmental Medicine, 10 General Greene Avenue, Natick, MA 01760, United States of America
| | - Brett R Ely
- Department of Health Sciences, Providence College, Providence, RI 02918, United States of America
| | - Samuel N Cheuvront
- Sports Science Synergy, LLC, Franklin, MA 02038, United States of America
| | - Nisha Charkoudian
- US Army Research Institute of Environmental Medicine, 10 General Greene Avenue, Natick, MA 01760, United States of America
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Casa DJ, Szymanski MR, Jardine JF, Stearns RL, Adams WM, Eason CM, Hosokawa Y, Huggins RA, Lopez RM, McDermott BP, Miller KC, Nolan JK, Pryor RR, Scarneo-Miller SE, Vandermark LW. Letter on the 2023 ACSM Expert Consensus Statement on Exertional Heat Illness. Curr Sports Med Rep 2023; 22:336-337. [PMID: 37678353 DOI: 10.1249/jsr.0000000000001100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Affiliation(s)
- Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
| | - Michael R Szymanski
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
| | - John F Jardine
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
| | - Rebecca L Stearns
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
| | | | - Christianne M Eason
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
| | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University. Tokorozawa, Saitama, Japan
| | - Robert A Huggins
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
| | - Rebecca M Lopez
- School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Brendon P McDermott
- Exercise Science Research Center, College of Education and Health Professions, University of Arkansas, Fayetteville, AR
| | - Kevin C Miller
- Texas State University, Department of Health and Human Performance, San Marcos, TX
| | - Julie K Nolan
- Athletic Training Education Program, Sacred Heart University, Fairfield, CT
| | - Riana R Pryor
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY
| | | | - Lesley W Vandermark
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY
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House C, Stacey M, Woods D, Allsopp A, Roiz de Sa D. Procedure for assessing patients referred to the UK's military Heat Illness Clinic: a case series. BMJ Mil Health 2023; 169:310-315. [PMID: 34266969 DOI: 10.1136/bmjmilitary-2021-001875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/03/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The UK military operates a Heat Illness Clinic (HIC) to aid the return to exercise, training and occupational duty recommendations for individuals who have suffered exertional heat illness or heatstroke. This paper describes the process of assessment and reports representative data from n=22 patients referred to the HIC. METHOD The assessment included clinical consultation, and measurement of maximal oxygen consumption (V̇O2max) and a heat tolerance test (HTT) conducted on a treadmill in an environmental chamber with an air temperature of 34°C and 44% relative humidity. Patients began the HTT wearing military clothing, carrying a rucksack (mass 15 kg) and walking at 60% V̇O2max, at 30 min the rucksack and jacket were removed and the T-shirt at 45 min, individuals continued walking for 60-90 min. Patients were considered heat tolerant if rectal temperature achieved a plateau. RESULTS N=14 patients were heat tolerant on the first assessment and of the n=8 patients required to return for repeat assessment, five were heat tolerant on the second assessment and the remaining three on the third assessment. CONCLUSIONS In conjunction with patient history and clinical evaluation, the HTT provides a physiological basis to assist with decisions concerning patient management and return to duty following an episode of heat illness.
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Affiliation(s)
- Carol House
- Institute of Naval Medicine, Gosport, UK
- School of Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - M Stacey
- Department of Surgery and Cancer, Imperial College, London, UK
- Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
| | - D Woods
- Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
- Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- Northumbria NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - A Allsopp
- Institute of Naval Medicine, Gosport, UK
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Tochihara Y, Lee JY, Son SY, Bakri I. Heat strain of Japanese firefighters wearing personal protective equipment: a review for developing a test method. Ergonomics 2023; 66:676-689. [PMID: 35959644 DOI: 10.1080/00140139.2022.2113150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 08/06/2022] [Indexed: 06/15/2023]
Abstract
The aim of this review was to develop a test method for the evaluation of heat strain for structural firefighters wearing personal protective equipment (PPE) in Japan. We analysed a series of our laboratory's questionnaires and experimental studies and reviewed international standards on test methods. We investigated the actual average working conditions (total firefighting time on one incidence, working time with full PPE, maximum temperature and humidity during firefighting) at structural firefighting site in Japan by conducting a large-scale questionnaire survey of Japanese firefighters. We discussed test subjects (firefighters vs. non-firefighters; body size; physical fitness), exercise intensity (absolutes vs. relative; light vs. heavy) and duration, experimental temperature and relative humidity, experimental clothing items including station uniforms (shorts vs. long), and measurement variables (physiological and subjective responses), and suggested a standard test method to evaluate the heat strain of firefighters in hot and humid environments.Practitioner summary: We reviewed studies on human wear trials of firefighting personal protective equipment (PPE) in hot environments and suggested a standard test method to evaluate the heat strain of firefighters. The test method can be internationally utilised to examine the comfort functions and heat stress of PPE in hot, humid environments.
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Affiliation(s)
- Yutaka Tochihara
- Department of Human Science, Faculty of Design, Kyushu University, Fukuoka, Japan
| | - Joo-Young Lee
- Department of Textiles, Merchandising and Fashion Design College of Human Ecology, Seoul National University, Seoul, Korea
- Graphene Research Center for Convergence Technology, Advanced Institute of Convergence Technology, Suwon, Korea
| | - Su-Young Son
- Department of Home Economics Education Teachers College, Kyungpook National University, Daegu, Korea
| | - Ilham Bakri
- Industrial Engineering Department, Hasanuddin University, Makassar, Indonesia
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Laxminarayan S, Hornby S, Belval LN, Giersch GEW, Morrissey MC, Casa DJ, Reifman J. Prospective Validation of 2B-Cool : Integrating Wearables and Individualized Predictive Analytics to Reduce Heat Injuries. Med Sci Sports Exerc 2023; 55:751-764. [PMID: 36730025 DOI: 10.1249/mss.0000000000003093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION An uncontrollably rising core body temperature (T C ) is an indicator of an impending exertional heat illness. However, measuring T C invasively in field settings is challenging. By contrast, wearable sensors combined with machine-learning algorithms can continuously monitor T C nonintrusively. Here, we prospectively validated 2B-Cool , a hardware/software system that automatically learns how individuals respond to heat stress and provides individualized estimates of T C , 20-min ahead predictions, and early warning of a rising T C . METHODS We performed a crossover heat stress study in an environmental chamber, involving 11 men and 11 women (mean ± SD age = 20 ± 2 yr) who performed three bouts of varying physical activities on a treadmill over a 7.5-h trial, each under four different clothing and environmental conditions. Subjects wore the 2B-Cool system, consisting of a smartwatch, which collected vital signs, and a paired smartphone, which housed machine-learning algorithms and used the vital sign data to make individualized real-time forecasts. Subjects also wore a chest strap heart rate sensor and a rectal probe for comparison purposes. RESULTS We observed very good agreement between the 2B-Cool forecasts and the measured T C , with a mean bias of 0.16°C for T C estimates and nearly 75% of measurements falling within the 95% prediction intervals of ±0.62°C for the 20-min predictions. The early-warning system results for a 38.50°C threshold yielded a 98% sensitivity, an 81% specificity, a prediction horizon of 35 min, and a false alarm rate of 0.12 events per hour. We observed no sex differences in the measured or predicted peak T C . CONCLUSION 2B-Cool provides early warning of a rising T C with a sufficient lead time to enable clinical interventions and to help reduce the risk of exertional heat illness.
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Affiliation(s)
| | | | - Luke N Belval
- Korey Stringer Institute, University of Connecticut, Storrs, CT
| | | | | | - Douglas J Casa
- Korey Stringer Institute, University of Connecticut, Storrs, CT
| | - Jaques Reifman
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Development Command, Fort Detrick, MD
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13
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Roberts WO, Armstrong LE, Sawka MN, Yeargin SW, Heled Y, O'Connor FG. ACSM Expert Consensus Statement on Exertional Heat Illness: Recognition, Management, and Return to Activity. Curr Sports Med Rep 2023; 22:134-149. [PMID: 37036463 DOI: 10.1249/jsr.0000000000001058] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
ABSTRACT Exertional heat stroke is a true medical emergency with potential for organ injury and death. This consensus statement emphasizes that optimal exertional heat illness management is promoted by a synchronized chain of survival that promotes rapid recognition and management, as well as communication between care teams. Health care providers should be confident in the definitions, etiologies, and nuances of exertional heat exhaustion, exertional heat injury, and exertional heat stroke. Identifying the athlete with suspected exertional heat stroke early in the course, stopping activity (body heat generation), and providing rapid total body cooling are essential for survival, and like any critical life-threatening situation (cardiac arrest, brain stroke, sepsis), time is tissue. Recovery from exertional heat stroke is variable and outcomes are likely related to the duration of severe hyperthermia. Most exertional heat illnesses can be prevented with the recognition and modification of well-described risk factors ideally addressed through leadership, policy, and on-site health care.
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Affiliation(s)
- William O Roberts
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN
| | - Lawrence E Armstrong
- Professor Emeritus, Department of Kinesiology, University of Connecticut, Storrs, CT
| | - Michael N Sawka
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA
| | - Susan W Yeargin
- Department of Exercise Science, University of South Carolina, Columbia, SC
| | - Yuval Heled
- Department of Medicine, Heller Institute of Medical Research, Sheba Medical Center, Ramat Gan, Israel
| | - Francis G O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
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Wallum M, Whipple T, Peterson A. Wrestling with Heat Illness: Acquired Idiopathic Generalized Anhidrosis in the Pediatric Athlete. Curr Sports Med Rep 2023; 22:113-114. [PMID: 37036457 DOI: 10.1249/jsr.0000000000001052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Affiliation(s)
- Michael Wallum
- Department of Emergency Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Terese Whipple
- Department of Emergency Medicine, Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Andrew Peterson
- Department of Pediatrics, Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
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15
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Stacey MJ, Hill NE, Parsons IT, Wallace J, Taylor N, Grimaldi R, Shah N, Marshall A, House C, O’Hara JP, Brett SJ, Woods DR. Relative changes in brain and kidney biomarkers with Exertional Heat Illness during a cool weather marathon. PLoS One 2022; 17:e0263873. [PMID: 35176088 PMCID: PMC8853487 DOI: 10.1371/journal.pone.0263873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 01/29/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Medical personnel may find it challenging to distinguish severe Exertional Heat Illness (EHI), with attendant risks of organ-injury and longer-term sequalae, from lesser forms of incapacity associated with strenuous physical exertion. Early evidence for injury at point-of-incapacity could aid the development and application of targeted interventions to improve outcomes. We aimed to investigate whether biomarker surrogates for end-organ damage sampled at point-of-care (POC) could discriminate EHI versus successful marathon performance.
Methods
Eight runners diagnosed as EHI cases upon reception to medical treatment facilities and 30 successful finishers of the same cool weather marathon (ambient temperature 8 rising to 12 ºC) were recruited. Emerging clinical markers associated with injury affecting the brain (neuron specific enolase, NSE; S100 calcium-binding protein B, S100β) and renal system (cystatin C, cysC; kidney-injury molecule-1, KIM-1; neutrophil gelatinase-associated lipocalin, NGAL), plus copeptin as a surrogate for fluid-regulatory stress, were sampled in blood upon marathon collapse/completion, as well as beforehand at rest (successful finishers only).
Results
Versus successful finishers, EHI showed significantly higher NSE (10.33 [6.37, 20.00] vs. 3.17 [2.71, 3.92] ug.L-1, P<0.0001), cysC (1.48 [1.10, 1.67] vs. 1.10 [0.95, 1.21] mg.L-1, P = 0.0092) and copeptin (339.4 [77.0, 943] vs. 18.7 [7.1, 67.9] pmol.L-1, P = 0.0050). Discrimination of EHI by ROC (Area-Under-the-Curve) showed performance that was outstanding for NSE (0.97, P<0.0001) and excellent for copeptin (AUC = 0.83, P = 0.0066).
Conclusions
As novel biomarker candidates for EHI outcomes in cool-weather endurance exercise, early elevations in NSE and copeptin provided sufficient discrimination to suggest utility at point-of-incapacity. Further investigation is warranted in patients exposed to greater thermal insult, followed up over a more extended period.
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Affiliation(s)
- Michael J. Stacey
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
- * E-mail:
| | - Neil E. Hill
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Iain T. Parsons
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, United Kingdom
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
- School of Cardiovascular Medicine and Sciences, King’s College London, London, United Kingdom
| | | | | | - Rachael Grimaldi
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Nishma Shah
- University College London, London, United Kingdom
| | | | - Carol House
- Environmental Medicine Services, Institute of Naval Medicine, Gosport, United Kingdom
| | - John P. O’Hara
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
| | - Stephen J. Brett
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- General Intensive Care Unit, Hammersmith Hospital, London, United Kingdom
| | - David R. Woods
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, United Kingdom
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
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16
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Zheng G, Fan Z, Ge M, Li C. Establishing a warning index for evaluating the physiological stress of sanitation workers in high temperature weather. J Therm Biol 2021; 100:103074. [PMID: 34503811 DOI: 10.1016/j.jtherbio.2021.103074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/23/2021] [Accepted: 08/05/2021] [Indexed: 11/19/2022]
Abstract
High temperature weather occurs frequently in recent years. As a heat-vulnerable group, sanitation workers suffer great physiological safety risks in high temperature weather. In this paper, a physiological warning index (PWI) is established to quantify the physiological stress of the sanitation workers. Firstly, the dynamic weights of the physiological parameters are calculated by the norm grey correlation method. Secondly, the PWI is established by the efficacy coefficient method and the warning level of the PWI is divided based on the relationships between the PWI and thermal sensation vote (TSV). Finally, the reasonability of the PWI is verified. The results show that the weights of the physiological parameters are dynamic, changing with the environments and the physiological states. The weight ranges of the mean skin temperature (MST), tympanic temperature (TT), systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) are 0.036-0.538, 0.000-0.369, 0.000-0.362, 0.018-0.367 and 0.009-0.348. And the MST and DBP are more affected by the high temperature than the TT, SBP and HR. The warning interval of PWI is: (0, 0.25] (no warning), (0.25, 0.45] (mild warning), (0.45, 0.7] (moderate warning), and (0.7, 1.0] (severe warning). The PWI can provide simple real-time physiological warning and guarantee physiological health for sanitation workers in high temperature weather.
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Affiliation(s)
- Guozhong Zheng
- School of Energy, Power and Mechanical Engineering, North China Electric Power University, Baoding, 071003, China; State Key Laboratory of Green Building in Western China, Xian University of Architecture & Technology, Xian, 710055, China.
| | - Zhuangzhuang Fan
- School of Energy, Power and Mechanical Engineering, North China Electric Power University, Baoding, 071003, China
| | - Meng Ge
- School of Energy, Power and Mechanical Engineering, North China Electric Power University, Baoding, 071003, China
| | - Cong Li
- School of Energy, Power and Mechanical Engineering, North China Electric Power University, Baoding, 071003, China
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17
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Roberts WO, Armstrong LE, Sawka MN, Yeargin SW, Heled Y, O'Connor FG. ACSM Expert Consensus Statement on Exertional Heat Illness: Recognition, Management, and Return to Activity. Curr Sports Med Rep 2021; 20:470-484. [PMID: 34524191 DOI: 10.1249/jsr.0000000000000878] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
ABSTRACT Exertional heat stroke (EHS) is a true medical emergency with potential for organ injury and death. This consensus statement emphasizes that optimal exertional heat illness management is promoted by a synchronized chain of survival that promotes rapid recognition and management, as well as communication between care teams. Health care providers should be confident in the definitions, etiologies, and nuances of exertional heat exhaustion, exertional heat injury, and EHS. Identifying the athlete with suspected EHS early in the course, stopping activity (body heat generation), and providing rapid total body cooling are essential for survival, and like any critical life-threatening situation (cardiac arrest, brain stroke, sepsis), time is tissue. Recovery from EHS is variable, and outcomes are likely related to the duration of severe hyperthermia. Most exertional heat illnesses can be prevented with the recognition and modification of well-described risk factors ideally addressed through leadership, policy, and on-site health care.
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Affiliation(s)
- William O Roberts
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN
| | | | - Michael N Sawka
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA
| | - Susan W Yeargin
- Department of Exercise Science, University of South Carolina, Columbia, SC
| | - Yuval Heled
- Clinical and Integrative Physiology Unit, Heller Institute of Medical Research, Sheba Medical Center, ISRAEL
| | - Francis G O'Connor
- Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, MD
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18
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Abstract
The International Society on Thrombosis and Haemostasis (ISTH) scoring system has been used for diagnosing overt disseminated intravascular coagulation (DIC). However, the cut-off points of fibrin-related markers remain unclear. The ability of the ISTH DIC score and Multiple Organ Dysfunction (MODS) score to predict mortality in cases of exertional heat illness (EHI) was tested. In the process, 3 different D-dimer cut-off values for diagnosing overt DIC were evaluated.Data were obtained on the first day of hospitalization for 76 patients with EHI. The DIC score was calculated according to the ISTH scoring system using 3 D-dimer cut-off values.In predicting mortality, methods 1 and 2 had the same sensitivity and specificity, which were 85% and 73.2%, respectively. The sensitivity for method 3 was 70%. Furthermore, the specificity of the DIC score for method 3 was 89%, which was higher than that of the other 2 methods. The correlation coefficients of the DIC and MODS scores of these 3 methods were 0.757, 0.748, and 0.756, respectively. For the prediction of mortality, the area under the receiver operating characteristic (ROC) curve for the DIC scores of these 3 methods was 0.838, 0.842, and 0.85, respectively. Furthermore, the area under the ROC curve of the MODS score was 0.927.The DIC score had a certain predictive power of a poor outcome of EHI patients, but this was not better than the MODS score. The present data may serve as a reference in selecting the appropriate D-dimer cut-off point for the ISTH DIC score.
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Affiliation(s)
- Tie-Ying Gao
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital
- Department of Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Wen-Chao Yang
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital
| | - Fei-Hu Zhou
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital
| | - Qing Song
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital
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19
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Turcano P, Chirila RM. 36-Year-Old Man With Respiratory Distress and Altered Mental Status. Mayo Clin Proc 2020; 95:e125-e130. [PMID: 33276851 DOI: 10.1016/j.mayocp.2020.04.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/22/2020] [Accepted: 04/03/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Pierpaolo Turcano
- Resident in Neurology, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL
| | - Razvan M Chirila
- Advisor to resident and Consultant in General Internal Medicine, Mayo Clinic, Jacksonville, FL.
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20
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Yazdanirad S, Golbabaei F, Monazzam MR, Dehghan H, Foroushani AR. Development of a personal heat strain risk assessment (PHSRA) index in workplaces and its validation. BMC Public Health 2020; 20:837. [PMID: 32493326 PMCID: PMC7268248 DOI: 10.1186/s12889-020-08874-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 05/07/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is not a comprehensive heat stress index to screen the people susceptible to heat disorders and illnesses in hot workplaces. The present study was aimed to develop a personal heat strain risk assessment (PHSRA) index in workplaces and validate it. METHODS This cross-sectional study was carried out on 201 Iranian male employees under various thermal conditions. At first, the demographical data of participants were gathered. After that, the heart rate and tympanic temperature of the subjects were carefully measured at times of 30, 60, and 90 min of starting the work. Environmental factors were measured simultaneously. The metabolism rate and insulation value of clothes were also estimated. At the end, a novel index of the heat strain was developed using structural equation modeling in AMOS and validated using linear regression analysis in SPSS. RESULTS Indirect effect coefficients of personal factors including age, body mass index, maximum aerobic capacity, and body surface area were equal to 0.031, 0.145, - 0.064, and 0.106, respectively. The coefficients of main factors including dry temperature, wet temperature, globe temperature, wind speed, metabolism, and clothing thermal insulation were obtained as 0.739, 0.688, 0.765, 0.245, 0.482, and 0.383, respectively. These coefficients and normalized values of the factors were used to develop a novel index. The total score of the index was categorized into four levels by optimal cut-off points of 12.93, 16.48, and 18.87. Based on the results of regression analysis, this index justifies 77% of the tympanic temperature as a dependent variable (R2 = 0.77). CONCLUSIONS In general, the results indicated that the novel index developed by the personal and main factors had proper validity in the prediction of thermal strain.
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Affiliation(s)
- Saeid Yazdanirad
- Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Golbabaei
- Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Monazzam
- Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Habibollah Dehghan
- Department of Occupational Health Engineering, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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21
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Affiliation(s)
- Renee N Salas
- From the Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, and the Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, and the Harvard Global Health Institute, Cambridge - all in Massachusetts
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22
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Smith CJ. Pediatric Thermoregulation: Considerations in the Face of Global Climate Change. Nutrients 2019; 11:nu11092010. [PMID: 31454933 PMCID: PMC6770410 DOI: 10.3390/nu11092010] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/10/2019] [Accepted: 08/16/2019] [Indexed: 12/16/2022] Open
Abstract
Predicted global climate change, including rising average temperatures, increasing airborne pollution, and ultraviolet radiation exposure, presents multiple environmental stressors contributing to increased morbidity and mortality. Extreme temperatures and more frequent and severe heat events will increase the risk of heat-related illness and associated complications in vulnerable populations, including infants and children. Historically, children have been viewed to possess inferior thermoregulatory capabilities, owing to lower sweat rates and higher core temperature responses compared to adults. Accumulating evidence counters this notion, with limited child–adult differences in thermoregulation evident during mild and moderate heat exposure, with increased risk of heat illness only at environmental extremes. In the context of predicted global climate change, extreme environmental temperatures will be encountered more frequently, placing children at increased risk. Thermoregulatory and overall physiological strain in high temperatures may be further exacerbated by exposure to/presence of physiological and environmental stressors including pollution, ultraviolet radiation, obesity, diabetes, associated comorbidities, and polypharmacy that are more commonly occurring at younger ages. The aim of this review is to revisit fundamental differences in child–adult thermoregulation in the face of these multifaceted climate challenges, address emerging concerns, and emphasize risk reduction strategies for the health and performance of children in the heat.
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Affiliation(s)
- Caroline J Smith
- Department of Health and Exercise Science, Appalachian State University, Boone, NC 28608, USA.
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23
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Mansor Z, Rosnah I, Ismail NH, Hashim JH. Effects of hydration practices on the severity of heat-related illness among municipal workers during a heat wave phenomenon. Med J Malaysia 2019; 74:275-280. [PMID: 31424033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The continue rise in temperatures due to climate change increases the risk of heat-related illness (HRI) among outdoor workers. This study aims to evaluate the effects of hydration practices on the severity of HRI during a heat wave episode among municipal workers in Negeri Sembilan. METHOD A cross-sectional study was performed in March and April 2016. The outdoor temperatures were measured using the wet-bulb globe temperature (WBGT) tool. The participants completed a self-administered questionnaire containing sociodemographic factors prior to work shift; while working profile, hydration practices, and HRI symptoms at the end of work shift. The hydration status of the respondents was assessed by direct observation of their urine colour. Multiple logistic regression was performed to ascertain the effects of age, working profile, hydration practice, history of previous HRI, and hydration status on the likelihood that outdoor workers having moderate to severe HRI. RESULTS A total of 320 respondents completed the questionnaire. The mean (standard deviation) outdoor workplace temperature was 30.5°C (SD 0.53°C). The percentage of respondents who experienced moderate to severe HRI was 44.1%. The likelihood that outdoor workers experienced moderate to severe HRI symptoms was associated with irregular fluid intake [odds ratio (OR): 16.11, 95% confidence interval (95%CI): 4.11; 63.20]; consumption of non-plain water (OR: 5.92, 95%CI: 2.79; 12.56); dehydration (OR: 3.32, 95%CI: 1.92; 5.74); and increasing outdoor workplace temperature (OR: 1.85, 95%CI: 1.09; 3.11). CONCLUSION Irregular drinking pattern and non-plain fluid intake was found to have a large effect on HRI severity among outdoor workers exposed high temperatures during a heat wave phenomenon.
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Affiliation(s)
- Z Mansor
- Universiti Kebangsaan Malaysia Medical Center, Faculty of Medicine, Department of Community Health, Cheras, Kuala Lumpur, Malaysia.
| | - I Rosnah
- Universiti Kebangsaan Malaysia Medical Center, Faculty of Medicine, Department of Community Health, Cheras, Kuala Lumpur, Malaysia
| | - N H Ismail
- Universiti Kebangsaan Malaysia Medical Center, Faculty of Medicine, Department of Community Health, Cheras, Kuala Lumpur, Malaysia
| | - J H Hashim
- Universiti Kebangsaan Malaysia Medical Center, United Nations University-International Institute for Global Health (UNU-IIGH), Cheras, Kuala Lumpur, Malaysia
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Mansor Z, Ismail NH, Rosnah I, Hashim JH. Thirst as the threshold symptom to prevent worsening heat-related illness. Med J Malaysia 2019; 74:1-7. [PMID: 30846654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The heat-related illness (HRI) is a continuum illness ranging from minor health effects to life-threatening medical emergencies when the pathological effects of heat load are not prevented. The aim of this study was to demonstrate the threshold HRI symptom for deciding to take simple preventative actions both by the individual workers and employers. METHOD A total of 328 municipal workers were enrolled in April to March 2016 were asked to recall if they experienced eleven HRI symptoms during the previous work day. Rasch Measurement Model was used to examine the unidimensional parameters and bias for gender before identifying the threshold of HRI symptoms. We determined the threshold symptom based on the person-item map distribution on a logit ruler value. RESULTS A total of 320 respondents were analysed. The psychometric features HRI symptoms suggested evidence of unidimensionality and free of bias for gender (DIF size =0.57; DIF t value =1.03). Based on the person-item map distribution, the thirst item was determined as the threshold item (Cut-off point = -2.17 logit) for the preventative action purposes to group the person as mild and moderate/severe HRI groups. CONCLUSION Thirst item is viewed as threshold symptoms between mild and moderate or severe HRI symptoms. It is a reliable symptom to initiate behavioural response to quench the thirst by adequate fluids. Failure to recognise the thirst symptom may lead to devastating unwanted health complications.
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Affiliation(s)
- Z Mansor
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Community Health, Kuala Lumpur, Malaysia.
| | - N H Ismail
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Community Health, Kuala Lumpur, Malaysia
| | - I Rosnah
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Community Health, Kuala Lumpur, Malaysia
| | - J H Hashim
- United Nations University-International Institute for Global Health (UNU-IIGH), Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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25
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Herbut P, Angrecka S, Walczak J. Environmental parameters to assessing of heat stress in dairy cattle-a review. Int J Biometeorol 2018; 62:2089-2097. [PMID: 30368680 PMCID: PMC6244856 DOI: 10.1007/s00484-018-1629-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 07/12/2018] [Accepted: 10/05/2018] [Indexed: 05/05/2023]
Abstract
Considering the significant influence of high ambient temperature and heat waves on the well-being and productivity of dairy cows, it is to be expected that, in the course of the next few decades, climate conditions for raising cattle will deteriorate. Research has shown that heat stress causes many negative consequences in terms of physiological and behavioural disturbances and significant losses in milk production. The effort to reduce the risk of the occurrence of heat stress among dairy cows also involves the search for new environmental methods of predicting heat stress. The aim of this paper is to review and systematise the current state of knowledge on the topic of the most widely used environmental methods of determining and predicting heat stress in dairy cows and also to show the directions of studies for the future. Based on an analysis of the most popular indexes, the study evaluated their suitability for forecasting heat stress related to maintenance systems and climate conditions for cows. However, the negative results of heat stress often appear with a delay, and a carry-over effect may be experienced (summer heat stress may affect the cows until autumn). The time of the year and breed of cows could have a big impact on when animals become sensitive to increasing heat loads. This likely can be a big contributor to the discrepancies within the different heat stress equations. It is essential to prevent the occurrence of heat stress, predicting it by observing local microclimate conditions and using meteorological forecasts. Thanks to these measures, a breeder may prepare and implement suitable solutions for protecting the animals.
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Affiliation(s)
- Piotr Herbut
- Department of Rural Building, University of Agriculture in Krakow, al. Mickiewicza 24-28, 30-059, Krakow, Poland
| | - Sabina Angrecka
- Department of Rural Building, University of Agriculture in Krakow, al. Mickiewicza 24-28, 30-059, Krakow, Poland.
| | - Jacek Walczak
- Department of Production Systems and Environment, National Research Institute of Animal Production, 1, Krakowska Street, 32-083, Balice near Krakow, Poland
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26
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Kovács L, Kézér FL, Ruff F, Szenci O, Jurkovich V. Association between human and animal thermal comfort indices and physiological heat stress indicators in dairy calves. Environ Res 2018; 166:108-111. [PMID: 29885611 DOI: 10.1016/j.envres.2018.05.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/25/2018] [Accepted: 05/30/2018] [Indexed: 06/08/2023]
Abstract
Warm summer episodes have a significant effect on the overall health and well-being of young cattle; however, it is not known which temperature measure should be used for estimating heat stress in dairy calves. In this study, generalized linear mixed-effects models were used to estimate the relationships between thermal comfort indices and animal-based heat stress indicators in sixteen Holstein bull calves that were housed in individual calf hutches. Data were collected under continental weather characteristics over a 5-day period: day 1 (lower-temperature day), days 2 and 3 (heat stress days), and a 2-day post-stress period. Relative humidity, ambient temperature, the heat index, the humidex and five different temperature-humidity indices (THI) were used as thermal indices. Physiological variables monitored included respiratory rate, rectal temperature, ear skin temperature and heart rate. The heat index and the humidex measuring human thermal comfort were more closely associated with physiological measures than were the ambient temperature or the THIs (in case of heat index: R2 = 0.87 for respiratory rate, R2 = 0.63 for rectal temperature, R2 = 0.70 for ear skin temperature, and R2 = 0.78 for heart rate, respectively; in case of humidex: R2 = 0.85 for respiratory rate, R2 = 0.60 for rectal temperature, R2 = 0.68 for ear skin temperature, and R2 = 0.75 for heart rate, respectively). Based on our results, parameters of human outdoor comfort seem better to estimate heat stress in dairy calves in a continental region than those of THIs or ambient temperature.
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Affiliation(s)
- L Kovács
- MTA-SZIE Large Animal Clinical Research Group, Üllő-Dóra major H-2225, Hungary; Institute of Animal Husbandry, Faculty of Agricultural and Environmental Science, Szent István University, Páter Károly utca 1, Gödöllő H-2100, Hungary.
| | - F L Kézér
- MTA-SZIE Large Animal Clinical Research Group, Üllő-Dóra major H-2225, Hungary; Institute of Animal Husbandry, Faculty of Agricultural and Environmental Science, Szent István University, Páter Károly utca 1, Gödöllő H-2100, Hungary
| | - F Ruff
- Department of Methodology, Hungarian Central Statistical Office, Keleti Károly utca 5-7, Budapest H-1024, Hungary
| | - O Szenci
- MTA-SZIE Large Animal Clinical Research Group, Üllő-Dóra major H-2225, Hungary
| | - V Jurkovich
- Department of Animal Hygiene, Herd Health and Veterinary Ethology, University of Veterinary Medicine, István utca 2, Budapest H-1078, Hungary
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Unruh EM, Theurer ME, White BJ, Larson RL, Drouillard JS, Schrag N. Evaluation of infrared thermography as a diagnostic tool to predict heat stress events in feedlot cattle. Am J Vet Res 2017. [PMID: 28650235 DOI: 10.2460/ajvr.78.7.771] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether infrared thermographic images obtained the morning after overnight heat abatement could be used as the basis for diagnostic algorithms to predict subsequent heat stress events in feedlot cattle exposed to high ambient temperatures. ANIMALS 60 crossbred beef heifers (mean ± SD body weight, 385.8 ± 20.3 kg). PROCEDURES Calves were housed in groups of 20 in 3 pens without any shade. During the 6 am and 3 pm hours on each of 10 days during a 14-day period when the daily ambient temperature was forecasted to be > 29.4°C, an investigator walked outside each pen and obtained profile digital thermal images of and assigned panting scores to calves near the periphery of the pen. Relationships between infrared thermographic data and panting scores were evaluated with artificial learning models. RESULTS Afternoon panting score was positively associated with morning but not afternoon thermographic data (body surface temperature). Evaluation of multiple artificial learning models indicated that morning body surface temperature was not an accurate predictor of an afternoon heat stress event, and thermographic data were of little predictive benefit, compared with morning and forecasted weather conditions. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated infrared thermography was an objective method to monitor beef calves for heat stress in research settings. However, thermographic data obtained in the morning did not accurately predict which calves would develop heat stress later in the day. The use of infrared thermography as a diagnostic tool for monitoring heat stress in feedlot cattle requires further investigation.
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Mallette MM, Hodges GJ, McGarr GW, Gabriel DA, Cheung SS. Spectral analysis of reflex cutaneous vasodilatation during passive heat stress. Microvasc Res 2017; 111:42-48. [PMID: 28065673 DOI: 10.1016/j.mvr.2016.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 11/19/2022]
Abstract
Previous work has demonstrated that spectral analysis is a useful tool to non-invasively ascertain the mechanisms of control of the cutaneous circulation. The majority of work using spectral analysis has focused on local control mechanisms, with none examining reflex control. Skin blood flow was analysed using spectral analysis on the dorsal aspect of the forearm of 7 males and 7 females during passive heat stress, with mean forearm and local temperature at the site of measurement maintained at thermoneutral (33°C) to minimize the effect of local control mechanisms. Participants were passively heated to ~1.2±0.1°C above baseline rectal temperature (d=4.0, P<0.001) using a water-perfused, tube lined suit, with skin blood flow assessed using a laser-Doppler probe with an integrated temperature monitor. Spectral analysis was performed using a Morlet wavelet on the entire data set, with median power extracted during 20min of data during baseline (normothermia) and hyperthermia. Passive heat stress significantly increased laser-Doppler flux above baseline (d=4.7, P<0.001). Spectral power of the endothelial nitric oxide-independent (0.005-0.01Hz; d=1.1, P=0.004), neurogenic (0.2-0.05Hz; d=0.6, P=0.025), myogenic (0.05-0.15Hz; d=1.5, P=0.002), respiratory (0.15-0.4Hz; d=1.4 P=0.002), and cardiac (0.4-2.0Hz; d=1.1, P=0.012) frequency intervals increased with passive heat stress. In contrast, the endothelial nitric oxide-dependent frequency interval did not change (0.01-0.02Hz; d=0.3, P=0.09) with passive heat stress. These data suggest that cutaneous reflex vasodilatation is neurogenic in origin and not mediated by endothelial-nitric oxide synthase, and are congruent with invasive examinations of reflex cutaneous vasodilatation.
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Affiliation(s)
- Matthew M Mallette
- Environmental Ergonomics Laboratory, Department of Kinesiology, Brock University, St. Catharines, Canada
| | - Gary J Hodges
- Environmental Ergonomics Laboratory, Department of Kinesiology, Brock University, St. Catharines, Canada
| | - Gregory W McGarr
- Environmental Ergonomics Laboratory, Department of Kinesiology, Brock University, St. Catharines, Canada
| | - David A Gabriel
- Electromyographic Kinesiology Laboratory, Department of Kinesiology, Brock University, St. Catharines, Canada
| | - Stephen S Cheung
- Environmental Ergonomics Laboratory, Department of Kinesiology, Brock University, St. Catharines, Canada.
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Schauer SG, Pfaff JA. A Soldier With an Exertional Heat Injury, Ischemic-Appearing Electrocardiogram, and Elevated Troponins: A Clinical Case Report. J Spec Oper Med 2017; 17:14-16. [PMID: 28285475 DOI: 10.55460/ka54-5lbt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 06/06/2023]
Abstract
Heat injuries are a common occurrence in the military training setting due to both the physically demanding nature of the training and the environments in which we train. Testing is often done after the diagnosis of a heat injury to screen for abnormalities. We present the case of a 20-year-old male Soldier with an abnormal electrocardiogram (ECG) with a possible injury pattern and an elevated troponin level. He underwent a diagnostic cardiac angiogram, which demonstrated no abnormal findings. He was returned to duty upon recovery from the catheterization. Ischemic-appearing ECG and troponin findings may be noted after heat injury. In this case, it was not associated with any cardiac lesions.
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Abstract
Heat-related illnesses can occur in workplaces where hot environments pose a threat to at-risk workers. Operations involving high air temperatures and humidity, radiant heat sources, direct physical contact with hot objects, or strenuous physical activities have potential for inducing heat stress in employees engaged in job functions in specific industries. Exposure to high temperatures can lead to a progression of symptoms in the body, which can result in widespread tissue damage, organ damage, and even death if not treated in a timely and effective manner. Strategies to reduce the effects of heat in the workplace include engineering controls, administrative controls, and personal protective equipment. Occupational and environmental health nurses must be able to recognize and treat the broad range of symptoms that can result from exposure to high temperatures. They must work together with interdisciplinary teams to provide training and education to the work force so that workers are able to take appropriate measures to prevent the onset of a heat-related illness, recognize the early symptoms, and seek treatment. Interdisciplinary teams must ensure that appropriate controls in the work environment reduce the risk of heat exposure and related heat stress disorders. Education and early intervention are key to avoiding heat-induced illness and eliminating or minimizing the effects of high temperature environments.
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Affiliation(s)
- Bonnie Rogers
- North Carolina Occupational Safety and Health Education and Research Center and Occupational Health Nursing Program, University of North Carolina, School of Public Health, Chapel Hill, NC, USA
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Glancy DL. Syncope on a Hot Summer Day. Am J Cardiol 2016; 117:1998-2000. [PMID: 27131612 DOI: 10.1016/j.amjcard.2016.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/16/2016] [Accepted: 03/16/2016] [Indexed: 11/28/2022]
Abstract
In a 63-year-old man, episodes of ventricular tachycardia causing syncope and myocardial infarction are the first manifestations of triple vessel coronary disease in the absence of arteriographic evidence of a fresh occlusion.
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Affiliation(s)
- David Luke Glancy
- Section of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana.
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Elgendi M, Fletcher R, Norton I, Brearley M, Abbott D, Lovell NH, Schuurmans D. On Time Domain Analysis of Photoplethysmogram Signals for Monitoring Heat Stress. Sensors (Basel) 2015; 15:24716-34. [PMID: 26404271 PMCID: PMC4634460 DOI: 10.3390/s151024716] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/14/2015] [Accepted: 09/21/2015] [Indexed: 11/30/2022]
Abstract
There are a limited number of studies on heat stress dynamics during exercise using the photoplethysmogram (PPG) and its second derivative (APG). However, we investigate the most suitable index from short PPG signal recordings for heat stress assessment. The APG waveform consists of a, b, c and d waves in systole and an e wave in diastole. Our preliminary results indicate that the use of the energy of aa area, derived from PPG signals measured from emergency responders in tropical conditions, is promising in determining the heat stress level using 20-s recordings. After examining 14 time domain features using leave-one-out cross-validation, we found that the aa energy extracted from PPG signals is the most informative feature for classifying heat-stressed subjects, with an overall accuracy of 79%. Moreover, the combination of the aa energy with the traditional heart rate variability index of heat stress (i.e., the square root of the mean of the squares of the successive aa intervals) improved the heat stress detection to an overall accuracy of 83%.
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Affiliation(s)
- Mohamed Elgendi
- Electrical and Computer Engineering in Medicine Group, University of British Columbia and BC Children's Hospital, Vancouver, BC V6H 3N1, Canada.
- Department of Computing Science, University of Alberta, Edmonton, AB T6G 2E8, Canada.
| | - Rich Fletcher
- Media Lab, Massachusetts Institute of Technology, Boston, MA 02139, USA.
| | - Ian Norton
- National Critical Care and Trauma Response Centre, Darwin, NT 0810, Australia.
| | - Matt Brearley
- National Critical Care and Trauma Response Centre, Darwin, NT 0810, Australia.
| | - Derek Abbott
- School of Electrical and Electronic Engineering, University of Adelaide, Adelaide, SA 5005, Australia.
| | - Nigel H Lovell
- Graduate School of Biomedical Engineering, UNSW, Sydney, NSW 2052, Australia.
| | - Dale Schuurmans
- Department of Computing Science, University of Alberta, Edmonton, AB T6G 2E8, Canada.
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Bishop-Williams KE, Berke O, Pearl DL, Kelton DF. A spatial analysis of heat stress related emergency room visits in rural Southern Ontario during heat waves. BMC Emerg Med 2015; 15:17. [PMID: 26245846 PMCID: PMC4527124 DOI: 10.1186/s12873-015-0043-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 07/28/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In Southern Ontario, climate change may have given rise to an increasing occurrence of heat waves since the year 2000, which can cause heat stress to the general public, and potentially have detrimental health consequences. Heat waves are defined as three consecutive days with temperatures of 32 °C and above. Heat stress is the level of discomfort. A variety of heat stress indices have been proposed to measure heat stress (e.g., the heat stress index (HSI)), and has been shown to predict increases in morbidity and/or mortality rates in humans and other species. Maps visualizing the distribution of heat stress can provide information about related health risks and insight for control strategies. Information to inform heat wave preparedness models in Ontario was previously only available for major metropolitan areas. METHODS Hospitals in communities of fewer than 100,000 individuals were recruited for a pilot study by telephone. The number of people visiting the emergency room or 24-hour urgent care service was collected for a total of 27 days, covering three heat waves and six 3-day control periods from 2010-2012. The heat stress index was spatially predicted using data from 37 weather stations across Southern Ontario by geostatistical kriging. Poisson regression modeling was applied to determine the rate of increased number of emergency room visits in rural hospitals with respect to the HSI. RESULTS During a heat wave, the average rate of emergency room visits was 1.11 times higher than during a control period (IRR = 1.11, CI95% (IRR) = (1.07,1.15), p ≤ 0.001). In a univariable model, HSI was not a significant predictor of emergency room visits, but when accounting for the confounding effect of a spatial trend polynomial in the hospital location coordinates, a one unit increase in HSI predicted an increase in daily emergency rooms visits by 0.4% (IRR = 1.004, CI95%(IRR) = (1.0005,1.007), p = 0.024) across the region. One high-risk cluster and no low risk clusters were identified in the southwestern portion of the study area by the spatial scan statistic during heat waves. The high-risk cluster is located in a region with high levels of heat stress during heat waves. CONCLUSIONS This finding will aid hospitals and rural public health units in preventing and preparing for emergencies of foreseeable heat waves. Future research is needed to assess the relation between heat stress and individual characteristics and demographics of rural communities in Ontario.
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Affiliation(s)
- Katherine E Bishop-Williams
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, N1G 2W1, Canada.
| | - Olaf Berke
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, N1G 2W1, Canada.
| | - David L Pearl
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, N1G 2W1, Canada.
| | - David F Kelton
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, N1G 2W1, Canada.
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Chan APC, Yang Y. Practical on-site measurement of heat strain with the use of a perceptual strain index. Int Arch Occup Environ Health 2015; 89:299-306. [PMID: 26139094 DOI: 10.1007/s00420-015-1073-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 06/24/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES There have been increased interests in research on quantifying heat strain of construction workers and formulating corresponding guidelines for working in hot weather. The aim of this study was to validate a subjective measurement tool, the perceptual strain index (PeSI), for measuring heat strain in real-work settings. METHODS A total of sixteen construction workers were invited to participate in the field surveys. Empiric-based human monitoring was carried out with simultaneous micrometeorological (wet-bulb globe temperature, WBGT), physiological (heart rate, HR), and perceptual (perceived exertion, RPE; thermal sensation, TS) measurements throughout the test. The relative heart rate (RHR), the physiological strain index (PSIHR), and the PeSI were then calculated accordingly. RESULTS The PeSI exhibited moderate correlations with WBGT and RHR (r = 0.42 and 0.40, respectively), which indicated the PeSI was sensitive to the variants of WBGT and RHR. The results of regression analysis indicated that the PeSI changed in the same general manner as the PSIHR, with a relatively large determination coefficient (R(2) = 0.67). The established perceptual strain zone illustrated that the PeSI ranging from 7 to 8 would be the exposure limit of construction workers in hot weather. CONCLUSION The PeSI is a simple, robust, reliable, and user-friendly tool for heat strain assessment in occupational settings. The perceptual strain zone will provide practical guidelines for on-site heat strain monitoring for construction workers.
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Affiliation(s)
- Albert P C Chan
- Department of Building and Real Estate, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Y Yang
- Department of Building and Real Estate, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China.
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35
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Augustine JJ. Severe Heat Illness. What's the key to recognizing a patient in danger? EMS World 2015; 44:15-19. [PMID: 26137834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Dehghan H, Mortzavi SB, Jafari MJ, Maracy MR. Development and Validation of a Questionnaire for Preliminary Assessment of Heat Stress at Workplace. J Res Health Sci 2015; 15:175-181. [PMID: 26411664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 06/02/2015] [Accepted: 06/30/2015] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Current heat stress indices are not completely suitable for heat strain screening in developing countries due to their inherent and applied limitations. The aim of this study was development of a questionnaire method entitled "Heat Strain Score Index" (HSSI) in order to perform a preliminary assessment of heat stress at work. METHODS This research included six phases (i) Item generation (ii) Content validity (iii) Reliability analysis (iv)Structure validity (v) Concurrent validity and (vi) Classification of thermal risk level. In item generation phase, 40 items were identified to have impact on the heat strain. Content validity was evaluated by occupational health specialists. RESULTS In consistency assessment, Cronbach's coefficient (α) of items was 0.91. Exploratory factor analysis on items HSSI draft identified four subscales which explained 71.6% of the variance. Correlation between the HSSI score with aural temperature was 0.73. Cut-off point; sensitivity and specificity for upper no thermal strain zone were 13.5, 91% and 50%, respectively. Whereas Cut-off point, sensitivity and specificity for lower thermal strain zone were 18, 86% and 73%. CONCLUSIONS The results showed that 18 variables that were measurable through subjective judgment and observation in the HSSI scale covered heat stress key factors. This scale demonstrated reliability and initial validity in scale were suitable. Therefore HSSI scale for primary evaluation heat stress is appropriate.
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Affiliation(s)
- Habibollah Dehghan
- Department of Occupational Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Seyed Bagher Mortzavi
- Department of Occupational Health Engineering, School of Medicine, Tarbiat Modares University, Tehran,
| | - Mohamad Javad Jafari
- Department of Occupational Health Engineering, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohamad Reza Maracy
- Environment Research Center and Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Sankoff J. Heat illnesses: a hot topic in the setting of global climate change. Aust Fam Physician 2015; 44:22-26. [PMID: 25688955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Heat illnesses affect a large number of people every year and are becoming an increasing cause of pathology as climate change results in increasing global temperatures. OBJECTIVE This article will review the physiological responses to heat, as well as the pathophysiological processes that result in heat illnesses. The emphasis will be on providing general practitioners (GPs) with an understanding of how to prevent heat illness in their patients and how to predict who is most at risk. DISCUSSION Heat illnesses may be thought of as minor or major illnesses, any of which may present to the GP. Consideration must be given to identifying those who need more critical intervention and on when to transfer for higher-level of care.
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Affiliation(s)
- Jeffrey Sankoff
- MD, FACEP, Associate Professor, Emergency Medicine, University of Colorado, School of Medicine, Denver Health Medical Center, Denver, Colorado, USA
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Norton PL, Gold JR, Russell KE, Schulz KL, Porter BF. Camelid heat stress: 15 cases (2003-2011). Can Vet J 2014; 55:992-996. [PMID: 25320390 PMCID: PMC4187376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This case series describes novel findings associated with heat stress in 15 cases in South American camelids that had no pre-existing illnesses and which had clinical signs of illness after exposure to a warm environment. Novel findings include decreased packed cell volume and albumin concentration and mild spinal axonal degeneration. Heat stress should be considered in weak camelids with a history of hyperthermia.
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Groot E, Abelsohn A, Moore K. Practical strategies for prevention and treatment of heat-induced illness. Can Fam Physician 2014; 60:729-e394. [PMID: 25122818 PMCID: PMC4131963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Emily Groot
- Resident in public health and preventive medicine in the Department of Family Medicine at Queen's University in Kingston, Ont
| | - Alan Abelsohn
- Assistant Professor in the Department of Family and Community Medicine and the Dalla Lana School of Public Health at the University of Toronto in Ontario
| | - Kieran Moore
- Associate Professor in the Department of Family Medicine at Queen's University, and Associate Medical Officer of Health at Kingston, Frontenac and Lennox & Addington Public Health
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Santelli J, Sullivan JM, Czarnik A, Bedolla J. Heat illness in the emergency department: keeping your cool. Emerg Med Pract 2014; 16:1-22. [PMID: 25422847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Heat illness spans a broad spectrum of disease, with outcomes ranging from benign rash to fatal heat stroke. Heat illness is broadly divided into 2 types: classic and exertional. Both types occur as a result of exposure to elevated temperature with inadequate thermoregulation; however, classic illness occurs without preceding physical activity. Treatment consists of rapid cooling, fluid replacement, and physiologic support. Other milder forms of heat illness include heat fatigue, heat syncope, heat edema, and heat rash. Drugs, drug combinations, drug side effects, and infections can also cause or complicate heat illness and these manifestations may not respond to standard cooling maneuvers and treatments alone; each requires specific additional therapy or antidotes to reverse the cycle of heat and organ damage. This review examines the physiology, diagnosis, and treatment of exertional, classic, and drug-induced hypothermia. Field and prehospital diagnosis and treatment are also reviewed, with recommendations for rehydration and monitoring in rhabdomyolysis.
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Gaura E, Kemp J, Brusey J. Leveraging knowledge from physiological data: on-body heat stress risk prediction with sensor networks. IEEE Trans Biomed Circuits Syst 2013; 7:861-70. [PMID: 24473550 DOI: 10.1109/tbcas.2013.2254485] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The paper demonstrates that wearable sensor systems, coupled with real-time on-body processing and actuation, can enhance safety for wearers of heavy protective equipment who are subjected to harsh thermal environments by reducing risk of Uncompensable Heat Stress (UHS). The work focuses on Explosive Ordnance Disposal operatives and shows that predictions of UHS risk can be performed in real-time with sufficient accuracy for real-world use. Furthermore, it is shown that the required sensory input for such algorithms can be obtained with wearable, non-intrusive sensors. Two algorithms, one based on Bayesian nets and another on decision trees, are presented for determining the heat stress risk, considering the mean skin temperature prediction as a proxy. The algorithms are trained on empirical data and have accuracies of 92.1±2.9% and 94.4±2.1%, respectively when tested using leave-one-subject-out cross-validation. In applications such as Explosive Ordnance Disposal operative monitoring, such prediction algorithms can enable autonomous actuation of cooling systems and haptic alerts to minimize casualties.
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Tsuruta R, Todani M. [Predictive prognostic factors in severe patients]. Nihon Rinsho 2012; 70:976-980. [PMID: 22690603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
International classification of heat illness including heat stroke, heat exhaustion, the others is well known. However, the new classification from the grade III(severe) to the grade I(mild) is more common in Japan. There is a good correlation between the two classifications. The Heatstroke Surveillance Committee of the Japanese Association for Acute Medicine has collected the data using the new classification. The outcome of patients who were mechanically ventilated due to heat illness was not affected by cooling procedures but independently associated with systolic blood pressure and SpO2 at the scene, and arterial base excess on admission.
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Affiliation(s)
- Ryosuke Tsuruta
- Department of Emergency and Critical Care Medicine, Yamaguchi University Graduate School of Medicine
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Update: heat injuries, active component, U.S. Armed Forces, 2011. MSMR 2012; 19:14-6. [PMID: 22452717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In 2011, the number of service members treated for heat stroke (n=362) was higher than the number in 2010, but lower than the numbers in 2007-2009. Incidence rates of heat stroke were highest among males, service members in combat-specific occupations, in the Marine Corps and Army, and among those younger than 20 years of age. The number of service members treated for "other heat injuries" was higher in 2011 (n=2,652) than in any of the four prior years; however, there were fewer hospitalizations for "other heat injuries" in 2011 than in recent prior years. In contrast to heat stroke, the incidence rate of "other heat injuries" was higher among females than males and the rate among enlisted members was more than twice that of officers.
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Lee JY, Nakao K, Takahashi N, Son SY, Bakri I, Tochihara Y. Validity of infrared tympanic temperature for the evaluation of heat strain while wearing impermeable protective clothing in hot environments. Ind Health 2011; 49:714-725. [PMID: 22020015 DOI: 10.2486/indhealth.ms1291] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The purpose of this study was to investigate the validity of infrared tympanic temperature (IR T(ty)) as a thermal index to evaluate the heat strain of workers in hot environments, in comparison with rectal temperatures at various depths (T(re-4, -8, and -16) for 4, 8 and 16 cm from the anal sphincter). Eight males underwent twelve experimental conditions: two activities (rest and exercise) × three clothing levels [Control, HDPE (high-density polyethylene coverall) and PVC (polyvinyl chloride coverall) condition] × two air temperatures (25 and 32℃ with 50%RH). The results showed that 1) in the conditions with most heat strain (HDPE or PVC condition at 32℃), IR T(ty) was equal to or even higher than T(re); 2) during exercise, physiological strain index (PSI) using IR T(ty) did not underestimate PSI-values using T(re-16), and overestimated those PSI-values from T(re-16) in HDPE and PVC conditions at 32℃; 3) during exercise, the relationships between IR T(ty) and heart and total sweat rate were stronger than those between T(re-16) and heart and total sweat rate. These results indicated that IR T(ty) is valid as a thermal index to evaluate the heat strain of workers wearing impermeable protective coveralls in hot environments. However, the application of IR T(ty) is limited only for strenuous works wearing encapsulated personal protective clothing with a hood in heat.
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Affiliation(s)
- Joo-Young Lee
- Department of Human Science, Faculty of Design, Kyushu University, Fukuoka, Japan.
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Wright HE, Selkirk GA, Rhind SG, McLellan TM. Peripheral markers of central fatigue in trained and untrained during uncompensable heat stress. Eur J Appl Physiol 2011; 112:1047-57. [PMID: 21735219 DOI: 10.1007/s00421-011-2049-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 06/11/2011] [Indexed: 11/26/2022]
Abstract
The development of fatigue is more pronounced in the heat than thermoneutral environments; however, it is unclear whether biomarkers of central fatigue are consistent with the higher core temperature (T (c)) tolerated by endurance trained (TR) versus untrained (UT) during exertional heat stress (EHS). The purpose of this study was to examine the indicators of central fatigue during EHS in TR versus UT. Twelve TR and 11 UT males (mean ± SE [Formula: see text] = 70 ± 2 and 50 ± 1 mL kg LBM(-1) min(-1), respectively) walked on a treadmill to exhaustion (EXH) in 40°C (dry) wearing protective clothing. Venous blood was obtained at PRE and 0.5°C T (c) increments from 38 to 40°C/EXH. Free tryptophan (f-TRP) decreased dramatically at 39.5°C for the TR. Branch chain amino acids decreased with T (c) and were greater for UT than TR at EXH. Tyrosine and phenylalanine remained unchanged. Serum S100β was undetectable (<5 pg mL(-1)). Albumin was greater for the UT from PRE to 39.0°C and at EXH. Prolactin (PRL) responded to relative thermal strain with similar EXH values despite higher T (c) tolerated for TR (39.7 ± 0.09°C) than UT (39.0 ± 0.09°C). The high EXH PRL values for both groups support its use as a biomarker of the serotonin and dopamine interplay within the brain during the development of central fatigue.
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Affiliation(s)
- Heather E Wright
- Faculty of Health, Kinesiology and Health Science, York University, Toronto, ON, M3J 1P3, Canada.
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Abstract
CONTEXT Exertional heat illness (EHI) is the third leading cause of death among athletes, but with preparticipation screening, risk factors can be identified, and some EHIs can be prevented. OBJECTIVE To establish content validity of the Heat Illness Index Score (HIIS), a 10-item screening instrument designed to identify athletes at risk for EHI during a preparticipation examination. DESIGN Delphi study. SETTING The Delphi technique included semistructured face-to-face or telephone interviews and included electronic questionnaires administered via e-mail. PATIENTS OR OTHER PARTICIPANTS Six individuals with extensive research experience and/or clinical expertise in EHI participated as expert panelists. MAIN OUTCOME MEASURE(S) We used a Delphi panel technique (3 rounds) to evaluate the HIIS with the consensus of expert opinions. For round 1, we conducted face-to-face interviews with the panelists. For round 2, we solicited panelists' feedback of the transcribed data to ensure trustworthiness, then provided the participants with the revised HIIS and a questionnaire eliciting their levels of agreement for each revision from the previous round on a visual analog scale (11.4 cm) with extreme indicators of strongly disagree and strongly agree. We calculated the mean and SD for each revision and accepted when the mean was greater than 7.6 cm (agree) and the SD still permitted a positive response (> 5.7 cm), suggesting consensus. For round 3, we instructed participants to indicate their levels of agreement with each final, revised item and their levels of agreement with the entire instrument on a 4-point Likert scale (1 = strongly disagree, 4 = strongly agree). RESULTS In round 1, panelists supported all 10 items but requested various revisions. In round 2, 16.3% (7 of 43) revisions were rejected, and 2 revisions were modified. In round 3, 100% of panelists reported agreeing (n = 3 of 6) or strongly agreeing (n = 3 of 6) with the final instrument. CONCLUSIONS Panelists were able to achieve consensus and validated the content of the HIIS, as well as the instrument itself. Implementation and further analysis are necessary to effectively identify the diagnostic accuracy of the HIIS.
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Martello LS, Savastano H, Silva SL, Balieiro JCC. Alternative body sites for heat stress measurement in milking cows under tropical conditions and their relationship to the thermal discomfort of the animals. Int J Biometeorol 2010; 54:647-52. [PMID: 19908071 DOI: 10.1007/s00484-009-0268-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 08/11/2009] [Accepted: 08/13/2009] [Indexed: 05/20/2023]
Abstract
This study was conducted to determine the relationship among temperatures measured at different anatomical sites of the animal body and their daily pattern as indicative of the thermal stress in lactating dairy cows under tropical conditions. Environmental dry bulb (DBT) and black globe (BGT) temperatures and relative humidity (RH) were recorded. Rectal temperature (RT), respiratory frequency (RF), body surface (BST), internal base of tail (TT), vulva (VT) and auricular temperatures (AT) were collected, from 37 Black and White Holstein cows at 0700, 1300 and 1800 hours. RT showed a moderately and positive correlations with all body temperatures, ranging from 0.59 with TT to 0.64 with BST. Correlations among AT, VT and TT with RF were very similar (from 0.63 to 0.64) and were greater than those observed for RF with RT (0.55) or with BST (0.54). RF and RT were positively correlated to TT (0.63 and 0.59, respectively), AT (r = 0.63 for both) and VT (r = 0.64 and 0.63, respectively). Positive and very high correlations were observed among AT, VT and TT (from 0.94 to 0.97) indicating good association of temperatures measured in these anatomical sites. Correlations of BST with AT and VT were positive and very similar (0.71 and 0.72, respectively) and lower with TT (0.66). The AT, TT, VT and BST presented similar patterns and follow the variations of DBT through the day. Temperatures measured at different anatomical sites of the animal body have the potential to be used as indicative of the thermal stress in lactating dairy cows.
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Affiliation(s)
- Luciane S Martello
- Faculdade de Zootecnia e Engenharia de Alimentos (FZEA), Universidade de São Paulo, São Paulo, Brazil.
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Ilardi D. Extreme heat: a prevention guide to promote health and safety for all ages. School Nurse News 2010; 27:20-24. [PMID: 20476531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Cusack L, Arbon P, Ranse J. Pre-hospital clinical management of heat stress. Aust Nurs J 2010; 17:30-32. [PMID: 20358736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Lynette Cusack
- School of Nursing and Midwifery, Flinders University, South Australia
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Pietraszkiewicz T, Borodulin-Nadzieja L, Janocha A, Woźniak W, Stańda M. [Evaluation of telemetric method in the assessment of heat stress of copper miners]. Med Pr 2010; 61:35-42. [PMID: 20437887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the applicability of telemetric method in assessing heat stress of copper miners in a hot environment. MATERIAL AND METHODS The studies were conducted in 15 mining machine operators (working without air condition). The evaluated parameters were skin temperature, core temperature, heart rate and respiration rate. RESULTS In every examined miner we have obtained about 340 results (registrations of evaluated parameters during work shift) and this allowed us to evaluate physiological work cost and to determinate thermal homeostasis disturbances. CONCLUSIONS The telemetric method (VitalSense System) proved to be very useful in monitoring physiological parameters of miners working in a hot environment.
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