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Revisiting classical experiments on the impact of air resistance on metabolic rate, we aimed to overcome limitations of previous research, notably: low participant numbers (n=1-3), highly turbulent wind, and confounding effects of rising body temperature. In a custom-built wind tunnel with reduced turbulence, 14 participants (8 males, 6 females) walked (5 km.h-1) and ran on a treadmill (70%VÌO2max) at 0, 2, 4 and 6 m.s-1 headwind or tailwind in a counterbalanced design, with rest-breaks between each exposure to avoid rises in body core temperature. Oxygen consumption (VÌO2) exhibited strong linear relationships versus wind direction, dynamic pressure and air speed squared(Vwr2), lower in magnitude for headwind than tailwind. A moderate linear relationship was observed between heart rate, wind direction, dynamic pressure and Vwr2. Below 4 m⸱s-1, the effect of wind was well within inter- and intra-individual variation and equipment uncertainty, and only at wind speeds ≥4 m⸱s-1 did the differences in physiological responses reach statistical significance. Our data indicate that at running speeds below 4 m⸱s-1 (14.4 km/h), indoor treadmill and outdoor running are comparable in terms of the metabolic impact of air movement relative to the person. However, this does not extend to the thermoregulatory effect of wind, with outdoor running providing a higher cooling rate due to the self-generated wind created during running. By removing the confounding impact of core temperature rises, the observed effects of headwind were lower and those of tailwind larger than observed previously. In the context of middle-distance running, headwind created by running at 21.5 km.h-1 would result in a 2.2% increase of VÌO2. A relative tailwind of the same speed would lead to a 3.1% reduction.
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The purpose of this study was to investigate which climate/heat indices perform best in predicting heat-induced loss of physical work capacity (PWCloss). Integrating data from earlier studies, data from 982 exposures (75 conditions) exercising at a fixed cardiovascular load of 130 beats·min-1, in varying temperatures (15-50°C), humidities (20-80%), solar radiation (0-800 W·m-2), wind (0.2-3.5 m·s-1), and two clothing levels, were used to model the predictive power of ambient temperature, universal thermal climate index (UTCI), wet bulb globe temperature (WBGT), modified physiologically equivalent temperature (mPET), heat index, apparent temperature (AT), and wet bulb temperature (Twb) for the calculation of PWCloss, skin temperature (Tskin) and core-to-skin temperature gradient, and thermal perception (thermal sensation vote, TSV) in the heat. R2, RMSE, and Akaike information criterion were used indicating model performance. Indices not including wind/radiation in their calculation (Ta, heat index, AT, and Twb) struggled to provide consistent predictions across variables. For PWCloss and TSV, UTCI and WBGT had the highest predictive power. For Tskin, and core-to-skin temperature gradient, the physiological models UTCI and mPET worked best in seminude conditions, but clothed, AT, WBGT, and UTCI worked best. For all index predictions, Ta, vapor pressure, and Twb were shown to be the worst heat strain predictors. Although UTCI and WBGT had similar model performance using the full dataset, WBGT did not work appropriately in windy, hot-dry, conditions where WBGT predicted lower strain due to wind, whereas the empirical data, UTCI and mPET indicated that wind in fact increased the overall level of thermal strain. The findings of the current study highlight the advantages of using a physiological model-based index like UTCI when evaluating heat stress in dynamic thermal environments.NEW & NOTEWORTHY There is an urgent need to determine the optimal heat stress metric when forecasting the impact of heat stress on human performance, physiological stress, and perception. We analyzed a wealth of laboratory data, simulating heart rate (HR)-paced work with wide variations in air temperature, humidity, wind speed, solar radiation, and clothing. We conclude that the universal thermal climate index (UTCI) [followed by wet-bulb globe temperature (WBGT)] is the optimal heat index to reliably predict reductions in performance, and elevations in physiological and perceptual stress.
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Regulación de la Temperatura Corporal , Temperatura Corporal , Clima , Calor , Sensación Térmica , Humanos , Sensación Térmica/fisiología , Temperatura Corporal/fisiología , Regulación de la Temperatura Corporal/fisiología , Temperatura Cutánea/fisiología , Humedad , Viento , Masculino , Modelos BiológicosRESUMEN
Manual outdoor work is essential in many agricultural systems. Climate change will make such work more stressful in many regions due to heat exposure. The physical work capacity metric (PWC) is a physiologically based approach that estimates an individual's work capacity relative to an environment without any heat stress. We computed PWC under recent past and potential future climate conditions. Daily values were computed from five earth system models for three emission scenarios (SSP1-2.6, SSP3-7.0, and SSP5-8.5) and three time periods: 1991-2010 (recent past), 2041-2060 (mid-century) and 2081-2100 (end-century). Average daily PWC values were aggregated for the entire year, the growing season, and the warmest 90-day period of the year. Under recent past climate conditions, the growing season PWC was below 0.86 (86% of full work capacity) on half the current global cropland. With end-century/SSP5-8.5 thermal conditions this value was reduced to 0.7, with most affected crop-growing regions in Southeast and South Asia, West and Central Africa, and northern South America. Average growing season PWC could falls below 0.4 in some important food production regions such as the Indo-Gangetic plains in Pakistan and India. End-century PWC reductions were substantially greater than mid-century reductions. This paper assesses two potential adaptions-reducing direct solar radiation impacts with shade or working at night and reducing the need for hard physical labor with increased mechanization. Removing the effect of direct solar radiation impacts improved PWC values by 0.05 to 0.10 in the hottest periods and regions. Adding mechanization to increase horsepower (HP) per hectare to levels similar to those in some higher income countries would require a 22% increase in global HP availability with Sub-Saharan Africa needing the most. There may be scope for shifting to less labor-intensive crops or those with labor peaks in cooler periods or shift work to early morning.
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Agricultura , Cambio Climático , Calor , Productos Agrícolas , América del SurRESUMEN
The majority of research dealing with the impacts of the Himalayan climate on human physiology focuses on low air temperature, high wind speed, and low air pressure and oxygen content, potentially leading to hypothermia and hypoxia. Only a few studies describe the influence of the weather conditions in the Himalayas on the body's ability to maintain thermal balance. The aim of the present research is to trace the heat exchange between humans and their surroundings during a typical, 6-day summit attempt of Mount Everest in the spring and winter seasons. Additionally, an emergency night outdoors without tent protection is considered. Daily variation of the heat balance components were calculated by the MENEX_HA model using meteorological data collected at automatic weather stations installed during a National Geographic expedition in 2019-2020. The data represent the hourly values of the measured meteorological parameters. The research shows that in spite of extreme environmental conditions in the sub-summit zone of Mount Everest during the spring weather window, it is possible to keep heat equilibrium of the climbers' body. This can be achieved by the use of appropriate clothing and by regulating activity level. In winter, extreme environmental conditions in the sub-summit zone make it impossible to maintain heat equilibrium and lead to hypothermia. The emergency night in the sub-peak zone leads to gradual cooling of the body which in winter can cause severe hypothermia of the climber's body. At altitudes < 7000 m, climbers should consider using clothing that allows variation of insulation and active regulation of their fit around the body.
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Hipotermia , Montañismo , Humanos , Montañismo/fisiología , Estaciones del Año , Hipotermia/etiología , Calor , AltitudRESUMEN
Humans are unique among mammals in having a functionally naked body with a hair-covered scalp. Scalp hair is exceptionally variable across populations within Homo sapiens. Neither the function of human scalp hair nor the consequences of variation in its morphology have been studied within an evolutionary framework. A thermoregulatory role for human scalp hair has been previously suggested. Here, we present experimental evidence on the potential evolutionary function of human scalp hair and variation in its morphology. Using a thermal manikin and human hair wigs at different wind speeds in a temperature and humidity-controlled environment, with and without simulated solar radiation, we collected data on the convective, radiative, and evaporative heat fluxes to and from the scalp in relation to properties of a range of hair morphologies, as well as a naked scalp. We find evidence for a significant reduction in solar radiation influx to the scalp in the presence of hair. Maximal evaporative heat loss potential from the scalp is reduced by the presence of hair, but the amount of sweat required on the scalp to balance the incoming solar heat (i.e., zero heat gain) is reduced in the presence of hair. Particularly, we find that hair that is more tightly curled offers increased protection against heat gain from solar radiation.
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Regulación de la Temperatura Corporal , Cabello , Cuero Cabelludo , Cabello/anatomía & histología , Cabello/fisiología , Regulación de la Temperatura Corporal/fisiología , Humanos , Evolución Biológica , Agua , Viento , Energía SolarRESUMEN
The purpose of this study was to characterize thermoregulatory and performance responses of elite road-race athletes, while competing in hot, humid, night-time conditions during the 2019 IAAF World Athletic Championships. Male and female athletes, competing in the 20 km racewalk (n = 20 males, 24 females), 50 km racewalk (n = 19 males, 8 females), and marathon (n = 15 males, 22 females) participated. Exposed mean skin (Tsk) and continuous core body (Tc) temperature were recorded with infrared thermography and ingestible telemetry pill, respectively. The range of ambient conditions (recorded roadside) was 29.3°C-32.7°C air temperature, 46%-81% relative humidity, 0.1-1.7 m·s-1 air velocity, and 23.5°C-30.6°C wet bulb globe temperature. Tc increased by 1.5 ± 0.1°C but mean Tsk decreased by 1.5 ± 0.4°C over the duration of the races. Tsk and Tc changed most rapidly at the start of the races and then plateaued, with Tc showing a rapid increase again at the end, in a pattern mirroring pacing. Performance times were between 3% and 20% (mean = 113 ± 6%) longer during the championships compared with the personal best (PB) of athletes. Overall mean performance relative to PB was correlated with the wet-bulb globe temperature (WBGT) of each race (R2 = 0.89), but not with thermophysiological variables (R2 ≤ 0.3). As previously reported in exercise heat stress, in this field study Tc rose with exercise duration, whereas Tsk showed a decline. The latter contradicts the commonly recorded rise and plateau in laboratory studies at similar ambient temperatures but without realistic air movement.NEW & NOTEWORTHY This paper provides a kinetic observation of both core and skin temperatures in 108 elite athletes, during various outdoor competition events, adding to the very limited data so far available in the literature taken during elite competitions. The field skin temperature findings contrast previous laboratory findings, likely due to differences in relative air velocity and its impact on the evaporation of sweat. The rapid rise in skin temperature following cessation of exercise highlights the importance of infrared thermography measurements being taken during motion, not during breaks, when being used as a measurement of skin temperature during exercise.
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Regulación de la Temperatura Corporal , Deportes , Humanos , Masculino , Femenino , Regulación de la Temperatura Corporal/fisiología , Sudoración , Temperatura Cutánea , Ejercicio Físico/fisiología , CalorRESUMEN
Critical environmental limits are temperature-humidity thresholds above which heat balance cannot be maintained for a given metabolic heat production. This study examined the association between individual characteristics [sex, body surface area (AD), aerobic capacity (VÌo2max), and body mass (mb)] and critical environmental limits in young adults at low metabolic rates. Forty-four (20 M/24 F; 23 ± 4 yr) subjects were exposed to progressive heat stress in an environmental chamber at two low net metabolic rates (Mnet); minimal activity (MinAct; Mnet = â¼160 W) and light ambulation (LightAmb; Mnet = â¼260 W). In two hot-dry (HD; ≤25% rh) environments, ambient water vapor pressure (Pa = 12 or 16 mmHg) was held constant and dry-bulb temperature (Tdb) was systematically increased. In two warm-humid (WH; ≥50% rh) environments, Tdb was held constant at 34°C or 36°C, and Pa was systematically increased. The critical wet-bulb globe temperature (WBGTcrit) was determined for each condition. During MinAct, after entry of Mnet into the forward stepwise linear regression model, no individual characteristics were entered into the model for WH (R2adj = 0.01, P = 0.27) or HD environments (R2adj = -0.01, P = 0.44). During LightAmb, only mb was entered into the model for WH environments (R2adj = 0.44, P < 0.001), whereas only VÌo2max was entered for HD environments (R2adj = 0.22; P = 0.002). These data demonstrate negligible importance of individual characteristics on WBGTcrit during low-intensity nonweight-bearing (MinAct) activity with a modest impact of mb and VÌo2max during weight-bearing (LightAmb) activity in extreme thermal environments.NEW & NOTEWORTHY Our laboratory has recently published a series of papers establishing the upper ambient temperature-humidity thresholds for maintaining heat balance, termed critical environmental limits, in young adults. However, no studies have investigated the relative influence of individual characteristics, such as sex, body size, and aerobic fitness, on those environmental limits. Here, we demonstrate the contributions of sex, body mass, body surface area, and maximal aerobic capacity on critical wet-bulb globe temperature (WBGT) limits in young adults.
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Trastornos de Estrés por Calor , Calor , Humanos , Adulto Joven , Temperatura , Humedad , Ejercicio Físico , Temperatura CorporalRESUMEN
A real-time, noninvasive, and clinically applicable aging test in humans has yet to be established. Herein we propose a sweat- and wearable-based test to determine biological age. This test would empower users to monitor their aging process and take an active role in managing their lifestyle and health.
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Técnicas Biosensibles , Dispositivos Electrónicos Vestibles , Humanos , SudorRESUMEN
As a global industry, sport makes potentially significant contributions to climate change through both carbon emissions and influence over sustainability practices. Yet, evidence regarding impacts is uneven and spread across many disciplines. This paper investigates the impacts of sport emissions on climate and identifies knowledge gaps. We undertook a systematic and iterative meta-analysis of relevant literature (1992-2022) on organized and individual sports. Using a defined search protocol, 116 sources were identified that map to four sport-related themes: (1) carbon emissions and their measurement; (2) emissions control and decarbonization; (3) carbon sinks and offsets; and (4) behavior change. We find that mega sport events, elite sport, soccer, skiing, and golf have received most attention, whereas grass-roots and women's sport, activity in Africa and South America, cricket, tennis, and volleyball are understudied. Other knowledge gaps include carbon accounting tools and indicators for smaller sports clubs and active participants; cobenefits and tradeoffs between mitigation-adaptation efforts in sport, such as around logistics, venues, sports equipment, and facilities; geopolitical influence; and scope for climate change litigation against hosts and/or sponsors of carbon-intensive events. Among these, researchers should target cobenefits given their scope to deliver wins for both climate mitigation and risk management of sport.
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Carbono , Industrias , Femenino , Humanos , Cambio Climático , América del SurRESUMEN
High workplace temperatures negatively impact physical work capacity (PWC). Although PWC loss models with heat based on 1-h exposures are available, it is unclear if further adjustments are required to accommodate repeated work/rest cycles over the course of a full work shift. Therefore, we examined the impact of heat stress exposure on human PWC during a simulated work shift consisting of six 1-h work-rest cycles. Nine healthy males completed six 50-min work bouts, separated by 10-min rest intervals and an extended lunch break, on four separate occasions: once in a cool environment (15 °C/50% RH) and in three different air temperature and relative humidity combinations (moderate, 35 °C/50% RH; hot, 40 °C/50% RH; and very hot, 40 °C/70%). To mimic moderate to heavy workload, work was performed on a treadmill at a fixed heart rate of 130 beats·min-1. During each work bout, PWC was quantified as the kilojoules expended above resting levels. Over the shift, work output per cycle decreased, even in the cool climate, with the biggest decrement after the lunch break and meal consumption. Expressing PWC relative to that achieved in the cool environment for the same work duration, there was an additional 5(± 4)%, 7(± 6)%, and 16(± 7)% decrease in PWC when work was performed across a full work shift for the moderate, hot, and very hot condition respectively, compared with 1-h projections. Empirical models to predict PWC based on the level of heat stress (Wet-Bulb Globe Temperature, Universal Thermal Climate Index, Psychrometric Wet-Bulb Temperature, Humidex, and Heat Index) and the number of work cycles performed are presented.
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Trastornos de Estrés por Calor , Masculino , Humanos , Respuesta al Choque Térmico/fisiología , Calor , Regulación de la Temperatura Corporal/fisiología , Lugar de TrabajoRESUMEN
In a series of three companion papers published in this Journal, we identify and validate the available thermal stress indicators (TSIs). In this third paper, we conducted field experiments across nine countries to evaluate the efficacy of 61 meteorology-based TSIs for assessing the physiological strain experienced by individuals working in the heat. We monitored 372 experi-enced and acclimatized workers during 893 full work shifts. We continuously assessed core body temperature, mean skin temperature, and heart rate data together with pre/post urine specific gravity and color. The TSIs were evaluated against 17 published criteria covering physiological parameters, practicality, cost effectiveness, and health guidance issues. Simple meteorological parameters explained only a fraction of the variance in physiological heat strain (R2 = 0.016 to 0.427; p < 0.001), reflecting the importance of adopting more sophisticated TSIs. Nearly all TSIs correlated with mean skin temperature (98%), mean body temperature (97%), and heart rate (92%), while 66% of TSIs correlated with the magnitude of dehydration and 59% correlated with core body temperature (r = 0.031 to 0.602; p < 0.05). When evaluated against the 17 published criteria, the TSIs scored from 4.7 to 55.4% (max score = 100%). The indoor (55.4%) and outdoor (55.1%) Wet-Bulb Globe Temperature and the Universal Thermal Climate Index (51.7%) scored higher compared to other TSIs (4.7 to 42.0%). Therefore, these three TSIs have the highest potential to assess the physiological strain experienced by individuals working in the heat.
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In a series of three companion papers published in this Journal, we identify and validate the available thermal stress indicators (TSIs). In this first paper of the series, we conducted a systematic review (registration: INPLASY202090088) to identify all TSIs and provide reliable information regarding their use (funded by EU Horizon 2020; HEAT-SHIELD). Eight databases (PubMed, Agricultural and Environmental Science Collection, Web of Science, Scopus, Embase, Russian Science Citation Index, MEDLINE, and Google Scholar) were searched from database inception to 15 April 2020. No restrictions on language or study design were applied. Of the 879 publications identified, 232 records were considered for further analysis. This search identified 340 instruments and indicators developed between 200 BC and 2019 AD. Of these, 153 are nomograms, instruments, and/or require detailed non-meteorological information, while 187 can be mathematically calculated utilizing only meteorological data. Of these meteorology-based TSIs, 127 were developed for people who are physically active, and 61 of those are eligible for use in occupational settings. Information regarding the equation, operating range, interpretation categories, required input data, as well as a free software to calculate all 187 meteorology-based TSIs is provided. The information presented in this systematic review should be adopted by those interested in performing on-site monitoring and/or big data analytics for climate services to ensure appropriate use of the meteorology-based TSIs. Studies two and three in this series of companion papers present guidance on the application and validation of these TSIs, to guide end users of these indicators for more effective use.
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In a series of three companion papers published in this Journal, we identify and validate the available thermal stress indicators (TSIs). In this second paper of the series, we identified the criteria to consider when adopting a TSI to protect individuals who work in the heat, and we weighed their relative importance using a Delphi exercise with 20 experts. Two Delphi iterations were adequate to reach consensus within the expert panel (Cronbach's α = 0.86) for a set of 17 criteria with varying weights that should be considered when adopting a TSI to protect individuals who work in the heat. These criteria considered physiological parameters such as core/skin/mean body temperature, heart rate, and hydration status, as well as practicality, cost effectiveness, and health guidance issues. The 17 criteria were distributed across three occupational health-and-safety pillars: (i) contribution to improving occupational health (55% of total importance), (ii) mitigation of worker physiological strain (35.5% of total importance), and (iii) cost-effectiveness (9.5% of total importance). Three criteria [(i) relationship of a TSI with core temperature, (ii) having categories indicating the level of heat stress experienced by workers, and (iii) using its heat stress categories to provide recommendations for occupational safety and health] were considered significantly more important when selecting a TSI for protecting individuals who work in the heat, accumulating 37.2 percentage points. These 17 criteria allow the validation and comparison of TSIs that presently exist as well as those that may be developed in the coming years.
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The present comprehensive review (i) summarizes the current knowledge on the impacts of occupational heat stress on outdoor workers, (ii) provides a historical background on this issue, (iii) presents a meta-analysis of published data, (iv) explores inter-individual and intra-individual factors, (v) discusses the available heat mitigation strategies, (vi) estimates physical work capacity, labour productivity, and metabolic rate for the year 2030, and (vii) provides an overview of existing policy and legal frameworks on occupational heat exposure. Meta-analytic findings from 38 field studies that involved monitoring 2,409 outdoor workers across 41 jobs in 21 countries suggest that occupational heat stress increases the core (r = 0.44) and skin (r = 0.44) temperatures, as well as the heart rate (r = 0.38) and urine specific gravity (r = 0.13) of outdoor workers (all p < 0.05). Moreover, it diminishes the capacity of outdoor workers for manual labour (r = -0.82; p < 0.001) and is responsible for more than two thirds of the reduction in their metabolic rate. Importantly, our analysis shows that physical work capacity is projected to be highly affected by the ongoing anthropogenic global warming. Nevertheless, the metabolic rate and, therefore, labour productivity are projected to remain at levels higher than the workers' physical work capacity, indicating that people will continue to work more intensely than they should to meet their financial obligations for food and shelter. In this respect, complementary measures targeting self-pacing, hydration, work-rest regimes, ventilated garments, and mechanization can be adopted to protect outdoor workers.
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The present research describes the development and validation of a cardiovascular model (CVR Model) for use in conjunction with advanced thermophysiological models, where usually only a total cardiac output is estimated. The CVR Model detailed herein estimates cardio-dynamic parameters (changes in cardiac output, stroke volume, and heart rate), regional blood flow, and muscle oxygen extraction, in response to rest and physical workloads, across a range of ages and aerobic fitness levels, as well as during exposure to heat, dehydration, and altitude. The model development strategy was to first establish basic resting and exercise predictions for cardio-dynamic parameters in an "ideal" environment (cool, sea level, and hydrated person). This basic model was then advanced for increasing levels of altitude, heat strain, and dehydration, using meta-analysis and reaggregation of published data. Using the estimated altitude- and heat-induced changes in maximum oxygen extraction and maximum cardiac output, the decline in maximum oxygen consumption at high altitude and in the heat was also modeled. A validation of predicted cardiovascular strain using heart rate was conducted using a dataset of 101 heterogeneous individuals (1,371 data points) during rest and exercise in the heat and at altitude, demonstrating that the CVR Model performs well (R2 = 0.82-0.84) in predicting cardiovascular strain, particularly at a group mean level (R2 = 0.97). The development of the CVR Model is aimed at providing the Fiala thermal Physiology & Comfort (FPC) Model and other complex thermophysiological models with improved estimations of cardiac strain and exercise tolerance, across a range of individuals during acute exposure to environmental stressors.NEW & NOTEWORTHY The present research promotes the adaption of thermophysiological modeling to the estimation of cardiovascular strain in individuals exercising under acute environmental stress. Integration with advanced models of human thermoregulation opens doors for detailed numerical analysis of athletes' performance and physiology during exercise, occupational safety, and individual work tolerability. The research provides a simple-to-validate metric of cardiovascular function (heart rate), as well as a method to evaluate key principles influencing exercise- and thermoregulation in humans.
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Deshidratación , Ejercicio Físico , Gasto Cardíaco/fisiología , Ejercicio Físico/fisiología , Humanos , Modelos Teóricos , OxígenoRESUMEN
Many populations experience high seasonal temperatures. Pregnant women are considered vulnerable to extreme heat because ambient heat exposure has been linked to pregnancy complications including preterm birth and low birthweight. The physiological mechanisms that underpin these associations are poorly understood. We reviewed the existing research evidence to clarify the mechanisms that lead to adverse pregnancy outcomes in order to inform public health actions. A multi-disciplinary expert group met to review the existing evidence base and formulate a consensus regarding the physiological mechanisms that mediate the effect of high ambient temperature on pregnancy. A literature search was conducted in advance of the meeting to identify existing hypotheses and develop a series of questions and themes for discussion. Numerous hypotheses have been generated based on animal models and limited observational studies. There is growing evidence that pregnant women are able to appropriately thermoregulate; however, when exposed to extreme heat, there are a number of processes that may occur which could harm the mother or fetus including a reduction in placental blood flow, dehydration, and an inflammatory response that may trigger preterm birth. There is a lack of substantial evidence regarding the processes that cause heat exposure to harm pregnant women. Research is urgently needed to identify what causes the adverse outcomes in pregnancy related to high ambient temperatures so that the impact of climate change on pregnant women can be mitigated.
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Nacimiento Prematuro , Femenino , Procesos de Grupo , Calor , Humanos , Recién Nacido , Placenta , EmbarazoRESUMEN
A common effort for both military and civil healthcare is to achieve knowledge-based health care in cold weather injuries and fatal accidents in harsh arctic environment. The Cold Weather Operations Conference in November 2021, having more than 300 participants from 20 countries, was addressing the prevention and treatment of injuries and trauma care in cold weather conditions and the challenges for military prehospital casualty care. The intention of the programme was to stimulate further research and systematic knowledge-based clinical work. The abstracts from the conference present cold weather research and clinical experience relevant for readers of the International Journal of Circumpolar Health.