Kidney Function in Rice Workers Exposed to Heat and Dehydration in Costa Rica.

The aim of this study was to evaluate heat exposure, dehydration, and kidney function in rice workers over the course of three months, in Guanacaste, Costa Rica. We collected biological and questionnaire data across a three-month-period in male field (n = 27) and other (n = 45) workers from a rice company where chronic kidney disease of unknown origin (CKDu) is endemic. We used stepwise forward regression to determine variables associated with estimated glomerular filtration rate eGFR at enrollment and/or change in eGFR, and Poisson regression to assess associations with incident kidney injury (IKI) over the course of three months. Participants were 20−62 years old (median = 40 in both groups). Dehydration was common (≥37%) in both groups, particularly among other workers at enrollment, but field workers were more exposed to heat and had higher workloads. Low eGFR (<60 mL/min/1.73 m2) was more prevalent in field workers at enrollment (19% vs. 4%) and follow-up (26% vs. 7%). Field workers experienced incident kidney injury (IKI) more frequently than other workers: 26% versus 2%, respectively. Age (ß = −0.71, 95%CI: −1.1, −0.4), current position as a field worker (ß = −2.75, 95%CI: −6.49, 0.99) and past work in construction (ß = 3.8, 95%CI: −0.1, 7.6) were included in the multivariate regression model to explain eGFR at enrollment. The multivariate regression model for decreased in eGFR over three month included current field worker (ß = −3.9, 95%CI: −8.2, 0.4), current smoking (ß= −6.2, 95%CI: −13.7−1.3), dehydration (USG ≥ 1.025) at both visits (ß= −3.19, 95%CI: −7.6, 1.2) and pain medication at follow-up (ß= −3.2, 95%CI: −8.2, 1.95). Current fieldwork [IR (incidence rate) = 2.2, 95%CI 1.1, 5.8) and being diabetic (IR = 1.8, 95%CI 0.9, 3.6) were associated with IKI. Low eGFR was common in field workers from a rice company in Guanacaste, and being a field worker was a risk factor for IKI, consistent with the hypothesis that occupational heat exposure is a critical risk factor for CKDu in Mesoamerica.

Climate Trends at a Hotspot of Chronic Kidney Disease of Unknown Causes in Nicaragua, 1973-2014.

An ongoing epidemic of chronic kidney disease of uncertain etiology (CKDu) afflicts large parts of Central America and is hypothesized to be linked to heat stress at work. Mortality rates from CKDu appear to have increased dramatically since the 1970s. To explore this relationship, we assessed trends in maximum and minimum temperatures during harvest months between 1973 and 2014 as well as in the number of days during the harvest season for which the maximum temperature surpassed 35 °C. Data were collected at a weather station at a Nicaraguan sugar company where large numbers of workers have been affected by CKDu. Monthly averages of the daily maximum temperatures between 1996 and 2014 were also compared to concurrent weather data from eight Automated Surface Observing System Network weather stations across Nicaragua. Our objectives were to assess changes in temperature across harvest seasons, estimate the number of days that workers were at risk of heat-related illness and compare daily maximum temperatures across various sites in Nicaragua. The monthly average daily maximum temperature during the harvest season increased by 0.7 °C per decade between 1973 and 1990. The number of days per harvest season with a maximum temperature over 35 °C increased by approximately five days per year between 1974 and 1990, from 32 days to 114 days. Between 1991 and 2013, the number of harvest days with a maximum temperature over 35 °C decreased by two days per year, and the monthly average daily maximum temperature decreased by 0.3 °C per decade. Comparisons with weather stations across Nicaragua demonstrate that this company is located in one of the consistently hottest regions of the country.

Overheating or overcooling: heat transfer in the spot to fight against the pandemic obesity.

The prevalence of obesity has nearly doubled worldwide over the past three and a half decades, reaching pandemic status. Obesity is associated with decreased life expectancy and with an increased risk of metabolic, cardiovascular, nervous system diseases. Hence, understanding the mechanisms involved in the onset and development of obesity is mandatory to promote planned health actions to revert this scenario. In this review, common aspects of cold exposure, a process of heat generation, and exercise, a process of heat dissipation, will be discussed as two opposite mechanisms of obesity, which can be oversimplified as caloric conservation. A common road between heat generation and dissipation is the mobilization of Free Faty Acids (FFA) and Carbohydrates (CHO). An increase in energy expenditure (immediate effect) and molecular/metabolic adaptations (chronic effect) are responses that depend on SNS activity in both conditions of heat transfer. This cycle of using and removing FFA and CHO from blood either for heat or force generation disrupt the key concept of obesity: energy accumulation. Despite efforts in making the anti-obesity pill, maybe it is time to consider that the world's population is living at thermoneutrality since temperature-controlled places and the lack of exercise are favoring caloric accumulation.

Heat stress monitoring based on heart rate measurements.

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

Prevalence and Risk Factors for CKD Among Brickmaking Workers in La Paz Centro, Nicaragua.

RATIONALE & OBJECTIVE: In Central America, there is a high prevalence of chronic kidney disease (CKD) of nontraditional etiology often observed among agricultural workers. Few studies have assessed CKD prevalence among workers in nonagricultural occupations, which was the objective of this investigation. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: Male and female workers (n = 224) employed by artisanal brickmaking facilities in La Paz Centro, Nicaragua. PREDICTORS: Age, sex, education, smoking status, body mass index, alcohol consumption, water consumption, first-degree relative(s) with CKD, years worked, hours worked per week, job category, study visit (baseline and follow-up), and self-reported hypertension and diabetes. OUTCOMES: CKD defined as estimated glomerular filtration rate (eGFR) < 60mL/min/1.73m2 at 2 time points 4 months apart and CKD stage. ANALYTICAL APPROACH: A linear mixed-effects model with an unstructured covariance matrix was used to evaluate the association between demographics, occupational risk factors, and eGFR at baseline. The interaction between risk factors and time with change in eGFR was also evaluated. Multivariable logistic regression models were used to evaluate predictors of CKD. RESULTS: The CKD prevalence was 12.1% (n = 27), 100% of cases were male, 30% had stage 5 CKD (eGFR < 15mL/min/1.73m2), and 22% were younger than 35 years. Proportions of participants with eGFRs < 60mL/min/1.73m2 at baseline and follow-up were 13.8% and 15.2%, respectively. Linear regression analysis demonstrated significant predictors of lower kidney function at baseline including oven work, older age, lack of education, and having an immediate family member with CKD. Predictors of CKD identified using logistic regression analysis included oven work and lack of education. LIMITATIONS: Crude job classification measures, loss to follow-up, self-reported exposures. CONCLUSIONS: The prevalence of CKD is high in this population of brick workers, suggesting that the epidemic of CKD affecting Mesoamerica is not limited to agricultural workers. These results are consistent with the hypothesis that occupational heat exposure is a risk factor for kidney disease in this region.

Camphor, Applied Epidermally to the Back, Causes Snout- and Chest-Grooming in Rats: A Response Mediated by Cutaneous TRP Channels.

Thermoregulatory grooming, a behavioral defense against heat, is known to be driven by skin-temperature signals. Because at least some thermal cutaneous signals that drive heat defenses are likely to be generated by transient receptor potential (TRP) channels, we hypothesized that warmth-sensitive TRPs drive thermoregulatory grooming. Adult male Wistar rats were used. We showed that camphor, a nonselective agonist of several TRP channels, including vanilloid (V) 3, when applied epidermally to the back (500 mg/kg), caused a pronounced self-grooming response, including paw-licking and snout- and chest-"washing". By the percentage of time spent grooming, the response was similar to the thermoregulatory grooming observed during exposure to ambient warmth (32 °C). Ruthenium red (a non-selective antagonist of TRP channels, including TRPV3), when administered intravenously at a dose of 0.1 mg/kg, attenuated the self-grooming behavior induced by either ambient warmth or epidermal camphor. Furthermore, the intravenous administration of AMG8432 (40 mg/kg), a relatively selective TRPV3 antagonist, also attenuated the self-grooming response to epidermal camphor. We conclude that camphor causes the self-grooming behavior by acting on TRP channels in the skin. We propose that cutaneous warmth signals mediated by TRP channels, possibly including TRPV3, drive thermoregulatory self-grooming in rats.

Thymol supplementation effects on adrenocortical, immune and biochemical variables recovery in Japanese quail after exposure to chronic heat stress.

Chronic heat stress (CHS) exposure negatively impairs avian' immunoneuroendocrine interplay. Thymol has shown several bioactive properties including antioxidant, bactericidal, antifungal and gamma-aminobutyric acid modulator activities. Indeed, supplementation with thymol has been used with positive effects on poultry production and immune-related variables. This study evaluates whether a thymol dietary supplementation can be used as a new functional feed strategy to mitigate CHS deleterious effects on endocrine, biochemical and immune-related variables. Starting at 100 days of age, 24 fully adult Japanese quail were fed with a diet supplemented with thymol (≈80 mg/quail per day) and other 24 quail remained non-supplemented (control diet). Between 119 and 127 days of age, half of the quail within those groups were submitted to a CHS by increasing environmental temperature from 24°C to 34°C during the light phase and the other half remained at 24°C (non-stressed controls). A period of 3 days after CHS ended (during the recovery period), corticosterone, albumin, total proteins and globulins and glucose concentrations, inflammatory response, antibody production and heterophil to lymphocyte (H/L) ratio were assessed. No differences between groups were found in basal corticosterone concentrations. Total proteins, total globulins and glucose concentrations were found elevated in the previously CHS group compared with their control counterparts. Regardless of the previous CHS exposure, thymol supplementation increased albumin concentrations and inflammatory responses and decreased antibody titers. An interaction between thymol supplementation and prior CHS exposure was found on the H/L ratio. Quail previously exposed to CHS and supplemented with thymol showed similar H/L values than their control non-stressed counterparts, suggesting that thymol has a stress preventive effect on this variable. The present findings together with the already reported thymol bioactive properties, suggest that feed supplementation with this compound could be a useful strategy to help overcoming some of the CHS induced alterations.

Occupational Heat Stress and Kidney Health: From Farms to Factories.

Millions of workers around the world are exposed to high temperatures, intense physical activity, and lax labor practices that do not allow for sufficient rehydration breaks. The extent and consequences of heat exposure in different occupational settings, countries, and cultural contexts is not well studied. We conducted an in-depth review to examine the known effects of occupational heat stress on the kidney. We also examined methods of heat-stress assessment, strategies for prevention and mitigation, and the economic consequences of occupational heat stress. Our descriptive review summarizes emerging evidence that extreme occupational heat stress combined with chronic dehydration may contribute to the development of CKD and ultimately kidney failure. Rising global temperatures, coupled with decreasing access to clean drinking water, may exacerbate the effects of heat exposure in both outdoor and indoor workers who are exposed to chronic heat stress and recurrent dehydration. These changes create an urgent need for health researchers and industry to identify work practices that contribute to heat-stress nephropathy, and to test targeted, robust prevention and mitigation strategies. Preventing occupational heat stress presents a great challenge for a concerted multidisciplinary effort from employers, health authorities, engineers, researchers, and governments.

Physical performance and environmental conditions: 2014 World Soccer Cup and 2016 Summer Olympics in Brazil.

This editorial is for the special issue "Temperature sciences in Brazil" of the journal Temperature. It focuses on the physical performance and environmental conditions during the 2014 World Cup and the coming 2016 Summer Olympics. It emphasizes that a hot and humid environment imposes a great challenge to the human thermoregulation system, can lead to performance decrements, and increases the risk of developing hyperthermia. Adequate hydration, acclimatization, and body cooling strategies are effective interventions to minimize the risks associated with exercise in the heat.

A pilot field evaluation on heat stress in sugarcane workers in Costa Rica: What to do next?

BACKGROUND: Climate change is producing major impacts including increasing temperatures in tropical countries, like Costa Rica, where the sugarcane industry employs thousands of workers who are exposed to extreme heat. OBJECTIVES: This article outlines a pilot qualitative evaluation of working conditions and heat in the sugarcane industry. DESIGN: A literature review, direct observations and exploratory interviews with workers were conducted to reach a preliminary understanding of the dimensions of heat-related health issues in the sugarcane industry, as a basis for the design of future studies. RESULTS: The industry employs temporary workers from Nicaragua and Costa Rica as well as year-round employees. Temporary employees work 12-hour shifts during the harvest and processing ('zafra') season. In many cases, sugarcane field workers are required to carry their own water and often have no access to shade. Sugar mill workers are exposed to different levels of heat stress depending upon their job tasks, with the most intense heat and workload experienced by the oven ('caldera') cleaners. CONCLUSIONS: Research is needed to achieve better understanding of the multiple factors driving and interacting with heat exposures in the sugarcane industry in order to improve the health and safety of workers while maintaining worker productivity.