Heat-related mortality and ambulance transport after a power outage in the Tokyo metropolitan area.

Background: Air conditioners can prevent heat-related illness and mortality, but the increased use of air conditioners may enhance susceptibility to heat-related illnesses during large-scale power failures. Here, we examined the risks of heat-related illness ambulance transport (HIAT) and mortality associated with typhoon-related electricity reduction (ER) in the summer months in the Tokyo metropolitan area. Methods: We conducted event study analyses to compare temperature-HIAT and mortality associations before and after the power outage (July to September 2019). To better understand the role of temperature during the power outage, we then examined whether the temperature-HIAT and mortality associations were modified by different power outage levels (0%, 10%, and 20% ER). We computed the ratios of relative risks to compare the risks associated with various ER values to the risks associated without ER. Results: We analyzed the data of 14,912 HIAT cases and 74,064 deaths. Overall, 93,200 power outage cases were observed when the typhoon hit. Event study results showed that the incidence rate ratio was 2.01 (95% confidence interval [CI] = 1.42, 2.84) with effects enduring up to 6 days, and 1.11 (95% CI = 1.02, 1.22) for mortality on the first 3 days after the typhoon hit. Comparing 20% to 0% ER, the ratios of relative risks of heat exposure were 2.32 (95% CI = 1.41, 3.82) for HIAT and 0.95 (95% CI = 0.75, 1.22) for mortality. Conclusions: A 20% ER was associated with a two-fold greater risk of HIAT because of summer heat during the power outage, but there was little evidence for the association with all-cause mortality.

Community-Based Trial Educational Heat Disorder Program in Local Salons for Older Adults.

We investigated whether a combined program for heat disorder prevention can improve the behaviors and knowledge of heat disorder prevention in older adults participating in salons. This non-randomized parallel-group comparison study includes 59 participants from two salons. The intervention group met on alternate weeks on a salon day to watch an educational DVD and conduct hands-on education (Wet-Bulb Globe Temperature (WBGT) measurements inside and outside the meeting place). The intervention group conducted calls every other week except salon week to prevent action for heat disorder prevention information based on a leaflet and monitored WBGT in their bedrooms daily at bedtime. We assessed changes in recognition of heat disorders and prevention behavior between baseline, one and a half months after intervention, and post-season (approximately two months after baseline), using the Wilcoxon signed rank test. Recognition of heat disorder scores and preventive behavior improved from pre- to post-season in the intervention group. It was suggested that the approach toward older adults participating in salons could improve their recognition and behavior in preventing heat disorders.

Multiparametric cardiac magnetic resonance reveals persistent myocardial inflammation in patients with exertional heat illness.

OBJECTIVES: To explore the clinical potential of multiparametric cardiac magnetic resonance (CMR) in evaluating myocardial inflammation in patients with exertional heat illness (EHI). METHODS: This prospective study enrolled 28 males with EHI (18 patients with exertional heat exhaustion (EHE) and 10 with exertional heat stroke (EHS)) and 18 age-matched male healthy controls (HC). All subjects underwent multiparametric CMR, and 9 patients had follow-up CMR measurements 3 months after recovery from EHI. CMR-derived left ventricular geometry, function, strain, native T1, extracellular volume (ECV), T2, T2*, and late gadolinium enhancement (LGE) were obtained and compared among different groups. RESULTS: Compared with HC, EHI patients showed increased global ECV, T2, and T2* values (22.6% ± 4.1 vs. 19.7% ± 1.7; 46.8 ms ± 3.4 vs. 45.1 ms ± 1.2; 25.5 ms ± 2.2 vs. 23.8 ms ± 1.7; all p < 0.05). Subgroup analysis showed that ECV was higher in the EHS patients than those in EHE and HC groups (24.7% ± 4.9 vs. 21.4% ± 3.2, 24.7% ± 4.9 vs. 19.7% ± 1.7; both p < 0.05). Repeated CMR measurements at 3 months after baseline CMR showed persistently higher ECV than HC (p = 0.042). CONCLUSIONS: With multiparametric CMR, EHI patients demonstrated increased global ECV, T2, and persistent myocardial inflammation at 3-month follow-up after EHI episode. Therefore, multiparametric CMR might be an effective method in evaluating myocardial inflammation in patients with EHI. CLINICAL RELEVANCE STATEMENT: This study showed persistent myocardial inflammation after an exertional heat illness (EHI) episode demonstrated by multiparametric CMR, which is a potential promising method to evaluate the severity of myocardial inflammation and guide return to work, play, or duty in EHI patients. KEY POINTS: • EHI patients showed an increased global extracellular volume (ECV), late gadolinium enhancement, and T2 value, indicating myocardial edema and fibrosis. • ECV was higher in the exertional heat stroke patients than exertional heat exhaustion and healthy control groups (24.7% ± 4.9 vs. 21.4% ± 3.2, 24.7% ± 4.9 vs. 19.7% ± 1.7; both p < 0.05). • EHI patients showed persistent myocardial inflammation with higher ECV than healthy controls 3 months after index CMR (22.3% ± 2.4 vs. 19.7% ± 1.7, p = 0.042).

Thermoregulatory, Cardiovascular and Perceptual Responses of Spectators of a Simulated Football Match in Hot and Humid Environmental Conditions.

Major sporting events are often scheduled in thermally challenging environments. The heat stress may impact athletes but also spectators. We examined the thermal, cardiovascular, and perceptual responses of spectators watching a football match in a simulated hot and humid environment. A total of 48 participants (43 ± 9 years; n = 27 participants <50 years and n = 21 participants ≥50 years, n = 21) watched a 90 min football match in addition to a 15 min baseline and 15 min halftime break, seated in an environmental chamber (Tair = 31.9 ± 0.4 °C; RH = 76 ± 4%). Gastrointestinal temperature (Tgi), skin temperature (Tskin), and heart rate (HR) were measured continuously throughout the match. Mean arterial pressure (MAP) and perceptual parameters (i.e., thermal sensation and thermal comfort) were scored every 15 min. Tri (37.3 ± 0.4 °C to 37.4 ± 0.3 °C, p = 0.11), HR (76 ± 15 bpm to 77 ± 14 bpm, p = 0.96) and MAP (97 ± 10 mm Hg to 97 ± 10 mm Hg, p = 0.67) did not change throughout the match. In contrast, an increase in Tskin (32.9 ± 0.8 °C to 35.4 ± 0.3 °C, p < 0.001) was found. Further, 81% of participants reported thermal discomfort and 87% a (slightly) warm thermal sensation at the end of the match. Moreover, the thermal or cardiovascular responses were not affected by age (all p-values > 0.05). Heat stress induced by watching a football match in simulated hot and humid conditions does not result in substantial thermal or cardiovascular strain, whereas a significant perceptual strain was observed.

Consistency and applicability of return to function guidelines in tactical-athletes with exertional heat illness. A systematic review.

OBJECTIVE: To assess the consistency of return to sport and occupation recommendations following EHI provided in published clinical practice guidelines, consensus statements, position statements, and practice alerts. The agreement between medical policies governing the return to duty following EHI between the branches of the United States Armed Forces and published recommendations was assessed. METHODS: Ovid MEDLINE, Web of Science, and CINAHL databases were searched for clinical practice guidelines and position statements published at any time that guided return to activity in individuals with EHI. Methodological quality was assessed, and the specific recommendations for clinical management were extracted. Consistency of recommendations was evaluated. Agreement between published guidelines and the policies governing return to activity in military tactical athletes with heat injury were also evaluated. RESULTS: Guidelines developed by two civilian sports medicine societies in the United States detailing recommendations for return to function following EHI were identified. There was consistency between guidelines regarding recommendations that addressed abstinence from activity; medical follow-up; graded resumption of activity; and return to function. Pertaining military policy, contemporary regulations published in recent years reflected the recommendations provided in the professional guidelines. The greatest incongruence was noted in older military policies. CONCLUSIONS: This systematic review highlights the need for consistent recommendations across all branches of the military and medical specialties pertaining to returning servicemembers to duty after EHI .

La salud humana frente al estrés térmico por el cambio climático

Introducción: La alteración del clima planetario, atribuida directa o indirectamente a la actividad humana, que modifica la composición de la atmósfera mundial y se suma a la variabilidad natural del clima, es conocida como cambio climático global. Sus efectos en la salud, directos e indirectos, ya presentes, perturbarán a la mayoría de las poblaciones en las próximas décadas y pondrán en riesgo la vida y el bienestar de miles de millones de personas. Objetivo: Describir, a partir de una revisión, los principales riesgos para la salud humana derivados de la mayor frecuencia e intensidad de episodios de estrés térmico derivados del cambio climático. Métodos: Se realizó una revisión bibliográfica relativa a los efectos de la temperatura sobre la salud humana, así como su influencia sobre la mortalidad general, en el periodo 2008 hasta 2021, en las bases de datos Scopus, PubMed/Medline, SciELO, Ebsco, LiLACS, así como, otras fuentes y recursos de información disponibles en Internet. Se utilizó el vocabulario controlado del Descriptor en Ciencias de la Salud. Resultados: Se recuperaron 32 publicaciones sobre de la influencia del clima y sus cambios en la salud humana que plantearon, por lo general, que las altas temperaturas guardaron relación con el incremento de la mortalidad principalmente por enfermedades cardiovasculares, cerebrovasculares y respiratorias, se han convertido en un contribuyente considerable a la carga de morbilidad. Conclusiones: Las temperaturas extremas incrementan la morbilidad y mortalidad agudas, principalmente en grupos de riesgo. La promoción de una adecuada hidratación y el uso de ropas adecuadas, ayudará a las personas en la prevención de afecciones por las temperaturas extremas, erigiéndose en acciones individuales de protección contra los efectos de la mayor frecuencia e intensidad de eventos de estrés térmico asociado al cambio climático, a incorporar a la cotidianidad.

Introduction: The alteration of the planetary climate, attributed directly or indirectly to human activity, which modifies the composition of the world atmosphere and adds to the natural variability of the climate, is known as global climate change. Its direct and indirect health effects, already present, will disturb most populations in the coming decades and put the lives and well-being of billions of people at risk. Objective: To describe, based on a review, the main risks to human health derived from the greater frequency and intensity of episodes of thermal stress derived from climate change. Methods: A bibliographic review was carried out regarding the effects of temperature on human health, as well as its influence on general mortality, in the period 2008 to 2021, in the Scopus, PubMed/Medline, SciELO, Ebsco, LiLACS, as well as other information sources and resources available on the Internet. The controlled vocabulary descriptors in Health Sciences were used. Results: 32 publications on the influence of climate and its changes on human health were recovered, which generally stated that high temperatures were related to the increase in mortality, mainly due to cardiovascular, cerebrovascular and respiratory diseases, and have become a significant contributor to the burden of disease. Conclusions: Extreme temperatures increase acute morbidity and mortality, mainly in risk groups. The promotion of adequate hydration and the use of adequate clothing will help people in the prevention of conditions caused by extreme temperatures, establishing individual actions to protect against the effects of the greater frequency and intensity of heat stress events associated with climate change, to incorporate into daily life.

Exertional heat fatalities in Australian sport and recreation.

OBJECTIVES: To describe the number and case characteristics of sport and recreation-related exertional heat deaths in Australia and summarise recommendations derived from case narratives. DESIGN: Descriptive, population-based, retrospective cohort study. METHODS: Cases were identified using the National Coronial Information System (NCIS) through multiple search strategies comprising queries, keywords and cause of death codes. Cases were included where there was evidence that the deceased was actively engaged in sport or recreation and exertional heat illness was causal or contributory to the death. Data extraction were performed independently, in duplicate, to ensure accuracy. Descriptive statistics are used to report deceased's socio-demographic characteristics, incident characteristics, type of sport/recreational activity and time sequence of events. Content analysis is used to summarise recommendations. RESULTS: Thirty-eight deaths (males n = 29, 74%; median age = 40 years, range 8-77) were identified during the study period (2001 to 2018), with 22 recommendations for five cases. Two cases occurred during organised sport and 36 during active recreation, of which 27 were in hiking. Eleven (29%) individuals were international visitors. There were 22 recommendations across 5 cases presented, with a focus on education and training. CONCLUSIONS: Exertional heat deaths in outdoor recreation in Australia were far more prevalent than cases in organised sport. The largest proportion of deaths occurred in hiking with two populations featuring: males aged 15-45 years and international visitors. Considering the incident characteristics and time sequence of events, measures such as early recognition of symptoms, provision of first aid and timely access to emergency medical care are important to prevent fatalities.

Sports related heat injury in Victoria, Australia: An analysis of 11 years of hospital admission and emergency department data.

OBJECTIVES: Heat injuries have become a considerable health risk for sport and exercise participants in Australia. This study seeks to update the Australian sports case numbers by considering data from hospital admission and emergency department (ED) presentations (collectively referred to as total hospitalisations). Specifically, this study aimed to report epidemiological features (incidence and case characteristics) for sport related heat injury (SRHI) cases treated in hospital, over an 11-year period in Victoria, Australia. DESIGN: Analysis of administrative health data. METHODS: Data were extracted from the Victorian Injury Surveillance Unit for hospital admissions and ED presentations separately using diagnosis and activity codes (focused on subgroups of T67 - effects of heat and light and U5000-U7100). Descriptive data were reported by age, sex, financial year and activity, and population trends reported for SRHI incidence rate. RESULTS: A total of 323 SRHI cases (ED=142, 44%; admissions=181, 56%) were identified, representing 10.2% of all heat injury cases (non-sport cases=2834). The highest number of SRHI cases were in golf (n=43, 13.3%) and lawn bowls (n=38, 11.8%). The age groups >65 and 15-34years reported a total of 114 cases (35.3%) and 106 cases (32.8%), respectively. CONCLUSIONS: Findings were consistent with previous Australian studies with SRHI comprising 10% of all heat injury cases. Strategies for SRHI awareness can be aimed at the age and sport groups with greater representation in the cases identified. We had expected several-times more ED presentations than admissions, suggesting fewer of the mild-moderate cases of SRHI attend for emergency care and that alternative data are needed to capture these.

From theory to practice: operationalizing a climate vulnerability for sport organizations framework for heat hazards among US High schools.

BACKGROUND: Sport organizations must comprehensively assess the degree to which their athletes are susceptible to exertional heat illnesses (i.e. vulnerable) to appropriately plan and adapt for heat-related hazards. Yet, no heat vulnerability framework has been applied in practice to guide decision making. OBJECTIVES: We quantify heat vulnerability of state-level requirements for health and safety standards affecting United States (US) high school athletes as a case study. DESIGN: Observational. METHODS: We utilize a newly developed climate vulnerability to sports organizations framework (CVSO), which considers the heat hazard of each state using summer maximum wet bulb globe temperature (WBGT) in combination with an 18-point heat safety scoring system (18 = best policy). Heat vulnerability is categorized as "problem" [higher heat (>27.9°C) and lower policy score (≤9)], "fortified" [higher heat (>27.9°C) and higher policy score (>9)], "responsive" [lower heat (<27.9°C) and lower policy score (≤9)], and "proactive" [lower heat (<27.9°C) and higher policy score (>9)]. RESULTS: Across the US, the mean WBGT was 28.4±2.4°C and policy score was 6.9±4.7. In combination, we observed organizations within each of the four vulnerability categories with 16% (n=8) in fortified, 16% (n=8) in proactive, 29% (n=15) in problem, and 39% (n=20) in responsive. CONCLUSIONS: The CSVO framework allowed us to identify different degrees of vulnerability among the state's and to highlight the 29% (n=15) of states with immediate needs for policy revisions. We found the CSVO framework to be highly adaptable in our application, suggesting feasibility for use with other sports governing bodies.

Research progress in mechanism and protection of high temperature environment influencing the body function / 中华创伤杂志

The thermal environment increases the risk of thermal injury for persons under high temperature environment. A full understanding of the effects and hazards of the thermal environment on the human body is of great significance to improve the awareness of persons under high temperature environment and reduce occupational heat damage during work. The authors mainly review the thermal environment from aspects of the definition, mechanism of its influence on main functional systems of the human body, influencing factors of heat stress and progress of protection, so as to provide references for the identification and protection of heat-induced diseases for workers under high temperature environment.

Thermal stress inside a disabled submarine.

BACKGROUND: Submarine operations require strict adherence to standard operating and safety procedures and errors in judgement or accidents could lead to catastrophe and impair the submarine's ability to surface. In case of disablement of a submarine (DISSUB), the crew would have to survive inside the submarine for a variable period awaiting rescue. Microclimate and habitability of the submarine would have to be maintained and crew would have to consume emergency rations and water. METHODS: In order to validate these procedures, a simulation was carried out in which 80 crew members were closed up inside a submarine in harbour for 24 h simulating a DISSUB situation without power and ventilation. RESULTS: Average temperature of the submarine compartments rose from 29.33 °C at the beginning of the simulation to 33.5 °C at the end of 24 h. Relative humidity increased from 79% to 87.67%. Crew members consumed an average to 973 kcal worth of rations during the 24 h of the exercise with 500 ml water. CONCLUSION: Submarine crew could survive successfully inside a disabled submarine awaiting rescue if thermal stress could be addressed. In the present simulation, the crew suffered from effects of thermal stress. Thermal stress would not only affect damage control capabilities, but could also lead the crew into earlier escape. Greater research and further studies are required to mitigate thermal stress and its effects in order to prolong survival.

Association Between Work-Related Hyperthermia Emergency Department Visits and Ambient Heat in Five Southeastern States, 2010-2012-A Case-Crossover Study.

The objective of this study is to assess ambient temperatures' and extreme heat events' contribution to work-related emergency department (ED) visits for hyperthermia in the southeastern United States to inform prevention. Through a collaborative network and established data framework, work-related ED hyperthermia visits in five participating southeastern U.S. states were analyzed using a time stratified case-crossover design. For exposure metrics, day- and location-specific measures of ambient temperatures and county-specific identification of extreme heat events were used. From 2010 to 2012, 5,017 work-related hyperthermia ED visits were seen; 2,298 (~46%) of these visits occurred on days when the daily maximum heat index was at temperatures the Occupational Safety and Health Administration designates as having "lower" or "moderate" heat risk. A 14% increase in risk of ED visit was seen for a 1°F increase in average daily mean temperature, modeled as linear predictor across all temperatures. A 54% increase in risk was seen for work-related hyperthermia ED visits during extreme heat events (two or more consecutive days of unusually high temperatures) when controlling for average daily mean temperature. Despite ambient heat being a well-known risk to workers' health, this study's findings indicate ambient heat contributed to work-related ED hyperthermia visits in these five states. Used alone, existing OSHA heat-risk levels for ambient temperatures did not appear to successfully communicate workers' risk for hyperthermia in this study. Findings should inform future heat-alert communications and policies, heat prevention efforts, and heat-illness prevention research for workers in the southeastern United States.

Risk perception of heat related disorders on the workplaces: a survey among health and safety representatives from the autonomous province of Trento, Northeastern Italy.

INTRODUCTION: This study will investigate knowledge, attitude and practices towards heat-related health issues in a sample of safety representatives from Northern Italy (H&SRs). METHODS: A cross-sectional questionnaire survey was conducted in 2016-2017 among 298 H&SR. Knowledge status was measured both in general but as well and focusing on first-aid issues. Assessment of risk perception included severity and frequency of heat-related events. Multivariate logistic regression analysis assessed individual and work-related characteristics associated with H&SRs' risk perception. RESULTS: 258 questionnaires were retrieved (participation rate 86.6%; mean age 48.2 ± 8.4 years). Knowledge status was relatively good on technical/preventive issues (62.3% ± 16.8) and first aid measures (72.6% ± 27.2), but a large share of respondents ignored the risk from exertional heat stroke (35.9%), and for heat strokes elicited by non-environmental heat (e.g. machineries, use of protective equipment, etc. 47.9%). The majority of respondents acknowledged the high frequency of extreme events like heat waves (62.0%), but only 44.6% agreed on their potential health threat, with an unsatisfying cumulative risk perception score (55.4% ± 23.5). A specific first-aid formation course was reported by 49.2% of respondents, while 10.9% had any previous interaction with heat-related disorders. Specific countermeasures for heat waves had been put in place by parent company in 20.1% of cases. Eventually, higher educational achievements (mOR 2.239, 95% CI 1.184-4.233) and a better general knowledge status (mOR 1.703, 95% CI 1.073-2.979) were positive predictors for higher risk perception. CONCLUSIONS: Although H&SRs exhibited a good understanding of heat-related health issues, stakeholders should improve the implementation of specific countermeasures on the workplaces.

Epidemiology of exertional heat illnesses in organised sports: A systematic review.

OBJECTIVE: This systematic review summarises reports of the incidence of exertional heat illnesses (EHI) in organised sports, to examine any trends in the EHI incidence over time, and to describe EHI incidence based on sporting activity, geographic location, and type of EHI. METHOD: Three electronic databases (CINAHL, PubMed, SportDiscuss) were searched from inception to January 2019. Original data in all epidemiological studies (any design except case-studies and case-series) that reported EHI incidence data in organised sports, across all age categories, and published in an English language peer-reviewed journal were included. RESULTS: The primary search yielded 3556 results of which 62 studies were included in the final analysis, with 71% being from the USA. Reported EHI incidence rates ranged from 0.01 (cheerleading) to 4.19 (American football) per 1000 athletic-exposures (AEs), and 0.01 (mini-marathon) to 54.54 (desert ultra-marathon) per 100 participants. Endurance type events (running, cycling, adventure races) reported the highest EHI incidence rates per 100 participants. There was a considerable increase in EHI fatalities reported in the literature over the last three decades in American football and an increased reporting of EHI incidence in endurance type events during the last 5-years. CONCLUSION: Use of different terminology and injury definitions in most studies have resulted in an inconsistency in reporting EHI incidence data, and also likely underreporting of less-severe forms of EHI conditions. Longitudinal studies focused on different sports and conducted in more countries (outside the USA), are needed for better understanding the global impact of EHI and the impact of prevention measures.

Estresse por calor na Atenção Primária à Saúde: uma revisão clínica / Heat stress in Primary Health Care: A clinical review / Estrés por calor en la Atención Primaria a la Salud: una revisión clínica

Introdução: A exposição nociva ao calor ganha mais relevância com a progressão do aquecimento global antropogênico e a Atenção Primária à Saúde (APS) tem um papel crescente nesse cenário. No Brasil, as ondas de calor entre 2014 e 2015 duraram mais tempo que nos anos prévios, além disso, entre 2000-2015 a associação entre temperatura e hospitalizações variou de acordo com a duração da exposição ao calor. Nesse contexto, o objetivo desta revisão é realizar uma atualização sobre manejo clínico de patologias relacionadas ao calor na APS. Metodologia: Realizou-se a busca na base de dados ACCESSS, que utiliza a pirâmide 5.0 da assistência à saúde baseada em evidências. Foram identificados 103 sumários sintetizados para referência clínica com as palavras "Heat stress", "Heat Stroke", "Heat Wave" e "Heat Exhaustion", mas apenas três entravam no escopo deste estudo. Resultados e Discussão: O estresse pelo calor é uma condição comum, negligenciada e evitável que afeta diversos pacientes, iniciando-se com uma má adaptação ao calor que se não for corrigida pode gerar uma cascata de eventos inflamatórios. O estresse pelo calor é caracterizado por sintomas inespecíficos, como mal-estar, cefaleia e náusea. O tratamento envolve o resfriamento do paciente e monitoramento, garantindo hidratação adequada. A exaustão pelo calor, se não tratada, pode evoluir para insolação, uma doença grave que pode levar ao coma e morte, envolvendo disfunção do sistema nervoso central - necessitando de um tratamento mais agressivo além do resfriamento

Introduction: The nocive exposure to heat gets more attention with anthropogenic global warming, and Primary Health Care (PHC) has a growing role in this scenario. In Brazil heat waves between 2014 and 2015 lasted longer than in previous years. Further, in addition between 2000-2015 the association between temperature and hospitalizations varied according to the duration of heat exposure. Therefore, the aim of this review is to perform an update on clinical management of heat related pathologies in PHC. Methodology: The ACCESSS database was searched using the evidence-based health care pyramid 5.0, where we identified 103 synthesized summaries for clinical reference with words "Heat stress", "Heat Stroke", "Heat Wave" and "Heat Exhaustion", but only three fell within the scope of this study. Results and Discussion: Heat stress is a common, neglected and preventable condition that affects several patients, it starts with a poor adaptation to heat that if it is not adjusted it can generate a cascade of inflammatory events. Heat stress is characterized by nonspecific symptoms such as malaise, headache and nausea. The treatment involves patient monitoring and cooling, ensuring adequate hydration. Heat exhaustion, if untreated, can progress to heatstroke, a serious illness that can lead to coma and death, involving central nervous system dysfunction - requiring more aggressive treatment than cooling.

Introducción: La exposición nociva al calor gana más destaque con la progresión del calentamiento global antropogénico, y la Atención Primaria a la Salud tienen un papiel cresciente en este escenario. En Brasil las olas de calor entre 2014 y 2015 duraron más tiempo que en los años previos, además entre 2000-2015 la asociación entre temperatura y hospitalizaciones ha variado de acuerdo con la duración de la exposición al calor. En este contexto, el objetivo de esta revisión es realizar una actualización sobre manejo clínico de patologías relacionadas al calor en la APS. Metodología: Se realizó la búsqueda en la base de datos ACCESSS, que utiliza la pirámide 5.0 de la asistencia a la salud basada en evidencias. Se han identificado 103 sumarios sintetizados para referencia clínica con las palabras "Heat stress", "Heat Stroke", "Heat Wave" y "Heat Exhaustion", pero sólo tres son considerados en el ámbito de este estudio. Resultados y Discusión: El estrés por el calor es una condición común, descuidada y evitable que afecta a varios pacientes, iniciándose con una mala adaptación al calor que si no se corrige puede generar una cascada de eventos inflamatorios. El estrés por el calor se caracteriza por síntomas inespecíficos, como malestar, cefalea y náuseas. El tratamiento implica el enfriamiento del paciente y el monitoreo, garantizando la hidratación adecuada. El agotamiento por el calor, si no se trata, puede evolucionar hacia la insolación, una enfermedad grave que puede llevar al coma y a la muerte, involucrando disfunción del sistema nervioso central - necesitando un tratamiento más agresivo además del enfriamiento.

Estimation of Heat Stress and Maximum Acceptable Work Time Based on Physiological and Environmental Response in Hot-Dry Climate: A Case Study in Traditional Bakers.

BACKGROUND: Heat stress is common among workers in hot-dry areas. To take preventive strategies for the protection of workers against heat stress, it is important to choose a suitable index that can accurately explain environmental parameters relative to physiological responses. OBJECTIVE: To evaluate heat stress and maximum acceptable work time (MAWT) based on physiological and environmental response in hot-dry climate among traditional bakers. METHODS: The current study was carried out on 30 traditional bakers of 3 different bread baking systems in Ahvaz, Iran. Environmental and physiological parameters were measured simultaneously for a work shift. The work-rest time was also determined based on the relative heart rate (RHR) and the wet-bulb globe temperature (WBGT) index. RESULTS: The average WBGT index was estimated to be higher than the standard limit for all baking stations. Despite the higher-than-the-recommended-limit WBGT index, there was no significant relationship between the WBGT index and physiological parameters. The results indicated a significant (p<0.05) difference between the percentages of work-rest time estimated using the WBGT and RHR index. CONCLUSION: Based on the results of environmental and physiological monitoring of this study as well as the limitations of the use of the WBGT index, it seems that using WBGT as a standard index would not suit heat stress management in hot-dry climates. A revision of this standard to adapt to hot climatic conditions should be in order.

Risk perceptions for exertional heat illnesses in junior cricket in Sri Lanka.

OBJECTIVES: Exertional heat illnesses (EHI) can occur when sport is played in hot and humid environments, such as those common across Asia. Measures to reduce the risk of EHI are important; however, causal data on EHI occurrence are limited and challenging to capture. To gain an initial understanding of EHI risks, we aimed to assess the risk perceptions of EHI of youth cricketers. METHODS: A descriptive cross-sectional survey, comprised of 14 questions on EHI risks, was conducted with 365 Sri Lankan junior male cricketers (age=12.9±0.9 years) who typically play in hot and humid conditions. RESULTS: For climate related risks, relative humidity was perceived as having a low risk of EHI compared with ambient temperature. The EHI risk associated with wearing protective gear, as commonly used in cricket, was perceived as low. Most junior cricketers perceived a low level of risk associated with recommended preventive measures such as body cooling and heat-acclimatisation. CONCLUSION: This is the first study to explore EHI risk perceptions in any sporting context. Young players may not be mindful of all risks. Therefore, leadership and initiative from competition organisers and parents is required to promote countermeasures.

Consensus Statement- Prehospital Care of Exertional Heat Stroke.

Exertional heat stroke (EHS) is one of the most common causes of sudden death in athletes. It also represents a unique medical challenge to the prehospital healthcare provider due to the time sensitive nature of treatment. In cases of EHS, when cooling is delayed, there is a significant increase in organ damage, morbidity, and mortality after 30 minutes, faster than the average EMS transport and ED evaluation window. The purpose of this document is to present a paradigm for prehospital healthcare systems to minimize the risk of morbidity and mortality for EHS patients. With proper planning, EHS can be managed successfully by the prehospital healthcare provider.

Consistency between Sweat Rate and Wet Bulb Globe Temperature for the Assessment of Heat Stress of People Working Outdoor in Arid and Semi-arid Regions.

BACKGROUND: Heat stress is common among workers in arid and semi-arid areas. In order to take every preventive measure to protect exposed workers against heat-related disorders, it is crucial to choose an appropriate index that accurately relates environmental parameters to physiological responses. OBJECTIVE: To investigate the consistency between 2 heat stress and strain indices, ie, sweat rate and wet bulb globe temperature (WBGT), for the assessment of heat stress of people working outdoor in arid and semi-arid regions in Iran. METHODS: During spring and summer, 136 randomly selected outdoor workers were enrolled in this study. Using a defined protocol, the sweat rate of these workers was measured 3 times a day. Simultaneously, the environmental parameters including WBGT index were recorded for each working station. RESULTS: The level of agreement between sweat rate and WBGT was poor (κ<0.2). Based on sweat rate, no case exceeding the reference value was observed during the study. WBGT overestimated the heat stress in outdoor workers compared to sweat rate. CONCLUSION: It seems that the sweat rate standards may need some modifications related to real condition of work in arid and semi-arid regions in Iran. Moreover, it seems that judging workers solely based on monitoring their sweat rate in such regions, can probably result in underestimation of heat stress.