[5 cases of occupational heat illness].

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.

Diagnosis and Management of Heatstroke.

Heatstroke is a life-threatening  and the most severe form of heat-related illnesses, characterized by body temperature >40ºC and central nervous system dysfunction. Heatstroke is classified into Non-Exertional Heatstroke (NEHS) and Exertional Heatstroke (EHS). The pathophysiology of heatstroke involves a combination of direct heat effects on the host, the systemic inflammatory and coagulopathic response. The diagnosis of heatstroke based on Bouchama's definition or Japan Association of Acute Medicine (JAAM) criteria. The basic principle of heatstroke management is early resuscitation and immediate cooling. Cold water immersion or convection evaporation method can be implemented based on the specific patient characteristic. Preventive strategies are early recognition by health workers, socialization to vulnerable groups and adequate acclimatization.

The impact of heatwaves on emergency department visits in Brisbane, Australia: a time series study.

INTRODUCTION: The acute health effects of heatwaves in a subtropical climate and their impact on emergency departments (ED) are not well known. The purpose of this study is to examine overt heat-related presentations to EDs associated with heatwaves in Brisbane. METHODS: Data were obtained for the summer seasons (December to February) from 2000-2012. Heatwave events were defined as two or more successive days with daily maximum temperature ≥34°C (HWD1) or ≥37°C (HWD2). Poisson generalised additive model was used to assess the effect of heatwaves on heat-related visits (International Classification of Diseases (ICD) 10 codes T67 and X30; ICD 9 codes 992 and E900.0). RESULTS: Overall, 628 cases presented for heat-related illnesses. The presentations significantly increased on heatwave days based on HWD1 (relative risk (RR) = 4.9, 95% confidence interval (CI): 3.8, 6.3) and HWD2 (RR = 18.5, 95% CI: 12.0, 28.4). The RRs in different age groups ranged between 3-9.2 (HWD1) and 7.5-37.5 (HWD2). High acuity visits significantly increased based on HWD1 (RR = 4.7, 95% CI: 2.3, 9.6) and HWD2 (RR = 81.7, 95% CI: 21.5, 310.0). Average length of stay in ED significantly increased by >1 hour (HWD1) and >2 hours (HWD2). CONCLUSIONS: Heatwaves significantly increase ED visits and workload even in a subtropical climate. The degree of impact is directly related to the extent of temperature increases and varies by socio-demographic characteristics of the patients. Heatwave action plans should be tailored according to the population needs and level of vulnerability. EDs should have plans to increase their surge capacity during heatwaves.

A randomized controlled trial of aspirin and exertional heat stress activation of platelets in firefighters during exertion in thermal protective clothing.

PURPOSE: Platelet aggregation is enhanced in firefighters following short bouts of work in thermal protective clothing (TPC). We sought to determine if aspirin therapy before and/or following exertion in TPC prevents platelet activation. METHODS: In a double-blind, placebo-controlled study, 102 firefighters were randomized to receive daily therapy (81 mg aspirin or placebo) for 14 days before and a single dose (325 mg aspirin or placebo) following exercise in TPC resulting in four potential assignments: aspirin before and after exercise (AA), placebo before and after exercise (PP), aspirin before and placebo after exercise (AP), and placebo before and aspirin after exercise (PA). Platelet closure time (PCT) was measured with a platelet function analyzer before the 2-week treatment, after the 2 week treatment period, immediately after exercise, and 30, 60, and 90 minutes later. RESULTS: Baseline PCT did not differ between groups. PCT changed over time in all four groups (p < 0.001) rising to a median of >300 seconds [IQR 99, 300] in AA and >300 [92, 300] in AP prior to exercise. Following exercise, median PCT decreased to in all groups. Median PCT returned to >300 seconds 30 minutes later in AA and AP and rose to 300 seconds in PA 60 minutes after exercise. CONCLUSIONS: Daily aspirin therapy blunts platelet activation during exertional heat stress and single-dose aspirin therapy following exertional heat stress reduces platelet activation within 60 minutes.

Effectiveness of exercise-heat acclimation for preventing heat illness in the workplace.

The incidence of heat-related illness in the workplace is linked to whether or not workers have acclimated to a hot environment. Heat acclimation improves endurance work performance in the heat and thermal comfort at a given work rate. These improvements are achieved by increased sweating and skin blood flow responses, better fluid balance and cardiovascular stability. As a practical means of acclimatizing the body to heat stress, daily aerobic exercise training is recommended since thermoregulatory capacity and blood volume increase with physical fitness. In workers wearing personal protective suits in hot environments, however, little psychophysiological benefit is received from short-term exercise training and/or heat acclimation because of the ineffectiveness of sweating for heat dissipation and the aggravation of thermal discomfort with the accumulation of sweat within the suit. For a manual laborer who works under uncompensable heat stress, better management of the work rate, the work environment and health is required.

Heat-related illness.

Heat-related illness is a set of preventable conditions ranging from mild forms (e.g., heat exhaustion, heat cramps) to potentially fatal heat stroke. Hot and humid conditions challenge cardiovascular compensatory mechanisms. Once core temperature reaches 104°F (40°C), cellular damage occurs, initiating a cascade of events that may lead to organ failure and death. Early recognition of symptoms and accurate measurement of core temperature are crucial to rapid diagnosis. Milder forms of heat-related illness are manifested by symptoms such as headache, weakness, dizziness, and an inability to continue activity. These are managed by supportive measures including hydration and moving the patient to a cool place. Hyperthermia and central nervous system symptoms should prompt an evaluation for heat stroke. Initial treatments should focus on lowering core temperature through cold water immersion. Applying ice packs to the head, neck, axilla, and groin is an alternative. Additional measures include transporting the patient to a cool environment, removing excess clothing, and intravenous hydration. Delayed access to cooling is the leading cause of morbidity and mortality in persons with heat stroke. Identification of at-risk groups can help physicians and community health agencies provide preventive measures.

Heat stress and dehydration in kendo.

AIM: This study aimed to analyze sweat rate, water percentage alteration, and temperature variation during kendo practice in order to relate the thermal stress induced by such sports and draw recommendations for its secure practice. METHODS: Participants were 12 male individuals. The studied variables were: age, weight, stature, body mass index, fat percentage, water loss percentage, tympanic temperature, and sweat rate. Measures were obtained in one day of 120 min practice (T: 24.1 ± 2.5 °C; RH: 73 ± 8.5%) using obligatory training equipment. RESULTS: The age of participants was on average 26 ± 6.2 years, stature 1.8 ± 0.03 m, weight 78 ± 13.7 kg, BMI 24.12 ± 4.03 kg/m² and fat percentage 15.7 ± 5.1%. Weight and temperature final values were significantly different from the initial ones (P<0.01). Estimated sweat rate was 0.35 L.h-1 (95% CI = [0.299; 0.400]) and estimated percentage of water loss was 0.946% (95% CI = [0.694; 1.174]). CONCLUSION: Kendo practice using obligatory equipment significantly increases temperature, even when sweat rate and water loss percentage are low. The almost complete obstruction of the evaporative surface leads to heat accumulation, which may result in risks comparable to those of American football players. Thus, preventive measures must be established to minimize the risks of the combination among environment (tropical climate), equipment (bogu) and the high physiological demand of this sport in order to prevent greater damages to the health of practitioners.

Preventing heat-related illness among Hispanic farmworkers.

Hispanic and Latino farmworkers are at risk for negative occupational health and safety outcomes due to issues such as their extreme work conditions, their reliance on employer beneficence, and cultural barriers. The purpose of this article is to explain the unique characteristics of heat-related illness in the Hispanic agricultural work force and to provide an overview of the problems of poor hydration and heat exposure in this population. Culturally appropriate preventive strategies are discussed because industrial-type solutions may not work in a crop production environment where language and beliefs may interfere with adaptation.

[Community-based prevention of climate-associated health risks]. / Prävention klimabedingter Gesundheitsrisiken in der Kommune.

BACKGROUND: Climate changes and their impact on public health services are presenting officials with new challenges. The Klimzug Nordhessen project provides a framework for the development of suitable adaptation strategies to deal with climate changes. PROJECT: The demographic and climatic circumstances in the region in and surrounding Kassel require a focus on the prevention of heat-caused morbidity and mortality among adults 75 or more years old. The Klimzug Nordhessen project assesses the feasibility of heat monitoring for city and county regions and collects data about the temperature-related comfort of older people. The main focus of the project is the development of prevention strategies for older people who live at home in climatic and demographic high-risk regions. CONCLUSIONS: In the face of inadequate data, the current cooperation between science and practice seems to be an appropriate base for the development of verifiable empirical methods and instruments as well as evidence-based prevention strategies at the communal level.

[Identifying residential areas with heat-related health risks. Sociodemographic and climate data mapping as a planning tool for targeted prevention strategies]. / Wohngebiete mit hitzeabhängigen Gesundheitsrisiken ermitteln. Soziodemografische und klimatische Kartierung als Planungsinstrument gezielter Prävention.

Prognosticated heat waves in the context of climate change require appropriate strategies to prevent harmful health effects in the population. In a model project within the public health department of the Kassel region, elderly living in areas at risk of over-heating will be identified and advised. The localization of high-risk residential areas was part of the planning process. Through mapping of demographic and microclimate data and the characteristics of the material of the residential buildings, high-risk areas that require preventive measures as a top priority were identified. The prevention of heat-related mortality and morbidity by communal health authorities requires close cooperation with other administrative bodies, especially with town planning departments. Mapping demographic and microclimate data and the characteristics of the material of the residential buildings can facilitate the planning of preventive measures.

[The importance of atmospheric heat waves for health service in already altered people]. / Klimatische Hitzewellen und deren Konsequenzen für die gesundheitliche Betreuung vorgeschädigter Personen.

The paper deals with the problems of heat exhaustion and heat stroke related to exercise or elevation of environmental temperature. After recommending a classification of heat disorders, the different clinical symptoms are presented. Old people and people with preexisting diseases are particularly affected and in danger. Therapeutic measures have to consider different mechanisms of an alteration of liquid and salt balance.

Health risks and precautions for visitors to the Tokyo 2020 Olympic and Paralympic Games.

BACKGROUND: In 2020, Japan will host the Tokyo Olympic and Paralympic Games in 2020 (Tokyo 2020) which will involve a large population influx from various countries to Tokyo, the most populated city in Japan. We summarize the potential health risks for visitors to Tokyo 2020, related to communicable disease risks and other health threats, based on recent national and local surveillance reports. METHODS: We reviewed up-to-date surveillance reports published by the National Institute of Infectious Diseases and Tokyo Metropolitan Infectious Disease Surveillance Center. RESULTS: Communicable disease risks for vaccine-preventable illnesses such as measles and rubella, as well as food and waterborne diseases represent the most likely risks. The risk of acquiring vector-borne diseases is considered low in Japan. On the other hand, however, heat-related illness represents a potential risk, as Tokyo 2020 is scheduled during the hottest season in Japan, with temperatures generally expected to exceed 30 °C. CONCLUSION: Maintaining an up-to-date routine vaccination schedule is highly recommended for visitors attending the Tokyo 2020 and appropriate hygiene measures for food and waterborne diseases as well as health promotion for heat-related illness. It may also be useful to increase the number of multilingual triage clinicians whom can be placed within emergency departments during the Tokyo 2020 to provide first contact services and coordination of emergency care among non-Japanese speaking visitors to Tokyo.

Air velocity influences thermoregulation and endurance exercise capacity in the heat.

This study examined the effects of variations in air velocity on time to exhaustion and thermoregulatory and perceptual responses to exercise in a hot environment. Eight male volunteers completed stationary cycle exercise trials at 70% peak oxygen uptake until exhaustion in an environmental chamber maintained at 30 °C and 50% relative humidity. Four air velocity conditions, 30, 20, 10, and 0 km/h, were tested, and the headwind was directed at the frontal aspect of the subject by 2 industrial fans, with blade diameters of 1 m and 0.5 m, set in series and positioned 3 m from the subject's chest. Mean ± SD time to exhaustion was 90 ± 17, 73 ± 16, 58 ± 13, and 41 ± 10 min in 30-, 20-, 10-, and 0-km/h trials, respectively, and was different between all trials (P < 0.05). There were progressive elevations in the rate of core temperature rise, mean skin temperature, and perceived thermal sensation as airflow decreases (P < 0.05). Core temperature, heart rate, cutaneous vascular conductance, and perceived exertion were higher and evaporative heat loss was lower without airflow than at any given airflow (P < 0.05). Dry heat loss and plasma volume were similar between trials (P > 0.05). The present study demonstrated a progressive reduction in time to exhaustion as air velocity decreases. This response is associated with a faster rate of core temperature rise and a higher skin temperature and perceived thermal stress with decreasing airflow. Moreover, airflow greater than 10 km/h (2.8 m/s) might contribute to enhancing endurance exercise capacity and reducing thermoregulatory, cardiovascular, and perceptual strain during exercise in a hot environment.

Ensuring the Right to Rest: City Ordinances and Access to Rest Breaks for Workers in the Construction Industry.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of city Rest Break Ordinance (RBO) policies in expanding access to rest at work. METHODS: We use data from surveys of construction workers in Austin and Dallas, Texas, in 2009, 2012, and 2015 (n = 557) to calculate the odds of receiving a rest break in pre- versus post-RBO Austin and in post-RBO Austin versus pre-RBO Dallas, controlling for demographic and employment characteristics. RESULTS: Construction workers were 35% more likely to report receiving a rest break in Austin post-RBO and 16% less likely in Dallas without a RBO as compared to Austin with a RBO. CONCLUSION: The increased likelihood of receiving rest breaks at work in a RBO city suggests that, in the absence of enforceable national standards, city-level RBOs can be an important first step to effective prevention of heat-related illnesses (HRIs) and heat-related fatalities at work.