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Fulltext Perceptions of heat-health impacts and the effects of knowledge and preventive actions by outdoor workers in Hanoi, Vietnam

Lohrey S, Chua M, Gros C, Faucet J, Lee JKW

Sci Total Environ, 2021 Nov 10;794:148260.
PMID: 34328123 DOI: 10.1016/j.scitotenv.2021.148260

Extreme heat is an increasing climate threat, most pronounced in urban areas where poor populations are at particular risk. We analyzed heat impacts and vulnerabilities of 1027 outdoor workers who participated in a KAP survey in Hanoi, Vietnam in 2018, and the influence of their mitigation actions, their knowledge of heat-risks, and access to early warnings. We grouped respondents by their main income (vendors, builders, shippers, others, multiple jobs, and non-working) and analyzed their reported heat-health impacts, taking into consideration socioeconomics, knowledge of heat impacts and preventive measures, actions taken, access to air-conditioning, drinking amounts and use of weather forecasts. We applied linear and logistic regression analyses using R. Construction workers were younger and had less knowledge of heat-health impacts, but also reported fewer symptoms. Older females were more likely to report symptoms and visit a doctor. Access to air-conditioning in the bedroom depended on age and house ownership, but did not influence heat impacts as cooling was too expensive. Respondents who knew more heat exhaustion symptoms were more likely to report impacts (p < 0.01) or consult a doctor (p < 0.05). Similarly, those who checked weather updates were more likely to report heat impacts (p < 0.01) and experienced about 0.6 more symptoms (p < 0.01). Even though occupation type did not explain heat illness, builders knew considerably less (40%; p < 0.05) about heat than other groups but were twice as likely to consult a doctor than street vendors (p < 0.01). Knowledge of preventive actions and taking these actions both correlated positively with reporting of heat-health symptoms, while drinking water did not reduce these symptoms (p < 0.01). Child carers and homeowners experienced income losses in heatwaves (p < 0.01). The differences support directed actions, such as dissemination of educational materials and weather forecasts for construction workers. The Red Cross assisted all groups with cooling tents, provision of drinks and health advice.

Matched MeSH terms: Heat Stress Disorders*
Fulltext Changes in wet bulb globe temperature and risk to heat-related hazards in Bangladesh

Kamal ASMM, Fahim AKF, Shahid S

Sci Rep, 2024 May 06;14(1):10417.
PMID: 38710893 DOI: 10.1038/s41598-024-61138-8

The rise in temperatures and changes in other meteorological variables have exposed millions of people to health risks in Bangladesh, a densely populated, hot, and humid country. To better assess the threats climate change poses to human health, the wet bulb globe temperature (WBGT) is an important indicator of human heat stress. This study utilized high-resolution reanalysis data from the fifth-generation European Centre for Medium-Range Weather Forecasts (ECMWF ERA5) to analyze the spatiotemporal changes in outdoor WBGT across Bangladesh from 1979 to 2021, employing Liljegren's model. The study revealed an increase in the annual average WBGT by 0.08-0.5 °C per decade throughout the country, with a more pronounced rise in the southeast and northeast regions. Additionally, the number of days with WBGT levels associated with high and extreme risks of heat-related illnesses has shown an upward trend. Specifically, during the monsoon period (June to September), there has been an increase of 2-4 days per decade, and during the pre-monsoon period (March to May), an increase of 1-3 days per decade from 1979 to 2021. Furthermore, the results indicated that the escalation in WBGT has led to a five-fold increase in affected areas and a three-fold increase in days of high and extreme heat stress during the monsoon season in recent years compared to the earlier period. Trend and relative importance analyses of various meteorological variables demonstrated that air temperature is the primary driver behind Bangladesh's rising WBGT and related health risks, followed by specific humidity, wind speed, and solar radiation.

Matched MeSH terms: Heat Stress Disorders/epidemiology
Thirst as the threshold symptom to prevent worsening heat-related illness

Mansor Z, Ismail NH, Rosnah I, Hashim JH

Med J Malaysia, 2019 02;74(1):1-7.
PMID: 30846654

INTRODUCTION: The heat-related illness (HRI) is a continuum illness ranging from minor health effects to life-threatening medical emergencies when the pathological effects of heat load are not prevented. The aim of this study was to demonstrate the threshold HRI symptom for deciding to take simple preventative actions both by the individual workers and employers.
METHOD: A total of 328 municipal workers were enrolled in April to March 2016 were asked to recall if they experienced eleven HRI symptoms during the previous work day. Rasch Measurement Model was used to examine the unidimensional parameters and bias for gender before identifying the threshold of HRI symptoms. We determined the threshold symptom based on the person-item map distribution on a logit ruler value.
RESULTS: A total of 320 respondents were analysed. The psychometric features HRI symptoms suggested evidence of unidimensionality and free of bias for gender (DIF size =0.57; DIF t value =1.03). Based on the person-item map distribution, the thirst item was determined as the threshold item (Cut-off point = -2.17 logit) for the preventative action purposes to group the person as mild and moderate/severe HRI groups.
CONCLUSION: Thirst item is viewed as threshold symptoms between mild and moderate or severe HRI symptoms. It is a reliable symptom to initiate behavioural response to quench the thirst by adequate fluids. Failure to recognise the thirst symptom may lead to devastating unwanted health complications.

Matched MeSH terms: Heat Stress Disorders/diagnosis*; Heat Stress Disorders/pathology; Heat Stress Disorders/physiopathology
Fulltext The Impact of Heat on Health and Productivity among Maize Farmers in a Tropical Climate Area

Sadiq LS, Hashim Z, Osman M

J Environ Public Health, 2019;2019:9896410.
PMID: 31061664 DOI: 10.1155/2019/9896410

Background: Heat stress disorders may cause negative health outcome and subsequent productivity reduction especially in those who work under direct sunlight for an extended number of hours.
Objective: This study assessed the impact of heat on the health and productivity among maize farmers in a hot tropical country.
Methods: A cross-sectional study was conducted among 396 maize farmers, randomly selected across Gombe province, Nigeria. The wet bulb globe temperature monitor (WBGT) Model QuesTemp036 was used in determining the heat index. Health was determined using a validated questionnaire, while productivity was determined by recording work output based on the number of ridges cultivated during the working hours.
Results: The farms recorded mean heat index with standard deviation (SD) of 31.56 (2.19) and 34.08 (1.54) in the hours of 9 am to 12 pm and 12-3 pm respectively, which exceeded the threshold level set by the ACGIH. Heavy sweating (93.2%), tiredness (48.5%), dizziness (34.1%), and headache (40.4%) were experienced by the respondents almost on daily basis. The finding further showed a significant difference in the farmers' productivity during the three time duration of the work day (p < 0.001). The productivity was significantly higher between the hours of 6-9 am (p < 0.001) and 12-3 pm (p < 0.001), compared to the hours of 9 am to 12 pm (p < 0.001). The factors that significantly predict the productivity outcome include temperature (p < 0.001), gender (p < 0.001), age (p=0.033), and BMI (p=0.008).
Conclusion: The farmers were frequently experiencing heat exhaustion which decreased their productivity.

Matched MeSH terms: Heat Stress Disorders/epidemiology*; Heat Stress Disorders/physiopathology; Heat Stress Disorders/psychology
Effects of hydration practices on the severity of heat-related illness among municipal workers during a heat wave phenomenon

Mansor Z, Rosnah I, Ismail NH, Hashim JH

Med J Malaysia, 2019 08;74(4):275-280.
PMID: 31424033

INTRODUCTION: The continue rise in temperatures due to climate change increases the risk of heat-related illness (HRI) among outdoor workers. This study aims to evaluate the effects of hydration practices on the severity of HRI during a heat wave episode among municipal workers in Negeri Sembilan.
METHOD: A cross-sectional study was performed in March and April 2016. The outdoor temperatures were measured using the wet-bulb globe temperature (WBGT) tool. The participants completed a self-administered questionnaire containing sociodemographic factors prior to work shift; while working profile, hydration practices, and HRI symptoms at the end of work shift. The hydration status of the respondents was assessed by direct observation of their urine colour. Multiple logistic regression was performed to ascertain the effects of age, working profile, hydration practice, history of previous HRI, and hydration status on the likelihood that outdoor workers having moderate to severe HRI.
RESULTS: A total of 320 respondents completed the questionnaire. The mean (standard deviation) outdoor workplace temperature was 30.5°C (SD 0.53°C). The percentage of respondents who experienced moderate to severe HRI was 44.1%. The likelihood that outdoor workers experienced moderate to severe HRI symptoms was associated with irregular fluid intake [odds ratio (OR): 16.11, 95% confidence interval (95%CI): 4.11; 63.20]; consumption of non-plain water (OR: 5.92, 95%CI: 2.79; 12.56); dehydration (OR: 3.32, 95%CI: 1.92; 5.74); and increasing outdoor workplace temperature (OR: 1.85, 95%CI: 1.09; 3.11).
CONCLUSION: Irregular drinking pattern and non-plain fluid intake was found to have a large effect on HRI severity among outdoor workers exposed high temperatures during a heat wave phenomenon.

Matched MeSH terms: Heat Stress Disorders/diagnosis; Heat Stress Disorders/etiology; Heat Stress Disorders/prevention & control*; Heat Stress Disorders/psychology
Fulltext Assessment of heat stress contributing factors in the indoor environment among vulnerable populations in Klang Valley using principal component analysis (PCA)

Muhamad SN, How V, Lim FL, Md Akim A, Karuppiah K, Mohd Shabri NSA

Sci Rep, 2024 Jul 15;14(1):16265.
PMID: 39009671 DOI: 10.1038/s41598-024-67110-w

Rising global temperatures can lead to heat waves, which in turn can pose health risks to the community. However, a notable gap remains in highlighting the primary contributing factors that amplify heat-health risk among vulnerable populations. This study aims to evaluate the precedence of heat stress contributing factors in urban and rural vulnerable populations living in hot and humid tropical regions. A comparative cross-sectional study was conducted, involving 108 respondents from urban and rural areas in Klang Valley, Malaysia, using a face-to-face interview and a validated questionnaire. Data was analyzed using the principal component analysis, categorizing factors into exposure, sensitivity, and adaptive capacity indicators. In urban areas, five principal components (PCs) explained 64.3% of variability, with primary factors being sensitivity (health morbidity, medicine intake, increased age), adaptive capacity (outdoor occupation type, lack of ceiling, longer residency duration), and exposure (lower ceiling height, increased building age). In rural, five PCs explained 71.5% of variability, with primary factors being exposure (lack of ceiling, high thermal conductivity roof material, increased building age, shorter residency duration), sensitivity (health morbidity, medicine intake, increased age), and adaptive capacity (female, non-smoking, higher BMI). The order of heat-health vulnerability indicators was sensitivity > adaptive capacity > exposure for urban areas, and exposure > sensitivity > adaptive capacity for rural areas. This study demonstrated a different pattern of leading contributors to heat stress between urban and rural vulnerable populations.

Matched MeSH terms: Heat Stress Disorders/epidemiology
Growth performance and immune response of two commercial broiler strains fed diets containing Lactobacillus cultures and oxytetracycline under heat stress conditions

Zulkifli I, Abdulllah N, Azrin NM, Ho YW

Br Poult Sci, 2000 Dec;41(5):593-7.
PMID: 11201439

1. Hubbard x Hubbard (HH) and Shaver x Shaver (SS) chicks given a dietary supplement of either 50 mg/kg oxytetracycline (OTC) or 1 g/kg Lactobacillus culture (LC) were exposed to 36 +/- 1 degrees C for 3 h daily from day (d) 21 to 42. 2. Prior to heat treatment, body weight (d 21) and weight gain (d 1 to d 21) of OTC and LC birds were greater than those fed the control diet. Chicks given LC had the best food efficiency followed by OTC and control birds during d 1 to d 21. Body weight (d 1 and d 21) and weight gain (d 1 to d 21) were greater for HH tlhan SS chicks. 3. After 3 weeks of heat exposure, birds receiving the LC diet had greater body weight and weight gain, higher food intake and lower food efficiency than OTC and control chicks. 4. Antibody production against Newcastle discase vaccine on d 21 was not affected by strain or diet. On d 42, while diet had negligible effect on this variable among the SS broilers, HH birds fed LC had higher antibody production than those on the control diet. 5. Neither strain nor diet had a significant effect on mortality.

Matched MeSH terms: Heat Stress Disorders/immunology*; Heat Stress Disorders/physiopathology; Heat Stress Disorders/prevention & control
Heat stress monitoring in the paintshop and bodyshop at an automotive assembly plant

Azwan A., Rusli N., Nik Khairol Reza M.Y., Ahmad Syaarani Y., Edimansyah A., Mazalisah M., et al.

Journal of Occupational Safety and Health, 2007;4(1):11-17.
MyJurnal

Heat stress is considered to be the sum of heat generated in the body (metabolic heat) plus the heat gained from the environment (environmental heat) minus the heat lost from the body to the environment. The consequences of heat stress can caused heat disorder such as heat stroke, heat syncope, heat exhaustion, heat cramps and other heat related diseases. The objective of this study was to compare the pattern of heat stress in each section. A crosssectional study was carried out in two sections (Paintshop A and Bodyshop B) in a selected automotive assembly plant in Selangor to monitor the environmental heat stress. The environmental heat monitoring was done on 89 March 2005. Heat stress monitor (Model: QUESTemp o 34 Thermal Environment Monitor, Quest Technologies, USA) was used to record the pattern of heat exposure in the workplace over a period of eight hours. Heat parameters such as dry temperature, wet temperature, globe temperature and relative humidity were measured. Wet Bulb Globe Temperature index (WBGT) and workload evaluation were used to compare both sections. Heat parameters such as timeweighted average wet bulb globe temperature for indoor setting (TWAWBGT indoor ), dry temperature (DB), natural wet bulb temperature (WB), globe temperature (GB) in Paintshop A were higher than those in Bodyshop B. The relative humidity in Paintshop A was hotdry compared to Bodyshop B which is hotwarm. Paintshop A was considered a hot area compared to Bodyshop B which is normal. Workers in both sections were not faced with heat stress problems because they were worked under acceptable condition according to American Conference of Governmental Industrial Hygienists standard. Both sections in the automotive assembly plant exhibited acceptable working condition for workers in a tropical environment.

Matched MeSH terms: Heat Stress Disorders
Fulltext Development of physical workload and heat stress questionnaire for construction industry in Malaysia

Solehan Imran Shariffudin, Jafri Mohd. Rohani, Mohd Firdaus Mohd Taib, Roseni Abd. Aziz

Journal of Occupational Safety and Health, 2016;13(2):93-97.
MyJurnal

Geographically, Malaysia is situated in the equatorial region, thus having a climate of hot and humid throughout the
year. Effect of heat stress and physical work load at construction industry need to be investigated because of the high number of
accidents. Thus, perception of physical workload and heat stress by the construction workers in Malaysia needed to be investigated
and documented. The aim of this paper is to establish a set of questionnaires containing the item generation regarding on physical
workload and the heat stress perception of construction workers. Physical workload factors such as fatigue, risks, concentration,
work rhythm, responsibility, satisfaction, and autonomy are inserted as the items in assessing the physical workload. While heat
stress are assessed using heat risk factors such as temperature, humidity, heat radiation, air movement, workload, clothing and
acclimatisation. A questionnaire has been developed resulted from various reviewing of literatures on physical workload and heat
stress and better suited to the Malaysia working environment.

Matched MeSH terms: Heat Stress Disorders
Fulltext Heat acclimation attenuates the increased sensations of fatigue reported during acute exercise-heat stress

Willmott AGB, Hayes M, James CA, Gibson OR, Maxwell NS

Temperature (Austin), 2019 Sep 19;7(2):178-190.
PMID: 33015245 DOI: 10.1080/23328940.2019.1664370

Athletes exercising in heat stress experience increased perceived fatigue acutely, however it is unknown whether heat acclimation (HA) reduces the magnitude of this perceptual response and whether different HA protocols influence the response. This study investigated sensations of fatigue following; acute exercise-heat stress; short- (5-sessions) and medium-term (10-sessions) HA; and between once- (ODHA) and twice-daily HA (TDHA) protocols. Twenty male participants (peak oxygen uptake: 3.75 ± 0.47 L·min-1) completed 10 sessions (60-min cycling at ~2 W·kg-1, 45°C/20% relative humidity) of ODHA (n = 10) or non-consecutive TDHA (n = 10). Sensations of fatigue (General, Physical, Emotional, Mental, Vigor and Total Fatigue) were assessed using the multi-dimensional fatigue scale inventory-short form pre and post session 1, 5 and 10. Heat adaptation was induced following ODHA and TDHA, with reductions in resting rectal temperature and heart rate, and increased plasma volume and sweat rate (P heat adaptations followed ODHA and TDHA, perceived fatigue is prolonged within TDHA.
Abbreviations: ∆: Change; ANOVA: Analysis of variance; HA: Heat acclimation; HR: Heart rate; IL-6: Interleukin-6; MFS-SF: Multi-dimensional fatigue symptom inventory-short form (MFSI-SF); MTHA: Medium-term heat acclimation; Na+: Sodium; ODHA: Once daily heat acclimation; PV: Plasma volume; RH: Relative humidity; RPE: Rating of perceived exertion; SD: Standard deviation; SE: Standard error of the slope coefficient or intercept; SEE : Standard error of the estimate for the regression equation; STHA: Short-term heat acclimation; TDHA: Twice daily heat acclimation; TC: Thermal Comfort; Tre: Rectal temperature; TSS: Thermal sensation; V̇O2peak: Peak oxygen uptake; WBSL: whole-body sweat loss.

Matched MeSH terms: Heat Stress Disorders
Fulltext Heat alleviation strategies for athletic performance: A review and practitioner guidelines

Gibson OR, James CA, Mee JA, Willmott AGB, Turner G, Hayes M, et al.

Temperature (Austin), 2020;7(1):3-36.
PMID: 32166103 DOI: 10.1080/23328940.2019.1666624

International competition inevitably presents logistical challenges for athletes. Events such as the Tokyo 2020 Olympic Games require further consideration given historical climate data suggest athletes will experience significant heat stress. Given the expected climate, athletes face major challenges to health and performance. With this in mind, heat alleviation strategies should be a fundamental consideration. This review provides a focused perspective of the relevant literature describing how practitioners can structure male and female athlete preparations for performance in hot, humid conditions. Whilst scientific literature commonly describes experimental work, with a primary focus on maximizing magnitudes of adaptive responses, this may sacrifice ecological validity, particularly for athletes whom must balance logistical considerations aligned with integrating environmental preparation around training, tapering and travel plans. Additionally, opportunities for sophisticated interventions may not be possible in the constrained environment of the athlete village or event arenas. This review therefore takes knowledge gained from robust experimental work, interprets it and provides direction on how practitioners/coaches can optimize their athletes' heat alleviation strategies. This review identifies two distinct heat alleviation themes that should be considered to form an individualized strategy for the athlete to enhance thermoregulatory/performance physiology. First, chronic heat alleviation techniques are outlined, these describe interventions such as heat acclimation, which are implemented pre, during and post-training to prepare for the increased heat stress. Second, acute heat alleviation techniques that are implemented immediately prior to, and sometimes during the event are discussed. Abbreviations: CWI: Cold water immersion; HA: Heat acclimation; HR: Heart rate; HSP: Heat shock protein; HWI: Hot water immersion; LTHA: Long-term heat acclimation; MTHA: Medium-term heat acclimation; ODHA: Once-daily heat acclimation; RH: Relative humidity; RPE: Rating of perceived exertion; STHA: Short-term heat acclimation; TCORE: Core temperature; TDHA: Twice-daily heat acclimation; TS: Thermal sensation; TSKIN: Skin temperature; V̇O2max: Maximal oxygen uptake; WGBT: Wet bulb globe temperature.

Matched MeSH terms: Heat Stress Disorders
Occupational heat stress of workers in a Plastic Industry, Selangor

Goh See Ben, Zailina Hashim, Rosnan Hamzah

Journal of Occupational Safety and Health, 2004;1(2):56-63.
MyJurnal

A cross sectional study to determine the exposure of heat and its biological effects on the workers in a plastic factory located in the Shah Alam Industrial Estate, Selangor, Malaysia. Forty five respondents from the polymer section in the factory were selected as the respondents. Variables measured were the environmental temperature (WBGTin), air velocity, relative humidity, body temperature, average heart and recovery heart rate. QUESTEMP°34 Area Heat Stress Monitor was used to measure the environmental temperature in °C (WBGTin) and relative humidity (%). Velocicheck Model TSI 8830 was used to measure the air velocity in meter per second (m/s) while the OMRON Blood Pressure Monitor Model T3, was used to measure average heart rate and recovery heart rate. Body temperature (°C) was measured by the Instant Ear Thermometer-OMRON Gentle Temperature Model MC509. Interviews using questionnaires were used to determine respondents’ socioeconomic background, previous risk factors on heat exposure and other information related to heat stress. Results showed that the mean environmental temperature for the exposed group was 28.75°C, the mean air velocity was 0.15 m/s and the mean relative humidity was 58.1%. These production workers were exposed occasionally to heat when loading plastic powder into the molds as well as demolding the finished plastic products from the molds. The average time of monitoring was 2 hours for intermittent exposure and 8 hours duration for overall exposure. Maximum demand for work load was measured 1 minute after work activities were stopped at the demolding section. There was a significant difference between body temperature and average heart rate before work, after 2 hours of work and after 8 hours of work ( p < 0.001). The mean recovery heart rate after 1 min was 88.0 ± 12.0 beat per min. (bpm), indicating that there is no excessive physiological demand. Body temperature (36.8 ± 0.40°C) and average heart rate after 8 hours (78 ± 12 bpm) indicated a good body control of heat exposure. Five out of six workplaces monitored had temperatures of greater than 28°C (ACGIH TLV). The workers were exposed to moderate heat stress during the study period, however, body temperature and average heart rate measurement did not reach unacceptable level of physiologic strain.

Matched MeSH terms: Heat Stress Disorders
Fulltext Heat stress modifies the lactational performances and the urinary metabolomic profile related to gastrointestinal microbiota of dairy goats

Contreras-Jodar A, Nayan NH, Hamzaoui S, Caja G, Salama AAK

PLoS One, 2019;14(2):e0202457.
PMID: 30735497 DOI: 10.1371/journal.pone.0202457

The aim of the study is to identify the candidate biomarkers of heat stress (HS) in the urine of lactating dairy goats through the application of proton Nuclear Magnetic Resonance (1H NMR)-based metabolomic analysis. Dairy does (n = 16) in mid-lactation were submitted to thermal neutral (TN; indoors; 15 to 20°C; 40 to 45% humidity) or HS (climatic chamber; 37°C day, 30°C night; 40% humidity) conditions according to a crossover design (2 periods of 21 days). Thermophysiological traits and lactational performances were recorded and milk composition analyzed during each period. Urine samples were collected at day 15 of each period for 1H NMR spectroscopy analysis. Principal component analysis (PCA) and partial least square-discriminant analysis (PLS-DA) assessment with cross validation were used to identify the goat urinary metabolome from the Human Metabolome Data Base. HS increased rectal temperature (1.2°C), respiratory rate (3.5-fold) and water intake (74%), but decreased feed intake (35%) and body weight (5%) of the lactating does. No differences were detected in milk yield, but HS decreased the milk contents of fat (9%), protein (16%) and lactose (5%). Metabolomics allowed separating TN and HS urinary clusters by PLS-DA. Most discriminating metabolites were hippurate and other phenylalanine (Phe) derivative compounds, which increased in HS vs. TN does. The greater excretion of these gut-derived toxic compounds indicated that HS induced a harmful gastrointestinal microbiota overgrowth, which should have sequestered aromatic amino acids for their metabolism and decreased the synthesis of neurotransmitters and thyroid hormones, with a negative impact on milk yield and composition. In conclusion, HS markedly changed the thermophysiological traits and lactational performances of dairy goats, which were translated into their urinary metabolomic profile through the presence of gut-derived toxic compounds. Hippurate and other Phe-derivative compounds are suggested as urinary biomarkers to detect heat-stressed dairy animals in practice.

Matched MeSH terms: Heat Stress Disorders

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