Heat Syncope Research Articles

Heat acclimation alleviates the heat stress-induced impairment of vascular endothelial cells

Heat acclimation (HA) is found to help decrease the incidence of heat-related illnesses such as heat syncope and exertional heat stroke. However, the response of vascular endothelial cells to HA remain to be elucidated. In this study, mouse brain microvascular endothelial cells (bEnd.3), human umbilical vein endothelial cells (HUVEC), and human aortic endothelial cells (HAEC) were selected. The cells were first subjected to HA at 40 ℃ for 2 h per day for 3 days, and then subjected to heat stress at 43 ℃ for 2 h or 4 h. After heat stress, HA-pretreated cells showed a significant increase in cell viability, cell integrity, a decrease in the proportion of S phase cells, cell apoptosis, and cytoskeletal shrinkage compared with the cells without HA pretreatment. Additionally, the expression of VEGF, ICAM-1, iNOS and EPO in HA-pretreated cells significantly increased. We also presented evidence that HA upregulated HSP70 and bcl-2, while downregulated p-p53 and bax. Notably, the suppression of HSP70 expression attenuated the protective role of heat acclimation. Furthermore, HA mitigated injuries in vital organs of mice exposed to heat stress. Conclusively, these findings indicated the HA can increase the vitality of vascular endothelial cells after heat stress, partially restore the function of vascular endothelial cells, and this protective effect may be related to the upregulation of HSP70 expression.

The method to predict damage of body areas due to occupational injury among firefighters

Background. Occupational injuries indicate the level of safety at work and are subject to controlled management. Impossible to eliminate entirely, injuries lend to minimization only. Injuries are investigated not only by medical professionals exclusively. At the same time, by knowing the occupational injury dynamics and the types of potential body injuries, we can prospectively assess the required capacities and resources to eliminate the consequences. The objective is to develop a tool to forecast the scale of occupational body injury in firefighters of the Federal Firefighting Service (FFS) of the EMERCOM of Russia.Methods. The paper analyses occupational injury reports for 2012–2021 produced by the FFS of the EMERCOM of Russia. Total 1769 injuries were registered and matched to injury groups contained in chapter XIX of the International Classification of Diseases and Behavioral Disorders (ICD-10). Personnel injury risks for different body parts are identified and calculated with adjustments for non-identified (absence of diagnoses in injury records) and poorly identified injuries (generalized diagnoses are given). The body injury risk level among the personnel was (11.96 ± 0.89) ∙ 10–4 injuries/(individual ∙ year), which was greater than the level of injuries – (9.19 ± 0.54) ∙ 10–4, since each case of injury correlated with an average of 1.3 diagnoses, with 1.4 in firefighters, including those involved in elimination of other emergency consequences, conducive of concomitant and combined injuries. The curves show high, positive and statistically significant congruence (r = 0.686; p < 0.05), suggesting the impact of identical (unidirectional) factors as an underlying cause. External impacts include mechanical injuries amounting to 83.6 %, burns – 11.6 %, heat syncope – 1.5 %, poisoning by combustion products – 3.3 %. The average age of the injured FFS personnel of the EMERCOM of Russia was (36.2 ± 0.3) years, including (10.2 ± 0.3) years of work experience, with the overall FFS forces standing at (191.3 ± 3.3) thousand people. Results and discussion. The predicted number of occupational injuries among the FFS personnel of the EMERCOM of Russia was calculated using the discriminant formula: y = (2.49 z1 + 0.21 z2 + 0.91 z3 + 0.68 z4 + 0.72 z5 + 0.71 z6 + 0.88 z7 + + 0.43 z8 + 1.87 z9 + 1.11 z10 + 1.11 z11)∙10–4 × (2.54∙10–4 t2 – 2.98∙10–2∙t + 1.72) × (–2.94∙10–4∙s2 – 1.76∙10–2 ∙ s + 1.24), where y is the number of occupational injuries of the FFS of the EMERCOM of Russia; x is the number of personnel (absolute); t is the average age, years; s is the average professional experience, years; z1–z11 is the predicted number of body damages (contained in chapter XIX of the ICD-10) derived by multiplying the corresponding coefficient by the number of firefighters per 10 thousand people (10–4): z1 is head (S00–S09), z2 is neck (S10–S19), z3 is chest (S20–S29), z4 is abdomen, lower back, lumbar spine and pelvis (S30–S39), z5 is shoulder girdle and shoulder (S40–S49), z6 is elbow and forearm (S50–S59), z7 is wrists and carpus (S60–S69), z8 is hip and thigh areas (S70–S79), z9 is knee and lower leg (S80–S89), z10 is ankle and feet (S90–S99), z11 is other external impacts, i.e. thermal and chemical burns (T20–T32), combustion by-product poisoning (T58–T59), heat syncope (T67.1). Linear discriminant formulas are provided to calculate body lesions split by categories of personnel (operational, preventive, technical and managerial personnel).Conclusions. The method allows to predict the total number of occupational injuries among firefighters, including injuries of certain body areas and thereby calculate the resources and efforts required for treatment and rehabilitation.

The influence of extreme thermal stress on the physiological and psychological characteristics of young women who sporadically use the sauna: practical implications for the safe use of the sauna.

Many individuals who use the sauna at a temperature of 120°C of higher are not aware of the negative consequences of extreme thermal stress. Despite extensive research into sauna use, the impact of extreme thermal stress on the physiological and psychological characteristics of sauna users have not been examined to date. The aim was to determine the effect of 20 min sauna sessions with a temperature of 80°C and 120°C on the physiological and psychological characteristics of women who sporadically visit the sauna. The study was conducted on 22 full-time female university students. Physical activity (PA) levels were evaluated with the Polish short version of the International Physical Activity Questionnaire (IPAQ). Anthropometric characteristics were measured before the first sauna session by the InBody270 body composition analyzer. Physiological parameters, including heart, energy expenditure, physical effort, and blood pressure (systolic blood pressure - SBP, and diastolic blood pressure - DBP), were assessed indirectly using Polar V800 heart rate monitors and the Omron M6 Comfort blood pressure monitor. The participants' wellbeing was assessed with the Profile of Mood States (POMS) questionnaire. The presence of significant correlations between heat exhaustion and heat stress variables and syncope during the second sauna session was examined with the use of classification and regression trees (CRT) and the cross-validation technique. Twenty-minute sauna sessions with a temperature of 80°C and 120°C induced a significant (p < 0.001) decrease in the values of SBP (excluding the temperature of 120°C), DBP, and body mass, as well as a significant increase in HR and forehead temperature. Exposure to a temperature of 80°C led to a significant (p < 0.001) increase in vigor with a simultaneous decrease in tension, depression, anger, fatigue, and confusion. In turn, sauna bathing at a temperature of 120°C had an opposite effect on the above mood parameters. Vomiting and confusion were the main predictors of syncope that occurred in some of the surveyed women. Excessive air temperature can induce symptoms characteristic of heat exhaustion and heat stress nausea, heavy sweating, fast weak or strong HR, high body temperature, and confusion. Therefore, sauna bathing at a temperature of 80°C can be recommended to women who sporadically use the sauna, whereas exposure to a temperature of 120°C is not advised in this group of sauna users. The present findings provide highly valuable inputs for managing wellness and SPA centers.

Heat illness presentations to emergency departments in Western Sydney: surveillance for environmental, personal and behavioural risk factors.

To pilot surveillance to describe environmental, personal and behavioural risk factors for people presenting to hospital emergency departments (EDs) with heat illness. We conducted a retrospective case series and telephone interview study of people presenting to EDs across South Western Sydney, Western Sydney and Nepean Blue Mountains Local Health Districts with heat illness over the 2017/18 and 2018/19 summer periods (1 December to 28 February). We used the Public Health Rapid Emergency Disease Syndromic Surveillance (PHREDSS) 'heat problems' syndrome to identify people with heat illness and medical records to find contact details. We developed a detailed questionnaire instrument to guide the telephone interview. A total of 129 individuals presented with 'heat problems' (57 in 2017/18 and 72 in 2018/19). The median age was 44 years (range 1-89 years). Most attended hospitals via the NSW Ambulance Service (58%) or private car (40%). Of the total, 53% were classified as triage category 3 (potentially life-threatening), 27% as category 4 (potentially serious) and 16% as category 2 (imminently life-threatening). The main supplementary codes were heat exhaustion (35%), heat syncope (39%), and heat stroke (30%). The majority were discharged from the emergency department after completing treatment (73%), with 21% requiring admission. A total of 38 follow-up interviews were completed (29% response rate). Almost all individuals were exposed to heat outside their home environment: 11 (29%) were engaged in paid work, 5 (13%) in outdoor housework, and 10 (26%) in outdoor recreational activities. Our pilot surveillance study successfully collected home, local environment and behavioural risk factors on a small cohort presenting with 'heat problems' to EDs in Western Sydney during the summer months. Most were exposed to heat outdoors while engaged in work or recreation outside the home, and were preventable.

Heatwaves and human sleep: Stress response versus adaptation

The World Meteorological Organization considers a heatwave as “a period of statistically unusual hot weather persisting for a number of days and nights”. Accompanying the ongoing global climate change, sharp heatwave bouts occur worldwide, growing in frequency and intensity, and beginning earlier in the season. Heatwaves exacerbate the risk of heat-related illnesses, hence human morbidity and mortality, particularly in vulnerable elderly and children. Heat-related illnesses present a continuum from normothermic (prickly heat, heat edema, heat cramps, heat tetany) to hyperthermic syndromes (from heat syncope and heat exhaustion to lethal heat stroke). Heat stroke may occur through passive heating and/or exertional exercise. “Normal sleep”, such as observed in temperate conditions, is altered during heatwaves. Brisk excessive heat bouts shorten and fragment human sleep. Particularly, deep N3 sleep (formerly slow-wave sleep) and REM sleep are depleted, such as in other stressful situations. The resultant sleep loss is deleterious to cognitive performance, emotional brain function, behavior, and susceptibility to chronic health conditions and infectious diseases. Our group has previously demonstrated that sleep constitutes an adaptive mechanism during climatic heat acclimatization. In parallel, artificial heat acclimation procedures have been proposed in sports and military activities, and for the elderly. Other preventive actions should be considered, such as education and urban heat island cooling (vegetation, white paint), thus avoiding energy-hungry air conditioning.

Analysis of the Health and Safety Challenges Faced by Construction Workers in Extreme Hot Weather Conditions

The increasing number of extremely hot days globally has made outdoor workers more vulnerable to heat-related illnesses such as heat syncope, heat exhaustion, heat edema, and heat stress. The objective of this article is to identify and analyze the challenges experienced by construction workers who work in extremely hot weather conditions for extended periods of time. To achieve this objective, a questionnaire was developed and distributed through the online platform QuestionPro. The 100 responses that were collected were analyzed using the Kruskal-Wallis test, and analyses were performed based on physiological indicators such as heart rate and blood pressure and personal indicators such as climate acclimatization and clothing comfort. The results of the analyses revealed that challenges such as physical fatigue, dehydration, excessive sweating, inability to concentrate, and frequent mood fluctuations were unique to individuals based on their acclimatization level, heart rate, and blood pressure. Optimized work-rest hours, the provision of adequate time for workers to acclimate to extreme conditions, and adoption of technologies such as cooling vests and continuous monitoring of workers’ physical parameters are some of the strategies that can be used to protect workers from heat-related health hazards. The article also briefly discusses the practices and regulations that are currently in effect to protect construction workers who are exposed to prolonged hot weather conditions. The findings presented in this article will help professionals in the construction sector effectively manage and safeguard workers’ health in extreme hot weather conditions.

Common Health Problems Among Agricultural Workers in A Selected Rural Area of Mymensingh, Bangladesh

This cross-sectional descriptive study was conducted in Churkhai village of Bhavokhali union during December 2018 to find out common health problems among 200 agricultural workers in a selected rural area of Mymensingh as a part of Residential Field Site Training by 3rd year MBBS students session 2016-17. 63 percent of population lives in rural area. Agricultural workers have illnesses common to general population. Moreover socioeconomic and work condition poses extra burden. The study was carried out on 200 agricultural workers who were selected purposively. Data were collected on a predesigned questionnaire by face to face interviewing agricultural workers. Data analysis was done by SPSS version 20.0. Age distribution of respondents ranged from 19 years to 80 years; mean age 46.53 years and standard deviation 14.891 years. Males were predominant (male: female ratio 506.06: 100. Majority of them (57.50%) were literate. Most of them (65.00%) belonged to middle class family. More than half (55.00%) of agricultural workers were suffering from illness. Respiratory illnesses 16.00% were predominant followed by skin disease 10.50%, gastrointestinal disease 6.50%, conjunctivitis 6.00%, arthritis 6.00%, hypertension 6.00%, diabetes mellitus 5.00%, anemia 4.50% and hearing loss 0.50%. In summer heat exhaustion (14.50%) was predominant followed by heat syncope (10.00%. In rainy season ARI (12.00%) was predominant followed by diarrheal diseases (10.50%). In winter mild hypothermia (27.00%) was predominant followed by ARI (4.50%). In recall of last 1 year the important events were crop loss 12.50%, damage to house 10.00%, and unemployment 2.50%. There was no case of anthrax and bird flu. Prevalence of occupational accidents was 5.00%. which includes fall from height 0.50%, heavy object fallen on body 1%, domestic fire 1%, electrocution in house 1%, electrocution by power pump 0.50%, cattle hitting by horn 0.50% and accidental insecticide poisoning 0.5%. Most of the injury occurred in the current week. Majority of the workers (66.50%) had partial tetanus toxoid immunization. Morbidity in this study was better than several studies conducted in Bangladesh and India. By knowing health problems we can give health care to agricultural workers which will prevent diseases and illnesses of them, prolong their healthy life, promote their health and efficiency.&#x0D; CBMJ 2022 July: vol. 11 no. 02 P: 125-130

Factors Affecting Incidence Rate of Exertional Heat Illnesses: Analysis of 6 Years of High School Football Practices in North Central Florida

Background:Although experts have advocated for regionally specific heat safety guidelines for decades, guidelines have not been universally adopted.Purpose:To describe the rate and risk factors associated with exertional heat illness (EHI).Study Design:Descriptive epidemiology study.Methods:For a 3-month period (August-October) over 6 years (2013-2018), athletic trainers at 13 high schools in North Central Florida recorded varsity football practice time and length, wet-bulb globe temperature (WBGT), and incidences of EHI, including heat stroke, heat exhaustion, and heat syncope.Results:Athletes sustained 54 total EHIs during 163,254 athlete-exposures (AEs) for the 3-month data collection periods over 6 years (incidence rate [IR], 3.31 /10,000 AEs). Heat exhaustion accounted for 59.3% (32/54), heat syncope 38.9% (21/54), and heat stroke 1.9% (1/54) of all EHIs recorded. Of the EHIs, 94.4% (51/54) were experienced within the first 19 practices. The first 19 practices had an IR of 7.48 of 10,000 AEs, and the remaining 44 practices had an IR of 0.32 of 10,000 AEs, demonstrating that the risk of EHI for practices 1 to 19 was 23.7 times that of the remaining practices. When comparing morning to afternoon practices, 35.2% (19/54) EHI incidents occurred during morning practices. The risk of EHI during practices with WBGT >82°F (27.8°C) was 3.5 times that of practices with WBGT <82°F.Conclusion:In the current study, the risk of EHI was greatest in the first 19 practices of the season and during practices with WBGT >82°F. As modifiable risk factors for EHI, increased vigilance and empowerment to adhere to acclimatization guidelines can mitigate EHI risk. Health care providers must continue to advocate for implementation of regulations and the authority to make decisions to ensure patient safety.

Exertional heat illnesses in marching band artists: a case series.

Marching band (MB) artists frequently spend many hours engaged in outdoor physical activity. Anecdotal evidence and small studies have indicated that MB artists do experience heat-related health problems. Yet, unlike athletes, military personnel, or workers, there is very little research on heat-related hazards among this unique population. Here, we seek to understand the incidence and circumstances under which exertional heat illnesses (EHIs) occur among MB artists over a 31-year period (1990-2020) across the USA. Using an on-line news dataset, we identified 34 separate events and at least 393 total EHIs. Heat syncope (~ 55%) and heat exhaustion (~ 44%) comprised the majority of EHIs, although a small number of exertional heat stroke cases were also reported. EHIs were reported in all types of MB activities with ~ 32% during rehearsal, ~ 29% during parades, ~ 21% during competition, and ~ 15% during a performance. Also, the vast majority of events occurred with high school (~ 88%) marching bands. Finally, EHIs overwhelmingly occurred when the weather was unusually hot by local conditions. In light of these findings, we emphasize the need for MB specific heat polices that incorporate weather-based activity modification, acclimatization, education about EHIs, and access to on-site medical professionals.

Epidemic of heat-related illnesses among workers exposed to hot working environments in the changing climate scenario

Rising global temperatures, coupled with decreasing access to clean drinking water, may enhance the effects of heat exposure to general and working populations across the globe. People working in jobs that require moderate or heavy manual labor in hot environments are at particular risk caused by the combined effect of exposures to high environmental heat and internal heat production. Exposures to heat can lead to a range of clinical health effects such as fatigue, exhaustion, heat syncope, fainting, heat stroke or even death. Furthermore, heat-related physical exhaustion leads to a reduction of the worker's ability to work with consequent productivity losses that may cause substantial economic losses for the businesses. The result of such continuous heat exposures, manual work and repeated dehydration are also known to cause acute kidney injuries that can further develop into chronic kidney diseases. With the predicted rise in temperatures due to climate change, the health effects for the working population are expected to become worse without appropriate interventions. With this background, the present review focuses on the heat-related health illnesses with special attention to kidney disease among workers engaged in manual physical labor in different occupational sectors.

Diagnosis and treatment of patients with heat-related illnesses

Heat stress disorders or heat-related illnesses are a kind of physiological damage that occurs when the body cannot dissipate enough heat due to its thermoregulatory dysfunction. This paper aims to summarize the latest information on the diagnosis and treatment of heat-related illnesses. Heat stress disorders come in a variety of forms including heat edema, heat rash, heat cramps, heat syncope, heat tetany, severe heat exhaustion, and life-threatening heatstroke. Major risk factors may include excessive exercise, continuous exposure to high temperatures or humid environments, lack of acclimation, excessive clothing or protective equipment, obesity, and dehydration. Additional risk factors may include the patientʼs existing medical condition, environmental and personal factors, and the use of various drugs. Mild heat-related illnesses can be treated only by supportive care such as moving patients to a cool place and laying them in a supine position while elevating their legs and loosening their clothes. However, in the case of heatstroke, quickly lowering the body temperature is an essential in reducing the mortality rate. The most effective cooling method is to immerse the entire body in ice cold water.

Monitoring and analysis of the effects of atmospheric temperature and heat extreme of the environment on human health in Central Iran, located in southwest Asia

Investigation of temperature extremes is very important as one of the most important climate parameters in different parts. If exposed to enough heat, humans will suffer from extreme heat. Maximum temperature and heat can adversely affect many living organisms. The effects of extreme heat on people with chronic lung disease, including asthma and emphysema, are greater; even for people with healthy lungs, outdoor activities are not recommended during high ozone levels. The purpose of this study is to monitor and analyze the effects of atmospheric temperature extreme and extreme heat on human health in Central Iran. Therefore, the minimum and maximum data of 15 synoptic stations in the study area for the period (1988–2018) using hybrid artificial neural network (HANN) and adaptive neuro-fuzzy inference system (ANFIS) models were used. Finally, multi-criteria decision-making (MCDM) models TOSIS and SAW were used to prioritize the areas exposed to rising temperature. The results showed that according to ANFIS modelling for predicting extreme temperatures, the lowest mean training error and the mean error of validation for the minimum temperature were equal to 0.10 for the Yazd Station and 1.66% for the Damghan station. The lowest mean training error and the mean error of validation for the maximum extreme temperature obtained 0.016 for the Garmsar station and 9.39% for the Shahroud station. The maximum extreme temperature of two stations of Garmsar and Bafgh (1 and 0.9689, respectively) was more exposed to extreme temperatures based on the TOPSIS model. Garmsar and Salafchegan Stations (1 and 0.9873, respectively) were more exposed to extreme temperatures based on the SAW model. Climate change is fundamentally changing the Earth’s climate system in a way that directly and indirectly endangers human physical and mental health. Severe increase in temperature is directly associated with death from cardiovascular and respiratory diseases, especially in the elderly. Also in the study area, the house is a place for peace and comfort for every human being. Climatic and weather conditions have a direct impact on creating a sense of comfort in any architectural space. Proper heating and air conditioning in the interior of the building is another case of architecture that will not be easy because this architectural issue is related to the comfort or non-comfort of man, and the concepts of heat or cold are mostly due to the natural feeling of man and his physiological conditions. The rising trend of thermal stresses in the studied stations increases the need to pay attention to the issue of thermal stresses and the spread of diseases (heat attack, syncope, and muscle cramps) in terms of crisis planning and management.

Cardiovascular-Running

HISTORY: A healthy, 26-year-old marathon runner was brought to the emergency department (ED) for altered mental status during an eighteen-mile run. At his fifteenth mile, he reported feeling increasingly warm with burning sensations. He sustained a witnessed collapse with loss of consciousness. He was alert in the ED, asymptomatic, but with anterograde amnesia. He denied prodrome including headache, dizziness, weakness, chest pain, dyspnea, or palpitations. During his ED course, he sustained a second witnessed episode of vomiting and syncope. PHYSICAL EXAMINATION: Comfortable appearing male. Skin was warm to touch, mildly flushed. Lungs were clear to auscultation. Cardiac exam regular rate and rhythm with normal S1 and S2. He exhibited mild tenderness to palpation in lower distal extremities without peripheral edema. Compartments were soft. He was neurologically intact. DIFFERENTIAL DIAGNOSIS: Heat syncope Metabolic disorder Cardiogenic - Acute coronary syndrome, cardiomyopathy, exercise related dysrhythmia, channelopathy Seizure Rhabdomyolysis TEST AND RESULTS: - CPK 7,639, peaked at 15,551 - Troponin 0.553, peaked at 2.19 - EKG with t-wave inversions and ST depressions in precordial leads - pH 7.27, pCO2 41.3, Lactate 5.9 - Na 143, K 5.2, Cl 107, Bicarb 18.9 Glucose 97 Calcium 10.6 - Bun 24 Cr 2.2 - Urine tox negative FINAL WORKING DIAGNOSIS: Rhabdomyolysis TREATMENTS AND OUTCOMES: - Admitted to the cardiac ICU for NSTEMI secondary to rhabdomyolysis, recurrent syncope, acute kidney injury, and metabolic acidosis. - Cardiac echo showed normal ejection fraction without wall motion abnormalities. - EKG abnormalities normalized on 5 days continuous telemetry - Maintained on intravenous fluids and bicarbonate drip. Secondary organ function improved, with discharge on hospital day 5 - NSTEMI and recurrent syncope are unusual presentations of rhabdomyolysis in young, healthy athletes - Pending - outpatient electrophysiology, genetic screening, cardiac rehabilitation, precautions in return to distance running

Heat Policy Revision for Georgia High School Football Practices Based on Data-Driven Research.

Interscholastic heat policies for football have not been evidence based. Therefore, their effectiveness in mitigating exertional heat illness has not been assessed. To discuss the development of the Georgia High School Association heat policy and assess the effectiveness of revised guidelines. Descriptive epidemiology study. Georgia high schools. Interscholastic football players in grades 9 through 12. Heat syncope and heat exhaustion (HS/HE) illness rates (IRs) were calculated per 1000 athlete-exposures (AEs), and relative risk (RR) was calculated as a ratio of postpolicy (POST) IR divided by prepolicy (PRE) IR. A total of 214 HS/HE cases (172 PRE, 42 POST) and 341 348 AEs (178 230 PRE, 163 118 POST) were identified. During the first 5 days of the PRE period, approximately 50% of HS/HE illnesses occurred; HS/HE IRs doubled when practice sessions increased from 2 to 2.5 hours and tripled for practices ≥3 hours. The HS/HE IRs in the PRE period increased from 0.44/1000 AEs for wet-bulb globe temperatures (WBGTs) of <82°F (<27.8°C) to >2.0/1000 AEs for WBGTs from 87°F (30.6°C) to 89.9°F (32.2°C). The RRs comparing PRE and POST policy periods were 0.29 for WBGTs of <82.0°F (<27.80°C), 0.65 for WBGTs from 82.0°F (27.8°C) to 86.9°F (30.5°C), and 0.23 for WBGTs from 87.0°F (30.6°C) to 89.9°F (32.2°C). No HS/HE illnesses occurred in the POST period for WBGTs at >90°F (>32.3°C). Results from the PRE period guided the Georgia High School Association to revise its heat and humidity policy to include a mandated 5-day acclimatization period when no practices may exceed 2 hours and the use of WBGT-based activity-modification categories. The new policy reduced HS/HE IRs by 35% to 100%, depending on the WBGT category. Our results may be generalizable to other states with hot and humid climates similar to that of Georgia.

Current paradigms in the prehospital care of exertional heat illness: A review

Exertional heat illness, including muscle cramps, heat syncope, heat exhaustion, and heat stroke, occur each year in athletes and military soldiers. Exertional heat stroke, the most concerning type of exertional heat illness, is a life-threatening condition defined clinically by a core body temperature greater than 104° F (40°C) and central nervous system dysfunction. Heat stroke may lead to multiorgan failure and death and is one of the leading causes of nontraumatic death in athletes participating in outdoor activities. Current recommendations are discussed regarding prehospital and first responder care of exertional heat illness, particularly heat stroke, with an emphasis on rapid recognition, assessment, and implementation of cooling and advanced care strategies. This overview is of particular interest to orthopaedic team physicians who often are first responders on the field.

Analysis the syndrome differentiation of sepsis by the theories of "four patterns and four methods" under the guidance of "ministerial fire theory"

At present, the main use of Chinese medicine in the treatment of sepsis and sepsis shock is "four patterns and four methods". Although this method is suitable for clinical treatment, it is difficult for doctors to use, and the relationship between "four patterns" has not been clarified. The author introduces the dialectical thinking of "ministerial fire theory", and aims to interpret "four patterns and four methods". Sepsis and sepsis shock can be devided into four stages: Yang excess, Yin insufficient, fire damage, and fire decay, which corresponding to four disease stages: heat syndrome, heat syncope, cold syncope, and decaying, and the corresponding treatments are heat clearing, nourishing Yin, rescue Yang, rescue shock respectively. Abdominal problems should be considered during this process.

Pilot study predicting core body temperatures in hot work environments using thermal imagery

Introduction Heat stress can lead to various health issues that include heat rash, heat exhaustion, heat syncope, cramps, and heat stroke. Core body temperature, a reliable and accepted measurement for heat stress, can only be assessed via invasive means such as ingestible thermometer pills and rectal thermometers. The goal of this study was to determine a more convenient method of assessing heat stress by comparing temperature measurements from thermometer pills to measurements of a participant’s face taken with an infrared camera. Methods Workers at hot worksites had their temperatures recorded via ingestible thermometer pill and infrared camera over the course of a daytime work shift. Multivariate linear regression was used to evaluate the relationship, if any, between the thermometer pill and infrared camera while taking into account additional factors such as indoor and outdoor temperatures, age, gender, and BMI. Results/discussion A Pearson Correlation Coefficient of r = 0.611 was found. This is a strong correlation and shows potential for the infrared camera as a non-invasive alternative to the thermometer pill and rectal thermometer. One thermometer pill measurement of 86 °C was excluded due to verbal confirmation from the participant that they had taken a drink of water prior to measurement. Conclusions Statistical results showed that the ability of the infrared camera to successfully predict core body temperature measurements taken thermometer pill was strong (r = 0.611). More research should be conducted during times with warm outdoor temperatures and with larger sample sizes.

Knowledge and Belief Toward Heat Safety and Hydration Strategies Among Runners: A Preliminary Evaluation.

Little is known about how educating runners may correct common misconceptions surrounding heat safety and hydration strategies. To investigate (1) beliefs and knowledge about heat safety and hydration strategies among recreational runners and (2) the effectiveness of an educational video in optimizing performance in the heat. Cross-sectional study. Survey. A total of 2091 (25.1%) of 8319 runners registered for the 2017 Falmouth Road Race completed at least 1 of the 3 administered surveys. A 5.3-minute video and an 11-question survey regarding heat safety and hydration strategies were developed, validated, and implemented. The survey was e-mailed to registrants 9 weeks before the race (PRERACE), after they viewed the video (POSTEDU), and the afternoon of the race (POSTRACE). The total score for responses to 2 multiple choice questions and nine 5-point (response range = strongly agree to strongly disagree) Likert-scale questions. The PRERACE results showed that more than 90% of respondents recognized the importance of staying hydrated beginning the day before the planned activity, correctly identified that dark color urine is not a sign of euhydration, and believed that dehydration may increase the risk for heat syncope. Conversely, fewer than 50% of respondents knew the number of days required to achieve heat acclimatization, the role of sweat-rate calculation in optimizing one's hydration strategy, or the risk of water intoxication from drinking too much water. An improvement in survey score from PRERACE to POSTEDU was observed (mean difference = 2.00; 95% confidence interval = 1.68, 2.33; P < .001) among runners who watched the video, and 73% of the improvement in their scores was retained from POSTEDU to POSTRACE (mean difference = -0.54; 95% confidence interval = -0.86, -0.21; P < .001). The video successfully shifted runners' beliefs and knowledge to enable them to better optimize their performance in the heat.

Investigation into the thermal comfort of university students conducting outdoor training

Heat stress negatively influences human health and performance, leading to lower efficiency in daily activities. In particular, strenuous training in outdoor hot environment conditions increases the potential for developing heat illness, such as heat cramps, heat exhaustion, and heat stroke. Few investigations have been conducted on heat stress during high-intensity outdoor training. The present study aims to summarize the evidence on the relations between high-intensity outdoor training and heat illness and between heat indices, including Wet Bulb Globe Temperature (WBGT), Physiological Equivalent Temperature (PET) and Universal Thermal Climate Temperature (UTCI), and environmental parameters. In this investigation, fresh students were invited as volunteers to answer the questionnaire about their heat perception with microclimate measurements when they had a rest in a session of outdoor training. The results showed that some students had heat syncope and more than 30% suffered from “profuse sweating.” The effect of air temperature on thermal comfort was most significant. The stress categories of WBGT, PET, and UTCI need to be modified for freshmen outdoor training to avoid overexposure in a hot outdoor environment.

Latex glove industry: Prevalence of heat‐related illness among Malaysian workers

AbstractGlove production involves work processes with a high temperature. However, few studies have been conducted on the hazards of high temperature among workers. This study was conducted to evaluate the prevalence of heat‐related illness among glove industry workers under heat stress conditions. This cross‐sectional study was conducted in a glove factory at Selangor. The total number of workers (n = 82) were interviewed using adapted questionnaires. The highest prevalent heat‐related illnesses in respondents were dehydration (82.2%), followed by heat exhaustion (81.1%), heat cramps (23.2%), heat rashes (22.2%), heat stroke (5.6%), and heat syncope (4.4%). The workers are highly exposed to dehydration and heat exhaustion illness. Therefore, prevention of heat stress is very important in this industry. It is the duty of the employers to implement suitable prevention measures to protect the health and safety of their workers. As a recommendation, personal protective equipment such as a cool vest also helps in protection from the hot working environment. The cool vest has inserted frozen liquid placed between the fabrics and is worn on the upper trunk. This helps in giving workers freedom to move around, as it has no attached lines. This suit has a constant and steady cooling effect on the whole body. Besides this, training on heat stress and on the ways of controlling heat stress should be provided by employers. This training program can help in educating and creating awareness among workers on the symptoms of heat‐related illness, which can help in preventing any worst case of heat stress from occurring. The training program may include the description of heat stress, including the symptoms of heat‐related illness and the first‐aid measures for each disorder.