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This book provides fundamental concepts in human thermal physiology and their applications in general public, occupational, military, and athletics settings from the biometeorological perspective. The book includes a section on human physiology, epidemiology and special considerations in aforementioned populations, and behavioral and technological adjustments people may take to combat thermal environmental stress and safeguard their health. The book is the first of its kind to compile multiple disciplines--human physiology, climatology, and medicine--in one to provide fundamental concepts in human thermal physiology and their applications in general public, occupational, military, and athletics settings from the biometeorological perspective; Developed by experts, scientists, and physicians from exercise physiology, climatology, public health, sports medicine, and military medicine; Highlights special considerations and applications of thermal physiology to general public, occupational, military, and athletics settings.

Climate change is leading to variations in weather patterns and an apparent increase in extreme weather events, including heat-waves. Recent heat-waves in the WHO European Region have led to a rise in related mortality but the adverse health effects of hot weather and heat-waves are largely preventable. This guidance results from the EuroHEAT project on improving public health responses to extreme weather/heatwaves, co-funded by WHO and the European Commission. It explains the importance of the development of heat-health action plans, their characteristics and core elements, with examples from several European countries that have begun their implementation and evaluation.

Purpose Global warming has led to an increase in the number and intensity of extreme heat events, posing a significant threat to the health and safety of workers, especially those working outdoors, as they often have limited access to cooling strategies. The present systematic literature review (a) summarizes the current knowledge on the impacts of climate change on outdoor workers, (b) provides historical background on this issue, (c) explores factors that reduce and increase thermal stress resilience, (d) discusses the heat mitigation strategies, and (e) provides an overview of existing policy and legal frameworks on occupational heat exposure among outdoor workers. Materials and methods In this systematic review, we searched scientific databases including Scopus ( N  = 855), Web of Science ( N  = 828), and PubMed ( N  = 202). Additionally, we identified relevant studies on climate change and heat-stress control measures through Google Scholar ( N  = 116) using specific search terms. In total, we monitored 2001 articles pertaining to worker populations (men = 2921; women = 627) in various outdoor climate conditions across 14 countries. After full-text assessment, 55 studies were selected for inclusion, and finally, 29 eligible papers were included for data extraction. Results Failure to implement effective control strategies for outdoor workers will result in decreased resilience to thermal stress. The findings underscore a lack of awareness regarding certain adaptation strategies and interventions aimed at preventing and enhancing resilience to the impact of climate change on heat stress prevalence among workers in outdoor tropical and subtropical environments. However, attractive alternative solutions from the aspects of economic and ecological sustainability in the overall assessment of heat stress resilience can be referred to acclimatization, shading, optimized clothing properties and planned breaks. Conclusion The integration of climate change adaptation strategies into occupational health programs can enhance occupational heat resilience among outdoor workers. Conducting cost-benefit evaluations of health and safety measures for thermal stress adaptation strategies among outdoor workers is crucial for professionals and policymakers in low- and middle-income tropical and subtropical countries. In this respect, complementary measures targeting hydration, work-rest regimes, ventilated garments, self-pacing, and mechanization can be adopted to protect outdoor workers. Risk management strategies, adaptive measures, heat risk awareness, practical interventions, training programs, and protective policies should be implemented in hot-dry and hot-humid climates to boost the tolerance and resilience of outdoor workers.

As atmospheric greenhouse gas concentrations continue to rise, temperature and humidity will increase further, causing potentially dire increases in human heat stress. On physiological and biophysical grounds, exposure to higher levels of humidity should worsen heat stress by decreasing sweat evaporation. However, population-scale epidemiological studies of heat exposure and response often do not detect associations between high levels of humidity and heat-related mortality or morbidity. These divergent, disciplinary views regarding the role of humidity in heat-related health risks limit confidence in selecting which interventions are effective in reducing health impacts and in projecting future heat-related health risks. Via our multidisciplinary perspective we seek to ) reconcile the competing realities concerning the role of humidity in heat-related health impacts and ) help ensure robust projections of heat-related health risks with climate change. These objectives are critical pathways to identify and communicate effective approaches to cope with present and future heat challenges. We hypothesize six key reasons epidemiological studies have found little impact of humidity on heat-health outcomes: ) At high temperatures, there may be limited influence of humidity on the health conditions that cause most heat-related deaths (i.e., cardiovascular collapse); ) epidemiological data sets have limited spatial extent, a bias toward extratropical (i.e., cooler and less humid), high-income nations, and tend to exist in places where temporal variations in temperature and humidity are positively correlated; ) analyses focus on older, vulnerable populations with sweating, and thus evaporative, impairments that may be further aggravated by dehydration; ) extremely high levels of temperature and humidity (seldom seen in the historical record) are necessary for humidity to substantially impact heat strain of sedentary individuals; ) relationships between temperature and humidity are improperly considered when interpreting epidemiological model results; and ) sub-daily meteorological phenomena, such as rain, occur at high temperatures and humidity, and may bias epidemiological studies based on daily data. Future research must robustly test these hypotheses to advance methods for more accurate incorporation of humidity in estimating heat-related health outcomes under present and projected future climates. https://doi.org/10.1289/EHP11807.

Few studies have examined variation in the associations between heat waves and mortality in an international context. We aimed to systematically examine the impacts of heat waves on mortality with lag effects internationally. We collected daily data of temperature and mortality from 400 communities in 18 countries/regions and defined 12 types of heat waves by combining community-specific daily mean temperature ≥90th, 92.5th, 95th, and 97.5th percentiles of temperature with duration ≥2, 3, and 4 d. We used time-series analyses to estimate the community-specific heat wave-mortality relation over lags of 0-10 d. Then, we applied meta-analysis to pool heat wave effects at the country level for cumulative and lag effects for each type of heat wave definition. Heat waves of all definitions had significant cumulative associations with mortality in all countries, but varied by community. The higher the temperature threshold used to define heat waves, the higher heat wave associations on mortality. However, heat wave duration did not modify the impacts. The association between heat waves and mortality appeared acutely and lasted for 3 and 4 d. Heat waves had higher associations with mortality in moderate cold and moderate hot areas than cold and hot areas. There were no added effects of heat waves on mortality in all countries/regions, except for Brazil, Moldova, and Taiwan. Heat waves defined by daily mean and maximum temperatures produced similar heat wave-mortality associations, but not daily minimum temperature. Results indicate that high temperatures create a substantial health burden, and effects of high temperatures over consecutive days are similar to what would be experienced if high temperature days occurred independently. People living in moderate cold and moderate hot areas are more sensitive to heat waves than those living in cold and hot areas. Daily mean and maximum temperatures had similar ability to define heat waves rather than minimum temperature. https://doi.org/10.1289/EHP1026.

Population exposure to heat waves (HWs) is increasing worldwide due to climate change, significantly affecting society, including public health. Despite its significant vulnerabilities and limited adaptation resources to rising temperatures, South America, particularly Brazil, lacks research on the health impacts of temperature extremes, especially on the role played by socioeconomic factors in the risk of heat-related illness. Here, we present a comprehensive analysis of the effects of HWs on mortality rates in the 14 most populous urban areas, comprising approximately 35% of the country’s population. Excess mortality during HWs was estimated through the observed-to-expected ratio (O/E) for total deaths during the events identified. Moreover, the interplay of intersectionality and vulnerability to heat considering demographics and socioeconomic heterogeneities, using gender, age, race, and educational level as proxies, as well as the leading causes of heat-related excess death, were assessed. A significant increase in the frequency was observed from the 1970s (0–3 HWs year -1 ) to the 2010s (3–11 HWs year -1 ), with higher tendencies in the northern, northeastern, and central-western regions. Over the 2000–2018 period, 48,075 (40,448–55,279) excessive deaths were attributed to the growing number of HWs (>20 times the number of landslides-related deaths for the same period). Nevertheless, our event-based surveillance analysis did not detect the HW-mortality nexus, reinforcing that extreme heat events are a neglected disaster in Brazil. Among the leading causes of death, diseases of the circulatory and respiratory systems and neoplasms were the most frequent. Critical regional differences were observed, which can be linked to the sharp North-South inequalities in terms of socioeconomic and health indicators, such as life expectancy. Higher heat-related excess mortality was observed for low-educational level people, blacks and browns, older adults, and females. Such findings highlight that the strengthening of primary health care combined with reducing socioeconomic, racial, and gender inequalities represents a crucial step to reducing heat-related deaths.

Background The health system plays a critical role in safeguarding the well-being of communities in the face of health risks associated with climate change. This review maps evidence on health systems' adaptation to climate risk and barriers to effective adaptation. Methods This review followed the recommendations by Arksey and O’Malley for conducting scoping review. Search for records was conducted in PubMed, Central, Web of Science, JSTOR, Google, and Google Scholar. Only peer-reviewed papers published in English language were included in this review. All the 63 included studies were critically appraise d. Results We found that efforts are being made to create resilient health systems by incorporating climate change into health policies. Investments are being made in innovative technologies, climate-resilient health infrastructure, enhancing healthcare delivery, developing the capacity of climate specialists and agencies to provide high-quality evidence for resilient health systems. We also found that several obstacles prevent health system adaptation to climate risk, including poor policy implementation and evaluation. The obstacles are further exacerbated by financial constraints, including poverty, a lack of political commitment, inadequate data, and deficient healthcare systems, especially in developing countries. There is also a lack of integration of climate change into mental health actions and the health and safety of healthcare workers. Conclusion Efforts to develop resilient health systems against climate risks are underway, but persistent obstacles, including inadequate policy implementation, resource limitations, and a lack of integration of climate change into critical health domains, hinder comprehensive adaptation measures, particularly in developing nations.

To evaluate the prevalence of dehydration in occupational settings and contextualize findings to effects on performance in cognitively dominated tasks, simple and complex motor tasks during moderate and high heat stress. The study included an occupational part with hydration assessed in five industries across Europe with urine samples collected from 139 workers and analyzed for urine specific gravity. In addition, laboratory experiments included eight male participants completing mild-intensity exercise once with full fluid replacement to maintain euhydration, and once with restricted water intake until the dehydration level corresponded to 2% bodyweight deficit. Following familiarization, euhydration and dehydration sessions were completed on separate days in random order (cross-over design) with assessment of simple motor (target pinch), complex motor (visuo-motor tracking), cognitive (math addition) and combined motor-cognitive (math and pinch) performance at baseline, at 1°C (MOD) and 2°C (HYPER) delta increase in body core temperature. The field studies revealed that 70% of all workers had urine specific gravity values ≥1.020 corresponding to the urine specific gravity (1.020±0.001) at the end of the laboratory dehydration session. At this hydration level, HYPER was associated with reductions in simple motor task performance by 4±1%, math task by 4±1%, math and pinch by 9±3% and visuo-motor tracking by 16±4% (all P<0.05 compared to baseline), whereas no significant changes were observed when the heat stress was MOD (P>0.05). In the euhydration session, HYPER reduced complex (tracking) motor performance by 10±3% and simple pinch by 3±1% (both P<0.05, compared to baseline), while performance in the two cognitively dominated tasks were unaffected when dehydration was prevented (P>0.05). Dehydration at levels commonly observed across a range of occupational settings with environmental heat stress aggravates the impact of hyperthermia on performance in tasks relying on combinations of cognitive function and motor response accuracy.

Background Farmworkers are at risk of heat-related illness (HRI). We sought to: 1) evaluate the effectiveness of farmworker Spanish/English participatory heat education and a supervisor decision-support mobile application (HEAT intervention) on physiological heat strain; and 2) describe factors associated with HRI symptoms reporting. Methods We conducted a parallel, comparison group intervention study from May–September of 2019 in Central/Eastern Washington State, USA. We used convenience sampling to recruit adult outdoor farmworkers and allocated participating crews to intervention ( n  = 37 participants) and alternative-training comparison ( n  = 38 participants) groups. We measured heat strain monthly using heart rate and estimated core body temperature to compute the maximum work-shift physiological strain index (PSI max ) and assessed self-reported HRI symptoms using a weekly survey. Multivariable linear mixed effects models were used to assess associations of the HEAT intervention with PSI max , and bivariate mixed models were used to describe factors associated with HRI symptoms reported (0, 1, 2+ symptoms), with random effects for workers. Results We observed larger decreases in PSI max in the intervention versus comparison group for higher work exertion levels (categorized as low, low/medium-low, and high effort), after adjustment for maximum work-shift ambient Heat Index (HI max ), but this was not statistically significant (interaction − 0.91 for high versus low/medium-low effort, t = − 1.60, p  = 0.11). We observed a higher PSI max with high versus low/medium-low effort (main effect 1.96, t = 3.81, p  < 0.001) and a lower PSI max with older age (− 0.03, t = − 2.95, p  = 0.004), after covariate adjustment. There was no clear relationship between PSI max and the number of HRI symptoms reported. Reporting more symptoms was associated with older age, higher HI max , 10+ years agricultural work, not being an H-2A guest worker, and walking > 3 min to get to the toilet at work. Conclusions Effort level should be addressed in heat management plans, for example through work/rest cycles, rotation, and pacing, in addition to education and other factors that influence heat stress. Both symptoms and indicators of physiological heat strain should be monitored, if possible, during periods of high heat stress to increase the sensitivity of early HRI detection and prevention. Structural barriers to HRI prevention must also be addressed. Trial registration ClinicalTrials.gov Registration Number: NCT04234802 , date first posted 21/01/2020.