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With a view to occupational effects of climate change, we performed a simulation study on the influence of different heat stress assessment metrics on estimated workability (WA) of labour in warm outdoor environments. Whole-day shifts with varying workloads were simulated using as input meteorological records for the hottest month from four cities with prevailing hot (Dallas, New Delhi) or warm-humid conditions (Managua, Osaka), respectively. In addition, we considered the effects of adaptive strategies like shielding against solar radiation and different work-rest schedules assuming an acclimated person wearing light work clothes (0.6 clo). We assessed WA according to Wet Bulb Globe Temperature (WBGT) by means of an empirical relation of worker performance from field studies (Hothaps), and as allowed work hours using safety threshold limits proposed by the corresponding standards. Using the physiological models Predicted Heat Strain (PHS) and Universal Thermal Climate Index (UTCI)-Fiala, we calculated WA as the percentage of working hours with body core temperature and cumulated sweat loss below standard limits (38 °C and 7.5% of body weight, respectively) recommended by ISO 7933 and below conservative (38 °C; 3%) and liberal (38.2 °C; 7.5%) limits in comparison. ANOVA results showed that the different metrics, workload, time of day and climate type determined the largest part of WA variance. WBGT-based metrics were highly correlated and indicated slightly more constrained WA for moderate workload, but were less restrictive with high workload and for afternoon work hours compared to PHS and UTCI-Fiala. Though PHS showed unrealistic dynamic responses to rest from work compared to UTCI-Fiala, differences in WA assessed by the physiological models largely depended on the applied limit criteria. In conclusion, our study showed that the choice of the heat stress assessment metric impacts notably on the estimated WA. Whereas PHS and UTCI-Fiala can account for cumulative physiological strain imposed by extended work hours when working heavily under high heat stress, the current WBGT standards do not include this. Advanced thermophysiological models might help developing alternatives, where not only modelling details but also the choice of physiological limit criteria will require attention. There is also an urgent need for suitable empirical data relating workplace heat exposure to workability.

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BACKGROUND: Exposure to heat stress is a documented risk for Central American sugarcane harvesters. However, little is known about heat-related illness in this population. METHODS: This study examined the frequency of heat-related health effects among harvesters (n = 106) exposed to occupational heat stress compared to non-harvesters (n = 63). Chi-square test and gamma statistic were used to evaluate differences in self-reported symptoms and trends over heat exposure categories. RESULTS: Heat and dehydration symptoms (headache, tachycardia, muscle cramps, fever, nausea, difficulty breathing, dizziness, swelling of hands/feet, and dysuria) were experienced at least once per week significantly more frequently among harvesters. Percentages of workers reporting heat and dehydration symptoms increased in accordance with increasing heat exposure categories. CONCLUSIONS: A large percentage of harvesters are experiencing heat illness throughout the harvest demonstrating an urgent need for improved workplace practices, particularly in light of climate change and the epidemic of chronic kidney disease prevalent in this population.

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BACKGROUND: Occupational heat stress is a major concern in sugarcane production and has been hypothesized as a causal factor of a chronic kidney disease epidemic in Central America. This study described working conditions of sugarcane harvesters in Costa Rica and quantified their exposure to heat. METHODS: Non-participatory observation and Wet Bulb Globe Temperatures (WBGT) according to Spanish NTP (Technical Prevention Notes) guidelines were utilized to quantify the risk of heat stress. OSHA recommendations were used to identify corresponding exposure limit values. RESULTS: Sugarcane harvesters carried out labor-intensive work with a metabolic load of 261 W/m² (6.8 kcal/min), corresponding to a limit value of 26° WBGT which was reached by 7:30 am on most days. After 9:15 am, OSHA recommendations would require that workers only work 25% of each hour to avoid health risks from heat. CONCLUSIONS: Sugarcane harvesters are at risk for heat stress for the majority of the work shift. Immediate action is warranted to reduce such exposures.

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While climate change continues to increase ambient temperatures, the resulting heat stress exposure to workers in non-climate controlled settings is not well characterized, particularly in low and middle income countries. This preliminary report describes current heat stress in Nicaraguan work places and estimates occupational heat stress in 2050. From over 400 measurements of heat exposure using wet bulb globe temperature, more than 10% of all measurements exceeded the safety threshold for the combination of light work and rest at the ratio of 25:75. By 2050, that percentage of "over-heated" days is projected to increase to over 15%. These findings support the idea that common working conditions in Nicaragua already represent a threat to the health and safety of the workers and that climate change driven trends could mean either a necessary curbing of economic productivity or an increased threat to worker health and safety.

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Climate change is increasing heat exposure in places such as Central America, a tropical region with generally hot/humid conditions. Working people are at particular risk of heat stress because of the intrabody heat production caused by physical labor. This article aims to describe the risks of occupational heat exposure on health and productivity in Central America, and to make tentative estimates of the impact of ongoing climate change on these risks. A review of relevant literature and estimation of the heat exposure variable wet bulb globe temperature (WBGT) in different locations within the region were used to estimate the effects. We found that heat stress at work is a real threat. Literature from Central America and heat exposure estimates show that some workers are already at risk under current conditions. These conditions will likely worsen with climate change, demonstrating the need to create solutions that will protect worker health and productivity.

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[Prólogo. Mirta Roses - Directora]. La epidemiología es la base y el fundamento de la salud pública. Como agencia de salud, la principal disciplina de la Organización Panamericana de Salud es por ende la epidemiología, la cual nos permite medir, definir y comparar los problemas y condiciones de salud y su distribución en un contexto poblacional, espacial y temporal. La epidemiología nos dota de instrumentos fundamentales para el contacto con las comunidades y para la observación de los proyectos en el mismo campo de acción. Uno de mis sueños posibles, además de hacer realidad las metas de los Objetivos de Desarrollo del Milenio (ODM), es la eliminación de aquellos padecimientos o enfermedades que aún afectan a nuestros semejantes a pesar de que disponemos del conocimiento y los instrumentos para su virtual desaparición. Esto es posible y, por lo tanto, es éticamente impostergable que nos pongamos en marcha con determinación. Por ello, me complace presentarles la segunda edición en español de Epidemiología básica, porque representa precisamente una herramienta útil para la aplicación de la epidemiología a la prevención de enfermedades y a la promoción de la salud. Este libro presenta los métodos básicos de la epidemiología, con un énfasis en las aplicaciones de la salud pública en los países en desarrollo, y promueve buenas prácticas clínicas, al introducir conceptos de la epidemiología clínica...

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