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Children, particularly infants and those with chronic conditions, are highly vulnerable to heat-induced health risks, similarly to the elderly. This narrative review synthesizes current evidence on the impact of heat exposure on pediatric and perinatal health. A systematic literature search was conducted using PubMed/MEDLINE and manual reference checks, focusing on studies from 2000 to 2024. Findings indicate that maternal heat exposure is associated with adverse pregnancy outcomes, including pre-eclampsia, gestational diabetes, hypertension, and increased hospital admissions. Additionally, prenatal heat stress correlates with preterm birth, low birth weight, birth defects, and stillbirth. In childhood, heat-related health consequences range from heatstroke and dehydration to renal impairment, respiratory diseases, and gastrointestinal infections. Psychosocial effects, including cognitive impairment, sleep disturbances, and mental health issues, have also been reported in school-age children and adolescents. Despite strong epidemiological evidence, critical knowledge gaps remain, including the exact temperature thresholds that increase disease risk and how these thresholds vary by age and underlying health conditions. Urgent public health measures are required to mitigate these risks, while further research is needed to define exposure–response relationships and effective interventions. Addressing the rising burden of heat-related pediatric illness is essential in the context of climate change and increasing global temperatures. [ABSTRACT FROM AUTHOR]

This case report describes a successful use of normothermic targeted temperature management (TTM) for the treatment of a 14-year-old girl with exertional heat stroke. Upon hospitalization, she exhibited a 40.5 ℃ core temperature and multiorgan failure. We immediately applied the TTM, targeting a range of 36-37 ℃. Her condition improved rapidly, with vital signs stabilized and consciousness fully regained by day 3. She experienced a bimodal pattern of rhabdomyolysis during recovery, which was managed without further complications. No neurological sequelae were observed, and all laboratory parameters were normalized before discharge on day 10. This case suggests the potential efficacy of normothermic TTM in pediatric heat stroke.

AbstractSoftware-driven wearable technologies are emerging as a control for heat-related illnesses. Such devices collect biometric data and estimate risk noninvasively. However, little is known about workplace implementation strategies and stakeholder acceptance of the devices. As part of a mixed-methods pilot study to evaluate the feasibility of wearable technologies, the authors invited six agricultural workers with no device experience to participate in a semi-structured focus group, after wearing two devices (e.g., MākuSafe, Des Moines, IA, United States; SlateSafety, V2, Atlanta, GA, United States) for a standard work week. The focus group was separated into two parts: the first assessed the overall understanding of heat stress, and the second captured workers’ perceptions of the wearable technologies. For each topic, the authors extracted relevant themes that describe farm workers’ general understanding of heat hazards and worker interaction with wearable technology used in heat-related risk. These themes provide relevant answers to the questions outlined in the semi-structured questionnaire that can guide future research into the use of these devices in occupational settings. Wearable technologies continue to be used to control heat-related illnesses. Therefore, it is critically important to gather key strategies for employer implementation and user-interface considerations. [ABSTRACT FROM AUTHOR]

Objectives: Climate change is increasing the risk of heat-related illness in outdoor sports. Coaches have a responsibility to protect the athletes in their care. In this study, the knowledge and practice of German coaches in heat prevention were evaluated nationwide. Methods: Coaches (n = 1,200) from the ten largest outdoor sports in Germany were asked about their knowledge using the knowledge of heat-related illness symptoms index (KOSI, range [0–14]). Prevention measures currently implemented by coaches were analyzed in terms of relative compliance with specified recommendations (heat prevention score (HPS), range [0–100]). Results: The KOSI averaged 10.31 ± 1.81 and pointed to clear knowledge deficits: the lowest score values were shown by coaches in skiing (9.85 ± 1.80), soccer (10.07 ± 2.33) and golf (10.09 ± 1.75; pANOVA = 0.015). Heat protection in training was also deficient: The HPS showed a mean value of 62.41 ± 14.89. The greatest deficits existed in tennis (57.71 ± 14.29), mountain sports (58.17 ± 13.08) and soccer (58.70 ± 13.86; pANOVA < 0.001). No correlation between theoretical knowledge and practical prevention was found. Conclusion: In Germany, coaches are insufficiently prepared for the health hazards of heat. Promoting onsite educational programs seems essential to ensure safer sports environments. [ABSTRACT FROM AUTHOR]

ObjectiveEstimate the association between environmental temperature (wet bulb globe temperature [WBGT]) and work rate over the course of a workday.MethodsRepeated-measures regression was used to identify characteristics impacting work rate in a cross-sectional study of Latino farmworkers. Minute-by-minute work rate (measured by accelerometer) and WBGT were averaged over 15-minute intervals.ResultsWork rate decreased by 4.34 (95% confidence interval [CI], -7.09 to -1.59) counts per minute per degree Celsius WBGT in the previous 15-minute interval. Cumulative quarter hours worked (2.13; 95% CI, 0.82 to 3.45), age (-3.64; 95% CI, -4.50 to -2.79), and dehydration at the end of workday (51.37; 95% CI, 19.24 to 83.50) were associated with counts per minute as were gender, pay type (piece rate vs hourly) and body mass index ≥25 kg/m 2 . The effects of pay type and body mass index were modified by gender.ConclusionIncreased temperature was associated with a decrease in work rate.

• Effective heat strain reduction in elderly agricultural workers. • Geriatric nursing-led program boosts heat resilience. • Sustainable approach to occupational health in agriculture. • Tailored education and prevention significantly lower heat strain risks. • Study supports policy development for outdoor laborer safety. This study assesses a geriatric nursing-led sustainable heat prevention program for elderly agricultural workers. It targets those aged 60 and above, addressing the heightened risk of heat strain in the era of climate change. A community-based quasi-experimental design involved 120 elderly agricultural workers, divided into intervention and control groups. The program, spanning three months, included education on hydration, rest, protective clothing, and recognition of heat-related illnesses. The intervention led by geriatric nursing professionals showed significant improvements in heat strain metrics. The Heat Strain Score Index (HSSI) and the Observational-Perceptual Heat Strain Risk Assessment (OPHSRA) Index indicated increased safety levels and reduced risk categories among participants. The study demonstrates the effectiveness of a geriatric nursing-led, tailored prevention program in reducing heat strain among elderly agricultural workers. It highlights the crucial role of nursing in adapting healthcare practices to the challenges posed by climate change. ClinicalTrials.gov, ID NCT06192069 retrospectively registered. [ABSTRACT FROM AUTHOR]

ObjectivesClimate change is increasing the risk of heat-related illness in outdoor sports. Coaches have a responsibility to protect the athletes in their care. In this study, the knowledge and practice of German coaches in heat prevention were evaluated nationwide.MethodsCoaches (n = 1,200) from the ten largest outdoor sports in Germany were asked about their knowledge using the knowledge of heat-related illness symptoms index (KOSI, range [0–14]). Prevention measures currently implemented by coaches were analyzed in terms of relative compliance with specified recommendations (heat prevention score (HPS), range [0–100]).ResultsThe KOSI averaged 10.31 ± 1.81 and pointed to clear knowledge deficits: the lowest score values were shown by coaches in skiing (9.85 ± 1.80), soccer (10.07 ± 2.33) and golf (10.09 ± 1.75; pANOVA = 0.015). Heat protection in training was also deficient: The HPS showed a mean value of 62.41 ± 14.89. The greatest deficits existed in tennis (57.71 ± 14.29), mountain sports (58.17 ± 13.08) and soccer (58.70 ± 13.86; pANOVA < 0.001). No correlation between theoretical knowledge and practical prevention was found.ConclusionIn Germany, coaches are insufficiently prepared for the health hazards of heat. Promoting onsite educational programs seems essential to ensure safer sports environments.

A unique wet-bulb temperature of 35°C is often used as the threshold for human survivability, but recent experiments have shown that a person's core temperature starts to rise at a wide range of critical wet-bulb temperatures. Here, it is shown that the model underlying the heat index correctly predicts those critical wet-bulb temperatures, explaining 95% of the variance in the values observed in laboratory heat-stress experiments. This is the first time the heat-index model has been validated against physiological data from laboratory experiments. For light and moderate exertion in an indoor setting, the heat index model predicts that the critical wet-bulb temperature ranges from 20°C to 32°C, depending on the relative humidity, consistent with experimental results. For the same setting and exertion, the heat index model predicts fatal wet-bulb temperatures ranging from 24°C to 37°C.NEW & NOTEWORTHY Recent experiments have identified the critical combinations of heat and humidity, in an indoor setting, above which an individual is unable to maintain a standard core temperature, indicating severe heat stress. It is shown here why this state of severe heat stress cannot be predicted using the wet-bulb temperature. Instead, it is shown that the recently extended heat index model can explain nearly all of the variance in the observed critical combinations of temperature and humidity, and can be used to calculate fatal combinations.

Background: Occupational heat stress, exacerbated by factors such as climate change and insufficient cooling solutions, endangers the health and productivity of workers, especially in low‐resource workplaces. Objective: To evaluate the effectiveness of two cooling strategies in reducing physiological strain and productivity of piece‐rate workers over a 9‐h work shift in a southern Thailand sawmill. Methods: In a crossover randomized control trial design, 12 (33 ± 7 y; 1.58 ± 0.05 m; 51 ± 9 kg; n = 5 females) medically screened sawmill workers were randomly allocated into three groups comprising an established phase change material vest (VEST), an on‐site combination cooling oasis (OASIS) (i.e., hydration, cold towels, fans, water dousing), and no cooling (CON) across 3 consecutive workdays. Physiological strain was measured via core temperature telemetry and heart rate monitoring. Productivity was determined by counting the number of pallets of wood sorted, stacked, and stowed each day. Results: Relative to CON, OASIS lowered core temperature by 0.25°C [95% confidence interval = 0.24, 0.25] and heart rate by 7 bpm [6, 9] bpm, compared to 0.17°C [0.17, 0.18] and 10 [9,12] bpm reductions with VEST. It was inconclusive whether productivity was statistically lower in OASIS compared to CON (mean difference [MD] = 2.5 [–0.2, 5.2]), and was not statistically different between VEST and CON (MD = 1.4 [–1.3, 4.1]). Conclusions: Both OASIS and VEST were effective in reducing physiological strain compared to no cooling. Their effect on productivity requires further investigation, as even small differences between interventions could lead to meaningful disparities in piece‐rate worker earnings over time. [ABSTRACT FROM AUTHOR]

Mientras el clima de Florida lo hace ideal para producir una amplia variedad de cultivos, la intensidad del calor y la humedad también pueden representar peligros importantes para quienes trabajan en la agricultura. Con tres de los años más calurosos registrados en Florida en los últimos cuatro años (NOAA, 2019), los dueños de fincas, sus familias y empleados deben conocer los síntomas, el tratamiento y la prevención de las enfermedades relacionadas con el calor (ERC).

Heat stress is associated with workplace injuries, likely through a combination of fatigue, reduced cognitive function, and thermal discomfort. The purpose of this study was to evaluate four cognitive tasks for sensitivity to heat stress. Eight participants performed treadmill exercise followed by assessments of serial reaction time (RT), Stroop effect, verbal delayed memory, and continuous performance working memory in an environmental chamber. A control (21.1 °C) trial, and Hot 1 and Hot 2 (both 37.8 °C) trials were run sequentially on two separate days to evaluate the four cognitive tasks. Heat strain (comparing Hot 1 and Hot 2 with the control trial) resulted in impairments in the serial RT test response and Stroop accuracy. Delayed memory was impacted only in the Hot 2 trial compared with the control trial. Given the demonstrated impact of heat on cognitive processes relevant to workers real-world functioning in the workplace, understanding how to assess and monitor vigilant attention in the workplace is essential.

Exposure to extreme heat is a known risk factor that is associated with increased heat-related illness (HRI) outcomes. The relevance of heat wave definitions (HWDs) could change across health conditions and geographies due to the heterogenous climate profile. This study compared the sensitivity of 28 HWDs associated with HRI emergency department visits over five summer seasons (2011−2016), stratified by two physiographic regions (Coastal and Piedmont) in North Carolina. The HRI rate ratios associated with heat waves were estimated using the generalized linear regression framework assuming a negative binomial distribution. We compared the Akaike Information Criterion (AIC) values across the HWDs to identify an optimal HWD. In the Coastal region, HWDs based on daily maximum temperature with a threshold > 90th percentile for two or more consecutive days had the optimal model fit. In the Piedmont region, HWD based on the daily minimum temperature with a threshold value > 90th percentile for two or more consecutive days was optimal. The HWDs with optimal model performance included in this study captured moderate and frequent heat episodes compared to the National Weather Service (NWS) heat products. This study compared the HRI morbidity risk associated with epidemiologic-based HWDs and with NWS heat products. Our findings could be used for public health education and suggest recalibrating NWS heat products.

ObjectiveDetermine compliance with and effectiveness of California regulations in reducing farmworkers' heat-related illness (HRI) risk and identify main factors contributing to HRI.MethodsIn a cross-sectional study of Latino farmworkers, core body temperature (CBT), work rate, and environmental temperature (WBGT) were monitored over a work shift by individual ingestible thermistors, accelerometers, and weather stations, respectively. Multiple logistic modeling was used to identify risk factors for elevated CBT.ResultsAlthough farms complied with Cal/OSHA regulations, worker training of HRI prevention and hydration replacement rates were insufficient. In modeling (AOR [95% CI]) male sex (3.74 [1.22 - 11.54]), WBGT (1.22 [1.08 - 1.38]), work rate (1.004 [1.002 - 1.006]), and increased BMI (1.11 [1.10 - 1.29]) were all independently associated with elevated CBT.ConclusionRisk of HRI was exacerbated by work rate and environmental temperature despite farms following Cal/OSHA regulations.

Farm workers are exposed to high risk of heat-related illness, especially when their jobs require working outside at a fast pace during hot days. Climate change has increased the number of days with high temperatures, and thereby the amount of time that farm workers are likely exposed to extreme heat. To better understand how high heat exposure affects farm workers, this study investigates how crop workers respond to heat exposure and estimates the effects of different pay and work arrangements on workers' responses to heat exposure. We explore, specifically, whether piece-rate arrangements increase workers' effort during periods with high heat exposure compared to workers paid by hourly wages. We use observational data from detailed measurements of localized heat exposure and individual workers' effort in the field. First, these results show workers adjust their effort in response to heat exposure when the heat exposure level changes. Second, piece-rate arrangements increase workers' effort during work shifts. Third, piece-rate arrangements allow workers to modify their effort more easily during different heat exposure levels. When facing low levels of heat exposure, workers who were paid by piece-rate arrangements exert a higher effort than workers paid by hourly wages, up until WBGT is 26.6˚C. When facing high levels of heat exposure (with WBGT exceeding 29.6˚C), workers paid by piece-rate arrangements lower their effort compared to workers paid by hourly wage arrangements.

Objectives: To explore the clinical potential of multiparametric cardiac magnetic resonance (CMR) in evaluating myocardial inflammation in patients with exertional heat illness (EHI). Methods: This prospective study enrolled 28 males with EHI (18 patients with exertional heat exhaustion (EHE) and 10 with exertional heat stroke (EHS)) and 18 age-matched male healthy controls (HC). All subjects underwent multiparametric CMR, and 9 patients had follow-up CMR measurements 3 months after recovery from EHI. CMR-derived left ventricular geometry, function, strain, native T1, extracellular volume (ECV), T2, T2*, and late gadolinium enhancement (LGE) were obtained and compared among different groups. Results: Compared with HC, EHI patients showed increased global ECV, T2, and T2* values (22.6% ± 4.1 vs. 19.7% ± 1.7; 46.8 ms ± 3.4 vs. 45.1 ms ± 1.2; 25.5 ms ± 2.2 vs. 23.8 ms ± 1.7; all p < 0.05). Subgroup analysis showed that ECV was higher in the EHS patients than those in EHE and HC groups (24.7% ± 4.9 vs. 21.4% ± 3.2, 24.7% ± 4.9 vs. 19.7% ± 1.7; both p < 0.05). Repeated CMR measurements at 3 months after baseline CMR showed persistently higher ECV than HC (p = 0.042). Conclusions: With multiparametric CMR, EHI patients demonstrated increased global ECV, T2, and persistent myocardial inflammation at 3-month follow-up after EHI episode. Therefore, multiparametric CMR might be an effective method in evaluating myocardial inflammation in patients with EHI. Clinical relevance statement: This study showed persistent myocardial inflammation after an exertional heat illness (EHI) episode demonstrated by multiparametric CMR, which is a potential promising method to evaluate the severity of myocardial inflammation and guide return to work, play, or duty in EHI patients. Key Points: • EHI patients showed an increased global extracellular volume (ECV), late gadolinium enhancement, and T2 value, indicating myocardial edema and fibrosis. • ECV was higher in the exertional heat stroke patients than exertional heat exhaustion and healthy control groups (24.7% ± 4.9 vs. 21.4% ± 3.2, 24.7% ± 4.9 vs. 19.7% ± 1.7; both p < 0.05). • EHI patients showed persistent myocardial inflammation with higher ECV than healthy controls 3 months after index CMR (22.3% ± 2.4 vs. 19.7% ± 1.7, p = 0.042). [ABSTRACT FROM AUTHOR]

To assess the consistency of return to sport and occupation recommendations following EHI provided in published clinical practice guidelines, consensus statements, position statements, and practice alerts. The agreement between medical policies governing the return to duty following EHI between the branches of the United States Armed Forces and published recommendations was assessed. Ovid MEDLINE, Web of Science, and CINAHL databases were searched for clinical practice guidelines and position statements published at any time that guided return to activity in individuals with EHI. Methodological quality was assessed, and the specific recommendations for clinical management were extracted. Consistency of recommendations was evaluated. Agreement between published guidelines and the policies governing return to activity in military tactical athletes with heat injury were also evaluated. Guidelines developed by two civilian sports medicine societies in the United States detailing recommendations for return to function following EHI were identified. There was consistency between guidelines regarding recommendations that addressed abstinence from activity; medical follow-up; graded resumption of activity; and return to function. Pertaining military policy, contemporary regulations published in recent years reflected the recommendations provided in the professional guidelines. The greatest incongruence was noted in older military policies. This systematic review highlights the need for consistent recommendations across all branches of the military and medical specialties pertaining to returning servicemembers to duty after EHI. [ABSTRACT FROM AUTHOR]