Abstract Through highlighting occupational heat stress mitigation programs in five regions (i.e., South Asia, Southeast Asia, Middle East, Europe, and Mesoamerica) we will explore the adaptation and ...scaling of effective programs. The session explores the need to collectively gather and analyse information on a global level, and the considerations required for effective uptake in the private and public sectors. Experiences from leading experts and programs will provide insight into what elements of interventions have been effective, what have historically been overlooked and the opportunities that each has created. Building on these individual experiences, the objective of the session is to lay the foundation for future collaborative, inclusive and transdisciplinary efforts to mitigate the negative impacts of occupational heat stress on workers, industry and public institutions. Special attention will be given to practical considerations with a focus on what makes interventions viable, the need for effective protocol design and subsequent implementation support to ensure adherence by workers and employers. We will also discuss how we have used findings for improving public and private polices impacting worker protections in a warming world while guaranteeing all stakeholders, especially workers at risk, have a voice in the design and intended impact of such efforts. The intended outcomes of this Special Session are: 1) convey the essential elements of leading occupational heat stress mitigation programs 2) provide insights and discuss emergent opportunities from each of these efforts, and 3) propose a way forward for the development of future heat stress mitigation programs through collaborative and transdisciplinary approaches
Abstract Introduction Chronic kidney disease of non-traditional origin (CKDnt) is a global health emergency, with epidemics identified in several tropical regions. Manual sugarcane cutters with the ...highest levels of workload are at high risk of developing the disease. Other industries impacted include construction, mining, salt pans, and brick production. These settings have in common physically demanding work, high environmental temperature, and poor labor protections. Objectives Without prevention, CKDnt epidemics will likely accelerate due to climate change. In response, we established PREP (Prevention, Resilience, Efficiency and Protection), a workplace intervention program designed to prevent heat strain and kidney damage among workers at a sugarcane mill in Nicaragua with the aim to adapt the program to other geographies and industries. Results Despite initial implementation challenges a 72% reduction of cross-harvest kidney injury, a 94% reduction in hospitalized acute kidney injury due to heat stroke, a 22% ROI for the employer and increase of productivity of at least 10% were achieved. With treatment and remediation costing at least 1000% more per person than prevention, CKDnt inaction is depleting health systems. Significance for policy and practice PREP has already expanded to other sugarcane mills and other industries at risk for heat stress and CKDnt. Climate change means more extreme temperatures in already impacted regions, and the likelihood that regions further north and south of the equator will also be impacted by CKDnt. It is essential to develop a model to protect worker health and productivity. Occupational heat stress and resulting CKDnt require increased attention and resources.
Background:
Mesoamerican sugarcane cutters are at a high risk of chronic kidney disease of non-traditional origin, a disease likely linked to heat-related acute kidney injury (AKI). Studies in ...general populations have described a positive association between high environmental temperatures and clinically assessed kidney outcomes, but there are no studies in occupational settings.
Method:
We accessed routine records of clinically diagnosed AKI (AKI-CD) and wet bulb globe temperatures (WBGT) at a large Nicaraguan sugarcane plantation and modeled the relationship between these using negative binomial regression. A rest-shade-hydration intervention was gradually enhanced during the study period, and efforts were made to increase the referral of workers with suspected AKI to healthcare.
Results:
Each 1°C WBGT was associated with an 18% (95% confidence interval CI: 4, 33%) higher AKI-CD rate on the same day and a 14% (95% CI −5, 37%) higher rate over a week. AKI-CD rates and severity, and time between symptoms onset and diagnosis decreased during the study period, that is, with increasing rest-shade-hydration intervention. Symptoms and biochemical signs of systemic inflammation were common among AKI-CD cases.
Discussion:
Occupational heat stress, resulting from heavy work in environmental heat, was associated with a higher rate of clinically diagnosed AKI in a population at risk of CKDnt. Promoting rest-shade-hydration may have contributed to reducing AKI rates during the study period. Occupational health and safety personnel have key roles to play in enforcing rest, shade, and hydration practices, referring workers with suspected AKI to healthcare as well as collecting and analyzing the data needed to support workplace heat stress interventions.
Ionizing radiation is commonly delivered by medical linear accelerators (LINAC) in the form of shaped beams, and it is able to induce Cherenkov emission in tissue. In fluorescence-based microscopy ...excitation from scanned spots, lines, or sheets can be used for fast high-resolution imaging. Here we introduce Cherenkov-excited luminescence scanned imaging (CELSI) as a new imaging methodology utilizing 2-dimensional (∼5-mm-thick) sheets of LINAC radiation to produce Cherenkov photons, which in turn excite luminescence of probes distributed in biological tissues. Imaging experiments were performed by scanning these excitation sheets in three orthogonal directions while recording Cherenkov-excited luminescence. Tissue phantom studies have shown that single luminescent inclusions ∼1 mm in diameter can be imaged within 20-mm-thick tissue-like media with minimal loss of spatial resolution. Using a phosphorescent probe for oxygen, PtG4 with the CELSI methodology, an image of partial pressure of oxygen (pO₂) was imaged in a rat lymph node, quantitatively restoring pO₂ values in differently oxygenated tissues.
Current and lifetime rates of disorders outlined in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.,
DSM-III-R
) were compared in 78 adult children caring for a parent with a ...progressive dementia and 78 control subjects. The frequencies of depressive and anxiety disorders did not differ between groups in the years prior to caregiving, and there were no differences between groups in first-degree relatives' incidence of psychiatric disorder. During the years they had been providing care, 34% of caregivers met
DSM-III-R
criteria: 24% for a depressive disorder and 10% for an anxiety disorder. In contrast, 8% of the matched controls met criteria during the same time period for depressive or anxiety disorders. Results support the chronic strains of caregiving being linked to the onset of both depressive and anxiety disorders in adult children caring for a demented parent.
Compared self- and other-rated depression in spousal caregivers for 23 Alzheimer's patients, 23 Parkinsons' Disease patients, and 23 control subjects. Two caregiver groups were similar in length of ...time they had been giving care and in caregiver distress and both caregiver groups were more depressed than control subjects. (Author/NB)
This study contrasted the relative effectiveness of an interviewer-rated instrument, the Hamilton Depression Rating Scale, and 2 self-report scales, the short form of the Beck Depression Inventory ...and the depression scale from the Brief Symptom Inventory, in identifying cases of depression. Cases of major depression, dysthymia, and depressive disorder not otherwise specified (NOS) were identified by means of the Structured Clinical Interview for
DSM-III-R
(
SCID
) in a sample of 177 elderly community-dwellers. Receiver operating curves were used to evaluate the relative abilities of the 3 screening instruments to identify cases of depression. All 3 instruments identified major depression and depressive disorder NOS. None was consistently sensitive to cases of dysthymia. The incremental utility of the interview-based instrument for screening was nonsignificant, suggesting that the increased expense in a community setting may not be justified.
Mesoamerican nephropathy (MeN), an epidemic in Central America, is a chronic kidney disease of unknown cause. In this article, we argue that MeN may be a uric acid disorder. Individuals at risk for ...developing the disease are primarily male workers exposed to heat stress and physical exertion that predisposes to recurrent water and volume depletion, often accompanied by urinary concentration and acidification. Uric acid is generated during heat stress, in part consequent to nucleotide release from muscles. We hypothesize that working in the sugarcane fields may result in cyclic uricosuria in which uric acid concentrations exceed solubility, leading to the formation of dihydrate urate crystals and local injury. Consistent with this hypothesis, we present pilot data documenting the common presence of urate crystals in the urine of sugarcane workers from El Salvador. High end-of-workday urinary uric acid concentrations were common in a pilot study, particularly if urine pH was corrected to 7. Hyperuricemia may induce glomerular hypertension, whereas the increased urinary uric acid may directly injure renal tubules. Thus, MeN may result from exercise and heat stress associated with dehydration-induced hyperuricemia and uricosuria. Increased hydration with water and salt, urinary alkalinization, reduction in sugary beverage intake, and inhibitors of uric acid synthesis should be tested for disease prevention.
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