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- Ioannou, Leonidas G., et al.
(author)
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Occupational heat stress : Multi-country observations and interventions
- 2021
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In: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 18:12
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Journal article (peer-reviewed)abstract
- Background: Occupational heat exposure can provoke health problems that increase the risk of certain diseases and affect workers’ ability to maintain healthy and productive lives. This study investigates the effects of occupational heat stress on workers’ physiological strain and labor productivity, as well as examining multiple interventions to mitigate the problem. Methods: We monitored 518 full work-shifts obtained from 238 experienced and acclimatized individuals who work in key industrial sectors located in Cyprus, Greece, Qatar, and Spain. Continuous core body temperature, mean skin temperature, heart rate, and labor productivity were collected from the beginning to the end of all work-shifts. Results: In workplaces where self-pacing is not feasible or very limited, we found that occupational heat stress is associated with the heat strain experienced by workers. Strategies focusing on hydration, work-rest cycles, and ventilated clothing were able to mitigate the physiological heat strain experienced by workers. Increasing mechanization enhanced labor productivity without increasing workers’ physiological strain. Conclusions: Empowering la-borers to self-pace is the basis of heat mitigation, while tailored strategies focusing on hydration, work-rest cycles, ventilated garments, and mechanization can further reduce the physiological heat strain experienced by workers under certain conditions.
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- Kingma, B. R.M., et al.
(author)
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Climapp—integrating personal factors with weather forecasts for individualised warning and guidance on thermal stress
- 2021
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In: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 18:21
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Journal article (peer-reviewed)abstract
- This paper describes the functional development of the ClimApp tool (available for free on iOS and Android devices), which combines current and 24 h weather forecasting with individual information to offer personalised guidance related to thermal exposure. Heat and cold stress assessments are based on ISO standards and thermal models where environmental settings and personal factors are integrated into the ClimApp index ranging from −4 (extremely cold) to +4 (extremely hot), while a range of −1 and +1 signifies low thermal stress. Advice for individuals or for groups is available, and the user can customise the model input according to their personal situation, including activity level, clothing, body characteristics, heat acclimatisation, indoor or outdoor situation, and geographical location. ClimApp output consists of a weather summary, a brief assessment of the thermal situation, and a thermal stress warning. Advice is provided via infographics and text depending on the user profile. ClimApp is available in 10 languages: English, Danish, Dutch, Swedish, Norwegian, Hellenic (Greek), Italian, German, Spanish and French. The tool also includes a research functionality providing a platform for worker and citizen science projects to collect individual data on physical thermal strain and the experienced thermal strain. The application may therefore improve the translation of heat and cold risk assessments and guidance for subpopulations. ClimApp provides the framework for personalising and downscaling weather reports, alerts and advice at the personal level, based on GPS location and adjustable input of individual factors.
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- Lai, Eric T. C., et al.
(author)
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Understanding pathways to inequalities in child mental health : a counterfactual mediation analysis in two national birth cohorts in the UK and Denmark
- 2020
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In: BMJ Open. - : BMJ. - 2044-6055. ; 10:10
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Journal article (peer-reviewed)abstract
- Objectives We assessed social inequalities in child mental health problems (MHPs) and how they are mediated by perinatal factors, childhood illness and maternal mental health in two national birth cohorts.Design Longitudinal cohort studySetting We used data from the UK Millennium Cohort Study and the Danish National Birth Cohort.Primary and secondary outcome measures We applied causal mediation analysis to longitudinal cohort data. Socioeconomic conditions (SECs) at birth were measured by maternal education. Our outcome was child MHPs measured by the Strength and Difficulty Questionnaire at age 11. We estimated natural direct, indirect and total effects (TEs) of SECs on MHPs. We calculated the proportion mediated (PM) via three blocks of mediators—perinatal factors (smoking/alcohol use during pregnancy, birth weight and gestational age), childhood illness and maternal mental health.Results At age 11 years, 9% of children in the UK and 3.8% in Denmark had MHPs. Compared with high SECs, children in low SECs had a higher risk of MHPs (relative risk (RR)=4.3, 95% CI 3.3 to 5.5 in the UK, n=13 112; and RR=6.2, 95% CI 4.9 to 7.8 in Denmark, n=35 764). In the UK, perinatal factors mediated 10.2% (95% CI 4.5 to 15.9) of the TE, and adding maternal mental health tripled the PM to 32.2% (95% CI 25.4 to 39.1). In Denmark, perinatal factors mediated 16.5% (95% CI 11.9 to 21.1) of the TE, and including maternal mental health increased the PM to 16.9% (95% CI 11.2 to 22.6). Adding childhood illness made little difference in either country.Conclusion Social inequalities in child mental health are partially explained by perinatal factors in the UK and Denmark. Maternal mental health partially explained inequalities in the UK but not in Denmark.
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- Stenzinger, Albrecht, et al.
(author)
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Implementation of precision medicine in healthcare—A European perspective
- 2023
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In: Journal of Internal Medicine. - 0954-6820 .- 1365-2796. ; 294:4, s. 437-454
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Research review (peer-reviewed)abstract
- The technical development of high-throughput sequencing technologies and the parallel development of targeted therapies in the last decade have enabled a transition from traditional medicine to personalized treatment and care. In this way, by using comprehensive genomic testing, more effective treatments with fewer side effects are provided to each patient—that is, precision or personalized medicine (PM). In several European countries—such as in England, France, Denmark, and Spain—the governments have adopted national strategies and taken “top-down” decisions to invest in national infrastructure for PM. In other countries—such as Sweden, Germany, and Italy with regionally organized healthcare systems—the profession has instead taken “bottom-up” initiatives to build competence networks and infrastructure to enable equal access to PM. In this review, we summarize key learnings at the European level on the implementation process to establish sustainable governance and organization for PM at the regional, national, and EU/international levels. We also discuss critical ethical and legal aspects of implementing PM, and the importance of access to real-world data and performing clinical trials for evidence generation, as well as the need for improved reimbursement models, increased cross-disciplinary education and patient involvement. In summary, PM represents a paradigm shift, and modernization of healthcare and all relevant stakeholders—that is, healthcare, academia, policymakers, industry, and patients—must be involved in this system transformation to create a sustainable, non-siloed ecosystem for precision healthcare that benefits our patients and society at large.
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- Vigh-Larsen, J. F., et al.
(author)
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Muscle Metabolism and Fatigue during Simulated Ice Hockey Match-Play in Elite Players
- 2020
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In: Medicine and science in sports and exercise. - : Ovid Technologies (Wolters Kluwer Health). - 0195-9131 .- 1530-0315. ; 52:10, s. 2162-2171
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Journal article (peer-reviewed)abstract
- Purpose: The present study investigated muscle metabolism and fatigue during simulated elite male ice hockey match-play. Methods: Thirty U20 male national team players completed an experimental game comprising three periods of 8 x 1-min shifts separated by 2-min recovery intervals. Two vastus lateralis biopsies were obtained either during the game (n= 7) or pregame and postgame (n= 6). Venous blood samples were drawn pregame and at the end of the first and last periods (n= 14). Activity pattern and physiological responses were continuously monitored using local positioning system and heart rate recordings. Further, repeated-sprint ability was tested pregame and after each period. Results Total distance covered was 5980 +/- 199 m with almost half the distance covered at high skating speeds (>17 km.h(-1)). Average and peak on-ice heart rate was 84% +/- 2% and 97% +/- 2% of maximum heart rate, respectively. Muscle lactate increased (P <= 0.05) more than fivefold and threefold, whereas muscle pH decreased (P <= 0.05) from 7.31 +/- 0.04 pregame to 6.99 +/- 0.07 and 7.13 +/- 0.11 during the first and last periods, respectively. Muscle glycogen decreased by 53% postgame (P <= 0.05) with similar to 65% of fast- and slow-twitch fibers depleted of glycogen. Blood lactate increased sixfold (P <= 0.05), whereas plasma free fatty acid levels increased 1.5-fold and threefold (P <= 0.05) after the first and last periods. Repeated-sprint ability was impaired (similar to 3%;P <= 0.05) postgame concomitant with a similar to 10% decrease in the number of accelerations and decelerations during the second and last periods (P <= 0.05). Conclusions Our findings demonstrate that a simulated ice hockey match-play scenario encompasses a high on-ice heart rate response and glycolytic loading resulting in a marked degradation of muscle glycogen, particularly in specific sub-groups of fibers. This may be of importance both for fatigue in the final stages of a game and for subsequent recovery.
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