As the Earth warms, heatwaves are expected to occur more often, with sharper intensity and for longer periods. Rising temperatures adversely affect worker productivity and human health, but for policymakers to take substantive action for heat adaptation, and meet what researchers see as a life-saving Paris climate agreement, making an economic case is key.
BY NATALIE GROVER
As the Earth warms, heatwaves are expected to occur more often, with sharper intensity and for longer periods. Rising temperatures adversely affect worker productivity and human health, but for policymakers to take substantive action for heat adaptation, and meet what researchers see as a life-saving Paris climate agreement, making an economic case is key. This article first appeared in Horizon Magazine in August 2020.
It’s actually quite easy for us to point out the problem — we have increasing temperatures, increasing frequency of heatwaves…it affects our physical and cognitive performance,’ said Lars Nybo, a professor of integrative physiology from the University of Copenhagen, Denmark. He worked on a project called HEAT-SHIELD designed to examine the effects of heat exposure on worker productivity in industrial sectors that employ half of Europe’s workforce: manufacturing, construction, transportation, tourism, and agriculture. The project ran from January 2016 until December 2021.
Globally, 2021 was among the seven hottest on record, with Europe experiencing its hottest summer to date. In the Mediterranean region, an intense and prolonged heatwave in July and August lead to new temperature records and devastating wildfires, a poignant reminder that the achievement of the Paris climate agreement to keep global mean temperature increases well below 2°C is as important as ever.
Data from HEAT-SHIELD project suggest that exposure to external heat in combination with physical activity, which elevates the body’s production of heat, can result in physiological changes that can diminish occupational performance, via reduced working endurance, vision, motor coordination and concentration. This can lead to more mistakes as well as injuries.
‘Roughly 70% of all European workers, at some time during the working day, are not optimally hydrated,’ Prof. Nybo said. The solution to the problem, he added, is intuitive: drink water, replace electrolytes and reduce physical activity, but implementing these measures whilst maintaining productivity is where things get tricky.
‘You could just say to the worker stay at home and drink cold margaritas in the shadow to prevent heat stress,’ he joked. ‘But that will not help productivity.’
As coordinator of HEAT-SHIELD, Prof. Nybo and his team were tasked with not just assessing the extent of the problem — modelling the expected rise in temperature in Europe in the coming years and its impact on worker productivity — but also devising and implementing solutions that are location and vocation specific to adjust to the inevitable increases in temperature.
A construction worker wears a safety helmet, which impairs the body’s ability to purge heat, but the worker thinks this problem cannot be solved because it is intrinsic to their work, Prof. Nybo noted.
Surmounting challenges like this was one of the key objectives of the project — conceiving ways to weave in heat mitigation strategies alongside the practicalities of the job.
For instance, outdoor workers should be vigilant of weather patterns and plan work earlier in the day during periods of extreme heat, take a short break every hour and secure easy access to water. Similar remedies for workers in enclosed settings could mean a combination of air conditioning, working in shade and improving ventilation — keeping in mind the ecological footprint of such measures.
But on a macro level, for climate change policymakers to take concrete action here and now — the numbers are key, Prof. Nybo said.
In Europe, agricultural and construction workers for instance, lose some 15% of effective working time when the temperature goes beyond 30°C, which works out to almost one working day per week, he noted, citing HEAT-SHIELD analyses.
If you are a policymaker, he says, the numbers show that there’s an incentive to act now: if you mitigate the problem the cost will stabilise at a lower level in the long run than if you don’t.
Diminished worker productivity and the downstream economic damage are prominent impacts of rising temperatures caused by climate change. But to get a full picture of the consequences, it’s necessary to understand what excessive heat does to the human body.
It can damage organs such as the heart and the lungs, exacerbate a range of diseases, and increase the risk of death.
Extreme heat can increase the occurrence of heart attacks and strokes in susceptible patients due to increased blood viscosity, and raise the risk of cardiovascular death in vulnerable patients. Hot, humid days can also trigger asthma symptoms and have been shown to increase airway resistance, while warmer climates tend to extend the pollen season.
Another side effect of rising temperatures is the association with air pollution — the largest environmental killer in Europe, causing roughly 500,000 premature deaths annually.
Observational data and modelling suggest that as it gets warmer, air pollution levels — particularly surface ozone gas (O3) and fine particulate matter (PM2.5) — increase in some populated regions, even when emissions of air pollutants have not risen, as well as create conditions favourable for forest fires.
Both extreme heat and air pollution raise the risk of cardiovascular and respiratory disease, which currently costs the European Union an estimated €600bn a year. If these environmental stressors continue to accumulate unabated, these costs could jump.
But the synergistic relationship between air pollutants and rising temperatures is not well understood and existing health-risk projections in Europe do not properly account for adaptive measures that can be taken to ameliorate associated health risks, according to Dr Kristin Aunan, a senior researcher at the Norway-based Center for International Climate Research.
‘There’s quite a lot of literature on short-term impact — in terms of the day-to-day variation on the impact of heat stress on mortality — but when it comes to long-term impact, there is not a lot of information,’ she said.
As part of a project called EXHAUSTION that kicked off in 2019 and is due to run until May 2023, researchers including project coordinator Dr Aunan, are focused on quantifying the risks of cardiopulmonary disease in different temperatures.
The project is also working on identifying interventions to minimise the risks to health sparked by environmental stressors and demystifying the link between air pollution and temperature hikes.
Quantifying the cascading effect of cardiopulmonary diseases on the economy is key to affecting action on climate change, she suggests.
EXHAUSTION researchers, for instance, are devising a macro-economic model that tracks increased hospitalisation and mortality in different age groups to measure the impact on the broader economy in different European countries. ‘We also have a bottom-up model — where you put a price on every premature death or hospital admission and add up to estimate the economic cost.’
One of the main questions the researchers hope to answer is the magnitude of impact limiting temperature spikes to 1.5°C — the aim of the Paris climate agreement — will have on health.
‘I have no answer to that today — but the reason why we’re doing this project…is that we think there are reasons to believe that being able to comply with a Paris agreement will save very many lives and reduce human suffering,’ Dr Aunan said.
‘When you discuss climate policy and discuss the costs of it — it’s very expensive to reduce emissions of greenhouse gases, etc. But you also need to consider the benefits and that’s what we are doing with this project — hoping that we can contribute to the other side of the coin.’
This article first appeared in Horizon Magazine in August 2020.
HL7 FHIR, the Future of Health Information Exchange?
Health Level 7 International is an association that calls itself a non profit organization, ANSI-accredited standards developing organization devoted to creating a thorough structure and standards set for the exchange, incorporation, sharing, and retrieval of digital health data that endorses clinical practice and the management, delivery, and evaluation of health services.
A next-generation standards framework developed by HL7, FHIR is described as such on the HL7 website. The best aspects of HL7’s v2, v3, and CDA product lines are combined in FHIR, which also makes use of the most recent web standards and places a strong emphasis on implementation.
Do you wonder what’s the difference between HL7 and FHIR? The core development technologies are the fundamental distinction between HL7 and FHIR. FHIR depends on open web technologies like JSON and RDF data formats as well as RESTful web services. FHIR reduces the learning curve for developers because they are already familiar with these technologies, allowing them to start working more immediately.
FHIR is essentially an effective mechanism for healthcare professionals to communicate data about patients in a range of settings, including in-patient, ambulatory, acute, long-term, community, allied health, etc. The implementation of FHIR through its Resources is the aspect of it that matters the most to providers. The resources are comparable to “paper ‘forms’ indicating various types of medical and administrative data that can be gathered and shared,” as stated on their website. Each Resource or “form” is assigned a template by FHIR.
Data was locked in proprietary structures for many years. Providers, payers, and patients frequently had to revert to outdated, time-consuming techniques to transmit information, such as faxing chart notes or physically transferring paper-based records. Or systems had to transmit whole papers to answer a doctor’s demand for specific health information. Doctors have to search through entire paperwork to find a single piece of information, which drains them and takes lots of time. Luckily, each Resource can be provided using FHIR without the whole clinical record. This enables a quicker and significantly more effective interchange of health information.
Sharing data is made easier, implementation is greatly simplified, and mobile apps are support FHIR better. Additionally, it provides crucial use cases that are advantageous to patients, payers, and providers.
To expedite decision-making, physicians can exchange patient data more effectively among teams. Medical data can be added to claims data by insurance companies to enhance risk assessment, reduce costs, and enhance outcomes. Additionally, patients can have more influence over their health by getting access to medical data via user-friendly apps that operate on smartphones, tablets, and wearables.
Although FHIR differs from earlier standards in numerous ways, there are two fundamental distinctions that make it so remarkable:
Security: TLS/SSL encryption is necessary for any production health data exchanged over FHIR. This makes it significantly safer than earlier HL7 standards.
Resources: FHIR makes use of uniform data components and formats, also referred to as “Resources.” The lowest feasible transactional unit in FHIR is a Resource, which provides significant data through a known identity.
FHIR can be used in a wide range of situations, such as mobile apps, cloud communications, data sharing based on electronic health records, server communication in large institutional healthcare providers, and more. Open source, cost-free, scalable, and adaptable summarize FHIR.
Time to address mental health issues in the workplace
With an estimated 12 billion workdays lost annually due to depression and anxiety, costing the global economy nearly $1 trillion, more action is needed to tackle mental health issues at work, the World Health Organization (WHO) and the International Labour Organization (ILO) said on Wednesday. The UN agencies have launched two publications which aim to prevent negative work situations and cultures while also offering mental health protection and support for employees.
Performance and productivity affected
“It’s time to focus on the detrimental effect work can have on our mental health,” said Tedros Adhanom Ghebreyesus, Director-General at WHO, which has issued global guidelines on the issue.
“The well-being of the individual is reason enough to act, but poor mental health can also have a debilitating impact on a person’s performance and productivity.”
The WHO guidelines contain actions to tackle risks to mental health at work such as heavy workloads, negative behaviours, and other factors that can create distress.
For the first time, the UN health agency recommends manager training, to build their capacity to prevent stressful work environments and respond to workers’ needs.
A workplace taboo
WHO’s World Mental Health Report, published in June, revealed that of one billion people estimated to be living with a mental disorder in 2019, 15 per cent of working-age adults experienced a mental disorder.
The workplace amplifies wider societal issues that negatively affect mental health, including discrimination and inequality, the agency said.
Bullying and psychological violence, also known as “mobbing,” is a key complaint of workplace harassment that has a negative impact on mental health. However, discussing or disclosing mental health remains a taboo in work settings globally.
The guidelines also recommend better ways to accommodate the needs of workers with mental health conditions and proposes interventions that support their return to work.
They also outline measures to ease entry into the jobs market, for those workers with severe mental health conditions.
Importantly, the guidelines call for interventions for the protection of health, humanitarian, and emergency workers.
The objective is to support the prevention of mental health risks, protect and promote mental health at work, and support those with mental health conditions, so they can participate and thrive at work.
“As people spend a large proportion of their lives in work – a safe and healthy working environment is critical,” said, Guy Ryder, the ILO Director-General.
“We need to invest to build a culture of prevention around mental health at work, reshape the work environment to stop stigma and social exclusion, and ensure employees with mental health conditions feel protected and supported.”
Lack of national programmes
However, only 35 per cent of countries reported having national programmes for work-related mental health promotion and prevention.
The crisis exposed how unprepared governments were for its impact on mental health, as well as a chronic global shortage of mental health resources.
In 2020, governments worldwide spent an average of just two per cent of health budgets on mental health, with lower-middle income countries allocating less than one per cent.
A good night’s sleep is a tonic to remember
BY ANTHONY KING
Everyone suffers restless nights from time to time. Chewing over failures or worries at the end of the day undermines rest, especially deep sleep. ‘A ruffled mind makes a restless pillow,’ wrote author Charlotte Brontë.
A good night’s sleep serves as a tonic. What’s more, it is long recognised that shuteye gives learning and memory a boost. More recently, scientists revealed that the early phase of deep slow-wave sleep is especially important.
‘When you learn something in the evening, that information becomes reactivated during sleep,’ said Dr Bjoern Rasch, who took part in the Horizon-funded MemoSleep project and is a professor at the University of Fribourg.
The Swiss researcher added that ‘Ruminations and negative thoughts increase our awakenings during sleep, make us wake earlier than we want and make us sleep less deeply.’
But there is good news too. Positive thoughts can also be reactivated in brain circuits and, in the process, improve sleep, according to Dr Rasch. He organized an experiment around the whole idea.
His test was a small boon to students in his university who received 50 Swiss francs (EUR 52) for every night they spent snoozing in a comfortable four-bed sleeping laboratory.
The students were connected to an electroencephalogram that monitored their brain waves. They also had their muscles monitored to record when they fell into slumber and what sleep-state they were in.
Some relaxation strategies allow people to fall asleep faster, but don’t change the quality of sleep afterwards, according to Dr Rasch. He played hypnotic tapes with imagery such as a fish swimming in deep water, and with words suggestive of safety and relaxation, for the students.
‘The subjects spent more time in the deeper slow-wave sleep stage after listening to the hypnotic tape,’ said Dr Rasch. ‘We would explain this by an increased reactivation of relaxing and reassuring thoughts during sleep, heard previously during the hypnosis tape.’
In future studies, Dr Rasch hopes to help patients who suffer from insomnia.
‘It could not only help them fall asleep but could actually make their sleep more restful,’ he said. Furthermore, this could aid people with psychological illnesses, such as post-traumatic stress disorder, who sleep poorly.
Seahorses and learning
The seahorse-shaped part of the brain called the hippocampus (from the Greek word for seahorse) is especially important for learning and memory. Scientists often use rodents to investigate their hippocampus in learning and sleep.
Rats, for example, are masters at remembering paths through mazes to find foods. The hippocampus is key to this recall.
Dr Juan Ramirez-Villegas uses rodents to probe how mammalian brains store memories – work that could eventually contribute to fighting human illnesses such as Alzheimer’s.
As part of the Horizon-funded DREAM project, he discovered that another part of the brain – the brainstem – plays a crucial role along with the hippocampus and becomes active beforehand.
‘It seems like the brainstem is setting up some scenery so that the hippocampus can reactivate memories across different stages of sleep,’ said Dr Ramirez-Villegas, who is a postdoctoral fellow at the Institute of Science and Technology Austria.
He has attached electrodes to record activity in the brains of rats as they navigate a maze and afterwards as they sleep. Sleeping allows the brain to replay daytime events and etch them as long-term memories.
‘It is very striking that the cells fire in the same order during sleep that they did during learning, but they are more compressed in time during sleep,’ said Dr Ramirez-Villegas.
How we remember
The discovery was surprising because it suggests that the brainstem has an overlooked function in stimulating and changing memory formation. This seems to be true for rodents as much as for primates and, as a result, is likely to be a basic mechanism of the brains of mammals, including people.
The research, while crucial to understanding the basic operation of the brain, could have clinical benefits too. ‘We are untangling the basic principles of memory processes, but we can also use these to ameliorate the effects of memory-related illnesses,’ said Dr Ramirez-Villegas.
The research in this article was funded via the EU’s European Research Council and the Marie Skłodowska-Curie Actions (MSCA). This article was originally published in Horizon, the EU Research and Innovation Magazine.
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