Dataset Information

Epidemiology of Exertional Heat Illness in the Military: A Systematic Review of Observational Studies.

ABSTRACT: Exertional heat illness (EHI) is an occupational hazard among military personnel. This systematic review describes the incidence, risk factors, clinical manifestations, and biomarkers of EHI in the military. Six databases from inception to 28 May 2020 were systematically reviewed using the PRISMA guidelines. Forty-one articles met the inclusion criteria and the incidence of EHI ranged from 0.2 to 10.5 per 1000 person years, while the prevalence rates ranged from 0.3% to 9.3%. Intrinsic risk factors influencing EHI were gender, physical fitness, obesity, previous history of heat illness, and motivation, while the extrinsic factors included hot environmental conditions and service unit. Evidence suggests that loss of consciousness, absence of sweating and confusion were the common clinical features of exertional heat stroke (EHS). The mean core temperature ranged from 40 to 41.6 °C, while elevated levels of creatine phosphokinase, liver enzymes, and creatinine were common biochemical markers of EHS. The findings of the review suggest a variation in the incidence of EHI among military populations possibly due to the varying definitions used. Although some risk factors of EHI were identified, more analytical studies are needed to investigate the association between EHI and other important factors such as acclimatisation and occlusive clothing.

SUBMITTER: Alele FO

PROVIDER: S-EPMC7579124 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Epidemiology of Exertional Heat Illness in the Military: A Systematic Review of Observational Studies.

Alele Faith O FO Malau-Aduli Bunmi S BS Malau-Aduli Aduli E O AEO J Crowe Melissa M

International journal of environmental research and public health 20200925 19

Exertional heat illness (EHI) is an occupational hazard among military personnel. This systematic review describes the incidence, risk factors, clinical manifestations, and biomarkers of EHI in the military. Six databases from inception to 28 May 2020 were systematically reviewed using the PRISMA guidelines. Forty-one articles met the inclusion criteria and the incidence of EHI ranged from 0.2 to 10.5 per 1000 person years, while the prevalence rates ranged from 0.3% to 9.3%. Intrinsic risk fact ...[more]

PMID: 32993024

Similar Datasets

Project description:Background and objectives: Environmental monitoring allows for an analysis of the ambient conditions affecting a physically active person's ability to thermoregulate and can be used to assess exertional heat illness risk. Using public health models such as the precaution adoption process model (PAPM) can help identify individual's readiness to act to adopt environmental monitoring policies for the safety of high school athletes. The purpose of this study was to investigate the adoption of policies and procedures used for monitoring and modifying activity in the heat in United States (US) high schools. Materials and Methods: Using a cross-sectional design, we distributed an online questionnaire to athletic trainers (ATs) working in high schools in the US. The questionnaire was developed based on best practice standards related to environmental monitoring and modification of activity in the heat as outlined in the 2015 National Athletic Trainers' Association Position Statement: Exertional Heat Illness. The PAPM was used to frame questions as it allows for the identification of ATs' readiness to act. PAPM includes eight stages: unaware of the need for the policy, unaware if the school has this policy, unengaged, undecided, decided not to act, decided to act, acting, and maintaining. Invitations were sent via email and social media and resulted in 529 complete responses. Data were aggregated and presented as proportions. Results: Overall, 161 (161/529, 30.4%) ATs report they do not have a written policy and procedure for the prevention and management of exertional heat stroke. The policy component with the highest adoption was modifying the use of protective equipment (acting = 8.2%, maintaining = 77.5%). In addition, 28% of ATs report adoption of all seven components for a comprehensive environmental monitoring policy. Conclusions: These findings indicate a lack of adoption of environmental monitoring policies in US high schools. Secondarily, the PAPM, facilitators and barriers data highlight areas to focus future efforts to enhance adoption.

Project description:BACKGROUND:Self-medication is the use of drugs to treat self-diagnosed disorders and/or symptoms, or the intermittent or continued use of a prescribed drug for recurrent disease or symptoms. This phenomenon is alarmingly increasing over time despite the occurrence of health-related hazards. This study is, therefore, aimed to quantitatively estimate self-medication practice and possible reasons for it in Ethiopia. METHODS:Data were identified from major databases and indexing services including EMBASE (Ovid), PubMed, MEDLINE (Ovid), and Google Scholar. Both published and unpublished records addressing self medication practice in Ethiopia without time limit were included for the study. Data were extracted with structured format prepared in Microsoft Excel and exported to OpenMeta[analyst] version 3.3 software for analyses. Pooled estimation of outcomes was performed with DerSimonian-Laird random-effects model at 95% confidence level. Sensitivity and subgroup analyses were also considered. Degree of heterogeneity of studies was presented with I2 statistics. Publication bias was also performed with the help of Comprehensive Meta-Analysis version-3 software and presented with funnel plots of standard error supplemented by Begg's and Egger's tests. The study protocol is registered on PROSPERO with reference number ID: CRD42018093790. RESULTS:A total of 27 studies with 9586 participants were included for the study. The pooled prevalence of self-medication in Ethiopia was found to be 44.0% (95% confidence interval [CI]: 35.1, 52.8). Geographical-based subgroup analysis revealed that the highest prevalence was observed at the capital of Ethiopia, Addis Ababa, 62.8% (95% CI: 42.3, 83.2). Population based analysis indicated that healthcare professionals and students were the main practitioners of self-medication. Besides, the prevalence of self-medication practice in pregnant women is approximately 22.9% (95% CI: 9.8, 36). The most common reasons to practice self-medication were previous experience of clients and/or familiarity of treatments, 31.3% (95% CI: 21.5, 41.1) and perceived mildness of the illness, 31.1% (95% CI: 26.0, 36.2). The pooled prevalence of analgesics, antimicrobial agents and gastrointestinal drugs were 46.1% (95% CI: 36.2, 56.1), 28.2% (95% CI: 19.6, 36.8), and 14.9% (95% CI: 7.8, 21.9), respectively. CONCLUSION:Self-medication practice becomes a common phenomenon in Ethiopia. The use of prescription-only medications including antimicrobial agents without medical consult has become alarmingly high. This practice will come with potential health related hazards including emergence of antimicrobial resistance. Therefore, there must be a multitude of strategies for reversing the current worrying trends of self-medication.

Project description:BackgroundInjuries are a common occurrence in military recruit training, however due to differences in the capture of training exposure, injury incidence rates are rarely reported. Our aim was to determine the musculoskeletal injury epidemiology of military recruits, including a standardised injury incidence rate.MethodsEpidemiological systematic review following the PRISMA 2020 guidelines. Five online databases were searched from database inception to 5th May 2021. Prospective and retrospective studies that reported data on musculoskeletal injuries sustained by military recruits after the year 2000 were included. We reported on the frequency, prevalence and injury incidence rate. Incidence rate per 1000 training days (Exact 95% CI) was calculated using meta-analysis to allow comparisons between studies. Observed heterogeneity (e.g., training duration) precluded pooling of results across countries. The Joanna Briggs Institute Quality Assessment Checklist for Prevalence Studies assessed study quality.ResultsThis review identified 41 studies comprising 451,782 recruits. Most studies (n = 26; 63%) reported the number of injured recruits, and the majority of studies (n = 27; 66%) reported the number of injuries to recruits. The prevalence of recruits with medical attention injuries or time-loss injuries was 22.8% and 31.4%, respectively. Meta-analysis revealed the injury incidence rate for recruits with a medical attention injury may be as high as 19.52 injuries per 1000 training days; and time-loss injury may be as high as 3.97 injuries per 1000 training days. Longer recruit training programs were associated with a reduced injury incidence rate (p = 0.003). The overall certainty of the evidence was low per a modified GRADE approach.ConclusionThis systematic review with meta-analysis highlights a high musculoskeletal injury prevalence and injury incidence rate within military recruits undergoing basic training with minimal improvement observed over the past 20 years. Longer training program, which may decrease the degree of overload experienced by recruit, may reduce injury incidence rates. Unfortunately, reporting standards and reporting consistency remain a barrier to generalisability.Trial registrationPROSPERO (Registration number: CRD42021251080).

Project description:BackgroundThe risk of heat-related illness and death may continue to increase in many locations as a consequence of climate change, but information on the effectiveness of policies to protect populations from the adverse effects of excessive heat is limited. In 2009, the National Athletic Trainers' Association Inter-Association Task Force (NATA-IATF) released guidelines to reduce exertional heat illness (EHI) among U.S. high school athletes participating in preseason sports activities, including preseason practice sessions for American football. A subset of state high school athletic associations have implemented state-mandated guidelines consistent with the 2009 NATA-IATF recommendations, but their effectiveness for reducing preseason EHI is unknown.ObjectivesThis study examines the association between the enactment of state high school athletic association-mandated NATA-IATF guidelines and the rate of EHI among high school students during preseason American football practice sessions.MethodsWe performed a quasi-experimental interrupted time-series study of EHI during high school American football practices in the 2005/2006-2016/2017 school years. We estimated state-level EHI rates using High School Reporting Information Online injury and athlete-exposure data, and used generalized estimating equations Poisson regression models to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) comparing state-years with and without mandated NATA-IATF guidelines. State-level covariates included state-year-specific average August temperatures, yearly deviations from each state's August average temperature across the study period, and school year.ResultsData were available for 455 state-years from 48 states, including 32 state-years (7.0%) from 8 states when mandated guidelines consistent with the NATA-IATF recommendations were implemented. During an estimated 2,697,089 athlete-exposures, 190 EHIs were reported. Estimated preseason EHI rates were lower during state-years with versus without mandated guidelines (adjusted [Formula: see text], 95% CI: 0.23, 0.87).ConclusionsOur findings suggest that high school athletes would benefit from enactment of the 2009 NATA-IATF guidelines. Similar analyses of the effectiveness of other public health policies to reduce adverse health effects from ambient heat are warranted. https://doi.org/10.1289/EHP4163.

Project description:BACKGROUND:Extreme heat is an important public health risk. Climate change will likely increase the temperatures humans are exposed to through exacerbated heat wave intensity and frequency, possibly increasing health risks from heat. To prevent adverse effects on human health, heat prevention plans and climate change adaptation strategies are being implemented. But are these measures effectively reducing heat-related mortality and morbidity? This study assesses the evidence base in 2014. METHODS:We conducted a systematic review of peer-reviewed published literature. We applied a combined search strategy of automated search and journal content search using the electronic databases PubMed, Web of Knowledge, Biological Abstracts, CAB Abstracts and ProQuest Dissertation & Theses A&I. Quality appraisal was conducted using CASP checklists, and we identified recurrent themes in studies with content analysis methodology. We conducted sub-group analyses for two types of studies: survey and interview research on behavioral change and perception, and observational studies with regression. RESULTS:30 articles were included in the review. The majority of studies (n?=?17) assessed mortality or morbidity reductions with regression analysis. Overall, the assessments report a reduction of adverse effects during extreme heat in places where preventive measures have been implemented. Population perception and behavior change were assessed in five studies, none of which had carried out a pre-test. Two themes emerged from the review: methodological challenges are a major hindrance to rigorous evaluation, and what counts as proof of an effective reduction in adverse health outcomes is disputed. CONCLUSIONS:Attributing health outcomes to heat adaptation remains a challenge. Recent study designs are less rigorous due to difficulties assigning the counterfactual. While sensitivity to heat is decreasing, the examined studies provide inconclusive evidence on individual planned adaptation measures.

Dataset Information

Epidemiology of Exertional Heat Illness in the Military: A Systematic Review of Observational Studies.

Publications

Epidemiology of Exertional Heat Illness in the Military: A Systematic Review of Observational Studies.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets