Reducing the health effects of hot weather and heat extremes: from personal cooling strategies to green cities.

Heat extremes (ie, heatwaves) already have a serious impact on human health, with ageing, poverty, and chronic illnesses as aggravating factors. As the global community seeks to contend with even hotter weather in the future as a consequence of global climate change, there is a pressing need to better understand the most effective prevention and response measures that can be implemented, particularly in low-resource settings. In this Series paper, we describe how a future reliance on air conditioning is unsustainable and further marginalises the communities most vulnerable to the heat. We then show that a more holistic understanding of the thermal environment at the landscape and urban, building, and individual scales supports the identification of numerous sustainable opportunities to keep people cooler. We summarise the benefits (eg, effectiveness) and limitations of each identified cooling strategy, and recommend optimal interventions for settings such as aged care homes, slums, workplaces, mass gatherings, refugee camps, and playing sport. The integration of this information into well communicated heat action plans with robust surveillance and monitoring is essential for reducing the adverse health consequences of current and future extreme heat.

Heating, ventilation and air conditioning (HVAC) in intensive care unit.

The aim of this review is to describe variation in standards and guidelines on 'heating, ventilation and air-conditioning (HVAC)' system maintenance in the intensive care units, across the world, which is required to maintain good 'indoor air quality' as an important non-pharmacological strategy in preventing hospital-acquired infections. An online search and review of standards and guidelines published by various societies including American Institute of Architects (AIA), American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), Centers for Disease Control and Prevention (CDC), Department of Health Estates and Facilities Division, Health Technical Memorandum 2025 (HTM) and Healthcare Infection Control Practices Advisory Committee (HICPAC) along with various national expert committee consensus statements, regional and hospital-based protocols available in a public domain were retrieved. Selected publications and textbooks describing HVAC structural aspects were also reviewed, and we described the basic structural details of HVAC system as well as variations in the practised standards of HVAC system in the ICU, worldwide. In summary, there is a need of universal standards for HVAC system with a specific mention on the type of ICU, which should be incorporated into existing infection control practice guidelines.

Influência das condições térmicas do galpão de espera climatizado na mortalidade pré-abate de frangos de corte / The influence of thermal conditions from an environmentally controlled preslaughter lairage on mortality of broiler chickens

Avaliou-se o efeito das condições ambientais da espera pré-abate na mortalidade de frangos de corte, mantidos em galpão climatizado em um abatedouro comercial. Foram avaliados 215 caminhões de transporte de um abatedouro comercial quanto ao número de aves mortas durante as operações pré-abate e à temperatura retal dos animais em condição de espera no abatedouro. Os dados foram obtidos no galpão de espera climatizado por meio de ventiladores e nebulizadores, em diferentes períodos: manhã, tarde e noite. As variáveis térmicas, distância, tempo de espera e densidade de aves por caixa foram consideradas na análise. Destacaram-se os efeitos da temperatura, da umidade relativa e do tempo de espera na variação tanto do número de aves mortas por caminhão quanto da temperatura retal dos animais. Com relação à interação entre temperatura e umidade relativa interna do galpão de espera, houve eficiência do ambiente climatizado no abatedouro quanto à diminuição do número de aves mortas. A climatização foi mais expressiva na redução do número de aves mortas e da temperatura retal quando a temperatura do galpão de espera estava entre 21 e 24°C, principalmente em condições de umidade relativa interna em torno de 70%. Nessas condições climatizadas, o tempo de espera acima de duas horas proporcionou maior conforto às aves.

The effect of environment conditions of preslaughter lairage on broiler mortality was assessed in the present study. Daily preslaughter data from 215 broiler flocks were recorded regarding the number of dead chickens during preslaughter operations and rectal temperature of broilers submitted to a lairage environment prior to slaughtering. A holding area at a slaughterhouse with environmental control was assessed. The thermal variables, distance between farms and slaughterhouse, lairage time and density of birds per cage was considered in this analysis. The effect of dry-bulb temperature, relative humidity and lairage time on death before arrival and rectal temperature was highlighted in this assessment. Regarding the interaction between temperature and inside relative humidity, a decrease in preslaughter mortality was observed due to exposure to a controlled environment. The environment control promoted an expressive reduction in dead birds and rectal temperature when the temperature inside the holding area was between 21 and 24 °C, mainly with inside relative humidity around 70%. In these environment control conditions lairage above 2 hours was necessary to reduce the thermal stress of birds.

Traffic in the operating room: a review of factors influencing air flow and surgical wound contamination.

Surgical wound contamination leading to surgical site infection can result from disruption of the intended airflow in the operating room (OR). When personnel enter and exit the OR, or create unnecessary movement and traffic during the procedure, the intended airflow in the vicinity of the open wound becomes disrupted and does not adequately remove airborne contaminants from the sterile field. An increase in the bacterial counts of airborne microorganisms is noted during increased activity levels within the OR. Researchers have studied OR traffic and door openings as a determinant of air contamination. During a surgical procedure the door to the operating room may be open as long as 20 minutes out of each surgical hour during critical procedures involving implants. Interventions into limiting excessive movement and traffic in the OR may lead to reductions in surgical site infections in select populations.

Defining indoor heat thresholds for health in the UK.

INTRODUCTION: It has been recognised that as outdoor ambient temperatures increase past a particular threshold, so do mortality/morbidity rates. However, similar thresholds for indoor temperatures have not yet been identified. Due to a warming climate, the non-sustainability of air conditioning as a solution, and the desire for more energy-efficient airtight homes, thresholds for indoor temperature should be defined as a public health issue. AIMS: The aim of this paper is to outline the need for indoor heat thresholds and to establish if they can be identified. Our objectives include: describing how indoor temperature is measured; highlighting threshold measurements and indices; describing adaptation to heat; summary of the risk of susceptible groups to heat; reviewing the current evidence on the link between sleep, heat and health; exploring current heat and health warning systems and thresholds; exploring the built environment and the risk of overheating; and identifying the gaps in current knowledge and research. METHODS: A global literature search of key databases was conducted using a pre-defined set of keywords to retrieve peer-reviewed and grey literature. The paper will apply the findings to the context of the UK. RESULTS: A summary of 96 articles, reports, government documents and textbooks were analysed and a gap analysis was conducted. Evidence on the effects of indoor heat on health implies that buildings are modifiers of the effect of climate on health outcomes. Personal exposure and place-based heat studies showed the most significant correlations between indoor heat and health outcomes. However, the data are sparse and inconclusive in terms of identifying evidence-based definitions for thresholds. Further research needs to be conducted in order to provide an evidence base for threshold determination. CONCLUSIONS: Indoor and outdoor heat are related but are different in terms of language and measurement. Future collaboration between the health and building sectors is needed to develop a common language and an index for indoor heat and health thresholds in a changing climate.

[Current status of life support systems for cosmonauts and ways of their enhancement in near future].

The paper reviews the results of efforts undertaken so far to develop three types of life support systems: fill-and-draw and physicochemical reclamation systems for space flights of up to one year in duration, and systems for more extended missions. The authors point to the engineering and logistical issues that should be given the highest priority in the next decades.

The relationship of housing and population health: a 30-year retrospective analysis.

OBJECTIVE: We analyzed the relationship between health status and housing quality over time. METHODS: We combined data from two nationally representative longitudinal surveys of the U.S. population and its housing, the National Health and Nutrition Examination Survey and the American Housing Survey, respectively. We identified housing and health trends from approximately 1970 to 2000, after excluding those trends for which data were missing or where we found no plausible association or change in trend. RESULTS: Changes in housing include construction type, proportion of rental versus home ownership, age, density, size, moisture, pests, broken windows, ventilation and air conditioning, and water leaks. Changes in health measures include asthma, respiratory illness, obesity and diabetes, and lead poisoning, among others. The results suggest ecologic trends in childhood lead poisoning follow housing age, water leaks, and ventilation; asthma follows ventilation, windows, and age; overweight trends follow ventilation; blood pressure trends follow community measures; and health disparities have not changed greatly. CONCLUSIONS: Housing trends are consistent with certain health trends over time. Future national longitudinal surveys should include health, housing, and community metrics within a single integrated design, instead of separate surveys, in order to develop reliable indicators of how housing changes affect population health and how to best target resources. Little progress has been made in reducing the health and housing disparities of disadvantaged groups, with the notable exception of childhood lead poisoning caused by exposure to lead-based paint hazards. Use of these and other data sets to create reliable integrated indicators of health and housing quality are needed.

Avaliaçäo microbiológica ambiental em salas de centros cirúrgicos utilizadas em cirurgias oftalmológicas / Environmental microbiological evaluation of ophthalmic surgery rooms

Objetivo: determinar a flora microbiana ambiental dos centros cirúrgicos oftalmológicos, com os aparelhos de ar condicionado ligados ou näo. Metodologia: placas de cultura foram colocadas por tempo determinado ao lado do campo, durante a cirurgia, em 7 centros cirúrgicos ambulatoriais e 7 hospitalares da cidade de Säo Paulo. Resultados: foram isoladas 258 colônias de microrganismos, sendo 228 de bactérias e 30 de fungos. Do total das bactérias, encontrou-se 78 p/cento de cocos gram-positivos coagulase negativa (Staphylococcus epidermidis e Staphylococcus saprophyticus) e 22 por cento de outras bactérias (S.aureus, bacilos diferóides e Bacillus sp.). Do toal de microrganismos encontrou-se

House-dust mite exposure reduction in specially designed, mechanically ventilated "healthy" homes.

Exposure to house-dust mites (Dermatophagoides spp.) was investigated in 30 asthmatic patients before and after moving to homes with mechanical ventilation systems. Median house-dust mite concentration was 110 mites per gram of mattress dust at the initial investigation and 20 mites per gram at the first follow-up after a mean of 4.7 months in the new homes. This was lower (P < 0.05) than counts in a control group of 23 asthmatic patients that had unchanged counts. At a second follow-up, after 15.0 months, mite counts in the study group were further reduced (P < 0.01) from initial values. Among 16 patients, with initial mite counts above the recommended threshold limit value (TLV) of 100 mites per gram of dust, the mite counts fell, in most cases, below this TLV. Air-exchange rates increased (P < 0.001) from a median value of 0.40 air changes per hour (ach) to 1.52 ach at the second follow-up investigation. Furthermore, a reduction (P < 0.01) was found in indoor absolute air humidity, with a median value of 5.6 g of water/kg. No such changes were found in the control group. The present study indicates that reduction of air humidity through an increased supply of fresh air may significantly diminish and, in some cases, even eliminate house-dust mites in homes.