Risk of Exertional Heat Illnesses Associated with Sickle Cell Trait in U.S. Military

Singer, Darrell E.; Byrne, Celia; Chen, Ligong; Shao, Stephanie; Goldsmith, Jonathan C.; Niebuhr, David W.

doi:10.1093/milmed/usx085

Cited by 16 publications

(20 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The titles and abstracts were screened, and 1502 articles excluded, leaving 154 articles for full-text review. Data in Table S2 depict that 41 articles were included in the review [ 13 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ], comprising 29 descriptive and cross-sectional studies [ 13 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 34 , 35 …”

Section: Resultsmentioning

confidence: 99%

“…Younger age was identified as a potential risk factor in nine studies ( Box 1 ) [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. However, the findings from six (6) studies which assessed the relationship between EHI and age were inconsistent [ 33 , 34 , 49 , 50 , 53 , 57 ]. While one study reported that younger people had an increased risk [ 50 ], another study reported that older people had an increased risk of EHI [ 53 ].…”

Section: Resultsmentioning

confidence: 99%

“…However, the findings from six (6) studies which assessed the relationship between EHI and age were inconsistent [ 33 , 34 , 49 , 50 , 53 , 57 ]. While one study reported that younger people had an increased risk [ 50 ], another study reported that older people had an increased risk of EHI [ 53 ]. In contrast, no association was reported in four studies [ 33 , 34 , 49 , 57 ].…”

Section: Resultsmentioning

confidence: 99%

“…In nine (9) studies, gender was identified as a potential risk factor of EHI ( Box 1 ) [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. However, five (5) studies investigated the association between EHI and gender using multivariate analysis [ 13 , 32 , 49 , 50 , 53 ] ( Table 3 ). The evidence suggests an increased risk of EHI among females ( Table 3 ).…”

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

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

Alele

Malau‐Aduli

et al. 2020

IJERPH

View full text Add to dashboard Cite

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.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

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

Alele

Malau‐Aduli

et al. 2020

IJERPH

View full text Add to dashboard Cite

show abstract

“…Numerous studies have attempted to capture the potential risk factors implicated in heat illness. Commonly cited precipitants include: alcohol (Armstrong et al, 2007), medications (Epstein, 1990;Armstrong et al, 2007) (particularly psychiatric), recreational drugs (Epstein et al, 1999;Armstrong et al, 2007), sickle cell trait (Nelson et al, 2017;Singer et al, 2018), recent febrile illness/diarrheal illness (Epstein, 1990;Armstrong et al, 2007), sleep deprivation (Armstrong et al, 1990(Armstrong et al, , 2007Bolton et al, 2006;Stacey et al, 2015), sunburn (Armstrong et al, 2007), obesity (Gardner et al, 1996;Epstein et al, 1999;Wallace et al, 2006;Bedno et al, 2014), dehydration (Montain et al, 1998;Armstrong et al, 2007) as well as the known intrinsic factors such as environmental temperature and humidity, clothing and activity levels (Kark et al, 1996;Howe and Boden, 2007). More militarily relevant studies have associated the increased risk of prior heat stroke (Armstrong et al, 2007), combat or healthcare occupational roles, reservists (Bricknell, 1996), subjects over 30 (Epstein, 1990), female sex (Fortney and Senay, 1979;Carter et al, 2005), lower levels of physical fitness (Shvartz et al, 1977b;Epstein, 1990;Gardner et al, 1996;Wallace et al, 2006;Bedno et al, 2014), lack of acclimatization (Epstein, 1990;Bricknell, 1996;Armstrong et al, ...…”

Section: Practices and Pitfalls In Generating And Sustaining Heat Adamentioning

confidence: 99%

Heat Adaptation in Military Personnel: Mitigating Risk, Maximizing Performance

2019

View full text Add to dashboard Cite

The study of heat adaptation in military personnel offers generalizable insights into a variety of sporting, recreational and occupational populations. Conversely, certain characteristics of military employment have few parallels in civilian life, such as the imperative to achieve mission objectives during deployed operations, the opportunity to undergo training and selection for elite units or the requirement to fulfill essential duties under prolonged thermal stress. In such settings, achieving peak individual performance can be critical to organizational success. Short-notice deployment to a hot operational or training environment, exposure to high intensity exercise and undertaking ceremonial duties during extreme weather may challenge the ability to protect personnel from excessive thermal strain, especially where heat adaptation is incomplete. Graded and progressive acclimatization can reduce morbidity substantially and impact on mortality rates, yet individual variation in adaptation has the potential to undermine empirical approaches. Incapacity under heat stress can present the military with medical, occupational and logistic challenges requiring dynamic risk stratification during initial and subsequent heat stress. Using data from large studies of military personnel observing traditional and more contemporary acclimatization practices, this review article (1) characterizes the physical challenges that military training and deployed operations present (2) considers how heat adaptation has been used to augment military performance under thermal stress and (3) identifies potential solutions to optimize the risk-performance paradigm, including those with broader relevance to other populations exposed to heat stress.

show abstract