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This study investigated the effect of heat stress exposure on heat-related symptoms and severe heat-related symptoms associated with heat stroke in Thai sugarcane workers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Sugarcane workers in Nakhon Sawan Province, Thailand, recruited during cooler and hotter months of 2023 provided information on demographics, health behaviours, working conditions, and 21 heat-related symptoms, including 8 severe heat-related symptoms. Environmental heat was assessed using Wet-Bulb Globe Temperature (WBGT). Full shift time-weighted average effective WBGTs (WBGT\n                      <jats:sub>eff<\/jats:sub>\n                      -FS-TWA) were estimated and adjusted for clothing to represent heat stress exposure. Associations between heat stress exposure and symptom counts were examined using generalised negative binomial regression, adjusting for available confounders. Generalised binary logistic regression assessed associations between heat stress exposure and having\u2009\u2265\u200910 heat-related symptoms or\u2009\u2265\u20093 severe heat-related symptoms.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean measured WBGT was 28.9\u2009\u00b1\u20092.6 \u00b0C. The mean WBGT\n                      <jats:sub>eff<\/jats:sub>\n                      -FS-TWA was 31.3\u2009\u00b1\u20092.8\u00a0\u00b0C, with more than 40% exposed to 32.0\u201334.0\u00a0\u00b0C. Of the 295 participants (165 males, 130 females), there were no significant gender differences observed in the risk of heat-related symptoms. Ninety-eight percent experienced\u2009\u2265\u20091 heat-related symptom, and 74% reported\u2009\u2265\u20091 severe heat-related symptom. Relative risk (RR (95%CI)) for the number of heat-related symptoms was 1.10 (1.08, 1.13) per 1\u00a0\u00b0C increase in WBGT\n                      <jats:sub>eff<\/jats:sub>\n                      -FS-TWA, whereas for severe heat-related symptoms, the RR was 1.19 (1.14, 1.24). Odds ratio (OR) for\u2009\u2265\u200910 heat-related symptoms was 1.50 (1.29, 1.75) per 1\u00a0\u00b0C; for\u2009\u2265\u20093 severe heat-related symptoms OR was 1.49 (1.30, 1.72).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Sugarcane workers in Thailand report very high prevalence of heat-related symptoms. The number of reported heat-related and severe heat-related symptoms increases significantly as temperature increases. These results highlight the urgent need to protect sugarcane and other agricultural workers from excessive heat stress.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00420-026-02216-4","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T16:09:59Z","timestamp":1781626199000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Occupational related heat stress exposure and heat-related symptoms among sugarcane workers in Thailand"],"prefix":"10.1007","volume":"99","author":[{"given":"Martie","family":"van Tongeren","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0937-3802","authenticated-orcid":false,"given":"Tadpong","family":"Tantipanjaporn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Povey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holly A.","family":"Shiels","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Gittins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"2216_CR1","volume-title":"2025 TLVs and BEIs: based on the documentation of the threshold limit values for chemical substances and physical agents & biological exposure indices","author":"American Conference of Governmental Industrial Hygienists","year":"2025","unstructured":"American Conference of Governmental Industrial Hygienists (2025) 2025 TLVs and BEIs: based on the documentation of the threshold limit values for chemical substances and physical agents & biological exposure indices. 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