{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:30:47Z","timestamp":1787009447429,"version":"build-2736575974"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T00:00:00Z","timestamp":1666656000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000761","name":"Imperial College London","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000761","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,4,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Aerosol personal protective equipment (PPE) is subjectively reported to negatively impact healthcare workers\u2019 performance and well-being, but this has not been assessed objectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This randomized controlled crossover study aimed to quantify the heat stress associated with aerosol PPE and to investigate its impact upon mood, cognitive and motor function, and task performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Sixteen healthy, young, lean participants (eight males) undertook an exercise protocol, which simulated the metabolic expenditure of hospital work: once wearing aerosol PPE (PPE visit) and once wearing standard surgical attire (control visit). Participants walked on a treadmill for 2 h followed by 30-min rest. Core temperature, heart rate, urine specific gravity, weight, grip strength, mood (Bond\u2013Lader scale) and task performance (Intubation of a Manikin) were recorded. Values are between-visit mean (standard deviation) differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>On the PPE visit core temperature (+0.2 (0.3)\u00b0C; P &amp;lt; 0.01), heart rate (+12 (13) bpm; P &amp;lt; 0.001), urine specific gravity (+0.003 (0.005); P &amp;lt; 0.05) and intubation task time (+50 (81) s; P &amp;lt; 0.01) were greater than on the control visit; and alertness (\u221214 (21) mm; P &amp;lt; 0.001), contentment (\u221214 (15) mm; P &amp;lt; 0.001) and grip strength (\u22124 (4) N; P &amp;lt; 0.01) were less.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study demonstrates that wearing aerosol PPE in a simulated hospital environment results in heat exhaustion and has a negative impact upon mood, motor function, and task performance. Whilst wearing PPE is important to prevent disease transmission, strategies should be developed to limit its impact upon healthcare workers\u2019 performance and well-being.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/occmed\/kqac114","type":"journal-article","created":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T11:53:41Z","timestamp":1665057221000},"page":"120-127","source":"Crossref","is-referenced-by-count":8,"title":["Heat stress associated with aerosol PPE and its impact"],"prefix":"10.1093","volume":"73","author":[{"given":"N","family":"Chaudhari","sequence":"first","affiliation":[{"name":"MSk Lab, Imperial College London , London W12 0BZ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5202-099X","authenticated-orcid":false,"given":"P H","family":"Strutton","sequence":"additional","affiliation":[{"name":"MSk Lab, Imperial College London , London W12 0BZ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A J","family":"Wickham","sequence":"additional","affiliation":[{"name":"Theatres and Anaesthesia, Imperial College Healthcare NHS Trust , London W2 1NY , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A H","family":"McGregor","sequence":"additional","affiliation":[{"name":"MSk Lab, Imperial College London , London W12 0BZ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4502-333X","authenticated-orcid":false,"given":"C J","family":"Mullington","sequence":"additional","affiliation":[{"name":"MSk Lab, Imperial College London , London W12 0BZ , UK"},{"name":"Theatres and Anaesthesia, Imperial College Healthcare NHS Trust , London W2 1NY , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,10,25]]},"reference":[{"key":"2023042613420342500_CIT0001","volume-title":"COVID-19: infection prevention and control (IPC)","author":"Public Health England.","year":"2020"},{"key":"2023042613420342500_CIT0002","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1080\/23328940.2016.1148526","article-title":"Exercise in personal protective equipment in a hot, humid environment does not affect risk propensity","volume":"3","author":"Schlader","year":"2016","journal-title":"Temperature"},{"key":"2023042613420342500_CIT0003","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1618\/jhes.9.13","article-title":"Simulated helicopter flight performance is affected by heat strain","volume":"9","author":"Caldwell","year":"2006","journal-title":"J Hum-Environ Syst"},{"key":"2023042613420342500_CIT0004","doi-asserted-by":"crossref","first-page":"4751","DOI":"10.1113\/jphysiol.2008.157420","article-title":"Hyperthermia impairs short-term memory and peripheral motor drive transmission","volume":"586","author":"Racinais","year":"2008","journal-title":"J Physiol"},{"key":"2023042613420342500_CIT0005","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.jenvp.2012.01.002","article-title":"Sensory displeasure reduces complex cognitive performance in the heat","volume":"32","author":"Gaoua","year":"2012","journal-title":"J Environ Psychol"},{"key":"2023042613420342500_CIT0006","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.ijpsycho.2005.10.002","article-title":"Heat stress, plasma concentrations of adrenaline, noradrenaline, 5-hydroxytryptamine and cortisol, mood state and cognitive performance","volume":"61","author":"McMorris","year":"2006","journal-title":"Int J Psychophysiol"},{"key":"2023042613420342500_CIT0007","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.jhin.2020.11.027","article-title":"Heat stress and PPE during COVID-19: impact on healthcare workers\u2019 performance, safety and well-being in NHS settings","volume":"108","author":"Davey","year":"2021","journal-title":"J Hosp Infect"},{"key":"2023042613420342500_CIT0008","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1093\/eurpub\/ckz055","article-title":"Physical workload and bodily fatigue after work: cross-sectional study among 5000 workers","volume":"29","author":"Blafoss","year":"2019","journal-title":"Eur J Public Health"},{"key":"2023042613420342500_CIT0009","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1111\/j.1365-2648.2007.04580.x","article-title":"Burnout and physical and mental health among Swedish healthcare workers","volume":"62","author":"Peterson","year":"2008","journal-title":"J Adv Nurs"},{"key":"2023042613420342500_CIT0010","doi-asserted-by":"crossref","first-page":"1588","DOI":"10.1152\/jappl.1999.86.5.1588","article-title":"Relative contribution of core and cutaneous temperatures to thermal comfort and autonomic responses in humans","volume":"86","author":"Frank","year":"1999","journal-title":"J Appl Physiol"},{"key":"2023042613420342500_CIT0011","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/0149-7634(84)90056-3","article-title":"Thermal pleasantness and temperature regulation in man","volume":"8","author":"Attia","year":"1984","journal-title":"Neurosci Biobehav Rev"},{"key":"2023042613420342500_CIT0012","doi-asserted-by":"crossref","first-page":"S147","DOI":"10.1111\/j.1753-4887.2012.00527.x","article-title":"Thirst and hydration status in everyday life","volume":"70","author":"Millard-Stafford","year":"2012","journal-title":"Nutr Rev"},{"key":"2023042613420342500_CIT0013","doi-asserted-by":"crossref","first-page":"215","DOI":"10.2340\/00015555-1671","article-title":"Tumescent suction curettage vs. curettage only for treatment of axillary hyperhidrosis evaluated by subjective and new objective methods","volume":"94","author":"Tronstad","year":"2014","journal-title":"Acta Derm Venereol"},{"key":"2023042613420342500_CIT0014","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1111\/j.2044-8341.1974.tb02285.x","article-title":"The use of analogue scales in rating subjective feelings","volume":"47","author":"Bond","year":"1974","journal-title":"Br J Med Psychol"},{"key":"2023042613420342500_CIT0015","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1080\/09084282.2013.793191","article-title":"Decline of executive function in a clinical population: age, psychopathology, and test performance on the Cambridge Neuropsychological Test Automated Battery (CANTAB)","volume":"21","author":"Janssen","year":"2014","journal-title":"Appl Neuropsychol Adult"},{"key":"2023042613420342500_CIT0016","first-page":"R838","article-title":"The physiology of heat regulation","volume":"268","author":"Webb","year":"1995","journal-title":"Am J Physiol"},{"key":"2023042613420342500_CIT0017","first-page":"39","article-title":"Fever versus hyperthermia","volume":"38","author":"Stitt","year":"1979","journal-title":"Fed Proc"},{"key":"2023042613420342500_CIT0018","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1111\/anae.14454","article-title":"Body temperature, cutaneous heat loss and skin blood flow during epidural anaesthesia for emergency caesarean section","volume":"73","author":"Mullington","year":"2018","journal-title":"Anaesthesia"},{"key":"2023042613420342500_CIT0019","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1152\/physrev.1974.54.1.75","article-title":"Human cardiovascular adjustments to exercise and thermal stress","volume":"54","author":"Rowell","year":"1974","journal-title":"Physiol Rev"},{"key":"2023042613420342500_CIT0020","doi-asserted-by":"crossref","first-page":"1692","DOI":"10.1152\/japplphysiol.01124.2005","article-title":"Neural control and mechanisms of eccrine sweating during heat stress and exercise","volume":"100","author":"Shibasaki","year":"2006","journal-title":"J Appl Physiol"},{"key":"2023042613420342500_CIT0021","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1207\/s15327876mp0904_6","article-title":"The impact of chemical protective clothing on military operational performance","volume":"9","author":"Headley","year":"1997","journal-title":"Mil Psychol"},{"key":"2023042613420342500_CIT0022","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1080\/00140139.2019.1683617","article-title":"The thermal demands of flood rescue and impacts on task performance","volume":"63","author":"Tipton","year":"2020","journal-title":"Ergonomics"},{"key":"2023042613420342500_CIT0023","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1111\/anae.15198","article-title":"Human factors issues of working in personal protective equipment during the COVID-19 pandemic","volume":"76","author":"Hignett","year":"2021","journal-title":"Anaesthesia"},{"key":"2023042613420342500_CIT0024","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/0003-6870(80)90228-8","article-title":"Subjective estimates of physiological responses and perceptual-motor performance in the heat","volume":"11","author":"Ramsey","year":"1980","journal-title":"Appl Ergon"},{"key":"2023042613420342500_CIT0025","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1111\/aphw.12275","article-title":"Changes in cognitive control and mood across repeated exercise sessions","volume":"13","author":"Nieman","year":"2021","journal-title":"Appl Psychol Health Well Being"},{"key":"2023042613420342500_CIT0026","doi-asserted-by":"crossref","first-page":"R847","DOI":"10.1152\/ajpregu.00010.2015","article-title":"Cognitive and perceptual responses during passive heat stress in younger and older adults","volume":"308","author":"Schlader","year":"2015","journal-title":"Am J Physiol Regul Integr Comp Physiol"},{"key":"2023042613420342500_CIT0027","volume-title":"Heat exhaustion and heatstroke, 2021","author":"NHS."},{"key":"2023042613420342500_CIT0028","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1007\/s00421-012-2427-4","article-title":"Influence of heat stress and exercise intensity on vastus lateralis muscle and prefrontal cortex oxygenation","volume":"113","author":"Periard","year":"2013","journal-title":"Eur J Appl Physiol"},{"key":"2023042613420342500_CIT0029","volume-title":"Personal protective equipment and heat: risk of heat stress","author":"Health and Safety Executive.","year":"2021"},{"key":"2023042613420342500_CIT0030","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.tacc.2015.03.003","article-title":"Management of heat stroke","volume":"5","author":"Chan","year":"2015","journal-title":"Trends Anaesth Crit Care"}],"container-title":["Occupational Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/occmed\/article-pdf\/73\/3\/120\/50099476\/kqac114.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/occmed\/article-pdf\/73\/3\/120\/50099476\/kqac114.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T09:46:47Z","timestamp":1682502407000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/occmed\/article\/73\/3\/120\/6772544"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,25]]},"references-count":30,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,10,25]]},"published-print":{"date-parts":[[2023,4,26]]}},"URL":"https:\/\/doi.org\/10.1093\/occmed\/kqac114","relation":{},"ISSN":["0962-7480","1471-8405"],"issn-type":[{"value":"0962-7480","type":"print"},{"value":"1471-8405","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,4,1]]},"published":{"date-parts":[[2022,10,25]]}}}