{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T02:16:43Z","timestamp":1794017803695,"version":"4.8.0"},"reference-count":25,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"unspecified","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/V033743\/1"],"award-info":[{"award-number":["MR\/V033743\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Dutch National Postcode Lottery"},{"name":"UK Colt Foundation","award":["CF\/02\/18"],"award-info":[{"award-number":["CF\/02\/18"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,2,26]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Chronic heat stress and recurrent dehydration from strenuous labour in hot environments are recognised drivers of acute kidney injury among agricultural workers in Mesoamerica and may contribute to Chronic Kidney Disease of Unknown Aetiology (CKDu). This study explored how members of a long-term community-based cohort in northwest Nicaragua perceive, experience and adapt to extreme heat, within the broader context of environmental and labour changes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This qualitative study used focus group discussions with participants from a community-based cohort followed for over a decade and community members. Transcripts were analysed thematically using an interpretative approach, with trustworthiness ensured through peer debriefing, audit trails, triangulation and achievement of thematic saturation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Settings<\/jats:title>\n                    <jats:p>Rural agricultural communities in northwest Nicaragua participating in a long-term community-based cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Participants were purposively sampled from a prospective community-based cohort and community members were invited to participate. Men and women across different age groups were invited. In total, 91 adults aged \u226518 years participated in 11 face-to-face focus groups, each comprising 8\u201311 men or women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>Themes describing experiences of heat stress, occupational risk and adaptive responses among agricultural workers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participants described worsening heat linked to deforestation, unsafe and inadequate water access and unrealistic production targets that prioritised output over health. In response, workers reported adaptive practices including self-paced labour, hydration routines and peer monitoring. Community solidarity and mutual aid emerged as key sources of resilience despite structural constraints.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Heat stress amplifies occupational hazards and exacerbates health inequities among marginalised agricultural workers. Integrating climate adaptation and equity into labour protections\u2014ensuring access to clean water, adequate shade and fair workloads\u2014can strengthen resilience in agricultural communities facing rising heat-related health risks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-115295","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T15:35:45Z","timestamp":1773934545000},"page":"e115295","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Experiences of heat stress and adapting practices among farmworkers in northwest Nicaragua: a qualitative study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8748-1044","authenticated-orcid":false,"given":"Ana L","family":"Pineda Reyes","sequence":"first","affiliation":[{"name":"Department of Environmental and Occupational Health, Kate Marmion School of Public Health, The University of Texas at San Antonio, San Antonio, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andres","family":"Jaime","sequence":"additional","affiliation":[{"name":"Office of Research and Partnerships, Kate Marmion School of Public Health, The University of Texas at San Antonio, San Antonio, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurora","family":"Arag\u00f3n","sequence":"additional","affiliation":[{"name":"Wuku\u2019 Kawoq Maya Health Alliance, Chimaltenango, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indiana","family":"L\u00f3pez-Bonilla","sequence":"additional","affiliation":[{"name":"Wuku\u2019 Kawoq Maya Health Alliance, Chimaltenango, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9938-7852","authenticated-orcid":false,"given":"Neil","family":"Pearce","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK"},{"name":"Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9544-164X","authenticated-orcid":false,"given":"Ben","family":"Caplin","sequence":"additional","affiliation":[{"name":"Bladder and Kidney Centre, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0093-6357","authenticated-orcid":false,"given":"Marvin","family":"Gonz\u00e1lez-Quiroz","sequence":"additional","affiliation":[{"name":"Department of Environmental and Occupational Health, Kate Marmion School of Public Health, The University of Texas at San Antonio, San Antonio, Texas, USA"},{"name":"Bladder and Kidney Centre, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"2026031908352965000_16.3.e115295.1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2013.10.062"},{"key":"2026031908352965000_16.3.e115295.2","unstructured":"WHO . Global health estimates 2021: deaths by cuse, age, sex, by country and by region, 2000-2021. World Health Organization; 2024."},{"key":"2026031908352965000_16.3.e115295.3","unstructured":"PAHO . The burden of kidney diseases in the region of the Americas, 2000-2019. Pan American Health Organization; 2021."},{"key":"2026031908352965000_16.3.e115295.4","doi-asserted-by":"crossref","DOI":"10.1186\/s12882-023-03381-1","article-title":"Kidney disease characteristics, prevalence, and risk factors in Le\u00f3n, Nicaragua: a population-based study","volume":"24","author":"Strasma","year":"2023","journal-title":"BMC Nephrol"},{"key":"2026031908352965000_16.3.e115295.5","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2009.12.012"},{"key":"2026031908352965000_16.3.e115295.6","doi-asserted-by":"crossref","DOI":"10.1093\/ije\/dyad151","article-title":"Population-level detection of early loss of kidney function: 7-year follow-up of a young adult cohort at risk of Mesoamerican nephropathy","volume":"53","author":"Gonzalez-Quiroz","year":"2024","journal-title":"Int J Epidemiol"},{"key":"2026031908352965000_16.3.e115295.7","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfx136"},{"key":"2026031908352965000_16.3.e115295.8","article-title":"Chronic Kidney Disease of Unknown Origin: A Mysterious Epidemic","volume":"13","author":"Paidi","year":"2021","journal-title":"Cureus"},{"key":"2026031908352965000_16.3.e115295.9","doi-asserted-by":"crossref","first-page":"3379","DOI":"10.1016\/j.ekir.2025.07.013","article-title":"Heat Stress Nephropathy in CKD of Uncertain Etiology Hotspots of Bargarh District Odisha, India","volume":"10","author":"Biswas","year":"2025","journal-title":"Kidney Int Rep"},{"key":"2026031908352965000_16.3.e115295.10","doi-asserted-by":"crossref","first-page":"110","DOI":"10.34067\/KID.0005572022","article-title":"Global Dialysis Perspective: Nicaragua","volume":"4","author":"Cajina-Aguirre","year":"2023","journal-title":"Kidney360"},{"key":"2026031908352965000_16.3.e115295.11","article-title":"Reducing the gap of chronic kidney disease in low- and middle-income countries: what is missing?","volume":"28","author":"L\u00f3pez","year":"2023","journal-title":"Lancet Reg Health Am"},{"key":"2026031908352965000_16.3.e115295.12","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-13-350","article-title":"Chronic kidney disease in Nicaragua: a qualitative analysis of semi-structured interviews with physicians and pharmacists","volume":"13","author":"Ramirez-Rubio","year":"2013","journal-title":"BMC Public Health"},{"key":"2026031908352965000_16.3.e115295.13","doi-asserted-by":"crossref","first-page":"45","DOI":"10.37757\/MR2018.V20.N3.9","article-title":"Researchers\u2019 Perceived Challenges in Studying Chronic Kidney Disease of Nontraditional Etiology in Mesoamerica","volume":"20","author":"Wright","year":"2018","journal-title":"MEDICC Rev"},{"key":"2026031908352965000_16.3.e115295.14","unstructured":"Salda\u00f1a JM . The Coding Manual for Qualitative Researchers. 4th edn. London, England: SAGE Publications, 2016."},{"key":"2026031908352965000_16.3.e115295.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2015.07.007"},{"key":"2026031908352965000_16.3.e115295.16","doi-asserted-by":"publisher","DOI":"10.1002\/ajim.22204"},{"key":"2026031908352965000_16.3.e115295.17","doi-asserted-by":"crossref","unstructured":"Kjellstrom T , Gabrysch S , Lemke B , et al . The \u201cHothaps\u201d programme for assessing climate change impacts on occupational health and productivity: an invitation to carry out field studies. Glob Health Action 2009;2. doi:10.3402\/gha.v2i0.2082","DOI":"10.3402\/gha.v2i0.2082"},{"key":"2026031908352965000_16.3.e115295.18","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.3402\/gha.v2i0.2047","article-title":"Workplace heat stress, health and productivity \u2013 an increasing challenge for low and middle-income countries during climate change","volume":"2","author":"Kjellstrom","year":"2009","journal-title":"Glob Health Action"},{"key":"2026031908352965000_16.3.e115295.19","unstructured":"Solis Zepeda GA . Impacto de las medidas preventivas para evitar el deterioro de la funci\u00f3n renal por el s\u00edndrome de golpe por calor en trabajadores agr\u00edcolas del ingenio san antonio del occidente de nicaragua, ciclo agr\u00edcola 2004-2006. Universidad Nacional Autonoma de Nicaragua; 2007."},{"key":"2026031908352965000_16.3.e115295.20","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph110202125"},{"key":"2026031908352965000_16.3.e115295.21","doi-asserted-by":"crossref","DOI":"10.1186\/1476-069X-14-6","article-title":"Drinking well water and occupational exposure to Herbicides is associated with chronic kidney disease, in Padavi-Sripura, Sri Lanka","volume":"14","author":"Jayasumana","year":"2015","journal-title":"Environ Health"},{"key":"2026031908352965000_16.3.e115295.22","doi-asserted-by":"publisher","DOI":"10.1056\/nejmra1813869"},{"key":"2026031908352965000_16.3.e115295.23","doi-asserted-by":"crossref","first-page":"R189","DOI":"10.1152\/ajpregu.00351.2018","article-title":"Soft drink consumption during and following exercise in the heat elevates biomarkers of acute kidney injury","volume":"316","author":"Chapman","year":"2019","journal-title":"Am J Physiol Regul Integr Comp Physiol"},{"key":"2026031908352965000_16.3.e115295.24","doi-asserted-by":"crossref","DOI":"10.3390\/nu14102070","article-title":"Current Hydration Habits: The Disregarded Factor for the Development of Renal and Cardiometabolic Diseases","volume":"14","author":"Johnson","year":"2022","journal-title":"Nutrients"},{"key":"2026031908352965000_16.3.e115295.25","doi-asserted-by":"publisher","DOI":"10.1152\/ajpregu.00354.2015"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-115295","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T15:35:49Z","timestamp":1773934549000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-115295"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":25,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3,19]]},"published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1136\/bmjopen-2025-115295"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-115295","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]}}}