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Table 3 Complete list of interventions evaluated by effectiveness, cost, feasibility and sustainability

From: Sustainable solutions to mitigate occupational heat strain – an umbrella review of physiological effects and global health perspectives

Intervention Strength of evidence Effectiveness (best/ (worst) scenario) Cost (considering acquisition and operation) Feasibility (indoor/ small spaces Feasibility (outdoor/ open spaces) Environmental impact (ecological foot print)
Environmental conditioning
 Air conditioning 2 3.0 / (0.75) HIGH −0.8 −2.9 HIGH
 Misting fan 2 2.5 / (1.4) MOD −1 −1.8 MOD
 Fanning 3 2.4 / (1.2) MOD −0.8 −1.9 MOD
 Shading 1 2.3 / (0.6) LOW −0.7 −1.3 LOW
Clothing
 Air cooled garments 3 3.0 / (2.3) HIGH −2 − 2.6 HIGH
 Liquid cooled garments 3 3.0 / (2.3) HIGH −2.3 −3 HIGH
 Cooling vest 3 1.7 / (1.7) MOD −1.3 −2 MOD
 Elevated design clothing 1 1.2 / (1.2) MOD −1.4 − 1.7 MOD
 Ventilator-incorporated clothing 1 1.1 / (1.1) MOD −1.8 − 1.8 MOD
 Compression garments 3 1.0 / (0.8) MOD −1.3 −1.6 LOW
 Protective clothing 2 0.7 / (0.6) MOD −1.6 − 1.7 LOW
Innate conditioning
 Short term HA 3 1.9 / (1.8) NONE −1.7 −1 NONE
 Medium term HA 3 2.5 / (2.4) NONE −1.4 −0.9 NONE
 Long term HA 3 2.9 / (2.6) NONE −1.6 − 1.1 NONE
 Aerobic fitness 3 2.9 / (2.1) NONE −1.2 −1.0 NONE
Personal cooling solutions
 Cold water immersion 3 2.2 / (1.9) MOD −1.6 −1.9 LOW
 Intravenous cooling 2 2.3 / (1.7) HIGH −2.3 −2.6 MOD
 Cold air inhalation 2 2.1 / (1.2) HIGH −2.1 −2.5 MOD
 Cold fluid ingestion 3 2.0 / (1.7) MOD −1.3 −1.5 LOW
 Cooling packs 3 1.8 / (1.5) MOD −1.6 −2.1 MOD
 Skin wetting 3 1.7 / (1.4) LOW −1.9 −1.6 LOW
 Neck/head cooling 3 1.2 / (1.1) MOD −1.7 − 1.5 LOW
 Ice towels 2 1.5 / (1.3) MOD −2.2 −1.9 LOW
 Cooling glove 2 0.8 / (0.6) MOD −1.8 −2.2 MOD
 External menthol use 3 0.7 / (0.3) LOW −2 −1.9 LOW
 CInternal menthol use 3 0.7 / (0.3) LOW −1.8 − 1.7 LOW
Pacing
 Change in work schedule 0 2.0 / (1.5) NONE −1.5 −1.6 NONE
 Work intensity reduction 1 1.8 / (1.8) NONE −1 −1.1 NONE
 Breaks 1 1.3 / (1.3) NONE −1 −1.1 NONE
Hydration and nutrition
 Hydration 3 2.0 / (2.0) LOW −1 −0.9 NONE
 Electrolyte consumption 1 1.2 / (0.9) LOW −0.7 −0.6 NONE
 Carbohydrate ingestion 2 0.6 / (0.6) LOW −0.7 −0.6 LOW
 Protein ingestion 2 0.3 / (0.3) LOW −0.7 − 0.6 LOW
  1. Table 3 is a summary table of all the identified available solutions to mitigate occupational heat strain, which have been evaluated on four-point scales for five different criteria: the strength of evidence in the literature, the proven effectiveness of the method in best (bolded numbers) and worst case (numbers in parentheses) scenarios, the cost, the feasibility (separated into indoors and outdoors) and the environmental impact. Scores for strength of evidence were: 0, expert knowledge or non-human based research; 1, original research; 2, systematically reviewed but not meta-analysed; and 3, systematically reviewed and meta-analysed. Effectiveness scores were: 0, ineffective or detrimental; 1, slightly beneficial; 2, moderately beneficial; and 3, beneficial. Cost evaluations were: none, low, moderate (MOD) and high. Feasibility scores were: 0, no disruptions to normal work; − 1, minor interruptions; −2, moderate interruptions; and − 3, major interruptions. Environmental impact scores were: none, low, moderate (MOD) and high.