Martina Anna Maggioni

(1) Background: Physical fatigue, either in short anaerobic exercises or in aerobic ones, affects locomotion patterns. Those effects, if consistently observed, may function as fatigue proxies. The present study focuses on the regularity of the pseudo-periodic acceleration patterns measured by a wearable sensor. Studies during laboratory anaerobic tasks on healthy subjects and on persons with multiple sclerosis during 6 min walking tests demonstrated that regularity decreases with fatigue. This study’s objective is to verify if the gait regularity during an unsupervised endurance aerobic walking task progressively decreases in healthy subjects. (2) Methods: Ten healthy male adults, not competitive recreational athletes, equipped with an accelerometer, participated in a non-competitive 100 km walk in about 24 h. (3) Results: Eight participants took from about 22 to 25 h to complete the task. Two did not finish. The trend of locomotion regularity (on average −6.3%, p < 0.001, effect size 1.41) was negative for all the participants. The gait speed decrease, in all the participants, explained less than 20% of the regularity decrease. Other outcome indices, such as that related to cadence, did not provide unique trends. (4) Conclusions: Regularity decrease is associated with fatigue in submaximal locomotor efforts; due to the experimental group limitations in size and composition, further studies should extend regularity assessments to women, and to persons with neuromuscular disabilities or attending walking rehabilitation.

The rapid increase in global temperatures coupled with persistent malaria transmission presents substantial health burdens in sub-Saharan Africa. Here this randomized pilot field study assessed the feasibility of sustainable housing modifications via passive cooling approaches and vector proofing. Forty houses were randomly allocated to four arms: cool-roof, cross-ventilation, mat-ceiling or control. Doors, windows and eaves of the intervention houses (not control) were screened for malaria mosquito vectors. Indoor temperature and humidity were monitored continuously to assess Heat Index (HI), predicted mean value and psychrometric charts. The HI in cool-roof houses was the lowest (daytime −3.3 °C, P < 0.001; nighttime −2.4 °C, P < 0.01). Mat-ceiling houses lowered daytime HI but increased nighttime HI compared to control. No differences in HI were observed for cross-ventilation houses. Screening reduced the number of female Anopheles funestus mosquitoes by 77% and the number of Culex mosquitoes by 58% compared to control houses. Eighty-five percent of the households expressed willingness to use their resources for housing intervention. Cool-roofs combined with vector proofing is an effective, practical and sustainable housing modification for heat adaptation and for reducing indoor mosquito numbers in rural African households.

Rising temperatures in Africa present an increasing threat to agricultural productivity and public health, particularly among subsistence farming communities reliant on rain-fed agriculture. Heat exposure can impair farmers' work capacity, disrupt harvests, and heighten health risks, especially for young children vulnerable to undernutrition. The Heat to Harvest (H2H) study investigates how environmental heat exposure influences farmers' physiological and behavioral responses, and how these in turn affect harvest yields and child nutrition. It also examines differences in labor performance and recovery between households with and without cool roof coatings, although this intervention is not the central focus. H2H is designed as a prospective cohort study nested within two Health and Demographic Surveillance Systems (HDSS) in Nouna, Burkina Faso, and Siaya, Kenya. The study integrates environmental monitoring (temperature and humidity sensors used to compute Wet Bulb Globe Temperature), biometric data (via wearables tracking heart rate, temperature, physical activity, energy expenditure, and sleep), and GPS tracking (capturing spatial mobility and labor duration). The study is embedded within a larger cluster-randomized controlled trial, facilitating comparative analysis under varying thermal conditions. Findings will provide evidence-based insights into how climate-related heat stress affects health and agricultural outcomes, supporting the development of targeted adaptation strategies to enhance resilience, health, and food security in vulnerable farming communities.

Introduction Climate change and HIV are interconnected epidemics that increase vulnerability in people living with HIV (PLWH), particularly in sub-Saharan Africa. Despite their public health significance, research on the synergistic effects of these epidemics on the health of PLWH is limited. The advancement of non-invasive wearable technology offers an opportunity to leverage objective health data for large-scale research, addressing this knowledge gap. This study will examine the impact of weather events on distinct health variables of PLWH within the Siaya Health and Demographic Surveillance System (HDSS) in rural Kenya. Methods and analysis Over a period of 6 months, we continuously monitored health parameters of a total of 200 participants including heart rate, activity and sleep, using consumer-grade wearable devices. We will correlate these health data with real-time weather parameters (ambient temperature, wet bulb globe temperature, precipitation level) from five weather stations within the HDSS area and compare between HIV-positive participants and an HIV-negative control group. Additionally, a convergent mixed-methods approach will explore participants’ perceptions of the impact of weather events on their health and personal experiences. The study aims to inform future research on the complex relationship between HIV and weather events, which are projected to increase in frequency in this region due to climate change and provide valuable insights for policymakers to develop effective measures to protect this vulnerable population amid the growing climate crisis. Ethics and dissemination This study has been approved by the Research Ethics Committees at Kenya Medical Research Institute, Nairobi (approved on 23 October 2023; SERU 4826) and Heidelberg University Hospital, Germany (approved on 14 February 2023; S-824/2022). Written informed consent was obtained from all participants prior to enrolment, with data anonymised and handled according to Kenyan and German data protection regulations. Research findings will be disseminated through peer-reviewed publications and presented at scientific conferences.

Sub-Saharan Africa faces increasing heat events due to climate change, affecting health and productivity. Wearable technology, though promising for monitoring these impacts, is underexplored in this region. This pilot study evaluated the acceptability and feasibility of research-grade wearables for monitoring heat stress among Kenyan subsistence farmers. In Siaya, 48 farmers (50% women) were monitored for 14 days using sensors to measure heart rate, core temperature, sleep, activity, and geo-location, alongside environmental data loggers for wet bulb globe temperature. Participants mostly rated their experience on a 5-point Likert scale and provided additional non-Likert feedback, with over 95% reporting high device likability and minimal disruption. Data availability was 88% for actigraphy and 100% for core temperature, with a median completeness of 100% for most devices. Women experienced greater heat strain than men. These findings demonstrate that research-grade wearables are acceptable and feasible for real-time heat stress monitoring in rural Africa.

Cardiac vagal modulation indicates the self-regulatory activity of the autonomic nervous system and can thus be used to assess an individual’s ability to integrate physiological, cognitive, and emotional responses in the decision-making process. In this paper, cardiac vagal modulation, quantified by heart rate variability (HRV), was used to predict decision-making in two types of moral dilemmas: First, sacrificial dilemmas which create a moral conflict between utilitarian (acting to maximise aggregate well-being by sacrifice) and deontological (rejecting the sacrifice) alternatives; second, everyday dilemmas which create a conflict between altruistic (acting non-selfish) and egoistic (acting self-centered) alternatives. HRV was analysed in 112 healthy participants before, during, and after decision-making, allowing to assess not only self-regulatory ability (resting HRV) but also self-regulatory capacities (HRV during and after decision-making). HRV predicted concrete decisions, but effects were only found in women. In sacrificial dilemmas, deontological women showed a stronger vagal withdrawal but also a faster cardiac vagal recovery compared to high utilitarian women. In everyday moral dilemmas, altruism was associated with reduced vagal outflow and increased sympathetic activity. Findings suggest differences in the acquisition of self-regulatory capacities between decision-makers in both types of moral dilemmas, which can be measured by HRV.

Background The rapid increase in global temperatures coupled with persistent malaria transmission has significant public health ramifications, especially in Sub-Saharan Africa. Indoor thermal comfort and malaria transmission depend on building designs and structural properties of houses. This study assessed the impact of housing modification, combining passive cooling options with vector proofing for indoor temperature reduction and mosquito control. Method s Forty houses were randomly allocated to one of four arms: reflective roof, cross ventilation, mat ceiling or control. Additionally, doors, windows and eaves of the intervention houses were screened for vector proofing. Indoor temperatures and humidity were monitored daily whereas, mosquito numbers were assessed monthly. Community knowledge, attitude, and perception were assessed using structured questionnaires. Findings Female An. funestus were 67% lower in screened compared to unscreened houses after modification and 6-fold higher before compared to after screening. Houses with reflective roofs and mat ceilings had significantly lower mean day temperature compared to the control, RR=0.08: 95%CI (0.04-0.17) and RR=0.35: 95%CI (0.17-0.74) respectively. At night, houses with cross ventilation and mat ceiling had significantly higher temperatures compared to the control, RR=2.35:95%CI (1.45-3.84) and RR=6.66: 95%CI (4.09-10.85) respectively. Up to 85% of the households expressed willingness to use their resources to modify their houses. Interpretation The combinations of cool roofs and vector proofing are effective for the reduction of indoor temperatures and mosquito control in rural African houses. Cross ventilation is prone to user bias as it relies on household members keeping their doors and windows open for air circulation and cooling whereas mat ceilings are effective in keeping indoor temperature low during the day but are relatively warm at night. Funding Funded by SeaFright Labs through Habitat for Humanity International.

Background: Multisystem Inflammatory Syndrome in Children (MIS-C) has emerged as a severe pediatric complication during the SARS-CoV-2 pandemic, with potential long-term cardiovascular repercussions. We hypothesized that heart rate and blood pressure control at rest and during postural maneuvers in MIS-C patients, months after the remission of the inflammatory syndrome, may reveal long-term autonomic dysfunctions. Methods: We assessed 17 MIS-C patients (13 males; 11.9 ± 2.6 years, m ± SD) 9 months after acute infection and 18 age- (12.5 ± 2.1 years) and sex- (13 males) matched controls. Heart rate and blood pressure variability, baroreflex function, and hemodynamic parameters were analyzed in supine and standing postures. Results: MIS-C patients exhibited reduced heart rate variability, particularly in parasympathetic parameters during standing (pNN50+: 6.1 ± 6.4% in controls, 2.5 ± 3.9% in MIS-C; RMSSD: 34 ± 19 ms in controls, 21 ± 14 ms in MIS-C, p < 0.05), with no interaction between case and posture. Blood pressure variability and baroreflex sensitivity did not differ between groups except for the high-frequency power in systolic blood pressure (3.3 ± 1.2 mmHg² in controls, 1.8 ± 1.2 mmHg² in MIS-C, p < 0.05). The MIS-C group also showed lower diastolic pressure–time indices (DPTI) and systolic pressure–time indices (SPTI), particularly in standing (DPTI: 36.2 ± 9.4 mmHg·s in controls, 29.4 ± 6.2 mmHg·s in MIS-C; SPTI: 26.5 ± 4.3 mmHg·s in controls, 23.9 ± 2.4 mmHg·s in MIS-C, p < 0.05). Conclusions: Altered cardiovascular autonomic control may persist in MIS-C patients with, however, compensatory mechanisms that may help maintain cardiovascular homeostasis during light autonomic challenges, such as postural maneuvers. These results highlight the importance of assessing long-term cardiovascular autonomic control in children with MIS-C to possibly identify residual cardiovascular risks and inform targeted interventions and rehabilitation protocols.