Most epidemiological studies of high temperature effects on mortality have focused on urban settings, while heat-related health risks in rural areas remain underexplored. To date there has been no meta-analysis of epidemiologic literature concerning heat-related mortality in rural settings. This study aims to systematically review the current literature for assessing heat-related mortality risk among rural populations. We conducted a comprehensive literature search using PubMed, Web of Science, and Google Scholar to identify articles published up to April 2018. Key selection criteria included study location, health endpoints, and study design. Fourteen studies conducted in rural areas in seven countries on four continents met the selection criteria, and eleven were included in the meta-analysis. Using the random effects model, the pooled estimates of relative risks (RRs) for all-cause and cardiovascular mortality were 1.030 (95% CI: 1.013, 1.048) and 1.111 (95% CI: 1.045, 1.181) per 1 °C increase in daily mean temperature, respectively. We found excess risks in rural settings not to be smaller than risks in urban settings. Our results suggest that rural populations, like urban populations, are also vulnerable to heat-related mortality. Further evaluation of heat-related mortality among rural populations is warranted to develop public health interventions in rural communities.

Harriet Hardy, protégé of Alice Hamilton, spent 1948 in the Health Division of Los Alamos Scientific Laboratory. The contemporary campaign for federal legislation to compensate nuclear workers brought to the fore living retirees in whose cases of occupational illness Hardy had a role in diagnosis or case management. A third case is documented in archival records. Methods of participatory action research were used to better document the cases and strategize in light of the evidence, thereby assisting the workers with compensation claims. Medical and neuropsychological exams of the mercury case were conducted. Hardy's diary entries and memoirs were interpreted in light of medicolegal documentation and workers' recollections. Through these participatory research activities, Harriet Hardy's role and influence both inside and outside the atomic weapons complex have been elucidated. An important lesson learned is the ongoing need for a system of protective medical evaluations for nuclear workers with complex chemical exposures.