Firefighters' occupational exposure: Contribution from biomarkers of effect to assess health risks

Exposure to benzotriazoles and benzothiazoles in Czech male population and its associations with biomarkers of liver function, serum lipids and oxidative stress

INTRODUCTION

Benzotriazoles and benzothiazoles (BTs) are high-production volume chemicals as well as widely distributed emerging pollutants with potential health risk. However, information about human exposure to BTs and associated health outcomes is limited.

OBJECTIVE

We aimed to characterise exposure to BTs among Czech men, including possible occupational exposure among firefighters, its predictors, and its associations with liver function, serum lipids and oxidative stress.

METHODS

165 participants (including 110 firefighters) provided urine and blood samples that were used to quantify the urinary levels of 8 BTs (high-performance liquid chromatography-tandem mass spectrometry), and 4 liver enzymes, cholesterol, low-density lipoprotein, and 8-hydroxy-2'-deoxyguanosine. Linear regression was used to assess associations with population characteristics and biomarkers of liver function, serum lipids and oxidative stress. Regression models were adjusted for potential confounding variables and false discovery rate procedure was applied to account for multiplicity.

RESULTS

The BTs ranged from undetected up to 46.8 ng/mL. 2-hydroxy-benzothiazole was the most predominant compound (detection frequency 83%; median 1.95 ng/mL). 1-methyl-benzotriazole (1M-BTR) was measured in human samples for the first time, with a detection frequency 77% and median 1.75 ng/mL. Professional firefighters had lower urinary 1M-BTR compared to non-firefighters. Urinary 1M-BTR was associated with levels of γ-glutamyl transferase (β = - 17.54%; 95% CI: - 26.127, - 7.962).

CONCLUSION

This is the first study to investigate BT exposure in Central Europe, including potentially exposed firefighters. The findings showed a high prevalence of BTs in the study population, the relevance of 1M-BTR as a new biomarker of exposure, and an urgent need for further research into associated adverse health outcomes.

Firefighter Health: A Narrative Review of Occupational Threats and Countermeasures

Structural firefighters are responsible for protecting properties and saving lives during emergency operations. Despite efforts to prepare firefighters for these hazardous occupational demands, the unfortunate reality is that the incidence of health morbidities is increasing within the fire service. Specifically, cardiovascular disease, cancer, and mental health disorders are among the most documented morbidities in firefighters. Pubmed and Google Scholar search engines were used to identify peer-reviewed English language manuscripts that evaluated firefighters' occupational health threats, allostatic factors associated with their occurrence, and evidence-based strategies to mitigate their impact. This narrative review provides fire departments, practitioners, and researchers with evidence-based practices to enhance firefighters' health.

Firefighters' personal exposure to gaseous PAHs during controlled forest fires: A case study with estimation of respiratory health risks and in vitro toxicity

Firefighters are daily exposed to adverse health-hazardous pollutants. Polycyclic aromatic hydrocarbons (PAHs), well known endocrine disruptors with carcinogenic, mutagenic, and teratogenic properties, are among the most relevant pollutants. The characterization of firefighters' occupational exposure to airborne PAHs remains limited; information is scarce for European firefighters. Also, the in vitro assessment of firefighters' respiratory health risks is inexistent. To reply to these scientific gaps, this work characterizes the levels of gaseous PAH in firefighters' personal air during regular working activities at controlled forest fires and at fire stations (control group). Breathable levels were 2.2-26.7 times higher during fire events than in the control group (2.63-32.63 μg/m3versus 1.22 μg/m3, p < 0.001); the available occupational guidelines (100 and 200 μg/m3 defined by the US National Institute for Occupational Safety and Health and the North American Occupational Safety and Health Administration, respectively) were not exceeded. Concentrations of (possible/probable) carcinogenic PAHs were 1.9-15.3 times superior during firefighting (p < 0.001). Increased values of total benzo(a)pyrene equivalents (p = 0.101), dose rates (p < 0.001), and carcinogenic risks (p = 0.063) were estimated in firefighters during controlled fires comparatively with the control group. Firefighters' breathable gaseous phase collected during fire events contributed to induce a significant viability decrease (<70 %; p < 0.05) in A549 and Calu-3 cell lines. The principal component analysis (PCA) allowed the differentiation between firefighters participating in controlled fire events from the control group. PCA analysis demonstrated the potential of PAHs to distinguish different sources of firefighters´ occupational exposure and of combining estimated health risk parameters with in vitro toxicities determined with human-breathable air collected during real-life scenarios. Overall, the participation in controlled fire events contributes to the respiratory health burden of firefighting forces. However, more studies are needed to corroborate these preliminary findings, explore the respiratory toxicological mechanisms, and support the implementation of preventive actions and mitigation strategies to pursue firefighters' health.

Exploring wearable technology use and importance of health monitoring in the hazardous occupations of first responders and professional drivers

OBJECTIVES

Hazardous materials (HAZMAT) pose risks to the health and safety of professionals involved with transportation and emergency responses. Two distinct occupational groups that encounter HAZMAT events are first responders and professional drivers. Wearable technology is a tool that can assist with monitoring the health of professionals involved in HAZMAT events. The aim of this study was to compare and evaluate the perceptions of first responders and professional drivers on wearable technology and attitudes toward health monitoring.

METHODS

A survey was administered to first responders (n = 112) and professional drivers (n = 218). Statistical approaches included bivariate analysis, latent class analysis, logistic regression analysis, and path analysis for the variables of interest.

RESULTS

There were significant differences between the groups in perceptions of the benefits of monitoring certain health indicators. Professional drivers were more likely to have a history of wearable technology use compared with first responders (odds ratio [OR] = 10.1; 95% CI, 4.42-22.9), reported greater exposure to HAZMAT (OR = 4.32; 95% CI, 2.24-8.32), and were more willing to have their health data monitored by someone other than themselves (OR = 9.27; 95% CI, 3.67-23.4). A multinomial regression model revealed that occupation was not a significant predictor of class preference for acceptance of monitoring specific health indicators.

CONCLUSIONS

Occupation appeared to be important but further analysis uncovered that characteristics of individuals within the occupations were more salient to the use of wearable technology. HAZMAT exposure, someone else monitoring health data, and experience with wearable technology use were found to be important factors for perceptions about benefits of health monitoring with wearable technology.

Physical fitness test performance in firefighter trainees: Differences between graduated and released trainees and predicting academy graduation

BACKGROUND

Fitness tests have been previously used to predict academy graduation and highlight specific capacities to be targeted in applicants/trainees to optimise their potential for academy success.

OBJECTIVE

To compare the fitness of graduated and released (did not complete academy requirements) firefighter trainees and explore using decision tree analysis to predict academy graduation via fitness tests.

METHODS

Retrospective analysis was conducted on 686 trainees who completed an occupational physical ability test (OPAT): Illinois agility test; push-ups; pull-ups; leg tucks; estimated maximal aerobic capacity (VO2max); backwards overhead 4.54-kg medicine ball throw; 10-repetition maximum deadlift; and 91.44-m farmer's carry. Data were recorded in raw and scaled scores (tests scored from 0-100; maximum OPAT score was 800). Trainees were split into 'graduated' (GRAD; n = 576) or 'released' (REL; n = 110) groups. Mann-Whitney U-tests compared between-group OPAT scores. A decision tree analysis using Chi-square automatic interaction detection was conducted, with raw and scaled scores entered into the analysis. A separate analysis was conducted with only the raw scores.

RESULTS

GRAD trainees outperformed REL trainees in all OPAT events (p < 0.001). OPAT total score was the best predictor of academy graduation (p < 0.001), followed by the deadlift score (p = 0.003). Estimated VO2max was the only significant raw score predictor (p < 0.001).

CONCLUSIONS

GRAD trainees were fitter than the REL trainees. Fitness could predict trainees who graduated from the academy. Overall fitness (OPAT total score), muscular strength (deadlift) and aerobic capacity were important graduation predictors. Training staff could develop these fitness qualities in their trainees to potentially improve fire academy graduation rates.

Air pollution inside fire stations: State-of-the-art and future challenges

Firefighters are frequently exposed to products of combustion and pyrolysis. Exposure to these substances occurs not only during fires but also at fire stations, particularly where fire equipment and fire uniforms are stored after firefighting operations. The aims of this study were to review the research on the concentrations of various air pollutants in fire stations, identify the limitations and strengths of such research, identify research gaps and related future challenges, and highlight potential solutions for reducing firefighter exposure to air pollution at fire stations. A total of 32 articles published in international journals during 1987-2023 were selected for analysis. The most frequently studied pollutants in fire stations were polycyclic aromatic hydrocarbons, particulate matter, and diesel particulate matter. Research was most often conducted on changing rooms and garages. Firefighting equipment, personal protective equipment, fire trucks, and combustion tools were identified as the main sources of pollution at fire stations. Recommendations aimed at reducing the concentration of pollutants in fire stations were mainly concerned with the systematic decontamination of equipment and the introduction of ventilation solutions that would remove exhaust fumes from garages. This in-depth literature review indicates a lack of comprehensive research on the state and quality of air at fire stations. It also highlights the emerging need for more knowledge on the concentrations of air pollutants in fire stations, health exposure related to these substances, and an analysis of the effectiveness of the proposed solutions.

Continent-based systematic review of the short-term health impacts of wildfire emissions

This review systematically gathers and provides an analysis of pollutants levels emitted from wildfire (WF) and their impact on short-term health effects of affected populations. The available literature was searched according to Population, Exposure, Comparator, Outcome, and Study design (PECOS) database defined by the World Health Organization (WHO) and a meta-analysis was conducted whenever possible. Data obtained through PECOS characterized information from the USA, Europe, Australia, and some Asian countries; South American countries were seldom characterized, and no data were available for Africa and Russia. Extremely high levels of pollutants, mostly of fine fraction of particulate matter (PM) and ozone, were associated with intense WF emissions in North America, Oceania, and Asia and reported to exceed several-fold the WHO guidelines. Adverse health outcomes include emergency department visits and hospital admissions for cardiorespiratory diseases as well as mortality. Despite the heterogeneity among exposure and health assessment methods, all-cause mortality, and specific-cause mortality were significantly associated with WF emissions in most of the reports. Globally, a significant association was found for all-cause respiratory outcomes including asthma, but mixed results were noted for cardiovascular-related effects. For the latter, estimates were only significant several days after WF emissions, suggesting a more delayed impact on the heart. Different research gaps are presented, including the need for the application of standardized protocols for assessment of both exposure and adverse health risks. Mitigation actions also need to be strengthened, including dedicated efforts to communicate with the affected populations, to engage them for adoption of protective behaviors and measures.

Optimizing human performance in extreme environments through precision medicine: From spaceflight to high-performance operations on Earth

Humans operating in extreme environments often conduct their operations at the edges of the limits of human performance. Sometimes, they are required to push these limits to previously unattained levels. As a result, their margins for error in execution are much smaller than that found in the general public. These same small margins for error that impact execution may also impact risk, safety, health, and even survival. Thus, humans operating in extreme environments have a need for greater refinement in their preparation, training, fitness, and medical care. Precision medicine (PM) is uniquely suited to address the needs of those engaged in these extreme operations because of its depth of molecular analysis, derived precision countermeasures, and ability to match each individual (and his or her specific molecular phenotype) with any given operating context (environment). Herein, we present an overview of a systems approach to PM in extreme environments, which affords clinicians one method to contextualize the inputs, processes, and outputs that can form the basis of a formal practice. For the sake of brevity, this overview is focused on molecular dynamics, while providing only a brief introduction to the also important physiologic and behavioral phenotypes in PM. Moreover, rather than a full review, it highlights important concepts, while using only selected citations to illustrate those concepts. It further explores, by demonstration, the basic principles of using functionally characterized molecular networks to guide the practical application of PM in extreme environments. At its core, PM in extreme environments is about attention to incremental gains and losses in molecular network efficiency that can scale to produce notable changes in health and performance. The aim of this overview is to provide a conceptual overview of one approach to PM in extreme environments, coupled with a selected suite of practical considerations for molecular profiling and countermeasures.

Exploring the Applicability of Physiological Monitoring to Manage Physical Fatigue in Firefighters

Physical fatigue reduces productivity and quality of work while increasing the risk of injuries and accidents among safety-sensitive professionals. To prevent its adverse effects, researchers are developing automated assessment methods that, despite being highly accurate, require a comprehensive understanding of underlying mechanisms and variables' contributions to determine their real-life applicability. This work aims to evaluate the performance variations of a previously developed four-level physical fatigue model when alternating its inputs to have a comprehensive view of the impact of each physiological variable on the model's functioning. Data from heart rate, breathing rate, core temperature and personal characteristics from 24 firefighters during an incremental running protocol were used to develop the physical fatigue model based on an XGBoosted tree classifier. The model was trained 11 times with different input combinations resulting from alternating four groups of features. Performance measures from each case showed that heart rate is the most relevant signal for estimating physical fatigue. Breathing rate and core temperature enhanced the model when combined with heart rate but showed poor performance individually. Overall, this study highlights the advantage of using more than one physiological measure for improving physical fatigue modelling. The findings can contribute to variables and sensor selection in occupational applications and as the foundation for further field research.

Assessment of coarse, fine, and ultrafine particulate matter at different microenvironments of fire stations

The concentrations of respirable particulate matter (PM) and the impact on indoor air quality in occupational settings remains poorly characterized. This study assesses, for the first time, the cumulative and non-cumulative concentrations of 14 fractions of coarse (3.65-9.88 μm), fine (0.156-2.47 μm), and ultrafine (0.015-0.095 μm) PM inside the garage of heavy vehicles, firefighting personal protective equipment' storage room, bar, and a common area of seven Portuguese fire stations. Sampling campaigns were performed during a regular work week at the fire stations. Levels of daily total cumulative PM ranged from 277.4 to 413.2 μg/m³ (maximum values of 811.4 μg/m³), with the bar (370.1 μg/m³) and the PPE' storage room (361.3 μg/m³) presenting slightly increased levels (p > 0.05) than the common area (324.8 μg/m³) and the garage (339.4 μg/m³). The location of the sampling site, the proximity to local industries and commercial activities, the layout of the building, the heating system used, and indoor sources influenced the PM concentrations. Fine (193.8-301.0 μg/m³) and ultrafine (41.3-78.2 μg/m³) particles were predominant in the microenvironments of all fire stations and accounted for 71.5% and 17.8% of daily total cumulative levels, respectively; coarse particles (23.3-47.1 μg/m³) represented 10.7% of total PM. The permissible exposure limit (5.0 mg/m³) defined by the Occupational Safety and Health Organization for respirable dust was not overcome in the evaluated fire stations. Results suggest firefighters' regular exposure to fine and ultrafine PM inside fire stations which will contribute to cardiorespiratory health burden. Further studies are needed to characterize firefighters' exposure to fine and ultrafine PM inside fire stations, identify main emission sources, and evaluate the contribution of exposures at fire stations to firefighters' occupational health risks.

In vitro data for fire pollutants: contribution of studies using human cell models towards firefighters' occupational

Firefighters are the principal line of defense against fires, being at elevated risk of exposure to health-relevant pollutants released during fires and burning processes. Although many biomonitoring studies exist, only a limited number of human in vitro investigations in fire risk assessment are currently available. In vitro studies stand out as valuable tools to assess the toxicity mechanisms involved following exposure to fire pollutants at a cellular level. The aim of the present review was to contextualize existing in vitro studies using human cell models exposed to chemicals emitted from fire emissions and wood smoke and discuss the implications of the observed toxic outcomes on adverse health effects detected in firefighters. Most of the reported in vitro investigations focused on monocultures respiratory models and exposure to particulate matter (PM) extracts collected from fire effluents. Overall, (1) a decrease in cellular viability, (2) enhanced oxidative stress, (3) increased pro-inflammatory cytokines levels and (4) elevated cell death frequencies were noted. However, limited information remains regarding the toxicity mechanisms initiated by firefighting activities. Hence, more studies employing advanced in vitro models and exposure systems using human cell lines are urgently needed taking into consideration different routes of exposure and health-related pollutants released from fires. Data are needed to establish and define firefighters' occupational exposure limits and to propose mitigation strategies to promote beneficial human health.

Indirect Methods to Determine the Risk of Damage to the Health of Firefighters and Children Due to Exposure to Smoke Emission from Burning Wood/Coal in a Controlled Environment

People are constantly exposed to particulate matter and chemicals released during fires. However, there are still few studies on gas and particulate emissions related to exposure to burning firewood and charcoal during forest fires, making it difficult to understand the effects on the health of the population. The objective of this study was to quantify the metal(loid)s present in the smoke from wood and charcoal fires through the deposition of metals in beef topside and pork loin, considering the routes of skin exposure, inhalation, and ingestion, contributing to the understanding of metals in the increase of the risks of cancer and mortality associated with firefighting and children. The concentrations of metals [aluminum (Al), chromium (Cr), copper (Cu), iron (Fe), magnesium (Mg), manganese (Mn), molybdenum (Mo), vanadium (V), zinc (Zn)] and metalloids arsenic (As) were determined by inductively coupled plasma-mass spectrometry (ICP OES) after microwave digestion. Moreover, we assessed the associated risk regarding the elemental intake of these elements through the smoke, using the hazard quotient (HQ), hazard index (HI), Total Hazard Index (HIt), and carcinogenic risk (CR). All samples had results for HQ and HIt < 1, indicating a non-potential health risk. However, the carcinogenic risks posed by As and Cr via the three exposure pathways (except for inhalation exposure to children and adults, and by Cr via ingestion and inhalation for children and adults) exceeded the standard threshold. In conclusion, continuous exposure of firefighters or children to smoke from fires containing high concentrations of heavy metals such as As and Cr can be harmful to health. The study used animal tissues; thus, new methods must be developed to quantify the concentration of heavy metals deposited in human tissue when humans are exposed to smoke from fires.

Biomonitoring of firefighting forces: a review on biomarkers of exposure to health-relevant pollutants released from fires

Occupational exposure as a firefighter has recently been classified as a carcinogen to humans by International Agency for Research on Cancer (IARC). Biomonitoring has been increasingly used to characterize exposure of firefighting forces to contaminants. However, available data are dispersed and information on the most relevant and promising biomarkers in this context of firefighting is missing. This review presents a comprehensive summary and critical appraisal of existing biomarkers of exposure including volatile organic compounds such as polycyclic aromatic hydrocarbons, several other persistent other organic pollutants as well as heavy metals and metalloids detected in biological fluids of firefighters attending different fire scenarios. Urine was the most characterized matrix, followed by blood. Firefighters exhaled breath and saliva were poorly evaluated. Overall, biological levels of compounds were predominantly increased in firefighters after participation in firefighting activities. Biomonitoring studies combining different biomarkers of exposure and of effect are currently limited but exploratory findings are of high interest. However, biomonitoring still has some unresolved major limitations since reference or recommended values are not yet established for most biomarkers. In addition, half-lives values for most of the biomarkers have thus far not been defined, which significantly hampers the design of studies. These limitations need to be tackled urgently to improve risk assessment and support implementation of better more effective preventive strategies.

Risk Factors for Cardiometabolic Disease in Professional Firefighters

OBJECTIVE

Firefighters are plagued with cardiometabolic disease (CMD). Obesity, poor cardiorespiratory and muscular fitness, and blood lipids (low-density lipoprotein cholesterol, triglycerides, low high-density lipoprotein cholesterol) are risk factors for CMD. However, markers of oxidative stress, inflammation, and insulin resistance can provide further insight regarding CMD risk.

METHODS

This study investigated the relationships between fitness metrics (cardiorespiratory and muscular fitness, percent body fat, waist circumference), blood lipids, blood pressure, and years of experience as a firefighter to blood markers of insulin resistance: Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), oxidative stress: advanced oxidation protein products (AOPPs), and inflammation: C-reactive protein.

RESULTS

Waist circumference and blood concentrations of triglycerides were significantly related to AOPPs and HOMA-IR. Cardiorespiratory fitness was inversely related to AOPPs, HOMA-IR and C-reactive protein.

CONCLUSION

These findings demonstrate the importance of high cardiorespiratory fitness and low waist circumference to reduce markers of CMD.

Suburban firefighter perceptions of health and wellness using patient-reported outcome measures

BACKGROUND

Firefighting is among the most dangerous professions and requires exceptional physical fitness and focus while working. Patient-reported outcomes are a commonly used method to evaluate subjective health information and may be utilized by fire departments to identify the health status of firefighters and provide insight to promote their health and wellness.

OBJECTIVE

This study is a novel analysis of firefighters' self-reported health to potentially identify musculoskeletal dysfunction, assist in therapeutic intervention, and improve overall health and wellness.

METHODS

Firefighters were evaluated using seven different self-reported health surveys to assess various physical capabilities and quality of life. The questionnaires were delivered via online format and administered once to provide a snapshot of a suburban Oklahoma fire department.

RESULTS

Using the Disablement in the Physically Active Scale, 14 of the 35 firefighters answered "slight, moderate, or severe" for the pain and motion variables. Only two of the firefighters indicated no stiffness or soreness after activity on the Nirschl Phase Rating Scale. The firefighters mean rating for "energy/fatigue" via the RAND-36 was 54.14 out of 100.

CONCLUSION

Firefighters frequently report pain, impaired motion, and soreness, indicating areas in which health and wellness interventions may be helpful. The incorporation of periodic health surveys into firefighter health and wellness programming can highlight the presence of concerns, as well as intervention effectiveness by subjective health status reporting. By combining the health surveys with aerobic and core strength exercises, fire departments may be able to monitor and improve firefighter health.

Firefighters With Higher Cardiorespiratory Fitness Demonstrate Lower Markers of Cardiovascular Disease Risk

OBJECTIVE

High cardiorespiratory fitness (CRF) is associated with reduced markers of oxidative stress and cardiovascular disease (CVD) risk factors; however, this relationship has not been elucidated in firefighters. The purpose of this study was to examine differences in markers of CVD risk between firefighters who have either high or low levels of CRF.

METHODS

Forty-six firefighters participated in a maximal graded exercise test and a dual-energy x-ray absorptiometry scan and provided a fasted blood sample. V˙O 2max values were categorized based on American College of Sports Medicine guidelines to establish high- and low-fitness groups.

RESULTS

High fitness firefighters demonstrated significantly higher high-density lipoprotein cholesterol and lower markers of CVD risk: cholesterol, triglycerides, low-density lipoprotein cholesterol, insulin, homeostatic model assessment for insulin resistance, C-reactive protein, and advanced oxidation protein products concentrations.

CONCLUSION

Firefighters are encouraged to maintain high CRF to reduce risk of CVD.

Body Composition and Fitness Characteristics of Firefighters Participating in a Health and Wellness Program: Relationships and Descriptive Data

This study investigated body composition and fitness test relationships from firefighters participating in a health and wellness program and categorized firefighters according to population norms relative to sex and age. Data from 270 firefighters (men = 258, women = 12) were analyzed, including body composition (body mass index [BMI], body fat percentage [BF%], waist circumference [WC], waist-to-hip ratio) and fitness (sit-and-reach, grip strength, leg press, crunches, push-ups, maximal aerobic capacity [V̇O_2max]) tests. Mann-Whitney U-test analysis (p < 0.05) showed that male firefighters had a greater WC, WHR, grip strength and leg press. Female firefighters had a greater BF% and better sit-and-reach. Partial correlations controlling for sex indicated 22/24 correlations between body composition and fitness were significant (r = -0.143--0.640). ~52% of firefighters were overweight, and 25% were Obesity Class I-III. ~76% had an increased risk of cardiovascular disease (CVD) considering BMI and WC. ~22% were fatter than average-to-overfat considering BF%. Most firefighters (73-94%) were good-to-excellent in sit-and-reach, grip strength, and push-ups; average-to-well above average in crunches; average-to-above average in leg press; and had good-to-superior V̇O_2max. Although most firefighters had better fitness compared to the general population, many had increased CVD risk. The data highlighted the need for comprehensive approaches to improving firefighter health and decreasing CVD risk.

Exposure to PAHs during Firefighting Activities: A Review on Skin Levels, In Vitro/In Vivo Bioavailability, and Health Risks

Occupational exposure as a firefighter is a complex activity that continuously exposes subjects to several health hazards including fire emissions during firefighting. Firefighters are exposed to polycyclic aromatic hydrocarbons (PAHs), known as toxic, mutagenic, and carcinogenic compounds, by inhalation, dermal contact, and ingestion. In this work, a literature overview of firefighters' dermal exposure to PAHs after firefighting and data retrieved from skin in vitro/in vivo studies related to their dermal absorption, bioavailability, and associated toxicological and carcinogenic effects are reviewed. The evidence demonstrates the contamination of firefighters' skin with PAHs, mainly on the neck (2.23-62.50 ng/cm²), wrists (0.37-8.30 ng/cm²), face (2.50-4.82 ng/cm²), and hands (1.59-4.69 ng/cm²). Concentrations of possible/probable carcinogens (0.82-33.69 ng/cm²), including benzopyrene isomers, were found on firefighters' skin. PAHs penetrate the skin tissues, even at low concentrations, by absorption and/or diffusion, and are locally metabolized and distributed by the blood route to other tissues/organs. Lighter PAHs presented increased dermal permeabilities and absorption rates than heavier compounds. Topical PAHs activate the aryl hydrocarbon receptor and promote the enzymatic generation of reactive intermediates that may cause protein and/or DNA adducts. Future research should include in vitro/in vivo assays to perform a more realistic health risk assessment and to explore the contribution of dermal exposure to PAHs total internal dose.

Lifestyle and environmental factors may induce airway and systemic inflammation in firefighters

Health status depends on multiple genetic and non-genetic factors. Nonheritable factors (such as lifestyle and environmental factors) have stronger impact on immune responses than genetic factors. Firefighters work is associated with exposure to air pollution and heat stress, as well as: extreme physical effort, mental stress, or a changed circadian rhythm, among others. All these factors can contribute to both, short-term and long-term impairment of the physical and mental health of firefighters. Increased levels of some inflammatory markers, such as pro-inflammatory cytokines or C-reactive protein (CRP) have been observed in firefighters, which can lead to local, acute inflammation that promotes a systemic inflammatory response. It is worth emphasizing that inflammation is one of the main hallmarks of cancer and also plays a key role in the development of cardiovascular and respiratory diseases. This article presents possible causes of the development of an inflammatory reaction in firefighters, with particular emphasis on airway inflammation caused by smoke exposure.

Redox Implications of Extreme Task Performance: The Case in Driver Athletes

Redox homeostasis and redox-mediated signaling mechanisms are fundamental elements of human biology. Physiological levels of reactive oxygen species (ROS) and reactive nitrogen species (RNS) modulate a range of functional processes at the cellular, tissue, and systemic levels in healthy humans. Conversely, excess ROS or RNS activity can disrupt function, impairing the performance of daily activities. This article analyzes the impact of redox mechanisms on extreme task performance. Such activities (a) require complex motor skills, (b) are physically demanding, (c) are performed in an extreme environment, (d) require high-level executive function, and (e) pose an imminent risk of injury or death. The current analysis utilizes race car driving as a representative example. The physiological challenges of this extreme task include physical exertion, g loading, vibration, heat exposure, dehydration, noise, mental demands, and emotional factors. Each of these challenges stimulates ROS signaling, RNS signaling, or both, alters redox homeostasis, and exerts pro-oxidant effects at either the tissue or systemic levels. These redox mechanisms appear to promote physiological stress during race car driving and impair the performance of driver athletes.

Human Biomonitoring of Selected Hazardous Compounds in Portugal: Part I-Lessons Learned on Polycyclic Aromatic Hydrocarbons, Metals, Metalloids, and Pesticides

Human biomonitoring (HBM) data provide information on total exposure regardless of the route and sources of exposure. HBM studies have been applied to quantify human exposure to contaminants and environmental/occupational pollutants by determining the parent compounds, their metabolites or even their reaction products in biological matrices. HBM studies performed among the Portuguese population are disperse and limited. To overcome this knowledge gap, this review gathers, for the first time, the published Portuguese HBM information concerning polycyclic aromatic hydrocarbons (PAHs), metals, metalloids, and pesticides concentrations detected in the urine, serum, milk, hair, and nails of different groups of the Portuguese population. This integrative insight of available HBM data allows the analysis of the main determinants and patterns of exposure of the Portuguese population to these selected hazardous compounds, as well as assessment of the potential health risks. Identification of the main difficulties and challenges of HBM through analysis of the enrolled studies was also an aim. Ultimately, this study aimed to support national and European policies promoting human health and summarizes the most important outcomes and lessons learned through the HBM studies carried out in Portugal.