Face-to-face with scorching wildfire: potential toxicant exposure and the health risks of smoke for wildland firefighters at the wildland-urban interface

As wildfire risks have elevated due to climate change, the health risks that toxicants from fire smoke pose to wildland firefighters have been exacerbated. Recently, the International Agency for Research on Cancer (IARC) has reclassified wildland firefighters' occupational exposure as carcinogenic to humans (Group 1). Wildfire smoke contributes to an increased risk of cancer and cardiovascular disease, yet wildland firefighters have inadequate respiratory protection. The economic cost of wildland fires has risen concurrently, as illustrated by the appropriation of $45 billion for wildfire management over FYs 2011-2020 by the U.S. Congress. Occupational epidemiological studies of wildland firefighters are crucial for minimizing health risks; however, they must account for the mixture of exposures in wildfire smoke. This review focuses on four aspects of wildland firefighters' health risks at the wildland-urban interface: 1) economic costs and health impact, 2) respiratory protection, 3) multipollutant mixtures, and 4) proactive management of wildfires.

Variations in length of stay of inpatients with COVID-19: A nationwide test of the new model of care under vision 2030 in Saudi Arabia

Objective

The coronavirus disease 2019 (COVID-19) has impacted the Kingdom of Saudi Arabia (KSA) as it has other nations. However, length of stay (LOS), as a healthcare quality indicator, has not been examined across the healthcare regions in the KSA. Therefore, this study aimed to examine factors associated with LOS to better understand the Saudi Health System's performance in response to the COVID-19 pandemic in the newly suggested five Saudi regional business units (BUs).

Methods

A retrospective study was conducted using Ministry of Health (MOH) data on hospital LOS during the period from March to mid-July 2020. Participants were adult inpatients (18 years or older) with confirmed COVID-19 (n = 1743 patients). The 13 regions of the KSA were united into the defined five regional BUs during the reorganization of the health system. Covariates included demographics such as age and sex, comorbidities, and complications of COVID-19. A multiple linear regression with stepwise forward selection was used to model LOS for other explanatory variables associated with LOS, including demographic, comorbidities, and complications.

Results

The mean LOS was 11.85 days which differed significantly across the BUs, ranging from 9.3 days to 13.3 days (p value < 0.001). BUs differed significantly in LOS for transferred patients but not for patients in the intensive care unit (ICU) or those who died in-hospital. The multiple regression analysis revealed that the LOS for inpatients admitted in the Eastern and Southern BUs was significantly shorter than for those in the Central BU. (p value < 0.001). Admission to the ICU was associated with lengthier stays (p value < 0.0001). Factors significantly associated with shorter stays (compared to the reference), were being Saudi, death during admission, and patients referred to another hospital (p value < 0.05).

Conclusion

The LOS for patients with COVID-19 differed across the proposed regional healthcare BUs, suggesting regional differences in quality of care under the reorganization of the national health system. Since patient and disease characteristics did not explain these findings, differences in staffing and other resources need to be examined to develop interventions.

Occupational heat stress assessment and protective strategies in the context of climate change

Global warming will unquestionably increase the impact of heat on individuals who work in already hot workplaces in hot climate areas. The increasing prevalence of this environmental health risk requires the improvement of assessment methods linked to meteorological data. Such new methods will help to reveal the size of the problem and design appropriate interventions at individual, workplace and societal level. The evaluation of occupational heat stress requires measurement of four thermal climate factors (air temperature, humidity, air velocity and heat radiation); available weather station data may serve this purpose. However, the use of meteorological data for occupational heat stress assessment is limited because weather stations do not traditionally and directly measure some important climate factors, e.g. solar radiation. In addition, local workplace environmental conditions such as local heat sources, metabolic heat production within the human body, and clothing properties, all affect the exchange of heat between the body and the environment. A robust occupational heat stress index should properly address all these factors. This article reviews and highlights a number of selected heat stress indices, indicating their advantages and disadvantages in relation to meteorological data, local workplace environments, body heat production and the use of protective clothing. These heat stress and heat strain indices include Wet Bulb Globe Temperature, Discomfort Index, Predicted Heat Strain index, and Universal Thermal Climate Index. In some cases, individuals may be monitored for heat strain through physiological measurements and medical supervision prior to and during exposure. Relevant protective and preventive strategies for alleviating heat strain are also reviewed and proposed.

Neurotoxicology and development: human, environmental and social impacts

The 12th International symposium of the Scientific Committee on Neurotoxicology and Psychophysiology, International Commission on Occupational Health was held in Cape Town, South Africa on March 24-27, 2013. Reflecting the meeting aiming to build greater focus on challenges facing working populations and communities in developing countries, the Symposium theme was Neurotoxicology and Development: Human, Environmental and Social Impacts. A total of 23 countries were represented with strong participation from 5 African countries. In addition to the more traditional topics of these Symposia, like metal, solvents and pesticides neurotoxicity, the conference embraced several new themes including affective disorders arising from chemical exposure, neurodevelopmental impacts in early life and novel approaches to genetic and epigenetic biomarkers for the assessment of neurotoxic impact. The theme of the conference prompted extensive discussions, which have laid the basis for a number of new directions for research, advocacy and capacity building to prevent and manage chemical neurotoxicity in workplace and community settings across the globe.