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Human biomonitoring studies are of increasing importance in regulatory toxicology; however, there is a paucity of human biomonitoring data for the Irish population. In this study, we provide new data for urinary biomarker concentrations of aluminium, arsenic, cadmium, chromium, copper, mercury, manganese, lead and selenium. One hundred urine samples, collected between 2011 and 2014 from healthy participants of the EuroMOTOR project, were randomly selected. Metal concentrations were measured via ICPMS. Descriptive statistics for each of the metals stratified by gender were performed. There were 58 male and 42 female participants and metals were detectable for all samples. Geometric mean urinary concentrations for each metal in males were as follows: aluminium 8.5 μg/L, arsenic 8.1 μg/L, cadmium 0.3 μg/L, chromium 0.5 μg/L, copper 5.1 μg/L, mercury 0.4 μg/L, manganese 0.3 μg/L, lead 1.3 μg/L and selenium 10.8 μg/L; and in females: aluminium 8.5 μg/L, arsenic 10.2 μg/L, cadmium 0.4 μg/L, chromium 0.6 μg/L, copper 5.6 μg/L, mercury 0.3 μg/L, manganese 0.2 μg/L, lead 1.6 μg/L and selenium 13.7 μg/L. We observed higher geometric mean concentrations in women for arsenic, cadmium, chromium, copper, lead and selenium, with equal geometric mean concentrations for aluminium and manganese, leaving only mercury with lower geometric mean concentrations in women. Aluminium, cadmium, chromium, lead and urinary concentrations of metals were slightly elevated compared to European data, while for arsenic, copper, manganese and selenium, Irish levels were lower. Our findings highlight that there are differences in urinary metal concentrations between European populations.

International audience; One of the aims of the European Human Biomonitoring Initiative, HBM4EU, was to provide examples of and good practices for the effective use of human biomonitoring (HBM) data in human health risk assessment (RA). The need for such information is pressing, as previous research has indicated that regulatory risk assessors generally lack knowledge and experience of the use of HBM data in RA. By recognising this gap in expertise, as well as the added value of incorporating HBM data into RA, this paper aims to support the integration of HBM into regulatory RA. Based on the work of the HBM4EU, we provide examples of different approaches to including HBM in RA and in estimations of the environmental burden of disease (EBoD), the benefits and pitfalls involved, information on the important methodological aspects to consider, and recommendations on how to overcome obstacles. The examples are derived from RAs or EBoD estimations made under the HBM4EU for the following HBM4EU priority substances: acrylamide, o-toluidine of the aniline family, aprotic solvents, arsenic, bisphenols, cadmium, diisocyanates, flame retardants, hexavalent chromium [Cr(VI)], lead, mercury, mixture of per-/poly-fluorinated compounds, mixture of pesticides, mixture of phthalates, mycotoxins, polycyclic aromatic hydrocarbons (PAHs), and the UV-filter benzophenone-3. Although the RA and EBoD work presented here is not intended to have direct regulatory implications, the results can be useful for raising awareness of possibly needed policy actions, as newly generated HBM data from HBM4EU on the current exposure of the EU population has been used in many RAs and EBoD estimations.

Artisanal and small-scale gold mining (ASGM) is often associated with no or compromised attention to health and safety. Although headlines of fatal accidents in Zimbabwe characterise ASGM, little attention is paid to prevention strategies. This study, therefore, explores health and safety risk mitigation in ASGM in Zimbabwe to inform prevention strategies. A qualitative design was used with focus group discussions and in-depth interviews. Data were analysed using thematic analysis, coding, and descriptive statistics. Reported factors contributing to compromised health and safety included immediate causes, workplace factors, ASM related factors, and contextual factors, with interconnectedness between the causal factors. In addition, factors related to ASGM were significant. For risk mitigation, formalisation, organisation of risk reduction, behaviour change, and enforcement of prevention strategies is proposed. A multi-causal analysis is recommended for risk assessment and accident investigation. A multi-stakeholder approach could be considered for risk mitigation including community and public health interventions. However, risk mitigation has been characterised by gaps and weaknesses such as lacking ASM policy, lack of capital, poor enforcement, negative perceptions, and non-compliance. Therefore, we recommend addressing the threats associated with health and safety mitigation to ensure health and safety protection in ASGM.

People living and working in artisanal and small-scale gold mining (ASGM) areas are frequently exposed to elemental mercury (Hg), which is used for gold extraction. However, additional exposure to other toxic metals such as arsenic (As), cadmium (Cd) and lead (Pb) may result from mining-related activities and could be ingested via dust, water or food. In these areas, only limited biomonitoring data is available for toxic metals other than Hg. In particular, data about the exposure to As, Cd and Pb is unavailable for the Zimbabwean population. Therefore, we conducted a cross-sectional study in two ASGM areas in Zimbabwe to evaluate the internal exposure to these metals. In total, urine and blood samples from 207 people that identified themselves as miners were collected and analysed for As and Cd in urine as well as Pb in blood by GF-AAS. Median levels (interquartile ranges in μg/l) of As and Pb were 9.7 μg/l (4.0, 18.5) and 19.7 μg/l (12.5, 34.5), respectively. The 25th percentile and the median for Cd were below the limit of detection (0.5 μg/l); the 75th percentile was at 0.9 μg/l. The results were compared to reference values found for the general population in the USA and Germany, and a significant number of participants exceeded these values (As, 33 %; Cd, 27 %; Pb, 32 %), indicating a relevant exposure to toxic metals. Although not representative for the Zimbabwean population, our results demonstrate that the exposure to toxic metals is relevant for the public health in Zimbabwe and requires further investigation. Supplementary Information The online version contains supplementary material available at 10.1007/s11356-021-15940-w.

Airborne grass (Poaceae) pollen measurements are used in public warning systems to inform people about the risk of allergic symptoms. However, there is no consensus about which exact thresholds of pollen concentrations provoke the allergic symptoms. The aim of this study was to review the relevant scientific information on the relationship between grass pollen concentrations and the occurrence of emergency department (ED) visits, hospital admissions (HA), drug consumption and allergic symptoms. Literature search was conducted by experts’ consultation and snowball strategy. Studies meeting the criteria for inclusion were assessed regarding their risk of bias (RoB). A high RoB resulted in exclusion of the study from data synthesis. Extensive data were extracted and qualitatively compared. The review is registered in PROSPERO. 32 Studies were eligible while 18 showed a low RoB and were qualitatively synthesised. Emergency department visits and hospital admissions were mostly investigated. Threshold values of 10 grains/m3 and 12 grains/m3 were reported for ED visits and HA. Evidence exists that an increase of 10 grains/m3 of air leads to a significant increase in adverse health outcomes. Especially at a three-day lag, adverse health effects were shown. Variations in exposure and outcome measurement make the definition of pollen thresholds difficult. As a consequence, no defined pollen threshold values could be identified. Studies with uniform exposure measures and statistical methods are necessary to gain a better understanding of the impact of grass pollen on human health. Determining personal thresholds could be beneficial for affected people.

People in artisanal and small-scale gold mining (ASGM) areas are frequently exposed to high levels of mercury (Hg). Hg analyses in urine and whole blood are the gold standard of biomonitoring, although this may not provide sufficient information about the source of exposure, e.g., due to the use of Hg for gold extraction or due to nutrition. To evaluate, whether the pharmacokinetic properties of individual Hg species may be useful for exposure assessment, we determined the Hg levels in different blood components from 199 participants. Therefore, whole blood was centrifuged on-site to yield erythrocytes and plasma. Globin was isolated from the erythrocytes by precipitation with ethyl acetate. Albumin was isolated from plasma by gradual precipitation with saturated ammonium sulfate solution. Hg levels in all samples were determined by using a direct Hg analyzer. Median Hg levels for whole blood, erythrocytes, and plasma were 2.7, 3.7, and 1.3 μg/l, respectively. In globin and albumin, median Hg levels were 10.3 and 7.9 μg/kg, respectively. The distribution of Hg was strongly correlated with whole blood Hg levels (p < 0.01) and the time between the last use of Hg and the date of the participation (p < 0.01). The results suggest that the distribution of Hg in blood is substantially affected by the extent and the frequency of the exposure to elemental Hg. Therefore, the analysis of Hg in erythrocytes and plasma may be a valuable tool for Hg exposure assessment in ASGM areas. Supplementary Information The online version contains supplementary material available at 10.1007/s12011-021-02714-1.

Mercury (Hg) is a global pollutant and a danger to human health. Human biomonitoring of Hg using a dried blood matrix instead of venous blood sampling for exposure assessment is of growing interest. This study aims to develop, validate, and evaluate the application of volumetric absorptive microsampling (VAMS) for Hg biomonitoring in humans. Sampling, drying, and storage conditions were evaluated during method development. Storage in pre-cleaned glass vials after drying for 2 h in a desiccator ensured analyte stability for at least 4 weeks. Sixty-eight paired capillary VAMS and venous blood samples from volunteers in Munich, Germany, were used for method validation. Hg levels in VAMS and venous blood samples were determined by direct mercury analysis. The limits of detection and quantitation for VAMS were 0.18 and 0.61 µg/l, respectively. However, sensitivity could be improved by using two microsamples for analysis instead of one. Hg levels in VAMS samples correlated very well with Hg levels in venous blood samples (R2 = 0.958). Furthermore, VAMS showed a high accuracy (median recovery: 117%) and precision (median relative standard deviation: 8.7%), especially for Hg concentrations above 1.0 µg/l. In fact, accuracy and precision of VAMS improved with increasing Hg concentrations. In conclusion, VAMS in combination with direct mercury analysis is an accurate and viable alternative for human biomonitoring of Hg. Graphical abstract

The Lancet Commission on pollution and health reported that pollution was responsible for 9 million premature deaths in 2015, making it the world's largest environmental risk factor for disease and premature death. We have now updated this estimate using data from the Global Burden of Diseases, Injuriaes, and Risk Factors Study 2019. We find that pollution remains responsible for approximately 9 million deaths per year, corresponding to one in six deaths worldwide. Reductions have occurred in the number of deaths attributable to the types of pollution associated with extreme poverty. However, these reductions in deaths from household air pollution and water pollution are offset by increased deaths attributable to ambient air pollution and toxic chemical pollution (ie, lead). Deaths from these modern pollution risk factors, which are the unintended consequence of industrialisation and urbanisation, have risen by 7% since 2015 and by over 66% since 2000. Despite ongoing efforts by UN agencies, committed groups, committed individuals, and some national governments (mostly in high-income countries), little real progress against pollution can be identified overall, particularly in the low-income and middle-income countries, where pollution is most severe. Urgent attention is needed to control pollution and prevent pollution-related disease, with an emphasis on air pollution and lead poisoning, and a stronger focus on hazardous chemical pollution. Pollution, climate change, and biodiversity loss are closely linked. Successful control of these conjoined threats requires a globally supported, formal science-policy interface to inform intervention, influence research, and guide funding. Pollution has typically been viewed as a local issue to be addressed through subnational and national regulation or, occasionally, using regional policy in higher-income countries. Now, however, it is increasingly clear that pollution is a planetary threat, and that its drivers, its dispersion, and its effects on health transcend local boundaries and demand a global response. Global action on all major modern pollutants is needed. Global efforts can synergise with other global environmental policy programmes, especially as a large-scale, rapid transition away from all fossil fuels to clean, renewable energy is an effective strategy for preventing pollution while also slowing down climate change, and thus achieves a double benefit for planetary health.

Zusammenfassung Aufgrund des Klimawandels lässt sich in Deutschland bereits eine (spürbare) Steigerung von Anzahl, Dauer und Intensität von Hitzeperioden beobachten, mit Auswirkungen auf die menschliche Gesundheit, insbesondere älterer und pflegebedürftiger Personen. Das Klinikum der Universität München entwickelt Anpassungsstrategien an den Klimawandel zum Schutz der Gesundheit und in diesem Rahmen Bildungsmodule für Gesundheitsberufe sowie einen Hitzemaßnahmenplan für vollstationäre Einrichtungen der Altenpflege.

Background: Children are among the most vulnerable to suffer from health consequences due to climate change. Parents as caregivers play an important role in protecting them adequately. Pediatricians are regularly seen as highly-trusted health professionals, but it remains unclear whether they are an information source for parents regarding climate change and health. According to the Health Action Process Approach, parents’ risk perception is an important pre-intender for intention building. Methods: A sample of parents (N = 243) living in Germany completed an online, cross-sectional survey distributed in summer 2020. Regarding climate change and health, we asked about information sources, relevance estimation, and risk perception of parents. Multiple linear regression with general and individual risk perception as outcomes were used to analyze the effect of knowledge and personal relevance. Results: Parents seek information about climate change and health primarily via internet and social media. Pediatricians are rarely considered as suitable information source. Parents see the highest risk for their child through increasing air pollutants and stronger UV-radiation. Relevance (β = .52, t = 5.79, p < .001) and knowledge (β = .02, t = .36, p = .72) explain 18.2% of general risk perception (F(5, 208) = 9.25, p < .001, ΔR2 = .13). The effect is lower (13%) for individual risk perception (F(5, 189) = 5.67, p < .001, ΔR2 = .07). Conclusions: Pediatricians can play a valuable role in informing parents about climate change and health; nevertheless, they are not yet seen as suitable information sources by parents. Results demonstrate that knowledge about climate change and health is not sufficient to increase risk perception of parents, but strengthening risk perception is possible through rising relevance estimation. When informing parents about the expected health impact of climate change, this should be considered.

Background: Children and adolescents are considered to be particularly vulnerable to the psychological effects of climate change, such as extreme weather events. What are the protective factors and stressors for the mental health of the young population after extreme weather events in Germany? Methods: Nine semi-structured interviews with representatives of occupational groups providing care to children, adolescents, and political stakeholders were conducted in Simbach am Inn, a German town affected by flooding in 2016. The interviews were analyzed using qualitative content analysis according to Mayring. Results: The interviews show that the parents’ dealing with what they had experienced and the concern for their relatives were the most influential stressors for children and adolescents. As protective factors, they felt that conversations with familiar people and restoring a certain “normality” were particularly important. The interviewees described both, the time of the flooding, and the time after the initial state of shock had subsided, as particularly stressful. Consequently, the experts reported on children and adolescents acutely complaining of fear, helplessness, and extreme tension. Nevertheless, the demand for psychological care increased only slightly after the flooding in Simbach am Inn. Conclusion: The social environment of children and adolescents is essential for their psychological well-being after an extreme weather event. Research, especially on children and adolescents who have already been affected, must increase in order to be able to describe influencing factors even more precisely, to protect individuals from adverse mental health effects, and to identify healthcare requirements.

BACKGROUND Allergic diseases pose a health problem worldwide. Pollen are widespread aeroallergens which can cause symptoms like shortness of breath, cough, itchy eyes, or rhinitis. Apart from preventive measures and pharmacological treatment, also non-pharmacological interventions have been suggested to reduce symptoms. The objective of this work was to review studies investigating the effectiveness of non-pharmacologic interventions to reduce allergic symptoms. METHODS PubMed, EMBASE, and CENTRAL were systematically reviewed in July 2018 and April 2020. Several authors worked on the screening of titles, abstracts, and full texts. One author for each literature search performed the data extraction and the risk of bias assessment. Studies were included if they met the inclusion criteria defined by the PECOs. Studies which investigating the effect of non-pharmacologic interventions on patients with allergic rhinitis were included. RESULTS Twenty-nine studies investigating eleven types of non-pharmacologic interventions to avoid and reduce allergic symptoms due to pollen exposure were included in this review. Out of all studies, seven studies addressed nasal rinsing and 22 included acupuncture, air filtering, artisanal tears, individual allergen avoidance advice, various nasal applications, self-hypnosis, rhinophototherapy, and wraparound sunglasses. CONCLUSION Most studies had a high risk of bias and small sample sizes. There were only a few high-quality studies that give hints about the effectiveness of non-pharmacological interventions. For future research, more high-quality studies are required to confirm the effectiveness of simple, safe, and cost-effective interventions.

Background Bisphenol A (BPA) is an industrial chemical mostly used in the manufacture of plastics, resins and thermal paper. Several studies have reported adverse health effects with BPA exposures, namely metabolic disorders and altered neurodevelopment in children, among others. The aim of this study was to explore BPA exposure, its socio-demographic and life-style related determinants, and its association with neurodevelopmental outcomes in early school age children from Poland. Methods A total of 250 urine samples of 7 year-old children from the Polish Mother and Child Cohort Study (REPRO_PL) were analyzed for BPA concentrations using high performance liquid chromatography with online sample clean-up coupled to tandem mass spectrometry (online-SPE-LC-MS/MS). Socio-demographic and lifestyle-related data was collected by questionnaires or additional biomarker measurements. Emotional and behavioral symptoms in children were assessed using mother-reported Strengths and Difficulties Questionnaire (SDQ). Cognitive and psychomotor development was evaluated by Polish adaptation of the Intelligence and Development Scales (IDS) performed by trained psychologists. Results Urinary BPA concentrations and back-calculated daily intakes (medians of 1.8 μg/l and 46.3 ng/kg bw/day, respectively) were similar to other European studies. Urinary cotinine levels and body mass index, together with maternal educational level and socio-economic status, were the main determinants of BPA levels in Polish children. After adjusting for confounding factors, BPA has been found to be positively associated with emotional symptoms (β: 0.14, 95% CI: 0.022; 0.27). Cognitive and psychomotor development were not found to be related to BPA levels. Conclusions This study represents the first report of BPA levels and their determinants in school age children in Poland. The exposure level was found to be related to child emotional condition, which can have long-term consequences including social functioning and scholastic achievements. Further monitoring of this population in terms of overall chemical exposure is required.

Venous blood is a preferred matrix for the determination of total mercury (Hg) in human biomonitoring but has some drawbacks such as the requirement for an uninterrupted cold chain for transport and storage and the need of medical personnel for sample collection. Therefore, we tested and implemented a simpler and less expensive method for measuring Hg in human blood using dried blood spots (DBS). For method development, we investigated the influence of different storage conditions (temperature, storage vessel, time) on DBS samples. For method validation, we compared DBS and venous blood and investigated whether DBS sampling is suitable for measuring Hg in the general population in countries with low Hg exposure such as Germany. Based on our results, we found that pre-cleaned glass tubes were most suitable for storage of DBS samples, as this allowed the samples to remain stable for at least 4 weeks even at high temperatures (40 °C). When comparing venous blood and DBS, a very good correlation (r = 0.95, p

We report the severe mercury poisoning of a 4-year-old child by a so far unknown route of exposure, namely, by skin-to-skin contact. The child was admitted to the hospital with episodic pain in his extremities, tachycardia, hypertension, increased sweating, behavioral changes and weight loss. Extensive examinations eventually revealed an acute mercury poisoning. The initial mercury levels were 19 µg/L in urine (reference level 0.4 µg/L) and 37 µg/L in blood (reference level 0.8 µg/L). A facial cream bought online, containing approximately 18% mercury, was identified as the primary source of intoxication. The symptoms improved after disposal of the cream and chelation therapy. Further analyses, home visits and interviews suggested that the child was accidently intoxicated by skin-to-skin contact with the mother, although other routes of exposure such as dust ingestion and surface-to-skin contact cannot be excluded. The mercury levels in urine and blood samples of the child and other family members as well as in domestic dust samples decreased considerably over time.

Hitzeperioden werden aufgrund des Klimawandels zunehmen und stellen insbesondere fur altere Menschen ein hohes gesundheitliches Risiko dar. Verstarkende Risikofaktoren, wie Immobilitat, Pflegebedurftigkeit, chronische und akute Erkrankungen sowie Medikamenteneinnahme fuhren dazu, dass diese Altersgruppe besonders sensibel auf Hitze reagiert. Pflegefachkrafte und beim Hausarzt tatige medizinische Fachangestellte sind zwei Berufsgruppen, die altere, pflegebedurftige Menschen in Hitzeperioden zu Hause praventiv und kurativ versorgen konnen. Um beide Berufsgruppen fur die Thematik zu sensibilisieren und zu befahigen, auf Hitzeereignisse adaquat zu reagieren, wurde im Rahmen eines 2‑jahrigen Projektes am Klinikum der Universitat Munchen ein interprofessionelles Blended-Learning-Angebot entwickelt. Dieses kombiniert eigenstandiges Lernen mittels online verfugbarer Videos und Prasentationen und die konkrete Wissensanwendung an Fallbeispielen in einer Prasenzphase. Das Konzept, die Ergebnisse und Schlussfolgerungen des im Oktober 2018 abgeschlossenen Projektes werden in diesem Beitrag vorgestellt. Bildungsangebote sind Teil der Anpassung an Hitzeereignisse. In den „Handlungsempfehlungen fur die Erstellung von Hitzeaktionsplanen zum Schutz der menschlichen Gesundheit“ wird festgestellt, dass „Fort- und Weiterbildung von Beschaftigten im Gesundheits- und Sozialwesen dazu beitragen, wichtige Inhalte zum adaquaten Handeln wahrend Hitzeperioden zu vermitteln.“ Dieser Forderung wird mit dem entwickelten Bildungsangebot entsprochen. Um einen moglichst breiten Einsatz zu ermoglichen, stehen die Schulungsmaterialien kostenfrei zur Verfugung. Diese konnen auf der Seite www.klimawandelundbildung.de heruntergeladen werden.

Im Zuge des Klimawandels ist in Deutschland eine Zunahme von meteorologischen Extremwetterereignissen (EWE), wie Starkniederschlag und Uberschwemmungen, zu beobachten. Schwerwiegende EWE konnen starke Angste hervorrufen und traumatische Erlebnisse darstellen. Diese Traumata und anhaltender Stress im langeren Verlauf nach dem Ereignis konnen Ursache fur negative psychische Gesundheitsauswirkungen sein. Kinder und Jugendliche gelten als vulnerable Gruppe, da ihnen weniger Bewaltigungsstrategien als Erwachsenen zur Verfugung stehen und sie stark von ihrer Umwelt abhangig sind. Der vorliegende narrative Ubersichtsbeitrag soll die Pravalenzen von psychischen Erkrankungen nach einem EWE und die in diesem Zusammenhang stehenden Risikofaktoren zusammenfassen, um aussagekraftige Ruckschlusse auf die psychische Gesundheit von Kindern und Jugendlichen in Deutschland ziehen zu konnen. Dafur wurde die vorhandene Literatur aus der WHO-Region Europa sowie aus Landern mit einem ahnlichen Einkommensniveau (u. a. Kanada, Australien, USA) berucksichtigt. Da Uberschwemmungen und Starkniederschlag in Deutschland die am haufigsten auftretenden EWE sind, wurde auf diese der Schwerpunkt gelegt. Nach EWE ist ein Anstieg von Angststorungen, depressiven Symptomen, posttraumatischem Belastungsstress und Verhaltensstorungen bei Kindern und Jugendlichen zu beobachten. Die Literatur gibt jedoch wenig Aufschluss daruber, wie hoch die Pravalenz solcher psychischen Gesundheitseffekte infolge von EWE und deren Auswirkungen ist und welche Risikofaktoren dabei von Bedeutung sind. Es gibt somit international und insbesondere in Deutschland noch erheblichen Forschungsbedarf.

Artisanal and small-scale gold mining (ASGM) employs 14–19 million people globally. There is limited research on accidents, injuries, and safety in Zimbabwe’s ASGM. This study investigates the prevalence of accidents and injuries, as well as the associated risks and existing safety practices. A cross-sectional survey was conducted among artisanal and small-scale gold miners. Data from 401 participants were analyzed using descriptive statistics and regression analysis. The prevalence of accidents and injuries was 35.0% and 25.7%. Accidents associated with experiencing injuries included mine collapses and underground trappings. The major injury risk factors were digging, blasting, being male, being 18–35 years old, crushing, and the underground transportation of workers and materials. Injuries were reported highest among the miners working 16 to 24 h per day. Participants had heard about personal protective equipment (PPE). There was training and routine inspections mainly on PPE use. Mine owners and supervisors were reported as responsible for OSH, which was mainly PPE use. Practices including the use of wire winch ropes and escape routes were rare. There was ignorance on underground mine shaft support. The mining regulations that had the potential to introduce comprehensive safety controls were not adaptable. We recommend applicable health and safety regulations for Zimbabwe’s ASGM.

Objectives: Our aim was to identify if working during hot days while wearing Covid-19 related personal protective equipment causes occupational heat stress for nurses and nursing assistants in Germany. Design: Using an online survey, we assessed the impact of hot weather on nurses and nursing assistants working with personal protective equipment. Respondents were recruited by distributing the link to the survey via personal communication, email and various social media channels to nursing staff from hospitals, nursing homes and outpatient care. Results: There were in total 428 participants (18.2% male, 82.5% female), mostly (30.5%) aged between 45 and 55 years. Half of respondents (48.3%) had more than 20 years of experience in nursing. Cardiac, pulmonary, or other pre-existing conditions were reported by 46.2%.Nurses and nursing assistants working in personal protective equipment during hot days were exposed to occupational heat stress. Work was found exhaustive by 96.5% of the participants during those days. 93.0% reported breathing problems and 85.8% reported difficulties with focusing on their work. Many workplaces did not provide adequate heat protection, with distinct differences concerning the amount of prophylactic and heat mitigating measures across institutions. There were significant differences across institutions when it comes to the number of drinks served (p

The COVID-19 pandemic started in the cold months of the year 2020 in the Northern hemisphere. Concerns were raised that the hot season may lead to additional problems as some typical interventions to prevent heat-related illness could potentially conflict with precautions to reduce coronavirus transmission. Therefore, an international research team organized by the Global Health Heat Information Network generated an inventory of the specific concerns about this nexus and began to address the issues. Three key thermal and covid-19 related topics were highlighted: 1) For the general public, going to public cool areas in the hot season interferes with the recommendation to stay at home to reduce the spread of the virus. Conflicting advice makes it necessary to revise national heat plans and alert policymakers of this forecasted issue. 2) For medical personnel working in hot conditions, heat strain is exacerbated due to a reduction in heat loss from wearing personal protective equipment to prevent contamination. To avoid heat-related injuries, medical personnel are recommended to precool and to minimize the increase in body core temperature using adopted work/rest schedules, specific clothing systems, and by drinking cold fluids. 3) Fever, one of the main symptoms of COVID-19, may be difficult to distinguish from heat-induced hyperthermia and a resting period may be necessary prior to measurement to avoid misinterpretation. In summary, heat in combination with the COVID-19 pandemic leads to additional problems; the impact of which can be reduced by revising heat plans and implementing special measures attentive to these compound risks.

ObjectivesOur aim was to identify whether working during hot days alongside with Covid-19 related personal protective equipment causes heat stress for nursing professionals in Germany.MethodsUsing an online survey, we assessed the impact of hot weather on nursing staff performing in personal protective equipment. A random selection of nursing staff from hospitals, nursing homes and outpatient care participated in the survey.ResultsOut of 428 participants, 6.3% were between 16 and 25 years old, 22.8% between 26 and 35 years, 21.9% between 36 and 45 years, 30.5% between 45 and 55 years, 18.2% between 56 and 65 years, and 0.3% were older than 65 years. Out of all participants, 18.2% were male and 82.5% female. The results of the survey showed that 48.3% had more than 20 years of experience in nursing and 46.2% cardiac, pulmonary, or other pre-existing conditions. Work was found exhaustive while working in PPE by 96.5% of the participants, and 93% complained of worse breathing. We found out that 85.8% reported difficulties to focus. Many workplaces turned out to lack adequate heat protection, with distinct differences concerning the amount of prophylactic and heat mitigating measures across institutions.ConclusionsOur results clearly show that employers must make more of an effort to provide adequate heat protection for their nursing staff. In order to secure the public health care, there is a need for action, especially in the case of previous conditions of caregivers.What is already known about this subject?►Working in personal protective equipment is often needed during pandemics, to protect nurses, doctors and staff from an infection.►However, the equipment can also hamper efficiency and productivity of healthcare workers and lead to personal discomfort, for example, during heat waves.What are the new findings?►According to our study, nurses and nursing assistants in Germany are often older than 45 years and, in many cases, suffer from pre-existing conditions, which exacerbate the problems with personal protective equipment during periods of hot temperatures.►Many healthcare institutions do not offer adequate ways to mitigate heat stress for their staff.How might this impact on policy or clinical practice in the foreseeable future?►The results from this study can inform policy makers and clinical practitioners to modify their protocols to include better protective measures during extreme heat or other adverse environmental conditions.

Sleep disturbances caused by noise exposure are the most relevant outcome measured in disability adjusted life years (DALYs). In analogy to the combined effects of noise from multiple sources on annoyance, these are also of interest for sleep disorders. The study “Overall Noise Assessment” Innsbruck examined data from 1031 personal interviews. Aircraft, rail and road noise were correlated. To choose participants combined exposures were clustered into small, medium and severely affected living situations. The effect of demographic features, noise sensitivity, access to a silent façade and other factors on self-reported sleep disturbances was investigated applying bivariate analyses. Exposure-response curves and their 95% confidence intervals with cut-off values of 72% for “highly disturbed sleep” were generated and the results were discussed in comparison to recently published curves. Using source-specific exposure-response relationships, an overall model for evaluating sleep disorders was developed based on the “annoyance equivalents model”. The “total sleep disturbance response” shows an accumulative outcome for each source measured. A protective effect of road traffic noise as background noise for air and railroad sources could not be proven. Both the “Total Sleep Disruption Assessment Model” and the “Dominant Source Model” have a Spearman-Rho of 0.3 and are therefore suitable for use in noise assessment.

Background: In Indonesia, many occupations and industries involve a variety of hazardous and toxic materials. The ILO estimates that about 21.1% of the tracheal, bronchial, and lung cancer deaths among men were attributable to workplace hazardous substances. This study investigated the relationship between occupations or workplace exposure and the risk of lung cancer in the country. The results will help determine how Indonesia can best mitigate the risk for its workers. Objectives: This case-control study utilizes the Indonesian Standard of Industrial Classification (IndSIC) 2015 with the aim of exploring the risk of lung cancer among Indonesian workers. Methods: The study included patients aged 35 years old or older receiving thoracic CT at the radiology department of Persahabatan Hospital. The cases were histological confirmed primary lung cancers, while the controls were negative thoracic CT scan for lung cancer. The subjects’ job titles and industries were classified according to IndSIC 2015 and blind to the patient’s grouping as a case or control. Logistic regression was used to determine the odds ratios for lung cancer among all sections and some divisions or groups of IndSIC 2015. Findings:The mean age was 58.1 (±10.23) years for lung cancer patients and 54.5 (±10.23) years for controls. The majority of subjects (19.6%) worked in Section G (Wholesale and retail trade; repair of motor vehicles and motorcycle). After adjusting for age, gender, level of education, and smoking habit, the risk of lung cancer was nearly three-times higher (OR = 2.8, 95% CI = 1.11–7.02) in workers of Division A01 (crop, animal production, and hunting) and two-times higher (OR = 1.9, 95% CI = 1.05–3.46) in workers of Section F (construction) compared to the workers in other sections or divisions. Conclusions: The excess risk of lung cancer among certain categories of workers confirms the need for improved policy, monitoring, and control of occupational exposure for primary cancer prevention and workers’ compensation purposes.

Background The role of artisanal and small-scale gold mining (ASGM) as a source of income is rapidly gaining importance in the economically difficult times in Zimbabwe. Small-scale miners are now responsible for over 50% of the Zimbabwean gold production. However, the sector is still characterised by high labour-intensity, low productivity and capital, limited mechanisation and outdated technologies. Since increasing efforts in recent years to improve miners’ health while reducing the exposure to mercury have not been effective, a more sustainable approach is needed to identify interventions targeting the health of artisanal and small-scale miners and the mining communities. Objective The main objective of this study was the accurate and extensive empirical identification of the determinants of health in ASGM and of the miners’ health needs. In tandem with these needs, topics which generate more effective, sustainable, and feasible future health interventions targeting occupational health should be identified. Methods Based on the identification of determinants of health, a health needs assessment (HNA) was used to conduct miners’ needs by applying a mixed methods approach and triangulation. This included qualitative and quantitative interviews with individuals, group interviews, focus group discussions, observations and informal conversations. Results There were 85 structured and 84 semi-structured interviews, a focus group discussion, and observations conducted. Six main themes were identified around which miners’ health needs can be aggregated as follows: living conditions, nutrition and hygiene; safe work environment and mining processes; financial support; health care services; formalisation and education. Discussion The following aspects were considered most important for sustainable interventions: possible health impacts, feasibility, value for miners and their willingness to adapt. Accordingly, interventions aiming at increasing education, knowledge and awareness of miners were identified as most promising in improving occupational health.

A 4-yr old patient was admitted to the hospital with pain attacks in his extremities, tachycardia, hypertension, increased sweating, behavioral changes and weight loss. Extensive examinations eventually revealed an acute mercury poisoning. The mercury levels in blood and urine were 36.7 µg/l and 90 µg/g creatinine, respectively. A facial cream bought online, containing approximately 18 % mercury, was identified as the primary source of intoxication. The symptoms improved after disposal of the cream and chelation therapy. Biomonitoring of the mother and the brother, who remained asymptomatic, indicated an increased exposure to mercury, too. The mother, who had been using the cream for approximately three months, denied its application on her children. Further analyses, home visits and interviews suggested that the child was accidently intoxicated by skin-to-skin contact with the mother. Other mercury sources were excluded and mercury levels decreased considerably over time. The family will be closely monitored to exclude any long-term health issues. Lessons learnt from this case of an acute mercury intoxication is that even skin to skin contact with a mercury containing cream can have significant negative health effects for a child.

BackgroundCommunities around Kabwe/Zambia are exposed to lead due to deposits from an old lead (Pb) and zinc (Zn) mining site. Children are particularly more vulnerable than adults, presenting with greatest risk of health complications because of their increased oral uptake due to their hand to mouth activities. Spatial analysis of childhood lead exposure is useful in identifying specific areas with highest risk of pollution. The objective of the current study was to use a geospatial approach investigate spatial clustering and hotspots of blood lead levels in children within Kabwe.MethodsWe analysed data on blood lead levels (BLL) for 363 children below the age of 15 from Kabwe town. We used spatial autocorrelation methods involving the global Moran’s I and local Getis-Ord Gi*statistic in ArcMap 10.5.1, to test for spatial dependency among the blood lead levels in children.ResultsBLL in children from Kabwe are spatially autocorrelated with a Moran’s Index of 0.62 (pConclusionUsing geocoded data, we found clustering of childhood blood lead and identified distinct hot spot areas with particular high lead levels for Kabwe town. The geospatial approach used is especially valuable in resource-constrained settings like Zambia, where the precise identification of the locations of risk areas allows to initiate targeted remedial and treatment programs.