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Objective: Occupational and environmental medicine (OEM) clinicians require specialized electronic health records (EHRs) to address the privacy, data governance, interoperability, and medical surveillance concerns that are specific to occupational health., Methods: The American College of Occupational and Environmental Medicine (ACOEM) Section of Health Informatics evaluated clinical workflow concerns, assessed health information requirements, and developed informatics recommendations through iterative consultation with ACOEM members., Results: The ACOEM presents 10 recommendations that specialized occupational EHR systems (OEHRs) should meet to serve the information needs and practice requirements of OEM clinicians. Common challenges in OEM practice and potential informatics solutions are used to illustrate each recommendation., Conclusions: The recommendations serve as a framework for occupational health clinicians to consider in their adoption of OEHRs and provide software engineers a set of requirements to facilitate the development and improvement of OEHRs., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 American College of Occupational and Environmental Medicine.)

Background: Identifying and recognizing environmental risk factors for childhood cancer is crucial to prevent it. Medical guild are the first contact to monitor children's health. Therefore, courses about the contribution of chemical toxins in the environment and health outcomes such as cancer should be included in their professional training. This study aimed to evaluate the perceptions and attitudes of a medical guild and undergraduate students in health sciences about the contribution of the environment to childhood cancer., Methods: A pilot study was conducted, an online survey including thirteen questions was shared among medical guild members and undergraduate students in health sciences. Frequencies, percentages, and chi-square homogeneity tests were calculated to compare groups., Results: Genetic factors ranked as the first possible cause of childhood cancer (88.2% medical guild and 97.7% undergraduate students). However, 70.6% of medical guild and 64.6% of undergraduate students reported that they have ever suspected that childhood cancer could be related to the environmental conditions in which children live. More than 95% of the participants reported that they would find it useful to have more knowledge about environmental risks and cancer. When data were analyzed by profession (medical guild) and academic year (undergraduate students), no significant differences were observed. Nonetheless, comparisons by academic discipline between undergraduate students, showed that a higher percentage of medicine and environmental sciences and health (over 98%) reported environmental exposure as risk factors associated with childhood cancer compared to 75% from physiotherapy, (p = 0.001)., Conclusions: In this study, the environmental contribution to childhood cancer is not clear among the medical guild and undergraduate students. They should be trained on the topic of cancer and the environment., (© 2024. The Author(s).)

Founded in 1947 as the Institute of Industrial Medicine, the Nelson Institute and Department of Environmental Medicine at New York University (NYU) Grossman School of Medicine (NYUGSOM) was supported by a National Institute of Environmental Health Science (NIEHS) Center Grant for over 56 years. Nelson Institute researchers generated 75 years of impactful research in environmental and occupational health, radiation effects, toxicology, and cancer. Environmental health research is continuing at NYUGSOM in its departments of medicine and population health. The objective of this historical commentary is to highlight the major achievements of the Nelson Institute and the department in the context of its history at facilities in Sterling Forest, Tuxedo, NY and Manhattan, NY. Aspects of our discussion include leadership, physical facilities, and research in many areas, including air pollution, health effects of environmental radiation exposures, inhalation toxicology methodology, carcinogenesis by chemicals, metals, and hormones, cancer chemoprevention, human microbiome, ecotoxicology, epidemiology, biostatistics, and community health concerns. The research of the institute and department benefited from unique facilities, strong leadership focused on team-based science, and outstanding investigators, students, and staff. A major lasting contribution has been the training of hundreds of graduate students and postdoctoral fellows, many of whom have been and are training the next generation of environmental and occupational health researchers at various institutions., (© 2024 The Author(s). Annals of the New York Academy of Sciences published by Wiley Periodicals LLC on behalf of The New York Academy of Sciences.)

We describe a case of severe accidental hypothermia of a kayaker with preserved consciousness and shivering despite a rectal temperature of 22.9°C following a 50-min immersion in 3°C water with an estimated core temperature cooling rate of 10.6°C/h. Based on survival at sea prediction curves and cooling rates from physiology studies, cold water (eg, 0-5°C) immersion is expected to drop core temperature by 2 to 4°C/h. Furthermore, accidental hypothermia classification systems predict that severely hypothermic patients are usually unconscious and not shivering. The patient in this report rewarmed rapidly at 3.6°C/h with only minimally invasive measures and was discharged fully neurologically intact. In 41 similar cases of survival in moderate to severe hypothermia with core temperatures <32°C due to cold water immersion, cold air exposure, or avalanche burial, mean cooling rates were 4.3±3.3°C/h (range 0.4-10.6°C/h). Including the current patient, shivering was reported in only four cases. We found several other cases of rewarming from moderate to severe hypothermia with only minimally invasive measures. The current and summarized cases lead us to conclude that patients may be at risk of severe hypothermia in <60 min of cold water immersion and that it is possible for severely hypothermic patients to have preserved consciousness, close to normal vital signs, and shivering. Minimally invasive or noninvasive rewarming of patients with severe hypothermia is also possible, especially in those who continue to shiver. Hypothermia management should not necessarily be guided by classification systems or core temperature alone but rather by a careful consideration of the entire clinical picture.

The prevalence of autism has been increasing at an alarming rate. Even accounting for the expansion of autism spectrum disorder diagnostic (ASD) criteria throughout the 1990's, there has been an over 300% increase in ASD prevalence since the year 2000. The often debilitating personal, familial, and societal sequelae of autism are generally believed to be lifelong. However, there have been several encouraging case reports demonstrating the reversal of autism diagnoses, with a therapeutic focus on addressing the environmental and modifiable lifestyle factors believed to be largely underlying the condition. This case report describes the reversal of autism symptoms among dizygotic, female twin toddlers and provides a review of related literature describing associations between modifiable lifestyle factors, environmental exposures, and various clinical approaches to treating autism. The twins were diagnosed with Level 3 severity ASD "requiring very substantial support" at approximately 20 months of age following concerns of limited verbal and non-verbal communication, repetitive behaviors, rigidity around transitions, and extensive gastrointestinal symptoms, among other common symptoms. A parent-driven, multidisciplinary, therapeutic intervention involving a variety of licensed clinicians focusing primarily on addressing environmental and modifiable lifestyle factors was personalized to each of the twin's symptoms, labs, and other outcome measures. Dramatic improvements were noted within several months in most domains of the twins' symptoms, which manifested in reductions of Autism Treatment Evaluation Checklist (ATEC) scores from 76 to 32 in one of the twins and from 43 to 4 in the other twin. The improvement in symptoms and ATEC scores has remained relatively stable for six months at last assessment. While prospective studies are required, this case offers further encouraging evidence of ASD reversal through a personalized, multidisciplinary approach focusing predominantly on addressing modifiable environmental and lifestyle risk factors., Competing Interests: The authors declare no conflicts of interest.

Aim: Hypothermia is associated with poor prognosis in patients with sepsis. However, no studies have explored the correlation between the severity of hypothermia and prognosis., Methods: Using data from the Japanese accidental hypothermia network registry (J-Point registry), we examined adult patients aged ≥18 years with infectious diseases whose initial body temperature was ≤35°C from April 1, 2011 to March 31, 2016, in 12 centers. Patients were divided into three groups according to their body temperature: Tertile 1 (T1) (32.0-35.0°C), Tertile 2 (T2) (28.0-31.9°C), and Tertile 3 (T3) (<28.0°C). In-hospital mortality was employed as a metric to assess outcomes. We conducted a multivariate logistic regression analysis to investigate the relationship between the three categories and the occurrence of in-hospital mortality., Results: A total of 572 patients were registered, and 170 eligible patients were identified. Of these patients, 55 were in T1 (32.0-35.0°C), 76 in T2 (28.0-31.9°C), and 39 in T3 (<28.0°C) groups. The overall in-hospital mortality rate in accidental hypothermia (AH) patients with infectious diseases was 34.1%. The in-hospital mortality rates in the T1, T2, and T3 groups were 34.5%, 36.8%, and 28.2%, respectively. The multivariable analysis demonstrated no significant differences regarding in-hospital mortality among the three groups (T2 vs. T1, adjusted odds ratio [OR]: 1.29; 95% confidence interval [CI]: 0.58-2.89 and T3 vs. T1, adjusted OR: 0.83; 95% CI: 0.30-2.31)., Conclusion: In this multicenter retrospective observational study, hypothermia severity was not associated with in-hospital mortality in AH patients with infectious diseases., Competing Interests: YO has received a research grant from the ZOLL Foundation and overseas scholarships from the Japan Society for Promotion of Science, the FUKUDA Foundation for Medical Technology, and the International Medical Research Foundation. These organizations have no role in conducting this study., (© 2024 The Author(s). Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.)

Climate change is considered one of the greatest threats to humanity and the most significant global public health emergency of our lifetime. Millions of people from throughout the globe suffer and die each year from degraded air quality, extreme heat, water and vector-borne diseases as well as the mental health effects of climate change. Because clinicians are considered one of the most trusted sources of climate information, they have a unique opportunity to communicate the many health-related effects of climate change to their patients. It is important for clinicians to understand the most beneficial techniques to use when communicating with patients who may need more information regarding climate change and extreme weather events. These include 1) meeting patients where they are, 2) providing patient education, and 3) telling authentic stories. Developing and delivering effective communication strategies to our patients to prevent and prepare for climate-related health issues are paramount- if we are to make meaningful progress., Competing Interests: Conflict of interest: None., (© Copyright 2023 by the American Board of Family Medicine.)

The Wilderness Medical Society (WMS) convened an expert panel in 2011 to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat illness. The current panel retained 5 original members and welcomed 2 new members, all of whom collaborated remotely to provide an updated review of the classifications, pathophysiology, evidence-based guidelines for planning and preventive measures, and recommendations for field- and hospital-based therapeutic management of heat illness. These recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks or burdens for each modality. This is an updated version of the WMS clinical practice guidelines for the prevention and treatment of heat illness published in Wilderness & Environmental Medicine. 2019;30(4):S33-S46.

Rapidly advancing evidence documents that a broad array of synthetic chemicals found ubiquitously in the environment contribute to disease and disability across the lifespan. Although the early literature focused on early life exposures, endocrine-disrupting chemicals (EDCs) are now understood to contribute substantially to chronic disease in adulthood, especially metabolic, cardiovascular, and reproductive consequences as well as endocrine cancers. The contribution to mortality is substantial, with over 90,000 deaths annually and at least $39 billion/year in lost economic productivity in the United States (US) due to exposure to certain phthalates that are used as plasticizers in food packaging. Importantly, exposures are disproportionately high in low-income and minoritized populations, driving disparities in these conditions. Though non-Hispanic Blacks and Mexican Americans comprise 12.6% and 13.5% of the US population, they bear 16.5% and 14.6% of the disease burden due to EDCs, respectively. Many of these exposures can be modified through safe and simple behavioral changes supported by proactive government action to both limit known hazardous exposures and to proactively screen new industrial chemicals prior to their use. Routine healthcare maintenance should include guidance to reduce EDC exposures, and a recent report by the Institute of Medicine suggests that testing be conducted, particularly in populations heavily exposed to perfluoroalkyl substances-chemicals used in nonstick coatings as well as oil- and water-resistant clothing., (© 2023 The Association for the Publication of the Journal of Internal Medicine.)

Primary amebic meningoencephalitis (PAM) is a necrotizing and hemorrhagic inflammation of the brain and meninges caused by Naegleria fowleri, a free-living thermophilic ameba of freshwater systems. PAM remains a neglected disease that disproportionately affects children in tropical and subtropical climates, with an estimated mortality rate of 95-98%. Due to anthropogenic climate change, the average temperature in the USA has increased by 0.72 to 1.06 °C in the last century, promoting the poleward spread of N. fowleri. PAM is often misdiagnosed as bacterial meningitis or viral encephalitis, which shortens the window for potentially life-saving treatment. Diagnosis relies on the patient's history of freshwater exposure and the physician's high index of suspicion, supported by cerebrospinal fluid studies. While no experimental trials have been conducted to assess the relative efficacy of treatment regimens, anti-amebic therapy with adjunctive neuroprotection is standard treatment in the USA. We performed a literature review and identified five patients from North America between 1962 and 2022 who survived PAM with various degrees of sequelae., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

People can be affected by various environmental factors (e. g., odor, noise) which can lead to medical complaints or illnesses. Few adequate contact points are available for patients with suspected environmental complaints in Germany. Illustrated by the outpatient clinics for environmental medicine in Hamburg and Munich, this report shows how patients with suspected environmental medical diseases are cared for in Germany. For the exemplary presentation, the data of the environmental medicine outpatient clinics of both the university hospitals from 01.01.2019 to 31.03.2021 are presented and compared. Overall, more female than male patients were treated at both facilities. Suspected exposure to "heavy metals" was most frequently mentioned by patients as the assumed reason for their complaints. Nonetheless, the suspected exposure or "intoxication" could be ruled out in the majority of cases by appropriate examination methods in accordance to current medical guidelines. The data provided by the environmental medicine outpatient clinics show that there is a continuous demand for environmental medical care. A close cooperation between the private practice sector and the outpatient clinics for environmental medicine providing medical care to patients should therefore be sought., Competing Interests: SH: Stellvertretende Leiterin des Landesinstitutes arbeits- und umweltbezogener Gesundheitsschutz und Produktsicherheit sowie Leiterin des Sachgebiets Arbeits- und umweltbezogener Gesundheitsschutz am Bayersichen Landesamt für Gesundheit und Lebensmittelsicherheit; Tätigkeit für das Institut und die Poliklinik für Arbeits-, Sozial- und Umweltmedizin am Klinikum der Universität München. CH: Mitglied der Amtsleitung des Bayerischen Landesamtes für Gesundheit und Lebensmittelsicherheit und dadurch entsprechend Kontakt mit Forschungsprojekten mit thematischem Bezug; Brückenprofessur Umweltbezogener Gesundheitsschutz Ludwig-Maximilians-Universität. DN: leitet eine universitäre umweltmedizinische Ambulanz für gesetztlich und privat Versicherte am Klinikum der Universität München., (Thieme. All rights reserved.)

Objective: The need to confront the obesity epidemic and its impact on employers requires a serious look at how we address the treatment of obesity. This article focuses on the core components of obesity care and the need for employers to offer a comprehensive obesity benefit (COB) as part of employee insurance coverage., Methods: In May 2022, the American College of Occupational and Environmental Medicine convened a roundtable meeting, which brought together five corporate medical directors and representatives from aerospace/defense and energy industries to learn about the disease of obesity and provide clinical insights regarding health and safety in their respective industries. The goals of the program were to provide awareness of benefits for the treatment of obesity and identify the feasibility for employers of implementing a COB for their employees. Participants learned how a comprehensive approach to covering obesity treatments is necessary, and what benefits should be offered to employees., Results: Participants were invited to review the insurance benefits they currently offer to employees and compare them to the COB. Outcomes were limited by a lack of participation by the employers invited to participate. Participants identified actions that need to be addressed for employers to develop a more comprehensive approach to obesity care., Conclusion: Implementing a COB can help employers increase access and utilization of comprehensive obesity care by employees., Competing Interests: Conflict of interest: C.G. reports funding from Novo Nordisk, Inc, Eli Lilly and Company, Pfizer, Currax Pharmaceuticals, and WW (Weight Watchers), (Copyright © 2023 American College of Occupational and Environmental Medicine.)

Competing Interests: Conflict of interest: B.A.B. is currently a board member of ABPM. J.L.L. is Senior advisor for Southwest Ag Center (NIOSH, 2 U54OH007541-21-00) as well as NIOSH COVID-19 IPA. He is currently a board member of ABPM and vice chair of Occupational and Environmental Medicine. H.O. is currently a board member of ABPM. J.D.M. received grant T42 OH008422 (New York/New Jersey Education and Research Center) from the National Institute for Occupational Safety and Health and honorarium as editor-in-chief of the American Journal of Industrial Medicine (John Wiley & Sons, publisher). He is currently a board member of ABPM. C.C. is a full-time employee of ACT. ABPM contracted with ACT, Inc, to provide the research services described in this article; the contract has concluded. W.E.B. is currently Board Chair of ABPM. All authors are members of the ABPM Board except Carla Caro who works for ACT Credentialing and Career Services.

The environmental impact on health is an inevitable by-product of human activity. Environmental health sciences is a multidisciplinary field addressing complex issues on how people are exposed to hazardous chemicals that can potentially affect adversely the health of present and future generations. Exposure sciences and environmental epidemiology are becoming increasingly data-driven and their efficiency and effectiveness can significantly improve by implementing the FAIR (findable, accessible, interoperable, reusable) principles for scientific data management and stewardship. This will enable data integration, interoperability and (re)use while also facilitating the use of new and powerful analytical tools such as artificial intelligence and machine learning in the benefit of public health policy, and research, development and innovation (RDI). Early research planning is critical to ensuring data is FAIR at the outset. This entails a well-informed and planned strategy concerning the identification of appropriate data and metadata to be gathered, along with established procedures for their collection, documentation, and management. Furthermore, suitable approaches must be implemented to evaluate and ensure the quality of the data. Therefore, the 'Europe Regional Chapter of the International Society of Exposure Science' (ISES Europe) human biomonitoring working group (ISES Europe HBM WG) proposes the development of a FAIR Environment and health registry (FAIREHR) (hereafter FAIREHR). FAIR Environment and health registry offers preregistration of studies on exposure sciences and environmental epidemiology using HBM (as a starting point) across all areas of environmental and occupational health globally. The registry is proposed to receive a dedicated web-based interface, to be electronically searchable and to be available to all relevant data providers, users and stakeholders. Planned Human biomonitoring studies would ideally be registered before formal recruitment of study participants. The resulting FAIREHR would contain public records of metadata such as study design, data management, an audit trail of major changes to planned methods, details of when the study will be completed, and links to resulting publications and data repositories when provided by the authors. The FAIREHR would function as an integrated platform designed to cater to the needs of scientists, companies, publishers, and policymakers by providing user-friendly features. The implementation of FAIREHR is expected to yield significant benefits in terms of enabling more effective utilization of human biomonitoring (HBM) data., Competing Interests: Author AP is employed by esqLABS GmbH. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Zare Jeddi, Galea, Viegas, Fantke, Louro, Theunis, Govarts, Denys, Fillol, Rambaud, Kolossa-Gehring, Santonen, van der Voet, Ghosh, Costa, Teixeira, Verhagen, Duca, Van Nieuwenhuyse, Jones, Sams, Sepai, Tranfo, Bakker, Palmen, van Klaveren, Scheepers, Paini, Canova, von Goetz, Katsonouri, Karakitsios, Sarigiannis, Bessems, Machera, Harrad and Hopf.)

In the 21st century, an accumulation of complex crises such as climate change, biodiversity loss, environmental pollution, wars, and pandemics is leading to economic, social, and health problems for people of current and future generations. These problems are essentially due to the disregard of natural regenerative capacities of ecosystems. Health approaches such as One Health and Planetary Health have gained popularity since the early 2000s and are increasingly used in politics, science, and the health professions. Environmental medicine is also influenced by the growing number of crises and environmental problems and the increasing interest in the concepts of One Health and Planetary Health.In this discussion paper, the development of the two concepts is first presented. Then, their significance for environmental medicine will be discussed. Health professionals working on environmental medicine issues must now consider both local and global causes and health effects when assessing environmental impacts, which can complicate decisions and lead to conflicting objectives., (© 2023. The Author(s).)

Evidence concerning PM 1 exposure, maternal blood pressure (BP), and hypertensive disorders of pregnancy (HDP) is sparse. We evaluated the associations using 105,063 participants from a nationwide cohort. PM 1 concentrations were evaluated using generalized additive model. BP was measured according to the American Heart Association recommendations. Generalized linear mixed models were used to assess the PM 1 -BP/HDP associations. Each 10 μg/m 3 higher first-trimester PM 1 was significantly associated with 1.696 mmHg and 1.056 mmHg higher first-trimester SBP and DBP, and with 11.4% higher odds for HDP, respectively. The above associations were stronger among older participants (> 35 years) or those educated longer than 17 years or those with higher household annual income (> 400,000 CNY). To conclude, first-trimester PM 1 were positively associated with BP/HDP, which may be modified by maternal age, education level, and household annual income. Further research is warranted to provide more information for both health management of HDP and environmental policies enactment., Competing Interests: The authors declare no competing interests., (© 2023 The Authors.)

Competing Interests: Competing interests: None declared.

Autoimmune diseases comprise a very heterogeneous group of disorders characterized by disruptive immune responses against self-antigens, chronic morbidity and increased mortality. The incidence and prevalence of major autoimmune conditions are particularly high in the western world, at northern latitudes, and in industrialized countries. This study will mainly focus on five major autoimmune conditions, namely type 1 diabetes, multiple sclerosis, inflammatory bowel diseases, rheumatoid arthritis, and autoimmune thyroid disorders. Epidemiological and experimental evidence suggests a protective role of sunlight exposure on the etiology of major autoimmune conditions mediated by the endogenous production of vitamin D and nitric oxide. A historical perspective shows how the rise of anthropogenic air pollutants is temporally associated with dramatic increases in incidence of these conditions. The scattering caused by ambient particulate matter and the presence of tropospheric ozone can reduce the endogenous production of vitamin D and nitric oxide, which are implicated in maintaining the immune homeostasis. Air pollutants have direct detrimental effects on the human body and are deemed responsible of an increasingly higher portion of the annual burden of human morbidity and mortality. Air pollution contributes in systemic inflammation, activates oxidative pathways, induces epigenetic alterations, and modulates the function and phenotype of dendritic cells, Tregs, and T-cells. In this review, we provide epidemiological and mechanistic insights regarding the role of UV-mediated effects in immunity and how anthropic-derived air pollution may affect major autoimmune conditions through direct and indirect mechanisms., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The impact of man-made climate change is already affecting millions of people worldwide. The health care sector in the US is a relevant contributor, accounting for about 8 to 10% of national greenhouse gas emissions. This special communication describes the harmful impact of propellant gases in metered dose inhalers (MDI) on the climate and summarizes and discusses current knowledge and recommendations from European countries. Dry powder inhalers (DPI) are a good alternative to MDIs and are available for all inhaler drug classes recommended in current asthma and COPD guidelines. Changing an MDI to PDI can significantly reduce carbon footprints. The majority of the US population is willing to do more to protect the climate. Primary care providers can engage in this by addressing the impacts of drug therapy on climate change in medical decision making., Competing Interests: Conflict of interest: None., (© Copyright by the American Board of Family Medicine.)

Objective: To evaluate the presence of diversity, equity, and inclusion (DEI) among US occupational and environmental medicine (OEM) residency program websites., Methods: In January to February 2022, two independent reviewers evaluated the websites of all 24 US accredited OEM residency programs and documented the presence of 10 predetermined DEI metrics and resident/faculty photographs and biographies., Results: Program websites included a median of 1 (0-3) DEI element with 46% of websites containing none of the DEI metrics. Faculty photographs and biographies were included in 83% and 75% of websites, respectively. Resident photographs and biographies were included in 50% and 25% of websites, respectively., Conclusions: Many OEM residency program websites lack DEI presence. Programs should consider presenting information relevant to DEI on their websites to help attract more diverse applicant pools., Competing Interests: Conflict of Interest: Z.C., C.W., L.C., and A.S. have no potential conflicts to declare. Rupali Das declares the following potential conflicts: She may receive support for attending meetings and/or travel from her employer, Zenith Insurance. She is President of the Western Occupational and Environmental Medical Association and Chair of its Justice, Equity, Diversity, and Inclusion (JEDI) Committee, both voluntary positions for which she receives no compensation. She owns stock in Amgen, AstraZeneca, Cigna Corp, Dexcom Inc., Geron Corp, Roche Holdings, Sanofi, United Health Group., (Copyright © 2022 American College of Occupational and Environmental Medicine.)

Lead is an environmental hazard that should be addressed worldwide. Over time, human lead exposure in the western world has decreased drastically to levels comparable to those among humans living in the preindustrial era, who were mainly exposed to natural sources of lead. To re-evaluate the potential health risks associated with present-day lead exposure, a two-pronged approach was applied. First, recently published population metrics describing the adverse health effects associated with lead exposure at the population level were critically assessed. Next, the key results of the Study for Promotion of Health in Recycling Lead (SPHERL; NCT02243904) were summarized and put in perspective with those of the published population metrics. To our knowledge, SPHERL is the first prospective study that accounted for interindividual variability between people with respect to their vulnerability to the toxic effects of lead exposure by assessing the participants' health status before and after occupational lead exposure. The overall conclusion of this comprehensive review is that mainstream ideas about the public and occupational health risks related to lead exposure urgently need to be updated because a large portion of the available literature became obsolete given the sharp decrease in exposure levels over the past 40 years., (© 2022. The Author(s).)

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the mucous membranes of the nose and sinuses. Eosinophilic inflammation is described as a common endotype. The anti-IL5 antibody mepolizumab was approved in November 2021 as an add-on therapy to intranasal glucocorticosteroids for the treatment of adults with severe chronic rhinosinusitis with nasal polyps when systemic glucocorticosteroids or surgery do not provide adequate disease control. While national and international recommendations exist for the use of mepolizumab in CRSwNP, it has not yet been adequately specified how this therapy is to be monitored, what follow-up documentation is necessary, and when it should be terminated if necessary., Methods: A literature search was performed to analyze previous data on the treatment of CRSwNP with mepolizumab and to determine the available evidence by searching Medline, Pubmed, the national and international trial and guideline registries and the Cochrane Library. Human studies published in the period up to and including 10/2022 were considered., Results: Based on the international literature and previous experience by an expert panel, recommendations for follow-up, adherence to therapy intervals and possible therapy breaks, as well as termination of therapy when using mepolizumab for the indication CRSwNP in the German health care system are given on the basis of a documentation sheet., Conclusions: Understanding the immunological basis of CRSwNP opens up new non-surgical therapeutic approaches with biologics for patients with severe, uncontrolled courses. Here, we provide recommendations for follow-up, adherence to therapy intervals, possible therapy pauses, or discontinuation of therapy when mepolizumab is used as add-on therapy with intranasal glucocorticosteroids to treat adult patients with severe CRSwNP that cannot be adequately controlled with systemic glucocorticosteroids and/or surgical intervention., Competing Interests: B. Wollenberg hat Honorare und/oder Forschungsgelder von MSD, Sanofi, Astra Zeneca, Novartis, BMS Adboard außerhalb der vorliegenden Arbeit erhalten.J. Hagemann gibt an, Zuwendungen für Vorträge und Honorare für Advisory Boards von den Firmen Sanofi Aventis, Fa. Novartis Pharma GmbH und GlaxoSmithKline erhalten zu haben.A.M. Chaker führt über die Technische Universität München (TUM) Beratungsleistungen (z. B. Advisory Boards, DSMBs), Vorträge oder weitere Aktivitäten durch oder hat über die TUM klinische Studien durchgeführt oder Forschungsgelder erhalten von: Allergopharma, ALK-Abello, Astra Zeneca, Bencard/Allergen Therapeutics, GSK, HAL Allergy, Immunotek, Novartis, SanofiGenzyme und Regeneron, Zeller AG; EIT Health; BMBF. AMC ist ferner Funktionsträger der EUFOREA, EAACI, AeDA und DGAKI.H. Olze erhielt Honorare und/oder Forschungsgelder von F. Hoffmann- La Roche Ltd, Sanofi-Aventis Deutschland GmbH, AstraZeneca GmbH, GlaxoSmithKline GmbH & Co. KG und Novartis Pharma GmbH.L. Klimek berichtet über Zuschüsse und/oder Honorare von Allergopharma, MEDA/Mylan, HAL Allergie, ALK Abelló, LETI Pharma, Stallergenes, Quintiles, Sanofi, ASIT Biotech, Lofarma, Allergy Therapeut., AstraZeneca, GSK, Inmunotk außerhalb der eingereichten Arbeit, und Mitgliedschaft bei folgenden Organisationen: AeDA, DGHNO, Deutsche Akademie für Allergologie und klinische Immunologie, HNO-BV GPA, EAACI.U. Förster-Ruhrmann erhielt Honorare für Vorträge von Novartis, AstraZeneca, Sanofi und GSK außerhalb der vorliegenden Arbeit.S. Strieth berichtet über Stipendien der Deutschen Forschungsgemeinschaft (DFG), Bonn, Stipendien der Stiftung Tumorforschung Kopf-Hals, Wiesbaden, Stipendien und nichtfinanzielle Förderungen der MED-EL AG, Innsbruck, Personalhonorar von Auris Medical, Basel, Personalhonorar von Merck Serono, Darmstadt, Personalhonorar Otonomy, Inc., San Diego (USA), Personalhonorar Nordmark Arzneimittel, Uetersen, Zuschuss Andreas Fahl Medizintechnik-Vertrieb, Köln, Zuschuss Atos Medical, Troisdorf, Zuschuss Tracoe Medical, Nieder-Olm, Stipendien von Heimomed Heinze, Kerpen, Stipendien von Bromepithetik, Heidelberg, Stipendien von Fresenius Kabi, Bad Hersfeld, Personalhonorar von Sonofi Genzyme, Berlin, Personalhonorar von ALK-Abelló Arzneimittel, Hamburg, außerhalb der eingereichten Arbeit.M. Cuevas erhielt Honorare und/oder nichtfinanzielle Unterstützung von Novartis, Sanovi-Aventis, Allergopharma, HAL Allergie, Leti Pharma, AstraZeneca, GlaxoSmithKline, ALK Abelló, Bencard Allergie, Stallergenes und Roxall außerhalb der eingereichten Arbeit und berichtet über Mitgliedschaften bei folgenden Organisationen: AeDA, DGHNO.A. G. Beule hat Honorare für Vorträge, Berater- oder Forschungstätigkeiten von Allakos, Astra Zeneca, BMS, GSK, Medtronic, MSD, Novartis, Olympus, Pharmalog, Pohl Boskamp und Sanofi Aventis außerhalb der vorliegenden Arbeit erhalten.O. Guntinas-Lichius erhielt Honorare von MED-EL, Merck, Novartis, MEDICE und Merz außerhalb dieser Arbeit, und er ist Mitglied bei den folgenden Organisationen: DGHNO, BVHNO.T. K. Hoffmann nimmt an honorierten Advisory Boards der Firmen Merck, MSD und BMS teil, thematisch jedoch außerhalb der vorliegenden Arbeit.C. Bachert erhielt Honorare/Forschungsgelder von den Firmen Sanofi, GSK, Novartis, AstraZeneca und ALK außerhalb der vorliegenden Arbeit.H. Wrede berichtet über Vortragshonorare von Allergopharma, MEDA/Mylan, HAL Allergie, LETI Pharma, Stallergenes, Sanofi, Lofarma, Allergy Therapeut. und GSK außerhalb der eingereichten Arbeit und Mitgliedschaft bei folgenden Organisationen: AeDA, HNO-BV.T. Stöver erhielt Forschungs- und Studiengelder sowie Honorare für Vortrags- und/oder Beratertätigkeiten von MED-EL Elektromedizinische Geräte Deutschland GmbH und Cochlear Deutschland GmbH & Co. KG außerhalb der eingereichten Arbeit. Es bestehen Mitgliedschaften bei der DGHNO-KHC, im Expertengremium über Medizinprodukte und In-vitro-Diagnostika im Auftrag der EU, im Beirat des Hörzentrums Oldenburg GmbH, in der Task Force „Living Practice Guidelines“, im Beirat des Niedersächsischen Zentrums für Biomathematik, als Vorsitzender des Stiftungsbeirats der Stiftung zur Hör- und Sprachförderung Friedberg sowie als Mitherausgeber der Zeitschrift Laryngo-Rhino-Otologie.C. Beutner berichtet über Honorare von GSK, Sanofi und Novartis, ALK Abello außerhalb dieser Arbeit.M. Laudien unterstützte und erhielt in den letzten 5 Jahren Unterstützung, Vortrags- und Beraterhonorare von Olympus Deutschland GmbH, Olympus Europa SE & CO. KG, Novartis Pharma GmbH, Sanofi-Aventis Deutschland GmbH, Brainlab Sales GmbH, GlaxoSmithKline GmbH & Co. KG und der John Grube Foundation außerhalb der vorliegenden Arbeit.M. Gröger berichtet über Zuschüsse und Vortragshonorare von Sanofi, Novartis, AstraZeneca und GSK außerhalb der eingereichten Arbeit.C. Bergmann berichtet über Zuschüsse und Honorare von GlaxoSmithKline (GSK), Sanofi Aventis, Bencard Allergy GmbH/Allergy Therapeutics, HAL Allergie GmbH/HAL Allergy Holding BV außerhalb dieser Arbeit.O. Pfaar gibt Honorare und/oder Studiengelder von ALK-Abelló, Altamira, Allergopharma, Stallergenes Greer, HAL Allergy Holding B.V./HAL Allergie, AAAAI, Bencard Allergie /Allergy Therapeutics, Lofarma, Biomay, Circassia, ASIT Biotech Tools S.A., Dänisches Konsultat, Laboratorios LETI/LETI Pharma, MEDA Pharma/MYLAN, Anergis S.A., Mobile Chamber Experts, Indoor Biotechnologies, GlaxoSmithKline, Astellas Pharma Global, EUFOREA, ROXALL, Novartis, Sanofi-Aventis and Sanofi-Genzyme, Med Update Europe, streamedup!, Pohl-Boskamp, Inmunotek S.L., Wiley and Sons, Paul-Martini-Stiftung, Regeneron Pharmaceuticals Inc., RG Aerztefortbildung, Firma Meinhardt, PneumoLIVE, Institut für Disease Management, Deutsche Forschungsgesellschaft, Springer, Thieme, AstraZeneca, Deutsche Allergie-Liga, AeDA, IQVIA Commercial, Ingress Health, Wort&Bild Verlag, Verlag ME, Procter&Gamble, Alfried-Krupp Krankenhaus an, alle außerhalb des vorliegenden Positionspapiers, und er ist Mitglied des Vorstandes/Excom der EAACI und Mitglied des erweiterten Vorstandes der DGAKI. Ferner ist er Hauptautor oder Co-Autor diverser Leitlinien und Positionspapiere in der Allergologie und Rhinologie.A. S. Hoffmann erhielt Honorare von GSK, Sanofi und Novartis für Vorträge und Advisory Boards außerhalb dieser Arbeit.T. Hildenbrand berichtet über Vortragshonorare von AstraZeneca und Novartis außerhalb dieser Arbeit.R. Weber hat Honorare für Vortrags- und Beratungstätigkeit der Firmen GSK, Infectopharm, KARL STORZ SE & Co KG, NMP, Sanofi, Sidroga-Pharma und Stryker erhalten.W. Schlenter, S. Becker, F. Bärhold, T. Deitmer, H.J. Welkoborsky, S. Dazert, T. Huppertz, C.A. Hintschich, J. Zuberbier, C. Rudack, J. Gosepath, P. Werminghaus, F. Klimek und I. Casper haben keine Interessenkonflikte im Zusammenhang mit der vorliegenden Arbeit., (Thieme. All rights reserved.)

Lead is an environmental hazard that should be addressed worldwide. Over time, human exposure to lead in the Western world has fallen drastically to the levels comparable to those in humans living in the pre-industrial era, who were mainly exposed to natural sources of lead. To re-evaluate the health risks possibly associated with present-day lead exposure, a three-pronged approach was applied. First, we critically assessed the recently published population metrics describing the adverse health effects associated with lead exposure at the population level. Next, we summarized the key results of the Study for Promotion of Health in Recycling Lead (SPHERL; NCT02243904) and analyzed these results in the context of the published population metrics. Last but not least, we performed a brief literature review on the present-day lead exposure level in Poland. To our best knowledge, SPHERL is the first prospective study that accounted for interindividual variation in vulnerability to the toxic effects of lead exposure by assessing the participants' health status before and after occupational lead exposure, with blood pressure and hypertension as the primary outcomes. The overall conclusion of this comprehensive review on blood pressure and hypertension is that mainstream ideas about the public and occupational health risks related to lead exposure need to be urgently updated because a large part of the available literature has become obsolete given present-day exposure levels that sharply declined over the past 40 years.

Objective: The aim of this study is to examine the awareness, opinions, and use of individual fit testing of hearing protection devices (HPDs) among occupational medicine practitioners., Methods: Members of the Michigan Occupational and Environmental Medicine Association completed a 21-question survey on individual fit testing of HPDs., Results: The survey response rate was 67%, 53% reported having heard of individual fit testing of HPDs, and 24% reported that their clinic/site performed the testing. Major barriers to its use were perceived time to perform (63%), cost (51%), lack of an Occupational Safety and Health Administration requirement (51%), and lack of long-term studies of its effectiveness (20%)., Conclusions: Further work to educate practitioners about the availability, implementation, and potential benefits of fit testing of HPDs is needed if use of this technology is to become more widespread., Competing Interests: Conflict of interest: None declared., (Copyright © 2022 American College of Occupational and Environmental Medicine.)

Abstract: Occupational and environmental medicine (OEM) is an ACGME-accredited preventive medicine specialty focused on work as a social determinant of health and population health. OEM providers recognize and mitigate workplace and environmental hazards, treat resultant injuries and illnesses, and promote the health, wellness and resiliency of workers and communities. Multidisciplinary residency training in clinical medicine, epidemiology, public and population health, toxicology, exposure and risk assessment, and emergency preparedness equips them with the skill set needed for leadership roles in diverse settings. These include clinical practice, academia, corporate settings, and governmental agencies. Despite robust job opportunities, a shortage of formally trained OEM physicians remains and is expected to worsen given a declining number of training programs. We examine root causes of the system-level issues impacting the supply of OEM physicians and potential solutions., Competing Interests: ACOEM requires all substantive contributors to its documents to disclose any potential competing interests, which are carefully considered. ACOEM emphasizes that the judgmentsexpressed herein represent the best available evidence at the time of publication and shall be considered the position of ACOEM and not the individual opinions of contributing authors.The authors declare no conflicts of interest., (Copyright © 2022 American College of Occupational and Environmental Medicine.)

Virus surveillance in wastewater can be a useful indicator of the development of the COVID-19 pandemic in communities. However, knowledge about how the amount of SARS-CoV-2 RNA in wastewater relates to different data on the burden on the health system is still limited. Herein, we monitored the amount of SARS-CoV-2 RNA and the spectrum of virus variants in weekly pooled wastewater samples for two years from mid-February 2020 and compared them with several clinical data. The two-year monitoring showed the weekly changes in the amount of viral RNA in wastewater preceded the hospital care needs for COVID-19 and the number of acute calls on adult acute respiratory distress by 1-2 weeks during the first three waves of COVID-19. Our study demonstrates that virus surveillance in wastewater can predict the development of a pandemic and its burden on the health system, regardless of society's test capacity and possibility of tracking infected cases., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article., (© 2022 The Author(s).)

Introduction: Publication and peer review are fundamental to career advancement in science and academic medicine. Studies demonstrate that women are underrepresented in science publishing. We evaluated the gender distribution of contributors to Wilderness & Environmental Medicine (WEM) from 2010 through 2019., Methods: We extracted author data from ScienceDirect, reviewer data from the WEM Editorial Manager database, and editorial board data from journal records. Gender (female and male) was classified using automated probability-based assessment with Genderize.io software., Results: A total of 2297 unique authors were published over the 10-y span, generating 3613 authorships, of which gender was classified for 96% (n=3480). Women represented 26% (n=572) of all authors, which breaks down to 22% of all, 19% of first, 28% of second, and 18% of last authorships. Women represented 20% of peer reviewers (508/2517), 20% of reviewers-in-training (19/72), and 16% of editorial board members (7/45). The proportion of female authors, first authors, and reviewers increased over time. Women received fewer invitations per reviewer than men (mean 2.1 [95% CI 2.0-2.3] vs 2.4 [95% CI 2.3-2.5]; P=0.004), accepted reviews at similar rates (mean 73 vs 71%; P=0.214), and returned reviews 1.4 d later (mean 10.4 [CI 9.5-11.3] vs 9.0 d [95% CI 8.5-9.6]; P=0.005)., Conclusions: While female representation increased over the study period, women comprise a minority of WEM authors, peer reviewers, and editorial board members. Gender equity could be improved by identifying and eliminating barriers to participation, addressing any potential bias in review processes, implementing strategies to increase female-authored submissions, and increasing mentorship and training., (Copyright © 2022 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)

Environmental toxicant exposure, according to many researchers in the field, is the leading cause of chronic disease and premature death globally. For the purposes of this review, we will use obesity and type 2 diabetes as examples of toxicant-induced chronic diseases. Endocrine Disrupting chemicals (EDCs) such as phthalates and bisphenols, per- and polyfluoroalkyl substances (PFAS), and persistent organic pollutants (POPs) have been linked to increased risk for obesity and type 2 diabetes in both animal and large epidemiologic studies. These two conditions are well-documented examples of evidence for mechanisms of both adipose metabolism disruption and pancreatic cell dysfunction. The implications for health care directives to both identify, prevent, and treat these exposures are reviewed., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose: The association between secondhand smoke (SHS) and peripheral arterial disease (PAD) was inconsistent and the studies were relatively scarce, hence, we conducted a meta-analysis of the association between SHS and PAD., Materials and Methods: We systematically searched three electronic databases (PubMed, EMBASE, and Web of Science), and calculated the pooled prevalence risk ratio (RR) and estimated standard error by random effect model from the meta-analysis. Furthermore, we performed a subgroup meta-analysis according to the location of SHS exposure., Results: We initially identified 502 articles from the electronic database, and 6 articles, cross-sectional data from 4 cross-sectional studies and 2 prospective cohort studies, were included in the meta-analysis. Among these six articles, two studies showed a significant correlation between SHS exposure and PAD, whereas no study showed a negative correlation between SHS exposure and PAD. In the meta-analysis, pooled prevalence showed a significant association between SHS exposure and PAD (RR = 1.23; 95% confidence interval [CI] 1.08-1.41; z = 3.02, p = 0.003). In the subgroup analysis based on location of SHS exposure, the prevalence RR of PAD at home was 1.30 (95% CI 1.14-1.49, Z-3.99, p < 0.0001). The prevalence RR in the subgroup of SHS exposure at work was not significant (RR = 0.89; 95% CI 0.55-1.44; z = 0.48, p = 0.63)., Conclusion: Exposure to SHS was significantly and positively associated with PAD. Moreover, we found a significant association between exposure to SHS and PAD at home, but the association was not significant at work., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background:  Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the paranasal sinus mucosa with eosinophilic inflammation as the most common endotype. The anti-IL5 antibody mepolizumab was approved for the treatment of severe CRSwNP in the EU in November 2021., Methods:  A literature search was performed to analyze the immunology of CRSwNP and determine the available evidence by searching Medline, Pubmed, and the German national and international trial and guideline registries and the Cochrane Library. Human studies published in the period up to and including 12/2021 that investigated the effect of mepolizumab in CRSwNP were considered., Results:  Based on the international literature and previous experience, recommendations for the use of mepolizumab in CRSwNP in the German health care system are given by an expert panel on the basis of a documentation form., Conclusions:  Understanding about the immunological basis of CRSwNP opens new non-surgical therapeutic approaches with biologics for patients with severe courses. Mepolizumab is approved since November 2021 for add-on therapy with intranasal corticosteroids for the treatment of adult patients with severe CRSwNP who cannot be adequately controlled with systemic corticosteroids and/or surgical intervention., Competing Interests: U. Förster-Ruhrmann erhielt Honorare für Vorträge von Novartis, AstraZeneca, Sanofi und GSK außerhalb der vorliegenden Arbeit.S. Strieth berichtet über Stipendien der Deutschen Forschungsgemeinschaft (DFG), Bonn, Stipendien der Stiftung Tumorforschung Kopf-Hals, Wiesbaden, Stipendien und nicht-finanzielle Forderungen der MED-EL AG, Innsbruck, Personalhonorar von Auris Medical, Basel, Personalhonorar von Merck Serono, Darmstadt, Personalhonorar Otonomy, Inc., San Diego (USA), Personalhonorar Nordmark Arzneimittel, Uetersen, Zuschüsse Andreas Fahl Medizintechnik-Vertrieb, Koln, Zuschüsse Atos Medical, Troisdorf, Zuschüsse Tracoe Medical, Nieder-Olm, Stipendien von Heimomed Heinze, Kerpen, Stipendien von Bromepithetik, Heidelberg, Stipendien von Fresenius Kabi, Bad Hersfeld, Personalhonorar von Sonofi Genzyme, Berlin, Personalhonorar von ALK-Abello Arzneimittel, Hamburg, außerhalb der eingereichten Arbeit;H. Olze erhielt Honorare und/oder Forschungsgelder von F. Hoffmann-La Roche Ltd, Sanofi-Aventis Deutschland GmbH, AstraZeneca GmbH, GlaxoSmithKline GmbH & Co. KG.A. M. Chaker führt über die Technische Universitat München Beratungsleistungen (z. B. Advisory Boards, DSMBs), Vorträge oder weitere Aktivitäten für Allergopharma, ALK-Abello, Astra Zeneca, GSK, HAL Allergy, Mundipharma, Nexter, Immunotek, Lofarma, SanofiGenzyme und Regeneron durch; hat klinische Studien oder Forschungsgelder über die Technische Universität München erhalten von ALK, Allergopharma, Astra Zeneca, Bencard/Allergen Therapeutics, ASIT Biotech, GSK, Novartis, Roche, und Zeller AG, ferner Forschungsmittel erhalten vom Umweltbundesamt der Bundesrepublik Deutschland, EIT Health und DZL (BMBF).Ferner Honorare und Reisekostenerstattungen erhalten vom Bayerischen Arzteblatt, der Deutschen Gesellschaft fur Allergologie und klinische Immunologie (DGAKI) und der European Academy of Allergy and Clinical Immunology.B. Wollenberg hat Honorare und/oder Forschungsgelder von MSD, Sanofi, AstraZeneca, Novartis, BMS Adboard auserhalb der vorliegenden Arbeit erhalten.C. Bachert erhielt Honorare und/oder Forschungsgelder von Sanofi, Novartis, GSL, Astra-Zeneca außerhalb der vorliegenden Arbeit.L. Klimek berichtet über Zuschüsse und/oder Honorare von Allergopharma, MEDA/Mylan, HAL Allergie, ALK Abelló, LETI Pharma, Stallergenes, Quintiles, Sanofi, ASIT Biotech, Lofarma, Allergy Therapeut., AstraZeneca, GSK, Inmunotk außerhalb der eingereichten Arbeit und Mitgliedschaften bei folgenden Organisationen: AeDA, DGHNO, Deutsche Akademie für Allergologie und klinische Immunologie, HNO-BV GPA, EAACI.J. Hagemann gibt an, Zuwendungen der Fa. Novartis Pharma GmbH für Vorträge erhalten zu haben.M. Cuevas erhält Forschungshonorare im Rahmen einer Studie von AstraZeneca. M. Cuevas erhielt Honorare von AstraZeneca, GSK, Sanofi und Novartis (außerhalb dieser Arbeit).Ch. Bergmann, P.V. Tomazic, C. A. Hintschich, T. Huppertz, H.J. Welkoborsky, F. Klimek und T. Stöver, A. G. Beule, T. K. Hoffmann, S. Dazert, T. Deitmer, H. Wrede, W. Schlenter, J. Zuberbier, C. Rudack, O. Guntinas-Lichius, S. Becker haben keine Interessenkonflikte im Zusammenhang mit dieser Arbeit., (Thieme. All rights reserved.)

A tribute to Dr. Irving J. Selikoff MD, the founder of this journal, is indeed welcome now more than two decades after his passing. He was known during his lifetime as the US Father of Environmental Medicine which at the time encompassed occupational medicine and much more as industry also polluted the general environment. The 1970s were a busy time as OSHA and the EPA were newly formed and high exposures to workers were no exception. Dr. Selikoff was a brave pioneer examining workers throughout the country and Canada, publicizing their exposures, and writing and presenting the scientific results. Industry was not always receptive and controlled an astounding amount of narrative, with the creation of the American Journal of Industrial Medicine filling a void of scientific need. We four authors write about the ethics of occupational health, the plight of nuclear energy workers, the climate crisis and opportunity for unions to engage workers, and the global march toward educating medical students on workers' health and safety. All four of us interacted with Dr. Selikoff during his tenure at Mount Sinai, and over the years joined each other in promoting his legacy. Toward that end we have written articles honoring his memory., (© 2022 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals LLC.)

Objective: To learn how occupational and environmental medicine (OEM) expertise is developed and maintained around the world and to inform strategies for further international development of OEM., Methods: An anonymous survey was conducted of leaders of the 48 member societies (from 43 countries) of the International Occupational Medicine Society Collaborative (IOMSC) to evaluate OEM training, certification, maintenance, and recertification requirements., Results: OEM physician leaders representing 46 of the 48 IOMSC member societies (95.8%) completed the survey between December 2019 and February 2020. Academic post-graduate and on-the-job training were the most frequent methods for developing OEM expertise, with little use of online coursework and minimal OEM content in medical school in most countries. Occupational medicine board certification usually required graduate specialty training and passing a certification examination, while occupational medicine recertification requirements were uncommon., Conclusion: The IOMSC is positioned to support the international development of OEM expertise by sharing information on competencies, best practices in medical education curriculum content and examples of OEM specialty certification pathways from different countries., Competing Interests: Conflicts of interest: None declared., (Copyright © 2022 American College of Occupational and Environmental Medicine.)

Anthropogenic ultrafine particulate matter (UFPM) and industrial and natural nanoparticles (NPs) are ubiquitous. Normal term, preeclamptic, and postconceptional weeks(PCW) 8-15 human placentas and brains from polluted Mexican cities were analyzed by TEM and energy-dispersive X-ray spectroscopy. We documented NPs in maternal erythrocytes, early syncytiotrophoblast, Hofbauer cells, and fetal endothelium (ECs). Fetal ECs exhibited caveolar NP activity and widespread erythroblast contact. Brain ECs displayed micropodial extensions reaching luminal NP-loaded erythroblasts. Neurons and primitive glia displayed nuclear, organelle, and cytoplasmic NPs in both singles and conglomerates. Nanoscale Fe, Ti, and Al alloys, Hg, Cu, Ca, Sn, and Si were detected in placentas and fetal brains. Preeclamptic fetal blood NP vesicles are prospective neonate UFPM exposure biomarkers. NPs are reaching brain tissues at the early developmental PCW 8-15 stage, and NPs in maternal and fetal placental tissue compartments strongly suggests the placental barrier is not limiting the access of environmental NPs. Erythroblasts are the main early NP carriers to fetal tissues. The passage of UFPM/NPs from mothers to fetuses is documented and fingerprinting placental single particle composition could be useful for postnatal risk assessments. Fetal brain combustion and industrial NPs raise medical concerns about prenatal and postnatal health, including neurological and neurodegenerative lifelong consequences.

Pulmonary gas exchange during diving or in a dry hyperbaric environment is affected by increased breathing gas density and possibly water immersion. During free diving, there is also the effect of apnea. Few studies have published blood gas data in underwater or hyperbaric environments: this review summarizes the available literature and was used to test the hypothesis that arterial Po 2 under hyperbaric conditions can be predicted from blood gas measurement at 1 atmosphere assuming a constant arterial/alveolar Po 2 ratio (a:A). A systematic search was performed on traditional sources including arterial blood gases obtained on humans in hyperbaric or underwater environments. The a:A was calculated at 1 atmosphere absolute (ATA). For each condition, predicted arterial partial pressure of oxygen ([Formula: see text]) at pressure was calculated using the 1 ATA a:A, and the measured [Formula: see text] was plotted against the predicted value with Spearman correlation coefficients. Of 3,640 records reviewed, 30 studies were included: 25 were reports describing values obtained in hyperbaric chambers, and the remaining were collected while underwater. Increased inspired O 2 at pressure resulted in increased [Formula: see text], although underlying lung disease in patients treated with hyperbaric oxygen attenuated the rise. [Formula: see text] generally increased only slightly. In breath-hold divers, hyperoxemia generally occurred at maximum depth, with hypoxemia after surfacing. The a:A adequately predicted the [Formula: see text] under various conditions: dry ( r = 0.993, P < 0.0001), rest versus exercise ( r = 0.999, P < 0.0001), and breathing mixtures ( r = 0.995, P < 0.0001). In conclusion, pulmonary oxygenation under hyperbaric conditions can be reliably and accurately predicted from 1 ATA a:A measurements.

Objective: Transfer of military medical facilities to the Defense Health Agency is transforming the Military Health System. Our objective is to inform this transformation with respect to optimum application of occupational and environmental medicine (OEM) expertise., Methods: We defined and analyzed the external influences on military OEM practice using a structured framework to identify key drivers., Results: Key drivers are political and economic factors. These may change the size or military/civilian ratio of the specialty. Limited career development pathways should prompt consideration of making OEM a second or combined residency, and military-funded training of civilian physicians may be required. OEM specialist utilization should be reassessed., Conclusions: OEM is a highly adaptable specialty defined by the needs of its stakeholders. Comprehensive analysis of external influences can ensure that OEM practice remains in step with changing needs., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 American College of Occupational and Environmental Medicine.)

Objectives: Occupational and environmental medicine (OEM) departments in healthcare institutions can be quickly overwhelmed when COVID-19 infection rates rapidly and simultaneously increase in the workforce and the patients served. Our goal is to present a detailed toolkit of practical approaches for use by front-line OEM specialists to address workforce management tasks during pandemic surges., Methods: Specific focus is on tasks related to employee symptom triage, exposure risk assessment, workplace contact tracing, and work restrictions., Results: Tools include strategies used by customer call centers, two decision support algorithms (exposure due to cohabitation or non-cohabitation), a color-coded employee case tracking tool, a contact tracing protocol, and documentation templates that serve as memory aids for encounters., Conclusions: These tools are created with commonly used software. Implementation is feasible in most front-line OEM settings, including those with limited resources., Competing Interests: Conflict of interest: All authors, except for Yann Wester, have been employed by VA Loma Linda Healthcare (VALLHS) within the last 36 months. Yann Wester is an Occupational Medicine resident who is employed by the Loma Linda University Health residency program and was employed within the last 3 years in the internship program at Einstein Medical Center, Philadelphia. Within the last 36 months, Cesar Reis was employed at Kaiser Permanente Healthcare System. All other relationships between authors and the listed entities are academic appointments without compensation. All entities are medical training institutes and peer-reviewed publication of scholarly work is encouraged. Hall, Guo, Diaz-Caturan, Reis, Carritte, Smith, and Wester have no relationships/conditions/circumstances that present potential conflict of interest., (Copyright © 2021 American College of Occupational and Environmental Medicine.)

Objective: Although several studies have reported that some meteorological factors such as ambient temperature and atmospheric pressure, affect the incidence of spontaneous intracerebral hemorrhage (ICH), the correlation remains unclear. This retrospective time-series analysis was aimed to clarify the effects of meteorological parameters on the incidence of ICH., Materials and Methods: Data of patients with ICH were obtained from a population-based survey of acute stroke patients between April 2016 and March 2019. All days during the study period were categorized into "no ICH day" when no ICHs occurred, "single ICH day" when only one ICH occurred, and "cluster day" when two or more ICHs occurred. Meteorological data were compared for among the three categories., Results: 1,691 ICH patients from 19 hospitals were registered. In a total of 1,095 days, 250 were categorized as no ICH days, 361 as single ICH days, and 484 as cluster days. Daily ambient temperature declined in parallel with the daily number of ICHs, and it was a significant predictor for single ICH days and cluster days. Furthermore, the incidence of ICH in patients aged 65 years or above, men, those who emerged at home, those with modified Rankin Scale 3-5; and those with hypertension; and ICHs in the basal ganglia, brain stem, and cerebellum were more likely to be affected by low ambient temperature., Conclusion: Daily ambient temperature was significantly associated with ICH incidence. Patients' activity, history of hypertension, and location of hemorrhage were also related to the impact of low ambient temperature on the incidence of ICH., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Competing Interests: M. Wagenmann hat innerhalb der vergangenen 3 Jahre Honorare für Beratung, Vorträge oder Forschungsunterstützung von folgenden Firmen erhalten: ALK-Abelló, Allergopharma, AstraZeneca, BencardAllergie, Genzyme, HAL Allergie, Infectopharm, LETI Pharma, MEDA Pharma, Novartis, Sanofi Aventis, Stallergenes, Teva – außerhalb der vorliegenden Arbeit.B. Wollenberg hat Honorare und/oder Forschungsgelder von MSD, Sanofi, AstraZeneca, Novartis, BMS Adboard außerhalb der vorliegenden Arbeit erhalten.J. Hagemann gibt an, Zuwendungen der Fa. Novartis Pharma GmbH für Vorträge erhalten zu haben.C. Bachert erhielt Honorare und/oder Forschungsgelder von Sanofi, Novartis, GSL, AstraZeneca außerhalb der vorliegenden Arbeit.A. Chaker führt über die Technische Universität München Beratungsleistungen (z. B. Advisory Boards, DSMBs), Vorträge oder weitere Aktivitäten für Allergopharma, ALK-Abello, AstraZeneca, GSK, HAL Allergy, Mundipharma, Nexter, Immunotek, Lofarma, SanofiGenzyme und Regeneron durch; hat klinische Studien oder Forschungsgelder über die Technische Universität München erhalten von ALK, Allergopharma, AstraZeneca, Bencard/Allergen Therapeutics, ASIT Biotech, GSK, Novartis, Roche und Zeller AG, ferner Forschungsmittel erhalten vom Umweltbundesamt der Bundesrepublik Deutschland, EIT Health und DZL (BMBF). AMC hat ferner Honorare und Reisekostenerstattungen erhalten vom Bayerischen Ärzteblatt, der Deutschen Gesellschaft für Allergologie und klinische Immunologie (DGAKI) und der European Academy of Allergy and Clinical Immunology.H. Olze erhielt Honorare und/oder Forschungsgelder von F. Hoffmann-La Roche Ltd, Sanofi-Aventis Deutschland GmbH, AstraZeneca GmbH, GlaxoSmithKline GmbH & Co. KG und Novartis außerhalb der eingereichten Arbeit.L. Klimek berichtet über Zuschüsse und/oder Honorare von Allergopharma, MEDA/Mylan, HAL Allergie, ALK Abelló, LETI Pharma, Stallergenes, Quintiles, Sanofi, ASIT Biotech, Lofarma, Allergy Therapeut., AstraZeneca, GSK, Inmunotek, außerhalb der eingereichten Arbeit; und Mitgliedschaft bei folgenden Organisationen: AeDA, DGHNO, Deutsche Akademie für Allergologie und klinische Immunologie, HNO-BV GPA, EAACIU. Förster-Ruhrmann erhielt Honorare für Vorträge von Novartis, AstraZeneca, Sanofi und GSK außerhalb der vorliegenden Arbeit.S. Strieth berichtet innerhalb der letzten 3 Jahre Forschungsförderungen der DFG und der MED-EL AG, Innsbruck, und Honorare von Merck Serono, Darmstadt, von Sonofi Genzyme, Berlin, und von ALK-Abelló Arzneimittel, Hamburg, außerhalb der eingereichten Arbeit; Mitgliedschaft bei folgenden Organisationen: DGHNO, DGAKI, DGA, DKG, DEGUM.W. Schlenter, S. Becker, A. G. Beule, T. Deitmer, H. J. Welkoborsky, S. Dazert, C. Rudack, T. Huppertz, T.K. Hoffmann, H. Wrede, C. Bergmann haben keine Interessenkonflikte im Zusammenhang mit der vorliegenden Arbeit.

No abstract present., (© 2021 The Author(s). Published by BRI.)

Background: We conducted a meta-analysis to quantitatively assess the association between asbestos exposure and esophageal cancer., Methods: We systematically collected articles from three electronic databases and calculated the pooled standardized mortality rate (SMR) from the meta-analysis. Subgroup analysis according to the type of asbestos exposure, follow-up years, sample size, industry classification, sex, and high-dose exposure was conducted., Results: From 242 studies, 34 cohort studies were included in our meta-analysis. Pooled SMR was positively associated with asbestos exposure and esophageal cancer (pooled SMR = 1.28; 95% confidence interval (CI) 1.19-1.38, p < 0.00001). In the subgroup analysis, (1) chrysolite, (2) four groups with follow-up over ten years, (3) the textile industry and shipyard, (4) both male and female, and (5) eight studies on highest asbestos exposure, all the subgroups showed significantly increased pooled SMRs., Conclusion: Asbestos exposure was significantly and positively associated with esophageal cancer, especially chrysolite. Considering the long latency period, we suggest that patients should be followed up for cancer, including esophageal cancer, for over ten years.

Introduction: Asthma is a complex, heterogeneous disease and one of the most common chronic diseases among children. Exposure to ambient air pollution in early life and childhood may influence asthma aetiology, but it is uncertain which specific components of air pollution and exposure windows are of importance. The role of socio-economic status (SES) is also unclear. The aims of the present study are, therefore, to investigate how various exposure windows of different pollutants affect risk-induced asthma in early life and to explore the possible effect SES has on that relationship., Methods: The study population was constructed using register data on all singleton births in the greater Stockholm area between 2006 and 2013. Exposure to ambient black carbon (BC), fine particulate matter (PM 2.5 ), primary organic carbon (pOC) secondary organic aerosols (SOA), secondary inorganic aerosols, and oxidative potential at the residential address was modelled as mean values for the entire pregnancy period, the first year of life and the first three years of life. Swedish national registers were used to define the outcome: asthma diagnosis assessed at hospital during the first six years of life. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were modelled with Cox proportional hazards model with age as the underlying time-scale, adjusting for relevant potential confounding variables., Results: An increased risk for developing childhood asthma was observed in association with exposure to PM 2.5 , pOC and SOA during the first three years of life. With an interquartile range increase in exposure, the HRs were 1.06 (95% CI: 1.01-1.10), 1.05 (95% CI: 1.02-1.09) and 1.02 (95% CI: 1.00-1.04), for PM 2.5 , pOC and SOA, respectively, in the fully adjusted models. Exposure during foetal life or the first year of life was not associated with asthma risk, and the other pollutants were not statistically significantly associated with increased risk. Furthermore, the increase in risk associated with PM 2.5 and the components BC, pOC and SOA were stronger in areas with lower SES., Conclusion: Our results suggest that exposure to air pollution during the first three years of life may increase the risk for asthma in early childhood. The findings further imply a possible increased vulnerability to air pollution-attributed asthma among low SES children., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Climate change is an urgent challenge amplified by socioeconomic factors that demands thoughtful public health responses from OEM professionals. This guidance statement from the American College of Occupational and Environmental Medicine focuses on the different strategies that these health professionals can implement to protect workers from health impacts associated with climate change hazards, foster workplace resilience in the face of rapidly changing environments, and take the necessary steps to mitigate the effects of global climate change., Competing Interests: The author declares no conflicts of interest., (Copyright © 2021 American College of Occupational and Environmental Medicine.)

Competency is defined as possession of sufficient physical, intellectual, and behavioral qualifications to perform a task or serve in a role which adequately accomplishes a desired outcome. Recognizing the need for defining competencies essential to occupational and environmental medicine (OEM) physicians, the American College of Occupational and Environmental Medicine developed its first set of OEM Competencies in 1998. Later updated in 2008, and again in 2014, the increasing globalization and modernization of the workplace, along with published research on OEM practice, required an update to ensure OEM physicians stay current with the field and practice of OEM. Delineation of core competencies for the profession provides employers, government agencies, health care organizations, and other health practitioners a solid context of the role and expertise of OEM physicians., Competing Interests: The author declares no conflicts of interest., (Copyright © 2021 American College of Occupational and Environmental Medicine.)

Fibrotic hypersensitivity pneumonitis (fHP) is a chronic, often progressive fibrosing form of interstitial lung disease caused by inhaled antigenic exposures. fHP can lead to impaired respiratory function, reduced disease-related quality of life, and early mortality. Management of fHP should start with exposure remediation where possible, with systemic immunosuppression and antifibrotic therapy considered in patients with symptomatic or progressive disease. Nonpharmacologic and supportive management should be offered and, in cases of treatment-resistant, progressive illness, lung transplant should be considered., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction: Hyperbaric chambers and underwater environments are challenging and at risk of serious accidents. Personnel aiming to assist patients and subjects should be appropriately trained, and several courses have been established all over the world. In healthcare, simulation is an effective learning technique. However, there have been few peer-reviewed articles published in the medical literature describing its use in diving and hyperbaric medicine., Methods: We implemented the curriculum of the Master's degree in hyperbaric and diving medicine held at the University of Padova with emergency medicine seminars created by the faculty and validated by external experts. These seminars integrated traditional lectures and eight in situ simulation scenarios., Results: For the hyperbaric medicine seminar, simulations were carried out inside a real hyperbaric chamber at the ATIP Hyperbaric Treatment Centre, only using air and reproducing compression noise without pressurization to avoid damages to the manikins. The four scenarios consisted of hyperoxic seizures, pneumothorax, hypoglycemia, and sudden cardiac arrest. Furthermore, we added a hands-on session to instruct participants to prepare an intubated patient undergoing hyperbaric oxygen treatment with a checklist and simulating the patient transfer inside and outside the hyperbaric chamber. The diving medicine seminar was held at the Y-40 The Deep Joy pool in Montegrotto Terme (Italy), also involving SCUBA/breath-hold diving (BHD) instructors to rescue subjects from the water. These diving medicine scenarios consisted of neurologic syndrome ("taravana/samba") in BHD, drowning of a breath-hold diver, pulmonary barotrauma in BHD, and decompression illness in a SCUBA diver., Conclusion: With this experience, we report the integration of simulation in the curriculum of a teaching course in diving and hyperbaric medicine. Future studies should be performed to investigate learning advantages, concept retention, and satisfaction of participants., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Paganini, Mormando, Savino, Garetto, Tiozzo, Camporesi, Fabris and Bosco.)

Background: This study aimed to clarify the effects of underlying diseases on clinical outcomes of patients aboard a world cruise ship., Methods: This prospective cohort study included patients who sought physician consultations at an onboard clinic on a 105-day world cruise (September-December 201X) on a ship chartered by a Japanese travel agency. Multivariable logistic regression analysis was performed to ascertain whether any concurrent disease, such as hypertension, was associated with additional onboard treatment by the primary physician or serious events, including unexpected final disembarkation, temporary disembarkation for hospitalization ashore, shore-side referral, and onboard clinic admission., Results: Of 313 patients, 182 (58%) had at least one underlying disease. Sixty-eight (22%) required additional treatment, and 24 (8%) experienced serious events. After adjusting for age, sex, and underlying diseases, the 60-69- and 70-74-year age groups had a lower risk of serious events than the ≤59-year age group (odds ratio [OR], 95% confidence interval [CI]: 0.24, 0.069-0.81; p = 0.022 and 0.045, 0.0051-0.47; p = 0.0055). Underlying disease was associated with serious events (OR, 95% CI: 3.2, 1.1-9.5; p = 0.036)., Conclusions: Unexpected events can occur in patients on world cruises regardless of age. Preexisting diseases may confer higher risk of serious events., (Copyright © 2021 Elsevier Ltd. All rights reserved.)