Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update.

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.

[Patient Care in German Outpatient Clinics for Environmental Medicine Illustrated by the Examples of Hamburg and Munich University Hospitals]. / Versorgung von Patient*innen an umweltmedizinischen Ambulanzen in Deutschland am Beispiel der Universitätskliniken in Hamburg und München.

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.

A Comprehensive Obesity Benefit as a Guide for Employers on the Core Components of Obesity Care: Guidance From the American College of Occupational and Environmental Medicine (ACOEM) Roundtable on Obesity.

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.

[The implications of the concepts One Health and Planetary Health for the environmental medicine of the 21st century]. / Die Bedeutung der Konzepte One Health und Planetary Health für die Umweltmedizin im 21. Jahrhundert.

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.

Empfehlungen zur Überprüfung der Wirksamkeit und Verlaufsdokumentation von Mepolizumab bei chronischer Rhinosinusitis mit Nasenpolypen (CRSwNP) im deutschen Gesundheitssystem ­ Empfehlungen des Ärzteverbandes Deutscher Allergologen (AeDA) und der AGs Klinische Immunologie, Allergologie und Umweltmedizin und Rhinologie und Rhinochirurgie der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie (DGHNOKHC).

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.

Awareness, Use, and Opinions of Individual Fit Testing of Hearing Protection Devices Among Practicing Michigan Occupational and Environmental Medicine Association Health Care Providers.

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.

A Cross-Sectional Descriptive Analysis of Diversity, Equity, and Inclusion Presence Among United States Occupational and Environmental Medicine Residency Program Websites.

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.

Environmental Medicine: Exploring the Pollutome for Solutions to Chronic Diseases.

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.

The Future 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.

Gender Distribution Associated With the Journal Wilderness & Environmental Medicine.

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.

The Occupational Medicine Pipeline: Report on the Results of a Survey of International Occupational Medicine Society Collaborative (IOMSC) Member Countries.

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.

The Future of Military Occupational and Environmental Medicine in the Department of Defense.

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.

Gender differences in authorship prior to and during the COVID-19 pandemic in research submissions to Occupational and Environmental Medicine (2017-2021).

OBJECTIVE: To explore whether the COVID-19 pandemic has impacted productivity of female academics in the field of occupational and environmental health, by examining trends in male and female authorship of submissions during and prior to the COVID-19 pandemic in Occupational and Environmental Medicine. METHODS: Administrative data on submissions between January 2017 and November 2021 were obtained through databases held at BMJ journals. Author gender was identified using an existing algorithm based on matching names to social media accounts. The number and proportion of female and male primary (first) and senior (last) authors were examined for each quarter, and the average change in share of monthly submissions from male authors in the months since the pandemic compared with corresponding months prior to the pandemic were identified using regression models estimating least squares means. RESULTS: Among 2286 (64.7%) and 2335 (66.1%) manuscripts for which first and last author gender were identified, respectively, 49.3% of prepandemic submissions were from male first authors, increasing to 55.4% in the first year of the pandemic (difference of 6.1%, 95% CI 1.3% to 10.7%), before dropping to 46.6% from April 2021 onwards. Quarterly counts identified a large increase in submissions from male authors during the first year after the onset of the pandemic, and a smaller increase from female authors. The proportion of male last authors did not change significantly during the pandemic. CONCLUSIONS: These findings suggest that there has been an increase in male productivity during the COVID-19 pandemic within the field of occupational and environmental health research that is present to a lesser extent among women.

Ethical thinking in occupational and environmental medicine: Commentaries from the Selikoff Fund for Occupational and Environmental Cancer Research.

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.

Positionspapier: Empfehlungen zur Anwendung von Mepolizumab bei chronischer Rhinosinusitis mit Polyposis nasi (CRSwNP) im deutschen Gesundheitssystem ­ Empfehlungen des Ärzteverbandes Deutscher Allergologen (AeDA) und der AGs Klinische Immunologie, Allergologie und Umweltmedizin und Rhinologie und Rhinochirurgie der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO-KHC).

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.