COVID-19 and heat waves: New challenges for healthcare systems.

Heat waves and Covid-19 overlap, as this pandemic continues into summer 2021. Using a narrative review, we identified overlapping risk groups and propose coping strategies. The high-risk groups for heat-related health problems as well as for high-risk COVID-19 groups overlap considerably (elderly with pre-existing health conditions). Health care facilities will again be challenged by Covid-19 during heat waves. Health care personnel are also at risk of developing heat related health problems during hot periods due to the use of personal protective equipment to shield themselves from SARS-CoV-2 and must therefore be protected from excessive heat periods. Some existing recommendations for heat health protection contradict recommendations for COVID-19 protection. This paper provides a preliminary overview of possible strategies and interventions to tackle these ambiguities. The existing recommendations for protection against heat-related illnesses need revisions to determine whether they include essential aspects of infection control and occupational safety and how they may be supplemented.

Exposure assessment of toxic metals and organochlorine pesticides among employees of a natural history museum.

Chemical compounds such as arsenic, mercury and organochlorine pesticides have been extensively used as preventive and curative conservation treatments for cultural and biological collections to protect them from pest and mold infestations. Most of the aforementioned compounds have been classified as carcinogenic, mutagenic and teratogenic and represent a health risk for members of staff exposed to contaminated objects. The present study addresses the internal exposure of 28 museum employees in Museum für Naturkunde Berlin by measuring arsenic species and mercury in urine as well as hexachlorocyclohexane isomers (α-HCH, ß-HCH, γ-HCH), hexachlorobenzene (HCB), dichlorodiphenyltrichloroethane (4,4'-DDT) and its main metabolite, dichlorodiphenyldichloroethylene (4,4'-DDE), and pentachlorophenol (PCP) in blood serum. This study was carried out in order to assess the internal exposure of Natural History Museum staff members to toxic metals and organochlorine pesticides. During a working week, two blood samples and five urine samples were taken from each participant, involving 8 women and 20 men. Information about work activity and exposure related factors such as dust development through work, use of personal protective equipment, as well as a nutrition diary were obtained through a questionnaire. Information on fish and seafood intakes as well as amalgam fillings was also available. The results of the study showed that the museum staff members had quantified concentrations of arsenic (median of 6.4 µg/l; maximum of 339 µg/l), mercury (median of 0.20 µg/l; max of 2.6 µg/l), ß-HCH (median of 0.12 µg/l; max of 0.39 µg/l) and 4,4'-DDT (median of 0.050 µg/l; max of 0.82 µg/l). Despite that all the concentrations were below the established reference values, multivariate regression models were able to show that museum staff members are currently exposed to the aforementioned compounds while handling museum objects. To validate our findings, further studies are required.

Monitoring of arsenic, mercury and organic pesticides in particulate matter, ambient air and settled dust in natural history collections taking the example of the Museum für Naturkunde, Berlin.

Chemical compounds such as arsenic, mercury and organochlorine pesticides have been extensively used as preventive and curative conservation treatments for cultural and biological collections to protect them from pest and mould infestations. Most of the aforementioned compounds have been classified as carcinogenic, mutagenic and teratogenic and represent a health risk for staff exposed to contaminated objects. A total of 30 compounds were analysed in settled dust, particulate matter and surrounding air collected at several locations in the natural history collections and adjacent rooms of the Museum für Naturkunde, Berlin (MfN, Natural History Museum, Berlin, Germany). Gas chromatography and mass spectrometry techniques were used to quantify dichlorodiphenyltrichloroethane (2,4'-DDT; 4,4'-DDT) and their metabolites (2,4'-DDE; 4,4'-DDE; 2,4'-DDD; 4,4'-DDD), hexachlorobenzene (HCB), 3 isomers of hexachlorocyclohexanes (α-HCH, ß-HCH, γ-HCH), the degradation product of γ-HCH with similar toxicological profile, gamma-pentachlorocyclohexene (γ-PCH) and pentachlorophenol (PCP). Atomic absorption spectrometry was used to analyse arsenic and mercury. In order to assess the pathways of contamination with biocides in dust, formations of particulate matter during individual daily work activities, particle number concentrations (PNCs) were measured. Heavy element concentrations found at the MfN were higher than the organochlorine compounds. The maximum concentration of arsenic and mercury in dust was 3507 mg/kg and 32 mg/kg, respectively, and in air, 48 ng/m3 and 1.6 ng/m3, respectively. The maximum concentration of the sum of DDTs in dust was 2 mg/kg (not detected in air); for PCP, the maximum levels in dust and air were 0.65 mg/kg and 10 ng/m3, respectively; for γ-HCH, 130 mg/kg and 320 ng/m3, respectively; and finally, for γ-PCH, 2.1 mg/kg and 230 ng/m3, respectively. Twelve PNC measurements were obtained from seven different collection rooms and the diaries of the participants' activities. PNCs were highly variable between work activities. Higher personal PNCs were associated with activities like opening storage boxes with prepared animals, reading old books or handling objects. This study has shown that taxidermic objects in museum collection may be a cause for arsenic exposure during handling of objects.

[Climate change and child health: A nationwide survey among paediatricians in Germany]. / Klimawandel und Kindergesundheit: eine bundesweite Befragung von Pädiater*innen in Deutschland.

BACKGROUND: Children are a vulnerable group affected by climate change. Paediatricians are important actors in protecting children from climate change-related health risks and in identifying and treating relevant health effects. The main objectives of this study were to determine how paediatricians assess the relevance of climate change-related health impacts, through which channels paediatricians can be reached most effectively, how often climate change-specific prevention measures are implemented and how they are assessed. METHODS: Between February and July 2020, an online survey was conducted among paediatricians. The cross-sectional survey was designed to gather knowledge and attitudes about the relevance of climate change, sources of information and prevention measures. All participants who answered only one question or none at all were excluded. Differences between groups were determined using one-factorial analysis of variance. Correlations were determined using Pearson's bivariate correlation analysis and tested for two-sided significance. RESULTS: A total of 408 questionnaires were analysed. Over 95% of the respondents were paediatricians, with just under half of them working in children's hospitals and a good third in paediatric practices. According to paediatricians, climate change has a relevant impact on children's health. The most significant effects on children's health were considered to be longer and stronger pollen seasons, neophytes and neozoa, Lyme disease and TBE (tick-borne encephalitis, summer meningoencephalitis), UV radiation and air pollutants. Certified training options in professional journals and participation in lectures or workshops at relevant congresses were identified as the two preferred types of training. Especially professional journals as the most frequently used source of information could function as a suitable tool to reach as many paediatricians as possible. 76% of the paediatricians have not yet carried out any corresponding prevention activities, although information activities for parents or children were seen as being effective by 80%. Whereas the possibilities of integrating climate change-oriented prevention activities into everyday practice, were perceived less positively. The most frequent reason given was lack of time. DISCUSSION: To satisfy this future need for knowledge, but also for offerings from paediatricians for patients and their parents, concrete further continuous education and consultancy services must be prepared. In the future, further training offers, including the consultancy services, should be integrated into profession-specific training modules, presented at congresses, and then implemented into paediatricians' daily routine. CONCLUSION: The results of the study illustrate that the topic "climate change and health" has a high relevance for paediatricians and that information measures for parents are considered to be effective. Although paediatricians are concerned with the topic, there is an implementation deficit. Support is needed in the form of intensifying awareness-raising projects and educational modules for paediatricians to move from knowledge to action.

Hot days and Covid-19: Online survey of nurses and nursing assistants to assess occupational heat stress in Germany during summer 2020.

Objectives: Our aim was to identify if working during hot days while wearing Covid-19 related personal protective equipment causes occupational heat stress for nurses and nursing assistants in Germany. Design: Using an online survey, we assessed the impact of hot weather on nurses and nursing assistants working with personal protective equipment. Respondents were recruited by distributing the link to the survey via personal communication, email and various social media channels to nursing staff from hospitals, nursing homes and outpatient care. Results: There were in total 428 participants (18.2% male, 82.5% female), mostly (30.5%) aged between 45 and 55 years. Half of respondents (48.3%) had more than 20 years of experience in nursing. Cardiac, pulmonary, or other pre-existing conditions were reported by 46.2%.Nurses and nursing assistants working in personal protective equipment during hot days were exposed to occupational heat stress. Work was found exhaustive by 96.5% of the participants during those days. 93.0% reported breathing problems and 85.8% reported difficulties with focusing on their work. Many workplaces did not provide adequate heat protection, with distinct differences concerning the amount of prophylactic and heat mitigating measures across institutions. There were significant differences across institutions when it comes to the number of drinks served (p < 0.001), the availability of room thermometers (p < 0.001), the use of mobile cooling devices (p < 0.001) and fans (p < 0.05). Conclusions: Results suggest employers must make more of an effort to provide adequate heat protection for their nursing staff. In order to ensure patient care, there is a need for action; in particular, attention must be paid to the pre-existing health conditions of the nursing staff.