A novel climate and health decision support platform: Approach, outputs, and policy considerations.

BACKGROUND: The adverse health impacts of climate change are increasingly apparent and the need for adaptation activities is pressing. Risks, drivers, and decision contexts vary significantly by location, and high-resolution, place-based information is needed to support decision analysis and risk reduction efforts at scale. METHODS: Using the Intergovernmental Panel on Climate Change (IPCC) risk framework, we developed a causal pathway linking heat with a composite outcome of heat-related morbidity and mortality. We used an existing systematic literature review to identify variables for inclusion and the authors' expert judgment to determine variable combinations in a hierarchical model. We parameterized the model for Washington state using observational (1991-2020 and June 2021 extreme heat event) and scenario-driven temperature projections (2036-2065), compared outputs against relevant existing indices, and analyzed sensitivity to model structure and variable parameterization. We used descriptive statistics, maps, visualizations and correlation analyses to present results. RESULTS: The Climate and Health Risk Tool (CHaRT) heat risk model contains 25 primary hazard, exposure, and vulnerability variables and multiple levels of variable combinations. The model estimates population-weighted and unweighted heat health risk for selected periods and displays estimates on an online visualization platform. Population-weighted risk is historically moderate and primarily limited by hazard, increasing significantly during extreme heat events. Unweighted risk is helpful in identifying lower population areas that have high vulnerability and hazard. Model vulnerability correlate well with existing vulnerability and environmental justice indices. DISCUSSION: The tool provides location-specific insights into risk drivers and prioritization of risk reduction interventions including population-specific behavioral interventions and built environment modifications. Insights from causal pathways linking climate-sensitive hazards and adverse health impacts can be used to generate hazard-specific models to support adaptation planning.

Determinants of butyrylcholinesterase inhibition among agricultural pesticide handlers in Washington State: an update.

OBJECTIVES: Organophosphate (OP) and N-methyl-carbamate (CB) insecticides are used widely in agriculture to manage insect pests of economic importance. Agricultural workers are more likely to suffer exposure because of the widespread use of OP/CBs in agriculture, and pesticide-related illnesses among handlers may be more severe when compared to other farm workers. The goal of this study was to identify occupational and personal characteristics associated with butyrylcholinesterase (BuChE) inhibition in participants recruited from the Washington State Cholinesterase Monitoring Program from 2006 to 2011. METHODS: We conducted a longitudinal study among agricultural pesticide handlers in Washington State during the OP/CB spray season (March-July) over a 6-year period (2006-2011). Linear mixed effects regression models were used to evaluate BuChE inhibition in relation to self-reported occupational and personal characteristics. RESULTS: Relative to pre-season baseline levels, the mean decrease in BuChE activity during the OP/CB spray season over all years of the study period was 3.77% (P < 0.001). Greater BuChE inhibition was observed among handlers who reported using multiple OP/CBs (ß = -2.70, P = 0.045), mixed or loaded OP/CBs (ß = -3.97, P = 0.002), did not store personal protective equipment (PPE) in a locker at work (ß = -3.4, P = 0.014), or did not wear chemical-resistant boots (ß = -16.6, P < 0.001). DISCUSSION AND CONCLUSIONS: The Washington State Cholinesterase Monitoring Program has provided a valuable opportunity to evaluate potential sources of OP/CB exposure among agricultural pesticide handlers. Several previously reported associations were confirmed in the current analysis, which included a larger number of pesticide handlers enrolled over a longer time period. The use of multiple OP/CBs and mixing/loading activities were significant risk factors, and the use of chemical-resistant boots and lockers for PPE storage were protective factors. Our findings point toward logical interventions to reduce exposure such as the implementation of engineering controls for mixing/loading activities, requirements for appropriate footwear, and the regular use of lockers for PPE storage.

Hazards faced by informal recyclers in the squatter communities of Asunción, Paraguay.

BACKGROUND: Informal recycling is widespread in developing countries and involves the collection, sorting, and selling of recyclable materials. Workers are exposed to hazards including the risk of cuts and musculoskeletal injury, infection, exposure to medical waste, and respiratory conditions like bronchitis, pneumonia, and sinusitis and often use insufficient personal protective equipment. OBJECTIVE: Assess the occupational and environmental health hazards faced by informal recyclers working at a landfill in Asunción, Paraguay. METHODS: We surveyed 102 informal recyclers and 12 formal recyclers about occupational health, workplace safety, general health, and household economics. Personal air samples were used to assess respirable dust and nobel metal exposure on 18 workers. RESULTS: Exposures to hazards such as syringes, medical waste, and broken glass as well as risk factors such as eating food found in the trash, lack of personal protective equipment (PPE), and inadequate sanitation were frequent among informal recyclers. Minors under 18 years of age constituted 13% of the workforce and experienced equal or greater exposure to these hazards. Formal recyclers had better access to water, sanitation, PPE, and experienced fewer cuts, injuries, and illnesses than formal recyclers. Informal recyclers were exposed to respirable dust that were considerably higher than they would have been exposed to at home or doing other work in their neighborhood. CONCLUSIONS: Better regulation of sharps and medical waste and the provision of adequate sanitation and personal protective equipment would address the most pressing occupational health issues in this high risk group.