Developing urban resilience in Haifa: preparedness to climate change in health and welfare agencies

Background

Extreme climate events (wildfires, floods, heatwaves, cold spells) are becoming more frequent in the Mediterranean, but adaptation levels in the health and welfare sectors remain low. The city of Haifa in northern Israel is prone to both war and extreme climate events. Focusing on Haifa, we aim to 1) examine local officials' risk perceptions of different extreme events, 2) compare preparedness to war vs. climate events, and 3) conduct a spatial analysis of climate and health vulnerabilities.

Methods

Mixed-Methods: a qualitative component including 30 in-depth interviews with local government health and welfare officials, and a qualitative component that includes mapping vulnerability indicators such as socio-economic status, recipients of welfare allowances, and temperature, focusing on urban heat islands.

Results

The city of Haifa developed a comprehensive resilience policy for war and wildfire. However, there is no awareness or preparedness for other climate events that have not yet been experienced. Similarly, hospitals are prepared for emergencies, but not for extreme climate events. There are no national budget or guidelines for climate adaptation at the city level or in hospitals. Correspondingly, risk perceptions of climate change among health and welfare officials remain low. At the city level, social and climatic vulnerabilities are correlated, so that downtown neighborhoods are characterized by poorer socio-economic, health and welfare conditions, and higher summer temperatures.

Conclusions

Haifa has good preparedness for events that had been experienced in the past. While emergency preparedness provides a good infrastructure for climate change preparedness, awareness and adaptation to the unique aspects of climate change preparations are needed, including reference to related spatial dimensions. Identifying the gaps between preparedness to various emergency events, can contribute to better climate change preparedness at the local level.

Key messages

In the city of Haifa, emergency preparedness exists but is not extended to extreme climate events, and awareness to health risks of climate change remains low in the health and welfare agencies. Learning from emergency preparedness to wars, wildfires and earthquakes may contribute to enhancing preparedness to extreme climate events at the local level.

Ontogenic and seasonal variations of metal content in a small pelagic fish (Trachurus picturatus) in northwestern African waters

Marine organisms are exposed to great changes induced by human beings due, among others, to discharges into the oceans, increasing marine pollution. For this study, 294 specimens of Trachurus picturatus from the Canary Islands were analyzed during a period of 2 years. The concentration of 11 anthropic metals and trace elements was determined in each individual using the Inductively Coupled Plasma Optical Emission Spectrometry (ICP-OES) technique. Statistical analyses were carried out considering the following factors: oceanographic season, maturity of the gonads, size of the specimens, season. Immature specimens had higher concentration in more metals than the mature specimens. This fact may be due to the fact that these specimens require a much higher metabolic rate due to their growth and do not detoxify like mature specimens.

A meta-review of literature reviews assessing the capacity of patients with severe mental disorders to make decisions about their healthcare

BACKGROUND

Determining the mental capacity of psychiatric patients for making healthcare related decisions is crucial in clinical practice. This meta-review of review articles comprehensively examines the current evidence on the capacity of patients with a mental illness to make medical care decisions.

METHODS

Systematic review of review articles following PRISMA recommendations. PubMed, Scopus, CINAHL and PsycInfo were electronically searched up to 31 January 2020. Free text searches and medical subject headings were combined to identify literature reviews and meta-analyses published in English, and summarising studies on the capacity of patients with serious mental illnesses to make healthcare and treatment related decisions, conducted in any clinical setting and with a quantitative synthesis of results. Publications were selected as per inclusion and exclusion criteria. The AMSTAR II tool was used to assess the quality of reviews.

RESULTS

Eleven publications were reviewed. Variability on methods across studies makes it difficult to precisely estimate the prevalence of decision-making capacity in patients with mental disorders. Nonetheless, up to three-quarters of psychiatric patients, including individuals with serious illnesses such as schizophrenia or bipolar disorder may have capacity to make medical decisions in the context of their illness. Most evidence comes from studies conducted in the hospital setting; much less information exists on the healthcare decision making capacity of mental disorder patients while in the community. Stable psychiatric and non-psychiatric patients may have a similar capacity to make healthcare related decisions. Patients with a mental illness have capacity to judge risk-reward situations and to adequately decide about the important treatment outcomes. Different symptoms may impair different domains of the decisional capacity of psychotic patients. Decisional capacity impairments in psychotic patients are temporal, identifiable, and responsive to interventions directed towards simplifying information, encouraging training and shared decision making. The publications complied satisfactorily with the AMSTAR II critical domains.

CONCLUSIONS

Whilst impairments in decision-making capacity may exist, most patients with a severe mental disorder, such as schizophrenia or bipolar disorder are able to make rational decisions about their healthcare. Best practice strategies should incorporate interventions to help mentally ill patients grow into the voluntary and safe use of medications.

Macroelement, trace element, and toxic metal levels in leaves and infusions of yerba mate (Ilex paraguariensis)

Mate is an infusion made from the dried leaves of yerba mate (Ilex paraguariensis). Yerba mate may be an important source of essential elements but could contain toxicologically relevant metals. Macroelements (Ca, Mg, Na, K), trace elements (B, Ba, Sr, V, Li, Ni, Fe, Zn, Cu, Cr, Co, Mn, Mo), and toxic metals (Al, Cd, Pb) content have been determined in 32 samples of yerba mate by ICP-OES (inductively coupled plasma-optical emission spectrometry) with the aim of determining the element content of yerba mate leaves and the influence of temperature in the extraction of these elements from the plant to the infusion, and estimating the dietary intake for each element studied. The highest element contents have been found in infusions prepared with hot distilled water (70-75 °C); the most noteworthy are K (303 mg/L), Mn (4.85 mg/L), and Al (4.52 mg/L). The consumption recommended by the producers (500 mL infusion/day) contributes significantly to the daily intake of essential elements such as Mn, Mg, and Cu. This consumption does not pose a health risk, although it is necessary to assess the risk/benefit of Ni intake from mate consumption for people with impaired renal function (500 mL/day accounts for 52.2% of the TDI).

Trace Element Levels in Vegetable Sausages and Burgers Determined by ICP-OES

The consumption of vegetable sausages or hamburgers is growing. The consumption of this type of product has increased exponentially in recent years for two main reasons: the rejection of meat consumption and the search for healthier foods. Vegetable sausages are relatively new products on the market and, as with other foods, they may contain trace elements, both essential and toxic. Thus, the objective of this work is the determination of the content of trace elements (B, Ba, Co, Cr, Cu, Fe, Li, Mn, Mo, Ni, Sr, V, Zn, Al, Cd, Pb) in 67 samples of vegetable sausages and burgers (27 samples of vegetable sausages and 39 samples of vegetable burgers) by means of ICP-OES (inductively coupled plasma optical emission spectrometry). The highest trace element levels were found in the sausage's samples, which remarkably are the Fe (14.1 mg/kg wet weight), Al (5.10 mg/kg ww), and Pb (0.05 mg/kg ww) content. Meanwhile, the levels of Zn (8.35 mg/kg ww), Mn (5.04 mg/kg ww), and Sr (2.77 mg/kg ww) were higher in burger's samples. The dietary exposure reveals that the consumption of 100 g/day of these products offers an important intake of Fe, Mn, and Cu. About the toxic trace elements, the consumption of the vegetable sausages (100 g/day) represents an intake of 14.6% of the TDI (tolerable daily intake) of Pb and sets in 0.5 μg/kg body weight/day. The consumption of 100 g/day of vegetable sausages and burgers does not pose a health risk. However, a higher consumption can carry a risk; for that reason, it is necessary to set a maximum level of certain elements in this kind of products.

Fluoride levels in supply water from a volcanic area in the Macaronesia region

Fluoride is a widely distributed ion in the environment and, consequently, in water as well. High levels of fluoride in waters can be found in the Canary Islands because of their volcanic origin. Due to the risk and detrimental effects associated with a high fluoride intake, the content of this ion has been potentiometrically determined in 256 supply water samples from the islands of Tenerife, El Hierro, and La Palma, using a fluoride selective ion electrode. Fluoride mean concentration found on Tenerife is 4.22 mg/L, exceeding the parametric value of 1.5 mg/L set out in Spanish legislation. The consumption of 2 L of water from the studied municipalities of Tenerife would mean there is an excessive fluoride intake. The consumption of this water poses a serious risk to health. It is necessary to take action aimed at reducing the level of fluoride in the north of the island of Tenerife.

Human exposure assessment to macro- and trace elements in the most consumed edible seaweeds in Europe

Seaweed consumption has increased considerably in Europe as a result of new trends in food. The macroelement (Na, Ca, K, Mg) and trace element (B, Ba, Co, Cr, Cu, Fe, Li, Mn, Mo, Ni, Sr, V, Zn) levels in different species of edible brown seaweeds were determined by inductively coupled plasma optical emission spectrometry (ICP-OES). European Himanthalia elongata species had the highest recorded concentrations of K (57480 mg/kg dry weight). Asian Undaria pinnatifida species had the highest Fe content (58.8 mg/kg dw). Five grams/day of dehydrated seaweed of the Asian U. pinnatifida species mainly contributes to the admissible daily intake of Mg (9.32% adults) and Na (7.05% adults). In any case which exceeds the maximum intake values of any of the elements analyzed, the macro- and trace element levels can vary considerably in a short period of time, so it is necessary to assess the toxic risk in edible seaweeds.

Toxic (Al, Cd, and Pb) and trace metal (B, Ba, Cu, Fe, Mn, Sr, and Zn) levels in tissues of slaughtered steers: risk assessment for the consumers

The levels of toxic metals (Al, Cd, Pb) and trace metals (B, Ba, Cu, Fe, Mn, Sr, Zn) were analyzed by inductively coupled plasma optical emission spectrometry (ICP-OES) in the muscle (sirloin and chuck) and liver from a total of 180 samples of steers (less than 2 years old) (Bos taurus) of foreign and local origin slaughtered on the island of La Palma (Canary Islands, Spain). As regards toxic metals, Al was the metal with the highest contents in both tissues of the foreign steers (3.75 mg/kg in the muscle and 55.3 mg/kg in the liver) and the local steers (5.60 mg/kg in the muscle and 8.65 mg/kg in the liver). In conclusion, the present study confirmed that beef is a source of trace elements, mainly Fe and Zn. In addition, the consumption of this type of beef did not show significant intakes of toxic metals (Al, Cd, and Pb) and, therefore, the consumption of the steer muscle and liver does not pose a toxicological risk for Spanish consumers.

Toxic Metals and Trace Elements in Artisanal Honeys from the Canary Islands

Honey is a natural product made by honey bees from the nectar of flowers or secretions produced by other living plant parts. The metal content of the honeys is related to the levels of metals in the environment. Due to the importance of honey in the human diet and the increase of environmental pollution, it is necessary to determine the content of metals in honey to evaluate the toxicological risk derived from its consumption. The objective of this study was to determine the content of 20 metals (Al, B, Ba, Ca, Cd, Co, Cr, Cu, Fe, K, Li, Mg, Mn, Mo, Na, Ni, Pb, Sr, V, and Zn) in different samples of artisanal honey from the Canary Islands (Spain) in order to evaluate the dietary intake derived from the consumption of these honeys. A total of 161 samples of different types of Canary honey were analyzed by ICP-OES (inductively coupled plasma-optical emission spectrometry). K (825 mg/kg) was the macroelement found in highest concentration, while B (4.25 mg/kg) was the trace element with the highest mean concentration. Al (3.33 mg/kg) was the most abundant toxic metal, followed by Pb (0.040 mg/kg) and Cd (0.002 mg/kg). A mean consumption of 25 g/day of honey mainly contributes to the recommended daily intake of Cu (1.34% adults) and K (0.67% adults). As regards the toxic metals, the contribution percentage to the TDI (tolerable daily intake) of Pb at 2.92% for adults is noteworthy. However, the consumption of honey does not imply a high intake of metals and, therefore, does pose a risk to the health of adult men and women.

Placental levels of metals and associated factors in urban and sub-urban areas of Seville (Spain)

Environmental exposure to metals among women, revealed their adverse effects on pregnancy. The fetus is exposed to these toxic elements only via the placenta which are able to accumulate there or cross it, compromising the protective functions of this organ. Numerous studies have shown associations between the prenatal exposition to some metals and an impact on cognitive, motor and intellectual development of the child. Sixty two placental samples were taken at delivery to determine the mineral content (Al, B, Ba, Ca, Cd, Cr, Cu, Fe, K, Li, Mg, Mn, Mo, Na, Ni, Pb, Sr, V, Zn) by ICP-OES. Among these metals, essential ones (B, Ca, Cu, Fe, Mg, Mn, Mo, Na, Zn) can have health beneficial effects at low levels however, in high concentration are potentially toxic. On the other hand, elements such as Al, Cd, Pb, are classified as toxic metals, no matter what its concentration is. The aim of this study is to find the potential relationships between these metals levels, newborn's parameters, pregnancy details and the epidemiologic information obtained using a questionnaire data from the participant pregnant women from Seville (Spain). The main maternal determinant of detectable placenta Cd levels was smoking during pregnancy. Other maternal factors that may affect placenta metal levels were gestational age (Al, B, Ba, and Pb) or dietary supplement (Fe). It has to be stressed that our results have to be interpreted with caution, because of the small study group and the low exposure levels, along with the lack of information on potential sources of exposure to these metals. The use of placenta samples obtained at delivery can be considered strength of this study since the concentration of some metals in placenta can indicate the extent of maternal exposure during gestation.

Toxic metals (Al, Cd, Pb and Hg) in the most consumed edible seaweeds in Europe

Algae are becoming increasingly common because of their importance in vegan and vegetarian diets. Although they are a source of essential minerals, vitamins and antioxidants, these marine organisms have a high absorption capacity that can lead to the accumulation of toxic metals which are dangerous in humans. The objective of this study is to determine the content of toxic metals (Al, Cd, Pb and Hg) in edible seaweed samples marketed in Spain (Europe) to assess the toxicological risk from the intake of these metals. A total of 73 European and Asian algae samples marketed in Tenerife (Canary Islands, Spain) were analyzed by ICP - OES (Inductively Coupled Plasma - Optical Emission Spectrometry) and by CV-AAS (Cold Vapor - Atomic Absorption Spectrophotometry). The major toxic metal was Al, whose highest level was recorded in seaweed salad (57.5 mg Al/kg dry weight). Regarding the origin, the highest concentrations of Al (38.9 mg/kg dw), Cd (0.59 mg/kg dw) and Pb (0.40 mg/kg dw) were found in Asian algae, which may be due to the high levels of industry in the Asian countries. However, the highest concentration of Hg (0.017 mg/kg dw) was found in European algae. The consumption of 5 g of dehydrated seaweed per day represents a percentage of contribution to the tolerable weekly intake of Cd of 22.7%, this percentage may entail a risk when considering total Cd intake. However, the consumption of 5 g a day of dehydrated seaweed would not, pose a risk to the health of adults.

Metal Contents in the Most Widely Consumed Commercial Preparations of Four Different Medicinal Plants (Aloe, Senna, Ginseng, and Ginkgo) from Europe

Medicinal plants like Aloe barbadensis, Ginkgo biloba, Panax ginseng, and Cassia angustifolia are being increasingly used but self-medication is a major public health challenge because of their numerous interactions. Furthermore, dietary exposure to metals through the consumption of these commercial preparations should be evaluated. Some of these metals may have a nutritional interest but others are metals of toxicological relevance. The content of essential and toxic metals has been analyzed by inductively coupled plasma optical emission spectrometry (ICP-OES) in 80 samples of both organically and conventionally grown aloe, senna, ginseng, and ginkgo pharmaceutical formats to establish their metallic profile, to evaluate their nutritional value and to assess the toxic metal risk resulting from their consumption. Ca (9181 mg/kg ww) in senna, Fe (30.0 mg/kg ww) in ginseng, and Al (15.7 mg/kg ww) in ginseng are noteworthy. The consumption of 9 g/day of ginkgo represents 6.44% of the RDI set for Ca. The consumption of 25 mL/day of aloe syrup is 3.06% (men) and 1.52% (women) of the RDI of Fe. Al exposure from 25 mL/day of aloe consumption is 2.71% of its TDI. Considering the dosages recommended by the manufacturers, the intake of toxic metals does not pose a health risk but the intake of essential metals is worth mentioning.

Exposure to Metals from Artisanal Cheeses Made with Goat's Milk

Cheeses are an important source of essential elements. Nevertheless, the level of some metals could pose a health risk. Therefore, the concentration of trace elements and toxic metals (Cr, Cu, Li, Ni, Sr, Pb, Cd, and Al) has been determined in artisanal cheeses from different geographical locations, and the intake of these metals from cheese consumption has been evaluated. The metal concentration was determined in a total of 90 cheese samples from different locations by using inductively coupled plasma atomic emission spectroscopy. The highest concentration of Al (35.1 ± 4.42 mg/kg, wet weight) was found in artisanal cheeses from Zamora (Spain), followed by Sr (6.85 ± 0.35 mg/kg, wet weight) in artisanal cheeses from Cadiz (Spain). A daily consumption of 23.2 g of cheese provides a significant dietary contribution for Al of 0.82% of its tolerable weekly intake of 1 mg/kg of body weight per week. Canary Islands cheeses have a higher metal content than the non-Canary cheese, which could be because of the volcanic characteristics of the island soils. The intake of toxic metals and trace elements poses no risk to the health of adults.

Metal Concentrations in Wild-Harvested Phaeophyta Seaweed from the Atlantic Ocean (Canary Islands, Spain)

Seaweeds are being consumed more often worldwide and are a source of essential minerals, fiber, vitamins, amino acids, and various bioactive compounds that have many beneficial effects on human health. However, marine pollution and the high capacity of seaweed to absorb metals may mean this food can also be dangerous to human health. The concentrations of some trace elements (B, Ba, Fe, Ni, Li, and V) and toxic metals (Al, Cd, and Pb) were determined in various species of wild seaweeds in the Phaeophyta group of brown algae from the Atlantic Ocean. Inductively coupled plasma atomic emission spectrometry revealed high concentrations of Al (256 mg/kg dry weight), Pb (3.92 mg/kg dry weight), and Cd (0.20 mg/kg dry weight) in Padina pavonica. Pb contributed the most to the tolerable daily intake (TDI) of toxic metals in these samples; 57.2 and 45.3% of the TDI for Pb was found in 5 g of dehydrated P. pavonica and Halopteris scoparia, respectively. This percent contribution is half of the recommended TDI for this metal, which is 34.24 μg/day; therefore, high consumption of these species is discouraged. The maximum TDIs established by various institutions for the other metals were not exceeded from the daily consumption of 5 g of the other dehydrated seaweeds evaluated in this study.

Assessment of mercury content in Panga (Pangasius hypophthalmus)

Panga (Pangasius hypophthalmus), originating from Vietnam, is one of the most consumed fish because of its low cost, mild taste and presentation (fillets without skin and bones). Nevertheless, due to the high levels of contamination of the rivers where it lives, and to the fact that the panga is a predator, whereby it will accumulate a higher mercury concentration, the main objectives of the present study were to evaluate the toxic risk from mercury ingestion as a result of the consumption of this fish. A total of 80 frozen panga samples natural and marinade from different commercial establishments have been analyzed using cold vapour atomic absorption spectrophotometry (CV-AAS). The results obtained show a wide range of mercury concentrations between 0.10 and 0.69 mg/kg, with an average value of 0.22 mg/kg. In addition, it has been found that the average mercury concentration in the marinated presentation (0.18 mg/kg) is higher than that obtained in the natural panga (0.16 mg/kg). However, no significant differences were found between commercial establishments or in the presentation formats, with the conclusion that they did not influence the mercury content in the samples. Assuming a weekly consumption of 350 g of panga, the contribution rate to Tolerable Weekly Intake (TWI) of mercury (4 μg/kg bw/week) is 32% and 27.5% for women and men, respectively. Based on the results obtained in this study, an exhaustive control of the mercury content in this type of fish is necessary. In addition, a consumption restriction to children will be established.

Trace element and toxic metal intake from the consumption of canned mushrooms marketed in Spain

Mushrooms are a valuable foodstuff because they are an important source of fiber and essential amino acids, but they have a great capacity to capture metals from substrate. Due to this reason, the content of 14 metals (B, Ba, Cr, Cu, Fe, Li, Mo, Ni, Sr, V, Zn, Al, Cd, Pb) of 100 samples of canned mushrooms grown in Spain were analyzed by inductively coupled plasma atomic emission spectroscopy. Fe (9.55 mg/kg) was the most notable trace element, followed by Zn (2.39 mg/kg). The most abundant toxic metal was Al (17.80 mg/kg). Significant statistical differences between the absorption of metals have been observed when comparing species. Lentinula edodes and Lactarius deliciosus are the species which had the highest metal contents. Taking the average consumption 300 g per day for adults into account, the exposure to trace toxic metals from the consumption of the studied mushrooms does not pose a health risk. However, contribution percentages of Pb (87.6%) and Al (59.2%) found in Lentinula edodes and Pholiota nameko samples, respectively, are near the maximum intake.

Potentiometric Determination of Fluoride Concentration in Beers

Beer is a widely consumed drink throughout the world, and because its manufacture involves the use of water, beer can be, in some cases, a source of fluorides. For this reason, the objective of this study was to determine the concentration of fluorides in 50 samples of beers from different sources sold in two different types of container (aluminum can and glass bottle). The possible significant differences between the different types of packaging and the intake of fluoride from the consumption of these beers were evaluated. The concentration of fluoride in beers has been determined using the potentiometric method of fluoride determination by standard addition. The concentration of fluoride ranged between 0.06 and 1.77 mg/L. In general, the concentration was below 1 mg/L, except for three beer samples from Ireland and the USA, whose concentration was over 1.5 mg/L. No significant differences were found between the types of packaging. The contribution of fluoride to the diet from beer consumption is not high (<27%); however, it is necessary to warn consumers whenever they are in areas of high concentrations of fluoride in the water supply.

Correction to: Potentiometric Determination of Fluoride Concentration in Beers

The original version of the article unfortunately contained a mistake. The first author Inmaculada Gutiérrez was omitted.

Metal Concentrations in Samples of Frozen Cephalopods (Cuttlefish, Octopus, Squid, and Shortfin Squid): An Evaluation of Dietary Intake

Cephalopods are an important source of nutrients and some of the most widely consumed marine foods. However, because of contamination of the oceans and the bioaccumulative nature of toxic metals, these foods may pose a health risk. For this reason, the concentrations of some trace elements (chromium [Cr], lithium, strontium [Sr], copper [Cu], and nickel) and toxic metals (aluminum [Al], cadmium, and lead) were determined in 65 frozen samples of cuttlefish, octopus, common squid, and shortfin squid by inductively coupled plasma optical emission spectrometry to evaluate dietary intake and toxic risk. Sr was the major trace element (3.03 mg/kg) in cuttlefish; however, Cu (1.57 mg/kg) was found in the highest concentration in common squid. Among the toxic metals, Al had the highest concentration (3.09 mg/kg) in common squid. Al can pose an important health risk to individuals with kidney problems and to children because these groups are most vulnerable to the toxic effects. Significant differences among the four cephalopod types were found in the concentrations of most of the metals examined. Taking into account the average consumption of cephalopods, the contribution of toxic metals does not pose a risk to the health of adults.

Determination of Fluoride in Organic and Non-organic Wines

Fluorine is an element of great importance to human health, as it is considered to be an essential element. However, both a deficiency and an excess, it can cause various problems. It is for this reason that values have been established regarding the recommended daily intake (RDI) and acceptable daily intake (ADI). The largest source of incorporation of fluoride is water, but it can be found in other foods and beverages, such as vegetables, tea, and wine. The aim of the study was to establish the fluoride concentration in organic and non-organic wines from different appellations of origin of the Canary Islands and mainland Spain, in order to assess the contribution of fluoride and toxic risk. A total of 53 samples of red, white, and rosé wines, both organic and non-organic, from different appellations of origin were analyzed. They were analyzed by potentiometric determination with ion-selective electrode for fluoride using the method of standard addition. The wines analyzed are within the recommended limits set by the International Organisation of Vine and Wine. RDI is not exceeded for adults, taking into account the data provided by the Spanish Agency for Consumer Affairs, Food Safety and Nutrition on the average consumption of "table wines" in Spain. Fluoride intake from wine poses no risk to the health of adults. The fluoride concentration of organic and non-organic wines is within the range of 0.03 to 0.70 mg/L.