Mortality and morbidity in populations in the vicinity of coal mining: a systematic review

Establishing the health and wellbeing needs of mining host community in Brazil, Chile and Peru: a mixed-method approach to identify priority areas for action to help communities meet their SDG3 targets

BACKGROUND

The global mining industry is an important partner in advancing the 2030 Agenda for Sustainable Development. In 2018, Anglo American plc published their Sustainable Mining Plan, containing a goal for improving health and wellbeing aligned with the Sustainable Development Goal 3 (SDG3) targets. Having formed an independent multidisciplinary research consortium, we designed and implemented a mixed-methods approach to attain a deeper understanding of SDG3 priorities within the local context of communities hosting Anglo American mining operations located in Latin America.

METHODS

In 2019, within the host communities of three mining operations in Chile, three in Brazil, and one in Peru, we conducted a qualitative study which included stakeholder workshops and key informant interviews. We also quantitatively appraised existing health data. Findings emerging from the qualitative and quantitative assessments were compared to identify health and wellbeing priority areas for action relevant to each community.

RESULTS

Across the three countries, 120 people took part in workshops and 35 in interviews. In these workshops and interviews, non-communicable diseases (SDG3.4), harmful alcohol consumption (SDG3.5), and pollution, particularly air pollution (SDG3.9), were consistently identified as areas for priority action. There were similarities in the reporting of individual, interpersonal, community, societal, and structural factors underlying these priority areas across the different communities. The availability of quantitative data was generally good at the state level, becoming increasing sparse as we focused on smaller geographies. The priorities identified in the quantitative assessments generally aligned with those highlighted in the qualitative data.

CONCLUSIONS

We highlight the importance of engaging with local populations to understand and address health needs. To address the priorities identified, intervention packages tailored to the specific needs of host communities, that tackle associated upstream societal level factors, are required. To facilitate this, appropriate monitoring systems and epidemiological investigations should be implemented to better understand the local context and quantify health issues. In the host communities, it is essential for the mining sector to be a key health partner in promoting integrated programmes that contribute to achieving the priority objectives and targets aligned with the SDG3 agenda.

Analyses of oxidative DNA damage among coal vendors via single cell gel electrophoresis and quantification of 8-hydroxy-2'-deoxyguanosine

Looking at the development status of Nigeria and other developing nations, most low-income and rural households often use coal as a source of energy which necessitates its trade very close to the communities. Moreover, the effects of exposure to coal mining activities are rarely explored or yet to be studied, not to mention the numerous street coal vendors in Nigeria. This study investigated the oxidative stress levels in serum and urine through the biomarker 8-OHdG and DNA damage via single cell gel electrophoresis (alkaline comet assay). Blood and urine levels of 8-OHdG from 130 coal vendors and 130 population-based controls were determined by ELISA. Alkaline comet assay was also performed on white blood cells for DNA damage. The average values of 8-OHdG in serum and urine of coal vendors were 22.82 and 16.03 ng/ml respectively, which were significantly greater than those detected in controls (p < 0.001; 15.46 and 10.40 ng/ml of 8-OHdG in serum and urine respectively). The average tail length, % DNA in tail and olive tail moment were 25.06 μm, 18.71% and 4.42 respectively for coal vendors. However, for controls, the average values were 4.72 μm, 3.63% and 1.50 for tail length, % DNA in tail and olive tail moment respectively which were much lower than coal vendors (p < 0.001). Therefore, prolonged exposure to coal dusts could lead to higher serum and urinary 8-OHdG and significant DNA damage in coal vendors observed in tail length, % DNA in tail, and olive tail moment by single cell gel electrophoresis. It is therefore established that coal vendors exhibit a huge risk from oxidative stress and assessment of 8-OHdG with single cell gel electrophoresis has proven to be a feasible tool as biomarkers of DNA damage.

Pollution and risk assessment of potentially toxic elements in soils from industrial and mining sites across China

Potentially toxic elements in soils (SPTEs) from industrial and mining sites (IMSs) often cause public health issues. However, previous studies have either focused on SPTEs in agricultural or urban areas, or in a single or few IMSs. A systematic assessment of the pollution and risk levels of SPTEs from IMS at the national scale is lacking. Here, we obtained SPTE (As, Cd, Cr, Cu, Hg, Ni, Pb, and Zn) concentrations from IMSs across China based on 188 peer-reviewed articles published between 2004 and 2022 and quantified their pollution and risk levels using the pollution index and risk assessment model, respectively. The results indicated that the average concentrations of the eight SPTEs were 4.42-270.50 times the corresponding background values, and 19.58% of As, 14.39% of Zn, 12.79% of Pb, and 8.03% of Cd exceeded the corresponding soil risk screening values in these IMSs. In addition, 27.13% of the examined IMS had one or more SPTE pollution, mainly distributed in the southwest and south central China. On the examined IMSs, 81.91% had moderate or severe ecological risks, which were mainly caused by Cd, Hg, As, and Pb; 23.40% showed non-carcinogenic risk and 11.70% demonstrated carcinogenic risk. The primary exposure pathways of the former were ingestion and inhalation, while that for the latter was ingestion. A Monte Carlo simulation also confirmed the health risk assessment results. As, Cd, Hg, and Pb were identified as priority control SPTEs, and Hunan, Guangxi, Guangdong, Yunnan, and Guizhou were selected as the key control provinces. Our results provide valuable information for public health and soil environment management in China.

Indigenous communities and the mental health impacts of land dispossession related to industrial resource development: a systematic review

Globally, many resource extraction projects such as mines and hydroelectric dams are developed on the territories of Indigenous Peoples. Recognising land as a determinant of Indigenous Peoples' health, our objective is to synthesise evidence about the mental health impacts on Indigenous communities who experience land dispossession due to industrial resource development (mining, hydroelectric, petroleum, and agricultural). We systematically reviewed studies that focused on Indigenous land dispossession in Australia, Aotearoa (New Zealand), North and South America, and the Circumpolar North. We searched Scopus, Medline, Embase, PsycINFO, and Global Health on OVID for peer-reviewed articles published in English from database inception to Dec 31, 2020. We also searched for books, research reports, and scholarly journals specialising in Indigenous health or Indigenous research. We included documents that reported on primary research, focused on Indigenous Peoples in settler colonial states, and reported on mental health and industrial resource development. Of the 29 included studies, 13 were related to hydroelectric dams, 11 to petroleum developments, nine to mining, and two to agriculture. Land dispossession due to industrial resource development had predominantly negative mental health impacts on Indigenous communities. The impacts were consequences of colonial relations that threatened Indigenous identities, resources, languages, traditions, spirituality, and ways of life. Health impact assessment processes in industrial resource development must expressly consider risks and potential impacts on mental health and respect Indigenous rights by making knowledge about mental health risks a central component to decisions about free, prior, and informed consent.

Just Transition for Healthy People on a Healthy Planet

The definition of Just Transition in recent years has been shaped by the political and ideological leanings of multiple stakeholders. Labor movements look at a Just Transition that secures workers' rights and jobs; environmental justice groups include whole communities impacted by fossil fuel in their description; multilateral institutions, investors, and transnational corporations see it through lenses of economics, financial support, and investment. However, a perspective on health is missing in all these approaches. The COVID-19 pandemic has established the importance of health-based planning, making evident the co-dependence of ecological health and human well-being. The debilitating post-pandemic economic crisis has reiterated the interlinkage between economics, public health, and the environment. This document posits that health is the overlapping but missing link between the different movements' dream for Just Transition into an equitable world, and to heal people and the planet damaged by fossil fuels. We need Just Transition that has holistic health systems and accessible healthcare services at its core.

Emissions monitoring and carcinogenic risk assessment of PM10-bounded PAHs in the air from Candiota's coal activity area, Brazil

The city of Candiota contains a great amount of coal resources. Coal activities, including coal combustion, are major releasers of polycyclic aromatic hydrocarbons (PAHs). The PAHs are considered priority air pollutants regarding their large carcinogenic potential. So, the carcinogenic risk assessment of populations living near areas with PAH sources is mandatory. This study aimed to evaluate the carcinogenic health risk of the PAH inhalation exposure of individuals living in Candiota City. A total of 158 individuals were enrolled in the study. Monitoring of PAH and meteorological parameters were carried out, and the health risk assessment was determined through the benzo(a)pyrene equivalent toxic equivalent quotient (BaP-TEQ) and the incremental lifetime cancer risk (ILCR) estimation. The coal activity area of Candiota demonstrated an annual PAH concentration of 27.7 ng/m³, PM10 concentration of 26.3 µg/m³, SO₂ concentration of 9.5 µg/m³, a BaP-TEQ value of 0.3 ng/m³, and a daily inhalation of 62.4 ng/day. The comparison among seasons showed no difference in PAH concentration and BaP-TEQ. It was observed ILCR values of 2.8 × 10^-6 and 2.6 × 10^-6 for estimation based on reference and real values, respectively, and these levels were above the reference limit of 10^-6, indicating cancer risk. Therefore, an epidemiological survey of cancer cases in the region and its relationship with environmental exposure and air pollutants levels must be required.

Comparative effectiveness of contact tracing interventions in the context of the COVID-19 pandemic: a systematic review

Contact tracing is a non-pharmaceutical intervention (NPI) widely used in the control of the COVID-19 pandemic. Its effectiveness may depend on a number of factors including the proportion of contacts traced, delays in tracing, the mode of contact tracing (e.g. forward, backward or bidirectional contact training), the types of contacts who are traced (e.g. contacts of index cases or contacts of contacts of index cases), or the setting where contacts are traced (e.g. the household or the workplace). We performed a systematic review of the evidence regarding the comparative effectiveness of contact tracing interventions. 78 studies were included in the review, 12 observational (ten ecological studies, one retrospective cohort study and one pre-post study with two patient cohorts) and 66 mathematical modelling studies. Based on the results from six of the 12 observational studies, contact tracing can be effective at controlling COVID-19. Two high quality ecological studies showed the incremental effectiveness of adding digital contact tracing to manual contact tracing. One ecological study of intermediate quality showed that increases in contact tracing were associated with a drop in COVID-19 mortality, and a pre-post study of acceptable quality showed that prompt contact tracing of contacts of COVID-19 case clusters / symptomatic individuals led to a reduction in the reproduction number R. Within the seven observational studies exploring the effectiveness of contact tracing in the context of the implementation of other non-pharmaceutical interventions, contact tracing was found to have an effect on COVID-19 epidemic control in two studies and not in the remaining five studies. However, a limitation in many of these studies is the lack of description of the extent of implementation of contact tracing interventions. Based on the results from the mathematical modelling studies, we identified the following highly effective policies: (1) manual contact tracing with high tracing coverage and either medium-term immunity, highly efficacious isolation/quarantine and/ or physical distancing (2) hybrid manual and digital contact tracing with high app adoption with highly effective isolation/ quarantine and social distancing, (3) secondary contact tracing, (4) eliminating contact tracing delays, (5) bidirectional contact tracing, (6) contact tracing with high coverage in reopening educational institutions. We also highlighted the role of social distancing to enhance the effectiveness of some of these interventions in the context of 2020 lockdown reopening. While limited, the evidence from observational studies shows a role for manual and digital contact tracing in controlling the COVID-19 epidemic. More empirical studies accounting for the extent of contact tracing implementation are required.

The impacts of mining on the food sovereignty and security of Indigenous Peoples and local communities: A global review

Mineral extraction areas represent an environmental, social, and also a food sovereignty challenge for several countries. Indigenous Peoples and local communities (IPLC) are particularly vulnerable to the impacts of mining activities, particularly those that affect their lands and waters. At the global level, scientific evidence on the impacts of mining on the food sovereignty of IPLC is meagre, scattered, and fragmented across disciplines and geographic regions. This study aims to assess whether factors such as mining, trace elements contamination, social inequality, lack of environmental deficitary environmental policy and practice, and socio-environmental conflicts directly impact the food sovereignty of IPLC worldwide. Through a comprehensive literature review of 403 articles, we mapped globally the impacts of mining activities on the food sovereignty of IPLC. Our results reveal that the combination of mining, social inequality and weak environmental strategies impinge negatively on the food sovereignty of IPLC. A hundred and six articles reviewed contained a detailed ecotoxicological analysis of food resources used by IPLC in mining areas. Of all documented species, 52.9 % were vascular plants, 40.3 % were fish and 6.8 % were mammals, presenting substantial scientific evidence of the contamination of food systems of IPLC as a direct result of mining. Given the magnitude of the evidence presented in this review, we propose strategic policy actions to address the impacts of mining on IPLC food sovereignty, such as the strengthening of social, cultural, and environmental safeguards in the mining sector, which should include provisions for the protection of the food systems of IPLC and their culturally-valued food resources, as well as monitoring of contaminant concentrations in the environment and in culturally-valued food resources.

Pollution characteristics and probabilistic health risk of potentially hazardous elements in soils near a typical coal mine in Panzhihua City, Southwest China

This study first assessed the pollution characteristics and probabilistic health risks of potentially hazardous elements (PHEs) in soils from the Dabaoding coal mining area in southwest China using Monte Carlo simulation. Experimental results showed that Cd was moderately enriched in soils, while Ni, Cr, and V were slightly enriched. However, the geoaccumulation index (I_geo) illustrated that the coal mining area had a low level of Cd pollution. PHEs produced a very high ecological risk to soils in the coal mining area, whereas Cd showed the highest contribution (82.56%). The mean hazard index of all soil PHEs was 7.45E - 02 and 4.18E - 01 for local adults and children, respectively, all of which were obviously lower than the maximum acceptable level of 1.0. However, Monte Carlo simulation analysis indicated that 1.08% of noncarcinogenic risk values for local children still exceeded the maximum acceptable level. Additionally, 10.84% and 18.40% of the total carcinogenic risk values for local adults and children, respectively, exceeded the threshold of 1E - 04. Indeed, Cr and Ni had the highest contributions to noncarcinogenic and carcinogenic risks, respectively. These findings suggest that Cd, Cr, and Ni should be identified as priority pollutants in coal mining areas. This study also provides valuable implications for policy-makers and environmental engineers, proposing efficient policies for better soil pollution control and remediation strategies in coal mining areas.

Environmental Health: A Position Paper From the American College of Physicians

Environmental health refers to the health effects associated with environmental factors, such as air pollution, water contamination, and climate change. Environmental hazards are associated with poor outcomes in common diseases, including diabetes and heart disease. In this position paper, the American College of Physicians (ACP) seeks to inform physicians about environmental health and offers policymakers recommendations to reduce the adverse health consequences of climate change, improve air and water quality, reduce exposure to toxic substances, and address environmental injustice. ACP affirms that all communities, including people of color, people with low income, and marginalized populations, deserve to live in a healthy environment.

Gestational and Neonatal Outcomes in Cities in the Largest Coal Mining Region in Brazil

Brazil has one of the largest mineral coal reserves in the world. More than 40% of this ore is in the Candiota Mine, in the extreme south of Brazil, which was previously identified as a hotspot of environmental pollution. In addition, an important part of Brazil's population suffers from socioeconomic vulnerability. Since there is no information on unfavorable gestational and neonatal outcomes associated with these problems, we conducted a cross-sectional study with 1950 mother-child binomials, aiming to evaluate the association between these outcomes and air pollution as well as socioeconomic, demographic and health variables in seven cities in the region. Of the total births, 11.6% were preterm and 9.5% of neonates had low birth weight (<2500 g). These conditions were also associated with skin color, previous abortions, birth type and prenatal care, as well as exposure to higher levels of coarse particulate matter (PM₁₀) during the first trimester of pregnancy. Regarding air pollutants, although the daily limits for PM₁₀ were exceeded on less than 5% of days, the annual average overtook the values proposed by WHO. Thus, we concluded that prematurity and low birth weight in this region are related to air pollution, and to socioeconomic variables and health care.

Impact on mental health and wellbeing in Indigenous communities due to land loss resulting from industrial resource development: protocol for a systematic review

BACKGROUND

Indigenous Peoples are impacted by industrial resource development that takes place on, or near, their communities. Existing literature on impacts of industrial resource development on Indigenous Peoples primarily focus on physical health outcomes and rarely focus on the mental health impacts. To understand the full range of long-term and anticipated health impacts of industrial resource development on Indigenous communities, mental health impacts must be examined. It is well-established that there is a connection between the environment and Indigenous wellbeing, across interrelated dimensions of mental, physical, emotional, and spiritual health.

METHODS

This paper identifies how the Community Advisory Team and a team of Indigenous and settler scholars will conduct the review. The literature search will use the OVID interface to search Medline, Embase, PsycINFO, and Global Health databases. Non-indexed peer-reviewed journals related to Indigenous health or research will be scanned. Books and book chapters will be identified in the Scopus and PsycINFO databases. The grey literature search will also include Google and be limited to reports published by government, academic, and non-profit organizations. Reference lists of key publications will be checked for additional relevant publications, including theses, dissertations, reports, and other articles not retrieved in the online searches. Additional sources may be recommended by team members. Included documents will focus on Indigenous Peoples in North America, South America, Australia, Aotearoa New Zealand, and Circumpolar regions, research that reports on mental health, and research that is based on land loss connected to dams, mines, agriculture, or petroleum development. Literature that meets the inclusion criteria will be screened at the title/abstract and full-text stages by two team members in Covidence. The included literature will be rated with a quality appraisal tool and information will be extracted by two team members; a consensus of information will be reached and be submitted for analysis.

DISCUSSION

The synthesized evidence from this review is relevant for land use policy, health impact assessments, economic development, mental health service planning, and communities engaging in development projects.

SYSTEMATIC REVIEW REGISTRATION

Registered in the International Prospective Register of Systematic Reviews (PROSPERO; Registration number CRD42021253720 ).

The Labin Region, an ecologically vulnerable geographical area in Croatia: Mortality characteristics in an area polluted by industrial over a 40-year period

The history of the Labin region in Croatia includes intensive industrial development with repercussions of pollution on environment and health. Assuming that prolonged exposure to polluted environments causes qualitative changes in mortality, the aim was to analyse the mortality characteristics of the population of the Labin Region for the 1968-2008 period based on data from the Croatian Bureau of Statistics. Public health and social opportunities in this geographical area carry a long-term burden of exposure to an industrial polluted environment with outcomes expressed by mortality or/and morbidity in the population. This study includes data on 11,903 deaths, most of which due to diseases of the circulatory, respiratory and digestive systems as well as neoplasms. In the third and fourth decade of the study period, a group of neoplasms showed significant increases, while the increase in respiratory diseases were more gradual. The female population died mostly from diseases of the circulatory and endocrine system as well as neoplasms, while the male population mainly died from diseases of the digestive system and external causes. This research provides guidelines that could create better public health, raising the quality of life and contribute to a future environmental protection in local communities by targeted policies.

An integrated approach to quantify ecological and human health risks of soil heavy metal contamination around coal mining area

Soil heavy metals harm ecological biodiversity and human health, and quantifying the risks more accurately is still obscure. In this study, a network environ analysis was applied to quantify risks between ecological communities based on control allocation and human health risk models to calculate human health exposure risks from soil heavy metals around Greenside coal mining in South Africa. Ecological and human health risks were apportioned using PMF model. Results showed assessed heavy metals (mean) exceeded local background content with a cumulative of moderately polluted using pollution load index (PLI). Total initial risk (R_i), the risk to biological organisms from direct soil exposure, was 0.656 to vegetation and 1.093 to soil microorganisms. Risk enters the food web via vegetation and harms the whole system. Integrated risks (initial, direct, and indirect) to vegetation, herbivores, soil microorganisms, and carnivores were 0.656, 0.125, 1.750, and 0.081, respectively, revealing that soil microorganisms are the most risk receptors. Total Hazard Index (HI_T) was <1 for adults (0.574) whereas >1 for children (4.690), signifying severe non-cancer effects to children. Total cancer risk (TCR) to children and adults surpassed the unacceptable limit (1.00E-04). Comparatively, Cr is a high-risk metal accounted for 63.24% (adults) and 65.88% (children) of the HI_T and 92.98% (adults) and 91.31% (children) of the TCR. Four sources were apportioned. Contributions to R_i (soil microorganisms and vegetation) from F3 (industrial), F4 (atmospheric), F2 (coal mining), and F1 (natural) were 42.20%, 24.56%, 23.55%, and 9.68%, respectively. The non-cancer risk from F3 (37.67% to adults and 38.40% to children) was dominant, and TCR to children from the sources except F1 surpassed the unacceptable limit. An integrated approach of risk quantification is helpful in managing risks and reducing high-risk pollution sources to better protect the environment and human health.

Study on the Spatial and Temporal Distribution Characteristics and Influencing Factors of Particulate Matter Pollution in Coal Production Cities in China

In recent years, with the continuous advancement of China's urbanization process, regional atmospheric environmental problems have become increasingly prominent. We selected 12 cities as study areas to explore the spatial and temporal distribution characteristics of atmospheric particulate matter in the region, and analyzed the impact of socioeconomic and natural factors on local particulate matter levels. In terms of time variation, the particulate matter in the study area showed an annual change trend of first rising and then falling, a monthly change trend of "U" shape, and an hourly change trend of double-peak and double-valley distribution. Spatially, the concentration of particulate matter in the central and southern cities of the study area is higher, while the pollution in the western region is lighter. In terms of social economy, PM_2.5 showed an "inverted U-shaped" quadratic polynomial relationship with Second Industry and Population Density, while it showed a U-shaped relationship with Generating Capacity and Coal Output. The results of correlation analysis showed that PM_2.5 and PM₁₀ were significantly positively correlated with NO₂, SO₂, CO and air pressure, and significantly negatively correlated with O₃ and air temperature. Wind speed was significantly negatively correlated with PM_2.5, and significantly positively correlated with PM₁₀. In terms of pollution transmission, the southwest area of Taiyuan City is a high potential pollution source area of fine particles, and the long-distance transport of PM_2.5 in Xinjiang from the northwest also has a certain contribution to the pollution of fine particles. This study is helpful for us to understand the characteristics and influencing factors of particulate matter pollution in coal production cities.

How do we identify acute medical admissions that are suitable for same day emergency care?

Medical emergencies causing unplanned hospital admission place considerable demands on acute healthcare services. Some patients can be assessed and treated through ambulatory pathways without inpatient admission, via same day emergency care (SDEC), potentially benefiting patients and reducing demands on inpatient services. There is currently considerable variation within acute medicine in aspects of SDEC delivery ranging from overall service design to patient selection methods. Scoring systems identifying patients likely to be successfully managed through SDEC services have been suggested, but evidence of utility in diverse populations is lacking. Specific scoring systems exist for some common medical problems, including cardiac chest pain and pulmonary embolism, but further research is needed to demonstrate how these are most effectively incorporated into SDEC services. This review defines SDEC and describes the variation in services nationally. It reviews the evidence for their clinical impact, tools to screen patients for SDEC and current gaps in our knowledge regarding service deployment.

Is Population Density Associated with Non-Communicable Disease in Western Developed Countries? A Systematic Review

Over the last three decades, researchers have investigated population density and health outcomes at differing scale. There has not been a systematic review conducted in order to synthesise this evidence. Following the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines, we systematically reviewed quantitative evidence published since 1990 on population density and non-communicable disease (NCD) within Westernised countries. Fifty-four studies met the inclusion criteria and were evaluated utilising a quality assessment tool for ecological studies. High population density appears to be associated with higher mortality rates of a range of cancers, cardiovascular disease and COPD, and a higher incidence of a range of cancers, asthma and club foot. In contrast, diabetes incidence was found to be associated with low population density. High and low population density are therefore risk markers for a range of NCDs, indicating that there are unidentified factors and mechanisms underlying aetiology. On closer examination, our synthesis revealed important and complex relationships between population density, the built environment, the nature of greenspace and man-made exposures. In light of increasing rates of morbidity and mortality, future research is required to investigate these associations in order to establish causative agents for each NCD.

Long-Term Safety of Prenatal and Neonatal Exposure to Paracetamol: A Systematic Review

Introduction: Paracetamol is the most commonly used antipyretic and analgesic in pregnancy. It is also increasingly used off-label in the neonatal intensive care unit. Despite the frequent use of paracetamol, concerns have been raised regarding the high variability in neonatal dosing regimens and the long-term safety of early life exposure. Objective: To investigate the available evidence on the long-term safety of prenatal and neonatal paracetamol exposure. Methods: We conducted a systematic search of the electronic databases Ovid Medline, Ovid Embase and Web of Science from inception to August 2021 for original research studies of any design that described the use of paracetamol in the prenatal or neonatal (within the first four weeks of life) periods and examined the occurrence of neurodevelopmental, atopic or reproductive adverse outcomes at or beyond birth. Results: We identified 1313 unique articles and included 30 studies in the final review. Of all studies, 27 (90%), two (7%) and one (3%) were on the long-term safety of prenatal, neonatal and both prenatal and neonatal exposure, respectively. Thirteen (46%), 11 (39%) and four (15%) studies examined neurodevelopmental, atopic and reproductive outcomes. Eleven (100%), 11 (100%), and three (27%) studies on prenatal exposure reported adverse neurodevelopmental, atopic and reproductive outcomes. Only one study found a possible correlation between neonatal paracetamol exposure and long-term adverse outcomes. Conclusions: The available evidence, although limited, suggests a possible association between prenatal paracetamol exposure and an increased risk of neurodevelopmental, atopic and reproductive adverse outcomes. There is an immediate need for robust data on the long-term safety of paracetamol exposure in the prenatal and neonatal periods.

Polymorphisms in DNA Repair and Xenobiotic Biotransformation Enzyme Genes and Lung Cancer Risk in Coal Mine Workers

Background: Currently coal mining employs over 7 million miners globally. This occupational setting is associated with exposure to dust particles, heavy metals, polycyclic aromatic hydrocarbons and radioactive radon, significantly increasing the risk of lung cancer (LC). The susceptibility for LC is modified by genetic variations in xenobiotic detoxification and DNA repair capacity. The aim of this study was to investigate the association between GSTM1 (deletion), APEX1 (rs1130409), XPD (rs13181) and NBS1 (rs1805794) gene polymorphisms and LC risk in patients who worked in coal mines. Methods: The study included 639 residents of the coal region of Western Siberia (Kemerovo region, Russia): 395 underground miners and 244 healthy men who do not work in industrial enterprises. Genotyping was performed using real-time and allele-specific PCR. Results: The results show that polymorphisms of APEX1 (recessive model: OR_adj = 1.87; CI 95%: 1.01–3.48) and XPD (log additive model: OR_adj = 2.25; CI 95%: 1.59–3.19) genes were associated with increased LC risk. GSTM1 large deletion l was linked with decreased risk of LC formation (OR_adj = 0.59, CI 95%: 0.36–0.98). The multifactor dimensionality reduction method for 3-loci model of gene–gene interactions showed that the GSTM1 (large deletion)—APEX1 (rs1130409)—XPD (rs13181) model was related with a risk of LC development. Conclusions: The results of this study highlight an association between gene polymorphism combinations and LC risks in coal mine workers.

Mapping the Morbidity Risk Associated with Coal Mining in Queensland, Australia

The populations in the vicinity of surface coal mining activities have a higher risk of morbidity due to diseases, such as cardiovascular, respiratory and hypertensive diseases, as well as cancer and diabetes mellitus. Despite the large and historical volume of coal production in Queensland, the main Australian coal mining state, there is little research on the association of coal mining exposures with morbidity in non-occupational populations in this region. This study explored the association of coal production (Gross Raw Output—GRO) with hospitalisations due to six disease groups in Queensland using a Bayesian spatial hierarchical analysis and considering the spatial distribution of the Local Government Areas (LGAs). There is a positive association of GRO with hospitalisations due to circulatory diseases (1.022, 99% CI: 1.002–1.043) and respiratory diseases (1.031, 95% CI: 1.001–1.062) for the whole of Queensland. A higher risk of circulatory, respiratory and chronic lower respiratory diseases is found in LGAs in northwest and central Queensland; and a higher risk of hypertensive diseases, diabetes mellitus and lung cancer is found in LGAs in north, west, and north and southeast Queensland, respectively. These findings can be used to support public health strategies to protect communities at risk. Further research is needed to identify the causal links between coal mining and morbidity in non-occupational populations in Queensland.

Cancer and mortality in coal mine workers: a systematic review and meta-analysis

Coal mine workers are exposed to a number of workplace hazards which may increase the risk of cancer and mortality. We conducted a systematic review and meta-analysis to investigate cancer and mortality in coal mine workers We searched in Ovid Medline, PubMed, Embase and Web of Science databases using keywords and text words related to coal mines, cancer and mortality and identified 36 full-text articles using predefined inclusion criteria. Each study's quality was assessed using the Newcastle-Ottawa Scale. We performed random-effect meta-analyses including 21 of the identified articles evaluating cancer and/or mortality of coal mine workers. The meta-analysis showed an increased risk of all-cause mortality (SMR 1.14, 95% CI 1.00 to 1.30) and mortality from non-malignant respiratory disease (NMRD) (3.59, 95% CI 3.00 to 4.30) in cohorts with coal workers' pneumoconiosis (CWP). We found a somewhat increased risk of stomach cancer (1.11, 95% CI 0.97 to 1.35) and of mortality from NMRD (1.26, 95% CI 0.99 to 1.61) in the cohorts of coal miners with unknown CWP status. The meta-analysis also showed a decreased risk of prostate cancer and cardiovascular and cerebrovascular mortality among coal miners. This may be a result of the healthy worker effect and possible lower smoking rates, and perhaps also reflect the physically active nature of many jobs in coal mines. The meta-analysis for lung cancer did not show increased risk in coal miners with CWP (1.49, 95% CI 0.70 to 3.18) or for coal miners of unknown CWP status (1.03, 95% CI 0.91 to 1.18). Lower smoking rates in coal mine workers could explain why case-control studies where smoking was controlled for showed higher risks for lung cancer than were seen in cohort studies. Coal mine workers are at increased risk of mortality from NMRD but decreased risk of prostate cancer and cardiovascular and cerebrovascular mortality. Studies of coal mine workers need long-term follow-up to identify increased mortality and cancer incidence.

The Impact of Meteorological Factors on Communicable Disease Incidence and Its Projection: A Systematic Review

Background: Climate change poses a real challenge and has contributed to causing the emergence and re-emergence of many communicable diseases of public health importance. Here, we reviewed scientific studies on the relationship between meteorological factors and the occurrence of dengue, malaria, cholera, and leptospirosis, and synthesized the key findings on communicable disease projection in the event of global warming. Method: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flow checklist. Four databases (Web of Science, Ovid MEDLINE, Scopus, EBSCOhost) were searched for articles published from 2005 to 2020. The eligible articles were evaluated using a modified scale of a checklist designed for assessing the quality of ecological studies. Results: A total of 38 studies were included in the review. Precipitation and temperature were most frequently associated with the selected climate-sensitive communicable diseases. A climate change scenario simulation projected that dengue, malaria, and cholera incidence would increase based on regional climate responses. Conclusion: Precipitation and temperature are important meteorological factors that influence the incidence of climate-sensitive communicable diseases. Future studies need to consider more determinants affecting precipitation and temperature fluctuations for better simulation and prediction of the incidence of climate-sensitive communicable diseases.

Maternal, neonatal and socio-economic factors associated with intellectual development among children from a coal mining region in Brazil

Coal is the most aggressive energy sources in the environment. Several adverse outcomes on children's health exposure to coal pollutants have been reported. Pollutants from coal power plants adversely affect the intellectual development and capacity. The present study aimed to evaluate the intellectual development and associated factors among children living a city under the direct influence (DI) and six neighboring municipalities under the indirect influence (II) of coal mining activity in the largest coal reserve of Brazil. A structured questionnaire was completed by the child's guardian, and Raven's Progressive Color Matrices were administered to each child to assess intellectual development. A total of 778 children participated. In general, no significant difference was observed between the two cities. The DI city had better socioeconomic conditions than the II municipalities according to family income (< 0.001). The prevalence of children who were intellectually below average or with intellectual disabilities was 22.9%, and there was no significant difference (p > 0.05) between municipalities. In both unadjusted and adjusted analyses, intellectual development was associated with maternal age, marital situation and maternal education level, birth weight, breast feeding, frequent children's daycare, paternal participation in children's care and child growth. Living in the DI area was not associated with intellectual disability. The results suggest that socioeconomic conditions and maternal and neonatal outcomes are more important than environmental factors for intellectual development of children living in a coal mining area.

Systematic review of empirical studies comparing the effectiveness of non-pharmaceutical interventions against COVID-19

Objectives

To evaluate which non-pharmaceutical interventions (NPIs) have been more and less effective in controlling the COVID-19 pandemic.

Methods

We performed a systematic review of published and unpublished empirical studies, either observational or interventional, analysing the comparative effectiveness of NPIs against the COVID-19 pandemic. We searched Embase/Medline and medRxiv to identify the relevant literature.

Results

We identified 34 studies. During the first wave of the COVID-19 pandemic, school closing was the most effective NPI, followed by workplace closing, business and venue closing and public event bans. Public information campaigns and mask wearing requirements were also effective in controlling the pandemic while being less disruptive for the population than other NPIs. There was no evidence on the effectiveness of public transport closure, testing and contact tracing strategies and quarantining or isolation of individuals. Early implementation was associated with a higher effectiveness in reducing COVID-19 cases and deaths, while general stringency of the NPIs was not.

Conclusions

In this systematic review, we found that school closing, followed by workplace closing, business and venue closing and public event bans were the most effective NPIs in controlling the spread of COVID-19. An early response and a combination of specific social distancing measures are effective at reducing COVID-19 cases and deaths. Continuous monitoring of NPIs effectiveness is needed in order to adapt decision making.

Climate Change and Mental Health: A Scoping Review

Climate change is negatively impacting the mental health of populations. This scoping review aims to assess the available literature related to climate change and mental health across the World Health Organisation's (WHO) five global research priorities for protecting human health from climate change. We conducted a scoping review to identify original research studies related to mental health and climate change using online academic databases. We assessed the quality of studies where appropriate assessment tools were available. We identified 120 original studies published between 2001 and 2020. Most studies were quantitative (n = 67), cross-sectional (n = 42), conducted in high-income countries (n = 87), and concerned with the first of the WHO global research priorities-assessing the mental health risks associated with climate change (n = 101). Several climate-related exposures, including heat, humidity, rainfall, drought, wildfires, and floods were associated with psychological distress, worsened mental health, and higher mortality among people with pre-existing mental health conditions, increased psychiatric hospitalisations, and heightened suicide rates. Few studies (n = 19) addressed the other four global research priorities of protecting health from climate change (effective interventions (n = 8); mitigation and adaptation (n = 7); improving decision-support (n = 3); and cost estimations (n = 1)). While climate change and mental health represents a rapidly growing area of research, it needs to accelerate and broaden in scope to respond with evidence-based mitigation and adaptation strategies.

Environmental risk factors associated with respiratory diseases in children with socioeconomic disadvantage

Children are more vulnerable to environmental exposures determinant of respiratory diseases due to their dynamic developmental physiology. Whereas social determinants of health are also associated with a higher risk of these diseases in children exposed to environmental risk factors, most studies incorporate them as covariates in the statistical analysis rather than focusing on specific vulnerable populations. In this study a systematic review searched and selected studies of respiratory diseases in children with socioeconomic disadvantage to identify the environmental risk factors associated with these diseases. The review followed the PRISMA protocol to identify eleven eligible studies of children with socioeconomic conditions that included low income and low socioeconomic status, overcrowding, adults with low education level and Indigenous status. Infectious respiratory diseases, asthma, rhinitis and mortality due to respiratory diseases were associated with risk factors such as biomass fuel use, tobacco smoking, particulate matter, coal dust and other pollutants including ozone, nitrogen dioxide and sulphur dioxide. The most common associations were between respiratory infections and household air pollution and asthma with indoor and outdoor air pollution. The findings support previous reports on these associations and suggest that specific vulnerabilities such as indigenous children and living with adults with low socioeconomic status and education level increase the risk of respiratory diseases. These populations can be given special attention to prioritize public health interventions to lower the burden of disease of respiratory diseases in children.

Maternal proximity to Central Appalachia surface mining and birth outcomes

Supplemental Digital Content is available in the text.

Maternal residency in Central Appalachia counties with coal production has been previously associated with increased rates of low birth weight (LBW). To refine the relationship between surface mining and birth outcomes, this study employs finer spatiotemporal estimates of exposure.

The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises

For the Chinese, French, German, and Spanish translations of the abstract see Supplementary Materials section.

Meteorological normalisation of PM10 using machine learning reveals distinct increases of nearby source emissions in the Australian mining town of Moranbah

The impacts of poor air quality on human health are becoming more apparent. Businesses and governments are implementing technologies and policies in order to improve air quality. Despite this the PM₁₀ air quality in the mining town of Moranbah, Australia, has worsened since measurements commenced in 2011. The annual average PM₁₀ concentrations during 2012, 2017, 2018 and 2019 have all exceeded the Australian National Environmental Protection Measure's standard, and there has been an increase in the frequency of exceedances of the daily standard. The average annual increase in PM₁₀ was 1.2 ± 0.5 μg m - 3 per year between 2011 and 2019 and has been 2.5 ± 1.2 μg m - 3 per year since 2014. The cause of this has not previously been established. Here, two machine learning algorithms (gradient boosted regression and random forest) have been implemented to model and then meteorologically normalise PM₁₀ mass concentrations measured in Moranbah. The best performing model, using the random forest algorithm, was able to explain 59% of the variance in PM₁₀ using a range of meteorological, environmental and temporal variables as predictors. An increasing trend after normalising for these factors was found of 0.6 ± 0.5 μg m - 3 per year since 2011 and 1.7 ± 0.3 μg m - 3 per year since 2014. These results indicate that more than half of the increase in PM₁₀ is due to a rise in local emissions in the region. The remainder of the rise in PM₁₀ was found to be due to a decrease of soil water content in the surrounding region, which can facilitate higher dust emissions. Whether the presence of open-cut coal mines exacerbated the role of soil water content is unclear. Although fires can have drastic effects on the local air quality, changes in fire patterns are not responsible for the rising trend. PM₁₀ composition measurements or more detailed data relating to local sources is still needed to better isolate these emissions. Nonetheless, this study highlights the need and potential for action by industry and government to improve the air quality and reduce health risks for the nearby population.

Blood markers among residents from a coal mining area

Coal extraction and processing generate environmental contamination, which has several negative impacts on human health. Hematological and biochemical parameters are effective biomarkers of the exposure of a population to air pollutants. Thus, this study aimed to evaluate hematological and biochemical parameters in adult residents in a coal mining region in the largest national reserve in Brazil, as well as to investigate their relations with air quality. The study included three cities in the south of Brazil, which are located near an important power plant and coal mine. The air quality was analyzed by PM10, NOx, and SO₂ at five air quality monitoring stations, socioeconomic and demographic characteristics were evaluated with a questionnaire, and biochemical parameters were assessed in blood samples. The mean PM10 in the study area was 19.18 μg/m³. The air quality varied among the five monitoring stations, and the Candiota station exceeded the reference limit by 63.3%. In general, participants had lived more than 10 years in the municipality and had hepatic and renal parameters within the reference values. A higher prevalence of alterations was found in hematological parameters (43.1%) and liver function (30%). Among the three cities, the population of Pedras Altas seems to have a greater impairment of the blood parameters evaluated. The only parameter that was correlated with PM10 was the hematocrit level (r = 0.33; P < 0.001).

Estimating the prevalence and spatial clusters of coal workers' pneumoconiosis cases using medicare claims data, 2011-2014

BACKGROUND

Workers employed in the coal mining sector are at increased risk of respiratory diseases, including coal workers' pneumoconiosis (CWP). We investigated the prevalence of CWP and its association with sociodemographic factors among Medicare beneficiaries.

METHODS

We used 5% Medicare Limited Data Set claims data from 2011 to 2014 to select Medicare beneficiaries with a diagnosis of ICD-9-CM 500 (CWP). We aggregated the data by county and limited our analysis to seven contiguous states: Illinois, Indiana, Kentucky, Ohio, Pennsylvania, Virginia, and West Virginia. We estimated county-level prevalence rates using total Medicare beneficiaries and miners as denominators and performed spatial hotspot analysis. We used negative binomial regression analysis to determine the association of county-wise sociodemographic factors with CWP.

RESULTS

There was significant spatial clustering of CWP cases in Kentucky, Virginia, and West Virginia. Spatial clusters of 210 and 605 CWP cases representing an estimated 4200 to 12 100 cases of Medicare beneficiaries with CWP were identified in the three states. Counties with higher poverty levels had a significantly elevated rate of CWP (adjusted rate ratios [RR]: 1.15; 95% CI, 1.12-1.18). There was a small but significant association of CWP with the county-wise catchment area. Rurality was associated with a more than three-fold elevated rate of CWP in the unadjusted analysis (RR: 3.28, 95% CI, 2.22-4.84). However, the rate declined to 1.45 (95% CI, 1.04-2.01) after adjusting for other factors in the analysis.

CONCLUSIONS

We found evidence of significant spatial clustering of CWP among Medicare beneficiaries living in the seven states of the USA.

Air Pollution Emissions 2008-2018 from Australian Coal Mining: Implications for Public and Occupational Health

Occupational exposure limits for respirable coal dust are based on exposure during working hours, but coal miners may experience additional community-based exposures during nonworking hours. We analyzed Australia National Pollutant Inventory (NPI) data for the years 2008–2018 to estimate air pollutants (metals, nitrogen oxides, particulate matter ≤ 10 micrometers (PM10) and ≤2.5 micrometers (PM2.5)) originating from coal mines. PM10 levels from community-based air monitors in Queensland and New South Wales were also compared between mining and nonmining communities. Results indicated that tons of coal mined increased over the study period, and that levels of particulate matter, metals, and nitrogen oxides increased significantly over time as well. Coal mines accounted for 42.1% of national PM10 air emissions from NPI sites. PM2.5 from coal mines accounted for 19.5% of the national total, metals for 12.1%, and nitrogen oxides for 10.1%. Coal mining occurred in 57 different post codes; the 20 coal-mining post codes with the highest PM10 emissions were home to 160,037 people. Emissions of all studied pollutants were significantly higher from coal mining sites than from other types of NPI sites. Results from community-based air monitoring stations indicated significantly higher population PM10 exposure in coal mining communities than in nonmining communities. The health of the public at large is impacted by coal mining, but to the extent that miners also live near coal mining operations, their total exposure is underestimated by consideration of exposure only during working hours.

Personal exposure to polycyclic aromatic hydrocarbons in Appalachian mining communities

Coal mining activities may increase residential exposure to polycyclic aromatic hydrocarbons (PAHs), but personal PAH exposures have not been studied in mining areas. We used silicone wristbands as passive personal samplers to estimate PAH exposures in coal mining communities in Central Appalachia in the United States. Adults (N = 101) wore wristbands for one week; 51 resided in communities within approximately three miles of surface mining sites, and 50 resided 10 or more miles from mining sites. Passive indoor polyurethane foam (PUF) sampling was conducted in residents' homes, and a sample of 16 outdoor PUF samples were also collected. Nine PAH congeners were commonly detected in wristbands (mean ± standard deviation), including phenanthrene (50.2 ± 68.7 ng/g), benz[a]anthracene (20.2 ± 58.2 ng/g), fluoranthene (19.4 ± 24.1 ng/g) and pyrene (15.2 ± 18.2 ng/g). Controlling for participant characteristics and season, participants living closer to mining sites had significantly higher levels of phenanthrene, fluorene, fluoranthene, pyrene and ∑PAHs in wristbands compared to participants living farther from mining. Indoor air showed no significant group differences except for pyrene, but outdoor air showed significant or marginally significant differences for phenanthrene, fluorene, pyrene and ∑PAHs. The results suggest that mining community residents face exposure to outdoor mining-related pollutants, and demonstrate that personal silicone wristbands can be deployed as effective passive sampling devices.

Impacts of Coal Use on Health

This article reviews evidence for the public health impacts of coal across the extraction, processing, use, and waste disposal continuum. Surface coal mining and processing impose public health risks on residential communities through air and water pollution. Burning coal in power plants emits more nitrogen oxides, sulfur dioxide, particulate matter, and heavy metals per unit of energy than any other fuel source and impairs global public health. Coal ash disposal exposes communities to heavy metals and particulate matter waste. Use of coal in domestic households causes public health harm concentrated in developing nations. Across the coal continuum, adverse impacts are disproportionately felt by persons of poor socioeconomic status, contributing to health inequities. Despite efforts to develop renewable energy sources, coal use has not declined on a global scale. Concentrated efforts to eliminate coal as an energy source are imperative to improve public health and avert serious climate change consequences.

Using human epidemiological analyses to support the assessment of the impacts of coal mining on health

The potential impacts of coal mining on health have been addressed by the application of impact assessment methodologies that use the results of qualitative and quantitative analyses to support their conclusions and recommendations. Although human epidemiological analyses can provide the most relevant measures of risk of health outcomes in populations exposed to coal mining by-products, this kind of studies are seldom implemented as part of the impact assessment methods. To review the use of human epidemiological analyses in the methods used to assess the impacts of coal mining, a systematic search in the peer review literature was implemented following the PRISMA protocol. A synthesis analysis identified the methods and the measures used in the selected publications to develop a thematic review and discussion. The major methodological approaches to assess the impacts of coal mining are environmental impact assessment (EIA), health impact assessment (HIA), social impact assessment (SIA) and environmental health impact assessment (EHIA). The measures used to assess the impacts of coal mining on health were classified as the estimates from non-human-based studies such as health risk assessment (HRA) and the measures of risk from human epidemiological analyses. The inclusion of human epidemiological estimates of the populations exposed, especially the general populations in the vicinity of the mining activities, is seldom found in impact assessment applications for coal mining. These methods rather incorporate HRA measures or other sources of evidence such as qualitative analyses and surveys. The implementation of impact assessment methods without estimates of the risk of health outcomes relevant to the potentially exposed populations affects their reliability to address the environmental and health impacts of coal mining. This is particularly important for EIA applications because these are incorporated in regulatory frameworks globally. The effective characterization of the impacts of coal mining on health requires quantitative estimates of the risk, including the risk measures from epidemiological analyses of relevant human health data.

Factors influencing high respiratory mortality in coal-mining counties: a repeated cross-sectional study

BACKGROUND

Previous studies have associated elevated mortality risk in central Appalachia with coal-mining activities, but few have explored how different non-coal factors influence the association within each county. Consequently, there is a knowledge gap in identifying effective ways to address health disparities in coal-mining counties. To specifically address this knowledge gap, this study estimated the effect of living in a coal-mining county on non-malignant respiratory diseases (NMRD) mortality, and defined this as "coal-county effect." We also investigated what factors may accentuate or attenuate the coal-county effect.

METHODS

An ecological epidemiology protocol was designed to observe the characteristics of three populations and to identify the effects of coal-mining on community health. Records for seven coal-mining counties (n = 19,692) were obtained with approvals from the Virginia Department of Health Office of Vital Statistics for the years 2005 to 2012. Also requested were records from three adjacent coal counties (n = 10,425) to provide a geographic comparison. For a baseline comparison, records were requested for eleven tobacco-producing counties (n = 27,800). We analyzed the association of 57,917 individual mortality records in Virginia with coal-mining county residency, county-level socioeconomic status, health access, behavioral risk factors, and coal production. The development of a two-level hierarchical model allowed the coal-county effect to vary by county-level characteristics. Wald tests detected sets of significant factors explaining the variation of impacts across counties. Furthermore, to illustrate how the model estimations help explain health disparities, two coal-mining county case studies were presented.

RESULTS

The main result revealed that coal-mining county residency increased the probability of dying from NMRD. The coal-county effect was accentuated by surface coal mining, high smoking rates, decreasing health insurance coverage, and a shortage of doctors. In Virginia coal-mining regions, the average coal-county effect increased by 147% (p-value< 0.01) when one doctor per 1000 left, and the effect increased by 68% (p-value< 0.01) with a 1% reduction of health insurance rates, holding other factors fixed.

CONCLUSIONS

This study showed a high mortality risk of NMRD associated with residents living in Virginia coal-mining counties. Our results also revealed the critical role of health access in reducing health disparities related to coal exposure.