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In the wake of the COVID-19 pandemic, millions worldwide are still struggling with persistent or recurring symptoms known as long COVID. Fatigue is one of the most prevalent symptoms associated with long COVID, and for many it can be debilitating. Understanding the potential pathological processes that link fatigue to long COVID is critical to better guide treatment. Challenges with diagnosis and treatment are reviewed, recognizing that post-COVID fatigue does not always present with corroborating clinical evidence, a situation that is frustrating for both patients and healthcare providers. Firefighters are a group of public safety workers who are particularly impacted by long COVID-related fatigue. Firefighters must be able to engage in strenuous physical activity and deal with demanding psychological situations, both of which may be difficult for those suffering from fatigue. Disruption in public safety worker health can potentially impact community welfare. This review creates a framework to explain the clinical-pathological features of fatigue resulting from long COVID, addresses diagnosis and treatment challenges, and explores the unique impact fatigue may pose for public safety workers and their organizations.

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Firefighting is a physically demanding profession associated with unacceptably high on-duty cardiovascular mortality. Low endogenous total testosterone (TT) is an emerging cardiometabolic (CM) risk factor in men, but limited data exists on its interactions with physical fitness (PF). Data from occupational health and fitness assessments of 301 male career firefighters (FFs) were analyzed. TT was categorized as low (<264 ng/dL), borderline (264-399 ng/dL), and reference (400-916 ng/dL). PF tests included cardiorespiratory fitness (submaximal treadmill), body fat percentage (BF%), push-ups, plank, and handgrip strength assessments. In the crude analyses, FFs in the low TT group had worse muscular and cardiorespiratory fitness measures compared to the referent group. However, after adjusting for age and BF%, none of the PF differences remained statistically significant. Similarly, the odds of less-fit FFs (PF performance below median values) having low TT were higher compared to the fitter ones only before adjusting for age and BF%. Therefore, in the final adjusted model, there was no significant association between TT and PF. Our data suggest that age and body fat confound the association between PF and TT. Low TT and poor PF are important components of FFs' CM risk profile, and there is potential benefit to considering TT screening as part of a comprehensive occupational health program that manages performing medical evaluations and provides education and preventative programming.

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BACKGROUND: Firefighting is a physically demanding profession. Firefighters (FFs) need adequate physical fitness (PF) to perform duty tasks efficiently. While FFs' work demands are constant throughout their career, there is an expected age-related decline in PF. OBJECTIVE: To describe longitudinal changes in cardiorespiratory fitness (CRF) based on a fixed (12.0 METs) and an age-adjusted standard and compare the prevalence of fit/unfit firefighters (FFs) over eight years. METHODS: 297 Brazilian male firefighters were randomly selected. CRF was assessed by the 12-minute Cooper test. To compare the prevalence's of fit/unfit FFs depending on the standard (12 METs vs. age-adjusted), the McNemar test was used. RESULTS: The reduction in the prevalence of fit firefighters was 4.4-fold higher when the analysis did not consider age. CONCLUSION: After eight years, the prevalence of fit FFs decreased by 30.5% based on the fixed standard, while this reduction was only 7% when using an age-adjusted standard.

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Background and Purpose: Team-based care has been proposed as a means of improving maternity care in the United States. Methods: The study evaluated the individual and group-level psychometric properties of the Collaborative Practice Scale (CPS) among 108 midwives and physicians who provided team-based care in military hospitals. Results: Psychometric properties of the CPS included Cronbach's alpha of .98. Internal consistency was measured with item-to-total correlations from .83 to .94 and inter-item correlations from .71 to .88. Principal components analysis resulted in a single-factor loading, accounting for 80% of total variance. Properties of the scale at the group level; strong within team agreement (r wg( j ) = .94) and between team variance (ICC1 = .15, ICC2 = .65). Conclusion: The CPS demonstrated reliability and validity of the instrument at the individual and group levels. The collaborative process can be measured among midwife-physician teams.

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BACKGROUND: Minimum cardiorespiratory fitness (CRF) has been recommended for firefighters due to job requirements. Thus, it is important to identify accurate and readily available methods to assess CRF in this population. Non-exercise CRF estimates (NEx-CRF) have been proposed but this approach requires validation in this population. OBJECTIVE: To evaluate the accuracy of a NEx-CRF, as compared to a field maximum exercise test, among career military firefighters of both genders using a comprehensive agreement analysis. METHODS: We evaluated the accuracy of a NEx-CRF estimate compared to the Cooper 12 min running test among 702 males and 106 female firefighters. RESULTS: Cooper and NEx-CRF tests yielded similar CRF in both genders (differences <1.8±4.7 ml/kg-1.min-1; effect size <0.34). However, NEx-CRF underestimated Cooper-derived CRF among the fittest firefighters. NEx-CRF showed moderate to high sensitivity/specificity to detect fit or unfit firefighters (71.9% among men and 100% among women). Among men, the NEx-CRF method correctly identified most firefighters with less than 11 METs or greater than 13 METs, but showed lower precision to discriminate those with CRF between 11-13 METs. CONCLUSIONS: The NEx-CRF method to estimate firefighters' CRF may be considered as an alternative method when an exercise-based method is not available or may be used to identify those who require more traditional testing (CRF 11-13 METs).

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BACKGROUND: Low endogenous testosterone has been associated with increased cardiovascular risk in men. OBJECTIVES: To determine the prevalence of low serum testosterone level (TT) in a cohort of male US career firefighters and to examine its relation with left ventricular wall thickness (LVWT). MATERIALS AND METHODS: We conducted a cross-sectional study among 341 career firefighters, (age: 37.5 ± 10.3 years; BMI: 28.9 ± 4.5 kg/m2 ), who underwent an occupational medical screening examination. TT quartiles were determined, and LVWT distribution among them was plotted. Then, TT values were categorized as low (<264 ng/dL), borderline (264-399 ng/dL), reference range (400-916 ng/dL), and high (>916 ng/dL). To further investigate the association of mildly decreased TT on LVWT, we divided the borderline group into borderline-low (264-319 ng/dL) and borderline-high (320-399 ng/dL) ranges. LVWT values were classified as low LVWT when <0.6 cm. A multivariate model was used to compare LVWT, age, BMI, systolic blood pressure (SBP), and HbA1c among groups by TT values. RESULTS: The prevalence of low TT was 10.6% and of borderline was 26.4%, while 58.7% had levels in the reference range. The low-TT group was older and had higher BMI and SBP as compared to the reference group (P < .01). LVWT values were different among groups (P = .04) and significantly lower in firefighters with borderline-low TT as compared to the reference group (P < .05). This finding also occurred within obese firefighters (P = .03). The borderline-low group had a higher adjusted risk for a low LVWT as compared to the reference group [OR: 4.11 (95% CI: 1.79-9.43)]. DISCUSSION: Our findings highlight the possible relationship between a mild reduction in testosterone levels (borderline) and lower LVWT. CONCLUSIONS: A high prevalence of subnormal TT levels (low and borderline: 37%) was observed in this relatively homogeneous cohort of career firefighters. Mildly decreased TT levels and lower LVWT might represent a preclinical condition and a window of opportunity for cardiovascular preventive interventions in firefighters.

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INTRODUCTION: Obesity may interfere with job performance and increase the risk of injury during firefighting activity. Obesity also has many deleterious effects on health indices and is associated with higher all-cause mortality. Studies report a high prevalence of obesity in the fire service. Also, firefighters' work schedule (12-hour to 24-hour shifts) and food availability during night shifts may be related to weight gain. Studies in American firefighters have shown annual weight gain between 0.5 and 1.5 kg. This study aims to report the obesity prevalence in the fire service to describe how it varies based on country and region, job status, type of firefighter and gender. METHODS AND ANALYSIS: The main outcome evaluated will be obesity prevalence. We will systematically search the literature databases PubMed, Medline, Web of Science, Sportdiscus, Academic Search Premier, Cumulative Index of Nursing and Allied Health Literature (CINAHL), SciTech Premium Collection, Sports Medicine & Education Index, Research Library and Scopus. One reviewer will perform the search. Two independent reviewers will select studies, extract data from eligible studies and evaluate their methodological and reporting quality. Agreement between reviewers will be measured using Cohen's kappa. Other data of interest will include age, body mass index, body fat percentage, job status (career, volunteer or military), years of service and type of firefighter (eg, structural and wildland firefighter). We will produce a narrative summary of our findings. Tables will be generated to summarise data. ETHICS AND DISSEMINATION: This systematic review does not require ethics clearance since published studies with non-identifiable data will be used. The results of the systematic review will be disseminated via publication in a peer-reviewed journal and through conference presentations. PROSPERO REGISTRATION NUMBER: CRD42019129122.

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BACKGROUND: Firefighters' activities require constant adjustments of the cardiovascular system with cardiac autonomic function (CAF) playing an important role. Despite the crucial role of CAF in regulating stress response, little is known about firefighters' CAF. OBJECTIVE: We aimed to characterize the resting on-duty and off-duty CAF of male firefighters, in association with cardiorespiratory fitness (CRF). METHODS: We evaluated 38 firefighters in an on-duty rest condition and 26 firefighters in an off-duty laboratory-controlled condition. CAF was addressed by means of heart rate variability (HRV). We compared HRV measurements between CRF categories (<12METs vs ≥12METs). Wilcoxon, Mann-Whitney texts and Spearman correlation were used and General Linear Model was applied for age and BMI adjustments. RESULTS: Firefighters' resting CAF is characterized by a predominant sympathetic modulation and a large inter-individual dispersion in all HRV indices, in both groups. We found a positive correlation between a higher CRF, the overall CAF and the higher parasympathetic activity (p <  0,03). Firefighters with CRF ≥12 METs showed a higher parasympathetic modulation. CONCLUSIONS: Firefighters' resting CAF is characterized by a predominant sympathetic modulation and a large inter-individual dispersion in all HRV indices, in both groups. Our results support mandatory physical training focused in improving firefighters' CAF as a cardiopretective effect.

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