Milca Meconnen

Rising planetary temperatures and extreme heat events have led to an increased incidence of heat-related illnesses, such as heat stroke, globally. Widespread adoption of measures to prevent and treat heat-related illnesses is an increasingly urgent issue given the rising global temperatures; promotion of such evidence-based strategies is needed to reduce heat-related morbidity and mortality globally. Such heat-related environmental illnesses are differentially experienced by those without access to ambient cooling and those engaged in outdoor work and recreation. Moreover, the adverse impacts of heat-related illness experienced by residents of the Global South necessitates the inclusion of high-quality recommendations around prevention and treatment into clinical and public health practice in order to address health equity and human rights considerations. The current guidance on prevention strategies and therapeutic interventions for heat-related illness has been iterated and published by the Wilderness Medical Society (WMS). In this critical appraisal, we have summarized the evidence-based guidelines and highlighted the updated recommendations that reflect evolving issues in heat illness research. Application of the Appraisal of Guidelines for Research and Evaluation (AGREE) II framework has enabled a quality assessment of the guidelines to be performed, which we present herein. The adoption of evidence-based practices around heat-related illness has the potential to reduce morbidity and mortality and improve global population-level health in light of the warming climate.

Background: Neuropathic pain (NP), resulting from damage to the somatosensory nervous system, affects 7–10% of the global population and remains poorly managed despite available therapies. Smoking has been associated with increased pain severity and disease burden, yet its role in neuropathy/NP has not been systematically reviewed. This systematic review synthesizes the existing literature on smoking status and its relationship with neuropathy/NP incidence, prevalence, and severity. Methods: The review was conducted in accordance with PRISMA guidelines and included studies that assessed smoking consumption, dependency, quantity, and cessation in individuals with neuropathy/NP. Summary estimates were stratified by exposure type, and pooled odds ratios and relative risks were calculated. Results: Across 62 studies comprising cohort, case–control, and cross-sectional designs, smoking was consistently associated with greater NP prevalence and pain severity. Smoking dependency was linked to increased incidence, while cessation was associated with reduced risk of NP. Despite considerable heterogeneity and risk of bias, particularly from subjective exposure measurement and inconsistent classification, this relationship remained statistically significant. Conclusions: Findings support the role of smoking as a modifiable risk factor in various etiologies of neuropathy/NP. Cessation may represent a low-cost, low-risk, low-tech adjunctive therapy; however, further robust cessation interventional trials are needed, particularly for less common infectious causes of chronic NP such as leprosy.