BACKGROUND: Climate vulnerability of the unborn can contribute to adverse birth outcomes, in particular, but it is still not well understood. We investigated the association between ambient temperature and stillbirth risk among a historical population in northern Sweden (1880-1950). METHODS: We used digitized parish records and daily temperature data from the study region covering coastal and inland communities some 600 km north of Stockholm, Sweden. The data included 141,880 births, and 3,217 stillbirths, corresponding to a stillbirth rate of 22.7 (1880-1950). The association between lagged temperature (0-7 days before birth) and stillbirths was estimated using a time-stratified case-crossover design. Incidence risk ratios (IRR) with 95% confidence intervals were computed, and stratified by season and sex. RESULTS: We observed that the stillbirth risk increased both at low and high temperatures during the extended summer season (April to September), at -10°C, and the IRR was 2.3 (CI 1.28, 4.00) compared to the minimum mortality temperature of +15°C. No clear effect of temperature during the extended winter season (October to March) was found. Climate vulnerability was greater among the male fetus compared to the female counterparts. CONCLUSION: In this subarctic setting before and during industrialization, both heat and cold during the warmer season increased the stillbirth risk. Urbanization and socio-economic development might have contributed to an uneven decline in climate vulnerability of the unborn.
BACKGROUND: Evidence indicates that high temperatures are a risk factor for preterm birth. Increasing heat exposures due to climate change are therefore a concern for pregnant women. However, the large heterogeneity of study designs and statistical methods across previous studies complicate interpretation and comparisons. We investigated associations of short-term exposure to high ambient temperature with preterm birth in Sweden, applying three complementary analytical approaches. METHODS: We included 560,615 singleton live births between 2014 and 2019, identified in the Swedish Pregnancy Register. We estimated weekly mean temperatures at 1-km(2) spatial resolution using a spatiotemporal machine learning methodology, and assigned them at the residential addresses of the study participants. The main outcomes of the study were gestational age in weeks and subcategories of preterm birth (<37 weeks): extremely preterm birth (<28 weeks), very preterm birth (from week 28 to <32), and moderately preterm birth (from week 32 to<37). Case-crossover, quantile regression and time-to-event analyses were applied to estimate the effects of short-term exposure to increased ambient temperature during the week before birth on preterm births. Furthermore, distributed lag nonlinear models (DLNM) were applied to identify susceptibility windows of exposures throughout pregnancy in relation to preterm birth. RESULTS: A total of 1924 births were extremely preterm (0.4%), 2636 very preterm (0.5%), and 23,664 moderately preterm (4.2%). Consistent across all three analytical approaches (case-crossover, quantile regression and time-to-event analyses), higher ambient temperature (95th vs 50th percentile) demonstrated increased risk of extremely preterm birth, but associations did not reach statistical significance. In DLNM models, we observed no evidence to suggest an increased effect of high temperature on preterm birth risk. Even so, a suggested trend was observed in both the quantile regression and time-to-event analyses of a higher risk of extremely preterm birth with higher temperature during the last week before birth. CONCLUSIONS: In Sweden, with high quality data on exposure and outcome, a temperate climate and good quality ante-natal health care, we did not find an association between high ambient temperatures and preterm births. Results were consistent across three complementary analytical approaches.
The article describes and reflects upon how multi-level governance and planning in Sweden have been affected by and reacted upon three pending major challenges confronting humanity, namely climate change, migration and the Covid-19 pandemic. These ‘crises’ are broadly considered ‘existential threats’ in need of ‘securitisation’. Causes and adequate reactions are contested, and there are no given solutions how to securitise the perceived threats, neither one by one, no less together. Government securitisation strategies are challenged by counter-securitisation demands, and plaguing vulnerable groups in society by in-securitising predicaments. Taking Sweden as an example the article applies an analytical approach drawing upon strands of securitisation, governance and planning theory. Targeting policy responses to the three perceived crises the intricate relations between government levels, responsibilities, capacities, and actions are scrutinized, including a focus upon the role of planning. Overriding research questions are: How has the governance and planning system – central, regional and local governments – in Sweden responded to the challenges of climate change, migration and Covid-19? What threats were identified? What solutions were proposed? What consequences could be traced? What prospects wait around the corner? Comparing crucial aspects of the crises’ anatomies the article adds to the understanding of the way multilevel, cross-sectional, hybrid governance and planning respond to concurrent crises, thereby also offering clues for action in other geopolitical contexts. The article mainly draws upon recent and ongoing research on manifestations of three cases in the Swedish context. Applying a pragmatic, methodological approach combining elements of securitisation, governance and planning theories with Carol Lee Bacchi’s ‘What is the problem represented to be’ and a touch of interpretive/narrative theory, the study reveals distinct differences between the anatomies of the three crises and their handling. Urgency, extension, state of knowledge/epistemology, governance and planning make different imprints on crises management. Sweden’s long-term climate change mitigation and adaptation strategies imply slow, micro-steps forward based on a combination of social-liberal, ‘circular’ and a touch of ‘green growth’ economies. Migration policy displays a Janus face, on the one hand largely respecting the UN refugee quota system on the other hand applying a detailed regulatory framework causing severe insecurity especially for minor refugees wanting to stay and make their living in Sweden. The Covid-19 outbreak revealed a lack of foresight and eroded/fragmented responsibility causing huge stress upon personnel in elderly and health care and appalling death rates among elderly patients, although governance and planning slowly adapted through securitising policies, leading to potential de-securitisation of the issue. The three crises have caused a security wake-up among governments at all levels and the public in general, and the article concludes by discussing whether this ‘perfect storm’ of crises will result in a farewell to neoliberalism – towards a neo-regulatory state facing further challenges and crises for governance, planning and the role of planners. The tentative prospect rather indicates a mixture of context-dependent ‘hybrid governance’, thus also underlining the crucial role of planners’ role as ‘chameleons’ in complicated governance processes of politics, policy and planning.
BACKGROUND: Antimicrobial resistance (AMR) is a growing global crisis with long-term and unpredictable health, social and economic impacts, with which climate change is likely to interact. Understanding how to govern AMR amidst evolving climatic changes is critical. Scenario planning offers a suitable approach. By envisioning alternative futures, stakeholders more effectively can identify consequences, anticipate problems, and better determine how to intervene. This study explored future worlds and actions that may successfully address AMR in a changing climate in a high-income country, using Sweden as the case. METHODS: We conducted online scenario-building workshops and interviews with eight experts who explored: (1) how promising interventions (taxation of antimicrobials at point of sale, and infection prevention measures) could each combat AMR in 2050 in Sweden given our changing climate; and (2) actions to take starting in 2030 to ensure success in 2050. Transcripts were thematically analyzed to produce a narrative of participant validated alternative futures. RESULTS: Recognizing AMR to be a global problem requiring global solutions, participants looked beyond Sweden to construct three alternative futures: (1) “Tax Burn Out” revealed taxation of antimicrobials as a low-impact intervention that creates inequities and thus would fail to address AMR without other interventions, such as infection prevention measures. (2) “Addressing the Basics” identified infection prevention measures as highly impactful at containing AMR in 2050 because they would contribute to achieving the Sustainable Development Goals (SDGs), which would be essential to tackling inequities underpinning AMR and climate change, and help to stabilize climate-induced mass migration and conflicts; and (3) “Siloed Nations” described a movement toward nationalism and protectionism that would derail the “Addressing the Basics” scenario, threatening health and wellbeing of all. Several urgent actions were identified to combat AMR long-term regardless which future un-folds, such as global collaboration, and a holistic approach where AMR and climate change are addressed as interlinked issues. CONCLUSION: Our participatory scenario planning approach enabled participants from different sectors to create shared future visions and identify urgent actions to take that hinge on global collaboration, addressing AMR and climate change together, and achieving the SDGs to combat AMR under a changing climate.
The purpose of this study was to describe the epidemiology of Lyme neuroborreliosis (LNB) in Kalmar County, in southern Sweden, between 2008 and 2019, and to analyse the relationship between the LNB incidence and climate factors. Data containing cerebrospinal fluid (CSF) cell counts and borrelia CSF/serum antibody index results was received from the departments of clinical chemistry and microbiology at Kalmar County hospital. For this study, we defined LNB as a case with a positive borrelia antibody CSF/serum index and CSF leukocytes > 5 x 10^6/L.. Climate data including mean temperature, humidity and precipitation covering Kalmar County was collected from the Swedish Meteorological and Hydrological Institute. A total of 5051 paired serum-CSF samples from 4835 patients were investigated of which 251 laboratory LNB cases were found. The average annual LNB incidence in Kalmar County 2008-2019 was 8.8 cases per 100,000 inhabitants. Positive relationships were observed between mean temperature and LNB incidence (p<0.001) as well as precipitation and LNB incidence (p=0.003), both with a one calendar month delay. The results suggest an association between climate factors such as mean temperature and precipitation and LNB incidence, presumably through increased/decreased human-tick interactions. This calls for increased awareness of LNB in both the short perspective after periods of warmth and heavy precipitation as well as in a longer perspective in relation to possible climate change. Further studies with larger study groups, covering other geographical areas and over longer periods of time are needed to confirm these findings.
Road weather is a major concern for the public safety and health, industries and transport sectors. Half of the yearly 27,000 road and 50,000 pedestrian injuries in Finland, Norway and Sweden can be traced back to slippery road and walkway conditions. We simulated the climate change impacts on future roads and walkways for mid- and end-century in Finland, Norway and Sweden with the road weather model RoadSurf, driven by the regional climate model HCLIM38 with boundary data from two global climate models following the RCP8.5 scenario. Our simulations for mid-century suggest strong road surface temperature increases, especially in southern Finland (+ 5.1 degrees C) and Sweden (+7.1 degrees C). Snowy and icy road surface conditions decreased by 23 percentage points, causing 18.5 percentage points less difficult driving conditions during the cold season. Zero-degree-crossing days mostly decreased in autumn and spring by up to 7 days and increased in winter by up to 5 days. Sidewalks mostly showed a decrease in slipperiness, but a five percentage point increase of water above ice layers on the sidewalks in winter, suggesting the slip-season might become shorter, but more slippery. Our results are upper extreme estimates but can serve as a reference to help local decision-makers plan mitigation and adaptation measures ahead of time.
Using a mixed-method approach consisting of interviews with preschool teachers and modelling of the outdoor thermal conditions using the mean radiant temperature as an indicator of heat stress, the occurrence of heat stress in Gothenburg preschools during the summer of 2018 and its effects have been studied. One third of 440 preschool yards modelled have more than 50% of the preschool yard-area exposed to strong heat stress during a warm and sunny summer day, implying children in many preschools have considerably less play area than current guidelines deem sufficient. Shade, where present, was mostly from trees within the preschool yards themselves rather from objects in surrounding areas, provided effective heat mitigation. In-terviews confirmed that excessive heat conditions at preschool yards resulted in tired, drowsy and overheated children as well as forcing the preschool to prioritise care over pedagogical activities. The results demonstrated that heat stress occurs at Gothenburg preschools, with difficulties in ensuring the well-being of children at many preschools as a consequence. Many preschools need more shade, preferably from trees to provide healthy and secure environments for preschool children. Finally, the study highlights the need for more research on how weather and outdoor environments affect children’s activity and well-being.
BACKGROUND: Evidence of the role of interactions between air pollution and pollen exposure in subjects with allergic asthma is limited and need further exploration to promote adequate preventive measures. The objective of this study was to assess effects of exposure to ambient air pollution and birch pollen on exacerbation of respiratory symptoms in subjects with asthma and allergy to birch. METHODS: Thirty-seven subjects from two Swedish cities (Gothenburg and Umeå) with large variation in exposure to both birch-pollen and air pollutants, participated in the study. All subjects had confirmed allergy to birch and self-reported physician-diagnosed asthma. The subjects recorded respiratory symptoms such as rhinitis or eye irritation, dry cough, dyspnoea, the use of any asthma or allergy medication and peak respiratory flow (PEF), daily for five consecutive weeks during two separate pollen seasons and a control season without pollen. Nitrogen oxides (NO(x)), ozone (O(3)), particulate matter (PM(2.5)), birch pollen counts, and meteorological data were obtained from an urban background monitoring stations in the study city centres. The data were analysed using linear mixed effects models. RESULTS: During pollen seasons all symptoms and medication use were higher, and PEF was reduced in the subjects. In regression analysis, exposure to pollen at lags 0 to 2 days, and lags 0 to 6 days was associated with increased ORs of symptoms and decreased RRs for PEF. Pollen and air pollution interacted in some cases; during low pollen exposure, there were no associations between air pollution and symptoms, but during high pollen exposure, O(3) concentrations were associated with increased OR of rhinitis or eye irritation, and PM(2.5) concentrations were associated with increased ORs of rhinitis or eye irritation, dyspnea and increased use of allergy medication. CONCLUSIONS: Pollen and air pollutants interacted to increase the effect of air pollution on respiratory symptoms in allergic asthma. Implementing the results from this study, advisories for individuals with allergic asthma could be improved, minimizing the morbidities associated with the condition.
The aim of this study was to analyse the association between season of birth, temperature and neonatal mortality according to socioeconomic status in northern Sweden from 1880 to 1950. The source material for this study comprised digitised parish records combined with local weather data. The association between temperature, seasonality, socioeconomic status and neonatal mortality was modelled using survival analysis. We can summarise our findings according to three time periods. During the first period (1880–1899), temperature and seasonality had the greatest association with high neonatal mortality, and the socioeconomic differences in vulnerability were small. The second period (1900–1929) was associated with a decline in seasonal and temperature-related vulnerabilities among all socioeconomic groups. For the last period (1930–1950), a new regime evolved with rapidly declining neonatal mortality rates involving class-specific temperature vulnerabilities, and there was a particular effect of high temperature among workers. We conclude that the effect of season of birth on neonatal mortality was declining for all socioeconomic groups (1880–1950), whereas weather vulnerability was pronounced either when the socioeconomic disparities in neonatal mortality were large (1880–1899) or during transformations from high to low neonatal rates in the course of industrialisation and urbanisation.
During the summer of 2018 Sweden experienced a high occurrence of wildfires, most intense in the low-densely populated Jämtland Härjedalen region. The aim of this study was to investigate any short-term respiratory health effects due to deteriorated air quality generated by the smoke from wildfires. For each municipality in the region Jämtland Härjedalen, daily population-weighted concentrations of fine particulate matter (PM(2.5)) were calculated through the application of the MATCH chemistry transport model. Modelled levels of PM(2.5) were obtained for two summer periods (2017, 2018). Potential health effects of wildfire related levels of PM(2.5) were examined by studying daily health care contacts concerning respiratory problems in each municipality in a quasi-Poisson regression model, adjusting for long-term trends, weekday patterns and weather conditions. In the municipality most exposed to wildfire smoke, having 9 days with daily maximum 1-h mean of PM(2.5) > 20 ?g/m(3), smoke days resulted in a significant increase in daily asthma visits the same and two following days (relative risk (RR) = 2.64, 95% confidence interval (CI): 1.28-5.47). Meta-estimates for all eight municipalities revealed statistically significant increase in asthma visits (RR = 1.68, 95% CI: 1.09-2.57) and also when grouping all disorders of the lower airways (RR = 1.40, 95% CI: 1.01-1.92).
Food security is a global concern affecting even highly developed countries. Ongoing globalisation of food systems, characterised by trading interdependencies, means that agricultural production can be disrupted by climate change, affecting food availability. This study investigated Sweden’s food security by identifying major food import categories and associated trade partners (using the World Integrated Trade System database) and vulnerability to frictions in trade deriving from climate change. Vulnerability was assessed through three indicators: exposure based on diversity of sources, dominance and direct trade from supplying countries; sensitivity, assessed using the Climate Risk Index, and adaptive capacity, assessed using the Fragile State Index. The results revealed that Sweden’s grain imports may be most vulnerable, and animal products least vulnerable, to climate change. Management strategies based on this preliminary assessment can be developed by integrating climate vulnerability deriving from food trading into the ‘Gravity’ model, to improve prediction of trade flows.
Considering that several meteorological variables can contribute to weather vulnerability, the estimation of their synergetic effects on health is particularly useful. The spatial synoptic classification (SSC) has been used in biometeorological applications to estimate the effect of the entire suite of weather conditions on human morbidity and mortality. In this study, we assessed the relationships between extremely hot and dry (dry tropical plus, DT+) and hot and moist (moist tropical plus, MT+) weather types in summer and extremely cold and dry (dry polar plus, DP+) and cold and moist (moist polar, MP+) weather types in winter and cardiovascular and respiratory hospitalizations by age and sex. Time-series quasi-Poisson regression with distributed lags was used to assess the relationship between oppressive weather types and daily hospitalizations over 14 subsequent days in the extended summer (May to August) and 28 subsequent days during the extended winter (November to March) over 24 years in 4 Swedish locations from 1991 to 2014. In summer, exposure to hot weather types appeared to reduce cardiovascular hospitalizations while increased the risk of hospitalizations for respiratory diseases, mainly related to MT+. In winter, the effect of cold weather on both cause-specific hospitalizations was small; however, MP+ was related to a delayed increase in cardiovascular hospitalizations, whilst MP+ and DP + increased the risk of hospitalizations due to respiratory diseases. This study provides useful information for the staff of hospitals and elderly care centers who can help to implement protective measures for patients and residents. Also, our results could be helpful for vulnerable people who can adopt protective measures to reduce health risks.
Knowing how people perceive multiple risks is essential to the management and promotion of public health and safety. Here we present a dataset based on a survey (N?=?4,154) of public risk perception in Italy and Sweden during the COVID-19 pandemic. Both countries were heavily affected by the first wave of infections in Spring 2020, but their governmental responses were very different. As such, the dataset offers unique opportunities to investigate the role of governmental responses in shaping public risk perception. In addition to epidemics, the survey considered indirect effects of COVID-19 (domestic violence, economic crises), as well as global (climate change) and local (wildfires, floods, droughts, earthquakes, terror attacks) threats. The survey examines perceived likelihoods and impacts, individual and authorities’ preparedness and knowledge, and socio-demographic indicators. Hence, the resulting dataset has the potential to enable a plethora of analyses on social, cultural and institutional factors influencing the way in which people perceive risk.
Hydroclimatic change may affect the range of some infectious diseases, including tularemia. Previous studies have investigated associations between tularemia incidence and climate variables, with some also establishing quantitative statistical disease models based on historical data, but studies considering future climate projections are scarce. This study has used and combined hydro-climatic projection outputs from multiple global climate models (GCMs) in phase six of the Coupled Model Intercomparison Project (CMIP6), and site-specific, parameterized statistical tularemia models, which all imply some type of power-law scaling with preceding-year tularemia cases, to assess possible future trends in disease outbreaks for six counties across Sweden, known to include tularemia high-risk areas. Three radiative forcing (emissions) scenarios are considered for climate change projection until year 2100, incuding low (2.6 Wm(-2)), medium (4.5 Wm(-2)), and high (8.5 Wm(-2)) forcing. The results show highly divergent changes in future disease outbreaks among Swedish counties, depending primarily on site-specific type of the best-fit disease power-law scaling characteristics of (mostly positive, in one case negative) sub- or super-linearity. Results also show that scenarios of steeper future climate warming do not necessarily lead to steeper increase of future disease outbreaks. Along a latitudinal gradient, the likely most realistic medium climate forcing scenario indicates future disease decreases (intermittent or overall) for the relatively southern Swedish counties Örebro and Gävleborg (Ockelbo), respectively, and disease increases of considerable or high degree for the intermediate (Dalarna, Gävleborg (Ljusdal)) and more northern (Jämtland, Norrbotten; along with the more southern Värmland exception) counties, respectively.
The spatial synoptic classification (SSC) is a holistic categorical assessment of the daily weather conditions at specific locations; it is a useful tool for assessing weather effects on health. In this study, we assessed (a) the effect of hot weather types and the duration of heat events on cardiovascular and respiratory mortality in summer and (b) the effect of cold weather types and the duration of cold events on cardiovascular and respiratory mortality in winter. A time-stratified case-crossover design combined with a distributed lag nonlinear model was carried out to investigate the association of weather types with cause-specific mortality in two southern (Skåne and Stockholm) and two northern (Jämtland and Västerbotten) locations in Sweden. During summer, in the southern locations, the Moist Tropical (MT) and Dry Tropical (DT) weather types increased cardiovascular and respiratory mortality at shorter lags; both hot weather types substantially increased respiratory mortality mainly in Skåne. The impact of heat events on mortality by cardiovascular and respiratory diseases was more important in the southern than in the northern locations at lag 0. The cumulative effect of MT, DT and heat events lagged over 14 days was particularly high for respiratory mortality in all locations except in Jämtland, though these did not show a clear effect on cardiovascular mortality. During winter, the dry polar and moist polar weather types and cold events showed a negligible effect on cardiovascular and respiratory mortality. This study provides valuable information about the relationship between hot oppressive weather types with cause-specific mortality; however, the cold weather types may not capture sufficiently effects on cause-specific mortality in this sub-Arctic region.
Aims: The present study aimed to investigate if set thresholds in the Swedish heat-wave warning system are valid for all parts of Sweden and if the heat-wave warning system captures a potential increase in all-cause mortality and coronary heart disease (CHD) mortality. An additional aim was to investigate whether neighbourhood deprivation modifies the relationship between heat waves and mortality. Methods: From 1990 until 2014, in 14 municipalities in Sweden, we collected data on daily maximum temperatures and mortality for the five warmest months. Heat waves were defined according to the categories used in the current Swedish heat-wave warning system. Using a case-crossover approach, we investigated the association between heat waves and mortality in Sweden, as well as a modifying effect of neighbourhood deprivation. Results: On a national as well as a regional level, heat waves significantly increased both all-cause mortality and CHD mortality by approximately 10% and 15%, respectively. While neighbourhood deprivation did not seem to modify heat wave-related all-cause mortality, CHD mortality did seem to modify the risk. Conclusions: It may not be appropriate to assume that heat waves in Sweden will have the same impact in a northern setting as in a southern, or that the impact of heat waves will be the same in affluent and deprived neighbourhoods. When designing and implementing heat-wave warning systems, neighbourhood, regional and national information should be incorporated.
