Global warming is projected to have major implications on global health. It is however not yet clear how this will translate to impacts on the healthcare system. By linking changes in temperature with changes in required bed days at a hospital level, through the use of a simple bed model, we quantify the projected impacts UK hospitals will need to adapt to. We show that there is already a local peak of bed days required in the main summer months due to hot temperatures. The results further show that there will be a significant increase during the main summer in both the mean and maximum number of beds needed, but a non-significant decrease during the peak winter months. These changes lead to a more constant need of care of the year and shift the seasonal cycle of lowest hospital needs.
AIMS: There are a growing number of organisations working to address the connections between climate change and health. This article introduces the concept of ‘theories of change’ – the methodology by which organisations or movements hope to bring about social change – and applies it to the current climate change and health movement in England. Through movement mapping, the article describes and offers reflections on the climate change and health ecosystems in England. METHODS: Organisations working on climate change and health in England were identified and publicly available information was collated to map movement characteristics, target stakeholders and methodologies deployed, using an inductive, iterative approach. RESULTS: A total of 98 organisations working on health and climate change (and/or sustainability) were initially identified, of which 70 met the inclusion criteria. Most organisations target two or more stakeholders, with healthcare workers, management structures, and government being most commonly cited. Methodological approaches identified include Formal education programmes; Awareness-raising; Purchasing-procurement power; Advocacy; Financial; Media-messaging; Networking; Knowledge generation; and Policy making, of which education, awareness-raising, and advocacy are most commonly used. CONCLUSION: There is a tendency for climate change and health organisations in England to focus on individual level and sectoral change over system change. More could be made of the potential for the healthcare professions’ voice and messaging for the wider climate movement. Given the rapid boom of climate change and health organisations in recent years, a mind-set shift that recognises different players as part of a cohesive ecosystem with better coordination and collaboration may reduce unnecessary work, and facilitate more cohesive outcomes.
Previous studies have investigated the effects of air pollution on chronic obstructive pulmonary disease (COPD) patients using either fixed-site measurements or a limited number of personal measurements, usually for one pollutant and a short time period. These limitations may introduce bias and distort the epidemiological associations as they do not account for all the potential sources or the temporal variability of pollution.We used detailed information on individuals’ exposure to various pollutants measured at fine spatiotemporal scale to obtain more reliable effect estimates. A panel of 115 patients was followed up for an average continuous period of 128 days carrying a personal monitor specifically designed for this project that measured temperature, nitrogen dioxide (NO(2)), ozone (O(3)), nitric oxide (NO), carbon monoxide (CO), and particulate matter with aerodynamic diameter <2.5 and <10 μm at 1-min time resolution. Each patient recorded daily information on respiratory symptoms and measured peak expiratory flow (PEF). A pulmonologist combined related data to define a binary variable denoting an "exacerbation". The exposure-response associations were assessed with mixed effects models.We found that gaseous pollutants were associated with a deterioration in patients' health. We observed an increase of 16.4% (95% CI 8.6-24.6%), 9.4% (95% CI 5.4-13.6%) and 7.6% (95% CI 3.0-12.4%) in the odds of exacerbation for an interquartile range increase in NO(2), NO and CO, respectively. Similar results were obtained for cough and sputum. O(3) was found to have adverse associations with PEF and breathlessness. No association was observed between particulate matter and any outcome.Our findings suggest that, when considering total personal exposure to air pollutants, mainly the gaseous pollutants affect COPD patients' health.
Brexit, COVID-19 and climate change pose challenges of national and global importance. They continue to have impacts across the economy, society, health, and the environment, all of which are determinants of health and well-being. Between 2018 and 2021, Public Health Wales undertook three Health Impact Assessments (HIA) in relation to the impact of the challenges in Wales. Based on these, work has been carried out to map the synergies across the ‘Triple Challenge’. This paper highlights the commonalities in the impact of the three challenges for Wales, discusses the process carried out, learns from it and proposes actions that can be taken to mitigate harm. Results indicate the three components of the Triple Challenge must not be viewed as separate silos as they have cumulative multi-faceted impacts. This affects some population groups more negatively than others and present a ‘Triple Challenge’ to nation states in the UK and Europe. A HIA approach can enable a range of stakeholders to critically view similar challenges not just as single issues but as a holistic whole to mobilise action.
Although England has been experiencing major floods dating back thousands of years, the hazard is increasing in frequency and intensity, exacerbated by climate risks with potentially serious consequences. Despite attempts to mitigate climate risks (manifested via recurrent flooding) in line with international disaster risk reduction agendas, the impacts/effects of floods continue to increase in England. This is partly due to negligence in inculcating contemporary flood risk perceptions (FRP) into climate risk management (CRM) strategies. This research aims to investigate contemporary FRM in England through a qualitative case study approach in Wainfleet All Saints in Lincolnshire County that experienced unprecedented floods in June 2019. Empirical investigation was conducted with the flood-affected community members and flood managers with oversight of CRM in the region. Key findings reveal the June 2019 floods had both tangible and intangible impacts for the affected community with dreadful effects. Challenges to CRM revealed issues around limited funding; climate changes’ potential to increase flood risk and low community perception of their own risks reflected in poor/none-preparedness for contemporary floods. The multi-agency response to the June 2019 floods was found to be positive, albeit with a few concerns. Based on the analysis of the findings, a series of policy recommendations are proffered with the aim to spur organisational/institutional resilience to CRM. This article underscores the relevance to continuously include contemporary FRP into CRM strategies especially to enhance community participation and involvement in mitigating their own risks.
Heatwaves pose a protracted health risk depending on its intensity and exposure time. Not only cities but countryside areas are also exposed to risk of summertime heat which has not been recently updated at the bucolic scale. This study aims to associate temperature and mortality and explore its temporal variation. A Poisson regression model combined with a distributed lag non-linear model was applied over daily mortality and maximum temperature data from 1981 to 2018 to formulate the lagged response of summer temperature. The relative risk (RR) and mortality attributable fraction (AF) with respect to minimum mortality temperature (MMT) in Southeast England and Aberdeenshire, UK was calculated. The RR and AF for high and extreme (95th and 99th percentile) temperature with respect to MMT have increased (RR- 1% and 7%; AF- 1.33 and 1.9 times, respectively) in Southeast England but reduced in Aberdeenshire (RR- 2% and 6%; AF- 0.49 and 0.15 times, respectively) in last two decades. However, lagged risk persists for very extreme temperature after several days of exposure at both sites and the hazard cannot be underestimated and neglected. Hence, action is needed to update the heat action plan for extreme temperature management formulating appropriate heat-mitigation strategies focused on vulnerable populations.
Dinophysis is a genus of dinoflagellates with the potential to cause diarrhoeic Shellfish Poisoning (DSP) in humans. The lipophilic toxins produced by some species of Dinophysis spp. can accumulate within shellfish flesh even at low cell abundances, and this may result in the closure of a shellfish farm if toxins exceed the recommended upper limit. Over the period 2014 to 2020 inclusive there were several toxic events along the South West coast of U.K. related to Dinophysis spp. The Food Standards Agency (FSA) monitoring programme measure Dinophysis cell abundances and toxin concentration within shellfish flesh around the coasts of England and Wales, but there are few schemes routinely measuring the environmental parameters that may be important drivers for these Harmful Algal Blooms (HABs). This study uses retrospective data from the FSA monitoring at three sites on the south Cornwall coast as well as environmental data from some novel platforms such as coastal WaveRider buoys to investigate potential drivers and explore whether either blooms or toxic events at these sites can be predicted from environmental data. Wind direction was found to be important in determining whether a bloom develops at these sites, and low air temperature in June was associated with low toxicity in the shellfish flesh. Using real time data from local platforms may help shellfish farmers predict future toxic events and minimise financial loss.
The short- and long-term impacts of air pollution on human health are well documented and include cardiovascular, neurological, immune system and developmental damage. Additionally, the irritant qualities of air pollutants can cause respiratory and cardiovascular distress. This can be heightened during exercise and especially so for those with respiratory conditions such as asthma. Meteorological conditions have also been shown to adversely impact athletic performance; but research has mostly examined the impact of pollution and meteorology on marathon times or running under laboratory settings. This study focuses on the half marathon distance (13.1 miles/21.1 km) and utilises the Great North Run held in Newcastle-upon-Tyne, England, between 2006 and 2019. Local meteorological (temperature, relative humidity, heat index and wind speed) and air quality (ozone, nitrogen dioxide and PM(2.5)) data is used in conjunction with finishing times of the quickest and slowest amateur participants, along with the elite field, to determine the extent to which each group is influenced in real-world conditions. Results show that increased temperatures, heat index and ozone concentrations are significantly detrimental to amateur half marathon performances. The elite field meanwhile is influenced by higher ozone concentrations. It is thought that the increased exposure time to the environmental conditions contributes to this greater decrease in performance for the slowest participants. For elite athletes that are performing closer to their maximal capacity (VO(2) max), the higher ozone concentrations likely results in respiratory irritation and decreased performance. Nitrogen dioxide and PM(2.5) pollution showed no significant relationship with finishing times. These results provide additional insight into the environmental effects on exercise, which is particularly important under the increasing effects climate change and regional air pollution. This study can be used to inform event organisation and start times for both mass participation and major elite events with the aim to reduce heat- and pollution-related incidents.
Introduction: Flooding causes significant mortality and morbidity, with impacts expected to increase with climate change. Ensuring adequate country-level flood mitigation and response capacity is key. Lifeguards, traditionally used for drowning prevention, may represent an additional workforce for flood emergency response. Methods: Through an anonymous, online survey, we explored experiences, beliefs, and attitudes of a convenience sample of surf lifeguards from Australia and England towards lifeguards’ involvement in flood response. Respondents were recruited via Surf Life Saving Australia and Great Britain and had prior training in flood rescue. Analysis comprised descriptive statistics and thematic coding of free-text responses. Results: Forty-four responses were received (93.2% male, 34.1% aged 50-59 years; 61.4% from Australia; 61.4% with >= 16 years lifesaving experience). Twenty-nine respondents (65.9%) self-reported having previously responded to flooding, 15 of which responded prior to receiving flood training. Lifeguards commonly reported being involved in the flood response phase (n = 28). Respondents identified rescue skills (n = 43; 97.7%), awareness of water conditions (n = 40; 90.9%), and radio communication protocols (n = 40; 90.9%) as relevant in a flood scenario. Respondents broadly agreed lifeguards were an asset in flood response due to transferrable skills, including to bolster existing capacity. However, respondents noted need for greater recognition, for involvement earlier in flood response and for flood-specific training and equipment prior to deployment. Discussion & Conclusions: Lifeguards represent a willing and able workforce to support flood mitigation and response, some of whom are already being tasked with such work. Provision of flood-specific training and equipment are vital, as is addressing intemperability tensions.
Extreme weather events are increasing in frequency and severity as a consequence of climate change and pose a significant threat to population mental health. This is the case even in temperate regions such as the United Kingdom (UK) where flooding and heat waves are forecast to become more common. We conducted a systematic review to quantify the prevalence and describe the causes of common mental health problems in populations exposed to extreme weather events in the UK. We searched Web of Science, EMBASE and PsycINFO for studies that measured the prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) in populations exposed to extreme weather events in the UK, published up to 12 December 2019. We included 17 studies, four of which were included in meta-analyses to determine the point prevalence of common mental health problems in the period within 12 months following extreme weather events. The point prevalence was 19.8% for anxiety (k = 4; n = 1458; 95% CI 7.42 to 32.15), 21.35% for depression (k = 4; n = 1458; 95% CI 9.04 to 33.65) and 30.36% for PTSD (k = 4; n = 1359; 95% CI 11.68 to 49.05). Key factors that affected mental ill health in people exposed to flooding were water depth and absence of flood warnings. Displacement from home underscored the narratives associated with people’s perceptions of the impact of flooding. The high prevalence of common mental health problems suggests that the prevention of mental ill health in populations at risk or exposed to extreme weather events should be a UK public health priority.
BACKGROUND: It is known that on days with high temperatures higher mortality is observed and there is a minimum mortality temperature (MMT) point which is higher in places with warmer climate. This indicates some population adaptation to local climate but information on how quickly this adaptation will occur under climate change is lacking. METHODS: To investigate this, we associated daily mortality data with temperature during the warm period in 2004-2013 for London inhabitants born in five climatic zones (UK, Tropical, Sub-tropical, Boreal and Mixed). We fitted Poisson regression with distributed-lag non-linear models for each climatic zone group separately to estimate group-specific exposure-response associations and MMTs. We report relative risks of death comparing the 95th percentile (21 °C) and maximum (25 °C) of the temperature distribution in London with the zone-specific minimum mortality temperature. RESULTS: No heat-related mortality was observed for people born in countries with Sub-tropical and Mixed climates. We observed an increase of 26%, 35% and 39% in the risk of death at 25 °C compared to the MMT in people born in the UK (marine climate), Tropical and Boreal climate respectively. The temperatures with the lowest mortality in these groups ranged from 15.9 to 17.7 °C. DISCUSSION: Our findings imply that people born in different climatic zones do not adapt fully to their new environment within their lifetime. This implies that populations may not adapt readily to climate change and will suffer increased effects from heat. In the presence of climate change, policy makers should be aware of a delayed process of adaptation.
Increasing summer temperatures in a warming climate will increase the exposure of the UK population to heat-stress and associated heat-related mortality. Urban inhabitants are particularly at risk, as urban areas are often significantly warmer than rural areas as a result of the urban heat island phenomenon. The latest UK Climate Projections include an ensemble of convection-permitting model (CPM) simulations which provide credible climate information at the city-scale, the first of their kind for national climate scenarios. Using a newly developed urban signal extraction technique, we quantify the urban influence on present-day (1981-2000) and future (2061-2080) temperature extremes in the CPM compared to the coarser resolution regional climate model (RCM) simulations over UK cities. We find that the urban influence in these models is markedly different, with the magnitude of night-time urban heat islands overestimated in the RCM, significantly for the warmest nights (up to 4 degrees C), while the CPM agrees much better with observations. This improvement is driven by the improved land-surface representation and more sophisticated urban scheme MORUSES employed by the CPM, which distinguishes street canyons and roofs. In future, there is a strong amplification of the urban influence in the RCM, whilst there is little change in the CPM. We find that future changes in soil moisture play an important role in the magnitude of the urban influence, highlighting the importance of the accurate representation of land-surface and hydrological processes for urban heat island studies. The results indicate that the CPM provides more reliable urban temperature projections, due at least in part to the improved urban scheme.
Non-optimal temperatures, both warm and cold, are associated with enhanced mortality in the United Kingdom (UK). In this study we demonstrate a pathway to sub-seasonal and medium range forecasting of temperature-related mortality risk by quantifying the impact of large-scale weather regimes and synoptic scale weather patterns on temperature-associated excess deaths in 12 regions across the UK. We find a clear dominance of the NAO- regime in leading to high wintertime excess mortality across all regions. In summer, we note that cold spells lead to comparable cumulative excess mortality as moderate hot days, with cold days accounting for 11 (London) to 100% (Northern Ireland) of the summer days with the highest 5% cumulative excess mortality. However, exposure to high temperatures is typically associated with an immediate but short lived spike in mortality, while the impact of cold weather tends to be more delayed and spread out over a longer period. Weather patterns with a Scandinavian high component are most likely to be associated with summer hot extremes, while a strong zonal jet stream weather pattern which rarely occurs in summer is most likely to be associated with summer cold spells.
This study set out to empirically determine the current state of individual and household adaptation to climate change in the United Kingdom and how policy makers can improve on it. The study utilized both qualitative and quantitative approaches (mixed method). For the quantitative aspect of the study, a quota-sampling technique was employed in the selection of 650 respondents for the study using a well-structured questionnaire. The quota representation was based on age and gender. Data were analyzed using descriptive statistics and binary logit regression. In addition, qualitative content/topic analysis of an in-depth interview of the respondents was employed in further analyzing why and how policy makers can improve climate change adaptation. Findings from the study indicate the dire need for continued government support in household and individual adaptation in Leeds, and this support should also be encouraged in other cities where government intervention is low. Interventions in the form of subsidies, direct regulations, and public awareness are needed. The implementation of these measures is expected to generate a wide range of additional benefits to most vulnerable groups who should be central to the rapidly expanding climate change research and policy agenda in the United Kingdom. SIGNIFICANCE STATEMENT Evidence shows that periods of extremely cold winters have been perceived to have increased in frequency in the United Kingdom over the years. This points to the need to uncover what policy and behavioral adaptation measures required to improve individual and household adaptation measures to cold spells in the United Kingdom. We utilized both qualitative and quantitative approaches (mixed method) to find out the drivers and hindrances to adaptation against cold spells, using Leeds as a case study. We found out that over 70% of the respondents adopted all of the short-term coping strategies, whereas 55% did not indicate any changes in their behavior in response to cold spells. Also, government support, the prospect of relocation (people’s intention of leaving their home), and the high technicalities in installing adaptation tools significantly affect individuals’ tendency to adopt long-term coping strategies.
The global literature on drought and health highlights a variety of health effects for people in developing countries where certain prevailing social, economic and environmental conditions increase their vulnerability especially with climate change. Despite increased focus on climate change, relatively less is known about the health-drought impacts in the developed country context. In the UK, where climate change-related risk of water shortages has been identified as a key area for action, there is need for better understanding of drought-health linkages. This paper assesses people’s narratives of drought on health and well-being in the UK using a source-receptor-impact framing. Stakeholder narratives indicate that drought can present perceived health and well-being effects through reduced water quantity, water quality, compromised hygiene and sanitation, food security, and air quality. Heatwave associated with drought was also identified as a source of health effects through heat and wildfire, and drought-related vectors. Drought was viewed as potentially attributing both negative and positive effects for physical and mental health, with emphasis on mental health. Health impacts were often complex and cross-sectoral in nature indicating the need for a management approach across several sectors that targets drought and health in risk assessment and adaptation planning processes. Two recurring themes in the UK narratives were the health consequences of drought for ‘at-risk’ groups and the need to target them, and that drought in a changing climate presented potential health implications for at-risk groups.
The epidemiological research relating mortality and hospital admissions to ambient temperature is well established. However, less is known about the effect temperature has on Accident and Emergency (A&E) department attendances. Time-series regression analyses were conducted to investigate the effect of temperature for a range of cause- and age-specific attendances in Greater London (LD) between 2007 to 2012. A seasonally adjusted Poisson regression model was used to estimate the percent change in daily attendances per 1 °C increase in temperature. The risk of overall attendance increased by 1.0% (95% CI 0.8, 1.4) for all ages and 1.4% (1.2, 1.5) among 0- to 15-year-olds. A smaller but significant increase in risk was found for cardiac, respiratory, cerebrovascular and psychiatric presentations. Importantly, for fracture-related attendances, the risk rose by 1.1% (0.7, 1.5) per 1 °C increase in temperature above the identified temperature threshold of 16 °C, with the highest increase of 2.1% (1.5, 3.0) seen among 0- to 15-year-olds. There is a positive association between increasing temperatures and A&E department attendance, with the risk appearing highest in children and the most deprived areas. A&E departments are vulnerable to increased demand during hot weather and therefore need to be adequately prepared to address associated health risks posed by climate change.
Consideration of the implications of solar UV exposure on public health during extreme temperature events is important due to their increasing frequency as a result of climate change. In this paper public health impacts of solar UV exposure, both positive and negative, during extreme hot and cold weather in England in 2018 were assessed by analysing environmental variations in UV and temperature. Consideration was given to people’s likely behaviour, the current alert system and public health advice. During a period of severe cold weather in February-March 2018 UV daily doses were around 25-50% lower than the long-term average (1991-2017); however, this would not impact on sunburn risk or the benefit of vitamin D production. In spring 2018 unseasonably high temperatures coincided with high UV daily doses (40-75% above long-term average) on significant days: the London Marathon (22 April) and UK May Day Bank Holiday weekend, which includes a public holiday on the Monday (5-7 May). People were likely to have intermittent excess solar UV exposure on unacclimatised skin, causing sunburn and potentially increasing the risk of skin cancers. No alerts were raised for these events since they occurred outside the alerting period. During a heat-wave in summer 2018 the environmental availability of UV was high-on average of 25% above the long-term average. The public health implications are complex and highly dependent on behaviour and sociodemographic variables such as skin colour. For all three periods Pearson’s correlation analysis showed a statistically significant (p<0.05) positive correlation between maximum daily temperature and erythema-effective UV daily dose. Public health advice may be improved by taking account of both temperature and UV and their implications for behaviour. A health impact-based alert system would be of benefit throughout the year, particularly in spring and summer.
INTRODUCTION: Heat illness among the UK Armed Forces is usually exertional, and therefore preventable, yet the incidence has not reduced since 2011. JSP 539 explicitly states that wet bulb globe temperature (WBGT) should be measured ‘at the location of greatest heat risk’, not ‘that of most convenience’. A handheld WBGT tracker used at point-of-exertion could reduce this incidence if proven to be as accurate as the current in-service device. METHODS: Longitudinal observational comparison and equipment feasibility study of the Kestrel 5400 and QUESTemp 34 (QT-34) in worldwide firm base and deployed UK Armed Forces locations. The locations chosen were Kenya, South Sudan, Belize, Tidworth, Aldershot and Brecon. Paired data points of WBGT readings were collected from November 2017 to August 2018 in all weather conditions. RESULTS: WBGT readings were comparable between the QT-34 and Kestrel 5400 across the UK and overseas. In addition, there was no change in accuracy between readings taken from the Kestrel 5400 when tripod-mounted and handheld. The Kestrel was easy to set up and far less susceptible to resupply or power supply limitations, as it requires no user input for wet bulb temperature, and runs on AA batteries. CONCLUSION: This equipment feasibility study has shown that the Kestrel 5400 gives an acceptable accuracy and is easier to use than the QT-34. The authors recommend that the Kestrel 5400 is introduced as an adjunct to the QT-34, and its use within the military setting monitored through ongoing comparative data collection in a large-scale proof-of-concept study.
BACKGROUND: Associations between extreme temperatures and health outcomes, such as mortality and morbidity, are often observed. However, relatively little research has investigated the role of extreme temperatures upon ambulance dispatches. METHODS: A time series analysis using London Ambulance Service (LAS) incident data (2010-2014), consisting of 5,252,375 dispatches was conducted. A generalized linear model (GLM) with a quasi-likelihood Poisson regression was applied to analyse the associations between ambulance dispatches and temperature. The 99(th) (22.8°C) and 1(st) (0.0°C) percentiles of temperature were defined as extreme high and low temperature. Fourteen categories of ambulance dispatches were investigated, grouped into ‘respiratory’ (asthma, dyspnoea, respiratory chest infection, respiratory arrest and chronic obstructive pulmonary disease), ‘cardiovascular’ (cardiac arrest, chest pain, cardiac chest pain RCI, cardiac arrhythmia and other cardiac problems) and ‘other’ non-cardiorespiratory (dizzy, alcohol related, vomiting and ‘generally unwell’) categories. The effects of long-term trends, seasonality, day of the week, public holidays and air pollution were controlled for in the GLM. The lag effect of temperature was also investigated. The threshold temperatures for each category were identified and a distributed lag non-linear model (DLNM) was reported using relative risk (RR) values at 95% confidence intervals. RESULTS: Many dispatch categories show significant associations with extreme temperature. Total calls from 999 dispatches and ‘generally unwell’ dispatch category show significant RRs at both low and high temperatures. Most respiratory categories (asthma, dyspnoea and RCI) have significant RRs at low temperatures represented by with estimated RRs ranging from 1.392 (95%CI: 1.161-1.699) for asthma to 2.075 (95%CI: 1.673-2.574) for RCI. The RRs for all other non-cardiorespiratory dispatches were often significant for high temperatures ranging from 1.280 (95% CI: 1.128-1.454) for ‘generally unwell’ to 1.985 (95%CI: 1.422-2.773) for alcohol-related. For the cardiovascular group, only chest pain dispatches reported a significant RR at high temperatures. CONCLUSIONS: Ambulance dispatches can be associated with extreme temperatures, dependent on the dispatch category. It is recommended that meteorological factors are factored into ambulance forecast models and warning systems, allowing for improvements in ambulance and general health service efficiency.
BACKGROUND: Flooding can have extensive effects on the health and wellbeing of affected communities. The impact of flooding on psychological morbidity has been established; however, the wider impacts of flooding exposure, including on health-related quality of life (HRQoL), have not been described. METHODS: Using data from the English National Study of Flooding and Health cohort, HRQoL 2 and 3 years post-flooding was assessed with the EuroQol Group EQ-5D-5L tool. Associations between exposure groups (flooding and disruption from flooding) and HRQoL were assessed, using ordinal and linear regression, adjusting for a priori confounders. RESULTS: For both 2 and 3 years post-flooding, the median HRQoL scores were lower in the flooded and disrupted groups, compared with unaffected respondents. A higher proportion of flooded and disrupted respondents reported HRQoL problems in most dimensions of the EQ-5D-5L, compared with unaffected respondents. In year 2, independent associations between exposure to flooding and experiencing anxiety/depression [adjusted odds ratio (aOR) 7.7; 95% CI 4.6-13.5], problems with usual activities (aOR 5.3; 95% CI 2.5-11.9) and pain/discomfort (aOR 2.4; 95% CI 1.5-3.9) were identified. These problems persisted 3 years post-flooding; associations between exposure to flooding and experiencing anxiety/depression (aOR 4.3; 95% CI 2.5-7.7), problems with usual activities (aOR 2.9; 95% CI 1.5-6.1) and pain/discomfort (aOR 2.5; 95% CI 1.5-4.2) were identified. CONCLUSIONS: Exposure to flooding and disruption from flooding significantly reduces HRQoL. These findings extend our knowledge of the impacts of flooding on health, with implications for multi-agency emergency response and recovery plans.
OBJECTIVES: To identify key predictors of general practitioner (GP) consultations for allergic rhinitis (AR) using meteorological and environmental data. DESIGN: A retrospective, time series analysis of GP consultations for AR. SETTING: A large GP surveillance network of GP practices in the London area. PARTICIPANTS: The study population was all persons who presented to general practices in London that report to the Public Health England GP in-hours syndromic surveillance system during the study period (3 April 2012 to 11 August 2014). PRIMARY MEASURE: Consultations for AR (numbers of consultations). RESULTS: During the study period there were 186?401 GP consultations for AR. High grass and nettle pollen counts (combined) were associated with the highest increases in consultations (for the category 216-270 grains/m(3), relative risk (RR) 3.33, 95%?CI 2.69 to 4.12) followed by high tree (oak, birch and plane combined) pollen counts (for the category 260-325 grains/m(3), RR 1.69, 95%?CI 1.32 to 2.15) and average daily temperatures between 15°C and 20°C (RR 1.47, 95%?CI 1.20 to 1.81). Higher levels of nitrogen dioxide (NO(2)) appeared to be associated with increased consultations (for the category 70-85?µg/m(3), RR 1.33, 95%?CI 1.03 to 1.71), but a significant effect was not found with ozone. Higher daily rainfall was associated with fewer consultations (15-20?mm/day; RR 0.812, 95% CI 0.674 to 0.980). CONCLUSIONS: Changes in grass, nettle or tree pollen counts, temperatures between 15°C and 20°C, and (to a lesser extent) NO(2) concentrations were found to be associated with increased consultations for AR. Rainfall has a negative effect. In the context of climate change and continued exposures to environmental air pollution, intelligent use of these data will aid targeting public health messages and plan healthcare demand.
